bluuebunny/crossref_metadata_2025 huggingface dataset:
846-P: Risk of Anaphylaxis among New Users of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs)
Authors: ANTHONY MARY S. , DJEBARRI LEILA , BEACHLER DANIEL C. , ARODA VANITA R. , CALINGAERT BRIAN , PAN CHUNSHEN , CROWE CHRISTOPHER , LANES STEPHAN , ROTHMAN KENNETH J. , SALTUS CATHERINE W. , BERREGHIS SOFIA , PARLETT LAUREN E. , BOCAGE CLAIRE , WALSH KATHLEEN E. , JUHAERI JUHAERI , JOHANNES CATHERINE
Published: June 2023

GLP-1 RAs are peptides used to treat patients with T2D. Anaphylaxis has been observed with these treatments, and in the lixisenatide development program, more cases of anaphylaxis were reported for lixisenatide than placebo (0.2% vs 0.1%). The aim was to assess anaphylaxis incidence rates (IRs) among patients with T2D initiating GLP-1 RAs, with a focus on lixisenatide. We conducted a cohort study in 3 large US claims databases using data from 2017-2021. We included new users of GLP-1 RAs with T2D aged ≥18 years and enrolled ≥6 months in the database before GLP-1 RA initiation (start of follow-up). Medications included were: lixisenatide and insulin glargine/lixisenatide, exenatide, liraglutide and insulin degludec/liraglutide, dulaglutide, and semaglutide. We identified the first anaphylaxis event during follow-up using a validated algorithm. We report anaphylaxis crude IRs and 95% confidence intervals (CIs) for each medication cohort, pooled across data sources. There were 696,089 new users with 456,612 person-years (p-y) of exposure to GLP-1 RAs. Baseline characteristics (demographics, medications, medical conditions) were similar across the medication cohorts. IRs ranged from 1.0 (lixisenatide) to 6.0 (exenatide) per 10,000 p-y with wide 95% confidence intervals (Figure). Anaphylaxis is rare with GLP-1 RA treatments. Lixisenatide is unlikely to confer higher risk of anaphylaxis than other GLP-1 RAs.

Disclosure

M.S.Anthony: Other Relationship; Sanofi. C.W.Saltus: Other Relationship; Sanofi. S.Berreghis: Employee; Sanofi. L.E.Parlett: Employee; HealthCore Inc., Research Support; Sanofi. C.Bocage: Employee; Anthem, Inc, Stock/Shareholder; Anthem, Inc. K.E.Walsh: Consultant; Sanofi. J.Juhaeri: Employee; Sanofi. C.Johannes: Other Relationship; Sanofi-Aventis U.S. L.Djebarri: Employee; Sanofi. D.C.Beachler: Employee; Anthem, Inc, HealthCore Inc. V.R.Aroda: Consultant; Applied Therapeutics Inc., Fractyl Health, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Other Relationship; Janssen Pharmaceuticals, Inc., Research Support; Applied Therapeutics Inc., Eli Lilly and Company, Fractyl Health, Inc., Novo Nordisk, Sanofi. B.Calingaert: Other Relationship; Sanofi. C.Pan: None. C.Crowe: Employee; HealthCore Inc. S.Lanes: None. K.J.Rothman: None.
855-P: Evolution of KT-A112, an AAV-Mediated Gene Therapy for the Treatment of Type 1 Diabetes
Authors: SMITH CHARI , HARRINGTON WILLIAM W. , STONE MICHELE , KARADGE UMA , LIU JIEWU , QUINN WILLIAM J. , BASSIRI ASHLYN , MALLORY JASON , JIMENEZ VERONICA , BOSCH FATIMA , RHODES MELISSA
Published: June 2023

Type 1 Diabetes (T1D) is a chronic, life-threatening autoimmune disorder characterized by profound insulin deficiency that results from progressive destruction of insulin-producing pancreatic β-cells. For over a century, exogenous insulin delivery was the only option to help T1D patients manage persistent hyperglycemia and reduce the risk of severe microvascular and macrovascular complications. Recent exploratory treatments use complex cell-based therapies requiring long-term immunosuppression. This abstract describes a unique AAV-mediated gene therapy approach to drive skeletal muscle expression of human glucokinase (GcK) and human insulin (INS). One-time IM administration to the quadriceps, gastrocnemius and tibialis anterior muscles of STZ-induced diabetic mice resulted in dose-related increases of pharmacologically active INS at fasting levels (~1 ng/mL) and human C-peptide that decreased fed and fasted blood glucose, lowered HbA1c by >5% at the highest dose, and reduced AUCGlu upon oral glucose challenge. Elevated triglycerides seen in control STZ-treated animals were normalized. No hypoglycemia or other adverse effects were observed through 8 weeks. No immunosuppression was required. Next steps in evaluation of KT-A112 involve a rolling dose-escalation study in STZ-treated NHPs.

Disclosure

C.Smith: Consultant; Horizon Therapeutics plc, Employee; Kriya Therapeutics. F.Bosch: None. M.Rhodes: None. W.W.Harrington: Consultant; Kriya Therapeutics. M.Stone: None. U.Karadge: None. J.Liu: None. W.J.Quinn: Employee; Kriya Therapeutics. A.Bassiri: None. J.Mallory: Employee; Kriya Therapeutics. V.Jimenez: None.
857-P: Quiescence Recovers Adipose Tissue–Derived Stromal Cells from Senescence-Associated Secretory Phenotype, Leading to Enhanced Angiogenesis and Diabetic Wound Healing
Authors: FUNAKI MAKOTO , HATA AKIKO , YOSHIDA MITSUTERU , MIYAMOTO NAOKI , IKUTA TAKAHISA , UEMURA YUTA , AKIZUKI MINATO , TANGOKU AKIRA , YUMOTO HIROMICHI , OGAWA HIROHISA , OYA TAKESHI
Published: June 2023

