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2014 ADA Posters 1319-2206.Indd EPIDEMIOLOGY—AGINGCATEGORY glucose metabolism (AGM) for women postpartum with previous gestational health care priorities. We conducted an epidemiologic analysis using the diabetes mellitus (GDM). A 75 g OGTT underwent at 6-8 weeks after delivery National Health and Nutrition Examination Survey (NHANES) to assess in 179 GDM patients. The clinical and obstetric characteristics, serum lipid trends in glycemic, blood pressure (BP), and cholesterol controls. ADA level (TCH, TG, LDL-C, HDL-C), insulin level, GA, IGF-1, IGF-BP3, HOMA-B, recommended treatment goals for older adults were used to evaluate the and HOMA-IR were compared between the two groups. We found that: (1) metabolic control. This analysis included 1604 adults aged ≥ 65 who reported 45.8% (82/179) of GDM patients remained abnormal glucose level. The rates a diabetes diagnosis at age 30 and older. The mean (SE) age was 73 (0.2) of DM, IGT, IFG and IGR were 20.1% (36/179), 17.3% (31/179), 3.3% (6/179) years; 55% female; 72% white, 13% black, and 5% Mexican Americans. The and 5% (9/179) respectively. (2) Compared to the women who reverted to mean diabetes duration was 12.4 (0.2) years, and mean BMI was 30.7 (0.23) normal, women with AGM showed shorter pregnant period (38.04±1.18 kg/m2. A1c, BP, and LDL-C had improved overall from 1999 to 2010. The mean weeks vs. 38.42±1.11 weeks, P=0.003), signifi cantly higher fasting insulin A1c was 7.3% (0.10), 6.7% (0.07), and 7.0% (0.06) in 1999-2002, 2003-2006, (FINS) level (58.59±38.22 pmol/L vs. 46.46±28.32 pmol/L, P=0.021), higher and 2007-2010, respectively (p for trend, 0.029). The mean SBP was 144 (1.6), 2h postprandial insulin (2hINS) concentration (375.63±325.83 pmol/L vs. 142 (2.0), and 137 (1.3) mmHg in the respective 3 periods; the mean LDL-C 223.93±169.17 pmol/L, P=0), higher GA level (13.53±2.45% vs. 11.85±0.99%, was 110 (5.5), 101 (2.7), and 92 (0.7) mg/dL in the 3 periods (both p for trends P=0), lower HOMA-B (71.29±50.73 vs. 89.27±55.86, P=0.03), higher HOMA- <0.0001). Still, in 2007-2010 about 40% did not meet the recommended goals IR (2.41±1.81 vs. 1.51±0.96, P=0) as well as more DM family history (43.9% for BP or LDL-C, and more than 60% did not meet the LDL-C goals in persons vs. 27.8%, P=0.025). (3) Compared to the prediabetic patients after GDM with CVD history (Table). Improving diabetes care remains a public health (IFG, IGT and IGR), diabetic patients had higher BMI (P=0.042), higher priority in older adults. maximum pre-pregnancy weight (P=0.012), higher maximum pre-pregnancy U.S. Older Adults with Diabetes Achieved Metabolic Targets According to BMI (P=0.011), higher GA level (P=0.001) and higher HOMA-IR (P=0.002). (4) 2014 ADA Recommendations. Multiple stepwise regression analysis revealed that fasting blood glucose, 1999-2002 2003-2006 2007-2010 P for trend FINS and 1hPG were the independent risk factors for the development of insulin resistance after delivery. This study has identifi ed a high prevalence of HbA1c 60(3) 79(2) 74(2) <0.0001 AGM after GDM. Insulin resistance is the major contributor. The medication HbA1c 73 (5) 88 (2) 88 (2) 0.21 of relieving insulin resistance may be useful for the GDM patients with BP 40(3) 45(3) 58(2) <0.0001 sustained higher FBG, FINS and 1hPG after delivery. LDL 40 (9) 53 (5) 63 (7) <0.0001 Supported By: Chinese Society of Endocrinology LDL 25 (3) 28 (3) 34 (6) <0.0001 1316-P Supported By: Sun Yat-sen University-Johns Hopkins University Collaboration; Screening for Gestational Diabetes—Oral Glucose Challenge Test NIDDK vs. Fasting Plasma Glucose OLALEYE SANU, GREGORY KALU, London, United Kingdom, Brighton, United & 1318-P Kingdom Hyperglycemia Is Associated with Persistently Lower Grip Strength This study aimed to compare detection rate for Gestational Diabetes in Older Persons without History of Diabetes: The Rancho Bernardo (GDM) in women using two stage screening - 1hour 50gram Oral Glucose Study Genetics Challenge Test ( 1-h 50g OGCT) irrespective of last meal , and subsequent RITA R. KALYANI, SHENGCHUN KONG, BIN NAN, DONNA KRITZ-SLIVERSTEIN, POSTERS 75 gram - 2hour Oral Glucose Tolerance Test (2 -h 75g OGTT) for those with GAIL A. LAUGHLIN, LUIGI FERRUCCI, CATHERINE KIM, ELIZABETH L. BARRETT- Epidemiology/ positive 1-h OGCT ; with one stage screening using Fasting Plasma Glucose CONNOR, Baltimore, MD, Ann Arbor, MI, San Diego, CA (FPG). Persons with diabetes