bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glycemic Control and Infections among U.S. Hemodialysis Patients with Diabetes Mellitus
Authors: RHEE JINNIE J. , ZHENG YUANCHAO , MONTEZ-RATH MARIA , WINKELMAYER WOLFGANG 
Published: June 2018

Patients with diabetes mellitus (DM) and those who are on hemodialysis (HD) may be particularly vulnerable to infections, but there is a dearth of clinical data on the relationship between glycemic control and infections in patients with DM on HD. We used data from the U.S. Renal Data System and the electronic health records from a large U.S. dialysis provider (DaVita, Inc.) merged at the patient level. We included adult Medicare-insured patients with DM aged ≥18 years who initiated in-center maintenance HD treatment from 20to 2011 and survived &gt;90 days. The exposure was time-averaged HbA1c and quarterly mean HbA1c values were categorized as follows: &lt;5.5%, 5.5-&lt;6.5% (reference), 6.5-&lt;7.5%, 7.5-&lt;8.5%, and ≥8.5%. We used Medicare claims to ascertain infection-related hospitalizations and the ESRD Death Notification (CMS-2746) to identify death from infections. The primary outcome was the composite of infection-related death or hospitalization with all-cause death and transplant treated as competing risks using the Kaplan-Meier multiple imputation (MI) method. Missing data were handled through MI. We used extended-Cox models to estimate multivariable-adjusted hazard ratios (HR) and 95% CI for the associations between time-averaged HbA1c and the outcome, adjusting for baseline demographics and quarterly updated comorbidities from claims, central venous catheter use, and time-averaged vital signs and laboratory results. Among 33,753 eligible patients, 9415 infection-related hospitalizations occurred and 6deaths were linked to infection. Compared with patients with HbA1c 5.5-&lt;6.5%, the adjusted HRs for infection-related death or hospitalization were 1.03 (CI, 0.96, 1.10), 1.03 (CI, 0.97, 1.09), 1.02 (0.95, 1.09), and 1.02 (CI, 0.95, 1.09) for patients with HbA1c &lt;5.5%, 6.5-&lt;7.5%, 7.5-&lt;8.5%, and ≥8.5%, respectively (P-trend=0.97).
In summary, time-averaged HbA1c was not associated with the risk of a composite outcome of infection-related mortality or hospitalization.

Disclosure
J.J. Rhee: None. Y. Zheng: None. M. Montez-Rath: None. W. Winkelmayer: Advisory Panel; Self; Akebia Therapeutics, Amgen Inc., Bayer AG, FibroGen, Inc., AMAG Pharmaceuticals, Vifor Fresenius Medical Care Renal Phama, Relypsa Inc..
The Impact of Sarcopenia and Diabetes on Postoperative Complications in Abdominal Surgery Patients
Authors: DAVIS GEORGIA , FAYFMAN MAYA , SINGER ADAM , UMPIERREZ MONICA , KAKARALA APARNA , PENG LIMIN , NAIR SHAILESH , PASQUEL FRANCISCO J. , UMPIERREZ GUILLERMO E. 
Published: June 2018

