bluuebunny/crossref_metadata_2025 huggingface dataset:
947-P: Glycemic Control Utilizing Continuous Glucose Monitoring vs. Point-of-Care Testing in Older Adults with Type 2 Diabetes in Long-Term Care Facilities
Authors: IDREES THAER , CASTRO-REVOREDO IRIS A. , GAVALLER MONICA D. , OH HYUNGSEOK , ZABALA ZOHYRA , MORENO EMMELIN M. , MOAZZAMI BOBAK , GALINDO RODOLFO J. , CABB ELENA , JOHNSON THEODORE M. , PENG LIMIN , UMPIERREZ GUILLERMO
Published: June 2023

We compared the efficacy of continuous glucose monitoring (CGM) and point of care (POC) testing (standard of care) in assessing glycemic control in older adults with T2D treated with either basal insulin or insulin secretagogues plus sliding scale in long-term care facilities (LTCF). All 97 subjects underwent POC testing before meals and bedtime and wore a Dexcom CGM. Treatment adjustment was performed by the primary care team, with a target glucose of 140-180 mg/dL, and for a duration of intervention up to 60 days. Study endpoints included differences in hypoglycemia < 70 and 54 mg/dL and hyperglycemia > 180 and 250 mg/dL by POC and CGM. Participants baseline characteristics (age: 74.7±11 years, BMI: 29.6±7.9, HbA1c: 8.06±2.2%) admitted to skilled nursing care/subacute rehab (80%) or long-term care (20%) facilities with a median length of participation of 17 (interquartile range 11, 29) days. The mean daily glucose by POC was lower than CGM (171±45 vs. 188±45 mg/dL, p<0.01). CGM detected significant greater proportions of subjects with hypoglycemia <70 mg/dL (40% vs. 14%) and <54 mg/dL (21% vs. 1.0%); as well as hyperglycemia >250 mg/dL (77% vs. 56%) compared to POC testing, all p<0.001. Conclusion: In older adults with T2D admitted to long-term care facilities, the use of CGM significantly improved detection of hypoglycemic and hyperglycemic events compared to POC.

Disclosure

T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. M.D.Gavaller: None. H.Oh: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None.

Funding

Dexcom, Inc. (IIS-2020-119_6X)
951-P: Intermittently Scanned Continuous Glucose Monitoring (isCGM) for T1DM—Subgroup Analysis from the FLASH-UK Study
Authors: LEELARATHNA LALANTHA , SUTTON CHRIS J. , EVANS MARK , NEUPANE SANKALPA , RAYMAN GERRY , LUMLEY SARAH , CRANSTON IAIN C. , NARENDRAN PARTH , BARNARD KATHARINE , TAXIARCHI VICKY P. , BURNS MATTHEW , CAMM MAISIE E. , THABIT HOOD , WILMOT EMMA G. , BEHALF OF THE FLASH-UK TRIAL STUDY GROUP ON
Published: June 2023

The recently published1, multi-site, FLASH-UK, randomized controlled trial (n=156, males 56%, Baseline HbA1c 71±9 mmol/mol, age 44±15) showed improved HbA1c and sensor-based metrics in adults with type 1 DM and an HbA1c ≥58 mmol/mol. Here we present results from pre-specified subgroup analysis for HbA1c (Table 1) and “Time in range (TIR)” (Table 2).

The effect of isCGM on both HbA1c and TIR did not differ significantly across subgroups for baseline HbA1c category, treatment modality, prior structured education, sex, deprivation status or depression category. The effect of isCGM on HbA1c was larger for younger people. Those with at least a bachelor’s degree had greater TIR improvement.

Conclusion: isCGM is effective across a range of clinical and demographic factors.

1N Engl J Med. 2022 Oct 20;387(16):1477-1487

Disclosure

L.Leelarathna: Advisory Panel; Abbott Diabetes, Medtronic, Insulet Corporation, Sanofi, Research Support; Abbott Diabetes, Novo Nordisk, Speaker's Bureau; Sanofi, Abbott Diabetes. V.P.Taxiarchi: None. M.Burns: None. M.E.Camm: None. H.Thabit: Advisory Panel; Dexcom, Inc., Roche Diabetes Care, Research Support; Dexcom, Inc., Speaker's Bureau; Eli Lilly and Company. E.G.Wilmot: Advisory Panel; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi, Roche Diabetes Care, Embecta, Consultant; Springer Healthcare, Research Support; Abbott Diabetes, Diabetes UK, Insulet Corporation, Novo Nordisk, NIH - National Institutes of Health, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi, Ypsomed AG, Glooko, Inc. On behalf of the flash-uk trial study group: n/a. C.J.Sutton: None. M.Evans: Advisory Panel; Zucara Therapeutics, Pila Pharma, Dexcom, Inc., Other Relationship; Novo Nordisk, AstraZeneca, Abbott Diabetes, Speaker's Bureau; Eli Lilly and Company. S.Neupane: Advisory Panel; Quin, Abbott Diabetes, Roche Diabetes Care, Insulet Corporation, Other Relationship; Abbott Diabetes. G.Rayman: Other Relationship; Diabetes UK, Novo Nordisk, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Lilly Diabetes, Sanofi. S.Lumley: None. I.C.Cranston: Research Support; Eli Lilly and Company, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, Viatris Inc. P.Narendran: Advisory Panel; Omnipod, Speaker's Bureau; Abbott Diabetes, Lilly Diabetes. K.Barnard: Advisory Panel; Abbott Diabetes, Roche Diabetes Care, Sanofi, Consultant; LifeScan Diabetes Institute, Tandem Diabetes Care, Inc., Research Support; Novo Nordisk.

