bluuebunny/crossref_metadata_2025_split huggingface dataset:
2391-PUB: Determinants of Poor Glycemic Control among Adolescents with Type 1 Diabetes
Authors: ALADSANI AFAF M.S.A. 
Published: June 2019

Objective: The majority of adolescents with type 1 diabetes have poor glycemic control, calling for an action to be taken. The aim of this study was to identify the determinants of poor glycemic control among adolescents with type 1 diabetes.
Methods: Data were collected for all adolescents with type 1 diabetes (age &lt; 20 years), who attended diabetes clinics at one hospital, and had at least one result of HbA1c performed during the study year. The average level of HbA1c was calculated from all the HbA1c results collected over one year. Glycemic control was defined as poor if the HbA1c was &gt;8%. Variables studied were gender, age, age at diagnosis, diabetes duration, annual clinic attendance, frequency of blood glucose monitoring, healthy eating, medication adherence, and frequency of HbA1c performance over one year.
Results: The study included 78 adolescents with type 1 diabetes (47.4% males). Mean age was 15.4+2.0 years, mean age at diagnosis was 9.0+3.6 years, and mean duration of diabetes was 6.6+3.8 years. The mean of the average level of HbA1c was 10.2+1.9%, and 84.6% had HbA1c &gt;8%. Mean frequency of HbA1c performance was twice per year, and mean annual clinic attendance was three visits. Poor glycemic control was significantly associated with female gender (p&lt;0.05). Healthy eating, medication adherence, and frequent HbA1c performance (&gt; 3 per year) were significantly associated (p&lt;0.001) with better glycemic control (HbA1c&lt;8%). With regression analysis, healthy eating, medication adherence and HbA1c performance remained as the major determinants of the glycemic control.
Conclusions: The overall glycemic control in adolescents with type 1 diabetes was poor, putting them at high risk of developing diabetes complications at an early stage of life. Healthy behavior was a major determinant of glycemic control. Behavioral healthy intervention strategies should be integrated in the management plan of diabetes care to improve glycemic control and reduce diabetes complications in this vulnerable group.

Disclosure
A.M.A. Aladsani: None.
2392-PUB: Health-Care Cost Avoidance in Indian Participants with Type 2 Diabetes Initiating Second-Line Treatment: The DISCOVER Study, India Subset
Authors: KALRA SANJAY , SRINIVASAN BHARATH 
Published: June 2019

Aim: DISCOVER is a 3 year-global, observational study of patients with type 2 diabetes (T2D) initiating second-line glucose lowering treatment in 37 countries. Here we report healthcare cost avoidance pattern of 3139 participants from India.
Methods: Participants were recruited from 28 centers in India from both primary and specialist healthcare settings. Data were collected using a standardized case report form. This is a 3-year prospective ongoing observational study and here we analyze the healthcare cost avoidance patterns at baseline, 6 months and 12 months. Healthcare cost avoidance was measured through a patient questionnaire.
Results: Majority of the participants had no health insurance coverage. More than 90% of the participants in this study didn’t avoid any healthcare services due to cost reason and most of them didn’t avoid a medication prescribed for cost reasons.
Conclusions: Though majority of the participants enrolled were self-paying, and not covered by insurance or government schemes, the majority rarely or never missed to follow the physician’s advice. This reflects on health care adherence related patient behavior in India. Majority of the participants had completed secondary education which might have added some bias to the results.

Disclosure
S. Kalra: None. B. Srinivasan: None.

Funding
AstraZeneca
2397-PUB: PowerHouse: A Lifestyle Intervention for Youth at Risk for Type 2 Diabetes (T2D)
Authors: EL MIKATI HALA K. , PIKE JULIE , HABERLIN-PITTZ KATIE , YAZEL-SMITH LISA , MCKINNEY BRETT M. , HANNON TAMARA S. 
Published: June 2019

The prevalence of T2D is increasing in youth partly because of the lack of effective prevention strategies. Lifestyle intervention is established for adult T2D prevention and family-based lifestyle intervention is the most efficacious non-surgical treatment of obesity in youth. We developed a 16-wk family-based program modeled after the U.S. Diabetes Prevention Program, using Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity. Sessions included physical activity, separate adult/youth nutrition education and goal setting, and a shared meal. Youth inclusion criteria were age 7-18 y, BMI &gt; 85th %ile, a caregiver to participate, and ≥ 2 risk factors: family history of T2D, maternal history of gestational diabetes, minority race/ethnicity. Paired t-tests were used to compare BMI and HbA1c at baseline (BL) and 4 months (M4) and at BL and 12 months (M12, data set currently incomplete). Between Feb 2017 and Nov 2018, 79 eligible youth enrolled (Table) the majority of whom had government-issued health insurance. Youth HbA1c was maintained at M4 (p = 1.0) and M12 (p = 0.45). Similarly, BMI SDS were stable at M4 (p = 0.67) and M12 (p = 0.12) while BMI scores increased at M4 (p = 0.007), but not at M12 (p = 0.23). As excessive weight-gain is correlated with T2D development, programs that maintain BMI could have significant impact on preventing or delaying T2D in youth.

