bluuebunny/crossref_metadata_2025 huggingface dataset:
141-LB: Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (rt-CGM) vs. Intermittent-Scanning Continuous Glucose Monitoring (is-CGM) from a U.S. Payer Perspective in Patients with Type 2 Diabetes on Multiple Daily Injections of Insulin (PwT2D on MDI)
Authors: ALSHANNAQ HAMZA , NORMAN GREGORY J. , LYNCH PETER M.
Published: June 2023

Diabetes management for PwT2D on MDI requires access to timely glucose readings to inform treatment decisions and avoid acute events like severe hypoglycemia (SHE) and Diabetic Ketoacidosis (DKA). CGM systems have different features that can impact glycemic outcomes and disease complications and costs. There is a gap in the literature on the cost-effectiveness of rt-CGM vs is-CGM systems. We conducted lifetime projections of disease outcomes and costs from a US payer perspective using the IQVIA Core Diabetes Model v9.5+. Cohort characteristics and clinical inputs were sourced from the DIAMOND T2D and REPLACE RCTs. Applying Bucher's adjusted indirect comparison method resulted in an HbA1c effect of -0.33 favoring rt-CGM, SHE incidence rates of 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and DKA rates were estimated using Time-Above-Range (0.0313 and 0 PPY, respectively). The cost of both CGM systems is based on Medicare pricing and 80% reimbursement (HCPCS code A4239). A utility for fear of hypoglycemia (FoH) reduction was applied from the ALERTT1 RCT. The model associates rt-CGM use with reduced eye (-5.64%), renal (-7.42%), neural (-4.08%), and cardiovascular (-2.56%) complications compared to is-CGM. It projects rt-CGM users to have higher quality-adjusted life years (QALYs) by 0.454 with cost savings of -$1,355, and an incremental cost-effectiveness ratio of -$2,983/QALY. Rt-CGM remained cost-effective under the $50,000 willingness-to-pay threshold even when its cost was increased by 70% (+$1,713). Scenario analysis with 50% lower FoH utility, SHE, and DKA rates reduced QALYs gained to 0.264. Our analysis suggests that rt-CGM is cost-saving and cost-effective vs is-CGM in PwT2D on MDI in the US and can inform US payers of the economic value of different CGM systems.

Disclosure

H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. P. M. Lynch: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.
142-LB: Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (rt-CGM) vs. Intermittent-Scanning Continuous Glucose Monitoring (is-CGM) in Patients with Type 2 Diabetes on Multiple Daily Injections of Insulin (T2D MDI) in Canada
Authors: ALSHANNAQ HAMZA , NORMAN GREGORY J. , WILLIS MICHAEL , NILSSON ANDREAS
Published: June 2023

Rt-CGM systems provide real-time glucose values, hypo- and hyperglycemia alerts, and predictive “urgent low soon” alerts that have been shown to improve glycemic outcomes and reduce severe hypoglycemic events (SHEs) in patients with T2D, without the need for periodic scanning. The economic value of rt-CGM vs is-CGM is unknown for patients with T2D MDI in Canada. We conducted a cost-effectiveness analysis comparing the two systems for this patient population using the INESSS Canadian payer perspective. ­ A 30-year analysis was performed using the validated ECHO-T2DM. Patient characteristics were sourced from Karter (2021). Efficacy and safety were derived from the DIAMOND T2D and REPLACE RCTs. The HbA1c difference of -0.33 (favoring rt-CGM) was derived using Bucher's adjusted indirect comparison, SHE rates were 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and severe hyperglycemia/DKA rates were proxied by the difference in time above range (0.0313 and 0 PPY, respectively). Costs and disutility weights were sourced from published Canadian literature and discounted at 1.5% annually. A reduction in fear of hypoglycemia (FOH) utility was sourced from the ALERTT1 RCT. Sensitivity analyses were performed. Rt-CGM was associated with quality-adjusted life year gains of 0.346 and incremental costs of CAD 5,737, with an incremental cost-effectiveness ratio (ICER) of CAD 16,598. No DKA events for is-CGM and a 50% reduction in FOH utility increased the ICERs to CAD 30,987 and CAD 29,116, respectively. ICER was CAD 2,278 when both CGM costs were reduced by 50% and rt-CGM became cost-saving (dominant) at a 65% reduction. These results suggest rt-CGM is cost-effective vs is-CGM in patients with T2D MDI in Canada. These findings can inform government and commercial healthcare decision-makers when considering reimbursement of CGM systems.

Disclosure

H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. M. Willis: None. A. Nilsson: None.

Funding

Dexcom, Inc.
143-OR: Prevailing Glucose Levels Alter Left Ventricular Contractions Pattern, Myocardial Performance, and Myocardial Energy Efficiency
Authors: ANDREASEN CHRISTINE R. , ANDERSEN ANDREAS , HAGELQVIST PER G. , MAYTHAM KAISAR , SENGELØV MORTEN , KNOP FILIP K. , OLSEN FLEMMING J. , VILSBØLL TINA
Published: June 2023

Mechanical dispersion (MD) describes heterogeneity in ventricular contraction patterns, and myocardial work (MW) indices quantify ventricular performance. Investigating the myocardial and functional response to acute hypoglycemia and hyperglycemia may aid in identifying putative mechanisms linking glycemia and cardiovascular disease (CVD). From echocardiography performed during euglycemic, hyperglycemic and hypoglycemic clamps, we explored the relationship between glycemia and MD and MW indices in individuals with type 1 diabetes, type 2 diabetes and without diabetes. MD was measured by speckle-tracking echocardiography, and MW measures were derived from pressure-strain loop analyses. We analyzed data (mean±SD) from 84 individuals: 20 young individuals with type 1 diabetes (age: 30±8 years); 24 middle-aged individuals with type 1 diabetes (age: 53±12 years); 21 older individuals with type 2 diabetes (63±7 years), and 21 controls (62±8 years). Results for MD and MW indices are illustrated in Figure 1. In conclusion, acute hyperglycemia leads to an energy-effective myocardium with homogeneous left ventricular contractions. Hypoglycemia increases constructive myocardial work, followed by a less energy-efficient myocardium and more heterogeneous left ventricular contractions, perhaps alluding to a possible link between hypoglycemia and CVD.

