bluuebunny/crossref_metadata_2025_split huggingface dataset:
961-P: Glycemic Control and Glycemic Variability Before and After Hypoglycemia in Patients with T1D Treated with MDI or CSII
Authors: MELMER ANDREAS , ZÜGER THOMAS , PÖTTLER TINA , KOJZAR HARALD , CIGLER MONIKA , ABERER FELIX , LAIMER MARKUS , MADER JULIA K. 
Published: June 2019

Studies on CGM assume equal glycemic control between MDI and CSII. However, observation periods are often short and the impact of hypoglycemia on glycemic control and variability is unclear. In this study, we analyzed 12846 days (35 years; CSII 2232 days [6 years]; MDI 10614 days [29 years]) of CGM readings obtained from 99 patients with T1D. In the overall analysis mean glucose was 169.6 ± 18.9mg/dl for CSII and 175.0 ± 29.5 mg/dl for MDI. Estimated A1c was 7.54 ± 0.66% (CSII) and 7.7 ± 1.0% (MDI). Percentage of readings in target range (70-180mg/dL) was 54.0 ± 15.5% for CSII and 57.4 ± 11.4% for MDI. In total, 3.1/2.2% of readings were &lt; 54 mg/dL and 14.9/12.4% were &gt; 250mg/dL for CSII and MDI, respectively. In total, 464 hypoglycemic events (&lt; 54mg/dL) occurred in CSII (day: 305 [64%]; night: 170 [36%]), corresponding to 0.21 hypoglycemic events daily. In MDI, 2297 hypoglycemic events occurred (day: 1507/66%; night: 783/34%), corresponding to 0.22 hypoglycemic events daily. Mean duration of hypoglycemia was 146.5 ± 65.9 minutes (CSII) and 132.8 ± 42.8 minutes (MDI); 233 (CSII) vs. 982 (MDI) events were prolonged (&gt;120 minutes). CV was 41.1 ± 6.7% for CSII and 40.8 ± 3.8% for MDI. In the 24 hours prior to hypoglycemia, mean glucose was higher (182.9 ± 30.5 vs. 166.9 ± 26.6mg/dl; p&lt;0.001 for CSII and 167.2 ± 14.7 vs. 152.7 ± 19.1mg/dl; p=0.013 for MDI) and CV was lower (p&lt;0.001 for both treatments) compared to the subsequent 24 hours. Age correlated to CV (r=-.254; p=0.028 for MDI), HbA1c to eA1c (r=.611; p=0.009 for CSII; r=.482; p=0.028 for MDI), and C-peptide to CGM-readings in target range (r=.246; p=0.042 for MDI), which negatively correlated to HbA1c (r=-.484; p&lt;0.001 for MDI). Glycemic control was comparable between MDI and CSII in T1D. Glycemic variability was lower prior to a hypoglycemic event and in older patients, while remaining insulin secretion was associated with longer time in target range.

Disclosure
A. Melmer: None. T. Züger: None. T. Pöttler: None. H. Kojzar: None. M. Cigler: None. F. Aberer: None. M. Laimer: None. J.K. Mader: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Prediktor Medical, Roche Diabetes Care, Sanofi. Speaker's Bureau; Self; Abbott, AstraZeneca, Dexcom, Inc., Novo Nordisk Inc. Stock/Shareholder; Self; decide Clinical Software GmbH.
969-P: Use of Professional CGM in T2DM Patients with Low Socioeconomic Status
Authors: MEHROTRA NEHA , SISTLA DIVYA , KORYTKOWSKI MARY T. , MON SANN 
Published: June 2019

