Incidence Rate Of Type Research Articles

IVF and risk of Type 1 diabetes mellitus: a population-based nested case-control study.

Is the mode of conception (natural, subfertility and non-IVF, and IVF) associated with the risk of Type 1 diabetes mellitus among offspring? The risk of Type 1 diabetes in offspring does not differ among natural, subfertility and non-IVF, and IVF conceptions. Evidence has shown that children born through IVF have an increased risk of impaired metabolic function. A population-based, nested case-control study was carried out, including 769 children with and 3110 children without Type 1 diabetes mellitus within the prospective cohort of 2228073 eligible parent-child triads between 1 January 2004 and 31 December 2017. Using registry data from Taiwan, the mode of conception was divided into three categories: natural conception, subfertility, and non-IVF (indicating infertility diagnosis but no IVF-facilitated conception), and IVF conception. The diagnosis of Type 1 diabetes mellitus was determined according to the International Classification of Diseases, 9th or 10th Revision, Clinical Modification. Each case was matched to four controls randomly selected after matching for child age and sex, residential township, and calendar date of Type 1 diabetes mellitus occurrence. Based on 14.3 million person-years of follow-up (median, 10 years), the incidence rates of Type 1 diabetes were 5.33, 5.61, and 4.74 per 100000 person-years for natural, subfertility and non-IVF, and IVF conceptions, respectively. Compared with natural conception, no significant differences in the risk of Type 1 diabetes were observed for subfertility and non-IVF conception (adjusted odds ratio, 1.04 [95% CI, 0.85-1.27]) and IVF conception (adjusted odds ratio, 1.00 [95% CI, 0.50-2.03]). In addition, there were no significant differences in the risk of Type 1 diabetes according to infertility source (male/female/both) and embryo type (fresh/frozen). Although the population-level data from Taiwanese registries was used, a limited number of exposed cases was included. We showed risk of Type 1 diabetes was not associated with infertility source or embryo type; however, caution with interpretation is required owing to the limited number of exposed events after the stratification. The exclusion criterion regarding parents' history of diabetes mellitus was only applicable after 1997, and this might have caused residual confounding. It has been reported that children born to parents who conceived through IVF had worse metabolic profiles than those who conceived naturally. Considering the findings of the present and previous studies, poor metabolic profiles may not be sufficient to develop Type 1 diabetes mellitus during childhood. This study was supported by grants from Shin Kong Wu Ho-Su Memorial Hospital (No. 109GB006-1). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. The authors have no competing interests to disclose. N/A.

Changing landscape of diabetes in Asia - What are the unmet needs?

The incidence rates of type 2 diabetes among adults in Asia have been stable, but the rates in youth and young adults have increased. In territory-wide surveillance in Hong Kong, Special Administrative Region of People's Republic of China, all-cause mortality rates among people with diabetes have exhibited a declining trend in the past 15 years, with a narrowing in the mortality gap between people with and without diabetes. At the same time, the improvement in survival resulted in a changing age structure and disease profile of people with diabetes, towards an increasing proportion of older people with long diabetes duration and multi-morbidities. Reductions in event rates were not observed in the youngest age group who also had the least gains in risk factor control and uptake in organ protective drugs over time. A young age at diabetes diagnosis, associated with exposure to high glycemic burden from an early age, predicted higher risks of complications and premature mortality compared with later-onset of diabetes. People presenting with type 2 diabetes below 40 years of age were 5-fold more likely to die and their life expectancy was shortened by 8 years than age-matched counterparts without diabetes. Analysis of population-based data in Hong Kong Chinese identified hypertension followed by chronic kidney disease as the leading contributor to mortality in young people, indicating that efforts to optimize non-glycemic risk factors and organ protection are as important in young individuals as it is in the older population.

THU144 Highs And Lows: Trends In The Incidence Of Pediatric Type 2 Diabetes Mellitus Related To The COVID 19 Pandemic

Abstract Disclosure: J. Goroff: None. P. Hanley: None. A. Gannon: None. T. Grunwald: None. The COVID 19 pandemic and associated lock downs resulted in a definitive change in lifestyle that has had multiple associated outcomes for child health. There has been report of dramatic increases in the incidence of Type 2 Diabetes in the months and years immediately following the start of the pandemic. However, whether this demonstrates an overall upward trend in disease burden, or a discrete spike has yet to be described. In this retrospective cohort study patients younger than 21 years old diagnosed with Type 2 Diabetes from January 2017 to December 2022 at a large stand-alone children’s hospital were compared. Chart review was conducted at participants’ first endocrinology office visit or inpatient hospital stay for new onset Type 2 Diabetes. Diagnosis was confirmed with anti-body status for each participant. Statistical significance between incidences was determined using standard descriptive statistics. A total of 213 new onset Type 2 Diabetes cases were included. The average incidence of Type 2 Diabetes from 2017 to 2019 was 19 cases per year; compared to 65.5 cases per year from 2020 to 2021 representing a statistically significant increase in the incidence of Type 2 Diabetes (p<0.001). 2022 saw a fall in incidence to 25 cases per year. This was a significantly lower incidence rate than 2020 to 2021 (p=0.01). There was no difference in incidence rate of Type 2 Diabetes from 2017 to 2019 and 2022 (p=0.39). These results support a significant increase in Type 2 Diabetes diagnoses with the onset of the COVID 19 pandemic. This may be secondary to sedentary lifestyle, increased mental health and psychosocial stressors or increased BMI. However, we demonstrate that two years after the onset of the pandemic there was a return to pre-pandemic incidences of Type 2 Diabetes. Type 2 Diabetes continues to pose a significant health threat to the pediatric population and burden for the medical system as they age. Nevertheless, if this trend continues and is reflected across other institutions, it is reassuring and may offer insight into modifiable risk factors yet to be investigated. Presentation: Thursday, June 15, 2023

The role of polymorphic variants of the kisspeptin gene in the pathogenesis of ovarian insufficiency in patients with type 1 diabetes mellitus, genital endometriosis and combination of these diseases

BACKGROUND:Type 1 diabetes mellitus and genital endometriosis have a negative impact on female reproductive system. There is an opinion that kisspeptin plays an important role in the pathogenesis of ovarian insufficiency in patients with diabetes and endometriosis.
 AIM:The aim of this study was to evaluate the role of the kisspeptin gene (KISS1) polymorphism in the pathogenesis of ovarian insufficiency in patients with type 1 diabetes mellitus, genital endometriosis and in women with combination of these diseases.
 MATERIALS AND METHODS:The allele and genotype frequencies of the polymorphic variants rs5780218 (c.145delT) and rs3924587 (c.89GA) of theKISS1gene were evaluated in 258 women using polymerase chain reaction-restriction fragment length polymorphism technique. This study included 73 patients with type 1 diabetes mellitus, 83 patients with genital endometriosis, 35 patients with combination of type 1 diabetes mellitus and genital endometriosis, and 67 control subjects. The control group is represented by women of the population.
 RESULTS:The analysis of theKISS1gene showed that incidence rates of type 1 diabetes mellitus, genital endometriosis and combination of these diseases do not differ in the presence of the ins/del, del/del, and ins/ins (rs5780218) genotypes. Thus, the del allele and the ins/del and del/del genotypes are not associated with an increased risk of these diseases. It was found that in patients with type 1 diabetes mellitus, the frequency of normogonadotropic ovarian insufficiency was higher (odds ratio 15.955; 95% confidence interval4,4757,0;p 0.05) in the presence of the G/A genotype according to the polymorphic variant rs3924587 compared to the G/G genotype.
 CONCLUSIONS:The data obtained allow for explaining the high incidence of ovarian insufficiency in women with type 1 diabetes mellitus. In patients with type 1 diabetes mellitus with the G/A genotype who are planning pregnancy, even in case of regular menstrual cycle, it is advisable to perform hormone blood tests in dynamics for timely diagnosis of ovarian insufficiency and prescription of hormonal therapy.

