Type 1 Diabetes Adults Research Articles

Trajectories of Meat Intake and Risk of Type 2 Diabetes: Findings from the China Health and Nutrition Survey (1997-2018).

Few articles have investigated the impact of long-term meat intake trends and their changes during follow-up on the risk of type 2 diabetes (T2D). We aimed to explore the long-term trajectories of meat intake and determine its association with T2D risk in Chinese adults. This study used seven rounds of data from the China Health and Nutrition Survey (1997, 2000, 2004, 2006, 2009, 2015, and 2018), and 4464 adults aged 18 years or older were analyzed. The group-based trajectory modeling was used to identify meat intake trajectories over 21 years. Multivariate Cox proportional hazard and restricted cubic spline models were used to analyze the association and dose-response relationship between meat intake and T2D. Four trajectory groups were identified: "low-increase intake group" (Group 1), "moderate-increase intake group" (Group 2), "medium-stable intake group" (Group 3), and "high intake group" (Group 4). Compared with Group 2, Group 4 was associated with a higher risk of developing T2D (hazard ratio 2.37 [95% CI 1.41-3.98]). After adjusting for demographic characteristics, lifestyle, total energy intake, waist circumference, and systolic blood pressure, and using the third quintile as a reference, the risk of T2D was increased by 46% in the lowest quintile with meat intake (hazard ratio 1.46 [95% CI 1.07-2.01]) and by 41% in the highest quintile with meat intake (HR 1.41 [95% CI 1.03-1.94]). A U-shape was observed between meat intake and T2D risk (p for nonlinear < 0.001). When the intake was lower than 75 g/day, the risk of T2D was negatively correlated with meat intake, while the risk of T2D was positively correlated with meat intake when the intake was higher than 165 g/day. We identified four trajectory groups of meat intake from 1997 to 2018, which were associated with different risks of developing T2D. A U-shaped association was observed between meat intake and T2D in Chinese adults.

Evaluating the clinical effectiveness and safety of insulin glargine 300 U/mL in individuals with type 2 diabetes uncontrolled on basal insulin: A real-world evidence study from Saudi Arabia (EVOLUTION).

To evaluate the effectiveness and safety profile of switching to insulin glargine 300 U/mL (Gla-U300) in patients with uncontrolled type 2 diabetes (T2D) on basal insulin in Saudi Arabia. We conducted a multicentre retrospective study that retrieved the medical records of adult T2D patients switched to Gla-U300 because of poor glycaemic control on their basal insulin. Data covering 6 months ± 30 days before and after the switch were retrieved. Data from 718 patients were analysed. The mean HbA1c decreased significantly 6 months after switching to Gla-U300, with a mean reduction of 0.7% (95% confidence interval [CI] 0.6%-0.9%; P < .001). The percentage of patients with HbA1c levels of less than 7% increased from 6.4% before switching to 10.3% after switching to Gla-U300. The percentage of patients achieving the predefined individualized HbA1c goal increased from 8.6% before switching to 17.3% after switching to Gla-U300. The mean daily insulin dose decreased from a baseline level of 32.2 (± 14.7) to 31.0 (± 15) U (P = .09). About 36.1 of the patients required adjustment to the initial dose. Gla-300 was well tolerated; 4.5% of the patients experienced overall confirmed or symptomatic hypoglycaemia, compared with 15.3% before switching to Gla-U300. The incidence of severe hypoglycaemia after switching was 0.6% (n = 4 patients), compared with 1% before switching. Real-world evidence supports the effectiveness of switching to Gla-U300 from first-generation basal insulin in T2D in Saudi Arabia.

Ideal cardiovascular health metrics and risk of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective cohort studies

Background and aimsStudies suggest a potential link between ideal cardiovascular health (CVH) and the risk of type 2 diabetes (T2D). However, systematic reviews are lacking to pool these data and present a balanced review about this association. Methods and resultsWe performed a systematic search of PubMed/Medline, Web of Sciences, and Scopus from inception until November 2022 to search for prospective observational studies assessing the link between ideal CVH metrics, as introduced by the American Heart Association, and the risk of T2D in adults. Nine cohort studies with 78,912 participants and 6242 cases of T2D were included. The pooled relative risk of T2D for the highest versus the lowest category of ideal CVH metrics was 0.36 (95% confidence interval [CI]: 0.25, 0.47; risk difference: 5 fewer per 100 patients, 95% CI: 6 fewer, 4 fewer; Grading of Recommendations Assessment, Development and Evaluation certainty = high). Each unit increase in the components of the ideal CVH metrics was associated with a 20% lower risk of T2D. Dose-response meta-analysis indicated a monotonic inverse association between ideal CVH metrics and the risk of T2D. Results from analysis of individual components showed that having a normal weight, adopting a healthy diet, and having normal blood pressure levels were associated with a reduced risk of T2D. ConclusionsHaving an ideal CVH profile and a unit increase in any CVH metric are inversely associated with the risk of T2D. Systematic review registrationPROSPERO CRD42022376934.

