bluuebunny/crossref_metadata_2025_split huggingface dataset:
1053-P: Prevalence, Predictors, and Consequences of Unplanned Pregnancy in Women with Preexisting Diabetes
Authors: OKIGBO CHINELO C. , MCLAUGHLIN CLAIRE , KIRKMAN M. SUE 
Published: May 2022

Objective: Women with diabetes who have unplanned pregnancies are more likely to have poor glycemic control in early pregnancy which is associated with poor maternal and fetal outcomes. We assessed the prevalence, predictors, and consequences of unplanned pregnancy among women with preexisting diabetes.
Methods: We used EHR data of 486 women aged 18-49 with preexisting type 1 or 2 diabetes who received pregnancy care at a university hospital in North Carolina between 10/2015 and 02/2020. The outcome was unplanned pregnancy while the predictors were maternal demographic, socioeconomic, and health factors. The consequences assessed were maternal infection, cesarean delivery, postpartum contraception, preterm delivery, NICU admission, macrosomia, LBW, fetal abnormality, and fetal death. We estimated statistical associations as odds ratios (OR) and 95% confidence intervals (CI) .
Results: Of the 554 pregnancies that occurred in the sample, 32% were documented as unplanned, 25% as planned, and 43% had no documented intention. The predictors of unplanned pregnancy were age younger than 25 (OR 2.7; CI 1.5-5.0) , African American race (OR 2.7; CI 1.6-4.5) , being single (OR 1.9; CI 1.3-2.9) , having 2+ comorbidities (OR 2.1; CI 1.2-3.7) , and having 3+ previous pregnancies (OR 2.1; CI 1.2-3.9) . Adjusting for maternal factors including early pregnancy HbA1c, unplanned pregnancy increased the odds of macrosomia (OR 2.2; CI 1.2-4.2) and fetal death (OR 1.8; 95% CI 1.1-3.0) , but not maternal infection, cesarean delivery, preterm delivery, NICU admission, LBW, or fetal abnormality. Women with unplanned pregnancies were more likely to receive postpartum contraception (OR 1.7; CI 1.1-2.6) .
Conclusion: Unplanned pregnancies remain common among women with preexisting diabetes and are associated with adverse pregnancy outcomes independent of maternal HbA1c at the start of the pregnancy. Further efforts are needed to expand preconception care and support pregnancy planning in these women.

Disclosure
C.C.Okigbo: None. C.Mclaughlin: None. M.Kirkman: Research Support; Bayer AG, Novo Nordisk.

Funding
Society of Family Planning Research Fund (SFPRF13-ES12)
1057-P: The Prevalence of Gestational Diabetes Mellitus and Large-for-Gestational-Age Infants across the United States from 2012 to 2018
Authors: HERNANDEZ-ZEPEDA MIRIAM L. , GARG BHARTI , VALENT AMY M. 
Published: May 2022

Background: With the increasing rates of GDM and variations in screening guidelines, this study sought to investigate the relationship between GDM and LGA across the U.S.
Methods: This is a retrospective cohort study using National Vital Statistics data (2012-2018) . We included singleton, non-anomalous births with gestational age of 23-42 weeks and excluded women with pre-existing diabetes. The states were divided into four regions (Northeast, Midwest, South, and West) . Chi-square test and multivariable logistic regression models were used.
Results: In the cohort of 24,938,357 births, 14.5% were in Northeast, 21.7% in Midwest, 39.2% in South and 24.6% in West. Midwest had higher prevalence of GDM (6.4%) as well as LGA (10.9%, Figure 1) . After adjusting for maternal race, age, education, BMI, prenatal care, smoking status, hypertension, and year of delivery, risk of LGA is highest in women from South with GDM (aOR=1.16, 95%CI:1.14-1.18) as compared to women from West with GDM.
Conclusions: Further studies are needed to determine factors associated with rising rates of LGA.

