bluuebunny/crossref_metadata_2025_split huggingface dataset:
1072-P: Diabetes Mellitus and Risk of Breast Cancer: A Large-Scale, Prospective, Population-Based Cohort Study
Authors: XIONG FANXIU , WANG JINGXUAN , NIERENBERG JOVIA L. , SCHMAJUK GABRIELA , GRAFF REBECCA E. 
Published: May 2022

Background: A previous meta-analysis identified a weak association between diabetes and breast cancer (BCa) risk among postmenopausal women. The heterogeneity among studies, however, was substantial, and many of the included studies were susceptible to residual confounding by body mass index (BMI) and other BCa risk factors. The objective of this study was to evaluate associations of diabetes overall, type 1 diabetes (T1D) , and type 2 diabetes (T2D) with BCa risk within the UK Biobank cohort.
Methods: We included 250,312 women aged 40-69 years between 20 and 2010, who were free of cancer at enrollment. Multivariable Cox regression models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of diabetes and its two major types with the time from enrollment to incident BCa.
Results: We identified 8182 BCa diagnoses during a median follow-up of 11.1 years. We found no overall association between diabetes and BCa risk (adjusted HR [aHR] = 1.03, 95% CI = 0.93- 1.15) . When further accounting for diabetes subtype, T2D did not demonstrate a significant association with BCa (aHR = 1.01, 95% CI = 0.90- 1.12) . Women with T1D, however, had a higher risk of BCa than women without diabetes (aHR = 1.51, 95% CI = 1.03 - 2.22) . The associations of diabetes, T1D, and T2D with BCa did not vary by age, menopausal status, BMI, or other BCa risk factors.
Conclusions: We did not observe associations between diabetes or T2D and BCa among women within the UK Biobank. However, our data suggested that women with T1D may have an increased risk of BCa. Larger studies are warranted to investigate the relationship of T1D with BCa and its subtypes.

Disclosure
F. Xiong: None. J. Wang: None. J.L. Nierenberg: None. G. Schmajuk: None. R.E. Graff: None.
1074-P: Variation in Predicted Fracture Risk by Diabetes and Obesity Status in Older U.S. Asian and White Women
Authors: LO JOAN C. , CHANDRA MALINI , GORDON NANCY P. , LEE CATHERINE 
Published: May 2022

Introduction: Diabetes (DM) is a risk factor for fracture but women with DM have less osteoporosis by bone density (BMD) , due in part to higher body mass index (BMI) . The FRAX fracture risk calculator incorporates age, race/ethnicity, BMD, BMI, and other risk factors but not DM. Few studies have examined FRAX by DM and obesity status in different race groups. We compared predicted fracture risk in US Asian and White women by DM and obesity status.
Methods: We studied 3,640 Asian (26% DM, 24% osteoporosis, 15% obese) and 11,7White (11% DM, 12% osteoporosis, 40% obese) women aged 65-75y with BMD, excluding those with recent fracture, osteoporosis therapy, dialysis/transplant, metabolic bone disease or advanced cancer. DM (≥2 visit diagnoses + DM treatment) , obesity (BMI ≥30 kg/m2) and osteoporosis (BMD T score ≤-2.5) were obtained from electronic health data. Using the US FRAX with BMD, 10-year predicted hip fracture risk ≥3% was considered high (above treatment threshold) .
Results: The overall proportions with FRAX-Hip ≥3% were higher for those with No DM vs. DM (White 18% vs. 11%; Asian 9% vs. 7%) . However, within both DM and no DM groups, FRAX-Hip ≥3% was much higher in non-obese vs. obese women of both races (FIGURE) .
Conclusion: Predicted hip fracture risk varies by DM and especially by obesity status in White and Asian women. Future studies should examine the accuracy of FRAX for actual hip fracture risk in these subgroups.

Disclosure
J.C.Lo: None. M.Chandra: None. N.P.Gordon: None. C.Lee: None.

