bluuebunny/crossref_metadata_2025_split huggingface dataset:
1200-P: Predictors of Glycaemic and Weight Response to Empagliflozin Treatment: The ABCD Nationwide Empagliflozin Audit
Authors: THONG KEN , CHUNG-WAH-CHEONG JONATHAN , YADAGIRI MAHENDER , CULL MELISSA L. , BICKERTON ALEX , PHILLIPS SUZANNE M. , EVANS ALISON , SENNIK DEVESH K. , ROHILLA ANURITA , REID HAZEL , MORRIS DAVID S. , ATKIN MARC , ROBINSON ANTHONY M. , WILLIAMS DAVID M. , STEPHENS JEFFREY W. , GALLEN IAN W. , ADAMSON KAREN , RYDER ROBERT E. 
Published: June 2019

Introduction: We investigated clinical parameters that are potentially associated with improved empagliflozin treatment response.
Methods: We obtained data from a large-scale audit of empagliflozin use in the UK. We analyzed the association between patients’ baseline age, HbA1c, weight, diabetes duration, alanine aminotransferase (ALT), sex, chronic kidney disease (CKD) stage, empagliflozin dose (25 vs. 10mg), use of GLP-1RAs and use of insulin with HbA1c and weight changes at 26 weeks of treatment.
Results: Among 1436 patients, HbA1c reduced by, mean[95% CI], 1.35%[1.27,1.42] (p&lt;0.0001) from a baseline of, mean±SD, 9.41±1.41%. Among 1381 patients, weight reduced by 3.6 kg[3.3,3.9] (p&lt;0.0001) from a baseline of 100.2±20.7 kg. Results of univariate analyses are shown in Table 1. In multivariate analysis, higher baseline HbA1c (p&lt;0.0001), lower CKD stage (p=0.002) and higher ALT (log transformed)(p=0.02) were associated with greater HbA1c reduction. Higher baseline weight (p&lt;0.001) and non-insulin use (p&lt;0.0001) were associated with greater weight reduction.
Conclusion: As expected, HbA1c reduction was associated with baseline HbA1c and background renal function, while weight reduction was associated with baseline weight. The interactions between HbA1c reduction and ALT levels, and weight reduction with insulin treatment status warrant further investigations.

Disclosure
K. Thong: None. J. Chung-Wah-Cheong: None. M. Yadagiri: None. M.L. Cull: None. A. Bickerton: Employee; Self; MyWay Digital Health. S.M. Phillips: None. A. Evans: None. D.K. Sennik: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. A. Rohilla: None. H. Reid: None. D.S. Morris: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., NAPP Pharmaceuticals Limited, Novo Nordisk A/S, Sanofi-Aventis. M. Atkin: Advisory Panel; Self; NAPP Pharmaceuticals Limited. Consultant; Self; My mHealth. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk Inc. A.M. Robinson: Advisory Panel; Self; Takeda UK. D.M. Williams: None. J.W. Stephens: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, NAPP Pharmaceuticals Limited. I.W. Gallen: None. K. Adamson: None. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest.

Funding
Association of British Clinical Diabetologists
1204-P: The Effects of Insulin Treatment on Circulating Ketone Levels in Patients with Type 2 Diabetes on Sodium-Glucose Cotransporter 2 Inhibitors
Authors: LEE CHI HO , LAM JOANNE K. , LEE ALAN C. , LUI DAVID T.W. , CAROL FONG HO YI , WOO YU CHO , LAM KAREN S. , TAN KATHRYN C. 
Published: June 2019

