bluuebunny/crossref_metadata_2025_split huggingface dataset:
1630-P: Glycemic Burden and Treatment Effectiveness in Young-Onset Type 2 Diabetes
Authors: KE CALVIN , LUK ANDREA , SHAH BAIJU R. , STUKEL THERESE , LAU ERIC S. , MA RONALD C. , KONG ALICE P. , CHOW ELAINE , CHAN JULIANA C. 
Published: June 2019

Objective: To examine how T2D onset age affects A1C trajectory and A1C lowering with insulin and other drugs.
Methods: We conducted a cohort study (2000-16) in adults aged 18-75 years (y) with young-onset T2D (YOD; onset age &lt;40 y) and usual-onset T2D (UOD; onset age ≥40 y). In the Hong Kong Diabetes Registry (n=21,016), we estimated the mean glycemic burden (area under curve of A1C over time) across the lifespan, stratifying by onset age. In the population-based Hong Kong Diabetes Surveillance Database (n=328,199), we examined the effect of onset age on A1C trajectory for incident T2D using linear mixed effects models, accounting for drugs using time-varying covariates. We followed for 10 y, censoring at death or insulin start. For those started on insulin (n=20,877), we used similar methods to examine the effect of time to insulin start on the post-insulin A1C trajectory.
Results: Glycemic burden was tripled in YOD versus UOD (38.8 versus 11.8 A1C-y). After accounting for drugs, YOD was associated with a higher baseline A1C (7.6%) and slope (0.05%/y) versus UOD (7.4%, 0.00%/y). Non-insulin drugs lowered A1C similarly across onset ages. The post-insulin A1C remained elevated for YOD, regardless of time to insulin start, but improved significantly for UOD.
Conclusions: YOD is associated with an aggressive A1C rise and excess glycemic burden despite insulin and other drugs. More effective strategies are needed to lower A1C in people with YOD.

Disclosure
C. Ke: None. A. Luk: None. B.R. Shah: None. T. Stukel: None. E.S. Lau: None. R.C. Ma: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Bayer AG, Pfizer Inc. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca. A.P. Kong: Advisory Panel; Self; Lilly Diabetes. Research Support; Self; AstraZeneca, Lilly Diabetes. Speaker's Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. E. Chow: Research Support; Self; Powder Pharmaceuticals Inc., Sanofi-Aventis. J.C. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare.

Funding
University of Toronto; Royal College of Physicians and Surgeons of Canada; Canadian Society of Endocrinology and Metabolism; Chinese University of Hong Kong; Asia Diabetes Foundation
1641-P: Development and Validation of a Clinical Predictive Score for Insulin Requirement during Glucocorticoid Treatment
Authors: KAWASHIMA MIKAKO , KITADA YOSHIHIKO , KAJITA KAZUO , MORI ICHIRO , ISHIZUKA TATSUO , MURAKAMI DAISUKE , OKADA HIDEYUKI , MORITA HIROYUKI 
Published: June 2019

Insulin is often administered for glucocorticoid (GC) -induced hyperglycemia. We have developed and validated a scoring system to predict insulin requirement for optimal control of hyperglycemia during GC treatment through retrospective studies. The Developing set: 303 adults out of 2718 patients, undergoing their first treatment of prednisolone (PSL) with a dosage of 5 mg/day or more for 4 weeks at least, were divided into 2 groups depending on with or without administration of insulin during GC treatment. Risk factors for insulin requirement were identified by a stepwise logistic regression analysis after univariate analyses of clinical parameters before GC treatment between the 2 groups. We constructed a point-addition scoring system, consisting of several categories and their coefficients in each risk factor, derived from another multivariate analysis. We validated it to validation sets A (n=44) and B (n=77) in another two facilities, respectively. Male, FPG, HbA1c, serum CRE, and an initial dose of PSL were identified as the risk factors. The AUC by ROC analysis of the total scores when the Developing set was scored, showed 0.94. The sensitivity, specificity, and accuracy were 90%, 88%, and 88%; 88%, 67%, and 71%; 83%, 76%, and 77% in the Developing set, Validation set A, and B, respectively if the cut off value of the total scores was defined as 19 points. The scoring system: Table is useful.

