bluuebunny/crossref_metadata_2025_split huggingface dataset:
52-LB: Insulin Cost-Saving Estimate for Injection Technique (IT) Training in Subjects Injecting into Lipohypertrophy (LH)
Authors: CHEN LIMING , XING QIULING , LI JING , ZHOU JIANXIN , HOU YUE , YUE NING , YUAN YI 
Published: June 2019

Background: LH with prevalence of 53.1% [1] among diabetic population in China, is one of the most common clinical complications related to injection therapy. IT training includes rotation of injection sites, adjustment of doses, stop needle reuse, etc. is an education intervention for those diabetic patients injecting into LH.
Objective: This study aims to assess the effect of IT training on Total Daily Dose (TDD) of insulin for those diabetic patients injecting into LH and estimate the related insulin cost savings.
Methods: A 6-month prospective randomized controlled trial carried out in 210 diabetic patients with LH in Tianjin. Patients in intervention group (n=106) were given IT training including avoiding injections into LH, reducing TDD by 10-20%, rotating injection sites, and stopping needle reuse. Patients in control group (n=104) kept their injection habits. The annual cost of insulin in China were calculated with the TDD, unit cost of insulin, the population of insulin therapy and insulin adherence rate. Unit costs of insulin was 0.25 RMB/IU [2], 9 million insulin injecting patients and 42% insulin therapy adherence in China [1] (the exchange rate is 1 USD =6.617 RMB in 2018). The discount rate was set as 3%.
Results: The TDD for the control group and intervention group were 45.31(21.83) IU and 47.08(20.62) IU at 0 month and 45.06(21.29) IU and 40.53(19.97) IU at 6 months respectively. Patients in intervention group had a significant TDD decrease at 6.84 IU per day (P&lt;0.05) after 6 months training. However, the TDD for control group only decreased at 0.91 IU per day. The estimated annual cost of decrease of insulin uptake because of IT training is approximately 1.37 billion RMB (207.0 million USD).
Conclusion: IT training in patients with LH can significantly reduce the insulin uptake and then saving medical expenditure both from the patient and the healthcare sectors’ perspective. Thus, the IT training should be applied in a greater population with insulin therapy in China.

Disclosure
L. Chen: Research Support; Self; Becton, Dickinson and Company. Q. Xing: Research Support; Self; Becton, Dickinson and Company. J. Li: Research Support; Self; Becton, Dickinson and Company. J. Zhou: Research Support; Self; Becton, Dickinson and Company. Y. Hou: Employee; Self; Becton, Dickinson and Company. N. Yue: Employee; Self; Becton, Dickinson and Company. Y. Yuan: Employee; Self; Becton, Dickinson and Company.

Funding
Becton, Dickinson and Company
526-P: Dapagliflozin Improves the Urinary CKD273 Proteomic Score When Added to Renin-Angiotensin Blockade in Patients with Type 2 Diabetes and Nephropathy
Authors: PERSSON FREDERIK , EICKHOFF MIE K. , MISCHAK HARALD , FRIMODT-MOLLER MARIE , ROSSING PETER 
Published: June 2019

Objective: Evaluating effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on the urinary CKD273 proteomic score in patients with type 2 diabetes (T2D) and albuminuria.
Methods: A double-blinded, randomized, placebo-controlled, crossover trial of 12 weeks dapagliflozin (10 mg) or matching placebo added to standard care. Patients included (n=40) had T2D and albuminuria (UACR≥30 mg/g). At baseline and end of treatment periods HbA1C was measured, spot urine for urinary proteomics and three consecutive morning spot urines for albuminuria were collected and 24h blood pressure and 51Cr-EDTA (GFR) were performed. Urine proteomic patterns was evaluated using the CKD273 score. To determine high-risk or low risk of diabetic kidney disease a previously defined cut off of 0.154 was used. Results were compared using mixed model analysis adjusted for age, sex, systolic blood pressure, HbA1c, albuminuria and GFR. Chi-square analysis was used to examine change in risk category based on proteomics.
Results: Baseline values for the 36 participants completing the study: Geometric mean urinary albumin creatinine ratio (UACR) = 147 (IQR 82-330) mg/g, mean eGFR = 84 ml/minute/1.73 m2 (SD±19.3), HbA1c = 73 mmol/mol (SD±15) and 24h blood pressure = 147/82 mmHg (SD±12.0/8.1). Dapagliflozin reduced UACR by 44% (95% CI 17-78%, p&lt;0.01), GFR by 10.6 (6-15) ml/minute/1.73m2 (p&lt;0.01), HbA1c by 7.4 (5-10) mmol/mol (p&lt;0.01) and 24h blood pressure by 4.1/2.9 mmHg (p=0.058/p&lt;0.01). The CKD273 proteomic score improved from mean 0.457 with -0.217 (p&lt;0.01) and renal risk category improved from 72% at high risk to 47% after dapagliflozin (p=0.032).
Conclusions: Dapagliflozin added to standard care in T2D patients with albuminuria significantly reduced the urinary CKD273 proteomic score and renal risk. This indicates a possible direct beneficial effect on the kidneys, which may explain part of the renal benefit of SGLT2i seen in clinical trials.

