bluuebunny/crossref_metadata_2025_split huggingface dataset:
2406-PUB: Characterization of Hypoglycemia following New-Onset Diabetes Mellitus Education
Authors: MUSICK TIFFANY S. , MCDONOUGH RYAN 
Published: June 2019

Background: Beginning in January 2017, our institution transitioned new-onset diabetes mellitus education to the ambulatory setting for all children 5 years of age and older. During this transition, our education and practice standards were reviewed and updated. Education historically had been provided during a two-day inpatient hospitalization. With the shift to ambulatory education, teaching was spread out to three separate classes in the first month after diagnosis given that the patients were not under direct supervision. Our primary aim was to prevent hypoglycemia at home, so we introduced new standard insulin doses during the education transition. Glargine doses were reduced to 0.2 units/kg (&lt; 5 years), 0.25 units/kg (5-10 years), and 0.3 units/kg (&gt; 10 years) to minimize hypoglycemia risk while preventing DKA. Due to the lower basal insulin, we lowered insulin sensitivity factors (ISF) to 150 for children under 5 years, 75 for 5-10 years, and 50 for children 11 and older. Corrections were given at meal time to prevent stacking of insulin. Initial carbohydrate ratios remained the same.
Methods: We monitored incidence of high-risk events between classes by characterizing the frequency of hypoglycemia less than 70 mg/dL, hypoglycemia less than 50 mg/dL, use of glucagon, and development of ketones/DKA.
Results: From 1/3/2017 to 12/31/2018 there were 451 patients diagnosed with diabetes at our center. Hypoglycemia questionnaires were completed by 320/451 (71%) of patients/families 1 week after diagnosis. Hypoglycemic episodes with BG &lt; 70 mg/dL occurred in 41% of patients and BG &lt; 50 mg/dL occurred in 8% of patients. Only 1 patient required glucagon for a severe hypoglycemic episode. While 22% of patients had ketones, no patients developed DKA after initial diagnosis.
Conclusions: Conservative dosing with glargine, along with more aggressive carbohydrate and correction dosing at meals is safe and effective in preventing severe hypoglycemia and DKA for patients educated in the ambulatory setting.

Disclosure
T.S. Musick: None. R. McDonough: None.
2407-PUB: Glycemic Patterns Derived from Masked Continuous Glucose Monitoring in Adolescents with Type 1 Diabetes on Contemporary Management
Authors: ABRAHAM MARY B. , SMITH GRANT J. , BOCK MARTIN DE , KING BRUCE R. , FAIRCHILD JAN , AMBLER GEOFFREY , CAMERON FERGUS , DAVIS ELIZABETH A. , ONEAL DAVID N. , JONES TIMOTHY 
Published: June 2019

Background: There has been a change in the management of type 1 diabetes (T1D) with the availability of continuous glucose monitoring (CGM) systems. In Australia, subsidized CGM is available to patients below the age of 21. A randomized controlled trial (RCT) evaluating hybrid closed loop therapy is currently underway and the baseline data provided an opportunity to analyze the glycemic patterns in patients on contemporary management.
Methods: Adolescents and young adults with T1D and HbA1c &lt;10.5% were eligible. All participants wore masked CGM (Enlite® Sensor 3, Medtronic) for 3 weeks during the run-in period. Glucose data from masked CGM were evaluated for glycemic patterns including sensor glucose (SG), glucose variability, percentage time in range, time in hypoglycemia and hyperglycemia.
Results: Data were analyzed from 100 participants (47M, 53F; pump 80, MDI 20) with (mean±SD) age 14.9±2.7 years, diabetes duration 7.6±0.9 years, HbA1c 7.9±0.9% of which 55% participants were on real-time CGM. The (mean±SD) SG was 9.6±1.6mmol/l with fasting SG of 8.8±1.9mmol/l. The SG coefficient of variation was 41.3±6.04%. The median [IQR] %time in range (3.9 to 10mmol/l) was 55.9 [44.1,62.3]. The %time in hypoglycemia (&lt;3.0 and &lt; 3.9mmol/l) were 1.1[0.3,2.2] and 4.4[2.2,8.6] respectively. The %time in hyperglycemia (&gt;10 and &gt;13.9mmol/l) were 35.5[24.7,45.7] and 14.1[8.1,18.8] respectively.
Conclusion: Majority of adolescents in the trial were on insulin pump therapy with half of them on CGM. The baseline CGM data of these participants provide a snapshot of the glycemic management in patients with T1D on current therapy; especially highlighting the reduced time in hypoglycemia compared to earlier trials. The data can further inform the conduct of future trials.

