bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antiplatelet Therapy as a Primary Prevention Strategy for Cardiovascular Disease in Type 2 Diabetes Mellitus in Taiwan—A Population-Based Study
Authors: YEH YI-CHUN , CHEN PEI-YIN , CHEN YEN-YU 
Published: June 2018

Purpose: The American diabetes association (ADA) standards of medical care in diabetes 2017 recommends considering aspirin therapy as a primary prevention strategy for patients with type 2 diabetes who are at increased cardiovascular risk. The aim of this study was to investigate the prescription rate of antiplatelet as a primary prevention treatment in diabetes patients in Taiwan.
Methods: We conducted a new user cohort from the Taiwan longitudinal cohort of diabetes patients (LCDP) between 1999 and 2013 in diabetes patients aged over 20. We stratified these patients into three risk group (low, intermediate, and high risk) according to the standards of medical care in diabetes 2017 to explore the utilization of antiplatelet agent as a primary prevention strategy in each risk stratification.
Results: We assembled a diabetic cohort (n=513,012) who were potentially eligible for primary prevention therapy. We then stratified them into low (n= 27,572), intermediate (n=190,038) and high (n= 295,402) cardiovascular risk. Around 1% of patients in the low-risk group were dispensed antiplatelet agents, 8% in the intermediate-risk group, and about 16% in the high-risk groups. The median dispensing days for total follow-up period in those with low risk was 189 days, equally 12% of the period from initiating antiplatelet agents to study end. The median dispensing days for those with high risk was 392 days, about one-fourth of the period from starting antiplatelet agents to study end.
Conclusions: Aspirin or alternative effective antiplatelet agents as a primary prevention treatment for type 2 diabetes patients with increased cardiovascular risks were underutilized in Taiwan.

Disclosure
Y. Yeh: None. P. Chen: None. Y. Chen: None.
Type 2 Diabetes Remission—Analysis of Three Population-Level Historical Cohorts
Authors: TANGELLOJU SRIKANTH , VU GIANG , CHAVIS-BLAKELY HUNTER , LITTLE BERT B. 
Published: June 2018

Objective: To analyze the characteristics of individuals who went into remission for type 2 diabetes mellitus (T2DM) in the absence of bariatric surgery in three large population level datasets.
Methods: Data from three large T2DM cohorts were used in this analysis: a) 10,059 subjects from a longitudinal Medicare cohort (n=2.4 Million); b) 4,997 subjects, Continuous NHANES (n=82,091); and c) 562 subjects, NHANES III (n=33,994). A Medicare T2DM individual with no T2DM related claims continuously for more than 12 months was considered to be in remission. In the NHANES data T2DM remission was defined as an HbA1c ≤ 5.7 without T2DM related medications. Cox proportional hazards was used to identify significant variables associated with T2DM “remission” in the Medicare data. NHANES data were analyzed with multiple logistic regression with T2DM remission as the dependent variable.
Results: In the Medicare dataset 4.97% met the criteria for T2DM remission in a five-year longitudinal study, while 2.76% and 1.97% of the continuous NHANES and the NHANES III subjects, respectively, achieved remission in the cross-sectional cohorts. The factors associated with T2DM remission were no statin use; no insulin use; no hypertension; no hyperlipidemia; no neuropathy; no retinopathy; female gender; non-African American ethnicity; decreased waist circumference and lower systolic blood pressure (Bonferroni adjusted p≤0.05). The rate of T2DM remission appears to be approximately 1.97 to 4.97%.
Conclusions: T2DM remission triggers exist (Lancet, Dec 2017). Of the factors associated with T2DM remission, only ethnicity and gender are non-modifiable risk factors. Therefore, diabetes prevention and management programs should concentrate on lowering body weight, lipids, and blood pressure. Management of these factors is associated with T2DM remission. Identification of other factors associated with T2DM may lead to more efficacious programmatic management of the disease and attenuation of serious co-morbidities.

