bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU271 Identification Of Candidate Biomarkers For Type 1 Diabetes Mellitus By Bioinformatics Analysis Of Pooled Microarray Gene Expression Datasets In Gene Expression Omnibus
Authors: Feng Kevin , Chen Wenqiang 
Published: October 2023

Abstract
Disclosure: K. Feng: None. W. Chen: None.
Background: Type 1 diabetes (T1DM) is a serious threat to childhood life and has a complicated pathogenesis. Currently, molecular mechanisms of T1DM remain largely unclear. The aim of this study was to identify the candidate genes in T1DM by integrated bioinformatics analysis. Methods: Transcriptomic datasets (GSE156035) in the GEO database were analyzed for differentially expressed genes (DEGs) using the R statistical language. The differentially expressed genes (DEGs) were identified, and the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. A protein - protein interaction (PPI) network was applied to screen out the candidate genes. Results: The results revealed that 273 DEGs of the three datasets were ascertained in our study, including 135 upregulated genes and 138 downregulated genes. The GO and KEGG enrichment analysis results showed that the functions of DEGs mainly involved in regulation of transcription from RNA polymerase II promoter, specific granule lumen, transcriptional activator activity, Osteoclast differentiation pathway, etc. Through the PPI analysis network, the core genes with the highest degree of 6 nodes were selected: FOS, RHOA, CXCL8, FOSB, EGR1, and DUSP1. Conclusion: The genes, identified in this study, may play a vital regulatory role in the occurrence and development of T1DM. Also, they are closely related to obesity and diabetes mellitus. Our results provide novel biomarkers that could be used as representa­tive reference indicators or potential therapeutic targets for T1DM clinical applications.
Presentation: Thursday, June 15, 2023
THU288 An Analysis Of The Association Between Age, HbA1c, Central Corneal Thickness, And Lens Thickness Using Swept-source Optical Coherence Tomography
Authors: Borkhetaria Rucha K , Karakoleva Ema V , Devireddy Nitya , Rosen David B , Pantanelli Seth M 
Published: October 2023

Abstract
Disclosure: R.K. Borkhetaria: None. E.V. Karakoleva: None. N. Devireddy: None. D.B. Rosen: None. S.M. Pantanelli: None.
An increase in age is positively correlated with an increase in the thickness of the crystalline lens of the eye. Lens thickness changes have also been observed in diabetics. However, whether a predictable relationship exists between HbA1c and certain biometric variables is unknown. The aim of this study was to investigate any associations between age, HbA1c levels, central corneal thickness (CCT), and lens thickness (LT) using a swept-source optical coherence tomography (SS-OCT) based optical biometer in the eyes of patients with diabetes mellitus. A retrospective, consecutive case series was conducted. CCT and LT were measured with the IOLMaster 700 swept-source optical biometer (Carl Zeiss Meditec). HbA1c of diabetics recorded within 3 months of biometry measurements were abstracted from the medical record. The data were analyzed using a linear regression model. We evaluated 391 eyes of 391 patients: 107 diabetics and 284 age-matched non-diabetics. Amongst non-diabetics, age was positively associated with LT (p&lt;0.001), with an increase in LT of 0.02 mm per year of age. There was no association elucidated between age and CCT in this group (p=0.754). Amongst diabetics, HbA1c was independently associated with LT (p=0.005) after controlling for age, with a decrease in LT of 0.07 mm per 1-unit increase in HbA1c. Age (p=0.119) nor HbA1c (p=0.310) were associated with CCT amongst diabetics. There was a positive correlation between age and lens thickness amongst diabetics and non-diabetics. HbA1c was independently associated with lens thickness amongst diabetics. There was no correlation between age, HbA1c, and central corneal thickness.
Presentation: Thursday, June 15, 2023
THU290 Identifying Trends In Glycemic Management In A Comprehensive Cancer Center
Authors: Kikani Nupur , Thosani Sonali 
Published: October 2023

Abstract
Disclosure: N. Kikani: None. S. Thosani: None.
Hyperglycemia in the inpatient setting contributes to morbidity and mortality. Glycemic management in the emergency room is the gateway for inpatient management. An institutional quality improvement initiative to improve glycemic management was initiated in January 2020. Interventions included a diabetes related questionnaire at triage triggering a mandatory point of care (POC) glucose check if positive and the addition of quick access acute hyperglycemia orders in the emergency management electronic medical record (EMR) order set. In this study, we gathered baseline glycemic data on patient visits to urgent care center from January 2019-November 2022 to explore trends in monitoring and management prior to and after the implementation of initiative.
The highest value of glucose documented per encounter was utilized for calculations. During this period, an average of 1,912 individual patients were evaluated and accounted for 2,239 visits per month. For the entire patient population, 7% of visits were characterized by glucose values between 200-249mg/dL, 3% of visits with glucose values between 250-299 mg/dL, and 2% with glucose values ≥300mg/dL. 59% of visits resulted in inpatient admission and 25% of admitted patients had point of care glucose monitoring orders.
17.8% of patients had known diabetes and on average, 24%, 13% and 8% of these patient visits were characterized by glucose between 200-249 mg/dL, 250-299 mg/dL and ≥300mg/dL respectively. 64% of visits culminated with inpatient admission with 46% of admitted patients having POC glucose monitoring orders and 79% of patients with insulin orders on admission.
In 2019, a mean of 25% of total admitted patient encounters had a POC glucose order on admission compared to 21% in 2020, 25% in 2021, and 30% in 2022. Of those patient encounters with known diabetes, 49%, 39%, 43%, 52% had a POC glucose order on admission in the years 2019, 2020, 2021, and 2022 respectively. Of the encounters with patients with known diabetes, 37% were admitted with an insulin sliding scale order in 2019, 26% in 2020, 26% in 2021, and 36% in 2022. In 2019, 76% of encounters with diabetes patients had an insulin order on admission, 80% in 2020, 79% in 2021, and 79% in 2022.
Over the four years, the mean distribution of POC blood glucose values remained stable across both the general and diabetes specific populations. The admission rate for both these populations also had little variability. Of the patients with diabetes, the rate of POC glucose order at admission increased from 49% to 52%. Those with an insulin order remained stable from 76% to 79%. Additionally, only 26% to 37% of patients with diabetes were admitted with an insulin sliding scale order. These trends provide valuable insight into areas that may be targeted for early intervention in glycemic management which has the potential to improve hospital outcomes in patients with diabetes mellitus.
Presentation: Thursday, June 15, 2023
THU302 Protective Effects Of Lactation On Maternal Metabolism
Authors: Hens Julie R , Ding Yuyan , Brown Stacey , Song Huijia , Wysolmerski John J , De Aguiar Renata Belfort 
Published: October 2023

Abstract
Disclosure: J.R. Hens: None. Y. Ding: None. S. Brown: None. H. Song: None. J.J. Wysolmerski: None. R. Belfort De Aguiar: None.
A history of lactation significantly lowers the risk of developing Type 2 diabetes (T2D) by almost 50%. However, little is known about how milk production durably changes maternal metabolism. We hypothesized that lactation protects against diabetes by improving maternal glucose metabolism. Changes in body composition, glucose metabolism, insulin secretion and tissue triglyceride levels were measured in age-matched cohorts of mice that lactated (L) or did not lactate but went through a pregnancy (NL); age-matched virgins served as controls (V). L and NL mice were studied 4 weeks after weaning of pups from the L group. An euglycemic-hyperinsulinemic clamp was used to further examine glucose metabolism. Multiple rounds of lactation were examined to determine if body composition or glucose metabolism changed with repeated cycles of reproduction. Liver weight was higher in L mice when compared to V mice. Liver triglycerides were lower in L and NL mice when compared to V mice. Circulating fasting levels of plasma free fatty acids were unchanged between the three groups. Perigonadal fat trended higher in NL mice compared to L and V mice after one round of lactation. However, after two rounds of lactation, NL mice had significantly more perigonadal fat than L or V mice. Fasting glucose trended lower in L mice compared to NL mice, but there was no difference in insulin levels between groups. The area under the curve of glucose tolerance test was not different between groups. Pancreases from L mice had increased numbers of islets compared to NL and V mice. Insulin action was assessed in chow-fed, conscious, unrestrained L, NL, and V mice using the euglycemic-hyperinsulinemic clamp technique. Tail-vein glucose was clamped at 100-120 mg/dL. The normalized glucose infusion rate to insulin was significantly lower (p=0.01) in NL mice (41.9 +/- 17) compared to V mice (91.8 +/- 14 and L mice (83.8 +/- 27). Our results suggest that pregnancy and lactation significantly alter the metabolic functions of liver, adipose, muscle, and pancreas. Furthermore, a history of lactation improves insulin sensitivity in parous mice. Further study of the metabolic changes occurring during lactation may have wide-ranging implications for women’s health.
