bluuebunny/crossref_metadata_2025_split huggingface dataset:
1551-P: Baseline Characteristics of Patients in the First Pan-India, Prospective, Longitudinal Study to Assess Management and Outcomes of T2D in Real-World Settings—LANDMARC
Authors: GHOSH ROMIK , DAS ASHOK KUMAR , UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , KALRA SANJAY , THACKER HEMANT ,   LANDMARC STUDY GROUP
Published: June 2019

Background and Aims: LANDMARC (LongitudinAl NationwiDe StuDy On Management And Real World OutComes of Diabetes In India, CTRI/2017/05/008452) is the first prospective, observational, longitudinal study to understand the development of diabetes complications over a 3-year (yr) period in India with high number of sites (450) and a larger cohort of patients.
Methods: Adult subjects with T2D treated with ≥2 antihyperglycemic drugs (controlled/uncontrolled on A1c) were enrolled for assessment and baseline characteristics were analyzed using descriptive statistics.
Results: Of 6332 enrolled subjects, 6280 were eligible for baseline assessment. Mean (SD) age, BMI, and T2D duration were 52.12 (9.15) yr, 27.21 (4.59) kg/m2, and 8.57 (5.62) yr, respectively. Baseline A1c (n=4613; mean [SD]) was 8.0 (1.6) % and 1331 subjects (29%) hadA1c &lt;7.0%. Mean (SD) FPG (n=5176) and PPG (n=5067) were 142.6 (50.4) mg/dL and 205.2 (71.8) mg/dL, respectively. Approximately 70% of subjects (n=4556) received only oral antihyperglycemic drugs OADs and 1687 subjects received both OADs and injectables (INJ). Biguanides (n=5829, 92.8%) and sulfonylureas (n=4785, 76.2%) were the most frequently prescribed OADs, and majority of subjects (n=2766, 44.3%) were prescribed two OAD classes. The mean (SD) duration (yr) of T2D was shorter in subjects receiving OADs (7.58 [4.88]) than INJ (11.01 [6.69]) or OAD+INJ (11.21 [6.57]). Most of the eligible subjects (n/N=3266/6280) had ≥1 CV risk factors; hypertension (n=2566, 40.9%) and dyslipidemia (n=1619, 25.8%) being most prevalent. Subjects with baseline A1c &gt;7% to ≤8% had higher incidence of hypertension and dyslipidemia than other A1c groups. Neuropathy was the most common complication (n/N=728/6280, 11.6%) followed by nephropathy (n/N=153/6280, 2.44%).
Conclusion: These real-world data provide first insights on the epidemiology and treatment landscape of people with T2D in India.

Disclosure
R. Ghosh: Employee; Self; Sanofi. A.K. Das: None. 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. S. Kalra: None. H. Thacker: None.

Funding
Sanofi
1569-P: Cholesterol Efflux Capacity (CEC) and HDL Subspecies Associate with Estimated Insulin Sensitivity (eIS) in Type 1 Diabetes (T1D)
Authors: BUCKNER TERESA , BORNFELDT KARIN , HEINECKE JAY , VAISAR TOMAS , SNELL-BERGEON JANET K. 
Published: June 2019

People with T1D have higher HDL cholesterol (HDLc) yet are more insulin resistant and have increased cardiovascular disease (CVD) risk than people without diabetes. We hypothesized that HDL is dysfunctional in people with T1D, explaining this paradox. We examined the association between eIS, serum HDL CEC, and HDL subspecies in adults with T1D. This study was conducted in a sub-cohort (N=134) randomly selected from the Coronary Artery Calcification in type 1 diabetes study (N=652). eIS was calculated using a validated equation that includes waist circumference, triglycerides, adiponectin, diastolic blood pressure and insulin dose. We quantified CEC from a macrophage cell line (J774) and through the cholesterol transport proteins ABCA1 and ABCG1 and HDL particle concentration and size using calibrated ion mobility analysis. The analyzed HDLs were extra small (XS-HDL), small (S-HDL), medium (M-HDL) and large (L-HDL) populations. Associations were assessed by multivariable linear regression. J774 and ABCA1 CEC were negatively associated with eIS, as was S-HDL (Table). eIS positively associated with L-HDL, whereas other HDL metrics were not associated with eIS. Higher eIS associated with fewer S-HDL particles and reduced macrophage- and ABCA1-mediated CEC, suggesting novel interactions among insulin sensitivity and HDL metrics, which may contribute to CVD risk in T1D.

