Personal History Of Diabetes Research Articles

Awareness of Gestational Diabetes Mellitus Maternal and Neonatal Outcomes Among Women Attending Primary Healthcare Centers in Qassim, Saudi Arabia.

Background Gestational diabetes mellitus (GDM), diagnosed during pregnancy, can harm both mothers and neonates. GDM awareness among women varies among various countries. Understanding the level of awareness is vital for designing effective health interventions. Objectives This study aimed to evaluate GDM awareness among married females at primary healthcare centers (PHCCs) in Qassim, Saudi Arabia, focusing on knowledge regarding adverse maternal and fetal outcomes of GDM. Methods An observational cross-sectional study was conducted among married females at PHCCs in Qassim, from June 2023 to October 2023. A two-stage cluster sampling method was used. Four PHCCs were selected in the first stage, and study participants were selected from these centers in the second stage. A self-administered questionnaire was used. Statistical Product and Service Solutions (SPSS, version 23;IBM SPSS Statistics for Windows, Armonk, NY) was used for statistical analysis. Results Of the 270 participants, the majority (72.2%) demonstrated 'poor' knowledge about GDM adverse outcomes for both mothers and neonates, 17.8% demonstrated a 'fair' level, and only 10% displayed a 'good' knowledge. Participants' educational level, personal history of diabetes, and age were associated with knowledge levels. Awareness of specific outcomes related to GDM, both maternal and neonatal, varied among participants. Information on GDM was mainly obtained from mass media and personal networks, while healthcare providers were reported as the least common source. Conclusion Based on the results of our study, weconclude that educational interventions, especially involving healthcare providers, are essential to improve awareness about GDM adverse outcomes. Strategies involving educational sessions by healthcare providers and health education materials at PHCCs can improve awareness leading to effective management of GDM and improved maternal and neonatal outcomes.

Nutritional Calorie Labeling and Menu Ordering Practices Among US Adults With Chronic Illnesses.

The relationship between diet and the management of chronic illnesses is well established. However, it is unknown the extent to which people with chronic illnesses pay attention to nutritional information and act upon the information obtained. We evaluated the menu ordering practices of adults with chronic illnesses. We analyzed the 2018 Health Information National Trends Survey (HINTS 5 Cycle 2). Our analytic cohort included 3,154 respondents (weighted population size=228,464,822) who answered questions regarding a personal history of diabetes, hypertension, heart disease, and obesity. They also answered questions about their nutritional habits regarding whether they noticed caloric information at fast-food or sit-down restaurants and how that information influenced their dietary choices. Among respondents with these chronic illnesses, only obese patients were significantly more likely to pay attention to caloric information (OR=1.56; 95%CI: 1.06-2.31). However, noticing the calorie information was not associated with ordering less calories among all categories of respondents with chronic illnesses. US adults with chronic illnesses do not pay sufficient attention to the calorie information of their diet. Furthermore, awareness of the calorie information did not influence their dietary choices. Healthcare professionals should incorporate dietary counseling into the management of chronic illnesses of their patients.

Awareness of chronic kidney disease and its risk factors in the former Soviet Union countries

<b>Purpose:</b> Assessment of public knowledge of chronic kidney disease (CKD) is an essential step in<b> </b>development of CKD prevention and screening programs. Our aim was to estimate the level of public CKD knowledge and its predictors in the former Soviet Union countries using a validated questionnaire.<br /> <b>Materials and methods: </b>This cross-sectional survey was conducted in 10 countries using an adapted validated online questionnaire. Descriptive statistics were used to describe participants’ characteristics and assess public CKD knowledge level. A multiple linear regression analysis was performed to identify predictors of CKD knowledge.<br /> <b>Results: </b>2,715 participants satisfied the inclusion criteria. Respondents having higher level of education, living in countries belonging to the lower middle-income countries, having a personal history of diabetes and hypertension, and having a family history of kidney disease showed significantly better CKD knowledge.<br /> <b>Conclusions:</b> The level of CKD knowledge among the population of post-Soviet states was found to be low, although some personal characteristics were associated with better CKD knowledge.

