High Rates Of Type Research Articles

DNA methylation in the TXNIP gene is associated with type 2 diabetes in Pacific Peoples living in NZ

Abstract Background Pacific Peoples living in Aotearoa New Zealand (NZ) have higher rates of type 2 diabetes (T2D) and have benefited less from improvements in cardiovascular health outcomes when compared with other populations in NZ. DNA methylation markers of T2D have been identified in non-Pacific populations and could be used to monitor the cumulative effects of T2D on cardiovascular disease risk. However, no study has yet investigated the relationships between T2D and DNA methylation in Pacific Peoples living in NZ. Purpose This study aimed to quantify the relationship between DNA methylation and T2D in two cohorts of Pacific Peoples living in NZ. Methods Whole-blood DNA methylation at over 850,000 loci was measured on Illumina MethylationEPIC arrays in 288 Pacific participants from the Pasifika Heart Study (PHS, n=191), a community cohort, and the Multi-Ethnic NZ Study of Acute Coronary Syndromes (MENZACS, n=97), a cohort of patients with acute coronary syndromes. In the PHS, the median age was 41 years, and 98 (51%) participants were female. In MENZACS, the median age was 53 years, and 18 (19%) participants were female. In both cohorts, T2D cases were defined by either previous diagnosis (n=58) or had an HbA1c measurement >58 mmol/mol (n=7). We compared 65 participants with T2D and 223 participants without T2D of Samoan (n=116), Tongan (n=66), Fijian (n=61), Cook Island Māori (n=22), Niuean (n=9), or of Other/Multiple Pacific (n=14) ethnicity in a meta epigenome-wide association study (EWAS). EWAS comparisons were adjusted for age, sex, and imputed blood cell composition. We compared the difference in means at differentially methylated loci between the European and Pacific MENZACS participants using a two-sample z statistic. For the 525 European participants, 85 had T2D, the median age was 57 years, and 149 (28%) were female. Results One locus cg19693031, in the thioredoxin interacting protein (TXNIP) gene, exhibited differential methylation between those with T2D and those without in the meta EWAS (false discovery rate =6.9x10-9). In the PHS we observed a mean reduction in cg19693031 methylation of 7.0% (95% CI, 5.0, 8.9) between those with T2D and those without. Similarly in the MENZACS Pacific participants we observed a mean reduction in cg19693031 methylation of 10.9% (95% CI, 7.6, 12.4) between those with T2D and those without. The MENZACS European participants with T2D had a mean reduction in cg19693031 methylation of 6.5% (95% CI, 5.3, 7.7, p<0.001) compared to those without T2D. The difference in means in T2D cases and controls between MENZACS Pacific and European participants was non-significant (p =0.08). Conclusion DNA methylation at cg19693031 is associated with T2D in Pacific Peoples living in NZ and may be a sensitive marker of T2D in Pacific Peoples with acute coronary syndromes. DNA methylation at this locus may provide valuable information on the relationship between T2D and cardiovascular disease.Miami plot of Pacific T2D EWAST2D methylation by population in MENZACS

Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol

IntroductionThe Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families. MethodsThe purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study. SummaryThis study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.

Accelerated Longitudinal Glycemic Changes in Relation to Urinary Toxic/Essential Metals and Metal Mixtures Among Mexican Americans Living in Starr County, Texas.

