bluuebunny/crossref_metadata_2025_split huggingface dataset:
617-P: Current Practices and Gaps in Management of Type 2 Diabetes Mellitus (T2DM) with Dyslipidemia as per American Diabetes Association (ADA) Guidelines Subset Analysis from LEADD (Learning with Experts to Advance Diabetic Dyslipidemia Management) Study
Authors: UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , DAS ASHOK KUMAR , SABOO BANSHI D. , KALRA SANJAY , AYYAR VAGEESH , TIWASKAR MANGESH HARIHAR 
Published: June 2019

Background: CAD (Coronary Artery Disease) and diabetes is strongly associated with high low-density lipoproteins (LDL) levels.
Objective: Understand evaluation practices and treatment for dyslipidemia with statin intensity in T2DM participants as per ADA guidelines.
Methods: A subset analysis of real world, prospective, cross sectional, observational LEADD study in T2DM participants conducted at 226 sites. “n”=number of participants analyzed for each parameter. Available lipid profile was recorded and stratified based on age and Atherosclerotic cardiovascular disease (ASCVD) risk factors and ASCVD as per ADA guidelines for percentages achieving LDL-C target and high intensity of statin.
Results: A total of 4002 participants enrolled with mean (±SD) Hb1Ac 8.15 ± 1.7%, LDL- C levels 117.7 ± 37.6 mg/dl. Rosuvastatin was given in 87% (n=2419/2757) participants. Participants &lt;40 years, ASCVD risk factors and ASCVD were present in 95% (n=207/217) and 3.2% (n=7/217), in &gt;40 years it was 86.7% (n=2908/3354) and 12.8% (n= 432/3354). Mean (±SD) LDL- C levels in ASCVD risk factors and ASCVD participants in &lt;40 years was 129±37.9 mg/dl and 121±42mg/dl, in &gt;40 years it was 120.9±36mg/dl and 118±41mg/dl. 64% (n= 155/162) and 80% (n= 4/5) participants &lt;40 years with ASCVD risk factors and ASCVD, in &gt;40 years 91.4% (n= 1925/2104) and 87.9% (278/316) were not on target LDL - C levels. In &lt;40 years 15.6% (n = 22/141) and 83% (n = 5/6) statin receiving participants in the ASCVD risk factors and ASCVD group and in &gt;40 years 87% (n = 1869/2143) and 77.8% (n = 271/348) were not receiving high intensity statins.
Conclusion: Adherence to ADA guidelines for diabetic participants despite having ASCVD risk factors/ASCVD was sub-optimal in study participants, when high intensity statins is required for dyslipidemia to achieve desired outcomes in them. The findings need further research.

Disclosure
A. Unnikrishnan: Other Relationship; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Dr. Reddys Laboratories, Eli Lilly and Company, Eris Pharmaceuticals, Ipca Laboratories Ltd., MSD, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi. A.K. Das: None. B.D. Saboo: None. S. Kalra: None. V. Ayyar: None. M.H. Tiwaskar: None.

Funding
Diabetes Care India; Dr. Reddy's Laboratories
622-P: Mechanism of Lin28a Promoting Vascular Smooth Muscle Cell Proliferation and Migration in Restenosis
Authors: ZHANG QIAN , ZHOU XIAOJUN , SHEN XUE , JIANG SHAN , XIE TIANYUE , ZOU ZHIWEI , XU CHUNMEI , ZHANG RUI , CUI YUJIAO , GONG PIYUN , DONG JIANJUN , LIAO LIN 
Published: June 2019

