bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Gestational Diabetes and Preexisting Type 2 Diabetes in a 10-Year Multistate Hospital Discharge Cohort
Authors: HERRICK CYNTHIA J. , KELLER MATTHEW , OLSEN MARGARET A. 
Published: June 2018

Background: Gestational diabetes (GDM) and preexisting type 2 diabetes (T2DM) in pregnancy are important public health challenges. Our study updates previous literature, using hospital discharge data to define the trends in GDM and preexisting T2DM in multiple states over 10 years.
Methods: Utilizing a validated ICD-9 code algorithm, we defined a retrospective cohort of deliveries from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for FL, NY, and NE from 2005-2014. The HCUP SID contains hospital discharge data for all hospitalizations within a year. Prevalence of GDM and preexisting T2DM were calculated by state and year. Associations with race and socioeconomic status were explored.
Results: Of 4,690,551 births in the cohort, 270,623 were complicated by GDM (5.8%) and 26,261 (0.6%) were complicated by preexisting T2DM. The prevalence of GDM increased from 4.8% in 20to 6.7% in 2014. The prevalence of preexisting T2DM increased from 0.5% in 20to 0.7% in 2014. Native Americans had the highest rates of both preexisting T2DM (0.8-1.7%) and GDM (8.0-15.1%). Preexisting T2DM was next most common among African Americans (0.7% in 20to 1.1% in 2014), and GDM was next most common among Asian/Pacific Islanders (8.1% in 20to 13.1% in 2014). Rates of preexisting T2DM were higher in the lowest income compared to the highest income zip codes (0.8 vs. 0.5% FL, 0.6 vs. 0.3% NY, 0.7 vs. 0.3% NE), with rates declining across income quartiles. Women missing income quartile data had higher rates of preexisting T2DM (0.8-0.9%). GDM did not show a similar trend with socioeconomic status.
Conclusions: The prevalence of GDM and preexisting T2DM increased between 20and 2014 with rates varying by race. Lower socioeconomic status was associated with higher rates of preexisting T2DM. We will use multivariable analysis to explore associations between GDM and preexisting T2DM and demographic, clinical, and healthcare system access variables.

Disclosure
C.J. Herrick: Stock/Shareholder; Spouse/Partner; Cardinal Health. M. Keller: None. M.A. Olsen: Research Support; Self; Sanofi Pasteur. Consultant; Self; Pfizer Inc.. Research Support; Self; Pfizer Inc..
Sweet Transitions—Improving Outcomes for Hospitalized Patients with Diabetes
Authors: BERGER KIMBERLY , CORBIN ADELE , KAMAL PALWASHA , BACHMAN NICHOLE E. , RIDDELL LYNDSEY A. , FALCIGLIA MERCEDES 
Published: June 2018

Effective diabetes care after hospitalization is commonly limited by poor care coordination. Key information from hospitalization is often not communicated to outpatient clinicians as diabetes is rarely the reason for admission. Published interventions to address this problem are limited or lack sustainable benefit. We studied the effectiveness of Sweet Transitions (ST), a program providing and coordinating diabetes care after hospitalization. Sweet Transitions enrolled patients at a 750-bed hospital with poorly controlled diabetes (A1C ≥ 9%) for visits and phone communication with a nurse practitioner and diabetes educator. The ST dyad provided education, identified barriers, adjusted medication, and coordinated care within the organization and community. An individualized plan was transferred to the clinician responsible for diabetes care. Readmissions for ST patients were compared to matched controls, and A1C was assessed before and after ST intervention. For a median of 43 days, 197 patients participated in the program (64% male, age 52 ± 0.9). In 160 patients with repeat A1C at 131 ± 7 days, A1C decreased from 12.0 ± 0.1 to 9.1 ± 0.2% (p &lt;0.0001), and A1c decreased to ≤ 8.5% in 52%. A1C reduction was sustained in 94 patients with repeat A1C at 378 ± 5 days (12.0 ± 0.1 to 9.0 ± 0.3%, p&lt;0.0001). There was a trend toward lower 30-day readmission rates in ST patients (11% vs. 17%, p=0.08). Readmissions were commonly elective among cardiovascular (CV) admissions (46 vs. 11%). Further analysis by admission diagnosis showed lower readmission rates in ST patients admitted for non-CV reasons vs. matched controls (8 vs. 17% p=0.02). Sweet Transitions was associated with improved glycemic control that persisted at 1 year as well as lower readmission rates. Sustained improvements at 1 year suggest effective engagement and communication at the level of patient, organization, primary care, and community. Scalability of ST’s effectiveness relies on identifying factors and processes contributing to improved outcomes.