Although a number of studies have shown that mesenchymal stem cells (MSCs) promote diabetic wound healing, their clinical applications are still limited. One of the reasons is that MSCs exhibit a senescence-associated secretory phenotype (SASP) in diabetes, which results in attenuation of their anti-inflammatory functions. We previously reported that adipose tissue-derived stromal cells (ADSCs), one type of MSCs used in multiple clinical trials, are able to exhibit their anti-inflammatory functions when they become quiescent in gels with a stiffness mimicking that of adipose tissue. We also showed that transplants containing quiescent ADSCs enhanced diabetic wound healing more than those containing non-quiescent ADSCs. Here, we investigated the effect of inducing quiescence in ADSCs on their angiogenic functions in a high glucose environment both in vitro and in vivo. High glucose-induced attenuated migration and tubular formation of HUVECs, an endothelial cell line, were ameliorated more significantly by conditioned medium from quiescent ADSCs cultured under high glucose than by that from non-quiescent ADSCs cultured under high glucose. Furthermore, ADSCs cultured at a high glucose level in vitro enhanced angiogenesis and wound healing in STZ-induced diabetic mice similarly to ADSCs cultured at a normal glucose level in vitro, when they were made quiescent in gels and subcutaneously injected into the mice. These results suggest that quiescence restores ADSCs from SASP and enhances angiogenesis even under diabetic conditions, which may be crucial for MSC-based cell therapies against diabetic microangiopathy.

Disclosure

M.Funaki: Board Member; Mechanogenic, Inc. H.Ogawa: None. T.Oya: None. A.Hata: None. M.Yoshida: None. N.Miyamoto: None. T.Ikuta: None. Y.Uemura: None. M.Akizuki: None. A.Tangoku: None. H.Yumoto: None.
868-P: Empagliflozin (EMPA) Improves Vascular Insulin Sensitivity and Enhances Skeletal and Cardiac Muscle Microvascular Perfusion in Persons with Type 2 Diabetes
Authors: JAHN LINDA , HARTLINE LEE , AYLOR KEVIN W. , HORTON WILLIAM B. , BARRETT EUGENE
Published: June 2023

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) decreased cardiac events in large clinical trials; however, an understanding of the physiology driving this benefit is lacking. To investigate this, we measured micro- and macrovascular insulin sensitivity in 10 adults with T2DM before and after 12 weeks of EMPA 10 mg daily. We also measured endothelial function (FMD), peripheral and central aortic pressures, and skeletal (SM) and cardiac (CM) muscle microvascular perfusion (MBV- microvascular blood volume; MFV-microvascular flow velocity; MBF-microvascular blood flow) before and during a 120 min euglycemic insulin clamp at weeks 0 and 12. We hypothesized that EMPA would diminish micro- and macro-vascular insulin resistance and improve vascular function. At week 0, insulin infusion lowered peripheral SBP (132±6 vs 125±5, p<0.05) but diminished SM perfusion MBV (1.75±0.2 vs 1.29±0.1, p<0.01) MFV (0.08±0.01 vs 0.05±0.01, p<0.001) and MBF (0.14±3 vs 0.07±0.01, p<0.01). After 12 weeks of EMPA, insulin infusion improved FMD (7.6 ± 1.2 vs 8.7 ±1.6%, p <0.03), lowered peripheral SBP (127±6 vs 107±5, p<0.001); DBP (74±4 vs 65±3, p<0.04); MAP (92±3 vs 79±3, p<0.01); and PP (53±5 vs 42±3, p<0.05) as well as aortic SBP (117±5 vs 96±4, p<0.001); DBP (75±4 vs 66±3, p<0.03); MAP (89±3 vs 76±3, p<0.01); and PP (43±4 vs 30±2, p<0.01). In addition, EMPA improved SM perfusion (MBV: 1.29±0.1 vs 2.02±0.3, p<0.02; MFV: 0.05±0.01 vs 0.08±0.01, p<0.02; MBF: 0.07±0.01 vs 0.18±0.04, p<0.03) and CM perfusion (MBV: 4.51±0.6 vs 5.11±0.4, p=0.18; MFV: 0.37±0.04 vs 0.52±0.06, p<0.05; MBF: 1.80±0.4 vs 2.74±0.5, p<0.05). In conclusion, 12 weeks of EMPA in adults with T2D improved endothelial function (FMD), reduced central and peripheral blood pressures, and augmented SM and CM microvascular perfusion in response to insulin. These changes may contribute to the improved CV outcomes seen with SGLT2i therapy.

Disclosure

L.Jahn: None. L.Hartline: None. K.W.Aylor: None. W.B.Horton: None. E.Barrett: None.

Funding

National Institutes of Health (1R01HL142250-01A1)
87-OR: Engineered Vasculature Induces Functional Maturation of Pluripotent Stem Cell–Derived Islet Organoids
Authors: NGUYEN-NGOC KIM-VY
Published: June 2023

Blood vessels play a critical role in islet health and function. Native islets are richly vascularized and their interaction with blood vessels is important for β-cell function. Therefore, vasculature ought to be an integral component of a model for studying human islet physiology and diabetes pathobiology. Here, we develop a vascularized islet organoid model by integrating hPSC-derived islets (SC-islets) with human endothelial cells (ECs) and fibroblasts (FBs). To analyze β-cell function, we generated an hPSC line carrying GCaMP6f, a Ca2+ reporter, as Ca2+ oscillation can be used as a proxy for insulin secretion. Comparing β-cell Ca2+ responses of non-vascularized and vascularized SC-islets revealed more frequent and stronger Ca2+ influx in response to high glucose and the GLP-1 analogue in vascularized SC-islets. To identify vasculature-derived signals beneficial to β-cell function, we performed cell-cell interaction network analyses based on single-cell transcriptomic data from SC-islets, ECs, and FBs. Among the top candidates were integrin receptors that interact with extracellular matrix proteins. Consistent with these predictions, a higher number of β-cells were in contact with EC-derived basement membrane proteins (e.g., laminin α1, collagen IV) and exhibited activation of integrin β1. The analysis also revealed BMP4-BMPR2 as a potential crosstalk between ECs and β-cells. Indeed, BMP4 addition augmented Ca2+ response and insulin secretion of β-cells under glucose stimulation. Finally, to develop a system mimicking in vivo physiology, we integrated SC-islets into a microfluidic platform where the organoids are supported by a network of perfused microvessels. Our newly-established model of vascularized SC-islet organoids will enable further studies of crosstalk between β-cells and vasculature under conditions mimicking the native islet microenvironment. The model will serve as a platform to study disease mechanisms of diabetes and test therapeutics.

