bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Number of Teeth Is Associated with Diabetic Nephropathy
Authors: KURIHARA WATARU , MIYAKE TERUKI , FURUKAWA SHINYA , SENBA HIDENORI , YAMAMOTO SHIN , SAKIKO YOSHIDA , JOKO KOUJI , UEDA TERUHISA , NIIYA TETSUJI , MIYAOKA HIROAKI , MATSUURA BUNZO , HIASA YOICHI 
Published: June 2018

Background: Progression of diabetic nephropathy has serious effects on the life expectancy of diabetic patients. Although diagnoses, lifestyle interventions, and treatment of diabetic nephropathy have been often attempted, diabetic nephropathy has not been sufficiently overcome. Previous studies show that periodontitis, the inflammation of oral cavity, might lead to endothelial and renal dysfunction. Moreover, periodontitis does not only negatively affect glycemic control but is also associated with diabetes-related complications. Therefore, we conducted this study to examine the relationship between number of teeth, which is one of the factors associated with periodontal disease markers, and diabetic nephropathy.
Methods: This study included 1767 patients with type 2 diabetes mellitus, grouped according to number of teeth, with cut-off distribution points of 13 and 27. Diabetic nephropathy was defined using albumin-creatinine ratio (albuminuria, ≥30 mg/mmol creatinine, and macroalbuminuria ≥300 mg/mmol creatinine). Adjustment was made for age, sex, body mass index, hemoglobin A1c, and hypertension status.
Results: Patients with diabetic nephropathy had significantly fewer teeth than those without diabetic nephropathy (albuminuria, p &lt; 0.001; macroalbuminuria, p = 0.002). The group with fewer number of teeth was significantly associated with a higher prevalence of diabetic nephropathy; the adjusted odds ratios (95% confidence intervals) for diabetic albuminuria for 27-32 teeth, 13-26 teeth, and 0-13 teeth were 1.00 (reference), 1.219 (0.932-1.596), and 1.509 (1.147-1.988), respectively (p for trend = 0.003), and for diabetic macroalbuminuria were 1.00 (reference), 1.061 (0.644-1.748), and 1.756 (1.1-2.844), respectively (p for trend = 0.015).
Conclusion: The number of teeth is positively associated with diabetic nephropathy for patients with type 2 diabetes mellitus, and could assist clinicians in the identification of patients at high risk for diabetic nephropathy.

Disclosure
W. Kurihara: None. T. Miyake: None. S. Furukawa: None. H. Senba: None. S. Yamamoto: None. Y. Sakiko: None. K. Joko: None. T. Ueda: None. T. Niiya: None. H. Miyaoka: None. B. Matsuura: None. Y. Hiasa: None.
Characteristics and Mortality of Recurrent Diabetic Ketoacidosis (DKA) in Adults and Children with Type 1 Diabetes (T1D)
Authors: VELLANKI PRIYATHAMA , PENG LIMIN , DHRUV NEIL , RAMOS CLEMENTINA , HAW J. SONYA , GALINDO RODOLFO J. , DAVIS GEORGIA , FAYFMAN MAYA , PASQUEL FRANCISCO J. , UMPIERREZ GUILLERMO E. 
Published: June 2018

Recurrent DKA is associated with increased mortality in children; however, data is limited in adults. We compared clinical characteristics and outcomes of adults (≥ 18 years) and children (&lt; 18 years) at enrollment with history of recurrent DKA (≥ 1 episode) within the T1D Exchange clinic registry (n=33,902). DKA episodes were self-reported as those experienced 12 months prior to enrollment and before each study visit.
We identified 1758 people with recurrent DKA after diagnosis (Table). Median follow-up was 3.6 years. Adults with recurrent DKA had more islet cell or pancreatic transplant, less insurance and higher mortality compared to children, but less DKA at diagnosis. In both children and adults, mortality was higher with age (children: OR 1.24, 95% CI 1.02,1.50; adults: OR 1.09, 95% CI 1.06, 1.11) and no insurance (children: OR 3.83, 95% CI 1.32, 11.09; adults: OR 2.29, 95% CI 1.12, 4.69). Children with recurrent DKA had higher mortality (OR: 4.21, 95% CI 1.28, 13.86) compared to adults (OR: 2.36, 95% CI 0.53, 10.46). DKA at diagnosis of T1D was associated with higher mortality in adults (OR: 2.97, 95% CI 1.44, 6.11) but not in children (OR: 1.40, 95% CI 0.49, 3.97).
Adults and children with recurrent DKA have poor control but differ in socioeconomic factors and presentation of T1D. Even though adults present less with DKA at diagnosis, presentation with DKA is associated with higher mortality.
Children (n=1193)Adults (n=565)p-valueAge, years12.3 ± 3.931.9 ± 14.8&lt;0.001Duration of DM, years5.2 ± 3.615.7 ± 11.6&lt;0.001BMI, kg/m221.5± 4.925.2 ± 4.9&lt;0.001HbA1c (%)9.6 ± 1.99.8 ± 2.30.55Female, n (%)628 (55)316 (59)0.17Race, White n (%)773 (65)371 (66)0.47Pump Use, n (%)457(38)244(43)0.13Islet cell or pancreatic transplant, n (%)0 (0)10 (9.1)&lt;0.001No Insurance, n (%)6 (0.8)26 (7.6)&lt;0.001DKA at diagnosis, n (%)577 (59)135 (46)&lt;0.001Death, any cause, n (%)6 (0.5)9 (1.6)0.025Data are presented as mean ± SD unless noted otherwise