Disclosure
K. Berger: None. A. Corbin: None. P. Kamal: None. N.E. Bachman: None. L.A. Riddell: None. M. Falciglia: None.
Mechanisms by Which Glucagon Acutely Stimulates Hepatic Mitochondrial Oxidation and Gluconeogenesis
Authors: PERRY RACHEL J. , WANG YONGLIANG , BRILL ALLISON L. , PENG LIANG , ZHANG DONGYAN , DUFOUR SYLVIE , ZHANG YE , ZHANG XIAN-MAN , NOZAKI YUICHI , CLINE GARY , EHRLICH BARBARA E. , PETERSEN KITT , SHULMAN GERALD I. 
Published: June 2018

Glucagon has been suggested to be both pathogenic and protective against type 2 diabetes (T2D) reflecting our poor understanding of the molecular mechanisms by which glucagon alters hepatic metabolism. Using Positional Isotopomer NMR Tracer Analysis (PINTA) we found that acute glucagon infusion stimulates rates of hepatic gluconeogenesisin glycogen-depleted mice by promoting increases in intrahepatic lipolysis and hepatic acetyl-CoA content (75±6 vs. 101±6 nmol/g, p=0.01), pyruvate carboxylase flux (VPC, 70.9±3.9 vs. 99.9±7.1 µmol/[kg-min], p=0.008) and mitochondrial oxidation (90.0±12.9 vs. 452.1±78.3 µmol/[kg-min], p=0.001) in vivo. Each of these effects was abrogated in liver-specific Inositol Trisphosphate Receptor-I (InsP3R-I) knockout mice demonstrating that intracellular calcium signaling is necessary for these processes. Liver specific knockdown of adipocyte triglyceride lipase abolished acute glucagon stimulation of gluconeogenesis (control 70.5±2.9 vs. 103.3±3.3 µmol/[kg-min], p&lt;0.0001 and ATGL knockdown 69.7±1.7 vs. 69.6±2.0 µmol/[kg-min], p=0.9) and VPC (control 63.3±5.0 vs. 100.0±4.8 µmol/[kg-min], p=0.0003, ATGL knockdown 58.9±4.9 vs. 59.2±3.2 µmol/[kg-min], p=0.9) in WT mice demonstrating the necessity of hepatocellular lipolysis in mediating this process. Chronic increases in plasma glucagon concentrations reversed high fat diet-induced hepatic steatosis (liver triglyceride 50.1±8.5 vs. 28.3±5.1 mg/g, p=0.04; liver membrane diacylglycerol 801±142 vs. 448±47 nmol/g, p=0.03, PKCε membrane/cytosol 1.76±0.40 vs. 0.23±0.04, p=0.0009) and glucose intolerance (GTT glucose AUC 1.44±0.vs. 1.13±0.mM-min, p=0.003, insulin AUC 226.8±18.7 vs. 90.2±11.2 nM-min, p&lt;0.0001). These results provide new insights into glucagon biology and suggest that glucagon and InsP3R-I may be therapeutic targets to reverse nonalcoholic fatty liver disease and T2D.

Disclosure
R.J. Perry: None. Y. Wang: None. A.L. Brill: None. L. Peng: None. D. Zhang: None. S. Dufour: None. Y. Zhang: None. X. Zhang: None. Y. Nozaki: None. G. Cline: None. B.E. Ehrlich: None. K. Petersen: Research Support; Spouse/Partner; Gilead Sciences, Inc.. Advisory Panel; Spouse/Partner; AstraZeneca, Merck & Co., Inc., Novo Nordisk A/S. G.I. Shulman: Advisory Panel; Self; AstraZeneca, Janssen Research & Development, Merck & Co., Inc., Novo Nordisk Inc.. Research Support; Self; Gilead Sciences, Inc..
Plasma Metabolomics Reveal Novel Metabolites in Early Pregnancy in Association with Gestational Diabetes Risk
Authors: ZHANG CUILIN , ANNE FENG YEN-CHEN , FIEHN OLIVER , TSAI MICHAEL Y. , ZHU YEYI , ALBERT PAUL , LIANG LIMING 
Published: June 2018