Disclosure
F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M.K. Eickhoff: None. H. Mischak: Stock/Shareholder; Self; Mosaiques Diagnostics. M. Frimodt-Moller: None. P. Rossing: Advisory Panel; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp. Other Relationship; Self; Novartis AG, Novo Nordisk A/S.

Funding
AstraZeneca
529-P: Hemoglobin Glycation Index Is Associated with Incident Chronic Kidney Disease in Subjects with Impaired Glucose Metabolism: A 10-Year Longitudinal Cohort Study
Authors: HUH JI HYE , KIM WONJIN , KIM MIN KYUNG 
Published: June 2019

Objectives: We investigated associations between HGI and incident chronic kidney disease (CKD) in treatment naïve subjects with prediabetes or diabetes.
Methods: A prospective cohort study was conducted in 2,187 subjects with prediabetes or diabetes. The HGI was calculated as the measured HbA1c minus predicted HbA1c, which was calculated from the linear relationship between HbA1c and fasting plasma glucose levels. Incident CKD was defined as occurring if eGFR decreased to less than 60 mL/min per 1.73 m2 and decreased by more than 25% from baseline during follow-up. The hazard ratio (HR) for incident CKD was calculated using Cox models.
Results: The overall prevalence of CKD was 335 (15.3%) during the 10-year follow-up period. While the prevalences of CKD significantly increased from the first to third tertile of HGI, this phenomenon was not seen in HbA1c (Figure). In multivariate analysis, the highest HGI tertile group showed the highest adjusted HR for incident CKD (HR, 1.57; 95% CI, 1.06-2.34) and this was significant even after adjustment for HbA1c.
Conclusion: High HGI was associated with increased risk for incident CKD in treatment naïve subjects with prediabetes or diabetes. These finding suggest that HGI might provide additional information for predicting CKD in patients with impaired glucose tolerance independently of HbA1c levels.

Disclosure
J. Huh: None. W. Kim: None. M. Kim: None.
535-P: Relationship between Renal Capacities to Reabsorb Glucose and Kidney Disease in Patients with Diabetes
Authors: MATAR ODETTE , POTIER LOUIS , ABOULEKA YAWA , FUMERON FRÉDÉRIC , MOHAMMEDI KAMEL , HADJADJ SAMY , ROUSSEL RONAN , VELHO GILBERTO , MARRE MICHEL 
Published: June 2019

Hyperglycemia can impair tubulo-glomerular balance and cause kidney disease by opening pre-glomerular resistances. Susceptibility to kidney disease is heterogeneous among diabetic patients, and renal capacities to reabsorb glucose may contribute to it. We studied if renal capacities to reabsorb glucose relate to kidney disease in diabetic patients. The diabetic patients attending over 6 months our tertiary referral center in Paris, France (where SGLT2 inhibitors are not available), were studied consecutively for their fractional glucose reabsorption (1-[urinary glucose x plasma creatinine]/[urinary creatinine x plasma glucose]) according to their glycemia (&lt;6, 6-11, &gt;11mM), and kidney disease (normo-, micro-, macroalbuminuria, and estimated Glomerular Filtration Rate (eGFR, CKP-EPI equation) &gt;90, 90-60, 59-30, and &lt;30-16 ml/min/1.73m2; patients with eGFR ≤15ml/min/1.73m2 were excluded). Of 637 participants, 106 displayed glycemia &lt;6mM, 288 6-11mM, and 243 &gt;11mM. Fractional glucose reabsorption was similar in participants with glycemia &lt;6mM and 6-11mM: median 99.90 (interquartiles 99.60-99.94)%. It was lower in those with glycemia &gt;11mM, proportional to kidney disease: normoalbuminuria (n=135) 93.50 (81.60-99.34)%, microalbuminuria (n=77) 96.56 (93.77-99.71)%, macroalbuminuria (n=31) 99.12 (94.20-99.64)% (p&lt;0.001); eGFR &gt;90ml/min/1.73m2 (n=111) 94.13 (82.34-98.58)%, 90-60ml/min/1.73m2 (n=72) 96.35 (87.81-99.75)%, 59-30ml/min/1.73m2 (n=46) 98.88 (92.19-99.78)%, &lt;30-16 ml/min/1.73m2 (n=14), 99.11 (97.57-99.77)% (p&lt;0.01). On multivariate analyses, fractional glucose reabsorption in participants with glycemia &gt;11mM contributed independently to their urinary albumin excretions and eGFR values. Renal capacities to reabsorb glucose were linked to kidney disease in diabetic patients with glycemia &gt;11mM. Inter-individual capacities to reabsorb glucose may contribute to kidney disease of diabetic patients.

