bluuebunny/crossref_metadata_2025_split huggingface dataset:
677-P: Bioimpedance Phase Angle in Diabetes and Change after an Interdisciplinary Care and Diabetes Self-Management Education Program
Authors: SILVA-TINOCO RUBÉN , CUATECONTZI-XOCHITIOTZI TERESA , CASTILLO-MARTÍNEZ LILIA , LEÓN-GARCÍA PLACIDO , CABRERA-GERARDO DOLORES , HERNÁNDEZ JORGE , FERREIRA-HERMOSILLO ALDO , ZÁRATE CLAUDIA , DELATORRE-SALDAÑA VIRIDIANA A. 
Published: June 2019

Bioimpedance phase angle (PA) is an index of cellular health and function, and a high PA suggest better cellular membrane integrity and a higher cell mass. PA has been identified as a valuable measurement for the diagnosis, monitoring and prognosis of various disorders. We evaluated baseline differences and change in PA in patients who attended a five months Interdisciplinary Care and Diabetes Self-management Education Program in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa in 2018. In 327 persons with type 2 diabetes, PA was evaluated by bioelectrical impedance multifrequency analysis (Seca® 515/514, 50 Hz). Diabetes-related microvascular complications (MiVC) were defined by fundoscopy with mydriatic camera assessed by an ophthalmologist (retinopathy) and increased urine albumin/creatinine ratio and/or decreased estimated glomerular filtration rate (diabetic kidney disease). Women represented 67% and 56% had elementary or less education. Mean age was 55±10 years old, mean duration of diabetes was 12±8 years, 32.7% presented nephropathy and 24.8% retinopathy. Baseline PA was different among participants with or without MiVC (4.66±0.65 vs. 5.02±0.58, p&lt;0.0001). Change in PA was different among participants with non-MiVC (5.02±0.58 to 5.11±0.62, p=&lt;0.0001) but not among participants with MiVC (4.66±0.65 to 4.62±0.65, p=0.136) after the program. Diet self-care behavior improvement (2.6± 1.6 to 5.4±0.9 days/week, p=&lt;0.001) and HbA1c reduction (9.45±2.0 to 6.7±1.2%, p=&lt;0.001) were also observed with no differences among groups. Baseline PA was different according to the MiVC profile implying its prognosis and diagnosis role. PA improvement in persons with diabetes and absence of MiVC suggest a monitoring role of PA, but also suggest an added effect and the efficacy of this program since it favors the achievement of multiple diabetes care goals, that could be being reflected in PA as a marker of cellular integrity.

Disclosure
R. Silva-Tinoco: Speaker's Bureau; Self; Novo Nordisk Inc. T. Cuatecontzi-Xochitiotzi: None. L. Castillo-Martínez: None. P. León-García: None. D. Cabrera-Gerardo: None. J. Hernández: None. A. Ferreira-Hermosillo: Speaker's Bureau; Self; Sanofi, Takeda Mexico. C. Zárate: None. V.A. DeLaTorre-Saldaña: None.
682-P: Early Detection and Prevention of Dulaglutide-Induced Asymptomatic Nocturnal and Persistent Hypoglycemia in Patients with Advanced Diabetic Kidney Disease
Authors: NISHIHARA HARUMI , INOUE MAYA , UMEZU JUNKO , ARAI KAORI , SUDO TOMIKO , SASAKI JUNKO , KOIZUMI CHIAKI , SAITO MASUMI , SUNAGAWA HIROSHI , HIRAI AIZAN 
Published: June 2019