Although metabolomics may shed light on the pathophysiology of glucose metabolism in pregnancy, systematic studies on their roles in the development of gestational diabetes (GDM) are sparse. We aimed to prospectively investigated metabolomics (both targeted and non-targeted) and GDM risk in a matched case-control study of 107 GDM and 214 non-GDM women in a multi-racial cohort. GDM diagnosis was based on Carpenter and Coustan Criteria. Twenty-two amino acids were quantified using plasma collected at gestational weeks (GW) 10-14, 15-26, 23-31, and 33-39. In addition, 331 primary metabolites were quantified by GC-TOF-MS as a part of our non-targeted approach. Adjusted odds ratios (aORs) of GDM related to metabolites (in quartiles (Q)) were estimated using conditional logistic regression after adjusting for major GDM risk factors including BMI. The present report focuses on findings using blood samples in early pregnancy 10-14GW. Alanine in GW 10-14were higher in GDM women than controls (mean: 30.5 vs. 27.6 umol/dl) and were positively related to GDM risk; aORs across increasing Qs were 1.00, 1.69, 2.86, 3.05, (P for trend =0.020). By contrast, asparigine and glycine were significantly lower in GDM women, and were inversely related to GDM risk; aORs across increasing Qs were 1.00, 0.92, 0.74, and 0.48 (P for trend = 0.045) for asparagine and 1.00, 0.42, 0.36, and 0.24 (P &lt;0.001) for glycine. In addition, among primary metabolites from the non-targeted approach, isocitric acid levels were positively related to GDM risk; aORs across increasing Qs were 1.00, 1.30, 1.04, 2.32 (P for trend = 0.002). Furthermore, two unknown metabolites were strongly and inversely associated with GDM risk (aORs were 1.00, 0.52, 0.18, 0.11, and 1.00, 0.33, 0.12, 0.respectively; both P &lt; 10-4).
Conclusion: Our study revealed several novel metabolites that may be implicated in the early pathogenesis of GDM, which might provide new etiological insight into the development of GDM.

Disclosure
C. Zhang: None. Y. Feng: None. O. Fiehn: None. M.Y. Tsai: None. Y. Zhu: None. P. Albert: None. L. Liang: None.
Association between Dementia and Glycemic Control in Elderly Patients
Authors: YASUDA TAKUMA , MURO SEIJI , FUJITA HARUKA , FUJIMURA MASAKI , HATOKO TOMONOBU , MORI EISAKU , YONEMITSU SHIN 
Published: June 2018

Background: The goals of glycemic control based on their cognitive function are recommended for elderly patients. However, the recommendation of the glycemic control is different among the associations. That is, IDF and the Japan Diabetes Society set lower limit of HbA1c and ADA doesn’t. Moreover, there is not a clear course of treatments for elderly diabetics with dementia.
Methods: We retrospectively assessed the correlation between blood glucose management and cognitive function of 616 outpatients aged 65 years or older who visited our hospital from March 14 to April 30, 2017. HbA1c, blood glucose level, and therapeutic agents were obtained from medical records. Cognitive function was evaluated with Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21), which the Japan Diabetes Society and the Japan Geriatrics Society approve. The patients were allocated to three categories based on cognitive function (normal function: I, mild dementia: II, moderate and severe dementia: III), and two categories based on therapeutic agents (not using insulin, SU, or glinide: A, using insulin, SU, and/or glinide: B).
Results: The numbers of the patients in IA, IB, IIA, IIB, IIIA, and IIIB were 138, 362, 11, 66, 7, and 32, respectively. The proportion of the patients whose HbA1c were below the lower limit was significantly higher in IIIB than that in IIB (43.8% vs. 19.7%, p &lt;0.05). The proportion of the patients who underwent hypoglycemia (blood glucose &lt;70 mg/dl) within recent 1 month was significantly higher in IIIB than that in IIB (28.1% vs. 18.2%, p &lt;0.05). In IIIB, there were more hypoglycemic events in the patients whose HbA1c were above the lower limit than the patients whose HbA1c were below the lower limit (38.9% vs. 14.3%, p &lt;0.05).
Conclusions: This study shows that progression of cognitive impairment increases the risk of hypoglycemia. Moreover, this result suggests that the risk of hypoglycemia shouldn’t be evaluated only with HbA1c for elderly patients with dementia.

