bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous Glucose Monitoring in Patients With or Without Symptoms of Hypoglycemia after Bariatric Surgery
Authors: LEE CLARE , BROWN TODD , SCHWEITZER MICHAEL , MAGNUSON THOMAS , CLARK JEANNE 
Published: June 2018

Objective: Hypoglycemia after bariatric surgery is an increasingly recognized metabolic complication. We sought to determine the sensitivity and specificity of a prior hypo-sx survey in detecting post-bariatric surgery hypoglycemia (PBSH) using a continuous glucose monitor (CGM).
Methods: Among the patients who underwent bariatric surgery at our institution and completed the hypo-sx survey, we enrolled 13 Roux-en-Y gastric bypass (RYGB, 7 with and 6 without hypo-sx) and 19 sleeve gastrectomy (SG, 9 with and 10 without hypo-sx) patients. Patients wore the CGM (Dexcom, San Diego, CA) for 72-120 hours at home. Hypoglycemia was defined as postprandial interstitial glucose (IG)&lt;54 mg/dl. We used Kruskal Wallis test to compare the difference in hypoglycemia across groups.
Results: A total of 19 patients (59%) had hypoglycemia (Table 1), with a mean low glucose of 46.8 mg/dl. Two patients reported hypo-sx. The prevalence of hypoglycemia did not differ by the type of surgery (69% vs. 53%) or the presence of hypo-sx by survey (63% vs. 56%). The survey had a specificity of 53.8% and sensitivity of 52.6% for measured PBSH.
Conclusions: Asymptomatic postprandial hypoglycemia was common in post-bariatric patients regardless of surgery type. Assessments that focus on hypoglycemic symptoms may not adequately capture PBSH. Future studies should consider CGM to assess the true prevalence and impact of PBSH.
Table 1. Baseline Characteristics and Results from continuous glucose monitoring on post-bariatric surgery patients who were categorized as with or without symptoms of hypoglycemia based on their survey responsesRYGB with Hypo-sx (N=7)RYGB without Hypo-sx (N=6)SG with Hypo-sx (N=9)SG without Hypo-sx (N=10)P ALLP RYGB vs SGP With vs Without Hypo-sxMean Age, years52.9 (5.1)52.0 (10.0)41.9 (11.3)44.8 (11.9)% Female67%56%89%82%% Caucasian71%67%33%60%Time since surgery (years)7.3 (3.2)4.8 (1.3)4.7 (0.7)4.2 (0.8)Percent Patients with Postprandial Hypoglycemia (N)71% (5)67% (4)56% (5)50% (5)Total Average IG (mg/dl, SD)97.0 (6.7)103.5 (12.5)93.0 (8.1)96.9 (6.4)0.3730.2270.228Average Minimum IG (mg/dl, SD)47.7 (10.9)45.8 (9.7)46.4 (5.6)47.0 (9.9)0.8570.7440.429Postprandial Minutes/day IG &lt;54 mg/dl (SD)9.5 (12.7)4.7 (4.9)3.0 (3.9)11.3 (25.1)0.8020.3370.955Abbreviations: SD: standard deviation , RYGB: Roux-en-Y gastric bypass, Hypo-sx: hypoglycemic symptoms, SG: sleeve gastrectomy, IG: interstitial glucose, Postprandial: within 3 hours of eating

Disclosure
C. Lee: None. T. Brown: Advisory Panel; Self; Merck & Co., Inc. M. Schweitzer: Consultant; Self; Ethicon US, LLC.. T. Magnuson: None. J. Clark: None.
Hospitalization and Emergency Department Visits for Severe Hypoglycemia among U.S. Adults with Diabetes and Serious Comorbid Conditions
Authors: MCCOY ROZALINA G. , VAN HOUTEN HOLLY , LIPSKA KASIA J. , SHAH NILAY 
Published: June 2018