Disclosure
M.B. Abraham: None. G.J. Smith: None. M. de Bock: None. B.R. King: None. J. Fairchild: None. G. Ambler: None. F. Cameron: None. E.A. Davis: None. D.N. ONeal: None. T. Jones: Research Support; Self; Dexcom, Inc., Medtronic MiniMed, Inc. Speaker's Bureau; Self; Eli Lilly and Company, Roche Diabetes Care.
241-LB: Identification of Novel and Population-Specific Signals for Type 2 Diabetes in Large-Scale Study of Hispanic/Latino Individuals
Authors: PETTY LAUREN E. , BELOW JENNIFER E. ,   DIAMANTE HISPANIC/LATINO CONSORTIUM
Published: June 2019

Hispanic/Latino populations are both disproportionately burdened by type 2 diabetes (T2D) and drastically less studied compared to non-Hispanic whites. We present results of the final data freeze of the DIAMANTE Hispanic/Latino Consortium, comprising the largest genome-wide meta-analysis and transcriptome-wide association study of T2D in a Hispanic/Latino population and including a total of 13,151 T2D cases and 21,511 controls. We identified a novel locus in an intronic region of BACE1 for T2D adjusted for body mass index, which has previously been linked to gestational diabetes susceptibility, but never before to T2D. We also identified two variants in known loci with evidence (p &lt;1x10-5) of a residual effect after adjusting for the closest known variant, suggesting that these may be population-specific effects due to H/L linkage disequilibrium structure. We used S-PrediXcan to compute the association of tissue-specific imputed expression for 48 tissues with T2D, revealing novel associations with ten genes and replicating six known genes. These novel genes include three genes previously associated with blood pressure traits: MOV10, ST7L, and WNT2B, as well as two genes previously associated with adiposity, measured by waist and hip circumference: MOV10 and WNT2B. Three novel genes have compelling evidence due to known roles of their biological pathways, including PTCH1, in the hedgehog pathway, which is known to play a role in pancreas development, ST7L, which is a miR-24 target and previous studies have indicated that miR-24 is elevated in diabetes, and WNT2B, part of the WNT signaling pathway, which is known to be involved in glucose homeostasis. These results demonstrate that genetic study of T2D in H/L populations can both help prevent a major health disparity through inclusion of this henceforth overlooked population and can also enable further discovery.

Disclosure
L.E. Petty: None. J.E. Below: None.
2412-PUB: Demographics of Women with Gestational Diabetes Attending a Diabetes and Pregnancy Clinic: 2000-2002, 2010-2012, and 2014-2016
Authors: KHANNA PARUL , ANUKAM KINGSLEY , CHOW LINDSEY , BRYDGES EVAN , LIU SELINA L. , MAHON JEFFREY , JOY TISHA R. , MCMANUS RUTH M. 
Published: June 2019

Background: Numbers of women attending Diabetes and Pregnancy Clinics (DPC) are increasing. Potential reasons include: obesity; fertility intervention access; diagnostic changes for gestational diabetes (GDM). The DPC in London Ontario sees all pregnant women with diabetes within the catchment area with stable clinic structure and procedures. Longitudinal characteristics of GDM women were documented for demographic insights.
Methods: DPC pregnancy charts were assessed for 2000-2002, 2010-2012 and 2014-2016. Data were abstracted for: age; weight, infertility interventions; GDM diagnostic method. Continuous results were analyzed by one-way analysis of variance (ANOVA), non-parametric results by Chi-square testing; p≤ 0.05 signifying significance.
Conclusions: Over the study interval, women with a GDM diagnosis increased 240%. The change may be related to obesity; changes to GDM diagnostic criteria and week of testing; but not late pregnancy weight gain or use of fertility interventions.