Sarcopenia and diabetes (DM) are independent predictors of poor postoperative outcomes. Limited data exists on the prevalence and impact of both conditions on perioperative outcomes in abdominal surgery patients. We performed a retrospective analysis of patients undergoing abdominal surgery who had abdominal CT imaging within 30 days prior to surgery. Measurements of psoas muscle surface area and attenuation values (in Hounsfield units) were recorded at the most anterior convex part of the lumbar spine corresponding to the level of the L3/L4 vertebrae. Sarcopenia was defined as the lowest sex-specific quartile of psoas muscle density. Composite of complications was determined using ICD-9 coding and included: acute MI, stroke, wound infection, pneumonia, UTI, bacteremia and respiratory failure. Among 343 patients, 85 (24%) met criteria for sarcopenia. Patients with sarcopenia were older, more likely to be Caucasian, had a longer length of hospital stay and had more postoperative complications. In fully adjusted analyses, patients with both DM and sarcopenia had four-fold higher rates of complications compared to those without DM or sarcopenia (Table).
In summary, sarcopenia is associated with higher rates of complications in patients with and without DM; the combination of sarcopenia and DM confers an additional risk of perioperative complications in patients undergoing abdominal surgery. No Sarcopenia (n=258)Sarcopenia (n=85)P-valueAge, years56.7 ± 15.2763.5 ± 14.290.001BMI, kg/m227.3 ± 6.6827.2 ± 7.030.64Male gender, n (%)119 (46)39 (46)0.97Race, n (%) 0.005Caucasian154 (60)66 (78) African American82 (32)18 (21) Other20 (8)1 (1) Diabetes status, n (%) 0.06No diabetes202 (78)58 (68) Diabetes56 (22)27 (32)LOS, median, days (interquartile range)9 (6, 17)15 (10, 29)&lt;0.01No diabetes, composite complications Odds ratio* (95% CI)1.0 (Ref)2.47 (1.31-4.66)Diabetes, composite complications Odds ratio* (95% CI)0.61 (0.3-1.25)3.68 (1.48-9.19)*Odds ratio of composite of complication adjusted for age, gender, BMI and race

Disclosure
G. Davis: None. M. Fayfman: None. A. Singer: None. M. Umpierrez: None. A. Kakarala: None. L. Peng: None. S. Nair: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..
Impact of Glycaemic Control on Bone Metabolism in Adult Patients with Type 1 Diabetes Mellitus
Authors: BARMPA ELEFTHERIA , VLYCHOU MARIANNA , TIGAS STELIOS , KOUKOULIS GEORGE N. , BARGIOTA ALEXANDRA 
Published: June 2018

Introduction: Type 1 diabetes mellitus (T1DM) is associated with reduced bone mineral density (BMD), increased bone turnover and impaired bone microarchitecture. However, data regarding the influence of glycaemic control on bone metabolism are limited. The aim of this study was to evaluate BMD and bone remodeling markers in patients with T1DM in relation to changes in glycaemic control.
Methods/Design: We studied 118 patients with T1DM and age 20-50 years (mean 34.6±7.9years, M/F:53/65), diabetes duration &gt;5 years and no diabetic complications and 95 healthy controls matched for age, sex and body mass index (BMI). All T1DM participants were re-examined after one-year (FU). In both groups, measurements of glycated hemoglobin (HbA1c) and BMD at lumbar spine (LS) and femoral neck (FN) by dual energy X-ray absorptiometry (DXA) were performed. Bone resorption and formation was assessed by measurements of β-crosslaps and of type 1 procollagen total N-terminal propeptide (TP1NP) in serum. Currently, seventy T1DM patients completed the FU and had repeat biochemical and BMD measurements. Based on current literature, BMD changes of ≥3% at the LS and of ≥6% at the FN were considered significant.
Results: In the T1DM group, mean duration of the disease was 15.9±7.6 years and mean HbA1c was 8.1±1.4%. Subject in the T1DM group had lower BMD and Z-score at LS and FN compared to those in the control group (LS:p=0.039,p=0.02) (FN:p=0.041,p=0.038). At baseline, no significant differences in β-crosslaps and TP1NP were observed between the two groups. Out of the 70 T1DM patient who have completed FU so far, 42/70 patients had ≥0.5% reduction in HbA1c, 12/70 had about the same HbA1c (±0.4%) and 16/70 had ≥0.5% increase in HbA1c. In the 42 patients with improved HbA1c, BMD increased by 3.4% at the LS and by 5.7% at the FN, and TP1NP was significantly higher compared to baseline (p=0.043).
Conclusion: T1DM is associated with reduced BMD but improvement of glycaemic control appears to ameliorate BMD and bone turnover.

