bluuebunny/crossref_metadata_2025 huggingface dataset:
ODP266 Deficiency of Calcitriol and Sex Hormones, Which Leads to a Severe Course of Psoriasis
Authors: Samburskaya Olga , Svetlana Kalinchenko , Batkaeva Nadejda
Published: November 2022

Materials and methods

The study group consisted of 17 patients with psoriasis from 19 to 76 years. All patients underwent studies to determine the body's vitamin D supply by its metabolite calcidiol 25(OH)D by enzyme immunoassay and to determine the level of steroid hormones by the steroid profile of saliva by mass spectrometry: progesterone, testosterone, estradiol.

Results

Vitamin D insufficiency was detected in 9 patients (n=9, 52.9%), the average level was 24.3±0.96 ng/ml. Vitamin D deficiency was observed in 3 patients (n=3, 17.7%), the average level was 16.6±1.634 ng/ml. Adequate vitamin D levels was detected in 5 patients (n=5, 29.4%), the average level was 34.56±1.955 ng/ml. In all patients (n=17, 100%), psoriasis was in a progressive stage, PASI more than 20 points – severe psoriasis. When evaluating the steroid profile of saliva in 7 patients (n=7, 41.2%) the level of progesterone was below the reference values (reference values 80-180 pg/ml), average level 56.86±6.53 pg/ml. In 11 patients (n=11, 64.7%), including 7 patients with progesterone deficiency plus 4 patients whose progesterone levels are within the reference values, have the level of testosterone was below the reference values (reference values from 114.8 pg/ml) the average level 51.93±9.5 pg/ml.

Discussion

Considering steroidogenesis [1], even though only 4 (n=4, 23.5%) patients had estradiol levels below reference values (reference values 4.17-9.28 pg/ml), we conclude that estradiol deficiency was observed in at least 11 patients (n=11, 64.7%). Also, knowing the effect of vitamin D on steroidogenesis (increases the expression of the 3b-HSD gene, thereby increasing progesterone synthesis [2]), thus we already know that if a patient is vitamin D insufficient or deficient, even when within the reference values, progesterone levels will not be sufficient for this individual, and therefore there will be testosterone and estradiol deficiency. It follows that another 8 patients with vitamin D insufficiency or deficiency will have progesterone deficiency, that is, out of 17 patients, 15 (n=15, 88.2%) have progesterone deficiency and, therefore, testosterone and estradiol deficiency. In enzyme immunoassay vitamin D determination, a cross-reaction occurs with another metabolite - 24.25(OH)D, whose concentration is up to 20% of the total calcidiol concentration. Therefore, it is necessary to subtract up to 20% from the data obtained in order to determine the true level of 25(OH)D [3], which means that all patients have vitamin D deficiency. Estrogens enhance the synthesis and effects of 1,25(OH)D, through an increase in the expression of the CYP27B1 (1α-hydroxylase) gene and VDR [4].

Conclusion

The sufficient intake of vitamin D and a sufficient level of calcidiol, the intensity of the synthesis of the hormonal form of vitamin D and the realization of its effects depend on several factors, which include a sufficient level of sex hormones.

Presentation: No date and time listed
ODP542 Challenging Management of Fasting Hypoglycemia in a Patient With Pancreatic Neuroendocrine Tumor and Lupus Nephritis
Authors: Alba Rebecca , Go Hanah , Joven Mark
Published: November 2022

Background

Derangements of calcium metabolism are common in patients with cancer.1 Unlike hypercalcemia which is well-recognized, little is known about hypocalcemia of malignancy.2 In fact, there were only 2 studies published to date that investigated its incidence among cancer patients. 2,3 Clinical Case: A 40-year-old male consulted an ENT specialist for a 2×2 cm left parotid mass of 3 years duration. There was no fever, cough, night sweats or significant weight loss. Histological analysis of the mass revealed parotid gland adenocarcinoma. Tumor metastases to lung and spine were seen on PET CT scan. Consequently, he received 18 cycles of chemotherapy and 10 sessions of radiotherapy without surgery because of the advanced stage. He initially exhibited good response with the treatment. A year after, he developed shortness of breath, numbness of hands with seizure episode. Chest x-ray showed pleural effusion and osteoblastic changes while cranial CT scan revealed brain metastasis. Bone scintigraphy was evident for multiple osseous metastases. He underwent stereotactic brain surgery, and thoracentesis with pleural fluid analysis consistent with malignancy. Biochemical tests were remarkable for hypocalcemia (0.99, n>1.12 mmol/L, normomagnesemia (0.89, n>0.74 mmol/L), low vitamin D (11.6, n>30 ng/mL), elevated phosphate (1.73; n: <1.49 mg/dL), and elevated intact PTH which eventually dropped (157.7 to 9, n>15 pg/mL). Ultrasound of the neck revealed diffuse thyroid calcifications. Despite oral calcium supplementation (14.4 grams elemental calcium), calcium infusion (1.35 mg/kg/hour elemental calcium) and vitamin D supplementation (6000 IU cholecalciferol and 0.5 mg calcitriol daily), he remained hypocalcemic. His condition eventually worsened, and he succumbed to death in due course despite aggressive measures provided.

Conclusion

To our knowledge, this is the first case illustrating the therapeutic challenge in addressing an intractable hypocalcemia in the setting of an advanced parotid carcinoma in our country.Reference: (1)Carl Blomqvist. A Hospital Survey of Hypocalcemia in Patients with Malignant Disease. Acta Med Scand. 1986;220. (2) Schattner et al. Hypocalcaemia of Malignancy. The Netherlands Journal of Medicine. July 2016, Vol. 74, No. 6. (3) Goncalves. Hypocalcemia in cancer patients: An exploratory Study. Porto Biomed. J. (2019) 4: 4

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP589 Acute Hypercalcemic Crisis in an Elderly with Granulomatous Disease
Authors: Capellan Maria Leonora , Tiu JR Leo
Published: November 2022

We present here a case of an 81 year old female who developed changes in neurologic status due to elevated serum calcium levels in the setting of an elevated Vitamin D and low-normal parathyroid hormone level. Upon evaluation of PTH-independent causes of hypercalcemia, she was noted to have Tuberculosis. Anti-Koch's and steroids were initiated on top of vigorous hydration and diuresis which lead to improvement in the patient's serum calcium levels and clinical status. Tuberculosis rarely leads to clinically significant hypercalcemia. However, elderly patients remain predisposed due to advanced age, multiple comorbidities and polypharmacy. Hypercalcemia is a life threatening condition, but with prompt diagnosis and management it portends excellent outcomes.

Presentation: No date and time listed
OR01-6 Bone Health Outcomes Post-Lung Transplantation in Cystic Fibrosis Patients
Authors: Li Xilong , Maalouf Naim , Tran Triet Vincent
Published: November 2022

Background

Osteoporosis is a common comorbidity in patients with cystic fibrosis (CF); malabsorption, chronic glucocorticoid use, and chronic inflammation all contribute to increased bone resorption and decreased bone formation. Although lung transplantation (LTx) improves quality of life and short- and long-term outcomes of CF patients, there is little research examining long-term bone health outcomes following LTx in these patients.

Methods

We collected demographic and clinical data on patients who underwent LTx at a single institution between 2006-2019 and had bone mineral density (BMD) measured pre- and post-transplantation. We compared baseline characteristics, long-term BMD trends, and fracture incidence between the two patient populations. We also examined factors associated with post-LTx fractures in CF patients.

Results

Charts of 59 LTx recipients were reviewed including 30 with CF and 29 without CF. Compared with non-CF patients, patients with CF were significantly younger (32.8±10.0 vs. 56.7±10.7 years), had lower body mass index (19.7±3.0 vs. 26.7±4.4 kg/m2), and significantly lower baseline BMD Z-scores at the lumbar spine (-2.0±1.1 vs. -0.3±1.6), femoral neck (-1.6±0.8 vs. -0.7±1.0), and total hip (-1.6±0.8 vs. -0.7±1.0) (all p<0.001). BMD at all three sites declined significantly in both groups in the first year post-LTx. In subsequent years, and compared with non-CF patients, CF patients exhibited better BMD recovery relative to pre-transplantation, but continued to have lower BMD post-LTx. Post-transplant fractures were relatively common, occurring in 30% and 34% of CF and non-CF patients, respectively. Within the CF group, those who developed fractures after LTx were more likely to have lower baseline BMD T-scores at the femoral neck (p=0.017) and total hip (p=0.050), and lower pre-transplantation percent predicted forced expiratory volume in 1 second (FEV1%) (p=0.042).

Conclusions

Compared with their non-CF counterparts, CF patients undergoing lung transplantation start with significantly lower BMD pre-LTx but exhibit better BMD recovery post-LTx. Despite their younger age at transplantation, CF patients experience a similarly high rate of post-LTx fractures. In CF patients, lower BMD and worse FEV1% pre-LTx are associated with development of post-LTx fractures. These findings highlight the unique contribution of the CF disease process to bone health, as well as a clear need for better prevention and treatment of osteoporosis in CF patients before and after LTx.

Presentation: Saturday, June 11, 2022 12:45 p.m. - 1:00 p.m.
PSAT194 Prolonged Hypercalcemia after Calcium Sulfate Beads Use
Authors: Pajuelo Cynthia Rivas , Tariq Sarah
Published: November 2022

Calcium sulfate beads (CSB) preparations are used for antibiotic release to prevent or treat periprosthetic infections. Transient hypercalcemia in the setting of CSB use have been reported, with most cases being mild. Here we present a case of prolonged hypercalcemia after the use of CSB

A 92-year old man with history of CKD stage is admitted to the hospital after sustaining a fall. He underwent a right femur periprosthetic fracture repair. Intraoperatively, he received 30 cc of antibiotic impregnated calcium sulfate beads into the wound. Preoperative labs showed calcium of 9.8 mg/dl, albumin 3.6g/dL, with creatinine of 1.6 mg/dl. 48-hours post-operative, patient developed acute encephalopathy, with laboratory analysis showing a calcium corrected for albumin raising up to 13.2 mg/dL, and creatinine of 1.8 mg/dl in the following days. PTH levels, PTH-rp, 25-OH Vitamin D were normal. He had no history of calcium disorders, kidney stones or pathological fractures. He was started on gentle IV fluids with normal saline, and calcitonin weight based (4 iu/kg) every 12 hours for a total of 6 doses with no improvement of calcium levels. Since he continued with persistent hypercalcemia, we decided to give 1 dose of Zoledronic Acid IV. Patient mental status improved; and calcium levels normalized along with creatinine 11 days after Zoledronic acid.

Hypercalcemia secondary to CSB is rare. The use of CSB implantation has increased by orthopedics in the last years. CSB releases 100% of its antibiotic load to improve antibiotic delivery for prevention and treatment of peri-prosthetic infections. There are only two studies evaluating the outcomes of CSB that reported hypercalcemia. In a prospective observational study involving 755 patients receiving CSB implantation, only 5.7% developed mild hypercalcemia, and 2 of them were symptomatic, requiring IV fluids and 1 dose of Bisphosphonates. Hypercalcemia can appear 1 day post-operatively and improve after 5 days. Infrequently, hypercalcemia can be moderate to severe causing symptoms as in our patient. It is important to keep in mind transient hypercalcemia with the use of CSB, especially in high-risk patients. Discussion should include alternate options to prevent peri-prosthetic infections and closer monitoring of calcium and creatinine within the first 24-48 hours of implantation. To our knowledge, this is the second case report of prolonged moderate to severe hypercalcemia.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT216 Turner Syndrome and Congenital Hypoparathyroidism
Authors: Jovanovic Filip , Lane Chelsea , Sudhakar Aboorva
Published: November 2022

Background

Patients with Turner syndrome may have multiple associated metabolic comorbidities, some of which are rare. We present a case report with Turner syndrome and congenital hypoparathyroidism.

Clinical Case

A 30-year-old Caucasian female with Turner syndrome and primary ovarian insufficiency was referred for evaluation of osteopenia and elevated TSH. On her initial visit, the patient was asymptomatic, physical exam was significant only for short stature. The DEXA scan showed a T-score of -2 at the lumbar spine and -1.8 at the femoral neck. TSH was elevated at 4.81 (0.5–5.0 mIU/L), with normal serum levels of free T3 and free T4 consistent with subclinical hypothyroidism. Patient previously underwent aortic root imaging with no evidence of dilatation. Her only home medication was a combination oral contraceptive tablet (Yaz; drospirenone and ethinyl estradiol) for primary amenorrhea. The patient was started on calcium 500 mg daily and vitamin D3 400 IU. On her next visit, patient's calcium was 8.7 mg/dL (8.6–10.6 mg/dL), phosphorus 4.4 mg/dL (3–4.3 mg/dL), albumin 3.9 g/dL (3.4–5.4 g/dL), 25-hydroxy vitamin D 63.2 ng/dL (30-100 ng/dL), 24-hour urine calcium 93 mg/day (100-300 mg/day), and PTH 20 pg/mL (15–65 pg/mL) suggestive of hypoparathyroidism. There have only been a few case reports of congenital hypoparathyroidism in patients with Turner syndrome. (1) The patient was started on calcitriol 0.25 mcg daily and her calcium was increased to 500 mg twice daily. Repeat serum calcium was 9.1 and 25-hydroxy vitamin D 75.6 ng/dL showing that the patient responded appropriately to calcium and calcitriol supplementation. In the absence of a history of neck surgery or autoimmune diseases, the etiology behind hypoparathyroidism in this patient with Turner syndrome appears to be secondary to genetic mutation.

Conclusion

We highlight the importance of measuring parathyroid hormone level in patients with Turner syndrome who exhibit symptoms or signs of osteopenia as part of diagnostic workup.

Reference

(1) Suzuki Y, Watanabe H, Haeno S, Omori T, Hiramatsu R, Asada M, Tanaka F, Maeda T, Okada M, Suzuki T, et al. Primary hypoparathyroidism in Turner's syndrome. Intern Med. 1995 Nov;34(11): 1071-3.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
LBODP033 The Compliant Patient - When Adherence Hurts
Authors: Cheah Zhen Fung , Kuan Yueh Chien
Published: November 2022

Metformin is a biguanide oral antidiabetic agent which lowers blood glucose by decreasing hepatic gluconeogenesis. In the absence of contraindications, it is the initial treatment in most patients with type 2 diabetes along with lifestyle modifications. This drug however is commonly associated with gastrointestinal side effects especially diarrhoea which could be potentially life-threatening if prolonged. We report a case of chronic severe painless diarrhoea with weight loss over 8 months in a 40-year-old man after starting metformin for his newly diagnosed type 2 diabetes. Although the diarrhoea resolved when the patient temporarily stopped taking metformin, he decided to resume the medication to ensure his blood glucose is optimally controlled. He suspected metformin to be the cause of his diarrhoea but did not report this to his doctor during follow-up. The patient was later admitted for hypovolemic shock and severe metabolic acidosis with acute kidney injury when his diarrhoea worsened with acute gastroenteritis. He required mechanical ventilation, inotropic support and Continuous Renal Replacement Therapy in the ICU. This was further complicated by left eye ischemic optic neuropathy attributed to the acute volume loss as radiological investigations were unremarkable. Multiple laboratory and radiological investigations were done to look for the cause of the diarrhoea with no underlying pathology found. Metformin was discontinued upon admission and his diarrhoea subsequently resolved 8 days later. Upon follow-up a month later, the patient continued to be diarrhoea free without metformin. This case highlights the importance of patient education on the side effects of a medication like metformin upon commencement of the drug and to encourage the patient to notify their healthcare provider timely if they experience those side effects. This not only empowers patients to participate in their own healthcare but would avoid severe drug-related adverse events that can result in unwanted long-term sequelae.

Presentation: No date and time listed
LBODP039 Glycogenic Hepatopathy- An Underrecognized Complication Of Diabetes
Authors: Chamakkala Tess , Silparshetty Santh
Published: November 2022

Introduction

Glycogenic hepatopathy (GH) is an infrequently described complication of predominantly type 1 diabetes characterized by liver dysfunction and hepatomegaly. This condition is different from the more common nonalcoholic fatty liver disease (NAFLD) which is clinically indistinguishable. Liver biopsy is currently the only way to differentiate the two conditions. We present a 19 year old female with persistent transaminasemia secondary to glycogenic hepatopathy associated with poorly controlled type 1 diabetes.

