bluuebunny/crossref_metadata_2025_split huggingface dataset:
145-OR: Ultra Rapid Lispro (URLi) Improves Postprandial Glucose (PPG) Control vs. Humalog (Lispro) in Patients with Type 2 Diabetes (T2D): PRONTO-T2D
Authors: BLEVINS THOMAS , ZHANG QIANYI , FRIAS JUAN P. , JINNOUCHI HIDEAKI , CHANG ANNETTE M. 
Published: June 2019

URLi is a novel prandial insulin lispro formulation developed to more closely match physiological insulin secretion. This phase 3, multicenter, treat-to-target, 26-week trial evaluated the efficacy and safety of URLi vs. lispro in patients with T2D. Primary endpoint was A1C change from baseline to week 26, with multiplicity adjusted objectives for PPG excursions (PPGE) with meal test. After 8-week lead-in to optimize basal insulin glargine or degludec and transfer to prandial lispro treatment, patients were randomized to double-blind URLi (n=336) or lispro (n=337) injected 0 to 2 minutes prior to meals. Patients could continue metformin and/or SGLT2 inhibitor.
Non-inferiority for primary endpoint was confirmed for URLi: estimated treatment difference (ETD) 0.06 [95% CI -0.05; 0.16], with mean change in A1C of -0.38% URLi and -0.43% lispro (Figure). Mean A1C at week 26 was 6.92% URLi and 6.86% lispro. URLi was superior to lispro in controlling 1- and 2-h PPGE with standardized meal test at week 26, with lower PPGE from 0.5-4 h with URLi (Figure). There were no significant treatment differences in rates of severe or overall hypoglycemia. Incidence of overall treatment-emergent adverse events was similar between treatments.
URLi in a basal-bolus regimen led to superior PPG control vs. lispro in patients with T2D.

Disclosure
T. Blevins: Research Support; Self; Amgen Inc., Gan and Lee Pharma, Lilly Diabetes, Mylan, Novo Nordisk Inc. Speaker's Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Lilly Diabetes, Sanofi US. Other Relationship; Self; Medtronic MiniMed, Inc. Q. Zhang: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J.P. Frias: Advisory Panel; Self; Becton, Dickinson and Company, Eli Lilly and Company, Gilead Sciences, Inc., Sanofi. Consultant; Self; Echosens, Genentech, Inc., Johnson & Johnson Diabetes Institute, Novo Nordisk Inc., Zafgen, Inc. Research Support; Self; AbbVie Inc., Akcea Therapeutics, Allergan, Amgen Inc., AstraZeneca, Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Cirius Therapeutics, Elcelyx Therapeutics, Inc., Eli Lilly and Company, Enanta Pharmaceuticals, Inc., GENFIT, Intarcia Therapeutics, Inc., Intercept Pharmaceuticals, Inc., Ionis Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., NGM Biopharmaceuticals, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Oramed Pharmaceuticals, Pfizer Inc., Sanofi, TaiwanJ Pharmaceuticals Co., Ltd., Theracos, Inc. Speaker's Bureau; Self; Merck & Co., Inc., Sanofi. H. Jinnouchi: None. A.M. Chang: Employee; Self; Eli Lilly and Company.

Funding
Eli Lilly and Company
1462-P: Diabetes-Associated Residual Risk in Statin-Treated Patients with Atherosclerotic Cardiovascular Disease
Authors: WONG NATHAN D. , ZHAO YANGLU , XIANG PIN , ANTONIO J , LOPEZ G 
Published: June 2019