Disclosure

C.R.Andreasen: None. A.Andersen: None. P.G.Hagelqvist: None. K.Maytham: None. M.Sengeløv: None. F.K.Knop: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Novo Nordisk, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Lundbeck. F.J.Olsen: None. T.Vilsbøll: Consultant; AstraZeneca, Boehringer Ingelheim Inc., Gilead Sciences, Inc., Eli Lilly and Company, Mundipharma, Merck & Co., Inc., Novo Nordisk A/S, Sanofi, Sun Pharmaceutical Industries Ltd., Bristol-Myers Squibb Company.

Funding

Danish Diabetes Academy (17SA0031406); Novo Nordisk Foundation (16230)
144-LB: Assessment of Drug Prescription Patterns of Patients with Type 2 Diabetes Mellitus in India
Authors: CHAVDA VIPUL , SABOO BANSHI D. , ABHICHANDANI VK , DESAI SANDEEP , PATADIA VIPUL , MORI BIRJU S. , PATEL SUSHIL , PRAJAPATI AAKASH M. , PAREKH MALAY N. , VORA FALGUNI , VORA TANISHA , HASNANI DHRUVI
Published: June 2023

Rationale: Drug prescribing studies can suggest modifications in the current prescribing practices, which in turn will reduce the treatment cost, non-compliance and complications.

Purpose: To identify the prescription patterns in patients with type 2 diabetes mellitus with respect to the duration of the disease.

Methods: Patients with type 2 diabetes mellitus seeking regular care at twelve of the locations in Western India were included in the study. Using MEDEVA (EMR), an integrated research platform, information on medical history, laboratory values and medications was recorded. Data collected from 1st December 2022 to February 25th 2023 was considered for the analysis.

Results: Of the 920 patients enrolled in the study, 607 had a duration of diabetes and prescribed medications recorded. Patients with a duration ≤ 5 years are about 53.0%, 5-10 years are 28.8% and >10 years are 18.1%. Biguanides and Sulfonylureas, followed by DPP-4, are the most common drug classes prescribed in patients with ≤ 5 years duration and Insulins in patients with a duration of more than 10 years.

Conclusion: This study offers valuable information on the trends in oral antidiabetic medications and insulins in diabetic patients. As the duration of the disease increases insulin is the most prescribed medication.

Disclosure

V. Chavda: None. B. D. Saboo: None. V. Abhichandani: None. S. Desai: None. V. Patadia: None. B. S. Mori: None. S. Patel: None. A. M. Prajapati: None. M. N. Parekh: None. F. Vora: None. T. Vora: None. D. Hasnani: None.
145-LB: Consistent Care of Teens and Young Adults with Diabetes during the COVID-19 Pandemic
Authors: HSIA DANIEL S. , BEYL ROBBIE A. , RUMSEY RENEE
Published: June 2023

The transition period from pediatric to adult care is associated with worsening glycemic control and poor attendance with adult providers, which has only been complicated by the COVID-19 pandemic. Diabetes transition clinics and model programs may improve outcomes, but they remain few in number and underutilized. The aim of our cross-sectional, retrospective study was to compare diabetes control in our diabetes transition clinic (DTC) patients versus those who remained in pediatric endocrine care (non-DTC) over a 5 year period. A random sample of 82 patients ages 16 to 25 years seen in clinic from 9/11/2017 to 9/10/2022 were included. Each patient had at least one visit before and after 3/11/2020, when COVID-19 was declared a global pandemic. Those who attended DTC were similar to the non-DTC group except for insurance status (Table). The DTC group had a mean HbA1c of 8.8% vs. 9.0% (p=0.80) and a mean of 4.1 vs. 3.8 visits (p=0.69); whereas, the non-DTC group had a mean HbA1c of 10% vs. 9.6% (p=0.27) and a mean of 5.2 vs. 4.2 visits (p=0.19) before versus after 3/11/2020. Telehealth visits consisted of 15.7% of the visits in the DTC group versus 13.3% in the non-DTC group after 3/11/2020 (p=0.56). Despite the challenges of the COVID-19 pandemic, patients who moved to DTC during this time maintained glycemic control and continued to attend clinic visits consistently similar to those who remained in pediatric endocrine care.

Disclosure

D. S. Hsia: None. R. A. Beyl: None. R. Rumsey: None.

Funding

National Institute of General Medical Sciences (U54GM104940)
1451-P: Risk of Progression to Clinical Type 1 Diabetes in Older Adolescents Positive for Islet Autoantibodies
Authors: WAUGH KATHLEEN , GENO RASMUSSEN CRISTY , DONG FRAN , GESUALDO PATRICIA D. , FROHNERT BRIGITTE I. , REWERS MARIAN
Published: June 2023

Objective: Evaluate progression to type 1 diabetes (T1D) among adolescents with persistent islet autoimmunity.

Background: Few studies have continued to follow adolescents with islet autoimmunity through to young adulthood. With the emergence of treatments to delay clinical diabetes and general population screening, there is need to accurately predict and communicate risk for progression to T1D in autoantibody positive persons.

Methods: Included in this analysis were 203 participants of prospective studies (DAISY, TEDDY Graduates, ASK) who were persistently positive for islet autoantibodies and free of diabetes between 13-15 y of age. Of those, 51% were female, 52% non-Hispanic white, and 32% had a first-degree T1D relative. Autoantibodies to insulin, GAD, IA-2, and ZnT8 were measured using standard radio-binding assays.

Results: During the median 3.0 y (IQR 1.2-5.2) follow-up, 14.8% (n=30) of the participants progressed to T1D. The 5-year risk of progression to clinical diabetes was 33.1% (95%CI 20.0-51.7%) among adolescents with multiple autoantibodies vs 7.8% (95%CI 3.9-15.2%) in those with a single persistent autoantibody. Independent predictors of progression to diabetes included: multiple autoantibodies (HR=3.2, 95%CI 1.4-7.5, p=0.008) and higher baseline HbA1c (HR=1.7 per 0.5%, 95%CI 1.2-2.2. p=001). A receiver operating characteristic based on autoantibody status and HbA1c (AUC 0.78) did not improve significantly with addition of sex, ethnicity, and family history of T1D (AUC 0.81).

Conclusion: One third of adolescents with multiple islet autoantibodies progress to clinical diabetes within 5 years, with baseline HbA1c being highly predictive of progression.

Disclosure

K.Waugh: None. C.Geno rasmussen: None. F.Dong: None. P.D.Gesualdo: None. B.I.Frohnert: Advisory Panel; Provention Bio, Inc. M.Rewers: Research Support; Provention Bio, Juvenile Diabetes Research Foundation (JDRF), Hemsley Charitable Trust, Dexcom, Inc., Janssen Research & Development, LLC.

Funding

National Institutes of Health (5R01DK032493-36); JDRF (2-SRA-2022-1270-S-B)
1491-P: ER Stress Drives the VEGF Expression in Monocytic Cells by Mechanisms Involving CHOP/ROS/HIF-1alpha/NRF2 and NF-kappaB/p38 MAPK Pathways
Authors: SINDHU SARDAR A.K. , AKHTER NADEEM , WILSON AJIT , AREFANIAN HOSSEIN , AL MADHOUN ASHRAF , THOMAS REEBY S. , KOCHUMON SHIHAB P. , ALRASHED FATEMA , BAHMAN FATEMAH , ALZAID FAWAZ , ALMULLA FAHD , AHMAD RASHEED
Published: June 2023

Obesity is marked by metabolic inflammation and by metabolic impairment caused by increased endotoxin, free fatty acids, and vascular endothelial growth factor (VEGF) levels; and involves the endoplasmic reticulum (ER) stress as well. However, it remains unclear whether the ER stress can induce/amplify VEGF expression in metabolically-stressed monocytic cells; and if so, by which mechanism(s). To test this, metabolic stress was induced in THP-1 monocytic cells by treating cells separately with lipopolysaccharide (LPS), palmitic acid (PA), and oleic acid (OA), in presence/absence of ER stressor thapsigargin (TG). Gene expression of VEGF/ER stress markers was assessed by qRT-PCR, protein expression by ELISA, ROS by DCFH-DA assay, phosphorylation of HIF-1α, NF-κB, ERK1/2, and p38 MAPK by immunoblotting, and the insulin response in stressed cells by glucose-uptake assay. Regarding clinical analyses, adipose VEGF gene and protein expression was detected using qRT-PCR and IHC, respectively, while plasma hs-CRP, TNF-α, MDA, and OX-LDL levels were measured by ELISA. The experimental data show that a cooperative interaction between the metabolic and ER stresses led to the expression of VEGF, ROS, CHOP, ATF6, SOD2, and NRF2 (P˂0.05), as well as stimulated the CHOP and NRF2 promoter activities in reporter cells (P˂0.05). However, the glucose uptake was not impaired. The VEGF expression was dependent on phosphorylation of HIF-1α, NF-κB, and p38 MAPK; and the inhibitors of NF-κB/MAPK pathways as well as antioxidants or ROS scavengers suppressed the VEGF production. Further, individuals with obesity showed increased VEGF expression which associated positively with plasma levels of hs-CRP, TNF-α, MDA, and OX-LDL (P≤0.05). Overall, our findings support a cooperativity model in which the ER and metabolic stresses interact to augment VEGF expression in monocytic cells via the mechanisms involving CHOP/ROS/HIF-1α/NRF2 and NF-κB/p38 MAPK pathways.

Disclosure

S.A.K.Sindhu: None. F.Alzaid: None. F.Almulla: None. R.Ahmad: None. N.Akhter: None. A.Wilson: None. H.Arefanian: None. A.Al madhoun: None. R.S.Thomas: None. S.P.Kochumon: None. F.Alrashed: None. F.Bahman: None.

Funding

Kuwait Foundation for the Advancement of Sciences (RA2015-027, RA2010-003, RAHM-2019-022)
1497-P: Comprehensive Metabolic Assessment Reveals Excellent and Stable Glucose Control during First Year after Pancreas Transplantation
Authors: JEET KAUR RAVINDER , RAZA RIZVI SHAFAQ , REID COREY , SMITH BYRON H. , KUKLA ALEKSANDRA , STEGALL MARK D. , KUDVA YOGISH C.
Published: June 2023

Introduction: Limited data are available regarding comprehensive metabolic evaluation after Pancreas transplantation (PT) for T1DM.

Methods: We prospectively studied 15 PT recipients at baseline, 4 months & 1 year after PT. Subjects used Dexcom G4/G6 CGM for 1 week & a standard Mixed Meal Test (MMT) was performed.

Results: PT recipient were 45.1 ± 11.9 years old, F 10, BMI (Kg/m2) 24.4 ± 3.6 & mean duration diabetes 26.8 ± 14.3 years. Seven patients received pancreas alone, five simultaneous pancreas kidney & three pancreas after kidney transplants. Baseline values were Hb 10.4 ± 1.2 (g/dl), HbA1c 6.6 ± 1.1 %, Albumin 4.0 ± 0.4 g/dl, Fructosamine 245.7 ± 37.2 (µmol/L), Fasting glucose 94.9 ± 20.6 mg/dl, C-peptide 4.4 ± 2.8 (ng/ml), eGFR 64.7 ± 17.6 ml/min and AST 18.5 ± 6.7 U/L. Two participants developed partial graft failure: one due to a peri-pancreatic abscess requiring long term drainage & the second patient had nonadherence issues. MMT after adjusting for eGFR revealed excellent glucose concentration & C-peptide/insulin concentrations at all 3 visits. On CGM analysis, mean CGM was similar at V1, V2 and V3 & overall glucose control was excellent with > 89 % of readings within 70-180mg/dL on all visits (Table).

Conclusion: PT recipients demonstrate excellent glucose control on comprehensive assessment at multiple time points in the first year after PT.

