bluuebunny/crossref_metadata_2025_split huggingface dataset:
57-LB: The Wellness Bus: Closing the Gap in Type 2 Diabetes Prevention and Promoting Population Health
Authors: MARCUS ROBIN L. , BANNON BRITTANY L. , DELANEY REBECCA K. , FAGERLIN ANGELA 
Published: June 2019

More than 150,000 Utahns have diabetes, costing the state over one billion dollars each year. The risk for developing type 2 diabetes is significantly higher among members of minority racial or ethnic groups. The Wellness Bus is a mobile health unit that aims to reduce the burden of type 2 diabetes in Utah’s underserved communities. The program represents a unique partnership between researchers, community health workers, student volunteers, and community health partners.
Objective: To describe the characteristics and needs—both medical and social—of community members being served by the Wellness Bus in its first 6 months of implementation, and to discuss how the mobile health unit and its partners are addressing these critical gaps in access to care.
Methods: Participants included 501 individuals who visited the Wellness Bus’s weekly neighborhood sites between June and December of 2018. Participants were ages 18 to 88 years (Mean age = 46.8), 50% Female; 28% white; and 67% Hispanic/Latino. Descriptive data from routinely-collected assessments during Wellness Bus visits at the weekly sites including participant self-report surveys, biometric screenings, and social service referrals were analyzed with R statistical software.
Results: Of all individuals, 57% reported Spanish as their primary language, 67% were uninsured, and 61% did not have a primary care provider; 23% had been previously diagnosed with diabetes or prediabetes. More than half of high-risk individuals had HbA1c levels &gt; 5.7. Mean BMI = 29.8, with 82% overweight or obese; more than half screened with elevated blood pressure. Service referrals were made for 160 individuals, most to community medical/dental services. In regard to the social risk assessment, 35% reported experiencing food insecurity. Through the first 6 months of the Wellness Bus program, we have gained an understanding of our communities’ needs and are addressing these gaps. We are developing strategies to increase the number of follow-up visits.

Disclosure
R.L. Marcus: None. B.L. Bannon: None. R.K. Delaney: None. A. Fagerlin: None.
580-P: Cardiovascular Autonomic Neuropathy Is Associated with Carotid Intima-Media Thickness and Arterial Stiffness in Patients with Type 2 Diabetes
Authors: SOHN TAE SEO 
Published: June 2019

Cardiac autonomic neuropathy (CAN) is a frequent but underdiagnosed complication of diabetes mellitus. CAN represents a significant cause of morbidity and mortality in patients with diabetes and is associated with a high risk of cardiac arrhythmia and sudden death. The aim of this study is to evaluate the association between CAN and carotid intima-media thickness (CIMT) and arterial stiffness in patients with type 2 diabetes mellitus (T2DM). CAN, CIMT, ankle-brachial index (ABI) and pulse wave velocity (PWV) were evaluated in a cross-sectional sample of 321 patients (147 men and 174 women) with T2DM. CAN was assessed by Ewing’s method which employs five non-invasive tests of autonomic function. Among 321 patients, CAN was found in 87 patients (27%). Compared with the patients without CAN, those with CAN were significantly older and had significantly longer duration of diabetes, lower glomerular filtration rate, higher hs-CRP, mean CIMT, PWV, and ABI. The CAN scores correlated positively with mean CIMT and PWV (P&lt;0.05). Using multivariate regression analysis, CAN score independently predicted mean CIMT in patients with T2DM after adjustment for age and DM duration.
In conclusion, CAN was associated CIMT and increased arterial stiffness in patients with T2DM. CAN might be associate with the development of cardiovascular disease through CIMT and arterial stiffness in T2DM.

Disclosure
T. Sohn: None.
60-OR: Sitagliptin for the Prevention and Treatment of Perioperative Hyperglycemia in Diabetic Patients Undergoing Cardiac Surgery
Authors: CARDONA SAUMETH , TSEGKA KATERINA G. , JACOBS SOL , ALBURY BONNIE S. , GALINDO RODOLFO J. , MIGDAL ALEXANDRA , HALKOS MICHAEL E. , KEELING WILLIAM B. , MILLER JEFFREY S. , MACHEERS STEVEN K. , GUYTON ROBERT A. , VELLANKI PRIYATHAMA , DAVIS GEORGIA , FAYFMAN MAYA , PENG LIMIN , PASQUEL FRANCISCO J. , UMPIERREZ GUILLERMO E. 
Published: June 2019

