bluuebunny/crossref_metadata_2025_split huggingface dataset:
1549-P: Factors Associated with Osteoporosis among Hospitalized Patients With and Without Diabetes
Authors: IZUORA KENNETH , ALLENBACK GAYLE , GEWELBER CIVON L. , NEUBAUER MICHAEL F. 
Published: June 2019

Background: Diabetes (DM) is a risk factor for osteoporosis (OP). Patients with DM are known to have a higher prevalence of periodontal disease (PD). The aim of this study was to determine factors associated with OP in a cohort of patients with and without DM and to see if there is any relationship with PD.
Method: We administered a questionnaire, inspected the dentition and conducted chart review of consecutive hospitalized patients to gather demographic information, dental health history, smoking history and history or presence of osteoporosis. Data was analyzed using T-tests, Chi-square tests and logistic regression models.
Result: Out of 301 patients enrolled, 102 had DM. Overall; the prevalence of PD was 91% and OP was 10%. In uni-variate analyses, factors significantly associated with diagnosis of OP included older age (p &lt;0.001), female gender (p=0.046), having more discharge medications (p=0.01) and presence of DM (p=0.049). There was no significant relationship between PD or number of healthy teeth and OP. In logistic regression analyses including the significant factors associated with OP, age remained a significant predictor of having OP overall and in the non-DM population. However, in the DM population, female gender was the only significant predictor for having OP, after adjusting for age.
Conclusion: There was no significant relationship between having PD and OP, in our sample. Overall, age was the only significant predictor of having OP. In the DM group, female gender was a stronger predictor of having OP than age. Earlier screening for OP in female patients with DM may be useful to help identify OP sooner in this group.

Disclosure
K. Izuora: None. G. Allenback: None. C.L. Gewelber: None. M.F. Neubauer: None.
1560-P: A History of CHF Predicts Adverse Outcomes of Hospitalizations for Hyperglycemic Crises—Data from National and Local Cohorts
Authors: AGARWAL MANYOO , JAIN NIDHI , KODE SUDHA , PODILA PRADEEP S. , KHOUZAM RAMI N. , IBEBUOGU UZOMA N. , REED GUY , DAGOGO-JACK SAMUEL 
Published: June 2019

Background: The impact of a history of congestive heart failure (CHF) on the outcomes of DKA and HHS hospitalizations is unknown, and current guidelines provide no clear recommendations for patients with CHF history.
Objective: To test the hypothesis that a history of CHF impacts the outcomes of DKA/HHS hospitalizations.
Design: Retrospective cohort study of DKA/HHS hospitalizations using Nationwide Inpatient Sample (NIS) database 2003 to 2014 (n= 1,793,983) and University Hospital cohort (n= 1,528).
Outcomes: All cause in-hospital mortality, acute respiratory failure events, length of stay and post discharge utilization of nursing home.
Results: In the NIS cohort, a history of CHF was present in 83,173 (4.6%) patients among DKA/HHS hospitalizations and was associated with higher adverse outcomes (mortality: 2.8% in CHF vs. 0.6% in no-CHF, adjusted odds ratio (AOR) = 1.5, 95% confidence interval (CI) 1.4 to 1.6; acute respiratory failure- 9.8% vs. 2.2%, AOR = 2.1, 95% CI 2.0 to 2.2). CHF history also predicted higher utilization of post discharge nursing home services (19.6% vs. 5.2%, AOR = 1.4, 95% CI 1.3 to 1.5) even after extensive adjustment for patient demographics, Elixhauser comorbidities and Charlson comorbidity index. In the University cohort, CHF history was present in 129 (8.4%) patients among 1,528 HGc hospitalizations and was associated with higher in-hospital complications (in-hospital mortality and acute respiratory failure [(13.2% vs. 5.2%, AOR = 2.1, 95% CI 1.2 to 3.7)] and higher utilization of post discharge nursing home (15.2% vs. 2.6%, AOR = 2.5, 95% CI 1.3 to 4.7) when compared with those without CHF. Mean length of stay was higher in patients with CHF history compared with no-CHF history in both datasets.
Conclusions: A history of CHF is an under-recognized risk factor for adverse outcomes of hospitalizations for hyperglycemic crises. Prospective studies are warranted to better understand and mitigate these differences in outcomes.