Disclosure

R.Kaur: None. S.Rizvi: None. C.Reid: None. B.H.Smith: None. A.Kukla: Advisory Panel; Novo Nordisk, Other Relationship; Dexcom, Inc. M.D.Stegall: None. Y.C.Kudva: Advisory Panel; Novo Nordisk, Research Support; Dexcom, Inc.
1515-P: Effect of Aging on Insulin Clearance in Mice
Authors: NIAZUR RAHMAN S.M. , ZAIDI SOBIA , MUTURI HARRISON T. , NAJJAR SONIA M. , GIACCA ADRIA
Published: June 2023

Aging is commonly linked with hyperinsulinemia and insulin resistance. Age-related hyperinsulinemia results from increased insulin secretion and/or decreased insulin clearance as compensatory mechanisms to peripheral insulin resistance. Several studies have reported reduced β-cell function in elderly rodents and humans. Earlier reports on decreased insulin clearance due to aging suggest that hyperinsulinemia in elderly could be explained predominantly by a reduction in insulin clearance. Hence, we aim to better understand the role of aging on insulin clearance following fat infusion. To investigate the aging effect, 3 months and 10-14 months old C57BL6 mice were infused with ethylpalmitate for 48h (hydrolyzed to palmitate and ethanol in plasma), to achieve elevated circulating FFA in a non-toxic manner. Mice were then subjected to hyperglycemic clamp, and during the clamp plasma C-peptide and insulin were measured to evaluate insulin clearance. Glucose infusion rate (GINF), insulin sensitivity index (SI) and disposition index (DI) were also assessed during clamp analysis. GINF is a measure of glucose tolerance whereas DI evaluates β-cell function. Whereas insulin secretion did not increase, insulin clearance was reduced in the aging mice, as indicated by the lower C-peptide/insulin molar ratio, observed during hyperglycemic clamp. No significant changes were observed in GINF between old and young mice; however, SI and DI were lower in elderly group. These results collectively suggest that with advancing age, β-cells may lose their ability to maintain a higher insulin secretion and that reduced hepatic insulin clearance plays a more dominant role to compensate for age-related decline in insulin sensitivity.

Disclosure

S.Rahman: None. S.Zaidi: Other Relationship; BullFrog AI. H.T.Muturi: None. S.M.Najjar: None. A.Giacca: None.
1607-P: FGF1 Induces Glucokinase Upregulation and Increased Lactate Export in Mouse Hepatocytes
Authors: KABIR MORVARID , ADER MARILYN , THOMAS NAREG , SEKI EKIHIRO , BERGMAN RICHARD N.
Published: June 2023

Rodent studies performed in Dr. Schwartz's lab showed that a single injection of fibroblast growth factor 1 (FGF1) has glucose-lowering activity in diabetic animals and induces concomitant increases in glucokinase (GCK) activity and plasma lactate (Scarlett, JM, Nat Med, 2016). In addition, in vivo experiments performed by our group demonstrated that hepatic lactate export is a surrogate for GCK activity. The mechanism by which FGF1 exerts these effects at cellular level in hepatocytes is unknown. In this study, we treated C57BL/6 mouse hepatocytes with different concentrations of FGF1 (100, 200, or 400 ng/ml) and evaluated GCK gene expression and lactate export from hepatocytes into the medium after 24 h of treatment. FGF1 increased lactate export with 200 to 400 ng/ml FGF1 increased lactate export by 1.5-fold (P<0.05). FGF1 concentration from 100-400 ng/ml did not change cell proliferation, and 200 to 400 ng/ml FGF1 upregulated the expression of GCK by 2.3 and 3-fold (P<0.05), respectively. Thus, these data provide a possible mechanism by which of FGF1 upregulates GCK and, consequently, increases lactate export by hepatocytes.

Disclosure

M.Kabir: None. M.Ader: None. N.Thomas: None. E.Seki: Research Support; Nippon Zoki Ltd, Jubilant. R.N.Bergman: Consultant; Lilly, ReCor Medical, Inc., Research Support; AstraZeneca.

Funding

National Institutes of Health (R01DK027619-33A1)
164-OR: Factors Influencing Young Adults Rationing Insulin and Diabetes Supplies
Authors: NORIEGA KIMBERLY , MONZON ALEXANDRA , CORRY JOLINDA , PATTON SUSANA R. , CARAKUSHANSKY MAURI , WASSERMAN RACHEL M.
Published: June 2023

Background: Despite known risks, young adults (YAs) may ration insulin and type 1 diabetes (T1D) supplies past their recommended use for many reasons, such as changes in health insurance, increased insulin costs, and gaps in health care. In this study, we examined the frequency with which YAs ration insulin and T1D supplies, and related individual and social factors.

Methods: We surveyed 203 YAs with T1D (age 18-25; 54% Female, 1.5% Transgender, 82% Non-Hispanic White, 9% Hispanic/Latino, 11% Non-Hispanic Black, 46% in college, 63% pump-users, and mean HbA1c = 7.69 ± 1.61%.) in a cross-sectional design. Participants completed a validated risk questionnaire including a question about how often they “tried to make insulin or diabetes supplies last longer than recommended” (Likert scale: Never to Daily), and the Diabetes Distress Scale. Participants also reported on social factors including race/ethnicity, insurance status, frequency of T1D appointments, and living with parents (Yes or No). We examined bivariate correlation between diabetes distress (DD) and frequency of rationing insulin/supplies and performed independent samples t-tests comparing groups based on social factors.

Results: Sixty percent of the sample reported rationing insulin/supplies at least once in the last year. Frequency of rationing insulin/supplies correlated with diabetes distress (r= 0.24). Independent samples t-test revealed that participants who lived with a parent or other family member were less likely to ration insulin/supplies t(201) = 2.34, p< 0.05. No other social factors were significant.

Conclusion: Rationing insulin/supplies is common in YAs. YAs who live away from their parents may be at greater risk for rationing, though the relation is not causal. Similarly, YAs who ration insulin/supplies may report higher DD. Clinicians may consider assessing for rationing supplies and its potential detrimental effect on glycemic control. Additional research is needed to examine why YAs might ration insulin/supplies.

Disclosure

K.Noriega: None. A.Monzon: None. J.Corry: None. S.R.Patton: None. M.Carakushansky: None. R.M.Wasserman: None.

Funding

Society of Pediatric Psychology
165-OR: Early Electronic Consultation Reduces Glucose and Health Care–Associated Infection in Hospital—The STOIC-D Surgery Randomised Controlled Trial
Authors: BARMANRAY RAHUL , KYI MERVYN , COLMAN PETER G. , ROWAN LOIS M. , COLLINS LUCY , DONALDSON LAURA E. , MONTALTO STEPHANIE , SUN EMILY , LE MINH V.H. , WORTH LEON J. , FOURLANOS SPIROS
Published: June 2023

Aims: To assess the effect of early intervention with electronic-based proactive specialist diabetes care in surgical inpatients on glycaemia and clinical outcomes.