Disclosure
E. Barmpa: None. M. Vlychou: None. S. Tigas: None. G.N. Koukoulis: None. A. Bargiota: None.
Depressive Symptoms and Glycemic Control among Puerto Rican Adults with Diabetes
Authors: MATTEI JOSIEMER , FALCON LUIS M. , TUCKER KATHERINE L. 
Published: June 2018

A bidirectional relationship between depression and diabetes risk has been suggested. Less is known about the dynamics between depressive symptomatology and glycemic control among individuals already at risk of both conditions. We aimed to examine the prospective bidirectional associations between depressive symptomatology and glycemic control. We used data from 488 participants of the Boston Puerto Rican Health Study (mean (SD) age= 58.9 (7.2) y) with type 2 diabetes (fasting plasma glucose ≥ 126 mg/dL or use of medication). At baseline, participants were categorized as having uncontrolled hemoglobin A1c (≥7%) vs. controlled, and as having depressive symptomatology (Center for Epidemiological Studies-Depression (CES-D) score ≥16) vs. not. Categories for 2-year changes in glycemic control were set as (&gt;-0.5%=improved; -0.5% to 0.5%=stable; ≥0.5%=worsened); 2-year changes in CES-D score as (&gt;-3=improved; -3 to 3=stable; ≥3=worsened). In logistic regressions adjusted for sociodemographic and lifestyle variables and number of medical conditions, having baseline depressive symptomatology was associated with 1.96 (95% CI: (1.10, 3.50; p=0.022) higher odds of having worsened hemoglobin A1c at 2-year compared to keeping it stable. Baseline uncontrolled hemoglobin A1c was not associated with change in depression score. When modeling 2-year change categories as predictors, improved depression score (vs. stable) was associated with lower odds (0.42 (0.21, 0.81); p=0.01) of worsened hemoglobin A1c, while worsened glycemic control (vs. stable) was associated with lower odds (0.40 (0.21, 0.78); p=0.007) of improved depression score.
In conclusion, a bidirectional association between changes in depressive symptomatology and glycemic control over 2 years among individuals with diabetes suggests that timely attention to both conditions should be given simultaneously. Interconnected diabetes and depression management practices should be recommended for adults with diabetes.

Disclosure
J. Mattei: None. L.M. Falcon: None. K.L. Tucker: None.
Differences in Risk Factor Profile between Carotid Intimal Medial Thickness and Pulse Wave Velocity in African-Americans with Type 2 Diabetes
Authors: ELUWOLE AYOBAMI , ADEDAYO AJIBOLA M. , TEDLA FASIKA , KREMER ARYE , MASTROGIOVANNI NICOLE , ROSENBERG CARL , DREIZEN PAUL , LAROSA JOHN , SALCICCIOLI LOUIS , BOUTJDIR MOHAMED , BANERJI MARY ANN , BROWN CLINTON , SALIFU MORO , BAKILLAH AHMED , LAZAR JASON 
Published: June 2018

Background: Diabetes is a robust risk factor for cardiovascular events which is marked in African Americans for reasons that may be attributed to socioeconomic and biologic vulnerabilities. Both structural (arterial thickening) and functional (arterial stiffness) abnormalities of the vasculature are predictive of incidental clinical events. Study objective was to determine the risk factors and relationship between large artery stiffness and carotid intimal thickness in African Americans with type II diabetes.
Methods: 125 patients with diabetes were recruited from medical clinics. Medical information was obtained via interview and electronic medical record review. Large artery stiffness was assessed by carotid-femoral pulse wave velocity (PWV) using applanation tonometry. Carotid Intimal Medial Thickness (CIMT) was obtained using B-mode ultrasound image analysis of the common carotid artery. Statistical analysis was done using SPSS version 23.
Results: Mean age 60±8 years, 64% female. 82% hypertension, dyslipidemia 83%, diabetes duration 10.2±7.6 years, Mean HbA1C= 8.1±2.2%. Mean CIMT=0.68±0.15, PWV= 8.6±2.9. There was no significant association between PWV and CIMT. CIMT positively correlated with gender (r=0.302, p=0.001), smoking (r=0.278, p=0.002), creatinine (r=0.260, p=0.006), triglycerides (r=0.279, p=0.002), pooled cohort score (r=0.353, p=0.001), and negatively with HDL (r= -0.196, p=0.031). PWV positively correlated with creatinine (r=0.300, p=0.001), duration of diabetes (r=0.195, p=0.037) and age (β=0.359, p&lt;0.0001) and pooled cohort score (r=0.248, p=0.003). After adjusting for cardiovascular risk factors, gender (β=-2.000, p=0.019), and age (β=0.119, p=0.018) independently predict PWV but not CIMT.
Conclusion: Our findings indicate that PWV and CIMT differ in risk factor profile in African Americans with type II diabetes mellitus. Further studies are needed to clarify mediating factors.

