bluuebunny/crossref_metadata_2025 huggingface dataset:
967-P: Evaluation of CV and SD as Glucose Variability Metrics Based on Data from the GOLD and SILVER Trials
Authors: FATULLA PAVEL J. , IMBERG HENRIK , HIRSCH IRL B. , HEISE TIM , LIND MARCUS
Published: June 2023

Objective: Coefficient of variation (CV) and standard deviation (SD) are key metrics of glucose variability (GV) in clinical care and research. We evaluated the adequacy of CV and SD as GV metrics over a wide range of mean blood glucose (MBG) levels in people with (T1D).

Methods: Analyses were performed on data from the randomized clinical GOLD and SILVER trials (n=160). Mixed effects models were used to evaluate the SD in relation to MBG during stable therapy, accounting for subject-specific trends and correlations in repeated measures data.

Results: The SD of blood glucose levels did not increase linearly with MBG level during CGM and blood glucose monitoring (BGM) treatments (both p<0.0001). The lack-of-fit of the constant CV model was most distinct at high glucose levels >12 mmol/L (Fig.). During BGM, a 33% reduction in MBG from 12 to 8 mmol/L was associated with a 20% (95% CI 14.9 to 24.9%) reduction in SD. The treatment effect on MBG-adjusted GV measured by CV was underestimated by 27%, compared to an adjusted analysis accounting for a quadratic relation between SD and MBG.

Conclusion: CV is not an optimal GV measure since SD changes less than the MBG during stable glucose-lowering therapy. A quadratic model adjusting SD to MBG is instead suggested when evaluating glucose-lowering therapies in people with T1D.

Fig. - Association between SD and MBG in the GOLD and SILVER trials during stable glucose-monitoring method CGM/SMBG.

Disclosure

P.J.Fatulla: None. H.Imberg: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc. T.Heise: Advisory Panel; Novo Nordisk, Consultant; Gan & Lee Pharmaceuticals, Research Support; Adocia, AstraZeneca, Biocon, Crinetics Pharmaceuticals, Inc., Eli Lilly and Company, Genova, Novo Nordisk, Sanofi, Zealand Pharma A/S, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. M.Lind: Consultant; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Research Support; Eli Lilly and Company.
969-P: Utilization of Continuous Glucose Monitoring (CGM) among Older Adults with Type 1 Diabetes (T1D)—An Analysis of Real-World Clinical Data
Authors: KAHKOSKA ANNA R. , WEINSTEIN JOSHUA M. , MUTHUKKUMAR RASHMI , YOUNG LAURA A.
Published: June 2023

There is a dearth of data to quantify the utilization of diabetes technology among the growing population of older adults with T1D. We assessed differences in the use of CGM between those receiving endocrine care versus those not. We analyzed electronic health record (EHR) data from a large, public health care system in the southeast US, including 12 affiliated hospitals and over 200 academic and community-based practices. We included data from adults ages 65+ years with T1D in 04/01/2019-2022. We used logistic regression to model the likelihood of using CGM among those who had a visit with endocrinology in the past year versus those who did not. We used entropy balancing weights to create an analytic sample that was balanced on covariates. Our sample included 560 older adults with T1D, comprised of 32% using CGM. Of CGM users, 43% had an endocrinology appointment and 22% did not. Those with endocrine care had higher odds of using CGM compared to those who did not (aOR: 2.38, 95% CI: 1.65, 3.45). In probability terms, those with an endocrinology appointment in the previous year had a 17.8 percentage point (95% CI: 9.9, 25.6) higher probability of using CGM than those who did not (Fig). In a regional sample, we found relatively low CGM utilization and disparities therein across the receipt of endocrine care among older adults with T1D. Limitations include data from one healthcare system only.

Disclosure

A.R.Kahkoska: None. J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim.

Funding

National Institutes of Health (KL2TR002490, UL1TR002489)
97-OR: Antidiabetic TIX100 Improves NAFLD/NASH in Mice With and Without Diabetes and Obesity
Authors: JO SEONGHO , CHEN JUNQIN , JING GU , HABEGGER KIRK M. , SHALEV ANATH
Published: June 2023

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are often associated with diabetes, but are becoming an even bigger world-wide epidemic with over 1 billion people affected. Nevertheless, while some diabetes medications such as glucagon-like peptide 1 and peroxisome proliferator-activated receptor agonists have shown some beneficial effects in the context of NAFLD with diabetes, no approved therapy is currently available for NAFLD/NASH. Interestingly, the new antidiabetic small molecule thioredoxin-interacting protein (Txnip) inhibitor, TIX100, effectively protected obese and diabetic db/db mice against steatosis. TIX100 also significantly reduced the elevated expression levels of lipogenic genes found in db/db livers, many of which have also been shown to be elevated in human NAFLD and are being pursued as potential therapeutic targets. Importantly, the beneficial effects of TIX100 were not due to any weight loss as the severe obesity of the db/db mice was not affected by the treatment. In contrast, TIX100 did demonstrated strong antidiabetic effects and normalized the blood glucose of db/db mice to the levels observed in lean control animals. Therefore, to address the question of whether TIX100 would still be effective in the absence of diabetes, obesity and any genetic leptin-receptor deficiency, we next used a validated choline-deficient, amino acid-defined, high-fat diet to induce NASH. Indeed, compared to control chow, this diet significantly increased plasma liver enzymes indicating liver injury, led to elevated hepatic expression of inflammatory and fibrogenic markers and resulted in clear histological changes, demonstrating lipid accumulation and steatosis as well as pronounced fibrosis and upregulation of liver macrophages. Excitingly, TIX100 treatment blunted or improved all these pathological changes. Thus, TIX100 may not only be effective in diabetes, but may also provide an attractive novel approach for NAFLD/NASH.