Background: Continuous glucose monitoring (CGM) is now considered as a standard of care for glycemic status assessment and therapy adjustment in all patients with T1DM and T2DM patients treated with intensive insulin therapy. CGM has been available to people with diabetes for more than a decade, however, it is used by only about 15% in T1DM and fewer in T2DM. There is even more disparity in the access of its availability in the community with low socio-economic status (SES). The purpose of this study was to examine potential benefits of CGM in patients with limited access to technology.
Method: CGM (Freestyle Libre Pro) was placed for 10-14 days in 36 patients, age (mean age 63.4 years +/- 15.4), 61.1% female, BMI (mean 34.2 +/- 8.33 kg/m2 with T2DM (83.4% on Insulin therapy). The patients were asked to keep food and activity logs during the testing period. CGM data was downloaded after the testing period and glucose results were retrospectively reviewed with patients. Individuals also received self-management education. Shared decision making was encouraged to improve knowledge of how their choices affected their diabetes control using CGM data.
Results: Thirty-three (91.7%) patients were able to use CGM for ≥72 hours and had a follow-up visit with the endocrinologist for interpretation of the data and discussion of medication adjustments as well as behaviors that may have led to BG excursions based on food and activity logs. A1C at baseline (8.23+/-1.88%) slightly improved to mean A1C (7.86+/-1.41%) at follow-up. (p value 0.28).
Conclusion: CGM may be a useful supplement to assess glycemic control, to make therapeutic adjustment and to provide educational feedback on patients’ behaviors among T2DM with low SES who have limited access to technology otherwise. Our study favors a slight improvement in overall glycemic control through patient education and recognition of glucose patterns informed by the professional CGM especially in those with low SES.

Disclosure
N. Mehrotra: None. D. Sistla: None. M.T. Korytkowski: None. S. Mon: None.
97-LB: Point-of-Care HbA1c Testing in Redesign of Diabetes Management Program Lowered Costs and Improved Outcomes
Authors: GALLO JOE P. , RICHARDSON MATT ,   DIABETIC EDUCATION AND CASE MANAGEMENT TEAM
Published: June 2019

Introduction: Empowering a low-income population of diabetic patients with onsite HbA1c testing results, coaching, and culturally appropriate diabetes self-management education materials improve outcomes and lower costs in a public health setting.
Objectives: This study examines the positive outcomes of a redesign in the Diabetes Education and Care Management (DECM) program at Denton County Public Health, (DCPH) a participant in Delivery System Reform Incentive Payment (DSRIP) plan.
Methods: Funding for ongoing management of diabetic patients across the U.S.A. remains an ongoing challenge. The DECM program elected to participate in the DSRIP program to secure funding to reach more diabetic patients with the goal of reducing their HbA1c and improve quality of life. Diabetic patients with an HbA1c of more than 9% met the DSRIP criteria for eligibility to DSRIP. Participants in the education program who followed the quarterly HbA1c appointment schedule were provided with diabetic medications and testing supplies to monitor glucose at no cost. Glycemic control was monitored by onsite testing of HbA1c during a quarterly visit at DCPH with the objective to lower the patients baseline HbA1c by 2.5%. Results presented reflect patient outcomes from Oct 2014 to Sept 2017.
Results: Approximately 251 of the 400 patients met the DSRIP criteria of HbA1c over 9% during the selected dates. The average baseline HbA1c was 10.7% in year 3, which was lowered to 8.2% by year end. Health economic models have shown that, for a population of 500 patients, the improvement of 1.0% in the HbA1c results can lead to multiple complications episodes avoidance (e.g.,: amputation, cataract extraction, etc.) which would result in over U$ 500,000.00 in savings for the healthcare system.
Conclusions: Our study suggests that empowering diabetic patients with education, state of art diabetes management, and onsite testing can lower overall HbA1c results leading to the reduction of complications and heath care costs.

Disclosure
J.P. Gallo: None. M. Richardson: None.
978-P: Ambulatory Glucose Monitoring and Pre-Ramadan Counseling in Patients with Type 2 Diabetes: Results from a Single Center Real-World Study
Authors: SHAIKH SALOMI SAJID , SHEHLA SAJID SHAIKH 
Published: June 2019

