bluuebunny/crossref_metadata_2025_split huggingface dataset:
57-LB: The Real-World Study of 2+N System Therapy in Remission of Type 2 Diabetes
Authors: ZENG KEJING , LI HEJUN , SONG YINGYING , YANG YIN , HUANG YALI , XU GUGEN 
Published: June 2023

Background: Type 2 diabetes mellitus (T2DM) has been considered as a chronic disease which requires long-term treatment with hypoglycemic drugs. However, recent clinical studies have shown that comprehensive lifestyle intervention can effectively reduce body weight and alleviate T2DM, which become a new strategy and the latest clinical practice for the treatment of T2DM.
Objective: Our team has applied the first and exclusive "2+N system therapy", (Integrated traditional Chinese and Western medicine combined with nutrition, psychology and lifestyle comprehensive interventions) to obese and type 2 diabetes patients since 2015. This study aims to summarize the real-world efficacy of 2+N system therapy in alleviating type 2 diabetes.
Method: The clinical data of 1086 patients with T2DM who were treated with 2+N systematic therapy in the Second People's Hospital of Guangdong Province from 2015 to 2022 were analyzed by self-control method, and the clinical data of patients before and after treatment (3 and 6 month) were observed. Results: After 3 months of 2+N system therapy intervention, body weight, BMI, waist circumference, hip circumference, HbA1c, lipid indexes (TC, TG, LDL-c), uric acid, HOMA-IR, area under OGTT curve were all decreased (P&lt;0.05). The area under the curve of HDL-c, HOMA-β were increased (P&lt;0.05). After 6 months, the metabolic indexes were further improved, the body weight and BMI were decreased by (9.18±4.33)kg and (3.22±1.45)kg/m2, respectively, and T2DM remission rate reached to 88.4%. MR analysis further showed that the liver and pancrease fat deposit rate both were decreased. Conclusions: In T2DM patients, 2+N system therapy can effectively reduce body weight, improve metabolic indexes and β cell function, and finally achieve T2DM remission.

Disclosure
K. Zeng: None. H. Li: None. Y. Song: None. Y. Yang: None. Y. Huang: None. G. Xu: None.

Funding
National Natural Science Foundation of China (81902004, 52203206); Natural Science Foundation of Guangdong Province (2023.1.1-2025.12.31 to K.Z.)
572-P: Transition Survey of Adult Diabetes Education Centers in Ontario, Canada
Authors: VARGHESE AKSHAY , ALCAIDE AMANDA , LAPIER HEATHER V.M. , YANG SABRINA , SPAIC TAMARA 
Published: June 2023

Young adults with type 1 diabetes face many physiological and psychological issues in adolescence, which negatively impact glycemic control and long-term health outcomes. Dedicated transition programs facilitating the transition from pediatric to adult care have shown favourable outcomes with regards to clinic follow-up, glycemic control, and diabetes-related complications. In Ontario, Canada, it is unclear how transition programs are implemented given the lack of formal processes. Our study surveyed adult diabetes education centers in Ontario with the goal of identifying current availability and characteristics of various transitional programs, while exploring perspectives on transitional practices, clinical experiences, and barriers. There were 53 (20.2%) diabetes education centers that participated in our survey. Majority respondents were females (n=50, 94%), between age 40-50 years (n=21, 40%), identifying as a nurse or dietitian (n=35, 66%), working in a community setting (n=43, 81%). Only 25% (n=13) of respondents identified a transition program in their center, however 30.2% (n=16) provided care to both pediatric and adult patients. Where no transition programs were available, the main reason was low perceived importance and/or need (n=22, 41.5%). A lack of guidelines on what program to adopt in addition to lack of personnel and financial resources were the main barriers reported. Where transition programs were available they included education materials (n=9, 17%) and a joint clinic between pediatric and adult care (n=5, 9.4%). Only 5.7% (n=3) respondents identified a designated transitional coordinator. Almost a third of respondents (n=15, 28.3%) noted that the most common referral method was from the emergency room or following a hospitalization, rather than from a pediatric-based program (n=9, 17%). Despite a greater awareness of transition issues over the last decade, the use of structured transition programs requires further improvement across the province of Ontario, Canada.

Disclosure
A.Varghese: None. A.Alcaide: None. H.V.M.Lapier: None. S.Yang: None. T.Spaic: Advisory Panel; Sanofi, Research Support; Novo Nordisk, Lilly, Speaker's Bureau; Dexcom, Inc.
574-P: A Ketogenic Diet Improves Aerobic Capacity in Hyperglycemic Mice by Sex-Dependent Mechanisms
Authors: PATTAMAPRAPANONT PATTARAWAN , FORMATO MIA , NOGUEIRA SOARES ROGERIO , LESSARD SARAH J. 
Published: June 2023

Hyperglycemia is associated with lower aerobic exercise capacity (VO2peak) in humans and rodent models. We tested whether reducing blood glucose levels with a dietary intervention can restore VO2peak in hyperglycemic mice. Male and female CD-1 mice were injected with low dose streptozotocin (STZ) to induce moderate hyperglycemia (&gt;200 mg/dL). Hyperglycemic mice were randomized to receive a standard diet (STZ-CHOW) or a ketogenic diet (STZ-KETO). KETO significantly reduced blood glucose in STZ-treated mice. Next, both groups underwent similar volumes of exercise training by voluntary wheel running, or remained sedentary for 8 wks. In males, VO2peak during maximal exercise testing was similar in sedentary mice, regardless of diet. However, with training, VO2peak was significantly improved in STZ-KETO, but not STZ-CHOW males (see Figure). In females, KETO significantly increased VO2peak in sedentary mice, with no additional increase in response to training. Improved VO2peak with KETO in females was associated with a 50% increase in skeletal muscle mitochondrial ATP synthase protein. In contrast, ATP synthase was not regulated by diet in males. Our data demonstrate that a ketogenic diet can improve VO2peak in mice with hyperglycemia. In males, improved VO2peak with KETO was exercise-dependent, while in females, the beneficial effects of KETO on VO2peak and mitochondrial content were exercise-independent.

Disclosure
P.Pattamaprapanont: None. M.Formato: None. R.Nogueira soares: None. S.J.Lessard: None.
586-P: Light Physical Activity Prevents the Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes
Authors: OSAKA TAKAFUMI , OKADA HIROSHI , FUKUI MICHIAKI 
Published: June 2023

Background and aim: Diabetic nephropathy is one of the most important complications of diabetes mellitus. In recent years, aerobic exercise has been reported to be potentially effective in preventing nephropathy. However, the relationship with light physical activity (LPA), activities of daily living, is not clear. In this study, we researched the effect of LPA assessed by tri-axial acceleration sensors on the progression of nephropathy in patients with type 2 diabetes
Materials and methods: We analyzed retrospectively the cohort study of type 2 diabetic patients (T2DM) with urinary albumin-to-creatinine ratio (UACR) under 300 mg/gCr who visited Ayabe City Hospital from April 2018 to March 2020 and were observed until May 2022. The progression of nephropathy was defined as an increase in the category of diabetic nephropathy. LPA time was measured using a tri-axial accelerometer ActiGraph GT3X-BT instructed to use the accelerometer for 7 days, except while bathing and sleeping. LPA was defined as 100-1,952 counts per min. Hazard ratio of LPA for the progression of nephropathy was calculated by Cox hazard model after adjusting by age, gender, BMI, hemoglobin A1c (HbA1c), smoking states, alcohol consumption, use of renin-angiotensin system inhibitor at baseline.
Results: 167 patients (109 men) including 132 with stage1 and 35 with stage 2, mean age, body mass index, HbA1c, UACR, LPA and median observation period were 72.1 ± 12.3 years, 23.4 ± 3.4 kg/m2, 7.6 ± 0.9 %, 56.8 ± 137.4 mg/gCr, 305.6 ± 85.5 minutes/day and 1246 (406-1283) days. During follow-up, progression of nephropathy was observed in 39.5 % (66/167). The adjusted hazard ratio of LPA per 1 hour of progression of nephropathy was 0.81 (95% confidence interval 0.67-0.98, P = 0.031).
Conclusion: Patients with T2DM with low LPA were shown to be at higher risk of developing diabetic nephropathy. This suggests that increasing activities of daily living in patients with T2DM is important in terms of preventing diabetic nephropathy.

Disclosure
T.Osaka: None. H.Okada: None. M.Fukui: None.
592-P: Exercise Training and a Chow Diet Improve High-Fat Diet (HFD)–Induced Metabolic Disorders via Different Pathways in Female Mice
Authors: ZHU LIN , AN JULIA , LITTS BRIDGET , ATZRODT CASSANDRA L. , STAFFORD JOHN M. 
Published: June 2023