Disclosure

K.Nguyen-ngoc: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (UG3DK1226390); JDRF (3-PDF-2017-386-A-N, 3-PDF-2020-932-A-N)
88-OR: Targeted Drug Delivery to Human ß-Cells Using Novel Nanocapsule Delivery Vehicle for T1D Treatment
Authors: COLLINS JILLIAN , HOLCOMB KEIFER , OCAMPO ANDRES , SHILLEH ALI , RUSS HOLGER A. , FARNSWORTH NIKKI L.
Published: June 2023

In type 1 diabetes (T1D), autoreactive immune cells destroy insulin secreting β-cells in pancreatic islets. Islet transplantation shows promise in restoring glucose homeostasis without exogenous insulin; however, long-term graft survival remains a critical barrier to the success of this treatment. Therapies aimed to protect or proliferate endogenous β-cells have off target affects and require targeted delivery to improve efficacy. We have developed a nanocapsule (NC) delivery system to specifically target and deliver cargo to human β-cells. We hypothesize NCs will selectively be taken up by human β-cells and deliver therapeutic cargo. NCs were synthesized with a water in oil emulsion evaporation technique. NCs were coated via ionic interactions with ectonucleoside triphosphate diphosphohydrolase 3 (ENTPD3) antibody, a human β-cell specific marker or Exendin-4 conjugated to hyaluronic acid (HA-Ex4). NC size, size distribution, charge, stability, and drug release profiles were determined. NCs loaded with pentamidine (PTM) or Cy5 were cultured for 24-168h with human iPSC-derived β-cells (sBC) or injected into the tail vein of NOD-SCID mice. Confocal microscopy confirmed delivery of cargo to β-cells and pancreatic islets, viability, and cytotoxicity. NCs were 271 ± 7nm in size with excellent size homogeneity (polydispersity index 0.06 ± 0.03, n=3). NCs displayed a sustained release of cargo for >45 days (n=5). In vitro, we observed no cytotoxicity of NCs up to 168h (n=3) and a significant increase in β-cell death with PTM loaded ENTPD3 coated NCs compared to controls at 24 (p<0.001, n=4) and 72h (p<0.01, n=4). sBCs treated with PTM loaded ENTPD3 coated NCs had more insulin+ dead cells (88 ± 4%) than controls (p<0.01, n=4). ENTPD3 or HA-Ex4 NCs were internalized into sBCs in vitro and pancreatic islets in vivo respectively. Our data shows long term stability and in vivo targeting of NCs to β-cells and supports use of our NCs for targeted delivery of therapeutics to human β-cells to treat T1D.

Disclosure

J.Collins: None. K.Holcomb: None. A.Ocampo: None. A.Shilleh: None. H.A.Russ: Advisory Panel; Sigilon Therapeutics, Inc., Consultant; Prellis, Minutia, Eli Lilly and Company. N.L.Farnsworth: None.

Funding

JDRF (1-INO-2022-1231-S-B); National Institutes of Health (P30-DK116073)
880-P: Effects of Sodium–Glucose Cotransporter-2 Inhibitors on the Risk of Atrial Fibrillation in Older Adults with Type 2 Diabetes
Authors: LI YUJIA , GUO YI , KIMMEL STEPHEN , BIAN JIANG , SCHATZ DESMOND , GUO JINGCHUAN
Published: June 2023

Clinical evidence suggested a protective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on the risk of atrial fibrillation (AF) in type 2 diabetes (T2D) patients, but the results were mixed. We aimed to compare the risk of AF in SGLT2i users compared to dipeptidyl peptidase-4 inhibitors (DPP4i) users and determine the effect in different subgroups. Using a 15% random sample of 2017-2018 Medicare claims data, we identified individuals with T2D, no preexisting AF, and initiated SGLT2i or DPP4i. The index date was defined as the date of the first filled prescription of SGLT2i or DPP4i. The outcome was the first incident of diagnosed AF. Inverse probability treatment weighted Cox regression models were used for analyses. Of the 97,660 eligible individuals (age 71.2±9.8 years, 54.6% women), 1.01% (n=989) had incident AF over a median follow-up of 361 days. The crude incidence rate was 8.39 (95% CI: 6.67-9.99) and 11.70 (95% CI: 10.9-12.55) per 1000 person-years in the SGLT2i group and DPP4i group, respectively. SGLT2i was associated with a significantly lower risk of incident AF (HR 0.72 [95% CI 0.56-0.89]) than DPP4i. The risk reduction of incident AF was more pronounced in Hispanic individuals and subgroups with existing cardiovascular (CV) and renal conditions. (Figure) Use of SGLT2i was associated with a lower risk of AF in individuals with T2D.

Disclosure

Y.Li: None. Y.Guo: None. S.Kimmel: Consultant; GlaxoSmithKline plc., Other Relationship; Janssen Research & Development, LLC. J.Bian: None. D.Schatz: Advisory Panel; Medtronic, Avotres Inc., QuLab Medical Ltd., Kriya Therapeutics. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health.
882-P: Effects of YG1699 and Sotagliflozin on Intestinal Glucose Absorption and GLP-1 in Mice
Authors: LI JACKY , XU ROGER W. , HE JIAOJUAN , LAPUERTA PABLO
Published: June 2023

Background and Aims: YG1699, a dual inhibitor of SGLT1 and SGLT2, recently showed greater glucose reduction than dapagliflozin in patients with type 1 diabetes. This study examined whether YG1699 provides gastrointestinal SGLT1 inhibition.

Materials and Methods: Male BALB/c mice (n=105) were randomly divided into five groups: vehicle, YG1699 at low (1mg/kg), medium (3mg/kg), and high doses (10mg/kg), and LX4211 (sotagliflozin) 10mg/kg by oral gavage. Animals received a 5g/kg glucose challenge 15 minutes after study drug. Animals were euthanized at various times to examine intestinal plasma GLP-1 and glucose content in small intestine, cecum, and colon. Differences between groups were evaluated by ANOVA.

Results (See Table 1): Small intestinal glucose content 1 hour after glucose challenge increased in a dose-related fashion with YG1699 compared to vehicle (p<0.001 for each YG1699 group vs. vehicle). Similar results were found in cecum (p<0.05 for each YG1699 group vs. vehicle). Plasma GLP-1 and PYY concentrations at 1 hour were higher on YG1699 vs. vehicle. Intestinal glucose content in the sotagliflozin group was similar to vehicle and the plasma GLP-1 were only numerically increased in this group.

