bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Lifestyle Intervention on Metabolism Profile in People with Impaired Glucose Tolerance—The China Da Qing Diabetes Prevention Study
Authors: QIAN XIN , CHEN YANYAN , JIA HONG-MEI , ZOU ZHONG-MEI , GONG QIUHONG , AN YALI , WANG JINPING , LI HUI , SHI NA , LI GUANGWEI 
Published: June 2018

Aims: To investigate the effects of lifestyle intervention on metabolism profile in people with impaired glucose tolerance (IGT), and potential biomarkers for prevention of diabetes.
Methods: The study participants were identified as IGT by OGTT in 1986 and followed in 2006. Sixty participants were selected in the intervention group (I_Group) and 57 in control group (C_Group). UPLC-MS/MS analysis was performed by using the plasma samples. Principal component analysis and orthogonal partial least squares discriminant analysis were used for the data analysis.
Results: In 20-year follow-up study, I_Group had lower fasting plasma glucose, triglycerides and urine albumin/creatinine ratio comparing with C_Group. The metabolism profile was significant different between I_Group and C_Group, a total of 65 altered variables were obtained, and 9 metabolic pathways were changed, 4 pathways were considered as the most pertinent in the process of intervention: glycerophospholipid, arachidonic acid (AA) metabolism, glycosylphosphatidylinositol (GPI)-anchor biosynthesis and vitamin B6 metabolism. In I_Group, after 6-year lifestyle intervention, 26 were still in IGT status and 34 change to diabetes after 20-year follow-up. The metabolism profile was significant difference between development of diabetes and still in IGT subjects, a total of 53 altered metabolites were obtained. Compared with the 65 metabolites, 7 metabolites decreased after intervention but increased when they change to diabetes, 1 metabolite had opposite change tendency. The above 8 metabolites involved in 5 metabolic pathways: glycerophospholipid metabolism, GPI-anchor biosynthesis, linoleic acid, α-Linolenic acid, and AA metabolism.
Conclusions: The 65 metabolites and 4 metabolic pathways were changed after lifestyle intervention, 8 altered metabolites involved in 5 pathways were considered as the potential biomarkers related to diabetes outcome.

Disclosure
X. Qian: None. Y. Chen: None. H. Jia: None. Z. Zou: None. Q. Gong: None. Y. An: None. J. Wang: None. H. Li: None. N. Shi: None. G. Li: None.
Serum Fibroblast Growth Factor-21 Is Related to Atherosclerosis Independent of Nonalcoholic Fatty Liver Disease and Predicts Incident Atherosclerotic Cardiovascular Diseases
Authors: WU LIANG , QIAN LINGLING , LI HUATING , JIA WEIPING 
Published: June 2018

Fibroblast growth factor 21 (FGF-21), a key hepatokine regulating lipid metabolism, is related to several atherosclerotic diseases. But whether this relationship is mediated by nonalcoholic fatty liver disease (NAFLD) is not clear. Here we assessed the association of serum FGF-21 with atherosclerosis in non-NAFLD subjects and further investigated prospectively whether baseline FGF-21 could predict incident atherosclerotic cardiovascular disease (ASCVD) in a 7-year community study.Serum FGF-21 were measured in a cross-sectional cohort of 371 type 2 diabetic patients without NAFLD as determined by hepatic magnetic resonance spectroscopy, and a population-based prospective cohort of 7subjects from the Shanghai Diabetes Study. In the cross-sectional study, serum FGF-21 was significantly higher in those with subclinical carotid atherosclerosis (268.8 [139.0-415.2] vs. 188.3 [100.2-376.4] pg/ml, P=0.005). Multiple logistic regression analysis showed that serum FGF-21 was independently associated with atherosclerosis. In the prospective study, baseline serum FGF-21 was significantly higher in those who developed ischemic heart disease (479.5 [302.4-627.0] pg/ml, P=0.004) or cerebral infarction (401.6 [238.3-616.4] pg/ml, P=0.021) than those who did not (325.2 [189.0-498.9] pg/ml) during the follow-up. In multivariable Cox regression analysis, baseline serum FGF-21 independently predicted incident ASCVD events and significantly improved discriminatory and reclassifying abilities of the prediction model after adjustment for established cardiovascular risk factors.This study provides the first evidence that FGF-21 is elevated, independent of NAFLD, in subjects with subclinical atherosclerosis. Baseline FGF-21 is an independent predictor of incident ASCVD and could be utilized as a novel biomarker for primary prevention in general population.