Understanding the mechanism by which healthy diet or exercise training improves metabolic outcomes is crucial to developing therapeutic targets for obesity-associated diseases. In this study, female mice were fed a high-fat diet (HFD) for 12 weeks and divided into 4 groups of lifestyle interventions that followed for 6 weeks: a. HFD; b. diet-change to chow; c. HFD+exercise; d. diet-change+exercise. Age-matched mice continuously fed a chow diet served as controls. An oral glucose tolerance test was performed 48 hours after the final exercise session. HFD induced obesity, dyslipidemia, fatty liver, and impaired glucose tolerance, which were completely reversed by diet-change. Exercise alone did not change obesity but partially improved glucose tolerance and fatty liver. The increased daily energy intake caused by HFD feeding was corrected by diet-change while exercise alone increased the energy expenditure and decreased RQ. Western blotting showed that HFD decreased pAKT, pAMPKβ, Glut4, and proteins involved in β-oxidation pathways in skeletal muscles compared to controls, which was reversed by diet-change alone. Exercise training alone partially reversed pAKT and Glut4 but significantly increased proteins in β-oxidation pathways compared to controls and the diet-change group. Exercise and diet-change in combination improved metabolic outcomes similarly to diet-change alone. RNAseq of visceral adipose tissue showed that HFD modified multiple canonical pathways. Among those pathways, 1) Ca+, G-protein coupled receptor, and hepatic fibrosis signaling were reversed by diet-change and exercise training alone; 2) cAMP-mediated and ILK signaling were reversed by diet-change alone; and 3) PKA signaling was reversed by exercise training alone. Further analysis of those pathways showed several genes that were modified by HFD and reversed by all three lifestyle interventions, which could be potentially targeted for improving metabolic diseases.

Disclosure
L.Zhu: None. J.An: None. B.Litts: None. C.L.Atzrodt: None. J.M.Stafford: None.

Funding
National Institutes of Health (DK109102, HL144846, AG077038); U.S. Department of Veterans Affairs (BX005459-01)
597-P: Effects of Exercise Interventions on Blood HbA1c and Lipid Concentrations in Healthy Pregnant Women—The FitMum RCT
Authors: JENSEN IDA K.B. , ROLAND CAROLINE B. , KNUDSEN SIGNE P. , JESSEN ANNE D. , ALOMAIRAH SAUD A. , MORTENSEN OLE H. , FRIIS-HANSEN LENNART J. , BENDIX JANE M. , MOLSTED STIG , STALLKNECHT BENTE , CLAUSEN TINE D. , LØKKEGAARD ELLEN 
Published: June 2023

Concentrations of maternal glucose and lipid during pregnancy affect both fetal growth and the risk of pregnancy complications. The aim of this study was to investigate the effect of two different exercise interventions on maternal blood HbA1c and lipid concentrations. Healthy pregnant women (n=219) were enrolled in the study at gestational age ≤15+0 weeks and randomized 2:2:1 to supervised exercise sessions three times per week, to a motivational group having seven counselling sessions on physical activity, or to standard care. Venous blood samples were drawn at 6+4 to 15+0 weeks, at 28+0-6 weeks, at 34+0-6 weeks and at delivery. HbA1c, total cholesterol, LDL-C and triglyceride concentrations were measured by standard biochemical methods and compared within and between groups using constrained linear mixed models. No differences in HbA1c or lipid concentrations between the groups were detected (Figure 1). Overall, HbA1c decreased from ≤15+0 to 28+0-6 weeks (p&lt;0.001) and increased from ≤15+0 to 34+0-6 weeks (p=0.032). Overall, total cholesterol, LDL-C and triglyceride concentrations increased throughout pregnancy (all p&lt;0.001 for ≤15+0 weeks vs. 28+0-6 weeks, 34+0-6 weeks and delivery). Exercise interventions did not affect maternal HbA1c or lipid concentrations during pregnancy. The overall pattern of changes during pregnancy resembled findings from previous studies.

Disclosure
I.K.B.Jensen: None. B.Stallknecht: None. T.D.Clausen: None. E.Løkkegaard: None. C.B.Roland: None. S.P.Knudsen: None. A.D.Jessen: None. S.A.Alomairah: None. O.H.Mortensen: None. L.J.Friis-hansen: None. J.M.Bendix: None. S.Molsted: None.
60-LB: Social Media as a Last Resort—Barriers to Accessing Diabetes Medications and Supplies
Authors: HAREL SHIRAZ , WILCOX ANNABELLE , LUKASIK JAMES , SUTTIRATANA SAKINAH C. , LIPSKA KASIA J. , WEINZIMER STUART A. , GUJRAL JASMINE , NALLY LAURA M. 
Published: June 2023