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

There are reports of increasing incidence of pediatric diabetes since the onset of the COVID-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesize estimates of changes in incidence rates. To compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic. In this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the gray literature were searched between January 1, 2020, and March 28, 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA). Studies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English. From records that underwent full-text review, 2 reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively. The primary outcome was change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic. Forty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36). This study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

Denosumab and incidence of type 2 diabetes among adults with osteoporosis: population based cohort study

ObjectiveTo estimate the effect of denosumab compared with oral bisphosphonates on reducing the risk of type 2 diabetes in adults with osteoporosis.DesignPopulation based study involving emulation of a randomized target...

The effect of ambient ozone exposure on three types of diabetes: a meta-analysis

BackgroundOzone as an air pollutant is gradually becoming a threat to people's health. However, the effect of ozone exposure on risk of developing diabetes, a fast-growing global metabolic disease, remains controversial.ObjectiveTo evaluate the impact of ambient ozone exposure on the incidence rate of type 1, type 2 and gestational diabetes mellitus.MethodWe systematically searched PubMed, Web of Science, and Cochrane Library databases before July 9, 2022, to determine relevant literature. Data were extracted after quality evaluation according to the Newcastle Ottawa Scale (NOS) and the agency for healthcare research and quality (AHRQ) standards, and a meta-analysis was used to evaluate the correlation between ozone exposure and type 1 diabetes mellitus (T1D), type 2 diabetes mellitus (T2D), and gestational diabetes mellitus (GDM). The heterogeneity test, sensitivity analysis, and publication bias were performed using Stata 16.0.ResultsOur search identified 667 studies from three databases, 19 of which were included in our analysis after removing duplicate and ineligible studies. Among the remaining studies, three were on T1D, five were on T2D, and eleven were on GDM. The result showed that ozone exposure was positively correlated with T2D [effect size (ES) = 1.06, 95% CI: 1.02, 1.11] and GDM [pooled odds ratio (OR) = 1.01, 95% CI: 1.00, 1.03]. Subgroup analysis demonstrated that ozone exposure in the first trimester of pregnancy might raise the risk of GDM. However, no significant association was observed between ozone exposure and T1D.ConclusionLong-term exposure to ozone may increase the risk of T2D, and daily ozone exposure during pregnancy was a hazard factor for developing GDM. Decreasing ambient ozone pollution may reduce the burden of both diseases.

Spatio-Temporal Trends in the Incidence of Type 2 Diabetes in Germany.

There are no data on recent trends in the incidence rate of type 2 diabetes (T2D) in Germany. The aim of this study was to determine the sex-, age-, and region-specific trends in the T2D incidence rate between 2014 and 2019. Based on nationwide data from statutorily insured persons in Germany, negative binomial regression models were used to analyze age- and sex-specific trends in the T2D incidence rate. Age- and sex-adjusted trends were calculated for 401 administrative districts using a Bayesian spatio-temporal regression model. During the period concerned, approximately 450 000 new cases of T2D were observed each year among some 63 million persons. Taking all age groups together, the incidence rate decreased in both women and men, from 6.9 (95% confidence interval [6.7; 7.0]) and 8.4 [8.2; 8.6] respectively per 1000 persons in 2014 to 6.1 [5.9; 6.3] and 7.7 [7.5; 8.0] per 1000 persons in 2019. This corresponds to an annual reduction of 2.4% [1.5; 3.2] for women and 1.7% [0.8; 2.5] for men. The incidence rate increased in the age group 20-39 years. The age- and sex-adjusted incidence rate decreased in almost all districts, although regional differences persisted. The T2D incidence rate should be closely monitored to see whether the decreasing trend continues. One must not forget that the prevalence can rise despite decreasing incidence. For this reason, the findings do not necessarily mean a decrease in the disease burden of T2D and the associated demand on healthcare resources.

