bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Diabetic Peripheral Neuropathy on Pinch Proprioception
Authors: YAHYA ABDALGHANI , KLUDING PATRICIA , PASNOOR MAMATHA , SANTOS MARCIO 
Published: June 2018

Background: Deficits in finger proprioception might impact the ability to perform tasks such as picking up pills, monitoring blood sugar and injecting insulin. However, no tests are available for finger proprioception with functional relevance for tasks using pinch between the index finger and thumb. This study investigates the impact of diabetic peripheral neuropathy (DPN) on pinch proprioception in people with type 2 diabetes (T2D).
Methods: This study tested pinch proprioception in 8 healthy participants (3 males, 57±5.6 years), 11 participants with T2D without DPN (T2D-only) (5 males, 61±5.9 years), and 13 participants with T2D and DPN (T2D+DPN) (6 males, 59.9±6.4 years). We used a device previously tested for reliability. Following familiarization with a 15° target position of the index finger and thumb, subjects performed 3 trials where they attempted to reproduce the target position without visual feedback. The average of the absolute error matching the 15° target represented accuracy, and the standard deviation from the trials denoted precision.
Results: Descriptive statistics presented as Means ± SD. Accuracy: healthy (0.67±0.64), T2D-only (0.94±1.2), and T2D+DPN (3.51±2.24).
Precision: healthy (0.59±0.41), T2D-only (0.79±0.53), and T2D+DPN (2.81±2.4). Kruskal-Wallis test was significant for accuracy (p = .003) and precision (p = .001). Pinch proprioception was significantly different between the T2D+DPN group and the T2D-only group (accuracy and precision: p = .003) as well as between the T2D+DPN group and the healthy group (accuracy: p = .006; precision: p = .001). There were no significant differences between the T2D-only group and the healthy group: accuracy (p = .98) and precision (p = .5).
Conclusion: Our results showed that pinch proprioception was disrupted in people with DPN, but not in people with T2D without DPN. Detection of pinch proprioceptive deficits will potentially improve the neurological screening and can be used in future studies for other neurological populations.

Disclosure
A. Yahya: None. P. Kluding: None. M. Pasnoor: None. M. Santos: None.
Improving Management of Diabetic Dyslipidemia—Effect of Online CME
Authors: SPYROPOULOS JELENA , HEALY COLLEEN S. 
Published: June 2018

Introduction: Although statins represent the cornerstone of dyslipidemia treatment, certain statins may increase the incidence of new-onset diabetes mellitus (DM). This study was conducted to determine if online continuing medical education (CME) could improve knowledge/competence of diabetologists/endocrinologists (D/E) and primary care physicians (PCPs) in tailoring statin therapy to reduce the risk for DM.
Methods: Physicians participated in at least one of two 30-minute video-based online CME activities. The activities addressed educational themes related to effects of statins on lipid metabolism and tailoring statin therapy to reduce the risk of DM. 6 matching pre-education/post-education questions associated with these themes were analyzed by comparing participant responses from pre- to post-education using a repeated-pairs design. For all questions combined, the McNemar’s chi-square test was used to assess differences from pre- to post-assessment.
Results: Significant improvements (P &lt; .05) were seen after education across both CME activities for D/E (N=438) and PCPs (N=1023). For all questions combined, average relative improvements in knowledge/competence were 44% for D/E and 73% for PCPs (P&lt;.05). Pre-assessment, the average correct response rate was 43% for D/E and 48% for PCPs, while post-assessment average correct response rates were 62% and 83%, respectively. Significant improvements were observed (all P&lt;.05): effect of statins on glucose metabolism: 49% relative improvement among D/E (43% vs. 64%) and 103% improvement among PCPs (37% vs. 75%). Tailoring statin therapy to reduce the risk of DM: 64% improvement among D/E (50% vs. 82%).
Conclusions: This study demonstrates the success of online CME on improving knowledge/competence of D/E and PCPs regarding tailoring lipid-lowering strategies in high-risk patients. Properly implemented, this type of intervention can translate into improvements in guideline-based patient care and improve long-term outcomes for at-risk patients.

