bluuebunny/crossref_metadata_2025_split huggingface dataset:
BMI Z-Score Trajectories in Youth with T1D—An International Comparison
Authors: WU MENGDI , PHELAN HELEN , SCHWANDT ANKE , FOSTER NICOLE C. , COUPER JENNY , STEIGLEDER-SCHWEIGER CLAUDIA , WILLI STEVEN M. , JONES TIM , KROSCHWALD PETER , MAAHS DAVID M. , PRINZ NICOLE , CRAIG MARIA E. 
Published: June 2018

Obesity in youth with type 1 diabetes (T1D) has emerged as a challenge in care. Data from the Australasian Diabetes Data Network (ADDN), Diabetes Prospective Follow-up (DPV) in Austria and Germany, and T1D Exchange (T1DX) registry in the U.S. were compared to assess international differences in BMI z-score trajectories in youth with T1D. Longitudinal data from 11,513 participants between ages 8-17 years with T1D duration ≥1 year. and ≥5 aggregated body mass index (BMI) values (ADDN: N=1073, 46% female, mean HbA1c 8.3%; DPV: N=8722, 46% female, mean HbA1c 7.8%; T1DX: N=1718, 45% female, mean HbA1c 8.6%) were analyzed. Participants diagnosed with celiac and/or thyroid disease were excluded. Latent class growth modeling by Nagin was used to identify subgroups following similar BMI z-score trajectories. Five distinct trajectories were identified in ADDN and T1DX participants, and six in DPV (Figure). In all registries most participants in ADDN and T1DX maintained weight status over time. However, obese (BMI z-score ≥2) participants from ADDN achieved weight loss over time, compared to obese participants in T1DX, whose BMI SD increased during the teen years. In DPV, there were trajectories indicating dramatic weight gain/loss during puberty. Further analysis by sex and minority status will help to understand the within-registry and between-registry variation and may help target clinical interventions to achieve healthy weight in youth with T1D.

Disclosure
M. Wu: None. H. Phelan: None. A. Schwandt: None. N.C. Foster: None. J. Couper: None. C. Steigleder-Schweiger: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim GmbH. Other Relationship; Self; Caladrius Biosciences, Inc.. Consultant; Self; GlaxoSmithKline plc., JAEB Center For Health Research. T. Jones: None. P. Kroschwald: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. N. Prinz: None. M.E. Craig: None.
Impact of Laparoscopic Sleeve Gastrectomy on Thyroid Function Profiles in Chinese Euthyroid Obese Patients
Authors: LI LIANG , WANG XINGCHUN , GAO JINGYANG , QU SHEN 
Published: June 2018

There exists close relationship between thyroid function and obesity. Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery in weight loss and obesity-associated comorbidities. However, only a few studies involve in the alteration of thyroid hormones after LSG with inconsistent results. This study aimed to investigate the impact of LSG on thyroid function profiles in Chinese euthyroid obese subjects. A retrospective study was performed of prospectively collected data in 36 obese patients (17 males and 19 females) who underwent LSG. Thyroid function profiles (TT4, FT4, TT3, FT3 and TSH, all within normal reference ranges), anthropometric data, and glucose-lipid metabolic parameters were recorded at baseline, 3 and 6 months after LSG (abbreviated as 3M/6M Post-LSG). Correlations between TSH with other parameters were evaluated. In all individuals, BMI was dramatically decreased at 3M/6M Post-LSG accompanied by decreased fasting blood glucose, fasting insulin, fasting C-peptide, triglyceride and increased HDL-c (P&lt;0.01 or P&lt;0.05). FT3, FT4 and TT3 without TT4 levels were gradually declined from baseline to 6M Post-LSG (P&lt;0.01 or P&lt;0.05, with slight changes in numerical values and still within their normal reference ranges). TSH levels remained unchanged at 3M/6M Post-LSG compared with baseline. In females, the TSH decrease (δTSH) was positively correlated with BMI decrease (δBMI, P&lt;0.05), percentage of total weight loss (%TWL, P&lt;0.01), and percentage of excess weight loss (%EWL, P=0.051, approximately significant) at 6M Post-LSG, while no correlation was observed in males.
In summary, we speculate that euthyroid obese subjects are adept at preserving their thyroid function homeostasis despite of morbid obesity at baseline as well as dramatic weight loss and significant improvement of glucose-lipid metabolism after LSG. In addition, δBMI/%TWL/%EWL may be the predictor of improved TSH levels after LSG in female but not male obese patients.