Objective: Use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) is associated with ketosis. On the other hand, insulin treatment inhibits lipolysis, hepatic ketogenesis, and promotes ketone oxidation in the peripheral tissues. Here, we investigated the effects of insulin therapy on circulating ketone levels in patients with type 2 diabetes (T2DM) receiving SGLT2i.
Research Design and Methods: 150 patients with T2DM on SGLT2i (51.3% on concomitant insulin therapy) and 100 not on SGLT2i were recruited from Diabetes Clinic. Fasting serum levels of β-hydroxybutyrate (βOHB)and free fatty acids (FFA) were measured by colorimetric assays.
Results: Participants on SGLT2i had significantly better glycemic control than those not on SGLT2i (HbA1c 7.7±1.2% and 8.8±1.5%, respectively; p &lt;0.001). However, serum βOHBlevels were significantly higher in participants on SGLT2i compared with those who were not (347 uM [228-507] vs. 196 [151-274], respectively, p &lt;0.001), despite similar age, body mass index (BMI), duration of diabetes and serum FFA levels (111 uM [81-148] vs. 108 [88-143]). In the group of participants on SGLT2i, those on insulin therapy had significantly higher BMI and HbA1c than those not on insulin therapy (BMI: 30.3±5.5 kg/m2vs. 27.5±5.5, respectively, p=0.002; HbA1c: 8.1±1.3% vs. 7.4±1.0%, respectively, p=0.001) but the duration of diabetes was similar. The median total daily dose of insulin was 50 units. Despite the concomitant use of insulin, serum βOHBlevels were comparable between participants on SGLT2i with or without insulin therapy (347 uM [220-485] vs. 347 [230-523], respectively), and were similar even after adjustments for BMI and HbA1c levels.
Conclusions: Serum ketone levels were increased in patients with T2DM on SGLT2i, and concomitant insulin therapy did not suppress the increase in circulating ketone levels. Further prospective studies or randomized controlled trials are required to confirm the above findings.

Disclosure
C. Lee: None. J.K. Lam: None. A.C. Lee: None. D.T. Lui: None. H. Fong: None. Y. Woo: None. K.S. Lam: None. K.C. Tan: None.
1209-P: Relationship between Canagliflozin Treatment Response and Duration of Diabetes: The Association of British Clinical Diabetologists (ABCD) Nationwide Canagliflozin Audit
Authors: RYDER ROBERT E.J. , PHILLIPS SUZANNE M. , EVANS ALISON , SENNIK DEVESH K. , ROHILLA ANURITA , BICKERTON ALEX , THONG KEN , YADAGIRI MAHENDER , CULL MELISSA L. , WYRES MELANIE C. , WINOCOUR PETER , DARZY KEN H. , STRZELECKA ANNA , GOHIL SHAILESH G. , GALLAGHER ALISON , GALLEN IAN W. 
Published: June 2019

In the ABCD nationwide liraglutide audit the impact of liraglutide on HbA1c was found to lessen with increasing duration of diabetes (abstract 1038-P, ADA 2012). We were interested to examine the relationship between change in HbA1c and duration of diabetes in response to canagliflozin in real clinical use in the ABCD nationwide canagliflozin audit. By December 2018 the audit had accumulated data on 972 canagliflozin treated patients of whom there were 604 with baseline HbA1c ≥ 7% and follow-up HbA1c (mean ± SD age 60.3 ± 11.1 year, BMI 33.7 ± 6.7 kg/m2, 62% male, median (IQR) diabetes duration 6.0 (2.6-11) year). By 1st return to clinic after commencing canagliflozin at median (IQR) 4.1 (3.0-6.1) months, mean ± SD HbA1c fell by 0.91 ± 1.2%, from 9.2 ± 1.5 to 8.3 ± 1.3% (p&lt;0.001). Patients with duration of diabetes data (n=434) were divided into 3 groups: 0-5, 6-10, &gt;10 years with mean ± SD baseline HbA1c 9.1 ± 1.6, 9.2 ± 1.5 and 9.3 ± 1.3% respectively (p=0.62). The mean ± SD falls in HbA1c for the 3 groups were 0.87 ± 1.3%, 0.88 ± 1.2%, and 0.86 ± 1.2%, respectfully (p=0.99) (Figure). There was thus no relationship between duration of diabetes and fall in HbA1c in this audit of canagliflozin in real clinical use in the UK. This result contrasts with that from the ABCD liraglutide audit and is in keeping with the differing modes of action of liraglutide and canagliflozin.

