bluuebunny/crossref_metadata_2025 huggingface dataset:
92-LB: Higher Adherence and Persistence for Dulaglutide Compared with Oral Semaglutide at Six-Months Follow-Up with U.S. Real-World Data
Authors: PACZKOWSKI ROSIRENE , HOOG MEREDITH , PELESHOK JENNIFER , YU MARIA , HUANG AHONG , LIMONE BRENDAN , MANJELIEVSKAIA JANNA
Published: May 2022

A retrospective, observational analysis of administrative claims data from the IBM MarketScan Databases assessed adherence and persistence among GLP-1 RA naive adult patients with T2D newly initiating dulaglutide (DU) or oral semaglutide (OS) between Sept 2019 and Nov 2020.

Patients had continuous enrollment in the 6-mo pre-index period and 6-mo follow-up periods. The DU patients were propensity-score matched 1:1 to OS patients (6,166 pairs) . The median age was 54 years at index date, and 48% were female. At pre-index, mean aDCSI was 0.6 and 10% of patients had ASCVD. Most patients used oral anti-hyperglycemic medication (87%) ; a smaller proportion used insulin (15%) . The most common prescribing provider was primary care (62%) .

More DU patients were adherent (proportion days covered [PDC] ≥80%) (65% vs. 50%, p<0.001) and had higher mean PDC vs. OS (0.78 vs. 0.68, p<0.001) . More DU patients were persistent on therapy compared to OS patients (72% vs. 57% p<0.001) and had longer mean duration of persistence (148 vs. 128, p<0.001) . Among patients with ≥2 fills of their index drug, 73% of DU and 62% of OS patients were adherent.

During the 6-mo follow-up period, DU patients had significantly higher adherence and persistence compared to OS patients.

Disclosure

R. Paczkowski: Employee; Eli Lilly and Company. M. Hoog: Employee; Eli Lilly and Company, Stock/Shareholder; Abbott, Eli Lilly and Company. J. Peleshok: Employee; Eli Lilly and Company, Eli Lilly and Company. M. Yu: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A. Huang: None. B. Limone: None. J. Manjelievskaia: Employee; IBM Watson Health, Other Relationship; Eli Lilly and Company.

Funding

Eli Lilly and Company
925-P: European Survey on Adults with Type 1 Diabetes (T1D) and Their Caregivers: Insights into Experience of T1D Management
Authors: KULZER BERNHARD , DOWN SU , SEIGNEZ ANTOINE , VIVES ALIZE , BONNEMAIRE MIREILLE , PENFORNIS ALFRED
Published: May 2022

Background and Aims: T1D requires constant self-management and can substantially impact quality of life. We aimed to survey patient and caregiver experiences of T1D management.

Methods: Adult people with T1D (PwD) or their caregivers living in France, Germany, Italy, Spain, or the UK were invited to complete an online survey (July-August 2021) .

Results: Responders were 458 PwD (54% female, mean age 47.8 years, mean age at diagnosis 24.4 years) and 54 caregivers. For PwD, moderate to very high impacts of T1D on daily life included fatigue (77%) and anxiety (65%) . The top 2 other illnesses with significant impact on PwD’s lives were hypertension (29%) and depression (26%) . Many PwD (68%) would have liked more psychological support, mainly from healthcare professionals (HCPs) . Most caregivers (76%) would have liked support, mainly from HCPs, especially diabetologists (39%) , nutritionists (31%) and psychologists (28%) . Over half of responders felt they lack knowledge on T1D (53% PwD, 56% caregivers) . Only 57% of PwD and 39% of caregivers had participated in education programmes; of those <30% of PwD/caregivers still regularly attended. There were regional differences in the proportion of PwD who had attended education programmes (Figure) , but not in the proportion who still were regularly attending.

Conclusion: In Europe, PwD and their caregivers require more support and education for T1D management.

Disclosure

B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care. S.Down: Advisory Panel; Viatris, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi, Viatris. A.Seignez: Employee; Else Care. A.Vives: Other Relationship; Sanofi. M.Bonnemaire: Employee; Sanofi. A.Penfornis: Board Member; Insulet Corporation, Medtronic, Mundipharma, Novo Nordisk, Sanofi, Speaker's Bureau; Glooko, Inc., Insulet Corporation, Lilly, Novo Nordisk, Ypsomed AG.

Funding

Sanofi
926-P: Improving Glycemic Control in Adolescents and Young Adults (AYA) with Diabetes: The University of Washington (UW) AYA Diabetes Program
Authors: MALIK FAISAL , HIRSCH IRL B. , PIHOKER CATHERINE , TAPLIN CRAIG , ROBERTS ALISSA J. , LOWRY SARAH J. , YI-FRAZIER JOYCE , MOSS ASHLEY , HUANG ALYSSA , EHRHARDT NICOLE M. , PAGET ALIA , HOCH KATRINA , WEAVER KATHRYN W.
Published: May 2022

Background: The UW AYA Diabetes Program is a partnership between Seattle Children’s Hospital and UW Medicine designed to meet AYA health care transition and mental health needs.

Objective: To evaluate the impact of the UW AYA Diabetes Program on glycemic control.

Methods: The study included 453 AYA with diabetes (baseline visit: mean age 20.8 years, 51% male, 70% Non-Hispanic White, 27% public insurance, 95% type 1 diabetes, 55% continuous glucose monitoring (CGM) use, 55% pump/automated insulin delivery use) who have received diabetes care within the UW AYA Diabetes Program for ≥6 months. Mixed-effects linear regression with a random effect for individual to account for repeated measures was used to evaluate change in A1C over time. Regression model was adjusted for age, race, ethnicity, diabetes technology use, and health insurance.

Results: Mean adjusted A1C decreased steadily with increasing time in the UW AYA Diabetes Program (Figure) . The difference was statistically significant compared to baseline A1C levels by the time participants had been in the program for 2 years (8.1%, 95% CI: 7.8-8.4 vs. 8.8%, 95% CI: 8.6-9.0) . A1C improvement did not vary by age, diabetes technology use, or health insurance (all p>0.05) .

