bluuebunny/crossref_metadata_2025_split huggingface dataset:
1308-P: Glutamic Acid Decarboxylase Autoantibodies (GADA) in Type 2 Diabetes Do Not Predict Long-Term Diabetes Complications
Authors: PILLA SCOTT J. , KNOWLER WILLIAM C. , BALASUBRAMANYAM ASHOK , HAMPE CHRISTIANE S. , PIETROPAOLO SUSAN , ANDERSON ANDREA M. , LI MO , ZHAO NI , ZEGER SCOTT L. , RAMELIUS ANITA , BENNET RASMUS , LERNMARK ÅKE , MATHIOUDAKIS NESTORAS N. , CLARK JEANNE , MARUTHUR NISA M. 
Published: June 2023

Some adults with type 2 diabetes (T2D) have islet autoantibodies that may explain clinical heterogeneity, yet limited long-term studies have examined their relationship with diabetes outcomes. We investigated the association between GADA, the most prevalent islet autoantibody, and diabetes complications and mortality in Look AHEAD (Action for Health in Diabetes), a trial that randomized adults with clinically-diagnosed T2D to intensive lifestyle intervention vs. control for 9.6 years, and then followed them observationally. GADA was measured by radioligand binding assay in 87% of the cohort at baseline and categorized as negative, low-level (35-199 U/mL) or high-level (≥200 U/mL). We used Cox proportional hazards regression adjusted for age, sex, race/ethnicity, and study arm to analyze the association between GADA category and time-to-event outcomes: CVD (MI, stroke, hospitalized angina, CVD death), incident eGFR &lt;45 ml/min/1.73m2, incident end stage kidney disease, and all-cause mortality. Among 4,492 participants, the median age was 59 years and diabetes duration 5 years. GADA was low-level and high-level positive in 131 (2.9%) and 85 (1.9%), respectively. Over a median follow-up of 17 years, there was no significant association between GADA levels and outcomes (Table). Overall, the presence of GADA above 35 U/mL was not predictive of CVD, or renal outcomes or mortality.

Disclosure
S.J.Pilla: None. A.Ramelius: None. R.Bennet: None. Å.Lernmark: Advisory Panel; Diamyd Medical. N.N.Mathioudakis: None. J.Clark: None. N.M.Maruthur: Other Relationship; Johns Hopkins HealthCare Solutions. W.C.Knowler: None. A.Balasubramanyam: None. C.S.Hampe: Employee; Immusoft corp. S.Pietropaolo: None. A.M.Anderson: None. M.Li: None. N.Zhao: None. S.L.Zeger: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK126825, K23DK128572)
1310-P: Causes of Death among Australians with Type 1 or Type 2 Diabetes, 2002–2019
Authors: TOMIC DUNYA , CHEN LEI , MAGLIANO DIANNA J. , SHAW JONATHAN E. 
Published: June 2023

Objective: We sought to explore the conditions driving the diversification in causes of death among people with diabetes.
Methods: We linked Australians with type 1 or type 2 diabetes of all ages on the National Diabetes Services Scheme (Diabetes Registry) to the National Death Index for 2002-2019. We investigated causes of death over time across eight categories of causes of death. Underlying causes of death were classified according to the International Classification of Diseases, Tenth Revision codes.
Results: Between 2002-2019, there was a shift in the underlying cause of death among Australians with diabetes. The proportion of deaths attributed to cardiovascular disease declined in both sexes (Ptrend &lt; 0.001), most substantially among females with type 2 diabetes from 48.2% in 2002 to 30.7% in 2019 (Figure). Among males, cancer overtook cardiovascular disease as the leading cause of death. The proportion of deaths due to dementia increased among all people with diabetes, from 2% in 2002 to 7% in 2019, across all age-groups, notably from 1% to 4% in those aged 70-79. The proportion of deaths due to falls also increased.
Conclusions: We are seeing a shift of causes of death among those with diabetes away from cardiovascular and renal disease towards conditions such as dementia, falls, and respiratory disease, which may have serious consequences for health systems and will require consideration in resource allocation.

Disclosure
D.Tomic: None. L.Chen: None. D.J.Magliano: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, Lilly, Zuellig Pharma Holdings Pte. Ltd., Mylan, Research Support; AstraZeneca, Speaker's Bureau; AstraZeneca, Roche Diagnostics, Lilly, Amgen Inc., Sanofi, Zuellig Pharma Holdings Pte. Ltd.
1311-P: Insulin Resistance in Non-obese Young Adults with Type 1 Diabetes
Authors: CHARTIER-LOGAN CATHERINE J. , SCHAUER IRENE E. , CREE-GREEN MELANIE , PYLE LAURA , BERGMAN BRYAN C. , SNELL-BERGEON JANET K. 
Published: June 2023

Insulin resistance has been noted in youth and adults with type 1 diabetes (T1D) and is associated with higher levels of cardiovascular and kidney complications. Obesity is increasing in populations with T1D, and the degree of insulin resistance in younger adults with T1D who are free from complications and non-obese isn’t clear. We performed hyperinsulinemic euglycemic clamps in non-obese adults aged 20-45 with and without T1D. Inclusion criteria included diabetes duration &gt; 5 years and HbA1c &lt;9% among people with T1D, or no diabetes based on fasting glucose and HbA1c among controls; Body mass index (BMI) &lt; 30 kg/m2, no use of statins or other medication affecting insulin sensitivity, non-smokers and normal thyroid function. Participants were given a fixed macronutrients study diet for 2 days and were asked to refrain from vigorous exercise for 72 hours. Clamps were performed by a single investigator after an overnight stay. A sliding scale insulin infusion was used overnight for participants with T1D. Arterial stiffness (brachial artery distensibility, pulse wave velocity and reactive hyperemia index) was assessed. There were 47 participants, 24 with T1D and 23 without diabetes. 53% were women (25/47), and the average age did not differ between controls and people with T1D (31 ± 6 years vs. 28 ± 6 years, p=0.12). Whole body insulin sensitivity estimated by glucose infusion rate (GIR) per kg fat free mass was reduced by more than half in adults with T1D (LS mean ± SE =5.4 ± 1.0 mg/kg FFM/min) compared to adults without diabetes (12.7 ± 1.0 mg/kg FFM/min, p&lt;0.0001). In contrast, there were no differences in BMI, body fat, urinary albumin, or measures of arterial stiffness by diabetes status. Young, non-obese adults with T1D are profoundly insulin resistant compared to nondiabetic adults, even when no differences in vascular stiffness or kidney complications are apparent. These results suggest that insulin resistance may occur earlier than vascular or kidney complications in people with T1D and is independent of obesity.

Disclosure
C.J. Chartier-Logan: None. I.E. Schauer: None. M. Cree-Green: Consultant; Pollie Inc. Research Support; Amino Corp LLC. L. Pyle: None. B.C. Bergman: Research Support; Eli Lilly and Company. J.K. Snell-Bergeon: None.

Funding
JDRF (2-SRA-2019-849-S-B)
1312-P: Relationship between Progression of Diabetic Nephropathy and Seasonal Fluctuation of Estimated GFR
Authors: YUKI MASAHIRO , YAMAZAKI TSUTOMU , MIYASHITA KAZUTOSHI , SAKAMOTO MASAYA 
Published: June 2023

Introduction: The seasonal fluctuation of estimated glomerular filtration rate (GFR) in type2 diabetes mellitus (T2DM) patients remains unknown. The present study is first to examine seasonal fluctuation of eGFR and its relationship to the progression of diabetic nephropathy (DN).
Methods: This retrospective study initially analyzed data on 21,307 T2DM patients with hypertension (HT). Seasonal fluctuation of eGFR were evaluated using the intrapersonal coefficient of variation (CV) of 20 or more serial measurements of body weight, Blood pressure and HbA1c during a 5-year period from 2014-2018. The primary objective was to determine if there is seasonal fluctuation of eGFR or not. Secondary objective is to examine the relationship between progression of DN and seasonal fluctuation of eGFR. DN was assessed by eGFR and urinary albumin excretion (UAE) changes.
Results: The figure shows the changes of eGFR monthly averages. eGFR is significantly lower in summer each year (vs winter, P&lt;0.001). Classified into two groups based on median CV of eGFR, eGFR decrease was obvious in the group with large CV of eGFR (vs group with small CV, P&lt;0.001). In addition, UAE increase was also obvious in the group with large CV of eGFR (vs group with small CV, P&lt;0.001).
Conclusion: This study suggests that eGFR is fluctuated by season in T2DM patients with HT. The seasonal fluctuation of eGFR was associated with the progression of DN.

Disclosure
M.Yuki: None. T.Yamazaki: None. K.Miyashita: None. M.Sakamoto: None.
1313-P: The Prevalences of NAFLD and Liver Fibrosis Are High in Individuals with Type 1 Diabetes and Increase with Disease Progression
Authors: FUHRI SNETHAGE COCO , MEIJNIKMAN ABRAHAM S. , DE GROEN PLEUN , CALLENDER CENGIZ , RAMPANELLI ELENA , BROUWER CATHERINE B. , VAN RAALTE DANIËL , NIEUWDORP MAX , HANSSEN NORDIN 
Published: June 2023

Introduction: Approximately 30% of the global population has nonalcoholic fatty liver disease (NAFLD). This can result in nonalcoholic steatohepatitis (NASH) and liver fibrosis (2% in general population). NAFLD with fibrosis increases overall morbidity and mortality significantly. T2D increases the risk of fibrosis progression in NAFLD, but little is known about NAFLD in T1D. Therefore, the aim of this study was to assess the prevalence of NAFLD and liver fibrosis in T1D.
Methods: In this cross-sectional study 453 individuals with T1D were included for analyses (41.0 ±14years old, 64% female, HbA1c 55.6 ±12mmol/mol, median T1D duration 14 [IQR: 6-29] years. Participants underwent a FibroScan® to assess liver stiffness, with a cut-off of 238 dB/m for steatosis and 7.0 kPa for fibrosis. Data analyses was performed in R studio, using a Students T- or Mann-Whitney U test, as appropriate.
Results: Prevalence of liver steatosis was 29.5% and fibrosis was 7.7%. Steatosis was significantly higher in individuals with longer T1D duration (median:15 [IQR:7-25] vs. 23 [9-33] years), higher 24-hour insulin dose (34 [24-47] vs. 46 [33-62] units), higher BMI (mean 24.3±SD 3.5 vs. 27.9±4.6 kg/m2), higher CRP levels (1.0 [0.5-2.1] vs. 1.6 [0.8, 3.7] mg/L), higher triglyceride levels (0.6±0.3 vs. 0.8±0.5 mmol/L) and lower TIR (67 [51-82] vs. 62 [48-75] %). Presence of fibrosis was associated with a longer duration of T1D (16 [7-27] vs. 30 [20-39] years) a higher 24-hour insulin (36.0 [26-50] vs. 42 [34-63] units), higher BMI (25.1±4.1 vs. 27.8±4.6 kg/m2), higher CRP levels (1.2 [0.6-2.4] vs 1.5 [0.8-3.9] mg/L) and lower TIR (67 [51, 8] vs. 58 [46, 71] %).
Conclusion: The prevalence of NAFLD and liver fibrosis was 7.7% in individuals with T1D. Duration of T1D, markers of insulin resistance, glycemic control and inflammation are likely contributors to this high prevalence and more attention should be paid to this possible complication.

Disclosure
C. Fuhri Snethage: None. A.S. Meijnikman: None. P. de Groen: None. C. Callender: None. E. Rampanelli: None. C.B. Brouwer: None. D. van Raalte: Consultant; Boehringer Ingelheim and Eli Lilly Alliance, AstraZeneca, Merck & Co., Inc. Research Support; Boehringer Ingelheim and Eli Lilly Alliance, AstraZeneca, Merck & Co., Inc. M. Nieuwdorp: Advisory Panel; caelus health. N. Hanssen: Research Support; Novo Nordisk. Consultant; Novo Nordisk.

Funding
DNF DON Grant 2020 (2020.10.002)
1314-P: Adherence to Life’s Essential 8 and Incident Chronic Kidney Disease—A Prospective Study of 142,567 UK Biobank Participants
Authors: TANG RUI , WANG XUAN , LI XIANG , MA HAO , HEIANZA YORIKO , QI LU 
Published: June 2023

Background: The American Heart Association (AHA) recently updated an improved method for evaluating cardiovascular health (CVH): Life’s essential 8 (LE8). We aimed to investigate the association between levels of CVH and the risk of CKD in UK biobank.
Methods: A total of 142,567 participants free of CKD and CVD were included. LE8 score at baseline was created including DASH diet, physical activity, smoking, sleep, BMI, non-HDL cholesterol, HbA1c, and BP. CVH levels were categorized as low, moderate, and high. Cox proportional hazard model was used to investigate the association between LE8 and CKD.
Results: During a median follow-up of 11.8 years, 4,914 CKD cases were documented. We observed a linear dose-response relationship. Compared to participants with a low CVH, those with a moderate CVH were associated with a 35% lower risk of developing CKD (HR=0.65, 95% CI: 0.59, 0.73). Participants with a high CVH had a 48% lower risk of CKD incidence (HR=0.52, 95% CI: 0.45, 0.60) after adjustment for covariates. Additionally, the HR (95% CI) for each SD increment in behavior subscale score was 0.46 (0.39, 0.53) for CKD, and the HR (95% CI) for each SD increment in biological subscale score was 0.86 (0.76, 0.98) for CKD.
Conclusion: Participants with high CVH, defined by LE8, were significantly associated with a lower risk of CKD. The burden of CKD may be reduced by promoting adherence to optimal CVH levels.

Disclosure
R.Tang: None. X.Wang: None. X.Li: None. H.Ma: None. Y.Heianza: None. L.Qi: None.
1315-P: Examining Excess Hospitalizations in People With vs. Without Diabetes—A National U.S. Study
Authors: HARDING JESSICA L. , UPPAL TEG S. , TOMIC DUNYA , ALI MOHAMMED K. , MAGLIANO DIANNA J. 
Published: June 2023

Background: A diversification of diabetes-related complications has been observed due, in part, to declines in cardiovascular mortality and increases in time spent living with diabetes. We examined leading causes of excess hospitalizations among people with vs. without diabetes.
Methods: We used the 2019 National Inpatient Sample (numerator) and the 2019 Behavioral Risk Factor Surveillance Survey (denominator), weighted to reflect the U.S. population, to estimate rates of cause-specific hospitalizations in adults (≥18 years) with and without diabetes defined by ICD codes (numerator) and self-report (denominator). Annual age-standardized hospitalization rates were determined using three-digit ICD-10 codes, with excess risk and rate ratios reported. We grouped the top ten causes of excess hospitalizations as 1) traditional (e.g., vascular diseases); 2) emerging (e.g., liver disease); or 3) other complications.
Results: Americans with diabetes are at increased risk of hospitalization for most conditions, ranging from a 3% [rate ratio (RR): (1.00-1.05)] to a 9-fold increased risk [RR: 9.00 (8.96-9.04)]. The major causes for excess hospitalization in people with vs. without diabetes, according to traditional, emerging, or other complications are reported in Table 1.
Conclusions: The conditions responsible for excess hospitalizations in people with diabetes are more diverse than previously recognized.

Disclosure
J.L. Harding: None. T.S. Uppal: None. D. Tomic: None. M.K. Ali: Research Support; Merck & Co., Inc. Advisory Panel; Bayer Inc., Eli Lilly and Company. D.J. Magliano: None.
1318-P: Type 2 Diabetes as a Risk Factor for Dementia—An Analysis of Australian National Registries
Authors: MEHTA KANIKA , SALIM AGUS , SACRE JULIAN W. , ANSTEY KAARIN J. , MAGLIANO DIANNA J. , SHAW JONATHAN E. 
Published: June 2023

High dementia prevalence and associated disability have necessitated a focus on the identification of potentially modifiable risk factors. One such example is type 2 diabetes; however, there are not enough large population-based studies that can provide an accurate estimate of the strength of the association. Therefore, we investigated prospective associations between diabetes and dementia using Australian national registries. The study included ~850,000 people with type 2 diabetes (median age=66.2 years, females=45.5%) registered on the National Diabetes Services Scheme (NDSS) during the period 2002-2014 and followed up for at least 1 year (median 7.0 years). Propensity score matching (based on logistic regression with birth year, sex, socio-economic index and medication history as predictors) was then conducted to match (1:1) people with diabetes to a general population control group without diabetes. The latter comprised people with no registration history on NDSS or record of taking glucose lowering drugs on the Pharmaceutical Benefits Scheme (median age=67.3 years, females=43.9%, median follow up=7.5 years). Dementia was defined either by dementia drug use (cholinesterase inhibitors or memantine) or dementia-related death. The association between diabetes and dementia was examined using Cox’s proportional hazard model that treated each individual with diabetes and their matched control as one stratum. Diabetes was associated with an increased risk of dementia-related death (HR 1.19, 95% CI 1.17, 1.22), while no significant association was observed between diabetes and dementia medication use (HR 0.99, 95% CI 0.97, 1.02). When both dementia-related death and dementia drug use were included in the outcome, diabetes was still associated with an increased risk of dementia (HR 1.11, 95% CI 1.09, 1.14). These findings highlight the need for clinicians to be vigilant in identifying and managing diabetes as a potentially modifiable risk factor for cognitive decline and dementia.

Disclosure
K.Mehta: None. A.Salim: None. J.W.Sacre: None. K.J.Anstey: Speaker's Bureau; Nutricia. D.J.Magliano: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, Lilly, Zuellig Pharma Holdings Pte. Ltd., Mylan, Research Support; AstraZeneca, Speaker's Bureau; AstraZeneca, Roche Diagnostics, Lilly, Amgen Inc., Sanofi, Zuellig Pharma Holdings Pte. Ltd.

Funding
Deakin University (to K.M.); Alicia Baker and Eleanor Shaw Gender Equity Fellowship (to D.J.M.); National Health and Medical Research Council (APP1173952 to J.E.S.); Victorian Government’s Operational Infrastructure Support Program
132-LB: Real-World Effectiveness of My Dose Coach (MDC)-Assisted Basal Insulin (BI) Titration in People with Type 2 Diabetes (PWT2D) in Saudi Arabia and Kuwait
Authors: AL-SOFIANI MOHAMMED , ALMEHTHEL MOHAMMED , ALOZAIRI EBAA S. , SADIK JAMAA , HAO LICHEN , AKIL YASSER 
Published: June 2023

Insulin titration inertia is a key barrier to optimal glycemic control, particularly in areas where diabetes is highly prevalent and specialized healthcare professionals (HCP) are limited. MDC is a US FDA-approved digital smartphone application designed to help PWT2D to titrate BI according to HCP-prescribed individualized titration plan. This real-world analysis evaluated clinical outcomes in PWT2D in Saudi Arabia (SA) and Kuwait who were on BI therapy, registered on MDC from 05/01/2021 to 08/31/2022, and recorded ≥2 FBG readings in the app over a 2-week period. FBG target achievement, change in FBG, and hypoglycemia were assessed. A total of 197 MDC users with mean (SD) age of 51.5 (14.4) years were included (Table). Overall, 116 (58.9%) users achieved their individualized FBG target, 14 (7.1%) were still titrating and 67 (34.0%) stopped using MDC. The mean (SD) time to reach FBG target was 16.3 (20.8) days. Mean (SD) FBG decreased from 172.4 (75.7) mg/dL at baseline to 136.5 (54.3) mg/dL and BI dose increased from 21.9 (16.8) U to 25.1 (16.2) U. Moreover, high usage of MDC app was associated with a greater reduction in FBG versus moderate or low usage. Overall, hypoglycemia events were reported in 7 (3.6%) participants. PWT2D from SA and Kuwait were able to successfully utilize MDC app to titrate their BI doses and achieve FBG target with low risk of hypoglycemia

Disclosure
M. Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. M. Almehthel: None. E. S. Alozairi: None. J. Sadik: Employee; Sanofi. L. Hao: Employee; Sanofi. Y. Akil: Employee; Sanofi.

Funding
Sanofi
132-OR: Ten-Year Evaluation of Diabetes Categories in Youth Shows a Continuous Increase in Frequency of Newly Diagnosed Type 2 Diabetes—Results from the Worldwide SWEET Registry
Authors: CHERUBINI VALENTINO , ECKERT ALEXANDER J. , AMED SHAZHAN , BESANÇON STÉPHANE , CAVALLO AITA FRED , CRIMMINS NANCY A. , GEVERS EVELIEN F. , JEFFERIES CRAIG A. , KIM JAEHYUN , SHAH SEJAL , VAMVAKIS ANASTASIOS , GESUITA ROSARIA , BEHALF OF THE SWEET STUDY GROUP ON 
Published: June 2023

Background: To evaluate the frequency of youth with type 2 diabetes (T2D) using data from the multinational consortium SWEET e.V.
Methods: The frequency of newly diagnosed T2D across all categories of diabetes in youth under 21 registered in the SWEET database during 2012-2021 was analysed. Trends in biennial proportions in five world regions (Europe, EU; Australia/New Zealand, AU/NZ; South America, SA; North America/Canada, NA; Asia/Africa, AS/AF) were estimated using logistic regression models adjusted for age at onset and sex.
Results: Table 1 shows the proportion of patients across diabetes categories over the study period in two-year steps. The increase in T2D rate was 9.0% per two years [95% CI 5.7-12.3] and was significant in EU (10.4% [3.8-17 .3]), AU/NZ (13.6% [3.5-24.7]), and NA (8.7% [3.8-14.0]). The overall increase in T2D during COVID-19 pandemic was similar to the previous biennial increase, while AU/NZ and NA showed the highest increase (respectively from 9.5% to 12.2%, p=0.999; from 7.7% to 13.2%, p&lt;0.001).
Conclusions: There has been a steady increase in T2D observed worldwide over time. Findings suggest that more prevention efforts are needed to contain the public health impact in the near future. The Covid-19 pandemic did not affect the overall trend in frequency of youth with T2D observed over the 10-year period.

Disclosure
V.Cherubini: None. S.Shah: Research Support; Boehringer-Ingelheim, Takeda Pharmaceutical Co., Ltd. A.Vamvakis: None. R.Gesuita: None. On behalf of the sweet study group: n/a. A.J.Eckert: None. S.Amed: None. S.Besançon: None. F.Cavallo aita: None. N.A.Crimmins: None. E.F.Gevers: Other Relationship; Novo Nordisk, Speaker's Bureau; Novo Nordisk. C.A.Jefferies: None. J.Kim: None.
1320-P: Causal Mediators of Underlying Socioeconomic Status Disparities in Hospitalization Risk among Patients with Type 2 Diabetes (T2D)
Authors: CHEN WEI-HAN , HUANG YU , DONAHOO WILLIAM T. , BIAN JIANG , GUO JINGCHUAN 
Published: June 2023

Socioeconomically disadvantaged groups carry a disproportionally increased risk of T2D-related adverse outcomes, yet few studies have addressed how modifiable social risk factors drive such health disparities. We aimed to estimate to what extent housing instability explained unemployment or education disparities in hospitalization risk in patients with T2D. We used electronic health records data from the University of Florida Health System and identified patients with T2D in 2015-2020. We conducted causal mediation analyses using marginal structural models to test the causal mediator role of housing insecurity in the association between education or employment and hospitalization risk. Of 9,144 eligible patients, mean (SD) age was 58 (13) years, and 17% were hospitalized in the follow-up year. We observed an increased hospitalization risk in those who were unemployed (odds ratio [OR]: 1.21, 95% CI: 1.04-1.41) and those with lower education levels (1.38 [1.17-1.62]). Housing insecurity, as a causal mediator, explained 11% of the unemployment-hospitalization association, but it had minimal contribution to the education-hospitalization association (2%). Unemployment status and lower education were associated with an increased risk of hospitalization in T2D. Housing insecurity modestly contributed to unemployment disparities in hospitalization risk in T2D.

Disclosure
W.Chen: None. Y.Huang: None. W.T.Donahoo: None. J.Bian: None. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)