917-P: Treatment Satisfaction with Omnipod DASH System vs. Usual Care in Adults with Type 1 Diabetes in Australia

Background: Conventional insulin pumps can be inconvenient and increase diabetes distress in people with type 1 diabetes (T1D). A tubeless insulin pump discreetly controlled by a handheld device, may be more acceptable. This is the first randomized controlled trial on patient-reported outcomes with tubeless insulin pumps. Aim: To compare treatment satisfaction with Omnipod DASH® Insulin Management System (Insulet, Acton MA) vs. usual care (MDI or conventional IPT) in T1D adults self-monitoring with fingerstick blood glucose. Methods: T1D adults were randomized to 12-weeks of Omnipod DASH System (intervention) or usual care (control). At study-end, treatment satisfaction was assessed by the difference in Diabetes Technology Questionnaire current score (DTQ-current). Secondary outcomes included patient-reported measures assessed through six other questionnaires and HbA1c. Results: Baseline characteristics were similar between both groups. Those on Omnipod DASH System expressed significantly higher treatment satisfaction, better sleep quality, reduced fear of hypoglycemia and diabetes distress than those on usual care. HbA1c reduction was clinically relevant in the intervention group. Conclusion: This study demonstrated that Omnipod DASH System is associated with better treatment satisfaction and patient-reported outcomes whilst maintaining glycemia in T1D adults. Disclosure Y.W.Kong: None. E.I.Ekinci: Advisory Panel; Eli Lilly Australia Pty Limited, Research Support; Eli Lilly Australia Pty Limited, Novo Nordisk, Boehringer Ingelheim and Eli Lilly Alliance, Insulet Corporation, Medtronic. D.N.O'neal: None. C.Yuan: None. K.V.Kiburg: None. K.Brown: None. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). A.Partovi: None. K.L.Roem: None. N.Harrison: None. S.Fourlanos: Advisory Panel; Viatris Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance. Funding Insulet Corporation

653-P: Associations between Anxiety and Depression Levels and Hypoglycemia Awareness and Beliefs in Long-Term Advanced Diabetes Technology Users with Type 1 Diabetes (T1D)

The information characterizing anxiety and depression levels and associated factors in long-term T1D advanced diabetes technology users is sparse. A cross-sectional observational study in T1D adults using continuous glucose monitors (CGMs) ≥1 year was conducted in a tertiary academic medical center. The Hospital Anxiety and Depression Scale was used to evaluate anxiety levels (HADS-A) and depression levels (HADS-D). CGM % of time with glucose &amp;lt;70 mg/dL, hypoglycemia awareness (measured with Gold questionnaire), hypoglycemia beliefs (with Attitude to Awareness of Hypoglycemia questionnaire) and demographic information were collected. Multivariable linear regression was used to identify factors associated with higher HADS-A and HADS-D. Among 196 participants (63% female; mean±SD age 47±16; 91% non-Hispanic Caucasian; 80% using insulin pumps with 55% closed-loop pump users), mean±SD HADS-A was 6.5±4.0 (40% scores≥8), HADS-D was 4.1±3.1 (15% score≥8), and % of CGM time &amp;lt;70 mg/dL was 2.0±3.0%; 34% had impaired hypoglycemia awareness. Higher HADS-A was independently associated with less time with glucose &amp;lt;70 mg/dL, female sex, younger age, lower hypoglycemia awareness, weaker hypoglycemia concern minimization, and stronger hyperglycemia avoidance prioritization (P&amp;lt;0.05). Higher HADS-D was independently associated with less time with glucose &amp;lt;70 mg/dL, lower hypoglycemia awareness, and stronger hyperglycemia avoidance prioritization (P&amp;lt;0.05). In summary, clinically significant anxiety and depression presented in 40% and 15% of T1D patients using advanced diabetes technologies, respectively. Hypoglycemia awareness and hypoglycemia beliefs, rather than time spent in hypoglycemia, were associated with greater anxiety and depression levels. Attention to hypoglycemia awareness, hypoglycemia beliefs and mental health are needed to improve overall outcomes in T1D advanced technology users. Disclosure Y. Lin: None. J.E. Aikens: None. W. Ye: None. G. Piatt: None. S. Fisher: None. R. Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp. Research Support; Novo Nordisk. Consultant; Novo Nordisk, Roche Diagnostics. Research Support; Medtronic, National Institutes of Health. Consultant; Procter &amp; Gamble. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724); Michigan Center for Clinical and Translational Research (P30DK092926)

717-P: Unmet Needs and Communication Preferences for mHealth Self-Management Solutions in People with Type 1 Diabetes and Insulin Resistance

