bluuebunny/crossref_metadata_2025_split huggingface dataset:
Searching for the High-Risk Group in Type 2 Diabetes by Anchoring of Distress
Authors: LIAO YIN-KAI , YANG YI-SUN , HUANG CHIEN-NING , PENG HSIU-LING 
Published: June 2018

Objective: This is a cross-sectional study aimed to explore the risk factors associated with diabetes distress in type 2 diabetes.
Research Design and Methods: Patients with type 2 diabetes were recruited from tertiary hospital in central Taiwan for a diabetes distress evaluation. Diabetes distress was assessed both at baseline using a 17-item Diabetes Distress Scale (DDS-17) in Chinese version. Baseline demographic characteristics and biochemistry data were collected. Linear regression models were used to examine the relationship between baseline variables and the scores in DDS-17.
Results: Three hundred and sixty participants completed DDS-17 scale, their mean (SD) age and diabetes duration were 59.9 (11.6) years and 9.8 (7.4) years, respectively, and 49.1% were women.The correlation between glycaemia and distress was significantly positive (r=.472, p&lt;.01) and distress can predict glycaemia significantly (R2=.223, p&lt;.01). The correlation between HbA1C and diabetes duration, diabetes distress were significantly positive (r = .142, .294, p&lt;.01). Furthermore, when diabetes distress predicted HbA1C, diabetes duration and age were mediators (βd = -.121, δR2 = .102, p&lt;.05; βa = -.128, δR2 = .091, p&lt;.05). Linear regression models, diabetes duration less than 4 years group were 3.26 times than the others (OR = 3.26, 95% CI 1.22-8.71). Younger age less than 50 years old were 5.53 times than the older aged (OR = 5.53, 95% CI 5.23-5.83). If considering age and duration simultaneously, the odds ratio of younger age and shorter disease duration were 10.71 times (OR = 10.71, 95% CI 2.28-50.36).
Conclusions: The high-risk group for diabetes distress was younger than 50 years old and shorter duration less than 4 years. HbA1C was easily raised in shorter duration of disease and in younger age patients when their diabetes distress increased. The findings can help clinicians to select in education or psychotherapy, and improve their distress and stabilize their glycemic control.

Disclosure
Y. Liao: None. Y. Yang: None. C. Huang: None. H. Peng: None.
Prevalence of Depression among Nepalese Patients with Type 2 Diabetes Attending Endocrine Clinic in Kathmandu, Nepal
Authors: YONZON PRIYADARSHINI , JOSHI ANSUMALI , GHIMIRE MONIKA 
Published: June 2018

Background: Diabetes mellitus is a common chronic metabolic disorder in Nepal.Stressful living conditions and chronic illnesses make Nepalese people psychologically vulnerable. In a meta-analysis review the prevalence of major depression in people with diabetes was 11%.Limited studies have investigated the prevalence of depression in Nepalese population with diabetes.
Objective: To identify the prevalence of depression among Nepalese patients with type 2 diabetes and to examine the relationship between depression and socio-demographic factors, clinical factors and glycemic level.
Methods: This was a descriptive cross sectional study conducted at Kathmandu Diabetes and Thyroid Center Pvt Ltd, Nepal. Hundred thirty patients diagnosed with type 2 diabetes without prior history of depression were enrolled in the study. The translated Nepali version of Beck Depression Inventary (Ι a) was used to identify prevalence of depression. Data was analyzed with SPSS 16.
Results: The proportion of respondents with depression was 29.2%. Using chi-square test, the result showed significant association of gender (p=0.010), occupation (p=0.057) and complications of diabetes (p=0.001) with depression (Table).
Conclusion: Among the respondents, 29.2% were potential cases of depression. Psychological assessment should be included as a routine clinical evaluation for patients with diabetes.Total (n)DepressedNot depressedp- valueAge &lt;55 yrs&gt;55 yrs626829.03% (n 18)29.41%(n 20)70.96% (n 44)70.58% (n 48)0.962GenderMaleFemale646618.75% (n 12)39.39% (n 26)81.25% (n 52)60.60% (n 40)0.010Marital statusMarriedUnmarried1201027.5%(n 33)20% (n 5)72.5% (n 87)50% (n 5)0.133Family typeNuclearJoint745627.02% (n 20)32.14% (n 18)72.97% (n 54)67.85% (n 38)0.525Duration of illness&lt; 5 years&gt;5 years607026.67% (n 16)31.43% (n 22)73.33% (n 44)68.57% (n 48)0.552Complication of DiabetesPresentAbsent458546.66% (n 21)20% (n 17)53.33% (n 24)80% (n 68)0.001Fasting glucose level80-110 mg/dL&gt;110 mg/dL508024% (n 12)32.5% (n 26)76% (n 38)67.5% (n 54)0.300