Disclosure
P. Khanna: None. K. Anukam: None. L. Chow: None. E. Brydges: None. S.L. Liu: Consultant; Self; Novo Nordisk Inc., Sanofi. Research Support; Self; Physicians' Services Inc. Foundation. J. Mahon: None. T.R. Joy: Speaker's Bureau; Self; Amgen Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Amgen Inc., AstraZeneca, Novo Nordisk Inc. R.M. McManus: None.
2413-PUB: Demographics of Women with Type 1 Diabetes Attending a Diabetes and Pregnancy Clinic, 2000-2002, 2010-2012, and 2014-2016
Authors: KHANNA PARUL , ANUKAM KINGSLEY , CHOW LINDSEY , BRYDGES EVAN , LIU SELINA L. , MAHON JEFFREY , JOY TISHA R. , MCMANUS RUTH M. 
Published: June 2019

Background: The numbers of women attending Diabetes and Pregnancy Clinics (DPC) are increasing. Some of the increase may reflect obesity effects on GDM prevalence, but changes in numbers and characteristics of women with type 1 diabetes (T1DM) are unknown. The DPC in London Ontario sees all pregnant women with diabetes within the catchment area with stable clinic structures and procedures. Longitudinal characteristics of women with T1DM were documented for demographic insights.
Methods: DPC pregnancy charts were assessed for 2000-2002, 2010-2012 and 2014-2016. Data were abstracted for: age; weight, A1C and medication use. Continuous results were analyzed by one-way analysis of variance (ANOVA); non-parametric results by Chi-square testing; p≤ 0.05 signifying significance.
Conclusions: Clinic numbers of pregnant women with T1DM increased non-significantly over the study timeline while pump usage rose concurrent with access to government funding. A1C values fell 0.5% from first to last visit in all time periods. A1C values at first visit rose over the time periods suggesting women with less optimal glucose control were conceiving pregnancies.

Disclosure
P. Khanna: None. K. Anukam: None. L. Chow: None. E. Brydges: None. S.L. Liu: Consultant; Self; Novo Nordisk Inc., Sanofi. Research Support; Self; Physicians' Services Inc. Foundation. J. Mahon: None. T.R. Joy: Speaker's Bureau; Self; Amgen Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Amgen Inc., AstraZeneca, Novo Nordisk Inc. R.M. McManus: None.
2422-PUB: Short-Chain Acylcarnitines as Early Predictors of Gestational Diabetes in Mexican Population
Authors: RAZO-AZAMAR MELISSA , NAMBO-VENEGAS RAFAEL , DELGADILLO-VELAZQUEZ JAIME , PALACIOS-GONZALEZ BERENICE 
Published: June 2019

Gestational diabetes (GD) represents the main metabolic alteration during pregnancy affecting 17% of pregnancies in Mexico. The clinical relevance of this pathology is the short and long-term complications such as obesity, diabetes, and hypertension; that affect mother and child. GD is often diagnosed between weeks 24 to 28 of gestation through an oral glucose tolerance test. The aim of the present study was to identify early pregnancy metabolites (under 18 weeks of gestation) present on women who were diagnosed with GD; in order, to generate an early prediction model to identify those women who will later be diagnosed with GD. We used targeted metabolomics (11 amino acids and 39 acylcarnitines) to select early serum biomarkers with the most predictive power to identify women who will later be diagnosed with GD on a Mexican cohort of pregnant women. We assessed 79 pregnant women, which 66 underwent a normal pregnancy and 13 were diagnosed with GD under the IADPSG criteria. Random forest analyses were performed to assess the contribution and association of the metabolites identified to the development of GD. We developed a model that included two short-chain acylcarnitines (namely AC4 and AC5:1) that allowed an AUC of 0.904 (0.843-0.965, 95 CI) for classification of gestational diabetes. This model allows the identification of women on early stages of pregnancy that will be diagnosed with gestational diabetes between weeks 24 to 28 of gestation. However, additional studies in a large sample of pregnant women are required.

Disclosure
M. Razo-Azamar: None. R. Nambo-Venegas: None. J. Delgadillo-Velazquez: None. B. Palacios-Gonzalez: None.
2426-PUB: Circulating WBC, RBC, and Hemoglobin Level in Relation to Metabolic Syndrome and Incident Prediabetes in a Biracial Cohort of Normoglycemic Subjects with Parental Type 2 Diabetes
Authors: ABUTINEH IMAN , UMEKWE NKIRU A. , ARIGANJOYE FOLABI , DAGOGO-JACK SAMUEL 
Published: June 2019

