Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes

Adverse childhood experiences (ACE) have been associated with a greater prevalence of risky behaviors and chronic health conditions, such as diabetes in adulthood. While adolescents with risk taking behaviors experience worsening of diabetic metabolic control, it is yet to be determined whether glycemic management in children and adolescents is negatively and independently influenced by ACEs. This study examines the relationship between ACEs in children and adolescents with type 1 diabetes (T1DM) and glycemic control, BMI and lipids. For such children, we hypothesized that hemoglobin A1c (HbA1c) is positively correlated with ACE scores. Parents of children (age 2–18 years) with T1DM completed a validated ACE questionnaire. The associations between parent and child ACE score and HbA1c, lipids and BMI z-scores were assessed using linear regression. The prevalence of any ACE was 27.9% among children and 49.0% among parents. HbA1c was significantly higher in children who had exposure to three or more ACEs (β:0.63 (4.5 mmol/mol); p = 0.02), in those who had a parent exposed to four or more ACEs (β:0.87 (7.2 mmol/mol); p = 0.03), in children who had exposure to household incarceration (β:0.62 (4.4 mmol/mol); p = 0.05) and children who witnessed or had been victim of violence in the neighborhood (β:0.71 (5.4 mmol/mol); p = 0.02). ACEs were highly prevalent among children with T1DM and had a positive association with glycemic control.</jats:p

The Biodiversity of Pelagic Fish Caught by Purse Seines in Tripoli, northern Lebanese Coast.

This study highlights for the first time the biodiversity of fish assemblages in purse seine fisheries in the Tripoli region, north of Lebanon. A total of 925 specimens from 17 species of 11 families were identified and studied from the monthly samples collected between April and November 2017. The catch was dominated by 3 families (Clupeidae, Engraulidae and Dussumieriidae) in varying abundances. Seasonal variation of abundance was detected with Sardina pilchardus (32%) in Spring, Engraulis encrasicolus (56%) in Summer and Sardinella maderensis (58%) in Fall. Weight length relationships (W=aLb ) were estimated for the most abundant species, and they show a positive allometry for Engraulis encrasicolus (b=3.276), as well as, Herklotsichthys punctatus (b=3.477), and a negative allometry for Sardinella aurita (b=2.886). Seasonal diversity was evaluated and the highest diversity was observed during the spring season following Shannon Index (H’=1.44), Pielou evenness (J’=0.74) and Simpson Index (1-D=0.74). The Shannon Index differed from one season to another reaching the highest value in Spring. Despite the progress in studying diversity and abundance, variation in pelagic fish catches is evident in Lebanese sea water, where a management plan for purse seine fisheries should be applied under the framework of ecosystem approach to fisheries.</jats:p

1501-P: Reproducibility of Glycemic Measures among Youth and Adults with Impaired Glucose Tolerance (IGT) or Recently Diagnosed Type 2 Diabetes (T2D) in the Restoring Insulin Secretion (RISE) Study

Fasting and 2-h OGTT glucose along with HbA1c are used in clinical practice for diagnosing IGT and T2D, and in clinical trials for assessing eligibility. While previous studies found poor reproducibility of such measures in adults and youth at risk for dysglycemia, no studies have assessed group differences in reproducibility. We assessed reproducibility of glycemic measures in treatment-naïve youth and adults screened for RISE. Central laboratory measurements of plasma glucose and HbA1c from two standardized 2-h OGTTs completed 4 weeks apart were compared in 66 youth (mean age 14.2 y) and 354 adults (52.7 y) with IGT or recently diagnosed T2D, using ADA criteria. Between screening and baseline, mean coefficient of variation (CV) was lowest for HbA1c in both groups (Table). HbA1c variability was greater in youth than adults, whereas 2-h glucose variability was greater in adults. Status concordance was highest with HbA1c and lowest with 2-h glucose alone, and significantly lower in youth than adults using HbA1c alone. This variability produced discordant glycemic classification at screening vs. baseline in over 25% of participants. The variability and lack of classification concordance in youth and adults highlights the limitations of one-time testing for diagnostic classification in clinical practice and trials. Disclosure A.H. Tjaden: None. S. Edelstein: None. S.A. Arslanian: None. E. Barengolts: None. S. Caprio: None. M. Cree-Green: None. A.A. Lteif: None. K.J. Mather: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, Merck &amp; Co., Inc., Novo Nordisk A/S, Sanofi. M. Savoye: None. A. Xiang: None. S.E. Kahn: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Novo Nordisk A/S. Consultant; Self; Neurimmune. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck &amp; Co., Inc., Novo Nordisk A/S. R. Consortium: None. Funding American Diabetes Association (1-14-RISE-01 to S.E.K.); National Institute of Diabetes and Digestive and Kidney Diseases </jats:sec