Consumption of Sugar-Sweetened Beverages: a cross-sectional study among university students in Sarawak

Objective: The purpose of this study was to examine the prevalence and type of SSB among the students at a public university in Sarawak. Methods: This was a cross-sectional study conducted among undergraduate students in a public university of Malaysia. Using questionnaire, data on socio-demographic, SSB consumption, family and personal history of diabetes, knowledge on SSB intake was collected, together with anthropometry measurement. Data was analyzed using IBM SPSS version 22.0. Results: A total of 208 respondents participated in the study. About one fourth of the respondents consumed SSB at least one time daily (83.6%) and as high as 72.1% consumed SSBs more than three times a week. The top three most consumed types of SSBs were coffee, flavoured milk and 3-in-1 sachet drink (53.4 to 76.0%). Only ethnicity showed a significant association with daily intake of SSB where Malay and other ethics groups (Bumiputra Sarawak, Bumiputra Sabah, Indian and other ethnic groups) had higher daily consumption (≥1 times) of SSB compared to Chinese respondents. Other independent variables showed no significant difference between those who consumed SSB and consumed more than once per day. Conclusions: Understanding the SSB consumption among young adults is important to formulate a more effective intervention strategy especially at Malaysia with a multicultural society, in which every ethnicity has their own eating culture.

Evaluation of Perioperative Factors Influencing Vaginal Cuff Dehiscence After Minimally Invasive Hysterectomy [ID: 1372339

INTRODUCTION: Vaginal cuff dehiscence (VCD) is one of the few surgical complications identified more commonly in minimally invasive hysterectomies (MIHs) versus open hysterectomies. The objective of this study is to determine perioperative risk factors that contribute to the development of VCD in patients undergoing MIH. METHODS: From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of VCD. RESULTS: One thousand one hundred eighty-nine patients underwent MIH. Only 10 (0.8%) patients developed VCD. There was no significant difference in mean body mass index, postoperative length of stay, or estimated blood loss between those with VCD versus those without. Incidence of VCD was highest in total laparoscopic hysterectomy versus all other MIH modalities (P=.002). There were no cases of VCD in laparoscopic-assisted vaginal hysterectomy. No patients with endometriosis experienced VCD, and there was no difference in the incidence in patients with cancer versus benign conditions (1.3% versus 0.8%, P=.488, odds ratio [OR] 1.29, 95% CI 0.68–8.23). Personal history of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, or smoking did not affect the incidence of VCD (P>.05) as well as insurance status and race (P=.728 and P=.775, respectively). Patients who developed deep surgical site infections (SSIs) had significant increase in VCD (10.0% versus 2.3%, P=.006, OR 4.79, 95% CI 0.587–33.22). CONCLUSION: We observed that mode of MIH and SSI were perioperative risk factors that contribute to the development of VCD. What is notable is that demographics and medical comorbidities did not affect the incidence of VCD.

Insulin requiring Gestational Diabetes: Risk factors and correlation with postpartum diabetes and prediabetes.

A2 gestational diabetes mellitus (A2GDM) is a more severe form of GDM that requires additional medical intervention, such as insulin or oral antidiabetic drug (OAD). The present study explored the determinants of A2GDM and analyzed the associated risk of post-partum diabetes or prediabetes. This retrospective study included 247 pregnant women, diagnosed with GDM and followed up until delivery at the Obstetric Medicine Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2014 and January 2018. Women with personal history of diabetes or prediabetes were excluded. Collected data included patient's age, body mass index, personal history of thyroid dysfunction and GDM, HbA1c level at diagnosis, management of GDM (diet only, insulin, or OAD), and postpartum metabolic assessment. The prevalence of A2GDM was 29.6%, of which 21.5% were insulin-requiring and 8.1% were OAD-requiring cases. The risk of A2GDM was independently associated with a positive history of GDM (OR=3.19, 95% CI = 1.41-7.20) and HbA1c >7% (OR=8.66, 95%CI = 2.15- 34.94); the model explained 20% of the variance of A2GDM. The postpartum assessment showed that 10.1% have developed prediabetes, while no one developed overt diabetes. Postpartum prediabetes was independently predicted by age category ≥45 years (OR=39.94, 95%CI = 4.62-345.06), history of GDM (OR=0.18, 95%CI = 0.03 - 0.97), and A2GDM (OR=6.96, 95%CI = 1.91-25.42). Approximately one-third of GDM patients in our institution require insulin or OAD for glycemic control and are at high risk of developing prediabetes postpartum. Adherence to and effectiveness of medical nutrition therapy should be further explored among GDM patients to improve their glycemic control and both maternal and fetal prognosis.

