bluuebunny/crossref_metadata_2025_split huggingface dataset:
527-P: Renal Hemodynamic and RAAS Profiles in Patients with Type 2 Diabetes (T2D) and Heart Failure (HF)
Authors: LYTVYN YULIYA , BURNS KEVIN D. , LYTVYN ANDRIY , AMBINATHAN JAYA P. , OSUNTOKUN OLUWATOSIN , GODOY LUCAS C. , CHERNEY DAVID , PARKER JOHN D. 
Published: June 2019

HF is associated with decreased renal blood flow and RAAS activation, which may be aggravated in the presence of T2D. The renal arterial-venous gradient for RAAS markers has not been previously reported in HF patients. Our aim was to characterize renal hemodynamic function and renal arterial-venous gradient for RAAS markers in patients with: (1) HF with T2D, (2) HF without T2D, and (3) controls without HF or T2D.
In this post hoc analysis, GFRinulin, ERPFPAH, plasma angiotensin converting enzyme (ACE), ACE2, aldosterone, angiotensinogen, plasma renin activity (PRA) and ACE activity were measured in renal artery and vein samples from 20 HF with T2D, 28 HF without T2D and 24 controls. RAAS inhibitors were used in 90% of HF and 63% of controls.
GFR and ERPF were higher in controls vs. HF with and without T2D (p&lt;0.05). There was a larger renal arterial-venous gradient for PRA and ACE levels in HF patients, regardless of T2D status, compared to controls (p&lt;0.01). There were no arterial-venous differences in HF with T2D vs. HF without T2D (Figure 1).
HF patients exhibited lower renal perfusion vs. non-HF patients regardless of T2D status. A larger renal arterial-venous gradient for the RAAS markers suggests a renal origin for neurohormonal activation in HF patients. T2D status did not impact renal hemodynamics or RAAS markers in patients with HF, highlighting the need to broadly target neurohormonal abnormalities in these patients.

Disclosure
Y. Lytvyn: None. K.D. Burns: None. A. Lytvyn: None. J.P. Ambinathan: None. O. Osuntokun: None. L.C. Godoy: None. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Prometic Life Sciences Inc., Sanofi. J.D. Parker: Research Support; Self; Ironwood Pharmaceuticals, Inc., Luitpold Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Theracos, Inc. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Servier, Theracos, Inc.
531-P: Weight Change and the Incidences of End-Stage Renal Disease and Proliferative Diabetic Retinopathy in Patients with Newly Diagnosed Diabetes Mellitus: A Nationwide Cohort Study
Authors: KWON HYUK-SANG , SONG KI-HO 
Published: June 2019

Aims/Hypothesis: This study aimed to investigate the impact of weight changes on the clinical outcomes of diabetic nephropathy and retinopathy among patients with newly diagnosed diabetes.
Methods: Using nationally representative data from the Korean National Health Insurance System, 181,872 patients newly diagnosed with diabetes who were free of end-stage renal disease (ESRD) and proliferative diabetic retinopathy (PDR) during 2007-2012 were followed to the end of 2016. Weight change was defined as the difference in body weight from the time of diabetes diagnosis to 2 years later.
Results: There were 180 cases of ESRD (0.10%) and 780 cases of PDR (0.43%) followed-up for a median of 5.5 years from the index year at 2 years after diagnosis. Those with moderate weight gain (+5% to +10%) showed a significantly higher hazard ratio (HR) for ESRD, compared with those with modest weight changes (−5% to +5%) after adjusting for several confounding factors, including the baseline estimated glomerular filtration rate (HR, 1.732; 95% CI 1.125-2.667). Those with severe weight loss (−5% to −10%) showed the lowest HR for PDR (HR, 0.591; 95% CI 0.372-0.938), whereas those with severe weight gain (&gt; +10%) showed the highest HR for PDR (HR, 1.732; 95% CI 1.125-2.667).
Conclusion: This study provides direct evidence that a change in body weight affects the risk of diabetic microvascular complications. Strategies to control body weight may reduce the risk of ESRD and PDR in patients with newly diagnosed diabetes.

