bluuebunny/crossref_metadata_2025_split huggingface dataset:
1594-P: The Impact of Diabetes on Productivity in China
Authors: HIRD THOMAS R. , ZOMER ELLA , OWEN ALICE J. , CHEN LEI , ADEMI ZANFINA , MAGLIANO DIANNA J. , LIEW DANNY 
Published: June 2019

Diabetes increases the risk of premature death and reduces work productivity. We estimated the impact of diabetes in China in terms of mortality, years of life lost, and productivity-adjusted life years (PALYs) lost in the Chinese population. Life table modelling was used with simulated follow-up of those with diabetes in the Chinese population of working age (20-49 years in women and 20-59 years in men) until retirement age (50 years for women and 60 years for men). Data regarding the prevalence of diabetes, as well as excess mortality, labor force drop out and productivity loss attributable to diabetes, were taken from published sources. Models were constructed for the cohort with diabetes and repeated for the same cohort assuming that they had no diabetes. The differences in number of deaths, years of life lived and PALYs lived between the two models reflected the impact of diabetes. The World Health Organization standard 3% annual discount rate was applied to years of life and PALYs lived. In 2017, an estimated 56.4 million people of working age in China (7.1%) had diabetes. With simulated follow-up, those with diabetes were predicted to experience an estimated 4.1 million more deaths, the loss of 22.7 million years of life (3.7%) and the loss of 75.8 million PALYs (15.3%). This was equivalent to an average of 1.4 PALYs lost per person with diabetes. Based on gross domestic product (GDP) per full time worker in 2017, the loss in PALYs equated to a total of CNY ¥17.4 trillion (USD $2.6 trillion) in lost GDP due to reduced productivity, with an average of ¥307,923 ($45,959) lost per person with diabetes. Our study demonstrates the significant cumulative impact of diabetes on productivity across the working lifetime in the Chinese population, highlighting the potential economic payoff of diabetes prevention in the longer term.

Disclosure
T.R. Hird: None. E. Zomer: Consultant; Self; Amgen Inc., AstraZeneca, Pfizer Inc., Shire. A.J. Owen: None. L. Chen: None. Z. Ademi: None. D.J. Magliano: None. D. Liew: Advisory Panel; Self; AstraZeneca, Bayer AG. Research Support; Self; AbbVie Inc., AstraZeneca, Bristol-Myers Squibb Company, CSL Behring, Pfizer Inc.
1596-P: Triglyceride and Glucose (TyG) Index Is an Effective Predictor of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis
Authors: KIM KYUNG-SOO , HWANG YOU CHEOL , AHN HONG-YUP , PARK SUNG-WOO , PARK CHEOL-YOUNG 
Published: June 2019

Nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) is associated with insulin resistance and considered as a liver manifestation of metabolic syndrome. Triglycerides and glucose (TyG) index is a useful marker of insulin resistance but there are few studies about association between TyG index and NAFLD/NASH. The aim of this study was to investigate the ability of TyG index to identify NAFLD/NASH through comparing with fatty liver index (FLI) in a Korean population using a large health study database. We enrolled 187,725 subjects (107,246 men and 80,479 women) in the Kangbuk Samsung Health Study cohort. All subjects were completed a comprehensive annual or biennial health examination from 2007 through 2013. The presence of NAFLD was ascertained by ultrasonography in the absence of other known liver diseases. NASH was defined as NAFLD with FIB-4 index &gt; 1.3. Mean age was 37 years and mean body mass index (BMI) was 23.26 m/kg2. The prevalences of NAFLD and NASH were 35.66% (n = 66,946) and 3.06% (n = 5,749), respectively. During a median 3.92-year follow-up, the hazard ratios (HR) of TyG index and FLI for NAFLD were 1.772 (95% CI 1.747-1.798) and 1.424 (95% CI 1.411-1.438), respectively. After adjusting for age, sex, and BMI, there were still elevated HRs for NAFLD (TyG index: 1.322, 95% CI 1.301-1.344; FLI: 1.094, 95% CI 1.073-1.116). The area under the ROC curve for identifying NAFLD of TyG index and FLI were 0.799 and 0.873, respectively. In non-obese subjects (BMI &lt; 23 kg/m2), higher TyG index was associated with an increased risk of NASH (HR 1.222; 95% CI 1.095-1.363) but FLI was not (HR 1.056; 95% CI 0.922-1.209). In addition, there were similar results in obese subject (TyG index: 1.085, 95% CI 1.046-1.126; FLI: 0.994, 95% CI 0.942-1.049). These results suggested that TyG index was superior to FLI in association with NAFLD/NASH risk. The TyG index is effective to identify subjects at risk for NAFLD/NASH.

Disclosure
K. Kim: None. Y. Hwang: None. H. Ahn: None. S. Park: None. C. Park: None.
160-OR: Pretreatment Diabetes Has Lower Mortality Rate, Independent of Immune-Related Adverse Events, in Cancer Patients with Immune-Check Point Inhibitor
Authors: HISANAGA KAORI , UCHINO HIROSHI , YOSHIKAWA FUKUMI , SHIGIYAMA FUMIKA , KUMASHIRO NAOKI , HIROSE TAKAHISA , ANDO YASUYO , MIYAGI MASAHIKO , ISOBE KAZUTOSHI , HOMMA SAKAE 
Published: June 2019

Objective: Immune checkpoint inhibitors (ICIs) are novel anticancer agents, also generate peculiar dysimmune toxicities, related to immune-related adverse events (irAEs) that might potentially prolong the survival rate. Our aim was to evaluate diabetes prior to ICIs has any effect on mortality rate, associated with irAEs, to the response in patients inappropriate to operation lung cancer.
Methods: Subjects diagnosed during Sep 1, 2015 to Jul 31, 2018 were retrospectively enrolled and followed until Jan 20, 2018, using Toho University NEPTUNE database. Hazard ratios were estimated using Cox regression weighted for propensity scores. Odds ratios (ORs [95% CI]) were calculated with logistic regression and adjusted for imbalanced variables (standardized difference more than 0.2). The Kaplan-Meier method was used to overall survival, and the generalized Wilcoxon test was used to compare median survivals.
Results: A total of 88 patients participated, of whom 22 (25.0%) had pre-ICIs diabetes (DM) and 57 (75.0%) were not pre-ICIs diabetes (nonDM). The irAEs was observed in 12.2% of DM and 9.1% of nonDM (p=0.33). Both nonDM and DM has not been associated to irAE’s status for baseline characteristics (age, sex, clinical stage, thyroid status, and renal function) and propensity score matching. Multiple logistic regression analyses revealed that the risk of overall survival was significantly lower in subjects with male than those with female (OR = 0.11, 95% CI = 0.01-0.94, p = 0.044). During a mean follow-up of 21.1 months (adherence rate, 88%), overall 37-month post-ICIs survival was significantly lower in the DM group (Kaplan-Meier estimates 77% vs. 66%; p=0 043), resulting in a 38% reduction in the mortality hazard ratio (0 62 [95% CI 0 40-0 95]).
Conclusion: Pre-ICIs treatment diabetes per se, diminish mortality rate in inappropriate to operation lung cancer patients, independently to irAEs on immune-check point inhibitor.

Disclosure
K. Hisanaga: None. H. Uchino: None. F. Yoshikawa: None. F. Shigiyama: None. N. Kumashiro: Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi, Takeda Pharmaceutical Company Limited. T. Hirose: None. Y. Ando: None. M. Miyagi: None. K. Isobe: None. S. Homma: None.
1608-P: Suboptimal Management of Diabetes in India: Findings from a Large Community-Based Study
Authors: MOHAN SAILESH , VENKATESHMURTHY NIKHIL SRINIVASAPURA , JARHYAN PRASHANT , SHARNNGADHARAN GANESH KUMAR 
Published: June 2019

Over the past few decades diabetes prevalence has rapidly increased across India. However, limited information is available on the levels of awareness, treatment and control, particularly in epidemiologically transitioning communities. We estimated the prevalence, awareness, treatment and control rates of diabetes in a large representative population sample aged ≥ 30 years, selected using a multistage cluster random sampling technique, residing in rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples to estimate fasting plasma glucose (FPG) and HbA1C. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-report of physician diagnosis or being on treatment. Participants were considered to be aware of diabetes if they reported a diagnosis or being on treatment. Control was defined as HbA1C &lt; 7%. In total 12243 participants (6208 in North and 6035 in South) were surveyed. The mean (±SD) age was 47.7 (±12.5) years. Women constituted 54%. The age-standardized prevalence of diabetes was 14.2 (95% CI: 13.6 - 14.9), with significant difference between urban (21.4%; 20.4-22.5) and rural (7.5%; 6.8-8.2) areas. Among those with diabetes, the awareness, treatment and control rates were 49.4% (46.6-52.2), 38.6% (35.9-41.3) and 12.6% (10.9-14.5) respectively. Compared to urban residents, rural counterparts were less likely to be aware (35% Vs. 55%), treated (26% Vs. 43%) and controlled (8% Vs. 14%). Similarly, patients in the lowest tertile of wealth index had lower awareness (33% Vs. 55%), treatment (22% Vs. 43%) and control rates (5% Vs. 15%) compared to those in the highest tertile. Despite a high burden, management of diabetes is sub-optimal in India. Health system strengthening to better manage diabetes with a focus on rural residents and the poor is imperative to stem the rising burden and improve diabetes related health outcomes.