PSUN258 New-Onset Ketosis-Prone Diabetes (A- β+) Associated with Covid-19: A Unique Form of Atypical Diabetes

Abstract Since the beginning of the Covid-19 pandemic in December 2019, much has been written about its bidirectional prognostic association with newly diagnosed diabetes, which can either be precipitated new-onset or unmasked previously undiagnosed diabetes, both often presenting as diabetic ketoacidosis. Various mechanisms have been proposed, including stress- or drug-induced hyperglycemia, proinflammatory direct and indirect effects on insulin secretion and activity, as well as direct viral cytolytic effect on the pancreatic β cells via action on the ACE2 receptor integral to islet cell homeostasis. We present a case of a 51-year-old normosthenic male with no known comorbidities, who came in with 2-day history of nausea and epigastric discomfort along with progressively worsening dyspnea and nonproductive cough. He tested positive for Covid-19 by TMA, with elevated acute-phase reactants (CRP and ferritin), and had received his first dose of Covid vaccine 10 days prior. Further evaluation was consistent with diabetic ketoacidosis (glucose 487 mg/dL, pH 7.22, anion gap 27, HCO3 10 mmol/L, beta-hydroxybutyrate 9.71 mmol/L) with concurrent pancreatitis (lipase 2327 U/L, no leukocytosis, lactate 1.41 mmol/L) and acute kidney injury (EGFR 58). His BMI at presentation was 26 kg/m2 with a hemoglobin A1c of 16.9, and no personal history of diabetes. His father and paternal grandmother both had type 2 diabetes. He was managed with hydration and insulin drip titrated as per protocol, with subsequent resolution of DKA and transition to subcutaneous basal-bolus insulin on the second hospital day. Mild-moderate respiratory Covid symptoms improved with dexamethasone, remdesivir, and oxygen supplementation via nasal cannula. Glucose was controlled throughout the hospital stay, and he was discharged improved on the fifth hospital day with twice-daily basal insulin. When he presented to the DKA clinic for follow-up five months post-hospital discharge, his HbA1c was remarkably down to 7.1. There was no evidence of any macrovascular or microvascular complications. GAD-65 and islet cell antibodies were negative. Given good glucose control and adequate β cell function as confirmed by C-peptide level of 3.50 ng/mL, we were hence able to further decrease his basal insulin to once daily and start metformin. With an increasing number of reports of patients with new-onset DKA following Covid-19 infection, without a typical phenotype of type 1 diabetes, it is possible that Covid-19 is associated with a unique form of provoked A- β+ Ketosis Prone Diabetes (KPD). Identical to our case, patients belonging to this subgroup resemble type 2 diabetes patients in that they have adult-onset diabetes, are overweight or obese, lack islet autoantibodies and have substantial β cell functional reserve measured shortly after the index episode of DKA. Awareness of this phenomenon is important as it can help guide a unique treatment path for these patients and avoid injudicious use of insulin moving forward. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PSUN253 Cocaine Use Resulting in Inadvertent Sulfonylurea Overdose

Abstract Introduction Most street cocaine is cut with other substances to increase drug volume. Often, cutting agents are used that change or intensify the effects of the drug. We present a case in which sulfonylurea-laced cocaine resulted in life-threatening hypoglycemia. Clinical Case A 61-year-old male with a history of heart failure with reduced ejection fraction, moderate aortic stenosis, and substance abuse was found unconscious with a fingerstick of 25 mg/dL. He had no personal history of diabetes. No one in his household had diabetes, and he denied any use of insulin or oral anti-diabetic medications. In the emergency department, he had recurrent hypoglycemia despite D10 boluses, glucagon, oral glucose tablets, and a full meal. He required initiation of a continuous intravenous D10 drip, which was titrated to 250 mL/hr to maintain normoglycemia. The endocrinology service was consulted for further evaluation and treatment. The patient recalled smoking a new supply of cocaine prior to his current admission. He had been admitted to two other hospitals within the month prior with similar episodes of severe hypoglycemia. Biochemical evaluation during a prior hospitalization suggested hyperinsulinemic hypoglycemia and a CT abdomen did not visualize an insulinoma. However, diagnostic evaluation was not completed at that time as the patient left against medical advice.Tests during this hospitalization included a low serum glucose 42 mg/dL, high insulin 107 uIU/mL (normal <3), high proinsulin 42.8 pmol/L (normal <5 pmol/L), high c peptide 13 ng/mL (normal <0.6) and low beta-hydroxybutyrate 1.2 mg/dL (normal >2.7mg/dL), consistent with hyperinsulinemic hypoglycemia. Other results included negative insulin antibody, normal TSH, and appropriately elevated cortisol levels. Given desire to rapidly wean D10 drip to avoid volume overload, octreotide therapy was initiated. He received octreotide 50mcg subcutaneously three times over a span of 24 hours, and the D10 drip was discontinued. His sulfonylurea screen subsequently resulted positive for glipizide. Considering the timing of cocaine use preceding the onset of hypoglycemia, it was postulated that the hyperinsulinemic hypoglycemic event was due to use of cocaine that was intermixed with sulfonylurea. Conclusion In cases of hypoglycemia with a known history of illicit substance abuse, clinicians should consider the presence of contributing cutting agents, such as sulfonylureas. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