Disclosure
L. Wu: None. L. Qian: None. H. Li: None. W. Jia: None.
Plasma Strontium and Interactions between Calcium and Strontium for Type 2 Diabetes—A Hospital-Based Case-Control Study
Authors: CHEN LIANGKAI , WANG QIANG , HU XIAOLI , WANG XIAOQIAN , SUN TAOPING , BAO WEI , LIU LIEGANG 
Published: June 2018

Objective: Strontium and calcium play an essential role in bone metabolism but a paucity of epidemiological or experimental studies referring the role of strontium in the development type 2 diabetes (T2D). Prior studies have reported conflicting results for the relationships between plasma strontium and T2D. We therefore investigated the association between plasma strontium as well as the ratio of calcium to strontium (Ca/Sr) and newly diagnosed T2D.
Methods: After propensity score matching for age and sex, 2,5newly-diagnosed T2D patients and 2,5controls with normal glucose tolerance were recruited in the case-control study. Plasma strontium and calcium levels were determined by inductively coupled plasma mass spectrometry (ICP-MS). Multivariate logistic regression analysis was used to evaluate the independent association of plasma strontium levels and Ca/Sr values with the likelihood of T2D.
Results: Compared with the middle quintile, the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals of T2D associated with the lowest quintile and the highest quintile of plasma strontium were 2.01 (1.66, 2.44) and 2.01 (1.65, 2.44), of plasma Ca/Sr were 2.11 (1.75, 2.54) and 2.01 (1.66, 2.43), respectively. In spline analysis, the U-shaped associations were consistently indicated, with the lowest odds of T2D at the plasma strontium concentration of 42.52 μg/L, and Ca/Sr value of 1500 approximately. We also discovered the pattern of high plasma calcium and low strontium level was associated with the highest odds of T2D, while the pattern of high plasma calcium and moderate to high strontium level was associated with the lowest odds of T2D.
Conclusions: Our results suggested U-shaped associations between plasma strontium, Ca/Sr and T2D; both low and high levels of plasma strontium and Ca/Sr were associated with higher odds of newly diagnosed T2D. We should not only pay attention to calcium, but also to strontium and the homeostasis of the both.

Disclosure
L. Chen: None. Q. Wang: None. X. Hu: None. X. Wang: None. T. Sun: None. W. Bao: None. L. Liu: None.
Population-Level Burden of Diabetes by Leisure, Transportation, and Work-Based Physical Activity—NHANES, 2011–16
Authors: ECHEVERRIA SANDRA , DIVNEY ANNA A. , TSUI EMMA K. , MIRZAYI CHLOE 
Published: June 2018

Introduction: An abundance of evidence has shown that leisure-time physical activity (PA) is associated with reduced risk of diabetes. Adults, however, engage in various forms of PA, with potentially differential health effects. We tested if specific modes of PA are differentially associated with diabetes prevalence in a population-based adult sample.
Methods: Among 16903 racially/ethnically diverse adults ≥20 years old participating in NHANES 2011-16, we fit separate log binomial models to test associations between mode of PA and diabetes, and whether associations differed by race/ethnicity. Participants completed none, some (1-149 min/week) or met national PA guidelines (150+ min/week) for leisure time, work, transportation and combined modes (’All’). Diabetes was based on laboratory-confirmed HbA1C ≥ 6.5% or ever being told by a health professional respondent had diabetes.
Results: For each mode of PA and All modes combined, respondents completing 150+ minutes of PA were 33% to 39% less likely to have diabetes than respondents who completed no PA, even after controlling for covariates. There was a general gradient of decreasing prevalence with increasing PA. Effects varied by race/ethnicity for all PA modes except work-based PA (P&lt;.01).
Conclusions: Meeting PA guidelines via any mode appears to confer protection from diabetes, but there are differential effects by mode and race/ethnicity.

Disclosure
S. Echeverria: None. A.A. Divney: None. E.K. Tsui: None. C. Mirzayi: None.
Impact of Childhood and Adult Socioeconomic Position (SEP) on Incidence of Type 2 Diabetes—The REGARDS Study, 2003–2016
Authors: BECKLES GLORIA L.A. , WU CHENGYI , MCCLURE LESLIE A. , CARSON APRIL P. , BULLARD KAI M. , IMPERATORE GIUSEPPINA , UNVERZAGT FREDERICK , HOWARD VIRGINIA J. 
Published: June 2018

