bluuebunny/crossref_metadata_2025_split huggingface dataset:
1214-P: Trends in the Use of Glycemic Testing for Diabetes among Medicare Fee-for-Service Beneficiaries, 2001–2018
Authors: ANDES LINDA J. , BENOIT STEPHEN R. , ROLKA DEBORAH B. , IMPERATORE GIUSEPPINA , HOLLIDAY CHRISTOPHER S. 
Published: June 2023

Glycemic tests are an important tool in screening patients for diabetes and prediabetes but there is little literature describing changes in patterns of glycemic testing over time. Using claims data for Medicare Fee-for-Service (FFS) beneficiaries without diabetes, we examined trends and demographic variation in the use of glycemic screening tests. Beneficiaries with diabetes were identified by ICD diagnosis codes while tests were identified with HCPCS/CPT procedure codes.
The number of fully enrolled Medicare FFS beneficiaries without diagnosed diabetes ranged from 17.1 million in 2001 to 14.6 million in 2018. The total number of tests ranged from 2.7 million in 2001 to 4.8 million in 2018, and after 2009, the majority administered were HbA1c tests. The rate of glycemic testing was calculated as the percent of beneficiaries without diagnosed diabetes having at least one of any glycemic test per year. Testing rates were calculated by sex, age, race/ethnicity and state. The annual percentage of beneficiaries without diabetes who had any glycemic test increased from 10.6% in 2001 to 22.5% in 2018. Testing rate varied little across sex, age and race/ethnicity groups with 2 exceptions: beneficiaries age 85+ had a much lower testing rate (17.8% in 2018) than other age groups (23.6%); and beneficiaries of Asian or Pacific Islander descent had a much higher testing rate (31.7% in 2018) than other race/ethnicity groups (between 22.0–24.8%). However, testing rates did vary considerably among states: in 2018, ranging from a low of 11.1% in Wyoming to a high of 33.9% in Hawaii.
Glycemic testing for diabetes has increased steadily since 2010, largely due to increased use of HbA1c tests. However, fewer than 1 in 4 Medicare FFS beneficiaries were tested in 2018, suggesting that opportunities remain to improve screening and diagnosis of diabetes among older adults.

Disclosure
L.J.Andes: None. S.R.Benoit: None. D.B.Rolka: None. G.Imperatore: None. C.S.Holliday: None.
1215-P: Attitudes towards Diabetes Technology in Older Adults with Diabetes
Authors: ZENG ALISON , XU EMILY , BELL TREVOR , BRISTOW TRACY L. 
Published: June 2023

Diabetes technology such as insulin pumps and continuous glucose monitors (CGMs) have been shown to improve glycemic control and reduce the burden of diabetes. Despite these benefits, however, there remain challenges to technology adoption in the aging population. This study aimed to explore older people with diabetes' (PWD) attitudes towards technology and understand barriers to its implementation.
In December 2022, 2,585 PWD aged 65 or older (24% type 1, 61% female) in the United States took an online survey assessing how aging affects their ability to manage diabetes as well as how beneficial they believe diabetes technology to be. Those who did not view diabetes technology as very or extremely beneficial (n=737) further elaborated on their hesitations towards adopting technology in open-ended responses (5% type 1, 69% female). Results were analyzed both quantitatively and qualitatively.
The most common aging-related challenges with managing diabetes were difficulty exercising (39%), reduced hypoglycemia awareness (11%), and forgetting to take medication/insulin (8%). Interestingly, technology was of little concern; only 1% had difficulties using diabetes technology and the majority (66%) rated diabetes technology as very or extremely beneficial for diabetes management. CGM users (92% vs. 51%, p&lt;.001) and pump users (96% vs. 59%, p&lt;.001) in particular were more likely to view diabetes technology as beneficial than non-users. Qualitative analysis identified main barriers to adopting technology among older PWD, which included cost/insurance coverage (18%), satisfaction with current treatment options (14%), and time and effort spent learning how to use the device (12%).
This research reveals that negative actual and perceived benefits of diabetes technology likely do not serve as barriers to their implementation among older PWD. Rather, barriers to adoption stem primarily from cost-related factors and concerns about training, suggesting the need to invest in more in-depth education for older PWD.

Disclosure
A.Zeng: Employee; dQ&A. E.Xu: Employee; dQ&A. T.Bell: Employee; dQ&A. T.L.Bristow: Employee; dQ&A.
1218-P: All-Cause Mortality in Individuals Aged 65+ Years with Type 2 Diabetes With and Without Frailty—Clinical Utility of Electronic Frailty Index to Individualise HbA1c Targets
Authors: CRABTREE THOMAS S.J. , VINOGRADOVA YANA , ALDAFAS RAMI , GORDON JASON , IDRIS ISKANDAR R. 
Published: June 2023

Frailty and type 2 diabetes (T2D) is fast becoming a clinical challenge especially in the elderly population. Despite clear guidance on the need to evaluate individualised HbA1c targets in connection with frailty status with mortality risk, there is a lack of formal evidence on these associations. To guide healthcare professionals in setting appropriate HbA1c targets, this study aimed to investigate the association between mortality in connection with electronic frailty index (eFI) and HbA1c, as well as exploring the clinical utility of eFI as a tool to individualise HbA1c targets in frail patients with T2D.
Methods: We included patients with T2D aged 65+ within UK primary care electronic database (the Clinical Practice Research Datalink) and Hospital Episode Statistics from 2014-19. All-cause mortality (ACM) risk associated with 4 frailty groups (non-frail; mild; moderate and severe) (defined by electronic frailty index scores, eFI) and seven HbA1c groups at 1.0% intervals were assessed using multivariate Cox regression analysis adjusted for demographic and clinical characteristics. The reference group was defined as “non-frail” individuals with HbA1c 6.5-7.5%.
Results: 179,723 individuals (mean±SD; age 74.8±7.6years, diabetes duration 7.3±6.1years, HbA1c 55.7±15.8mmol/mol) were followed for mean 1.7 years. Within all frailty groups, the risk of ACM was greatest at HbA1c&lt;5.5%, with highest risk observed in moderate (HR 3.34; 95%CI 2.80, 3.99) and severe frailty (HR 3.27; 95%CI 2.73, 3.91) groups. In all groups, ACM risk increased with higher HbA1c levels compared to HbA1c 6.5-7.5% (a “U-shaped” curve).
Conclusion: Both high and low HbA1c levels increase the risk of ACM for people 65+ with T2D and frailty in a “U-shaped” association between HbA1c and ACM. This study supports eFI as a useful tool to facilitate HbA1c target setting in older patients with T2D and to manage ACM risk.

Disclosure
T.S.J.Crabtree: Speaker's Bureau; Abbott Diabetes, Novo Nordisk, Lilly, Sanofi, Insulet Corporation. Y.Vinogradova: None. R.Aldafas: None. J.Gordon: Employee; Health Economics and Outcomes Research Ltd. I.R.Idris: None.
1220-P: Age Differences in the Effects of Multicomponent Periodontal Treatments on Oral and Metabolic Health among People with Diabetes Mellitus—A Meta-epidemiological Study
Authors: ZHU ZHENG , QI XIANG , ZHENG YAGUANG , PEI YAOLIN , WU BEI 
Published: June 2023

