epidemiology—aging category · garcia, alzira, spain, valencia, spain we would like to evaluate...

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ADA-Supported Research

EPIDEMIOLOGY—AGING

an add-on to Metformin, or a fi xed-dose combination of vildagliptin + Met-formin. This abstract reports subanalysis on patients aged >65 years.

A total of 819 patients aged >65 years were included in this subanaly-sis. Mean±SD age of the patients was 71.1±4.4 years, duration of diabetes 3.2±4.1 years and 71.4% were females. After 1-year of treatment with vilda-gliptin plus Metformin, more than half patients (55.2%) achieved HbA1c <7% without hypoglycemia and weight gain (>3% of baseline). The annualized rate of hypoglycemia was 0.09 (95% CI 0.056, 0.12), most of the events were mild and only two patients reported a severe event.

This long-term observational study showed that vildagliptin plus Met-formin improves glycemic control without any increased hypoglycemia risk in Russian elderly patients. Vildagliptin can be a useful option for treatment intensifi cation in Russian elderly patients.Table. Baseline, Effi cacy, and Safety Parameters after 1-year Treatment with Vildagliptin Plus Metformin.

Supported By: Novartis Pharma LLC

2370-PUBWITHDRAWN

2371-PUBComparison of Oral Glucose Tolerance Test (OGTT) vs. Glycohe-moglobin (A1c) to Identify Undiagnosed Type 2 Diabetes (T2D) in a High-Risk Elder Population: A Discrepancy that Gives a Subset of Subjects with High A1c and Normal OGTTRUBEN LOPEZ-LOPEZ, MARIA ELENA GONZALEZ VILLALPANDO, RUTH FUENTES, CLICERIO GONZALEZ VILLALPANDO, Cuernavaca, Mexico, Mexico City, Mexico

We explored, in the 2008 evaluation of The Mexico City Diabetes Study, the results of using a standard 75 gr OGTT vs. A1c values for the diagno-sis of T2D according to the criteria of the ADA. Of 1171 subjects, we found (OGTT vs. A1c): 412 (35.2%) vs. 129 (11.0%) normoglycemic, 372 (31.8%) vs. 298 (25.4%) prediabetics and 387 (33.0%) vs. 744 (63.6%) diabetics. The ROC curve of the A1c criterion compared with the OGTT criterion shows an AUC of 0.852, sensitivity of 62.3% and specifi city of 95.4% with A1c of 8.0% (64 mmol/mol). Kappa statistic shows a concordance of 31.6% between the criteria. We identifi ed a group of 188 (45.6%) individuals with normal OGTT and abnormal A1c (higher than 6.5%). Since the method we used for the determination of A1c had a cv of 6.03% in accordance to the National Gly-cohemoglobin Standardization Program 2009 We removed the proportion of subjects encompassed within the upper limit of the distribution adding the coeffi cient of variation. A subset of 90 subjects (21.8% of normal OGTT, mean age of 61.6 yrs, BMI of 28.9 kg/m2) with A1c ≥7.0% (53 mmol/mol). We contacted the most of these subjects. We found a total of 69 nondiabetics, 5 prediabetics, 3 diabetics (self-reported), 5 subjects had died. We think this subgroup (normal OGTT and abnormal A1c) might represent a variant in the pathophysiological process that is conducive of dysglycemia in this of obese elder population. The cutoff point of the A1c recommended by the ADA will need to be adjusted according to the age, BMI and level of risk of the popu-lation studied.

Supported By: Consejo Nacional de Ciencia y Tecnologia

EPIDEMIOLOGY—AGING

2367-PUBInsulin Sensitivity and Secretion with Increasing Age Differs between Black South African Men and WomenJULIA GOEDECKE, CINDY GEORGE, KATHERINE VERAS, NASHEETA PEER, CARL LOMBARD, HENDRIENA VICTOR, KRISELA STEYN, NAOMI LEVITT, Cape Town, South Africa, São Paulo, Brazil

This study examined the effect of sex and age on insulin sensitivity and insulin secretion in black South African (SA) men and women. In this cross-sectional study, 237 men and 346 women between 25 and 74 years of age, without known diabetes, were randomly selected from a peri-urban setting in Cape Town. All had an oral glucose tolerance test from which insulin sen-sitivity (insulin sensitivity index, ISI0,120) and secretion (insulinogenic index, IGI) and the disposition index (DI) were calculated. Despite marked differ-ences in BMI between men and women (median [interquartile range]: 22.7 [20.1-26.2] vs. 31.6 [26.3-37.1] kg/m2, p<0.001), the prevalence of impaired glucose metabolism (14.4 vs. 14.0%) and type 2 diabetes (5.0 vs. 5.3%) did not differ (p=0.978) and increased similarly with age in both sexes (p<0.001). A hyperbolic relationship between IGI and ISI0,120 was observed in men and women with normal glucose tolerance (NGT) only (β (95% CI): -0.70 (-1.19 to -0.20), p=0.006 and -0.71 (-1.30 to -0.12), p=0.018, respectively). In NGT, DI was not different (p=0.107), but ISI0,120 was higher (p=0.005) and IGI was lower (p=0.118) in men compared to women after adjusting for age and BMI. With increasing age, DI (β (95% CI): -24.4 (-36.3 to -12.5), p<0.001) and IGI (-4.9 (-7.5 to -2.2), p<0.001), but not ISI0,120 (0.005 (-0.20 to 0.03), p=0.675) decreased similarly in both sexes. Black SA women have lower insulin sen-sitivity than men, but hypersecrete insulin to maintain normoglycemia. With increasing age, insulin sensitivity does not change, but insulin secretion decreases at a similar rate in men and women.

2368-PUBReal-World Safety and Effi cacy of SGLT2 Inhibitors in Elderly Type 2 Diabetic PatientsCARLOS TRESCOLI, CARMEN FAJARDO, JOSE ARANZO, ANA TRESCOLI, MAR GARCIA, Alzira, Spain, Valencia, Spain

We would like to evaluate the real world experience in safety and effi cacy of adding SGLT2 inhibitors to Elderly DM2 patients with an inadequate gly-caemic control. Elderly patients are frailer, have been diabetics for longer, have more diabetic complications, comorbities and polypharmacy and there-fore might be more susceptible to the effect of SGLT2 inhibitors.

We studied 67 elderly DM2 patients who had been treated with SGLT2 inhibitors for more than 6 months in our Health Department during 2015. Safety data was collected on most frequent and harmful events in this frail group as recorded in the computerized Primary and Hospital Care Medical Records. Patients´s data: mean age: 67 years, 39% women, mean period dia-betes: 12, 5 years. 79% had hypertension, 81% had dyslipemia, 51% had a BMI > 30 and, 33% had a previous cardiovascular event. Antidiabetic treat-ment: 36% on insulin, 75% on Metformin, 45% on sulphonilurea (SU), 37% on DPP-IV inhibitors, 12% on pioglitazon and 13% on GLP-1 analogues. Mean treatment period was 8 months.

Results (SD) before and after SGLT2 inhibitors treatment were: HbA1c. 8, 48 (1, 1) vs. 7, 44 (0.8)% (p < 0, 01); (37% achieved HbA1c < 7%) Weight: 91, 0 (18) vs. 88, 8 (17) kg (p< 0, 01); Systolic BP: 134 (9) vs. 131 (8) mmHg (P: 0, 04). There were no statistical signifi cant changes in e-GFR, lipid profi le, haema-tocrit, dyastolic BP and heart rate. No severe hypoglyacemya, falls, diabetic ketoacidosis, or fungal infections were recorded during this period. Only 3 patients were treated for urinary tract infections. Two patients had thiaz-ide treatment withdrawed during summer period because of symptomatic hypotension. No new cardiovascular events during treatment period. Hypo-glycaemia records were associated to insulin and SU treatment.

SGLT2 inhibitors are safe and effective in not well controlled elderly DM2 patients in a real world experience. Effect on systolic BP should be consid-ered as antihypertensive treatment might need to be reviewed.

2369-PUBReal-World Evaluation of Vildagliptin Plus Metformin in Elderly Patients with Type 2 Diabetes: Results from a One-Year Observa-tional Study in RussiaALEXEY ZILOV, AIDA EMIROVA, Moscow, Russian Federation

Management of type 2 diabetes in elderly poses unique challenges due to associated comorbidities, polypharmacy, and increased risk of hypo-glycemia. We conducted a 1-year, real-world, observational, noninterven-tional study in Russia to assess effectiveness and safety of vildagliptin as

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EPIDEMIOLOGY—CARDIOVASCULAR DISEASE

Table. Lipid Profi les and HbA1c in People Treated vs. Not Treated with LLT.LLT No LLT

Diagnosed with CVD at baseline

(n = 1,885)

Diagnosed with CVD at baseline

(n = 1,787)

Without CVD diagnosis

at baseline(n = 1,041)

HbA1c, %BaselineChange from baseline to Week 24

8.7 (1.02) a−1.4 (1.13) a

8.8 (1.05) −1.5 (1.19)

9.0 (1.09) −1.6 (1.24)

Non-HDL-C, mg/dLBaselineChange from baseline to Week 24

142.85 (48.42) a−9.10 (39.67) a

159.78 (41.92) −5.20 (29.57)

151.04 (50.31) −3.85 (43.34)

LDL-C, mg/dLBaselineChange from baseline to Week 24

99.94 (37.05) a−0.98 (30.48) a

120.83 (36.39) 1.51 (27.42)

116.31 (32.96) 0.51 (25.96)

HDL-C, mg/dLBaselineChange from baseline to Week 24

43.83 (11.42) a0.32 (7.17) a

45.69 (13.30) 0.56 (10.12)

45.27 (13.08) 0.36 (10.58)

Triglycerides, mg/dLBaselineChange from baseline to Week 24

241.40 (247.69) a−51.20 (220.81)

210.99 (163.16) −38.84 (141.93)

181.51 (129.15) −25.83 (106.05)

Data represent mean (SD); HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol. a Indicates P < 0.05 between LLT and No LLT.

Supported By: Sanofi

2374-PUBThe Power of Thyroid Stimulating Hormone to Predict Cardiovas-cular Mortality in Nonobese Patients Is Signifi cantly Modulated by Type 2 DiabetesALEXANDER VONBANK, DANIELA ZANOLIN, ANDREAS LEIHERER, PHILIPP REIN, CHRISTOPH H. SAELY, HEINZ DREXEL, Feldkirch, Austria, Triesen, Liechtenstein, Philadelphia, PA

Elevated thyroid stimulating hormone (TSH) is associated with cardio-vascular risk factors, in particular with hypercholesterolemia, diabetes and obesity. We investigated the association between TSH and cardiovascular mortality in nonobese patients with our without type 2 diabetes (T2DM). We measured TSH in a high-risk cohort of 1741 nonobese patients undergo-ing coronary angiography for the evaluation of suspected coronary artery disease. Prospectively, the incidence of vascular events was recorded over 10 years. At baseline, TSH was not signifi cantly different between patients with T2DM (n=502) and those who did not have T2DM (2.31±4.59 vs. 2.06±2.66 µU/ml; p=0.446). During follow-up, 553 patients suffered vascular events; the event rate was signifi cantly higher in patients with T2DM than in nondiabetic subjects (40% vs. 29%; p<0.001). TSH proved to be a strong and independent predictor of vascular events in nonobese patients with-out T2DM (standardized adjusted HR 1.34 [1.03-1.66]; p=0.013), but not in those with T2DM (HR 0.963 [0.894-1.037]; p=0.315). An interaction term TSH x T2DM was signifi cant (p=0.026), indicating that TSH was a signifi cantly stronger predictor of vascular events in nonobese subjects without T2DM than in those with T2DM. We conclude that the power of thyroid stimulating hormone to predict cardiovascular mortality in nonobese patients is signifi -cantly modulated by the presence of T2DM.

2375-PUBPrevalence of Diabetes Mellitus and Other Cardiovascular Risk Factors among Residents of a Greek Island: PERSEAS StudyIOANNIS IOANNIDIS, CHRISTOS KAPELIOS, IOANNIS KYRIAZIS, KONSTANTI-NOS SGOUROS, CHARILAOS DIMOSTHENOPOULOS, ERIFYLI CHATZIANGELAKI, STAVROS LIATIS, Athens, Greece

Introduction: The prognostic value of various risk factors in the incidence of cardiovascular morbidity and mortality has been established by numerous studies. The prevalence of these factors in different regions of Greece has not been investigated.

Purpose: Determining the prevalence of diabetes mellitus (DM) and other risk factors in the residents of Elafonisos Island in Laconia: PERSEAS study [Prospective Evaluation of vascular Risk Surrogates: the Elafonissos Area Study] is a 5-years follow up study of this population.

Method: This population was followed-up for during the period 2012-2014 for the the presence of CVD risk factors, and the presence of known CVD.

Permanent residents who took part in the study responded to a struc-tured questionnaire on demographic, anthropometric data and information related to type 2 diabetes and other CVD risk factors. Participants under-

EPIDEMIOLOGY—CARDIOVASCULAR DISEASE

2372-PUBCardiometabolic Health in Asians with Diabetes in the U.S.ANDY MENKE, SARAH STARK CASAGRANDE, CATHERINE COWIE, Silver Spring, MD, Bethesda, MD

Previous studies have found that Asians develop diabetes at lower levels of body mass index than people of other race/ethnicities. However, there is limited data investigating the health of U.S. Asians with diabetes. We com-pared cardiovascular and metabolic risk factors in U.S. Asians with diabetes to people of other race/ethnicities with diabetes. Among 2,556 adults in the 2011-2012 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of the civilian noninstitutionalized U.S. population, the levels of cardiovascular and metabolic risk factors were estimated by race/ethnicity and diabetes status using conditional margins in regres-sion models after adjustment for confounders. Among people with diag-nosed and undiagnosed diabetes, non-Hispanic Asians generally had lower adjusted BMI, waist circumference, and prevalence of hypertension com-pared to people of other race/ethnicities (Table). There were no differences in total cholesterol, HDL cholesterol, and history of cardiovascular disease (p>0.05). The differences by race/ethnicity were generally consistent among people with prediabetes and with normal glucose levels (data not shown). In conclusion, adiposity and blood pressure in U.S. non-Hispanic Asians with diabetes are lower than that of people of other race/ethnicities with diabe-tes, while lipid levels and history of cardiovascular disease are similar.Table. Adjusted* Mean or Percent Cardiovascular and Metabolic Factors by Race-Ethnicity.

Supported By: National Institute of Diabetes and Digestive and Kidney Diseases (GS10F0381L)

2373-PUBEffect of Glucose-Lowering Treatment on Lipid Profi les in People with Type 2 Diabetes (T2D): Relationship to Lipid-Lowering TherapyMARKOLF HANEFELD, LOUISE TRAYLOR, LING GAO, MAYA VINCENT, WOLF-GANG LANDGRAF, Dresden, Germany, Bridgewater, NJ, Somerset, NJ, Paris, France, Frankfurt, Germany

Dyslipidemia is a major risk factor for cardiovascular disease (CVD), which is the major cause of mortality in T2D.

This subject-level analysis included data from 11 RCTs (target FPG 100 mg/dL, ≥ 24-week duration) conducted with insulin glargine 100 units/mL vs. comparator antihyperglycemic drugs between 1999 and 2008. The effects of all glucose-lowering therapies on lipid status at baseline and 24 weeks were examined in participants with CVD receiving lipid lowering therapy (LLT) at the discretion of their physician, people with CVD not receiving LLT, and con-trol subjects without CVD and not receiving LLT.

Overall, 1,940 people were treated with LLT and 2,828 did not receive LLT (81%/82% on insulin ± OADs, 19%/18% with OADs alone). LLT included sta-tins (88%), fi brates (11%), and others (10%). 97% (with LLT) and 63% (with-out LLT) were diagnosed with CVD at study entry. People with CVD and not receiving LLT had signifi cantly higher levels of LDL-C and non-HDL-C than other groups at baseline (Table). Over 24 weeks, non-HDL-C and triglyceride levels improved most; LDL-C and HDL-C levels remained almost unchanged, irrespective of LLT use.

About 50% of people with T2D and CVD did not receive appropriate LLT, and the vast majority did not meet ADA/AHA targets. Our data sug-gest a positive effect of glucose-lowering treatment on atherogenic lipids in people with T2D and CVD.

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EPIDEMIOLOGY—CLINICAL—DIAGNOSIS AND SCREENING

covered diabetes, and to characterize this clinical entity by comparing it to autoimmune type 1 diabetes (T1D), and T2D. Among 189 newly diagnosed diabetic patients 90 had classical symptoms with DKA or ketonuria at onset, 21 of whom (13 males/8 females) were considered to have KPD. Clinical parameters were compared to newly diagnosed T1D (n=66) and T2D (n=99). Genetic features were compared to a databank with registered diabetic patients (T1D: n=545, T2D: n=1297). For statistical analyses SPSS 20 (IBM) was used. Age at onset, BMI, HbA1c, and gamma-GT liver enzyme levels were higher in the KPD group compared to the other 2 groups (p<0.0001, for each group and each parameter). Fasting C-peptide levels did not differ between KPD and T2D patients, however, only 2/21 KPD patients had a fast-ing C-peptide level above normal range compared to the 26/99 patients with T2D (p<0.0001). Middle-, and high-risk HLA-DR, -DQ status were signifi cantly lower in KPD than in T1D (13% vs. more than 70%, respectively, p<0.0005). No signifi cant difference was found regarding the allele frequency of the TCF7L2 rs7903146 polymorphism between the KPD and T2D. After a mean follow-up time of 9.97 years (SD 3.35) 14 patients needed, and 7 did not need insulin treatment to reach therapeutic goals. These results show that KPD may be presented in Caucasians, and despite the ketosis at onset noninsulin treatment could be considered long-term.

2378-PUBCombined Effect of Body Mass Index and Weight-Height Ratio on Incidence of Diabetes: A Population-based, Large-Scale, Cohort StudyNORIYUKI KITAGAWA, YOSHITAKA HASHIMOTO, MUHEI TANAKA, HITOSHI TODA, MASAHIRO YAMAZAKI, MICHIAKI FUKUI, Kyoto, Japan

Previous studies showed that both body mass index (BMI) and waist-to-height ratio (WHtR) is associated with incident type 2 diabetes (T2DM). However, the impact of combined effect of BMI and WHtR on incident T2DM remains to be elucidated. We performed a cross-sectional and a 5-years follow-up cohort study. Overweight was defi ned as BMI ≥ 23 kg/m2 and abdominal obesity was defi ned as WHtR ≥ 0.5. We divided participants into four groups according to presence of overweight and/or abdominal obesity. The logistic regression analyses were performed to calculate odds ratio (OR) of the four groups for prevalence or incident diabetes. Among 3737 partici-pants, 286 participants had T2DM at baseline examination. The adjusted ORs for prevalence of diabetes compared with non-overweight without abdominal obesity were as follow: 1.87 (95% confi dence interval 1.09-3.14, P = 0.024) in non-overweight with abdominal obesity, 1.51 (0.87-2.55, P = 0.141) in overweight without abdominal obesity and 3.25 (2.37-4.52, P < 0.001) in overweight with abdominal obesity. In the follow-up examination, 86 participants were newly diagnosed as diabetes among 2318 participants. The adjusted ORs for incident T2DM compared with non-overweight with-out abdominal obesity were as follow: 2.24 (0.78-6.02, P = 0.131) in non-overweight with abdominal obesity, 1.50 (0.54-3.86, P = 0.420) in overweight without abdominal obesity and 2.67 (1.44-5.17, P = 0.002) in overweight with abdominal obesity. Non-overweight with abdominal obesity as well as over-weight with abdominal obesity was associated with T2DM compared with non-overweight without abdominal obesity. Thus, to prevent the further risk of T2DM, we should pay more attention to WHtR than BMI.