Disclosure
M. Kawashima: None. Y. Kitada: None. K. Kajita: None. I. Mori: None. T. Ishizuka: None. D. Murakami: None. H. Okada: None. H. Morita: None.

Funding
Sanofi; Eli Lilly Japan K.K.
1645-P: Risk Factors for Household Food Insecurity among Adults with Dysglycemia: Evidence from the 2013-2017 National Health Interview Survey
Authors: FRANCIS LUCINE , TURKSON-OCRAN RUTH-ALMA N , SPAULDING ERIN , KOIRALA BINU , BAPTISTE DIANA , ECHOUFFO TCHEUGUI JUSTIN B. , COMMODORE-MENSAH YVONNE 
Published: June 2019

Background: Food insecurity (FI), defined as limited access to nutritious foods, hampers dietary management of dysglycemia. We examined the prevalence of and risk factors for FI among adults with dysglycemia.
Methods: We performed a cross-sectional analysis of data among adults with dysglycemia from the 2013-2017 National Health Interview Survey. We defined dysglycemia as self-reported prediabetes or diabetes diagnosis. FI was defined by an affirmative response on ≥3 questions on the 10-item Food Security Scale. We used Poisson regression and multivariable logistic regressions to estimate the prevalence of and risk factors for FI.
Results: We included 26,960 adults with dysglycemia; mean age was 61 years, and 56% were female. The prevalence of FI among those with dysglycemia was 10%. Risk factors for FI identified included being Nnon-Hispanic black (OR: 1.30; 95% CI: 1.11-1.53), Other race (OR: 1.72; 95% CI: 1.12-2.62); having some college (OR: 1.17; 95% CI: 1.01-1.35), unemployed (OR: 1.57; 95% CI: 1.35-1.83), benefiting from the Supplemental Nutrition Assistance Program (OR: 2.31; 95% CI: 2.02-2.65), and insured (OR:1.51; 95% CI: 1.20-1.91) (Table).
Conclusion: Developing targeted interventions and health policy for improving access to nutritious foods among adults with dysglycemia with risk factors for FI may improve glycemic control in this population.

Disclosure
L. Francis: None. R.N. Turkson-Ocran: None. E. Spaulding: None. B. Koirala: None. D. Baptiste: None. J.B. Echouffo Tcheugui: None. Y. Commodore-Mensah: None.

Funding
National Institute of Nursing Research (to R-A.N.T-O.), (F31DR017328, T32NR012704 to E.S.); National Institute of Diabetes and Digestive and Kidney Diseases (T32NR012704, 3T32DK062707 to R-A.N.T-O.); Ruth L. Kirschstein National Research Service Award (to E.S.); Johns Hopkins Clinical Research Scholars Program (5KL2TR001077-05 to Y.C.M.)
1650-P: Metabolically Healthy Obese Status and Incident Dementia Events among 5.7 Million Elderly People
Authors: BAE JAEHYUN , LEE JI-YEON , CHO YONGIN , LEE MINYOUNG , LEE SANG BAE , LEE INKUK , KANG EUN SEOK , CHO SUNG J. , HAN KYUNGDO , CHA BONG-SOO , LEE YONG-HO 
Published: June 2019