Disclosure
A. Eluwole: None. A.M. Adedayo: None. F. Tedla: None. A. Kremer: None. N. Mastrogiovanni: None. C. Rosenberg: None. P. Dreizen: None. J. LaRosa: None. L. Salciccioli: None. M. Boutjdir: None. M. Banerji: Speaker's Bureau; Self; Merck & Co., Inc.. C. Brown: None. M. Salifu: None. A. Bakillah: None. J. Lazar: None.
Development of an Inflammatory Food Index and Association with Inflammatory Markers and Diabetes—Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: RIBOLDI BARBARA P. , LUFT VIVIAN C. , SCHMIDT MARIA I. , DUNCAN BRUCE B. 
Published: June 2018

Introduction: Diet plays a central role in the regulation of inflammation and is closely related to the development of chronic diseases. Dietary patterns portray eating habits more comprehensively than nutrients or foods alone, and provide better understanding and predictive power in relation to causal processes. The objective was to develop an Index of Food Inflammation (IFI) derived from Reduced Rank Regression (RRR) based on its relation with inflammatory markers in the ELSA-Brasil population, and to evaluate its association with weight gain and incidence of diabetes.
Methods: Food consumption data were obtained from a food frequency questionnaire of 9778 participants, after exclusions. The RRR methodology initially involved 42 food groups. Spearman’s correlation coefficients were used to evaluate the associations between quantitative variables, and, for the IFI, linear regression to evaluate its association with weight gain, logistic regression with large gains, and Cox regression with incident diabetes.
Results: The inflammatory dietary pattern was composed of 17 pro-inflammatory food groups, including processed or red meat, pork, sugary soft drinks, and hotdogs, and seven anti-inflammatory groups, notably fruits, nuts and wine. The IFI was associated with weight gain, risk of a large weight gain (quartile 4 vs. 1: adjusted OR=1.42; 95% CI 1.15-1.76) and risk of developing diabetes (quartile 4 vs. 1: adjusted HR=1.29; 95% CI 1.01-1.65).
Conclusion: The associations, although small, suggest that subclinical inflammation could be one of the ways by which diet causes certain chronic diseases. Ultra-processing of foods could be an important determinant in the pro-inflammatory aspect of some current dietary patterns.

Disclosure
B.P. Riboldi: None. V.C. Luft: None. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.
The Effect of Liraglutide on 24-Hour Ambulatory Blood Pressure in Patients with T2DM—A Pilot Study
Authors: LOVRE DRAGANA , KATALENICH BONNIE , OLMEDA CARLY CARRION , CAMITTA SARAH B. , KHAN AMNA N. , FONSECA VIVIAN , THETHI TINA K. 
Published: June 2018