Conclusion: YG1699 delays intestinal glucose absorption and induces an incretin response in BALB/c mice, indicating significant gastrointestinal SGLT1 inhibition.

Disclosure

J.Li: None. R.W.Xu: Consultant; Youngene Therapeutics. J.He: None. P.Lapuerta: Board Member; 4M Therapeutics, Consultant; Youngene Therapeutics, ViaCyte, Inc., Encuragen, Capsida, Provention Bio, Inc., Decibel Therapeutics, Crinetics, Next Phase Therapeutics.
906-P: Audit of Technologies Used for Glucose Monitoring and Insulin Delivery in Patients with Type 1 Diabetes at a Single Diabetes Center during 2019–2022—Real-World Data
Authors: BEM ROBERT , VÁVRA DAVID , SOCHOROVA KLARA , MÜLLEROVÁ MARTINA , HALUZIK MARTIN
Published: June 2023

The new NICE guidelines recommend that all adults with type 1 diabetes (T1D) should have access to either Continuous Glucose Monitoring (CGM) orIntermittently Scanned CGM (isCGM). The latest treatment modality for T1D is represented by the hybrid closed-loop systems (HCL), which consist of an insulin pump (CSII), a CGM and a smart algorithm. The aim of the study was to evaluate the effect of methods used for glucose monitoring and insulin delivery on diabetes control in patients with T1D treated during 2019-2022. We analyzed 2132 patients with T1D (48.9% males, mean age 43, 6 years) registered in our Diabetes Centre, 1165 (54.6 %) with multiple daily injections and 967 (45.4 %) using CSII, including 354 (36.6%) using HCL in 2022. A significant increase in the proportion of patients using CGM or isCGM in comparison to Blood Glucose Monitoring (BGM) during the years 2019-2022 was noted (14%/21%/65% in 2019 vs 43%/30%/27% in 2022; p<0.001). There was a significant improvement in diabetes control in CGM and isCGM users between 2019-2022, but not in the BGM group (CGM: 2019 7.9±1.2 % vs. 2022 7.5±1.1 %; p<0.0001; isCGM: 8.1±1.4 % vs. 7.8±1.3 %; p<0.001; BGM: 7.7±1.5 % vs. 7.6±1.5 %; NS). Patients using CGM had better diabetes control than patients with isCGM in 2022 (p<0.001). HbA1c significantly decreased during the past 2 years in all patients using CSII (2020: 8±1.2 % vs. 2022 7.7±1.1 %, p<0.001). In 2022, patients using HCL reached better glycemic control than only CSII users (HCL 7.5±1.2 % vs. CSII 7.8±1.1 %; p˂0.05). Patients using HCL had a significantly more pronounced decrease of glycated hemoglobin between 2020 to 2022 as compared to CSII users (2022: 7.5±1.2 % vs. 2020: 8±1.3 %; p<0.001). Our study demonstrated that more than 2/3 of patients meet the NICE guidelines for glucose monitoring in 2022, and this ratio is improving every year. CGM, isCGM and CSII treatment, especially with HCL are associated with better diabetes control.

Disclosure

R.Bem: None. D.Vávra: None. K.Sochorova: Advisory Panel; Ypsomed AG, Consultant; Medtronic. M.Müllerová: None. M.Haluzik: Advisory Panel; Novo Nordisk, Lilly Diabetes, Boehringer-Ingelheim, Research Support; Sanofi, Speaker's Bureau; Abbott, AstraZeneca.

Funding

National Institute for Research of Metabolic and Cardiovascular Diseases (EXCELES LX22NPO5104)
909-P: Predictors of Successful Fasting and Attaining Glycemic Targets during the Month of Ramadan among People with Type 1 Diabetes
Authors: AL-SOFIANI MOHAMMED , ALHARTHI SAHAR , ALBUNYAN SARAH , ALZAMAN NAWEED , KLONOFF DAVID C. , ALGUWAIHES ABDULLAH M.
Published: June 2023

Introduction: Muslims abstain from eating and drinking from dawn to dusk during Ramadan. We aim to evaluate the fasting experience of people with type 1 diabetes (PwT1D) and identify predictors of successful fasting and attaining glycemic targets during Ramadan.

Methods: We included the 149 PwT1D who attempted to fast during Ramadan 2022, were seen in our Endocrine clinics during the month preceding Ramadan, and were using a continuous glucose monitor (CGM). They were categorized, based on their treatment modality, into 3 groups: a) Hybrid closed loop (HCL) pump (n=39); b) Open loop pump (n=12); and c) Multiple daily injections (MDI) (n=98). CGM Reports for Ramadan and the month preceding Ramadan and self-administered surveys about fasting experience were evaluated. Predictors for attaining the “double target” of: a) breaking fast ≤2 days and b) maintaining glucose time in range (TIR) ≥70% during Ramadan were analyzed using uni- and multi-variable logistic regression.

Results: The “double target” of a) breaking fast ≤2 days and b) maintaining TIR≥70% during Ramadan was attained by 21.5% of PwT1D. Users of the HCL therapy, compared to the open loop and MDI users, had a significantly lower glycemia risk index (GRI), glucose management indicator (GMI), time below range (TBR), time above range (TAR), and average glucose during Ramadan (all p<0.05). Those with health insurance and better “pre-Ramadan” glycemic control (i.e. lower GRI, TAR, and coefficient of variation and higher TIR) were more likely to attain the “double target” during Ramadan. Users of the HCL pumps were more likely to attain the “double target” compared to the users of MDI + CGM [OR (95% CI): 25.47 (4.72, 137.49)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration.

Conclusion: Using HCL pump therapy and having better pre-Ramadan CGM metrics predict attainment of the double target of fasting most of days and having TIR ≥70% during Ramadan among PwT1D.