Diabetes care guidelines recommend more relaxed glycemic targets for patients with specific chronic conditions because they are thought to have an increased risk of hypoglycemia, limited life expectancy, and/or high clinical complexity. These include dementia, end stage renal disease (ESRD), stages 3-4 chronic kidney disease (CKD), myocardial infarction, heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, cancer, arthritis, urinary incontinence, falls, depression, hypertension, cirrhosis, proliferative retinopathy, and peripheral neuropathy. The rates of severe hypoglycemia among patients with these conditions are unknown. We quantified rates of hospital and emergency department care for hypoglycemia among 216,839 adults (mean 65.5 years old) with diabetes in 2015 using the OptumLabs Data Warehouse (administrative database of &gt;100 million commercially-insured and Medicare Advantage beneficiaries). Hypoglycemia rates varied widely: 10.6/1000 person-years (PY) in patients with hypertension, 26.9/1000 PY with CKD, 26.8/1000 PY with cirrhosis, 37.7/1000 PY with dementia, and 58.3/1000 PY with ESRD. Hypoglycemia was rare among patients with no conditions (2.0/1000 PY). After adjustment for all conditions, prior hypoglycemia, age, sex, race, HbA1c, and diabetes medications, the risk of severe hypoglycemia was significantly increased for all conditions except arthritis, incontinence, and cancer. Hypoglycemia risk increased rapidly with the number of comorbidities: OR 1.8 (95% CI 1.4, 2.2) for 2 conditions, 7.7 (6.2, 9.64) for 5, 16.6 (13.1, 21.1) for 7, and 25.6 (30.4, 32.2) for ?8 conditions compared with ?1 condition. Severe hypoglycemia is common among patients with chronic conditions. Rates vary between conditions but increase dramatically in patients with multiple comorbidities. These data can help inform decisions about glucose-lowering therapy for patients with comorbidities.

Disclosure
R.G. McCoy: None. H. Van Houten: None. K.J. Lipska: Other Relationship; Self; Centers for Medicare and Medicaid Services. Research Support; Self; National Institutes of Health. N. Shah: None.
Beta-Blocker Usage and Hypoglycemia in Hospitalized Patients with Diabetes Mellitus
Authors: MERRILL JENNIFER , DUNGAN KATHLEEN M. 
Published: June 2018

Background: Although ?-blockers (BB) theoretically increase the risk of severe or prolonged hypoglycemia, studies have suggested that BB may decrease the risk of hypoglycemia-associated arrhythmias and death. However, there is little evidence in hospitalized patients on insulin.
Aim: To determine the relationship between BB use and incidence of hypoglycemia and mortality in hospitalized patients.
Methods: We retrospectively identified non-critically ill hospitalized patients receiving subcutaneous insulin and undergoing bedside glucose monitoring over a 2 year period. BB and basal insulin use were identified on the admission medication list. Hypoglycemia, defined as any glucose &lt; 70 mg/dl within 24 hours of admission (Hypo24) or throughout the hospitalization (HypoT) and any glucose &lt;40 mg/dl throughout the hospitalization (Hypo40) were compared between patients with and without BB.
Results: 13,424 patients were included, with 2648 patients receiving a BB at admission (19.7%). After controlling for other variables, the odds of Hypo24 HypoT and Hypo40 were higher for BB recipients (Hypo24 OR 3.79, 95% CI 3.21-4.50, p&lt;0.0001, fully adjusted model; HypoT OR 7.70, 95% CI 6.77-8.77, p&lt;0.0001, fully adjusted model; Hypo40 OR 1.95, 95% CI 1.49-2.57, p&lt;0.0001). However, there was a significant interaction across basal insulin usage, with increased odds of HypoT and Hypo40 among basal insulin non-users but not basal insulin users. Hypo24, HypoT, and Hypo40 were associated with increased mortality in adjusted models. There was evidence of an interaction by BB status in the relationship between Hypo24 and mortality (with increased mortality among non-users but not users), but not at other time points.
Conclusions: BB use is associated with higher risk of hypoglycemia in hospitalized basal insulin non-users, but not basal insulin users. Hypoglycemia is associated with increased hospital mortality, regardless of BB use, but early hypoglycemia-associated mortality risk is attenuated by BB use.