Disclosure
J. Spyropoulos: None. C.S. Healy: None.
Circulating PCSK9 in Statin-Treated Patients with Type 2 Diabetes Mellitus (T2DM)
Authors: WALUS-MIARKA MALGORZATA , KAPUSTA MARIA , KAWALEC EWA , IDZIOR-WALUS BARBARA 
Published: June 2018

Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) is a natural circulating inhibitor of the LDL receptor. There is evidence that PCSK9 is a risk factor for coronary artery disease. In this study we aimed to determine factors associated with PCSK9 in patients with DMt2, according to statin treatment. Material included 116 consecutive patients with DMt2. Fasting serum lipids were determined enzymatically, apolipoproteins B100, A1 by immunoturbidimetry, apo C3, B48, pentraxin 3 (PTX3) and PCSK9 by ELISA, glycated hemoglobin A1c by HPLC. In the examined group 67 persons were statins users. Mean (SD) age of patients was 59.1 (11.1) years, HbA1c 8.6 (2.4%). Mean (SD) values of serum LDL-cholesterol were 2.6 (1.16) mmol/l and of serum PCSK9 255,4 (106,97) ng/ml. Patients treated with statins were older and had lower LDL-C: 2.38 (1.1) vs. 2.96 (1.2) mmol/l, p&lt;0.05, apoB 100: 81.8 (20.6) vs. 99.7 (29.8) mg/dl, p&lt;0.001 and higher waist circumference p&lt;0,05. We did not observe differences in PCSK9 between patients receiving and not receiving statins: 248.6 (99.9) vs. 272.1 (112.5) ng/ml, p=0.2488 respectively. Median (IR) of apo B48 was lower in statin treated patients: 3529 (2370) vs. 5136.5 (3424.5) ng/dl, p&lt;0.01. Correlation analysis revealed in both groups of patients significant correlation between PSCK9 and total cholesterol, LDL-C, triglycerides, PTX3 and apo B100. In statin users PCSK9 concentration was associated with apo A1 (p&lt;0.001) and apo B48 (p&lt;0.05). In patients not taking statins negative correlation between HbA1c and PCSK9 was found (p &lt;0.05). The results indicate, that circulating PCSK9 is significantly associated with atherogenic markers - LDL-C, apo B 100, triglycerides and inflammation marker PTX3; in statin users also with apo A1, a negative risk marker, and apo B 48. In patients not taking statins significant negative association between PCSK9 and HbA1c was noted. These associations might be of value in understanding the pathways involved in atherosclerosis and dyslipidemia, mediated by PCSK9.

Disclosure
M. Walus-Miarka: None. M. Kapusta: None. E. Kawalec: None. B. Idzior-Walus: None.
Maternal High-Fat Diet Persistently Alters Bone Marrow Immune Cell Proportions and Function in a Nonhuman Primate Model
Authors: NASH MICHAEL J. , SODERBORG TAYLOR K. , JANSSEN RACHEL C. , PIETRAS ERIC M. , FRIEDMAN JACOB E. 
Published: June 2018

Maternal obesity is rapidly increasing in prevalence and predisposes offspring to many serious health risks such as cardiovascular disease, obesity, and nonalcoholic fatty liver disease. Maternal high-fat diet (MHFD) can alter offspring metabolism and predispose offspring to obesity through many mechanisms, including alterations in immune cell function. However, whether maternal diet impacts development of the neonatal immune system remains unclear. To investigate the impact of MHFD on offspring bone marrow, a major site of immune cell generation via hematopoiesis, we utilized two distinct cohorts of non-human primates (NHPs). Bone marrow from a cohort of early third trimester fetuses was examined to determine the effects of MHFD vs. chow diet on bone marrow cellularity and function. The second cohort, 3-year-old juvenile NHPs exposed to MHFD early in life, then shifted to a chow diet at weaning for the remaining 2.5 years, were studied to see whether bone marrow phenotypes resulting from MHFD exposure were reversible upon altering diet later in life. Colony-forming assays of plated fetal bone marrow cells showed a significant 34.5% relative increase in innate immune system cells at the expense of erythroid (-78.9%) and multilineage (-53.8%) progenitors, and a decrease in total numbers of all cell types. Bone marrow stem cells differentiated to macrophages were treated with LPS and showed significantly lower IL1B expression and trending decreased IL10 and TNF via qPCR, suggesting hyporesponsivity to inflammatory LPS stimuli. Similar phenotypes were found in the cohort of juveniles exposed to MHFD then shifted onto a chow diet, suggesting that exposure to MHFD has long lasting immunological consequences in offspring not correctable by dietary changes later in life. Further, our results suggest remodeling in macrophage function, potentially implicating an epigenetic programming event early in life driven by maternal diet.