Disclosure
H. Kwon: None. K. Song: None.
556-P: Noninvasive Measurements of AGE Products in the Crystalline Lens of the Eye Can Distinguish Subjects with Prediabetes and Type 2 Diabetes and Correlated with Severity of Neuropathy
Authors: TAVAKOLI MITRA 
Published: June 2019

The accumulation of advanced glycation end products (AGEs) in the body contributes to pathogenesis of many diseases including complications of diabetes including retinopathy and neuropathy. Proteins in the lens of the eye do not turnover and therefore give an indication of the average glucose levels over a very long period of time. AGEs have a unique measurable fluorescence, however non-invasive measurement of AGEs was not available until recently with introducing a new scanning confocal biomicroscope. The main aim of the present study was to investigate if measurement of lens Auto fluorescence (FL) can distinguish subjects with impaired Glucose Tolerance (IGT) and type 2 diabetes (T2DM) from Healthy control subjects and to investigate the relationship between levels of FL. ratio, and corneal nerves morphology. 20 T2DM, 20 IGT and 20 Healthy aged matched control subjects underwent comprehensive medical and neurological assessments including corneal confocal microscopy and measurement of Crystalline Lens Autofluorescence by using a confocal bio microscope. There was a significant difference at the level of fluorescence ratios in Control subjects, IGT patient and T2DM patients. There was a significant correlation between FL. Ratios and level of HbA1C, and CNFL.
The results of this study showed the Lens fluorescence is significantly greater in patients with IGT and T2DM. The level of AGEs products was correlated with HbA1C and alterations in corneal nerves morphology. However, the relationship with HbA1c was rather poor since HbA1c cannot completely reflect long-term glycation process. Lens autofluorescence could be a robust marker of long-term diabetes control predicting future complication risks. This supports the feasibility of lens autofluorescence to screen subjects for undiagnosed type 2 diabetes. However, confirmation of such hypothesis will need larger and long-term clinical studies.

Disclosure
M. Tavakoli: None.
567-P: Influence of Sex on Cardioautonomic Neuropathy in Patients with Type 1 Diabetes
Authors: NATTERO-CHÁVEZ LÍA , DIAZ SARA ALONSO , MONTANEZ LAURA , FERNÁNDEZ ELENA , LOPEZ SANDRA REDONDO , UREÑA MARTA GARNICA , BAYONA ANE , ESCOBAR-MORREALE HÉCTOR FRANCISCO , RAMÍREZ MANUEL LUQUE 
Published: June 2019

Objective: Cardiovascular autonomic neuropathy (CAN) is a common complication of type 1 diabetes (DM1). The risk of CAN is lower in middle-aged healthy women than in men, a fact that might be related to a more dominant parasympathetic regulation in the former. This sex-related effect in favor of women appears to disappear beyond 50 year-old. We assessed the effects of age and sex on CAN in patients with DM1.
Research Designs and Methods: Cross-sectional study in 281 consecutive patients (158 males and 123 females) with DM1. CAN was assessed by the Ewing Score using the variability of heart rate (HR) in response to deep breathing, standing, and the Valsalva’s maneuver, and the response of blood pressure to active standing. A composite score ≥ 1 was diagnostic of CAN. CAN was classified as early or mild when the Ewing score was between 1-2, and definitive when ≥ 2.
Results: The mean age of our study population was 36±12 years-old and their average duration of DM1 was 20±11 years. Their mean HbA1cwas 7.6±1.3%. The global prevalence of CAN was 30.6% (25.5-36.2). CAN was categorized as early/mild in 79 (92%) cases and definitive in 7 (8%) cases. CAN prevalence was not significantly different between men and women when analyzing all subjects regardless of age. When age was taken into account, the prevalence of CAN was independent of sex among individuals below 50 year-old, but in subjects aged ≥ 50 years (21 males and 19 females) the prevalence of CAN was larger in women than in men [63.2% (41.0-80.9) vs. 23.8% (10.6-45.1), respectively; χ2: 6.32, p= 0.012]. The OR of having CAN was 5.5 (1.4-21.6) in women aged ≥ 50 years compared to their male counterparts and 3.9 (1.4-10.7) compared to women under 50 years.
Conclusions: The increase in CAN risk in subjects with type 1 DM may be greater in women over 50 years than in men of similar age. Moreover, women aged ≥ 50 years-old associate to a higher risk of CAN than younger women and men. This finding might be related to the menopausal-related decline in sex steroids.

Disclosure
L. Nattero-Chávez: None. S. Alonso Diaz: None. L. Montanez: None. E. Fernández: None. S. Redondo Lopez: None. M. Garnica Ureña: None. A. Bayona: None. H. Escobar-Morreale: None. M. Luque Ramírez: None.