Perioperative hyperglycemia (BG &gt;180 mg/dl) is reported in more than 80% of patients with T2D after cardiac surgery and is associated with high morbidity and mortality. Continuous insulin infusion (CII), the recommended for treatment of perioperative hyperglycemia is labor intensive and is associated with hypoglycemia risk. Because, treatment with DPP-4is has been shown to improve glucose control without hypoglycemia in general surgery patients, we conducted a double-blinded randomized trial to test the hypothesis that sitagliptin could prevent and treat hyperglycemia after CABG. A total of 202 patients with T2D were randomized to sitagliptin (n=101) or placebo (n=101) once daily, starting the day prior to surgery and continued in the ICU and after transition to regular wards.
We observed no differences in BG prior to or during surgery, ICU stay or after transition to floor between groups. There were no differences in the number of patients requiring insulin therapy in the ICU or in regular floors, frequency of hypoglycemia or in hospital complications. Sitagliptin was associated with lower SQ insulin requirements without increased risk of hyper- or hypoglycemia compared to placebo after transition to regular floor.
Conclusion: Sitagliptin cannot be recommended for the prevention or treatment of perioperative hyperglycemia in patients with T2D undergoing cardiac surgery.

Disclosure
S. Cardona: None. K.G. Tsegka: None. S. Jacobs: None. B.S. Albury: None. R.J. Galindo: Advisory Panel; Self; Abbott, Novo Nordisk Inc., Sanofi US. Research Support; Self; Novo Nordisk Inc. A. Migdal: None. M.E. Halkos: Board Member; Self; Medtronic. W.B. Keeling: None. J.S. Miller: None. S.K. Macheers: None. R.A. Guyton: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. Research Support; Self; National Institutes of Health. G. Davis: None. M. Fayfman: None. L. Peng: None. F.J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.

Funding
Merck & Co., Inc.
607-P: Hyperhomocysteinemia Is Closely Associated with Macular Edema in Type 2 Diabetes
Authors: LI JIANBO , ZHANG HONGMAN , LV QING , LU HUAN , ZHOU JUN 
Published: June 2019

Macular edema that impairs central vision is one of leading causes of blindness related to diabetes. Hyperhomocysteinemia is more common in type 2 diabetes, which may damage endothelium by excessive sulphation of connective tissues. In this study, we for the first time explored the relation of plasma total homocysteine concentration to diabetic macular edema in patients with type 2 diabetes. We enrolled 176 type 2 diabetic patients and 115 healthy subjects in a cross-sectional hospital-based study. Using fundus photographs documented retina statuses and using fluorescence polarization immunoassay measured homocysteine concentration. Risk factors for diabetic macular edema were obtained from fasting blood samples and interviewer- questionnaire. We found that diabetic patients had increased plasma homocysteine compared with normal control, and plasma homocysteine levels were higher in subjects with diabetic macular edema than without ((11.4 ± 2.7) vs. (8.5 ± 1.9) (μmol/l), p = 0.000). The association of homocysteine with diabetic macular edema was independent of major risk factors for diabetic macular edema (duration of diabetes, HbA1c, lipid) and determinants of higher homocysteine concentration (age, gender, serum folate and vitamin B12, renal status, and biguanide use) (OR: 1.63 (1.02-2.14), p = 0.018). Furthermore, a 1 μmol/l increase in plasma homocysteine concentration was associated with a 0.5% to 2.2% increase of diabetic macular edema and per increase of 5.0 μmol/l plasma homocysteine was significantly related to macular edema (OR: 1.64 (1.04-2.16), p = 0.019) after adjusting for duration of diabetes per 5 year increase, HbA1c per 1% increase, serum folate per 10 nmol/l increase, serum B12 per 100 pmol/l increase, serum creatinine per 10 μmol/l increase and urinary ACR per 5 mg/g increase. We concluded that hyperhomocysteinemia is independently associated with occurrence of macular edema in type 2 diabetes. Future prospective studies are warranted to clarify the relationship.

Disclosure
J. Li: None. H. Zhang: None. Q. Lv: None. H. Lu: None. J. Zhou: None.
625-P: Metallothionein Improves Angiogenic Function of Endothelial Progenitor Cells via HIF-1α/SDF-1/Akt Pathway in Diabetic Limb Ischemia
Authors: WANG KAI , DAI XIAOZHEN , HE JUNHONG , YANG CHENGKUI , CHEN JING , WINTERGERST KUPPER A. , EPSTEIN PAUL N. , CAI LU , TAN YI 
Published: June 2019