Background: Change in meal timing and content during Ramadan fasting predisposes patients with type 2 diabetes to adverse glycaemic changes like hypoglycemia. Ambulatory blood glucose monitoring (ABGM) may be a valuable tool for monitoring and prevention of complications.
Methods: A single center observational surveillance, conducted during Ramadan, May 2018. ABGM was recorded 7 days before Ramadan and during first 7 days of fasting using the FreeStyle® Libre™. All patients received Ramadan related education and appropriate adjustments to the dosage and timing of medication as per IDF-Ramadan guidelines. Average glucose level and glycaemic variability were compared before and during the fasting period.
Results: 59 patients gave consent to ABGM during Ramadan fasting. Their mean age was 51.4 years, duration of diabetes 6.5 years, BMI 28.2 kg/m2, systolic blood pressure 124.2 mm Hg and diastolic blood pressure 79.6 mm Hg. Antidiabetic medication included metformin (100%), sulfonylureas (72.9%), dipeptidyl peptidase inhibitors (83%) and alpha-glucosidase inhibitor (6.8%). Co-morbidities included hypertension (52%), dyslipidemia (44%), neuropathy (33.9%) and hypothyroidism (12%). Mean HbA1c was 7.7%. Average glucose levels noted 7 days before Ramadan was 143.4 mg/dL, which reduced to 126.7mg/dL (p &lt;0.0001) during Ramadan (first 7 days of fast). Mean glycaemic pattern demonstrated that time in target was 55.71% and 59.9% (p&gt;0.05), while the time below target (predicting the probable risk of hypoglycaemia) was 10.2% and 16.6% (p = 0.007) before and during Ramadan respectively.
Conclusion: Results from this real world study showed that ABGM could be a guiding tool to adapt the overall diabetes management especially during Ramadan, including patient counselling and education on modification of lifestyle and medications, which has a favorable impact on glycaemic control as well as variability (including probability of hypoglycaemia), during Ramadan.

Disclosure
S.S. Shaikh: None. S.S. Shaikh: None.
99-OR: Leptin Mediates Postprandial Thermogenesis through a Hypothalamic-Adrenomedullary-BAT Axis
Authors: PERRY RACHEL J. , RABIN-COURT AVIVA , DONG JIANYING , LYU KUN , LI XIRUO , SHULMAN GERALD I. 
Published: June 2019

The mechanism by which meal ingestion causes thermogenesis remains unknown. Here we show that refeeding leads to a 10x increase in plasma leptin concentrations associated with a 2.5x increase in plasma catecholamine concentrations in 48h-fasted lean rats. This leptin/catecholamine surge was associated with a 1°C increase in body temperature (BT) (fed 35.9±0.1°C, fasted 35.4±0.0°C, P&lt;0.001; refed 36.4±0.1°C, P&lt;0.001 vs. fasted and P&lt;0.05 vs. fed). Leptin infusion in fasted rats replicated these increases in epinephrine and BT. However, the effect of leptin to increase BT was abrogated in adrenalectomized (ADX) rats following refeeding and leptin infusion. Treatment with a β1-adrenergic antagonist (atenolol) or surgical removal of brown adipose tissue (BAT) also prevented leptin- and refeeding-induced thermogenesis. The effect of refeeding to increase leptin and cause thermogenesis depended on the meal composition: a dextrose meal increased leptin, epinephrine, and BT whereas an isocaloric fat meal did not (AUC P&lt;0.01, 0.05, and 0.01, respectively). Meal thermogenesis was not observed in obese rats, in which fasting plasma leptin failed to fall below the threshold (∼1.8 ng/mL) at which reductions in leptin lowered catecholamine concentrations. In order to examine the potential role for meal thermogenesis to regulate energy balance, we compared rats fed for 10 days with a carbohydrate-rich meal replacement by either two boluses daily or a continuous intragastric infusion. Bolus feeding increased BT and reduced BW gain (bolus feeding 0.1±0.3% weight loss vs. continuous feeding 1.7±0.3% weight gain, P&lt;0.001), an effect abrogated by atenolol.
Conclusion: Leptin induces postprandial thermogenesis through stimulation of the hypothalamic-adrenomedullary axis resulting in increased plasma catecholamines, which stimulate BAT through increased β1-adrenergic activity. These results provide a potential mechanism by which time-restricted feeding may improve metabolic health.