Funding

Diabetes UK (18/0005836)
956-P: Association between Glycemia Risk Index (GRI) and Diabetic Retinopathy in Type 2 Diabetes—A Prospective Cohort Study
Authors: WANG YAXIN , LU JINGYI , NI JIAYING , WANG MING , SHEN YUN , LU WEI , ZHU WEI , BAO YUQIAN , RODBARD DAVID , VIGERSKY ROBERT A. , JIA WEIPING , ZHOU JIAN
Published: June 2023

Background: The glycemia risk index (GRI) is a new composite metric for assessing the quality of glycemia based on expert ranking by 330 clinicians of 14-day continuous glucose monitoring (CGM) tracings. Compared with time in range (TIR), GRI has been shown to correlate more closely with the clinicians’ opinions as to the overall quality of glycemia profiles. However, the relationship between GRI and diabetes-related outcomes remains unknown. We aimed to investigate the association between GRI and incident diabetic retinopathy (DR).

Methods: A total of 1,204 adult type 2 diabetes without DR at baseline were included between 2005-2019 from a single center in Shanghai, China. GRI was obtained from 3-day CGM data at baseline. Cox proportional hazards regression models were used to estimate the association between GRI and incident DR.

Results: During a median follow-up of 8.4 years, 301 patients developed DR. The multivariable-adjusted (age, sex, current smoking status, diabetes duration, BMI, systolic BP, TG, HDL-C, and LDL-C) hazard ratios (HRs) for incident DR across ascending GRI quartiles (≤14 [reference], 15~28, 29~47 and >47) were 1.00, 1.05 (95% CI 0.74-1.48), 1.33 (95% CI 0.96-1.84) and 1.53 (95% CI 1.11-2.11), respectively. For per 1-SD increase in GRI, the risk of DR was increased by 20% (HR=1.20, 95% CI 1.07-1.33) after adjustment for confounders. With respect to TIR, per 1-SD decrease was associated with a 23% (HR=1.23, 95% CI 1.10-1.37) increased risk of DR. There was no statistically significant difference in risk discrimination for incident DR when using GRI and TIR, as measured by C statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) (all P>0.05), after adjustment for confounders.

Conclusion: In patients with type 2 diabetes, higher GRI is associated with an increased risk of incident DR, with a predictive value comparable to TIR. The potential value of GRI needs to be explored in future studies.

Disclosure

Y.Wang: None. R.A.Vigersky: Employee; Medtronic. W.Jia: None. J.Zhou: None. J.Lu: None. J.Ni: None. M.Wang: None. Y.Shen: None. W.Lu: None. W.Zhu: None. Y.Bao: None. D.Rodbard: Consultant; Lilly Diabetes.
960-P: Hemodialysis-Related Glycemic Patterns among People with Insulin-Treated Type 2 (T2D) Diabetes—Role of Continuous Glucose Monitoring (CGM)
Authors: GALINDO RODOLFO J. , MOAZZAMI BOBAK , GERGES AMANY Y.G. , PENG LIMIN , TUTTLE KATHERINE R. , UMPIERREZ GUILLERMO
Published: June 2023

Background: Hemodialysis (HD) impacts glucose and insulin metabolism and increases hypoglycaemia rates. Glucose-containing dialysate decreases the risk, but studies using CGM metrics are lacking.

Methods: Prospective observational study of insulin-treated adults with T2D, receiving hemodialysis (dialysate glucose 100mg/dl), at least thrice weekly. Subjects were instructed to wear a Dexcom G6-Pro for 10 days. We assessed CGM metrics (mean glucose, %TIR, %TAR, %TBR, and hypoglycemic and hyperglycemic rates) during three time periods: 20-hours before (PreHD), during (HD, ~4 hours), and 20-hours after (PostHD) hemodialysis sessions.

Results: Among 56 subjects (mean age 57.3±9, HbA1c 7.2±1.4), mean glucose, %TAR, %TIR and rates of hypoglycaemia <70mg/dl were significantly better during HD. %TAR >180mg/dl and > 250mg/dl were significantly higher after HD, see Table 1. Other hypoglycaemia metrics were overall low, and not different in relation to HD timing.

Conclusion: CGM patterns demonstrated improved glycemic control during dialysis, with tendency for higher glucose metrics before HD. Hypoglycaemia metrics were low, while severe hyperglycemia excursions are common across all HD-related periods. Future studies using newer CGM technology and providing longer duration of CGM monitoring are needed for subjects with T2D treated by HD.

Disclosure

R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. B.Moazzami: None. A.Y.G.Gerges: None. L.Peng: None. K.R.Tuttle: Consultant; Lilly, AstraZeneca, Gilead Sciences, Inc., Research Support; Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Novo Nordisk, Goldfinch Bio, Inc., Traveere Pharmaceuticals. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.
962-P: Impact of Digital Diabetes Solution on Glycemic Control in Adults with Type 2 Diabetes Mellitus in the United States—A Retrospective Cohort Study
Authors: THINGALAYA NITA , KERR DAVID , KUMAR POTUKUCHI PRAVEEN , WILSON LAURA , LEE KENI C. , HAN-BURGESS EDWARD JONATHAN K. , EDWARDS ALISON , YU XINYAN , KENNEDY ADEE , LEE FELIX
Published: June 2023

Background: Dario Diabetes Solution (DDS) is a digital health application (app) that combines a blood glucose (BG) monitoring system with a smartphone app, allowing tracking of BG levels in real time. This study evaluated effectiveness of DDS on HbA1c between DDS users and matched nonusers.

