bluuebunny/crossref_metadata_2025_split huggingface dataset:
1225-P: Dietary Fiber and Glycemic Control in Women with Diabetes in Pregnancy—A Systematic Review and Meta-analysis
Authors: JONES DANIELLE , KYRIAKIDOU ANNA , COOPER LOUISE , ATTA NOORIA , TOBOLSKA PATRYCJA , SMITH SUZANNE , TURNER ELIZABETH , PETRY CLIVE J. , MEEK CLAIRE L. 
Published: June 2024

Dietary fiber improves glycemic control in type 2 diabetes, but its therapeutic role in pregnancy diabetes is unclear. We assessed the effect of dietary fiber on glycemia in women with diabetes in pregnancy.
Methods: We searched three databases (Cochrane Library, MEDLINE, Web of Science) to identify RCTs exploring the effect of dietary fiber, high fiber diets or fiber supplementation on fasting blood glucose (FBG), postprandial blood glucose (PBG), and requirement for insulin therapy in pregnant women with any type of diabetes. Data was pooled for each outcome, and we calculated Hedges’ g from standardised mean differences between groups to estimate effect size.
Results: Of 1,462 identified studies, data from 20 eligible trials containing 1,016 participants were pooled. On meta-analysis, a higher fiber intake was associated with reduced FBG (Hedges’ g= -1.11, 95%CI; -1.92, -3.0), PBG (Hedges’ g= -0.66, 95%CI; -1.17, -0.14), and requirement for insulin (logOR -1.43, 95%CI; -2.07, -0.78). There was significant heterogeneity for FBG and PBG (&gt;90%), attributable to differences in Intervention type (DASH, Low GI, supplement; p&lt;0.01) and study duration &lt;4wks (for PBG: p=0.04; not for FBG). Studies were mostly scored as high risk of bias due to lack of blinding (Cochrane Risk of Bias Tool v.2.0).
Conclusion: High-quality dietary intervention studies in pregnancy are lacking. Our results suggest that high-fiber diets improve fasting and postprandial glycemia and reduce the likelihood of requiring insulin in women with diabetes in pregnancy.

Disclosure
D. Jones: None. A. Kyriakidou: None. L. Cooper: None. N. Atta: None. P. Tobolska: None. S. Smith: None. E. Turner: None. C.J. Petry: None. C.L. Meek: Research Support; Dexcom, Inc.
1230-P: Clinical Risk Factors and First Gestational 75g OGTT May Predict Recurrent and New-Onset Gestational Diabetes in Multiparous Women
Authors: MIRABELLI MARIA , TOCCI VERA , CHIEFARI EUSEBIO D. , PATRIZIA FOTI DANIELA , BRUNETTI ANTONIO 
Published: June 2024

Women who had gestational diabetes mellitus (GDM) in their first pregnancy are again prone to GDM in a second pregnancy. Even women with no previous history of GDM may be at risk of GDM in a future pregnancy. Identifying women who are more likely to have recurrent or new onset GDM is important for effective planning of future pregnancies.
Multiparous women (n=759), tested for GDM in two consecutive pregnancies, were retrospectively enrolled. GDM was diagnosed by 75g OGTT (IADPSG criteria). OGTT was performed at 24-28 weeks or earlier in case of a former GDM diagnosis. To compare clinical features and OGTT glucose curves, women were divided into four groups: NGT women at both pregnancies (n=493); women with first occurrence of GDM at their second pregnancy (n=74); women with non-recurrent GDM at second pregnancy (n=92); women with recurrent GDM at second pregnancy (n=100).
Intergroup comparisons revealed clinical predictors of GDM at the first pregnancy (family history of type 2 diabetes, PCOS, early menarche, advanced maternal age, pregravid obesity) and at the second pregnancy (interpregnancy BMI gain), and predictors of recurrent GDM (pregravid obesity, PCOS). Among these women, a positive correlation was observed between the OGTT glucose curves of consecutive pregnancies. Adjusted logistic regression showed that higher level of 1h-postload glucose (ROC optimal cut-point: 130 mg/dL) at the first pregnancy would enhance the likelihood of a new occurrence of GDM in a second pregnancy (OR 2.50, 95%CI 1.51-4.13), whereas higher levels of 2h-postload glucose (ROC optimal cut-point: 153 mg/dL) at the first diagnostic OGTT would enhance the likelihood of GDM recurrence (OR 2.21, 95%CI 1.06-4.63).
Clinical risk factors, and their dynamic changes throughout female reproductive life span, as well as postload glucose at first gestational OGTT, can help predict GDM in multiparous women and tailor preventive interventions, including interpregnancy weight loss.

