bluuebunny/crossref_metadata_2025_split huggingface dataset:
39-OR: Real-Time Continuous Glucose Monitoring–Guided Glucose Management in Hospitalized Patients with Diabetes Receiving Short-Term Continuous Subcutaneous Insulin Infusion—A Randomized Clinical Trial
Authors: WANG YAXIN , LU JINGYI , WANG MING , NI JIAYING , LU WEI , ZHU WEI , BAO YUQIAN , ZHOU JIAN 
Published: June 2024

Background: The use of rtCGM remains largely investigational in the hospital setting. The current study aimed to evaluate the effect of rtCGM in inpatients with diabetes treated with short-term continuous subcutaneous insulin infusion (CSII).
Methods: In endocrinology wards located in a tertiary hospital, we assigned 475 adults with type 1 and type 2 diabetes requiring short-term CSII during hospitalization, to receive either rtCGM program (Figure 1) (n=237) or point-of-care (POC) standard of care with blinded CGM (n=238). Primary outcome was the difference in the percentage of time within the target glucose range of 3.9 to 10 mmol/L (TIR, %).
Results: The mean TIR was 71.1±15.8 % in the rtCGM group and 62.9±18.9 % in the POC group (P&lt;0.001). The mean time above range &gt;10mmol/L was significantly lower in rtCGM group than in POC group (28.3±15.8% vs. 36.6±19.0%, P&lt;0.001), whereas there was no significant between-group difference in the time below range &lt;3.9mmol/L (P=0.11). Moreover, the time to reach target glucose was significantly shorter in rtCGM group than in POC group (2.0 [1.0-4.0] vs. 4.0 [2.0-5.0] days, P&lt;0.001).
Conclusion: In inpatients with diabetes receiving short-term CSII, rtCGM program resulted in better glucose control than POC standard of care, without increasing the risk of hypoglycemia.

Disclosure
Y. Wang: None. J. Lu: None. M. Wang: None. J. Ni: None. W. Lu: None. W. Zhu: None. Y. Bao: None. J. Zhou: None.
401-P: Fibrosis-4 Index Independently Predicts CKD Progression in Patients with Type 2 Diabetes and MAFLD
Authors: ZHANG CHENGHUI , SUYUAN WANG 
Published: June 2024

Background: Fibrosis-4 (FIB-4) index is recommended by the American Diabetes Association Standard of Care 2024 for liver fibrosis screening in T2D. While the association between FIB-4 and increased cardiovascular disease has been established, its impact on the progression of chronic kidney disease (CKD) remains uncertain. This study aims to assess the influence of liver fibrosis, as measured by FIB-4, on CKD progression in patients with T2D and MAFLD.
Methods: The prospective cohort study enrolled 244 patients with both T2D and MAFLD. At baseline, FIB-4 was calculated based on several laboratory tests (AST/ALT/Platelets). The primary outcome was the progression of CKD, defined as a change of at least one CKD stage or incidence of macroalbuminuria or new-onset end-stage renal disease.
Results: The baseline characteristics are presented in Table 1. Over a median follow-up period of 2.1 years, 31 (12.7%) patients developed CKD progression. In multivariable Cox model, each unit increase in FIB-4 was associated with a 1.72-fold higher risk (95% CI:1.09-2.71; P=0.019) of CKD progression. Furthermore, compared with the patients in tertile 1, the adjusted-HR of CKD progression was 3.14 (95% CI: 0.80-12.25, P=0.100) and 4.90 (95% CI: 1.34-17.96, P=0.017) for those in tertile 2 and tertile 3, respectively.
Conclusion: In this cohort study of patients with T2D and MAFLD, FIB-4 was found to be an independent predictor of CKD.

Disclosure
C. Zhang: None. W. Suyuan: None.