Disclosure
M.J. Nash: None. T.K. Soderborg: None. R.C. Janssen: None. E.M. Pietras: None. J.E. Friedman: Advisory Panel; Self; Janssen Pharmaceuticals, Inc..
Combination of Premixed Insulin with Glucagon-Like Peptide-1 Receptor Agonist (GLP-1) for Uncontrolled Type 2 Diabetes Mellitus (T2DM) Patients
Authors: FAZELI SASAN , EHRHARDT NICOLE 
Published: June 2018

Background: Despite multiple therapeutic options for people with T2DM, 48% of people do not achieve Hemoglobin A1c (HbA1c) goal. GLP-1 receptor agonists may be beneficial to patients with T2DM who are on large insulin doses and are obese. GLP-1 receptor agonists are often used with oral medications and/or basal insulin. GLP-1 agents are not typically used with those on prandial insulin.
Clinical cases: We present 2 cases of uncontrolled T2DM whose HbA1c significantly improved on GLP-1 and daily mixed insulin. Patient A is a 62 y/o M with T2DM for 15 years, weight of 112 kg (BMI 35), HbA1c of 10.2% (diabetes ref range &gt; 6.4%), on 65u insulin detemir BID (total daily insulin 0.9 u/kg). HbA1c decreased to 7.1% by 2 month on dulaglutide 1.5mg weekly, insulin Humalog mix 75/25 45u BID (total daily insulin 0.8u/kg) and metformin ER 1000mg BID. HbA1c at 12 months was 6.1% and weight 112kg (BMI 35). Patient B is a 61 y/o F with T2DM for 17 years, weight of 92 kg (BMI 35), HbA1c of 10.9%, on 50u insulin glargine BID and not adherent to her insulin lispro (total daily insulin 1.6 u/kg). HbA1c decreased to 6.3% at 2 month on dulaglutide 1.5 mg weekly, insulin Novolog mix 70/30 30u BID (total daily insulin 0.7u/kg) and metformin ER 500mg BID. HbA1c at 12 months was 6.6%, and weight decreased to 87kg (BMI 34).
Discussion: Our patients were on metformin and high dose insulin without HbA1c improvement. Their regimens were changed to once weekly GLP-1 agonists with mixed insulin which showed improved and sustained glycemic control after one year without major hypoglycemic events.
Conclusion: These cases highlight the potential utility of GLP-1 receptor agonist therapy in combination with mixed insulin for patients with uncontrolled T2DM on high dose insulin. We hypothesize that increased compliance may be an import factor but further research needs to be completed.

Disclosure
S. Fazeli: None. N. Ehrhardt: None.
Identifying Barriers of Our Youngsters with Type 1 Diabetes Transitioning to an Adult Unit
Authors: DE VILLAR NOEMI GONZALEZ PEREZ , IGARTUA MARIA COS , HILLMAN NATALIA , GASPAR RUTH , DE IBARRA LOURDES SAEZ , BLANCO ANA COS , HERRANZ LUCRECIA 
Published: June 2018