Disclosure
O. Matar: None. L. Potier: Advisory Panel; Self; Merck Sharp & Dohme Corp. Consultant; Self; Sanofi. Y. Abouleka: None. F. Fumeron: None. K. Mohammedi: None. S. Hadjadj: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Bayer AG, Janssen Research & Development. Speaker's Bureau; Self; Abbott, Valbiotis. R. Roussel: Advisory Panel; Self; Merck Sharp & Dohme Corp., Sanofi. Consultant; Self; Abbott, AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Physiogenex. Research Support; Self; Janssen Pharmaceuticals, Inc. G. Velho: None. M. Marre: Advisory Panel; Self; Servier. Board Member; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S.
54-LB: Let’s Play! A Diabetes Education Board Game
Authors: CURL MICHELLE , POZEFSKY DIANE , JAIN NINA 
Published: June 2019

Background: The adolescent years are challenging time for diabetes educators, medical providers and families with type 1 diabetes. We developed a unique board game to assess knowledge, increase dialogue, and provide education. The game curriculum utilizes Blooms taxonomy and focuses on the cognitive, affective and psycho-motor domains of educational learning. Game-based learning can enhance student/patient motivation and improve knowledge acquisition. Games also provide a safe format for the learner to try new experiences and gain insight from their successes and failures.
Objectives: To enhance dialogue among the diabetes educator, teenagers and parents regarding type 1 diabetes management. To assess players’ knowledge of diabetes and provide additional education and support.
Methods: Ninety parent-child dyads participated in the game over the course of 18 months. Thirty percent were teenage participants (13-17 yo). The game design encourages players to apply their skills and knowledge in simulated, real world scenarios. On every turn, players must use basic math skills to advance to the next challenge. The game focuses on the following diabetes self-management themes: glucose monitoring, physical activity, medication management, healthy eating, problem solving, exercise and sick day management.
Results: Diabetes educators reported increased dialogue and teen engagement during diabetes education. Game play facilitated the assessment of teens’ knowledge, skills and emotional well-being. Based on this assessment, educators addressed the specific needs of each parent-child dyad. Educators also reported improved interdisciplinary communication. Pediatric endocrinologists reported an improved ability to individualize patients’ medical care based on the identified knowledge/skill deficits.
Conclusion: This diabetes board game has the potential to improve dialogue and guide education for each parent-child dyad.

Disclosure
M. Curl: None. D. Pozefsky: None. N. Jain: None.
540-P: Time Is an Independent Risk Factor for Diabetic Nephropathy in African Americans (AA) Compared with Caucasians
Authors: FERRARI ALDO DE , OVALLE FERNANDO 
Published: June 2019

Background: AA have a higher prevalence of diabetic nephropathy (DN) than Caucasians. However, the prevalence of DN between AA and Caucasians as a function of time is less well understood.
Methods: We retrospectively reviewed the medical charts of 1211 adults who consecutively presented to our diabetes clinic from 2001-10. We collected data from their initial clinic visit. We defined DN as microalbuminuria &gt;300 mg/g or GFR &lt;60 mL/min/1.73m2. Primary objectives were to estimate the prevalence of DN among AA and Caucasians, estimate DN prevalence as a function of time since diabetes diagnosis, and determine risk factors associated with DN.
Findings: The prevalence of DN among AA and Caucasians was 32% and 19.6%, respectively. The prevalence of DN increased as a function of time for both AA and Caucasians, but was significantly higher among AA &gt;10 years after diabetes diagnosis (Figure). In multivariable logistic regression, having hypertension (OR = 3.0, 95% CI 2.03 - 4.49), diabetes for &gt;10 years (2.64, 1.91 - 3.68), A1c &gt;8% (1.40, 1.01 - 1.96), and being AA (1.88, 1.32 - 2.66) were independently associated with DN. Diabetes subtype, BMI, and gender were not associated with DN.
Interpretation: Differences in DN prevalence between AA and Caucasians appear ∼10 after diabetes diagnosis, independent of A1c and hypertension control. AA may benefit from early prevention and aggressive risk factors control.

