bluuebunny/crossref_metadata_2025_split huggingface dataset:
180-OR: Glycemic Markers Are Differentially Associated with Cardiovascular Imaging and Outcomes in Long-Duration Type 1 Diabetes
Authors: GREGORY YU MARC , VISHVA TEJA JANGOLLA SURYA , ZIEMNIAK NOLAN A. , VIEBRANZ ELIZABETH R. , SHAH HETAL , KING GEORGE L. 
Published: June 2024

Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes (T1D). While glycemic control is related to CVD outcomes in T1D, there is a lack of information on the risk of glycemic excursions and comparative contributions of glycemic markers to CVD in aging populations with T1D. Among the Joslin “Medalists” with T1D≥50 years (n=1043), mean historical HbA1c was obtained across longitudinal visits (median 4.1 years), while a single consecutive 14-day block of continuous glucose monitoring (CGM) data was remotely obtained from a subset of Medalist CGM users (n=110). Additionally, Medalists underwent coronary artery calcification scans (CAC; n=153) and cardiac magnetic resonance imaging of left ventricular (LV) structure and function (CMR; n=111). In the overall cohort, HbA1c was associated with CVD (p&lt;0.001). CGM metrics for hyperglycemia (mean glucose, p=0.03; glucose management indicator, p=0.03; and time above range&gt;180 mg/dL, p=0.02), but not hypoglycemia or day-to-day glycemic variability, were associated with LV remodeling. Plasma assays for advanced glycation end-products (AGEs; n=200), N-carboxyethyl-lysine (CEL), N-carboxymethyl-lysine (CML), and methylglyoxal-derived hydroimidazolone (MGH1), showed associations with CVD (p=0.04, p=0.04, and p=0.01, respectively); CAC (p=0.05, p=0.01, and p=0.01, respectively); and LV remodeling (p=0.09, p=0.05, and p=0.04, respectively). The association of CEL with CVD replicated in a separate Medalist subset (n=311) with self-reported CVD data (p=0.01). These findings indicated that glycemic parameters assessing long-term, irreversible markers of hyperglycemia (AGEs) are the strongest drivers of CVD in people with long-duration T1D, as compared to hypoglycemia or day-to-day glycemic variability. Our results highlight the need for glycemic control in aging populations with T1D, even after other risk factors like hyperlipidemia and hypertension have been controlled.

Disclosure
M. Yu: None. S. Jangolla: None. N.A. Ziemniak: None. E.R. Viebranz: None. H. Shah: None. G.L. King: None.

Funding
American Diabetes Association (9-18-CVD1-005); Mary K. Iacocca FoundationThomas J. Beatson Foundation; National Heart, Lung, and Blood Institute (R01 HL161864-02)
1800-LB: Reprogramming of Macrophage Metabolism by Pyruvate Dehydrogenase Attenuates Atherosclerosis through Mitigation of iNOS-Induced Foam Cell Formation
Authors: JEON JAE-HAN , KIM MI-KYUNG , LEE IN-KYU 
Published: June 2024

Background: Prior transcriptomic analyses have illuminated a correlation between the upregulation of glycolysis, induced by oxidized low-density lipoprotein (ox-LDL), and the extent of foam cell formation. This study aimed to elucidate the impact of metabolic redirection via pyruvate dehydrogenase complex (PDH) in macrophages on the formation of foam cells and the progression of atherosclerosis.
Methods: We employed a mouse model wherein bone marrow cells from either wild-type or PDK 2/4-knockout mice were transplanted into lethally irradiated LDL receptor-deficient (LDLR-/-) mice, which were subsequently maintained on a Western diet (WD) for 18 weeks. Additionally, bone marrow-derived macrophages (BMDMs) were isolated, treated with a PDK inhibitor, and then stimulated with ox-LDL for 24 hours.
Results: Evaluation of atherosclerotic lesions via Oil-Red-O staining demonstrated that mice transplanted with PDK2/4-deficient bone marrow and fed a WD exhibited a reduction in plaque formation. The administration of the PDK inhibitor curtailed ox-LDL-induced M1 macrophage polarization, as evidenced by decreased Nos2 expression, alongside a notable reduction in nitric oxide production by the treated BMDMs.
Conclusion: Modulation of macrophage metabolism through PDH activation can mitigate atherosclerosis by inhibiting iNOS-induced foam cell formation. These observations underscore the potential of targeting PDK as a therapeutic strategy for atherosclerosis.