Disclosure
M. Agarwal: None. N. Jain: None. S. Kode: None. P.S. Podila: None. R.N. Khouzam: None. U.N. Ibebuogu: None. G. Reed: Other Relationship; Self; Translational Sciences. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.
1564-P: Prevalence of Sarcopenia in Community Dwelling Korean Older Adults with Diabetes
Authors: KANG SUNYOUNG , OH TAE JUNG , CHOI SUNGHEE , PARK KYONG SOO , CHUL JANG HAK 
Published: June 2019

Objective: Diabetes has been suggested to be one of the risk factors of physical disability in older adults. The aim of this study is to examine the prevalence of sarcopenia in Korean older adults with diabetes compared to nondiabetic adults.
Methods: We analyzed 1,241 adults aged 70-84 years, who were enrolled in the Korean Frailty and Aging Cohort Study (KFACS). The skeletal muscle mass was assessed by dual-energy X-ray absorptiometry, and muscle strength was assessed by hand grip strength (HGS). Physical performance was assessed by the Short Physical Performance Battery (SPPB), and the Timed Up and Go (TUG) test. Sarcopenia was defined using the criteria of Asian Working Group for Sarcopenia (AWGS) and the Foundation for the National Institutes of Health (FNIH).
Results: The mean age of the subjects was 76.2 ± 9.3 years, and 46.8% were men. Prevalence of diabetes was 31.1% in men and 23.8% in women. Subjects with diabetes had higher levels of fasting glucose, insulin, HbA1c, and HOMA-IR, compared to the nondiabetic group. In men, the prevalence of sarcopenia and muscle mass index was not different between diabetic and nondiabetic groups, but the diabetic subjects had lower HGS and gait speed, and they took longer time on TUG test compared to the nondiabetic group. In women, the prevalence of sarcopenia defined by AWGS was higher in the diabetic group compared to the nondiabetic group. Women with diabetes had lower gait speed and SPPB score, and took longer time on TUG test compared to the nondiabetic group, although HGS and muscle mass index were not different between the two group.
Conclusion: Prevalence of sarcopenia was higher in older women with diabetes compared to nondiabetic group, but those are not different in men. In older adults with diabetes, physical performance and muscle strength were reduced, whereas muscle mass was relatively preserved compared to the nondiabetic group. Thus, in older adults, diabetes might be associated with developing sarcopenia, especially in a form of decreased muscle quality.

Disclosure
S. Kang: None. T. Oh: None. S. Choi: None. K. Park: None. H. Jang: None.
157-LB: Mealtime Insulin “Rescue” with Canagliflozin
Authors: PHILLIPS LAWRENCE S. , MOREHEAD FOLAYAN , SAVOYE LOUISE P. , RHEE MARY K. , OLSON DARIN , BURGESS ELIZABETH H. , CUI XIANGQIN , CALHOUN PETER , BAILEY RYAN 
Published: June 2019

Many type 2 diabetes patients require mealtime insulin to help maintain glycemic control, but this carries a risk of hypoglycemia. Since the glucose-lowering mechanism of SGLT2 inhibitors does not require beta-cell function, we asked if addition of the SGLT2 inhibitor canagliflozin (CANA) could “rescue” patients from the need for mealtime insulin. In a pilot study, after 2 week run-in, 26 pts requiring QID basal-bolus insulin with negative GAD antibodies were randomized, double-blind, to CANA or placebo (PLBO); dosage was 100 mg/d for 2 week, then 300 mg/d for 22 week. At baseline, the groups were similar: mean age 64 year, BMI 31.2, 100% male, 64% black, HbA1c 8.0%, insulin 107 units/day, CGM time in range (TIR, 70-180 mg/dl) 75.5%, hypoglycemia (&lt;54 mg/dl) 0.41%, and hyperglycemia (&gt;180 mg/dl) 22.8% (all p&gt;0.05). Over 24 weeks, insulin was adjusted weekly in all pts to improve control but avoid hypoglycemia. One PLBO pt had a penile infection and d/c’d study drug, but other adverse events were similar, and there was no severe hypoglycemia. Among 13 CANA and 11 PLBO pts who followed the protocol for 24 week, during the last 12 week, despite a 27% reduction in insulin dosage to 78 units/day with CANA vs. a 7% increase to 112 units/day with PLBO (p=ns), 37% of CANA pts were able to d/c mealtime Rx entirely, and 4% to switch to glipizide, for &gt;1 meal/day, vs. 32% and 8% with PLBO, respectively (p=ns); CGM metrics were better with CANA as well, TIR 79% vs. 74%, hypoglycemia 0.58% vs. 0.84%, and hyperglycemia 18.7% vs. 23.9% with CANA vs. PLBO, respectively, all p=ns, and HbA1c was 7.4% with CANA vs. 7.6% with PLBO (p=ns).
Conclusions: Addition of canagliflozin to the regimens of patients using basal-bolus insulin, allows some patients to discontinue mealtime medication entirely, and others to switch from insulin to an oral agent, for at least one meal/day, with concomitant improvement in glycemic control, although differences from placebo were not statistically significant in this pilot study. Intensive management allows many patients to reduce their need for mealtime insulin.

