bluuebunny/crossref_metadata_2025_split huggingface dataset:
2398-PUB: The Interplay of Type 1 Diabetes and Weight: A Qualitative Study of Thematic Progression with Age
Authors: ADDALA ANANTA , IGUDESMAN DARIA , KAHKOSKA ANNA R. , MUNTIS FRANKLIN R. , SOURIS KATHERINE J. , WHITAKER KERI J. , PRATLEY RICHARD E. , MAYER-DAVIS ELIZABETH 
Published: June 2019

The impact of weight management in persons with type 1 diabetes (T1D) from childhood into adulthood is not well described. The purpose of the study is to explore qualitative themes presented by young adults on both weight and T1D management.
We analyzed focus group data from 17 young adults with T1D via inductive qualitative analysis. Major themes were compared to published themes presented by youth with T1D to categorize thematic progression from youth to adulthood.
Themes from young adults with T1D, when compared to youth, are categorized as: unchanged, evolving, and newly reported. Hypoglycemia and a sense of futility around exercise was an unchanged theme. Importance of insulin usage and a need for a healthy personal relationship with T1D evolved to gather greater conviction. Newly reported themes are unique to integration of adulthood into T1D, such as family planning and work-diabetes balance. Young adults also newly reported negative experiences with providers in their younger years and desire for more supportive provider relationships.
Issues identified by youth regarding the dual management of T1D and weight rarely resolve, but rather, persist unchanged or integrate other aspects of young adulthood via evolving or newly emerged themes. Individualized and age-appropriate clinical support and practice guidelines are warranted to facilitate the dual management of weight and T1D in persons with T1D

Disclosure
A. Addala: None. D. Igudesman: None. A.R. Kahkoska: None. F.R. Muntis: None. K.J. Souris: None. K.J. Whitaker: None. R.E. Pratley: Consultant; Self; Sanofi US. Other Relationship; Self; AstraZeneca, Eli Lilly and Company, GlaxoSmithKline plc., Janssen Global Services, LLC., Janssen Research & Development, Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk Inc., Pfizer Inc., Sanofi, Takeda Development Center Americas, Inc. E. Mayer-Davis: None.
2399-PUB: Multidisciplinary Clinic-Based Model for Mild Ketosis and Dehydration Management in Youth with Diabetes
Authors: KIM GRACE K. , MIXON ALVA , MARSHALL MELISSA A. , TAUB MICHELLE E. , JARAMILLO MARIANA , SCROGGINS DIANA , BANSAL NIDHI , KARAVITI LEFKOTHEA , MCKAY SIRIPOOM 
Published: June 2019

Background: Diabetic ketoacidosis (DKA) is a major cause of emergencies in youth with type 1 diabetes constituting a health burden. Nonadherence and knowledge gaps are key contributors. Patients with mild ketosis and dehydration are typically managed in the EC without multidisciplinary evaluation.
Objective: We developed a quality improvement initiative to improve access and reduce emergency center (EC) visits for pediatric patients with type I diabetes with mild ketosis not tolerating oral intake, and to deliver family centered multidisciplinary education addressing diabetes knowledge gaps and psychosocial barriers.
Methods: A multidisciplinary focus group of physicians, nurses, certified diabetes educators (CDE), and social workers (SW), determined criteria for patients who could be cared for in Urgent Care Bay (UCB) rather than EC. Eligible patients with type 1 diabetes were &gt;5 years old who could not tolerate oral intake, and had low-to-moderate ketones. SW identified and addressed psychosocial barriers to optimal diabetes management. CDE assessed and provided structured education addressing knowledge gaps.
Results: Of 17 referred patients, 9 were seen in UCB (8 by CDE; 7 by SW). None required transfer to EC. SW referred 4 patients to psychology: 2 seen in UCB, 2 referred to community psychology. Time spent in multidisciplinary UCB visit was not longer than traditional EC-managed visits.
Conclusion: This multidisciplinary approach may help pediatric patients with diabetes with mild ketosis who are not tolerating oral intake. Multidisciplinary teaching and psychosocial interventions provided while patients are only mildly sick may help patients avoid future admissions. It remains to be seen whether this comprehensive model of education and hydration of mildly sick patients with diabetes will provide cost effectiveness in terms of overall EC admissions.