Purpose: Dulaglutide, a long acting GLP-1 receptor agonist (GLP-1 RA) is reported to reduce decline in eGFR in patients with diabetic kidney disease (DKD). Dulaglutide has been applied to the treatment and prevention of advanced DKD. GLP-1RA is well known to suppress glucagon secretion from the pancreas. In advanced DKD, renal gluconeogenesis is reduced due to the progression of DKD, and thereby the incidence of hypoglycemia is increased in advanced DKD. However, hypoglycemia due to GLP-1RA is rarely reported in advanced DKD. The present study was performed in order to get further insight into the risk management of hypoglycemia in advanced DKD patients treated with GLP-RA using continuous glucose monitoring (CGM).
Methods: Eleven patients with advanced DKD (eGFR&lt;45) were included in the present study. Whole patients were treated with dulaglutide over 1 year and no other hypoglycemic agents were administered. Two weeks CGM was performed using Free Style Libre Pro. In the case of nocturnal hypoglycemia, the effect of oral administration of medium-chain triglyceride (MCT), which directly stimulates hepatic glucose production, was studied.
Results: Two weeks CGM revealed that asymptomatic nocturnal and persistent hypoglycemia lasting 4 to 6 hours occurred in patients with advanced DKD during dulaglutide monotherapy. Late evening oral administration of a small amount (10-15g) of MCT is effective to avoid dulaglutide-induced nocturnal and persistent hypoglycemia.
Discussion: Dulaglutide-induced nocturnal hypoglycemia in advanced DKD may be attributed to reduced hepatic glycogenolysis and renal gluconeogenesis.
Conclusion: The present study firstly demonstrated that dulaglutide produced asymptomatic nocturnal and persistent hypoglycemia in patients with advanced DKD, which can be prevented by the administration of MCT. CGM is essential for early detection and prevention of dulaglutide-induced hypoglycemia.

Disclosure
H. Nishihara: None. M. Inoue: None. J. Umezu: None. K. Arai: None. T. Sudo: None. J. Sasaki: None. C. Koizumi: None. M. Saito: None. H. Sunagawa: None. A. Hirai: None.
692-P: Development and Adoption of CDISC Clinical Data Standards for Type 1 Diabetes (T1D)
Authors: OWEN JOHN M. 
Published: June 2019

Development and adoption of global, non-proprietary and platform-independent CDISC standards a) enables traceability from data collection through data analysis, b) improves data quality, c) reduces costs, d) streamlines processes facilitating data sharing, and e) enables reliable and accurate data reuse.
CDISC collaborates with type 1 diabetes subject matter experts to lead a unique effort that brings academia and industry together to create T1D clinical data standards in the areas of pediatrics, devices, exercise, and prevention. The T1D team is tasked with developing standards for collection, tabulation, and analysis of the data by building on existing foundational diabetes standards. They will use a multiphase, consensus-driven process, that includes scoping key data concepts commonly used in T1D clinical studies.
The Pediatrics and Devices team has identified several data concepts that would benefit from development of data standards: diabetic ketoacidosis, diabetes history, CGM data, insulin management, laboratory tests related to diabetes, and vital signs percentiles for pediatrics. The public review of the standards developed will be launched in Summer 2019.
The Prevention and Exercise team has initiated the scoping process to identify the most urgent areas for standards development, which will be followed by modeling. The public review of these standards will commence beginning of 2020.
As the project progresses, the T1D community is encouraged to participate in the informational webinars and public review stages, which will enable all-inclusive development and adoption of the resultant data standards. Factors involved in the adoption of clinical data standards within organizations will be discussed.

Disclosure
J.M. Owen: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
7-OR: Effect of Dapagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, on Vascular Function in Patients with Type 2 Diabetes Compared with Gliclazide
Authors: LIM SOO , CHERNEY DAVID 
Published: June 2019