Insulin resistance (IR) is prevalent within type 1 diabetes (T1D) and associated with increased morbidity and mortality. Mobile health (mHealth) applications are useful platforms for delivering health behaviour interventions, but technologies focusing on addressing IR in T1D are absent. The aim of this formative study was to identity salient unmet patient needs, communication preferences, and barriers for mHealth self-management solutions in people with T1D and IR. 70 adults with type 1 diabetes (male=57%; HbA1c 8.1±3.4%; 28±5years) completed an online survey evaluating skills gaps in self-management and priorities for diabetes mHealth apps. Survey responses were ranked using a 9-point scale and analysed using descriptive and inferential statistics. Qualitative write-in responses were subsequently coded and analysed using inductive thematic analysis. IR was assessed using estimated glucose disposal rate (eGDR). Among all respondents, 49% (n=34) identified glycemic control/variability as the principle unmet self-management need. Fewer than 5% (n=3) reported having no self-perceived skills gaps. 89% (n=62) identified paternalistic communication and weight stigmatization as barriers to mHealth use. Real-life/situational feedback for glucose control/variability was reported as the single largest facilitator of mHealth use (65%, n=46). Preferred communication strategies were empathy, concern, and compassion (81%, n=57), and informal, open, and direct (77%, n=54). Our results highlight that glucose control/variability is the principle unmet self-management need in T1D adults with IR. Several communication barriers negatively impact mHealth acceptability and efficacy in this group, particularly paternalistic and weight-stigmatizing language. mHealth solutions that target glycemic control/variability and are non-weight stigmatizing are urgently needed for people with T1D and IR. Disclosure A.R.Wilson: None. M.Farrar: None. M.D.Campbell: None.

677-P: Exploring the Impact of CGM on Perceived Control of Non-Intensive Insulin Treated Type 2 Diabetes—“I liked keeping my line with as few spikes as possible”

Background and Aims: Progression of type 2 diabetes (T2D) demands complex treatment modalities, which may impair patients’ confidence and psychological health. Technologies allowing improved understanding of the dynamic disease process may improve engagement with therapy. Methods: As part of a larger observational study, we previously reported findings highlighting the impact of using Dexcom G6 real-time CGM (rtCGM) with T2D adults (diverse therapies) and prediabetes over a 12-week period. We now explored qualitative data generated from a subsample of T2D participants (N=38) on non-intensive insulin therapy (Basal only=24%, No insulin=76%). Participants answered open-ended questions about their experiences using CGM including self-reported learnings and changes in behavior. Primary themes from qualitative data were derived using content analysis and confirmed with inter-coder reliability. Results: Overall, most participants (&amp;gt;90%) ended the study with high levels of perceived control (PC) of their diabetes. For further analysis, participants’ change in PC at study end were plotted based on low, medium, or high PC before CGM use. Interesting group differences emerged wherein fewer participants reporting medium PC at baseline reported high PC at study end (vs. others with low and high baseline PC). Qualitative themes around perceived illness severity, depressive symptoms, and self-efficacy along with differences in demographics and glycemic metrics helped translate these meaningful findings. Conclusions: rtCGM use provided valuable improvements in participants’ engagement and understanding of their diabetes with potential for long-term clinical benefits. Future studies exploring relationships between perceived control of diabetes and progression of T2D may indicate potential areas for improved engagement with diabetes technology. Disclosure M.A.Crawford: Employee; Dexcom, Inc. C.Hicks: Employee; Dexcom, Inc. P.Genge: Employee; Dexcom, Inc. K.Greenawald: Employee; Dexcom, Inc. M.Tressler: Employee; Dexcom, Inc. D.R.Cherñavvsky: None. H.Singh: Employee; Tandem Diabetes Care, Inc., Dexcom, Inc. Funding Dexcom, Inc.

263-OR: Older Adults Benefit from Virtual Support for CGM Use but Require Longer Visits