Disclosure
M. Mirabelli: None. V. Tocci: None. E.D. Chiefari: None. D. Foti: None. A. Brunetti: None.
1238-P: Is Hypoglycemia following Glucose Load Associated with Adverse Neonatal or Maternal Outcomes?
Authors: GOULD ALEXANDER , KASSIR ELIAS , SIAVOSHI MEHRNAZ , KWAN LORNA , HAN CHRISTINA S. 
Published: June 2024

Introduction & Objective: Gestational diabetes (GDM) is typically diagnosed by elevated plasma glucose on a screening 50-gram 1-hour oral glucose challenge test (1H), followed by two elevated values on a diagnostic 100-gram 3-hour glucose tolerance test (3H). Pregnancy outcomes of individuals with hypoglycemia (HG) during a 1H or 3H have not been well-studied. We aimed to evaluate risk of adverse neonatal outcomes (ANO) and adverse maternal outcomes (AMO) in pregnancies including HG on a 1H or 3H.
Methods: In this retrospective cohort study, we examined patients who delivered at two academic centers from January 2021-June 2022. Singleton pregnancies with a 1H and/or 3H done 8-16 weeks before delivery were included. Pregnancies with fetal anomalies, pre-gestational DM, gastric bypass and cystic fibrosis were excluded. HG was defined as &lt;70 mg/dL. Patients with HG on 1H or 3H were compared to patients with normal 1H. The primary outcome was a composite of ANO/AMO. Groups were compared using Kruskal-Wallis and Chi-square tests, as appropriate. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated from logistic-regression models.
Results: The cohort included 2,867 pregnancies: 2,146 with normal 1H, 102 with HG on 1H, and 147 with HG on 3H. Differences in demographic and risk factors between groups included maternal age at delivery, race/ethnicity, pre-pregnancy BMI and pre-diabetes, maternal cardiac disease, and total weight gain in pregnancy. After adjusting for these differences, HG following 1H or 3H was not associated with increased risk of ANO/AMO overall (1H ANO: aOR 1.292 [CI 0.734-2.276]; 1H AMO: aOR 1.077 [CI 0.638-1.819]; 3H ANO: aOR 0.883 [CI 0.574-1.358]; 3H AMO: aOR 0.998 [CI 0.654-1.523]).
Conclusion: In this cohort of singleton pregnancies, HG following glucose load was not associated with increased risk of ANO/AMO overall. HG following glucose load may indicate abnormal glucose metabolism, though its clinical significance in pregnancy is unclear.

Disclosure
A. Gould: None. E. Kassir: None. M. Siavoshi: None. L. Kwan: None. C.S. Han: None.
1247-P: Outcomes of Pregnancies Complicated by Type 1 Diabetes in a Diverse Patient Population at an Urban Diabetes Center
Authors: LONIER JACQUELINE , BEJERANO SHAI , EVANS ANABEL , GOLAND ROBIN 
Published: June 2024

T1D is associated with increased risk of adverse pregnancy outcomes, which can be mitigated by tight glycemic control. There is a paucity of data demonstrating the outcomes of diverse populations of pregnant women with T1D utilizing current diabetes technology. Here we describe the outcomes of 129 pregnancies in 118 women with T1D who delivered between January 2019 and December 2022, managed by a multidisciplinary diabetes care team at a single center. Of this cohort, 42% identified as non-Hispanic white (NHW), 6% as non-Hispanic Black (NHB), 34% as Hispanic, and 5% as Asian or other; 39% were publicly insured. Insulin pumps were used in 67% of pregnancies, CGMs in 90%, and hybrid closed-loop systems in 38%. The median of the average HbA1c through pregnancy in the entire cohort was 6.0%. Preeclampsia occurred in 28% of pregnancies, preterm delivery (&lt;36 weeks) in 25%, macrosomia in 10%, neonatal hypoglycemia in 13%, NICU admission in 28%, and fetal anomalies in 3%. There were no neonatal deaths. Compared to multiple daily injections, insulin pump use was associated with lower average A1c through pregnancy (median 5.8% vs 6.8%, p&lt;0.001) and lower risk of preterm delivery (21% vs 42%, p=0.03). NHB and Hispanic women had higher average A1c compared to NHW women (respectively median 6.6% and 6.5% vs 5.6%, p&lt;0.001), higher risk of preterm delivery (43% and 48% vs 10%, p=0.001), and neonates with lower birthweight (median 3035g and 3215g vs 3465g, p=0.005). Similar trends of higher risk of adverse outcomes were observed in publicly insured women compared to those with private insurance. Our data demonstrates the feasibility of achieving glycemic targets on a population level in pregnant women with T1D. Concerns remain regarding disparities in outcomes between NHB and Hispanic women compared to NHW women and in those with public vs private insurance. Analyses of larger populations are needed to further delineate these disparities and inform systems-level approaches to care of pregnant women with T1D.

Disclosure
J. Lonier: None. S. Bejerano: None. A. Evans: None. R. Goland: None.

Funding
Columbia University Diabetes Research Center
1260-P: Forecasting Health Disparity Burden of Cardiometabolic Diseases among U.S. Middle-Aged Adults—A Microsimulation Study
Authors: KIM DAVID , WANG LU , MOZAFFARIAN DARIUSH , WONG JOHN B. 
Published: June 2024

Background: Understanding the future health disparity burden of cardiometabolic diseases across racial-ethnic and socioeconomic (SES) groups is essential for policy and priority setting.
Methods: Using a validated US Diabetes, Obesity, Cardiovascular Disease microsimulation (DOC-M) model, we predicted absolute and relative changes (Δ) in the prevalence of diabetes, obesity, cardiovascular diseases (CVD), and all-cause mortality over the next 20 years, overall and by racial-ethnic and SES groups (education and income) among the US population aged 40-79 using the NHANES 2017-2020 data (n=5,745, representing 142.5 million).
Results: As the population aged over the next 20 years, our model predicted that all-cause mortality reached 40.9% overall, with the largest increase in non-Hispanic Black adults (46.7%), followed by adults with less than high school education (44.3%). CVD was projected to increase most in Hispanic adults (11.0% to 23.4%, Δ=↑113.5%), adults with high school equivalent education (18.4% to 33.4%, Δ=↑81.7%), and middle-income adults (16.1% to 29.2%, Δ=↑80.9%). Diabetes prevalence would grow the fastest among Hispanic adults (24.3% in 2020 to 52.9% in 2040, Δ=↑118.3%), versus Non-Hispanic Black adults (23.7% to 45.0%, Δ=↑90.2%) and Non-Hispanic White adults (17.1% to 30.0%, Δ=↑75.5%). Although diabetes prevalence would grow fastest among college-educated adults (16.5% to 31.2%, Δ=↑89.3%) and high-income adults (16.1% to 30.3%, Δ=↑88.0%), the greatest burden of diabetes remains among adults with less than high school education (27.0% to 47.0%, Δ=↑74.4%) and low-income adults (25.9% to 44.2%, Δ=↑74.4%).
Conclusion: Our population health model predicts worsening obesity, diabetes, and CVD that will exacerbate health disparities without targeted health interventions and policies.

Disclosure
D. Kim: None. L. Wang: None. D. Mozaffarian: Research Support; National Institutes of Health, Gates Foundation, Kaiser Permanente Fund, National Association of Chain Drug Stores Foundation, Rockefeller Foundation. Consultant; Acasti Pharma, Inc. Board Member; Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart Health, January Inc., Season Health, Validation Institute, Perfect Day, Tiny Organics. Stock/Shareholder; Calibrate, HumanCo. Other Relationship; UpToDate. J.B. Wong: None.

Funding
NIH/NHLBI (R01HL115189)
1261-P: Is Higher A1C in Older Adults with Cognitive and Functional Impairment Enough to Protect against Hypoglycemia?
Authors: CONERY COLIN D. , SLYNE CHRISTINE , LOO URBINA KENYIN , KRAKOFF NOA , BRABANT HALEY , MUNSHI MEDHA , TOSCHI ELENA 
Published: June 2024

Background: Older adults with diabetes with cognitive or functional impairment are recommended to have higher A1C. However, impact of higher A1C on CGM metrics in impaired and unimpaired patients are not well studied.
Methods: A cross-sectional analysis of baseline data across three studies was performed in older adults (age ≥65 years) with diabetes on insulin. Demographic and clinical characteristics including cognitive and functional status, and continuous glucose monitoring (CGM) data were reviewed.
Results: Data on 209 participants stratified as unimpaired (MoCA ≥26 and no frailty) and impaired (MoCa &lt;26 and/or frailty ≥1) were analyzed. Compared to the 66 patients with unimpaired status, the 143 patients with impaired status were more likely to live alone, had greater hypoglycemia fear, and high burden of comorbidities (Table 1). Although the impaired patients had higher HbA1c (7.9% ), both unimpaired and impaired patients had high burden of hypoglycemia (time spent &lt;70 mg/dL)(4.4% and 3.2% respectively) and extreme hyperglycemia (time spent &gt;250 mg/dL(13% and 19% respectively).
Conclusion: Liberal A1C goals based on cognitive and/or functional impairment may not protect against risk of hypoglycemia and extreme hyperglycemia in older adults. CGM should be considered for diabetes care decisions in the older population independent of health status.

Disclosure
C.D. Conery: None. C. Slyne: None. K. Loo Urbina: None. N. Krakoff: None. H. Brabant: None. M. Munshi: Consultant; Sanofi. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1268-P: Association of Triglyceride–Glucose Index and Homeostasis Model Assessment of Insulin Resistance with the American Heart Association's Life's Essential 8—A Nationwide Population-Based Study
Authors: WANG SIBO , WANG LIANSHENG 
Published: June 2024

Introduction & Objective: Life’s Essential 8 (LE8) is an updated metric released by the American Heart Association for assessing cardiovascular health. This study aimed to investigate the relationship between triglyceride-glucose (TyG) index and homeostasis model assessment of insulin resistance (HOMA-IR), commonly-used insulin resistance-related parameters, and LE8.
Methods: This study used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. LE8 score was measured according to the AHA LE8 algorithm. The association between TyG index and HOMA-IR (exposure), LE8 scores (outcome) and inflammatory marker (C-reactive protein [CRP]) (mediator) was explored using weighted multivariable linear regression, restricted cubic spline (RCS) models, and mediation analysis. Multiple stratified analyses and sensitivity analyses were also performed.
Results: A total of 13,750 participants, representing 186.3 million US non-institutionalized adults, were included. After multivariable adjustments, compared with the lowest quartile, the β with 95% CIs in the highest quartile were -16.61 (-17.47, -15.75) for TyG index and LE8 (P for trend&lt;0.001) and -15.64 (-16.37, -14.91) for HOMA-IR and LE8 (P for trend&lt;0.001). RCS plots showed a linear negative association between TyG index and LE8 and a nonlinear negative association between HOMA-IR and LE8. Besides, this negative association was significantly stronger in women than in men (P for interaction&lt;0.05). Mediation analysis revealed that CRP significantly mediated the relationship of TyG index and HOMA-IR to LE8 scores with mediation proportions of 13.1% and 22.5%, respectively.
Conclusion: TyG index and HOMA-IR were negatively associated with LE8 scores and cardiovascular health in US adults, especially in women, and systemic inflammation was a partial mediator of this association.

Disclosure
S. Wang: None. L. Wang: None.

Funding
Key Clinical Frontier Technology Project of Department of Science and Technology of Jiangsu Province (NO. BE2022806); National Natural Science Foundation of China (NO. 82070367)
127-OR: Identification of Exosomal miRNA as a Novel Causal Biomarker for Cognitive Impairment in Type 2 Diabetes Mellitus—Triangulating Evidence from Mendelian Randomization Analyses and Multicenter Cohort
Authors: BI YAN , YANG SIJUE , ZHANG ZHOU 
Published: June 2024

Introduction & Objective: Diabetes elevated cognitive impairment risk. Early identification of at-risk diabetes patients is crucial. This study explores exosomal microRNAs (exo-miRNAs) as potential biomarkers for early detection of cognitive impairment in T2DM.
Methods: Small RNA sequencing was conducted on exosomes from adipose tissue of T2DM patients and healthy controls. Mendelian randomization (MR) analysis was employed to detect the causal effect of miRNAs on cognitive impairment. Diagnostic performance of the candidates was tested in serum samples from a training cohort and validated in a multicenter cohort.
Results: Twenty-six miRNAs were significantly upregulated in adipose tissue exosomes of T2DM patients. MR analyses identified three miRNAs (miR-25-5p, miR-584-5p, and miR-625-5p) that were causally linked to impaired cognitive function (β=-0.016~ -0.012, P&lt;0.05) and dementia (OR=1.06~1.12, P&lt;0.05). The panel of these three exo-miRNAs in serum samples exhibited a robust ability to detect dementia in T2DM patients (AUC= 0.82, 95%CI 0.71~0.96), which was further confirmed in an external validation cohort.
Conclusions: The study revealed a causal link between exo-miRNAs and dementia in T2DM, providing a new perspective for early detection and therapeutic targets of cognitive impairment in T2DM.