Disclosure
T. Buckner: None. K. Bornfeldt: None. J. Heinecke: None. T. Vaisar: Consultant; Self; MedImmune. Research Support; Self; MedImmune. J.K. Snell-Bergeon: None.

Funding
American Diabetes Association (7-13-CD-10 to J.K.S-B.)
1571-P: Dietary Quality, Weight Loss, and Diabetes Incidence in the Diabetes Prevention Program (DPP)
Authors: ALLAIRE BENJAMIN , TJADEN ASHLEY H. , APOLZAN JOHN W. , DABELEA DANA , DELAHANTY LINDA M. , EDELSTEIN SHARON , HOSKIN MARY A. , JAACKS LINDSAY M. , TEMPLE KARLA A. , VENDITTI ELIZABETH M. , WYLIE-ROSETT JUDITH ,   DPP RESEARCH GROUP
Published: June 2019

We evaluated whether dietary quality is a predictor of reduced diabetes risk and/or weight loss, independent of caloric intake in the diverse DPP cohort, a randomized clinical trial of adults at risk for diabetes. This secondary analysis included the 2920 participants (90.3% of randomized) with complete baseline and 1-year data (967 intensive lifestyle (ILS), 979 metformin, 974 placebo). Dietary intake was assessed using a 117-item food frequency questionnaire. Dietary quality was quantified using the Alternative Healthy Eating Index 2010 (AHEI), which ranges from 0 to 110 with higher scores corresponding to healthier diets. Participants were 50.8 ±10.6 years, 67.5% female, 44.7% minority race/ethnicity and baseline AHEI was 44.2 ±10.4. ILS participants had greater improvement (p&lt;0.001) in AHEI over 1-year (4.2 ±9.0) compared to metformin (1.2 ±8.5) and placebo (1.4 ±8.4). We examined the association between AHEI change and weight change from baseline to 1 year using linear regression. One-year AHEI change and incident diabetes, based on fasting and 2h OGTT glucose, was evaluated using Cox proportional hazards models over an average 3 years follow-up. All models were evaluated within treatment group and adjusted for demographics, smoking, alcohol use, family history of diabetes, caloric intake, physical activity, BMI and AHEI, and change in caloric intake and physical activity. Models testing incident diabetes were further adjusted for baseline fasting and 2h glucose. AHEI change was associated with weight loss in ILS [β per unit increase (SE) -0.12 kg (0.03, p&lt;0.001)], metformin [-0.09 kg (0.02, p&lt;0.001)] and placebo [-0.05 kg (0.02, p=0.01)]. However, AHEI change did not predict incident diabetes in any group: hazard ratio per unit increase (95% CI) 1.00 (0.98-1.03) for ILS, 1.00 (0.98-1.02) in metformin and 1.00 (0.98-1.02) in placebo, before or after adjustment for weight change. Our results suggest that diet quality helps achieve weight loss, an important factor in diabetes prevention.

Disclosure
B. Allaire: None. A.H. Tjaden: None. J.W. Apolzan: None. D. Dabelea: None. L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Inc., Weight Watchers International, Inc. S. Edelstein: None. M.A. Hoskin: None. L.M. Jaacks: None. K.A. Temple: None. E.M. Venditti: None. J. Wylie-Rosett: None. DPP Research Group: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
1573-P: Branched-Chain Amino Acids, Dietary Protein, and Improvement in Hepatic Fat and Abdominal Fat Distribution in Weight-Loss Diet Intervention: The POUNDS Lost Trial
Authors: LI XIANG , SUN DIANJIANYI , ZHOU TAO , BRAY GEORGE , SACKS FRANK , QI LU 
Published: June 2019

Background: Recent evidence has related high levels of plasma branch-chained amino acids (BCAAs) with liver and visceral fat. We examined the associations of plasma BCAAs with liver fat and abdominal fat distribution and assessed the potential modification of weight-loss diet interventions on these relations.
Methods: The current study included 184 participants with available data on plasma BCAAs, hepatic fat and abdominal fat distribution over 2 years, who were randomly assigned to 1 of 4 diets varying in macronutrient components.
Results: Decrease in plasma BCAAs after weight loss was significantly associated with improvement in hepatic density (a marker for hepatic fat; p=0.03) and reduction in visceral fat (p=0.01). We also found that a decrease in BCAAs was associated with decreased insulin, HOMA-IR, and triglycerides (p&lt;0.05 for all). Moreover, we observed significant interactions between total plasma BCAAs and dietary protein on hepatic density (p-interaction=0.01). Individuals with a larger decrease in total BCAAs had a greater increase in hepatic density when consuming a high protein diet.
Conclusion: Our findings indicate that weight-loss diets decrease BCAAs, which are in turn associated with the reduction of hepatic and visceral fat. Finally, dietary protein modifies the direction of these associations.