Disclosure
L. Li: None. X. Wang: None. J. Gao: None. S. Qu: None.
Attitudes Regarding Technology and Weight Loss in Patients with Diabetes and Prediabetes in a Military Health System
Authors: BEAUVAIS ALEXIS , WARDIAN JANA L. , SAUERWEIN TOM J. 
Published: June 2018

Background: Military dependents and veterans have obesity, prediabetes and diabetes rates similar to the general U.S. population. This project examined the attitudes of patients with prediabetes and diabetes regarding weight loss and the use of technology in weight management.
Method: A survey was distributed to three primary care clinics and a diabetes specialty care clinic in the San Antonio Military Health System (SAMHS) over a two week period in February 2017. Demographics included age, sex, and presence of medical diagnoses including prediabetes and diabetes. Access to and attitudes regarding multiple types of personal technology were assessed. Data analysis was completed using SPSS version 22.
Results: There were 424 surveys collected. Prediabetes was self-reported by 25 (6.6%) respondents and 151 (39.6%) respondents self-reported a diabetes diagnosis. Interest in weight loss was high for patients with prediabetes (100%) and diabetes (73.5%); of those with diabetes that also self-identified as obese, 50 (96%) were interested in losing weight. Patients with prediabetes and diabetes were interested in using fitness trackers (65.5%), online videos (57.1%), receiving text messages (53.9%), fitness apps (53.3%), and the existing patient online portal (52.1%). Access to technology was high; many patients owned a personal computer or tablet (76.6%), used text messaging (75%), or owned a smart phone (64.5%). A majority (59.7%) believed technology was helpful for weight loss, but relatively few had used technology in past weight loss efforts (32.4%).
Conclusions: This survey showed that SAMHS patients with prediabetes and diabetes have significant interest in weight loss, access to personal technology devices, and interest in using technology to assist with weight loss. These results will be used to augment existing weight management and health interventions for people with prediabetes and diabetes.

Disclosure
A. Beauvais: None. J.L. Wardian: None. T.J. Sauerwein: Speaker's Bureau; Self; Merck & Co., Inc., AstraZeneca.
A Smartphone App–Based Lifestyle Intervention Promotes Weight Loss—Results of a Prospective, Randomized, Controlled Clinical Trial (RCT)
Authors: VAZ CHERIE LISA , SUTHAR AKASHKUMAR G. , POUSTI BOBAK T. , AYE SU M. , WILLIAMS KEVIN JON , ZHAO HUAQING 
Published: June 2018

Despite widespread use of smartphones and wearables, we have limited evidence that they aid weight loss or lifestyle. Here, we report results of a 6-month RCT of our smartphone app-based lifestyle intervention vs. standard of care (in-person weight management visits at 0, 3, and 6 months) in a cohort of overweight or obese subjects.
The app downloads objective data of daily weights from smartscales and physical activity from 3-axis accelerometers. The technology allows peer social networking and remote professional coaching employing behavior modification techniques delivered via group and private messaging, emoticons, shared activity and weight data, shared photographs of meals, and a virtual reward system for behavior modification. Intervention group: n=13, 85% F, age 39.5 ± 3.71 y, initial weight 94.3 ± 3.42 kg, BMI 34.5 ± 1.3 kg/m2. Control group: n=15, 86% F, age 45.1 ± 3.31 y, initial weight 92.3 ± 4.37 kg, BMI 33.8 ± 1.kg/m2 (means ± SE).
We found a clinically and statistically significant weight difference of -4.2 ± 2.0 kg (95% CI -8.3 to -0.02 p=0.0488) after 6 months of our smartphone app-based lifestyle intervention (prespecified primary outcome, intervention vs. control). In the intervention group, weight change was -7.2 ± 1.8 kg (95% CI -11.1 to -3.3, p = 0.0017); % weight change was -7.9% ± 2.2% (95% CI -12.6 to -3.2, p=0.0031). Weight change significantly associated with median step counts (Pearson’s correlation coefficient r=-0.61, p=0.027), numbers of text messages from each subject (r=-0.83, p=0.0005), and numbers of diet photos shared (r =-0.83 p=0.0005).
Our app-based lifestyle intervention met the prespecified primary outcome of clinically meaningful and statistically significant weight loss at 6 months over control. The strongest correlations with weight loss in the intervention group were physical activity (step counts) and subjects’ engagement in behavior modification coaching (messages and diet photos).

