bluuebunny/crossref_metadata_2025_split huggingface dataset:
2410-PUB: Insulin Pumps Accessed through Provincial Funding and Quality of Life: A Qualitative Study
Authors: HAYNES EMILY J. , LEY MARISSA N. , TALBOT PAM J. , DUNBAR MARGARET , CUMMINGS ELIZABETH A. 
Published: June 2019

The Nova Scotia Insulin Pump Program (NSIPP) subsidizes the cost of insulin pump (CSII) therapy for patients aged 25 and under with type 1 diabetes. Its medical eligibility criteria ensure structured care and follow-up with focused diabetes teams according to provincial guidelines. Studies on CSII and quality of life are mostly survey-based, thus first voice patient experiences are limited. This qualitative study examined patient/parent perspectives on how CSII affects quality of life and is unique in the context of provincial funding. A phenomenological approach was used. In-depth semi-structured telephone interviews averaging 36 minutes were completed with NSIPP enrollees and/or their parents, depending on age. Saturation was reached after 23 interviews. Verbatim transcripts were coded independently by two researchers using NVivo. Analysis began with a discussion of coding discrepancies, which were resolved using concept mapping to clarify relationships between codes and identify main themes. More freedom in daily life, feelings of control over life and diabetes, less worry and more positive intra/interpersonal social experiences were main themes, but how they were expressed depended on the patient’s stage of life. CSII facilitated precise insulin delivery, allowing more freedom in daily activities. This freedom led to feelings of control, less worry and improvements in social life. These outcomes manifested in how common life events were experienced. For example, parents often saw CSII as enabling their teen to gain independence, while young adults focused on CSII supporting them to function at work, school, and in relationships. Finally, NSIPP’s financial help was necessary for those without private insurance and experiences with NSIPP’s defined, structured care and follow-up were positive for all. Overall, NSIPP’s financial support to access CSII therapy and its structured care and follow-up improved quality of life, and the exact ways depended on the patients’ stage of life.

Disclosure
E.J. Haynes: None. M.N. Ley: None. P.J. Talbot: None. M. Dunbar: None. E.A. Cummings: None.

Funding
Dalhousie Medical Research Foundation
2423-PUB: Rosiglitazone Has a Neutral Effect on the Risk of Dementia in Type 2 Diabetes Patients
Authors: TSENG CHIN-HSIAO 
Published: June 2019

Background: This study investigated whether rosiglitazone might affect dementia risk.
Methods: The Taiwan’s National Health Insurance database was used to enroll a cohort of 1:1 matched-pairs of ever and never users of rosiglitazone based on propensity score from patients with new onset type 2 diabetes during 1999-2006. The patients were alive on January 1, 2007 and were followed-up for dementia until December 31, 2011.
Results: A total of 5048 pairs of never users and ever users were identified. The incident case numbers were 127 and 121, respectively. The overall hazard ratio was 0.895 (95% confidence interval: 0.696-1.151) for ever versus never users. The hazard ratios for the first (&lt;12.1 months), second (12.1-25.1 months) and third (&gt;25.1 months) tertiles of cumulative duration were 0.756 (0.509-1.123), 0.964 (0.685-1.357) and 0.949 (0.671-1.341), respectively. When cumulative duration was treated as a continuous variable, the hazard ratio was 1.000 (0.992-1.008). Subgroup analyses conducted in ever users and never users of metformin and in patients whose diabetes was diagnosed during three different periods of time, i.e., 1999-2000, 2001-2003 and 2004-2006, all supported a neutral effect of rosiglitazone.
Conclusions: Rosiglitazone has a neutral effect on dementia risk in patients with type 2 diabetes mellitus.