Disclosure
S. Tangelloju: Employee; Self; Humana Inc.. G. Vu: None. H. Chavis-Blakely: None. B.B. Little: None.
The Number of Metabolic Syndrome Components and Incidence Rates of Type 2 Diabetes—A Korean National Sample Cohort Study
Authors: LEE MIN-KYUNG , KWON HYUK-SANG 
Published: June 2018

Background: Metabolic syndrome (MetS) is associated with an increased risk of diabetes. In this study, we aimed to investigate the incidence rate of type 2 diabetes according to the number of MetS components using data from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC).
Methods: A total of 24,582,108, aged 20 years or older, with no history of diabetes were recruited between 2009 and 2012. MetS components were defined using the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Type 2 diabetes was defined as a current medication history of antidiabetic drugs and the presence of International Classification of Diseases (ICD)-10 codes (E11-E14) as diagnosis.
Results: The number of MetS components gradually increased with increasing age. Over a total of 118,311,497.11 person-years of follow-up, 658,934 subjects were diagnosed with type 2 diabetes. The multivariable-adjusted hazard ratios for incident diabetes for the number of MetS components were 2.54, 4.83, 7.92, 11.78 and 20.94 for one, two, three, four or five components, respectively, compared with the absence of components. The risk of diabetes with regard to each component of MetS was 1.76 for high fasting plasma glucose, 1.44 for high blood pressure, 1.19 for central obesity, 1.17 for high triglycerides, and 1.15 for low HDL cholesterol. The combinations that included high fasting plasma glucose level appeared to be more strongly associated with the risk of diabetes than other combinations with the same number of MetS components.
Conclusions: The risk of diabetes gradually increased with the increasing number of MetS components. Among the components, hyperglycemia was the most powerful predictor of diabetes. Our findings indicate that the risk stratification of individuals by the number of MetS components and hyperglycemia status can detect individuals with a high risk of diabetes.

Disclosure
M. Lee: None. H. Kwon: None.
Prospective Association between Gestational Diabetes and Subsequent Abnormal Liver Function Scores 9 to 16 Years after Pregnancy
Authors: DONNELLY SARAH , HINKLE STEFANIE , RAWAL SHRISTI , GRUNNET LOUISE , CHAVARRO JORGE E. , VAAG ALLAN A. , WU JING , DAMM PETER , MILLS JAMES , LI MENGYING , BJERREGAARD ANNE A. , BAUN THUESEN ANNE CATHRINE , GORE-LANGTON ROBERT E. , FRANCIS ELLEN C. , LEY SYLVIA , HU FRANK , TSAI MICHAEL Y. , OLSEN SJURDUR F. , ZHANG CUILIN 
Published: June 2018

Chronic hyperglycemia is a risk factor for liver dysfunction. Women with gestational diabetes mellitus (GDM), glucose intolerance first recognized in pregnancy, may identify a population of individuals at an increased risk for liver complications. However, large prospective studies examining liver function following a GDM pregnancy are lacking. The Diabetes & Women’s Health (DWH) Study (2012-2014) followed women with and without GDM in the Danish National Birth Cohort (DNBC). DNBC was a population-based cohort study of pregnant Danish women (1996-2002). At 9-16 years postpartum, the DWH Study conducted a clinical exam and collected bio-specimens on 607 of 1,274 women with GDM and 619 of a random sample of 1,457 women without GDM during the index DNBC pregnancy. Markers of liver function measured at follow-up included: alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). Liver function scoring indices were used to assess liver capacity including: nonalcoholic fatty liver disease liver fat score (NAFLD-LFS), fatty liver index (FLI), hepatic steatosis index (HSI), and liver fat percentage. The mean (standard deviation) age (years) at follow-up for women without and with prior GDM was 43.4 (4.5) and 43.8 (4.6), respectively. Women with prior GDM had an increased risk at follow-up of elevated NAFLD-LFS (Adjusted Relative risk [RR], 2.34; 95% CI, 1.68-3.27), FLI (RR, 1.59; 95% CI, 1.27-1.99), and HSI (RR, 1.44; 95% CI, 1.21-1.71) adjusted for pre-pregnancy BMI and other relevant risk factors compared to women without prior GDM. Women with prior GDM also had a significantly higher fatty liver percentage (Adjusted difference (%), 1.93; 95% CI, 1.10-2.77). Women with GDM during pregnancy were at an increased risk for subsequent abnormal liver function 9-16 years postpartum. GDM may serve as another risk indicator for the early identification and prevention of liver dysfunction.

