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2569-PODifferences in Health Utility Scores among Persons With Normal Glucose Level, Impaired Glucose Regulation, and Diabetes: China Diabetes Impact StudyWENHUI ZHAO, WENYING YANG, JIANZHONG XIAO, RUI LI, PING ZHANG, KATARZYNA K. SKARBEK, ERIN SCHNEIDER, JONATHAN BROWN, WEIPING JIA, LINONG JI, XIAOHUI GUO, ZHONGYAN SHAN, JIE LIU, HAOMING TIAN, ZHIGUANG ZHOU, QIUHE JI, JIAPU GE, GANG CHEN, Beijing, China, Atlanta, GA, Brussels, Belgium, Shanghai, China, Shenyang, China, Taiyuan, China, Chengdu, China, Changsha, China, Xi’an, China, Urmqi, China, Fuzhou, China

The relation between health utility scores and glucose level needs to be understood for assessing burden of pre-diabetes and diabetes and the cost-effectiveness of interventions for preventing pre-diabetes/diabetes. Little such data are available for Chinese population. As a part of the China Diabe-tes Impact Study, a 12-site national study of the health and economic burden of pre-diabetes and diabetes among adults in China, 1553 participants with normal glucose tolerance (NGT), 1514 with impaired glucose regulation (IGR), and 1482 with diabetes (DM) reported their health related quality of life by fi lling the Health Utility Index Self-Administered Questionnaire (HUI®). We used multivariable regression models to estimate the association between HUI scores and glucose status, adjusting for patient’s demographic charac-teristics, social economic and smoking status. Persons with diabetes had a signifi cant lower HUI scores (0.82) than persons with NGT (0.87, P<0.01) and persons with IGR (0.86, P<0.01), which were mainly due to worse vision, im-paired cognition and higher pain. Difference in HUI score between persons with NGT and IGR was not signifi cant (P=0.126). After adjusting other covari-ates, diabetes status was associated with a decrease of 0.03(P=0.003) in HUI score than NGT. Being a woman, older age, having a lower household income or educational level, and, having a longer time since diagnosis of diabetes were signifi cantly associated with lower utility score. Diabetes reduces health-related quality of life, mainly because of losses in vision and cognitive functions, and increased pain. Our estimated HUI scores for Chinese can be used for estimating the loss in quality of life associated with pre-diabetes and diabetes and health utility scores benefi ts of preventing diabetes.

2570-PODiabetes in Minority Pregnancy: Epidemiology and Evaluation of Diagnostic ToolsMADONA AZAR, JULIE STONER, DONNY WYNN, JUNPING CHEN, LANCER STE-PHENS, JOHN GOODMAN, TIMOTHY LYONS, Oklahoma City, OK, Talihina, OK

The prevalence of Type 2 Diabetes (T2DM) has increased in recent years. In addition to being more prevalent, T2DM now tends to occur in younger individuals, particularly in women of childbearing age. Minorities may be more affected. Undiagnosed and thus untreated diabetes in pregnancy may have adverse consequences on both mother and fetus and may promote long term development of T2DM in the offspring. In addition, timing and diagnos-tic thresholds used for screening of diabetes in pregnancy are still subject to controversy. We proposed to determine an estimate of the prevalence of T2DM and impaired glucose tolerance (IGT) at the fi rst trimester (9-13 weeks) of pregnancy in minority (Native American), high risk women using a 75g, two-hour oral glucose tolerance test (OGTT), along with hemoglobin A1c (HbA1c), HOMA-IR and skin advanced glycation end-products (SCOUT) measurements to delineate alternate ways to diagnose diabetes and help predict later development of diabetes in pregnancy if normoglycemic at the fi rst trimester. This is an interim analysis of 111 participants thus far recruit-ed. Mean age was 25.0 (± 5.2) years; all were of Native American ancestry. 59% (n=65) had a family history of T2DM and 17% (n=19) had a family history of T1DM. Average BMI is 29.4(±6.6) kg/m2. Of those 111 participants, and using current ADA diagnostic thresholds for the diagnosis of T2DM at the fi rst trimester, one had T2DM (1%). 18% (n=19) had IGT based upon abnormal OGTT response and/or HbA1c level ranging from 5.7% to 6.4%. 82% (n=91) had normal glucose tolerance. The average SCOUT score was14.4 in the one diabetic patient, 17.9 in pre-diabetic patients and 17.6 in the normoglycemic patients. The average HOMA-IR was 3.6 (± 2.7) in the pre-diabetic women and 3.2 (±5.2) in the normoglycemic women. There was no correlation be-tween fasting insulin, HOMA-IR or SCOUT score and glycemic status at the fi rst trimester.

Supported by: Oklahoma Center for the Advancement of Sciences and Technology

2571-POImpact of Ramadan Fasting on Blood Glucose Control in Patients With Type 2 Diabetes MellitusJOYCE Y. LEE, MELANIE SIAW, RUIMIN CHUA, KAIZHEN YAP, DARREN SEAH, MATTHIAS TOH, DANIEL CHEW, Singapore, Singapore

Ramadan is one of the religious observances widely carried out by Mus-lims all over the world. However, the practice of fasting between sunrise and sunset has raised concerns on its effect on the glycemic control of Muslim patients with diabetes. In this study, we compared the changes in HbA1c before and after the Ramadan month in the year 2010 for Muslim patients in Singapore. A total of 5,172 Muslim patients from nine primary care facilities were evaluated and divided into three groups based on the HbA1c levels: Group 1: 10% (n= 397), Group 2: 7.1 to 9.9% (n= 2,877) and Group 3: 7% (n= 1,898). The mean age was 60 ± 10.65 years with 61.2% of female and 38.8% male patients. Using Friedman two-way ANOVA with Bonferroni ad-justment, the mean HbA1c for Groups 1 and 2 decreased by 1.4% and 0.1%, respectively after Ramadan (p<0.001) while Group 3 increased by 0.2% after Ramadan (p<0.001). Mean HbA1c was increased at follow-up by 0.2% for Groups 2 and 3 (p<0.001) and by 0.1% for Group 1 (p>0.05). Among the three groups, patients with HbA1c of 10% had the most signifi cant decrease in mean HbA1c after Ramadan (Kruskall Wallis one-way ANOVA with Bonfer-roni adjustment, p<0.001). The impact of Ramadan fasting on the glycemic control appeared to be greatest in Muslim patients with HbA1c of 10%.

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2573-POSexual Dysfunction in Patients With Diabetes Mellitus is Accompa-nied by a High Degree of Erectile Dysfunction Severity, but Does Not Present Gender DifferentiationCHRISTOS SAMPANIS, BARBARA NIKOLAIDOU, ARETI TRIANTAFYLLOU, ELENI GAVRIILAKI, PANAGIOTA ANYFANTI, IOANNA ZOGRAFOU, EUGENIA GKALIAG-KOUSI, KONSTANTINOS PETIDIS, MICHAEL DOUMAS, STELLA DOUMA, Thes-saloniki, Greece

Diabetes mellitus is a key player in the atherosclerotic process, which primarily affects small vessels all over the body including the genitalis. Sex-ual dysfunction, currently considered a disease of vascular origin, is highly prevalent in patients with cardiovascular risk factors, following a pattern of increased prevalence among men in the general population. Whether men with diabetes mellitus exhibit higher levels of sexual dysfunction compared to their female counterparts, and the severity of the presented erectile dys-function, remain unclarifi ed. We thus investigated consecutive patients with diabetes mellitus type II who attended the Diabetes Centre of our hospital.

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The Female Sexual Dysfunction Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used for the assessment of fe-male and male sexual function, respectively. A total of 220 diabetic patients, 127 female and 93 male, 65.9±10.9 years old, were studied. Sexual dysfunc-tion affected 80.6% of male and 89.8% of female patients (p=0.055). Among male patients with erectile dysfunction, 49% exhibited severe, 16% moder-ate, and 35% mild erectile dysfunction. Sexual dysfunction affects the vast majority of patients with diabetes mellitus, and despite a trend for statisti-cal signifi cance, its prevalence is comparable between men and women. In-terestingly, half of affected male patients exhibit a severe degree of erectile dysfunction, contrary to what is generally observed in the presence of other cardiovascular risk factors, where increased prevalence of erectile dysfunc-tion is primarily encountered in a mild form. This fi nding might imply that apart from atherosclerosis triggered from the background of diabetes mel-litus, additional factors contribute to the severity of erectile dysfunction in this particular group of patients and should be thoroughly investigated.

2574-POAssociation between the Severity of Obesity and Some Cardiovas-cular Risk Factors in Non-Insulin-Treated Patients With Type 2 Dia-betes from Spain in a Pooled AnalysisLUIS A. VÁZQUEZ, JESÚS REVIRIEGO, LUIS E. GARCÍA-PÉREZ, ÁNGEL RODRÍGUEZ, HELMUT PETTO, JUAN F. ASCASO, JAVIER SALVADOR, Alcobendas, Spain, Vi-enna, Austria, Valencia, Spain, Pamplona, Spain

This research evaluated how obesity relates to several cardiovascular risk factors (CVRF) in non-insulin-treated T2D patients from Spain. For this post-hoc analysis cross-sectional data about several known CVRF were pooled from 5 recent observational studies. Mean values with 95% CIs were cal-culated within 5 BMI strata. A generalized logit model (stepwise selection at p<0.05) was used to analyze the relationship between CVRF (independent variables) and the BMI strata (dependent outcome). A total of 6442 patients were analyzed. The mean (SD) age and T2D duration were 63.2 (10.9) and 7.4 (6.7) years, respectively. More unfavorable blood pressure, triglycerides and HDL-cholesterol values were associated with an increased likelihood of hav-ing a higher BMI (fi gure). There was an inverse relationship of age and T2D duration with BMI. The same CVRF, in addition to having female sex, were associated with higher BMI in the regression analysis (table). Expectedly, BMI was associated with CVRF in T2D patients. The association of higher BMI with younger age and shorter T2D duration is consistent with the notion that the occurrence of obesity at earlier ages is a key part of current T2D epidemic.

Values are odds ratios (OR)OR BMI 25-30 vs

<25

OR BMI 30-35 vs

<25

OR BMI 35-40 vs

<25

OR BMI >40 vs

<25Gender (male vs. female) 1.10 0.69 0.39 0.18Age (change per year) 0.97 0.85 0.71 0.52SBP (change per 17.5 mm Hg) 1.07 1.08 1.17 1.30DBP (change per 10.1 mm Hg) 1.25 1.46 1.50 1.44T2D duration (change per 6.8 years) 0.88 0.76 0.67 0.61Triglycerides (change per 1.03 mmol/L) 1.47 1.60 1.66 1.55HDL cholesterol (change per 0.37 mmol/L) 0.89 0.84 0.80 0.80

Supported by: Eli Lilly and Company

2575-PO

2576-POA Systematic Review of Effectiveness of Weight Loss Interventions among Persons With Type 2 DiabetesXUANPING ZHANG, WILLIAM THOMAS, EDWARD W. GREGG, DESMOND E. WIL-LIAMS, PING ZHANG, GIUSEPPINA IMPERATORE, Atlanta, GA

We conducted a systematic review to assess the effectiveness of life-style and behavioral weight loss interventions among persons with type 2 diabetes. Through computerized searches of multiple electronic bibliograph-ic databases, we identifi ed randomized controlled trials in any language that examined weight loss or weight control strategies using dietary, physical activity, behavioral interventions, or their combination, Studies with a fol-low-up interval of 12 months or more were included. Random-effects model was used in pooling intervention effects. We identifi ed fi fty-six studies, with a total of 15922 participants and follow-up ranging from 1 to 5 years. Pooled effects for any intervention or a combination compared to usual care showed by weight loss of 5.05 kg (95 % confi dence interval [4.77-5.33]). Sev-eral other health outcomes improved signifi cantly (Table 1). In some studies, the control arm also achieved signifi cant weight loss (up to 10.5 kg). De-creases in glycated hemoglobin (A1C) generally corresponded to decreases in body weight. The number of intervention sessions was positively related to weight loss, with more sessions associated with greater weight loss. In persons with type 2 diabetes, weight loss strategies using dietary, physi-cal activity, behavioral interventions or combinations can achieve signifi cant improvements in body mass index, A1C, fasting glucose, systolic blood pres-sure, diastolic blood pressure, and high density lipid cholesterol. These strat-egies have a pivotal role in secondary prevention efforts.

Table 1. Interventions versus usual care, with follow-up 1 to 2yOutcome # of study # of participant Estimate (95% CI)Weight (kg) 18 7537 -5.05 (-5.33, -4.77)BMI (kg/m2) 5 1207 -0.56 (-1.03, -0.08)Fasting glucose (mmol/l) 6 5586 -0.56 (-0.86, -0.44)A1C (%) 14 7135 -0.45 (-0.50, -0.40)Systolic BP (mmHg) 10 6724 -2.57 (-3.39, -1.75)Diastolic BP (mmHg) 10 6724 -0.80 (-1.26, -0.33)HDL cholesterol (mmol/l) 10 6672 0.05 (0.04, 0.06)

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2578-POAssociation of Adiposity Trajectories With Insulin Sensitivity and Glycemic Deterioration: A Longitudinal Study of Rural Chinese Twin AdultsRONG LIU, XIAOBIN WANG, WENDY BRICKMAN, Beijing, China, Baltimore, MD, Chicago, IL

The aim of this study is to evaluate associations between adiposity trajec-tories over time and insulin sensitivity and glucose deterioration in a Chinese twin cohort.This study focused on 341 males and 292 females who aged 20-50 years old at baseline and had physical, clinical examinations and oral glucose tolerance test(OGTT) at two time points with an average of 6 years apart. Body mass index (BMI), waist circumference (WC), percent body fat (PBF), and percent trunk fat (PTF) trajectories were classifi ed into 5 track groups based on age- and gender-specifi c tertiles at each visit. We calculated the odds of the insulin sensitivity index(0,120) (ISI(0.120)) or glycemic deteriora-tion at follow-up among 5 defi ned trajectories (tertilebaseline tertilefollow-up) us-ing generalized estimate equations (GEE). Additionally, we applied structural equation models to examine genetic and environmental infl uences on adi-posity, adiposity change over time(ACO), ISI(0,120), and the inter-relationships.Participants with adiposity (BMI, WC, PBF and PTF) stable in the highest tertile or shifting to the highest tertile tended to have the lowest ISI(0,120) at follow-up or experience glycemic deterioration. Genetic factors exerted the major infl uence on adiposity, but environmental factors unique to each twin contributed more strongly to ISI and ACO. Correlations between adiposity/ACO and insulin sensitivity were mainly due to environmental infl uences. When adiposity stays or becomes high, insulin sensitivity falls and risk of glycemic deterioration rises. Additionally, we found that genetic factors ex-erted the major infl uence on adiposity, while environmental factors played the principal role for ACO and insulin sensitivity.

Supported by: R01 AG032227

2579-POLow Serum High-Molecular-Weight Adiponectin Level Predicts Worsening of Glucose Tolerance in Non-Diabetic Japanese MenHIROSHI HIROSE, HIROSHI KAWABE, IKUO SAITO, Tokyo, Japan

In this 6-year follow-up study employing health check-ups, we attempted to identify factors affecting glucose tolerance worsening in non-diabetic men. Informed consent was obtained from subjects among participants in annual health check-ups in both 2004 and 2010. In total, 390 Japanese male teachers and other workers, 25 to 60 years of age at baseline, were enrolled in this study. Subjects diagnosed as having diabetes mellitus (DM) were excluded. Mean age was 44.8 ± 8.3 years, BMI 23.6 ± 3.1 kg/m2. Height, weight, blood pressure, fasting plasma glucose (FPG), HbA1c, serum lipids, insulin and high-molecular-weight (HMW)-adiponectin levels were mea-sured after an overnight fast. The subjects were respectively divided into 3 groups in 2004 and 2010: DM (FPG 125 mg/dl or HbA1c 6.5%), Pre-DM (FPG 110-125 and/or HbA1c 6.0-6.4%) and normal glucose tolerance (NGT) (FPG < 110 and HbA1c < 6.0%). Serum insulin concentrations were measured by EIA and serum HMW-adiponectin by ELISA. [1] After 6 years, glucose tol-erance had improved in only 2 subjects, was unchanged in 347 and worsened in 41 (25 from NGT to Pre-DM, 9 from Pre-DM to DM, and 7 from NGT to DM). [2] Baseline factors correlating signifi cantly with status [No change = 0/Worsened = 1] were age, BMI, blood pressure, plasma glucose, HOMA-IR, HOMA- , TG, LDL-cholesterol, HMW-adiponectin, uric acid, AST and ALT. No correlations were observed with baseline smoking, alcohol consumption or exercise status. [3] Stepwise multiple regression analysis of [No change/Worsened] as a dependent variable revealed baseline glucose (F = 37.6, r’ = 0.30), HMW-adiponectin (F = 12.0, r’ = -0.17) and age (F = 5.1, r’ = 0.11) to show signifi cant independent correlations (P= 0.0001, R2= 0.156). To summa-rize, in this 6-year follow-up study of non-diabetic men, baseline low HMW-adiponectin, along with baseline glucose level and age, was suggested to predict worsening of glucose tolerance.

Supported by: Ministry of Education, Science and Technology, Japan

2580-POCharacteristics of Adults With Type 1 Diabetes in Latin America: Results from the International Diabetes Management Practices Survey (IDMPS)PABLO ASCHNER, JUAN JOSE GAGLIARDINO, JULIANA CHAN, JEAN-MARC CHANTELOT, ELIZABETH GENESTIN, MARIE-PAULE DAIN, HASAN ILKOVA, FER-NANDO JAVIER LAVALLE-GONZÁLEZ, AMBADY RAMACHANDRAN, Bogota, Colombia, La Plata, Argentina, Shatin, Hong Kong, Paris, France, Istanbul, Turkey, Monterrey, Mexico, Chennai, India

IDMPS is an ongoing 5-year multinational observational study docu-menting the current quality of care provided to people with type 1 or type 2 diabetes. Feasibility analyses were previously performed to validate the chances of pooling all the data collected during 4 years in Latin America and to identify variables that could be included in the analysis. The aims of this analysis were to describe the characteristics of people with type 1 diabetes mellitus (TIDM) in Latin America as a fi rst step toward further multivariate analysis. The characteristics assessed included profi les of self-management patients, patients’ education, type of insulin/devices used, and degree of glycemic control. Data from 2693 T1DM patients were collected by diabetologists (70.3%) and general practitioners (29.7%) between 2005 and 2009 in the form of annual surveys consisting of 2-week cross-sectional studies. The mean age of the T1DM patients was 38 ± 16 years; 63.6% of the patients were < 40 years and 43.5% were male. The mean age at diagnosis was 23 ± 15 years. The mean body mass index (BMI) was 24.7 ± 4.5 kg/m2 with 38.9% having a BMI of > 25 kg/m2. Mean A1C levels were 8.4 ± 2.1% and 25.1% of patients had A1C levels < 7%. Education on diabetes was received by 65% of the patients, 81.1% performed capillary blood testing (SMBG), and 62.9% self-adjusted their insulin dose. Both SMBG and self-adjustment of insulin was performed by 58.1% of the patients. The majority of the patients (83.5%) were covered by health insurance. The mean number of years patients were on insulin treatment was 12.5 ± 10.87 years; 65.3% were on basal-prandial insulin, 48.9% used insulin pens, 51.35% used vi-als and syringes, and 2.2% used pumps. This study presents valuable data on the characteristics of people with T1DM in Latin America and provides useful information for the development of strategies to optimize diabetes control and outcomes in this population.

Supported by: sanofi -aventis

2581-PODiabetic Patients With Hypertension Are 6 Times More Likely to Ex-hibit Sexual Dysfunction than Their Normotensive CounterpartsCHRISTOS SAMPANIS, IOANNA ZOGRAFOU, ZORITSA LAZOVIC, PANAGIOTIS PANAGOPOULOS, IORDANIS GIAVANIDIS, PANAGIOTIS DOUKELIS, GEORGIOS NEOKOSMIDIS, IOANNA DIMASI, KONSTANTINOS PETIDIS, STELLA DOUMA, Thessaloniki, Greece

Diabetes mellitus frequently coexists with other highly prevalent co-morbidities like hypertension and sexual dysfunction. Both diabetes melli-tus and hypertension have been established as independent predictors of sexual dysfunction in the general population. However, the predictive role of hypertension regarding sexual dysfunction in patients with comorbid dia-betes mellitus has not been fully elucidated. We aimed at investigating the effect of hypertension on prevalence of sexual dysfunction in a sample of consecutive patients with diabetes mellitus type II who attended the Dia-betological Outpatient Clinic of the 2nd Propedeutic Department, Aristotle University, Thessaloniki, Greece. Offi ce systolic and diastolic blood pressure (SBP/DBP) levels were recorded, and a thorough medical history was taken with emphasis placed upon presence of hypertension. Sexual function was evaluated with the Female Sexual Dysfunction Index (FSFI) and the Inter-national Index of Erectile Function (IIEF) questionnaires. A total of 220 dia-betic patients, 127 female and 93 male, 65.9±10.9 years old, were studied. Sexual dysfunction affected 86% of our population. Mean SBP/DBP was 144.9±22.9/77.2±11.6 mmHg. Offi ce SBP levels in patients with sexual dys-function were signifi cantly higher compared to patients with normal sexual functioning (146.2±23.5 versus 136.6±16.9 respectively, p=0.029). Accord-ingly, increased offi ce SBP was associated with a slightly increased risk of sexual dysfunction (OR: 1.02 [CI: 1.002 - 1.040], p=0.031). Most importantly, presence of hypertension was associated with a 5.6-fold higher risk of sexu-al dysfunction (OR: 5.61 [CI: 2.053 - 15.38], p<0.001). Physicians implicated in the management of diabetic patients should be aware of this likelihood and screen their patients for sexual dysfunction, in order to proceed with neces-sary therapeutic interventions and alleviate the burden of this quality-of-life diminishing disease.

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2582-POThe SAGES-Observatory’s Study of Diabetes Medication Therapy in Ambulatory Care Patients With Type 2 Diabetes, Aged 65 and OlderMICHEL PINGET, LAURENT BECQUEMONT, RISSANE OURABAH, Strasbourg, France, Le Kremlin Bicetre, France, Chatillon, France

We investigated the real-life clinical characteristics and medical manage-ment of elderly patients with type 2 diabetes (T2D) in France. This was a pro-spective interventional study conducted by 227 general practitioners (GPs) representative of French GPs, in T2D patients aged 65 years. Patients were treated with oral antidiabetic agents (OADs) and/or insulin and followed for a period of three years. We report data collected from April 2009 until July 12th, 2011. Our population included 959 patients (52% men, aged 76.6 ± 5.9 years, mean ± SD). The patients had diabetes for 11.2 years ± 8.7 and had BMI of 29.0 ± 4.9 kg/m2. Personal medical history (% patients) included: hypertension (81.8%), vascular disease such as cerebrovascular or coronary artery disease complication (18.5%), ocular complications (14.9%), renal disease (11%), diabetic neuropathy (6.8%). 47.5% of patients utilized self-measurement of blood glucose. At clinical examination, 68.5% of patients had moderate obesity (25 BMI <35 kg/m2) and 10.9% severe or morbid obesity (BMI 35 kg/m2) and their blood pressure was well controlled (SBP / DBP = 135.3 / 76.5 mmHg, mean values). In 35.6% of patients, HbA1c was <6.5%, and 14% of patients had HbA1c 8%. Patients were treated with either OAD monotherapy (44.8%) or with OADs multi-therapy (36.7%). 6.8% of patients received insulin alone and 11.7% received insulin + OADs. In con-clusion, most of the 959 TD2 patients analyzed had good glycemic control, but they were often overweight and had complications. OADs were the most frequent therapy, with only 18.6% of patients treated with insulin (alone or in combination with OADs).

2583-POA Rapidly Modifi able Diabetes Risk Score, PreDx®, is a Better In-dicator of Risk of Progression to Type 2 Diabetes than a Patient’s WaistlineSTEPHANIE B. MAYER, SISI J. HESTER, CONNIE R. THACKER, HOWARD J. EISEN-SON, RONALD S. SHA, ROBERT W. GERWIEN, MARK N. FEINGLOS, Durham, NC, Huntersville, NC, Emeryville, CA

Health care providers often identify patients at high risk for type 2 dia-betes (T2D) by focusing on obesity and waist circumference (WC). However, the number of such patients far exceeds available resources. We recruited a cohort of 58 obese patients without T2D (by fasting plasma glucose or A1c) from clients at the Duke Diet and Fitness Center, a residential-style program of lifestyle modifi cation for weight loss. They received dietary, fi tness, and behavioral counseling for 24 days. We stratifi ed these “high risk” patients using PreDx® Diabetes Risk Score (DRS), BMI and WC, and then assessed the impact of short term lifestyle modifi cation on these 3 measures. PreDx®

DRS, a commercially available, validated, blood-based, multi-biomarker as-say (range 1 - 10) predicts 5 yr risk of developing T2D (ex., DRS of 9=23.9% risk). Baseline characteristics were as follows: mean age 52.4 yr (SEM 1.5), 51.7% male, 91.4 % Caucasian, mean BMI 41.1 kg/m² (SEM 1.4),mean A1c 5.6% (SEM 0.05), mean WC 128.7 cm (SEM 2.6). Thirteen patients (22.4%) had DRS of highest risk (8.0-10.0). Neither baseline median BMI nor me-dian WC was signifi cantly different among DRS risk classes (Kruskal-Wallis p=0.32, p=0.49 respectively); thus, neither BMI nor WC stratifi ed patients as being at highest risk. In this brief intervention, DRS fell signifi cantly in those 13 patients (paired t tests, p<0.001). BMI fell signifi cantly (p<.001) and WC decreased (p=0.08), but those changes were not signifi cantly correlated with the change in DRS (r= -0.277, p=0.36 and r=0.026, p=0.93, respectively). Seemingly vulnerable patients may be at varying risk to develop T2D. Stan-dard measures such as BMI and WC may not differentiate those at highest risk, limiting optimal resource allocation. Thus, an accurate risk assessment tool that is also sensitive to acute changes in lifestyle and health may be valuable.

Supported by: Tethys Biosciences

2584-POFasting Blood Glucose Predicts the Risk of Developing Type 2 Dia-betes over 15 Years among Rural South IndiansSENTHIL K. VASAN, NIHAL THOMAS, G.I. SANDHYA, R. SELVAKUMAR, JAY-APRAKASH MULIYIL, Stockholm, Sweden, Vellore, India

Type 2 diabetes is a global public health problem with higher prevalence rates in developing countries.Current estimates on diabetes prevalence in India are based on studies conducted in urban cities. Rural India is undergo-ing rapid life style transition and socio-economic growth and the prevalence is expected to be high. Therefore, in the current study, we estimated diabe-

tes prevalence, incident diabetes and risk predictors over 15 years among rural Indians living in Kanyambadi rural block, Vellore, Tamil Nadu, India. Baseline data was obtained from 3108 participants aged 30-60 years during 1991-1993. A follow-up examination in 2006, included 1721 eligible non-dia-betic subjects who had a fasting plasma glucose value of 80 - 125 mg/dl at baseline. A sub cohort of 590 people, selected by stratifi ed random sampling were classifi ed into four groups at a class interval of 10 based on baseline fasting plasma glucose (FPG) ranging from 80-125mg/dl to determine risk predictors in each group. The overall crude prevalence of diabetes at base-line was 3% and the projected 14.16 year estimated cumulative incidence was 12.5%. An exponential increase in the annual incidence of diabetes was observed in ascending FPG groups. The annual incidence of diabetes was highest in the group with FPG 110-125.9mg/dl (46.21 per 1000 subjects based on ADA criteria). Multivariate regression models showed increased diabetes risk at a FPG over 100mg/dl [OR 6.36, 95% CI 2.91-13.88]. Other predictors included Body Mass Index 20kg/m2 and triglycerides 150mg/dl. We demonstrate that elevated fasting plasma glucose is an independent predictor of subsequent type 2 diabetes among rural Indians, and is associ-ated with threefold increase in the incidence of diabetes over 15 years. The current study points to the urgent need for intervention studies aimed at pre-vention of the progression from pre-diabetes to diabetes with an emphasis on targeting rural populations in India.

Supported by: Fluid Research Grant, Christian Medical College, Vellore, India

2585-POGestational Diabetes Mellitus in Pakistan: Frequency Using Up-dated CriteriaFARHAN J. DAR, Karachi, Pakistan

It is expected that the new criteria for diagnosis of Gestational Diabetes Mellitus (GDM) by American Diabetic Association (ADA) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) will signifi -cantly increase GDM cases in Pakistani females. Primary objective is to de-termine the frequency of GDM in pregnant females tested with 75-g Oral Glucose Tolerance Test (OGTT) from January 2010 to December 2011. Sec-ondary objective is to explore if one level (fasting, 1 h or 2 h) is suffi cient to establish GDM diagnosis in our population as adopted by ADA. This is an ob-servational study conducted in section of Chemical Pathology, Department of Pathology and Microbiology, Aga Khan University. Retrospective analysis of 75-g OGTT test performed in pregnant females at the clinical laboratory was done. The cuts off for diagnosis used were any of the plasma glucose value exceeding the upper limit; Fasting 92 mg/dl; or 1 h 180 mg/dl; or 2 h 153 mg/dl. The SPSS 19.0 was used for statistical analysis. 10913 pregnant

females were registered for 75-g OGTT. Out of these 52 cases were excluded due to overt diabetes as diagnosed on basis of fasting plasma glucose 126 mg/dl. Mean age of females were 27.92±4.85 years. Females in age group 25-29 years were the most tested for GDM, 4512 (41.5%). Out of 10861 females 1347 (12.4%), 1112 (10.2%), 920 (9.2%) were labeled GDM at one fasting, 1 h and 2 h respectively. The frequency of GDM diagnosed at two different levels: Fasting and 1 h glucose were 566/10861 (5.2%), fasting and 2 h glucose were 390/10861 (3.6%) and 1 and 2 h glucose were 550/10861 (5.1%). On repeated measures analysis of variance, test of sphericity p-value <0.001, epsilon 0.941, and Huynh-Feldt correction, the null hypothesis i.e. one level of glucose is not suffi cient to diagnose GDM was rejected (p-value <0.001). Thus at present cuts off, one level is suffi cient to diagnose GDM in Pakistani population. The frequency of GDM is raised in Pakistan using new criteria of diagnosing GDM proposed by ADA and IADPSG.