Disclosure
P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. L. Peng: None. N. Dhruv: None. C. Ramos: None. J. Haw: None. R.J. Galindo: None. G. Davis: None. M. Fayfman: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..
Association between Glycemic Control and Visits with Diabetes Care Team in Youth with Type 1 Diabetes
Authors: TRAVIS KATE , JONES AUSTIN , LYONS SARAH , DESALVO DANIEL J. 
Published: June 2018

Clinical care of youth with type 1 diabetes (T1D) involves a multidisciplinary team including diabetes provider, registered dietitian (RD), certified diabetes educator (CDE), and social worker (SW) or psychologist. There is limited evidence to guide the ADA recommendations for visit frequency, so this study sought to evaluate the association between visit frequency and glycemic control. A cross-sectional analysis of demographic, clinical, and visit frequency data was performed from 1,995 T1D youth with diabetes duration ≥ 1 year, and ≥ 1 diabetes clinic visit during a 1-year period at a pediatric diabetes center. Patient demographics included 50.6% female, age 13.9±4.2 years, T1D duration 6.3±4 years, HbA1c 8.6±1.8%, and race/ethnicity: 52.4% white, 23.4% Hispanic, 16.7% black, and 7.7% other. The cohort averaged 2.9±1.3 annual provider visits. Patients with 3 or 4 annual provider visits had statistically lower mean HbA1c than those with 1, 2, or ≥ 5 visits (Figure 1). In total, 43.6% attended ≥1 CDE, 50.5% RD, and 71.8% SW/psychology visit. Seeing a CDE, RD, or SW/psychologist was not associated with lower HbA1c among the overall cohort, but was associated with lower HbA1c among privately insured patients. These findings reflect the complex, multidimensional nature of T1D management. Further investigation into clinical, psychosocial, and patient-reported outcomes beyond glycemic control is warranted.

Disclosure
K. Travis: None. A. Jones: None. S. Lyons: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation.
Altered Neural Dynamics during a Flanker Attention Task in Patients with Type 1 Diabetes
Authors: EMBURY CHRISTINE M. , MCDERMOTT TIMOTHY J. , WIESMAN ALEX I. , BRAU KAITLIN , DESOUZA CYRUS , DRINCIC ANDJELA , WILSON TONY W. 
Published: June 2018

Background: Patients with type 1 diabetes appear to have deficits in specific cognitive domains, particularly in attention and executive function (1). In this study, we used magnetoencephalography (MEG; 2), a noninvasive functional neuroimaging method, to identify neuronal changes in attention processing in otherwise healthy young adults with type 1 diabetes during euglycemia.
Methods: Adults with type 1 diabetes and no micro- or macro-vascular complications (N = 38) completed a visual selective attention task during MEG. A demographically-matched control group without type 1 diabetes was used for comparison. Each trial began with a fixation cross presented centrally, followed by a row of 5 arrows. Participants were asked to respond regarding the direction of the middle arrow (right index finger for left, right middle finger for right) and ignore the flanking arrows that were presented in either the same (congruent condition) or opposite direction (incongruent condition). All MEG data was processed following standard protocols (3), and the resulting images of functional brain activity were examined statistically.
Results: While no differences in reaction time or accuracy were found between groups, patients recruited a more widespread network of task relevant brain regions compared to controls, particularly the prefrontal cortex and anterior cingulate. Patients had a greater alpha increase from baseline in the anterior cingulate (p &lt; .01), an important brain region in attention, and in the prefrontal cortex (p &lt; .01) as compared to controls, likely reflecting compensatory mechanisms at play.
Conclusions: These results indicate that type 1 diabetes affects neural activity in attention networks of patients who are otherwise healthy and without major comorbidities, reflecting the recruitment of compensatory neural responses to complete task goals.