Disclosure
A. De Ferrari: None. F. Ovalle: Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk A/S.
549-P: Renal Outcome of Patients with Type 2 Diabetes Exhibiting Normoalbuminuric Renal Insufficiency
Authors: NISHIWAKI YUI , HANAI KO , BABAZONO TETSUYA 
Published: June 2019

Recent studies have identified a unique subgroup of patients with type 2 diabetes exhibiting reduced renal function in spite of being normoalbuminuric; however, information is limited regarding the clinical course of these patient. Here, we evaluated renal outcome of patients with normoalbuminuric renal insufficiency. This was a single-center, historical cohort study. We studied 7,152 adult Japanese patients with type 2 diabetes (mean age: 61 years, men: 64%) who had never undergone renal replacement therapy (RRT). The subjects were classified into 6 groups based on the baseline estimated glomerular filtration rate (eGFR): ≥ 60 or &lt; 60 mL/min/1.73 m2and urinary albumin-to-creatinine ratio: ACR (&lt;30: normoalbuminuria, 30-299: microalbuminuria, or ≥ 300 mg/g: macroalbuminuria). Two separate endpoints were defined as follows: 1) ≥ 30% decline in eGFR from the baseline value or initiation of RRT, whichever came first, and 2) annual decline in eGFR, estimated using a linear mixed-effect model. During a median follow-up of 5.7 years, 1,374 patients reached the first endpoint. The adjusted hazard ratios (vs. patients with normal eGFR and normoalbuminuria [n= 3,881]) for patients with reduced eGFR and normoalbuminuria (n= 823), normal eGFR and microalbuminuria (n= 1,010), reduced eGFR and microalbuminuria (n= 508), normal eGFR and macroalbuminuria (n= 235), and reduced eGFR and microalbuminuria (n= 695) were 1.55, 2.74, 4.15, 10.00, and 29.02, respectively (all p&lt; 0.001). The adjusted annual decline in eGFR (least square mean ± standard error) in patients with reduced eGFR and normoalbuminuria was 0.66 ± 0.10 mL/min/1.73 m2/year, which was significantly lower than those in other 5 groups (p&lt; 0.001).
In conclusion, patients with type 2 diabetes manifesting normoalbuminuric renal insufficiency are likely to have a better kidney prognosis, with an extremely slow decline rate of renal function.

Disclosure
Y. Nishiwaki: None. K. Hanai: None. T. Babazono: None.
555-P: Poor Sleep Quality Linked to Decreased Brain Gray Matter Density in Type 2 Diabetes
Authors: CABRERA-MINO CRISTINA , ROY BHASWATI , WOO MARY A. , KUMAR RAJESH , CHOI SARAH E. 
Published: June 2019

Background: Adults with type 2 diabetes mellitus (T2DM) frequently report poor sleep quality. However, the impact of poor sleep, which may exacerbate brain changes in T2DM patients, is unclear. Study aim was to evaluate sleep symptoms and the relationship between sleep quality and brain changes in T2DM using high-resolution magnetic resonance imaging (MRI) procedures.
Methods: Brain MRI images were collected from 17 T2DM patients (age 55.8 ± 7.0 years, 7 males) and 52 controls (age 55.7 ± 1.8 years, 32 males) using a 3.0-Tesla MRI scanner. Sleep symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI) and images evaluated using gray matter density (GMD) maps. Statistical analysis included partial correlations and ANCOVA (covariates: age, sex).
Results: T2DM patients showed worse sleep symptoms compared to controls (7.2 ± 4.0 vs. 3.6 ± 2.0; p&lt;0.001). There were negative correlations between GMD (including frontal cortices, hippocampi, and cerebellum) and sleep quality (lower density in persons with higher PSQI/worse sleep) [left cerebellum GMD vs. PSQI, r = -0.742, p = 0.002; right GMD vs. PSQI, r = -0.722, p = 0.002].
Conclusion: Adults with T2DM show reduced GMD negatively correlating with increased sleep disturbance symptoms. Potential mechanisms are unclear, but may involve altered glucose metabolism or hypoxic-induced processes. Efforts to improve sleep quality may help mitigate brain changes in T2DM patients.