Disclosure
M.L.Hernandez-zepeda: None. B.Garg: None. A.M.Valent: None.
107-LB: Progression of Position of Basal Insulin in the Treatment of Type 2 Diabetes—A Real-World Analysis
Authors: SCHAPIRO DAVID , MEEKS ALEXANDRA , LIU DONGJU , GELSEY FELICIA , JUNEJA RATTAN , PEREZ-NIEVES MAGALY , HUANG AHONG 
Published: May 2022

Background: In the past 5 years, type 2 diabetes practice guidelines have shifted to prioritize agents with cardiovascular (CV) and renal benefit. This study assessed whether real-world medication use has changed in line with these evolving guidelines.
Methods: We retrospectively examined the treatment patterns (12 months pre and post) of people with T2D (PwT2D) who initiated basal insulin (BI) in either 2015 (cohort 1) , 2017 (cohort 2) , or 2019 (cohort 3) using IBM® MarketScan® Databases. Between-group differences were analyzed via t-test or chi-square as appropriate.
Results: In the study period, 6,396,441 PwT2D were identified. The number of PwT2D initiating BI was 17,801/948,805 (1.88%) in 2015 vs. 10,870/622,455 (1.75%) in 2019 and a progressively larger share of BI initiators had prior GLP-1RA use (14.8% in cohort 1 vs. 25.2% in cohort 3; p &lt; 0.001) or SGLT-2i use (11.4% in cohort 1 vs. 20.5% in cohort 3; p &lt; 0.001) . Furthermore, in patients without prior GLP-1RA, SGLT-2i, or bolus use who initiated GLP-1RA or SGLT-2i in the first year of BI, time to first GLP-1RA (132.4 days in cohort 1 vs. 120.5 days in cohort 3; p = 0.02) or SGLT-2i (131.5 days in cohort 1 vs. 113.3 days in cohort 3; p = 0.002) decreased.
Conclusions: Real-world data suggests growing and earlier use of GLP-1RA and SGLT-2i among BI users, and a growing proportion of PwT2D on BI-GLP-1RA combination treatment, in line with changing practice guidelines.

Disclosure
D. Schapiro: Employee; Eli Lilly and Company. A. Meeks: Employee; Eli Lilly and Company. D. Liu: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. F. Gelsey: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. R. Juneja: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Perez-nieves: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A. Huang: None.

Funding
Eli Lilly and Company
1082-P: Cardiovascular Effectiveness of SGLT-2 Inhibitors and GLP-1 Receptor Agonists in Routine Care of Frail People with Type 2 Diabetes
Authors: KUTZ ALEXANDER , GOPALAKRISHNAN CHANDRASEKAR , KIM DAE H. , PATORNO ELISABETTA 
Published: May 2022

Frailty is important in diabetes management but its impact on the cardiovascular (CV) effectiveness of SGLT-2i and GLP-1 RA as used in routine care is unexplored. Using Medicare claims data, we identified three pairwise 1:1 propensity score (PS) matched cohorts of people with type 2 diabetes who initiated a SGLT-2i, a GLP-1 RA, or a DPP-4i between 04/2013-12/2018. The primary outcome was a composite of major adverse CV events (MACE) including acute myocardial infarction, ischemic stroke, hospitalization for heart failure, or all-cause mortality. We estimated hazard ratios (HR) and absolute rate differences (RD) per 1`000 person-years, with their 95% CI, in each PS-matched cohort by level of frailty, using a validated claims-based frailty index (3 strata: non-frail, &lt;0.15; pre-frail, 0.15-0.24; frail, ≥0.25) , controlling for &gt;150 baseline covariates. We used the Wald test for homogeneity to assess treatment heterogeneity across strata. The HR for MACE associated with SGLT-2i vs. DPP4i (n=91`141 PS-matched pairs) was 0.82 (95% CI 0.72 to 0.93) in frail, 0.71 (0.67 to 0.75) in pre-frail, and 0.78 (0.71 to 0.86) in non-frail people (p for homogeneity=0.033) . The HR for MACE associated with GLP-1 RA vs. DPP4i (n=90`988 pairs) was 0.84 (0.76 to 0.93) in frail, 0.77 (95% CI 0.73 to 0.81) in pre-frail, and 0.82 (0.74 to 0.91) in non-frail people (p for h.=0.150) . The HR for MACE associated with SGLT-2i versus GLP-1 RA (n=67`067 pairs) was 0.87 (0.75 to 1.01) in frail, 0.93 (95% CI 0.87 to 1.01) in pre-frail, and 0.90 (0.79 to 1.03) in non-frail people (p for h.=0.692) . Compared to DPP-4i, the absolute benefit of either SGLT-2i or GLP-1 RA was largest in frail people [RD, -25.0 (-42.1 to -7.9) , p for h.&lt;0.001, NNT=20; and RD, -24.9 (-39.0 to -10.7) , p for h.&lt;0.001, NNT=21; respectively]. While, compared to DPP4i, SGLT-2i and GLP-1 RA were associated with similar relative risk reductions in MACE among people with and without frailty, their absolute benefits were largest in frail people.