Diabetes mellitus associated dysfunction of endothelial progenitor cells (EPCs) may contribute to dysregulation of endothelial regeneration. Metallothionein (MT) acts as an antioxidant in various pathophysiological processes. Whether MT in EPCs has positive angiogenic effects and the mechanisms involved remain unclear. Endothelial MT overexpression (JTMT) mice were made diabetic by high fat diet followed by STZ administration (HFD/STZ). Diabetic hind limb ischemia model was established by femoral artery ligation. Bone marrow derived mononuclear leucocytes (MNCs) collected from JTMT mice were transplanted into db/db mice with hind limb ischemia. Blood reperfusion was monitored and oxidative stress was measured. High glucose and hypoxia conditions in culture were adopted to mimic diabetic ischemia in vitro. MT improved blood perfusion of ischemic hind limb and promoted angiogenesis in HFD/STZ diabetes. Oxidative stress of ischemic muscles was aggravated under diabetic condition, which was reduced in JTMT mice. Compared with WT mice, the expression of HIF-1α, SDF-1, VEGF and p-Akt were all increased in JTMT mice, along with elevation of plasma SDF-1α and VEGF. Moreover, transplantation of MT overexpressed MNCs showed better therapeutic effect on db/db diabetic mice with hind limb ischemia than control or transplantation of normal MNCs. Transplantation was accompanied by elevated HIF-1α, SDF-1 and Akt signaling. Vitro studies demonstrated that MT overexpression reduced high glucose and hypoxia induced EPC dysfunction and preserved high glucose and hypoxia impaired HIF-1α, SDF-1, VEGF and Akt signaling, all of which were abolished by siRNA knockdown of HIF-1α.
In conclusion, elevated MT enhances angiogenic function and therapeutic efficacy of EPCs in diabetic limb ischemia. The benefits of MT are predominantly mediated by a HIF-1α/SDF-1/Akt pathway under diabetic ischemia conditions.

Disclosure
K. Wang: None. X. Dai: None. J. He: None. C. Yang: None. J. Chen: None. K.A. Wintergerst: None. P.N. Epstein: None. L. Cai: None. Y. Tan: None.

Funding
American Diabetes Association (1-15-BS-018, 1-18-IBS-082 to L.C.); 1-13-JF-53 (to Y.T.)
626-P: Association between Peripheral Neuropathy and Biomechanics Performance in Patients with Type 2 Diabetes Mellitus
Authors: DENG WUQUAN , DENG FANG , CHEN BING , MA YU , JIANG XIAOYAN , ARMSTRONG DAVID , ZHOU HE 
Published: June 2019

Objective: To explore the effect of DPN on the gait and balance ability using new a biomechanical monitoring technology.
Methods: 176 subjects were divided into 4 groups: Group A (no DPN signs and symptoms, NCV negative, 48), group B (no DPN signs and symptoms, NCV positive, 45), group C (with DPN signs and symptoms, NCV positive, 51) and group D (normal control, 32). The gait, balance, timed up and go test were conducted using the LEGSys and BalanSens system. The difference of biomechanics parameters and their relationship with NCV were analyzed.
Results: The stride, stride to height ratio, walking speed, step height and swing (left) of diabetic groups were significantly lower than group D (P &lt; 0.05). The support (left) and double support (right) of diabetic groups were significantly higher than group D (P &lt; 0.05). In eyes-open hard surface stand test, the center of gravity (COG) sway range of side to side and front to back, the ankle sway range of side to side, the COG sway area, the ankle sway area, the COG sway index and the ankle sway index in group B and C were significantly higher than group D (P &lt; 0.05). The stride length and stride to height ratio of group C were lower than group A (P &lt; 0.05). The walking speed, step height and steps per minute of group C were significantly lower than group A and B (P &lt; 0.05). In the eyes open or closed stand balance test, COG sway range of front to back and the sway index of group C were significantly higher than group A (P &lt; 0.05). In the eyes open state, the ankle sway range of front to back, ankle sway index and COG sway velocity of group C were significantly higher than group A (P &lt; 0.05). In the eyes closed state, the hip sway area of group C were higher than group A (P &lt; 0.05). In the mCTSIB test, the COG sway index of group C were significantly higher than group A (P &lt; 0.05).
Conclusion: The biomechanics performance in diabetic patients are impaired and further worse by DPN. These defects may achieve an early detection by the new biomechanical monitoring technology.

Disclosure
W. Deng: None. F. Deng: None. B. Chen: None. Y. Ma: None. X. Jiang: None. D. Armstrong: None. H. Zhou: None.

