bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atypical Antipsychotics and Metabolic Complications
Authors: AKUNJEE MUNAZA , GANDHI SHRUTI M. , NYLEN ERIC 
Published: June 2018

Introduction: Second generation antipsychotics (SGA) such as olanzapine are often used for psychotic disorders due to their efficacy and fewer neurological side effects. However, they have been associated with weight gain, prediabetes, diabetes ketoacidosis (DKA), myopathy and rarely rhabdomyolysis. These side effects were reported in individual cases. Our case had both DKA and rhabdomyolysis with chronic olanzapine use of 9 years.
Case: A 36 year-old AAM with schizophrenia on olanzapine and risperidone, diet-controlled hyperlipidemia, obesity and prediabetes (HbA1c 6%,) admitted with fatigue, polyuria, polydipsia and confusion. He was diagnosed with DKA with HbA1c 13.7%, rhabdomyolysis (CK 13000 units/L) and acute kidney injury (peak creatinine 12, eGFR&lt;10), requiring insulin infusion, dialysis and mechanical ventilation. Olanzapine was discontinued; his creatinine and glucose improved. His C-peptide was 4.28 ng/ml. Anti-GAD and islet cell antibodies were negative. He was discharged on glargine and risperidone. Two months after discharge, HbA1c was 5.8%, creatinine 1 (eGFR&gt;60) and insulin was stopped.
Discussion: This case highlights the importance of monitoring patients on SGA for metabolic complications. Olanzapine’s association with DKA is rare and with rhabdomyolysis is very rare. Several mechanisms for SGA-induced glucose intolerance exist, the most common being the antagonistic effect of olanzapine on serotonin 5HT2C and histamine (H1) receptors in the hypothalamus which leads to increased appetite and weight gain (our patient gained 40 lbs). Additionally, few reports on the association between olanzapine and rhabdomyolysis have been published. The mechanism remains unclear but may be due to drug-related myopathy secondary to high affinity for H1, 5-HT2A and D2 receptors. It is possible that the development of DKA predisposed our patient to developing rhabdomyolysis.

Disclosure
M. Akunjee: None. S.M. Gandhi: None. E. Nylen: None.
Use of Continuous Glucose Monitoring during Dose Adjustment for Normal Eating Course Favors the Emergence of Positive Patient–Provider Language Code
Authors: MAMED MARCELO DOS SANTOS , GASTALDI GIACOMO 
Published: June 2018

Personalized approach to diabetes care and educations are worldwide recognized to favor health outcomes and health-related quality of life. Continuous glucose monitoring (CGM) can be a powerful tool to help diabetes education. Language and the way clinicians use it has an interactive impact on education. The aim of the study is to explore the language in narrative form emerging from the patient-provider interactions mediated by the use of CGM readings. Researchers transcribed and coded the data collected during the seven sessions of Dose Adjustment For Normal eating course taking place at University Hospital of Geneva in Switzerland. The course involved 3 health care providers (dietician, nurse and medical doctor) and 12 participants. All the sessions were filmed and semi-structured interviews of 10 participants and the 3 providers completed the data. Conversation Analysis of the interactive and discursive space created by the narrative’s experiences from participants mediated by CGM readings was investigated as well as Content analysis of the semi-structured interviews in order to put in perspective learning traces through participant's discourses. The results have shown that health care providers adjust and coordinate their languages through CGM readings in order to organize the narrative’s experiences from the participants. The use of technology reduced judgmental and negative words and promoted the development of a patient-provider narrative useful for learning. The narrative organization clearly impacted the participants. Diabetes technology and particularly CGM readings are powerful tools to develop a specific patient-provider language code promoting effective diabetes education.

Disclosure
M. Dos Santos Mamed: None. G. Gastaldi: Speaker's Bureau; Self; Abbott, Eli Lilly and Company, Novo Nordisk A/S, Medtronic, Dexcom, Inc., Sanofi, Roche Diabetes Care Health and Digital Solutions, Boehringer Ingelheim GmbH.
Rapid Improvement of Metabolic Control in Type 1 Diabetes after Transition from Paediatric Clinics to an Adult Diabetes Center
Authors: MAURIZI ANNA RITA , PIERALICE SILVIA , TUCCINARDI DARIO , GUGLIELMI CHIARA , LAURIA ANGELO , MADDALONI ERNESTO , FIORITI ELVIRA , MANFRINI SILVIA , POZZILLI PAOLO 
Published: June 2018

Transition from paediatric to adult diabetes clinics for type 1 diabetes (T1D) patients represents a critical phase often characterized by worsening effects on diabetes outcomes as care visit attendance, metabolic control and diabetes related complications. Aim of this study was to evaluate metabolic control of 122 T1D patients [82/40 M / F, mean (SD), age 25.1 ± 5.7 years, disease duration 17.2 ± 8.1 years, HbA1c 7.9% ± 1.4] at time of transition from paediatric clinics to our adult diabetes center. At baseline, 102 patients were on multiple daily insulin injections (MDI) and 20 subjects were on continuous subcutaneous insulin infusion (CSII). The transition process was performed in a specific "transition clinic" according to the protocol of the Consensus Statement of the American Academy of Paediatrics, American Diabetes Association, Academy of Family Physicians and the American College of Physicians. Results after 3 and 6 months follow-up showed a significant improvement in metabolic control with reduction of HbA1c in the whole population [Δ HbA1c 0-3 months: -0.3% (p &lt;0.05), Δ HbA1c 0-6 months: -0.5% (p &lt;0.02)] as well as in the different age groups [15-20, 21-30 (p &lt;0.05, p &lt;0.001, respectively)]. At baseline females showed a worst metabolic control compared to male patients (HbA1c: 8.3% ± 1.5 vs. 7.6% ± 1.1, p = 0.005) and this result was confirmed at the end of the study period (HbA1c: 7.9% ± 1.0 vs. 7.1% ± 0.8, p &lt;0.001). After 6 months since transition 27% of patients were on CSII compared to 16% of patients in the pre-transfer period, however improvement of metabolic control was independent of CSII use.
In conclusion, our data showed that transition from paediatric to our adult diabetes center promotes a very fast reduction of HbA1c already detectable after 3 months of follow-up. This unexpected improvement is likely due not only to increased use of technology but to a more proper clinical setting for emerging adults as recommended by different scientific societies.

Disclosure
A. Maurizi: None. S. Pieralice: None. D. Tuccinardi: None. C. Guglielmi: None. A. Lauria: None. E. Maddaloni: Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; European Foundation for the Study of Diabetes. E. Fioriti: None. S. Manfrini: None. P. Pozzilli: Research Support; Self; Sanofi. Speaker's Bureau; Self; Eli Lilly and Company. Research Support; Self; Merck Sharp & Dohme Corp..
"It Was All Trial and Error"—The Perspective of Parents of Emerging Adults with Type 1 Diabetes during the Transition to Independence
Authors: ALBANESE-O'NEILL ANASTASIA , WESTEN SARAH C. , THOMAS NICOLE T. , HALLER MICHAEL J. , SCHATZ DESMOND 
Published: June 2018

Introduction: Emerging adults ages 18-25 years with type 1 diabetes (T1D) navigate the transition to independence in partnership with their parents. Few programs exist to meet the educational needs of parents during this transition, and little is known about their perceived knowledge deficits or readiness to provide guidance for their children. The purpose of this study was to describe the lived experience and diabetes-specific educational needs of parents of emerging adults with T1D.
Methods: Parents of adults with T1D aged 18-25 years were recruited to participate. Written informed consent was obtained and participants then took part in a semi-structured interview. Interviews were digitally recorded and professionally transcribed. A descriptive content analysis of the transcripts began after the first interview and proceeded until saturation was reached. Following the interview, participants were sent links to the study’s diabetes education website that included information on transition topics.
Results: Twenty-two parents (5 fathers, 17 mothers) of emerging adults participated in the study. Six themes emerged from the transcribed interviews: No Roadmap, Few Resources; Peers as Primary Source of Support; New Roles Require a New Communication Style; Parents Sometimes Excluded from Care; Begin Early, Go at the Child’s Pace; and Fears, Challenges, and Opportunities. All participants expressed openness to diverse education modalities, including in person, online, group videoconference, and social media. Participants received 110 push notifications, resulting in 964 page views on the study website.
Conclusions: Parents of emerging adults with T1D have a central role in their child’s transition to independence, but may not receive adequate guidance to be successful in this endeavor. The results of this study underscore the need for a tailored diabetes education program for parents of emerging adults that includes a component of peer support.

