bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dietary Energy Density (DED) Is Significantly Associated with Obesity in Japanese Patients with Type 2 Diabetes Mellitus (T2DM)
Authors: TAKEDA YASUNAGA , FUJIHARA KAZUYA , MORIKAWA SAKIKO Y. , HORIKAWA CHIKA , HATTA MARIKO , ISHII DAI , HIRASAWA REIKO , YACHI YOKO , SONE HIROHITO 
Published: June 2018

DED, defined as the ratio of energy intake (EI) to food weight, is receiving increased attention reflecting recent reports of its associations with elevated risks for obesity and T2DM in general populations. However, only a few studies have investigated the associations between DED and metabolic variables in patients with established diabetes, which led us to analyze the association between DED and obesity in Japanese patients with T2DM. Cross-sectionally investigated were 1,576 outpatients with T2DM (men 60.8%) who attended 26 clinics having diabetes specialists. Dietary habits were obtained by the Food Frequency Questionnaire based on food groups (FFQg). DED (kcal/g) was calculated by dividing EI (kcal) from foods (excluding beverages) by these food weights (g) and was categorized into tertiles (low (L), &lt;1.36; medium (M), 1.36-1.53; high (H), ≥1.54). We compared nutritional intake between groups by ANCOVA. Multivariate logistic regression model was used to estimate adjusted odds ratios for obesity (BMI≥25) in each tertile and per 1 kcal/g of DED, together with tests of combined tertiles of DED and EI. Both EI (kcal) (L, 1692; M, 1787; H, 1862, p for trend&lt; 0.001) and the fat-energy ratio (%) (L, 28.5; M, 29.5; H, 30.7, p for trend&lt; 0.001) were positively associated according to tertiles of DED. Adjusted odds ratios for obesity were also significantly increased according to tertiles of DED (L, ref; M, 1.33(95% CI:1.01-1.75); H, 1.76(1.32-2.36), p for trend&lt; 0.001) and 4.29(2.38-7.73) per 1 kcal/g of DED. Possibility of obesity was significantly higher for patients in the top tertile of DED regardless of EI but was not significant for those in the bottom tertile regardless of EI.
In conclusion, higher DED, which is related to higher fat intake, was strongly associated with a greater chance of having obesity in T2DM patients regardless of EI. Therefore, DED is critical in assessing diet quality and has clinical relevance in obesity management of patients with T2DM.

Disclosure
Y. Takeda: None. K. Fujihara: None. S.Y. Morikawa: None. C. Horikawa: None. M. Hatta: None. D. Ishii: None. R. Hirasawa: None. Y. Yachi: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..
Changes of the Bone Metabolism Markers and Body Composition in Nonalcoholic Fatty Liver Disease by the SGLT2 inhibitor
Authors: WATANABE CHIZURU , AKUTA NORIO , SUZUKI YOSHIYUKI , KOBAYASHI MASAHIRO , MORI YASUMICHI , KUMADA HIROMITSU 
Published: June 2018

We reported that histological improvement was confirmed after 24 weeks of Canagliflozin (CANA) therapy in nonalcoholic fatty liver disease (NAFLD). While increase of the fracture according to the CANVAS Program was reported. In type 2 diabetes patients with NAFLD (T2ND) who showed histological improvement by using CANA (100 mg/ day), we investigated the bone metabolism markers and the body composition (measured using an INBODY770) after at least 1 year of same treatment. The changes of the parameters (Liver enzymes, serum bone specific alkaline phosphatase (BAP: nMBCE/mMCr) and urinary N-telopeptide of collagen type-I (uNTx: U/L)) were investigated before starting treatment (Pre), after 24 weeks (24W), and at the end of follow-up (Post). Six patients (4 men and 2 women, aged 55.3±7.2 years, HbA1c8.4±2.0%, BMI: 28.6±2.2 and the duration 8.0±7.7 years) were able to evaluate bone metabolism, and the follow-up period was 1.3±0.2 years. HbA1c, Liver enzymes and Ferritin levels showed further improvement after more than 24 weeks. The Post-Pre difference of bone minerals (BMi) showed a significant positive correlation with the change of skeletal muscle mass and a significant negative correlation with HbA1c at 24W. In 2 cases that the rate of skeletal muscle mass loss for total body weight loss at 24W was ≥ 30%, the Post BMi decreased more than 5%. There was no correlation with the improvement of the NAFLD activity score by the liver biopsy. BAP levels didn’t change during CANA treatment, while uNTx levels increased in all patients at 24W, but almost returned to Pre levels at Post. (uNTx: Pre 31.3(8.2)/ 24W 425.9(344.5)/ Post 38.1(3.9)). The uNTx levels showed a pronounced increase from Pre (24.0) to 24W (2143.3) in 1 patient with a history of fracture. During long-term CANA therapy, there was ongoing improvement of the liver inflammation markers in T2ND, while these findings suggest that early changes of bone resorption by CANA therapy predict the subsequent state of bone metabolism.