Disclosure

S. Jo: None. J. Chen: None. G. Jing: None. K.M. Habegger: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Glyscend Inc. Stock/Shareholder; Glyscend Inc. Research Support; Glyscend Inc. A. Shalev: Other Relationship; TIXiMED.

Funding

National Institutes of Health (R01DK078752); Human Islet Research Network (U01DK120379)
970-P: Effectiveness of Continuous Glucose Monitoring Use for Diabetes Management in an Academic Endocrinology Practice
Authors: GRENNAN KRISTA N. , RIZVI ALI A. , KATHURIA AMITA
Published: June 2023

The achievement of individualized glycemic targets in patients with diabetes is often a significant challenge. Empowering patients with technological tools in the ambulatory setting can pave the way for improved glucose control. We retrospectively examined the records of 94 patients managed in an academic endocrinology practice who were referred for management of diabetes over a 12-month period. Forty-one patients (18 females and 23 males, average age 57.7 years), who had at least two hemoglobin A1c measurements and two 14-day periods of personal continuous glucose monitoring (CGM) data, were included in the analysis. Nine patients had type 1 and 32 patients had type 2 diabetes. Eight patients were not on any insulin therapy, 8 patients were on basal insulin, 18 were using multiple daily insulin injections, and 7 were managed with insulin pump therapy. A multidisciplinary management approach was utilized. The pharmacologic regimen, including both insulin and other medications, was adjusted every 2-4 weeks via in-person visits and remote data upload as necessary. The average A1c was 8.4% at initial visit and 7.1% at the most recent follow-up, a decrease of 1.3% (p=0.0002). Review of CGM data showed that the average time-in-range (70-180 mg/dl) increased from 63.6% at first CGM download to 74.1% at a mean follow-up of 301 days (p=0.0097), while the amount of time in the hyperglycemic range (time-above-range, >180 mg/dl) decreased from 33.5% to 22.1% (p=0.0079). Time-below-range (<70 mg/dl) remained statistically unchanged, signifying no worsening of hypoglycemia. In conclusion, in ambulatory patients with diabetes and suboptimal glucose control, frequent and tailored adjustments in insulin and noninsulin medications aided by CGM use with close follow-up can lead to significant improvement in glycemic control. The latter, if sustained, can translate to fewer complications and greater patient satisfaction in the long-term.

Disclosure

K.N.Grennan: None. A.A.Rizvi: None. A.Kathuria: None.
972-P: Significant Weight Loss among People with Diabetes Despite Using Antidiabetic Medications Associated with Weight Gain after 90-Day Fitterfly Digital Therapeutics Program
Authors: PATANGE SONALI A. , VERMA RITIKA , SELVAN CHITRA , KALRA SANJAY , TIWASKAR MANGESH H. , METHIL VINOD , PATIL BHAGYASHRI V. , MALDE FORUM , NAIR VINEET , JOSHI SHILPA , SINGAL ARBINDER K.
Published: June 2023

Background and Aim: Majority of people with Diabetes (PWD) use insulin and sulfonylurea (SU) as a necessary part of treatment regimen for glycemic control. Weight gain associated with these medications becomes a major challenge in effectively managing diabetes. The study evaluates the real-world effectiveness of the Fitterfly Diabetes program for weight management in PWD using antidiabetic medications associated with weight gain and weight loss.

Methods: Deidentified data of 79 participants (mean age: 45.4 ± 10.4 years, female: 54.4 %) with T2DM enrolled in the program was analyzed. Out of all participants, 28 people used antidiabetic medications associated with weight gain (thiazolidinediones, meglitinides, SU, and insulin) while 51 participants used antidiabetic medications associated with weight loss (biguanides, sodium-glucose cotransporter-2 inhibitors). Participants using medications from both groups or any other antidiabetic medications were excluded. Data has been shown as the median (IQR).

Results: After 90 days, participants using antidiabetic medications associated with weight loss showed reduction in HbA1c, weight, and waist circumference by -0.5 (-1.0, 1.0) %, -3.5 (-6.0, -1.1) kg, -5.0 (-9.0, -1.5) cm from the pre-program baseline of 7.6 (7.1, 8.4) %, 81.0 (68.0, 92.0) kg, and 105.0 (97.0, 110.0) cm respectively (P<0.001 for all). Participants using antidiabetic medications associated with weight gain showed reduction in HbA1c, weight and waist circumference by -1.3 (-2.8, -0.02) %, -2.0 (-3.6, 0.9) kg, -2.0 (-4.7, 0.0) cm from the baseline of 9.6 (8.1, 10.7) %, 73.0 (66.2, 79.4) kg, and 99.0 (92.0, 105.8) cm respectively (P<0.05 for all).

Conclusion: Significant reduction in weight, HbA1c, and anthropometric parameters was observed after 90 days on the program irrespective of the effect of antidiabetic medications on weight. PWD looking to lose weight are good candidates for such programs.

Disclosure

S.A.Patange: None. S.Joshi: Consultant; Fitterfly Health Tech Pvt. Ltd. A.K.Singal: Employee; Fitterfly Healthtech Pvt Ltd. R.Verma: Employee; Fitterfly Healthtech Pvt Ltd. C.Selvan: None. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. M.H.Tiwaskar: None. V.Methil: None. B.V.Patil: None. F.Malde: None. V.Nair: None.