Disclosure
C. Tseng: None.
2430-PUB: Analysis of Transient Elastography Data and the Risk of Metabolic Syndrome
Authors: HUANG ZHIMIN , DENG WANPING , CHEN HONGYAN , NG KAKA , LI YANBING 
Published: June 2019

Aim: To investigate the correlation between Fibroscan® data controlled attenuation parameter (CAP), liver stiffness measurement (LSM) and metabolic syndrome (MetS) components.
Methods: A total of 817 subjects in this year’s staffs physical checkup screening for nonalcoholic fatty liver disease (NAFLD) were recruited. Questionnaires were filled, anthropometries including neck and waist circumferences, body mass index were collected. Fasting glucose, lipid profiles, serum insulin and plasma adiponectin were measured. Controlled attenuation parameter and LSM were recorded using FibroScan®. The subjects were divided into MetS and control groups. Clinical characteristics were compared. Independent predictors for MetS were analyzed.
Results: The CAP (277 ± 48 vs. 237 ± 44 dB/m, P&lt;0.001), LSM (4.9 ± 2.2 vs. 4. 1 ± 1.0kpa, P&lt;0.001), neck circumference (37.1 ± 3.3 vs. 34.1 ± 3.0, P&lt;0.001) and fasting insulin (9.3 ± 4.7 vs. 5. 7 ± 2.9μU/mL, P&lt;0.001) were significantly elevated in the MetS group, whereas adiponectin (10.6 ± 8.8 vs. 18.7 ± 14.9 ng/mL, P&lt;0.001) were lower. With the accumulation of MetS components, thus increased CAP and LSM. When CAP and LSM were divided into quartiles, the number of MetS components increased with increasing quartiles, and CAP showed a stronger correlation with MetS than LSM. Binary Logistic regression analysis showed that CAP, age, neck circumference, adiponectin and fasting insulin were independent predictors for MetS. Even with no MetS components, subjects with CAP≥248dB/m had elevated BMI, neck and waist circumference, waist to hip ratio, increased fasting insulin, triglyceride, uric acid and reduced adiponectin.
Conclusion: CAP showed a close relationship with MetS. Increased CAP was associated with increased body weight and dyslipidemia, reduced adiponectin even before the occurrence of MetS.

Disclosure
Z. Huang: None. W. Deng: None. H. Chen: None. K. Ng: None. Y. Li: None.
2438-PUB: Adherence to Hypoglycemic Agents among Type 2 Diabetes Patients with Claims Database in Japan
Authors: HORII TAKESHI , MOMO KENJI , YASU TAKEO , KABEYA YUSUKE , ATSUDA KOICHIRO 
Published: June 2019

Several studies have been conducted to understand adherence and to identify the determinants associated with it showing that medication adherence is influenced by numerous factors that may be related to patients and medication. There are no data of large-scale medication adherence originating in Japan. In this study, we examined non-adherence and predictive factors of T2DM patients in Japan. This was a retrospective cohort study using a Japanese claims database of patients with type 2 diabetes. Adherence to therapy was measured using the proportion of days covered (PDC) method over a fixed period of 3 years. If PDC &lt;80%, patients were considered non-adherent, a commonly used standard. To assess the odds ratio (OR) of non-adherence, we performed a logistic regression analysis, having adjusted for patient characteristics. The final sample contained 885 patients. The mean PDC was 79.6%, with 50.2% of patients classified as non-adherence. The mean number of medicines was 2.4, with 11.1% of patients classified as polypharmacy. According to the inflection point of the ROC curve, the cut-off value of the number of outpatient visits associated with adherence was 17 times. In the multivariate logistic regression analysis, polypharmacy (OR:0.18), the older age (60y∼ OR:0.37, 50y∼OR:0.39) showed lower odds ratio. Men (OR:2.20), 17 or less times of outpatient visits in 3 years (OR:27.1) showed higher odds ratio. In this study, we investigated medication non-adherence in 3 years and showed adherence adequacy a little lower to that reported previously, which is one year observation period. Also, medication adherence tended to be lower in younger ages and cases with fewer drugs. Maintaining good medication adherence and achieving the targeted HbA1c in these cases are important for suppressing the onset of diabetic complications. We think that it is necessary to consider methods of intervention aimed at maintaining good medication adherence, such as by utilizing on-line medical treatment.