Funding
Science and Technology Project of Tibet Autonomous Region (XZ202201ZR0037G)
417-P: Diabetic Foot Ulcer Amputation Increases the Risk of Severe Renal and Retinal Microvascular Complications—A Korean National Health Information Database Study
Authors: HYUN SONG NA , KIM BONGSEONG , JANG JINSUN , YANG HYEWON , SON HEEJUN , SEUNG JUNG HYE , MIN CHO YOUNG , SOO PARK KYONG , HAN KYUNGDO , HEON KWAK SOO 
Published: June 2024

Diabetic foot ulcer (DFU) and subsequent amputation represents significant health burden associated with diabetes. It is widely recognized that individuals with diabetic end stage kidney disease (ESKD) and proliferative diabetic retinopathy (PDR) face an elevated risk of limb amputation, but vice versa remains unclear. This study aimed to investigate the incidence rate and quantify the risk of ESKD and PDR in people who experienced DFU amputation. Using the database from National Health Insurance Service in South Korea, we included people with diabetes who received national health screening from 2009 to 2012. DFU amputation was defined using International Classification of Diseases 10th revision codes (ICD-10). Incident cases of ESKD or PDR were defined as diagnoses occurring at least one year following DFU amputation, as determined by the ICD-10 codes. Cox proportional hazard regression analysis was used to estimate the risk of incident ESKD or PDR after DFU amputation adjusting for covariates. Among 1,447,438 individuals enrolled, 1,512 (0.10%) had received DFU amputation at baseline. The incidence rate (IR) of ESKD was significantly higher in people who received DFU amputation compared to those who did not (14.8 vs 1.6 per 1,000 person-years), and adjusted hazard ratio (HR) was 2.46 (95% CI 2.08-2.91). Similar result was observed for PDR; IR was 24.7 vs 6.5 per 1,000 person-years and adjusted HR was 2.08 (95% CI 1.82-2.38). When we performed subgroup analysis based on major vs minor amputation, subjects who received major amputations had higher risk for ESKD (HR 3.13, 95% CI 2.39-4.11) and PDR (HR 2.39, 95% CI 1.87-3.07) compared with subjects who received minor amputations (ESKD: HR 2.17, 95% CI 1.75-2.69; PDR: HR 1.97, 95% CI 1.68-2.31). In summary, using a national health information database, we found that people who received DFU amputation have significantly increased risk of microvascular complications of ESKD or PDR.

Disclosure
N. Song: None. B. Kim: None. J. Jang: None. H. Yang: None. H. Son: None. H. Jung: Research Support; Novo Nordisk. Y. Cho: None. K. Park: None. K. Han: None. S. Kwak: Employee; SNUH Venture.
432-P: Retrospective Analysis of Serum Lactate Levels and Risk for Contrast-Induced Nephropathy in Type 2 Diabetes Patients after Emergent Coronary Angiography or Emergent Percutaneous Coronary Intervention by Presence or Absence of Metformin
Authors: KONO YASUYUKI , HARAGUCHI MIKIKO , CHOU SHENGPU 
Published: June 2024

Biguanides (BGs) rarely cause lactic acidosis, but it is induced by contrast media inhibiting renal excretion of BGs. However, there are few reported data on clinical influence of BGs to serum lactate levels under the use of contrast media, and risk for contrast-induced nephropathy (CIN) under BGs use is unknown. We included type 2 diabetes patients who underwent emergent coronary angiography (eCAG) or emergent percutaneous coronary intervention (ePCI) in New Tokyo Hospital from Jan. 1, 2015, to Dec. 31, 2021. We omitted cases confirmed with conditions that contraindicate metformin (Met) previously and selected 529 cases with pre-exam laboratory value of serum creatinine (SCr), albumin, hemoglobin, HbA1c, B-Type Natriuretic Peptide (BNP) and C-reactive protein, and creatine kinase-MB (CK-MB) within 48 hours. We retrospectively evaluated serum lactate and risk factors for CIN in this cohort by Welch’s t-test. Within 3 hours, two cases started hemodialysis and serum lactate was measured in 241 cases. There was no significant difference in maximum serum lactate between 63 Met users and 178 non-Met users, though the average and median were higher in Met users. Next, we evaluated risk factors for CIN. Within 72 hours, five cases died and SCr was follow-upped in 485 cases. BNP (p&lt;0.05), HbA1c (p&lt;0.05), and maximum CK-MB (p&lt;0.01) were significantly higher in 68 CIN cases than in 417 non-CIN cases, but Met use or amount showed no significant difference. However, in 129 Met users, multiple CAG or PCI was significantly more frequent in CIN cases than in non-CIN cases (p&lt;0.05). In diabetes patients undergoing eCAG or ePCI, Met use does not affect serum lactate significantly, and BNP, HbA1c, and maximum CK-MB are correlated to CIN. Multiple CAG or PCI may be related to CIN in Met users, and a further study with larger population is needed to evaluate this possibility.

Disclosure
Y. Kono: None. M. Haraguchi: None. S. Chou: None.
435-P: Prediabetes and Cardiovascular Disease (CVD) Risk—Insights from a Large-Scale Japanese Cohort Investigating the Impact of Regular Hospital Visits
Authors: MURAI KOSHIRO , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAMAMOTO MASAHIKO , MATSUBAYASHI YASUHIRO , KITAZAWA MASARU , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO 
Published: June 2024

We examined associations between prediabetes and the incidence of CVD according to whether patients made regular clinic visits for hypertension (HT) and dyslipidemia (DL). Enrolled were 1,137,069 Japanese without a history of CVD or glucose abnormality. During a median follow-up of 5.4 y, 10,893 people developed CVD. Prescription of antihypertensive or cholesterol-lowering agents indicated instructions to make regular clinic visits for HT or DL. Of those without regular clinic visits, CVD risk increased stepwise with increasing HbA1c values from the cutoff between diabetes and prediabetes. Those with HbA1c 6.5-6.8 had a higher CVD risk than those with prediabetes (Table). Conversely, of those making regular clinic visits, the CVD risk was significantly higher in persons with HbA1c levels just below criteria for diabetes (6.2-6.4%) than with normal HbA1c (≤5.6%). However, CVD risk did not significantly increase in those with HbA1c only slightly above the criteria for diabetes (6.5-6.8%). By regular clinic visits for HT or DL, a diagnosis of incident diabetes is speculated to trigger a quick response by attending physicians resulting in a better cardiovascular outcome than in those not attending clinic. These results indicate the need for strategies directed toward patients with early diabetes who do not regularly attend clinics for other diseases.

Disclosure
K. Murai: None. K. Fujihara: None. M.H. Yamada: None. M. Yamamoto: None. Y. Matsubayashi: None. M. Kitazawa: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
441-P: Visceral Fat–to–Subcutaneous Fat Ratio Is Associated with High Carotid Plaque Score in Individuals with Type 2 Diabetes
Authors: YEL SHIN JANG 
Published: June 2024

Visceral fat is considered as a major risk factor for metabolic disease and cardiovascular disease. This study investigated whether visceral fat to subcutaneous fat ratio (VSR) was associated with high carotid plaque score (PS) in individuals with type 2 diabetes. A total of 1966 patients with type 2 diabetes was enrolled. Visceral fat and android fat were automatically assessed using a dual energy X-ray absorptiometry and subcutaneous fat (g) were calculated as follows: android fat (g) - visceral fat (g). Carotid PS was ranged from 0 to 12 and high PS was defined as ≥ 3. Patients with high PS were 841 (42.8%). They were more likely to be old and male and had higher systolic blood pressure (SBP), visceral fat, and VSR, but lower diastolic BP (DBP), HDL cholesterol, estimated glomerular filtration rate (eGFR), subcutaneous fat, and grip strength than those without high PS. Subjects in the highest sex-specific VSR tertile group were older and had higher SBP, waist circumference (WC), visceral fat, triglyceride, and PS, but lower DBP, subcutaneous fat, appendicular skeletal muscle mass (ASM)/BMI, grip strength, HDL cholesterol, and eGFR compared with those in the lowest group. The prevalence of high PS was progressively increased with increasing sex-specific VSR tertile (lowest vs. middle vs. highest = 28.1% vs. 42.2% vs. 57.9%, p &lt; 0.001). The odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of high PS after adjusted for age and sex, were 1.45 (1.12 - 1.87. p = 0.004) in the middle and 1.92 (1.48 - 2.49, p &lt; 0.001) in the highest VSR tertile groups. The ORs and 95% CIs in the higher VSR groups were remained significant after further adjusted for WC, SBP, DBP, triglyceride, HDL cholesterol, eGFR, ASM/BMI, and grip strength (p &lt; 0.01).
In conclusion, higher VSR was significantly associated with high PS in patients with type 2 diabetes, independent of multiple potential risk factors.

Disclosure
J. Shin: None.
454-P: Screening for Cardiovascular Abnormalities in Chinese patients with Early-Onset Type 2 Diabetes Combined with Cluster Classification
Authors: LIAN HONG , REN QIAN , LIU WEI , ZHANG RUI , ZOU XIANTONG , HAN XUEYAO , JI LINONG 
Published: June 2024

Introduction: Patients with early-onset type 2 diabetes (EOD) have 1.6-fold increased risk of cardiovascular death. Our study intends to screen for early cardiovascular abnormalities in EOD patients, and distinguish the population with cardiovascular risk through cluster classification.
Method: A total of 400 newly diagnosed EOD patients come from the Early onset diabetes Prospective multicenter study from Mar.2021 to Nov.2023. Echocardiography and carotid ultrasound were performed within 3 months after diagnosis. K-means was used for cluster classification based on age, BMI, HbA1c, HOMA2-β, HOMA2-IR, and GAD antibodies.
Result: Patients with left atrial/ventricular enlargement had higher BMI (32.78±5.58 vs. 28.92±5.10 kg/m2, p&lt;0.001), C-peptide (3.86[3.02,4.76] vs. 3.05[2.23,4.07] ng/ml, p&lt;0.001), and fasting insulin level (19.85[15.11,33.29] vs. 14.23[9.03,23.29] uU/ml, p&lt;0.001). After adjusting for gender and BMI, patients with higher fasting insulin levels had an increased risk of left atrial/ventricular enlargement (OR=2.238, 95% CI: 1.179-4.250).
Conclusion: A higher proportion of EOD patients were diagnosed with cardiovascular abnormalities, especially those with obesity and insulin resistance (MOD and SIRD subtype). Cluster classification can help accurately distinguish patients at higher risk of cardiovascular complications.

Disclosure
H. Lian: None. Q. Ren: None. W. Liu: None. R. Zhang: None. X. Zou: None. X. Han: None. L. Ji: None.

Funding
Beijing Science and Technology Committee Fund (Z201100005520012)
455-P: The Triglyceride–Glucose Index and Type 2 Diabetes are Mutually Independent Predictors of Major Cardiovascular Events in Patients with Established Cardiovascular Disease
Authors: PLATTNER THOMAS , LARCHER BARBARA , MADER ARTHUR , VONBANK ALEXANDER , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ , SAELY CHRISTOPH H. 
Published: June 2024

The triglyceride-glucose index (TyG) is a validated biomarker of insulin resistance. Its power to predict major cardiovascular events (MACE) in patients with established cardiovascular disease is unclear and is addressed in the present study. We enrolled 1790 consecutive patients, 1481 with angiographically proven CAD and 309 with sonographically proven PAD. Prospectively, MACE were recorded over a mean follow-up period of 10.7±5.0 years. At baseline, the TyG index was significantly higher in patients with T2DM (n=586) than in nondiabetic subjects (9.2±0.7 vs. 8.7±0.5; p&lt;0.001). During follow-up, 916 of our patients suffered MACE. The event rate was significantly higher in patients with T2DM than in nondiabetic subjects (60.2 vs. 47.7%; p&lt;0.001). The TyG index in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index, and LDL cholesterol independently predicted MACE in the total study population (standardized adjusted HR 1.21 [1.12-1.30], p&lt;0.001); HRs in patients without T2DM and in diabetic subjects were 1.08 [0.95-1.25], p=0.272 and 1.16 [1.03-1.31], p=0.013, respectively, with no evidence of an interaction between TyG and T2DM (p=0.093). With T2DM additionally entered into the regression model, TyG in the total study population predicted cardiovascular events independently from the presence of T2DM (HR 1.12 [1.03-1.23], p=0.008), while T2DM remained independently predictive of MACE after adjustment for TyG (HR 1.42 [1.19-1.67]; p&lt;0.001). From our data we conclude that the TyG index and T2DM are mutually independent predictors of MACE in patients with CAD.

Disclosure
T. Plattner: None. B. Larcher: None. A. Mader: None. A. Vonbank: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None. C.H. Saely: None.
460-P: Dual Role of Factor XI in Mortality and Diabetes—Insights from the Ludwigshafen Risk and Cardiovascular Health Study
Authors: PRYSTUPA KATSIARYNA , HENI MARTIN , HÖRBER SEBASTIAN , PETER ANDREAS , HELLSTERN PETER , KELM MALTE , YAMAZAKI HAJIME , RODEN MICHAEL , WAGNER ROBERT 
Published: June 2024

Introduction & Objective: We investigated the effect of FXI on mortality in a cohort at increased risk for cardiac death, with a specific focus on risk-modification in case of type 2 diabetes (T2D) or current heart failure.
Methods: The prospective LURIC study recruited 3063 persons undergoing coronary diagnostics. Mortality risk was assessed using Cox proportional hazards models employing restricted cubic splines adjusted for age, sex, BMI and coronary artery disease, with interaction terms between FXI activity and T2D status as well as between FXI activity and brain natriuretic peptide (NTproBNP).
Results: In the unadjusted model, FXI activity demonstrated a U-shaped association with mortality risk (p=0.025): It was protective between 89-139%, but the risk increased at levels outside this range. A significant interaction of FXI activity with T2D (p=0.036) revealed that higher FXI activity was linked to reduced mortality in people without diabetes. However, this relation was inverted in participants with T2D (Fig. 1). NTproBNP was a further significant modifier of the relationship between FXI activity and mortality (p=0.0085).
Conclusion: T2D and NTproBNP significantly alter FXI activity's effect on mortality, underscoring a multifaceted interplay. Upcoming FXI-targeted therapies should be carefully evaluated in persons with diabetes with regards to their efficacy and safety.

Disclosure
K. Prystupa: None. M. Heni: Research Support; Boehringer-Ingelheim. Advisory Panel; Amryt Pharma Plc. Speaker's Bureau; Amryt Pharma Plc. Advisory Panel; Boehringer-Ingelheim, Boehringer-Ingelheim. Speaker's Bureau; Lilly Diabetes, Novartis AG, Novo Nordisk, Sanofi. S. Hörber: None. A. Peter: None. P. Hellstern: None. M. Kelm: Research Support; Edwards Lifesciences Coroporation, Microvision Medical, B.Braun, IPP Med GmbH - Institut für Pharmakologie u. präventive Medizin GmbH, Mars Scientific Advisory Council (MSAC). Other Relationship; Bayer Inc., Abiomed. Board Member; ESC-European Society of Cardiology, DGIM-Deutsche Geselleschaft für Innere Medizin, DSHF-Deutsche Stiftung für Herzforschung, DGK-Deutsche Gesellschaft für Kardiologie. Other Relationship; Kel Con GmbH, diaplan. H. Yamazaki: Other Relationship; AstraZeneca, Janssen Pharmaceuticals, Inc., Mitsubishi Tanabe Pharma Corporation, Kowa Company, Ltd., Kyorin Pharmaceutical Co. Ltd, Takeda Pharmaceutical Company Limited, Takeda Pharmaceutical Company Limited, Magmitt Pharmaceutical Co. M. Roden: Advisory Panel; Eli Lilly and Company. Research Support; Boehringer-Ingelheim. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; TARGET PharmaSolutions, Inc. Speaker's Bureau; AstraZeneca. R. Wagner: Speaker's Bureau; Sanofi. Advisory Panel; Lilly Diabetes. Speaker's Bureau; Boehringer-Ingelheim, Novo Nordisk.
465-P: Distribution of Remnant Cholesterol in Patients with Type 2 Diabetes and in Nondiabetic Patients with Established Cardiovascular Disease
Authors: DREXEL HEINZ , PLATTNER THOMAS , LARCHER BARBARA , MADER ARTHUR , VONBANK ALEXANDER , LEIHERER ANDREAS , MUENDLEIN AXEL , SAELY CHRISTOPH H. 
Published: June 2024