Disclosure
P. Yonzon: None. A. Joshi: None. M. Ghimire: None.
The Mitochondrial Cholesterol Transporter TSPO—Gatekeeper of Gestational Progesterone Production
Authors: HAGHIAC MARICELA , MINIUM JUDI , SKOMOROVSKA-PROKVOLIT YELENNA , CATALANO PATRICK , DE MOUZON SYLVIE HAUGUEL 
Published: June 2018

During pregnancy, progesterone is exclusively produced by the placenta. As in all steroidogenic tissues, the first and rate-limiting step for the biosynthesis of placental progesterone is the import of cholesterol into the mitochondria via specific transporters. Plasma progesterone is 20% lower in pregnant obese women despite increased cholesterol availability suggesting an impairment in cholesterol import mechanisms. We investigated the role of the outer mitochondrial translocator protein (TSPO), the placental analog of StAR, as a potential regulator of placental progesterone production.
Study design: Villous fragments of placentas were collected at term scheduled Cesarean delivery of lean and obese women with normal glucose tolerance. Trophoblast cells were isolated and plated for primary culture. In vitro silencing of TSPO was performed by transfecting primary trophoblast cells with siRNA. Progesterone production was measured in lysates of trophoblast cells before and after TSPO silencing.
Results and Discussion: TSPO mRNA and protein expression were 2 to 3-fold lower in placentas of obese vs. lean women. TSPO siRNA silencing in trophoblast cells induced a 90% (p&lt;0.001) decrease in TSPO protein expression, with no change in other proximal translocators: the voltage anion dependent channel (VDAC) and the adenine nucleotide translocator (ANT). Progesterone concentration dropped by 85% (p&lt; 0.001) upon TSPO silencing. These results demonstrate that the cholesterol translocator TSPO directly regulates the production of placental progesterone. Together, our data point to mitochondrial dysfunction as a component of progesterone deficiency in obese pregnant women.

Disclosure
M. Haghiac: None. J. Minium: None. Y. Skomorovska-Prokvolit: None. P. Catalano: None. S. Hauguel de Mouzon: None.
Evaluation of the GLUCOCARD® W Blood Glucose Monitoring System’s Ease of Use
Authors: WALKER JULIE , GILL PATRICIA , MAHER DANIELLE , GLEISNER JOHN M. 
Published: June 2018

Background: It is critical that Blood Glucose Monitoring System’s (BGMS) are easy to use since they are an important tool in the management of diabetes mellitus, including the prevention of micro and macrovascular complications. The GLUCOCARD® W BGMS is intended for consumer use and is an aid in monitoring the effectiveness of diabetes management. The “Ease of Use” consumer study is typically evaluated as part of the FDA 510(k) approval process for BGMS.
Purpose: The objective of this study was to evaluate the Ease of Use for the GLUCOCARD® W BGMS.
Methods: A total of 148 untrained consumers with diabetes performed a fingerstick self-test and answered a questionnaire directed at Ease of Use of the device and test strip. The topics in the questionnaire included, “Inserting a Test Strip into Meter to Turn it On”; “Blood Draw into Test Strip (Capillary Action)”; “Reading the Meter Display”; “Removing Test Strip from Meter” and “Performing a Blood Glucose Test from your Fingertip.” The subjects were asked to rate the topics as Very Easy, Easy, Ok, Difficult or Very Difficult. For evaluation purposes, these topics were grouped as Positive (Very Easy/Ease/Ok) and Negative (Difficult/Very Difficult).
Results: The topics in the questionnaire received the following positive ratings (%): “Inserting a Test Strip into Meter to Turn it On”, 97.3% (144/148); “Blood Draw into Test Strip (Capillary Action)”, 100.0% (147/147, one subject did not rate this topic); “Reading the Meter Display” received a 99.3% (147/148); “Removing Test Strip from Meter”, 100.0% (148/148) and “Performing a Blood Glucose Test from your Fingertip”, 100.0% (148/148).
Conclusion: The GLUCOCARD® W BGMS scored an overall positive rating of 99.3% (average of the ratings) from the untrained consumers with diabetes evaluating the BGMS as Very Easy to Ok to use.

