bluuebunny/crossref_metadata_2025_split huggingface dataset:
1464-P: Optimal Blood Pressure Goals for Cardiovascular Health in Individuals with Type 1 Diabetes
Authors: GUO JINGCHUAN , MILLER RACHEL G. , COSTACOU TINA , ORCHARD TREVOR J. 
Published: June 2019

The study was aimed to determine optimal blood pressure (BP) goals for minimizing coronary artery disease (CAD) risk in adults with childhood-onset type 1 diabetes (T1D). The Pittsburgh Epidemiology of Diabetes Complications study participants without known baseline CAD (n=605) were recruited and then followed for 25 years. The associations of time-updated cumulative (mmHg-year) and time-weighted (mmHg) BP measures (systolic [SBP], diastolic [DBP], and mean artery pressure [MAP]) with incident CAD were examined using Cox proportional hazard models. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were summarized by different cut-points of time-weighted BPs. Risk stratification analyses were then undertaken based on time-weighted BP (&lt; vs. ≥ 120/80 mmHg) and time-weighted HbA1c (&lt; vs. ≥ 8%). All time-updated cumulative BP measures independently predicted incident CAD over the follow-up period. A dose-gradient association was observed for categorized time-weighted SBP, DBP and MAP in their association with CAD risk. According to both Cox models and AUCs, the optimal cut-points for SBP, DBP and MAP were approximately 120, 80 and 90 mmHg, respectively. Participants with a BP ≥120/80 mmHg, compared to &lt;120/80 mmHg, were associated with 1.9 (95% CI: 1.4, 2.6) times greater risk of developing CAD. Compared to participants with good control of both BP (&lt;120/80 mmHg) and HbA1c (&lt;8%), the high BP only group (HR: 2.0 [1.1, 3.9]) carried a similar risk as compared to high HbA1c only group (HR: 1.6 [0.97, 2.8]). These findings support that lower BP goals (i.e., 120/80 mmHg) than 2018 ADA recommendations (140/90 mmHg) may be needed for young adults with T1D. Lowering BP may further reduce cardiovascular risk in addition to maintaining good glycemic control in these individuals.

Disclosure
J. Guo: None. R.G. Miller: None. T. Costacou: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.

Funding
National Institutes of Health
1470-P: EHR-Based vs. Population-Based CVD Risk Predictions for Diabetes Patients
Authors: ZHONG JUDY , BLAUM CAROLINE , YU JAEHONG , FERRIS ROSIE , HA JINKYUNG , XIA YUHE , KABETO MOHAMMED , CIGOLLE CHRISTINE 
Published: June 2019

Electronic health records (EHR) are an increasingly common data source for studying disease risks, having large sample sizes and frequently sampled clinical predictors/outcomes. In contrast to population-based cohorts, EHRs are not population-representative random samples, as subjects tend to be sicker, with higher healthcare utilization. We compared risk predictions of the same outcome (time to incident CVD) in the same population of interest (DM2 patients &gt;50 years) using 2 data sources: waves 1993-2014 of the nationally representative Health and Retirement Survey (HRS) and 2009-2017 New Langone Health Epic data. In each dataset, we estimated the incidence rate (IR) of subsequent CVD in DM2 patients and adjusted hazard ratios (HR) of CVD risk factors using the Cox-regression model. The HRS sample included 2,739, of whom 423 developed CVD. The NYU-Epic sample included 9,179, of whom 1,264 developed CVD. The estimated subsequent CVD IRs were 28.5 (95% CI: 25.9-31.3) (HRS) and 67.1 (95% CI: 63.5-90.9) (NYU-Epic) per 1,000 person-years since DM2 onset. HR estimates were comparable between the datasets for most demographic covariates/biomarkers (Table). Our findings showed that the EHR sample was enriched with a higher proportion of sicker DM2 patients. Our study supports EHR use in DM2 research: EHR-based HR estimates of CVD risk factors have promise to be population-generalizable despite higher CVD IRs in the EHR samples.

