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The Diabetes Control and Complications Trial (DCCT, 1983–1993) showed that intensive therapy (mean HbA1c 7.2%) compared with conventional therapy (mean HbA1c 9.0%) markedly reduced the risks of retinopathy, nephropathy, and neuropathy, and these reductions in complications were entirely attributable, statistically, to the difference in mean HbA1c levels. The DCCT cohort has been followed in the Epidemiology of Diabetes Interventions and Complications (EDIC) study (1994 to date). Early in EDIC, mean HbA1c levels in the former intensively and conventionally treated groups converged. Nevertheless, the beneficial effects of DCCT intensive versus conventional therapy on microvascular complications not only persisted but increased during EDIC. The differences in complications during EDIC were wholly explained, statistically, by differences between groups in HbA1c levels during DCCT. These observations give rise to the concept of metabolic memory. Subsequent similar findings from the UKPDS gave rise to a similar concept, which they called the legacy effect. In this report, we present the evidence to support metabolic memory as both a biological and epidemiological phenomenon and discuss potential underlying mechanisms. We also compare metabolic memory and the legacy effect and conclude that the two are likely biologically similar, with comparable effects on long-term outcomes. The long-term influence of metabolic memory on the risk of micro- and macrovascular complications supports the implementation of intensive therapy, with the goal of maintaining near-normal levels of glycemia, as early and as long as safely possible in order to limit the risk of complications.

In January 2019, the ABCD nationwide semaglutide audit was launched with the aim of providing real world evidence on semaglutide use in UK clinical practice. Methods: Data were extracted from the ABCD audit tools and included providing they had sufficient follow-up data. Data were analysed in Stata SE 16. A planned sub-analysis of those switched from any other glucagon like peptide receptor-1 agonist (GLP1-RA) was performed. Results: 1467 patient data sets were included with a mean±SD age 58.9 years ±11.1, weight 106.4kg ±23.2, BMI 36.8kg/m2 ±7.4, HbA1c 9.4% ±1.7 (79.1mmol/mol±18.6). This population is significantly different to the randomised control trial populations which had mean weight approx. 93kg and mean HbA1c approx. 8.2% (66mmol/mol). Median diabetes duration 10.6 years (IQR 5-14.7); 55.3% were male. The median follow-up period was 0.6years (IQR 0.4-0.8). In this cohort mean changes in HbA1c -1.2% (95% CI -1.1, -1.3) or -13.2mmol/mol (95% CI -11.8, -14.5) (P Conclusion: This early analysis demonstrates the differences between our real-world cohort and the more stringently controlled randomised control trial cohorts - in the UK semaglutide is being used in people with diabetes who are heavier and with higher HbA1c levels at baseline. Additional reductions in HbA1c and weight were observed in those switching from alternative GLP1-RAs. Disclosure T. S. J. Crabtree: Other Relationship; Self; Novo Nordisk, Sanofi. R. E. Ryder: Other Relationship; Self; Novo Nordisk. A. Bickerton: None. D. K. Sennik: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. A. Rohilla: None. S. Sivappriyan: None. D. Barnes: None. M. L. Cull: None. I. W. Gallen: None. K. Adamson: None. Funding Association of British Clinical Diabetologists

Current guidelines recommend prescribing SGLT2 inhibitors to patients (pts) with type 2 diabetes (T2D) and established or at high risk for cardiovascular (CV) disease, irrespective of HbA1c levels. We assessed whether the CV and renal benefits of dapagliflozin vary by baseline HbA1c. In the Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 study 17160 pts with T2D were randomized to dapagliflozin (DAPA) or placebo (PBO) for a median follow up of 4.2 years. Baseline HbA1c was 0.05, figure). In a pre-specified subgroup analysis, high HbA1c levels posed greater CV and renal risk, yet the benefits of DAPA were observed irrespective of baseline HbA1c including those with HbA1c Disclosure A. Cahn: Advisory Panel; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Eli Lilly and Company, Novo Nordisk, Consultant; Self; Glucome, Medial Early Sign, Speaker’s Bureau; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk. I. A. Gause-nilsson: Employee; Self; AstraZeneca. A. Langkilde: Employee; Self; AstraZeneca, Stock/Shareholder; Self; AstraZeneca. M. S. Sabatine: Consultant; Self; Althera, Amgen Inc., Anthos Therapeutics, AstraZeneca, Bristol-Myers Squibb Company, Intarcia Therapeutics, Inc., Merck & Co., Inc., Research Support; Self; Amgen Inc., Anthos Therapeutics, AstraZeneca, Daiichi Sankyo, Eisai Inc., Intarcia Therapeutics, Inc., Medicines Company , MedImmune, LLC, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc. I. Raz: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi, Consultant; Self; AstraZeneca, BOL, Camereyes, Concenter BioPharma Ltd., DarioHealth, Diabot, Exscopia, GlucoMe, Insuline Medical, Medial EarlySIgn, Orgenesis Inc., Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi, Stock/Shareholder; Self; BOL, Camereyes, DarioHealth, Diabot, GlucoMe, Orgenesis Inc. S. D. Wiviott: Consultant; Self; Aegerion Pharmaceuticals Inc., Allergan, AngelMed, Arena Pharmaceuticals, Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Boston Clinical Research Institute, LLC., Bristol-Myers Squibb Company, Daiichi Sankyo, Eisai Inc., Eli Lilly and Company, ICON Clinical, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Servier, St. Jude Medical, Xoma, Employee; Spouse/Partner; Merck & Co., Inc., Research Support; Self; Amgen Inc., Arena Pharmaceuticals, Inc., AstraZeneca, Bristol-Myers Squibb Company, Daiichi Sankyo, Eisai Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. O. Mosenzon: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., BOL Pharma, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Self; AstraZeneca, Novo Nordisk, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi. S. Murphy: Research Support; Self; Abbott, Amgen Inc., Anthos, AstraZeneca, Daiichi Sankyo, Eisai Co., Ltd., Intarcia Therapeutics, Inc., MedImmune, LLC, Merck & Co., Inc., Novartis AG. E. L. Goodrich: Research Support; Self; AstraZeneca. D. L. Bhatt: Research Support; Self; Afimmune Limited, Amarin Corporation plc, Amgen Inc., AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Idorsia Pharmaceuticals Ltd, Lexicon Pharmaceuticals, Inc., PLx Pharma Inc., Sanofi-Aventis. L. A. Leiter: Advisory Panel; Self; Abbott Diabetes, Amgen Inc., AstraZeneca, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Esperion, Janssen Pharmaceuticals, Inc., Funding AstraZeneca

Despite newer diabetes medications and technology, glycemic control is shown to be inadequate. Furthermore, differences in glycemic control among different racial groups has been reported. To investigate Therapeutic Inertia in terms of HbA1c trend and potential differences among different racial groups, HbA1c results of four racial groups, obtained over an 18-month period, were examined. 430 records of patients seen in a community clinic from January 2017 through June 2019 were reviewed (Table 1). Our study shows that half of the people whose HbA1c is above 7% stay above target in the second test and more at the final test. More Burmese and Hispanic individuals with HbA1c above 7% stay above target in both second and final test however that differences diminish at higher HbA1c level (Table 2). Disclosure N. Aung: None. A. Courtney: None. M. E. Lape: None. M. E. Warfel: None. S. Chabot: None. H. T. Hua: None. B. L. Zylinski: None. D. Sharma: None. M. Ratnaraj: None. J. J. Vallon: None.

Type 2 DM in patients with BMIs > 25 is well defined. Gaps exist in understanding lean diabetes (LD), those with BMI < 25. In the US, LD presents in < 12% of patients and most prevalent in minorities. Childhood malnutrition, low socioeconomic status, and early age of onset contribute to this disease variant in developing countries. In Peru, diabetes is estimated to be prevalent in 7% of the population and may be, contrary to some publications, more widespread in remote Amazonian communities where poverty is common and access to health care is lacking. This study identifies characteristics in LD in comparison to individuals with overweight/obese (OOD) type 2 diabetes in Peru. A subsample of individuals with diabetes from a larger pilot study were profiled [F/M = 42/24, age ≥ 18 yrs] in the Amazonian town of Yurimaguas, Peru. We collected glycated hemoglobin (HbA1c), fasting blood lipids panels, height and weight from participants. Diabetes was determined using American Diabetes Association guidelines for HbA1c. In our sample (n = 64), 31.3% of individuals (n = 20) had BMI < 25. HbA1c percentages were significantly higher for LD compared to OOD (11.51%, 9.97% res, p = 0.034). We found no mean difference in age and lipid biomarkers for LD and OOD; for age (54.50 yrs, 53.89 yrs res, p = 0.841), triglycerides (223.56 mg/dL, 218.58 mg/dL res, p = 0.886), LDL (111.97 mg/dL, 114.85 mg/dL res, p = 0.731), HDL (48.12 mg/dL, 48.25 mg/dL res, p = 0.954). The proportion of LD with triglyceride levels > 150mg/dL was less than expected compared to OOD (χ2 = 4.30, df = 1, p = 0.038). We found a larger than expected portion of LD. Consistent with other studies, LD had higher HbA1c levels and less incidences of elevated triglycerides. Elevated blood lipids may be more important when screening OOD. For LD the focus should center on controlling HbA1c levels. Cause for concern is the high number of LD concealed in this study, in a population with a low prevalence of diabetes, and regional physicians could overlook screening in this population. Disclosure D. C. Robbins: None. B. C. Dean: None. C. Gerhold: None. M. Mosher: None. J. Camargo: None. Funding KU Diabetes Institute

Objective: This study aims to show the usefulness of basic carbohydrate counting (BCC) in the glycemic control of patients with type 2 diabetes (T2DM) and to investigate the effects of BCC on body compositions. Subjects and Methods: We included T2DM 20 patients in no insulin therapy with stable dosage of antidiabetic medication 8 weeks before and during the study period. We provided the meal planning according to the indicated sugar mass, which was set to 50% of their energy amount per day. HbA1c levels, daily carbohydrate intake, and body compositions (measured with InBody 770) were collected before and 12 ± 4 weeks after BCC. Results: Before/after BCC of their daily carbohydrate intake and HbA1c levels were 210.7 ± 42.1/171.5 ± 34.9 g (p = 0.0018), and 8.1 ± 1.1/7.4 ± 0.9 % (p = 0.0002), respectively. To examine the effects of BCC on their body compositions, 16 patients with improved HbA1c levels were selected for further analysis. BCC improved their body weight (before/after BCC, 64.4 ± 17.6/63.0 ± 16.6 kg, p = 0.005), BMI (25.7 ± 5.3/25.2 ± 5.0 kg/m2, p = 0.004), body fat mass (21.8 ± 9.5/20.1 ± 8.7 kg, p = 0.014), and abdominal circumference (95.0 ± 13.6/92.9 ± 13.2 cm, p = 0.0004). There was no significant difference in overall SMI, but the muscle mass of right arm, left arm, and trunk significantly decreased while the muscle mass of legs was not affected by BCC. Discussion and Conclusion: Our findings demonstrate that BCC is an effective strategy for improving the glycemic control of T2DM patients. The patients with improved HbA1c levels also showed significant reduction in their body weight, BMI, body fat mass, and abdominal circumference. While preserving the muscle mass of their legs, the muscle mass reduction in their arms and trunks was observed. Combining with resistant training of arms and trunk, BCC may make more positive effects on T2DM patients. Disclosure M. Taniguchi: None. K. Maeda: None. R. Morita: None. R. Harada: None. F. Yoshino: None. Y. Mukai: None. M. Ikeda: None. K. Harada: None. M. Yoshiyama: None. H. Nakano: None.