Conclusion: The UW AYA Diabetes Program offers a promising approach to improve glycemic control in AYA transitioning from pediatric to adult diabetes care.

Disclosure

F.Malik: n/a. N.M.Ehrhardt: Advisory Panel; Dexcom, Inc., Novo Nordisk, Research Support; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk. A.Paget: None. K.Hoch: None. K.W.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Bigfoot Biomedical, Inc., GWave, Roche Diabetes Care, Research Support; Beta Bionics, Inc., Insulet Corporation, Medtronic. C.Pihoker: None. C.Taplin: Advisory Panel; Insulet Corporation, Speaker's Bureau; Medtronic. A.J.Roberts: None. S.J.Lowry: None. J.Yi-frazier: None. A.Moss: None. A.Huang: None.

Funding

Forest Foundation, Sequoia Foundation
933-P: Maternal Choices and Preferences for Screening Strategies of Gestational Diabetes Mellitus: A Discrete Choice Experiment
Authors: XU TINGTING
Published: May 2022

Aims: This study aimed to investigate maternal preferences for gestational diabetes mellitus (GDM) screening options in China to identify an optimal GDM screening strategy.

Methods: Pregnant women at 24−28 gestational weeks were recruited from Shandong province, China. A discrete choice experiment (DCE) was conducted to elicit pregnant women’s preferences for GDM screening strategy defined by five attributes: number of blood draws, out-of-pocket costs, screening waiting-time, number of hospital visits, and positive diagnosis rate. A mixed logit model was employed to quantify maternal preferences, and to estimate the relative importance of included attributes in determining pregnant women’s preferences for two routinely applied screening strategies (“one-step”: 75g oral glucose tolerance test [OGTT] and “two-step”: 50g glucose challenge-test plus 75g OGTT) . Preference heterogeneity was also investigated.

Results: N=287 participants completed the DCE survey. All five predefined attributes were associated with pregnant women’s preferences. Diagnostic rate was the most influential attribute (17.5% vs. 8.0%, OR: 2.89; 95%CI: 2.10−3.96) . When changes of the attributes of “two-step” to “one-step” strategies, the changes of women’s uptake probability from full “two-step” to “one-step” was positive with 71.3% (95%CI:52.2%-90.1%) , but no significant difference with the first step of “two-step” (-31.0%,95%CI:-70.2%-8.1%) .

Conclusion: Chinese pregnant women preferred the “one-step” screening strategy to the full “two-step” strategy, but were indifferent between “one-step” and the first step of "two-step" strategies. A careful consideration of maternal preferences can assist clinical practitioners and healthcare policymakers in promoting GDM screening acceptability and compliance in rural China to achieve better health outcomes for mothers and babies.

Disclosure

T.Xu: None.
949-P: Pharmacist Interventions within a Collaborative Enhanced Primary Care Team Process Improves Diabetes Care
Authors: HESS DANIELLE , MCCOY ROZALINA G. , MATULIS JOHN , KESSLER MAYA , MARA KRISTIN , HERGES JOSEPH
Published: May 2022

Purpose: An enhanced primary care diabetes model (EPCD) was implemented to provide proactive longitudinal care to adult patients with diabetes, grounded in close partnership between primary care providers (PCP) , registered nurses (RN) , and Medication Management Services (MMS) pharmacists. In this model, care team RNs could request pharmacist support through chart review for comprehensive diabetes management. The purpose of this study is to evaluate the impact of the MMS pharmacist in the EPCD model for patients with diabetes.

Methods: All adults with diabetes paneled to a PCP in six primary care clinics in the Midwest U.S. were eligible for the EPCD model. We compared the change in diabetes care quality between patients who received pharmacist chart review and care recommendations to matched patients who did not. The index date was defined as the date of MMS pharmacist review after referral from the care team RN or date of RN review and no subsequent pharmacist consult. The primary outcome was the change in the proportion of patients meeting the composite of four diabetes treatment goals (D4) , including hemoglobin A1c control (HbA1c less than 8%) , blood pressure control (less than 140/90 mmHg) , aspirin use if indicated, and statin use if indicated at six months from the index date. Secondary outcomes were each of the four indicators individually.

Results: The proportion of patients meeting the D4 after 6 months increased with pharmacist chart reviews (N=85) compared to matched patients with no review (N=170) (27% vs. 7%, p<0.001) . The change in patients meeting treatment goals of HbA1c (12.9% vs. 4.1%, p=0.020) , blood pressure (9.4% vs. 2.4%, p=0.023) , aspirin use (10.6% vs. 2.9%, p=0.018) , and statin use (17.6% vs. -1.2%, p<0.001) were increased with a pharmacist review.

Conclusions: Pharmacist engagement in the EPCD model improved diabetes care quality. This supports the inclusion and utilization of pharmacists in multidisciplinary efforts to improve diabetes care.

Disclosure

D.Hess: None. R.G.Mccoy: Consultant; Emmi. J.Matulis: None. M.Kessler: None. K.Mara: None. J.Herges: None.
95-OR: Impact of Flash Glucose Monitoring in People with Type 2 Diabetes Inadequately Controlled with Noninsulin Antihyperglycemic Therapy: IMMEDIATE study
Authors: BROWN RUTH E. , ARONSON RONNIE
Published: May 2022