Objective: Recent studies showed that sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce the risk of cardiovascular events and mortality in patients with type 2 diabetes (T2D). However, the mechanisms underlying this effect remain unclear. We compared the effects of dapagliflozin, a SGLT2 inhibitor, with those of gliclazide on vascular function in patients with T2D.
Research Design and Methods: This was a prospective, randomized, blinded-endpoint, comparative clinical trial. In 2016−2017, T2D patients treated with ≥750 mg of metformin (HbA1c, 7.5%−10.0%; n = 32) were enrolled and randomized to receive either gliclazide (30 mg/day) with uptitration, or dapagliflozin (10 mg/day) for 24 weeks. The primary endpoint was a change in flow-mediated dilation (FMD) from baseline to the end of the study. The secondary outcomes included changes in pulse wave velocity (PWV), microvascular reactivity, ankle-brachial index (ABI), and carotid intima-medial thickness (IMT). Biochemical parameters related to glucose homeostasis, atherogenic dyslipidemia, oxidative stress, and adverse events, were evaluated.
Results: Glycated hemoglobin and fasting glucose levels decreased significantly in both groups. The FMD, PWV, microvascular reactivity, and ABI improved significantly in the dapagliflozin group, but not in the gliclazide group. Lipoprotein(a), oxidized LDL, and thiobarbituric acid reactive substance levels decreased, whereas LDL particle sizes increased, in the dapagliflozin group exclusively. Hypoglycemia was more common in the gliclazide group.
Conclusions: Dapagliflozin therapy for 24 weeks improved vascular function, alleviated atherogenic dyslipidemia, and decreased oxidative stress in patients with T2D. Glucose independent changes in cardiometabolic risk factors may contribute to the cardiovascular benefits observed in clinical trials with SGLT2 inhibitors.

Disclosure
S. Lim: None. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Prometic Life Sciences Inc., Sanofi.
700-P: Treatment of New-Onset Type 2 Diabetes after Age 65: A Longitudinal Cohort Study
Authors: MISHRA PRANITA , GOPALAN ANJALI , GRANT RICHARD W. 
Published: June 2019

As the U.S. population ages, more older adults will be newly diagnosed with type 2 diabetes (T2D). These individuals have a greater prevalence of comorbidities placing them at increased risk for T2D-related adverse drug events. We identified adults ≥ 65 within an integrated care system with newly diagnosed T2D, defined by a first elevated A1c (≥6.5%) with no evidence of T2D prior 18 months. We examined treatment initiation (metformin, sulfonylurea [SFU], insulin) during the 5 years following diagnosis among patients with 3 treatment-sensitive comorbid conditions (chronic kidney disease [CKD], dementia, frailty) at time of diagnosis. We compared A1c levels between treatment initiators vs. non-initiators and identified independent predictors of treatment initiation using multivariate logistic models. The 4,011 older adults with new T2D had mean age 72.2 ± 6.4 years, 53% were women, 50% were non-Hispanic white. Among those with advanced CKD (≥ stage 3b, 4% of cohort), nearly one-quarter (23%) were initiated on metformin (mean A1C 8.3 ± 2.7 vs. untreated 7.3 ± 1.4 p&lt;0.01). Among people with dementia (1.8%), 27.8% were initiated on SFU (8.7 ± 1.2 vs. not treated 7.2± 1.2, p &lt;0.01) and 8.3% on insulin (8.7 ± 2.8 vs. 7.5±1.5, p &lt;0.34). Among frail elders (self-reported physically inactive [43%] or requiring a walker [5%]), 29.6% were started on SFU (8.6 ± 2.2 vs. not treated 7.2 ±1.4, p &lt;0.01) and 7.5% on insulin (9.5 ± 2.8 vs. untreated 7.5 ± 1.6, p&lt;0.01). Overall, 63% of the cohort was initiated on treatment, including 6.7% on insulin. Independent predictors of insulin initiation included age 65-74 (vs. 75+, aOR 1.42 [95% CI:1.03-1.95], p=0.03), higher A1c (aOR 4.86[3.60-6.56] per 1% increase), and presence of cardiovascular disease (1.52 [1.15-2.02], p&lt;0.01). Among older adults with newly diagnosed T2D, treatment is frequently initiated among individuals with potentially risky co-morbid conditions. Our results suggest the need for more robust evidence-based guidelines tailored for older adults with newly diagnosed T2D.