Disclosure
J. Jeon: None. M. Kim: None. I. Lee: None.
1803-LB: Improving Diabetic Foot Ulcer Management with Electrochemical Skin Conductance
Authors: VITTRANT BENJAMIN , GAUTIER JEAN-FRANÇOIS , RIVELINE JEAN-PIERRE , POTIER LOUIS , BOURRON OLIVIER , BRUNSWICK PHILIPPE , BAUDUCEAU BERNARD , DEVILLE KARINE , CRITON ALINE 
Published: June 2024

Introduction: Addressing the challenges in diabetic foot ulcer (DFU) management is critical, given the high morbidity, mortality, and healthcare costs associated with this devastating complication of diabetes. This study introduces an innovative strategy for DFU risk stratification using Electrochemical Skin Conductance (ESC) measurements from the Sudoscan device. It is a quick, non-invasive, painless, reproducible technique that does not require fasting or stopping treatment.
Methods: The study involved 2157 diabetic patients from four French hospitals, evaluating the association between ESC measures and DFU risk stratification scores based on 10g monofilament testing.
Results: Multivariate analysis affirmed the association, independently of others covariate (age, sex), between the ESC and the DFU grades. ROC curve analysis demonstrated good predictive power for DFU grades 3, 2, and 1 (AUC=0.82/0.62/0.62.) but revealed limitations for grade 0 (AUC=0.34) due to the wide range of ESC values. Heatmap analysis showcased ESC's granularity within low-grade patients, suggesting potential subgroups not captured by the standard grading system.
Conclusion: With a quantifiable association between ESC measures and high DFU grades while revealing differences for low DFU grade, this approach offers an avenue for improving precision in risk assessment at early and reversible diabetic peripheral neuropathy stages therefore fostering early clinical intervention.
Healthcare Equity: The standardized and objective nature of ESC measurements while having a low cost contributes to more equitable healthcare delivery. By reducing disparities in risk identification, this approach ensures consistent and accurate assessments, regardless of geographical location or healthcare provider.

Disclosure
B. Vittrant: Employee; Withings. J. Gautier: Board Member; Sanofi. Other Relationship; Sanofi. Speaker's Bureau; AstraZeneca, Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc. J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. L. Potier: Research Support; Abbott. Consultant; AstraZeneca, Bayer Inc., Eli Lilly and Company, Novo Nordisk, Sanofi, Boehringer-Ingelheim. O. Bourron: Speaker's Bureau; Novo Nordisk, Sanofi, Lilly Diabetes, AstraZeneca, Bayer Inc. Research Support; Withings. P. Brunswick: Consultant; Impeto medical. B. Bauduceau: Consultant; Lilly Diabetes, Boehringer-Ingelheim, AstraZeneca. A. Criton: Employee; Withings.
1805-LB: Attenuation of Niacin-Induced Skin Flushing Response—A Potential Clinical Adjunctive Diagnostic Instrument for Diabetic Peripheral Neuropathy
Authors: JIANG TIANYUAN , LIU FANG 
Published: June 2024

Objectives: Explore the potential of using niacin-induced skin flushing response (NSFR) as a diagnostic method for diabetic peripheral neuropathy (DPN) based on the microangiopathic characteristics of DPN.
Methods: This study involved 114 diabetic patients (51 with DPN, 59 without DPN, and 4 with an undetermined diagnosis) and 91 healthy controls(HC). DPN was assessed through clinical symptoms and/or signs, quantitative sensory tests, and electromyography. NSFR is detected using a modified 6-chamber sandwich patch and six different concentrations of aqueous methyl nicotinate (AMN). The sum of the 6 AMN concentrations' flushing area scores within 10 minutes after reaction were calculated and defined as the total NSFR score.
Results: NSFR to gradient concentration stimulation of AMN is reduced and delayed in diabetes patients compared to HCs, and the total NSFR score was significantly decreased (6827.3 (5038.45) vs. 10680 (5060.2)mm2, P &lt; 0.001). The decline in NSFR was more pronounced in diabetes patients with DPN compared to those without DPN (4517.9 (3909.3) vs. 8896.5 (5179.7)mm2, P &lt; 0.001). The association between NSFR and diabetic neuropathy was further evaluated using a multinomial logistic regression model. After adjusting for covariates that might affect NSFR or neuropathy (including age, sex, diabetes duration, BMI, fasting C-peptide, and HbA1c), NSFR was still independently associated with diabetic neuropathy (odds ratio: 0.903 (95% CI: 0.843-0.968), P=0.004). The optimal cut-off point of total NSFR score to distinguish diabetic neuropathy from non-diabetic neuropathy was 8530mm2, with a sensitivity of 88.2% and a specificity of 49.2%.
Conclusions: NSFR reduction is closely and independently associated with the existence of peripheral neuropathy in diabetic patients, and has great potential as an auxiliary tool in diagnosing diabetic peripheral neuropathy.

