The incretin effect in type 2 diabetes is reduced, but the mechanisms behind are uncertain. We hypothesized that the incretin effect associates with degree of enteric autonomic nerve dysfunction and evaluated gastrointestinally mediated glucose disposal (GIGD), as a proxy for the incretin effect, and rectal sensitivity to mechanical distension representing afferent gut signalling. Sixty-six participants with either 1) longstanding type 2 diabetes, 2) newly onset (<1 year), medically untreated diabetes, or 3) healthy controls, underwent a 75 g oral glucose tolerance test (OGTT) and an intravenous isoglycemic glucose infusion to determine GIGD. Earliest sensation to rectal rapid balloon distention was determined as a proxy for autonomic neuropathy. Compared to controls (59.3±14.4%), GIGD was reduced in both early (36.4±14.7%) and longstanding diabetes (17.4±22.3%), with significant difference between all three groups (P<0.01). Both groups of diabetes needed higher pressure during rapid rectal balloon distention (3.7±1.1 kPa for longstanding diabetes, 4.0±1.3 for early diabetes), compared to controls (3.0±0.9 kPa, P<0.01), with no significant difference between the two diabetes groups. GIGD was inversely correlated with pressure at earliest sensation (rho 0.341, P<0.01). For those needing a pressure between 1 and 3 kPa and between 4 and 7 kPa, respectively, GIGD was 46.2%±24.9 and 34.4±23.9% (P=0.05). GIGD was inversely and significantly correlated with glucose values during OGTT, with strongest correlation to the 90-minute value (rho 0.873, P<0.01), and HbA1c (rho 0.653, P<0.01). We show that the degree of rectal hyposensitivity correlates with reduced GIGD and confirm that GIGD correlates with the degree of dysglycemia. These results warrant further studies on the potential role of gut autonomic dysfunction in the reduced incretin effect characterizing type 2 diabetes. Disclosure S.Meling: Consultant; Novo Nordisk, Lilly, AstraZeneca, Boehringer-Ingelheim, Sanofi. E.Tjora: None. N.Ejskjaer: None. S.Carlsen: None. F.K.Knop: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Novo Nordisk, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Lundbeck. P.Njølstad: None. C.Brock: Research Support; Abbott, ElectroCore. R.B.Nedergaard: Other Relationship; Grünenthal Group. E.Søfteland: None. Funding Helse Vest, Norway (F-11637/4800002072); Johan Selmer Kvanes Legat (Legacy)

Introduction: A national value-based health care project, VBHC-PRO-DIA, was initiated in 2017 to develop and evaluate a scalable solution for value based diabetes care in Denmark. Our project was undertaken in partnership and alignment with a national PRO diabetes program. We present the study design for this national project. Materials and Methods: A participatory multi-stakeholder research design process 2017-2020 with systematic involvement of > 70 PWD using interviews, workshops, clinical & qualitative research: 1) A minimal patient-important diabetes outcome domain set (VBHC structure) . 2) A unified PRO diabetes “logic model” for how to use PRO to drive health value. 3) A national psychometric PRO Diabetes Questionnaire & Decision-Algorithm. 4) A VBHC-PRO IT Tool for seamless use of outcome data in routine diabetes care. 5) A multi-center real-world PRO pilot study of public health potential (RE-AIM) . 6) Implementation planning, data-driven VBHC model design and effectiveness study. Results: National PRO Model: PWD fills out PRO before visit. PRO is used in-visit for collaborative, focused, whole-person care. A multi-dimensional PRO questionnaire (36-70 items) covering: General health/wellbeing, daily life with diabetes, diabetes distress, self-care, BG regulation, symptoms, access to care, personal goals and priorities. Real-world 10-site PRO study : Interim data: > 460 PWD/ 30 HCPs showed high acceptability and experience of benefits related to active engagement of PWD and person-centred diabetes care quality. Disclosure N.Ejskjaer: None. P.H.Kjaer: None. D.B.Berthelsen: None. S.H.Kaplan: n/a. P.O.Jakobsen: None. C.Glümer: n/a. S.E.Skovlund: Consultant; Roche Diabetes Care.