Metal and metalloid exposures (hereafter "metals") are associated with adverse health outcomes, including type 2 diabetes; however, previous studies were largely cross-sectional or underpowered. Furthermore, underserved racial and ethnic groups are underrepresented in environmental health research despite having higher rates of type 2 diabetes and a greater risk of metal exposures. Consequently, we evaluated continuous glycemic traits in relation to baseline urinary toxic metal, essential metal, and metal mixtures in a cohort of Mexican American adults. A total of 510 participants were selected based upon self-reported diabetes status and followed over 3 years. Urinary metals were assessed at baseline. Linear mixed-effects models were used to estimate per-month changes in hemoglobin A1c, fasting plasma glucose, and postload glucose in relation to urinary metal levels. Multiple statistical approaches were used to assess the associations between glycemic traits and metal mixtures. After adjustment, higher urinary levels of arsenic, selenium, copper, molybdenum, nickel, and tin were associated with faster increases in measures of glycemia. The toxic metal mixture composed of arsenic, lead, cadmium, nickel, and tin was associated with faster increases in postload glucose. Using postload glucose criteria, highest versus lowest arsenic was predicted to accelerate conversion of normoglycemia to prediabetes and diabetes by 23 and 65 months, respectively. In this underrepresented, high-risk Mexican American population, exposure to toxic metals and alterations in essential metal homeostasis were associated with faster increases in glycemia over time that may accelerate type 2 diabetes development.

Visceral Fat and Diabetes: Associations With Liver Fibrosis in Metabolic Dysfunction–Associated Steatotic Liver Disease

BackgroundThe prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is increasing globally. Noninvasive methods, such as bioelectrical impedance analysis (BIA), which measures body composition, including visceral fat, are gaining interest in evaluating MASLD patients. Our study aimed to identify factors associated with significant liver fibrosis, compare noninvasive scores, and highlight the importance of visceral fat measurement using BIA. MethodsMASLD patients seen in our OPD underwent comprehensive evaluations, including liver stiffness using transient elastography, body composition analysis using BIA, and metabolic measurements. Significant fibrosis was defined as liver stiffness measurement ≥8.2 kPa. Using multivariate analysis, we identified factors associated with significant liver fibrosis and compared four noninvasive scores with a novel DVF15 score. ResultsWe analyzed data from 609 MASLD patients seen between February 2022 and March 2023. The median age was 43 years (81% male). Among these, 78 (13%) had significant fibrosis. Patients with significant fibrosis had higher rates of type 2 diabetes (41% vs 21%, p<0.001) and elevated levels of AST, ALT, HbA1c, Fib-4, APRI, and NFS scores. They also exhibited higher visceral and subcutaneous fat. Binary logistic regression revealed type 2 diabetes and visceral fat >15% as associated with significant liver fibrosis. Additionally, the DVF15 score, combining these factors, showed a modest area under the ROC curve of 0.664 (p<0.001). ConclusionOur study identified diabetes and high visceral fat as factors associated with significant liver fibrosis in MASLD patients. We recommend that visceral fat measurement using BIA be an essential part of MASLD evaluation. The presence of either diabetes or visceral fat >15% should prompt clinicians to check for significant fibrosis in MASLD patients. Further research is warranted to validate our findings and evaluate the utility of the DVF15 score in larger cohorts and diverse populations.

Patient, imaging, and surgical factors associated with supraspinatus re-tear pattern after rotator cuff repair

BackgroundThis study aimed to characterize patient, imaging, and surgical factors associated with re-tear patterns after rotator cuff repair, as well as to identify predictors of type 2 failure in a large patient cohort. MethodsA retrospective case-control study was performed at a single urban academic institution. All patients that underwent an arthroscopic rotator cuff repair by two fellowship trained shoulder and elbow surgeons between 2005 and 2022 and were subsequently found to have a symptomatic re-tear on MRI were included. Patients were characterized as either a type 1 (failure at bone-tendon interface) or type 2 (failure medial to the bone-tendon junction) re-tear based on the Cho classification. Chart review was performed to collect demographic, imaging, and intraoperative surgical factors. Multivariable analysis was performed to determine patient and imaging factors associated with type 2 failure. ResultsFifty-seven patients were included in the study. Overall, 33 (57.9%) patients were classified as a Cho 1 re-tear and 24 (42.1%) were classified as Cho 2 re-tear. No differences in preoperative tear characteristics (tear width, tear retraction, tendon length) or fatty infiltration were found between Cho 1 and Cho 2 re-tears. Bivariate analysis comparing Cho 1 vs Cho 2 found male sex was associated with a higher incidence of a Cho 2 re-tear (79.2% vs. 20.8%; p=0.033). No significant differences in repair construct (single row vs. double row) (p=0.816), biceps treatment (p=0.552), concomitant subscapularis repair (p=0.306), number of medial anchors (p=0.533), or number of lateral anchors (p=0.776) were noted between re-tear types. After controlling for potential confounding factors, multivariable regression analysis demonstrated that male sex was predictive of developing a Cho 2 re-tear (OR 3.8; 95% CI 1.1-13.3; p=0.039). Repair construct was not found to be predictive of re-tear pattern (p=0.580). ConclusionsRepair construct utilized during rotator cuff repair does not appear to influence re-tear pattern. Male sex was associated with a higher rate of type 2 failure.