Disclosure
T. Jiang: None. F. Liu: None.

Funding
National Natural Science Foundation of China (82170827); Natural Science Foundation of Shanghai Science and Technology Commission(22ZR1450100); Shanghai Science and Technology Innovation Action Plan - Yangtze River Delta Region Collaboration Project(22002400600)
1812-LB: Association of Plasma Ceramides with Progression to Diabetes in the Diabetes Prevention Program (DPP) and Outcomes Study (DPPOS)
Authors: ASUZU PEACE , STENTZ FRANKIE B. , WAN JIM Y. , MANDAL NAWAJES , DAGOGO-JACK SAMUEL , PREVENTION PROGRAM RESEARCH GROUP DIABETES 
Published: June 2024

Objective: Ceramides (CER) have been implicated in the pathogenesis of type 2 diabetes (T2D). Here, we assessed baseline plasma CER profiles in relation to incident T2D in the DPP/DPPOS.
Methods: Adults at high risk for T2D were randomized in DPP to intensive lifestyle, metformin, or placebo to compare their effects on diabetes incidence, and followed long-term in DPPOS. For this DPP ancillary study, we evaluated 198 randomly selected participants from the DPP placebo group, comprising 100 who had progressed to T2D (P) by DPPOS Year 11 (~15 years after randomization) and 98 non-progressors (NP), frequency matched by sex, age group and race/ethnicity. Plasma levels of 30 CER species, including 10 monohexosylceramides (MHC) and 10 lactosylceramides (LAC), were assayed in DPP baseline specimens using LC-MS/MS.
Results: At DPP baseline, mean (&lt;u&gt;+&lt;/u&gt; SD) age (51.6 &lt;u&gt;+&lt;/u&gt; 8.5 y vs 51.4 &lt;u&gt;+&lt;/u&gt; 9.0 y), BMI (34.5 &lt;u&gt;+&lt;/u&gt; 7.7 kg/m2 vs. 34.1 &lt;u&gt;+&lt;/u&gt; 6. 1 kg/m2), waist circumference, lipids, hsCRP and adiponectin levels were similar, but fasting plasma glucose (FPG) (110 &lt;u&gt;+&lt;/u&gt; 8.8 mg/dl vs 104 &lt;u&gt;+&lt;/u&gt; 6.3 mg/dl, P&lt;0.0001) and 2-hour plasma glucose (2hPG) (167&lt;u&gt;+&lt;/u&gt; 15.8 mg/dl vs 160 &lt;u&gt;+&lt;/u&gt; 16.4 mg/dl, P=0.0007) were higher in P vs. NP. Baseline levels of total CER, long-chain CER C20:0 - C26:0 and MHC C22:0 were higher, and LAC C18:0, C20:0 and C26:1 were lower, in P vs. NP, adjusted for age, race, sex, BMI, FPG and 2hPG (P’s = 0.02 to &lt;0.0001). The ratios of CER C26:0/C26:1 (P=0.005) and MHC C24:0/C24:1 (P= 0.008) were higher in P vs. NP. In logistic regression models, baseline plasma ratios of CER C26:0/C26:1 predicted incident T2D: OR 1.26 per 0.1 unit, 95% CI 1.09-1.49, P=0.004, adjusted for baseline age, race, sex, BMI, FPG, and 2hPG
Conclusion: Higher baseline plasma levels of long-chain CER and MHC, and lower levels of LAC, were associated with incident T2D during ~15 years of follow-up in the DPP/DPPOS. The saturated-to-unsaturated CER C26:0/C26:1 ratio is a potential biomarker of incident T2D risk among individuals with pre-diabetes.

Disclosure
P. Asuzu: None. F.B. Stentz: None. J.Y. Wan: None. N. Mandal: None. S. Dagogo-Jack: Consultant; Merck Sharp & Dohme Corp., Medtronic, Bayer Inc. Stock/Shareholder; Aerami.
1817-LB: Association between the Neutrophil Percentage–to–Albumin Ratio and Mortality in Patients with Diabetic Foot Ulcer
Authors: ZHU HONG 
Published: June 2024