Disclosure
R.J. Perry: Research Support; Self; AstraZeneca. A. Rabin-Court: None. J. Dong: None. K. Lyu: None. X. Li: None. G.I. Shulman: Advisory Panel; Self; AstraZeneca, Janssen Research & Development, Merck & Co., Inc. Advisory Panel; Spouse/Partner; Merck & Co., Inc. Board Member; Self; Novo Nordisk A/S. Consultant; Self; Aegerion Pharmaceuticals, IMetabolic BioPharma Corporation, Longitude Capital, Nimbus Discovery, Inc., Staten Biotechnology B.V.

Funding
National Institutes of Health (R01DK113984, P30DK059635, T32DK101019, K99/R00CA215315, R01NS087568, UL1TR000142, T32DK007058, R01DK075632, R01DK089044, R01DK096010, R01DK111401)
997-P: Effect on DPP-4 Inhibitors on Fat Metabolism in Patients with Diabetes and Obesity
Authors: AMETOV ALEXANDER , GUSENBEKOVA DINARA 
Published: June 2019

Objective: To evaluate the influence of combined therapy of sitagliptin and metformin on fat metabolism in patients with type 2 diabetes mellitus.
Methods: The study included 82 patients (age, 55.3±9.1 years) with obesity and lipid metabolism disorders. None of the patients had reached their target glycated haemoglobin levels after metformin and diet therapy. Patients in gr1 (n=42) received 1.5-2-g metformin daily before the study and were switched to a formulation of 100-mg sitagliptin and 2-g metformin once a day. Patients in gr 2 (n=40) were on a diet therapy before inclusion and were started on 2-g metformin/day. The following were evaluated at baseline and after 6 months of therapy: fasting glucose levels, postprandial glucose levels, HbA1c, weight, waist circumference and lipid profile; insulin, proinsulin, leptin and adiponectin levels; HOMA IR and HOMA-β. In addition, magnetic resonance imaging was performed to assess the amount of visceral fat for the total cohort.
Results: After 6 months, HbA1c decreased by 18.52% (p &lt;0.001) in gr 1 and by 8.17% (p &lt;0.001) in gr 2. FPGl and PPG levels in gr 1 were reduced by 21% (p &lt;0.001) and 26.35% (p &lt;0.001), respectively; the corresponding reductions in gr 2 were 1.45% (p &gt;0.05) and 5.31% (p &lt;0.05), respectively. HOMA-β increased by 33% in gr1 (p &lt;0.001) and by 11% in gr 2 (p &gt;0.05). Adiponectin levels increased by 27.06% (p &lt;0.001) in gr 1 and by 7.16% in gr 2 (p &lt;0.001). Leptin levels were reduced by 30.47% (p &lt;0.001) in gr 1 and by 5.41% in gr 2 (p &lt;0.001). MRI showed a 7.52% reduction in visceral fat for gr 1 (p &lt;0.001) and a 1.76% reduction for gr2 (p &lt;0.01). The comparison of subcutaneous fat dynamics did not show statistically significant differences between the groups.
Conclusion: Compared with metformin monotherapy, sitagliptin and metformin combination therapy had a prominent effect on nonglycaemic parameters, with more marked decreases in visceral fat and leptin and increases in adiponectin levels.

Disclosure
A. Ametov: None. D. Gusenbekova: None.
Fatty Liver Among Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study)
Authors: Knorr Sine , Bytoft Birgitte , Lohse Zuzana , Boisen Anne B. , Clausen Tine D. , Jensen Rikke B. , Damm Peter , Beck-Nielsen Henning , Holst Jens J. , Hartmann Bolette , Møller Holger J. , Højlund Kurt , Gravholt Claus H. , Jensen Dorte M. 
Published: June 2019

OBJECTIVE
Intrauterine exposure to maternal type 1 diabetes is associated with a less favorable metabolic profile later in life. Nonalcoholic fatty liver disease is the hepatic manifestation of a cluster of metabolic abnormalities linked to insulin resistance. This study aimed to evaluate the effect of maternal pregestational type 1 diabetes on the presence of fatty liver in offspring and the association between maternal BMI, glycemic control during pregnancy, offspring metabolic risk factors, and offspring level of soluble CD163 (sCD163) (a marker of macrophage activation) and risk of fatty liver.