Lack of Durable Improvements in β-Cell Function Following Withdrawal of Pharmacological Interventions in Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes

OBJECTIVE The Restoring Insulin Secretion (RISE) Adult Medication Study compared pharmacological approaches targeted to improve β-cell function in individuals with impaired glucose tolerance (IGT) or treatment-naive type 2 diabetes of &amp;lt;12 months duration. RESEARCH DESIGN AND METHODS A total of 267 adults with IGT (n = 197, 74%) or recently diagnosed type 2 diabetes (n = 70, 26%) were studied. Participants were randomized to receive 12 months of metformin alone, 3 months of insulin glargine with a target fasting glucose &amp;lt;5 mmol/L followed by 9 months of metformin, 12 months of liraglutide combined with metformin, or 12 months of placebo. β-Cell function was assessed using hyperglycemic clamps at baseline, 12 months (on treatment), and 15 months (3 months off treatment). The primary outcome was β-cell function at 15 months compared with baseline. RESULTS All three active treatments produced on-treatment reductions in weight and improvements in HbA1c compared with placebo; the greatest reductions were seen in the liraglutide plus metformin group. At 12 months, glucose-stimulated C-peptide responses improved in the three active treatment groups and were greatest in the liraglutide plus metformin group, but the arginine-stimulated incremental C-peptide response was reduced in the liraglutide plus metformin group. Despite on-treatment benefits, 3 months after treatment withdrawal there were no sustained improvements in β-cell function in any treatment group. CONCLUSIONS In adults with IGT or recently diagnosed type 2 diabetes, interventions that improved β-cell function during active treatment failed to produce persistent benefits after treatment withdrawal. These observations suggest that continued intervention may be required to alter the progressive β-cell dysfunction in IGT or early type 2 diabetes. </jats:sec

Hyperglucagonemia Does Not Explain the β-Cell Hyperresponsiveness and Insulin Resistance in Dysglycemic Youth Compared With Adults: Lessons From the RISE Study

OBJECTIVE To determine whether β-cell hyperresponsiveness and insulin resistance in youth versus adults in the Restoring Insulin Secretion (RISE) Study are related to increased glucagon release. RESEARCH DESIGN AND METHODS In 66 youth and 350 adults with impaired glucose tolerance (IGT) or recently diagnosed type 2 diabetes (drug naive), we performed hyperglycemic clamps and oral glucose tolerance tests (OGTTs). From clamps we quantified insulin sensitivity (M/I), plasma fasting glucagon and C-peptide, steady-state glucagon and C-peptide at glucose of 11.1 mmol/L, and arginine-stimulated glucagon (acute glucagon response [AGR]) and C-peptide (ACPRmax) responses at glucose &amp;gt;25 mmol/L. RESULTS Mean ± SD fasting glucagon (7.63 ± 3.47 vs. 8.55 ± 4.47 pmol/L; P = 0.063) and steady-state glucagon (2.24 ± 1.46 vs. 2.49 ± 1.96 pmol/L, P = 0.234) were not different in youth and adults, respectively, while AGR was lower in youth (14.1 ± 5.2 vs. 16.8 ± 8.8 pmol/L, P = 0.001). Significant age-group differences in insulin sensitivity, fasting C-peptide, steady-state C-peptide, and ACPRmax were not related to glucagon. Fasting glucose and glucagon were positively correlated in adults (r = 0.133, P = 0.012) and negatively correlated in youth (r = −0.143, P = 0.251). In both age-groups, higher fasting glucagon was associated with higher fasting C-peptide (youth r = 0.209, P = 0.091; adults r = 0.335, P &amp;lt; 0.001) and lower insulin sensitivity (youth r = −0.228, P = 0.066; adults r = −0.324, P &amp;lt; 0.001). With comparable fasting glucagon, youth had greater C-peptide and lower insulin sensitivity. OGTT suppression of glucagon was greater in youth. CONCLUSIONS Youth with IGT or recently diagnosed type 2 diabetes (drug naive) have hyperresponsive β-cells and lower insulin sensitivity, but their glucagon concentrations are not increased compared with those in adults. Thus, α-cell dysfunction does not appear to explain the difference in β-cell function and insulin sensitivity in youth versus adults. </jats:sec