Disclosure
P. Mishra: None. A. Gopalan: None. R.W. Grant: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
71-LB: Personal Metabolic Responses to Food Predicted Using Multi-omics Machine Learning: The PREDICT I Study
Authors: SPECTOR TIM D. , BERRY SARAH , CHAN ANDREW T. , DAVIES RICHARD J. , DREW DAVID A. , VALDES ANA M. , FRANKS PAUL W. 
Published: June 2019

Background: Postprandial glycemic variations impact diabetes risk and are influenced by food consumed, a focus of major nutritional guidelines. However, a person’s biological characteristics and environment likely influence postprandial response.
Methods: In ∼1000 healthy UK (unrelated + DZ/MZ twins) and 100 unrelated U.S. adults, glycemic responses to a variety of meals were tested in clinic and at home (using CGM). Baseline factors included metabolomics, genomics, gut metagenomics and body composition. Genetic contributions to postprandial responses were determined by classical twin methods.
Results: Within-individual concordance in metabolic responses (2hr glucose iAUC) for pairs of isocaloric meals at home was moderate to high: high fat (fat = 40g/71% energy) (ICC=0.46, 95% CI:0.37,0.55), high protein (protein = 41g/32% energy) (ICC=0.54, 95% CI:0.44,0.62), high carb (carbohydrate = 95g/76% energy) (ICC=0.65, 95% CI:0.59,0.70), average lunch (carbohydrate = 68g/54% energy) (ICC=0.61, 95% CI:0.53,0.67), and OGTT (carbohydrate = 75g) (ICC=0.66, 95% CI:0.61,0.71). Inter-individual variability for the same meals was (IQRs: 20, 29, 45, 68, 76 mmol/L*min, respectively). Using the twin data, the unadjusted genetic contribution of postprandial glycemic responses in the clinic was 53%. An interim machine learning algorithm predicted 46% of the variation in glycemic responses based on meal content, meal context and the participant’s baseline characteristics, excluding genetic and microbiome features.
Conclusions: Variation in metabolic responses to the same meals between healthy people is high, helping explain why ‘one-size-fits-all’ nutritional guidelines often fail. The genetic component to these responses is moderate, which leaves much of the variation potentially modifiable. By collecting information on glucose responses to over 100,000 meals, we now have excellent power to use machine learning to predict which foods optimize responses.

Disclosure
T.D. Spector: None. S. Berry: Consultant; Self; Zoe Ltd. A.T. Chan: Consultant; Self; Bayer AG, Janssen Pharmaceuticals, Inc., Pfizer Inc. R.J. Davies: Employee; Self; Zoe Global Limited. D.A. Drew: Consultant; Spouse/Partner; PathAI. A.M. Valdes: Consultant; Self; Zoe Ltd Global. Research Support; Self; Pfizer Inc. P.W. Franks: Board Member; Self; Zoe Ltd. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Novo Nordisk Foundation, Sanofi, Servier.

Funding
UK National Institute for Health Research; UK Wellcome Trust; Zoe Global Limited
712-P: Lessons from a Pragmatic Trial to Implement a Patient Self-Management Support Program in Primary Care
Authors: FERNALD DOUGLAS , HESSLER DANIELLE M. , BOWYER VICKY , JORTBERG BONNIE , WEARNER ROBYN , FISHER LAWRENCE , DICKINSON PERRY 
Published: June 2019