Exposure to socioeconomic stressors during early life may influence the incidence of type 2 diabetes (T2DM). We examined data from 1,207 African American (AA) and 4,149 white REGARDS participants aged ≥45 years with no evidence of T2DM at baseline (2003-2007), who completed the Childhood and Family Life Questionnaire (2011-2013) and the 2nd in-home visit (2013-2016). Incident T2DM cases were identified by self-reported physician diagnosis plus use of hypoglycemic drugs, fasting plasma glucose ≥126 mg/dL, or random plasma glucose ≥200 mg/dL. We estimated incidence rate as cases/1000 persons. Childhood SEP (CSEP) was derived from participants’ parental/caregiver education level and material assets. Adult SEP (ASEP) was derived from participants’ own education level and annual household income at baseline. SEP scores were categorized as low/medium/high. We fit multivariable logistic regression models to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) for the separate and simultaneous effects of SEP measures on T2DM incidence, stratified by race. In 9.1 years of follow-up, 572 new cases of T2DM occurred; crude incidence rate=106.8/1000 (AA=168.2/1000; white= 88.9/1000). Controlled for age, sex, and percent life lived in Stroke Belt, low CSEP was associated with incident T2DM in AAs (aOR=1.65, 95% CI 1.05-2.52) but not in whites (aOR=1.01, 95% CI 0.703-1.46). Low ASEP was associated with incident DM in both racial groups: AA aOR=2.57 (95% CI 1.42-4.64); white aOR=2.42 (95% CI 1.69-3.45). With both SEP measures in the model, CSEP was no longer significant in AA but ASEP remained significant in both racial groups. Controlling for traditional T2DM risk factors the ASEP ORs remained significant in AA and whites. Low CSEP was associated with incident T2DM among AA but not whites; however, this may reflect indirect action through low ASEP. Low ASEP was associated with T2DM in both racial groups, partly explained by traditional T2DM risk factors.

Disclosure
G.L.A. Beckles: None. C. Wu: None. L.A. McClure: None. A.P. Carson: Research Support; Self; Amgen Inc.. K.M. Bullard: None. G. Imperatore: None. F. Unverzagt: None. V.J. Howard: None.
Risk of Islet and Celiac Autoimmunity in Cotwins of Probands with Type 1 Diabetes
Authors: TRIOLO TAYLOR M. , FOUTS ALEXANDRA R. , PYLE LAURA , YU LIPING , GOTTLIEB PETER , STECK ANDREA 
Published: June 2018

Concordance for persistent islet autoimmunity (IA) and type 1 diabetes (T1D) in monozygotic twins (MZ) after one twin is diagnosed has been highly variable (30-70%), while risk for development of IA in dizygotic twins (DZ) is thought to be similar to non-twin siblings. Since 1995, the Twin Family Study at the Barbara Davis Center has followed 336 twins (168 twin probands diagnosed with T1D and 168 cotwins) with a median follow-up of 14 years (ICR:10-18 years). Zygosity testing confirmed a total of 80 MZ pairs and 88 DZ pairs. Cotwins were followed for the development of IA and celiac autoimmunity (CDA). In MZ cotwins, cumulative incidence for IA was 14% by age 20 and 63% by age 45, while development of CDA was 10% by 20 years. Development of IA and CDA by age 20 was 9.2% and 12.3% in DZ cotwins respectively, with development of IA reaching 70% by age 30 (Figure). In Cox proportional hazards models, only the proband’s age at diagnosis, but not sex, HLA-DR3 nor DR4 were associated with time to IA and CDA in cotwins. In MZ twins, younger age of the proband was associated with an increased hazard ratio (HR) for both IA and CDA, while younger age in DZ twins was associated with an increased HR for IA only.
In conclusion, CDA risk does not appear to increase after age 15. With long term follow-up, cumulative incidence for IA is high in DZ twins, similar to MZ twins, suggesting a role of possible early environmental factors shared by T1D-discordant cotwins.

Disclosure
T.M. Triolo: None. A.R. Fouts: None. L. Pyle: None. L. Yu: None. P. Gottlieb: Advisory Panel; Self; Bristol-Myers Squibb Company. Research Support; Self; Caladrius Biosciences, Inc.. Advisory Panel; Self; Eli Lilly and Company. Board Member; Self; ImmunoMolecular Therapeutics. Consultant; Self; Kamada. Research Support; Self; JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk Inc., MacroGenics, Inc., Pfizer Inc.. Advisory Panel; Self; Viacyte, Inc.. Research Support; Self; GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc.. A. Steck: None.
Continuous Glucose Monitoring Predicts Progression to Diabetes in Autoantibody-Positive Children
Authors: STECK ANDREA , DONG FRAN , TAKI IMAN , HOFFMAN MICHELLE R. , SIMMONS KIMBER , FROHNERT BRIGITTE I. , REWERS MARIAN 
Published: June 2018

