bluuebunny/crossref_metadata_2025_split huggingface dataset:
1280-P: The Maturity-Onset Diabetes of the Young (MODY) Calculator Overestimates MODY Probability in Hispanic Youth
Authors: ALARCON GUIDO , NGUYEN ANH D. , JONES ANGUS , REDONDO MARIA J. , SHIELDS BEVERLEY , TOSUR MUSTAFA 
Published: June 2023

The applicability of the MODY probability calculator (Shields et al., Diabetologia, 2012) to non-European populations remains unknown. We aimed to test its utility in Hispanic youth. We performed a retrospective chart review of Hispanic youth (&lt;23 years) with diabetes (n=2033) in a large, pediatric tertiary care center in the U.S. We calculated MODY probability for all subjects, splitting into two cohorts in line with the two equations underlying the MODY calculator: Individuals who were started on insulin within 6 months of diabetes diagnosis (Cohort 1) and those who were not (Cohort 2). MODY genetic testing was carried out on limited individuals based on clinicians’ suspicion of MODY. Cohort 1 and Cohort 2 comprised 1566 (mean age: 15.8 ± 4.7 years, 49% female) and 467 youth (mean age: 17.2 ± 3.5 years, 62% female), respectively. Of 1566 early insulin treated individuals in cohort 1, the mean MODY probability was 6% suggesting an expected 6% (94 individuals) with MODY. This is higher than previous prevalence estimates (1-4%) and much higher than the number identified from genetic testing (6 individuals out of 30 tested). For the 467 non-insulin treated individuals (cohort 2), the mean probability was 62% suggesting an expected 289 individuals with MODY, which again was much higher than previous prevalence estimates and the number identified from genetic testing (10 individuals out of 12 tested). Individuals with a confirmed pathogenic variant in a MODY-associated gene were more likely to have a younger age at diagnosis and lower non-HDL (cohort 1) or lower HbA1c (cohort 2). However, both cohorts had similar MODY probabilities compared to the remaining individuals in each cohort. The MODY calculator likely overestimates the probability of MODY in Hispanic youth, particularly those who are not early insulin treated, where young-onset type 2 diabetes is the more likely diagnosis. The calculator needs updating for use in this population.

Disclosure
G.Alarcon: None. A.D.Nguyen: None. A.Jones: None. M.J.Redondo: None. B.Shields: None. M.Tosur: Advisory Panel; Provention Bio, Inc.
1283-P: Pilot Study Reveals Excellent Agreement between the Newly Developed Pastry Sugar Tolerance Test and the OGTT in the Diagnosis of Diabetes
Authors: SCHENK BLAYNE R. , HURSTON JAMAIICA , DE DIEU GATETE JEAN , DUBOSE CHRISTOPHER , MABUNDO LILIAN , YANG SHANNA , WORTHY CHARLITA , COURVILLE AMBER B. , JAGANNATHAN RAM , SUMNER ANNE E. 
Published: June 2023

Achieving early diagnosis of type 2 diabetes (T2D) in Africans is challenging. The Glucola used in the OGTT is expensive and unavailable in most African countries. Alternatives to the OGTT are fasting plasma glucose (FPG) and A1C, but they have a low diagnostic sensitivity in Africans. As an alternative to the Glucola (75g glucose) used in the OGTT, we developed the Pastry Sugar Tolerance Test (PSTT) with pastry sugar (75g glucose powder) dissolved in hot water. Pastry sugar is inexpensive and widely available in Africa. Hence, our aim was to determine the diagnostic agreement between (1) OGTT and PSTT; (2) OGTT and A1C; (3) OGTT and FPG in the detection of T2D in 48 African-born Blacks living in America (male: 67%; age: 41±10y (mean±SD)). At Visit 1, an OGTT, A1C and FPG were performed. At Visit 2, which occurred 8±3 days later, a PSTT was performed (Fig). ADA criteria were used for the OGTT, A1C≥6.5% and FPG≥126 mg/dL. Agreement between tests was determined by κ-statistic. T2D, prediabetes and normal glucose tolerance occurred in 8% (4/48), 31% (15/48) and 61% (29/48), resp. All individuals with T2D were detected by both the OGTT and PSTT (κ=0.99). Yet, A1C only detected 50% (2/4) (κ=0.65), and FPG only detected 25% (1/4) (κ=0.38) of Africans with T2D. This pilot study suggests that in the detection of T2D, agreement between the PSTT and the OGTT may be both excellent and superior to A1C and FPG.

Disclosure
B.R.Schenk: None. A.E.Sumner: None. J.Hurston: None. J.Gatete: None. C.Dubose: None. L.Mabundo: None. S.Yang: None. C.Worthy: None. A.B.Courville: None. R.Jagannathan: None.
1289-P: Predictors of New-Onset Type 2 Diabetes after Infection with COVID-19 in the COVID-OUT Randomized Trial
Authors: NICKLAS JACINDA M. , LEMUS WIRTZ ESTEBAN J. , MURRAY THOMAS A. , LIEBOVITZ DAVID , FENNO SARAH , ANDERSON BLAKE , AVULA NANDINI , REDDY NEHA , BRAMANTE CAROLYN 
Published: June 2023

Background: There are mixed data on whether COVID-19 infection is associated with increased incidence of type 2 diabetes (T2DM). The majority of data have been derived from retrospective datasets. We sought to identify predictors of new onset T2DM in a prospective cohort enrolled in the multi-site phase 3 randomized quadruple-blinded placebo-controlled COVID-OUT clinical trial.
Methods: Adults with overweight or obesity aged 30-85 were enrolled within 3 days of a positive SARS-CoV-2 test and &lt;7 days of symptoms. Participants were randomized to 1 or 2 of 3 oral medications (immediate-release metformin increasing over 6 days to 1500 mg daily for a total of 14 days; ivermectin 430mcg/kg/day for 3 days; fluvoxamine 50mg day 1 then 50mg twice daily through 14 days) or placebo using a two by three parallel treatment factorial design. Starting 60 days after randomization we sent automated email surveys every 30 days through 300 days about new diabetes diagnoses, as well as changes in weight and sleep. We conducted univariable analyses to determine predictors of T2DM diagnosis.
Results: Among 1093 subjects, 25 reported a new diagnosis of diabetes within 300 days of COVID-19 infection. There were no significant differences in incidence by treatment arm or vaccination in univariate analysis. Participants with new onset T2DM had a higher baseline BMI (OR 1.08, 95% CI 1.03 to 1.13), and were more likely to report weight gain between the start of the pandemic and their first infection and more likely to report difficulty sleeping, OR 1.04 (95% CI 1.01 to 1.07) and OR 2.86 (95% CI 1.16 to 7.06), respectively. Multivariate analysis is pending.
Conclusions: Patients with higher BMIs at baseline, those who gained weight between the onset of the pandemic and their first COVID-19 infection, or had difficulty sleeping were more likely to develop T2DM. Covid treatment with metformin, ivermectin, and fluvoxamine and vaccination status were not significant predictors of new T2DM.

Disclosure
J.M.Nicklas: None. E.J.Lemus wirtz: None. T.A.Murray: None. D.Liebovitz: None. S.Fenno: None. B.Anderson: None. N.Avula: None. N.Reddy: None. C.Bramante: None.

Funding
Rainwater Foundation; Parsemus Foundation; United Health Foundation; National Center for Advancing Translational Sciences (KL2TR002492, UL1TR002494); National Institute of Diabetes and Digestive and Kidney Diseases (K23DK124654-01-A1); National Heart, Lung, and Blood Institute (K23HL133604)
129-OR: Effect of Tirzepatide on the Counterregulatory Response to Hypoglycemia during a Hypoglycemic Clamp in People with Type 2 Diabetes
Authors: PIEBER THOMAS , SVEHLIKOVA EVA , URVA SHWETA , HAUPT AXEL , ZHOU CHUNMEI , COSKUN TAMER , MILICEVIC ZVONKO , PRATT EDWARD J. 
Published: June 2023

We explored the effects of tirzepatide (TZP) on counter-regulatory response during a hypoglycemic clamp. Patients with type 2 diabetes (N=42) were randomized to TZP (15 mg) or placebo (PBO) for 12 wk, in a crossover design, with a wash-out period of 8 to 12 wk. The primary objective was the change in glucagon (GCG) during clamp-induced hypoglycemia (HG) from plasma glucose (PG) 100 mg/dL to nadir PG (45 mg/dL). Secondary measures were changes in other counter-regulatory hormones, insulin, and C-peptide during clamp-induced HG and PG recovery from nadir PG to 72 mg/dL. Time to recovery and HG symptom scores were assessed. At 12 wk, HbA1c change from baseline was -1.5% with TZP vs +0.5% with PBO. Increases in GCG from PG 100 mg/dL to nadir PG and during recovery did not differ between treatments (p=0.756 and p=0.565, respectively) (Table). Growth hormone and adrenaline responses did not differ between treatments, while increases in cortisol and noradrenaline responses were delayed with TZP, which explains a lower HG symptom score with TZP vs PBO at nadir (p=0.007). The proportion of patients aware of HG did not differ between treatments. Mean time to recovery from HG was 47 min with TZP and 43 min with PBO (p=0.002); however, nadir PG was lower with TZP (44 vs 47 mg/dL; p=0.015). In conclusion, the response of glucagon to hypoglycemia is maintained with TZP.

Disclosure
T.Pieber: Advisory Panel; Arecor, Novo Nordisk A/S, Consultant; Lilly, Research Support; AstraZeneca, Novo Nordisk A/S, Sanofi, Speaker's Bureau; Roche Diagnostics. E.Svehlikova: Other Relationship; Mylan. S.Urva: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A.Haupt: Employee; Lilly, Stock/Shareholder; Lilly. C.Zhou: Employee; Eli Lilly and Company. T.Coskun: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Z.Milicevic: Employee; Eli Lilly and Company. E.J.Pratt: Employee; Eli Lilly and Company.

Funding
Eli Lilly and Company
1298-P: Independent Associations of GAD65, IA2, and ZnT8 Autoantibody (Ab) Positivity with C-Peptide (CPep) in a Diverse Cohort of Youth with Diabetes (DM)
Authors: REDONDO MARIA J. , HARRALL KYLIE K. , GLUECK DEBORAH H. , TOSUR MUSTAFA , UYSAL SERIFE , MUIR ANDREW , VEHIK KENDRA , BRUSKO TODD M. , ATKINSON MARK A. , ORAM RICHARD A. , DABELEA DANA , HAGOPIAN WILLIAM ,   DISCOVER STUDY GROUP
Published: June 2023

The current DM classification does not fully enable precision medicine in DM due to heterogeneity between and within DM types, especially in racially diverse populations. Insulin deficiency (ID) is one of the most clinically actionable DM outcomes and, while its association with islet autoimmunity is known, the influence of Ab type and number after DM onset is uncertain. Thus, we assessed the effect of Ab characteristics on ID (measured as Cpep loss) in youth with established DM. We studied 151 youth with DM (median [IQR] age 15.0 [4.2] yrs, DM duration 5.4 [3.4] yrs), 61% female, 53% Hispanic and 17% non-Hispanic African American. We measured postprandial serum Cpep, glucose and Ab (GAD65, IA2 and ZnT8) and collected clinical/demographic data. Cpep loss was pre-specified as postprandial CPep &lt;0.6 ng/ml. We found 0, 1, 2, or 3 +Ab in 34%, 22%, 31% and 13% of participants, respectively (Figure, left panel). A Breslow-Day statistic suggested homogeneity of the risk ratios across the 3 Ab types for CPep loss (p = 0.42), which were all larger than 1 (Figure, right panel). Cpep loss was significantly associated with ≥1 (vs 0) Ab+ (p &lt; 0.0001) but not with single (vs multiple) Ab+ (p = 0.60). In sum, each of GAD65, IA2 and ZnT8 Ab are significantly associated with ID among diverse youth with DM. This suggests that models predicting ID post-onset should include each of GAD65, IA2 and ZnT8 Ab.

Disclosure
M.J.Redondo: None. R.A.Oram: Consultant; Janssen Research & Development, LLC, Research Support; Randox R & D. D.Dabelea: None. W.Hagopian: Research Support; Janssen Research & Development, LLC, Provention Bio, Inc., Randox R & D. Discover study group: n/a. K.K.Harrall: None. D.H.Glueck: None. M.Tosur: Advisory Panel; Provention Bio, Inc. S.Uysal: None. A.Muir: None. K.Vehik: None. T.M.Brusko: Consultant; Repertoire Immune Medicines, Quell Therapeutics, Research Support; Immunocore, Ltd., Adaptive Biotechnologies. M.A.Atkinson: None.