Objective: We assessed the relationships among blood cell counts, metabolic syndrome (MetS), and prediabetes risk in a biracial cohort of African Americans (AA) and European Americans (EA) with parental type 2 diabetes mellitus (T2DM).
Methods: We studied 603 normoglycemic subjects (264 EA, 339 AA), mean (+SD) age 46.14 ± 10.58 y and BMI 31.1 + 7.30 kg/m2. Each subject underwent clinical examination and OGTT. Blood specimens were analyzed for RBC, WBC and differentials, and lipids. MetS markers were identified using NCEP cut-offs for waist, blood pressure, HDL cholesterol and triglyceride (TG) levels.
Results: Total WBC count correlated positively with waist circumference (P=&lt;0.001), TG (P=0.018) and fasting plasma glucose (FPG) (P=0.023) and inversely with HDL level (P=0.005), as did segmented neutrophil and monocyte counts. RBC count also correlated positively with waist (P= 0.0002), TG (P= 0.0004), FPG (P=0.035) and WBC count (P=0.0016) and inversely with HDL cholesterol level (P=&lt;0.0001). Hemoglobin (Hb) and hematocrit (Hct), both strongly reflecting RBC count (r=0.75, P=0.0001), mirrored the association with MetS markers seen with RBC. Among 372 subjects followed longitudinally for 5 y, baseline MetS markers, absolute eosinophil and basophil counts, and Hb significantly predicted progression to prediabetes. After adjustment for age and BMI, logistic regression odds ratio [95% CI] for incident prediabetes was 1.37[1.094-1.633], P=0.0045 for MetS; 1.21[1.037-1.405], P=0.015 for Hb; 1.006[1.002-1.011], P=0.0093 for absolute basophil count; and 1.003[1.000-1.005], P=0.0237 for absolute eosinophil count.
Conclusions: The known association between cardiometabolic risk and WBC extends to RBC count as well. Moreover, Hb level, eosinophil and basophil counts specifically predict increased risk of prediabetes, probably via proinflammatory and iron-related mechanisms.

Disclosure
I. Abutineh: None. N.A. Umekwe: None. F. Ariganjoye: None. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.

Funding
National Institutes of Health
2428-PUB: Circulating microRNAs Are Associated with Latino Ancestry but Not Prediabetes
Authors: FLOWERS ELENA , LAZO-DE-LA-VEGA-MONROY MARIA-LUISA , SUCHER ANATOL , AOUIZERAT BRADLEY , KANAYA ALKA M. 
Published: June 2019

Introduction: Circulating microRNAs (miRs) may be predictive biomarkers to identify individuals at risk for type 2 diabetes (T2D). Latinos are at particular high risk for T2D, and the reasons are entirely known.
Methods: We compared expression of circulating miRs between 66 individuals who self-identified with Latino ancestry in the United States (n=21) and native Mexicans living in or near Leon, Mexico (n=45), who had prediabetes (n=36) or normal glycemic status (n=30). Expression of three miRs (i.e., miR-126, miR-146a, miR-15) associated with risk for T2D in other race/ethnic groups was measured using quantitative polymerase chain reaction.
Results: All miRs were strongly correlated (r2&gt;0.7, p&lt;0.05 for all). MiR-146a and miR-15 were increased in U.S. Latinos compared to native Mexicans, (p&lt;0.05 for both). There were no significant differences in expression of any miR associated with prediabetes compared to normal glycemic status. There were no significant interactions between geographic region and miRs in logistic regression models for prediabetes. In a logistic regression model for prediabetes that only included common covariates (i.e., age, sex, body mass index (BMI)), and no miRs, BMI was the only significant predictor (p&lt;0.05), and there was a significant interaction between BMI and geographic region (p&lt;0.05). We tested associations between miRs and common covariates. MiR-146a was correlated with BMI (r2=0.3, p&lt;0.05). When miR-146a was added to a model for prediabetes, the relationship between BMI and prediabetes was no longer significant. There was no significant interaction between miR-146a and geographic region.
Conclusions: Our study failed to validate associations between miRs and prediabetes observed in other racial groups, but we did identify differences in expression levels associated with geographic region. Further studies are needed to determine which miRs are widely associated with risk for T2D across racial groups versus miRs that identify unique risk within a racial subgroup.

Disclosure
E. Flowers: None. M. Lazo-de-la-Vega-Monroy: None. A. Sucher: None. B. Aouizerat: None. A.M. Kanaya: None.

