bluuebunny/crossref_metadata_2025_split huggingface dataset:
2277-PUB: Lower Serum Albumin, Sodium, Calcium, and Phosphorus in Elderly Diabetic Patients with Community-Acquired Pneumonia
Authors: ZHENG FANGQIU 
Published: June 2019

Objectives: To compare the laboratory features between elderly (aged ≥60) diabetic patients with community-acquired pneumonia(CAP) and elderly diabetic patients without CAP.
Methods: This is a retrospective data analysis of in-hospital subjects. A total of 121 elderly patients diagnosed with type 2 diabetes: 41 with CAP and 80 without CAP. The course of disease was similar between the two groups. Mean (SD) age of patients with CAP was 70.84 (5.37) years, mean (SD) age of patients without CAP was 68.32(5.19) years. Laboratory data of the two groups were compared using univariate analysis.
Results: Fasting serum albumin, sodium, calcium, phosphorus and 24-hour urine calcium, 24-hour urine phosphorus in elderly diabetic patients with CAP were significantly lower than those in elderly diabetic patients without CAP. Elderly diabetic patients with CAP had lower albumin: 33.73 (4.85) vs. 38.84 (4.93) g/L, p&lt;0.05, sodium: 134.98 (7.05) vs. 138.77 (6.77) mmol/L, p&lt;0.05, calcium:2.23 (0.13) vs. 2.35 (0.15) mmol/L, p&lt;0.05, phosphorus: 0.92 (0.22) vs. 1.14 (0.22) mmol/L, p&lt;0.05, 24-hour urine calcium: 111.30 (75.02) vs. 185.23 (127.49) mg/24 hours, p&lt;0.05, and 24-hour urine phosphorus:340.48 (227.62) vs. 462.19 (286.73) mg/24 hours, p&lt;0.05. No significant differences were found in levels of fasting blood glucose, insulin, HbA1c, blood urea nitrogen, creatinine, alkaline phosphatase.
Conclusion: In-hospital type 2 diabetes patients aged 60 and older complicated by CAP had a lower serum albumin, sodium, calcium and phosphorus compared with elderly diabetic patients without CAP. These differences should elicit medical attention and may be the risk factors for the elderly diabetic patients complicating CAP.

Disclosure
F. Zheng: None.
228-LB: Obesity Status and Health Information Technology Use in U.S. Adults with Type 2 Diabetes
Authors: WANG SEAMUS , YEH HSIN-CHIEH 
Published: June 2019

One of the many goals of the Affordable Care Act is to improve healthcare quality through the use of technology. However, little is known about health information technology (HIT) use among adults with diabetes. We analyzed data from the National Health Interview Survey (2016-2017) to determine the prevalence of HIT use, and to examine whether HIT use differs by obesity status. All analyses were weighted to account for the complex survey design. We identified 4,857 individuals 18 years or older who had type 2 diabetes by self-report. 45.7% were 65 years or older, 43.3% were female, 14.5% were non-Hispanic black, 15.5% were Hispanic, 18.2% had less than high school education, and 5.0% had no health insurance; mean (SE) body mass index (BMI) was 34.1 (0.25) kg/m2. 28.9% normal weight, 36.7% overweight, and 45.8% obese adults with type 2 diabetes reported looking up health information online. Similarly, electronic health service use (defined as filling a prescription online, scheduling appointment with healthcare provider online, or communicating with healthcare provider by email) were more prevalent in patients with overweight (20.5%) or obesity (25.7%), than those with normal weight (17.7%). After adjustments for age, sex, race/ethnicity, education level, and insurance, compared with adults who had normal weight, the odds ratios (OR) of looking up health information online among overweight and obese adults were 1.32 (95% CI, 1.01-1.74) and 1.65 (95% CI, 1.27-2.15), respectively. The adjusted ORs of using electronic health services were 1.12 (95% CI, 0.81 to 1.55) and 1.46 (95% CI, 1.07-1.99) in overweight and obese adults, respectively. This data showed that HIT is under-utilized among people with diabetes. Still, higher proportion of HIT use in patients with higher BMI suggested HIT may serve as an alternative to more traditional methods of obtaining health information or communicating with health care providers, which in turn may help those with obesity to better manage their weight and comorbidity.