Funding
National Institutes of Health (R01DK124395)
1331-P: Association of Short-Term and Long-Term Glycemic Variability and the Renal Complications in the ACCORD Trial
Authors: OKUNO TOMOKI , REAVEN PETER , ZHOU JIN 
Published: June 2023

Recent studies have shown that long-term and short-term glycemic variability (measured by low concentrations of the biomarker 1,5-anhydroglucitol (1,5-AG)) were associated with incident diabetes complications; yet, none have assessed their relative importance. Using the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, we measured 1,5-AG 12 months from randomization (when HbA1c was stable) in 4,000 randomly selected samples and assessed the risk of short-term and long-term glycemic variability for incident renal complications. The coefficient of variation of fasting glucose (CV-FG) was used to measure long-term variability. Primary outcomes were time (after 12 months) to 1) microalbuminuria and 2) macroalbuminuria. Risks were estimated using Cox proportional hazard models. Both CV-FG and lower 1,5-AG were independently associated with microalbuminuria even after adjusting for other risk factors (Table). Only CV-FG was a significant risk factor for macroalbuminuria. After adjusting for average glycemic control, the CV-FG association remained. Subgroup analysis indicated that CV-FG and 1,5 AG were more harmful in those receiving less intensive glucose control. The secondary outcome analysis supported the main conclusion (Table). This post hoc analysis indicates that long-term and short-term glucose variability may play a role in developing renal diseases in T2D.

Disclosure
T.Okuno: None. P.Reaven: Research Support; Dexcom, Inc. J.Zhou: None.

Funding
National Institutes of Health (R01HG006139, DMS-2054253, IIS-2205441, R21HL150374)
1335-P: The Association between Exposure to Famine in Early Life and Risks of Diabetic Complications in Adult Patients with Type 2 Diabetes in China
Authors: LIN CHU , CAI XIAOLING , JI LINONG 
Published: June 2023

Background: The historical origin for the T2D pandemic in China may lie in the 1959-1961 Chinese famine. This study is aimed to exam the associations between exposure to famine in early life and risks of diabetic complications in adult patients with T2D in China.
Method: The participants in this study were selected from China National HbA1c Surveillance System (2009-2013), and further stratified according to the birth year. The participants born in 1959-1961 were classified as fetal exposed group (70852 participants). The participants born in 1956-1959 were classified as infant/toddler exposed group (93616 participants). The participants born in 1962-1964 were classified as unexposed group (72723 participants). By using the logistic regression approach, we analyzed the association between exposure to famine in early life and risks of diabetic complications.
Results: As for diabetic complications, the adjusted model indicated that, compared with T2D without exposure to famine, the risks of coronary heart disease (fetal exposed: OR=1.254, 95%CI: 1.196-1.315; infant/toddler exposed: OR=1.343, 95%CI: 1.286-1.403), cerebrovascular disease (fetal exposed: OR=1.290, 95%CI: 1.200-1.388; infant/toddler: OR=1.342, 95%CI: 1.254-1.436) and diabetic retinopathy (fetal exposed: OR=1.083, 95%CI: 1.036-1.132) were significantly increased while the reduced risk of diabetic kidney disease (infant/toddler exposed:OR=0.885, 95%CI: 0.841-0.932) was observed in adult T2D patients with early-life exposure to famine.
Conclusions: Early-life exposure to famine in patients with T2D was associated with increased risks of coronary heart disease, cerebrovascular disease, diabetic retinopathy but reduced risks of diabetic kidney disease in adulthood. Improving early-life nutritional status may promote better risk prevention and management of diabetic complications and comorbidities in patients with T2D.

Disclosure
C.Lin: None. X.Cai: None. L.Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck & Co., Inc., Bayer Inc., Sanofi-Aventis U.S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics.

