bluuebunny/crossref_metadata_2025_split huggingface dataset:
581-P: The Effects of Resistance Training on Insulin Resistance Development in Female Rodents with Type 1 Diabetes
Authors: SAMMUT MITCHELL , MCBEY DAVID , JAMES MELLING C.W. 
Published: June 2023

The etiology of insulin resistance (IR) development in type 1 diabetes (T1D) remains unclear; however, impaired glucose metabolism in skeletal muscle may play a role. While IR development has been established in male rodents with T1D, female rodents have yet to be examined in this context. Resistance exercise training (RT) has been shown to improve IR and is associated with a lower risk of hypoglycemia onset in T1D compared to aerobic exercise. The purpose of this study was to investigate the effects of RT on IR development in female rodents with T1D. Forty Sprague-Dawley 8-week-old female rats were divided into four groups: control sedentary (CS; n=10), control trained (CT; n=10), T1D sedentary (DS; n=10), T1D trained (DT; n=10). Multiple low-dose Streptozotocin injections (20 mg/kg each day for 7 consecutive days) were used to induce T1D. Blood glucose levels were maintained in normal range (4-9mmol/L) with one implanted insulin pellet (2IU/day). CT and DT underwent weighted ladder climbing 5 days/week for 6 weeks. Intravenous glucose tolerance tests (IVGTT) were conducted on all animals during weeks 4 and 7. Results demonstrate that DS animals exhibited significantly increased weekly blood glucose measures compared to all groups including DT (p&lt;0.05), despite similar insulin dosage levels. This was concomitant with a significant increase in area under the curve following IVGTT from week 4 to week 7 in DS (p&lt;0.05), indicative of a reduction in insulin sensitivity. DS animals also exhibited significantly greater glycogen content in white gastrocnemius muscle compared to all groups (p&lt;0.05). These results indicate that female rodents with T1D develop poor glycemic control and IR which can be attenuated with RT, possibly related to differences in glycogen content within muscle. This data supports the negative role of elevated muscle glycogen on insulin sensitivity in T1D and the potential role of RT in ameliorating these metabolic changes.

Disclosure
M.Sammut: None. D.Mcbey: None. C.Melling: None.
593-P: Effect of Nurse-Led Exercise Intervention in Type 2 Diabetes Mellitus
Authors: LIU XIAOQIAN , JIA ZHUMIN , NIU WENCHANG , FANG WENJING 
Published: June 2023

Objective: To investigate the effect of diabetes nurse specialist-led exercise on ankle-brachial index (ABI) and glucose and lipid metabolism in patients with type 2 diabetes mellitus (T2DM).
Methods: 60 patients with T2DM without exercise contraindication who were discharged from the Department of Endocrinology in a hospital were selected and randomly divided into the experimental group (36 cases) and the control group (24 cases). The two groups were given routine diabetes diet and medication guidance, while the experimental group wore a scanning flash glucose monitoring (FGM), heart rate arm watch, and exercised in the endocrinology clinic once every other day for 45 minutes for a total of two weeks. Nurse specialists give the home exercise guidance based on the exercise program obtained from the outpatient exercise intervention, and the patient sent the exercise status to the WeChat group for a total of 22 weeks. The control group were guided by nurse specialists in accordance with the exercise guidelines for 24 weeks. The changes of ABI, fasting blood glucose, glycosylated hemoglobin, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and triglyceride contents were compared between the two groups.
Results: After 24 weeks, the ABI in the experimental group was higher than that in the control group (1.07±0.73 vs 1.04±0.09, P&lt;0.05), the glycosylated hemoglobin in the experimental group was lower than that in the control group (6.81±1.09 vs 7.57±1.66 mmmol/L,P&lt;0.05), and the low density lipoprotein cholesterol in the experimental group was lower than that in the control group (1.88±0.73 vs 2.80±0.78 mmmol/L,P&lt;0.01).
Conclusion: Diabetes nurse specialist-led exercise intervention can significantly improve ABI and glucose and lipid metabolism in T2DM.

