bluuebunny/crossref_metadata_2025_split huggingface dataset:
1600-P: Duplicate Oral Glucose Tolerance Tests Reveal Excellent Reproducibility for Detection of Diabetes but Inconsistent Results for Prediabetes: A Study of Africans
Authors: BRIKER SARA M. , HORLYCK-ROMANOVSKY MARGRETHE F. , ADUWO JESSICA Y. , MUGENI REGINE , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , HA JOON , SHERMAN ARTHUR , SUMNER ANNE E. 
Published: June 2019

As both diabetes (DM) and prediabetes (preDM) reach epidemic proportions in sub-Saharan Africa, there is growing need for reliable diagnostic tests. Although the OGTT is time-consuming, it is unaffected by hemoglobinopathies which are common in Africa and interfere with other methods of detection. However, the reproducibility of the OGTT in Africans is unknown. Therefore, our goal was to perform duplicate OGTTs in Africans and determine if the diagnosis made at the first OGTT was confirmed by the second. One-hundred and five African-born blacks (64% male (67/105), age 39±11y (mean±SD), BMI 27.4±4.5 kg/m2) living in the Washington, DC area had two OGTTs performed 11±7 days apart. Glucose tolerance status was defined by glucose criteria for the OGTT. κ-statistic was used to assess reproducibility (slight: 0.00 to 0.20; fair: 0.21 to 0.40; moderate: 0.41 to 0.60; substantial: 0.61 to 0.80, excellent: 0.81 to 1.0). At OGTT-1, DM, preDM and normal glucose tolerance (NGT) occurred in 23% (24/105), 26% (27/105) and 51% (54/105), resp. At OGTT-2, DM, preDM and NGT occurred in 19% (20/105), 26% (27/105) and 55% (58/105) resp. Reproducibility for the diagnosis of DM was excellent (κ=0.88). No one transitioned from DM to NGT. Further, all participants with DM at OGTT-2 had also been diagnosed with DM at OGTT-1. In contrast, reproducibility for the diagnosis of preDM was only moderate (κ=0.48). Between OGTT-1 and OGTT-2, 10% (11/105) of people transitioned from preDM to NGT; and 7% (7/105) transitioned from NGT to preDM. However, 78% (14/18) of the people who transitioned between NGT and preDM had fasting glucose levels between 90 and 99 mg/dL. Overall, as duplicate OGTTs provided highly reproducible results for the diagnosis of DM, detection of DM by a single OGTT should trigger health care consideration. Diagnosis of preDM was not consistent, but fasting glucose between 90 mg/dL and 99 mg/dL suggests that transition from NGT to preDM is likely.

Disclosure
S.M. Briker: None. M.F. Horlyck-Romanovsky: None. J.Y. Aduwo: None. R. Mugeni: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. J. Ha: None. A. Sherman: None. A.E. Sumner: None.
1604-P: Diabetes, Glycemic Control, and Risk of Infection Morbidity and Mortality: A Cohort Study
Authors: CHANG CHIA-HSUIN , WANG JIUN-LING , WU LI-CHIU , CHUANG LEE-MING , LIN HSIEN-HO 
Published: June 2019

Background: Diabetic patients have an elevated risk of infection, but the optimal level of glycemic control with the lowest infection risk remains unclear, especially among the elderly. We conducted a cohort study to investigate the relation between fasting plasma glucose (FPG) level and risk of infection-related morbidity and mortality.
Methods: Data of participants from a community-based health screening program in Taiwan during 2005-2008 (n=118,645) were analyzed. Incidence of hospitalization for infection and infection-related death was ascertained from the National Health Insurance Database and National Death Registry. Cox proportional hazards regression modelling was used to estimate the hazard ratio (HR) between FPG and risk of infection, adjusting for major risk factors of infection. Separate analyses were also performed to evaluate the risk of hospitalization among the elderly (&gt; 65 years).
Results: During a median follow-up of 8.13 years, 14,372 cases of hospitalization for infection and 422 infection-related deaths occurred. The incidence rate of hospitalization for any infection was 36.33 and 14.26 per 1,000 person-years among diabetics and nondiabetics in the total study population, but increased to 70.02 and 45.21 per 1,000 person-years in the elderly. In the Cox regression analysis, the adjusted HR comparing diabetics to nondiabetics was 1.59 (95% CI: 1.52-1.67) for any hospitalization for infection and 1.71 (95% CI: 1.36-2.16) for infection-related mortality. The hazard for infection morbidity and mortality was higher at both extremes (&lt;80 and &gt;200 mg/dl) of FPG. The above relations were consistently observed in older people and across different sites of infection.
Conclusion: The U-shape association between glycemic control and infection risk suggested that very tight glucose control may not provide additional benefits in risk reduction. In older adults, the absolute risk of infection associated with diabetes was high.

