bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safer Glycemic Control Using Fructose-Based Enteral Formula—A Randomized Crossover Clinical Trial
Authors: KUMBIER MAGALI , TEIXEIRA CASSIANO , HELAL LUCAS , ALMEIDA JUSSARA 
Published: June 2018

Background: Glycemic control during nutritional therapy in patients under intensive care has shown a great importance in relation to morbidity and mortality. To avoid glycemic oscillation in patients under enteral nutrition, usually a low-carbohydrate diet is offered, but differing among themselves by carbohydrate type. A question that remains unanswered is whether the presence of fructose interferes with glycemic oscillation or not.
Objective: The aim of this clinical trial was to evaluate the effect of two diabetes-specific diets (fructose-based vs. maltodextrin-based) in the glycemic variability of critically ill patients. We hypothesized that patients under the fructose-based diet would have lower glycemic variability.
Materials and Methods: This is a randomized, active-controlled, double-blinded crossover clinical trial comparing diabetes-specific enteral formula with and without fructose in critically ill patients. Twenty-five patients, who developed hyperglycemia during intensive care unit stay, were included. Patients were randomized to receive each diet for 2 days. Capillary blood sample was taken every 4 hours and glycemic variability was defined as the difference between each time point. A significance level of 0.was defined for all statistical inferences.
Results: Patients which underwent the fructose-based diet reduced their glycemic variability against that under usual care overtime -11.92 mg/dL (95% CI -19.22 to -4.63 mg/dL), p = 0.0013 for between-group differences. We observed also some differences on specific time frames, especially in measures 6, 8 and 12. This effect was seen without any risk of hypoglycemia and complications.
Conclusions: Diabetes-specific enteral formula with fructose was associated with lower glycemic variability in critically ill patients when compared to diabetes-specific enteral formula without fructose.

Disclosure
M. Kumbier: None. C. Teixeira: None. L. Helal: None. J. Almeida: None.
Relationship of Vitamin B12 and Homocysteine Status with Nephropathy and Neuropathy in Metformin-Treated Patients with Type 2 Diabetes
Authors: PATIL SHIVAJIRAO , PAWLAK ROMAN , THOMBARE APARNA , BALTARO RICHARD , HICKS KRISTIE , CUMMINGS DOYLE M. 
Published: June 2018

Limited evidence suggests that both vitamin B12 (B12) and homocysteine (Hcy) status are impacted by metformin use and may be associated with diabetes complications. The goal of this research project was to assess the cross-sectional association between B12 and Hcy status and kidney function and neuropathy among patients with type 2 diabetes (T2D) taking metformin. Adult patients in an academic primary care clinic (n = 52; mean age = 53 ± 12.5 years; female 56%; African American 70%) with T2D (mean duration = 9.8 year) and taking metformin (mean duration = 9.2 year) provided informed consent and had blood and urine specimens drawn for: A1c, B12, Hcy, serum creatinine (sCr), urine albumin/creatinine ratio, and eGFR. Neuropathy was assessed using the validated Michigan Neuropathy Screening Instrument. Mean B12 and Hcy levels were 568.7pg/ml and 12.85 µmol/L, respectively. Serum B12 was significantly correlated with Hcy (r = -0.3, p = 0.035) and with A1c (r = 0.36, p = 0.01). Hcy was significantly correlated with both sCr (r = 0.70: p = 0.0001) and eGFR (r = -0.68; p = 0.0001). While B12 was not directly correlated with either diabetes duration or duration of metformin therapy, the correlation of B12 with total metformin exposure (dose x years) approached significance (r = -0.26; p = 0.06). There was no relationship of either B12 or Hcy with neuropathy scores. The bivariate relationship of B12 and Hcy to renal function measures was not different in patients with a diabetes duration of less than 10 years vs. 10 or more years. Consistent with previous studies our findings suggest that B12 status, in addition to correlating with renal function, correlated with glycemic control. Periodic measurement of B12 status should be considered in metformin-treated patients with T2D.

