Disposal Rate Research Articles

Versatile cleaning service robot based on a mobile manipulator with tool switching for liquids and garbage removal in restrooms

In recent years, the labor shortage has become a significant problem in Japan and other countries due to aging societies. However, service robots can play a decisive role in relieving human workers by performing various household and assistive tasks. Restroom cleaning is one of such challenging tasks that involve performing motion planning in a constrained restroom setting. In this study, we propose a mobile manipulator to perform various tasks related to restroom cleaning. Our key contributions include system integration of multiple tools on an arm with high DoF mounted on a mobile, omni-directional platform capable of versatile service cleaning and with extended reachability. We evaluate the performance of our system with the competition setting used for the restroom cleaning task of the Future Convenience Store Challenge at the World Robot Summit 2020, where we obtained the 1st Place. The proposed system successfully completed all the competition tasks within the time limit and could remove the liquid with a removal rate of 96%. The proposed system could also dispose of most garbage and got an average garbage disposal rate of 90%. Further experiments confirmed the scores obtained in the competition with an even higher liquid removal rate of 98%.

Higher NADH Dehydrogenase [Ubiquinone] Iron-Sulfur Protein 8 (NDUFS8) Serum Levels Correlate with Better Insulin Sensitivity in Type 1 Diabetes.

Objective: The aim of the study was to evaluate NADH dehydrogenase [ubiquinone] iron–sulfur protein 8 (NDUFS8) serum concentration as a marker of Complex I, and the relationship with insulin resistance in type 1 diabetes mellitus (T1DM). Design and methods: Participants were adults with T1DM, recruited over the course of 1 year (2018–2019). NDUFS8 protein serum concentration was measured using the ELISA test. Insulin resistance was evaluated with indirect marker estimated glucose disposal rate (eGDR). The group was divided on the base of median value of eGDR (higher eGDR—better insulin sensitivity). Results: The study group consists of 12 women and 24 men. Medians of eGDR and NDUFS8 protein concentration are 7.6 (5.58–8.99) mg/kg/min and 2.25 (0.72–3.81) ng/mL, respectively. The group with higher insulin sensitivity has higher NDUFS8 protein serum concentration, lower waist to hip ratio (WHR), body mass index (BMI), and they are younger. A negative correlation is observed between NDUFS8 protein serum concentration and WHR (rs = −0.35, p = 0.03), whereas a positive correlation is observed between NDUFS8 protein serum concentration and eGDR (rs = 0.43, p = 0.008). Univariate logistic regression shows a significant association between insulin sensitivity and lower age, as well as a higher NDUFS8 serum level. A multivariate logistic regression model confirms the significance (AOR 2.38 (1.04–5.48). p = 0.042). Multivariate linear regression confirms a significant association between insulin sensitivity and better mitochondrial function (beta = 0.54, p = 0.003), independent of age, duration of diabetes, and smoking. Conclusions: Higher NDUFS8 protein serum concentration is associated with higher insulin sensitivity among adults with T1DM.

Impact of estimated glucose disposal rate for identifying prevalent ischemic heart disease: findings from a cross-sectional study

BackgroundInsulin resistance is one of the major mechanisms for cardiovascular events. Estimated glucose disposal rate(eGDR) has been demonstrated as a simple, accurate, and cost-effective estimator of insulin resistance. Our study aims to evaluate the correlation between eGDR and the prevalent IHD and assess the incremental value of eGDR for identifying prevalent IHD in the rural general population.MethodsOur study enrolled 10,895 participants from a cross-sectional survey of a metabolic management program. The survey was conducted in the rural areas of southeastern China between October 2019 and April 2020. eGDR = 21.158 − (0.09 * waist circumference) − (3.407 * hypertension) − (0.551 * HbA1c).ResultsThe prevalence of IHD was 4.20%. After adjusting for demographic, anthropometric, laboratory, and medical history covariates, each SD increase of eGDR brought a 25.9% risk reduction for prevalent IHD. After dividing eGDR into groups, the top group had a 58.9% risk reduction than the bottom group. Furthermore, smooth curve fitting demonstrated that the correlation between eGDR and prevalent IHD was linear in the whole range of eGDR. Additionally, AUC suggested that eGDR could significantly improve the identification of prevalent IHD by adding it to cardiovascular risk factors (0.703 vs. 0.711, P for comparison = 0.041). Finally, the category-free net reclassification index and integrated discrimination index also implicated the improvement from eGDR to identify prevalent IHD.ConclusionOur data demonstrated a significant, negative, and linear correlation between eGDR and prevalent IHD. Our findings could suggest the potential usefulness of eGDR to improve the identification of prevalent IHD in the rural general population.

