bluuebunny/crossref_metadata_2025_split huggingface dataset:
1061-P: Need for Insulin Therapy in Gestational Diabetes Mellitus: A Predictive Model Assessment
Authors: CAPORUSSO MARIANGELA , GIOIA LUDOVICO DI , SORICE GIAN PIO , CIGNARELLI ANGELO , NATALICCHIO ANNALISA , GIORGINO FRANCESCO , LAVIOLA LUIGI 
Published: May 2022

A significant portion of pregnant women with Gestational Diabetes Mellitus (GDM) eventually requires insulin therapy, thus necessitating closer monitoring. In this study, we assessed a predictive model for the need of insulin therapy in women with GDM. In a retrospective cohort study, baseline data from 246 women with GDM (43% on subsequent insulin therapy, 57% on nutritional therapy alone) were analyzed using logistic regression. Diagnosis of GDM in previous pregnancies, previous GDM managed with insulin therapy, previous maternal impaired fasting glucose, fasting serum glucose diagnostic for GDM, and 0h and 2h diagnostic values at 75-g oral glucose tolerance test were independent qualitative significant predictors for subsequent insulin therapy. Pre-conceptional maternal body mass index, fasting serum glucose, HbA1c and gestational age at GDM diagnosis were independent quantitative significant predictors for subsequent insulin therapy. According to the odds ratios produced by the logistic regression, a risk score was developed, with identification of low (score &lt;10, p &lt;0.001) , moderate (score ≥and &lt;14, p = 0.052) and high (score ≥14, p &lt; 0.001) risk categories for need of insulin therapy during pregnancy. The area under the ROC curve (AUC) for the internal validation of the predictive model was 0.724. The risk assessment tool was then validated with an independent cohort of 22 GDM women, resulting in a similar predictive power (AUC = 0.744) . Thus, a simple risk score based on easily available clinical and biochemical data at the first visit can predict the need for insulin therapy in GDM women, leading to closer monitoring and timely initiation of therapy in pregnancies at higher risk.

Disclosure
M.Caporusso: Other Relationship; Eli Lilly and Company. L.Di gioia: Other Relationship; Eli Lilly and Company, Menarini Group. G.Sorice: None. A.Cignarelli: None. A.Natalicchio: Consultant; Novo Nordisk, Other Relationship; AstraZeneca, Lilly Diabetes, Sanofi. F.Giorgino: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk, Consultant; Lilly Diabetes, Sanofi, Research Support; Lilly Diabetes, Roche Diabetes Care, Takeda Pharmaceutical Company Limited. L.Laviola: Advisory Panel; Lilly Diabetes, Novo Nordisk, Roche Diabetes Care, Sanofi, Speaker's Bureau; A. Menarini Diagnostics, Abbott Diabetes, Medtronic, Terumo Corporation.
1070-P: Association between Social Determinants of Health and Risk of Type 2 Diabetes in Young Adults Aged 18–45
Authors: ZHANG YAHAN , ZHANG PING , PAVKOV MEDA E. , WANG YU , GUO JINGCHUAN , ZHANG YONGKANG , SHAO HUI 
Published: May 2022

Objective: The prevalence of diagnosed diabetes among adults aged 18-45 years old continues to increase. Since type 2 diabetes (T2D) is preventable through lifestyle modification, implementing lifestyle intervention in those at high risk for T2D may help to reduce the overall diabetes burden. A better understanding of how social determinants of health (SDOH) are related to T2D risk can help to better identify those who are at high risk of T2D for intervention. This study aims to examine the association between a wide array of SDOH factors and risk of T2D in young adults aged 18-45.
Methods: We included data on 14,325 individuals with and without T2D in the 2007-2016 National Health and Nutrition Examination Survey. Forty-four factors covering three SDOH domains (education access and quality, economic stability, and healthcare access and quality) in the databases were selected. Stepwise logistic regression was used to identify statistically significant SDOH risk factors for T2D and estimate the corresponding odds ratios (OR) and 95% confidence intervals (CI) , controlling for age, sex and race/ethnicity.
Results: Among 14,325 sampled individuals, 394 (2.75%) had T2D. SDOH risk factors that were associated with a higher risk of T2D included educational level below high school (OR: 1.89, 95% CI: 1.22-2.86, ref: education above high school) , receiving social security/railroad retirement income (1.89 [1.38-2.56], ref: not receiving social security income) , receiving food stamp benefit (1.45 [1.11- 1.89], ref: not receiving food stamp benefit) , unstable housing (1.50 [1.16-1.93], ref: owning a house) , unstable employment (1.34 [1.04-1.73], ref: stable employment) , and having a higher number of meals not prepared at home in a week (1-10: 1.36 [1.00-1.86]; ≥11: 2.23 [1.35-3.68], ref: 0) . SDOH factors play an important role in the risk of T2D in young adults.
Conclusions: Our findings may help improve tools for screening or prevention of T2D in clinical and community settings.

Disclosure
Y.Zhang: None. P.Zhang: None. M.E.Pavkov: None. Y.Wang: None. J.Guo: None. Y.Zhang: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.
1071-P: A Scoping Review on Diabetes Management in People with Mild Cognitive Impairment (MCI) : Glycemic Control, Medications, and Onset of Alzheimer's and Related Dementias (ADRD)
Authors: ABULOHA SUMAYA , ALSHEHRI ALAA A. , OSPINA NAYKKY SINGH , JAFFEE MICHAEL , SHAO HUI 
Published: May 2022

Controversy exists in diabetes management after the onset of MCI, and the ideal treatment goals and medication use in this population remain inconclusive. This review aimed to comprehensively summarize the existing literature on diabetes management after MCI onset, focusing on the change of A1c goals, medication choices, and the risk of ADRD onset. We conducted a systematic literature search in PubMed (2000.1.1-2021.9.30) to identify studies related to mild cognitive impairment, glycemic goal, and medication use after MCI onset. Study types include guidelines, clinical trials, and observational studies. A standard literature searching process including title/abstracts screening, duplication removal, eligibility assessment, and data extraction was conducted by two reviewers independently. We have identified 30 studies addressing the management of diabetes in patients with MCI. The study contents were categorized into two main focuses; glycemic control (moderate vs. intensive) and the role of medications in delaying ADRD onset. Most guidelines recommend individualized goal setting to a relaxed glycemic target to avoid hypoglycemia after MCI onset. On the other hand, existing evidence linked improved glycemic control with a lower risk of ADRD onset. Observational studies and small-sized trials found the use of metformin, TZD, DPP4, and GLP-1 receptor agonists may be able to slow down the cognitive function decline. However, whether such effects were attributable to improved glycemic control or other mechanisms such as neutral protective effect is inconclusive. The risk-benefit tradeoff in glycemic control is vital in diabetes population with MCI. A large gap exists in understanding the underlying mechanism for the potential protective effect of cognitive function from glucose-lowering medications.

Disclosure
S.Abuloha: None. A.A.Alshehri: None. N.Singh ospina: None. M.Jaffee: Advisory Panel; Novo Nordisk. H.Shao: Board Member; BRAVO4HEALTH, LLC.
1075-P: Racial/Ethnic Differences in the Association between Frailty and Depression among Adults with Diabetes
Authors: EGEDE LEONARD E. , DAWSON APRILL Z. , CAMPBELL JENNIFER A. , WALKER REBEKAH J. 
Published: May 2022

Individuals with diabetes are at increased risk of developing depression. The prevalence of depression in non-Hispanic Blacks (NHB) with diabetes is about 25%, higher than the prevalence among non-Hispanic Whites (NHWs) . Frailty, a measure of biological age and one’s increased susceptibility to negative health outcomes and has been found to be associated with disability and dependency. The aim of this study was to examine the association between depression and frailty and to understand whether this association differs by race/ethnicity among adults with diabetes. Data on 3792 adults with diabetes from NHANES (2003-2005) were analyzed. Depression was assessed using scores from the 9-item Patient Health Questionnaire (PHQ-9) . Frailty index composed of 46 variables (comorbidities, disability, symptoms, labs, general health) was created ranging from 0 - 1 (frail&gt;=0.21; not frail&lt;0.21) . Unadjusted and adjusted linear regression models were used to assess the association between depression and frailty. Covariates included age, sex, education, income-to-poverty ratio, marry, insurance, employment, smoke, physical activity, and body mass index. All models were stratified by race/ethnicity. Unadjusted models showed an association depression and frailty across all racial/ethnic groups with those who were frail having significantly higher PHQ9 scores (NHW: b 2.63; 95%CI:1.36, 3.89; NHB: b 3.26; 95%CI:2.23, 4.23; Hispanic/Other (H/O) : b 1.33; 95%CI:0.52, 2.14) . The association remained significant across all groups in adjusted models (NHW: b 4.5; 95%CI:1.9, 7.1; NHB: b 6.3; 95%CI:4.2, 8.4; H/O: b 2.1; 95%CI:0.5, 3.7) .While depression was associated with frailty across all racial/ethnic groups, NHBs who were frail had the highest mean PHQ9 score. Additional research is needed to identify the key drivers of this relationship and potential targets for home-based lifestyle intervention to improve care provided to and outcomes for frail patients with diabetes.

Disclosure
L.E.Egede: None. A.Z.Dawson: None. J.A.Campbell: None. R.J.Walker: None.

Funding
American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive and Kidney Diseases (grant K24DK093699, R01DK118038, R01DK120861, Principal Investigator (PI) : Leonard Egede, MD) National Institute on Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)
1076-P: Racial/Ethnic Differences in the Association between Frailty and Clinical Outcomes among Adults with Diabetes
Authors: DAWSON APRILL Z. , WALKER REBEKAH J. , CAMPBELL JENNIFER A. , EGEDE LEONARD E. 
Published: May 2022

Racial/ethnic minorities with diabetes have increased risk of complications. Frailty, an indicator of increased vulnerability to adverse health outcomes is associated with dependency and disability. The aim of this study was to examine the association between frailty and clinical outcomes (blood pressure (BP) , hemoglobinA1C (HbA1C) , low-density lipoprotein (LDL)) and whether associations differ by race/ethnicity among adults with diabetes. Data on 3792 adults with diabetes from NHANES (2003-2005) were analyzed. Frailty index composed of 46 variables (comorbidities, disability, symptoms, labs, general health) was created ranging from 0 - 1 (frail&gt;=0.21; not frail&lt;0.21) . Linear regression models were used to assess the association between clinical outcomes and frailty. Models were adjusted for age, sex, education, income-to-poverty ratio, marry, insurance, employment, smoke, physical activity, and body mass index; and were stratified by race/ethnicity. Unadjusted models showed an association between systolic BP (SBP) and frailty with those who were frail having significantly higher SBP (NHW: b 19.6; 95%CI:2.5,26.2; non-Hispanic Black (NHB) : b 6.22; 95%CI:0.95,11.5; Hispanic/Other (H/O) : b 13.5;95%CI:7.7, 19.3) ; significantly lower diastolic BP (DBP) for H/O (b -5.5;95%CI:-8.9,-2.1) , and significantly lower HbA1c for NHW (b -0.60;95%CI:-0.99,-0.20) compared to not frail. In adjusted models, frailty was associated with lower DBP for H/O (b -9.8; 95%CI:-17.8,-1.8) , higher LDL for H/O (b 154;95%CI:97.5,210.6) , and higher HbA1C for NHWs (b 0.91;95%CI:0.004,1.8) and NHBs (b 2.5;95%CI:0.97,4.0) . Associations between frailty and clinical outcomes differed by race/ethnicity among adults with diabetes. Frailty should be assessed as part of routine care for patients with diabetes and interventions accounting for limitations and cultural differences of diverse groups of frail adults with diabetes should be developed to improve clinical outcomes.

Disclosure
A.Z.Dawson: None. R.J.Walker: None. J.A.Campbell: None. L.E.Egede: None.

Funding
American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive and Kidney Diseases (grant K24DK093699, R01DK118038, R01DK120861, Principal Investigator (PI) : Leonard Egede, MD) National Institute on Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)
108-LB: Ultrarapid Lispro (URLi) Improved Postprandial Glucose (PPG) Excursion vs. Humalog (HL) in Predominantly Chinese Adult Patients with Type 2 Diabetes (T2D)
Authors: ZHOU JIAN , CHEN SI , CHENG JIE , SHEN LI , ZHU JIANKUN , LOU YING , BAO YUQIAN , JIA WEIPING 
Published: May 2022

URLi is a novel formulation of insulin lispro developed to better match physiological insulin response to a meal that demonstrates faster absorption and onset of action than HL. This study aimed to evaluate the efficacy and safety of URLi vs. HL in predominantly Chinese adult patients with T2D. It was a Phase 3, randomized, double-blind study, in which patients with T2D randomly received URLi (395 patients) or HL (200 patients) plus glargine or degludec for 26 weeks. The primary endpoint was the treatment difference in the change in HbA1c from baseline to Week 26 (noninferiority margin 0.4%) . The treatment differences in the 1- and 2-hour PPG excursions at Week 26 were assessed as the multiplicity-adjusted endpoints. URLi achieved noninferiority to HL on change in HbA1c with least squares mean difference (95% confidence interval) of 0.07% (-0.07, 0.21) . URLi was superior to HL in controlling 1-hour (4.8 mmol/L vs. 5.6 mmol/L, P &lt;0.001) and 2-hour PPG excursions (6.2 mmol/L vs. 7.4 mmol/L, P &lt;0.001) at Week 26. A greater decrease in daily mean 1- and 2-hour PPG excursions with URLi than HL from baseline to Week 26 was observed in the 10-point self-monitored blood glucose profile. Increase in the dose of bolus insulin from baseline to Week 26 was slightly higher with URLi than HL (0.21 U/kg/day vs. 0.18 U/kg/day, P=0.045) . During the 26-week treatment period, both groups showed similar and low rate and incidence of severe hypoglycemia and documented symptomatic hypoglycemia. The incidences of serious adverse events and treatment-emergent adverse events were comparable between both groups. URLi vs. HL in a basal-bolus regimen demonstrated noninferior glycemic control as assessed by HbA1c and superior control on PPG excursions in predominantly Chinese adult patients with T2D with a similar safety profile.

Disclosure
J. Zhou: n/a. S. Chen: None. J. Cheng: Employee; Eli Lilly and Company. L. Shen: Employee; Eli Lilly and Company. J. Zhu: Employee; Eli Lilly and Company. Y. Lou: None. Y. Bao: None. W. Jia: None.

Funding
Eli Lilly and Company
1084-P: Trends in Cardiovascular Risk Factors (CRF) for Youth with Incident Diabetes: The SEARCH for Diabetes in Youth Study
Authors: BELL RONNY A. , RIGDON JOSEPH , BELLATORRE ANNA , DABELEA DANA , DAGOSTINO RALPH , DIVERS JASMIN , DOLAN LAWRENCE M. , IMPERATORE GIUSEPPINA , JENSEN ELIZABETH T. , LIESE ANGELA D. , LUSTIGOVA EVA , MARCOVINA SANTICA M. , MERJANEH LINA , PETTITT DAVID J. , PIHOKER CATHERINE , SHAH AMY S. , SOUTH ANDREW M. , WAGENKNECHT LYNNE E. 
Published: May 2022

To examine CRF trends that may impact future CVD risk, the SEARCH study assessed CRF for diabetes-related complications in incident cohorts established from 2002 - 2016. Linear regression was used to assess trends over each incident year for non-HDL-c, LDL-c, VLDL-c, TG, BMI z-score, systolic and diastolic blood pressure (BP) z-scores, albumin/creatinine ratio (ACR) and eGFR. Models were stratified by diabetes type (Type 1, N=4600; Type 2, N=932) , adjusted for age at diagnosis, sex, DM duration and race/ethnicity. An interaction analysis was conducted to assess differential time trends by type. For youth with type 1, non-HDL-c, BP, BMI and ACR &gt;30 decreased while HDL-c increased over time. For youth with type 2, non-HDL-c, and eGFR decreased, and BMI increased over time (table) . Significant time change interactions by type were seen for HDL-c and for BMI z-score and BP measures (table) .We observed small but significant changes in several CRFs over time in youth with incident DM, especially lipids, with greater improvements seen in youth with type 1. Youth with type 2 had worsening trends over time in BMI, BP, and kidney function. Further research is needed to better understand these trends and their implications for long term CVD risk.

Disclosure
R.A.Bell: None. A.D.Liese: None. E.Lustigova: None. S.M.Marcovina: None. L.Merjaneh: None. D.J.Pettitt: n/a. C.Pihoker: None. A.S.Shah: None. A.M.South: None. L.E.Wagenknecht: None. J.Rigdon: None. A.Bellatorre: None. D.Dabelea: None. R.Dagostino: Consultant; Aetion, Inc., AstraZeneca, Biogen, Bristol-Myers Squibb Company, Daiichi Sankyo, Merck & Co., Inc. J.Divers: None. L.M.Dolan: None. G.Imperatore: None. E.T.Jensen: Consultant; Regeneron Pharmaceuticals Inc.

Funding
Centers for Disease Control and Prevention U18DP006131
109-LB: An Investigation into Local Infusion Site Pain after Infusion of URLi Excipients across Sites and Depths
Authors: IGNAUT DEBRA A. , FUKUDA TSUYOSHI , RAMANJINEYULU BANDI , ERMER MARCEL , STOFFEL MARC S. , ZIJLSTRA ERIC , PAAVOLA D 
Published: May 2022

A Phase 1, randomized, 1-day 5-period crossover study in adults with type 1 diabetes on CSII investigated whether pain is dependent on the site and/or depth of infusion of ultra rapid lispro (URLi) excipients.
Forty participants (mean age 40.5 years; BMI 27.5) were randomized to 1 of 5 infusion site sequences consisting of the abdomen, arm, thigh, and buttock (6 mm cannula depth) , and abdomen (9 mm depth) . Basal infusion of sodium citrate, treprostinil, and magnesium chloride in diluent was initiated (1 U/h) and 15 unit-equivalent boluses were given at 3, 6, and 9 h after basal initiation. Participants rated local infusion site pain perception by the 0-100 mm validated visual analog scale (VAS) at 5 min before bolus and 1 and 15 min post bolus.
An increased VAS score was occasionally reported at 1 min post bolus, more frequently for the arm. Most scores were ≤10 mm (little to no discomfort) while 7 of 577 were &gt;45 mm (generally considered clinically meaningful pain) . VAS score distributions were similar between cannula depths (Figure) . After 15 min, scores were similar to pre bolus. No participants discontinued the study.
Local infusion site discomfort after infusion of URLi excipients was reported by a subset of participants; it was transient, tolerable, and dependent on infusion site. Given differences among sites within individuals, patients may consider changing infusion site if they experience discomfort.

Disclosure
D. A. Ignaut: None. T. Fukuda: Employee; Eli Lilly and Company. B. Ramanjineyulu: None. M. Ermer: None. M. S. Stoffel: None. E. Zijlstra: Speaker’s Bureau; Gan & Lee Pharmaceuticals, Novo Nordisk. D. Paavola: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company.

Funding
Eli Lilly and Company
109-OR: Physiologic Subtypes of Gestational Glucose Intolerance and Risk of Future Prediabetes
Authors: SELEN DARYL J. , THAWEETHAI TANAYOTT , YU CHU , HSU SARAH , JAMES KAITLYN , ECKER JEFFREY L. , MEIGS JAMES B. , POWE CAMILLE E. 
Published: May 2022

Background: Gestational glucose intolerance (GGI, abnormal initial gestational diabetes [GDM] screen) conveys an increased risk of future diabetes (DM) , even when GDM criteria is not met. We previously defined subtypes of GGI/GDM according to the underlying mechanism leading to hyperglycemia (insulin resistance vs. deficiency) . We aimed to determine if GGI subtypes are at differential risk for future prediabetes/DM; we hypothesized increased risk with insulin deficient subtypes.
Methods: We defined GGI as glucose loading test 1-hr glucose ≥ 140 mg/dL at &gt; 22 weeks’ gestation. We applied homeostasis model assessment (HOMA) to fasting glucose and insulin at 16-20 weeks’ gestation and classified pregnancies with GGI without GDM into subtypes according to the presence of insulin resistance and/or deficiency. We used Cox proportional-hazards models with time-varying exposures to assess risk of preDM/DM (HbA1c ≥ 5.7% at ≥ 3 months after delivery) in each GGI subtype compared to pregnancies with normal glucose tolerance after adjustment for age, race/ethnicity, health insurance, and first trimester BMI. Women were censored at the time of last HbA1c or GDM diagnosis.
Results: Of 671 women with a median 9.9 years of follow-up, 29% (n=196) developed preDM/DM. Among pregnancies in 113 women with GGI, 54% had the insulin resistant subtype (IR) , 25% had the insulin deficient subtype (ID) , and 16% had the mixed pathophysiology subtype (MP) . Subtypes with insulin deficiency (ID + MP) and insulin resistance (IR) were both associated with increased risk of preDM/DM (ID + MP hazard ratio [HR]=1.8 [1.1-2.9], p=0.02 and IR HR=1.7 [1.1-2.6], p=0.01) . Each insulin deficient subtype also appeared to carry increased risk: ID HR=1.7 (0.9-3.1, p=0.12) and MP HR=2.1 (1.0-4.2, p=0.048) .
Conclusions: GGI confers an increased risk of future prediabetes/DM, regardless of the mechanism leading to glucose intolerance. A combination of insulin resistance and deficiency may convey the highest risk of future prediabetes/DM.

Disclosure
D.J. Selen: None. T. Thaweethai: None. K. James: None. J.L. Ecker: None. J.B. Meigs: Consultant; Quest Diagnostics. C.E. Powe: None.

Funding
National Institutes of Health (T32DK007028) , Massachusetts General Hospital (Physician Scientist Development Award and Claflin Distinguished Scholar’s Award)
11-OR: Transcriptome Heterogeneity in Insulin-Positive Insulitic vs. Noninsulitic Human Islets in Type 1 Diabetes (T1D)
Authors: DYE ALYSSA M. , ASHBERY GRACE , LENCHIK NATALIYA I. , ATKINSON MARK A. , MATHEWS CLAYTON E. , CAMPBELL-THOMPSON MARTHA , GERLING IVAN C. 
Published: May 2022

Insulitis involves the infiltration of predominantly CD3+ T cells in islets in a patchy distribution between lobes in a pancreas. We hypothesized that gene expression profiling of insulin containing islets (INS+CD3-) vs. insulin containing insulitic islets (INS+CD3+) would show heterogeneity in autoimmune and ßcell dysfunction pathways within the same donor. Pancreatic islets were obtained by laser-capture microdissection from nPOD donors (5 autoantibody positive nondiabetic (AAb+) and 6 T1D) . Transcriptome data was collected and compared in 83 individual islets. INS+CD3+ islets were compared to the average of all INS+CD3- islets in each donor. For each INS+CD3+ islet we created two registries of genes &gt;2-fold up or &gt;2-fold downregulated that were analyzed to detect differences in pathways and ontologies. Islets were analyzed based on five categories: immunity, mitochondrial, metabolism, secretion, and cell signaling. A majority of donors (64%) had all 5 categories represented in either up or downregulated pathways. The most upregulated category in T1D donor islets was immunity (39%) and most downregulated was secretion (33%) . These islets were distinguished by extreme heterogeneity in signaling pathways. In AAb+ donor islets, the most upregulated category was immunity (32%) , with the most downregulated noted as metabolism (21%) . Similarly, AAb+ donor islets had heterogeneity in signaling pathways. In contrast, we observed great intra-donor heterogeneity; each individual islet had 65% unique genes upregulated and 58% downregulated compared to other INS+CD3+ islets within the same donor.
In summary, similar themes of up or downregulated categories were noted in INS+CD3+ compared to averaged INS+CD3- islets. Most strikingly, significant heterogeneity between INS+CD3+ islets within donors at the individual gene levels was observed. These findings indicate substantial complexity of pancreatic islet destruction leading to T1D.

Disclosure
A.M.Dye: None. G.Ashbery: None. N.I.Lenchik: n/a. M.A.Atkinson: None. C.E.Mathews: None. M.Campbell-thompson: Consultant; TRex Bio. I.C.Gerling: None.

Funding
NIH-NIDDK (HIRN-CBDS) UC4 DK104155-01LeBonheur Children’s Foundation Research Institute (CFRI) Fellows Research Grant