Funding
National Natural Science Foundation of China (81970698, 81970708); Beijing Natural Science Foundation (7202216)
134-OR: Associations of Growth Hormone (GH) Mediators with Loss of Glycemic Control in Youth with Type 2 Diabetes (T2D)
Authors: LU CHANG , WOLFS DANIELLE , EL GHORMLI LAURE , LAFFEL LORI M. , PATTI MARY-ELIZABETH , ISGANAITIS ELVIRA M. 
Published: June 2023

T2D in youth has a more severe phenotype than in adults, with puberty as a potential contributor to this difference. Pubertal changes in GH mediators (e.g., insulin-like growth factor 1 (IGF-1), growth hormone receptor (GHR), insulin-like growth factor binding protein 1 (IGFBP-1)) may impact insulin sensitivity and beta cell function. We examined associations of GH mediators with loss of glycemic control in youth with T2D using the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort (N= 310). We performed paired comparison of plasma concentrations of IGF-1, GHR, and IGFBP-1 (ELISA), between 0mo and 36mo based on TODAY primary outcome of loss of glycemic control vs. maintained glycemic control (LGC vs MGC), with LGC defined as HbA1c ≥ 8% for 6 months and/or insulin dependence. We studied associations of GH mediators with HbA1c, insulinogenic index, oral disposition index, and 1/fasting insulin. Models were adjusted for age, sex, race, treatment arm, and baseline HbA1c (linear regression). Mean plasma IGF-1 (ng/mL) was lower in LGC group at 0mo (LGC: 451 ± 141, MGC: 485 ± 155, p = 0.04), and at 36mo (LGC: 340 ± 117, MGC: 400 ± 136, p&lt; 0.0001). Increase in IGF-1 between 0-36mo predicted lower HbA1c at 36mo (B = -3.2E-3, SE = 9.0E-4, p &lt; 0.001). Higher GHR was associated with higher HbA1c (B = 1.2E-2, SE = 3.0E-3, p &lt; 0.001) and lower 1/fasting insulin (B = -6.6E-4, SE = 2.1E-4, P &lt; 0.01) at 0mo. Increase in GHR between 0-36mo predicted higher 36mo HbA1c (B = 3.0E-2, SE = 9.4E-3, p &lt; 0.01). IGFBP-1 was positively associated with 1/fasting insulin at 0m (B = 1.1E-3, SE = 4.9E-4, p = 0.03). In exploratory analyses stratified by Tanner stage (TS) at study entry, GH mediators changed differentially between TS 1-3 (n = 31) vs TS 4-5 (n = 274). In conclusion, GH mediators differed based on primary outcome in TODAY, and were associated with HbA1c and insulin sensitivity. Whether changes in GH mediators contribute to, or are the result of, changes in glucose metabolism is a key area for future studies.

Disclosure
C.Lu: None. D.Wolfs: None. L.El ghormli: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. M.Patti: Consultant; MBX Biosciences, AstraZeneca, Hanmi Pharm. Co., Ltd., Other Relationship; Fractyl Health, Inc. E.M.Isganaitis: None.

Funding
National Institutes of Health (2T32DK007260-46); National Institute of Diabetes and Digestive and Kidney Diseases (5U01DK061230-16)
1343-P: Decreasing Lifetime Prevalence of Diabetes-Related Foot Ulcers over 25 Years—Longitudinal Analyses of the Trøndelag Health Study (HUNT), Norway
Authors: RIISE HILDE K.R. , IGLAND JANNICKE , GRAUE MARIT , HAUGSTVEDT ANNE , OSTBYE TRULS , SØFTELAND EIRIK , HERMANN MONICA , CARLSSON SOFIA , ÅSVOLD BJØRN O. , IVERSEN MARJOLEIN M. 
Published: June 2023