Continuous glucose monitoring (CGM) has been shown to improve glycemic outcomes in people with diabetes using insulin therapies. In this multi-site, randomized trial, we studied adults with T2D inadequately controlled with non-insulin antihyperglycemic therapy to evaluate the impact of flash glucose monitoring (FGM) on glycemic and patient-reported outcomes. Participants received FGM + diabetes self-management education (DSME) or matched DSME alone for 16 weeks. Primary outcome was assessed by a blinded CGM device worn at baseline and at outcome. Among 116 participants enrolled (age 58.4 ± 10.1 years; T2D duration 10.1 ± 6.1 years; HbA1c 8.6 ± 1.1%) , the initial 82 completers (41 FGM + DSME, 41 DSME) showed time in range significantly greater in the FGM + DSME arm (76.1 ± 16.9%) compared to DSME arm (64.3 ± 23.2%) (p<0.01) . Time above range was similarly lower in the FGM + DSME arm (21.5 ± 17.8% vs. 31.3 ± 25.6%, p=0.03) . Hypoglycemia was rare in both arms. Glucose monitoring satisfaction scores improved in the FGM + DSME arm only (0.6 ± 0.5 vs. 0.0 ± 0.5, p<0.01) . Change in HbA1c was also greater in the FGM + DSME arm (-0.9 ± 0.9% vs. -0.5 ± 0.9%, p=0.03) . In this interim analysis, FGM users with T2D using non-insulin therapies had significantly greater time in range, satisfaction with glucose monitoring, and a greater reduction in HbA1c.

Disclosure

R.E.Brown: None. R.Aronson: Consultant; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Gilead Sciences, Inc., HTL Strefa, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; AstraZeneca, Bausch Health, Canada, Bayer AG, Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Kowa Pharmaceuticals America, Inc., Medpace, Novo Nordisk, Sanofi, Tandem Diabetes Care, Inc., Xeris Pharmaceuticals, Inc., Zealand Pharma A/S.

Funding

Abbott Diabetes Care, Inc.
955-P: Glucagon Prescription Rates in Insulin-Treated Patients with Diabetes at a Teaching Outpatient Clinic
Authors: ABDULWAHID TIBA , LLOYD JACOB , SELK KAREN
Published: May 2022

Introduction: Hypoglycemia is a major barrier to optimal glycemic control and is a significant cause of morbidity and mortality in patients with diabetes. Additionally, hypoglycemia accounted for 235, 000 emergency department visits in 2016 according to the CDC. The ADA recommends that glucagon should be prescribed for all patients at increased risk of level 2 or 3 hypoglycemia so that it is available should it be needed. We hypothesize that glucagon is under-prescribed in patients with diabetes who are on prandial or premixed insulin at a tertiary center teaching hospital.

Methods: We performed a retrospective observational study of patients seen at an outpatient clinic at a tertiary center teaching hospital from February 2020 to July 2021. We chart audited 482 patients seen at least 3 times at the clinic with the diagnosis of diabetes on their electronic medical record. We included only patients who were on prandial or premixed insulin. We performed an analysis looking at the rate of glucagon prescription in the clinic.

Results: A total of 1patients were included in our final analysis with mean age [standard deviation] of 56.86[13.13], 44.1% Female, 66.6% African American, BMI of 33.62[9.92], HbA1C of 9.07[2.08], and 96.4% had health insurance. Only 5 patients (4.5%) of the qualified cohort were prescribed glucagon at our clinic.

Conclusion: Glucagon is under-prescribed at our clinic, with only 4.5% of the qualified cohort being prescribed glucagon. This rate is significantly lower than a previously published study showing a rate of 28%. Health insurance is unlikely to be a contributing factor. This could be due to a knowledge gap among providers about the standards of diabetes care guidelines. An educational intervention to help improve the prescription rate of glucagon and potentially decrease the hypoglycemia burden is warranted.

Disclosure

T.Abdulwahid: None. J.Lloyd: None. K.Selk: None.
957-P: A Community–Academic Practice Partnership to Optimize Outcomes in High-Risk Underserved Patients with Diabetes
Authors: FOWLER TERRI O. , STERRETT JAMES , COLLINS LASHONDA T. , POOLE ANTHONY D. , WEEDA ERIN , DUBOSE-MORRIS RAGAN A. , ROEVER KARI
Published: May 2022

Background: The project aims to establish an interprofessional diabetes team within a Federally Qualified Health Center (FQHC) to increase patient access and improve the health of underserved patients with diabetes.

Methods: The program is a community-academic practice partnership implemented in a FQHC in the Southeastern United States. The program utilizes an interprofessional diabetes care model (in-person and telehealth) with a nurse practitioner, pharmacist, population health specialist, certified medical assistant, dietician, and primary care team to provide comprehensive diabetes care focused on treatment optimization, self-management, and identification of medical and community resources.

Results: A total of 175 patients were seen from November 2020 to October 2021. The median (IQR) A1C at baseline was 9.6% (8.4-11.5%) versus 8.6% (7.0-10.0%) at follow-up (p<0.001) . The median BMI decreased by 0.4 kg/m3. Improvements were noted in diabetes quality metrics (Table 1) . Patient, primary care provider, and student surveys demonstrate 100% satisfaction with the diabetes team.

Conclusions: A community-academic practice partnership supports comprehensive diabetes management and improved health outcomes. Next steps include expansion of the program to additional practice sites and continued data analysis on patient outcomes, cost, and satisfaction.

Disclosure

T.O.Fowler: None. J.Sterrett: None. L.T.Collins: None. A.D.Poole: None. E.Weeda: None. R.A.Dubose-morris: None. K.Roever: None.

Funding

The Duke Endowment (6878-SP)
96-OR: Adverse Micro- and Macrovascular Outcomes in Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH and TODAY Studies
Authors: MOTTL AMY K. , ISOM SCOTT , TRYGGESTAD JEANIE B. , GUBITOSI-KLUG ROSE , DOLAN LAWRENCE M. , DAGOSTINO RALPH , DREWS KIMBERLY
Published: May 2022

We sought to determine incidence rates for micro- and macrovascular events in youth-onset type 1 (T1D) and type 2 (T2D) diabetes in the SEARCH (T1D: N=564; T2D: N=149) and TODAY (T2D: N=495) studies. At study visits, we ascertained self-reported ophthalmologic, kidney, neuropathy, cardiac, and peripheral and cerebrovascular events , obtained medical records for these events, and adjudicated each event using predetermined standardized and harmonized criteria. Data were available from more than 6,000 person-years in T1D and more than 8,000 person-years in T2D. Incidence rates (events per 10,000 person-years) were calculated. As shown in the table, despite similar mean diabetes duration of 10-13 years and mean HbA1c >9%, the incidence of reported complications was higher in the youth with T2D than those with T1D, with rates 2.5-fold higher for microvascular and 4.0-fold higher for macrovascular disease. These data support the aggressive nature of youth-onset T2D.