The Virtual Diabetes Specialty Clinic (VDiSC) provided type 1 (T1D) and type 2 diabetes (T2D) adults taking insulin virtual care with remote CGM training and support. HbA1c improved from baseline to 6 months in T1D (7.8% to 7.0%) and T2D (8.2% to 7.0%) with increased time in range (70-180 mg/dL; TIR). Here we compare glycemic outcomes (Table 1) and duration of remote CGM training visits (Table 2) in adults ages &amp;lt;40 yr, 40-59 yr and ≥ 60 yr. HbA1c and %TIR improved in each group. Limitations include a small sample size that was mostly White. Results suggest that both T1D and T2D adults ≥60 years of age experience glycemic benefit after remote training and support in the use of CGM from CDCESs, but when compared to young adults, older adults require more time for training. Support for approaches that address the individual needs of older adults with diabetes is required. Disclosure R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. T.S.Mcarthur: None. B.A.Olson: Stock/Shareholder; Abbott. S.Oser: Advisory Panel; Cecelia Health, Dexcom, Inc., Consultant; Medscape, Research Support; Abbott Diabetes. T.Oser: Advisory Panel; Cecelia Health, Consultant; Dexcom, Inc., Medscape, Research Support; Abbott. D.Raghinaru: None. R.Beck: Consultant; Eli Lilly and Company, Novo Nordisk, Diasome, Insulet Corporation, Research Support; Tandem Diabetes Care, Inc., Beta Bionics, Inc., Dexcom, Inc., Bigfoot Biomedical, Inc., Medtronic, Ascensia Diabetes Care, Roche Diabetes Care, Eli Lilly and Company, Novo Nordisk. G.Aleppo: Advisory Panel; Medscape, Consultant; Bayer Inc., Insulet Corporation, Research Support; Dexcom, Inc., Eli Lilly and Company, Emmes, Insulet Corporation, Fractyl Health, Inc., WellDoc, Speaker's Bureau; Dexcom, Inc. Z.Thompson: None. R.M.Bergenstal: Advisory Panel; Abbott Diabetes, Eli Lilly and Company, Medtronic, Novo Nordisk, Roche Diabetes Care, Zealand Pharma A/S, Consultant; Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Hygieia, Onduo LLC, Sanofi, Vertex Pharmaceuticals Incorporated, Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi, UnitedHealth Group. T.L.Cushman: None. R.L.Gal: None. C.Kollman: Research Support; Insulet Corporation, Dexcom, Inc., Tandem Diabetes Care, Inc. D.F.Kruger: Advisory Panel; Abbott Diabetes, Lilly, Medtronic, Novo Nordisk, Research Support; Dexcom, Inc., Beta Bionics, Inc., Speaker's Bureau; Dexcom, Inc., Lilly, Xeris Pharmaceuticals, Inc., Novo Nordisk. K.K.Hood: Consultant; Cecelia Health. M.L.Johnson: Research Support; Abbott, Lilly, Insulet Corporation, NIH - National Institutes of Health, Patient-Centered Outcomes Research Institute, Novo Nordisk, Tandem Diabetes Care, Inc., Medtronic, Hemsley Charitable Trust, Jaeb Center for Health Research. Funding The Leona M. and Harry B. Helmsley Charitable Trust; Dexcom, Inc.

922-P: Improved Satisfaction while Maintaining Safety and High Time in Range (TIR) with a Medtronic Investigational Enhanced Advanced Hybrid Closed-Loop System (eAHCL)

Background: Hybrid closed loop (HCL) systems are evolving. We aimed to assess treatment satisfaction and glucose control with an investigational eAHCL system. Methods: Adults with type 1 diabetes (T1D) received sequentially the MiniMed™ 780G /Guardian™ Sensor 3 AHCL system, and a Medtronic investigational eAHCL system each for 12 weeks. The eAHCL system incorporates updated software, a new simple to use, no calibration, all-in-one sensor, and 7 day extended wear infusion set. The primary outcome was difference in treatment satisfaction measured using “current” and “change” versions of the Diabetes Technology Questionnaire (DTQ) following each 12 week period. Secondary outcomes included time spent changing infusion sets and sensors recorded on a phone app and CGM metrics. Results: Twenty-one adults (11 men, mean [SD] age 48 [12.4] years) completed the trial. DTQ “current” score improved on eAHCL, and 86% of participants reported less “Effort to keep low blood sugar from happening” on DTQ “change”. There was less fear of hypoglycemia; more time in Auto Mode; fewer alarms; less time spent changing infusion sets and sensors; reduced CGM hypoglycemia and glycemic variability (Table 1). Conclusions: Transition to eAHCL in T1D adults resulted in a better user experience and reduced fear of and time in hypoglycemia while maintaining safety and &amp;gt;80% TIR. Disclosure C.Yuan: None. R.Macisaac: None. E.Netzer: None. B.Paldus: None. L.Robinson: None. A.Roy: Employee; Medtronic. C.M.Sims: Stock/Shareholder; Medtronic. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). S.Vogrin: None. D.N.O'neal: None. Y.W.Kong: None. T.Amoore: None. K.Brown: None. B.Grosman: Employee; Medtronic. A.Jenkins: Advisory Panel; Insulet Corporation, Board Member; Insulin for Life, Research Support; Abbott Diabetes, Medtronic, Hemsley Charitable Trust, Juvenile Diabetes Research Foundation (JDRF), National Institutes of Health. H.Jones: None. N.Kurtz: Employee; Medtronic. M.H.Lee: Speaker's Bureau; Medtronic.

109-LB: Quality of Life Benefits for Insulin-Using Adults with Type 2 Diabetes after Six Months of Pump Therapy—A Quasi-experimental Approach