Background: Restenosis (RS) after percutaneous transluminal angioplasty severely affects the curative effect of patients with lower extremity peripheral arterial disease. Our previous research indicated that abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) was the key factor in the RS plaque formation. The process of Lin28a regulating cell proliferation demonstrates similarities with the proliferation of VSMCs in RS. Here, we aim to explore the specific role of Lin28a in RS.
Methods: To distinguish from atherosclerotic lesions, RS and atherosclerosis (AS) models were simultaneously established in type 2 diabetic rats. Lin28a level in VSMCs was detected by immunofluorescence double staining. The changes of VSMCs were determined when modulating Lin28a in vivo and vitro and downstream mechanism was further explored.
Results: Thirty-two folds higher level of Lin28a was found in VSMCs in RS compared with AS (P&lt;0.05). Overexpression of Lin28a significantly promoted proliferation and migration of VSMCs in vitro. Let7 was identified as the direct target of Lin28a; screening for Let7 subtypes by in vivo and vitro showed that Let7c, let7d, let7g, miR98 were negatively regulated by Lin28a in VSMCs. Among them, downregulation of Let7c markedly suppressed the VSMCs’ proliferation and migration accompanied by upregulation of Lin28a expression; while these effects were alleviated by overexpression of Let7c.
Conclusion: The present study demonstrated that Lin28a is critically involved in the progression of RS via facilitating the proliferation and migration of VSMCs. A double negative feedback loop is often present in Let7 and Lin28a, thus Let7 subtypes were detected and Let7c could be the direct downstream of Lin28a in regulating VSMCs in RS. Combined with the fact that Lin28a was also regulated by Let7c, we inferred a feedback loop could be formed between Let7c and Lin28a. Above all, the interaction in Lin28a and Let7c may contribute to rapid formation of RS.

Disclosure
Q. Zhang: None. X. Zhou: None. X. Shen: None. S. Jiang: None. T. Xie: None. Z. Zou: None. C. Xu: None. R. Zhang: None. Y. Cui: None. P. Gong: None. J. Dong: None. L. Liao: None.

Funding
National Natural Science Foundation of China (81670757, 81570742, 81770822, 81800732); Shandong Provincial Natural Science Foundation of China (ZR2017LH025); Shandong Provincial Medicine and Health Science and Technology Development Program (2017WS461)
63-LB: Transthyretin Contributes to Insulin Resistance and Its Role in Exercise-Induced Improvement of Insulin Sensitivity in Obese Mice
Authors: HE YINGZI , WANG ZHE , ZHENG FENPING 
Published: June 2019

A major cause of type 2 diabetes is impaired insulin sensitivity. Our aim is to investigate the role of transthyretin (TTR), a molecule implicated in exercise-induced anorexia, in obesity-related insulin resistance and exercise-induced insulin sensitivity improvement. We found that serum TTR levels were elevated in obese C57BL/6 mice (DIO) induced by high-fat diet and 14 people with metabolic syndrome. Serum TTR levels in normal or DIO mice were decreased or normalized by treadmill training as a result of the decreased TTR-mRNA expression in the liver. Injection of recombinant TTR- adenovirus by tail-vein in normal mice caused TTR overexpression in the liver and increased TTR secretion to circulation, resulting in insulin resistance and glucose intolerance. Although the increased TTR levels in serum did not further impair glucose intolerance, it counteracted the exercise-induced improvement of insulin sensitivity in DIO mice. As expected, AMPK activity in muscle was induced by treadmill training in both normal and DIO mice, whereas it was inhibited by TTR overexpression. Although we did not find TTR-mRNA expression in the muscle, we detected TTR protein in muscle by western blotting and immunohistochemistry. Markedly, the change of TTR levels in muscle was in consistent with that in serum of both normal and DIO mice with exercise or not. Further in C2C12 skeletal muscle cells, we demonstrated that TTR protein could be internalized in a time-dependent manner, and exogenous TTR pure protein or adenovirus-mediated high expression of TTR protein inhibited the AMPK pathway activity in a dose-dependent manner. Our results suggest that TTR contributes to insulin resistance, and exercise may improve insulin resistance by reducing TTR expression in the liver, TTR secretion to circulation, and TTR uptake in skeletal muscle, thus increasing AMPK activity.