Disclosure
J. Merrill: None. K.M. Dungan: Research Support; Self; Novo Nordisk Inc.. Advisory Panel; Self; Sanofi-Aventis. Research Support; Self; Sanofi-Aventis, GlaxoSmithKline plc.. Consultant; Self; GlaxoSmithKline plc.. Research Support; Self; AstraZeneca. Other Relationship; Self; DKBmed, Horizon, Projects in knowledge, Rockpointe.
Effect of Hypoglycemia during Intensive Insulin Therapy on Long-Term Glycemic Control in Patients with Newly Diagnosed Type 2 Diabetes
Authors: XU LIJUAN , LI YANBING 
Published: June 2018

Aims: Short-term intensive insulin therapy induces long-term drug-free euglycemic remission in half of patients with newly diagnosed type 2 diabetes mellitus (T2DM) but causes an increased risk of hypoglycemia. Studies identifying the impact of hypoglycemia are necessary.
Methods: We analyzed data from three randomized prospective trials conducted at our institution from 2002 to 2015. A continuous subcutaneous insulin infusion (CSII) was provided to achieve the glycemic goals and then maintained for 14 days.
Results: Patients who attained one-year drug-free glycemic remission were younger (48.06±9.85 vs. 50.95±11.70 years, P=0.037) and had a higher body mass index (BMI) (25.53±3.52 vs. 24.66±3.20 kg/m2, P=0.046) than those who did not. Notably, the median number of episodes of mild hypoglycemia with nadir glucose values of 3.0-3.9 mmol/L was higher in the remission group than in the non-remission group (5 (6) vs. 2 (5), P&lt;0.001). However, the number of episodes of clinically significant hypoglycemia (&lt;3.0 mmol/L) was insignificantly lower in the remission group (0 (1) vs. 0 (1), P=0.273). Patients with higher glucose levels (glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG)) and lower ?-cell functions (homeostasis model assessment of ?-cell function (HOMA-B)) at baseline faced a greater risk of clinically significant hypoglycemia (OR=2.02, 95% CI 1.40-2.92, P&lt;0.001). According to the logistic regression analysis, mild hypoglycemic episodes were positively and independently related to long-term glycemic remission.
Conclusions: Mild hypoglycemic episodes during CSII therapy are related to better long-term drug-free glycemic remission in patients with newly diagnosed T2DM. However, clinically significant hypoglycemia is not correlated and should be avoided.

Disclosure
L. Xu: None. Y. Li: None.
Postprandial Insulin Initiation—Evaluation of Adverse Outcomes in Older Veterans
Authors: TSENG CHIN-LIN , SOROKA ORYSYA , POGACH LEONARD 
Published: June 2018

We assessed one-year adverse outcomes (emergency department visits for hypoglycemia (HYPO-ED), death) and potential overtreatment (A1c &lt;6.5%) post prandial initiation in veterans &gt;= 65 years receiving only basal insulin in 2009-2011 and dually enrolled in Veterans Health Administration and Medicare using linked data. Rates were compared by race (blacks, whites, others) and comorbidity categories (advanced diabetes complications (D), diminished life expectancy (L), major neurological disorders/dementia/cognitive impairment/major depression/substance abuse (M) and cardio vascular conditions (C)). Of the 3,465 studied patients, 457 (13%) died or incurred HYPO-ED. Of the 200 (5.8%) that incurred HYPO-ED, 16%, 24.5%, and 23% had the event within 1, 2-3, and 4-6 months, respectively; of the 271 (7.8%) deaths, 10.7%, 12.5%, and 25.8% occurred in the same time intervals. Of the 2,789 (80%) patients having some A1c values within a year post-prandial, 10% had an A1c &lt;6.5%. Compared to whites (n=2,708; 78%), blacks (336; 10%) had a higher HYPO-ED rate (8.0% vs. 5.6%, p=0.08) and a comparable death rate (8.6% vs. 8.4%, p=0.88). Both races had similar rates of having an A1c &lt;6.5% (11.6% vs. 13.1%, p=0.48). Most (85%) patients had at least one of the studied comorbidity categories; the prevalence order was: C (69%), D (39%), M (21%), and L (16%). Patients with M (21%) had higher rates in adverse outcomes than those with only C (26%) and those without any studied comorbidities (15%): for HYPO-ED, the rates were 6.3%, 5.9%, and 5.4% (p=0.76); for death, 12.6%, 5.8%, and 2.3% (p&lt;0.001); for having an A1c &lt;6.5%, 14.5%, 11.8%, and 10.2% (p=0.11). Among basal insulin users started on prandial, we found that within a year after prandial initiation, HYPO-ED rate was 1.4 fold greater in blacks than whites, patients with mental/cognitive/neurological diseases had higher rates in HYPO-ED and death, and at least one in ten had an A1c &lt;6.5%. Prandial insulin should be used cautiously in older adults with complex comorbidities.