Disclosure
S. Wang: None. H. Yeh: None.
2285-PUB: Risk of Developing T2DM in Lebanon: The Role of Health Literacy, Quality of Life, and Dietary Habits
Authors: SUKKARIEH-HARATY OLA ALI , KHARMA JOELLE ABI , FARRAN NATALI , BASSIL MAYA 
Published: June 2019

Background: International T2DM Federation (IDF) estimates T2DM prevalence in Lebanese adults around 14%. Identifying people at risk of developing type 2 T2DM mellitus (T2DM) as to prevent rising prevalence and development of T2DM related complications is crucial.
Aim: to identify people at high risk for developing T2DM.
Methods: A convenience sample (N=198) of healthy Lebanese adults, 40 years of age and above, were recruited through snowballing from all over Lebanon. Food Frequency Questionnaire (FFQ), Short Test of Functional Health Literacy in Adults (STOFHLA), World Health Organization Quality of Life-BREF (WHOQoL-BREF), and ARABRISK were administered.
Results: Majority of the participants were 40 to 54 years (74.25%), females (57.58%), married (51.02%), employed (59.90%) and reported having “enough to make ends meet” (64.29%). Significant association resulted between ARABRISK scale score and WHOQoL-BREF scale (β= -1.642, p= 0.001) as well as two of its subscales, physical (β= -2.21, p &lt; 0.001) and psychological (β= -1.17, p= 0.003). Significant association was noted between ARABRISK scale score and demographic characteristics; mainly marital status, particularly being “married” (β= 15.47, p &lt; 0.001) and “widowed/divorced” (β= 25.72, p &lt; 0.001), and employment statuses particularly “not enough to make ends meet” (β= 8.64, p= .021).Significant association resulted between ARABRISK scale score and at whole grain consumption (β= -4.97, p = 0.035) and red meat (β= 13.02, p = 0.003). Marital status, red meat consumption, whole grains consumption, and physical health subscale were significantly associated with ARABRISK in the fully adjusted multiple linear regression model. The combination of the latter variables accounted for 36.83% of the variance of ARABRISK score.
Conclusion: Findings will help health care practitioners to understand the determinants of T2DM risk, which will set the stage for effective preventive measures in reducing the risk and incidence of T2DM.

Disclosure
O.A. Sukkarieh-Haraty: None. J. Abi Kharma: None. N. Farran: None. M. Bassil: None.

Funding
Lebanese American University
2286-PUB: Factors Associated with Stigma toward Antidepressants among Latino Patients with Type 2 Diabetes Mellitus and Comorbid Depression in Safety-Net Clinic
Authors: OH HYUNSUNG , ELL KATHLEEN 
Published: June 2019

Stigma toward antidepressants (STA) undermines effectiveness of depression care for Latinos with type 2 diabetes mellitus (T2DM) in safety-net clinics. However, we don’t know who are more susceptible to STA among Latinos with T2DM and comorbid depression in safety-net clinics. To fill this gap, we analyzed cross-sectional data collected from 333 Latino patients recruited from three safety-net clinics located within Latino ethnic enclaves in Los Angeles, California. We analyzed a portion of baseline survey in a randomized clinical trial that tested the effectiveness of community health workers in safety-net clinics, accredited Patient-Centered Medical Home, and participants had to show PHQ-9 score ≥10 to be eligible (56.6 the mean age; 13.8% male; 91.0% Spanish only; 75.4% below high school; 46.8% married). STA was measured by the Latino Scale for Antidepressant Stigma (LSAS). Predictors include patient’s demographic attributes (age, gender, Spanish speaking, education, marital status), depression status (previous diagnosis with major depressive disorder, PHQ-9 score), the Patient Assessment of Chronic Illness Care (PACIC), and the Self-Efficacy for Managing Chronic Disease (SEMCD). When compared patients who endorsed any stigma (LSAS ≥1; N=217) and those who didn’t (LSAS ≥ 0; N=116), those with any stigma were less likely to be married (p&lt;.01) and reported lower PACIC score (p&lt;.01) Multiple regression was used to identify factors associated with STA. The adjusted R square was 0.098, and speaking Spanish (β=.12; p&lt;.05), never married (β =.12; p&lt;.01; ref=married), and SEMCD (β=-.19; p&lt;.01) were associated with STA. When a Latino patient with T2DM was screened for elevated depressive symptoms and is prescribed with antidepressants in a community health center, services helping debunk stigma is recommended to those speaking Spanish, isolated, or presenting lower self-efficacy for managing diabetes.

Disclosure
H. Oh: None. K. Ell: None.