Objective: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus, and it is also the main cause of infection, hospitalization, amputation and even death in patients with DFU. Neutrophil percentage-to-albumin ratio (NPAR) has been proved to be a predictor of death in many diseases. The aim of this study is to investigate the relationship between NPAR and mortality in patients with DFU.
Methods: This study included 1719 participants with DFU. The cutoff value of NPAR was determined according to the receiver operating characteristic (ROC) curve, and then the patients were divided into two groups: low NPAR group and high NPAR group. Cox proportional hazard regression was used to evaluate the association between NPAR and the risk of death in DFU patients. The difference in survival between groups was evaluated using Kaplan-Meier analysis and the log-rank test. Subgroup analyses were performed to determine whether there were differences in the effects of NPAR in different subgroups.
Results: The median age of all participants was 68 years old, and 61.1% of participants were males. By the end of follow-up, a total of 715 patients with DFU died. Patients with higher NPAR exhibited a significantly lower overall survival rate (P &lt;0.001). The median survival in lower NPAR group is 119 months, compared to only 69 months in the high NPAR group. In multivariate Cox regression analysis, higher NPAR was an independent risk factor in patients with DFU compared with lower NPAR [adjusted hazard ratio (HR): 1.56; 95% confidence interval (CI): 1.29 - 1.89, P &lt;0.001]. There was no statistically significant interaction between NPAR and any of the other DFU risk variables in the subgroup analysis. Conclusions NPAR is an independent predictor of the risk of mortality in patients with DFU. Higher NPAR is associated with increased mortality.
Keywords: Percentage of neutrophils; Albumin; Diabetic foot ulcer; Mortality

Disclosure
H. Zhu: None.
1819-LB: A Health Communication Assessment of Oral Self-Care Contents in Web-Based Education Materials for People with Diabetes
Authors: ZHANG YUQING , BERGER KIMBERLY , LEVEILLE SUZANNE 
Published: June 2024

Introduction & Objective: Periodontal disease is the most prevalent diabetes complication affecting more than half of the diabetes population. However, it is unclear to what extent oral self-care recommendations have been incorporated into diabetes patient education websites, and, if available, how clear these are for patients to prevent and control oral complications of diabetes. This study aimed to evaluate availability and clarity of web-based oral self-care content for people with diabetes (PWD).
Methods: Google and Bing searches with keywords, “diabetes information for patients”, “living with diabetes”, and “diabetes self-management”, were performed. The first three pages of search results were reviewed excluding sponsored websites. We examined publicly available health information websites linked to major medical centers, health systems or government agencies, and excluded commercial websites. We assessed oral health information webpages for clarity and actionability using the CDC’s Community Communication Index (CCI).
Results: After eliminating duplicates, 52 diabetes education websites were assessed. Two-thirds had no information about oral health and one-fifth included minimal content such as statements about need for regular dental checkups. Seven websites had full pages on oral health information and were assessed using the CCI, with an average score of 77 (Range 64-88).
Conclusion: Although there are many websites providing patient education information on diabetes, only one-third include information about oral health. There is great need for reliable, accessible, and easy to use web-based patient education material to improve oral health awareness and behaviors, equipping PWD with the necessary knowledge and skills to practice optimal oral self-care.

Disclosure
Y. Zhang: None. K. Berger: None. S. Leveille: None.

Funding
American Diabetes Association (ADA 11-22-JDFHD-06)
1826-LB: Enhancing Diabetes Self-Management Education—Perspectives of Patients and Primary Care Providers on Influencing Factors of Binge Eating in Black Adults with Type 2 Diabetes
Authors: ALEXANDER RAMINE C. , HARPER-COOKS TYISHA , GODOY SARAH , WOLFE HANNAH , GOODE RACHEL W. 
Published: June 2024

Introduction & Objectives: Current diabetes self-management education (DSME) has minimal impact on HbA1c in Black adults with type 2 diabetes mellitus (T2DM). One reason may be that DSME does not address binge eating. Black adults with T2DM are six times more likely to binge eat compared to other racial or ethnic groups. Little is known about how to mitigate binge eating in this population. Thus, this study explores the perspectives of patients and primary care providers on factors influencing binge eating in Black adults with T2DM, and strategies that could enhance DSME.
Methods: Black adults with T2DM who experienced at least 2 binge eating episodes a month (n = 14) and DSME providers (n = 9) who treated Black adults with T2DM were invited to complete in-depth interviews to identify facilitators of binge eating and explore strategies that could enhance DSME. A constructivist grounded theory approach was used to develop a framework explaining factors influencing binge eating in Black adults with T2DM.
Results: Participants identified multilevel stressors and barriers that influenced their binge eating episodes and T2DM treatment: a) active food restriction; b) emotional eating; and c) feelings of deprivation. Providers acknowledged limited training in disordered eating, insufficient patient interaction time, and patient shame related to T2DM.
Conclusion: Results of this study identify salient factors that exacerbate binge eating behavior in Black adults with T2DM. Understanding these specific factors and barriers can enhance DSME and improve long-term T2DM self-management in Black adults.

