bluuebunny/crossref_metadata_2025_split huggingface dataset:
1613-P: Increased Risks of Temporary and Permanent Work Disability among People with Type 1 and Type 2 Diabetes Mellitus: A Danish Register-Based Longitudinal Study with Up to 17 Years Follow-Up
Authors: NEXO METTE A. , PEDERSEN JACOB , CLEAL BRYAN , BJORNER JAKOB B. 
Published: June 2019

Background and Aim: Diabetes has been associated with considerable work disability, but different risks of disability have not been assessed systematically among people with type 1 (T1D) and type 2 diabetes mellitus (T2D). This study evaluated risks of long-term sickness absence (LTSA), unemployment, return to work and disability pension in individuals with T1D or T2D.
Method: We observed individuals with T1D (n=431), T2D (n=4,047) and without diabetes (n=101,295) in Danish national registers of health, work and social benefits from 1994 -2011. In a multi-state model, Cox proportional analyses estimated hazard ratios (95% Confidence Intervals) of each transition between work, LTSA, unemployment and disability pension. Analyses were performed separately for men and women.
Results: Compared to people without diabetes, women and men with T1D and T2D had significantly higher hazard ratios of LTSA and disability pension (Table 1). Except for women with T1D we observed significantly higher risks of unemployment. Women with T2D had significantly lower chances of returning to work from LTSA or unemployment.
Conclusions: People with T1D and T2D have elevated risks of temporary and permanent work disability. Future studies should include all work-related outcomes to avoid underestimating the burden of living with T1D and T2D.

Disclosure
M.A. Nexo: None. J. Pedersen: None. B. Cleal: None. J.B. Bjorner: Employee; Self; Optum Patient Insights.
1615-P: A Multicountry Trend Analysis of Diabetes Incidence
Authors: MAGLIANO DIANNA J. , ISLAM RAKIBUL M. , CHEN LEI , CARSTENSEN BENDIX , PAVKOV MEDA E. , GREGG EDWARD W. , TABESH MARYAM , KOYE DIGSU , HARDING JESSICA L. , SHAW JONATHAN E. ,   GLOBODIAB WRITING GROUP
Published: June 2019

Several studies have suggested a fall or stabilisation of diabetes incidence rates in the last decade. We therefore conducted a multi-country analysis of trends in diabetes incidence over time. Data from 16 countries comprising 17 administrative sources and one set of annual surveys were analysed according to a standard protocol mainly from the period 1995-2015. We modelled incidence rates using age and calendar time as quantitative variables (scored as the midpoint of each interval), and using restricted cubic splines with 6 knots for age and one knot per 4 years of observation for calendar time. The estimated rates from the models were presented as age- and sex-standardized rates (standardized to the 2010 EU population) for each centre to provide an overview of general trends. To formally assess temporal changes in incidence rates, we also fitted joinpoint models with joinpoints at one of the dates 2009, 2010, 2011, and 2012, estimating the average trend before and after the joinpoint. Among the 18 populations we assembled, 4 of the studies were from predominantly non-Europid populations (Taiwan, Korea, Singapore, Hong Kong) and only 2 of the studies were from middle-income countries (Ukraine and Latvia). In general, from 2000 (or when data were available) until 2010 we saw increasing trends in incidence rates in populations from the U.S., Canada, Australia, Denmark, UK, Spain, Scotland and Latvia, while we saw decreasing incidence rates in Israel, Italy, UK, Hong Kong, Taiwan and Korea. In contrast, after 2010, incidence rates appeared stable or decreasing in 14/18 centres, with U.S. (Kaiser Permanente Healthcare), Ukraine, Singapore, and Taiwan showing increasing trend of diabetes incidence.
In conclusion, incidence rates of diabetes have shown a tendency to stabilise or even fall across some high-income populations in Europe, Asia, Canada and Australia. Patterns in low to middle income countries may be different, but little information is currently available from these.

Disclosure
D.J. Magliano: None. R.M. Islam: None. L. Chen: None. B. Carstensen: Consultant; Self; Leo Pharma. Speaker's Bureau; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk Inc. M.E. Pavkov: None. E.W. Gregg: None. M. Tabesh: None. D. Koye: None. J.L. Harding: None. J.E. Shaw: Advisory Panel; Self; Abbott, Merck Sharp & Dohme Corp. Speaker's Bureau; Self; AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis.