2586-POBody Size and Postprandial Glucose Levels—Should the Diagnosis Criteria of Diabetes Consider Height?YI NING, SHIBING YANG, KIRSTEN HERRICK, KATE LAPANE, Richmond, VA

It has been speculated that the diagnosis of type 2 diabetes based on postprandial glucose levels may be biased as height itself may be positively associate with postprandial glucose levels. We conducted a study to evalu-ate the association of height with postprandial glucose, fasting glucose, and glycated haemoglobin (A1C) levels. The study population included 3488 men and women with available values of fasting glucose, 2-hour postpran-dial blood glucose from 75-gram OGTT, A1C, and anthropometric measures from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 and 2007-2008. We excluded participants less than 18 years, pregnant women, and participants who used diabetic medications or self-reported diabetes. Participants provided blood samples after at least 9 hours of fast-ing and two hours after drinking 75 grams of glucose. Multiple linear regres-sion analyses were conducted for the dependent variables OGTT, fasting

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glucose and A1C, respectively. We evaluated their association with height, body weight, and BMI, adjusting for age, gender, race, and MHAMES sur-vey cycle. Body weight and BMI were signifi cantly and positively associated with OGTT, A1C and fasting glucose (P<0.001) in men and women. However, height was inversely and signifi cantly associated with OGTT in men (-4.59 mg/dl per 10 cm, p=0.001) and women (-6.23 mg/dl per 10 cm, p=0.001), but not with A1C and fasting glucose (p>0.48), after adjustment for age, race and survey year. The association between height and 2-hour postprandial blood glucose from 75-gram OGTT did not change appreciably even after the ad-justment for weight or BMI, with A1c or fasting glucose. Our fi ndings suggest an independent inverse association between height and postprandial blood glucose. The association was independent of body weight, BMI, A1C, and fasting glucose. Clinical diagnosis of diabetes using 75-g OGTT on 2-hour postprandial blood glucose should take account of height.

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2588-POBoth Serum Apolipoprotein B and the Apolipoprotein B/Apolipopro-tein A-I Ratio Were Associated With Carotid Intima-Media Thick-ness: Findings from a Chinese Population With Normal Glucose ToleranceYUHONG CHEN, FEI HUANG, BAIHUI XU, JIE ZHANG, MIN XU, YU XU, YU LIU, JIELI LU, WEIQING WANG, YUFANG BI, GUANG NING, Shanghai, China

There are accumulating evidences suggesting that apolipoproteins are better predictors for risk of cardiovascular disease (CVD) than traditional lipids. However, associations between apolipoproteins and carotid intima-media thickness (CIMT) are less explored. We aimed to assess whether the associations of apolipoprotein B (apoB), apolipoprotein A-I (apoA-I), the apoB/apoA-I ratio with CIMT were independent of traditional CVD risk fac-tors and traditional lipids in middle-aged and elderly Chinese with normal glucose tolerance (NGT). A cross-sectional analysis was performed in 6069 participants aged 40 years or older with NGT from Shanghai, China. Serum fasting traditional lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and trig-lycerides (TG)], apoA-I and apoB were assessed. A high-resolution B-mode ultrasonography was performed to measure CIMT. CIMT increased progres-sively across the quartiles of serum apoB (P for trend <0.0001). In the logistic regression, concentrations of apoB [odd ratio (OR) 1.266, 95% confi dential interval (CI) 1.179-1.360], TC (OR 1.231, 95% CI 1.144-1.324), LDL-C (OR 1.248, 95% CI 1.161-1.341) and TG (OR 1.113, 95% CI 1.035-1.197) were signifi cantly related to elevated CIMT after adjusted for age and sex. Meanwhile, the apoB/apoA-I ratio (OR 1.253, 95% CI 1.168-1.344) related to elevated CIMT. Serum apoB (OR 1.232, 95% CI 1.003-1.514) and the apoB/apoA-I ratio (OR 1.187, 95% CI 1.034-1.361) remained signifi cantly associated with elevated CIMT, after adjusted for the traditional CVD risk factors including traditional lipids. The present study showed that there were signifi cant associations between serum apoB, the apoB/apoA-I ratio and elevated CIMT. Serum apoB and the apoB/apoA-I ratio might be independent predictors of early atherosclerosis in NGT.

2589-POPatient Characteristics at Type 2 Diabetes Diagnosis for Patients With Medicaid and Those With Employer Based Health InsuranceKIMBERLY A. WILSON, TZUYUNG D. KOU, KIMBERLY G. BRODOVICZ, MONA CAI, CHARLES M. ALEXANDER, SAMUEL S. ENGEL, CYNTHIA J. GIRMAN, North Wales, PA

Socioeconomic status (SES) has been shown to impact multiple factors in diabetes management. Large automated insurance claims databases of-ten lack patient-level SES measures, but insurance type is often available. This study describes the characteristics of patients with type 2 diabetes mellitus (T2DM) in a large US insurance claims database who had either Medicaid (MCD) or employer-based commercial insurance (COM). 1,208,471 patients with T2DM diagnosis or oral hyperglycemic agent (OHA) prescrip-tion between 2003 and 2010, aged 25-64, were identifi ed, of whom 22,380 (1.85%) had MCD. Patients with 12 months of history in the database with no T2DM claims before the index T2DM diagnosis were considered newly diagnosed patients. Patient characteristics and comorbidities were

compared by insurance type. Compared to COM, MCD patients with T2DM were slightly younger, female, used more triple therapy or insulin, and had a higher frequency of diabetes related complications (table). In prevalent T2DM patients, all complications were greater for MCD than COM. In newly diagnosed T2DM patients, this trend was attenuated. In summary, T2DM pa-tients with MCD had important differences in characteristics and treatment patterns compared to those with COM. Insurance type is associated with multiple factors including socioeconomic status which have been shown to be associated with differences in outcomes across chronic diseases. This study demonstrates the need to understand and try to adjust for differences in patient characteristics such as socioeconomic status.

2590-POThe Prevalence of Type 2 Diabetes, Arterial Hypertension and Coro-nary Artery Disease in Perimenopausal Women With Polycystic Ovary Syndrome Wedge Resected in 1972-1989POLINA V. POPOVA, ALINA Y. BABENKO, ELENA N. GRINEVA, Saint-Petersburg, Russian Federation

Introduction: The aim of this study was to evaluate the prevalence of type 2 diabetes mellitus (DM), arterial hypertension and CAD in perimenopausal women with a history of PCOS treatment. Design: A group of 38 perimeno-pausal women (mean age 53.57+ 4.42 years), who had been diagnosed of PCOS in reproductive age, was included in the study. They had undergone wedge ovarian resection in 1972-1989. PCOS diagnosis was retrospectively based on Rotterdam Consensus Criteria. An age-matched sample of women without PCOS (N = 308) was selected. Anthropometric data, blood pressure, fasting and 2 hours glycemia during OGTT, insulinemia and lipid profi le were assessed. In patients with clinical appearance of CAD we performed stress-echocardiography to confi rm the diagnosis. Results: There was no differencebetween the two groups in waist circumference and in the proportions of women with obesity (BMI >30 kg/m2 in 39.5% of PCOS and 40% of control women). The mean fasting glucose in PCOS group was higher than in controls (6.02 + 0.83 versus 5.23 +1.06 mmol/l, p =0.001). The mean concentrations of lipids showed no difference in the two groups. Patients with PCOS had higher prevalence of type 2 DM (23.7 % versus 6,3 %, p = 0.02) and arterial hypertension (73.7 % versus 53.1 %, p = 0.012). The prevalence of CAD in the PCOS group was 15.8 %. Although it was a little bit higher than in the con-trol group (12.1 %), the difference did not reach statistical signifi cance (p = 0.53). The presence of PCOS noticeably increased the risk of the develop-ment of DM (OR=4.36; 95% CI 1.18 - 11.31 for women with PCOS vs. control group). Conclusions: Women with PCOS make up a subgroup in the general population at high risk for developing type 2 diabetes mellitus and arterial hypertension and need screening for these diseases.

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2591-POAnalysis of the Contribution of Adiponection and Apolipoprotein B to Incident Type 2 Diabetes in an Aboriginal Canadian PopulationPHILIP W. CONNELLY, SYLVIA LEY, MARY MAMAKEESICK, STEWART B. HAR-RIS, BERNARD ZINMAN, ROBERT A. HEGELE, ANTHONY J. HANLEY, Toronto, ON, Canada, Sandy Lake, ON, Canada, London, ON, Canada

Analysis of the contribution of adiponection and apolipoprotein B to in-cident Type 2 diabetes in an Aboriginal Canadian population. We have re-ported that adiponectin, apolipoprotein B (apoB) and the HNF1A G319S poly-morphism are signifi cantly predictive of incident Type 2 diabetes (T2DM) in an Aboriginal Canadian population. We have now done further analyses to 1) test models that combine these factors; and 2) determine whether there is a graded dose-response for the relationship of baseline values of adiponectin and apoB with incident T2DM. Data from a 10 year follow-up of 479 subjects free of T2DM at baseline were analyzed. Logistic regression analysis with forward selection was performed with the factors waist circumference, log10(adiponectin), apoB, impaired glucose tolerance (IGT) at baseline and HNF1A. Adiponectin contributed signifi cant, independent information in all models, and showed a graded response with concentration. Analysis of the incidence of T2DM across the concentration range of apoB showed that there was a threshold effect at a plasma concentration of 1 g/L apoB. ApoB remained signifi cant in the baseline model plus adiponectin when it was en-tered as a dichotomous variable. The magnitude of the predictive value of apoB < or > 1 g/L (odds ratio of 2.71 CI 1.4-5.3) was similar to that of presence or absence of IGT (odds ratio of 2.07 CI 1.06-4). Thus subjects who presented with apoB above 1 g/L are at 2.71 -fold higher risk for development of T2DM, independent of IGT status. The results for forward selection analysis and cu-mulative receiver operator curve area were: waist circumference (p<0.0001) (ROC 0.7), HNF1A G319S (p<0.0001) (ROC 0.74), apoB< > 1 g/L (p<0.0001) (ROC 0.77), log10(adiponectin) (p=0.01) (ROC 0.78) and IGT (p=0.03)(ROC 0.79). The negative predictive value of apoB < 1 g/L was 0.92 and the positive predictive value apoB > 1 g/L was 0.27. We conclude that plasma apoB <1 g/L predicts a low risk for incident T2DM in this cohort.

2592-POThe Changes of Bone Mineral Density in Japanese Patients With Type 2 DiabetesKANTA FUJIMOTO, YOSHIYUKI HAMAMOTO, SACHIKO HONJO, YUKIKO KAWA-SAKI, ATSUKO MATSUOKA, KANAKO MORI, HISATO TATSUOKA, YOSHIHARU WADA, HIROKI IKEDA, JUN FUJIKAWA, HIROYUKI KOSHIYAMA, Osaka, Japan

Although the bone mineral density (BMD) in type 2 diabetes (T2DM) is generally high, some patients of T2DM have lower BMD. We have previously reported that BMD is positively associated with urinary C-peptide secre-tion, or exogenous insulin dosage, and negatively associated with serum cholesterol level, and that BMD is higher in overt nephropathy, while BMD is not infl uenced by statin use. To evaluate the changes of BMD in Japanese patients with T2DM, we examined the changes of 2nd-4th lumbar spines BMD in patients with T2DM between 2006 and 2011 in our institute. The observa-tion period was 48 months (every 12 months follow-up). We also examined the changes of BMD in healthy subjects. The changes of BMD were defi ned as differences from baseline T-score. The subjects included 481 patients with T2DM (mean age, 66 ± 10 years; 252 men and 229 women; mean HbA1c value, 6.82 ± 1.10%) and 1238 healthy subjects (mean age, 58 ± 12 years; 645 men and 593 women). In the patients with T2DM, baseline T-score was -0.32 ± 1.85 and Z-score was 1.15 ± 1.72. T-score showed no signifi cant changes from the baseline at all points; 12 months (-0.16 ± 1.93; P=0.29), 24 months (-0.34 ± 1.75; P=0.82), 36 months (-0.45 ± 1.68; P=0.48), 48 months (-0.21 ± 2.03; P=0.93). There was no correlation between the change of T-score and HbA1c value. In healthy subjects, baseline T-score was -0.24 ± 1.60 and Z-score was 0.81 ± 1.51. T-score was reduced signifi cantly from the baseline at 36 months (-0.45 ± 1.62; P=0.023) and 48 months (-0.66 ± 1.77; P=0.0007). We showed the BMD in T2DM was high and was not decreased during 48 months, while BMD in healthy subjects was decreased.

2593-POLow Muscle Strength, Independent of Muscle Mass, Was Associ-ated With a Greater Likelihood of Having Type 2 Diabetes: Findings from the Korean Health and Genome Study (KHGS)JANG WON SON, HEE KYOUNG JEONG, SEONG SU LEE, SUNGRAE KIM, SOON JIB YOO, NAM H. CHO, Bucheon, Republic of Korea, Suwon, Republic of Korea

Sarcopenia is the age-related loss of muscle mass and strength. The pres-ent study aimed to explore the relationship of muscle strength with type 2 diabetes. We conducted a cross-sectional analysis of 2511 subjects in the Korean Health and Genome Study. The diabetes status of each subject was

determined by using a 75g OGTT, and body composition was estimated via dual-energy X-ray absorptiometry. Handgrip strength was assessed with a Jamar dynamometer. The study subjects were divided into the following four groups: normal group, low muscle strength but normal muscle mass group (presarcopenia I), low muscle mass but normal muscle strength group (presarcopenia II) and sarcopenia group. Pre-and sarcopenia were defi ned using the lowest quintile of handgrip strength and appendicular skeletal muscle mass (ASM)/weight. Among subjects with type 2 diabetes (n = 614), a substantial increase in the prevalence of presarcopenia and sarcopenia was observed, as compared to patients with non-diabetes. As expected, the handgrip strength displayed a positive association with the ASM/weight af-ter adjusting for age and gender. The odds ratio (O.R) for type 2 diabetes was greater for subjects in the presarcopenia I compared to the normal group, after adjusting for age, gender, smoking, alcohol drinking, physical activity (O.R 1.39; 95%CI 1.06-1.83). Similarly, this statistical signifi cance was ob-served for the presarcopenia II and sarcopenia group. The sarcopenia group was at a greater likelihood of having type 2 diabetes compared to the pre-sarcopenia I group after multiple adjustments (O.R 1.49; 95% CI 1.00-2.21), but this signifi cance was not found between presarcopenia II and sarcoepnia group. In conclusion, low muscle strength, independent of muscle mass, was associated with a greater likelihood of having type 2 diabetes. In addition, low muscle mass exacerbates low muscle strength-associated the risk of type 2 diabetes.

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2595-POAccelerated Improvement in Diabetes and Diabetes Risk-Related Markers With an Intense Lifestyle Intervention in Morbidly Obese IndividualsROBERT HUIZENGA, CAREN RAISIN, MICHAEL URDEA, Los Angeles, CA, Em-eryville, CA

Exercise and fat loss each improve insulin sensitivity and glucose control. The effect of intense exercise with mild caloric restriction on morbidly obese persons with diabetes has not been studied. Fifteen morbidly obese subjects (all fi gures are means; BMI=47), including individuals with diabetes (N=4)

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and pre-diabetes (N=4, ADA 2010 criteria) participated in an aggressive exercise-centric medical weight loss program (The Biggest Loser, Season 12) pitting “old” (n=5, age=61, BMI= 42) vs. “middle-aged” (n=5, age=43, BMI= 50) vs. “young” contestants (n=5, age=29, BMI= 48). Glucose, HbA1c, insulin, IL2R , hsCRP, ferritin, adiponectin (components of the PreDx® Diabetes Risk Score (DRS)), weight, body composition, LFTs and lipid panels were measured at 0, 2, 5, 8 and 27 wks (weeks). OGTTs were performed at 0 and 8 wks. The average percentage weight loss at 2, 5, 8 and 27 wks was 7, 11, 17 and 33 for females (range 15-44 at 27 wks) and 7, 13, 18, 40 for males (range 28-48). The old and female groups lost signifi cantly less weight than the young, middle age and male groups. Diabetes status did not affect weight loss results. At 8 wks, all diagnostic defi nitions of pre-diabetes and diabetes were absent in all the contestants. The rate of HbA1c decrease was rapid in the diabetic contestants; the mean at the start of the study was 7.1 (range 6.8-7.9), but by 60 days had reached 5.3 (range 5.0-5.5) remaining lower at 27 wks (mean 5.2). At 27 wks, subjects who initially had diabetes were compared to pre-diabetic and non diabetic contestants. HbA1c decreased (24, 7 & 2%, respec-tively) while fasting insulin levels dropped (94, 82 & 68%) and adiponectin increased (83, 52 & 35%); ferritin, hsCRP and IL2R changed similarly in each group. At 27 wks all contestants had a low DRS. The results seen in this small group, reproduced in other Biggest Loser seasons, illustrate that an aggressive weight loss approach resulted in the rapid, complete reversal of all diagnostic signs of diabetes.

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2597-POA Latent Variable Approach to the Metabolic Syndrome in Andean HispanicsDIANA A. CHIRINOS, JOSEFINA MEDINA-LEZAMA, RONALD GOLDBERG, NEIL SCHNEIDERMAN, MARC GELLMAN, OSCAR O. MOREY, ROBERTO PAZ, MUHAM-MAD WAHEED RAJA, ZUBAIR KHAN, JULIO A. CHIRINOS, MARIA M. LLABRE, Coral Gables, FL, Arequipa, Peru, Philadelphia, PA

The utility of the Metabolic Syndrome (MetS) as a unifi ed disease construct beyond the contribution of its individual components has been challenged. A previous study in a multiethnic population supported the presence of a MetS construct using a latent variable approach that incorporated all 5 traditional MetS components. A latent variable is a hypothetical construct measured by the variance shared between observed variables (i.e., waist circumfer-ence, blood pressure). Studies assessing the MetS as a latent construct in Hispanic samples are lacking. We aimed to develop a latent variable model of the MetS in a sample of Andean Hispanics and compare the MetS struc-ture across genders. The study population consisted of 1141 men and 1372 women, enrolled in the PREVENCION Study, a population-based study in Peru. A model of the MetS latent factor using waist circumference, systolic (SBP) and diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides and glucose levels was tested within the structural equation modeling framework. Results supported the proposed structure of the MetS latent model evidenced by adequate fi t indexes (CFI=1.00, RMSEA=0.02, SRMR=0.01). Waist circumference showed the highest correlation with the MetS factor (standardized factor loading=0.68, p<0.001), followed by SBP (0.53, p<0.001), DPB (0.52, p<0.001), triglycerides (0.45, p<0.001) and glucose levels (0.33, p<0.001). HDL-C was not found to be signifi cantly correlated with the MetS factor (0.01, p=0.83). Differences by gender in loading magnitudes for all indicators of the MetS were found. Our fi ndings support a MetS latent factor structure measured by fi ve indicators: waist circumference, SBP, DBP, triglyceride and glucose levels. HDL-C was not found to be a component of the MetS latent factor challenging the predictive value of HDL-C in Andean His-panics. This suggests that the defi nition of the MetS should be revised for this population. Differences by gender were found in the MetS latent structure.

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2599-POThe Degree of Periodontal Status and Its Related Factors in Type 2 DiabetesJUN SUNG MOON, KYU CHANG WON, HEE KYUNG LEE, JI SUNG YOON, HY-OUNG WOO LEE, Daegu, Republic of Korea

This study was intended to provide basic data for developing an oral health management program for diabetic patients by understanding their oral health condition and defi ning the infl uence of diabetes on oral health. From November 2005 to February 2006, 93 of 122 patients with type 2 diabetes(T2DM) were enrolled and examined intraoral examination and questionnaire surveys. The following results were obtained that diabetic pa-tients who have over 20 original teeth Papillary bleeding index(PBI) was sig-nifi cantly higher in females(p<0.05). Tooth mobility index(TMI) were lower in a exercising group(p<0.05) but there was no signifi cance among an aging, a smoking and a drinking group. TMI, Periodontal index(PI), and PBI were lower as the academic background got higher(p<0.05). As the duration of diabetes increased, TMI, PI, and PBI got higher(p<0.001, p<0.05, p<0.05 ). As the blood sugar level before meal increased, TMI, PI, Russell Index(RI), and PBI were higher(p<0.05), but no signifi cant difference were found in a group that had glycosylated hemoglobin over 7%. In a group which received oral hygiene education, the RI was lower than those in a group which didn’t(p<0.001). TMI and RI were lower in a group which recognized themselves healthy com-pared to the one which didn’t recognize themselves to be healthy(p<0.05). Multiple regression results show that the duration of diabetes infl uenced on all the oral health condition, which is dependent variables. As the duration of diabetes increased, TMI, PI, RI, and PBI got higher. And PBI was infl u-enced by monthly income and a diet signifi cantly(p<0.05). In short, this study shows that the duration of diabetes infl uenced on all the oral health condi-tions signifi cantly. This study also suggests that not only diabetic control but also general oral care should be included in self-management education for diabetic patients and appropriate oral health education programs and staff should be provided.

2600-POPrevalence of Type 2 Diabetes in Indigenous and Non-Indigenous Mexicans: The Comitan StudyAIDA JIMENEZ-CORONA, ROBERT G. NELSON, MARIA E. JIMENEZ-CORONA, ROSALBA ROJAS-MARTINEZ, LEONARDO JIMENEZ-CORONA, SOCORRO A. BORGES-YAÑEZ, FRANCISCO J. PANIAGUA-MORGAN, Cuernavaca, Morelos, Mexico, Phoenix, AZ, Mexico City, Mexico, Comitan, Chiapas, Mexico

Ethnic differences in the prevalence of type 2 diabetes (T2DM) may relate to differences in susceptibility and lifestyle. We determined the prevalence of T2DM in indigenous (IND) and non-indigenous (NIND) populations from the Municipality of Comitan, Chiapas, Mexico. All eligible IND persons were invited to participate, whereas NIND persons were chosen randomly (3 and 4 localities, respectively). 1494 individuals (866 indigenous and 628 non-indigenous) aged 20 years (response 70%) were examined. Subjects were considered IND by self-report or if they spoke an IND language. Dia-betes was diagnosed according to WHO criteria (fasting serum glucose >7.8 mmol/l or 2 hour post load serum glucose >11.1 mmol/l or previous medical diagnosis). Age-sex adjusted mean BMI (25.5 vs. 23.7 kg/m²), total choles-terol (160.4 vs. 142.4 mg/dL), and triglycerides (228.7 vs. 168.2 mg/dL) were higher in the NIND population. The age-sex adjusted prevalence of T2DM was 2.4% (95% CI 1.2-4.8) in the IND people and 12.1% (95% CI 11.8-19.9) in the NIND people. Prevalence of T2DM by age and BMI is shown in the table. In multiple logistic regression, prevalence was signifi cantly lower in IND people (OR= 0.18, 95%CI 0.08-0.38) compared with NIND people after adjustment for age, sex, BMI, and level of education. Diabetes prevalence was signifi cantly lower in IND than in NIND people. This difference is not explained entirely by differences in age, sex, body weight or level of educa-tion. Longitudinal data as diet and exercise from our study will permit us to estimate incidence and identify predictors of T2DM in these populations.

Prevalence (%) and CI of type 2 diabetes in indigenous and non-indigenous population

IndigenoussubjectsN=866

Non-indigenoussubjects(N=628)

BothN=1494

Age(years)<40 1.6 (0.4-2.8) 5.8 (3.0-8.5) 3.2 (1.9-4.5)

40 5.4 (3.3-7.6) 21.4 (17.1-25.7) 12.7 (10.3-15.0)BMI (age-sex adjusted)

Normal 1.9 (1.1-3.8) 6.6 (3.4-12.3) 3.7 (1.9-6.8)Overweight 3.5 (1.7-7.1) 12.1 (7.0-20.1) 6.9 (3.9-11.9)Obesity 6.6 (2.9-14-4) 21.0 (11.9-34.2) 12.5 (6.6-22.5)

Supported by: Consejo National de Ciencia y Tecnología, Mexico

2601-POThe Subjective vs. Objective: The Relationship between Race/Eth-nicity and DiabetesLISA D. MARCEAU, JOHN B. MCKINLAY, GAVIN MIYASATO, REBECCA J. PIC-COLO, Watertown, MA

That the prevalence of diabetes (T2DM) varies signifi cantly by race/eth-nicity is widely viewed as settled fact: the websites of both the ADA and the NIDDK report race/ethnicity is an independent contributor to diabetes. We examine the factual basis for this assertion suggesting it may result from twin biases created by subjective reporting. Both a) race/ethnicity and b) diabetes status (“have you ever been told by a health provider that you have…”) are typically ascertained by self-report. Data are from a com-munity-based cohort of Boston, Massachusetts residents aged 36+ years. Fasting glucose (FG) and A1c were collected during an early AM in-home interview, to objectively ascertain diabetes status. Genetic ancestry infor-mative markers (AIMs) that objectively discriminate European, African and Native American ancestry are derived independently by a laboratory blinded to any subject characteristics (n=374 subjects). Black, Hispanic and White self reported race/ethnicity comprised 32%, 33% and 35% of the sample, respectively. There is a highly signifi cant (p=.0001) relationship between race/ethnicity and T2DM, when both are measured subjectively. This is con-sistent with NHANES results using both a self-report of race/ethnicity and a physician’s diagnosis of T2DM. There is no relationship between objec-tively ascertained ancestry and diabetes defi ned by ADA standards: using either FG >125 mg/dl (p=.25) or A1c > 6.5% (p=.13). When race/ethnicity and diabetes status are objectively measured there appears to be no relation-ship between the two. These preliminary results require verifi cation, using our entire dataset and with other studies. The belief that race/ethnicity is a contributor to T2DM may result from twin biases produced by lack of objec-tive measurement of both exposure and outcome, distracting attention from potentially more important and modifi able contributors, especially behavior relating to socio-economic status.

Supported by: NIDDK (R01DK080786)

2602-POHypoglycemia Surveillance Within an Online Diabetes Social Net-workELISSA R. WEITZMAN, SKYLER KELEMEN, MARYANNE QUINN, EMMA EGG-LESTON, KENNETH MANDL, Boston, MA

Despite widespread use of insulin, hypoglycemia surveillance is limited to tracking emergency department visits and clinical trial samples. We quan-tifi ed reports of hypoglycemia, related harms and social harm-mitigation strategies among members of a global online diabetes social network (SN). 557 insulin-using SN members who joined a consented research cohort (25% of n=2,246) used a software app supporting SN-mediated research to report on: recent lows (past 2 week), severe lows (past 12 month times became unconscious, seized, required glucagon, medical treatment, or help from another due to hypoglycemia), harms, and communication about risk with social ties. Adjusted odds of harms/communication for groups reporting re-cent/severe lows were estimated using logistic regression. In all, 49.9% had >4 (median) recent lows, 29.8% experienced 1 severe low. Harms were high for all and acute for those reporting a severe low (range 27.4%-70.5%); communication with social ties was modest (range 24.2%-45.9%) but more common among those reporting a severe low (36.6%-63.5%, all p-values <.05). Findings may support targeted health promotion including through the app and SN given they afford opportunity for bidirectional communication, tracking and follow-up.

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Table 1. Harms associated with hypoglycemiaTotal N

(%)N (%)

>4 recent events

N (%)4

recent events

OR (95% CI)>4 recent events†

N (%)1

severe event

N (%)0

severe events

OR (95% CI)1 severe event†

Total Sample 557(100)

278(49.9)

279(50.1)

166(29.8)

391(70.2)

History of ac-cident or injury, lifetime

89(16.1)

56(20.2)

33(12)

1.4(.81, 2.3)

45(27.4)

44(11.3)

2.7(1.6, 4.4)***

Worry about hypo affects daily life

253(45.4)

147(52.9)

106(38)

1.5(1.05, 2.2)*

107(64.5)

146(37.3)

2.8(1.9, 4.2)***

Withdrawal behaviors( 2 of 4), daily for the past 6 months

220(39.5)

127(45.7)

93(33.3)

1.7(1.2, 2.5)**

91(54.8)

129(33)

2.3(1.5, 3.3)***

Avoid being alone strategies( 1 of 2), daily for the past 6 months

272(48.8)

140(50.4)

132(47.3)

1(.7, 1.5)

117(70.5)

155(39.6)

3.4(2.3, 5)***

For both tables:*p<.0001

For both tables:†Adjusted for age, sex, race, diabetes type, disease length, device use, cost barriers

Table 2. Hypoglycemia-motivated communication with clinical and social tiesTotal N

(%)N (%)

>4 recent events

N (%)4

recent events

OR (95% CI)>4 recent events†

N (%)1

severe event

N (%)0

severe events

OR (95% CI)1 severe event†

Discuss hypoglycemia and its prevention with own diabetes doctor220

(39.5)125(45)

95(34.1)

1.6(1.1, 2.3)*

89(53.6)

131(33.5)

2.2(1.5, 3.2)***

Discuss hypoglycemia symptoms and treatment with social ties (among respondents reporting those ties):

Family 252(45.9)

130(47.6)

122(44.2

.97(.67, 1.4)

96(58.9)

156(40.4)

1.9(1.3, 2.8)**

Friends 155(28.3)

83(30.1)

72(26.5)

.9(.6, 1.3)

60(36.6)

95(24.7

1.6(1.04, 2.4)*

Coworkers 108(24.2)

57(25.2)

51(23.1)

1(.62, 1.6)

51(37.8)

57(18.3)

2.5(1.6, 4)**

Roommates 94(43.5)

50(43.5)

44(43.6)

.76(.41, 1.4)

47(63.5)

47(33.1)

3.1(1.6, 5.8)**

Travel companions

143(34.7)

73(34.1)

70(35.4)

.76(.48, 1.2)

59(49.6)

84(28.7)

2.2(1.4, 3.5)**

Supported by: CDC

2603-POImpact of Comorbid Conditions on Long-Term Glycemic Control in Veterans With Newly Identifi ed Diabetes MellitusSRI RAM PENTAKOTA, CHIN-LIN TSENG, MANGALA RAJAN, LEONARD POGACH, East Orange, NJ

Our objective was to evaluate long term glycemic control among veter-ans with newly identifi ed diabetes mellitus (DM), stratifi ed by age-groups and type of comorbidity. Retrospective cohort study of veterans with newly identifi ed DM in FY2002 based upon administrative ICD 9-CM codes or DM-related medication records. Veterans were classifi ed into 5 chronic co-morbid illness groups (CCIG) using a competing demands framework: none, only concordant (DM related), only discordant (non-DM related), both, or dominant (short life expectancy). All HbA1c values in FY 2002-09, at least 30 days apart, were included in the analysis. General linear regressions were used to evaluate annual trends of HbA1c by CCIG and age-groups. We identifi ed 27,564 veterans: 96.6% male, 30% < 55 years, 25% 55-64 years, 45% > 65 years, and 25% had no comorbidity. The overall mean (sd) HbA1c and range by CCIG in FY02 was [7.06 (1.83); range: 6.88-7.17]; it decreased to [6.63(1.26); 6.47-6.67] in FY03 and gradually increased in the following years to [7.18(1.46); 6.62-7.23] in FY09. Glycemic control was worse in veter-

ans <55years in all years, with FY02 (7.43(2.20), range: 7.14-7.92) and FY09 (7.56(1.72); 7.25-7.93). In all age groups, veterans with only concordant or no comorbidities had higher HbA1c levels, followed by only discordant, both (concordant/discordant), and dominant groups. Age-and-sex adjusted an-nual slopes were similar across all CCIGs [FY02-FY03: -0.54%; FY03-FY09: 0.08%]. Among veterans <55 years, the annual slope for FY03-FY09 was 0.14% (no comorbidities); patients in only discordant (0.11%), both (0.10%), and dominant (0.10%) groups were signifi cantly different from those with-out comorbidities. Among older age groups, annual slopes did not differ by CCIG. HbA1c values decreased fi rst then gradually increased in all CCIGs, with higher levels among younger individuals. The presence of comorbid discordant, both, and dominant conditions was associated with lower mean HbA1c values.

