bluuebunny/crossref_metadata_2025_split huggingface dataset:
1155-P: Association of NT-proBNP and CA125 with Cardiometabolic Markers in Indigenous Argentinean Children Living in the Andes Foothills
Authors: HIRSCHLER VALERIA , CASTANO LUIS , FLORES LUIS E. 
Published: June 2024

Background: We have shown that children living in the Andes exhibit dyslipidemia and reduced cardiac size, suggesting that these children may develop adaptive mechanisms associated with changes in biomarkers such as NT-proBNP and CA125.
Objective: To determine the associations between NT-proBNP and CA 125 and variables such as age, sex, BMI, BP, hemoglobin, leucocytes, and lipids in indigenous Argentinean children living at high altitudes.
Methods: Cross-sectional data were gathered from 73 children attending two schools in the villages of Cobres and Cerro Negro, at 4,500 m above sea level in La Poma, Salta (Argentina). Age, sex, BP, BMI, triglycerides (TG), HDL-C, complete blood count, CA 125, and NT-proBNP were obtained. Univariate and multivariate analyses were performed to assess the associations between LnNT-proBNP and LnCA 125 and metabolic markers.
Results: Seventy-three children (38 M) aged 8.5±3.1 y were included; 11 (15.1%) were overweight, and 5 (6.8%) were obese (per CDC). Mean values were as follows: BMI 17.8±3.0 kg/m2, z-BMI 0.4±0.8, systolic BP 81 ±11 mmHg, diastolic BP 56±8 mmHg, hemoglobin 13±1g/dL, leucocytes 6672±1387, HDL-C 39 ±6 mg/dL, TG 122±45 mg/dL, NT-proBNP 66.7±52.8 pg/ml, and CA125 18.4±6.9 U/ml. Mean levels of HDL-C and TG suggested dyslipidemia. Multiple linear regression analyses showed that LnCA125 was inversely associated with age and directly with leukocytes (R20.23), whereas LnNT-proBNP was inversely associated with age, heart rate, and HDL-C and directly with diastolic BP (R20.30); adjusted for confounding variables.
Conclusion: This study showed NT-proBNP and CA125 were associated with cardiometabolic and inflammatory markers in indigenous children living at high altitudes. Further longitudinal studies should be performed to confirm these findings.

Disclosure
V. Hirschler: None. L. Castano: None. L.E. Flores: None.
1180-P: Blood Pressure and Hormonal Factors in Adolescent with Type 1 Diabetes
Authors: MOHAMMAD EMAAD , LENHERR-TAUBE NINA , MAHMUD FARID H. , MOINEDDIN RAHIM , SOCHETT ETIENNE B. 
Published: June 2024

Introduction & Objective: Hypertension is common in type 1 diabetes (T1D). Renin-angiotensin aldosterone system (RAAS) and calcium-phosphate metabolism modulate blood pressure (BP). This study aimed to investigate the association of these factors with BP in adolescents with T1D.
Methods: Samples from 106 T1D (duration 7 years) and 106 healthy controls (HC) (similar age (10-17 years) and sex distribution) were analyzed for 25(OH)D, calcium, phosphate, PTH, FGF-23, klotho, plasma renin activity (PRA), aldosterone and urinary RAAS. Mean of two office blood pressure measurements, unpaired T-test, Chi-square, and linear regression (MLR) were used.
Results: Significant differences between TID and HC, were respectively: sBP (114.71 v 111.41), dBP (66.72 v 63.59), and BMI (22.16 v 20.91 kg/m2). PRA level was lower (0.21 v 1.8) and plasma aldosterone higher (444 v 65); higher urinary angiotensinogen (5.08 v 2.12) and urinary ACE2 activity (271.76 v 69.22) and lower urinary ACE activity (1.17 v 123.30); higher klotho (31.10 v 27.52) and PTH (36.42 v 24.11), lower 25(OH)D (56.94 v 88.42) and calcium (2.43 v 2.51). In T1D, unadjusted MLR; sBP was associated with BMI (p &lt;0.005) and plasma phosphate (p &lt;0.005); dBP with BMI (p &lt;0.005), PTH (p = 0.026) and phosphate (p &lt;0.005). Adjusted MLR; sBP was associated with BMI (&lt; 0.005) and dBP with FGF 23 (0.047) and BMI (0.010).
Conclusion: Adolescents with T1D had higher BP and significant differences in RAAS, calcium and vitamin D hormones than HC, suggesting hormonal factors may modulate BP regulation pre-hypertension.

Disclosure
E. Mohammad: None. N. Lenherr-Taube: None. F.H. Mahmud: Research Support; Dexcom, Inc. R. Moineddin: None. E.B. Sochett: None.
1183-P: Integrating Schools into Diabetes Device Interventions for Underserved Youth with Type 1 Diabetes (T1D)
Authors: CHEN CHARLOTTE , DURANTE ALEXA J. , MAYNARD MARGARET G. , LAFFEL LORI M. , AGARWAL SHIVANI 
Published: June 2024

Interventions that increase diabetes tech use reduce inequity in outcomes for underserved youth with T1D, but are usually clinic and not-school based, despite youth spending most of their time in school. We employed user-centered design methodology to incorporate perspectives of school-based health providers (SBHP) into future diabetes tech interventions that extend to school, that may increase efficacy, acceptability, and sustainability. We conducted 17 virtual workshops to discuss barriers and facilitators of youth device use and co-create multidisciplinary solutions to increase use. Workshops included 14 youth ages 13-17 yo; 23 parents; and 6 school-based and 11 clinic-based healthcare providers from Children’s Hospital at Montefiore and Montefiore School Health Program. Here, we report data from SBHP and clinic providers. Workshop recordings were thematically analyzed by 3 independent coders, using an inductive coding approach. Both SBHP and clinic-based providers endorsed benefits of devices, citing the need for its prioritization for medical and educational well-being, and an interest to support more device use. School-based barriers included limited communication with clinic-based providers and expertise in managing devices. Clinic-based barriers included navigating insurance coverage and having limited time to adequately introduce families to devices. Common barriers among providers included lack of time to address and help families with device or supply issues. Overall themes for co-created solutions by SBHP and clinic-based providers included the need for extra staff to help families navigate the healthcare system, specialized device troubleshooting support, and streamlined communication between clinic and school. Adding SBHP perspectives to inform the development of a device intervention for youth with T1D has defined new targets. These include enhanced communication between clinic and school and bolstering education of SBHP on devices.

Disclosure
C. Chen: None. A.J. Durante: None. M.G. Maynard: None. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation. S. Agarwal: Research Support; Dexcom, Inc. Advisory Panel; Medtronic. Consultant; Beta Bionics, Inc.

Funding
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Physician-Scientist Career Development Award (K12DK133995)
1184-P: Presence of Depressive Symptoms as a Predictor of Engagement with Diabetes Self-Management Habits in Adolescents and Young Adults with Type 1 Diabetes
Authors: KARWAL NISHA , TALLON ERIN M. , WILLIAMS DAVID D. , VANDERVELDEN CRAIG , LOCKEE BRENT , DEWIT EMILY L. , PATTON SUSANA R. , CLEMENTS MARK A. 
Published: June 2024

Introduction: In type 1 diabetes (T1D), depressive symptoms (DS) can negatively impact engagement with diabetes self-management behaviors.
Objective: In adolescents and young adults (AYA) with T1D, we examined whether DS independently predicted engagement with six key diabetes self-management habits, assessed as a total habit score (THS). THS has been shown to have an inverse relationship with HbA1c.
Methods: We retrospectively analyzed electronic health record and depression screening data from 1,834 AYA (12-22 years old; T1D duration ≥1yr) receiving care from a diabetes clinic network in the Midwest USA (January 2020 - November 2023). We used mixed-effects Poisson regression to adjust for multiple encounters per AYA and examined predictors of THS (range: 0-6). The six habits comprising the THS included: (1) using a continuous glucose monitor or checking glucose ≥4 times/day; (2) giving ≥3 boluses/day; (3) using an insulin pump; (4) bolusing before meals; (5) reviewing glucose data between visits; and (6) adjusting insulin doses between visits. We defined a positive screen for DS as a Patient Health Questionnaire-2 (PHQ-2) score ≥3 (i.e., experiencing DS most days).
Results: AYA (52.5% male; 78.7% White; mean [SD] age, 15.7 [2.1] years; 60.4% private insurance) screened positive for DS at 7.6% (632/8,309) of encounters. We observed negative associations between THS and older age (incidence risk ratio, 0.98; 95% CI, 0.97-0.99), Black race (0.78; 0.72-0.84; vs. White), other minority race (0.85; 0.80-0.91; vs. White), and not having private insurance (0.88; 0.85-0.90). THS did not differ in individuals who did, versus did not, screen positive for DS (0.97, 0.93-1.02).
Conclusion: Age, race, and insurance status - but not DS - were independent predictors of THS. Future studies should evaluate whether more sensitive and specific measures of DS predict THS and whether DS impact engagement with individual self-management behaviors.

Disclosure
N. Karwal: None. E.M. Tallon: None. D.D. Williams: None. C. Vandervelden: None. B. Lockee: None. E.L. DeWit: None. S.R. Patton: None. M.A. Clements: Research Support; Abbott. Consultant; Glooko, Inc. Research Support; Dexcom, Inc.
1215-P: Maternal Glycemia Associations with Cord Blood DNA Methylation in the Hyperglycemia and Adverse Pregnancy Outcome Study
Authors: BIANCO MONICA E. , LOWE WILLIAM L. , JOSEFSON JAMI L. , SCHOLTENS DENISE , HIVERT MARIE-FRANCE , GURRA MIRANDA 
Published: June 2024

Maternal hyperglycemia during pregnancy is associated with impaired offspring glycemia later in life. Differential methylation of offspring DNA could be an underlying mechanism for this association. Using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study, a large, international, mother-child cohort, we conducted an epigenome-wide association study to identify associations between maternal glucose sum of z-scores from a fasting 2-hr oral glucose tolerance test (OGTT) during pregnancy (mean 27.6 wks gestation) and offspring cord blood DNA methylation (cb DNAm). We analyzed cb DNAm with Illumina EPIC arrays (791,359 CpG sites after QC) on 3,041 HAPO samples. Using linear regression models adjusted for maternal covariates and field center, we identified 16 CpG sites after accounting for multiple testing (Bonferroni-adjusted p&lt;0.05). The significant associations included two CpG sites near TXNIP, a gene that encodes the thioredoxin-interacting protein, which is involved in glucose-sensing. Our analyses identified new loci in addition to external validation of previous findings identifying TXNIP as a differentially methylated locus in relation to in utero exposure to hyperglycemia. These findings support DNA methylation as a potential mechanism underlying the association between maternal hyperglycemia and programming of offspring metabolic health.

Disclosure
M.E. Bianco: None. W.L. Lowe: None. J.L. Josefson: None. D. Scholtens: None. M. Hivert: None. M. Gurra: None.

Funding
National Institutes of Health (R01DK118403)
1224-P: Diabetes in Teenage Pregnancy—Prevalence and Outcomes within a Population-Based Cohort
Authors: CHRISTIE HANNAH E. , MOHAN SNEHA , PLAZA ENRIQUEZ LEIDY , VELLA ADRIAN , CREO ANA , EGAN AOIFE M. 
Published: June 2024

Diabetes and low maternal age are independently associated with an increased risk of adverse pregnancy outcomes. However, population data on prevalence and outcomes of diabetes in teenage pregnancy are limited. We used the Rochester Epidemiology Project to identify Olmsted County residents with a confirmed pregnancy &lt;20 years of age from 2013-22. We identified 696 women (19.3% Hispanic), with 790 pregnancies. The average age at pregnancy was 17.9 ± 1.3 years and BMI was 26.6 ± 6.3 kg/m2. In total, 37 pregnancies (4.7%) were affected by diabetes: 5 with type 1 (0.6%; population prevalence: 0.4%), 3 with type 2 (0.4%), 20 with GDM (2.5%; population prevalence: 18%), and 9 with impaired glucose tolerance (1.1%). Prepregnancy contraception was prescribed in 37.5% with prepregnancy diabetes versus 19.8% of those without (p=0.21), noting a prepregnancy HbA1c of 9.4 ± 3.0% in the subgroups with type 1 or 2 diabetes. Hypertensive disorders were higher in maternal diabetes (15.1 v 39.4%, nil diabetes v diabetes respectively, p&lt;0.001). Live births occurred in 623 (82.7%) pregnancies compared to 32 (86.0%) in those with diabetes (p=0.55). Congenital anomaly rates were not higher in infants of women with diabetes (16.1 v 11.8%, p=0.52), but large for gestational age birthweights (6.2 v 15.6%, p= 0.03) and neonatal hypoglycemia were significantly higher (12.0 v 38.7%, p&lt;0.001). Of those with GDM, 25% attended postpartum glucose testing. While the prevalence of diabetes in teenage pregnancy is relatively low, these data reveal that those affected are at significantly higher risk of adverse pregnancy outcomes and will benefit from targeted, multidisciplinary preconception and obstetric care.

Disclosure
H.E. Christie: None. S. Mohan: None. L. Plaza Enriquez: None. A. Vella: Research Support; Novo Nordisk. Consultant; Hanmi Pharm. Co., Ltd., Crinetics Pharmaceuticals, Inc. Advisory Panel; Rezolute, Inc. A. Creo: Advisory Panel; Sanofi. A.M. Egan: None.

Funding
National Institutes of Health (DK134767)
1232-P: Real-World Association of Race/Ethnicity with Adverse Maternal and Fetal Outcomes in Women with Diabetes
Authors: FARROKHI FARNOOSH , GUO YIAN , SCOTT ALEXANDRA , LANE RASHON , KERR DAVID 
Published: June 2024

Introduction: Diabetes in pregnancy is associated with greater risk of maternal-fetal complications. However, studies exploring the impact of race and ethnicity on pregnancy outcomes using real-world data are limited. The aim of this study was to compare differences in pregnancy outcomes by diabetes status and race/ethnicity.
Methods: ICD-10 codes were used to assess maternal and fetal outcomes between 1/1/2021 and 8/31/2023 among people who gave birth at Sutter Health - a large, integrated health system in Northern California, stratified by diabetes diagnosis and race/ethnicity.
Results: A total of 67,789 deliveries included 11,916 complicated by diabetes (2.4% with type 1, 11% with type 2, 86% with gestational diabetes). A diabetes diagnosis was associated with significantly worse outcomes including prematurity, pre-eclampsia, c-section, NICU admission, neonatal respiratory distress, macrosomia, neonatal hypoglycemia, (all p&lt; 0.001), small for gestational age (p=0.004), and shoulder dystocia (p=0.001). Black and American Indian/Alaskan Native women had worse outcomes compared with other race/ethnicity groups:

Table. Association of race/ethnicity with adverse maternal/fetal outcome in women with diabetes.
Conclusion: Using real-world data, the increased risk of serious maternal/fetal outcomes associated with diabetes, vary disproportionately by race/ethnicity.

Disclosure
F. Farrokhi: None. Y. Guo: None. A. Scott: None. R. Lane: None. D. Kerr: Advisory Panel; Abbott Diagnostics. Consultant; Sanofi, Better Therapeutics, Inc. Stock/Shareholder; Glooko, Inc.
1241-P: Pharmacologic Treatment of GDM and Perinatal Outcomes
Authors: HEDDERSON MONIQUE M. , XU FEI 
Published: June 2024

Medical nutritional therapy is the recommended initial treatment for GDM, but 30-50% of patients with GDM require the addition of pharmacologic therapy. Insulin is the only pharmacologic treatment recommended by the American Diabetes Association. However, oral agents have several advantages over insulin including cheaper cost, greater ease of use, and adherence among patients. ACOG recognizes that clinical situations may necessitate the use of oral agents and suggests metformin (and possibly glyburide) as a reasonable alternative. We examined the association between GDM pharmacologic treatment and perinatal outcomes in a large and racially diverse cohort of GDM pregnancies livebirths between 2008 and 2021 (n = 19,903) in Kaiser Permanente Northern California. GDM was defined based on laboratory glucose values and/or clinician diagnosis. We used modified poisson regression to estimate risk ratios. Overall, 75% were prescribed glyburide, 8% Metformin, and 17% insulin only. Compared to GDM pregnancies initiated on Insulin, pregnancies initiated on Glyburide had a 17% reduced risk of Preterm birth [risk ratio[RR]: 0.83 (0.75 - 0.92) and a 12% reduced risk of having a small for gestational age infant [RR: 0.88 (0.77 - 0.99)] and no association with having a large for gestational age infant [0.97 (0.90 - 1.04)] adjusting for age, pre-pregnancy BMI, race/ethnicity, and parity. Compared to GDM pregnancy initiated on Insulin, pregnancies initiated on Metformin were associated with an 18% reduced risk of preterm birth [risk ratio: 0.82 (RR: 0.69 - 0.98)], a 28% reduction in large for gestational age [adjusted relative risk: 0.72 (RR: 0.63 - 0.82)], and no association with small for gestational age infant [0.97 (RR: 0.80 - 1.18)] in adjusted models. These findings suggest that oral agents may be associated with a lower risk of perinatal complications. Future work needs to address possible confounding due to disease severity.

Disclosure
M.M. Hedderson: None. F. Xu: None.

Funding
R01DK138135
1242-P: Effect of Intensity and Duration of Lactation on Postpartum Adiponectin after Gestational Diabetes
Authors: RAMOS-ROMAN MARIA , LO JOAN C. , SUN BAIYANG , WHEELER MICHAEL B. , GUNDERSON ERICA P. 
Published: June 2024

Higher circulating adiponectin is associated with insulin sensitivity. Prior studies from pregnancy to 12 mo postpartum suggest that adiponectin is suppressed from mid pregnancy until 6-12 mo postpartum in women practicing exclusive lactation, regardless of glucose tolerance during pregnancy. A decrease in adiponectin during pregnancy and lactation is consistent with physiologic insulin resistance. Therefore, our objective was to determine the relationship between intensity and duration of lactation and the suppression of circulating adiponectin in women after GDM delivery. In this prospective study, we evaluated longitudinal blood samples collected during 2-h 75 g OGTTs at 6 wk (V1 baseline), 1 yr (V2) and 2 yr (V3) postpartum in women with recent GDM and without diabetes (DM) at V1 in the SWIFT study. The outcome variables were change in adiponectin from V1-V2 and V2-V3 stratified by incident DM (Y/N); 4 exposure categories for breastfeeding duration (BF current, BF recent, BF past, BF minimal); covariables: age, BMI, log HOMA-IR, and log HOMA-B at V1 in multivariable regression models. Compared with 6 wk postpartum, at 1 yr postpartum (1) adiponectin was lower in the 4 exposure categories, (2) the magnitude of the decrease in adiponectin was greatest in the BF past versus BF current within incident DM at follow up, (3) the magnitude of the decrease in adiponectin was greatest in the BF recent versus BF current in the group without DM at follow up. From 1 yr to 2 yr postpartum, BF past was the only group with incident DM with an increase in adiponectin.
In conclusion, lactation followed by weaning triggers an accelerated decrease in adiponectin that depends on current DM status. In addition, the 2-year visit captured the greater increases in adiponectin among women who lactated and stopped lactation within months from the assessment. We suggest that low adiponectin during lactation communicates to insulin-dependent tissues that a shift in the priority of glucose utilization has occurred.

Disclosure
M. Ramos-Roman: None. J.C. Lo: None. B. Sun: None. M.B. Wheeler: None. E.P. Gunderson: None.