Disclosure
R.E.J. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest. S.M. Phillips: None. A. Evans: None. D.K. Sennik: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. A. Rohilla: None. A. Bickerton: Employee; Self; MyWay Digital Health. K. Thong: None. M. Yadagiri: None. M.L. Cull: None. M.C. Wyres: None. P. Winocour: None. K.H. Darzy: None. A. Strzelecka: None. S.G. Gohil: None. A. Gallagher: Speaker's Bureau; Self; Novo Nordisk A/S. I.W. Gallen: None.

Funding
Association of British Clinical Diabetologists
1224-P: Improving Compliance with SGLT2 Inhibitors by Reducing the Risk of Genital Mycotic Infections: The Outcomes of Personal Hygiene Advice
Authors: WILLIAMS SCOTT M. , AHMED SYED HARIS 
Published: June 2019

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have now become established as important second line agents for the management of type 2 diabetes, and are known to have clinical glycaemic, renal and cardiovascular benefits. The development of genital mycotic infections is more common with SGLT2 inhibitors (overall incidence in clinical trials of 4% to 6%) compared to other oral hypoglycaemic agents, and can dissuade patients from persisting with treatment.
Aims: To determine whether the provision of hygiene advice is beneficial in the prevention of genital mycotic infections in patients commenced on SGLT2 inhibitors.
Methods: Patients in an outpatient setting were provided with hygiene advice to rinse the genital area with water after every void and before going to bed, when commencing an SGLT2 inhibitor including dapagliflozin, empagliflozin and canagliflozin. The incidence of genital mycotic infections in these patients was compared to patients who were not given hygiene advice whilst receiving an SGLT2 inhibitor during a three-year period (2015 to 2018) using a linear regression analysis considering the confounding factors of age, sex, glycaemic control (HbA1c) and previous genital mycotic infection.
Results: Of the 125 patients who received hygiene advice, 6 (4.8%) developed a genital mycotic infection, whereas 51 of the 125 patients (40.8%) who were not given hygiene advice developed a genital mycotic infection within the first 6 months. 15 of the 51 patients had mild infection and continued an SGLT2 inhibitor with antifungal treatment, and 36 stopped due to severe infection. There was a significant reduction in the risk of these infections (p = 0.015) in patients given hygiene advice, and compliance was significantly higher in this group (p = 0.012).
Conclusion: Personal hygiene advice should be provided for all patients commenced on SGLT2 inhibitor therapy to improve compliance with this clinically beneficial treatment.

Disclosure
S.M. Williams: None. S.H. Ahmed: None.
123-OR: Effect of Surgical vs. Medical Therapy on Diabetic Kidney Disease (DKD) in Severely Obese Adolescents with Type 2 Diabetes (T2D)
Authors: BJORNSTAD PETTER , HUGHAN KARA S. , KELSEY MEGAN M. , SHAH AMY , LYNCH JANE L. , NEHUS EDWARD , MITSNEFES MARK , JENKINS TODD M. , XU PEIXIN , XIE CHANGCHUN , INGE THOMAS H. , NADEAU KRISTEN J. 
Published: June 2019