Investigation on Waste Management Training Effectiveness on Community Behavior in Household Waste to Reduce the Waste Number Into the River in Penawar Village, Kerinci Regency

Poor waste management can result in chemical exposure and health issues. With a %age of 42.63 %, Kerinci district is the district in Jambi province with the largest number of river trash disposals, while Penawar Village is the village with the highest number of river waste disposals. This study aims to investigate waste management training effectiveness on community behaviour in household waste to reduce the waste number into the river in Penawar village, Kerinci Regency. This research is a quasi-experimental study employing a pretest-posttest design group with a research sample of 46 houses and simple random sampling. The results showed that before the intervention, the majority of housewives' knowledge was lacking (34.8%), the majority attitude was negative (69.6%) and the majority action was poor (71.7%). After the implementation of the Household Waste Management Training, the majority of housewives' knowledge was good (89.1%), positive attitude (100%) and majority action was good (73.9%). Compared before intervention. The application of the training proved to be effective in increasing household waste management behavior with (p) < 0.05. Waste management training effectively enhances the knowledge, attitudes, and behaviors of housewives in managing home trash to lower the rate of garbage disposal into the river in Penawar Village, Kerinci Regency.

Abdominal adipose tissue associates with adiponectin and TNF in middle-aged healthy men

Background and Aims : Backgroun: Adipokines, including adiponectin, visfatin and TNF (tumor necrosis factor)-α, are highly active bio-peptides involved in glucose metabolism, insulin regulation and the development and progression of obesity and its associated diseases. It includes, among others Aim: In this cross-sectional study, we aimed to investigate whether gene expression levels in subcutaneous adipose tissue (SAT) of selected adipokines and their corresponding circulating levels associate with the amount of AT in superficial (sSAT), deep (dSAT) and visceral (VAT) AT, assessed by computed tomography (CT). Any association with glucometabolic variables were also exploredMethods: Methods: In 103 healthy Caucasian men, fasting venous blood and SAT samples from the gluteal region were collected. Ninety-four of the participants underwent CT assessment of the abdominal AT, which was divided into VAT and superficial - and deep subcutaneous AT (sSAT and dSAT). Circulating levels were measured by ELISA and AT gene-expression by PCR. Insulin sensitivity was determined by glucose clamp, assessing glucose disposal rate (GDR).Results: Results: Circulating adiponectin and TNF gene expression correlated inversely and positively to sSAT, dSAT and VAT (r=-0.266 to -0.276, p<0.05 for all) and (r=0.323 - 0.368, p<0.05 for all), respectively, with strongest correlations to the amount of AT in sSAT and dSAT. Circulating adiponectin correlated inversely to insulin, C-peptide and waist circumference (r=-456 to -0.373, p<0.001) and positively to GDR (r=0.356, p<0.001). AT-expressed visfatin correlated inversely to insulin and C-peptide (r=-0.370 and r=-0.404, p<0.001).Conclusions: Conclusion: Increased amount of AT is associated with low levels of adiponectin and increased levels of TNF. Background and Aims : Backgroun: Adipokines, including adiponectin, visfatin and TNF (tumor necrosis factor)-α, are highly active bio-peptides involved in glucose metabolism, insulin regulation and the development and progression of obesity and its associated diseases. It includes, among others Aim: In this cross-sectional study, we aimed to investigate whether gene expression levels in subcutaneous adipose tissue (SAT) of selected adipokines and their corresponding circulating levels associate with the amount of AT in superficial (sSAT), deep (dSAT) and visceral (VAT) AT, assessed by computed tomography (CT). Any association with glucometabolic variables were also explored Methods: Methods: In 103 healthy Caucasian men, fasting venous blood and SAT samples from the gluteal region were collected. Ninety-four of the participants underwent CT assessment of the abdominal AT, which was divided into VAT and superficial - and deep subcutaneous AT (sSAT and dSAT). Circulating levels were measured by ELISA and AT gene-expression by PCR. Insulin sensitivity was determined by glucose clamp, assessing glucose disposal rate (GDR). Results: Results: Circulating adiponectin and TNF gene expression correlated inversely and positively to sSAT, dSAT and VAT (r=-0.266 to -0.276, p<0.05 for all) and (r=0.323 - 0.368, p<0.05 for all), respectively, with strongest correlations to the amount of AT in sSAT and dSAT. Circulating adiponectin correlated inversely to insulin, C-peptide and waist circumference (r=-456 to -0.373, p<0.001) and positively to GDR (r=0.356, p<0.001). AT-expressed visfatin correlated inversely to insulin and C-peptide (r=-0.370 and r=-0.404, p<0.001). Conclusions: Conclusion: Increased amount of AT is associated with low levels of adiponectin and increased levels of TNF.

