bluuebunny/crossref_metadata_2025 huggingface dataset:
PSUN138 Demonstration of Progressive Beta-Cell Failure in Familial Partial Lipodystrophy
Authors: De Freitas Maria Foss , Neidert Adam , Schill Rebecca , Maung Jessica , Rosenberg Drake , MacDougald Ormond , Oral Elif
Published: November 2022

Background

Familial Partial Lipodystrophy Type 2 (FPLD2) is an autosomal dominant disorder caused by inherited mutations on the LMNA gene, typically on exon 8 and 11. Insulin resistance and diabetes mellitus are common clinical manifestations in patients with partial lipodystrophy. Despite aggressive treatment aiming reduction in insulin resistance, patients usually require insulin treatment, highlighting the presence of insulin secretion defects. The sequence of events to develop metabolic derangement is not well studied. This study aims to compare the metabolic changes and insulin secretion in two generations of patients with FPLD2.

Methods

In a longitudinal study, we are studying the metabolic and morphometric changes in younger patients carrying the mutation who have not fully expressed the phenotype and comparing their findings to their affected older relatives. In the first year of the study, six affected young patients (age: 17±4 years, 4F/2M) and four affected older relatives (age: 46±7 years, all-female) have completed a 5-hour OGTT with 75g of glucose to determine the metabolic parameters at 30-minute intervals as well as the area under the curve (AUC) for these parameters.

Results

Patients in the younger group did not have a clinical diagnosis of diabetes (mean HbA1c of 5.3±0.3%), while all patients in the older generation had the diagnosis of diabetes mellitus with higher HbA1c (7.9±3.1%, p=0.05). Younger patients showed a lower AUC for glucose (28703±12037 mg/dL/min), triglycerides (38820±15305 mg/dL/min, p<0.05)) and free fatty acids (FFA) (78±29mmol/L/min) compared to older affected patients (glucose AUC: 67563±39089 mg/dL/min; triglycerides AUC: 96461±39989 mg/dL/min; FFA AUC: 159±125 mmol/L/min). However, insulin and C-peptide AUC were higher in the younger group compared to the older generation (insulin AUC: 60664±66802 vs. 29331±23341 mcU/mL/min; C-peptide AUC: 3466±1646 vs. 2548±1391 mg/L/min). The change in C-Peptide in the first 30 min post glucose was significantly higher in the younger group compared to the older group (12±1.8 vs. 5±4 mg/L; p<0.05). Insulin secretion during the first 30 min of the test was numerically higher in the younger group versus the older group (213±90 vs. 90±115 mcU/mL).

Conclusion

Our data (albeit limited) show that the clinical manifestation of diabetes mellitus in older patients with FPLD2 is associated with impairments in insulin secretion, therefore highlighting the importance of beta-cell failure in the development of diabetes mellitus in this population. These data draw attention to the need for further investigation of the pancreatic endocrine dysfunction to treat and better understand diabetes mellitus in this population. Strategies to address just insulin resistance may not be sufficient to prevent the development of diabetes in the long run.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN139 Leukemoid Reaction in Severe Diabetic Ketoacidosis: An Indicator of Severity or Predictor of Infection?
Authors: Sarigumba Marion , Gonzales Cecilia
Published: November 2022

Background

Acute infectious illness can precipitate episodes of ketoacidosis in patients with diabetes mellitus. For this reason, a diligent search for a focus is essential in the initial evaluation of patients with DKA since patients often appear ill and may have non-specific symptoms.

Clinical Case

An 18-year old Filipino with Type 1 Diabetes Mellitus sought consult due to abdominal pain. He is on premixed NPH/regular insulin twice daily but was lost to follow-up due to the COVID-19 pandemic. He has no other comorbidities but asserted a prior history of poor compliance with both diet and insulin therapy besides an erratic sleep-wake cycle. Prior to consult, he reported 5 episodes of vomiting associated with generalized abdominal pain. Due to poor appetite, he missed due doses of insulin with subsequent worsening of condition.

On admission, he was lethargic with Kussmaul's breathing. Initial vital signs were stable. He had dry lips and oral mucosa, sunken eyeballs and generalized abdominal tenderness. COVID-19 PCR was negative. Serum lipase (8.79, n: 8-78) and CT scan of abdomen were likewise unremarkable. Initial CBG was HIGH with elevated ketones (5.4, n: <0.6) and arterial blood gas revealed a pH of 7.0, pCO2 22, HCO3 incalculable, lactate 3.9, with high anion gap. The initial WBC was high (44.3×109/uL, n: 4.4-11) with 84% neutrophils, 10% lymphocytes, 1% metamyelocytes, and 5% monocytes. Hemoglobin (18.5 g/dl), hematocrit (51.7%) and platelet count (614k/uL) were also elevated. Peripheral blood smear revealed normal cell morphology. Urinalysis revealed elevated specific gravity, marked glycosuria and ketonuria, negative nitrites and leukocyte esterases. Blood specimen were obtained for culture. Therapy was instituted with intravenous fluids, insulin drip and broad spectrum antibiotics.

The following day, glucose was 218 mg/dl, pH 7.16, bicarbonate 7.8 meq/L, hematocrit 44%, WBC 25.21×109/uL and platelet count was 401k/uL. LAP score was requested but was unavailable. On the fourth hospital day, the patient was well and tolerating diet, with normalization of blood glucose, WBC 9.87 (85% neutrophils, 10% lymphocytes, 5% monocytes) and control of acidosis. Since cultures were negative and patient was afebrile, antibiotics were discontinued. He was discharged stable on with basal-bolus insulin.