Funding
Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness (PI1400649, PI151686, PIE1600050); Fondo Europeo de Desarrollo Regional
569-P: Prefrontal Cortex Brain Damage and Glycemic Control in Patients with Type 2 Diabetes
Authors: CHOI SARAH E. , ROY BHASWATI , KUMAR RAJESH , FREEBY MATTHEW , MULLUR RASHMI S. , WOO MARY A. 
Published: June 2019

Cognitive impairments are common in patients with type 2 diabetes (T2DM) and adversely impact self-care and glycemic control. However, brain injury in a site that controls cognition (prefrontal cortices; PFC) and its relationship to glycemic outcomes in T2DM remains unclear.
Methods: We examined 9 T2DM patients (age 58.2 ± 4.6 years; BMI 30.3 ± 5.0 kg/m2;3 males) and 47 healthy controls (age 55.7 ± 4.2 years; BMI 26.4 ± 3.0 kg/m2; 29 males) for cognition (Montreal Cognitive Assessment [MoCA]), glycemic control (hemoglobin A1c [A1C]), and PFC status via brain magnetic resonance imaging (MRI). Two high-resolution T1-weighted images were collected using a 3.0-Tesla MRI scanner to evaluate PFC status with voxel-based morphometry (VBM) procedures.
Results: No significant differences in age and gender emerged between T2DM and control subjects. However, BMI values were significantly higher in T2DM subjects over controls. MoCA scores were significantly lower in T2DM patients compared to controls (24.3 ± 2.4 vs. 26.9 ± 2.3; p = 0.004). Mean A1C was 7.6±0.8% (51-68 mmol/mol) in T2DM patients. Reduced PFC volume was observed in T2DM patients compared to controls (left 0.35±0.02 vs. 0.41±0.03, p&lt;0.001; right 0.31±0.02 vs. 0.38±0.02, p&lt;0.001). PFC volume was positively correlated with cognition; left PFC regions (r= 0.94, p=0.002) and right PFC regions (r= 0.89, p=0.007) with age and gender as covariates. Significant negative correlations were found between PFC volume and A1C; left PFC (r= -0.92, p=0.003) and right PFC regions (r=-0.92, p=0.004) with age and gender as covariates.
Conclusions: T2DM patients have PFC brain damage which is associated with cognitive deficits and poor glycemic control. Further research is needed to identify causal relationships between A1C and brain changes in T2DM and to examine interventions to enhance brain/neurogenesis and its impact on A1C.

Disclosure
S.E. Choi: None. B. Roy: None. R. Kumar: None. M. Freeby: None. R.S. Mullur: None. M.A. Woo: None.

Funding
National Institutes of Health (R01NR017190)
570-P: The Slipping Slipper Sign Predicts Risk of Falling in Patients with Type 2 Diabetes Mellitus
Authors: RAMDATH MOSHANTI M. , NANDLAL RESHAM R. , TEJA BOPPANA LEELA KRISHNA , TEELUCKSINGH SURUJPAL 
Published: June 2019

Background: Patients with diabetes, particularly those with peripheral neuropathy, are known to be at increased risk for falls. The objective of this study was to determine if the presence of a positive Slipping Slipper Sign (SSS) - a clinical marker of severe diabetic peripheral neuropathy could be associated with an increase tendency towards falls, recurrent falls and fractures.
Subjects and Methods: Using a case control design, among 78 subjects selected from our diabetic clinic there were 26 subjects with the SSS and 52 controls without the SSS. Questionnaires were administered to obtain data related to the frequency of falls, recurrent falls and fractures which occurred within a one year time period (May 2015 to May 2016), in addition to demographic and medically relevant data.
Results: Overall 33 subjects had experienced a fall giving an incidence of 42% for the entire cohort whereas all 26 (100%) subjects with the SSS had experienced a fall within the one year-period. Only 7 (13·5%) subjects had fallen in the group with a negative SSS, p&lt;0·001. Furthermore, 17 (65·4%) subjects with the SSS were found to have experienced recurrent falls as compared to only 4 (7·7%) non-SSS subjects, p&lt;0.001. Similarly, 10 (38·5%) SSS subjects but only 3 (5·8%) subjects without the SSS were found to have sustained fractures, p = 0·001. Most falls occurred during the act of walking. Multivariate analysis showed the significant predictors of the SSS were: duration of diabetes (p = 0·001), female sex (p = 0·026) and the use of oral hypoglycemic agents (p = 0·047). The relative risks of falls, recurrent falls and fractures were 7·43 (95% CI: 3·73 - 14·79), 8·50 (95% CI: 3·18 - 22·69) and 6·67 (95% CI: 2·005 - 22·16) times greater for subjects with the SSS compared to those without.
Conclusion: A positive SSS among subjects with T2DM predicted the risk of falls, recurrent falls and fractures and has potential as a screening tool to reduce morbidity and mortality from falls among those with diabetic peripheral neuropathy.

Disclosure
M.M. Ramdath: None. R.R. Nandlal: None. L. Boppana: None. S. Teelucksingh: None.
571-P: Analysis of Hearing Loss Characteristics in Prediabetic Patients
Authors: MENG YAN , ZHUANG XIAOMING , LU BIN , WU XIAOJUAN 
Published: June 2019

Objective: The goal was to study auditory function in prediabetes. Pure Tone Audiometry (PTA), Distortion Product Otoacoustic Emission (DPOAE) and Auditory Brainstem Response (ABR) were used to detect whether there is early hearing deterioration in the prediabetes.
Methods: 168 participants underwent the Oral Glucose Tolerance Test (OGTT). 58 prediabetes patients younger than 60 years old, and 50 controls, age and sex matched, were enrolled. All subjects underwent PTA, DPOAE and ABR examinations. All relevant parameters including air and bone conduction pure tone audiometry, DPOAE amplitude and ABR latencies were collected.
Results: (1) There were 25 cases with hearing loss in prediabetes (43%), while 6 cases in the control group (12%) by PTA; the difference was statistically significant (P &lt;0.001). The hearing thresholds at each frequency (0.25kHz, 0.5kHz, 1kHz, 2kHz, 4kHz and 8kHz) in the prediabetes were higher than those in controls but only statistically significant at 4kHz and 8kHz (P &lt; 0. 001). Air- and bone-conduction pure-tone thresholds synchronization increased. The difference between air conduction and bone conduction checked by PTA was less than 10dB. (2) DPOAE amplitude at each frequency in the prediabetes group was lower than control group; there were statistically significant differences at 1, 1.5, 2, 3, 4, 6 kHz (P &lt; 0. 001). (3) There were no significant differences of neuron response latencies in ABR measurements between prediabetes and the control group.
Conclusions: (1) Loss of auditory function began in the prediabetes stage. Sub-clinical presentations were more pronounced in the prediabetes stage. (2) Bilateral symmetry sensorineural hearing loss, especially at high frequencies, is very characteristic in prediabetic patients. (3)The preliminary findings are that DPOAE is needed to detect the usually slight hearing loss in prediabetes whereas PTA was less sensitive and did not detect such losses. (4) The damage is mainly cochlear, not in the central nervous system.

Disclosure
Y. Meng: None. X. Zhuang: None. B. Lu: None. X. Wu: None.

Funding
Capital Health Research and Development of Special Fund (2016-2-7022, 2019-1-1091); Science and Technology Plan of Beijing Municipal Education Commission (KM201610025020)
573-P: Diagnostic Performance of Heart Rate Variability for Detecting Diabetic Cardiac Autonomic Neuropathy
Authors: KOO BO KYUNG , MOON MIN KYONG 
Published: June 2019

Heart rate variability (HRV) has been considered as a useful tool for detecting cardiac autonomic neuropathy (CAN) and predicting mortality in individuals with diabetes. We evaluated its diagnostic performance for CAN in a hospital-based cohort.
CAN was defined and classified according to Ewing’s criteria using standard 5 cardiovascular reflex test. HRV and power spectral density (PSD) were assessed by DiCAN (Medicore, Seoul, Korea); and diagnostic performance of Standard Deviation Normal to Normal (SDNN) and each PSD domain (total power, TP; very low frequency, VLF; low frequency, LF; high frequency, HF) were evaluated using receiver operating characteristic (ROC) analysis and Youden's index.
After excluding subjects with insufficient data, 2,209 diabetic patients were included the analyses (mean age, 60 ± 11 years; men, 49.6%). Early, definite, and severe CAN were detected in 38.7%, 10.4%, and 4.1% in them. Multivariable Poisson regression adjusted for age and sex showed that all SDNN, TP, VLF, LF, and HF were decreased as severity of CAN increased (P&lt;0.001). Their area under curve of ROC for diagnosis of definite CAN was 0.67 (95% confidence interval, 0.64 - 0.70), 0.71 (0.68 - 0.74), 0.68 (0.65 - 0.71), 0.73 (0.70 - 0.75), and 0.68 (0.65 - 0.71), respectively; and their sensitivity was 0.74, 0.80, 0.70, 0.70, and 0.79, respectively in this analysis. For detection of early CAN, their sensitivity was more decreased to 0.71, 0.64, 0.52, 0.64, and 0.74, respectively.
In conclusion, even though there was significant decrease in HRV according to severity of CAN, HRV could not detect about 30% of diabetic subjects with CAN especially in the case with early impairment. Further studies evaluating diagnostic performance of HRV in various populations are needed.