Disclosure
C. Vaz: None. A.G. Suthar: None. B.T. Pousti: None. S.M. Aye: None. K. Williams: Stock/Shareholder; Self; Hygieia, Gemphire, Inc.. Advisory Panel; Self; Gemphire, Inc.. H. Zhao: None.
Human Brown Adipose Tissue Density Assessed by Near-Infrared Time-Resolved Spectroscopy Inversely Correlates with the Body Mass Index in Patients with Type 2 Diabetes
Authors: WAKI HIRONORI , WATANABE NAOKO , FUSE SAYURI , KUROSAWA YUKO , YAMAUCHI TOSHIMASA , KIME RYOTARO , HAMAOKA TAKAFUMI , KADOWAKI TAKASHI 
Published: June 2018

Background: Near-infrared time-resolved spectroscopy is a non-invasive method that facilitates analysis of human brown adipose tissue (BAT) density. We measured BAT density in middle-aged patients who had type 2 diabetes by this method and examined the relationship using clinical parameters.
Methods: We studied 33 Japanese middle-aged diabetic patients (30 male and 3 female, age 53.8±10.1 years, BMI 25.4±4.5, and HbA1c 7.2±1.1%). Tissue hemoglobin concentration (tHb) of the supraclavicular region was measured using near-infrared time-resolved spectroscopy, and normalized by subcutaneous fat thickness at the measurement sites.
Results: The average tHb concentration was 51.1±17.7 μM and lower than 77.8 μM—the value equivalent to the detection threshold of BAT by standard FDG-PET in young adults. Univariate regression analysis showed that the tHb of the supraclavicular region was inversely correlated with BMI (r = −0.55, p=0.0009), but the tHb of the deltoid region was not (r = 0.04, p = 0.31). Other parameters showing significant correlations with BAT mass included systolic blood pressure (r = −0.47, p = 0.01) and insulin treatment (r=0.45, p=0.01). Multivariate regression analysis suggested that BMI (β=−0.42, p=0.005), systolic blood pressure (β=−0.29, p=0.042), and insulin treatment (β=0.34, p=0.015) independently account for BAT density.
Conclusion: Our findings suggest that BAT density in middle-aged diabetic patients may relate to obesity more closely than previously thought.

Disclosure
H. Waki: Research Support; Self; MSD K.K., Novartis Pharma K.K., Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi K.K., Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Takeda PHarmaceutical Co., Ltd.. N. Watanabe: None. S. Fuse: None. Y. Kurosawa: None. T. Yamauchi: Research Support; Self; Novo Nordisk Inc., Daiichi Sankyo Company, Limited, Sanofi, Takeda, Tanabe-Mitsubishi. R. Kime: None. T. Hamaoka: None. T. Kadowaki: Consultant; Self; Novo Nordisk A/S, AstraZeneca, Merck Sharp & Dohme Corp.. Research Support; Self; Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sanofi, Kyowa Hakko Kirin Co., Ltd., Novo Nordisk A/S, Astellas Pharma, Daiichi Sankyo Company, Limited, Takeda, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd.. Speaker's Bureau; Self; Astellas Pharma, AstraZeneca, Merck Sharp & Dohme Corp., Ono Pharmaceutical Co., Ltd., Takeda, Eli Lilly and Company, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk A/S.
The Association between Body Mass Index and All-Cause Mortality in Type 2 Diabetic Inpatients With and Without Diabetic Microangiopathy—A Retrospective Cohort
Authors: HSUAN LI Y. , LEE I-TE 
Published: June 2018