Methods: This retrospective cohort study included adults with type 2 diabetes mellitus (T2DM) with a baseline (BL) HbA1c ≥7% who used DDS (users) or received usual care (nonusers) between January 1, 2017, to October 31, 2021. BL period was 1 year before index date (first DDS registration [users] or first claim date in the quarter [nonusers]); follow-up period was 6 months. DDS user and nonuser cohorts were matched 1:3 using exact and propensity score matching. Primary endpoint was change in HbA1c from BL to 6 months, with subgroup analyses of patients (pts) with BL HbA1c >7.5%, >8%, >9%, and ≥1% drop from BL. Difference-in-difference results are reported using least squares (LS) means from linear models.

Results: The study included 568 DDS users and 1699 nonusers. For all 2267 pts, mean ± SD age was 57.5±11.3 years and HbA1c was 9.14±1.83% at BL. At 6 months, LS mean difference between groups was −0.23% (mean HbA1c change vs BL: users, −1.02% [95% CI, −1.15, −0.89]; nonusers, −0.79% [−0.87, −0.71]; P=0.004). HbA1c drop ≥1% from BL to 6 months was achieved by 47% of users vs 37% nonusers (difference: 10%; P<0.001). Subgroup analysis at all BL HbA1c showed users achieved more significant HbA1c reductions vs nonusers (P<0.05). For pts with BL HbA1c >9%, the healthcare effectiveness data and information set performance measure, mean difference between groups was -0.47% (users, -2.25% [-2.50, -1.99]; nonusers, -1.78% [-1.92, -1.63]; P=0.002).

Conclusions: Adults with uncontrolled T2DM using DDS had better outcomes at 6 months, with more significant HbA1c reductions than matched nonusers across various BL HbA1c levels, showing incremental improvements to usual care.

Disclosure

N.Thingalaya: None. F.Lee: Employee; Sanofi, Stock/Shareholder; Sanofi. D.Kerr: Consultant; Sanofi-Aventis U.S. P.Potukuchi: None. L.Wilson: Employee; Sanofi. K.C.Lee: Employee; Sanofi. E.K.Han-burgess: Employee; Sanofi. A.Edwards: Employee; Symphony Health, an ICON plc company, Other Relationship; Sanofi. X.Yu: None. A.Kennedy: None.

Funding

Sanofi
965-P: The Related Factors Affecting the Relationship between HbA1c and Glucose Management Indicator in Adult T2D Patients with Good Glycemic Control
Authors: LIU ZHIGU , LIN BEISI , CHEN DANRUI , LIN HUIMIN , YANG DAIZHI , YAN JINHUA , YAO BIN , XU WEN
Published: June 2023

Aim: Glucose Management Indicator (GMI) is correlated with HbA1c, while studies reported the discrepancy between them. Factors affecting this discrepancy, especially in patients with good glycemic control, remain unclear. This study was designed to explore the related factors affecting the relationship between HbA1c and GMI in adult T2D patients with good glycemic control.

Methods: Adult T2D patients with good glycemic control who received HbA1c test and CGM were retrospectively analyzed. GMI and glycemic variability (GV) indices including SD and MAGE were derived from CGMS. The absolute value of hemoglobin glycation index (HbA1c minus GMI) (|HGI|) was used to quantify the difference between HbA1c and GMI. Linear regression and correlation analyses were used to analyze the correlation between GV indices and |HGI|, HbA1c and GMI and whether GV affected their relationship.

Results: Eighty-four patients (median HbA1c 6.6%, median GMI 6.4%) were included. |HGI| was higher than 0.5% in 40% of the patients (n=34). |HGI| was linearly correlated with SD and MAGE (β = 0.291 and 0.294, P<0.05). HbA1c was linearly correlated with GMI (β=0.525, P<0.001). This correlation remained after adjusting for sex, age, diabetes course, BMI, hemoglobin level and with chronic diabetic complications or not (Model 1, β=0.496, P<0.001). Further adjusting for SD (Model 2) or MAGE (Model 3) based on Model 1, the correlation between HbA1c and GMI became weaker (β=0.398 and 0.425, respectively). The correlation between HbA1c and GMI was closer in the patients with normal SD (<1.4mmol/L) than those with abnormal SD (r=0.563 vs. r=0.505). A similar result could be found in patients with normal MAGE (<3.9mmol/L) and abnormal MAGE (r=0.579 vs. r=0.514).

Conclusion: HbA1c was positively correlated with GMI. But even in adult T2D patients with good glycemic control, the correlation between HbA1c and GMI was significantly affected by GV. SD or MAGE accounted for this discrepancy.

Disclosure

Z.Liu: None. B.Lin: None. D.Chen: None. H.Lin: None. D.Yang: None. J.Yan: None. B.Yao: None. W.Xu: None.
984-P: Importance and Use of Smart Insulin Pens with Connectivity for Diabetes Management
Authors: HEINEMANN LUTZ , EHRMANN DOMINIC , HERMANNS NORBERT , ROOS TIMM , KULZER BERNHARD
Published: June 2023