Advanced primary care models emphasize patient-centered care, including self-management support (SMS). Connection to Health (CTH) is a comprehensive, evidence-based SMS program that enhances interactions between primary care clinicians and patients. Uptake and maintenance of programs such as CTH in primary care have been limited by the inability of practices to adapt and implement program components into their culture, patient flow, and work processes. Thirty-six primary care practices participated in a three-arm, cluster-randomized trial to determine the incremental benefit of brief, targeted practice facilitation on the implementation of CTH. Practices receiving the CTH program, compared to those receiving only standard SMS education, showed significantly greater improvement in SMS activities (e.g., goal setting, action planning, patient follow-up, behavioral health discussions), as assessed by chart audit (p&lt;0.022). Yet, there was variable practice-level use of the CTH tools during the 9-month intervention. Practices receiving practice facilitation used CTH more with patients with higher hemoglobin A1c levels and more comorbidity. Qualitative analysis of interviews and field notes point to barriers impeding uptake and maintenance of SMS: lack of visible champions, lack of shared vision, low interest in CTH/SMS, emergent higher priorities, clinician/staff turnover, and perceived redundancy of CTH. Facilitating factors included alignment with system priorities, role and time dedicated to SMS delivery, functional practice teams, and adapting CTH to fit with existing workflows. The overall effect of introducing the SMS program and facilitation support suggests primary care practices can improve their delivery of SMS to patients with T2DM with a brief targeted intervention. However, broadly implementing and sustaining SMS programs in primary care will require attention to overcoming barriers and building on individual practice’s facilitating factors.

Disclosure
D. Fernald: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. V. Bowyer: None. B. Jortberg: None. R. Wearner: None. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. P. Dickinson: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1R18DK096387-01)
714-P: How Often Do Patients on Insulin Therapy Measure Postprandial Glycemia and Modify Insulin Doses Accordingly? From an Online Survey in Spain
Authors: TEJERA CRISTINA , LECUMBERRI EDURNE , MUÑOZ-GARACH ARACELI , AMPUDIA BLASCO FRANCISCO JAVIER , AMPUDIA BLASCO FRANCISCO JAVIER 
Published: June 2019

Introduction: Controlling postprandial glycemia (PPG) is critical to achieve glycemic targets and has been associated with poor cardiovascular outcomes. However, few patients measure PPG and even less make changes on treatment based on these data.
Objectives: To evaluate how often patients on insulin therapy analyze PPG and modify insulin doses based on these data. As secondary objectives, we evaluate how patients discussed PPG during the visits and the predictive factors for PPG measurement.
Material and Methods: This was an anonymous on-line cross-sectional observational study of an unselected sample of diabetes patients on insulin. Data were extracted from a questionnaire available in two internet sources: Canal Diabetes and the Spanish Diabetes Foundation. The study was approved by the Ethics Committee of the Fundación Jiménez Díaz Hospital in Madrid.
Results: Data presented as means ± (SD) or frequencies (%).
Among the predictive factors for PPG measurement and based treatment changes were diabetes type, follow-up setting (Specialized vs. Primary Care), insulin injection number and CGM use.
Conclusions: In this unselected on-line sample of insulin-treated adults, 50.7% measured their PPG, despite this was recommended by HCP and most (95%) considered PPG measurement as relevant. Therefore, improvement in diabetes education on PPG and its treatment is key to improve overall glycemic control.

Disclosure
C. Tejera: None. E. Lecumberri: None. A. Muñoz-Garach: Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis. F. Ampudia Blasco: None. F. Ampudia Blasco: None.
730-P: Inverse Association between Physical Activity and Blood Glucose Is Independent of Sex, Menopause, and Family History of Diabetes
Authors: HU XIANG , GU XUEJIANG 
Published: June 2019