Recruiting hand therapists improves disposal of unused opioid medication

BackgroundOpioids often remain unused after upper extremity surgery, and leftover prescriptions are frequently diverted. When administered in a hand surgery clinic, an educational brochure outlining a simple method of opioid disposal has been shown to improve disposal rates after surgery. PurposeTo understand whether administration of an opioid disposal educational brochure in a hand therapy clinic would increase opioid disposal rates, compared to a hand surgery clinic. Study DesignProspective cohort study. MethodsPatients who presented to a hand therapy clinic postoperatively were recruited to participate in this prospective cohort study. An educational brochure outlining a simple method of opioid disposal was made available at the hand therapy and surgery clinics. A questionnaire was later issued to obtain: location of brochure receipt, demographic information, pre- and post-operative opioid use history, and opioid disposal patterns. Chi-square tests and multivariable binary logistic regression assessed associations between medication disposal and explanatory variables. ResultsPatients who received the brochure were significantly more likely to dispose of excess opioid medication, compared to those who did not receive the brochure (57.1% vs 10.8%, p < .001). Patients who received the brochure at the hand therapy clinic were significantly more likely to dispose of excess opioids (86.4%) compared to those who received the brochure at the surgery clinic (25.0%). Older age was predictive of increased disposal (p =.028*). There were no significant associations between gender, length of follow-up, or surgery type with the incidence of opioid disposal. ConclusionRecruiting both hand therapists and surgeons in the distribution of a simple, educational brochure on opioid disposal can increase disposal rates. Patients who received the brochure from the hand therapist were more likely to dispose of excess opioids. The longstanding patient-therapist relationship creates an opportunity for educational initiatives and discussion of stigmatized topics, such as opioid use.

Effect of Liraglutide Treatment on Whole-body Glucose Fluxes in C-peptide-Positive Type 1 Diabetes During Hypoglycemia.

The effect of liraglutide in C-peptide-positive (C-pos) type 1 diabetes (T1D) patients during hypoglycemia remains unclear. To investigate the effect of a 12-week liraglutide treatment on the body glucose fluxes during a hypoglycemic clamp in C-pos T1D patients and its impact on the alpha- and beta-cell responses during hypoglycemia. This was a randomized, double-blind, crossover study. Each C-pos T1D patient was allocated to the treatment sequence liraglutide/placebo or placebo/liraglutide with daily injections for 12 weeks adjunct to insulin treatment, separated by a 4-week washout period. Fourteen T1D patients with fasting C-peptide ≥ 0.1 nmol/L. All patients underwent a hyperinsulinemic-stepwise-hypoglycemic clamp with isotope tracer [plasma glucose (PG) plateaus: 5.5, 3.5, 2.5, and 3.9 mmol/L] after a 3-month liraglutide (1.2 mg) or placebo treatment. The responses of endogenous glucose production (EGP) and rate of peripheral glucose disposal (Rd) were similar for liraglutide and placebo treatment during the clamp. The numbers of hypoglycemic events were similar in both groups. At the clamp, mean glucagon levels were significantly lower at PG plateau 5.5 mmol/L in the liraglutide than in the placebo group but showed similar responses to hypoglycemia in both groups. Mean C-peptide levels were significantly higher at PG-plateaus 5.5 and 3.5 mmol/L after liraglutide treatment, but this effect was not reflected in EGP and Rd. Hemoglobin A1c and body weight were lower, and a trend for reduced insulin was seen after liraglutide treatment. The results indicate that 3 months of liraglutide treatment does not promote or prolong hypoglycemia in C-pos T1D patients.

Neurodevelopmental outcomes and neurophysiological parameters in children with congenital hyperinsulinism