MO095THE FECAL ABUNDANCE OF SHORT CHAIN FATTY ACIDS IS INCREASED IN MEN WITH A NON-DIPPING BLOOD PRESSURE PROFILE

Abstract Background and Aims Gut microbiota (GM) has been involved in the pathophysiology of hypertension (HT), possibly via its role in the production of short chain fatty acids (SCFAs) from diet carbohydrate fermentation. The absence of a significant drop in night-time BP (also known as the non-dipping BP profile) measured by 24-hour ambulatory BP monitoring (24h-ABPM) has been associated with poor renal and cardiovascular outcomes, independently of HT. The putative link between GM-derived metabolites and BP dipping status is still unknown. Method We investigated a cohort of male volunteers who were prospectively recruited and subjected to 24h-ABPM, stool sample collection and a medical questionnaire. A patient was categorized as non-dipper if the ratio between night and day systolic BP was >0.9. The patients were categorized in two groups, i.e. NT or HT, on the basis of the European Society of Hypertension criteria. Metabolomics analyses were conducted using Nuclear Magnetic Resonance. Fecal concentrations of acetate, butyrate and propionate were obtained by integrating the signals at 1.93 ppm, 1.56 ppm and 1.05 ppm, respectively. Mann-Whitney test and Chi-square test were used to compare continuous and categorical variables, respectively. Results Our 44-case cohort included 13 non-dippers (29.6%) and 31 dippers, with 35 HT (79.4%) and 9 NT patients. Ten non-dippers (28.6%) and 25 dippers were HT. Nineteen HT patients were under anti-hypertensive medications (43.1%), including 7 non-dippers and 12 dippers. The mean age and body mass index (BMI) of the cohort were 50.8±9.5 years and 26.3±3.5 kg/m², respectively. No significant difference in age, BMI, smoking habits, alcohol consumption, familial HT, personal history of diabetes, cardiovascular or gastro-intestinal disorders was observed between dippers and non-dippers. The relative quantification of fecal SCFAs showed higher amounts of acetate, butyrate and propionate in the stools of non-dippers versus dippers (p=0.0252, p=0.0468, and p=0.0496, respectively; n=44 in toto) (Figure 1A). Similarly, the fecal amounts of acetate, butyrate and propionate were higher in non-dippers versus dippers in patients without anti-hypertensive medications (p=0.0414, p=0.0108, and p=0.0602, respectively; n=25 in toto) (Figure 1B). When focusing only on HT patients without any anti-hypertensive medications, a not significant trend for higher amounts of the 3 main SCFAs was still found in the stools of non-dippers versus dippers (p=0.0556; n=16 in toto). Conclusion Our pilot study highlights a putative link between GM-derived SCFAs and the BP dipping status, despite the BP status itself or the anti-hypertensive medications. No significant confounding factors were found between dippers and non-dippers in our cohort. The non-dipping BP profile is thought to reflect the disruption of the circadian BP rhythm. A circadian misalignment between peripheral and central clocks has also been described in the GM of jetlagged animals and patients, which may in turn perturb the rhythmic secretion of metabolites. One may thus speculate that the non-dipping BP profile may be linked to an altered homeostasis of GM-derived SCFAs. Although confirmatory data in larger cohorts are required, our original observations unravel innovative pathophysiological pathways in the field of the circadian regulation of BP levels.