Disclosure
X. Li: None. D. Sun: None. T. Zhou: None. G. Bray: Advisory Panel; Self; Herbalife International of America, Inc., Medifast. F. Sacks: None. L. Qi: None.

Funding
National Heart, Lung, and Blood Institute (HL0791981, HL034594, HL126024); National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383, DK078616); Boston Nutrition Obesity Research Center (DK46300); United States-Israel Binational Science Foundation (2011036); American Heart Association (0730094N to L.Q.)
158-OR: Major Adverse Cardiovascular Events for Kidney Disease Patients Treated with Metformin or Sulfonylurea
Authors: ROUMIE CHRISTIANNE , CHIPMAN JONATHAN J. , MIN JEA YOUNG , HUNG ADRIANA M. , HACKSTADT AMBER J. , GREEVY ROBERT A. , GRIJALVA CARLOS G. , ELASY TOM , GRIFFIN MARIE R. 
Published: June 2019

Background: Safety concerns limit metformin use in kidney disease. We compared major adverse cardiovascular events (MACE) for metformin or sulfonylureas users with reduced glomerular filtration rate (GFR).
Methods: A retrospective cohort combined Veterans Administration, Medicare, and National Death Index databases. Metformin or sulfonylurea users were followed from renal threshold (GFR &lt;60 ml/min or creatinine 1.4/1.5 [female, male] mg/dL) until MACE, treatment change, loss to follow-up, non-cardiovascular death or study end. MACE included myocardial infarction, stroke, transient ischemic attack hospitalization or cardiovascular death. The analysis compared MACE hazard for metformin vs. sulfonylurea users in a matched weighted cohort accounting for competing risks of non-persistence or non-cardiovascular death.
Results: There were 67752 and 28976 persistent metformin and sulfonylurea users who reached renal threshold. The weighted cohort included 24683 metformin vs. 24801 sulfonylurea patients; 98% male; 82% white, median age 70 years (62.8, 77.8). Median GFR was 56 ml/min [51.6, 58.2] and HbA1c 6.6% [6.1, 7.1]. Metformin users had lower cause specific hazard of MACE vs. sulfonylurea (adjusted HR 0.81 [0.75, 0.87]). Subgroup results were similar by age, race and GFR.
Conclusion: Compared to sulfonylureas, metformin use in patients with reduced GFR is associated with lower MACE risk.

Disclosure
C. Roumie: None. J.J. Chipman: None. J. Min: None. A.M. Hung: None. A.J. Hackstadt: None. R.A. Greevy: None. C.G. Grijalva: None. T. Elasy: None. M.R. Griffin: None.

Funding
U.S. Department of Veterans Affairs (CX000570-06)
1583-P: Intake of Fish and Related Nutrients in Association with Obesity in Japanese Patients with Type 2 Diabetes (T2D)
Authors: HATTA MARIKO , FUJIHARA KAZUYA , MATSUBAYASHI YASUHIRO , TAKEDA YASUNAGA , NEDACHI RINA , ISHII DAI , HORIKAWA CHIKA , KATO NORIKO , MAEGAWA HIROSHI , SONE HIROHITO ,   JDDM STUDY GROUP
Published: June 2019

Although cardiovascular risk and mortality increases in the presence of comorbid obesity among patients with T2D while fish intake is known to decrease such risks, the association between obesity and fish intake is only poorly understood. Thus, we aimed to clarify these possible associations, including the effects of fish-related nutrients. Analyzed were 1891 Japanese patients with T2D (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. BMI&gt;25 was defined as obesity. Associations between obesity and intake of fish and related nutrients were analyzed by quintiles. Vitamin B12 (VB12) (correlation coefficient, 0.97), vitamin D (VD) (0.94), and long-chain omega-3 polyunsaturated fatty acids (n-3) (0.74) were significantly and potently associated with fish intake. Odds ratio (OR) for obesity was significantly decreased to approximately 0.6 in patients in Q4 (men, 80-108g; women, 77-103g) and Q5 (&gt;108g; &gt;103g) of fish intake compared to Q1 (&lt;37g; &lt;40g) (Table). Intake of all three nutrients showed significant inverse trends with obesity, as did fish intake. Results were unchanged even after additional adjustment by use of medications, including insulin. Dietary instructions for daily fish intake of ≥100g could be provided to decrease the risk of obesity in Japanese patients with T2D. Underlying mechanisms via the related nutrients examined await further investigation.