Methods: The Specialist Treatment of Inpatients: Caring for Diabetes (STOIC-D) Surgery randomised controlled trial (RCT) recruited consecutive adults admitted to surgical units of the Royal Melbourne Hospital (Australia) in 2021 with diabetes or blood glucose ≥200 mg/dL and length of stay (LOS) ≥24 hours. Intervention arm patients received remote proactive consultation by the inpatient diabetes service (IDS) in the electronic medical record (Epic®) within 24 hours of admission and, if escalation criteria were met, received a bedside consultation. Patients receiving standard care were reviewed by the IDS at the bedside only following referral. Insulin and non-insulin agents were used to target glucose 90-180 mg/dL. Outcomes included glucometrics, healthcare-associated infection (HAI), and mortality. Registration: ACTRN12620001303932.

Results: 1,383 admissions met inclusion criteria; 689 received the intervention. The primary outcome of mean patient-day mean glucose was lower in the active (158.4 mg/dL, standard deviation [SD] 48.6) vs. control arm (162.0 mg/dL, SD 46.8, p<0.001). HAI (most commonly pneumonia) was lower in the active vs. control arm (11% vs. 16%, p=0.02). Mortality (2.4% vs. 4.2%, p=0.08) and LOS (10.7 vs. 10.0 days, p=0.26) were no different. The number needed to treat for HAI prevention was 22. Hypoglycaemia <72 mg/dL was not increased (1.0% active vs. 0.9% control, p=0.23). The IDS performed a bedside consultation in 333 (49%) of the active vs. 93 (14%) of the control arm.

Conclusion: The STOIC-D Surgery trial is the largest RCT of a diabetes model-of-care intervention in non-critical care. Early, electronic-based specialist diabetes intervention significantly reduced patient-day mean glucose and HAIs in a surgical population.

Disclosure

R.Barmanray: None. L.J.Worth: None. S.Fourlanos: Advisory Panel; Viatris Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance. M.Kyi: None. P.G.Colman: None. L.M.Rowan: None. L.Collins: None. L.E.Donaldson: Stock/Shareholder; Medtronic, Novo Nordisk. S.Montalto: None. E.Sun: None. M.V.H.Le: None.
1657-P: Post–Mixed Meal Glucagon Secretion Is Not Influenced by Residual Beta-Cell Function in Type 1 Diabetes
Authors: TAYLOR GUY , SMITH KIERAN , BASHIR AYAT , MCDONALD TIMOTHY J. , STEVENSON EMMA J. , SHAW JAMES A. , WEST DANIEL J.
Published: June 2023

Aims: Postprandial glucose excursions contribute to dysglycemia in type 1 diabetes (T1D). Hyperglucagonaemia may play a role but the relationship between beta and alpha-cell dysfunction together with incretin response remains unclear. We sought to elucidate this in people with established T1D with and without C-peptide.

Methods: Participants (n=29, age 38 ± 12 years, HbA1c 57 ± 9 mmol/mol, T1D duration 20 ± 13 years) with a range of postprandial urine C-peptide were recruited. A Meal Tolerance Test (MTT, 240 mL Fortisip: 360kcal, 14.4g protein, 13.92g fat, 44.16g carbohydrate) was completed after an overnight fast, maintaining normal basal insulin, without an insulin bolus. Blood samples were taken pre and 30min intervals for 180 minutes post-drink and analysed for glucose, C-peptide, glucagon, proinsulin, GLP-1 and GIP. Participants were grouped by peak C-peptide (high >200 pmol/L, low 3-200pmol/L, undetectable). [Incremental] area under the curves ([i]AUC) were compared by one way ANOVA, Spearman's correlation and multiple regression with significance accepted p≤0.05.

Results: Ten participants had high peak C-peptide (680 ± 426 pmol/L), 8 low (39 ± 34 pmol/L), and 11 undetectable. Glucagon was comparable in all groups with mean AUC 1721 ± 890 pmol/L*180min (p=0.84). Glucagon correlated with GLP-1 (r=0.81, p<0.01) and GIP (r=0.43, p=0.02) response, but not C-peptide (R=-0.10, p=0.61), proinsulin (r=-0.18, p=0.35) or proinsulin/C-peptide ratio (r=0.04, p=0.85). C-peptide predicted glucose AUC using multiple regression (R2 = 44.3%, F(1, 27) = 21.4, p<0.01). C-peptide in combination with glucagon predicted glucose iAUC (R2 = 41.1% F(2, 26) = 9.1, p<0.01).

Conclusion: Residual C-peptide is a predictor of MTT glucose excursions but not glucagon response in established T1D. Postprandial glucagon contributed to glucose excursion as well as correlating with incretin response. This supports altered alpha-cell phenotype in T1D, aberrantly responding to or secreting incretin.

Disclosure

G.Taylor: None. K.Smith: None. A.Bashir: None. T.J.Mcdonald: None. E.J.Stevenson: None. J.A.Shaw: Advisory Panel; Betalin Therapeutics, Provention Bio, Inc., Consultant; Mogrify. D.J.West: None.

Funding

Diabetes Research and Wellness Foundation (SCA/OF/12/15); Francis James Bell Endowment Fund; Country Durham Community Foundation
1753-P: Islet GLP-1R Protein Expression Is Reduced in Humans with Cystic Fibrosis–Related Diabetes
Authors: VEMIREDDY RACHNA , CASTILLO JOSEPH J. , FOUNTAINE BRENDY S. , BAMMLER THEO K. , MACDONALD JAMES , HULL-MEICHLE REBECCA L. , GHARIB SINA , ZRAIKA SAKENEH
Published: June 2023