Disclosure
J. Zhong: None. C. Blaum: None. J. Yu: None. R. Ferris: None. J. Ha: None. Y. Xia: None. M. Kabeto: None. C. Cigolle: None.

Funding
National Institute on Aging
1471-P: Visceral and Subcutaneous Adipose Tissue Attenuation Differs by Type 1 and Type 2 Diabetes Status
Authors: KESHAWARZ AMENA , ALMAN AMY C. , LOW WANG CECILIA C. , MITCHELL STACEY , SCHAUER IRENE E. , REUSCH JANE E.B. , REGENSTEINER JUDITH G. , SNELL-BERGEON JANET K. 
Published: June 2019

Adipose tissue (AT) volume and quality may contribute to cardiovascular risk. AT volume and attenuation can be derived from computed tomography (CT) scans, with greater attenuation indicating poor AT quality and increased fibrosis. We examined whether AT quantity and quality were associated with coronary artery calcium (CAC) in a sample of adults without diabetes (non-DM), with type 1 diabetes (T1D), and with type 2 diabetes (T2D).
294 non-DM adults (mean age±SD 55±9 years), 226 adults with T1D (mean age±SD 52±9 years), and 52 adults with T2D (mean age±SD 53±9 years) completed CT scans for CAC measurement and abdominal CT scans at lumbar 4-5 for visceral (VAT) and subcutaneous (SAT) AT volume and attenuation measurement.
Adults with T2D had significantly more VAT and SAT when adjusting for age and sex compared with T1D and non-DM adults, but after adjusting for BMI there was no difference in VAT volume by diabetes status. Adults with T2D had significantly lower SAT volume when adjusted for BMI as compared with both non-DM and T1D adults (157 cm3 vs. 177 cm3 and 183 cm3, p=0.0008). Adults with T1D had significantly higher SAT attenuation as compared with non-DM and T2D adults (p&lt;0.0001 for both). Square root-transformed CAC volume was significantly higher in both T1D (mean volume±SD 10.4±14.7) and T2D (mean volume±SD 9.6±15.9) compared to non-DM adults (mean volume±SD 4.5±8.2). Greater attenuation of VAT and SAT was associated with increased CAC (p=0.03 for both), but there was no association between AT volume and CAC in this sample.
AT attenuation was significantly higher in T1D and independently associated with subclinical atherosclerosis in a sample of non-DM, T1D, and T2D adults. AT fibrosis is associated with metabolic dysfunction, decreased angiogenesis, and increased inflammation; our results suggest that despite similar AT volume, T1D adults have adverse fat quality that may indicate fibrosis. This may be a mechanism through which T1D is associated with greater levels of CAC.

Disclosure
A. Keshawarz: None. A.C. Alman: None. C.C. Low Wang: Advisory Panel; Spouse/Partner; Bayer Healthcare, LLC, CSL Behring, Genentech/Roche, Hema Biologics, Novo Nordisk Pharmaceuticals, Inc, Octapharma Pharmazeutika, Shire. Speaker's Bureau; Self; Medical Education Resources. S. Mitchell: None. I.E. Schauer: Other Relationship; Spouse/Partner; Kestrel Labs. J.E.B. Reusch: Board Member; Self; American Diabetes Association. Other Relationship; Self; Merck & Co., Inc. J.G. Regensteiner: None. J.K. Snell-Bergeon: None.

Funding
American Diabetes Association (7-13-CD-10 to J.K.S-B.)
1476-P: Comparison of Cardiovascular Risk Factors between Type 1 and Type 2 Diabetes
Authors: MOSSLEMI MITRA , PARK HANNAH L. , MCLAREN CHRISTINE E. , WONG NATHAN D. 
Published: June 2019

The incidences of both T1D and T2D are increasing in the U.S., and CVD is the leading cause of death among both cohorts. Despite differences in the underlying pathophysiology of T1D and T2D, CVD prevention approaches for T1D have been widely extrapolated from T2D studies. A few prior studies have compared CVD incidence and mortality rates between patients with T1D and T2D; however, a comparison of CVD risk factors between T1D and T2D within the same study cohort, as a measure of differences in progression to CVD events, has not been done. We thus compared CVD risk factors between patients with T1D and T2D, among U.S. adults (≥age 20) with self-reported diabetes from NHANES 1999-2016. First, we classified diabetes cases (n=5347) into T1D (n=230) and T2D (n=4677) using a treatment-based approach we developed, regardless of age at diagnosis (n=440 excluded as unassigned). Next, we compared the demographics, classical CVD risk factors and diabetes-related risk factors by diabetes type using bivariate analysis, and stepwise model selection. The final model comprised race, age, education, diabetes duration, triglycerides, CKD, BMI, and HbA1c [Table]. The similarity between the final model and the bivariate association results, suggests that differences in CVD risk factors between T1D and T2D are mainly due to the underlying pathophysiology and cannot merely be explained by demographic and diabetes-related differences between the two types.

Disclosure
M. Mosslemi: None. H.L. Park: None. C.E. McLaren: None. N.D. Wong: Advisory Panel; Self; Novartis Pharmaceuticals Corporation. Consultant; Self; Akcea Therapeutics, AstraZeneca. Research Support; Self; Amarin Corporation, Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc.
1484-P: Association between Bariatric Surgery and Cardiovascular Events, Mortality, and Glycemic Control among Diabetes Patients: Evidence from a Large EMR Network
Authors: KURANZ SETH 
Published: June 2019

Introduction: Studies show that cardiovascular (CV) risk among patients with type 2 diabetes (T2D) and obesity is not always well managed by lifestyle changes. The following study used RWD to examine the effect of bariatric surgery (BS) on CV outcomes and glycemic control (GC) among high risk T2D patients.
Methods: In a 1:1 matched propensity score (PS) analysis using the TriNetX database, a federated EMR network representing over 40M patients, T2D patients undergoing BS were compared to T2D patients who were not. Definitions were based on ICD9/10, CPT, RxNorm, and LOINC codes. Patients aged 18-90 were required to have two T2D diagnosis codes 6 months apart, no type 1 diabetes, and a BMI ≥ 30 kg/m2 in the year prior to the index event (IE). The IE was defined by the first BS code in the treated group and the first RxNorm or CPT code in the comparison group. Outcomes of interest were a combined CV event (stroke, MI, or angina) and overall survival (OS). GC (HbA1c &lt; 6.5%) was examined among patients with a HbA1c greater than 9% at baseline. Risk ratios (RR; 95% CIs) and KM curves were calculated for each outcome.
Results: In two matched cohorts of 2,972 patients each, a standardized mean difference of &lt;10% was observed for all variables used to calculate the PS. At the time of the IE, patients were 51 (11) and 50 (13) years old, 69% and 68% female, and 62% and 64% white in the BS and comparison groups, respectively. Patients undergoing BS were 60% (70-50%) less likely to experience a CV event (n = 65 events and 173 events, respectively). The 5-year OS was 97% compared to 94% (p&lt;0.01). In a matched subsample of 904 patients with a HbA1c of &gt; 9% in the year prior to the IE, patients undergoing BS were 3.6 (2.4-5.5) times more likely to achieve a HbA1c of &lt; 6.5 in the 12-18 months after the IE.
Conclusion: This analysis provides RWE to support a growing body of literature that BS reduces the risk of CV events and mortality, and increase glycemic control, among high risk T2D patients.