RESEARCH DESIGN AND METHODS
This study was a prospective nationwide follow-up study of offspring (n = 278) of mothers with pregestational type 1 diabetes between 1993 and 1999 and matched control subjects (n = 303). Mean age at the time of follow-up was 16.7 years (range 13.0–20.4 years). We used the fatty liver index (FLI) and waist-to-height ratio (WHtR) to evaluate the presence of fatty liver among the offspring. An FLI ≥60 or WHtR &gt;0.469 were used as cutoff points for fatty liver.

RESULTS
More type 1 diabetes–exposed offspring had high FLI and WHtR indices compared with unexposed control subjects. We found significant associations between increasing maternal prepregnancy BMI, being born large for gestational age, offspring level of sCD163, as well as offspring metabolic risk factors (decreasing adiponectin and HDL cholesterol and increasing leptin, HOMA of insulin resistance, and HOMA of insulin secretion) and degree of fatty liver.

CONCLUSIONS
Intrauterine exposure to maternal type 1 diabetes and higher maternal prepregnancy BMI may predispose to fatty liver in the offspring. Offspring metabolic risk factors, including sCD163 levels, are associated with indices of fatty liver.
Empathy and Burnout – A Cross-Sectional Study Among Mental Healthcare Providers in France
Authors: Sturzu Livia ,   Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, “Centre Psychothérapique de Nancy”, Laxou, France,   Centre Hospitalier Spécialisé de Sarreguemines, Sarreguemines, France,   Dr. Livia Sturzu, Centre Hospitalier Spécialisé, 2ème Service de Psychiatrie Adulte, 1 Rue Calmette, 57200 Sarreguemines, France. E-mail: livia.sturzu@chs-sarreguemines.fr, Lala Adrian ,   Centre Hospitalier de Sarreguemines, Hôpital “Robert Pax”, Service des Urgences, Sarreguemines, France, Bisch Michael ,   “Centre Psychothérapique de Nancy”, Laxou, France, Guitter Marie ,   Centre Hospitalier Spécialisé de Sarreguemines, Sarreguemines, France, Dobre Daniela ,   “Centre Psychothérapique de Nancy”, Laxou, France, Schwan Raymund ,   Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, “Centre Psychothérapique de Nancy”, Laxou, France,   “Centre Psychothérapique de Nancy”, Laxou, France,   INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France,   Maison des Addictions, CHRU Nancy, France,   University Lorraine, Faculty of Medicine, Department of Psychiatry, Vandoeuvre-Les-Nancy, France
Published: June 2019

Previous studies have established a correlation between empathy and burnout among healthcare providers. The aim of this study is to explore whether empathy – the ability to understand what another person is experiencing, was related to mental healthcare staffs’ burnout.
We performed a descriptive, cross-sectional, observational study among medical and nursing mental healthcare staff working in the district of Moselle, France. Participants completed a survey including The French versions of the Jefferson Scale of Empathy (JSPE) and The Maslach Burnout Inventory-Human Services Survey (MBI-HSS).
The sample included 241 (n=241) participants (N=420, response rate=51.7%). 187 (77.6%) respondents had low burnout, 43 (17.8%) had intermediate burnout and 11 (4.6%) had high burnout. 41 (17%) had low empathy, 156 (64.7) had moderate empathy and 44 (18.3%) scored high.
Empathy scores were positively correlated with scores of personal accomplishment of the MBI-HSS (r=0.2; p<0.001), but negatively correlated with scores of depersonalization (r=-0.2; p<0.003). Highest means of depersonalization (DP) (M=8.7; SD=6.8; p<0.009) and lowest means of compassionate care (M=40.05; SD=7.9; p=0.0001) were found among forensic psychiatric security units staff.
Participation in the Omega educational program was associated with lower scores of EE on the MBI-HSS survey (mean score 14.7 versus a mean score of 19.7 for nonparticipants).
Empathic mental healthcare providers have lower levels of burnout. Forensic psychiatric staff showed low means of compassionate care and high depersonalization.
Interventions designed to foster attributes and skills such as empathy, resilience, and perception of security may be an essential step in reducing and preventing burnout.
Is syncope a predictor of mortality in acute pulmonary embolism?
Authors: Ploesteanu Rodica Lucia ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania,   Rodica Lucia Ploesteanu Department of Cardiology, “Sf. Pantelimon” Clinical Emergency Hospital, Bucharest, 340-342 Pantelimon Road, Code 21659, Bucharest, Romania, Tel.: 40740280282, E-mail: ploesteanu_rodica@yahoo.com,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania, Nechita Alexandru Cristian ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania, Andrucovici Silvia ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania, Delcea Caterina , Mihu Elena Mihaela ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania, Gae Diana ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania, Stamate Sorin Costel ,   Sf. Pantelimon Emergency Hospital, Bucharest, Romania,   Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
Published: June 2019