Disclosure
S. Patil: None. R. Pawlak: None. A. Thombare: None. R. Baltaro: None. K. Hicks: None. D.M. Cummings: None.
Decrease in High Readings and Severe Hyperglycemic Events for People with T2D over the Full Year of 2017 in Users Monitoring with a Digital Diabetes Management System
Authors: HERSHCOVITZ YIFAT , DAR SHARON , FENIGER EITAN 
Published: June 2018

One of the goals of a digital diabetes management system is to improve patient’s self-management and control of their condition. High blood glucose level is defined as 180-400 mg/dL while severe hyperglycemia (above 400 mg/dL) is considered a medical emergency. Digital engagement can play a pivotal role in the care of patients with diabetes and other chronical conditions, assisting patients to enhance their compliance. The DarioTM Blood Glucose Monitoring System (BGMS) connects physically to a smart mobile device and automatically logs blood glucose measurements into designated App. Data is transmitted to the Dario cloud.
Method: A retrospective data evaluation study was performed on the DarioTM cloud database. A population of active type 2 diabetic (T2D) users that continuously measured their blood glucose using DarioTM BGMS during the full year of 2017 was evaluated. The study assessed the ratio of high (180-400 mg/dL) and hyperglycemic (&gt;400mg/dL) blood glucose readings during full year of 2017 as recorded in the database. The average of high and hyperglycemic glucose readings were calculated in periods of 30-60, 60-90, 90-120, 120-150, 150-180, 180-210, 210-240, 240-270, 270-300, 300-330, 330-360 days and compared to first 30 days as a starting point of analysis.
Results: For 225 T2D active users the ratio of high events (180-400 mg/dL) was reduced gradually in 19.6% (from 23.4% to 18.8% of the entire measurements) from baseline compared to the 12th month of the year. Moreover, the ratio of severe hyperglycemia events (&gt;400 mg/dL) was decreased in 57.8% (from 0.90% to 0.38% of the entire measurements) at the same period.
Conclusion: By means of glucose meter and App patients have the potential to promote behavioral modification and enhance adherence to diabetes management, demonstrating better glycemic control.

Disclosure
Y. Hershcovitz: Employee; Self; DarioHealth. S. Dar: Employee; Self; DarioHealth. E. Feniger: Employee; Self; DarioHealth.
Effect of Fiber Intake on Glycemia, Insulin Secretion, and Inflammation in Patients with Type 2 Diabetes
Authors: TANG CHI , GHANIM HUSAM , GREEN KELLY , MAKDISSI ANTOINE , BATRA MANAV , CHAUDHURI AJAY , DANDONA PARESH 
Published: June 2018

Hypothesis. In view of the reduction in post prandial glucose concentrations and an increase in insulin concentrations and the inhibition of post prandial endotoxemia and increases in TLR-4 and TLR-2 expression following the intake of fiber with a high fat high calorie meal (HFHC) in normal subjects, we hypothesized that a similar effect would be observed following the intake with such a meal in patients with type 2 diabetes.
Methods. Ten patients with type diabetes were included in the study and were administered the HFHC meal alone on one day and with dietary fiber (28gram of mainly insoluble fiber) a week later. Fasting premeal and post meal samples were obtained sequentially at hourly intervals for 5 hours. Blood samples were processed for preparation of peripheral blood mononuclear cells (MNC), plasma and serum.
Results. Post meal glucose concentrations were not altered significantly but the peak increase in post meal insulin concentrations was greater after fiber (34±6 vs. 26±4µU/ml, p&lt;0.01) as well as the area under curve (AUC5h) (3234±733 vs. 2214±464µU*5h*ml-1, p&lt;0.01). Fiber intake also induced an early peak of GLP-1 within 15 minutes (29±15% over baseline, NS) which was missing without fiber. Reactive oxygen species (ROS) generation and NFκB binding by MNC was significantly suppressed after fiber by 32±11% and 38±13%, respectively (p&lt;0.01), as was the magnitude of endotoxemia AUC5h by 23±8% (p&lt;0.05). In addition, the increase in the expression of TLR-4 and TLR-2 was also suppressed by 42±15% and 36±14%, respectively (p&lt;0.05)
Conclusions. The intake of fiber resulted in an early peak of GLP-1 and a greater increase in insulin concentrations but the increase in glucose was not altered. Fiber intake also suppressed ROS generation and NFκB binding while reducing the magnitude of endotoxemia and the receptor to endotoxin. Thus, the intake of fiber increases insulinogenesis and reduces oxidative and inflammatory stress in patients with type 2 diabetes.