Funding
Centers for Disease Control and Prevention
1618-P: Time Trends of Diabetes Prevalence and Incidence in France: A Nationwide Study
Authors: FUENTES SONSOLES , FOSSE-EDORH SANDRINE , BERNILLON PASCALE , BONALDI CHRISTOPHE , COSSON EMMANUEL 
Published: June 2019

Background: Our objective was to assess trends on incidence and prevalence rates of pharmacologically-treated diabetes in France between 2010 and 2016.
Methods: Diabetes cases were identified in the National Health Data System (SNDS), covering the whole of France, i.e., 66 million people, through a validated algorithm based on antidiabetic drugs reimbursements. Incident cases were identified as new diabetes cases in people free of diabetes during the 2 previous years. For a given year, mean number of residents in France was used to calculate prevalence and incidence rates. Finally, Poisson models were applied to assess possible effects of age, sex and geographical region on time trends.
Results: Prevalence slightly increased from 4.3% in 2010 to 4.9% in 2016, with a significant increasing annual time trend for the period of 1.9% (95% CI: 1.7%-2.1%). After adjustment, the increasing time trend was more important among people under 45 and people over 75 years. In 2012, incidence was 4.2 while in 2016 it was 3.9 cases per 1000 person-years. A non-significant decreasing annual time trend was observed for the period 2012-2016 (-1.3%, 95% CI -2.8%, 0.2%). This decreasing time trend was stronger in adults over 45 years and among women, after adjustment.
Conclusion: Between 2010 and 2016, the prevalence of diabetes increased while incidence of diabetes remained stable. Further efforts on diabetes prevention are required.

Disclosure
S. Fuentes: None. S. Fosse-Edorh: None. P. Bernillon: None. C. Bonaldi: Employee; Spouse/Partner; Novartis France. E. Cosson: Board Member; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Novartis France, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. Research Support; Self; Air Liquide, Lilly Diabetes, Novo Nordisk A/S, Roche Diagnostics France, Roche Foundation, Sanofi.

Funding
Santé Public France
1620-P: Trends in Cannabis Use among Patients with Diabetes—The National Survey on Drug Use and Health, 2005-2017
Authors: ALSHAARAWY OMAYMA 
Published: June 2019

Cannabis legalization for medical and recreational uses has increased, driven by the more permissive attitudes towards cannabis. Potential beneficial effects of cannabinoids have been reported in studies of diabetic retinopathy and neuropathy. Higher prevalence of diabetic ketoacidosis, however, was reported in type 1 diabetes patients who use cannabis. Whether cannabis use has changed over time among patients with diabetes is unknown. Here, we estimate the prevalence of cannabis use among participants with diabetes in the National Survey on Drug Use and Health (NSDUH, 2005-2017), a large nationally representative sample of the United States non-institutionalized population aged 12 years and older. Audio computer-assisted self-interview system (ACASI) assessed cannabis use in the participant residence. During the ACASI, participants were asked whether a doctor or health care professional had ever told them that they had diabetes. The number of NSDUH participants with diabetes ranged from 1537 (weighted % = 6.7) in 2005 to 2919 (9.3%) in 2017. The prevalence of past 30-day cannabis use among diabetes patients was 1.7% (95% CI = 1.1, 2.6) in 2005, increasing to 4.8% (95% CI = 3.8, 6.0) in 2017. Similarly, past 12-month use has increased from 2005 to 2017. This increasing trend is observed across age, sex, ethnic self-identification and education subgroups, and in states with or without medical cannabis laws.
In summary, cannabis use has increased ∼180% in NSDUH participants with diabetes from 2005 to 2017. Physicians should educate patients on cannabis use, including its effects on appetite and gastric emptying, and its effect on perception and treatment adherence, which can be crucial in insulin-dependent diabetes. Additional research is also needed to understand the effect of cannabis on glucose metabolism and diabetes complications.

Disclosure
O. Alshaarawy: None.

Funding
National Center of Complementary and Integrative Health (R00AT009156); Michigan State University
1621-P: Nonlinear Relationship between Elevated Hemoglobin Level and the Risk of Glucose Intolerance in Tibet Residents
Authors: SUYUAN WANG , YUNHONG WU , CHENGHUI ZHANG , MINGXIA LI 
Published: June 2019

Introduction: The aim of this study is to explore the relationship between hemoglobin level and the risk of glucose intolerance in Tibet residents.
Method: Eligible participants were aged from 20 to 80 years old, living in Tibet plateau for more than 3 months. The exclusion criteria were diagnosed diabetes, anemia or other hematological diseases, having been received transfusion in the past month. OGTT test was performed. Logistic regression and generalize additive models was used to explore the relationship between hemoglobin level and the risk of impaired glucose intolerance.
Result: A total of 818 people was enrolled in our research, including 586 (71.6%) male and 232 (28.4%) female. Participants were divided into normal group (Hb&lt;210, n=747), and polycythemia group (Hb&gt;210, n=71). There were 229 (30.66%) and 33 (46.48%) people were glucose intolerance in two groups separately (P&lt;0.001). The odds ratio for male and female patients were 1.821 (95% CI 1.026-3.232) and 0.603 (95% CI 0.940-2.824), respectively. After stratified by sex, we find a “J” shaped relationship in male participants (Figure), and the turning point was 196g/L.
Conclusion: Elevated hemoglobin level is associated with increasing risk of glucose intolerance in male participants. When hemoglobin level is over 198g/L, the risk raised obviously as the hemoglobin level raising in male Tibet residents.