Funding
National Institute on Aging, National Institutes of Health (AG069992)
1078-P: Elderly Patient with DM2 during the COVID-Pandemia: Forgotten but Good Glycemic Control
Authors: TRESCOLI CARLOS , QUINTANA JAVIER , PLA ZULEMA , VERCHER MANUEL , GARCIA GABRIEL , GALIPIENSO NADIA , SANCHO PABLO 
Published: May 2022

COVIDpandemic has changed clinical practice in Primary and Hospital Care. Chronic Diseases Care have been relegated after COVID19, emergencies and severe pathologies (cancer) Elderly patients with DM2 had less access to medical services due to COVIDprotocols. HbA1c is important to manage patients with DM2. Between COVIDwaves and specially in 2021 there was a program to recover Diabetic Care in our 250000 inhabitants Health Department, specially most frail elderly patients with DM2
Aim: Find out if Elderly patients with DM2 chronic care was reduced during the COVIDpandemic period and if that affected their diabetic control.
Methodology: HbA1c tests taken to patients with DM2 and &gt; 70 year between January 20 and November 2021 were obtained as they are all done in our hospital either from Primary or Hospital Care. Data was calculated by Mean Monthly Number HbA1c tests (MMNHT) during prepandemic: March 20to February 2020, pandemic: March 2020 to February 2021 and postpandemic: March 2021 to November 2021. Diabetic control was calculated in three groups: % HbA1c &lt;7%; 7-8% and &gt; 8% of all tests done in those three periods.
Results: MMNHT had increased by 5% annually and a trend to better diabetic control was seen since 20until 2019. MMNHT were prepandemic vs. pandemic: 1313 vs. 10 (- 22.5%) and pandemic vs. postpandemic: 10vs. 1334 (+ 31%) % . Those changes were similar in Primary and Hospital Care.%HbA1c 7; 7-8 and &gt; 8% was in prepandemic: 50, 31 and 19%; pandemic: 50, 30 and 20% and postpandemic: 67, 28 and 11%.
Summary: During COVIDpandemic, Elderly patients with DM2 had less chronic medical care as had a 23% reduction of MMNHT although it did recover posteriorly. Protocols to identify and recover diabetic chronic care in patients &gt; 70 year might be helpful in our experience. Diabetic control was similar before, during and after the COVIDpandemic period: March 2020 to February 2021.

Disclosure
C.Trescoli: None. J.Quintana: None. Z.Pla: None. M.Vercher: None. G.Garcia: None. N.Galipienso: None. P.Sancho: None.
1092-P: Lipoprotein Insulin Resistance Index and Mortality in Heart Failure: A Population Study
Authors: TURECAMO SARAH , WOLSKA ANNA , OTVOS JAMES D. , REMALEY ALAN , CONNERS KATIE , JOO JUNGNAM , PARK HO YOUNG , SAMPSON MAUREEN , BIELINSKI SUZETTE J. , SAUVER JENNIFER ST , ROGER VERONIQUE L. 
Published: May 2022

Heart failure (HF) is associated with metabolic alterations, including insulin resistance (IR) . Perturbations in lipid metabolism and insulin signaling may impact outcomes, but the relationship between IR and mortality is not well characterized. The Lipoprotein Insulin Resistance Index (LPIR) is a score (0-100; higher values signify greater IR) calculated from 6 lipoprotein subclass/size parameters measured by nuclear magnetic resonance (NMR) . We examined the association between LPIR and death in a HF community cohort. LPIR was measured by NMR LipoProfile®. Meta-Analysis Global Group in Chronic HF (MAGGIC) scores were calculated from clinical data. Kaplan-Meier curves were used to evaluate survival; Cox regression was used to estimate risk of death by LPIR quartile. Among 1,381 community-dwelling persons with HF, the median LPIR score was 38 (IQR 21-56) . Higher LPIR was associated with younger age, diabetes, smoking, obesity, and lower MAGGIC scores, but not ejection fraction. Survival increased by LPIR quartile (p&lt;0.001) and at 5 years was 36% [95% CI 31-42], 42% [95% CI 38-48], 51% [95% CI 46-56], and 65% [95% CI 60-70] for quartile 1-4, respectively. The association between LPIR and death was independent of MAGGIC score (Figure) . Higher LPIR was associated with better survival in HF, independently of a validated clinical risk score. More research is needed to examine this paradoxically protective association.

Disclosure
S. Turecamo: None. A. Wolska: None. J.D. Otvos: Employee; LabCorp. K. Conners: None. S.J. Bielinski: Consultant; Novartis Pharmaceuticals Corporation. J. St Sauver: Research Support; Exact Sciences. V.L. Roger: None.

Funding
Research was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute (NHLBI) at National Institutes of Health and by the NIH Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, the American Association for Dental Research, and the Colgate-Palmolive Company.
1095-P: Clusters of Prediabetes and Type 2 Diabetes Stratify All-Cause Mortality in a Cohort of Participants Undergoing Invasive Coronary Diagnostics
Authors: PRYSTUPA KATSIARYNA , DELGADO GRACIELA , MOISSL ANGELA P. , KLEBER MARCUS E. , HENI MARTIN , BIRKENFELD ANDREAS L. , FRITSCHE ANDREAS , MAERZ WINFRIED , WAGNER ROBERT 
Published: May 2022

Risk for complications and mortality among patients with type 2 diabetes (T2D) is heterogenous. Different trajectories can be identified in the prediabetic state, which comprises heterogenous metabolic clusters. It is not known whether such pathophysiologic clusters of prediabetes and diabetes affect survival in at-risk persons being evaluated for coronary heart disease. The LURIC Study recruited patients referred for coronary angiography at a median age of 63 (IQR 56-70) who have since been followed-up for a median of 14.5 (IQR 9.6-17.7) years. Clustering of 1269 subjects without diabetes was performed with oGTT-derived glucose and insulin; fasting triglyceride, high-density lipoprotein, BMI, waist and hip circumference. Patients with T2D (n=794) were clustered using age, BMI, glycemia, homeostasis model assessment, and islet autoantibodies. Associations of clusters with mortality were analyzed using Cox regression. Individuals without diabetes were classified into six subphenotypes, with 884 assigned to subjects at low-risk (cluster 1,2,4) and 385 at high-risk (cluster 3,5,6) for diabetes. We found significantly increased mortality in clusters 3 (hazard ratio (HR) 1.42) , 5 (HR 1.43) and 6 (HR 1.46) age-, BMI-, HbA1c- and sex-adjusted. In the T2D group, 5were assigned to mild age-related diabetes (MARD) , 183 to severe insulin-resistant diabetes (SIRD) , 84 to mild obesity-related diabetes (MOD) , to severe insulin-deficient diabetes (SIDD) . Compared to the low-risk nondiabetes group, crude mortality was not different in MOD. An increased mortality was found for MARD (HR 2.2) , SIRD (HR 2.2) and SIDD (HR 2.5) . Metabolic clustering successfully stratifies survival even among persons already undergoing invasive coronary diagnostics. Novel clustering approaches based on glucose metabolism can identify persons who require special attention as they are in danger of increased mortality

Disclosure
K.Prystupa: None. G.Delgado: None. A.P.Moissl: None. M.E.Kleber: Employee; SYNLAB Holding Deutschland GmbH. M.Heni: Advisory Panel; Boehringer Ingelheim International GmbH, Research Support; Boehringer Ingelheim International GmbH, Sanofi, Speaker's Bureau; Amryt Pharma Plc, Boehringer Ingelheim International GmbH, Novo Nordisk. A.L.Birkenfeld: None. A.Fritsche: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. W.Maerz: None. R.Wagner: Advisory Panel; Akcea Therapeutics, Daiichi Sankyo, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH.