Disclosure
C. Tang: None. H. Ghanim: None. K. Green: None. A. Makdissi: Speaker's Bureau; Self; Eli Lilly and Company. M. Batra: Speaker's Bureau; Self; Eli Lilly and Company. A. Chaudhuri: Speaker's Bureau; Self; AstraZeneca, Eli Lilly and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc. P. Dandona: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca.
The Effect of Two Isocaloric and Energy-Matched Plant-Based and Processed-Meat Meals on Glucose Metabolism, Gastrointestinal Hormones, and Satiety in Subjects with T2D, Obese Subjects, and Healthy Controls—A Randomized Crossover Study
Authors: KLEMENTOVA MARTA , BELINOVA LENKA , HALUZIK MARTIN , PAVLOVICOVA RENATA , HILL MARTIN , PELIKANOVA TEREZIE , KAHLEOVA HANA 
Published: June 2018

Objective: Gastrointestinal hormones play a key role in glucose metabolism and energy homeostasis.
Methods: A randomized cross-over study was used to test the effects of two energy- (600 kcal) and macronutrient-matched plant-based and processed-meat meals (41% carbohydrates, 19% protein, and 40% lipids) on glucose metabolism, plasma concentrations of gastrointestinal hormones, and satiety in subjects with T2D (n=20), obese subjects (n=20) and healthy controls (n=20). Plasma concentrations of glucose, immunoreactive insulin, C-peptide, GLP-1, GIP, amylin and PYY, along with satiety, were determined at 0, 30, 60, 120 and 180 min. Repeated-measures ANOVA was used for statistical analysis.
Results: An increase in stimulated secretion of immunoreactive insulin was observed in T2D and obese subjects (p=0.005, and p=0.045, respectively) after the plant-based meal. We observed an increase in stimulated secretion of C-peptide in all groups after the plant-based meal (p&lt;0.001 for T2D, p=0.014 for obese subjects, and p=0.001 for healthy controls). An increase in postprandial concentrations of amylin was observed in T2D and healthy controls after the plant-based meal (p&lt;0.001 for both groups). An increase in stimulated secretion of GLP-1 was observed in T2D obese subjects and healthy controls (p&lt;0.001, and p=0.01, respectively) after the plant-based meal. A decrease in peak concentrations of GIP (at 60 min.), and an increase in peak concentrations of PYY, were observed in all groups after the plant-based meal. The participants in all groups reported greater satiety after the plant-based meal (p=0.004 for T2D, p&lt;0.001 for obese subjects, and p&lt;0.001 for healthy controls).
Conclusions: Our study suggests that plant-based meals may be effective in increasing stimulated secretion of GLP-1, insulin, amylin and PYY, as well as in promoting satiety.