To compare DKD rates over 5-years of follow-up in two cohorts of severely obese adolescents with T2D undergoing medical vs. surgical interventions.
A secondary analysis of data collected by the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of type 2 diabetes in Adolescents and Youth (TODAY) studies was performed. Teen-LABS participants underwent bariatric surgery; TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, and insulin therapy was given when there was loss of glycemic control. TODAY participants (irrespective of treatment group assignment) were frequency matched to the 30 Teen-LABS participants with T2D by baseline age (13-18 years), ethnicity, sex, and baseline BMI (&gt;35 kg/m2). Urinary albumin excretion (UAE), estimated glomerular filtration rate (eGFR) by creatinine and cystatin C equation, and prevalence of elevated UAE (≥ 30mg/g) and hyperfiltration (eGFR ≥ 135ml/min/1.73m2) were assessed.
Thirty Teen-LABS participants with T2D (mean±SD age, 16.9±1.3 years; 70% female; 66% white; BMI 54.4 kg/m2) and 63 TODAY participants (15.3±1.3 years; 44% female; 71% white; BMI 40.5 kg/m2) were compared. During 5-years of follow-up, hyperfiltration decreased from 20% to 13% in Teen-LABS and increased from 5% to 37% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI and HbA1c, Teen-LABS participants had 15-fold lower odds of hyperfiltration (OR: 0.06, 95% CI 0.01-0.38) and 27-fold lower odds of elevated UAE (OR: 0.04, 95% 0.01-0.20) at 5-years of follow-up. Decreases in HbA1c and BMI showed the strongest associations with attenuation of hyperfiltration and elevated UAE, respectively.
Compared with medical treatment, bariatric surgery of severely obese youth with T2D was associated with significantly lower odds of DKD over 5-years of follow-up.

Disclosure
P. Bjornstad: Advisory Panel; Self; Horizon, XORTX. Consultant; Self; Bayer US, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company. K.S. Hughan: None. M.M. Kelsey: None. A. Shah: None. J.L. Lynch: Board Member; Self; American Academy of Pediatrics. Consultant; Self; Novo Nordisk Inc. Research Support; Self; Daiichi Sankyo Company, Limited, National Institutes of Health, Novo Nordisk Inc., Pediatric Diabetes Consortium. E. Nehus: Other Relationship; Self; Certara. M. Mitsnefes: None. T.M. Jenkins: None. P. Xu: None. C. Xie: None. T.H. Inge: Other Relationship; Self; Independent Medical Expert Consulting Services, Standard Bariatrics, UpToDate. K.J. Nadeau: None.

Funding
National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases
1231-P: Dapagliflozin (DAPA) in Type 1 Diabetes (T1D): Pooled Outcomes from DEPICT-1 and -2
Authors: DANDONA PARESH , MATHIEU CHANTAL , PHILLIP MOSHE , HANSEN LARS , THOREN FREDRIK A. , SCHEERER MARKUS F. , XU JOHN , LANGKILDE ANNA MARIA 
Published: June 2019

DEPICT-1 and -2 (NCT02268214, NCT02460978) were near identical studies assessing DAPA 5 and 10 mg as add-on to insulin (INS) in T1D. Here we present an analysis of the pooled population from the two studies. Safety data were available for 548, 566 and 532 patients (pts) in the DAPA 5 mg, 10 mg and placebo (PBO) groups, respectively and efficacy data for 530, 529 and 532 pts in each group, respectively. Baseline characteristics were similar between groups. Overall mean (SD) age was 43 (14) years, BMI 28 (5) kg/m2, duration of T1D 20 (12) years and HbA1c 8.5 (0.7)%. At week (week) 24 and 52 DAPA decreased HbA1c, systolic blood pressure (BP) and weight vs. PBO (Table). At week 24, INS dose was decreased with DAPA 5 mg (−8.3%) and 10 mg (−10.5%) but increased with PBO (+1.4%); this pattern was also seen up to week 52. More DAPA vs. PBO pts achieved HbA1c reduction ≥0.5% without severe hypoglycemia (hypo; Table). Safety of DAPA was consistent with previous observations in T1D and T2D. Severe hypo was balanced across groups. Events adjudicated as definite diabetic ketoacidosis (DKA) occurred more frequently with DAPA vs. PBO (in 3.8 vs. 1.1% of pts after 52 weeks); most were of mild or moderate intensity.
In conclusion, over 52 weeks in this large group of pts with T1D, DAPA provided glycemic, weight and BP benefits along with reductions in INS, increased DKA events, but with a low frequency of severe hypo.