Disclosure
A.Kutz: Research Support; Novo Nordisk. C.Gopalakrishnan: None. D.H.Kim: None. E.Patorno: Research Support; Boehringer Ingelheim International GmbH, National Institutes of Health, Patient-Centered Outcomes Research Institute.

Funding
National Institute on Aging (K08AG055670)
1098-P: Impact of Health Factors on Incident Cardiovascular Disease (CVD) According to Glucose Tolerance Status
Authors: IIJIMA TAKANOBU , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAMAMOTO MASAHIKO , OSAWA TAEKO , MATSUBAYASHI YASUHIRO , SATO TAKAAKI , YAGUCHI YUTA , IWANAGA MIDORI , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO 
Published: May 2022

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (sleep, breakfast, snacks, body mass index (BMI) , physical activity, drinking alcohol, and smoking status) . Cardiovascular health metrics (CVHMs) defined according to the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking status, BMI, physical activity, diet, systolic blood pressure &lt;120 mmHg and diastolic blood pressure &lt;80 mmHg, total cholesterol &lt;200 mg/dl, and fasting blood glucose &lt;100 mg/dl) . To clarify the impacts of HPI or CVHMs on incident CVD according to glucose tolerance status, we analyzed a nationwide claims-based database of 128,290 people included from 2008-aged 20-72 y in Japan (86,279 with normal glucose tolerance; 36,1with prediabetes; 5,9with diabetes) . HPI and CVHMs were divided into three categories (high, middle, and low) based on the number of ideal health factors present (Table) . Multivariate Cox regression analysis showed that people with prediabetes with an HPI of ≥5 or people with prediabetes and diabetes who had ≥5 CVHMs had no increased risks for CVD compared with those in the high HPI/CVHMs category for normal glucose tolerance (Table) .
In summary, not only to follow a healthy lifestyle but to achieve laboratory treatment targets may be essential in people with diabetes.

Disclosure
T.Iijima: None. T.Yamada: None. S.Kodama: None. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. K.Fujihara: None. M.H.Yamada: None. M.Yamamoto: None. T.Osawa: None. Y.Matsubayashi: None. T.Sato: None. Y.Yaguchi: None. M.Iwanaga: None.
110-OR: Excellent Outcome of Solitary Pancreas Transplant Recipients with Brittle Diabetes and without Advanced Nephropathy
Authors: GRUESSNER ANGELIKA 
Published: May 2022

Introduction: In contrast to non-pancreatic transplantation, where nephrologists refer patients for kidney and hepatologists for liver transplantation, endocrinologists only rarely refer patients with brittle diabetes for solitary pancreas transplantation. While most pancreas transplants are performed in combination with a kidney graft, solitary pancreas transplants (PTA) without a previous kidney transplant accounted for only 6-7% of pancreas transplants per year although a PTA is the best treatment option to achieve long-term insulin-independence in patients with severe brittle diabetes.
Methods: The change in demographics and outcome of 1,636 primary PTAs were analyzed between 20 and 2020 in 5-year intervals. Graft survival was defined as complete insulin-independence. Multivariate analysis was performed to assess factors that impacted outcome and the potential need for a subsequent kidney transplant.
Results: Over time, recipient age increased, but donor age and preservation time decreased significantly. Most recipients received induction therapy and maintenance immunosuppression. These changes resulted in significant improvement in patient and pancreas graft survival. Three-year patient survival increased from 92% in 2001-to 96% in 2016-20. Three-year pancreas graft survival improved from 60% in 2001-to 77% in 2016-20 (p&lt;0.0001) . The most influential factors for this decrease were older recipient age and better immunosuppression. The rate of a subsequent kidney transplant declined significantly. It was primarily contingent on native graft function at the time of transplant. If the GFR was as &gt;70ml/min only 1% of patients required a kidney graft.
Conclusion: The results of PTA have significantly improved over the past 20 years. A PTA should be strongly considered in brittle diabetic patients before the development of advanced nephropathy.

Disclosure
A.Gruessner: None.
1108-P: Noninvasive Diabetes Risk Scores Identify Diabetes due to Insulin Resistance but Not ß-Cell Failure: The Africans in America Study
Authors: WENTZEL ANNEMARIE , PATTERSON ARIELLE , DUHUZE-KARERA M GRACE , WALDMAN ZOE C. , SCHENK BLAYNE R. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , SUMNER ANNE E. , HORLYCK-ROMANOVSKY MARGRETHE F. 
Published: May 2022

In low and middle-income countries in Africa, β-cell-failure in the absence of obesity is increasingly recognized as a frequent cause of type 2 diabetes (DM) . DM risk scores assume that insulin resistance (IR) is the primary cause of DM. Therefore, their ability to detect DM due to β-cell-failure is unknown. In 529 African-born Blacks living in the United States (age 38± (mean±SD) ; 64% male; BMI 28±5 kg/m2) , we assessed (1) DM prevalence, (2) prevalence of DM due to IR versus β-cell failure; and (3) the ability of six risk scores (Cambridge, FINDRISC, Kuwaiti, Omani, Rotterdam, and SUNSET) to detect previously undiagnosed DM due to either IR or β-cell-failure. DM was diagnosed by OGTT and/or HbA1c ≥6.5%. IR was defined by lowest quartile of the Matsuda index (≤2.04) . DM due to β-cell-failure required DM in the absence of IR. Data on BP, BMI, waist circumference (WC) , health behaviors, and medical history were collected. Area under the Receiver Operator Characteristics Curve (AROC) assessed discriminatory ability of each score. Criteria for AROC: no discrimination=0.50; poor=0.50-0.69; acceptable=0.70-0.79; excellent=0.80-0.89; outstanding=≥0.90. DM prevalence was 9% (46/529) . DM was due to IR in 57% (26/46) and β-cell-failure in 44% (20/46) . The IR group had higher BMI (31±5 vs. 27±4 kg/m2 P&lt;0.001) , and higher WC (101±vs. 91±cm P&lt;0.001) . Scores had poor to excellent detection of diabetes due to IR (AROC=0.67-0.81) . In contrast, detection of diabetes due to β-cell-failure had an AROC score in the range of no discrimination or poor (AROC=0.49-0.62) .
In summary, DM risk scores perform well for the detection of undiagnosed DM in Africans when the etiology is IR. However, scores fail to detect DM due to β-cell failure. Therefore, scores which evaluate DM risk when the cause is β-cell failure are urgently needed.

Disclosure
A.Wentzel: None. A.Patterson: None. M.Duhuze-karera: None. Z.C.Waldman: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. A.E.Sumner: None. M.F.Horlyck-romanovsky: None.
111-LB: CHM-273S Peptide Decreases Blood Glucose Level, Improves Insulin Sensitivity, and Induces Insulin Signaling Pathways in the Liver of Rats with Diet-Induced Metabolic Disorder
Authors: PAVSHINTSEV VSEVOLOD , MITKIN NIKITA , DORONIN IGOR , EMELIANOVA EKATERINA , LOVAT MAXIM , BABKIN GENNADY , MALYSHEV ANTON 
Published: May 2022

CHM-273S is a novel peptide derived from proprietary milk hydrolysate. It demonstrated the ability to induce IRS2 expression in primary murine fibroblasts. IRS2 is one of the main components of insulin receptor signaling pathway, and its expression activation is associated with the changes in the functioning of insulin- and glucose-dependent intracellular mechanisms in general. Such effect is typical for the main antidiabetic drugs including metformin and GLP-1R agonists and potentially indicates that CHM-273S can regulate cellular response to glucose and insulin. In the present work, we studied the ability of CHM-273S to alleviate symptoms of metabolic disorder caused by a high-sucrose diet (HSD) . Sprague-Dawley male rats (N=50) were given free access to 30% sucrose solution for 5 weeks. Animals with symptoms of a metabolic disorder - a stable significant increase in blood glucose concentration - were tested in the glucose tolerance test (GTT) . Single 1 mg/kg and 10 mg/kg CHM-273S i.p. administration 12, 2 and 0 hours prior to oral glucose injection in GTT significantly reduced blood glucose level. Additionally, CHM-273S administration 2 and 12 hours before blood sampling led to a decrease in fasting blood insulin concentration measured by ELISA and insulin resistance index HOMA-IR elevated as a result of HSD. These data indicates the peptide’s ability to alleviate the HSD-caused insulin resistance in experimental animals. Finally, the rats received CHM-273S and after 12 hours were injected with insulin 3 minutes before liver samples collection. CHM-273S restored pAKT (Thr308) and induced p-AKT (Ser473) levels in the liver, which indicates the ability of the peptide to normalize insulin signaling. The effect of CHM-273S on insulin signaling pathways in liver cells highly correlates with the observed decrease in blood glucose level in GTT and HOMA-IR values and could underly the mechanism of these effects.

Disclosure
V. Pavshintsev: None. N. Mitkin: None. I. Doronin: None. E. Emelianova: None. M. Lovat: None. G. Babkin: None. A. Malyshev: None.
1113-P: Trends in Prevalence, Awareness, and Risk Perception among U.S. Adults with Prediabetes: NHANES 2005–2018
Authors: YAN ALICE , SHI ZUMIN 
Published: May 2022

Introduction: Individuals with prediabetes (preDM) are at increased risk of developing type 2 diabetes and cardiovascular disease. Awareness and perceived risk of disease are key factors impacting lifestyle interventions. This study examined the prevalence, awareness, and perceived risk of preDM.
Methods: This nationally representative cross-sectional analysis of 2005-2018 National Health and Nutrition Examination Survey data was conducted on nonpregnant adults (aged≥20 years) . PreDM was based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) definitions recommended by the American Diabetes Association. We used fasting sample weight to generate nationally representative estimates. Measures also include sociodemographic, awareness, and perceived risk for DM or preDM. Analyses were accounted for the complex sample design and performed using Stata 17.
Results: Overall, among 15,968 adults, the weighted prevalence of PreDM increased from 31.5% (95%CI 28.5-34.4) in 2005-20to 47.2% (95% CI 43.7-50.7) in 2017-2018 with a significant linear trend (p&lt;;0.001) . The weighted prevalence of awareness of preDM increased yearly from 5.6% in 20- 20to 12.6% in 2017-2018 based on FPG/HbA1c definition (p&lt;;0.001) . Similarly, among those with preDM, the perceived risk increased from 28.2% in 20- 20to 32.9% in 20- 20 and plateaued at 36.9% in 2017-2018 without a significant linear trend (p=0.142) . Black and Mexican Americans had a higher prevalence of preDM than White. Education was positively associated with awareness and perceived risk, but the income was not. Women were less likely to have preDM but more likely to be aware of preDM than men. Overweight/obesity, hypertension, and depression were positively associated with preDM, awareness, and perceived risk.
Conclusions: Findings suggest that from 20to 2018, the prevalence of preDM continues to rise. More national efforts are needed to raise awareness of diabetes risk and target those at higher risk.

Disclosure
A.Yan: None. Z.Shi: None.
1115-P: Does Spouse’s Diabetes Status Impact the Diabetes Care Cascade? A National Study of Couples in India
Authors: VARGHESE JITHIN SAM , PATEL SHIVANI A. 
Published: May 2022

Background: Diabetes detection and treatment in married couples presents opportunities for designing dyadic interventions to improve screening and management.
Methods: Using data from 59237 heterosexual married couples (women: 18-49y, men: 21-54y) assessed in India’s National Family Health Survey (2015-16) , we estimated the diabetes care cascade as the percent diagnosed, treated, and controlled with measured high blood glucose (BG) by spouse’s diabetes status.
Results: The prevalence of high BG was 8.8% (men) and 14.2% (women) . In adults with high BG, the percent diagnosed, treated, and controlled was 22.6%, 18.7%, and 9.2% (men) and 22.5%, 18.0%, and 8.5% (women) , respectively. Of adults with high BG, the prevalence of diabetes diagnosis was higher in men (prevalence ratio [PR]: 1.85 [1.37, 2.49]) and women (PR: 2.03 [1.47, 2.8]) whose spouse was diagnosed (ref=spouse undiagnosed) . Among the diagnosed, the prevalence of being treated for diabetes did not differ by their spouse’s diagnosis status in men or women. Among the treated, the prevalence of blood glucose control was higher in women (PR: 1.45, [0.93, 2.25]) , but not men (PR: 0.96 [0.66, 1.40]) , whose spouse was diagnosed (ref=spouse undiagnosed) .
Conclusions: Spouse’s diabetes was associated with higher probability of detection of diabetes but not with treatment. Outreach among couples may improve medical management of diabetes in India.

Disclosure
J.Varghese: None. S.A.Patel: Research Support; Johnson & Johnson.
112-LB: In Vitro DILI Risk Assessment of IDG16177, a Potent and Selective GPR40 Agonist, for the Treatment of Type 2 Diabetes
Authors: YOON JONGMIN , SONG HAENGJIN , AN KYUNGMI , HONG CHANG-HEE , KWAK HYUN-JUNG , SONG HYO-JUNG 
Published: May 2022

G protein-coupled receptor 40 (GPR40) , also known as free fatty acid receptor 1 (FFA1/FFAR1) , is expressed primarily on pancreatic β-cells and induces insulin secretion only at high glucose levels, making it a promising target for type 2 diabetes mellitus (T2DM) . Fasiglipam (TAK-875) , a partial agonist of GPR40, was discontinued in phase 3 due to hepatotoxicity despite its potent hypoglycemic effect. Previous studies of hepatic transporter inhibition, mitochondrial function, covalent protein binding and toxicity to human hepatocytes confirmed the lower drug-induced liver injury (DILI) potential of IDG16177 compared to fasiglifam, but bile acid (BA) analysis and transcription factor profiling were further performed.
In a 3D human liver model, we indirectly evaluated the accumulation of BA in the liver by measuring the secretion of glycolic acid (GCA) , which is a major component of human BAs and has been identified as a significant increase in patients with DILI. Fasiglifam induced a significant accumulation of GCA at 4 μM lower than the human Cmax of 10 μM, whereas IDG16177 showed no significant accumulation at 1 μM higher than the predicted human Cmax of 0.3 μM.
IDG16177 did not have a significant effect in quantitative evaluation of the activity of various transcription factors, whereas treatment with 10 uM fasiglifam for 24 hours significantly increased the activities of peroxisome proliferator activating receptor (PPAR) , activator protein 1 (AP-1) and nuclear respiratory factor 2 (NRF2) , which were highly correlated with liver disease pathogenesis/progression. Interestingly, treatment with 10 μM IDG16177 for 48 h increased the activity of FXR, a master regulator of BA metabolism that inhibits BA absorption system and BA synthesis and promotes BA enterohepatic circulation, by 1.58-fold.
These results show that IDG16177 has the advantage of having a low DILI potential compared to fasiglifam in addition to its potent efficacy for the treatment of type 2 diabetes.

Disclosure
J. Yoon: None. H. Song: None. K. An: None. C. Hong: None. H. Kwak: None. H. Song: None.