Disclosure
J. Walker: Employee; Self; Arkray, Inc. P. Gill: Employee; Self; Arkray, Inc. D. Maher: Employee; Self; Arkray, Inc. J.M. Gleisner: Employee; Self; Arkray, Inc..
The New Paradigm of Diabetes Care
Authors: SAKKAL SAAD 
Published: June 2018

Background: Achieving targets in diabetes care is still an elusive dream since &lt; 54% reach HgA1c&lt;7%. Is there a better paradigm? CGMS has proven its excellent data and analytics value.The Virtual Pancreas System (VPS) has proven its therapeutic value, by reaching Targets in &gt;% 80, to achieve the triple aim of optimum HgA1c/glucose variability, zero hypoglycemia or weight gain,it is now cloud-based, reachable by any mobile or internet as a VPS/metabolic simulator. The value index is how much money ($) is spent on improving HgA1c 1% in three months
Methods and Design: We compared, using the value index, in 10 matched patients the standard paradigm (SP) and the new CGMS/VPS paradigm. We projected savings on total diabetes care for 10 million people with diabetes. We present data for both paradigms and consider the better option.
Results: CGMS/VPS lowered HgA1c by the absolute value of 2.4% and the relative value of 2.7% when compared to standard paradigm(SP), which is better than many newer standard medications (DPP-4 lowers HgA1c by an average of 0.5%, SLGT2: 0.8-1, Dulaglutide: 1.08). With CGMS/VPS the glucose in targets was 82%, FBS was 123, PPG 154, hypoglycemia 0.8%, and weight -5 lbs, the value index was $236 per quarter.In standard care, the glucose in the target was 66%, FBS 148, PPG 186, and weight +6 lbs, and the value index was $1400 per quarter.
Conclusion: CGMS/VPS is a superior new paradigm.Here is how I envision the new brave world of diabetes care in the future: 1) each patient registers through their medical home, to the cloud-based VPS with secure password, with CGMS daily data transmission 2) Patients and providers receive instant feedback to act. 3)diabetologists supervise the process, consult and advice when necessary. 4) The goal of optimum diabetes care is reached with optimal HgA1C, optimal weight, and no hypoglycemia with quarterly CGMS. 5) This new paradigm will cut the burden of the diabetic epidemic scourge by 30 Billion/year; we could prove it by initiating real-life large multi-center studies. This should be the new paradigm: promising and achievable.

Disclosure
S. Sakkal: None.
Photoactivation of Autologous Transplantation of Subcutaneous Adipose Tissue Improves Glucose Homeostasis
Authors: WU JIANBO 
Published: June 2018

Photoactivation of autologous transplantation of subcutaneous adipose tissue improves glucose homeostasis Increasing evidences indicated that normal adipose tissue transplantation improves whole-body energy metabolism and glucose homeostasis in a high-fat diet (HFD)-induced obese mice model. Adipose tissue macrophage is associated with glucose homeostasis and insulin resistance in type 2 diabetes and obese humans, offering a potential target for therapeutics. However, whether transplantation of autologous AT that changed macrophage phenotype directly contribute to systemic glucose intolerance has not been determined. Here we specifically developed our device, with more specific wavelengths of light, to activate macrophage phenotype in isolated sWAT from HFD mice. We found that the macrophage polarization, M1 marker genes expression, such as CD11c, IL-6 and monocyte chemoattractant protein-1, but also the M1-to-M2 ratio were increased by an HFD and decreased by photoactivation treatment. Furthermore, autologous transplantation of photoactivated sWAT into a HFD mice reduced blood glucose level and caused significant improvement in glucose tolerance, which was not shown in a sham-operated or non-photoactivated sWAT HFD mice. Moreover, Positron emission/computed tomography scans indicated higher glucose uptake in heart, but not liver, hindlimb muscles, and abdominal subcutaneous white adipose tissue. These data suggested that the correlation with photoactivation to shift ATMs polarization of HFD mice caused significant improvement in glucose homeostasis, and that autologous transplantation might be a promising therapeutic option for the treatment of diabetes.

Disclosure
J. Wu: None.
A Comparative Study of Hybrid Artificial Pancreas and Virtual Pancreas System
Authors: SAKKAL SAAD 
Published: June 2018

