bluuebunny/crossref_metadata_2025_split huggingface dataset:
728-P: Accuracy of Energy Expenditure Measurements by Activity Monitors in Type 1 Diabetes and Control Subjects
Authors: POONI RUBIN , MCGAUGH SARAH , PATEL RIDDHI , RIDDELL MICHAEL 
Published: June 2019

Physical activity monitors have become increasingly popular in recent years and researchers have started integrating these devices into artificial pancreas (AP) systems to improve the management of T1D. The accuracy of these devices at measuring energy expenditure (EE) may be important for the function of AP systems. Most research to date has determined the accuracy of activity monitors during steady state aerobic exercise in healthy individuals. In this study, the accuracy of the Fitbit Ionic and Garmin vívosmart 3 at measuring EE was assessed against indirect calorimetry (Cosmed K5) during 5 forms of non-steady state activities in individuals with and without T1D. Fourteen adults (Age: 25.8 ± 8.1 year; BMI: 24.1 ± 3.4 kg/m2; 8 T1D) performed a VO2 peak test, resistance exercise, activities of daily living, and high-intensity interval training on treadmill and cycle ergometer, while wearing a Fitbit and Garmin watch. A significant difference in accuracy was displayed by Garmin between individuals with T1D and healthy controls (T1D: 22.6 ± 35.4%; Control: -15.6 ± 24.0%, P&lt;0.0001), but no such difference was exhibited by Fitbit (T1D: 13.5 ± 35.8%; Control: 19.5 ± 37.0%) (Figure).
In summary, the Garmin vívosmart 3 overestimates EE during physical activity in individuals with T1D as compared to healthy controls. This difference may need to be addressed before integrating these devices into AP systems.

Disclosure
R. Pooni: None. S. McGaugh: None. R. Patel: None. M. Riddell: Advisory Panel; Self; Xeris Pharmaceuticals, Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation, Novo Nordisk Inc., Sanofi. Speaker's Bureau; Self; Medtronic MiniMed, Inc., OmniPod. Stock/Shareholder; Self; Zucara Therapeutics Inc.
729-P: Post-Breakfast Physical Activity Is Most Optimal for Improving Postprandial Glycemic Control in Healthy Adults
Authors: SOLOMON THOMAS P. , TARRY ELOISE , HUDSON CHLOE O. , FITT ALICE I. , LAYE MATTHEW 
Published: June 2019

Purposeful and deliberate exercise improves postprandial glucose control. However, there is less information concerning the effects of simple physical activities (standing, walking, circuit exercise) that can easily be integrated into a person’s day. Furthermore, the optimal timing between such an activity and a meal that elicits the most optimal glucose control is completely unknown. Three groups of 16 healthy adults volunteered to participate in three separate interventions: Stand (30-minutes standing still; RPE = 6±1), Walk (30-min treadmill walk at a self-selected brisk pace; RPE = 11±2, 5.6±0.8 kph), and Circuit (three sets of 10 squats, 10 push-ups, 10 lunges, 10 sit-ups; RPE = 11±2, 7.1±1.8 minutes to complete). In each intervention, participants completed four trials during which they drank a mixed-nutrient breakfast shake containing 500 kcals. Interstitial glucose responses were measured by continuous glucose monitoring (Dexcom G5). Postprandial glucose tolerance was quantified during the 2-hours period after meal ingestion. In each trial, the physical activity was completed either 2-hours after (trial A; control), immediately before (trial B), immediate after (trial C), or 30-minutes after (trial D) the meal. While trials B and D showed some improvement in postprandial glucose control compared to trial A, this was not statistically significant. Trial C, however, showed a significant improvement in mean glucose, standard deviation for glucose, and the area under the glucose curve in all three interventions (P&lt;0.05), when compared to trial A. Energy intake (diet records) and energy expenditure (Actigraph) were consistent throughout the studies and did not influence the findings.
In conclusion, low to moderate-intensity physical activity (either standing, walking, or body-weight circuit exercise) is best implemented soon after a meal to induce the greatest improvement in blood glucose control, in young healthy adults.

Disclosure
T.P. Solomon: None. E. Tarry: None. C.O. Hudson: None. A.I. Fitt: None. M. Laye: None.