Disclosure
B. Koo: None. M. Moon: None.
59-LB: Prevalence and Risk Factors of Lipohypertrophy and Lipoatrophy in Diabetes Patients Receiving Insulin Therapy
Authors: BUYRUK BETUL AYDIN , KEBAPCI NUR , YORULMAZ GOKNUR , ALAGUNEY ELIF SEVIL , AKALIN AYSEN , EFE BELGIN 
Published: June 2019

Objectives: Insulin therapy is associated with skin-related complications, such as lipoatrophy, lipohypertrophy (LH), edema, and allergy. Lipohypertrophy (LH) is the most common cutaneous complication of injectable insulin therapy in the treatment of diabetes. Our aim in this study was to evaluate skin-related complications in diabetic patients receiving insulin therapy.
Methods: In this study, diabetic patients who were treated with insulin therapy in Endocrinology Department between 2015 and 2018 were evaluated. Observation and palpation technique was used in the evaluation of lipohypertrophy in diabetic subjects. The degree of lipohypertrophy was classified as follows: grade 0 = no change; grade 1 = visible hypertrophy of fat tissue but with normal consistency on palpation; grade 2 = intensive fat tissue thickening but with firm consistency; and grade 3 = lipoatrophy
Results: A total of 204 diabetic participants (52, 5 % female) were evaluated. The number of patients using insulin for more than 10 years was 81 (39,7%). The 4-mm needle was used more commonly in the study (54, 4 %). The recommended injection sites are the abdomen, thigh, arm and buttocks. Overall, 55, 9 % of patients were injecting insulin in the area of abdomen and 40, 2 % were injecting insulin four times per day. The ratio of the patients who do not change needle tip for each injection was 43,6%. In addition, lipohypertrophy was seen in 61, 8 % of the 204 diabetics in the study and most patients were revealed to have grade 1 (35,3%). Lipoatrophy was seen in 5.6% of the patients. Of the cases diagnosed as lipohypertrophy, 56, 3 % were women and 43,7% were men. Females were significantly more likely to have LH than males were (P = 0.042).
Conclusions: Increased prevelance of lipohypertrophy is an important complication of insulin therapy and clinicians must be aware of this complication.

Disclosure
B. Aydin Buyruk: None. N. Kebapci: None. G. Yorulmaz: None. E. Alaguney: None. A. Akalin: None. B. Efe: None.
590-P: Is Abdominal Obesity Associated with Diabetic Retinopathy in Chinese individuals: An Exploratory Study
Authors: ZHOU JIAN-BO , YUAN JING , CAI YAO-HUA , SHU LIN-PING , YANG JIN-KUI 
Published: June 2019

Aim: To our knowledge, the independent associations of abdominal obesity (defined by waist circumference or waist hip ratio) with diabetic retinopathy (DR) remain unknown in Chinese individuals to date.
Methods: This study included two sets. Firstly, relationship between waist circumference (WC) or waist hip ratio (WHR) and DR was estimated in a case-control set (DR vs. non-DR) for the whole population before and after propensity-score matching (PSM). Subsequently, the accumulated evidence was explored to validate the relationship.
Results: Among 511 eligible patients, DR(N=156) and non-DR(N=156) patients who had similar propensity scores were included in the PSM analyses. Abdominal obesity (defined by waist circumference) was associated with risk of diabetic retinopathy (OR: 1.07(1.03-1.10)). Accumulated analysis of abdominal obesity on diabetic retinopathy showed that risk of DR might rise by 12% (OR 1.12, 95% CI: 1.02 to 1.22). Further accumulated evidences showed a significant association between continuous body mass index (BMI) and risk of proliferative diabetic retinopathy (PDR) (OR=0.96, 95% CI 0.93-0.98; P=.002; I2=50%).
Conclusions: Abdominal obesity, especially defined by waist circumference, is associated with the risk of diabetic retinopathy in Chinese population.

Disclosure
J. Zhou: None. J. Yuan: None. Y. Cai: None. L. Shu: None. J. Yang: None.

Funding
National Natural Science Foundation of China (81870556, 81670738); Beijing Municipal Administration of Hospital`s Youth Programme (QML20170204)