bluuebunny/crossref_metadata_2025_split huggingface dataset:
1202-P: Glucose Lowering with an SGLT2I Improves Trabecular Bone but Does Not Correct Bone Brittleness in TallyHo Model of T2D
Authors: THRAILKILL KATHRYN M. , BUNN R. CLAY , UPPUGANTI SASIDHAR , RAY PHILIP D. , POPESCU IULIANA , KALAITZOGLOU EVANGELIA , FOWLKES JOHN , NYMAN JEFFRY S. 
Published: June 2019

Higher fracture risk in T2D is attributed to disease specific deficits in micro-structural and material properties of bone. The TallyHO (TH) mouse is a polygenic model of early-onset T2D/obesity analogous to adolescent-onset T2D in humans. Male TH mice commence rapid weight gain at 4 weeks of age and by ∼10-14 weeks insulin resistance progressing to frank hyperglycemia is apparent in ∼75% of mice. Compared to SWR/J control strain, TH mice exhibit lower: 1) bone formation markers; 2) trabecular bone volume; and 3) fracture resistance. Utilizing this model, we examined the impact of glucose-lowering therapy by SGLT2I on diabetic bone. TH male mice (8-10 weeks) with confirmed hyperglycemia and age-matched, nondiabetic, male SWR/J mice were monitored ± canagliflozin (CANA: 125 ppm in chow) for 10 weeks of treatment. At study end, measurements of body weight, BG, HbA1c, serum insulin, and urine calcium/CR were obtained; femurs were harvested for analysis by µCT and three-point bending. At 20 weeks, these severely hyperglycemic TH mice (BG: 687±106 vs. 151±26 mg/dL; p&lt;0.0001) were obese and had longer femurs with increased cortical bone (↑Ct.Ar, Ct.Th; p&lt;0.001 for all) compared to SWR/J. However, trabecular bone was reduced (↓Tb.BV/TV, Conn.D, Tb.N, Tb.TMD; p&lt;0.001 for all) and TH bones were more brittle (↓toughness; p&lt;0.0001). CANA treatment of TH mice significantly lowered BG and HbA1c while increasing weight gain and insulin secretion (p&lt;0.0001 for all). With glycemic improvement, trabecular bone improved (↑Tb.BV/TV, p=0.0002; Tb.Th, p&lt;0.0001; Tb.TMD; p=0.002) compared to untreated TH mice, but toughness was not altered. Unexpectedly, CANA treatment of SWR/J mice lowered toughness of the femur diaphysis. Hypercalciuria was a consistent feature of both groups of TH mice; CANA also increased Ca excretion in SWR/J mice. CANA therapy may protect against elevated fracture risk in T2D with respect to trabecular rich sites but may not be beneficial if bone becomes brittle with duration.

Disclosure
K.M. Thrailkill: None. R. Bunn: None. S. Uppuganti: None. P.D. Ray: None. I. Popescu: None. E. Kalaitzoglou: None. J. Fowlkes: None. J.S. Nyman: Advisory Panel; Self; ActiveLife Scientific, Inc. Consultant; Self; Sanofi Genzyme. Research Support; Self; ActiveLife Scientific, Inc., Sanofi Genzyme.

Funding
National Institutes of Health (R21AR070620, R01DK084045); U.S. Department of Veterans Affairs (1l01BX001018)
1205-P: Baseline Lactate Level Is a Useful Predictor for Weight Loss after Long-Term SGLT2 Inhibitor Treatment
Authors: NOJIMA TOSHIAKI , MATSUBAYASHI YASUHIRO , YOSHIDA AKIHIRO , SUGANAMI HIDEKI , KAKU KOHEI , SONE HIROHITO 
Published: June 2019