Funding
Physiological Society
732-P: Insulin Sensitivity Nonresponders after Long-Term Intensive Exercise Training Are Characterized by Perturbed Amino Acid Metabolism and Mitochondrial Dysfunction
Authors: LEE SINDRE , GULSETH HANNE L. , DREVON CHRISTIAN A. , BIRKELAND KARE I. 
Published: June 2019

Exercise may effectively improve insulin sensitivity, although some individuals do not reap this benefit. Yet, mechanisms underlying variations in training-improved insulin sensitivity remain unknown. We investigated men with or without dysglycemia subjected to 12 w of high-intensity endurance and strength exercise, and classified them as nonresponders (n=5) or responders (n=21) based on glucose infusion rate (GIR) from euglycemic hyperinsulinemic clamping. We explored variables related to variation in training-improved GIR. VO2max, muscle strength, fat depots, adipose tissue (AT) and skeletal muscle (SkM) lipidomics, mRNA sequencing, and blood amino acid profiles were evaluated pre- and post-training. By design, nonresponders did not improve their GIR, whereas responders exhibited a pronounced increase (42%). There was no difference in attendance to training sessions between the groups, or any correlation between attendance rate and training-improved GIR. Both groups improved VO2max, leg press, pull down and chest press strength, but responders increased significantly more in VO2max and chest press strength. Nonresponders exhibited higher baseline plasma concentrations of leucine, isoleucine, valine, homocysteine and cysteine, more intraperitoneal AT and impaired insulin signaling, branched-chain amino acids and methionine and cysteine metabolism in AT, and higher SkM triacylglycerol, free fatty acids and cholesterol levels and impaired SkM oxidative phosphorylation, branched-chain amino acids degradation and tricarboxylic acid cycle. Failing to improve insulin sensitivity after long-term intensive training may relate to perturbed amino acids metabolism and mitochondrial dysfunction. Initial plasma levels of branched-chain and sulphur amino acids may determine individuals not obtaining glucometabolic improvements after training.

Disclosure
S. Lee: None. H.L. Gulseth: Consultant; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Merck Sharp & Dohme Corp., Sanofi-Aventis. C.A. Drevon: Board Member; Self; Vitas AS. Consultant; Self; Vitas AS. K.I. Birkeland: Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lifecare, Inc., Merck Sharp & Dohme Corp., Roche Diabetes Care. Other Relationship; Self; Norwegian Diabetes Association.
745-P: Lipidomics Studies on Brown Adipose Tissue by Exercise and Liraglutide in db/db Mice
Authors: YIN RUILI , ZHANG NING , ZHAO DONG 
Published: June 2019

Background: Brown adipose tissue (BAT) is characterized by regulating whole body energy expenditure, mediating glucose and lipid metabolism. Exercise is one of the favorable lifestyle interventions in against hyperglycemia, and liraglutide is also an ideal therapy in decreasing blood glucose into the normal range and regulating lipid metabolism. But how and whether exercise and liraglutide have an effect on BAT for mediating glucose metabolism are unknown.
Method: Male leptin receptor deficient db/db and age-matched C57BL/6 control mice were used at 6 weeks of age, db/db mice were subjected either to sedentary or exercise training (run on the treadmill, 5.2 m/minutes, 5 days per week) with or without liraglutide (200 ug/kg, twice one day, subcutaneous injection) for 8 weeks. Mice were monitored weekly for blood glucose and body weight. For glucose test, mice were fasted for 8 hours and blood glucose were collected at 0, 15, 30, 60, 90, and 120 minutes. Plasma were collected in heparinized tubes for insulin, triglyceride and cholesterol analysis, then BAT were collected for targeted lipidomics studies (including phosphatidylcholines, phosphatidyl ethanolamine, ceramides and sphingolipids) in a surveyor HPLC system (HPLC-MS/MS).
Results: Moderate exercise training and liraglutide treatment significantly lowered blood glucose in db/db mice, only exercise + liraglutide group showed down-regulated triglyceride level. BAT targeted lipidomics results showed that 7 Lysophosphatidyl choline, 4 phosphatidylcholines and 1 sphingolipids fatty acids did not expression in db/db mice than control. Surprisingly, compared with db/db mice, exercise training and liraglutide did not significantly change in any fatty acid expressions.
Conclusions: In this study, exercise training and liraglutide treatment exert a significant role in lowering blood glucose, but they may have no effective regulation of fatty acids metabolism on BAT.

Disclosure
R. Yin: None. N. Zhang: None. D. Zhao: None.