Supported by: VA Clinical Epidemiology Grant and Health Serv Res (REA 03-021)(Pogach-PI)

2604-POPeriodontitis and Self-Reported Kidney Problems in Diabetic El-derly in Mexico CitySOCORRO AIDA BORGES-YAÑEZ, ROBERTO C. CASTREJÓN-PÉREZ, AIDA JIMÉ-NEZ-CORONA, Distrito Federal, Mexico

Periodontitis is a chronic infl ammatory disease that destroys the support-ing structures of the teeth. Incidence of end-stage renal disease has been reported to be higher in diabetics with severe periodontitis compared to diabetics with no severe periodontitis. Objective: To identify an association between severe periodontitis and self-reported kidney problems related to diabetes in a sample of Mexican diabetic elderly subjects. Household survey in a representative sample of subjects 70 years living in one district of Mexico City (N=33347). Sample size =1294, 1124 persons were interviewed and 838 examined. Variables: age, sex, smoking, presence of diabetes, heart disease, hypertension, embolism, hypercholesterolemia, and hypertrig-lyceridemia, as answered to the question: a doctor ever told you that you have...; treatment for diabetes, complications of diabetes: kidney problems, circulatory problems in arms/legs, vision problems, Body Mass Index (BMI), and severe periodontitis: 2 teeth with loss of periodontal attachment >5mm. Mean age was 79±7 years, 56% were women, 16% had no school-ing, and 41% were widowed. 20.1% were diabetics (n=235), and 24% were obese. Of the 838 persons examined, 79% were dentate, of whom 8.9% had severe periodontitis, prevalence in diabetics was14.6% and 7% in non-diabetics (p<0.01). The prevalence of kidney problems in the 137 diabetics with periodontal exam was 25.9%. Periodontitis, vision and circulatory prob-lems were more prevalent (p<0.01) in diabetics with kidney problems than in diabetics with no kidney problems. A logistic regression model included circulatory and vision problems, periodontitis, smoking, sex, age and BMI. Among diabetics, males and those with severe periodontitis are 2.8 times (95%CI 1.12-7.1) and 7.2 times (95%CI 2.2-23.2) respectively more likely to have kidney problems, one unit increase in BMI lowers 11% the risk of kidney problems (OR=.089, 95%CI .99-.81). Periodontal health should be considered as a component of diabetes care.

2605-POPreventive Colonoscopy in Asymptomatic Persons With Diabetes May Reduce Their Risk of Colorectal CancerVLASTIMIL PROCHAZKA, RUDOLF CHLUP, PAVEL SYCHRA, JANA ZAPLETALOVA, IVONA CEPOVA, MICHAL KONECNY, JAN GREGAR, IGOR TOZZI, Olomouc, Czech Republic

Colorectal cancer develops over a long asymptomatic period exceeding 5 years. Type 2 diabetes mellitus (DM) is hypothesized to be a risk factor for this malignancy. The purpose of this retrospective study was to compare the prevalence of DM between 2 groups of persons with- or without clini-cal signs of gastrointestinal disorders who underwent colonoscopy and who were tested for the presence of diabetes mellitus. The fi rst group consisted of 670 subjects (age 23 - 89 y, median 65 y, 25th - 75th percentil of age 57 - 74 y, 424 men, 246 women) in which colonoscopy revealed adenoma or adeno-carcinoma in the colon and/or rectum. The second group consisted of 1810 subjects (age 20 - 94 y, median 59 y, 25th - 75th percentil of age 46 - 76 y, 806 men, 1004 women) with negative colonoscopic fi ndings. The fi rst group was older than the second group (Mann-Whitney, P<0.0001). The prevalence of DM (men and women together) in the fi rst group (23.2%) was greater than the prevalence of DM in the second group (12.5%), P<0.0001. In a separate assessment of men was the prevalence of DM in the fi rst group 25.6% and

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in the second group 14%, P<0.0001. In women was the prevalence of DM greater in the fi rst group (19.2%) vs. second group (11.2%), P<0.001. In the fi rst group, in 73 persons younger than 50 y there were 7 (9,6%) subjects with DM. In the second group, in 548 persons younger than 50 y there were 11 (2%) subjects with DM which is less than in the fi rst group (Fisher´s exact test, P<0.003). These fi ndings support the existing hypothesis that DM is a risk factor for colorectal carcinoma. Hence, preventive colonoscopy in as-ymptomatic persons with DM performed in 5-year intervals appears to be valid and should be recommended.

Supported by: Faculty of Medicine, Palacky University Olomouc

2606-POComplications among Inpatients With Newly Diagnosed vs. Previ-ously Recognized Type 2 Diabetes MellitusDONALD A. BRAND, MICHAEL S. RADIN, Mineola, NY

Patients with newly identifi ed type 2 diabetes face a substantially greater risk of adverse events in the hospital as compared to patients with previous-ly recognized diabetes. Studies have demonstrated higher rates of selected individual complications in the former group (e.g., pneumonia, acute renal failure), but they have not considered body systems as a whole. The main objective of the present study, therefore, was to examine complication rates by body system to gauge the scope of the increase in risk faced by patients with newly identifi ed disease. Data were obtained from a 4-month consecu-tive series of adult inpatients with comorbid type 2 diabetes admitted to an academic teaching hospital. Fisher’s Exact test or the Mann-Whitney test was used to compare groups, as appropriate. As compared to patients with previously recognized diabetes (n=1627), patients with newly identifi ed dis-ease (n=23) were 3 times as likely to develop a complication in the hospital (p<0.001) and 5 times as likely to develop multiple complications (p<0.001). Moreover, they were 2 to 8 times as likely to develop complications involving 10 of 13 body systems or disease categories (Figure). The median length of stay was 2.5 times greater in these patients (p<0.001), they were 4 times as likely to require intensive care (p<0.001), and they were 3 times as likely to die in the hospital (p=0.31). Patients with newly identifi ed type 2 diabetes face a markedly increased risk of in-hospital complications involving a wide range of organ systems. Providers should be aware of the scope of the prob-lem to assure appropriate monitoring and therapy.

2607-PO

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2608-POLipid Profi le Survey among Type 2 Diabetes Mellitus Outpatients in Tertiary Hospitals in Chinese MetropolisesMINGTONG XU, LI YAN, Guangzhou, China

Dyslipidemia is very common in Type 2 diabetic mellitus (T2DM) and it is an important risk factor for atherosclerosis and cardiovascular disease. Nationwide dada of dyslipidemia in T2DM conducted in multicenters have not been reported yet. The present study is a cross sectional multi-center survey of lipid profi le characteristics, treatment, and infl uencing factors of dyslipidemia in T2DM outpatients in Chinese metropolises. 4872 subjects aged 40-74 years in 20 hospitals were enrolled. 53.5% subjects were male. 30.8% subjects had smoking history of more than half a year. The dia-betic history of subjects varied from 0.44 to 42.02 years (7.74±5.98 years in average). Average body mass index(BMI) 24.82±3.51 Kg/m2, waistline 87.03±10.32 cm, hipline 95.52±8.84 cm. Average serum total cholesterol level, low density lipoprotein cholesterol (LDL-C) level, high density lipopro-tein cholesterol (HDL-C) level, and triglyceride (TG) was 4.96±1.34 mmol/L, 2.88±0.96 mmol/L, 1.27±0.38 mmol/L, 2.04±2.03 mmol/L respectively. Overall 78.51% subjects had dyslipidemia. Among them, 26.24% had high total cholesterol, 11.9% had high LDL-C, 36.77% had low HDL-C, 24.14% had hypertriglyceridemia and 33.10% had mixed dyslipidemia. The awareness rate of dyslipidemia was 55.5%. Overall, treatment rate of dyslipidemia was 44.8% (39.34% in patients with hypercholesterolemia, 37.0% in low HDL-C, and 44.61% in hypertriglyceridemia). According to the Chinese guideline, overall 11.63% T2DM patients with dyslipidemia attained the lipid profi le goal. The goal attainment rates was 18.58%, 5.85%, 14.48%, 21.11% and 6.21% for patients with high total cholesterol, hypertriglyceridemia, low HDL-C, high LDL-C and mixed dyslipidemia respectively. In conclusion, the prevalence of dyslipidemia in T2DM patients in Chinese metropolises is high. however, the awareness rate, treatment rate and goal attainment rate is comparatively low.

2609-POAchievement of Blood Pressure Targets in Diabetic and Non Diabet-ics Subjects With Hypertension in Primary Care in GreeceALEXIOS SOTIROPOULOS, ATHANASIA PAPAZAFIROPOULOU, ANTHI KOKOLAKI, CHRISTOS PAPAFRAGOS, GEORGIOS DELLIGIANNIS, IOANNIS DROSOS, ANAS-TASIOS SPANOS, EYSTATHIOS SKLIROS, Athens, Greece

Background and aims: Arterial hypertension is one of the major cardio-vascular risk factors and management of hypertensive subjects, especially diabetics, still remains a challenge for the clinicians. Despite the current antihypertensive agents subjects fail to achieve control of arterial hyperten-sion. Therefore, the aim of the present study was to estimate the prevalence of achievement of blood pressure targets in diabetic and non diabetics sub-jects with hypertension in primary care in Greece. Material and methods: 839 consecutive hypertensive subject; 249 diabetics (29.7%) (mean age ± SD: 67.7±8.4 years) and 590 non diabetics (70.3%) (mean age ± SD: 64.7±7.5) attending 105 primary care physicians during October 2008. A detailed medi-cal history and a thorough clinical examination were performed to each sub-ject. Arterial hypertension was defi ned according to the current guidelines. Results: Only 11.8 (n=29) of the diabetics achieved blood pressure targets vs. 25.9% (n=151) of the non diabetics (P<0.001). Diabetic subjects were more over weighted compared to non diabetics (75.6% vs. 51.1%, respectively, P<0.001), had more often coronary artery disease (77.0% vs. 12.2%, respec-tively, P<0.001) and peripheral artery disease (50.0% vs. 6.4%, respectively, P<0.001). It is noteworthy that diabetic subjects attending primary care had less often lipid disorders compared to non diabetics (28.6% vs. 46.0%, re-spectively, P<0.001). The two study groups did not differ in terms of smoking habits (51.6% vs. 48.5%, respectively, P=NS). Conclusion: A poor proportion of diabetic subjects with history of hypertension attending primary care in Greece achieved blood pressure targets. In addition, one to four non diabetic subjects with history of hypertension attending primary care achieved blood pressure targets.

2610-POPrevalence of Asymptomatic Bacteriuria in Type 2 Diabetic Sub-jects With and Without MicroalbuminuriaATHANASIA PAPAZAFIROPOULOU, ALEXIOS SOTIROPOULOS, ANTHI KOKOLAKI, IOANNIS DANIIL, STAVROS BOUSBOULAS, MARINA KARDARA, PETROULA STA-MATAKI, STAVROS PAPPAS, Nikaia, Greece

Background and aims: Diabetic subjects, especially women, show high prevalence of asymptomatic bacteriuria (ASB). The aim of the present study was to evaluate the prevalence of ASB in subjects with type 2 diabetes mel-litus (T2D) with and without microalbuminuria (MA). Material and methods:

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100 diabetic subjects with MA (53 males / 47 females, mean age ± standard deviation: 65.5 ± 11.1 years) and 100 subjects without MA (52 males / 48 females, mean age ± standard deviation: 65.4 ± 11.3 years), consecutively attending the outpatient diabetes clinic of our hospital were recruited in the study. Subjects with overt diabetic nephropathy or nephropathy from other causes were excluded. In addition, subjects with symptoms of urinary track infection or use of antimicrobial drugs in the last 14 days were excluded by the study. Results: Diabetic subjects with MA showed increased prevalence of ASB compared to diabetic subjects without MA (21% versus 8%, P<0.001, respectively). Univariate logistic analysis showed that ASB was associated with the presence of coronary artery disease [odds ratio (OR): 0.29, 95% Confi dence Intervals (95% CI): 0.09-0.95, P=0.04] and gender (OR: 0.09, 95% CI: 0.02-0.35, P<0.001) in the diabetic study group with MA. Conclusion: ASB is more prevalent among T2D subjects with MA. Screening for ASB is war-ranted in diabetic patients especially if pyuria is detected in urine analysis since ASB has been found to be a risk factor for developing symptomatic urinary tract infection.

2611-PO

2612-POPrevalence of Impaired Fasting Glucose in a Sample of Hyperten-sive Subjects Attending Primary Care in GreeceALEXIOS SOTIROPOULOS, ATHANASIA PAPAZAFIROPOULOU, ANTHI KOKOLAKI, CHRISTOS PAPAFRAGOS, GEORGIOS DELLIGIANNIS, IOANNIS DROSOS, ANAS-TASIOS SPANOS, EYSTATHIOS SKLIROS, Athens, Greece

Background and aims: Subjects with impaired fasting glucose (IFG) are at high risk, not only to develop diabetes mellitus, but also to experience an adverse cardiovascular event later in life. In addition, hypertensive subjects are at high cardiovascular risk. Therefore, the aim of the present study was to estimate the prevalence of IFG in a sample of hypertensive subjects at-

tending primary care in Greece. Material and methods: 1041 consecutive hypertensive subject (423 women / 618 men; mean age ± SD: 65.2±7.2 years) attending 105 primary care physicians during October 2008 .A detailed medical history and a thorough clinical examination were performed to each subject. Arterial hypertension and impaired fasting glucose was defi ned ac-cording to the current guidelines. Results: Prevalence of IFG in hypertensive subjects attending primary care was 18.1 (n=127). Subjects with IFG did not differ from non IFG subjects in terms of age (69.3±8.2 vs. 66.2±8.5 years, respectively, P=NS) and gender (59.5% males / 40.5% females vs. 60.8% males / 39.2% females, respectively, P=NS). Subjects with IFG were more over weighted compared to non IFG subjects (69.2% vs. 27.6%, respectively, P<0.001) and had more often coronary artery disease (25.2% vs. 14.8%, re-spectively, P=0.004). It is noteworthy that IFG subjects attending primary care had less often lipid disorders compared to non IFG subjects (30.0% vs. 45.90%, respectively, P-0.001). The two study groups did not differ in terms of smoking habits (50.4% vs. 46.3%, respectively, P=NS). Conclusion: A signifi cant proportion of hypertensive subjects attending primary care in Greece have IFG. Subjects with IFG were more over weighted and had more often coronary artery disease while they had better lipid profi le compared to non IFG subjects.

2613-POWaist Circumference among Egyptian Type 2 DiabeticsBRAHIM N. ELLEBRASHY, OZ ATEF BASSYOUNI, GAMAL HUSSEIN SALEM, ALY ABDELLA, SAYED AMAM, AMR MAHFOOZ, GADA HUSSEIN, Cairo, Egypt

Central obesity is a major contributor to the development of hypertension, insulin resistance, diabetes mellitus and dyslipidemia and considered as a cardiovascular risk. There is a racial and ethnic difference in the cutoff val-ues of waist circumference which refl ects the visceral adipose tissue and its relation to the metabolic risk factors. The aim of this work was to determine the waist circumference cutoff values among Egyptian type 2 diabetic pa-tients attending the in National Institute of Diabetes & Endocrinology (NIDE) in Cairo Egypt.A total of 16,000 type 2 diabetic subjects were recruited from the outpatient clinics of the National Institute of Diabetes and Endocrinol-ogy. Out of these patients, 11,056 (69.1%) were females and 4941 (30.9%) were males. 3,264 (20.4%) of our patients were non-obese while the re-mainder 12,736 (79.6%) were obese according to BMI. Random selection of 1000 of these patients underwent biochemical investigation.The mean waist circumference of our all studied patients was 99.7±14.8 cm, for the female diabetics it was 100.8±14.8 cm while for the male diabetics it was 97.3±14.6 cm. The prevalence of obesity, central obesity, hypertension, dyslipidemia among our patients were of 79.6%, 69.8%, 29.8%, and 94.9% respectively. Frequency of dyslipidemia was higher among those with central obesity and diabetic females. Central obesity and age above 50 year was the only predictor of dyslipidemia and hypertension respectively. It is concluded that central obesity as determined by waist circumference was very prevalent among Egyptian type 2 diabetics attending National Institute of Diabetes and Endocrinology in particular among female ones. Dyslipidemia was more frequent among those patients with central obesity.

Supported by: National Institute For Diabetes and Endocrinology, Cairo, Egypt

2614-POFine Scale Geospatial Analysis Provides Fresh Insight into Barri-ers Preventing the Underserved, Predominately Latino Patients With Diabetes in the Los Angeles County from Achieving Glycemic ControlWEI AN A. LEE, ANDREW CURTIS, Los Angeles, CA

The Diabetes and Metabolism Clinic(DMC) at the Los Angeles County(LAC) Medical Center is a diabetologist-staffed, specialty clinic managing under-served patients who have failed intervention by primary care physicians and staged diabetes management programs. This cohort poses the highest economic burden to the LAC medical system. Complex socioeconomic fac-tors in the environment of this cohort play a critical role in the management of their diseases. We piloted a novel method of capturing environmental infl uences through the use of cutting edge, spatial analytical methods. We utilized neighborhood level, spatial data to map responders (patients who achieve HBA1C in 3months) and nonresponders(patients who did not achieve HBA1C in 3months). 3522 diabetes patients who frequented emer-gency at LAC were geocoded and used as a denominator. 195 consecutive DMC patients were geocoded. 33 responders and 51 nonresponders. We narrowed the focus to Boyle Heights, a specifi c area within LAC. Figure 1 is a fi ne scale contour map illustrating statistically signifi cant clusters (95% confi dence through simulated runs using Monte Carlo method) of respond-ers (Green) and non responders (Red). From out preliminary study, there is

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encouraging results suggesting the value of fi ne scale, spatial analysis in elucidating environmental barriers that prevent high burden diabetes pa-tients of LAC from achieving their glycemic targets.

2615-PO

2616-POVitamin D Is Inversely Associated With Diabetes in Middle-Aged and Elderly in Chuncheon: Hallym Aging StudyOHK HYUN RYU, MOON-GI CHOI, JAE MYUNG YU, SUNG-HEE IHM, HYUNG JOON YOO, Chuncheon, Republic of Korea

Vitamin D defi ciency has become a health problem globally due to its in-creasing prevalence and potential health risks. Vitamin D and its metabo-lites are linked to the pathogenesis of diabetes by their action on insulin synthesis, secretion, and action as well as components of infl ammation. This cross-sectional study was conducted to investigate the relationship of vi-tamin D state and diabetes in middle-aged and elderly Korean populations. Data from a comprehensive questionnaire, a physical examination, and blood tests were obtained from the participants in HAS (Hallym Aging Study) 2010. Serum 25-hydroxyvitamin D [25(OH) D](ng/ml) was measured in 380

participants (men=173, women=207). Diabetes was defi ned by the history, fasting glucose, and HbA1C. The mean age was 73.5±7.6 and 71.4±7.8 and level of 25(OH)D was 13.0±7.1ng/ml and 11.7±7.2ng/ml in men and women, respectively. The risk of diabetes appeared to increase with increasing lev-els of 25 (OH)D even after adjusting for other covariates, among men only: adjusted odds ratios of diabetes across 25 (OH)D categories (< 10, 10-19.9, >=20.0) were 1.0, 0.49, and 0.05, respectively (P-value for trend 0.040). In women, the association between diabetes and 25(OH)D was not statisti-cally signifi cant. This study suggests that vitamin D is inversely related to diabetes middle-aged or elderly men in Korea.Table 1. Adjusted odds ratio of diabetes by vitamin D levels

Vitamin D (ng/mL) Adjusted odds ratio (aOR) of diabetesDiabetes Model 1 Model 2 Model 3Yes (n) No (n) 95% CI 95% CI 95% CIMen

<10.0 18 57 1 1 110.0-19.9 10 52 0.48 (0.20-1.19) 0.70 (0.26-1.88) 0.49 (0.16-1.46)

20.0 2 29 0.18 (0.04-0.87) 0.07 (0.01-0.63) 0.05 (0.01-0.57)P for trend 0.056 0.057 0.040

Women<10.0 18 86 1 1 110.0-19.9 10 60 0.87 (0.37-2.04) 0.82 (0.32-2.09) 1.57 (0.47-5.30)

20.0 1 30 0.17 (0.02-1.33) 0.20 (0.02-1.73) 0.13 (0.01-1.88)P for trend 0.241 0.340 0.237

Model 1: adjusted for age, Model 2: adjusted for age, BMI, Season, HTN, MetS, Model 3: adjusted for age, BMI, Season, HTN, MetS, Alcohol, Smok-ing, Exercise, CRP, HOMA, Adiponectin

2617-POGlycemic Control in HIV-Infected Patients With Type 2 Diabetes Mellitus and Its Associated Risk FactorsYIRONG CHEN, HWALIN LAW, ARLENE CHUA, JOYCE Y. LEE, Singapore, Singapore

The management of non-communicable diseases such as diabetes is becoming increasingly important in the management of human immunode-fi ciency virus (HIV)-infected patients whose life expectancy has improved dramatically due to the advent of anti-retroviral therapy. However, limited data exist on the prevalence of glycemic control in these patients. The aims of our study were to evaluate the prevalence of glycemic control in HIV pa-tients infl icted with type 2 diabetes, and to determine factors associated with glycemic control. We followed the glycemic control of these patients from the Communicable Disease Center in Singapore where the majority of HIV-infected patients receive treatment. Glycemic control was assessed at every 3-month for a year. Risk factors known to affect glycemic control were also evaluated. A total of 125 HIV-infected patients with type 2 diabetes were identifi ed between June 2008 and December 2009. Median age was 57.0 (range: 50-63) years and median CD4 count was 189 (64-361) cells/mm3.The median baseline fasting plasma glucose and HbA1c were 167 (138-228) mg/dL and 7.4 (6.6-12.7) %, respectively. Forty patients (32.0%) failed to maintain or achieve adequate HbA1c control of < 7% at 12-month. Elevated triglycerides (TG) of greater than 190 mg/dL was associated with inadequate glycemic control at 3-month (p=0.033); inadequate glycemic control was also observed after the initiation of a protease inhibitor (PI) and/or efavirenz at 6-month (p=0.037). Different risk factors appeared to affect glycemic control at different points in time over the one year period. Although the prevalence of uncontrolled glycemia was low in our study, close monitoring is warranted in patients with elevated TG, and in patients using PI and/or efavirenz.

2618-POSerum Resistin Is Mainly Associated With Circulating Neutrophil and Monocyte Counts in the General Japanese Population: The Toon Health StudyRYOICHI KAWAMURA, WATARU NISHIDA, ISAO SAITO, YASUHARU TABARA, YASUNORI TAKATA, MAYO AIBIKI, MAKI SHIBA, YUKINOBU NOMI, YUKO KA-DOTA, AI OKAMOTO, TATSUYA NISHIMIYA, HIROSHI ONUMA, TETSURO MIKI, TAKESHI TANIGAWA, HARUHIKO OSAWA, Toon, Ehime, Japan

Resistin, secreted from adipocytes, antagonizes the action of insulin in mice. We previously reported that the G/G genotype of single nucleotide polymorphism -420 in the human resistin gene was a primary variant de-termining type 2 diabetes susceptibility (Am J Hum Genet 75: 678, 2004). Circulating resistin is also associated with infl ammation and cardiovascular

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diseases. In humans, resistin is predominantly expressed in macrophages, and its expression and secretion are induced by infl ammatory stimuli. How-ever, the relation between serum resistin and differential white blood cell (WBC) count in general populations remains to be elucidated. The Toon Health Study is a cohort study for surveying risk factors for cardiovascu-lar diseases and diabetes in community based subjects. In this study, 1,109 residents aged 30-79 years were enrolled from 2009 to 2010. The 1,108 participants whose serum resistin was measured by ELISA were analyzed. Resistin was natural log-transformed for statistical analysis. Serum resistin was positively correlated with total WBC count (correlation coeffi cient [R] 0.33, P<0.0001). Precisely, analysis of WBC components showed that se-rum resistin was increased with the increasing of neutrophil and monocyte counts (neutrophil, R 0.34; monocyte, R 0.20; both P<0.0001). These asso-ciations did not change substantially after adjustment for age, sex, body mass index, fasting insulin, fasting plasma glucose, high density lipoprotein cholesterol, triglycerides, blood pressure, estimated glomerular fi ltration rate, high-sensitivity C-reactive protein, smoking, and drinking. There were modest correlations between serum resistin and lymphocyte, eosinophil, or basophil counts (R 0.09, 0.11, 0.16, respectively), with the caution that the percentage of basophil in total WBC was very low. In summary, serum resistin was mainly associated with neutrophil and monocyte counts in the general Japanese population.

2619-PO25-Hydroxyvitamin D and Incident Hyperglycemia in a Chinese Han Population: A Prospective Cohort StudyYUN GAO, XIANGXUN ZHANG, YING LIU, HONGLIN YU, QIANLIN WU, FANG-FANG YAN, TIANPENG ZHENG, XINGWU RAN, TAO CHEN, YAN REN, YANG LONG, HAOMING TIAN, Chengdu, China

This study aims to prospectively evaluate the relationship between 25-hy-droxyl vitamin D (25OHD) levels and risk of hyperglycemia in a Chinese Han population. 352 participants (aged 20-73years; 50.6% women), who consist of 47 subjects with prediabetes and 305 with normal glucose tolerance and reside permanently in Chengdu in Southwestern China, had been recruited for the China National Diabetes and Metabolic Disorders Study from June to September 2007. They were followed up by performing an oral glucose tolerance test from June to September 2011 and then were divided into four groups: prediabetic individuals developing into diabetes (Group A); normo-diabetic individuals developing into diabetes(Group B) or prediabetes(Group C); individuals with constant glucose stability(Group D). Vitamin D status was assessed by measuring 25OHD levels. Hyperglycemia, that is prediabe-tes and diabetes mellitus, was defi ned by WHO defi nition. Hazard ratios for hyperglycemia according to 25OHD levels were estimated using a Cox pro-portional hazard model. By the end of follow-up, 18 prediabetic (10 men and 8 women) and 10 normoglycemic individuals(9 men and 1 women) developed diabetes; 58 normoglycemic individuals (27 men and 31 women) developed prediabetes. Among male subjects, when compared with Group D, lower 25OHD level in Group C (p=0.014) but not in Group A (p=0.102) and Group B (p=0.164) were found, adjusting for age, BMI, baseline 25OHD level. When Group A, B and C combined into subjects with incident hyperglycemia, they had lower 25OHD level than Group D (p=0.003). Compared with those with the highest quartile, subjects with the lowest quartile of 25OHD levels were at increased risk for hyperglycemia ( relative risk, 1.99; 95% confi dence in-terval, 1.03-3.83; p=0.040) after adjusting for age, sex, a family of diabetes, baseline BMI, systolic blood pressure, triglyceride. Vitamin D insuffi ciency may contribute to an increased risk of hyperglycemia in the Chinese Han population.

Supported by: The Chinese Medical Association Foundation and Chinese Dia-betes Society

2620-POThree Quarters of Adults in Kiritimati Screen Positive for Prediabe-tes or DiabetesELIZABETH O. BEALE, JOHN TEKANENE, ALEXANDRA ANDERSON, BROOKE LEJEUNE, TERAIRA BANGAO, Los Angeles, CA, Ronton, Kiribati

Pacifi c Islanders have the world’s highest prevalence of type 2 diabetes (T2D). In August 2011 we conducted the fi rst in-depth screening study on isolated Kiritimati (pop 7,500) in order to inform the development of a cost-effective management program and to obtain insight into the pathogenesis of this disorder. Adults >25years were invited to attend free screening clinics which included fasting fi nger stick glucose (FBG). Complete data was ob-tained for 398 individuals of whom 99 reported a prior diagnosis of T2D. Of the 299 with no history of T2D, 76 were normoglycemic, 149 had impaired fasting glucose (IFG) and 74 T2D, 21% were overweight and 69% obese. Dys-

glycemia increased with age [e.g. mean (sd) FBG (mg/dl) 25-35yrs 112.6(34.8) vs. 45-54yrs 131.6(45.9) (p=0.003)]. In a subgroup with lipid measurements metabolic syndrome was present in males: 42/68 (61.8%) [22/40 (55%) with-out DM] and females: 75/94 (80%)[42/57 (74%) without DM]. Overall 42% smoke. On average fi sh is eaten 6 days/week and fresh meat 6 times/ year. Of those with T2D 87% had LDL >100mg/dl and 50% had BP>130/80mmHg. Genetic analysis of buccal smears and 2 day dietary recall analysis are pend-ing. We conclude that prediabetes or diabetes is present in 75% of adults in Kiritimati with no history of the disease attending a free screening clinic, and in 81% overall. The presence of IGT as the norm in the youngest age group assessed indicates early onset of dysglycemia and that preventive strategies for ubiquitous modifi able risk factors should begin early.

All Subjects Data mean (sd)FBG(mg/dl) [N] Age (years) M:F [N] SBP (mmHg) DBP (mmHg) BMI (kg/m2) Waist (cm) LDL (mg/dl)90.9 (7.3) [76] 37.9 (11.1) 18:58 116 (15.4) 77.2 (10.2) 34.6 (8.2) 102.1 (12.2) 116.9 (24.7)110.6 (7.6) [149] 42.9 (12.3) 62:87 121.3 (18.24) 79.4 (10.2) 34.6 (8.2) 102.0 (12.5) 125.4 (27.8)183.3 (64.2) [173] 49.0 (11.6) 60:113 125.3 (18.6) 81.7 (11.3) 34.6 (9.5) 103.7 (13.6) 135.4 (28.2)

Supported by: PIMA, Institute Global Health USC, Perrigo, Abaxis

2621-PODiabetes Epidemic in DetroitMEREB ARAIA, RENATO ROXAS, ABDUL B. ABOU-SAMRA, BERHANE SEYOUM, Detroit, MI

The purpose of this study was to examine the rate of Diabetes and Pre-Diabetes in previously undiagnosed individuals in the Detroit area. This region has a high minority population with over 90% being African- Ameri-cans (AAs). Diabetes screening is especially important for this population because AAs are more prone to develop complications. A program called “Healthy Detroit-Diabetes Initiative”, was developed at the Detroit Receiv-ing Hospital-Ambulatory Rapid Center (DRH-ARC) in collaboration with the Wayne State University Physicians Group (WSUPG). The program provides free diabetes screening for patients coming to the walk in unit of the DRH-ARC. A total of 4,184 patients, who did not have a history of diabetes, con-sented for screening during the period of March 2010 through February 2011. A total of 1,744 (42%) patients were found to have A1C values in the range of pre-diabetes or diabetes. The prevalence of diabetes increased with age in both men and women. The average age of patients with normal, pre-diabe-tes, and diabetes A1C values was: 31.8±12.0, 39.7±13.8, and 46.0±13.8 years, respectively, for women and 35.8±12.9, 42.7±12.6, and 49.2±11.0 years, re-spectively for men. Among patients with elevated blood pressure (systolic >130 or diastolic >80 mmHg) 49% had abnormal A1C values. In contrast, 37% of patients with normal blood pressure had abnormal A1C values. The data also indicate an extremely high prevalence of undiagnosed pre-diabetes and diabetes. Continued screening of population at risk for diabetes is essential. Public health awareness programs, such as the Healthy Detroit-Diabetes Initiative and the Diabetes Education and Lifestyle Modifi cation, should be initiated in similar areas where minority populations are prevalent.

