bluuebunny/crossref_metadata_2025_split huggingface dataset:
2273-PUB: Translational Analytics Clustering Type 2 DM Patients Treated on Wholesome Millet in Reducing HbA1c
Authors: VAIRAMUTHU SEKAR , SEKAR BRAHATHESHWAR , MARAPPAN SIVAPRAKASH , ANANTHASUBRAMANI RAJAGOPAL 
Published: June 2019

Aim: To study the effect of whole grain millet based food in type 2 DM patients on HbA1c reduction.
Methodology: The contexts of the datasets of patients were studied as they arrive at Coimbatore Diabetes Foundation for over a period of 3 years, were classified based on initial visit according to the HbA1c results. High risk &gt; 8%, moderate risk 7% ≤ 8% and low risk &lt; 7%, among 100 patients, were further clustered (as 1,2 and 3 containing 41, 49 and 10 patients respectively) based on age, BMI, FBS, PPBS, and HbA1c, using K-Mean cluster. The translational analytics focus on the conclusions of the datasets from the passive deduction scope to active prescriptive scalability for real time practice on the effect of wholesome millet diet (WMD), millets are small seeded grasses grown as a cereal crops. This approach of real time application of clinical practice in fundamental research that can be easily practiced for treatment of DM, despite the natural limitation of hereditary and aging process. The patients who were following WMD were tested for HbA1c periodically. The Translational analytics: The Interval Plot and individual control chart with the analysis of variance examines the significance of the reduction in the average level of HbA1c% for each cluster.
Findings: 1. Significant reduction of HbA1c between first and second visit from 11.7 to 7.4% (at P value = 0) for cluster group 3 after a lapse of 106 days. This was sustained in the 4th visit up to 480 days 2. In cluster 2 the average reduction from 8.9 to 7.1% in the interval of 79 days and further significant reduction was visible in 4 th visit at 6.6% (at P value 0) up to 335 days. 3. In cluster 1 the significant reduction of HbA1c was noticed at the fourth visit at 6.8% from 7.4% after a lapse of 361 days (P value at 0.007).

Disclosure
S. Vairamuthu: None. B. Sekar: None. S. Marappan: None. R. Ananthasubramani: None.
228-OR: Cerebral Glucose Transport and Metabolism in Obesity
Authors: GUNAWAN FELONA , JIANG LIHONG , LEVENTHAL JESSICA , PACH JOLANTA J. , RANGEL ELIZABETH SANCHEZ , BELFORT-DEAGUIAR RENATA , COPPOLI ANASTASIA , ROTHMAN DOUGLAS L. , SHERWIN ROBERT , MASON GRAEME F. , HWANG JANICE J. 
Published: June 2019

Metabolic derangement triggered by a high fat diet has been associated with decreased brain glucose uptake in mice through downregulation of GLUT-1 expression at the blood-brain barrier. Likewise, a prior study by our group using 1H magnetic resonance spectroscopy (MRS) showed diminished change in brain glucose level during acute hyperglycemia in patients with obesity and diabetes. However, whether this reflected differences in absolute brain concentrations remains unknown. We utilized 13C MRS scanning at 4 Tesla to compare the rate of glucose transport (Tmax) and cerebral metabolic rate of glucose (CMRgl) in the occipital lobe during a 2-hour hyperglycemic clamp. Plasma glucose concentration of ∼180mg/dl was achieved using a variable 1-13C-glucose infusion. The study included 8 healthy lean (1M/7F, age 29 ± 5 years, BMI 21 ± 2 kg/m2, HgbA1c 5.4 ± 0.2%) and 6 obese participants (4M/2F, age 30 ± 3 years, BMI 33 ± 3 kg/m2, HgbA1c 5.5 ± 0.2%). Insulin and free fatty acids (FFA) levels were measured during the clamp. Despite nearly identical plasma glucose concentrations at steady state (lean 182.5 ± 9.0 mg/dL, obese 186.5 ± 13.5 mg/dL, P=0.55, averaged over time 60-120 minutes), the absolute brain glucose concentrations were 30% less in obese compared to lean participants (P=0.02). Moreover, using previously reported Michaelis-Menten Kt of 1.1 mM, the calculated Tmax/CMRgl at steady state were 37% less in obese participants (P=0.01), suggesting reduced glucose transport. A trend of higher insulin and FFA levels in obese participants during hyperglycemia was observed. In addition, FFA levels at steady state were negatively correlated with absolute brain glucose concentrations (r= -0.575, P=0.05). We conclude that obesity is associated with diminished absolute concentration of brain glucose during acute hyperglycemia, likely explained by reduced cerebral glucose transport capacity. These findings may have implications for understanding the impact of obesity on central regulation of feeding behavior as well as neurocognitive function.