Explanation of the personality factor with the Enneagram in the selection of the specialty branch of the intern doctors

IntroductionPersonality characteristics have an important place in the choices of interns who are at the stage of deciding how their profession will be shaped in the future. While the Big 5 personality model has been widely used in evaluating the personality traits factor in career planning, the Enneagram has increased in popularity in recent years. In this study, it was aimed to investigate how senior medical students evaluate their professional future between these choices and the students’ personality types.Objectives Forms and scales were presented to 221 interns who agreed to participate in our study and were studying in their final year in the 2022-2023 period at three different faculties, two state universities and one private university in the Marmara Region in Turkey.MethodsThe sociodemographic data form, Enneagram Personality Types and Subtypes Inventory, and Positive Future Expectation Scale, prepared by the researchers and containing questions about the factors that may be effective in choosing medical specialization, obtained through a face-to-face pilot interview with ten students and literature review, were applied to the participants. Participants answered the forms and scales via ‘Google forms’.Results211 out of 221 participants, who did not constitute outliers, were included in the analysis. The mean age of the participants was 24.43 (S.E= 0.11)In terms of Enneagram typologies, Type 2 (39.3%) exhibited the highest prevalence, followed by Type 1 (13.3%), Type 6 (11.8%), and Type 7 (8.5%).Furthermore, a statistically significant relationship was found between specialization area and Enneagram types (Fisher exact &lt;.001, p&lt; .001). Post-hoc examinations highlighted specific associations, such as the relationship between Type 3 and Cardiovascular Surgery, Orthopedics and Traumatology; Type 4 and Pneumology, Psychiatry; Type 5 and PRC, Type 6 and Infectious Diseases, Neurology, Medical Microbiology; Type 7 and Cardiology; Type 8 and Pediatrics, Medical Biochemistry; and Type 9 and Family Medicine, Radiology, Psychiatry, Medical Pathology.ConclusionsWhen the results are evaluated, the highest rate of type 2 and type 1 of the Enneagram typology in senior medical faculty students supports the fact that the medical profession consists of responsible and principled people who love helping others. It is compatible with the character traits of people with type 9 who avoid stress and conflict, preferring the department to have a low workload, and turning to family medicine, radiology, psychiatry and medical pathology departments, which are estimated to have relatively fewer working hours and emergency applications.Our study suggests that this scale be used more widely, as the Enneagram typology, which is used in many professional and career choices, shows results compatible with the participants’ preferences in choosing a medical specialty.Disclosure of InterestNone Declared

Changing etiology and epidemiology of hepatocellular carcinoma: Asia and worldwide.

