bluuebunny/crossref_metadata_2025_split huggingface dataset:
611-P: Direct and Indirect Pathways between Food Insecurity and Glycemic Control in Adults with Diabetes
Authors: WALKER REBEKAH J. , AMJAD RABIA , EGEDE LEONARD E. 
Published: June 2023

Background: Extensive research has identified food insecurity as a driver of poor glycemic control in adults with diabetes. The goal of this study was to investigate the direct and indirect relationships between food insecurity and glycemic control, focusing on three possible pathways: body composition, anthropometrics, and healthy eating.
Methods: Using national US data collected through the 2011-2018 National Health and Nutrition Examination Survey (NHANES), we created measures for body composition (total fat, total lean, fat mass index, lean mass index), anthropometrics (body mass index, waist circumference) and healthy eating index (food group component scores and overall HEI score). Food insecurity was scored based on the standard USDA scale, glycemic control was continuous HbA1c, and diabetes was based on self-report. Structural equation modeling using Stata v17 was used to investigate direct and indirect relationships in a sample of adults with diabetes. Total lean, waist circumference, and overall HEI score served as indicators for each of the three possible pathways based on preliminary correlations that found these as the strongest relationships for each category.
Results: The final model was well fit (RMSEA=0.00, CFI=1.0, pclose 1.0) and showed higher food insecurity was directly associated with higher HbA1c (B=0.09, p&lt;0.001) and indirectly associated through waist circumference and HEI score (B=0.008, p&lt;0.001) in adults with diabetes. Food insecurity was significantly associated with higher waist circumference (B=0.07, p&lt;0.001) and lower healthy eating (B=−0.09, p&lt;0.05). Higher waist circumference (B=0.03, p&lt;0.001) and lower healthy eating (B=−.06, p&lt;0.05) were significantly associated with higher HbA1c. Body composition was not a significant pathway.
Conclusions: Waist circumference and overall healthy eating index are significant pathways through which food insecurity is associated with worse glycemic control in adults with diabetes.

Disclosure
R.J.Walker: None. R.Amjad: None. L.E.Egede: None.

Funding
National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)
616-P: Glucose Metabolism—Does Chronotype Matter?
Authors: DE AMICIS RAMONA , FOPPIANI ANDREA , LEONE ALESSANDRO , GALASSO LETIZIA , MONTARULI ANGELA , ROVEDA ELIANA , CASTELLI LUCIA , ESPOSITO FABIO , BERTOLI SIMONA , BATTEZZATI ALBERTO 
Published: June 2023

Glucose and insulin follow circadian-mediated metabolic profiles. Accumulating evidence has demonstrated significant associations between circadian disruption-related lifestyles and an increased risk of type 2 diabetes typical of Evening-types (E-types), more active in the last part of the day, compared to Morning-types (M-types). However, few studies have examined the contribution of chronotype to abnormalities of glucose profile considering both lifestyle factors and body composition. We conducted a cross-sectional study on 575 adults (71% females, 48.5±12.8 years, BMI 29.3±6.0 kg/m2) with no endocrine diseases and no consumption of medications affecting endocrine function. Chronotype was assessed through the reduced Morningness-Eveningness Questionnaire (rMEQ), glycemia, insulinemia and HbA1c plasma levels HOMA-IR were estimated. Anthropometric parameters were collected and abdominal fat distribution was measured by ultrasonography. Smoking and physical activity habits were collected by a medical history and adherence to Mediterranean diet was assessed by MEDAS questionnaire. Logistic regression models were used to investigate the association between glycemia, insulinemia and chronotype. Sex, age, BMI, total body fat, visceral and subcutaneous fat, physical activity, smoking habits and MEDAS were included in all models. Insulin levels were significantly higher in the E-Types compared to M-Types. We did not find a significant interaction between chronotype, glycemia and HbA1c, however insulin and HOMA-IR decreased with increasing rMEQ score and morningness, indicating that E-Types have +5,6 and +1,4 points of insulinemia and HOMA-IR, respectively, compared to M-Types (β=−0.28 [−0.5; −0.1], p=0.003; β=−0.07 [−0,12; −0,02], p=0.005). Chronotype is independently associated with abnormalities in insulin profile, pointing to the importance of understanding the mechanisms underlying the impact of circadian disruption on glucose metabolism, which may contribute to improved glycemic control.

Disclosure
R.De amicis: None. A.Battezzati: None. A.Foppiani: None. A.Leone: None. L.Galasso: None. A.Montaruli: None. E.Roveda: None. L.Castelli: None. F.Esposito: None. S.Bertoli: None.

Funding
Italian National Recovery and Resilience Plan Mission 4 Component 2 Investment 1.3 - Call for Proposals (341) of 15 March 2022 of Italian Ministry of University and Research funded by the European Union - NextGenerationEU (PE00000003) Concession Decree (1550) of 11 October 2022 adopted by the Italian Ministry of University and Research (CUP D93C22000890001)
617-P: Time in Range following Mealtime Protein Supplementation Is Predicted by Liver Health and ß-Cell Function in Adults with Type 2 Diabetes
Authors: SMITH KIERAN , TAYLOR GUY , WALKER MARK , BOWDEN DAVIES KELLY A. , STEVENSON EMMA J. , WEST DANIEL J. 
Published: June 2023

Background: Consuming mealtime whey protein supplementation increases daily time in euglycemic range [TIR] in adults with type 2 diabetes [T2D] with inter-individual responses. The present post-hoc analysis aimed to identify metabolic predictors to the effectiveness of pre-meal whey protein.
Methods: In a randomized-crossover design, 16 individuals with T2D [HbA1c 57±9 mmol/mol) underwent two 7d free-living periods where they consumed a whey protein (15g) or placebo beverage before each main meal. Glucose control was captured by blinded continuous glucose monitoring. Patient anthropometric and fasting markers of liver health and glucose metabolism were obtained at baseline. β-cell function was determined by the ratio of the incremental changes in insulin secretion to glucose during a feeding test. The relationship between TIR and clinical markers were analyzed by correlational analysis, and predictors of TIR were determined by multiple regression.
Results: β-cell function was a strong determinant to TIR during both the whey (rs=0.615; p=0.011) and placebo (rs=0.598; p=0.019) weeks. Around 76% of the variance in TIR during the whey week was accounted by β-cell function, and fasting insulin and alanine aminotransferase concentrations (adj R2=0.760; p&lt;0.001). During the whey intervention, TIR was inversely associated with aspartate aminotransferase (rs=−0.506; p=0.046) and tended to be related to fasting glucagon (rs=−0.482; p=0.058), whereas there were no associations between liver health or fasting hormonal markers with TIR during placebo (p&gt;0.05).
Conclusions: In a small cohort of people with T2D, our data indicates that those with compromised liver health and reduced β-cell function may experience a reduction in TIR when consuming mealtime protein supplementation. This is possibly due to disruptions in the liver-α-cell axis, which may be further aggravated by increasing plasma amino acid availability from protein supplementation.

Disclosure
K.Smith: None. G.Taylor: None. M.Walker: None. K.A.Bowden davies: None. E.J.Stevenson: None. D.J.West: None.

Funding
Francis James Bell Endowment Fund; County Durham Community Foundation
619-P: An Isocaloric High Saturated Fat Diet Increases Endogenous Cholesterol Production Which Is Reversed by a Protein-Enriched Diet in Normal-Weight Humans
Authors: KRUSE MICHAEL , MATYSIK SILKE , HOFFMANN DANIELA , FRAHNOW TURID , PFEIFFER ANDREAS F. 
Published: June 2023

Lathosterol is a marker of endogenous cholesterol synthesis whereas plant sterols (e. g. campesterol) reflect cholesterol absorption. Obesity and type 2 diabetes mellitus are associated with increased endogenous cholesterol production and decreased cholesterol absorption. Only few studies evaluated cholesterol homeostasis under isocaloric nutritional conditions. This study investigated endogenous cholesterol production in healthy humans after consumption of isocaloric diets enriched with carbohydrates (KH) or saturated fat (HF) or protein (HP). 24 normal weight participants (women and men, age 18 - 70) were investigated for 18 weeks. An isocaloric diet rich in carbohydrates (55% carbohydrates, 30% fat, 15% protein, KH) was applied followed by an isocaloric diet rich in saturated fat (40% carbohydrates, 45% fat, 15% protein, HF) and finally followed by an isocaloric diet enriched with proteins (45% carbohydrates, 30% fat, 25% protein, HP); each for 6 weeks. Body weight (BW), serum total and LDL cholesterol and serum lathosterol and campesterol levels were analyzed after the KH period, after one week (HF1) and 6 weeks (HF6) of the HF and after the HP period. BW did not change during the study. Serum total and LDL cholesterol increased from 4.38±0.2 and 2.74±0.2 mmol/L, respectively at KH to 4.82±0.2 and 2.97±0.2 mmol/L, respectively at HF6 (both P&lt;0.01) and were decreased back to KH levels at HP. Serum lathosterol levels increased 1.26-fold and 1.16-fold, respectively at HF1 and HF6 (P&lt;0.05 compared to LF), however decreased by 10.1% at HP (compared to KH levels, P&lt;0.05). Serum campesterol levels moderately decreased at HF1 and HF6 and were restored to KH levels at HP (P&lt;0.01 compared to HF6). These data show that composition of macronutrients are responsible for diet induced elevation of serum cholesterol levels due to an increased endogenous cholesterol production in normal weight humans regardless of the energy content of the diet.