Disclosure
H.K. El Mikati: None. J. Pike: None. K. Haberlin-Pittz: None. L. Yazel-Smith: None. B.M. McKinney: None. T.S. Hannon: Advisory Panel; Self; Eli Lilly and Company.

Funding
Indiana University School of Medicine; Indiana University
2402-PUB: Clinical and Demographic Factors Associated with Morbidity in Adolescents and Young Adults with Type 1 Diabetes
Authors: CYMBALUK ANNA L. , CORATHERS SARAH , YAYAH JONES NANA-HAWA 
Published: June 2019

Purpose: This study investigates clinical and demographic variables associated with youth who died of type 1 diabetes mellitus [T1D] complications between the years 2011-2018.
Methods: Retrospective chart review was performed on patients with T1D who died between the years 2011 to 2018 at a single center. Deceased youth autopsy reports were reviewed for causation of death.
Results: In the deceased cohort, 57% were female, 71% were non-Hispanic white, median age at death 19 years (range 15-22), 40% Medicaid. One case was excluded in analysis as youth transitioned T1D care to adult provider prior to death. Median duration between T1D diagnoses and death was 9.9 years. Median/mean hemoglobin A1c (A1c) year prior to death was 9.65/9.71%. Majority of patients (71%) were on basal bolus insulin regimen at time of death. Causation of death was determined as diabetic ketoacidosis in 85% of patients; unclear in others, although one case review documented precedent hypoglycemia. At the time of death, 71% of patients had transitioned out of the care of their primary caregiver (i.e., parent/guardian) into either state custody, college, or living independently. Notably, one patient had a history of 14 (known) addresses, with cohort mean/median # of lifetime addresses 5.57/3.
Conclusions: Although T1D providers clinically suspect the psychosocial factors that predispose to T1D complications, little is known about the contextual characteristics of youth who die of T1D. Given the low volume but extreme risk of T1D death in youth, it is prudent to investigate clinical and demographic variables to develop predictive models by which to inform interventions. Study findings indicate that A1C is not a predictor of mortality, but address history and transition of care out of the primary caregiver may be. Future direction includes comparing data between living and deceased patients to determine a predictive risk factor score for early death; and thus institute targeted interventions.

Disclosure
A.L. Cymbaluk: None. S. Corathers: None. N.Y. Jones: None.
2404-PUB: Evaluating a Multidisciplinary Chronic Illness Management Program for Children and Adolescents
Authors: MARCHETTA CLAIRE M. , MARUYAMA RYO , O'REILLY COLIN R. 
Published: June 2019

Objective: Among youth with type 1 diabetes mellitus (T1DM), older adolescents have demonstrated decreased compliance to treatment adherence, resulting in unfavorable disease control. Poor disease management established in this population can continue into adulthood, perpetuating the health and economic burden to the individual and society. This study aims to evaluate the effectiveness and sustainability of an inpatient multidisciplinary approach to treating children and adolescents with T1DM.
Methods: Patients with a diagnosis of T1DM admitted to the Chronic Illness Management Program (CIMP) between 1/1/2016 and 12/31/2017 were eligible for inclusion. Data related to physiological and psychosocial outcomes were compared between admission and discharge. Outpatient providers were contacted following a patient’s discharge from the CIMP for A1C and health care utilization data.
Results: During the 2-year study period, 57 inpatient admissions of children and adolescents with T1DM were included in the analysis sample. On average, there was a significant (p &lt; 0.0001) reduction in A1C values from admission (11.1%) to discharge (9.1%). Patients improved significantly (p &lt; 0.01) in all psychosocial outcome measures during their inpatient stay. While patient’s A1C values increased 3 months after discharge, they still sustained clinically significant improvements from admission values. Among outpatient providers successfully contacted, none reported any patient hospitalizations or diabetic ketoacidosis episodes in the 3 months following discharge from the CIMP.
Conclusion: The inpatient setting allows for an intensive multidisciplinary treatment model for T1DM management that demonstrates sustainable clinical improvements post discharge. This program model should be considered for adolescents who have been unable to successfully manage their T1DM with outpatient treatment alone. Evaluation of successful long-term management after the CIMP is currently underway.