Disclosure
L.S. Phillips: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. Research Support; Self; AbbVie Inc., GlaxoSmithKline plc., Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc. Stock/Shareholder; Self; Diasyst Inc. Other Relationship; Self; Diasyst Inc., Janssen Pharmaceuticals, Inc. F. Morehead: None. L.P. Savoye: None. M.K. Rhee: None. D. Olson: None. E.H. Burgess: None. X. Cui: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. R. Bailey: None.

Funding
U.S. Department of Veterans Affairs; National Institutes of Health
157-OR: Is Metformin Associated with Frailty in Older Veterans with Diabetes?
Authors: GUERRA JULIANA FERRI , MILYANI RANEEM , APARICIO-UGARRIZA RAQUEL , SHAH AAKASHI , POTLURI SRIRAVALI , BHARATULA PRAVALLIKA , VALENCIA WILLY , FLOREZ HERMES , RUIZ JORGE G. 
Published: June 2019

Diabetes mellitus (DM) may promote accelerated aging fostering the development of frailty, a state of vulnerability to stressors resulting in higher morbidity, mortality and healthcare utilization, particularly among Veterans. Metformin may reduce the development of frailty by decreasing inflammation and insulin resistance. The aim of this study was to determine whether metformin is associated with a lower risk of frailty in older Veterans with DM. In a cross-sectional study, we evaluated 775 Veterans, 56.4% white, 77% non-Hispanic, 98.1% male, mean age was 72.73 (SD=6.83) years. Frailty was assessed using a 44-item frailty index (FI), which was constructed using the following variables: socio-demographic, medical and psychological comorbidities, number of medications, laboratory tests, and activities of daily living. Most patients were frail (FI≥0.21, n=393, 50.7%), followed by pre-frail (0.10&gt; FI &lt;0.21, n=359, 46.3%) and a few were robust (FI≤ 0.10, n=23, 3%). We evaluated the association using binomial logistic regression models with frailty status dichotomized as non-frail (robust and prefrail) and frail as the outcome variable and use of metformin as the independent variable. After adjusting for age, race, ethnicity, BMI, use of hypoglycemic drugs (insulin or sulfonylureas), DM complications, levels of glycemic control, and comorbidities, metformin use was associated with a lower risk of frailty (OR=0.520, 95% CI=.383-.707, p&lt;.0005). These results suggest that metformin may reduce the risk of frailty in older adults with DM. Further studies assessing the benefits of metformin to prevent functional decline and promote healthier aging may be warranted.

Disclosure
J. Ferri Guerra: None. R. Milyani: None. R. Aparicio-Ugarriza: None. A. Shah: None. S. Potluri: None. P. Bharatula: None. W. Valencia: None. H. Florez: None. J.G. Ruiz: None.

Funding
Miami VA Healthcare System Geriatric Research Education and Clinical Center
1582-P: Exploring the Heterogeneity of Inner-City African-American Patients with Diabetes and Food Insecurity Using Cluster Analysis
Authors: DAVIS GEORGIA , FLINT KRISTEN L. , PENG LIMIN , UMPIERREZ GUILLERMO E. 
Published: June 2019

Food insecurity (FI) is associated with diverse socioeconomic factors and negatively impacts glycemic control in patients with diabetes (DM). Previous interventions have successfully improved food security status and access to nutritious food, but have not consistently shown improvement in glycemic control. This suggests an underlying heterogeneity in the FI population that may impact glycemic control. We explored characteristics of FI in patients with DM. Unsupervised cluster analysis was performed using survey data from non-Hispanic African American (AA) patients with FI in an urban safety-net DM clinic. Among 117 patients with FI, two distinct groups emerged. Group 1 was younger with worse glycemic control, lower food security status and less economic support, but more supplemental nutritional assistance program (SNAP) income and DM knowledge. Group 2 was older with better glycemic control, more federal economic and insurance support, but less SNAP assistance and lower medication adherence. Our results highlight the heterogeneity of FI-associated characteristics among AA patients with DM. Insurance status, economic and financial support may confer some protective effect for adequate glycemic control in the face of food insecurity.

