bluuebunny/crossref_metadata_2025_split huggingface dataset:
603-P: In Type 1 Diabetes, Meta-analysis Identifies Variable Glucose Response to Exercise Based on Intensity
Authors: PHAN CAITLINE , FISHER SIMON J. , ZHANG XIAOHUA D. 
Published: June 2024

Introduction & Objective: For people with Type 1 diabetes, changes in sugar levels in response to exercise can be highly variable. A meta-analysis of recent continuous glucose monitoring (CGM) studies was conducted to identify glucose changes in response to exercise.
Methods: A literature search was conducted on the PubMed database using keywords "CGM," "Type 1 Diabetes," and "Exercise". Forest plots were created using the R language to visualize mean glucose change and its confidence intervals utilizing the random effect model.
Results: The literature search identified 5 CGM studies matching the criteria. Overall, glucose levels did not change significantly in response to exercise although the changes in glucose levels was highly variable. When subdivided based on exercise intensity, moderate intensity exercise demonstrated significant decrease in glucose levels (p&lt;0.001), whereas high intensity exercise tended to demonstrate an increase in glucose levels but the change is not statistically significant.
Conclusion: This meta-analysis of CGM exercise studies in people with Type 1 diabetes demonstrate that the glucose response to exercise is highly variable in part because moderate intensity aerobic exercise lowers glucose levels while high intensity aerobic exercise tends to increase glucose levels.

Disclosure
C. Phan: None. S.J. Fisher: None. X.D. Zhang: None.

Funding
the National Institutes of Health (UL1TR001998, 1U01DK135111 and OT2HL161847) and by the DRC at Washington University (P30 DK020579)
605-P: Barriers of Exercise in Children and Adolescents with Diabetes Mellitus in Hong Kong
Authors: POON IRIS Y.M. 
Published: June 2024

Objective: According to World Health Organization (WHO), children and adolescents are recommended to exercise at least 150 mins per week to maintain good physical and psychosocial health. This study aimed to determine the barriers of exercise among children and adolescents with diabetes.
Methods: School-aged children who attended Diabetes Clinic at the Hong Kong Children’s Hospital between January 2021 and December 2023 were invited to complete questionnaire in December 2023 on their exercise habits and their barriers in achieving the recommended exercise duration.
Results: 52 children (male: 50%, median age: 12.6 years) completed the questionnaire. 45 had type 1 and 7 had type 2 diabetes, median duration of diabetes was 4.2 years. Median total duration of school PE class per week was 90 minutes, while median total duration of sports outside PE class was 90 minutes. 19 (36.5%) had total duration of exercise less than 150 minutes per week. The top 3 barriers of achieving optimal exercise duration were 1) busy school schedule, 2) weather conditions and 3) location of sports facilities / inconvenience transportation. Interestingly, the group with the lowest socioeconomic status had the lowest rate of achieving the recommended exercise duration (55% vs 100% in the highest socioeconomic class).
Conclusion: More than one-third of our included subjects could not achieved WHO exercise recommendation. To tackle the identified exercise barriers, school-based exercise program especially targeting the less resourceful families is recommended. Also, healthcare providers could promote home exercise to overcome the limitation on time, weather and transportation issues.

Disclosure
I.Y.M. Poon: None.
608-P: Carbohydrate Intake, Glycemic Control, and Cardiometabolic Risk Factors in Type 1 Diabetes—A Systematic Review and Meta-regression
Authors: KOUTNIK ANDREW P. , WOOD THOMAS , STOROSCHUK KRISTI , LENNERZ BELINDA S. 
Published: June 2024