Disclosure
C.M. Embury: None. T.J. McDermott: None. A.I. Wiesman: None. K. Brau: None. C. Desouza: Consultant; Self; Novo Nordisk A/S, Sanofi. Research Support; Self; Merck & Co., Inc.. Advisory Panel; Self; Medscape. A. Drincic: None. T.W. Wilson: None.
Chronic Kidney Disease (CKD) in U.S. Adults with Self-Reported Cardiovascular Disease (CVD)—A National Estimate of Prevalence by KDIGO 2012 Classification
Authors: WANG TONGTONG , XI YUZHI , LUBWAMA ROBERT N. , KORO CAROL 
Published: June 2018

Overall prevalence of CKD in the U.S. adult general population was estimated to be 14.8%. But data on the prevalence of CKD among CVD population are limited.
Using the NHANES 2007-2014 data, we conducted a cross-sectional analysis of an adult sample with self-reported CVD (n=2325), aged ≥18 years, to assess prevalence of CKD in U.S. adults with CVD using KDIGO 2012 classification. Participants with CVD were identified based on self-reported personal interview data on a broad range of health conditions—congestive heart failure, coronary heart disease, angina, stroke, or heart attack. Appropriate sample weights were used to provide a national estimate.
Results of prevalence of CKD in U.S. adults with self-reported CVD are presented in Table 1. The prevalence of moderately to severely decreased renal impairment based on eGFR below 60 ml/min/1.73m2 was 24.9%: 14.1% with Stage 3a, 7.8% with Stage 3b, and 3.0% with Stage 4 or 5. The prevalence of mildly decreased renal impairment (stage 2, eGFR=60-90 ml/min/1.73m2) was 45.2%: 36.8% with UACR&lt;30 mg/g (normal to mildly increased albuminuria), 7.4% with UACR≥ 30-300 mg/g (moderately increased albuminuria) and 1.1% with UACR &gt;300mg/g (severely increased albuminuria).
This study confirms the high prevalence of CKD in CVD, and provides insights into distribution by CKD categories based on the KDIGO 2012 classification.

Disclosure
T. Wang: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc.. Y. Xi: None. R.N. Lubwama: None. C. Koro: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; GlaxoSmithKline plc..
The Waist Circumference That Predicts Insulin Resistance in Africans Is Higher in Women than Men—A Population-Specific Study
Authors: KABAKAMBIRA JEAN DAMASCENE , BRIKER SARA M. , BAKER RAFEAL L. , COURVILLE AMBER B. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , CHUNG STEPHANIE T. , MIZANUR RAHMAN MD. , SUMNER ANNE E. 
Published: June 2018

Waist circumference (WC) is an inexpensive marker of both insulin resistance (IR) and visceral adipose tissue (VAT). As Africa is experiencing a rapid rise in diseases related to IR such as diabetes and heart disease, identifying the WC of risk in Africans would have great clinical utility. Yet the WC which predicts IR in Africans is unknown. Further WC varies by race and gender and cannot distinguish between VAT and subcutaneous adipose tissue (SAT). Nonetheless the International Diabetes Federation states until more data is available, WC thresholds determined in whites (men 94 cm; women 80 cm) should be applied to Africans. However, data from South Africa suggests that the WC threshold which best predicts IR in black women is between 90 and 100 cm and higher in women than men. Whether this is true in Africans from other regions is unknown. Our goals were to determine in Africans (a) the WC which best predicts IR and (b) whether sex differences in VAT and SAT distribution contribute to sex differences in the WC of risk. Therefore, 360 blacks born in Africa (West 52%, Central 23%, East 25%) and living in the United States (men 68%, age 38±10y (mean±SD)) had CT scans to measure VAT and SAT. OGTT were performed to determine glucose tolerance status. IR was defined by the lowest quartile of the Matsuda Index. AUC-ROC and Youden Index were used to determine the WC which best predicted IR. Compared to women, men had lower BMI (27.2±3.9 vs. 28.6±5.4, P&lt;0.001), higher VAT and lower SAT (both P&lt;0.001). The optimal WC for the prediction of IR in men and women were 91 cm and 96 cm, respectively. Regression analyses with VAT and sex as independent variables and either SAT or WC as dependent variables revealed an interaction (P&lt;0.001) between sex and VAT. So at the same VAT, both SAT and WC were higher in women than men. Overall, in Africans the WC which optimally predicts IR is 91 cm in men and 96 cm in women. Higher SAT at the same level of VAT explains why the WC which predicts IR is higher in African women than men.