Funding
Cultivation Project of Chongqing Youth Medical High-End Reserve Talents (2017HBRC015)
631-P: Negative Pressure Wound Therapy May Affect Circulating Plasma MicroRNAs in Patients with Diabetic Foot Ulceration
Authors: KAPUSTA PRZEMYSłAW , HOHENDORFF JERZY , ZURANSKA JUSTYNA , BORYS SEBASTIAN , KONIECZNY PAWEL , KIEC-WILK BEATA M. , WOLKOW PAWEL P. , MALECKI MACIEJ 
Published: June 2019

Background: Negative pressure wound therapy (NPWT) has been successfully used as treatment for diabetic foot ulceration (DFU). However, the molecular mechanisms of its action, especially outside of the wound bed, are not fully understood. We assessed the effect of NPWT on levels of circulating plasma microRNAs in patients with type 2 diabetes (T2DM) and DFU.
Methods: We included 33 patients with T2DM and DFU - 23 individuals were assigned to NPWT and 10 to standard treatment (ST). Assignment to NWPT was based on routine clinical recommendations and not random. MicroRNAs enriched RNA was extracted from plasma at two time points: before treatment and after 8±1 days of treatment. Prepared small RNA libraries were sequenced on the NextSeq 500 sequencer (Illumina). Generated reads were aligned to mirBase 21 using Bowtie and counted using miRDeep2 software. Statistical analysis of differentially expressed microRNAs was performed via the edgeR package in the R environment.
Results: The NPWT and ST groups were similar in terms of basic clinical characteristics, such as age (67.8 vs. 67.8 years, p=0.95) and HbA1c level (7% vs. 7.8%, p=0.15). We identified three miRNAs - miR-6842, miR-3690 and miR-11400 - that were expressed at a higher level post-treatment in the NPWT group as compared to the ST group. Interestingly, miR-3690 has been previously predicted to target mRNA of T-cell surface glycoprotein CD3 gamma chain (CD3G), therefore, it may be hypothesized that it affects the expression of CD3 and modulate the immune response. Additionally, in the NPWT group we observed a downregulation of miR-9 as compared to the initial level. MiR-9 is expressed in human monocytes and neutrophils upon activation. Thus, it may regulate the synthesis of proinflammatory mediators.
Conclusions: We found initial evidence that short-term NPWT use in T2DM patients with DFU may affect miRNA expression in plasma and act through promoting immune system factors in the wound bed.

Disclosure
P. Kapusta: None. J. Hohendorff: Other Relationship; Self; Abbott, Ascensia Diabetes Care, Novo Nordisk A/S, Sanofi-Aventis. J. Zuranska: None. S. Borys: None. P. Konieczny: None. B.M. Kiec-Wilk: None. P.P. Wolkow: None. M. Malecki: Advisory Panel; Self; Abbott Laboratories, AstraZeneca, Bioton, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi-Aventis. Speaker's Bureau; Self; Merck & Co., Inc.

Funding
National Science Centre of Poland (2013/11/B/NZ5/03298)
638-P: Innovative Diagnostic Tool for Assessment of Plantar Skin Temperature to Spot Diabetes-Related Foot Complications
Authors: SHAHADE ARATI A. , SHAHADE ANUJ A. , SHAHADE AMBRISH M. , WAGH SAGAR P. , OZARKAR SHOUNAK 
Published: June 2019

Objective: Our aim was to measure plantar skin temperature using an innovative diagnostic device; thereby identifying early diabetes-related foot complications such as ulceration and Charcot foot.
Materials and Methods: The innovative portable device is a box with an inclination on upper side to place foot on a temperature sensitive mat connected to a microprocessor. Readings are recorded at 5 predefined areas, viz. ball of the great toe, 1st and 5th meta-tarsals, lateral arch and heel on both feet with patients in sitting position placing their feet on the mat for 30 seconds.105 patients; 83 diabetes [15 with diabetic neuropathy - symptoms or signs (DN) and 68 patients without DN] and 22 nondiabetes aged 24-80 years visiting Shahade Hospital OPD during last 6 months were included. Patients with skin diseases, edema, ulcer and known neurological illness were excluded.
Results: 78% of DN patients recorded higher temperature at the predefined areas. Diabetes patients with DN had 0.36°C higher plantar skin temperature (mean difference) compared to nondiabetes patients. Mean difference in temperature for DN patients on left foot was (0.20°C, 0.29°C, 0.52°C, 0.37°C, 0.53°C) and right (0.02°C, 0.44°C, 0.39°C, 0.29°C, 0.54°C), respectively. Diabetes patients without DN had 0.18°C higher temperature compared to nondiabetes patients. DN patients had diabetes of 9.67 ± 5.46 years with HbA1c of 9.8 ± 2.8%; duration of diabetes in patients without DN was 7.26 ± 5.64 years with HbA1c 7.23 ± 1.23%. The device also noted that 64.4% of diabetes patients without DN or any symptoms of DN were having higher temperature at predefined areas compared to nondiabetics, which warrants further monitoring.
Conclusions: The innovative device is precise for sensing plantar skin temperature change that could help clinicians in monitoring diabetes related foot complications. The device is handy, reliable, and gives instantaneous results that will aid self-monitoring by patients and care givers.