Disclosure
W. Suyuan: None. W. Yunhong: None. Z. Chenghui: None. L. Mingxia: None.
1623-P: Changes in Glycemic and Insulin Distributions among U.S. Adults without Diabetes by Socioeconomic Position, 1988-2016
Authors: CHENG YILING J. , IMPERATORE GIUSEPPINA , BULLARD KAI M. , MERCADO CARLA , GREGG EDWARD W. 
Published: June 2019

National surveys in the U.S. have shown an increased incidence of diagnosed diabetes through 2009 followed by consistent reductions. Whether similar population-level changes are occurring in A1C, fasting glucose (FPG), and fasting insulin (FI) is unknown. It is also unknown whether changes in these glucose metabolism measures vary by socioeconomic position (SEP). We analyzed morning fasting data on 22,492 men and non-pregnant women aged ≥20 years without any diabetes from the National Health and Nutrition Examination Survey 1988 through 2016. Family income to poverty ratio (IPR) and education level were used as measures of SEP (Table). We adjusted all estimates for age, sex, and race/ethnicity accounting for the sampling design using linear/quantile regression. There were significant increases in mean levels of A1C (annual percentage change: 0.1%) and FI (1.8%) from 1988-1994 to 2011-2016 (all p &lt;0.05) and no statistically significant changes in FPG. Patterns for medians of measurements by SEP and year were similar (Table). The risk of hyperinsulinemia was increasing among the U.S. adults, especially among lower IPR population. The increases in insulin levels in the context of little changes in glucose levels suggests a worsening of insulin resistance at the population level.

Disclosure
Y.J. Cheng: None. G. Imperatore: None. K.M. Bullard: None. C. Mercado: None. E.W. Gregg: None.
163-OR: Sensitivity Analysis of Alternate Definitions of Multiple Islet Autoantibody Positivity
Authors: LIU BIN , GHALWASH MOHAMED , ANAND VIBHA , KOSKI EILEEN , NG KENNEY , DUNNE JESSICA L. , LUNDGREN MARKUS , LARSSON HELENA ELDING , HAGOPIAN WILLIAM , VEIJOLA RIITTA , FROHNERT BRIGITTE I. ,   T1DI STUDY GROUP
Published: June 2019

The development of multiple islet autoantibodies (IA) predicts progression to type 1 diabetes (T1D), and forms the basis of current staging of T1D. However, age at seroconversion, persistence of IA, and frequency of sampling influence the determination of multiple IA status. Individual IA may appear at different timepoints and fluctuate. This analysis aims to understand how differences in the stringency of multiple IA status definition impact risk estimates of progression to stage 3 T1D.
We combined data from three birth-cohort studies (N=18,537): DAISY (U.S.), DiPiS (Sweden) and DIPP (Finland), defining four groups by IA positivity pattern and accounting for variability in persistence and timing in concurrent and sequential patterns of IAA, IA2A, and GADA. Subjects were placed exclusively in their most stringent IA group. Cumulative incidence of progression to T1D was estimated by survival analysis and log-rank test, which showed group differences (p&lt;0.0001). T1D risk 15 years after seroconversion [95% CI] increased according to increasing stringency of the definition: Single IA/Persistent 10% [6%, 14%], multiple IA/Any 17% [3%, 29%], multiple IA/Same Visit 40% [17%, 57%], and multiple IA/Persistent 74% [69%, 77%]. Enhanced understanding of the characteristics of IA patterns can better inform recruitment for intervention studies and improve communication of risk during pre-symptomatic T1D screening.

Disclosure
B. Liu: None. M. Ghalwash: None. V. Anand: None. E. Koski: None. K. Ng: None. J.L. Dunne: None. M. Lundgren: None. H. Elding Larsson: None. W. Hagopian: Research Support; Self; Novo Nordisk A/S. R. Veijola: None. B.I. Frohnert: None.