Background and objectives: Data on time trends in diabetes-related foot ulcer (DFU) prevalence are limited. We aimed to determine trends in the lifetime prevalence of DFU in the Trøndelag Health Study (HUNT) conducted in three waves between 1995 and 2019.
Research Design and Methods: This longitudinal population-based study consists of individuals ≥20 years with diabetes who participated in at least one of the three HUNT surveys from 1995-2019. Type 2 diabetes was defined as glutamic acid decarboxylase antibodies (GADA) &lt;5 IU/mL (&lt;0.09 ai) and age at diagnosis ≥30 years. Type 1 diabetes was defined as GADA ≥5 IU/mL (≥ 0.09 ai) and/or age at diagnosis &lt;30 years. We used the following question to assess prevalence of DFU: “Have you had a foot ulcer that required more than three weeks to heal?”. The lifetime prevalence of DFUs was evaluated using cross-sectional data.
Results: The total diabetes population was 1630 in HUNT2, 1824 in HUNT3 and 2393 in HUNT4. Approximately 85% of the participants had type 2 diabetes. Among those with type 2 diabetes, the lifetime prevalence (95% confidence interval (CI)) of a DFU requiring three or more weeks to heal was 10.1% (8.5-11.8) in HUNT2, 7.4% (6.2-8.8) in HUNT3 and 5.0% (4.1-6.0) in HUNT4. Corresponding numbers in those with type 1 diabetes were 14.9% (11.1-19.8), 8.5% (5.4-13.3) and 7.2% (4.8-10.5), respectively. The decline in DFU prevalence persisted after adjusting for age, sex, educational level, marital status, work situation, body mass index, systolic blood pressure, smoking, and HbA1c.
Conclusion: The results of this longitudinal population-based study suggest that the lifetime prevalence of DFUs in Norway has declined substantially during the past 25 years.

Disclosure
H.K.R.Riise: None. M.M.Iversen: None. J.Igland: Research Support; Pfizer Inc., Sanofi. M.Graue: None. A.Haugstvedt: Advisory Panel; Novo Nordisk. T.Ostbye: None. E.Søfteland: None. M.Hermann: None. S.Carlsson: None. B.O.Åsvold: None.

Funding
Western Norway Regional Health Authority (F-12131)
1345-P: Proinsulin–to–C-Peptide Ratio Is Associated with the Time above the Target Glucose Range and the Duration of Type 2 Diabetes
Authors: MIYA AIKA , NAKAMURA AKINOBU , NOMOTO HIROSHI , KAMEDA HIRAKU , ATSUMI TATSUYA 
Published: June 2023

Background: The proinsulin-to-C-peptide (PI:C) ratio is thought to be an index of pancreatic β-cell dysfunction, and in subjects with prediabetes and type 2 diabetes (T2DM), abnormally high PI:C ratios have been identified. In the present study, we investigated the relationships of the duration of diabetes and glucose variability in subjects with T2DM with the PI:C ratio.
Methods: We performed a prospective observational study of 272 Japanese outpatients with T2DM who underwent blinded professional continuous glucose monitoring (CGM) and fasting blood sample collection. Their fasting PI:C ratio and CGM-related indices were calculated. After placing all the participants into four groups on the basis of quartile (Q) of diabetes duration (Q1 &lt;8 years, Q2 8-13 years, Q3 14-21 years, Q4 ≥22 years), the characteristics associated with PI:C ratio were identified. All of the statistical tests were two-sided and P&lt;0.05 was considered to indicate statistical significance.
Results: The mean age of the cohort was 68.0 years, their mean HbA1c 7.1%, and their mean body mass index (BMI) 24.9 kg/m2. High PI:C ratio was associated with a short duration of diabetes (P&lt;0.001). In each group, there was a positive correlation between PI:C ratio and the time above the target glucose range (TAR; &gt;180 mg/dL) in Q1, Q2, and Q3. The closest correlation between PI:C ratio and TAR was found for Q1 but there was no significant correlation for Q4 (Q1: ρ=0.38, P=0.003; Q2: ρ=0.28, P=0.019; Q3: ρ=0.24, P=0.045; Q4: ρ=0.03, P=0.811).
Conclusions: We have shown that the PI:C ratio was positively associated with TAR in subjects with a short duration of T2DM. Given that insufficient pancreatic β-cell function and hyperglycemia is closely related, the PI:C ratio may play a role as the index of pancreatic β-cell dysfunction in subjects with a short duration of T2DM, but not in those with long-standing T2DM.

Disclosure
A.Miya: None. A.Nakamura: Research Support; Abbott Japan Co., Ltd., Boehringer Ingelheim Japan, Inc., Daiichi Sankyo, Taisho Pharmaceutical Holdings Co., Ltd., Teijin Pharma Limited, Kowa Company, Ltd., Mitsubishi Tanabe Pharma Corporation. H.Nomoto: Speaker's Bureau; Novo Nordisk, Sumitomo Pharma, Co., Ltd. H.Kameda: None. T.Atsumi: Speaker's Bureau; Eli Lilly Japan K.K., Kowa Company, Ltd.

Funding
Japan Society for the Promotion of Science (22K17766)