While an increasing number of adults with type 2 diabetes (T2D) on multiple daily insulin injections (MDI) are initiating insulin pump therapy, little is known about how, or if, pump therapy may contribute to quality of life (QoL) gains. Adults with T2D on MDI who contacted Insulet about starting a tubeless insulin pump (Omnipod DASH® Insulin Management System) completed two self-report surveys: one before pump start (baseline) and one 6 months later. The surveys assessed self-reported HbA1c, and a series of QoL measures, including overall well-being (WHO-5), diabetes distress (T2-DDAS Core), diabetes impact (DIDP), and perceived restrictions due to T2D. We compared 6-month outcomes in participants who started and remained on Omnipod DASH vs. those who never started on pump therapy and remained on MDI. Of N=435 who completed the baseline survey, 220 (51%) completed the 6-month survey. Of these, the majority (80%) were current pump users, and 20% remained on MDI. There were no significant differences between pump users and continuing MDI (c-MDI) users in any baseline demographics, HbA1C or QoL measures. At 6 months, pump users evidenced a significantly greater rise than c-MDI users in overall well-being (+8.3 vs. -3.1) and greater drops in diabetes distress (-0.97 vs. -0.30), diabetes impact (-0.29 vs. +0.20), and perceived restrictions, including feeling less limited regarding food and exercise and feeling freer to live life as they might want (in all cases, p &amp;lt; 0.005). Also, both pump and c-MDI groups reported a significant HbA1C improvement from baseline, though the difference between groups was not significant (-1.1% vs -0.9%; p=0.10). In this sample of T2D adults, the introduction of pump therapy was associated with broad improvement in QoL after 6 months, compared to those who were interested in, but never started pump therapy. These results provide initial evidence of significant psychosocial benefits of pump therapy for adults with T2D. Disclosure W. H. Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., MannKind Corporation, Provention Bio, Inc., Sanofi-Aventis U. S., Vertex Pharmaceuticals Incorporated. E. C. Soriano: None. Funding Insulet Corporation

628-P: Symptoms of Autonomic Nervous System Dysregulation and Diabetes Distress in T2D Adults

Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 2 diabetes (T2D). US adults (n=299) with self-identified type 2 diabetes completed a web-based survey in October 2022, including demographics, ANS reactivity symptoms (Body Perception Questionnaire; BPQ), diabetes-related distress (Diabetes Distress Scale-17; DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). Mean age was 60.2 years (S.D. = 13.6), 58.7% female, 82.9% White, with a median annual household income of $40,000-$60,000. Mean self-reported A1c was 7.0% (S.D. 1.2%). Self-reported medications: oral hypoglycemic agents (51.8%), oral medications and injectable insulin or other medications (26.7%), and diet and exercise alone (8.4%). Mean glucose checks was 1.5 times/day (S.D. = 4.9). The sample reported high levels of comorbid hypertension (65.4%), dyslipidemia (55.8%), sleep apnea (33.9%) and depression (36.2%). Mean DDS-17 score was 2.3 (S.D. 1.0; moderate severity). The highest scores were observed in the emotional burden (mean = 2.6; S.D. 1.3) and regimen-related distress (mean = 2.7; S.D. 1.2) subscales. Mean PHQ-8 score was 6.7 (S.D. = 6.0; mild) and the mean GAD-7 score was 4.74 (S.D. 5.6, mild). BPQ mean T scores were 49.9 (S.D. 9.4) for Supradiaphragmatic and 52.0 (S.D. 8.8) for Subdiaphragmatic Reactivity subscales. Positive correlations between the DDS-17 and BPQ subscales (range: r=0.53-0.58, all p’s&amp;lt;.05) were observed. Controlling for covariates, significant differences in BPQ subscale T scores were observed across clinical severity levels of the DDS on all subscales, with the highest BPQ scores observed in the ‘high’ distress DDS category compared to ‘no/mild distress’ (p’s &amp;lt; 0.05). Findings confirm a relationship between ANS reactivity symptoms and diabetes-related distress, consistent with the Polyvagal Theory. Development of interventions that target ANS regulation to treat DD for T2D adults are needed. Disclosure M.De groot: Consultant; Barbara Kenner Family Foundation, Medscape, Mediflix, Inc. B.A.Myers: None. T.Stump: None. D.Dana: None. J.Kolacz: None. S.W.Porges: None.

Adherence to diet with higher dietary diabetes risk reduction score is associated with reduced risk of type 2 diabetes incident in Iranian adults

BackgroundThe Dietary diabetes risk reduction score (DDRRS) has recently been considered by researchers as a diet quality index to predict the risk of chronic diseases, such as type 2 diabetes (T2D). In this study, we aimed to assess the association of DDRRS with T2D risk in Iranian adults.MethodsSubjects aged ≥ 40 years without T2D (n = 2081) were selected for the current study from participants of the Tehran Lipid and Glucose Study (2009–2011) and followed for a mean of 6.01 years. We used the food frequency questionnaire to determine the DDRRS that is characterized by eight components, including higher consumption of nuts, cereal fiber, coffee, and polyunsaturated to saturated fat ratio and lower consumption of red or processed meats, trans fats, sugar-sweetened beverages, and high glycemic index foods. The multivariable logistic regression analysis was used to determine the odds ratio (ORs) and 95% confidence interval (CI) of T2D across the DDRRS tertiles.ResultsThe mean ± SD age of individuals was 50.4 ± 8.2 years at baseline. The Median (25–75 interquartile range) DDRRS of the study population was 24(22–27). During the study follow-up, 233(11.2%) new cases of T2D were ascertained. In the age and sex-adjusted model, the odds of T2D were decreased across tertiles of DDRRS (OR = 0.68; 95%CI: 0.48–0.97, P for trend = 0.037). Based on the multivariable-adjusted model, after controlling all potential confounders, the risk of T2D is reduced across tertiles of DDRRS (OR = 0.66; 95%CI: 0.44–0.98, P for trend = 0.047). Also, higher scores (lower consumption) of red and processed meat (OR = 0.59; 95%CI: 0.39–0.88, P = 0.012) and sugar-sweetened beverages (OR = 0.49; 95%CI: 0.32–0.76, P = 0.002) as DDRRS components were associated with decreased T2D incident.ConclusionsOur findings suggested that a diet with a higher score of DDRRS may be related to reducing the risk of T2D in Iranian adults.