Disclosure
Y. Bi: None. S. Yang: None. Z. Zhang: None.
1275-P: Higher Plasma HDL-C Levels Are Associated with a Reduced Risk of Cardiovascular Disease —A 16-Year Follow-up Community-Based Cohort Study in Korea
Authors: EUN YOO SEUNG , HO MOON JOON 
Published: June 2024

Low plasma levels of HDL-C have consistently been identified as a predictor of CVD risk. However, the impact of high HDL-C on reducing CVD risk is controversial, with some studies indicating a U-shaped risk pattern. So, we aim to investigate whether the U-shaped risk pattern is applicable to the Korean population. We conducted a 16-year follow-up on a community-based cohort, excluding individuals with a history of cancer, CVD, CKD (GFR&lt; 30 mL/min), or currently on lipid-lowering medication. Participants were categorized into 4 groups : HDL &lt; 40, 40-60, 60-80, and &gt;80 mg/dL. The primary endpoint was incident CVD, which includes acute myocardial infarction, coronary artery disease, and cerebrovascular disease. The secondary endpoint was carotid IMT. Hazard ratios for incident CVD (with reference to HDL-C &lt;40 mg/dL) were 0.81 (P=0.03), 0.77 (P=0.045), and 0.31 (P=0.045) for the 40-60 mg/dL, 60-80 mg/dL, and &gt; 80 mg/dL groups, respectively. Both left and right carotid IMT inversely correlated with HDL-C groups. In this study, we observed that individuals with very high HDL-C plasma level have a lower risk of CVD in the Korean population. Elevated levels of HDL-C are associated with thinner carotid IMT, indicating reduced future CVD risk. Compared to Western populations, Koreans exhibit significantly lower CVD risk with very high HDL-C levels.

Disclosure
S. Yoo: None. J. Moon: None.
129-OR: Increased Triglyceride Levels Are Associated with a Distinct Lipid-Associated Protein Biomarker Profile of Diabetic Foot Ulcers
Authors: PETKOVIC MARIJA , RAGUZ JANA A. , RASMUSSEN ANNE , KIRKETERP-MØLLER KLAUS , JERSIE-CHRISTENSEN ROSA R. , ANDERSEN JONAS H. , KÜMLER THOMAS , ROSSING PETER , VEVES ARISTIDIS , DALGAARD LOUISE T. , SINGH AHLUWALIA TARUNVEER 
Published: June 2024

Background and Aims: The substantial challenges to medical regimens of persons with diabetic foot ulcers (DFU) are associated with clinical heterogeneity and poorly defined risk factors. We examined the proteomic profile of newly detected DFUs to identify at-risk patients and propose a strategy for timely interventions.
Materials and Methods: 112 people with type 1 and 2 diabetes, whose ulcer tissue swaps were collected upon the first observation, were included in an observational study. Enrolled persons were categorised according to healing time: fast healing (FH, &lt;40 days), slow healing (SH, &gt;40 days; &lt;6 months), and chronic non-healing (CH, &gt;6 months). After 6 months of follow-up data were obtained from the electronic patient register. Protein profiles of tissue ulcer swaps were assessed using untargeted proteomics and MaxQuant tools. Proteins with less than 3 valid observations per group were excluded. The analysis included a significance level of 0.05 after FDR correction.
Results: Triglyceride levels of 2.5 mmol/l in CH were markedly elevated compared to FH (1.7, p= 0.013). Out of 223 proteins, 46 were highly correlated to plasma lipid and lipoprotein abnormalities. Gene Ontology (GO) and pathway enrichment from Panther.db show that 28 multiple and overlapping pathways are associated with chylomicrons lipoprotein particle remodelling (&gt;100-fold-enrichment, p&lt;0.0001). Furthermore, the dyslipidaemia pattern in CH compared to FH was characterised by the downregulation of HDL-controlling apolipoproteins family members apoA2, 4 (0.7-fold), upregulation of apoC1-3 involved in triglyceride-rich lipoproteins (1.4-fold), as well as the principal cholesterol carrier Apo-E (1.4-fold).
Conclusions: Our findings show consistent wound tissue lipoprotein profile alterations corresponding to a chronic wound phenotype. We plan to validate these findings using multiomics approaches, before integrating them into routine clinical practice.

Disclosure
M. Petkovic: None. J.A. Raguz: None. A. Rasmussen: None. K. Kirketerp-Møller: None. R.R. Jersie-Christensen: None. J.H. Andersen: None. T. Kümler: None. P. Rossing: Other Relationship; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Gilead Sciences, Inc., Novo Nordisk, Eli Lilly and Company, Novartis AG, Abbott Diagnostics. A. Veves: None. L.T. Dalgaard: None. T. Ahluwalia: None.

Funding
Danish Diabetes and Endocrine Academy (DDEA)(NNF22SA0079901); MAP-D-FOOT (NNF23OC0084081)