Disclosure
P. Dandona: Advisory Panel; Self; AbbVie Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; AbbVie Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. C. Mathieu: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Roche Diabetes Care, Sanofi. Speaker's Bureau; Self; AstraZeneca, Novartis AG, Novo Nordisk A/S, Sanofi. M. Phillip: Consultant; Self; Qulab Medical, RSP Systems A/S. Research Support; Self; Bristol-Myers Squibb Company, Dexcom, Inc., JDRF, Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., OPKO. Stock/Shareholder; Self; DreaMed Diabetes, Ltd., NG Solutions Ltd., Nutriteen Professional Ltd. Other Relationship; Self; AstraZeneca, Eli Lilly and Company, Insulet Corporation, Medtronic MiniMed, Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. L. Hansen: Employee; Self; AstraZeneca, MedImmune. Stock/Shareholder; Self; Bristol-Myers Squibb Company, Novo Nordisk A/S. F.A. Thoren: Employee; Self; AstraZeneca. M.F. Scheerer: Employee; Self; AstraZeneca. J. Xu: Employee; Self; AstraZeneca. A. Langkilde: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca.

Funding
AstraZeneca
1234-P: Cost-Coping Behaviors Differ between Patients With and Without Diabetes Mellitus
Authors: HOLLAR LAURA , HUMBLE SARAH , HERRICK CYNTHIA J. , JAMES AIMEE S. 
Published: June 2019

Background: Cost-coping behaviors, including skipping doses or borrowing money, are a recognized consequence of rising medication costs. Patients with diabetes mellitus (DM) have higher annual healthcare costs; however, there is limited data comparing cost-coping decisions in patients with and without DM.
Methods: We recruited 270 adults aged 35-80 with at least one chronic health condition, one medication and concern about cost. Participants were enrolled from academic multispecialty and community primary care clinics and newspaper ads. Individual hour-long surveys covered demographics, healthcare utilization and literacy, insurance, medications and diagnoses, financial strain, and provider communication. We compared survey data from patients with (n=81) and without (n=189) DM.
Results: The sample was 59% female and 83% African American. The majority had a high school education or less and 47% made less than $800 monthly. In patients with DM, monthly self-reported medication cost was higher ($92 vs. $42, p=0.001) and more variable month to month (25% vs. 15%, p=0.05). Those with DM were less likely to have never skipped doses to cut cost (44% vs. 59%, p=0.02) and were more likely to ask for and receive free samples (52% vs. 29%, p=0.0004). They were more likely to have filed for bankruptcy (38% vs. 22%, p=0.005) and reported spending less on basic needs to pay for medications (58% vs. 42%, p=0.01). These patients spent less on food/groceries first, followed by utilities, transport, and housing. More patients with DM had ever talked with a doctor about affordability of healthcare or medications (67% vs. 49%, p=0.008) and 86% were comfortable with the discussion.
Conclusion: Patients with DM are vulnerable to rising healthcare cost and utilize cost-coping strategies that could negatively affect health; however, most report being comfortable talking to a doctor about cost. Interventions that acknowledge and address cost-coping must be incorporated in practice to improve medication adherence.

Disclosure
L. Hollar: None. S. Humble: None. C.J. Herrick: Stock/Shareholder; Spouse/Partner; Cardinal Health. A.S. James: None.

Funding
National Institutes of Health (R01MD010445 to A.S.J.)
1241-P: Understanding Patients through Their Own Lens: The Lives of Individuals with Complex Diabetes as Revealed through Photo-Elicitation Interviews
Authors: PAUL MARGARET M. , SAAD ANDREA DAVILA , TAGLIAFERRO M. BARBARA , BILLINGS JOHN , BLECKER SAUL , BERRY CAROLYN 
Published: June 2019