The GLP-1 receptor agonists have been shown to decrease blood pressure (BP) in clinical trials using office BP measurements. However, the effect of GLP-1 agonist liraglutide on 24-hour ambulatory blood pressure and on the nocturnal BP decrease (dipping) have not been adequately assessed in large trials. To better characterize the effect of GLP-1 agonists on 24-hour ambulatory BP in subjects with T2DM we conducted a randomized controlled trial comparing the effects of liraglutide to placebo. Eleven subjects with T2DM (mean age 58.6±7.4 years, female 63.7%, African-American 72.7%) were randomized to 8 weeks of treatment with liraglutide (n=6) or placebo (n=5). ABPM and EndoPAT (Peripheral Arterial Tone) for assessment of endothelial dysfunction were done at baseline, 4 weeks and 8 weeks of therapy. Mixed models with repeated measures was used to estimate the treatment effect over time. Treatment with liraglutide was found to increase the nighttime SBP (LSM±SE): 135.3±4.3 vs. 102.1±4.5 (mmHg), p=0.0015), diastolic BP (DBP) (74.7±6.1 vs. 57.5±5.6 (mmHg), p=0.047) and increase daytime heart rate (109.5±9.2 vs. 77.1±7.9 (mmHg), p=0.021) after adjusting for age, race, history of hypertension, current use of ACE-I/ARBs and Reactive Hyperemia Index (RHI). There was no significant change in BMI between baseline and 8 weeks (1.5±2.4 vs. 1.0±2.5 (kg/m2), p=0.65). After adjustment for treatment and other covariates, abnormal RHI (≤ 1.67) was associated with decreased nighttime SBP (110.6±3.4 vs. 126.8±3.4 (mmHg), p=0.0003), and increased nighttime DBP (69.1±5.0 vs. 63.2±5.1 (mmHg), p=0.16) although lack of power to detect the statistical significance.
In conclusion, our study showed that treatment with liraglutide over 8 weeks was unable to correct the abnormal elevation in nocturnal BP known to occur in patients with T2DM. ABPM also confirmed the known side effect of increase in heart rate previously seen in other liraglutide trials. Abnormal RHI tended to be associated with all patients with high DBP.

Disclosure
D. Lovre: None. B. Katalenich: None. C. Carrion Olmeda: None. S.B. Camitta: None. A.N. Khan: None. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis. T.K. Thethi: None.
Real-World Assessment of Sugar.IQ with Watson—A Cognitive Computing-Based Diabetes Management Solution
Authors: ZHONG YUXIANG , ARUNACHALAM SIDDHARTH , AGRAWAL PRATIK , NEEMUCHWALA HUZEFA , CORDERO TONI L. , KAUFMAN FRANCINE R. 
Published: June 2018

Background: Cognitive computing technology providing personalized insights based on correlations between behavior patterns and glycemic outcomes was leveraged to create an interactive mobile assistant for T1D patients.
Method: Medtronic MiniMed™ Connect users (N=256) were invited to take part in a 90-day Sugar.IQ app pilot program that began April 11, 2017. The percentage of time in target range (TIR, 70-180 mg/dL), &lt;70mg/dL, &gt;180mg/dL, and excursions (periods &gt;20 minutes and &lt;70mg/dL or &gt;180mg/dL) were collected 30 days before Sugar.IQ onboarding, and compared to those 90 days later (August 2017). Insights delivered to users and user feedback were also analyzed.
Results: There were 11,356 sensor-wear days; 10,761 unique Sugar.IQ usage sessions collected; and 4,688 insights delivered (1 every 3 days). Insights included 655 and 699 identifying behaviors associated with more time &lt;70mg/dL and &gt;180mg/dL, respectively. The Sugar.IQ app was used 2.1 times/day. Compared to baseline, TIR was 33 minutes longer per day (P&lt;0.15) and hypoglycemia events reduced by 1.0 per month (P&lt;0.001). A week after receiving insights associated with hypoglycemia, 55% and 54% of users had fewer hypoglycemia and hyperglycemia events, respectively. Hyperglycemia events &gt;2 hours reduced by 1.3 per month (P&lt;0.001). After receiving insights about low glucose associated with boluses delivered at rapid rates of change, users tended to take smaller boluses and consume less carb in the following 7 days. Among insights that included user feedback, 86% of users rated them as “Helpful” vs. “Not helpful.”
Conclusion: Timely and personalized insights, such as those provided during the Sugar.IQ pilot, may advance patient understanding of glucose trends, aid in behavioral change that improves therapy adherence, and lead to better outcomes.