Higher susceptibility to sunburn is associated with decreased plasma glutamine and increased plasma glutamate levels among US women: An analysis of the Nurses' Health Study I and II

Higher susceptibility to sunburn is associated with decreased plasma glutamine and increased plasma glutamate levels among US women: An analysis of the Nurses' Health Study I and II

Obstructive Jaundice due to Pancreatic Sarcoidosis

Purpose: Gastrointestinal involvement occurs in 0.1-0.9% of patients with sarcoidosis, being the liver and stomach the most affected organs. Pancreatic sarcoidosis is rare and usually asymptomatic. We herein report a case of a patient with a suspected pancreatic head neoplasia in whom, after performing a pancreaticoduodenectomy, presented a pancreatic sarcoidosis. Method: 61-year-old female with personal history of diabetes and sarcoidosis with lung, skin, and articular involvement. Patient started with obstructive jaundice with no other symptoms. A malignant stenosis of the common bile duct was observed by echoendoscopy and a covered metal stent was inserted using an endoscopic retrograde cholangiographic technique. Histological study after fine needle aspiration were suspected of neoplasia. A CT scan showed no evidence of invasion of surrounding organs, vessels, or lymph nodes. Surgical treatment was proposed due to a suspected pancreatic head neoplasia. Result: A tumor located in the pancreatic head was observed during surgical intervention. No signs of extrapancreatic extension were appreciated. A pancreaticoduodenectomy with inter-aorto-caval and hepatic hilum lymph-node dissection was performed. Subsequent reconstruction con pancreatojejunostomy, hepaticojejunostomy and gastrojejunostomy was made. After surgery, patient presented gastroparesis that required insertion of a nasogastric tube. Histology exam revealed the presence of a non-necrotizing granulomatous inflammatory reaction in the specimen with no tumor. With this findings diagnosis of pancreatic sarcoidosis was made. Conclusion: Pancreatic sarcoidosis may present as a tumor-like mass with obstructive jaundice, weight loss, and abdominal pain as main symptoms. Differential diagnosis of an inflammatory mass from a tumor mass is difficult in theses cases.

Factors Associated with High Blood Pressure in People Living with HIV at the National Teaching Hospital Hubert Koutoukou Maga and Cotonou Teaching Hospital of the Armed Forces

In Benin Republic, few data are available on the prevalence and determinants of arterial hypertension (AH) in people living with the human immunodeficiency virus (PLWHA). The present study was conducted in two outpatient treatment centers for PLWHA in Cotonou and was conducted from June 19 to July 04, 2019 with 314 PLWHA. We performed descriptive statistics and logistic regression for the estimates. The prevalence of high blood pressure (HBP) among PLWHA was 41.4% [CI (95%): (35.9 - 47)]. In univariate analysis: age, smoking, alcoholism, physical inactivity, family history of hypertension, personal history of diabetes, obesity, and total and LDL (low density lipoprotein) hypercholesterolemia were significantly associated with HBP. No association was found with duration of HIV (human immunodeficiency virus) infection, time to ARV (antiretrovirals) exposure, and treatment regimen. In multivariate analysis, age, sex, smoking, family history of hypertension, and total hypercholesterolemia remained associated with HBP. In conclusion, the prevalence of HBP in PLWHA was very high compared with the results in the general population, and the same risk factors described in the general population were found but with a more marked hypertense potential.

Comment on "Personal History of Diabetes as Important as Family History of Colorectal Cancer for Risk of Colorectal Cancer: A Nationwide Cohort Study".

Comment on "Personal History of Diabetes as Important as Family History of Colorectal Cancer for Risk of Colorectal Cancer: A Nationwide Cohort Study".

Knowledge about diabetes mellitus among Polish medical students

Introduction. Due to high prevalence of diabetes mellitus all over the world it is essential for students who will become doctors of different specialties to possess a basic knowledge of it in this field. This pilot surveybased study was designed to assess diabetes related knowledge among faculty of medicine students from all of the medical universities in Poland. Materials and methods. Students were invited to fulfill the questionnaire during Students’ Diabetology Conference and via the Internet (social media). The survey consisted of questions about respondent’s age and personal history of diabetes and diabetes related knowledge (etiology, symptoms, risk factors, complications and treatment of diabetes mellitus and additionally a section concerning gestational diabetes). Results. A total number of 1200 medical students from Poland (70% women; mean age [SD] 22.12 [1.83] years of age) completed the survey. Mean test result was 66.62%. The best score was observed in the group of students enrolled in the 5th and 6th year of study, and those with diabetes mellitus type 1. Conclusions. The study outcome proves that knowledge about diabetes mellitus among surveyed medical students in Poland is insufficient, therefore persistent improvement in transmitting it during the course of medical education is essential.