Disclosure
C.M. Marchetta: None. R. Maruyama: None. C.R. O'Reilly: None.
241-OR: Restenosis after Percutaneous Transluminal Coronary Angioplasty in Patients with Different Categories of Glucose Tolerance: A 2-Year Follow-Up Study
Authors: ZHANG LEI , GU YAN , YIN XIAOYAN , WANG JUN , WANG NA , YANG YUXIU , DONG YANHU 
Published: June 2019

Patients with diabetes (DM) are at high risk for restenosis after coronary stenting. Information relating the outcome of percutaneous transluminal coronary angioplasty (PTCA) to prediabetes is, however, limited. The study objective was to investigate the relationship between restenosis after PTCA and baseline glucose categories. We retrospectively analyzed data of 1003 patients (mean age 58.5±4.2 years, 61.5% of men, mean history of coronary heart disease 9.5±1.1 years) who undertook PTCA at Emergency Department between Jan 2008 and Dec 2011. Baseline measures included blood pressure (BP), fasting plasma glucose, lipid profile, HbA1c, C-reactive protein (C-RP), and 2-hour capillary glucose. All patients had follow-up coronary angiography 2 year after PTCA. Restenosis was defined as ≧ 50% stenosis in stent or within 5 mm adjacent to stent. The rate of restenosis was compared among patients with normal glucose tolerance (NGT, n=436), impaired glucose regulation (IGR, n=275), and DM (n=292) according to their baseline glucose levels or prior history of DM. Patients with DM had highest levels of body mass index (BMI), BP, triglycerides (TG), and C-RP, followed by those with IGR and NGT (P&lt;0.01).The number of lesion was 1.6, 1.8, and 2.5 in patients with NGT, IGR, and DM, respectively (p&lt;0.05). At year 2, the rate of restenosis were 4.2%, 5.3%, and 12.0% in patients with NGT, IGT, and DM, respectively (P&lt;0.05). Among DM subgroup, compared with patients with A1c&lt;8%, those with A1c&gt;8% had increased rate of restenosis (14.6% vs. 11.2%, P&lt;0.05). In the logistic regression model, the odd ratio (OR) of having restenosis was 1.46 (95% CI: 1.05-1.87) for DM and 1.10 (95% CI: 1.01-1.25) for IGR, after adjusting for age, history of coronary heart disease, BMI, BP, LDL-C, TG, and C-RP. Restenosis is more frequent in patients with compared those without DM. Prediabetes is associated with increased risk of restenosis after PTCA.

Disclosure
L. Zhang: None. Y. Gu: None. X. Yin: None. J. Wang: None. N. Wang: None. Y. Yang: None. Y. Dong: None.
2416-PUB: Healthy Lifestyle to Prevent Obesity-Adiposity and Diabetes in Young Offspring of Diabetic Mothers?
Authors: WAGLE SONALI S. , KUMARAN KALYANARAMAN , LADKAT RASIKA , BHAT DATTATRAY , KAMAT RAJASHREE , WADKE SAYALI , DESHMUKH MADHURA K. , YAJNIK PALLAVI C. , YAJNIK CHITTARANJAN S. 
Published: June 2019

Background: It’s well known that maternal diabetes increases risk of obesity-adiposity and hyperglycemia in children. Few studies have explored the modifying influence of child’s lifestyle (nutrition and physical activity, PA). Intensive treatment of GDM have not shown any protection against adiposity in the child. We assessed the current lifestyle in offspring of diabetic mothers (ODM) 2-26 years after birth and investigated its association with obesity-adiposity and hyperglycemia.
Methods: We studied 200 ODM and 177 offspring of nondiabetic mothers (ONDM, age and gender matched). Anthropometry, body composition (DXA) and blood glucose (capillary in &lt;10y, 1.75g/kg OGTT in &gt;10y) were measured. Overweight + obesity was classified by international standards [IOTF (≤18y), WHO (&gt;18y)], glucose intolerance (ADA 2014). Dietary intake was assessed using food frequency questionnaire (preceding 6 months) and PA by recording time and frequency of vigorous, moderate, and sedentary activities. We studied the influence of diet and activity on risks of obesity-adiposity and hyperglycemia.
Results: ODM consumed sweets, milk and milk products, vegetables and salads more frequently and cereals less frequently than ONDM. Frequent consumption of ‘healthy foods’ and infrequent consumption of ‘unhealthy foods’ were associated with decreased risk for obesity-adiposity. Higher level of moderate PA (&gt;60min/day) and lower sedentary PA (&lt;480 min/day) were associated with lower obesity-adiposity in both the groups. Hyperglycemia was not affected. These effects worked across both groups, there was no interaction with maternal diabetes.
Conclusions: Healthy lifestyle (food and activity) is protective against obesity-adiposity but not against hyperglycemia in young Indian children (both ODM and ONDM). Our results suggest a need for a formal lifestyle intervention in children born in diabetic pregnancies for reduction in obesity-adiposity and hyperglycemia.