Disclosure
S. Mohan: None. N.S. Venkateshmurthy: None. P. Jarhyan: None. G. Sharnngadharan: None.
1610-P: On the Combined Effect of C-Reactive Protein (CRP) and Serum Amyloid Component P (SAP) on Mortality Risk in Type 2 Diabetes
Authors: SCARALE MARIA GIOVANNA , COPETTI MASSIMILIANO , GAROFOLO MONIA , SALVEMINI LUCIA , CSOMO SALVATORE DE , LAMACCHIA OLGA , PENNO GIUSEPPE , TRISCHITTA VINCENZO , MENZAGHI CLAUDIA 
Published: June 2019

CRP and SAP are the two short, strongly homologous pentraxins produced in response to inflammation. Though their common contribution to innate immunity, they seem to differently affect atherosclerosis and related clinical outcomes. In the specific context of mortality rate i) CRP is a recognized risk biomarker; ii) data on SAP are sparse and conflicting; iii) no data are available on their possibly combined effect. Accordingly, the combined effect of CRP and SAP on mortality risk was investigated in the high-risk subset of patients with type 2 diabetes (T2D). Four cohorts of patients with T2D [i.e., Gargano Heart Study (GHS; n=358; follow-up (f-u)=5±3 years; 81 events); Gargano Mortality Study (n=650; f-u=11±4 years; 190 events); Foggia Mortality Study (n=530; f-u=7±3 years; 146 events) and Pisa Mortality Study (n=986; f-u=13±3 years; 230 events)] were analyzed by Cox proportional hazard models. In the pooled sample, with a total of 2,524 individuals experiencing 647 events, hs-CRP was positively [HR=1.53 (95% CI 1.41-1.66)] whereas SAP was negatively [HR=0.80 (95% CI 0.74-0.86)] associated with all-cause mortality. Similar results were observed on cardiovascular death in GHS: HR (95% CI) being 1.90 (1.48-2.44) and 0.78 (0.61-0.98) for hs-CRP and SAP, respectively. The whole sample was then stratified according to relatively low and high hs-CRP and SAP (&lt; or &gt; the median value), so to obtain four groups: low/high (1), low/low (2), high/high (3), and high/low (4) hs-CRP/SAP levels. As compared to group 1, group 2, 3 and 4 had HRs (95% CIs) of 1.25 (0.96-1.64), 1.80 (1.39-2.33) and 2.40 (1.81-3.17) for all-cause mortality (p for trend=1.1x10-11 or, in a model comprising study sample, age, sex, smoking habit, BMI, HbA1c, diabetes duration and all ongoing treatments, p=4.1x10-8).
In conclusion, in patients with T2D, hs-CRP and SAP show a combined effect on all-cause death. Whether their simultaneous use may prove to be useful in predicting mortality in T2D needs further investigation.

Disclosure
M. Scarale: None. M. Copetti: None. M. Garofolo: None. L. Salvemini: None. S. De Csomo: None. O. Lamacchia: None. G. Penno: None. V. Trischitta: None. C. Menzaghi: None.

Funding
Italian Ministry of Health (RF-2013-02356459)
1614-P: Relationship between Out-of-Pocket Costs, Life-Course Socioeconomic Status, and Acculturation in Immigrants with Diabetes
Authors: DAWSON APRILL Z. , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2019

