bluuebunny/crossref_metadata_2025_split huggingface dataset:
1256-P: Should Clinical Guidelines for Diabetes Screening Use Waist Circumference Instead of Body Mass Index?
Authors: AGGARWAL RAHUL , CHIU NICHOLAS , BHATT DEEPAK L. 
Published: June 2023

Introduction: Diabetes is increasing in the US. The USPSTF and ADA recommend screening based on body mass index (BMI). We evaluated if waist circumference was a better predictor of diabetes than BMI.
Methods: We used NHANES (2015-2018). We identified nonpregnant adults ages ≥20 years (N=10,614). A mediation analysis was performed, assessing if the association of BMI (kg/m2) with diabetes prevalence was mediated by waist circumference (cm), using survey weighted logistic regression. Estimates were US representative. Results: We identified 233,874,251 weighted adults. A one-point BMI increase was associated with a 0.95% (95% CI: 0.84%, 1.07%, P&lt;0.001) increase in diabetes prevalence. Similarly, a one-centimeter increase in waist circumference was associated with a 0.51% (95% CI: 0.46%, 0.55%, P&lt;0.001) increase in diabetes prevalence. After adjusting for waist circumference, BMI was not associated with diabetes prevalence (P&lt;0.001) (Figure), while waist circumference continued to predict diabetes prevalence by 0.87% (95% CI: 0.73%, 1.01%, P&lt;0.001) per one-centimeter increase. The association of BMI for diabetes prevalence was fully mediated by waist circumference (indirect effect ≥ total effect).
Conclusion: The predictive ability of BMI for diabetes is fully mediated by waist circumference. Clinical guidelines could consider waist circumference to replace BMI in screening guidelines.

Disclosure
R.Aggarwal: None. N.Chiu: None. D.L.Bhatt: Board Member; Bristol-Myers Squibb Company, Research Support; Lexicon Pharmaceuticals, Inc., Sanofi, Lilly, Boehringer Ingelheim Inc., AstraZeneca, Novo Nordisk.
1259-P: Resting Heart Rate and Sleep Disorders in Maturity-Onset Diabetes of the Young
Authors: AROSEMENA MARILYN A. , WROBLEWSKI KRISTEN , TASALI ESRA , PHILIPSON LOUIS H. 
Published: June 2023

Background: Sleep disturbances have been linked to higher resting heart rate (RHR), a marker of cardiovascular risk. Obstructive sleep apnea (OSA) and insomnia are common in other types of diabetes, but they have not been studied in Maturity Onset Diabetes of the Young (MODY), a unique subtype characterized by patients being lean and not using insulin.
Objective: To evaluate sleep disorders and RHR in MODY.
Methods: Participants were recruited from the Monogenic Diabetes Registry at the University of Chicago. The presence and severity of OSA was objectively assessed by a validated home screening device. Insomnia was assessed by a validated survey (Insomnia Severity Index). Resting (sleeping) heart rate was assessed by Fitbit activity tracker for 2 weeks.
Results: Considering all patients (n=51; Table 1), OSA was found in 37% (31% mild, 2% moderate, 4% severe). Insomnia was found in 47% of patients (10% clinical insomnia and 37% subthreshold insomnia). Overall, the mean RHR was 66±9 bpm, with transcription factor (TF) related MODY (HNF1A, HNF4A, HNF1B) having significantly higher RHR compared to GCK-MODY (70±10 bpm vs. 63±8.7 bpm; p=0.01).
Conclusion: OSA and insomnia are common in patients with MODY despite their lack of traditional risk factors for sleep disorders. TF-related MODY has a higher RHR compared to GCK-MODY. Future research should investigate the pathophysiology of sleep-diabetes relationship in MODY.

Disclosure
M.A.Arosemena: None. K.Wroblewski: None. E.Tasali: None. L.H.Philipson: Advisory Panel; Nevro Corp., Research Support; Novo Nordisk, Dompé, Provention Bio, Inc., Imcyse, Novo Nordisk Foundation.
1260-P: Verifying the Use of FIB4 and BARD Scores to Predict Advanced Fibrosis Using Transient Elastography in People with Type 2 Diabetes in a Tertiary Care Center in India
Authors: TEWARI AJOY , TEWARI JAY , MAHESHWARI ANUJ , TEWARI VINEETA , TEWARI BHAGWAT 
Published: June 2023

Background: There is a high prevalence of nonalcoholic fatty liver disease in people with type 2 diabetes. Liver biopsy is the gold standard for diagnosing advanced fibrosis but is usually not feasible in routine clinical practice. Transient elastography is accepted as a viable non-invasive alternative but is not universally available due to high cost. FIB4 and BARD scores are easy to perform in routine clinical practice and can guide for referral for transient elastography or liver biopsy. The aim of this study was to assess the utility of these simple scores (FIB4 and BARD) to exclude advanced fibrosis in people with type 2 diabetes.
Material and Methods: A total of 133 consenting people were subjected to fibro scan. Serum markers (AST, ALT, Platelet count) were measured, and FIB 4 and BARD scores were calculated using standard equations. LSM (liver stiffness measurement) cut-off value of 11.4 was used to exclude advanced fibrosis.
Results: Out of 133 people with diabetes in the study, 51.1% males and 48.9% were females, with a mean age of 50years, BMI 26.6, hba1c 8.7%, duration of diabetes 7.6yrs. The average LSM was 9.1, mean AST was 36 U/ml and ALT 38.5U/ml, platelet count was 208cubic mm. Mean FIB4 score was1.7 and BARD score was 3. 82.7% had a LSM value of &lt;11.5 and 17.3% had a LSM value of&gt;11.5%, neither BARD score nor FIB4 had significant correlation with liver stiffness measurement. Fib4 had a (Negative predictive value) NPV of 83.6% and BARD score had a NPV of 85.7% to exclude advanced fibrosis (&gt;11.4)
Conclusion: A FIB 4 score of less than 2.6 and BARD score of less than 2 have a high negative predictive value to exclude advanced fibrosis. Due to the high incidence of NAFLD in people with diabetes, these should be routinely used to exclude advanced fibrosis and the decision to referral for fibro scans and liver biopsy.

Disclosure
A. Tewari: None. J. Tewari: None. A. Maheshwari: None. V. Tewari: None. B. Tewari: None.
1261-P: Prevalence of Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Type 1 Diabetes
Authors: SALAH TAREQ , TOMAH SHAHEEN , AL-BADRI MARWA , KIBAA KARIM , DHAVER SHILTON E. , CURRY MICHAEL P. , LAI MICHELLE , JIANG ZHENGHUI , KHATER ABDELRAHMAN , MCCARRAGHER RYAN , DEMATTOS LILY , TRAN MINH , HAMDY OSAMA 
Published: June 2023

Nonalcoholic fatty liver disease (NAFLD) is a common comorbid condition in patients with type 2 diabetes. However, little is known about its prevalence among patients with type 1 diabetes (T1D). We used transient elastography to measure controlled attenuation parameter (CAP) as steatosis indicator and liver stiffness measurement (LSM) as fibrosis indicator. We evaluated 537 patients with T1D: age 49±16 years; 55% females; 81% non-Hispanic whites; BMI 27.6±5.5 kg/m2; diabetes duration 29±15.6 years; A1C 7.1±1.0%; total daily insulin (TDI) 49±28 U/day; ALT 19±10 IU/L; AST 22±8 IU/L. The prevalence of NAFLD (CAP≥274 dB/m) was 28.5% (95% CI 24.6-32.6) and fibrosis (LSM≥7 kPa) 8.4% (95% CI 6-11). Moreover, 4.1% (95%CI 2.6-6.2) of NAFLD had ≥F2 fibrosis (LSM ≥ 8.2 kPa) suggesting nonalcoholic steatohepatitis (NASH). Higher CAP positively correlated with higher BMI (p&lt;0.001); diabetes duration (p&lt;0.01); and TDI (p&lt;0.001). It was common in males (OR 2.1, 95%CI 1.3-3.5, p&lt;0.01). Among those with NAFLD, mean ALT was 21±11 IU/L (p=0.02), AST 22±7 IU/L, BMI 32.7±5.8 kg/m2, and waist circumference (WC) 103±15 cm. Among those with fibrosis, mean ALT was 23±10 IU/L (p=0.01), AST 24±7 IU/L (p=0.03), BMI 31.7±6.4 kg/m2 and WC 104±15 cm. Obesity (BMI &gt;30 kg/m2) and larger WC (&gt;102 cm in men, &gt;88 cm in women) were associated with increased risk for hepatic steatosis (OR 3.1, 95% CI 1.6-6.0, p=0.001; OR 4.0, 95% CI 2.2-7.5, p&lt;0.001, respectively). In conclusion, prevalence of NAFLD and liver fibrosis is considerable among patients with T1D, while liver enzymes are within normal range. Obesity and large waist circumference are associated with increased risk of hepatic steatosis. Independent predictors of NAFLD include: higher BMI, longer diabetes duration, higher TDI and male gender. Screening for NAFLD and liver fibrosis is advisable for patients with T1D irrespective of their liver enzymes, particularly in patients with higher BMI, longer diabetes duration or among those treated with larger insulin dose.

