bluuebunny/crossref_metadata_2025_split huggingface dataset:
130-OR: Does the Duration of Prediabetes Status Affect Reversibility with Lifestyle Intervention?
Authors: UMEKWE NKIRU A. , OWEI IBIYE , BREWER AMY A. , FRENCH LINDSEY , JAMES DEIRDRE J. , ARIGANJOYE FOLABI , DAGOGO-JACK SAMUEL 
Published: June 2019

Background: Intensive lifestyle intervention (ILI) prevents progression from prediabetes (Predm) to type 2 diabetes (T2D). Here we assessed reversion to normal glucose regulation (NGR) following ILI.
Subjects and Methods: The PROP-ABC (Pathobiology and Reversibility of Prediabetes in a Biracial Cohort) study followed an established cohort of African Americans (AA) and European Americans (EA) with parental T2D for 5 years and initiated ILI in subjects with Predm and those with newly incident Predm. ILI was started after variable intervals from onset of Predm, targeting 10% weight loss through calorie restriction, physical activity, and meal replacements. Serial assessments included anthropometry, fasting plasma glucose (FPG) and lipid levels, OGTT, IVGTT and insulin sensitivity. The primary endpoint was reversion to NGR.
Results: We studied 210 PROP-ABC participants: mean (SD) age 53.3(9.28) y; BMI 30.6(6.70) kg/m2; 70% female, 52.4% AA, 47.6% EA. Predm subjects (N=138) initiated ILI after a latency of 4.08 (2.02) years (range 3 months-8 years), and were stratified into &lt; 3 years (n=32), 3-5 years (n=59) or &gt;5 years (n=47), between onset of Predm and initiation of ILI. Control (N=72) were NGR subjects not receiving ILI. After 5y, FPG (-6.91±1.13 mg/dl vs.1.23 ± 1.43 mg/dl, P=0.0008), 2hPG (-8.23 ±3.27 mg/dl vs.-4.90 ± 8.63 mg/dl, P=0.08) and weight (-2.64 ± 0.85 kg vs. 1.24±1.13 kg, P= 0.04) decreased among ILI participants vs. control. Reversion to NGR occurred in 43.5%, stable Predm in 50%, and T2D in 6.5%. These outcomes did not differ significantly by time to initiation of ILI (chi-square P=0.901). Reversion to NGT occurred within 12 months of ILI and was significantly predicted by BMI, waist size, insulin sensitivity, insulin secretion, and HDL-c (P= 0.04-0.001).
Conclusion: Starting ILI within 3 months to 8 years of occurrence of prediabetes prevented T2D in &gt;90% and restored NGR in ~44% of AA and EA subjects with parental T2D, regardless of time to initiation of ILI.

Disclosure
N.A. Umekwe: None. I. Owei: None. A.A. Brewer: None. L. French: None. D.J. James: None. F. Ariganjoye: None. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.

Funding
National Institutes of Health (R01DK067269)
1301-P: An Analysis of Correlative Factors of HbA1c Achieving Rate in Follow-Up Cohort of Internet plus Diabetes Shared Care Clinic
Authors: LI ANG , YUAN XIAOYONG , LIN LIU , LU DIFEI , ZHANG DONGHUI , SUN YALAN , LI JUN , JING LULU , WANG YANNI , GUO XIAOHUI , ZHANG JUNQING 
Published: June 2019

Objectives: Our study aimed to investigate the correlative factors of HbA1c achieving rate in diabetic patients followed-up in Internet plus Diabetes Shared Care Clinic (IDSCC) in General Hospital.
Methods: Patients who were regularly followed-up in IDSCC were enrolled in the study from Oct. 2016. Up to Dec. 2018, demographic data of patients, HbA1c of each follow-up, diabetic medication and education power during online and offline follow-ups were recorded. Patients were divided into two groups according to whether HbA1c achieve target (&lt;7%) or not at the last follow-up. Logistic regression analysis was performed to analyze covariates of HbA1c at last follow-up, including age, diabetic duration (&lt;5 years, 5-10 years, 10-15 years, &gt;15 years), gender, baseline HbA1c, insulin usage, self-monitoring of pre-meal and postprandial glucose (none, &lt;=1 pair per week, &gt;1 pair per week), intensity of offline support and exposure of online support.
Results: 515 patients were enrolled. Shorter diabetic duration (OR=2.64, p=0.005), no usage of insulin (OR=3.83, p&lt;0.0001), achieving HbA1c target at first visit (OR=7.94, p&lt;0.0001) and higher exposure of online support (OR=1.84, p=0.009) were positively correlated to better HbA1c achieving rate.
Conclusions: Higher online self-management support (over 41.9 min/quarter) could bring better HbA1c achieving rate for diabetic patients in IDSCC.