Funding
National Natural Science Foundation of China
746-P: Effects of Exercise Modes to Improve Insulin Sensitivity in Obese and Patients with Type 2 Diabetes—A Meta-analysis
Authors: GARCIA MARIO , PERALES KRISTIN R. , WAGLER AMY E. , BAJPEYI SUDIP 
Published: June 2019

Physical activity is effective in improving insulin sensitivity in an obese and type 2 diabetic population (T2D). However, most Americans do not adhere to the ACSM exercise guidelines. The effectiveness of different exercise modes to improve insulin sensitivity in an obese and T2D is unknown. Therefore, the purpose of this study was 1) to compare the effects of aerobic, resistance, and combination exercise training and 2) to determine the role of volume and intensity (aerobic) and repetitions and sets (resistance) on exercise induced improvement in insulin sensitivity in an obese and T2D population. 73 studies were used for this review. Meta-analysis methods were used to evaluate the role of moderators, such as volume, intensity, number of sets and repetitions, in the effectiveness of exercise training to improve insulin sensitivity. Aerobic, resistance and combination exercise training were effective modes in improving insulin sensitivity in obese and T2D (Z=5.43, p&lt;.0001). Volume and intensity during aerobic exercise did not have an effect on degree of improvement in insulin sensitivity (Q=1323.6, p&lt;.0001). During resistance exercise, greater number of sets resulted in a greater improvement however, number of repetitions did not have an effect on improving insulin sensitivity (Z=3.1370, p=0.0017). Although traditional aerobic exercise is an effective training method in improving insulin sensitivity in obese and individuals with T2D, resistance and/or combination exercise provide beneficial alternative training methods to improve insulin sensitivity. While prescribing resistance exercise, focusing on number of sets (3 or more), rather than number of repetitions, should be emphasized to improve insulin sensitivity.

Disclosure
M. Garcia: None. K.R. Perales: None. A.E. Wagler: None. S. Bajpeyi: None.
748-P: Effects of Exercise on Continuous Glucose Monitoring Outcomes in Type 2 Diabetes: A Meta-analysis
Authors: MUNAN MATTHEW , PINTO OLIVEIRA CAMILA LEMOS , REES JORDAN , BOULE NORMAND G. 
Published: June 2019

Objective: To examine the short and long-term effects of exercise on glucose outcomes as assessed by continuous glucose monitors (CGM) in type 2 diabetes (T2D).
Methods: A search of databases was performed up to May 2018. Eligible studies had participants complete standardized exercise interventions using CGM. In all short-term studies (&lt;2 weeks, often a single exercise session) participants completed both an exercise and non-exercise control condition. In long-term studies (&gt;8 weeks) the difference pre and post exercise training values were compared. The within participant mean differences and standard errors in 24-hour glucose concentrations between conditions was used to obtain a weighted mean difference according to the Generic Inverse Variance method (RevMan version 5.3). The I2 statistic was calculated to represent the percentage of the variability due to heterogeneity.
Results: A total of 27 studies were included. Of these, 22 studies were short-term, and 5 studies were long-term interventions. Exercise decreased 24-hour glucose in short-term (-0.6 mmol/L; -0.8 to -0.4; p&lt;0.01, I2 =79%) and long-term studies (-0.5 mmol/L; -0.7 to -0.2; p&lt;0.01, I2= 0%). To explain the heterogeneity in the short-term studies, subgroup and meta-regression analyses were performed. Comparison of subgroups defined according to the timing of exercise in relation to meals revealed significant differences among subgroups. In the 11 studies that performed exercise after breakfast, 24-hour mean glucose was reduced by 0.7 mmol/L (-0.9 to -0.5). In the 3 studies that performed exercise before dinner, there was no effect on 24-hour glucose (0.0 mmol/L -0.2 to 0.2). Elevated glucose in the control condition predicted a greater decrease in mean 24-hour glucose following exercise (R2= 0.29, P=0.0001).
Conclusion: Both short and long-term exercise can lower glucose in individuals with T2D. The timing of exercise as well as non-exercise glucose values were predictors of glycemic response to short-term exercise.

Disclosure
M. Munan: None. C. Lemos Pinto Oliveira: None. J. Rees: None. N.G. Boule: Research Support; Self; Abbott, Medtronic.
749-P: What Type of Physical Activity Is More Important? The Nagahama Study
Authors: MANO FUMIKA , IKEDA KAORI , TANAKA DAISUKE , INAGAKI NOBUYA 
Published: June 2019