Disclosure
G. Davis: None. K.L. Flint: None. L. Peng: None. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.
1587-P: Prevalence and Impact of Food Insecurity on Clinical Outcomes in Inner-City African-American Patients with Diabetes
Authors: FLINT KRISTEN L. , DAVIS GEORGIA , PENG LIMIN , CAMPBELL SARAH H. , UMPIERREZ GUILLERMO E. 
Published: June 2019

Food insecurity (FI), or the uncertain or limited availability of nutritious food, disproportionately affects lower income and minority populations. To determine the prevalence and impact of food insecurity in non-Hispanic African American (AA) patients with diabetes (DM) in an urban safety-net diabetes clinic, we conducted a prospective, comprehensive analysis using validated surveys measuring FI severity, education, mental health, and socioeconomic factors. Parameters of glycemic control and DM complications were collected from the electronic medical record. Factors contributing to food insecurity and clinical outcomes were compared by food security status.
Among 243 AA patients surveyed, 53% of patients had FI. More FI patients had low income and gaps in insurance. FI patients also had worse self-reported physical and mental health, more complications of DM, and more hypoglycemia. Despite having more complications and hypoglycemia, there were no significant differences in glycemic control (HbA1c 8.7% ± 2.5 vs. 8.7% ± 2.3, p=0.88) or insulin use (75% vs. 74%, p=0.92) between patients with and without FI.
Our results indicate that FI affects over half of inner-city AA patients with DM and is associated with higher rates of diabetic complications, hypoglycemia and a lower quality of life. FI represents a common and significant challenge in treating low-income AA patients with DM.

Disclosure
K.L. Flint: None. G. Davis: None. L. Peng: None. S.H. Campbell: None. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.
1589-P: Trends in Prediabetes Prevalence and Incidence among Immigrants in Ontario, Canada, 2011-2015: A Population-Based Study
Authors: FAZLI GHAZAL , MOINEDDIN RAHIM , SHAH BAIJU R. , WU CAIXIA FANGYUN , BOOTH GILLIAN 
Published: June 2019

The burden of prediabetes appears to be increasing worldwide. We aimed to examine temporal trends in prediabetes prevalence and incidence among immigrants to Ontario, Canada between 2011 and 2015 using linked administrative health and immigration databases. Comprehensive laboratory data were used to identify individuals without prior diabetes who underwent diabetes screening (N=511,357 in 2011 and 557,081 in 2015). We used logistics multivariate regression and direct age and sex standardization methods with 2011 Canadian census data to calculate prediabetes prevalence and incidence. Using World Health Organization criteria to define prediabetes (fasting plasma glucose (PG) 110-125 mg/dl, 2-hour PG 140-199 mg/dl on a 75 gm OGTT, HbA1c6.0-6.4%), the age- and sex-adjusted prevalence of prediabetes decreased from 15.8% to 12.2% over the 5-year period (p&lt;0.001). These patterns were consistent across all ethnic groups, except immigrants from Sub-Saharan African and the Caribbean, where a rise in prevalence from 14.1 to 15.3% was observed. The largest declines were observed among South Asians and Latin Americans (20.1% to 15.3% and 16.1% to 9.4%, respectively in 2011 vs. 2015, p&lt;0.001). Age- and sex-adjusted prediabetes incidence exhibited similar trends, declining from 11.1 to 9.6 per 100 person-years, with similar patterns by ethnic group as observed for prevalence. These patterns were generally consistent across age groups.
In summary, the prevalence and incidence of prediabetes in Canadian immigrants appears to be declining, which may relate to changes in the underlying risk of diabetes in these populations or in screening and prevention practices.

Disclosure
G. Fazli: None. R. Moineddin: None. B.R. Shah: None. C.F. Wu: None. G. Booth: None.
159-OR: Changes in Dairy Product Consumption and Risk of Type 2 Diabetes among U.S. Men and Women
Authors: DROUIN-CHARTIER JEAN-PHILIPPE , LI YANPING , ARDISSON KORAT ANDRES V. , DING MING , LAMARCHE BENOÎT , MANSON JOANN E. , RIMM ERIC , WILLETT WALTER C. , HU FRANK 
Published: June 2019