Objectives: To explore the age differences in the effect of multi-component periodontal treatment on oral and metabolic indicators in people with periodontitis and diabetes.
Methods: Six databases (PubMed/Medline, Embase, CINHAL, Web of Science, Cochrane Library, and ProQuest) were searched from database inception to August 2022. Trials reporting the effects of multi-component periodontal treatment on oral and metabolic indicators in people over 18 years old with periodontitis and diabetes were included. We used bivariate and multivariate meta-regression models to examine the association between age and treatment effect size. The primary outcomes were changes in pocket depth (PD), clinical attachment level (CAL), and hemoglobin A1c (HbA1c).
Results: A total 115 trials (119 articles) met the inclusion criteria. Pooled evidence demonstrated that multi-component periodontal treatment significantly reduced PD (g=0.929, 95% CI [0.689-1.169], I2=94.1%), CAL (g=0.879, 95% CI [0.669-1.089], I2=92.1%), and HbA1c (g=0.603, 95% CI [0.443-0.763], I2=87.5%). There was a significant decreasing trend in the effect size for PD (P for trend = 0.020) and CAL (P for trend = 0.028) as age increases. Results from multivariate meta-regression showed that age was associated with smaller effects of PD (β [standard error] = -0.123 [0.041], P=0.004) and CAL (-0.159 [0.055], P=0.006). The effect size for HbA1c was smaller in participants older than 55 years compared to their younger counterparts (-0.792 [0.322], P=0.017).
Conclusions: The effect size of multi-component periodontal treatments on PD and CAL may decrease as people with periodontitis and diabetes age increases. The treatment effect on HbA1c is significantly lower in people older than 55 compared to their younger counterparts. The components of periodontal treatment should be adjusted to the individual’s periodontal and glycemic control levels.

Disclosure
Z.Zhu: None. X.Qi: None. Y.Zheng: None. Y.Pei: None. B.Wu: None.

Funding
National Institutes of Health (P30AG059304, P50MD017356)
1231-P: Influence of Diabetes on the Progression of Preclinical Stage B Heart Failure Phenotypes to Heart Failure
Authors: ECHOUFFO TCHEUGUI JUSTIN , NDUMELE CHIADI E. , ZHANG SUI , MATSUSHITA KUNIHIRO , NAMBI VIJAY , SKALI HICHAM , SELVIN ELIZABETH 
Published: June 2023

Introduction: The extent to which diabetes influences progression from preclinical heart failure (HF) stage B phenotypes (2021 Universal Definition) to overt HF or death is unknown.
Methods: We included 4,264 adults with preclinical HF (stage A [n = 1,174] or B [n = 3,090]) who attended the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 (2011-2013). Stage A was defined by HF risk factors only. Stage B1: echocardiographic abnormalities but no biomarker elevation; Stage B2: elevated NT-pro-BNP ≥125 pg/mL and/or hscTnT&gt;14 ng/L but no echocardiographic abnormality; Stage B3: echocardiographic and biomarker abnormalities. We assessed the associations of diabetes and each preclinical stage B phenotype with incident HF and HF or death.
Results: Among the participants (mean age 76 years, 62% women, 24% Black), there were 383 HF events and 730 deaths during 8.6 years of follow-up. Diabetes conferred a high absolute risk of HF across all preclinical stages B HF, but more so for the Stage B3 phenotype (Table). In cross-categories of preclinical HF stages (A and B) and diabetes status, participants with diabetes and Stage B3 had the highest risks of HF or HF and death combined, compared to those in stage A without diabetes.
Conclusion: Addressing diabetes appears to be critical in stage B individuals with both echocardiographic and biomarkers abnormalities for preventing the progression to HF.

Disclosure
J.Echouffo tcheugui: None. C.E.Ndumele: None. S.Zhang: None. K.Matsushita: Consultant; Fukuda Denshi, Akebia Therapeutics, Inc., AMGA, Other Relationship; Kowa Company, Ltd. V.Nambi: Research Support; Amgen Inc., Kowa Pharmaceuticals America, Inc. H.Skali: Consultant; Astellas Pharma Inc., Elsevier, Wolters Kluwer Health, APM Tunisia / Hikma. E.Selvin: None.

Funding
National Institutes of Health (K23HL153774)
1233-P: The Association between Subgingival Microbiome, Subclinical Cardiovascular Disease, and Type 1 Diabetes
Authors: XIAO MIANLI , SARKAR ANUJIT , SNELL-BERGEON JANET K. , CHANDRASEKARAN SANGEETHA , JOHNSON LONNIE R. , BURKHARDT BRANT R. , PETROSINO JOSEPH , ALMAN AMY C. 
Published: June 2023

Background: Dysbiosis in the subgingival microbiome is the root cause of periodontal disease, a risk factor of cardiovascular disease (CVD), but its association with subclinical CVD, particularly among those with type 1 diabetes (T1D) is unclear.
Methods: We included 283 subjects with (n=141) and without (n=142) T1D. We performed 16S rDNA sequencing on subgingival plaque samples and identified amplicon sequence variants. Subclinical CVD was measured by carotid intima-media thickness (cIMT), pulse wave velocity (PWV), and brachial artery distensibility (BrachD).
Results: Beta diversity differed between T1D and the nondiabetes (ND) group (F = 1.66, P=0.024). As shown in Figure 1, in the stratified generalized linear model (adjusted for age, gender, race, smoking, alcohol drinking, BMI, and additionally HbA1c in the T1D model), we observed 4 taxa in the T1D group and 28 taxa in the ND group to be associated with cIMT (all Padj&lt; 0.05). Moreover, 8 and 17 taxa were associated with BrachD (lower value suggests worse status) in T1D and ND groups, and 6 and 5 for PWV (all Padj &lt; 0.05). Some associations were in opposite directions by diabetes status, especially for cIMT.
Conclusion: We observed differences in the subgingival microbiome profile between those with and without T1D. Subgingival microbiome taxa were associated with subclinical CVD measures, with some differences observed by diabetes status.

Disclosure
M. Xiao: None. A. Sarkar: None. J.K. Snell-Bergeon: None. S. Chandrasekaran: None. L.R. Johnson: None. B.R. Burkhardt: None. J. Petrosino: None. A.C. Alman: None.

Funding
National Institutes of Health (5R01DE026480)
1243-P: Usefulness of New Criteria for Metabolic Syndrome Optimized for Prediction of Cardiovascular Diseases in Japanese
Authors: MITSUMA YURIE , FUJIHARA KAZUYA , MURAI KOSHIRO , SATO TAKAAKI , YAGUCHI YUTA , YAMADA MAYUKO H. , YAMAMOTO MASAHIKO , OSAWA TAEKO , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMADA TAKAHO , KATO KIMINORI , SONE HIROHITO 
Published: June 2023

The use of multiple diagnostic criteria for metabolic syndrome (MetS) may miss high-risk populations for cardiovascular disease. Moreover, since women are more likely to have subcutaneous fat deposits than men, the predictive ability of cardiovascular disease may be improved by optimizing the cut-off value of each component of criteria according to sex and considering whether to include waist circumference (WC) as a required component. In a nationwide cohort of 565,079 men and women from 2008 to 2016 in Japan, we analyzed the association between MetS and each component and the development of CAD, CVD, or CAD/CVD using multivariate Cox regression. Of these 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD, with a 1.3- to 2.9-fold increased risk of CAD/CVD when current MetS components were met. The optimal thresholds for predicting CAD/CVD by ROC analysis in men and women were WC 83 and 77 cm, triglycerides 130 and 90 mg/dl, HDL-C 50 and 65 mg/dl, BP 130/80 and 120/80 mmHg, and FPG of 100 and 90 mg/dl, respectively. Although no significant difference was detected between the current MetS criteria and our modified criteria in the ability to predict CAD/CVD, using the new criteria increased prevalence of MetS and significantly improved sensitivity (Table). Optimizing MetS criteria could significantly reduce the number of high-risk individuals overlooked by the current criteria.

Disclosure
Y.Mitsuma: None. Y.Matsubayashi: None. M.Iwanaga: None. T.Yamada: None. K.Kato: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. K.Murai: None. T.Sato: None. Y.Yaguchi: None. M.H.Yamada: None. M.Yamamoto: None. T.Osawa: None. M.Kitazawa: None.
1254-P: Assessing Prediabetes and Diabetes Screening Eligibility and Detection in Adults by ADA and USPSTF Guidelines in the NIH’s All of Us Research Program
Authors: ZENG CHENJIE , CASSINI THOMAS , FERRARA TRACEY M. , SCHLUETER DAVID , TRAN TAM C. , DENNY JOSH 
Published: June 2023

ADA and USPSTF recommended diabetes screening starting at age 35 recently. We estimated the percentage of adults with undiagnosed prediabetes or diabetes who can be detected by USPSTF and ADA guidelines in all and by racial/ethnicity groups in the All of Us cohort. We then identified predictors of incident T2D. Among 50,705 eligible participants, we identified 20,150 with undiagnosed prediabetes and 1,860 with undiagnosed diabetes at enrollment, &gt;99% of whom met the ADA 2022 screening criteria, which outperformed USPTSF ones (57.4% and 67.4%). All results were similar to findings from a recent NHANES study. Substantial racial disparities were identified in stratified analyses. The percentage of undiagnosed prediabetes was 37.7%, 50.8% and 38.2% in White, Black and Hispanic populations, respectively and it was 2.6%, 7.8% and 3.8%, respectively, for undiagnosed diabetes (all p&lt;2e-16). However, the ADA 2022 guideline can detect almost all (&gt;98.8%) the undiagnosed, particularly in the understudied populations. During the 4 year follow up, 23% of the undiagnosed diabetes were subsequently diagnosed, with race, income, education, and insurance being the strongest predictors. In summary, the new ADA guideline can effectively facilitate early detection of diabetes across all populations, but barriers still exist to effectively screen and diagnose equitably.

Disclosure
C.Zeng: None. T.Cassini: None. T.M.Ferrara: None. D.Schlueter: None. T.C.Tran: None. J.Denny: None.

Funding
National Institutes of Health (HG200417)
1257-P: Changes in Circulating Pancreatic Islet-Specific MicroRNA-375 Levels and Improvements in Insulin Sensitivity and Glucose Metabolism in Response to Weight-Loss Diets with Different Compositions of Macronutrients—The POUNDS Lost Trial
Authors: HEIANZA YORIKO , XUE QIAOCHU , MA HAO , BRAY GEORGE , SACKS FRANK , QI LU 
Published: June 2023

Pancreatic islet-specific microRNA-375 (miR-375) regulates insulin secretion and has an essential role in β-cell compensation when escalating insulin demand. We recently reported that changes in circulating miR-375 were associated with improved diabetogenic fat depots. Here, we investigated whether changes in circulating miR-375 induced by weight-loss diet interventions with different macronutrient intakes (fat, carbohydrate (carb), and protein) were related to improved insulin sensitivity and glucose metabolism. This study included participants from the POUNDS Lost trial with available data on circulating miR-375-3p at baseline (n=520) and its changes from baseline to 6 months after weight-loss diet interventions (n=508). At baseline, higher levels of miR-375 were related to lower degrees of BMI, total adipose tissue mass, and whole-body fat content (P &lt;0.05 for all). There was a significant increase in miR-375 levels from baseline to 6 months (P by paired t-test &lt;0.001). We found that associations of changes in miR-375 with changes in fasting insulin, glucose, and insulin resistance (HOMA-IR) were significantly modified by carb and fat intakes (P interaction &lt;0.05 for all). In response to a low-fat and high-carb diet, a greater increase in miR-375 was significantly associated with larger reductions of fasting insulin and HOMA-IR at 6 months, regardless of baseline miR-375 levels. On the other hand, in response to a high-fat and low-carb diet intervention, there were significant positive associations between miR-375 changes and changes in glucose, insulin, and HOMA-IR. These results suggest that changes in the pancreatic islet-specific miRNA expression are associated with weight-loss diet intervention outcomes on insulin sensitivity and glucose metabolism. Different macronutrient intakes may modify these associations.

Disclosure
Y.Heianza: None. Q.Xue: None. H.Ma: None. G.Bray: Advisory Panel; Medifast, Inc., Herbalife International of America, Inc. F.Sacks: None. L.Qi: None.

Funding
National Institutes of Health (DK091718, DK100383, DK115679)
1258-P: Gestational Diabetes by IADPSG Criteria and Risk of Adverse Birth Outcomes
Authors: CARTER SARAH A. , LIN JANE C. , CHOW TING , MARTINEZ MAYRA P. , KLARA FELDMAN R. , PAGE KATHLEEN A. , XIANG ANNY 
Published: June 2023

This study assessed risk of adverse birth outcomes (ABO) associated with GDM by Carpenter-Coustan (C&C) and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) with and without abnormal fasting at OGTT screening. Data included 355,506 singletons born in a single healthcare system. Data on demographics, maternal GDM status with or without abnormal fasting, and six ABOs [caesarean section (CS), shoulder dystocia (SD), fetal distress (FD), neonatal hypoglycemia (NH), preterm birth (PTB), and large-for gestational age (LGA)] were extracted from electronic medical records. Logistic regression was used to assess associations adjusting for covariates. In this cohort, 27,990 (7.9%) were diagnosed by C&C and 21,464 (6.0%) by IADPSG. In the C&C group, 37.3% had abnormal fasting (C&C_AF); among IADPSG, 23.3% met OGTT fasting thresholds (IADPSG_AF). Table 1 shows odds ratios (OR) of ABOs associated with GDM diagnostic types relative to no GDM. GDM by C&C or IADPSG with or without abnormal fasting was associated with higher odds of CS, PTB (except IADPSG_AF), and LGA (except C&C without abnormal fasting). IADPSG without abnormal fasting was associated with higher odds of SD and NH, and C&C_AF was associated with higher odds of SD but lower odds FD and NH. These data suggest GDM by IADPSG was associated with risk of some ABOs; this group may benefit from diabetes care in pregnancy to reduce risk of ABOs.

Disclosure
S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. R.Feldman: None. K.A.Page: None. A.Xiang: None.
1263-P: Gender Differences in the Impact of Low Muscle Mass on Type 2 Diabetes Incidence—Eighteen-Year Follow-up Data from the Prospective Korean Genome and Epidemiology Study
Authors: SOOK KIM EUN , CHO YUNJUNG , HONG OAK-KEE , MOON SUNGDAE , HAN JEHO , JIB YOO SOON , CHO NAM H. 
Published: June 2023

Background: Current evidence suggests that diminished muscle mass is associated with an increased risk of diabetes. This study aimed to investigate whether the effect of low muscle mass (LMM) on incident diabetes varied depending on the tracking period using a prospective, longitudinal design.
Methods: We recruited 6968 subjects without diabetes, aged 40 to 69 years, from the Korean Genomes and Epidemiology study and followed them to monitor the development of type 2 diabetes mellitus (T2DM). A standard 75-g oral glucose tolerance test was conducted at every 2-year follow-up visit. Skeletal muscle mass was assessed using bioelectrical impedance analysis, and a weight-adjusted skeletal muscle mass was defined as muscle mass index (MMI). We assessed the relationship between LMM, the sex-specific lowest tertile of MMI, and the risk of developing T2DM using Cox regression models.
Results: Of 6968 (47.4% men), 1846 progressed diabetes during the 18-year follow-up. LMM was associated with an increased risk of T2DM at 10 years and 10-18 years of follow-up in both genders after adjustment for confoundings. After additional adjustment for waist circumference, men with LMM were at significant risk of incident diabetes during the 10-year follow-up (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.28-1.86) but lost significance in 10-18 years., whereas women with LMM were at significantly increased risk (HR 1.32, 95% CI 1.03-1.69) only in 10-18 years. Over 18 years, LMM in men was consistently associated with an increased risk of diabetes from the initial period (at 2-year follow-up), whereas LMM in women has been shown to increase risk in the late period (from 12-year follow-up).
Conclusion: This study showed that LMM is an independent risk factor for T2DM with gender differences over time. LMM was a constant risk factor for diabetes in men, whereas it affected the later onset of diabetes in women.

Disclosure
E.Kim: None. Y.Cho: None. O.Hong: None. S.Moon: None. J.Han: None. S.Yoo: None. N.H.Cho: None.