Background: Persons with atherosclerotic cardiovascular disease (ASCVD) on statins remain at higher risk of CV events. The added residual risk that diabetes mellitus (DM) confers has not been well-quantified. We examined initial and total ASCVD events in statin treated persons with ASCVD and the added risk of DM.
Methods: We studied 3,271 subjects with ASCVD on statins from the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes trial cohort. We examined rates for first and total ASCVD events. Cox regression examined the risk of first ASCVD events over 3 years with and without DM at baseline.
Results: 40% of subjects had DM. Those with vs. without DM were slightly older, less likely male, white, currently smoking, had higher systolic but lower diastolic blood pressure, lower HDL-C, LDL-C, lipoprotein (a), but higher triglycerides and BMI (all p&lt;0.01). First and total ASCVD event rates are shown (Figure). Total ASCVD events were about 50% greater than initial events, with the difference largest in men with DM. From fully adjusted analyses, DM conferred a 22% greater risk of first ASCVD events compared to no DM (HR=1.22, 95% CI=1.03-1.44, p=0.02).
Conclusion: Despite statin therapy, DM carries significantly greater residual risk over having ASCVD alone. More aggressive approaches are needed to reduce the increased risk with ASCVD and DM.

Disclosure
N.D. Wong: Advisory Panel; Self; Novartis Pharmaceuticals Corporation. Consultant; Self; Akcea Therapeutics, AstraZeneca. Research Support; Self; Amarin Corporation, Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. Y. Zhao: None. P. Xiang: Employee; Self; Amgen Inc. J.G. Lopez: Employee; Self; Amgen Inc. Stock/Shareholder; Self; Amgen Inc.

Funding
Amgen Inc.
1469-P: Associations between Heart Rate, Glycemia, and A1c Levels
Authors: CASAGRANDE SARAH , COWIE CATHERINE C. , SOSENKO JAY M. , MIZOKAMI-STOUT KARA R. , BOULTON ANDREW J. , POP-BUSUI RODICA 
Published: June 2019

Previous evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease, for which persons with diabetes are at increased risk. We examined the association between heart rate and levels of glycemia in a nationally representative sample of U.S. adults.
This study included 27,602 adults age ≥20 years from the 2011-2014 National Health and Nutrition Examination Surveys. Levels of glycemia were defined as: diagnosed diabetes (self-report); undiagnosed diabetes [fasting plasma glucose (FPG) ≥126mg/dL or A1c ≥6.5%]; prediabetes (FPG 100-125mg/dL or A1c 5.7%-6.4%); normoglycemia (FPG &lt;100mg/dL and A1c &lt;5.7%). Predictive margins regression was used to determine mean HR by participant characteristics and glycemic status; and among those with diagnosed diabetes, by participant characteristics and A1c level. Mean HR was adjusted for age, sex, race/ethnicity, education, poverty income ratio, health insurance, smoking status, body mass index, history of cardiovascular disease, kidney disease, and antihypertensive medications; models by A1c level were additionally adjusted for oral antidiabetic medications. Mean HR was significantly higher for those with diagnosed and undiagnosed diabetes compared to those with normoglycemia (74 bpm vs. 72 bpm, p&lt;0.05, for both). In the fully adjusted model, mean HR remained significantly higher for those with diagnosed (76 bpm) and undiagnosed diabetes (75 bpm) compared to those with normoglycemia (71 bpm, p&lt;0.05 for both). Among persons with diagnosed diabetes, there was a positive association between HR and glycemic levels as measured by A1c (72 bpm, 75 bpm, 77 bpm, and 81 bpm for A1c &lt;7.0%, 7.0%- &lt;9.0%, 9.0%- &lt;11.0%, and A1c ≥11.0%, respectively, p&lt;0.001), and this association remained after adjustment for risk factors.
In conclusion, mean HR was higher among persons with diabetes and increased glycemia, which may reflect subtle autonomic and/or myocardial dysfunction among those with diabetes.