Background: The relationship between changes in dairy product consumption and risk of type 2 diabetes (T2D) has not been evaluated.
Objective: We evaluated the association of 4-year changes in dairy product consumption with subsequent 4-year risk of T2D among U.S. men and women.
Methods: We followed-up 35,148 men in the Health Professionals Follow-up Study (1986-2012), 78,357 women in the Nurses’ Health Study (1986-2012), and 82,937 women in the Nurses’ Health Study II (1991-2013). Diet was assessed using validated food frequency questionnaires every 4 years. Cox proportional regression models were used to calculate hazard ratios (HRs) for T2D associated with 4-year changes in dairy product consumption, with adjustment for initial dairy intake and multiple T2D risk factors including BMI and diet quality. Results of the 3 cohorts were pooled using an inverse variance-weighted, fixed-effect meta-analysis.
Results: During 2,849,389 person-years of follow-up, we documented 12,007 incident T2D cases. Changes in milk consumption during a 4-year period were not associated with T2D risk in the following 4 years. Increasing yogurt consumption by &gt;0.5 serving/day was associated with a 13% (95% CI: 6%, 19%) lower risk of T2D compared with maintaining a stable consumption. Increasing cheese consumption by &gt;0.5 serving/day was associated with an 8% (95% CI: 2%, 16%) higher risk of T2D. Substituting reduced-fat milk for whole milk or low-fat cheese for high-fat cheese was not associated with subsequent T2D risk. However, increasing intake of yogurt or reduced-fat milk by 1 serving/day and concomitantly decreasing cheese intake by 1 serving/day was associated with a 16% (95% CI: 10%, 22%) and 11% (95% CI: 7%, 15%) lower risk of T2D, respectively.
Conclusion: Increasing yogurt consumption was associated with a moderately lower risk of T2D, while increasing cheese consumption was associated with a moderately higher risk. Substituting yogurt or reduced-fat milk for cheese was associated with lower risk of T2D.

Disclosure
J. Drouin-Chartier: Other Relationship; Self; Dairy Farmers of Canada. Y. Li: None. A.V. Ardisson Korat: None. M. Ding: None. B. Lamarche: Advisory Panel; Self; Dairy Farmers of Canada. J.E. Manson: None. E. Rimm: Advisory Panel; Self; Take C/O, US Highbush Blueberry Council/USDA. W.C. Willett: None. F. Hu: None.

Funding
National Institutes of Health (UM1CA186107, UM1CA176726, UM1CA167552, DK112940, HL60712, HL118264); Canadian Institutes of Health Research (BPF-156628)
1593-P: Time Trends in Diabetes Incidence and Obesity Prevalence in Six Countries
Authors: HIRD THOMAS R. , CHEN LEI , ISLAM RAKIBUL M. , PAVKOV MEDA E. , GREGG EDWARD , TABESH MARYAM , KOYE DIGSU , BARR ELIZABETH L. , SHAW JONATHAN E. , MAGLIANO DIANNA J. ,   GLOBODIAB WRITING GROUP
Published: June 2019

Data from several countries have shown a stabilization or decrease in diabetes incidence since the mid-2000s. It is intuitively appealing to think that trends in risk factors for diabetes would parallel these changes, although such trends have not been explored. We compared age-standardized (WHO standard population) trends in obesity prevalence, from nationally representative cross-sectional surveys, with trends in diabetes incidence, from national diabetes registries or administrative data sources, in six countries where data was available for both national obesity prevalence and diabetes incidence between 1990-2015. In 5 out of 6 countries, diabetes incidence increased until the mid-2000s followed by a decreasing trend; in Korea incidence decreased across the whole time period for which data were available. An increasing trend in obesity prevalence was observed in all 6 countries with no evidence for a fall in obesity prevalence, although the rate of increase in obesity prevalence slowed in United Kingdom in the early 2000s. Among the datasets in this study, current evidence on trends in obesity prevalence do not appear to explain the recent decrease in diabetes incidence, suggesting an uncoupling of these trends. Further research on trends in other major diabetes risk factors, such as prediabetes, and the influence of diagnostic guidelines and practice may provide additional insights into trends in diabetes incidence.

Disclosure
T.R. Hird: None. L. Chen: None. R.M. Islam: None. M.E. Pavkov: None. E. Gregg: None. M. Tabesh: None. D. Koye: None. E.L. Barr: None. J.E. Shaw: Advisory Panel; Self; Abbott, Merck Sharp & Dohme Corp. Speaker's Bureau; Self; AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis. D.J. Magliano: None.

Funding
Centers for Disease Control and Prevention