Background: The U-shaped association between body mass index (BMI) and mortality has been extensively reported in patients with type 2 diabetes. It has been shown that overweight patients had a lower mortality risk compared to normal-weight individuals, referred as “obesity paradox.” However, limited data reported the relation between on admission BMI and all-cause mortality in diabetic inpatients, and if obesity paradox exist in diabetic inpatients with microangiopathy.
Research Design and Methods: A total of 2885 patients had admitted due to a primary diagnosis of type 2 diabetic with poor glucose control were enrolled. BMI was measured when admission. Cox proportional hazards model hazard ratios for all-cause mortality were calculated after adjusting for confounders.
Results: During a mean follow-up period of 6.6 years, 1483 deaths occurred. A U-shaped association was observed between admission BMI and all-cause mortality, with BMI between 24 and 27 kg/m2 showing the lowest mortality risk across all BMI category. (BMI category including &lt;18, 18-21.9, 22-23.9, 24-26.9, 27-29.9, ≥30 kg/m2, HR of 1, 0.68 [95% CI: 0.55 to 0.84], 0.54[95% CI: 0.43 to 0.67], 0.50[95% CI: 0.41 to 0.62], 0.52[95% CI: 0.41 to 0.65], 0.52[95% CI: 0.40 to 0.67, respectively]. However, among inpatients with macroalbuminuria, the protective effect of overweight was attenuated (P=0.52) and U-shaped association was not observed. The result was similar in patients with diabetes retinopathy (P=0.053).
Conclusions: A U-shaped association existed between admission BMI and all-cause mortality in diabetic inpatients. However, the obesity paradox was not observed in type 2 diabetic inpatients with existing diabetic microangiopathy.

Disclosure
L.Y. Hsuan: None. I. Lee: None.
U.K. First National Health Service (NHS) Endobarrier (EB) Service—Outcomes in First 38 Patients to Reach Six Months after Device Explant
Authors: RYDER ROBERT E.J. , YADAGIRI MAHENDER , IRWIN SUSAN P. , BURBRIDGE WYN , WYRES MELANIE C. , GANDHI HARDEEP , CULL MELISSA L. , ALLDEN RACHAEL , BLEASDALE JOHN , FOGDEN EDWARD , ANDERSON MARK , GUPTA PIYA SEN 
Published: June 2018

EB, a 60cm endoscopically implanted proximal intestinal liner, reduces weight and HbA1c over 1 year. In the 1st NHS EB service, we provided EB for patients with sub optimally controlled diabesity and monitored outcomes in a registry. The 1st 38 patients have completed 6 months post EB removal and of these 31/38 (82%) (age 51.4 ± 6.8 years, 51.6% male, diabetes duration 12 (6-21) years) attended follow-up. During EB implant, mean ± SD HbA1c fell by 2.5 ± 2.0%, from 10.0 ± 2.0 to 7.5 ± 1.2% (p&lt;0.001), weight by 15.8 ± 9.0 kg from 120.6 ± 27.6 to 104.9 ± 28.9 kg (&lt;0.001), systolic BP from 138.3 ± 15.6 to 123.0 ± 14.6 mmHg (&lt;0.001), serum alanine-aminotransferase (ALT-marker of liver fat) from 29.7 ± 17.6 to 19.6 ± 11.5 U/L (p&lt;0.001). Median (IQR) total daily insulin dose reduced from 102 (48-129) to 25 (0-59) units (p&lt;0.001), n=20. 6 months post EB explant 21/31 (68%) had maintained the improvement and this was reflected in the figures for the group as a whole (Table). 7/20 (35%) insulin treated patients discontinued insulin. Of the 10 whose weight and/or HbA1c deteriorated, 7/10(75%) had depression. 4/38 (10.5%) patients had early Endobarrier-removal: 3 GI bleed, 1 liver abscess (Table). All 4 had full recovery after removal. All other patients achieved a full year of EB treatment. Our data demonstrates EB as highly effective in patients with refractory diabesity, with maintenance of improvement after removal in 68%.