Dietary Diversity and Inflammatory Diet Associated with All-Cause Mortality and Incidence and Mortality of Type 2 Diabetes: Two Prospective Cohort Studies.

A higher dietary diversity score (DDS) and a lower energy-adjusted dietary inflammatory index (E-DII) may be associated with lower risks of type 2 diabetes (T2D) and mortality. This cohort study aimed to investigate the associations of DDS and E-DII with all-cause mortality, incidence of T2D, and mortality of T2D, as well as the joint effects of these two dietary factors. A total of 181,360 participants without all types of diabetes at baseline from the UK Biobank and 42,139 participants from the US NHANES were included. Cox proportional hazards models were used to assess the associations of DDS and E-DII with outcomes. In the UK Biobank data, 8338 deaths, 3416 incident T2D cases, and 353 T2D deaths occurred during a median follow-up of 12.5 years. In the US NHANES data, 6803 all-cause deaths and 248 T2D-specific deaths were recorded during a median follow-up of 9.6 years. We observed that higher DDS and lower E-DII were significantly associated with lower risks of total mortality and incident T2D. Compared with low DDS, the hazard ratios (HRs) and 95% confidence intervals (CIs) of high DDS were 0.69 (0.64, 0.74) for all-cause mortality, 0.79 (0.70, 0.88) for incident T2D in the UK Biobank, and 0.69 (0.61, 0.78) for all-cause mortality in the US NHANES. Compared with participants in tertile 3 of E-DII, those in tertile 1 had a lower risk of overall death [HR 0.86 (95% CI: 0.81, 0.91) in UK Biobank; 0.83 (0.77, 0.88) in US NHANES] and incident T2D [0.86 (0.79, 0.94)] in UK Biobank. No evidence was observed of the interactive effects of DDS and E-DII on either all-cause mortality or the incidence and mortality of T2D. There was no significant association found between any exposure and T2D mortality in this study. In conclusion, our results revealed that higher DDS and lower E-DII were associated with both total mortality and incident T2D in UK and US adults.

Associations of non-invasive indices of liver steatosis and fibrosis with progressive kidney impairment in adults with type 2 diabetes

Longitudinal data linking non-alcoholic fatty liver disease to kidney dysfunction in type 2 diabetes (T2D) are limited. This study evaluated the associations of non-invasive indices of liver steatosis and liver fibrosis with kidney impairment, and the mediatory role of the pro-angiogenic factor leucine-rich α-2 glycoprotein 1 (LRG1). T2D adults (n = 2057) were followed for a mean period of 6.1 ± 1.6years. Baseline liver steatosis [(hepatic steatosis index (HSI) and Zhejiang University index (ZJU)] and liver fibrosis [aspartate transaminase/alanine transaminase ratio (AAR) and BARD] indices derived from composite scoring systems were calculated. Plasma LRG1 levels were quantified using immunoassay. The study outcomes were progressive kidney function decline defined as estimated glomerular filtration rate (eGFR) decline of ≥ 40% and albuminuria progression defined as an increase in albuminuria category. Cross-sectionally, liver steatosis and liver fibrosis indices were associated with increased albuminuria (urinary albumin/creatinine ratio ≥ 30µg/mg) and reduced renal function (eGFR < 60mL/min/1.73m2) after covariate adjustment, respectively. Approximately 32% of the participants experienced progressive kidney function decline, while 38% had albuminuria worsening over time. Longitudinal analysis revealed that baseline AAR (hazard ratio: 1.56; 95% CI 1.15-2.11) and BARD (hazard ratio: 1.16, 95% CI 1.04-1.28) predicted progressive kidney function decline, partly mediated by LRG1. In contrast, liver steatosis (HSI and ZJU) but not liver fibrosis (AAR and BARD) indices were independently associated with albuminuria progression. Increased liver steatosis scores were associated with albuminuria deterioration. Conversely, liver fibrosis indices may be associated with progressive kidney function decline, potentially driven by increased inflammation and angiogenesis.