Personal History of Diabetes as Important as Family History of Colorectal Cancer for Risk of Colorectal Cancer: A Nationwide Cohort Study.

Diabetes mellitus (DM) and colorectal cancer (CRC) share some risk factors, including lifestyle and metabolic disturbances. We aimed to provide in-depth information on the association of CRC risk, especially early-onset CRC, with DM, family history of CRC, and age at DM diagnosis. A nationwide cohort study was conducted using Swedish family cancer data sets, inpatient, and outpatient registers (follow-up: 1964-2015), including all individuals born after 1931 and their parents (12,614,256 individuals; 559,375 diabetic patients; 162,226 CRC patients). DM diagnosis before the age of 50 years was associated with a 1.9-fold increased risk of CRC before the age of 50 years (95% CI for standardized incidence ratio: 1.6-2.3) vs 1.3-fold risk of CRC at/after the age of 50 years (1.2-1.4). DM diagnosis before the age of 50 years in those with a family history of CRC was associated with 6.9-fold risk of CRC before the age of 50 years (4.1-12) and 1.9-fold risk of CRC at/after the age of 50 years (1.4-2.5). Diabetic patients had a similar lifetime risk of CRC before the age of 50 years (0.4%, 95% CI: 0.3%-0.4%) to those with only a family history of CRC (0.5%, 0.5%-0.5%), double that of the population (0.2%, 0.2%-0.2%). Our large cohort with valid information on DM and family history of cancer showed that DM is associated with increased risk of CRC in a magnitude close to having family history of CRC. Associations of DM and CRC family history with increased CRC risk were most prominent in young adults. These findings warrant further studies on harms, benefits, and cost-effectiveness of CRC screening in patients with diabetes, especially type 2, at earlier ages than in the general population.

Exposure to Bisphenol A and Bisphenol S and Incident Type 2 Diabetes: A Case-Cohort Study in the French Cohort D.E.S.I.R.

Background:The question of whether exposure to bisphenol A (BPA) contributes to the development of type 2 diabetes is still unresolved. Most epidemiological evidence on the association between BPA and diabetes is from cross-sectional studies or longitudinal studies with single urinary measurements. No prospective study has examined exposure to BPA analogs such as bisphenol S (BPS) in relation to incident type 2 diabetes.Objectives:We aimed to investigate whether exposure to BPA and BPS, assessed at up to two time points, was associated with the incidence of type 2 diabetes.Methods:We performed a case–cohort study on 755 participants without diabetes at baseline and followed-up over 9 y as part of the French prospective cohort Data from an Epidemiological Study on the Insulin Resistance Syndrome (D.E.S.I.R.). BPA-glucuronide (BPA-G) and BPS-glucuronide (BPS-G) were assessed in fasting spot urine samples collected during the health examinations at baseline and 3 y later. Associations with incident diabetes were examined using Prentice-weighted Cox regression models adjusted for potential confounders.Results:A total of 201 incident cases of type 2 diabetes were diagnosed over the follow-up, including 30 in the subcohort. Compared with participants with the lowest average BPA exposure (below the first quartile), participants in the second, third, and fourth quartile groups of exposure had a near doubling of the risk of type 2 diabetes, with a hazard ratio 2.56 (95% CI: 1.16, 5.65), 2.35 (95% CI: 1.07, 5.15), and 1.56 (95% CI: 0.68, 3.55), respectively. The detection of BPS-G in urine at one or both time points was associated with incident diabetes, with an 2.81 (95% CI: 1.74, 4.53).Discussion:This study shows positive associations between exposure to BPA and BPS and the incidence of type 2 diabetes, independent of traditional diabetes risk factors. Our results should be confirmed by recent, population-based observational studies in different populations and settings. Overall, these findings raise concerns about using BPS as a BPA substitute. Further research on BPA analogs is warranted. https://doi.org/10.1289/EHP5159