Disclosure
A. Li: None. X. Yuan: None. L. Lin: None. D. Lu: None. D. Zhang: None. Y. Sun: None. J. Li: None. L. Jing: None. Y. Wang: Employee; Self; iHealth Labs Inc. X. Guo: None. J. Zhang: None.
1302-P: Availability and Affordability of WHO Essential Medicines for Diabetes in Low- and Middle-Income Countries—Assessing the Gap and Needs from a Systematic Review
Authors: DIALLO ALPHA MAMADOU , ALI MOHAMMED K. , VENKAT NARAYAN K.M. 
Published: June 2019

Background: The burden of diabetes is overwhelming worldwide and more important in low- and middle-income countries (LMICs). Preventing cardiovascular morbidity and mortality by providing essential medicines for diabetes and its associated risk factors is a major concern in a context of scarcity of resources and weak health systems. We conducted a systematic review from the recent literature to assess and synthesize the gap and needs for access to essential diabetes medicines in LMICs.
Methods: We selected the recently published literature on essential medicines for diabetes in LMICs using the PubMed database. Articles were found using the following keywords: "Diabetes AND Essential Medicines" and "Diabetes AND Access to Insulin." Relevant studies conducted in one or more LMICs, as defined by the World Bank, were selected for analysis.
Results: Availability and affordability of essential medicines for diabetes is poor in LMICs. Availability of insulin was as low as 10.3% in low income countries while 63% of households could not afford insulin in the PURE study conducted in 22 countries (18 LMICs). In two national surveys conducted in Uganda and Zambia, none of the heathcare facilities was meeting the WHO Standards for essential tools and medicines in Uganda and few (6 out of 46) in Zambia, with only 11% availability of insulin in rural area.
Conclusions: The LMICs include a wide range of countries with varying levels of health care resources and quality. To meet the challenge of access to essential medicines for diabetes and other noncommunicable diseases, it is necessary to categorize needs by region and by country in order to prioritize interventions.

Disclosure
A.M. Diallo: None. M.K. Ali: None. K. Narayan: None.
1303-P: Improving Rate of Glucose Recheck after Hypoglycemia through the PDSA Model
Authors: YUNXIA LIU , YI LI , LI CHUNRUI , ZHENGGUO YANG , KAREN LAU KA HEI , POBER DAVID M. , ZHANG LINDA (YAN) , GABBAY ROBERT A. , HSU WILLIAM C. 
Published: June 2019

Recent studies have linked severe hypoglycemic episodes with increased risk for adverse cardiovascular outcomes. The ADA guidelines recommend that hospitals implement a hypoglycemia management protocol that includes rechecking for hypoglycemia 15 minutes after each hypoglycemic episode.
Sunshine Union Hospital in China collaborated with Joslin Diabetes Center to implement an inpatient glucose management (IPGM) program. A steering committee was set up to oversee the implementation of inpatient protocols. As a quality improvement pilot to enhance patient safety, the committee focused effort on improving the rate of rechecking blood glucose within 15-30 minutes after a hypoglycemic episode (&lt; 70mg/dL). Following the Plan-Do-Study-Act (PDSA) method, which is a four-step model that tests small changes to identify best practices, outcomes were tracked, analyzed, and communicated monthly with the nursing and medical staff.
Hypoglycemic events occurred 56.9 ± 22.1 times/month in the 1000-bed hospital. Hypoglycemic recheck frequency (15-30 minutes post a hypoglycemic event) steadily improved over the 12 month-period, from 0% in December of 2017 to over 95% in the last three months of 2018 (Figure 1). Most common reasons for missing hypo-recheck included patient refusal and busy nursing schedule.
PDSA model was helpful in improving outcomes in this IPGM pilot. Future efforts will leverage a similar approach to reduce inpatient hypoglycemia.

Disclosure
L. Yunxia: None. L. Yi: None. C. Li: None. Y. Zhengguo: None. K. Lau: None. D.M. Pober: None. L. Zhang: None. R.A. Gabbay: Advisory Panel; Self; HealthReveal, Hygieia, Lark, Onduo LLC. Consultant; Self; Sanofi. W.C. Hsu: Consultant; Self; Onduo LLC.
1304-P: “They Were All Together...Discussing the Best Options For Me”: Integrating Specialist Diabetes Care within Primary Care
Authors: KUZULUGIL DENIZ O. , HARRIS MELISSA L. , BYLES JULIE E. , PARSONS MARTHA E. , PHILCOX ANNALISE N. , ACHARYA SHAMASUNDER H. 
Published: June 2019