Funding
JDRF
1647-P: High Serum YKL-40 Concentration Is Associated with One-Hour Post-Load Hyperglycemia
Authors: IKEDA YUKIO , HISAKAWA NAOKO , TAKATA HIROSHI , OHGURO TAKASHI , NISHIUCHI JUNKO , KUMON YOSHITAKA 
Published: June 2019

Objective: Postprandial hyperglycemia is associated with oxidative stress and low-grade inflammation, which is involved in the pathogenesis of cardiovascular disease. The aim of this study was to examine whether post-load plasma glucose during oral glucose tolerance tests (OGTT) affect inflammatory biomarkers in nondiabetic subjects.
Methods: We recruited 322 nondiabetic Japanese subjects including 252 with a normal glucose tolerance (NGT) and 70 with an impaired glucose tolerance (IGT). All subjects underwent OGTT and measurement of several inflammatory biomarkers.
Results: No significant differences were observed in white blood cell counts, high-sensitive CRP, high-mobility group box 1 protein (HMGB1) or S100A8/A9 levels between NGT subjects with 1-h post-load plasma glucose (1h-PG) &lt; 155 mg/dL and subjects with 1h-PG ≥ 155 mg/dL. Conversely, NGT subjects with 1h-PG ≥ 155 mg/dL exhibited higher YKL-40 levels than subjects with 1h-PG &lt; 155mg/dL (101.6 ± 85.8 vs. 61.6 ± 53.9 ng/mL, P &lt; 0.0001). No significant difference was observed in YKL-40 levels between NGT subjects with 1h-PG ≥ 155 mg/dL and subjects with IGT. YKL-40 levels, but not white blood cell counts, high-sensitivity CRP, HMGB1 or S100A8/A9, showed significantly positive correlations with 1h-PG (r = 0.251, P &lt; 0.0001). Multiple regression analysis showed that YKL-40 levels were independently associated with 1h-PG, as were age, gender, alanine transaminase and systolic blood pressure.
Conclusions: In nondiabetic subjects, serum YKL-40 levels correlated positively with post-load plasma glucose levels. YKL-40 is produced by several cell types such as activated macrophages, vascular smooth muscle and endothelial cells, and plays an important role in the innate immune response, angiogenesis and remodeling of extracellular matrix. Elevated YKL-40 levels related to postprandial hyperglycemia may contribute to the progression of atherosclerosis and cardiovascular events.

Disclosure
Y. Ikeda: None. N. Hisakawa: None. H. Takata: None. T. Ohguro: None. J. Nishiuchi: None. Y. Kumon: None.
1649-P: Community Predictors of Diabetes Prevalence and Change in Burden Over Time: U.S. Counties, 2003-2012
Authors: LOPEZ PRISCILLA M. , FELDMAN JUSTIN , RUMMO PASQUALE E. , ELBEL BRIAN , THORPE LORNA 
Published: June 2019

Introduction: This study applies a novel epidemiologic approach to perform temporal, multilevel analysis of nationally representative, repeated cross-sectional data to assess the relationship between diabetes and various county-level environmental measures, including socioeconomic context, walkability, and the food environment.
Methods: We obtained data from the 2003-2012 Behavioral Risk Factor Surveillance System, an ongoing, nationally representative, cross-sectional telephone survey of the U.S. noninstitutionalized population ages ≥ 18 years. County-level variables included economic (unemployment), food (convenience store and fast food density), and built environment (active commuting) measures. Using random-effects within-between (REWB), we fit a logistic mixed-effects model to estimate associations between community exposures and odds of prevalent diabetes, adjusted for individual-level demographic and other characteristics. REWB models incorporate temporality into analyses of repeated cross-sectional surveys by using group-mean-centering.
Results: Age-adjusted diabetes prevalence across the study period was 7.9%. County unemployment, fast food density, and convenience store density were positively associated with diabetes prevalence, and active commuting had an inverse association. Odds ratios ranged from 0.95 for an increment in active commuting to 1.05 for convenience store density. Within-county associations were attenuated for convenience stores and fast food restaurants, but within-county change in active commuting was higher (aOR: 0.92; 95% CI: 0.82, 1.02).
Discussion: These analyses demonstrate the utility of REWB models in evaluating effects of group-level exposures on diabetes risk using repeated cross-sectional survey data and provide preliminary evidence towards our hypotheses of community-level drivers of diabetes risk.

