bluuebunny/crossref_metadata_2025_split huggingface dataset:
156-OR: Risk-Benefit of SGLT2 Inhibitors (SGLT2i) vs. GLP-1 Receptor Agonists (GLP-1RA) in Routine Care of Older Adults
Authors: PATORNO ELISABETTA , KIM DAE H. , PAWAR AJINKYA , SCHNEEWEISS SEBASTIAN , GLYNN ROBERT J. , MUNSHI MEDHA , BESSETTE LILY G. , KIM SEOYOUNG C. 
Published: June 2019

Both SGLT2i and GLP-1 RA have shown cardiovascular (CV) benefits in RCTs among diabetic patients generally younger than 65 years with CV disease. Whether these agents are associated with differential effectiveness and safety in routine care of older adults remains unexplored. Using claims data from Medicare (4/2013-12/2016), we identified 44,179 pairs of 1:1 propensity score-matched (PSM) patients ≥65 years with type 2 diabetes initiating a SGLT2i or a GLP-1 RA. We assessed a composite CV outcome (MI, stroke, or all-cause mortality), and hospitalization for heart failure (HHF). Safety outcomes of interest were severe hypoglycemia, bone fractures, lower-limb amputations (LLA), and diabetic ketoacidosis (DKA). We estimated HRs and 95% CIs in the PSM population well-balanced across &gt;140 baseline covariates. Compared to GLP-1 RA, SGLT2i were associated with a similar risk of the composite CV outcome [HR (95% CI) = 1.04 (0.93-1.15)], and its components, but with decreased risk of HHF [0.68 (0.56-0.83)], over a mean 8.4-month follow-up (Table). Results were consistent in patients with and without CV disease. SGLT2i initiators had similar risk of severe hypoglycemia and fractures, but increased risk of LLA [1.47 (1.07-2.04)] and DKA [1.63 (1.16-2.28)]. Overall in 1,000 person-years, SGLT2i initiation vs. GLP-1 RA was associated with about 2.2 fewer HHF events, but 0.9 more LLA and 1.0 more DKA events.

Disclosure
E. Patorno: Research Support; Self; National Institute on Aging. Other Relationship; Self; Boehringer Ingelheim International GmbH. D.H. Kim: None. A. Pawar: None. S. Schneeweiss: Consultant; Self; Aetion, WHISCON, LLC. R.J. Glynn: Research Support; Self; AstraZeneca, Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Pfizer Inc. M. Munshi: Consultant; Self; Lilly Diabetes, Sanofi. L.G. Bessette: None. S.C. Kim: Research Support; Self; Bristol-Myers Squibb Company, Genentech, Inc., Pfizer Inc.
1562-P: Diabetes as Leading Cause of Permanent Occupational Disability due to Ocular Diseases in the Mexican Institute of Social Security
Authors: JESUS ASCENCIO-MONTIEL IVAN DE , JESÚS ZITLE-GARCÍA EDGAR , ALBERTO REYES-MARTÍNEZ CARLOS , ALTAGRACIA GARCÍA-LOPEZ MÓNICA 
Published: June 2019

Eye diseases are an important cause of disability and economic burden on society, affecting economically active population. We described the rates of permanent occupational disability due ocular diseases and specifically due diabetic retinopathy in workers affiliated to the Mexican Institute of Social Security (IMSS), during the 2000-2016 period. A cross-sectional analysis was conducted with data from the IMSS permanent occupational disability database. Subjects with ocular diseases were classified using the International Classification of Diseases, 10th revision (ICD-10) in the following groups: diabetic retinopathy (ICD-10: E103, E113, E123, E133, E143, H280, H360), glaucoma (ICD-10: H40), age-related macular degeneration (ICD-10: H353), cataract (ICD-10: H25-H28), hypertensive retinopathy (ICD-10: H350), trachoma (ICD-10: B940) and blindness (ICD-10: H54). Data for each worker including sex, age at time of permanent occupational disability and ocular diseases were acquired. Permanent occupational disability rates were expressed x100,000 total worker affiliate population. There were 31,221 workers with permanent occupational disability due ocular diseases, 79.3% were male and mean age was 50.8 years old. Diabetic retinopathy was the most frequent cause of ocular permanent occupational disability with 21,161 workers (67.8%). Ocular disease rate increase from 10.52 to 13.78 x 100,000 affiliated workers during 2000 and 2016 respectively (percentage increase 30.9%), and diabetic retinopathy rate also showed an incremented in the same period (from 6.48 to 11.38 x 100,000 affiliated workers, percentage increase 75.7%).The increase in the number of workers with permanent occupational disability due to diabetic retinopathy, reflects an important diabetes complications incidence among the more than 19 million working people affiliated to the IMSS, the largest social security institution in Latin America.

