bluuebunny/crossref_metadata_2025_split huggingface dataset:
1336-P: High Prevalence of Complications in Young-Onset Type 2 Diabetes
Authors: SHARMA ANU , LAZARO-GUEVARA JOSE M. , STUCKI DEVORAH , PEZZOLESI MARCUS G. 
Published: June 2024

Introduction & Objective: The prevalence of type 2 diabetes (T2D) in young adults (age &lt;45 years) is increasing. There is limited data on the burden of diabetes-related complications in young-onset type 2 diabetes (YOT2D).
Methods: Adults with the diagnosis of T2D (ICD codes 250.xx and E11.xx; n=352 826) were identified from the Utah Diabetes Database, a subset of the Utah Population Database. The cohort was divided based on age at first diagnosis of T2D: YOT2D were first diagnosed between 18-44 years old and later-onset type 2 diabetes (LOT2D) were first diagnosed at ≥45 years old. Those with missing data (n=296 295) or laboratory data consistent with type 1 diabetes (n=204) were excluded.
Results: Of the 56 327 people with T2D included, 33% (n=13 087) had YOT2D and 77% (n=43 240) had LOT2D. The mean age at first diagnosis was 35±7 years in YOT2D vs 62±10 years in LOT2D. Female sex, ethnic minorities (Hispanics, non-Hispanic Black, Asian, Pacific Islanders, American Indians), and a positive family history of T2D were associated with YOT2D (p&lt;0.001). YOT2D had a higher prevalence of obesity (68% vs 62%, p&lt;0.001) and were more likely to have DKA and hypoglycemia despite similar C-peptide concentrations and insulin use compared to LOT2D. Glycemic control was worse in YOT2D, both at diagnosis (HbA1c 7.8±2.5 vs 7.2±2.0%, p&lt;0.001) and at 5 years follow up (HbA1c 7.6±3.0 vs 7.1 ±4.8%, p&lt;0.001). Risk for advanced hepatic fibrosis, as determined by the APRI score &gt;0.7, were equally high in both groups (6.9% vs 6.6, p=0.36). Similarly, frequencies of retinopathy (10%) and foot ulceration (3%) were no different. Overall, significant proportions of each group had moderately increased albuminuria (urine albumin ≥ 30 mg/g: 36% vs 34%, p&lt;0.003), diabetic nephropathy (13% vs 18%, p&lt;0.001), and diabetic neuropathy (17% vs 24%, p&lt;0.001).
Conclusion: YOT2D is associated with high prevalence of diabetes-related complications. Precision-focused mitigation strategies are needed to decrease excess adverse outcomes in YOT2D.

Disclosure
A. Sharma: None. J.M. Lazaro-Guevara: None. D. Stucki: None. M.G. Pezzolesi: None.

Funding
American Diabetes Association (7-22-JDFPM-04)
134-OR: The Safety and Efficacy of Virtual Insulin Pump Initiation in Children and Adolescents with Type 1 Diabetes in the United States
Authors: PELLIZZARI MARGARET , NWOSU BENJAMIN U. , PAVLOVIC MAIA , TALIB RASHIDA , SOHAIL RUBAB , CIRON JASON 
Published: June 2024

Introduction & Objective: This study aimed to determine the safety and efficacy of virtual insulin pump initiation compared to in-office insulin pump initiation resulting from the COVID-19 pandemic lockdown.
Methods: A longitudinal retrospective study of 112 subjects. Sixty-five percent (n=73), ages 11.2 ± 3.8 years, received in-office training, and 35% (n=39), ages 12.0 ± 4.0 years, received virtual training. Anthropometric, glycemia, and demographic data were collected at insulin pump initiation, 3 and 6 months.
Results: There were no differences in sex, race in the two groups. There were no differences in height, weight, BMI, A1c, and the duration of diabetes between the two groups at 0, 3, and 6 months. A1c and the glucose management indicator (GMI), correlated significantly at all time points. When subjects were stratified by sex, race, age into &lt;10 years and &gt;10 years and by normal-weight (BMI of &lt;85th percentile) or overweight or obese (BMI of ≥85th percentile), there was no difference in A1c and TIR. There was equally no relationship between age at pump initiation and BMI. However, the comparison between A1c and TIR among the races, Whites (n=61) versus non-Whites (n=44), showed a significantly elevated A1c in the non-White group at 6 months only: [7.45% (6.8-8.5) versus 6.9% (6.4-7.6)], p = 0.007.
Conclusion: Virtual insulin pump initiation may be safe and effective in children and adolescents with type 1 diabetes. This approach could bridge the gap in the adoption of diabetes technology in the minority population in the US.

Disclosure
M. Pellizzari: None. B.U. Nwosu: None. M. Pavlovic: None. R. Talib: None. R. Sohail: None. J. Ciron: None.
135-OR: The Effects of the WE-GDM Program for Women with Gestational Diabetes Mellitus and Their Partners on Blood Glucose Levels and Communal Coping—A Randomised Controlled Trial
Authors: GUO MIN , QIN SHIJIA , YANG HAIXIA , ZHANG YIN-PING 
Published: June 2024

Introduction & Objective: Gestational diabetes mellitus (GDM) is associated with suboptimal pregnancy outcomes and future health risks. Partner support is important for managing GDM; however, there is limited research on GDM interventions for couples. We developed the WE-GDM program based on communal coping theory and evaluated its effects on blood glucose levels and communal coping.
Methods: A randomised controlled trial was performed. Pregnant women with GDM and their partners were recruited from three hospitals in China and randomly allocated to intervention (IG; n = 70) and control (CG; n = 70) groups. Women in the CG received individual GDM education. Couples in the IG underwent the WE-GDM program (GDM education, shared illness appraisals, initiation of collaborative action, and consolidation of collaborative action). Data were collected at pre-intervention (T1), 1 week post-intervention (T2), and 8 weeks post-intervention (T3). They were analysed using generalised estimating equations.
Results: The average ages of the women and their partners were 31.1 and 32.2 years, respectively. The reductions in 2-hour postprandial blood glucose levels from T1 to T2 and from T1 to T3 were 0.22 and 0.41 higher, respectively in the IG than in the CG (β = -0.22 [-0.44 to 0.00]; β = -0.41 [-0.66 to -0.16]). Significant differences were also noted in the following dimensions regarding communal coping: at T2 and T3, the IG had higher scores for collaboration, instrumental support, and emotional support, as well as lower scores for critical and avoidance behaviors, compared to the CG.
Conclusion: The WE-GDM program effectively improved partner participation in GDM management and was beneficial for controlling blood glucose levels in pregnant women. This innovative program offers a new approach for couples managing GDM, as well as a reference for applying communal coping theory to other illnesses.

Disclosure
M. Guo: None. S. Qin: None. H. Yang: None. Y. Zhang: None.

Funding
China Scholarship Council [grant number 20210628183]; Key Research and Development Projects of Shaanxi Province [grant number 2023-YBSF-083].
1350-P: Incidence of Diabetic Kidney Disease (DKD) by Country of Birth among Immigrants and Long-Term Residents of Canada
Authors: MOHAMED SEBAT , LIPSCOMBE JENNIFER , LIPSCOMBE LORRAINE , KENASZCHUK CHRIS , THIRUCHELVAM DEVA , FAZLI GHAZAL S. , SHAH BAIJU R. , ROSELLA LAURA , KE CALVIN 
Published: June 2024

Introduction and Objective: It is unclear whether DKD incidence varies by world region of birth. We examined whether the incidence of DKD (defined as the Kidney Disease Improving Global Outcomes (KDIGO) categories 2-4) differs between immigrants and long-term residents (LTRs) with T2D in Ontario, Canada.
Methods: This retrospective cohort study used population-based linked databases to examine age-sex standardized incidence rates of DKD based on the most recent creatinine and urinary albumin-creatinine ratio (ACR) during the baseline (2012-16) and observation (2017-21) periods among adults aged 20-80 years with pre-existing T2D. We used the gamma distribution method to test for significant differences between immigrants and LTRs.
Results: We included 647,210 individuals (mean age 61.6 years, 44.9% female, 152,778 immigrants). Overall standardized incidence varied (category 2: 76.4; 3: 31.0; 4: 15.9 per 1000 person-years). Immigrants from Southeast Asia had significantly higher incidence of categories 2 and 3 (91.1, 36.4 respectively; p&lt;0.05) and a similar incidence of category 4 (16.6) versus LTRs. Incidence of categories 2-4 was lower among immigrants from East Asia (62.2, 18.5, 7.2 respectively) and several other regions versus LTRs (p&lt;0.05). Disparities in incidence narrowed as KDIGO category increased.
Conclusion: DKD incidence varies substantially by world region of birth.

Disclosure
S. Mohamed: None. J. Lipscombe: None. L. Lipscombe: Other Relationship; Novo Nordisk Canada Inc. C. Kenaszchuk: None. D. Thiruchelvam: None. G.S. Fazli: None. B.R. Shah: None. L. Rosella: None. C. Ke: Advisory Panel; Sanofi. Speaker's Bureau; AstraZeneca.

Funding
Novo Nordisk Network for Healthy Populations
1355-P: Association between Seasonal Fluctuations in Liver Enzymes and Long-Term Glycemic Control in Patients with Type 2 Diabetes Mellitus
Authors: TOKI RYOTA , SAKAMOTO MASAYA , IIDA MIHO , YUKI MASAHIRO , TAKEBAYASHI TORU 
Published: June 2024

Background: The importance of assessing liver function in patients with type 2 diabetes (T2DM) has been well established, but few studies have examined this from a time-series view. We investigated the effect of seasonal fluctuations in liver function on long-term glycemic control on T2DM.
Method: A total of 9,949 individuals (20-80 yo) were enrolled in a large registry study of T2DM in Japan from Jan 2014 (baseline) to Dec 2020. After excluding missing data on covariates, 9,438 were included in the analysis. Seasonal fluctuations of AST/ALT was defined as the amplitude of the seasonal component of each individual extracted by STL decomposition after multiple imputations. HbA1c at the final visit of each individual (final-visit A1c) was used as the index of glycemic control. Multivariate regression analysis was performed using standardized seasonal fluctuations in AST/ALT as explanatory variables and final-visit HbA1c as the objective variable. Covariates included sex, follow-up time, and age at baseline, BMI, HbA1c, log-transformed AST or ALT, drinking and smoking habits, diabetes duration, and insulin use. A sensitivity analysis was performed by adding seasonal BMI fluctuation during follow-up to the above model.
Result: During the follow-up of 6.0 ± 1.8 yrs, AST/ALT tended to be lower in summer and higher in winter. Multivariate analysis showed that the seasonal fluctuations of AST/ALT were significantly associated with final-visit A1c, with an estimated effect of +0.044% [95% CI: 0.017, 0.071] and +0.028% [0.002, 0.054] per 1SD increase, respectively. The results of the sensitivity analysis remained consistent.
Conclusion: This study indicated that seasonal fluctuations in liver enzymes might be a risk factor for poor glycemic control independent of traditional risk factors, as well as BMI fluctuation in Japanese patients with T2DM. Our results suggest that year-round assessment of liver enzymes may be important in clinical practice.

Disclosure
R. Toki: None. M. Sakamoto: None. M. Iida: None. M. Yuki: None. T. Takebayashi: None.
1374-P: Unrecognized Dysglycemia in a Nonurban Pediatric Population in Madagascar
Authors: MARZIALE NAUSICA , MAIZZA BENEDETTA , MARGHERITA MASSIMINO ANNA , MARIA MENGA LUCA , PARATORE GIULIA , PITTARELLO MATILDE , PROFETA LORENZO , FIORINA PAOLO , LANIA ANDREA 
Published: June 2024

Introduction & Objective: Madagascar has a predominantly young population and a high burden of malnutrition. The potential relationship between nutritional and glycemic status and the consequences of underdiagnosed dysglycemia-related diseases motivated this study. In the context of a medical student’s volunteering experience, we aimed at identifying dysglycemias and highlighting possible correlations with demographic factors and nutritional status in a pediatric population of Madagascar.
Methods: Glycemia was assessed on a population of 430 outpatients aged 0-12 years old by single fast fingerstick glycemic measurements. No exclusion criteria were set. General and nutritional information was collected. Data analysis was performed using R software, Python and WHO child growth standard software.
Results: Malnutrition had a 50% prevalence in the study population. 17 children (3.9% of the total) exhibited glycemic levels significantly deviating above the mean of the group with a healthy nutritional status, adjusted for the time elapsed since their last meal. These children, classified as outliers, were notably older. Most importantly, acute-on-chronic malnutrition (wasting-on-stunting) increased by almost 10 times the risk of the child being an outlier.
Conclusion: Acute-on-chronic malnutrition correlated with a state of dysglycemia, possibly confirming literature findings that a malnourished status might negatively impact pancreatic hormonal balance and beta cell functionality. The study holds both practical and epidemiological significance. It has increased awareness on dysglycemia and facilitated early recognition of possibly peculiar presentation in low-income countries. Epidemiologically, our study appears to encourage targeted glycemic screening in acutely on-chronic malnourished children and help resource allocation.

Disclosure
N. Marziale: None. B. Maizza: None. A. Massimino: None. L. Menga: None. G. Paratore: None. M. Pittarello: None. L. Profeta: None. P. Fiorina: None. A. Lania: None.
1389-P: Association between Serum Metabolomic and Overall Mortality among Individuals with Type 2 Diabetes
Authors: GAN LU , YANG SHUTING , ZHAO BIN , ZHOU ZHIGUANG , HUANG JIAQI 
Published: June 2024

Patients with Type 2 diabetes (T2D) demonstrate a remarkable increased risk of mortality. Yet, underlying metabolomic profiling and relevant biochemical alterations are not fully elucidated. We conducted a prospective metabolomic study of T2D mortality risk in 152 case-control pairs within the National Newly Onset Diabetes Cohort (2015-2017), which recruited nearly 18,000 newly diagnosed T2D patients from 46 centers in China. Using incidence-density sampling method, controls were selected from the cohort who were alive at the time of case death and individually matched to cases by age, sex, assessment center, and date of blood draw. Median time from baseline fasting serum collection to death for cases was 4.8 years. We identified 736 known metabolites through the Ultrahigh-performance LC-MS/GC-MS platform. Conditional logistic regression models were used, adjusting for age, sex, body mass index, smoking status, systolic and diastolic blood pressure, HbA1c, and triglyceride. Based on a false discovery rate (FDR) of 0.05, 86 metabolites were found to be associated with risk of mortality among T2D. Integrating approaches of LASSO, forward and stepwise logistic regression, eight metabolites were identified to be independently related to risk of mortality among T2D, including perfluorooctanoate, 5α-pregnan-3β,20α-diol monosulfate, maltose, N-palmitoyl-sphingosine (d18:1/16:0), eicosenedioate (C20:1-DC), behenoyl dihydrosphingomyelin (d18:0/22:0), deoxycholic acid glucuronide, and 16-hydroxypalmitate. Multivariate ROC regression estimated an AUC of 0.63 (referent model: above-mentioned adjusted covariates) versus 0.80 (extended model: additionally adjusted for the eight selected metabolites) (Wald test for comparison: P&lt;0.0001). Our data demonstrated that several serum metabolites are independently associated with mortality risk in T2D, which may provide novel insight on the molecular basis of progression and development among individuals with T2D.

Disclosure
L. Gan: None. S. Yang: None. B. Zhao: None. Z. Zhou: None. J. Huang: None.

Funding
National Natural Science Foundation of China (82100949)
1393-P: Potential Endocrine Disrupting Chemical Exposures among Rural Americans Using Remotely Collected Biosamples
Authors: QUINTERO ARIAS CAROLINA , FLORES TAMMY A. , YI HAESEUNG , MOTOLA HALEY L. , HEIDER MATTHEW , SMITH MOLLY , WISE NATHAN N. , THORPE LORNA , TRASANDE LEONARDO , LEE DAVID C. 
Published: June 2024

Introduction & Objective: Rural residents experience higher rates of diabetes than their urban counterparts. Main identified causes to date include poor diet and physical inactivity. Given limited access to fresh foods, however, rural residents are also known to have high rates of canned food intake, potentially resulting in more exposure to bisphenols, which have been linked to diabetes.
Methods: To examine dietary chemical exposures, we collected urine samples among rural residents both in-person and remotely to measure bisphenols level. Day 0 samples were immediately frozen and transported on dry ice to prevent any chemical degradation. Rural residents then remotely collected three consecutive days of urine samples, froze samples at home, and mailed them back using insulated cold packs. We examined daily levels among 30 study participants and performed a preliminary investigation of whether bisphenol levels correlated with HbA1c results.
Results: Daily average bisphenol A (BPA) levels were 0.391 ng/mL on Day 0, 0.620 ng/mL on Day 1, 1.300 ng/mL on Day 2, and 1.088 ng/mL on Day 3. The intraclass correlation coefficient (ICC) for bisphenol A was 0.063 demonstrating very low correlation between daily values among study participants. We similarly found low ICC for bisphenol S at 0.238 and for bisphenol F at 0.095. We also found that all three study participants with a mean BPA higher than 2.00 ng/mL had prediabetes.
Conclusion: We found no significant degradation of bisphenols between immediately frozen Day 0 samples and those mailed on Day 1 to 3, demonstrating the feasibility of collecting biosamples remotely. The low correlation between daily levels suggests the need to collect several samples given high daily variability and short half-lives of these chemicals. Our preliminary analysis finds a possible association between high BPA exposure and poor glycemic control among rural Americans that merits further exploration in a larger study.

Disclosure
C. Quintero Arias: None. T.A. Flores: None. H. Yi: None. H.L. Motola: None. M. Heider: None. M. Smith: None. N.N. Wise: None. L. Thorpe: None. L. Trasande: None. D.C. Lee: None.

Funding
National Institutes of Diabetes and Digestive and Kidney Disease (R01DK124400)
1398-P: Emulating Target Trials Using Instrumental Variables to Inform Care—Add-on Therapy to Metformin
Authors: ADLER AMANDA I. , LUGO-PALACIOS DAVID G. , BIDULKA PATRICK , CARROLL ORLAGH , BASU ANIRBAN , O'NEILL STEPHEN , GRIEVE RICHARD 
Published: June 2024