High remnant cholesterol is associated with the metabolic syndrome and with type 2 diabetes (T2DM) and has attracted much interest as a cardiovascular risk factor. However, its distribution in T2DM patients with established cardiovascular disease is not clear. This issue is addressed in the present study. We obtained remnant cholesterol in a large series of patients with established cardiovascular disease (1481 patients with angiographically diagnosed CAD and 323 patients with sonographically diagnosed PAD). From our patients, 592 had T2DM and 1210 did not have diabetes. Remnant cholesterol was significantly higher in T2DM patients than in nondiabetic patients (p&lt;0.001), with median values [interquartile ranges] of 23 [9-38] mg/dl vs. 16 [5-32] mg/dl. The distribution of remnant cholesterol in T2DM patients and in those without diabetes is shown in the histograms in figure 1. Both in T2DM patients and in nondiabetic patients the distribution was markedly right-skewed and deviated significantly (p &lt;0.001, by Kolmogrorov-Smirnov tests) from normal distribution. We conclude that remnant cholesterol in patients with established CAD is higher in patients with T2DM than in nondiabetic patients and both among T2DM patients and among those without diabetes is distributed in a markedly right-skewed manner.

Disclosure
H. Drexel: None. T. Plattner: None. B. Larcher: None. A. Mader: None. A. Vonbank: None. A. Leiherer: None. A. Muendlein: None. C.H. Saely: None.
469-P: Both LDL Cholesterol and LDL Particles Associated with MACE in Tibetan Patients with Type 2 Diabetes
Authors: ZHANG CHENGHUI , SUYUAN WANG , LI MINGXIA 
Published: June 2024

Background: LDL-C remains the primary treatment target for reducing major cardiovascular events (MACE) in patients with T2D. Our previous study revealed T2D patients residing in the Tibet Plateau exhibited elevated levels of LDL-C, LDL-particle number (LDL-P), but not small density LDL particles compared to those living in lowland areas. Whether the LDL-P is an independent predictor of MACE in Tibetan patients with T2D is unclear and is addressed in this study.
Methods: We conducted a perspective cohort study involving 165 patients, including 17 patients with established cardiovascular disease (13 of whom had angiographically confirmed stable coronary heart disease and 4 of whom had experienced stroke). Their demographic information, clinical feature, and standard lipid concentrations were collected and evaluated. LDL-P was measured by Nuclear magnetic resonance (NMR) spectroscopy. The primary outcome was MACE, including death from cardiovascular cause, non-fatal stroke, and non-fatal myocardial infarction. Cox proportional hazard models were utilized to examine the association between LDL-C and LDL-P with MACE.
Results: Over a median follow-up period of 26 months, 18 patients suffered MACE. The multivariate adjusted Cox regression model revealed a significant association between both LDL-C and LDL-P with MACE (Table 1).
Conclusion: Both LDL-C and LDL-P associated with MACE in Tibetan patients with T2D.

Disclosure
C. Zhang: None. W. Suyuan: None. M. Li: None.

Funding
Sichuan Medical Association (S21056)