Case Description

A 19 year old female was admitted with DKA secondary to facial cellulitis. She had a past history of poorly controlled type 1 DM since age 9, proteinuria, and transaminasemia since age 14. Initial labs showed elevated plasma glucose 365 mg/dL, bicarbonate 15 mEq/L, anion gap 22, positive betahydroxybutyrate, AST 208 mmol/L, ALT 136 mmol/L, and HbA1c 12. 0%. She was successfully resuscitated from DKA. Repeat liver function tests showed further elevation of AST 819 mmol/L and ALT 346 mmol/L. Ultrasound of liver showed increased echotexture reported as steatosis. Further history revealed significant financial difficulty due to which patient was using different kinds of basal and bolus insulins interchangeably. She would sometimes use bolus insulin to cover for lack of basal insulin. Prior gastroenterology workup showed ANA positivity in a speckled pattern but was otherwise unrevealing for infective, autoimmune, or alcoholic hepatitis. Liver biopsy was therefore recommended by inpatient gastroenterology. Liver biopsy revealed spotty mild lobular hepatitis and focal portal fibrosis consistent with glycogenic hepatopathy. Features of autoimmune hepatitis were not seen in liver biopsy.

Discussion

Glycogen hepatopathy seems to represent an acquired form of glycogen storage disorder. Pathophysiology is suspected to be a combination of hyperglycemia and hyperinsulinemia leading to increased glycogen accumulation in hepatocytes while glycogenolysis is suppressed. This mechanism seems to correlate with our patient who reported use of large doses of short acting insulin followed by glucose administration to counteract hypoglycemia. Abnormal glucagon activity or enzymes deficiencies in glycogenolysis pathway (as reported with congenital glycogenstorage disorders) have not been elucidated. Recent data has also questioned reversibility and long term safety as liver biopsies of patients with glycogenic hepatopathy have demonstrated varying degrees of fibrosis. Newer MRI protocols seem to be able to distinguish GH from NAFLD, and this is important as these are pathophysiologically distinct and will have different management strategies. This case highlights glycogenic hepatopathy as an underrecognized complication of diabetes that will require improved recognition and further investigation to evaluate long term consequences.

Presentation: No date and time listed
LBODP040 Positive Early Glucola Screening: Who Has Gestational Diabetes?
Authors: Class Madelyn , Sharma Ankita , Durgham Ryan , Anasti James N
Published: November 2022

This study set out to determine risk factors most predictive of early GDMA review was conducted of patients with positive early 1HR glucola screenings (≥135 mg/dL and reflex 3hr GTT before 20 weeks). Characteristics (comorbidities, family history, demographics) of patients who were diagnosed with early GDM were compared to those who were not. A multiple logistic regression model was constructed to compute adjusted odds ratios (aORs) for each covariate. Among 189 early GDM positive (BMI 36.1 ± 8.27; Age 32.7 ± 5.50) and 153 GDM negative (BMI 33.8 ± 7.24; Age 30.8 ± 5.45) patients were identified, the adjusted odds of developing GDM increases by: 6.7% (CI 1. 01-1.12; p 0. 01) or 4.5% (CI 1. 01-1. 08; p 0. 02) with a one unit increase in age or BMI, respectively. The aORs of developing GDM are 2. 0 (CI 1.24-3.26, p 0. 005), 3. 0 (CI 1.64-5.66; p 0. 0005), and 3.7 (CI 1.96-8.78, p 0. 0003) with family history of diabetes, prior history of GDM, or history of hypertension, respectively. This study was unique in that hypertension had the highest association with early GDM. Thus, individuals with HTN regardless of age, BMI, prior GDM, family history should receive an early glucola screen.

Presentation: No date and time listed
LBODP044 Effects Of Dietary Supplementation On Progression To Type 2 Diabetes Single Center Randomized Double-blind Placebo-controlled Trial An Interim Analysis At 24 Weeks
Authors: Chattieng Preeyapat , Nasomphan Tiersidh , Sathirakul Korbtham , Niramitmahapanya Sathit
Published: November 2022

Objectives

To examine the effect of dietary supplements on diabetic risk, blood glucose level and lipid profiles.

Methods

A randomized, double-blinded, placebo-controlled study was conducted at Rajavithi Hospital. Participants with prediabetes were randomly allocated to three arms of dietary supplements: placebo (PL) or curcumin plus fish oil and vitamin D (CFD), or curcumin plus fish oil (CF) for 24 weeks. Primary outcomes of the trial were progression to overt diabetes and glycemic indices (fasting plasma glucose, 75-g OGTT 2-h plasma glucose or HbA1C). Secondary outcomes were body weight change, BMI and lipid profiles.

Results

A total of forty-seven participants (PL, n = 16; CFD, n = 15; CF, n = 16) were included in the study. At 24 weeks, the intervention groups significantly lowered the progression of type 2 diabetes among prediabetes individuals, the interventions groups -0.77 ± 1.17, and 0.19 ± 1.28, the placebo group 0.64 ± 1.82, P value = 0. 046 (P<0. 05). However, the results failed to demonstrate the effect of dietary supplements on weight, BMI and blood chemistries.

Conclusion

The combined dietary supplements which contained curcumin-fish oil-vitamin D, lowered the risk of prediabetes progression to overt diabetes at six months follow up and well-tolerated among the participants. Keywords: dietary supplements, curcumin, fish oil, vitamin d, prediabetes

Presentation: No date and time listed
LBODP046 Reduction In "Cardiovascular Death Or Hospitalisation For Heart Failure" With Sglt-2is Is Dependent On Weight Reduction: A Meta-regression Analysis
Authors: Ghosal Samit , Sinha Binayak , Kar Partha
Published: November 2022

Aims

The modern management of type 2 diabetes (T2D) has shifted focus from a "glucocentric" approach to one that focuses on outcomes reduction. As a result, the aim of management is skewed toward specific molecules like sodium glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide receptor agonists (GLP1-RAs) associated with microvascular and macrovascular benefits. The aim of this meta-regression analysis is to assess whether these molecule specific results are dependent or independent of associated metabolic benefits.