Disclosure
G.K. Kim: None. A. Mixon: None. M.A. Marshall: None. M.E. Taub: None. M. Jaramillo: None. D. Scroggins: None. N. Bansal: None. L. Karaviti: None. S. Mckay: None.
2400-PUB: Assessment of Parental Preparedness for Transition of Their Child’s Diabetes Care from Pediatric to Adult Providers
Authors: SHANK KAITLYN R. , REALL MACY , KRISHNA KANTHI BANGALORE 
Published: June 2019

Background: Youth with diabetes and their parents are not prepared for transition to adult care. Several studies suggest that transition planning should start early, however, the role for parental input in this process is not well defined. At our center, we are working on implementing a transition readiness class to better prepare our families for transition care to adult providers. Parents were administered a standardized questionnaire (Gottransition.org) to assess their perspectives on their child’s transition readiness.
Results: Of the parents of 19 youth (13M, 6F; 11 on pumps, 8 on multiple daily injections (MDI)) only 37% felt confident about their child’s transition preparedness while nearly all (84%) felt it was important for their child to prepare for the transition before age 22. Table 1 shows the parental assessment of their child’s healthcare navigation and autonomy.
Discussion: While there is recognized importance for improving transition preparedness amongst diabetic youth, parents have poor confidence in their child’s ability to do so, which was found to be even lower in patients on MDI than on a pump. Parents believe there is need for education particularly on healthcare navigation and autonomy. These findings support the need for implementation of a formal curriculum to educate diabetic youth on specific healthcare navigation elements before transitioning to adult providers.

Disclosure
K.R. Shank: None. M. Reall: None. K. Bangalore Krishna: None.
2421-PUB: Effect of Incidental Postprandial Hypoglycemia on OGTT in Pregnancy on Maternal and Foetal Outcomes
Authors: POTHINA NARAYANA PRASAD , DESHMUKH HARSHAL , PANIKKAR MOHINI , MOHAMMED M. , SATHYAPALAN THOZHUKAT 
Published: June 2019

Aim: The implications of incidental hypoglycaemia during 75g oral glucose tolerance test in pregnant women affects the maternal and fetal outcomes is unclear.
Materials and Methods: We conducted a retrospective analysis of the 1663 women who underwent 75g 2 hour OGTT at 24-28 weeks of gestation between January 2015 to December 2017. Post-prandial hypoglycaemia was defined as blood sugar levels less than 4mmol/L. Sub-optimal birth weight was defined as birth weight less than 3000g. Parametric and non-parametric tests were used to compare baseline characteristics of those with and without post-prandial hypoglycaemia. Linear regression analysis was used to identify independent predictors of birth weight.
Results: Of the 1663 patients, 178 (10.7%) had GDM. In patients without GDM 126 (8%) had post-prandial hypoglycaemia. There were no significant differences in baseline anthropometric and clinical characteristics of those with and without post-prandial hypoglycaemia. After adjustments for age (p=0.003), gestational age at delivery (p&lt;0.0001), ethnicity (p-value&lt;00001), fasting glucose (p&lt;0.0001), and smoking (p-value&lt;0.0001), post-prandial hypoglycaemia was associated with lower birth weight (beta=-106.5, p value=0.01). After adjustment for the above covariates post-prandial hypoglycaemia was significantly associated with suboptimal-birth weight (OR=1.99(CI 1.5-2.4)p-value=0.005). There were no significant differences in APGAR score at 1 and 5 minute (9.63 vs. 9.70 p-value=0.28 at 5 minutes), mode of delivery, bleeding complications during delivery (p=0.8) and neonatal admission to critical care (p=0.8) in those with post-prandial hypoglycaemia as compared to those without it.
Conclusion: Incidental post-prandial hypoglycaemia during the OGTT is associated with suboptimal birth weight and these pregnant women need close follow-up to monitor fetal growth.

Disclosure
N. Pothina: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. H. Deshmukh: None. M. Panikkar: None. M. Mohammed: None. T. Sathyapalan: Speaker's Bureau; Self; Novo Nordisk Foundation. Other Relationship; Self; Bristol-Myers Squibb Company, Eli Lilly and Company, Sanofi-Aventis.
2424-PUB: Progressive Albuminuria as a Key Factor Potentially Determining Cardiovascular Prognosis in the Elderly with Type 2 Diabetes: From a Three-Year Interim Report of a Cohort Study, Nagano Study 2
Authors: YAMAZAKI MASANORI , SHIBATA YUSUKE , KAWAI YUKO , KOMATSU MITSUHISA 
Published: June 2019