Approximately 80% of hepatocellular carcinoma (HCC) cases arise in sub-Saharan Africa and Eastern Asia, following a similarly high prevalence of chronic hepatitis B virus (HBV) carriers in these regions. The etiology and epidemiology of HCC have recently changed worldwide. Although HBV infection is the main contributor to HCC development, a slow but continuous decline in HBV infection rates has been reported since 1990. Owing to the widespread use of direct-acting antivirals, the incidence of hepatitis C virus-related HCC has remarkably decreased in Japan and European countries. In Korea, Taiwan, and Singapore, the incidence of HBV-related HCC has significantly decreased owing to vaccination against HBV. Globally, while HBV accounted for more than half of HCCs in 1990, this had decreased to 42% in 2019. In contrast, the proportion of patients with alcoholic- and nonalcoholic steatohepatitis (NASH) increased from 13% to 18% and from 5% to 6%, respectively. NASH-related HCC has characteristics that differ from those of virus-associated HCC. Compared with other etiologies, patients with NASHassociated HCC are older, have a higher body mass index, and have higher rates of type 2 diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular disease. Nonalcoholic fatty liver disease (NAFLD)-associated HCC is also known to develop in the absence of cirrhosis, unlike alcohol-related and autoimmune liver diseases. Because patients with NAFLD usually have diabetes or obesity, surveying this population is challenging. Optimal selection of the target population and surveillance tools among patients with NAFLD needs to be determined.

Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome

BackgroundWhether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. ObjectivesThe authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. MethodsAll PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. ResultsAmong the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints. ConclusionsIn chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.

Vulnerability or Resiliency? A Two-Wave Panel Analysis of Social Network Factors Associated with Glycemic Levels among Mexican Immigrants in the Bronx, NYC, Before and During COVID-19.

Latinos have high rates of type 2 diabetes mellitus (T2DM) yet are characterized as having health-promoting social networks. The impacts of COVID-19 on personal networks were complex, especially in urban areas with high proportion of immigrants such as the Bronx in NYC. Our objective was to test the extent to which network characteristics increase vulnerability or resiliency for glycemic control based on data gathered from Mexican-origin Bronx dwellers. We used two-wave panel study analyzing self-reported personal social networks (n=30participants; 600network members) and HbA1c levels via dried blood spots in 2019, before the COVID-19 pandemic, and in 2021, a time after initial lockdowns and when the pandemic was still ravaging the community of study. Regression models adjusted for individual-level variables including sociodemographic and health indicators (i.e., physical health including COVID-19 and mental health). We found that an increase in the proportion of network members with diabetes predicted an increase in participant's HbA1c levels from 2019 to 2021 (β=0.044, p < 0.05). Also, a greater proportion of network members consuming "an American diet" in 2019 predicted a decrease in participant's HbA1c levels (β=-0.028, p < 0.01), while a greater proportion of network members that encouraged participants' health in 2019 predicted an increase in participant's HbA1c levels (β=0.033, p < 0.05). Our study sheds light on specific social network characteristics relevant to individual diabetes outcomes, including potential longitudinal mechanistic effects that played out at the peak of the COVID-19 crisis.

A pilot community-based Diabetes Prevention and Management Program for adults with diabetes and prediabetes

Abstract Background: West Virginia is a rural state with high rates of type 2 diabetes (T2DM) and prediabetes. The Diabetes Prevention and Management (DPM) program was a health coach (HC)-led, 12-month community-based lifestyle intervention. Objective: The study examined the impact of the DPM program on changes in glycosylated hemoglobin (A1C) and weight over twelve months among rural adults with diabetes and prediabetes. Program feasibility and acceptability were also explored. Methods: An explanatory sequential quantitative and qualitative one-group study design was used to gain insight into the pre- and 12-month changes to health behavior and clinical outcomes. Trained HCs delivered the educational sessions and provided weekly health coaching feedback. Assessments included demographics, clinical, anthropometric, and qualitative focus groups. Participants included 94 obese adults with diabetes (63%) and prediabetes (37%). Twenty-two participated in three focus groups. Results: Average attendance was 13.7 ± 6.1 out of 22 sessions. Mean weight loss was 4.4 ± 11.5 lbs at twelve months and clinical improvement in A1C (0.4%) was noted among T2DM adults. Program retention (82%) was higher among older participants and those with poor glycemic control. While all participants connected to a trained HC, only 72% had regular weekly health coaching. Participants reported overall acceptability and satisfaction with the program and limited barriers to program engagement. Conclusion: Our findings suggest that it is feasible to implement an HC-led DPM program in rural communities and improve A1C in T2DM adults. Trained HCs have the potential to be integrated with healthcare teams in rural regions of the United States.