The relationship between carbohydrate intake and cardiometabolic risk remains controversial in people with type 1 diabetes (T1D). In a systematic review of dietary carbohydrate (CHO) content [ranging from very-low (&lt;10% of daily caloric intake) to high (≥45%kcal)], we performed a linear spline meta-regression on glycemic control, total daily insulin dose (TDD), and blood lipids. Inclusion was met by 101 studies with 45,972 participants (54% female, 45% pediatric). CHO intake was non-linearly associated with HbA1c (Figure 1) and TDD. Below the knot of 225 g CHO/day (mean intake), CHO intake was positively associated with HbA1c (+0.52% per 50 g, p&lt;0.001) and TDD (+0.12 IU/kg/day per 50 g, p&lt;0.001). Above the knot, CHO intake was positively associated with higher standard deviation on continuous glucose monitoring (+11.6 mg/dL per 50 g, p=0.031), but not associated with HbA1c or TDD. CHO intake was not associated with LDL-C, HDL-C or triglycerides. The ADA target of HbA1c &lt;7% was achieved in 10% of high-, 24% of moderate- (26-44%kcal), 78% of low- (10-25%kcal), and 100% of very-low-CHO studies (p&lt;0.001). In summary, lower CHO intake was associated with improved glycemic control, without - unlike previously described - altering blood lipids. While observational in nature, these findings suggest that dietary CHO reduction may help reduce cardiometabolic risk in T1D.

Disclosure
A.P. Koutnik: Advisory Panel; Simply Good Foods, Nutrishus Brands. T. Wood: None. K. Storoschuk: None. B.S. Lennerz: None.

Funding
NIH NIDDK (R01DK135884, K23DK119546, R03DK123541)
619-P: Oral Hygiene Practices Linked to Dietary Fiber and Essential Nutrients Intake and Glycemic Management in Type 2 Diabetes
Authors: SEKIGUCHI DAN , HARADA KAYO , MAEDA YASUTAKA , TAMURA AYUMI , MATSUMOTO MOTONOBU , ISHIKADO ATSUSHI , MINAMI MASAE 
Published: June 2024

Introduction & Objective: In type 2 diabetes (T2D), dietary therapy focusing on high-fiber foods is recommended for better glycemic management. However, oral health issues like tooth loss disturb essential nutrient intake. This study investigates the relationship between oral hygiene, dietary intake, inflammation and glycemic markers in T2D.
Methods: The study involved 104 T2D outpatients with ≥15 natural teeth. We analyzed the association of questionnaire-based oral hygiene practices, tooth count (TC), nutrient intake (BDHQ) with clinical information (age, HbA1c, fasting glucose, TIR, BMI, insulin, HOMA-IR, UACR) and inflammation.
Results: Age 62.5 ± 9.7 years, 42% female, HbA1c 7.3 ± 0.7%, BMI 24.8 ± 4.6, number of teeth 25.0 ± 3.6, total dietary fiber 12.4 ± 6.0 g/day. TC positively correlated with green leafy vegetables, carrots/pumpkins, and carotenes intake. Participants with ≥24 teeth had higher fiber intake than those with fewer teeth. TC negatively correlated with age, and positively with dental visits, inversely with BMI, HbA1c, and fasting glucose. Tooth brushing frequency negatively correlated with male gender, BMI, UACR, hsCRP, and TNF-α. Frequent interdental cleaning correlated positively with TIR and negatively with male gender, BMI, insulin, HOMA-IR, hsCRP, IL-6, and TNF-α. Groups with frequent interdental cleaning or ≥20 teeth had lower CGM averages and higher TIR. Logistic regression showed interdental cleaning as significant for TIR &lt;70%, independent of inflammation.
Conclusion: Reduced oral health in T2D is linked to insufficient dietary fiber intake. Interdental cleaning habits significantly impact glycemic variability and inflammation, suggesting the importance of oral hygiene in glycemic management.