Hyperglycemic emergencies are life-threatening acute complications of diabetes. Efforts to prevent these events on the population level are hindered by inability to proactively identify those at highest risk. In this retrospective analysis of claims data of adults with type 1 and type 2 diabetes from OptumLabs Data Warehouse between 2014 and 2019, we calculated the adjusted (for age, sex, race/ethnicity, U.S. region) rates of hyperglycemic emergencies and examined their association with sociodemographic (age, sex, race/ethnicity, income), clinical (comorbidities), and treatment (diabetes medications, HbA1c level) factors using negative binomial regression. Among 16,621 adults with type 1 diabetes (age 46.7 [SD, 16.5] years, 48.9% female, 74.6% White) and 615,371 with type 2 diabetes (age 65.5 [SD, 11.9] years, 50.1% female, 56.4% White), adjusted rates of hyperglycemic emergencies were 47.8 (95% CI 43.9-52.0) and 3.7 (95% CI 3.5-3.8) per 1000 person-years, respectively. Table shows model results. Younger age, lower income, higher HbA1c, prior hyperglycemic and hypoglycemic emergencies, and presence of comorbidities (especially in type 2 diabetes) were associated with heightened risk of hyperglycemic emergencies. Event rates in type 2 diabetes increased over time. Proactive engagement of at-risk patients to address hyperglycemia may prevent these dangerous events. Disclosure R. G. Mccoy: None. K. Swarna: None. R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. H. Van houten: None. P. J. O’connor: None. N. Shah: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

There is robust evidence that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of adverse cardiovascular and kidney outcomes. The DAPA-CKD trial (NCT03036150) demonstrated a significant risk reduction in participants with chronic kidney disease (CKD), with and without type 2 diabetes, treated with dapagliflozin 10 mg once daily compared with placebo, as an adjunct to standard care. In this prespecified analysis, we compared the efficacy and safety of dapagliflozin according to baseline glycemic status. The trial included individuals with CKD with an estimated glomerular filtration rate (eGFR) of 25 to 75 mL/min/1.73 m2 and a urinary albumin-to-creatinine ratio of 200 to 5000 mg/g. The primary outcome was a composite of sustained decline in eGFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes. We analyzed results by baseline glycemic status based on the American Diabetes Association criteria for HbA1c level In conclusion, dapagliflozin reduced the risk of kidney and cardiovascular events independent of baseline glycemic status. Disclosure F. Persson: Advisory Panel; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Mundipharma International, Novo Nordisk, Advisory Panel; Spouse/Partner; AstraZeneca, Bristol-Myers Squibb Company, Research Support; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Mundipharma International, Novo Nordisk. R. D. Toto: Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Medscape Education, Otsuka America Pharmaceutical, Inc., Quest Diagnostics, Reata Pharmaceuticals, Inc., Relypsa Inc. A. Langkilde: Employee; Self; AstraZeneca, Stock/Shareholder; Self; AstraZeneca. D. C. Wheeler: Advisory Panel; Self; Merck Sharp & Dohme Corp., Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, GlaxoSmithKline plc., Janssen Global Services, LLC., Mundipharma International, Tricida, Inc., Speaker’s Bureau; Self; Amgen Astellas BioPharma, Astellas Pharma Inc., Napp Pharmaceuticals, Vifor Pharma Management Ltd. H. L. Heerspink: Consultant; Self; AbbVie Inc., Astellas Pharma Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Chinook, CSL Behring, Fresenius Medical Care, Gilead Sciences, Inc., Janssen Research & Development, LLC, Merck & Co., Inc., Mitsubishi Corporation Life Sciences Limited, Mundipharma International, Novo Nordisk, Retrophin, Inc., Research Support; Self; AbbVie Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Research & Development, LLC. Dapa-ckd study group: n/a. P. Rossing: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Merck KGaA, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Vifor Pharma Management Ltd. P. Vart: None. G. M. Chertow: Advisory Panel; Self; Ardelyx, Baxter, Cricket Health, DURECT Corporation, Gilead Sciences, Inc., Reata Pharmaceuticals, Inc., Other Relationship; Self; Akebia Therapeutics, Inc., AstraZeneca, Vertex Pharmaceuticals Incorporated. F. Hou: Consultant; Self; AstraZeneca. J. J. Mcmurray: Other Relationship; Self; AbbVie Inc., Amgen Inc., AstraZeneca, Bayer AG, Cytokinetics Inc., DalCor Pharmaceuticals, Merck & Co., Inc., Novartis AG, Servier Laboratories, Theracos, Inc. R. Correa-rotter: Consultant; Self; GlaxoSmithKline plc., Other Relationship; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Novo Nordisk Inc., Speaker’s Bureau; Self; AbbVie Inc., Janssen Pharmaceuticals, Inc., Takeda Pharmaceutical Co. H. S. Bajaj: Other Relationship; Self; Eli Lilly and Company, Novo Nordisk, Research Support; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Kowa Pharmaceuticals America, Inc., Merck & Co., Inc., Sanofi, Tricida, Inc. B. Stefansson: Employee; Self; AstraZeneca. Funding AstraZeneca

Worldwide guidance advocates regular HbA1c testing for people with diabetes, usually 2-4x/yr. Here we examine the effect of test interval variability (SD in test interval) on HbA1c change over 5yrs (Jun 2012-Jul 2019) using laboratory data. We focused on people with ≥6tests (23582 patients) over 5 years. We grouped cases based on the number of tests between t0 and t0+5yrs and calculated SDdecile for each group. We examined the link between SDdeciles and ΔHbA1c level, stratifying by starting HbA1c. We showed that higher variability in testing frequency links to worsening HbA1c control (Fig1). This effect was most evident in those with lower starting HbA1c levels(Fig1a-d). In those with a starting HbA1c 75mmol/mol, the same trends were seen. These effects were independent of testing interval. These findings indicate that testing consistency, not just numbers/yr, is critical to maintain diabetes control. This has implications for management of sporadic attenders. We need to develop systems to improve testing regularity. Disclosure A. A. Fryer: None. D. Holland: Other Relationship; Self; Siemens Corporation. M. Stedman: None. C. Duff: None. L. A. Green: None. J. Scargill: None. F. Hanna: None. P. Wu: None. A. H. Heald: None.

Introduction: Many cross-sectional studies have reported that higher diabetes knowledge test (DKT) scores were associated with better glycemic controls in outpatients with type 2 diabetes. We investigated whether inpatients with high DKT scores could achieve better glycemic control after discharge. Method: This multicenter longitudinal study included 37 inpatients with type 2 diabetes, who had poor glycemic control from October 2018 to November 2019 in Japan. The exclusion criteria were history of stroke, dementia, and psychiatric conditions. The baseline characteristics were HbA1c level, 10.5%±2.5%; median age, 70 y (58-76); median (first to third quartile); diabetes duration, 6 y (1-20); and fasting plasma C-peptide level, 1.4 ng/ml (0.9-2.0 ng/ml). The patients underwent the original DKT at discharge, consisting of 14 items (full score, 14 points). The Cronbach’s α was 0.71. The questions included Q6 “When is a good time to improve the postprandial blood glucose level if you exercise?”, Q11 “How many calories are in 100 g steamed white rice?”, and Q12 “Which beverage is inappropriate during hyperglycemia?” We investigated whether DKT score and baseline characteristics correlated with the HbA1c level at 48 weeks after discharge. Result: The HbA1c level at 48 weeks after discharge was 7.2% (6.3%-7.6%); ΔHbA1c, −2.6 (−4.6 to −1.2); and total DKT score, 10 (6-11). The total DKT score was negatively associated with the HbA1c level at 48 weeks after discharge (Spearman r: −0.26) and ΔHbA1c (r: −0.30). The subjects with shorter diabetes durations and higher ΔCPR showed improved HbA1c levels. The patients who correctly answered Q6, Q11, and Q12 dependently got better HbA1c levels at 48 weeks after discharge compared with those with incorrect answers(p Conclusion: The better total DKT score improved HbA1c levels in patients with type 2 diabetes at 48 weeks after discharge. Knowledge of calorie intake and best exercise timing may contribute to better glycemic control. Disclosure K. Okubo: None. T. Minami: None. A. Kameda: None. T. Yamada: None. H. Hiiragi: None. F. Yoshida: None. M. Takahashi: None. Y. Suzuki: None. Y. Terauchi: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K. K., Novo Nordisk, Sanofi, Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K. K., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Speaker’s Bureau; Self; Abbott, Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K. K., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited.

About 1/3 of GDM patients end up with insulin therapy due to failure of glucose control after diet modification. Interestingly, their glucose and HbA1c levels at the time of diagnosis may not be higher than those of GDM women who do not need insulin therapy. Therefore, identifying an indicator of insulin therapy in GDM is useful. Thirty-three women diagnosed with GDM by 100-g OGTT were enrolled. Blood and feces were collected at the time of GDM diagnosis (1st-2nd trimester; pre-treatment) and before delivery (GA ≥37 weeks; post-treatment). During the follow-up, 8 of 33 ended up with insulin therapy, while 25 of 33 could control their glucose levels by diet modification. BMI, fasting glucose, 2-h glucose, and HbA1c levels showed no difference between groups at pre-treatment. However, gut microbiota analysis in feces revealed that Eubacteria, Clostridiales, Lactobacillus, Bacteroidetes, and Enterobacteria were higher in insulin therapy group at pre-treatment (Figure 1). At post-treatment, all blood parameters and gut microbiota did not differ between groups (Figure 1). The results suggest that insulin therapy could attenuate gut dysbiosis. Interestingly, gut dysbiosis could be an indicator for insulin treatment in GDM. Thus, early modification of gut microbiota to relieve gut dysbiosis prior to the development of GDM may prevent insulin therapy as well as control glucose level throughout pregnancy. Disclosure L. Huang: None. C. Thonusin: None. P. Sililas: None. S. Luewan: None. T. Tongsong: None. N. Chattipakorn: None. S. C. Chattipakorn: None. Funding National Research Council of Thailand (to S.C.C.); Thailand Science Research and Innovation (MRG6280014); National Science and Technology Development Agency Thailand (to N.C.)

In the U.S., Hispanic/Latino populations bear a disproportionate burden of type 2 diabetes (T2D) and its complications. Research suggests that poor air quality may have an influence on progression of T2D. We compared HbA1c levels in Hispanic/Latino (95% Mexican-origin) adults with T2D by exposure to particulate matter HbA1c levels were measured on 101 participants (54±12 years, 65% female, 25% insulin users, 60% uninsured, 40% food insecure). A third (36%) had an HbA1c 9.0%. We matched HbA1c with California Air Resource Board (CARB) air pollution records to create a regression model relating HbA1c to average ambient PM2.5 concentration with participant zip codes 14 days prior to HbA1c measurement. PM2.5 exposure was stratified as “high” or “low,” (> or < 12 µg/m³ annual CARB standard PM2.5 concentration), controlling for other PM2.5-correlated factors (location, year and month fixed effects). Figure 1 shows regression-adjusted mean [95% CI] HbA1c for low (N=85) and high exposure individuals (N=16) and estimated difference between groups (2.2%, p Air pollution exposure should be considered as an independent factor impacting glycemic control in Hispanic/Latino adults with T2D. Disclosure N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. O. Deschenes: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc. Funding Eli Lilly and Company (2017-5864)

This study assessed HbA1c across the lifespan in people with T1D in Austria/Germany, Sweden, and the United States (U.S.) between 2011 and 2017. Data extracted from the DPV, Austria/Germany (n = 25651 in 2011, n = 29442 in 2017); SWEDIABKIDS/NDR, Sweden (n = 44474 in 2011, n = 53690 in 2017); and T1D Exchange, U.S. (n = 16198 in 2011, n= 17087 in 2017) registries were included in the analysis. Mean HbA1c across the lifespan in 2017 and changes in mean HbA1c between 2011 and 2017 overall and by age cohorts were analyzed. In 2017 mean HbA1c for adults ≥45 years converged across registries; HbA1c levels for subjects Disclosure A. Albanese-O’Neill: Consultant; Self; American Diabetes Association. J. Hermann: None. A. Svensson: None. K. Miller: None. K. Raile: None. K. Akesson: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. K. Eeg-Olofsson: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. R.W. Holl: None. R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. Funding German Center for Diabetes Research; The Leona M. and Harry B. Helmsley Charitable Trust (G-2016PG-T1D053)