Disclosure
C. Watanabe: None. N. Akuta: None. Y. Suzuki: None. M. Kobayashi: None. Y. Mori: None. H. Kumada: None.
Baseline Vitamin D as a Surrogate Marker for Type 2 Diabetes Remission and Weight Loss following Sleeve Gastrectomy
Authors: ALADEL ALANOUD , PIYA MILAN K. , AZHARIAN SAHAR , CHRISTIAN MARK , MENON VINOD , MCTERNAN PHILIP G. 
Published: June 2018

Background: Vitamin D deficiency is associated with obesity and type 2 diabetes mellitus (T2DM), although the use of circulating Vitamin D levels as a predictor of weight loss induced T2DM remission is unclear. Therefore, the aim of this study was to analyze whether pre-bariatric surgery vitamin D levels may predict T2DM outcomes 12 months post-SG.
Method: A cohort of 220 obese participants (74.5% female) with T2DM (Age: 50±9.5yr, BMI: 51.4±7Kg/m2; n=103) and without T2DM (Age: 46±9yr, BMI: 53.5±6.5Kg/m2; n=117) undergoing SG participated in an ethics approved study in a single bariatric centre in the UK. Patient anthropometric and biochemical data including vitamin D were collected at baseline and 12 months post-SG; no vitamin D supplementation at baseline was given.
Results: Baseline vitamin D levels inversely correlated with baseline BMI (P&lt;0.001, r=-0.35). Age, pre-op weight loss and vitamin D levels were correlated with HbA1c 12 months post-SG (P&lt;0.001, r=0.28, P&lt;0.001, r=-0.25 and P&lt;0.05, r=-0.19). Furthermore, baseline vitamin D levels predicted levels of HbA1c post-surgery following adjustment for pre-op weight loss and age. Within the T2DM group, those that achieved T2DM remission 12 months post-SG (49.5%; n=51) had a higher baseline vitamin D compared to those not in remission (43.5±23.8 vs. 33±19nmol/L; P&lt;0.05), with no significant differences between the two groups in baseline BMI, hypertension, pre-op weight loss or excess weight loss (EWL). Interestingly, patients with higher pre-surgical Vitamin D levels also had significantly lower BMI (P&lt;0.005) and higher % EWL (P&lt;0.05) 12 months post-surgery.
Conclusion: Baseline Vitamin D levels appear to be an independent indicator for successful T2DM remission and weight loss, 12 months following SG. The use of baseline Vitamin D levels may help us predict those more likely to do well and prioritize post-surgery support to achieve success for all participant groups.

Disclosure
A. Aladel: None. M.K. Piya: None. S. Azharian: None. M. Christian: None. V. Menon: None. P.G. McTernan: None.
Ascorbic Acid Supplementation Improves Postprandial Glucose and Blood Pressure in People with Type 2 Diabetes
Authors: MASON SHAUN , RASMUSSEN BODIL , WADLEY GLENN D. 
Published: June 2018