Background: Obese individuals with normal metabolic profiles, so-called “metabolically healthy obese (MHO)” status has shown better clinical outcomes via previous studies. However, studies dealing with the association between MHO and dementia, which is deeply associated with metabolic disorders, were still insufficient. We designed this study to assess the association between MHO and the risk of incident dementia.
Methods: The present study is a retrospective cohort study, including 5,669,488 patients aged 60 years old or over without any history of dementia, by using the National Health Insurance System of South Korea. Subjects were divided into 4 groups based on their metabolic health and obesity status. Metabolic health was determined based on the criteria of metabolic syndrome by Adult Treatment Panel-III. Obesity was judged based on the baseline body mass index. The incidence of dementia was checked and compared longitudinally between 4 groups.
Results: When we put the metabolically healthy non-obese group to the reference value (hazard ratio (HR) = 1), MHO group showed the lowest incidence of dementia (HR 0.87, 95% confidence interval (CI) 0.86-0.88). This trend was more prominent when we followed up the risk of Alzheimer’s disease as a subgroup analysis (HR 0.85, 95% CI 0.83-0.86). Non-obese subjects with metabolic syndrome showed significantly increased risk for overall dementia (HR 1.20, 95% CI 1.19-1.21), especially for vascular dementia (HR 1.41, 95% CI 1.38-1.45).
Conclusion: MHO status was associated with lower risk for dementia, especially for Alzheimer’s disease.

Disclosure
J. Bae: None. J. Lee: None. Y. Cho: None. M. Lee: None. S. Lee: None. I. Lee: None. E. Kang: None. S.J. Cho: None. K. Han: None. B. Cha: None. Y. Lee: None.
1655-P: Primary Care Visits and Ambulatory Care Sensitive Diabetes Hospitalizations among Adult Alabama Medicaid Beneficiaries
Authors: BRONSTEIN JANET M. , HUANG LEI , AGNE APRIL A. , MONDESIR FAVEL L. , PRESLEY CAROLINE A. , RIGGS KEVIN R. , PISU MARIA , LEVITAN EMILY B. , CHERRINGTON ANDREA 
Published: June 2019

Objective: To describe patterns of care use for adult Medicaid beneficiaries with diabetes and the association between primary care utilization and Ambulatory Care Sensitive (ACS) diabetes hospitalizations.
Methods: This retrospective cohort study analyzes Alabama Medicaid claims data from January 2010 to April 2018 for 52,549 covered adults ages 19 to 64 with diabetes. Individuals were characterized by demographics, comorbidities, and health care use including primary, specialty, mental health, pharmaceutical, laboratory and hospital care. Characteristics of those with and without any ACS diabetes hospitalization are reported. A set of 118,758 observations was created, pairing information on primary care use in one year with ACS hospitalizations in the following year. Logistic regression analysis was used to assess the impact of primary care use in one year on the occurrence of an ACS hospitalization in the following year.
Results: One third of the cohort had at least one ACS diabetes hospitalization over their observed periods; hospital users tended to have multiple ACS hospitalizations. Hospital users had more comorbidities and pharmaceutical and other types of care use than those with no ACS hospitalizations. Controlling for other types of care use, comorbidities and demographics, having a primary care visit in one year was significantly associated with a reduced likelihood of ACS hospitalization in the following year (adjusted odds ratio comparing 1-2 primary care visits versus none 0.79, 95% confidence interval 0.73-0.85).
Conclusions: Program and population health interventions that increase access to primary care can have a beneficial effect of reducing excess inpatient hospital use for Medicaid covered adults with diabetes.

Disclosure
J.M. Bronstein: None. L. Huang: None. A.A. Agne: None. F.L. Mondesir: None. C.A. Presley: None. K.R. Riggs: None. M. Pisu: None. E.B. Levitan: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen Inc. A. Cherrington: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
1657-P: Performance of Insulin Sensitivity Indices vs. the Hyperinsulinemic Euglycemic Clamp in Chronic Kidney Disease
Authors: MCMULLAN BARBARA C. , AKWO ELVIS A. , HUNG ADRIANA M. 
Published: June 2019

