bluuebunny/crossref_metadata_2025_split huggingface dataset:
489-P: Abnormal Combined Point-of-Care-Device DPN-Check and SUDOSCAN Results Predict All-Cause Mortality in People with Diabetes
Authors: SHAAN GOONOO MOHUMMAD , SELVARAJAH DINESH , SLOAN GORDON P. , TESFAYE SOLOMON 
Published: June 2023

Aims: Diabetic peripheral neuropathy (DPN) has been associated with increased mortality; however, data is not available for objectively diagnosed DPN using point-of-care-devices (POCDs). We therefore examined the predictive validity of POCD-diagnosed DPN for increased mortality in a prospective study.
Methods: A total of 245 consecutive people with diabetes (17 type 1 diabetes, age 62.3+14.3) attending retinal-screening had all annual review health checks in a One-stop Screening Service. DPN assessments included Toronto Clinical Neuropathy Score (TCNS) evaluation, 10g-monofilament test(10g-MFT) and two validated, objective POCDs, DPN-Check (handheld device measuring sural nerve conduction velocity/amplitude), and SUDOSCAN (measuring sudomotor function). Mortality data was collected at 7-year follow-up. Kaplan-Meier survival curves and Cox-proportional hazards models were generated to assess associations of DPN measures with all-cause mortality.
Results: At follow-up, 52 [21.2% (SE 6.8%)] had died. Those who died were older at screening [72.4 (10.9) vs 59.6 (13.9) years; (p&lt;0.001)]. The prevalence of screen-detected DPN was 12.6% (SE 4.4%) for 10g-MFT, 27.7% (SE 8.2%) for TCNS and 33.4% (SE 9.1%) for combined POCDs. In crude Kaplan-Meier analyses all-cause mortality risk was greater in patients with abnormal TCNS (p&lt;0.001) and POCDs (p&lt;0.001) but was equivalent in patients with normal or abnormal 10g-MFT (p=0.21). After adjusting for age, HbA1c and Total Cholesterol, only abnormal POCDs was significantly associated with all-cause mortality [HR 1.18 (p=0.04, 95%CI 1.00:1.39) vs TCNS [HR 1.33 (p=0.06, 95%CI 0.99:1.78)].
Conclusions: This is the first prospective study showing abnormal combined DPN-Check and SUDOSCAN results predict all-cause mortality after adjusting for other risk factors. However, 10g-MFT and TCNS that diagnose DPN late did not predict all-cause mortality.

Disclosure
M.Goonoo: None. D.Selvarajah: None. G.P.Sloan: None. S.Tesfaye: Advisory Panel; Bayer Inc., Wörwag Pharma GmbH & Co. KG, Angelini, Speaker's Bureau; Viatris Inc., Nevro Corp., Procter & Gamble, Novo Nordisk, Berlin-Chemie AG.
5-OR: Adipocyte ANGPTL8 Regulates Insulin Sensitivity and Thermogenic Programing
Authors: GHOSH ANINDYA , PRENTKI MARC , LEUNG YAT H. , YU JEFFREY C.Y. , SLADEK ROBERT M. , CHENIER ISABELLE , OPPONG ABEL , PEYOT MARIE-LINE , MADIRAJU MURTHY , AL-KHAIRI IRINA , ABUBAKER JEHAD , AL-MULLA FAHD , ABU-FARHA MOHAMED 
Published: June 2023

ANGPTL8 (A8), expressed mainly in the liver and adipocytes, regulates lipoprotein lipase (LPL) and lipid metabolism. Hepatic A8 and ANGPTL3 form a complex that inhibits LPL. However, the precise intracellular role of A8 in adipocytes is yet to be explored. We observed that RNAi-knockdown of A8 in mouse primary subcutaneous (SC) pre-adipocytes reduces adipocyte differentiation, glycerol, and fatty acid release at day 7 post-differentiation. RNAseq analysis of A8 siRNA or control siRNA transfected SC pre-adipocytes on days 0, 2, 4 and 7 of differentiation showed that A8 silencing impeded adipogenic and oxidative phosphorylation pathways and reduced expression of insulin signaling pathway genes IRS1, IRS2, PPARG, mTOR, early during differentiation, suggesting a role for A8 in the regulation of insulin sensitivity. Next, we investigated the functional role of adipose A8 by generating conditional adipocyte-specific A8 Knockout (AT-A8-KO) mice. AT-A8-KO mice on 45% high fat diet (HFD) with 30% fructose for 20 weeks showed a decrease in body weight gain, glycemia, brown fat mass, plasma TG and smaller cell size of SC adipocytes, while increased rectal temperature compared to controls. Interestingly, OGTT revealed AT-A8-KO mice in control diet or in HFD have significantly lower insulinemia. ITT results confirmed significant improvement of insulin sensitivity of AT-A8-KO mice on HFD. In addition, upon exposure to 6°C for 24h, AT-A8-KO mice exhibited elevated body temperature and energy expenditure compared to control mice, indicating that adipose tissue A8 negatively modulates cold-induced thermogenesis. Our results reveal that A8 regulates in vitro adipocyte differentiation, probably by modulating insulin signaling and mitochondrial respiration, and that deletion of adipocyte A8 in mice enhances insulin sensitivity, cold induced body temperature and energy expenditure. Therefore, targeting adipose specific A8 may be beneficial in promoting insulin sensitivity and preventing obesity.