Introduction: About 9.4% of the United States (U.S.) population has diabetes. Diabetes is a prevalent and expensive disease costing more than $320 billion annually. Immigrants, about 13% of the U.S. population, often lack health insurance and pay out of pocket for healthcare. Immigrants also have cultural and other barriers to accessing healthcare that affect their ability to care for chronic diseases like diabetes. The aim of this study was to examine the relationship between life-course socioeconomic status (SES), acculturation, and out of pocket (OOP) costs among immigrants with diabetes.
Methods: Data from the New Immigrant Survey, a multi-cohort study of U.S. immigrants, was analyzed. Linear regression with OOP costs as the outcome was used to investigate the relationship between acculturation and life-course SES. Additionally, a linear regression model with acculturation as an outcome was run to understand predictors including life-course SES in immigrants with diabetes.
Results: Three hundred seventeen individuals were included in the study. The mean age was 53 years, 56% were female, and 66% had less than high-school level of education. Unadjusted models found an association between acculturation and OOP costs (β: 664.4; p&lt;0.001), which remained significant after adjustment for age, sex, race/ethnicity, marital status, education and income (β: 663.7; p=0.008). Life-course SES was significantly associated with acculturation (β: 0.061; p=0.041) after adjusting for demographics.
Conclusions: Acculturated immigrants with diabetes have higher OOP costs compared to those who are not acculturated. Life-course SES was identified as a significant predictor of acculturation in this sample. Our findings support the idea of acculturation increasing access to care for foreign-born individuals with diabetes. Future research will examine direct and indirect relationships between life-course SES, acculturation, and diabetes outcomes in United States immigrants.

Disclosure
A.Z. Dawson: None. R.J. Walker: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.

Funding
National Institutes of Health
1617-P: Serum Fatty Acid Proportions Are Associated with Development of Abnormal Glucose Metabolism in Male Japanese: Tokushima Cohort Study
Authors: HATA AKIKO , AKI NANAKO , ICHIHARA TAKAKO , TAMURA AYAKO , MINAGAWA TAKAKO , KUWAMURA YUMI , FUNAKI MAKOTO 
Published: June 2019

Few prospective cohort studies have examined the association between serum fatty acid (FA) proportions and type 2 diabetes (T2D). In addition, the involvement of serum FAs in the development of early stage abnormality of glucose homeostasis remains unclear. The present study investigated the association between serum FA proportions or FA ratios, which reflect desaturase activity, and the incidence of early stage abnormal glucose metabolism before the actual onset of T2D. We here report a prospective occupational-based cohort study, which has been conducted since 2008 in Japan. A total of 396 male workers without abnormal glucose metabolism aged 20 to 60 years were followed-up prospectively (mean follow-up period: 5.9 years). Abnormal glucose metabolism was defined as either: 1) fasting plasma glucose ≥ 110 mg/dl, 2) HbA1c ≥ 6.0% or 3) medication for hyperglycemia. We evaluated serum FA proportions and the activities of ⊿5desaturase, ⊿6desaturase and ⊿9desaturase, which reflect desaturation of FAs estimated from the FA product-to-precursor ratios. In multivariate analysis after adjusting for age, BMI, smoking habit, alcohol intake, regular exercise, HDL cholesterol, triglycerides, family history of diabetes, and hypertension, the HR of developing abnormal glucose metabolism was 4.42 [95% CI: 1.81 to 10.76, P=0.001] in the highest quartile of baseline serum dihomo-γ-linolenic acid proportion, compared with the lowest quartile. In addition, the age-adjusted incidence and multivariate-adjusted HR of abnormal glucose metabolism also increased with increasing quartile of ⊿6desaturase (P for trend for both &lt;0.01). Our findings suggest that increased serum dihomo-γ-linolenic acid proportion and enhanced activity of ⊿6desaturase are predictive markers for the development of early stage abnormal glucose metabolism in male Japanese. These results imply that altered FA metabolism may associate with early stage disorders of glucose metabolism.

Disclosure
A. Hata: None. N. Aki: None. T. Ichihara: None. A. Tamura: None. T. Minagawa: None. Y. Kuwamura: None. M. Funaki: Consultant; Self; Happy, Inc. Research Support; Self; Otsuka Holdings Co., Ltd.

Funding
Japan Ministry of Education, Culture, Sports, Science and Technology
1619-P: Risk Factors for Sleep Apnea Syndrome in Nonobese Type 2 Diabetics
Authors: KAWASAKI SATSUKI , MISAWA HARUO , KONDO TETSURI , KONDO YOSHINOBU , TERAUCHI YASUO 
Published: June 2019