Disclosure
Y. Zhong: None. S. Arunachalam: None. P. Agrawal: None. H. Neemuchwala: None. T.L. Cordero: Employee; Self; Medtronic. F.R. Kaufman: Employee; Self; Medtronic.
HERV-W-Env Involvement in Human T1D Pathogenesis—New Insights from Two Mouse Models
Authors: LEVET SANDRINE , JOANOU JULIE , QUERUEL NELLY , PIERQUIN JUSTINE , PERRON HERVE J.F. 
Published: June 2018

Human endogenous retroviruses (HERVs), known to represent 8% of the human genome, have been associated with several autoimmune diseases. In particular, the envelope protein of HERV-W family (HERV-W-Env), which has been involved in the pathogenesis of Multiple Sclerosis (MS), displays pro-inflammatory and autoimmune properties. This has initially been demonstrated in an MS context, but it subsequently turned out to be relevant for type 1 diabetes (T1D). We recently observed that HERV-W-Env protein and RNA are detected respectively in sera and PBMC of more than 50% of T1D patients. We demonstrated that this pathogenic protein is expressed by acinar cells in human T1D pancreas, and is associated with the recruitment of macrophages within the pancreas of these patients. HERV-W-Env also displays direct pathogenic properties, as it inhibits insulin secretion by human Langerhans islets. In this new report, we present data from two transgenic mouse models in which HERV-W-Env is expressed under the control of HERV-LTR and CAG promoter. In a first model, transgenic mice, generated in a C57Bl6/J background, were challenged by repeated STZ injections. We observed that transgenic mice are more susceptible to pancreatic damage than wild type mice, as they developed more severe insulitis (P&lt;0.0001) and hyperglycemia (P&lt;0.01). In a second model, transgenic mice are currently backcrossed in a NOD/ShiLtJ background. Preliminary results revealed that NOD transgenic males start to develop a hyperglycemia as soon as 4 weeks old compared to their controls littermates. Early results from these transgenic mice support a role for HERV-W-Env in human T1D pathogenesis, particularly in patients expressing this pathogenic protein. They provide additional justification for the ongoing phase IIa clinical trial which is designed to neutralize HERV-W-Env in T1D patients using a monoclonal antibody named GNbAC1 (NCT03179423). Six months interim results of this new therapeutic approach will be available 3rd quarter 2018.

Disclosure
S. Levet: Employee; Self; Geneuro Innovation. J. Joanou: Employee; Self; Geneuro Innovation. N. Queruel: Employee; Self; Geneuro Innovation. J. Pierquin: Employee; Self; Geneuro Innovation. H.J.F. Perron: Employee; Self; GeNeuro SA.
Dietary Fiber Intake and Glycemic Control—Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study
Authors: BASU ARPITA , ALMAN AMY C. , SNELL-BERGEON JANET K. 
Published: June 2018

Background: Intake of sufficient dietary fiber has been recommended for glucose control, and typically low fiber intake is observed in the general population. The role of fiber in glycemic control in reported literature is inconsistent and few reports are available in populations with type 1 diabetes (T1D).
Methods: We conducted a cross-sectional analysis of data from the CACTI study [n=1257; T1D: n=568; nondiabetic controls: 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) at screening visit. We used linear regression models to examine associations of total dietary fiber with HbA1c as a continuous variable. Models were stratified by diabetes status, and adjusted for age, sex and total calories, and diabetes duration in the T1D group. We also examined correlations of fiber with HbA1c.
Results: Baseline dietary fiber intake and HbA1c in the T1D group were 16g [median (IQ): 11-22g) and 7.9±1.3% mean (SD), respectively, and in the nondiabetic controls were 15g [median (IQ): 11-21g) and 5.4±0.4%, respectively. Pearson partial correlation coefficients revealed a significant but weak inverse association of total dietary fiber with HbA1c when adjusted for age, sex, diabetes status and total calories (r= -0.07, p=0.01). In adjusted linear regression models, total dietary fiber was significantly and inversely associated with HbA1c in the T1D group [estimate (beta±SE)= -0.32±0.15, p=0.034], as well as in the nondiabetic controls [-0.10±0.04, p=0.009]. Thus, at observed levels of intake, total dietary fiber reveals a protective association against poor glycemic control in T1D adults and in nondiabetic controls.

Disclosure
A. Basu: None. A.C. Alman: None. J.K. Snell-Bergeon: Stock/Shareholder; Self; Abbott. Research Support; Self; Roche Diagnostics Corporation.