SGLT2 inhibitors (SGLT2is) reduce body weight. They also reduce insulin levels, which trigger lipolysis leading to subsequent fat-mass loss. Lactate (LAC) was reported to inhibit lipolysis in adipocytes and to mediate insulin-dependent inhibition of lipolysis. However, little is known of the effect of SGLT2is on LAC and its relation to weight loss. We investigated the effect of the SGLT2i tofogliflozin on LAC and explored its relation to subsequent weight loss in patients with type 2 diabetes mellitus (T2DM). Analyzed were 584 T2DM patients receiving tofogliflozin as an add-on to other antidiabetic agents from a Phase 3 trial. Baseline characteristics were: men (66%), age (mean 59y), mean HbA1c (8%), BMI (26kg/m2), LAC (11mg/dL) and eGFR (84mL/min/1.73m2). Patients were divided into two groups based on baseline LAC (bottom quartile [Q1: LAC mean 6mg/dL] and 3 higher quartiles [Q2-4]: 13). Adjusted changes in variables between groups were compared to explore the relation between baseline LAC and weight loss using multivariate analysis. LAC significantly decreased at week 4 (mean, -1.4mg/dL* p&lt;0.01 vs. baseline) and that reduction was maintained toward week 52 (-1.5*). Similar reductions in LAC were seen at week 52 in persons who had (-1.7mg/dL*) and had not received a biguanide (-1.4*). Baseline BMI, eGFR and fasting insulin were lower in Q1, while HbA1c was identical between groups. Mean changes in LAC in Q1 and Q2-4, respectively, were +1.6mg/dL*, and -2.4* at week 52 (p&lt;0.01 between groups). Weight loss in Q1 and Q2-4, respectively, were -3.8%*, and -4.5* at week 24 (p&lt;0.05) and -3.4*, and -4.4* at week 52 (p&lt;0.01) while reductions in HbA1c and fasting insulin at week 52 were identical between groups. Multivariate analysis showed greater weight loss in Q2-4 at week 52 than in Q1. Results suggested that LAC was significantly influenced by togfogliflozin according to baseline LAC. Baseline LAC may be a predictor of weight loss associated with lipolysis via long-term SGLT2i treatment for T2DM.

Disclosure
T. Nojima: Employee; Self; Kowa Co., Ltd. Y. Matsubayashi: None. A. Yoshida: Employee; Self; Kowa Pharmaceutical Co. Ltd. H. Suganami: Employee; Self; Kowa Co., Ltd. K. Kaku: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
1208-P: Empagliflozin and HbA1c Reduction in a National Cohort
Authors: CHANG PO-YIN , HEBERER KENT , LEE JENNIFER 
Published: June 2019

Empagliflozin, a sodium-glucose cotransport 2 inhibitor, provides A1c reduction by .6-1.0% in large randomized control trials. These trials included adults with type 2 diabetes (T2D) who had baseline A1c 7-10%. The use of empagliflozin in reducing A1c in clinical practice has not been investigated. We constructed a longitudinal cohort of 16391 adults with T2D who initiated empagliflozin from 11/1/2014 to 3/1/2018 in the Veterans Health Administration and followed them until 10/1/2018. We studied 7792 adults (96% men, 73% non-Hispanic white (NHW), 14% black) who had A1c measures at baseline and during follow-up and who did not change their antidiabetic medication regimens (58% with insulin, 36% without insulin). Linear regression estimated absolute A1c change at 6 months, adjusted for age, sex, race/ethnicity, baseline A1c, categorical BMI, kidney function, and concurrent insulin. At baseline, median A1c was 8.5% (12% with A1c ≥10%), median BMI was 33 kg/m2 (25% of adults with BMI 35-40 kg/m2, 18% BMI &gt;40 kg/m2), and 19% with reduced kidney function. Baseline A1c was 8.9% for black adults and 8.5% for NHW adults. The average reduction in A1c was .74% for black adults and .70% for NHW adults. Overall, average adjusted A1c reduction was .71%. Adults with baseline A1c ≥10% had a greater adjusted reduction compared to adults with baseline A1c 7-10% (1.76% vs. .46%, p&lt;.001). Adults with BMI 35-40 kg/m2 and &gt;40 kg/m2 had a greater adjusted reduction compared to normal and overweight adults (.71% and .75%, vs. .46% and .59%, respectively, p &lt;.001). Adults on a concurrent insulin regimen had a smaller adjusted reduction compared to those with a non-insulin regimen (.50% vs. .72%, p&lt;.001). Empagliflozin decreased A1c in T2D adults across a range of ages, races/ethnicities, BMIs and concurrent insulin prescription. Empagliflozin seems to offer the greatest A1c reduction for T2D adults with A1c ≥10% or BMI &gt;35. This study provides real-world evidence of empagliflozin use and A1c reduction in a large integrated healthcare system.