Funding
Patient-Centered Outcomes Research Institute
2287-PUB: Association of Depression Treatment and Glycemic Control in Adults with Diabetes
Authors: FU HELEN N. , RAITER ABAGAIL M. , CARLIN CAROLINE , PETERSON KEVIN A. 
Published: June 2019

Patients with diabetes and comorbid depression have an increased risk of complications. In a repeated panel cross-sectional study, we investigated the effect of depression care on glycemic control for adults with diabetes. Local health plan provided secondary data (N=29,227) that contained depression information and overall health risk calculated by Johns Hopkins ACG software using diagnosis code, visits, and medication claims. This data was matched with A1c, demographics, and neighborhood characteristics.
Study outcome is A1c change. Predictor of interest is depression treatment: (1) no depression in either year, (2) new onset is not treated in prior year but treated in sequential year, (3) past is treated in one year and none in sequential year, and (4) persistent is received treatment in both years. Covariates are age, sex, health risk, insurance types, and neighborhood characteristics. The analysis is a multiple linear regression model using a difference-in-differences framework. Adjusting for covariates, new onset of depression treatment was associated with better diabetes control, A1c decreased by 0.072 (p=0.025), compared to no depression. Compared to no depression, past depression treatment was associated with lower diabetes control, A1c increased by 0.071 (p=0.007). Persistent depression treatment had A1c change not different from no depression group (p=0.731).
Among patients with diabetes, past depression treatment appeared to have poorer glycemic control compared with those not depressed. New onset of depression treatment appeared to improve glycemic control. New diagnosis of depression increased patient contact with provider. A decline in diabetes control among patients received depression treatment in the past, may be related to a change in contact with provider. Future studies could investigate whether patient visit with providers was affected by a change in depression and examine if A1c testing rate correlates with health service utilization.

Disclosure
H.N. Fu: None. A.M. Raiter: None. C. Carlin: None. K.A. Peterson: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110732)
2290-PUB: Depression and Anxiety Screening for Young Adults with Type 1 Diabetes in Transition from Pediatric to Adult Diabetes Care
Authors: NAGRA HARPREET , JOARDER FARAHNAZ , ANDREAS LAURA , KRAUS KIMBERLY 
Published: June 2019

Objectives: Mood concerns among young adults with type 1 diabetes (T1D) can interfere with achieving optimal diabetes self-care, particularly during the transition from pediatric to adult care. Presented are the results of depression and anxiety screening for young adults who attended a multidisciplinary transition clinic.
Methods: All attendees of a multidisciplinary clinic for youth ages 17 to 25 with T1D completed measures of depression (PHQ-9) and anxiety (GAD-7).
Results: Of the 26 youth screened, 35% were female and the mean A1c was 9.1% (76 mmol/mol). PHQ-9 and GAD-7 score were not significantly different by gender. No association was found between A1c and PHQ-9 or GAD-7.
Conclusions: Previous research has linked depression and anxiety with poorer treatment adherence among individuals with T1D, however, there are few studies examining depression and anxiety in transition-age youth. Brief screening of young adults with T1D may illuminate potential threats to adherence as well as provide supplemental information to prevent future problems that may impact diabetes management. The study outcomes should be interpreted with caution given the small sample size and the homogeneous sample.

Disclosure
H. Nagra: None. F. Joarder: None. L. Andreas: None. K. Kraus: None.
2294-PUB: Professional Continuous Glucose Monitoring Improves Glucose Control in Type 2 Diabetes
Authors: LEIBOWITZ JONAS , WISOTSKY DANIEL J. 
Published: June 2019

Professional continuous glucose monitoring (CGM) systems are thought to provide information about hypoglycemia and glucose variability. There is little data to support its use in the type 2 diabetic population for improving glucose control. We evaluated all patients with type 2 diabetes who wore a professional CGM (IPRO2-Medtronic) over an 18-month period in a clinical endocrinology practice. All patients who had an HbA1c on file within 90 days of wearing the CGM and a follow-up HbA1c 90 to 180 days after wearing the CGM were included in the analysis. The patients were divided into those who used insulin in any therapy combination or those who did not use insulin. There were 92 insulin users who had a baseline A1c of 8.35% which improved to 8.11% after wearing the CGM. The 74 noninsulin users had a baseline A1c of 7.87% which improved to 7.30% after wearing the CGM. Our analysis indicated that type 2 diabetics benefit from the use of a professional CGM to improve glycemic control as lifestyle or medication intervention can be better guided.