Youngsters with type 1 diabetes feel anxious when transitioning from Pediatric to Adult Care. Loss of attendance and worsening of metabolic control are related to it. Some barriers reported are difficulty in getting appointment, unknown referral health-care provider and work issues.
Objective: To evaluate loss of attendance, metabolic control and satisfaction in a cohort of youngsters with T1D transitioning to Adult Care.
Methods: All Kids with T1D transitioning between 2015-2017 were included. Clinical/demographic data were collected. A1c levels prior and 1 year after Transition were compared. Loss of attendance was defined as “loss of 2 following visits.” An anonymous survey was created ad hoc to evaluate satisfaction. It had 15 questions with a 1-5 scale, being 1 “never” and 5 “always.”
Results: 42 kids transitioned. 31% women, transition age 18(±1.8) years, diabetes duration 11(±4.4) years, 16.7%CSII, 83.9% were students. Delay between Pediatrics and Adults was 2.84(±1.9) months. A1c before and after 1 year were similar: 7.8(±1.5)% vs. 7.9(±1.5)%,p=ns). Loss of attendance occurred in the 2nd year in 3 patients (7.1%). Only worsening of A1c the year before was associated with it. 80.9% of patients answered the survey. Satisfaction degree was “most of the times” or “always” in &gt;80% in questions related to: moment of transition, welcome, time expend on each visit, confidentiality, referral contact name/phone, share decision making or understanding therapy instructions. However, 1 out of 3 patients disagreed in questions about emotional support, feeling comfortable to talk about sex/drugs or feeling free to express their thoughts. Work issues was the most common cause of not compliance to visits.
Conclusion: Although rate of loss of visits is low and maintenance of metabolic control has been observed through Transition, an effort has to be made in our Team to improve satisfaction in terms of freedom to talk about sex or drugs, freedom to express their thoughts and to support their emotional needs.

Disclosure
N. Gonzalez Perez de Villar: None. M. Cos Igartua: None. N. Hillman: None. R. Gaspar: None. L. Saez De Ibarra: None. A. Cos Blanco: None. L. Herranz: None.
2017 Diabetic Food Apps—Are They Useful for the Diabetic Patient?
Authors: WU GLORIA , BILLARD LAURA , MURO ELENA , DOAN AMY , NGO VY-VY 
Published: June 2018

Diabetes affects 23 million Americans and additional 7 million of prediabetic patients. Medical health mobile apps has generated 3.2 billion downloads in 2016. Are apps helpful to our diabetic patients seeking food information?
Purpose: Do free diabetic food apps follow the Diabetes Self-management Education and Support (DSME) guidelines?
Methods: Using the search term, “diabetic foods,” we used Google search engine to identify 30 most commonly listed apps by bloggers, websites and web journalists. Then, accessing Google Playstore, we found the 10 most popular diabetic food apps in 2017 based on number of downloads. Inclusion criteria: 1000 downloads or more; ease of web accessibility during multiple downloads over 3 days (no malfunction, no malware). Exclusion criteria: apps which were purely informational. We downloaded the apps and evaluated their adherence to the DSME guidelines.
Results: The most popular diabetic food app is” Fooducate “with 1,000,000 downloads. Fooducate fulfills 8/10 categories, but 3 of them (Hb1AC, TG levels, and BMI) are paid features. Of the 10 food apps, only 3/10 have cal/carb counting feature.
Conclusions: Mobile apps for diabetic foods are still in its preliminary stages of development. More input by interested diabetes health care professionals will improve the quality of future mobile apps for diabetes education and management.

Disclosure
G. Wu: None. L. Billard: None. E. Muro: None. A. Doan: None. V. Ngo: None.
Activation of Browning Adipose Tissues by Placental Growth Factor
Authors: YIN RUILI , ZHOU JING , ZHANG CHUANHAI , YAN CEN , MA WEI , WU NANNAN , ZHAO DONG , FENG YINGMEI 
Published: June 2018