Background: Individuals living with complex diabetes in medically underserved areas face additional barriers to accessing needed services and support. This study used photo elicitation interviews (PEI) to develop a rich understanding of everyday life among individuals with complex diabetes living in such areas of New Mexico (NM).
Methods: Five individuals with T1DM and 3 with complex T2DM receiving care through Endo ECHO in NM received digital cameras and the task of taking photographs about their experience of living with diabetes, and then participated in interviews with our team, during which they selected 10 photos from their collections to discuss. Interviews were recorded and transcribed, and then coded using Grounded Theory in an iterative process.
Results: Six family-codes emerged: Self-management, health care, support, complications, food, and coping strategies. Three overarching axial codes were identified: Rural living, body self-knowledge, and diabetes burden. A picture of the relentless and never-ending nature of managing diabetes emerged in the analysis. Over half of the photos were of food, both healthy and forbidden; food is an overriding concern, and participants’ understanding of healthy food varied greatly. Participants noted important sources of support and optimism, and the joy of activities beyond diabetes care such as online gaming, raising chickens, or hiking.
Conclusions: Participants shared their unique perspectives; however, regardless of participants’ age, diabetes diagnosis, and gender, they uniformly expressed acute awareness of the permanent burden of their condition, the challenges of self-management, and the need to overcome the barriers of living in medically underserved areas. PEI proved to be a valuable method for ascertaining a deep understanding of individuals’ daily experience of living with complex diabetes.

Disclosure
M.M. Paul: None. A. Davila Saad: None. M. Tagliaferro: None. J. Billings: None. S. Blecker: Advisory Panel; Self; Medtronic. C. Berry: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1247-P: Anticipating the Impact of 2019 Guidelines: Use of SGLT2i and GLP-1RA in Patients with Diabetes and Cardiovascular Disease
Authors: RATTELMAN CORI R. , CIEMINS ELIZABETH L. , CUDDEBACK JOHN K. 
Published: June 2019

Objective: To describe use of GLP-1 RA and SGLT2i in the treatment of patients with diabetes and cardiovascular disease (CVD) using a large, clinical database.
Study Design: A retrospective descriptive analysis in a clinical database with 22 million longitudinal patient records across 22 health care organizations (HCOs).
Population Studied: A total of 2.6 million patients aged 18-75 with ≥ 2 ambulatory visits with primary care, endocrinology, cardiology, or nephrology in the past 18 months were included from 1/2013 to 3/2018. A subset of 350,000 patients with a type 2 diabetes (DM) diagnosis was observed during the 36 months ending 2016 Q1, 2017 Q1, 2018 Q1 for existing or new prescriptions of novel antidiabetic agents: GLP-1, SGLT2, or DPP-4. Patients were stratified by presence of cardiovascular disease (CVD), baseline DM medication regimen, and HbA1c ≥ 8.0, indicating need for advancing therapy.
Principal Findings: In 2018 Q1, the prevalence of CVD among patients with type 2 DM was 31%. Among patients with type 2 DM, a baseline oral antidiabetic regimen, and HbA1c ≥ 8.0, those with CVD were more likely to have any new DM medication class added (51% vs. 44%, p &lt; 0.001), but no more likely than those without CVD to have a GLP-1 or SGLT2 added (p = 0.70). Patients with CVD were more likely to be prescribed insulin than those without evidence of CVD (20.2% vs. 10.3%, p &lt; 0.001). From the 3-year period ending 2016 Q1 to that ending 2018 Q1, GLP-1 and SGLT2 prescriptions increased 3% and 4%, respectively, among all patients with type 2 DM.
Conclusions: Overall prescriptions of GLP-1 and SGLT2 are increasing but represent only 12% and 13%, respectively, of prescriptions for patients with type 2 DM (vs. 20% for DPP-4). Among patients with type 2 DM, these agents were prescribed no more frequently to those with established CVD than to those without CVD. Prescribing behavior complied with the new guidelines in only 14% of patients with both type 2 diabetes and CVD (range 8-31% across 20 HCOs).

Disclosure
C.R. Rattelman: None. E.L. Ciemins: None. J.K. Cuddeback: None.

Funding
Novo Nordisk