Presentation: Thursday, June 15, 2023
THU308 Metabolic And Neuroendocrine Adaptability Following One Night Of Partial Sleep Restriction In Dutch Males
Authors: Pelsma Iris , den Berg Rosa van , Kooijman Sander , Snel Marieke , Zhu Gewei , Moore Alison , Pople Jenny , Lavrijsen Sjan , Birch-Machin Mark , Bhogal Ranjit , El Ghalbzouri Abdoelwaheb , Martinez-Tellez Borja , Giesbrecht Timo , Kersten Sander , Weeghel Michiel van , Cornelis Meijer Onno , Pereira Arias Alberto Martin , Gunn David , Rensen Patrick , Biermasz Nienke 
Published: October 2023

Abstract
Disclosure: I. Pelsma: None. R. van den Berg: None. S. Kooijman: None. M. Snel: None. G. Zhu: None. A. Moore: Employee; Self; Unilever. J. Pople: Employee; Self; Unilever. S. Lavrijsen: None. M. Birch-Machin: None. R. Bhogal: Employee; Self; Unilever. A. El Ghalbzouri: None. B. Martinez-Tellez: None. T. Giesbrecht: Employee; Self; Unilever. S. Kersten: None. M. van Weeghel: None. O.C. Meijer: None. A.M. Pereira Arias: None. D. Gunn: Employee; Self; Unilever. P. Rensen: None. N. Biermasz: None.
Introduction: Chronic and acute short sleep associate with many adverse effects. Metabolic and neuroendocrine effects during the day following short sleep, however, are unknown. Methods: Randomized cross-over study using short sleep (4h) vs normal sleep (8h) in 31 males (31 years (IQR 23-47, BMI 26.0±4.2 kg/m2 (range 20.1-35.0). Glucose, lipid, incretin, ACTH, and cortisol levels, as well as respiratory exchange ratio (RER; indirect calorimetry) were assessed following standardized mixed meals. RNAseq of morning skeletal muscle biopsies and pathway analysis on differentially expressed genes was performed. Results: Short sleep increased fasting free fatty acids (0.34 mmol/L (IQR 0.26 - 0.38) vs 0.47 mmol/L (IQR 0.38 - 0.70), P&lt;0.0001). Cortisol levels peaked upon early wake-up, which eliminated a peak at normal wake-up. Morning postprandial glucose peaked later (time P&lt;0.001, levels P=0.106, pattern P=0.031), whilst insulin was unaffected. Afternoon postprandial insulin was lowered (time P&lt;0.001, levels P=0.044, pattern P=0.419), whilst glucose was unaffected. Morning and afternoon postprandial TC, and LDL-c were lowered (morning: TC, time P&lt;0.0001, levels P=0.009, pattern P=0.289; LDL-c, time P&lt;0.001, levels P=0.038, pattern P=0.797; afternoon: TC, time P&lt;0.001, levels P=0.007, pattern P=0.92; LDL-c, time P&lt;0.001, levels P=0.055, pattern P=0.991). Pathway analysis of muscle revealed increased fatty acid oxidation (FAO), reflected by increased Oxidative Phosphorylation and Mitochondrial Dysfunction pathways, accompanied by lowered fasting RER (0.87 (IQR 0.86 - 0.92) vs 0.86 (IQR 0.84 - 0.87), P=0.0033). Conclusions: Acute partial sleep restriction subtly and temporarily changed glucose dynamics (morning), and insulin levels (afternoon), and lowered TC and LDL-c levels in the morning and afternoon, with concurrent increased FAO and mitochondrial dysfunction pathways in skeletal muscle, and calorimetric shifting from glucose towards lipid oxidation (fasted and postprandial), potentially highlighting increased delipidation of chylomicrons following sleep restriction.
Presentation: Thursday, June 15, 2023
THU321 Indirect Effects Of COVID-19 On The Risk Of Gestational Diabetes And Factors Mediating Increased Risk
Authors: Rhou Yoon Ji J , Elhindi James , Melov Sarah J , Cheung N Wah , Pasupathy Dharmintra 
Published: October 2023

Abstract
Disclosure: Y.J. Rhou: None. J. Elhindi: None. S.J. Melov: None. N. Cheung: None. D. Pasupathy: None.