The effects of different physiologic concentrations of prolactin in association with reproductive hormones on the incidence of type 2 diabetes mellitus in men: Tehran Lipid and Glucose Study

BackgroundData is inconsistent and, for the most part, not sufficient to demonstrate the association between serum Prolactin (PRL) concentration within the physiologic range and the incidence rate of type 2 Diabetes Mellitus (DM) among men. Moreover, since both PRL and type 2 DM are associated with reproductive hormones, investigating these hormones might improve our understanding of how PRL might impose its effect on the incidence rate of type 2 DM.MethodsFor the present study, 652 eligible men aged 29–70 with a normal baseline PRL concentration were selected from the Tehran Lipid and Glucose Study (TLGS). Participants were sub-classified into three groups (tertiles) according to the serum concentration of PRL and were followed for 15.8 years. The incidence of type 2 DM and PRL, LH, FSH, testosterone, and AMH concentrations were measured. The effect of hormonal variables on the incidence of type 2 DM was estimated using the log-binomial model, adjusted for major confounding factors. The correlations between PRL and the indicators of glucose and lipid metabolism and other hormonal variables were also explored.ResultsIn the unadjusted model, PRL was not significantly associated with the incidence rate of type 2 DM (RR = 0.98, 95% CI: 0.94 − 1.03). After adjusting for potential confounders, the inverse effect of AMH on the incidence rate of type 2 DM was the only significant association. The analyses also indicated a significant positive association between PRL and LH/FSH ratio (r = 0.1, P = 0.01).ConclusionNo significant association was found between serum PRL concentrations within the physiologic range and the incidence rate of type 2 diabetes mellitus among middle-aged men. Men with higher concentrations of PRL within the physiologic range tended to show higher levels of LH and LH/FSH. AMH was the only variable significantly linked to the incidence rate of type 2 DM in men.

Body mass index trajectories in childhood and incidence rates of type 2 diabetes and coronary heart disease in adulthood: A cohort study

AimsWe examined associations between five body mass index (BMI) trajectories from ages 6–15 years and register-based adult-onset type 2 diabetes mellitus (T2D) and coronary heart disease (CHD) with and without adjustment for adult BMI. MethodsChild and adult BMI came from two Danish cohorts and 13,205 and 13,438 individuals were included in T2D and CHD analyses, respectively. Trajectories were estimated by latent class modelling. Incidence rate ratios (IRRs) were estimated with Poisson regression. ResultsIn models without adult BMI, compared to the lowest trajectory, among men the T2D IRRs were 0.92 (95 %CI:0.77–1.09) for the second lowest trajectory and 1.51 (95 %CI:0.71–3.20) for the highest trajectory. The corresponding IRRs in women were 0.92 (95 %CI:0.74–1.16) and 3.58 (95 %CI:2.30–5.57). In models including adult BMI, compared to the lowest trajectory, T2D IRRs in men were 0.57 (95 %CI:0.47–0.68) for the second lowest trajectory and 0.26 (95 %CI:0.12–0.56) for the highest trajectory. The corresponding IRRs in women were 0.60 (95 %CI:0.48–0.75) and 0.59 (95 %CI:0.36–0.96). The associations were similar in direction, but not statistically significant, for CHD. ConclusionsIncidence rates of adult-onset T2D were greater for a high child BMI trajectory than a low child BMI trajectory, but not in models that included adult BMI.

Division of Type 1 Diabetes Responsibility in Latinx and Non-Latinx White Mother-Adolescent Dyads.

Incidence rates of type 1 diabetes are increasing faster in Latinx youth than other ethnic groups, yet this population remains understudied. The current study (1) tested differences in division of diabetes-related responsibility (adolescent alone, mother alone, and shared) across Latinx and non-Latinx White families (N = 118 mother-adolescent dyads, 56 = Latinx dyads, Mage=13.24 years), and (2) examined associations between diabetes responsibility and adolescent health (HbA1c, diabetes self-management behaviors, and depressive symptoms). Latina mothers reported more shared and less adolescent responsibility than non-Latinx White mothers, but there were no ethnic differences in adolescent reports of responsibility. Independent of demographic and illness-related characteristics, mother- and adolescent-reports of shared responsibility were associated with higher self-management behaviors, while individual responsibility (adolescent or mother alone) was generally associated with lower self-management behaviors. Shared responsibility associations with higher mother-reported self-management behaviors occurred among Latinx families, but not non-Latinx White families. Shared and individual responsibility were not associated with HbA1c or depressive symptoms. The findings suggest the importance of shared responsibility for diabetes management in adolescence, particularly in Latinx families.

1185-P: Low Birth Weight Is Associated with a Nongenetic Higher Incidence Rate of Type 2 Diabetes

Background: Low birth weight, indictive of a poor fetal environment, is a risk factor for type 2 diabetes (T2D) . Most previous studies were based on cross sectional prevalence data and not designed to study the timing of onset of T2D in relation to birth weight (BW) . Furthermore, earlier studies have not adjusted for common genetic variation influencing BW. We aimed to examine associations of BW with age-specific incidence of T2D using BW polygenetic risk scores (BWPRS) to adjust for genetic confounding. Methods: Adults (30-60 years) enrolled in the Inter99 cohort from 1999-20with information on BW from original birth records, and without diabetes at baseline were eligible. Birth records were linked with individual-level data on T2D incidence from the Danish Diabetes Register and key covariates from the Inter99 study. Incidence rates of T2D as a function of age, sex and BW were modelled using Poisson regression and adjusted for adult BMI, socioeconomic status, maternal history of diabetes and BWPRS. Results: Among 4584 participants there were 438 incident cases of T2D during a mean follow-up of 18 years. BW was inversely associated with T2D with a higher incidence in men. T2D incidence increased with age and the rate of increase was higher in persons with lower BW compared with higher BW in a dose-response manner. Conclusion: A lower birth weight is associated with a greater increase in incidence rate of T2D in a non-genetic manner. Disclosure R.Wibaek: Stock/Shareholder; Novo Nordisk A/S. G.S.Andersen: Stock/Shareholder; Novo Nordisk A/S. A.Linneberg: None. N.Grarup: None. T.Hansen: None. C.Brøns: Stock/Shareholder; Novo Nordisk. D.Vistisen: Research Support; Bayer AG, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi, Stock/Shareholder; Novo Nordisk A/S. A.A.Vaag: Stock/Shareholder; AstraZeneca. Funding Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation (NNF17SA0031406)

Population level impact of the NHS Diabetes Prevention Programme on incidence of type 2 diabetes in England: An observational study.

SummaryBackgroundThe NHS Diabetes Prevention Programme (DPP) is the first nationwide type 2 diabetes prevention programme targeting people with prediabetes. It was rolled out across England from 2016 in three waves. We evaluate the population level impact of the NHS DPP on incidence rates of type 2 diabetes.MethodsWe use data from the National Diabetes Audit, which records all individuals across England who have been diagnosed with type 2 diabetes by 2019. We use difference-in-differences regression models to estimate the impact of the phased introduction of the DPP on type 2 diabetes incidence. We compare patients registered with the 3,282 general practices enrolled from 2016 (wave 1) and the 1,610 practices enrolled from 2017 (wave 2) to those registered with the 1,584 practices enrolled from 2018 (final wave).FindingsIncidence rates of type 2 diabetes in wave 1 practices in 2018 and 2019 were significantly lower than would have been expected in the absence of the DPP (difference-in-differences Incident Rate Ratio (IRR) = 0·938 (95% CI 0·905 to 0·972)). Incidence rates were also significantly lower than expected for wave 2 practices in 2019 (difference-in-differences IRR = 0·927 (95% CI 0·885 to 0·972)). These results remained consistent across several robustness checks.InterpretationIntroduction of the NHS DPP reduced population incidence of type 2 diabetes. Longer follow-up is required to explore whether these effects are maintained or if diabetes onset is delayed.FundingThis research was funded by the National Institute for Health and Care Research (Health Services and Delivery Research, 16/48/07 – Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research programme (Diabetes Prevention – Long Term Multimethod Assessment)). The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health and Care Research or the Department of Health and Social Care.