Disclosure
T. Horii: None. K. Momo: None. T. Yasu: None. Y. Kabeya: None. K. Atsuda: None.

Funding
Japan Association for Diabetes Education and Care
2447-PUB: The Effects of Acute Hyperglycemia on Driving Performance in People with T2DM
Authors: NGUYEN TIFFANY , DAO VIVIAN V. , TIMBERMAN JEFF , DAVIS SARAH , DOROUDGAR SHADI , SHUBROOK JAY H. 
Published: June 2019

Objective: Hyperglycemia has been shown to induce cognitive changes in processing speed, executive function, attention, and working memory in several laboratory based mental tasks. It has also been identified as the main culprit in diabetes related cognitive decline. Driving is a complex task that requires intricate coordination between cognitive and motor skills and provides information on how acute hyperglycemia may affect people with type 2 diabetes in the real world. This study aims to identify associations between acute hyperglycemia in subjects with normally well controlled type 2 diabetes and measures of driving ability.
Methods: This randomized experimental crossover study selected actively driving subjects with well controlled type 2 diabetes between the ages of 25-45. Subjects were asked to operate a driving simulator (STISIM Drive M100) in two glycemic states: euglycemia and acute hyperglycemia. Subjects were randomized and cross-covered with each session separated by one week to account for any learning effects. Hyperglycemia was induced by asking subjects to withhold their usual diabetes related medications the day before the study.
Results: A total of 12 subjects have completed this study. No significant associations were found in several parameters examining adherence to speed limits, ability to maintain lane position, number of collisions, or ability to follow a lead car. When comparing euglycemic driving to acute hyperglycemic, subjects had a mean speed of 45.1 ± 6.81 vs. 43.4 ± 1.86 (p=0.42), time above speed limit 12.8 ± 15.0 vs. 13.9 ± 7.83 (p= 0.78), standard deviation in lateral position 1.63 ± 0.36 vs. 1.58 ± 0.35 (p=0.79), centerline crossings 3.08 ± 6.01 vs. 2.50 ± 2.11 (p=0.77), modulus car following 0.60 ± 0.31 vs. 0.52 ± 0.32 (p=0.30), and number of collisions 0.50 ± 0.67 vs. 0.17 ± 0.39 (p=0.17).
Conclusion: The current data is inconclusive given the small sample size and merits further exploration with a larger study.

Disclosure
T. Nguyen: None. V.V. Dao: None. J. Timberman: None. S. Davis: None. S. Doroudgar: None. J.H. Shubrook: Advisory Panel; Self; Intarcia Therapeutics, Inc. Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc.

Funding
Touro University California
2450-PUB: Association between Intake of Magnesium and Obesity in Japanese Patients with Type 2 Diabetes Mellitus
Authors: NEDACHI RINA , FUJIHARA KAZUYA , HATTA MARIKO , MATSUBAYASHI YASUHIRO , TAKEDA YASUNAGA , ISHII DAI , HORIKAWA CHIKA , KATO MITSUTOSHI , MAEGAWA HIROSHI , SONE HIROHITO 
Published: June 2019

Obesity is known to increase the risks of cardiovascular events and mortality in patients with diabetes. Low serum magnesium (Mg) levels are reportedly associated with obesity and incident diabetes mellitus among nondiabetic individuals. Since only a few studies have addressed the relationship between intake of Mg and obesity, we analyzed our nationwide registry of diabetic patients to determine if there was an association between intake of Mg and obesity in Japanese patients with T2DM. We analyzed data on 1891 Japanese patients with T2DM (mean age, 62 y; men, 62%) who completed a food frequency questionnaire. Obesity was defined as BMI ≥25. Associations between obesity and intake of Mg were determined by multivariate regression and quintile analyses. After adjusting for confounders including energy intake, the odds ratio (OR) for obesity was 0.93 (0.91,0.96) per 10 mg increase in Mg intake. Quintile analysis revealed a stepwise significant decrease in ORs for obesity from Q1 (lowest, ref.) to Q5 (highest) (Table). Food groups potently related to Mg intake in our patients were beans (correlation coefficients, 0.64), vegetables (0.62), and fish (0.57). These results imply that intake of Mg might be closely associated with obesity in patients with T2DM, which should have clinical relevance in nutrition therapy.