Disclosure
C. Chang: None. J. Wang: None. L. Wu: None. L. Chuang: None. H. Lin: None.

Funding
Taiwan Ministry of Science and Technology (MOST105-2628-B-002-025-MY3)
1609-P: High Adiponectin Levels at Baseline and Increasing Adiponectin Levels over 2.4 Years Follow-Up Lower Risk of Metabolic Syndrome in Men
Authors: HUH JI HYE , KIM WONJIN , KIM MIN KYUNG 
Published: June 2019

Aim: We aimed to assess the impact of change in adiponectin levels on incident metabolic syndrome (MetS) in healthy Korean adults.
Methods: A prospective cohort study was conducted in 1,110 subjects without MetS at baseline. Plasma adiponectin levels were measured at baseline and again after a median follow-up 2.4 years. The subjects were categorized into 4 groups according to sex-specific adiponectin median levels at baseline and changes in adiponectin level at follow-up. The hazard ratio (HR) of new-onset MetS was calculated using Cox models.
Results: During the median 2.4-year follow-up period, 180 (16.2%) developed MetS. Compared to the low adiponectin at baseline and decreased adiponectin during follow-up group, the fully adjusted HR (95% CI) for new-onset MetS was the lowest in high adiponectin at baseline and increased adiponectin during follow-up group [0.33, (0.17-0.63)], followed by high adiponectin at baseline and decreased adiponectin during follow-up group [0.58,(0.40-0.84)], and low adiponectin at baseline and increased adiponectin during follow-up group [0.63, (0.41-0.93)], in that order (P for trend &lt; 0.001). This phenomenon was more prominent in men than in women. Among MetS components, increased adiponectin levels during follow-up were significantly associated with lower risk of incident low-HDL cholesterol and high blood pressure.
Conclusion: An increase in adiponectin level over 2.4-year follow-up period is significantly associated with a lower risk of developing MetS regardless of baseline adiponectin levels especially in men. These findings suggest that change in adiponectin level as well as adiponectin level at baseline might have a clinical role in developing MetS among men.

Disclosure
J. Huh: None. W. Kim: None. M. Kim: None.
1625-P: Characteristics of the Oral Glucocorticoid-Induced Diabetes Mellitus (GIDM) in Miners with Compromised Lung Function in a Limited Resource Setting
Authors: REDKAR VIVEK , REDKAR SAGAR , INAMDAR MANOHAR , INAMDAR ANIKET , REDKAR SUPRIYA , JAGTAP MOHAN , RANE SHRADDHA , KULKARNI SHRIRAM V. , DESHPANDE JAYSHREE , WADHWA U. 
Published: June 2019