Disclosure
P.M. Lopez: None. J. Feldman: None. P.E. Rummo: None. B. Elbel: None. L. Thorpe: None.
1654-P: Decreasing Incidence of Pharmacologically Treated Type 2 Diabetes in Hungary from 2001-2016: A Nationwide Cohort Study
Authors: JERMENDY GYÖRGY , KISS ZOLTAN , ROKSZIN GYÖRGY , ABONYI-TÓTH ZSOLT , WITTMANN ISTVAN , KEMPLER PETER 
Published: June 2019

The incidence and prevalence of type 2 diabetes mellitus (T2DM) vary in different regions and depend on several factors. Long-term nationwide epidemiological data are useful to assess trends over time. The aim of the study was to analyze the epidemiological changes of pharmacologically treated T2DM among adult patients in Hungary between 2001 and 2016. Annual incidence, prevalence and all-cause mortality rate of pharmacologically treated T2DM patients (age &gt;18 years) were evaluated from 2001 to 2016. In our analyses we used the central database of the National Institute of Health Insurance Fund Management (Hungary). All data were anonymized at data export. Numbers are age-adjusted and standardized to European Standard Population at 2013. The number of incident cases with newly registered T2DM decreased from 76,645 (858 cases/100,000 person-years) to 29,122 (300 cases/100,000 person-years) resulting in an annual reduction of 11.6% (p&lt;0.001) between 2001 and 2016. The number of prevalent cases continuously increased from 422,707 (4950 cases/100,000 person-years) to the highest number of 737,535 (8135 cases/100,000 person-years) in 2011, which plateaued during the next 3 years and slightly decreased thereafter. The standardized prevalence rate of T2DM increased by 60.5% in the investigated period. The prevalence rate of T2DM increased with increasing age; in 2016 it was ≥20% in patients with age of &gt;60 years. All-cause mortality rate decreased between 2001 and 2016 by 11.8% from 2186/100,000 person-years to 1928/100,000 person-years. Despite a clearly decreasing incidence of pharmacologically treated T2DM in adult patients, the prevalence increased from 2001 to 2011 followed by a 3-year-long plateau and a slight decrease thereafter. These long-term trends with the reduced mortality rate may indicate favorable effects of health promotional activities for preventing and treating T2DM in the period of 2001-2016 in Hungary.

Disclosure
G. Jermendy: None. Z. Kiss: None. G. Rokszin: None. Z. Abonyi-Tóth: None. I. Wittmann: None. P. Kempler: None.
1656-P: Skin Intrinsic Fluorescence (SIF) Scores and Mortality Risk in Type 1 Diabetes (T1D)
Authors: TOMASZEWSKI ERIN L. , ORCHARD TREVOR J. , HAWKINS MARQUIS S. , SONGER THOMAS , MAYNARD JOHN D. , COSTACOU TINA 
Published: June 2019

Advanced glycation end products (AGE) are biomarkers for metabolic stress and can be detected in skin collagen non-invasively via skin intrinsic fluorescence techniques (SIF). AGE have been linked to complications in T1D and to mortality in both hemodialysis and type 2 diabetes patients. However, the relationship of SIF scores and mortality in T1D is unknown. This study examined the association of SIF scores to all-cause mortality in T1D. Participants were identified from the Pittsburgh Epidemiology of Diabetes and Complications study, a cohort of individuals diagnosed with childhood-onset T1D from 1950-80. SIF score was measured with the SCOUT DS® device in the year 2003-04 (baseline analytic year) in a convenience sample of 112 participants [mean years of age= 48.9 +/- (7.3), HbA1c=7.6% +/- (1.5), cumulative glycemic exposure over lifetime, or, A1c months=1095.9 +/- (495.2) diabetes duration in years=38.3 +/- (7.3)]. Vital status was assessed as of 12/10/2018, up to which 18 mortality events occurred. Univariately, compared to those who survived, the deceased had longer diabetes duration (p&lt;0.001), higher A1c months (p&lt;0.001), higher SIF scores (p&lt;0.001), and were older (p&lt;0.001). SIF score was significantly associated with mortality after adjusting for baseline diabetes duration; for each one unit increase in SIF score the odds of death increased by 18% (OR=1.18, 95% CI 1.03-1.34). A significant association persisted after adjustment for both baseline diabetes duration and A1c months (OR=1.17, 95% CI 1.02-1.34). These findings support the hypothesis that SIF scores are associated with mortality in T1D. The study sample is limited by sampling method, small size, lack of diversity, and possibly survivor bias. Given these limitations, further studies are required to confirm these findings.

Disclosure
E.L. Tomaszewski: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH. M.S. Hawkins: None. T. Songer: Employee; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. J.D. Maynard: Consultant; Self; VisionQuest Biomedical LLC. Employee; Self; Avisa Pharma Inc. T. Costacou: None.

Funding
National Institutes of Health (DK34818); Rossi Memorial Fund