Disclosure
M. Klementova: None. L. Belinova: None. M. Haluzik: None. R. Pavlovicova: None. M. Hill: None. T. Pelikanova: None. H. Kahleova: None.
Motivational Interviewing to Improve Insulin Acceptance in Insulin-Naïve Korean Patients with Type 2 Diabetes
Authors: SONG YOUNGSHIN , CHO JEONGHWA , LEE HYUNJIN , PARK KEUMOK , LEE YOONHEE , KIM BOHYUN , SEO KAWOUN , LIM ANCHO , JUN YOUNGHEE , NAM SOOHYUN 
Published: June 2018

Despite the well documented effectiveness of insulin on glycemic control, many patients with type 2 diabetes are reluctant to receive insulin therapy, called Psychological Insulin Resistance (PIR). Motivational Interviewing (MI) is a client-centered counseling method that may improve PIR and insulin acceptance behavior. The purpose of the study was to examine the effect of MI on insulin acceptance in insulin naïve patients with type 2 diabetes. Participants were recruited from outpatient clinics in two academic affiliated hospitals in South Korea. A matched subjects design was used to allocate the intervention (n=55) and control (n=55) groups based on age, gender, and the stage of intention to receive insulin therapy. The stages of intention to receive insulin therapy were pre-contemplation, contemplation, and action stages. Sociodemographic and clinical factors (years of diabetes diagnosis, medications, HbA1c, comorbidity) were collected by chart reviews. Six MI sessions (2 face-to-face [60 min/session] + 4 telephone sessions [20 min/session]) were provided to the intervention group by 6 trained nurses for 3 months. The effect of MI was measured by attitudes toward diabetes, PIR, and intention to receive insulin therapy at baseline and at 3 months using validated measures. Data were analyzed with paired t-test, t-test, and χ²-test. There was no significant difference in clinical factors, attitudes toward diabetes, PIR, and intention to receive insulin therapy between intervention and control groups at baseline. After the 6 MI sessions, the intervention group improved the intention to receive insulin therapy (χ²=10.44, p=.01) and attitudes toward diabetes (t=2.60, p&lt;.01), and &lt;significantly decreased PIR (t=-2.71, p&lt;.01). MI combined with face-to-face and telephone sessions may be an effective strategy to improve attitudes toward diabetes, PIR, and intention to receive insulin therapy in insulin naïve Korean patients with type 2 diabetes.

Disclosure
Y. Song: None. J. Cho: None. H. Lee: None. K. Park: None. Y. Lee: None. B. Kim: None. K. Seo: None. A. Lim: None. Y. Jun: None. S. Nam: None.
Stigmatization of Adults with Type 1 Diabetes in Asia
Authors: LAM AMANDA Y.R. , GARDNER DAPHNE , RAMA CHANDRAN SURESH , TEO EDMUND P. , ZHU LING , KOH GERALD , GOH SU-YEN 
Published: June 2018

Background: Type 1 diabetes (T1D) is uncommon in Asia. Limited awareness can lead to stigmatization of those with T1D.
Aims: We aimed to evaluate diabetes stigma in adults with T1D in Singapore.
Methods: This was a cross-sectional sampling of adults with T1D in a tertiary public hospital, using the Type 1 Diabetes Stigma Assessment Scale (DSAS-1). Higher scores indicate greater levels of stigma.
Results: 125 Singaporeans (mean age 31.2 ± 11.2 y), T1D duration 13.8 ± 7.3 y, M/F: 51/74, 107 on insulin injections, 18 on insulin pumps were sampled. Item response patterns (Figure) suggest a greater burden of stigma in the blame and judgment and identity concerns subscales. DSAS-1 scores did not differ by gender, treatment regimen, age, education level or employment. Identity concerns subscale scores were lower in those with T1D for &gt;10y (n=73) than those with shorter T1D duration (18.9 ± 5.6 v 21.7 ± 7.3, p=0.045). Total DSAS-1 and subscale scores were similar to those of an Australian (Oz) cohort (n=900) (Sg-v-Oz: Total score 53.1 ± 12.9 vs. 53.0 ± 15.6, Treated differently 13.6 ± 4.0 v 13.6 ± 5.4, Blame and Judgment 19.9 ± 5.2 v 19.9 ± 6.0, and Identity Concerns: 19.6 ± 6.4 v 19.5 ± 7.2, all p&gt;0.05).
Conclusion: This is novel data documenting significant levels of diabetes stigma among adults in Singapore, particularly relating to blame and judgment and identity concerns. Despite the low prevalence of T1D in Asia, levels of stigma appeared similar to that of an Australian T1D cohort.