Disclosure
I. Ascencio-Montiel: None. E. Zitle-García: None. C. Reyes-Martínez: None. M. García-Lopez: None.

Funding
Consejo Nacional de Ciencia y Tecnología (72694 to I.D.A-M.)
1567-P: Diabetes Subtypes and Risk for Complications
Authors: BANCKS MICHAEL , CARNETHON MERCEDES R. , CHEN HAIYING , COTCH MARY FRANCES , KLEIN BARBARA E.K. , KLEIN RONALD , SZKLO MOYSES , BERTONI ALAIN 
Published: June 2019

Background: Recent reconsideration of the classification of diabetes identified novel unique diabetes phenotypes using data on traditional diabetes characteristics. Our objective was to assess whether unique diabetes phenotypes are present in a multi-ethnic U.S. sample and, if so, are differentially associated with incident complications.
Methods: We included 1201 MESA participants who were identified as having diabetes at exams 1 (2000-02) or 2 (2002-04) via any of the following: self-report of previous diabetes diagnosis, diabetes medication use, fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, and glycated hemoglobin (HbA1c) ≥6.5%. We used an iterative data-driven method (k-means clustering) to partition the sex-stratified sample into unique groups based on data for each of the following: age at diabetes diagnosis, body mass index, waist circumference, HbA1c, and years of insulin use. We estimated the association between diabetes subtype with risk for CVD, death, chronic kidney disease, and retinopathy from 2002 through 2015.
Results: We identified four unique subtypes of diabetes related to aging (AR; 52% of sample), insulin use (IU; 3%), severe obesity (SO; 32%), and severe hyperglycemia (SH; 14%). Compared to the AR group, risk for death was higher for the SH and IU groups and risk for retinopathy was higher for SH (Table).
Conclusions: Our work supports consideration of unique diabetes subtypes that have differential risk for complications.

Disclosure
M. Bancks: None. M.R. Carnethon: None. H. Chen: None. M. Cotch: None. B.E.K. Klein: None. R. Klein: None. M. Szklo: None. A. Bertoni: Consultant; Self; Merck & Co., Inc.

Funding
National Heart, Lung, and Blood Institute (HHSN268201500003I)
1572-P: Association of Genetic Variants Related to Hyperinsulinemia with Dietary Intake
Authors: MERINO JORDI , COLE JOANNE B. , LIM ELISE , YATES KAYLA , LIU CHING-TI , FLOREZ JOSE C. 
Published: June 2019