Disclosure
Y. He: None. Z. Wang: None. F. Zheng: None.

Funding
National Natural Science Foundation of China (491030-N11479)
636-P: Effect of Obesity and Weight Variations on the Decline of Ankle-Brachial Index in Type 2 Diabetes Subjects without Peripheral Artery Disease
Authors: YANG YEOREE , LIM JAYOUNG , LEE EUN YOUNG , YOON KUN-HO , CHA BONG-YUN , LEE SEUNG-HWAN , CHO YUNJUNG 
Published: June 2019

Object: There are very few studies that evaluate the influence of obesity and weight variations on change in ankle-brachial index (ABI) in subjects with type 2 diabetes (T2D) but without peripheral artery disease (PAD).
Methods: In this case-control study, T2D subjects who were without baseline PAD (0.9 ≤ ABI &lt; 1.4), and received minimum 2-year interval ABI exams were included. Subjects with prior diagnosed or treated PAD were excluded. Baseline body mass index (BMI) of all subjects was categorized as normal weight (&lt; 23 kg/m2), overweight (23∼25 kg/m2), and obesity (≥ 25 kg/m2). Weight changes during follow-up were categorized by the percentage of weight change; weight loss (&lt; -3%), stable (-3∼3%), gain (&gt; 3%). Subjects with ABI decline were defined as one or both legs worsened to the abnormal (ABI &lt; 0.9) at follow-up exam.
Results: A total of 575 subjects were analyzed (188 normal, 140 overweight, and 245 obesity). During the median 2.9 years of follow-up period, 122 (21.2%) subjects showed ABI decline. When split by category of BMI and weight change, the incidence rate of ABI decline showed stepwise increasing pattern according to the obesity and weight gain. Multivariable logistic regression analysis showed that baseline obesity (vs. normal) was significantly associated with the risk of developing ABI decline after adjusting for age, sex, smoking, diabetes duration, mean HbA1c, GFR, LDL cholesterol, blood pressure, hypertensive medication, insulin use, statin use, antiplatelet use, and weight change (OR = 2.06, 95% CI = 1.22 - 3.49). On the contrary, weight loss was significantly associated with reduction in risk of developing ABI decline (OR = 0.52, 95% CI = 0.31 - 0.86).
Conclusion: Obesity is an independent risk factor for developing ABI decline in T2D subjects without PAD, whereas weight loss is an independent protective factor. Weight loss should be emphasized especially in obese subjects with T2D.

Disclosure
Y. Yang: None. J. Lim: None. E. Lee: None. K. Yoon: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc. Speaker's Bureau; Self; Takeda Pharmaceutical Company Limited. B. Cha: None. S. Lee: None. Y. Cho: None.
645-P: QTc Prolongation as a Risk Factor for Five-Year Survival after Above-Ankle Amputation in Patients with Type 2 Diabetes
Authors: PUVANESWARALINGAM SHOBITHA , FAGHER KATARINA , LONDAHL MAGNUS 
Published: June 2019

Patients with diabetic foot ulcers (DFU) are considered high-risk individuals for increased cardiovascular disease and mortality. After a major amputation the mortality risk is even higher, with five-year mortality rates exceeding 70%. QTc interval prolongation is a potential indicator of increased cardiovascular risk in the general population as well as in patients with diabetes. The aim of this study was to evaluate the impact of QTc prolongation on 5-years survival after above ankle amputation in patients with type 2 diabetes. We retrospectively enrolled all patients (n=97) with type 2 diabetes, not older than 85 years without a pacemaker, who underwent a major amputation at two hospitals with multidisciplinary DFU teams. Patients were grouped according to QTc time ≤ or &gt;440 ms. Mortality data after 5 years was obtained from the Swedish National Death Registry. Non-parametric statistics were used when assessing differences and survival was analyzed with Kaplan-Meier estimates with log-rank test. As shown in the Figure, QTc prolongation was significantly associated with worse survival (82 vs. 57% 5-year mortality). Presence of ischemic heart disease, age and diabetes duration did not differ between groups.
In conclusion, we have demonstrated that routinely ECG screening with QT interval analysis in a DFU-population, provides important information regarding long-term survival.