Postlaminectomy lumbopelvic sagittal changes in patients with developmental lumbar spinal stenosis grouped into Roussouly lumbopelvic sagittal profiles: 2- to 10-year prospective follow-up.

Roussouly lumbopelvic sagittal profiles are associated with distinct pathologies or distinct natural histories and prognoses. The associations between developmental lumbar spinal stenosis (DLSS) and native lumbopelvic sagittal profiles are unknown. Moreover, the relative effects of multilevel decompression on lumbar sagittal alignment, geometrical parameters of the pelvis, and compensatory mechanisms for each of the Roussouly subtypes are unknown. This study aimed to explore the association between DLSS and native lumbar lordosis (LL) subtypes. It also attempts to understand the natural history of postlaminectomy lumbopelvic sagittal changes and compensatory mechanisms for each of the Roussouly subtypes and to define the critical lumbar segment or specific lordosis arc that is recruited after relief of the stenosis effect. A total of 418 patients with multilevel DLSS were grouped into various Roussouly subtypes, and lumbopelvic sagittal parameters were prospectively compared at follow-up intervals of preoperative to < 2 years, 2 to < 5 years, and 5 to ≥ 10 years after laminectomy. The variables analyzed included LL, upper lordosis arc from L1 to L4, lower lordosis arc from L4 to S1, and segmental lordosis from L1 to S1. Pelvic parameters included pelvic incidence, sacral slope, pelvic tilt, and pelvic incidence minus LL values. Of the 329 patients who were followed up throughout this study, 33.7% had Roussouly type 1 native lordosis, whereas the incidence rates of types 2, 3, and 4 were 33.4%, 21.9%, and 10.9%, respectively. LL was not reduced in any of the Roussouly subtypes after multilevel decompressions. Instead, LL increased by 4.5° (SD 11.9°-from 27.3° [SD 11.5°] to 31.8° [SD 9.8°]) in Roussouly type 1 and by 3.1° (SD 11.6°-from 41.3° [SD 9.5°] to 44.4° [SD = 9.7°]) in Roussouly type 2. The other Roussouly types showed no significant changes. Pelvic tilt decreased significantly-by 2.8°, whereas sacral slope increased significantly-by 2.9° in Roussouly type 1 and by 1.7° in Roussouly type 2. The critical lumbar segment that recruits LL differs between Roussouly subtypes. Increments and changes were sustained until the final follow-up. The study findings are important in predicting patient prognosis, LL evolution, and the need for prophylactic or corrective deformity surgery. Multilevel involvement in DLSS and the high prevalence of Roussouly types 1 and 2 suggest that spinal canal dimensions are closely linked to the developmental evolution of LL.

Latexin deficiency attenuates adipocyte differentiation and protects mice against obesity and metabolic disorders induced by high-fat diet

Obesity is a risk factor for many chronic diseases, and is associated with increased incidence rate of type 2 diabetes, hypertension, dyslipidemia and cardiovascular diseases. Adipocyte differentiation play critical role during development of obesity. Latexin (LXN), a mammalian carboxypeptidase inhibitor, plays important role in the proliferation and differentiation of stem cells, and highlights as a differentiation-associated gene that was significantly downregulated in prostate stem cells and whose expression increases through differentiation. However, it is unclear whether LXN is involved in adipocyte differentiation. The aim of this study was to evaluate the role of LXN on adipocyte differentiation, as well as its effects on high fat-induced obesity and metabolic disorders. In this study, we determine the expression of LXN in adipose tissue of lean and fat mice by Western blot, qPCR and immunohistochemistry. We found that LXN in fat tissues was continuous increased during the development of diet-induced obesity. We fed wild-type (WT) and LXN−/−mice with high-fat diet (HFD) to study the effects of LXN on obesity and related metabolic functions. We found that mice deficient in LXN showed resistance against high-fat diet (HFD)-induced obesity, glucose tolerance, insulin tolerance and hepatic steatosis. In vitro studies indicated that LXN was highly induced during adipocyte differentiation, and positively regulated adipocyte differentiation and adipogenesis in 3T3-L1 cells and primary preadipocytes. Functional analysis revealed that the expression of LXN was positively regulated by mTOR/RXR/PPARɤ signaling pathway during the differentiation of adipocytes, while LXN deletion decreased the protein level of PPARɤ in adipocyte through enhancing FABP4 mediated ubiquitination, which led to impaired adipocyte differentiation and lipogenesis. Collectively, our data provide evidence that LXN is a key positive regulator of adipocyte differentiation, and therapeutics targeting LXN could be effective in preventing obesity and its associated disorders in clinical settings.

Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study

PurposeEthnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese.MethodsThis population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes.ResultsDuring follow-up (median 9.8 years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90–20.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07–2.32)) and 30% higher in Blacks (HR 1.34 (1.23–1.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73–24.92) and 4.78 (4.51–5.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55–0.90)) and Blacks (HR 0.71 (0.51–0.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia.Conclusions/InterpretationType 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.

Teachers' knowledge about type 1 diabetes in public female elementary schools in Northern Saudi Arabia.

SummaryBackgroundSaudi Arabia ranks the 4th country in the world in incidence rate of Type 1 Diabetes (T1D), which is usually diagnosed in children and teens. Managing T1D at school is important for children’s short- and long-term health. Little is known about how much teachers are compatible to support students with diabetes in schools in northern Saudi Arabia. The aim of this study was to assess factual knowledge about T1D among teachers in public female elementary schools.Materials and methodsThis was a cross-sectional survey conducted in 18 elementary schools in Hail region, during October 16, 2019 to January 23, 2020. A structured self- administered questionnaire approached all school teachers and other school staff caring students (n = 600).ResultsA total of 504 questionnaires received completed (84.0% response rate). Overall, 220 (43.7%) teachers reported having had or currently having a student/s with T1D. Only a small percentage (10.8%) who stated that they had received training to support students with T1D. Participant attained an overall fair knowledge score (13.20 ± 3.81 on 20-point scale; 66.0%), however, only 27.3% who attained good score (≥ 80%) compatible with being an effective support person for students with diabetes. The multivariate logistic regression model, revealed that: (1) received training [adjusted Odds Ratio (aOR: 3.38; p < 0.001); (2) have/ever had diabetic student/s (aOR: 2.02; p = 0.002); (3) teacher himself is diabetic or have a near contact diabetic person (aOR: 2.35; p = 0.001); (4) family history of diabetes (aOR: 1.84; p = 0.015); and (5) teacher’s capacity to inject insulin (aOR: 1; p = 0.003), were factors that predicted teacher’s good knowledge.ConclusionTeachers in female elementary schools in our region need to improve their knowledge about diabetes in children, especially recognizing and management of diabetic emergencies. Training programs are crucially needed to empower teachers with knowledge and self-confidence in helping students with diabetes.

179-LB: Association of Leptin and Adiponectin with the Incidence of Type 2 Diabetes Independent of Visceral Adiposity and Liver Fat