Older people with T2D have a high prevalence of comorbidities, frailty and polypharmacy. We investigated the effects of linagliptin (LINA) 5 mg versus glimepiride (GLIM) 1-4 mg once daily across age groups in the CARdiovascular Outcome Study of LINAgliptin Versus Glimepiride in T2D (CAROLINA®). CAROLINA® recruited adults with relatively early T2D, HbA1c 6.5-8.5%, and elevated CV risk and its primary outcome was CV death, non-fatal myocardial infarction, or non-fatal stroke (3P-MACE), with secondary outcomes including mortality as well as change from baseline in HbA1c, weight and hypoglycemia. Of 6033 patients (median age 64 [range 36-85]), 846 (14.0%) were ≥75 years. During median follow-up of 6.3 years, CV and mortality outcomes rates did not differ between treatment groups overall and across age categories (interaction p-values >0.05). Over time, following some initial dynamics, changes in HbA1c levels were comparable between treatment-groups and across age, but hypoglycemia risk (Fig) and weight were significantly lower with LINA vs. GLIM overall and consistently across age groups. These data demonstrate that results for CV and mortality outcomes were consistent across age subgroups, but LINA has a modest benefit in weight and a significantly lower hypoglycemia burden than GLIM, which are important safety considerations when selecting therapy for the elderly. Disclosure M. Espeland: Other Relationship; Self; Boehringer Ingelheim International GmbH, Ironwood Pharmaceuticals. R.E. Pratley: Other Relationship; Self; AstraZeneca, Eli Lilly and Company, GlaxoSmithKline plc., Glytec, Janssen Scientific Affairs, LLC., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals Incorporated, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. J. Rosenstock: Research Support; Self; AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., GlaxoSmithKline plc., Lexicon Pharmaceuticals, Inc., Oramed Pharmaceuticals, PegBio Co., Ltd., Pfizer Inc., REMD Biotherapeutics. Other Relationship; Self; Applied Therapeutics, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. T. Kadowaki: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Abbott, Astellas Pharma Inc., AstraZeneca K.K., Boehringer Ingelheim Pharmaceuticals, Inc., Cosmic Corporation, Daiichi Sankyo, Eli Lilly Japan K.K., FUJIFILM, Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Medscape Education, Medtronic, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, NIPRO Medical Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Asahi Mutual Life Insurance. Y. Seino: Research Support; Self; ARKRAY, Bayer Yakuhin, Ltd., Boehringer Ingelheim International GmbH, Eli Lilly Japan K.K., Merck Sharp & Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Speaker’s Bureau; Self; Becton, Dickinson and Company, Eli Lilly Japan K.K., Kao Corporation, Merck Sharp & Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. B. Zinman: Advisory Panel; Self; Abbott, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi-Aventis. N. Marx: Other Relationship; Self; Amgen, AstraZeneca, Bayer Vital, Boehringer Ingelheim International GmbH, Daiichi Sankyo, Kowa Research Institute, Inc., Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. D.K. McGuire: Consultant; Self; Afimmune, Applied Therapeutics, Merck Sharp & Dohme Corp., Metavant. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Co., Ltd., Eli Lilly and Company, Esperion Therapeutics, Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. K.R. Andersen: None. M. Mattheus: None. A. Keller: Employee; Self; Boehringer Ingelheim International GmbH. O. Johansen: Employee; Self; Boehringer Ingelheim International GmbH. Funding Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance

Objective: To examine the relationships between diabetes care measures and HbA1c levels through analyzing the National Health and Nutrition Examination Survey (NHANES) data between 2007 and 2016. Methods: This cross-sectional study involved subjective and objective data obtained from the CDC NHANES website. Data was then analyzed by STATA14 with ordered logistic regression models, controlling for age, race, gender, health insurance coverage. Subjective data included participants’ answers to the general and diabetes-related questionnaires, and the objective data was their HbA1c levels at the time of the interview/standardized clinical examination. Results: Three of the eight regression analysis models showed statistically significant associations between HbA1c levels and identified diabetes care questions. Conclusion: The levels of HbA1c in people with diabetes were associated with how long ago the participant checked-in with a diabetes specialist, whether having a doctor for diabetes care or not, and how often the participant saw a doctor within a year before the NHANES interview/examination. These findings suggest that connecting with healthcare professionals (Questions 1 - 3) showed significant relationships with HbA1c levels, but the same relationships were not observed between receiving or performing the actual diabetes care measures (Questions 4 - 8) and HbA1c levels. Disclosure C.F. Young: None. H.E. Velasco: None.

CONCLUDE was a randomized, open-label, treat-to-target trial in participants with T2D, who received basal insulin ± oral antihyperglycemic drugs (OADs) and had ≥1 baseline hypoglycemia risk factors, including moderate renal impairment. Participants were randomized to degludec U200 or glargine U300 (± OADs). CONCLUDE demonstrated no significant difference in the overall symptomatic hypoglycemia rate with degludec U200 vs. glargine U300 in the maintenance period (primary endpoint, tested for superiority). However, lower rates of nocturnal symptomatic and severe hypoglycemia in the maintenance period (exploratory secondary endpoints) were observed with degludec U200 vs. glargine U300. The current post-hoc analysis investigated these hypoglycemia endpoints and HbA1c stratified by baseline estimated glomerular filtration rate (eGFR) subgroups ( Disclosure T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor, AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; Novo Nordisk A/S, Roche Diagnostics K.K. H.S. Bajaj: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Kowa Pharmaceuticals America, Inc., Novartis Pharmaceuticals Canada Inc., Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., mdBriefCase, Medscape, Merck Sharp & Dohme Corp., Novo Nordisk Inc. S.R. Heller: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Zealand Pharma A/S. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk A/S. Other Relationship; Self; MannKind Corporation. T. Jia: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. D.C. Klonoff: Consultant; Self; Abbott, Ascensia Diabetes Care, Dexcom, Inc., EOFlow, Fractyl Laboratories, Inc., Know Labs, LifeCare, Inc., Novo Nordisk Inc., Roche Diabetes Care. S. Ladelund: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. L.A. Leiter: Advisory Panel; Self; Abbott, Amgen, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Boehringer Ingelheim International GmbH, Eli Lilly and Company, HLS Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier. Research Support; Self; Amgen, AstraZeneca, Kowa Pharmaceuticals America, Inc., Medicines Company. Speaker’s Bureau; Self; Amgen, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, HLS Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Medscape, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier. M.V. Hansen: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. A. Philis-Tsimikas: Advisory Panel; Self; Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Funding Novo Nordisk A/S

Background: We used DISCOVER, a 3-year observational study of people with T2D, to assess the effects of second-line metformin combination therapies on weight, HbA1c level and risk of hypoglycemia. Methods: Adjusted changes from baseline in weight and HbA1c level at 6, 12, 24 and 36 months were assessed using linear mixed models. An interval censored analysis was used to assess the risk of hypoglycemia. Results: At baseline, 7613 patients from 37 countries received second-line therapy with metformin and a dipeptidyl peptidase-4 inhibitor (DPP-4i; 48.3%), a glucagon-like peptide-1 receptor agonist (GLP-1 RA; 2.4%), a sodium-glucose co-transporter 2 inhibitor (SGLT2i; 8.3%) or a sulfonylurea (SU; 40.9%). When used in combination with metformin, GLP-1 RAs, SGLT2is and DPP-4is were associated with greater weight loss than SUs at all time points (Figure). Beyond 12 months, changes in HbA1c from baseline were similar for all combinations. Patients prescribed metformin and an SU had a greater occurrence of hypoglycemia over 3 years (11.9%) compared with the other combinations (3.9-6.4%). Conclusions: A high proportion of patients received metformin and a DPP-4i or an SU as a second-line therapy. All combinations showed a similar reduction in HbA1c. However, combinations of metformin and an SU were associated with the highest risk of hypoglycemia and the lowest weight reduction. Disclosure K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. B. Charbonnel: Advisory Panel; Self; Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca. A. Cooper: Employee; Self; AstraZeneca. M.B. Gomes: None. L. Ji: None. P. Leigh: Employee; Self; AstraZeneca. Employee; Spouse/Partner; Merck Sharp & Dohme Corp. A. Nicolucci: Consultant; Self; AstraZeneca. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. M.V. Shestakova: None. A. Siddiqui: None. F. Tang: Research Support; Self; AstraZeneca. H. Watada: Advisory Panel; Self; Abbott, Ajinomoto, Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Fuji Film, Janssen Pharmaceuticals, Inc., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Research Support; Self; Astellas Pharma Inc., Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Yakult. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. H. Chen: None. Funding AstraZeneca

Introduction: While glucose remains the major determining factor of HbA1C, other conditions like hemolytic anemia, iron/vitamin B 12 deficiency anemia have also been shown to affect HbA1C. Material and Methods: A prospective study was carried out in a tertiary care center, Kasturba hospital, India over a period of two years, that included patients in the age group of 18 to 70 years with anemia and no proven diabetes. We excluded all patients with diabetes, other forms of anemia, major organ dysfunction, hemoglobin Anemia was treated with iron and/or cobalamin. Hemoglobin was measured every month till normal values were attained. HbA1C was measured at the beginning and at the end of completion of 3 months of treatment. For comparing pre and post therapy HbA1C levels, paired t-testwas used. A p value of Results: We found a significant decrease in HbA1C levels among 70% of the iron deficient group, 72% of the B12 deficiency group and 83% of the dual deficiency group with the treatment of anemia. In our study, as many as 27 (38%) patients were labeled as prediabetic without considering their anemic status. Conclusion: From the observations made in this study, it is evident that HbA1C could be influenced by the anemic state of an individual. Hence, it is advisable to treat patients with anemia before defining their diabetic status. Larger studies are required to know the degree of impact of anemia on HbA1C. Disclosure V. Pendela: None. S. Venugopal: None. P. Kudaravalli: None.

Background: Many studies have estimated the prevalence of type 2 diabetes in suburban regions of India, such as Ahmedabad, Gujarat. However, there are few studies that examine the progression of HbA1C levels in patients diagnosed with diabetes over multiple visits to healthcare facilities. Objective: The primary aims of this study were to assess the efficacy of patient treatment at a diabetes care center in Gujarat, India and determine factors that may affect the progression of HbA1C levels over multiple visits. Methods: A total of 2,037 individuals aged ≥25 years (mean age 53.7 years) were included in this retrospective study. All individuals were previously diagnosed with diabetes and received treatment at the Dia Care Advanced Diabetes Care Center in Ahmedabad. Patient data was acquired from the clinic’s HealthPlix EMR. Results: Of those meeting inclusion criteria, males constituted 69.1%. The average BMI of all subjects was 29.7 kg/m2. Of all 2,037 subjects, only 22.0% (n=442) patients were tested for HbA1C levels multiple times. On average, these subjects underwent blood tests for HbA1C values 3.3 times in a one-year period and HbA1C levels dropped by 0.51 mg/dl (95% CI 0.70-0.31). There was a substantial correlation between the number of clinic visits and the decrease in HbA1C values (R = 0.71). Over the course of one year, 22.6% (19.9-25.1) of subjects who returned to the clinic saw a drop in HbA1C to levels not indicative of diabetes (≤6.5 mg/dl). A significant correlation was observed between RBS measurements and HbA1C levels. Notably, there was also a slight negative correlation between BMI and the number of clinic visits (R = 0.74). Conclusion: Results from this study reinforce the conventional wisdom that frequent visits to one’s physician help achieve glycemic control. More importantly, these results also reflect the success of suburban clinics such as Dia Care and call for physicians to stress the importance of clinic visits and address improvement in metabolic status regularly. Disclosure S. Shah: None. B.D. Saboo: None. S. Shah: None. D. Hasnani: None. V. Chavda: None. J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. H.B. Shah: None. K.J. Patel: None.