Disclosure
C. Tseng: None. O. Soroka: None. L. Pogach: None.
Risk of Hypoglycemia in Aging Population with Insulin-Requiring Diabetes
Authors: MUNSHI MEDHA , SLYNE CHRISTINE , ATAKOV-CASTILLO ASTRID , GREENBERG JORDAN , GREAVES TORI , CARL SAM P. , TOSCHI ELENA 
Published: June 2018

Background: The impact of aging on insulin-dependent diabetes is not well studied.
Methods: We evaluated insulin-dependent older adults (age &gt;65 years) with type 1(T1D) and type 2 diabetes (T2D). All patients completed questionnaires for demographics, hypoglycemia fear survey (HFS II), hypoglycemia unawareness (Clarke’s method) and assessment of comorbidities. A1c was measured, and blinded CGM was performed over 2-week period.
Results: We evaluated 32 insulin-dependent older adults: 23 had T1D (age 70±4 years, A1C 8%) and 9 had T2D (age 80±9 years, A1C 8.9%). All with T1D were either on insulin pump or on ≥4 insulin injections/day compared to 55% of patients with T2D. Clinically significant hypoglycemia (glucose &lt; 55 mg/dl for ≥ 20 mins/episode) was observed in 91% of patients with T1D (21 of 23), compared with 22% with T2D (2 of 9). Nocturnal hypoglycemic episodes (10 pm-6 am) were observed in 15 out of 23 (65%) T1D patients, compared to 1 out of 9 (11%) with T2D. Older adults with T1D had greater fear of hypoglycemia as shown by HFS II score of 34 compared to 15 in T2D. However, hypoglycemia unawareness was similar in the two groups (9 of 23 (39%) with T1D, and 3 of 9 (33%) with T2D. Age-associated comorbidities in T1D and T2D older adults included Cognitive impairment (68% vs. 100%), depression (27% vs. 43%), recent falls within 6-months (24% vs. 43%), vision impairment (27% vs. 43%), and hearing impairment (36% vs. 50%) respectively.
Conclusions: Insulin-dependent older adults with T1D have a higher risk of total and nocturnal hypoglycemia compared to older adults with T2D. Associated multiple age-related comorbidities put them at higher risk of poor outcomes.

Disclosure
M. Munshi: Consultant; Self; Sanofi. C. Slyne: None. A. Atakov-Castillo: None. J. Greenberg: None. T. Greaves: None. S.P. Carl: None. E. Toschi: None.
The Impact of Fatty Liver Disease and Metabolic Syndrome on the Progression of Coronary Artery Calcification
Authors: CHO YUN KYUNG , KANG YU MI , PARK CHEOL-YOUNG , PARK SUNG-WOO , LEE WOO JE , PARK JOONG-YEOL , JUNG CHANG HEE 
Published: June 2018