Disclosure
A.Y.R. Lam: None. D. Gardner: None. S. Rama Chandran: None. E.P. Teo: None. L. Zhu: None. G. Koh: None. S. Goh: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim GmbH, Amgen Inc., Novo Nordisk A/S, Sanofi-Aventis, Servier.
Imeglimin Protects INS-1 Cells and Human Islets against High Glucose– and High Fructose–Induced Cell Death by Inhibiting the Mitochondrial PTP Opening
Authors: LABLANCHE SANDRINE , TUBBS EMILY , COTTET-ROUSSELLE CÉCILE , LAMARCHE FREDERIC , MOISAN ANAÏCK , PERSOONS VIRGINIE , BENHAMOU PIERRE Y. , HALLAKOU-BOZEC SOPHIE , FONTAINE ERIC 
Published: June 2018

Imeglimin (IME) is a novel glucose-lowering agent improving insulin secretion in response to glucose and insulin sensitivity by targeting mitochondrial bioenergetics. IME is currently in phase 3 in Japan. The toxicity of high glucose or fructose concentrations in INS-1 cells was linked to the opening of the permeability transition pore (PTP), a mitochondrial channel involved in cell death. IME has been shown to prevent PTP opening in human endothelial cells under oxidative stress. This study investigated whether IME could also prevent PTP opening and cell death induced by high glucose or fructose concentrations in INS-1 cells and human pancreatic islets. PTP status in intact cells was assessed by confocal microscopy by measuring mitochondrial membrane potential (TMRM) and NAD(P)H (autofluorescence). Cell viability was measured by flow cytometry. In INS-1 cells and human islets, 30 mM Glucose or 2.5 mM Fructose for 24h led to PTP opening (increase in the NAD(P)H/TMRM ratio), this phenomenon being prevented by 100µM IME. Compared to normal glucose concentration (100%), cell viability significantly decreased (p&lt;0.05) in cells exposed to 30 mM Glucose (76±5% and 47±18% in INS-1 cells and human islets, respectively) and to 2.5 mM Fructose for 72h (78±3% and 35±11% in INS-1 cells and human islets, respectively) but remained unchanged when these cells were preincubated with 100µM IME (in 30mM glucose: 94±3% and 98±3% / in 2.5mM fructose: 96±4% and 79±6% in INS-1 cells and human islets, respectively). We conclude that (i) IME is able to prevent high glucose and fructose-triggered cell death through an inhibition of PTP opening and (ii) a PTP-targeted strategy can prevent beta cell death. In addition to its beneficial effect on beta cell function, IME may have the potential to preserve beta cell mass in a dysmetabolic environment via its inhibitory effect on PTP opening.

Disclosure
S. Lablanche: Other Relationship; Self; Poxel SA. E. Tubbs: None. C. Cottet-Rousselle: None. F. Lamarche: None. A. Moisan: None. V. Persoons: None. P.Y. Benhamou: Consultant; Self; Abbott, Sanofi, Novo Nordisk Inc.. Other Relationship; Self; Eli Lilly and Company, Roche Diabetes Care Health and Digital Solutions. Advisory Panel; Self; Diabeloop S.A.. S. Hallakou-Bozec: None. E. Fontaine: Other Relationship; Self; Poxel SA.
Blog Use Is Associated with Lower Hemoglobin A1c in Adults with Type 1 Diabetes
Authors: OSER SEAN M. , OSER TAMARA , MCGINLEY ERIN L. , BERG ARTHUR , STUCKEY HEATHER L. 
Published: June 2018