2379-PUBTransitions between Chronic Kidney Disease Stages in Patients with Type 2 DiabetesROBERT B. MCQUEEN, SEPEHR FARAHBAKHSHIAN, KELLY F. BELL, KAVITA V. NAIR, JOSEPH SASEEN, Aurora, CO, Wilmington, DE, Fort Washington, PA

Our aim was to estimate real-world transitions between chronic kidney disease (CKD) stages as determined by estimated glomerular fi ltration rate (eGFR) in patients with type 2 diabetes (T2D). We used the Truven Health-care and Claims Dataset from 2009-2012 to create a retrospective cohort of patients stratifi ed by CKD stage as defi ned by eGFR (stages 1: ≥90; 2: 60-89; 3A: 45-59; 3B: 30-44; 4: 15-29; 5: <15). Index date was the fi rst eGFR labora-tory value during a 36-month continuous enrollment period. We estimated the frequency (%) of patients transitioning between CKD stages from index date to last follow-up eGFR lab value. Of 30,237 patients with an index eGFR value, 13,886 (45.92%) were in stage 1, 11,108 (36.74%) in stage 2, 4,224 (13.97%) in stage 3A, 751 (2.48%) in stage 3B, 220 (0.73%) in stage 4 and 48 (0.16%) in stage 5. Average last follow-up eGFR was measured 19 months post index date. Of 4,224 stage 3A patients at index date, 1,217 (28.81%) stayed, 2,658 (62.93%) transitioned to stages 2 or 1 (improved) and 349 (8.26%) transitioned to stages 3B, 4 or 5 (worsened) by their last measure-ment (Figure). Of 751 stage 3B patients at index date, 316 (42.08%) stayed, 343 (45.68%) transitioned to stages 3A, 2 or 1 (improved) and 92 (12.25%)

went weight, height and waist measurements, blood pressure measure-ment, and lipid and glycemic profi les.

Results: The study involved 612 permanent adult residents. Of these, 598 (97.7%) gave answers to questionnaires and 601 (98.2%) agreed to undergo blood sampling. These were 292 males (47.7%) and 164 (27%) were aged> 65 years.

37.2% were current smokers. Only 28.5% had a normal BMI, 34.7% were overweight, 34, 1% were obese. 42.8% were treated hypertension (HTN), while 31.1% had dyslipidemia. 7.7% of the population, had known DM. From our measurements measurements a diagnosis of DM established in addi-tional 25 subjects (4.2%), bringing the total percentage of DM in 11.9%. Moreover, the diagnosis of prediabetes established in 29 subjects (4.8%). 6.4% had coronary heart disease (CHD) 12% had a history of stroke and 8.2% a history of peripheral vascular disease (PAD).

Conclusion: Diabetes mellitus, Obesity, HTN, and dyslipidemia appears to have a particularly high prevalence among residents of the closed rural pop-ulation of Elafonisos.

Supported By: Abbott


2376-PUBEvaluation of Glucose Tolerance in Patients with Hypothyroidism due to Autoimmune ThyroiditisCELESTINO NEVES, SOFIA OLIVEIRA, JOÃO S. NEVES, BRUNO BOUÇA, HELENA GREENFIELD, MIGUEL PEREIRA, JOSÉ L. MEDINA, LUÍS DELGADO, DAVIDE CAR-VALHO, Porto, Portugal

Introduction: The oral glucose tolerance test (OGTT) is a helpful tool in clinical practice to diagnose prediabetes and diabetes in risk population, such as patients with hypothyroidism due to auto-immune thyroiditis.

Aims: To evaluate the frequency of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes in patients with hypothyroidism due to auto-immune thyroiditis.

Methods: We retrospectively analyzed the results of fasting glucose and insulin and at 2 h after the OGTT. The OGTT was performed in the morning, with measurement of plasma glucose and insulin at 0 and at 120 minutes after 75 g of glycose per os. Statistical analysis was performed with ANOVA and Person’s correlation test. Results are expressed as means±SD or per-centages.

Results: We studied 150 patients, 83% females with a mean age of 52.3±37.1 years. The BMI was 29.6±7.6 Kg/m2. The levels of TSH were 10.46±6.54 µUI/mL. The levels of anti-TPO antibodies were 763.26±101.62 UI/mL and anti-thyroglobulin 187.34±127.12 UI/mL. The fasting glucose was 92.35±10.28 mg/dl. In 18.9% of patients there was IFG and 2.3% of patients had fasting glucose levels >126mg/dl. The fasting insulin level were 14.86±8.78 µU/ml. The glucose concentrations 2 h after the OGTT were 124.08±30.79 mg/dl. In 28.1% of patients we found IGT. In 6.5% of patients we detected glucose levels >200 mg/dl 2 h after OGTT. The levels of insulin in the OGTT (2 h) were of 74.43±36.31 µU/ml. There was no signifi cant dif-ferences in age, BMI, TSH, FT3, FT4, anti-TPO and anti-thyroglobulin titters between the groups of patients with IFG, IGT and diabetes. We found no signifi cant correlation between the BMI and the levels of TSH. There were also no signifi cant correlation between the BMI and the anti-TPO and anti-thyroglobulin titters.

Conclusion: We found a high frequency of prediabetes in patients with auto-immune thyroiditis and hypothyroidism, regardless of BMI and hypo-thyroidism severity.

2377-PUBKetosis-Prone Type 2 Diabetes among Newly Diagnosed Adult Cau-casian Patients: A Follow-up StudyLASZLO JOZSEF BARKAI, TIMEA GOMBOS, KRISZTINA LUKACS, EMESE SIPTER, EVA PALIK, ISTVAN KARADI, PAL PANCZEL, NORA HOSSZUFALUSI, Budapest, Hungary

Ketosis-prone type 2 diabetes, an intermediate syndrome between type 1 and type 2 diabetes mellitus (T2D), was found mainly among non-Caucasian ethnicities. In our follow-up study, patients presenting ketosis or diabetic ketoacidosis (DKA), without pancreatic beta-cell autoimmunity (negative ICA and GAD antibody titer) and with preserved beta-cell function (at least normal fasting C-peptide level: 1.07-3.51 ng/ml), were considered to have ketosis-prone diabetes (KPD). Our aim was to assess the occurrence of KPD in Caucasian population among hospitalized adult patients with newly dis-

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discrimination with a cut-off value at 11pmol/L. The purpose of this evalua-tion was to assess the sensitivity and specifi city of the fi rst test prototypes, when used in a routine practice setting. POCT results were obtained from 40 patients and healthy subjects, and a venous blood sample was obtained for measurement of iPI by means of a quantitative ELISA reference method (TecoMedical, Sissach, Switzerland). Elevated iPI levels (> 11 pmol/L) were determined in 14 participants by the reference method, of which the 10 patients with the highest iPI values (>30 pmol/L) were also tested positive with the POCT (Sensitivity: 71%). All 26 subjects with low iPI levels were tested negative by the POCT (Specifi city: 100%). The test successfully detected elevated intact proinsulin levels in 71% of the tested subjects. Further developmental work is ongoing to enhance the test sensitivity by reaching the specifi ed cut-off. In addition, a series of broad screening proj-ects have been initiated to explore the usefulness of the POCT as a simple screening tool for identifi cation of high risk patients for development of type 2 diabetes and/or macrovascular events.

Supported By: InsulinNG, LLC

2383-PUBDiabetes or Prediabetes Should Be Actively Sought in Overweight Individuals Aged >45 with Family History of DiabetesLESZEK CZUPRYNIAK, ELEKTRA SZYMANSKA-GARBACZ, PAWEL BIJOS, JERZY LOBA, Warsaw, Poland, Lodz, Poland, Kutno, Poland

As at least a third of people with diabetes are unaware of their condition, there is an urgent need for simple diagnostic strategy. In 2014 we conducted a primary care physician (PCP)-based nationwide screening programme aiming at identifying individuals with undiagnosed diabetes or prediabetes. 561 PCPs enrolled 21 726 subjects. No earlier diagnosis of diabetes or predia-betes and the presence of at least one risk factor (age>45 yrs, family history of diabetes, sedentary lifestyle, smoking, presence of fatty liver disease, hypertension, hyperlipidemia, coronary artery disease, peripheral artery disease, obstructive sleep apnoea syndrome, polycystic ovary syndrome, history of stroke, gestational diabetes or having a child of birth weight >4 kg, BMI>25 kg/m2 or waist circumference >80 cm [women] or 94 cm [men)] were inclusion criteria. All subjects underwent fasting plasma glucose (FPG) measurement, and if it was >125 mg/dl, second FPG measurement was con-ducted. The subjects with fi rst FPG measurement 100-125 mg/dl had an oral 75 g glucose tolerance test (OGTT) performed. Diabetes was diagnosed in 4221 (19.4%), and prediabetes in 5829 (26.8%) subjects. 2825 (66.9%) dia-betes cases were diagnosed upon two FPG measurements >125 mg/dl. In 6265 (28.8%) subjects the concomitant presence of three main unmodifi able risk factors, simple to be identifi ed in PCP setting, i.e., age >45 years, family history of diabetes and BMI >25 kg/m2 were noted. In this subgroup 1989 (31.7%) individuals were found to have diabetes and 2101 (33.5%) to have prediabetes. Odds ratio (OR) for diabetes in this subgroup was 2.757 (95% CI 2.57-2.957), and for both diabetes or prediabetes 2.998 (2.818-3.189). In conclusion, almost half of the subjects visiting their PCP have undiagnosed diabetes or prediabetes. Screening individuals aged >45 years who have family history of diabetes and are overweight/obese should promptly help decrease the number of people with undiagnosed diabetes or prediabetes.

Supported By: Teva Pharmaceutical Industries Ltd.

2384-PUBDiabetes INSIDE: Clinical Factors Predicting A1c Levels in Primary CareROY E. FURMAN, KELLIE RODRIGUEZ, UMA GUNASEKARAN, KATHERINE L. NASHATKER, NOEL O. SANTINI, CLAY V. TOWNSEND, LUIGI F. MENEGHINI, Media, PA, Dallas, TX

As part of a quality improvement project, we statistically analyzed regis-try data from 7,840 “active” patients (≥3 primary care visits over 18 months) with T2DM at a large urban safety net health system. Our aim was under-standing factors underlying the wide A1c distribution (4.2-18%; mean=8.0%) among medical home patients.

We fi t A1c distributions with ≥20 predictors from patient demographics, physical characteristics, labs, meds (DM, BP, lipids), insurance, and treat-ment length. Clustering methods showed persistently elevated A1c in younger, normotensive patients with preserved renal function and elevated lipids. Linear regression (LR) modelled mean A1c, but excluded values away from the mean, which accounted for only 19% of the variance. The statis-tically signifi cant predictors included estimated glomerular fi ltration rate (eGFR), number of oral antidiabetic drugs (OAD), lipid levels, and age.

A mixture model of 3 Gaussians functions best fi t the A1c distribution with mean A1c values of 6.6, 7.9, and 9.8% approximating the ADA defi nitions of good, acceptable, and poor control. LR of each Gaussian function showed

transitioned to stages 4 or 5 (worsened). These real-world data suggest patients with T2D in moderate CKD stages 3A and 3B have the highest likeli-hood of transitioning compared to other CKD stages.Figure. Distribution of Follow-up eGFR Measurements Stratifi ed by eGFR at Index Date.

Supported By: AstraZeneca

2380-PUBEvaluation of OGTT and HbA1c Effi cacy in Identifying Diabetic Sub-jectsANTONELLO GIBBIN, MATTIA BELLAN, ALESSANDRO GUALERZI, MICHELA GENTILE, SERENA FAVRETTO, GIAN P. CARNEVALE SCHIANCA, MARIO PIRISI, Novara, Italy

The diagnostic criteria according to the American Diabetes Association (ADA) for the classifi cation of type 2 diabetes mellitus (T2DM), are based on HbA1c, fasting plasma glucose (FPG) or glycemia detected after an oral glu-cose tolerance test (OGTT). The best screening strategy is still to be defi ned. We aimed to compare the effi ciency of HbA1c and OGTT in T2DM identifi ca-tion. We included 1,564 subjects (M 691, F 873), referred to the Hypertension Outpatient Unit of our Division, tested for HbA1c and OGTT. Patients already known to be diabetics were not included. They were then classifi ed, accord-ing to ADA criteria, in normoglucotolerants (NGT), prediabetics (pre-DM) or diabetics. According to OGTT results we identifi ed 715 NGT, 619 pre-DM and 230 T2DM subjects. Out of 1406 subjects, with HbA1c < 6.5% and FPG < 126 mg/dl, we detected 714 NGT, 600 pre-DM and 92 T2DM according to OGTT. Considering all diabetic patients, the following proportions of the different combinations among the 3 diagnostic criteria were identifi ed: -39 classifi ed as diabetics according to all 3 criteria; -15 classifi ed according to post-OGTT plasma glucose concentration (2HG) + HbA1c; -25 classifi ed according to FPG and 2HG; -6 classifi ed according to FPG and HbA1c; -92 classifi ed only according to 2HG; -53 classifi ed only according to FPG; -20 classifi ed only according to HbA1c. The concordance between the 3 tests was 87.8%. Sen-sitivity for T2DM classifi cation was higher for 2HG (68.4%) vs. FPG (49.2%) and HbA1c (32%). OGTT as a whole showed a sensitivity of 92%. HbA1c has low sensitivity in identifying patients with T2DM; according to our analysis, Hb1Ac alone is not suffi cient as screening tool. Our evidences confi rm the importance of OGTT in the classifi cation of T2DM.

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2382-PUBPilot Study For Evaluation of a New Point-of-Care Test for Assess-ment of β-Cell Dysfunction and Insulin ResistanceANDREAS PFÜTZNER, DANIELA SACHSENHEIMER, FILIZ DEMIRCIK, ALEXAN-DER LIER, ANKE PFÜTZNER, ELSAYED HAFEZ, DIETER KONDEK, GUNTHER BUR-GARD, Mainz, Germany, Cairo, Egypt, Naples, FL

Elevation of intact proinsulin (iPI) in plasma is a direct indicator for late stage β-cell dysfunction and 100% specifi c biomarker for clinically relevant insulin resistance, two of the key disorders leading to type 2 diabetes and its macrovascular complications. Several prospective epidemiological trials have suggested that elevated fasting (and post-glucose challenge) iPI is a predictor for type 2 diabetes development and/or macrovascular events in normoglycemic subjects, even years before disease onset. We used propri-etary antibodies for development of a lateral-fl ow-based point of care rapid test (POCT) for qualitative assessment of iPI in capillary blood obtained by a fi nger prick. The test requires 10-20 µL of capillary whole blood and is visually read out after 15 min. The test is supposed to provide a qualitative

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used to visualize the spatial variation. Maps were created using ArcGIS/ArcMAP 10.2.

There were 38,679 patients with 50.5% men. Of those patients, 64.13% lived in an urban center at time of diagnosis. Based on the geographical maps for the incidence of diabetes in NL, it was found that females living further away from urban centers and accessible neighbourhoods were more likely to be late diagnosed while males were found to have relatively lower visits to their family physicians despite being closer to accessible neighbour-hoods.

Thus, while overall men were found to be more prone to diabetic compli-cations and have a later diagnosis, the women are more likely to suffer from diabetic co-morbidities likely from lack of access to healthcare. Keeping in mind the accessibility differences between the two genders can improve diabetes management by physicians.

2387-PUBImprovement of Diabetes Screening System for School Children Achieved by Close Cooperation with a Local Government of Atsugi CityMAKI SAITO, TAKANORI MOTOKI, AKIRA ITO, TAKERU ITO, AIZAN HIRAI, NAOKO TAJIMA, ICHIRO MIYATA, Atsugi, Japan, Tokyo, Japan, Ichihara, Japan

In Japan, screening of school children for diabetes using urinalysis has been performed to detect diabetes in childhood throughout the country. However, inadequate follow-up system of urine glucose screening caused several problems. The rate of participation in workup examination still remains less than 30%. Also, accurate annual incidences of children with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) detected by urine glu-cose screening have not been determined. Under the cooperation with Atsugi City (population: around 224,000), the present study was performed in order to achieve full participation of urine glucose positive children in workup examination, and to clarify accurate annual incidences of children with T1DM and T2DM in Atsugi City.

Subject and Method: On the request from Atsugi City to parents, all of urine glucose positive children by urine screening received workup examina-tion of diabetes at our hospital including HbA1c and anti-GAD antibody. We analyzed retrospectively clinical diagnosis and course of these children.

Results: From 2009 to 2015, a total of 129,125 school children in Atsugi City were tested for glucosuria to detect diabetes. A total of 36 children showed positive for urine glucose, and all of them received workup examina-tion. Through this screening, a total of 3 children were diagnosed as having T2DM. The overall incidence of T2DM was 2.28 per 100,000 per year. On the other hand, a total of 2 children were diagnosed as having T1DM. The overall incidence of T1DM was 1.58 per 100,000 per year. One child was diagnosed as having insulin receptor abnormality.

Discussion: The annual incidences of children with T2DM in Atsugi City is comparable with those in other municipalities (2.65-3.57 per 100,000 per year). On the other hand, the annual incidences of children with T1DM in Atsugi City is almost 3 times higher than that in Tokyo (0.51 per 100,000 per year). The reasons for this difference is unclear, further study is required.

2388-PUBWITHDRAWN

2389-PUBPrevalence of Diabetes and Prediabetes in the Kyushu-Okinawa Population Study and the Framingham Offspring StudyHIROAKI IKEZAKI, MASUMI AI, ERNST J. SCHAEFER, SEIKO OTOKOZAWA, BELA F. ASZTALOS, KATSUYUKI NAKAJIMA, YANHUA ZHOU, CHING-TI LIU, PAUL F. JACQUES, L. ADRIENNE CUPPLES, NORIHIRO FURUSYO, Boston, MA, Tokyo, Japan, Sapporo, Japan, Maebashi, Japan, Fukuoka, Japan

Our goal was to compare the markers of glucose homeostasis and their association with the prevalence rates of diabetes and prediabetes in Fuku-oka, Japan and Framingham, the United States. A population-based, inter-national cohort-comparative, cross-sectional study was performed. Using plasma samples obtained from overnight fasting men and women from Fukuoka (n=1108) and age (median, 53 years), gender and menopausal status matched subjects from the Framingham Offspring Study (n=1096), we mea-sured adiponectin, insulin, and glycated albumin levels, and used avail-able data on fasting serum glucose levels, body mass index (BMI), use of medications, and history of diabetes. Both populations were stratifi ed into normal, prediabetic, and diabetic groups according to the standard Ameri-can Diabetes Association criteria. The prediabetes prevalence rates in men

statistically signifi cant differences in predictor coeffi cients distinguishing patient subpopulations (see Table). These subpopulations differ with poor-est control observed in younger, taller patients with lower BMI, higher total cholesterol, fewer microvascular complications, and taking multiple OADs.

Table. A1c Correlations in Descending Order of Importance.Mean A1c value Positive correlations Negative correlations6.6% 1. Sulfonylurea treatment

2. Triglycerides3. Metformin treatment4. Advancing age

1. Smoking2. Male gender3. Serum creatinine

7.9% 1. Number of OADs2. eGFR3. Total cholesterol4. Triglycerides5. Lipid treatment6. Blood pressure (BP) 7. Length of treatment

1. Metformin treatment2. Insulin treatment3. Age4. HDL cholesterol

9.8% 1. Total cholesterol2. Number of OADs3. eGFR4. Patient height

1. Age2. BMI3. HDL cholesterol

Supported By: Eli Lilly and Company; Novo Nordisk Inc.; Sanofi -Aventis

2385-PUBClinical Factors Associated with Durable Glycemic Control in Patients with New-Onset Type 2 Diabetes: A Two-Year Follow-up StudyKYOUNG JIN KIM, JU HEE CHOI, KYEONG JIN KIM, SUN HWA KIM, JEE HYUN AN, NAM HOON KIM, HYE JIN YOO, HEE YOUNG KIM, JI A. SEO, NAN HEE KIM, KYUNG MOOK CHOI, SEI HYUN BAIK, DONG SEOP CHOI, SIN GON KIM, Seoul, Republic of Korea

To evaluate which factors are associated with durable glycemic con-trol besides anti-hyperglycemic medications in patients with new-onset type 2 diabetes. From the Anam Diabetes observational study, 194 patients who newly diagnosed with type 2 diabetes from January 2011 to March 2013, were followed up to March 2015. Glycemic durability was defi ned as maintaining optimal glycemic control (as HbA1c < 7%) over 2 years with-out changes of medications. Serum HbA1c was measured every 3 months. Patients’ medical information and demographics were recruited by struc-tured interview, and biochemical assays including serum fasting glucose, c-peptide, and insulin were routinely measured. At baseline, patients in durability group (n=114) had higher body mass index (BMI) (26.1 kg/m2 vs. 24.9 kg/m2), and lower HbA1c at diagnosis (8.6% vs. 9.7%) than non-dura-bility group (n=80). Initial choice of anti-hyperglycemic agents was compa-rable in both groups except insulin which was more frequently prescribed in non-durability group. In the multiple logistic regression analyses, higher education level, physical activity, and HOMA-β was signifi cantly associated with increased ORs of glycemic durability, but not age, BMI, and HOMA-IR. Lower HbA1c at diagnosis (<7%) was more associated with glycemic dura-bility compared to higher HbA1c at diagnosis (>9%) (OR, 5.84, 95% CI, 2.05-16.6). Importantly, lower HbA1c at the 1st follow-up visit was signifi cantly associated with glycemic durability after adjusting for confounding factors including medication use; HbA1c of <6% (OR 11.3 [2.02-62.8)], 6-7% (OR 6.81 [1.37-33.9)], as a reference of > 8%. In real clinical practice, various factors other than anti-hyperglycemic medications were associated with glycemic durability. Patients who achieved target HbA1c <7% during a shorter time after diagnosis were more likely to maintain optimal glycemic control.