Disclosure
S. Puvaneswaralingam: None. K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.

Funding
Craaford Foundation; Krapperyp Foundation; County of Skåne Foundation; Diabetes Foundation
646-P: The Efficacy and Safety of Cold Atmospheric Plasma as a Novel Therapy for Diabetic Wound In Vivo and In Vitro
Authors: HE RUI , LI QIN , YU MUYU , WANG TAO , LU HUIJUAN , LU JUNXI , ZHU WEI , LUO MING , ZHANG JIANKANG , GAO HAIWEI , XING WANLI , WANG DONG , LIU FANG 
Published: June 2019

Aims: Cold atmospheric plasma (CAP) interacted with tissue and had potential effects on wound healing and tissue regeneration. The aim of this study is to investigate the efficacy and safety of CAP as a novel therapy for diabetic wounds in vitro and in vivo.
Methods: The plasma consists of ionized helium gas that is produced by a high-voltage (8.5kV) and high-frequency (17kHz) power supply. Eight-week-old male db/db mice were treated with conventional wound dressing only (control group), additional 90’s CAP (low-dose group) or 180’s CAP (high-dose group) for 2 weeks, respectively. Skin samples around wound in 3, 7, 14 days and blood samples were collected and analyzed in three groups. We carried out in vitro analysis included scratch wound healing assays in immortalized human epidermal HaCaT cells.
Results: After 14 days of treatment, CAP could obviously promote diabetic wound healing because of inflammation inhibition and angiogenesis increase. Wound- closure rates of two CAP groups were significantly faster than that of control group. The protein expression of IL-6, TNF-α, iNOS and SOD significantly decreased while the protein level of VEGF, TGF-β in two CAP groups significantly increased compared to those in control group (all p &lt; 0.05). And such changes showed a good consistency with the change in mRNA level (all p &lt; 0.05). In vitro, scratch wound healing assays showed that plasma treatment could effectively accelerate the wound healing within 3 minutes exposure (all p &lt; 0.05). Additionally, there were no significant differences in histological observation and the level of serum ALT, AST, BUN, CREA and WBC among the three groups.
Conclusions: CAP treatment for 3 min daily improves diabetic wound healing by inhibiting inflammation, reducing oxidative stress and enhancing angiogenesis without toxicity to liver and kidney.

Disclosure
R. He: None. Q. Li: None. M. Yu: None. T. Wang: None. H. Lu: None. J. Lu: None. W. Zhu: None. M. Luo: None. J. Zhang: None. H. Gao: None. W. Xing: None. D. Wang: None. F. Liu: None.

Funding
National Natural Science Fund of China; Shanghai Science & Technology; Shanghai Municipal Education Commission
650-P: An Audit of the Clinical Outcomes of DAFNE Singapore (2011-2018)
Authors: TAN SARAH , CHANDRAN SURESH RAMA , LIM HUEE BOON , ADAIKAN KALA , GOH SU-YEN , GARDNER DAPHNE 
Published: June 2019