Long term exocrine and endocrine function after pancreatectomy

Introduction: Long-term pancreatic function after pancreatectomy is not well described, but is important for both pre-operative risk assessment and counseling having both short- and long-term health consequences. The objective of this study was to identify risk factors for pancreatic exocrine and endocrine insufficiency after pancreatectomy. Method: We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) from 2000 - 2017. Exocrine and endocrine insufficiency were defined as the need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative exocrine and endocrine insufficiency. Results: 1,716 patient records were analyzed (75% PD, 25% DP). Average age was 63 years, 52% were male, and surgery was for malignancy in 74% of patients. Median follow-up was 18 months. Post-operative exocrine insufficiency was present in 36% of patients. Race, body mass index (BMI), family history of diabetes, elevated pre-operative bilirubin, steatorrhea, and PD were correlated with increased risk of exocrine insufficiency. Post-operative endocrine insufficiency was present in 20% of patients. Male gender, BMI, tobacco use, family history of diabetes, personal history of diabetes, and PD were correlated with increased risk of endocrine insufficiency. Median time to onset of exocrine and endocrine insufficiency were 69 and 130 days, respectively. Conclusions: In this large series of pancreatectomy patients, 36% and 20% developed post-operative exocrine and endocrine insufficiency, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness for onset within the first four months after surgery.

Abstract 2213: A simple risk prediction model for high-risk adenomatous polyps at the time of colonoscopy

Abstract Introduction: The prediction of high risk adenoma polyp (HRAP) may help to prioritize the urgency and guide the performance of colonoscopy procedures. Our objective was to develop and internally validate a simple, scalable clinical prediction model. Methods: The study population consisted of 2,364 individuals aged 50 to 74 with no prior history of cancer who had a screening colonoscopy at the Forzani and MacPhail Colon Cancer Screening Centre in Calgary, Canada. A total of 190 HRAPs were identified (8.0%). A multivariable logistic regression model was created using colorectal cancer risk factors identified from prior research. Predictor variables were collected from a baseline health questionnaire and included patient demographic (age, sex, and ethnicity), lifestyle (body mass index, alcohol (daily vs. no), smoking (never vs. ever), physical activity (high vs. moderate to low), and non-steroidal anti-inflammatory drug (NSAID) use (yes vs. no)), medical (family history of colorectal cancer, personal history of diabetes, or fecal occult blood test within the past two years), and female-specific characteristics (menopausal status and hormone replacement therapy (yes vs. no)). The demographic variables were first used to create a baseline model and the benefits of adding the groups of lifestyle, medical, and female-specific variables into the model in various combinations was assessed. Five-fold internal cross validation was conducted. Performance was assessed using the C-statistic and Hosmer-Lemeshow goodness-of-fit test. Results: The average age of the participants was 58 years of whom 54.9% were male and 85.24% were Caucasian. The clinical prediction model included demographic and lifestyle variables. On average, the predicted probability of having a HRAP was 8.0% (IQR: 4.1% to 10.6%). The bias-adjusted C-statistic was 0.66 (95% CI: 0.62 to 0.70) and there was no evidence of a lack of calibration according to the Hosmer-Lemeshow goodness-of-fit test. The addition of the medical history variables (Δ AUC = +0.0001; p = 0.98) or female-specific variables (Δ AUC = + 0.006; p = 0.32) or both medical and female-specific groups of variables (Δ AUC = +0.004; p = 0.45) did not significantly improve predictive performance. Conclusions: A model based on demographic and lifestyle variables showed a modest predictive ability for having an HRAP at the time of colonoscopy in a population undergoing screening-related colonoscopies. Consideration of these factors may assist in guiding prioritization of limited screening resources. Next steps include external validation and testing the incremental predictive ability of circulating biomarkers. Citation Format: Devon J. Boyne, Lisa M. Lix, Susanna Town, Steven J. Heitman, Robert J. Hilsden, Darren R. Brenner. A simple risk prediction model for high-risk adenomatous polyps at the time of colonoscopy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2213.