Oral glucocorticoids are efficacious for treating respiratory diseases but with a high risk to induce diabetes. We analysed a subset of patients from the Redi iron ore miners from a rural setting (n=25,500), who were newly diagnosed diabetics on extensive chronic methylprednisolone equivalent glucocorticoid dose of ≥4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard (n=1100, males= 660, females=4400). t test and Fisher's exact test were used for the statistical analysis. The mean HbA1c was 7.1% (SD ± 0.62, 95% CI 7-7.3), mean age 51 years (SD ± 14, 95% CI 48 - 54), mean BMI 26 kg/m2 (SD ± 3.6, 95% CI 25 - 27), mean Fasting Plasma Glucose 146 mg/dl (SD ± 49, 95% CI 136-155) mg/dl, mean Post Prandial Glucose 207mg/dl (SD±74, 95% CI 192 - 221). HbA1c at diagnosis in the relatively low risk group (young - normal weight group with age &lt; 40 years, BMI &lt;25 kg/m2) (n=231) was less than the high risk group (older - overweight with age &gt; 40 years, BMI &gt;25 kg/m2) (n=616); mean HbA1c 6.7% (SD±0.33, 95% CI 6.5 - 6.8) vs. mean HbA1c 7.3% (SD±0.65, 95% CI 7.1 - 7.5) (p&lt;0.0001). There was a significant correlation for a high propensity of relatively younger &lt;50 years (n=506) and near normal weight people with BMI &lt; 26 kg/m2 (n=594) to develop GIDM (p=0.006). We observed that high incidence of GIDM (4.31%) is an alarmingly harmful problem which has pronounced comorbid implications, especially in the younger, economically productive population in the limited resource setting. The health care professionals need to be educated to limit the use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance in this population, makes the treatment of GIDM difficult, which calls for action to limit the mining activities and mitigate the risk of chronic complications due to diabetes.

Disclosure
V. Redkar: None. S. Redkar: None. M. Inamdar: None. A. Inamdar: None. S. Redkar: None. M. Jagtap: None. S. Rane: None. S.V. Kulkarni: None. J. Deshpande: None. U. Wadhwa: None.
1626-P: Alcohol Use and Clinical Outcomes in the T1D Exchange
Authors: ALESSI SHEILA M. , FOSTER NICOLE C. , RASH CARLA , VAN NAME MICHELLE A. , TAMBORLANE WILLIAM V. , WAGNER JULIE 
Published: June 2019

Alcohol consumption has serious potential consequences for persons with type 1 diabetes (T1D). This study examined associations between alcohol consumption status and diabetes outcomes. Participants were N=933 adults at Type 1 Diabetes Exchange Registry clinics who completed an emailed set of standardized self-report instruments that included items on alcohol use; A1c values were extracted from charts and reported by clinics. Participants were on average (SD) age 38 (16) years, 61% female, and 90% non-Hispanic white, and mean (SD) A1c was 7.8% (1.5%). The sample was 61% (n = 567) current non-binge drinkers, 19% (n = 174) current binge drinkers, 11% (n = 103) had never consumed alcohol, and 9% (n = 89) former drinkers. After controlling for relevant covariates, there was a trend toward higher diabetes self-care scores in never drinkers compared to current non-binge drinkers, current binge drinkers, and former drinkers, and a trend towards lower diabetes distress scores relative to current non-binge drinkers and former drinkers. The odds of a history of severe hypoglycemia, and odds of a neuropathy diagnosis, were lower among never drinkers relative to former drinkers (adjusted p &lt; .04). Never drinkers did not differ from other drinking status groups on frequency of self-monitoring blood glucose, A1c, history of diabetic ketoacidosis, or nephropathy diagnosis (adjusted p’s≤.01). BMI was higher among never drinkers compared to former drinkers and non-binge drinkers (adjusted p &gt; .05). These results suggest that experiencing severe hypoglycemia and being diagnosed with neuropathy may motivate some drinkers to stop drinking, and that never drinkers have more salutary self-care and distress, but higher BMI. Strategies to help patients with T1D manage alcohol are warranted.