Disclosure
X.Liu: None. Z.Jia: None. W.Niu: None. W.Fang: None.

Funding
Henan Province Science and Technology Project Joint Construction (LHGJ20190557)
594-P: Untrained Men and Women with Diabetes Mellitus Have Impaired Interoceptive Accuracy
Authors: SUMMERS JACK , MIKLJA ZACHARY , LOCKETTE WARREN 
Published: June 2023

Background: The ADA recommends 150 minutes/week of physical activity for patients with diabetes mellitus (DM). Training-induced reductions in autonomic reactivity could impair awareness of hypoglycemia (IAH) in some patients with DM unless there are compensatory signals of low blood glucose not dependent upon the autonomic nervous system. The receptors for exteroceptive senses (e.g. temperature, pain, vision, hearing) are known, interoceptive signal transduction is unexplored. This mechanism allows us to detect the cardiac, respiratory, and gastric sensations from stress (“My heart is pounding,” and “I can’t breathe,” and I feel queasy”).
Hypothesis: We posit cardiac interoceptive accuracy (IA) is impaired in patients with DM, but exercise training could enhance IA and reduce IAH. We assessed IA in healthy, fit subjects, and also, untrained men and women with DM.
Methods: IA was determined by comparing the number of heartbeats a subject could count without taking their pulse while their EKG was surreptitiously recorded. Heart rate variability (HRV) was assessed by measuring the root mean square of successive differences of the interval between sequential heartbeats.
Results: Although MAP was not significantly different between these two cohorts, when compared to DM (N=8), the fit subjects (N=9) had (all values in mean ± SEM) lower resting HR (63±3 vs. 85±4 bpm, p&lt;0.001) and greater HRV (85±4 vs. 69±11 ms, p=0.01) and IA (82±7 vs. 50±12 in percent, p=0.02). Furthermore, HR was highly correlated with both HRV (r=−0.63, p=0.007) and IA (r=−0.72, p=0.001). Conclusion: Untrained DM have diminished IA which may be improved by fitness training without fear of worsening IAH; resting HR should be used to track changes in HRV and IA as DM subjects undergo fitness training.

Disclosure
J.Summers: None. Z.Miklja: None. W.Lockette: None.
595-P: Exercise Training Improves Cardiorespiratory Parameters but Not VO2peak in People with Type 2 Diabetes
Authors: MIDDELBEEK ROELAND , SIMPSON LAURA , HANSBURY GEORGIA A. , CARBONE NICHOLAS P. , NIGRO PASQUALE , LESSARD SARAH J. , VAMVINI MARIA , GOODYEAR LAURIE 
Published: June 2023

Maximal oxygen consumption (VO2peak), a measure of cardiorespiratory fitness (CRF), is a strong predictor of mortality. People with type 2 diabetes (T2D) have lower VO2peak compared to healthy controls, and unfortunately, studies suggest that training has limited effects to improve VO2peak in T2D. Although VO2peak is a key component, additional respiratory functions may also be important markers of cardio-metabolic fitness. Here, we determined the effects of a 10-week moderate-intensity exercise training program on VO2peak, power (indicator of muscle strength), VO2/work (index of the body’s efficiency at producing work), OUES (protective in heart failure), and ventilatory threshold (marker of aerobic endurance) in lean, obese, and T2D subjects. Training improved VO2peak in lean and obese, but not in T2D (Table 1). Likewise, training increased power, and tended to increase OUES in lean and obese, but not T2D. However, training was effective in increasing ventilatory threshold (VT) and VO2/Work in T2D, and also improved glycemic control (HbA1c). We hypothesize that the increased VT functions to improve training-induced muscular efficiency and capillary delivery, contributing to improved glycemic control. In conclusion, despite no change in VO2peak, exercise training increases multiple CRF and metabolic parameters in people with T2D, and should continue to be a mainstay in treatment of T2D.

Disclosure
R.Middelbeek: Research Support; Novo Nordisk. L.Simpson: None. G.A.Hansbury: None. N.P.Carbone: None. P.Nigro: None. S.J.Lessard: None. M.Vamvini: None. L.Goodyear: None.

Funding
National Institutes of Health (K23DK114550 to R.M.), (R01DK112283 to L.G.); Joslin Diabetes Center (T32DK07260-038, 5P30DK36836)
6-OR: PAR2 Downregulates Adipose LPL through MIF—A Novel Adipose Mechanism Contributing to the Development of Hypertriglyceridemia
Authors: HUANG YIHENG , LI LISHA , CHEN LIUJUN , CHEN XI , GAO PINGYI , QI YADAN , QI DAKE 
Published: June 2023

Lipoprotein lipase (LPL) is a key enzyme that hydrolyzes circulating triglycerides to release fatty acid (FA). In adipose tissue, LPL is required for lipid storage. However, it is currently unknown whether alteration of LPL in white adipose tissue (WAT) contributes to the development of hypertriglyceridemia. Our present study indicated that WAT isolated from human obese patients have increased expression of PAR2 which is negatively associated with LPL gene. The reduced LPL expression is also negatively correlated with increased plasma TG levels, suggesting that adipose PAR2 may modulate hyperlipidemia through downregulating LPL. In mice, aging and high palmitic oil diet significantly increased PAR2 expression in adipose tissue which was associated with high plasma MIF levels. PAR2 deficiency attenuates the rise of MIF, suggesting a key role of PAR2 in regulating adipose MIF release. MIF reduced LPL expression and activity in adipocytes. In a MIF overexpressed animal model (Mif lung Tg), high circulating MIF levels inhibited adipose LPL which was associated with increased plasma triglyceride but not fatty acid. Following high palmitic oil diet feeding, adipose LPL expression and activity were also reduced, and this reduction was reversed in PAR2 knockout mice. Interestingly, PAR2 mediated LPL in adipose tissue regulates hypertriglyceridemia through controlling adipocyte lipid storage. In Par2-/- mice, recombinant MIF perfusion recovered high plasma MIF levels, which decreased LPL and attenuated adipocyte lipid storage leading to hypertriglyceridemia. These data together suggest that the downregulation of adipose LPL by PAR2/MIF is an important mechanism for the development of hypertriglyceridemia.

Disclosure
Y.Huang: None. L.Li: None. L.Chen: None. X.Chen: None. P.Gao: None. Y.Qi: None. D.Qi: None.

Funding
Canadian Institutes of Health Research (PJT156116)
606-P: The Effect of a Dietary Intervention on Insulin Requirements in Type 1 Diabetes—A 12-Week Randomized Clinical Trial
Authors: KAHLEOVA HANA 
Published: June 2023

Background and Objective: A plant-based has been shown to improve glycemic control and insulin resistance in people with type 2 diabetes. The aim of this study was to test the effect of this diet in people with type 1 diabetes.
Methods: Fifty-eight people with type 1 diabetes were randomly assigned to follow a low-fat vegan diet (vegan group, n=29), or a standard portion-controlled diet (control group, n=29) for 12 weeks. All meals were tracked, using the Cronometer mobile application. Insulin sensitivity was assessed, using the carbohydrate to insulin ratio, which was calculated as the number of grams of total dietary carbohydrate to total units of insulin administered. Total insulin dose was calculated as a sum of basal and bolus insulin units injected per day.
Results: The consumption of carbohydrates increased in the vegan group by an average of 118 g/day (p=0.002), compared with no significant change in the control group (−18 g/day; p=0.11; treatment effect +137 [95% CI, +65 to +208]; p&lt;0.001). Insulin sensitivity, assessed by the carbohydrate to insulin ratio, increased in the vegan group by 6.2 on average (p=0.002), compared with no significant change in the control group (−0.8; p=0.32; treatment effect +7.0 [95% CI, +3.1 to +10.9]; p=0.001). Total daily dose of insulin decreased by 12.1 units/day in the vegan group (p=0.007), compared with no significant change in the control group (−18 units/day; p=0.66; treatment effect −10.7 [95% CI, −21.3 to −0.2]; p=0.046).
Conclusions: This study suggests that a low-fat vegan diet may have beneficial effects on insulin sensitivity and insulin requirements in people with type 1 diabetes. Larger trials are needed to confirm these findings.
Trial Registration: ClinicalTrials.gov, NCT04944316

Disclosure
H.Kahleova: None.

Funding
Physicians Committee for Responsible Medicine (330072)
607-P: The Impact of Telenutrition vs. In-Person Nutrition Consultations on Glycemic Control in People with Type 1 Diabetes—Data from Saudi Arabia
Authors: AL-SOFIANI MOHAMMED , ALMUAMMAR SARA 
Published: June 2023

Background: Telehealth has the potential to improve accessibility to nutrition clinics, particularly in parts of the world where the number of certified nutritionists is limited. Here, we evaluate the impact of utilizing telehealth for nutrition consultations on glycemic control and patients satisfaction when managing people with type 1 diabetes (PwT1D).
Methods: A retrospective analysis of data from 137 PwT1D referred to the nutrition clinic at King Saud University to learn carb counting (2021-2022). Participants were divided into 2 groups: 1) Telenutrition group (those who had 4 virtual & 2-3 in-person visits) (n=107) and 2) In-person group (those who had 6-7 in-person & no virtual visits) (n=30). Changes in hemoglobin A1C and CGM metrics from baseline to month 3 (i.e. end of the study (EOS)) were compared between the groups. At the EOS, participants were asked to fill out a satisfaction survey.
Results: The reduction in A1c from baseline to EOS was comparable in both groups (1.2% and 1.1%, in the Telenutrition and In-person groups, respectively, both p&lt;0.01). Likewise, the glucose time in range (TIR) increased from 53.9% at baseline to 58.5% at the EOS (p&lt;0.01) in the telenutrition group and from 49.1% at baseline to 54.7% at the EOS (p=0.13) in the in-person group. This was accompanied by a significant reduction in the prandial insulin doses from baseline to EOS by 32% in the telenutrition group and 28% in the in-person group (both p&lt;0.01). Majority (98%) of those who attended the telenutrition clinic reported satisfaction with the quality of healthcare provided and 97% reported that their experience with the telenutrition clinic was as satisfying or more satisfying than that in the in-person clinic.
Conclusion: Telenutrition clinic is as effective in improving glycemic control in people with T1D as the traditional “in-person” nutrition clinics, and its utilization may improve patients' satisfaction and accessibility to certified nutritionists

Disclosure
M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Almuammar: None.
610-P: Comparison of Dietary Habits among Rural Americans With and Without Diabetes
Authors: RONY MELISSA , QUINTERO ARIAS CAROLINA , WISE NATHAN N. , PRABU ANIRUDH , DORAN KELLY , ANTHOPOLOS REBECCCA , ELBEL BRIAN , THORPE LORNA , LEE DAVID C. 
Published: June 2023

Introduction: Residents of rural communities face unique geographic challenges in accessing food and healthcare, which may contribute to poor diet quality and increase the risk of diabetes. We compared Alternative Healthy Eating Index (aHEI) scores among residents with and without a history of diabetes from a rural county in New York known to have poor health outcomes.
Methods: In 2021, we performed a cross-sectional survey and validated food frequency questionnaire (FFQ) among residents in Sullivan County, NY, a rural county that has the second-worst health outcomes among all counties in New York. We compared overall total aHEI scores and the 11 component scores of the aHEI between 155 rural participants with diabetes and 961 without a history of diagnosed diabetes.
Results: We found statistically lower healthy eating scores among rural study participants with diabetes compared to those without diabetes (p=0.01). While the overall magnitude of this difference in total aHEI was not large (54.1 versus 56.7), our analysis of aHEI component scores found that study participants with diabetes had statistically worse eating habits for nuts/legumes, red meat, trans-fats, and alcoholic drinks (p-values of 0.036, 0.001, 0.002 and 0.002 respectively). Notably, one category where rural residents with diabetes had better eating habits than those without diabetes was for sugary beverages/juice.
Discussion: Our study found worse eating habits among rural residents with diabetes compared to those without diabetes in a rural county with particularly poor health outcomes. Additionally, this study highlights the potential need for accessible nutritional education in high-risk rural communities. While study participants with diabetes on average, consumed fewer sugary beverages and juice, more attention may need to be focused on reducing other food categories that might increase the risk of poor glycemic control.

Disclosure
M.Rony: None. C.Quintero arias: None. N.N.Wise: None. A.Prabu: None. K.Doran: None. R.Anthopolos: None. B.Elbel: None. L.Thorpe: None. D.C.Lee: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)
618-P: Association of Intuitive Eating Patterns and Metabolic Control in Outpatients with Type 2 Diabetes
Authors: ALMEIDA JUSSARA , KOLLER OLIVIA G. , MENEZES VANESSA M. , BUSANELLO ALINE 
Published: June 2023

Aim: Evaluate the possible association between intuitive eating (IE) patterns and metabolic control in patients with type 2 diabetes (T2DM).
Methods: Cross-sectionally, outpatients with T2DM attended in University Hospital (Brazil) were submitted to clinical, laboratory, and lifestyle evaluation. IE was assessed by Intuitive Eating Scale-2 (IES-2). Metabolic control evaluated were BMI, HbA1c, LDL and triglycerides targets according to ADA recommendations. Eating patterns were identified by cluster analysis and patients characteristics were compared by appropriate tests. P&lt;0.05 (two-tailed) was considered statistically significant. Study approved Hospital's Ethics Committee (2020-0654).
Results: A total of 267 patients were evaluated: 62.2% female, 60 (53-65) years old, BMI=31.9±5.4kg/m², diabetes duration=16±9 years, HbA1c=8.5±1.5%, and median IES-2 total score was 58 (50-67)%. Three IE patterns were identified: Pattern 1=patients with higher intuitive eating; Pattern 2=non emotional-oriented coping; Pattern 3=patients with lower intuitive eating. Pattern 3 patients were younger, included a higher proportion of women, with obesity, psychotropic drugs use, and higher HbA1c values than those in Pattern 1, but not than Pattern 2. Pattern 1 patients presented a lower BMI, fasting plasma glucose and serum triglycerides values as compared to the other groups (P&lt;0.05 for all analyses). Logistic regression models confirmed the association of Pattern 3 with higher obesity prevalence (OR=2.21; 95%CI=1.04-4.70) and triglycerides values out of target (OR=3.32; 95%CI=1.53-7.71) as compared to Pattern 1, after adjusting for confounders. No associations were observed between HbA1c out of target and lower intuitive eating.
Conclusion: In this sample of outpatients with T2DM, eating less intuitively was associated with higher obesity prevalence and triglycerides values out of target as compared to eating more intuitively.

Disclosure
J.Almeida: None. O.G.Koller: None. V.M.Menezes: None. A.Busanello: None.

Funding
CAPES (001); FIPE/HCPA (2020-0654)
624-P: Portrayal of Perceived Stigma across Ages in Type 1 Diabetes—A BETTER Registry Analysis
Authors: HOUSNI ASMAA , KATZ ALEXANDRA , KICHLER JESSICA C. , NAKHLA MERANDA , BRAZEAU ANNE-SOPHIE 
Published: June 2023

Background: People with type 1 diabetes (PWT1D) perceiving high diabetes-related stigma are less likely to report in-target A1c levels. We hypothesized that people with higher levels of stigma have suboptimal psychosocial outcomes and that stigma would be perceived differently across age groups.
Methods: Cross-sectional analysis of 709 PWT1D aged ≥14 years in the BETTER T1D registry (Quebec, Canada) who completed the T1D Stigma Assessment Scale (DSAS-1). The DSAS-1 (/95) includes 3 subscales; Blame & Judgment (6 items), Identity Concern (7 items), and Treated Differently (6 items). Individuals who perceived more stigma compared to the total cohort (DSAS-1 mean score +1 standard deviation), were stratified into groups by age to determine associations with diabetes self-management behaviours and outcomes.
Results: Across groups, youth (n=105; 14-24 years) had the highest stigma perception (20%), followed by 18% in middle-aged adults (n=401; 35-64 years), then 15% for both young adults (n=130; 25-34 years) and seniors (n=73; 65+ years). The majority of youth, young and middle-aged adults, and seniors perceived stigma as Blame & Judgment (51%, 44%, 33%, and 19%, respectively). Stigma related to Identity Concern was highest among seniors (15%). In an age- and diabetes duration-adjusted models, 40% of adjusted variance in stigma score was explained by increased diabetes distress (p&lt;0.001), depression (p=0.005), hyperglycemia avoidance behaviours (p&lt;0.001), fear of hypoglycemia (p&lt;0.001) and decreased social support (p&lt;0.001).
Conclusion: Interventions targeting diabetes-related stigma need to be tailored for different age groups to target suboptimal diabetes self-management behaviours and improve psychosocial outcomes.

Disclosure
A.Housni: None. A.Katz: None. J.C.Kichler: None. M.Nakhla: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.

Funding
JDRF (4-SRA-2018-651-Q-R); Canadian Institutes of Health Research (JT1-157204)
63-LB: Real-Time Continuous Glucose Monitoring (rtCGM) Is Associated with Improved Clinical and Psychosocial Health in People with Type 2 Diabetes on Basal Insulin (T2D-BI)
Authors: CRAWFORD MARGARET A. , HICKS CHRISTIAN , ZHOU TERESA , KLEINHANZL AFSHAN , SINGH HARSIMRAN 
Published: June 2023

Background and Aims: Introduction of basal insulin (BI) can be an intimidating treatment escalation due to increased risk of hypoglycemia and weight gain for people with type 2 diabetes (T2D). There is growing evidence supporting the glycemic and quality of life benefits of rtCGM in T2D. We analyzed survey and rtCGM data for T2D-BI users of the Dexcom G6 rtCGM system to investigate the impact on sensor metrics, self-reported body weight, and psychosocial health.
Methods: Three hundred T2D-BI Dexcom G6 users completed online surveys regarding their demographics and diabetes health. Participants’ sensor metrics were analyzed for duration of wear and glycemic changes from CGM initiation onwards (14-day time periods with ≥70% data available). Changes in variables were evaluated for clinical significance (weight loss ≥5%, transition to A1C &lt;7%, ΔTIR ≥5%) and statistical significance (p&lt;0.05 from paired t-tests).
Results: Data from 150 CGM-naïve (prior to Dexcom G6 initiation) T2D-BI users were analyzed. Mean (IQR) age=60 years (53, 70), 45% female, 81% White, 50% reported annual household income &lt;$75K. CGM duration was 11 months (4, 13). Body weight at baseline=235 pounds (190, 270), A1C=8.4% (7, 9.3), TIR= 69% (58, 86). Reported weight loss averaged 13 (-20, 0) pounds, A1C decrease averaged 1.6 (-2.5, 0) percentage points (both p&lt;0.001) with no increase in hypoglycemia. Overall, 53 users experienced clinically significant weight loss (5% of total body weight), 48 improved their A1C to &lt;7%, and 46 improved TIR by ≥ 5%. Participants reported healthier eating patterns, simplified diabetes management routines, and increased peace of mind using Dexcom G6. Conclusions: These real-world outcomes demonstrate clinically valuable improvements in T2D-BI on Dexcom G6 with respect to glycemic control, body weight, diabetes behaviors, and psychosocial health.

Disclosure
M. A. Crawford: Employee; Dexcom, Inc. C. Hicks: Employee; Dexcom, Inc. T. Zhou: Employee; Pfizer Inc. A. Kleinhanzl: Employee; Dexcom, Inc. H. Singh: Employee; Tandem Diabetes Care, Inc., Dexcom, Inc.