2622-POChange in Glycaemic Status after Three Years Follow-Up in a Mixed Ancestry Population of Cape Town, South AfricaDAVID J. SOITA, Cape Town, South Africa

Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are considered pre-diabetes states. Our aim was to estimate the progression rates from normal glucose tolerance (NGT) to IFG, IGT and diabetes in sub-jects of mixed ancestry origin residing in a low-income community of Bell-ville South Cape Town, South Africa after 3 years. We followed up 101 sub-jects following an initial baseline survey three years ago. They underwent an overnight fast before being subjected to an OGTT. Fasting and 2 hr blood samples were drawn for analysis. A questionnaire was used to extrapolate necessary personal data, while anthropometric measurements and blood pressure were taken using standard protocols. At baseline, 38 had diabetes, 24 IFG or IGT and 39 were NGT. After 3 years, half of the subjects with IFG had developed IGT whilst the other half reverted to normaglycaemia. On the other hand, 26.3% of subjects with IGT reverted back to normal, 10.5% be-came diabetic and the rest remained IGT. Five percent of subjects that were normoglycaemic developed diabetes whilst 17.9% became hyperglycaemic (IFG or IGT). No signifi cant differences were observed between the risk fac-tors for diabetes (age and obesity indices) and the progression or improve-ment of glycaemic status. There is no data on progression rates from normal glucose tolerance (NGT) to IFG, IGT and diabetes in individuals with type 2

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diabetes from the mixed ancestry population of South Africa. Progression rates to diabetes in these participants are high thus intensive follow-up and intervention strategies are recommended for these high-risk individuals. A larger sample size is required to identify determinants of conversion.

Supported by: National Research Foundation, South Africa and Cape Peninsula University

2623-POReproductive Life History and Change in Prevalence of Diabetes over 12-Years in Turkish Women: Data from TURDEP-I and TURDEP-II SurveysILHAN SATMAN, SIBEL KALACA, KUBILAY KARSIDAG, NEVIN DINCCAG, YILDIZ TUTUNCU, AYSEGUL TELCI, SEMA GENC, SELDA GEDIK, FULYA TURKER, BULENT CANBAZ, BEYHAN OMER, BEKIR CAKIR, TEMEL YILMAZ, JAAKKO TUOMILEHTO, TURDEP-II STUDY GROUP, Istanbul, Turkey, Ankara, Turkey, Helsinki, Finland

Our purpose is to elucidate change in the association between general and reproductive life factors and the risk of diabetes mellitus over 12-years in Turkey using two national representative, population-based surveys. We analyzed data of 13708 and 16696 adult Turkish women from TURDEP-I (1998) and TURDEP-II (2010) cross-sectional surveys, respectively. Accord-ing to TURDEP-I (1998) the prevalence of diabetes among women in Turkey was 8% (1096), this fi gure increased to 17.2% (2871) after 12 years in TUR-DEP-II survey, (age-standardized prevalence of diabetes increased by 82% and reached to 14.6%). In TURDEP-II a multiple logistic regression model has shown that aging ([OR; 95%CI, p-value] 1.04; 1.03-1.05, p<0.001), meno-pause (1.49; 1.28-1.73, p<0.001), parity >4 (1.14; 1.01-1.28, p=0.03) stillbirth (1.26; 1.10-1.44, p=0.001), less than formal 8 years education (1.36; 1.04-1.78, p=0.025), family history of diabetes (2.29; 2.06-2.55, p<0.001), waist (1.02; 1.01-1.03, p<0.001) and BMI (1.01; 1.00-1.03, p=0.027) are factors associ-ated with increased risk of diabetes; whereas living in rural (0.86; 0.77-0.96, p=0.008), and current smoking (0.74; 0.59-0.92, p=0.008) are factors as-sociated with decreased risk of diabetes. However, in TURDEP-I a similar model had shown that all recently identifi ed factors except smoking and par-ity were signifi cant, additionally having a macrosomic baby was also a risk factor for diabetes. General (aging, obesity, family history of diabetes, and lesser education) and reproductive (menopause, excess parity, macrosomic baby, and stillbirth) life factors are associated with increased risk of diabe-tes. Advanced education and strategies aiming to increase awareness of risk factors could help decrease the prevalence of diabetes mellitus among women in Turkey.

Supported by: Istanbul Univ. Sci. Res. Fund, TUBITAK, SEMT, and DOM

2624-POUric Acid is a Predictor of Type 2 Diabetes, Hypertension, and Liver Function in a Chinese Senior CohortFENGJIANG WEI, SHUZHI FENG, NING SUN, CHUNYOU CAI, YAOGANG WANG, WEI-DONG LI, Tianjin, China

The prevalence of hyperuricemia has increased dramatically during the past several decades. To investigate the relationship between plasma uric acid and the risk of insulin resistance related traits, we carried out a 5-year retrospective study in a cohort with 5,510 subjects (4,308 males, 1,202 fe-males, age 64.7±13.0 yr). Physical exams and biochemical tests were per-formed annually during 2006-2010. Prevalence of hyperuricemia was 23.1% in the year 2010 (24.0% in males,19.9% in females). Logistic regression showed that the risk of type 2 diabetes might be predicated from plasma uric acid (OR=0.79, 95% CI 0.68-0.91), BMI (OR=1.10, 95% CI 1.08-1.12, P<0.001) and triglycerides (OR=1.19, 95% CI 1.15-1.24, P<0.001). For hypertension, hy-peruricemia (OR=1.12, 95% CI 1.02-1.23, P=0.02) and BMI (OR=1.09, 95% CI 1.07-1.10, P<0.001) were major risk factors. Plasma uric acid levels correlated with liver function traits, including plasma albumin, globulin, total and direct bilirubin, and aspartate aminotransferase (P<0.001, after adjustment for estimated glomerular fi ltration rate). Cumulative incidence of hypertension was consistently higher among individuals with hyperuricemia than among those with normal plasma uric acid levels. A Kaplan-Meier survival analysis showed that hyperuricemia predicted higher incidences of hypertension in a dose-dependent manner: hypertension onsets signifi cantly differed across quartiles of plasma uric acid levels. Our results suggest that plasma uric acid levels could be useful as indicators of hypertension, insulin resistance related traits, and liver function.

Supported by: National Science Foundation of China (NSFC) Grant 81070576 (W.D.L.)

2625-POThe Relationship between Combined Lifestyle and Eating Habit and Clustering of Components of Metabolic Syndrome in Type 2 Diabe-tes Mellitus—Based on the Diabetes Case Management Program 2001, TaiwanMARTIN M. FUH, PEGGY P. CHEN, CHIA-ING LI, HSIU YUEH SU, CHENG-CHIEH LIN, Taichung, Taiwan, Hsinchu, Taiwan, Taipei, Taiwan

Background and Aims: To evaluate the relationship between combined lifestyle and eating habit and clustering of components of metabolic syn-drome (MetS) for the ensuing development of prevention program. Materials and Methods: From 2007 to 2009, 2642 diabetes benefi ciaries participating cumulatively in DCMP 2001 were under study. Anthropometric and biochem-ical data were measured and the lifestyle measurements ( lifestyle I : no smoking, no alcoholic and regular exercise; lifestyle II : smoking and/or alco-holic and/or no exercise ), total daily caloric intakes, macronutrient consump-tions were also recorded. The eating habits of percentage of macronutrient of daily caloric intake were classifi ed by daily fat consumption, high fat diet ( fat >35% ) and low fat diet ( fat 35% ). The MetS defi ned was based on the criteria mentioned in the ATP III. Patients were obligatorily classifi ed under 6 groups, MetS with waist component, waist required and non-waist required; MetS without waist component, with 2 other components and with more than 2 components; Non-MetS with waist and without waist component. All patients in 6 groups with different combination of lifestyle and eating habit, high fat diet and low fat diet both with lifestyle I or II, were presented by case number and percentage distribution. Chi-Square test was used for data analysis. Results: The case and percentage distributions of 4 different groups of combination of lifestyle and eating habit with different clustering of components of MetS in 4 groups of MetS and 2 groups of Non-MetS in this T2DM cohort were shown in Table 1. There was statistically signifi cant difference in the percentage distributions of clustering of components of MetS and Non-MetS (p<0.0001). Conclusion: The results would be sug-gested that combination of lifestyle and eating habit would have signifi cant impact on the clustering of different components of MetS in T2DM.

2626-POResources on Chemical Exposures, Diabetes and ObesitySARAH G. HOWARD, JERROLD HEINDEL, KRISTINA THAYER, East Greenbush, NY, Research Triangle Park, NC, Morrisville, NC

In 2011, the National Institute of Environmental Health Sciences (NIEHS) gathered scientists to evaluate the evidence linking environmental chemi-cals with the development of diabetes and obesity. Major conclusions were positive associations in epidemiological studies and biological plausibility from laboratory studies. NIEHS provides numerous resources for research-ers, including: grant funding opportunities; Tox21 to evaluate the biological plausibility of diabetogenic and obesogenic chemicals (Figure 1); and Meta Data Viewer to review human studies (Figure 2). Additional online resources are provided by the Collaborative on Health and the Environment’s working group on diabetes and obesity, such as calls featuring leading scientists and a listserv. Identifying environmental chemicals as risk factors for diabetes and obesity is an important avenue for primary prevention. Figure 1 Top 30 chemi-

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cals identifi ed in Tox21 that may affect insulin signaling (top 5 in red). The circle’s 13 sectors represent biological targets involved in insulin signaling. Information: http://www.epa.gov/comptox/toxcast/. Figure 2 Human studies of PCBs and diabetes. Graphic produced from Meta Data Viewer, a public resource available at: http://ntp.niehs.nih.gov/go/tools_metadataviewer.

2627-POWhole Genome Association Study Identifi ed Novel Loci for Non-High-Density Lipoprotein Cholesterol at Baseline and in Response to High Fat IntakePING AN, ROBERT J. STRAKA, MARY F. FEITOSA, MARY K. WOJCZYNSKI, WAR-WICK DAW, PAUL N. HOPKINS, CHAO-QIANG LAI, MICHAEL A. PROVINCE, JOSE ORDOVAS, INGRID B. BORECKI, DONNA K. ARNETT, St. Louis, MO, Minneapolis, MN, Salt Lake City, UT, Boston, MA, Birmingham, AL

Non-high-density lipoprotein cholesterol (NHDL) is a recognized guideline-endorsed secondary target for lowering CV risk and a potentially superior predictor of CV risk compared to LDL alone. Therapy directed at lowering NHDL may generate additional benefi t beyond targeting LDL alone, which can be useful in lowering CV risk. Several loci for lipids (but not for derived NHDL) have been identifi ed in recent GWASs. As NHDL represents a spec-trum of atherogenic lipid fractions, its genomic signature may be distinct from that of LDL or VLDL alone. To test this, we performed GWAS in the GOLDN to uncover loci for NHDL and its response to a fat challenge (post-prandial lipemia, PPL) before fenofi brate treatment. This analysis included 817 Caucasians and 2.5 M SNPs. NHDL was calculated by subtracting HDL from TC at baseline, 3.5 hours, 6 hours after PPL. We calculated AUC using the trapezoid method to describe the change in NHDL during PPL using the growth curve method, and used standardized NHDL AUC residuals as the response. Baseline NHDL was adjusted for age, BMI, center and PC, by sex. NHDL response was similarly adjusted adding baseline NHDL. A linear mixed model in R using the kinship matrix was used for testing. GW signifi cant criterion (GWSC) p < 5E-8 was used to fl ag association signals from common SNPs with MAF > 1%. We identifi ed 3 loci near GWSC with p < 1E-6 (PIGF, 2p21-p16, p = 7E-7; not near genes, 2q32, p = 1E-7; not near genes, 3q11, p = 3E-7) for baseline NHDL. One additional locus emerged near GWSC (near FAR2, 12p11, p = 5E-7) for NHDL response. Both PIGF and FAR2 encode pro-teins involved in glycolipid / fatty acid metabolism. PIGF encodes a protein involved in GPI-anchor biosynthesis and functioned in the transfer of ethano-

laminephosphate to the third mannose in GPI. FAR2 catalyzes the reduction of fatty acyl-CoA to fatty alcohols. We found potentially interesting novel loci in / near PIGF and FAR2 among several other loci for baseline NHDL and its response to PPL.

2628-POIs Diabetes Patterned by Race/Ethnicity or by Socioeconomic Sta-tus? And What Are the Implications?JOHN B. MCKINLAY, LISA D. MARCEAU, REBECCA J. PICCOLO, Watertown, MA

That type 2 diabetes mellitus (T2DM) in the U.S. varies signifi cantly by race/ethnicity is a widely accepted fact and often invoked as an apriori probability during the process of clinical reasoning. Epidemiological studies repeatedly show undiagnosed T2DM varies much more by socioeconomic status (SES), than by race/ethnicity. This study seeks to understand the dis-crepancy between the true prevalence of undiagnosed T2DM by SES and its continually reported prevalence by race/ethnicity. Results from two differ-ent but complementary studies are employed: a) a large population-based epidemiologic survey, with suffi cient numbers of Black, Hispanic and White subjects, well-distributed across SES categories; and b) a factorial experi-ment to estimate the effect of patient characteristics on physician decision making for T2DM. Results from the epidemiologic survey show that both un-diagnosed signs and symptoms and diagnosed T2DM vary similarly by socio-economic status (SES). This fi nding is independently corroborated by Nation-al Health and Nutrition Examination Survey (NHANES) data for diagnosed T2DM. Complementary data from the clinical decision making experiment show the diagnosis of T2DM varies signifi cantly by a patients’ race/ethnic-ity, controlling for SES. While undiagnosed signs and symptoms of T2DM in the community vary signifi cantly by SES (rather than race/ethnicity), follow-ing diagnosis by primary care physicians they vary more by race/ethnicity (rather than by SES). Race/ethnicity and SES in the US are almost totally con-founded, such that measuring one is essentially also measuring the other. Consequently, physicians generally get the social patterning of T2DM right, but for entirely the wrong reason. Continued patterning of T2DM by race/ethnicity motivates the search for genetic and biophysiologic explanations and distracts attention from the more important and potentially modifi able contribution of SES circumstances to the prevalence of T2DM.

Supported by: NIDDK (R01DK080786 and U01DK056842)

2629-POThe Change Study of Diabetes Mellitus and Prediabetic State in Shandong Coastal AreaSHIHUA ZHAO, YANGANG WANG, PING WANG, CHANGGUI LI, DONGMEI MENG, FANG WANG, YING CHEN, ZHONGCHAO WANG, LIN HAN, YI LIU, SHENGLI YAN, Qingdao, China

Type 2 Diabetes Mellitus (T2DM) is a complex diseases which is infl uenced by genetic factors and environmental factors.In order to determine the cur-rent prevalence and risk factors of T2DM and impaired glucose regulation (IGR)among residents aged 20 years or older in Shandong coastal areas.We performed a random stratifi ed cluster sampling survey, and 5191 households were visited in Qingdao, Yantai, Weihai, Rizhao and Dongying.The results were compared with that in 2004. The standardized rate of the prevalence of DM was 9.51%, increasing by 1.53% (P<0.05) compared with 2004.While it was 9.86% in males and 9.26% in females, increasing by 2.11% and 0.94 %(P<0.05)respectively. In this epidemiological study, there were 374 newly diagnostic DM patients, which consisted 61.51% of the DM patients and in-creased by 10.2% (P<0.05) compared with 2004. The standardized rate of the prevalence of IGR was 11.86%, increasing by 2.02% (P<0.05).It was 14.19% in males and 9.79% in females.The prevalence of DM and IGR increased parallel with age, that is the prevalence of DM patients younger than 50 in 2009 was signifi cantly higher than that of 2004 (P<0.05), while that of IGR people aged younger than 60 was signifi cantly higher than that of 2004 (P<0.05). In contrast with 2004, the DBP, TG, TC, LDL-c, UA and HDL-c of IGR and DM patients increased obviously (P<0.05).DM patients had higher TG than IGR patients (P<0.01), while IGR patients had higher UA than DM pa-tients (P<0.01). Logistic regression analysis showed that age,BMI, SBP, TG, LDL-c were risk factors of IGR, while HDL-C and daily sea-food intake were protection factors of IGR. These datas show that compared with 2004, the prevalence of DM and IGR increases, especially in males. Aging, overweight, hypertension and lipid disorders are risk factors of DM, moderate sea-food intake is helpful for controlling blood glucose, and UA plays an important role at the beginning of DM.

Supported by: Chinese Diabetes Society

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2631-POPrevalence of Cardiovascular Disease Risk Factor Presence and Aggregation in the Chinese Subjects With Pre-DiabetesZHAOJUN YANG, JIANZHONG XIAO, JUMING LU, JIANPING WENG, WEIPING JIA, LINONG JI, WENYING YANG, S STUDY GROUP THE CHINA NATIONAL DIA-BETES AND METABOLIC DISORDER, Beijing, China, Guangzhou, China, Shanghai, China

The aim of the manuscript was to analyze cardiovascular risk factors and the prevalence of non-fatal CVD in subjects with pre-diabetes from data gathered from the 2007-2008 China National Diabetes and Metabolic Dis-orders Study. A nationally representative sample of 46,239 adults, aged 20 years or older, included 34293 of subjects with normal glucose toler-ance (NGT), 6997 with pre-diabetes(pre-DM), and 4949 with diabetes mellitus(DM), respectively. Lifestyle factors, diagnosis of cardiovascular disease , diabetes, and family history of each subject were collected, and an oral glucose tolerance test or a standard meal test and fasting lipid pro-fi les was performed. Non-fatal CVD were determined by the subjects’ self-reporting. SUDAAN software was used to perform all weighted statistical analyses. The prevalence of CVD was 1.06%(95CI: 0.87%-1.28%) in NGT, 1.79%(95%CI: 1.37%-2.33%) in pre-DM, and 3.83%(95%CI: 2.79%-5.24%) in diabetes, respectively. The presence of CVD in subjects with isolated impaired fasting glucose(iIFG), isolated impaired glucose tolerance(iIGT), and combined IFG and IGT was 0.66%(95%CI: 0.35%-1.24%), 2.09%(95%CI: 1.53%-2.83%), and 1.59%(95%CI: 0.84%-3.01%), respectively. In the pre-diabetic subgroup, the prevalence of one subject having 1, 2, 3, or 4 of the 4 defi ned risk factors (i.e., smoking, overweight or obese, hypertension, or dyslipidemia) was 26.05%(95%CI: 24.05%-28.15%), 34.82%(95%CI: 32.65%-37.06%), 23.20%(95%CI: 21.46%-25.04%), and 7.00%(95%CI 5.94%-8.23%), respectively. After adjustment for gender and age, the odds ratio of CVD for those who had iIGT and combined IFG/IGT was 2.88, and 2.12, respectively, when compared with subjects with iIFG. The prevalence of cardiovascular risk factors was high in the Chinese pre-diabetic population, with multiple risk factors present in the same individual. The postprandial hyperglycemia is more associated with CVD than the isolated fasting hyperglycemia.

Supported by: Chinese Medical Association Foundation

2632-POEye Care Utilization among a High-Risk, Underinsured Diabetic PopulationPAUL A. MACLENNAN, GERALD MCGWIN, CHRISTINE HECKEMEYER, VIRGINIA R. LOLLEY, SANDRAL HULLETT, CYNTHIA OWSLEY, Birmingham, AL

Little is known regarding eye care utilization among high-risk, underin-sured people with diabetes. We identifi ed a cohort of patients 19 years and older with a primary diagnosis of diabetes seen in 2007 in the general medi-cine or eye clinics of a large, urban, county hospital that serves primarily low income patients. Patients were followed for two-years to assess utilization of eye care services. Rate ratios (RRs) and 95% confi dence intervals (CIs) for the association between eye care utilization and selected clinical and demographic characteristics were calculated. There were 1,369 people with diabetes: 64.5% women, 79.2% African American, 56.1%, uninsured, with average age 54.2 years. The overall rate of eye care utilization was 39.5% within one year and 52.3% within two years. Age, years since fi rst diabetes diagnosis, uncontrolled diabetes or with complications, and African Ameri-can race were associated with signifi cantly increased rates of eye care uti-lization within 2 years; newly diagnosed diabetes was associated with sig-nifi cantly decreased rates. No signifi cant differences were found for other risk factors examined. The proportion of patients receiving eye care within one year is comparable to previous studies. Nonetheless, about half of the participants did not receive eye care within two years. Further investigation will help identify barriers to eye care utilization among this population.

Eye care < 1 year Eye care < 2 yearsCharacteristics RR (95% CI) RR (95% CI)Age (years) 1.02 (1.01-1.02) 1.01 (1.01-1.02)Diabetes duration (years) 1.04 (1.02-1.05) 1.03 (1.01-1.04)Newly diagnosed (< 1 year) 0.77 (0.61-0.97) 0.81 (0.66-0.98)Uncontrolled diabetes or with complications

1.17 (0.97-1.41) 1.21 (1.03-1.42)

African American race 1.20 (0.94-1.52) 1.29 (1.0-1.6)

Supported by: CDC 1U58DP002651 (INSIGHT Network)

2633-PODoes A1C Over Diagnose Impaired Fasting Glucose in Black Women?BEN LEON, ANDREA CARNIE, GLORIA ZALOS, RICHARD O. CANNON, BERNARD V. MILLER, Bethesda, MD

Black women (BW) have higher A1C than white women (WW) for the same glucose concentration. The current guidelines for diagnosing predia-betes with A1C (>=5.7 and <=6.4, %) are the same regardless of ethnicity. Therefore, we examined the relationship between A1C and impaired fasting glucose (IFG) in 32 BW and 29 WW without diabetes (by fasting glucose or A1C). BW [mean ± SD] (46 ±10, yr) were younger than WW (53 ± 9, yr). BMI (kg/m2) was not signifi cantly different in BW (34 ± 5) and WW (32 ± 6). Fast-ing glucose (BW = 88 ± 2, WW = 96 ± 3 mg/dL, p < 0.001) and A1C (BW = 5.7± 0.1, WW = 5.7 ± 0.2, %, p = 0.56) levels were adjusted for age and BMI. The prevalence of IFG was lower in BW (9%) than WW (31%). Prediabetes preva-lence diagnosed by A1C was 63% in BW and 55% in WW. The sensitivity and specifi city for an A1C diagnosis of prediabetes were lower in BW (25 and 39%) than WW (67 and 50%). Positive and negative predictive values were 6 and 79 % in BW, and 38 and 77% in WW. Our nominal logistic regression model using A1C, ethnicity and A1C*ethnicity to predict IFG (Y = glucose >= 100 and <= 125, and N = glucose < 100 mg/dL) showed an ROC-AUC = 0.75 for the whole cohort without an ethnicity*A1C interaction. In the individual groups ROC-AUC was lower in BW (0.60) than WW (0.68) and generated optimal A1C cut-off values that were higher in BW (5.8%) than WW (5.5%) for A1C in diagnosing IFG. We conclude that A1C may be a less sensitive test and over diagnose prediabetes due to IFG to a greater degree in BW than WW. Further investigations of the relationship between glucose metabolism and A1C are needed to delineate the role of racial differences in A1C related to diagnosing prediabetes.

Supported by: NIH

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2634-POCurrent Status of Management of Diabetes and Glycaemic Control in India: Preliminary Results from the Diabcare India 2011 StudyVISWANATHAN MOHAN, V. SESHIAH, B.K. SAHAY, S.N. SHAH, P.V. RAO, S. BA-NERJEE, S.K. WANGOO, A. KUMAR, S.R. JOSHI, S. KALRA, A.G. UNNIKRISH-NAN, R.V. SHETTY, A.K. DAS, Chennai, India

DiabCare India was an pan-Indian observational, cross-sectional study in patients with diabetes mellitus, undertaken to investigate the relationship between diabetes control, management and complications in a subset of ur-ban Indian diabetes population treated at referral diabetes care centres. The clinical profi les of these patients is described here. Subjects who had been registered for diabetes care at the diabetes clinic (defi ned as any clinic treat-ing over 100 patients/ month) for over 6 months were enrolled. The data was retrospectively reviewed, including diabetes history, treatment regimens and laboratory assessments. HbA1c was measured at a central laboratory by the Bio-Rad Variant method and in selected cases from their existing records. Data was collected in a standardized data collection form, entered into an SAS database, validated and descriptive analysis performed. 6168 subjects were screened in the study (mean age: 51.9 years; 53.8% males); the mean duration of diabetes was 6.9 years and 95.8% of these subjects had Type II Diabetes and a positive family history of diabetes was seen in 38.2% of all subjects. The mean BMI was 26.5 kg/m2 and the mean waist circumference was 89.2 cm. The mean HbA1c was 8.97 ± 2.19 in these subjects. 19.7% had HbA1c < 7%(type 1 diabetes: mean HbA1c = 10.3 ± 5.8, 16.3% < 7%; type 2 diabetes: mean HbA1c = 8.9 ± 2.2, 19.7% < 7%). Other glycaemic parameters were also high with the mean FPG > 8.2 ± 2.9 and PPG > 11.4 ± 3.8 mmol/ L. This multicentre observational study shows that type 2 diabetes sets in early in Indians and the glycaemic control is often sub optimal. These results also indicate a need for more structured intervention at an early stage of the diseases and a need for increased awareness on benefi ts of tight glycaemic control (ClinicalTrials.gov identifi er: NCT01351922).

2635-POPrediabetes and Diabetes Mellitus among Different Ethnic Groups in Makassar, IndonesiaFABIOLA M. ADAM, Makassar, Indonesia

Indonesia consists of several ethnic groups. In Makassar, East part of In-donesia there are 3 different large ethnic groups, the Makassar, Bugis and Toraja. Diabetes is increasing in Indonesia, the national prevalence now is approximately 7%. In this study we report the prevalence of prediabe-tes and diabetes mellitus from the three groups. During two years period, 2009 - 2011 we screened 3502 adult subjects in Makassar. After 12 hours fasting, blood was taken for fasting plasma glucose. Fasting plasma glu-cose was examined in the central laboratory using enzymatic hexokinase method. The fasting plasma glucose was divided into normal < 100 mg/dL, prediabetes100-125 mg/dL, and DM > 126 mg/dl. Ethnic groups was divided to three large groups Makassar, Bugis, dan Toraja. From the 3502 subjects, ethnic Makassar was 1039, Bugis 1246, and Toraja 472, totally 2757. In this 3 groups, the prevalence of prediabetes was 10.5%, and DM 8.5%, mostly at the age of > 40 years. The prevalence of prediabetes as well as DM was higher among the ethnic Toraja compared to the other two groups, but was not statistical difference (p < 0.447), i.e for prediabetes 10.7%, 10.4%, and 12.1% and DM 7.8%, 8.7%, and 10.2% for Makassar, Bugis and Toraja. The prevalence of diabetes mellitus and prediabetes is increasing in all ethnic groups, but the difference was not signifi cant.

2636-POCharacteristics of Adults With Type 1 Diabetes in the Middle East: Results from the International Diabetes Management Practices Survey (IDMPS)AMBADY RAMACHANDRAN, JUAN JOSE GAGLIARDINO, PABLO ASCHNER, JU-LIANA CHAN, JEAN-MARC CHANTELOT, ELIZABETH GENESTIN, MARIE-PAULE DAIN, HASAN ILKOVA, FERNANDO JAVIER LAVALLE-GONZÁLEZ, Chennai, India, La Plata, Argentina, Bogotá, Colombia, Shatin, Hong Kong, Paris, France, Istanbul, Turkey, Monterrey, Mexico

IDMPS is an ongoing 5-year multinational observational study docu-menting the current quality of care provided to people with type 1 or type 2 diabetes. Feasibility analyses were previously performed to validate the chances of pooling all the data collected during 3 years in the Middle East and to identify variables that could be included in the analysis. The aims of this analysis were to describe the characteristics of people with type 1 diabetes mellitus (TIDM) in the Middle East as a fi rst step toward further multivariate analysis. The characteristics assessed included profi les of self-management patients, patients’ education, type of insulin/devices used, and

degree of glycemic control. Data from 1316 T1DM patients were collected by diabetologists (62.8%) and general practitioners (37.2%) between 2006 and 2009 in the form of annual surveys consisting of 2-week cross-sectional studies. The mean age of the T1DM patient was 32 ± 13 years; 76.4% of the patients were < 40 years and 52.4% were male. The mean age at diagnosis was 20 ± 11 years. The mean body mass index (BMI) was 25.7 ± 4.9 kg/m² with 50.6% having a BMI > 25 kg/m². Mean A1C levels were 8.3 ± 2.0% and 22.4% of patients had A1C levels < 7%. Education on diabetes was received by about 60%; 74.2% performed capillary blood testing (SMBG), and 61.2% self-adjusted their insulin dose. Both SMBG and self-adjustment of insulin were performed by 51.3% of patients. The majority of the patients (69.0%) were covered by health insurance. The mean number of years patients were on insulin was 11.0 ± 8.8 years; 51.1% were on basal-prandial insulin, 49.8% used insulin pens, 49.6% used vials and syringes, and 1.6% used pumps. This study provides valuable data on the characteristics of people with T1DM in the Middle East and provides useful information for the development of strategies to optimize diabetes control and outcomes in this population.

Supported by: sanofi -aventis

2637-POHigher Total and VLDL Triglycerides and Lower HDL Cholesterol, but Not LDL Cholesterol, Predict Future Visceral Adiposity in Nondia-betic Japanese AmericansTOMOSHIGE HAYASHI, EDWARD J. BOYKO, KYOKO K. SATO, MARGUERITE J. MCNEELY, DONNA L. LEONETTI, STEVEN E. KAHN, WILFRED Y. FUJIMOTO, Osaka, Japan, Seattle, WA

It is well known that greater visceral fat is related to dyslipidemia char-acterized by abnormal concentrations of both triglycerides (TG) and lipopro-teins. However it is not known whether lipid concentrations predict future visceral fat accumulation. We prospectively studied the development of visceral adiposity in association with total-TG, VLDL-TG, nonVLDL-TG (= total-TG minus VLDL-TG), LDL cholesterol (C), and HDL-C levels. We followed 435 nondiabetic Japanese-American men and women over 5 years and 396 subjects over 10 years not taking lipid-lowering medications. We measured abdominal visceral fat (VFA) and subcutaneous fat (ASFA) areas by comput-ed tomography at baseline and at the 5-and 10-year follow-up examinations. Baseline variables of interest included the incremental insulin response (IIR) [(30-0 min insulin) / (30 min glucose)] during an OGTT, homeostasis model as-sessment (HOMA-IR), and total-TG, VLDL-TG, nonVLDL-TG, HDL-C, and LDL-C levels after an overnight fast. In multiple linear regression models, after adjustment for baseline VFA, ASFA, age, gender, HOMA-IR, and IIR, total-TG and VLDL-TG levels were positively associated with future VFA at 5 years (P = 0.028, 0.014, respectively) and 10 years (P = 0.044, 0.011, respectively), while HDL-C level was negatively associated with future VFA at 5 and 10 years (P = 0.004, 0.025, respectively). Both nonVLDL-TG and LDL-C level were not associated with future VFA at 5 and 10 years. In conclusion, higher total-TG and VLDL-TG and lower HDL-C precede visceral fat accumulation.