Conclusion

The association between DKA and leukocytosis in the absence of infection is described in literature. Exact mechanism is unknown but may in part be attributed to increased catecholamine release in response to stress and hemoconcentration from marked dehydration. Studies show a statistically significant relationship between pH, bicarbonate and leukocytes which denotes that WBC in DKA can be an indicator of the severity of ketoacidosis rather than a predictor of infection.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN141 Suspected Lipodystrophy in a Thin Young Man With Type 1 Diabetes
Authors: Moats Sarah , Ahrari Bijan , Yu Kaylee Gayong , Nakhle Samer , Vernetti Nicholas
Published: November 2022

Introduction

Lipodystrophies are a group of exceptionally rare adipose disorders typified by complete or partial lack of adipose tissue. They come in two forms, congenital and acquired. Global prevalence is approximately 3 cases per million people. Despite their rarity, lipodystrophies often have common derangements, including, insulin resistance, decreased leptin, lipid abnormalities, and non-alcoholic fatty liver disease. Identifying and diagnosing these disorders is challenging as so few cases exist and may easily be confused for a variety of other illnesses.

Case

Our patient was a 21 year old African American Male with BMI of 14.0 kg/m2 (46.72 kg, 28.35 cm), with antibody proven type 1 diabetes mellitus diagnosed and extreme weight loss at age 12. His diabetes has been poorly controlled since diagnosis, with episodes of DKA, and a persistently elevated A1c. He has evidence of insulin resistance, requiring about 2.57 units per kilogram of insulin daily. In spite of this fasting blood glucose routinely exceeds 300 mg/dL. Physical exam significant for a generalized lack of adipose tissue. Most recent laboratory results showed: HbA1c >14% (<5.7%), fasting plasma glucose 419 mg/dL (70-99 mg/dL), c-peptide <0.10 ng/mL (0.80-3.85 ng/dL), and GAD65 Ab 18 IU/mL (<5 IU/mL). Interestingly patient also had a decreased leptin of 0.5 ng/mL (1.8-19.9 ng/mL), a known feature of lipodystrophy. However, triglycerides are only 158 mg/dL (<150 mg/dL), which may point more toward isolated leptin deficiency without lipodystrophy.

Modified insulin challenge was administered in office to differentiate between true insulin resistance and poor compliance. Insulin lispro 0.3 units per kilogram subcutaneous (14 units total) was administered at time zero, with pre-test SMBG 575 mg/dL. Over the three-hour test, blood sugars reached a nadir of 297 mg/dL. Patient was observed throughout and did not eat or drink anything but water during the test. He showed no signs or symptoms of hypoglycemia at any time during the challenge. Results indicated significant insulin resistance for his body weight.

Conclusion

Physical exam features, labs, including leptin of 0.5 ng/mL, and relatively severe insulin resistance suggest possible lipodystrophy or isolated leptin deficiency. However, triglycerides were not extremely elevated as expected in lipodystrophy. We have ordered metreleptin for further elucidation of patient's condition.

Disclaimer: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN143 Perspectives of Patients Attending Endocrinology Clinic About COVID-19 Vaccination.
Authors: Mikkilineni Pushyami , Simon Rebecca , Bhan Arti , Rao Sudhaker D
Published: November 2022

Introduction

The outbreak of coronavirus disease 2019 (COVID-19) was initially detected in Wuhan, China in December 2019. It spread rapidly, and in March 2020, the World Health Organization (WHO) declared a worldwide pandemic. In May 2020, the 73rd World Health Assembly issued a resolution recognizing the role of extensive immunization as a global public-health goal for preventing and stopping transmission of COVID-19. Vaccine hesitancy is a great threat in fighting the COVID-19 pandemic, as it prevents populations from reaching target thresholds of coverage necessary for herd immunity. It is important to know the determinants of vaccine hesitancy so that we can develop tools to combat it. The goal of our study was to evaluate patient perspectives on vaccination in our outpatient Endocrinology clinics.

Methods

We created a 7-question survey study which was offered to all patients waiting to be seen in our three Endocrinology clinic locations. We distributed and collected data from all clinics over a 3-week period (5/31/21-6/18/21). We used descriptive statistics to analyze this data.

Results

We collected 446 responses between three clinic locations, one urban and two suburban. 361 patients (81%) reported planning to or already having received the COVID-19 vaccine. 29 patients (7%) reported being unsure and 56 patients (13%) reported they did not plan to get vaccinated. Among 85 patients with vaccine hesitancy, 51% are blacks, 35% are whites, 24% reported concerns related to side effects, 13% felt COVID was not as bad as the media portrays, 14% did not believe in vaccines and 29% wanted more data on side effects and efficacy before receiving it. Hesitancy is higher among blacks which is statistically significant (P = 0.035) and slightly higher at the urban compared to the suburban clinics (20% Vs. 15%; p=0.197). On chi square analysis, this had no significant difference.

Discussion

In the United States, COVID-19 vaccine acceptance ranged from 60 to 79% in five surveys among the general population. The rate of vaccination acceptance is higher in our study compared to general population. We suspect this is related to our clinic patients having better vaccine counseling as most patients have multiple risk factors for severe infection. The results did show higher vaccine hesitancy among black patients and those seen in our urban clinics suggesting the need for improvement in health literacy in these populations.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN158 INTENSIVE VS. CONVENTIONAL BLOOD PRESSURE GOALS IN OLDER PATIENTS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Rodriguez-Gutierrez Rene , Rodriguez Andrea Flores , Raygoza-Cortez Karina , Garcia-Leal Mariana , Mariño-Velasco Sofia , Plata-Huerta Hiram H , Sãenz-Flores Melissa , Ramirez-Garcia Luz A , Rojo-Garza Amanda , Colmenero Fernando Diaz-Gonzalez , Maraka Spyridoula , Singh-Ospina Naikky V , Brito Juan P , Gonzãlez-Gonzãlez Jose G
Published: November 2022

Background

Hypertension is a major cardiovascular risk factor that affects over 50% of individuals with type 2 diabetes. Lowering blood pressure to reduce the risk of micro- and macrovascular complications of diabetes is a strong recommendation advocated by contemporary clinical practice guidelines, however, proposed goals for older patients with diabetes are heterogeneous and rely on indirect evidence as they are frequently underrepresented in clinical trials. Herein, the optimal blood pressure goal and its associated risks remain uncertain in this population.

Objective

To assess the effect of intensive vs conventional blood pressure goals on patient important outcomes in older adults with type 2 diabetes.

Methods

A comprehensive search was performed using MEDLINE, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled trials, and Cochrane Database of Systematic Reviews, from database inception to March 2021. Randomized controlled trials comparing intensive vs conventional blood pressure goals in adults over 60 years of age with type 2 diabetes were included. Screening and data extraction were performed independently and in duplicate. Modified Mantel-Haenszel meta-analyses were conducted to estimate odds ratios (OR) for dichotomous outcomes and mean differences for continuous outcomes, alongside 95% confidence intervals (CIs). (PROSPERO registration number: CRD42019126078)

Results

Seven trials fulfilled our inclusion criteria.A 19% risk reduction (OR 0.81; 95% CI 0.69 to 0.95; I2= 8%; p= 0.35) in the occurrence of major adverse cardiovascular events (MACE) and 37% risk reduction (OR 0.63; 95% CI 0.51 to 0.79; I2= 0%; p= 0.56) in the occurrence of fatal or non-fatal stroke was documented in the intensive treatment group. There were no differences in the occurrence of all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and peripheral vascular disease. Data regarding treatment adverse effects and microvascular outcomes were scarcely reported among included studies.

Conclusion

In summary, our analysis provides evidence that intensive blood pressure goals in older patients with diabetes are associated with a lower risk of stroke and MACE. Nevertheless, data are very scarce regarding microvascular diabetes outcomes and treatment safety. Given that an intensive approach would increase the number of medications, cost, adverse events and probably decrease adherence, treatment of hypertension in this population should be conducted with a shared decision making approach that makes sense from an intellectual, emotional, and practical basis.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN169 Vitamin C Renal Leak in Diabetes
Authors: Ebenuwa Ifechukwude , Violet Pierre-Christian , Tu Hongbin , Wilkins Kenneth , Levine Mark
Published: November 2022

Background

People with diabetes have lower plasma vitamin C concentrations compared to nondiabetic individuals. The prevalence of urinary vitamin C loss, and its relationship to plasma vitamin C concentrations are unknown.

Methods

In this cross-sectional cohort study of 162 individuals; 82 with diabetes and 80 nondiabetic controls, we investigated the prevalence and clinical characteristics of vitamin C renal leak, using fasting plasma and matched 1h urine samples. Based on vitamin C renal threshold, vitamin C renal leak was defined as presence of vitamin C in urine with plasma concentrations less than the minimal elimination threshold (MET) of 43.2µM in women or 38.1µM in men. We also assessed group differences in mean plasma vitamin C concentrations and investigated the association between diabetes-related clinical variables and renal leak. Vitamin C in plasma and urine was measured using coulometric electrochemical detection with high performance liquid chromatography.

Results

When compared with nondiabetic controls, subjects with diabetes had significantly increased prevalence of vitamin C renal leak (8.8% vs 32.9%: OR5, p<0.001) and decreased plasma vitamin C concentrations (53.1µM vs 40.9µM, p<0.001). Higher fasting plasma glucose, glycosylated hemoglobin A1c, body mass index, micro/macro vascular complications and protein creatinine ratio were predictive of vitamin C renal leak.

Conclusion

Increased prevalence of vitamin C renal leak in diabetes is associated with reduced plasma vitamin C concentrations. Glycemic control, microvascular complications, obesity, and proteinuria were associated with renal leak.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN176 Fructosamine as a screening test for gestational diabetes
Authors: Kabadi Udaya , Exley Sarah , Illian Michelle , Lindell Larry
Published: November 2022

Background

All organizations use variable glucose criteria for diagnosis of gestational diabetes (GDM). However all involve OGTT. American college of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing; 1) 1 hour glucose level on 50 gm glucose ingestion at any time during the day (1 hour OGTT) and 2) 3 hour OGTT with 100 gm glucose ingestion after overnight fast in pregnant women with glucose > 140 mg/dl during 1 hour. OGTTs require preparation with least daily intake of carbohydrate 150 gm for 3 days before testing. Many women are hesitant getting tested because of nausea, vomiting on glucose ingestion. Thus, none of the tests is convenient.

Objective

We examined utility of serum Fructosamine level as a screening test for diagnosis of GDM.

Methods

Random serum glucose and Fructosamine (mcM/l) levels as well as HbA1c (%) were determined at 24-30 weeks in 206 pregnant women, ages 24-40 years along with 1 hour OGTT and then again with 3 hour OGTT in 46 pregnant women with abnormal 1 hour OGTT and 21 age matched non-pregnant women. Continuous glucose monitoring (CGM) for 2 weeks was performed in 5 pregnant women with abnormal 3 hour OGTT and 7 non-pregnant women.

Results

Fructosamine levels (192± 4) were significantly lower (p<0.01) in nondiabetic pregnant women when compared with age matched non-pregnant women (224 ± 5). Cutoff serum Fructosamine concentration between groups was 205. Glucose and HbA1c were not significantly different amongst groups. Serum Fructosamine levels in 26 pregnant with abnormal 1 hour but normal 3 hour OGTT were <205, similar to nondiabetic pregnant women. Serum Fructosamine concentrations in women with abnormal 3 hour OGTT and normal CGM e.g, 70-140 mg /dl matched levels in nondiabetic pregnant women.

Conclusion

CGM may be the most accurate test for diagnosis of GDM. Random serum Fructosamine level may be as accurate as CGM and more accurate than both OGTTs. Importantly, it is a simple and convenient test without requiring fast, glucose ingestion or preparation.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN188 Evaluating Response to GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus Managed at a Veterans Affairs Hospital
Authors: Davis Clifton , Samson Kaeli , Kunwar Sandeep , Desouza Cyrus , Shivaswamy Vijay
Published: November 2022

Type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality in people of all ages worldwide. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer an innovative and unique advancement in treatment for T2DM by not only benefiting blood glucose control but also potentially impacting other diabetes-related complications. However, clinical response to GLP-1 RA is not seen in all patient populations. Our goal was to determine the response rate of GLP-1 RA add-on therapy. We performed a retrospective study of veterans with T2DM initiated on any GLP-1 RA from January 1, 2015, to December 31, 2019, for a duration of at least 6 months to assess the response in terms of hemoglobin A1c (A1c), weight, and total daily insulin dose. Baseline characteristics of 332 patients were reviewed to evaluate response rate. Treatment response thresholds included an A1c reduction of at least 0.5%, weight loss of ≥ 3% of pretreatment body weight, and a ≥ 10% reduction in total daily insulin dose (TDD). We then classified veterans into those without a response, or with 1, 2, or all 3 responses based on data 6-12 months after initiating treatment. We considered it a complete response if all 3 categories were fulfilled. Semaglutide (n=141): 10.64% showed a response to A1c alone, 3.55% had weight reduction alone, and 2.84% had insulin reduction alone. 7.09% showed A1c and weight response, 24.82% had A1c and insulin response, and 13.48% had weight and insulin response. A complete response was seen in 33.33% of veterans. Liraglutide (n=131): 18.32% showed a response to A1c alone, 4.58% had weight reduction alone, and 11.45% had insulin reduction alone. 6.11% showed A1c and weight response, 19.08% had A1c and insulin response, and 8.40% had weight and insulin response. A complete response was seen in 25.19% of veterans. Dulaglutide (n=57): 22.81% showed a response to A1c alone, 3.51% had weight reduction alone, and 12.28% had insulin reduction alone. 8.77% showed A1c and weight response, 26.32% had A1c and insulin response, and 1.75% had weight and insulin response. A complete response was seen in 15.79% of veterans. In conclusion, semaglutide's most common response, in 33.33% of patients, was having a complete response, followed by a reduction in A1c and insulin reduction for 24.82% of patients, and then weight and insulin reduction for 13.48% of patients. Liraglutide's most common response, in 25.19% of patients, was having a complete response, followed by a reduction in A1c and insulin dose for 19.08% of patients, and then reduction in A1c alone for 18.32% of patients. Unlike the others, dulaglutide's most common response was not a complete response, but rather A1c and insulin reduction, for 26.32% patients. Dulaglutide also had 22.81% of patients respond with A1c alone.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN190 Is Euglycemic Diabetic Ketoacidosis an Underrecognized Risk of SGLT2 Inhibitor Utilization?
Authors: Block Romy , Imas Polina , Hoyt Jonah
Published: November 2022

Introduction

Sodium-glucose cotransporter-2 (SGLT2) inhibitors were first approved by the FDA in March of 2013 as a promising new medication in the treatment of Type II diabetes mellitus. The mechanism of action of the Sodium-glucose cotransporter-2 is in the convoluted tubule of the nephron and where it inhibits the reabsorption of glucose into the bloodstream. The utilization has increased with promising improvements in congestive heart failure and renal protection. However, as the use of these medications has risen, so have the concerns over their side effects, specifically the frequency of euglycemic diabetic ketoacidosis (euDKA). Initial trials reported an incidence of DKA among patients taking an SGLT2 inhibitor to be between 0.003% and 0.34%.

Hypothesis

As a quality initiative, we reviewed internal data at a large hospital system to evaluate the rate of euDKA. We hypothesized that the rate of euDKA from SGLT2 was higher than reported.

Methods

To test this hypothesis, a 5 year retrospective internal quality review was conducted to quantify the number of patients admitted to our institution with DKA while on an SGLT2 inhibitor medication. We used the Epic Database from 4 hospitals in our system and applied the application "Slicer Dicer". We used keywords for diabetic ketoacidosis. We then reviewed the medication lists prior to admission and upon admission for the 4 commercially available SGLT2 agents: empagliflozin, canagliflozin, dapagliflozin.

Results

1748 patients were identified with DKA from 2018-2021 were reviewed. Of this population, 164 of them were on SGLT2 medications. The data identified 9.4% of total patients admitted for DKA in our hospital system were taking SGLT2 medications on presentation. Out of this population: 41.5% were on empagliflozin, 27.4% were on canagliflozin, 29.3% were on dapagliflozin, and 1.8% were on ertugliflozin. Out of these same patients, 51.8% were taking a high dosage of SGLT2i medication, whereas 48.2% were taking a low dosage.

Conclusion/Discussion

This data supports the hypothesis that the incidence of SGLT2 induced euDKA is underreported. There was no correlation between DKA and the use of high versus low dosage of SGLT2i medications. Since DKA is a problem related to dehydration, future educational initiatives should emphasize the importance of educating providers on when to hold medications to prevent DKA. This should include how to plan for sick days and educating patients on the risks presented by their medication. We recommend that ICD codes are updated to include euglycemic DKA and side effects of SGLT2. We believe that these simple changes can reduce the incidence of euDKA in the diabetic population as the indications for therapy expand in vulnerable populations.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN196 Outcomes following SGLT-2 inhibitor use in 99 patients with type 1 diabetes: A single-centre, retrospective, chart-review study
Authors: William Jovitta , Cukier Kimberly , Harrison Natalie
Published: November 2022

Introduction

Despite the numerous benefits seen with the use of SGLT-2 inhibitors in patients with T1DM, the drug class has failed approval for this indication in both the US and Australia, largely due to the increased risk of ketosis and DKA. Resultantly there is limited real-world data for its use in this patient population.

Methods

We completed a retrospective medical record review of 99 patients with T1DM treated with an SGLT-2 inhibitor within a single outpatient clinic between 2014 to 2021. Our primary objective was to review the change in Hba1c and weight, as well as incidence of DKA, with secondary objectives to review the reduction in insulin dose, and reasons for cessation.

Results

Baseline characteristics demonstrated a female predominant population (63%) with a median BMI of 30kg/m2. Around half of our patients were on concurrent CSII therapy (53%) We observed an improvement in Hba1c in 72% of our patients, with a median decrease of 0.3% (P=0.001). 80% of patients noted a decrease in weight, with a median reduction of 4.2kg (P=0.10). Five patients developed DKA requiring hospitalisation, and the most common cause for SGLT-2i cessation was genital tract infection. The insulin requirement was noted to decrease by an median of 6.6 units (P=0.04).

Conclusion

SGLT-2 inhibitor class medications have a valuable role in the treatment of certain patients with T1DM. Our study is one of only a handful of real-life data sets, and unique in the number of patients involved. Future areas for review involve evaluating the effect of risk mitigation measures on the incidence of DKA.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN197 Rate of admission to the Intensive Care Unit in patients with Diabetic Ketoacidosis and its associated risk factors, a single centre experience.
Authors: Alotaibi Raghad , Samargandy Dr Shaza , Alotaibi Raghad , Alghamdi Maha , Alotaibi Rahaf , Alsulami Manar , Hijji Sumiah
Published: November 2022

Background

Diabetic ketoacidosis (DKA) is one of the most common admission diagnoses to the intensive care unit (ICU). This study aims primarily to identify the rate of DKA-related ICU admission, and to assess the possible leading risk factors. Secondarily, to assess the rate of ICU readmission and mortality.

Methods

This retrospective observational study took place in King Abdulaziz University Hospital and collected data from January 2018 till December 2020. Patients aged 15 years and older with DKA Related-ICU admissions were included. Association between variables such as, demographics, precipitating factor, biochemical data, ICU stay details. History of readmission, arising complications within the study period were collected. Mortality cases were identified and the direct cause of death was investigated. Statistical analysiswas performed using the SPSS program version 25. Qualitative data were expressed as numbers and percentages, and quantitative data were expressed as mean and standard deviation. Linear regression analysis was used to adjust for the predictors and their association with the admission to the ICU.

Result: ICU admissions were 28.4% of all DKA-related admissions (50 out of 176 patients), with a female predominance of 52%. Median length of ICU stay was 3 days. Medications nonadherence was the leading precipitating factor for ICU admission in 50% of the patients. Factors significantly associated with risk of ICU admission were on bivariate analysis: pH level of <7.0 (p =0.001), and Patients of >60 years as they had 4 times more risk of ICU admission compared to 15-20 years age group (P=0.04). Nine patients died, but none of them died primarily from DKA as the main cause of death was the DKA precipitating factor. Six patients were readmitted to the ICU (12%) during the study period, the mean duration between the two admissions was 19.74± 26.57 weeks.

Conclusion

Our findings highlight that nonadherence to medications is the most common precipitating factor to ICU-related DKA admission. Thus, educating patients and early dentification of patients at risk are crucial.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN200 Effect of carbohydrate counting education in children and adolescents with type I diabetes
Authors: Lee Hae I , Kwon Ahreum , Lee Myeongseob , Choi Han Saem , Song Kyungchul , Suh Junghwan , Chae Hyun Wook , Kim Ho-Seong
Published: November 2022

Background

The achievement and maintenance of normoglycemia is one of the most important goals to prevent both short and long-term complications in type 1 diabetes mellitus (T1DM). As carbohydrate acts as the primary macronutrient affecting postprandial glycemic response, carbohydrate counting is crucial in adjusting prandial insulin doses to preserve postprandial blood glucose within normal limits. The purpose of this study is to evaluate the effect of carbohydrate counting education in children and adolescents with T1DM.

Method: A retrospective chart review of 128 diagnosed T1DM patients who underwent carbohydrate counting education was conducted. All subjects were diagnosed with T1DM before December 2019, and were educated carbohydrate counting before December 2020 in pediatric endocrinology, Severance Children's Hospital, Seoul, Korea. We analyzed the data including clinical characteristics, education on carbohydrate counting, and glycated hemoglobin A1c (HbA1c) levels.

Results

In 128 T1DM subjects educated, 48 (38%) were male. Their mean age at diagnosis was 8.6 ± 4.0 (years) and mean age at the time of education was 22.6 ± 7.8 (years). Overall, HbA1c levels at 3, 6, and 12 months after education showed a significant decrease compared to the baseline. The mean ±SD(standard deviation) HbA1c level, which was 8.8 ±1.9 (%) at the baseline, decreased to 8.3 ±1.7 at 3 months, 8.3 ±1.7 at 6 months, and 8.3 ±1.7 at 12 months after education. In multivariate linear regression analyses, only the value of baseline HbA1c (P<0.001) as an indicator of DM management was significantly correlated with decrease in HbA1c.

Conclusions

In our study, carbohydrate counting education seems effective in glycemic control in patients with type 1 diabetes mellitus, but the decrease in HbA1c seems not enough. The effect of education differs according to the degree of glycemic management. For patients with poor management, providing proper education of carbohydrate counting can make improvement in glycemic control. For well-managed patients, more advanced approach beyond traditional education appears to be required. With proper education, better blood glucose control can be expected to reduce complications and improve quality of life in T1DM patients.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN221 Implementation of Scheduled Mealtimes for Improved Glycemic Control among Hospitalized Patients with Diabetic Meal Plans
Authors: Thompson Owen , Lee Grace
Published: November 2022

Objective

To improve inpatient glycemic control through implementation of scheduled diabetic mealtimes in coordination with standardized bedside glucose checks and insulin administration times

Methods

We performed a plan-do-study-act (PDSA) trial in which we modified our standard diabetic diet from on-demand service to scheduled mealtimes with a goal to complete bedside glucose monitoring, meal delivery, and insulin administration all within a one-hour window for each meal. Both patients and clinical staff were actively educated regarding the rationale for this approach; prominent visual cues were implemented, and the menu was modified to include patient-centered information regarding mealtime practices. Low-carbohydrate snacks were offered between meals. Electronic medical record integration included defaulting to scheduled insulin dosing rather than as-needed dosing.

Results

Early PDSA analysis demonstrated a 98% rate of pre-prandial glucose measurement with a 96% rate of correctional insulin doses ordered, while 91% of overall mealtimes successfully coordinated tray delivery, glucose testing, and insulin administration within one hour. Analysis of glycemic data from before and after our intervention demonstrated decreased overall mean daily glucose (167 to 164mg/dL, p = 0.001), fewer patients with any daily glucose greater than 250mg/dL (from 51% to 47%, p=0.001), and more for whom all glucose readings were between 70 and 249mg/dL (from 43% to 47%, p=0.001). Average pre-prandial blood sugars significantly improved before breakfast (156 to 152mg/dL, p=0.003) and dinner (173 to 165mg/dL, p< 0.001), while no effect was noted with pre-prandial lunchtime measurements. Evening blood sugars declined from 186 to 180mg/dL (p< 0.001). Subgroup analyses demonstrated that patients who presented with baseline poor glycemic control (admission blood sugar >250mg/dL) improved the percentage of patients with all glucose readings between 70 and 249mg/dL (from 12% to 19%, p=0.001), as well as the number of patients with any subsequent glucose >250mg/dL (from 85% to 77%, p=0.003). Patients who presented with better initial blood glucose control still improved their mean daily glucose (161 to 158mg/dL, p=0.005). The percentage of patients who had any glucose less than 70mg/dL did not significantly change throughout the intervention overall or with any subgroup analysis.

Discussion/Conclusion

The implementation of scheduled mealtimes within a diabetic meal plan contributes to improved glycemic control when compared with on-demand meal availability by streamlining the coordination of blood glucose measurement, meal delivery, and insulin administration.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN227 A retrospective comparison of Basal Bolus using Glargine U-300 and Glulisine with Premix Insulin
Authors: Abraham Santhosh , Daniel Sonia
Published: November 2022

Objectives

The objective of this retrospective analysis was to compare the occurrence of Level 1 hypoglycaemia, Level 2 hypoglycaemia, nocturnal hypoglycaemia and mean HBA1C reduction in patients treated with premixed insulin 30/70 (Insulin Isophane/NPH 70% + Human Insulin/Soluble Insulin 30%) and after initiating a basal bolus regime using Glargine U-300 and Glulisine. Level 1 hypoglycaemia is blood glucose less than 70 mg/dL but above 54 mg/dL. Level 2 hypoglycaemia is blood glucose less than 54 mg/dL.

Methodology and Data Analysis

Data was collected retrospectively over 6 months on adult outpatients who were on pre mix insulin 30/70 for at least 2 years and who frequently experienced hypoglycaemic episodes and after transitioning these patients to a basal bolus regime Glargine U-300 and Glulisine. Those were having an underlying etiology which would predispose them to hypoglycaemia were excluded. The exclusion criteria included malignancy, drug induced causes except premix insulin, Chronic Kidney disease stage 4 or 5 and acute or chronic hepatic failure. Blood glucose monitoring was done by a 7 point Self Monitoring of Blood Glucose. A total of 30 cases were randomly chosen and data were sought from patients’ home glucose logs, case notes and Electronic health care records. Data were analysed by Microsoft Excel and was compared with paired-T test.

Results

The average number of Level 1 hypoglycaemic episodes per week on premix insulin dropped from 6.517 to 0.9655 (t = -10.807456, p<0.00001) after initiating the basal bolus regime. The average number of level 2 hypoglycaemic episodes per week dropped from 2.034 to 0.379 (t = -8.733497, p<0.00001) after changing to basal bolus regime. There was also a reduction in the occurrence of average nocturnal hypoglycaemic episodes from 2.655 on pre mix insulin to 0.2068 on the basal bolus regimen (t = -8.635475, p<0.00001).The mean HbA1C reduction was 3.16% in three months after commencing the basal bolus regime (t = -27.554737, p<0.00001).

Conclusions

Outpatient treatment with the basal bolus regime consisting of Glargine U -300 and Glulisine as compared to the premix insulin use showed a marked reduction in Level 1 and Level 2 hypoglycaemic episodes and nocturnal hypoglycaemic episodes per week. The decreased hypoglycaemic event rates in hypoglycaemia resulted in better compliance and adherence which was reflected as a significant reduction in HbA1C. In the future more retrospective and prospective studies will be helpful with Glargine U-300 and Glulisine.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN239 Severe Insulin Resistance and Hyperglycemia with Mild COVID-19 Infection
Authors: Azmath Misbah , Bendaram Snigdha Reddy , Ferreira Jennifer , Tafader Asiya , Luong Lucas , Velamakanni Sruti , Mirza Faryal
Published: November 2022

Introduction

Covid-19 infection (CI) is known to cause hyperglycemia and insulin resistance in patients with and without diabetes. Prior reports have correlated the degree of hyperglycemia to the severity of the CI. However, not much data is available regarding severe insulin resistance in patients with mild CI who are otherwise asymptomatic and not on steroids.

Case

We report a 48-year old male with type-1 diabetes, asymptomatic CI and renal failure, on dialysis who was admitted with diabetic ketoacidosis (DKA). Patient had refused insulin and hemodialysis treatments for one week and was noted to be confused by staff in his long-term facility. Upon presentation, he was initiated on intravenous (IVIT) insulin infusion therapy and transitioned to subcutaneous (SQ) insulin the following morning. That evening, hyperglycemia worsened (>500 mg/dl), necessitating reinstatement of the IVIT. Hyperglycemia persisted (no excess carbohydrate intake reported by nursing) and IVIT was continued as attempts to change to SQ therapy were unsuccessful. He was dialyzed for two consecutive days after admission and then changed to alternate day schedule. On day 4, hyperglycemia worsened to >500 mg/dl persistently, IVIT rate was increased to 24 units/hr but blood sugars persisted in the >500 range. Work up for evaluating Covid-related inflammation and insulin resistance was sent. After 6 hours of IVIT at 24 U/hr, he was given a relatively higher dose of SQ-insulin (insulin glargine 20 units and insulin lispro 30 units SQ). IVIT rate was gradually tapered based on blood sugars and stopped 6 hours after SQ-insulin was given. Approximately eight hours after receiving SQ-insulin, he was noted to be hypoglycemic, and he received two amps of D-50. His blood sugar stabilized, and he continued to do well subsequently and was maintained on basal-bolus therapy. The on-call nurse confirmed good IV access for the IVIT access line. The IV insulin infusion fluid from bag was sent for analysis which showed that insulin was present in the infusion bag. Inflammatory markers showed high levels of cortisol, ferritin, growth hormone, C-reactive protein and sedimentation rate. Insulin antibodies were also present. D-dimer was normal, and fibrinogen was only mildly elevated.

Conclusion

This is a rare case of severe insulin resistance in a patient with mild Covid-19 infection and underlying type 1 diabetes, who developed severe insulin resistance with poor response to high doses IV insulin. He ultimately responded a combination of high dose subcutaneous insulin and high doses IV insulin infusion therapy with resolution of ketoacidosis and hyperglycemia.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
Human assembloids
Authors: Kanton Sabina , Paşca Sergiu P.
Published: November 2022

Deconstructing and then reconstructing developmental processes ex vivo is crucial to understanding how organs assemble and how physiology can be disrupted in disease. Human 3D stem cell-derived systems, such as organoids, have facilitated this pursuit; however, they often do not capture inter-tissue or inter-lineage cellular interactions that give rise to emergent tissue properties during development. Assembloids are self-organizing 3D cellular systems that result from the integration of multiple organoids or the combination of organoids with missing cell types or primary tissue explants. Here, we outline the concept and types of assembloids and present their applications for studying the nervous system and other tissues. We describe tools that are used to probe and manipulate assembloids and delineate current challenges and the potential for this new approach to interrogate development and disease.
Η επαγγελματική ανάπτυξη των εκπαιδευτικών μέσω της ενδοσχολικής επιμόρφωσης. Οι αντιλήψεις των εκπαιδευτικών πρωτοβάθμιας εκπαίδευσης
Authors: Στυλιανού Πασχαλίνα
Published: November 2022

Η  ενδοσχολική επιμόρφωση  είναι μια οριζόντια μορφή επιμόρφωσης μέσω της οποίας οι εκπαιδευτικοί  μπορούν να καταρτιστούν και να ενδυναμωθούν, προκειμένου να ανταποκριθούν αποτελεσματικά στο έργο τους.  Σε μια εποχή που η ενδοσχολική επιμόρφωση καταγράφεται ως οργανωτική υποχρέωση του διευθυντή του σχολείου, η διερεύνηση των αντιλήψεων των εκπαιδευτικών είναι αναγκαία για την κατανόηση των πρακτικών και των αποφάσεών τους. Οι αντιλήψεις των εκπαιδευτικών διαδραματίζουν βασικό ρόλο στον τρόπο με τον οποίο φιλτράρουν τις πληροφορίες και καθορίζουν τι θεωρείται σημαντικό και έχει αξία για τα παιδιά. Η περιγραφή της διδακτικής πρακτικής τους αντανακλά το σχολικό κλίμα καθώς και την κοινωνικά δομημένη κουλτούρα τους, η οποία διαμορφώνεται από τα πολλά πλαίσια στα οποία είναι ενταγμένοι (σχολείο, κοινότητα, εκπαιδευτικό σύστημα, αναλυτικό πρόγραμμα). Η παρούσα ποιοτική έρευνα διερευνά τις αντιλήψεις των εκπαιδευτικών πρωτοβάθμιας εκπαίδευσης για την ενδοσχολική επιμόρφωση και την αξία της για την επαγγελματική τους ανάπτυξη. Η έρευνα αξιοποιεί τη θεωρία της δραστηριότητας ως εργαλείο ανάλυσης για να φωτίσει το πλαίσιο δράσης των εκπαιδευτικών και να ερμηνεύσει τα ερευνητικά δεδομένα, καθώς είναι μια θεωρία μάθησης και ένα εργαλείο ανάλυσης που δίνει ιδιαίτερη σημασία  στο πλαίσιο εντός του οποίου αναπτύσσουν τη δράση τους οι εκπαιδευτικοί.
The effects of mouth rinsing and gargling with mouthwash containing povidone-iodine and hydrogen peroxide on the cycle threshold value of Severe Acute Respiratory Syndrome Coronavirus 2: A randomized controlled trial of asymptomatic and mildly symptomatic patients
Authors: Sulistyani Lilies Dwi , Julia Vera , Soeprapto Andrianto , Swari Rumartha Putri , Rosmanato Febriadi , Haryanto Budi , Cahyarini Cahyarini , Panjaitan Rinaldi , Maharani Diah Ayu
Published: November 2022

Background: Coronavirus disease 2019 can spread rapidly. Surgery in the oral cavity poses a high risk of transmission of severe acute respiratory syndrome coronavirus 2. The American Dental Association and the Centers for Disease Control and Prevention recommend the use of mouthwash containing 1.5% hydrogen peroxide (H2O2) or 0.2% povidone iodine (PI) to reduce the viral load in the upper respiratory tract and decrease the risk of transmission. The aim of the present study was to analyze the effect of mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H2O2, or 1.5% H2O2 and water on the cycle threshold (CT) value obtained by real-time reverse transcription polymerase chain reaction (RT-PCR).

Methods: This study is a randomized single blind controlled clinical trial which has been registered in the International Standard Randomized Controlled Trial Number (ISRCTN) registry on the 3rd February 2022 (Registration number: ISRCTN18356379). In total, 69 subjects recruited from Persahabatan General Hospital who met the inclusion criteria were randomly assigned to one of four treatment groups or the control group. The subjects were instructed to gargle with 15 mL of mouthwash for 30 s in the oral cavity followed by 30 s in the back of the throat, three times per day for 5 days. CT values were collected on postprocedural days 1, 3, and 5.

Results: The results of the Friedman test significantly differed among the groups (n=15). The CT values increased from baseline (day 0) to postprocedural days 1, 3, and 5.

Conclusions: Mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H2O2, or 1.5% H2O2 and water increased the CT value.
Effect of problem-based learning on students’ attitude towards learning physics: a cohort study
Authors: Kanyesigye Stella T. , Uwamahoro Jean , Kemeza Imelda
Published: November 2022

Background: Attitude is a learning scale that informs which approach should be used to call students to school. It can be seen a supporting tool that informs teachers, policymakers, and researchers of the needs for raising interest in learning a certain subject, such as physics. This study aimed at determining the effect of problem-based learning on students’ attitude towards learning physics.

Methods: The study followed a quantitative approach with a quasi-experimental design employing cross-sectional survey techniques. The participants of the study were 419 13th-grade physics students of the 2020/2021 school year in both Ugandan government and private secondary schools. Among these students, one group was taught using problem-based learning instruction while another group was taught using traditional instruction for 12 weeks. Data were collected using a standardized tool called Views About Science Survey. Using Microsoft Excel 2016 and Statistical Package for Social Scientist version 23.0, descriptive and inferential statistics were used to determine a significant difference between experiment and control groups.

Results: It was found that both problem-based learning and traditional instructions caused a statistically significant positive effect on students’ attitudes towards physics. However, the experimental group gained more positive attitude than the control group as they were more inclined towards the expert-like attitude (thinking like a scientist in a domain) than their counterparts due to the problem-based learning approach they learned in.

Conclusions: Therefore, it was concluded that problem-based learning is a more effective method of teaching physics than traditional methods. Hence, we suggest that secondary school teachers need to adopt the use of problem-based learning in the teaching of science concepts, especially physics.