Previous research has demonstrated an association between genetic variation in the CTRB1/2 gene and response to incretin therapies. We aimed to evaluate the role of CTRB1/2 rs7202877 (T>G) polymorphism in glycemic response to liraglutide among Greek people with T2D. 116 adults with T2D (51% female, mean BMI 35.4±6.4 kg/m2, mean age 68.3±10.9 years), who had been on treatment with liraglutide for at least 6 months were genotyped for the rs7202877 polymorphism, using real-time PCR. Responders met at least one of the following criteria: i) achievement of good glycemic control defined as HbA1c level of Disclosure A. Kyriakidou: None. A.V. Kyriazou: Research Support; Self; Novo Nordisk A/S. T. Koufakis: None. Y. Vasilopoulos: None. I. Avramidis: None. S. Baltagiannis: None. E. Manthou: None. D.G. Goulis: None. P. Zebekakis: None. K. Kotsa: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Sanofi-Aventis, Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Menarini Group. Other Relationship; Self; Novo Nordisk Inc. Funding Novo Nordisk (91220)

Aim: To assess the awareness of dietary constituents, perception of diet in those with diabetes. Methods: A cross-sectional, objective, qualitative questionnaire-based assessment was performed among outpatient diabetes patients who visited tertiary diabetes care centers in Metropolitan cities of India. The questionnaire was answered by diabetes patients in a simple ’Yes’ or ’No’ format about awareness of various foods. The questions were about diet, quantity that could be consumed, and myths about various food products consumed routinely. Patients’ perception of diet was categorized into ’correct’ and ’incorrect’ depending on their response to each question in a 10-point questionnaire. A score of ’1’ was given for each ’correct’ answer and ’0’ for an ’incorrect’ answer. Maximum score one can get is 10/10 and a minimum of 0/10. Results: Total 2295 patients with diabetes were assessed. Patients included were in age range 9 to 90 years with median age of 55 years. Males, females were 62% and 38% respectively. A mean score of 3.8 and median score of 4 was achieved. 2.2% patients achieved maximum correct answer score of 9/10 and 5.9% patients had minimum score 0/10. 44.8% patients scored 6. Socioeconomic status, education, HbA1c levels, occupation, Insulin use, duration of diabetes were the factors that contributed to better level of awareness about diet (p Conclusion: This study gives valuable insights into the lack of awareness about daily food products and the factors associated with the diet perceptions in diabetic patients. This facilitates health care providers to work on areas that could facilitate improving awareness about dietary practices in those with diabetes. Disclosure R.S. Erukulapati: None. M. Rm: None. K. Dash: None. S. Das: None. H. Reddy: None. V. S: None. A. Punjani: None. S. Yalamanchili: None. S. Tippisetty: None. V.K. Kolukula: None. S.G. Krishna: None.

CGM use is associated with lower HbA1c in people with T1D. We hypothesize early CGM initiation will improve longer term HbA1c. Youth with newly diagnosed T1D from July 2018 to May 2019 (pilot cohort, n=65), were offered CGM initiation in the 1st month of T1D diagnosis with 62 initiating CGM. We compared HbA1c outcomes in this pilot cohort with those diagnosed in 2014-2016 (control cohort, n=272) with follow-up duration restricted to 15 months. HbA1c trajectories were visualized using locally estimated scatter plot smoothing (Figure 1) and compared using a generalized mixed effects regression model adjusted for baseline characteristics (HbA1c at onset, age, sex, race and insurance type). Mean HbA1c at diagnosis was higher in the pilot cohort (12.0% vs. 10.7%). Over the first 15 months of T1D, CGM was initiated in 95% of the pilot cohort (78.5% within 30 days), whereas 56% initiated in the control cohort (1.8% within 30 days). Adjusting for baseline characteristics, mean HbA1c levels were 0.5% lower (95%CI: -1.0, -0.1) in the pilot cohort at 3 months and 1.7% lower (95% CI: -2.6, -0.8) at 6 months compared to the control cohort. Differences beyond 6 months were also in the expected direction and statistically significant at the 0.05 level. Early initiation of CGM in the new onset period was associated with lower HbA1c compared to historic controls. These data suggest that early CGM initiation should be considered a part of standard new onset T1D care. Disclosure P. Prahalad: None. V. Ding: None. A. Addala: None. C. New: None. B.P. Conrad: None. A. Chmielewski: None. E. Geels: None. J. Leverenz: None. A. Martinez-Singh: None. P. Sagan: None. J. Senaldi: None. A. Freeman: None. D. Scheinker: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M. Desai: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care.

DCCT/EDIC participants have been followed for an average of 32 years (N=1,054; mean age 60±7 years; duration T1DM 38±5 years). To evaluate cognitive function in T1DM, mental efficiency and memory were assessed five times during the study. Standardized z-scores were calculated relative to the DCCT baseline evaluation and averaged to obtain three summary domain scores (immediate recall, delayed recall, mental efficiency). Generalized linear mixed models were used. In 2018, mean HbA1c levels were 7.9±0.9% and 46% of participants had experienced ≥1 hypoglycemic coma/seizure. Adjusted for age, sex, and education, cognition declined over time (p Disclosure A.M. Jacobson: None. C.M. Ryan: None. B.H. Braffett: None. R. Gubitosi-Klug: None. G.M. Lorenzi: None. J.A. Luchsinger: Consultant; Self; vTv Therapeutics. V.R. Trapani: None. I. Bebu: None. N. Chaytor: Consultant; Self; Eli Lilly and Company. S.M. Hitt: None. K. Farrell: Stock/Shareholder; Spouse/Partner; Dexcom, Inc., Tandem Diabetes Care. J.M. Lachin: Board Member; Self; Tolerion, Inc. Funding National Institute of Diabetes and Digestive and Kidney Diseases

Glycemic control varies among different cohorts of pregnant women with diabetes. Most studies examining differences between groups using continuous glucose monitoring (CGM) data were performed with older CGM systems worn for 2-7 days. We examined differences in glycemic control and glycemic variability (GV) between pregnant women (n=32) with T1D (n=20), T2D (n=3), or GDM (n=9) in the 2nd and 3rd trimesters using the Dexcom G6 CGM system, worn for 10 days as part of a pregnancy CGM accuracy trial. Pair-wise comparisons were made between groups and group heterogeneity testing was performed. No adjustments were made for multiple comparisons analyses. Most women required insulin therapy (26/32, 81%). The baseline HbA1C levels were similar between groups (Table). The glucose management indicator (GMI) was numerically similar to HbA1C for the T1D and GDM cohorts. Time spent >140 mg/dL (p=0.009) was highest and time in range (63-140 mg/dL) was lowest (p=0.001) in women with T1D compared to the other groups. The coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE) were highest in the T1D group, lowest in the GDM group, and intermediate in the T2D group (p Disclosure S. Polsky: None. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. X. Zhang: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. S.J. Brackett: None. C. Levister: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. Funding Dexcom, Inc.

Background: There is a large variation in mean HbA1c levels even between high-income countries, with a decrease over time in HbA1c in some countries but an increase in others. Sweden has experienced a steady decrease in HbA1c over the past 10 years. The aim of this study was to illustrate how changes in HbA1c during the first two years after diagnosis in children and adolescents is related to calendar year for diagnosis of type 1 diabetes from 2010 to 2017. Methods:The Swedish SWEDIABKIDS registry collects data every ~3 months and has > 95% coverage up to age 18 years. We plotted all available HbA1c data vs. diabetes duration, presented as separate Loess curves per 2 consecutive year groups. Results: In total, 5,102 patients contributed with 51,550 HbA1c values over 8 years. HbA1c at onset has slightly increased from 93.9 to 95.0 mmol/mol (10.7 to 10.8 %) between 2010 and 2017. The HbA1c nadir (lowest level during first year) is around 4 months, and has become lower over the years. Early HbA1c tracking is apparent and is established with a difference between the groups from 1 year’s diabetes duration. Conclusions: Intensification of early diabetes treatment, resulting in a lower HbA1c nadir at 4 months and lower HbA1c from 1 year onwards is related to HbA1c two years after diagnosis. Thus, a modifiable factor for a long-term improvement in metabolic control has been identified. Disclosure R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. I.I. Steineck: None. J. Anderzén: None. K. Eeg-Olofsson: None. J. Ekelund: Employee; Spouse/Partner; AstraZeneca. S. Gudbjörnsdottir: None. L. Hanberger: None. J. Nåtman: None. A. Pundziute Lyckå: None. A. Svensson: None. S. Särnblad: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. K. Akesson: None.

In “Understanding Metabolic Memory: A Tale of Two Studies,” Miller and Orchard (1) purportedly disprove “metabolic memory.” However, their analyses do not directly address metabolic memory and their interpretations are flawed. The Diabetes Control and Complications Trial (DCCT) (2) demonstrated that randomly assigned intensive therapy, with mean HbA1c of ∼7%, dramatically reduced microvascular complications compared with conventional therapy, with mean HbA1c of ∼9%, an effect entirely attributable to the separation in HbA1c levels between the two groups (3). Afterward, all participants were taught intensive therapy and referred to their physicians for care, resulting in similar HbA1c levels of ∼8% in the two original groups. This would have been predicted to narrow the rate of complications between the original groups. However, with …

Poor adherence to medication is a clinically relevant issue closely associated with incidence and deterioration of complications in those with diabetes mellitus (DM). Although an elevated HbA1c level is an established risk factor for lower limb amputation, few studies have evaluated the impact of medication adherence combined with HbA1c levels on lower limb amputation. Thus, we analyzed data from 6,957 patients with DM whose records for oral hypoglycemic agents were available for at least 1 y. Medication adherence was evaluated by the proportion of days covered (PDC), with PDC Disclosure M. Kaneko: None. K. Fujihara: None. T. Osawa: None. M. Harada: None. M. Kitazawa: None. Y. Matsubayashi: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Effects of switching to a titratable fixed-ratio combination of insulin glargine plus lixisenatide (iGlarLixi) in patients (pts) with T2D on GLP-1 RAs have been unknown. LixiLan-G (NCT02787551), a randomized, open-label, 26-week trial, compared switching to iGlarLixi vs. continued GLP-1 RA use in pts with T2D and HbA1c 7-9% despite receiving a maximum tolerated dose of a GLP-1 RA (liraglutide QD, exenatide BID, exenatide extended-release QW, albiglutide QW, or dulaglutide QW) with metformin ± pioglitazone ± SGLT2i. Treatment effects seen across baseline factors, such as BMI, GLP-1 RA type, and pioglitazone or SGLT2i use, were consistent with the primary analysis. This exploratory analysis examined HbA1c change at week 26 and documented symptomatic hypoglycemia in 26-week completers (modified ITT) by screening subgroup HbA1c levels (≤7.5%, >7.5-≤8%, and >8%). At week 26, mean HbA1c levels for iGlarLixi were 6.6%, 6.6%, and 6.9%, respectively, vs. 7.2%, 7.4%, and 7.5%, respectively, for GLP-1 RAs. Reductions were greater for iGlarLixi than for GLP-1 RAs in all subgroups (p In conclusion, in pts with T2D inadequately controlled on GLP-1 RA and OAD(s), iGlarLixi demonstrated additional glycemic benefit across a broad range of HbA1c levels. Disclosure S. Del Prato: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, GlaxoSmithKline plc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Servier, Takeda Pharmaceutical Company Limited. Board Member; Self; AstraZeneca. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. L. Blonde: Consultant; Self; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Research Support; Self; Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US. R.R. Henry: Advisory Panel; Self; Elcelyx Therapeutics, Inc. Consultant; Self; Diasome Pharmaceuticals, Inc., Ionis Pharmaceuticals, Inc. Employee; Self; Eli Lilly and Company. Research Support; Self; AstaReal, Hitachi, Ltd., Viacyte, Inc. Speaker's Bureau; Self; Servier. Other Relationship; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Johnson & Johnson, Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. V.R. Aroda: Consultant; Self; ADOCIA, AstraZeneca, Becton, Dickinson and Company, Novo Nordisk Inc., Sanofi, Zafgen, Inc. Employee; Spouse/Partner; Merck & Co., Inc. Research Support; Self; AstraZeneca, Calibra Medical, Eisai Inc., Janssen Research & Development, Novo Nordisk Inc., Sanofi, Theracos, Inc. N. Shehadeh: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi-Aventis. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp. E. Niemoeller: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. E. Souhami: Employee; Self; Sanofi Research & Development. J. Wu: Employee; Self; Sanofi. X. Wang: Employee; Self; Sanofi Research & Development. C. Ji: Employee; Self; Sanofi Research & Development. J. Rosenstock: Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Genentech, Inc., GlaxoSmithKline plc., Lexicon Pharmaceuticals, Inc., Melior Pharmaceuticals, Inc., Bukwang Pharm. Co., Ltd., Merck & Co., Inc., Oramed Pharmaceuticals, PegBio Co., Ltd., Pfizer Inc. Other Relationship; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. Funding Sanofi