Disclosure
R. Nedachi: None. K. Fujihara: None. M. Hatta: None. Y. Matsubayashi: None. Y. Takeda: None. D. Ishii: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
2455-PUB: Number of Insulin Users May Explosively Increase with the Aging Population in Japan
Authors: KOKITA AYAKA , ARAKI MAKOTO 
Published: June 2019

Background: The impact of recent advances of oral antidiabetic agent on insulin users is unclear.
Methods: A retrospective observational and comparative study using medical records of patients who were prescribed insulin at our facility between 2009 and 2017 for various parameters, excluding dialysis patients.
Results: The number of insulin users was almost negligible (309-311 people). The age of the subjects was shifted to the old side on the frequency distribution polygon. The number of subjects who used ≥1 oral antidiabetic agents concurrently increased from 17.0% to 80.0%, especially among those aged &gt;80 years (about 8 times). HbA1c value remained negligible from 8.1% to 8.1%.
Conclusion: Our findings suggest an increasing number of patients with insulin secretory dysfunction masked using of oral antidiabetic agents.

Disclosure
A. Kokita: None. M. Araki: None.
2459-PUB: Clinical Characteristics and Management of Patients with Type 1 Diabetes—A National Population-Based Spanish Study (SED1)
Authors: GOMEZ-PERALTA FERNANDO , MENÉNDEZ-TORRE EDELMIRO , BARREIRO SANTIAGO CONDE , CONGET IGNACIO , NOVIALS ANNA 
Published: June 2019

Introduction: Little is known about the clinical characteristics and management of type 1 diabetes (T1D) in Spain from a national perspective. To sort this lack of information out the Spanish Diabetes Society (SED) promoted a national population-based audit study. (SED1 Study).
Material and Methods: Observational, cross-sectional study of a nationally representative sample of patients with DM1 in 78 Spanish sites, including children and adults.
Results: A total of 647 participants were included: Aged 36.5+14.4 years (7.6% &lt; 14), 55,3% female, 97.2% Caucasian, time since diagnosis 17.9±12.0 years and a BMI of 24.7±4.4 kg/m2 (40.2% &gt; 25; 12.1% ≥30). 75.0% of the population had secondary or university studies. 20.2% of patients were active smokers and 48.7% had any type of comorbidity, mainly dyslipidemia (25.8%). Any kind of retinopathy and nephropathy was present in 19.3 and 5.9% of patients. Regarding disease management, 75.9% used basal-bolus insulin therapy, 20.4% pump therapy, half of patients used insulin/carbohydrate ratio (ICR), performed 3.0±0.9 blood glucose measurements/day (BG) and 24.9% used continuous-glucose monitoring. Mean last-year HbA1c was 7.6±1.2% (&lt; 7%, 30.6%). The univariate logistic regression indicated that, HbA1c value was determined negatively by BG measurements (-0.045, p=0.03) and frequency of use of ICR (-0.236, p=0.008) and positively by disease duration (0.011, p=0.002) and lack of adherence to diet counseling (0.788, p=0.0001).
Conclusion: The management and type of treatment of T1D in Spain is similar to other western countries. There is still a substantial proportion of patients not reaching the recognized A1c target and with either overweight or obesity. Some factors related to T1D management prevent a greater effectiveness of treatment.