Disclosure
A. Albanese-O'Neill: None. S.C. Westen: None. N.T. Thomas: None. M.J. Haller: None. D. Schatz: None.
Exploring the Type 2 Diabetes Mellitus Experience from the Patient Perspective
Authors: YU-ISENBERG KRISTINA , GRAY GEOF D. , FOLEY CATHERINE , STOKES JONATHAN T. , SHIELDS ALAN , DICKIE GAVIN , LAMOUREUX ROGER , JACKSON CLARK V. , PADILLA BRAD , POLONSKY WILLIAM 
Published: June 2018

Introduction: Type 2 diabetes mellitus (T2DM) exacts tremendous burdens on the patient and patient-focused qualitative research can yield data to deepen our understanding of the individual disease experience.
Methods: Research was conducted to illustrate the T2DM patient experience ranging from its proximal signs/symptoms to its distal impacts (e.g., the disease’s impact on physical, social, or emotional functioning). A targeted literature review, meetings with therapeutic experts, and qualitative concept elicitation interviews with T2DM patients were conducted, and results were thematically analyzed and then harmonized into a conceptual model to organize the sign, symptom, and disease-related impact experiences most relevant to T2DM.
Results: A total of 38 unique sign/symptom and 62 impact concepts of T2DM were identified across the reviewed literature (N=26 publications), expert advice meetings (N=13), and patient interviews (N=20, mean age=60.5±9.5 years, 45% female). The signs/symptoms most frequently reported by patients were tiredness (n=16), dizziness (n=10), and neuropathy-related (n=10), while experts reported excessive thirst (n=12), frequent urination (n=11), and vision problems (n=11) most frequently. For disease impacts, the concepts most frequently reported by both experts and patients were the need to modify diet (n=11 and n=20, respectively), implement an exercise regimen (n=13 and n=17, respectively), and monitor glucose more frequently (n=10 and n=16, respectively). The most bothersome signs/symptoms reported by patients were neuropathy-related (n=8), tiredness (n=5), and vision disorders (n=4).
Conclusions: Patients with T2DM experience many signs, symptoms, and impacts that if improved could give meaningful treatment benefit. Data generated from this research could be used by researchers and healthcare providers to identify treatment outcomes and inform the target concepts of T2DM questionnaires to reliably assess those outcomes.

Disclosure
K. Yu-Isenberg: Employee; Self; Intarcia Therapeutics, Inc. G.D. Gray: Employee; Self; Servier Global Medical Affairs. C. Foley: Consultant; Self; Intarcia Therapeutics, Inc., Servier. J.T. Stokes: None. A. Shields: Consultant; Self; Intarcia Therapeutics, Inc. G. Dickie: Consultant; Self; Intarcia Therapeutics, Inc. R. Lamoureux: Research Support; Self; Intarcia Therapeutics, Inc.. C.V. Jackson: None. B. Padilla: None. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions.
Visiting Rate of Dental Clinic by the Recommendation Based on the Periodontal Screening Tests for DM Patients
Authors: KATO NORIKO 
Published: June 2018

Aim: To investigate the dental visit status of DM patients who needed to treatment of periodontitis screened by Perioscreen test in the medical and dental clinic cooperation at community base.
Material and Method: The study population was DM patient undergone perio dontal screening tests by diabetologist . In total, 100 subjects (65 male and 35 female) were selected. The dental visit status of DM patients with positive results was investigated according to correspondence between the medical and dental information including intraoral clinical examination: number of remaining teeth, maximum value of the periodontal pocket and percent of bleeding on probing, and type of periodontal treatment.
Result: 57 patients were positive for Perioscreen test. Among the patients with positive results, 34 patients (59.6%) visited one of three partnership dental offices and all received periodontal treatment. 26 patients (45.6%) were finished their periodontal treatment within 6 months. For the patients who finished dental treatment, parameters of periodontal diseases were improved.
Conclusion: About 60% DM patients who regularly attend the medical clinic were positive for periodontitis by Perioscreen test. Among them, about 60% patients attended for dental clinic by the recommendation by family doctor. These results may provide the basic information to medical and dental clinic cooperation and community medical care networks.