Disclosure
F. Gunawan: None. L. Jiang: None. J. Leventhal: None. J.J. Pach: None. E. Sanchez Rangel: None. R. Belfort-DeAguiar: Research Support; Self; Silver Palate Kitchens, Inc. A. Coppoli: None. D.L. Rothman: None. R. Sherwin: Other Relationship; Self; ICON plc., IQVIA, MannKind Corporation. G.F. Mason: None. J.J. Hwang: None.

Funding
American Diabetes Association (1-17-ICTS-013 to J.J.H.)
2280-PUB: Impact of Diabetes-Related Family and Social Discomfort on Diabetes Self-Management (DSM)
Authors: CAMPBELL JENNIFER A. , GARACCI EMMA , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2019

Background: DSM is key to diabetes care and critical for optimal outcomes. Understanding whether diabetes related discomfort with family or friends impacts DSM may have important implications for patient care.
Methods: Data from 1,901 adults from the Health and Retirement Survey (HRS) 2003 diabetes cohort was used. The outcome, DSM behaviors included medication adherence, diet, and blood sugar testing. The primary independent variable was perceived family or social discomfort with diabetes. Survey logistic regression models tested the likelihood of performing recommended DSM behaviors, and whether perceived family or social discomfort with diabetes was associated with DSM behaviors. The model controlled for age, gender, race, education, and marital status.
Results: Mean age of the population was 70 years. Overall, 21% reported experiencing diabetes related discomfort with family or friends. Compared to those who did not report any diabetes related discomfort with family or friends, reporting discomfort was related to higher odds of medication non-adherence (OR 2.33; CI 1.56-3.47). Ethnic minorities were more likely to be non-adherent to medications when reporting experiences of family discomfort compared to Whites (OR 2.36; CI 1.50-3.73). Reporting discomfort was also significantly related higher odds of diet non-adherence for fruits/vegetables (OR 1.72; CI 1.20-2.48). Eating high fat foods, junk food, and testing blood sugar were not statistically significant.
Conclusions: Patients with diabetes who report diabetes discomfort in their family and social relationships were more likely to be non-adherent to medications and more likely to be non-adherent to diet recommendations for fruits/vegetables. These results suggest that unique barriers to DSM behaviors may exist as a result of familial and social pressures related to living with diabetes, particularly for minority populations, necessitating tailored diabetes self-management education, support, and interventions.

Disclosure
J.A. Campbell: None. E. Garacci: 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; National Institute of Diabetes and Digestive and Kidney Diseases
2291-PUB: Web Application for In-Depth Analysis of Oral Glucose Tolerance Test
Authors: SHINDE SURESH N. , JOSHI ASHWINI S. , SHINDE RITUPARNA S. 
Published: June 2019

OGTT can be used to calculate various indexes of insulin secretion, resistance and beta cell function and to stratify the dysglycemic stage. Since calculating these indexes involves complex mathematical calculations, they are less commonly used. Realizing this, we created a single page web-based computer application to calculate these OGTT indexes. The values obtained during standard 75 gm, two-hour OGTT were entered in an Excel worksheet using standard formulas. This was then converted into a web-based calculator. The app can be used on all platforms and devices including smartphones. Once downloaded into a browser, the user needs to replace the default values with patient values obtained during OGTT. The app calculates and prints fasting, post glucose indexes and generates graphical charts showing the comparison between the patient and the expected normal values. It can email a copy for record and works in offline mode also. This app is in public domain and can be freely downloaded from www.ogtt.in. Even though less sensitive, HOMA indexes are commonly used due to their simple formulas. This calculator makes it very easy to calculate the post-glucose indexes which help in early recognition of specific organ resistance and clinical conditions such as obesity, prediabetes, fatty liver, PCOS, gestational diabetes, T2DM. Clinicians can use this rapid and easy tool for risk stratification of dysglycemia and to assess the response to therapy.