Disclosure
S. Casagrande: None. C.C. Cowie: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., Amgen Inc., Fresenius SE & Co. KGaA, General Electric, Johnson & Johnson, Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc. J.M. Sosenko: None. K.R. Mizokami-Stout: None. A.J. Boulton: None. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
1474-P: Changes in SGLT2i and GLP-1RA Real-World Initiator Profiles following Cardiovascular Outcome Trials—A Danish Nationwide Population-Based Study
Authors: KNUDSEN JAKOB S. , MUNKSGÅRD BAGGESEN LISBETH , LAJER MARIA , NURKANOVIC LARISA , USTYUGOVA ANASTASIA V. , SÔRENSEN HENRIK T. , THOMSEN REIMAR W. 
Published: June 2019

Objectives: To investigate changes in clinical characteristics of SGLT2i and GLP-1RA initiators in Denmark before/after landmark trials.
Materials and Methods: Compared first-time SGLT2i (25,070) and GLP-1RA (15,803) initiators to initiators of DPP-4i (without proven cardiovascular benefits), using linked population-based healthcare data to examine initiation incidence, medication patterns, and atherosclerotic cardiovascular disease (ASCVD) during 2014-2017.
Results: Nationwide incidence of SGLT2i initiators increased 3.6-fold (53/100,000 to 172/100,000 per year) vs. a 1.7-fold increase for GLP-1RA. DPP-4i initiation remained stable (Figure). From the end of 2015, SGLT2i was increasingly used as 2nd-line and GLP-1RA as 1st-line therapy. Among SGLT2i users, ASCVD increased slightly from 28% to 30%; age- and gender-adj. prevalence ratio (aPR) = 1.03 (95% CI:0.97-1.10). In contrast, among GLP-1RA initiators, ASCVD declined from 29% to 25% (aPR: 0.87 (95% CI:0.81-0.93)), and in DPP-4i initiators from 31% to 29% (aPR: 0.91 (95% CI:0.88-0.96)).
Conclusion: For SGLT2i, the EMPA-REG OUTCOME trial may have driven earlier adoption i.e., increased 2nd-line use, with minor increases in proportions with ASCVD. For GLP-1RA, we observed increased 1st-line use and decreasing ASCVD despite the LEADER trial, possibly due to anti-obesity treatment launch.

Disclosure
J.S. Knudsen: None. L.M. Baggesen: None. M. Lajer: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. L. Nurkanovic: Employee; Self; Boehringer Ingelheim International GmbH. A.V. Ustyugova: Employee; Self; Boehringer Ingelheim International GmbH. H.T. Sôrensen: None. R.W. Thomsen: None.

Funding
Boehringer Ingelheim
148-LB: Efficacy and Safety of Adding an Oral Hypoglycemic Agent or a GLP-1 Receptor Agonist to Insulin in Patients with Type 1 Diabetes: A Network Meta-analysis
Authors: KIM YOON JI , HWANG SEUN DEUK , LIM SOO 
Published: June 2019

Objective: Despite intensive insulin treatment in patients with type 1 diabetes (T1D), their glycemic levels often do not reach the recommended target goal. We performed a network meta-analysis to evaluate the efficacy and safety of additional therapy to insulin in patients with T1D.
Methods: We searched CENTRAL, MEDLINE, and Embase from 1970 until January 2019 to identify randomized controlled trials (RCTs) in T1D patients treated with insulin and oral hypoglycemic agents or glucagon-like peptide-1 receptor agonists. We performed network meta-analyses using Bayesian models and generated rankings of the different hypoglycemic agents by generation mixed treatment comparison.
Results: With 23 RCTs (n =3,839), we performed the network meta-analysis using eight groups; 1) insulin alone, 2) insulin and metformin, 3) insulin and canagliflozin, 4) insulin and dapagliflozin, 5) insulin and empagliflozin, 6) insulin and sotagliflozin, 7) insulin and liraglutide, and 8) insulin and exenatide. Compared with insulin alone, HbA1c was significantly lower in the group treated with insulin and sotagliflozin (mean difference: -0.43%; 95% Crl: -0.66, -0.20). Total daily insulin dose was significantly lower in the insulin and sotagliflozin group by 6.4 U/day than other groups. Compared with insulin alone, body weight was decreased in the group with insulin and canagliflozin by 4.5 kg, insulin and sotagliflozin by 2.8 kg, insulin and liraglutide by 4.5kg, and insulin and exenatide by 5.1 kg, respectively. Severe hypoglycemic episodes did not differ between the groups.
Conclusions: In patients with T1D, sotagliflozin treatment combined with insulin decreased HbA1c levels, insulin dose, and body weight without hypoglycemia compared with insulin monotherapy. Combined treatment of canagliflozin, liraglutide, or exenatide with insulin was also effective in weight loss compared with insulin alone in these patients.