Background: The Dose Adjustment for Normal Eating (DAFNE) is a type 1 diabetes (T1D) group education program to enable self-management. Shown to improve outcomes in the UK, its application in Asian countries remains uncertain. We assessed the outcomes of Singapore (Sg)DAFNE, which remains the only Asian centre, from 2011-2018.
Methods: Prior to DAFNE entry, most had received one-on-one education from DAFNE educators. HbA1c, total daily dose (TDD) of insulin were retrieved at these timepoints: 1y before, at entry, 1y after, latest profile. Paired sample t-tests and Chi square tests were used; data is presented as means±SD.
Results: n=115 (33.9% male), age 28.3±8.5y, T1D duration 11.2± 8.4y, follow-up post-DAFNE 3.5 ±2.3y. n=104 completed 1y follow-up post-DAFNE. Mean HbA1c pre-DAFNE fell by entry into DAFNE: pre-vs.-entry: 8.5±1.68% (68 mmol/mol) vs. 7.9±1.4%, p&lt;0.001. This fall was sustained 1y post-DAFNE and at latest follow-up (HbA1c 7.8±1.3%, 7.9±1.3%, all p&lt;0.001). Proportion of those in HbA1c category ≤ 7.5% rose while the proportion in higher HbA1c categories fell post-DAFNE (Figure). TDD insulin fell alongside improvement in glycaemic control (pre-vs.-post-DAFNE: 45.5+14.9 vs. 42.5+12.0, p=0.02).
Conclusion: This demonstrates the effectiveness of SgDAFNE. Sustained improved glycaemic control was achieved with reduced insulin dosages, reinforcing that the quality of insulin use matters more than the quantity.

Disclosure
S. Tan: None. S. Rama Chandran: None. H. Lim: None. K. Adaikan: None. S. Goh: None. D. Gardner: None.
665-P: Diabetes Self-Management Education (DSME): What Will It Take to Improve Participation?
Authors: KRALL JODI , KANTER JUSTIN , RUPPERT KRISTINE , ARENA VINCENT C. , SOLANO FRANCIS X. , SIMINERIO LINDA M. 
Published: June 2019

Despite evidence that DSME is a critical component of diabetes (DM) care, participation remains low. Innovative methods to improve attendance need to be explored. The purpose of this study was to evaluate the impact of a primary care (PC)-based DSME delivery model on DSME referrals and participation. Using a non-randomized design, diabetes educators (DEs) and PC practices were assigned to the intervention group (IG; 3 DEs, 6 practices) or control (CG; 2 DEs, 6 practices). IG practices applied patient-centered medical home elements to DSME delivery and had direct access to a DE. The CG employed traditional DSME delivery (PC patients referred to hospital-based DE). To examine DSME referrals and participation, medical record data were extracted for patients with DM, 18-75y, presenting to PC practices over 18 months (n=4,894; 59% IG, mean age 58.7y, 50.8% male) and compared between study groups. IG practices referred a higher percentage of patients to DSME compared to CG (18.4% v 13.4%; p&lt;0.0001). Of those referred, IG patients were more likely to attend DSME than CG (34.9% v 26.1%; p=0.02). This equated to a total of 6.8% IG and 3.5% CG patients participating in DSME. Adjusted multiple logistic regression modeling found that IG practices were 1.8 times more likely to refer patients to DSME than CG (Confidence Level 1.4-2.2). Other factors that predicted referrals were female (Odds Ratio=1.3, CL 1.1-1.6), obesity (OR=1.6, CL 1.3-2), and higher A1c (OR=1.4, CL 1.3-1.4). Older patients were less likely to be referred (OR=0.98, CL 0.975-0.999). Similar adjusted regression modeling found that IG patients were 1.7 times more likely to participate in DSME than CG (CL 1.1-2.6); lower A1c also predicted DSME attendance (OR=0.9, CL 0.8-0.999). This study demonstrates the positive influence of a PC-based intervention on DSME referral and participation. However, modest improvements in DSME rates, even with targeted efforts to address barriers, raise questions as to what is truly needed to drive meaningful change.