National usage of bariatric surgery for class I obesity: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

National and international consensus statements, as well as the National Institutes of Health (NIH), support the use of bariatric surgery for the treatment of class I obesity. Despite this, most payors within the United States limit reimbursement to the outdated 1991 NIH guidelines or a similar adaptation. This study aimed to determine the safety of bariatric surgery in patients with lower BMI compared with standard patients, as well as determine U.S. utilization of bariatric surgery in class I obesity in 2015-2019. A retrospective analysis was performed of the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass patients were divided into body mass index cohorts: class I obesity (<35 kg/m2) and severe obesity (≥35 kg/m2). Differences in preoperative patient selection and postoperative outcomes were established, and frequency trends were delineated. Analysis included 760,192 surgeries with 8129 (1%) for patients with class I obesity. The patients with class I obesity were older, more commonly female, and with lower American Society of Anesthesiologists (ASA) class, but with higher rates of type 2 diabetes, hyperlipidemia, and gastroesophageal reflux disease (P < .05). Variation was found for operative time, length of stay, 30-day readmission, and composite morbidity. Minimal annual variation was found for bariatric surgeries performed for patients with class I obesity. The short-term safety of bariatric surgery in patients with class I obesity was corroborated by this study. Despite consensus statements and robust support, rates of bariatric surgery in patients with class I obesity have failed to increase and remain limited to 1%. This demonstrates the impact of the outdated 1991 NIH guidelines regarding access to care for these potentially life-saving surgeries.

Comparison of the Cameriere's third molar maturity index and Olze et al.'s stages of radiographic visibility of the root pulp in a Turkish population.

The purpose of this study was to compare the Cameriere's third molar maturity index and Olze et al.'s stages of radiographic visibility of the root pulp in estimating the age of maturity in the Turkish population. The age of majority, which is legally significant, marks the transition from childhood to adulthood. In Turkey, the age of majority is set at 18 years. As the third molars continue to develop at this age, they can serve as an indicator of dental age. A total of 705 panoramic radiographs obtained from individuals aged 15 to 22 years, including children and adults, were included in this study. The left mandibular third molars were evaluated on panoramic radiographs using Cameriere's third molar maturity index and Olze's method of radiographic root pulp visibility (RPV) stages. Minimum and maximum values were noted for each stage, and a median with upper and lower quartiles, as well as mean and standard deviation were calculated. Sensitivity and specificity values were calculated. In males, Cameriere's third molar maturity index demonstrated a sensitivity of 0.77% and specificity of 0.96%, while in females, it showed a sensitivity of 0.57% and specificity of 0.92%. Regarding Olze et al.'s stage 0, the sensitivity and specificity values were 0.86% and 0.79% in males, and 0.85% and 0.75% in females, respectively. Although both methods can be used to distinguish individuals below or above the age of 18, the cut-off value suggested by Cameriere's method resulted in a higher rate of type 2 error (false negativity). Therefore, the method proposed by Olze et al., based on the radiographic visibility of the root pulp, can be employed to differentiate between adults and minors in the Turkish population.

Type 2 Diabetes Remission in Patients with Heterozygous Variants in the Leptin-Melanocortin Pathway after Roux-en-Y Gastric Bypass: A Matched Case-Control Study.