Disclosure
P. Chang: None. K. Heberer: None. J. Lee: None.

Funding
National Institute on Drug Abuse (T32DK007217); U.S. Department of Veterans Affairs
121-LB: Early Independent View of Quality of Life in Patients with Type 1 Diabetes Using Hybrid Closed-Loop Insulin Delivery System in Real-World Clinical Practice
Authors: ELDIB AHMED H. , TOSCHI ELENA , MAHMOUD NOOR , TASABEHJI MHD WAEL , ASHRAFZADEH SAHAR , TOMAH SHAHEEN , DHAVER SHILTON EDWARD , ATAKOV-CASTILLO ASTRID , ABDUL-GHANI AHMED E. , FARKOUH KATIE , TREVINO RAFAEL , HAMDY OSAMA 
Published: June 2019

The MiniMed™ 670G (670 HCL) is the first FDA-approved hybrid closed-loop insulin delivery system device for patients with type 1 diabetes (T1D). This study aimed at evaluating clinical and patient-reported outcomes (PROs) in patients with T1D utilizing this technology.
We evaluated 54 patients with T1D using the 670 HCL in real-world clinical practice (mean age 47.9±13.2 years, 57% females, BMI 28.8±5.9 kg/m2). Data were collected at baseline and after 3 months. Measures of PROs included: Pittsburgh Sleep Quality Index (PSQI), Hypoglycemia Fear Survey Worry (HFS_W) scale, and 36-Item Short-Form Health Survey (SF-36). We also measured changes in A1C after 3 months and % of time in auto-mode (% TIAM) over the two weeks preceding the 3-month visit. Regression analyses were done between these 2 parameters and PROs. Other glycemic and quality-of-life parameters were collected at 3 months and at one year but are not included in this early report.
At 3 months, A1C decreased by 0.4±0.12% from baseline (p=0.0027). Average % TIAM was 63.9±33.1%. Among all surveyed PROs, only fear of hypoglycemia and social functioning improved compared to baseline (p&lt;0.05 for both). There was no association between changes in PROs and reduction in A1C or % TIAM.
In conclusion, patients with T1D using the MiniMed™ 670G hybrid closed-loop system in real-world clinical practice are able to improve their A1C, fear of hypoglycemia, and social functioning but not other PROs included in the SF-36 after 3 months of use. The limited improvement in some of the PROs is not associated with the reduction in A1C or % TIAM.

Disclosure
A.H. Eldib: None. E. Toschi: Advisory Panel; Self; Lexicon Pharmaceuticals, Inc. N. Mahmoud: None. M. Tasabehji: None. S. Ashrafzadeh: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. S.E. Dhaver: None. A. Atakov-Castillo: None. A.E. Abdul-Ghani: None. K. Farkouh: None. R. Trevino: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.
1214-P: Effect of Short-Term Improvements in Glycemic Control with SGLT2 Inhibitor Therapy on Insulin and Glucagon Secretion: How Does It Differ With or Without Concurrent DPP-4 Inhibitor Therapy
Authors: MATSUI MAKIKO , TAKAHASHI HIROSHI , SAWANO SHOUKO , MORI YUTAKA , UTSUNOMIYA KAZUNORI 
Published: June 2019