Residual β-cell function in Brazilian Type 1 diabetes after 3 years of diagnosis: prevalence and association with low presence of nephropathy

BackgroundPersistence of β cell-function in Type 1 diabetes (T1D) is associated with glycaemia stability and lower prevalence of microvascular complications. We aimed to assess the prevalence of residual C- peptide secretion in long-term Brazilian childhood onset T1D receiving usual diabetes care and its association to clinical, metabolic variables and microvascular complications.MethodsA cross-sectional observational study with 138 T1D adults with ≥ 3 years from the diagnosis by routine diabetes care. Clinical, metabolic variables and microvascular complications were compared between positive ultra-sensitive fasting serum C-peptide (FCP +) and negative (FCP-) participants.ResultsT1D studied had ≥ 3 yrs. of diagnosis and 60% had FCP > 1.15 pmol/L. FCP + T1D were older at diagnosis (10 vs 8 y.o; p = 0.03) and had less duration of diabetes (11 vs 15 y.o; p = 0.002). There was no association between the FCP + and other clinical and metabolic variable but there was inversely association with microalbuminuria (28.6% vs 13.4%, p = 0.03), regardless of HbA1c. FCP > 47 pmol/L were associated with nephropathy protection but were not related to others microvascular complications.ConclusionResidual insulin secretion is present in 60% of T1D with ≥ 3 years of diagnosis in routine diabetes care. FCP + was positively associated with age of diagnosis and negatively with duration of disease and microalbuminuria, regardless of HbA1c.

Per- and Polyfluoroalkyl Substances and Outcomes Related to Metabolic Syndrome: A Review of the Literature and Current Recommendations for Clinicians

Per- and polyfluoroalkyl substances (PFAS) are a class of toxic, ubiquitous, anthropogenic chemicals known to bioaccumulate in humans. Substantial concern exists regarding the human health effects of PFAS, particularly metabolic syndrome (MetS), a precursor to cardiovascular disease, the leading cause of mortality worldwide. This narrative review provides an overview of the PFAS literature on 4 specific components of MetS: insulin resistance/glucose dysregulation, central adiposity, dyslipidemia, and blood pressure. We focus on prospective cohort studies as these provide the best body of evidence compared to other study designs. Available evidence suggests potential associations between some PFAS and type-2 diabetes in adults, dyslipidemia in children and adults, and blood pressure in adults. Additionally, some studies found that sex and physical activity may modify these relationships. Future studies should consider modification by sex and lifestyle factors (e.g., diet and physical activity), as well quantifying the impact of PFAS mixtures on MetS features and related clinical disease. Finally, clinicians can follow recently developed clinical guidance to screen for PFAS exposure in patients, measure PFAS levels, conduct additional clinical care based on PFAS levels, and advise on PFAS exposure reduction.

Adult Body Height Is Associated with the Risk of Type 2 but Not Type 1 Diabetes Mellitus: A Retrospective Cohort Study of 783,029 Individuals in Germany

Diabetes mellitus is a major global health burden associated with high morbidity and mortality. Although a short adult body height has been associated with increased risk of type 2 diabetes (T2D), there are large inconsistencies between the studies. Therefore, we aimed to investigate the association between body height and T2D in a large cohort of adult outpatients in Germany. A total of 783,029 adult outpatients with available body height data from the Disease Analyzer (IQVIA) database were included in Germany between 2010 and 2020. The incidence of diabetes mellitus (type 1 and type 2) was evaluated as a function of the patients' body height stratified by age, sex, and body-mass-index (BMI). In both women and men in all age groups, incidence of T2D decreased with the increasing body height (<50, 51-60, 61-70, and >70 years). There was no association between the body height and the individual HbA1c value. In multivariable Cox regression analyses adjusted for patient age and BMI, hazard ratios for the development of T2D were 1.15 (95% CI: 1.13-1.17) for each 10 cm decrease in body height in women and 1.10 (95% CI: 1.09-1.12) in men. No significant association was found between body height and the development of T1D. We present the first data from a large cohort of outpatients in Germany, providing strong evidence for an association between adult body height and T2D. These data add to the current literature and might help in implementing body height into existing diabetes risk stratification tools to further reduce morbidity and mortality worldwide.

IoMT-Enabled Real-Time Blood Glucose Prediction With Deep Learning and Edge Computing

Blood glucose (BG) prediction is essential to the success of glycemic control in type 1 diabetes (T1D) management. Empowered by the recent development of the Internet of Medical Things (IoMT), continuous glucose monitoring (CGM) and deep learning technologies have been demonstrated to achieve the state of the art in BG prediction. However, it is challenging to implement such algorithms in actual clinical settings to provide persistent decision support due to the high demand for computational resources, while smartphone-based implementations are limited by short battery life and require users to carry the device. In this work, we propose a new deep learning model using an attention-based evidential recurrent neural network and design an IoMT-enabled wearable device to implement the embedded model, which comprises a low-cost and low-power system on a chip to perform Bluetooth connectivity and edge computing for real-time BG prediction and predictive hypoglycemia detection. In addition, we developed a smartphone app to visualize BG trajectories and predictions, and desktop and cloud platforms to backup data and fine-tune models. The embedded model was evaluated on three clinical data sets including 47 T1D subjects. The proposed model achieved superior performance of root mean square error (RMSE), mean absolute error, and glucose-specific RMSE, and obtained the best accuracy for hypoglycemia detection when compared with a group of machine learning baseline methods. Moreover, we performed hardware-in-the-loop in silico trials with ten virtual T1D adults to test the whole IoMT system with predictive low-glucose management, which significantly reduced hypoglycemia and improved BG control.