Introduction. Congenital hyperinsulinism is a rare group of genetic disorders resulting in persistent hypoglycemia which can lead to delay of neurodevelopment.Aim. To assess psychomotor development and certain neurophysiological parameters of children treated for congenital hyperin-sulinism.Materials and methods. This prospective and retrospective cohort study included 73 infants with congenital hyperinsulinism admitted to the National Almazov Research Centre from 2017 to 2021. All subjects underwent standard clinical examination including physical and neurological assessment as well as 18F-DOPA PET/CT, genetic testing, electroencephalography. Developmental screening was performed using “Ages and Stages” questionnaire in 33 subjects. Possible risk factors for neurode-velopmental sequelae due to hypoglycemia were analyzed.Results and discussion. Normal neurodevelopment in general was observed in 23 subjects (69%), 10 patients had developmental delay. Focal form of CHI had the greatest modifying effect on positive neurodevelopmental outcome in general. Individual skills such as communication, fine and gross motor, problem solving in children with a focal form of CHI were significantly better than those with a nonfocal forms. Age of manifestation and verification of the disease, the minimum level of glycemia and the maximum level of glucose utilization did not significantly affect the formation of either individual skills (with the exception of gross motor skills) or psychomotor development in general. The indicators of gross motor skills in children with a lower level of glucose utilization turned out to be significantly better. Kaplan-Meier survival analysis showed that the alpha rhythm appearance was significantly earlier in patients with a focal form of CHI and with earlier verification of the diagnosis (&lt;28 days of life).Conclusion. The focal form of the disease has the greatest modifying effect on the positive outcome of the psychomotor development. The age-appropriate gross motor skills were observed more often in the group of children with low glucose disposal rates. The association of the early occurrence of the alpha rhythm with the focal form of congenital hyperinsulinism, as well as with the early verification of the disease, was found.

Optimizing Appropriate Disposal of Unused Postoperative Opioid: What Happens to Unused Medication?

Increase in opioid prescribing practices has occurred with concurrent increases in the levels of abuse, addiction, and diversion of opioid pain medication. With 82.5 opioid prescriptions prescribed for every 100 U.S. citizens, the need for more effective strategies aimed at improving opioid disposal exist. Our study sought to examine the planned rates of appropriate opioid disposal after introduction of an activated charcoal home drug disposal system (Deterra®) in combination with formalized opioid disposal education. Participants were recruited from an academic, public safety-net hospital and grouped into 3 cohorts, no formalized opioid disposal education (No Education), written and verbal patient education on appropriate opioid disposal (Education), and Deterra® in addition to formalized opioid disposal education (Deterra). Outcomes included patients reporting unacceptable methods of opioid disposal, storage of unused opiates, and patient satisfaction with disposal instructions. Reported unacceptable opioid disposal decreased from 80.6% (n = 87) in the no education group to 20% (n = 10) in the education group to 6% (n = 3) in the Deterra group (P < .001). Education decreased long-term storage of opioid medication after completion of usage from 42% (n = 36) to 2% (n = 1), P < .001. Between the education and Deterra groups, more patients felt that the disposal instructions were clear (94% (n = 47) vs 73% (n = 36), P = .006) and more followed acceptable disposal instructions (80% (n = 39) vs 94% (n = 47) P < .001). Deterra® along with formal opioid disposal education increases patients reporting plans for compliance with appropriate opioid disposal.

Abdominal Adipose Tissue Associates With Adiponectin and TNFα in Middle-Aged Healthy Men.

IntroductionAdipokines are highly active biopeptides involved in glucose metabolism, insulin regulation and the development and progression of obesity and its associated diseases. It includes, among others, adiponectin, visfatin and tumor necrosis factor alpha (TNFα). The sources of adipokines and their associations with glucometabolic variables are not completely understood.AimIn this cross-sectional study, we aimed to investigate whether gene expression levels in subcutaneous adipose tissue (SAT) of selected adipokines and their corresponding circulating levels associate with the amount of AT in superficial (sSAT), deep (dSAT) and visceral AT (VAT), assessed by computed tomography (CT). Any association with glucometabolic variables were also explored.MethodsIn 103 healthy Caucasian men, aged 39.5 years, fasting venous blood and SAT samples from the gluteal region were collected. Ninety-four of the participants underwent CT assessment of the abdominal AT, which was divided into VAT, sSAT and dSAT. Circulating levels of adipokines were measured by ELISA and AT gene-expression by PCR. Insulin sensitivity was determined by glucose clamp, assessing glucose disposal rate (GDR).ResultsCirculating adiponectin and TNFα gene expression correlated inversely and positively to the amount of AT in all three compartments (r=-0.266 to -0.276, p<0.05 for all) and (r=0.323 - 0.368, p<0.05 for all), respectively, with strongest correlations to the amount in sSAT and dSAT. When dividing AT compartments into quartiles, a tendency was observed towards lower circulating adiponectin and higher TNFα gene expression levels, respectively, with increasing amount of sSAT and dSAT. Circulating adiponectin correlated inversely to insulin, C-peptide and waist circumference (r=-456 to -0.373, p<0.001) and positively to GDR (r=0.356, p<0.001). AT-expressed visfatin correlated inversely to insulin and C-peptide (r=-0.370 and r=-0.404, p<0.001).ConclusionIncreased amount of AT is associated with lower levels of adiponectin and increased levels of TNFα AT expression.