Objective: We investigated the effect of short-term improvements in glycemic control with SGLT2i therapy on insulin and glucagon secretion with or without concurrent DPP-4 inhibitor (DPP-4i) therapy.
Patients and Methods: 78 type 2 diabetic patients admitted for glycemic control and subjected to meal tolerance tests (MTT) on the next day after admission and immediately before discharge using the same diabetes diet while off treatment were subjected to retrospective analysis. Of these, 41 patients were found to have received SGLT2i after admission, with 15 of these also found to have received concurrent DPP-4i. The patients were divided into those not receiving SGLT2i (n=37), those receiving SGLT2i without concurrent DPP-4i (n=26) and those receiving SGLT2i with DPP-4i (n=15) and were compared for changes in postprandial insulin and glucagon secretion. All patients were evaluated at admission and discharge for insulin secretion in terms of ΔCPR/ΔPG 0-30 min and AUC-CPR 0-2h, and as well as for glucagon (G) secretion in terms of ΔG/ΔPG 0-30 min and AUC-G 0-2h during the MTT.
Results: There was no significant difference between the 3 groups in their HbA1c, C-peptide index, and urinary CPR excretion at admission. With improvements in glycemic control, ΔCPR/ΔPG 0-30min and AUC-CPR 0-2h were significantly increased, and AUC-PG 0-2h were significantly decreased, in all groups. Again, with improvements in glycemic control, AUC-G 0-2h was significantly decreased in those not receiving SGLT2i, increased in those receiving SGLT2i without DPP-4i, and decreased in those receiving both SGLT2i and DPP-4i.
Conclusions: Postprandial insulin secretion was shown to be restored after short-term improvements in glycemic control irrespective of SGLT2i or concurrent DPP-4i, while glucagon secretion was shown to be increased with SGLT2i without DPP-4i but decreased with combined SGLT2i and DPP-4i.

Disclosure
M. Matsui: None. H. Takahashi: None. S. Sawano: None. Y. Mori: None. K. Utsunomiya: None.
1215-P: Adipose Tissue Insulin Resistance Predicts Ketosis via an SGLT2 Inhibitor
Authors: MATSUBAYASHI YASUHIRO , YOSHIDA AKIHIRO , NOJIMA TOSHIAKI , SUGANAMI HIDEKI , FUJIHARA KAZUYA , KAKU KOHEI , SONE HIROHITO 
Published: June 2019

Diabetic ketoacidosis characterized by lipolysis due to insulin deficiency is a side effect reported for SGLT2 inhibitors (SGLT2is). However, little is known about predictors of ketosis via SGLT2i. The antilipolytic effect of insulin in adipose tissue can be evaluated as adipose tissue insulin resistance (Adipo-IR). This study investigated predictors of ketosis via the SGLT2i, tofogliflozin (TOFO), in patients with type 2 diabetes (T2D) focusing on Adipo-IR. Analyzed were 304 T2D patients who received TOFO as initial monotherapy in two TOFO phase 2 and 3 studies. Adipo-IR was calculated by the product of fasting insulin (IRI) and fasting free fatty acids (FFA). Baseline characteristics were: males (67%), age (mean: 58 y), HbA1c (8%), BMI (26kg/m2), β-hydroxybutyrate (BHB) (75µmol/L), eGFR (84mL/min/1.73m2) and Adipo-IR (33pmol/L mmol/L). Participants were grouped by tertiles of baseline Adipo-IR levels (T1-T3). Differences across tertiles were analyzed by ANOVA, Kruskal Wallis and ANCOVA. Multivariate analysis explored the predictors of ketosis. In the order of T3-T1, younger age, higher baseline HOMA-IR levels and higher baseline HOMA-β levels were observed, while baseline HbA1c and BHB levels were identical across tertiles. At 24 weeks after TOFO administration, reduced HbA1c and body weight and increased urinary glucose excretion were identical among tertiles. Percent changes in FFA were T1, mean +50.9%* (* p&lt;0.001 vs. baseline); T2, +25.8*; and T3, +6.6 (p&lt;0.001 across tertiles); and those for BHB were T1, median +117.9%*; T2, +126.9*; and T3, +62.0* (p&lt;0.05). Conversely, percent changes in IRI were T1, mean -11.3%*; T2, -24.2* and T3, -28.3* and in Adipo-IR were T1, +31.1%*; T2, -2.9 and T3, -24.1* (p&lt;0.001 across tertiles). Multivariate analysis indicated an independent association of T3 with a weaker increase in BHB than T1 and T2.
In conclusion, high baseline Adipo-IR may attenuate ketosis via SGLT2i through improved Adipo-IR and the antilipolytic effect of insulin despite reduced IRI in T2D.