Disclosure
S. Donnelly: None. S. Hinkle: None. S. Rawal: None. L. Grunnet: None. J.E. Chavarro: None. A.A. Vaag: Employee; Self; AstraZeneca. J. Wu: None. P. Damm: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. M. Li: None. A.A. Bjerregaard: None. A. Thuesen: None. R.E. Gore-Langton: None. E.C. Francis: None. F. Hu: None. M.Y. Tsai: None. S.F. Olsen: None. C. Zhang: None.
Subjective Sleep Debt Is Correlated with Body Fat Percentage Independent of Sleep Duration
Authors: TAN XIAO , BENEDICT CHRISTIAN 
Published: June 2018

No study has investigated whether subjective sleep debt (i.e., the gap between self estimations of sleep duration and sleep requirement) is linked to body fat mass. We studied 20,531 Swedish adults aged between 36 and 78 years (mean age: 60.9 ± 8.5 years, 56.6% women). Self-reported sleep duration and sleep needed for feeling fully rested (both in hours/day) were obtained by questionnaire. Subjective sleep debt per day was calculated by subtracting the value of sleep requirement with sleep duration. Fat mass was estimated by bioelectrical impedance analysis. Body fat percentage was calculated based on fat mass (kg) per total body mass (kg). Analysis of covariance (adjusting for age, gender, and self-reported sleep duration) was utilized to test the body fat percentage differences between hours of sleep debt, followed with Bonferroni corrections for multiple comparisons. Compared to those without subjective sleep debt, adults reporting a sleep debt of 2 hours and 3 hours or more were respectively associated with a 0.9 (95% CI: 0.5, 1.3) and 2.2 (95% CI: 1.4, 3.1) higher percentage of body fat mass (both p &lt; 0.001). The corresponding differences when comparing these two groups to those reporting 1-hour sleep debt were 1.4 (95% CI: 1.0, 1.8) and 2.7 (95% CI: 1.9, 3.5), (both p &lt; 0.001). The results suggest that subjective sleep debt of greater than one hour per day is associated with significantly higher body fat percentage.
Subjective sleep debtBody fat percentageTotalWomenMenMean (95% CI)Mean (95% CI)Mean (95% CI)0 hour30.0 (29.9, 30.1)35.2 (35.0, 35.4)24.8 (24.7, 25.0)1 hour29.5 (29.4, 29.7)34.9 (34.7, 35.1)24.2 (24.0, 24.4)2 hours30.9 (30.7, 31.2)36.2 (35.8, 36.5)25.7 (25.3, 26.1)3 hours or more32.3 (31.7, 32.8)37.2 (36.5, 37.8)27.3 (26.5, 28.2)

Disclosure
X. Tan: None. C. Benedict: None.
Seasonal Trends in HbA1c Level in Adult Patients with Type 1 Diabetes Treated with Personal Insulin Pumps
Authors: MATEJKO BARTłOMIEJ , KIEC-WILK BEATA , MROZINSKA SANDRA , KLUPA TOMASZ , MALECKI MACIEJ 
Published: June 2018