2386-PUBGeographical Variation of Diabetes in Newfoundland and Labrador: Gender DifferencesRICHA PARIHAR, SHABNAM ASGHARI, St. John’s, NL, Canada

Diabetic patients are known to develop complications and co-morbidities as a result of the disease. Our previous studies have shown that men are more likely to develop diabetic co-morbidities and are diagnosed later com-pared to women. The objective of this study is to determine whether geo-graphical disparities exist for the incidence and late diagnosis of diabetes between men and women in Newfoundland and Labrador (NL).

This is a retrospective cohort study. Patients were followed for 5 years from the date of diagnosis, between 1998 to 2003, till their death or end of study (2008) whichever came fi rst. Individuals newly diagnosed with diabe-tes aged 20 years and older were identifi ed using provincial medico-adminis-trative data. The individuals were geo-referenced using the 6 digit post-code and were subsequently assigned to communities. Choropleth maps were

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2392-PUBLongitudinal Study 60-Month Intervention in Beijing Jinsong Com-munity Hospital Integrated Model on the Outcome of Patients with Type 2 DiabetesXUE-LIAN ZHANG, NING ZHUANG, JIAN-DONG ZHANG, GANG WAN, GUANG-RAN YANG, SHEN-YUAN YUAN, BCDS GROUP, Beijing, China

To explore the long-term effects of community-hospital integrated model in community diabetes, and to assess the changes in joint outcome rate over 60 months’ multifactorial interventions. 441 patients with type 2 diabetes in Jinsong community were assigned to the intensive group and the stan-dard group randomly. Based on co-operative between the GPs and Profes-sors in endocrinology, the multi-factorial intervention had been effi ciently implemented. All the patients were seen by a collaborative team every 2 to 3 months and more often if indicated. The important data were central-ized and tested in Beijing Tongren Hospital. In the intensive group, HbA1c was measured every 3 months and UAER every 6 months. In the standard group, HbA1c was measured every 6 months and UAER annually. The lipid profi le and fundus examinations were performed annually in all the patients. Optimal treatment target were defi ned as follows: Fasting plasma glucose <7.2mmol/L; HbA1c <7%; Blood pressure <130/80 mmHg; LDL-C <2.6mmol/L (diabetes without CVD) or LDL-C <1.8mmol/L (diabetes with CVD). Their out-come rates were compared before and after treatment 60 months. After comprehensive management, the joint outcome rate in the intensive group increase from 2.7% to 40.91%, which was signifi cantly higher than that in the standard group and leading international community level. The control rates of fasting plasma glucose, glycolated hemoglobin and blood pressure in the intensive group were increased from 54.1% to 75.4%, 40.0% to 70.9% and 68.2% to 86.8%, respectively. The differences were statistically sig-nifi cant. Moreover the outcome rate of HbA1c was higher in the intensive group than that in the standard group. Community health care combined with hospital integrated model could improve the joint outcome rate and HbA1c effectively. High joint outcome rate (40.91%) in this study due to the intensive multifactorial interventions in diabetic patients in Beijing.

Supported By: Capital Medical Development Foundation of China (2007-1035); Health Special Funding for Capital Development (2011-2005-01); International Dia-betes Federation (Z151100004015021)

2393-PUBWITHDRAWN

2394-PUBFavorable Performance of Noninvasive Diabetes Risk Score for the Diabetes Diagnosed by the Current CriteriaTAKAHIRO MIYAKOSHI, KEISHI YAMAUCHI, KAZUKO HIRABAYASHI, HIDEO KOIKE, TORU AIZAWA, Matsumoto, Japan

For the fi rst time, we created diabetes risk score (RS) on the basis of the current diagnostic criteria of diabetes. We analyzed the data from 4,233 health examinees without diabetes at baseline (men/women 2,753/1,480 and the mean age 52 yrs). Development of diabetes, if any, was ascertained by 75 g OGTT and HbA1c measurement or diagnosis by an attending physi-cian. During the mean follow-up period of 4.8 yrs, 165/4,233 (3.9%) have developed diabetes. Candidate baseline risk factors-male gender, physi-cal inactivity, family history (FH) of diabetes, aging, smoking, high systolic blood pressure (SBP), BMI, FPG, 2hPG, HbA1c and serum triglycerides and LDLc, and low HDLc levels- were examined for their signifi cance by logis-tic regression analysis (LRA). By the random assignment, the study subjects were divided into Derivation and Validation cohorts (1/2 each). RS1 was cre-ated using the results of LRA with non-invasive variables. RS2 was obtained using the results of LRA with the above listed variables minus 2hPG, and RS3 was generated by LRA with all the listed variables (Table). Performance of non-invasive RS (RS1) was reasonably good compared to the previous scores in which diabetes was diagnosed with the conventional criteria. Addition of biochemical data further improved the performance (RS2 and RS3). We envi-sion the risk scores, especially RS1, to serve as a tool for early intervention of the disease.

and women in Fukuoka were less than 50% of those observed in Framing-ham (P<0.001). However, the diabetes prevalence rate in Fukuoka men at 13.3% was twice as high (P=0.002) as the rate in Framingham men at 6.5%, while these rates were similar at 4.2% for Fukuoka women and 4.4% for Framingham women (P=0.977). Median BMI and waist circumference values in men and women in Fukuoka were signifi cantly (P<0.001) lower than those in Framingham. Median insulin levels in men and women in Fukuoka were about 50% lower (P<0.001) than in Framingham, as were median values for homeostasis model assessment of insulin resistance, adiponectin, and beta-cell function (all P<0.001). These population differences were still observed after subjects were stratifi ed by glucose homeostasis. Our overall data indi-cate that there is signifi cantly less obesity, prediabetes, insulin, and insulin resistance in Japanese than in Americans, which are consistent with prior studies. However men in Fukuoka have twice the prevalence rate of diabe-tes, which in our view is due to insulin defi ciency as compared to Framing-ham men.

Supported By: United States Department of Agriculture

2390-PUBRemnant Cholesterol Predicts the Development of Type 2 Diabetes Mellitus in Patients with Established Coronary Artery DiseaseCHRISTOPH H. SAELY, PHILIPP REIN, ANDREAS LEIHERER, ALEXANDER VON-BANK, DANIELA ZANOLIN, HEINZ DREXEL, Feldkirch, Austria, Triesen, Liechten-stein, Philadelphia, PA

Remnant cholesterol recently has attracted interest as a marker of cardio-vascular event risk and is associated with the metabolic syndrome as well as with type 2 diabetes (T2DM). However, it is unknown whether remnant cholesterol also predicts the development of diabetes in patients who do not have diabetes yet. We prospectively recorded incident diabetes over 6.1±3.7 years in 861 consecutive nondiabetic Caucasian patients with angiographi-cally proven coronary artery disease (CAD). Diabetes was diagnosed accord-ing to ADA criteria. At baseline, 41.3% of our nondiabetic CAD patients had impaired fasting glucose (IFG); remnant cholesterol was signifi cantly higher in IFG than in NFG patients (23±21 vs. 19±22 mg/dl; p<0.001). During follow-up, diabetes was newly diagnosed in 111 patients, i.e., in 12.9% of the study population. Remnant cholesterol strongly predicted diabetes both univari-ately (OR 1.88 [1.56-2.27]; p<0.001) and after multivariate adjustment includ-ing both fasting glucose and HbA1c values (OR 1.40 [1.40-2.11]; p<0.001). We conclude that the incidence of diabetes is high in patients with established CAD and that remnant cholesterol strongly and independently predicts the development of diabetes in this population.

2391-PUBConcordance of Glucose-based and of HbA1c-based Diagnoses of Diabetes in Patients with Peripheral Arterial Disease: A Compari-son between Men and WomenCHRISTOPH H. SAELY, DANIELA ZANOLIN, PHILIPP REIN, ANDREAS LEIHERER, ALEXANDER VONBANK, HEINZ DREXEL, Feldkirch, Austria, Triesen, Liechtenstein, Philadelphia, PA

Concordance between glucose-based and HbA1c-based diagnoses of diabetes differ between populations. Here, we aimed at investigating their concordance in men and in women with peripheral arterial disease (PAD). We measured fasting glucose as well as HbA1c and performed 75g oral glu-cose tolerance tests in 282 consecutive patients, 197 men and 85 women, who had sonographically proven PAD but not previously diagnosed diabetes. Based on glucose values, diabetes was diagnosed with fasting plasma glu-cose (FPG) ≥126 mg/dl or post-challenge glucose ≥200 mg/dl 2 hours after the oral glucose load; based on HbA1c values diabetes was diagnosed with HbA1c ≥6.5%. Among men, 25 had diabetes based on glucose criteria, of whom 13 also had diabetes according to the HbA1c criterion. Of the 172 men who did not have diabetes according to glucose criteria, 165 also did not have diabetes using HbA1c criteria; among women, 8 had diabetes based on glucose criteria, of whom 3 also had diabetes according to the HbA1c cri-terion. Of the 77 women who did not have diabetes based on glucose crite-ria, 74 also did not have diabetes according to HbA1c criteria. Concordance of glucose and HbA1c criteria was similar in men and women (90.6% and 90.4%; p=0.951). Applying glucose criteria as a standard, sensitivity, speci-fi city, positive predictive value (PPV) and negative predictive value (NPV) of the HbA1c criterion for men were 52.0%, 95.9%, 65.0%, and 93.2%, respec-tively. For women, sensitivity, specifi city, PPV and NPV of the HbA1c criterion were 37.5%, 96.1%, 50.0%, and 93.7%, respectively. We conclude that the concordance of glucose and HbA1c criteria among patients with PAD is high and is similar in men and women. However, for both sexes the sensitivity of the HbA1c criterion is poor in this patient population.

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1.70 (95% CI: 1.58-1.83), which was signifi cantly lower than that in the latter studies (4.09, 95% CI: 3.19-5.25). Substantial heterogeneity was observed in the former studies (I2 = 50.1%, P = 0.024) and moderate heterogeneity was observed in the latter studies (I2 = 34.7%, P = 0.216). No evidence of publica-tion bias was detected. The risk of T2DM with NAFLD in our previous knowl-edge might be underestimated due to the absence of 2 h PPG test.

Supported By: Natural Science Foundation of Shaanxi Province, China

2397-PUBOGTT (0-120) with Insulin Values Allows Obtaining Reliable Indices of Insulin Sensitivity and Insulin SecretionALESSANDRO GUALERZI, ANTONELLO GIBBIN, MATTIA BELLAN, MICHELA GENTILE, SERENA FAVRETTO, GIAN P. CARNEVALE SCHIANCA, MARIO PIRISI, Novara, Italy

The evaluation of insulin sensitivity (IS) and insulin secretion (ISE) provides additional informations on glucose tolerance, well characterized by OGTT (0-120). These informations can be obtained with the clamp techniques (gold standard), not feasible in the clinical setting, or can be derived from OGTT, measuring blood glucose (G) and insulin (I) values (surrogate measures).In research context, OGTT-derived indices including intermediate values (mea-sured at time 30’, 60’ and 90’) are often used, being considered better corre-lated to the clamp techniques than the standard OGTT (0-120). In this study we aimed to compare some IS and ISE indicators obtained from OGTT (0-120) with other OGTT-derived indices, acquired from a complete OGTT (5 times).

We considered 63 OGTT (5 times): 22 were conclusive for normal glucose tolerance, 21 for prediabetes and 20 for diabetes. Using baseline G and I we calculated HOMA-R and HOMA-B. Considering also the intermediate values we calculated ISI-Matsuda and ISI 60’-Stumvoll (indices of IS) and insulino-genic index (IGI), early-insulin secretion (ISP 60’ Stumvoll) and the ratio of the increment in insulin concentration to the increment in glucose concentration (ΔI/ΔG) (indices of ISE). Using the OGTT (0-120) we calculated ISI-Belfi ore, ISI-Gutt and ISI-Stumvoll as indices of IS and ISP-Stumvoll as index of ISE.

All the IS indices (0-120) correlate signifi cantly with ISI-Matsuda (p <0.0001). Correlations (r) ranged from 0.51 (ISI-Gutt) to 0.74 (ISI-Belfi ore) and was neg-ative with HOMA-R (r=-0.70, p <0.0001). Regarding the indices of ISE, ISP-Stumvoll (0-120), but not HOMA-B, correlated signifi cantly with IGI-30’, IGI-60’, ISP 60’ Stumvoll and ΔI/ΔG, (r ranging from 0.34 to 0.85, p <0.0001).

A reliable and accessible evaluation of IS and ISE can be obtained with a single test, the OGTT (0-120), if implemented with the simultaneous measure-ment of insulin values.

2398-PUB“OGTT-Plus”: A Web-Calculator to Determine Various Indices of Insulin Resistance and Glucose HomeostasisSURESH N. SHINDE, RITUPARNA S. SHINDE, VISWANATHAN MOHAN, Pune, India, Chennai, India

Oral Glucose Tolerance Test with insulin levels (OGTT-Plus) has been used extensively to assess the insulin resistance (IR) and various indices have been proposed and validated. Calculating these indices, though very useful in diagnosing and managing patients, is error-prone and time consuming. Though HOMA and Matsuda web-calculators are already available, a need was felt for a single page all-inclusive calculator. Therefore, we created an excel worksheet and converted the same into a web-application which works on all browsers on any computer or mobile device with internet connection. It calculates the HOMA1 and Matsuda IR indices, the HOMA and ISSI-2 dis-position indices, as well as the Insulinogenic index. In addition to this it also plots graphs of glucose and insulin level curves against the background of expected normal curves. After analyzing the results, the application gener-ates explanatory comments highlighting the present status of hepatic and whole body IR, the insulin secretion status and the pancreatic beta-cell function at that degree of glucose tolerance. Finally, the OGTT analysis of the glucose tolerance status is suggested. Using this application, newly screened patients can be grouped into following thirteen categories such as “DM, DM-IFG, DM-NFG, DM-IGT, IGT, IFG, IGT+IFG, IR30, IR60, IR3060, IRMatsuda, IRHepatic and NoDM.” The results are formatted on to A4 size paper for printing. Three hundred nondiabetic patients were screened with “OGTT-Plus.” The analysis revealed following category distribution, DM (52), DM-IFG (26), DM-IGT (7), DM-NFG (7), IFG (30), IFG-IGT (35), IGT (31), IR30 (19), IR3060 (33), IR60 (13), IRHepatic (4), IRMatsuda (20), NoDM (23). A road-map to “Destination Diabetes” using these categories is proposed. As this calculator cannot store the patient data, this facility, is provided in a MS excel fi le which is provided free for download-on-demand. This web-calcula-tor is available at www.ogttplus.com and is in Public Domain.

Table. Characteristics and Performance of the Three Risk Scores (RS).

2395-PUBPrevalence and Outcomes of Patients with Diabetes Mellitus in Haematology and Oncology Units: An 18-Month Study of Austin Health Diabetes Discovery InitiativeWEI-LING CHIU, LEONID CHURILOV, CHEE-HAU LIM, ALVIN KONG, PETER DAVEY, RAYMOND ROBBINS, HARVEY SUTCLIFFE, QUE LAM, NATALIE NANAYAKKARA, ANDREW LEE, ADRIAN LIO, JEFFREY D. ZAJAC, ELIF I. EKINCI, Melbourne, Aus-tralia

There is limited data regarding the prevalence of diabetes mellitus (DM) among patients with haematological and oncological conditions. The use of HbA1c to diagnose DM in hospital has potential benefi ts, as there is no need for fasting and it is less likely to be affected by stress hyperglycaemia.

We aimed to determine the prevalence of DM and to assess hospital out-comes of patients with DM in Haematology and Oncology Units. Using the Cerner Millennium Health IT Platform, routine HbA1c testing was performed in all patients aged >54 years admitted to Austin Health, a tertiary hospital, as part of the Diabetes Discovery Initiative between June 2013 and January 2015. DM was diagnosed in patients with HbA1c 6.5%. Clinical and demo-graphic characteristics were obtained from medical records.

Over the study period, 1076 inpatients were admitted to Haematol-ogy (n=298) and Oncology (n=778) units: 21% (n=231) and 8% (n=84) of this cohort had known and unrecognised DM, respectively. After adjusting for specialty unit, comorbidity score, age, haemaglobin and estimated glomeru-lar fi ltration rate, patients with known DM had signifi cantly longer length of stay (IRR=1.2; 95% CI:1.0-1.4; p=0.032), and higher likelihood of having multiple admissions, compared to those with no DM (167/231 (72%) vs. 500/761 (66%); IRR=1.4; 95% CI:1.0-1.9; p=0.047). No signifi cant differences in ICU admissions, 30-day readmissions and mortality rates were observed between patients with and without DM.

To conclude, approximately a third of Haematology and Oncology inpa-tients aged >54 years had DM. Patients with known DM tend to stay longer with multiple admissions, compared to those with no DM. Further study is currently being undertaken to assess the rates of glucocorticoid exposure.

2396-PUBThe Risk of Type 2 Diabetes Mellitus Associated with Nonalcoholic Fatty Liver Disease Might Be Underestimated: A Systematic Review and Meta-analysisSHAOYONG XU, JIE MING, QIUHE JI, Xi’an, China

Most previous cohort researches focusing on the association of nonal-coholic fatty liver disease (NAFLD) and the risk of type 2 diabetes mellitus (T2DM) did not use 2-hour postprandial glucose (2 h PPG) test to diagnose T2DM. We thus hypothesized that the risk might be underestimated. We searched electronic database (Pubmed, Embase and Web of Science) up to November 2015. Only cohort studies in which the presence of NAFLD was assessed by standard objective measurements, the exposure of interest was T2DM, and the outcome of interest was the incidence of T2DM were included. The adjusted risk estimate and 95% confi dence interval (CI) were extracted and pooled by using a random effect model. Sensitivity analyses were conducted; heterogeneity and publication bias were assessed. Over-all, 21 articles which identifi ed 15 studies (21569 patients with NAFLD and 52867 subjects with no NAFLD) were included. Of them, 12 were studies without suffi cient ascertainment of diabetes and 3 were studies with suf-fi cient ascertainment. The pooled risk estimate in the former studies was

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EPIDEMIOLOGY—DIABETES COMPLICATIONS

and 51.4%, respectively. The κcoeffi cients were 0.823 and 0.73 respectively. By using HbA1c ≥6.1% as the cutpoint, the prevalences of MS (IDF) and MS (ATPIII) were 34.4% and 38.1%, respectively. The agreement between use of HbA1c alone or FPG alone were 96.3% and 93.9%, respectively. The optimal HbA1c threshold with the highest level of agreement according to IDF and ATPIII criteria were 6.1% and 6.3%, respectively. These results suggested HbA1c may be used to defi ne MS. The optimal HbA1c threshold may vary according to different criterias.Table 1. Impact of Different HbA1c Thresholds to Defi ne Metabolic Syn-drome in Nondiabetic Subjects.

Supported By: Science and Technology Planning Project of Guangzhou City ([2014]151)

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2404-PUBA Predictive Model for Identifying Individuals with Diabetes at High Risk of Progression Using Diabetes Complication Severity IndexJING FAN, YANTING DONG, VINAY CHIGULURI, WILLIAM GLASHEEN, ANDREW RENDA, TODD PREWITT, VIPIN GOPAL, Louisville, KY

Diabetes is a serious metabolic condition that is highly prevalent and may lead to may serious complications of various body systems. Proper treat-ment and lifestyle changes could prevent or slow the development of the complications associated with diabetes. In this work, a predictive model was developed using health insurance administrative claims data with addi-tional demographic and socioeconomic data to proactively identify people with diabetes who are at high risk for disease progression in a population insured by a Medicare Advantage health plan. Diabetes progression was quantifi ed by the 13-point Diabetes Complication Severity Index (DCSI) using diagnosis of seven complications and their severity. The DCSI for the next 12 month was the prediction target for the model. More than 3,000 features, including cost and utilization for different clinical, behavioral and functional conditions, temporal features to capture changes over time, socioeconomic profi les and other pertinent data, were extracted from above data sources to provide a comprehensive profi le of individuals with diabetes. Various fea-ture transformation and selection, and machine learning algorithms includ-ing neural network, regression, LARS (least angle regression) and decision tree, were applied to capture the relationship between the member level risk profi les and future DCSI. C-statistics from testing dataset of 1.5 million sam-ples were used to measure model performance and select the fi nal model. The selected model achieved a C-statistics of 0.79 to predict individuals with

2399-PUBGlycemic Indices Variability in DiabetesGABRIEL UWAIFO, New Orleans, LA

HbA1c is the established index of glycemic (gly) control in diabetes (dm). Recent reports suggest variable degrees of glycation in different ethnic pop-ulations despite equal gly burdens. The differences between HbA1c, fruc-toseamine (frc) and glycomark (glym) and variability determinants was inves-tigated in dm patients (pts) for 1 yr.

All dm pts in our endocrine practice over 1 yr with at least one set of concurrent HbA1c, frc and glym had their clinical records reviewed. Retro-spective chart reviews were done to obtain mean glucose (MG), fasting glu-cose (FG), estimated average glucose (EAG) and demographic data. Further-more, lab data including hematocrit (hct), hemoglobin (hb), serum protein (pr) and albumin (alb) were obtained. Data analyses was done using JMP In.

96 pts records were reviewed. 52 were female and 73% were Caucasian (C) and 21% were African American (AA). The mean age; 61+/-12.7 yrs, mean BMI 33.2 +/-7.94kg/m2, mean HbA1c 7.5 +/-1.4%, mean frc 294 +/-67.3umol/L and mean glym 6.98 +/-6.8ng/ml. Actual glucose measures were FG; 157.5 +/- 68.3, EAG 170.3 +/-39.8 and MG 163.2 +/- 46.5 (all mg/dl). Frc had the best correlation to gly measures followed by HbA1c and then glym. Mul-tivariate modeling analysis showed that while the dominant single determi-nant of HbA1c variability are gly measures, frc is also signifi cantly infl uenced by weight and BMI while glym is also signifi cantly infl uenced by hb and hct. While there were no signifi cant ethnic differences in FG and MG, AA had sig-nifi cantly higher HbA1c, Frc and glym levels. Though HbA1c is the established index for gly tracking in diabetes other indices like the glym and frc offer additional information and in certain populations and settings may provide better correlation to actual glyc load. There appear to be signifi cant ethnic differences in gly indices which are not due to gly load whether FG or MG and need further characterization. The degree of these non glyc driven dif-ferences in pre dm vs. dm as well as the potential implications for thresholds and degree of complications needs in-depth study.

2400-PUBDiabetes Awareness among Coronary Artery Disease Patients Dif-fers Signifi cantly between Men and WomenCHRISTOPH H. SAELY, KARL-MARTIN EBNER, DANIELA ZANOLIN, PHILIPP REIN, ALEXANDER VONBANK, ANDREAS LEIHERER, HEINZ DREXEL, Feldkirch, Austria, Triesen, Liechtenstein, Philadelphia, PA

We aimed at investigating diabetes awareness among men and women with established coronary artery disease (CAD). We enrolled a total of 814 consecutive patients with angiographically proven CAD, 587 men and 227 women. Fasting glucose and HbA1c were measured and oral glucose tests were performed in all patients who did not report a history of diabetes. Overall, 74 men and 28 women (12.6 and 12.3%, respectively) reported a history of diabetes. Based on glucose criteria only (fasting plasma glucose ≥126 mg/dl or glucose ≥200 mg/dl two hours after a 75g oral glucose chal-lenge), diabetes was newly diagnosed in 33 men and 3 women (5.6 and 1.3%, respectively); when also HbA1c values ≥6.5% were considered for diabetes diagnosis, diabetes was newly diagnosed in 67 men and 13 women (11.4 and 5.7%, respectively). Thus, among those with diabetes, the proportion of newly diagnosed diabetes was higher in men than in women both when only glucose criteria and also when additionally the HbA1c criterion was applied for the diagnosis of diabetes (30.8 vs. 9.7%; p=0.007 and 47.5 vs. 31.7%; p=0.014; respectively). We conclude that among CAD patients with diabetes signifi cantly more women than men are aware of their condition.

2401-PUBUtility of Glycated Hemoglobin to Defi ne Metabolic Syndrome in Nondiabetic Chinese Aged over 50 YearsSHUO LIN, XIAOFENG LI, BILIAN ZHU, PING LI, KEYI LIN, LI HU, PANWEI MU, YAN-MING CHEN, LONGYI ZENG, Guangzhou, China

Our study aims to compare the use of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) to defi ne metablic syndrome (MS) in non-diabetic Chinese. A community-based cross-sectional survey was conducted from Oct 2010 to Jan 2011 in Shipai community, Guangzhou, China. A total of 1494 subjects (72.8%) over 50 years old were investigated. Physical examination and blood sample were performed among all subjects. MS was defi ned by IDF and ATPIII (2005) criteria, respectively. After excluding dia-betic patients and subjects with missing data, the remaining 1201 subjects (40.0% male) had mean age 61.6±8.7 years, FPG5.0±0.7mmol/l. Of them, 428 (35.6%) and 474 (39.5%) subjects were identifi ed with MS according to the IDF and ATPIII crtieria, respectively (Table 1). Using HbA1c ≥5.7% as defi ni-tion of dysglycemia, the prevalences of MS (IDF) and MS (ATPIII) were 43.3%

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Figure 1. Use of DN-related Treatments During the 6 Months Following Index.

Supported By: Takeda Development Center Americas, Inc.

2407-PUBClinical Study of Fungal Sinusitis with Ophthalmologic Compli-cations in Diabetes MellitusSUMA RADHAKRISHNAN, RADHAKRISHNAN CHANDNI, N.V. ANUSREE, Kozhi-kode, India

Diabetes is fast gaining the status of a potential epidemic in India and the incidence of fungal sinusitis is also on the rise. The aim of this study is to describe the demographic, clinical and radiological fi ndings of patients with invasive and non-invasive fungal sinusitis presenting with ophthalmologic complications and to analyze the outcome. This was a prospective study done at Government Medical College Hospital, Calicut, Kerala, India from April 2008 to April 2015. A total of 30 diabetic patients with ophthalmo-logic complications having a fi nal diagnosis of fungal sinusitis were stud-ied. These patients were analyzed for clinical profi le, duration and control of diabetes mellitus, clinicoradiological correlation and treatment outcome. In this study, 72% were with invasive fungal sinusitis, of which 90% were in the age group 50-70 yrs, with an uncontrolled glycemic status. All of them were presented with either optic nerve involvement or ophthalmoplegia or in combination. None of them had nasal symptoms except in two who had only nasal obstruction. Radiologically direct orbital involvement was seen only in 41.7%. 57% had defi nite evidence of bone erosion at presentation. Prompt and multiple surgical debridement and antifungal therapy gave better results in invasive fungal sinusitis. Fungal sinusitis is now reported with increasing frequency throughout the world with an expanding spec-trum of pathogens. In this study even though early symptoms and signs of fungal rhino sinusitis were nonspecifi c, early diagnosis and prompt treat-ment was life saving. Outcomes are signifi cantly more favorable for those patients with early diagnosis, prompt surgical and medical management and who have reversible predisposing factors that can be rapidly managed. Poor prognostic factors are immuno suppression, poor glycemic control, HbA1c more than 9%, multiple sinus involvement, nature of organism-mucor and intracranial involvement.

2408-PUBTo Validate Wrist Circumference as a Simple, Noninvasive Anthro-pometric Marker of Insulin Resistance in Overweight and Obese Nondiabetic, Nonhypertensive North Indian AdultsSHALINI JAGGI, SUDHISH SEHRA, MUGDHA SINGH, New Delhi, India

Introduction: There is need for developing simpler, inexpensive and non invasive anthropometric measure as clinical marker of insulin resistance identifying high risk individuals in source deprived countries.

Aims and Objectives: This is a prospective, non interventional, observa-tional, Unicentre study done in a tertiary care hospital:

1. To validate wrist circumference (WrC) as simple, effective anthropo-metric marker of insulin resistance in overweight, obese nondiabetic and non-hypertensive adults.

2. And to correlate WrC with the pre-established markers of insulin resis-tance namely waist (WC), hip and neck circumference (NC), WHR, waist height ratio (WHtR), BMI and HOMA-IR.

Material and Methods: Anthropometric measurements done in 100 adults with BMI≥23kg/m2 but no self reported Diabetes or Hypertension, including WC, NC, WrC, hip circumferences, WHR, WHtR and BMI using WHO speci-fi ed methods. Adults with BMI <23 kg/m2, FBS≥126mg/dl and BP≥130/80 mm were excluded. FBS, fasting serum insulin levels and insulin resistance were evaluated by the HOMA-IR. Statistical analysis was performed by the SPSS program for Windows, version 17.0 (SPSS, Chicago).

low DCSI (DCSI <4) progressing to a higher severity and a C-statistics of 0.90 to predict individuals with DCSI <8 at risk for progression. This model can be a valuable tool for early identifi cation of individuals with diabetes who are at high risk for progression and hence good candidates for interventions designed to slow or prevent disease progression thereby improving clinical outcomes.

2405-PUBPrevalence and Risk Factors of Periodontitis among Adults With or Without Diabetes MellitusTAE SEO SOHN, MIHEE HONG, HANNAH SEOK, KYUNG PYO LEE, KYUNG MO YANG, WOO JOONG KIM, YONG WOOK CHO, Uijeongbu, Republic of Korea

The aim of this study is to examine the prevalence and risk factors of periodontitis under the condition of diabetes mellitus (DM) in representative samples of Korean adults. The total of 4,477 adults (3,860 adults without DM (non-DM group) and 617 adults with DM (DM group)) over 30 years old was evaluated. The data was from Korean National Health and Nutritional Exam-ination Survey in 2012. Community Periodontal index was used to assess the status of periodontitis. Risk factors for periodontitis were compared in each group.The mean age was 49.8 years old with BMI 24 and number of teeth 24.9. The prevalence of periodontitis in DM group was 30 ± 1.2%, which was higher than 25 ± 1.2% of non-DM group (P < 0.0001). In non-DM group, asso-ciated factors for periodontitis were age, male, low education, low income, and rural habitation (P < 0.05). In DM group, associated factors were male and low education (P < 0.05). HbA1c, lipid profi les, and DM duration were not different. Using multiple logistic regression, we estimated odds ratio [OR (95% confi dence limit)] for independent risk factors for periodontitis. In non-DM group, associated factors for periodontitis were age [1.035 (1.025, 1.046)], male [1.644 (1.269, 2.131)], urban habitation [1.737 (1.229, 2.455)], waist circumference [1.014 (1.001, 1.028)], smoking [1.583 (1.215, 2.062)], and oral pain [1.486 (1.186, 1.861)], and tooth brushing frequency was inversely associated [0.777 (0.671, 0.899)]. In DM group, risk factors of periodonti-tis were smoking [1.939 (1.003, 3.751)] and oral pain [2.383 (1.4600, 3.888)]. Using oral hygiene product was inversely associated [0.505 (0.309, 0.826)]. Smoking is associated with periodontitis regardless of DM. Tooth brushing is inversely associated with periodontitis in adults without DM. Using oral hygiene product is inversely associated with periodontitis in adults with DM. In addition to tooth brushing and non-smoking, “oral hygiene product” can reduce periodontal disease in adults with DM.

2406-PUBReal-World Treatment for Diabetic Nephropathy (DN) in Patients with Type 2 Diabetes Mellitus (T2DM) PARESH CHAUDHARI, ZHOU ZHOU, HONGBO YANG, JING ZHAO, ERIC WU, RAAFAT SEIFELDIN, Deerfi eld, IL, Boston, MA

Severity of DN can be classifi ed as microalbuminuria (MiA) and macro-albuminuria (MaA). This study compared characteristics and DN-related treatment use of T2DM patients with MiA or MaA to those without DN. Adults (age 18+) with T2DM and ≥2 urine albumin (UA) tests were identi-fi ed in the Truven MarketScan claims database (2003-2014). Patients were classifi ed into distinct cohorts (MaA, MiA, normal [N)] based on a randomly selected UA test result (index). Patient characteristics were assessed during the year before index (baseline); DN-related treatment use was assessed during the 6 months post-index. MiA and MaA patients were mean 55 and 56 years of age, respectively, both more likely to be male, had a longer observed T2DM duration (MiA: 41; MaA: 44; N: 38 months), increased use of diabetic treatments (MaA: 88%; MiA: 87%; N: 82%), and a higher comor-bidity burden in conditions such as neuropathy and ischemic heart disease (MaA: 23%, 20%; MiA: 16%, 16%; N: 13%, 12%), compared to the normal cohort at baseline (all P<0.05). Increasing DN severity was associated with increased use of DN-related treatments after index (Figure 1). Compared to the normal cohort, more patients with MiA or MaA used angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, diuretics, and calcium channel blockers, as well as other antihypertensives. The results highlight the variety of agents that are used to treat DN.

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EPIDEMIOLOGY—NUTRITION

2410-PUBSerum Uric Acid Is an Independent Risk Factor for Metabolic Syn-drome in Nonobese Chinese PopulationQIN LI, BING HAN, NINGJIAN WANG, YINGLI LU, Shanghai, China

This study was designed to evaluate if elevated serum uric acid (SUA) levels are associated with higher risk of metabolic syndrome (MetS) in nonobese Chi-nese population. Our data were obtained from a cross-sectional survey on the prevalence of metabolic diseases and risk factors in East China in 2014. Sub-jects with a BMI≥18.5 kg/m2 and<25 kg/m2 were considered normal weight. Metabolic and anthropometric indicators were measured according to stan-dard methods. A total of 1863 participants with a mean age of 49.33±13.99 years were identifi ed for analysis. SUA quartiles were defi ned as: Q1: <240µmol/L; Q2: 241-286µmol/L; Q3: 287-344µmol/L; Q4: >345µmol/L. MetS was diagnosed based on the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. Independent predictors of MetS were identifi ed by multiple logistic regressions. The overall preva-lence of MetS was 14.12% in this study population and the prevalence was similar in men as in women (13.58% vs. 14.46%, P>0.05). The mean SUA was greater in MetS subjects compared with control participants (289.93±73.41 vs. 335.16±92.24µmol/L, P<0.01). Partial correlation analysis demonstrated strong correlation between SUA and BMI, neck circumference, waist circumference, blood pressure, HOMA-IR, creatinine, TC, TG and LDL cholesterol after adjust-ment for age and sex. In contrast, SUA levels were negatively correlated with eGFR and HDL cholesterol. The prevalence of MetS raised across the uric acid quartiles, the trends was still existed even after further adjustment for poten-tial confounders. In the highest uric acid quartile, the ORs were 3.57 [95% confi dence interval 2.06-6.18] (P < 0.001 for trend) for MetS compared to the lowest quartile of uric acid level after multiple adjustment. SUA is an indepen-dent risk factor for MetS in nonobese Chinese population.

Supported By: National Natural Science Foundation of China (81270885, 81070677, 81400796)

2411-PUBDevelopment of a Tool to Assess First Graders’ Knowledge of Diabe-tes and Healthy LifestylesSALIM H. SURANI, MOINUDDIN H. MOKHASHI, JOSE H. GUARDIOLA, SAHER-ISH SURANI, SEAN HESSELBACHER, JAHAZANIA RIOS, ZOYA SURANI, Corpus Christi, TX, Morgantown, WV

Introduction: The prevalence of childhood obesity is rapidly increasing, and has implications for diabetes, asthma, sleep apnea and a number of other long-term diseases. We aimed to gather baseline information about health habits from children in fi rst grade (typically 6-7 years of age). Our purpose was to develop a new questionnaire (iConquer Program) to assess this knowledge, since no validated tool existed for this purpose in this age group.

Methods: The entire fi rst grade class at a local elementary school com-pleted a 32-item questionnaire. The fi rst 5 questions addressed basic infor-mation; the remaining 27 questions covered healthy food choices, exercise and basic diabetes knowledge. The questionnaires were completed using the iClicker classroom response system (MPS, Gordonsville, VA). The stu-dents then completed the questionnaire in an identical manner 5 days later without specifi c intervention/education.

Results: The questionnaire was at least partially completed by 66 fi rst graders. Questions involving healthy choices (24 questions) were answered correctly 78% of the time overall (range 8-94%) and had 84% agreement on repeat testing (range 64-93%); 6% of the questions were not answered. Questions on diabetes (3 questions) were answered correctly 79% of the time overall (range 65-94%) and had 85% agreement on repeat testing; 7% of the questions were not answered.

The Cronbach’s alpha coeffi cient ranged between 0.7851 and 0.8127 for the fi rst day questionnaires, with mean for the set being 0.8021. The Cron-bach’s alpha coeffi cient ranged between 0.8365 and 0.8675 for the fi fth day questionnaires, with mean for the set being 0.8494.

Conclusions: The iConquer Program (fi rst grade) questionnaire reliably assesses the knowledge of 6-7 year-old children on healthy lifestyles knowl-edge and the basic understanding of diabetes.

2412-PUBIdentifying a Dietary Pattern Associated with Metabolic Syndrome by Reduced Rank Regression in Japanese Male WorkersAKIKO HATA, KOJI YONEMOTO, NANAKO AKI, TOHRU SAKAI, EMI SHUTO, TAK-AYUKI NAKAO, MASASHI MIYOSHI, MAKOTO FUNAKI, Tokushima, Japan, Fuku-oka, Japan

Previous epidemiological studies have shown that certain nutrients and foods are associated with metabolic syndrome (MetS). However, since

Results: Amongst 100 subjects mean age was 45.34± 8.81 years, 34 females 66 males. 12% were overweight and 82% obese. 61% subjects were insulin resistant with mean HOMA-IR of 3.35± 2.07. All four evalu-ated parameters i.e., NC (r=0.408, p<0.001), BMI (r=0.376, p<0.001), WHtR (r=0.364, p<0.001) and WrC (r=0.343, p<0.001) showed signifi cant correla-tion with HOMA-IR.

Conclusion: NC, BMI and WHtR were promising anthropometric indicators for assessing IR.

Cut-off for NC was 37.25cm in males, 35.30cm in females. WHtR 0.55 for males and 0.60 for females.

WrC was signifi cant only in males with a cut-off of 15.75 cm not in females.

We recommend larger prospective studies to validate wrist circumference as an anthropometric marker of insulin resistance.