Disclosure
N. Kato: None.
Exercise Performance Is Not Impaired by Hyperglycemia in Type 1 Diabetes
Authors: ROTHACKER KAREN , ARMSTRONG SAM , SMITH GRANT J. , BENJANUVATRA NAT , LAY BRENDAN S. , FOURNIER PAUL A. , ADOLFSSON PETER , JONES TIM , DAVIS ELIZABETH A. 
Published: June 2018

It is unclear whether acute hyperglycemia impairs exercise performance in T1D. To address this question we compared different exercise performance measures under 3 different conditions: euglycemia with basal insulin, hyperglycemia with basal insulin and hyperglycemia with low insulin.
In a randomized, counter-balanced, blinded study design, we studied 12 recreationally active individuals with T1D (8 males, 4 females, 17.9 ± 3.9 years, HbA1c 7.7 ± 1.0%, mean ± SD). Each completed exercise testing under 3 conditions: euglycemia (5 mM) with basal insulin (20 mU/m2 BSA/min) and hyperglycemia (17 mM) with basal insulin and hyperglycemia with low insulin (5 mU/m2 BSA/min). The clamp technique was used to achieve study conditions which were maintained for at least 60 min prior to exercise. Standardised exercise performance assessment consisted of 6 tests: a single cycle ergometer V˙2 peak test and the following tests performed in triplicate: 6-sec maximal sprint cycling, vertical jump, grip strength, single leg static balance, and modified Star Excursion Balance Test. Ten simple and choice reaction times were also performed.
Target glucose levels were achieved in all subjects: 4.9 ± 0.03 mM for euglycemia and 17.3 ± 0.04 mM for hyperglycemia (mean ± SE). Mean exercise testing duration was 110 min (range 90-130 min) with no observed ketosis. Analysis of the 6 exercise performance tests using mixed method models did not show any consistent difference in performance between the 3 study conditions. Choice reaction time was slower in hyperglycemia with low insulin compared to the other conditions (p&lt;0.01).
This is the first study to comprehensively assess the effect of acute hyperglycemia on exercise performance. Our findings show that hyperglycemia in either basal or low insulin condition does not impair exercise performance as measured by a combination of maximal muscle power and strength, postural balance, and maximal aerobic capacity in recreationally active individuals with T1D.

Disclosure
K. Rothacker: None. S. Armstrong: None. G.J. Smith: None. N. Benjanuvatra: None. B.S. Lay: None. P.A. Fournier: None. P. Adolfsson: Advisory Panel; Self; Abbott, Eli Lilly and Company, Roche Diagnostics Corporation. Speaker's Bureau; Self; JDRF, Nordic Infucare, Rubin Medical. T. Jones: None. E.A. Davis: None.
Optimal Insulin Correction Factor (ICF) for Post-exercise Hyperglycemia following High-Intensity Training in Adults with Type 1 Diabetes (T1D)—The FIT Study
Authors: ARONSON RONNIE , BROWN RUTH E. , RIDDELL MICHAEL 
Published: June 2018

The phenomenon of post-exercise hyperglycemia following high-intensity training (HIT) in T1D patients has led to debate of corrective therapy options but has not been definitively investigated to date. The FIT study was a randomized, cross-over investigation of 4 post-HIT bolus insulin correction strategies in patients with T1D. Patients with T1D (n=18) using multi-daily injections (MDI) were enrolled and underwent an 8-week insulin optimization period using insulin glargine 300 U/mL as their basal insulin. On 4 separate days, each subject performed 25 minutes of HIT. If hyperglycemia (&gt;8.0 mmol/L) resulted, subjects received a bolus insulin correction 15 minutes post-HIT, based on their own ICF, adjusted by one of 4 commonly used multipliers: 0%, 50%, 100%, or 150%. At 180 minutes following bolus correction, change in plasma glucose (PG) was greatest in both the 100% (-4.7 mmol/L) and 150% (-5.3 mmol/L) ICF arms, vs. 50% (-2.3 mmol/L, p&lt;.05) and 0% (+1.0 mmol/L, p&lt;.05) (Figure). Percent time in euglycemia (4.0-8.0 mmol/L) progressively increased with each increasing correction factor. Hypoglycemia was rare and only seen in the 150% arm. In correction of post-exercise hyperglycemia following HIT, correction based on a patient’s usual ICF is safe and effective. Optimal BG reduction, with no hypoglycemia, occurred in the 100% ICF correction arm.