Leptin and adiponectin are two major adipocytokines reported to be associated with type 2 diabetes. However, it is unknown whether their associations with the risk of incident type 2 diabetes are independent of visceral adiposity and liver fat in a prospective cohort study. We included 787 Japanese men aged 28 to 77 years without type 2 diabetes at baseline. The subjects were classified into four groups based on leptin-adiponectin profile at baseline, with the median concentration value as the cut-off point (median levels of leptin and adiponectin were 4.8 ng/dL and 5.7 µg/mL, respectively): low-high, low-low, high-high, and high-low group. Visceral fat was measured by computed tomography (CT) as intra-abdominal fat area at the umbilicus level. Liver fat was assessed by liver-to-spleen attenuation ratio measured by CT. Type 2 diabetes was diagnosed as fasting plasma glucose level ≥126 mg/dL, HbA1c ≥6.5%, or taking oral hypoglycemic medications or insulin. Cox proportional hazard models were used to estimate hazard ratios (HR) for developing type 2 diabetes. During 5215 person-years of follow-up, 72 subjects developed type 2 diabetes. Incidence rates of type 2 diabetes per 1000 person-years were 3.2, 9.2, 18.6, and 26.1 for the low-high, low-low, high-high, and high-low group, respectively. After adjustment for age, smoking status, alcohol consumption, regular physical activity, family history of diabetes, visceral fat, and liver fat, multiple-adjusted HRs (95% CI) of incident type 2 diabetes were 1.87 (0.63-5.50), 2.90 (1.02-8.21), and 3.41 (1.23-9.47) for the low-low, high-high, and high-low group compared with the low-high group. In conclusion, leptin and adiponectin were associated with incident type 2 diabetes independent of both visceral fat and liver fat. Disclosure I. Shibata: None. W. Y. Fujimoto: None. E. J. Boyko: None. T. Hayashi: None. M. Shibata: None. K. K. Sato: None. S. Uehara: None. N. Nishida: None. K. Okamura: None. Y. Yuyama: None. H. Koh: None. Y. Hikita: None.

Chaos detection in SIR model with modified Beddington–De Angelis type incidence rate and saturated treatment

In this paper, we construct an SIR epidemic model with a modified Beddington–De Angelis type incidence rate and saturated treatment rate. We modify the incidence rate to incorporate the isolation of infected individuals after detection, and separation of some susceptible individuals from the rest to avoid the infection, without an increase in the number of classes. We find that the system has a unique disease-free equilibrium (DFE) which is locally asymptotically stable when the reproduction number is less than unity. The multiple endemic equilibria may exist irrespective of the basic reproduction number. The existence of bistability is encountered. Supercritical transcritical (forward), as well as subcritical transcritical (backward) bifurcation, may occur at [Formula: see text] where contact rate, [Formula: see text] acts as the bifurcation parameter. Therefore, DFE need not be globally stable. The conditions for the existence of Andronov–Hopf bifurcation are deduced with maximum treatment capacity, [Formula: see text] as the bifurcation parameter. The impacts of isolation of confirmed infected cases and separation of some susceptible from rest are studied numerically as well as the effect of saturation in treatment. The existence of chaotic behavior is deduced by showing the maximum Lyapunov exponent to be positive as well as the sensitivity to initial conditions. The computation of the Kalpan–Yorke dimension to be fractional confirms the existence of fractal-type strange attractor. The positive Kolmogorov–Sinai entropy further strengthens the claim of the existence of chaos.

Type 2 diabetes and the risk of colorectal polyps: A retrospective nationwide population-based study.

The incidence rates of type 2 diabetes mellitus (T2DM) and colorectal polyps have been increasing over the last decades. However, direct associations between T2DM and colorectal polyps have not been extensively reported. We will explore the relationship between T2DM and colorectal polyps.In the retrospective study, we classified DM and NonDM groups (control) from 993,516 people in Taiwan nationwide population insurance database from the period of 2000 to 2013. We collected data on income and comorbidities through the international classification of diseases, ninth revision—clinical modification (ICD-9-CM) codes.The T2DM group had a higher incidence rate of colorectal polyps (31.97%, 95% confidence interval [CI] = 30.97–33.28) than the control group (25.9%, 95% CI = 25.1–26.72), and the crude incidence ratio was 1.235 (95% CI = 1.174–1.300). In 13 years of follow-up (2000–2013), T2DM was linked to a significantly higher cumulative probability of colorectal polyps (log-rank test: P = .0001).Patients with T2DM had a 1.23-fold higher risk of new colorectal polyps than control patients in 13 years of follow-up. We explain the T2DM increases incidence for colorectal polyps in long term follow-up.