Disclosure
Y. Matsubayashi: None. A. Yoshida: Employee; Self; Kowa Pharmaceutical Co. Ltd. T. Nojima: Employee; Self; Kowa Co., Ltd. H. Suganami: Employee; Self; Kowa Co., Ltd. K. Fujihara: None. K. Kaku: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
1225-P: The Association between Long-Term Glucose Variability (GV), Cardiovascular (CV) Death, and Heart Failure (HF) Outcomes in the EMPA-REG OUTCOME Trial
Authors: CERIELLO ANTONIO , OFSTAD ANNE PERNILLE , ZWIENER ISABELLA , KASPERS STEFAN , GEORGE JYOTHIS , NICOLUCCI ANTONIO 
Published: June 2019

Markers of GV have been associated with CV outcomes in type 2 diabetes (T2D), however, the association of GV with HF outcomes remains unclear. In EMPA-REG OUTCOME, empagliflozin reduced the risk of CV death by 38% and HF hospitalizations (HHF) by 35%. Here we explore the association between GV and CV death/HHF outcomes.
In EMPA-REG OUTCOME, 7,020 patients with T2D and established CV disease received placebo (PBO), empagliflozin (EMPA) 10 mg or 25 mg and were observed for a median period of 3.1 years. We defined within-patient GV as range and standard deviation of HbA1c measurements on-treatment until week 28. The associations with CV death, first HHF, and HHF or CV death were explored in PBO and pooled EMPA arms separately with landmark (LM) analyses at week 28 by Cox regression models adjusted for baseline risk factors including changes in HbA1c from baseline to week 12.
GV levels were lower with EMPA (Table). In the LM analysis, higher GV increased the risk for CV death and CV death or HHF in both treatment arms. For HHF, no significant association could be shown (Table).
In EMPA-REG OUTCOME, EMPA reduced GV. An increase in GV correlated with increased risk of subsequent CV death and CV death or HHF. The association with HHF alone was not significant maybe due to a lower numbers of HHF events, or the assumption that the effects of EMPA on HHF are largely glucose-independent.

Disclosure
A. Ceriello: Advisory Panel; Self; Abbott Laboratories, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S, Vifor Pharma. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; A. Menarini Diagnostics, AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim Pharmaceuticals, Inc. A. Ofstad: Employee; Self; Boehringer Ingelheim International GmbH. I. Zwiener: Employee; Self; Boehringer Ingelheim Pharma GmbH & Co KG, Merck KGaA. S. Kaspers: Employee; Self; Boehringer Ingelheim International GmbH. J. George: Employee; Self; Boehringer Ingelheim International GmbH. A. Nicolucci: Consultant; Self; AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Artsana S.p.A., Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis.