The aim of the study was to investigate whether ascorbic acid (AA) supplementation improves postprandial glucose responses under free living conditions in people with type 2 diabetes (T2D). Thirty-one people with T2D (26 male, 5 female; aged 61.8 ± 6.8y; duration of diabetes 5.6 ± 4.6y [mean ± SD]) and stable glucose control (HbA1c 7.6 ± 0.7%) and blood pressure (SBP 139 ± 10; DBP 85 ± 9 mmHg) completed a randomized cross-over study involving 4 months of oral AA (2 x 500 mg/day) supplementation and 4 months of placebo supplementation (# ACTRN12616000276459). A minimum wash-out of 4 weeks separated treatments. Participants were affixed with continuous glucose monitors for 48h and consumed standardized meals pre and post supplementation. Intention to treat analyses were used to analyse data. Postprandial glucose area under the curve for 3.5h post meals (10.5h total) and the percent of day spent in hyperglycaemia (&gt;10 mmol/l) were significantly lower by 31% and 11% (∼2.5h) after AA supplementation when compared to placebo, respectively (p&lt;0.05). Significantly lower systolic (-6 mmHg) and diastolic (-4 mmHg) blood pressures were also found after AA supplementation compared to placebo. There were no effects of AA supplementation on percent of day spent in hypoglycaemia (&lt;4 mmol/l), average 24h glucose or HbA1c. Treatments were well tolerated by participants, with no adverse effects reported. Capsule compliance was high for both treatments (AA: 93 ± 11%; placebo: 95 ± 7%).
In summary, AA supplementation attenuated the daily post-prandial glucose response and the proportion of day spent in hyperglycaemia in people with T2D. AA also improved blood pressure in this group. This evidence collected under free-living conditions strengthens the argument for AA as a beneficial adjunct therapy to improve glycaemic control and cardio-metabolic health for people with T2D.

Disclosure
S. Mason: None. B. Rasmussen: None. G.D. Wadley: None.
Social Support or Diabetes Distress—What Relates More Closely to Diabetes Self-Management in Hispanics?
Authors: CLARK TAYLOR , EUYOQUE JOHANNA A. , PHILIS-TSIMIKAS ATHENA , GALLO LINDA , FORTMANN ADDIE L. 
Published: June 2018

Adherence to recommended self-management behaviors is particularly poor among Hispanics with type 2 diabetes (T2D), which increases risk for developing serious complications. In addition to minority status, research has also shown diabetes distress to predict poorer diabetes self-management. In contrast, social-environmental support for disease management has emerged as a potential protective factor, given associations of greater support with better diabetes self-care. This study aimed to compare the relative associations of support [Chronic Illness Resource Survey] and diabetes distress [Diabetes Distress Scale] with diabetes self-management [Summary of Diabetes Self-Care Activities]. A cross-sectional baseline analysis of N=126 Hispanic adults with poorly controlled T2D (HbA1c ≥ 7.5%) at federally-qualified health centers in Southern California was performed. When examined separately, lower diabetes distress (rs = -.26 and -.18) and higher support (rs = .49 and .22) were both significantly associated with better diet and exercise, respectively (ps &lt; .05). However, when entered in joint linear regression models, only support remained a statistically significant predictor of diet (β = 0.46) and exercise (β = 0.18), ps &lt; .05. The associations of diabetes distress with self-management behaviors decreased in magnitude by 30-58% after control for support, and were no longer statistically significant. While diabetes distress certainly impacts self-management behaviors, these findings indicate that support may be a relatively stronger correlate in this population - perhaps due to the emphasis the Hispanic culture places on interpersonal relationships. Findings point to social-environmental support for disease management (not just distress) as an important target for diabetes self-management interventions. However, further longitudinal research is needed to fully disentangle the associations among distress, support, and self-management behaviors.

Disclosure
T. Clark: None. J.A. Euyoque: None. A. Philis-Tsimikas: Research Support; Self; Dexcom, Inc.. Advisory Panel; Self; Dexcom, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; Novo Nordisk A/S, Sanofi, Mylan. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc.. Stock/Shareholder; Spouse/Partner; Esperion Therapeutics, Ionis Pharmaceuticals, Inc.. Advisory Panel; Self; AstraZeneca. L. Gallo: None. A.L. Fortmann: None.
Establishing a Clinical Cut-Point for the PAID-Peds (Problem Areas in Diabetes-Pediatric) Survey
Authors: COMMISSARIAT PERSIS V. , TINSLEY LIANE J. , VOLKENING LISA , BUTLER DEBORAH A. , ANDERSON BARBARA , LAFFEL LORI M. 
Published: June 2018