Objective: The purpose of this study is to explore potential prognostic factors and contribute scientific evidence of treatment for the elderly with type 2 diabetes (T2D).
Methods: Japanese patients with T2D aged ≥20, who had received regular medical examination for at least a year and had no history of malignancy for 5 years before enrollment, were consecutively registered. Information on subjects’ physical findings, laboratory data, and outcome was collected each year. In this study statistical analysis was performed in the participants followed for 3 years.
Results: As of October 2017, 205 patients were identified as analytical objects. The patients were divided into two groups; the elderly: ≥65 years (n=111, age 73.6 years, T2D duration 16.4 years, HbA1c 7.1%) and the non-elderly: &lt;65 years (n=94, age 55.6 years, T2D duration 12.3 years, HbA1c 7.1%). At baseline, as compared with the non-elderly, the elderly had significantly low BMI (24.4 vs. 27.1 kg/m2), diastolic blood pressure (74.1 vs. 78.2 mmHg), fasting plasma glucose levels (107.5 vs. 125.0 mg/dL), eGFR (63.7 vs. 75.5 mL/min/1.73 m2), and fasting triglyceride levels (107.5 vs. 125.0 mg/dL). Over 3 years, a significant difference in those above was continuously observed between the two groups, whereas the elderly had significantly lower postprandial triglyceride levels than the non-elderly (130.0 vs. 155.7 mg/dL). In addition, urinary albumin excretion rate significantly increased from a baseline of 220.7 to 400.5 mg/gCr with eGFR decline (56.9 mL/min/1.73 m2) in the elderly, but not in the non-elderly.
Conclusions: Albuminuria is well known to be associated with development of cardiovascular diseases. In Japanese elderly patients with long T2D duration and well-controlled HbA1c, blood pressure, and blood lipid, progressive albuminuria with eGFR decline may have the potential to determine their cardiovascular prognosis.

Disclosure
M. Yamazaki: None. Y. Shibata: None. Y. Kawai: None. M. Komatsu: None.
2431-PUB: Distance from Glycemic Target at the Time of Intensification in Patients with Type 2 Diabetes (T2D) Failing Metformin Dual Therapy in the United States
Authors: FERNANDES GAIL , SAWHNEY BAANIE , HANNACHI HAKIMA , WANG TONGTONG , MCNEILL ANN MARIE , IGLAY KRISTY , RAJPATHAK SWAPNIL 
Published: June 2019

Several studies have previously reported “clinical inertia” in the sequential treatment of T2D patients. The objective of the study was to quantify the distance from HbA1c target at the time of treatment intensification among patients failing dual therapy of metformin and another oral antihyperglycemic agent (OAHA). This retrospective study was conducted using GE Centricity Electronic Medical Record database (2015 data). Patients included those with diagnosed T2D on metformin dual therapy with at least 12 months of continuous enrollment prior to index date (initiation of dual therapy), documented HbA1c ≥7% and intensifying therapy within two years following index date. Treatment intensification was defined as either addition of another OAHA or initiation of insulin/glucagon-like peptide-1 receptor agonists. Distance from glycemic target was calculated as the median difference of HbA1c from target of 7% at the time of therapy intensification. 864 patients met the study criteria; mean age of 57.5 years, 48% were female, 26.3% had microvascular and 18.4% had macrovascular complications. Median difference from HbA1c target of 7% was 1.4%, with 29% (n=253) of patients between 1 to 2%, and 36% (n=315) greater than 2% distance from HbA1c target. When we excluded those for whom higher HbA1c target may be more appropriate (those ≥65 years, with micro- or macrovascular complications or with history of hypoglycemia), the median difference was 1.6%. This study suggests that majority of metformin dual therapy patients (65.7%) were at least 1% away from target of 7% at the time of intensification of therapy. Future studies should explore reasons behind this lack of earlier intensification and factors associated with clinical inertia.

Disclosure
G. Fernandes: None. B. Sawhney: Consultant; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson & Johnson. Employee; Self; Merck & Co., Inc. A. McNeill: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: None.
2437-PUB: Prevalence of Liver Fibrosis in Diabetic Nonalcoholic North Indian Patients Attending a Tertiary Care Hospital
Authors: KAKKAR ARPIT 
Published: June 2019