Is Screening for Early Gestational Diabetes Mellitus Associated with a Better Prognosis? An Observational Study Including 8,713 Women

In addition to screening for gestational diabetes mellitus (GDM) after 24 gestational weeks (GW), the IADPSG proposed to screen in early pregnancy and to refer women with early GDM (eGDM) for immediate care. The usefulness of this strategy is still unknown. We included women with a singleton pregnancy, without personal history of diabetes or bariatric surgery, who delivered in our hospital between 2012 and 2016. We compared the incidence of preeclampsia or large for gestational age infant or shoulder dystocia in women with an early screening before 22 WG -leading to care for eGDM (FPG) 92-125 mg/dL) or diabetes in pregnancy (DIP: FPG≥126 mg/dL) if present- (screened group) or without (unscreened group). Compared with women in the unscreened group (n=4634, 53.3%), those in the screened group (n=4079) had different ethnicities (p<0.0001) and more risk factors for GDM: overweight (48.6 vs. 45.7, p<0.01), family history of diabetes (27.8 vs. 25.0%, p<0.01), personal history of GDM (6.4 vs. 4.3%, p<0.01) and macrosomic infant (3.6 vs. 2.7%, p<0.05). Early screening increased from year 2012 to 2016 (p<0.0001). In the early screened group, the prevalence of GDM and DIP was 22.8% (including 10.3% of eGDM) and 0.9%, respectively. In the unscreened group, the prevalence of GDM was 17.2% and DIP 1.2%. The rate of insulin therapy was 8.6% in the screened group and 5.6% in the unscreened group (p<0.001). The rate of the composite criterion was similar in the screened and unscreened groups (12.5 vs. 11.8%, p=0.3534), also when we only considered women with risk factors for GDM (14.0 vs. 14.9%, p=0.3137). The incidence of other outcomes was similar in both groups. To conclude, a strategy including early FPG measurement during pregnancy may not improve pregnancy prognosis but we still need to adjust the results for confounding factors (ongoing) because the women in the early-screened group had a similar prognosis as those only screened after 22 GW despite a higher risk of complications. Disclosure E. Cosson: Consultant; Self; Lilly France. Board Member; Self; Novartis France. Consultant; Self; Roche Diagnostics France. Board Member; Self; Ascensia Diabetes Care. Consultant; Self; Bezins France. Board Member; Self; MSD France. D. Sandre Banon: None. F. Gary: None. I. Pharisien: None. J. Portal: None. P. Valensi: None. L. Carbillon: None.

Public knowledge of chronic kidney disease evaluated using a validated questionnaire: a cross-sectional study

BackgroundScreening programs may help to address the burden of chronic kidney disease (CKD) in Australia. Public awareness is an important determinant of the uptake of screening programs. However, data on the public knowledge of CKD in Australia is lacking. The aim of this study was to develop a validated questionnaire and assess the Australian public knowledge of CKD.MethodsA CKD knowledge questionnaire was developed after reviewing the literature and discussions with nephrology experts. Content validity was performed by nephrologists (n = 3), renal nurses (n = 3) and research personnel (n = 4). The questionnaire was piloted in 121 public participants. Next, discriminant validation was performed by recruiting two additional groups of participants: final year undergraduate pharmacy students (n = 28) and nephrologists (n = 27). Reliability of the questionnaire was assessed by calculating Cronbach’s alpha. Next, a cross-sectional survey of the Australian public (n = 943) was conducted by using the validated questionnaire. It was administered using an online Omnibus survey. Quota sampling was used for participant selection and to ensure that the final sample would match the key characteristics of the Australian population. Finally, a standard multiple regression analysis was performed to identify predictors of the public knowledge.ResultsThe median CKD knowledge scores of the public, students and nephrologists were 12, 19 and 23 (maximum score of 24), respectively, with statistically significant differences in the scores across the three groups (p < 0.001; Kruskal-Wallis test). The Cronbach’s alpha was 0.88 (95% CI: 0.86–0.91), indicating that the questionnaire had good internal consistency. In the cross-sectional survey of the Australian public, the participants’ mean (SD) age was 47.6 (±16.6) years and 51.2% were female. The mean (SD) knowledge score was 10.3 (± 5.0). The multivariate analysis showed that participants with a higher level of education; with a family history of kidney failure; with a personal history of diabetes; and currently or previously living in a relationship had significantly higher knowledge scores.ConclusionThe Australian public knowledge of CKD was relatively poor. Improving public knowledge may assist in increasing early detection and subsequent management of CKD in Australia.