Funding
German Federal Ministry of Education and Research (BMBF) (01GI0925)
1114-P: Diabetes Screening among Asian Americans after the 2015 American Diabetes Association Guideline Update
Authors: DEMARSILIS ANTEA , USISKIN ILANA , MUKAMAL KENNETH J. 
Published: May 2022

In 2015, the American Diabetes Association (ADA) lowered the BMI cut-off for diabetes screening for Asian-Americans (AA) from BMI ≥ 25 to ≥ 23 kg/m2. We asked whether this led to increased screening among AA with BMI 23-25. We analyzed pooled, weighted data from the 2013, 2014, 2018, and 20Behavioral Risk Factor Surveillance System (BRFSS) , a nationally-representative phone survey. A question on self-reported incidence of diabetes screening in the past three years was included by 20 states in all 4 study years. We included AA ages 18-80 with BMI 23-24.9 and 25-29.9 without prediabetes or diabetes. We calculated screening rates before (2013, 2014) and at least three years after (2018, 2019) the update. By a difference-in-differences approach, we compared change in diabetes screening by BMI group, using generalized linear models with an identity link adjusted for age and sex. A total of 6,672 respondents were included. The weighted screening rate among AA with BMI 23-25 was similar before and after the guideline update (Table) . The change in likelihood of diabetes screening among AA with BMI 23-25 did not differ from those with BMI 25-30 (difference in differences -3.5%, 95% CI: -13.3% to 6.4%, p=0.49) . We found no increase in diabetes screening among AA with lower BMI despite updated ADA guidelines. Increased attention to screening in this at-risk group is needed. Note: Two first authors contributed equally.

Disclosure
A.Demarsilis: None. I.Usiskin: None. K.J.Mukamal: Other Relationship; US Highbush Blueberry Council.
1127-P: Diabetes Risk in Marginalized Urban Settings in Mexico City
Authors: SILVA-TINOCO RUBÉN , BOUCHAN-DELINO SAMUEL , REVUELTA-LARA LUIS , TREJO DANIEL , ARISTA GILBERTO , MARTINEZ-SANTANA NANCY , NÚÑEZ-RODRÍGUEZ ADRIÁN , GUTIERREZ TERESA , LEÓN-GARCÍA ENRIQUE , OCHOA-MORENO JORGE , SERNA JAVIER , LOPEZ-ARELLANO OLIVA 
Published: May 2022

Type 2 diabetes (T2D) is a leading cause of morbidity and mortality in Mexico. Routine identification of persons with high risk for developing T2D is poorly executed in low- and middle-income countries. Thus, we aimed to analyze the characteristics of participants of a public health initiative to identify diabetes risk (SaludEnTuVida/Health In Your Life) in habitants of the mayoralty of Iztapalapa in Mexico City. The mayoralty of Iztapalapa is characterized by being a densely populated area, with a high index of marginalization, and adverse determinants of health. FINDRISC score (FDS) was used to assess the risk of T2D in adults over 20 years of age from September to December 2021. Data from 15,271 participants was analyzed. The mean age of participants was 46.3±15.4 years, most participants were woman (67%) , and with secondary or less education (59.8%) . The following proportions of risk factors were reported: first degree familiar history of T2D in 52.6%, overweight in 41.3%, obesity in 32%, and hypertension in 14.4%. Low risk with FDS &lt;7 was observed in 22.1% of the sample (BMI 24.5±3.2 kg/m2, female 55.7%) compared to 77.9% in the greater risk (GR) group with FDS ≥7 (BMI 29.1± kg/m2, female 70.3%, p&lt;0.0001, p&lt;0.00 respectively) . Among GR group, there were variable T2D risk levels; slightly elevated 31.9%, moderately elevated 32.6%, and highly elevated 13.3%. GR risk for T2D were observed in women (OR 1.88 95%IC 1.7-2.1) and in participants with secondary or less education (OR 1.91 95%IC 1.72-2.12) . The prevalence of overweight and obesity in young adults (&lt;40 years old) was 66.6%, and 62% were found with increased risk for T2D. These results show a higher risk of T2D in the population evaluated compared to the reported in national health surveys. Our findings enhances the need for the implementation of preventive public health care policies in high risk populations, including binding actions to diagnosis and to prevention care programs, particularly in women, people with low education, and young adults of marginalized urban settings.

Disclosure
R.Silva-tinoco: n/a. J.Ochoa-moreno: n/a. J.Serna: None. O.Lopez-arellano: None. S.Bouchan-delino: None. L.Revuelta-lara: None. D.Trejo: None. G.Arista: None. N.Martinez-santana: None. A.Núñez-rodríguez: n/a. T.Gutierrez: None. E.León-garcía: None.
1136-P: A Population-Based Assessment of the Risk of Severe Hypoglycemia with Concomitant Use of Sulfonylureas and Peptidomimetic Dipeptidyl Peptidase-4 Inhibitors
Authors: DIMAKOS JENNY , CUI YING , PLATT ROBERT W. , RENOUX CHRISTEL , FILION KRISTIAN B. , DOUROS ANTONIOS 
Published: May 2022

Background: Dipeptidyl peptidase-4 inhibitors (DPP-4i) interact with sulfonylureas (SU) to increase their risk of hypoglycemia. However, it is unclear whether this risk varies with the pharmacologic properties of DPP-4i. Thus, we compared the risk of severe hypoglycemia between concomitant use of SU and peptidomimetic DPP-4i (vildagliptin, saxagliptin) vs. non-peptidomimetic DPP-4i (sitagliptin, linagliptin, alogliptin) in patients with type 2 diabetes.
Methods: We conducted a retrospective cohort study using the UK's Clinical Practice Research Datalink linked to hospitalization and vital statistics data of patients with type 2 diabetes initiating SU between 20 and 2020. Time-dependent Cox models estimated hazard ratios (HR) with 95% confidence intervals (CI) of severe hypoglycemia associated with current concomitant use of SU and peptidomimetic DPP-4i compared to current concomitant use of SU and non-peptidomimetic DPP-4i, adjusted for baseline confounders. Secondary analyses stratified by age (&lt;65 vs. ≥65 years) and sex.
Results: Our cohort included 196,138 SU initiators. The crude incidence rate of severe hypoglycemia was 7.2 per 1000/year. Compared to concomitant use of SU and non-peptidomimetic DPP-4i, concomitant use of SU and peptidomimetic DPP-4i was not associated with the risk of severe hypoglycemia (HR, 0.96; 95% CI, 0.76-1.22) . In female patients, concomitant use of SU and peptidomimetic DPP-4i was associated with a trend towards an increased risk (HR, 1.32; 95% CI, 0.97-1.81) ; in male patients, there was an association with a decreased risk (HR, 0.69; 95% CI, 0.48-0.99) . Age did not modify the association.
Conclusion: Our population-based study showed no increased risk of severe hypoglycemia with concomitant use of SU and peptidomimetic DPP-4i compared to concomitant use of SU and non-peptidomimetic DPP-4i. Further research is needed to corroborate the observed effect modification by sex.

Disclosure
J.Dimakos: None. Y.Cui: None. R.W.Platt: Consultant; Amgen Inc., Biogen, Merck & Co., Inc., Nant Pharma, Pfizer Inc. C.Renoux: None. K.B.Filion: None. A.Douros: None.

Funding
Canadian Institutes of Health Research (PJT-165882)
1137-P: Continuous Glucose Monitoring (CGM) Use and Its Impact on Glycemic Control and Acute Complications among Older-Onset Type 1 Diabetes Patients within the Veterans Health Administration (VHA)
Authors: ZHOU JIN , NEWELL MICHELLE , RIVAS SALVADOR , ZHOU XINKAI , NORMAN GREGORY J. , REAVEN PETER 
Published: May 2022

There is increasing recognition that older onset type 1 diabetes (T1D) is not uncommon. Although CGM use is rising dramatically among those with T1D, little is known regarding its use and benefits within this older T1D population. To address these questions, we identified new CGM users (new CGM sensor prescriptions for T1D developing after military enrollment) and non-users (T1D receiving care and glucose strips from the VHA) during the years 2015-2020 and used national VHA healthcare data and ICD-9/ICD-diagnostic codes from visit encounters to compare baseline characteristics, change in glucose control and new emergency (ER) or hospital admissions. Linear mixed models and Cox proportional models (with propensity score overlap weighting) , were used to compare pre/post changes in HbA1c, and time to acute admissions, respectively. Compared with 4732 nonCGM users, CGM users (n=5,143) had similar HbA1c levels but differed in many ways at initiation of CGM, including: being significantly younger (59 vs. 65 years) , higher proportion White (83 vs. 75%) , and more frequently using glucagon (36 vs. 12 %) , short-acting insulin (99 vs. 86%) and insulin pumps (54 vs.7%) . After propensity overlap weighting, all characteristics were nearly identical between groups. Initiation of CGM was associated with reduced HbA1c levels (- 0.2 and -0.26% at 6 and 12 months (p’s&lt; 0.001) compared with nonCGM users. Similarly, CGM users also had greater declines in risk for total hospitalizations (HR = .88; CI 0.79-0.98) and hypoglycemic (HR = .69; CI 0.53-0.90) and hyperglycemic (HR = .77; CI 0.64-0.94) related ER visits/hospitalizations (all p’s &lt; 0.02) . In this large national study of CGM initiation in older T1D patients, CGM use was linked with improved glucose control as well as reduced ER and/or hospital admissions for hypoglycemia, hyperglycemia or any cause.

Disclosure
J.Zhou: Research Support; Dexcom, Inc. M.Newell: Research Support; Dexcom, Inc. S.Rivas: None. X.Zhou: None. G.J.Norman: Employee; Dexcom, Inc. P.Reaven: Research Support; AstraZeneca, Dexcom, Inc.

Funding
DexCom, Inc
1142-P: In-Hospital Hyperglycemia: An Independent Marker for In-Hospital Health Care-Associated Infection and Acute Kidney Injury in Patients with and without Known Diabetes: The DINGO Study
Authors: BARMANRAY RAHUL , KYI MERVYN , WORTH LEON J. , COLMAN PETER G. , FAZIO TIMOTHY N. , RAYMAN GERRY , FOURLANOS SPIROS 
Published: May 2022

Objective: To investigate the relationship between hyperglycemia and adverse in-hospital outcomes in patients with and without known diabetes
Research Design and Methods: The Diabetes IN-hospital: Glucose and Outcomes (DINGO) prospective cohort study was conducted over 26 weeks between Oct-20 and Mar-2020 at The Royal Melbourne Hospital. Admissions with ≥2 capillary glucose values and length of stay &gt;24 hours were eligible. Stratification was by in-hospital hyperglycemia (IHH) , defined as ≥2 capillary glucose values of ≥11.1 mmol/L [≥200 mg/dL].
Results: We included 2,6admissions, of which 1,189 (46%) experienced in-hospital hyperglycemia. Following adjustment (covariates) , IHH was independently associated with in-hospital healthcare-associated infection (HAI) , acute kidney injury (AKI) , stroke, and mortality (see figure for incidence rate ratios [IRR]) . For each outcome the association was independent of diabetes status, except for mortality where the association was stronger in those without known diabetes. Patient-day mean glucose was elevated in those with HAI and AKI, on both whole-of-admission and prior-to-event calculations.
Conclusions: In-hospital hyperglycemia is independently associated with in-hospital HAI and AKI in patients with and without known diabetes.

Disclosure
R.Barmanray: None. M.Kyi: None. L.J.Worth: None. P.G.Colman: None. T.N.Fazio: None. G.Rayman: None. S.Fourlanos: Advisory Panel; Pfizer Inc., Viatris Inc., Speaker's Bureau; AstraZeneca, Novo Nordisk.

Funding
Rowe Family Foundation Perpetual GrantAustralian Government Research Training Program Scholarship