Disclosure
M. Hatta: None. K. Fujihara: None. Y. Matsubayashi: None. Y. Takeda: None. R. Nedachi: None. D. Ishii: None. C. Horikawa: None. N. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
1584-P: Associations of Dietary Patterns with Atherosclerosis in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study
Authors: BASU ARPITA , ALMAN AMY C. , SNELL-BERGEON JANET K. 
Published: June 2019

Background: Among the modifiable risk factors, diet plays an important role in the risks and progression of atherosclerotic cardiovascular disease (ASCVD). However, few studies have examined this association in people with type 1 diabetes (T1D) who are at a greater risk of developing ASCVD than nondiabetic (non-DM) controls.
Methods: We conducted cross-sectional and longitudinal analyses of data from CACTI study [n=1257; T1D: n=568; non-DM: n=689] collected between March 2000 and April 2002. Participants completed a validated food frequency questionnaire, a physical examination and fasting biochemical analyses (12h fast), and coronary artery calcification (CAC) was measured using electron beam computed tomography. At baseline, dietary patterns based on variations in food group intake were created with principal components analysis (PCA). Logistic regression was used to examine associations of dietary patterns with the CAC prevalence in a model adjusted for age and sex and stratified by diabetes status.
Results: Three dietary patterns were identified using PCA as follows: ‘fruits, veggies, meats, cereal’, ‘baked desserts’ and ‘convenience foods and alcohol’ patterns. At baseline, no significant associations of dietary patterns with CAC prevalence were observed. At year-6, ‘baked dessert’ pattern was significantly associated with increased risk of CAC (&lt;0 vs. 0) in T1D [odds ratios (OR) and 95% CI: 2.05 (1.19, 3.51)], but not in non-DM [0.74 (0.51, 1.06)] when adjusted for age, sex and baseline total calories, as well as duration of diabetes for T1D.
Conclusions: Habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and fats, such as in baked desserts may increase risks of atherosclerosis in T1D. Thus, dietary adjustments to improve this pattern may be atheroprotective.

Disclosure
A. Basu: None. A.C. Alman: None. J.K. Snell-Bergeon: None.

Funding
American Diabetes Association (7-13-CD-10 to J.K.S-B.)
1591-P: The Primordial Prevention Project: Motivating Family Behavior Change through Disclosure of Child's Diabetes Genetic Risk
Authors: WESSEL JENNIFER , SMITH MITCHELL 
Published: June 2019

The prevalence of obesity and type 2 diabetes (T2D) in children has risen dramatically. We hypothesized that providing child’s genetic risk information, to families at high T2D risk, would serve as a motivator to improve behaviors related to the development of risk factors for T2D. We conducted a pilot intervention study of parents (n=51) and their children (n=44) aged 2-8. Family’s physical activity, children’s eating behaviors related to obesity (CEBQ); and parent’s attitudes and motivations for lifestyle change were collected at baseline and 3-month follow-up (3MFU). At baseline, saliva samples were collected from children for genotyping of obesity and T2D risk variants identified in genome-wide association studies. Parents were on average 35±6 years old, BMI 31±7 kg/m2, 60% mothers, 31% black and 7% Latino. Children were 4±2 years with a BMI of 72±26 percentiles. At the risk disclosure session, anxiety (STAI-S) and depressive symptoms (POMS) of parents were measured immediately before and after disclosure of child’s risk; and a significant increase in tension (X =2.58, p=0.03) and anxiety (X =-2.98, p=0.002) was observed. Parents then received a quasi-motivational interviewing and behavioral education intervention. After receiving the intervention parents reported a significant increase in their confidence to change their family’s behaviors (X =-0.31, p=0.002) compared to pre-disclosure. This led to 100% of parents committing to a personalized diet or activity change. At 3MFU, children demonstrated a reduction in their desire to drink (X =1.52, p=0.002) and responsiveness to food (X =1.86, p=0.005). In parents, no elevation in depressiveness or anxiety remained. No change in BMI or physical activity was observed in either group. Our data suggest returning genetic risk results can motivate commitment to behavior change. Future work will test whether combining genetic risk with an established lifestyle intervention may facilitate lowering T2D risk.

Disclosure
J. Wessel: Employee; Spouse/Partner; Eli Lilly and Company. M. Smith: None.