Disclosure

M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.
917-P: Treatment Satisfaction with Omnipod DASH System vs. Usual Care in Adults with Type 1 Diabetes in Australia
Authors: KONG YEE W. , YI YUAN CHENG , KIBURG KATERINA V. , BROWN KATRIN , TRAWLEY STEVEN , PARTOVI ANDISHEH , ROEM KERRYN L. , HARRISON NATALIE , FOURLANOS SPIROS , EKINCI ELIF I. , O'NEAL DAVID N.
Published: June 2023

Background: Conventional insulin pumps can be inconvenient and increase diabetes distress in people with type 1 diabetes (T1D). A tubeless insulin pump discreetly controlled by a handheld device, may be more acceptable. This is the first randomized controlled trial on patient-reported outcomes with tubeless insulin pumps.

Aim: To compare treatment satisfaction with Omnipod DASH® Insulin Management System (Insulet, Acton MA) vs. usual care (MDI or conventional IPT) in T1D adults self-monitoring with fingerstick blood glucose.

Methods: T1D adults were randomized to 12-weeks of Omnipod DASH System (intervention) or usual care (control). At study-end, treatment satisfaction was assessed by the difference in Diabetes Technology Questionnaire current score (DTQ-current). Secondary outcomes included patient-reported measures assessed through six other questionnaires and HbA1c.

Results: Baseline characteristics were similar between both groups. Those on Omnipod DASH System expressed significantly higher treatment satisfaction, better sleep quality, reduced fear of hypoglycemia and diabetes distress than those on usual care. HbA1c reduction was clinically relevant in the intervention group.

Conclusion: This study demonstrated that Omnipod DASH System is associated with better treatment satisfaction and patient-reported outcomes whilst maintaining glycemia in T1D adults.

Disclosure

Y.W.Kong: None. E.I.Ekinci: Advisory Panel; Eli Lilly Australia Pty Limited, Research Support; Eli Lilly Australia Pty Limited, Novo Nordisk, Boehringer Ingelheim and Eli Lilly Alliance, Insulet Corporation, Medtronic. D.N.O'neal: None. C.Yuan: None. K.V.Kiburg: None. K.Brown: None. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). A.Partovi: None. K.L.Roem: None. N.Harrison: None. S.Fourlanos: Advisory Panel; Viatris Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance.

Funding

Insulet Corporation
922-P: Improved Satisfaction while Maintaining Safety and High Time in Range (TIR) with a Medtronic Investigational Enhanced Advanced Hybrid Closed-Loop System (eAHCL)
Authors: YI YUAN CHENG , KONG YEE W. , AMOORE TESS , BROWN KATRIN , GROSMAN BENYAMIN , JENKINS ALICIA , JONES HANNAH , KURTZ NATALIE , LEE MELISSA H. , MACISAAC RICHARD , NETZER EMMA , PALDUS BARBORA , ROBINSON LESLEY , ROY ANIRBAN , SIMS CATRIONA M. , TRAWLEY STEVEN , VOGRIN SARA , O'NEAL DAVID N.
Published: June 2023

Background: Hybrid closed loop (HCL) systems are evolving. We aimed to assess treatment satisfaction and glucose control with an investigational eAHCL system.

Methods: Adults with type 1 diabetes (T1D) received sequentially the MiniMed™ 780G /Guardian™ Sensor 3 AHCL system, and a Medtronic investigational eAHCL system each for 12 weeks. The eAHCL system incorporates updated software, a new simple to use, no calibration, all-in-one sensor, and 7 day extended wear infusion set. The primary outcome was difference in treatment satisfaction measured using “current” and “change” versions of the Diabetes Technology Questionnaire (DTQ) following each 12 week period. Secondary outcomes included time spent changing infusion sets and sensors recorded on a phone app and CGM metrics.

Results: Twenty-one adults (11 men, mean [SD] age 48 [12.4] years) completed the trial. DTQ “current” score improved on eAHCL, and 86% of participants reported less “Effort to keep low blood sugar from happening” on DTQ “change”. There was less fear of hypoglycemia; more time in Auto Mode; fewer alarms; less time spent changing infusion sets and sensors; reduced CGM hypoglycemia and glycemic variability (Table 1).

Conclusions: Transition to eAHCL in T1D adults resulted in a better user experience and reduced fear of and time in hypoglycemia while maintaining safety and >80% TIR.

Disclosure

C.Yuan: None. R.Macisaac: None. E.Netzer: None. B.Paldus: None. L.Robinson: None. A.Roy: Employee; Medtronic. C.M.Sims: Stock/Shareholder; Medtronic. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). S.Vogrin: None. D.N.O'neal: None. Y.W.Kong: None. T.Amoore: None. K.Brown: None. B.Grosman: Employee; Medtronic. A.Jenkins: Advisory Panel; Insulet Corporation, Board Member; Insulin for Life, Research Support; Abbott Diabetes, Medtronic, Hemsley Charitable Trust, Juvenile Diabetes Research Foundation (JDRF), National Institutes of Health. H.Jones: None. N.Kurtz: Employee; Medtronic. M.H.Lee: Speaker's Bureau; Medtronic.
927-P: Robustness of MiniMed Advanced Hybrid Closed-Loop (AHCL) Algorithm on a Spectrum of Glycemic Control
Authors: SHIN JOHN , DAI ZHENG , NIU FANG
Published: June 2023

Objective: To evaluate effectiveness of MiniMed™ AHCL on outcomes of study participants with different glycemic management challenges.

Methods: Adults (N=128, ≥18 years) with T1D from 16 investigational sites, underwent baseline run-in (~2wks) of continuous subcutaneous insulin infusion (CSII), sensor-augmented pump (SAP) or HCL therapy, followed by study period (3 months) with MiniMed™ AHCL. In this exploratory analysis, participants with different baseline glycemic characteristics (mean SG and SD of SG) were identified using Hierarchical Clustering Analysis with Ward’s method and stratified into 5 cohorts. AHCL glycemic outcomes were evaluated and compared to run-in outcomes.

Results: After AHCL initiation, overall glycemic control improved regardless of baseline glycemic characteristics (i.e., low-to-high mean SG and SD of SG) (Table). As expected, those from Cluster 5 with highest baseline mean SG and SD of SG improved the most. While those from Cluster 1 with lowest baseline mean SG and SD of SG achieved the highest TIR. Although those from Cluster 2 achieved better glycemic outcomes compared to their baseline, they didn’t outperform those from Cluster 3, possibly due to their higher SD of SG and less aggressive carb ratio.