Disclosure

A.K.Mottl: Advisory Panel; Bayer AG, Board Member; Bayer AG, Research Support; Alexion Pharmaceuticals, Inc., Aurinia, Bayer AG, Boehringer Ingelheim International GmbH, Pfizer Inc. S.Isom: None. J.B.Tryggestad: None. R.Gubitosi-klug: None. L.M.Dolan: None. R.Dagostino: Consultant; Aetion, Inc., AstraZeneca, Biogen, Bristol-Myers Squibb Company, Daiichi Sankyo, Merck & Co., Inc. K.Drews: None.

Funding

National Institutes of Health DK061230; R01DK127208 Center for Disease Control
961-P: The Effect of Obesity on HbA1c among Adults with Type 1 Diabetes: A U.S. Based Multicenter Study
Authors: NOOR NUDRAT , AKTURK HALIS K. , DESIMONE MARISA , BASINA MARINA , RIOLES NICOLE , ROMPICHERLA SAKETH , HAW JEEHEA SONYA , GOLDEN LAUREN , EBEKOZIEN OSAGIE
Published: May 2022

Background: The primary objective of this U.S. based multi-center study was to determine if obesity is associated with an increase in A1c levels among adults with T1D. Additionally, we also examined patient and clinical profile across all BMI groups in the adult T1D population.

Methods: Electronic health record data from the T1D Exchange Quality Improvement (T1DX-QI) Collaborative for adult patients aged 21 years and older, between 2017-2021 was analyzed. BMI (kg/m2) was categorized into: Underweight (<18.5 kg/m2) , normal weight (18.5-24.9 kg/m2) , overweight (25.0-29.9 kg/m2) , obese (30.0-39.9 kg/m2) , and severely obese (≥ 40 kg/m2) . HbA1c levels were taken from patients’ most recent clinic visit. Multivariable regression analysis was used to examine the association between obesity and HbA1c levels.

Results: This analysis included 7,496 T1D adult patients, of which 3% were underweight, 42% normal weight, 33% overweight, 21% obese and 2% severely obese. Compared with normal weight people with T1D, the obese group were older (Mean (SD) , yrs: 36 (15) vs. 43 (15) ; p<0.001) , and less likely to use a CGM (72% vs. 66%; p<0.001) or insulin pump device CGM (63% vs. 57%; p<0.001) . Compared to normal weight individuals, obese people had higher HbA1c levels (B (SE) :0.17; p=0.002) adjusted for age, gender, insurance status and race/ethnicity.

Conclusion: In this large real-world study, we found obese adults were more likely to have higher A1c levels than normal weight adults with T1D.

Disclosure

N.Noor: None. H.K.Akturk: Research Support; Dexcom, Inc., Eli Lilly and Company, REMD Biotherapeutics. M.Desimone: None. M.Basina: None. N.Rioles: None. S.Rompicherla: None. J.Haw: None. L.Golden: None. O.Ebekozien: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
968-P: Improvement in Glycaemic Control and Cost of Diabetes Care Using Diahome, a Smartphone Application
Authors: RAGHAVAN ARUN , NANDITHA ARUN , SATHEESH KRISHNAMOORTHY , SUSAIRAJ PRISCILLA , VINITHA RAMACHANDRAN , NAIR DHRUV , JEYARAJ SANTHOSH , SHARAD VAJPAYEE , RAMACHANDRAN AMBADY
Published: May 2022

Digital healthcare is on the rise. Paucity of clinical data exists on the efficiency and effectiveness of the applications in diabetes management. We compared glycaemic outcomes at 4 months among type 2 diabetes (T2DM) patients opting virtual care using Diahome® app and in-person hospital visits. Data of 173 (91 app-users, 82 non app-users) were analysed. The two groups were similar by age, gender distribution and duration of T2DM. At follow-up, fasting plasma glucose significantly reduced among app-users alone (156 ± 70 vs.129 ± 40 mg/dl, p<0.02) . There was a significant change in HbA1c in both groups; improvement was better among app than non-app users (15.8% vs.10.4% p=0.004) . The app was overall acceptable. Cost of treatment per visit reduced ($57 vs. $112) . Diahome® app was superior to hospital visits for routine diabetes care.

Disclosure

A.Raghavan: None. A.Nanditha: None. K.Satheesh: None. P.Susairaj: None. R.Vinitha: None. D.Nair: None. S.Jeyaraj: None. V.Sharad: None. A.Ramachandran: None.
972-P: DKA: Comparing Care in Medical ICU vs. Stepdown in a Community Hospital
Authors: AHMAD TAHREEM , MEHROTRA NEHA , ALI WAQAS , REN DIANXU , ARNOLD JONATHAN , KORYTKOWSKI MARY T. , MON SANN YU
Published: May 2022

Background: Although DKA has been traditionally managed in intensive care units (ICU) , some studies suggest that DKA can be safely treated in non-critical care areas.

Objective: To compare safety & efficacy of a DKA IV insulin protocol in ICU with stepdown unit (SDU) .

Methods: A retrospective chart review of all DKA patients (Age >yrs) admitted to ICU (N=45) & SDU (N=23) from January 20to August 2020. The admission to SDU was based on our hospital protocol (pH>7.2 without organ failure) . We analyzed the compliance to the DKA protocol (Table) and adverse outcomes. Mann-Whitney U & Chi-square/Fishers exact tests were used to compare continuous & categorical variables respectively.