Disclosure
D. Sekiguchi: None. K. Harada: Employee; Sunstar Inc. Y. Maeda: Speaker's Bureau; Sanofi, Abbott Japan Co., Ltd., Terumo Corporation, Novo Nordisk. A. Tamura: None. M. Matsumoto: Employee; SUNSTAR Inc. A. Ishikado: Employee; Sunstar Inc. M. Minami: None.
621-P: A First Glimpse into the Usual Dietary Intake of Older Adults with Type 1 Diabetes (T1D)
Authors: CRISTELLO SARTEAU ANGELICA , GOPISETTY NIKHITA R. , SPRINKLES JESSICA , ERCOLINO GABRIELLA , FRUIK ANGELA , QU XIAORUI , MAYER-DAVIS ELIZABETH J. , KAHKOSKA ANNA 
Published: June 2024

Introduction & Objective: We characterized dietary intake of older adults with T1D as a first step towards developing interventions and informing guidelines in this growing and understudied population.
Methods: Older adults (≥65 years) with T1D recruited through a university-affiliated hospital system completed an online survey (Sept-Nov 2023) that included the 30 item dietary screener questionnaire (DSQ). We calculated sex-stratified (M/F) mean and median intakes of dietary factors relevant to United States dietary guidelines and predicted probabilities of sub-optimal intakes based on guideline targets.
Results: The DSQ was completed by 77 older adults (age 71.3 ± 4.1 yrs, 45.5% male, 93.5% non-Hispanic White) with T1D (duration 33.5± 18.1 yrs, Hba1c 6.8 ± 1.1%). Probabilities of sub-optimal intake across almost all dietary factors were greater among females, including over twice the probability of low calcium and fiber intake (Table 1).
Conclusion: This is the first study to characterize dietary intake of older adults with T1D relative to national guidelines. We noted sub-optimal intakes of key nutrient groups in our overall sample. Females may be at higher risk than males. Further studies should characterize intakes alongside diabetes behaviors. Unpacking the reasons and clinical significance of these estimates is also essential to inform population-specific interventions and clinical guidance.

Disclosure
A. Cristello Sarteau: None. N.R. Gopisetty: None. J. Sprinkles: None. G. Ercolino: None. A. Fruik: None. X. Qu: None. E.J. Mayer-Davis: None. A. Kahkoska: None.

Funding
K12TR004416
623-P: Remission of Type 2 Diabetes by Low-Calorie Meal Replacement and Real Food–Based Diets—A Six-Month Pilot Intervention in China
Authors: ZHONG VICTOR W. , WANG SUJING , LIU YANG , FENG NANNAN , WANG JIE , DU XIHAO , XU YAQING , TAO FENG 
Published: June 2024

Objective: To determine the feasibility of achieving type 2 diabetes (T2D) remission by low calorie meal replacement diet (LCMRD) and real food-based diet (LCRFD) in Chinese people with T2D.
Methods: This 6-month intervention consisted of a 3-month isocaloric intensive weight loss phase (815-835 kcal/d) and a 3-month weight maintenance phase (supervised transition to normal diet). Enrolled patients with T2D had BMI 24-45 kg/m2 and (HbA1c 6.5-12.0% or taking diabetes drugs). Everyone stopped diabetes drugs on day 1 and were non-randomly assigned to receive LCMRD (n=21) or LCRFD (n=20). Both diets had similar macronutrient compositions. LCMRD used Quaker’s Smart Calories. LCRFD was prepared by central kitchen daily. The primary outcomes were weight loss and T2D remission (HbA1c &lt;6.5%, no drugs for ≥3 months). Intention to treat analysis was performed.
Results: The 41 participants had a mean age of 40.4 years, BMI of 29.8 kg/m2, HbA1c of 8.0% and diabetes duration of 2.7 years. Three people in LCMRD and 6 in LCRFD quit the intervention. At 6 months, the mean ± SD weight loss was 10.2 ± 8.0 kg in the LCMRD group and 8.9 ± 4.6 kg in the LCRFD group (P &lt;0.001); ~80% of lost weight were fat mass in both groups. T2D remission rate was 62% in LCMRD and 50% in LCRFD. In those with ≥10% weight loss, T2D remission rate was 75% in both groups. Insulin sensitivity assessed by insulin tolerance test improved (P &lt;0.001) whereas insulin secretory capacity assessed by arginine stimulation test did not change, in both groups. Significant improvement in cardiometabolic risk profiles were seen including blood pressure, serum lipids, inflammatory markers, among many other factors (all P &lt;0.05). The most common adverse events were constipation and fatigue. No serious adverse event related to the intervention was reported.
Conclusion: Both LCMRD and LCRFD reduced weight effectively, led to T2D remission in the majority, were feasible, and appeared safe in Chinese people with T2D and overweight/obesity.