Introduction/Aim: The DCCT and other studies showed that the variability in HbA1c added to mean HbA1c increases the risk of the development of complications of diabetes. There were some earlier reports showing a seasonal variability in the HbA1c level in a pediatric population.
Methods: We evaluated seasonal HbA1c changes over a period of 9 years (2009-2017) in 453 adults with type 1 diabetes (T1DM) treated with personal insulin pumps. HbA1c was measured at a tertiary care university hospital on the Bio-Rad D10 hemoglobin testing system. Differences between groups (12 groups for 12 months and 6 for every consecutive two months) were assessed using the Kruskal-Wallis and post-hoc tests.
Results: Patients median age was 24 years [range 18-80 years], median BMI 22.9 kg/m2 [15.6-43.7 kg/m2], median diabetes duration 12 years [1-40 years] and median duration on personal insulin pump 6 years [0-18 years]. A total of 1, 438 HbA1c measurements were analyzed. Median HbA(1c) level for the whole study period was 7.25% [55.7 mmol/mol] (range 4.8-12.8% [29-116.4 mmol/mol]). There were seasonal differences in HbA1c over 12 months (p=0.02): The lowest HbA1c was observed in summer (July, 6.8% [50.8 mmol/mol) and the highest in winter months (from 7.1% [54.1 mmol/mol] in January to 7.3% [56.3 mmol/mol] in February). HbA1c was lower in July than in February (p=0.03). After combining two consecutive months in one group seasonality of HbA1c values was still observed (p=0.008). Median HbA1c in July/August (6.9% [51.9 mmol/mol]) was lower than in January/February (7.2% [55.2 mmol/mol], p=0.01) and in November/December groups (7.3% [56.3 mmol/mol], p=0.02).
Conclusion: To our knowledge this is the first report concerning HbA1c seasonal fluctuations in well controlled cohort of adult T1DM patients treated with insulin pumps. Seasonal changes of HbA1c levels (peak in summer months, drop in winter months) in such a group of patients should be considered in patient education and diabetes management.

Disclosure
B. Matejko: None. B. Kiec-Wilk: None. S. Mrozinska: None. T. Klupa: None. M. Malecki: Consultant; Self; Abbott, Bioton, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi-Aventis, AstraZeneca, Servier, MSD K.K..
Shared Decision-Making for Diabetes Prevention—One-Year Results from the Prediabetes Informed Decision and Education (PRIDE) Study
Authors: MOIN TANNAZ , TURK NORMAN , MANGIONE CAROL , CASTELLON-LOPEZ YELBA , SKRINE JEFFERS KIA , NORRIS KEITH C. , TSENG CHIHONG , KENRIK DURU O. 
Published: June 2018

Lifestyle change (e.g., the DPP) and metformin can reduce diabetes risk. Real-world uptake of both strategies remains low. In a pragmatic, cluster-randomized controlled trial, we tested the effectiveness of a shared decision-making (SDM) intervention. After an in-person SDM visit with a pharmacist, overweight patients with prediabetes (A1c 5.7-6.4%) chose to start DPP, metformin, both strategies, or continue usual care. We randomized 20 primary care clinics to intervention vs. usual care, and enrolled 364 study patients with prediabetes from the 10 intervention clinics. We used propensity score matching to identify 1,086 comparison patients within the 10 usual care clinics. The primary outcome was uptake of any diabetes prevention strategy (DPP +/- metformin) within 8 months of the SDM visit. A secondary outcome was change in weight at 1 year after the SDM visit. We used data from the electronic health record (EHR) together with data from 2 local DPP vendors to assess DPP attendance. We used data from the EHR to track metformin uptake and weight change, and ran generalized estimating equation models that controlled for clustering by clinic. Among 364 intervention patients, 57% chose DPP, 17% chose DPP + metformin, 9% chose metformin, and 17% chose to continue usual care. Intervention patients were more likely to join the DPP and/or take metformin than matched controls, 43% (n=155) vs. 3% (n=36; p&lt;.001). In a complete-case analysis among patients with follow-up weight available in the EHR, weight loss was greater for all intervention patients who had an SDM visit (n=312) vs. control patients (n=841) at 12 months (-5.2 lbs vs. -0.29 lbs, p&lt;.001). A prediabetes SDM intervention can enhance patient engagement in evidence-based therapies to prevent diabetes and can promote weight loss at 12 months. Shared decision making in prediabetes may be a promising approach to enhance prevention efforts among patients at highest risk.