Disclosure
S.N. Shinde: None. A.S. Joshi: None. R.S. Shinde: None.
2293-PUB: Evaluation of Utility of Flash Glucose Monitoring (FGM) in People with Type 2 Diabetes in an Urban Indian Setting
Authors: CHAWLA MANOJ , CHAWLA PURVI M. , SHAH AMI 
Published: June 2019

The scientific utility of Self-Monitoring of Blood Glucose (SMBG) has been recently challenged by scientific reports. Therefore, we aimed to understand the utility of FGM in Indian setting. FGM is a standard care of practice at our center to deliver effective metabolic care. We analyzed the FGM reports (Libre Pro) from the LINA cohort (n=102; males 67, females 35), to understand the impact of measures adopted for glycemic control. We compared the baseline HbA1c with the repeat HbA1c when the patients reported for at least one follow-up within six months, of undergoing the FGM and being recommended changes in lifestyle with appropriate therapeutic changes, on the basis of FGM findings. Statistical analysis was performed by student t test. The mean age was 60 years (SD±13, 95% CI 57-62). Mean duration of diabetes 13 years (SD±9.2, 95% CI 11-15). The mean baseline HbA1c 8.5% (SD±1.5, 95% CI 8.2-8.8) significantly reduced to mean HbA1c 8% (SD±1.4, 95% CI 7.7-8.3) (p=0.144). Mean reduction in HbA1c was -0.5% (SD±1.4, 95% CI -0.78 to -0.22). Out of 102 patients for HbA1c comparison for change in HbA1c, 68 reported reductions in HbA1c of which 47 (69%) reported HbA1c reductions greater than 0.5%. We corroborated the reported estimated HbA1c (eHbA1c) from Libre Pro with conventional HbA1c reports at follow-up. The higher mean difference in HbA1c of 0.82%, does not justify the utility of eHbA1c in FGM. This often is a misleading tool and a deterrent to efficacious glycemic care. The greater adoption of FGM in our setting empowered patients to choose a healthy lifestyle and the health care professionals to judiciously customize the therapy, with reduction in glycemic variability and increasing the time in range. The rationality of the utility of eHbA1c, which has been questioned in our real-world data, need to be addressed through a higher level of evidence by a larger, nation- wide prospective multicentric study.

Disclosure
M. Chawla: None. P.M. Chawla: None. A. Shah: None.
2296-PUB: Serum Metabolome Reflects the Status of Glucose Metabolism of Japanese Pregnant Women
Authors: SAKURAI KENICHI , EGUCHI AKIFUMI , WATANABE MASAHIRO , YAMAMOTO MIDORI , MORI CHISATO 
Published: June 2019

Objective: We reported that some metabolites during early pregnancy could predict subsequent development of gestational diabetes. In this study, to elucidate the metabolic status of pregnant women associated with glucose metabolism, we examined the association of the metabolomic profile and the glycohemoglobin (A1c) levels in Japanese pregnant women.
Research Design and Methods: This study was conducted with participants enrolled by the Center of Chiba Unit of the Japan Environment and Children’s Study. Of those, 237 participants were enrolled in this study. Metabolite levels of their serum obtained during early pregnancy were analyzed using hydrophilic interaction chromatography tandem mass spectrometry. To examine the association between A1c levels and metabolic profiles, we performed least absolute shrinkage and selection operator (lasso) regression. The study protocol was approved by the Biomedical Research Ethics Committee of the Graduate School of Medicine, Chiba University.
Results: Characteristics of participants were followed: age 32.0 (5.0) years, pre-gestational BMI 22.7 (4.6) kg/m2, A1c 5.09 (0.37) %. The association between their A1c levels and the metabolomic profiles, analyzed using lasso regression showed that nineteen metabolites were associated with A1c levels. Enrichment analysis revealed that the metabolites associated with A1c were related to ABC transporters, aminoacyl-tRNA biosynthesis, arginine and proline metabolism, glycine, serine and threonine metabolism, and metabolic pathway.
Conclusion: Our results suggest the association of the serum metabolomic profile with the level of glycemia during pregnancy.