Conclusion: Improved glycemic control was observed with MiniMed™ AHCL regardless of glycemic conditions at baseline.

Disclosure

J.Shin: Employee; Medtronic. Z.Dai: Employee; Medtronic. F.Niu: None.
93-OR: Hepatic Acyl-Protein Thioesterases Prevent Insulin Resistance
Authors: SPECK SARAH L. , ZHANG QIANG , BHATT DHAVAL P. , ADAK SANGEETA , DONG GUIFANG , WEI XIAOCHAO , SEMENKOVICH CLAY F.
Published: June 2023

Elevated fatty acids in the context of metabolic disease are associated with insulin resistance. Fatty acids covalently and reversibly modify proteins through a process known as palmitoylation. We hypothesized that depalmitoylation by acyl-protein thioesterases 1 and 2 (APT1 and APT2) in the liver regulates glucose metabolism. The hepatic roles of APT1 and APT2 are unknown. We deleted APT1 and/or APT2 from the livers of mice, followed by high-fat diet (HFD) feeding. We performed acyl resin-assisted capture (acyl-RAC) to isolate palmitoylated proteins from APT KO livers followed by mass spectrometry. APT1 primarily depalmitoylated proteins linked to mitochondrial function and amino acid metabolism, including glutamine and branched-chain amino acid metabolism. To identify direct substrates of APT1 and APT2, we determined the protein-protein proximity network of each APT by fusing each enzyme to the highly efficient biotin ligase, miniTurbo (mT). We expressed these APT-mT constructs in human hepatocellular carcinoma HepG2 cells, followed by purification of biotin-labeled proteins and analysis by mass spectrometry. The APT proximity networks demonstrated that both APT1 and APT2 interact with mitochondrial proteins. APT1 and APT2 were also proximal to several glutamine transporters including Slc1a5 (also known as ASCT2), the only glutamine transporter known to localize to mitochondria. Male mice with dual but not single deletion of APT1 and APT2 from the liver (DLKO mice) had impaired insulin sensitivity independent of p-Akt levels or expression of Pck1 and G6pc. Elevated overnight fasting glucose in DLKO mice was associated with increased glutamine-driven gluconeogenesis and decreased liver mass. These data suggest that APT1 and APT2 regulate hepatic glucose metabolism, insulin signaling, and amino acid flux in a functionally redundant manner. These novel findings are the first to illustrate the hepatic depalmitoylation substrates and protein-protein proximity networks of APT1 and APT2.

Disclosure

S.L.Speck: None. Q.Zhang: None. D.P.Bhatt: None. S.Adak: None. G.Dong: None. X.Wei: None. C.F.Semenkovich: Consultant; Alnylam Pharmaceuticals.

Funding

National Institutes of Health (T32GM007200, F30DK131830, R01HL157154, P30DK020579)
935-P: Racial and Ethnic Disparities in the Application of Continuous Glucose Monitoring in Real-World Clinical Settings
Authors: ZHENG YAGUANG , ITURRATE EDUARDO , WU BEI , FLETCHER JASON , MELKUS GAIL D. , JOHNSON STEPHEN B.
Published: June 2023

Background: The use of continuous glucose monitoring (CGM) has improved glycemic control. Disparity in CGM use has been reported; however, the utilization of CGM across a health system in real-world clinical settings remains unknown. We aimed to characterize patients who use CGM and compare them to patients with diabetes who do not use CGM in a large health system.

Methods: We retrospectively reviewed the electronic health record (EHR) of patients who received care at NYU Langone Health from 2015. CGM users were those whose EHR records had at least one uploaded CGM report, while CGM non-users were those who had at least one outpatient encounter in which a diabetes diagnosis was documented and who did not have any CGM files uploaded into Epic.

Results: We identified 10,515 CGM users and 108,395 CGM non-users. CGM use significantly increased in patients with type 2 diabetes (T2D) after 2019, with higher use of CGM in patients with T2D than those with type 1 diabetes (T1D) (63.6% vs. 36.4%; p<.001). The rate of CGM use was significantly different across racial/ethnic groups: 9.9% of Whites, 7.8% Hispanics/Latinos, 7.5% African Americans, 7.2% Asian, and 7.1% Native Americans. When comparing CGM user among racial groups, CGM user was higher (than non-use) among Whites (60.4% vs 53.1%) and Filipinos (0.68% vs 0.55%), but less frequent among African Americans (13.0% vs 15.6%), Chinese (0.71% vs 1.7%), and Koreans (0.19% vs 0.45%) (p<.001). Regarding the ethnicity, more CGM users were Salvadoran (0.83% vs 0.45%), while less were Puerto Rican (3.3% vs 3.6%), Dominican (1.2% vs 1.4%), and Mexican (0.55 vs 1.4) (p<.001).

Conclusions: Using a large real-world clinical setting dataset, our study identified disparity in the CGM use in patients with T1D compared to T2D. Further we noted racial/ethnic disparities in the CGM use and heterogeneity within Hispanics and Asian Americans. Researchers and clinicians should consider interventions to reduce disparities in CGM prescription patterns.

Disclosure

Y.Zheng: None. E.Iturrate: None. B.Wu: None. J.Fletcher: None. G.D.Melkus: None. S.B.Johnson: None.

Funding

National Institutes of Health (P30DK111022)
936-P: Three-Month Interim Analysis from the Prospective Bigfoot Unity Real World Study (BURST)
Authors: MALONE JAMES K. , BECK ROY , TILLMAN JOHN , CALHOUN PETER , MOUSE THOMAS J. , BAILEY RYAN , OLSON BYRON P. , VAUGHAN SARAH , NAUREEN SHEIKH F.
Published: June 2023

Background: The Bigfoot Unity® System is an FDA-cleared smart pen cap system incorporating CGM data (Abbott FreeStyle Libre 2), real-time alerts, and clinician-directed insulin dose recommendations. The objective was to analyze real world, 3-month data for System users.

Methods: We conducted a per-protocol 3-month interim analysis (N=54, 15 clinics) from the prospective, BURST study (NCT05088265). Participants reported baseline demographics and completed adverse event surveys every 2 weeks. For A1C data, an at-home kit or electronic medical record was used for baseline and 3-month values; CGM metrics were collected post System initiation.