Background: Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and premature death. Insulin resistance (IR) is prevalent in CKD and is one of the most important nontraditional CV risk factors in CKD. We investigated the association between practical insulin sensitivity (IS) indices and the gold standard hyperinsulinemic euglycemic clamp (HEGC) among CKD (estimated GFR = 15-59ml/min) and non-CKD persons.
Methods: The relationship of insulin sensitivity in kidney disease (RISKD) study was a cross-sectional investigation involving 140 nondiabetic patients (52 CKD and 88 non-CKD). Insulin sensitivity was assessed by the HEGC-derived insulin sensitivity index (ISI), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), McAuley index, and leptin-adiponectin ratio (LAR). Spearman correlation (rs) and multivariable linear models were used to investigate the association between the practical indices and ISI.
Results: Compared to non-CKD controls, CKD patients had a higher prevalence of IR based on published cut-points for practical IS markers (HOMA-IR: 83% vs. 32%, p&lt;0.0001; LAR: 60% vs. 46%, p&lt;0.0001). HOMA-IR had the strongest correlation (rs = -0.59, p=0.002) with ISI in CKD patients while McAuley had the weakest correlation (rs = 0.50, p=0.0001). Conversely, in non-CKD controls, McAuley had the strongest correlation with ISI (rs = 0.72, p=0.0001). In multivariable models, sex, leptin, and eGFR were independently associated with ISI (p = 0.04, &lt;0.001, and 0.03 respectively).
Conclusion: Patients with CKD had a higher prevalence of IR. While all IS indices showed significant correlations with clamp-derived ISI, HOMA-IR performed best in CKD patients while McAuley performed best in non-CKD persons. These data suggest that HOMA-IR is the preferred practical index to be used to assess insulin sensitivity in large cohort investigations involving CKD patients.

Disclosure
B.C. McMullan: None. E.A. Akwo: None. A.M. Hung: None.

Funding
U.S. Department of Veterans Affairs (I01CX000982 to A.M.H.)
1658-P: Socioeconomic Position and All-Cause Mortality among Adults with Diagnosed Diabetes across Racial/Ethnic Groups—United States, 1997-2011
Authors: MERCADO CARLA , CHENG YILING J. , SAYDAH SHARON , IMPERATORE GIUSEPPINA 
Published: June 2019

Among all adults with diagnosed diabetes (DM), the rate of all-cause mortality is inversely associated with socioeconomic position (SEP). However, the social patterning among adults of different racial/ethnic origin is less clear. We examined changes in 5-year all-cause mortality rates in U.S. adults with diagnosed DM across racial/ethnic groups [non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic] by SEP [education and income to poverty ratio (IPR)]. Using data on 32,986 participants aged ≥25 years with DM from the National Health Interview Survey during 1997-2011, we calculated race/ethnicity stratified mortality rates and changes in rates using predictive margins from Poisson regression adjusted for age. From 1997-2001 to 2007-2011 in adults with education of &lt;high school, mortality rates decreased in NHW [from 30.4 to 24.6 deaths/1000 person-years: change = -5.8 (95% confidence interval: -10.4, -1.2)], NHB [21.7 to 16.8: -4.9 (-9.5, -0.4)], and Hispanics [16.7 to 11.4: -5.3 (-9.7, -1.0)]. In those with a high school education, although mortality rates did not change significantly in NHB and Hispanics, there was a decrease in mortality rate in NHW [25.9 to 21.4: -4.5(-8.2, -0.7)]. No significant changes were observed in those with &gt;high school education during this time. When considering changes related to IPR, there were significant decreases in mortality rates in NHW adults with IPR between 200-399% [26.0 to 20.4: -5.7 (-10.1, -1.2)] and ≥ 400% [23.1 to 15.4: -7.7 (-12.5, -2.9)] but no significant changes for IPR of &lt;100% and 100-199%. In contrast, there was a decrease in mortality rates for IPR &lt;100% in NHB [28.7 to 17.5: -11.2 (-19.6, -2.8)] and Hispanics [16.3 to 10.2: -6.1 (-11.4, -0.7)] but no significant changes for IPRs of 100-199%, 200-399%, or ≥ 400% in these groups. Improvements in mortality rates in U.S. adults with DM by educational attainment were similar across racial/ethnic groups but varied when considering IPR for SEP.