Background: The carbohydrate-insulin model of obesity postulates that hyperinsulinemia induces weight gain through increased hunger and lower energy expenditure. We investigated the extent to which genetic risk for hyperinsulinemia associates with energy intake and dietary composition.
Methods: We conducted a population-based study of 148,494 unrelated individuals from the UK Biobank with available genetic and dietary data. Insulin resistance (IR) and secretion (IS) were captured by a 10 and 19-variant genetic risk score (GRS) respectively. Dietary intake was evaluated using a web-based 24-hour diet recall. Linear regression models were used to examine the associations of IR-GRS and IS-GRS with total energy intake and dietary composition after adjusting for confounders. We tested for effect modification by age, sex, and body mass index. In sensitivity analyses we excluded individuals with diabetes.
Findings: The IR-GRS was associated with higher energy (β=131 kcal/day [95% CI 73 to 189] P=0.02) and polyunsaturated fat intake (β=0.52% of energy [95% CI 0.27 to 0.77] P=0.03). We noted interactions between the IR-GRS and age on carbohydrate (Pint=0.03) and sugar intake (Pint=0.02), showing that age magnified the effect of the IR-GRS on carbohydrate (top decile of age compared to the bottom decile: β=2.62% of energy[95% CI -0.02 to 5.26] vsβ=-4.24% of energy [95% CI -7.24 to -1.24]) and sugar intake (β=2.45% of energy[95% CI 0.18 to 5.12] vs. β=-3.12% of energy[95% CI -5.60 to -0.64]). These findings were consistent in individuals free of diabetes (n=140,969). There were no significant findings for the IS-GRS.
Interpretation: These data suggest that genetically driven hyperinsulinemia is associated with dietary intake, and that age could modify the association between genetic risk and carbohydrate intake. Our findings underline the importance of hyperinsulinemia on eating behavior and may serve as preliminary evidence to inform novel strategies for the prevention of common complex metabolic diseases.

Disclosure
J. Merino: None. J.B. Cole: None. E. Lim: None. K. Yates: None. C. Liu: None. J.C. Florez: None.

Funding
European Commission
1575-P: Influence of Adolescent and Maternal Coffee Consumption on Risk of Obesity and Type 2 Diabetes Mellitus in Middle-Aged Women and Their Offspring: Results from Two Prospective Cohort Studies in the United States
Authors: ALPERET DERRICK , DHANA KLODIAN , CHAVARRO JORGE E. , SUN QI 
Published: June 2019

In a double-blind randomized trial, coffee intake was shown to decrease fat mass in healthy overweight adults, suggesting that coffee could be modulating lower type 2 diabetes mellitus (T2DM) risk (as ascertained in observational studies) among adults through pathways involving adiposity. However, it is not known if earlier-life (e.g., in-utero, adolescence) exposure to coffee intake could modulate risk of developing childhood obesity and, ultimately, T2DM later in life. In individuals free of diabetes, cancer or cardiovascular disease at baseline, we examined the relationship between: 1) adolescent caffeinated coffee intake (assessed using a validated high-school FFQ in 1998) and later-life (mean ages 43 to 57 years) T2DM risk [self-reported physician-diagnosed cases during follow-up (1998-2011) confirmed by a validated supplementary questionnaire] among 47,355 middle-aged women in the Nurses’ Health Study II (NHSII) using Cox proportional hazards regression; and, 2) prenatal/perinatal coffee intake [ascertained using validated FFQs adjacent to pregnancy (1989-1995)] among 7,629 mothers in NHSII and risk of obesity [defined according to age- and sex- specific BMI thresholds during follow-up (2004-2013)] among 10,657 male and female offspring in the Growing Up Today Study II using log-binomial regression. Adolescent caffeinated coffee intake was associated with 17% lower T2DM risk [≥1 cup/day vs. never/rarely: HR 0.83 (95% CI 0.71-0.98); P-trend=0.03] in later-life. Moderate to large increase (median: +17.5 cups/week) in caffeinated coffee intake from adolescence to adulthood was associated with 20% lower T2DM risk [&gt;1 cup/day increase vs. no change: HR 0.80 (95% CI 0.72-0.89); P-trend&lt;0.0001] in later-life. Total caffeinated or decaffeinated coffee intake during peri-pregnancy was not significantly associated with childhood obesity risk.

Disclosure
D. Alperet: None. K. Dhana: None. J.E. Chavarro: None. Q. Sun: Consultant; Self; Emavant Solutions GmbH.