Disclosure
R.C. Alexander: None. T. Harper-Cooks: None. S. Godoy: None. H. Wolfe: Employee; Within Health.

Funding
American Diabetes Association (11-21-ICTSHD-12)
183-OR: Risk Factors for Combined Severe Diabetic Complications (CSDC) in Patients with Type 2 Diabetes Mellitus (T2DM)
Authors: NANAKO TANAKA , FUJIHARA KAZUYA , YAGUCHI YUTA , YAMADA MAYUKO H. , YAMAMOTO MASAHIKO , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO 
Published: June 2024

Since advanced microangiopathy in diabetes severely impairs activities of daily living and quality of life and is life-threatening regardless of severity, treatment of diabetes requires appropriate risk management to avoid ALL of those severe complications. A simultaneous assessment of the risk of complications rather than individual assessments is essential to developing optimal treatment strategies. Thus, we examined the association between CSDC and the number of achieved treatment targets. CSDC were defined as follows: vision-threatening retinopathy, initiation of dialysis, amputation of lower extremity, and cardiovascular disease including heart failure. Studied were 86,633 patients with no history of CSDC. Achieved targets as analyzed by multivariate Cox model for treatment were HbA1c &lt;7%, SBP &lt;130, LDL-C &lt;120, and non-smoking. During a median follow up of 4.6 years, 4,542 cases of CSDC (12.9/1,000 person-years) occurred. Risk of CSDC decreased as the number of achieved targets increased. The risk of CSDC was extremely reduced in patients who achieved all targets compared with patients who did not achieve any of the 4 targets (Figure). The risk of CSDC decreased as the number of achieved targets for atherosclerotic risk factors increased, suggesting that multifactorial interventions are necessary to prevent these conditions.

Disclosure
T. Nanako: None. K. Fujihara: None. Y. Yaguchi: None. M.H. Yamada: None. M. Yamamoto: None. M. Kitazawa: None. Y. Matsubayashi: 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.
1842-LB: Adapting Behavioral Family Systems Therapy for Diabetes (BFST-D), a Virtual Family-Based Intervention for Improving Transition Readiness in Youth with Type 1 Diabetes (T1D)
Authors: PAPADAKIS JACLYN L. , WEISSBERG-BENCHELL JILL , SUHS MADELEINE C. , O'DONNELL ALEX , HARRIS MICHAEL A. 
Published: June 2024

Introduction & Objective: Many youth with T1D do not transfer to adult diabetes care successfully, resulting in adverse medical and psychosocial outcomes. Modifiable individual and family factors are associated with transition, yet there are no empirically-based interventions targeting such factors. The objective of this study is to (1) describe the adaptation of BFST-D to BFST-DT, a virtual family-based T1D transition intervention, and (2) describe baseline findings of a pilot pre-post intervention trial.
Methods: Focus groups were conducted to inform the adaptation of BFST-D to address transition readiness. A pilot trial assessed acceptability/feasibility of the intervention in 30 families. Analyses evaluated transition readiness and psychosocial variables at baseline.
Results: Eight focus groups of youth with T1D, their caregivers, and diabetes providers (total n=44) were conducted. Thematic analysis revealed individual and family-level barriers and facilitators to transition and feedback on the adapted intervention. Twenty adolescents (Mage= 16.6 years; 55% female) and their caregiver (95% mothers) are currently enrolled in the intervention. At baseline, adolescents reported the greatest transition readiness in insulin/pump management (M=4.33), followed by health behaviors (M=3.73), diabetes knowledge (M=2.64), and healthcare navigation (M=2.27). Total transition readiness was correlated with diabetes-related resilience and distress, and parent self-reported diabetes-related distress, self-efficacy, and family conflict (p’s &lt; .05).
Discussion: Stakeholder focus groups highlighted the need for a family-based T1D transition intervention and were vital to BFST-DT development. Transition readiness is associated with individual and family-level psychosocial variables. Future studies will evaluate the efficacy and acceptability/feasibility of BFST-DT.

Disclosure
J. Weissberg-Benchell: Consultant; Beta Bionics, Inc. Advisory Panel; American Diabetes Association. Research Support; Juvenile Diabetes Research Foundation (JDRF), National Institute of Diabetes and Digestive and Kidney Diseases. A. O'Donnell: None.

Funding
JDRF (4-SRA-2023-1287-M-B)