Roux-en-Y gastric bypass (RYGB) is associated with a high rate of type 2 diabetes (T2D) remission. Carriers of heterozygous variants in the leptin-melanocortin pathway (LMP) are more likely to experience weight recurrence after RYGB. Our aim was to investigate if carrier status and associated weight regain affects the rate of T2D remission after RYGB. Carriers of LMP variants with a diagnosis of T2D prior to RYGB (N = 16) were matched to non-carriers (N = 32) based on sex, age,and BMI. We assessed for post-operative T2D remission status post-surgery on a yearly basis, for up to 15years. Our primary endpoint was the proportion of patients achieving T2D remission at 1year. We conducted a survival analysis for all patients that achieved remission at least at one time-point to evaluate for maintenance of T2D remission by using a log-rank test. Both carriers and non-carriers had similar baseline and procedural characteristics. The proopiomelanocortin gene in the LMP pathway had the most variants (n = 5, 31%). Carriers had a lower total body weight loss percentage at nadir (28.7% ± 6.9) than non-carriers (33.7% ± 8.8, p = 0.04). The proportion of patients achieving T2D remission at 1year was 68.8% for carriers and 71.9% for non-carriers (p = 1.0). Survival curves for maintenance of first remission were similar for both groups (p = 0.73), with a median survival of 8years for both carriers and non-carriers. Despite inferior weight loss outcomes at nadir, carriers had similar T2D remission rates when compared to non-carriers. Weight-independent metabolic benefits of RYGB might contribute to this observation.

FRI448 Mother Versus Daughter Attitudes Toward Breastfeeding In American Indians: Implications For Reproductive Health Education

Abstract Disclosure: E.W. Seely: None. J.R. Demirci: None. L.E. Hebert: None. E. Kelty: None. M. heydarpour: None. K. Moore: Consulting Fee; Self; Novo Nordisk. D. Charron-Prochownik: None. Background: Breastfeeding has well established health benefits for mothers and their children, being associated with a reduction in incidence of type 2 diabetes and childhood overweight/obesity. Accordingly, the American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, followed by 1-2 years of continued breastfeeding. American Indian and Alaska Native (AIAN) women have among the lowest rates of breastfeeding of all races/ethnicities in the United States. The low rate is striking given the high rates of type 2 diabetes and obese/overweight AIAN children and young adults. To explore the low breastfeeding rates, we examined breastfeeding attitudes among AIAN mother-daughter dyads at 5 sites (Southwest, Northeast, Plains, and Northwest Coast, U.S.) in data from the Stopping GDM randomized controlled trial (NCT02723266). Methods: We used data collected among 149 mother-daughter dyads, who were asked 7 questions from the CDC’s Infant Feeding Practices Survey II focusing on the importance of breastfeeding and its potential health benefits. An additional question was asked: “If a child was breastfed, he/she will be less likely to get diabetes.” We compared mother/daughter attitudes using Chi-square tests. Results: Mean age + standard deviation of mothers was 44.1 + 9.3 and daughters 16.7 + 3.0 years. Eighty percent of both mothers and daughters agreed or strongly agreed that “Infant formula is not as good as breast milk.” However, attitudes that the best way to feed a baby is breastfeeding and that babies should be exclusively breastfed for the first 6 months were both statistically higher in mothers than daughters (74% vs. 59% and 68% vs. 40%, respectively). Mothers also had significantly higher agreement with the statements that breastfeeding was beneficial for prevention of ear infections (66% vs. 18%), respiratory illness (67% vs. 27%), diarrhea (48% vs. 22%), obesity (42% vs. 12%) and diabetes (35% vs. 13%) than daughters. Conclusion: Significant agreement between mothers/daughters exists for the belief that infant formula is not as good as breast milk. However, daughters’ attitudes toward the benefits of breastfeeding differ significantly from mothers with daughters endorsing weaker beliefs in infant health benefits of breastfeeding. This information is important to design early interventions to increase breastfeeding in AI women by increasing awareness of benefits and eliciting maternal support for adolescents and young adult women prior to planning a pregnancy. Presentation: Friday, June 16, 2023

Neighbourhood deprivation and type 2 diabetes in patients with bipolar disorder: A nationwide follow-up study.

Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997-2018) included adults in Sweden ≥20years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40-1.86) for men and 1.83 (1.60-2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17-1.56) in men and 1.39 (1.20-1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment.