Introduction: To address the rising costs of insulin and diabetes supplies, many people with diabetes (PWD) have sought support from social media (SM). We describe the impact on and individual experiences of PWD who have reached out to SM for diabetes medications and supplies.
Methods: We conducted a qualitative cross-sectional descriptive study of PWD or their caregivers who have used SM to obtain diabetes medications and/or supplies. Participants (18+ yrs) were recruited through SM by self-reported use of SM to obtain diabetes support. Interviews were transcribed, coded, and emerging patterns were combined into descriptive content categories. Analyses were conducted using a consensus model approach.
Results: Thirty individuals (27+/- 8 yrs, 87% F, 63% NHW) were interviewed, including 5 caregivers of PWD. Five main themes emerged from the data (Table). Health insurance and affordability were the most commonly reported barriers. Most respondents changed their diabetes management (e.g. rationed) as a result, and financial and medical consequences were common.. All interviewees reported fear for their or their child’s health and safety.
Conclusion: This study describes broad barriers to accessing diabetes medications and supplies, leading to potentially harmful compensatory behaviors and psychological distress. Healthcare reform is needed to improve access to these lifesaving medications and supplies.

Disclosure
S. Harel: None. A. Wilcox: None. J. Lukasik: None. S. C. Suttiratana: None. K. J. Lipska: Other Relationship; UpToDate. S. A. Weinzimer: Consultant; Zealand Pharma A/S, Other Relationship; Abbott Diabetes, Zealand Pharma A/S, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. J. Gujral: None. L. M. Nally: Research Support; Novo Nordisk, Medtronic, Dexcom, Inc.

Funding
None
604-P: Effects of the OPTIFAST (OP) Total and Partial Meal Replacement Program (MRP) on Weight and Glycemic Outcomes in Adults with Normoglycemia (NG) or Dysglycemia—Exploratory Analysis of the OPTIWIN Study
Authors: ROTHBERG AMY E. , ARD JAMY D. , DAR MOAHAD , LOPER JUDY , HAWKINSON ANDREA H. , COHEN SARAH S. , ERIK JOHANSEN ODD 
Published: June 2023

Weight loss improves glycemia. We performed exploratory analysis of an RCT using the OP (n=135) MRP vs food-based (FB) diet (n=138), that showed significant weight loss at week (W) 26 (reduction phase) and W52 (maintenance), to evaluate potential differential glycemic/weight effects by glycemic status (NG: no type 2 diabetes [T2D], HbA1c &lt; 5.7%, and FPG &lt; 100 mg/dL, or dysglycemia: prediabetes or T2D). We assessed changes in anthropometrics and glycemia using a linear and logistic (Odds Ratio [OR]) mixed effects model. Baseline (BL) characteristics were similar within the OP/FB subgroups, but the NG (n=134) vs dysglycemia (n=139) group were slightly younger (mean age 44/50 yrs) and had a lower HbA1c (5.4/6.1%). FPG and HbA1c decreased at W26 within both groups (Table), with a differential effect for FPG favoring OP in those with NG. At W52, the pattern was similar, but with smaller reductions. Weight loss was numerically greater with OP vs FB in those with dysglycemia vs NG at both W26 and W52; ORweight loss ≥10% W26: 5.80 (2.62, 12.86), p&lt;0.0001 vs NG: 3.36 (1.58, 7.15), p=0.002; ORweight loss ≥10% W52: 4.26 (1.85, 9.83), p=0.001 vs NG: 2.08 (0.97, 4.47), p=0.06). Although both groups significantly lost weight, those with dysglycemia at BL had greater weight loss and the higher protein content in the OP MRP may play a role.

Disclosure
A.E.Rothberg: None. J.D.Ard: Advisory Panel; Novo Nordisk, Consultant; Eli Lilly and Company, Intuitive Surgical, Regeneron, Other Relationship; Optum Labs, Weight Watchers International, Research Support; Nestlé Health Science, Boehringer Ingelheim Inc., Epitomee, KVK Tech. M.Dar: None. J.Loper: Advisory Panel; Nestlé Health Science. A.H.Hawkinson: Employee; Nestlé Health Science. S.S.Cohen: Consultant; Nestlé Health Science. O.Johansen: Employee; Nestlé Health Science.

Funding
Nestlé Health Science
609-P: Postprandial GLP-1 Response to Two Diabetes-Specific Formulas Compared with Instant Oatmeal in Adults With Type 2 Diabetes
Authors: THOMAS SARA , BESECKER BETH , CHOE YONG 
Published: June 2023

Diabetes specific formulas (DSFs) are designed with an optimized macronutrient profile as a meal or snack replacement to meet the nutritional needs of people with diabetes while helping to manage blood glucose response. Macronutrients found in DSFs have been shown to promote glucagon-like peptide-1 (GLP-1) secretion, a key hormone involved in regulating incretin response to manage blood glucose levels during the postprandial period. We tested the postprandial GLP-1 response in two randomized, controlled crossover studies in adults with T2D with two DSFs (DSF-1; Study 1, DSF-2; Study 2) varying in macronutrient composition compared to isocaloric instant oatmeal (IOM). In each study, participants were randomly allocated to receive IOM or the study DSF on two test days separated by 4 - 14 days. Total GLP-1 concentration was measured at baseline, 15, 30, 45, 60, 90, 120, 180, and 240 minutes after consumption. Outcome parameters included adjusted peak GLP-1 concentration, and positive area under the curve (pAUC) over 0 - 240 minutes for each participant. Respectively, Study 1 and Study 2 included 26 (n = 15 males, n = 11 females; mean age = 63.6 ± 1.4 years; mean BMI = 30.0 ± 0.9) and 22 (n = 14 males, n = 8 females; mean age = 64.6 ± 2.0 years; BMI = 32.8 ± 0.9) completed participants. Median (1st and 3rd quartile) adjusted peak GLP-1 concentration was significantly higher for DSF-1 (9.2 (6.4, 16.5) pmol/L vs. 3.7 (2.5, 9.0) pmol/L; p = 0.012) and DSF-2 (10.8 (7.5, 20.0) pmol/L vs. 6.3 (4.3, 9.4) pmol/L; p &lt; 0.001) compared to IOM. DSFs significantly increased pAUC for GLP-1 response (DSF-1: 901 (410, 1091) vs. IOM: 177 (47, 421); p &lt;0.001 and DSF-2: 1122 (682, 1820) vs. IOM: 403 (183, 778); p &lt; 0.001) by 410% and 178%, respectively. As part of a diabetes management plan, DSFs can serve as a convenient tool to meet nutritional needs while improving GLP-1 response to help manage blood glucose.

Disclosure
S.Thomas: Employee; Abbott Nutrition. B.Besecker: Employee; Abbott Nutrition, Stock/Shareholder; Abbott Nutrition. Y.Choe: Employee; Abbott Nutrition.
61-LB: Blood Pressure and Lipid-Lowering Medication Adherence in Young Adults with Youth-Onset Type 2 Diabetes and Hypertension or Dyslipidemia—The TODAY2 iCount Study
Authors: TRIEF PAULA M. , WEINSTOCK RUTH S. , BURKE BRIAN K. , WEN HUI , KALICHMAN SETH , BULGER JANE D. , ANDERSON-THOMAS BARBARA J. 
Published: June 2023

Youth-onset type 2 diabetes (T2D) is associated with early development of vascular complications. Treatment of hypertension and dyslipidemia are critical to reduce morbidity. iCount examined adherence to blood pressure (BP) and lipid-lowering medications in young adults with youth-onset T2D (mean age 26 y, duration of T2D 12 y, BMI 37 kg/m2) and hypertension/nephropathy (n=196) or dyslipidemia (n=146) during the observational phase of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY)2 study (2017-2019). They were receiving diabetes care in their communities. Adherence was assessed with 3 monthly unannounced phone pill counts at 2 times 1 year apart. Percent low adherent (&lt;80% pill-taking) and high-adherent (≥80% pill-taking) did not change over time. Of participants with hypertension and/or nephropathy, 80.1% were low adherent, 19.9% were high adherent. Those who were low adherent had fewer years of education (p=0.004), higher HbA1c (p=0.001) and shorter diabetes duration (p=0.031). Of those with dyslipidemia, 93.8% were low adherent, 6.2% high adherent. Those low adherent to BP (p&lt;0.001) and lipid-lowering (p≤0.008) medications were also low adherent to oral hypoglycemic medications or insulin. Beliefs that medications are necessary were lower for those low adherent to BP and lipid-lowering medications (unadjusted analyses); concerns about medications also were lower for those low adherent to lipid-lowering medications. In adjusted multivariable analyses of participants with hypertension or nephropathy, having ≥1 material need insecurity predicted medication adherence 1 year later (p=0.010). Belief about medicines, diabetes distress, self-efficacy, depressive and anxiety symptoms, and self-management support were not 1 yr predictors of medication adherence. To prevent early vascular events, approaches that further identify and address unmet needs should be studied.

Disclosure
P. M. Trief: None. R. S. Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. B. K. Burke: None. H. Wen: None. S. Kalichman: None. J. D. Bulger: None. B. J. Anderson-thomas: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)