Objectives: Exercise training is critical to the prevention, treatment and management of diabetes and prediabetes. The present study was to investigate the association between physical activity and blood glucose, as well as the influence of sex, menopause status, and family history of diabetes.
Methods: Subjects with normal weight (body mass index ≥ 18.5 and &lt; 25) were selected from REACTION study, and divided into inactive (moderate-to-vigorous-intensity physical activity [MVPA] &lt; 30 min/week), low-degree (MVPA ≥ 30 and ≤ 420 min/week), and high-degree (MVPA &gt; 420 min/week) active groups.
Results: A total of 2601 individuals with an average age of 57.85 ± 8.39 years were enrolled. Multivariate ANOVA uncovered that after adjustment for sex and menopause status and first-degree family history of diabetes respectively, fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), and glycated hemoglobin A1c (HbA1c) decreased through inactive, low-degree and high-degree active groups (all P for trend &lt; 0.05). The association of blood glucose indexes with physical activity was independent of this association with sex and menopause status and family history of diabetes, respectively. Multivariate linear regression analyses showed that MVPA was an independent factor associated negatively with FPG (standardized β = -0.057, P = 0.003), 2hPG (standardized β = -0.094, P &lt; 0.001), and HbA1c (standardized β = -0.071, P &lt; 0.001), respectively.
Conclusions: Higher degree of physical activity was associated with lower blood glucose regardless of sex, menopause status, and family history of diabetes. MVPA is a negative factor associated with blood glucose independently. Physical activity with adequate time and intensity is strongly recommended to individuals with susceptibility to diabetes but without overweight/obesity.

Disclosure
X. Hu: None. X. Gu: None.

Funding
National Key Research and Development Program of China (2016YFC1305202); Wenzhou Science & Technology Bureau (Y20170047)
744-P: Associated Factors with Limb Muscle Volume Distribution in Type 2 Diabetes
Authors: MOTOYAMA KOKA , TAZOE SATOSHI , TAMAI ANNA , SAKURA TAKESHI , OHARA MASAYA , YAKUSHIJI YOSUKE , FUKUMOTO MARIKO , HOSOI MASAYUKI 
Published: June 2019

Background: Type 2 diabetes (T2DM) and sarcopenia have a reciprocal association and could cause a vicious cycle. Resistance training has been proposed to prevent the cycle. It has been postulated that the associated factors with upper limb muscle volume (MV) and lower limb MV were different in T2DM. For efficient resistance training programs, it is needed to understand the factors affect to the imbalance between upper and lower limb MV in T2DM. Aim: We aimed to clarify the clinical associated factors for lower-to-upper limb MV ratio in T2DM.
Method: We assessed in 505 patients with T2DM visited at Osaka City Hospital (male: n=303, mean ages 63.5±13.1, female: n=202, mean ages 64.3±13.4). MV in upper and lower limb were measured by a bioelectrical impedance analysis. The association between lower-to-upper limb MV ratio and clinical parameters were investigated.
Results: Mean body mass index (BMI) were 26.2±5.0kg/m2 in male and 26.8±5.5kg/m2 in female. Mean lower-to-upper limb MV ratio were significantly lower in male than female (male: 2.9±0.3 vs. female: 3.2±0.5, p&lt;0.001). Mean lower-to-upper limb MV ratio in male was correlated with age, BMI, visceral fat area (VFA), estimated GFR (eGFR), hemoglobin (Hb), C reactive protein (CRP). In female, that was correlated with age, BMI, VFA, Hb, CRP and HbA1c. Multiple regression analysis showed that BMI and Hb were the negative independent factors, and VFA and systolic blood pressure were the positive independent factors for lower-to-upper limb MV ratio in male T2DM (R2=0.262, p&lt;0.001). In female T2DM, BMI was the negative independent factor for lower-to-upper limb MV ratio. Notably, VFA exhibit positive correlation to lower-to-upper limb MV ratio in male obese T2DM (r=-0.252, p=0.001), but VFA negatively correlated in male non-obese T2DM (r=0.244, p=0.006).
Conclusions: Gender, blood pressure, Hb and especially visceral obesity, were the important relevant factors for imbalance between upper and lower limb muscle volume in type 2 diabetes.

Disclosure
K. Motoyama: None. S. Tazoe: None. A. Tamai: None. T. Sakura: None. M. Ohara: None. Y. Yakushiji: None. M. Fukumoto: None. M. Hosoi: Speaker's Bureau; Self; Eli Lilly and Company.