Results: ICU & SDU groups were demographically similar: mean age (36.2 ± 15.2 vs. 37.6 ± 18.9 yrs) , sex (F 67% vs. 70%) & BMI (21.2 vs. 21.8 kg/m2) . As expected, ICU group had severe DKA as compared to SDU group with higher mean BG & lower mean serum Bicarb (p<0.05) . There was a trend towards stricter adherence to protocol in ICU. Length of stay (78 vs. 63 hrs) , hypoglycemia (9 vs. 13) , reoccurrence of DKA within 72 hrs (8 vs. 4.3) & 30-day readmission (53% vs. 65.2%) were similar in both groups (p>0.05) .

Conclusions: Our study suggested that a DKA IV insulin can be safely managed in SDU in selected patients, which can help avoid ICU overcrowding. The observed trend toward less strict compliance with the DKA protocol can be overcome with nurse education and optimal nurse to patient ratio.

Disclosure

T.Ahmad: None. N.Mehrotra: None. W.Ali: None. D.Ren: None. J.Arnold: None. M.T.Korytkowski: None. S.Mon: None.
98-LB: Outcomes from the Insulin-Only Bionic Pancreas Pivotal Extension Study
Authors: LYNCH JANE L.
Published: May 2022

The bionic pancreas (BP) is initialized with body weight only, makes all insulin dosing decisions autonomously, and uses meal announcements without carbohydrate counting. After completing a Pivotal RCT, 90 of the 107 (aged 6-71) participants who were randomized to the 13-week baseline standard-care (SC) arm in the RCT participated in the 13-week Insulin-Only BP Pivotal Extension Study (ES) . Visit completion rate was 100%. During the baseline SC period, 1 adult participant had 2 severe hypoglycemia (SH) events; the same participant had 2 additional SH events during the ES. During the baseline SC period there were no DKA events; 1 pediatric participant had a DKA event due to infusion set failure during the ES. A decrease of HbA1c, mean CGM glucose, percent of time <70 mg/dl, percent of time >180 mg/dl, and glucose coefficient of variability (CV) , and increased percent of time in range (TIR) occurred in the Extension Study when compared to the baseline SC period. Changes from baseline were similar in adult (N=42) and pediatric (N=48) participants, except for reductions in time <70 mg/dl and CV, which were statistically significant in the pediatric but not adult sub-groups (Table) . The 90 participants who randomized to a 13-week baseline SC period and transitioned to the 13-week ES had statistically significant improvements in HbA1c and CGM outcomes following transition to the Insulin-Only BP without increases in hypoglycemia.

Disclosure

J. L. Lynch: Consultant; Novo Nordisk, Novo Nordisk, Novo Nordisk, Research Support; Beta Bionics, Inc., Beta Bionics, Inc., Beta Bionics, Inc., Jaeb Center for Health Research, Jaeb Center for Health Research, Jaeb Center for Health Research.

Funding

Funding from National Institute of Diabetes and Digestive and Kidney Diseases (grant #1UC4DK108612-01) Funding and bionic pancreas devices from Beta Bionics, Inc. Fast-acting insulin aspart and insulin aspart provided by Novo Nordisk Insulin lispro by Eli LillyBlood glucose meters and test strips (Contour?Next One Blood Glucose Monitoring System) provided by Ascensia Diabetes Care, Basel, CH. Continuous glucose monitor sensors and transmitters were purchased from Dexcom, Inc. at a discounted price.
981-P: Gut Microbiome Profile of American Indian Children with Obesity and Comparison with Industrialized and Preindustrialized Microbiomes
Authors: KOSTIC ALEKSANDAR , HANSON ROBERT L. , SINHA MADHUMITA
Published: May 2022

Gut microbial composition is associated with metabolic risk and differs markedly between industrialized (IND) and non-industrialized (non-IND) populations.

Objective: To characterize the gut microbiome of American Indian (AI) children with overweight/obesity relative to IND and non-IND individuals (including ancient AI gut microbiomes) .

Methods: Stool samples were from 7-10-year-old AI children with overweight/obesity enrolled in a lifestyle intervention trial on diabetes risk factors (2019-21) . Metagenomic analysis was performed on 39 samples from 25 individuals and compared to samples from age-matched (5-12-year-old) non-AI children in IND (N=380) or non-IND (N=90) populations.

Results: Mean age was 8.4 years (SD 1.11) , 44% were male. Mean age-sex-adjusted BMI z-score was 2.12 (SD 0.45) . By principal coordinates analysis, AI samples clustered in an intermediate position between the IND and non-IND samples (Figure 1) . AI children shared microbes with non-IND children that are rare in IND populations but common in ancient AI individuals (Prevotella copri, Coprococcus catus) .

Conclusions: The gut microbiome in a subset of AI children is distinct from the non-AI American gut microbiome. Further, AI children may have "inherited" gut microbes from their AI ancestors, which may contribute to differences in their metabolism relative to non-AI children.

Disclosure

A.Kostic: None. R.L.Hanson: None. M.Sinha: None.

Funding

American Diabetes Association (1-17-INI-13) ; National Institutes of Health (P30DK036836)
992-P: Pediatric Diabetes Providers Are Poorly Adherent to the ADA Treatment Guidelines for New-Onset Type 2 Diabetes (T2D)
Authors: SAID JERIES H. , WOLFGRAM PETER , CABRERA SUSANNE M.
Published: May 2022

Since 2018, the ADA Standards of Medical Care has provided evidence-based treatment guidelines for clinically suspected youth-onset T2D. We hypothesized adherence of pediatric diabetes providers to these guidelines was poor. We conducted a retrospective chart review of new onset T2D youth seen for initial consultation at our multidisciplinary tertiary care pediatric diabetes clinic. Between 7/20 and 6/2020, 90 youth completed initial visits: mean initial HbA1c 9.7% (6.5-14%) , mean age of 14.5 (range 9-19) , 57% female, 85% English-speaking, 60% Black, 10% Non-Hispanic White, and 27% Hispanic. Forty-one had an initial HbA1c <8.5% without acidosis, with 34 of these 41 (83%) started on metformin, in accordance with ADA guidelines. Four of the 41 (10%) patients were started on insulin therapy; these 4 had higher HbA1c than those started on metformin alone (8.1% vs. 6.7%, p = 0.0003) . In contrast, 49 of the 90 patients presented with an initial HbA1c ≥8.5% without acidosis. Of these 49, 6 (12%) were started on metformin and basal insulin, in accordance with ADA guidelines; however, the basal insulin was dosed at a mean of 0.27 unit/kg (0.20-0.45) rather than the recommended 0.5 unit/kg. Metformin with basal + prandial insulin was started in 23 (47%) . Sixteen of 49 (33%) were started on basal (0.20 unit/kg) + prandial insulin without metformin. Notably, in patients with HbA1c ≥8.5%, initial treatment choice did not differ by age, HbA1c, or race/ethnicity. Overall, providers exhibited greater fidelity to ADA treatment recommendations in those with HbA1c < 8.5% (83% adherence) than those with HbA1c ≥ 8.5% (12%) . In 80% of patients with a HbA1c ≥ 8.5, providers appeared to default to typical T1D treatment with an initial basal dose of 0.2 unit/kg and inclusion of prandial insulin. These findings demonstrate poor adherence to youth-onset T2D guidelines. A quality improvement project is underway to reduce practice variance and optimize the care of youth with newly diagnosed T2D.

Disclosure

J.H.Said: None. P.Wolfgram: n/a. S.M.Cabrera: None.

Funding

American Diabetes Association (1-18-ICTS-094)
995-P: LRG1 Mediates Diet-Induced Hyperinsulinemia by Enhancing Glucose-Stimulated Insulin Secretion
Authors: MORALES DESIRAE , RYU JIYOON , LYNCH JANE L. , DUGGIRALA RAVINDRANATH , DONG LILY Q.
Published: May 2022

Childhood obesity and metabolic syndrome sequelae associated with early-onset insulin resistance and type 2 diabetes are at epidemic levels globally with increasing evidence for worrisome young adult health sequelae trajectories. Pediatric obesity is often associated with dramatic rise in hyperinsulinemia and acanthosis during puberty, a risk for progression to type 2 diabetes and/or hepatic steatosis. Recently, we reported leucine-rich alpha-2-glycoprotein 1 (LRG1) as an adipokine, which levels in sera are positively associated with BMI in humans. LRG1 binds with multiple metabolic organs in vivo, including the liver and pancreas. Deletion of the Lrg1 gene in mice alleviates high-fat diet (HFD) -induced hyperinsulinemia, hepatosteatosis, insulin resistance, and obesity at a young age. Our current study indicates that treating the MIN6 beta-cells with LRG1 was sufficient to trigger insulin secretion both in the absence and presence of glucose in a dose-dependent manner, specifically enhancing the first phase of insulin secretion. We also identified an LRG1 monoclonal antibody that neutralizes LRG1-related stimulation of insulin secretion in MIN6 beta-cells. Serum levels of LRG1 in young mice fed with HFD led to enhanced levels of LRG1 in sera in these mice, which preceded hyperinsulinemia and subsequent increased weight gain. Together, our results reveal that up-regulated LRG1 in circulation could be a causal factor for persistent hyperinsulinemia by directly targeting pancreatic beta-cells to enhance insulin secretion in childhood obesity and a likely biomarker for early childhood hyperinsulinemia and treatment assessments. Understanding the impact of LRG1 on childhood obesity provides critical information to prevent early-stage insulin resistance and type 2 diabetes.

Disclosure

D.Morales: None. J.Ryu: None. J.L.Lynch: Consultant; Novo Nordisk, Novo Nordisk, Novo Nordisk, Research Support; Beta Bionics, Inc., Beta Bionics, Inc., Beta Bionics, Inc., Jaeb Center for Health Research, Jaeb Center for Health Research, Jaeb Center for Health Research. R.Duggirala: None. L.Q.Dong: None.
PENGEMBANGAN MODUL MATEMATIKA MATERI HUBUNGAN ANTAR SUDUT PADA DUA GARIS SEJAJAR
Authors: Nugrahani Permata , Apriani Maria Suci
Published: May 2022

This study aims to determine the quality of the module that are considered from material and media aspects and to know students' responses at the product trial stage. This research was Research and Development (R&D). To find out the quality of the module, that was looked from the validity, we used expert judgment from three Mathematics Education lecturers. Meanwhile, to find out the students' responses, we conducted a trial on 32 students of Class VII F, SMP Regina Pacis Surakarta. The results of this study are the quality of the mathematical module that has been designed in terms of material the results are very good with an average of 3.29 and need to add exercises to accommodate the questions of cognitive demands analyzing or creating. The quality of the mathematics module in terms of media is very good with an average of 3.33 and it is necessary to add exercises about HOTS. Students respond very well to the mathematics module that is designed with an average of 3.39 and accept this module to help students learn independently outside the learning process in class
POST-TAX CHANGE RATES: PERCEPTIONS OF MSME IN BREBES DISTRICT IN TAX RATES
Authors: Rahmadiane Ghea Dwi
Published: May 2022

The phenomenon in Indonesia regarding the level of taxpayer compliance is still relatively low when compared to the growth in the number of businesses. This research aims at determining the perception of taxpayers of micro, small and medium enterprises after changes in tax rates government regulation. This research method used was descriptive qualitative statistical analysis. The population used was MSMEs in Brebes District, and the sample taken is 5 MSMEs that could represent each business field with a simple random sampling technique. The respondents used in this research were MSMEs in Brebes District which experienced a decrease in income and get more comprehensive information on the latest tax regulations. The conclusion from this research was that MSME actors objected to the tax rate of 1% of turnover. MSME actors were represented by respondents who appreciated the new tax rate of 0.5% of the turnover contained in PP No. 23 of 2018.
MSME PERFORMANCE EFFECTIVENESS DURING COVID 19 PANDEMIC PERIOD
Authors: Hariadi Hariadi , Humairoh Fitri , Desmiyawati Desmiyawati , Azlina Nur
Published: May 2022

This research aims at examining the influence of the effect of e-commerce, innovation and accounting information systems on the MSMEs’ performance in the Bengkalis district. The population method used in this research was MSMEs in Bengkalis district. The samples in this research were 100 MSMEs that fit the criteria that have been determined. The data used in this research was primary data with a questionnaire as an instrument. Additionally, the data collection in this research used purposive sampling, where the total number of respondents in this research was 100 respondents. The data analysis was done with a multiple linear regression model with Statistical Product and Service Solution (SPSS) software 25.0 version. The results obtained were e-commerce, inovation and accounting information systems that had a significant effect on MSMEs'  performance.
AGENCY PROBLEM ANALYSIS FROM COMMITTEE AND OWNERSHIP STRUCTURES
Authors: Setia Bayu Indra , Alghifari Erik Syawal , Nugraha Nugraha , Sari Maya
Published: May 2022

This study aims to determine the factors that influence the agency problem. A sample of 14 restaurant, hotel, and tourism sub-sector companies listed on the Indonesia Stock Exchange during the 2010–2019 period with a total of 140 observations was used as the unit of analysis. The method used is descriptive and verified with panel data regression analysis. The results showed that the audit committee and independent commissioners had a positive and significant effect on agency problems, while managerial ownership and institutional ownership had a negative and significant effect on agency problems
EXAMINING EARNINGS MANAGEMENT AND FIRM AGE: A QUANTITATIVE COMPARATIVE STUDY
Authors: Hamzah Ruth Samantha , Gozali Efva Octavina Donata , Khamisah Nur
Published: May 2022

This paper examines the association of firm age on earnings management (EM). We compared the large samples of 688 and 844 year-observation on listed firms in Indonesia stock exchange (IDX) and Singapore stock exchange (SGX), respectively. SGX is used as a benchmark of South East Asia (SEA) stock market. Despite SGX transaction has the highest rank in SEA stock exchange, yet the firm age average is newer than the IDX counterparts. Panel data regression was employed in analyzing the data. In addition, we conducted an anova pairwise t-test to examine the difference of firm age and EM depedency association in IDX and SGX. The result shows that both on IDX and SGX, firm age have a negative and significant effect towards EM. Moreover, it is found that there is a significant difference between the effect of firm age to EM in the firm listed on IDX and SGX.
FINANCIAL LEVERAGE AND IDIOSYNCRATIC RISK IN INDONESIA: DOES INTEGRATED REPORTING MATTER?
Authors: Geno Much. Rizal P. , Firmansyah Amrie , Prakosa Dani Kharismawan , Widyansyah Ahmad Surya
Published: May 2022

This study empirically examines the association between financial leverage and idiosyncratic risk. This study also includes integrated reporting elements as moderating variables. This study employs a quantitative approach with secondary data obtained from the www.idx.co.id, www. finance.yahoo.com, and related company websites. The research population includes companies engaged in the manufacturing sector, listed on the IDX in 2016–2020, with a sample of 450 companies based on purposive sampling. The data analysis method used is panel data regression analysis. This study finds that financial leverage positively affects idiosyncratic risk. Also, this study suggests that integrated reporting strengthens the positive effect of financial leverage on idiosyncratic risk. This study indicates that the Financial Services Authority of Indonesia should increase the policy of integrated reporting implementation by the listed companies.
Penggunaan Media Interaktif Dengan Pembelajaran Model Assure Untuk Meningkatkan Kemampuan Komuniasi Matematis Dan Pemecahan Masalah Serta Self Confidence Siswa Pada Materi Bangun Ruang Sisi Lengkung
Authors: Rosnawati Popon
Published: May 2022

Penelitian ini bertujuan untuk mengkaji peningkatan kemampuan Komunikasi Matematis dan Pemecahan Masalah serta Self Confidence Siswa kelas IX pada materi bangun ruang sisi lengkung dengan penggunaan media interaktif dalam pembelajaran model ASSURE ditinjau berdasarkan nilai KAM (Kemampuan Awal Matematika). Penelitian ini menggunakan metode campuran (Mixed Methods), dan penelitian ini adalah penelitian tindakan kelas yang terdiri dari 6 pertemuan dalam tiga siklus. Dengan subjek penelitian siswa kelas IX SMP Negeri 5 Sumedang sebanyak 3 kelas. Instrumen yang digunakan adalah instrumen tes kemampuan komunikasi dan pemecahan masalah, instrumen  non tes lembar observasi, angket dan hasil wawancara, dan nilai PAT kelas VIII semester 2 dijadikan sebagai KAM. Berdasarkan hasil penelitian diperoleh kesimpulan bahwa: secara keseluruhan Pembelajaran model ASSURE dapat meningkatkan kemampuan komunikasi matematis dan pemecahan masalah serta self confidence  siswa pada KAM berkategori tinggi dan rendah. Penggunaan media interaktif dengan pembelajaran model ASSURE dapat meningkatkan kemampuan komunikasi matematis dan pemecahan masalah serta self confidence  siswa pada siswa berkategori KAM tinggi dan rendah. Adanya perbedaan peningkatan kemampuan komunikasi matematis dan pemecahan masalah matematis antara siswa yang mendapat  Pembelajaran model ASSURE, siswa yang mendapatkan Pembelajaran penggunaan media interaktif dengan model ASSURE dan siswa yang mendapatkan Pembelajaran Konvensional. Terdapat peningkatan self confidence siswa antara siswa yang mendapatkan Pembelajaran model ASSURE dan siswa yang mendapatkan penggunaan media interaktif dengan pembelajaran model ASSURE, dari siswa yang mendapatkan Pembelajaran konvensional. Terdapat korelasi dengan kategori baik antara kemampuan komunikasi matematis dan kemampuan pemecahan masalah serta Self Confidence siswa dimana semakin tinggi tingkat kemampuan komunikasi matematis dan kemampuan pemecahan masalah matematis akan semakin tinggi self confidence siswa. Namun demikian kondisi korelasi dapat terganggu dengan beberapa faktor diantaranya, ketidakmampuan siswa untuk konsentrasi, keadaan kondisi sosial dan ekonomi, serta kurangnya kemampuan guru dalam menyampaikan materi.
Penerapan Model Pembelajaran Kooperatif Tipe CRH (Course, Review, Horray) Untuk Meningkatkan Kemampuan Pemahaman Matematis Siswa SMP
Authors: Auliya Risma Nurul , . Darhim , Nurlaelah Elah
Published: May 2022

Penelitian ini bertujuan untuk mengkaji penerapan model pembelajaran kooperatif tipe CRH (Course, Review, Horray) untuk meningkatkan kemampuan pemahaman matematis siswa SMP. Desain penelitian yang digunakan adalah kuasi eksperimen. Populasinya, yaitu seluruh siswa SMP kelas VIII di salah satu SMP Negeri Jakarta Selatan. Adapun, sampelnya terdiri dari 32 siswa kelas CRH (kelompok eksperimen) dan 34 siswa kelas konvensional (kelompok kontrol) yang dipilih menggunakan teknik purposive sampling. Masalah yang diteliti, yaitu peningkatan kemampuan pemahaman matematis. Analisis kuantitatif menggunakan independent sample t-test, sedangkan analisis kualitatif dilakukan secara deskriptif. Hasil penelitian menunjukkan peningkatan kemampuan pemahaman matematis siswa yang mendapatkan pembelajaran dengan model pembelajaran kooperatif tipe CRH lebih baik daripada siswa yang mendapatkan pembelajaran konvensional.
Kemampuan Representasi Matematis Siswa dalam Pembelajaran Flipped-Project-Based Learning
Authors: Handoko Bayu Tri
Published: May 2022

The goal of this study is to see how effective flipped-project-based learning models are at improving students' mathematical representation skills in class X at SMK Negeri 1 Jepon, Blora Regency. This study is quantitative research with an experimental method and uses a true experimental design with a pretest-posttest control group design strategy. This study focuses on students in class X at SMK Negeri 1 Jepon, Blora Regency during the academic year 2021/2022. A mathematical representation skills test was employed as a data collection approach before and after studying trigonometric content. The average difference test, individual completeness test, classical completeness test, and skills improvement test were all used in the data analysis. The average value of mathematical representation skills in the experimental class is 73.85, higher than the average value of mathematical representation skills in the control class, 70.10; the average value of mathematical representation skills in the experimental class is 73.85, higher than the minimum completeness criterion of 70; the proportion of students' completeness in the experimental class is 89%, higher than 75%; and the proportion of students' completeness in the experimental class is 73.85 and an increase in the skills of mathematical representation in the experimental class with moderate criteria
Implementasi Pelaksanaan Pelayanan Bimbingan dan Konseling di SDIT
Authors: Astutik Choli , Astuti Yeni Puji , Zainuddin Zainuddin
Published: May 2022

Pelayanan bimbingan dan konseling perlu disesuaikan dengan karakteristik siswa Sekola Dasar (SD) yaitu disesuaikan dengan tugas-tugas perkembangannya. Dalam menjalankan tugas-tugas perkembangannya, anak sering menemui hambatan dan permasalahan sehingga mereka banyak tergantung dengan orang-orang yang disekitarnya seperti orang tua dan guru, karena itu anak usia SD saat memerlukan perhatian khusus dari para guru di sekolah untuk menjalankan tugas perkembangannya secara optimal. layanan bimbingan dan konseling di SDIT Al- Hidayah Sumenep yaitu meliputi perencanaan, pelaksanaan dan evaluasi. Perencanaan Bimbingan Knseling di SDIT Al- Hdayah terdiri dari prgram tahunan, program bulanan, program mingguan dan program harian. Layanan yang diberikan meliputi yaitu layanan orientasi, layanan informasi, layanan konsultasi dan layanan konseling kelompok. Upaya yang dilakukan yaitu untuk mengatasi hambatan tersebut yaitu konselor bekerja sama dengan wali kelas untuk memberikan penjelasan di saat ada paguyuban kelas.
Peningkatkan Motivasi Belajar Siswa Melalui Bimbingan Kelompok
Authors: Sudarti Kris
Published: May 2022

The purpose of this study was to find out whether the efforts to improve motivation to learn through group guidance to Class VII students. H Middle School 1 TrangkilPati semester 2 academic year 2017/2018. PTBK Hypothesis: There are efforts to increase motivation to learn through group guidance to Class VII students. H Trangkil Middle School 1 Pati semester 2 academic year 2017/2018. Research design: 1) planning / planning, 2) acting / acting, 3) observation / observing), 4) reflection / reflection. Research subjects were only 7 students whose learning motivation was low compared to other friends. The reason for choosing class VII. H as a respondent of guidance and counseling actions. Conclusions from the research: 1) PTBK hypothesis which states that there is an effort to increase motivation to learn through group guidance for Class VII students. H Trangkil Pati 1 Middle School in semester 2 of the academic year 2017/2018, tested and proven true. 2) The effectiveness of group guidance services in improving the learning motivation of Class VII students. H Trangkil Pati 1 Middle School in semester 2 of the academic year 2017/2018, tested and proven to be true based on the findings data from the initial conditions to the second cycle there was an increase of 27.86%.
Peningkatkan Minat Belajar Melalui Layanan informasi Pada Siswa SMP
Authors: Rusmini Rusmini
Published: May 2022

The purpose of this study is to know the increase in students' interest in learning through information services provided by counselors. The study was designed with a classroom action research model with a subject of 32 students of class VIII of Cluwak Middle School 1 2017/2018. The results revealed that there was a significant increase between before the study, after the first and second cycles. Researchers suggest that information service innovations continue to be provided to continue to improve the quality of guidance services and counseling, especially information services.