Disclosure
J. Krall: None. J. Kanter: None. K. Ruppert: None. V.C. Arena: None. F.X. Solano: None. L.M. Siminerio: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
666-P: Development of a Self-Stigma Scale in Patients with Diabetes
Authors: SEO KAWOUN , CHO JEONGHWA , KU BON JEONG , LIM ANCHO , KO GEUMBO , SONG YOUNGSHIN 
Published: June 2019

Stigma is known as social isolation of an individual because of his/her situation such as chronic disease conditions. Stigma in chronic disease have been associated with patients’ psychosocial behaviors. Stigma is classified as social stigma and self-stigma, but studies of self-stigma in diabetes was insufficient due to lack of measuring tools. The aim of this study was to develop and evaluate the self-stigma scale in patients with diabetes. The preliminary items of self-stigma scale developed through hybrid concept analysis. To confirm the psychometric properties, contents validity by experts, construct validity such as item analysis, exploratory and confirmatory factor analysis, and reliability were performed. Total 399 patients with diabetes (type 1 and type 2) were recruited from two University hospital in Korea. Initial 40 items were extracted through literature review and in-depth interview during hybrid concept analysis. In content validity, 27 items remained. At item analysis for construct validity, two items below score 0.2 for total correlation of correlated items were deleted. In exploratory factor analysis, 21 items with 4 factors (incompetence, social withdrawal, self-devaluation, and negative feeling) were extracted and it accounted for 51.17% of the variance. In confirmatory factor analysis, 5 items below 0.4 for standard regression weight were dropped. Final 16 items with four factors was acceptable level of goodness-of-fit parameters (CMIN/DF=2.742, SRMR=0.149, RMSEA=0.090, GFI=0.867, AGFI=0.816, CFI=0.910). The reliability of the scale was Cronbach’s alpha=.89.
In conclusion, the self-stigma scale in diabetes have shown good validity and reliability. This scale can be used as an effective tool to measure diabetes related self-stigma, and be investigated what factors can be associated with self-stigma in diabetes in future study.

Disclosure
K. Seo: None. J. Cho: None. B. Ku: Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes, Sanofi-Aventis. A. Lim: None. G. Ko: None. Y. Song: None.
668-P: A Coaching Intervention with Low Literacy Progress Report Improves Glycemic Control
Authors: WOLF RACHEL , BARNES CATHERINE S. , WAN CLAIRE , CAUDLE JANE , ZIEMER DAVID C. 
Published: June 2019

Diabetes imposes a greater burden on minority and disadvantaged populations. Tailored interventions are needed to improve self-management outcomes among these populations.
Purpose: To determine a) the effect of tailored coaching on patient knowledge, attitudes, and A1c and b) whether patient age, diabetes duration, or education level moderated intervention effect.
Methods: A pre-post efficacy analysis of a randomized patient coaching intervention in an urban diabetes clinic was conducted. Eligibility included diagnosed diabetes, A1c ≥ 7.0%, on insulin or high dose oral agents, at least two clinic visits in the prior year and at least four coaching sessions at ∼6-month intervals. Participants received either standard diabetes handouts (N=192) or one-on-one, low literacy tailored coaching (N=161). Coaching included review of home and clinic blood sugars/A1c using a color coded graphical printed progress report, goal setting and formulation of questions for the provider. Outcomes included A1c/blood sugar target knowledge, measured A1c, Diabetes Empowerment Scale scores, and Patient Activation Measure scores.
Results: Most participants were female (64%), black (96%), had household incomes &lt; $15,000/year (83%), and had type 2 diabetes (96%). Mean age was 56.5 years and mean baseline A1c was 8.7%. Coaching increased knowledge of target A1c compared to control (OR 3.2, CI 1.6-6.2) but not knowledge of target blood sugar. Coaching improved measured A1c (-1.0% vs. -0.4% p &lt; 0.05). The magnitude of improvement tended to be somewhat greater at higher educational levels (high school -0.97, p&lt;.01; more than high school -1.19, p&lt;.05). Coaching did not significantly increase diabetes self-efficacy or patient activation.
Summary: Personalized, multi-component low literacy coaching significantly improves A1c and knowledge of A1c control targets. Repeated coaching sessions can enhance the effectiveness of medical management visits.

Disclosure
R. Wolf: None. C.S. Barnes: None. C. Wan: None. J. Caudle: None. D.C. Ziemer: None.

Funding
American Diabetes Association (7-05-CR-03 to C.S.B.)