Disclosure
T.Salah: None. R.Mccarragher: None. L.Demattos: None. M.Tran: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation. S.Tomah: Employee; Altimmune. M.Al-badri: None. K.Kibaa: None. S.E.Dhaver: None. M.P.Curry: Advisory Panel; Mallinckrodt PLC, Alexion Pharmaceuticals, Inc., Albireo. M.Lai: None. Z.Jiang: Advisory Panel; Olix Pharmaceutical, Research Support; Pfizer Inc., Gilead Sciences, Inc. A.Khater: None.
1265-P: Insights and Implications—Creating and Executing the First National-Scale Home Sample Collected Autoantibody Screening Service for Type 1 Diabetes (T1D) Risk Assessment for JDRF’s T1Detect
Authors: SEFTEL DAVID 
Published: June 2023

On December 12, 2020, a unique home-collected sample T1D autoantibody detection program was launched online. Serving 48 states, the JDRF T1Detect autoantibody screening program features a pioneering 3-year collaboration between the JDRF and a clinical reference laboratory spun out of the University of California at Berkeley and Stanford University. Using a completely novel, and now patented, way of detecting antibodies - using unique DNA barcodes that bind to antibodies and are thus readable by standard PCR machines - the T1Detect program was able to offer gold-standard-matching accuracy using easily-collectable dried blood spot samples. The approach, called Antibody Detection by Agglutination PCR (ADAP) was co-invented by 2022 Nobel Laureate in Chemistry, Stanford Prof. Carolyn Bertozzi. ADAP was validated over 6 years via multiple studies with the NIDDK, TrialNet, the National Science Foundation, the JDRF, the Joslin Diabetes Center, Mayo Clinic and Stanford Pediatric Endocrinology. The presentation covers these aspects: Econometric, individual and public health benefits of T1D risk screening, including selecting patients for closer glycemic monitoring and consideration for therapeutic intervention. Summary of both pediatric and adult T1D incidence studies underlying the emerging consensus around longitudinal general population screening. How the joint program with JDRF was conceived and executed - from ideation to realization. Key T1Detect screening program data findings and outcomes to date. How clinicians can best collaborate with screening programs to enhance the care of first-degree relatives of T1D patients and their general patient population. In summary, the developmental journey of this T1D testing initiative with JDRF and the resulting insights are distinctively first-in-class and can be uniquely instructive and helpful to clinicians and researchers alike.

Disclosure
D.Seftel: Employee; Enable Biosciences, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (5R44DK111005-03); The Leona M. and Harry B. Helmsley Charitable Trust; Sweden National Science Foundation (1758698); JDRF (2-SRA-2018-535-S-B)
1273-P: Guidance to Persons Who Screen Positive for Islet Autoantibodies and Their Health Care Providers—Ask the Experts
Authors: SIMMONS KIMBER M. , BAUTISTA KIMBERLY A. , GENO RASMUSSEN CRISTY , KARBAN RACHEL , O'DONNELL HOLLY K. , FROHNERT BRIGITTE I. , STECK ANDREA , REWERS MARIAN 
Published: June 2023