Disclosure
T. Moin: None. N. Turk: None. C. Mangione: None. Y. Castellon-Lopez: None. K. Skrine Jeffers: None. K.C. Norris: Other Relationship; Self; AbbVie Inc.. C. Tseng: None. O. Duru: None.
Serum Levels of Soluble LR11 Are Associated with Insulin Resistance in the Patients with Type 2 Diabetes Mellitus
Authors: UNOKI-KUBOTA HIROYUKI , JIANG MEIZI , KAJIO HIROSHI , YAMAMOTO-HONDA RITSUKO , TOBE KAZUYUKI , NODA MITSUHIKO , BUJO HIDEAKI , KABURAGI YASUSHI 
Published: June 2018

Obesity is now a worldwide epidemic, with overweight, obesity, and morbid obesity all increasing. Recently, there is increasing support that obesity is a major risk factor for developing insulin resistance and type 2 diabetes mellitus (T2D). Plasma soluble low-density lipoprotein receptor-relative with 11 ligand-binding repeats (sLR11) plays a role in the development of atherosclerosis, and has also been linked to the metabolism of triglyceride-rich lipoproteins and adiposity. To assess the relationship between sLR11 levels and T2D, we analyzed the sLR11 levels in T2D patients. Serum sLR11 levels were measured in 70 patients with T2D (mean age 60.8 ± 7.0, 68.6% males, and BMI 24.7 ± 3.2) and 76 healthy control subjects (mean age 58.5 ± 6.5, 65.8% males, and BMI 24.1 ± 2.5) by ELISA. Circulating sLR11 levels were significantly increased in T2D patients compared with healthy control subjects (10.2 ± 4.2 vs. 8.3 ± 2.1, P = 1.4 × 10-3). Stepwise multivariate regression analysis showed that serum sLR11 levels were significantly associated with HOMA-IR (β = 0.26, P = 4.8 × 10-3), BMI (β = 0.24, P = 1.0 × 10-2) and age (β = 0.20, P = 2.7 × 10-2). Logistic regression analyses indicated that sLR11 was independently associated with HOMA-IR (odds ratio [OR], sLR11 tertile increment: 6.81; 95% confidence interval [CI]: 1.71—27.13) and BMI (OR, sLR11 tertile increment: 1.86; 95% CI: 1.03—3.35). We then analyzed a gene-dosage effect that links LR11 expression to insulin resistance and obesity using db/db mice with genetic loss of LR11 (LR11-KO db/db). LR11-KO db/db mice displayed significantly lower fasting plasma glucose and insulin levels, and improved glucose tolerance compared with age-matched db/db mice, although there was no significant difference in body weight between them. Our findings imply that LR11 may be mechanistically involved in the prevalence and development of insulin resistance and T2D.

Disclosure
H. Unoki-Kubota: None. M. Jiang: None. H. Kajio: None. R. Yamamoto-Honda: None. K. Tobe: Research Support; Self; Bristol-Myers Squibb Company, Takeda Pharmaceutical Company, Teijin Pharma Limited, Japan Diabetes Society, Eli Lilly and Company, MSD K.K., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Pfizer Inc., Astellas Parma Inc, Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Company, Limited, Novo Nordisk Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Tsumura & Co., Ono Pharmaceutical Co., Ltd., Novartis Pharma K.K., Sumitomo Dainippon Pharma Co. M. Noda: None. H. Bujo: None. Y. Kaburagi: None.
Association between Polycystic Ovarian Syndrome and Bone Mineral Density—A Systematic Review and Meta-analysis
Authors: UPALA SIKARIN , EHRMANN DAVID A. 
Published: June 2018