Effects of preoperative bicarbonate and lactate levels on short-term outcomes and prognosis in elderly patients with colorectal cancer

PurposeThe aim of this study was to analyze the effect of preoperative bicarbonate and lactate levels (LL) on the short-term outcomes and prognosis in elderly (≥ 65 years) patients with colorectal cancer (CRC).MethodsWe collected the information of CRC patients from Jan 2011 to Jan 2020 in a single clinical center. According to the results of preoperative blood gas analysis, we divided patients into the higher/lower bicarbonate group and the higher/lower lactate group, and compared their baseline information, surgery-related information, overall survival (OS) and disease-free survival (DFS).ResultsA total of 1473 patients were included in this study. Comparing the clinical data of the higher/lower bicarbonate group and the higher/lower lactate group, the lower group were older (p < 0.01), had higher rates of coronary heart disease (CHD) (p = 0.025), a higher proportion of colon tumors (p < 0.01), larger tumor size (p < 0.01), higher rates of open surgery (p < 0.01), more intraoperative blood loss (p < 0.01), higher overall complications (p < 0.01) and 30-day deaths (p < 0.01). The higher LL patients had more male patients (p < 0.01), higher body mass index (BMI) (p < 0.01) and drinking rates (p = 0.049), higher rates of type 2 diabetes mellitus (T2DM) (p < 0.01) and lower rates of open surgery (p < 0.01). In multivariate analysis, age (p < 0.01), BMI (p = 0.036), T2DM (p = 0.023), and surgical methods (p < 0.01) were independent risk factors of overall complications. The independent risk factors for OS included age (p < 0.01), tumor site (p = 0.014), tumor stage (p < 0.01), tumor size (p = 0.036), LL (p < 0.01), and overall complications (p < 0.01). The independent risk factors of DFS included age (p = 0.012), tumor site (p = 0.019), tumor stage (p < 0.01), LL (p < 0.01), and overall complications (p < 0.01).ConclusionPreoperative LL significantly affected postoperative OS and DFS of CRC patients, but bicarbonate might not affect the prognosis of CRC patients. Therefore, surgeons should actively focus on and adjust the LL of patients before surgery.

Characteristics of Idiopathic Subglottic Stenosis in the Elderly.

To compare characteristics of patients ≥65 years presenting with idiopathic subglottic stenosis (iSGS) to patients diagnosed at <65 years. We hypothesize that the groups have similar comorbidities and disease courses. Medical records of patients treated for iSGS at a tertiary care institution from January 2005-September 2022. Patient demographics, time from symptom onset to diagnosis, medical history and comorbidities, and treatment modalities/intervals were recorded and analyzed. Characteristics of patients ≥65 and <65 years at presentation were compared using Chi-square analysis for non-numeric values and the Mann-Whitney U-test for numeric values. One hundred seven patients with iSGS were identified and 16 (15%) were aged ≥65 years (mean age 72.6, 15 female) at presentation. These patients were compared to 91 patients aged <65 years (mean age = 47.6, 90 female). Patients ≥65 years had higher rates of type 2 diabetes mellitus (T2DM) (p = 0.004) and tobacco use (p = 0.004). There were no significant differences in body mass index, gastroesophageal reflux disease, hormone replacement therapy, time from symptom onset to presentation, or length of operative treatment intervals. Patients ≥65 years with iSGS have higher rates of tobacco use, suggesting that alterations in wound healing may play a role in the development of iSGS in this age group. Although rates of T2DM were higher in the elderly group, clinical significance may be limited given the overall higher rate of diabetes mellitus in the elderly population. 4 Laryngoscope, 133:3075-3079, 2023.