Multiple linear regression models of baseline TG and lipoproteins for 5- and 10-year VFA.

Square root of VFA at 5 years

Square root of VFA at 10 years

StandardizedRegressioncoeffi cient

p Standardized Regressioncoeffi cient

p

Model 1 Log (Total-TG)* 0.070 0.028 0.074 0.044Model 2 Log (VLDL-TG)* 0.080 0.014 0.096 0.011Model 3 Log (nonVLDL-TG)* 0.030 0.301 0.023 0.495Model 4 LDL-C* 0.034 0.257 0.023 0.508Model 5 HDL-C* -0.101 0.004 -0.091 0.025*Adjusted for VFA, ASFA, HOMA-IR (Log e (HOMA-IR) for modeling VFA at 10 years), IIR, age, and gender at baseline.

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2639-POMortality Causes in a Recently Diagnosed Type 2 Diabetic Patients Cohort in Primary Care Followed Up to 20 YearsMANEL MATA-CASES, Sant Adrià de Besòs, Spain

Background and objective: To describe the causes of mortality in type 2 Diabetes Mellitus (T2DM) patients diagnosed between 1991 and 2000 and followed up until July 2011. Patients and methods: A retrospective, longi-tudinal study was performed based on the records of a cohort of all T2DM patients diagnosed in an urban primary care center from 1991 to 2000 and followed up until July 2011. In this cohort, all patients without a previous glycemic test in the 3 years before diagnosis were excluded in order to be sure that they were at the beginning of the disease. Patients who became diabetes-free during the follow-up were also excluded. Death causes were obtained from the electronic clinical records and were validated in the mor-tality register of Spanish’s Statistics National Institute. Results: There were 598 new cases of T2DM registered during the study period, of which only 469 of them accomplished the inclusion criteria (mean age [SD]: 59.7 [11.4] years; 51.3% women). During this period 146 patients died (31.1%): 72 men (33.3%) and 74 women (29.3%) (p=ns). 37 cases (25.3% of the deceased) died from macrovascular causes (19.4 % in men and 31.1% in women, p=ns); 44 (30.1%) from cancer (43.1% in men and 17.6% in women, p<0,001), 46 (31.5%) from other causes (29.2% in men and 33.8% in women, p=ns), and 19 cases (6.2%) by unknown causes (8.3% in men and 17.6% in women, p=ns). The most frequent specifi c cardiovascular causes were: coronary heart disease 10.2% (11.1% in men and 9.5% in women, p=ns) and stroke 8.9% (5.6% in men and 12.2% in women, p=ns). Among the neoplastic causes the most frequent were lung cancer (12.5% in men and 0% in women: p<0.01) and colorectal (8.3% in men and 2.7% in women, p=ns). Conclusions: 31.1% of patients died during follow up, however only about one quarter of them died due to macro-vascular cause. Men patients died more frequently from cancer.

2640-PO

2641-PORelation between Family History of Neoplasms and Impaired Fast-ing Glucose in Obese-Overweight Non-Diabetic SubjectsGIUSEPPE SEGHIERI, GIANNA FABBRI, FEDERICA TESI, ROBERTO ANICHINI, Pis-toia, Italy

There is a signifi cant association between prevalence of malignant neo-plasms (MN) and diabetes/dysglycemia or obesity in general population. There are, however, no data eventually linking dysglycemia with family his-tory of malignancies in non diabetic individuals. Aim of this study was to look for presence of any relationship between family history of MN and fast-ing plasma glucose (FPG) using the database concerning 1344 (491M/853F) overweight-obese subjects consecutively admitted to dietetic clinic of our hospital to obtain therapeutic dietetic advice. This database contains an-thropometric and biochemical parameters needed to perform the diagno-sis of metabolic syndrome (MS) as well as data pertaining history of MN among fi rst-second-degree relatives. Considering only non-diabetic sub-

jects, prevalence of family history of MN resulted greater among females (F) than among males (M) (43% vs. 36%; 2=6.76; p=0.009). Mean FPG was signifi cantly higher in those with history of MN only among F (5.4±0.7mmol/L vs. 5.2±0.7mmol/L in F; p=0.01, and 5.3±0.7mmol/L vs. 5.2±0.7mmol/L in M; p=ns). Presence of impaired fasting glucose (IFG; FPG 5.6mmol/L and <7mmol/L) was likewise signifi cantly associated to history of MN among F ( 2=5.78; p=0.01), not among M ( 2=0.73; p=ns). After adjusting for age, BMI, smoking and presence of MS, the risk of having a fi rst-second-degree relative affected by MN rose by about the 30% for every increase of 1 FPG mmol/L among F (OR:1.29; 95%CI:1.02-1.65), not among M (OR:0.90; 95%CI:0.66-1.20). Similar results were observed after introducing in the model family history of diabetes: risk of having family history of MN was about 44% higher in F with diabetic relatives (OR:1.44; 95%CI:1.03-2.01). In conclusion in this population of non-diabetic overweight-obese outpatients, the risk of having a fi rst-or-second-degree relative affected with a MN seems to be linearly related to increase in FPG and/or to the presence of IFG only among females.

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2643-PODiscrepancies between Screening Modes for Diabetes Mellitus and Impaired Glucose Tolerance among Severely Obese PatientsJEAN MICHEL ANDRIEU, JACQUES MICHEL, FRÉDEDIC DAUDE, MICHEL DAUDE, Beziers, France, Boujan, France

Screening for diabetes mellitus (DM) and impaired glucose tolerance (IGT) is part of the assessment of morbidity in obese patients. We want to evaluate whether HbA1c measurement is concordant with measurements of fasting blood glucose (FBG) and 2-hour blood glucose value after a 75g oral glucose load (OGTT-2h BG) to set the status of glucose tolerance in this spe-cifi c population.One hundred patients with no previously know IGT or DM, including 81 women with age: 37 [18-65] years and BMI: 42 [35-66] kg/m2, 19 men with age: 38 [23-57], BMI :45 [38-66] were investigated. Citeria for IGT included FBG from 100 to 123 mg/dl and/or OGTT-2h BG from 140 to 199 mg/dl and/or HbA1c from 5.6 to 6.4%. DM was diagnosed according to WHO criteria and/or HbA1c > 6.4%. Criteria for IGT were present in 47.8, 38.8 and 48.6 % of cases according to FBG, OGTT-2h BG and HbA1c, respectively, while those for DM were present in 16.7, 7.8, and 7.5 %, respectively. Con-cordance rate between the 3 screaning indices was only 30 % for IGT and 20 % for DM. Concordance between only 2 screaning indices is shown in table 1. When changing criteria for IGT on HbA1c from 6 to 6.4 % as recently suggested, concordance rate fell from 60 % to 33 % with FBG and from 44 % to 25 % with OGTT-2h BG. Our data show an overall weak concordance between screening indices for IGT and DM in this population. While HbA1clevel shows 60 % concordance with FBG for the diagnosis of IGT, it falls down to 33% for DM whereas FBG and OGTT-2h BG show a much better con-cordance.Until further investigations elucidate the most accurate screening tool, FBG may be preferred for simplicity and cost reasons.

Concordance rate FBG-OGTT-2h BG FBG-HbA1c OGGT-2h Bg-HbA1cIGT 38 % 60 % 44 %Diabetes 65 % 33 % 42%

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2645-POCurrent Glycemic Control in 851 Type 1 Diabetic Patients in Guang-dong Province, ChinaJINHUA YAN, GE WU, GUOCHUN LUO, JIANGMING LANG, SHAODA LIN, XIUWEI ZHANG, GANXIONG LIANG, MEILUN XU, JIANCAI LIN, LIN YUANG, SHAOQING LI, JIANNENG WU, YONGXIN WU, LONGYI ZENG, YISHAN FANG, DEHONG CAI, WENXIN OU, KERONG ZHONG, NAIQIANG XIE, LU LI, DINGYU CHEN, GUOJU TAN, HUAZHANG YANG, JIANPING WENG, Guangzhou, China, Zhanjiang, China, Shenzhen, China, Shantou, China, Dongguan, China, Zhongshan, China, Huizhou, China, Jiangmen, China, Zhuhai, China, Qingyuan, China, Shaoguan, China, Mei-zhou, China, Jieyang, China, Maoming, China, Heyuan, China, Zhaoqing, China, Yangjiang, China

DCCT/EDIC study has demonstrated long-term benefi ts of intensive glyce-mic control in preventing chronic complications in type 1 diabetes mellitus (T1DM) patients. However, the overall glycemic control in Asian patients with T1DM remained unsatisfactory as shown in Diabcare-Asia 1998 study. Therefore, after more than 10 years, we initiated this survey to assess cur-rent status of glycemic control in Chinese T1DM patients, and to fi nd out related risk factors of hyperglycemia. From August 2010 to March 2011, we collected demographic and clinical data of 851 T1DM patients (443 females) from 105 hospitals in Guangdong Province, China. Whole blood specimens were shipped to Guangdong Diabetes Center and HbA1c values were mea-sured with high-performance liquid chromatography centrally. Age-specifi c target value of HbA1c (recommended by American Diabetes Association and Chinese Diabetes Society) was used to evaluate glycemic control. Charac-teristics of these patients were age 29.6 years (20.3-41.3) [median (inter-quartile range)], durations of T1DM 3.3 years (1.0-7.3), and body mass index 19.9 kg/m2 (17.9-21.8). HbA1c was 8.6% (6.9-11.0) and only 234 patients (27.5%) reached the age-specifi c targets. After adjustment for confounding factors, multivariate linear regression analysis showed correlates of poor-er glycemic control were lower family income (< $4,760/year), teenagers, shorter diabetes duration (< 1 year), lack of diabetic health education and diet control. Other factors such as sex, region, weight categories, diabetic ketoacidosis at onset, exercise, and insulin plus oral antidiabetic drugs or not, were not associated with glycemic control.In summary, our results showed poor glycemic control in Guangdong T1DM patients. Comprehensive management should be taken to control modifi able risk factors.

Supported by: Guangdong Provincial Department of Science and Technology (2010B031500008)

2646-POInappropriate Body Weight Management and Highly Prevalent Chronic Kidney Disease Without Albuminuria among Japanese Type 2 Diabetes PatientsFUMINOBU OKUGUCHI, TOSHIHIKO KAISE, MARIKO OISHI, HIDEKATSU SUGIM-OTO, KOICHI HIRAO, KOICHI KAWAI, MASASHI KOBAYASHI, ATSUNORI KASHI-WAGI, JAPAN DIABETES CLINICAL DATA MANAGEMENT STUDY GROUP, Sendai, Japan, Tokyo, Japan, Kyoto, Japan, Kitakyushu, Japan, Yokohama, Japan, Tsukuba, Japan, Takaoka, Japan, Otsu, Japan

The present research examined unmet needs in diabetes treatment by focusing on body weight control and comorbid chronic kidney disease (CKD) among Japanese type 2 diabetes mellitus (T2DM) patients. We examined T2DM patients enrolled in the diabetes database to which diabetes special-ists in 69 clinics/hospitals nationwide had registered clinical data since 2001. Body weight control was investigated by an observational retrospective lon-gitudinal study. We collected data of HbA1c and BMI in drug-naïve patients who started diet/exercise therapy or oral drug monotherapy and could be followed up for 3 years between 2001 and 2008. CKD and albuminuria were examined cross-sectionally by using data obtained between 2006 and 2008. Estimated glomerular fi ltration rate (eGFR) was calculated by applying serum creatinine data to the formula published by Japanese Society of Nephrology, and CKD stages were classifi ed by referring to eGFR and urine albumin. In the longitudinal study, major initial therapies were diet/exercise (n=1,595), sulfonylureas monotherapy (n=367) and biguanides monotherapy (n=84) among 2,142 drug-naïve patients, and about 50% of patients in each group could continue the initial therapy for 3 years. HbA1c was controlled to less than 7.2% for 3 years in these patients who continued the initial therapy, but body weight was not controlled in signifi cant proportion of the patients. BMI increased by more than 0.5 kg/m2 in 3 years in 18% and 56% of patients in diet/exercise and sulfonylureas monotherapy groups, respectively. In the cross-sectional study, the prevalence of CKD in stage 3-5 and albuminuria were 17.9% and 31.1%, respectively, of total 17,541 patients. CKD in stage 3-5 was found in as many as 14.3% of patients without albuminuria, sug-gesting that eGFR should be monitored even in normoalbuminuric patients.

Our results suggest that body weight control and monitoring of CKD should be further focused on for total management of T2DM.

Supported by: GlaxoSmithKline (K.K.)

2647-PO

2648-POLowering the Diagnostic Threshold for Impaired Fasting Glucose—Did It Capture More Impaired Glucose Tolerance?SUBRAMANIAN KANNAN, JAMES BENA, SEENIA PEECHAKARA, MARWAN HAMATY, Cleveland, OH

Impaired fasting glucose (IFG) defi ned as fasting glucose (FG) 110-125 mg/dl is associated with impaired glucose tolerance (IGT) in < 50% of people. Among people with IGT, 20-30% have co-existing IFG. Changing IFG diagno-sis to FG 100-125 mg/dl was recommended by ADA in 2003 to identify similar proportions of populations with IFG and IGT. Whether this change resulted in capturing more co-existing IGT is not known. IFG diagnostic criteria of (FG 100-125 mg/dl) were compared with FG 110-125 mg/dl in their ability to capture IGT by analyzing data from 5842 OGTTs done at Cleveland Clinic Foundation between Jan 2000 to Dec 2010. The numbers of missed cases of diabetes (DM) if FG were the sole diagnostic criterion were evaluated. Mean age for the cohort was 53 ± 15 years with 60% women. Table 1 shows prevalence of IGT and DM in the cohort. Table 1.

Fasting Glucose Normal <100(N=3606)

IFG-1 100-109(N=1019)

IFG-2 110-125(N=721)

Diabetes >125(N=478)

No IGT, No Diabetes 2930 (81%) 627 (61%) 231 (32%) 0 (0%)IGT 567 (16%) 301 (30%) 275 (38%) 0 (0%)Diabetes 109 (3%) 91 (9%) 215 (30%) 478 (100%)

Changing IFG diagnosis to FG 100-125 mg/dl decreased missed diagnosis of IGT from 15% to 10% of the total tested population (TTP). The change of IFG defi nition identifi ed 11%of the TTP with no IGT/DM to have hypergly-cemia; risk to develop diabetes for this group compared with IGT and IFG-2 is not adequately evaluated. People diagnosed with DM based on OGTT in association with FG < 100 and FG < 110 mg/dl were 2% and 3% of TTP re-spectively. Totally, 7% of TTP would have missed diagnosis of diabetes if FG was used for diagnosis (46% of all DM cases). Changing IFG diagnosis to FG 100-125 mg/dl enhanced the ability of IFG to capture co-existing IGT. There were still signifi cant residual problems of missing IGT and DM. OGTT should be considered in higher risk populations.

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2649-POState of Diabetes in Kuwait: Analysis, Trends, and Data Mining for Risk PredictionBASSAM FARRAN, ARSHAD M. CHANNANATH, ALPHONSE T. THANGAVEL, Ku-wait City, Kuwait

Despite having one of the highest rates of diabetes in the world, Kuwait has done little in terms of analysing trends and predicting the onset of dia-betes and its complications. For the fi rst time, Kuwait health data are avail-able, and we have access to 250,000+ patients’ data (12,000,000 records). Of these, 55,000+ are diabetic (~21%) and 28.9% are diagnosed with hyper-tension (HT). Of the 55,000+ diabetics, 79% had an out of range (OOR) HbA1c value, 58% had OOR microalbumin, 88.3% had OOR glucose levels, and the number of patients newly diagnosed with T2DM has risen from 1135 in the year 2000 to 17093 in 2011. The data also shows inadequacies in the Kuwaiti health system and nonadherence to international standards; for e.g. only 1% patients had an albumin creatinine ratio check, which is the international standard. Also, using only BMI, sex, HT, family history of diabetes, and age, we built risk calculators using logistic regression and k-nearest neighbours to predict the risk of T2DM onset which is 67% accurate. This work falls in the context of an integrative infrastructure that unifi es data and knowledge on diabetes in Kuwait from health, bio, and lifestyle informatics, which leads to identifi cation of domain-specifi c as well as combinatorial inter-domain risk factors.

2650-POIncreased C-Reactive Protein Associates With Elevated Carotid In-tima-Media Thickness in Chinese Adults With Normal Low Density Lipoprotein Cholesterol LevelsMIN XU, YUFANG BI, YU XU, TIANGE WANG, MIAN LI, JIELI LU, YUHONG CHEN, WEIQING WANG, GUANG NING, Shanghai, China

Low density lipoprotein cholesterol (LDL) is concerned as the primary tar-get of lipid-lowering therapy and in high-risk persons, the recommended goal is < 100 mg/dL. Clinical trials also raised the possibility that the benefi ts of statins might be greater in people with high CRP. However, few studies have focused on the association of higher CRP and low LDL levels with risk of increased carotid intima-media thickness (IMT), an early indicator of athero-sclerosis. We aimed to study the relationship of elevated CRP levels (1.0~2.9 or 3.0 mg/dL) with IMT in Chinese adults with normal LDL levels (< 100 mg/dL). A cross-sectional analysis was performed in 2499 eligible subjects who were recruited from a single community of Shanghai in 2008. IMT was measured by using a high-resolution B-mode ultrasound. As compared to CRP < 1.0 mg/dL (n = 1994), the subjects with CRP 1.0~2.9 (n = 265) and 3.0 mg/dL (n = 240) were much older, and had higher body mass index, waist circumference, systolic and diastolic blood pressure, hemoglobin A1c and serum triglycerides; the IMT was signifi cantly elevated in group of CRP 3.0 or 1.0~2.9 mg/dL (0.66 vs 0.65 vs 0.61 mm, p < 0.0001). The subjects with CRP

3 mg/dL had a 1.45 fold of risk for elevated IMT ( 0.7mm) (95% confi dence

interval, 1.02-2.06, p = 0.038), after a full adjustments. The association was more prominent in subjects with age less than 60 years (odds ratio (OR) = 2.04, p = 0.04), in diabetic patients (OR = 1.79, p = 0.04) and obese (OR = 1.55, p = 0.006). Increased serum CRP independently associates with elevated carotid IMT in Chinese adults with normal LDL levels. The association was more prominent in those who already had other risk factors of cardiovascular diseases (CVDs), such as central obesity and type 2 diabetes. Given that LDL is insuffi cient for fi nding subjects who at risk of developing CVDs, the infl am-mation marker, CRP, etc., should be pay more attention in the management of CVDs even LDL is normal.

2651-POLow Calorie Sweetener Consumption Patterns among U.S. Children and AdultsALLISON C. SYLVETSKY, JEAN A. WELSH, REBECCA J. BROWN, MIRIAM B. VOS, Bethesda, MD, Atlanta, GA

Consumption of added sugars has increased in parallel with obesity and diabetes rates. Low-calorie sweeteners (LCS), which provide sweet taste with negligible or no contribution to total energy intake, have emerged as an alternative. Our study aimed to assess current LCS consumption by de-mographic subgroups. We used National Health and Nutrition Examination Survey (NHANES) demographic and 24-hour dietary recall data collected in 2007-08 from 8,529 individuals >=2 y of age. NHANES food descriptions were used to determine LCS content in foods or beverages that participants reported consuming. Variances were adjusted to account for the complex sampling methods and results were weighted to be nationally representa-tive. Differences between groups were tested using ANOVA and Wald’s chi-squared test. We determined that 20% of U.S. children (2-17 y) and 32% of adults (>18 y) reported consuming at least 1 food or beverage containing a LCS during the previous day. Prevalence of LCS consumption among individu-als with diabetes was > 61%. LCS consumption was not correlated with daily caloric intake in children or in adults. Among the 21.5% of individuals who reported consuming LCS containing beverages, mean intake was 16.6 oz. among children and 28.0 oz. in adults. Children were more likely to consume calorie-containing beverages with LCS, such as light fruit juices and sports drinks, compared to non-caloric LCS containing beverages, such as diet so-das, while the opposite was true among adults. Consumption of condiments (i.e. jams, dessert toppings, syrups) containing LCS was reported in 10% of the total population. We conclude that LCS consumption is common in the U.S. Further research is needed to understand the diet and health implica-tions of LCS consumption and to develop guidelines regarding LCS use.

2652-PONeck Circumference Positively Related With Metabolic Syndrome by Different Defi nitions in Rural Chinese Subjects: A Community Based StudyLI HU, SHUO LIN, LONGYI ZENG, Guangzhou, China

Recently,neck circumference (NC) has been associated with hyperlipi-demia, impaired glucose homeostasis, and hypertension. Few reports fo-cus on the relationship between NC and metabolic syndrome (MS). To in-vestigate the relationship between NC and MS with different defi nitions in a rural Chinese population in south China, a cross sectional survey was conducted during Oct 2010 to Jan 2011 in Shipai community of Guangzhou city, Guangdong province, South China. A total of 1473 subjects aged over 50 years were investigated. Height, weight, neck circumference (NC), waist circumference (WC) and blood pressure were measured by using standard procedures. Fasting blood glucose and serum lipids levels were measured. MS was identifi ed by criteria of the Blood Cholesterol in Adults (Adult Treat-ment Panel III, or ATP-III), Chinese Diabetes Society(CDS) and International Diabetes Federation(IDF).The mean NC value was 35.6±3.2 cm in the total sample. It was signifi cantly correlated with numerous risk factors, includ-ing WC, body mass index (BMI), homeostatic model-assessed insulin re-sistance, blood pressure, fasting triglyceride, HDL-cholesterol and fasting blood glucose. After adjustment for all MS components, NC was associated signifi cantly with MS. In Receiver operating characteristics (ROC) analysis between NC and MS, the area under curve(AUC) was 0.823 in men and 0.777 in women according to IDF defi nition whereas that with CDS was 0.773 and 0.771 in men and women, respectively. Using the ATP-III defi nition the AUC was 0.762 in men and 0.763 in women (P<0.01). The optimal cut-points of NC for MS were 34.15cm, 34.25cm and 33.45cm in women by three defi nitions respectively, and was 38.45cm in men by all three defi nitions.These data show that NC is positively related with MS by using different defi nitions in rural subjects. It may be a useful screening tool to identify adults with metabolic syndrome.

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2653-POGLP-1 as an Insulinotropics and Its Association With Clinical Pa-rameters in Type 2 Diabetes PatientsSANG AH LEE, SUK JU CHO, DAE HO LEE, GWAN-PYO KOH, Jeju, Republic of Korea

Glucagon-like peptide 1 (GLP1) was identifi ed as an incretin hormone and function of GLP1 was known to be glucagonostatic, insulinotropic, and pro-liferative effects on pancreas and protecting effects on cardiovascular and neurologic systems. Many papers showed the physiology of GLP1 in human was published but the relevance of clinical manifestation with GLP1 was obscure in type 2 diabetes mellitus (T2DM). The aim of the study was to in-vestigate the relationship of plasma GLP1 levels with clinical and laboratory parameters in T2DM. The study population (n=64) was selected from pa-tients with T2DM who visited clinic of the Jeju National University Hospital between September 2010 and December 2011. All patients were diagnosed T2DM with C-peptide and clinical manifestation from 20 to 70 years without treatment of DPP4 inhibitors. Anthropometric parameters, biochemical pa-rameters, and active plasma GLP1 were measured after fasting for 12 hours. In addition to, C-peptide, insulin, and GLP1 was repeatedly measured at 30 minutes after diet. Fasting GLP1 levels were distributed within range 4.1-14.9 pmol/L. Fasting GLP1 level was signifi cantly correlated with DM duration ( =-0.398, P value 0.009), but not correlated with other clinical manifesta-tion including obesity, blood glucose control states, infl ammation, and lipid. Interestingly, however, fasting GLP1 level was strongly signifi cantly corre-lated with malondialdehyde levels as an oxidative stress marker ( =0.311, P value < 0.008) and showed correlation with medication including sulfonylu-rea, insulin, and -glucosidase inhibitors ( =0.350, 0.782, and 0.280, P value 0.007, <0.001, and 0.024). In addition to, delta GLP1 was signifi cantly related with delta insulin ( = 0.381, P value 0.003). Therefore, we concluded that basal GLP1 correlated disease duration, kinds of oral hypoglycemic agent, and oxidative stress states and delta GLP1 was correlated with secreting insulin states.

2654-PO

WITHDRAWN

2655-POThe Effects of Exercise Prescription in Prediabetic PatientsMI YOUNG LEE, GUN WOO KIM, YEON SIK CHOI, EUN SOO LEE, EUN JU CHO, EUN HEE KIM, EUN YOUNG SHIM, GEONG HEA KIM, JANG YEL SHIN, YOUNG GOO SHIN, CHOON HEE CHUNG, Wonju, Republic of Korea

Prediabetes, the term of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), could progress to type 2 diabetes in 30~40 % within 4~5 years. Moreover, cardiovascular and cerebrovascular events are in-creased in prediabetic patients like as type 2 diabetic patients. It is reported that regular physical training could prevent the progression of diabetes from prediabetes. In this study, we evaluated the effects of exercise prescrip-tion on insulin resistance and compared the effects of exercise between the subjects with actively followed exercise counseling and non- respond-ing subjects. Subjects diagnosed as IFG and IGT on the basis of a 75g oral glucose tolerance test (OGTT) according to American Diabetes Association criteria were enrolled. We measured anthropometric data, adipokines, and various biochemical markers and performed the insulin tolerance test, body fat, and abdominal fat computed tomography (CT) before and 3 months after exercise counseling. The amount of exercise was calculated by International physical activity Questionnaire (IPAQ) and the subjects showing increased IPAQ value more than 1000 METS were assigned to the actively responding group. In actively responding group, body weights, body mass index, visceral fat and subcutaneous fat amount confi rmed by body fat analyzer were sig-nifi cantly decreased and the Kitt value and adiponectin levels were signifi -cantly increased after exercise counseling. Also, the subcutaneous fat area measured by abdominal CT was signifi cantly decreased in actively respond-ing group. However, non-responding subjects did not show any signifi cant changes of the insulin sensitivity markers after the exercise counseling.We suggest that the efforts of improving the compliance are needed in order to ameliorate insulin resistance through the active exercise counseling in prediabetic patients.

2656-POHigh Prevalence of Early Cystic Fibrosis Related Diabetes in an University Hospital in São Paulo, Diagnosed by Routinely Screening With Oral Glucose Tolerance TestLUIS EDUARDO P. CALLIARI, RENATA M. DE NORONHA, NEIVA DAMACENO, LU-CIA H. MURAMATU, OSMAR MONTE, São Paulo, Brazil

Cystic Fibrosis Related Diabetes (CFRD) is the major co-morbidity that af-fects patients with Cystic Fibrosis (CF). The presence of CFRD reduces sur-vival in these patients and recent studies show an improvement in prognosis when the diagnosis is made earlier. The present recommendation is screen-ing with an oral Glucose Tolerance Test (oGTT) after 10 years of age, but there are authors who suggest that this should be done even below this age. Our objective was to assess the prevalence of CFRD in patients with Cystic Fibrosis (CF) followed in an University Hospital in São Paulo, Brazil. Also we wanted to determine whether screening is effective in diagnosing CFRD ear-lier than by simptoms, and if there is any advantage in reducing the age of oGTT for patients younger than 10 years (8-10 years). We analyzed patients treated as outpatients with CF (n = 63) regarding age, weight, height and BMI. In patients with no previous diagnosis of Diabetes Mellitus (DM) oGTT was performed from 8 years old on. \In patients 10 years (n = 47),we had 6 CFRD, 7 glucose intolerant and 34 with normal oGTT. 5 patients were previ-ously diagnosed as CFRD, and didn´t need the oGTT screening. Chronological age of patients with CFRD: Screening group = 13.0 (+ 2.2) vs. diagnosed by symptoms CA = 21.6 y (+ 5.4) (p = 0.011). In patients with CF above 10 years, we found 26.7% of DM or impaired glucose tolerance, and this diagnosis preceded the onset of symptoms in approximately 8 years. oGTT in patients aged 8 to 10 years diagnosed DM or IGT in 18.2%. We concluded that screen-ing with oGTT is crucial to early detection of CFRD and we suggest that initial screening age should be diminished to 8 years.

2657-POLong-Term Survival (Over 40 Years Duration) of Asian Indian Type 2 Diabetic PatientsSRAVAN DHULIPALA, RANJIT UNNIKRISHNAN, COIMBATORE S. SHANTHI RANI, RANJIT M. ANJANA, BALASUBRAMANIAM PARTHASARATHY, ANAN-DAKUMAR AMUTHA, VISWANATHAN MOHAN, Chennai, India

While there have been some studies assessing the long-term survival of patients with type 1 diabetes, similar studies of type 2 patients are lacking. Here we describe the clinical profi le of Asian Indian patients with type 2 diabetes of at least 40 years duration. After reviewing the medical records of patients at Dr. Mohan’s Diabetes Specialties Center, we identifi ed 238 pa-tients who had survived with type 2 diabetes for at least 40 years. Using the data from their most recent visit to our center, we compiled the biochemical and clinical profi le of these patients and the prevalence of complications. Macroalbuminuria was diagnosed if excretion of albumin in the urine was > 300 ug/mg of creatinine, and microalbuminuria if between 30-299 ug/mg. Peripheral vascular disease (PVD) was diagnosed in patients with an ankle:brachial (AB) index < 0.9. Neuropathy was diagnosed with a vibration perception threshold (VPT) > 20 in the great toes, and retinopathy was diag-nosed by retinal exam and fundus photography. Of the 238 type 2 diabetic patients (196 male and 42 female) with duration over 40 years, 218 were alive with a mean age of 76.7 + 6.9 years. Mean age at onset was 33.5 + 6.7 years with an average duration of 43.7 + 3.9 years. Twenty-one patients had survived for at least 50 years duration. Mean BMI and HbA1c were 23.6 + 4.1 kg/m2 and 8.4 + 1.6%, respectively. The mean serum cholesterol was 157.5 + 42.9 mg/dl, LDL was 87.2 + 35.1 mg/dl, and HDL was 45.1 + 13.1 mg/dl. Neuropathy and retinopathy occurred in 94.5% and 65.7% of patients, re-spectively, while PVD was found in 25.3% of patients. Long-term survival (> 40 years) is possible in those with of type 2 diabetes, many of whom remain free from micro- and macrovascular complications.