Disclosure
C. Mercado: None. Y.J. Cheng: None. S. Saydah: None. G. Imperatore: None.
166-OR: AMPK-Dependent Regulation of Skeletal Muscle Mitochondrial Function by FNIP1
Authors: XIAO LIWEI , LIU JING , SUN ZONGCHAO , YIN YUJING , MAO YAN , GAN ZHENJI 
Published: June 2019

Skeletal muscle mitochondria are essential for maintaining metabolic homeostasis in response to a myriad of physiologic or pathophysiological stresses. The folliculin (FLCN)-interacting protein 1 (FNIP1) forms a complex with AMP-activated protein kinase (AMPK), and we previously demonstrated that FNIP1 inhibits AMPK activity in myocytes. Using gain- and loss-of-function approaches in mice, we discovered that FNIP1 is necessary, but not sufficient, to suppress AMPK-dependent mitochondrial function in skeletal muscle. Muscles in FNIP1 knockout (KO) mice show enhanced red coloration, oxidative mitochondrial activity, and type I fiber transformation. Surprisingly, no change in mitochondrial oxidative capacity and fiber type switching was observed in transgenic mice overexpressing FNIP1 in muscle (FNIP1Tg), while restoration of the expression of FNIP1 in the KO muscle (FNIP1Tg/KO) reversed the mitochondrial oxidative metabolism program. RNA-seq profiling revealed that 3328 genes showed over 1.5-fold altered in FNIP1 KO muscle, and the majority number (2856) was regulated in a FNIP1-dependent manner. Gene ontology based analysis revealed that the primary FNIP1-altered genes were mitochondrial metabolic genes. Mitochondrial respiration analysis confirmed that both pyruvate- and succinate-driven state 3 respiration rates were significantly higher in FNIP1 KO muscle, whereas restoration of the expression of FNIP1 in KO muscle reduced the mitochondrial function. Importantly, AMPK, but not mTOR, was markedly induced in FNIP1 KO muscle but reduced in FNIP1Tg/KO muscle. Muscle-specific knockout of the two AMPKα subunits (AMPKα1α2 dmKO) reduced mitochondrial function in FNIP1 KO muscle. Similar results were obtained in skeletal myocytes in culture, using AMPK loss-of-function approaches in FNIP1 KO myocyte. Thus, FNIP1 represents a previously unrecognized negative regulator of muscle mitochondrial function and AMPK is vital for FNIP1 actions in skeletal muscle.

Disclosure
L. Xiao: None. J. Liu: None. Z. Sun: None. Y. Yin: None. Y. Mao: None.
1661-P: Outcomes of a Church-Based Lifestyle Intervention among Australian Samoans Living in South Western Sydney (SWS)—A Pilot Study
Authors: NDWIGA DOROTHY , MACMILLAN FREYA , MCBRIDE KATE , ALOFIVAE-DOORBINNIA OLATAGA , REATH JENNIFER , ABBOTT PENELOPE A. , SIMMONS DAVID 
Published: June 2019