Disclosure
S.S. Wagle: None. K. Kumaran: None. R. Ladkat: None. D. Bhat: None. R. Kamat: None. S. Wadke: None. M.K. Deshmukh: None. P.C. Yajnik: None. C.S. Yajnik: None.
242-OR: Do GLP-1RA and SGLT2i Reduce Cardiovascular Mortality in African-American Patients with Type 2 Diabetes? A Meta-analysis
Authors: MISHRIKY BASEM M. , POWELL JAMES R. , WITTWER JENNIFER A. , CHU JENNIFER X. , SEWELL KERRY , WU QIANG , CUMMINGS DOYLE M. 
Published: June 2019

While patients enrolled in the cardiovascular safety trials (CVST) for GLP-1RA and SGLT2i were mostly whites, the ADA’s updated recommendations are being generalized to all races. This raises a controversial question regarding the ability to generalize CVST results to African American (AA) patients.
We searched MEDLINE, EMBASE, and CENTRAL looking for CVST comparing diabetic medications to placebo in type 2 diabetes and reporting a statistically significant lower incidence of either the primary outcome of MACE or any of the pre-specified secondary outcomes. We then extracted cardiovascular outcomes for AA patients. Sensitivity and subgroup analyses were performed according to the class of diabetic medications.
We included 6 trials (GLP-1RA in 4; SGLT2i in 2). While those trials enrolled 53,978 patients, only 2794 were AA. There was no significant difference in CV outcomes between diabetic medications (GLP-1RA or SGLT2i) and placebo in AA patients (RR [95% CI] = 0.97 [0.68, 1.39]). On restricting the analysis to GLP-1RA, then to SGLT2i, results for AA patients remained non-significant. On comparing results for GLP-1RA to those with SGLT2i, there was no difference between the groups.
We conclude that AA are not well represented in CVST. Because cardiovascular outcomes were not significantly improved for AA, it remains unclear whether GLP-1RA or SGLT2i would reduce cardiovascular risk in AA.

Disclosure
B.M. Mishriky: None. J.R. Powell: None. J.A. Wittwer: None. J.X. Chu: None. K. Sewell: None. Q. Wu: None. D.M. Cummings: None.
2429-PUB: Circulating microRNAs Are Associated with Glycemic Variability over a 12-Month Period
Authors: FLOWERS ELENA , ALLEN ISABEL D. , KANAYA ALKA M. , AOUIZERAT BRADLEY 
Published: June 2019

Introduction: Circulating microRNAs (miRs) function as mediators of biological responses to the environment and may provide insights into mechanisms for type 2 diabetes (T2D). A limitation of prior studies is their cross-sectional design. We sought to characterize variability in fasting blood glucose (FBG) at 5 time-points over a 12-month period in order to determine whether FBG variability was associated with circulating miR expression and identify miR-associated biological pathways.
Methods: Participants were from a previously completed trial on restorative yoga for overweight/obese adults with prediabetes. FBG variability was defined using the standard deviation across 5 time-points. A subset of participants with high (n=10) vs. low (n=10) FBG variability, matched by age and sex, were evaluated. Expression of 336 miRs collected at baseline was measured with the Fireplex Circulating MicroRNA assay. False discovery rate (FDR) threshold of 0.2 was applied. The miRPathDB database was used to identify KEGG pathways.
Results: A total of 6 miRs (i.e., miR-192, miR-197, miR-206, miR-424, miR-486, miR-93) were differentially expressed between individuals with highly compared to low FBG variability. For the six miRs identified in both batches, 321 KEGG pathways were targeted. The Insulin signaling pathway was targeted by miR-197, miR-206, miR-424, and miR-486; the Insulin secretion pathway was targeted by miR-486; and the type 2 diabetes mellitus pathway was targeted by miR-197, miR-206, miR-424, and miR-486.
Conclusions: Circulating miRs are associated with variability in FBG and miRs target pathways that are known to underlie risk for T2D. The immediate next step is to perform longitudinal analysis of the relationships between FBG and circulating miRs to explore novel pathway targets to derive new insights about mechanisms for T2D.