Disclosure
S. Kuranz: Employee; Self; TriNetX, Inc.
1487-P: Comparison of the Framingham Risk Score, SCORE, and UKPDS Risk Engine for Predicting Cardiovascular Disease Complications in People with Diabetes
Authors: HO JOYCE C. , STAIMEZ LISA R. , NARAYAN K.M. VENKAT , SIMPSON ROY L. , HERTZBERG VICKI S. 
Published: June 2019

The epidemiology of cardiovascular disease (CVD) complications in people with diabetes is changing with the increasing prevalence of presentations other than coronary heart disease (CHD) (e.g., heart failure (HF), cardiomyopathy (CM)). Existing CVD risk estimators such as the Framingham Risk Score (FRS), SCORE, and UKPDS Risk Engine primarily assess CHD risk. Our goal was to assess the prediction accuracy of HF and CM from these risk equations.
We evaluated FRS, SCORE, and UKPDS to predict 1-year risk of CHD, HF, and CM from electronic health records of 469 diabetes patients seen at Emory Healthcare. Only adults without a prior history of CVD at baseline were included. A patient was denoted as a case if s/he had a subsequent ICD-9 code of HF, CHD, or CM at the next visit within a year, and if not, s/he was denoted as a control. We calculated the C-statistic of each score for each disease type.
Our population had an average age of 71 with 47% females and 58% Caucasian. CHD, HF, and CM annual incidence rates were 54%, 44%, and 38%, respectively. Across FRS, SCORE, and UKPDS, CHD had the highest C-statistic (0.589-0.608) with HF the next highest (0.547-0.578). CM (0.369-0.426) performed worse than chance. Moreover, UKPDS performed the best across the three CVD complications. These results suggest that CVD risk estimators need to be calibrated for variations in disease presentation.

Disclosure
J.C. Ho: None. L.R. Staimez: None. K. Narayan: None. R.L. Simpson: None. V.S. Hertzberg: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024); National Library of Medicine (1K01LM012924-01)
1488-P: HbA1c and Potential Misclassification of Diabetes and Prediabetes Diagnoses in the U.S.
Authors: STAIMEZ LISA R. , KIPLING LAUREN , FORD CHRISTOPHER N. , HAM J. NINA , RHEE MARY K. , PHILLIPS LAWRENCE S. 
Published: June 2019

HbA1c levels are widely used for diabetes diagnosis and management but may misrepresent underlying glucose levels. To assess potential misdiagnoses of diabetes (T2DM) and prediabetes (PreDM) by HbA1c, we examined representative samples of non-pregnant adults and youth in the National Health and Nutrition Examination Survey (NHANES), 2005-2016, who had a 75g OGTT. Normal glucose metabolism (NGM), PreDM, and T2DM were defined by ADA criteria. For each glycemic group, a linear regression model of HbA1c vs. glucose (i.e., mean of FPG and 2hrPG) yielded predicted HbA1c for each participant. The Hemoglobin Glycation Index (HGI), defined as observed - predicted HbA1c, was partitioned into tertiles. Of 10,737 adults aged 18-79 year (representing N=199,270,935), 52% female and 10% non-Hispanic black, with mean age 43.7 year and BMI 28.5 kg/m2. By OGTT criteria, 81.2% had NGM, 14.1% PreDM, and 4.6% T2DM. The high HGI tertile had a higher proportion of non-Hispanic black race (17.7%, vs. middle 8.7%, low 7.0%), as well as higher mean BMI and age, all p&lt;0.0001. A higher proportion of black race in the high HGI tertile was also found in adults &gt;65 year (p=0.0016, weighted N=24,142,366) and youth aged 12-17 year (p&lt;0.0001, n=2,218, weighted N=25,302,585). Across HGI tertiles, the distribution among diagnostic categories was similar by OGTT criteria, but differed by HbA1c criteria; those in the high HGI tertile were 53.7% PreDM and 3.5% T2DM - mostly abnormal, while those in the low HGI tertile were 98.0% NGM and 1.0% PreDM - mostly normal, with a similar pattern in older adults and youth, all p&lt;0.0001. Across all age groups, 15% (weighted N=33,569,933) had clinically significant HGI deviations of &gt;0.5%.
Conclusion: Diagnostic classification by HbA1c alone could lead to misdiagnosis in over 33 million Americans, a problem across all age groups. Overdiagnosis is a particular risk in those with black race, higher BMI, and older age. Complementing HbA1c with glucose testing should improve diagnostic classification and management.