Background: Moderate-intensity physical activity improves insulin sensitivity and shows beneficial effects for prevention of diabetes. However, it hasn’t been investigated what type of physical activity is more effective in reducing insulin resistance. In the current study, we examined the association between the type of physical activity and insulin resistance in Japanese general population.
Methods: We conducted cross-sectional analysis using a community-based cohort, the Nagahama Prospective Cohort for Comprehensive Human Bioscience. In this study, “exercise habits” means the habit of exercise for over 30 min a time, 2 or more times weekly, and “non-exercise activity” means physical activity in daily life equivalent to one-hour or more walking. Multiple linear regression analysis was performed with log HOMA-IR as a dependent variable and exercise habits, non-exercise activity, tobacco smoking, medical history of diabetes, family medical history of diabetes, age, sex and BMI as simultaneous independent variables.
Results: A total of 7047 subjects were included in the analysis. Multiple regression analysis showed that log HOMA-IR was determined by exercise habits (β = -0.027, p = 0.011), non-exercise activity (β = -0.025, p = 0.017) and BMI (β = 0.571, p &lt; 0.001). We divided subjects into two groups at the BMI of 23 (kg/m2), which is the cut point to consider diabetes screening for Asian adults (Diabetes Care, 2015). In the lower BMI group, multiple regression analysis showed that exercise habits (β = -0.047, p = 0.002) and BMI (β = 0.356, p &lt; 0.001) were significant determinants of log HOMA-IR. In the higher BMI group, on the other hand, non-exercise activity (β = -0.042, p = 0.033) and BMI (β = 0.369, p &lt; 0.001) were significant determinants of log HOMA-IR.
Conclusion: In Japanese people with BMI≧23 (kg/m2), “non-exercise activity” was more strongly associated with reduced insulin resistance, while in those with BMI&lt;23 (kg/m2), “exercise habits” was the stronger predictor of reduced insulin resistance.

Disclosure
F. Mano: None. K. Ikeda: Research Support; Self; Terumo Medical Corporation. D. Tanaka: Research Support; Self; Merck Sharp & Dohme Corp. N. Inagaki: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Japan Tobacco Inc., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited.
75-OR: Does Insulin Delivery Method Impact Risk of Hypoglycemia in Older Adults?
Authors: TOSCHI ELENA , SLYNE CHRISTINE , GREENBERG JORDAN , ATAKOV-CASTILLO ASTRID , DUFOUR ALYSSA B. , SIFRE KAYLA , CARL SAM , MUNSHI MEDHA 
Published: June 2019

Adults with type 1 diabetes (T1D) using insulin pump have a lower risk of hypoglycemia than those using multiple daily injections (MDI). However, it is not clear if these benefits are maintained in the older adult population.
Methods: We evaluated a cohort of older adults (age≥ 65 years) with T1D. All participants underwent continuous glucose monitoring (CGM) for 2 weeks along with questionnaires and assessments for hypoglycemia fear (HFS II), hypoglycemia unawareness (Clarke method), cognitive function (Montreal Cognitive Assessment (MoCA)), and demographic and medical history. Glycemic control was measured by A1C.
Results: We evaluated 86 older adults, 32 on MDI and 54 on insulin pump. Average age was 71 years in both cohorts, diabetes duration 36 and 41 years, and A1C 7.5% and 7.4%, respectively. Participants using MDI had more clinically significant hypoglycemia (glucose ≤54 mg/dl) than those using an insulin pump (48 minutes/day vs. 26 minutes/day, p&lt;0.05). Hypoglycemia unawareness and cognitive dysfunction did not differ between the groups (40% vs. 45%; 65% vs. 45%: p=ns respectively). The total scores on HFS II describing hypoglycemia fear were similar in both groups (32 vs. 25). However, participants using MDI were more fearful of hypoglycemia at night (p=0.03), and were more likely to keep their blood sugar higher than usual in social situations (p=0.03), or when doing important tasks (p=0.002).
Conclusions: Older adults with T1D using MDI had a higher risk of clinically significant hypoglycemia despite similar glucose control and hypoglycemia unawareness. Further studies are needed to understand the role of insulin administration methods on risk of hypoglycemia in older adults with T1D.

Disclosure
E. Toschi: Advisory Panel; Self; Lexicon Pharmaceuticals, Inc. C. Slyne: None. J. Greenberg: None. A. Atakov-Castillo: None. A.B. Dufour: None. K. Sifre: None. S. Carl: None. M. Munshi: Consultant; Self; Lilly Diabetes, Sanofi.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
751-P: Effect of Morning (Fasting) vs. Afternoon High-Intensity Interval Exercise on Blood Glucose in Type 1 Diabetes
Authors: YARDLEY JANE E. 
Published: June 2019