Funding
American Heart Association
1601-P: Sarcopenic Obesity and Its Association with Reduced Cognitive Performance in Type 2 Diabetes in Singapore
Authors: SERENA LOW KIAT MUN , LIM SU CHI , ANG KEVEN , TAVINTHARAN SUBRAMANIAM , FANG SUM CHEE 
Published: June 2019

Introduction: Little is known of association between sarcopenic obesity (SO) and cognition. We aim to examine body composition, and association between SO and cognitive performance in type 2 diabetes (T2D).
Methods: This was a cross-sectional study on 1,317 patients with mean age 61.7±8.2 years and T2D attending both primary and secondary diabetes care in Singapore. Sarcopenia was defined using multi-frequency bio-impedence estimated appendicular skeletal muscle mass divided by height2 with cut-off for Asians (&lt;5.7 kg/m2 in females; &lt;7 kg/m2 in males). Waist circumference (wc)≥80 cm (females) and 90 cm (males) was used to define abdominal obesity. SO was defined as (1) co-existence of sarcopenia and obesity; or (2) fat mass to fat-free mass (FM/FFM) ratio&gt;0.8. Cognition was assessed using Repeatable Battery for the Assessment of Neuropsychological Status.
Results: The distribution by body composition based on definition muscle mass and wc was: nonsarcopenic nonobese, 20.3%; nonsarcopenic obese, 55.1%; sarcopenic nonobese, 13.2%; sarcopenic obese, 11.4%. In contrast, the prevalence of sarcopenic obesity based on FM/FFM ratio was 20.2%. The sarcopenic obese group had the lowest total and index RBANS scores(p&lt;0.05). Multiple linear regression showed SO defined by FM/FFM ratio was significantly associated with reduced total score even after adjusting for demographics with β=-1.66 (95% CI -2.74 to -0.59; p=0.002), and demographics, education and clinical covariates with β=-1.14 (95% CI -2.14 to -0.14; p=0.026). SO was significantly associated with reduced index scores for immediate memory and language in fully adjusted models with β=-1.81 (95% CI -3.46 to -0.16; p=0.032) and β =-2.34 (95% CI -4.06 to -0.062; p=0.008) respectively.
Conclusions: The differing prevalence of SO based on different measures calls for need to standardize definition. SO was associated with reduced cognitive performance and should be considered in management of cognition in patients with T2D.

Disclosure
K. Low: None. S. Lim: None. K. Ang: None. S. Tavintharan: None. C. Sum: None.

Funding
National Medical Research Council of Australia (NMRC/CIRG/1398/2014)
1607-P: Prevalence and Correlates of Potential Glycemic Overtreatment and Undertreatment among U.S. Adults with Diabetes
Authors: MCCOY ROZALINA G. , LIPSKA KASIA J. , HOUTEN HOLLY VAN , SHAH NILAY 
Published: June 2019

Poor glycemic control increases the risk of long-term complications, while overtreatment exposes patients to hypoglycemia. In this study, we examined the rates and correlates of potential overtreatment and undertreatment among adults (≥18 years) with diabetes using OptumLabs® Data Warehouse, an administrative claims dataset of commercial and Medicare Advantage enrollees across the U.S. Patient comorbidities were ascertained in 2014. Demographics, HbA1c, glucose-lowering medications, and attributed provider (internal medicine [IM], family medicine [FM], endocrinology) were ascertained in 2015. Patients were classified as potentially over- or undertreated based on their HbA1c, treatment regimen, and clinical complexity.
The study cohort was comprised of 215,429 adults with diabetes; mean age 65.0 years, 59.4% white, 4.2% with type 1 diabetes, 23.1% ≥75 years, and 12.1% clinically complex. Overall, 21.3% were undertreated (22.7% low complexity, 10.9% high complexity) and 7.7% overtreated (5.4% low complexity, 23.8% high complexity).
Younger age, male sex, black/Hispanic race/ethnicity, type 1 diabetes, FM management, and low clinical complexity were associated with glycemic undertreatment (Table). Younger age, male sex, white/Asian race/ethnicity, type 1 diabetes, endocrine management, and high clinical complexity were associated with glycemic overtreatment.

Disclosure
R.G. McCoy: None. K.J. Lipska: Consultant; Self; Health Services Advisory Group (HSAG). Research Support; Self; National Institute on Aging. Other Relationship; Self; Centers for Medicare and Medicaid Services. H. Van Houten: None. N. Shah: None.

Funding
American Association of Retired Persons; OptumLabs; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)