Several studies focused on clinical inertia in the U.S. T2D population have demonstrated a significant delay in treatment intensification in real-world clinical practice. The objective of this study was to evaluate if there is a disparity in clinical inertia based on sociodemographic factors. The GE Centricity Electronic Medical Record database (2015 data) was used to identify T2D patients on dual therapy with metformin and another oral antihyperglycemic agent (OAHA). Included patients had ≥12 months of continuous enrollment prior to index date (initiation of dual therapy), further intensified therapy within 2 years following the index date and had an HbA1c measure available within 6 months prior to intensification. Treatment intensification was defined as addition of another OAHA or initiation of insulin/GLP-1RA. 991 patients met the inclusion criteria; mean age of 57.9 years and 47.4% were female. Table lists the distribution of sociodemographic factors by HbA1c categories. Results suggest that older patients were less likely to be intensified at higher HbA1c compared to younger patients. Furthermore, compared to whites, black patients were more likely to be intensified at higher HbA1c levels with no apparent pattern of intensification by region. In conclusion, decision to intensify in clinical practice may be associated with sociodemographic factors such as age and race. Disclosure G. Fernandes: None. B. Sawhney: Consultant; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson & Johnson. Employee; Self; Merck & Co., Inc. A. McNeill: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: None.

HbA1c is an important marker for glycemic control; however, not only plasma glucose levels but also RBCs' lifespan determines the value. Some of interferon-free, direct-acting antiviral regimens for hepatitis C are combined with ribavirin, which causes hemolytic anemia. Hemolytic anemia shortens the RBCs' lifespan and lowers HbA1c levels. We monitored HbA1c levels in 28 patients during and after antiviral therapy with daily sofosbuvir (400 mg) plus weight-based ribavirin for hepatitis C. Five cases (18%) had antidiabetic medication. The hemoglobin concentration, 13.9 ± 1.4 g/dl at the baseline, significantly fell to 12.0 ± 1.3 g/dl at the 4th week of treatment (P < 0.001). It hardly declined further during the treatment and immediately recovered after the end of treatment. Although there was no significant change in the random plasma glucose levels, the HbA1c level, 5.8% ± 0.7% at the baseline, gradually declined to 4.3% ± 0.7% (- 1.5% ± 0.7%, P < 0.001) at the end of treatment. It partly recovered to 4.8% ± 0.6% at the 4th week after treatment, then further increased to 6.2% ± 0.9% at the 12th week, and eventually returned to 5.7% ± 0.7%, which was similar to the value at baseline. Conclusions: interferon-free, direct-acting antiviral regimen combined with ribavirin temporally causes artificial declines in HbA1c levels. Disclosure A. Moriya: None. Y. Iwasaki: None. M. Ando: None.

Previous data showed that poor metabolic control existed in Guangdong type 1 diabetes mellitus(T1DM) patients. Thus, scheduled follow-ups were initiated in our diabetic clinic. This study aimed to assess the effect of scheduled management and explore related factors. From June 2011 to November 2018, 342 patients with T1DM registered in our diabetic clinic. Clinical data was obtained, HbA1c and plasma lipids were measured at enrollment and then once a year. Patients who had been followed-up for three years were included. A total of 201 patients (59.7% female) were analyzed, with median age of 26.9(18.1,35.5) years and diabetic duration of 5.6(0.4,8.8) years. HbA1c levels fell from 8.0±2.0% at enrollment to 7.3±1.2% in the third year progressively (P Disclosure Y. Zhou: None. J. Yan: None. D. Yang: None. S. Luo: None. X. Zheng: None. P. Ling: None. Z. Wu: None. Q. Huang: None. Y. Xian: None. C. Wang: None. Q. Lin: None. H. Liu: None. B. Yao: None. J. Weng: None. Funding Natural Science Foundation of Guangdong Province (2018A030313251); Science and Technology Planning Project of Guangzhou (201709010037)

HbA1c levels are widely used for diabetes diagnosis and management but may misrepresent underlying glucose levels. To assess potential misdiagnoses of diabetes (T2DM) and prediabetes (PreDM) by HbA1c, we examined representative samples of non-pregnant adults and youth in the National Health and Nutrition Examination Survey (NHANES), 2005-2016, who had a 75g OGTT. Normal glucose metabolism (NGM), PreDM, and T2DM were defined by ADA criteria. For each glycemic group, a linear regression model of HbA1c vs. glucose (i.e., mean of FPG and 2hrPG) yielded predicted HbA1c for each participant. The Hemoglobin Glycation Index (HGI), defined as observed - predicted HbA1c, was partitioned into tertiles. Of 10,737 adults aged 18-79 year (representing N=199,270,935), 52% female and 10% non-Hispanic black, with mean age 43.7 year and BMI 28.5 kg/m2. By OGTT criteria, 81.2% had NGM, 14.1% PreDM, and 4.6% T2DM. The high HGI tertile had a higher proportion of non-Hispanic black race (17.7%, vs. middle 8.7%, low 7.0%), as well as higher mean BMI and age, all p65 year (p=0.0016, weighted N=24,142,366) and youth aged 12-17 year (p0.5%. Conclusion: Diagnostic classification by HbA1c alone could lead to misdiagnosis in over 33 million Americans, a problem across all age groups. Overdiagnosis is a particular risk in those with black race, higher BMI, and older age. Complementing HbA1c with glucose testing should improve diagnostic classification and management. Disclosure L.R. Staimez: None. L. Kipling: None. C.N. Ford: None. J. Ham: None. M.K. Rhee: None. L.S. Phillips: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. Research Support; Self; AbbVie Inc., GlaxoSmithKline plc., Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc. Stock/Shareholder; Self; Diasyst Inc. Other Relationship; Self; Diasyst Inc., Janssen Pharmaceuticals, Inc.

Background: DISCOVER is a 3-year, observational study of patients with type 2 diabetes (T2D) initiating second-line glucose-lowering therapy in 38 countries. We assessed socioeconomic factors associated with poor glycemic control (HbA1c ≥ 9.0%) at baseline. Methods: In total, 15 342 participants from 36 countries were evaluated. HbA1c levels were recorded in 12 261 participants (79.9%). Factors associated with an increased likelihood of having HbA1c ≥ 9.0% were assessed using a hierarchical logistic regression model. Results: The mean HbA1c level was 8.4% (SD: 1.7%); 48.9%, 23.4% and 27.7% of patients had HbA1c < 8.0%, ≥ 8.0 to < 9.0%, and ≥ 9.0%, respectively. Socioeconomic factors associated with an increased likelihood of having HbA1c ≥ 9.0% (Figure) included living in lower middle-income (vs. high-income) countries, being treated at a site with public/governmental or mixed (vs. private) funding, having public or no (vs. private) health insurance and having primary or no formal (vs. secondary or higher) education. Male sex and being younger than 50 years of age were also associated with an increased likelihood of having HbA1c ≥ 9.0%. Conclusions: Lower socioeconomic status is associated with an increased likelihood of having HbA1c ≥ 9.0% in people with T2D initiating second-line therapy. Efforts are needed to address social determinants of health in patients with T2D. Disclosure M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. Research Support; Self; CNPq, FAPERJ. F. Tang: Employee; Self; Mid America Heart Institute. Research Support; Self; AstraZeneca. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. S. Pocock: Consultant; Self; AstraZeneca. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Novo Nordisk A/S. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S. M.V. Shestakova: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Novo Nordisk A/S, Sanofi. F. Surmont: Employee; Self; AstraZeneca. H. Watada: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Pfizer Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Kowa Pharmaceutical Europe Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Sanwa Chemical Industry Co. Ltd., Takeda Pharmaceutical Company Limited. J. Medina: Employee; Self; AstraZeneca. S.M. Sadikot: Consultant; Self; AstraZeneca. I. Shimomura: Advisory Panel; Self; AstraZeneca, Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho. Consultant; Self; MSD K.K., Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd. Research Support; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kowa Pharmaceutical Co., Ltd., Lotte Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. G. Luporini Saraiva: Employee; Self; AstraZeneca. A. Nicolucci: Consultant; Self; AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Artsana S.p.A., Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis. Funding AstraZeneca

Introduction: The prevalence of prediabetes and T2DM is increasing globally, and especially in developing countries like Cambodia. Comparisons between metabolic risk profiles of patients with prediabetes and T2DM in Cambodia have not previously been reported. Aims: To compare the clinical characteristics of patients with newly diagnosed prediabetes and T2DM who presented to the Community Medical Center in Phnom Penh, Cambodia. A secondary aim was to determine if any sex differences exist among individuals with T2DM. Methods: A retrospective study of 763 patients diagnosed with prediabetes or T2DM from July 2015 to July 2018 who had a complete biophysical profile. Comparisons were performed between groups using unpaired Student’s t-test. Results: Results are summarized in Table 1. Individuals with prediabetes had lower TG levels but otherwise had similar cardiometabolic risk profiles to those with T2DM. Females compared to males with T2DM presented with lower HbA1c levels, but with higher corrected waist circumferences, higher LDL, and a greater number of cardiometabolic risk factors. Conclusion: Cardiometabolic risk profiles were nearly indistinguishable in those with newly diagnosed prediabetes and T2DM. While females with T2DM presented with lower HbA1c values, they had a greater number of cardiometabolic risk factors compared to males. Disclosure A. Haas: None. S. Peng: None. P. Menh: None. P.G. Curran: None. M. Hudson: None. Funding National Institutes of Health

Background: Needle free insulin injector is designed for diabetics with needle anxiety or fear of injection pain resulting in reluctance to initiate insulin therapy when it is actually indicated. This device has faster absorption of insulin and has better glycemic control compared with conventional insulin pen. But the efficacy of glycemic control was only evaluated by postprandial blood glucose or the area under blood glucose curve. Objective: To investigate the efficacy of needle free insulin injector by HbA1c level compared with conventional insulin pen in insulin treated type 2 diabetic patients in multicenter, prospective, randomized, open-label trial. Methods: A total of 427 patients with HbA1c levels of ≥7.5% to ≤11% while receiving basal or premixed insulin were randomized 1:1 to needle free insulin injector group (NFII) or conventional insulin pen group (CIP). The primary efficacy endpoint was change of HbA1c leve after 16 weeks treatment. The change of 7-point blood glucose profile and the percentage of patients with HbA1c level Results: Of the 412 patients (mean age 57.92±10.03ys; BMI 28.33±2.96kg/m2; HbA1c 8.25±1.00%) who completed the study, 206 patients were insulin treated via NFII and 206 via CIP. There were no significant differences in baseline characteristics between the two groups (P> 0.05). The HbA1c reduction 0.55% (95% CI: -0.71, -0.39) at week 16 in NFII group was non-inferior and statistically superior compared with that of 0.26% (95% CI: -0.42, -0.11) in CIP group. There were no differences between two groups in the percentages of patients achieving the HbA1c target (27.32% vs. 24.26%; P> 0.05) or in the change of 7-point blood glucose profile at week 16. Conclusions: The device non-inferior and statistically superior efficacy in glycemic control compared to conventional insulin pen in insulin-treated type 2 diabetic Patients in China. Disclosure L. Gao: None. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck KGaA, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Roche Pharma, Sanofi. L. Guo: None. Y. Wang: None. L. Chen: Research Support; Self; Becton, Dickinson and Company. G. Wang: None. X. Ran: None. X. Xu: None. Z. Sun: None. Z. Ma: None. Z. Shan: None.