Disclosure
F. Gomez-Peralta: Advisory Panel; Self; Abbott, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Abbott, AstraZeneca, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S. E. Menéndez-Torre: None. S. Conde Barreiro: Other Relationship; Self; Lilly Diabetes, Sanofi. I. Conget: None. A. Novials: None.

Funding
Sanofi
2460-PUB: Metabolic Control in Three-Year Follow-Up in Guangdong Patients with Type 1 Diabetes Mellitus
Authors: ZHOU YONGWEN , YAN JINHUA , YANG DAIZHI , LUO SIHUI , ZHENG XUEYING , LING PING , WU ZEKAI , HUANG QIANWEN , XIAN YINGXIN , WANG CHAOFAN , LIN QIONGYAN , LIU HONGXIA , YAO BIN , WENG JIANPING 
Published: June 2019

Previous data showed that poor metabolic control existed in Guangdong type 1 diabetes mellitus(T1DM) patients. Thus, scheduled follow-ups were initiated in our diabetic clinic. This study aimed to assess the effect of scheduled management and explore related factors. From June 2011 to November 2018, 342 patients with T1DM registered in our diabetic clinic. Clinical data was obtained, HbA1c and plasma lipids were measured at enrollment and then once a year. Patients who had been followed-up for three years were included. A total of 201 patients (59.7% female) were analyzed, with median age of 26.9(18.1,35.5) years and diabetic duration of 5.6(0.4,8.8) years. HbA1c levels fell from 8.0±2.0% at enrollment to 7.3±1.2% in the third year progressively (P&lt;0.001) and the rate of age-specific target achievement raised from 38.0% to 47.2% (P=0.031).Serious hypoglycemia frequency decreased from 0.6(0,0.2) to 0.3(0,0) per month (P=0.046). Of adult patients(n=147) at enrollment, 71.3% of patients achieved the target level of blood pressure. Triglyceride (TG), low-and high-density lipoprotein cholesterol (LDL-C and HDL-C) were 1.0(0.6,1.2), 1.6(1.3,1.8) and 2.8(2.1,3.2) mmol/l, with 88.4%, 85.4% and 43.8% achieving targets, respectively. After follow-up, the rate of target achievement in HDL-C increased to 92.9% (P=0.039). LDL-C level increased to 2.9(2.3,4.3) mmol/l (P=0.008), with body mass index (BMI) (20.3±2.3 to 21.2±2.2kg/m2, P&lt;0.001) and insulin dosage (36.2(29,42) to 28.5(29.1,47.1)) units/day, P=0.01) increasing. Compared with the insufficient group, those achieving targets of HbA1c, lipids and blood pressure (20.1%) had more frequent self-monitored blood glucose (P=0.002) and lower BMI(P=0.025). The benefits of scheduled follow-up in glycemic control were sustained but not sufficient enough in the management of lipids in T1DM patients. Comprehensive management was needed to improve metabolic control.

Disclosure
Y. Zhou: None. J. Yan: None. D. Yang: None. S. Luo: None. X. Zheng: None. P. Ling: None. Z. Wu: None. Q. Huang: None. Y. Xian: None. C. Wang: None. Q. Lin: None. H. Liu: None. B. Yao: None. J. Weng: None.

Funding
Natural Science Foundation of Guangdong Province (2018A030313251); Science and Technology Planning Project of Guangzhou (201709010037)
2465-PUB: Successful Management of Severe Diabetic Ketoacidosis in a Type 2 Diabetes Patient with Insulin Allergy
Authors: NGUYEN ANH D. , LUONG CHINH Q. , CHU HIEU C. , NGUYEN VAN K. , NGUYEN CHI V. , NGUYEN TUAN A. , NGUYEN QUAN H. , MAI TON D. , NGUYEN DINH V. , NGUYEN BAY Q. , TRAN THONG H. , NGUYEN NGUYET N. , DO SON N. 
Published: June 2019