Recent technological advances in T1D self-management include not only devices like glucose meters, insulin pumps, and continuous glucose monitors (CGM), but also social media and the ability to find peer support more easily and quickly than ever. However, it is largely unknown how some social media, including blogs, are used in self-management and what effects they might have. This study compared A1c in adults with T1D who read T1D-themed blogs and adults with T1D who do not read such blogs.
Methods: Participants were recruited online through popular T1D-themed blogs and through a mailing to adults with T1D listed in the Penn State diabetes registry. Self-reported A1c, blog use, insulin pump use, CGM use, and sociodemographic factors were assessed. Univariate analysis evaluated for A1c differences between groups across variables including blog use, insulin pump use, and CGM use. Linear regression adjusted for significant covariates.
Results: 282 completed surveys were received (214 blog readers, 68 blog non-readers). A1c was lower for blog readers than blog non-readers (7.vs. 7.48, P=.006), for insulin pump users than multiple daily injections (7.04 vs. 7.65, P=.001), and for CGM users than CGM non-users (6.99 vs. 7.47, P=.001). After adjusting for significant covariates, the association between blog use and A1c remained significant (P=.039).
Conclusions: Reading T1D-themed blogs was found to be associated with glycemic control; self-reported A1c was 0.43% lower among blog readers than among blog non-readers, a clinically significant difference approaching the magnitude seen with CGM use (0.48%) and insulin pump use (0.61%). The A1c differences among pump users and CGM users in this study are similar to those found by others, lending support to the likelihood of a true association between A1c and blog use. To our knowledge, this is the first study to evaluate blog use and A1c and therefore the first to find an association between them. Further research should seek to explain the reasons for this association.

Disclosure
S.M. Oser: None. T. Oser: None. E.L. McGinley: None. A. Berg: None. H.L. Stuckey: Consultant; Spouse/Partner; Calibra Medical, Eli Lilly and Company. Research Support; Spouse/Partner; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc..
Diabetes Distress and Glycemic Control in Working People with Type 1 Diabetes—The Role of Intentional Hyperglycemia at Work
Authors: HANSEN ULLA M. , OLESEN KASPER , SKINNER TIMOTHY C. , WILLAING INGRID 
Published: June 2018

Aims: We set out to test the hypothesis that intentional hyperglycemia at work (henceforward IHW) mediates the link between diabetes distress and glycemic control in working adults with type 1 diabetes.
Methods: Clinical information on HbA1c, complications, diabetes duration and age was linked with self-report measures of psychosocial health and work life from people with type 1 diabetes of working age attending a specialist diabetes clinic in Denmark. Diabetes distress was assessed with a work-comprehensive measure encompassing the PAID-5 and two additional items assessing distress in reconciling diabetes and work life. IHW was assessed with one item. Glycemic control was assessed with HbA1c. Using structural equation modeling techniques we modelled a theory-based structural path model and tested the mediation hypothesis using bootstrap estimates and goodness-of-fit tests.
Results: The sample consisted of 1,126 working adults with type 1 diabetes. The model suggested that the effect of diabetes distress on glycemic control was fully mediated by IHW. Diabetes distress was associated with more frequent IHW (β = .23, p &lt; .001) which in turn was associated with elevated HbA1c (β = .28, p &lt; .001). The final model was able to account for 20% of the variance of IHW, and 11% of the variance in glycemic control. There was an excellent fit to the data according to established criteria (in parenthesis); X2/DF=3.3 (&lt;5), GFI=.995 (=.95), CFI=.990 (=.95), RMSEA=.047 [.030-.065] (&lt;.050).
Discussion: This study highlights the role of IHW as a mediator for the link between diabetes distress and glycemic control specific to working adults with type 1 diabetes. A sound understanding of the mechanisms linking diabetes distress to suboptimal glycemic control in working people with type 1 diabetes can inform intervention development and ultimately increase the chance of improving diabetes self-care and quality of life of working people with type 1 diabetes.

Disclosure
U.M. Hansen: None. K. Olesen: None. T.C. Skinner: Board Member; Self; Decision Support Analytics. I. Willaing: None.