Disclosure
A.Ghosh: None. I.Al-khairi: None. J.Abubaker: None. F.Al-mulla: None. M.Abu-farha: None. M.Prentki: None. Y.H.Leung: None. J.C.Y.Yu: None. R.M.Sladek: None. I.Chenier: None. A.Oppong: None. M.Peyot: None. M.Madiraju: None.

Funding
Dasman Diabetes Institute (731)
50-LB: Impact of an Avocado Voucher Program on Cardiometabolic Health in Hispanic/Latino Adults With or At-Risk of Type 2 Diabetes—A Pilot Study
Authors: BEVIER WENDY C. , MELERO LILIANA , SATO IMURO SANDRA E. , PAI AMRUTA , GORDON MAREA , GONZALEZ KARLA , GLANTZ NAMINO , SABHARWAL ASHUTOSH , KERR DAVID 
Published: June 2023

Hispanic/Latino (HL) adults bear a greater burden of type 2 diabetes (T2D), and dietary factors have been linked to almost half of cardio-metabolic disease deaths. Avocados are rich in beneficial fats, vitamins, minerals, & fiber. To test the hypothesis that avocado consumption will improve glucose control and cardio-metabolic health in HL adults with or at-risk of T2D, we recruited 59 HL adults (45 women) who were randomized to an Active (A) group - receiving free avocado vouchers for 12 weeks, or a Control (C) group - no avocado vouchers. Subjects (53 T2D, 4 at risk, 2 unknown) had clinical measurements, blood draws, and continuous glucose monitors (CGMs) at Baseline (BL) and Conclusion (CL). Daily avocado consumption logs were kept. At BL, A and C groups did not differ in avocado consumption/day (0.8±0.6 vs 0.5±0.3, respectively). At CL, A group consumption was significantly greater (1.4±0.4 vs 0.4±0.3), p&lt;0.001. Results are shown below. No significant differences between groups were found for time in range (TIR) 70-140 or 70-180 mg/dL or time above (TAR) 180 mg/dL. Providing vouchers to HL adults with or at-risk of T2D significantly increased avocado consumption and did not affect HbA1c, fasting glucose, weight, or CGM metrics but may have influenced waist circumference (WC) and triglycerides.

Disclosure
W. C. Bevier: None. L. Melero: None. S. E. Sato imuro: None. A. Pai: None. M. Gordon: None. K. Gonzalez: None. N. Glantz: None. A. Sabharwal: None. D. Kerr: Consultant; Sanofi-Aventis U. S.

Funding
Hass Avocado Board (C2021-0068)
507-P: Trajectories of Inflammatory Proteins over Diabetic Wound Healing Course
Authors: PICKETT SARA , MOON SALINA , THEOCHARIDIS GEORGIOS , MD DOM ZAIPUL , NIEWCZAS MONIKA , VEVES ARISTIDIS 
Published: June 2023

Background: Inflammatory processes are dynamic over the Diabetic Foot Ulceration (DFU) course. We aimed to evaluate longitudinal trajectories of circulating biomarkers in subjects with DFU.
Methods: The study cohort comprised 39 subjects with DFU from the Joslin-Beth Israel Deaconess Foot Center. During the 12 weeks of follow-up (6 bi-weekly visits), 15 subjects (38%) had their DFU healed (healers). Twenty-eight proteins were measured at each visit on the Luminex platform.
Results: Circulating IL-10 levels at baseline were significantly higher in DFU healers in comparison with non-healers (OR: 2.4, p=0.047). Moreover, IL-10 levels remained stable over time within each group (IL10 Δ in DFU healers: p=0.2 and in non-healers: p=0.8). Levels of 6 other proteins revealed dynamic trajectories over time in one or both groups: MMP-2, EGF, IFNγ, TNF, IL-8, and MIP1b. MMP-2 levels in healers increased from baseline to V6 (β=0.07, p=0.0003), but remained stable in non-healers.
Conclusion: We identified an anti-inflammatory cytokine, IL-10, as a prognostic biomarker of the diabetic wound healing course. Six inflammatory proteins (MMP-2, EGF, IFNγ, TNF, IL-8, and MIP1b) revealed dynamic temporal changes in levels within or across groups.

Disclosure
S.Pickett: None. S.Moon: None. G.Theocharidis: None. Z.Md dom: None. M.Niewczas: None. A.Veves: None.

Funding
National Institutes of Health (R61DK131915, R01DK091949); Joslin Diabetes Center; National Rongxiang Xu Foundation
508-P: Association between Initial Outpatient Diabetic Foot Ulcers Infection Management Strategy and Hospitalization
Authors: SCHMIDT BRIAN M. , ARMSTRONG DAVID G. , BUSUI RODICA 
Published: June 2023

The objective was to evaluate the impact of the initial management strategies for DFU infections diagnosed at an outpatient multidisciplinary center. In 2019, people with newly diagnosed DFU infection were followed for duration of therapy to determine hospitalization rates within 30 days of diagnosis. Consecutive patients were stratified according to Infectious Disease Society of America infection severity. Demographic, socioeconomic, and antibiotic data was recorded. Among 147 persons treated for DFU infection, 59% infections were mild, while 30% and 4% were moderate and severe, respectively. Empiric antibiotics, consisting of either a cephalosporin or penicillin (76%) were prescribed for initial treatment in 116 individuals, and 66% (n=77) of these had tissue cultures preceding the treatment. Despite initial management of outpatient infection, 42% of the entire cohort required hospitalization within 30 days of diagnosis; 50%, 38%, and 12% hospitalizations were mild, moderate, and severe infections, respectively. The percentage of hospitalizations which occurred in mild infection treated with only empiric antibiotic (58%) was 1.5x greater than culture-directed antibiotic therapy (34%) despite similar empiric antibiosis. High rates of hospitalizations occurred in moderate (49%) and severe (100%) DFU infection. Overall, there was a negative association (r = -0.50, p&lt;0.05) between implementation of culture-directed antibiotic strategy and hospitalization, and increased hospitalizations with applying empiric therapy for mild DFU infection. These data strongly support the practice to obtain tissue culture regardless of DFU infection severity to guide further treatment, as it is negatively associated with hospitalization rates. It is therefore essential to ensure foot infection treatment involves culture-directed antibiotic therapy and is applied uniformly across infection severity.

Disclosure
B.M.Schmidt: None. D.G.Armstrong: Research Support; Medaxis LLC. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK131261-01A1)
509-P: There Is No Blood for Improvement—Anemia Cuts Down Healing Chances in Diabetic Foot Patients
Authors: GIANGRECO FRANCESCO , IACOPI ELISABETTA , MALQUORI VITTORIO , PIERUZZI LETIZIA , GORETTI CHIARA , PIAGGESI ALBERTO 
Published: June 2023

Aim: Anemia is considered a marker of severity of diabetes and diabetic foot syndrome (DFS) but is still controversial if it can be taken as a predictor of negative outcomes in these patients. Our study aimed to evaluate if anemia could be associated with a reduction of healing chances in patients admitted for DFS.
Methods: We retrospectively analysed all patients admitted in our Department in 2021 for DFS, dividing them in two groups according to presence (Group A) or absence (Group B) of anemia, diagnosed on levels of total Hemoglobin (HB) and red blood cells (RBC) below normal values (HB 13 g/dl for men and 12 g/dl for women and RBC 4.5×106/mm3 for men and 4.2×106/mm3 for women). We compared the groups for clinical and demographic characteristics, blood chemistry, procedures and clinical outcomes: healing rate (HR) and recurrences rate (RR). Among anemic patients we compared clinical outcomes according to the reduction of HB or RBC alone or both.
Results: We derived data from 196 patients: 114 patients in Group A [58.1%; age 70.9±10.6 yrs; male/female 75.4/24.6%; DM1/DM2 7.0/93.0%; Hba1c 57.5±18.6 mmol/mol; diabetes duration (DD) 20.1±11.9 yrs] and 82 in Group B (41.8%; age 68.4±10.9 yrs; male/female 61.0/39.0%; DM1/DM2 9.8/90.2%; Hba1c 60.6±16.2 mmol/mol; DD 16.8±11.9 yrs). Group A presented higher (p&lt;0.05) male prevalence and shorter disease duration but no differences in comorbidities, and surgical or vascular procedures. Group A showed a lower HR (55.2% vs 76.8%, p=0.0028) and a higher RR (23.6% vs 17.1%, p&lt;0.002). No difference in terms of HR, HT or R according to the different diagnostic criteria for anemia. In Cox’s logistic regression analysis only anemia negatively affected healing (HR 2.8, CI 95% 1.4-5.4, p=0.0037).
Conclusions: Anemia is associated to a reduction in healing chances in DFS patients and represents an independent predictor of healing failure.

Disclosure
F.Giangreco: None. E.Iacopi: None. V.Malquori: None. L.Pieruzzi: None. C.Goretti: None. A.Piaggesi: None.
543-P: A Peer-Led Diabetes Self-Management Education (DSME) and Support (DSMS) Intervention for Black Men with Type 2 Diabetes—Results of a Three-Month Pilot Randomized Clinical Control Trial
Authors: EWEN ALANA , KLOSS KATHERINE A. , NWANKWO ROBIN , FUNNELL MARTHA M. , PIATT GRETCHEN , HAWKINS JACLYNN M. 
Published: June 2023

Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die from diabetes complications than non-Hispanic White men. To address the unique challenges this group faces in diabetes self-management, we implemented a 3-month peer-led and empowerment-based DSME/S intervention in metro-Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were recruited and randomized to either the intervention group (n=12) − 10 hours of DSME and 9 hours of DSMS, or to an enhanced usual care (EUC) group (n=13) − 10 hours of DSME. Peer leaders (n=3), trained by certified diabetes care and education specialists (CDCES) who used training materials related to Black men with diabetes, led the sessions (mean age: 59.7 years; 100% Black, male, and with at least some college education). Changes in A1C levels, diabetes self-care activities, and diabetes distress levels were assessed at baseline and post-intervention. In the intervention group, the mean A1C at baseline was 7.73%, SD 2.16, and at follow-up, 7.06%, SD 1.39. The EUC group experienced a 0.13% decrease in A1C levels (p = 0.68). Within the intervention group, differences in average diet and blood-glucose testing scores, both measured using the Summary of Diabetes Self-Care Activities (SDSCA) measure, from baseline were statistically significant [(p = 0.03, mean change: 1.32, SD 1.71) and (p &lt; 0.05, mean change: 0.50, SD 0.74), respectively]; EUC group general diet scores were: p = 0.08, mean change: 1.77. Diabetes distress scores among those who attended 1-6 sessions, ≤ 50%, (n=4): p = 0.92, mean change: −0.75, SD 14.06. Of those who attended 7-12 sessions, &gt; 50%, (n=7), the decrease in score was statistically significant: p = 0.003, mean change: −5.71, SD 3.20. Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the program is warranted to measure sustainability.

Disclosure
A.Ewen: None. K.A.Kloss: None. R.Nwankwo: None. M.M.Funnell: None. G.Piatt: None. J.M.Hawkins: None.

Funding
National Institute on Aging (2P30AG024824–16); Blue Cross Blue Shield Foundation of Michigan (003063.MG)
55-OR: HSK7653, a Novel Ultralong-Acting DPP-4 Inhibitor, as Monotherapy in Patients With Type 2 Diabetes—A Randomized, Double-Blind, Placebo-Controlled Phase III Trial
Authors: JI LINONG , BIAN FANG , PAN TIANRONG , JIANG HONGWEI , JIANG CHENGXIA , REN QIAN 
Published: June 2023

Background: HSK7653 is a novel ultralong-acting DPP-4 inhibitor that maintains the average plasma DPP-4 inhibition over 80% for 14 days after 10mg or 25mg dosing. This randomized, double-blind, placebo-controlled phase III trial was conducted to evaluate the efficacy and safety of HSK7653 biweekly as monotherapy for 52 weeks in drug naive type 2 diabetes patients with inadequate glycemic control on diet and exercise.
Methods: A total of 475 patients with a mean HbA1c level of 8.1% were randomized to HSK7653 10mg, 25mg or placebo biweekly at a ratio of 1:1:1 for 24 weeks of double-blind treatment, followed by 28 weeks of open-label extension treatment with HSK7653 25mg for all patients. The primary endpoint was the change in HbA1c from baseline at 24 weeks.
Results: At week 24, the least-squares mean change in HbA1c from baseline was -0.96% in HSK7653 10mg, -0.92% in HSK7653 25mg and -0.33% in placebo. HSK7653 10mg and 25mg treatment resulted in significant placebo-subtracted changes in HbA1c of -0.63% (95% CI: -0.81%, -0.46%, p&lt;0.0001) and -0.59% (95% CI: -0.77%, -0.42%, p&lt;0.0001), respectively. The percentage of patients achieving HbA1c&lt;7.0% was 44.2% in HSK7653 10mg group and 44.4% in HSK7653 25mg group versus 20.6% in placebo group (p&lt;0.0001 for HSK7653 groups vs. placebo). No meaningful body weight changes were observed in all treatment groups. In the open-label extension treatment (from week 24 to week 52), the sustaining reduction of HbA1c from baseline were observed in HSK7653 10mg switched to 25mg group and HSK7653 25mg maintenance group. There were no excess hypoglycemia events in HSK7653 vs. placebo, and the incidence of adverse events was similar in all groups during the treatment.
Conclusions: In people with type 2 diabetes who had inadequate glycemic control on diet and exercise, HSK7653 monotherapy significantly improved glycemic control with well tolerability and safety. Clinical trial information: NCT04556851.

Disclosure
L.Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck & Co., Inc., Bayer Inc., Sanofi-Aventis U.S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics. F.Bian: None. T.Pan: None. H.Jiang: None. C.Jiang: None. Q.Ren: None.
550-P: Food Insecurity and the Efficacy of a Gestational Diabetes (GDM) Risk Reduction Intervention—Healthy Eating Outcomes among American Indian and Alaska Native (AI/AN) Female Adolescents and Young Adults (FAYAs)
Authors: SEREIKA SUSAN M. , STOTZ SARAH A. , HEBERT LUCIANA E. , SCARTON LISA , MOORE KELLY R. , CHARRON-PROCHOWNIK DENISE 
Published: June 2023

AI/ANs are unduly impacted by GDM and food insecurity. Employing a clinical trials design, this secondary analysis used Stopping GDM trial data to describe and explore food insecurity as a moderator of the efficacy of a GDM risk reduction intervention on healthy eating behaviors and self-efficacy at 3 months among AI/AN FAYAs. Participants were AI/AN FAYAs and their mothers. Assessments included mother’s food insecurity using USDA Household Food Security Survey Module and FAYA’s healthy eating self-efficacy using Self-Efficacy for Healthy Eating and healthy eating behaviors from CDC Youth Risk Behavior Surveillance System. The sample (N=149 dyads) was FAYAs (mean age 16.7±3.0 years) and their mothers, with 64% (n=95) living together. More than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p=.045) and cohabitating dyads (p=.002). By 3 months healthy eating self-efficacy (p=.048) and limiting snacking between meals (p=.031) improved more in the control group than the intervention group but only for cohabitating dyads. For the full sample the intervention group had increases in times eating vegetables (p=.022) and fruit (p=.015), while the control group had declines. In the full sample food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p≥.05) but did moderate the group by time interaction for times drinking soda (p=.004) and days eating breakfast (p=.013). For cohabitating dyads food insecurity did moderate self-efficacy for eating 3 meals a day (p=.024) and days eating breakfast (p=.012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on ‘upstream causes’ of GDM health disparities among AI/AN communities.

Disclosure
S.M.Sereika: None. S.A.Stotz: None. L.E.Hebert: None. L.Scarton: None. K.R.Moore: Consultant; Novo Nordisk. D.Charron-prochownik: None. The stopping gdm study group: n/a.

Funding
National Institutes of Health (R01NR014831)
56-LB: “They did not anticipate anybody living a full life with type 1”—Perspectives on Aging with Type 1 Diabetes
Authors: HUGHES ALLYSON , KRUPAR MEGHAN , STUCKEY HEATHER L. , VANDYKE ERIKA 
Published: June 2023

People with type 1 diabetes are living longer and in 2030, 1/5 of the U.S. population will be older adults - 65 years of age and older. This study addressed the scarcity of research on the experiences of aging people with type 1 diabetes. All participants were recruited from T1D Exchange, an online community for individuals with type 1 diabetes. Nineteen older adults with diabetes (average age = 65.63, SD = 6.27 years, average type 1 diabetes duration = 36.97, SD = 18.94 years) were interviewed. The interviews were recorded, transcribed, and thematically analyzed by two independent coders. Participants described their disease management challenges, and gaps in available resources. Themes included positive and negative changes over their lifespan due to advancements in technology and knowledge, diabetes micro-management strategies, hypoglycemia unawareness, diabetes psychological health, and lack of diabetes resources about aging. Also, a lack of support may promote poor health outcomes and diabetes distress. Additional research should be conducted to better understand the needs of this population and what federal and state policies can be created or tailored to support them.

Disclosure
A. Hughes: None. M. Krupar: None. H. L. Stuckey: Consultant; Eli Lilly and Company. E. Vandyke: None.