Introduction: India, diabetes capital of the world has over 50 million people with type 2 DM. Incidence of DM is increasing, so does the complications, including nonalcoholic fatty liver disease (NAFLD) and consequent liver fibrosis. NAFLD, regarded as hepatic manifestation of metabolic syndrome, affects 40-70% of DM patients and about 7% of these had advanced liver fibrosis on MR Elastography.
Aim: To determine prevalence of liver fibrosis in nonalcoholic diabetics attending our hospital in North India.
Material and Methods: Type 2 DM patients aged between 18-65 years, who attended outdoor clinics were included in this single center prospective observational study. Patients with decompensated chronic liver disease, pregnancy and T1 DM were excluded. All patients underwent ultrasound shear wave elastrography (USG-SWE). Average of serial intercostals space scan values (kilopascals and metavir) was calculated and analyzed.
Results: Of the 64 eligible patients, their mean age was 54 years and male to female ratio was 0.7:1. Normal liver parenchyma was found in 59.37% diabetic patients and 40.6% were found to have different grades of fibrosis.
Conclusion: The prevalence of nonalcoholic liver fibrosis among type 2 DM patients in North Indian population is 40.6%. With this obtained high number, we recommend screening of every diabetic patient with USG-SWE as an early modality to diagnose liver fibrosis.

Disclosure
A. Kakkar: None.
2445-PUB: Impact of Primary Aldosteronism on Renal Function in Type 2 Diabetes Patients
Authors: KATSURAGAWA SHO , TSURUTANI YUYA , TAKIGUCHI TOMOKO , SAITO JUN , NISHIKAWA TETSUO 
Published: June 2019

Primary aldosteronism (PA) is associated with higher renal damage than essential hypertension (HT). In particular, the prevalence of chronic kidney disease increases after treatment for PA, as actual renal damage may be underestimated in untreated PA due to glomerular hyperfiltration. Previous studies have indicated the role of the renin-angiotensin-aldosterone system in renal dysfunction in type 2 diabetes (T2DM) patients, but whether PA causes additional renal function damage in T2DM is unclear. The aim of this study was to investigate this issue. A retrospective review of all T2DM outpatients who visited our high-volume center for PA in the FY 2017 was carried out. We segregated patients that underwent PA treatment (PA group) and those without PA (non-PA group). Treatment for PA was defined as adrenalectomy or the use of aldosterone receptor antagonists (MRAs). Untreated PA was excluded, since renal damage might be underestimated in these patients. We compared the renal function between these two groups. There were 83 patients in the PA group and 1580 patients in the non-PA group. In the PA group, 21 patients underwent adrenalectomy, 60 patients underwent MRA treatment, and 2 patients underwent both. Compared to the non-PA group, patients in the PA group were younger (62 [55-69] vs. 66 [55-75] years, p=0.014), and had a higher BMI (25.9 [23.8-27.8] vs. 24.8 [21.7-28.1] kg/m2, p=0.019) and lower HbA1c (6.8 [6.5-7.1] vs. 7.3 [6.7-8.0]%, p&lt;0.001). In the renal function evaluation, the PA group had significantly lower eGFR (66.3 [52.4-78.2] vs. 70.5 [56.0-85.6] ml/min/1.73 m2, p=0.047) than the non-PA group. Multiple regression analysis revealed that PA was a factor for decreased eGFR, independent from age, sex, BMI, HbA1c, and HT (p=0.007). PA induced a 3.3 (95% CI: 0.90-5.7)-ml/min/1.73 m2 decrease in eGFR, equivalent to 3.8 years of aging. Our results show that PA was a risk factor for renal dysfunction independent from HT in T2DM patients. To prevent the progression of renal failure, PA should not be overlooked.

Disclosure
S. Katsuragawa: None. Y. Tsurutani: Research Support; Self; Astellas Pharma Inc. T. Takiguchi: None. J. Saito: None. T. Nishikawa: None.
2461-PUB: Increased Apolipoprotein A1 Can Suggest the Presence of Latent Autoimmune Diabetes and a Lower Cardiovascular Risk Compared with Type 2 Diabetes
Authors: LJUBIC SPOMENKA , JAZBEC ANAMARIJA , ANTAL IVANA , CUDINA IVONA , TOMIC MARTINA , VUCIC LOVRENCIC MARIJANA 
Published: June 2019