Objectives: Fatty liver disease (FLD) is a well-known risk factor for cardiovascular disease (CVD). However, it is unclear whether FLD per se is an independent risk factor of CVD or combined unfavorable metabolic components with metabolic syndrome (MetS). In this study, we examined the independent impact of FLD on the coronary artery calcification (CAC) score progression.
Methods: We examined 1,173 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. Subjects were categorized into 4 groups according to the presence (+) or absence (-) of FLD and MetS. The CAC score progression was defined as either incident CAC in a population free of CAC at baseline or increase ≥ 2.5 units between the baseline and final square root of CAC scores participants who had detectable CAC at baseline examination.
Results: Among the participants, 44.8% (526), 23.2% (272), 8.8% (103) and 23.2% (272) were classified as FLD(-)/MetS(-), FLD(+)/MetS(-), FLD(-)/MetS(+), and FLD(+)/MetS(+), respectively. The proportions of subjects who developed CAC progression was 18.6% (98), 28.3% (77), 29.1% (30) and 32.0% (87) in FLD(-)/Mets(-), FLD(+)/Mets(-), FLD(-)/MetS(+), and FLD(+)/MetS(+), respectively. In logistic regression analysis, FLD(+)/MetS(+) were at significantly higher risk of CAC progression compared to FLD(-)/MetS(-) [multivariate adjusted-odds ratio (OR) 1.76, 95% confidence interval (CI) 1.18-2.62]. FLD(+)/MetS(-) also demonstrated higher risk of CAC progression [multivariate adjusted-OR 1.53, 95% CI 1.05-2.23].
Conclusions: FLD is an independent risk factor for CAC progression irrespective of the presence of metabolic syndrome. Special attention should be paid to subjects with FLD for the prevention of future cardiovascular events, even though MetS does not coexist.

Disclosure
Y. Cho: None. Y. Kang: None. C. Park: None. S. Park: None. W. Lee: None. J. Park: None. C. Jung: None.
Temperature Regulating Shoes for Prevention of Diabetic Foot Ulcers
Authors: ERSEN ALI , ADAMS LINDA S. , MYERS RYAN T. , HIRSCHMAN GORDON B. , LAVERY LAWRENCE A. , YAVUZ METIN 
Published: June 2018

Diabetic foot ulcers (DFU) continue to burden Americans with over 100,000 amputations every year. We believe that better understanding of the etiology and a multi-factorial approach that combines in-shoe temperature regulation along with plantar stress reduction could dramatically improve this outcome. Previous research indicated that soft tissue is prone to ulceration at warmer temperatures. Likewise, animal studies indicate higher tissue resistance to break-down when cooled to 25 °C to 28 °C. Insulated diabetic footwear and load-bearing activity lead to high plantar tissue temperatures and increased risk of DFU. The purpose of this study was to design/develop a novel temperature regulating footwear and test cooling effectiveness. An extra-depth diabetic shoe was instrumented with temperature control apparatus set to cool to 28 °C. Three subjects wore this shoe and a non-cooling (control) shoe while walking for 10 minutes. Post-walking thermographs of the regulated foot revealed: forefoot temperatures below 28 °C; heel temperatures around 28 °C with a 3.9 °C bilateral cooling effect; midfoot regions 2.9 °C less than the control foot but still over 28 °C, perhaps due to poor contact with the cooling insole or a need for increased localized control of cooling. These results suggest feasibility of in-shoe temperature regulation. Further research is needed to improve our design and ultimately explore DFU prevention in a clinical trial.

Disclosure
A. Ersen: Other Relationship; Self; Vivonics Inc. L.S. Adams: Other Relationship; Self; Vivonics, Inc. R.T. Myers: Employee; Self; Vivonics, Inc. G.B. Hirschman: Stock/Shareholder; Self; Vivonics, Inc.. Employee; Self; Vivonics, Inc.. Board Member; Self; Vivonics, Inc. L.A. Lavery: Speaker's Bureau; Self; Osiris Therapeutics, Inc., Integra LifeSciences. Research Support; Self; Cardinal. Speaker's Bureau; Self; Smith & Nephew. Research Support; Self; EO2. Consultant; Self; Aplion, Harbor MedTech, Boehringer Ingelheim GmbH, Medline Industries, Inc. M. Yavuz: Research Support; Self; Derma Sciences, PulseFlow Technologies. Other Relationship; Self; vivonics.
Pro-B-Type Natriuretic Peptide Strongly Predicts Future Cardiovascular Events in Cardiovascular Disease Patients with Type 2 Diabetes as Well as in Those Without Type 2 Diabetes
Authors: SAELY CHRISTOPH H. , VONBANK ALEXANDER , HEINZLE CHRISTINE , ZANOLIN DANIELA , LARCHER BARBARA , MADER ARTHUR , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ 
Published: June 2018