Disclosure
M.Kruse: None. S.Matysik: None. D.Hoffmann: None. T.Frahnow: None. A.F.Pfeiffer: Advisory Panel; Abbott Diabetes, Speaker's Bureau; Novo Nordisk, Sanofi-Aventis Deutschland GmbH.

Funding
German Federal Ministry of Education and Research (0315424)
62-OR: Six Months Experience on Meal Announcement with Three Personalized Presets of Carbohydrates vs. Precise Carbohydrate Counting in Adolescents with Type 1 Diabetes Using the MiniMed 780G System
Authors: PETROVSKI GORAN , CAMPBELL JUDITH , HUSSAIN KHALID , PASHA MAHEEN F. , DIABETES GROUP SIDRA 
Published: June 2023

Objective: To compare six months glycemic control in adolescents with Type 1 Diabetes (T1D) on MiniMed 780G system that used simplified meal announcement to those that used precise carbohydrate counting.
Research Design and Methods: 34 participants (12-18 years) with T1D that initiated MiniMed 780G system were randomly assigned to the Fix group (simplified meal announcement by preset of 3 personalized fixed carbohydrate amounts) or the Flex group (precise carbohydrate counting). After 3 months, participants in Fix group could choose to continue with the same regimen, or to switch to precise carbohydrate counting. HbA1c, Time in Ranges, insulin and sensor data were analyzed after 3 and 6 months.
Results: TIR was 73.5±6.7% in the Fix and 80.3±7.4% in the Flex group (p=0.043) at 3 months. 88% of participants (n=15) in Fix group continued to use same regime for the additional 3 months (TIR of 72.7±7.8% in Fix group and 79.4±6.9 in Flex group, p=0.006). HbA1c below 7% was achieved in both groups, without a group difference during the study.
Conclusion: Adolescents on the MiniMed 780G system using simplified meal announcement can reach and maintain international targets of glycemic control. This method may be a valuable alternative to precise carbohydrate counting in users, challenged by precise carbohydrate counting.

Disclosure
G.Petrovski: None. J.Campbell: None. K.Hussain: None. M.F.Pasha: None. Sidra diabetes group: n/a.
621-P: Subphenotyping of Type 2 Diabetes Based on Pathophysiology and Its Association with Diabetes Remission in Urban Indians
Authors: TRIPATHI PRAMOD , VYAWAHARE ANAGHA R. , KADAM NIDHI S. , SHARMA BABY , GANLA MALHAR H. , DAS BISWAS MAYURIKA , SABOO BANSHI D. 
Published: June 2023

Background and Aim: Sub-classification of type 2 diabetes (T2D) based on pathophysiological abnormalities is documented to facilitate better T2D management. Aim of the study was to classify 270 Indian patients with recently diagnosed T2D based on phenotype and the impact of each phenotype on the rate of remission, after a structured diabetes remission program.
Methods: We retrospectively extracted and analyzed baseline data of patients with T2D (diagnosed as per WHO criteria) enrolled for a one-year diabetes management program at the Freedom from Diabetes Clinic, India. Inclusion criteria included a recent diagnosis of T2D (&lt;2 years). Using the homeostatic assessment model, patients were categorized into 3 sub-phenotypes: insulinopenic (high insulin sensitivity (IS) and low beta cell function (BCF)), classical (low IS and low BCF), and hyperinsulinemic (low IS and high BCF) T2D. Post-intervention, remission was defined as maintaining HbA1c&lt;48 mmol/mol without the use of glucose-lowering medications for at least 3 months.
Results: Of the 270 patients, the majority were hyperinsulinemic (35.9%) followed by insulinopenic 17.4% and classical (13.3%) T2D. Additionally, a novel category of patients with both high IS and high BCF was observed (labeled ‘Unclassified’-33%). Hyperinsulinemic patients had the highest BMI (median 28 kg/m2), dyslipidemia, hypertension, and history of heart disease with the lowest remission rate (14.4%). One in four classical patients was on oral hypoglycemic agents and showed poor glycemic control but 25% remission. Unclassified patients showed the highest remission (28.1%).
Conclusion: Pathophysiological sub-phenotyping could assist caregivers in better management of T2D through targeted treatment options. Remission rates were observed to be better in classical and unclassified (high insulin sensitivity and beta function) T2D. Further large-scale studies to understand the unclassified group are warranted.

Disclosure
P.Tripathi: Board Member; Freedom from Diabetes Clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. B.Sharma: Research Support; Freedom From Diabetes clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. M.Das biswas: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.
626-P: Integrated Approach of Yoga Therapy (IAYT) Improves Cerebrovascular Functions and Prefrontal Hemodynamic Activities Related to Cognition in Type 2 Diabetes
Authors: SINGH DEEPESHWAR , KALIGAL CHIDANANDA , M VIDYASHREE , KANTHI AMIT 
Published: June 2023

The present study aimed to assess the integrated approach of yoga therapy (IAYT) effect on cerebrovascular reactivity in middle cerebral artery (MCA), prefrontal cortex (PFC) oxygenation and cognitive functions in patients with T2DM. Method: 75 patients were randomized to the IAYT group [n=38; 07 female; mean age 52.95 (8.20) years] and the waitlist control group [n=37; 06female; mean age (SD) 49.62 (10.94) years]. The cerebral blood flow and prefrontal hemodynamic activities were assessed using transcranial doppler and functional near-infrared spectroscopy, respectively, during resting and cognitive performance. IAYT group participants received 3 months of intervention and assessments were done at baseline (0-week), mid (after 6-week), and post (after 12-week). Results: After a 12-week intervention, participants of the yoga group showed improved accuracy and reaction time in a 2-back condition of the working memory task, and the scores of the Corsi Block Tapping task. Further, cerebrovascular changes were observed in the middle cerebral artery, which showed increased peak systolic velocity, mean blood flow velocity, end-diastolic velocity, and breath-holding index after 12-week yoga practice. The oxygenation was also higher at dorsolateral, dorsomedial, and ventromedial and orbitofrontal PFC in the 12th week of the yoga practitioners group compared to the control group. Moreover, during 2-back working memory task, yoga group participants demonstrated increased oxygenation at dorsolateral PFC compared to pre and higher oxygenation at dorsolateral, ventrolateral, ventromedial and orbitofrontal PFC compared to control group. Conclusion: The results suggest that IAYT practice may improve cognitive functions by improving cerebral blood flow through the middle cerebral artery and hemodynamic activities in the prefrontal regions in patients with T2DM.

Disclosure
D.Singh: None. C.Kaligal: None. V.M: None. A.Kanthi: None.

Funding
Ministry of Ayush, Government of India (Z.280152092015-HPC(EMR)-AYUSH)
629-P: Social Vulnerability Index and Recognition Status with the National Diabetes Prevention Program (National DPP)
Authors: FORMAGINI TAYNARA , REZWAN ARIBA , RODRIGUEZ DAPHNEE , PENG NG BOON 
Published: June 2023

Individuals in low socioeconomic status (SES) areas are disproportionately affected by diabetes and have poor lifestyle change outcomes. Organizations delivering the CDC National DPP lifestyle change program receive pending, preliminary, or full recognition status based on specific program criteria and outcomes. Full recognition is critical for organizations to sustain the program and receive reimbursements to cover costs, but organizations in low SES areas may face barriers to receiving it. A multinomial logit model was used to examine the association between the CDC social vulnerability index (SVI) and in-person full recognition organizations at the county level, adjusting for confounders (n=843). Using the National DPP registry, Census data, SVI, and CDC Diabetes Surveillance System, a three-level categorical dependent variable was created: counties without full recognition organizations, counties with at least one non-full recognition organization, and counties with all organizations with full recognition (reference group). The CDC created a four-level categorical SVI (Low, Low-Medium, Medium-High, High) using 16 Census variables to rank counties by social vulnerability: SES, Household Composition and Disability (e.g., age), Minority Status and Language, and Housing Type and Transportation (e.g., vehicle). Of the studied counties, 38.4% had no organizations with full recognition, 22.6% had at least one organization without full recognition, and 39.0% had all organizations with full recognition. Counties with higher SVI were more likely to be in counties without full recognition organizations (High vs. Low; OR=2.71, P &lt;0.001). Counties with high SVI lack fully recognized programs, indicating barriers for organizations in high SVI areas to attain full recognition. This study highlighted the need to develop strategies to ensure organizations in high SVI areas can reach full recognition status to better serve at-risk populations.

Disclosure
T.Formagini: None. A.Rezwan: None. D.Rodriguez: None. B.Ng: None.
63-OR: The Contribution of Social-Needs Factors to Racial Differences in Type 2 Diabetes
Authors: VUPPUTURI SUMA , KIM SEOHYUN , CLENNIN MORGAN , CROMWELL LEE , DAUGHERTY STACIE L. 
Published: June 2023

Studies have attributed gaps in type 2 diabetes (T2D) between Black/African-American (BAA) and White adults to socioeconomic factors. We quantified the contribution of social risk factors to racial gaps in T2D in 6 Kaiser Permanente health systems across the U.S. We utilized data collected from the National KP Social Needs Survey conducted in 2020 among 10,226 health system members. We linked survey data to electronic health record data. Exposures included financial strain, food insecurity, and housing instability in the past year. The outcome, prevalent T2D, was defined as either a diagnosis of T2D or medication fills for antidiabetic medications. Self-reported BAA and White race were used to stratify data. Other covariates included demographics, insurance type, clinical measures, and comorbidities. Cross-sectional logistic regression models assessed the odds of T2D by race and the Oaxaca-Blinder decomposition method calculated the percent contribution of all variables to the racial difference in T2D. All statistical analysis were weighted to account for the complex survey design. Our final analysis included 1,223 BAA and 3,372 White survey participants. BAA participants were more likely to be younger, female, report more social risk factors, and have a greater burden of comorbidities. The prevalence of T2D was 22% in BAA patients and 11% in White patients. The covariates in the Oaxaca-Blinder analysis explained 43% of the 11% overall difference in T2D prevalence between BAA and White patients. Of this explained difference, the combined variable of financial strain, food insecurity, or housing instability significantly contributed to the racial gap in T2D by 11%. Our results demonstrated, that if social risk factors of BAA patients were equal to White patients, the racial difference in T2D would be reduced by 11% in our population with access to health care. However, the impact is relatively small and other social factors (e.g. discrimination) will be important to explore using this methodology.

Disclosure
S. Vupputuri: None. S. Kim: None. M. Clennin: None. L. Cromwell: None. S.L. Daugherty: None.

Funding
Kaiser Permanente Social Needs Network for Evaluation and Translation
630-P: Objective Self-Management Behaviors in Adolescents with Disordered Eating
Authors: O'DONNELL HOLLY K. , TROJANOWSKI PAIGE J. , ALONSO GUY T. , DRISCOLL KIMBERLY A. 
Published: June 2023

Introduction: The positive association between disordered eating and A1C in individuals with type 1 diabetes is well-established, but little is known about the association between disordered eating and objectively measured self-management behaviors, which are essential behavioral precursors to A1C. The goal of this study was to describe these associations in adolescents with type 1 diabetes.
Methods: Participants included N=142 adolescent pump users (M age=13.8±2.1 years; M A1C=8.0±1.5%; 82.5% White, Non-Hispanic; 50.0% female) who completed the 16-item Diabetes Eating Problems Survey-Revised (DEPS-R), a type 1 diabetes-specific self-report questionnaire. A cut point of ≥20 was used to identify those with clinically elevated symptoms of disordered eating warranting further attention. Self-management behaviors were calculated using data exclusively obtained from devices (i.e., no self-reported data).
Results: Adolescents (n=26; 19%) who reported elevations on the DEPS-R engaged in significantly fewer self-management behaviors, including blood glucose readings per day [t(151)=3.0, p&lt;0.01], carbohydrate entries per day [t(150)=3.3, p&lt;0.001], and boluses administered per day [t(151)=2.3, p&lt;0.05]. Adolescents with clinically elevated disordered eating scores also entered fewer carbohydrates per day into their insulin pump (137.6 vs. 90.8 grams of carbohydrates) [t(150)=3.3, p&lt;0.001].
Conclusions: This is the first study to examine the association between disordered eating behaviors and objectively measured self-management behaviors in youth with T1D that use an insulin pump. Differences in self-management behaviors between those who reported elevations on the DEPS-R vs. those that did not were particularly pronounced for behaviors related to food. Objective data from device downloads may be a useful tool to cue providers to inquire about eating patterns during routine visits.

Disclosure
H.K.O'donnell: None. P.J.Trojanowski: None. G.T.Alonso: None. K.A.Driscoll: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK063687)