Disclosure
L.R. Staimez: None. L. Kipling: None. C.N. Ford: None. J. Ham: None. M.K. Rhee: None. L.S. Phillips: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. Research Support; Self; AbbVie Inc., GlaxoSmithKline plc., Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc. Stock/Shareholder; Self; Diasyst Inc. Other Relationship; Self; Diasyst Inc., Janssen Pharmaceuticals, Inc.
1495-P: Distance to Glycemic Target of Patients (Pts) with Type 2 Diabetes (T2D) and Established Cardiovascular Disease (eCVD) and/or Chronic Kidney Disease (CKD) Failing Metformin Monotherapy in the U.S.
Authors: FERNANDES GAIL , SAWHNEY BAANIE , HANNACHI HAKIMA , WANG TONGTONG , MCNEILL ANN MARIE , IGLAY KRISTY , RAJPATHAK SWAPNIL 
Published: June 2019

Previous studies have shown that a large proportion of pts with T2D are not at glycemic target, but the distance to target is not well characterized, including among high risk patients such as those with eCVD/CKD. The objective of the study was to assess the distance to glycemic target by eCVD/CKD status. This retrospective study using GE Centricity Electronic Medical Record database (2016 data) included adult T2D pts on metformin monotherapy with ≥12 months of enrollment prior to index date (initiation of metformin) and prescribed an add-on agent. Distance to target was calculated as median difference from 3 HbA1c targets: &lt;7%, &lt;7.5% and &lt;8%. Of the 1741 included pts, mean age was 57 years, 49% were female, 25% had eCVD/CKD. Table shows the distance to glycemic targets by eCVD/CKD status. Median difference from target ranged from 0.2%-1.2% depending on the specified threshold. 44.6%, 33.6% and 25.6% of pts were ≥1.5% away from targets of 7%, 7.5% and 8%, respectively, at time of add-on therapy. Difference from target and proportion of pts ≥1.5% from target was even higher for those without compared to with eCVD/CKD.
In conclusion, a significant proportion of pts on metformin are more than 1.0% away from glycemic targets at the time of intensification and those without eCVD/CKD are likely to be intensified at much higher HbA1c.

Disclosure
G. Fernandes: None. B. Sawhney: Consultant; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson & Johnson. Employee; Self; Merck & Co., Inc. A. McNeill: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: None.
1499-P: Apolipoprotein C-III as a Novel Predictor for T2D Incidence in Amerindians
Authors: HSUEH WEN-CHI , WALTER MARY , NELSON ROBERT , KNOWLER WILLIAM C. , HANSON ROBERT L. 
Published: June 2019

Amerindians, particularly Pima Indians, are at high risk for type 2 diabetes (T2D). Our previous studies have shown that lipid levels (high triglycerides or TG, and low HDL-cholesterol, or HDL-C) are important predictors of T2D incidence. There are few data on the extent to which apolipoprotein levels, particularly apolipoprotein CIII (apoC-III), which is a potential therapeutic target to treat high TG, predict T2D. Thus, we examined whether circulating apolipoprotein levels predict T2D risk in addition to known risk factors. We measured serum TG, HDL-C and 5 apolipoprotein levels (apoA-I, apoA-V, apoB100, apoC-III, apoE), in 1,916 nondiabetic Pima Indians at baseline (mean age=31.2±10 years, 43% male). After mean follow-up of 6.26 years, ∼24% of subjects (n=454) developed T2D.
BMI, HDL-C and TG predicted T2D, when adjusted for sex and age (hazard ratio [HR] per s.d. unit was 1.05, 0.74 and 1.18, respectively; all p&lt;0.0005). TG had moderate correlation with apoC-III (r=0.68), apoE (r=0.56) and HDL-C (r=-0.31). With adjustment for age and sex, only apoA-V predicted T2D incidence (HR=1.12 P=0.02). When effects of BMI, HDL-C, TG and each one of 5 apoliproteins were evaluated together, the apoA-V effect was attenuated (HR=1.09, p=0.08). However, higher apoC-III was protective for T2D incidence (HR for apoC-III=0.83, p=0.007; HR=1.43, 0.87, and 1.29 for BMI, HDL-C, and TG, respectively, all p&lt;0.05). Formal significance testing for apoC-III effect showed that it has distinct predictive value for T2D incidence in addition to TG (0.008). As TG and apoC-III are positively correlated, apoC-III may be a risk factor for T2D. However, our findings suggest that, controlled for BMI, TG and HDL-C levels, apoA-I, apoA-V, apoB100 and apoE add little information about T2D risk prediction, whereas higher apoC-III is associated with reduced T2D risk. The mechanisms underlying this association are not presently known.