Funding
University of California Institute for Mexico and the United States; El Consejo Nacional de Ciencia y Tecnología
2432-PUB: Predictors of Imminent Glycemic Worsening in Adults with Screen-Detected Diabetes
Authors: AGUIRRE REBECCA S. , HANNON TAMARA S. , CONSIDINE ROBERT , KIRKMAN M. SUE , MATHER KIEREN J. 
Published: June 2019

Reliable clinical indicators of near-term risk of worsening glycemia in type 2 diabetes (T2D) could help guide individual-level interventions. Here we analyzed data from the Early Diabetes Intervention Program (EDIP) to identify predictors of near-term glycemic progression. EDIP evaluated progression of fasting blood glucose (FBG) above 140 mg/dl on consecutive quarterly measurements in individuals with screen-detected T2D and FBG below 140 at study entry (age 52.6 + 11.5 years, 41.9% male, mean entry FBG 121±14 mg/dL; mean 2-hour OGTT glucose 236±30; mean HbA1C 6.4+0.57%). We investigated accessible clinical parameters (weight, glycemia, lipids, and insulin levels) as potential near-term predictors of progression, evaluating absolute levels and yearly changes preceding progression. Variables were evaluated individually in age/sex/race-adjusted analyses and in combination in multivariable Cox progression models. Change over the preceding 1 year in fasting glucose, but not in weight or insulin levels, was predictive of glycemic progression in the subsequent year in adjusted univariate analyses (p&lt;0.03). In multivariable modeling, the FBG concentration (hazard ratio HR 1.14) and the antecedent 1-year change in FBG (HR 0.90) were the strongest predictors of progression, and both retained significance in multivariable models including all specified variables (p&lt; 0.0001). Adding changes in fasting insulin, HOMA-IR, or oral disposition index to the modeling did not change this result. There was a significant correlation between current FBG and the antecedent 1-year change (r=0.587; p&lt;0.01), highlighting that change in FBG was contributing in part via its effect on current FBG. In the EDIP study population with screen-detected T2D, current FBG and antecedent 1-year change in FBG were the best predictors of upcoming glycemic worsening. These data underscore the value of serially monitoring fasting glucose, and suggest a similar monitoring paradigm should be evaluated in prediabetes.

Disclosure
R.S. Aguirre: None. T.S. Hannon: Advisory Panel; Self; Eli Lilly and Company. R. Considine: None. M. Kirkman: Research Support; Self; Bayer AG, Novo Nordisk A/S, Theracos, Inc. K.J. Mather: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk A/S, Sanofi.
2434-PUB: Comparison of Diabetes Prevalence and Severity between Chinese and Non-Chinese Populations in New York City
Authors: LIU GEORGE , GEORGE JOHN D. , SHARP JAMES W. , HU ANTHONY , CHANG TA-MIN 
Published: June 2019

Diabetes mellitus (DM) is the 7th leading cause of death in the U.S. in 2015. According to Center of Disease Control (CDC), prevalence of DM has increased in recent years affecting 9.4% of U.S. population and 12.5% of New York City (NYC) population in 2015. Increased DM prevalence is a worldwide trend associated with increasing age of the population.
Aim: To determine prevalence and severity of diabetes/prediabetics in NYC Chinese population in comparison with those of non-Chinese patients.
Methods: We obtained and analyze HMO A1C data of 276,854 Chinese (age 18-98 with median of 51 years, 55% female, 45% male, representing the largest population studies) and non-Chinese sampling population in NYC from January 2015 to October 2018 using BioReference Lab. Patients (57,612 Chinese, 49,548 non-Chinese) classified as prediabetics with A1C between 5.7-6.4% upon initial A1C test had follow-up test after management according to CDC Prediabetic management protocol.
Results: Of 197,487 Chinese who had A1C test indicated prevalence of 18.5% diabetes, 45.6% of prediabetic and 35.6% nondiabetics. The male group had a higher incidence of diabetes than females (21% vs. 16.5%). Among 1,341,054 non-Chinese clients, there were 51.6% nondiabetics, 31.4% prediabetics and 18.0% diabetes. The severity of diabetes with respect to A1C data in 36,596 Chinese were 6.5-7.4, 57%; 7.5-9.0, 27%; &gt;9.0, 16% whereas in 241,180 non-Chinese they were 44%, 29% and 28%, respectively. Among Chinese prediabetics, 30% reversed to nondiabetics and 5.7% progressed to diabetic categories, whereas among non-Chinese prediabetics, 25.8% reverse to nondiabetics and 11.1% progressed to diabetics during the study time.
Conclusion: Prevalence of diabetes in NYC population is higher than that found in 2015. More severe diabetes with higher A1C levels was found in non-Chinese than Chinese patients. The NYC Chinese had higher incidence of prediabetics but had better management outcome than non-Chinese community.

Disclosure
G. Liu: None. J.D. George: None. J.W. Sharp: None. A. Hu: None. T. Chang: None.