Introduction & Objective: Guidelines now rely on studies using routinely-collected clinical data to emulate a ‘target trial’, a hypothetical randomized controlled trial (RCT) one would wish to do. A key question remains what drug to add to metformin to improve glycemic control in people with type 2 diabetes (T2D). To inform care for people excluded from RCTs, we developed a target trial comparing add-on therapy with dipeptidyl peptidase-4 inhibitors (DPP4) vs. sulfonylureas (SU), a relevant choice in many settings. We used an instrumental variable as a ‘natural randomizer’.
Methods: We used anonymized data from the UK Clinical Practice Research Datalink (2011 to 2015) to identify people with T2D on metformin monotherapy prescribed &lt;60 days before starting 2nd-line DPP4 or SU. We recreated the inclusion criteria of a ‘real’ RCT (Nauck et al. 2007) that tested non-inferiority of sitagliptin vs. glipizide on HbA1c at 1 year. We then broadened the eligibility to include people over age 78 years or with HbA1c &gt;10% (85.8 mmol/mol), which we analyzed separately. We used an instrumental variable (IV), a GPs’ preference for prescribing either DDP4 or SU, to test the effect of treatment on HbA1c at 1 year, and to minimize confounding. Our study did not estimate complications or adverse effects.
Results: We identified 13,240 people for the target trial: 6,497 met and 6,743 would not have met the criteria for the real RCT (1172). The mean baseline HbA1c by subgroup was 68.2 (s.d. 8.3) and 79.4 (22.3) mmol/mol. The difference in HbA1c at 1 year for DPP4 vs. SU (negative reflects lower values for DPP4) for people in the target trial who met the real RCT criteria was -0.3 (-2.3, 1.6) compared with 0.2 (-0.9, 1.3) for the actual trial. For those in the target trial who would have been excluded from the real RCT, the difference was -3.4 (-6.6, -0.1).
Conclusion: Emulating a target trial provides evidence when none exists. If IV assumptions hold, then DPP4 appear more effective than SU in the subgroup of patients excluded from a key trial.

Disclosure
A.I. Adler: None. D.G. Lugo-Palacios: None. P. Bidulka: None. O. Carroll: None. A. Basu: None. S. O'Neill: None. R. Grieve: None.

Funding
UK NIHR
1401-P: Long-Term Impact of Diabetes Prevention Program (DPP) Interventions on Walking Endurance
Authors: MUNSHI MEDHA , VENDITTI ELIZABETH M. , TJADEN ASHLEY H. , KNOWLER WILLIAM C. , BOYKO EDWARD J. , MIDDELBEEK ROELAND J.W. , LUCHSINGER JOSE A. , LEE CHRISTINE , HAZUDA HELEN P. , SALIVE MARCEL E. , EDELSTEIN SHARON , STORER THOMAS W. , RESEARCH GROUP DPP 
Published: June 2024

Introduction & Objective: Type 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. Our main aim was to examine the long-term effects of metformin or intensive lifestyle intervention (ILS) in adults at high risk of T2D on their 6-minute walk test (6MWT) performance.
Methods: Participants at high risk of T2D were randomized in the 3y DPP to ILS (physical activity [PA] and weight loss goals), metformin 850 mg bid, or placebo, and subsequently followed in the DPP Outcomes Study with brief lifestyle classes offered to all and metformin continued open label. A 6MWT was conducted 15y after DPP ended (mean 20y after randomization, 64% had developed T2D). The associations between DPP interventions and 6MWT completion (defined as achieving a distance ≥200 meters with or without a walking aid) were assessed using logistic regression. Among test completers, differences in distance walked in 6 min (6MWD) by DPP interventions were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of BMI and grip strength along with mean measures of HbA1c and self-reported PA over ~20y.
Results: Data on 1830 participants (mean baseline age 50y) were analyzed. The DPP interventions were neither associated with test completion, nor 6MWD among test completers (362, 364 and 360 m in the lifestyle, metformin, and placebo groups respectively, p=0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and 6MWD after adjustment. Grip strength, PA, and education were positively associated with 6MWD, while age, BMI and HbA1c were negatively associated with 6MWD.
Conclusion: Although we did not observe a sustained effect of the original randomized interventions, we confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at-risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle.

Disclosure
M. Munshi: Consultant; Sanofi. E.M. Venditti: None. A.H. Tjaden: None. W.C. Knowler: None. E.J. Boyko: None. R.J.W. Middelbeek: Research Support; Novo Nordisk. J.A. Luchsinger: Consultant; Merck KGaA. Other Relationship; EMD Serono, Wolters Kluwer Health. C. Lee: Employee; Pfizer Inc. H.P. Hazuda: None. M.E. Salive: None. S. Edelstein: None. T.W. Storer: None. D. Research Group: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, UDK048400)