Disclosure
V.W. Zhong: None. S. Wang: None. Y. Liu: None. N. Feng: None. J. Wang: None. X. Du: None. Y. Xu: None. F. Tao: None.

Funding
National Natural Science Foundation of China (82373551)
627-P: Prediabetes Reduction from Food Allergen Elimination—A Controlled Pilot Study
Authors: BUCK WILLIS F , FLINT BRONSON 
Published: June 2024

Currently Diabetes affects over 500 million people, worldwide, and the expense of treating this disease exceeded $870 Billion US dollars. Diabetes Mellitus Type 2 (DM2) is comorbid with numerous other pathologies including obesity and hypertension. The objective of this 6-month controlled pilot study was to determine if food allergy elimination is effective in reducing the HbA1c values in Pre-diabetic (PDM) patents.
Methods: Twenty-four PDM subjects were enrolled in this study (5.7 - 6.4 HbA1c), obesity and hypertension were also seen in these subjects (N=24). All subjects received nutritional counseling and recommendations for aerobic exercise, (the current standard of care for PDM). The EXP subjects had blood drawn for ALCAT leukocyte reaction testing to identify sub-acute food allergens (N=250 foods). Food Allergens were eliminated (or exchanged) for the 6-month study’s duration. The dependent variables in this study will be change in HbA1c and BMI (Enrolment, 3 and 6 months). Differences were calculated using a repeated measures ANOVA.
Results: The preliminary results at 90 of 180 days revealed that the EXP subjects had a significant HbA1c reduction (mean -0.8), while the CON subjects showed increases in A1c (mean +0.7), (p &lt; 0.0001). The EXP subjects also showed significant reductions in BMI (-1.1), Blood pressure (-20%). Fat Mass (-8 pounds), and waist circumference (-2”).
Conclusion: The purpose of this controlled 6-month pilot study was to determine if food allergy elimination is effective in reducing the HbA1c values in Pre-diabetic (PDM) patents, and that change was significant in the first 90 days. The next investigation will examine efficacy of this protocol in a 4-year, global, randomized controlled trial.

Disclosure
F. Willis: None. B. Flint: None.

Funding
Travel will be paid for by Cell Science Systems.
63-PUB: Diabetes Control and Complications in South India—Three-Year Results of LANDMARC Trial
Authors: THACKER HEMANT , PRASANNA KUMAR K.M. , DAS ASHOK K. , RAMANATHAN BALAMURUGAN , ASIRVATHAM ARTHUR K. , SHUNMUGAVELU MINAKSHISUNDARAM , MRUTHYUNJAYA MAHESH D. , SELVAN CHITRA , SUNDARAM VIVEK , PHILIP ELIZABETH , MENON SHALINI K. , GADEKAR ARVIND , CHODANKAR DEEPA 
Published: June 2024

Glycemic control, therapy trends, and diabetes complications were evaluated in LANDMARC — a prospective observational 3-year (y) study (CTRI/2017/05/008452) of participants with T2D on ≥2 antihyperglycemic medications. This sub-analysis of 135 sites in South India (Bangalore, Chennai, Coimbatore, Hyderabad, Kerala, and Vijayawada) included 2354 participants (mean [SD] baseline [BL] age: 51.4 [9.2] y, T2D duration: 8.4 [5.5] y and A1C: 8.1% [1.6]). At BL, most were insulin-naïve (n=1665; 70.8%), mainly on OADs (n=1638; 69.6%). At 3 y, 1149 (57.8%) participants were on OADs only, while 806 (40.5%) were on insulin + OADs. Biguanides was the most prescribed drug class (BL: 2184/2353 [92.8%] and 3 y: 1853/1988 [93.2%]). Basal insulin usage increased from BL (n=335; 14.2%) to 3 y (n=465; 23.4%). A decrease in mean (SD) A1C (-0.6 [1.7] %), FPG (-18.0 [60.3] mg/dL), and PPG (-30.3 [81.5] mg/dL); and an increase in those with A1C&lt;7% (BL: 414 [24.5%]; 3 y: 440 [30.1%]), was noted. MI and neuropathy were the most common macro and microvascular complications, respectively (Table). The rate of microvascular complications (n, %) was highest in South India (519, 22.1%) vs. West (252, 18.8%), North (243, 14.4%) and East (107, 12.7%) at 3 y. Hypertension and dyslipidemia were the most common CV risk factors. There is need to further evaluate diabetes management strategies employed in South India to achieve optimal glycemic control.