Methods

A web-based search identified five citations for the analysis. The meta-analysis was conducted on a pooled population of 46,969 patients with 26,765 patients in the SGLT-2is arm and 20,204 participants in the placebo arm. A two-step approach to analysis was planned. The first step included a meta-analysis of the cardiovascular death or hospitalization due to heart failure (CV death or hHF) end point using the random effects model to identify significant heterogeneity of the effect size. If identified, the second step would involve conducting a meta-regression analysis using three moderators (HbA1c, weight, and systolic blood pressure) to identify the co-variate explaining this heterogeneity.

Results

The pooled effect size of the CV death or hHF endpoint was associated with significant heterogeneity (Q: 8. 06, df: 4, I2: 50.44, p=0. 09). The model using HbA1c difference (p=0.17) between the two groups or difference in SBP (p=0.86) did not explain the variance in the observed effect size. However, the difference in weight between the SGLT-2is and placebo group correlated significantly with the variance in CV death or hHF effect size (95% CI 0. 05-0.32, p=<0. 01). The relationship between weight differential and CV death of hHF reduction is given by the formula, Y=-0.5441+0.1883*Weight difference.

Conclusion

The reduction in CV death or hHF with SGLT-2is is not an exclusive molecule-specific effect but dependent on weight reduction.

Presentation: No date and time listed
LBSUN206 Provider Prescribing Habits And Use Of Newer Agents For Type 2 Diabetes In A Large Multicenter Health Care System
Authors: Yaseen Aseel , Lahiri Sharon
Published: November 2022

Introduction

Type 2 diabetes (T2D) management approaches have evolved, with current algorithms recommending early use of newer agents such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) when cardiovascular (CV) and renal disease are present. National prescribing data indicate stable metformin use and a decline in sulfonylurea use; prescriptions for newer agents have increased but remain low. High cost, difficulty with prior authorization, and insufficient experience have been proposed as reasons why newer agents are not prescribed more often. Our aims were to determine providers’ prescribing habits and use of newer agents for T2D in our health care system and to identify the factors influencing prescribers’ choice of medications and the barriers to prescribing GLP-1 RAs and SGLT2i.

Methods

This study was conducted at a large multicenter health care system. Health care providers were asked to complete an anonymous online survey. The survey was sent to 515 providers (357 primary care physicians, 26 nephrologists, 113 cardiologists, and 19 endocrinologists).

Results

There were 125 respondents (24%): 81 (64.8%) in primary care, 22 (17.6%) in cardiology, 13 (10.4%) in endocrinology, and 9 (7.2%) in nephrology. All respondents in endocrinology and primary care, 45.5% in cardiology, and 66.7% in nephrology prescribed T2D medications. Metformin, SGLT-2i, and insulin were prescribed most frequently (76.8%, 78.4%, and 73.4%, respectively), followed by GLP-1 RAs (66.9%), DPP-4 inhibitors (43.9%), sulfonylureas (35.5%), and thiazolidinediones (8.9%). After metformin, SGLT-2i (57.6%) and GLP-1 RAs (55.2%) were most frequently chosen as second-line T2D medications. The top perceived benefits of using GLP-1 RAs and SGLT2i were improvement of hemoglobin A1c and decreased comorbidity risks. Most respondents also chose "to minimize weight gain/promote weight loss" as a benefit of GLP-1 RA use and "mortality benefit" as a benefit of SGLT-2i use. High cost and problems with prior authorization were the primary perceived barriers to prescribing GLP-1 RAs and SGLT-2i. Over half felt that the need to inject was a barrier to GLP-1 RA use, and concern for adverse reactions was a barrier to SGLT-2i use. Cardiology and nephrology specialists viewed limited experience as a barrier to prescribing GLP-1RAs.

Conclusions

At our health system, practices for prescribing T2D therapies were in accordance with published algorithms that recommend early use of GLP-1 RAs and SGLT-2i. High cost and need for prior authorization were the main perceived barriers to prescribing newer agents. Limited experience with newer agents was a barrier for nephrologists and cardiologists. Education on patient assistance programs, insurance formularies, and how to incorporate GLP-1RAs and SGLT-2i for CV and renal benefits may increase the use of these agents.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN215 Evaluation Of Glycemic Control By Continuous Glucose Monitoring Among Hospitalized Older Adults With Type-2 Diabetes And Frailty
Authors: Idrees Thaer , Zabala Z E , Moreno E M , Gerges A , Urrutia M A , Ruiz J G , Vaughan C , Vellanki P , Pasquel F J , Peng L , Umpierrez G E
Published: November 2022

Recent observational and meta-analyses have reported a frailty prevalence between 10% and 25% in people with diabetes, in particular in those older than 60 years of age. The impact of frailty on hospital glycemic control and glycemic variability (GV) by continuous glucose monitoring (CGM) in insulin-treated older adults with type 2 diabetes (T2D) is not known. Accordingly, we reviewed data from 3 inpatient randomized clinical trials using CGM in insulin-treated patients with T2D. The validated laboratory-based frailty index (FI-LAB) scale was used for frailty assessment, and participants were categorized into three groups [non-frail: (0-<0.1), pre-frail (≥0.1-<0.21), and frail (≥0.21)] in 84 older adults. | There were no differences on admission clinical characteristics between the non-frail/pre-frail older adults and the frail older adults except for Creatinine (BMI: 32.4 ± 9 vs. 36.83± 13, p=0.21; HbA1c%: 9.3 ± 2 vs. 8.72± 2, p=0.18; Admission BG: 227 ± 114 vs. 194. 07± 75 mg/dl, p=0.26; Cr: 1.16 ± 1 vs. 1.65± 1. 0). There were no differences in GV by coefficient of variation (CV), amplitude of glucose excursion (MAGE), and standard deviation (SD) between the two groups. The correlation between FI-LAB score and percent time with CGM <70 was 0.204 (p=0. 064) and the correlation between FI-LAB score and percent time with percent time with CGM<54 was 0.217 (p=0. 049). Results from standard linear regression and zero-inflated Beta regression further suggest that frail old patients with higher frailty scores may be associated with larger percent time with CGM below range <70 and CGM <54 mg/dL.

Conclusion

Our results indicate that older adults with T2D with higher frailty score experience more time in hypoglycemia during their hospital stay despite having comparable mean daily blood glucose, time in range and glycemic variability compared to non-frail or pre-frail older adults. A larger prospective study is needed to confirm these findings and determine the impact of frailty on clinical outcome. Providers should be vigilant when using insulin or insulin secretagogues in hospitalized older adults with diabetes and frailty.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP179 Development of Derivatization-free ID-LC/MS/MS Method for Simultaneous Measurement of Human Serum Monosaccharides
Authors: Tse Chui , Zhang Li , Dahya Komal , Pokuah Fidelia , Sugahara Otoe , Danilenko Uliana , Vesper Hubert
Published: November 2022

According to the CDC's National Diabetes Statistics Report for 2020, it is estimated that 34.2 million, 10.5% of the U. S. population, have diabetes. High fructose intake has also been associated with increased de novo lipogenesis in the liver leading to non-alcoholic fatty liver disease (NAFLD). Emerging evidence suggests that measuring fructose, galactose, and other saccharides in addition to glucose may be helpful for diagnosis of metabolic disorders and other diseases. Therefore, there is a need for an accurate and precise laboratory method for measuring serum monosaccharide panels. Traditional monosaccharide assays used in patient care often can only quantitate one monosaccharide at a time. We aim to develop a high-throughput analytical method for simultaneous measurement of serum monosaccharides that is suitable for large scale epidemiologic studies. Our assay is based on a derivatization-free ID-LC/MS/MS procedure. Certified primary reference materials of monosaccharides from NIST (Gaithersburg, MD) were used for assay calibration. The serum samples were spiked with 13 C labeled internal standards. The monosaccharides were isolated from serum matrix by acetonitrile protein precipitation and filtration in 96-well filter plate (0.2um, porous PTFE). Aliquot of the acetonitrile filtrate was applied on an AB SCIEX Triple Quad™ 6500 LC/MS/MS system for analysis. The monosaccharides including glucose, galactose, fructose, mannose, and potential interferences were resolved from each other on Unison UK Amino column (3×250mm) eluted with acetonitrile and water gradient. Selective reaction monitoring in negative electrospray ionization mode was used for quantitation of monosaccharides in the samples. The measurement ranges covered 10–402 mg/dL for glucose, which is sufficient to monitor the serum glucose levels in normal, hypo-, and hyperglycemia patient samples. Using 4 levels of NIST SRM 965b (values assigned using GC-MS based reference measurement procedure), the method demonstrated excellent measurement accuracy of over 98% for serum glucose. The imprecision of serum glucose measurement was within 3%. Imprecision and accuracy of lower abundant serum monosaccharides were lower than 6% and above 96%, respectively. The application of 96-well format filter plate and automated liquid handler system significantly improves the throughput of sample preparation. The current analytical method can be used to simultaneously measure the concentrations levels of a panel of serum monosaccharides with appropriate accuracy and precision. Free of derivatization, simple sample procedure and application of automation system significantly improves throughput of the assay which are suitable for routine serum monosaccharides assay in clinical laboratories and for large biomonitoring studies.

Presentation: No date and time listed
ODP180 Diabetes Apps: Do They Help Our Patients?
Authors: Xia Alexander , Wu Gloria , Zhao Weichen
Published: November 2022

Background

The CDC in 2020 stated that 34.1 million US adults have diabetes and 88 million have pre-diabetes. The Association of Diabetes Care and Education Specialists (ADCES) published self-care behaviors in Feb 2021 highlighting 7 characteristics (ADCES7): Healthy Coping Healthy Eating Being Active Taking Medication Monitoring Reducing Risk Problem Solving Purpose: To determine if mobile diabetes apps fulfill ADCES7 guidelines to meet patient needs.

Methods

Google search engine to find the top 10 free apps using the search term "diabetes." Inclusion criteria: Free, English, USA accessible,>100K downloads. Exclusion criteria: <100K downloads Using the ADCES7 self-care behaviors, we investigated these criteria in the apps: (1) Healthy coping: Goal setting, online peer support, mental health status, (2) Healthy eating: calorie counting, lessons in nutrition, (3) Being Active: exercise reminder, step counting, heart rate, (4) Taking Medication: reminder for medication, push notification, (5) Monitoring: blood glucose, weight, blood pressure, (6) Reducing Risk: general education, (7) Problem Solving: Data export Results The top apps (by most downloads(DL) to fewer): 1. mySugr(1M), 2. OneTouch Reveal® mobile app for Diabetes(1M), 3. Blood Sugar(1M), 4. Blood Glucose Tracker(0.5M), 5. Diabetes(0.5M), 6. Health2Sync - Diabetes Care(0.5M),7. Diabetes: M(0.5M),8. Glucose Buddy Diabetes Tracker(0.5M), 9. Beat Diabetes(0.1M), 10. Diabetes Diary(0.1M). 3/10 apps have goal setting, 0/10 have online peer support, 3/10 monitor mental health status, 5/10 have calorie counting, 4/10 have lessons in nutrition, 2/10 have exercise reminders, 6/10 have reminders for medication, 8/10 monitor blood glucose, 6/10 monitor weight, 6/10 monitor blood pressure, 8/10 have data exports, 5/10 have general education. None have heart rate or step counting.

Conclusion

The free apps fulfill some ADCES7 guidelines, with emphasis on monitoring but not for healthy coping. However, they may be useful in medication compliance and diabetes care for our diabetic patients. As physicians, we can continue to help our patients navigate the mobile health space.

Presentation: No date and time listed
ODP195 EUGLYCEMIC DIABETIC KETOACIDOSIS AFTER BARIATRIC SURGERY IN ASSOCIATION WITH USE OF SGLT2I.
Authors: Vaghasia Nishit , Bononi Patricia , Custodio Paul
Published: November 2022

Introduction

The risk of euglycemic DKA (EuDKA) is well-known with use of SGLT2i. We present two cases where EuDKA occurred despite discontinuing SGLT2i one week prior to bariatric surgery.

Case 1

A 43 year old male with type II diabetes mellitus and obesity class III presented with nausea and vomiting two weeks following gastric sleeve surgery. Preoperatively, the patient was taking glargine, lispro, empagliflozin and metformin. Empagliflozin was discontinued seven days before surgery. After surgery, patient was discharged on empagliflozin only. Labs showed blood glucose 266 mg/dl, anion gap (AG) 32 mmol/L, HCO3 11 mmol/L and betahydroxybutyrate > 6 mmol/L. He was admitted to the ICU and managed according to the guidelines for DKA. On discharge, his empagliflozin was discontinued.

Case 2

31 year old female with type II diabetes, obesity class III developed nausea and vomiting a day after Roux-en-Y gastric bypass surgery. Preoperatively patient was taking glargine, metformin, dulaglutide and empagliflozin. Patient discontinued empagliflozin seven days before surgery. Labs showed glucose 232 mg/dl, AG 23 mmol/L, HCO3 6 mmol/L and betahydroxybutyrate 6.96 mmol/L. She was admitted to the ICU and managed according to the guidelines for DKA. Empagliflozin was discontinued on discharge.

Discussion

In case 1, EuDKA occurred two weeks postoperatively. In case 2, EuDKA occurred one day postoperatively. In both cases the SGLT2i was discontinued seven days before the surgery. The use of SGLT2i is a cause of EuDKA. The pathophysiology of EuDKA is not clear but thought to be related to a relative carbohydrate deficit, increased glucosuria and low insulin levels. Additionally, SGLT2i may directly stimulate glucagon release leading to increased lipolysis. There have been number of case reports suggestive of EuDKA after gastric bypass surgery in association with use of SGLT2i. Bariatric surgery causes changes in incretin pathways which in turn changes insulin: glucagon ratio and responses to blood glucose in immediate post-operative period. Additionally, preoperatively these patients are on water or ketogenic diet causing ketogenic state. However, in our cases the SGLT2i were discontinued seven days before surgery. It is not known if the use of SGLT2i therapy in the preoperative period might pose an increased risk of EuDKA due to changes in incretin based pathways associated with weight loss surgery and SGLT2i.

Conclusion

It is important to recognize that use of SGLT2i in setting of bariatric surgery perioperatively increases the risk of EuDKA. Our cases suggest two things. One it may be necessary to discontinue SGLT2i more than seven days before bariatric surgery and second initiating SGLT2i for patients with history of bariatric surgery should be considered an additional risk factor for EuDKA due to permanent changes in incretin based pathways and other mechanisms.

Presentation: No date and time listed
ODP206 High Burden of Chronic Kidney Disease in Young Adults with Type 1 Diabetes
Authors: Favel Kristen , Elliott Thomas , Panagiotopoulos Constadina , Mammen Cherry
Published: November 2022

Background

Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD). We sought to assess the burden of CKD and albuminuria, and risk factors contributing to CKD development.

Methods

This retrospective cohort study (1996-2020) involved Canadian adults diagnosed with T1D before 30 years of age, followed in a sub-speciality clinic in British Columbia. CKD was defined as an estimated GFR <60 ml/min/1.73 m 2 and persistent albuminuria was defined as a urine albumin-to-creatinine ratio (ACR) ≥2 mg/mmol (≥2 measurements over 6 months). Logistic regression was used to describe the relationship between CKD and diabetes-related risk factors.

Results

Of the 268 adults followed in the clinic, 63.4% were male, and the median age at diagnosis of T1D was 13.7 years (IQR 11.9 years). Over a median duration of T1D of 27.1 years (IQR 21.2 years), 8.2% of the adults developed CKD and 32.5% developed albuminuria (19.8% ACR 2-20 mg/mmol, 12.7%≥20 mg/mmol). Five adults went on to develop end-stage renal disease within the follow-up period. A longer duration of T1D (≥30 years) was associated with 4-fold increase in the odds of developing CKD (odds ratio 4. 09, 95% CI 1.37-15.10). History of medical and psychiatric comorbidities, A1C≥7%, systolic blood pressure ≥130 mmHg, and ACR ≥2 mg/mmol were also associated with greater odds of developing CKD.

Conclusion

In this contemporary Canadian cohort of young adults with T1D, CKD and albuminuria are common. Contributing risk factors include comorbid medical and psychiatric conditions, suboptimal glycemic control, systolic hypertension, and albuminuria.

Presentation: No date and time listed
ODP220 Latent Autoimmune Diabetes of Adults and PCOS - an Unusual Combination
Authors: Pisklakova Alexandra , Nagrani Mark , Mohanachandran Saurabh , Abraham James
Published: November 2022

Introduction

Latent autoimmune diabetes of adults (LADA) is an adult-onset subtype of autoimmune type 1 diabetes mellitus (T1DM), that is often misdiagnosed as T2DM. We present a case of LADA that was diagnosed in a young female with PCOS (polycystic ovaries syndrome) previously unsuccessfully managed as a T2DM patient.

Case report

20-years-old female with past medical history of hyperlipidemia, newly diagnosed PCOS and suspected T2DM, presented to the PCP office for a routine follow up. Patient medication regimen consisted of Metformin 500 mg BID, Spironolactone 50 mg daily and oral contraceptive. Her BMI was 27.1. Routine blood work resulted in A1C 12.6% (estimated average glucose of 306 mg/dL), total cholesterol 278 mg/dL, triglycerides 1216 mg/dL, HDL cholesterol 31 mg/dL. She was also found to be Vitamin D deficient (Vitamin D, 25-OH 9.8 ng/mL). Based on a very young age and unusually elevated A1C she was assessed for LADA and found to have glutamic acid decarboxylase antibody (GAD-65) titer greater than 28.9 IU/mL (normal 0 - 5. 0 IU/mL), C-peptide of 0.8 ng/mL (normal 0.8-3.5 ng/mL) and negative anti pancreatic islet cells antibody level. Based on those results, she was diagnosed with LADA and initiated on insulin therapy (long acting and short - acting mealtime insulin). Metformin and OCP were discontinued given very high cholesterol level, but she started on Fenofibrate 160 mg daily, Vitamin D supplements and continued with Spironolactone 50 mg daily. Within 3 months her HbA1c decreased to 6.9% and she is doing remarkably well with the new medication regimen.

Discussion

LADA shares similar genetic and autoimmune profiles with T1DM, however LADA insidious presentation overlaps with T2DM, often resulting in misdiagnosis and delaying diagnosis and adequate treatment. Insulin resistance appears to underlie many of the endocrine features of PCOS in most of the patients. The risk of T2DM among PCOS patients is 5- to 10-fold higher than normal, however there is no clear correlation established between PCOS and T1DM, including LADA. Our case warrants newly diagnosed young adults with diabetes should be screened for LADA if there are atypical findings (such as very young age, remarkably elevated A1C, close to normal BMI). Among the anti-islet antibodies, GAD-65 are the most sensitive self-antigen-antibody markers of autoimmune diabetes. Early insulin therapy preserves residual β-cell function, improves glycemic control, and reduces the risk of long-term complications.

Presentation: No date and time listed
ODP255 Woman With Maturity-Onset Diabetes of the Young Type 2 (MODY2) Mistakenly Diagnosed and Treated as Type 2 Diabetes Mellitus
Authors: Nacache Deborah Sasha Bernardes , Neto Eriberto , Vasques Jobert , Fayad Paulo
Published: November 2022

Background

MODY2 is a rare, monogenic form of diabetes, caused by mutations in the glucokinase gene (GCK), and is often misclassified as type 2 diabetes. Clinical case: A 37-year-old woman, during childhood, at the age of 9, was characterized as overweight and had a poor diet, despite being physically active. Her pediatrician diagnosed her with DM2 and started treatment with metformin. However, there was no improvement in fasting glucose levels, so the family decided to stop the medication on their own. In 2008, the patient became pregnant, presenting fasting glucose levels between 120-130 mg/dl (n<99 mg/dl), and continued without hypoglycemic treatment. In 2010, she resumed treatment for glycemic control having used: metformin, sulphonylurea, IDDP4, and basal insulin. Despite the various treatments tested, there was altered fasting glycemia, in the 130mg/dl range. In 2012, she increased her physical activity by training for a half marathon run. At the peak of her form, but maintaining hyperglycemia (always measuring while fasting), she started liraglutide 1.8mg. In 2019, she presented episodes of malaise during training, being indicated by her physician, to discontinue liraglutide, then starting dapagliflozin, but there was still no improvement of blood glucose levels. In August 2019, she was instructed to take the following medications: insulin degludec, liraglutide, and dapagliflozin. Current weight was 53kg, height 1,57cm and a BMI 21,5kg/. Laboratory exams were requested with the following results: A1C 6,6% (n: <5,7%), mean glycemia 143mg/dL (n: 70-99 mg/dL), fasting glycemia 127mg/dL (n: <100mg/dL), urea 24mg/dL (n: 13-43 mg/dL), creatinine 0,83mg/dL (n: 0,8-1,3 mg/dL), AST 16U/L (n: 10-34 U/L), ALT 17U/L (n 10-130 U/L), LDL 109mg/dL (n<100mg/dl), HDL 80mg/dL (n>60 mg/dL), TG 90mg/dL (n<150 mg/dL), total cholesterol 207mg/dL (<200 mg/dL). Faced with the suspicion of diabetes with different behavior than DM1 and DM2, genetic testing was requested for confirmation. In September 2019, the result arrived, pointing out a genetic change in heterozygosis in the GCK gene. This is a rare mutation that results in the depletion of the phenylalanine amino acid at position 150 of the protein glucokinase. This result confirmed the diagnose of MODY type 2. The patient was oriented to discontinue anti-hyperglycemic agents, maintain a low glycemic index diet, and daily physical exercises. Thus, she has been maintaining excellent glycemic control and adequate weight.

Conclusion

Suspicion and characterization of MODY through clinical history, and confirmation of diagnosis through genetic testing, is essential to avoid unnecessary or inefficient treatments, and to ensure a better quality of life for the patient.

Presentation: No date and time listed