Aim: COVID-19 has had indirect effects on pregnancy outcomes. This study aimed to assess the risk of gestational diabetes (GDM) in distinct COVID-19 exposure periods and determine the potential factors contributing to increased risk of GDM in a multiethnic population. Methods: Multicentre, retrospective cohort study of singleton pregnancies at three hospitals two years pre-COVID-19 (January 2018 - January 2020), 1st year of COVID-19 with low COVID-19 pandemic burden and limited restrictions (February 2020 - January 2021), and 2nd year of COVID-19 with increased pandemic burden and stringent restrictions (February 2021 - January 2022). Baseline maternal characteristics, gestational weight gain (GWG) and pregnancy outcome data were compared between time periods. The primary outcome of GDM was assessed using univariate and multivariate generalized estimating equations models. Results: Of 28,207 pregnancies, 14,663 occurred in the two years pre-COVID-19, 6,890 in COVID-19 Year 1 and 6,654 in COVID-19 Year 2. The study population was diverse, comprising 82.5% of non-Caucasian ethnicity and 22.7% in the quintile of greatest socioeconomic disadvantage. Maternal age increased across exposure periods (30.7 ± 5.0 years pre-COVID-19 vs 31.0 ± 5.0 years COVID-19 Year 1 vs 31.3 ± 5 years COVID-19 Year 2; p&lt;0.001). There were increases in prepregnancy BMI (25.5 ± 5.7 kg/m2 vs 25.7 ± 5.6 kg/m2 vs 26.1 ± 5.7 kg/m2; p&lt;0.001), proportion who were obese (17.5% vs 18.1% vs 20.7%; p&lt;0.001) and proportion with other traditional risk factors for GDM including South Asian ethnicity and prior history of GDM. Weekly rate of GWG and proportion exceeding recommended GWG increased across pandemic exposure periods (64.3% vs 66.0% vs 66.6%; p=0.009). GDM diagnosis increased across exposure periods (21.2% vs 22.9% vs 24.8%; p&lt;0.001). Both COVID-19 Year 1 and Year 2 were associated with increased risk of GDM on univariate analysis, only COVID-19 Year 2 remaining significantly associated after adjusting for maternal baseline characteristics and GWG (OR 1.17 [1.06, 1.28], p=0.01). Conclusion: Diagnosis of GDM increased with pandemic exposure. Progressive sociodemographic changes and greater GWG may have contributed to increased risk. However, exposure to the 2nd year of COVID-19 remained independently associated with GDM after adjusting for shifts in baseline maternal characteristics and GWG.
Presentation: Thursday, June 15, 2023
THU323 Extreme Insulin Resistance In Type 1 Diabetic After Covid 19 Infection
Authors: Zakkar Adam A , Fadanelli Margaret , Al Mushref Mazen 
Published: October 2023

Abstract
Disclosure: A.A. Zakkar: None. M. Fadanelli: None. M. Al Mushref: None.
Patient is a 46-year-old African American female with a medical history of Diabetes Mellitus Type 1 for 20 years, hypothyroidism, rheumatoid arthritis and celiac disease who presented with a complaint of dizziness and heavy menstrual periods. When she presented, labs were significant for a glucose of 513 mg/dL, anion gap of 22 with a bicarbonate of 8, HbA1c of 10%, Hemoglobin of 8.1 and UA revealed ketones and she was thus started on an insulin drip for diabetic ketoacidosis. Patient was also complaining of a cough and weakness and thus a sputum sample was obtained which was positive for Streptococcus pneumoniae and she was started on antibiotics. At the time of arrival the patient was A&Ox4 and stated that her glucose has been really difficult to control over the last 6 months after she had been infected with COVID-19 and over that time she has also lost approximately 50 lbs. She stated that one month prior to the patient having COVID-19 infection, she was taking aspart 20 units per/meal and detemir 32 units qAM and 62 units qHS, and had an HbA1c of 8.5%. Just prior to presentation, the patient was taking 70 units of the U-100 aspart insulin per meal and 60 units of glargine U300 twice daily with persistent hyperglycemia. Insulin antibodies were tested and returned remarkably high. GAD-65 antibody was also high. The patient's glucose remained in the 500-600 mg/dL range and the acidosis worsened to a pH of 6.9 despite receiving continuous intravenous insulin aspart at 30units/hr with the addition of detemir 100 units q12-hours. The patient's acidosis resolved after two days and she was transitioned to Humulin R-U-500 at 80 units TID and aspart 40 units every 4-hours for tube feeding coverage but was still hyperglycemic in the 200-300 mg/dl range. Due to autoimmunity and extreme insulin requirements the patient was started on methylprednisolone 20 mg q8hr with improvement of glucose to the 150 to 200 mg/dl range and a decrease in her daily insulin requirements and thus she was transitioned to 60mg of prednisone daily with a 10mg taper weekly. By the time she was discharged 2 weeks later, her glucose was more controlled and her insulin requirements were decreased to aspart 14 units per/meal and detemir 40 units BID. Conclusion: In patients with diabetes mellitus who develop extreme insulin resistance following COVID -19 infection, consider autoimmune etiology in the differential diagnosis, such as insulin inactivating antibodies or insulin receptor blocking antibodies. In our experience laboratory testing of the specific antibodies was not available. Management of autoimmune mediated hyperglycemia will require immunosuppressivetherapy.