Disclosure
K. Sakurai: None. A. Eguchi: None. M. Watanabe: None. M. Yamamoto: None. C. Mori: None.

Funding
Japan Society for the Promotion of Science; Japan Ministry of the Environment
230-LB: Intraindividual Variability of Measures of Beta-Cell Response
Authors: ANNA NEYMAN , EVANS-MOLINA CARMELLA , DIMEGLIO LINDA , MIRMIRA RAGHAVENDRA , MATHER KIEREN J. , HANNON TAMARA S. , SIMS EMILY K. 
Published: June 2019

Diabetes intervention study designs require knowledge of within-subject variability of outcome measures. We evaluated the variability of measures of β-cell response assessed across 9-12 weeks in 3 nondiabetic adult populations relevant to type 1 diabetes (T1D) research: relatives of individuals with T1D who are single islet autoantibody (Ab) +, first degree relatives (FDR) with TID who are Ab -, and Ab- adults with no family history of T1D.
C-peptide and glucose levels were measured in repeated mixed meal tolerance tests (MMTT) and hyperglycemic clamps separated by means of 2.8 months and 3.0 months. The 12 participants (22-49 y; 50% male) included 3 single Ab + FDRs, 5 Ab-FDRs, and 4 with no family history of T1D. Fasting proinsulin:C-peptide (PI:C) ratios were calculated as molar ratios. For MMTTs and clamps, stimulated C-peptide measures were calculated. Between-visit coefficients of variation and intraclass correlations were calculated.
Test-retest variability differed between measures (Table). Test-retest correlations were highest for fasting PI:C and first-phase C-peptide response measures.
In nondiabetic adults with or without known T1D risk factors, test-retest variability ranged from 10-30% for measures of β-cell response. These observations will inform study design including choice of methodology and sample sizes needed to detect treatment effects using these methods.

Disclosure
A. Neyman: None. C. Evans-Molina: None. L. DiMeglio: Research Support; Self; Amgen Inc., Caladrius Biosciences, Inc., Janssen Research & Development, Medtronic, Sanofi. Other Relationship; Self; Dexcom, Inc. R. Mirmira: None. K.J. Mather: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. T.S. Hannon: Advisory Panel; Self; Eli Lilly and Company. E.K. Sims: None.

Funding
JDRF (2-SRA-2017-498-M-B)
2305-PUB: Effects of Dulaglutide on Renal Function, Glycemic Control, and Weight Outcomes in Indian Patients with Type 2 Diabetes: A Real-World Study
Authors: PATANGE SONALI A. 
Published: June 2019

Objective: This study aims to evaluate the changes in estimated glomerular filtration rate (eGFR) and glycosylated hemoglobin (HbA1c) together with waist-to-hip ratio (WHR) and body weight (BW) in Indian patients with type 2 diabetes (T2D) treated with once weekly dulaglutide in a real-world setting.
Methodology: Patients with inadequately controlled T2D (N = 41) from a tertiary care center in India were treated with once weekly dulaglutide as an add-on medication to oral antidiabetics (OADs) with or without insulin (mean eGFR [standard deviation [SD]]: 76.11 [20.23] mL/minute in patients with &lt;120 mL/min/1.73 m2; mean HbA1c [SD]: 9.33 [1.18] %; mean WHR [SD]: 0.96 [0.06]; mean BW [SD]: 82.44 [14.55] kg; mean BMI [SD]: 31.19 [4.29] kg/m2). A total of 5 patients presented with glomerular hyperfiltration (eGFR&gt;120 mL/min). Improvements in eGFR, HbA1c, WHR, and BW from baseline to 6-month follow-up were analyzed using paired t test.
Results: Follow-up of 6 months with dulaglutide therapy was associated with a significant increase (P&lt;.001) in eGFR (for patients with baseline eGFR ≤120 mL/min) with a mean increase ± standard error of the mean (SEM) of 10.39 ± 1.58 mL/min. Moreover, patients with glomerular hyperfiltration demonstrated a reduction in eGFR with a mean reduction (MR) ± SEM of 37.20 ± 1.64 mL/minute that was statistically not significant. A significant reduction (P&lt;.001) in HbA1c, 2.45 ± 0.11% was demonstrated. In addition, a significant reduction in WHR, BW, and BMI with MR ± SEM of 0.050 ± 0.004, 6.30 ± 0.39 kg, and 2.90 ± 0.22 kg/m2, respectively was demonstrated. Adverse events (AEs) reported include nausea (n = 9), loose stools (n = 2), and loss of appetite (n = 2) that were managed with probiotics and rabeprazole as required.
Conclusion: In a real-world setting, dulaglutide as add-on therapy was well tolerated and significantly improved renal function and glycemic control along with WHR and BW in Indian patients with T2D.