Studies of high intensity interval training (HIIE) in individuals with type 1 diabetes (T1D) have had variable blood glucose outcomes, including increases, decreases, and no significant change during and after exercise. A potential unaccounted factor that may influence these outcomes is the time of day during which participants exercise. We hypothesized that morning (fasting) exercise (AMx) would increase blood glucose levels, while afternoon exercise (PMx) would decrease blood glucose levels throughout exercise (45 min) and recovery (60 min). Ten individuals with T1D (4M/6F) aged 31±6.6 years, with VO2peak 42.2±7.2 mLO2·kg-1·min-1, and diabetes duration 18.7±10.3 years, performed a HIIT protocol both while fasting in the morning (7 am), and in the late afternoon (5 pm). Sessions were separated by at least 48 hours, with the order randomly assigned. A standard snack was provided one hour prior to PMx to replicate previous study designs. The HIIE protocol consisted of a warm-up (10 min), 12 maximal sprints (10 seconds every 2 minutes - 24 min), and a cool down (11 min). Exercise was followed by a monitored recovery period (60 min). Capillary glucose (CG) was recorded at baseline, at the end of exercise, and 60 minutes post-exercise. Data were analyzed using a 2X3 ANOVA. An interaction of time and condition (p = 0.017) was found, indicating that CG levels followed different trajectories during AMx and PMx. Changes in CG during exercise were not significantly different between conditions (AMx = +1.8±2.6 vs. PMx = -0.4±3.2 mmol/L; p=-.141). Changes during the 60-minute recovery were significantly different (p=0.039) with the AMx condition resulting in a continued increase in CG (+0.4±1.5 mmol/L) while CG declined during recovery in PMx (-1.2±2.8 mmol/L). The design of future studies of HIIE in T1D, as well as recommendations for insulin adjustments and carbohydrate intake, should take into account the time of day that exercise is performed.

Disclosure
J.E. Yardley: Research Support; Self; Abbott, Dexcom, Inc., LifeScan Canada. Speaker's Bureau; Self; Dexcom, Inc.

Funding
Augustana College
754-P: Full-Fat and Low-Fat Dairy, within the Same Caloric Intake, Have Similar Impact on A1C and Cardiovascular Risk Factors: A Randomized Controlled Study
Authors: MITRI JOANNA , TOMAH SHAHEEN , MOTTALIB ADHAM , SALSBERG VERONICA , ASHRAFZADEH SAHAR , ELSEAIDY TAHA , MARADNI AHMAD AL , ALSIBAI KHALED , ELDIB AHMED H. , TASABEHJI MHD WAEL , POBER DAVID M. , HAMDY OSAMA 
Published: June 2019

The USDA Dietary Guidelines recommend consumption of 3 servings of low/non-fat dairy per day. However, the effect of higher consumption and fat content in type 2 diabetes (T2D) is unknown. This study evaluates the impact of higher consumption of full-fat (FF) and low-fat (LF) dairy on A1C and cardiovascular risk factors in patients with T2D.
We enrolled 111 patients with uncontrolled T2D (age 58.5±8.9 years, 46.8% female) who were consuming &lt;3 servings of dairy/day and randomized them into 3 groups: control group maintained baseline dairy intake, LF group incorporated ≥3 servings of LF dairy/day, and FF group incorporated ≥3 servings of FF dairy/day. Participants were counseled by a registered dietitian to maintain their daily caloric intake and body weight. Patients maintained their diabetes, antihypertensive, and lipid lowering medications during the study. Participants were evaluated at baseline, 3 months, and 6 months. At baseline, T2D duration was 13.2±8.3 years, A1C 8.1±0.97%, body weight 93.3±18.9 Kg, BMI 32.47±5.68 Kg/m2, daily caloric intake 1925±553 kcal (43.4±7.0% carbohydrates, 37.8±5.5% total fat, 13.1±2.9% saturated fat, and 18.2±3.7% protein), LDL-C 84.3±27.4 mg/dL, TG 163.5±154.8 mg/dL, systolic BP 130±16 mmHg, and diastolic BP 71±9 mmHg. There were no differences between groups at baseline except for higher HOMA-IR in the FF group. At 6 months, % calories from saturated fat increased by 3.6% from baseline in the FF group (p&lt;0.0001) and decreased by 1.9% in the LF group (p&lt;0.05). The % calories from protein increased by 4.5% in the LF group (p&lt;0.0001), but did not change in the FF group. There were no differences in total caloric intake, % calories from carbohydrates or protein, A1C, BMI, body weight, lipid parameters, or BP between the 3 groups.
Conclusion: When on isocaloric diet, increasing consumption of dairy to ≥3 servings/day has similar impact on A1C, lipid profile and BP in patients with T2D, irrespective of fat content.

Disclosure
J. Mitri: Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceutical Europe Co. Ltd., National Dairy Council. Research Support; Spouse/Partner; Takeda Pharmaceutical Company Limited. Other Relationship; Self; National Dairy Council. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A. Mottalib: None. V. Salsberg: None. S. Ashrafzadeh: None. T. Elseaidy: None. A. Al Maradni: None. K. Alsibai: None. A.H. Eldib: None. M. Tasabehji: None. D.M. Pober: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.

Funding
National Dairy Council