Limited access to pediatric diabetes mental health care suggests a need to readily identify youth requiring referral. The current study aimed to establish a clinically meaningful cut-point on the PAID-Peds, a previously validated measure of diabetes distress in youth with type 1 diabetes (T1D).
The 20-item PAID-Peds has shown construct validity with measures of depressive symptoms, diabetes-specific family conflict (DSFC), and general quality of life (QoL). Higher scores (range 0-100) indicate more distress. ROC analyses in youth 8-17 years old compared PAID-Peds scores against established clinical cutoffs for depressive symptoms on the Center for Epidemiological Studies - Depression Scale (CES-D) and Depression Scale for Children (CES-DC) to identify a meaningful clinical cutoff for the PAID-Peds. Confirmation of the cutoff score included assessment of convergent validity with glycemic control and teen-reported measures of treatment adherence, diabetes specific family conflict, and QoL.
The sample included 427 youth ((M±SD) age 14.3±2.1 years, T1D duration 6.4±3.7 years, and A1c 8.4±1.1%); 49% were male, 83% white, 83% from 2-parent families, and 69% pump-treated. ROC analyses identified a cut-point of 41, with sensitivity of 79%, specificity of 69%, and negative predictive value (NPV) of 94%. Youth with PAID-Peds scores ≥41 (n=168) vs. &lt;41 were more likely to be female (59 vs. 45%), perform less frequent BG monitoring (4.8 vs. 5.5x/day), and have higher A1c (8.6 vs. 8.2%) (p &lt;.01 for all). Youth endorsing more distress (≥41 vs. &lt;41) also reported lower adherence and QoL, and more DSFC (p &lt;.001 for all).
The cutoff score of 41 on the PAID-Peds has acceptable sensitivity, specificity, and NPV, and warrants future assessment in clinical research and practice. Establishing a cut-point for clinically meaningful diabetes distress may help clinicians to identify youth at risk for poorer biomedical and psychosocial outcomes, thereby prompting timelier referral for mental health support.

Disclosure
P.V. Commissariat: None. L.J. Tinsley: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..
Diabetes Distress and All-Cause Mortality in Patients with Type 2 Diabetes—A Prospective Cohort Study
Authors: HAYASHINO YASUAKI , OKAMURA SHINTARO , TSUJII SATORU , ISHII HITOSHI 
Published: June 2018

We studied a cohort of 3,3Japanese patients with type 2 diabetes to determine the prospective association between diabetes distress measured by problem areas in diabetes (PAID) survey at baseline and subsequent risk of all-cause mortality. Longitudinal data were obtained from this cohort who completed the PAID survey at baseline. We excluded patients with a past history of any cancer. We categorized PAID total score into quintiles and assessed the independent correlation with all-cause mortality using the Cox proportional hazards model adjusted for potential confounders [age, gender, BMI, HbA1c, diabetes therapy, urine albumin/creatinine ratio, retinopathy, diabetic neuropathy, and past medical history]. Mean patient age, BMI, and HbA1c level were 64.9 years, 24.6 kg/m2, and 7.5% (57.6 mmol/mol), respectively. Median total PAID score was 29 overall, and 21, 25, 30, 39, and 55 for the1st to 5th quintiles, respectively. We observed 251 of any death cases during median follow-up of 6.1 years. Compared with the 1st quintile of PAID score, the multi-variable adjusted hazard ratios of all-cause mortality were 1.11 (95% CI, 0.78-1.60; p = 0.56), 0.87 (95% CI, 0.56-1.35; p = 0.524), 0.95 (95% CI, 0.62-1.44; p = 0.802), and 1.60 (95% CI, 1.09-2.35; p = 0.016).
In conclusion, diabetes distress measured by the PAID survey was associated with a subsequent risk of all-cause mortality in patients with type 2 diabetes.