Impaired insulin secretion underlies the development of cystic fibrosis-related diabetes (CFRD). Glucagon like peptide-1 (GLP-1) is produced in islet α cells, and potentiates insulin secretion by binding GLP-1 receptors (GLP-1Rs) on β cells. In CFRD, α-cell mass is increased. Despite this, we hypothesized that levels of GLP-1 and/or its signaling components are reduced in CFRD, thereby contributing to deficits in insulin secretion. To address our hypothesis, paraffin-embedded pancreas sections from humans with CFRD and age-matched nondiabetic controls (from nPOD) underwent immunohistochemistry to quantify protein levels of active GLP-1 and GLP-1R (n=5-6/group). Spatial transcriptomics (NanoString) was also performed to assess differentially expressed α- and/or β-cell genes between CFRD and control pancreas (n=3/group; 15 CFRD + 9 control islets). GLP-1 immunoreactivity was unchanged between CFRD and control pancreas (0.33±0.15 vs 0.51±0.15, % GLP-1 area/pancreas area; p=0.4), however islet GLP-1R immunoreactivity was significantly reduced (4.35±1.21 vs 18.70±0.50, % GLP-1R area/islet area; p=0.004). Surprisingly, few α- or β-cell genes were differentially expressed between CFRD and control islets. However, a gene set test (ROAST) to assess transcripts involved in GLP-1 production/signaling revealed that those in α cells (GCG, PCSK1, PCSK2, DPP-4) significantly changed in mixed directions (up- or down-regulated; p=0.001). No such perturbation was seen in the β-cell gene set (INS, GLP1R, DPP-4, PLCG1, PIP4P2, ITPR3, ADCY1, ADCY6, PRKACA, RAPGEF4; p=0.4). In sum, our data suggest CFRD is not associated with altered intra-islet GLP-1 levels, however α-cell genes that modulate GLP-1 levels are dysregulated. Also, islet GLP-1R protein levels are reduced, though expression of genes downstream of GLP-1R is unchanged. Thus, interventions to restore protein levels of islet GLP-1R and/or promote intracellular signaling beyond GLP-1R may improve β-cell function in CFRD.

Disclosure

R. Vemireddy: None. J.J. Castillo: None. B.S. Fountaine: None. T.K. Bammler: None. J. MacDonald: None. R.L. Hull-Meichle: Research Support; Casma Therapeutics, Cystic Fibrosis Foundation, NIH - National Institutes of Health. Employee; Veterans Administration. Research Support; Veterans Administration. S. Gharib: None. S. Zraika: None.

Funding

National Institutes of Health (P30DK089507, P30DK017047)
178-OR: Better Glycemic Control with Once-Weekly Insulin Icodec vs. Once-Daily Insulin Degludec in Insulin-Naïve Type 2 Diabetes (ONWARDS 3)
Authors: LINGVAY ILDIKO , ASONG MARISSE , DESOUZA CYRUS , GOURDY PIERRE , KAR SOUMITRA , VIANNA ANDRE G. , VILSBØLL TINA , VINTHER SIRI M. , MU YIMING
Published: June 2023

Efficacy and safety of once-weekly insulin icodec (icodec) vs once-daily insulin degludec (degludec) in insulin-naïve adults with T2D were examined in ONWARDS 3 (NCT04795531), a 26-week, randomized, double blind, double dummy, treat-to-target, phase 3a trial. Participants (n=588) were randomized 1:1 to icodec or degludec. Key outcomes are shown in the table. The primary endpoint was A1C change from baseline (BL) to week 26. Estimated mean A1C change was greater with icodec (−1.57%; BL: 8.55%) vs degludec (−1.36%; BL: 8.48%); estimated treatment difference −0.21%-points (95% CI −0.34, −0.08), confirming non-inferiority (p<0.0001) and superiority (p=0.0016). Level 2 or 3 hypoglycemia rates were numerically but not statistically significantly higher with icodec vs degludec in the on-treatment period. Odds of achieving A1C <7% without level 2 or 3 hypoglycemia were statistically significantly higher with icodec vs degludec. There were no significant differences in weekly insulin dose from week 24 to 26 or body weight change from BL to week 26 between arms. No unexpected safety findings were observed. Overall, once-weekly icodec demonstrated superior A1C reduction vs once-daily degludec with low level 2 or 3 hypoglycemia rates in both arms. Icodec may facilitate insulin treatment acceptance and adherence by reducing basal insulin injections from ≥365 to 52 per year.

Disclosure

I.Lingvay: Advisory Panel; Novo Nordisk A/S, Lilly Diabetes, Boehringer-Ingelheim, Sanofi, Consultant; Carmot Therapeutics, Inc., Merck Sharp & Dohme Corp., Janssen Scientific Affairs, LLC, Pfizer Inc., Intercept, Intarcia, Valeritas, TargetRWE, Shionogi, Zealand Pharma, Structure, Bayer, Research Support; Novo Nordisk A/S, Boehringer-Ingelheim. M.Asong: Employee; Novo Nordisk. C.Desouza: Advisory Panel; Novo Nordisk A/S, Bayer Inc., Consultant; Asahi Kasei Corporation, Research Support; Eli Lilly and Company. P.Gourdy: Advisory Panel; Novo Nordisk, Eli Lilly and Company, Sanofi, Bayer Inc., Merck Sharp & Dohme Corp., Novartis, Intercept Pharmaceuticals, Inc., Research Support; Novo Nordisk, Speaker's Bureau; Novo Nordisk, Eli Lilly and Company, Sanofi, Abbott, AstraZeneca, Boehringer-Ingelheim. S.Kar: None. A.G.Vianna: Advisory Panel; AstraZeneca, Board Member; Abbott Diabetes, Novo Nordisk, Medtronic, Research Support; Novo Nordisk, Anji Pharmaceuticals, Lilly, Speaker's Bureau; AstraZeneca, Novo Nordisk, Medtronic. T.Vilsbøll: Consultant; AstraZeneca, Boehringer Ingelheim Inc., Gilead Sciences, Inc., Eli Lilly and Company, Mundipharma, Merck & Co., Inc., Novo Nordisk A/S, Sanofi, Sun Pharmaceutical Industries Ltd., Bristol-Myers Squibb Company. S.M.Vinther: Employee; Novo Nordisk. Y.Mu: Speaker's Bureau; Abbott Diabetes, Boehringer Ingelheim Inc., Novo Nordisk (China), Sanifit.