Introduction: Advances in the last decade in Artificial Pancreas system (APS) have been promising and accelerating with the introduction of Hybrid CGMS/Pump infusion technology as a major step toward long-term Artificial durable pancreas. Also, there exist virtual system termed the Virtual Pancreas System (VPS) that makes treatment effective, and cut cost to achieve the triple aim of optimum HgA1c/glucose variability, averting hypoglycemia or weight gain. The system also adjusts insulin pump setting and recently used the data from CGMS to direct therapy. However, what is the cost-effectiveness of such system compared to Hybrid Artificial Pancreas?
Methods: We compared the features of both systems from the literature review. We wanted to determine how much money ($) is spent on improving HgA1c by 1% in three months, reaching glucose within target (70-170) range, and hypoglycemia rate &lt; 70 for both.
Results: 1.) VPS/CGMS lowered HgA1c by the absolute value of 2.4 in more than 90%. APS reported improvement in HgA1C of 1% recently.The Longest study is three months.
2.) VPS needs 14 glucose tests per month to get the optimum control or may use CGMS. APS needs CGMS.
3.) The diabetes care value index was: $236 per 1% HgA1C drop for VPS/CGMS, APS Value index still pending long-term study but short term it is $4000.
4.) VPS gets 90% glucose within target, APS 76% at this time, hypoglycemia 0 per patient in the VPS (or &lt;0.2%), 1.1 per patient in APS (or &lt;2%).
5.) VPS/CGMS costs $ 600/ year. APS as technology is still expensive. Our estimate it will be $12000/year for the next ten years
6.) VPS technology is available now. APS is still in early stage II or III clinical testing and will need ten years of clinical practice.
Conclusion: Virtual Pancreas System has superior Diabetes Care Value Index compared to any form of artificial pancreas system including the recently approved hybrid model intensive care. VPS will save more than $12000 yearly per patient, and $ 6 Billion nationally when compared to APS if applied only to &lt;10% of people with diabetes.

Disclosure
S. Sakkal: None.
Characteristics of Patients Newly Prescribed IDegLira in U.S. Real-World Practice
Authors: MOCARSKI MICHELLE , DA ROCHA FERNANDES JOAO DIOGO , KALLENBACH LEE , VASEY JOE , KEN JESSICA , BOGDANOV ALINA N. , RADIN MICHAEL , EGEDE LEONARD E. 
Published: June 2018

Background: IDegLira, a fixed-ratio combination of a basal insulin (BI), insulin degludec, and liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1), was approved by the FDA in Q4 2016 for the treatment of type 2 diabetes Mellitus (T2DM). This study describes characteristics of adult patients (pts) who initiated IDegLira in a real-world setting.
Methods: Demographic and clinical data for pts prescribed IDegLira between May and November 2017 were extracted from the Practice Fusion ambulatory care database. Pt characteristics were described for the 6-months prior to initiation. Pts were grouped by most recent antidiabetic therapy regimen in the prior 6-months.
Results: Pts prescribed IDegLira (n=388) received one of five prior therapy regimens: BI as only injectable (BI-INJ, N=88), GLP-1 as only injectable (GLP-INJ, N=47), GLP-1+insulin (GLP-INS, N=65), multiple daily insulin injections (MDI, N=35), and no injectable therapy (N-INJ, N=153). On average, IDegLira pts were 58 years old (SD 11.5); the majority (66%) between 40 and 64 years of age. Pts’ mean BMI was 35 (7.6). Mean A1C was 9.0 (1.82), with 12% below &lt;7%, 19% between 7-7.9%, 25% between 8-8.9%, and 44% &gt;9%. The N-INJ group had the highest mean A1C prior to initiating IDegLira (9.6), BI-INJ and GLP-INJ had intermediate means (both 9.0), and the GLP-INS and MDI groups had the lowest (8.4, 8.3). IDegLira patients previously treated with GLP-INS, MDI, and N-INJ had higher Charlson Comorbidity and Diabetes Complication Severity scores compared to patients previously treated with BI-INJ or GLP-INJ. Most prescriptions were written by PCPs (53%).
Conclusion: This analysis shows that initial use of IDegLira has been across a range of practices and clinical profiles. Most IDegLira prescribing occurred among pts on a previous injectable therapy, with those on single injectable therapy having higher A1Cs than those on multiple injectable therapies. Pts prescribed IDegLira with no injectable therapy in the prior 6 months had the highest A1C values.