A benefit evaluation for recycling medical plastic waste in China based on material flow analysis and life cycle assessment

Recycling medical plastic waste has the potential to significantly reduce environmental pollution while also providing significant economic benefits. This study develops a benchmark model for the benefit evaluation of China's medical plastic waste recycling decision system in 2019, focusing on the recovery system's benefits and costs. Following model construction, a sensitivity analysis is conducted on the relevant parameters affecting the recycling system's efficiency. Finally, the system's primary recovery indexes are predicted for three development scenarios based on the results of sensitivity analysis: low-speed, medium-speed, and high-speed development. The results indicate that each ton of medical plastic waste generates an economic benefit of 2708.6 yuan in 2019, 187.8 μg TEQ of dioxin during incineration, and 1.48 tons of carbon dioxide during the recovery process. The total emission reduction is approximately 0.76 tons when compared to the initial production. If the illegal recovery rate is reduced by 0.5% and the mixed disposal rate is reduced by 5%, the comprehensive benefits increase by approximately 15.3% and 2.2%, respectively. The results of the scenario simulations indicate that the recovery benefit and potential for emission reduction associated with each ton of medical plastic waste increase year after year, while carbon dioxide emissions exhibit an inverted “U" shape evolution.

Chitinase enzyme in bacterial species and fungal growth inhibition against A. niger and Penicillium

Chitin is the most abundant polysaccharide in nature, second after cellulose as it found in the structure of crustaceans, insects and fungi being a significant component. Sea food waste disposal pose a great problem as chitin in nature degrade at a very gradual rate. Efforts are being made to use chitinase enzyme from different organisms to increase the rate and efficiency of chitin waste disposal. Moreover, chitinase and chitinase producing bacteria are widely being exploited to be used as bio-control agents to inhibit crop pathogens. On the basis of its mechanism of action, chitinase can either be endochitnase or exochitinase. Endo chitinases randomly hydrolyses internal glycosidic bonds in chitin. Exochitinase is exoglycosidase that can be divided into two subtypes based on the specificity of their action Chitinase is synthesized by a number of different microbes including bacteria, fungi and other organisms like mammals, insects etc. This paper gives information about the production of different chitinase enzymes from different bacterial gram-positive species. Antifungal activity for different isolates were tested against A. niger and Penicillium. The isolates showed varying degree of fungal growth inhibition against different fungi.

TyG Index Performs Better Than HOMA-IR in Chinese Type 2 Diabetes Mellitus with a BMI < 35 kg/m2: A Hyperglycemic Clamp Validated Study

Background and objectives: Chinese type 2 diabetes mellitus (T2DM) patients are characterized by a low body mass index (BMI), and significant insulin resistance (IR). The triglyceride glucose (TyG) index has not been studied as a means of assessing IR in Chinese T2DM patients with a BMI < 35 kg/m2. Materials and Methods: An open-label cross-sectional study recruited 102 Chinese T2DM patients with a BMI < 35 kg/m2. The hyper-insulinemic euglycemic clamp, homeostatic model assessment of IR (HOMA-IR), and TyG index were used to determine the level of IR. Based on Pearson’s correlations, glucose disposal rate (GDR), TyG index, and HOMA-IR were analyzed. HOMA-IR and TyG index for IR were evaluated using multiple linear regression and multivariate logistic regression analyses. On the basis of the receiver operating characteristic (ROC) curve, the sensitivity, specificity, and optimal cut-off value of HOMA-IR and the TyG index were determined. Results: The mean values of GDR, HOMA-IR, and TyG index were 4.25 ± 1.81, 8.05 ± 7.98, and 8.12 ± 0.86 mg/kg/min, respectively. Pearson’s correlation coefficient was −0.418 between GDR and TyG index and −0.324 between GDR and HOMA-IR. ROC curve analysis showed that, among both sexes, the TyG index was a better discriminator of IR than HOMA-IR. The area under the ROC curve (AUC) of the TyG index (0.785, 0.691–0.879) was higher than that of HOMA-IR (0.73, 0.588–0.873) in all genders. The optimal cut-off values of the TyG index and HOMA-IR were 7.99 and 3.39, respectively. Conclusions: The TyG index showed more effectiveness in identifying IR in Chinese T2DM patients with a BMI < 35 kg/m2 compared to HOMA-IR.

Toward Personalized Exercise Medicine: A Cautionary Tale.