Background: Gestational diabetes mellitus (GDM) is a type of metabolic disorders. Browning adipose tissue (BAT) activity is reduced which strengthens insulin resistance in GDM. Placenta growth factor (PlGF) is one of the main factors produced by placenta during pregnancy. Once secreted into circulation, it participates in angiogenesis in peripheral tissues. However, whether and how PlGF modulates BAT function is yet unknown.
Methods: We recruited 91 nondiabetic pregnant participants and 73 GDM patients. Serum levels of PlGF were quantified by ELISA. Skin temperature was measured by Far infrared thermography in the supraclavicular region where classical BAT was located. Primary human preadipocytes isolated from intercapsular BAT were differentiated under different concentrations of PlGF in vitro. Terminally differentiated adipocytes were characterized by qPCR, western blot and oxygen consumption rates by respirometry. Phosphorylation signaling pathways in differentiated cells were dissected using Bio-Plex target assay (Bio-Rad). Cells were exposed with 1 ng PlGF in the presence or absence of 1 nM AMPK inhibitor Compound C to assess UCP-1 expression.
Results: Serum levels of PlGF were lower in GDM patients than non GDM controls, which was accompanied by decreased skin temperature in the supraclavicular region. By qPCR, PlGF dose-dependently induced BAT marker expression in differentiated brown adipocytes (BAC) and peaked at 1 ng as evidenced by the increased mRNA expression of UCP-1 and Oxphos. The increased BAT marker expression was further confirmed by western blot in differentiated BAC exposed to 1 ng PlGF. Accordingly, PlGF-exposed BAC showed higher oxygen consumption rates than control and stimulated AMPK phosphorylation. Blockade of AMPK phosphorylation abrogated UCP-1 and Oxphos expression in BAC induced by PlGF.
Conclusions: Physically, PlGF improves preadipocyte differentiation into active BAC. Decreased PlGF levels might contribute to the reduced BAC activity in GDM.

Disclosure
R. Yin: None. J. Zhou: None. C. Zhang: None. C. Yan: None. W. Ma: None. N. Wu: None. D. Zhao: None. Y. Feng: None.
Exercise Improves Sleep and Sleep Improves Glucose Control
Authors: SAKKAL SAAD 
Published: June 2018

Background: 77% of people with diabetes have insomnia. Sleep disturbance results in impaired glucose control in healthy individuals or worsens glucose control in people with diabetes. Short-term sleep studies (1-6 weeks) improved glucose control and insulin resistance in obese “healthy” individuals. Few studies have tested the hypothesis that improving sleep quality will improve glucose control. Exercise has been proven to help both sleep and glucose control. We wanted to test, in this abstract, the impact of improving sleep with exercise.
Methods: We recommend aerobic exercise 10 minutes after each meal (HIIT) to all our patients, but not all adhere for a variety of reasons. We also advise balance and stretch.We compared 50 non-adherent type 2 patients to a matched exercise-adherent patients. We quantified feeling of well being, shortening latency of sleep onset, and sleep duration extension. We measured their glucose control with AM insulin/glucose ratio, HgA1c, and in-target glucose when CGMS was available (12 patients). All patients followed our standard diabetes treatment protocol for type 2.
Results: At 12 months, adhering to exercise improved the feeling of well being in 68%, sleep hygiene in 66% of patients; Sleep increased by 28 minutes, and sleep onset latency decreased by 8 minutes. Insulin/glucose ratio was 16/133=0.12, HgA1c 7.1%, HgA1c&lt;7 in 69%, and in-target glucose in 74% on CGMS (7 patients). Non-adherent had feeling of well being in 45%, sleep hygiene in 14%; with sleep increasing by 4 minutes, and sleep onset latency decreased by 2 minutes. Insulin/Glucose ratio was 38/174=0.21, HgA1c 7.9%, HgA1c&lt; 7 in 50%, and in-target-glucose in 54% on CGMS (5 patients.) diabetes medications used were 3 in both groups. Percentage needing basal insulin at the end was 8% in the exercise group, 21% in the non-adherent group.
Conclusion: Exercise Improved sleep and insulin resistance with improved glucose control. However, what is the contribution of each factor will need further study.