Children with islet autoantibodies (Ab+) are at high risk for developing clinical type 1 diabetes (T1D) and need accurate surveillance for prediction and diagnosis of T1D. Monitoring typically utilizes repeated 2-hour oral glucose tolerance tests. The objective of this study was to explore whether continuous glucose monitoring (CGM) could be an alternative measure for T1D prediction. In the Diabetes Autoimmunity Study in the Young (DAISY), 23 Ab+ subjects with a baseline CGM were followed for development of T1D for a mean of 28 months (8 of these progressed to T1D at a mean age of 15.2 years). Compared to non-progressors, subjects who progressed to T1D had significantly increased glycemic variability (SD 29 vs. 21 mg/dl, p=0.047), daytime sensor average (122 vs. 1mg/dl, p=0.02), and daytime sensor AUC (p=0.047). They spent 24% of time above 140 mg/dl and 12% above 160 mg/dl compared to, respectively, 8% and 3% (both p=0.005) for non-progressors; time spent over 200 mg/dl was minimal and not different between groups. Performance of prediction by receiver operating curve (ROC) analyses showed AUC of 0.85 for both %time spent above 140 mg/dl and 160 mg/dl. The cutoff of 18% time spent above 140 mg/dl had 100% specificity and 100% PPV with good sensitivity for diabetes prediction (Table).
In conclusion, ≥18% CGM time spent above 140 mg/dl accurately predicts progression to clinical diabetes in islet Ab+ children.TableIndexCutoffPPVNPVSensitivitySpecificity% time &gt; 12036%0.7140.8120.6250.867% time &gt; 14018%1.0000.8830.7501.000% time &gt; 1606%0.8330.8240.6250.933% time &gt; 1802%0.7140.8130.6250.867% time &gt; 2000.2%0.5460.8130.7500.667

Disclosure
A. Steck: None. F. Dong: None. I. Taki: None. M.R. Hoffman: None. K. Simmons: None. B.I. Frohnert: None. M. Rewers: None.
Teraspanin 7 Autoantibodies in Type 1 Diabetes and Latent Autoimmune Diabetes in Adults
Authors: ZHOU ZHIGUANG , SHI XIAJIE , ZHENG PEILIN , HUANG GAN , WANG YANFEI , DENG CHAO 
Published: June 2018

Objective: This study aimed to investigate the prevalence of the newly-identified islet autoantibody, tetraspanin 7 autoantibody (TSPAN7A) in Chinese type 1 diabetes (T1D) and Latent Autoimmune Diabetes in Adults (LADA), and the correlation between TSPAN7A and islet function in LADA patients.
Research Design and Methods: Patients with newly onset T1D (n=158), long-lasting T1D (n=157), LADA (n=175), type 2 diabetes (T2D; n=204) and healthy control subjects (n=170) were recruited for the cross sectional study. Another cohort including 46 LADA patients with 3-year follow-up was recruited forthe longitudinal study. TSPAN7A was assayed by luciferase immunoprecipitation system assay.
Results: The prevalence of TSPAN7A in newly onset T1D, non-newly onset T1D, T2D, LADA and healthy control subjects were 25.3% (40/158), 10.2% (16/157), 0.5% (1/204), 21.1 (37/175) and 1.2% (2/170), respectively. Out of the 23 patients with newly onset T1D but negative for GADA, IA2 and ZnT8A, 3 patients were positive for TSPAN7A (13.0%) improving the detection of autoantibodies from 81.6% to 83.5% in T1D. In LADA patients, analysis of logistic regression demonstrated that duration (OR=1.77, P=0.026), GADA titer (OR=2.79, P=0.006) and TSPAN7A (OR=2.86, P=0.034) were the risk factors to islet function while BMI was the protection factor (OR=0.35, P=0.001). In the follow-up study, LADA patients with TSPAN7A showed a worse islet function compared those negative for TSPAN7A after 3-year diagnosis.
Conclusion: TSPAN7A is a novel diagnostic tool for T1D and LADA. Combination of TSPAN7A with other autoantibodies can improve the diagnosis of T1D. TSPAN7A is negatively correlated with islet function in LADA.