Funding

Fitterfly Healthtech Pvt. Ltd.
973-P: Wearing a Long-Term Implanted Continuous Glucose Monitoring (CGM) System vs. Conventional CGM in Adults with Type 1 Diabetes—The Physical Burden
Authors: ROBINSON LESLEY , OBEYESEKERE VARUNI R. , JONES HANNAH , KONG YEE W. , YI YUAN CHENG , BERTSCH KRISTA , ROUTH TIMOTHY L. , SIMS CATRIONA M. , BUTLER ANTHONY , TAN JASON , MARTHA SANDRA L. , O'NEAL DAVID N.
Published: June 2023

Aim: To compare device tolerance & participant’s subjective experience wearing a surgically implanted long term glucose sensor versus conventional CGM in adults with Type 1 Diabetes.

Method: A prototype CGM (Eclipse 3 sensor, GlySens, San Diego, CA) with masked glucose data transmitted to a study iPhone was surgically inserted superficial to the rectus sheath in 8 Adults with Type 1 Diabetes (4 Female; Mean [SD] Age 56 [7]Y; BMI 25[3]). One daily fingerstick glucose calibration was required. Participants simultaneously wore a conventional TGA approved multi-Day sensor that also transmitted unblinded glucose information to the Study iPhone. The two systems were compared using a standardized 5-point Leichardt scale questionnaire completed by participants at day 1, 7 and 14 post-implantation and monthly thereafter for the duration of study participation.

Results: The investigation and comparator sensors were worn 100% and 98% percent of the time respectively over the study duration. Figure 1 summarizes the participant experience.

Conclusions: Over time there was a general trend by all participants to favour the GlySens sensor and experience over the comparator CGM.

.

Figure 1: Participant experience over 10 months of sensor implantation.

Disclosure

L.Robinson: None. J.Tan: None. S.L.Martha: Employee; GlySens Incorporated. D.N.O'neal: None. V.R.Obeyesekere: None. H.Jones: None. Y.W.Kong: None. C.Yuan: None. K.Bertsch: Employee; GlySens. T.L.Routh: Employee; GlySens Incorporated. C.M.Sims: Stock/Shareholder; Medtronic. A.Butler: Employee; GlySens Incorporated.
978-P: Correlation between Continuous Glucose Monitoring Metrics, Oral Glucose Tolerance Test, and HbA1c in Individuals with Impaired Glucose Tolerance
Authors: CHOW ELAINE , HE JIE , CHU NATURAL , POON EMILY W.M. , CHAN JULIANA C.
Published: June 2023

Aims: Prediabetes is defined by HbA1c, fasting (FPG) and 2-hour plasma glucose (2h-PG) during 75 gram oral glucose test (OGTT) although these values often show poor concordance. Most diabetes prevention trials involved people with impaired glucose tolerance (IGT) diagnosed as 2h-PG 7.8-11.0 mmol/L. Continuous glucose monitoring (CGM) may detect early dysglycemia especially postprandial glucose excursions. We examined correlations amongst HbA1c, FPG, 1-h and 2h-PG during OGTT and CGM metrics in individuals with IGT.

Methods: 85 Chinese with IGT (mean±SD age 57±8 years, 51 (60%) female, BMI 26.6±4.0 kg/m2) participating in a lifestyle modification study had measurement of HbA1c, PG during 75g OGTT and 14-day CGM metrics (Freestyle Libre, Abbott) during a 3-week period at baseline. We examined their correlations using Spearman coefficients.

Results: The mean HbA1c was 5.8±0.3 %, FPG 5.3±0.4 mmol/L, 1h-PG 11.0±1.6 mmol/L and 2h-PG 8.5±1.3 mmol/L. For CGM, the mean glucose management index (GMI) was 5.9±0.2 % and time in tight glycemic range (TITR 3.9-7.8 mmol/L) was 86.7±6.6 %. There was a tendency for HbA1c (r=0.587, p=0.097) to correlate with GMI and negatively with TITR (r=-0.644, p=0.061). The respective correlates between FPG and GMI was r=0.623 (p=0.073) and that between FPG and TITR was r=-0.559 (p=0.118). There was weak correlation between 1h-PG and CGM time above range >7.8 mmol/L (r=0.301, p=0.43). There was no correlation amongst 1h-PG, 2h-PG with HbA1c and other conventional CGM metrics.

Conclusions: In individuals with IGT, HbA1c and FPG showed better correlations with CGM metrics of average glycemia than PG values during OGTT. Future studies are needed to define the use of CGM and appropriate metrics in detection of IGT.

Disclosure

E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. J.He: None. N.Chu: None. E.W.M.Poon: None. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd.

Funding

Health and Medical Research Fund (17180431)
979-P: Glycemic Improvements in CGM-Naïve Patients during SMBG and Implantable CGM Use
Authors: TWEDEN KATHERINE S. , ROMAROWSKI BEN , MDINGI COLLEEN , KAUFMAN FRANCINE R.
Published: June 2023

Background: Multiple pivotal and post market studies have confirmed the safety and accuracy of implantable Eversense CGM Systems. A post market study was initiated to compare Eversense 90-day and 180-day systems to SMBG in CGM naïve patients. Methods: This post market study is a prospective, multicenter, one year comparison of SMBG to Eversense in CGM naïve adults with diabetes in US sites (up to 925 users). After baseline assessment including HbA1c, patients used SMBG for 6 months (phase 1) followed by Eversense for 6 months (phase 2). Sensors were inserted at the start of phase 2. Visits occurred q 90 days to collect SMBG or CGM data and assess adverse events. HbA1c was measured at 6 and 12 months. Glucometrics were calculated in both phases. Enrollment and follow-up visits are ongoing.