Disclosure
J. Leibowitz: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc. D.J. Wisotsky: None.
2299-PUB: Liraglutide-Based Therapy Attained A1C Target with Little Risk of Hypoglycemia: Optimization by Average Daily Risk Range Measurement
Authors: KASHIMA KOJI , SHIMIZU HIROYUKI , YAMADA MASANOBU 
Published: June 2019

Objective: Attainment of appropriate A1C target is indispensable to reduce the risk of diabetes complications in type 2 diabetic (T2D) patients. The aim of this study is to evaluate the ability of GLP-1 receptor agonist, liraglutide (Lira), to achieve A1C &lt;7.0% without increase of hypoglycemia risk.
Methods: A total of 194 patients (65.5±12.6 year-old) on Lira-based therapy (LBT) with T2D were included in the analysis. Effectiveness was compared before and after introduction of LBT. Glycaemic variability was evaluated by calculating hypoglycemia-sensitive ADRR score in patients who did self-blood glucose monitoring (SMBG). To avoid hypoglycemia, basal insulin was reduced when fasting blood glucose level reached &lt;80mg/dL.
Results: 1) Before change to LBT, even on insulin based basal-bolus therapy (BBT) (n=21) only 23.8% of the patients achieved the target, and on pre-mixed insulin therapy (MIX) (n=34), 20.6%. 2) Change to LBT improved the average of A1C from 9.7% to 7.1%, and the target was achieved in 55.7% of all patients (n=108/194). 3) Further, all patients were analyzed after divided into 3 groups by the treatment: Lira mono-injection (n=71), Lira+basal insulin (n=106), Lira+BBT/MIX therapy (n=17) group. In Lira mono-injection group, A1C was markedly improved from 10.1% to 6.6%, although the duration of diabetes was shortest (6.7±8.0 years) among 3 groups. The proportion of patients who achieved the target was 69.0%, 50.0%, and 35.3%, respectively. 4) 61.8% of patients at age of 70s also achieved the target by LBT. 5) To optimize blood glucose excursion, SMBG was done in 59.3% of patients. In patients who achieved A1C &lt;7.0%, 82.2% (37/45) showed ADRR scores less than 10. Moreover, in patients who achieved more stringent A1C &lt;6.0%, 73.3% (11/15) of patients showed much lower ADRR scores less than 5, indicating marked reduction of hypoglycemia risk.
Conclusion: LBT makes it easier to achieve lower A1C target without risking hypoglycemia in all ages.

Disclosure
K. Kashima: None. H. Shimizu: None. M. Yamada: None.
2300-PUB: The Efficacy and Safety of Combinations of SGLT2 Inhibitors and GLP-1 Receptor Agonists in the Treatment of Type 2 Diabetes: A Systematic Review and Meta-analysis
Authors: GUO MAN , GU JUNLING , LI JINGSONG , XU YONG 
Published: June 2019

Objective: The aim of this study was to evaluate the efficacy and safety of combination therapy with sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in the treatment of type 2 diabetes mellitus (T2DM).
Methods: We searched clinical trials indexed in PubMed, Embase, CENTRAL, Web of Science, and Scopus from inception through December 3, 2018. A meta-analysis was conducted of trials involving patients receiving SGLT2 inhibitors and GLP-1 agonists using Stata 12.0 software.
Results: A total of 9 clinical trials, including 5 randomized controlled trials (RCTs), that enrolled 1369 participants were identified for meta-analysis. Compared with the control/placebo group, the combination therapy group had significantly reduced fasting plasma glucose level by 0.78 mmol/L (95% confidence interval [CI]: -1.36, -0.2), 2-h postprandial glucose level by 0.47mmol/L (95% CI: -0.69, -0.24), glycosylated hemoglobin (HbA1c) by 0.73% (95% CI: -1.45, 0); body weight that was lower by 0.39 kg (95% CI: -0.59, -0.18) (4 non-randomized controlled trials indicated a larger reduction in body weight of 3.53 kg), and systolic blood pressure (SBP) that was lower by 0.26 mmHg (95% CI: -0.40, -0.11). The total incidence of adverse events (AEs) and genital and urinary infections in the therapy group did not significantly differ from those in the control group, with relative risks (RRs) of 1.06 (95% CI: 0.96, 1.17) and 1.19 (95% CI: 0.69, 2.07), respectively. An increased incidence of hypoglycemia was seen in the combination therapy group (RR=2.49; 95% CI: 1.40, 4.45).
Conclusions: SGLT2 inhibitor and GLP-1 agonist combination treatment improved glycemic control, reduced body weight, and decreased SBP without an increase in total AEs or genital and urinary infections in patients with T2DM. However, the risk of hypoglycemia should be carefully monitored in future clinical trials.