Disclosure
S.A. Patange: None.
2306-PUB: Long-Term Effect of Liraglutide on the Prevention of Progression of Diabetic Nephropathy in Elderly Patients with Type 2 Diabetes
Authors: YOSHIDA MAMI , YOSHIDA AI , OH ERIKO , YAMAMOTO NAOMUNE , SASAKI EUN , SAEKI AKIO , YOSHIDA SHIGERU , KUZUYA TAKESHI , OHSAWA NAKAAKI , SUGINO MASAKAZU 
Published: June 2019

Purpose: The aim of this study was to assess the long-term efficacy of liraglutide on diabetic nephropathy in elderly patients with type 2 diabetes.
Methods: Liraglutide was administrated to elderly patients with poorly controlled type 2 diabetes in Aino Hospital. We recruited and retrospectively reviewed 31 patients who were treated with liraglutide for 5 years (Group L: 7 males/24 females, 75.4±8.1 years old of age, 16 with cerebrovascular and 8 patients with cardiovascular diseases at baseline) and 25 patients who were not treated with liraglutide (Group N, 9 males/16 females, 74.6±11.6 years old of age). Daily dose of liraglutide was 0.9mg except 2 patients (0.6 mg).
Results: After 5 years of treatment, HbA1c, FPG, and 2h-PPG significantly decreased in both groups (7.5±0.4 to 6.8±0.5 vs. 7.4±0.6 to 6.9±0.4%, 138±19 to 120±11 vs. 132±16 to 113±13, 206±31 to 173±18 vs. 186±23 to 163±18mg/dl, respectively(p&lt;0.01)). Triglycerides significantly decreased in Group L but not in Group N. Body mass index (BMI) significantly decreased in Group L but not in Group N (25.5±4.1 to 24.8±3.8 (p&lt;0.05) vs. 24.1±3.8 to 24.8±3.8kg/m2 (NS)). Estimated glomerular filtration ratio (eGFR) significantly increased in Group L but significantly decreased in Group N (45.6±17.8 to 49.9±18.5 (p&lt;0.05) vs. 48.7±18.9 to 46.3±21.7 ml/min/1.73m2 (p&lt;0.05). When results were stratified according to eGFR at baseline in Group L (Group A(n=6): eGFR &gt;60, Group B (n=18): eGFR = 30-60, Group C (n=7): eGFR&lt;30), eGFR level increased in Group B (43.6±7.6 to 50.8±8.2 (p&lt;0.01)) and in Group A (73.0±10.5 to 76.8±11.1 (NS)), but not in Group C(24.0±3.4 to 23.0±6.3 (NS)). No hypoglycemia requiring medical care was observed. During the treatment period, no newly onset cerebro- and cardiovascular disease were observed.
Conclusion: Liraglutide improved glycemic control, lipid profile and BMI of elderly patients with type 2 diabetes. Liraglutide also demonstrated its beneficial effect on renal function.