This study aimed to examine individual exercise response rates across a range of cardiometabolic variables, cardiorespiratory fitness, and body composition in adults. A retrospective analysis of data from three randomized controlled trials was used in this study. Participants include those who completed the given trial (control, n = 87; intervention, n = 251). Anthropometric (weight, body mass index, waist circumference), cardiorespiratory fitness (V̇O 2peak ), MRI-measured total adipose tissue (AT), abdominal subcutaneous AT, and visceral AT and common cardiometabolic variables were assessed pre- and postintervention using standard methodologies. The technical error (TE), which includes both the day-to-day variability and instrument error, was calculated using pre- and postintervention data from the time-matched control group. On average, all anthropometric, MRI, and V̇O 2peak variables improved significantly after intervention compared with the control group ( P < 0.05). With the exception of glucose disposal rate (37%), after intervention less than 13% of participants improved cardiometabolic outcome measures beyond the day-to-day variability of measurement. In other words, the individual response for 63%-96% of participants fell within the uncertain range (2 TE). Similarly, for absolute V̇O 2peak (L·min -1 ), only 45% of participants improved beyond 2 TE. By comparison, for MRI-derived variables, the majority of participants (77%, 58%, and 51% for total AT, abdominal subcutaneous AT, and visceral AT, respectively) improved beyond 2 TE. The observed reductions beyond 2 TE for WC and body weight were 53% and 63%, respectively. The findings suggest extreme caution when inferring that the cardiometabolic and cardiorespiratory fitness response for a given individual is attributable to the exercise dose prescribed.

The relationship between estimated glucose disposal rate and bone turnover markers in type 2 diabetes mellitus.

To investigate the relationship between estimated glucose disposal rate (eGDR) and bone turnover markers in patients with type 2 diabetes mellitus (T2DM). This is a cross-sectional study, which recruited 549 patients with T2DM. The eGDRs of patients were calculated based on the presence of hypertension, glycated hemoglobin, and body mass index. All patients were divided into high-eGDR group and low-eGDR group using the median of eGDR as the boundary. The patients were further divided into two subgroups: males and postmenopausal females. The lower the eGDR, the more severe was insulin resistance. The levels of osteocalcin (OC), type I collagen carboxyl-terminal peptide (β-CTX), and type I procollagen amino-terminal peptide (PINP) were significantly lower in the low-eGDR group than those in the high-eGDR group. The eGDR was positively correlated with OC, β-CTX, and PINP in all patients, and in the male subgroups. In the postmenopausal female subgroup, there was no correlation between eGDR and OC, β-CTX, or PINP. In addition, this positive correlation remained after adjusting for other factors in multilinear regression analysis. Our study was the first to demonstrate that eGDR is positively correlated with bone turnover markers in patients with T2DM. This correlation was observed among the male patients with T2DM but not among postmenopausal female patients with T2DM.

Prevalence of Insulin Resistance in Type 1 Diabetes Mellitus and Its Correlation with Metabolic Parameters: The Double Trouble.

The phenotype of type 1 diabetes mellitus has changed over the last few decades. Little attention has been paid to the presence of insulin resistance in individuals with type 1 diabetes mellitus. The appearance of insulin resistance in type 1 diabetes mellitus patients has been labeled as "double diabetes." This phenotype of double diabetes has been seen to have higher rate of microvascular as well as macrovascular complica- tions. The aim of the current study was to estimate the burden of insulin resistance in patients with type 1 diabetes mellitus and its correlation with various metabolic parameters and microvascular complications. It was a cross-sectional study in which a total of 95 type 1 diabetes mellitus patients (children/adolescents (<18 years) and adults ≥18 years) presenting to Endocrinology OPD were screened for the presence of insulin resistance using estimated glucose disposal rate. Estimated glucose disposal rate (mg/kg/min) was calculated as = 21.16- (0.09 ×WC) - (3.407×HTN) - (0.551×HbA1c [%]) where, WC is waist circumference (cm) and HTN is hypertension (1= yes, 0 = no). Based on previous studies, an estimated glucose disposal rate <8 was considered to have the presence of insulin resistance and double diabetes. Using an estimated glucose disposal rate <8 as the cut-off for the presence of insulin resistance, the overall prevalence was 16.8%. Prevalence was high in adults 12 (29.3%) compared to children/adolescents 4 (7.4%) which was statistically significant [χ2 = 7.95; P = .004]. In comparison of the anthropometric and metabolic parameters in those with an estimated glucose disposal rate <8 versus ≥8, there was a significant statistical difference. Those having an estimated glucose disposal rate <8 had higher age, longer duration of diabetes, and body mass index [P ≤ .05]. Also, they had poor glycemic control, higher blood pressure, triglycerides, low-density lipoproteins levels. Using Spearman correlation coefficient there was a statistically significant (P < .05) negative correlation between the estimated glucose disposal rate and various anthropo- metric as well as metabolic parameters. This study shows that with increasing duration of disease, insulin resistance (low estimated glucose disposal rate) could be a serious problem in type 1 diabetes mellitus patients, especially in those who are metabolically unhealthy. As insulin resistance could be a major contributing factor in the onset and progression of various vascular complications, evaluation of the presence of insulin resistance using estimated glucose disposal rate could be useful in recognizing individuals who would benefit the most from preventa- tive strategies.