Disclosure
T. Yasuda: None. S. Muro: None. H. Fujita: None. M. Fujimura: None. T. Hatoko: None. E. Mori: None. S. Yonemitsu: None.
Readmission and Comprehension of Diabetes Education at Discharge (ReCoDED Study)
Authors: SWAMI JANYA , DONIHI AMY , SIMINERIO LINDA M. , FRENCH ESRA KARSLIOGLU , DELISI KRISTIN , HLASNIK DEBORAH S. , PATEL NEETI , PINKHASOVA DIANA , RUBIN DANIEL J. , KORYTKOWSKI MARY T. 
Published: June 2018

Diabetes (DM) is a major contributor to risk for hospital readmission. The Diabetes Early Readmission Risk Indicator (DERRI) is a predictor of 30-day readmission in patients with DM that may allow early identification and intervention for high-risk patients. A limitation to DERRI is the absence of DM-specific factors as contributors to this risk. To address this, we investigated HbA1c, glycemic measures and variability (GV), changes in DM therapy at discharge, and patient responses to a novel post-discharge questionnaire directed at Patient Comprehension (PC) of instructions provided for home DM management. Non-critically ill adult patients with DM were contacted by phone within 48 hours of hospital discharge to complete the PC Questionnaire. To date, 70 subjects (type 1 n=9, type 2 n=53, pancreatogenic DM n=8) (mean age 57.2 ± 12.8 years, BMI 31 ± 8.8 kg/m2, 56% men, 71% Caucasian, HbA1c 8.6 ± 2.0%, DM duration 19 ± 12 years, mean BG prior to discharge (210 ± 49 mg/dL), GV (66 ± 35 mg/dl) have been recruited. Of 41 subjects completing the PC questionnaire, those reporting that discharge instructions for home DM management were not provided had lower PC scores (70.6% vs. 81.5%, p=0.025) and more readmissions (OR 5.6, p=0.04) than those reporting that instructions were given. Among the 60 subjects with one-month post-discharge data, 22 patients (37%) reporting ≥1 readmission had higher DERRI scores than those without readmissions (26% vs. 20%, p=0.023). HbA1c, GV and changes in DM treatment regimens were not associated with readmission.
In summary, these results demonstrate that PC of discharge instructions may be a novel mediator of readmission risk and may add an additional measure of risk for hospital readmission.

Disclosure
J. Swami: None. A. Donihi: None. E. Karslioglu French: None. K. Delisi: None. D.S. Hlasnik: None. N. Patel: None. D. Pinkhasova: None. D.J. Rubin: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. M.T. Korytkowski: Advisory Panel; Self; Novo Nordisk Inc.. Other Relationship; Self; JAEB Center For Health Research.
Metformin and Lifestyle Interventions in DPP Do Not Have Long-Term Effects on Bone Density or Falls
Authors: SCHWARTZ ANN V. , PAN QING , ARODA VANITA , CRANDALL JILL P. , KRISKA ANDREA , PIROMALLI CHRISTOPHER S. , TEMPROSA MARINELLA , FLOREZ HERMES ,   DPP RESEARCH GROUP
Published: June 2018