Disclosure
Y. Kim: None. S. Hwang: None. S. Lim: None.
1481-P: Relationship among BMI, WC, and Cardiovascular Disease Risk Factors: Findings from the Korea National Health Insurance System (KNHIS) Health Checkup Data
Authors: SON JANG WON , LEE SEONG-SU , KWON HYUK-SANG , JIB YOO SOON 
Published: June 2019

The clinical utility of the combined use of BMI and waist circumference (WC) to indicate the cardiovascular disease (CVD) risk factors in Asians remains unclear. Using a large-scale population-based cohort from the KNHIS health checkup data from 2009 to 2015, we investigated the relationship between BMI, WC and subsequent CVD risk factors (at least one from type 2 diabetes, hypertension or dyslipidemia). BMI was categorized into 5 subgroups at 18.5, 23.0, 25.0 and 30.0kg/m2. The cut-off points of WC for central obesity were 90cm in men and 85cm in women. The participants were subdivided into a total of 10 subgroups according to the presence of central obesity in each of the 5 BMI ranges. The incidence risk of CVD risk factors in each subgroup was comparatively analyzed using a multivariable Cox's proportional hazard model. Participants were 14,170,134 adults above 20 years of age who did not have type 2 diabetes, hypertension or dyslipidemia at the baseline examinations. During a mean follow-up of 5.3 years, CVD risk factors developed in 1,857,307 participants. The HRs for CVD risk factors were increased by 8.2% per 1kg/m2 increment of BMI. The HRs (95% CI) for CVD risk factors across BMI categories were 0.573, 1.0, 1.479, 1.962 and 3.03, respectively, after adjusting for age, sex, smoking, alcohol drinking, physical activity, and monthly income. Compared to the group with BMI of 18.5 to 23 kg/m2 without central obesity, which served as the reference group, the multivariable-adjusted HRs in those with central obesity was significantly increased from 1.00 to 1.27 with a BMI of 18.5 to 23.0 kg/m2, from 1.45 to 1.64 with a BMI of 23.0 to 25.0 kg/m2, from 1.83 to 2.10 with a BMI of 25.0 to 30.0 kg/m2, and from 2.56 to 3.08 with a BMI of 30.0 kg/m2 or over. These findings show that assessment of central obesity provided additional clinical utility beyond BMI for reclassifying the risk of CVD risk factors in Korean populations, even those with a low BMI.

Disclosure
J. Son: None. S. Lee: None. H. Kwon: None. S. Yoo: None.
149-LB: The MetAP2 Inhibitor, ZGN-1061, Improves Insulin Sensitivity and Beta-Cell Function in Patients with Type 2 Diabetes
Authors: FABUNMI ROSALIND , BERGMAN RICHARD N. , PICCININI FRANCESCA , KIM TERRI , ZHUANG DONGLIANG , TAYLOR KRISTIN , KIM DENNIS D. 
Published: June 2019

