bluuebunny/crossref_metadata_2025_split huggingface dataset:
440-P: Suboptimal Blood Pressure in Adolescents and Young Adults with Type 1 Diabetes: Data from the Australasian Diabetes Data Network (ADDN) Registry
Authors: JAMES STEVEN , PERRY LIN , LOWE JULIA , COLMAN PETER G. , CRAIG MARIA E. ,   ADDN STUDY GROUP
Published: May 2022

Hypertension increases complication risk in type 1 diabetes (T1D) . We examined blood pressure (BP) in young people with T1D from ADDN, a prospective clinical diabetes registry in Australia and New Zealand. Inclusion criteria: T1D (duration ≥1 year) and age 16-25 years at last visit (2011-2020) . Hypertension was defined as (on ≥3 occasions) systolic BP (SBP) and/or diastolic BP (DBP) &gt;95th percentile for age &lt;18 years, and SBP &gt;130 and/or DBP &gt;80 mmHg for age ≥18 years. Data from 6,338 young people (male 52.6%) attending 24 participating centres across 36,655 T1D healthcare visits were included; 2,812 (44.4%) had BP measured at last visit (Table 1) . Across all visits, 19.4% of youth aged &lt;18 years and 21.7% of those aged ≥18 years met criteria for hypertension. Using multivariable Generalised Estimating Equations that included all visits, BP in the hypertensive range was associated with: male gender (B=0.36; 95% CI 0.01-0.24, p&lt;0.001) , injection vs. pump therapy (B=0.16; 0.05-0.28, p&lt;0.001) , higher HbA1c (B=0.10; 0.12-0.70, p&lt;0.001) and overweight/obesity (B=0.56; 0.45-0.67, p&lt;0.001) . We demonstrate that hypertension is common in young people with T1D, highlighting the importance of monitoring and treating BP in this at-risk population.

Disclosure
S.James: None. L.Perry: None. J.Lowe: None. P.G.Colman: None. M.E.Craig: None. Addn study group: n/a.
461-P: Prevalence and Patient Recognition of Distal Symmetric Neuropathy (DSP) in a Predominantly Low-Income U.S. Patient Population
Authors: GAGNE ALEXANNDRA , MARCUS HUDA , DAWOOD THAIR , BACHUWA GHASSAN , KVALSUND MICHELLE , FELDMAN EVA L. , SKOLARUS LESLI , CALLAGHAN BRIAN C. , ELAFROS MELISSA 
Published: May 2022

Introduction: DSP is a disabling, painful condition among individuals with glucose intolerance. Patient awareness of DSP is essential to reduce the risk of infection and amputation. While DSP risk factors, such as glucose intolerance, are more common among Black people and those with low-income, these populations are underrepresented in DSP studies. The Flint Neuropathy Study is assessing glucose intolerance and DSP in a predominantly Black, low-income setting.
Methods: Patients &gt;40 years presenting to the Hurley Medical Center Outpatient Internal Medicine Residency Clinic in Flint, Michigan were enrolled. Demographics, clinical characteristics including medication use, anthropomorphic measurements, fasting lipids, fasting glucose, and Hemoglobin A1C were obtained. Glucose intolerance was defined using the 2021 ADA diagnosis and classification of diabetes mellitus criteria. DSP was defined using the Michigan Neuropathy Screening Instrument Questionnaire Index (MNSIQI) . Descriptive statistics were assessed using means and frequencies.
Results: 81 participants (62% female, 57.5yrs (SD 8.7) . 67% Black, 53% Medicaid, 22% &lt;high school education) have enrolled. 40 (49%) had a history of glucose intolerance, 4 (5%) denied a history of glucose intolerance despite a prior diagnosis, and 7 (9%) were diagnosed as glucose intolerant through study labs. (23%) reported a history of neuropathy. Mean MNSIQI score was 2.65 (SD 1.56) ; 46 (57%) had DSP. 28 (55%) participants with glucose intolerance had DSP. Among participants with a history of glucose intolerance and DSP, 16/21 (76%) were unaware they had DSP. 7/ (64%) participants who did not know they had glucose intolerance prior to participation had DSP.
Conclusions: DSP is extremely common and underrecognized in this patient population with low incomes. Improving awareness of glucose intolerance and DSP is imperative to ensure appropriate foot care and reduce the risk of amputation.