Introduction: In Australia, over a third of encounters with health care providers for diabetic patients fail to provide clinical guideline appropriate care. The Diabetes Alliance, integrated care model implemented across a large healthcare district with a view to enhance diabetes care capacity at primary care through intensive case-conferencing with primary care team, patients and visiting specialist team; whole practice performance feedback, and; regular diabetes masterclasses. Here, we aimed to provide in-depth insight into the case-conferencing process and impact of the model of care for patients with diabetes.
Methods: Patients from 5 practices (including 2 with high and 3 with low proportions of patients with a recent HbA1c) provided the sampling frame. Patients were selected according to Patient Activation Measure scores to achieve maximum variation with 1 or 2 patients with high scores and 2 or 3 patients with low scores were selected from each practice. Participants were sampled until saturation was achieved. Thematic content analysis was applied to the 19 interviews.
Results: Patients largely found the model of care a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition), with the program providing an opportunity to refocus when “life gets in the way.” Other key aspects of the program that were viewed positively included the holistic approach to healthcare, reduced travel time and congestion, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Patients however also described difficulties in coping with diabetes as a chronic illness and adherence to treatment recommendations.
Conclusion: Providing timely integrated specialist care within the primary care setting is an efficient means of enhancing the engagement of diabetic patients with their diabetes care and therefore their outcomes.

Disclosure
D.O. Kuzulugil: None. M.L. Harris: None. J.E. Byles: None. M.E. Parsons: None. A.N. Philcox: None. S.H. Acharya: None.
1305-P: Detection of Diabetes Status and Type in Youth Using EMRs
Authors: WELLS BRIAN J. , LENOIR KRISTIN M. , WAGENKNECHT LYNNE E. , MAYER-DAVIS ELIZABETH , DABELEA DANA , LAWRENCE JEAN M. , PIHOKER CATHERINE , SAYDAH SHARON , IMPERATORE GIUSEPPINA , CASANOVA RAMON , TURLEY CHRISTINE B. , LIESE ANGELA D. , STANDIFORD DEBRA , HAMMAN RICHARD F. , KAHN MICHAEL G. , DIVERS JASMIN 
Published: June 2019

Diabetes surveillance often requires manual chart review to confirm status and type. This project aimed to derive and validate an EMR-based algorithm using structured data in the era of ICD-10 codes for improving screening efficiency. Youth (&lt;20 years) with potential evidence of diabetes based on in- and out-patient visits were identified from EMRs at 3 Children’s Hospitals participating in the SEARCH Study. Charts were reviewed to determine presence and type of diabetes based on provider notes. Two methods were compared: a multinomial regression evaluating 29 predictors, and a deterministic approach based on ratios of ICD-10 codes (≥2 diabetes codes with the most frequently occurring type-specific codes to indicate type). To evaluate performance, data from two hospitals were used for model building and the third for testing. From 8,752 potential cases, 5,308 true cases were identified; T1D (89.2%), T2D (7.5%), Other types (3.3%). Age, race/ethnicity, ICD-10 codes, and medications were the strongest predictors in the multinomial regression. Performance metrics are shown. Both methods performed well for diabetes diagnosis and for classification of T1D (all metrics ≥0.95). For T2D, the regression model had substantially lower sensitivity (0.59 vs. 0.90), but higher positive predictive value (0.80 vs. 0.62). The ICD-10 ratio model is easier to implement and could be combined with targeted chart reviews to increase efficiency for surveillance efforts.

Disclosure
B.J. Wells: None. K.M. Lenoir: None. L.E. Wagenknecht: None. E. Mayer-Davis: None. D. Dabelea: None. J.M. Lawrence: None. C. Pihoker: None. S. Saydah: None. G. Imperatore: None. R. Casanova: None. C.B. Turley: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., CVS/Caremark, Edwards Lifesciences Corporation, Johnson & Johnson, Novartis AG, Pfizer Inc. A.D. Liese: None. D. Standiford: None. R.F. Hamman: None. M.G. Kahn: None. J. Divers: None.