Disclosure
J. Kabakambira: None. S.M. Briker: None. R.L. Baker: None. A.B. Courville: None. L. Mabundo: None. C. DuBose: None. S.T. Chung: None. M. Rahman: None. A.E. Sumner: None.
Relationship between Glycemic Control and Treatment Intensity in Patients with Type 2 Diabetes
Authors: IGLAY KRISTY , HANNACHI HAKIMA , ENGEL SAMUEL S. , LI XUEYING , O'CONNELL DAVID J. , MOORE LORI M. , RAJPATHAK SWAPNIL 
Published: June 2018

Previous studies have shown suboptimal glycemic control among patients with type 2 diabetes (T2D); however, the level of glycemic control has not been specifically evaluated for different degrees of treatment intensity. To assess this, we used the Quintiles Electronic Medical Record database to examine T2D patients ≥18 years with ≥1 encounter from Oct 2014 to Sept 2015, ≥1 year of available medical history, ≥1 HbA1c measure, and no insulin use at their last recorded encounter. Of the 678,447 eligible patients, median age was 65 years, 54% were female, and median HbA1c was 6.5%. The table shows the distribution of HbA1c range vs. treatment intensity. Overall, 32% of patients had suboptimal HbA1c levels (≥7%). Of those patients, 10% were untreated, 35% were on monotherapy, and 55% were not at goal despite being on 2 or 3+ agents. In patients with HbA1c ≥9%, 9% were untreated and 28% were on monotherapy. Among patients at the treatment target of &lt;7%, only 24% were on dual or triple therapy, suggesting that patients on monotherapy who are not at goal were not consistently advanced to dual/triple therapy. Results were generally similar when subgroups with/without cardiovascular disease were examined.
In conclusion, 32% of our cohort had suboptimal HbA1c control. Given the distribution of therapy, opportunity exists to initiate/intensify treatment to improve glycemic control in this population.

Disclosure
K. Iglay: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. S.S. Engel: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. X. Li: None. D.J. O'Connell: None. L.M. Moore: None. S. Rajpathak: Employee; Self; Merck & Co., Inc..
Immigrants from Sub-Saharan Africa and the Caribbean Experience Different Rates of Obesity but Similar Rates of Diabetes—The New York City Community Health Survey
Authors: HORLYCK-ROMANOVSKY MARGRETHE F. , SUMNER ANNE E. , HUANG TERRY 
Published: June 2018

Foreign-born blacks from sub-Saharan Africa and the Caribbean represent 4.2% and 19% of the foreign-born population in New York City (NYC). As foreign-born blacks are often grouped with African Americans, data on risk of obesity and diabetes (DM) in Africans and Caribbeans in NYC is scant. Our goal was to determine (a) if the prevalence of either obesity or DM differed in African and Caribbean immigrants; and (b) whether duration of stay in the United States (U.S.) affected odds of either outcome.
Working with the New York City Community Health Survey 2009-13 data was obtained for 363 blacks born in sub-Saharan Africa (60% male, age 43 ±24y (mean ±SD), BMI 27.1 ±7.8 kg/m2) and 2,539 blacks born in the Caribbean (39% male, age 46 ±23y, BMI 27.9 ±8.5 kg/m2). Weighted logistic regression examined odds of obesity and DM, adjusting for socioeconomic and demographic variables such as age, gender, education, income, marital status, children &lt;18 at home, BMI and duration of stay in the U.S.
Prevalence of obesity in Africans was 16.7% and in Caribbeans was 29.7%. The prevalence of DM was 10.5% in Africans and 14.7% in Caribbeans. Africans had significantly lower odds of obesity [OR=0.60 (95% CI 0.40-0.90) P=0.01], but there was no difference in odds of DM between the two groups. Odds of obesity were higher in African [OR=2.35 (95% CI 1.16-4.78) P=0.02] and Caribbean women [OR=2.20 (95% CI 1.63-2.98) P=&lt;.001] than their male counterparts. In both groups, duration of stay in the U.S. did not affect odds of either obesity or DM.
Overall Africans living in NYC are less obese than Caribbean blacks, but the odds of DM do not differ. This suggests that the association between BMI and DM risk differs in blacks according to region of origin. In short, combining foreign-born blacks into a single category may mask important differences in health status.