Objective: To report an episode of severe diabetic ketoacidosis (DKA) in a type 2 diabetes mellitus (DM) patient with insulin allergy treated by continuous intravenous (IV) regular insulin infusion.
Methods: We describe the clinical features, laboratory data, and management of severe DKA in a type 2 DM patient with insulin allergy.
Results: A 58-year-old man with type 2 DM initiated subcutaneous insulin administration (SIA) after failure of oral antidiabetic therapies. Symptoms of an allergic reaction then developed, especially distinct at the injection site. Pruritic wheals appeared within 10 minutes of injection and lasted over 24 hours. Both skin prick and intradermal tests were positive with different types of insulin. Two days before admission, he stopped SIA because of allergic symptoms, and then experienced weakness and upper abdominal pain. On admission, his heart rate was 130 beats/min, temperature 37°C, blood pressure 150/90 mmHg, and respiratory rate 28 breaths/min. Blood glucose level was 374.6 mg/dL, pH 6.984, bicarbonate 2.5 mmol/L, lactate 1.5 mmol/L, BUN 24.1 mg/dL, creatinine 1.46 mg/dL, and urinary ketone was 66.48 mg/dL. Over 24 hours, the metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as hemodialysis. Ultimately, he received continuous IV regular insulin infusion at an initial rate of 0.1 units/kg/hour, no further allergic reactions were observed. On the day 5, ketonemia and metabolic acidosis completely resolved. He had transition from IV insulin infusion to SIA on day 14. He was discharged on the day 21 with the treatment of SIA. Three months later, he had a good glycemic control, but has still appeared allergic symptoms at the injection sites of insulin.
Conclusion: In this patient, SIA caused an allergic reaction in contrast to continuous IV insulin infusion, for which allergic symptoms did not appear. Thus, identical insulin molecules could behave in markedly different ways depending on the route of injection.

Disclosure
A.D. Nguyen: None. C.Q. Luong: None. H.C. Chu: None. V.K. Nguyen: None. C.V. Nguyen: None. T.A. Nguyen: None. Q.H. Nguyen: None. T.D. Mai: None. D.V. Nguyen: None. B.Q. Nguyen: None. T.H. Tran: None. N.N. Nguyen: None. S.N. Do: None.
2469-PUB: Exploring the Mechanisms of Berberine against Type 2 Diabetes Mellitus and Its Complications by Network Pharmacology
Authors: DI SHA , HAN LIN , ZHAO LINHUA , TONG XIAOLIN 
Published: June 2019

Berberine (BBR), an extracted isoquinoline alkaloid from medicinal plants, is widely used to treat gastrointestinal infections, hypertension, hypercholesterolemia, diabetes, as well as diabetic complications (DC). In this study, network pharmacology was employed to exhibit the potential pharmacological mechanisms of BBR treating type 2 diabetes mellitus (T2DM) and DC, which need further research. Thirty-one overlapped targets were obtained from 313 potential targets of BBR and 178 related targets of T2DM retrieved and screened from databases, such as STITCH, PharmMapper, TTD, PharmGKB. It is worth noting that UCP2, AHR, GLUT4, PPARA, PTGS1/S2, LPL, HMGR, and NR1H4 have been reported which related to both BBR and T2DM. Visualized networks of function-target-pathway, revealed the underlying mechanisms of drug function, showed the core targets such as CYP3A4, CYP2C9 were mainly involved in xenobiotics/retinol/drug metabolism, as well as PPARA, INSR in PPAR/adipocytokine/insulin signaling pathway. Of which, several targets have relationship with DC, such as CYP2C9/PPARA related to blood vessel, RXRA related to retina reported. Taken together, this study revealed that BBR has efficacy effect on T2DM and DC mediated by vital targets using network pharmacology, which also provided a time-saving efficient approach in drug research including medicine function mechanism, and new drug development.

Disclosure
S. Di: None. L. Han: None. L. Zhao: None. X. Tong: None.

Funding
National Natural Science Foundation of China (81704067, 81430097)