Disclosure
A.Gagne: None. H.Marcus: None. T.Dawood: None. G.Bachuwa: None. M.Kvalsund: None. E.L.Feldman: None. L.Skolarus: None. B.C.Callaghan: None. M.Elafros: None.

Funding
NIH NINDS (5R25NS089450) ; NIH NCATS (UL1TR002240) ; NIH NIDDK (P30-DK-02926) ; NIH NIDDK (P30-DK089503)
470-P: Mitochondrial Long Noncoding RNA and the Compromised Electron Transport Chain Machinery in Diabetic Retinopathy
Authors: KOWLURU RENU , MOHAMMAD GHULAM , KUMAR JAY 
Published: May 2022

Purpose: Diabetic retinopathy has a complex pathogenesis, and mitochondrial damage is considered to play a central role. Diabetes dysfunctions the mitochondria and damages their DNA (mtDNA) , decreasing the transcription of mtDNA-encoded genes including Cytochrome B (CYTB) , which is important for the functioning of complex III of the electron transport chain system (ETC) . This propagate the vicious cycle of free radicals. Diabetes also decreases mtDNA-encoded long non-coding RNA Cytochrome B (LncCytB) . Although long noncoding RNAs have no open reading frame for translation, they can bind to the DNA or RNA in a sequence specific manner and alter the gene expression. Our aim was to investigate the role of LncCytB in regulating CYTB-ETC system in diabetic retinopathy.
Methods: Human retinal endothelial cells, incubated in 5mM (normal) or 20mM (high) D-glucose, were used to quantify the expressions of LncCytB (by strand-specific PCR) and CYTB (qRT-PCR) . The binding of LncCytB at CYTB promoter was determined by Chromatin isolation by RNA Purification method. Role of LncCytB in regulating CYTB expression and mitochondrial damage was performed in the cells overexpressing LncCytB.
Results: Compared to cells in normal glucose, LncCytB and CYTB levels were decreased by over 50% in the cells exposed to high glucose, the binding of LncCytB at CYTB promoter was reduced by ∼40% and the activity of the complex III was inhibited. Overexpression of LncCytB ameliorated glucose-induced decrease in CYTB gene transcripts, and increase in mtDNA damage and in mitochondrial reactive oxygen species.
Conclusions: Due to decreased interactions between LncCytB-CYTB in hyperglycemic milieu, CYTB transcripts are decreased, and this compromises the ETC system, resulting in increased mitochondrial ROS. Thus, regulating LncCytB levels in diabetes could halt the self-propagating cycle of free radicals, and prevent the development of diabetic retinopathy.

Funding
EY014370, EY017313, and EY022230
471-P: Glycated Haemoglobin in the First Year after Diagnosis of Type 1 Diabetes Is an Independent Risk Factor for Diabetic Retinopathy: The IMDIAB 25 Years Follow-Up Study
Authors: MADDALONI ERNESTO , CARLONE ANGELA , PITOCCO DARIO , LEANZA GIULIA , SURACI CONCETTA , ALTOMARE MARIA , CAVALLO MARIA G. , BARCHETTA ILARIA , MORANO SUSANNA , MORETTI CHIARA , VISALLI NATALIA , TRAMONTANA FLAVIA , CRINO ANTONINO , SCHIAFFINI RICCARDO , BUZZETTI RAFFAELLA , POZZILLI PAOLO ,   IMDIAB STUDY GROUP
Published: May 2022

Background: Intensive glycemic control reduces the risk of diabetic retinopathy (DR) in people with type 1 diabetes (T1D) . However, the impact of glycemic control during the peri-diagnostic period on the long-term risk of DR is not known.Aim: To evaluate the association between the glycemic control obtained within the first year after T1D diagnosis and the long-term risk of DR.
Methods: We retrospectively studied a cohort of 150 subjects enrolled within 1 year of T1D diagnosis in intervention trials conducted by the IMmunotherapy DIABetes (IMDIAB) group between 1994 and 20 and still attending follow-up visits in one of the IMDIAB centers. Data regarding clinical and biochemical features at T1D onset and during the first year of the disease were collected at the time of enrollment in the IMDIAB studies. Follow-up data about clinical features including presence of chronic complications were collected between January 2020 and January 2021 through the consultation of medical records.
Results: After a median follow-up of 25 [25th-75th percentiles: 22-28] years, 26 (17.3%) people had developed DR. People with DR showed significantly higher updated first-year HbA1c (6.8 [6.2-7.8] % vs. 6.3 [5.7-7.2] %, p=0.037) and higher HbA1c at follow-up (8.0 [6.9-8.9]% vs. 7.2 [6.5-7.8]%, p=0.005) compared to people free from DR. Higher updated first-year HbA1c was also a significant predictor of higher HbA1c at follow-up (beta-coefficient: 0.24, p=0.015) . The association between the updated first-year HbA1c and DR did not significantly change after adding HbA1c at follow-up and disease duration in the multivariate model.
Conclusion: Glycemic control obtained during the very first year after T1D onset is associated with long-term risk of diabetic retinopathy independently from subsequent glycemic control and other confounders.

Disclosure
E.Maddaloni: Consultant; Merck KGaA, Speaker's Bureau; Abbott, Medical Technology & Devices, PIKDARE S.p.A. C.Moretti: None. N.Visalli: Consultant; Sanofi. F.Tramontana: None. A.Crino: None. R.Schiaffini: Advisory Panel; Abbott, Sanofi. R.Buzzetti: Board Member; Lilly, Novo Nordisk, Sanofi, Speaker's Bureau; Abbott, AstraZeneca. P.Pozzilli: Advisory Panel; Dompé, Consultant; Abbott, Speaker's Bureau; Dompé, Lilly Diabetes, Medtronic, Sanofi. Imdiab study group: n/a. A.Carlone: None. D.Pitocco: None. G.Leanza: None. C.Suraci: None. M.Altomare: None. M.G.Cavallo: Advisory Panel; Eli Lilly and Company, Board Member; Novo Nordisk, Speaker's Bureau; AstraZeneca, Sanofi. I.Barchetta: None. S.Morano: None.

Funding
Italian Ministry of University and Research (PRIN 2017: 20175L9H7H)
475-P: Plasma Fatty Acid Composition Is Associated with Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Patients
Authors: HIGA MARIKO , ICHIJO TAKAMASA 
Published: May 2022

Type 2 diabetes is frequently complicated by nonalcoholic fatty liver disease (NAFLD) , which is mainly caused by high-fat and high-calorie diets, and obesity. In this regard, both the quantity and quality of fat accumulating in the liver are important, and in particular, the proportion of each fatty acid may be an important biomarker for NAFLD. We investigated whether serum fatty acid composition, especially n-6 polyunsaturated fatty acid (PUFA) and, saturated fatty acid (MUFA) and desaturase activity are associated with NAFLD in type 2 diabetes patients. Eighty-five type 2 diabetes patients (age: 60.3±13.9 years, BMI 27.5±5.8 kg/m2) who had no history of alcohol drinking, and had a negative result for hepatitis viruses were included as study subjects. Fatty liver (FL) was diagnosed based on liver ultrasonographic findings. Patients with FL were included in the FL group (n=51) , whereas those without FL included in the non-FL group (n=34) . Serum fatty acid levels were measured using gas chromatography. Desaturase activity for n-6 PUFAs was calculated as the ratio of arachidonic acid to dihomo-gamma-linolenic acid (DGLA) for Δ5 desaturase (D5D) . Waist circumference, BMI, serum triglyceride (TG) concentration, and ALT level were significantly higher in the FL group than in the non-FL group. The FL group also demonstrated higher levels of palmitic acid (PAL) and stearic acid (STA) , PAL/STA ratio, and DGLA than the non-FL group. In the FL group D5D activity was significantly lower than that in the non-FL group. PAL level, DGLA, and PAL/STA ratio showed a significant positive correlation with TG and ALT levels. Multiple regression analysis showed that DGLA was independently associated with FL development. These results suggest that type 2 diabetes patients with NAFLD have changes in their blood fatty acid profile, especially increased DGLA and PAL levels. The high levels of blood DGLA indicate downregulation of n-6 PUFA metabolism, probably caused by the decreased activity of D5D.

Disclosure
M.Higa: None. T.Ichijo: None.
506-P: Project ECHO for Diabetes Improves Physician Assistant Students’ Knowledge and Confidence for Complex Diabetes Care
Authors: PHELPS MEGAN , ALDOUS ANNETTE , EHRHARDT NICOLE M. 
Published: May 2022

Objective: Assess whether participation in a well-established tele-education mentorship program, ECHO (Extension for Community Healthcare Outcomes) , improves preclinical providers’ self-efficacy, confidence, and knowledge in managing complex diabetes (DM) .
Methods: Over 3 cycles of ECHO sessions from 2018-2021, we engaged 42 physician assistant students (PAS) in efforts to increase knowledge prior to clinical practice. Using didactics and case-based learning via videoconferencing, the ECHO model allowed participants to receive tele-mentoring from an endocrinologist, a diabetes educator, and rotating specialists. Over 14-16 bimonthly sessions, PAS (n=42) received an evidence-based curriculum on complex DM management. Pre and post course surveys measured self-efficacy (13 questions) , confidence in management (6) , factual knowledge (12) and prescribing practices (11) .
Results: Twenty-three PAS completed at least 50% of sessions; 18 completed both evaluations. On a 7-point Likert scale, self-efficacy increased from 3.18 (slightly competent) pre-intervention to 4.78 (competent) post (p&lt;.0001) . PAS’ belief in their competence to be an endocrinology resource in the community increased from 1.94 to 4. (p&lt;.0001) . Confidence increased from 3.32 (neutral) to 5.33 (somewhat confident) (p&lt;.0001) . PAS answered correctly on 3.78 of 12 knowledge questions before the intervention, increasing to 5.76 after (p&lt;0.01) . Students’ anticipated frequency of prescribing diabetes medication increased from 1.73 (rarely) to 3. (sometimes) (p&lt;.001) and of technology from 1.46 to 2.79 (p&lt;.001) on a 4-point scale.
Conclusion: Our ECHO model is the first to evaluate healthcare trainees. PAS showed improved self-efficacy, knowledge, and confidence in DM management and increased comfort in prescribing. However, overall participation in live sessions was low. Further research is assessing incorporation of pre-recorded ECHO sessions into the PA curriculum.

Disclosure
M.Phelps: None. A.Aldous: None. N.M.Ehrhardt: Advisory Panel; Dexcom, Inc., Novo Nordisk, Research Support; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk.

Funding
Merck Foundation, Merck and Novo Nordisk
529-P: Impact of Medication Adherence (MA) to Oral Glycemic Agents (OHAs) on Initiation of Dialysis in Patients with Moderately Impaired Renal Function
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , YAMADA MAYUKO H. , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , IWANAGA MIDORI , KITAZAWA MASARU , YAMAMOTO MASAHIKO , KODAMA SATORU , SONE HIROHITO 
Published: May 2022

Although we showed a significant association of poor adherence to OHAs with start of dialysis, this relationship according to the estimated glomerular filtration rate (eGFR) was not clarified. Patients with eGFR &lt;60 mL/min/1.73m2 are at high risk for dialysis. To identify the impact of MA by eGFR categories, we analyzed a nationwide claims-based database of 7,862 people with DM and without prior dialysis from 2008-16 aged 18-72 y with available records for OHAs for at least 1 year (mean age 54 y, HbA1c 7.2%) . MA was evaluated by the proportion of days covered (PDC) , and PDC &lt;80% indicated poor adherence. Other factors were also analyzed (Table) . Median follow-up was 5.1 years. Incidence of dialysis per 1000 person-years was 10.7 in the eGFR&lt;60 group and 0.62 in the eGFR ≥60 group. By Cox regression analysis (Table) an increased risk of dialysis was associated with poor MA (HR 2.98[95% CI 1.69-5.23]) , high systolic blood pressure (SBP) (1.27[1.11-1.44]) ], or current smoking (1.98[1.11-3.51]) in the eGFR&lt;60 group and with high SBP (1.41[1.10-1.80]) and high HbA1c (1.45[1.13-1.87]) in the eGFR ≥60 group. Other factors in addition to MA might lead to dialysis, but poor MA was a strong risk factor for dialysis in this short observation period, especially in patients with impaired renal function. Clinicians should pay special attention to MA in these patients to prevent dialysis.

Disclosure
Y.Yaguchi: 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. Y.Matsubayashi: None. T.Yamada: None. M.Iwanaga: None. M.Kitazawa: None. M.Yamamoto: None. S.Kodama: None.
533-P: A Ketogenic Diet Reduces Blood Glucose and Restores Exercise Training–Induced Improvements in Aerobic Capacity in Hyperglycemic Mice
Authors: NAVA ROBERTO C. , COONEY EILEEN M. , LESSARD SARAH J. 
Published: May 2022

Evidence suggests that hyperglycemia can blunt improvements in aerobic capacity (VO2peak) with exercise training. Accordingly, people with diabetes have lower VO2peak than normoglycemic controls, increasing their risk of complications and mortality. We hypothesized that reducing blood glucose levels with a dietary intervention would restore exercise training-induced improvements in VO2peak in hyperglycemic mice. To test this, we induced hyperglycemia in male CD-1 mice with streptozotocin (STZ) , which increased random blood glucose to 220 ± 31 mg/dL on a standard diet (80% carbohydrate, 10% fat & protein) . A subset of STZ mice was fed a ketogenic (KETO) diet consisting of 90% fat and 10% protein, which reduced blood glucose to 177 ± 26 mg/dL. Eight weeks after starting the dietary intervention, STZ and KETO mice underwent voluntary wheel running or remained sedentary for 8 weeks. Exercise training improved VO2peak and time to exhaustion during a graded exercise test in KETO-fed mice while no significant improvement was observed in STZ mice. Trained STZ and KETO mice had similar fat and lean mass, indicating improved VO2peak in trained KETO mice was independent of body composition. Our data demonstrate that reducing blood glucose using a carbohydrate-restricted diet may restore training-induced improvements in exercise capacity that are prevented by hyperglycemia.

Disclosure
R.C.Nava: None. E.M.Cooney: None. S.J.Lessard: None.

Funding
National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) RDK124258 National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) T32 Postdoctoral Training Fellowship 5T32DK007260-45
549-P: A Premeal Drink of Low-Dose Whey Protein (WP) Microgel Rapidly Increases Bioavailability of Branched Chain Amino Acids (BCAA) in People with Type 2 Diabetes (T2D) : A Randomized, Placebo-Controlled Crossover Study
Authors: NEELAND IAN , AHRÉN BO , CORTHÉSY JOHN V. , GRZYWINSKI YOHAN , MAGOS ZOLTAN , VON EYNATTEN MAXIMILIAN , JOHANSEN ODD ERIK 
Published: May 2022

BCAAs are key ingredients of WPs with biomodulatory effects. We recently reported that a highly-concentrated low-dose (10g, 40 Cal) WP pre-meal drink (125 mL) , generated with novel micelle-technology (WP microgel [WPM]) , ingested 15 min ahead of a pizza-meal (622 Cal) , vs placebo (PBO) , reduced the 2h incremental area under the glucose curve (iAUC) by 22%, increased 2h GLP-1 iAUC by 61% and, delayed 1h gastric emptying by 17%, in 26 people with T2D. Here, we analyzed 2h free plasma BCAA trajectories in 25 persons (mean age 62 yrs, HbA1c 7,5%, BMI 29 kg/m2) that completed this single dose study. The pre-meal WPM drink significantly altered the BCAA trajectory vs. PBO (Figure) . For leucine, ΔiAUCWPM vs PBO increased by 267%, with a shorter time to maximum (median ΔTmax [min, max]: -60 [-120,0] min, p&lt;0.0001) , and peak concentration (mean ΔCmax [SD]: 123 [49] umol/L, p&lt;0.0001) . A similar pattern was seen for isoleucine (ΔiAUC +240%, ΔTmax: -60 [-120,0], p&lt;0.0001, ΔCmax: 68 [31], p&lt;0.0001) and valine (ΔiAUC +194%, ΔTmax: -60 [-120, 30], p &lt; 0.0001, ΔCmax: 63 [38], p&lt;0.0001) . We conclude that 10g WPM as a pre-meal drink, induced a rapid plasma increase, and high bioavailibilty, of BCAAs in people with T2D. The rapid BCAA availability might be a likely factor for the metabolic modulatory effects observed with WPM.

Disclosure
I.Neeland: Advisory Panel; Boehringer Ingelheim International GmbH, Merck & Co., Inc., Consultant; Nestlé Health Science. B.Ahrén: Speaker's Bureau; Nestlé, Novo Nordisk, Stock/Shareholder; AstraZeneca, Novo Nordisk A/S. J.V.Corthésy: Employee; Nestlé. Y.Grzywinski: None. Z.Magos: Consultant; Nestlé Health Science. M.Von eynatten: Employee; Nestlé Health Science. O.Johansen: Employee; Boehringer Ingelheim International GmbH, Nestlé Health Science.

Funding
Nestlé Health Science
556-P: The Relationship between Short-Chain Fermentable Carbohydrates (FODMAPs) , Gut Microbiome, and Glucose Intolerance: An Exploratory Analysis
Authors: CHU NATURAL , HE JIE , MA RONALD C. , KONG ALICE P. , CHAN JULIANA C. , CHOW ELAINE 
Published: May 2022

Fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) are fermentable short-chain carbohydrates that include fructans, galactooligosaccharides (GOS) , lactose, excess fructose, mannitol and sorbitol. Low FODMAP diets in irritable bowel syndrome were associated with reductions in metabolically beneficial, short-chain fatty acids (SCFA) - producing bacteria. We examined the interactions between FODMAP, gut microbiota and glucose tolerance in this exploratory analysis. Twenty subjects underwent oral glucose tolerance tests (OGTT) with C peptide measurements. Ten were classified as normal glucose tolerant (mean ±SD 55±years, body mass index (BMI) 22.7­±2.5 kg/m2, 2-hour plasma glucose 5.7±1.0 mmol/L) and with impaired glucose tolerance (58±­5 years, BMI 23.5±2.9 kg/m2, 2-hour glucose 9.0±0.9 mmol/L) . FODMAPs and macronutrients were assessed from 3-day food diaries. Fecal samples were collected for microbiome analysis. Total FODMAPs were positively correlated to presence of Dorea (r=0.49, p=0.027) . For individual FODMAP items, lactose was positively correlated with Akkermansia (r=0.54, p=0.013) , Bifidobacterium (r=0.42, p=0.037) and negatively correlated with Shigella (r=0.35, p=0.031) in both groups. GOS were positively correlated with Lactobacillus (r= 0.21, p=0.006) and negatively with Shigella (r=0.28, p=0.043) . In the whole group, lower insulin resistance as shown by homeostasis model assessment HOMA2-IR was associated with higher abundance of Bifidobacterium logum (r=0.48, p=0.01) . HOMA2-beta showed correlation with Dorea (r=0.43, p=0.056) . FODMAPs increased the health-promoting microbiota (e.g. Dorea, Lactobacillus, Akkermansia, and Bifidobacterium) . These SCFA promoting microbiota were associated with lower insulin resistance and improved beta-cell function while suppressing the growth of opportunistic pathogens, such as Escherichia spp.

Disclosure
N. Chu: None. J. He: None. R.C. Ma: Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH. A.P. Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd. Research Support; Boehringer Ingelheim. Speaker's Bureau; AstraZeneca, Bayer, Eli Lilly and Company, Sanofi. Stock/Shareholder; Aptorum Group Limited. Other Relationship; AstraZeneca, Novo Nordisk. J.C. Chan: Board Member; Asia Diabetes Foundation. Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Celltrion, Merck Sharp & Dohme Corp., Roche Diabetes Care, Viatris Inc. Research Support; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Hua Medicine, Servier Laboratories. Stock/Shareholder; GemVCare Ltd. E. Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc. Speaker's Bureau; Novartis AG, Sanofi.

Funding
Health Medical Research Fund (17180431) Hong Kong College of Physicians Young Investigator's Research Grant