Disclosure
R.E.J. Ryder: Other Relationship; Self; AstraZeneca. Speaker's Bureau; Self; Bioquest, Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Novo Nordisk A/S. M. Yadagiri: None. S.P. Irwin: None. W. Burbridge: Other Relationship; Self; Menarini Group. M.C. Wyres: None. H. Gandhi: None. M.L. Cull: None. R. Allden: None. J. Bleasdale: None. E. Fogden: None. M. Anderson: None. P. Sen Gupta: None.
The A Body Shape Index and Type 2 Diabetes Are Mutually Independent Predictors of Cardiovascular Events in Patients with Peripheral Artery Disease
Authors: VONBANK ALEXANDER , SAELY CHRISTOPH H. , HEINZLE CHRISTINE , ZANOLIN DANIELA , LARCHER BARBARA , MADER ARTHUR , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ 
Published: June 2018

The A Body Shape index (ABSI) is calculated based on waist circumference, height and BMI and is a validated measure of visceral adiposity. In the general population, the ABSI has been shown to be an independent risk factor for premature mortality. Its power to predict cardiovascular events in patients with peripheral artery disease (PAD) is not known and is addressed in the present study. We prospectively recorded cardiovascular events in 319 patients with sonographically verified PAD over a mean follow-up time of 7.2±2.1 years. At baseline, the ABSI was significantly higher in patients with type 2 diabetes (T2DM) than in those who did not have diabetes (19.5±1.9 vs. 14.0±1.1; p&lt;0.001). Prospectively, the ABSI significantly predicted the incidence of cardiovascular events (n=57) both univariately (standardized HR 1.36 [1.20-1.52]; p&lt;0.001) and after adjustment for age, gender, smoking, LDL cholesterol, HDL cholesterol, hypertension and T2DM (standardized adjusted HR 1.17 [1.08-1.29]; p=0.010); also T2DM significantly predicted cardiovascular events in this fully adjusted model (adjusted HR 1.48 [1.25-1.74]; p&lt;0.001). We conclude that the ABSI and T2DM are mutually independent of cardiovascular events in patients with PAD.

Disclosure
A. Vonbank: None. C.H. Saely: None. C. Heinzle: None. D. Zanolin: None. B. Larcher: None. A. Mader: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.
Metabolic Surgery Counseling, Diabetes Remission, and A1C Control in Patients with Diabetes and Obesity
Authors: CHANG LEE-SHING , MALMASI SHERVIN , HOSOMURA NAOSHI , ZHANG HUABING , BROWN CHRISTOPHER J. , LEI VICTOR J. , RUBIN ALEXA , TING CLARA , TONG KIMHOUY , TURCHIN ALEXANDER 
Published: June 2018

Metabolic surgery (MS) can lower A1c and achieve DM remission. Counseling by a healthcare provider is an important initial step in considering MS. We hypothesized that MS counseling results in a significant increase in DM remission and A1c improvement. We retrospectively studied 3,676 adults aged 18-65 with T2DM, BMI ≥35 kg/m2, and A1c ≥6.5% followed at two academic medical centers between 2000-2015, using a software tool to identify MS counseling in EMR notes. Counseling and outcomes were assessed over one and three years after study entry, respectively. Study patients’ mean age was 50.8 years and mean baseline A1c was 8.2%. Over one year after study entry, 20.2% of patients had MS counseling. In univariate analyses, patients who received MS counseling had a higher rate of DM remission (A1c&lt;6.5% and no DM medications besides metformin) and were more likely to have achieved A1c control (&lt;7.0%) vs. those who did not (Figure). In multivariable analyses adjusted for patient demographics and comorbidities, MS counseling was associated with an OR of 1.43 (95% CI 1.11-1.84; p=.0051) for achieving DM remission and an OR of 1.44 (95% CI 1.15-1.81; p=.0015) for achieving A1c control. In this large study of patients with T2DM and obesity, MS counseling was associated with significantly greater rates of DM remission and A1c control. These findings suggest MS counseling is an important step in the treatment of DM and obesity.