Disclosure
H. Thacker: Other Relationship; Merck Sharp & Dohme Corp., Novartis India, Sanofi. K. Kumar: None. A.K. Das: Other Relationship; Sanofi. B. Ramanathan: None. A.K. Asirvatham: None. M. Shunmugavelu: None. M.D. Mruthyunjaya: None. C. Selvan: None. V. Sundaram: None. E. Philip: Other Relationship; Sanofi, Novo Nordisk, Eris Lifesciences Ltd. Research Support; Sun Pharmaceutical Industries Ltd. S.K. Menon: Employee; Sanofi. A. Gadekar: None. D. Chodankar: Employee; Sanofi.

Funding
Sanofi
636-P: Disordered Eating and Glycemic Control among Youth with Type 2 Diabetes
Authors: KREYNIN ANNA , MANN ELIZABETH A. , FENSKE RACHEL 
Published: June 2024

Introduction and Objective: Disordered eating (DE) has been associated with poorer glycemic control among youth with Type 2 diabetes (T2D). Screening may help identify patients at risk for DE. We sought to determine whether screening positive for DE was associated with a significant difference in average HbA1c compared to screening negative for DE among youth with T2D.
Methods: A retrospective chart review of youth with T2D receiving care at a pediatric diabetes clinic was completed. Demographic information, DE screening results, and HbA1c were collected for all visits occurring between October 2020 and September 2023. Registered Dietitians (RDs) used a 4-item modified version of the Screen for Disordered Eating (SDE), with the goal of screening all youth aged 12 and older with T2D once per year. Mean HbA1c between groups were compared using t-tests.
Results: Of the 59 screened, 39.0% (n=23) reported a positive screen (2 or more positive responses) and 61.0% (n = 36) reported a negative screen. Those who screened positive had an average HbA1c of 7.9 (+/- 2.5) and those who screened negative had an average HbA1c of 8.4 (+/- 2.5; p = 0.50). Demographic information is presented in Table 1.
Conclusion: Among a diverse sample of youth with T2D, more than one-third of screened patients were positive on a DE questionnaire. Screening positive for DE was not associated with a significant difference in average HbA1c compared to screening negative for DE.

Disclosure
A. Kreynin: None. E.A. Mann: None. R. Fenske: None.
64-PUB: Risk of Complications in Type 2 Diabetes Mellitus with Increase in Disease Duration—A Report of Real-World Data of Indian Population
Authors: SESHADRI KRISHNA , POLISETTI SUBHADRA , TIPPISETTY SUREKHA , KRISHNA KOLUKULA VAMSI 
Published: June 2024