EPIDEMIOLOGY—NUTRITION

2409-PUBDietary Habit Rich in Salt Is Closely Associated with the Prevalence of Diabetes in Females, Not in Males, within Rural Areas of JapanJUNKO UMEZU, ERI YAKUSIGAMI, YOKO AOKI, RIE MASUYA, YUKA SAKAMOTO, SAKI KONO, TAEKO HASHIMOTO, YASUYO OGIMORI, AYA NAKAGAWA, TAK-ENORI SAKAI, AIZAN HIRAI, MICHIYA ISHIKIDO, Minano, Japan, Yawatahama, Japan, Ichihara, Japan

Sodium consumption of Japanese people exceeds that in western coun-tries and the WHO recommendation. High sodium intake is reported to potentiate the risk for renal and/or cardiovascular complications in diabetic patients. However, it has not been determined yet whether dietary habit rich in salt may have any implication in the prevalence of diabetes in Japanese people. In order to clarify this issue, the present study was performed in two rural areas in Japan. In mass medical examination of residents in Minano town, the estimated daily salt intake (eDSI) was determined using Tanaka’s equation for estimating Na excretion from the fi rst morning urine in addition to regular items such as BMI, fasting blood sugar (FBS) and HbA1c. Due to the value of eDSI, examined residents were divided to two groups, i.e., high salt group (HS; eDSI >10g/day) and low salt group (LS; eDSI<10g/day). In female, not in male, BMI, FBS, HbA1 and the prevalence of diabetes in HS group are signifi cantly higher than those in LS group (Table 1). In Yawatahama City, a food intake survey was conducted in 102 health women in addition to the determination of eDSI, Dietary intake of total calorie, carbohydrate, protein and fat in HS group are signifi cantly higher than those in LS group (Table 2). The present fi ndings may provide a new insight into population approach for the prevention of diabetes and its complications in Japan.Table 1. Comparison of Estimated Daily Salt Intake, BMI, FBS, HbA1c, and the Prevalence of Diabetes in the Residents of Minano Town.

Table 2. Comparison of Estimated Daily Salt Intake and Dietary Intake of Total Calorie, Carbohydrate, Protein, and Fat in the Female Residents of Yawatahama City.

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EPIDEMIOLOGY—OTHER

nutrition patterns and T2DM in Nepal despite evidence that the prevalence of diabetes is increasing dramatically.

Objective: The objective of this study was to assess the associations between type 2 diabetes and major dietary patterns derived using principal component analysis in suburban Nepal.

Methods: This cross-sectional study was conducted among 479 adult participants (18 years or above) of the Dhulikhel Heart Study, who provided blood samples in the baseline survey. Dietary intake information was col-lected through a validated semi-quantitative food frequency questionnaire (FFQ). Principal component analysis identifi ed four major dietary patterns (mixed, fast food, refi ned grains-meat-alcohol, solid fats-dairy). Type 2 diabe-tes was defi ned as glycated hemoglobin (HbA1c) of 6.5% or higher. We used generalized estimating equations (GEE) with multivariate logistic regression (with household as cluster), exchangeable correlations and robust variance to assess the association between the derived dietary patterns and type 2 diabetes adjusting age, sex, ethnicity, religion, marital status, income and education, alcohol consumption, smoking, physical activity, blood pressure, total cholesterol, triglyceride, and high density lipoprotein.

Results: Type 2 diabetes was positively associated with the refi ned grains-meat-alcohol pattern (aOR 1.18, 95% CI: 0.93 -1.49), and fat and dairy pattern (aOR 1.17, 95% CI: 0.89 -1.54). However, the associations were not statistically signifi cant (p>0.05). There was no signifi cant effect modifi cation by age, sex, and body mass index in the association between the food pat-terns and type 2 diabetes (p>0.05).

Conclusions: Our fi ndings were inconclusive regarding the association between the derived dietary patterns and type 2 diabetes. The hypothesis should be tested in a larger sample.


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2417-PUBHypertensive Disorders of Pregnancy in Women with Gestational Diabetes Mellitus on Overweight Status of Their ChildrenSHUANG ZHANG, LEISHEN WANG, JUNHONG LENG, HUIKUN LIU, WEIQIN LI, TAO ZHANG, NAN LI, WEI LI, GANG HU, Tianjin, China, Baton Rouge, LA

Hypertensive disorders of pregnancy (HDP) as a group of medical compli-cations in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the infl uence on offspring’s body composition is not clear. The aim of the present study was to evaluate the relationship between hypertensive disorders of pregnancy and overweight status in the offspring of gestational diabetes mellitus (GDM) mothers. We conducted a cross-sectional study among 1263 GDM mother-child pairs in Tianjin, China. Hypertensive dis-orders of pregnancy were determined on the basis of self-report of doctors-diagnosed hypertension during pregnancy. Overweight or obesity was defi ned as a body mass index higher than the 85th percentiles for age and gender using the WHO growth reference. General linear models and logistic regression models were used to assess the associations of pregnancy-induced hyperten-sion with anthropometry and overweight status in the offspring from birth to 1-5 years old. Offspring of GDM mothers who were diagnosed with hyperten-sive disorders during pregnancy had higher mean values of birth weight for gestational age Z score and birth weight for length for gestational age Z score, and higher mean values of weight for age Z score, weight for length/height Z score, and body mass index for age Z score at 1-5 years old than those of GDM mothers with normal blood pressure during pregnancy. Hypertensive disorders of pregnancy were associated with increased risks of large for gestational age [ORs 95% CIs=1.74 (1.08-2.79)] and macrosomia age [ORs 95% CIs=2.02 (1.23-3.31)] at birth, and childhood overweight and obesity at 1-5 years old [ORs 95% CIs=1.83 (1.13-2.97)]. For offspring of mothers with GDM, maternal hyperten-sion during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity at 1-5 years old.

Supported By: National Institutes of Health; European Foundation for the Study of Diabetes

2418-PUBWITHDRAWN

meals comprise a combination of many types of food, a more practical way to tackle MetS would be to identify a MetS-associated dietary pattern (DP), instead. Moreover, meals affect metabolism, which would lead to altera-tions in biomarkers. Thus, the DP that most effectively explains alternations in biomarkers for MetS could be a MetS-associated DP. We here report a cross-sectional study, which was conducted during 2010-2012 in Japan. Briefl y 1,784 male workers aged 20-60 years underwent screening exami-nation. After exclusion of 566 subjects who had already eaten breakfast, did not have a blood sample or food frequency questionnaire data, or had an implausible total energy intake, the remaining 1,218 subjects were enrolled in this analysis. We established a DP related to seven biomarkers (waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, glucose, high-sensitivity C-reactive protein and total adi-ponectin) known to be associated with MetS by reduced rank regression. Furthermore, each participant’s DP score, which indicates how much one’s diet would fi t to the MetS-associated DP, was calculated and used to evalu-ate the relationship of the DP with MetS. As a result, a DP characterized by a high intake of cereals, eggs, nuts and seeds, fats and oils, spice and season-ings, and a lower intake of milk and dairy products, and confectionery was identifi ed. In multivariate analysis after adjusting for age and energy intake, OR of MetS was 2.10 [95% CI: 1.24 to 3.59, P=0.006] in the highest decile of DP score, compared with the fi rst to ninth deciles. These results suggest that the identifi ed DP is associated with prevalence of MetS in Japanese male workers, and application of the DP score to lifestyle intervention may become an effective countermeasure against MetS.

2413-PUBMetabolic and Dietary Factors Associated with Abnormal Glucose Metabolism in Brazilian Adults: A Community-based StudyKATIA MCLELLAN, HUGO KANO, RODRIGO MANDA, JOSE EDUARDO CORR-ENTE, LANCE SLOAN, ROBERTO BURINI, Lufkin, TX, Botucatu, Brazil

Diet is one of the factors associated with the increased prevalence of diabetes (DM) and Visceral Insulin Resistance Adiposity Syndrome (VIRAS), also known as Metabolic Syndrome, worldwide. The aim of the present study was to identify dietary factors associated with impaired glucose metabolism (IGM) among Brazilian adults. A prospective community-based study was conducted with 910 adults clinically enrolled to participate in a lifestyle modifi cation program “Move for Health,” from 2005 to 2015. Blood pressure, anthropometric, dietary, and plasma biochemical assessments were performed in all participants. Individuals were divided in three groups according to serum glucose levels: normal fasting glucose (<100mg/dL), IGM (≥100-126mg/dL), and DM (≥126mg/dL). Logistic regression analysis was performed in order to identify dietary and metabolic determinants of abnor-mal glucose metabolism. Individuals with IGM and DM had higher body mass index, waist circumference (WC), percentage of muscle mass, and sagittal abdominal diameter (SAD), along with higher levels of total cholesterol, trig-lycerides (TG), us-CRP, uric acid and urea, and lower levels of HDL-c when compared to normoglycemics. Those individuals also presented a higher intake of total carbohydrates (CHO), sugar, protein (meat), saturated fatty acids (SFA), and low intake of dietary fi ber. The following factors were sig-nifi cantly associated with 80% of hyperglycemia: CHO and sugar, TG, SAD, and HOMA-IR. The major dietary determinants of IGM were CHO and sugar, protein (meat), total fat and fractions. For diabetes, the major determinants were total CHO, cereal and sugar, protein (meat), total fat and SFA, fruits. Urea and WC were also found to be determinants for IGM while TG was a determinant for both IGM and diabetes. IGM and diabetes were determined by abdominal fat, hypertriglyceridemia and high caloric diet characterized by refi ned carbohydrates, high fat, low fi ber and animal protein intake.

Supported By: Brazilian National Council for Scientifi c and Technological Devel-opment

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2415-PUBFood Patterns Measured by Principal Component Analysis and Dia-betes in the Nepalese AdultARCHANA SHRESTHA, ANNETTE FITZPATRICK, RAJENDRA P. KOJU, FREDERICK A. CONNELL, KWUN CHAN, SHIRLEY BERESFORD, Boston, MA, Seattle, WA, Dhu-likhel, Nepal

Background: Although type 2 diabetes mellitus (T2DM) has become an epidemic, little data exist on relationships between food consumption or

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2421-PUBCharacteristics of Patients Who Discontinue Sulfonylureas follow-ing Initiation of Basal InsulinANN MARIE MCNEILL, JINAN LIU, GAIL FERNANDES, KRISTY IGLAY, TONGTONG WANG, RAVI SHANKAR, Chapel Hill, NC, Kenilworth, NJ

Although combination use of sulfonylurea (SU) with insulin in patients with T2 diabetes has been associated with increased risk of hypoglycemia, treat-ment guidelines do not recommend discontinuation of SUs (DSU) once insulin has been initiated. To understand factors that infl uence this treatment pat-tern (DSU post insulin initiation), patients with T2D taking Metformin and SU with or without other anti-hyperglycemic agents at time of basal insulin (BI) initiation (n=41,042) were identifi ed from the Marketscan Commercial and Medicare claims database (2006-2014). Overall, DSU occurred in 30%, 9%, 6% and 5% of patients by 3, > 3 to 6, > 6 to 9 and > 9-12 months fol-lowing BI initiation, respectively (cumulative discontinuation 50%). Median time to DSU was 72 days (IQR 27-169). Using Cox PH regression, chronic renal disease was associated with time to DSU, however, patients’ age, sex, healthcare use, number of AHAs at baseline and other co-morbidities were not (Table). In this study, although half of patients discontinued SUs within the fi rst year after starting BI, data available from medical/pharmacy claims did not identify factors strongly predictive of DSU. Studies that include data from medical records, (e.g., HbA1c, BMI) before and after insulin start or interviews with prescribers may be needed to better understand the rea-sons for this treatment change, and subsequent risk of hypoglycemia.Table.

Met+SU (n=41,042) Baseline Covariates Discontinued SU*

50.1% (n=20,567) Continued SU

49.9% (n=20,475) Adjusted HR(95% CI) **

Age (mean, SD) 58.0 (11.8) 58.9 (10.6) –Age in 5 year increments – – 0.99 (0.98, 1.00) Male 57.9% 59.8% 1.03 (1.00, 1.06) History of Hypoglycemia 6.2% 5.4% 1.00 (0.94, 1.06) History of Macrovascular complications 29.6% 28.8% 0.99 (0.96, 1.02) History of Microvascular complications 23.9% 20.9% 1.02 (0.98, 1.06) History of Pulmonary/chronic lung disease 12.6% 11.5% 1.01 (0.97, 1.05) History of Chronic renal disease 5.5% 3.7% 1.24 (1.16, 1.33) History of Liver disease 5.7% 4.5% 1.02 (0.96, 1.09) History of Depression 6.5% 5.5% 0.97 (0.92, 1.03) History of Cancer 7.4% 6.3% 1.04 (0.99, 1.10) No. of MD visits in last 12 mo 11.3 (10.5) 10.9 (10.1) 1.00 (1.00, 1.00) No. of Hospitalizations in last 12 mo 0.30 (0.64) 0.21 (0.523) 1.05 (1.02, 1.08) No. of ER visits in last 12 mo 0.33 (1.54) 0.25 (0.69) 1.00 (1.00, 1.01) Use of Lipid-lowering agents in last 12 mo 72.5% 78.1% 0.95 (0.92, 0.98) No. of unique medication prescriptions in last 12 mo

9.2 (3.6) 9.1 (3.4) 1.01 (1.00, 1.01)

HR= Hazard Ratio. CI= Confi dence Interval. *Discontinuation of SU post basal insulin initiation was defi ned from pharmacy fi ll date and days supply of each subsequent pharmacy claim for an SU and an accompanying grace period. For the primary analysis, the grace period, or allowable gap, between the calcu-lated end of one prescription and the start of another was 90 days. Sensitivity analyses was conducted by varying the allowable gap between end of days supply and start of subsequent (re-fi ll) prescription date from 45-120 days, resulting in variance in the observed proportion of patients identifi ed as dis-continuing SU (46-61%), but very similar HRs and 95% CIs from Cox PH regression models. **Also adjusted for geographic region, physician spe-cialty, insurance type, and generation of SU.

2419-PUBThe Clinical and Biochemical Profi le of a Patient with Sickle Cell Disease and Diabetes MellitusMAHA ALHUSSEINI, JULIE SAMANTRAY, Detroit, MI

The prevalence of diabetes mellitus in sickle cell disease (SCD) patients is reported to be lower than the general population. Furthermore, the preva-lence of type 1 diabetes in SCD patients has been mentioned in case reports. We herein report a case of a SCD patient who developed new onset diabe-tes with detectable auto-immune antibody and describe her course over a two-year period. A 29 year-old African American patient with SCD presented to the hospital with polyuria, polydypsia, and fatigue. Family history was signifi cant for type 2 diabetes in the paternal and maternal grandmother. She was found to have a blood glucose of 445 mg/dL with a normal anion gap and negative ketones. HbA1c was found to be 5.8%, fructosamine 347 Micromole/L (170-285), c-peptide of 1.2 ng/mL (0.9-6.9) when glucose was 85 mg/dL, GAD antibody was 7 Units/mL (0-5), anti-islet antibody was nega-tive. She was started on basal/bolus regimen at 0.4 units per kg as well as Metformin which was later stopped because she could not tolerate it. Two years post diagnosis, her c-peptide is 0.3 ng/mL, HbA1c is 4.8%, and is now on basal/bolus insulin at 0.5 units/kg. Her insulin dose is being adjusted according to her recorded capillary blood glucose readings and continuous glucose monitoring. Given our patient’s mildly elevated GAD antibody, posi-tive family history of T2D, and total daily insulin requirements, she likely has T2D. However, given the decrease in c-peptide levels overtime, she likely has become insulin-dependent due to a destructive pancreatic process. As demonstrated in this case, diagnosis and monitoring of diabetes mellitus in SCD patients can be challenging.

2420-PUBRacial-Ethnic Differences in Diabetes Prevalence Are Accentuated when BMI Is Accounted for in the Veteran PopulationKELLY J. HUNT, MELANIE L. DAVIS, ROBERT N. AXON, CLARA E. DISMUKE, CHERYL P. LYNCH, MULUGETA GEBREGZOABHER, BARBARA WOJCIECHOWSKI, LEONARD EGEDE, Charleston, SC

While it is well established that diabetes prevalence varies by race-eth-nicity and by obesity level, few studies are able to examine the impact of obesity level on racial-ethnic disparities in diabetes simultaneously across multiple racial-ethnic groups. Patient and administrative fi les from the Vet-erans Health Administration National Patient Care databases were linked to create a comprehensive national database of veterans who received care at a VA facility in 2012 from which a weighted sample was selected (i.e., 1.23 of 5.46 million). Diabetes was defi ned by primary or secondary diagnoses (ICD-9-CM 250.xx) at least twice within a 12 month period across inpatient/out-patient visits. Data were analyzed using complex survey-specifi c procedures that accounted for the stratifi ed weighted sampling design. Diabetes prev-alence was 21.8% in non-Hispanic whites, 24.5% in non-Hispanic blacks, 26.3% in Hispanics, 18.2% in Asians, 22.8% in Native Americans, 25.6% in Pacifi c Islanders and 17.8% in those with unknown race-ethnicity. Because the mean age of the veteran population differed by gender (i.e., 63.3, men; 48.4, women), logistic regression models predicting prevalent diabetes were stratifi ed by gender (See Table). BMI (kg/m2) was modeled using the six NIH defi ned categories. In summary, racial-ethnic differences in diabetes preva-lence are accentuated when BMI is accounted for.Table. Odds Ratios (and 95% Confi dence Intervals) Predicting Prevalent Dia-betes in the VA in 2012 Adjusted for Age, Rural-urban Residence, Geographic Region of the Country, Confl ict Served in and Service Related Disability.

Supported By: U.S. Department of Veterans Affairs

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cose and blood pressure were 51.9% and 52.2% at baseline, and increased to 62.9% and 68.0% at the last visit, respectively (both P<0.001). Simi-lar statistically signifi cant increase in the control rate of blood lipids was not observed. The screening tests including urinary albiumin, fundus, dia-betic foot and ECG were performed in 4.6%, 6.1%, 0.6% and 23.5% of all patients before management and increased to 40.7%, 60%, 93.9% and 42.3% at annual visit, respectively (all P<0.001). Shorter disease duration with diabetes, insulin treatment and coverage of medical care was found to be associated with a higher rate of blood glucose control. The “5+1” SDTM module improved disease control of type 2 diabetes as refl ected by selected biomarkers in a Chinese community population. Patients with shorter disease duration, insulin treatment and medical care coverage were found to have better outcomes.

Supported By: National Natural Science Foundation of China (71373132)

2425-PUBHbA1c Trajectory and Its Associated Factors in Patients with Type 2 DiabetesTZU-YUN YU, TSAI-CHUNG LI, CHENG-CHIEH LIN, Taichung, Taiwan

Diabetes is a global concerned disease. Investigating the trajectories of diabetes-related parameters is scant in literature. This study aims to explore the pattern of long-term trajectory of HbA1c level and to identify risk fac-tors that are associated with the trajectory of HbA1c in patients with type 2 diabetes (T2DM) who were enrolled in the Diabetes Care Management Pro-gram (DCMP) of China Medical University Hospital (CMUH). We conducted a retrospective cohort study consisting of 5,000 patients aged > 20 years old with T2DM in the DCMP of CMUH and with more than 1 year of follow-up. The main outcome was trajectory of HbA1c level. Mixed models were used to examine the associations between risk factors and HbA1c trajectory. Mean of HbA1c level at baseline was 8.38%. Without considering any risk factors, HbA1c level showed a slight increase before year 1, but the increasing rate accelerated after year 1 (linear slope 0.3% per year, quadratic slope 1.3% per year, P < 0.001). After multivariate adjustment, HbA1c trajectory indicated that the mean HbA1c level decreased before year 1 and then increased after year 1, and the increase in rate increased as participants were followed up (linear slope -2.6% per year, quadratic slope 1.1% per year, P < 0.001). Patients who had age < 65 years old, early-onset, hyperlipidemia, leg clau-dication, neuropathy, diabetic retinopathy, and exposure for passive smok-ing at workplace, higher eGFR level, and longer duration of T2DM and who were female had a higher level of HbA1c. Before year 1, the decrease rate in HbA1c reduced as TG level increased, and the increase rate accelerated as TG level increased after year 1 (P for interaction of TG and center-time < 0.001). Our study identifi ed gender, age, early-onset, passive smoking at workplace, eGFR level, duration of T2DM, hyperlipidemia, leg claudication, neuropathy, and diabetic retinopathy are associated with HbA1c level. In addition, we observed difference in the HbA1c trajectory in patients with different levels of TG.