Funding

Novo Nordisk A/S
184-LB: The Effect of Early Screening and Intervention for Gestational Diabetes Mellitus on Pregnancy Outcomes—The TESGO Randomized Controlled Trial
Authors: KUO CHUN-HENG , LIN SHIN-YU , LIN MING-WEI , LEE CHIEN-NAN , CHANG CHIN-HAO , HAN CHANG YU , TAI YI-YUN , CHEN SAIGE , WENG YEN I , FAN KANG-CHIH , HSU CHIH-YAO , HUANG KUAN-YING , HSU WEN-WEI , KANG JESSICA , LI HUNG-YUAN
Published: June 2023

Background: Women with gestational diabetes mellitus (GDM) have excessive fetus growth weeks earlier than the recommended screening period, suggesting that earlier screening and intervention may improve pregnancy outcomes and the health of the offspring. This trial aimed to investigate if early screening and intervention could alter pregnancy outcomes, compared to the standard group.

Methods: We conducted an open-label randomized controlled trial in singleton pregnant women at National Taiwan University Hospital from 2018 to 2021. GDM is diagnosed by 75g 2-hour oral glucose tolerance tests at 18-20 weeks of gestational age for the early-screening group and at 24-28 weeks for the standard-screening group. The diagnostic cutoffs are according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. The primary outcome is a composite measure of pregnancy outcomes, including primary cesarean section, birth weight >90th percentile, neonatal hypoglycemia, cord serum C-peptide >90th percentile, gestational hypertension, preeclampsia and birth trauma.

Results: Total 967 subjects were enrolled, including 483 subjects in the early-screening group and 484 subjects in the standard-screening group. Primary outcome was not statistically different between the two groups (early-screening group, 34.74%; standard-screening group 30.75%, p=0.20). There was also no significant difference in each individual outcome of the primary outcome between two groups except neonatal hypoglycemia, which was significantly higher in the standard-screening group than in the early-screening group (4.14% vs. 1.71%, p=0.0278).

Conclusions: Early screening and intervention of GDM by the one-step method does not improve pregnancy outcomes as compared to standard practice.

Disclosure

C. Kuo: None. S. Lin: None. M. Lin: None. C. Lee: None. C. Chang: None. Y. Chang: None. Y. Tai: None. S. Chen: None. I. Yen: None. K. Fan: None. C. Hsu: None. K. Huang: None. W. Hsu: None. J. Kang: None. H. Li: None.
194-LB: Aggregate Effect of Hemoglobin A1c–Related Genetic Variants on A1c–Glycemia Discordance by Ancestry
Authors: THANGTHAENG NOPPORN , FACIBENE MARIELLA N. , KARTIK SAADHVI , MANDLA RAVI , SCHROEDER PHILIP H. , NORGIL NARA R. , MERCADER JOSEP M. , LEONG AARON
Published: June 2023

Introduction: The aggregate effect of genetic variants reported to lower A1c independently of glycemia by ancestry remains unclear.

Methods: We recalled 177 patients from the Mass General Brigham biobank with genetic data, enriching recruitment for carriers of the African G6PD variant (rs1050828), α thalassemia 3.7kb deletion, and people in the tails of a European polygenic score (PS) composed of variants associated with A1c but not glucose in GWAS. Subjects underwent 14 days of continuous glucose monitoring (CGM). We defined genetic ancestry using principal component analysis, and calculated A1c-glycemia discordance (measured A1c minus estimated A1c by CGM; ADAG study equation).

Results: Measured A1c and mean glucose were correlated in all groups (r2>0.9). Mean A1c-glycemia discordance was 0.4%-unit higher in African vs. European ancestry. In African ancestry, discordance was 0.5%-unit lower in carriers of the G6PD T allele vs. noncarriers. The bottom decile of PS had 0.3%-unit lower discordance vs. top decile (Figure; p<0.01; all comparisons). Discordance was similar regardless of α thalassemia deletion.

Conclusions: While A1c is an excellent proxy for glycemia in all groups, the A1c-glucose relationship differed by genotype and ancestry. Genetic variation should be considered to promote care equity in diverse populations and avoid misestimating glycemia when using A1c in clinical practice.

Disclosure

N. Thangthaeng: None. M. N. Facibene: None. S. Kartik: None. R. Mandla: None. P. H. Schroeder: None. N. R. Norgil: None. J. M. Mercader: None. A. Leong: Other Relationship; Merck & Co., Inc.

Funding

Doris Duke Charitable Foundation (2020096)
202-OR: Automated Cluster Analysis by Machine Learning Reveals Important Dissimilarities in the Immune Phenotype of T1D, MS, and SLE
Authors: PRIETL BARBARA , ANTONIO VERA-RAMOS JOSÉ , PFEIFER VERENA , KHALIL MICHAEL , HERBSTHOFER LAURIN , SOURIJ HARALD , PIEBER THOMAS
Published: June 2023

Background: Dysfunction of the immune cell control and break-down of self-tolerance are important in chronic conditions such as type 1 diabetes (T1D), multiple sclerosis (MS), rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). Investigating common patterns and dissimilarities between these diseases can help identifying new therapeutic intervention strategies for T1D.

Methods: Unsupervised, automated gating and machine learning (ML) was used to identify clusters of immune cell phenotypes in fluorochrome stained PBMCs from patients with T1D (n=70), RA (n=70), SLE (n=50), MS (n=60) and healthy controls (n=70). The pipeline includes unsupervised pre-gating, FlowSOM clustering, and a statistical analysis (MANOVA) to check for significant differential abundances of cell populations among the conditions.

Results: The unsupervised analysis revealed important differences in the immune cell phenotype of peripheral CD4posT cells between the different auto-immune conditions. IL7alpha receptor (CD127) positive T cell clusters, such as CD3hiCD4hiCD15sposCD127hiCD161med cells are significantly decreased in T1D (p<0.001) compared to MS. Clusters of IL7Rpos memory T cells, expressing the co-stimulatory CD28 molecule are significantly increased in T1D (p<0.001) and SLE (p<0.001) compared to MS. Clusters including Treg-like phenotypes are significantly decreased in MS (p<0.001) compared to T1D, SLE and RA.

Discussion: IL-7R (CD127) and its gene polymorphism plays a major role in MS and mediates homeostatic proliferation in T1D. In SLE serum sIL-7R is associated with disease activity. Using unsupervised machine learning we were able to identify interesting clusters of immune cells expressing CD127 that show significantly different abundancies. Learning from immune modifying therapies used in MS and SLE treatment could help to develop new strategies for future T1D (combinational)-therapies targeting IL7/IL7R complexes.