Smart insulin pens have the potential to fulfill some of the unmet needs of people with diabetes through the accurate administration of bolus doses, the simplification of documentation relating to diabetes therapy, the improvement of communication and the quality of advice given to patients. 305 (2021) and 336 diabetologists in Germany (2022; 38% female, average age 55.2 years) were asked via an online survey about the importance and use of smart insulin pens. In 2022, only 4.8% of all people with type 1 diabetes and 1.5% of all people with type 2 diabetes used a smart pen. The total estimated utilization in 5 years is 18.3% (2021: 23.9%). The importance of smart pens is currently estimated by diabetologists at 8.0%, which is not very high and lower than in 2021 (15.5%). This also applies to the estimated relevance in 5 years (2022: 24.7 %; 2021: 37.9 %). However, 29.7% of all people with type 1 diabetes are considered to have an indication for a smart pen, 30.8% of people with type 2 diabetes and basal insulin therapy, and 37.6% with multiple injection therapy. The main barriers to smart pens identified were patient preference for prefabricated pens (54.6% agreement), low added benefit (49.4%), lack of interoperability with glucose analysis software (44.3%), lack of interoperability with apps (35.6%), too little choice (need to change insulin), and too high cost (33.9%). Despite a very positive attitude towards digitization of diabetes therapy among physicians (2021: 81.9%; 2022: 86.3%), smart pens are currently used only very rarely and their importance for diabetes therapy is considered rather low. Better, simpler, and patient-friendly solutions are needed so that all types of smart insulin devices can be read easily by glucose management software and users experience perceivable benefits.

Disclosure

L.Heinemann: Consultant; 9am.health. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. T.Roos: None. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care.
985-P: Is Insulin Titration Supported by a Titration App Safe? Safety Results of an RCT
Authors: KULZER BERNHARD , EHRMANN DOMINIC , ROOS TIMM , FINKE-GROENE KATHARINA , HERMANNS NORBERT
Published: June 2023

A multicenter RCT in people with type 2 diabetes has shown that the use of a basal insulin titration app (myDose Coach) reduced A1c levels by 0.35 percentage points compared to titration without an app. Is the use of such a titration app associated with safety issues? We used negative binomial regressions to analyze the occurrence of adverse and serious adverse events (AE, SAE) and exposure to dangerously low (<54 mg/dl) or high (>250 mg/dl) glucose levels in 251 participants (age 60.0 years IQR 56.0 - 66.5; HbA1c 8.2 IQR 7.7 - 9.1%) randomized equally to the control and intervention groups. A total of 30 AEs (16 vs. 14 events) occurred in the control and intervention groups, of which 14 were SAEs (7 vs. 7 events). No event was judged to be associated with study participation or the interventions. The rates of dangerous low and high glucose in the control and intervention group were 0.12% vs. 0.10% for %< 54 mg/dl and 4.9% vs. 3.6% for %< 250 mg/dl, respectively (see Figure 1 for IRR and p values for superiority). A post-hoc non-inferiority test for the occurrence of %< 54 mg/dl and >250 mg/dl with non-inferiority margins of < 1% and < 5%, respectively, showed significant non-inferiority regarding the intervention group (both p < 0.01) with a post-hoc power by 75% respectively 55%. The results did not indicate an increased risk for insulin titration by the evaluated app compared to the control condition in terms of AE or extreme glucose excursions.

Disclosure

B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. K.Finke-groene: None. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG.

Funding

Sanofi
987-P: Digital Signals from Continuous Glucose Monitors Predict 90-Day Median Glucose in Type 2 Diabetes
Authors: YUAN LI ZE , CLARK CALLAHAN , SAHA SANKALITA
Published: June 2023

The use of continuous glucose monitors (CGMs) among people with type 2 diabetes continues to expand beyond those treated with insulin or at high-risk for hypoglycemia. Defining precision CGM utilization strategies and augmenting A1c monitoring approaches is increasingly important to inform the application of episodic or continuous wearable data in clinical, payer, and digital health settings. We offer a method to predict 90-day glucose from 30 days of CGM data, offering an accelerated intervention window for people with T2D at low risk of hypoglycemia and no insulin treatment.

We used linear regression to predict 90-day glucose from initial median glucose and glycemic variability (Fig1A - eq 2). Of 5516 people with T2D in a digital diabetes program with rtCGM and no insulin use (2019 - 2022), 497 had sufficient data for inclusion (age 56.5 +/- 8.9; 49.5% F, 75% with > 81 days CGM wear in the first 90 days). The data was 80/20 train/test split. The model predicted median glucose at 77 - 90 days with MAE +/- 14.7 mg/dL, RMSE 21.9 mg/dL and adj R2 =0.424 for training; and MAE +/- 16.7 mg/dL, RMSE +/- 26.0 mg/dL for testing. Fig 1B shows the distribution of the MAE of full dataset across different initial median glucose levels. Hence, based on the plot, error IQR and outlier boundary increase beyond 177.6 mg/dL, the model may be best used with initial glucose level < 177.6 mg/dL.

Disclosure

Z.Li: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. S.Saha: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
99-OR: Outcomes of Patients With and Without Severe Renal Impairment Admitted with Moderate and Severe Diabetic Foot Infections
Authors: COYE TYLER L. , CRISOLOGO PETER , SULUDERE MEHMET A. , LAVERY LAWRENCE A.
Published: June 2023

Renal impairment considerations have largely been absent diabetic foot literature, despite evidence that people with severe renal impairment are at elevated risk complications following diabetic foot infections. We evaluated clinical outcomes in patients who were admitted to hospital with diabetic foot infections with severe renal impairment compared with patients without a disability. This was a retrospective study of patients with diabetes mellitus who had been hospitalized at a level 1 trauma center with moderate and severe diabetic foot infections. Patients were grouped according to their Glomerular Filtration Rate (GFR). Patients with severe renal impairment were defined as having a GFR < 30mL/min. Primary outcomes were mortality, wound healing and reinfection rates. Primary and secondary outcomes were compared using multivariable regression RStudio. A total of 307 patients with diabetic foot infections (62 patients with SRI and 245 patients without SRI) were included in the analysis. Multivariate analysis revealed that patients with severe renal impairment had higher rates of peripheral arterial disease (87% vs 66.9%; p = 0.003) and lower hemoglobin levels (9.8 vs 12.0; p <0.001). We found that patients with diabetes and severe renal impairment at admission had significantly lower glycosylated hemoglobin levels (7.2% vs 9.2%; p < 0.001). There was no difference in severity of infections between the two groups. We found that diabetic patients with severe renal impairment had higher mortality rates (8.1% vs 2.0%; p = 0.044) and higher rates of re-admission of new infections at different sites (51.6% vs 22.9%; p < 0.001). There was no significant difference between the other outcomes of interest (wound healing and reinfection). In conclusion, patients with severe renal impairment who were admitted to hospital moderate and severe diabetic foot infections had higher mortality rates and elevated readmission risk than those without severe renal impairment.

Disclosure

T.L.Coye: None. P.Crisologo: None. M.A.Suludere: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.
990-P: Estimating the National Costs of T2DM in the UK within the Context of Contemporary Guidelines
Authors: MCEWAN PHILIP , FOOS VOLKER , MARTIN REBECCA , CHEN JIELING
Published: June 2023

Background: The updated National Institute for Health and Care Excellence (NICE) type 2 diabetes (T2D) guidelines extend the recommendation of SGLT2 inhibitors (SGLT2i) for hyperglycaemia management to include their use in those with atherosclerotic cardiovascular disease (ASCVD), chronic heart failure (HF), chronic kidney disease (CKD) or high CVD risk. Our study estimates the potential cost consequence in the UK of the broad positioning of SGLT2i within updated guidelines (NG28-2022) versus previous guidelines (NG28-2015).

Methods: The Cardiff T2D model was used to project lifetime outcomes and costs for T2D patients across established UK treatment pathways including metformin, sulfonylurea, DPP-4 inhibitors and NPH insulin with or without SGLT2i combination to reflect former vs. updated guidelines. Analyses were conducted in four subgroups (ASCVD, HF with reduced ejection fraction (HFrEF), CKD, high CVD risk). Projected outcomes were extrapolated to national level using population estimates from NICE’s guideline companion resource impact report.

Results: Predicted lifetime costs for 1.7 Mn SGLT2i eligible T2D patients in the UK were estimated at £87.1 Bn with NG28-2022 compared to £101.7 Bn with NG28-2015. Net savings associated with NG28-2022 management of £14.56 Bn were attributable to comorbid CKD (£5.09 Bn), high CVD risk (£4.77 Bn), ASCVD (£3.96 Bn) and comorbid HFrEF (£0.74 Bn). Overall net savings were predicted despite an increase in pharmacy costs of £5.57 Bn. Changes in metabolic parameters and reduction in cardiovascular and kidney progression rates were predicted to prevent 20183 myocardial infarction events, 66651 HF events and 140303 events of end stage kidney failure. The magnitude of savings was a combination of event reductions and the number of eligible patients in subgroups.

Conclusion: Our study indicates that uptake of SGLT2 inhibitors in line with NICE guidelines has the potential to improve health and be cost saving despite an increase in pharmacy costs.

Disclosure

P.Mcewan: Other Relationship; AstraZeneca. V.Foos: Other Relationship; AstraZeneca. R.Martin: Employee; AstraZeneca. J.Chen: Employee; AstraZeneca, Eli Lilly and Company.
992-P: Coronary Artery Calcium Scoring to Improve Statin Use in Adults with Type 2 Diabetes Not on Statin Therapy—Anticipated Cost Utility
Authors: LAU DARREN , PEARSON GLEN J. , RAGGI PAOLO , KLARENBACH SCOTT
Published: June 2023

Background: Statin use in adults with diabetes is sub-optimal. Coronary artery calcium (CAC) scoring can provide a visual quantification of CV risk and may improve statin initiation and long-term use. Objective: Estimate the cost-utility of CAC scoring compared to traditional CV risk counselling only, for improving statin use in adults with diabetes who have not previously had a CV event, and are not on statin therapy.

Methods: Probabilistic Markov model from a health system perspective, over a 10-year time horizon. The effectiveness of CAC scoring was obtained from the EISNER trial. Outcomes included acute coronary syndrome (ACS), stroke, heart failure, mortality, and radiation-induced cancer. Outcome rates and costs were obtained from an analysis of Alberta administrative data, and from publicly available sources. The base population modeled was men age 60, with additional analyses for other age, sex-groups and scenarios.

Results: CAC scoring increased statin use to 44% vs 25% with traditional CV risk counselling only. There were 8.4 fewer ACS, 5.5 fewer strokes, and 1.6 fewer deaths / 1000 individuals. Costs were slightly lower (-$14, 95% CI [-$402-(+$208)]) (CAD), for a small benefit in quality-adjusted life years (+0.01, [0.00-0.02]), with mean ICER of $7,132 (-$27,828-(+$65,513)) / QALY. At a willingness-to-pay of $50,000 / QALY, CAC was cost-effective in 95% of trials. CAC scoring was not cost-effective in younger men or in women, but could be cost-effective or cost savings in men (age ≥ 40) and older women (age ≥ 60) who refuse statin therapy, but would be persuaded by personalized evidence of coronary artery disease (CAC score > 10).

Conclusion: CAC scoring may be cost-effective in older men not receiving statins, and in men or older women who agree to use statins if shown personalized evidence of coronary artery disease.

Disclosure

D.Lau: None. G.J.Pearson: Advisory Panel; HLS Therapeutics Inc., Novartis Pharmaceuticals Corporation, Pharmacience, Consultant; Trimedic Therapeutics. P.Raggi: None. S.Klarenbach: Research Support; Bayer Inc., Allergan, GlaxoSmithKline plc., CSL Behring, Lundbeck, University Hospital Foundation (University of Alberta), Purdue Canada.
Current evidence for moderate and ultra-hypofractionated radiation therapy in prostate cancer: a summary of the results from phase 3 randomised trials
Authors: Lilleby Oscar , Meidahl Petersen Peter , Daugaard Gedske , Anne Perell Katharina
Published: June 2023

Problem: A low α/β ratio for prostate cancer (PCa) compared to surrounding normal tissue theoretically implies therapeutical advantages with hypofractionated treatment. Data from large randomised control trials (RCTs) comparing moderate hypofractionated (MHRT, 2.4–3.4 Gray/fraction (Gy/fx)) and ultra-hypofractionated (UHRT, >5 Gy/fx) with conventionally fractionated radiation therapy (CFRT, 1.8–2 Gy/fx) and the possible clinical implications have been reviewed.Materials and method: We searched PubMed, Cochrane and Scopus for RCT comparing MHRT/UHRT with CFRT treatment of locally and/or locally advanced (N0M0) PCa. We found six RCTs, which compared different radiation therapy regimes. Tumour control and acute and late toxicities are reported.Results: MHRT was non-inferior to CFRT for intermediate-risk PCa, non-inferior for low-risk PCa and not superior in terms of tumour control for high-risk PCa. Acute toxicity rates were increased compared to CFRT, especially an increase in acute gastrointestinal adverse effects was seen. Late toxicity related to MHRT seems to be comparable. UHRT was non-inferior in terms of tumour control in one RCT, with increased acute toxicity, but with comparable late toxicity. One trial, however, indicated increased late toxicity rates with UHRT.Discussion and conclusion: MHRT delivers similar therapeutic outcomes compared to CFRT in terms of tumour control and late toxicity for intermediate-risk PCa patients. Slightly more acute transient toxicity could be tolerated in favour of a shorter treatment course. UHRT should be regarded as an optional treatment for patients with low- and intermediate-risk disease applied at experienced centres in concordance with international and national guidelines.
LANDSCAPE DYNAMICS IN THE SOMEȘ CORRIDOR. CASE STUDY: GURUSLĂU DEPRESSION (ROMANIA)
Authors:   ", COSTEA Andreea ,   Babeş-Bolyai University, Faculty of Geography,   Territorial Identities and Development Research Centre, 5-7 Clinicilor Street, 400006, Cluj-Napoca, ROMANIA", GLIGOR Viorel ,   "Babeș-Bolyai University, Faculty of Geography, Department of Regional Geography and Territorial Planning; Territorial Identities and Development Research Centre, 5-7 Clinicilor Street, 400006, Cluj-Napoca, ROMANI", IRIMUȘ Ioan-Aurel ,   "Babeş-Bolyai University, Faculty of Geography, Department of Physical and Technical Geography, 5-7 Clinicilor Street, 400006, Cluj-Napoca, ROMANIA"
Published: June 2023

Changes in land use patterns induced by different agricultural practices are reflected territorially through transformations at the level of elementary landscape units, with an impact on territorial identity and cohesion. The aim of this study is to highlight the dynamics of the territorial structures in the post-communist period (1990-2018), diachronically reflected in the transformations of the landscape of the Guruslău Depression, using the landscape metrics. The main direction of the scientific research was based on the analysis of land use changes and the identification of the spatial elements of structural-landscape distinction with impact on land degradation process. The evaluation of the landscape dynamics in the current context uses several effective metrics and tools, which increasingly require the identification of interdisciplinary methods of analysis, with a decisive impact on territorial development. Besides, the present approach is also motivated by the increasing environmental impact of climate change. The methodology used in the present paper is based both on the geoprocessing of vector data using GIS tools and correlated spatial analysis, and on the identification of landscape types using a new process of reclassifying land use categories, according to a set of landscape definition variables. The results of the research highlighted both the particularities of landscape transformations that occurred in the reference interval, as well as the favourable conditions for addressing biocultural diversity, by identifying traditional agricultural practices and the resilience of geographical landscapes given the adaptation to changing development strategies. Meanwhile, by detecting the landscape structures affected by change, in correlation with the impact induced on the biodiversity of the territory, the present study has a wide applicability in the most appropriate implementation of local development policies, as well as in identifying the forms of sustainable valorisation of the landscape in the study area.
THREE WOMEN ON THREE FRONTS: THE FEMININE EXPERIENCE OF THE FIRST WORLD WAR AS REFLECTED IN WAR JOURNALS AND LETTERS
Authors:   Babeş-Bolyai University, Alexandru Duma Museum, Cluj-Napoca, ROMANIA, DEAC Eliza
Published: June 2023

The aim of this article is to provide a close reading of two illustrative texts for the feminine version of the war diary during WWI in the Romanian territory, namely Yvonne Blondel’s War Journal: 1916-1917 and Queen Marie’s unabridged version of the diary she kept between 1916 and 1918. The contrastive element is represented by Sextil Pușcariu’s Memoirs, which are relevant from a threefold perspective: gender, geography, and the representation of the feminine figure. The article will focus on six feminine roles: the nurse, the patriot, the diplomat, the wife, the mother, and the writer.
REPRESENTATIONS OF WOMEN AND OF THEIR ROLES IN THE WORLD OF THE ROMANIAN VILLAGE. PICTURE POSTCARDS FROM THE END OF THE 19TH CENTURY AND THE FIRST HALF OF THE 20TH CENTURY
Authors:   Babeș-Bolyai University: Cluj-Napoca, ILOVAN Oana-Ramona , CIUPE Ioana Alexandra ,   Territorial Identities and Development Research Centre, Babeş-Bolyai University, Cluj-Napoca, ROMANIA, MUNTEAN Adrian-Daniel ,   Faculty of Geography and Territorial Identities and Development Research Centre, Babeş-Bolyai University, Cluj-Napoca, ROMANIA
Published: June 2023

This study aims to explore the visual discourse about women and their roles in the Romanian village, a discourse created by the picture postcards from the end of the 19th century and the first half of the 20th century. To reach this aim, we considered the following objectives: to realise a typology of the used research material, to identify the main representations of women, to analyse the relationship between the representations of women and the other represented elements (men, children, rural landscapes, households, tools, etc.), to discuss the main features of the visual discourse about the women from the rural area, for the respective period, based on the previous identification of the elements that became iconic through repeated representation. We used a critical visual methodology and discourse analysis to explore the picture postcards that represented women from the Romanian village, underlining the connection between their meanings and the cultural reality. Our findings are useful for similar research on gender and its visual construction from the end of the 19th century and the beginning of the 20th.
The Future of Philosophy
Authors: Gabriel Susan Krantz
Published: June 2023

In the past, philosophy, as it was brought to life originally by the ancient Greeks, was based on the audacious premise that the cosmos is intelligible, that human reason can come to understand reality at least in part.  In the early to mid-twentieth century, however, philosophy was declared dead on both sides of the analytic-continental divide, so it seems appropriate to ask whether philosophy has a future and, if so, what sort of future this could and should be.  In this essay, I first look at the claims of philosophy’s demise and their philosophical milieu, focusing on Martin Heidegger, Bertrand Russell, and Ludwig Wittgenstein.  Then I suggest a reason for the dire forecast, namely, the aftermath of what has been called the “Second Thirty Years’ War,” and respond to objections that can be raised against this explanation.  Finally, I indicate the sort of future that I think we should envision for philosophy.
The Impact of New Social Media Technologies on the Populist Phenomenon
Authors: Bavili Negin
Published: June 2023

This research studies how social media has transformed the populist politics. Qualitative research study will be done by means of examining the case of populist politicians use of social media in Turkey in 14 May 2023. At the first sectition of research, the difference between main stream media and social media are clarified. At the second part of the resaerch, the relavence of social media in populist communication is studied. In this section the research attempts to answer why populist politicians prefer social media platforms? The third part of the study, will investigate how new social communicative tools like twitter and instagram contextualisatıon of new insights in to an old phenomenon of populism? In the Fourth section of the reseach, the case of Turkey’s election will be investigated to see how use of social Media has affected populism in turkey? In brief, this research is a case study that looks how social media affected populist politicians in Turkey.
Politik Kebangkitan Adat dalam Praktik Wacana Orang Ambon
Authors: Batlayeri Willem
Published: June 2023

In Indonesia, the emergence of indigenous revivalism (or adat revivalism) is equated with unequal treatment at the local level, such as the seizure of adat lands to be converted into national development concessions. The conversion of “negeri adat” (indigenous villages) in Ambon, which is the main locus of this study, represents an instance of this. Indigenous revivalism intends to fight for indigenous values and regain equality that was neglected during the New Order Regime. However, unfortunately, it has become rooted in the discourse of power. This indigenous euphoria in the Reformasi era did not answer the challenge of indigenous values, but instead got caught up in local political interests by bureaucratizing, managerializing, and/or administering indigenous values. The consequence is ethnic projection. The discourse of indigenous revival has turned into a discourse of ethnic identity revival. In that context, especially regarding the revival of indigenous discourse in Ambon, I would like to discuss three main issues, namely: genealogy, power relations, and subjectivity. The discussion of the third issue will utilize Michel Foucault’s critical discourse analysis method.
Simulasi (Gosip) Infotainment dalam Retorika Image (Keaiban) Selebritis
Authors: Windarto Anicetus
Published: June 2023

This study is intended to: (1) become aware of forms of celebrities’ rhetorical (im)morality which are constructed as (floating) signifiers in infotainment; (2) understand and interpret the political media minutely based on communication technology of virtual reality and/or real virtuality that is produced by forms of celebrities’ rhetorical (im)morality in infotainment; (3) reconstruct and disseminate the understanding and action of cultural paradigms based on the results of re-examination of reality and / or infotainment virtuality which inspired the idea of celebrity (im)morality. The main contribution of this study is to offer a perspective that attempts to understand, interpret, and become aware of infotainment shows through Baudrillard’s notion of simulation. This study attempts to describe the reality as that which had been created through the infotainment show by its celebrity’s rhetorical (im)morality and how ironic an impact it has in our society.
From Critical Psychology and Cultural-Historical Psychology to “Culturally-Turned” Psychology
Authors: Supratiknya Augustinus
Published: June 2023

Critical psychology and cultural-historical psychology are two approaches emerging as critiques to mainstream psychology that is often perceived to be hedonistic and individualistic. Adopting the spirit of critical psychology and cultural-historical psychology that strive to break the grips of mainstream psychology as well as absorbing the inspiration from Thomas Teo’s psychological humanities, Svend Brinkmann’s cultural psychology, Richard Johnson’s cultural circuit, and Stuart Hall’s cultural studies, as a critical review this article proposes an approach coined as psikologi berhampiran budaya (culturally-turned psychology) based on the socio-cultural realities of the present-day Indonesian society. Psikologi berhampiran budaya offers four models of psychological research in the production of knowledge on both the subject and the society of the present-day Indonesia. The application of the four models in such culturally turned production of knowledge is expected to simultaneously and serendipitously produce a specifically Indonesian psychology.
Remote Sensing and GIS Techniques in Monitoring Land Use Land Cover Change
Authors:   Middle Technical University, Technical Institute of Anbar, Iraq, Kareem Sameer Mohammed
Published: June 2023

This examination by utilizing GIS and Remote Sensing procedures to planning highlights of Al-Kut city, Iraq from 2004 to 2014, in order to classify developments that has occurred between these periods. The using of satellite image (Quick bird satellite) with depending on remote detecting and GIS to identify Land Use/Land Cover change which is defined as the amount of the distinct information and current change data that can incite continuously touchable bits of information into basic strategies, including land spread and land use changes. The process of defining the Changes related to LULC properties called change detection and it’s referenced to Geo-registered high resolution. It is useful in many applications such as identification of land use changes, the amount of deforestation, urban extension, and other cumulative changes through spatial and historical analysis techniques. The dependable method briefly by data acquisition (satellite image with resolution 0.60 m) and geo-referenced with GCPs to produce a thematic map of feature classified and making the statistical analyzing.ARC map software help us to make this easy by depending on entering two types of data, first one is satellite image and second one is ground control points. This study shows a development in built-up land and expansion from 2004 to 2014, however in the city, land decreasing, which is due to the development and growth in it. Finally, the result shows the decreasing in waterbodies and waste land area with noticed increasing of using land. These progressions are mainly happening with uncontrolled urban growth.
Using of Stepped Shape Rock filled Weir as Squandering Energy Structure in Rectangular Channels : A Laboratory Study
Authors:   Directorate of Water Resources in Kerbala, 56001, State Commission on Operation of Irrigation and Drainage Projects, Ministry of Water Resources, Iraq, Al-Fawzy Ali , Al-Shukur Abdul-hassan , Al-Mohammed Fadhil , Hommadi Ali ,   Civil Department, College of Engineering, University of Babylon, 11702, Babylon, Iraq,   Kerbala Technical Institute, Al-Furat Al-Awsat Technical University, 56001, Karbala, Iraq,   Al-Hindyiah Barrage Project, Babylon, 11702, State Commission of Dams and Reservoirs, Ministry of Water Resources, Iraq
Published: June 2023

Measuring the ability of hydraulic structures on works performing may be consider as a definition of the flow energy. The current study goal is to know the dispersed energy of flow in the steps-shaped, rockfill weir. A set of twenty five laboratory experiments and one hundred seventy five operation tests were carried out by using a laboratory handled metal channel with multiple discharge values. The tested hydraulic models has a different five lengths, and the filling material used was natural quarry crushed stone with five different median diameters. The results of analysis showed that the energy dissipationincreases by increasing the discharge value, and decreases by increasing both the length ratio of the rockfill weir, and the diameter of the rockfill sample used. The resulted equation for energy dissipation refers toa positive agreement between the predicted and measured energy dissipation values.
Исследования безопасности технологии MPLS VPN
Authors: Зольников Константин , Чтинзюинь Ли
Published: June 2023

MPLS использует метки, направляющие новую технологию высокоскоростной и эффективной передачи данных в открытой коммуникационной сети. Технология QoS, основанная на MPLS VPN, может сделать голос, видео и другие ключевые виды обеспечения качества обслуживания в режиме реального времени, вполне может решить «Triple Play». В этом документе представлена теория MPLS VPN, затем обсуждаются безопасность и характеристики MPLS VPN. Схема с MPLS VPN состоит из ограничений безопасности, использует шифрование группы доступа VPN и аутентификацию на основе PKI для обеспечения безопасности VPN-подключения и маршрутизации. Наконец, используя программное обеспечение OPNET, проведите имитационные эксперименты для доступа к сайту членов группы VPN, иначе вы не будете захватывать или заливать потоки данных передачи VPN на сайт, который может быть вызван только действительными членами группы VPN.

Ключевые слова: MPLS; VPN; PKI
DIGITALPRENEUR POTENTIAL ANALYSIS OF EDUCATIONAL STUDENTS
Authors: Perwita Dyah , Widuri Retno , Afif Nur Choirul , Thoha Didik Ahmad
Published: June 2023

Indonesia is currently in the creative and digital economy stage in the developmentof the industrial economy. Reflecting on information and communicationtechnology in the era of the industrial revolution 4.0 which is developing veryrapidly, the opportunity to create digital enterpreneurs is quite large. Highereducation is one of the institutions tasked with creating a superior generation thatis able to contribute its thoughts to the progres of the Indonesian nation. This studyaims to determine the potential of digital enterpreneurs (digipreneurs) in educationstudents at Jenderal Soedirman University, and develop the Indonesian economythrough digitalization of education. This study used a qualitative approach whichwas carried out through several stages, namely: data presentation, data processing,research findings, and discussion of research findings. Data collection techniquesusing interviews, observation, questionnaires, and documentation. The results ofthe study illustrate that education students have the potential to becomedigitalpreneurs in the field of education with a variety of bussiness ideas, such asonline tutoring, content creators through the Youtube platform, digital schoolequipment bussinesses,building start-up companies in the field of education andcounseling, building platforms mentoring students, establishing an EspostAcademy, becoming a writer or editor of a blog site or website regarding education,and building an educational start-up company.Keywords: Digital Enterpreneur; Digipreneur; Digitalpreneur; EducationalStudent; Enterpreneur