Funding
R01 DK118409, Gunderson PI; R01 HD050625, Gunderson PI; UT Southwestern pilot and feasibility grant in biomedical research, Department of Internal Medicine, Ramos-Roman PI
1244-P: Prospective Cohort Study on the Impact of Restricted Gestational Weight Gain on Fetal Growth in Women with Gestational Diabetes Mellitus Undergoing Dietary Treatment
Authors: CHANDRA ABHISHEK , JHA RAJESH K. , AHMAD KHAWAJA A. , PRAKASH AKHOURI S. 
Published: June 2024

Introduction: Managing weight gain during pregnancy is crucial, particularly for women with Gestational Diabetes Mellitus (GDM), as it significantly impacts fetal growth and development. This study investigates how restricted gestational weight gain influences fetal growth in women with GDM undergoing dietary treatment.
Methods: This prospective cohort study enrolled 200 GDM patients and divided them into two groups depending on their adherence to a gestational weight gain-restricting diet. Category A rigorously followed the food restrictions, whereas Category B relaxed. Fetal growth markers such abdomen circumference, femur length, and predicted weight were examined monthly by ultrasound. During pregnancy, maternal weight gain was recorded.
Results: Restricted gestational weight gain in Category A was associated with more optimal fetal growth parameters compared to Category B. Specifically, Category A had a significantly lower incidence of macrosomia (10% in Category A vs. 25% in Category B, p&lt;0.05) and a reduced rate of large-for-gestational-age infants (12% in Category A vs. 30% in Category B, p&lt;0.01). The incidence of small-for-gestational-age newborns did not significantly differ between the two groups.
Conclusion: A diet helps women with GDM avoid macrosomia and large-for-prenatal-age newborns by restricting gestational weight gain. These findings emphasize the necessity of nutritional management in managing weight increase during pregnancy for GDM women to preserve fetal health. Further research is required to optimize dietary guidelines and examine long-term maternal and child health impacts.

Disclosure
A. Chandra: None. R.K. Jha: None. K.A. Ahmad: None. A.S. Prakash: None.
1251-P: CGM-Derived Metrics and Neonatal Outcomes in Pregnant Women with Insulin-Treated Diabetes—Time for Refinement?
Authors: CITRO FABRIZIA , BIANCHI CRISTINA , ARAGONA MICHELE , MARCHETTI PIERO , BERTOLOTTO ALESSANDRA 
Published: June 2024

Introduction: Pregnancy-specific thresholds for TIR, TAR and TBR have been validated. However, recommendations on other CGM-derived metrics (GMI, CV, mean glucose) are lacking. We aimed to better assess the association between CGM metrics and neonatal outcomes (NeO).
Methods: In 37 pregnant women with insulin-treated diabetes (21 T1D, 11 T2D, 5 GDM), clinical, metabolic and CGM data at each trimester were prospectively evaluated (June 2018 - September 2023). Mann-Whitney test was used to compare CGM metrics in women with and without adverse NeO. Logistic regression and ROC-curve were used to identify predictive variables.
Results: Adverse NeO were reported in 75% women (90% T1D vs 40% GDM, p=0.038). At 3rd trimester, women with adverse NeO had higher mean glucose, TAR, GMI, CV and lower TIR, with no difference in HbA1c (Table 1). At logistic regression, TAR was the strongest risk factor (OR: 1.142 [1.012-1.289], p=0.032), regardless of diabetes type and HbA1c. The ROC-curve identified an increased risk of adverse NeO for TAR ≥18% (AUC: 0.845 [0.707-0.982], p=0.03, sens 71%, spec 89%).
Conclusion: At 3rd trimester, women with adverse NeO showed higher mean glucose, TAR, GMI, CV and lower TIR, suggesting that all CGM metrics should be evaluated in pregnancy, pending proper identification and validation of pregnancy-specific thresholds. To minimize the risk of adverse NeO, TAR&lt;18% should be targeted.

Disclosure
F. Citro: None. C. Bianchi: Consultant; Novo Nordisk, Merck Sharp & Dohme Corp., Lilly Diabetes. M. Aragona: None. P. Marchetti: Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. A. Bertolotto: None.

Funding
EC and MUR under PNRR – M4C2-I1.3. Project PE_00000019 “HEAL ITALIA”