Results: Most (85%) had T2D and median age was 57 years; 58% were Caucasian and 58% were female. Mean A1C decreased from 9.2±1.8% at baseline to 7.9±1.3% at 3 months (mean difference −1.2%, 95%CI −1.6 to −0.8, p<0.001). Four severe hypoglycemia events in 3 participants and 1 DKA occurred and were not related to the System. Percent time below range and other 3-month glycemic outcomes and System use data are shown (Table).

Discussion: In this cohort, consisting primarily of older adults with T2D using MDI and suboptimal glycemic control, durable glycemic improvement occurred using Bigfoot Unity at 3 months. The observed reduction in A1C in this older cohort does not compromise them in meeting established hypoglycemia targets of <4 and <1% for percent time below 70 and 54 mg/dL, respectively.

Disclosure

J.K.Malone: Employee; Bigfoot Biomedical, Inc. R.Beck: Consultant; Eli Lilly and Company, Novo Nordisk, Diasome, Insulet Corporation, Research Support; Tandem Diabetes Care, Inc., Beta Bionics, Inc., Dexcom, Inc., Bigfoot Biomedical, Inc., Medtronic, Ascensia Diabetes Care, Roche Diabetes Care, Eli Lilly and Company, Novo Nordisk. J.Tillman: Employee; Bigfoot Biomedical, Inc. P.Calhoun: None. T.J.Mouse: None. R.Bailey: None. B.P.Olson: Employee; Bigfoot Biomedical, Inc. S.Vaughan: Employee; Bigfoot Biomedical, Inc. F.Sheikh: Employee; Bigfoot Biomedical, Inc.

Funding

Bigfoot Biomedical, Inc.
94-LB: Pharmacological Intensification in Patients with Type 2 Diabetes in a Low-Cost Diabetes Care Center (CAD)
Authors: VIOLANTE RAFAEL , FERNANDEZ NORMA , SALGUERO DULCE , GUTIERREZ HANNIA
Published: June 2023

Pharmacological intensification is one of the most important factors needed to get more patients to reach goals in type 2 diabetes mellitus (DM2). The objective of this research protocol is to demonstrate the degree of metabolic control in patients with DM2 and their glycemic control at 3, 6 months and 1 year after their pharmacological intensification in a Low Cost Diabetes Care Center (CAD). Descriptive, cross-sectional and retrospective study from 2019 to 2022, an HbA1c ≤ 7% was considered a meta control. Of the 422 patients studied, 66.8% (n=282/422) were women and 33.2% men. 33.2% comprised the 3-month cohort, 20.4% at 6 months, and 46.4% at 1 year. At the start of treatment in CAD, 81% of the patients were outside the goals, of these, 31.5% had an A1C between 7.1-9%, 49.4% between 9.1-12% and 19% ≥12.1%. Regarding treatment, 12.6% had no drug treatment, 34.6% monotherapy, 45.7% double oral therapy, 6.6% triple and 0.5% quadruple. 20.1% of the participants used insulin and 0.9% GLP-1. 78.9% were taking metformin, 36.7% sulfonylureas, 15.4% IDPP4, 6.2% ISGLT2, 5.9% acarbose, and 4.7% TZDs. During pharmacological intensification there was an increase in the use of medications: Metformin +18.3%, IDPP4 +26.1%, iSGLT2 +25.8% and TZD +12.4%. Glibenclamide was reduced to -6%, all of them statistically significant (p=0.000). Patients without treatment decreased from 12.6 to 1.4% (p= 0.005) and in monotherapy from 34.6 to 15.9% (p= 0.000), dual therapy increased from 45.7 to 50.9%, triple from 6.6 to 27% and quadruple from 0.5 to 4.7% (p=0.003). The use of insulin doubled from 20.81 to 44.3%, likewise GLP-1 from 0.9 to 6.4%; both were statistically significant (p=.000). According to glycemic control, at 3 months 89.3% improved their glucose levels and 35% of the participants reached control goals, at 6 months 94.2% improved their glucose levels and 53. 5% achieved their control goals. At one year, 90.3% improved their glucose levels and 71.4% reached control goals.

Disclosure

R. Violante: None. N. Fernandez: None. D. Salguero: None. H. Gutierrez: None.

Funding

None
941-P: Improved Glycemic Control with Real-Time CGM in Adults with Type 2 Diabetes Not Treated with Insulin
Authors: JEPSON LAUREN H. , WELSH JOHN , GREEN COURTNEY R. , THOMAS ROY , LAYNE JENNIFER E.
Published: June 2023

Background: Little is known about real-time continuous glucose monitoring (rt-CGM) in adults with T2D who are not using insulin. We analyzed real-world data to evaluate the association of rt-CGM use and glycemic control in this population.

Methods: Data from US-based adults who reported a T2D diagnosis, age ≥18 years, not using insulin and who first uploaded Dexcom G6 data from the Dexcom app between 9/2021 and 6/2022 were analyzed. Individuals with follow-up data at 3 months and baseline time in range (TIR, 70-180 mg/dL) <70% were included. Outcomes included change in CGM metrics and percentage of users with TIR ≥70% at follow-up.

Results: CGM users (n=3,505) were [mean (SD)] 52.2 (11.2) years of age and 46% female. TIR increased by 16.2 percentage points from 40.2% (21.7) at baseline to 56.4% (28.2) at 3 months (p <0.001), which was largely attributable to reduced hyperglycemia (Table). The proportion of CGM users meeting the consensus target of TIR ≥70% increased from 0% to 37%. Over the course of 3 months, CGM was worn 91.7% of the time. Most CGM users (77.6%) accessed Clarity summary reports of CGM data and most (80.2%) enabled the optional high glucose alert.

Conclusion: In adults with T2D not using insulin and not meeting treatment targets, use of rt-CGM was associated with clinically meaningful improvements in glycemic control. Ongoing use of rt-CGM may result in further improvements in glycemic control.

Disclosure

L.H.Jepson: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. C.R.Green: Employee; Dexcom, Inc. R.Thomas: Employee; Dexcom, Inc. J.E.Layne: Employee; Dexcom, Inc., Verily Life Sciences.