Objective: Detecting early-stage type 1 diabetes (T1D) by screening for islet autoantibodies (IA) can prevent serious morbidity at clinical onset and allow for a trial prevention, e.g., FDA-approved teplizumab therapy. The Ask the Experts program provides confirmation of positive screening results, monitoring, and education for individuals who screen positive for IA as well as their families and health care providers (HCPs).
Methods: Individuals and HCPs concerned for T1D (e.g., screen positive for IA) can enroll in Ask the Experts via phone, e-mail or website. We recommend and facilitate screening or confirmation of IA status and collect demographic and clinical data. When IA positivity is confirmed, we partner with HCPs to provide early T1D training and collaborative follow-up, customized to HCP interest and clinical capacity.
Results: We have enrolled 71 participants to date, mostly youth (83%), aged 1 to 62 years (61% female; 79% non-Hispanic white). Most referrals were for confirmation of IA results (52%) or HCP concern for early T1D based on dysglycemic HbA1c or glucose (30%). IA were measured at 6 commercial laboratories, including the Barbara Davis Center Autoantibody Laboratory with 53% screening positive for a single IA and 47% for multiple IA. The most common IA detected was insulinoma antigen-2 IA (48%) with glutamic decarboxylase 65 and insulin IAs both present in 41% of those who screened positive. Of those who presented with one or more IA on screening, 66% were negative for all four major IA on confirmation testing completed at the Barbara Davis Center Autoantibody Laboratory. 80% of individuals confirmed IA positive have engaged in remote monitoring while 20% have been followed by their local HCP with our training and support.
Conclusion: Persons who screen positive for IA should have confirmation testing completed given the discordance between screening and confirmation results. HCPs require support for following screening detected individuals.

Disclosure
K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc., Provention Bio, Inc., Research Support; Novartis. K.A.Bautista: None. C.Geno rasmussen: None. R.Karban: None. H.K.O'donnell: None. B.I.Frohnert: Advisory Panel; Provention Bio, Inc. A.Steck: None. M.Rewers: Research Support; Provention Bio, Juvenile Diabetes Research Foundation (JDRF), Hemsley Charitable Trust, Dexcom, Inc., Janssen Research & Development, LLC.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1277-P: Prediction of HbA1c Test Eligibility in Emergency Department
Authors: SMART MARY , LIN JANET , LEE TODD , LAYDEN BRIAN T. , EISENBERG YUVAL , DANIELSON KIRSTIE K. , KONG ANGELA 
Published: June 2023

Introduction: Diabetes screening using best practice advisory (BPA) alerts integrated into the emergency department (ED) workflow may efficiently identify at-risk patients disproportionally affected by diabetes. The objectives of this study were to 1) validate a BPA algorithm informed by the American Diabetes Association (ADA) screening criteria using elements from the electronic medical record (EMR) to identify eligible patients for hemoglobin A1c (HbA1c) testing, and 2) compare the characteristics of the ADA-based algorithm with one informed by the United States Preventative Services Task Force (USPSTF) recommendations.
Methods: This cross-sectional study involved adults admitted to the University of Illinois Health ED in May 2021 with labs ordered (n=2963). Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) estimated the BPA algorithm’s ability to correctly identify patients eligible for diabetes screening using manual EMR chart review as the reference standard. Receiver operator characteristic (ROC) curves and area under the curve (AUC) were calculated to compare ADA and USPSTF-informed algorithms.
Results: The sensitivity, specificity, PPV, and NPV of the ADA model were 0.70 (95% CI: 0.66-0.75), 0.91 (0.90-0.92), 0.76 (0.73-0.79), and 0.88 (0.86-0.89), respectively. Compared to the ADA model, the USPSTF model’s sensitivity was worse (0.25 (0.22-0.27)) and specificity was slightly higher (0.94 (0.93-0.95)), though PPV remained similar (0.75 (0.71-0.79)) and NPV was lower (0.64 (0.62-0.66)). The ROC AUC for the ADA and USPSTF-based models were 0.91 (0.89-0.93) and 0.86 (0.84-0.89), respectively.
Conclusion: Despite moderate to low sensitivity, the PPVs and large AUCs are acceptable due to the high prevalence of at-risk populations presenting to the ED. Findings suggest that a BPA algorithm informed by the ADA guideline is an adequate tool to identify eligible patients for diabetes screening in the ED, especially given its ease of workflow integration.

Disclosure
M.Smart: None. J.Lin: Research Support; Novo Nordisk, Xeris Pharmaceuticals, Inc. T.Lee: None. B.T.Layden: Consultant; Bayer Inc. Y.Eisenberg: None. K.K.Danielson: None. A.Kong: None.

Funding
Novo Nordisk (G2111)
1278-P: Prevalence of Untreated Prediabetes and Alterations of Glucose Metabolism in Mexico—A Nationally Representative Analysis Spanning 2016–2021
Authors: FERMÍN-MARTÍNEZ CARLOS A. , PAZ CABRERA CÉSAR D. , PEREZALONSO ESPINOSA JERONIMO , EDUARDO ANTONIO VILLA NEFTALI , RAMÍREZ-GARCÍA DANIEL , VARGAS-VÁZQUEZ ARSENIO , FERNÁNDEZ CHIRINO LUISA , SEIGLIE JACQUELINE A. , YAXMEHEN BELLO-CHAVOLLA OMAR 
Published: June 2023

Background: Identifying phenotypes at risk of diabetes may be useful in guiding prevention efforts. Here, we estimated the prevalence of glucose metabolism disturbances in Mexico and the association of different prediabetes criteria with cardiometabolic conditions.
Methods: We conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2021), excluding individuals with diagnosed or undiagnosed diabetes. Prediabetes was defined using ADA (FPG 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (FPG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%).
Results: We analyzed a total of 21,440 participants. Prediabetes prevalence in Mexico rose between 2020 (19.2% [95% CI: 17.1-21.4]) and 2021 (27.3% [24.4-30.2]) (Fig1A), with the increase largely driven by higher HbA1c (Fig1B). Prediabetes prevalence was highest in older adults (≥60 years), individuals with obesity (BMI ≥30 kg/m2), and those with high social disadvantage. Prevalence of prediabetes defined by concordant ADA, WHO and IEC criteria were low; however, these definitions better identified cardiometabolic alterations (Fig1C).
Conclusion: The burden of prediabetes is rising in Mexico and in high-risk populations. Use of concordant ADA criteria and higher diagnostic thresholds may help identify subjects at increased risk of cardiometabolic comorbidities.

Disclosure
C.Fermín-martínez: None. C.D.Paz cabrera: None. J.Perezalonso espinosa: None. N.Antonio villa: None. D.Ramírez-garcía: None. A.Vargas-vázquez: None. L.Fernández chirino: None. J.A.Seiglie: Consultant; BDMT Global, Techspert Expert Network. O.Bello-chavolla: None.
1284-P: Prediabetes with Obesity Is a Major Risk Factor for NAFLD and Liver Fibrosis
Authors: GODINEZ LEIVA EDDISON , LOMONACO ROMINA , SHRESTHA SULAV , MARANGI STEPHEN A. , CHI XIAOFEI , KALAVALAPALLI SRILAXMI , SHETTY SHWETHA S. , ORTIZ ROCHA ANDREA , VALDEZ SAENZ ENRIQUE , GONZALEZ MARIA A. , MANSOUR LYDIA , CALVET MARIANNA M. , BARB DIANA , MATHEWS APRIL , SHARMA ANU , CUSI KENNETH 
Published: June 2023

Clinical practice guidelines suggest that patients with prediabetes (preDM) are at a higher risk of NAFLD and liver fibrosis, among other high-risk groups. However, there is limited data available. The aim of this study was to examine the prevalence of liver steatosis and fibrosis in preDM in unselected patients attending their regular outpatient visits, unaware of having NAFLD. To this end, we recruited 711 middle-aged patients in whom elastography was performed to screen for liver fibrosis (liver stiffness measurement or LSM, 1º outcome) and for steatosis (CAP: ≥274 dB/m, 2º outcome). Among them, 127 had preDM, 254 T2DM and 330 were healthy controls (CON). The 3 groups were matched for age, gender and BMI. The prevalence of NAFLD (by CAP) was higher in T2DM (67%) and preDM (54%) vs. CON: 40% (both p&lt;0.01 vs. CON). Overall, the OR 95% CI for steatosis in preDM vs. CON was 1.64, 1.05-2.58 (p&lt;0.01). Steatosis also increased in preDM independent of obesity (non-obese [OB] CON: 26% vs. non-OB preDM: 38% vs. non-OB T2DM: 47%; p &lt;0.05 vs. CON). The prevalence of any liver fibrosis (LSM ≥7.0 = ≥F1) was 3-fold higher among preDM vs. CON (6% and 2%, p=0.015), but significantly lower than in T2DM (17%; p&lt;0.001). Moderate-to-severe fibrosis (≥F2) also happened more often in preDM 5% vs. CON 1% (in T2DM = 9%; both vs. CON p&lt;0.01). Obesity led to a higher prevalence of NAFLD in T2DM (78%) and in preDM (71% vs. 26% in non-OB CON; p&lt;0.01). Obesity increased the prevalence of liver fibrosis in preDM and T2DM (increasing from 1% [non-OB] to 13% [OB] and from 4% to 23%, respectively; both p &lt;0.05) with the majority having F≥2 (10% and 13%, respectively). Prediabetes with obesity vs. CON with obesity had a 3-fold rate of liver fibrosis (3.35, 1.04-10.82; p&lt;0.001). Conclusion: Prediabetes is associated with a high prevalence rate of NAFLD and liver fibrosis, both increasing significantly in the presence of obesity. Prediabetes deserves screening and fibrosis risk stratification to prevent cirrhosis, in particular, in the presence of obesity.

Disclosure
E.Godinez leiva: None. M.A.Gonzalez: None. L.Mansour: None. M.M.Calvet: None. D.Barb: None. A.Mathews: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. R.Lomonaco: None. S.Shrestha: None. S.A.Marangi: None. X.Chi: None. S.Kalavalapalli: None. S.S.Shetty: None. A.Ortiz rocha: None. E.Valdez saenz: None.

Funding
National Institutes of Health (R01120331-01A1)
1286-P: Hyperinsulinemia Is Common in Individuals with Normoglycemia in a Nationwide Working-Age Population
Authors: LOUIE JUDY Z. , SHIFFMAN DOV , MEIGS JAMES B. , MCPHAUL MICHAEL J. 
Published: June 2023

Introduction: Hyperinsulinemia is associated with future diabetes and cardiovascular disease. However, fasting insulin (FI) levels are rarely assessed in individuals with normoglycemia. To investigate the potential magnitude of undiagnosed hyperinsulinemia (FI &gt;16 uIU/mL), we assessed the prevalence of hyperinsulinemia in individuals with normoglycemia (fasting glucose [FG] 70 to &lt;100 mg/dL) in a nation-wide study of working-age individuals without diabetes.
Methods: The study included employees and spouses who participated in an annual health assessment program at Quest Diagnostics (October 2020 to February 2021). Those with diabetes, with FG &lt;70 or ≥100 mg/dL, or with missing data were excluded. FI was measured by a mass-spectrometry assay standardized for the peptide content of WHO reference materials.
Results: Participants included 23,339 individuals (68% women) with normoglycemia (FG ≥70 or &lt;100 mg/dL) and median age of 43 years (IQR 34 to 53). Hyperinsulinemia was observed in 7% (n =1,546) of participants. Of these, 1,064 individuals also participated in the health assessment program in a subsequent year and 46% (n =490) of them had persistent hyperinsulinemia. Obesity (BMI ≥30 kg/m2) was more common (83% vs. 71%) in those with persistent hyperinsulinemia than in those without (P &lt;0.001) and they had lower HDL-C levels (45 vs 47 mg/dL, P &lt;0.001) Age, sex, and triglyceride levels did not differ between those with and without persistent hyperinsulinemia (all P &gt;0.05). Of the 490 individuals with persistent hyperinsulinemia, 76% (n =373) had persistent normoglycemia.
Conclusion: In a large population of working-age individuals, hyperinsulinemia was found in about 1 in 15 individuals with normoglycemia. Those with persistent hyperinsulinemia in a subsequent year were more likely to have obesity and lower HDL-C levels, and about 1 in 5 were no longer normoglycemic. Measurement of FI levels may have value in even apparently metabolically normal individuals.

Disclosure
J.Z.Louie: Employee; Quest Diagnostics. D.Shiffman: Consultant; Quest Diagnostics, Employee; Quest Diagnostics. J.B.Meigs: Consultant; Quest Diagnostics. M.J.Mcphaul: Employee; Quest Diagnostics.