Disclosure
L. Chang: None. S. Malmasi: None. N. Hosomura: None. H. Zhang: None. C.J. Brown: None. V.J. Lei: None. A. Rubin: None. C. Ting: None. K. Tong: None. A. Turchin: Research Support; Self; Sanofi-Aventis. Advisory Panel; Self; Merck Sharp & Dohme Corp., Monarch Medical Technologies. Stock/Shareholder; Self; Brio Systems. Research Support; Self; Eli Lilly and Company.
Detection of Pancreatic Beta-Cell DNA in the Circulation Using the Dual Amplification Refractory Mutation System PCR
Authors: KURODA AKIO , YAMADA MISUZU Y. , TOMINAGA YUKARI , SUZUKI REIKO , TAMAKI MOTOYUKI , AKEHI YUKO , TAKASHI YUICHI , KOGA DAISUKE , SHIMOKITA EISUKE , TANIHARA FUMINORI , KURAHASHI KIYOE , YOSHIDA SUMIKO , ENDO ITSURO , AIHARA KEN-ICHI , ABE MASAHIRO , FERRERI KEVIN , MATSUHISA MUNEHIDE 
Published: June 2018

Background: CpG cytosine in the human insulin gene (INS) is uniquely unmethylated in pancreatic β-cells. It has been reported that a few unmethylated CpG specific PCR in circulating cell-free DNA could detect injury of pancreatic β-cells. However, the same CpG methylation pattern with these CpG sites are also existing in non-β-cells, thus the false positive results might be involved in these reports.
Aim: To develop a precise method for detecting pancreatic β-cell DNA in the circulation.
Methods: We have developed the dual Amplification Refractory Mutation System (ARMS) PCR, which amplifies only if 4 CpG sites were all unmethylated. The first ARMS PCR amplifies if 2 CpG sites (+331, 404bp of transcription start sites (TSS) of INS) are unmethylated simultaneously, and followed by the second ARMS PCR, which amplifies if 2 CpG sites (+367, 374bp of TSS of INS) are unmethylated simultaneously. This method was applied to 52 patients with type 1 diabetes (T1D) (duration 12.6 +/- 10.1 years). We confirmed the positive samples using DNA sequence analysis.
Results: Pancreatic β-cell DNA were detected in 3 T1D (11.8, 2.5, 912.7 copies in 0.1mL of serum) who are diagnosed as slowly progressive T1D, and 4 among 16 healthy control subjects (1.2, 2.2, 1.9, 3.7 copies in 0.1mL of serum).
Conclusion: We have developed the dual ARMS PCR which is a precise method to detect circulating pancreatic β-cell DNA. Almost no β-cell DNA was circulating in the long standing T1D, however, β-cell DNA was detectable in slowly progressive T1D. Also, there were not so many, but a few β-cell DNA in the circulation of healthy control subjects. Therefore, this method is useful to evaluate pathogenesis of type 1 diabetes.

Disclosure
A. Kuroda: None. M.Y. Yamada: None. Y. Tominaga: None. R. Suzuki: None. M. Tamaki: None. Y. Akehi: None. Y. Takashi: None. D. Koga: Employee; Self; Otsuka Pharmaceutical Co.,Ltd.. E. Shimokita: None. F. Tanihara: None. K. Kurahashi: None. S. Yoshida: None. I. Endo: None. K. Aihara: None. M. Abe: None. K. Ferreri: None. M. Matsuhisa: None.