240-OR: Quantifying Glucose Utilization and Endogenous Glucose Production during Resistance Exercise in People with Type 1 Diabetes (T1D)

Glucose dynamics during and after resistance exercise in people with T1D is not well understood. We recruited 25 people with T1D to perform 3 separate sessions of in-clinic resistance exercise under low (basal) , medium (1.5x basal) , or high (3.0x basal) insulin infusion levels. Blood glucose was clamped by intravenous dextrose infusion 3 hours prior to, and 4 hours after a 45-minute session of strength training. Glucose tracer was infused to match the rate of endogenous glucose production (EGP) . Glucose and tracer data were used to fit a two-compartment model and quantify the rate of glucose disposal (Rd) and EGP. For 58 sessions across 25 participants, blood glucose levels remained constant during and after resistance exercise. The mean change in area under the curve (AUC) for Rd was not higher during resistance exercise compared to baseline (+1.2 mM, p=0.69) , but increased during previously published aerobic exercise (+12.5 mM, p&amp;lt;0.01) . Mean AUC for EGP rose during resistance exercise (+6.5 mM, p&amp;lt;0.01) primarily due to non-insulin mediated factors and the increase was higher than during aerobic exercise (+2.mM, p&amp;lt;0.01) . Resistance exercise is characterized by a strong rise in EGP that is predominantly driven by non-insulin mediated effects. This may mitigate drops in blood glucose caused by increased glucose utilization in peripheral tissues during anaerobic activity. Disclosure G.Young: None. M.Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Consultant; Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. J.El youssef: None. P.G.Jacobs: Other Relationship; Pacific Diabetes Technologies, Research Support; Dexcom, Inc. N.S.Tyler: None. T.P.Nguyen: None. J.R.Castle: Advisory Panel; Insulet Corporation, Novo Nordisk, Zealand Pharma A/S, Stock/Shareholder; Pacific Diabetes Technologies. L.M.Wilson: n/a. D.Branigan: None. V.Gabo: None. F.H.Guillot: Stock/Shareholder; Pacific Diabetes Technologies. Funding National Institutes of Health (5R01DK110175, 1F30DK128914)

745-P: Short-Acting Exenatide Added Three Times Daily to Insulin Therapy Improves Insulin Sensitivity in Type 1 Diabetes

Average life expectancy in type 1 diabetes is reduced by more than a decade due to cardiovascular (CV) disease. Reduced insulin sensitivity as assessed by low values of estimated glucose disposal rate (eGDR) has been observed to correlate with increased risk of CV events. How short-acting glucagon-like peptide 1 receptor agonists (GLP-1RA) influence eGDR in type 1 diabetes remains unknown. We analyzed eGDR post-hoc in a phase 2, double-blind, randomized (1:1) , clinical trial (NCT03017352) that evaluated the short-acting GLP-1RA exenatide μg added three times daily to insulin therapy as compared with placebo over 26 weeks of treatment in 1individuals with type 1 diabetes (76/32 men/women, age 50 (14) years (mean (standard deviation)) , diabetes duration 21 (12) years, BMI 28 (4) kg/m2, glycated hemoglobin A1c 8.2 (0.7) % / 66 (7) mmol/mol) . Exenatide significantly increased eGDR by 0.36 mg/kg/min (95 % confidence interval 0.03; 0.69, P = 0.032) (Table 1) as compared with placebo after 26 weeks’ treatment. Short-acting exenatide apparently improved insulin sensitivity in patients with long-standing type 1 diabetes and inadequate glycemic control, alluding to potential CV benefits of this GLP-1RA in type 1 diabetes. Disclosure N.Johansen: Employee; Novo Nordisk A/S. T.F.Dejgaard: Advisory Panel; Novo Nordisk, Research Support; Novo Nordisk, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk. A.Lund: Speaker's Bureau; Novo Nordisk A/S. T.Vilsbøll: Consultant; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Gilead Sciences, Inc., GlaxoSmithKline plc., Merck Sharp &amp; Dohme Corp., Mundipharma, Novo Nordisk, Sun Pharmaceutical Industries Ltd. H.U.Andersen: Advisory Panel; Abbott Diabetes, Stock/Shareholder; Novo Nordisk A/S. F.K.Knop: Advisory Panel; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Sanofi, ShouTi, Zucara Therapeutics, Consultant; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Pharmacosmos A/S, Sanofi, ShouTi, Zealand Pharma A/S, Zucara Therapeutics, Research Support; AstraZeneca, Novo Nordisk, Sanofi, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Stock/Shareholder; Antag Therapeutics. Funding Partly funded by AstraZeneca