Lessons learned from the pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands

BackgroundThe Republic of the Marshall Islands (RMI) has a high rate of type 2 diabetes mellitus (T2DM). To address the high rate of T2DM, we tested a culturally adapted family model of diabetes self-management education and support (F-DSMES). We report the results of the 12-month post-intervention data collection and describe the lessons learned from the delivery of the F-DSMES intervention. MethodsRecruitment took place in four churches in Majuro and included 10 h of content delivered over 8–10 weeks. Forty-one participants with T2DM were included. The primary study outcome was glycemic control measured by a change in HbA1c. We also conducted participant interviews to document the participant-reported barriers encountered during the F-DSMES intervention. ResultsParticipants did not show improvements in their biometric markers; however, participants did show improvement on multiple measures of diabetes knowledge and family support. We identified five areas to improve future interventions: 1) issues with recruitment, retention, and attendance; 2) needing help accessing information and additional healthcare provider counseling; 3) struggles with adhering to diet recommendations; 4) difficulty getting exercise, and 5) improving lessons within the intervention. ConclusionAlthough the biomarker data did not show improvement, valuable information was gained to improve the development of larger-scale trials. The results provide evidence of the need for these trials and the desire of participants to continue pursuing this effort. Others doing similar work in other low-to-middle income countries will need to take into consideration the potential barriers and facilitators within participants’ social and physical environments.

Postpartum uptake of diabetes screening tests in women with gestational diabetes: The PANDORA study.

To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non-Indigenous women with gestational diabetes mellitus (GDM). PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75-g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA1C ] or fasting plasma glucose) were assessed for women with GDM (n= 712). Associations between antenatal factors and screening with any test (OGTT, HbA1C , fasting plasma glucose) by 6months postpartum were examined using Cox proportional hazards regression. Postpartum screening rates with an OGTT by 12 weeks and 6months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non-Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6months, p < 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6-month HbA1C compared to non-Indigenous women (16% vs. 2%, p < 0.001). Screening by 6months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non-Indigenous women (p=0.304). Characteristics associated with higher screening rates with any test by 6months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.

The influence of neighbourhood-level socioeconomic deprivation on developing type 2 diabetes in older men: a longitudinal analysis of the British Regional Heart Study cohort data

BackgroundEvidence from the British longitudinal studies on the influence of neighbourhood-level socioeconomic deprivation in older men on developing type 2 diabetes mellitus is scarce. This study investigates the prospective associations of neighbourhood-level deprivation and individual socioeconomic position with type 2 diabetes mellitus incidence in older men. MethodsThe British Regional Heart Study comprises a cohort of 4252 men aged 60–79 years in 1998–2000 from 24 towns across the UK. Neighbourhood-level deprivation was based on the country specific 2004–05 Index of Multiple Deprivation (IMD) quintiles for participants' postcode of residence at baseline. Individual socioeconomic position was defined as occupational social class based on longest-held occupation at recruitment. Participants with prevalent diabetes were excluded. The incidence of type 2 diabetes mellitus was ascertained from biannual reviews of primary care records over 18 years of follow-up. Cox proportional hazard models were undertaken to examine associations. FindingsThe incidence of type 2 diabetes mellitus cases observed was 368 (9·9%), amongst the 3706 male participants. Age-adjusted rates of type 2 diabetes mellitus increased from IMD quintile 1 (least deprived) to quintile 4 (second most deprived), before decreasing in quintile 5. Compared with quintile 1, the age and individual social class adjusted hazard ratio (aHR) in quintile 4 was 1·52 (95% CI 1·09–2·13), remaining significant after further adjustments for obesity and family history of type 2 diabetes mellitus. Participants in the lowest social class had the highest rates of type 2 diabetes mellitus. The aHR by age and IMD scores for type 2 diabetes mellitus in the lowest social class compared with the highest social class was 2·12 (95% CI 1·15–3·89). InterpretationNeighbourhood-level and individual-level socioeconomic factors remain important predictors of developing type 2 diabetes mellitus in older men, demonstrating that inequalities persist in later life. Inequalities in diabetes and its underlying modifiable risk factors need to be addressed to reduce the burden of this disease in socioeconomically deprived older-age populations. FundingNone.