Funding
National Institutes of Health (UM1CA176726, UM1CA176726, P30DK046200, U54CA155626, T32DK007703-16, HD066963, HL096905, DK084001, OH009803, MH087786)
1576-P: Metabolomic Profiling of the Dietary Approaches to Stop Hypertension (DASH) Diet: Novel Insights for the Nutritional Epidemiology of Type 2 Diabetes Mellitus (T2DM)
Authors: YASHPAL SHAHEN , LIESE ANGELA D. , WAGENKNECHT LYNNE E. , HAFFNER STEVEN M. , JOHNSTON LUKE W. , BOUCHER BEATRICE , BAZINET RICHARD P. , REWERS MARIAN , ROTTER JEROME I. , WATKINS STEVE M. , HANLEY ANTHONY 
Published: June 2019

Background: The DASH diet is inversely associated with T2DM risk. Metabolic changes due to DASH adherence and their potential relationship with incident T2DM have not been described.
Objective: To determine metabolite clusters associated with adherence to a DASH-type diet in the Insulin Resistance Atherosclerosis Study (IRAS) cohort and explore if they predict 5-year T2DM incidence.
Methods: DASH adherence for 570 nondiabetic multi-ethnic participants aged 40-69 years was determined using a 10-point scale for 8 DASH food groups. Data for 88 metabolites (acylcarnitines, amino acids, bile acids, sterols, and fatty acids) were obtained at baseline. Metabolite clusters associated with a DASH-type diet were determined using partial least squares analysis (PLS). Multivariable-adjusted logistic regression was used to explore the associations between metabolite clusters and incident T2DM.
Results: A group of acylcarnitines loaded strongly on two components retained under PLS (Figure). Component 2 was inversely associated with incident T2DM (OR: 0.86; 95% CI 0.79-0.95) after adjustment for demographic and metabolic covariates. Component 1 was not associated with T2DM risk (OR: 0.97; 95% CI 0.87-1.10).
Conclusion: Adherence to a DASH-type diet may contribute to reduced T2DM risk in part through modulations in acylcarnitine physiology.

Disclosure
S. Yashpal: None. A.D. Liese: None. L.E. Wagenknecht: None. S.M. Haffner: None. L.W. Johnston: None. B. Boucher: None. R.P. Bazinet: None. M. Rewers: None. J.I. Rotter: None. S.M. Watkins: Stock/Shareholder; Self; Verso Biosciences, Inc. A. Hanley: None.

Funding
National Institutes of Health
1578-P: Meal Consumption Patterns and Contributions of Meals and Snacks to Total Nutrient Intakes by Diabetes Status
Authors: KELLY OWEN , FANELLI STEPHANIE M. , KROK-SCHOEN JESSICA L. , TAYLOR CHRISTOPHER A. 
Published: June 2019

Glycemic control greatly relies on total dietary and carbohydrate intakes, but more importantly the distribution of these intakes throughout the day. The purpose of this study was to understand meal and snack patterns and their contribution to the day’s intakes in people with and without diabetes. Meal and snack intakes were assessed for adults over 30 years of age (n=23708) using dietary and hemoglobin A1c data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Dietary intakes were assessed from a 24-hour dietary recall. Participants self-reported meals and snacks. Intakes were aggregated to obtain nutrients consumed at meals and snacks and were used to compute the percent of the total day’s intakes contributed by each meal or snack. Participants were stratified into diabetes status using A1c values: &lt;5.7% (nondiabetes, n=14841); 5.7-6.4% (prediabetes, n=5923); 6.5-6.9% (controlled diabetes, n=923); and &gt;7% (poorly controlled diabetes, n=2021). Data were weighted to create a nationally representative sample. Significantly less adults with controlled and poorly controlled diabetes consumed all three meals per day (60-62%, P&lt;0.001). Lunch was the most skipped meal (19.8-25.8%) across all groups, with nondiabetes having the highest percent (P&lt;0.001). Snacks contributed more energy, carbohydrates, and added sugars than breakfast in all groups. Dinner contributed nearly 40% of protein, sodium, and saturated fat intakes as well as more than one-third of total energy. Breakfast accounted for nearly half the day’s whole grain intake, yet mean daily intakes were below 0.5 ounces. Distributing food intake, especially carbohydrates, throughout the day is an effective strategy to promote optimal glycemic control. Meal skipping, particularly lunch more than breakfast, was more common in adults with diabetes, with considerable intakes of energy and carbohydrates obtained during dinner and snacks, suggesting uneven meal distribution is prevalent.