Disclosure
Y. Hayashino: None. S. Okamura: None. S. Tsujii: None. H. Ishii: None.
Behavior Change of Participants in Group vs. Individual DPP Weight Loss Interventions—The SHINE Study
Authors: TRIEF PAULA M. , DELAHANTY LINDA M. , CIBULA DONALD A. , WEINSTOCK RUTH S. 
Published: June 2018

Objective: To compare change in physical activity (PA) and dietary fat intake (DFI) in the SHINE (Support, Health Information, Nutrition and Exercise) Study. SHINE was a randomized, controlled weight loss trial (n=257) of 2 telephone (to increase reach) translations of the Diabetes Prevention Program (DPP) lifestyle change intervention, delivered at 5 diverse healthcare sites.
Methods: Participants (metabolic syndrome, no diabetes) were randomized to the DPP lifestyle change program, participating individually (solo; n=129) or in a group conference call (group; n=128). The 16-session DPP curriculum was delivered in year-1 by trained primary care staff and coaches, with continued contact in year-2. Participants: mean age= 51.8 years, 74.3% female, 85.6% white, 44.1% employed, 36.9% annual income &lt;$30K, mean BMI= 39.3 kg/m2, mean PA = 2428.0 mets/week, mean DFI = 33.5% of total calories. We previously reported that both group and solo arms lost significant weight, but solo participants regained. Here we look at change in PA (International Physical Activity Quest.) and DFI (NCI Fat Screener). Mixed linear models compared mean change from baseline in PA and DFI, within and between arms, at 6, 12 and 24 mos. for this longitudinal dataset.
Results: Compared to baseline, the group arm increased PA at 6, 12 and 24 mos. (71.0, 139.5, 255.0 mets/week), the solo arm only improved at 24 mos. (102.0 mets/week). Compared to baseline, the group arm showed decreased DFI at 6, 12 and 24 mos. (1.4%, 1.4%, 1.4%); the solo arm improved at 6 and 12 mos. (2.6%, 2.9%) but not at 24 mos. There were no differences between arms in means for PA or DFI.
Conclusions: Primary care staff can be trained to deliver a telephonic DPP translation that is effective to achieve significant PA and DFI behavior change. Despite anecdotal concerns that group contact may be less tailored to individuals and thus less effective, we found that group may be more effective than solo contact in achieving activity and diet changes associated with weight loss.

Disclosure
P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. L.M. Delahanty: Consultant; Self; Janssen Pharmaceuticals, Inc., Akcea Therapeutics, Nutrisystem, Inc.. Advisory Panel; Self; Jana Care Inc., Omada Health, Inc.. D.A. Cibula: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases.
Psychosocial Benefits of Structured Support for Self-Care in Teens with Type 1 Diabetes (T1D)—Results of an RCT
Authors: COMMISSARIAT PERSIS V. , VOLKENING LISA , BUTLER DEBORAH A. , ANDERSON BARBARA , LAFFEL LORI M. 
Published: June 2018

There are salient outcomes beyond A1c, including patient-reported outcomes, in the current era of diabetes interventions. The current study assessed psychosocial effects over 1 year in the Teenwork Study, an RCT utilizing text-messaging (TM) and problem solving (PS) interventions in a 2x2 factorial design, in teens with T1D.
Teens ages 13-17 from 2 U.S. clinical sites were randomized to 4 groups: PS, TM, PS+TM, or usual care. The PS and PS+TM groups had quarterly intervention sessions with study staff targeting barriers and strategies to improve self-care related to BG monitoring and insulin administration. The TM and PS+TM groups received reminders to check BG levels at self-selected times from 1-4 times/day. All teens completed measures of affect around BG monitoring, depressive symptoms, self-efficacy, parent involvement in diabetes care, diabetes-specific family conflict, diabetes distress, and general quality of life at baseline and 1 year. Changes in survey scores from 0 to 12 months were analyzed by group assignment, controlling for baseline scores.
The sample included 281 teens ([M±SD] age 15.0±1.3 years, T1D duration 6.6±3.8 years, 4.6±1.9 BG checks/day, A1c 8.5±1.1%). Teens were 51% male, 78% white, and 80% from 2-parent families; 64% used pump therapy. At entry, groups had similar demographic and diabetes characteristics. After 1 year, all 4 groups had a significant increase in independent care behaviors (less parent involvement) (p&lt;.001). Teens in the PS+TM group had decreases in diabetes family conflict (p=.009) and diabetes distress (p=.01). There were no changes in other psychosocial measures.
Increased independent self-care across groups was likely developmentally driven. Combined PS+TM reduced teen-reported diabetes family conflict and diabetes distress. Providing problem-solving skills at quarterly visits with text reminders between visits together may serve to encourage and empower teens with T1D, thus improving their psychosocial outcomes.

Disclosure
P.V. Commissariat: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..