2658-PODigital Data Collection for Tackling Diabetes in the 21st CenturyERIKA M. CERRI, ALI R. FISHER, SHAHRAD TAHERI, Birmingham, United Kingdom

The Internet provides the opportunity to collect digital data from a mul-titude of sources and platforms including digital newspapers, dedicated healthcare websites, social media sites, public domain discussion boards and search engines. This digital data lends itself well to unobtrusive data collection methods, used for decades in social sciences. Research using unobtrusive methods is already being conducted with data captured from single platforms for single conditions and there is enormous potential in accelerating our understanding of diabetes by tapping into the multitude of different digital data pools available through the Internet. We assessed the breadth of information, which could be collected through unobtrusive

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methods in two distinct platforms: a digital newspaper and online message boards. The New York Times (NYT) API was used to identify the number of articles per year, which contained the terms “diabetes” in the last 25 years. Boardreader was used to identify the message boards with discussions of “diabetes” over the last year. Qualitative analysis was conducted on both data sets to determine the type of information available. The NYT printed 7880 articles containing “diabetes” in the last 25 years. Qualitative analysis of articles (n=87) of a peak month in a peak year (Jan 2006) showed 100% of articles written by journalists (n=20) focused on diabetes at a population level. Boardreader identifi ed 281 individual message boards with discus-sions containing “diabetes” in the last year. Qualitative analysis of English language and accessible boards (n=98) showed 74% related to diabetes at an individual level. Both sources of digital data collected unobtrusively provided distinctly different data, which can augment the understanding of diabetes and contribute to the development of strategies for tackling diabe-tes. While digital research on a single condition through a single platform is being conducted, accessing multiple platforms to provide a broader under-standing of the disease is warranted.

2659-PODiabetes Mellitus as Public Health Priority in Zagreb, Croatia (2001–2009)MARINA POLIc-VIŽINTIN, DANIJELA ŠTIMAC, ANICA BADANJAK, LEA SMIRcIcDUVNJAK, INGRID TRIPKOVIc, Zagreb, Croatia, Split, Croatia

To assess the public health signifi cance of diabetes mellitus (DM). Data were obtained from the hospitalized patient database containing data on all individuals treated as inpatients at Zagreb hospitals. Mortality data were obtained from the National Bureau of Statistics. Expressed as general, spe-cifi c and standardized rates and potential years of life lost (PYLL). Anatomi-cal therapeutic chemical/defi ned daily dose (ATC/DDD) methodology was used to assess the utilization of antidiabetics. Variation in the mortality rate during a period1971-2008 was analyzed and endocrine diseases showed a constant and signifi cant rise (138%). Age-standardized mortality rate diabe-tes (SDR/100000) for all ages in 2009 was 19.2, above the EU average (12.5) and Hungary (17.9), but lower than Austria (23.5). SDR for ages 0-64 was 2.9, lower than Austria (3.9) and Hungary (5.7), but higher than the EU average (2.7). The analysis of trends from 2004 to 2009 registers an increase in SDR for all ages (16.0 in 2004), but for ages 0-64 is in decrease (3.4 in 2004). The premature death due to DM (up to 75) accounted 567.5 potential years of life lost (PYLL). In 2009, the rate of hospitalizations for DM was 34.2/10000 with the mean length of hospitalization 7.9 days. The rate of hospitalizations for insulin-independent DM is in increase (6.7 in 2001 to 19.5 in 2009), as the mean length of hospitalization (5.5 days in 2001 to 7.5 in 2009). In the same time, outpatient utilization of antidiabetics increases for 20%. The most pre-scribed antidiabetic in Zagreb is glimepirid which utilization increases from 1.35 (2001) to 10.85 DDD/TID. Diabetes morbidity and mortality have been on an increase, as well as trend of the utilization of antidiabetics. The high-est priority is now related to coping with unhealthy behavior of the popula-tion such as physical inactivity, and dietary issues that should be modifi ed and controlled through implementation of health promotion and preventive programs.

2660-POA Retrospective Analysis on the Occurrence of Malignant Tumors of Hospitalized Type 2 Diabetic PatientsYANG GUOQING, DOU JINGTAO, CHEN PING, MU YIMING, LU JUMING, PAN CHANGYU, Beijing, China

Background: Diabetes and malignant tumors are the most common dis-eases that threaten human health and lead to death. Many studies have been reported the relationship between type 2 diabetes and a variety of malignant tumors, but there are still inconclusive. Methods:Search for the information of patients diagnosed as T2DM from September 2005 to No-vember 2011, and generates the database for statistical analysis. Results: During the study period, 3,756 patients (mean age 55.4±14.1years) were hospitalized for type 2 diabetes mellitus (WHO 1999); 39.69% of them were female (1,496/3,756). A total of 193(5.12%) were diagnosed with cancer be-fore or during the stay in hospital, whose mean age was higher than those without cancer (63.8±12.4 vs 54.9±14.0, p<0.01). Of those, 99 were male and 94 were female. There were gender differences in corresponding incidence rates (4.355% vs 6.28%, p=0.0086). Among those patients, breast cancer (24 cases, male/female=0/24), lung cancer (22 cases, male/female=17:5), thyroid cancer (21 cases, male/female=5:16), colorectal cancer (20 cases, male/female=10:10), primary hepatocellular carcinoma (16 cases, male/female=13:3) are found to be the fi rst fi ve cancers. Others include kidney

cancer (14 cases, male/female=10:4), pancreatic cancer (9 cases, male/fe-male=5:4), maxillofacial cancer (9 cases, male/female=?), bladder cancer (8 cases, male/female=6:2), esophageal carcinoma (5 cases, male/female=3:2), gallbladder cancer or cholangiocarcinoma (4 cases, male/female=3:1) and not-classifi ed (31 cases). Logistic regression analysis showed that sex (r=2.082,p<0.01) and age (r=1.063,p<0.01) were two independent risk factors associated with cancer incidence in patients with type 2 diabetes mellitus.Conclusions: The prevalence rate of cancer in patients with type 2 diabetes mellitus was 5.12%. Sex and age were independent risk factors associated with cancer incidence.

2661-POHigh Prevalence of Metabolic Syndrome in Ternate City—A Small Remote Island in the Eastern Part of IndonesiaINDAH S. WIDYAHENING, SIDARTAWAN SOEGONDO, EM YUNIR, Jakarta, Indo-nesia

Ternate Island, the legendary “Spice Island” in the pre-colonial era, is part of North Moluccas Province, Eastern Indonesia. Many believe that the eastern part of Indonesia is not as much developed as the western part of Indonesia (mainly Java, Bali and Sumatra islands). Furthermore, people are still living their traditional ways despite lifestyle changes due to urban-ization. Traditional marriages between close relatives are still commonly practiced today. This study was aimed to know the prevalence of metabolic syndrome (MetS) in Ternate City and its associated risk factors. A survey was conducted in 2008 in adult population of Ternate City aged 20 years or more. Subjects who randomly selected from population database were interviewed regarding metabolic risk factors by a standard questionnaire. Anthropometric (height, weight, waist and hip circumference) and blood pressure measurements were also taken. Blood samples were also col-lected for measurement of total cholesterol, LDL cholesterol, HDL choles-terol and triglyceride level. The ATP III modifi ed for Asian criteria was used for diagnosis of MetS. 495 subjects consisted of 187 (37.8%) men and 308 (62.2%) women aged 20 to 84 years (mean age 47.30+12.78) were enrolled. Prevalence of MetS is 38.7%. This prevalence is higher than Jakarta (28.4%), the capital city of Indonesia and Bali (18.2%), the tourism capital of Indone-sia. Additionally, 53.6% were obese, 18.4% had elevated triglycerides level, 57.5% had low HDL level, 41.1% had elevated blood pressure and 26.2% had high fasting plasma glucose concentration. Factors associated with the increase risk of MetS are being woman (OR=2.5, 95% CI=1.6-3.9) and age 45 or higher (OR=2.7, 95%CI=1.8-4.1).The high prevalence of metabolic syndrome in Ternate City which was also considered a less-developed area should raise awareness about the emergence of a potentially public health problem in suburban population in Indonesia.

2662-POEarthquake Stress Impact on Pancreatic Alpha-Cell and Beta-Cell FunctionYANG MING, CHEN SHU, ZHANG MIN, LONG JIANZHU, REN MIN, WANG JUNK-ANG, Chengdu, China

People suffered earthquake were depression, anxiety and stress, which Leaded to Negative infl uence to -cell function , but to -cell function was uncertain. We evaluated 3230 participants in Wenchuan county of China which suffered earthquake on may 12,2008. and 2062 participants in Chengdu without earthquake-attacked in the same time. Surveyed the sex, age, height, weight, blood pressure, Tested fasting glucose and insulin, triglyceride (TG), Total Cholesterol (TC), Glucagon, glucocorticoid, C-peptide, postprandial plasma glucose, serum insulin and C-peptide level. Logistic regression was used to derive odds ratio of -cell and -cell function, To

-cell function, it indicated that older age (or=1.77, 95% CI:1.28, 2.46), higher body mass index (BMI) (or=1.38, 95% CI: 1.14, 1.67), high blood pressure (HBP) (or=1.51, 95% CI:1.16, 1.93) were the factors independently associated with -cell function (P<0.001); older age (or=1.77, 95% CI:1.28, 2.46), higher BMI (or=1.62, 95% CI:1.06, 2.51), HBP (or=1.34, 95% CI:1.11, 1.62), higher TC (or=0.56, 95% CI:0.36, 0.94), (Earthquake stress) ES (or=1.27, 95% CI:1.03, 1.52) remained as the factors independently effected the -cell function (P<0.001); Earthquake stress did not signifi cantly effect -cell function with-in a short term (six months), but strongly effect the -cell function, which Secreted excessively on performance. Pancreatic -cell dysfunction may be the early representation of diabetes mellitus.

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GENETICS—TYPE 1 DIABETES

GENETICS—TYPE 1 DIABETES

2663-POThe rs763361 Variant of CD226 Gene Increases Susceptibility to Type 1 Diabetes in a Population of São Paulo-BrazilTERESA C. MATTANA, ARITANIA S. SANTOS, SERGIO R. MATIOLI, DÉBORA T. MAINARDI, VINÍCIUS S. COSTA, ROSA T. FUKUI, MARIA ELIZABETH R. SILVA, São Paulo, Brazil

Recently genome-wide association studies provided statistical support for a new locus in CD226 gene (rs763361) as a candidate for type 1 diabetes (T1D) susceptibility. CD226 is implicated in coestimulation and activation of the immune cells, and intracellular signals transduction. In order to as-sess the association of CD226 gene and T1D in patients of the city of São Paulo-Brazil, 491 T1D patients (mean age 23.2±12.8 years, 60.5% female, and 80.5% of European ancestry) diagnosed according to the ADA criteria, and 513 controls (mean age 28.9±12.1 years, 39.8% female, and 63.8% of European ancestry) were enrolled. CD226 gene coding regions and boundar-ies were amplifi ed by polymerase chain reactions and submitted to direct sequencing analyses in 106 T1D and 102 controls. Twelve variants already described in data base were identifi ed. No new variants were found. The analysis of estimated haplotypes, including those 8 variants with frequency above 5% (rs75418532A/G, rs1788101A/C, rs62090790C/T, rs72481820G/A, rs72481819G/A, rs763362T/C,rs763361A/G, and rs727088A/G) identifi ed 3 haplotypes (AACAGTAG, ACCGGCAG and AACGGTAG) and also a group of rare haplotypes, associated with susceptibility to T1D (P<0.0001) only in whites. Two variants (rs727088 at the 3’ UTR region, involved with CD226regulation, and rs763361) were genotyped in 480 T1D and in 480 controls. The GG genotype (P=0.0416, OR=1.357) of rs727088 and the AA genotype of rs763361 (P=0.0054, OR=1.503) variants were associated with T1D risk, but only the last one persisted signifi cant after correction of Bonferroni. Further-more, recent T1D patients (disease duration 2 years) with the AA genotype of the rs763361 variant had lower C-peptide levels when compared to those with the AG+GG genotypes (0.41±0.30 vs 0.70±0.53ng/dL P=0.0218). The current study suggests that the rs763361 variant of CD226 gene is associ-ated with susceptibility to T1D and a greater aggressiveness of the disease in a Brazilian cohort.

Supported by: FAPESP

2664-POExpressional Regulation of Type 1 Diabetes Susceptibility Genes by TGF-beta in CD4+ T lymphocytesYUKO HISANAGA-OISHI, HIRONORI UEDA, Osaka, Japan

Type 1 diabetes (T1D) is characterized by autoimmune destruction of insulin-producing pancreatic beta cells. A T-cell regulatory gene / cytotoxic T lymphocyte antigen 4 gene (CTLA4) has been shown to be associated with T1D susceptibility (Ueda H et al Nature 2003). Now approximately 50 genes or gene regions have been identifi ed. However, the functional relationships of these genes are elusive. Thus, to identity functional relationships among T1D susceptibility genes, expressional regulation of T1D susceptibility genes were studied in EL4 T cell lines, which maintains many T-cell properties, and primary CD4+ T lymphocytes from NOD, an animal model of T1D and con-trol C57BL/6 mice. Twenty very best functional/positional candidates T1D susceptibility genes of man and animal models were chosen as Ubash3a, Ctla4, Ptpn22, Ptpn2, Il2, Lnk (Sh2b3), Cblb, Ikzf1, Vav3, Erbb3, Prkcq, Rnls (C10orf59), Clec16A (Kiaa0350), Il2ra (CD25), Bach2, Dlk1, Pparg, CD101, Zac1 and Glis3. Transforming growth factor- (TGF- ) is a regulatory cytokine with pleiotropic functions in control of T cell responses. TGF- 1-defi cient mice or mice with T cell-specifi c deletion of TGF- receptors develop early fatal multifocal infl ammatory diseases, highlighting a pivotal role for TGF- in T cell tolerance, similarly as CTLA4-defi cient mice. In this study, EL4 cells and primary CD4+ T lymphocytes were stimulated with anti-CD3/CD28 beads in the presence of or in the absence of TGF- , and expressions of twenty were analyzed by Taqman real-time-PCR. The expressions of the genes were analyzed at different time points (3days, 5days and 7days). This study leads us to identify “putative TGF- regulated T1D susceptibility genes” in CD4+ T lymphocytes, and our study might contribute to fi ll in the missing link be-tween T1D susceptibility genes and functional immunology in CD4+ T cell signaling in both human and animal models of T1D.

Supported by: Promoting Science and Technology of the Ministry of Education, Japan

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2666-POType 1 Diabetes Protective HLA DRB1 Alleles in RomaniaCRISTIAN GUJA, VASILICA CRISTESCU, IULIANA CEAUSU, CONSTANTIN IONES-CU-TIRGOVISTE, Bucharest, Romania

Type 1 diabetes (T1DM) is an autoimmune disease conditioned by genetic and environmental factors. The main susceptibility genes reported belong to the HLA class II region, DQB1 and DRB1 loci. For these, both diabetogenic and protective alleles were described. The aim of our study was to assess the diabetes protective effect of some HLA-DRB1 alleles in the Romanian population. The study group comprised 1,515 individuals with 439 T1D pa-tients (206 male/224 female) and 1,076 unaffected fi rst degree relatives. mOn this study group, an comprehensive typing of HLA/DRB1 alleles was performed. Genotyping was done by PCR-SSOP. Data were analysed using the Transmission Disequilibrium Test (TDT) using Stata® 8.1 (http://www.stata.com). We found a signifi cant decreased transmission to diabetics of HLA DRB1*07 (25.3% transmission, pTDT = 6.5x10-7), DRB1*10 (20% trans-mission, pTDT = 0.003), DRB1*11 (20.15% transmission, pTDT = 4.81 x 10-12), DRB1*12 (5.56% transmission, pTDT = 0.0002), DRB1*13 (25.29% transmis-sion, pTDT = 4.03 x 10-6), DRB1*14 (10.26% transmission, pTDT = 6.91% x 10-7)and DRB1*15 (10.81% transmission, pTDT = 1.56% x 10-11). The transmission of the same alleles to unaffected siblings was not signifi cantly different from 50%. Our results indicate a possible protective effect of HLA-DRB1*07, HLA-DRB1*10, HLA-DRB1*11, HLA-DRB1*12, HLA-DRB1*13, HLA-DRB1*14 and HLA-DRB1*15 alleles for T1DM appearance in the Romanian population. This is in accordance with the known protective effect of the HLA-DR antigens encoded by these DRB1 alleles: HLA-DR2, HLA-DR5, HLA-DR6 and HLA-DR7, an effect already reported in other Caucasian populations. However, this effect is likely to be secondary to the strong linkage disequilibrium with the protective alleles from the HLA-DQB1 locus (DQB1*06, DQB1*0301 and DQB1*0303) already proven for the Romanian population. For the elucidation of this issue, the analysis of a much larger study group of families (ascer-tained using the same protocol) from the Romanian population is required.

2667-POAssociation of SLC30A8 rs13266634 C/T Polymorphism With Type 1 Diabetes: Case-Control Study and Meta-AnalysisLI QIAN, KUANFEN XU, ZILIN SUN, TAO YANG, Nanjing, China

To evaluate the relationship between SLC30A8 rs13266634 C/T polymor-phism and T1DM.A case-control study with 351 T1DM and 429nondiabetic subjects was performed. All participants underwent genotyping of the SLC30A8 rs13266634 polymorphism. Additionally, systematic review and meta-analysis of the literature for genetic association studies of SLC30A8 rs13266634 polymorphism and T1DM were performed in Pubmed and CNKI. In the case-control study, the results showed that rs13266634 C/T polymor-phism was not associated with T1DM: OR=0.96, 95% confi dence interval (CI)=0.79-1.18, P =0.71,. The literature search identifi ed four studies that ana-lyzed the association of theSLC30A8 rs13266634 polymorphism with T1DM, our meta-analysis included 5 studies (10646 cases and 10207 controls), as I2 =0% and Pheterogeneity=0.595, all the studies were combined with fi xed ef-fects model, we found that odds ratios of C allele to T allele was 1.02 (95% CI: 0.98~1.06, P=0.38), Begg’s test revealed no signifi cant publication bias.Our results indicated that SLC30A8 rs13266634 polymorphism was not as-sociated with increased risk for T1DM.

2668-POHLA Class II and IGF-1, TGF-B1, LRP5 Polymorphisms and Their Role in Susceptibility to Type 1 DiabetesHEGLAYNE P. SILVA, KARLA S. SOUZA, MARCELA A. URURAHY, YONARA M. OLIVEIRA, MELINA B. LOUREIRO, JOÃO F. BEZERRA, GUSTAVO H. OLIVEIRA, FAB-RÍCIO M. SANTOS, RICARDO F. ARRAIS, ROSARIO D. HIRATA, MARIO H. HIRATA, EDUARDO A. DONADI, MARIA G. ALMEIDA, ADRIANA A. REZENDE, Natal, Brazil, São Paulo, Brazil, Ribeirao Preto, Brazil

Type 1 diabetes (T1DM) is a heterogeneous polygenic disorder, with about 20 of loci contributing to the susceptibility to disease. HLA class II DRB1 and DQB1 represent the major T1DM genetic susceptibility loci, however, poten-tial candidates genes as IGF-1, TGF- 1 and LRP5 genes are also involved in

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T1DM risk. The aim of our study was to investigate the distribution of HLA DRB1, DQB1, DQA1 and IGF-1 (-1245G>A), TGF- 1 (-509C>T) and LRP5 (126188 C>T) polymorphisms in type 1 diabetic children and adolescents assisted at a pediatric hospital (HOSPED/UFRN) in Natal-RN/Brazil in order to understand their role in susceptibility to the disease. This study included 101 type 1 diabetic patients (T1DM group) and 106 normoglycemic subjects (NG group) aged between 6 and 20 years. Metabolic control was evaluated by glucose and glycated hemoglobin. HLA class II DRB1 and DQB1 were genotyped using PCR SSO (reverse) method. Polymorphism of IGF-1, TGF- 1 and LRP5 was de-termined by allelic discrimination technique in real-time PCR using TaqMan®

pre-designed SNP assays from Applied Biosystems. The most signifi cant HLA alleles associated with T1DM were DRB1*03:01 (p>0001; OR=11,79), DQA1*05:01 (p>0001; OR=9,03) and DQB1*02:01 (p>0001; OR=4,81. The haplotypes DRB1*03:01-DQA1*05:01-DQB1*02:01 (p<0,0001; OR=11,79) and DRB1*04:05-DQA1*03:02-DQB1*03:02 (p=0,0084; OR=13,30) had a stronger association with susceptibility to T1DM. LRP5 polymorphism was associ-ated to T1DM (NG: CC-834%, CT-16% and TT-06%; T1DM: CC-707%, CT-271% and TT-22% - p=0020). No association was found between IGF-1 (NG: GG-4552%, GA-4759% and AA-6,90%; T1DM:GG-5366%; GA-3902% and AA-732% - p=0626) and TGF- 1 (NG: GG-4690%, GA-40% and AA-1310%; T1DM:GG-4146%; GA-4512% and AA-1341% - p=0998) polymorphisms and T1DM. These results strengthen the effect of HLA-Class II and revealed an association between LRP5 (126188 C>T) polymorphism on susceptibility to T1DM in children and adolescents of Natal-RN/Brazil.

Supported by: CNPq/Brazil

2669-POAnalyses of Clinical and Genetic Backgrounds of Patients With Type 1 Diabetes Associated With Systemic Autoimmune DiseasesKANAKO SHIMURA, JUNNOSUKE MIURA, YASUSHI KAWAGUCHI, MANABU KAWAMOTO, SARI HOSHINA, HIROSHI SAKURA, YASUKO UCHIGATA, Tokyo, Japan

It is very rare that patients with type 1 diabetes mellitus (T1D) are as-sociated with systemic autoimmune diseases (SAD). Recently, several can-didate genes related with susceptibility to autoimmune disease (AD) have been reported. However the clinical and genetic backgrounds of patients with both T1D and SAD have not been clarifi ed as yet. In the present study, we analyzed those backgrounds of patients with T1D associated with SAD. Subjects were 6 patients with T1D associated with SAD; 3 with systemic scleroderma, 2 with systemic lupus erythematosus, 1 with Adult Onset Still’s Disease. Single nucleotide polymorphisms (SNPs) of genes related to AD were investigated. The subjects were all women and the average age was 50.2 years old (from 28 to 71). The onset age of T1D were less than 13 years old in 4 cases and more than 58 years in 2 cases. SAD developed after T1D in 4 younger onset cases and before in 2 middle-aged onset cases. Five cases had single or multiple organ-specifi c ADs except T1D. All cases had HLA-DRB1*0405 or DRB1*0901 associated with Japanese T1D. Five cases had A24 and 4 had B54 as the class I allele. The cytotoxic-T-lymphocyte-associated protein4 gene (CTLA4) 49G and 6230G allele and small ubiquitin-like modifi er 4 gene (SUMO4) 163G allele associated with both T1D and SAD, were existed in all and 3 cases, respectively. All cases didn’t have +1858C>T SNP in a lymphoid tyrosine phosphatase gene (PTPN22) which was reported to be associated with multiple AD in Caucasian, but -1123G>C SNP in the promoter region was in 5 cases. SAD-risk alleles which were reported of Interferon regulatory factor 5 (IRF5), B lymphoid tyrosine kinase (BLK) and signal transducer and activator of transcription 4 (STAT4) were in all, 5, and 4, respectively. It was suggested that the subjects with T1D and SAD had a cluster of genetic risk alleles related to immune system, and additional some triggers might be necessary for the onset of SAD.

2670-POAn Unusual Diabetes Variant: Beyond Type 1 DiabetesGABRIEL UWAIFO, New Orleans, LA

Diabetes Mellitus (DM) is a clinical syndrome with multiple etiologies which inform the current classifi cation system. While type1, type 2, sec-ondary and gestational DM are most commonly recognized, recent clinical observations are expanding the profi le of secondary DM. Monogenic vari-ants of DM (MODYs) have a prevalence of ~3-5% among type 2 DM cohorts. Recent reports suggest that the boundaries between DM types are largely artifi cial with the possibility of individual patients and/or cohorts having multiple underlying coexisting causes. We present the unusual case of a 39 yr old lady with features of both Monogenic (? MODY5) and type 1 autoim-mune DM. The patient is 39 yr old African American lady referred for DM care. She had a history of DM presumably type 1 fi rst detected at 6yrs in the

setting of DKA. She had been insulin dependent (now Glargine+Lispro) since then and has complications including proliferative retinopathy, nephropa-thy requiring kidney transplantation 12 yrs ago and peripheral paraesthe-siae suggestive of sensory neuropathy. She has an extensive family history of DM spanning three generations most presumed to be “type 1” as they were mostly thin and insulin dependent with early age of onset. Several affected relatives developed major renal disease requiring dialysis. Major examination fi ndings included a BMI of 25.5, hypertension and no acanthosis nigricans. Lab evaluation showed a HBA1c of 8.5, undetectable random C -peptide and elevated GAD65 antibodies (0.06nmol/l). Genetic testing for MODY showed a mis-sense mutation of the HNF -1 beta gene consistent with MODY5 but also heterozygous sequence variants on the IPF 1 gene (associated with MODY4), the HNF -4 alpha gene (associated with MODY1) and the TCF-1 gene (associated with MODY3). The possibility of multiple etiologies in the cause and type of DM should be considered in subjects with unusual history and/or clinical course. MODYs should be included in this differential diagnosis to enable genetic counseling and appropriate DM prognostication and classifi cation.

GENETICS—TYPE 2 DIABETES

2671-POIGF Binding Protein Genes Impact Longitudinal Glycaemic Control in Type 2 DiabetesRAM P. NARAYANAN, SIMON G. ANDERSON, ANTHONY PAYTON, BO FU, JOHN P. NEW, ADRIAN H. HEALD, WILLIAM E. OLLIER, JOHN M. GIBSON, Salford, United Kingdom, Manchester, United Kingdom

Associations of genes for IGF binding proteins with longitudinal glycaemic trends have not been studied. This is highly relevant as serum IGF binding protein levels are implicated in the development of diabetes and its many complications. We studied longitudinal trends in HbA1c for 528 Caucasian individuals with type 2 diabetes over an 8 year period. Phenotypic data were derived from linked electronic primary care and hospital records. Genotyping of HapMap selected single nucleotide polymorphisms (SNPs) was performed on Sequenom iPlex and quality assurance using SVS7 (Golden Helix). Mixed effects regression was used to analyse longitudinal trends in Stata 10SE and adjusted genewise for multiple testing. Nine IGFBP1, one IGFBP2, seven IGFBP3, two IGFBP4, four IGFBP5 and one IGFBP6 haplotype tagging SNPs were selected . 11 SNPs were associated with longitudinal trends in HbA1c adjusted for gender, age, diabetes duration and use of metformin, sulpho-nylureas, thiazolidinediones and insulin. Minor alleles of 5 IGFBP1 SNPs were longitudinally associated with HbA1c reduction-rs1065780 ( -0.07 [95% CI -0.11 to -0.02] p=0.001); rs3828998 ( -0.06 [95% CI -0.10 to -0.02] p=0.002); rs3793344 ( -0.07 [95% CI -0.11 to -0.02] p=0.001); rs2854843 (-0.07 [95% CI -0.12 to -0.02] p=0.005); rs10274500 ( -0.08 [95% CI -0.13 to -0.04] p<0.001) and one with worsening of HbA1c -rs1908751 ( 0.06 [95% CI 0.02 to 0.11] p=0.004). The rs1065780 and rs3828998 SNPs were in LD (r2 0.98). Minor alleles of two IGFBP3 SNPs - rs3793345 ( 0.09 [95% CI 0.03 to 0.14] p=0.001) and rs2471551 ( 0.10 [95% CI 0.04 to 0.15] p<0.001) and two IGFBP5 SNPs rs1978346 ( 0.12 [95% CI 0.07 to 0.16] p<0.001) and rs3755137 ( 0.08 [95% CI 0.02 to 0.13] p=0.005) were associated with elevated HbA1c. Both IGFBP3 SNPs were in strong LD (r2 0.98). These novel associations are perhaps the fi rst step towards understanding how the genetic determination of IGF binding proteins that impact IGF bioavailability may infl uence glycae-mic outcomes in type 2 diabetes.

2672-PODiscovering Another Gene Responsible for Wolfram Syndrome by Homozygosity MappingJONATHON WASSON, TONY HINRICHS, BRIAN SUAREZ, M. ALAN PERMUTT, St. Louis, MO

Wolfram syndrome (WS) is a rare autosomal recessive genetic disease characterized by young onset insulin dependent diabetes mellitus, later fol-lowed by optic atrophy, blindness, deafness, and other neurological dysfunc-tions and death from marked neurodegeneration in the 3rd or 4th decade. WS results from a specifi c pathogenic mechanism, endoplasmic reticulum (ER) stress. A number of loss-of function mutations have been described in a causative gene, WFS1, on chromosome 4p16. WFS1 was sequenced in 17 consanguineous Lebanese WS pedigrees revealing only 3 families with mutations. Mitochondrial DNA and WFS2 were also tested and found to be negative. Other groups have reported about 10% of their WS patients do not have mutations in WFS1. To further elucidate this fi nding, we analyzed 4 polymorphic markers around WFS1. This revealed that 3 of the 17 families

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were not linked to WFS1. For affected individuals in these 3 families, a whole genome scan was conducted using Affymetrix SNP v6.0 arrays. After data cleaning 649,345 SNPs were used in the analysis. Analysis parameters with runs of 500 kb with at least 25 SNPs and no more than two heterozygotes were used. Homozygosity Mapper, Genotyping Console, and Gene Distiller softwares were used in the analysis. Preliminary results showed 13 chromo-somal regions with homozygosity in affected individuals representing less than 0.3% of the genome. Candidate genes for sequencing and mutation analysis are being selected from these regions based on the signifi cance of the gene in endoplasmic reticulum stress pathways.

Regions of HomozygosityChr size in

base pairsnumberof genes

Chr size inbase pairs

numberof genes

1 633753 9 10 1357572 242 801004 6 11 533476 43 1115097 19 14 515316 84 658012 1 15 616481 84 673367 5 17 734813 46 555303 1 21 589495 28 517615 3

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2674-POAssessment of New Clinical Search Criteria for HNF1A MODY in Pa-tients With Initial Diagnosis of Type 1 or Type 2 Diabetes MellitusMALGORZATA GRZANKA, MAGDALENA SZOPA, BEATA KIEC-WILK, NATALIA NOWAK, BARTłOMIEJ MATEJKO, MACIEJ T. MALECKI, TOMASZ KLUPA, Krakow, Poland

The most common form of maturity-onset diabetes of the young (MODY) is caused by mutations in the hepatocyte nuclear factor 1A (HNF1A) gene. It has been established that patients with HNF1A MODY are very sensitive to sulphonylureas (SU) and can also discontinue insulin treatment. However, most patients with this monogenic diabetes form are misdiagnosed as hav-ing type 1 (T1DM) or type 2 (T2DM) diabetes mellitus and hence receive non-optimal treatment. The aim of our study was to test new, other than

standard, clinical criteria for selecting patients for HNF1A MODY molecular testing: a) for patients initially diagnosed with T2DM, the selection criteria were as follows - effective SU based oral treatment for more than 15 years and body mass index < 30 kg/m2 ; b) for patients with T1DM clinical diagno-sis - total daily insulin requirement (TDIR) of less than 0.3 IU/Kg at least fi ve years after diabetes diagnosis and basal insulin requirement of less than 20% of TDIR. We analyzed the medical records of 664 diabetic patients, 524 clinically diagnosed as T2DM and 140 classifi ed as T1DM. Based on ex-amined clinical criteria, we selected 14 subjects from patients with a clini-cal diagnosis of T2DM; eventually 11 of them were available for the HNF1A gene sequencing. In one patient from this group, we found a large deletion including nucleotides 1380-1408, which is a causative variant of diabetes in this subject (9% of sequenced cases). Among patients with clinical diagno-sis of T1DM, the previously described diabetes-related mutation in exon 4 (P291fsinsC) was found in one individual (50% of analyzed cases). In conclu-sion, we present new clinical criteria which may be helpful in pre-selecting patients for molecular testing in search for the HNF1A MODY.