Disclosure
M. Yoshida: None. A. Yoshida: None. E. Oh: None. N. Yamamoto: None. E. Sasaki: None. A. Saeki: None. S. Yoshida: None. T. Kuzuya: None. N. Ohsawa: None. M. Sugino: None.
2311-PUB: Effectiveness of Incretin-Based Therapies in Children with Early Stage Slowly Progressive Type 1 Diabetes
Authors: URAKAMI TATSUHIKO , AOKI MASAKO , ABE YURIKO 
Published: June 2019

In the Japanese population, type 1 diabetes (T1D) exhibits heterogeneity in clinical form: the abrupt onset form and slowly progressive form. Patients with the slowly progressive form of T1D can be managed with a low dose of insulin within one year of diagnosis; nevertheless, insulin supplementation is necessary from diagnosis to maintain optimal glycemic control in pediatric cases. On the other hand, incretin-based therapies might be an option even for T1D patients in whom β-cell function is preserved at the early stage of diabetes. We administered incretin-based therapies to 4 children with slowly progressive T1D as initial treatment and investigated their clinical course. Slowly progressive T1D was detected in 4 children (9-15 years) with mild metabolic decomposition via urine glucose screening at schools. All children showed positivity for β-cell autoantibodies. These children showed preserved endogenous insulin secretion with glucagon-stimulated C-peptide levels of 1.54-2.67 ng/mL. As initial treatment, they received incretin-based therapies: 3 children were treated with glucagon-like peptide-1 receptor agonists and 1 was treated with a dipeptidyl peptidase 4 inhibitor. They sustained postprandial C-peptide levels of 2.29-6.60 ng/mL and maintained hemoglobin A1c levels of 5.6%-6.6% for 8-18 months following diagnosis, without insulin treatment. No problematic adverse events, including hypoglycemia, were observed with administration of the incretin-based therapies. These findings suggest that incretin-based therapies could be effective for safe maintenance of optimal glycemic control and preservation of β-cell function at an early diabetic stage in children with slowly progressive T1D. However, it is necessary to confirm the efficacy and safety of incretin-based therapies in a large number of patients.

Disclosure
T. Urakami: None. M. Aoki: None. Y. Abe: None.
2317-PUB: Diabetic Ketoacidosis in Adult Type 1 Diabetes Mellitus Patients on Insulin Pumps
Authors: AMIR MARYAM , ASHI SULEIMAN AL , LANSANG M. CECILIA , AL-JAGHBEER MOHAMMED 
Published: June 2019

Background: Insulin pumps are increasingly being used as a method of insulin delivery in patients with type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) is a serious complication of T1DM. This study aims to identify causes of DKA in T1DM patients on insulin pump, and to compare these with patients with T1DM on multiple daily insulin injections (MDII).
Methods: This was a prospective observational pilot study assessing DKA between 2 groups of patients with T1DM: (1) on insulin pump and (2) on MDII. Demographic and clinical data were obtained from chart review. Patients’ knowledge on insulin and diabetes care was assessed with a questionnaire we devised.
Results: We enrolled 17 adult patients - 12 on insulin pump (7 Medtronic, 3 Tandem, 2 Animas) and 5 on MDII - who were admitted to the ICU for DKA management. Eleven (65%) were females, all were Caucasian, with median age in pump users 27.0 years (IQR 22.5,39.5) vs. MDII 38.0 (IQR 32.0,51.0)(p=0.045). The rest of the demographic data were comparable. Majority of the patients on insulin pump had a pump &gt;5 years and had the current pump &lt;5 years. Six were given pump training in the physician’s office and 6 by the insulin pump company. In patients on insulin pump, 41% of DKA cases were pump- and tubing- related, 41% were due to non-adherence and 18% were due to an infection. In contrast, all the MDII patients had DKA due to non-adherence. Insulin pump patients had significantly higher adherence (p= 0.014) and better knowledge of managing hyperglycemia on sick days (p = 0.029) than MDII patients.
Conclusion: A significant proportion of DKA in pump users was due to pump issues. Non-adherence was common in both pump users and MDII. Continued education on pump use may reduce the rate of DKA in pump users.

Disclosure
M. Amir: None. S. Al Ashi: None. M. Lansang: None. M. Al-Jaghbeer: None.