Disclosure
S. Sakkal: None.
Free Fatty Acids–Mediated Inflammation and Insulin Resistance/Insulin Production in Healthy and Gestational Diabetes Pregnant Women
Authors: CHEN XINHUA , STEIN THOMAS P. , SCHOLL THERESA O. , STEER ROBERT A. 
Published: June 2018

We investigated the relationship of individual free fatty acid (FFA, GCMS), inflammatory biomarkers (multiplex assay) with insulin resistance (HOMA-IR) and production (C-peptide) levels during pregnancy from the Camden Study - a prospective longitudinal cohort (n=1,784, African-American 36%, Hispanic 48%, Caucasian 16%, age 22 ± 5.2 year., BMI 25.6 ± 6.1 kg/m2). Multivariate analyses were performed along with separate analyses for each individual FFA. All of the analyses were adjusted for maternal age, pre-pregnancy BMI, parity, cigarette smoking and ethnicity.
The results obtained at entry to care (16 weeks gestation) are summarized: (i) Elevated HOMA-IR and C-peptide levels were associated with a 50% to 2-fold (p&lt;0.01 to p&lt;0.0001) increased risk for developing gestational diabetes mellitus (GDM); (ii) Specific FFAs (%) (palmitoleic, oleic, linolenic acids) were significantly associated with decreased HOMA-IR and C-peptide levels (p&lt;0.01 to p&lt;0.0001); In contrast, palmitic, stearic, arachidonic acids and dihomo-γ-linolenic acid were associated with increased HOMA-IR and C-peptide (p&lt;0.01 to p&lt;0.0001); (iii) TNF-α, IL-8 and resistin levels were positively and adiponectin was negatively correlated with HOMA-IR and C-peptide (p&lt;0.001 to p&lt;0.0001); and (iv) FFAs predicted cytokine levels. For example, women with elevated palmitic acid were 50% (p&lt;0.01) more likely to have higher IL-8 and TNF-α (highest quartile), whereas women with higher palmitoleic, oleic, linolenic acids levels had a reduced risk (∼2-fold, p&lt;0.01 to p&lt;0.001) of having higher IL-8, IL-6 and TNF-α levels.
Our data suggest that different FFAs are involved in the regulation of insulin resistance and production during pregnancy. The effects are either direct or indirect via modulating inflammatory responses. Thus, recognition and modifying individual FFAs are important in lowering the risk for impaired glucose tolerance and the development of GDM.

Disclosure
X. Chen: None. T.P. Stein: None. T.O. Scholl: None. R.A. Steer: None.
Relationship of Habitual Sedentary Behavior with Glycemic Control in People with Type 2 Diabetes
Authors: ALOTHMAN SHAIMA , ALSHEHRI MOHAMMED , ALENAZI AQEEL M. , KLUDING PATRICIA 
Published: June 2018

Objective: Sedentary behavior (SB) has been shown to have an acute negative effect on glucose and insulin metabolism in people who are healthy and those with diabetes. It is unknown whether habitual SB will negatively affect long-term glycemic control as measured by HbA1c. Therefore, the purpose of this study is to examine the relationship between habitual SB and HbA1c in people with type 2 diabetes (T2D).
Methods: Objective assessment of SB and overall daily physical activity was collected in people with T2D in this cross-sectional analysis by asking the participants to wear an activity monitor with accelerometer and inclinometer measures (ActivPAL) for 7 days. The following variables average were included to examine the relationship with HbA1c (measured via disposable blood finger stick test using (A1cNow+) kit): total sitting time (TST), standing time (ST), walking time (WT).
Results: Total of 31 participants (65 ± 7.64 years, 10 males) were included in the analysis. The main outcomes averages were as follow: HbA1c 7.33 ± 1.41, TST 11.43 hr. ± 2.21, ST 3.86 hr. ± 1.65, WT 1.49 hr. ± 0.7. Person correlation coefficients test showed that HbA1c was positively correlated with TST (r= 0.365, p&lt;0.05) but not with ST (r= - 0.293, p=0.11) or WT (r= - 0.291, p=0.11).
Conclusion: The results of this study indicates that SB level is an important modifiable factor in glycemic control in people with T2D. This effect appears to be independent of daily physical activity level. Future studies should focus on establishing causality between SB and long-term glycemic control. As many people with T2D struggle to meet recommended physical activity levels, targeting SB may be an important step in the process of reaching a healthy lifestyle.

Disclosure
S. Alothman: None. M. Alshehri: None. A.M. Alenazi: None. P. Kluding: None.