Disclosure
O. Kelly: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. S.M. Fanelli: None. J.L. Krok-Schoen: None. C.A. Taylor: Consultant; Self; Abbott Laboratories. Research Support; Self; Abbott Laboratories. Other Relationship; Self; Elsevier.

Funding
Abbott Nutrition
1579-P: Higher Calcium Intake Is Associated with Lower Incidence of Diabetic Nephropathy in Japanese Patients with Type 2 Diabetes
Authors: HORIKAWA CHIKA , AIDA REI , TANAKA SHIRO , TANAKA SACHIKO , KAMADA CHIEMI , YOSHIMURA YUKIO , ARAKI ATSUSHI , MORIYA TATSUMI , KATAYAMA SHIGEHIRO , AKANUMA YASUO , SONE HIROHITO 
Published: June 2019

Evidence for optimal dietary intake of calcium for prevention of diabetic complications is sparse although population-based cohort studies showed that calcium intake reduces the risk of type 2 diabetes (T2D). We aimed to investigate the relationship between calcium intake and the incidence of diabetes complications in Japanese patients with T2D aged 40-70 years with HbA1c ≥6.5%. This analysis was conducted as a multicenter prospective study of the incidence of and risk factors for macro- and microvascular complications among 2205 Japanese patients with T2D from outpatient clinics in 59 university and general hospitals in Japan. Analyzed were 1588 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups or a dietary record. Primary outcome was the 8-year risk of nephropathy, retinopathy, and cardiovascular disease (CVD). Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, BMI, HbA1c, smoking, energy intake, and other confounders. Mean calcium intake in quartiles ranged from 487.5 to 751 mg/day, and more than half of participants had calcium intake below the recommended daily dietary allowance in Japan (men 700 mg/d; women 650 mg/d). After adjusting for confounders, HRs of diabetic nephropathy in the 2nd, 3rd, and 4th quartiles for calcium intake compared with the 1st quartile were 1.20 (95% confidence interval 0.67-2.18, p=0.540), 0.60 (0.28-1.28, p=0.185), and 0.42 (0.18-0.97, p=0.024), respectively. There were no significant associations of calcium intake with retinopathy and CVD in the 2nd to 4th quartiles relative to the 1st quartile (retinopathy: 1.15 (0.81-1.64, p=0.441), 1.14 (0.78-1.68, p=0.491), and 0.93 (0.59-1.46, p=0.809); CVD: 0.86 (0.51-1.44, p=0.558), 0.92 (0.53-1.61, p=0.763), and 0.81 (0.42-1.53, p=0.508). Findings suggested an association of high calcium intake with a lower incidence of diabetes nephropathy in Japanese patients with T2D.

Disclosure
C. Horikawa: None. R. Aida: None. S. Tanaka: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. A. Araki: Speaker's Bureau; Self; Dainippon Sumitomo Parma Co. Ltd., Merck & Co., Inc., Tanabe Mitsubishi Pharma Corporation. T. Moriya: None. S. Katayama: None. Y. Akanuma: None. 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.

Funding
Japan Society for the Promotion of Science; Japan Ministry of Health, Labour and Welfare
1580-P: Dietary Index of Insulin Resistance and Insulin Secretion Predicts Diabetes Risk in Asian Indians
Authors: FORD CHRISTOPHER N. , STAIMEZ LISA R. , SHAIKH NIDA I. , TANDON NIKHIL , PRABHAKARAN DORAIRAJ , NARAYAN VENKAT K.M. , GARG VANDANA 
Published: June 2019