2426-PUBGender-specifi c Association of Serum Prolactin Levels with Insulin ResistanceMAKOTO DAIMON, AYA KAMBA, HIROSHI MURAKAMI, KAZUHISA TAKA-HASHI, HIDEYUKI OTAKA, HIROSHI MURAKAMI, KOTA MATSUKI, YUKI MATSU-HASHI, MIYUKI YANAGIMACHI, KAORI SAWADA, IPPEI TAKAHASHI, SHIGEYUKI NAKAJI, Hirosaki, Japan

Except for lactation, prolactin (PRL) has roles in various physiological functions. Experimental studies suggested its benefi cial infl uences on type 2 diabetes (DM) via several mechanisms including growth of pan-creatic β-cells and decreasing insulin resistance. Clinically, based on the facts observed in subjects with prolactinoma, increased serum PRL levels (SP) seem to have adverse effects on metabolism. However, few stud-ies with subjects with physiological SP showed benefi cial effects of SP on DM. We here determined the association of SP with HOMA indices in a general population. Participants of the 2014 population-based Iwaki study of Japanese were enrolled (n (M/F): 1, 051 (386/665); age: 54.1±15.0 years). Although univariate linear regression analyses showed signifi cant association of SP with HOMA indices in both genders, adjustment with multiple factors made the association of SP with HOMA-β insignifi cant, while those with HOMA-R remained signifi cant (M/F; β= 0.098, p= 0.011/β= -0.067, p=0.049). Nonlinear regression analyses with curve fi tting with Gaussian model supported the inverse association of SP with HOMA-R in women, but showed a regression curve with a peak at SP, 9.79 ng/ml (Figure), indicated a positive association of SP with HOMA-R below the peak in men (β= 0.170, p<0.001). The facts indicate that increased SP in

2422-PUBSocioeconomic Status Related to Early-Onset Type 2 Diabetes in ChinaXIAOYING CHEN, MEIFANG SU, YUE CHEN, CHAOWEI FU, QINGWU JIANG, Shanghai, China, Yuhuan, China, Ottawa, ON, Canada

The reason for early-onset of type 2 diabetes (T2D) is not clear. We explored the impact of socioeconomic status on early-onset T2D among newly diagnosed Chinese patients.

The current study was conducted in Yuhuan County, Zhejiang province in 2012, and included a total of 1695 patients with newly diagnosed T2D according to WHO 1999 criteria. T2D patients that had early-onset T2D were those who had the disease that was diagnosed at the age of less than 40 years. High income was defi ned as monthly household income per capita of more than U.S. $317. High education was defi ned as more than 6 years of school education. Poisson regression model was used to estimate adjusted relative risks (aRRs) and their 95% confi dence intervals (95% CIs) for the risk of early-onset type 2 diabetes by STATA12.

Of 1695 T2D patients, 75 (4.4%) were diagnosed at the age ranging from 23 to 39 years. After adjustment for covariates such as sex, overweight, regular physical exercise, occupation and other variables, the risk of early-onset T2D was signifi cantly associated with high income (aRR=5.15, 95% CI: 2.46-10.79) and high education level (aRR=6.80, 95% CI: 3.87-11.95).

In conclusion, early-onset T2D was not very common in this country and high socioeconomic status tended to be independent infl uencing factors for early-onset T2D.

2423-PUBWhich Metabolic Parameter Is Most Likely Responsible for Fatty Liver Disease in Type 2 Diabetes Mellitus?HANS-DIETER JANISCH, Erlangen, Germany

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is frequent in patients with type 2 diabetes. It is not clearly known which of the metabolic parameters found in these patients is at least most likely responsible for the development of fatty liver disease and what is the infl uence of the actual antidiabetic treatement. We evaluated in 251 con-secutive pts. with type 2 diabetes and fatty liver disease proven by ultra-sonography the infl uence of different metabolic parameters (BMI, HbA1c, cholesterole, triglycerides, creatinine, ALT, AST, GGT, alkaline phospatase, gammaglobulin fraction) under different treatments for diabetes control (Metformin (M), insulin (I) or a combination of both (IM). 62% of the pts. were male, 38% were female. The mean age in the male group was 64, 2 +/-12.7 yrs. vs. 63.3+/-11.7 in females. Fatty liver activity measured by GGT correlated only positively with BMI (p<0.007) whereas HbA1c, cholesterol, triglycerides, creatinine, other liver enzymes, gammaglobuline fraction and type of treatment (I, M, IM) did not correlate positively with fatty liver activ-ity in patients with type 2 diabetes mellitus. The infl ammatory liver activity is mainly infl uenced by the body mass Index. Insulin, Metformin or insulin combined with Metformin were not positively correlated with fatty liver dis-ease. Therefore reducing body weight is probably the best recommendation to treat steatohepatitis in patients with type 2 diabetes mellitus and fatty liver disease.

2424-PUBAnalysis of the Effect of a Community-based “5+1” Staged Diabetes Targeting Management Module on Selected Biomarkers and Poten-tial Infl uencing FactorsQINLIN LOU, BOCAI TANG, YONGZHONG ZHUANG, XIAOJUN OUYANG, LIUBAO GU, HAIDI WU, TIANTIAN LU, YAN HU, JIHAI CHEN, JIAREN XU, RONGWEN BIAN, Nanjing, China

To evaluate the effect of a community-based “5+1” staged diabetes tar-geting management (SDTM) module on selected biomarkers in patients with type 2 diabetes (T2D) and to identify patient characteristics which may infl uence the effectiveness of the management module. Patients with T2D from 11 community health service centers of Nanjing city were enrolled from June 2011 to Aug 2013. The electronic archives were estab-lished and the patients were followed up according to the master decision path of “5+1” SDTM. “5+1” module contains “5” treatment goals (including blood pressure < 140/80mmHg, LDL-C < 2.6mmol/L, HbA1c <=7.0%, giving up smoking and taking aspirin if necessary) and chronic complications screening “1” time every year. All the patients were divided into maintain-ing stage or adjusting stage and received different treatment intervention according to achieving these goals or not. 2612 patients were included in this management procedure, but of which 1488 patients who had com-pleted 1 year assessment were analyzed. The control rates of blood glu-

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2430-PUBDifferences in Prevalence of Diabetes Mellitus and Obesity in Greece between 2002 and 2014ALEXIOS SOTIROPOULOS, ANASTASIOS KOUTSOVASILIS, OURANIA APOS-TOLOU, MARIA PAPPA, DIONISIS KRANIOU, PARASKEVI VERGIDOU, ILIAS TAM-VAKOS, STAVROS PAPPAS, Nikaia, Greece

The rising prevalence of diabetes and obesity worldwide has been described as a global pandemic.

The aim of this study is to examine the prevalence of DM and obesity in the adult population of Salamina island, where relevant studies have been carried out in 2002 and 2006 with the same methodology.

Data was derived from three consecutive population-based surveys con-ducted in Salamina, during three election days (13 October 2002, 15 October 2006 and 25 May 2014). There were 2805 randomly selected adults (> or =20 years) in 2002, 3478 in 2006 and 2527 in 2014 of similar age and sex distribu-tion to the target population.

The rates per age group for the 2002, 2006 and 2014 surveys for diabetes prevalence were: 0.4%, 0.6% and 0.3% (p=0.128) in individuals aged 20-29, 3.6%, 3.7% and1.9% (p=0.048) in individuals aged 30-39%, 7.3%, 7.2% and 9.4% (p=0.033) in individuals aged 40-49, 21.6%, 21.2% and 26.4% (p=0.026) in individuals aged 50-59, 31.8%, 31.2% and 30.2% (p=0.214), in individuals aged 60-69, and 35%, 36% and 31.8% (p=0.030) in individuals aged over 70. The mean age for diabetes diagnosis was 57.6±11.9 while the mean diabetes duration was 12.3 years for 2014 comparable with the other two surveys (p=0.086). At the same time, the age-adjusted prevalence of obe-sity increased from 17.9 to 21.1% and to 27.9% (for year 2014) (p<0.0001). The largest increase in obesity prevalence was in individuals aged 50-59 (p=0.016) and 60-69 (p=0.028).

DM prevalence is higher than the one predicted according to older studies, basically confi rming IDF’s predictions. An increase of prevalence is observed in younger ages and, according to the prediction for 2032, approximately one out of fi ve people in Greece will have diabetes indicating a dramatic increase in diabetes prevalence among Greek adults.

2431-PUBBaseline Characteristics of the Diabetes Collaborative Registry®: A New Resource for Diabetes Research and Quality ImprovementSUZANNE V. ARNOLD, SILVIO E. INZUCCHI, DARREN K. MCGUIRE, SANJEEV N. MEHTA, ABHINAV GOYAL, LAURENCE S. SPERLING, THOMAS M. MADDOX, DANIEL EINHORN, NATHAN D. WONG, PETER FENICI, NIKLAS HAMMAR, JOHN J. SHEEHAN, JENNIFER L. WONG, MIKHAIL N. KOSIBOROD, Kansas City, MO, New Haven, CT, Dallas, TX, Boston, MA, Atlanta, GA, Denver, CO, San Diego, CA, Irvine, CA, Rome, Italy, Mölndal, Sweden, Fort Washington, PA, Washington, DC

Background: DM continues to increase globally, with marked impact on health and resource use. There is a need to develop longitudinal practice level reporting of outpatient DM care to evaluate practice patterns and establish a framework for large-scale quality improvement. The Diabetes Collaborative Registry (DCR) was formed as a joint effort of the ADA, ACC,

physiological levels is a risk for men but a benefi t for women for insulin resistance.Figure.

Supported By: Japan Science and Technology Agency

2427-PUBDiabetics Present Higher Concentrations of Micronucleated Buccal CellsERIKA C.O. NALIATO, VICTOR L.S. REY, RAMON G.S. OLIVEIRA, PÂMELLA G.F. SILVA, RAFAELA C. ROCHA, ALINE P.M. SILVA, ALESSANDRA S. CORDEIRO, Teres-opolis, Brazil

DM has been associated with an increased incidence of cancer. The pres-ence of micronuclei is suggestive of DNA damage.

In this cross-sectional study, we evaluated the prevalence of micro-nucleated buccal cells (MN) in diabetics (DB) and healthy controls, analyzing clinical history, anthropometric measures, serum hemoglobin A1c (HbA1c) and exfoliated buccal cells in 156 DB and 146 controls. For each subject, a total of 2000 exfoliated buccal cells were evaluated and MN concentration was reported as MN/1000 cells. DB were older than controls (61.7 ± 14.8 vs. 38.9 ± 15.3 years, respectively; p <0.0001) and had higher waist circumfer-ence (98.5 ± 13.9 vs. 89.6 ± 12.3 cm, respectively; p < 0.0001) and body mass index (BMI: 29.15 ± 5.70 vs. 27.27 ± 5.14 kg/m², respectively; p = 0.0022). The prevalence of tobacco and alcohol consumers was lower among DB (4.5% vs. 38.5%, and 21.3% vs. 33.1%, respectively; p < 0.0001). Most DB had arte-rial hypertension (51.3%). Mean time elapsed since the diagnosis of DM was 10.4 ± 8.8 years. Most DB (70.5%) used antidiabetic drugs (among the 110 under treatment: 74.6% with Metformin; 30%, sulfonylureas; 24.6%, DPP-4 inhibitors; 23.6%, insulin; 8.2%, piogitazone; 5.5%, repaglinide; 3.6%, lira-glutide). Mean HbA1c of the DB corresponded to 7.1 ± 1.6%, similar to the mean HbA1c value calculated for the previous 12 months. DB had a higher concentration of MN than controls (3.4 ± 4.9 vs. 2.9 ± 6.5 MN/1000 cells; p =0.0002). In the multiple regression analysis, a model that included BMI, the presence of arterial hypertension and treatment with DPP-4 inhibitors explained 35.05% of the variance of MN in DB (p = 0.0489). The present study corroborates the literature regarding the increased levels of DNA damage and cancer risk in DB. In this sample of DB, the concentration of MN was higher in patients with lower BMI, concomitant diagnosis of arterial hypertension and treated with DPP-4 inhibitors.

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EPIDEMIOLOGY—TYPE 1 DIABETES

ciated with higher risk for death in men. Age ≥60 years, presence of hyper-tension and HbA1c-SD) ≥0.3% were signifi cantly associated with higher risk for death in women. The AUCs of ROC for mortality prediction were 0.75 and 0.74 in men and women, respectively. The satisfaction survey revealed that the model helped patients to understand their disease status (89.13%) and motivated them to change their lifestyle (86.85%). Our research group has successfully established a mortality prediction model of diabetes patients. The model would help physicians to make better clinical decision and moti-vate patients to modify their lifestyle. More precise estimation of health care outcome in diabetes patients would result in reduction of social health-care expense.

2434-PUBThe Impacts of Noninsulin Antidiabetic Drugs on Weight Changes in Type 2 Diabetes: A Meta-analysisYIFEI CHEN, XIAOLING CAI, WENJIA YANG, XUEYING GAO, XUEYAO HAN, LINONG JI, Beijing, China

The aim of this study is to clarify the weight changes in type 2 diabe-tes mellitus (T2DM) patients with different noninsulin antidiabetic treat-ment through a meta-analysis. Studies were identifi ed by a literature search of Medline, Embase, and others from the time that recording com-menced until December 2015. The meta-analysis was performed by com-puting the weighted mean difference (WMD) and 95% confi dence interval (CI) for a change from baseline to the study endpoint for placebo vs. non-insulin antidiabetic drugs. 206 randomized controlled trials were judged to be appropriate for inclusion in the meta-analysis. Compare with placebo, the Metformin group (2113 participants) has no signifi cant weight change from baseline (WMD -0.77 kg; p\0.06). Compare with placebo, the alpha-glucosidase inhibitor group (2417 participants) has a signifi cantly greater decrease in the weight change from baseline (WMD -0.53 kg; p\0.008). Com-pare with placebo, the Glucagon-like peptide-1 analogue group (4119 partici-pants) has a signifi cantly greater decrease in the weight change from base-line (WMD -1.35 kg; p\0.00001). Compare with placebo, the sodium-glucose cotransporter 2 inhibitor group (8193 participants) has a signifi cantly greater decrease in the weight change from baseline (WMD -1.86 kg; p\0.00001). Compare with placebo, the dipeptidyl peptidase-4 inhibitor group (16080 participants) has a signifi cantly greater increase in the weight change from baseline (WMD 0.26 kg; p\0.00001). Compare with placebo, the thiazolidin-edione group (7763 participants) has a signifi cantly greater increase in the weight change from baseline (WMD 2.48 kg; p\0.00001). Compare with pla-cebo, the sulphonylurea group (1902 participants) has a signifi cantly greater increase in weight change from baseline (WMD 2.12 kg; p\0.00001). Accord-ing to this meta-analysis, the weight changes in different treatments were comprehensively concluded.


2435-PUBValidation in the Real Life of a Prognostic Model Developed to Pre-dict Major Outcomes in Type 1 DiabetesMONIA GAROFOLO, ELEONORA RUSSO, DANIELA LUCCHESI, LAURA GIUSTI, VERONICA SANCHO-BORNEZ, ROSALIA BELLANTE, ELISABETTA SALUTINI, ROBERTO MICCOLI, GIUSEPPE PENNO, STEFANO DEL PRATO, Pisa, Italy

EURODIAB assesses risk for major outcomes (CHD, stroke, ESRD, ampu-tation, blindness and all-cause death) in T1DM by a model based on age, HbA1c, waist-hip ratio, urinary ACR and HDL, identifi ng 3 groups at low- (LR, score <16), intermediate- (IR, 16-20) and high- (HR >20) risk. The model per-formance against all-cause mortality was tested in a follow-up of 8.3±2.3 yrs in 774 T1DM: 407M/367F, age 40.2±11.7, DD 19.3±12.2 yrs; HbA1c 7.8±1.2% (range 5.2-15.1); ACR 0.49 mg/mmol (0.03-142.6); HDL 62.5±15.2 mg/dl (8-103), WHR 0.92±0.06 (0.74-1.14). Risk distribution was LR n. 466 (60.2%), IR n. 205 (26.5%) and HR n. 103 (13.3%) in the whole cohort, and LR n. 461 (62.9%), IR n. 195 (26.6%) and HR n. 77 (10.5%) after exclusion of 41 T1DM (5.3%) who had major outcomes: HR 26/103 (25.2%) >IR 10/205 (4.9%) >LR 5/466 (1.1%; p<0.0001). Main factors associated with IR and HR were age, HbA1c and ACR (p<0.0001 for all). IR and HR increased with DD quartiles (p<0.0001). Were increasing from LR to HR: sBP, dBP, LDL cholesterol, trig-lycerides, fi brinogen, uric acid. Were decreasing: eGFR (CKD-EPI) 108±15, 99±13, 83±20 ml/min/1.73m2 (p<0.001) and current smokers 31.9, 29.7, 19.0% (p=0.037); advanced retinopathy increased (6.2, 23.6 and 42.9%, p<0.0001). Mean follow-up was similar in the 3 risk groups (p=0.394). All-cause mortal-ity was 5.2% in the whole cohort: HR (23.3%, 24/103) >IR (4.9%, 10/205) >LR (1.3%, 6/466; p=0.0001); 22.1%, 5.1% and 1.3% after exclusion of T1DM with

ACP, AACE, and Joslin Diabetes Center as a national quality improvement registry, encompassing the spectrum of primary and specialty care for DM.

Methods: Primary care, endocrinology, cardiology, and multispecialty practices are invited to participate in DCR. Data are continuously extracted from EHRs. Cardiology/multispecialty practices in NCDR PINNACLE were targeted as initial sites for DCR given the existing IT platform for data extraction.

Results: Since 2015, 256 practices (primary and specialty care) enrolled in the DCR. The initial data on the 812,037 patients with T2DM are shown in the Table, and refl ects the early predominance (>90%) of cardiology sites.

Conclusions: DCR is a large-scale, multidisciplinary registry of persons with DM. Characteristics show a high burden of CV risk factors and compli-cations, refl ecting both the CVD risk associated with T2DM and early pre-dominance of cardiology sites in DCR; and will likely evolve as the contribu-tion of primary care and other specialties increases over time.Table. Baseline Characteristics of Initial Patients Enrolled in the Diabetes Collaborative Registry.

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2433-PUBMortality Risk Model in Subjects with Diabetes in KoreaJOONYUB LEE, SEUNG-HWAN LEE, JAE HYOUNG CHO, KUN-HO YOON, YEOREE YANG, EUNYOUNG LEE, BORAMI KANG, Seoul, Republic of Korea, Boston, MA

Subjects with diabetes are at increased risk of mortality than normal pop-ulation. Only a few researches had been performed to predict mortality in patients with diabetes and its clinical applicability has been unsatisfactory. The purpose of this study was to propose a mortality prediction model in Korean subjects with diabetes. Subjects with diabetes who visited Seoul St. Mary hospital from 2009 to 2013 were enrolled in the study (n=7,137). Eighty percent of total population (n=5,714) were randomly selected to develop mortality prediction model using multivariate logistic regression analysis in men and women, separately. Validity of the model was measured through AUC of ROC (Receiver Operating Characteristic) curve in remaining 20% of study population (n=1,423). A satisfactory survey was conducted in 38 vol-unteered patients to measure clinical effi cacy of the model. Among total of 5,714 subjects, 249 deaths occurred during the follow-up. Age ≥70 years, BMI <18.5 kg/m2, presence of hypertension, GFR < 90 ml/min/1.73m2 and standard deviation of serially measured HbA1c (HbA1c-SD) ≥0.1% were asso-

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glycemia was more common and severe hyperglycemia was less common in patients ≥ 65 years, and severe hypo- and hyperglycemia were both more common in patients with low renal function (eGFR).

There were no marked differences in effectiveness and long-term safety of DAI, although there were minor differences in clinical characteristics between patients who used the three types of insulin. Severe hypoglycemia was more common in older patients, while severe hypo- or hyperglycemia were more common in patients with impaired renal function.