423-P: Predictors of Epicardial Adipose Thickness in Overweight and Obese Youth with Type 1 Diabetes

Objectives: Cardiovascular disease (CVD) is the leading cause of death in adults with type 1 diabetes mellitus (T1D) and risk factors for CVD are present early in the disease course. Epicardial adipose thickness (EAT) , a novel independent marker of CVD, is significantly increased in children with T1D compared to healthy controls. Obesity, a known CVD risk factor, is increasingly prevalent in the pediatric population and may confer additional risk in youth with T1D. The purpose of this study was to examine EAT in overweight/obese pediatric patients with T1D. Methods: This was a single-center, cross-sectional study of 37 youth with T1D and BMI &amp;gt; 85th percentile (BMI percentile=93.1±4.3, age 13.5y±3.4, 62.1% female) . Waist circumference, blood pressure, HbA1C and a 2D echocardiogram measuring EAT were obtained. Insulin resistance was calculated via estimated glucose disposal rate (eGDR) . Results: EAT was correlated with age (r=0.45, P=0.006) , BMI (r=0.58, P=0.0001) , waist circumference (r=0.64, P=0.0001) , and diastolic BP (r=0.37, P=0.023) , while inversely correlated with eGDR (r=-0.49, P 0.002) and most recent HDL level (r=-0.43, P=0.027) . There were no significant correlations between EAT and HbA1C (r=-0.01, P=0.9) or duration of diabetes (r=0.16, P=0.4) . After multivariate regression analysis, age and BMI were independent predictors explaining 43.7% of the variance in EAT (P=0.001) . Conclusions: EAT is associated with measures of adiposity and CVD risk, however, only age and BMI were independent predictors of EAT among overweight and obese youth with T1D. In addition to a focus on tight glycemic control to prevent CVD in overweight and obese youth with T1D, further studies are needed to investigate the impact of BMI lowering interventions on EAT. Disclosure L.Cielonko: None. M.Olson: None. A.A.Sabati: None. M.Chambers: None. D.Newbern: None. V.Chakravarthy: None. J.Schmidt: None. J.Mullen: None. N.Lutz: None. G.Q.Shaibi: None.

734-P: The Effect of Adjunctive Therapy with Liraglutide on Insulin Sensitivity in Overweight Persons with Type 1 Diabetes

Type 1 diabetes is associated with an almost threefold higher mortality rate than the general population, primarily driven by excess mortality from cardiovascular disease. Insulin sensitivity evaluated by the estimated glucose disposal rate (eGDR) is a recognized predictor of cardiovascular disease. Here, we evaluated the effect of adjunctive therapy with the glucagon-like peptide 1 receptor agonist (GLP-1RA) liraglutide on eGDR in patients with type 1 diabetes. We calculated eGDR post-hoc in a randomized (1:1) , placebo-controlled, double-blind, clinical trial (NCT01612468) that evaluated the effect of liraglutide 1.8 mg once daily (uptitrated via 0.6 mg and 1.2 mg over 2 weeks) as add-on to insulin treatment compared with placebo in 100 overweight persons with type 1 diabetes (35/65 women/men, age 48 (12) years (mean (standard deviation)) , diabetes duration 23 (12) years, BMI 30 (3) kg/m2, glycated hemoglobin A1c 8.7 (0.7) % / 72 (8) mmol/mol) . After 12 weeks of treatment, liraglutide significantly increased eGDR compared with placebo. However, at end of treatment at week 26, the between-group difference was not statistically significant (Table 1) . These data indicate that liraglutide may improve eGDR, a recognized predictor of cardiovascular disease, in overweight persons with long-standing type 1 diabetes and inadequate glycemic control. Disclosure T.F.Dejgaard: Advisory Panel; Novo Nordisk, Research Support; Novo Nordisk, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk. C.S.Frandsen: None. N.Johansen: Employee; Novo Nordisk A/S. S.Madsbad: None. F.K.Knop: Advisory Panel; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Sanofi, ShouTi, Zucara Therapeutics, Consultant; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Pharmacosmos A/S, Sanofi, ShouTi, Zealand Pharma A/S, Zucara Therapeutics, Research Support; AstraZeneca, Novo Nordisk, Sanofi, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Stock/Shareholder; Antag Therapeutics. H.U.Andersen: Advisory Panel; Abbott Diabetes, Stock/Shareholder; Novo Nordisk A/S. Funding Supported by an unrestricted grant by Novo Nordisk