Background: The diets of Asian Indians (AIs) may place them at greater risk of diabetes Caucasian populations. The objective of this study was to develop a dietary index of diabetes risk in adult AIs.
Methods: Data were included from a representative sample of adults from Delhi, India in 2014 - 2015 (n = 2,660). Insulinogenic Index (IGI), Disposition Index (DI), Matsuda’s index (MI), HOMA-IR and HOMA-B were calculated from fasting, 30-min and 2-hour insulin and plasma glucose from an OGTT. Intakes of 25 food groups were estimated using a 28-item food frequency questionnaire, the Indian Food Composition Table and Nutritionist Pro. Reduced rank regression (RRR) was used to estimate the relationship between dietary variables and standardized natural logs of IGI, DI, MI, HOMA-IR and HOMA-B (response variables). The first RRR pattern was extracted, RRR pattern score was computed, and respondents were split into quartiles according to RRR pattern score. Logistic regression was used to estimate the relationship between quartile of RRR pattern score and diabetes, adjusting for age and gender.
Results: There were 2,572 (96.7%) respondents with complete data for diet and response variables. The first RRR pattern explained 3.1% of the variation in response variables, 7.1% of the variance in diet variables, and was moderately correlated with MI (-0.24), HOMA-IR (0.19) and HOMA-B (0.17) (all p &lt;0.05). Intakes of pickles (0.52), milk-based products (0.32), milk (0.27), uncooked vegetables (0.27) low-sugar fruits (0.24), rice (-0.52), fish (-0.35), and organ meats (-0.33) were significantly correlated with the first RRR pattern. Those in Q4 of the first RRR pattern were 1.63 (95% CI: 1.31, 2.02) as likely as those in Q1 to have diabetes. The relationship was attenuated with adjustment for age and gender (OR: 1.29; 95% CI: 1.03, 1.61).
Conclusion: A diet pattern high in intakes of pickles, milk and milk-based products, and low in intakes of rice, fish and organ meats may increase diabetes risk in adult AIs.

Disclosure
C.N. Ford: None. L.R. Staimez: None. N.I. Shaikh: None. N. Tandon: None. D. Prabhakaran: None. K. Narayan: None. V. Garg: None.

Funding
National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN
1581-P: Increase of Diabetes and Obesity among Descendants of First-Generation Filipino Immigrants to Italy
Authors: PIERALICE SILVIA , TORO ROSSELLA DEL , KHAZRAI YEGANEH MANON , MADDALONI ERNESTO , MAURIZI ANNA RITA , MANFRINI SILVIA , POZZILLI PAOLO 
Published: June 2019

Aims: Filipino people are one of the largest immigrant populations in Italy. Aim of this study was to assess differences in T2D, prediabetes and obesity between native Italians and Filipino immigrants living in Rome. Changes in metabolic characteristics and dietary habits between first-generation immigrants and their descendants were examined.
Methods: A cross-sectional survey was carried out adopting principles of community-based participatory research. A total of 132 first-generation Filipinos aged 35-60 years resident in Rome for ≥ 5 years, 164 age and sex-matched native Italians and 27 descendants of the first-generation immigrants aged 10-18 years were studied. Diabetes history and dietary habits were investigated by standardized questionnaires; anthropometrics, blood pressure and fasting capillary blood glucose were measured.
Results: T2D, impaired fasting glucose and obesity were all more prevalent among first-generation immigrants (13.5%, 35.4% and 41.7% respectively) than Italians (7.2%, 22.6% and 36.8%). Descendants showed higher prevalence of overweight and obesity (48.1%) than first-generation immigrants (p&lt;0.05). First-generation immigrants consumed traditional food more days per week compared to their descendants, who preferred western food, with a large consumption (&gt;4 times/week) of eggs (96%), processed meat (74%) and sweet foods or beverages (96%). Body Mass Index was directly related to years spent in Italy (r=0.19, p=0.03) and educational level (r=0.19, p=0.04). Size of household was directly related to weight gain in first-generation immigrant women (r=0.40, p&lt;0.001).
Conclusion: This survey reveals a higher prevalence of diabetes and its risk factors among the Filipino community resident in Rome. Obesity prevalence is higher in the second-generation, probably due to unhealthy changes in dietary pattern. These alarming data stress the need of appropriate health programs addressed to the minority groups immigrating in western countries.

Disclosure
S. Pieralice: None. R. Del Toro: None. Y. Khazrai: None. E. Maddaloni: Speaker's Bureau; Self; Merck & Co., Inc., Pikdare. A. Maurizi: Consultant; Self; AstraZeneca. S. Manfrini: None. P. Pozzilli: None.