Disclosure
S.M. Alessi: None. N.C. Foster: None. C. Rash: None. M.A. Van Name: Research Support; Self; Novo Nordisk Inc. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceutical Company Limited. J. Wagner: None.
1629-P: Changes in the Prevalence of Diabetes, Its Management, and Complications over 15 Years in a Rural Australian Population
Authors: SIMMONS DAVID , GLENISTER KRISTEN , MAGLIANO DIANNA J. , BOURKE LISA 
Published: June 2019

Objective: Diabetes screening and management guidelines have changed over the last 15 years. We compared diabetes prevalence, management, metabolic control and complications in 2 surveys, conducted 15 years apart.
Methods: Repeat cross-sectional studies 2001-2003 (XRDS1) and 2016-2018 (XRDS2) across 4 rural Australian towns with previously low access to primary care, involving a household survey followed by biomedical assessments (including OGTTs) among randomly selected individuals.
Results: Overall, household survey/clinic responses were &gt;60% involving 4464/1042 and 2315/748 residents in XRDS1 and 2 respectively. The prevalence of known diabetes increased overall (5.4% to 10.4% p&lt;0.001), in those &lt;50, 50-59, 70+ years; but not 60-69 years (2.5% vs. 4.8% p&lt;0.001, 6.5% vs. 9.7% p&lt;0.05, 9.9% vs. 18.4% p&lt;0.001; 12.8% vs.13.4%). Proportions with undiagnosed diabetes and IFG/IGT were not significantly different (2.3% vs. 1.5%; 11.7% vs. 10.0%). Diabetes screening increased from 48.9% to 59.5% (p&lt;0.001). Among those with known diabetes age (59±16 vs. 63±16 p&lt;0.01), lipid testing (84.8% vs. 92.8% p&lt;0.05), hypertension (52.2% vs. 65.8% p&lt;0.01) and dyslipidaemia (21.9% vs. 55.8% p&lt;0.001) diagnoses, increased. Age at diagnosis (53±15 vs. 52±16 years), BMI (30.4±6.9 vs. 30.8±7.1 kg/m2), glycaemia testing (97.1 vs. 95.3%) and BP testing (98.4% vs. 98.2%) were similar. Mean HbA1c and diastolic BP were similar but systolic BP (143±24 vs. 136±19 mm Hg p&lt;0.05) and total cholesterol (4.8±0.9 vs. 4.4±1.1 mmol/l p&lt;0.05) were lower. Complication rates were similar (nephropathy 27.8% vs. 22.4%, non-fatal stroke 6.2% vs. 5.0%) or increased (depression 14.1% vs. 33.5% p&lt;0.01; cardiac condition 24.1% vs. 32.4% p&lt;0.05).
Conclusions: Over 15 years, diabetes prevalence increased, CVD risk management improved but complications were unchanged or increased. Further work is required to understand the extent to which changing survival, migration, access to care and ageing have contributed to these patterns.

Disclosure
D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic. K. Glenister: None. D.J. Magliano: None. L. Bourke: None.

Funding
National Health and Medicine Research Council of Australia
1633-P: State-Specific Incidence of Type 2 Diabetes Treated with Medication in the Privately Insured, United States, 2001-2017
Authors: ROGERS MARY A.M. , IMPERATORE GIUSEPPINA , BASU TANIMA , KIM CATHERINE , BENOIT STEPHEN R. , ROLKA DEBORAH B. , SAYDAH SHARON 
Published: June 2019

While type 2 diabetes is one of the most common chronic diseases in the United States, nationwide figures for incidence are difficult to obtain. We used data from a large national health insurer (Clinformatics Data Mart Database, years 2001-2017) to estimate the incidence of type 2 diabetes by state of residence at first diagnosis. Cases were adults, ages 20 years, with type 2 diabetes (ICD-CM codes with antidiabetic medication). Individuals with type 1 diabetes or secondary diabetes were excluded. The incidence rate per 100,000 person-years ranged from 450.9 in Texas to 164.1 in South Dakota (incidence rate ratio (IRR) 2.7; 95% CI: 2.5, 3.1). The states with the highest incidence were Texas, Mississippi and Alabama. States with the lowest incidence included South Dakota, North Dakota and Massachusetts. For men, the incidence rate of type 2 diabetes ranged from 524.9 in Mississippi to 212.8 in North Dakota (IRR 2.5; 95% CI: 2.2, 2.8). There was greater variation in the incidence for women; it ranged from 409.2 in Alabama to 109.8 in South Dakota (IRR 3.7; 3.1, 4.5). The median age at diagnosis was 54 years in men and 56 years in women.
In conclusion, there is considerable interstate variability in the incidence of type 2 diabetes for the privately insured. Although many of the high incidence states were in the southern census region of the U.S., incidence rates were also high in Hawaii and Arizona.