Disclosure
M. Mocarski: Employee; Self; Novo Nordisk Inc.. Stock/Shareholder; Self; Novo Nordisk A/S. J. da Rocha Fernandes: Employee; Self; Novo Nordisk A/S, International Diabetes Federation. L. Kallenbach: None. J. Vasey: None. J. Ken: None. A.N. Bogdanov: None. M. Radin: Employee; Self; Novo Nordisk Inc. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Preferable Conversion Rate from Intravenous to Subcutaneous Insulin in Hyperglycemic Emergencies in Diabetic Patients
Authors: TAKAMINE HIKARU , NAMIKI YULIA , HIIRAGI HIROKO , YAMADA TAKU , TAKANO YUYA , OSADA URU N. 
Published: June 2018

To clarify the safe and effective conversion ratio from continuous intravenous insulin infusion (II) to subcutaneous long-acting insulin injection (SI) in diabetic ketoacidosis (DKA) or hyperosmolar hyper glycemic state (HHS), we conducted single center, retrospective, cohort study. Based on electronic medical records at our hospital from inception through September 2017, we extracted the subjects with DKA/HHS diagnosis. Other inclusion criteria were 1) no intermission between II and SI, 2) co-administered II and SI within 3 hours, and 3) aged ≥18 years old. We defined II requirement (IR) as the total II dose within 24 hours before conversion to SI. Then we divided subjects into 4 groups according to the percentage of SI to IR [group stratification: 0-39% (Q1), 40-69% (Q2), 70-89% (Q3), ≥90% (Q4)], and compared primary outcome which was the percentage achieving glycemic target of 80-180 mg/dl within 24 hours after the conversion. As the result, 44 subjects were included (male 52%, mean age 59 years old, mean HbA1c 11.6%, DKA 75%, median serous-CPR (CPR) 0.17 ng/ml). Median IR and the percentage of SI to IR were in inverse correlation; Q1=51 units (U), Q2=25.2U, Q3=27.2U, and Q4=7.1U (p=0.0001). In primary analysis, the median percentage achieving the glycemic target was highest with 67.5% in Q4, and was comparatively lower in the other groups; Q1=13.4% (p=0.01), Q2=16.7% (p=0.01), Q3=40% (p=0.089). In multivariate analysis adjusted with age, BMI, CPR and IR, ≥90% (β=14.6, SE=5.7, p=0.01) and ≥70% (β=9.1, SE=4.4, p=0.04) but not ≥40% were the significant factor to achieve the glycemic target. Hypoglycemia ≤70 mg/dl occurred only in 2% of entire subjects, and the incident rate were not different between the groups.
In summary, our result indicated that at least 70% of the conversion ratio was required for the safe and effective conversion from SI to II in DKA/HHS.

Disclosure
H. Takamine: None. Y. Namiki: None. H. Hiiragi: None. T. Yamada: None. Y. Takano: None. U.N. Osada: None.
Antidiabetic Effect of JP-2266, a Novel SGLT1/2 Dual Inhibitor, for the Treatment of Type 1 Diabetes
Authors: PARK YOUNGJUN 
Published: June 2018

JP-2266, a potent, a new synthetic small molecule, is highly selective sodium glucose cotransporter (SGLT) 1 and 2 inhibitor, and offers new therapeutic regimen by improving glycemic control for type 1 diabetes mellitus (T1DM). Insulin used for blood glucose lowering, which is an important agent in controlling blood glucose in T1DM patients, however, it is not easy to be administrated due to inconvenience of injection and hypoglycemic risk. JP-2266, as adjunct therapy to insulin, is expected to overcome the shortcomings of insulin monotherapy in T1DM.
We discovered JP-2266, a preclinical candidate to develop as an agent for the treatment of type 1 diabetes. IC50 values of JP-2266 were 10.1 nM and 1.3 nM, respectively, for SGLT1 and SGLT2 in vitro glucose uptake assay. Sotagliflozin which is known as a SGLT1 and 2 dual inhibitor was 36 nM and 1.8 nM, respectively, in vitro glucose uptake assay.
Also JP-2266 showed a significant decrease postprandial blood glucose level in type 1 diabetes rat models. When JP-2266 was treated with 1, 2, or 5 mg/kg by single oral administration in streptozotocin (STZ)-induced T1DM rat model, AUC0-4h (mg·h/dL) for 4 hours in OGTT was 38.4%, 48.1% and 56.4%, respectively, compared to vehicle treated group. Moreover, STZ rats treated with 5mg/kg of JP-2266 showed the same AUC0-4h reduction rate as the high-dose insulin treated group (1.8U/kg), and blood glucose reduction rate of JP-2266 and Sotagliflozin at 10 mg/kg was 49.4% and 39.1%, respectively, compared to vehicle treated group in oral repeated administration for 28 days. Additionally, HbA1c of JP-2266 treated group was 6.4%, while Sotagliflozin treated group was 7.2% at 10 mg/kg.
We suggest that JP-2266 will be a potent candidate agent for the treatment of T1DM, since JP-2266 has a more potent reducing effect on hyperglycemia in OGTT and showed comparable effect by oral repeated dose administration than those of Sotagliflozin.

Disclosure
Y. Park: None.