ZGN-1061 is a second-generation methionine aminopeptidase 2 (MetAP2) inhibitor in development for treatment of T2D. Full results of a Phase 2 clinical trial of ZGN-1061 vs. placebo (PBO) administered SC for 12 weeks on change from baseline in A1C in subjects with T2D are reported elsewhere. Baseline (ITT population N=175) A1C 8.6±1.1%, BMI 37±7 kg/m2, T2D duration 8±6 y. ZGN-1061 was generally well tolerated; 93% completed the trial. LS mean±SE A1C change was 0.2±0.1% for PBO vs. ±0.4±0.1% and -0.9±0.2% for 0.9 and 1.8 mg ZGN-1061 (both p&lt;0.001 vs. PBO). PBO weight change was -0.6±0.3 kg vs. -1.4±0.3 kg (p=ns) and ±2.8±0.5 kg (p&lt;0.001) for 0.9 and 1.8 mg ZGN-1061. This analysis included a subset of subjects who participated in a mixed-meal tolerance test (MMTT) at baseline and week 12. ZGN-1061 produced dose-dependent improvements in fasting and postprandial glucose (p&lt;0.05 vs. PBO). Minimal model analysis showed improvements in insulin sensitivity (SI) and disposition index (DI_OB; a measure of β-cell compensation) from baseline to week 12 with ZGN-1061 (Table). In an exploratory combined analysis of 0.9+1.8 mg ZGN-1061, SI and DI_OB increased (p=0.02 and p=0.07). SI and DI_OB were unchanged with PBO. In patients with T2D, improved glycemic control with ZGN-1061 may be driven by changes in insulin sensitivity and β-cell function. These results support future assessments using other definitive methods.

Disclosure
R. Fabunmi: None. R.N. Bergman: Consultant; Self; Zafgen, Inc. F. Piccinini: None. T. Kim: Employee; Spouse/Partner; Celgene Corporation. Employee; Self; Zafgen, Inc. D. Zhuang: Employee; Self; Zafgen, Inc. K. Taylor: Employee; Self; Zafgen, Inc. D.D. Kim: Employee; Self; Zafgen, Inc.

Funding
Zafgen, Inc.
1492-P: Patients with Diabetes: Perspectives on Obesity Management
Authors: HUQ SABRINA , TODKAR SUPRIYA , LAHIRI SHARON 
Published: June 2019

In 2018 we surveyed our Endocrinology Clinic’s non-pregnant patients with diabetes, age ≥18, and BMI &gt;30 kg/m2. Findings with 54 respondents indicated most were middle-aged, female, black, with an income &lt;$50,000. BMI was ≥40 kg/m2 in 33.3%, 35-39.9 kg/m2 in 37%, and 30-34.9 kg/m2in 29.6%. Nearly all (95%) agreed that obesity is related to heart disease, early death, diabetes, and hypertension. Despite being obese, 62% selected overweight and 5.7% normal weight. About half (56.6%) were aware of their BMI. For why it is important to lose weight, most answered better physical function (86.8%), decreased medications (75.5%), improved self-esteem (56.6%) and physical appearance (55%). Half (52%) said they asked their health care providers (HCPs) about obesity treatment, and more (73%) recalled their HCP discussing obesity. Respondents discussed obesity with Primary Care (75.7%), Endocrinology (56.8%), Bariatric Surgery (19%), other subspecialty (10.8%), and OB/GYN (5.4%). Not discussing obesity was explained by knowing what to do (62.5%) and self-responsibility to manage weight (37.5%). None said clinic visit time was insufficient. Few (2%) reported referral to a specialty that manages obesity, anti-obesity medications (5.7%), or bariatric surgery (15%). Barriers to dietary changes were lack of time (35%), high cost (41%), knowledge (25%), or motivation (22%). Barriers to exercise were lack of time (47%) or inability to exercise due to health problems (27%). Barriers to anti-obesity medications included lack of knowledge (43%) and concern with side effects (29%). Barriers to bariatric surgery included risk of complications (35.3%), expense (17.6%), and lack of knowledge (15.7%). Barriers to initiating weight loss were a preference for unhealthy food (52.8%) and lack of exercise (67.9%). These findings reveal an excellent awareness of obesity as a health problem and the need for improved knowledge and discussion on anti-obesity medications and bariatric surgery.