Disclosure
W. Hsueh: None. M. Walter: None. R. Nelson: None. W.C. Knowler: None. R.L. Hanson: None.

Funding
National Institutes of Health
15-OR: Renal Outcomes from the DECLARE-TIMI 58 Trial: Quantifying the Health-Care Implications
Authors: MCEWAN PHILIP , KARTMAN BERNT , BENNETT HAYLEY , EDMONDS CHRISTOPHER , GAUSE-NILSSON INGRID ANNA 
Published: June 2019

Chronic kidney disease (CKD) and end stage renal disease (ESRD) pose a significant global health burden. Approximately 40% of people with type 2 diabetes develop CKD. The Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 trial showed a reduced rate of the composite endpoint of sustained decrease of ≥40% in estimated glomerular filtration rate (eGFR) to &lt;60 mL/min/1.73m2, ESRD, or renal death when comparing dapagliflozin (DAPA) to placebo (PBO) (hazard ratio 0.53; 95% CI 0.43, 0.66). This study aimed to quantify the implications of renal outcomes from DECLARE-TIMI 58, in terms of direct healthcare costs and resource use. DECLARE-TIMI 58 event rates were used to characterize expected numbers of patients experiencing sustained decrease of ≥40% in eGFR to &lt;60 mL/min/1.73m2 (‘CKD progression’) or ESRD, per 1,000 patients over a 4-year time horizon. Renal replacement therapy (RRT) was assumed following the incidence of ESRD events only and the distribution of RRT modalities based on U.S. Renal Data. Published annual U.S. costs (2017 $) of ESRD and excess healthcare associated with CKD stage 3 versus CKD stage 2 were applied and discounted at 3% annually. Per 1,000 patients, PBO was associated with 25.6 CKD progression events and 2.4 ESRD events over four years, while DAPA was associated with 11.8 (-46%) and 1.6 (-67%) fewer events, respectively. Consequently, over 4 years DAPA was estimated to avoid 1,126 days of RRT per 1,000 patients, of which over 70% relate to a need for dialysis. The estimated cost of CKD progression and ESRD associated with PBO was $460,277 per 1,000 patients over 4 years, while costs associated with DAPA were an estimated $285,444 lower (-62% versus PBO). Economic modelling utilizing renal outcomes data from DECLARE-TIMI 58 indicate that treatment with DAPA may translate into renal cost savings within a short-term horizon. Potential delays to ESRD may have a more profound impact on patients’ quality of life, cost savings, and service delivery over the longer-term.

Disclosure
P. McEwan: Consultant; Self; AstraZeneca. Employee; Self; Health Economics and Outcomes Research Ltd. B. Kartman: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. H. Bennett: Consultant; Self; AstraZeneca. Employee; Self; Health Economics and Outcomes Research Ltd. C. Edmonds: Employee; Self; AstraZeneca. I.A. Gause-Nilsson: Employee; Self; AstraZeneca.

Funding
AstraZeneca