Disclosure
R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck & Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc.. R.E. Brown: None. M. Riddell: Speaker's Bureau; Self; Medtronic. Consultant; Self; Eli Lilly and Company, JAEB Center For Health Research, Xeris Pharmaceuticals, Inc.. Research Support; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; Zucara Theraputics. Other Relationship; Self; JDRF.
Provider Perspectives on Exercise in Children with Type 1 Diabetes
Authors: ILKOWITZ JENIECE , GALLAGHER MARY PAT 
Published: June 2018

Background: The benefits of exercise for adults with type 1 diabetes (T1D) are well known but literature in children is limited creating knowledge deficits for pediatric providers and patients. The objective of this study was to determine provider awareness of guidelines, current practices and barriers to counseling during visits.
Methods: Members of the Pediatric Endocrine Society were asked to take an online survey including questions about provider demographics and perspectives on exercise counseling for children with T1D. Descriptive analyses were performed.
Results: A total of 80 providers completed the survey. The majority practice in an urban setting (69%) at academic medical centers (82%). Of respondents, 54% reported they were unaware of exercise guidelines from the American Diabetes Association (ADA) that suggest 60 minutes of exercise daily. Of those who reported awareness, 16 of 37 identified them correctly but only 7 of the 16 reported recommending them clinically. Most providers (40%) reported recommending at least 30 minutes of exercise 5 days per week. The majority reported exercise counseling should be a priority at all visits (55% strongly agree, 30% agree) and cited barriers to counseling were: presence of more pressing issues (76%) and lack of time (61%). Respondents reported cardiovascular health (85%), improved insulin sensitivity (68%) and weight control (56%) as the most important exercise benefits.
Conclusions: Pediatric endocrinologists report exercise counseling is important for patients with T1D but time barriers to counseling exist for the majority. Counseling tools that require less time during clinical visits may be beneficial to providers and patients. Also, even respondents who were aware of current guidelines reported recommending shorter periods of exercise. The reason for this discrepancy is unknown but it may reflect the desire to recommend more realistic goals. Further research about the benefits of shorter periods of exercise in this population is needed.

Disclosure
J. Ilkowitz: None. M. Gallagher: None.
Variability and Reproducibility in the Rise in Blood Glucose Levels in Response to High Intensity Interval Training (HIIT) in Type 1 Diabetes (T1D)—The FIT Reproducibility Study
Authors: RIDDELL MICHAEL , POONI RUBIN , BROWN RUTH E. , YAVELBERG LOREN , LI ZOEY , KOLLMAN CRAIG , ARONSON RONNIE 
Published: June 2018

Hyperglycemia can occur when individuals with type 1 diabetes (T1D) perform high intensity interval training (HIIT). However, the reproducibility of the glycemic response to a HIIT session has not been definitively tested. Seventeen patients with T1D, all using insulin glargine 300 U/mL (Toujeo®) as basal insulin, were asked to perform four separate in clinic HIIT sessions in an overnight fasted state. HIIT consisted of two bouts of cycling at 90% peak power, separated by a series of ‘CrossFit’-type activities, spanned over a 25 min period (∼75-95% of maximal heart rate). Plasma glucose (YSI) was measured pre-exercise (-10 min) and at 5- and 15-min into the HIIT session, as well as at 5- and 15-min in recovery. A total of 64 HIIT sessions were compiled. Pre-exercise blood glucose levels were similar among the four HIIT visits (8.8 ± 1.0 mmol/L, mean SD), as were the rise in glucose levels in response to HIIT (+3.9 ± 1.6; +3.8 ± 1.8; +3.9 ± 2.3; +3.9 ± 1.5 mmol/L, in visits 1-4, respectively). In almost all occasions (63 of 64 sessions), HIIT produced a rise in glycemia, but the inter-individual responses did vary, ranging from -0.3 to +9.0 mmol/L. The change in glucose during HIIT was not influenced by the baseline glucose concentration and was predictable within an individual based on the measured response in visit 1 (composite correlation with post-exercise glucose rise among the four visits was 0.56 [0.33-0.79, 95% CI]). Following HIIT, there appears to be a consistent increase from the pre-exercise glucose concentration in patients living with T1D and the degree of response is moderately reproducible within a given patient. Individualized insulin correction strategies, which take into account the rise in glucose observed and the patient’s sensitivity to insulin, may be helpful in restoring glucose control after HIIT in patients living with T1D.

Disclosure
M. Riddell: Speaker's Bureau; Self; Medtronic. Consultant; Self; Eli Lilly and Company, JAEB Center For Health Research, Xeris Pharmaceuticals, Inc.. Research Support; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; Zucara Theraputics. Other Relationship; Self; JDRF. R. Pooni: None. R.E. Brown: None. L. Yavelberg: None. Z. Li: None. C. Kollman: Research Support; Self; JDRF, Bigfoot Biomedical, Dexcom, Inc., Tandem Diabetes Care, Inc., Medtronic MiniMed, Inc., Helmsley Charitable Trust. R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck & Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc..