HbA1c Across Sex and Age Categories in Type 2 Diabetes: Results from Three Independent Temporal Cohorts Spanning 2012–2024

Characterizing population-level changes in type 1 diabetes (T1D) management can inform public health policies and interventions. To characterize trends and disparities in glycemic control and use of diabetes technology among US youths and adults with T1D. This serial, cross-sectional analysis used the Optum Labs Data Warehouse, a national, deidentified database of electronic health records, to identify US youths (aged <18 years) and adults (aged ≥18 years) with T1D. Data were obtained from records from January 1, 2009, to December 31, 2023. Calendar years divided into 3-year study periods from 2009 to 2011 to 2021 to 2023. Glycemic control (mean hemoglobin A1c level, <7%) and use of diabetes technology (continuous glucose monitoring systems and/or insulin pumps) were defined using laboratory data and prescriptions, procedures, and diagnoses codes from electronic health records. A total of 186 590 participants with T1D was identified (mean [SD] age, 40 [19] years; 96 766 [52%] male; 12 493 [7%] Hispanic, 2819 [2%] non-Hispanic Asian, 21 459 [12%] non-Hispanic Black, and 141 847 [76%] non-Hispanic White). Of these, 26 853 participants were youths (mean [SD] age, 12 [4] years; 14 060 [52%] male; 19 822 [74%] non-Hispanic White) and 159 737 were adults (mean [SD] age, 45 [16] years; 82 706 [52%] male; 122 025 [76%] non-Hispanic White). From the 2009-2011 to 2021-2023 study periods, the prevalence of glycemic control (mean hemoglobin A1c level <7%) increased from 7% (95% CI, 7%-8%) to 19% (95% CI, 19%-20%) in youths (P < .001 for trend) and 21% (95% CI, 21%-22%) to 28% (95% CI, 28%-29%) in adults (P < .001 for trend). During this same period, there was a substantial increase in the percentage of patients using continuous glucose monitoring (4% to 82% for youths; 5% to 57% for adults), insulin pumps (16% to 50% for youths; 11% to 29% for adults), and both devices concurrently (1% to 47% for youths; 1% to 22% for adults) (P < .001 for trend for all). The prevalence of glycemic control and use of diabetes technology were lowest in Hispanic, non-Hispanic Black, and Medicaid-insured youths and adults, and differences persisted or increased over time. In this cross-sectional study, there was a rapid increase in the use of diabetes technology and notable improvements in glycemic control among youths and adults with T1D during the past 15 years. Nonetheless, the prevalence of glycemic control remained low, and racial, ethnic, and socioeconomic differences grew over time.

&lt;p dir="ltr"&gt;Objective&lt;/p&gt;&lt;p dir="ltr"&gt;Racial/ethnic disparities in glycemic control among Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) veterans with type 2 diabetes (T2D) have been reported. This study examined trends in early glycemic control (EGC) by race/ethnicity to understand how disparities soon after T2D diagnosis have changed between 2008 and 2019 among cohorts of newly-diagnosed US veterans.&lt;/p&gt;&lt;p dir="ltr"&gt;Research Design and Methods&lt;/p&gt;&lt;p dir="ltr"&gt;We estimated annual percent of EGC (average A1c&lt;7%) in the first 5 years post-diagnosis among 837,023 veterans (95% male) with newly-diagnosed T2D in primary care. We compared EGC by racial/ethnic group among cohorts defined by diagnosis year (2008-2010, 2011-2013, 2014-2016 and 2017-2018) using mixed effect models with random intercepts. We estimated odds ratios of EGC comparing racial/ethnic groups to NHW, adjusting for age, sex and years of diagnosis. &lt;/p&gt;&lt;p dir="ltr"&gt;Results&lt;/p&gt;&lt;p dir="ltr"&gt;The average annual percent of veterans who achieved EGC during follow-up was 73%, 72%, 72%, and 76% in four cohorts respectively. All racial/ethnic groups were less likely to achieve EGC compared to NHW veterans in the 2008-2010 cohort. In later cohorts, NHB and Hispanic veterans were more likely to achieve EGC; however, Hispanic veterans were also more likely to have A1c≥9% within 5 years in all cohorts. EGC disparities for Non-Hispanic Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native veterans persisted in cohorts until the 2017-2018 cohort.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions&lt;/p&gt;&lt;p dir="ltr"&gt;Overall EGC trends among newly-diagnosed veterans have been stable since 2008, but trends differed by racial/ethnic groups and disparities in very poor control were still observed. Efforts should continue to minimize disparities between racial/ethnic groups.&lt;/p&gt;

&lt;p dir="ltr"&gt;Objective&lt;/p&gt;&lt;p dir="ltr"&gt;Racial/ethnic disparities in glycemic control among Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) veterans with type 2 diabetes (T2D) have been reported. This study examined trends in early glycemic control (EGC) by race/ethnicity to understand how disparities soon after T2D diagnosis have changed between 2008 and 2019 among cohorts of newly-diagnosed US veterans.&lt;/p&gt;&lt;p dir="ltr"&gt;Research Design and Methods&lt;/p&gt;&lt;p dir="ltr"&gt;We estimated annual percent of EGC (average A1c&lt;7%) in the first 5 years post-diagnosis among 837,023 veterans (95% male) with newly-diagnosed T2D in primary care. We compared EGC by racial/ethnic group among cohorts defined by diagnosis year (2008-2010, 2011-2013, 2014-2016 and 2017-2018) using mixed effect models with random intercepts. We estimated odds ratios of EGC comparing racial/ethnic groups to NHW, adjusting for age, sex and years of diagnosis. &lt;/p&gt;&lt;p dir="ltr"&gt;Results&lt;/p&gt;&lt;p dir="ltr"&gt;The average annual percent of veterans who achieved EGC during follow-up was 73%, 72%, 72%, and 76% in four cohorts respectively. All racial/ethnic groups were less likely to achieve EGC compared to NHW veterans in the 2008-2010 cohort. In later cohorts, NHB and Hispanic veterans were more likely to achieve EGC; however, Hispanic veterans were also more likely to have A1c≥9% within 5 years in all cohorts. EGC disparities for Non-Hispanic Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native veterans persisted in cohorts until the 2017-2018 cohort.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions&lt;/p&gt;&lt;p dir="ltr"&gt;Overall EGC trends among newly-diagnosed veterans have been stable since 2008, but trends differed by racial/ethnic groups and disparities in very poor control were still observed. Efforts should continue to minimize disparities between racial/ethnic groups.&lt;/p&gt;

Racial and ethnic disparities in glycemic control among non-Hispanic Black (NHB) and non-Hispanic White (NHW) veterans with type 2 diabetes (T2D) have been reported. This study examined trends in early glycemic control by race and ethnicity to understand how disparities soon after T2D diagnosis have changed between 2008 and 2019 among cohorts of U.S. veterans with newly diagnosed T2D. We estimated the annual percentage of early glycemic control(average A1C <7%) in the first 5 years after diagnosis among 837,023 veterans (95% male) with newly diagnosed T2D in primary care. We compared early glycemic controlby racial and ethnic group among cohorts defined by diagnosis year (2008-2010, 2011-2013, 2014-2016, and 2017-2018) using mixed-effects models with random intercepts. We estimated odds ratios of early glycemic controlcomparing racial and ethnic groups with NHW, adjusting for age, sex, and years since diagnosis. The average annual percentage of veterans who achieved early glycemic controlduring follow-up was 73%, 72%, 72%, and 76% across the four cohorts, respectively. All racial and ethnic groups were less likely to achieve early glycemic controlcompared with NHW veterans in the 2008-2010 cohort. In later cohorts, NHB and Hispanic veterans were more likely to achieve early glycemic control; however, Hispanic veterans were also more likely to have an A1C ≥9% within 5 years in all cohorts. Early glycemic controldisparities for non-Hispanic Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native veterans persisted in cohorts until the 2017-2018 cohort. Overall early glycemic controltrends among veterans with newly diagnosed T2D have been stable since 2008, but trends differed by racial and ethnic groups and disparities in very poor glycemic control were still observed. Efforts should continue to minimize disparities among racial and ethnic groups.

BackgroundDisparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D.Methods and findingsA T2D cohort was identified from the Royal College of General Practitioners Research and Surveillance Centre dataset: a nationally representative sample of 164 primary care practices (general practices) across England. Diabetes healthcare provision and glucose-lowering medication use between 1 January 2012 and 31 December 2016 were studied. Healthcare provision included annual HbA1c, renal function (estimated glomerular filtration rate [eGFR]), blood pressure (BP), retinopathy, and neuropathy testing. Variables potentially associated with disparity outcomes were assessed using mixed effects logistic and linear regression, adjusted for age, sex, ethnicity, and socioeconomic status (SES) using the Index of Multiple Deprivation (IMD), and nested using random effects within general practices. Ethnicity was defined using the Office for National Statistics ethnicity categories: White, Mixed, Asian, Black, and Other (including Arab people and other groups not classified elsewhere). From the primary care adult population (n = 1,238,909), we identified a cohort of 84,452 (5.29%) adults with T2D. The mean age of people with T2D in the included cohort at 31 December 2016 was 68.7 ± 12.6 years; 21,656 (43.9%) were female. The mean body mass index was 30.7 ± SD 6.4 kg/m2. The most deprived groups (IMD quintiles 1 and 2) showed poorer HbA1c than the least deprived (IMD quintile 5). People of Black ethnicity had worse HbA1c than those of White ethnicity. Asian individuals were less likely than White individuals to be prescribed insulin (odds ratio [OR] 0.86, 95% CI 0.79–0.95; p < 0.01), sodium-glucose cotransporter-2 (SGLT2) inhibitors (OR 0.68, 95% CI 0.58–0.79; p < 0.001), and glucagon-like peptide-1 (GLP-1) agonists (OR 0.37, 95% CI 0.31–0.44; p < 0.001). Black individuals were less likely than White individuals to be prescribed SGLT2 inhibitors (OR 0.50, 95% CI 0.39–0.65; p < 0.001) and GLP-1 agonists (OR 0.45, 95% CI 0.35–0.57; p < 0.001). Individuals in IMD quintile 5 were more likely than those in the other IMD quintiles to have annual testing for HbA1c, BP, eGFR, retinopathy, and neuropathy. Black individuals were less likely than White individuals to have annual testing for HbA1c (OR 0.89, 95% CI 0.79–0.99; p = 0.04) and retinopathy (OR 0.82, 95% CI 0.70–0.96; p = 0.011). Asian individuals were more likely than White individuals to have monitoring for HbA1c (OR 1.10, 95% CI 1.01–1.20; p = 0.023) and eGFR (OR 1.09, 95% CI 1.00–1.19; p = 0.048), but less likely for retinopathy (OR 0.88, 95% CI 0.79–0.97; p = 0.01) and neuropathy (OR 0.88, 95% CI 0.80–0.97; p = 0.01). The study is limited by the nature of being observational and defined using retrospectively collected data. Disparities in diabetes care may show regional variation, which was not part of this evaluation.ConclusionsOur findings suggest that disparity in glycaemic control, diabetes-related monitoring, and prescription of newer therapies remains a challenge in diabetes care. Both SES and ethnicity were important determinants of inequality. Disparities in glycaemic control and other areas of care may lead to higher rates of complications and adverse outcomes for some groups.

Immune checkpoint inhibitors (ICIs) activate the immune system by blocking PD-1, CTLA-4, and PD-L1, thereby inducing autoimmune-mediated adverse reactions known as immune-related adverse events (irAEs). When two or more organs are involved, this condition is defined as multi-organ immune-related adverse events (multi-organ irAEs). Patients with multi-organ irAEs account for approximately 20%-30% of all irAE cases; however, clinical research focusing on this subset remains limited. The purpose of this study is to analyze the clinical characteristics, optimal therapeutic approaches, and mortality-related risk factors of multi-organ irAEs. We searched all case reports of irAEs associated with ICIs in the PubMed, Web of Science, Cochrane Library, and Embase databases from their inception to January 2022. Search terms included "Immune Checkpoint Inhibitors", "Checkpoint Inhibitors, Immune", "Immune Checkpoint Blockers", "PD-L1", "CTLA-4 Inhibitor", "PD-1", and "Case report". After removing duplicate literature and applying strict inclusion/exclusion criteria, a total of 2,740 articles were included, encompassing 2,964 patients (782 with multi-organ irAEs and 2,182 with single-organ irAEs). Patients were stratified by the number of affected organs to compare clinical characteristics between multi-organ and single-organ irAE groups. For patients with multi-organ irAEs, subgroup analyzes were performed based on glucocorticoid dosage to identify optimal treatment strategies, and further stratified by survival status to explore potential mortality risk factors. No statistically significant differences in age or sex were observed between patients with multi-organ irAEs and those with single-organ irAEs (P > 0.05). However, the multi-organ irAE group exhibited significantly higher proportions of cardiovascular toxicity, thyroid toxicity, skin toxicity, and severe adverse reactions (P < 0.05), as well as a significantly elevated mortality rate (P < 0.05). Among patients with severe multi-organ irAEs, there were no significant differences in sex or age between high-dose and low-dose glucocorticoid subgroups (P > 0.05); notably, the high-dose glucocorticoid group had a significantly higher mortality rate (P < 0.05). For patients with non-severe multi-organ irAEs, no statistically significant differences in sex, age, mortality, or prognosis were detected between high-dose and low-dose glucocorticoid groups (P > 0.05). Multivariate logistic regression analysis revealed that cardiovascular toxicity, pulmonary toxicity, hepatotoxicity, and myositis were positively correlated with mortality in patients with multi-organ irAEs (OR > 1, P < 0.05). The most common organ combinations in multi-organ irAEs are "cardiac + neurological, cardiac + pulmonary, thyroid + pituitary, cardiac + hepatic, and gastrointestinal + skin". Multi-organ irAEs are generally more severe and associated with poorer outcomes compared to single-organ irAEs. High-dose glucocorticoids did not demonstrate superior prognostic outcomes and may be associated with an increased mortality risk in severe irAEs.clinical decisions regarding glucocorticoid dosing should be individualized based on the severity of irAEs and the specific organs involved.Cardiovascular toxicity, pulmonary toxicity, hepatotoxicity, and myositis are potential mortality risk factors for multi-organ irAEs induced by ICIs.

To determine the relationship between glycaemic control trajectory and the long term risk of severe complications in people with type 1 diabetes mellitus, as well as the effects of paediatric and adult HbA 1c levels. Data linkage study of data for adults with childhood-onset type 1 diabetes (diagnosed during 1975–2010) who had transitioned from paediatric diabetes care at the Royal Children's Hospital (Melbourne) to adult diabetes care at the Royal Melbourne Hospital during 1992–2013. Severe complications were categorised as severe diabetic retinopathy (SDR), chronic kidney disease, ulceration or amputation, and death. Mean HbA 1c levels were calculated for the paediatric and adult periods. Four glycaemic control trajectories were defined according to mean paediatric and adult HbA 1c levels: stable low (paediatric and adult HbA 1c ≤ 66 mmol/mol); improving (paediatric HbA 1c > 66 mmol/mol, adult HbA 1c ≤ 66 mmol/mol); worsening (paediatric HbA 1c ≤ 66 mmol/mol, adult HbA 1c > 66 mmol/mol); and stable high (paediatric and adult HbA 1c > 66 mmol/mol). 503 eligible participants (253 men) were identified, 26 (5.2%) of whom had at least one severe complication, including 16 with SDR (3.2%). No-one in the stable low group, but 4% of the improving, 1% of the worsening, and 7% of the stable high groups developed SDR. Higher mean paediatric (per 10.9 mmol/mol increase: odds ratio [OR], 2.9; 95% CI, 1.9–4.3; P < 0.01) or adult HbA 1c levels (OR, 2.1; 95% CI, 1.4–3.1; P < 0.01) were associated with increased risk of SDR, as was longer duration of type 1 diabetes (per additional year: OR, 1.3; 95% CI, 1.2–1.5; P < 0.01). SDR was associated with higher paediatric HbA 1c levels, independent of glycaemic control during adulthood; it was not documented in patients with a stable low glycaemic control trajectory.

Despite advances in diabetes self-management education and support (DSMES), disparities persist in clinical, behavioral, and psychosocial outcomes. Evidence suggests that, in addition to racial/ethnic disparities in diabetes self-management, gender disparities in glycemic control (A1c) exist in patients with type 2 diabetes (T2D). However, there is a knowledge gap in determining if gender differences in A1c are mediated by Diabetes Distress (DD) and/or Depressive Symptoms (DS), or if gender moderates this relationship. Therefore, we aimed to investigate the relationship between gender, DD, DS, and A1c in 94 African American adults with T2D from 9 churches in metro-Detroit, MI. All churches participated in a 15-month, cluster randomized controlled trial focused on DSMS efforts to maintain T2D outcomes following DSME. DD was defined as DD Scale score &amp;gt;=3. DS was measured with the PHQ-9. PHQ-9 was categorized into no DS (PHQ-9 score &amp;lt; 5), minimal DS (PHQ-9 score &amp;gt;=5&amp;lt;10), and depression (PHQ-9 scores &amp;gt;=10). Participants were 44% male, had a mean age of 65.0±10.46 years, and 32% were prescribed insulin. Mean baseline A1c was 7.1±1.7 (males: 7.4±2.0; females: 6.9±1.5, p=0.78). 34.4% of participants reported having DD. More females (35%) reported DD compared to males (31.2%) p=0.72. Approximately 63% of participants reported no DS, 21% reported minimal DS, and 16% reported having DS. There were no differences in PHQ-9 scores when stratified by gender (p=0.17). Mixed effects logistic regression revealed that gender did not moderate the relationship between DD or DS and A1c. However, DD mediated gender differences in A1c (β=-1.7, p=0.02) but DS did not (β=-0.25, p=0.76). Gender differences in a1c for patients with T2D may be attributable to DD, but not DS. As females traditionally report higher DD levels than males and a1c is often worse in males than females, increased attention to these gender differences is warranted, particularly among African Americans. Disclosure J. M. Hawkins: None. N. J. Koscielniak: None. R. Nwankwo: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. K. A. Kloss: None. D. Hall: None. G. Piatt: None. Funding National Institutes of Health (5R01DK10473305)

Background: The burden of type 2 diabetes (T2D) is disproportionately higher among racial and ethnic minorities, particularly African American individuals who have low socioeconomic status (SES). According to the cumulative SES life-course model, stressful experiences in early life and later life can accumulate to influence disease risk. Yet, little is known about the association between cumulative SES, or the combined effects of different SES phenotypes (i.e., education, wealth, income, etc.), over the life course and development of T2D. Objective: To estimate the association of cumulative SES and incident T2D among men and women without T2D and cardiovascular disease at baseline (2000-2004) from the Jackson Heart Study (JHS) (n=3078). Methods: Using cohort data from JHS (mean age 52.8 years; 1969 women, 1109 men), we derived standardized cumulative SES scores at baseline, conceptualized using 6 SES indicators (e.g. educational attainment, wealth, income, occupation, employment status and mother’s education) and dichotomized the score as high SES (median and above - referent) and low SES (below the median). Incident T2D was defined at exam 2 (2005-2008) or exam 3 (2009-2013) based on a fasting glucose ≥126 mg/dL, or HbA1c ≥ 6.5, or those who had been on diabetic medication 2 weeks prior to these visits, or those who reported a physician diagnosis. Interval censoring proportional hazards regression was used to estimate the association between cumulative SES and incident T2D using hazard ratios (HR, 95% confidence interval-CI), where time-to-event was approximated as the interval between the first visit and the visit in which T2D was ascertained. Sex differences were evaluated using interaction terms and descriptive statistics. The fully-adjusted model included baseline covariates: age, waist circumference, health behaviors, and family history of diabetes. Results: There were 544 total incident T2D cases and 65% (351) of cases were characterized as having low SES. The dichotomized cumulative score was associated with incident T2D ( p &lt;0.05) in unadjusted chi square analyses. In the fully-adjusted models, low (vs. high) cumulative SES and the standardized score were marginally associated with incident T2D (HR 1.14; 95% CI (0.95, 1.38) and HR 0.99; 95% CI (0.90, 1.08), respectively). There were no significant sex differences in the association between cumulative SES and incident T2D. Conclusion: Low cumulative SES was not significantly associated with development of T2D when adjusting for potential confounders. Future work should consider examination of adverse experiences related to low SES and other environmental factors such as built environment and neighborhood SES.

Landscape of sex differences in obesity and type 2 diabetes in subcutaneous adipose tissue: a systematic review and meta-analysis of transcriptomics studies.

Obesity represents a significant risk factor in the development of type 2 diabetes (T2D), a chronic metabolic disorder characterized by elevated blood glucose levels. Significant sex differences have been identified in the prevalence, development, and pathophysiology of obesity and T2D; however, the underlying molecular mechanisms remain unclear. This study aims to identify sex-specific biomarkers in obesity and T2D and enhance our understanding of the underlying mechanisms associated with sex differences by integrating expression data.A systematic review, individual transcriptomic analysis, gene-level meta-analysis, and functional characterization were performed to achieve this aim. Eight studies and 236 subcutaneous adipose tissue samples were analyzed, identifying common and sex-specific biomarkers, many of which were previously associated with obesity or T2D.The obesity meta-analysis yielded nineteen differentially-expressed biomarkers from a sex-specific perspective (e.g.,SPATA18, KREMEN1, NPY4R, andPRM3), while a comparison of the expression profiles between sexes in T2D prompted the identification and validation of specific transcriptomic signatures in males (SAMD9, NBPF3, LDHD, andEHD3) and females (RETN, HEY1, PLPP2, andPM20D2). At the functional level, we highlighted the fundamental role of the Wnt pathway in the development of obesity and T2D in females and the roles of more significant mitochondrial damage and free fatty acids in males.Overall, our sex-specific meta-analyses supported the detection of differentially expressed genes in males and females associated with the development of obesity and T2D, emphasizing the relevance of sex-based information in biomedical data and opening new avenues for research.HighlightsFirst meta-analysis on WAT with sex as a central perspective in obesity and T2DThis study identifies 19 sex-differential biomarkers in obesity, highlighting NPY4Sex specific transcriptional signatures in SAT in the development of T2DWnt pathway genes show sex-specific roles in obesity and T2D, notably in femalesObesity increases mitogenesis in male, mediated by SPATA18, with an increased role of free fatty acids in T2D

Purpose: This study examines and compares the differences between self-esteem and health promotion behavior of health department and non-health department college students. Method: The research instruments were as follows : The first one is RSES developed by Rosenberg and translated into Korean by Jeon. The second one is HPLP developed by Walker et al, and including six subareas by Lee and modified to be suitable to Korean culture by Suh. Data were statistically analyzed with SPSS PC/12.0. Results : 1. Comparison of self-esteem had no significant difference(p=.190) and health promotion behaviors had significant differences(p=.000) between the two groups. 2. According to general characteristics and health-related characteristics, the differences of self-esteem in health department showed significant differences in grade(p=.020), sex(p=.000), age(p=.000), parents' economic conditions(p=.048), and smoking(p=.030) while non-health departments revealed significant differences in grade(p=.003), sex(p=.000), age(p=.000) and smoking(p=.001). 3. According to general characteristics and health-related characteristics, the differences of health promotion behaviors in health department showed significant differences in grade(p=.008), sex(p=.021), age(p=.000) and parents' economic conditions(p=.017) while non-health department revealed significant differences in sex(p=.000) and age(p=.000). 4. There were positive correlations between self-esteem, health promotion behaviors and subareas in health department (r=.422) and non-health department (r=.383). Conclusion: There were significant positive correlations between self-esteem and health promotion behaviors in health and non-health department college students. Therefore, health related programs should be developed to enhance self-esteem and health management by college students can influence themselves on self-esteem and health promotion behaviors.

Patients with type 1 diabetes (T1D) have higher cardiovascular disease (CVD) risk than the general population. This observational study aims to evaluate sex-related differences in CVD prevalence and CVD risk estimates in a large cohort of T1D adults. We conducted a multicenter, cross-sectional study involving 2041 patients with T1D (mean age 46 years; 44.9% women). In patients without pre-existing CVD (primary prevention), we used the Steno type 1 risk engine to estimate the 10-year risk of developing CVD events. CVD prevalence (n = 116) was higher in men than in women aged ≥55 years (19.2 vs 12.8%, P = .036), but comparable between the 2 sexes in those aged <55 years (P = .91). In patients without pre-existing CVD (n = 1925), mean 10-year estimated CVD risk was 15.4 ± 0.4% without any significant sex difference. However, stratifying this patient group by age, the 10-year estimated CVD risk was significantly higher in men than in women until age 55 years (P < .001), but this risk equalized after this age. Carotid artery plaque burden was significantly associated with age ≥55 years and with a medium and high 10-year estimated CVD risk, without any significant sex difference. Diabetic retinopathy and sensory-motor neuropathy were also associated with higher 10-year CVD risk and female sex. Both men and women with T1D are at high CVD risk. The 10-year estimated CVD risk was higher in men aged <55 years than in women of similar age, but these sex differences disappeared at age ≥55 years, suggesting that female sex was no longer protective.

Sarcopenia (low muscle mass/muscle function [MM/MF]) and sarcopenic obesity (sarcopenia+obesity, SO) have relevant clinical implications, but few data are available on pts with type 2 diabetes (T2D), especially in Western populations. We assessed the proportion of Caucasian pts with T2D and sarcopenia/SO and clinical correlates of sarcopenia. During routine follow-up outpatient visits (Jun-Dec 2022), we measured skeletal MM by bioelectrical impedance analysis (BIA) and MF by hand-grip strength in all pts except those with contraindications to BIA. Low MM and low MF were diagnosed using validated sex- and sex-/age-specific cut-offs, respectively, as recommended by ESPEN &amp; EASO. Anthropometrics, glycemic control (HbA1c) and type/number of complications were recorded for all pts. A total of 116 pts with T2D were included (64.7% F, median [25°; 75° percentile] age 70.0 [62.3; 78.0] years, 35.3% with obesity). Sarcopenia was diagnosed in 12.9% of pts. Of these, 40% (5.2% of the total) had SO. Low MM with normal MF (LMM) and low MF with normal MM (LMF) were found in 16.4% and 21.6% of pts. There were no significant differences in sex, age, HbA1c, or number of complications between patients with or without sarcopenia nor among subgroups, but the proportion of elderly pts (age ≥65y) was lower among those with vs those without sarcopenia (26.7% vs 57.4%, p=0.026). Median BMI was greater (p&amp;lt;0.05) in pts with LMM or sarcopenia vs those with normal MM/MF or LMF (31.6 [30.5; 34.6], 29.2 [26.1; 34.8], 26.7 [23.4; 30.4] and 24.5 [21.3; 29.8] kg/m2, respectively). At logistic regression adjusted by sex and age, the likelihood of sarcopenia increased by 11.4% for each unit increase in BMI (odds ratio 1.114, [95%CI 1.01; 1.23] p=0.037). In conclusion, the majority of Caucasian pts with T2D has low MM, MF or both (sarcopenia), the risk of sarcopenia increasing with greater BMI. The lower proportion of elderly suggests reduced life expectancy in T2D pts with sarcopenia. The assessment of sarcopenia in T2D should be implemented in routine clinical practice. Disclosure C.Conte: None. S.Boussetta: None. F.Leva: None. P.Moro: None. C.C.Berra: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Medtronic, Research Support; Gelesis, Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Novo Nordisk, Novartis.

Background: Despite well-established national complication screening programmes for patients with diabetes, complication rates in young adults with type 1 diabetes (T1D) remain high and uptake of screening unclear. It is important to determine risk factors that restrain newly diagnosed patients from attending the health care services. Methods: Our incident cohort included all 1832 patients who were diagnosed with T1D younger than 16 years of age between 1990 and 2009 at the Children's Hospital at Westmead, Sydney, NSW. Median age at diagnosis was 8.8 years [5.5-11.6] and 51% were female. Data was analysed from all their documented visits at our clinic between 1st January 1990 and 22nd February 2017 including personal data, clinical variables, blood tests. DCAS attenders (67%) were compared to non-DCAS attenders (34%) for: BMI, HbA1c and socioeconomic disadvantage (SES) which was based on postal codes of Australian Bureau of Statistics. Results: Comparing non-DCAS attenders with DCAS attenders, diabetes clinic attendance in the first 2 years was 1.7 vs. 2.5 times per year (p&amp;lt;0.001), with a significant difference in their median HbA1c (7.9 vs. 8.0%, p=0.03) over this time, but no difference in BMI at 2-years. The difference in median lifetime HbA1c was even more significant (8.1 vs. 8.3%, p=&amp;lt;0.001). DCAS attenders continued in the Diabetes Service for a mean of 9.1 years whereas the non-DCAS attenders were followed for 3.8 years (p&amp;lt;0.001). 40% of the non-DCAS group were socio-economical disadvantaged compared to only 23% of the DCAS group (p&amp;lt;0.001). In multivariable analysis, DCAS attendance was associated with more visits in clinics over the first 2 years, less SES and higher median lifetime HbA1c. Conclusions: SES and less frequent clinic attendance in the first 2 years after diagnosis but not obesity, were predictors of non-uptake of complication screening and are likely to influence the outcome of T1D for these patients. It remains unclear if the non-attenders had medical follow-up at other services. Disclosure J. Aulich: None. A.K. Chan: None. J. Cusumano: None. A. Pryke: None. P.Z. Benitez-Aguirre: None. M.E. Craig: None. K.C. Donaghue: None.