Funding
Centers for Disease Control and Prevention
1318-P: Fructose Consumption Contributes to Hyperinsulinemia in Obese Adolescents through a GLP-1-Mediated Mechanism
Authors: GALDERISI ALFONSO , VAN NAME MICHELLE A. , GIANNINI COSIMO , SAVOYE MARY , CAPRIO SONIA 
Published: June 2019

Background: The consumption of high-fructose beverages is associated with higher risk for T2D. Fructose can stimulate GLP-1 secretion in lean adults, in the absence of any inhibitory effect on appetite. We hypothesized that the ingestion of glucose (GLC) and fructose (FRU) may differentially stimulate GLP-1 and insulin response in lean and obese adolescents.
Methods: We studied 14 lean (4F, 15.9±1.6y, 21.8±2.2 kg/m2) and 23 obese (5F, 15.1±1.6y, 34.5±4.6 kg/m2) adolescents. Participants received, in a double blinded cross-over study, 75g of GLC or FRU. Plasma was obtained every 10min for 60 minutes GLC was determined by YSI Analyzer; insulin and GLP-1 were measured by Millipore RIA; data were expressed as incremental values from baseline and compared by linear mixed effect model between lean and obese.
Results: Obese adolescents exhibited greater insulin (p&lt;0.001) and GLP-1 (p&lt;0.001) rise after FRU than lean peers, at each time points (Figure), in the absence of a significant difference in plasma GLC (p0.699). After GLC ingestion, neither the rise in plasma GLC (p0.099), nor in insulin (p0.099) and GLP-1(p0.083) differed between lean and obese youths.
Conclusion: Fructose, but not glucose, ingestion elicits higher insulin and GLP-1 response in obese as compared to lean adolescents. High-fructose consumption may contribute to the hyperinsulinemic phenotype through a GLP-1 mediated mechanism.

Disclosure
A. Galderisi: None. M.A. Van Name: Research Support; Self; Novo Nordisk Inc. C. Giannini: None. M. Savoye: None. S. Caprio: None.

Funding
National Institutes of Health (1R01DK085577-01, R01HD40787, R01HD28016; P30DK045735, K12DK094714-02; R01DK111038-01A1; Pediatric Endocrine Society; Robert E. Leet and Clara Guthrie Patterson Trust; European Medical International Framework (EMIF115372)
1321-P: Reduced Heart Rate Variability (HRV) in Young Adults with Youth-Onset Type 2 Diabetes (T2D) Is Related to Glycemic Control: The TODAY Study
Authors: SHAH AMY SANGHAVI , GHORMLI LAURE EL , BACHA FIDA , FARRELL RYAN M. , GIDDING SAMUEL , KATZ L. E. , TRYGGESTAD JEANIE B. , VAJRAVELU MARY ELLEN , WHITE NEIL H. , URBINA ELAINE M. 
Published: June 2019

Cardiovascular autonomic neuropathy (CAN), a complication of T2D, affects the autonomic nerves innervating the heart and can adversely affect cardiac performance. Reduction in HRV is an early manifestation of CAN with parasympathetic loss preceding sympathetic dysfunction. Whether HRV is influenced by prior diabetes treatment or glycemic control in young adults with youth-onset T2D is not known.
Heart beats over 10 minutes from an ECG were measured by Sphygmocor to derive the normal R-R intervals (NN intervals). HRV outcomes included: the standard deviation of the NN intervals (SDNN), the root mean square differences of the NN intervals (RMSSD), and the frequency domain low to high (LF:HF) power. TODAY participants (n=400) 7 y post-randomization (T2D duration 7.7±1.5 y) were compared to 133 obese controls without T2D. We assessed whether prior randomized treatment (metformin alone, metformin+ rosiglitazone or metformin+ intensive lifestyle) or glycemic control over time (time-weighted HbA1c) were associated with HRV.
Compared to obese controls, TODAY subjects were younger (mean age 20.7±2.5 vs. 22.6±3.7 y) but not different by sex or BMI (35% male, BMI 36.6±8.1 kg/m2). TODAY participants had reduced overall HRV (SDNN; 57.9±29.6 vs. controls 67.1±25.4, p&lt;0.0001), including a pattern of parasympathetic loss (RMSSD; 53.0±36.6 vs. controls 67.9±35.2, p&lt;0.0001) with sympathetic overdrive (LF:HF power; 1.4±1.7 vs. controls 1.0±1.1, p&lt;0.0001). Among TODAY subjects, HRV did not differ by previously randomized treatment, but higher HbA1c over time was independently associated with lower SDNN and RMSSD and higher LF:HF power independent of age, race, sex, T2D duration and BMI.
Young adults with youth-onset T2D show early manifestations of CAN with both parasympathetic and sympathetic impairments that are associated with higher HbA1c.

Disclosure
A.S. Shah: None. L. El Ghormli: None. F. Bacha: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, Pediatric Diabetes Consortium. Other Relationship; Self; AstraZeneca, Jaeb Center for Health Research. R.M. Farrell: Stock/Shareholder; Self; Tandem Diabetes Care. S. Gidding: Research Support; Self; Color Genomics. L.E. Katz: None. J.B. Tryggestad: None. M. Vajravelu: None. N.H. White: None. E.M. Urbina: None.