Background: Polycystic ovarian syndrome (PCOS) affects at least 17-20% of female population. Little information is available about whether PCOS is related to low bone mineral density (BMD). In this meta-analysis, we try to explore and compare PCOS patient and normal female population to determine the relation between PCOS patients and osteoporosis as an outcome.
Methods: Two investigators searched published studies indexed in MEDLINE and EMBASE. This review included published observational studies evaluating the association between PCOS and bone mass, BMD, or osteoporosis. PCOS is diagnosed base on clinical, biochemical, radiological findings per Rotterdam criteria. The primary outcome of this study were differences in the total BMD (g/cm2) or BMD at different anatomical sites including lumbar spine, pelvis, femur and total body as measured by dual-energy X-ray absorptiometry between patients with PCOS and participants without PCOS (controls).
Results: Five cross sectional studies involving 1276 participants were included. Meta-analysis using the random-effects model to examine the difference in outcomes between PCOS and controls are performed. The pooled mean difference of total BMD in patients who have PCOS vs. controls in the five studies was -0.22 (95% confidence interval, -0.66 to 0.23; P = 0.35). The statistical between-study heterogeneity may represent substantial heterogeneity with an I2 of 99% (p&lt;0.01). For femoral neck BMD, the difference was not statistically significant, which was 0.00 (95% confidence interval, -0.03 to 0.02; P = 0.81). For lumbar spine BMD, the difference was also not statistically significant, which was -0.02 (95% confidence interval, -0.to 0.02; P = 0.25).
Conclusion: Women with PCOS have seemed to increase a chance of having osteoporosis more than the normal population. The real mechanism of PCOS and osteoporosis and a larger PCOS population need to be clarified and study more in the future.

Disclosure
S. Upala: None. D.A. Ehrmann: None.
Differential Effect of Nativity on Type 2 Diabetes Diagnosis Post-Gestational Diabetes, by Race/Ethnicity
Authors: BUTLER BRITTNEY , SALSBERRY PAMELA , BOWER JULIE K. 
Published: June 2018

Background: Women with GDM have seven times higher risk of T2D compared to women with normoglycaemic pregnancies, with black women having the highest risk. Immigrants are a growing share of the U.S. population, with approximately 9% of the black population and 34% of Hispanic population being foreign-born. Due to differences in acculturation and assimilation, foreign-born U.S. women experience different pregnancy-related outcomes and subsequent chronic disease development, depending on their race/ethnicity.
Objective: To examine the association between nativity and T2D diagnosis following a prior GDM pregnancy and whether this association differs by racial/ethnic group.
Methods: We conducted a cross-sectional analysis of data from the 2007-2014 National Health and Nutrition Examination Survey, a nationally representative survey of non-institutionalized Americans. The analytic population included women with at least one prior GDM pregnancy. Logistic regression (OR, 95% CI) was used to examine the association.
Results: Our final sample included 433 women. The population was predominantly non-Hispanic white (62%), followed by Hispanic (18%) and black (12%). T2D was found in 29% of the population. After controlling for confounders, foreign-born black women had 0.14 (0.02-0.82) times the odds of developing T2D post GDM compared to black U.S. born women. Nativity was not significantly associated with cumulative incidence of T2D among Hispanics (1.45, 0.48-4.41) or non-Hispanic whites (1.53, 0.04,-6.07).
Conclusion: We found differential effects of nativity across racial/ethnic groups consistent with prior literature. Among black women, being foreign-born significantly decreases the odds of developing T2D following a GDM pregnancy but not among other groups. This observed effect may be due to U.S. born black women experiencing higher levels of racialized and gendered stress, both associated with higher levels of inflammation that can lead to higher risk of T2D.

Disclosure
B. Butler: None. P. Salsberry: None. J.K. Bower: None.