Randomization to lifestyle intervention (ILS) or metformin (MET) in the Diabetes Prevention Program (DPP) resulted in weight loss and reduced progression to diabetes. The long term effects of these interventions on bone mineral density (BMD) and falls, both associated with weight loss, are not known. We determined if ILS or MET was associated with prevalence of osteoporosis, osteopenia or history of falls in the DPP Outcome Study (DPPOS).
During DPP, 3234 participants at high risk for diabetes were randomized to ILS, MET or PLB; 2779 continued in DPPOS and were offered modified group ILS.
During DPPOS, ILS was offered additional lifestyle reinforcement semi-annually and MET received unmasked metformin. This analysis includes 1384 DPPOS participants who had dual-energy X-ray absorptiometry hip scans at year 12 (Y12). Osteoporosis was defined as femoral neck BMD T-score ≤-2.5 and osteopenia as -2.5&lt;T-score≤-1. Participants were asked at Y12 if they had a fall in the previous year. Outcomes were compared across the 3 treatment groups using Pearson’s chi- squared test. Associations between treatment and outcomes were assessed with logistic regression.
Mean age at Y12 was 66.5 (±9.5) years. Mean time since DPP baseline was 15.6 (±0.7) years. Weight loss (DPP baseline to DPPOS Y12) did not differ across treatment groups (-4.4 kg ILS; -3.5 kg MET; -3.1 kg PLB; p=0.114). There were no differences across groups in the prevalence of osteoporosis in men (1.4% ILS, 1.3% MET, 0.7% PLB; p=0.836) or women (2.9% ILS, 2.9% MET, 3.1% PLB; p=0.983). Prevalence of osteopenia was also similar across groups. Prevalence of history of falls was similar across groups in men (16.0% ILS, 16.4% MET, 16.0% PLB; p=0.995) and women (25.7% ILS, 21.3% MET, 21.6% PLB; p=0.342). Prevalence of osteoporosis, osteopenia or history of falls did not differ between ILS or MET and PLB in men or women.
In a cohort at high risk of diabetes, lifestyle intervention or metformin did not have long-term effects on bone density or falls.

Disclosure
A.V. Schwartz: None. Q. Pan: None. V. Aroda: Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Novo Nordisk Inc., AstraZeneca, Calibra Medical, Eisai Inc., Sanofi. Consultant; Self; Sanofi. Research Support; Self; Theracos, Inc.. Employee; Spouse/Partner; Merck & Co., Inc.. Other Relationship; Self; American Diabetes Association. Consultant; Self; ADOCIA. J.P. Crandall: None. A. Kriska: None. C.S. Piromalli: None. M. Temprosa: Other Relationship; Self; Merck KGaA. H. Florez: Advisory Panel; Self; Sanofi. D. Research Group: None.
Joint Associations of Diabetes and Sarcopenia on All-Cause Mortality among U.S. Older Adults
Authors: XIA JIN , SONG YIQING 
Published: June 2018

Background: Recent studies have shown that sarcopenia defined as the loss of muscle mass and/or strength was associated with diabetes and independently predicted all-cause mortality in older adults; however, it is unclear whether sarcopenia and diabetes synergistically affect all-cause mortality.
Methods: We aimed to prospectively examine joint associations of sarcopenia (defined by either low muscle mass (LMM), low muscle strength (LMS), or both) and diabetes on all-cause mortality in a nationally representative sample of U.S. adults, including 4,449 participants aged 50 years and older from NHANES 1999-2002 with linked mortality data. Weighted multivariable logistic regression models were adjusted for age, sex, race, BMI, smoking, alcohol use, education, leisure time physical activity, sedentary time, and comorbid diseases.
Results: Overall, we had 971 with diabetes and 921 with sarcopenia defined by LMM (ALM/BMI), 762 with LMS, 207 with sarcopenia defined by both LMM (ALM/BMI) and LMS. The prevalence of sarcopenia was higher in diabetic than nondiabetic individuals (23.7% vs. 14.6% for LMM, 15.8% vs. 13.8% for LMS, and 4.0% vs. 3.5% for both LMM and LMS). In the joint analyses, diabetic individuals had increased risk of all-cause mortality than those without diabetes or LMM, whether they had LMM (OR=2.79; 95% CI: 1.56-4.98) or not (OR=1.40; 95% CI: 1.02-1.92) (P for joint effect=0.001). LMS was associated with higher risk of all-cause mortality among both diabetic (OR=4.10; 95% CI: 1.59-10.55) and nondiabetic individuals (OR=2.39; 95% CI: 1.77-3.23) (P for joint effect&lt;0.0001). Compared to those without diabetes or sarcopenia (both LMM and LMS), all-cause mortality risk was higher among individuals with sarcopenia alone (OR=1.78; 95% CI: 1.15-2.75) (P for joint effect=0.011).
Conclusions: Our results suggest that LMS was independently and strongly associated with elevated risk of all-cause mortality, with additional risk synergistically with diabetes among U.S. older adults.