Latent autoimmune diabetes (LADA) could be misdiagnosed as type 2 diabetes (DM2). Lipids, apolipoproteins, adiponectin (APN), interleukin-6 (IL-6), homocysteine (HCY), other markers of DM, including antibodies, were tested in 276 patients with DM1, DM2 and LADA. Quartiles of lipid accumulation product (LAP) (Q1:≤21.23, Q2:(21.23, 40.69], Q3:(40.69, 92.02], Q4:&gt;92.02) were calculated as: [waist (cm) - 65 for men/58 for women] x triglycerides (mmol/L)]. In all statistical tests: ANOVA and Tukey post hoc test, and stepwise multivariate regression, α=0.05 was considered statistically significant. ANOVA revealed significant differences in HCY, APN, IL-6 and apolipoprotein A1 (Apo A1) among DM types. Patients with DM1 (1.73±0.33) and LADA (1.66±0.38) had significantly higher values of HDL compared to DM2 (1.33±0.31). IL-6 was statistically increased in DM2 compared to DM1; Apo A1 was statistically increased in LADA (1.7±0.36) compared to DM2 (1.4±0.22), whereas HCY was decreased (LADA: 10.9±2.74 vs. DM2 18.2±9.44). APN was decreased in DM2 compared to the control group. Logistic regression for DM2 pointed to APN (OR=0.826; p=0.02), HCY (OR=1.202; p=0.08) and HDL (OR=0.142; p=0.08) as statistically significant predictors, whereas uric acid (OR=0.991; p=0.08) was a predictor of LADA. After stepwise procedure the best model for APN included HDL (R2=0.46), for HCY glomerular filtration (parR2=0.26) and Apo A1 (parR2=0.08), and for Apo A1 HDL (parR2=0.79) and fasting glucose (parR2=0.03). 60% of DM2 patients, but 10.5% of LADA were in the 4th LAP quartile. Patients in the 4th quartile had significantly lower values of APN and Apo A1 compared to 1th and 2nd quartiles; HCY was increased in 4th compared to the 1th quartile. Significantly increased HDL and Apo A1 and decreased HCY in LADA compared to DM2 uncover LADA prior to determination of antibodies. Only 10.5% of LADA patients in the 4th quartile pointed to a lower cardiovascular risk than in DM2.

Disclosure
S. Ljubic: None. A. Jazbec: None. I. Antal: None. I. Cudina: None. M. Tomic: None. M. Vucic Lovrencic: None.
2482-PUB: Circadian Clock Regulates Fuel Metabolism in Skeletal Muscles
Authors: LIU JIDONG , SUN ZHENG 
Published: June 2019

The nuclear receptors Rev-erbα and Rev-erbβ are transcription factors that function both as a core repressive component of the cell-autonomous circadian clock machinery. We conditionally depleted Rev-erbα and Rev-erbβ in skeletal muscles in mice to explore their function into energy metabolism. The conditionally knockout (KO) mice displayed glucose intolerance and reduced grip strength. The KO mice also had lower oxygen consumption and impaired glucose uptake during exercise, without alteration in the muscle fiber type composition, mitochondrial protein content, or home-cage locomotor activity. Transcriptional analysis in muscle revealed that Rev-erbs regulate many genes involved in fatty acid oxidation, glucose transportation, tricarboxylic acid (TCA) cycle, and BCAAs catabolism. These results demonstrate that muscle clock plays an important role in regulating the energy homeostasis for in skeletal muscles.

Disclosure
J. Liu: None. Z. Sun: None.

Funding
National Institutes of Health
2494-PUB: Betatrophin Inhibits Browning through AMPK Signaling in 3T3-L1 Cells
Authors: QI XIAOYAN , LIAO ZHEZHEN , WANG YADI , LI JIAOYANG , LIU JIANGHUA , XIAO XINHUA 
Published: June 2019

Browning of white adipocytes (beiging) is an attractive therapeutic strategy against obesity attributed to the enhanced capacity of heat production. Betatrophin as a novel cold-derived adipokines, is necessary for adipogenesis. Recent data suggest that Betatrophin deficient mice displayed increased thermogenesis and reduced body weight. But its role in the browning of white adipocytes remains unknown. Here, we report that deletion of Betatrophin in 3T3-L1 adipocytes enhanced expression of brown fat-specific markers (UCP-1, PRDM16 and CIDEA), mitochondrial biogenesis genes (PGC-1α) and the key lipid metabolism lipases (ATGL), Additionally, those effects were dramatically abolished by compound C, revealing silencing Betatrophin-induced browning depend on activation of AMPK signaling pathways. Overall, our findings suggest that Betatrophin is a candidate target gene treating obesity due to its function of inhibiting white adipocyte browning conversion.

Disclosure
X. Qi: None. Z. Liao: None. Y. Wang: None. J. Li: None. J. Liu: None. X. Xiao: None.