Hypoglycemia (HYPO) is a major barrier in achieving optimal glycemic control in T1D. Intensifying insulin therapy to lower HbA1c is frequently accompanied by an increased risk of HYPO. In two 52-week phase 3 studies (inTandem1 and 2), sotagliflozin (SOTA), a dual SGLT1 and 2 inhibitor as adjunct to optimized insulin therapy, demonstrated significant reduction in HbA1c and body weight without increasing the risk of severe hypoglycemia compared with placebo (PBO) in adults with T1D. To further evaluate the HYPO profile of SOTA added to insulin, we analyzed rates of confirmed HYPO (level 1, glucose ≤70 mg/dL in the study) and clinically important HYPO (level 2, glucose ≤55 mg/dL in the study) in a patient-level pooled analysis (n=1,368) using a negative binomial model adjusted for HbA1c at week 52. Rates of level 1 HYPO events per patient year were 99.48, 77.14, and 77.14 for PBO, SOTA 200mg, and 400mg, respectively (P In conclusion, at week 52 overall level 1 and 2 HYPO event rates were 22.5-30% lower with SOTA when used as adjunct to optimized insulin therapy vs. PBO and were reduced at any HbA1c level especially at lower HbA1c values. Disclosure T. Danne: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis. Speaker's Bureau; Self; Dexcom, Inc. J. Pettus: Advisory Panel; Self; Diasome Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi. Speaker's Bureau; Self; MannKind Corporation. A. Giaccari: Advisory Panel; Self; Sanofi. Board Member; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Merck Sharp & Dohme Corp., Sanofi. B. Cariou: Board Member; Self; Novo Nordisk A/S, Regeneron Pharmaceuticals. Consultant; Self; GENFIT, Sanofi-Aventis. Research Support; Self; Amgen Inc., Pfizer Inc. Speaker's Bureau; Self; Abbott, Akcea Therapeutics, Merck Sharp & Dohme Corp. H.W. Rodbard: Advisory Panel; Self; Bayer US, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Consultant; Spouse/Partner; Eli Lilly and Company. Consultant; Self; Gan & Lee Pharmaceuticals. Research Support; Self; Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. Speaker's Bureau; Self; Merck & Co., Inc., Novo Nordisk Inc. S.A. Weinzimer: Consultant; Self; Eli Lilly and Company, Sanofi. Consultant; Spouse/Partner; Tandem Diabetes Care. Consultant; Self; Zealand Pharma A/S. Speaker's Bureau; Self; Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. Stock/Shareholder; Self; InsuLine Medical Ltd. M. Bonnemaire: Employee; Self; Sanofi. S. Sawhney: Stock/Shareholder; Spouse/Partner; AstraZeneca, Gilead Sciences, Inc., GlaxoSmithKline plc., Merck & Co., Inc., Pfizer Inc. S. Wang: Employee; Self; Sanofi US. R. Castro: Employee; Self; Sanofi US. S.K. Garg: Advisory Panel; Self; Eli Lilly and Company, Roche Pharma, Sanofi-Aventis, Zealand Pharma A/S. Research Support; Self; Eli Lilly and Company, WebMD. Funding Lexicon Pharmaceuticals Inc.; Sanofi

Background: Thanks to technological advancements for medical devices, we can measure glucose by the minute for weeks using a sensor called the continuous glucose monitoring (CGM) system. CGM is time-series data and has been available since devices with low measurement error appeared 10 years ago. CGM can be relied upon to help make treatment decisions. A major issue regarding CGM is clinical interpretation by physicians. Methods: CGM data were obtained by flush glucose monitoring system in 156 type 2 diabetes patients. We divided the patients into 2 groups by mean HbA1c levels during 6 months before getting CGM data. High HbA1c group (High) had their mean HbA1c levels with equal to or above 7% and below 9%. Low HbA1c group (Low) had their mean HbA1c levels with equal to or above 5% and below 7%. The patients with their HbA1c levels equal to or above 9% was excluded from this study. We conducted the experiment with manually created dataset that is designed for evaluating the performance of trajectory extraction. Artificial intelligence (AI) performed pattern mining of raw data of flush glucose in 4 to 8 sequential data sets. Results: Among 156 patients, there were 83 High group patients, while 58 patients were defined as Low group. We excluded 15 patients from this study due to high HbA1c levels, while there was no patient with HbA1c level below 5%. AI constructed 1292 patterns of glucose trajectories from CGM data. We found that 67 patterns were significantly different between High and Low groups 8p Conclusion: In this session, we propose a method of extracting the trajectories of glucose values of CGM in type 2 diabetes patients. Our method could contribute to better CGM interpretation. Disclosure M. Makino: None. R. Yoshimoto: None. M. Kondo-Ando: None. Y. Yoshino: None. I. Hiratsuka: None. W. Maki: None. S. Sekiguchi-Ueda: None. A. Kakita: None. M. Shibata: None. Y. Seino: None. T. Takayanagi: None. M. Ono: None. A. Koseki: Employee; Self; IBM. M. Kudo: Employee; Self; IBM. K. Haida: None. R. Yanagiya: None. N. Hayakawa: None. A. Suzuki: Research Support; Self; Chugai Pharmaceutical Co., Ltd., Dai-ichi Life Insurance Company, IBM, MSD, Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Asahi Kasei Corporation, Daiichi Sankyo Company, Limited, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Taisho Pharmaceutical Co., Ltd.

A relationship between HbA1c levels and emotional regulation in T1/T2 diabetes has been reported. Accordingly, we developed a 10-session Emotion-Focused Cognitive Behavioral Treatment (EF-CBT) program to address this issue. Twenty patients with T2D were equally randomized to EF-CBT and Treatment As Usual (TAU). While both displayed HbA1c reductions mid-trial, the EF-CBT group showed a larger reduction [-1.23 ± 1.11 (d = 1.11)] compared with TAU [-0.67 ± 1.11 (d = 0.61)]. The difference at end- (d = 0.49), but not mid- (d = 0.03) trial, is likely because most EF-CBT elements are after mid-trial. Correlations between changes in HbA1c levels and in diabetes distress (r = 0.57)/Emotion Regulation (r = -0.52), both p < 0.02), were also observed at end-trial. Disclosure E.F. Coccaro: Consultant; Self; Avanir, Inc. Other Relationship; Self; Azevan, Inc. A.K. Busby: None. T.M. Potts: None. L.H. Philipson: Research Support; Self; Jaeb Center for Health Research, Johnson & Johnson. T. Drossos: None. Funding Chicago Center for Diabetes Translation Research (P30DK092949); University of Chicago

Background: Guidelines endorse a target HbA1c of < 7% for most people with T2D, but less stringent goals (e.g., HbA1c < 8%) and medications with a low risk of causing hypoglycemia are recommended for older patients. We examined the prevalence of potential overtreatment in a global cohort of older patients with T2D. Methods: DISCOVER is an ongoing, observational study of 15 992 patients with T2D initiating second-line glucose-lowering therapy in 38 countries. HbA1c levels and glucose-lowering therapies were recorded at baseline (initiation of second-line therapy), 6, 12 and 24 months. The analysis includes patients aged ≥ 65 years with a recorded baseline HbA1c level. Insulin, sulfonylureas, and meglitinides are medications associated with risk of hypoglycemia. Results: Among 3492 older patients, 2110 (60.4%) and 812 (23.3%) had an HbA1c level of < 8% and < 7% at baseline, respectively. The proportions of patients with HbA1c < 7% increased to more than 50% during follow-up (Figure). A third or more of these patients received medications associated with risk of hypoglycemia at baseline and during follow-up. Conclusions: In this global cohort, including patients from both lower-middle- and higher-income countries, many older patients with good glycemic control (HbA1c < 7%) received medications that are associated with increased risk of hypoglycemia. A more tailored management of hyperglycemia may be needed in this population. Disclosure B. Bongaerts: Advisory Panel; Self; AstraZeneca. S.V. Arnold: None. B. Charbonnel: Consultant; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Speaker's Bureau; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. Research Support; Self; CNPq, FAPERJ. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck KGaA, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Roche Pharma, Sanofi. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. M.N. Kosiborod: Consultant; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eisai Co., Ltd., GlaxoSmithKline plc., Glytec, LLC, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novartis AG, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. G. Luporini Saraiva: Employee; Self; AstraZeneca. J. Medina: Employee; Self; AstraZeneca. A. Nicolucci: Consultant; Self; AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Artsana S.p.A., Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis. S. Pocock: Consultant; Self; AstraZeneca. S.M. Sadikot: Consultant; Self; AstraZeneca. M.V. Shestakova: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Novo Nordisk A/S, Sanofi. I. Shimomura: Advisory Panel; Self; AstraZeneca, Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho. Consultant; Self; MSD K.K., Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd. Research Support; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kowa Pharmaceutical Co., Ltd., Lotte Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. F. Surmont: Employee; Self; AstraZeneca. F. Tang: Employee; Self; Mid America Heart Institute. Research Support; Self; AstraZeneca. H. Watada: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Pfizer Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Kowa Pharmaceutical Europe Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Sanwa Chemical Industry Co. Ltd., Takeda Pharmaceutical Company Limited. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Novo Nordisk A/S. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S. Funding AstraZeneca

Effects of SGLT2 inhibitors (SGLT2i) on renal functions were examined in patients with type 2 diabetes followed by our clinic. Subjects were 395 outpatients treated with SGLT2i (ipragliflozin 135; empagliflozin 101; canagliflozin 83; dapagliflozin 76; age 51.6 ± 11.3 years; duration of diabetes 7.21 ± 6.8 years; BMI 28.6 ± 4.5). Changes in eGFR at 1 year before and 2 years after the administration of SGLT2i versus at baseline were retrospectively analyzed in 2 groups divided by the baseline eGFR; eGFR-5/year before administration (n = 137), ΔGFR was +1.9 ± 5.3/year before administration (p HbA1c levels were 7.27 ± 1.19% and 7.67 ± 1.31 at 1 year before and baseline, respectively, and decreased at 2 years (-0.49 ± 1.16%, p Disclosure T. Tosaki: Research Support; Self; Daiichi Sankyo Company, Limited, Sanofi K.K. Speaker's Bureau; Self; Astellas Pharma Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. S.T. Sato: None. M. Kondo: None. Y. Yamada: None. A. Inagaki: None. S. Tsunekawa: None. T. Himeno: None. Y. Kato: Speaker's Bureau; Self; Merck & Co., Inc. J. Nakamura: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Japan Tobacco Inc., Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceu. Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. H. Kamiya: Speaker's Bureau; Self; Astellas Pharma Inc., Eli Lilly Japan K.K., MSD K.K., Novartis Pharma K.K., Novo Nordisk Oharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K.