Disclosure
Z. Zhou: None. X. Shi: None. P. Zheng: None. G. Huang: None. Y. Wang: None. C. Deng: None.
Initial Diastolic Blood Pressure and Risk of Pregnancy Hypertensive Disorders in Pregestational Diabetes—Can We Set a Number?
Authors: OPPERMANN MARIA LUCIA R. , HIRAKATA VÂNIA N. , ALESSI JANINE , WIEGAND DANIELA , REICHELT ANGELA J. 
Published: June 2018

Background: In pregestational diabetes (PGD) pregnancies, blood pressure (BP) close to normal is warranted to prevent pregnancy hypertensive disorders (PHD); targets are not well defined. Diastolic BP (DBP) was recently described as a modifiable factor.
Aim: to evaluate distinct levels of DBP as risk factors to PHD in a retrospective cohort of PGD women.
Methods: Women were cared for at a specialized prenatal care facility. DBP measured at the first antenatal appointment was categorized. Poisson regression with robust estimates was used.
Results: Baseline characteristics of women are in Table 1, and multivariable analysis, in Table 2.
Conclusion: In this PGD cohort, a DBP &gt;80 mmHg at booking was associated to increased risk of PHD, suggesting that levels above this value should be prevented.
Table 1. Characteristics of Pregestational WomenType 1 diabetes (n=84)Type 2 diabetes (n=129)PHD32 (38.1)No PHD52 (61.9)pPHD32 (24.8)No PHD97 (75.2)pAge (years)26.8 (5.5)27.7 (5.9)0.51534.1 (4.3)33.1 (5.8)0.385Self-declared white93.884.60.36496.970.10.004Years since diagnosis15.4 (7.3)11.9 (8.7)0.0586.8 (6.2)3.5 (4.2)0.008Previous PHD4 (12.5)3 (5.8)0.4986 (18.8)22 (22.7)0.826Chronic hypertension8 (25.0)4 (7.7)0.05016 (50.0)24 (24.7)0.014Systolic BP (mmHg)120 (14)116 (14)0.214128 (16)119 (14)0.003Diastolic BP (mmHg)77 (13)72 (10)0.04282 (13)76 (11)0.025DBP &gt; 70 mmHg56.248.10.61562.161.5&gt;0.999DBP &gt; 75 mmHg56.246.20.50062.160.4&gt;0.999DBP &gt; 80 mmHg21.95.80.06237.923.10.182Mean (SD) or %
Table 2. Risk of Pregnancy Hypertensive Disorders (n=178)Risk factorRelative risk95% CIpType 1 diabetes1.911.20-3.020.006Self-declared white skin3.711.22-11.270.021Primigravid1.130.76-1.680.558Diastolic blood pressure &gt; 80 mmHg1.641.05-2.560.031Initial A1c test ≥7.0%0.6780.44-1.050.083Excessive GWG1.551.04-2.300.030

Disclosure
M.R. Oppermann: None. V.N. Hirakata: None. J. Alessi: None. D. Wiegand: None. A.J. Reichelt: None.
Cost-Effectiveness of Structured Lifestyle Programs for Diabetes Prevention in the Medicaid Population
Authors: LAXY MICHAEL , ZHANG PING , SHAO HUI , PENG NG BOON , ALI MOHAMMED K. , GREGG EDWARD W. 
Published: June 2018

Background: The Diabetes Prevention Program (DPP) showed that structured lifestyle interventions can delay or prevent onset of type 2 diabetes in high risk individuals. Despite disproportionate diabetes burdens in low-income individuals, there are no data regarding expected health and economic impacts of structured diabetes prevention in the Medicaid population.
Objective: To examine the net costs and health benefits of extending coverage for structured lifestyle programs to the Medicaid population.
Methods: We modelled a prevention strategy consisting of triannual screening for prediabetes (FPG?100 mg/dl or A1c?5.7%) followed by a DPP-like lifestyle program vs. routine care in non-disabled U.S. Medicaid beneficiaries aged 25-64 years. Medicaid population characteristics were extracted from 2006-2016 NHANES surveys. Costs of diabetes and its complications were estimated from Medicaid administrative claims data of 8 states comprising 52% of the U.S. adult Medicaid population. Based on DPP-like studies in Medicaid populations, we assumed the intervention will reduce diabetes incidence by 32% and will be delivered at costs defined in the Medicare Payment Scheme. We estimated incremental health benefits (in quality-adjusted life-years (QALYs)) gained and net costs (in 2016 U.S. dollars) of screening and delivering lifestyle programs and subtracted savings through prevention of diabetes from a Medicaid perspective over a 10 year time horizon.
Results: Given a 25% screening and intervention uptake in approximately 27 million non-disabled Medicaid beneficiaries across 50 states, extending coverage could prevent or delay 135,000 cases of diabetes, gain 243,000 QALYs, and cost $1.35 billion (incremental cost effectiveness ratio $55,000 per QALY gained).
Conclusions: Extending Medicaid coverage for life-style diabetes prevention programs might be a good use of health care resources and will potentially diminish the diabetes burden in low income individuals.

Disclosure
M. Laxy: None. P. Zhang: None. H. Shao: None. B. Ng: None. M.K. Ali: None. E.W. Gregg: None.