Whether syncope as a presenting symptom independently classifies acute pulmonary embolism (APE) into a high mortality risk group remains a matter of controversy.
We retrospectively included all consecutive patients admitted to our clinic with APE from January 2014 to December 2016.
Our sample consisted of 76 patients with a mean age of 69 ±13.6 years, 64.5% female. 14.3% presented with syncope at admission. In-hospital mortality was 20.8%. Patients with syncope were more likely to require inotropic support (OR = 5.2, 95 % 1.17-23.70, p=0.03) due to the association of cardiogenic shock (OR= 15.95% CI 3.02-74.32, p < 0.001) and systolic blood pressure below 90 mmHg (OR=5.52, 95% CI 1.24-24.47, p=0.03). Patients with syncope had a higher PESI score (150.9 ± 51.1 vs 99.9 ± 30.1, p < 0.001) and a greater in-hospital mortality (OR= 4.5, 95% CI 1.14-17.62, p=0.03). However, multivariate logistic regression equations did not identify syncope as an independent predictor of mortality.
In our sample, syncope did not independently reclassify the patient in a higher mortality group, but due to the association with hemodynamic instability, which remains the primary tool in therapeutic decision-making.
A Adoração dos magos na Biblia Pauperum
Authors: Rosa Cintia Maria Falkenbach 
Published: June 2019

Nos séculos XIV e XV circulavam livremente duas Bíblias na Europa: a Vulgata, uma bíblia em Latim e a Bíblia Pauperum, uma edição ilustrada, com pouco texto, destinada aos que não sabiam ler; um dos primeiros incunábulos ilustrados impressos na Europa, de autoria anônima e data de aparecimento estimada por volta de 1460. Este livro foi impresso artesanalmente na técnica da Xilogravura. Grande divulgador da Doutrina Cristã na Idade Média, cópias permaneceram conservadas até a atualidade. Nosso objeto de estudo é a página da Epifania que se encontra nessa Bíblia.
Estratégias de circulação da pesquisa na universidade
Authors: Melim Regina 
Published: June 2019

Como circular as pesquisas realizadas na universidade? Que estratégias podemos criar para que textos, traduções e produções de diferentes ordens possam ser compartilhados em contextos acadêmicos e extra-acadêmicos? Para abordar tais questões, apresento dois projetos: ¿Hay en Portugués? e AULA, ambos integrados como projetos de pesquisa, cujo desdobramentos acontecem nas disciplinas que ministro na Pós-Graduação em Artes Visuais da Universidade do Estado de Santa Catarina.
Diminutas como figuras da experiência
Authors: Franca-Huche Patrícia 
Published: June 2019

Diminutas [2016] é o nome dado às séries de Marcadores de livro as quais mostram imagens retiradas de pinturas, desenhos, documentos e fotografias do Museu holandês Rijksmuseum [Amsterdãm]. São detalhes e fragmentos de obras que remetem ao contexto da floresta, do jardim e da infância — podendo-se pensar em frestas visuais. O título, Diminutas, designa o mínimo, o pequeno, o exíguo, algo que aponta para um lugar quase imperceptível.