Disclosure
S. Huq: None. S. Todkar: None. S. Lahiri: None.
1496-P: Clinical Inertia in Relation to Sociodemographic Factors among Patients with Type 2 Diabetes (T2D) in the United States
Authors: FERNANDES GAIL , SAWHNEY BAANIE , HANNACHI HAKIMA , WANG TONGTONG , MCNEILL ANN MARIE , IGLAY KRISTY , RAJPATHAK SWAPNIL 
Published: June 2019

Several studies focused on clinical inertia in the U.S. T2D population have demonstrated a significant delay in treatment intensification in real-world clinical practice. The objective of this study was to evaluate if there is a disparity in clinical inertia based on sociodemographic factors. The GE Centricity Electronic Medical Record database (2015 data) was used to identify T2D patients on dual therapy with metformin and another oral antihyperglycemic agent (OAHA). Included patients had ≥12 months of continuous enrollment prior to index date (initiation of dual therapy), further intensified therapy within 2 years following the index date and had an HbA1c measure available within 6 months prior to intensification. Treatment intensification was defined as addition of another OAHA or initiation of insulin/GLP-1RA. 991 patients met the inclusion criteria; mean age of 57.9 years and 47.4% were female. Table lists the distribution of sociodemographic factors by HbA1c categories. Results suggest that older patients were less likely to be intensified at higher HbA1c compared to younger patients. Furthermore, compared to whites, black patients were more likely to be intensified at higher HbA1c levels with no apparent pattern of intensification by region.
In conclusion, decision to intensify in clinical practice may be associated with sociodemographic factors such as age and race.

Disclosure
G. Fernandes: None. B. Sawhney: Consultant; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson & Johnson. Employee; Self; Merck & Co., Inc. A. McNeill: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: None.
1498-P: Multilevel Variation in Diabetes Screening within an Integrated Health System
Authors: OBINWA UDOKA C. , LINGVAY ILDIKO , MENEGHINI LUIGI , HALM ETHAN , BOWEN MICHAEL E. 
Published: June 2019

Although many individuals eligible for diabetes screening go untested, little is known about the contribution of patient, provider, and clinic level factors to variation in screening in clinical practice. We used electronic health record (EHR) data from an integrated safety net health system to create a retrospective cohort of non-pregnant, primary care patients age 18-64 years without diagnosed diabetes who completed ≥ 2 primary care visits from 2010-2015 across 12 clinics. Hierarchical nested 3-level and cross-classified models were used to evaluate multilevel variation in screening at the patient (age, sex, race, insurance, family history, BMI, HTN, HLD, CVD etc.), provider (attending, physician in training, advanced practitioner), and clinic (teaching vs. non-teaching) level. Of 56,818 patients, 70.4% completed screening over 3 years of follow-up with nearly two-fold variation across clinics (51-92%; p&lt;0.001). Of those meeting ADA (69%) and U.S. Preventive Services Task Force (36%) screening criteria, three-quarters were screened (73%,74%) with almost two-fold variation across clinics (ADA 53-92%; USPSTF 49-93%). Nearly 70% of patients not eligible for guideline-based screening were also tested. Overall yield of guideline-indicated screening was similar between USPSTF and ADA guidelines for diabetes (11% vs. 9%) and prediabetes (38% vs. 36%). Among those not meeting screening criteria, the USPSTF guideline missed more cases of diabetes (6% vs. 3%) and prediabetes (26% vs. 19%) than ADA. Even after adjustment for patient, provider, and clinic factors and accounting for clustering, there was unexplained two-fold variation in screening by clinic (Median OR 1.97; intra-class correlation 0.13). Screening rates vary widely in an integrated health system and are not fully accounted for by patient, provider, and clinic factors available in the EHR. Clinical decision support and other system level interventions are needed to optimize screening practices across clinics.

Disclosure
U.C. Obinwa: None. I. Lingvay: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., MannKind Corporation. Consultant; Self; AstraZeneca, Novo Nordisk Inc., Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Research Support; Self; Merck & Co., Inc., Mylan, Novo Nordisk Inc., Pfizer Inc. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. L. Meneghini: Advisory Panel; Self; AstraZeneca, Novo Nordisk Inc., Sanofi-Aventis. Consultant; Self; Sanofi-Aventis. Other Relationship; Self; American Diabetes Association. E. Halm: None. M.E. Bowen: None.

Funding
National Institutes of Health (DK104065)