Disclosure
M.F. Horlyck-Romanovsky: None. A.E. Sumner: None. T. Huang: None.
Diabetes Treatment in Patients with Renal Disease—How Many Are Receiving Contraindicated Drugs?
Authors: MATA-CASES MANEL , FRANCH-NADAL JOSEP , REAL JORDI , DE CAMPOS KARINE FERREIRA , CEDENILLA MARTA , GÓMEZ ANTÓN , MAURICIO DIDAC 
Published: June 2018

Objective: To estimate the CKD (GFR &lt;60 ml/min and/or UACR ≥ 30 mg/g) prevalence among T2DM patients and evaluate the use of antidiabetic drugs based on renal function.
Methods: Retrospective, cross-sectional study, analyzing data from the Spanish electronic records database “Information System for the Development of Research in Primary Care, SIDIAP”, from Jan, 2015 to Dec, 2016. The use of antidiabetic drugs for each stage of chronic renal failure (CRF; GFR&lt;60 mL/min) was evaluated in patients with available records of GFR. Furthermore, the adjusted RR for 5 events (global mortality, cardiovascular mortality, renal failure treated with dialysis or transplantation, acute renal failure and progression of kidney disease) according to KDIGO 2012 guidelines were assessed in those patients with available registers of both UACR and GFR.
Results: From the overall T2DM study population (373,185), 33% (122,296) had CKD, of those, 48% were women, with a mean age of 76 years, a mean T2DM duration of 11 years and a mean HbA1c value of 7.2% (SD 1.37). A total of 336,198 patients (90%) had GFR data, and 94,240 (28%) had CRF. Among those with GFR 30 to &lt; 45 mL/min (29,038; 8.9%), metformin was the most frequently used drug (49.6%), followed by insulin (33.5%), DPP-4i (21%) and sulfonylureas (15.9%). Among patients with GFR &lt; 30 mL/min (13,262, 4%), insulin was the most used drug (50%), followed by DPP-4i (23%), metformin (16%), repaglinide (16%) and sulfonylureas (6.1%). The KDIGO 5 event-adjusted RR distribution among the 236,830 patients with available values of both UACR and GFR was: Low: 60.9%; Mild: 21.6%, High: 9.8% and Very high: 7.7%.
Conclusion: CKD is a very frequent comorbidity among T2DM patients. The use of antidiabetic drugs is more complex in these patients because many people with kidney disease are often elderly, and have long lasting disease and significant comorbidities. A relevant number of T2DM patients are still treated with contraindicated antidiabetic drugs regarding their renal function.

Disclosure
M. Mata-Cases: None. J. Franch-Nadal: None. J. Real: None. K. Ferreira de Campos: Employee; Self; Merck Sharp & Dohme Corp. M. Cedenilla: Employee; Self; Merck Sharp & Dohme Corp. A. Gómez: Employee; Self; Merck Sharp & Dohme Corp. D. Mauricio: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Eli Lilly and Company, GlaxoSmithKline plc.. Research Support; Self; GlaxoSmithKline plc.. Advisory Panel; Self; Janssen-Cilag Pty Limited. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Board Member; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Sanofi.
Evaluating the Combination of Metabolic Syndrome and Different Body Mass Index Categories to Predict Risk for Mortality among U.S. Adults
Authors: SHI TING HUAI , NATARAJAN SUNDAR 
Published: June 2018

Body Mass Index (BMI) categories alone do not necessarily predict negative outcomes. We examined if further stratification based on metabolic syndrome (MetS) provides additional value in predicting mortality. We analyzed population-based data from adults in the National Health and Nutrition Examination Survey from 1999-2010. BMI categories (in kg/m2) were: normal (18.5-25), overweight (25-30) and obese (&gt;30). Normal BMI participants without MetS served as the reference group. After initial unadjusted analyses we performed Cox proportional hazards models controlling for age, gender, race-ethnicity, education, income and smoking. We included 12,048 participants. Unadjusted mortality curves (Figure) show that the normal MetS group had the highest mortality rate, followed by overweight MetS, which in turn is significantly higher than obese MetS. All the no MetS groups had significantly lower mortality than their MetS counterparts. Adjusted Cox regression showed that only the normal MetS (HR 1.7, CI 1.2-2.4) and obese MetS group (HR 1.3, CI 1.1-1.6) had higher hazard rates than the reference group. Metabolic syndrome and obesity categories provide significant additional prediction of mortality. Normal weight subjects with MetS have the highest mortality, in contrast to previous studies. Treatment strategies should incorporate MetS and obesity.

Disclosure
T. Shi: None. S. Natarajan: None.