Supported by: Jagiellonian University Scientifi c Grant K/ZDS/002310 and CEED3 Consortium

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2676-PODifferential Contribution of Polymorphisms Identifi ed Through Ge-nome-Wide Association Studies to the Risk of Type 2 Diabetes in Lebanese and Tunisian ArabsWASSIM Y. ALMAWI, RITA NEMR, NABIL MTIRAOUI, AKRAM ECHTAY, AMIRA TURKI, TOUHAMI MAHJOUB, Manama, Bahrain, Beirut, Lebanon, Monastir, Tu-nisia

Several type 2 diabetes mellitus (T2DM) susceptibility loci, identifi ed through genome-wide association studies (GWAS), were replicated in Caucasian and non-Caucasian populations. However, their association in Arab populations has not been reported. We investigated the contribu-tion of SNPs in ENNP1 (rs1044498), IGF2BP2 (rs1470579), KCNJ1 (rs5219), MLXIPL (rs7800944), PPAR (rs1801282), SLC30A8 (rs13266634), and TCF7L2 (rs7903146) to the risk of T2DM in Lebanese and Tunisian Arabs. Study sub-jects (case/control) were: Lebanese (751/918), and Tunisians (1470/838). Genotyping was carried out by the allelic discrimination method. In Leba-nese and Tunisians, neither ENNP1 nor MLXIPL were associated with T2DM, while TCF7L2 was signifi cantly associated with increased risk of T2DM in both Lebanese [P <0.001; OR(95% CI), 1.38 (1.20-1.59)] and Tunisians [P <0.001; OR(95% CI), 1.36 (1.18-1.56)]. Differential association of IGF2BP2, KCNJ1, PPAR , and SLC30A8 with T2DM was noted in the two populations. IGF2BP2 [P = 1.3 × 10-5; OR(95% CI), 1.66 (1.42 - 1.94)] and PPAR [P = 0.005; OR(95% CI), 1.41 (1.10 - 1.80)] was associated with T2DM in Lebanese but not Tunisians, while KCNJ1 [P = 8.0 × 10-4; OR(95% CI), 1.27 (1.09 - 1.47)] and SLC30A8 [P = 1.6× 10-5; OR(95% CI), 1.37 (1.15 - 1.62)] showed association with T2DM in Tunisians but Lebanese subjects, after adjustment for gen-der and body mass index. T2DM susceptibility loci SNPs identifi ed through GWAS showed differential association with T2DM in two Arab populations, further confi rming the ethnic contribution of these variants to T2DM sus-ceptibility.

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2678-POTag Single Nucleotide Polymorphism rs3212780 is Signifi cantly As-sociated With Diabetes-Related Metabolic PhenotypesAXEL MUENDLEIN, CHRISTOPH H. SAELY, SIMONE GELLER-RHOMBERG, AN-DREAS LEIHERER, ALEXANDER VONBANK, PHILIPP REIN, HEINZ DREXEL, Feld-kirch, Austria, Triesen, Liechtenstein, Philadelphia, PA

Janus kinase (JAK) 3 is involved in cytokine receptor-mediated intracellu-lar signal transduction. Inhibition of JAK3 protects beta-cells from cytokine toxicity and has been shown to delay the onset of diabetes in the mouse model. The infl uence of JAK3 single nucleotide polymorphisms (SNPs) on diabetes risk or on diabetes-related metabolic traits is unknown. We there-fore investigated the association of JAK3 tagging SNP rs3212780 (C>T) with metabolic phenotypes and type 2 diabetes (T2DM) in a cohort of coronary patients including 1220 non-diabetic subjects and 375 patients with T2DM, totally comprising 1595 individuals. Among non-diabetic subjects SNP rs3212780 was signifi cantly associated with HbA1c (CC: 5.8±0.4, CT: 5.7±0.4, TT: 5.6±0.4%; p=0.001), fasting glucose (CC: 5.4±0.7, CT: 5.3±0.7, TT: 5.5±1.1 mmol/L; p=0.010), and HDL-cholesterol (CC: 55±17, CT: 55±16, TT: 51±16 mg/dL; p=0.009), as well as with total cholesterol (CC: 212±44, CT: 206±46, TT: 196±48 mg/dL; p=0.002) and LDL-cholesterol (CC: 134±37, CT: 131±40, TT: 124±42 mg/dL; p=0.013). In patients with T2DM, the JAK3 variant was signif-icantly associated with fasting glucose (CC: 8.3±2.7, CT: 8.7±2.8, TT: 7.4±1.9 mmol/L; p=0.036). The association between SNP rs3212780 and T2DM did not reach statistical signifi cance (allelic odds ratio=1.18 [0.98-1.40]; p=0.076). We conclude that JAK3 tagging SNP rs3212780 is signifi cantly associated with phenotypes conferring an increased cardiometabolic risk, at least in non-diabetic coronary patients. The association between rs3212780 and the risk of T2DM warrants further investigation.

Supported by: Research Foundation of the Austrian National Bank

2679-POSox4 Modulates Insulin Secretion via Defects in Exocytotic Mecha-nismsDAVID DO, ALISON HOUGH, MICHELLE GOLDSWORTHY, ROGER COX, PATRIK RORSMAN, STEPHAN COLLINS, Oxford, United Kingdom

Mutations in the SOX4 gene has recently been implicated with diabetes and reduced insulin secretion in both an N-ethyl-N-nitrosourea (ENU) mouse model and in human Genome Wide Association Studies. This study aims to elucidate how a SOX4 mutation affects insulin secretion. Insulin release was measured in isolated islets from Sox4 mutant and wild-type mice (WT) by perifusion (1 and 20mM glucose). Granule release mechanisms were ex-amined by intracellular calcium fl uorimetry and standard whole-cell capaci-tance measurements. On-cell capacitance measurements were performed to directly estimate the relative proportions of full membrane fusion events, formation of a stable membrane fusion pore and its diameter. First phase glucose-induced insulin secretion was signifi cantly reduced in the Sox4 mutant compared to WT (n=3; P < 0.05) but the defect was due neither to changes in [Ca2+]i handling nor to problems lying at the level of exocytosis as such. However, on-cell capacitance measurements showed that ~50% of the release events were of the “kiss-and-run” type (incomplete granule release) in mutant beta-cells. Sox4 mutation in mice is associated with a re-duced and dysregulated glucose-stimulated insulin secretion which could be mediated via defective granule emptying mechanisms. This could contribute to the genetic susceptibility for type 2 diabetes.

Supported by: Wellcome Trust Senior Investigator Award

2680-POAssociation of Neutral Endopeptidase With Diabetic Nephropathy in Type 2 Diabetes among Singaporean ChineseCLARA TAN, ENG JOO PHUA, WAN CHING TOY, JIAN JUN LIU, DAWN LAU, MEL-VIN WONG, AMIZAH B. ASRAP, LEE YING YEOH, ADRIAN LIEW, TAVINTHARAN SUBRAMANIAM, CHEE FANG SUM, SU CHI LIM, Singapore, Singapore

Adrenomedullin (ADM), primarily an auto- and paracrine vasoactive peptide, has been regarded as an alternative to nitric oxide in the defense against vascular injury and may be involved in the pathogenesis of DN. A membrane-bound metalloprotease, neutral endopeptidase (NEP), cleaves endogenous peptides including ADM, thereby modulating its plasma con-centration. We examined the association between single nucleotide poly-morphisms (SNPs) of the NEP gene, plasma ADM concentrations and DN in a cohort of Singaporean Chinese subjects with type 2 diabetes. 61 haplo-type-tag SNPs (r2=1.0) were genotyped in 960 subjects with type 2 diabetes (>10 years) discordant for nephropathy using multiplex genotyping assays (BeadXpress, Illumina) in a case-control study. Cases (n=510) were defi ned on the basis of spot urinary albumin:creatinine ratio (ACR)>1000mg/g or se-

rum creatinine >112μmol/L. Controls (n=450) had ACR<30mg/g and serum creatinine <112μmol/L. SNPs conforming to Hardy-Weinburg equilibrium among controls were retained for further analysis. Cases and controls were similar in distribution for gender, age, diabetes duration and glycated hae-moglobin levels. Single locus analysis revealed 3 SNPs to be signifi cantly (nominally) associated with DN (odds ratio OR, 95% confi dence interval CI, p values in parentheses): rs7610758G>A (OR 0.502, CI 0.305-0.83, p=0.006), rs3736188G>A (OR 0.738, CI 0.552-0.96, p=0.024) and rs3773874C>A, (OR 0.733, CI 0.573-0.937, p=0.013). Minor A allele of intronic SNP rs3736188 (dominant model) was associated with increased plasma ADM in controls (carrier vs. non-carrier 0.50±0.15 vs 0.44±0.15 nmol/L, p=0.004). Haplotype analysis did not reveal additional signals in the gene region surrounding rs3736188. The association of rs3736188 minor allele with higher plasma ADM (intermediate phenotype) and reduced susceptibility to DN suggests a possible causal relationship between this variant allele and DN.

Supported by: Alexandra Health Endowment Fund - KTPH, SIG II FY2011

2681-POIdentifying T2D Risk Genes in Linkage Regions through Pleiotropy With Expression Levels in the GENNID African American PedigreesSWAPAN K. DAS, KURT A. LANGBERG, NEERAJ K. SHARMA, LIJUN MA, STE-VEN C. ELBEIN, CRAIG L. HANIS, SANDRA J. HASSTEDT, Winston-Salem, NC, Houston, TX, Salt Lake City, UT

We identifi ed four regions (chromosome 2, 7, 13, and 18) that potentially harbor T2D risk genes using linkage analysis on 1344 members of 530 African-American pedigrees from the Genetics of NIDDM (GENNID) study. To identify risk genes in these regions, we tested for pleiotropy between T2D and the ex-pression levels of genes under the linkage peaks. Transformed lymphocyte (TL) cell lines were available on 160 individuals (130 affected, 30 unaffected). We performed genome-wide expression analysis using TL total RNA by labeling and hybridization to Illumina HT-12 beadchip arrays, version 4 (San Diego, CA) according to the manufacturer’s instructions. The subset of the sample (N = 160) for whom cell lines were available supported linkage only on chromo-some 2 (at 68-121 Mb). In this region, expression levels were available for 174 probes (detection p-values 0.01) in 134 genes and genotypes were available for 3167 gene centric tag-SNPs (r2>0.7). We used jPAP to test each expres-sion level for pleiotropy with T2D by testing signifi cance of the correlation between the QTL effect for the expression level and the QTL effect for T2D as estimated in bivariate variance components linkage analysis. The table-1 presents all probes with nominal P < 0.01 for pleiotropy. Our novel genetics of gene expression analysis identifi ed four loci in chromosome 2 that modulates expression and may increase susceptibility to T2D in African Americans.

Table 1: Probes at Chromosome 2 region with nominal P<0.01Probe ID Nominal P-Value Gene Gene Position (Mb)ILMN_1805007 0.000510 SEMA4F 75ILMN_1812777 0.00613 MRPL35 86ILMN_2227338 0.00882 ANKRD23 98ILMN_2412807 0.00942 DCTN1 75

Supported by: NIH/NIDDK (R01 DK071100)

2682-POPlasma Resistin is Associated With Single Nucleotide Polymor-phisms of a Possible Resistin Receptor, the Decorin Gene, in the General Japanese PopulationHIROSHI ONUMA, To-on, Japan

Resistin is an adipokine secreted from adipocytes in mice. We reported that the G/G genotype of a single nucleotide polymorphism (SNP) at -420 in the promoter region of the human resistin gene was associated with type 2 diabetes susceptibility (Am J Hum Genet. 2004). Plasma resistin was highest in subjects with G/G genotype, followed by C/G and C/C (Diabetes Care 2007). Decorin is an extracellular matrix protein belonging to a family of small leucine-rich proteoglycans. A fragment of decorin ( decorin), pro-duced by proteolytic cleavage, was recently identifi ed as a resistin recep-tor in mice (Cell Stem Cell 2011). If decorin or its isoform is also a resistin receptor in humans, polymorphisms of the human decorin gene (DCN) could affect plasma resistin. In this study, we examined the association between 6 tag SNPs in the same linkage disequilibrium block around DCN, rs7139228, rs7956537, rs7308752, rs516115, rs3138167 and rs545666, and plasma re-sistin in 2,078 subjects in the general Japanese population. Plasma resistin was associated with the following genotypes: rs7139228 (GG 11.7±6.7, GA 10.4±5.5, TT 9.2±3.5 ng/ml; p=0.015), rs7956537 (TT 11.7±6.7, TG 10.4±5.5, GG 9.4±3.4 ng/ml; p=0.020), rs516115 (TT 12.0±7.1, TC 11.1±6.3, CC 11.0±5.8

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ng/ml; p=0.010), and rs3138167 (CC 11.8±6.9, CT 10.8±5.8, TT 10.6±6.8 ng/ml; p=0.006). A multiple regression analysis revealed that the genotype of rs7139228 (A/A), rs7308752 (G/G), or rs516115 (C/C) was associated with plasma resistin after adjusted for age, gender, BMI, and SNP-420. Since the effect of rs7139228 appears to be strongest, we examined the effect of a combination of rs7139228 and SNP-420 on plasma resistin. The effect ap-peared to be additive, although no synergistic interaction was observed.In conclusion, plasma resistin was associated with tag SNPs around DCN in the general Japanese population. This suggests that decorin or its isoform is a possible resistin receptor in humans.

2683-PO

2684-POCombined Genome-Wide Linkage and Association Analyses of Fast-ing Glucose Level in Healthy Twins and Families of KoreaYOUNG JU SUH, SO HUN KIM, JIA PARK, HYUN AE LIM, JOOHON SUNG, MOON-SUK NAM, Incheon, Republic of Korea, Seoul, Republic of Korea

Type 2 diabetes is a major chronic disease with high consistence in monozy-gotic (MZ) twins. Fasting glucose (FG) level is one of the traits related to type 2 diabetes. This study was undertaken to identify genetic polymorphisms that are associated with the risk of an elevated FG level using genome-wide anal-yses. We explored a quantitative trait locus (QTL) for FG level in a genome-wide study from a Korean twin-family cohort (the Healthy Twin Study) using a combined linkage and family-based association analysis approach. We in-vestigated 1,754 individuals, which included 432 families and 219 pairs of MZ twins. Regions of chromosomes 2q23.3-2q31.1, 15q26.1-15q26.3, 16p12.1, and 20p13-20p12.2, were found to show evidence of linkage with FG level, and several markers in these regions were found to be signifi cantly associated with FG level using family-based or general association tests. In particular, a SNP (rs6138953) on the PTPRA gene in the 20p13 region (combined p=1.8x10-6)was found to be signifi cantly associated with FG level, and the PRKCB1 gene (in 16p12.1) to be possibly associated with FG level. In addition, it was found that PTPRA (or PRKCB1) and several novel genes have epistatic effects on the risk of an elevated FG level. We found multiple regions that showed evidence of linkage and an association with FG level in our Korean twin-family cohort. The fi ndings of this study increase understanding of the pathogenesis of type 2 diabetes in the Korean population.

Supported by: NRF of Korea and Ministry of Health and Welfare, Republic of Korea

2685-POAllelic Heterogeneity of SORBS1 on Different Metabolic Traits and Progression of Obesity: A SAPPHIRe Cohort StudyTIEN-JYUN CHANG, CHAO A HSIUNG, WEN-CHENG WANG, YI-CHENG CHANG, IDA CHEN, JEROME ROTTER, LEE-MING CHUANG, SAPPHIRE STUDY GROUP, Tai-pei, Taiwan, Zhunan, Taiwan, Yunlin, Taiwan, Los Angeles, CA

SORBS1 is an established insulin signaling molecule. This study aimed to examine whether common SORBS1 genetic variations are associated with progression of insulin resistance phenotypes in a Chinese cohort. We genotyped nine common tagged single-nucleotide polymorphisms (SNPs) of the SORBS1 gene in 1269 subjects of Chinese origin from the Stanford Asia-Pacifi c Program for Hypertension and Insulin Resistance (SAPPHIRe) family study. Blood pressure and parameters of insulin, glucose, and lipid homeostasis were measured at baseline and at 5 years of follow-up. The as-sociations between traits and SNP genotypes or haplotypes were analyzed with family-based association test. The progression of metabolic pheno-types was measured using a proportional hazard model according to haplo-types of the SORBS1 gene. Among the 9 SNPs studied, 4 SNPs (rs3818540, rs61739184, rs2296966 and rs17849148) were associated with different metabolic traits. Further SNP haplotypes analyses according to LD blocks, we confi rmed respective association of the metabolic traits. However, only SNP haplotypes composed of rs2296966 and rs17849148 on block 3 were associated with progression of central obesity after a follow-up for 5 years, with the CC haplotype exhibiting a higher incidence of central obesity (haz-ard ratio: 1.48, 95% CI 1.03-2.07, p = 0.034). In conclusion, SORBS1 genetic variants are associated with blood pressure, hypertension, and glucose and lipid homeostasis at baseline. Particular variants on block 3 in Chinese were associated with the progression to central obesity during follow-up. How SORBS1 genetic polymorphisms lead to allelic heterogeneity of various phe-notypes requires further investigation.

Supported by: National Science Council, National Health Research Institute

2686-PO

2687-POReplication of Genome-Wide Association Signals of Type 2 Diabe-tes in Thai PopulationNATTACHET PLENGVIDHYA, WATIP TANGJITTIPOKIN, KANJANA CHANPRA-SERT, NALINEE CHONGJAROEN, PA-THAI YENCHITSOMANUS, Bangkok, Thailand

A genome-wide association studies have revealed several novel ge-netic loci linked with type 2 diabetes. We investigated whether these variations were associated with the disease and patients clinical charac-

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teristics in Thais. Fifteen single nucleotide polymorphisms (SNPs) of CDKAL1, CDKAN2A/2B, KCNQ1, UBE2E2E, HHEX, IGF2B2P2, SLC30A8, FTO, TCF7L2, MTNR1B genes were genotyped in 300 patients with type 2 diabetes and 300 non-diabetic controls by using high resolution melting analysis (HRM). We demonstrated that KCNQ1 rs2237892 (P=0.044), rs2237897 (P=0.001), rs2238228 (P=0.016), CDKN2A/2B rs10811661 (P=0.027) and TCF7L2rs7903146 (P=0.014) were associated with type 2 diabetes. Interestingly, CCACC and TTCTC haplotypes of KCNQ1/CDKN2A/2B/TCF7L2 were more com-mon in non-diabetic controls suggested their protective role (P=0.008 and 0.0066, respectively). The risk-conferring CDKAL1 rs7756992 G allele was associated with higher triglyceride level (P= 0.00045). UBE2E2 rs7612463 A allele and SLC30A8 rs13266634 T allele were associated with higher BMI (P=0.029 and 0.042, respectively). MTNR1B rs1387153 and rs10830963 were associated with lower HbA1c (P=0.033 and 0.019, respectively), only the for-mer was associated with higher HDL level (P=0.017). Participants who car-ried AA genotype of FTO rs8050136 were diagnosed diabetes at an earlier age than the non-carriers (P=0.005). The risk A allele was also associated with higher HbA1c (P=0.003). In conclusion, we have showed that variants of KCNQ1, CDKN2A/2B and TCF7L2 identifi ed from GWAS infl uenced the risk of developing type 2 diabetes in Thais. Moreover, the risk alleles of certain SNPS of CDKAL1, UBE2E2, SLC30A8, MTNR1B and FTO were associated with clinical characteristics related to metabolic syndrome. CCACC and TTCTC haplotypes of KCNQ1/CDKN2A/2B/TCF7L2 might be protective against diabe-tes in our population.

Supported by: Mahidol University and Senior Research Scholar of Thailand Re-search Fund

2688-POResponse to GLP-1 Mimetic in Carriers of TCF7L2 Gene Polymo-phismsMARI C. FERREIRA, ROSA FUKUI, ELIZABETH R. DA SILVA, MARIA DO CARMO A. MARQUES, DALVA M. ROCHA, ROSA F. DOS SANTOS, São Paulo, Brazil, Chapeco, Brazil

TCF7L2 (T-cell factor 7-like 2) is a Wnt signaling transcription factor, and plays an important role in -cell function. Many studies has demonstrated the association of single nucleotide polymorphisms (SNPs) in the TCF7L2 gene with an early-impaired -cell function and reduced GLP-1. Furthermore, the major genes involved in proinsulin processing contain TCF-binding sites in their promoters, suggesting that the TCF7L2 risk allele may predispose to impairing -cell proinsulin processing. The aim of the present study was to evaluate the effect of Exenatide on and cells responses to a mixed meal test, in Type 2 Diabetes(T2DM) carriers of TT genotype of rs 7903146. One hundred forty individuals(58 yr+/-5,BMI 29+/-3 kg/m2)with T2DM were genotyped for rs 7903146.These patients were tested on a mixed meal test twice, before and after Exenatide treatment 5 mg bid from day 1 to 30, and 10 mg bid from day 31 to 60. Blood samples were taken on fasting and 15,30,45,60,90,120,180, 240 minutes, for glucose, insulin, proinsulin, c-pep-tide and glucagon.The preliminary results correspond to the study of seven patients, was made the comparison of the curves before and after treat-ment, using ANOVA. In this population, the subtype wild (CC) was present in 43%,and the risk genotypes (CT and TT) in 47.1% and 9.9% respectively.The comparison between the mixed meal test before and after treatment showed that glucose(p = 0.005) and proinsulin(p<0.001) levels were reduced in TT treated patients(p <0.05), and the average of glucose level reduction was 28.24 mg/dL and proinsulin 36.18 pmol/L. There was no differences be-tween the responses of insulin (p= 0,057) glucagon (p=0.206) and c-peptide (p=0.097). In this study we observed that TT carriers presented decrease in glucose and proinsulin levels after treatment with Exenatide, without changes in insulin, c-peptide either glucagon. These preliminary data sug-gest that individuals T2DM TT carriers of rs7903146, probably had improve of processing of proinsulin during the treatment with Exenatide.

Supported by: FAPESP

2689-POA Common Genetic Variant of BDNF is Assocated With Type 2 Dia-betes in Chinese Han PopulationXUEYAO HAN, YINGYING LUO, YONG TANG, CHAO LV, XIUQIN SUN, XIANGHAI ZHOU, LINONG JI, Beijing, China

Aim: Recently, several genome wide association studies have identifi ed many loci associated with obesity or body mass index(BMI), of which Fto was also consistently confi rmed to affect genetic suceptibility to type 2 diabetes in the diferent population,although the association dispeared in European after adjustment for BMI.In contrast, several BMI related genetic loci such as BNDF,GNPDA2 and Fto were reported to be associated with

type 2 diabetes in Japanese independent of BMI effect.Our study aim to evaluate the contribution of NEGR,GNPDA2 and BDNF genetic loci to type 2 diabetes in Chinese Han population. Method: 1221 Chinese subjects with normal 75g oral glucose tolerance recruited from community near Peking University People’s Hospital and 1069 Chinese patients with type 2 diabe-tes from outpatients of Peking University People’s Hospital were include into this case control study. Three single nuleotide polymorphism including NEGR-rs2815752, GNPDA2-rs10938397 and BDNF-rs4074134 were geno-typed. The odd ratios(OR) for minor allele and 95% confi dence interval were calculated by logistic regression with adjustment for gender, age and BMI. Results: An association of BDNF-rs4074134, but not NEGR-rs2815752 and GNPDA2-rs10938397, with type 2 diabetes in Chinese was confi rmed with OR 0.88(95% CI 0.77-0.99),p=0.046 independent of gender,age and BMI.In non diabetes controls, a linear regression showed BDNF-rs4074134 A allele was negatively related to BMI after adjusting gender and age. Conclusion: Our study suggested BDNF-rs4074134 was associated with type 2 diabetes in Chinese Han population in Beijing ,China ,and this SNP also had an effect on BMI.

2690-POThe Comparison of Early-phase Secretion Function between Islet Alpha Cells and Beta Cells in Normal Glucose Tolerance Subjects With Family History of DiabetesXIAOHUI SUN, PING SHI, QINGXIA CHI, LUAN WANG, YUQIN QI, YANGANG WANG, Qingdao, China

Early phase dysfunction of islet cells is one of important marks of early type 2 diabetes, To compare the early-phase secretion function between islet alpha cells and beta cells in normal glucose tolerance subjects and explore the infl uence genetic factors on the function of islet cells,we col-lected 40 subjects with normal glucose tolerance and family history (FH +) and 55 healthy volunteers without family history (FH-). Fasting and L-arginine (L-ARG) stimulating insulin (INS), glucagon (GC) and fasting free fatty acid (FFA) and other indicators were determined in all subjects. Interestingly, jj-jjusting for sex, age and BMI, INS secretion peak of the two groups were all at two minute, and began to decline at four minute, the peak multiple of FH + group was signifi cantly less than that of FH-group (P<0.05)., GC secre-tion peak of the two groups were all at two minute and began to decline at four minute. FGC and peak multiple were not signifi cantly different (P> 0.05).while the ratio of fasting insulin and fasting glucagon of the two groups was not signifi cantly different (P> 0.05). These datas support the hypothesis that under genetic background, the function of beta cells in subjects with normal glucose tolerance decreases.

Supported by: Chinese Diabetes Society

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2692-POGenetic Variants of LPIN1 are Associated With Type 2 Diabetes Mellitus in a Chinese PopulationRONG ZHANG, FENG JIANG, CHENG HU, WEIHUI YU, CONGRONG WANG, SHANSHAN TANG, WEIPING JIA, Shanghai, China

Abstract Dyslipidemia makes considerable contributions to the diabetic state through insulin resistance. Lipin-1 plays an important role in metabolic homeostasis, which is associated with insulin sensitivity in different tissues. The aim of the study is to test the association of LPIN1 variants with the devel-opment of type 2 diabetes and clinical characteristics in large samples of the Chinese population. In the fi rst stage, fi fteen single nucleotide polymorphisms (SNPs) within LPIN1 region were selected and genotyped in 3,700 Chinese Han participants comprising of 1,892 type 2 diabetes patients and 1,808 controls with normal glucose regulation. In the second stage, the SNPs showing sig-nifi cant association or trend were genotyped in additional samples for repli-cation, including 1,518 diabetes patients and 1,604 controls. Meta-analyses and genotype-phenotype association studies were also performed. In the fi rst stage, we detected that rs16857876 was signifi cantly associated with type 2 diabetes with OR 0.806 (95% CI 0.677-0.958, P = 0.015) while rs11695610 showed a trend with type 2 diabetes (OR 0.846, 95% CI 0.709-1.009, P = 0.062). In the second stage, similar effect of rs11695610 on type 2 diabetes was ob-served (OR 0.849, 95% CI 0.700-1.030, P = 0.096). The meta-analyses combin-

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ing with two stages information showed a signifi cant effect of rs11695610 on type 2 diabetes with an OR of 0.847 (95% CI 0.744-0.965, P = 0.012). Finally, the phenotype-genotype association analyses showed that rs11695610 was asso-ciated with 2h plasma glucose (P = 0.040), triglyceride levels (P = 0.034), fi rst-phase and second-phase insulin secretion (P = 0.019 and 0.005, respectively). Our data implied that common SNPs within LPIN1 region were associated with type 2 diabetes and metabolic traits in the Chinese population.

2693-POSingle Nucleotide Polymorphisms and Haplotypes in the Adiponec-tin Gene Contribute to the Genetic Risk for Type 2 DiabetesWASSIM Y. ALMAWI, NABIL MTIRAOUI, INTISSAR EZZIDI, AMIRA TURKI, TOU-HAMI MAHJOUB, Manama, Bahrain, Monastir, Tunisia

We investigated the contribution of 13 polymorphisms in the promoter, coding regions, and 3’untranslated region of the adiponectin gene (APM1) to type 2 diabetes (T2DM) in 917 T2DM patients and 748 control Tunisian Arabs. Higher minor allele frequency of rs16861194 (P <0.001), rs17300539 (P <0.001), rs266729 (P <0.001), rs822396 (P =0.02), rs2241767 (P =0.03), and rs1063538 (P =0.02) was seen in T2DM patients. Varied association of APM1 genotypes with T2DM was seen according to the genetic model used (ad-ditive, dominant, and recessive). While rs17300539 and rs266729 showed a signifi cant association with T2DM under the three models, rs16861194 and rs1063538 remained signifi cant under the additive and dominant models, while rs822396 and rs2241767 did not associate signifi cantly with T2DM. Haploview analysis revealed low linkage disequilibrium between APM1 vari-ants, resulting in high recombination and haplotype diversity. These results support a signifi cant association of APM1 gene polymorphism with T2DM in Tunisian Arabs.