Disclosure
J. Xia: None. Y. Song: None.
Secular Trend for Cancer Incidence in Type 2 Diabetic Patients and the Association between Type 2 Diabetic Patients and Cancer between 2004 and 2014
Authors: GUO QI , XU HUILIN , XU DONGLI 
Published: June 2018

Background: Type 2 diabetes mellitus (T2DM) has been suggested to increase the risk of cancers. The aim of this study was to evaluate the secular trend for cancer incidence in T2DM patients in Minhang District of Shanghai and the incidence rate ratios from cancer between T2DM patients and the general population between 2004 and 2014.
Methods: All T2DM patients were enrolled from the standardized management system based on local electronic information system in Minhang District of Shanghai, China. Newly-diagnosed cancer cases were identified by record-linkage with the Shanghai Cancer Registry. The incidence rates (per 100,000) from cancer according to age for the T2DM patients for each year between 2004 and 2014 were calculated. Age-specific incidence from cancer for T2DM patients and their Standardized incidence ratios (SIR) and 95% confidence interval (CI) compared with the general population were estimated.
Results: A total of 2593 T2DM patients (1317 male and 1276 female) aged ≥40 years were included. A trend for an increase in the annual rate was observed for all age groups. The incidence (per 1000, 000) from cancer was 997.17 in male and 829.57 in female, with age-standardized rate (ASR) being 207.12 and 218.57, respectively. The incidence from cancer showed an upward trend with age compared with the general population, except the age of 40- and 45- year in female T2DM patients. The incidence from cancer was 588.16 at ages of 40- years, and 548.79 at ages of 45- years in female. Compared with the general population, an increased risk was observed in female patients, with SIRs being 2.15 (95% CI: 1.13-3.17) at ages of 40- years and 1.49 (95% CI: 1.05-1.93) at ages of 45- years.
Conclusions: We identified a secular trend of an increase in the rate of cancer incidence in the T2DM patients by ages. Our results suggested that a higher risk of cancer incidence in female T2DM patients at age of 40- and 45-years compared with the general population.

Disclosure
Q. Guo: None. H. Xu: None. D. Xu: None.
The Burden of Aging with Diabetes and the Impact of Cognitive Decline
Authors: SMALLS BRITTANY L. , BARDACH SHOSHANA H. , SCHOENBERG NANCY 
Published: June 2018

Objective: T2DM effects approximately 25% of older adults and prevalence of cognitive decline (CD) increases with age. Furthermore, some research suggests that individuals living with these conditions find it difficult to manage their health. The goal of this study was to use the 2015 BRFSS to assess the difference in disease burden experienced by older adults with T2DM and with or without CD.
Research Design and Methods: Older adults with T2DM were assessed for CD based on self-reported affirmative responses to the Cognitive Decline questions. Disease burden was assessed using Healthy Days—Health Related Quality of Life questions. Logistic regression was used to determine the likelihood of disease burden based on cognitive status. Differences in reported days of disease burden between those with and without CD using pairwise comparison of marginal linear predictions. An alpha level of .05 was used.
Results: The sample reported an average of 3 chronic conditions in addition to T2DM. Compared to those without CD, those with CD had a 57% increased likelihood of experiencing poor physical health, were 2.7x as likely to report poor mental health, and had a 97% increased likelihood of reporting poor physical or mental health impeded usual activities, including self-care. There was also a significant difference in the number of days of disease burden reported by those with cognitive decline for poor physical (+6.1 days) and mental health (+5.2 days) and the number of days that poor physical or mental health interfered with usual activities (+4.8 days).
Conclusion: As the population ages, it is imperative to understand how CD influences disease burden and ability to perform T2DM-related self-care activities. Future research is needed to understand, along with cognitive decline, how geriatric syndromes and other chronic conditions contribute to disease burden in older adults. Also, additional research is needed to identify potential social determinants that may be unique to older adults with T2DM.

Disclosure
B.L. Smalls: None. S.H. Bardach: None. N. Schoenberg: None.