HbA1c level reflects chronic glycemic status if reliable tests are used. The HbA1c testing improved with the efforts of many national and international organizations; however, in some regions, high performing assays might not be readily available. Here we report a comparison study of two immunoassay methods with a high-performance liquid chromatography (HPLC) assay, all of them available in Ecuador. We studied 114 fresh whole-blood samples from adults with normal and pathological HbA1c levels. HbA1c was measured in all samples by DCA-Vantage point-of-care analyzer, I-Chroma portable fluorescent scanner immunoassay and BioRad Variant II Turbo HPLC. Blood samples with variants of hemoglobin were excluded. HbA1c values were expressed in National Glycohemoglobin Standardization Program percentages and mmol/mol, as mean ± standard deviation. Results: HbA1c measurements by HPLC and DCA-Vantage were similar: 6.3±1.7% (45±18.6 mmol/mol) vs. 6.3±1.8% (45±19.7 mmol/mol), respectively, P=0.057, while HbA1c values by I-Chroma were lower than HPLC, 5.8±1.9% (40±20.8 mmol/mol), P Disclosure B.J. Pazmiño Gomez: None. F.E. Vera Lorenti: None. M.E. Guadalupe Vargas: None. G.M. Alvarez Condo: None. D. Veron: None. A.G. Cercado: None. E.I. Rodas Neira: None. B. Bahar: None. D. Veron: None. Funding Ministry of Higher Education, Science, Technology and Innovation, Ecuador/Prometeo Project/State University of Milagro, Ecuador (UNEMI-OCAS-SO-27092013-N?26 DV2013?2014, UNEMI-OCAS-SO-03072014-N8-DV2014-2015, UNEMI-OCAS-SO-30052016-N5-DV2015-2017)

Monitoring HbA1c levels in individuals affected by diabetes remains the standard of care for ensuring proper management of the condition. Typically, HbA1c is measured by venipuncture or fingerstick blood collection methods at regular intervals, and for nearly all diabetic patients, monitoring HbA1c is a lifelong endeavor. In general, venipuncture and fingerstick are standard blood collection procedures, which are considered inconvenient and painful. Patient surveys have shown that venipuncture induces fear (needle phobia) in more than 20% of adults and in 60% of children. We have designed, developed, and validated an innovative blood sampling device to collect and stabilize capillary blood from the patient’s upper arm. Using small skin incisions and vacuum, the device draws and deposits the blood onto self-contained matrices. The matrices’ cartridge is then shipped at room temperature to a clinical laboratory for HbA1c measurement. We conducted a clinical study at three sites within the U.S. to validate the use of the device on 146 enrolled participants. The primary study objective was to compare HbA1c measurement in samples collected by the device and venipuncture. Pain measurements were conducted to assess the discomfort associated with the use of the device, in comparison to venipuncture and fingerstick. The data demonstrated a strong correlation between the device and venipuncture (y=1.01-0.0131, R2=0.997) over a range of HbA1c values between 4.91 and 13.34%. Device lot-to-lot and operator-to-operator reproducibility studies showed CVs of 0.7% and 0.8%, respectively. Assessment of discomfort showed an average pain score of 1 for the device (on a scale 0 to 10) and the device was preferred over venipuncture and fingerstick by 79% of the subjects. We clinically validated an innovative blood sampling technology that provides a convenient, nearly painless, safe and effective alternative to venipuncture and fingerstick for HbA1c measurement in diabetic individuals. Disclosure E. Romeo: Employee; Self; Drawbridge Health, Inc. P.K. Bryant-Greenwood: None. K.N. Castorino: Consultant; Self; Abbott. Research Support; Self; Abbott, Dexcom, Inc., Drawbridge, Novo Nordisk Inc., Sanofi US. D.R. Liljenquist: None. B.L. Jordan: Employee; Self; Drawbridge Health. Employee; Spouse/Partner; Innovation Endeavors, LLC. M. Harrington: Employee; Self; Drawbridge Health. T. Holscher: Employee; Self; Drawbridge Health. C. Alexander: Consultant; Self; CAlexanderConsulting, LLC. V. Dokukin: Employee; Self; Drawbridge Health. M. Nerlekar: Employee; Self; Drawbridge Health. L. Williamson: Other Relationship; Self; Drawbridge Health. J. Sloane: Other Relationship; Self; Drawbridge Health.

Background: DISCOVER is an ongoing, observational study of people with T2D initiating second-line glucose-lowering therapy in 38 countries in six regions. We report changes in glucose-lowering therapies and HbA1c levels from the first to the second year of follow-up. Methods: HbA1c levels and changes in therapies were recorded at baseline, 1 and 2 years; 15 988 patients were included in the analysis. Results: Mean HbA1c levels at baseline, 1 and 2 years were 8.3%, 7.2% and 7.3%, respectively. At 1 and 2 years, mean HbA1c levels were close to 7.0% in patients receiving one or two oral drugs at 1 year, but were higher than 7.0% for those receiving more than two oral drugs or an injectable drug (Figure). The proportion of patients with HbA1c ≥ 8.0% was similar at 1 and 2 years (19.8% vs. 19.1%). Overall, 16.7% of patients changed therapy during the second year of follow-up. Treatment was intensified by the addition of an oral drug in 6.2% of patients receiving one or two oral drugs, and 3.2% of patients receiving oral therapies initiated an injectable drug. Results were consistent across regions. Conclusions: Glycemic levels were well controlled after 1 and 2 years of follow-up in participants receiving oral therapies, and treatment intensification occurred in a small proportion of people in this group. By contrast, glycemic control was suboptimal in people receiving injectable drugs. Disclosure B. Charbonnel: Consultant; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Speaker's Bureau; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. Research Support; Self; CNPq, FAPERJ. G. Luporini Saraiva: Employee; Self; AstraZeneca. J. Medina: Employee; Self; AstraZeneca. A. Nicolucci: Consultant; Self; AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Artsana S.p.A., Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis. S. Pocock: Consultant; Self; AstraZeneca. M.V. Shestakova: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Novo Nordisk A/S, Sanofi. I. Shimomura: Advisory Panel; Self; AstraZeneca, Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho. Consultant; Self; MSD K.K., Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd. Research Support; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kowa Pharmaceutical Co., Ltd., Lotte Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. S.M. Sadikot: Consultant; Self; AstraZeneca. F. Surmont: Employee; Self; AstraZeneca. F. Tang: Employee; Self; Mid America Heart Institute. Research Support; Self; AstraZeneca. J. Vora: Employee; Self; AstraZeneca. Research Support; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline plc., Merck KGaA, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. H. Watada: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Pfizer Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Kowa Pharmaceutical Europe Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Sanwa Chemical Industry Co. Ltd., Takeda Pharmaceutical Company Limited. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. Funding AstraZeneca

Recent published CV outcome trials have revealed that sodium-glucose cotransporter-2 inhibitors (SGLT2i) significantly reduced the combined CV endpoint and incidences of heart failure-associated hospitalizations in patients with type 2 diabetes mellitus (T2DM) and CV disease (CVD). However, detailed mechanisms of the benefits by SGLT2i still remain unknown. Especially, nobody can show the consensus opinion in the mechanistic effects of SGLT2i on the left ventricular (LV) diastolic dysfunction associated with T2DM. We focused the spectral tissue Doppler-derived E/e' ratio, which has been validated in simple and reproducible noninvasive assessment of LV diastolic pressures independent of rhythm, and evaluated whether or not the treatment of SGLT2i, luseogliflozin, used for 6 months could affect cardiac function in 25 patients with T2DM and CVD. Luseogliflozin used for 6 months significantly reduced HbA1c levels (8.2 ± 1.2% to 7.4 ± 0.6%, p < 0.01) and systolic blood pressure (SBP)(125.6 ± 18.1 mmHg to 119.3 ± 16.8 mmHg, p = 0.04) compared to baseline levels. Moreover, luseogliflozin also significant reduced left atrial (LA) (42.2 ± 5.7 mm to 39.9 ± 6.8 mm, p = 0.01) and LV diameters (diastolic, 49.5 ± 6.9 mm to 47.6 ± 7.6 mm, p = 0.01; systolic, 35.8 ± 9.1 mm to 33.9 ± 9.8 mm, p < 0.01). Remarkably, early annular tissue Doppler (e’) velocity and peak early diastolic velocity/basal septal diastolic velocity (E/e’) ratio were significantly improved, and these benefits were augmented in the group of e’< 6.0cm/sec of baseline (e’ velocity, 4.8 ± 0.6 cm/sec to 5.8 ± 0.9 cm/sec, p < 0.01; E/e’ ratio, 13.0 ± 4.9 to 10.9 ± 3.4, p = 0.03, respectively). There was a significant negative correlation between the changes in E/e’ ratio and baseline of E/e.’ These results indicated that lusegliflozin improved hemodynamics associated with LV diastolic function in the patients with T2DM and CVD, and support the cardio-protective effects of SGLT2i of T2DM with CVD. Disclosure Y. Ina: None. T. Kishi: None. N. Sekiguchi: None. N. Sakane: Board Member; Spouse/Partner; Kao Corporation.

Aims: Efficacy of a GLP-1 receptor agonist, dulaglutide, on renal functions in type 2 diabetic patients under the real-world clinical practice in Japan was retrospectively examined. Subjects: 154 patients with type 2 diabetes treated with dulaglutide (0.75 mg once weekly) in our clinic (mean administration period 540.7 ± 332 days; mean age 58.1 years; mean duration of diabetes 10.5 years). Methods: Dulaglutide was added to the conventional antidiabetes drugs. The dose of sulfonylurea was reduced by 50-67% and all the DPP-4 inhibitors were discontinued. The annual changes in eGFR between 1 year before and 2 years after the administration of dulaglutide were retrospectively analyzed in 2 groups divided by the baseline eGFR; eGFR Results: eGFR in the eGFR HbA1c levels were 8.70 ± 1.76% at baseline, -1.32 ± 1.69% at 1 year (p Conclusions: These observations suggest that dulaglutide may ameliorate renal hyperfiltration and protect renal functions. Disclosure S.T. Sato: None. T. Tosaki: Research Support; Self; Daiichi Sankyo Company, Limited, Sanofi K.K. Speaker's Bureau; Self; Astellas Pharma Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. M. Kondo: None. Y. Yamada: None. A. Inagaki: None. S. Tsunekawa: None. T. Himeno: None. Y. Kato: Speaker's Bureau; Self; Merck & Co., Inc. J. Nakamura: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Japan Tobacco Inc., Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceu. Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. H. Kamiya: Speaker's Bureau; Self; Astellas Pharma Inc., Eli Lilly Japan K.K., MSD K.K., Novartis Pharma K.K., Novo Nordisk Oharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K.