Funding
Boehringer Ingelheim; Eli Lilly and Company
1230-P: Addition of Canagliflozin to Insulin Improves Glycemic Control and Reduces Insulin Dose in Patients with Type 2 Diabetes Mellitus: A Study Based on Continuous Glucose Monitoring
Authors: TORIMOTO KEIICHI , OKADA YOSUKE , SATO YASUNORI , TANAKA YOSHIYA 
Published: June 2019

Background and Aims: No studies have compared insulin dose or hypoglycemic risks between type 2 diabetes mellitus (T2DM) treated with and without Sodium glucose cotransporter-2 (SGLT2) inhibitors using defined criteria for insulin dose adjustment to achieve the same level of glycemic control. The aim of this study was to evaluate the efficacy of canagliflozin in reducing the required insulin dose and the risk of hypoglycemia in T2DM.
Materials and Methods: This randomized, two-group comparative study was conducted in 34 patients treated with insulin alone or combined with oral hypoglycemic agents. They were randomly assigned to the control (n=17, insulin) and canagliflozin (n=17, insulin plus 100 mg/day) groups and wore a continuous glucose monitoring (CGM, ipro2®) for 14 days. In both groups, a defined insulin dose adjustment protocol was applied to achieve the same level of glycemic control.
Results: The change from baseline in daily insulin dose was significantly smaller in the canagliflozin group (3.9 units/day) than control group (13.4 units/day; p = 0.040). Low blood glucose index (LBGI) and predicted % of blood glucose (BG) &lt;70 mg/dL, which are hypoglycemia-related parameters, worsened significantly in the control group, but both remained unchanged in the canagliflozin group. The SD for nighttime BG levels improved significantly only in the canagliflozin group. Participants’ body weight (BW) decreased in both groups, but the change in BW showing a significant decrease in the canagliflozin group.
Conclusion: Supplementation of insulin therapy with 100 mg canagliflozin in patients with T2DM reduced the required insulin dose and hypoglycemic risk and flattened nighttime glycemic fluctuations while maintaining the same level of glycemic control. The addition of SGLT2 inhibitors may provide several benefits to patients on insulin therapy, enabling them to maintain strict glycemic control.

Disclosure
K. Torimoto: None. Y. Okada: None. Y. Sato: None. Y. Tanaka: None.
1235-P: Effects of Medicaid Expansion on Uninsured Rates: Diabetes Belt vs. Non-Belt Counties
Authors: LOBO JENNIFER M. , KIM SOYOUN , OCKER GABRIELLE M. , KANG HYOJUNG , MCMURRY TIMOTHY L. , SOHN MIN-WOONG 
Published: June 2019

Objective: To examine trends in insurance rates in 2012-2016 among low-income adults aged &lt;65 and determine whether Medicaid expansion helped reduce the gap in uninsured rates between Diabetes Belt (DB) and non-DB counties. The Diabetes Belt is a region with elevated rates of diabetes that includes 644 counties across 15 southeastern states.
Methods: Data for 1,180 county-level data from the Small Area Health Insurance Estimates and Area Health Resources File were used to analyze the trends in uninsured rates in populations with household income ≤138% federal poverty line (FPL). Multivariable analysis adjusted for county percent population aged 50-64 years, females, married, distress county index, and rurality.
Results: Crude uninsured rates were 5% higher in DB compared to non-DB counties (39% vs. 34%, p &lt; 0.001) in 2012. Uninsured rates declined rapidly in both DB and non-DB counties to 13% and 15% in 2016. Adjusted changes in uninsured rates between 2012 and 2016 were 31% in DB (p &lt; 0.001) and 21% in non-DB counties (p &lt; 0.001) with the adjusted uninsured rates being 16% in both areas in 2016. Figure below shows the trends.
Discussion: Medicaid expansion had the intended effects on reducing uninsured rates in both DB and non-DB counties. Initial disparities in uninsured rates between the two areas were completely eradicated by 2016. Medicaid expansion may have helped improve uptake of preventive care in the Diabetes Belt.

Disclosure
J.M. Lobo: None. S. Kim: None. G.M. Ocker: None. H. Kang: None. T.L. McMurry: None. M. Sohn: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)