Objectives: Samoan people are susceptible to early onset of type 2 diabetes and have low primary care participation. We have evaluated the effectiveness of a culturally adapted, church-based intervention delivered by Samoan coaches and Peer Support Facilitators to prevent and manage type 2 diabetes in Samoans associated with 3 churches in South Western Sydney (SWS).
Methods: This pre-post study included Samoans ≥18 years and involved the delivery of 12 lifestyle messages and 10 diabetes messages. Participants completed questionnaires, the diabetes knowledge and behavior questionnaire, anthropometric measurements and provided a non-fasting blood sample (‘new’ diabetes diagnosis was defined if HbA1c or random blood glucose was ≥6.5% (48 mmol/mol) or ≥11.1mmol/l respectively). Obesity was defined using a Pacific body mass index (BMI) threshold ≥32kg/m2.
Results: One hundred participants (70%) participated with 68 (mean age 49.6±14.2 years; female 57.4%) completing data collection 3-8 months after commencing the intervention. The prevalence of obesity was 73% and diabetes was 32.8% (19.8% previously diagnosed; 13% undiagnosed). Overall, HbA1c fell from baseline to follow-up (mean±SD; 6.4±1.7% (46 mmol/mol) vs. 6.0±1.4% (42 mmol/mol); p&lt;0.001). HbA1c reductions were greatest in participants with known diabetes (8.1±2.4% (65 mmol/mol) vs. 7.4±1.8% (57 mmol/mol); p=0.040). The number of participants engaging in moderate and vigorous activities per week increased significantly (336.7±136.3mins vs. 622.6±213.0 mins; p=0.019). Diabetes knowledge increased from baseline to follow-up (45.5±15.7% to 60.3±20.1%; p&lt;0.001). There were no significant reductions in weight, blood pressure or waist circumference at follow-up.
Conclusion: There is a high prevalence of diabetes and its risk factors among Samoans living in SWS. A structured church-based culturally tailored lifestyle intervention showed promise in reducing their diabetes risks.

Disclosure
D. Ndwiga: None. F. MacMillan: None. K. McBride: None. O. Alofivae-Doorbinnia: None. J. Reath: None. P.A. Abbott: None. D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic.

Funding
South Western Sydney Local Health District; South Western Sydney Primary Health Network; WentWest Health Care; Western Sydney University
1672-P: Identifying Type 1 Diabetes in Electronic Medical Records Data in Ontario: A Validation Study
Authors: WEISMAN ALANNA , YOUNG JACQUELINE , KUMAR MATTHEW , AUSTIN PETER , TU KAREN , JAAKKIMAINEN LIISA , LIPSCOMBE LORRAINE , BOOTH GILLIAN 
Published: June 2019

Electronic Medical Record (EMR) data are an efficient method for constructing large type 1 diabetes (T1D) cohorts but are limited by availability of accurate diagnosis codes. We sought to derive an algorithm for identifying T1D using Electronic Medical Records - Primary Care (EMRPC) also known as EMRALD, a database including records from &gt;300,000 primary care patients in Ontario, Canada. A 25% random sample of adults with diabetes and at least 1 year of records in EMRPC prior to September 30, 2015 formed the reference cohort. Charts of potential T1D cases (those on insulin±metformin) were abstracted; all others were classified as non-T1D. Algorithms were derived using variables from free-text searches (diagnosis terms in the Cumulative Patient Profile (CPP)) and standardized fields (medications, age, BMI) using 1)a priori combinations of variables; 2)classification and regression tree analysis (CART). Algorithms were evaluated for sensitivity, specificity, positive and negative predictive values (PPV and NPV) with adjustment for optimism for CART. Of 21,547 eligible patients with diabetes, the reference cohort was 5407: 4968 non-abstracted non-T1D, 240 abstracted non-T1D and 199 T1D. The prevalence of T1D was 3.7%. The optimal algorithm using a priori variable combinations was T1D diagnosis in the CPP + rapid-acting insulin (sensitivity 69.3% (95% CI 62.4-75.7%), specificity 99.8% (99.6-99.9), PPV 92.6% (87.2-96.3), NPV 98.8% (98.5-99.1)). CART partitioned on T1D diagnosis in the CPP, any insulin, and non-metformin oral hypoglycemic medications and improved performance with optimism-adjusted sensitivity of 77% (72.0-83.9), specificity 99.8% (99.8-100.0), PPV 96.8% (94.6-99.6), and NPV 99.1% (98.9-99.4). Simple algorithms using EMR variables yielded good diagnostic performance for identification of T1D and CART further improved performance. Pending additional validation these algorithms can be applied to study large T1D cohorts in EMR databases.

Disclosure
A. Weisman: None. J. Young: None. M. Kumar: None. P. Austin: None. K. Tu: None. L. Jaakkimainen: None. L. Lipscombe: None. G. Booth: None.

Funding
Diabetes Action Canada