REALI pooled database, encompassing Gla-300 studies conducted in different European countries, is a platform to identify factors contributing to glycemic control in patients with uncontrolled T2DM initiated on Gla-300. A stepwise multivariable regression analysis was performed on selected demographic and baseline characteristics associated with HbA1c drop ≥ 0.5% after 6 months of Gla-300 treatment from 8 studies (3 interventional and 5 observational). The criterion for retention in the model was p ≤ 0.05. From the 2624 subjects included, 64.2% have dropped their HbA1c level by at least 0.5%, 56% were male and 37% were insulin naïve. Means ± SD were 64 ± 9.4 years for age and 32.2 ± 5.4 kg/m2 for BMI. Mean ± SD baseline HbA1c was 8.5 ± 1% and 0.29 ± 0.18 U/kg/day for Gla-300 starting dose. Multivariable analyses identified baseline HbA1c as the major predictive factor associated with HbA1c reduction, with a nonlinear relationship, and odds were higher in the highest baseline HbA1c value (p < 0.0001). Lower BMI (p = 0.048), shorter duration of diabetes (p = 0.016), being insulin naïve (p < 0.0001), and lower Gla-300 starting dose (p < 0.001) have also been identified as potential predictors of HbA1c improvement. These results can help clinicians to identify T2DM patients who are likely to benefit most from Gla-300 treatment. Disclosure G. Bigot: None. M. Bonnemaire: Employee; Self; Sanofi. R.C. Bonadonna: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Sanofi-Aventis. Speaker's Bureau; Self; Eli Lilly and Company, Sanofi-Aventis. P. Gourdy: Advisory Panel; Self; AstraZeneca. Board Member; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis, Servier. Speaker's Bureau; Self; Abbott, Amgen Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis, Servier. D. Müller-Wieland: Advisory Panel; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi-Aventis Deutschland GmbH. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi-Aventis Deutschland GmbH. D. Mauricio: Advisory Panel; Self; Merck Sharp & Dohme Corp., Sanofi. Speaker's Bureau; Self; Almirall, S.A., Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Urgo Medical. A. Ciocca: Employee; Self; Sanofi. N. Freemantle: Advisory Panel; Self; Sanofi. Research Support; Self; Akcea Therapeutics, Allergan, AstraZeneca, Ipsen Biopharmaceuticals, Inc., Sanofi, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Sanofi. Funding Sanofi

Background: International guidelines recommend setting individualized HbA1c targets for people with type-2 diabetes (T2D). DISCOVER (NCT02322762) is an observational study of patients with T2D initiating second-line glucose-lowering therapy in 37 countries. We report the proportion of patients set individualized targets, the proportion meeting these targets after 1 year, and factors associated with meeting these targets. Methods: Patients included had HbA1c data at baseline and at 1 year. Factors associated with meeting targets were assessed using multivariable logistic regression. Results: Of the 7225 patients with complete HbA1c data who remained in the study after 1 year, 5070 (70.2%) had been set an individualized glycaemic control target. Targets were 7.0% for 2513 patients (49.6%), < 7.0% for 2073 patients, (40.9%) and > 7.0% for 484 patients (9.6%). Overall, 1744 of these patients (34.4%) met their target after 12 months of follow-up (range across regions: 21.4-42.7%). Factors associated with meeting HbA1c targets are shown in the Figure. Conclusions: Twelve months after initiating second-line therapy, almost one third of patients with set individualized HbA1c targets had met their targets, with considerable variation between regions. Older age, higher education level, lower baseline HbA1c level and higher target were factors associated with meeting targets. Disclosure K. Khunti: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Sanofi-Aventis, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Sanofi-Aventis, Pfizer Inc.. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; Novo Nordisk A/S. Consultant; Self; Pfizer Inc.. Research Support; Self; Novo Nordisk A/S. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. N. Hammar: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. K. Kennedy: Research Support; Self; AstraZeneca. Employee; Self; Mid America Heart Institute. M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck & Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. S. Pocock: Consultant; Self; AstraZeneca. M.V. Shestakova: None. I. Shimomura: Research Support; Self; Appliance Company, Panasonic Corporation. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Covidien Japan Inc.. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Eli Lilly Japan K.K., Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Kowa Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., MSD K.K., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K.. Research Support; Self; Novo Nordisk Pharma Ltd.. Speaker's Bureau; Self; Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd.. Research Support; Self; Roche DC Japan K.K., Rohto Pharmaceutical Co., Ltd. Speaker's Bureau; Self; Rohto Pharmaceutical Co., Ltd, Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Sanofi K.K.. Speaker's Bureau; Self; Sanofi K.K.. Research Support; Self; Shionogi & Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Taisho Toyama Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Taisho Toyama Pharmaceutical Co., Ltd.. Research Support; Self; Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Takeda Pharmaceutical Company Limited. Research Support; Self; Teijin Pharma Limited. Speaker's Bureau; Self; Teijin Pharma Limited. F. Surmont: Employee; Self; AstraZeneca. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Eli Lilly and Company, Bristol-Myers Squibb Company, Novartis AG, Novo Nordisk A/S, Merck & Co., Inc., Bayer AG, Merck Sharp & Dohme Corp., Takeda Development Center Asia, Pte. Ltd., Sanofi, Roche Pharma, Boehringer Ingelheim GmbH. Research Support; Self; AstraZeneca, Roche Pharma, Sanofi, Merck Sharp & Dohme Corp., Novartis AG, Eli Lilly and Company, Bristol-Myers Squibb Company.

Blacks have higher HbA1c levels than whites with similar glucose levels, suggesting that universal diagnostic criteria could lead to overdiagnosis of diabetes and prediabetes in blacks. We hypothesized alternative HbA1c diagnostic criteria could reduce misclassification in blacks. Data from 3,603 non-Hispanic (NH) white (67.6%) and 1,721 NH black (32.4%), nonpregnant adults (18-70 year) were included from 5 cycles (2005-2014) of the National Health and Nutrition Examination Survey with HbA1c and plasma glucose measures (i.e., fasting and 2 hour from oral glucose tolerance test, OGTT). Diabetes and prediabetes by HbA1c was compared with ’true’ OGTT classification to identify alternative HbA1c values with the lowest misclassification (false positives + false negatives). Survey-weighted rates were computed across a series of HbA1c cutpoints for diabetes (HbA1c ≥5.7 to ≥7.3%) and HbA1c ranges for prediabetes (4.9-5.6% to 6.8-7.5%) in 0.1% increments. By ADA OGTT criteria, the prevalence of diabetes and prediabetes in whites was 4.6% and 42.1%, respectively, and in blacks, 4.2% and 36.9%. Under ADA criteria for diabetes, misclassification was similar in whites (3.7%) and blacks (3.5%), but blacks had 6.3 times the rate of false positives (1.1% blacks vs. 0.2%; p Conclusion: Overdiagnosis of diabetes and prediabetes is disproportionately high among NH blacks compared to NH whites. Increasing the HbA1c diagnostic thresholds by 0.3-0.6% for NH blacks could potentially avert 3.2 million false positives. Disclosure L.R. Staimez: None. C.N. Ford: None. L. Daniels: None. A. Gonzalez: None. F.N. Khan: None. M. Rhee: None. P.W. Wilson: None. L.S. Phillips: Other Relationship; Self; DIASYST Inc.. Research Support; Self; Amylin Pharmaceuticals, Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, PhaseBio Pharmaceuticals, Inc., Roche Diabetes Care Health and Digital Solutions, AbbVie Inc., Vascular Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., GlaxoSmithKline plc., Pfizer Inc.. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Merck & Co., Inc..

A combination drug comprising teneligliptin (Ten) and canagliflozin (Can) became commercially available in Japan in September 2017. No studies reported the effect of this combination drug on variations in blood glucose levels through continuous blood glucose monitoring with the Free Style Libre Pro (Libre Pro). This study prospectively examined the effects in patients treated with either Ten or Can. The subjects were 15 outpatients with diabetes with HbA1c levels ranging from 6.5% to 15% who had been treated with Ten 20 mg (10 patients) or Can 100 mg (5 patients). Doses of antidiabetes drugs other than Ten and Can were maintained throughout the study. The subjects used Libre Pro for 2 weeks. During the first week, Ten or Can was administered. During the second week, the teneligliptin-canagliflozin combination drug (TC) was administered. After completing Libre Pro monitoring, TC was administered continuously for 3 weeks, while patients were followed on an outpatient basis (UMIN000029015). Glycoalbumin level of the Ten group and Can group decreased significantly after switching to TC (p = 0.002, p = 0.035). Over 7 days, the Libre Pro-measured mean blood glucose level of the both group ameliorated significantly after switching to TC (p < 0.001, p = 0.006). Regarding blood glucose variation, the median standard deviation (SD) decreased significantly from 39.2 to 30.5 of the Ten group after switching to TC (p = 0.002), and from 32.9 to 24.4 of the Can group (p = 0.024). In the Ten group, The mean amplitude of glycemic excursions (MAGE) at day 7 improved significantly from 75.0 mg/dL to 47.5 mg/dL after switching to TC (p = 0.013); in the Can group, from 88.5 mg/dL to 44.5 mg/dL (p = 0.043). There were no significant changes in fasting blood glucagon levels in either group. These results indicate that patients who switched from Ten to TC experienced significant improvements in blood glucose control, as assessed by Libre Pro. Disclosure T. Tosaki: Other Relationship; Self; Eli Lilly and Company, Takeda Development Center Asia, Pte. Ltd., MSD K.K., Mitsubishi Tanabe Pharma Corporation. H. Kamiya: Other Relationship; Self; MSD K.K., Ono Pharmaceutical Co., Ltd., Sanofi K.K., AstraZeneca, Astellas Pharma KK, Eli Lilly and Company, Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Ltd, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd.. S. Sato: None. A. Kudara: None. A. Inagaki: None. M. Kondo: None. S. Tsunekawa: None. Y. Kato: Speaker's Bureau; Self; Merck Sharp & Dohme Corp., Sanofi, Takeda Pharmaceutical Company, Eli Lilly Japan. J. Nakamura: Other Relationship; Self; Astellas Pharma US, Inc., AstraZeneca, Ono Pharmaceutical Co., Ltd., MSD K.K., Kyowa Hakko Kirin Co., Ltd., Kowa Pharmaceuticals America, Inc., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Mitsubishi Tanabe Pharma Corporation, Eli Lilly and Company, Novartis Pharma K.K., Pfizer Inc..

HbA1c levels are higher in AA than NHW independent of glycemia. We investigated whether genetics could explain observed differences in HbA1c levels between AA and NHW DPP participants. We tested 1) genetic variants known to cause hemoglobinopathies; 2) a genetic risk score (GRS) based on 60 variants associated with HbA1c in the most recent genome-wide association meta-analysis; and 3) Principal Components (PC) factors that are generated by a statistical procedure that uses a linear transformation to convert a set of observations of correlated genetic markers measured across the genome (HumanCore Exome arrays + 1000 Genomes imputation) into a set of values mirroring genetic variation due to continental ancestry to capture substructure admixture. Of 2,658 eligible DPP participants, 537 (20%) self-identified as AA and 1,476 (56%) as NHW. HbA1c was measured with ion-exchange high-performance liquid chromatography (Biorad Variant). Despite comparable fasting and 2h-glucose levels, AA had higher HbA1c (mean±SD= 6.2±0.6%) compared with NHW (5.8±0.4%; P In conclusion, genetic variants causing hemoglobinopathies or currently known to influence HbA1c explained a small proportion of HbA1c difference between AA and NHW. A larger proportion of the difference was associated with the first PC, suggesting that other yet unidentified genetic markers influence HbA1c in AA, in addition to non-genetic factors. Disclosure M. Hivert: None. C.A. Christophi: None. K.A. Jablonski: None. S. Edelstein: None. S.E. Kahn: Advisory Panel; Self; Boehringer Ingelheim GmbH, Elcelyx Therapeutics, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Janssen Research & Development, Merck & Co., Inc., Novo Nordisk A/S. S. Golden: None. S. Dagogo-Jack: None. K.J. Mather: Research Support; Self; Merck & Co., Inc., Sanofi-Aventis, Novo Nordisk A/S, Abbott. Advisory Panel; Self; Merck & Co., Inc.. J.A. Luchsinger: None. A. Caballero: None. E. Barrett-Connor: None. W.C. Knowler: None. J.C. Florez: Consultant; Self; Intarcia Therapeutics, Inc.. Consultant; Spouse/Partner; Santen. W.H. Herman: Other Relationship; Self; Merck Sharp & Dohme Corp., Lexicon Pharmaceuticals, Inc.. Consultant; Self; Janssen Scientific Affairs, LLC.. Research Support; Spouse/Partner; Nestlé. Other Relationship; Self; American Diabetes Association. Advisory Panel; Self; National Committee for Quality Assurance (NCQA). D. Research Group: None.