Results: In 15 sites, 84 users have completed the study (mean 47.6% male, 90.5% type 2 diabetes, 57.2 years age). In the initial users, reductions in HbA1c were seen in both phases and improvements in glucometrics were observed (Table) with CGM compared to SMBG.

Conclusion: In a CGM naïve population, 6 months of SMBG use reduced HbA1c. There was a further significant reduction after 6 months of using Eversense CGM, as well as significant improvement in glucometrics - an increase in Time in Range (70-180 mg/dL) with no increase Time below Range. These data suggest that Eversense CGM improves glucose management compared to SMBG.

Disclosure

K.S.Tweden: Employee; Senseonics. B.Romarowski: Employee; Senseonics. C.Mdingi: Employee; Senseonics. F.R.Kaufman: Consultant; MannKind Corporation, Twin Health, Stock/Shareholder; Senseonics.
980-P: Quantitatively Integrating Carbohydrate Counting, Insulin (I), and Continuous Glucose Monitoring (CGM)
Authors: MELISH JOHN S.
Published: June 2023

Introduction: Diabetes Care Education Specialists teach patients with insulin requiring Type 1 and 2 diabetes to develop CHO/I ratios to manage mixed diet glucose (G) excursions and improve A1c. and qualitatively examine summary CGM data when available. Conversely, medical scientists have used complex mathematical models, with/without radiolabeled glucose to describe meal-related glucose excursions.

Method: This study bypasses the above complexities as CGM regularly measures interstitial fluid glucose (ISFG) over time. CGM can define an individual’s meal specific G/I ratio as well as define Glucose Clearance (GCL) and Insulin Sensitivity Index (Si}. The approach uses referenced meal carbohydrate information (mg CHO). CGM frames the timing (T = t1 - t0) and amount (I) administered before the timed glucose excursion and return to baseline (t2 - t1). This and an Interstitial fluid (ISF) Volume of Distribution (Vd in dL) = 0.15*kg body weight*10 corrected for blood glucose values defines Timed Insulin Glucose Clearance ((T,I)GCL) = (T,I)Vd/(t2 - t1) and (T,I)Si = (T,I)GCL/I). (ISF) glucose for that meal.: Gisf = dietary glucose (Gd)/1.1. Rate Glucose disappearance from ISF space Gisf/(t2 - t1).

Discussion: The above parameters are patient specific and refer to the insulin related glucose disposal for that meal. They assess the glucose excursion using the timing and amount of insulin as well the inferring effect of the other dietary components, e.g., protein and fat that contribute to T, and t2 - t1. It avoids complicated descriptions of the glucose curve as it begins with glucose input. It includes hepatic glucose uptake and glucose production, as well as insulin resistance as these are reflected in prolonging of t1-t0 and t2 - t1.

Conclusion: CGM has provided the time values for the onset and duration of the meal-related glucose concentration curve. As with Vg, this will assist a patient to develop individualized (I) responses to complex meals using parameters unavailable before CGM.

Disclosure

J.S.Melish: None.
982-P: Effects of Digitization of Self-Monitoring of Blood Glucose Records Using a Mobile Application and the Cloud System on Glycemic Control and Self-Management in Outpatients with Diabetes
Authors: HANDA TOMOKO , ONOUE TAKESHI , KOBAYASHI TOMOKO , MAEDA RYUTARO , ARIMA HIROSHI
Published: June 2023

Objective: In this study, we evaluated the impact of an application-cloud cooperation system with feedback from the attending physician during face-to-face visits on outpatient management of diabetes.

Research Design and Methods: In this multicenter, open-label, single-armed prospective study, 48 patients with diabetes treated with insulin or GLP-1 receptor agonists and performing self-monitoring of blood glucose (SMBG) at three medical centers in Japan used the Smart e-SMBG system, an application-cloud cooperation system, for 24 weeks. The SMBG data were automatically uploaded to the cloud via the application. The patients could check their data, and their attending physicians reviewed the data through the cloud prior to the patients’ regular visits. The primary outcome was changes in HbA1c levels.

Results: While HbA1c levels did not change significantly in total patients, it significantly decreased at 12 weeks in 21 patients whose antidiabetic medication had not been adjusted during the intervention period (−0.26%, 95% confidence interval [CI], −0.47 to −0.05; p = 0.018). The frequency of SMBG was increased significantly at 12 weeks (+0.60/day, 95%CI, 0.19-1.00; p = 0.002) and 24 weeks (+0.43/day, 95%CI, 0.02-0.84; p = 0.039) compared to that before inducing the system. The Diabetes Treatment Satisfaction Questionnaire total score and “Q4; convenience” and “Q5; flexibility” scores significantly improved after using the Smart e-SMBG system, and 71.7% patients and 76.1% physicians reported that the Smart e-SMBG system helped them adjust insulin doses.

Conclusions: Digitization of SMBG records and sharing of the results with attending physicians during face-to-face visits improved glycemic control and self-management in patients with diabetes.