Supported By: Sanofi

2439-PUBWho Is Using Metformin as Adjunct Therapy in a Large Survey of 2,911 Individuals with Type 1 Diabetes?FERNANDO M. GIUFFRIDA, CARLOS ANTONIO NEGRATO, ROBERTA A. COBAS, MARILIA B. GOMES, SERGIO A. DIB, BRAZILIAN TYPE 1 DIABETES STUDY GROUP, Salvador, Brazil, Bauru, Brazil, Rio de Janeiro, Brazil, São Paulo, Brazil

Insulin-sensitizing effects of Metformin may offer potential benefi t to individuals with type 1 diabetes bearing insulin resistance or poor glycemic control. Nevertheless, study results are controversial and there is no con-sensus to guide clinicians in prescribing Metformin in this setting. Antidi-abetic treatment was reviewed in 2,911 individuals with type 1 diabetes in a real life multicenter study. Metformin is used by 6.9% of these individuals.

Table. Clinical Features of Individuals According to Metformin Prescription.with Metformin

(n=200) without Metformin

(n=2711) p

age (years) 28.9 ± 11.7 21.1 ± 11.9 < 0.001diabetes duration (years) 12 [7 - 17] 7 [4 - 14] < 0.001Total insulin dose (U)/Insulin dose per body weight (U/kg)

62.1 ± 26.6/0.89 ± 0.41

49.2 ± 22.9/0.89 ± 0.41

< 0.001/non-signifi cant (NS)

HbA1c (%) 9.4 ± 2.2 9.2 ± 2.3 NStotal cholesterol/triglycerides (mg/dl) 180.4 ± 39.3/

86 [62 - 131.75] 169.7 ± 41.0/

71 [53 - 102] 0.001/

< 0.001HDL-cholesterol/LDL-cholesterol (mg/dL) 51.7 ± 15.1/

106.1 ± 31.053.1 ± 14.8/99.3 ± 32.5

NS/0.006

familial history of type 2 diabetes (%) 28.1 14.3 < 0.001

Figure.

Individuals using Metformin were older and more frequently overweight, used higher total insulin doses, had worse lipid profi le, and showed more frequent familial history of type 2 diabetes. These data suggest cardiovas-cular risk factors, independent of glycemic control, to be the main criterion for using Metformin in individuals with type 1 diabetes.

previous outcomes. In logistic regression including gender, DD, BMI, lipids, BP, retinopathy, previous CVD, smoking and eGFR only to be current smok-ers (OR 3.94, p=0.009) and to have reduced eGFR (CKD2b: OR 5.00, p=0.004; CKD≥3: OR 6.86, p=0.001) add to the score (p<0.0001; IR, OR 3.96; HR, OR 20.41) as covariates of all-cause mortality. In our cohort, 30-40% of T1DM has HR (10%) or IR (25%) for major outcomes with an all-cause mortality of 3% per year in HR group. The EURODIAB score is confi med as a useful tool for estimating all-cause mortality risk in T1DM.

Supported By: Regione Toscana, Italy (CUP D55E11002680005)

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2437-PUBPrevalence, Distribution, and Associated Factors of Thyroid Dys-function among Type 1 Diabetes Mellitus PatientsRADHAKRISHNAN CHANDNI, U. BHAGYALAKSHMY, P. JAYESH KUMAR, Koz hi-kode, India

In diabetic patients, thyroid dysfunction is higher than that of the gen-eral population and up to a third of patients with type 1 diabetes (T1DM), ultimately develop thyroid dysfunction. Prompt therapeutic intervention of thyroid dysfunction is crucial to avoid the metabolic decompensation. The Aims of this study are to look into the prevalence and pattern of thyroid dysfunction in T1DM and to study the differences in age, gender, BMI, lipid profi le and HbA1c in T1DM with and without thyroid dysfunction. Fifty T1DM subjects attending the Government Medical College, Kozhikode, Kerala were included in this study. Patients who are seriously ill, pregnant, with thyroid dysfunction before onset of diabetes or on drugs affecting thyroid function were excluded from the study. Among the 50 subjects, 60% were females and 40% were males. Maximum number of patients (46%) belonged to the age group 11-20 yrs. 46% of patients had diabetes of less than 5 years dura-tion. Prevalence of thyroid dysfunction among our subjects found to be 12% which is higher than the general population where the prevalence is 5-10%. Four out of 30 females and two out of 20 males were found to have thyroid dysfunction. Females were found to have a higher incidence of thyroid dys-function, Anti-thyroid peroxidase (anti-TPO) antibody positivity in general population is considered to be between 2-10%, in T1DM it is much higher and this study showed Anti-TPO antibody positivity in 16%. Anti-TPO anti-body and thyroid dysfunction had signifi cant correlation. Of the 6 patients with thyroid dysfunction, 4 patients are having hypothyroidism, subclinical hypothyroidism in one patient and hyperthyroidism in one patient. FBG was higher among patients with thyroid dysfunction which was statistically sig-nifi cant showing poor metabolic control among patients with thyroid dys-function. Duration of Diabetes, BMI and Lipid profi le had no signifi cant rela-tion with the development of thyroid dysfunction in our study.

Supported By: Research Society for the Study of Diabetes in India, Kerala Chapter

2438-PUBSafety of Direct-Acting Insulin Analogues in Patients with Type 1 Diabetes: A Nationwide Observational StudyVINCENT LAK, ANN-MARIE SVENSSON, MERVETE MIFTARAJ, STEFAN FRAN-ZÉN, BJORN ELIASSON, Gothenburg, Sweden

Studies comparing direct-acting insulin analogues (DAI) in terms of effec-tiveness and long-term safety are scarce. Our aim was to explore these aspects in clinical practice in patients with type 1 diabetes, particularly in elderly patients and in patients with renal impairment.

We linked four national registers in a population-based cohort study. Patients with type 1 diabetes with continuous use of DAI (lispro, aspart or glulisine) 2005-2013 were followed for up to 7.5 years. Inverse probability of treatment weighting was used to adjust for differences in baseline charac-teristics between treatment groups. Unadjusted mean HbA1c and weights were plotted, and hazard ratios (HRs) and 95% CIs of cardiovascular events (CVE) and mortality were estimated using Cox proportional-hazards regres-sion models.

We included 41,165 patients: 14,047 lispro, 26,813 aspart, and 305 glulisine users (11% were 65 years or older). At baseline the mean age was highest in glulisine users (49.4 years; 41 and 40.1 for lispro and aspart, resp.) whereas diabetes duration was shortest (11.6 years; 19.5 and 15.4 years for lispro and aspart). The mean HbA1c and weights during follow-up were similar.

There were no signifi cant differences between groups regarding hyper-glycemia requiring hospitalization, CVE, mortality, while the Cox regression suggested lower rates of hypoglycemia in the glulisine users. Severe hypo-

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GENETICS—TYPE 1 DIABETES

2442-PUBMicroRNAs Expression in Different Tissues in Mouse Model of Type 1 DiabetesXINYUE LIANG, WEI LI, LU CAI, Louisville, KY, Changchun, China

MicroRNAs are involved in the pathogenesis of type 1 diabetes (T1D). The identifi cation of tissue-specifi c miRNAs implicated in T1D might be useful for the future development of strategies for diagnosis and therapeutic inter-vention of the complications of T1D. Here, we have chosen 11 microRNAs, functions involving in the regulation of metabolism, DNA damage and repair, and infl ammation and fi brosis to investigate their profi les at different time of diabetes. Using stem-loop real-time RT-PCR, we measured these 11 miRNAs expressions in different tissues: liver representing the main organ related to metabolism and cell proliferation, heart as one of the organ mainly related to metabolism without active cell proliferation, and testis as one of the organs predominantly with active cell proliferation, from T1D mouse model at two time points: 4 month and 6 month. We found a signifi cant diversity of microRNA expression alterations in different tissues of T1D. Of these, miR-21 and miR-185 were upregulated in all the three organs. Expression of miR-34a was upregulated in the liver and heart during the whole course. Increased level of miR-421 was found in the liver and testis. The expression of miR-199 was upregulated in diabetic heart and testis. The expression of miR-375 and miR-155 was upregulated signifi cantly on in the liver at 4 month, but decreased at 6 month. miR-221 was upregulated in the liver and heart at 4 month while miR-146a and miR-193a were upregulated in testis at 4 month and 6 month, respectively. In term of organ’s difference, in liver all three groups of microRNAs were affected by diabetes. In the heart, except metab-olism-related microRNAs, miR-21 and miR-199a were upregulated while in the testis, DNA damage response-related microRNAs increased obviously. This study showed the different patterns of expression of these microRNAs in liver, heart and testis in response to T1D. Whether these changes are associated with primary events related to the pathogenesis of T1D compli-cations needs further investigated.

Supported By: American Diabetes Association (1-15-BS-018 to L.C.)

2443-PUBBroad Blood Transcriptional Abnormalities and Complexity of Pathophysiology in Patients with Type 1 DiabetesF. JASON DUNCAN, BARTHOLOMEW J. NAUGHTON, DARREN MURREY, AARON S. MEADOWS, AMY WETZEL, PETER WHITE, ROBERT P. HOFFMAN, HAIYAN FU, Columbus, OH

Although type 1 diabetes is a well-studied disease, the events leading to initiation of the disease are still poorly understood, which hinders not only our understanding of the disease, but also the development of effective treatments. In this study, using genome-wide gene expression arrays, we analyzed blood RNA isolated from young female patients with type 1 diabe-tes (T1D) and matched healthy controls. Our data showed signifi cant altera-tions (≥2-fold, FDR <10%) in 270 genes in the blood of TID patients, includ-ing 258 genes that are known to play roles in diverse biological processes. Specifi cally, the T1D blood transcript abnormalities involve pathways of RNA binding/transcription/splicing, protein synthesis/posttranslational modifi ca-tion, metabolism, immune response, cell migration/traffi cking/transport, apoptosis, cytoskeleton and extracellular matrix, DNA binding and synthesis, oxidative stress, and erythrocytes development and function. Importantly, numerous dysregulated genes in T1D blood have been linked to various dis-ease conditions, including, metabolic disorders and diabetes, infl ammation, neurodegeneration and hematological disorders. Noteworthy, we observed alteration of numerous tissue-specifi c genes in T1D blood, involving brain, retina, skin, immune system, heart, bone marrow/erythrocyte, skeletal muscle and kidney. While the mechanisms are unclear, we demonstrate here that blood transcriptional profi les refl ect the complex pathology in T1D, and major long-term T1D complications, such as neuropathy, retinopathy and car-diovascular disorders, emerge early during the disease progression. Impor-tantly, some of the observed transcriptional abnormalities have not been previously linked to T1D. Therefore, genome-wide blood transcriptional pro-fi ling may offer an invaluable tool to reveal early pathophysiological changes in T1D and identify new therapeutic avenues.


2440-PUBVariants of the Interleukins IL-17A and IL-21 Receptor Genes Are Associated with Autoimmune DiabetesCINTIA SEMZEZEM, KARLA FABIANA B. GOMES, ARITANIA S. SANTOS, MARCIA R.S. CORREIA, ROSA T. FUKUI, LUCIANO A. BRITO, ÉRIQUE J.P. MIRANDA, MARIA REGINA S. SILVA, São Paulo, Brazil

Type 1 diabetes (T1D) is an autoimmune disease resulting from the inter-action of environmental factors, genetic predisposition and immunological changes. The T helper (Th) lymphocyte pathway is strongly associated with the infl ammatory process termed insulitis, resulting in the destruction of beta cells. The interleukins IL-17 and IL-21 of the Th17 pathway participate in the regulation of the autoimmune process. There are no studies analyzing the infl uence of variants of the genes of the receptors of IL17A (IL17RA) and IL21 (IL21R) in the predisposition to T1D. We evaluated 631 patients with T1D (25.1 ± 12.7 years) and 652 controls (28.6 ± 11.3 years). Selected variants of IL17RA (rs5748863, rs2241049, rs879577, rs5992628) and IL-21R (rs2214537, rs7193869, rs7199138, rs3093315, rs2285452) were genotyped by Vera Code methodology, Golden Gate (Illumina, U.S.). The autoantibodies anti-GAD65 and anti-IA2 were measured by radioimmunoassay, anti-ZnT8 by ELISA, anti-TPO and anti-TG by fl uoroimmunoassay and anti-parietal cell by direct immunofl uorescence. The frequencies of genotypes of the variants were in Hardy-Weinberg Equilibrium. The genotypic associations were analyzed by Chi-square or Fisher’s exact test and by binary logistic regression and mul-tivariate analysis. The rs5992628 TT of IL17RA was associated with greater frequency of anti-IA2 (ORa=1, 99; CI95%= 1, 29-3, 08; p=0.002) and anti-ZnT8 (ORa=1, 62; CI%=1, 01- 2, 62; p= 0.047). With regard to the IL21R, the rs3093315 TT was associated with higher frequency of anti-ZnT8 (ORa=1.89; CI95%=1.10-3.24; p=0.022) and rs7193869 TT with anti-IA2 (ORa:2, 34; CI95%: 1, 23-4, 45; p=0.014). The GG genotype of rs7199138 was associated with protection for T1D (OR: 0.71; CI: 0.53-0.95; p= 0.022) and lower fre-quency of anti-IA2 (OR: 0.61; CI: 0.41-0.90; p= 0.014). No variant infl uenced the frequency of extra-pancreatic antibodies. We concluded that IL17RA and IL21R variants are related to the pathophysiology of T1D.

2441-PUBHLA Class II and III Genetic Risk Factors of Type 1 Diabetes in SomaliLOYAL COSHWAY, SASIGARN BOWDEN, KATHERINE LINTER, BI ZHOU, ROBERT P. HOFFMAN, CHACK-YUNG YU, Columbus, OH

Somali have high prevalence of type 1 diabetes (T1D) after immigration to developed countries. We studied candidate genetic risk factors from human leukocyte antigen (HLA) class II genes and complement C4 defi ciency for T1D in Somali immigrated to central Ohio. We enrolled 22 Somali T1D patients aged 5-22 yrs, and 26 unrelated Somali healthy subjects as controls. HLA class II genotypes for DRB1, DQA1 and DQB1 were determined by oligonucleotide specifi c hybridization. Gene copy number variations for total C4, C4-long, C4-short, C4A, and C4B were determined by genomic Southern blots. HLA-DR3 (DRB1*0301-DQA1*0501-DQB1*0201) was found in 73% of patients vs. 46% of controls (p=.063). DRB1*04 (DRB1*0401/0403/0404/0405)-DQA1*0301/*03xx-DQB1*0302/0202) was signifi cantly more frequent in patients (40.9%) vs. controls (7.7%; p=.0052). Homozygous DRB1*0301 occurred in 22.7% of patients vs. 4% of controls (p=.049). Heterozygous DR3/DR4 occurred in 22.7% of patients and was not detected in any con-trols (p=.0064). Protective genotypes DRB1*15 and DRB1*11 were present in 3.8% and 7.7% of controls, respectively, neither of which were present in patients. Gene copy numbers of total C4, C4L, C4S, C4A, and C4B did not show statistical difference between patients and controls, although low GCN of total C4 were more prevalent in T1D. In conclusion, known high risk HLA types DRB1*0301 and *04 were also common in Somali T1D. Although HLA-DR3 was prevalent among Somali T1D and controls, the ancestral hap-lotype AH8.1 with DR3 and C4A defi ciency had low frequencies in Somali. There was no association between C4A or C4B defi ciency and type 1 diabe-tes in Somali. Thus, genetic factors for T1D susceptibility appear to differ in frequency and effect size among racial groups. Further studies on environ-mental triggers for Somali T1D would also be of interest, as Somali controls had high DR3 rate and often lacked protective genotypes. Controls were typically adult immigrants born in Somalia, as compared to patients who were youths born in the U.S.A.

Supported By: Nationwide Children’s Hospital

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2447-PUBPolymorphisms in the MASP-1 Gene: Their Infl uence on the Plasma Levels of the Belonging Gene Products in Type 2 DiabetesSARA S. KROGH, CHARLOTTE B. HOLT, RUDI STEFFENSEN, KRISTIAN FUNCK, ESBEN LAUGESEN, PERNILLE HØYEM, STEFFEN THIEL, PER L. POULSEN, TROELS KRARUP, Aarhus, Denmark, Aalborg, Denmark

Mounting evidence indicates adverse activation of the complement system plays a role in the development of diabetic vascular complications. The complement proteins; mannan-binding lectin (MBL) and its associated serine proteases (MASP-1 and MASP-2) are elevated in diabetes patients. We hypothesized that single nucleotide polymorphisms (SNPs) in the MASP-1 gene may contribute to altered plasma levels of the belonging gene products; MASP-1, MASP-3, and MAp44 in patients with type 2 diabetes and hence play a role in diabetic vascular complications.

We determined plasma levels of MASP-1, MASP-3, and MAp44 in 100 patients with type 2 diabetes and 100 sex- and age-matched controls using time-resolved immunofl uorometric assay. Carefully selected SNPs were analysed using TaqMan® genotyping assay. In addition, we included a strep-tozotocin induced diabetes mouse model to investigate the causality of dia-betes and altered MASP-1 levels.

The MASP-1 level was signifi cantly higher among patients with type 2 diabetes (P = 0.017). In the diabetes mouse model, diabetic mice had sig-nifi cantly higher MASP-1 levels compared with the control mice (P = 0.003) after inducing diabetes. In the preliminary genetic results, no difference of genotype distribution was found between the diabetes and control groups. The heterozygote genotype (AG) in rs874603 was associated with increased plasma level of MASP-3 (P = 0.011) for the entire study population and this tendency remained signifi cant in the diabetes group (P = 0.02) and border-line signifi cant in the control group (P = 0.07). Interestingly, we also found a positive correlation between body mass index, MASP-3 and MAp44 plasma levels (P = 0.02 and P = 0.01, respectively).

The MASP-1 level was higher among patients with type 2 diabetes. However, we did not observe any difference of genotype distribution or the impact of the genetic variations (SNPs) on the plasma level of MASP-1, MASP-3, and MAp44 between the diabetes and control group.

Supported By: Aase og Ejnar Danielsens Fond

2448-PUBSLC5A2 Polymorphism Infl uences both Glycemic Control and Risk for Diabetic Retinopathy in Type 2 Diabetes PatientsJASNA KLEN, KATJA GORICAR, VITA DOLZAN, Trbovlje, Slovenia, Ljubljana, Slo-venia

Kidneys participate in glucose homeostasis by gluconeogenesis and renal glucose excretion. Up to 99% of the fi ltered glucose is reabsorbed in proxi-mal tubules via sodium-glucose cotransporters (SGLTs), particularly SGLT2, coded by SLC5A2 gene. Besides SLC5A2 mutations that cause familial renal glucosuria, SLC5A2 genetic polymorphisms may infl uence glucose homeo-stasis. We investigated if common SLC5A2 rs9934336 polymorphism infl u-ences glycemic control and risk for macro or microvascular complications in Slovenian type 2 diabetes (T2D) patients. In our pilot study 181 clinically well characterised T2D patients were genotyped for SLC5A2 rs9934336 G>A polymorphism. Associations with glycemic control and T2D complications were analysed with nonparametric tests and logistic regression. SLC5A2 rs9934336 genotype distribution was as follows: GG 55.8%, GA 37.0% and AA 7.2%. Median (25%-75% range) basal blood glucose levels were 6.96 (6.40-7.99) mmol/L in patients with normal GG genotype, 7.96 (7.31-8.83) mmol/L in GA and 9.04 (7.43-10.51) mmol/L in polymorphic AA genotype (P<0.001). The association of rs9934336 genotype with HbA1c levels was signifi cant only under the dominant genetic model (P=0.030). Retinopathy was the only late T2D complication associated with SLC5A2 polymorphism after adjustment for T2D duration. Carriers of at least one polymorphic SLC5A2 rs9934336 A allele had signifi cantly higher risk for diabetic retin-opathy than non-carriers (OR=7.62; 95% CI=1.65-35.28; P=0.009). Our pilot study suggests an important role of SLC5A2 polymorphisms in the physi-ologic process of glucose reabsorption in kidneys in T2D patients. Further-more, we report for the fi rst time the association between SLC5A2 polymor-phism and diabetic retinopathy. Further studies are needed to investigate if genetic variability of SGLT2 transporters infl uences treatment outcome with the novel class of antidiabetic drugs that inhibit SGLT2.