Disclosure
M.A.M. Rogers: None. G. Imperatore: None. T. Basu: None. C. Kim: None. S.R. Benoit: None. D.B. Rolka: None. S. Saydah: None.

Funding
Centers for Disease Control and Prevention
1635-P: Risk of Pancreatitis among Patients with Type 2 Diabetes Receiving DPP-4 Inhibitors: Nationwide Case-Control Study
Authors: LEE MINYOUNG , SUN JIYU , HAN MINKYUNG , KIM JIN HEE , KIM YOUJIN , LEE INKUK , LEE SANG BAE , BAE JAEHYUN , CHO YONGIN , LEE JI-YEON , KIM CHUL HOON , NAM CHUNG MO , EUN SEOK KANG 
Published: June 2019

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used antidiabetic incretin-based drugs. There remain concerns about the pancreatic safety of DPP-4i due to its pleiotropic effects on the exocrine pancreas. We studied whether DPP-4i are associated with acute and chronic pancreatitis using nationwide population-based cohort study. This study included patients with newly diagnosed type 2 diabetes being treated with antidiabetic drugs (n = 33,208) from 2007 to 2013, from the sample cohort (n = 514,866) of the ***** National Health Insurance Service-Health Screening Cohort database. A Cox proportional hazards model with time-dependent covariates was used to calculate the risk. Lag time of 6 months was applied to reflect a cumulative effect of DPP-4i. Subgroup analyses were also performed according to various confounding factors. Of the 33,208 subjects, 10,210 new DPP-4i users and 22,998 new users of antidiabetic drugs other than DPP-4i were included. DPP-4i significantly increased the risk for pancreatitis (adjusted hazard ratio (aHR) 1.26, 95% CI 1.06-1.50) even after adjusting for age, sex, BMI, smoking and alcohol status, Charlson comorbidity index, and residential region. With a drug-use lag exposure of 6 months, aHR for pancreatitis was still statistically significant as similar (aHR 1.23, 95% CI 1.01-1.51) In subgroup analyses, the risk of pancreatitis was apparent only in subjects with a higher comorbidity score, suggesting a clinical factor which increases the risk of pancreatitis by DPP-4i use. In an analysis of data from a large nation-wide cohort database, we found that DPP-4i are associated with the increased risk of pancreatitis in patients with newly diagnosed type 2 diabetes.

Disclosure
M. Lee: None. J. Sun: None. M. Han: None. J. Kim: None. Y. Kim: None. I. Lee: None. S. Lee: None. J. Bae: None. Y. Cho: None. J. Lee: None. C. Kim: None. C. Nam: None. E. Kang: None.
164-LB: A Randomized Controlled Trial to Compare the Glycemic Effects of Dapagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, and Gliclazide Modified Release, a Sulfonylurea, Assessed by Continuous Glucose Monitoring among People with Type 2 Diabetes
Authors: VIANNA ANDRE G.D. , SILVA DE LACERDA CLAUDIO , MUNIZ PECHMANN LUCIANA , GARCIA POLESEL MICHELLE , CESTARI MARINO EMERSON , CRISTINE DETSCH JOSIANE , RAMOS MARQUES KLEBER , PINHEIRO ROCHA CLAUDIA 
Published: June 2019