Disclosure

T.Handa: None. T.Onoue: None. T.Kobayashi: None. R.Maeda: None. H.Arima: None.
993-P: Changes in Medical Expenditures and Out-of-Pocket Costs in Medicare Beneficiaries with Diabetes during the COVID-19 Pandemic
Authors: WANG YU , ZHANG PING , ZHOU XILIN , ROLKA DEBORAH B. , IMPERATORE GIUSEPPINA
Published: June 2023

How COVID-19 has affected payers and persons with diabetes mellitus (DM) is not well understood. We compared total and per capita medical expenditures and out-of-pocket (OOP) costs during and before the pandemic periods among Medicare beneficiaries with DM. We used data from all Medicare fee-for-service claims from 03/2019 to 02/2022. We identified 9,376,546 persons with DM using International Classification of Diseases codes. We calculated quarterly population total, per capita total, per capita OOP cost, and then per capita expenditure by service type. Changes in expenditure were calculated as the difference in the same quarter between the pandemic (03/2020~02/2022) and the pre-pandemic (03/2019~02/2020) periods. Population total and total per capita expenditure decreased sharply during the first few months of the pandemic (Figure). Population total expenditure had not returned to the pre-pandemic level while per capita total expenditure reached a higher than the pre-pandemic level by 02/2022. Changes in OOP costs had a similar pattern as the changes in total per capita expenditure, however, OOP costs in the pandemic were lower than the pre-pandemic level during the entire study period. Changes in per capita expenditure varied by service type. COVID-19 had different effects on total and per capita expenditure overall and by service type in Medicare beneficiaries with DM.

Disclosure

Y.Wang: None. P.Zhang: None. X.Zhou: None. D.B.Rolka: None. G.Imperatore: None.
996-P: Cost-Effectiveness of Sugar-Sweetened Beverage Tax Policies in California—A Microsimulation Study
Authors: CHEN YU , IMPERATORE GIUSEPPINA , ROLKA DEBORAH B. , ALLAIRE BENJAMIN T. , ONUFRAK STEPHEN J. , HOLLIDAY CHRISTOPHER S. , ZHANG PING
Published: June 2023

Sugar-sweetened beverage (SSB) consumption is associated with increased risk of diabetes and cardiovascular diseases. In California, state-wide SSB taxes were proposed to reduce its consumption. We projected the health and economic consequence of imposing a state-wide SSB excise tax of $0.01/ounce over 10 years in California, using the Microsimulation of Nutrition, Diabetes and Cardiovascular Disease (MONDAC) developed by Centers for Disease Control and Prevention and RTI International. The MONDAC model is a validated microsimulation model to track user-defined dietary changes on downstream outcomes: body-mass index, diabetes incidence, cardiovascular disease (CVD) incidence, all-cause mortality, quality-adjusted life-years (QALYs), direct medical costs, and cost-effectiveness. We generated a California representative sample aged ≥ 18 years based on data from the 2011-2014 National Health and Nutrition Examination Survey and 2018 census. Data on reduction of the SSB consumption (by 20%) and program’s costs resulting from the $0.01/ounce SSB taxes were from published literature. We found that imposing a $0.01-per-ounce excise SSB tax in California would reduce diabetes, CVD, deaths and healthcare costs but increase QALYs, thus this policy would be cost-saving (Table).

Disclosure

Y.Chen: None. G.Imperatore: None. D.B.Rolka: None. B.T.Allaire: None. S.J.Onufrak: None. C.S.Holliday: None. P.Zhang: None.
997-P: Social Risk Domains and Emergency Room Visits among Adults with Diabetes and Low Income
Authors: WILLIAMS JONI S. , XU YILIN , BHANDARI SANJAY , OZIEH MUKOSO N. , AKINBOBOYE OLAITAN J. , EGEDE LEONARD E.
Published: June 2023

Background: In the U.S., more than 34 million adults ≥18 years of age are estimated to have diabetes. Adults with low-income levels are disproportionately impacted. Adverse social conditions associated with poor health, or social risk factors, contribute to poorer access to care, lower quality of care, and worsened clinical outcomes among these adults. The objective of this study was to assess the relationship between social risk domains and hospital utilization among adults with diabetes and low income.

Methods: Data of 5,077 adults with diabetes and income <$50,000 or receiving income or assistance from welfare programs or disability insurance (weighted sample = 41,735,609) from the National Health Interview Survey (NHIS) were analyzed. The outcomes were “Have visited the Emergency Room (ER) about own health in past 12 months (yes/no)”, and “Number of times visited ER in past 12 months”. The independent variables were five social risk domains (economic instability, neighborhood and built environment, education access, food insecurity, social and community context). Covariates included age, sex, race/ethnicity, insurance, marital status, employment, comorbidity, region. Logistic regression models were used to assess the independent association between each outcome and each social risk domain.

Results: In the fully adjusted model, adults with social and community context risks had a 76% higher risk of visiting the emergency room for their own health in the past 12 months. Also, for each unit increase in the number of times an adult visited the emergency room, there was a significant association with economic instability (βeta (β) coefficient=0.39, (95% CI 0.14, 0.64)), food insecurity (β=0.31, (95% CI 0.13, 0.50)), and social/community risk (β=0.54, (95% CI 0.38, 0.70)).

Conclusions: These findings suggest the need for mitigating the influence of social and community factors, economic instability, and food insecurity among adults with diabetes and low income to reduce ER visits.

Disclosure

J.S.Williams: None. Y.Xu: None. S.Bhandari: None. M.N.Ozieh: None. O.J.Akinboboye: None. L.E.Egede: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861, R21DK123720)
Metformin for treatment of acute COVID-19: systematic review of clinical trial data against SARS-CoV-2
Authors: Erickson Spencer M. , Fenno Sarah L. , Barzilai Nir , Kuchel George , Bartley Jenna M. , Justice Jamie Nicole , B. Buse John , Bramante Carolyn T.
Published: June 2023

  

Objective: Observational and preclinical data suggest metformin may prevent severe COVID-19 outcomes. We conducted a systematic review of randomized, placebo-controlled clinical trials of metformin treatment for COVID-19 to determine whether metformin affects clinical or laboratory outcomes in individuals infected with SARS-CoV-2 and a structured summary of pre-clinical data.

Research Design and Methods: Two independent reviewers searched PubMed, Scopus, Cochrane Covid-19 Study Register, and ClinicalTrials.gov on February 1, 2023 with no date restrictions for trials which randomized adults with COVID-19 to metformin versus control and assessed clinical and/or laboratory outcomes of interest. The Cochrane Risk of Bias 2 tool was used to assess bias. The synthesis plan was developed a priori and was guided by SWiM guidelines. Summary tables and narrative synthesis were used. (PROSPERO 2022 CRD42022349896)

Results: Three randomized trials met inclusion criteria. Two of the trials found metformin improved clinical outcomes (prevented need for oxygen; and prevented need for acute healthcare use), and the third trial enrolled a larger portion of adults with diabetes but did show a direction of benefit similar to the other trials in the per-protocol group. The largest trial enrolled during the delta and omicron waves and included vaccinated individuals. The certainty of evidence that metformin prevents healthcare utilization due to COVID-19 was moderate per GRADE criteria. Many preclinical studies have found metformin to be effective against SARS-CoV-2. Limitations include inclusion of only three trials and heterogeneity between trials. 

Conclusions: Future trials will help define the role of metformin in COVID-19 treatment guidelines.
UPAYA PENINGKATAN HASIL BELAJAR PESERTA DIDIK DENGAN MODEL PEMBELAJARAN SMALL GROUP DISCUSSION BERBANTU MEDIA POWERPOINT INTERAKTIF PADA MATA PELAJARAN IPAS KELAS IV SDN TAPEN 2
Authors: Saputra Rifky Ericko , Suciptaningsih Oktaviani Adhi , Hindrayati Nurul
Published: June 2023

This study aims to describe the application of learning and improving science learning outcomes with the Small Group Discussion learning model assisted by interactive Powerpoint media in fourth grade students at SDN Tapen 2. This study used a class action research design consisting of 2 cycles. The research subjects were fourth grade students, totaling 17 students. Data collection instruments were carried out using observation techniques, documentation, and tests. Qualitative data analysis was carried out with the stages of data presentation, data reduction, data presentation and drawing conclusions. The results showed that the application of the Small Group Discussion model by teachers in cycle I was 80% and in cycle II the average increased to 91%. Student activity in process I obtained an average of 86% increasing to 92% in cycle II and classical completeness learning outcomes in cycle I obtained 59% with an average learning result of 76, experienced an increase in cycle II, namely 82% with an average score the average learning outcome is 81. So the conclusions obtained from the research results of applying the Small Group Discussion learning model assisted by interactive Powerpoint media can improve science learning outcomes in fourth grade students at SDN Tapen 2.
UPAYA MENINGKATKAN HASIL BELAJAR SISWA PADA MATA PELAJARAN IPAS MATERI “BAGAIMANA MENDAPATKAN SEMUA KEPERLUAN KITA” DENGAN MODEL PEMBELAJARAN PROJECT BASED LEARNING DI KELAS IV SDN POJOK KECAMATAN KAWEDANAN
Authors: Muniroh Afidatul , Wati Trilinggo
Published: June 2023

Penelitian ini dilakukan untuk mengetahui pengaruh metode pembelajaran mind mapping terhadap pemahaman konsep pembelajaran IPA siswa kelas V SDI Wahid Hasyim Sidoarjo. Berdasarkan hasil pengamatan dan observasi yang dilakukan pada siswa kelas V, rendahnya pemahaman konsep pembelajaran tematik khususnya pada muatan pembelajaran IPA. Metode pembelajaran mind mapping merupakan salah satu metode yang didalamnya berisi konten kreatif terkait gambar, symbol, warna dan garis garis yang menghubungkan sehingga terbentuknya sebuah pemetaan konsep materi pembelajaran yang mampu meningkatkan daya tarik individu dalam proses belajar. Penelitian ini merupakan penelitian eksperimen dengan menggunakan desain One Group Pretest Postest Design. Populasi dalam penelitian ini adalah siswa SDI Wahid Hasyim Sidoarjo dengan menggunakan sampel kelas V sebanyak 30 siswa yang diperoleh dengan menggunakan teknik probability sampling yang mengambil sampel secara acak. Teknik analisis data menggunakan statistik deskriptif meliputi uji validitas, reabilitas, normalitas dan homogenitas. Pengujian hipotesis menggunakan uji T-paired. Hasil pengujian hipotesis dengan menggunakan uji-t menghasilkan nilai sig sebesar 0,000. Untuk melihat nilai signifikansi hasil uji T-paired dapat diketahui dengan melalui nilai Sig yang kurang dari 5%. Karena nilai sig 0,000 < 0,05 maka H1 ditolak. Berdasarkan analisis yang dilakukan, dapat disimpulkan bahwa terdapat pengaruh metode pembelajaran mind mapping terhadap pemahaman konsep pembelajaran IPA siswa kelas V Sekolah Dasar.
ANALISIS ETNOMATEMATIK DALAM PERMAINAN CONGKLAK SEBAGAI MEDIA PEMBELAJARAN BANGUN DATAR DAN BANGUN RUANG DI SEKOLAH DASAR
Authors: Jannah Ma'rifatul , Suryandari Kus , Nurjanah Siti , Muhtadin Lastiadi , Maftuhah Hidayati Yulia , Desstya Anatri
Published: June 2023

Learning models, learning media, ethnomathematics studies in mathematics learning and others. So that this research complements previous research, this study analyzes the ethnomathematic elements in the congklak game as a medium used in conveying mathematics learning. The congklak game is a regional game that is usually done in pairs using a congklak board and the seeds are divided equally into each hole on the congklak board. This study aims to analyze the ethnomathematics concepts in the congklak game by integrating the geometric concepts, namely flat shapes and geometric shapes. This type of research is qualitative by describing the process of the game, the tools and materials used, the system for determining the winner, and the shape of the congklak board. The subjects of this study were grade 2 at SD Negeri Menuran 01, Baki, Sukoharjo. This study uses data collection techniques with interviews, documentation and observation. The analysis technique used is the triangulation technique on the data that has been obtained. The results of this study are: (1). Knowing the ethnomathematic elements in the congklak game, (2). Identifying the use of the congklak game as a medium for learning mathematics, and (3). Analyzing the relationship between the congklak game and the learning of flat shapes and geometric shapes in elementary schools. This research can be refined by further research by completing research studies.
The Impact of E-Learning on Student Interest during the Covid-19 Pandemic
Authors: Mudjijanti Fransisca , Srimulyani Veronika Agustini
Published: June 2023

E-learning is an alternative method of learning that can be applied during the Covid-19 pandemic. One advantage of online learning (e-learning) is that students will get more sources of reading/references. E-learning encourages students to learn actively and autonomously during online classes. Students accept many assignments, and there are many limitations in the online learning process. When a student experiences monotony in the teaching and learning process, it will result in a setback in learning outcomes; even students become no longer interested in attending lectures. Few students feel bored with online learning; this impacts student enthusiasm in learning which tends to decline compared to direct learning. The aim of this study is to obtain information about the description of student interest in learning during the pandemic, and to find out whether online learning is affected during the Covid-19 pandemic, student interest at Widya Mandala Surabaya Catholic University (WMSCU) Madiun City Campus. This research uses an exposed facto quantitative research approach. The research population of WMSCU Madiun City Campus students who took online learning in the even semester of 2021/2022 amounted to 661. The research sample consisted of 192 people who were determined based on the Isaac and Michael table with a confidence level of 10%. The instrument of data collection was questionnaire. Data analysis method was simple linear regression. The results showed that student interest in learning during the pandemic was 1% in the low category, 35% in the moderately high category, and 64% in the high category. The hypothesis “E-learning has a strong positive effect on student interest in WMSCU Campus Madiun City” is accepted because of the value of Sig. < 0.05. The results of this study indicate that the impact of e-learning on student interest in learning at WMSCU Madiun City Campus is 42.9%.
Brecha oferta-demanda de prestaciones en el control de la enfermedad renal crónica en EsSalud
Authors: Zanabria Calderón José
Published: June 2023

La Enfermedad Renal Crónica (ERC) es un problema de salud pública. EsSalud tiene aproximadamente 10,800 pacientes en diálisis, invirtiendo unos US $ 12,000 dólares por paciente al año, sin considerar el manejo de complicaciones. El objetivo general del estudio ha sido estimar la brecha oferta/demanda de prestaciones preventivas y recuperativas en el control de la ERC en EsSalud y los objetivos específicos fueron: 1. Estimar la distribución de los estadios de la ERC. 2. Estimar la brecha oferta demanda de prestaciones preventivas y recuperativas en su control y; 3. Estimar el gasto institucional en su manejo. Es un estudio observacional, descriptivo, transversal y correlacional de pacientes de EsSalud con diagnóstico de ERC, Hipertensión Arterial, Diabetes y mayores de 55 años de edad. Los principales resultados fueron: La población en riesgo de ERC llegó a 4’839,065 personas y se estiman 836,838 con la enfermedad. La prevalencia estimada de ERC en diálisis alcanzó el 0.099% y la distribución de la ERC aplicando los resultados del estudio NHANES III de USA, por estadios sería: 1: 3,3%; 2: 3,0%; 3: 4,34%; 4: 0,2% y 5: 0,1%; la brecha oferta/demanda de prestaciones preventivas de la ERC para el 2017 fue negativa; la brecha oferta/demanda de prestaciones recuperativas fue positiva para hemodiálisis y negativa para diálisis peritoneal mientras que el gasto institucional anual en el manejo de la ERC alcanzó S/. 400.8 millones representando el 3.95% del presupuesto. Se concluye que es necesario incrementar los esfuerzos por la prevención y manejo de la enfermedad.
Ritual Penti di Tanah Diaspora: Komunitas Manggarai di Kalimantan Barat
Authors: Sunarti Felomena
Published: June 2023

In order to unite the Manggarai people in West Kalimantan, the Manggarai community leaders on behalf of the “Manggarai people” invited all Manggarai people to discuss the Penti ritual. The meeting resulted in an agreement to hold the Penti ritual. They received support from the Dayak Mualang community, so that the ritual could be carried out. This study describes the similarities and differences of the Penti rituals practiced in Flores and in West Kalimantan. The Penti ritual is held as a form of gratitude for the Manggarai people to God (Mori Keraeng) and their ancestors for their success abroad. The methodology used in this study is the ethnographic imagination methodology introduced by Paul Willis. Concepts used in the analysis of this study are the concepts of crossing and dwelling from Thomas A. Tweed and of liminality and communitas from Victor Turner. This study shows that the Penti ritual practiced by Manggarai people living outside their West Kalimantan hometowns contains important aspects, namely giving thanks to Mori Keraeng (God) and ancestors, fostering family relationships, and introducing the ritual to the younger generation of Manggarai in West Kalimantan.
Orang-Orang Neurosis Obsesif yang Menghayati Hidup di Antara Dua Alam: Dunia Real Sehari-hari dan Dunia Virtual Artifisial Game
Authors: Nugroho Yohanes Padmo Adi
Published: June 2023

Games are an ever-interesting cultural phenomenon whose development has been very rapid. Now, there are offline games, online games, arcade games, multiplayer games, etc. Games cater to all ages, and now there are even offline games for toddlers. Meanwhile, there are also more and more genres of online games. Some utilize Virtual Reality, while others even bring virtuality into everyday reality, namely, Augmented Reality. Some of the most popular Augmented Reality games are Ingress, Pokémon Go and Mobbles. Such games, with virtual missions/quests elements in their gameplay, encourage players to go out of the house to adventure in the real world and to meet real people. This study aims to examine the players (subjects) of the Augmented Reality game Mobbles. Mobbles is an Augmented Reality game that was first released in 2012 and was very popular between 2013 and 2016. This is quite a long period of popularity for an online game that was developed DIY by a group of friends from the United States. Of course, as the work of “MSMEs”, in 2016 Mobbles lost its popularity to another game that carried a similar theme but was supported by much greater capital power, namely Pokémon Go. Even so, until 2019, people who are members of Mobbles communities continued to play it, and had even established “friendship communication” with the game’s developers. That is what makes Mobbles particularly interesting. This research uses the theory of subject formation from Lacanian psychoanalysis, especially the concept of the Borromean Knot (RSI). This research examines the activities of a group of players who are members of Mobbles communities, especially from 2014 to 2017. The approach and data search method used is (auto-)ethnography with direct participatory observation. The results obtained from this study are that the gamer subjects are subjects of Obsessive Neurosis. It shall be suggested that from this analysis of Augmented Reality, we can further see and critique the smartphone applications that help us so much that they have become an integral part of our daily lives.
Small-scale Waste Heat Recovery through incineration – a brief review
Authors: Bruno Eduardo Piske  , Fernanda Lopes  , Jonathan Utzig  , Vinicyus Rodolfo Wiggers
Published: June 2023

This paper brings a brief discussion about small-scale waste to energyunits, specificallyusing incineration. Solid waste treatment is an important issue around the world. Incineration has been applied successfullyin developed countries. In the south hemisphere landfills and dumps are still predominant.This study aims to show that there is a lack of small-scalewaste-to-energy(WtE) incineration plantsand one of the reasons is associated withthe high cost of the installations. The review performed showed that Organic Rankine Cycle (ORC) has been applied in small-scale plants as atentative to reduce costs related to infrastructure required for electrical energy production. The airpollution controlprocess also has a huge impact onthis kind of installation.The lackof data and information about the operation of these plants turndifficult the study. Public policies to encourage small-scale waste energy recoveryare required to improve these techniques, especiallyin developing countries.
Energy Flows Optimization in a Renewable Energy Community with Storage Systems Integration
Authors: I. Araújo  , A. Cerveira  , A. Cerveira  , J. Baptista
Published: June 2023

Currently, there is increasing implementation of renewable energy communities, where consumers and producers come together to form energy cooperatives. This growing trend has been accompanied by several studies aiming to optimize energy exchanges and sharing inside the community, always taking into account the most favorable tariff regimes for community members. This paper presents an analysis that, based on applying a linear programming model, optimizes energy transactions in a renewable energy community with the integration of storage systems. The results show the developed model's effectiveness, presenting substantial profits for the community.
Evaluation of the generation and protection capabilities of a grid-connected microgrid
Authors: J. García  , J. Rey  , G. Osma
Published: June 2023

Microgrids have been recognized for benefits to the electrical system such as improved reliability and reduced trans-mission costs and pollutant emissions. The study of microgrids makes it necessary to know and quantify the performance of tech-nical aspects and identify characteristics to improve their perfor-mance. The paperproposes to evaluate the performance of gener-ation and protection of a microgrid connected to the grid based on a procedure that includes the definition of indicators, the use of Power Factory software to obtain results and the weighting of in-dicators based on the DEMATEL technique. The laboratory mi-crogrid studied is located at the Universidad Industrial de Santan-derand has three 1.5 kW photovoltaic systems and meets de-mands of 5 and 10 kWh/day. The results show that its generation and protection capacities have a high performance.
Market Design for Cross-Border Co-Optimised Energy-Reserve Allocation
Authors: I. Vokony  , P. Sőrés  , B. Németh  , B. Hartmann
Published: June 2023

To achieve its energy goals, the European Union (EU) needs to establish a geographically large market by initially improving its cross-border electricity interconnections. The Hungarian project focuses on this topic. A geographically large market, based on imports and exports of electricity, could increase the level of competition, boost the EU’s security of electricity supply through creating alternative routes to the customers and integrate more renewables into energy markets. Electricity should, as far as possible, flow between Member States as easily as it currently flows within Member States, in order to increase sustainability potential and real competition, as well as to drive economic efficiency of the energy system. To this end, Facilitating Regional CROSS-border Electricity Transmission (FARCROSS) aims to address this challenge by connecting major stakeholders of the energy value chain and demonstrating integrated hardware and software solutions that will facilitate the “unlocking” of the resources for the cross-border electricity flows and regional cooperation. The targets of the project are to optimise the usage of the available cross-border capacity for reserve procurement while transitioning from ATC to Flow-based mechanism, to achieve simultaneous interconnector reservation for energy and balancing capacity to enable reserve market coupling and to create state-of-art technologies to materialise market coupling platforms.