Disclosure
M. Guo: None. J. Gu: None. J. Li: None. Y. Xu: None.

Funding
National Natural Science Foundation of China (81800741)
2314-PUB: No Clinical Factors, Except Baseline HbA1c, Can Predict Glycemic Response to Dulaglutide: Real-World Data in Korean Patients
Authors: YOON JEEHEE , HONG A. RAM , KIM HEEKYUNG , KANG HO-CHEOL 
Published: June 2019

Background: Dulaglutide, a once weekly glucagon-like peptide-1 receptor agonist, demonstrated efficacy and safety through several randomized controlled trials. The aim of our study was to evaluate glycemic response and to find the clinical factors useful in predicting glycemic response to dulaglutide in Korean patients with type 2 diabetes mellitus (T2DM).
Materials and Methods: We retrospectively reviewed medical records of T2DM patients treated with dulaglutide over 6 months in Chonnam National University Hwasun Hospital. Only patients who had baseline and serial HbA1c results (3 months and 6 months) after starting dulaglutide were included. We defined the good response as achieving HbA1c reduction ≥1.0% after 6-months’ treatment with dulaglutide. Clinical factors analyzed for prediction of glycemic response included age, sex, duration of T2DM, HbA1c, BMI, HOMA-β, and HOMA-IR.
Results: Among 77 patients, 38 patients (49.4%) achieved HbA1c reduction ≥1.0% after 6 months. Mean HbA1c level decreased from 8.78% at baseline to 8.03% at 6 months after treatment. Mean HbA1c reduction was -1.06% (95% confidence interval (CI); -1.45 and -0.67) at 3 months and -0.75% (95% CI; -1.27and -0.24) at 6 months after treatment. Mean weight reduction was 3.2 kg at 6 months. In subgroup analysis for predicting glycemic response to dulaglutide, only baseline HbA1c was associated with good response to dulaglutide in multivariate logistic regression analysis.
Conclusion: Dulaglutide is effective for glycemic control and higher baseline HbA1c is associated with good glycemic response to dulaglutide in Korean type 2 DM patients.

Disclosure
J. Yoon: None. A. Hong: None. H. Kim: None. H. Kang: None.
232-OR: The Joint Contribution of Social Determinants Factors to Mortality Risk in Adults with Diabetic Kidney Disease
Authors: OZIEH MUKOSO N. , GARACCI EMMA , EGEDE LEONARD E. 
Published: June 2019

Introduction: No studies have examined whether social determinants of health (SDOH) have a synergistic effect on health outcomes. The study aim is to examine the synergistic impact of socioeconomic status (SES), psychosocial and neighborhood factors on mortality in U.S. adults with diabetes and CKD.
Methods: We analyzed data from NHANES (2005-2010) for adults linked to mortality follow-up. Primary outcome was all-cause mortality. CKD stage was based on eGFR and albumin-to-creatinine ratio. Diabetes was based on self-report or HbA1c ≥6.5%. Cox proportional hazards models was used to estimate the association between SES (poverty income ratio(PIR)), psychosocial (depression) and neighborhood factors (food insecurity-FI) on all-cause mortality as independent predictors and in a joint-effect model while controlling for covariates.
Results: This study included 994 adults (representing 8,188,150 U.S. adults) with diabetes. The sample mean age was 66 years, 40% Non-Hispanic white, 27% Non-Hispanic black, 68% had a ≤high school degree, 39% had PIR of ≤130%, 49% with CKD stage 1-2 and 51% with CKD stage 3-5. In individuals with diabetes and CKD, an increase in PIR was associated with 19% lower mortality (unadjusted HR=0.81, 95% CI=0.68-0.96) while food insecurity (unadjusted HR=0.92, 95% CI=0.72-1.18) and depression (unadjusted HR=1.03, 95% CI=0.98-1.08) did not have a significant effect. After adjusting for demographics, lifestyle, access to care, risk factor control and comorbidities, FI was associated with a 29% higher mortality (adjusted HR=1.29, 95% CI=1.04-1.60); PIR was associated with 22% lower mortality (adjusted HR=0.78, 95% CI=0.61-1.01), marginally significant and depression remained non-significant (adjusted HR=1.02, 95% CI=0.98-1.07). SDOH factors such as FI are an important determinant of mortality risk in this population independent of other SDOH such as SES, psychosocial factor etc. and non-SDOH factors such as lifestyle, access to care, diabetes control etc.

Disclosure
M.N. Ozieh: None. E. Garacci: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.