Disclosure
C. Cabrera-Mino: None. B. Roy: None. M.A. Woo: None. R. Kumar: None. S.E. Choi: None.

Funding
National Institute of Nursing Research (1R01NR017190-01A1)
557-P: Impact of Extensive HbA1c Control on Major Microvascular Complications in Type 2 Diabetes Mellitus with Short Duration of Disease
Authors: TAVAKOLI MITRA , ISHIBASHI FUKASHI 
Published: June 2019

The aim of this study was to investigate the impact of extensive HbA1c control on major microvascular complications including neuropathy, retinopathy and nephropathy in T2DM patients with short duration. Detailed Clinical (e.g., full Lipid profile test, BMI, Blood Pressure, eGFR), ophthalmic (e.g., Fundus Photography, Optical Coherence Topography (OCT), Corneal Confocal Microscopy (CCM)) and neurological examinations (e.g., symptoms, electrophysiology, quantitative sensory testing, Cardiac Autonomic Neuropathy tests) were performed in 76 patients with T2DM at baseline and after glycemic control (GC) with or without Extensive HbA1C control (EHC) over 4 years along with 48 controls with normal glucose tolerance (NGT) and 34 subjects with impaired glucose tolerance (IGT). The mean HbA1c levels during whole follow-up period were closely related with the improvement in neurological markers. The multiple regression analysis indicates that the changes in all Corneal Nerve markers (CNF) and neurophysiological measures were closely associated with the mean HbA1c level over whole follow-up period. Higher SD and CV of HbA1c levels were negatively associated with some CNF and neurophysiological measures. The high baseline HbA1c levels deteriorated many neurological markers. In this study patients with poorly controlled type 2 diabetes returned to IGT by normalizing HbA1c level for 2 years without hypoglycemia. Nephropathy reduced from 34.2% to 18.4%. However, the prevalence of retinopathy progressed from 7.9% at baseline to 13.2%. Prevalence of neuropathy reduced from 13.2% to 2.6%. Although improvement of neurological markers in this study was significant, but the changes were small. The intensive GC in T2DM with short duration is associated with a reduction in microvascular complications (mostly albuminuria). The normalized HbA1c levels are more effective than standard care for preventing the development of neuropathy, but not retinopathy.

Disclosure
M. Tavakoli: None. F. Ishibashi: None.
56-LB: HCP Information: Drowning in Resources, Lacking Confidence?
Authors: MCDERMOTT JAMES M. , LEVINE BRIAN , LACKNER JOHANNA , SHOGER ERIK , CLOSE KELLY L. 
Published: June 2019

Objective: This study sought to identify gaps in diabetes care information resources for healthcare professionals (HCPs), as well as their confidence administering diabetes care.
Methods: In July 2018, a survey was delivered to 286 HCPs, including U.S. primary care physicians (PCPs), nurse practitioners (NPs), physician assistants (PAs), and certified diabetes educators (CDEs), to assess confidence in treating patients with diabetes, current use of diabetes information resources, and needs not met by existing resources. Survey respondents treated an average of at least 40 patients with diabetes per month.
Results: On average, HCPs are using 24 different resources to stay informed on developments in diabetes care. Over 60% of surveyed HCPs do not feel fully comfortable staying up to date with care guidelines and medication/technology advances, and 96% are interested in a consolidated diabetes information hub. Further, 59% of CDEs, 72% of PCPs, 84% of NPs, and 90% of PAs lack full confidence in their ability to help patients self-manage their diabetes. PAs have the lowest confidence in their ability to start every diabetes therapy and technology. Confidence among the other HCPs in initiating medications is high, though apart from CDEs, few are comfortable starting diabetes technology; only 17% of PAs, 32% of NPs, and 39% of PCPs are confident initiating CGM.
Conclusions: These results suggest that many HCPs lack confidence in their abilities to keep up with developments in diabetes and effectively help patients manage their diabetes. The availability of a consolidated diabetes information resource for HCPs has potential to enable better care delivery, improve outcomes, and reduce provider overwhelm.

Disclosure
J.M. McDermott: Other Relationship; Self; Various. B. Levine: Other Relationship; Self; Various. J. Lackner: None. E. Shoger: Other Relationship; Self; Abbott Laboratories, Ascensia Diabetes Care, Dexcom, Inc., Insulet Corporation, Medtronic, Sanofi, Senseonics, Tandem Diabetes Care, Valeritas, Inc. K.L. Close: Other Relationship; Self; Various diabetes companies.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust