bluuebunny/crossref_metadata_2025 huggingface dataset:
1826-LB: Enhancing Diabetes Self-Management Education—Perspectives of Patients and Primary Care Providers on Influencing Factors of Binge Eating in Black Adults with Type 2 Diabetes
Authors: ALEXANDER RAMINE C. , HARPER-COOKS TYISHA , GODOY SARAH , WOLFE HANNAH , GOODE RACHEL W.
Published: June 2024

Introduction & Objectives: Current diabetes self-management education (DSME) has minimal impact on HbA1c in Black adults with type 2 diabetes mellitus (T2DM). One reason may be that DSME does not address binge eating. Black adults with T2DM are six times more likely to binge eat compared to other racial or ethnic groups. Little is known about how to mitigate binge eating in this population. Thus, this study explores the perspectives of patients and primary care providers on factors influencing binge eating in Black adults with T2DM, and strategies that could enhance DSME.

Methods: Black adults with T2DM who experienced at least 2 binge eating episodes a month (n = 14) and DSME providers (n = 9) who treated Black adults with T2DM were invited to complete in-depth interviews to identify facilitators of binge eating and explore strategies that could enhance DSME. A constructivist grounded theory approach was used to develop a framework explaining factors influencing binge eating in Black adults with T2DM.

Results: Participants identified multilevel stressors and barriers that influenced their binge eating episodes and T2DM treatment: a) active food restriction; b) emotional eating; and c) feelings of deprivation. Providers acknowledged limited training in disordered eating, insufficient patient interaction time, and patient shame related to T2DM.

Conclusion: Results of this study identify salient factors that exacerbate binge eating behavior in Black adults with T2DM. Understanding these specific factors and barriers can enhance DSME and improve long-term T2DM self-management in Black adults.

Disclosure

R.C. Alexander: None. T. Harper-Cooks: None. S. Godoy: None. H. Wolfe: Employee; Within Health.

Funding

American Diabetes Association (11-21-ICTSHD-12)
183-OR: Risk Factors for Combined Severe Diabetic Complications (CSDC) in Patients with Type 2 Diabetes Mellitus (T2DM)
Authors: NANAKO TANAKA , FUJIHARA KAZUYA , YAGUCHI YUTA , YAMADA MAYUKO H. , YAMAMOTO MASAHIKO , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO
Published: June 2024

Since advanced microangiopathy in diabetes severely impairs activities of daily living and quality of life and is life-threatening regardless of severity, treatment of diabetes requires appropriate risk management to avoid ALL of those severe complications. A simultaneous assessment of the risk of complications rather than individual assessments is essential to developing optimal treatment strategies. Thus, we examined the association between CSDC and the number of achieved treatment targets. CSDC were defined as follows: vision-threatening retinopathy, initiation of dialysis, amputation of lower extremity, and cardiovascular disease including heart failure. Studied were 86,633 patients with no history of CSDC. Achieved targets as analyzed by multivariate Cox model for treatment were HbA1c <7%, SBP <130, LDL-C <120, and non-smoking. During a median follow up of 4.6 years, 4,542 cases of CSDC (12.9/1,000 person-years) occurred. Risk of CSDC decreased as the number of achieved targets increased. The risk of CSDC was extremely reduced in patients who achieved all targets compared with patients who did not achieve any of the 4 targets (Figure). The risk of CSDC decreased as the number of achieved targets for atherosclerotic risk factors increased, suggesting that multifactorial interventions are necessary to prevent these conditions.

Disclosure

T. Nanako: None. K. Fujihara: None. Y. Yaguchi: None. M.H. Yamada: None. M. Yamamoto: None. M. Kitazawa: None. Y. Matsubayashi: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
1842-LB: Adapting Behavioral Family Systems Therapy for Diabetes (BFST-D), a Virtual Family-Based Intervention for Improving Transition Readiness in Youth with Type 1 Diabetes (T1D)
Authors: PAPADAKIS JACLYN L. , WEISSBERG-BENCHELL JILL , SUHS MADELEINE C. , O'DONNELL ALEX , HARRIS MICHAEL A.
Published: June 2024

Introduction & Objective: Many youth with T1D do not transfer to adult diabetes care successfully, resulting in adverse medical and psychosocial outcomes. Modifiable individual and family factors are associated with transition, yet there are no empirically-based interventions targeting such factors. The objective of this study is to (1) describe the adaptation of BFST-D to BFST-DT, a virtual family-based T1D transition intervention, and (2) describe baseline findings of a pilot pre-post intervention trial.

Methods: Focus groups were conducted to inform the adaptation of BFST-D to address transition readiness. A pilot trial assessed acceptability/feasibility of the intervention in 30 families. Analyses evaluated transition readiness and psychosocial variables at baseline.

Results: Eight focus groups of youth with T1D, their caregivers, and diabetes providers (total n=44) were conducted. Thematic analysis revealed individual and family-level barriers and facilitators to transition and feedback on the adapted intervention. Twenty adolescents (Mage= 16.6 years; 55% female) and their caregiver (95% mothers) are currently enrolled in the intervention. At baseline, adolescents reported the greatest transition readiness in insulin/pump management (M=4.33), followed by health behaviors (M=3.73), diabetes knowledge (M=2.64), and healthcare navigation (M=2.27). Total transition readiness was correlated with diabetes-related resilience and distress, and parent self-reported diabetes-related distress, self-efficacy, and family conflict (p’s < .05).

Discussion: Stakeholder focus groups highlighted the need for a family-based T1D transition intervention and were vital to BFST-DT development. Transition readiness is associated with individual and family-level psychosocial variables. Future studies will evaluate the efficacy and acceptability/feasibility of BFST-DT.

Disclosure

J. Weissberg-Benchell: Consultant; Beta Bionics, Inc. Advisory Panel; American Diabetes Association. Research Support; Juvenile Diabetes Research Foundation (JDRF), National Institute of Diabetes and Digestive and Kidney Diseases. A. O'Donnell: None.

Funding

JDRF (4-SRA-2023-1287-M-B)
1848-LB: Peer Mentors in a Young Adult Transition Intervention
Authors: BAUDINO MARISSA , LEVY WENDY , CARREON SAMANTHA A. , STREISAND RANDI , TANG TRICIA S. , LYONS SARAH , MCKAY SIRIPOOM , ANDERSON-THOMAS BARBARA J. , MINARD CHARLES G. , HILLIARD MARISA E.
Published: June 2024

Introduction & Objective: Peer support interventions in diabetes have the potential to offer emotional support, improve health-related outcomes, and be delivered virtually. However, attention is focused largely on the individuals who receive rather than those who deliver support. We describe the psychosocial profiles of peer mentors in a transition intervention trial for young adults with type 1 diabetes.

Methods: At enrollment, 29 peer mentors completed psychosocial measures (diabetes distress, T1D-specific quality of life, social support patterns), self-reported demographics, clinical data, and reasons for participating.

Results: The table presents summary statistics for peer mentor characteristics and psychosocial measures at enrollment. Key motivators for participating included: want to help young adults with diabetes (100%), want to give back (93%), transitioning was tough and I wanted to share information I learned (69%), I wish I had a mentor when transitioning (65%), opportunity to participate in research (45%), money (7%).

Conclusions: Desire to help others dominated peer mentors’ drive to participate. Heterogeneity in peer mentors’ diabetes-specific psychosocial functioning suggests the absence of a predominant peer mentor profile. These data may help guide efforts in implementing future peer mentor interventions.

Disclosure

M. Baudino: None. W. Levy: None. S.A. Carreon: None. R. Streisand: None. T.S. Tang: None. S. Lyons: None. S. Mckay: None. C.G. Minard: None. M.E. Hilliard: None.

Funding

National Institutes of Diabetes and Digestive and Kidney Disease (1R01DK119246); National Institutes of Diabetes and Digestive and Kidney Disease (3R01DK119246-03S1); JDRF (2-PDF-2022-1173-A-N).
1853-LB: Survey of Social Media Use in Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: MAXWELL TARA K. , BRANKA LILLIAN A. , ADAM ATIF , WEITZMAN ELISSA R. , LAFFEL LORI M.
Published: June 2024

Aim: YA with T1D struggle with self-care and glycemic control. Given that social media is highly used by YA, it is timely to assess its utilization in those with T1D. This survey aimed to understand current use of social media by YA with T1D and its potential to provide information and support for self-care.

Methods: A multidisciplinary team developed an electronic survey composed of questions about general and diabetes-specific social media use. The survey also queried self-reported demographics/diabetes care characteristics and diabetes distress. We identified 855 YA aged 18-25 with T1D ≥1 year from the EHR and fielded the survey electronically by email using REDCap; responders received $50 compensation. Statistics were performed using Stata.

Results: There were 245 YA (29% initial response rate) with a mean age 22.3 years; 58% were female and 87% white; 81% reported using pump therapy and 96% used CGM. Of these, 74% of responders self-reported their last A1c; mean 7.0±0.8%. Nearly all (99%) used social media; most commonly-used platforms overall and for diabetes content were Instagram (51% overall, 54% diabetes) and TikTok (28% overall, 45% diabetes). Of those using social media, 11% used it for up to 1 hour per day; 45% 1-3 hours per day; 28% 3-5 hours per day; 6% 5-8 hours per day, and 11% over 8 hours per day. The majority (85%) of social media users reported that social media rarely or never changed the way they manage their diabetes. Over 25% of social media users reported that social media is their primary source of knowledge about new diabetes technology, while fewer reported it as their primary source of diabetes information (5%) and support (7%).

Conclusion: Social media is nearly universally used by this sample of YA with T1D who are already experienced in diabetes technology use. Yet, many reported that social media was their primary source of information about new diabetes technology. Social media may be a means to further disseminate advances in diabetes management to those in need of improvement.

Disclosure

T.K. Maxwell: None. L.A. Branka: None. A. Adam: None. E.R. Weitzman: None. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation.

Funding

Beatson Foundation (20005-2500361)
1881-LB: Inpatient Hyperglycemia—How to Overcome This Challenge
Authors: SANTOMAURO JUNIOR AUGUSTO C. , PALMIERI ANA CAROLINA M.R. , CORREIA JULIANA , TERESA SANTOMAURO ANA , RADUAN ROBERTO A.
Published: June 2024

Introduction & Objective: Inpatient hyperglycemia (IH) is a prevalent and clinically significant problem affecting millions of patients worldwide. IH is estimated to affect approximately 40% of hospitalized patients, with an even higher prevalence in intensive care units (ICUs), reaching up to 80%. The objective of introducing a protocol to control IH is to guarantee the achievement of the glycemic target in critically ill patients. The objective of this work is to show how in-service education and the involvement of various sectors can guarantee adherence, not only by the medical service, but by all sectors, especially nursing and the IT group.

Methods: Based on this data, from 2021 onwards, we introduced into our hospital service, which has more than 200 ICU beds, a protocol for the treatment of IH, which involves, in addition to the medical team, the nursing service, nutrition and the IT group. We initiate insulin use in critically ill patients with or without DM if there is hyperglycemia greater than 200 mg/dL, and continuous intravenous insulin infusion is the therapy of choice for them.

Results: After the introduction of the protocol there was a substantial decrease in the number of infections and days spent in ICU. The insulin pump adherence rate by the ICUs team was in 2021, 2022 and 2023, respectively: 82.1%, 88.9%, 95.7%. Hypoglycemia < 70 mg/dL rate was respectively 0.4%, 0.3%, 0.4%; Number of open files were respectively 2.559, 2,187, 1,514; Number of capillary blood glucose levels were respectively - 29,658, 23,944, 19,724.

Conclusion: We can observe that in the last year (2023) the adherence rate to the protocol improved and the hypoglycemia rate remained stable, in addition, the number of open records fell by almost 50%. The work aims to adapt IH, demonstrating that its management in critical beds is possible and can be carried out with the collaboration of everyone, which can be implemented in other sectors and other smaller hospitals.

Disclosure

A.C. Santomauro Junior: None. J. Correia: None. R.A. Raduan: None.
1889-LB: Type 2 Diabetic Medication Regimen in Treating Depression and Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) in Veterans Using PHQ-9 and FIB-4 Scores
Authors: NICOLE UBALDE SHANNEN , KHOURY JESSICA , DAVIS JESSICA , SEN SABYASACHI
Published: June 2024

Background: Depression and mental health issues are often co-morbidities and present with management challenges. Several veterans also have MASLD which is highly associated with T2DM and is a common cause of chronic liver disease and cardiovascular disease (CVD). No pharmacological agent has been approved for the treatment of MASLD, but novel T2DM drugs appear to demonstrate some benefit. We decided to examine the effects of various antidiabetic such as Metformin, sodium-glucose transport protein-2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor analogs (GLP-1RAs), as three groups of interest, compared to insulin(ins) alone, as the control, in T2DM patients with depression and liver fibrosis (based on FIB-4 score).

Methods: We conducted a retrospective chart review of patients from the Diabetes Clinic at VA Med Ctr over 10 months using (PHQ-9 score >5 for depression assessment FIB4 score > 1.3 to detect subjects at risk for liver fibrosis.

Results: Patient cohorts range from 53 to 87 years old with a 76% majority in the African American veteran population. All patients were either overweight or had obesity (BMI 25-45). The mean BMI was 32.29±0.80, which was similar across the groups with the SGLT2i (+/- ins) group having a slightly lower BMI of 27.80±1.28. Mean A1C was 8.0±0.2 with no difference found between groups. Our results were as follows: GLP-1 RA (+/- ins) had PHQ-9 score of 9.00 ±1.3 and FIB-4 score of 1.90±0.15, SGLT2i (+/- ins) PHQ-9 score of 9.40±1.2 and FIB-4 score of 2.50±0.39, Metformin (+/- ins) PHQ-9 score of 10.91±1.5 and FIB-4 score of 1.76±0.16, Insulin only PHQ-9 score of 10.92±1.9 and FIB-4 score of 1.93±0.10.

Conclusion: In T2DM veterans depression scores were lower in patients taking the GLP1RA and SGLT2i. However Metformin group appeared to have least correlation with FIB-4 score. However taking both depression and MASLD parameters into account GLP1A appears to have the best positive correlation.

Disclosure

J. Khoury: None. J. Davis: None. S. Sen: None.
1900-LB: Efficacy and Safety of Artificial Pancreas in Patients with Type 1 Diabetes—A Systematic Review and Meta-analysis
Authors: FAN WENQI , DENG CHAO , XU RUOYAO , LIU ZHENQI , ZHOU ZHIGUANG , LI XIA
Published: June 2024

Introduction & Objective: Artificial pancreas (AP) studies are upsurging, half of which were published in the last 5 years. We aimed to evaluate the efficacy and safety of AP in patients with type 1 diabetes (T1D).

Methods: We searched PubMed, Embase, Cochrane Library, web of science and ClinicalTrials.gov from inception to August 31, 2023. Randomized clinical trials that compared artificial pancreas with other insulin-based treatments in patients with T1D were considered eligible. The primary outcome was percentage of time in range (TIR) (3.9-10.0 mmol/L). Secondary outcomes were other glycemic metrics derived from continuous glucose monitoring, HbA1c and insulin dose. Safety outcomes included the incidence of severe hypoglycemia and diabetic ketoacidosis.

Results: A total of 3623 patients with 73 comparisons from 65 trials were included. The percentage of TIR was 11.74% (95% CI 9.37 to 14.12, P < 0.001) higher with AP compared with control treatments. Patients on AP had more pronounced improvement of time below range when diabetes duration was more than 20 years (-1.80% vs. -0.86%, P = 0.031) and baseline HbA1c lower than 7.5% (-1.93% vs. -0.87%, P = 0.033). Full closed-loop systems revealed a greater improvement in time above range compared with hybrid closed-loop systems (-15.53% vs. -9.22%, P = 0.020). Notably, glycemia risk index (GRI) (-3.74 [CI, -6.34 to -1.14], P < 0.01) was also improved with AP therapy.

Conclusion: AP showed significant advantages compared to other insulin-based treatments in improving glucose control represented by TIR and GRI in patients with T1D, with more favorable effect in hyperglycemia by full closed-loop systems as well as less hypoglycemia for patients who are within target for glycemic control and have longer diabetes duration.

Disclosure

W. Fan: None. C. Deng: None. R. Xu: None. Z. Liu: None. Z. Zhou: None. X. Li: None.

Funding

the Unveiling and Leading Program of Hunan Province (2021JC0003), the Science and Technology Innovation Program of Hunan Province (2020RC4044), and the Sinocare Diabetes Foundation (2021SD06, LYF2022039)
1914-LB: The Combined Effect of CGM with Antidiabetes Medications and the Association with Improved A1C in People with Type 2 Diabetes (PWT2D) Not on Insulin Therapy (NIT)
Authors: NEMLEKAR POORVA , HANNAH KATIA , NORMAN GREGORY J.
Published: June 2024

Background: CGMs are used to guide lifestyle modifications, prevent hypoglycemia, and inform therapies. This study aimed to evaluate whether CGM, alongside various classes of anti-diabetes medications, is associated with lower A1c in PWT2D NIT.

Materials and Methods: A retrospective analysis of deidentified Optum Clinformatics® US healthcare claims data was conducted. CGM naïve, PWT2D NIT, ≥ 30 years and A1c ≥ 8.0% who initiated a CGM between 01/2019 through 12/2022 (index date = start of CGM) were included. A control group consisted of CGM nonusers assigned a random index date. Continuous health plan coverage was required 6 months pre- (baseline) and post- (follow-up) index date. One A1c laboratory value at baseline and follow-up was required to calculate A1c change. In multivariate linear regression models A1c change was regressed on CGM use and its combined effect with five anti-diabetes medication classes (metformin, sulfonylurea, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors). Covariates included age, gender, race, insurance type, Charlson comorbidity score, baseline A1c and diabetes medications.

Results: A total of 52,394 PWT2D NIT (CGM users = 4,086) were identified. The CGM cohort was 67 years of age, 52% male, 69.3% non-Hispanic white, and 85% Medicare insured. Overall, CGM was associated with an adjusted A1c change of -0.26 to -0.27 in all models (p<0.0001). The joint effect of CGM when combined with either a GLP-1RA, sulfonylurea, or DPP-4 inhibitors resulted in additional A1c reductions (-0.13 to -0.26; p<0.05).

Conclusions: The findings suggest that, for people with T2D not using insulin, CGM use is associated with improvement in A1c independent of anti-diabetes medication use. Furthermore, there may be additional benefits of CGM when used in combination with therapies such as GLP-1RA and DPP-4 inhibitors.

Disclosure

P. Nemlekar: Employee; Dexcom, Inc. K. Hannah: Employee; Dexcom, Inc. G.J. Norman: Employee; Dexcom, Inc.
1917-LB: Association of FreeStyle Libre Utilization and Glycemic Outcomes among People with Type 2 Diabetes Treated with Basal Insulin and GLP-1RAs
Authors: HUANG EILEEN , KAO KALVIN , BRANDNER LAURA , BINDAL ANILA
Published: June 2024

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medication that is highly effective at treating Type 2 diabetes (T2D) due to its glucose-lowering ability. Although people with T2D treated with basal insulin may use both GLP-1 RA and Freestyle Libre (FSL) glucose monitors, the impact of FSL utilization on glycemic outcomes in the presence of GLP-1 RAs has not been widely studied. We conducted a retrospective cohort study using linked databases of FSL glucose values and Inovalon Insights insurance claims. Patients were ≥18 yrs old, diagnosed with T2D, initiated FSL between November 2017 and March 2022, and treated with basal insulin and GLP-1 RAs. FSL use and GLP-1 RA adherence were calculated using proportion of days covered (PDC) over 12-months from the index date (date of FSL initiation). Consistent FSL and adherent GLP-1 RA use were defined as PDC ≥0.8. Glucose management indicator (GMI) and % time in range (TIR) were calculated at baseline, 6-, and 12-months post index, and change in glycemic metrics from baseline to 12-months were assessed using paired t tests. A total of 2141 individuals met the inclusion criteria. Among consistent FSL users (56%), GMI and TIR did not change significantly from baseline to 12-months. However, among inconsistent FSL users (44%), changes were statistically significant overall: GMI increased by 0.27% (p<0.001) and TIR decreased by 3.94% (p<0.001). Subgroup analysis showed that regardless of GLP-1 RA adherence, inconsistent FSL users still had statistically significant worsening in GMI (nonadherent: 0.30%, p<0.001; adherent: 0.22%, p=0.006) and TIR (nonadherent: -3.70%, p<0.001; adherent: -4.34%, p=0.001). This study shows that frequent use of FSL plays a pivotal role in glucose management among people with T2D treated with basal insulin and GLP-1 RAs, where consistent FSL use is associated with sustained glycemic control, and inconsistent FSL use is associated with worsened glycemic outcomes.

Disclosure

E. Huang: Employee; Abbott. K. Kao: Employee; Abbott. L. Brandner: Employee; Abbott. A. Bindal: Employee; Abbott.
1918-LB: rtCGM Improves Postoperative Glucose Control in Liver Transplant Recipients with Diabetes Mellitus
Authors: HAGERF (VOGLOVÁ) BARBORA , PROTUS MAREK , NEMETOVA LENKA , MRAZ MILOS , HALUZIK MARTIN , GIRMAN PETER , KIESLICHOVA EVA , SVIRLOCHOVA VERONIKA , FRANEKOVA JANKA , JABOR ANTONIN
Published: June 2024

Introduction: Glycemic management early after liver transplantation (LTx) is challenging due to the patients’ critical state and corticoid therapy and can be complicated by preexisting diabetes mellitus (DM). We analyzed data from continuous glucose monitoring (CGM) in LTx recipients from an ongoing prospective trial (ClinicalTrials.gov NCT05585801), assessing the impact of CGM use on postoperative glucose control.

Methods: Patients undergoing LTx were randomized to a blinded or open-labelled CGM (Dexcom G6, San Diego, USA), used in addition to standard care. Protocol-based i.v. insulin therapy was used for glycemic management with CGM data helping insulin titration in the open arm. We compared CGM metrics between the study arms and in the subgroup of patients with pre-transplant DM. Mann-Whitney, t-test and Fisher test were used for data analysis.

Results: We included 108 LTx recipients (30 with DM). Baseline characteristics and CGM metrics are shown in Table 1. Overall CGM use was 97% of time, with 4 cases of sensor failure. Open-labelled CGM use was associated with reduced average glycemia and improved time in range in the subgroup of patients with DM, with a similar, albeit insignificant, tendency in the whole group.

Conclusion: Our study shows that integration of CGM in postoperative ICU care improved glycemic control in patients with DM after LTx, with a similar trend in the whole LTx recipient cohort.

Disclosure

M. Protus: None. L. Nemetova: None. M. Mraz: None. M. Haluzik: Advisory Panel; Sanofi, Novo Nordisk, Eli Lilly and Company, AstraZeneca, Bayer Inc., Johnson & Johnson Medical Devices Companies. Consultant; Merck & Co., Inc., Sanofi, Novo Nordisk, Eli Lilly and Company, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Johnson & Johnson Medical Devices Companies, Novatin. Research Support; Sanofi. Speaker's Bureau; Sanofi, Novo Nordisk. P. Girman: None. V. Svirlochova: None. J. Franekova: None.

Funding

Cooperatio Programme, section Medical Diagnostics and Basic Medical Sciences, Charles University, Prague, Czech Republic and by National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104) - Funded by the European Union – Next Generation EU) MH CZ - DRO ("Institute for Clinical and Experimental Medicine – IKEM, IN 00023001")
1931-LB: Cost of Continuous Glucose Monitoring vs. Self-Monitoring of Blood Glucose in Type 1 Diabetes Pregnancies
Authors: DISTEFANO MICHAEL J. , BRETT MCQUEEN R. , GAO VALERIE , SNELL-BERGEON JANET K. , JOHNSON CARLY A. , KLEIN MATTHEW P. , POLSKY SARIT
Published: June 2024

Introduction: This study was a cost minimization analysis of CGM use versus self-monitoring of blood glucose (SMBG) in T1D pregnancies, inclusive of NICU admission costs.

Methods: Costs of guideline recommended CGM device use and CGM device training, daily glucose finger sticks, and NICU admissions were identified in the literature and inflated to 2023 US dollars. In a base-case scenario, seven daily finger sticks were assumed for both groups in accordance with ADA guidelines for diabetes management in pregnancy. Proportion of births requiring NICU admissions, mean length of NICU stays, and frequency of CGM use were identified in a US retrospective study of the clinical effectiveness of CGM versus SMBG in T1D pregnancies at the Barbara Davis Center for Diabetes (Triple C Study). A scenario analysis assuming costs of real-world CGM device use and real-world frequency of SMBG testing was also conducted.

Results: In the base-case scenario, per-person costs of CGM and SMBG during T1D pregnancy including costs of NICU admissions were US $14,662 and $13,127, respectively. In the scenario analysis, per-person costs of CGM and SMBG were US $12,116 and $12,468, respectively.

Conclusion: The increased cost of CGM use in T1D pregnancies is largely offset by a reduced rate of NICU admissions in a US clinical setting. CGM use in T1D pregnancies is cost-saving when assuming real-world use and frequency of SMBG testing.

Disclosure

M.J. DiStefano: None. R. McQueen: Consultant; Provention Bio, Inc., Genentech, Inc. Advisory Panel; Merck & Co., Inc. V. Gao: None. J.K. Snell-Bergeon: None. M.P. Klein: None. S. Polsky: Other Relationship; diaTribe. Research Support; Dexcom, Inc., Hemsley Charitable Trust, Juvenile Diabetes Research Foundation (JDRF), Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

Dexcom, Inc.; NIH/NCRR Colorado CTSI (UL1 RR025780)
1949-LB: Clinical Characteristics and Dosing Patterns of Tirzepatide among Adults without Type 2 Diabetes—Real-World Results
Authors: HUNTER GIBBLE THERESA , CHINTHAMMIT CHANADDA , WARD JENNIFER , CAPPELL KATHERINE , SEDGLEY ROBERT , BONAFEDE MAC , LIAO BIRONG , HANKOSKY EMILY R.
Published: June 2024

Objective: Tirzepatide is a once weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist approved for treatment of type 2 diabetes (T2D) and obesity. This study aimed to understand characteristics and dosing patterns of tirzepatide in adults without T2D in a real-world setting.

Methods: This retrospective, descriptive, cohort study utilized the Veradigm EHR database linked with claims. The first tirzepatide prescription (National Drug Code for Mounjaro®) between May 13, 2022 and Aug 31, 2023 was the index date. Tirzepatide was only approved for the treatment of T2D during the index period, therefore any use of tirzepatide by individuals without T2D during this time was off-label and solely at the discretion of their prescribing physician. Patient characteristics and 6-month (mo) follow-up dosing patterns were assessed among anti-obesity medication eligible [BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with ≥1 weight-related comorbidity] adults with no history of T2D diagnosis or medications (except metformin); all were required to have 12-mo pre- and 6-mo post-index claims enrollment.

Results: 3,470 adults without T2D diagnosis or medications (except metformin) initiated tirzepatide. The majority were female (76%), Caucasian (50%), mean age 45 yrs, mean BMI 35.8 kg/m2 (n=1955), and mean weight 231.8 pounds (n=1985). 77% of adults had ≥1 obesity-related comorbidity with hypertension (41%), dyslipidemia (40%), and prediabetes (29%) being the most common. At initiation (n=3,470), 74% received 2.5mg, 18% 5mg, 4% 7.5mg, and 2% 10mg. At 5th prescription fill (n=849), 17% were receiving 2.5mg, 36% 5mg, 25% 7.5mg, 14% 10mg, 6% 12.5mg, and 2% 15mg.

Conclusion: Real-world evidence suggests by the 5th prescription fill, the majority of adults receiving tirzepatide without T2D were receiving doses less than 10mg and may not be titrating up to maximum tolerated doses (10mg or 15mg) from the clinical trial program.

Disclosure

T. Gibble: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. C. Chinthammit: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. J. Ward: Employee; Eli Lilly and Company. K. Cappell: Employee; Veradigm, Chicago, IL, USA. R. Sedgley: None. M. Bonafede: Employee; Veradigm. Other Relationship; Moderna, Inc. B. Liao: Employee; Eli Lilly and Company. E.R. Hankosky: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company.
1960-LB: A 3D Analysis of CD8+ Leukocytic Infiltration in Human Endocrine and Exocrine Pancreas at Type 1 Diabetes Onset
Authors: RIPPA ALEXANDRA , DROTAR DENISE M. , POSGAI AMANDA , HULME MAIGAN A. , WASSERFALL CLIVE , KUSMARTSEVA IRINA , CAMPBELL-THOMPSON MARTHA , ATKINSON MARK A.
Published: June 2024

Introduction: Elevations in immune cell numbers are well documented in both the endocrine and exocrine pancreas in type 1 diabetes (T1D), with CD8+ T cells representing the predominant cell type in islet inflammation (insulitis). To expand on previous 2D characterizations, we used 3D light sheet fluorescent microscopy (LSFM) to quantify CD8+ cells within islets and surrounding exocrine regions.

Methods: Pancreas samples from non-diabetic controls (ND, n = 4; age range 16-24 yr), non-diabetic GAD autoantibody-positive (GADA, n = 3; 18-24 yr), and recent-onset (duration <2 yr) T1D subjects (n = 4; 3-26 yr) were fixed, stained for insulin (INS), glucagon (GCG) and CD8a, cleared and imaged using LSFM. A mean tissue volume of 4.3x108 µm3 per donor was analyzed using Imaris. We generated 3D surfaces (INS+ and GCG+ signals) and 3D spots (CD8a+ cells), with analysis of 516 total islets (201 ND, 162 GADA, 153 T1D). Endocrine pancreas infiltration was quantified using CD8a spots contacting and inside islet surfaces. To assess exocrine infiltration, CD8a spots outside of the islets were quantified. Fold change and mean ± SEM values were analyzed by one-way ANOVA with Tukey's post-test.

Results: T1D donors had significantly increased CD8a+ cells in exocrine (5.5-fold more than ND, 3.6-fold more than GADA, p<0.05) and endocrine pancreas (13-fold more than ND, 12-fold more than GADA, p≤0.02). The percentage of islets containing at least one CD8a+ cell was also increased in T1D (64 ± 0.02%, p<0.05) vs ND (28 ± 0.06%) and GADA (23 ± 0.08%). The maximum number of CD8a+ cells per islet was higher in T1D (133.5 ± 40.5, p≤0.02) vs ND (7.5 ± 2.3) and GADA (10 ± 2.3).

Conclusion: This 3D analysis of the human pancreas provides a comprehensive view of immune cell distribution in T1D, enabling quantification of infiltration throughout the exocrine and endocrine compartments. Such efforts will advance our ability to identify the pathogenic mechanisms underlying pancreatic inflammation in T1D.

Disclosure

A. Rippa: None. A. Posgai: None. M.A. Hulme: None. C. Wasserfall: None. I. Kusmartseva: None. M. Campbell-Thompson: None. M.A. Atkinson: None.
1961-LB: Evaluation of Two Behavioral Economic Interventions for Youth with Type 1 Diabetes—A Randomized Controlled Trial
Authors: TSAI SARAH , MCDONOUGH RYAN , PATTON SUSANA R. , DEWIT EMILY L. , SPARTZ BRITANEY , WILLIAMS DAVID D. , LOCKEE BRENT , CLEMENTS MARK A.
Published: June 2024

Introduction & Objective: Mealtime insulin dosing behavior is critical to glycemic control in youth with type 1 diabetes (T1D). Behavioral Economic Incentives (BEI) have been shown to improve self-management behaviors. We report interim results of a randomized trial evaluating 2 forms of a BEI to improve mealtime insulin dosing in youth with T1D.

Methods: We recruited youth with T1D with current A1C >7.2%, and/or predicted to have a 90-day rise in A1C of 0.3% via machine learning-based model. Subjects were randomized into 3 groups: COIN2DOSE (C2D) - uses positive financial incentives to promote mealtime insulin use, with weekly bonuses for sustained meal dosing; LOAN2DOSE (L2D) - uses a loss aversion approach to promote mealtime insulin use; or control. The potential financial compensation was equal for C2D and L2D over the 12-week intervention period.

Results: To date, 32 youth have enrolled and 24 have completed the study [mean age= 14.8±1.4 years, mean T1D duration= 7.1± 3.2 years, mean A1C=8.9±1.6%, 58% female, 9 C2D, 6 L2D, 9 control]. At baseline, there were no differences in A1C, time in range (TIR), or mealtime insulin use (BOLUS) by group. Mean BOLUS score showed a non-statistically significant increase from 0.93±0.93 to 1.3± 0.92 in C2D baseline to post-treatment, which was sustained at 6-months post-baseline (p=0.64). Mean BOLUS score increased from 1.1±0.1to 1.4±1.0 in L2D baseline to post-treatment but decreased to 0.86±0.15 at 6-months post-baseline (p=0.82). The control group BOLUS score increased from 1.3±1.0 to 1.4±0.9 at post-treatment and 1.5±0.78 at 6-months post-baseline (p=0.86). Across groups, there were no changes in TIR and A1C at post-treatment or 6-months post-baseline.

Conclusion: Preliminary results suggest that either positive financial incentives or loss aversion may be associated with short-term improvement in mealtime insulin use, but not A1C or TIR. We continue the trial to enable more testing of group differences and long-term impact.

Disclosure

S. Tsai: Stock/Shareholder; Dexcom, Inc. R. McDonough: Speaker's Bureau; Provention Bio, Inc. S.R. Patton: None. B. Spartz: None. D.D. Williams: None. B. Lockee: None. M.A. Clements: Research Support; Abbott. Consultant; Glooko, Inc. Research Support; Dexcom, Inc.

Funding

Helmsley Charitable Trust
1964-LB: Association between Fasting Venous Lactate Level and Development of Preeclampsia in Pregnant Individuals with Gestational Glucose Intolerance
Authors: PURVIS REBECCA , VAN NES JACLYN , ZITE NIKKI , REEDER CALLIE , MASTRONARDI ALICIA , OYEDEJI OLUWAFEMIFOLA , BROSKEY NICHOLAS T. , MAPLES JILL M.
Published: June 2024

Introduction & Objective: Pre-eclampsia (PE) is a hypertensive disorder in pregnancy thought to result from abnormal vascular placentation that is associated with metabolic dysfunction. Blood lactate is also associated with metabolic dysfunction. Few studies have explored if lactate is associated with PE. The purpose of this pilot prospective cohort study was to determine if blood lactate is higher among patients with GGI (i.e. an abnormal screening glucose tolerance test (GTT) between 24-28 weeks gestational age) that subsequently developed PE.

Methods: Participants were included if they had GGI and fasting lactate collected during standard 100g GTT. Fasting venous blood was collected to determine lactate, insulin, and glucose and HOMA-IR was calculated. Chi-square, t-test, and Mann-Whitney U analyses were performed to assess differences between groups (PE vs no PE) and binary logistic regression analysis assessed for differences in lactate, to control for pre-pregnancy BMI.

Results: A total of 106 individuals were included in our analysis. Of these, 14 (13%) developed PE and 92 (87%) did not. There were no differences in fasting glucose, insulin, or HOMA-IR between groups. Median fasting lactate level was higher among those who developed PE (1.05mmol/L IQR 0.20 vs 0.9 mmol/L IQR 0.18, p=0.053) and was a significant predictor of PE after controlling for pre-pregnancy BMI (p=0.047).

Conclusion: Our study highlights evidence that fasting venous lactate levels are elevated in pregnant persons with GGI who subsequently develop PE in pregnancy. Future studies should attempt to identify why individuals who develop PE with GGI have increased fasting venous lactate levels.

Disclosure

R. Purvis: None. N. Zite: None. A. Mastronardi: None. O. Oyedeji: None. N.T. Broskey: None. J.M. Maples: None.
1974-LB: Impact of Maternal Hyperglycemic and Hypertensive Disorders on Adverse Pregnancy Outcomes across the COVID-19 Pandemic—A Comprehensive Analysis in an Underserved Population
Authors: ZHANG LIXIA , SHEN YUN , HU GANG
Published: June 2024

Objective: To evaluate the impact of COVID-19 on the associations between maternal hyperglycemic and hypertensive disorders and adverse pregnancy outcomes.

Methods: This retrospective study included 110,447 Louisiana Medicaid pregnant women with first-time delivery between January 1, 2016, to December 31, 2021. Adverse pregnancy outcomes were collected through Medicaid claim data. Logistic regression adjusted for maternal age and race and ethnicity, with additional interaction analyses were used.

Results: Participants delivered during early and late COVID-19 pandemic had significantly higher risk of these adverse pregnancy outcomes except preterm birth compared with before the pandemic. The incremental risk of preterm birth associated with HDP during late pandemic is not significant (P > 0.10) as well as LGA (P > 0.25; P > 0.10) and macrosomia (P > 0.50; P > 0.10) during early and late pandemic. Participates with pre-existing hypertension delivered during late pandemic had no significant risk of preterm birth (adjusted OR, 1.09 [95% CI 0.86-1.36]). Individuals with normal blood pressure delivered during early pandemic and with preeclampsia or eclampsia delivered during late pandemic had higher risk of LGA (adjusted OR, 1.32 [95% CI, 1.19-1.47]; 1.56 [95% CI, 1.15-2.10]) and macrosomia (adjusted OR, 1.31 [95% CI, 1.18-1.45]; 1.55 [95% CI, 1.16-2.08]). Participates with gestational hypertension and pre-existing hypertension delivered during late pandemic had no significant risk of LGA (adjusted OR, 1.22 [95% CI, 0.86-1.73]; 1.24 [95% CI, 0.88-1.76]) and macrosomia (adjusted OR, 1.27 [95% CI, 0.91-1.77]; 1.18 [95% CI, 0.84-1.67]).

Conclusions: In this large population-based study, associations between hyperglycemic and hypertensive disorders in pregnancy and adverse pregnancy outcomes including preterm birth, LGA and macrosomia varied by COVID-19 pandemic periods.

Disclosure

L. Zhang: None. Y. Shen: None. G. Hu: None.

Funding

This study is supported by the grant from the Public University Partnership Program at the Louisiana Department of Health, Bureau of Health Services Financing. Dr. Hu is partially supported by the grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK132011) and the National Institute of General Medical Sciences (U54GM104940).
1978-LB: Sleep Duration during Pregnancy and Cardiometabolic Biomarkers—A Multiracial Pregnancy Cohort
Authors: CHEN ZIYUAN , YU GUOQI , YIN XIN , ZHANG CUILIN
Published: June 2024

Introduction & Objectives: Adequate sleep is crucial for maintaining cardiometabolic health, yet its association with cardiometabolic biomarkers during pregnancy remains unclear and inconclusive.