Disclosure
E. Flowers: None. I.D. Allen: None. A.M. Kanaya: None. B. Aouizerat: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1R21DK117346-01A1)
243-LB: Characterization and Genetic Validation of Gene Expression Changes across Diabetes Development
Authors: CHEN HUNG-HSIN , PETTY LAUREN E. , MCCORMICK JOSEPH , MCCORMICK SUSAN P. , GAMAZON ERIC , BELOW JENNIFER E. 
Published: June 2019

Type 2 diabetes is a complex and heritable disease. Gene expression is influenced by a number of factors, including genetic and environmental factors as well as disease progression. Yet, the changes in genome-wide transcriptome profiles during diabetic development have not yet been studied. We recruited 58 subjects from Cameron County, Texas, whose fasting glucose was less than 126 mg/dl (mean 106.74 mg/dl). During the follow-up period, 24 subjects' fasting glucose elevated to the diabetes diagnostic level (≥126 mg/dl), and the other 34 subjects’ maintained healthy level (&lt;126 mg/dl). To explore the effect of gene expression, we applied RNA-sequencing to profile the peripheral blood transcriptome at both baseline and follow-up visit for all individuals. We then performed an unsupervised network approach, weighted gene co-expression network analysis, to cluster genes into modules with correlated changes in expression pattern over time. Among 17 identified modules, one showed significant differences in gene expression pattern over time between convert and control groups. This module contains 822 genes, including WDFY3, which accounted for the most variance, and STX3, which exhibited the highest connectivity. In addition, change pattern over time of MIR3605, ASB9P1, NUDT16, and MKNK1-AS1 had the highest correlation with transition status. To validate the function of genes in this interesting module, we examined the association between these 822 genes and diabetes and related metabolism disease via genetically regulated expression in a large electronic health record linked biobank at Vanderbilt University. We found that the genes in this module were significantly enriched with significant association to diabetes mellitus, disorders of pancreatic internal secretion, and disorders of mineral metabolism. In sum, we present a set of genes expression change correlated with diabetes progression, and validated their function on diabetes related disorders in a large biobank.

Disclosure
H. Chen: None. L.E. Petty: None. J. Mccormick: None. S.P. McCormick: None. E. Gamazon: None. J.E. Below: None.
2436-PUB: Predicting Risk for New-Onset Type 2 Diabetes in Chinese People with Coronary Heart Disease and Impaired Glucose Tolerance
Authors: XU SHISHI , SCOTT CHARLES A. , COLEMAN RUTH L. , TUOMILEHTO JAAKKO , HOLMAN RURY R. 
Published: June 2019

Background and Aims: Patients with cardiovascular disease are at high risk of type 2 diabetes (T2D), but little has been done to provide robust T2D risk estimates. We used Acarbose Cardiovascular Evaluation (ACE) trial data to develop a T2D risk calculator for Chinese people with coronary heart disease (CHD) and impaired glucose tolerance (IGT).
Methods: ACE recruited 6522 Chinese CHD patients with IGT, randomized 1:1 to acarbose or placebo, with prospective ascertainment of new-onset diabetes over median 5.0 years. Logistic regression was used to develop basic and full risk prediction models in the 6238 with the requisite baseline data. Clinically relevant variables and variables showing a univariate association (P&lt;0.1) with incident diabetes were included.
Results: Overall 918 (15%) of 6238 participants developed diabetes. The basic model, using only clinical variables, was a poor fit with an area under the receiver-operating characteristic curve (AUC) of 0.60, whilst the full model including routinely-available laboratory results had an AUC of 0.76 with excellent goodness of fit (Table).
Conclusion: In Chinese people with IGT and CHD, lower age, male sex, obesity, prior hypertension, calcium channel blocker use, nondiabetic hyperglycaemia and dyslipidaemia were major determinants for new-onset diabetes. A model comprising these factors can be used to predict 5-year T2D risk.

Disclosure
S. Xu: None. C.A. Scott: None. R.L. Coleman: None. J. Tuomilehto: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; AstraZeneca. Research Support; Self; Bayer AG. R.R. Holman: Advisory Panel; Self; Bayer AG, Novartis AG, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp. Other Relationship; Self; AstraZeneca, Bayer AG, GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc.