bluuebunny/crossref_metadata_2025 huggingface dataset:
1123-P: Wellness and Empowerment for Women —A Primary Care Approach to Treatment of Diabetes in Patients of Childbearing Age
Authors: AMIDON JOEL , KNAPP JESSICA L. , JINDAL MEENU
Published: June 2024

Introduction and Objectives: The rate of diabetes in pregnancy is increasing at a rapid rate increasing risks for adverse perinatal and maternal health outcomes in the peripartum period and beyond. This cycle is exacerbated by historically low rates of preconception counseling and low rates of post-partum follow-up with primary care for patients with Type 1, Type 2, and Gestational Diabetes. Thoughtful coordinated transitions of care for this patient population are needed to address this rising concern.

Methods: Through a facilitated transfer of care from a previously existing program for pregnant patients with diabetes into the primary care setting we aimed to continue glycemic control postpartum, completion of testing to confirm resolution of gestational diabetes, provide glycemic control prior to conception, and offer general primary care services. A team-based approach consisting of physicians, diabetic educators, clinical pharmacists, and clinical navigators was utilized.

Results: Patients with Type 1, Type 2 and gestational diabetes enrolled in our year long program showed decreased A1c and average of 8.7 to 8.2, decreased BMI from 37 to 33, and an increased attrition with a primary care team. Increased access to healthy food options, exercise programs, and diabetes technologies (continuous glucose monitors) was achieved.

Conclusion: Through a team-based approach and increased coordination of care we have demonstrated avenues to utilize existing structures within our healthcare system to provide meaningful care to patients of childbearing age with diabetes. This intervention not only benefits the patient but their children and ultimately the general health of the state of South Carolina.

Disclosure

J. Amidon: None. J.L. Knapp: None. M. Jindal: None.

Funding

BlueCross BlueShield of South Carolina Foundation (2022-07)
1126-P: Does the Use of a Case Manager Matter in Diabetes Care?
Authors: GATTI SARAH , BENNETTI MADELINE , JUTRAS ASHLEY A. , TOSCHI ELENA
Published: June 2024

Introduction & Objective: Navigating the health-care system is challenging and can impact diabetes care. Case managers (CM) hold expertise in accessing and navigating social services. However, there is limited information on the use and impact of CM in diabetes care.

Methods: A quality improvement project to assess impact of CM intervention was run over an 8-month period. Adult clinicians could refer any patient to CM for support. Retrospective analysis of demographic characteristics, reasons for referral, and number of visits the year prior (pre-CM) compared to during CM intervention were reviewed.

Results: Data of 72 patients referred showed an increase number of visits during CM compared to pre-CM. When patients were stratified by age as young adult (YA, ≤35 years) or adult (>35 years), YA required greater ongoing support and mental health services compared to adults that required more one-time tasks (see table).

Conclusion: Use of CM resulted in an increased number of clinical visits. Services provided by CM differed based on age. Further investigation on impact of CM use in adult clinic is warranted.

Disclosure

S. Gatti: None. M. Bennetti: None. A.A. Jutras: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi.

Funding

Joslin Young Adult Charitable Fund
1131-P: Successful Strategies to Reduce Delays in Quality Data Reporting
Authors: MUNGMODE ANN , WIRSCH ANTON , DAWSON JAMES , ACCACHA SIHAM , BASINA MARINA , COSSEN KRISTINA , SONYA HAW JEEHEA , HERRICK CYNTHIA J. , MANN ELIZABETH A. , MIYAZAKI BRIAN , PRAHALAD PRIYA , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI
Published: June 2024

Introduction: Collecting quality diabetes data can be burdensome and difficult. Benchmarking across multiple hospital systems is challenging due to unstandardized data collection and interoperability issues in electronic health records. T1D Exchange Quality Improvement Collaborative centers complete a comprehensive data mapping process for quality improvement and population health analysis. Between 2018 and 2020, this process took 20 months on average. This study summarizes results to expedite the T1DX-QI data mapping process.

Method: In 2021, the T1D Exchange implemented strategies to decrease mapping completion time: expanding data integration capacity with staff resources and cross-training, offering project management services (i.e., recurring project meetings and milestones tracking) and resources (i.e., electronic medical record templates and examples, step-by-step guides). Data is compared by centers that initiated mapping between 2018-2020 (pre; N=17) and 2021-2023 (post; N=13) overall, by center size, and population served.

Results: The average time to complete data mapping decreased from 20 to 13 months from pre- to post-implementation. There was also a reduction in variation between the two time periods (from 62 to 22 months, Figure 1).

Conclusion: This study highlights the ability to expedite the collection of quality diabetes data by supporting centers to improve patient care and process improvement.

Disclosure

A. Mungmode: None. A. Wirsch: None. J. Dawson: None. S. Accacha: Speaker's Bureau; Azurity. M. Basina: None. K. Cossen: None. J. Haw: None. C.J. Herrick: Consultant; Teladoc Health. Other Relationship; Eli Lilly and Company, Merck & Co., Inc. E.A. Mann: None. B. Miyazaki: None. P. Prahalad: None. O. Ebekozien: Advisory Panel; Sanofi, Medtronic. Research Support; Vertex Pharmaceuticals Incorporated. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; Medtronic, Lilly Diabetes, Abbott, Dexcom, Inc.

Funding

The Helmsley Charitable Trust
1153-P: Prevalence of Overweight/Obesity in a Largely Hispanic Pediatric Cystic Fibrosis Center
Authors: PILLAI RADHIKA , KOEK WOUTER , RAYAS MARIA S.
Published: June 2024

Background: Historically, cystic fibrosis (CF) has been characterized by malnutrition and pulmonary decline. Recent advances in CF care, including genetic modulator therapies such as elexacaftor/tezacaftor/ivacaftor (ETI), have improved nutrition and lung function. An unexpected consequence has been the rise in overweight/obesity among patients with CF. Although Hispanics are at greater risk of developing overweight/obesity compared to non-Hispanic whites (NHW), ethnic differences regarding the prevalence in CF are unknown.

Methods: To determine the prevalence of overweight and obesity in Hispanics and NHW, we performed a cross-sectional retrospective chart review of patients 2-18 years of age at our CF center. Demographics, socioeconomic status, CF-related variables, and cardiometabolic risk factors were extracted from the medical record. Overweight/obesity data were analyzed by logistic regression using the following independent variables: ethnicity, age, sex, income, ETI therapy, supplemental feeding, and pancreatic sufficiency.

Results: Sixty-eight children with CF (46% Hispanic, 51% female, ages 11 ± 4 years, 74% on ETI) were assessed. Twenty-four (35%) children were overweight/obese (11 Hispanic). No ethnic differences were apparent. When analyzed univariably, overweight/obesity was associated with less supplemental feedings (odds ratio [OR] 0.19, 95% CI 0.063 to 0.58, P = 0.003) and more pancreatic sufficiency (OR 10.50, 95% CI 2.01 to 54.84, P = 0.005). Multivariable analysis revealed overweight/obesity was only associated with decreased odds of supplemental feedings (OR 0.098, 95% CI 0.018 to 0.54, P = 0.008).

Conclusion: In our ethnically diverse CF center, overweight/obesity is prevalent in 1 in 3 children. Prospective, longitudinal multicenter studies performed in diverse CF populations are warranted to identify factors associated with the development of overweight/obesity and to inform management and obesity-related screening for children with CF.

Disclosure

R. Pillai: None. W. Koek: None. M.S. Rayas: None.
1166-P: Impact of Food Insecurity on Risk Prediction of DKA in Youth with Type 1 Diabetes
Authors: DESALVO DANIEL , SCHWARTZ DAVID D. , ERRAGUNTLA MADHAV , SONABEND RONA Y. , LYONS SARAH
Published: June 2024

Introduction: Food insecurity (FI) in youth with type 1 diabetes (T1D) has been associated with high-risk glycemic levels (A1c >9%) and more emergency department utilization (Mendoza et al., Diabetes Res Clin Prac, 2018). At our diabetes center, we routinely assess for FI using the Hunger Vital Sign™, a validated 2-question screening tool. The goal of the present work was to examine the contribution of FI on DKA risk prediction in youth with T1D.

Methods: Multiple logistic regression models were used to predict the probability of severe DKA (pH <7.0 and/or HCO3 <5 mEq/L) and multiple DKA events in the next year based on demographic and glycemic features from the previous two years in youth with T1D screened for FI (n=761, age 12.93.2y, 53%F, A1c 8.92.1%, 49% public health insurance, 9.6% with positive FI screen).

Results: Predictive model performance with and without incorporation of the FI feature is characterized using receiver operating curves in Figure 1. A positive food insecurity screen was a significant covariate in the model for predicting the risk of severe DKA (p=0.003) and multiple DKA events (p=0.025).

Conclusion: Diabetes clinics should incorporate FI screening into clinical care and future studies are needed to assess whether addressing FI with tailored resources such as SNAP benefits, food prescriptions, connection to local food banks, and/or home-delivery of healthy foods reduces future risk of DKA.

Disclosure

D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc. D.D. Schwartz: None. M. Erraguntla: None. R.Y. Sonabend: None. S. Lyons: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (2206-05307)
1186-P: Considerations for a Community Health Worker Enhanced Strategy to Address Racial Disparities in Youth Use of Diabetes Technology
Authors: MACLEISH SARAH A. , MCALEER SARAH , MASOTYA MARIE , RONIS SARAH
Published: June 2024

Introduction: Disparities by race in the use of diabetes technology by youth with T1DM risk exacerbating inequities in health outcomes among Black youth with T1DM. In preparation for a feasibility trial of an intervention to increase use of diabetes technology by Black youth, the purpose of this analysis was to define expectations for how a community health worker (CHW) might promote facilitators and address barriers to sustained adoption of diabetes technology.

Methods: Semi-structured interviews followed by 3 focus groups were conducted January-June 2023 with patients, caregivers, and healthcare workers in Ohio who had at least some experience with diabetes technology and/or CHWs. Content analysis was used to summarize participants’ perceptions regarding general barriers and facilitators to adoption of diabetes technology, and also specific feedback regarding the proposed intervention.

Results: Participants were 7 young adults with T1DM, 10 parents of a child with T1DM, and 11 healthcare workers. All young adults and parents plus 4 healthcare stakeholders identified as Black. Participants were favorable toward the proposed CHW intervention, emphasizing that CHWs should have similar lived experience to families in terms of both racial background and personal familiarity with T1DM. Stakeholder recommendations for the proposed intervention included: (1) CHW function -provide social and technical support to families, liase between family/community and healthcare team; (2) CHW tasks - identify and trouble shoot common barriers to wearing devices, acquisition of supplies, digital connectivity, and/or parent-child conflict regarding diabetes management; (3) CHW workflow - foster family-centeredness through flexibility in encounter location, format, frequency and duration.

Conclusion: CHW integration into the proposed intervention may promote equity for Black youth with T1DM by liaising between patient, clinical team, and community.

Disclosure

S.A. MacLeish: Speaker's Bureau; Insulet Corporation. Advisory Panel; Prevention Bio. S. McAleer: None. M. Masotya: None. S. Ronis: None.

Funding

National Institutes of Diabetes and Digestive and Kidney Diseases (R01 DK134953)
1194-P: Racial and Socioeconomic Differences in Technology Access in Children with Type 1 Diabetes (T1D)
Authors: AL NOFAL ALAA , RAJJO TAMIM , BASMACI RAMI , HEIEN HERBERT , MCCOY ROZALINA G.
Published: June 2024

Background: While prior studies demonstrated disparities in access to diabetes technology based on race and socioeconomic status (SES) in children with T1D, few examined these differences in nationwide studies or in children with access to commercial health insurance.

Aim: To examine the difference in fill rates of insulin pumps and continuous glucose monitors (CGMs) among insured children with T1D from differential racial and SES groups.

Methods: Using medical and pharmacy claims from OptumLabs® Data Warehouse between 2011-2021, we calculated the proportion of children and adolescents <18 years with T1D with a fill for pump or CGM at cohort entry, overall and stratified by race/ethnicity and annual household income.

Results: We identified 13,267 children with T1D, of which 36% had CGMs and 30.1% had insulin pumps. In this population, non-Hispanic Whites (NHW) had higher rates of access to CGMs and insulin pumps than non-Hispanic Blacks (NHB) (CGMs: 35.7% vs 22.4%. Pumps: 31.8% vs 21%, p <0.001). Children whose household income was <$40k had lower rates of access to CGMs and pumps than those whose household income was >$200k (CGM 25.3% vs 43.7%. Pumps: 22.4% vs. 38.7%, p <0.0001). Within similar household incomes of <$40k, NHB were had CGM and insulin pump less often than NHW (CGM: 15.2% vs. 27.9%, p value 0.006. Pumps: 12.9% vs 25.5%, p 0.004). This racial difference disappeared with household income >$200k (CGMs: 47.5% for NHB vs. 43.1% for NHW and pumps: 45.9% for NHB and 38.2% for NHW, p 0.45 and 0.57 respectively).

Conclusion: In a cohort of commercially insured pediatric patients with T1D, race and income play a role in access to diabetes technology. The racial disparity becomes less prominent as household incomes increase, and virtually disappeared when household incomes exceeded $200k. NHB with household income <$40k are at the highest risk of being excluded from access to these critical technologies. Greater effort is needed at the systems and individual levels to mitigate these disparities.

Disclosure

A. Al Nofal: None. T. Rajjo: None. R. Basmaci: None. H. Heien: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institute of Health (NIH) (K23DK114497)
1202-P: Trends in Body Mass Index in Latin American Children with New-Onset Type 1 Diabetes over Three Years
Authors: HIRSCHLER VALERIA , MOLINARI CLAUDIA , STUDY GROUP CODIAPED
Published: June 2024

Objective: To determine the trends in BMI z-score (z-BMI) and its correlation with insulin dose and HbA1c in children with new-onset type 1 diabetes (T1DM) from several Latin American centers over 3 years.

Methods: A retrospective chart review investigated the z-BMI trends in children aged 6 m-18 y with T1DM onset across 18 centers from 2019-2020 through 2023 in 5 Latin American countries: Argentina, Chile, Uruguay, Paraguay, and Peru. Anthropometric measures, insulin dose (U/kg/day), and Hb A1c (%) were collected at 3 months post-diagnosis and annually thereafter. Follow-up curves for z-BMI, HbA1c, and insulin dose were generated using the ANOVA method with repeated measures.

Results: A total of 421 children (48.9% females) aged 8.72 ± 3.75 years were included. The prevalence of obesity (OB) was 8.6%, overweight (OW) was 12.1%, and underweight (UW) was 10.0%. UW children increased their mean z-BMI by 2.28, whereas OW decreased by 0.29, and OB decreased by 0.94 at 3 years follow-up (P<0.01). Mean z-BMI values increased significantly over the 3-year follow-up compared with the initial year: year 0 (0.03) vs. year 1-2-3 (0.42, 0.43, 0.46). Concurrently, there was a significant increase in the insulin dose (U/kg/d) across each year: year 0 (0.56) vs. year 1 (0.62) vs. year 2 (0.70) vs. year 3 (0.74). Interestingly, the mean HbA1c in year 1 (8.52%) was significantly lower than in year 0 (8.98%), year 2 (8.74%), and year 3 (8.70%). The repeated measures model for the follow-up of the z-BMI over 3 years, adjusted for the differences in insulin dose and HbA1c (year 0 vs. year 3), showed a significant increase in z-BMI at the onset compared with years 1, 2, and 3, with insulin dose as a significant covariate.

Conclusion: We observed a significant increase in the z-BMI from T1DM onset through the 3-year follow-up in Latin American children, with insulin dose as a significant covariate. Although the insulin dose steadily increased, the impact on HbA1c (8.7%) does not appear to be close to optimal levels.

Disclosure

V. Hirschler: None. C. Molinari: None.
1214-P: Prepregnancy Use of Glucagon-Like Peptide 1 Receptor Agonists and Gestational Weight Gain in Type 2 Diabetes
Authors: MAYA JACQUELINE , PANT DEEPTI , JAMES KAITLYN , MICHALOPOULOS CHLOE , HSU SARAH , SHOOK LYDIA , THAWEETHAI TANAYOTT , HIVERT MARIE-FRANCE , POWE CAMILLE E.
Published: June 2024

Objective: The prevalence of type 2 diabetes (T2D) in pregnancy has tripled over the last two decades. Use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in pregnancy is contraindicated. Effects of pre-pregnancy GLP-1 RA use on pregnancy outcomes, including gestational weight gain (GWG), are poorly understood.

Methods: In a retrospective cohort of singleton pregnancies (2016 to 2022) in people with pre-existing T2D, we used propensity score matching on pre-pregnancy body mass index (BMI), maternal age, gestational age at delivery, race/ethnicity, and health insurance status to compare pregnancies with pre-pregnancy exposure to GLP-1 RA to unexposed pregnancies. We identified exposed pregnancies using prescription records and electronic chart searches. The primary outcome, GWG, was defined as the weight prior to delivery minus the pre-pregnancy weight, as documented in electronic medical record. A secondary outcome, excess GWG, was determined based on pre-pregnancy BMI, GWG, and clinical guidelines. We matched each GLP-1 RA exposed pregnancy to 3 unexposed pregnancies. We fit linear and logistic mixed models to evaluate associations between GLP-1 RA exposure and GWG.

Results: We included 188 pregnancies (47 exposed and 141 unexposed). Mean [SD] maternal age was 34.5 [5.3] years and mean [SD] pre-pregnancy BMI was 35.5 [7.6] kg/m2. GLP-1 RA exposed pregnancies had greater GWG (mean [SD]: 24.9 [12.0] lbs.) than unexposed pregnancies (19.1 [17.3] lbs., β= 5.9 lbs., 95% CI [0.60, 11.1], P=0.03). The proportion of pregnancies that exceeded recommended GWG was greater in GLP-1 RA-exposed than in unexposed pregnancies (61.7% vs 41.1%, P=0.02).

Conclusion: GWG in T2D-affected pregnancies with pre-pregnancy exposure to GLP-1 RA is greater than in matched pregnancies without pre-pregnancy GLP-1 RA exposure. Better understanding of the benefits and risks of pre-pregnancy use of GLP-1 RA is necessary to optimize care of T2D in pregnancy.

Disclosure

J. Maya: None. D. Pant: None. K. James: None. C. Michalopoulos: None. S. Hsu: None. L. Shook: None. T. Thaweethai: None. M. Hivert: None. C.E. Powe: Consultant; Mediflix. Other Relationship; Wolters Kluwer Health.

Funding

National Institutes of Health (T32DK007028-47S1)
1221-P: Optimal Delivery Timing in Pregnancies Complicated by Gestational Diabetes
Authors: BUCKLEY DEIRDRE , KHANUJA KAVISHA , AL-KOUATLY HUDA B. , MCLAREN RODNEY
Published: June 2024

Objective: To assess neonatal and maternal morbidity at birth for each week of gestation among pregnancies complicated with gestational diabetes (GDM) to evaluate optimal timing of delivery.

Design: This was a population-based cohort study of non-anomalous, singleton, live births between 36 and 40 weeks complicated by GDM using data from the U.S. Natality Vital Statistics Database from 2015 to 2022. Planned delivery group included births at each completed week from 36 to 40 weeks that had a labor induction or scheduled cesarean delivery, excluding spontaneous labor. Expectant management group included all births that delivered on or after the following week (i.e., planned birth at 36 0/7-36 6/7 compared to all births ≥37 0/7 weeks). The primary outcomes were a neonatal and maternal adverse composite, compared between groups at each week using multivariable analyses.

Results: There were 1,324,559 births included. After adjusting for the differences between groups, planned delivery ≥39 0/7 had lower odds of composite neonatal morbidity than the expectant management group. After 39 weeks, planned delivery and expectant management had similar odds of maternal morbidity.

Conclusion: In pregnancies complicated by GDM, planned delivery after 39 weeks was associated with lower odds of neonatal morbidity compared to expectant management. This data suggests that providers should be cautious about expectant management past 39 weeks.

Disclosure

D. Buckley: None. K. Khanuja: None. H.B. Al-Kouatly: None. R. McLaren: None.
1237-P: IADPSG Criteria of Gestational Diabetes—Is It Optimized across Ethnicities?
Authors: BIN TAN YU , LING PHAIK , QUAH ELAINE , HIAN TAN KOK
Published: June 2024

Introduction: Gestational Diabetes Mellitus (GDM) affects ~20% of Asian pregnancies, presenting substantial maternofetal risks. Despite the widespread adoption of International Association of Diabetes and Pregnancy Study Groups (IADPSG) GDM criteria, ethnic variations in insulin regulation, evidenced by unique oral glucose tolerance test (OGTT) profiles, have been noted. Our study investigates the relationship between three Asian ethnic groups (Chinese, Malay, Indian) and distinct OGTT phenotypes in GDM diagnosis within a multi-ethnic cohort.

Method: A retrospective review of 3,027 patients without pre-existing diabetes from KK Women's and Children's Hospital (2019) was conducted. GDM was diagnosed using the IADPSG criteria at 24-28 weeks. Adjusted multivariate analyses using a multinomial logistic regression with robust variances were used to estimate the relative risk ratios (RRR) between the ethnic-specific relative risk ratios and OGTT phenotypes, accounting for maternal age, parity, and first-trimester body mass index as potential confounders.

Results: GDM prevalence was highest among Indians (21.5%), followed by Chinese (18.4%) and Malays (14.2%). Compared to Malays, the Chinese and Indians were significantly associated with a higher risk of surpassing the OGTT threshold at 0h with a RRR of 2.33 (95% CI: 1.01-5.38, p<0.05), and RRR of 3.05 (95% CI: 1.23-7.56, p<0.05 respectively, with Indians being at the highest risk. Only the Chinese ethnic group was associated with an RRR of 2.88 (95% CI: 1.51-5.47, p<0.01) for surpassing the OGTT threshold at 2h, compared to the Malays.

Conclusion: Indians were at higher risk of exceeding the 0h-only OGTT threshold, while Chinese were at higher risk of surpassing both the 0h-only and 2h-only OGTT thresholds. These patterns highlight inherent ethnic variations in glucose metabolism, underpinning the diverse OGTT phenotypes observed. These metabolic distinctions call for the development of an ethnic-sensitive diagnostic criteria.

Disclosure

Y. Tan: None. P. Quah: None. K. Tan: None.

Funding

Singhealth Medical Student Talent Development Award
124-OR: Intervention of Select Lipid Signaling Reduces Type 1 Diabetes Incidence
Authors: WHITE TAYLEUR , ALMUTAIRI ABDULAZIZ , TUSING YING , HAMMOCK BRUCE , MCREYNOLDS CINDY , STEPHENSON DANIEL , CHALFANT CHARLES E. , RAMANADHAM SASANKA
Published: June 2024

Activation of Ca2+-independent phospholipase A2β (iPLA2β) leads to production of proinflammatory prostaglandins E2 (PGE2) and diols generated by cyclooxygenase (COX) and soluble epoxide hydrolase (sEH), respectively, and we reported that decreasing iPLA2β reduces T1D incidence. Importantly, we find that inhibiting PGE2 signaling with an EP4r antagonist or sEH inhibitor mitigates immune cell inflammatory phenotype. We therefore tested if inhibiting PGE2 signaling (with grapiprant, GP) or sEH (with EC5026) can prevent T1D onset. Starting at 4-weeks of age, NOD mice were treated with vehicle (PEG), GP, or EC and TID onset (≥275 mg/dl glucose) was monitored over 32 weeks of age. Further, as we noted that the production of proinflammatory PGs increases early and higher DHETs/EETs ratios occur closer to predicted T1D onset age, a 4th group was treated with GP starting at 4 weeks and EC added at 8 weeks of age. As expected, T1D incidence was 85% in PEG-treated NOD. Alone, GP reduced incidence modestly and EC5026 was without effect. However, the combination of both significantly reduced incidence. Intriguingly, near T1D onset age there was evidence of higher resolvins (Rvs), which are generated in response to inflammation to affect resolution. We therefore tested the effects of RvD2 and RvE1 supplementation and found that RvD2 was without effect. In contrast, RvE1 produced a significant decrease in incidence, compared with vehicle-treated NOD. In contrast to vehicle-treated diabetic NOD, circulating insulin levels were measured in nondiabetic NOD from both treatment regimens and there was no discernible drug cytotoxicity, as reflected by pathological assessments of pancreas, liver, kidney, and heart. These findings suggest consideration of targeting early inflammation and subsequent resolution phases to counter T1D development. Further, they provide a strong rationale for employing novel combination regimens to modulate select inflammatory and resolving lipid signaling to delay or prevent or T1D onset.

Disclosure

T. White: None. A. Almutairi: None. Y. Tusing: None. B. Hammock: Board Member; Eicosis. C. McReynolds: Employee; EicOsis. Consultant; Inipharm. D. Stephenson: None. C.E. Chalfant: None. S. Ramanadham: None.

Funding

NIH/NIAID 1R21AI169214-01JDRF 2-SRA-2022-1210-S-B3-SRA-2023-1362-S-B1-INO-2023-1344-A-NNIH/NIAID 1 R21 AI 146743UAB Department of CDIBUAB Comprehensive Diabetes Center
1249-P: Flash Glucose Monitoring in Gestational Diabetes—A Pilot Randomized Study
Authors: ZORKO KLARA , MUNDA ANA , SMID TANJA , ZAJEC ANASTAZIJA , JANEŽ ANDREJ , PONGRAC BARLOVIC DRAZENKA
Published: June 2024

Introduction & Objective: Despite the increasing use of systems for subcutaneous glucose measurement very limited data exists on its use and glycemic targets in women with gestational diabetes (GDM). Therefore, the aim of our study was to analyze the impact of flash glucose monitoring system (FGM) on glycemic and perinatal outcomes in GDM.

Methods: In an ongoing single-center pilot randomized controlled trial, 37 women with GDM were randomly assigned to either the self-monitoring of blood glucose (SMBG) group or the SMBG + FGM group. The primary outcome was glycemic control, measured by mean glucose levels and the percentage of measurements within the target range by using SMBG data. Secondary outcomes included FGM glycemic control and perinatal data. Statistical comparison between the two groups was performed using the Mann-Whitney U test.

Results: The SMBG group (n=21,(age: 32.4 ± 4.9)) and the SMBG+FGM group (n=16, (age: 30.3 ± 4.9)) exhibited a significant difference solely in the percentage of measurements in target range postprandially (92.6% [84.0-1.0] vs. 80.1% [59.5-91.4], p=0.047). FGM data revealed minimal variations among participants, with an average time-in-range (TIR) of 95.5 ± 4.0%. Notably, 93.8% of participants achieved a TIR above 90%. The coefficient of variation (CV) was 4.2. In the SMBG cohort, two newborns were classified as large for gestational age (LGA), while none were reported in the FGM group.

Conclusion: Our data suggest better glycemic control 1-hour postprandially in the SMBG group, despite a vast majority within the SMBG+FGM group achieved TIR levels above 90%. Possibly stricter glycemic targets will be needed in this population of women, where even slight variations in glucose levels imply more significant therapeutic interventions. Given the limited sample size, definitive conclusions cannot be drawn; further research is warranted.

Disclosure

K. Zorko: None. A. Munda: None. T. Smid: None. A. Zajec: None. A. Janež: Advisory Panel; Novo Nordisk A/S. Speaker's Bureau; Abbott, Eli Lilly and Company, Boehringer-Ingelheim, Ascensia Diabetes Care, Medtronic, AstraZeneca. D. Pongrac Barlovic: None.

Funding

University Medical Centre Ljubljana 20230134 and 20220126
1252-P: Markers of Alzheimer's Disease (AD) in Young Adults with Type 1 Diabetes, With and Without Diabetic Retinopathy (DR)
Authors: PAULEY MEGHAN E. , COUGHLAN CHRISTINA , BELLATORRE ANNA , SNELL-BERGEON JANET K. , DABELEA DANA , SHAPIRO ALLISON
Published: June 2024

Introduction & Objective: Diabetes increases risk of dementia, yet underlying neuropathology is unclear. While DR is associated with AD in adults with type 2 diabetes, less is known in young people with T1D. This study assessed plasma phosphorylated tau-181 (pTau181), a preclinical biomarker of AD, in young adults with T1D, by DR status.

Methods: Plasma pTau181 (pg/mL) was quantified in participants with T1D using samples from the SEARCH for Diabetes in Youth study Colorado site. Samples were taken from the baseline visit, at which time no DR was present (≤2 years of T1D duration; mean age 11 [4.2] years), and a follow-up (F/U) visit in young adulthood (mean age 21 [4.6] years). DR was assessed via fundus photography at F/U and defined as any DR present. Changes in levels of pTau181 over time were assessed with paired Wilcoxon signed-rank test and compared by DR status via Mann-Whitney U test.

Results: 45 participants were included (DR at F/U, n=18; No DR at F/U, n=27). pTau181 significantly increased over time in all participants (median [IQR]; 16.64 [12.60-23.67] to 109.60 [91.25-128.90], p<0.001) but there were no significant differences by DR status.

Conclusion: Young adults with T1D show increasing burden of preclinical markers of AD neuropathology over time, unrelated to DR. Studies are underway to investigate the implications of these findings on cognitive function and future risk of AD in T1D.

Disclosure

M.E. Pauley: None. C. Coughlan: None. A. Bellatorre: None. J.K. Snell-Bergeon: None. D. Dabelea: None. A. Shapiro: None.

Funding

NIH NIDDK and CDC (1R01DK127208-01, 1UC4DK108173); NIH NIDDK (T325T32DK063687); DiabDocs Physician-Scientist Career Development Award: NIH NIDDK (K12DK133995) & The Leona M. and Harry B. Helmsley Charitable Trust to Stanford University (2305-06041)
1255-P: Sulfonylurea Prescription in Elderly Patients with Diabetes Survey Using Real-World Data in Japan
Authors: SAKAMOTO MASAYA , YAMAZAKI MICHIKO , TAKEBE TOHRU , HOSOKAWA MASAYA , SAIKA TOMOYA , NAKAO YUTAKA , IKEDA SHUNYA
Published: June 2024

Introduction: Similar to the US, Japan has seen a decline in sulfonylureas (SUs) use in the elderly patients (pts) with diabetes, but the detailed usage status of SU is unknown.

Methods: To investigate real-world SU prescribing patterns, we conducted a retrospective cross-sectional survey using pharmacy data in Japan, targeting pts prescribed SUs, aged 20-100 years. From November 2022 to October 2023, we extracted data for 91,230 pts from the electronic prescription system Musubi (KAKEHASHI Inc., adopted in over 7,000 pharmacies, accounting for 10% market share, as of 2023 in Japan). The most commonly prescribed SUs were glimepiride (73,061 pts, 80.1%), gliclazide (14,841 pts, 16.3%), and glibenclamide (3,327 pts, 3.6%). Our analysis focused on adherence to Japanese guidelines in prescribing these SUs in elderly pts (adhering to limits of 1 mg/day for glimepiride and 40 mg/day for gliclazide, and avoiding glibenclamide).

Results: Of 91,230 pts showed 55,947 were male (61.3%) and a mean age of 68.8 years; 66,319 (72.7%) were aged ≥65 years. Elderly pts on average used 2.7 antidiabetic medications concurrently. The most common additional medications with SUs were DPP-4 inhibitor (49,963 pts, 75.3%), biguanide (34,266 pts, 61.2%), and SGLT-2 inhibitor (25,878 pts, 46.3%). Insulin was used concomitantly in 3,682 elderly pts (6.6%). Among elderly pts, 25.0% and 7.8% exceeded the recommended dosages for glimepiride (>1 mg/day) and gliclazide (>40 mg/day), respectively. Glibenclamide was prescribed to 2,578 elderly pts (77.5%). However, elderly pts used fewer diabetes medications on average: 3.3 for those <65 years, 3.0 for 65-<75 years, and 2.7 for ≥75 years.

Conclusion: We identified high-dose prescription of glimepiride and gliclazide, and glibenclamide use in elderly pts, indicating potential non-adherence to guidelines. Our findings highlight the need for enhanced education and appropriate SU usage to prevent hypoglycemia and diabetic complications.

Disclosure

M. Sakamoto: None. M. Yamazaki: None. T. Takebe: None. M. Hosokawa: None. T. Saika: None. Y. Nakao: None. S. Ikeda: None.
1264-P: Impacts of Diabetes (DM) on Severe Functional Disability (FD) and Care-Need Level Deterioration in Japanese
Authors: IKEDA IZUMI , FUJIHARA KAZUYA , SHIOZAKI HARUKA , MORIKAWA SAKIKO Y. , TSURUOKA KAHORI , YUKO YAMASHITA , MON KHIN LAY , WU SIJIA , YAGYUDA NORIKO , HORIKAWA CHIKA , SONE HIROHITO
Published: June 2024

Avoidance of FD and the deterioration of care level needs leading to a decline in ADL and increased medical costs is urgent. We aimed to clarify the association between lifestyle habits, non-communicable diseases (i.e., DM, HT, and dyslipidemia) and their combinations and the incidence of severe FD and deterioration of the care-level. Followed for a median of 3.7 years were 9673 people who underwent health checkups. Care-level ≥2 (total assistance needed) indicates severe FD and worsening from the initial examination indicates deterioration. During the study period, 111 cases of severe FD occurred. Multivariate analysis showed that aging (per 5y) (OR 2.24 [1.95-2.56]), male (1.76 [1.16-2.66]), BMI<18.5 (2.46 [1.40-4.35]), DM (1.81 [1.06-3.08]), HT (1.58 [1.05-2.38]), and lack of physical activity (PA) (2.17 [1.37-3.45]) were associated with severe FD. Prevalence of DM additively associated with severe FD. DM and ≥2 risk factors had a 10 times greater association than non-DM and no risk factor. Of 85 cases with worsening care needs, only DM was significantly associated with deterioration (2.88 [1.08-7.65]). DM is a significant risk factor for with double the increased risk of severe FD and triple care-need deterioration compared with those without DM. Also, in DM patients, low BMI, HT, and lack of PA greatly increased the risk of severe FD, suggesting the need for comprehensive treatment strategies.

Disclosure

I. Ikeda: None. K. Fujihara: None. H. Shiozaki: None. S.Y. Morikawa: None. K. Tsuruoka: None. Y. Yuko: None. L. Khin: None. S. Wu: None. N. Yagyuda: None. C. Horikawa: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
1278-P: Changes in Cardiovascular Disease (CVD) Incidence Due to Remission of Diabetes and Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD)
Authors: MATSUBAYASHI YASUHIRO , FUJIHARA KAZUYA , SATO TAKAAKI , YAMAMOTO MASAHIKO , ISHIGURO HAJIME , OSAWA TAEKO , KITAZAWA MASARU , SUZUKI HIROSHI , KODAMA SATORU , YAMADA TAKAHO , SONE HIROHITO
Published: June 2024

The leading cause of death in patients with steatotic liver disease (SLD) is CVD. As SLD is frequently associated with metabolic disorders such as type 2 diabetes (DM), the concept of MASLD has been proposed. MASLD can be classified according to the type of associated metabolic dysfunction. Among MASLD subtypes, MASLD with DM (DM-MASLD) was shown to have a major impact on the development of CVD. However, the presence of SLD and status of concomitant metabolic abnormalities change over time. Since it is unclear how the incidence of CVD changes when DM-MASLD transitions, this study aimed to clarify this issue. Included were 11592 participants selected from a nationwide claims database from 2008 to 2019 who underwent health screening 2 years before baseline (B-2) and who had DM-MASLD at B-2 but without CVD at baseline. Participants were classified by whether DM and MASLD remained or were in remission, respectively, from B-2 to baseline. Incidence of new onset of CVD in each category was analyzed by a multivariate Cox proportional hazard model. During a median follow up of 4.9 y, 446 CVD events occurred. Changes in incidence of CVD due to changes in DM and MASLD status are shown in Figure 1. Remission in DM and MASLD each significantly reduced the incidence of CVD. Remission of hepatic steatosis in DM-MASLD patients was comparable to remission of DM in preventing new onset of CVD.

Disclosure

Y. Matsubayashi: None. K. Fujihara: None. T. Sato: None. M. Yamamoto: None. H. Ishiguro: None. T. Osawa: None. M. Kitazawa: None. H. Suzuki: None. S. Kodama: None. T. Yamada: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.

Funding

Japan Society for Promotion of Science (JSPS) KAKENHI(JP 23K16814)
1281-P: Impact of Estimated Glomerular Filtration Rate (eGFR) on New-Onset Heart failure (HF) according to Glucose Tolerance Status
Authors: UEGAMI YOHEI , FUJIHARA KAZUYA , TAKIZAWA HIROKI , KITAZAWA MASARU , SUZUKI HIROSHI , OSAWA TAEKO , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO , SHIMAYAMA CHIHIRO
Published: June 2024

Chronic kidney disease, HF, and type 2 diabetes mellitus (DM) are common and interrelated. Although both low eGFR and high eGFR have been associated with an increased risk of cardiovascular disease in patients with DM, it is unclear whether this association differs according to glucose tolerance. Thus, we aimed to clarify the association between eGFR and the incidence of new-onset HF according glucose tolerance status in the same cohort. Study participants underwent medical checkups between 2008 and 2019. Based on glucose tolerance status they were divided into three groups (normoglycemia [n=510,300], prediabetes [n=222,327] or DM [n=42,903]). Participants were also classified by eGFR level. Risk for HF was analyzed by a multivariate Cox regression model. During a median follow-up period of 4.4 y, 362 cases of HF occurred. Compared with 60≤ eGFR <90, the risk of HF significantly increased in those with eGFR ≥105 in people with prediabetes and DM. However, this association was not observed in those with normoglycemia (Table). In addition, both participants with DM and eGFR ≥105 and with DM with eGFR <60 had an approximately 6-fold higher risk for HF than persons with normoglycemia and 60≤ eGFR <90. Results suggested HF risk may be increased by hyperfiltration accompanied with glucose abnormality. Further studies are required to clarify the mechanisms underlying this relationship.

Disclosure

Y. Uegami: None. K. Fujihara: None. H. Takizawa: None. M. Kitazawa: None. H. Suzuki: None. T. Osawa: None. Y. Matsubayashi: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd. C. Shimayama: Employee; Kowa Company, Ltd.
1290-P: Developing Machine Learning Model for Predicting Acute Coronary Syndrome in Type 2 Diabetes Mellitus Patients through Substitution of Propensity Scores for Binary Variables
Authors: LEE DAVID S.U. , WON JUNG-HYUN , LEE HOWARD
Published: June 2024

Introduction & Objective: T2DM patients have a high risk for acute coronary syndrome (ACS), requiring early and accurate risk stratification. However, traditional risk models lack generalizability for this patient population, while machine learning (ML)-based models have been plagued by inaccuracies in the training data, particularly those of binary information. Our study aims to develop an ML model for ACS prediction in T2DM patients by applying a novel data representation approach.

Methods: We used the EMRs of T2DM patients treated with basal insulin. The study unit was treatment period, during which the subjects were continuously treated with basal insulin. The primary outcome was ACS occurrence during this period. We addressed EMR inaccuracies by replacing binary information with their respective propensity scores (PS), re-defined as the probability of having a record given covariates. We used various ML algorithms to develop ACS prediction models and evaluated their performance. Additionally, the Shapley Additive Explanation (SHAP) method identified important clinical predictors of ACS.

Results: The study included 9,338 patients (mean age 60.2 years and 56.6% male) over 10,184 treatment periods. The most prevalent comorbidities were hypertension and dyslipidemia. Notably, 6.9% experienced ACS. Our best performing model achieved a 0.969 in all performance metrics. Compared with models developed via traditional methodologies, our approach improved prediction performance by over 6 percentage points. SHAP analysis showed that older age, higher baseline glucose, history of antithrombotic therapy, history of chest pain, and indicators of T2DM progression (e.g., senile cataract) were important ACS risk factors.

Conclusion: Our model showed a high generalizability for T2DM patients, improved prediction accuracy, and higher reliance on clinical predictors that align with current medical understanding.

Disclosure

D.S.U. Lee: None. J. Won: None. H. Lee: None.

Funding

the Seokchunnanum Foundation (SCY2205P); the BK21FOUR Program of the National Research Foundation of Korea (NRF) in the Ministry of Education (5120200513755)
131-OR: A Multiomics Study of Individual Responses to Long-Term Mediterranean Diet Interventions in the DIRECT-PLUS Trial
Authors: DONG DANYUE , LIU YUXI , STAMPFER MEIR , SHAI IRIS , HUTTENHOWER CURTIS , WANG DONG
Published: June 2024

Introduction: We applied multi-omics to study individual responses to dietary interventions and their effects on the gut microbiome in a long-term randomized controlled trial of Mediterranean Diet (MedDiet).

Methods: We profiled host genetics (Global Screening Array), the gut microbiome (shotgun metagenomics), and fecal and plasma metabolomics (LC-MS) at baseline and endpoint in the 18-month DIRECT-PLUS Trial with 294 participants randomized into three groups: healthy dietary guidelines, MedDiet and MedDiet + polyphenols (Fig. 1A).

Results: We observed large variability in individuals' responses to dietary interventions: mean coefficients of variation of post-intervention changes: BMI at 92 (Fig. 1B), hs-CRP at 103, and LDL/HDL at 96. Age, sex, baseline factors, and multi-omics collectively explained the variability in post-intervention changes: BMI (4%) and fasting glucose (11%; Fig 1C). Furthermore, the integration of baseline multi-omics significantly enhanced predicting individual diet responsiveness. (AUC from 0.55 to 0.78; Fig. 1D). Our longitudinal analysis revealed MedDiet-induced alterations in metabolites and the gut microbial taxonomy (Fig. 1E, F)

Conclusion: Our study demonstrates the application of multi-omics in predicting personalized responses to dietary intervention, laying the foundation for precision nutrition in metabolic disease prevention.

Disclosure

D. Dong: None. Y. Liu: None. M. Stampfer: Advisory Panel; Elysium Health. I. Shai: None. C. Huttenhower: Advisory Panel; Seres Therapeutics, Empress Therapeutics, ZOE Nutrition. D. Wang: None.

Funding

National Institutes of Health (R01NR01999, R00DK119412, P30DK046200); Deutsche Forschungsgemeinschaft (209933838); The Israel Ministry of Health (87472511); The Israel Ministry of Science and Technology (3-13604)
1319-P: Assessment of a Comprehensive Physical Fitness Index to Predict Various Metabolic Diseases
Authors: SATO TAKAAKI , FUJIHARA KAZUYA , YAGUCHI YUTA , YAMAMOTO MASAHIKO , KITAZAWA MASARU , SUZUKI HIROSHI , MATSUBAYASHI YASUHIRO , ISHIGURO HAJIME , OSAWA TAEKO , YAMADA TAKAHO , KATO KIMINORI , SONE HIROHITO
Published: June 2024

Although associations of the risk of developing type 2 diabetes or cardiovascular disease with muscle strength, balance, or flexibility were established separately, a comprehensive evaluation of physical fitness is required. We previously developed a composite measure of these fitness components designated as the Physical ScoreTM and reported its significant associations with the prevalence of diabetes, hypertension, dyslipidemia, fatty liver, and metabolic syndrome (MetS). We now examined longitudinal associations between the PS and incidence of these diseases.To calculate the PS data on 103,348 individuals (64,834 men) aged 30 to 69 y who underwent physical fitness assessments, principal component analysis was applied to the correlation matrix of fitness test results adjusted for age and sex. PS is close to the deviation for physical fitness, with a change in PS of 1 corresponding to a change of 10 deviations. Cox hazard regression analysis evaluated the relationship between PS at the initial assessment and subsequent development of each disease, with a minimum follow-up of 3 y. For every decrease of 1 in the PS from the initial evaluation, the hazard ratios for incident disease ranged from 1.04 to 1.22. PS was weakly associated with diabetes and most strongly associated with MetS. Findings suggest that the PS, which is convenient and non-invasive, could predict various metabolic diseases.

Disclosure

T. Sato: None. K. Fujihara: None. Y. Yaguchi: None. M. Yamamoto: None. M. Kitazawa: None. H. Suzuki: None. Y. Matsubayashi: None. H. Ishiguro: None. T. Osawa: None. T. Yamada: None. K. Kato: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
1321-P: A Machine-Learning Approach on Metabolomic Data to Predict Type 2 Diabetes Mellitus Incidence
Authors: LEIHERER ANDREAS , MUENDLEIN AXEL , SAELY CHRISTOPH H. , PLATTNER THOMAS , LARCHER BARBARA , MADER ARTHUR , VONBANK ALEXANDER , LAAKSONEN REIJO , FRAUNBERGER PETER , DREXEL HEINZ
Published: June 2024

Metabolomics, with its wealth of data, offers a valuable avenue for enhancing predictions and decision-making in diabetes. This observational study, aimed to leverage machine learning (ML) algorithms to predict the 4-year risk of developing T2DM using targeted quantitative metabolomic data. A cohort of 279 cardiovascular risk patients, who underwent coronary angiography and who were initially free of T2DM according to ADA criteria, were followed for up to 4 years. During this time, 11.5% newly developed T2DM. Targeted metabolomics (Biocrates, AUSTRIA) was performed at baseline, using liquid chromatography (LC), - mass spectroscopy (MS), and flow injection analysis (FIA) - MS respectively. After preprocessing the metabolomics data set, 362 variables were used for ML, employing the caret package (CRAN, R). The dataset was divided into training and test sets (75:25 ratio), and we used an oversampling approach to address the classifier (T2DM incidence) imbalance. The Multilayer Perceptron (MLP) after size-tuning demonstrated the most promising predictive capabilities, exhibiting a sensitivity of 63%, a specificity of 79%, and an accuracy of 77%. The most important variables (top20, figure) were ceramides, bile acids, and hexoses.

In conclusion, ML analysis of large metabolomic data is a promising tool for identifying individuals at risk of developing T2DM and opens avenues for personalized and early intervention strategies.

Disclosure

A. Leiherer: None. A. Muendlein: None. C.H. Saely: None. T. Plattner: None. B. Larcher: None. A. Mader: None. A. Vonbank: None. R. Laaksonen: None. P. Fraunberger: None. H. Drexel: None.