Funding
National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases
1322-P: Early Environment and Genetic Predisposition to Metabolically Obese Normal-Weight Phenotype in Children: Findings from a Cohort Study
Authors: LI MING , LI GE , GAO SHAN , WILLI STEVEN M. ,   BCAMS STUDY GROUP
Published: June 2019

Some normal-weight individuals are predisposed to obesity-related cardiometabolic abnormalities, namely, metabolically obese normal weight (MONW). Studies of the MONW phenotype in youths are scarce. We aimed to identify early environmental and genetic factors associated with MONW in children. Overall, 1,484 normal-weight Chinese children aged 6-18, including 588 subjects with MONW phenotype, were recruited from the Beijing Children and Adolescents Metabolic Syndrome cohort. Birth weight (BW) childhood lifestyle and socio-economic factors, and 20 genetic variants which had been previously shown to be associated with BMI or T2D in East Asian adults were examined for the associations with pediatric MONW phenotype. Metabolically unhealthy was defined as having any metabolic syndrome component or HOMA-IR≥3.0. Independent risk factors for MONW phenotype were low BW, increased BMI, and lower levels of physical activity, maternal education and family income (all P&lt;0.05), while amongst genetic variants, CDKAL1 rs2206734 shown the strongest association with MONW (OR per C allele=0.81, 95% CI=0.70-0.95; P=0.008). Moreover, rs2206734 interacted with BW on MONW phenotype (P interaction=0.005). Every C allele was associated with a 50% reduced risk of MONW in high (&gt;75th percentile) BW (95% CI=0.34-0.72; P=0.0002), while the genetic associations were nonsignificant in intermediate and low (≤75th percentile) BW (P&gt;0.1). The effect of high BW on the CDKAL1-MONW relationship could be further augmented by the combined impact of beneficial childhood environmental factors (physically active, high maternal education and family income) (Pinteraction=0.017).
In conclusion, both early environments, particularly BW, and genetic predisposition plus their interaction were associated with MONW in children. Our study provides new insights into MONW and suggests a long-term prevention strategy, especially in genetically susceptible individuals.

Disclosure
M. Li: None. G. Li: None. S. Gao: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Roche Diagnostic USA. Research Support; Self; Jaeb Center for Health Research, National Institute of Allergy and Infectious Diseases, Sanofi-Aventis. Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases.

Funding
National Key Research Program of China (2016YFC1304801); Beijing Municipal Science & Technology Commission (D111100000611001, D111100000611002); Beijing Natural Science Foundation (7172169); Beijing Science & Technology Star Program (2004A027), Novo Nordisk (2011A002); National Key Program of Clinical Science (WBYZ 2011-873); Central Research Institute Fund of Chinese Academy of Medical Sciences (2017PT32020, 2018PT32001)
1323-P: Offspring Diet Quality Modifies the Effect of Gestational Diabetes Exposure on Adiposity Outcomes: The EPOCH Study
Authors: SAUDER KATHERINE A. , BEKELMAN TRACI A. , HARRALL KYLIE K. , GLUECK DEBORAH H. , DABELEA DANA 
Published: June 2019

Intrauterine exposure to gestational diabetes (GDM) is associated with increased adiposity; however, not all exposed offspring exhibit excess adiposity, indicating that additional factors are involved. We examined whether higher diet quality in childhood and adolescence modifies the association between GDM exposure and adiposity outcomes. In 499 offspring (n=88 GDM-exposed), we assessed dietary intake (via food frequency questionnaire) and adiposity (BMI, waist-to-height ratio, visceral and subcutaneous adipose tissue [VAT, SAT], and subscapular-to-triceps skinfold ratio) at 6-12 and 12-19 years of age. Diet quality was estimated with the Healthy Eating Index (HEI). Linear mixed models were used to examine the association between GDM exposure and adiposity among those with higher (HEI≥60) versus lower (HEI&lt;60) diet quality, adjusting for sex, race/ethnicity, age, and pubertal status. Among those with lower diet quality, exposure to GDM was associated with increased adiposity for all outcomes (all p&lt;0.05; Table). Among those with higher diet quality, there was no association between GDM exposure and adiposity outcomes (all p&gt;0.05). Our results suggest that higher diet quality in childhood and adolescence may be a potential postnatal strategy for reducing adiposity among offspring exposed to GDM.

Disclosure
K.A. Sauder: None. T.A. Bekelman: None. K.K. Harrall: None. D.H. Glueck: None. D. Dabelea: None.

Funding
National Institutes of Health