ADIPOQ SNPs Associated with T2DMrs number Genome

positionGene

positionHWE

PCasesMAF

Controls MAF

P 2

rs16861194 186559175 - 11426 0.237 227 (0.12) 120 (0.08) <0.001 16.28rs17300539 186559210 - 11391 0.971 230 (0.13) 122 (0.08) <0.001 16.30rs266729 186559224 - 11377 1.000 583 (0.32) 379 (0.25) <0.001 16.39rs822396 186566627 - 3964 0.370 335 (0.18) 227 (0.15) 0.02 5.40rs2241767 186570946 349 0.882 482 (0.26) 345 (0.23) 0.03 4.41rs1063538 186573933 3286 0.372 535 (0.41) 535 (0.36) 0.02 5.14

2694-POGenetic Variants and Lipid Profi le in an Italian Population at Risk of Type 2 Diabetes: The GENFIEV StudyNICOLÒ PULIZZI, ROBERTO MICCOLI, CRISTINA BIANCHI, RICCARDO BONADON-NA, FRANCESCO GIORGINO, MARCHESINI GIULIO, FRANCO CAVALOT, GISELLA CAVALLO, FRIDA LEONETTI, ANDREA GIACCARI, ISABELLA CRISCI, MARIO CO-MASSI, LEIF GROOP, STEFANO DEL PRATO, ON BEHALF OF THE GENFIEV-FORISID STUDY GROUP, Pisa, Italy, Verona, Italy, Bologna, Italy, Turin, Italy, Rome, Italy, Malmo, Sweden

New genetic variants identifi ed by GWAS are associated with lipid traits in the general population. We have explored some of these associations in the GENFIEV (Genetics Physiopathology and Evolution of type 2 diabetes)

cohort, consisting of 864 subjects (56.6% women; age 49.5±11.2 yrs; BMI 29.1±5.3 Kg/m2) in whom clinical data, glucose tolerance (75 gr OGTT), and lipid profi le were determined. Obesity (BMI 30 kg/m2) occurred in 40% and type 2 (T2D) diabetes in 14.2% of the whole population. Nineteen gene vari-ants have been genotyped and their associations with lipids investigated by linear regression, whereas logistic regression was used to explore as-sociations with metabolic syndrome and obesity. All analyses were adjusted for age, gender, BMI and T2D. An additive genetic model was used. As de-scribed in other populations, we found that in individuals at risk of diabetes rs1260326 (GCKR), rs780094 (GCKR) and rs17145738 (BCL7B,TBL2,MLXIPL)were signifi cantly (p=0.05 or less) associated with increased triglycerides; rs12654264 (HMGCR) and rs780094 (GCKR) with high LDL-Cholesterol (C); rs4846914 (GALNT2) and rs1800775 (CETP) with low HDL-C; rs328 (LPL) with low triglycerides; rs1800588 (LIPC), rs328 (LPL) with high HDL-C. Rs1801282 (PPARG) was associated with high HOMA-IR; rs8050136 (FTO) with obe-sity; rs1260326 and rs780094 with MS. Moreover, new associations were found between rs1260326 (p=0.005) and high LDL-C; rs1260326 (p=0.0002), rs12654264 (p=0.01), rs17145738 (p=0.03), rs1800588 (p=0.01), rs3890183 (p=0.04) and rs780094 (p=0.0002) with increased Total-C and rs2156552 (p=0.03) with higher triglycerides. In conclusion while we confi rm in our Ital-ian population at risk for T2D associations previously described, we report new associations. These observations need to be confi rmed in other popu-lations, and more importantly, their associations with cardiovascular risk remain to be established.

Supported by: FoRiSID with an unconditioned Grant from Eli Lilly and Company

2695-POVariantions in the Promoter of Osteoprotegerin Gene and Its Asso-ciation With Diabetic OsteoporosisCHUNAI YANG, BIN WU, XIAO YAN ZENG, SHI ZHAO JIANG, HUI YING YANG, HONG LI, Kunming, China

Objective: Variantions in the promoter of osteoprotegerin (OPG) gene were reported to contribute to the genetic regulation of bone mass density(BMD) in patients with postmenopausal osteoporosis, however, its relationship with diabetic osteoporosis(DO),and whether OPG--- receptor activator of nuclear factor- B ligand (RANKL) pathway plays a role in the development of DO still unclear. In this study four single nucleotide polymorphisms (SNPs): A163G,G209A,T245G,and T950C in OPG promoter region were genotyped in 263 type 2 diabetic patients.Serum OPG,RANKL,25-(OH)VitD3 were mea-sured in order to investigate the relationship between variantions of OPG promoter gene and DO,RANKL/OPG. Methods: A163G,G209A and T245G polymorphisms were genotyped with TaqMan allelic discrimination assay and T950C polymorphisms with polymerase chain reaction-restriction frag-ment length method in 180 Non-DO(NDO) and 83 DO patients. OPG, RANKL, 25-(OH)VitD3 were measured with ELISA. BMD at lumbar spine, hip and fore-arm was assessed by dual-energy X-ray absorptiometry. Results: (1)There were no signifi cant differences in the genotypic and allelic distributions of A163G, G209A,T245G and T950C polymorphism between DO and NDO pa-tients . (2) In DO group: AA carriers of A163G polymorphism had higher L1 and L1-L4 BMD than that of AG+GG carriers, AA carriers also had higher OPG but lower RANKL/OPG ratio than that of AG+GG carriers. ConclusionsA163G polymorphism in the promoter region of the OPG gene may contribute to the genetic regulation of BMD in DO patients, in which allele A may be the protection factor of bone mass and allele G may be the risk factor of bone mass. These fi ndings suggest that OPG gene may regulate the BMD in DO patients through OPG-RANKL pathway.

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2697-POInteractions Among TBX5, ABI2, and FTO Polymorphisms are As-sociated With Fasting Glucose and Insulin Resistance in Chinese Type 2 Diabetes PatientsWEI-DONG LI, CHUNYOU CAI, PING YU, FENGJIANG WEI, CHAO LING, WENTAO SHI, LIMING CHEN, Tianjin, China

Genome wide association studies have shown that more than a dozen genes are associated with type 2 diabetes. However, some of these genes do not show the same level of signifi cance in Chinese as in Caucasian pa-

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tients. We genotyped 59 SNPs of 36 candidate genes in 909 Chinese type 2 diabetes patients. Quantitative association studies were carried out for 18 phenotypes related to body weight, lipids, insulin resistance, and blood pressure. Linear regressions were performed for each phenotype against age within sex. Standardized residuals were saved for quantitative associa-tion studies by PLINK software. We found moderate associations between these SNPs and many phenotypes, including an association between ABI2and hypertension (rs62183937, P=0.00018) and between PCAF and 2-hr glu-cose (rs2929402, P=0.0015). We further explored the pairwise genotype in-teractions (epistasis) among 36 genes in all 18 phenotypes. After Bonferroni correction, the epistasis between ABI2 (rs62183937) and TBX5 (rs11067076) for fasting glucose and between TBX5 (rs11067076) and FTO (rs17818920) for HOMA (homeostatic model assessment) remained signifi cant (P=1.22×10-7

and 1.17×10-7, respectively). We found interactions among all four ABI2 SNPs and two TBX5 SNPs for fasting and 2-hr glucose, and all pairwise epistasis analyses yielded P values < 1×10-4. Interestingly, FTO and TBX5 SNPs showed no signifi cant associations (P>0.001) for traits related to body weight and insulin resistance in our subjects. Many studies have found no association between FTO and body mass index (BMI) and/or type 2 diabetes in Chinese populations. However, FTO polymorphisms seem to be involved in genotype interactions for insulin resistance phenotypes. In previous studies, TBX5SNPs were consistently associated with BMI, although not with the genome wide levels of signifi cance (P<5×10-8). Further studies are needed to examine ABI2-TBX5-FTO interactions in other populations.

Supported by: National Science Foundation of China (NSFC) Grant 81070576 (W.D.L.)

2698-POA Single Nucleotide Polymorphism in Stromal Cell Derived Factor (SDF-1) is Associated With T2DM and its Complications in an Asian Indian PopulationPARTHIBAN MUTHUKUMARAN, DHAMODHARAN UMAPATHY, EZHILARASI KRISHNAMOORTHY, INDIRA PADMALAYAM, RAMA RAJARAM, VIJAY VISWA-NATHAN, Chennai, India, Birmingham, AL

SDF-1 (CXCL-12) is a member of the CXC chemokine family which is con-stitutively produced by bone marrow stromal cells. It plays a key role in the recruitment of leukocytes to the sites of infection and has been associated with infl ammation, angiogenesis, and autoimmunity. Further, a single nucle-otide polymorphism in SDF-1 has been shown to regulate its expression. Be-cause of its key role in the infl ammatory process, we are interested to see if SDF-1 is associated with the pathogenesis of type 2 diabetes (T2DM) and its complications. In this study we investigate a potential correlation between a SNP, G801A in the SDF-1 gene in an Asian Indian population with T2DM who attended our tertiary care hospital in Chennai, India. This polymorphism has been studied in conditions such as HIV, lymphoma and type 1 diabetes but there is no published data about it prevalence in T2DM and its compli-cations. This is the fi rst study which correlates a genetic polymorphism in SDF-1 gene with complications of T2DM. The study population consisted of total 531 subjects, divided into four groups. Group I consisted of 134 healthy volunteers, Group II had 116 subjects with T2DM but no complications, Group III had 170 subjects with diabetic nephropathy and Group IV had 111 sub-jects with diabetic foot ulcers. Peripheral blood genomic DNA was subjected to PCR-RFLP and analyzed for the presence of 302, 202 & 100 bps bands. The results showed a signifi cantly increased frequency of the homozygous wild genotype GG in the diabetic groups (groups II, III and IV) compared to healthy subjects (group I) suggesting an association of this genotype with diabetes. Further, the relative risk for GG genotype was higher in Group III 14.143 (3.314-60.353), suggesting an association with diabetes nephropathy (p<0.001). We conclude that the homozygous wild genotype GG of SDF-1 gene is signifi cantly associated with increased risk in diabetic nephropathy patients.

2699-POAssociation of OGG1, XRCC1 Gene Polymorphisms With a Risk of Type 2 Diabetes Mellitus and Diabetic Peripheral Neuropathy (DPN)JACEK KASZNICKI, MARCIN KOSMALSKI, AGNIESZKA SLIWINSKA, ANNA MERECZ, MAGDALENA CUCHRA, IRENEUSZ MAJSTEREK, JOZEF DRZEWOSKI, Lodz, Poland

Overproduction of reactive oxygen species in diabetic patients increases the risk of irreversible changes in all cellular components and is associated with the development of diabetic microvascular complications, including neuropathy. It is also suggested that DNA repair in diabetic patients is impaired. DNA lesions induced by oxidative stress are mainly removed by

base excision repair (BER). OGG1 and XRCC1 are proteins involved in the BER pathway. hOGG1 is one of the key glycosylases that recognizes and removes 8-hydroxy-2-deoxyguanine. The XRCC1 protein acts as a scaffold for other DNA repair proteins, such as DNA glycosylases, polymerase beta and ligase III. The aim of our study was to evaluate the association of the 326 Ser/Cys OGG1 and the 194 Arg/Trp XRCC1, and the 399 Arg/Gln XRCC1gene polymor-phisms with the risk of T2DM or diabetic peripheral neuropathy (DPN). Geno-types were determined by PCR-RFLP in 385 subjects, including 56 T2DM pa-tients with DPN, 117 T2DM patients without any signs of DPN, and 212 with normal glucose metabolism. The polymorphisms studied include codon 326 of OGG1 and 194, 399 of XRCC1 in the BER genes The results of the analysis of polymorphisms were statistically analysed by calculating the odds ratio (OR) and their 95% confi dence intervals (95% CI) using the 2-tests. Our data indicate that patients with T2DM (including those with neuropathy) had higher frequencies of the 399 Arg/Gln XRCC1 polymorphism in homozygote (G/G) (OR: 1.85 [95% CI: 1.07-3.22], P=0.03) and also increased frequency of 399Gln (G) allele (OR: 1.38 [95% CI: 1.03-1.83], P=0.03). No relation to other polymorphisms with increased risk of diabetes or DPN was seen. The results of our study suggest that the 399 Arg/Gln XRCC1 polymorphism may be considered as a risk factor for T2DM in Polish population and that lower effi ciency of DNA repair in diabetic patients may be associated with 399 Arg/Gln XRCC1 polymorphism.

Supported by: Polish Ministry of Science and Higher Education, Grant N402 375838

2700-POCommon Variants in p38 MAPK Gene have Effect on its mRNA Lev-els in a Han Population in BeijingNAN FENG, XIAOWEI MA, MENGMENG JIN, NAN GU, RUIFEN DENG, XIAOHUI GUO, Beijing, China

Mitogen-activated protein (MAP) kinase cascades represent one of the major signal systems in eukaryotic cells which transduces extracellular sig-nals into cellular responses. There are 4 MAP kinase subgroups including ERK, JNK, ERK5, and p38. Out of 4 isoforms of p38 MAPK identifi ed in human as p38 , p38 , p38 and p38 , the mRNA of p38 is generally expressed in human tissues such as liver, skeletal muscle and pancreas, etc. Our previous research data revealed that common SNP rs2072878 was associated with prediabetes (p =0.026), so we hypothesized that the genetic variations in the p38 MAPK genes may impact its mRNA levels in the normal Hans screened by 75-g OGTT. Total 98 unrelated normal subjects were genotyped by Mass spectrometry assay, the carriers of AG were 16 and AA 82, respectively, and then 14 subjects were selected from each genotype group. The mR-NAs and proteins from PBMC were extracted, and the mRNA levels of p38MAPK were detected by Real-time PCR (Taqman Probe), the protein levels of p38 MAPK were estimated by SDS-PAGE and Western blotting analysis (the specifi c antibodies to p38 MAPK purchased from Cell Signaling Technol-ogy, USA). We found that AA carriers at rs2072878 in p38 MAPK gene had lower mRNA levels compared to AG carriers (0.485±1.143 vs 2.250±2.719, p = 0.034)( Fig.1). But we did not fi nd any signifi cant difference in total protein levels of p38 MAPK between two genotype groups. Our fi ndings indicate that common variant(s) in p38 MAPK gene may impact its mRNA expres-sion in normal Han population in Beijing, while it may have no major effect on the protein expression of p38 MAPK .

Supported by: NSFC30771033

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GENETICS—TYPE 2 DIABETES

2701-POPGC-1 Gly482S ER Polymorphism Increases the Susceptibility to NAFLD in Type 2 Diabetic Patients through Impairing PEPCK-C Tran-scriptionYAN-MING CHEN, SHENG-QING HE, PAN-WEI MU, MAN-MAN WANG, LONG-YI ZENG, Guangzhou, China

The aim of this study is to investigate the relationship between peroxi-some proliferators-activated receptor coactivator-1 (PGC-1 ) Gly482Ser gene polymorphism and non-alcoholic fatty liver disease (NAFLD) with type 2 diabetes (T2DM), and to clarify the effect of this gene variant on the tran-scription of cytosolic phosphoenolpyruvate carboxykinase (PEPCK-C) gene. According to typical liver ultrasonographic fi ndings, 80 NAFLD with newly-diagnosed T2DM patients, 86 NAFLD patients, 80 newly-diagnosed T2DM patients and 84 NGT subjects were recruited into this study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to analyze the genotype of each individual. Then wild-type (Gly482) and mutated (Ser482) plasmids of PGC-1 were transfected respectively into liver cells. The mRNA and protein levels of PEPCK-C and PEPCK-C pro-moter activity were detected after transfection. We demonstrated that NAFLD patients were more obese and insulin resistant. PGC-1 Ser482Ser genotype frequency and Ser482 allele’s frequency were higher in NAFLD pa-tients complicated with T2DM than NGT group (P<0.05). Objects possessed this genotype had lower plasma HDL-C levels but higher LDL-C levels and had higher risk for NAFLD complicated with T2DM. And the PEPCK-C mRNA and protein levels in co-transfecting PGC-1 (Gly482) and HNF4 plasmids group increased more than PGC-1 (Ser482) plus HNF4 group (P<0.05). Moreover, PGC-1 (Gly482) increased PEPCK-C promoter activity with 2.0-fold and 2.2-fold versus PGC-1 (Ser482) in HepG2 and LO2 cells respectively (P<0.05).PGC-1 Gly482Ser variant contributed to the onset of NAFLD in type 2 dia-betic patients probably through impairing PEPCK-C gene transcription and exacerbating fat deposition.

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2703-POAssociation of SUMO4 M55V Polymorphism With Susceptibility to Diabetes Mellitus: A Meta-AnalysisQIU ZHANG, SONGTAO TANG, CHANGJIANG WANG, Heifei, China

Background: The association between small ubiquitin-like modifi er 4(SUMO4) gene polymorphism and type 1 diabetes mellitus(T1DM) or type 2 diabetes mellitus(T2DM) has been investigated in several studies. We con-ducted a meta-analysis to evaluate the association of SUMO4 gene polymor-phism with T1DM and T2DM susceptibility. Methods: A meta-analysis was performed on the published studies before August, 2011. The association of SUMO4 M55V polymorphism with T1DM and T2DM was evaluated. Meta-

analysis was performed for genotypes AA vs. GG, AA vs. AG, AA vs. AG+GG and A allele vs. G allele in a fi xed/random effect model. The combined odds ratio (OR) with 95% confi dence interval (95% CI) was calculated to estimate the strength of the association. Results: Sixteen case-control studies includ-ing 9190 cases and 10456 healthy controls were included. T1DM patients were divided into Asian and Caucasian subgroup. We detected a signifi cant association of SUMO4 M55V polymorphism with T1DM in Asian population (A vs. G: OR=0.79, 95%CI=0.72-0.86, P=0.000) and a signifi cant association of SUMO4 M55V polymorphism with T1DM in Caucasian population (A vs. G: OR=0.84, 95%CI =0.73-0.97, P = 0.007). Included T2DM patients were all Asian. Meanwhile, a signifi cant association of SUMO4 M55V polymorphism with T2DM was also found (A vs. G: OR=0.86, 95%CI =0.79-0.94, P = 0.001). Conclusions: Our study demonstrates signifi cant associations of SUMO4 M55V polymorphism with T1DM in Asian and Caucasian population and with T2DM in Asian population.

2704-POGenetic Variability in IRE1 Gene is Associated With the Risk of Prediabetes in a Chinese Han PopulationNAN GU, XIAOWEI MA, NAN FENG, MENGMENG JIN, XIAOHUI GUO, Beijing, China

Accumulation of unfolded or misfolded proteins in the endoplasmic re-ticulum (ER) induces the ER stress response, otherwise known as the un-folded protein response (UPR), which plays an important role in chronic metabolism disease, such as insulin resistance and the development of type 2 diabetes. Prediabetes, a state of type 2 diabetes, presents with an early stage of -cell dysfunction and insulin resistance. Inositeol Requiring 1(IRE1 ) was the most conserved UPR stress sensor, resulting in attenua-tion of protein translation and transcriptional activation of UPR genes. We hypothesized that the genetic variations in IRE1 gene may have an effect on the risk of the disturbance of glucose homeostasis, we selected 4 hap-lotype-tagging single nucleotide polymorphisms (SNPs) (r2<0.8, MAF 0.05 from CHB database in HapMap phaseII R#23), genotyped 828 unrelated prediabetic subjects and 620 normal controls screened by OGTT using mass spectrometry assay(Table1). Genotype distributions were in Hardy-Wein-berg equilibrium at all four SNPs. The minor allele G at rs880069 was the protective allele for prediabetes, with the carriers of genotype GG at lower risk of prediabetes compared to non-carriers (OR=0.779, p=0.020), after ad-justed for gender, age, BMI, the difference was still statistically signifi cant (OR’=0.802,p’=0.048). At rs196940, GG homozygotes had lower risk than the non-carriers (OR=0.801, p=0.038, p’=0.085, OR’=0.826 after adjustment). And at rs196914, TT homozygotes had higher insulin levels after 2h 75g-Oral glucose load (p=0.029).

Supported by: The National Natural Science Foundation (30771033)

2705-POTMPRSS6 Gene Polymorphisms, Body Iron Stores and Risk of Type 2 Diabetes Mellitus in a Chinese PopulationYING RONG, WEI BAO, ZHILEI SHAN, SHUANG RONG, DI WANG, YANTING ZHAO, XIAO XIAO, LIEGANG LIU, Wuhan, China, Bethesda, MD

Several studies have shown that iron overload (i.e., elevated body iron stores) is involved in the pathogenesis of type 2 diabetes mellitus (T2DM). rs4820268 and rs855791, single nucleotide polymorphisms (SNPs) in the

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GENETICS—TYPE 2 DIABETES

transmembrane protease serine 6 gene (TMPRSS6), were strongly associ-ated with serum iron concentrations in recent genome-wide association scans. However, whether rs4820268 and rs855791 are associated with risk of T2DM remains unknown. To determine the association between these variants and risk of T2DM, we conducted a case-control study of 688 cases of T2DM and 983 healthy controls in a Chinese population. In addition, we also explored the association between these variants and plasma ferri-tin concentrations in a subset of subjects who participated in the ferritin test. The frequency of rs4820268 G allele was 0.528 in controls and 0.516 in T2DM patients. As for rs855791 A allele, the frequency was 0.552 and 0.524, respectively. We found that neither rs4820268 nor rs855791 showed signifi cant association with risk of T2DM. For rs4820268, the odds ratio (OR) for T2DM among persons with GG genotype, compared to those with AA genotype, was 0.939 (95% confi dence interval (CI) 0.690-1.279) after ad-justment for age, sex and body mass index. For rs855791, after multivariate adjusted, the OR for T2DM among people with AA genotype, compared to those with GG genotype, was 0.846 (95% CI 0.621-1.153). On the other hand, in our study, no signifi cant associations were observed between the above variants and plasma ferritin concentrations. For rs4820268, the geometric means of ferritin were 130.52 ng/mL, 133.62 ng/mL and 132.30 ng/mL in persons carried AA, AG and GG genotypes (P > 0.05). For rs855791, the geo-metric means of ferritin were 134.39 ng/mL, 135.64 ng/mL and 126.14 ng/mL in persons carried GG, AG and AA genotypes (P > 0.05). In conclusion, our data indicate that rs4820268 and rs855791 in TMPRSS6 gene may not be associated with risk of T2DM or elevated body iron stores.

Supported by: National Natural Science Foundation (NSFC-30872116)

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2708-POAssociation of Ghrelin Leu72Met Polymorphism With Type 2 Diabe-tes Mellitus in Chinese PopulationLIU JING, Lanzhou, China

LIU JING, LIU JIA, TIAN LI-MIN, LIU JU-XIANG, BING YA-JUN, ZHANG JI-PING, WANG YUN-FANG, ZHANG LU-YAN, Lanzhou City, China

Objective: To investigate the distribution of ghrelin gene Leu72Met poly-morphism and its association with the type 2 diabetes mellitus in Chinese population. Methods: We conducted a case-control study on 836 patients with T2DM and 830 controls, which were genotyped by the polymerase chain reaction (PCR) technique, denaturing high performance liquid chroma-tography (DHPLC) and DNA sequence analysis. Laboratory analyses were carried out in the hospital laboratory. Results: No signifi cant difference in the Leu72Met genotype distributions and allele frequency was observed between type 2 diabetes mellitus and controls (both P>0.05). The polymor-phism was not associated with T2DM. However, among the T2DM group, the patients carrying Leu72Leu genotype had signifi cantly increased levels of FPG and serum creatinine compared with variant genotypes (Leu72Met and Met72Met) (P<0.05). In the control group, the subjects with variant geno-types had signifi cantly increased levels of FINS, HOMA-IR compared with Leu72Leu genotype (P<0.05). Conclusion: The Leu72Met polymorphism of the preproghrelin gene was not associated with T2DM in Chinese population. However, it may have some roles in the etiology of insulin resistance.

2709-POKnowledge Base on Diabetes-Related Genes and Genetic VariantsGAURAV THAREJA, SUMI E. JOHN, OSAMA ALSMADI, ALPHONSE T. THANGAV-EL, Kuwait City, Kuwait

Research efforts in diabetes have resulted in a vast reservoir of frag-mented data. In the era of Personal Genomes, the Genome-based diagnosis and prognosis require a curated knowledgebase on Genetics/Genomics of the diabetes with inherent ethnic specifi cities. The Knowledgebase inte-grates genetic, genomic, proteomic, epigenetic, phenotype information on diabetes-associated genome regions. Currently, our knowledge base con-tains 16229 Single Nucleotide Variations (SNPs) and 82 genes annotated for diabetes. These SNPs have been classifi ed into Type 1 (N = 5501), Type II (N = 10534), Gestational (N = 1), Insipidus (N = 44) and other specifi c types (N = 76) based on 104 phenotype descriptions. 73 SNPs have been associated with both Type I and Type II as phenotypes. They are associated with genes which belong to Insulin receptor Substrate 2 (-Log 10 p = 3.93) and Insulin like growth factor 1 receptor (-log 10 p = 2.74) signaling transduction pathways. Genes associated with the included SNPs give further insights on perturba-tions caused in pathways which can lead to other disorders and can also reveal potential susceptibility of other organs to different types of diabetes. Population-based allele frequencies (including those in Kuwaiti population) are provided with the Knowledgebase.

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IMMUNOLOGY

2710-POValidation of the Association between PSMA6 -8 C/G Polymorphism and Type 2 Diabetes Mellitus in Chinese Dongxiang and Han Popu-lationsLIU JING, Lanzhou, China

Abstract Objective: The aim of our study was to validate the association between the previously reported -8 C/G variant in the proteasome subunit alpha type-6 gene (PSMA6) and the risk of type 2 diabetes mellitus (T2DM) in the Dongxiang and Han populations from north-western China. Method: Genotyping of PSMA6 gene -8 C/G polymorphism was detected in nondia-betic control subjects and patients with T2DM in these populations, using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Result: The frequency of CG + GG genotype of PSMA6was obviously different from C/C genotype in the T2DM groups and control groups in the Chinese Dongxiang and Han populations (OR = 1.494, 95% CI: 1.182-1.889, P = 0.001; OR = 1.477, 95% CI: 1.210-1.802, P = 0.000, respec-tively). In Dongxiang population, the FPG, HOMA-IR, SBP and TC levels of the CG + GG genotype were markedly higher than that of the CC genotype, in control group (all P < 0.05) respectively. Furthermore the DBP level of the CG + GG genotype was markedly higher than that of the CC genotype in both T2DM group and control group (all P < 0.05) respectively. Conclusion: Our investigation suggests that the -8 C/G variant in the PSMA6 gene may be associated with T2DM and diabetes-related metabolic traits in Chinese Dongxiang and Han populations.

2711-POStudy of Resistin Gene Polymorphism in the Elderly Type 2 Diabetes Mellitus Han Patients in Northeast ChinaYA-DONG SUN, YAN MA, Changchun, China

The purpose of this study was to investigate the relationship between resistin gene polymorphism and the risk of type 2 diabetes mellitus (T2DM) in elderly Han people in Northeast China. 115 elderly patients and 99 normal controls in Han people in Northeast China were included. The single nucle-otide polymorphism (SNP) in resistin gene was found in 20 elderly patient us-ing PCR direct sequencing method. Then these SNPs were genotyped by PCR direct sequencing. Five SNPs (g.-638G>A, g.-537A>C, g.-420C>G, g.-358G>A, g.-238G>A) were detected in the intron reginos, but the allele frequencies of these SNPs were not signifi cantly different between type 2 diabetic patients and the control group(P>0.05). So we concluded no association of these SNPs in resistin gene with the risk of T2DM was found in elderly Han people in Northeast China.

2712-POComparison of Genome-Wide Variation between Kuwaiti and Hap-Map PopulationsGAURAV THAREJA, SUMI E. JOHN, MOHAMED F. ALKAYAL, OSAMA ALSMADI, ALPHONSE T. THANGAVEL, Kuwait City, Kuwait

Variations in gene allele frequencies can contribute to differences in the prevalence of complex diseases and differential drug responses among populations. Our analysis with GWAS data showed clear clusters between Kuwaitis and south Asian Group. Therefore, we compared genetic varia-tions frequencies, population substructures and Hardy Weinberg Equilibrium (HWE) between Kuwaiti and other HapMap populations. Allele frequencies were measured for 551345 single nucleotide polymorphisms across subjects. Allele frequencies in the Kuwaiti population (N = 122) were highly correlated with allele frequencies in HapMap populations of European ancestry (CEU (N =112) and TSI (N=102)) (Spearman’s r2 = 0.98). The correlation was lower be-tween Kuwaiti and other ancestry populations (r2 < 0.85). (Chinese Ancestry (CHB (N = 137), CHD (N = 113) and JPT (N = 113)), (African Ancestry (ASW (N = 53), LWK (N=110), MKK (N=150) and YRI (N=147)). Principal component Analy-sis revealed no population sub-structures among the Kuwaiti subjects but revealed clear clusters of various ancestry groups among HapMap popula-tion. A particular SNP of interest to diabetes community is rs1193179 that is associated with Type II Diabetes Mellitus in French case-control cohort. Our analysis showed similar allele frequencies (and hence similar risk) for this SNP in European and Kuwaiti population but with different HWE p-values; Cochran-Armitage association test after Bonferroni correction for multiple testing showed -log10 P values 10 for Chinese and African population, but -log10 P value of 0.024 for European population.

IMMUNOLOGY

2713-POEffect of Intensive Diabetes Treatment on the Association Between Periodontal Condition and GlycohemoglobinISAO MINAMI, TAKANORI CHIBA, MAKIYO MIMURA, KIICHIRO HIRAISHI, TAK-AYUKI WATANABE, Yokohama, Japan

It is well known that diabetic subjects with poor control are at high risk for periodontal disease. But it is unclear whether diabetes treatment improves periodontal condition. The aim of this study was to prospectively assess the effect of intensive diabetes treatment on periodontal disease by evaluat-ing the association between glycohemoglobin (A1c) and variables indicating periodontal condition. We assessed 36 diabetic patients (age: 53.1 ± 13.4 years; 19 men and 17 women) with poor control, who were admitted to our hospital for intensive treatment and education for diabetes management. Scaling and mechanical tooth cleaning were performed, and the patients were given oral hygiene instructions during the course of hospitalization. All the patients were treated as outpatients after discharge. Body mass index (BMI), A1c level and periodontal conditions of the patients were recorded at baseline and 6 months after hospitalization. The variables used for evaluat-ing periodontal conditions included percentage of bleeding on probing (BOP) and plaque control record (PCR). After 6 months, signifi cant reduction was noted in A1c level (10.7 ± 2.2% vs 7.4 ± 1.5%; p < 0.001 ) and the BOP rate (%BOP) (40.6 ± 27.8% vs 23.8 ± 20.7%; p < 0.001 ). However, no signifi cant change was observed in the BMI and the PCR rate (%PCR). Spearman’s rank correlation analysis showed positive correlation between A1c and %BOP (r = 0.388; p = 0.019), while %PCR also tended to be positively associated with %BOP (r = 0.321; p = 0.057). Furthermore, a stronger correlation be-tween A1c and %BOP was observed among 13 non-smoking patients (r = 0.757; p = 0.003), whereas no signifi cant correlation was found among 23 smoking patients (r = 0.020; p = 0.927). Our results suggested that improve-ment in the A1c level by intensive diabetes treatment might lead to a de-crease in the BOP rate, which is a marker of gingival infl ammation. PCR rate, which is a marker of oral hygiene status, and a smoking habit could also affect the BOP rate.

2714-POA Preliminary Report on Serum Monocyte Chemoattractant Pro-tein-1 (MCP-1) as a Biomarker in Diabetes and PeriodontitisPREETHI RADHAKRISHNAN, PADMA SRIKANTH, KRISHNA G. SESHADRI, B. RAMYA, Chennai, India

Role of Serum MCP-1 as a biomarker of periodontitis is well studied. How-ever its role in diabetes with periodontitis is not known. This study was conducted to determine the presence and concentration of serum MCP-1 in diabetic patients with and without periodontitis, and also correlate with glycemic status. A prospective study was conducted with 37 adult diabetic patients (excluding hemoglobinopathies, hypertension, renal and hepatic failure, cardiovascular diseases and pregnancy) grouped into well-controlled diabetes (HbA1c<7%) without periodontitis (n=7) (group I), well-controlled di-abetes with periodontitis (n=15) (group II) and uncontrolled diabetes (HbA1c

7%) with periodontitis (n=15) (group III). Blood samples were collected and a quantitative assay (ELISA) was done to estimate MCP-1 concentration in