Disclosure

B.Prietl: None. J.Vera-ramos: None. V.Pfeifer: None. M.Khalil: Advisory Panel; Novartis, Biogen, Gilead Sciences, Inc., Merck & Co., Inc., Research Support; Novartis, Biogen, Roche Pharmaceuticals. L.Herbsthofer: None. H.Sourij: Advisory Panel; Amgen Inc., Amryt Pharma Plc, Boehringer Ingelheim Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi, Speaker's Bureau; Boehringer Ingelheim Inc., Novo Nordisk A/S, Bayer Inc., Sanofi. T.Pieber: Advisory Panel; Arecor, Novo Nordisk A/S, Consultant; Lilly, Research Support; AstraZeneca, Novo Nordisk A/S, Sanofi, Speaker's Bureau; Roche Diagnostics.

Funding

JDRF/Lupus Research Alliance/National MS Society Joint RFA (2-SRA-2021-1043-S-B)
204-OR: An Early Immune Signature in Prediabetes Can Predict Progression to Type 2 Diabetes
Authors: BAIG SONIA , NI AUNG NWE , YI LEON HWANG YOU , TAN CRYSTAL , LEE MICHELLE H. , SHU QIN OOI DELICIA , SHABEER MUHAMMED , MAGKOS FAIDON , NIKOLAJCZYK BARBARA , GINHOUX FLORENT , TOH SUE-ANNE
Published: June 2023

Inflammation promotes conversion from metabolically healthy to type 2 diabetes (T2D) in animal models, but convincing demonstrations of this relationship have not been reported in people. We aimed at identifying the cellular and cytokine profile of immune cells, as major sources of inflammation, during progression to T2D. We studied subjects who did or did not convert to T2D in a longitudinal observational cohort study (APT-2D), where drug naïve individuals without T2D at baseline (with normoglycemia or prediabetes) are monitored for disease progression by assessing metabolic function every 6 months for 3 years or until conversion to T2D. Immune cell composition in peripheral blood was studied at baseline and at the point of T2D diagnosis. Correlation analysis was conducted between changes in cell frequency and metabolic parameters: Glycated hemoglobin (HbA1c), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR); fasting insulin (FI); insulin-mediated glucose disposal (M/I); and acute insulin response (AIR). Thirty-two converters aged 49.5 ± 1.6 years with BMI 28.8 ± 0.8 kg/m2 were studied, along with sixty-four non-converters matched for age, gender, and ethnicity. At baseline, our results revealed lower frequencies of classical monocytes and type 2 conventional dendritic cells among converters compared to non-converters, which correlated negatively with HbA1c, HOMA-IR and FI and positively with AIR. At onset of T2D, frequencies of CD8+ and CD4+ naïve T cells, CD19+ B cells, and basophils increased in converters compared to their pre-conversion state and among them CD4+ naïve T cell and CD19+ B cell frequencies correlated negatively with HOMA-IR and FI. Stimulated PBMCs from converters compared to non-converters at baseline produced lower amounts of cytokines (TNFa, IL17A, IL17F, TGFb, IFNg), which did not change after conversion to T2D. Flow cytometric and cytokine profiling thus indicated that changes in immune cell function in prediabetes is linked to T2D conversion.

Disclosure

S.Baig: None. F.Ginhoux: None. S.Toh: None. N.Aung: None. Y.Hwang: None. C.Tan: None. M.H.Lee: None. D.Ooi: None. M.Shabeer: None. F.Magkos: None. B.Nikolajczyk: None.

Funding

National Medical Research Council of Singapore (MOHIAFCat1/0048/2016)
226-OR: Time in Range Is Associated with Incident Diabetic Retinopathy in Adults with Type 1 Diabetes—A Seven-Year Longitudinal Study
Authors: SHAH VIRAL N. , SAKAMOTO CASEY , PYLE LAURA , AKTURK HALIS K. , POLSKY SARIT , FORLENZA GREGORY P. , SNELL-BERGEON JANET K.
Published: June 2023

Introduction: Continuous glucose monitoring (CGM) metrics such as time in range (TIR; 70-180 mg/dL) and their goals have been proposed as new metrics to assess diabetes management. However, longitudinal studies validating TIR with diabetes complications are lacking.

Methods: We analyzed up to 7 years of retrospective longitudinal CGM data of 90 adults with type 1 diabetes (T1D) without a diagnosis of diabetic retinopathy [DR] (Control group) and 70 adults with new incident diagnosis of DR between June 2018-December 2020 but had normal eye examinations in the past (DR group). Associations between DR and CGM metrics were assessed via linear mixed models adjusting for age and diabetes duration.

Results: Baseline characteristics are provided in Figure 1A. A1c was positively associated with development of DR in adults with T1D (Figure 1B). TIR was negatively associated with development of DR (Figure 1C). Time in tight target range (TTIR 70-140 mg/dL) and time above range (TAR>180 mg/dL) were also associated with DR (p<0.001).

Conclusion: CGM metrics such as TIR, TTIR and TAR were associated with development of incidental DR in adults with T1D. To our knowledge, this is the first longitudinal study to demonstrate association between CGM metrics and DR.

Disclosure

V.N.Shah: Advisory Panel; LifeScan Diabetes Institute, Medscape, Consultant; DKSH, Research Support; Novo Nordisk, Tandem Diabetes Care, Inc., Dexcom, Inc., Insulet Corporation, JDRF, National Institutes of Health, Speaker's Bureau; Dexcom, Inc., Insulet Corporation. C.Sakamoto: None. L.Pyle: None. H.K.Akturk: Advisory Panel; Senseonics, MannKind Corporation, Research Support; Medtronic, Tandem Diabetes Care, Inc., Dexcom, Inc., REMD Biotherapeutics, Eli Lilly and Company, IM Therapeutics. S.Polsky: Other Relationship; diaTribe, Research Support; Dexcom, Inc., Medtronic, Hemsley Charitable Trust, JDRF, NIH - National Institutes of Health. G.P.Forlenza: Advisory Panel; Medtronic, Consultant; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Lilly Diabetes, Research Support; Medtronic, Abbott, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. J.K.Snell-bergeon: None.

Funding

JDRF (2-SRA-2021-1069-S-B)