Methods: The study was based on data from a case-control study (N=321) nested in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort (N=2802). Sleep durations were longitudinally assessed by standard questionnaires from early pregnancy through delivery (visit 0: 8-13 gestational weeks (GWs), visit 1: 16-22 GWs, visit 2: 24-29, and visit 4: 34-37 GWs) and categorized into three groups (≤ 6 hours, 7-8 hours, ≥ 9 hours). Plasma cardiometabolic biomarkers, including glucose, insulin, HbA1c, C-peptide, HOMA-IR and C-reactive protein, were measured at the four study visits. Linear mixed models, incorporating both weight and paired stratum, were adopted to estimate associations between sleep duration and cardiometabolic biomarkers, adjusting for potential confounders.

Results: The proportion of participants with sleep duration ≤ 6 hours increased from 15.1% at study visit 0 to 39.6% at visit 4. At study visit 0, women who slept less than 6 hours had higher HbA1c levels than those who slept longer (β = 0.033, 95% CI=0.008, 0.056). Sleep duration ≥ 9 hours at visit 1 was positively associated to insulin level (β =0.208, 95% CI=0.002, 0.415). Besides, compared with sleep 7-8 hours, sleep duration ≥ 9 hours at study visit 2 was significantly and inversely associated with HbA1c, with β= -0.037 (95% CI= -0.070, -0.004), whereas positive association of sleep duration ≤ 6 hours with glucose level was observed at visit 2 (β = 0.153, 95% CI=0.027, 0.279).

Conclusion: Our findings highlight positive associations between less sleep duration and cardiometabolic biomarkers such as glucose and HbA1c at early-mid pregnancy. An adequate sleep may be essential for maintaining cardiometabolic health among pregnant individuals.

Disclosure

Z. Chen: None. G. Yu: None. X. Yin: None. C. Zhang: None.
1982-LB: Prevalence of Autoimmune Antibodies Associated with LADA in Patients Treated with Type 2 Diabetes
Authors: LOMELI LAURA D. , LUNDHOLM MICHELLE D. , XIAO HUIJUN , ZHOU KEREN , PANTALONE KEVIN M.
Published: June 2024

Introduction & Objective: Prevalence of latent autoimmune diabetes in adults (LADA) is estimated at 3-28.5%. We aim to assess LADA prevalence by measuring a complete panel of autoimmune antibodies (AAbs) in a community-based population of patients (pts) with type 2 diabetes (T2D), managed by endocrinology (Endo) vs primary care providers (PCP).

Methods: This single-center prospective study enrolled 202 adults with T2D without a history of LADA: 100 PCP and 102 Endo pts. AAbs were tested by ELISA: Glutamic Acid Decarboyxlase-65, anti-islet cell, Insulinoma Associated 2, Zinc Transporter 8, and anti-insulin.

Results: Overall, 14% (N=27) of pts tested positive (pos) for AAbs; 16% Endo vs 11% PCP pts (P=0.31). Other differences in Endo vs PCP pts are summarized in Table 1a. After excluding pts pos for only anti-insulin ab (N=12), insulin use was higher in pts AAb pos vs neg (53% vs 18%, P=0.004). There were no other significant differences in BMI, A1c, nor diabetes complications between pts AAb pos vs neg (Table 1b).

Conclusion: AAbs were detected in 14% of pts with T2D; no difference was observed between Endo vs. PCP pts. After excluding pts pos for only anti-insulin ab, just 8% tested pos for at least one AAb. Future studies are needed to evaluate the prevalence of AAbs at the onset of T2D, with longitudinal monitoring for AAb development, to better understand the pathogenesis and significance of identifying LADA among pts with T2D.

Disclosure

L.D. Lomeli: None. M.D. Lundholm: None. H. Xiao: None. K. Zhou: None. K.M. Pantalone: Speaker's Bureau; AstraZeneca. Consultant; AstraZeneca. Board Member; Bayer Inc. Research Support; Bayer Inc. Speaker's Bureau; Corcept Therapeutics. Consultant; Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc. Speaker's Bureau; Merck & Co., Inc. Research Support; Merck & Co., Inc. Consultant; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Twin Health. Consultant; Sanofi.

Funding

This study was funded from philanthropic donations made possible by generous donors and an internal granting mechanism: Caregiver Catalyst GrantsInternal (Grant # CCG0178)
1987-LB: Limitations of Artificial Intelligence Research in Predicting Type 2 Diabetes Macrovascular Complications—A Scoping Review
Authors: NUR AQSHA , HARBUWONO DANTE
Published: June 2024

Over 500 million people were estimated to live with diabetes in 2021, of which 96% were type 2. This leads to various complications, among which are macrovascular diseases (e.g., stroke and coronary heart diseases). As complications increase the 5-year mortality of patients, curbing their progression through early prediction and intervention is key. This scoping review explores the characteristics of current research on how artificial intelligence, including machine learning algorithms, has been utilized to predict diabetes macrovascular complications. In adherence to PRISMA-ScR guidelines, we systematically searched PubMed, Google Scholar, Scopus, IEEE Xplore, EMBASE, and Wiley for relevant literature up to 12 December 2023. Out of the 1,667 hits screened, 52 studies cumulating 7,510,245 people with type 2 diabetes are included. We found 43 studies from HICs/UMICs, in contrast to 9 from LMICs/LICs. 30 studies came from North America and Europe regions, while others from Asia and Australia. Of all macrovascular complications, cardiovascular diseases (e.g., coronary heart disease) have been the most investigated outcome. According to the features of the models, only 12 studies employed non-laboratory features as predictors, while the remaining studies applied solely laboratory (n=2) or mixed (n=38) features, signalling the lack of AI capability for history-taking and physical examination data alone, which are mostly available in low-resource settings. While artificial intelligence is promising in predicting diabetes complications, future studies should explore accessible features in low-resource settings and employ external validation. A systematic review and meta-analysis exploring the performance metrics of a variety of algorithms should be done.

Disclosure

A. Nur: None. D. Harbuwono: None.