Introduction: T2DM is a progressive disease characterized by worsening of not only β cell function but also an increased risk of complications with time.
Methods: In this real world single center study we did a cross sectional analysis of patients to evaluate common markers of diabetes complications based on the duration of diabetes (DoD). Total 3330 patients were identified who had sufficient information to qualify for the study. Patients were categorized as duration of &lt;1; 1 - &lt;5; 5 - 10 and &gt;10 years of diabetes (self-reported). BMI, waist circumference (WC), HbA1C, eGFR, UACR, FIB4 score and NT proBNP were collected.
Results: In 3330 T2DM patients, male and female were 1762 (53%) and 1568 (47%). Mean DoD was 7.6 years, age 45 years, HbA1c 8.3%, BMI 27.6 Kg/m2, WC 97.6 cms, NT proBNP 153 pg/mL and FIB4 1.34, eGFR 91 mL/min/1.73m2. A progressive increase in mean HbA1c 7.8% to 8.7%, NT proBNP 117 to 220 pg/mL, FIB4 score 1.15 to 1.48 and WC 97.9 to 97.2 cms for duration &lt; 1 to &gt;10 years was noted. eGFR declined from 94 to 86 mL/min/1.73m2 over same duration. Oral medication differed significantly from 70% to 41%, while injectable increased from 30% to 59%. Similarly, NT ProBNP (n=275), risk of heart failure increased from 37% to 45%; FIB4 score (n=802), at indeterminant and high risk of NAFLD significantly increased (p&lt;0.01) from 29% to 38% and 2% to 9%, respectively. eGFR level (n=1134) at mild to moderate and severe risk significantly increased from 44% to 53% and 2% to 20%, respectively.
Conclusion: Our study documents the duration associated decline in various markers of diabetes complications from a single center in India. Of note, this is one of the first studies to document the effect of duration on FIB4, NT proBNP and eGFR from this part of the world. An arbitrary 10-year mark seems to segregate significant deterioration of functional markers when compared to those with early disease. The effects of medication on delaying the progression of complications need to be considered in further analysis.

Disclosure
K. Seshadri: None. S. Polisetti: None. S. Tippisetty: None. V. Kolukula: None.
645-P: Feasibility of Kanasina Gulabi, a Peer Support Intervention for Young Adults with Type 2 Diabetes in Mysore, India
Authors: GOPISETTY NIKHITA R. , MURALIDHAR KIRANMAYEE , NINGAIAH NAGALAMBIKA , KARNAM RAGHAVI , CHINNAPPA RANI , JAYAKRISHNA POORNIMA , ARIELY SUMEDHA , PUFFER EVE S. , MADHIVANAN PURNIMA 
Published: June 2024

Introduction & Objective: To address the knowledge gap and emotional burden in young adults with type 2 diabetes (T2D), we designed a four-week education and goal-based peer support intervention, Kanasina Gulabi (Kannada: My Dream Rose), implemented in Mysore, India between June and July 2023.
Methods: The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to assess feasibility. Peer navigators (n=3, mean age: 33 years) were recruited from the community and trained to deliver the intervention. Twenty-eight adults ≤ 40 years of age with T2D were recruited and quasi-randomly allocated to the intervention group (n=14, mean age: 33 years) or the control group (n=14, mean age: 33 years). Hemoglobin A1c, T2D knowledge, diabetes distress, diabetes-related stigma, depression severity, and optimism were assessed at baseline, immediately after the intervention, and at the 2-month follow-up. Attendance, fidelity, and acceptability were also assessed.
Results: Intervention participants expressed high satisfaction with Kanasina Gulabi and expressed gratitude for the guided knowledge and mentorship from their peer navigators. Participants displayed excellent attendance and adherence, with an average of 5 hours of Kanasina Gulabi exposure over 4 weeks. Peer navigators delivered the intervention with 100% fidelity. Results showed reductions in diabetes distress (Intervention: 30.9%, Control: 6.5%), diabetes-related stigma (Intervention: 25.3%, Control: 14.5%), and depression severity (Intervention: 58.3%, Control: 38.5%). Both groups presented an increase in T2D knowledge (Intervention: 19.7%, Control: 25.2%).
Conclusion: Implementing Kanasina Gulabi in Mysore is feasible and acceptable, with intervention participants showing more positive changes on multiple psychosocial outcomes compared to the control group. Results support a full trial to evaluate its effectiveness and sustainability in young adults with T2D.

Disclosure
N.R. Gopisetty: None. K. Muralidhar: None. N. Ningaiah: None. R. Karnam: None. R. Chinnappa: None. P. Jayakrishna: None. S. Ariely: None. E.S. Puffer: None. P. Madhivanan: None.