have accelerated muscle loss. Yet, the relationship The analysis was carried out at Brighton and Sussex University Hospital of hyperglycemia per se to decreased grip strength, a clinical marker of poor (BSUH), United Kingdom with approximately 5900 deliveries per year, over mobility, has not been previously described. Participants were 1020 women a 12 month period. Women with positive 1-h 50g OGCT result of ≥140 mg/ and 636 men (mean age 71.3) without self-reported history of diabetes who dl (7.8 mmol/l) were offered the 2-h 75g OGTT. A diagnosis of Gestational had fasting plasma glucose (FPG) and 2-hr glucose (2HG) levels after a 75- Diabetes (GDM) was established using the American Diabetes Association gram OGTT at visit 7 (1992-1996). Grip strength, defi ned as the maximum (ADA) guidelines - FPG of ≥ 92mg/dl (5.1mmol/l) and/or 2-h post 75g OGTT of 3 trials in the non-dominant hand, was assessed at baseline and at an of ≥ 153mg/dl (8.5mmol/l). Women with no risk factors for GDM were average of 3.0±1.6 follow-up visits over a median 7 years. When categorized excluded. by sex-specifi c glucose quartiles, persistently lower grip strength was A total of 4536/5990 (77%) women, with risk factors for GDM, underwent observed in highest versus lowest glucose quartiles over time, with more 1-h 50g OGCT; of which 554/4536 (12%) were screened positive (≥140 mg/ dramatic differences in 2HG vs. FPG relationships for both sexes (Figure 1). dl (7.8mmol/l). Of the 554 women, 119/554 (21%) were diagnosed with GDM In men, after adjusting for age, education, height, weight, and neuropathy in post 2 -h 75g OGTT. Eighty-fi ve-85/119 (71%) women had FPG of ≥ 92mg/dl mixed effects regression models, each standard deviation (SD) higher FPG (5.1mmol/l). (SD=16.7 mg/dl) and 2HG (SD=49.8 mg/dl) was associated with lower grip Another 221 women, with risk factors for GDM, but negative 1-h 50g strength over time (-0.50 kg, p=0.04; and -0.85 kg, p=0.003; respectively). OGCT < 140mg/dl (7.7mmol/l and below) consented for 2 -h 75g OGTT. A In women, each SD higher 2HG (SD=45.4 mg/dl) was associated with total of 26/212 (12%) women were diagnosed with GDM, of which 22/26 lower grip strength (-0.36 kg, p=0.01) over time with no differences by FPG. (84%) had FPG of ≥ 92mg/dl (5.1mmol/l). Hyperglycemia is associated with persistently lower grip strength over time These data suggest that screening for GDM using a one stage screening and may be related to greater disability in the elderly. with FPG cut-off of ≥ 92mg/dl (5.1mmol/l), appears to be a good alternative to the two stage screening with 1-h OGCT, and subsequent 2 -h 75g OGTT. EPIDEMIOLOGY—AGING Guided Audio Tour: Diabetes and Aging (Posters: 1317-P to 1324-P), see page 15. & 1317-P Trends in Metabolic Control in U.S. Older Adults with Diabetes, 1999-2010 DAIZHI YANG, JIANPING WENG, NINA SHAH, HSIN-CHIEH YEH, Baltimore, MD, Guangzhou, China The care of older adults with diabetes is complicated by clinical heterogeneity. With continued increase in diabetes prevalence, a better understanding of metabolic control in this population is critical for setting ADA-Funded Research & Guided Audio Tour poster For author disclosure information, see page A743. A343 EPIDEMIOLOGY—AGINGCATEGORY 73% White, 14% Black, 2% Other race, 11% Unknown race, mean age 72). Cox & 1319-P analysis was used to test the relationship of updated mean A1c (average A1c Chronic Comorbidities and Glycemic Control in Older Adults with over follow-up) w/ time to fi rst fracture since baseline and logistic regression Diabetes for most recent A1c w/ fracture. We used the number of BMI measurements CHRISTINE LEE, GREGORY NICHOLS, Portland, OR as a surrogate for frequency of discrete visits. During followup (mean 3 yrs), Many older adults have chronic comorbidities (CC), thus we examined there were 969 events. Modeled continuously and controlled for age, sex and how CC are associated with glycemic control in older adults with diabetes race, updated mean A1c showed a cubic (J-shaped) relationship w/ fracture risk mellitus (DM). (p=0.005). When analyzed by category, compared to an updated mean A1c of This cross-sectional study included 11009 adults ages 65+ with DM in the 7-<8%, HRs (95% CIs) were: A1c <6.5% HR= 0.93 (0.79-1.10); 6.5-<7% HR=0.74 Kaiser Permanente Northwest Diabetes Registry 1997-2010. Thirteen CC (Table) (0.61-0.90); 8-<9% HR=1.45 (1.19-1.76); ≥9% HR=1.56 (1.21-2.01).
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