Presentation: Thursday, June 15, 2023
THU370 A Case Of Ketosis-prone Diabetes In A Caucasian Man
Authors: Saeed Zainab , Labib Christine , Trabulsi Maja , Varatharajah Malathy 
Published: October 2023

Abstract
Disclosure: Z. Saeed: None. C. Labib: None. M. Trabulsi: None. M. Varatharajah: None.
Introduction: Ketosis-prone diabetes (KPD) also known as Flatbush diabetes, atypical diabetes and type 1.5 diabetes was first reported in the 1990s in African Americans in the Flatbush neighborhood of Brooklyn, New York. Its exact incidence is still unknown; however, it predominantly affects African American and Hispanic population and is less prevalent in Asians and Caucasians. It presents as diabetic ketoacidosis, a hyperglycemic emergency, in patients with no prior history of diabetes. In addition, it is usually seen in middle-aged, obese patients with a strong family history of Type 2 diabetes mellitus. Here we briefly describe the case of a lean 62-year-old man who presented to the hospital with HHS/DKA and was diagnosed with ketosis-prone diabetes. Case Presentation: 62-year-old man (BMI 21.37 Index) with a past medical history of alcoholic cirrhosis, Crohn’s disease and no personal or family history of diabetes presented to the hospital with complaint of nausea, polyuria and polydipsia. He was found to have hyperosmolar hyperglycemic state with diabetic ketoacidosis. He had a blood glucose of 833 mg/dL (70-110 mg/dL), anion gap of 14, sodium 111 mmol/L (136-145 mmol/L), potassium 7.0 mmol/L (3.5-5.1 mmol/L), creatinine 5.7mg/dL (0.6-1.3 mg/dL), pH 7.26 L (7.35-7.45 pH units), bicarbonate 16 mmol/L (22-34 mmol/L). He was started on an Insulin drip and later transitioned to subcutaneous long and short acting insulin after closure of anion gap. His Hemoglobin A1c was found to be 12.8% (4.8-6.1% A1C, Cpeptide 4.32 ng/mL (0.48-5.05 ng/mL), GAD65 antibody was negative. Four months prior to his hospital admission, his Hemoglobin A1C was 4.9%. Patient was discharged from the hospital on Insulin NPH/Regular 70/30 twice a day and sliding scale with meals. He was followed outpatient in clinic. Within a month of discharge he began to have episodes of symptomatic hypoglycemia, lowest recorded blood sugar was 49. His Insulin NPH/Regular was gradually tapered; he did not require the sliding scale at all. Four months after the episode of HHS/DKA, his repeat hemoglobin A1C was 5.7%. Case Discussion: Despite being known for around three decades now, the exact mechanism of ketosis prone diabetes is still poorly understood. It is thought to be due to insulin resistance as well as severe deficits in insulin secretion. It is classified further based on beta cell function and autoimmunity. In patients with preserved beta cell function and absence of autoimmunity, like our patient, with aggressive management insulin can eventually be discontinued. However, these patients remain at risk of developing diabetes later in life. Our case aims to shed light on the ubiquity of this disease so that physicians can diagnose it promptly and treat accordingly.
Presentation: Thursday, June 15, 2023