Funding

Dexcom, Inc.
943-P: Improved Glycemic Outcomes after One Year among Level 2 Members
Authors: BACON SAM , THOMPSON NELS , FERRELL DAVID , FUNG JASON
Published: June 2023

Background: Level2’s virtual specialty clinic, offered across the United States to people with type 2 diabetes on participating insurance plans, combines providers, coaches, continuous glucose monitors (CGM), and fitness trackers to help members gain insight, and focus on long-term behavior change. We retrospectively assessed differences in glycemic outcomes following one year of participation in Level2.

Methods: People joining Level2 between 01/01/21 and 07/31/21 with 15 months of Level2 participation and 3 prior months of continuous enrollment in a participating commercial health plan were included in the analysis. We used CGM-derived GMI and A1c values available from a database of de-identified administrative claims to determine baseline and 12-month follow-up glycemic outcomes. Wilcoxon signed-rank tests were used to test for pair-wise improvements in glycemic measures between baseline and follow-up overall and stratified by baseline A1c.

Results: Of the 3,440 people identified for the analysis, a subset (N = 200) had both baseline A1c and valid GMIs during follow-up. This subset was 53% (N = 106) male with mean age of 55.4 (SD = 8.5) years and had mean baseline A1c of 7.97% (SD = 1.02). The median difference between baseline A1c and follow-up GMI was -0.83% (p < 0.001) overall, with significant differences of -0.82% (p < 0.001) and -2.41% (p < 0.001) in those with baseline 7% < A1c < 9% and A1c > 9%, respectively. Over 50% of people had a decrease in glycemic outcome of more than 0.5%, with 67% and 95% of people improving by more than 0.5% in the 7-9% and > 9% groups respectively. There were 87 people that also had an A1c at 12-month follow-up; the median difference in A1c was -0.65% (p < 0.001), 50% had a decrease of more than 0.5%, and median difference between GMI/A1c follow up values was 0.13 (p = 0.11).

Conclusion: Level2 members with baseline A1c and follow-up GMI saw significant improvements in glycemic control over one year of engagement. These improvements were observed for measures of both follow-up A1c and GMI.

Disclosure

S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. D.Ferrell: Stock/Shareholder; Level2, Medexpress Urgent Care. J.Fung: Employee; Level2.
948-P: Glycemic Monitoring Using the Dexcom G6 in Cardiac Surgery
Authors: INSLER STEVEN R. , WAKEFIELD BRETT J. , BENA JAMES F. , DEBS ANDREA , BRAKE KELLY , NWOSU IKENNA , CECILIA LANSANG M.
Published: June 2023

Hyperglycemia is associated with adverse post-surgical outcomes. We evaluated Dexcom G6 accuracy following cardiac surgery. A clinical glucose dataset included 1428 readings of 29 patients, Dexcom data included 45,645 measures. Clinical and Dexcom measures were restricted at least 1 hour after prior measure. Matching clinical and Dexcom measures were required within 5 min. Data were included at least 2 hr after Dexcom insertion and ICU admit. A dataset only measuring ≥24 hrs post ICU admit was created to explore device stability. Patients remained on Dexcom until discharge or 10 days postop. The population was 71% male 14% with known diabetes, 66% who went on intravenous insulin infusion. Figure 1a is Clarke error grid plot of all measures post-ICU admission: 53.5% were Zone A, 45.9% Zone B, and 0.6% (n=5) Zones D or E. Figure 1b uses restricted dataset beginning 24 hours post-ICU admission: 55.9% in Zone A, 43.9% in Zone B, and 0.2% in Zone D. MARD between clinical and Dexcom measures was 20.6% and 21.6% in post-ICU admission dataset and dataset excluding first 24 hours after ICU admission. Almost 100% of Dexcom G6 and clinical data matching points fell within areas considered as giving clinically correct decisions (Zone A) and clinically uncritical decisions (Zone B). If CGM readings are used for clinical decision-making, glucose targets or insulin dosing algorithms may need adjustment. As technology evolves, this device may limit glycemic fluctuations.

Disclosure

S.R.Insler: None. B.J.Wakefield: None. J.F.Bena: None. A.Debs: None. K.Brake: None. I.Nwosu: None. M.Lansang: Research Support; Dexcom, Inc., Abbott, Alertgy Inc.
955-P: A Novel Pathway to Equitably Promote Diabetes Technology Education and Awareness
Authors: WONG JESSIE J. , ADDALA ANANTA , ALAMARIE SELMA A. , HANES SARAH , KRUGMAN SARA , NARANJO DIANA , NELMES SIERRA , JACQUES ROSE KYLE , SCHNEIDER-UTAKA AIKA , TANENBAUM MOLLY L. , HOOD KOREY K.
Published: June 2023

Aim: To examine engagement with DiabetesWise.org, a free, unbranded online platform for diabetes technology education and resources.

Methods: A sample of 458 participants (Mage=37.1, SD=9.73; 66% female; 81% type 1) with minimal diabetes device use were enrolled, invited to use DiabetesWise.org, had their website activity tracked, and completed surveys. Chi-square and t-tests evaluated correlates of DiabetesWise.org engagement.

Results: Most participants (69%) logged into DiabetesWise.org at least once, which was related to being female, public/no insurance, lower income, and receiving care in private practice/community health settings. Nearly 38% logged in multiple times, which was more likely for those receiving diabetes care through primary care. Most who logged in used the CheckUp tool (85%), of whom 74% used meter and injections. Most CheckUps recommended meter and pump (63%), followed by sensor and pump (35%), then sensors with Smart pump (2%). Cost was the most frequent concern (51%). Most participants who completed the CheckUp reported diabetes distress (76%).

Conclusions: DiabetesWise.org is an innovative, unbiased approach to promote diabetes device education and awareness. Initial engagement is highest among people with fewer resources; repeat use is more likely when diabetes care is received in primary care. DiabetesWise.org may help offset disparities in diabetes technology awareness and access.

Disclosure

J.J.Wong: None. M.L.Tanenbaum: None. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. S.A.Alamarie: None. S.Hanes: None. S.Krugman: Consultant; Tandem Diabetes Care, Inc., Medtronic. D.Naranjo: None. S.Nelmes: None. K.Rose: Consultant; Diabeloop SA. A.Schneider-utaka: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust; National Institutes of Health (K23DK121771)