Supported By: Slovenian Research Agency (P1-0170)


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2445-PUBThe DNA Methylation of Single Nucleotide Polymorphism (SNP)-420 in RETN Is Associated with hs-CRP and BMI in the General Jap-anese PopulationHIROSHI ONUMA, YASUHARU TABARA, RYOICHI KAWAMURA, JUN OHASHI, YASU NORI TAKATA, YASUMASA OHYAGI, RYUICHI KAWAMOTO, KATSUHIKO KO HARA, TETSURO MIKI, HARUHIKO OSAWA, Toon, Japan, Kyoto, Japan, Tokyo, Japan

We previously reported that SNP-420 (C>G) (rs1862513) in the promoter region of the human resistin gene (RETN) was associated with type 2 diabetes (T2D) (Am J Hum Genet 2004). The G/G genotype of SNP-420 increased T2D susceptibility by enhancing its promoter activity. Plasma resistin was high-est in G/G genotype, followed by C/G, and C/C, and was positively correlated with insulin resistance (HOMA-IR) (Diabetes Care 2007). SNP-420 affects CpG sequences, which is a possible methylation site of DNA, and could affect gene expression of RETN. We reported that methylation at SNP-420 was inversely associated with plasma resistin in the same population of this study in the previous ADA scientifi c meeting. The aim of this study is to exam-ine whether methylation at SNP-420 is associated with clinical parameters in this population. We analyzed methylation at -420 in RETN in 2,078 Japa-nese subjects and assessed the relation between the methylation and clinical parameters. We performed multiple regression analyses involving methyla-tion at SNP-420 as a dependent variable, and age, sex, BMI and hs-CRP as independent variables in each of the SNP-420 genotypes. Hs-CRP was found to be inversely associated with methylation at SNP-420 in the C/C or C/G genotypes (β= -0.139, P< 0.0001, and β= -0.138, P< 0.0001, respectively). BMI was positively associated with methylation in C/C genotype of SNP-420 (β= 0.176, P< 0.0001), and tended to be associated with C/G genotype. Therefore the methylation at SNP-420 could be associated with hs-CRP and BMI. In con-clusion, hs-CRP and BMI could be possible environmental factors affecting methylation at SNP-420, thus infl uencing plasma resistin.

2446-PUBAssociation Study of rs1801282 (PPARG), rs9939609 (FTO), and rs9282541 (ABCA1) Polymorphisms in Mexican Children Population with Metabolic SyndromeMARTA MENJIVAR, ISELA MONTUFAR-ROBLES, LIZBETH DÍAZ-ROQUE, KATY SÁNCHEZ-POZOS, BÁRBARA ITZEL PEÑA-ESPINOZA, MARÍA DE LOS ÁNGELES GRANADOS-SILVESTRE, MARÍA G. ORTIZ-LÓPEZ, Mexico City, Mexico

Metabolic syndrome (MetS) prevalence in Mexico is 10% to 60% across the country, this is of great relevance, because MetS is a risk factor to develop type 2 diabetes (T2D) and cardiovascular diseases in adulthood. Previous reports had shown the association of PPARG, FTO and ABCA1 poly-morphisms with obesity and T2D mainly in Caucasian populations, however, their relationship with MetS in Mexican children is unknown. Thus, the aim of this study was to investigate the association of rs1801282, rs9939609 and rs9282541 with markers of the MetS in Mexican children from Chimalhua-can, a marginal population. There were studied 259 unrelated children, 8-12 years old, consent and assent letter were signed. Anthropometric measure-ments and biochemical analysis were performed. Genotyping was done by quantitative real-time PCR technology. Data were analyzed by ANCOVA with fi xed variables (age, gender and BMI), as well as by logistic regression model. Deviation from the Hardy-Weinberg equilibrium was not observed for any SNP. The prevalence of MetS was 20.5%. Interestingly, the results showed that children with MetS had signifi cant higher blood pressure, triglycerides, waist circumference (WC), and lower HDL-C levels than those without MetS (p <0.01), which denotes the appearance of metabolic disorders since child-hood. The rs9282541 had a signifi cant correlation with low HDL-C concen-trations, high WC and sistolic pressure in dominant and recessive model (p= 0.001 and p=0.04 respectively). As regards to rs1801282 a signifi cant correlation with low triglyceride levels (p=0.021) was found. The rs9939609 was associated with high WC in an age-dependent form (p=0.019, with C.I. 95% of 1.09-2.60). Remarkably, the results showed an association of rs9282541 with low HDL-C (p=0.01, with C.I. 95% of 0.95-0.98), supporting the involvement of lipid metabolism in MetS development. In conclusion, these SNPs could be used as a risk marker in Mexican children.

Supported By: Dirección General de Asuntos del Personal Académico (221014)

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patients harboring inactive ABCC8 mutations were characterized by hyper-insulinemia, overweight/obesity. These fi ndings suggested most of genes accounting for early onset T2DM are unknown and searching for new caus-ative genes of T2DM is essential.

2452-PUBRegulation of Glucose Metabolism by TIR-domain-containing Adapter-inducing Interferon-β (TRIF) during ObesityJING CHEN, AIMIN XU, CONNIE WAI WOO, Hong Kong, China

Toll like receptors (TLRs) are key proteins involved in innate immunity and TRIF is one of their cytosolic adaptors which mediate downstream signaling. TLRs are commonly associated with many metabolic diseases including glu-cose intolerance, diabetes and cardiovascular diseases. However, mecha-nism on their metabolic function in these diseases remained unknown. Our project aims to study the role of TRIF in glucose metabolism during high fat diet (HFD)-induced obesity. We found that fasting blood glucose in trif-/- mice fed a HFD was signifi cantly increased compared with wild type mice. Although fasting blood glucose in trif-/- mice remained unchanged under a normal chow diet, trif-/- mice developed impaired glucose tolerance; and this impairment was aggravated when mice were fed a HFD. However, the serum insulin level remained unchanged in trif-/- mice under HFD which indicate that the function of pancreas was intact. Moreover, in bone marrow trans-plantation experiment wild type recipients that received wild type bone marrow had similar glucose level compared with those received trif-/- bone marrow under a high fat diet; and the same was observed in trif-/- recipi-ents. These results indicated that TRIF could regulate glucose metabolism through metabolic cells, and excluded the possibility that trif-/- myeloid cells contributed to the observed glucose intolerance. The weights of white adi-pose tissue in trif-/- mice were decreased compared with those of wild type mice. Thus, we are going to study on the function of TRIF in the metabolic cells including adipocytes, hepatocytes and skeletal cells which may play a potential role in regulating glucose metabolism. In summary, TRIF may par-tially regulate glucose metabolism through metabolic cells. This project can provide different angles for studying the role of TRIF in metabolic diseases to have a new insight in therapeutic options.

2453-PUBGenetic Variant in Interleukin 6 Gene and Microvascular Complica-tions in Patients with Type 2 Diabetes MellitusSTAVROULA PAPAOIKONOMOU, NICHOLAS TENTOLOURIS, NICHOLAS KATSIL-AMBROS, KONSTANTINOS MAKRILAKIS, CHRISTODOULOS STEFANADIS, DIMI-TRIS TOUSOULIS, Athens, Greece

Infl ammation is involved in the pathogenesis of diabetes and its compli-cations. Proinfl ammatory cytokines are involved in the development of ath-erosclerosis. The association of genetic variants in infl ammatory genes with the prevalence of diabetic microvascular complications is unknown. We examined the association of 174GC polymorphism of IL6 gene with micro-vascular complications in patients with type 2 diabetes mellitus (T2DM). The IL6174GC polymorphism was detected in 431 patients with T2DM (mean age 66.5±9.96 years, 218 males) by polymerase chain reaction and appropriate restriction enzyme digestion (SfaNI). The presence of diabetic nephropathy was defi ned by presence of microalbuminuria and/or protei-nuria. Diabetic retinopathy (DR) was defi ned by direct funduskopy. Diabetic neuropathy was defi ned using the neuropathy disability score. The geno-type distribution was 49.1% GG, 26.8% GC and 24.1% CC, with no signifi -cant gender difference. In the total sample, 153 (35.5%) of the participants had nephropathy, 119 (27.6%) had DR, and 157 (36.4%) had neuropathy. The prevalence (%) of microvascular complications among the three genotypes was: GG:35.1, GC:44.5, CC:28.3 for nephropathy, GG:29.7, GC:27.3, CC:21.2 for DR and GG:47.7, GC:29.8, CC:22.5 for neuropathy, without signifi cant dif-ference (p=0.071, 0.326, 0.566), respectively. The prevalence (%) of neph-ropathy was lower in CC homozygotes in comparison with the GC genotype, odds ratio (OR):0.511, 95% confi dence intervals (CI): 0.284-0.914, p=0.024, even after controlling for confounding factors, p=0.014. In multivariate logis-tic regression analysis CC homozygotes had lower OR for DR in comparison with carriers of “G” allele, (GG+GC):29.6%, OR:0.505, 95% CI: 0.270-0.946, p=0.033. The prevalence of neuropathy revealed no signifi cant associations. The homozygocity of “C” allele in IL6174GC polymorphism protects from the prevalence of nephropathy and retinopathy, in patients with T2DM.

2449-PUBNAFLD Patients with Antidiabetic Therapy Had Lower Hepatic Enzyme Levels in Men: NAGALA StudyTAKAFUMI OSAKA, MASAHIDE HAMAGUCHI, MUHEI TANAKA, AKIHIRO OBORA, TAKAO KOJIMA, MICHIAKI FUKUI, Kyoto, Japan, Kameoka City, Japan, Gifu, Japan

Nonalcoholic fatty liver disease (NAFLD) plays a pivotal role in the patho-genesis of diabetes mellitus (DM), and some of patients with NAFLD are treated for DM. However, the infl uence on antidiabetic therapy for NAFLD has not been clarifi ed yet. Thus, we investigated the association of DM and antidiabetic therapy with the hepatic enzyme levels in patients with NAFLD. We performed a cross-sectional study in a medical health checkup program at a general hospital. We enrolled 1873 patients with NAFLD, and catego-rized them into 3 groups; non-DM (ND), DM without medication (DO) and DM with medication (DW). Diabetes mellitus was defi ned as HbA1c ≥ 6.5%. Adjusted least square mean aspartate aminotransferase (AST) or alanine aminotransferase (ALT) in each group was calculated by multivariate analy-sis of covariance. In the multivariate analyses, age, quantity of alcohol con-sumption, smoking status, physical activities and body mass index (BMI) were used as covariates. Adjusted least square mean AST or ALT in ND, DO or DW group was shown in Table 1. Those were signifi cantly different among three groups in women. Those in DO group were signifi cantly higher than those in ND group, and those in DW group were signifi cantly lower than those in DO group in men. In conclusion, the hepatic enzyme levels of DW group were lower than those of DO group in men, although those of DW group were higher than those of DO group in women.Table 1.

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2451-PUBPrevalence and Characteristics of 34 Monogenetic Diabetes in Chi-nese with Early-Onset Type 2 DiabetesMENG LI, XUEYAO HAN, SIQIAN GONG, SIMIN ZHANG, YINGYING LUO, XIAOL-ING CAI, LINGLI ZHOU, QIAN REN, WEI LIU, XIANGHAI ZHOU, LINONG JI, Beijing, China

Objective: This study aimed to evaluate prevalence and clinical character-istics of 34 monogenic diabetes in Chinese Han population with early onset diabetes (EOD).

Research Design and Methods: 1.) 96 patients with T2DM diagnosed before 35 years of age were recruited (Sample 1). 30 patients diagnosed with diabetes before 40 of age were included. 2.) Clinical data were col-lected from all patients: gender, age, duration of diabetes, BMI, and so on. 3.) And next generation sequencing was used to screen mutations in the exons of 34 known causative genes of diabetes in Sample 1. Putative causative mutations were screened in family members of index patients and nondiabe-tes controls. The samples of Sample 2 were used to search for more patients with potentially mutations in ABCC8.

Results: 1.) Of the 96 patients with EOD, 78.1% had overweight or obesity; 30.2% had hypertension and 85.4% showed dyslipidemia. 2.) 2 known HNF1A mutations (R263C and T10M) and 10 new mutations, including R1222W and R1222fsinsC in ABCC8, R311C in HNF4A, R455H in KLF11, Q88P in GLIS3, M32V and R146P in CAV1, S619F in WFS1, H263P in EIF2AK3 and A1152T in INSR, identifi ed as deleterious by bioinformatics analysis, were absent in nondiabetes controls. 3.) Two additional ABCC8 mutations (R306C and R298C) were identifi ed in an independent sample of 30 patients with T2DM, obesity and/or renal injury. Those with ABCC8 mutations had specifi c pheno-types, including hyperinsulinemia, overweight/obesity and renal injury.

Conclusions: Two monogenetic diabetes caused by ABCC8 and HNF1A mutations were the most common in Chinese patients with EOD. Diabetic

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IMMUNOLOGY TRANSPLANTATION

Table. Patient Characteristics.Characteristic All Patients

(N=207) Q1-3

(N=155) Q4

(N=52) P-value

Mean age (years) 56.6 +/- 10.4 56.1 +/- 11.0 58.02 +/- 8.3 p = 0.255Pre-Transplant Diabetes 74 (35.7%) 46 (29.7%) 28 (53.8%) p = 0.0025BMI 29.6 +/- 6.5 29.6 +/- 6.5 29.8 +/- 6.6 p = 0.84MELD Score 26.8 +/- 12.2 28 +/- 13.6 23 +/- 5.6 p = 0.64Any Infection to 6 Months 115 (55.5%) 93 (60%) 22 (42.3%) p = 0.035Rejection 75 (36.2%) 62 (40%) 13 (25%) p = 0.066Data are expressed as mean +/- SD or n (%) unless otherwise indicated.

Figure 1. Decreased Infection with Increased Insulin Drip Rate in Post-Liver Transplant Patients.

2458-PUBAttempts to Predict Islet Yield Based on Screening Methods and to Simplify Follow-up Measurements after Islet AutotransplantationJULIA SOLOMINA, SABRINA MATOSZ, CELESTE THOMAS, ZEHRA TEKIN, ANDRES GELRUD, LOUIS H. PHILIPSON, JUSTYNA GOLEBIEWSKA, KAROLINA GOLAB, LINDSAY SCHENCK, W. JAMES CHON, SABARINATHAN RAMACHAN-DRAN, MARTIN TIBUDAN, MACIEJ SLEDZINSKI, JEFFREY MATTHEWS, PIOTR WITKOWSKI, Chicago, IL, Gdansk, Poland

Decision about timing of total pancreatectomy (TP) for chronic pain and pancreatitis is diffi cult due to risk of postsurgical diabetes despite islet auto-transplantation (IAT). It was found in pediatric population, that islet isola-tion yield and chance for insulin independence could be predicted based on simple preoperative measurements, so we decided to verify it in our adult population. Next, we checked whether simple fasting blood measurements correlate with more logistically challenging stimulation test in order to sim-plify follow up procedure. We measured weight, body mass index, A1c, fast-ing glucose, c-peptide and creatinine, as well as performed mixed meal tol-erance test (MMTT) prior to TPIAT in 12 adult patients. Next, we analysed results of MMTT and fasting blood samples on day 75 and 1 year after the transplant looking for correlations. We did not fi nd correlation between isle yield in islet equivalent (IEQ) or IEQ/kg and following factors: time with pancreatitis, age, weight, body mass index, fasting serum glucose, fasting c-peptide to glucose creatinine ratio, peak glucose, c-peptide, insulin, area under the curve (AUC) for c-peptide from MMTT. We found weak correlation between A1c and IEQ/kg (r=-0.57, p=0.049) but not with IEQ (NS). After the transplant, peak glucose in MMTT correlated with SUITO index (rho=-0.68, p=0.001) and with fasting c-peptide/glucose (rho=-0.55, p=0.017); c-peptide AUC correlated with fasting c-peptide/glucose (rho=-0.55, p=0.016) but not with SUITO. We found also correlation between c-peptide AUC in MMTT on day 75 and islet dose (r-=0.89, p=0001) confi rming importance of high islet dose for effi cient insulin secretion after the transplant. We were unable to identify factors predicting islet yield after TP. Fasting measurements of blood glucose and c-peptide can approximate results of MMTT and can be utilized to simplifi ed patient follow up.

Supported By: National Institutes of Health

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2454-PUBWITHDRAWN

IMMUNOLOGY

2455-PUBIndividuals with a First-Degree Relative with Type 2 Diabetes Mani-fest Adverse Infl ammatory Responses following a Meal Rich in Car-bohydrateSONIA BAIG, EHSAN PARVARESH RIZI, MUHAMMED SHABEER, VANNA CHHAY, YVONNE TEO, E. SHYONG TAI, FAIDON MAGKOS, CHIN MENG KHOO, SUE-ANNE TOH, Singapore, Singapore

We have previously found that obese individuals with insulin resistance manifest adverse immune-metabolic responses that can be magnifi ed after consuming a meal rich in carbohydrate. Here, we studied normoglycemic men with (n=9) or without (n=9) a fi rst degree relative with type 2 diabetes (FDRT), matched for body mass index, waist circumference, age, and insulin sensitivity (homeostasis model assessment) during fasting, and after con-suming a 600-kcal liquid, carbohydrate rich meal (57% of energy from car-bohydrate). We assessed plasma glucose, insulin, triglycerides, non-esteri-fi ed fatty acids (NEFA), cytokines (IL6 and TNFα), and gene expression levels of NFκB complex (i.e., RelA, p105, IκBα, IκBβ), IL6, TNFα, IL1β, IL10, TGFβ, TLR4, and MCP1 in circulating mononuclear cells (MNC). Postprandial glu-cose excursion and NEFA suppression were not different between groups, but FDRT subjects had greater postprandial insulin and triglyceride concen-trations during the fi rst 2 h after the meal. Postprandial expression of TNFα and IL10 in MNC was greater in FDRT. There were also trends for increased expression of key pro-infl ammatory transcription factor (NFkB complex) genes and its target genes (i.e., MCP1 and IL6); and decreased expression of anti-infl ammatory genes (i.e., TGFβ) in MNC of FDRT subjects. Despite higher basal plasma IL6 concentrations in the FDRT, the postprandial IL6 response in plasma was similar between two groups. TNFα concentrations in plasma were too low to be detected in the majority of the samples. MNC gene expression (i.e., MCP1, IL10, and TGFβ) correlated positively with the 2 h postprandial rise in insulin concentrations. These results suggest that heredity of type 2 diabetes is associated with a pro-infl ammatory immune-metabolic response in the postprandial period. This may predispose FDRT individuals to greater cardio-metabolic risk.

Supported By: National Medical and Research Council of Singapore (to S-E.T.)

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TRANSPLANTATION

2457-PUBPeak Insulin Drip Rate Associated with Decreased Infections Post-Liver TransplantALISON AFFINATI, TERESA DERBY, HENRY ZELADA, ASHLEY THERASSE, DIANA OAKES, KATHLEEN SCHMIDT, JOSH LEVITSKY, BING HO, NEEHAR PARIKH, DAN-IELLE LADNER, ALFRED RADEMAKER, MARK MOLITCH, AMISHA WALLIA, Ann Arbor, MI, Chicago, IL

Hyperglycemia is associated with infection and rejection in post-liver transplant (LTX) patients (pts), but little is known about peak insulin require-ments and morbidity.

This retrospective cohort study (N=207) was conducted to evaluate peak insulin requirements and subsequent morbidity in post-LTX pts (2011-2012). Pts were further separated into quartiles (Q) by peak insulin drip (gtt) rate [U/hr].

Peak gtt rate ranged 0-62 (mean 15.65 ± 11) and Qs are shown in Figure 1. Comparisons were made between Q4 and Q1-3. Q4 pts were similar in age and BMI, but more had DM (Table). Q4 pts had signifi cantly fewer infections up to 6 mos and borderline lower rejection. Peak insulin gtt was associated with decrease odds of infection up to 6 mos following adjustment for BMI, MELD score, and DM status (OR: 0.50, p = 0.046 95% CI 0.25-0.99).

epidemiology—aging category · garcia, alzira, spain, valencia, spain we would like to evaluate...

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