Abstract P347: Measures of Microvascular Complications Varies Across Racial/Ethnic Groups Over a Seven Year Period: Post-Hoc Analysis of Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial Data

Introduction: Type 2 diabetes (T2D) microvascular complications is a major public health issue that disproportionately affects people of color in the U.S. and Canada. There is limited understanding of racial/ethnic disparities in the longitudinal natural history of microvascular complications. We aimed to address this gap in knowledge by examining racial/ethnic differences in microvascular complication-related measures over seven years among T2D adults living in the U.S. and Canada. Hypothesis: We assessed the hypothesis that measures of microvascular complications vary by race/ethnic group over a period of seven years. Methods: From 10,251 Action to Control Cardiovascular Risk in Diabetes (ACCORD) (2003-2009) trial participants, we derived 6,683 participants having a baseline and ≥ two years of outcome recordings for our analysis (baseline mean age 62 ± 6.6 years, and 11 ± 7.4 years of diabetes diagnosis). In this longitudinal study, we used T2D microvascular measurements recorded at baseline, yearly for seven years, and during a trial exit period. Neuropathy-related measures analyzed was the Michigan Neuropathy Screening Instrument (MNSI); Nephropathy-related measures included the glomerular filtration rate (eGFR) by four-variable Modification of Diet in Renal Disease equation (ml/min/1.73 m 2 ), urine albumin (mg/dl), and urine albumin : creatinine (mg/g). We examined differences in measurement among Black (n 1 = 1,176), White (n 2 = 4,282), and Other race adults (n 3 = 1,229). We used multigroup latent growth modeling to compare models from fully constrained to unconstrained means, covariances, and residual variances models. Results: MNSI, eGFR, and urine albumin significantly differed across racial/ethnic groups (ΔX 2 MNSI (2) = 231.8, p&lt;0.001; ΔX 2 eGFR (2) = 489.2, p&lt;0.001; ΔX 2 urine-albumin (2) = 194.6, p&lt;0.001). We noticed that at least one of the means and covariances differed across racial/ethnic groups. The average MNSI trajectory for Other race/ethnicity (intercept=1.88, slope=-0.08) were better than that for Black (intercept=2.07, slope=-0.09) and White adults (intercept=2.67, slope=-0.14). The average eGFR trajectories for Black (intercept=88.86, slope=-1.16) and Other race/ethnicity (intercept=85.68, slope=-1.15) were better than that for White adults (intercept=82.59, slope=-1.36). However, average urine albumin trajectories for Black adults were worst (intercept=10.77, slope=0.98) followed by Other race/ethnicity (intercept=9.36, slope=0.73) and White adults (intercept=7.65, slope=0.57). Conclusion: Trajectories of microvascular complication-related measures appear to vary by racial/ethnic group. Other race adults, with primarily consists of Hispanics, appeared to at lower risk of neuropathy for years than Black and White adults. Nephropathy outcomes could vary across racial/ethnic group depending on how nephropathy is defined.

Comparative cardiovascular effects of GLP-1 agonists using real-world data.

There is limited research using real-world data to evaluate protective cardiovascular effects of glucagon-like peptide-1 (GLP-1) agonists among adults with type 2 diabetes (T2D) early in treatment. We conducted a retrospective, active comparator cohort study using 2011-2015 administrative claims data to compare cardiovascular disease (CVD) event rates following initiation of exenatide extended-release (E-ER), exenatide immediate-release (E-IR) or liraglutide in T2D adults who previously received no other antidiabetic medication (ADM) except metformin. The primary outcome was time to first major adverse CVD event (ischaemic heart disease, stroke, congestive heart failure or peripheral arterial disease) after starting GLP-1. Cox proportional hazards regression was used to model the association between index GLP-1 and CVD events, adjusting for baseline patient, prescriber and plan characteristics. Primary analyses included all patients with ≥2 prescription fills for the index GLP-1, regardless of subsequent refill adherence or initiation of other ADM after index date. Compared with liraglutide, neither E-ER nor E-IR was associated with risk of composite major CVD events (hazard ratios [HRs] for E-ER and E-IR: 1.33 [95% C.I. 0.73-2.39] and 1.30 [0.81-2.09]). No associations were observed between event rates for individual CVD components. The HR for an ischaemic event with E-IR relative to liraglutide was 1.85 (95% C.I. 0.97-3.53). Adjusting for time-varying exposure to other ADM and CVD medications after index date produced similar results. Initiating either immediate or extended-release exenatide rather than liraglutide was not associated with significant differences in CVD risk in this observational real-world study.