Diabetics often have vascular diseases and other comorbidities. Sleep apnea syndrome (SAS) is a disorder characterized by repeated episodes of apnea and hypopnea during nocturnal sleep. Risk factors for SAS include obesity, male gender, and advanced age. It was reported that type 2 diabetes patients (T2DM) without obesity often have SAS. Among the 1,367 ambulant T2DM who were being treated at our institution, 245 (165 men, 80 women) with a BMI &lt;25kg/m2 and who agreed to undergo a portable sleep polygraph test, were evaluated to identify risk factors for SAS, focusing on micro- and macroangiopathy and stable comorbidities. The rates of retinopathy, nephropathy, carotid artery stenosis, coronary artery disease, and peripheral arterial disease were 32.2%, 45.1%, 19.3%, 39.6%, and 15.2%, respectively. The rates of intracranial lesions, respiratory diseases, cardiovascular diseases, cancer, thyroid diseases, and mental illness were 25.7%, 9.4%, 42.4%, 19.2%, 8.6%, and 4.1%, respectively. The apnea-hypopnea index (AHI) was 11.3±9.7 (mean±standard deviation) (12.1±9.9 in men, 9.8±9.1 in women). The prevalence of SAS (AHI≥15) was 25.5% in men and 18.8% in women. Carotid artery stenosis and intracranial lesions were more common among patients with SAS than among those without SAS (p&lt;0.05 each), while no such association was found for microangiopathy. Multivariate analysis adjusting for BMI, male gender, and age identified BMI (odds ratio, 1.23; 95% confidence interval, 1.04-1.47; p&lt;0.05) and intracranial lesions (2.93; 1.51-5.71; p&lt;0.005) as independent risk factors for SAS. The intracranial lesions identified were stable and diverse, ranging from infarction and hemorrhage to benign brain tumor and contusion. The association of intracranial lesions with hypoxia may be related to the respiratory centers, although the underlying mechanism is unknown. T2DM with stable intracranial lesions even without obesity, should be carefully monitored for nocturnal hypoxia, particularly during emergency hospitalization.

Disclosure
S. Kawasaki: None. H. Misawa: None. T. Kondo: None. Y. Kondo: None. Y. Terauchi: Advisory Panel; Self; AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Sanofi. Research Support; Self; Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Bayer Yakuhin, Ltd., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd.
162-LB: Pharmacokinetics, Pharmacodynamics, and Tolerability of Single- and Multiple-Dose of Janagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, in Chinese Patients with Type 2 Diabetes Mellitus
Authors: DING YANHUA 
Published: June 2019

Objectives: Janagliflozin (JGZ) is a novel sodium-glucose cotransporter 2 (SGLT2) inhibitor in development for the treatment of type 2 diabetes mellitus (T2DM). This study assessed the pharmacokinetics, pharmacodynamics, and tolerability of JGZ in Chinese patients with T2DM.
Methods: In this double-blind, parallel-controlled study, 36 patients with inadequately controlled T2DM were randomized into JGZ 25 mg, JGZ 50 mg, dapagliflozin 10 mg, or placebo cohort in a 1:1:1:1 ratio. Patients were treated with a single dose on Day 1, and then once daily from Day 4 to Day 17.
Results: JGZ was readily absorbed with Cmax observed at 2.00 hours (median). The half-life was estimated to be 21.2-23.3 hours at steady state. Plasma JGZ exposure increased in a dose-proportional manner and the accumulation rates were relatively low in Cmax (1.46-1.49) and AUC0-24 (1.67-1.81). Mean (SD) changes from baseline in 24 hour urinary glucose excretion (UGE) were 72.8 (26.2), 78.7 (17.3), 85.8 (25.2), and 2.20 (7.22) g after single dose, and were 92.4 (25.4), 94.2 (29.1), 87.6 (32.2), and 6.26 (24.3) g after multiple doses with JGZ 25 mg, JGZ 50 mg, dapagliflozin 10 mg, and placebo, respectively. Mean (SD) changes from baseline in fasting plasma glucose on Day 17 were 2.18 (1.62), 2.66 (2.01), 2.79 (1.44), and 1.70 (2.04) mmol/L for the four groups, respectively. Mean (SD) changes from baseline in A1C on Day 18 were 0.45% (0.29%), 0.33% (0.57%), 0.62% (0.35%), and 0.07% (0.80%) for the four groups, respectively. Adverse events were mostly mild or moderate with no hypoglycemia episode, serious adverse event, or discontinuation due to adverse event.
Conclusions: JGZ exhibited favorable pharmacokinetics profiles in Chinese patients with T2DM and was well tolerated. JGZ treatments resulted in increase in UGE and improvement in glycemic control. JGZ 25 mg and 50 mg are recommended for further clinical studies.

Disclosure
Y. Ding: None.

Funding
XuanZhu Pharma Co., Ltd.