Pro-B-type natriuretic peptide (proBNP) is a prognostic biomarker in various patient populations. Its power to predict cardiovascular events in the extremely high risk group of patients with the combination of established cardiovascular disease (CVD) and type 2 diabetes (T2DM) is unclear and is addressed in the present study. We measured serum proBNP in 900 patients with established CVD including 591 patients with angiographically verified coronary artery disease and 309 patients with sonographically proven peripheral artery disease. Prospectively, we recorded vascular events over 6.3±2.0 years. At baseline, proBNP was significantly higher in patients with (n=317) than in those without T2DM (990±2556 vs. 742±2328 pg/ml; p=0.003). The cardiovascular event rate was significantly higher among CVD patients with than among those without T2DM (50.5 vs. 35.1%; p&lt;0.001). ProBNP significantly predicted the incidence of cardiovascular events after adjustment for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol, HDL cholesterol and the eGFR both in patients with T2DM (standardized adjusted HR 1.48 [1.28-1.73]; p&lt;0.001) and in subjects without T2DM (HR 1.33 [1.20-1.47]; p&lt;0.001). We conclude that serum proBNP in patients with established CVD predicts future cardiovascular events independently of established cardiovascular risk factors both among those with as well as among those without T2DM.

Disclosure
C.H. Saely: None. A. Vonbank: None. C. Heinzle: None. D. Zanolin: None. B. Larcher: None. A. Mader: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.
The Effects of Cardiovascular Risk Factor Combined Antiplatelet Therapy and the Risk of Cerebrovascular Events in Patients with T2DM in an Urban Community over 96-Month Follow-Up—The Beijing Communities Diabetes Study 19
Authors: ZHANG XUE LIAN , YUAN SHEN YUAN , GROUP BCDS 
Published: June 2018

Objective: We investigated the prognostic significance of metabolic risk scores and aspirin with respect to cerebrovascular events.
Methods: A total of 25 communities of diabetic patients were enrolled in Beijing Community Diabetes Study (BCDS) from 2008. 3413 patients with T2DM in BCDS have complete screening data, including blood glucose, blood pressure, lipid profiles and anti-platelet therapy, which were assigned metabolic score (MS) and add up to the total metabolic score (TMS). According to the total metabolic score (TMS), the patients were divided into four equal groups: Group 1 (24&lt;TMS&lt;40), Group 2 (40&lt;TMS&lt;47), Group 3 (47&lt;TMS&lt;55) and Group 4 (55&lt;TMS&lt;87). After 96 months, patients were followed-up to assess the long-term effects of the multifactorial interventions.
Results: During 96-months follow-up, a total of 91 cerebrovascular events occurred, including acute cerebral infarction, acute cerebral hemorrhage and transient ischemic attack (TIA). The incidence of cerebrovascular events was higher in the Group 4 than in the Group 1. In Cox multivariate analyses, there are significant differences in incidences of cerebral infarction events among the four groups during the 96-months follow-up. Cox proportional hazards analysis revealed that, HbA1c (P=0.0000), systolic pressure (P=0.0015), aspirin free treatment (P=0.0023) are independent predictor for cerebrovascular events in diabetic patients.
Conclusions: This study indicates that total metabolic score (TMS) influences the incidence of cerebrovascular events in diabetic patients. In addition to good control of blood glucose, blood pressure and lipid profiles. The patients with diabetes need long-term anti-platelet therapy, which is important for the prevention of cerebrovascular events.

Disclosure
X. Zhang: None. S. Yuan: None.