Disclosure
A.A. Shahade: None. A.A. Shahade: None. A.M. Shahade: None. S.P. Wagh: Employee; Self; Biocon. S. Ozarkar: None.
639-P: Pharmacological Mobilization and Recruitment of Bone Marrow Stem Cells Accelerates Diabetic Wound Healing in Rats with Diabetic Complications
Authors: QI LE , AHMADI ALI REZA , HUANG JINNY , LIN QING , CHEN MELISSA , KUWABARA HIROSHI , IWASAKI KENICHI , BURDICK JAMES , SUN ZHAOLI 
Published: June 2019

Introduction: The lifetime incidence of foot ulcers has been estimated to be 19% to 34% among persons with diabetes. Diabetic wound healing(DWH) remains a challenge. Given the promising role of stem cells in wound healing, the current study proposed to improve DWH by mobilizing and recruiting bone marrow stem cells pharmacologically with combination of AMD3100 and low-dose FK506 (AF) in rats.
Methods: T2 GK rats and STZ induced T1DM SD rats were used. To determine the role of bone marrow stem cells, bone marrow from GFP tg Lewis were transplanted into wt Lewis rats and T1 rats were induced by STZ injection at 2 months following bone marrow transplantation. Full-thickness wounds were created in the dorsal skin or in the foot skin at 6 weeks after STZ injection or GK rats at 4 month old. Wounded rats were divided into two experimental groups and received saline or a combination of AMD3100 (1mg/kg) and FK506 (0.1mg/kg) immediately after wounding and every 2 days until complete healing.
Results: At the time of wounding, all animals developed peripheral artery disease and neuropathy. The back wound healing time was reduced from 27 to 19 days and the foot wound healing time was reduced from 25 to 20 days in T1DM rats treated with AF. Similarly, the back wound healing time was reduced from 26(S) to 21(AF) days in GK rats. Equally important, healing was accompanied by reduced scar and regeneration of hair follicles. Searching for the mechanisms, we found that AF therapy mobilized bone marrow stem cells to peripheral blood and recruited bone marrow-derived CD31+CD133+ endothelial progenitor cells, CD34+ stem cells and Ym1/2+ M2 macrophages into the wound sites and enhanced capillary and hair follicle neogenesis.
Conclusion: Combination of AMD3100 and low-dose FK506 results in better and faster healing of diabetic wounds in rats with diabetic peripheral artery disease and neuropathy. Our findings offer a significant therapeutic approach to healing of DFU.

Disclosure
L. Qi: None. A.R. Ahmadi: None. J. Huang: None. Q. Lin: None. M. Chen: None. H. Kuwabara: None. K. Iwasaki: None. J. Burdick: None. Z. Sun: None.
644-P: QTc Prolongation as a Risk Factor for Increased Mortality in People with Diabetes and Charcot Osteoarthropathy
Authors: SCHOUG JOHAN , FAGHER KATARINA , LONDAHL MAGNUS 
Published: June 2019

Background: Charcot neuropathic osteoarthropathy (CN) is an uncommon but potentially serious complication of diabetes mellitus (DM). Aspects of morbidity and mortality in CN patients have not been fully described. The aim of this study was to evaluate the impact of QTc prolongation on long-term mortality in people with DM and CN.
Methods: All patients diagnosed with acute CN at a tertiary hospital based Diabetic Foot Unit between 2003 and 2017 were retrospectively studied. QTc prolongation was defined as ≥440 ms and confirmed with manual measurement. Patients with QTc-prolonging drugs and pacemakers were excluded. Data are given as median (IQR). Log Rank tests were used for survival analysis. A Cox regression model was performed for 10-year mortality, using age, DM duration, QTc interval, HbA1c and creatinine as continuous variables, and hypertension, ischemic heart disease, cerebrovascular disease, smoking history and proliferative retinopathy as categorical variables.
Results: In all, 81 patients (age 62 [52.5-68] years, 44% females, 38% type 1 DM, DCCT 7.5% [6.8-8.6%]) were included. QTc prolongation was associated with significantly higher mortality (Figure 1). In the Cox regression model, only age (HR 1.08, p&lt;0.05) and QTc interval (HR 1.03, p&lt;0.05) remained significant factors.
Conclusions: QTc prolongation seems to be associated with increased mortality in people with DM and CN.

Disclosure
J. Schoug: None. K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.