Aims: This study aims to evaluate whether there is a difference between the effects of dapagliflozin and gliclazide MR (modified release) on glycemic variability (GV) and control, as assessed by continuous glucose monitoring (CGM), in individuals with uncontrolled type 2 diabetes (T2DM).
Methods: An open-label, randomized study was conducted in uncontrolled T2DM individuals drug naïve or on steady-dose metformin monotherapy which were treated with 10 mg dapagliflozin once daily or 60 to 120 mg of gliclazide MR once daily. CGM and GV indices calculation were performed at baseline and after 12 weeks.
Results: In total, 97 patients (age: 57.9 ± 8.7 years, male sex: 50.5%, baseline glycated hemoglobin (HbA1c): 7.9 ± 0.9) were randomized and 94 completed the 12-week protocol. Per protocol analysis demonstrated that the reduction of GV, as measured by the mean amplitude of glycemic excursions (MAGE), was superior in the dapagliflozin versus gliclazide MR group (-17.8 ± 33.3 vs. -3.3 ± 42.9 mg/dL, mean ± SD, p= 0.037). The improvement of GV, as measured by the coefficient of variation (CV) and the standard deviation (SD) was also superior in the dapagliflozin group (p=0.021 and 0.024, respectively). Moreover, dapagliflozin increased the time in range (TIR, between 70-180 mg/dL) by 28.6 ± 24.4% vs.19.8 ± 33.1 % (p=0.041). The intention-to-treat (ITT) analysis was also performed and did not alter the significance of the results.
Conclusions: Dapagliflozin reduced glycemic variability and increased the TIR more efficiently than gliclazide MR in individuals with T2DM after 12 weeks of treatment as demonstrated by continuous glucose monitoring evaluation.

Disclosure
A.G.D. Vianna: Board Member; Self; Abbott, Novo Nordisk Inc. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Lilly Diabetes. C.S. de Lacerda: None. L.M. Pechmann: None. M.G. Polesel: None. J.C. Detsch: None. K.R. Marques: None. C.P. Rocha: None.

Funding
AstraZeneca
164-OR: Efficacy of New-Onset Type 1 Diabetes (T1D) Intervention Trials: Variation in 1-Year Outcomes
Authors: HALLER MICHAEL J. , GRECO MADISON N. , SCHATZ DESMOND , ATKINSON MARK A. , BRUSKO TODD M. , MATHEWS CLAYTON E. , JACOBSEN LAURA M. , HEROLD KEVAN C. , GITELMAN STEPHEN E. , KRISCHER JEFFREY , BUNDY BRIAN N. 
Published: June 2019

Mean 2-hour area under the curve (AUC) C-peptide levels at 1 year remain the primary endpoint for most intervention trials in subjects with new onset T1D. Comparisons of efficacy across T1D intervention trials with positive outcomes remain limited. We performed a cross-trial comparison of the NIH TrialNet sponsored new-onset rituximab, abatacept, low-dose anti-thymocyte globulin (ATG) (2.5mg/kg), and ATG/GCSF trials and the NIH ITN sponsored high-dose ATG (6.5mg/kg), alefacept, and teplizumab trials. One-year study group mean AUC C-peptides were adjusted for baseline C-peptide and age and compared to their internal control to retain individual study effects. To further compare differences in AUC C-peptide across trials, rituximab was used as a reference and percent increase compared to rituximab effect was calculated. Using this methodology, low-dose ATG (164%) and teplizumab (171%) provided for the largest relative improvements in AUC C-peptide. Percent effects over rituximab of the other studies were: high-dose ATG (-43%), alefacept (33%), abatacept (37%) and ATG/GCSF (45%). Despite the limitations of meta-like analyses and the notable differences in control group AUC C-peptides, these data strongly support the notion that low-dose ATG and teplizumab provide for the greatest relative preservation of AUC C-peptide amongst recently completed new onset T1D interventions.

Disclosure
M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. M.N. Greco: None. D. Schatz: None. M.A. Atkinson: None. T.M. Brusko: Advisory Panel; Self; Caladrius Biosciences, Inc. Board Member; Self; OneVax, LLC. L.M. Jacobsen: None. K.C. Herold: Consultant; Self; Provention Bio, Roche Pharma. S.E. Gitelman: Advisory Panel; Self; Avortes, Intermountain Therapeutics, Lilly Diabetes, Tolerion, Inc. Research Support; Self; Caladrius Biosciences, Inc., Janssen Research & Development. Other Relationship; Self; Novo Nordisk Inc. J. Krischer: None. B.N. Bundy: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust; National Institutes of Health; JDRF; Sanofi; Amgen Inc.; McJunkin Family Charitable Foundation