bluuebunny/crossref_metadata_2025 huggingface dataset:
ODP188 Does Introduction of Oral Dextrose Gel Pathway Decrease the Length of stay in Neonates with Asymptomatic Hypoglycemia?
Authors: Beckett Omar , Kogelman Yelena , Bhutada Alok , Likourezos Antonios
Published: November 2022

Background

Neonatal hypoglycemia has been associated with various forms of neurological impairment including developmental delay, seizures, visual processing problems, and cognitive difficulties [1]. Consensus guidelines have been created to expedite the identification and resolution of hypoglycemic episodes. Interventions, such oral dextrose gel, have been shown to quickly and effectively reverse episodes of severe hypoglycemia [2]. However, more research needs to be conducted to quantify potential effects of oral glucose gel pathways on prevention of hypoglycemia in the neonatal period.

Objective

We evaluated the effects of introducing a clinical pathway for improving hypoglycemia with oral dextrose gel. We hypothesized a decrease in the length of stay of neonates with hypoglycemia after the introduction of the clinical pathway.

Design/Methods

We conducted a retrospective chart review evaluating neonates born ≥ 35 weeks gestational age, who exhibited asymptomatic hypoglycemia within 48 hours of life (HOL) while receiving exclusive oral feeds. The primary outcome was overall length of hospital stay. We extracted data from charts of children born prior and after the implementation of this oral dextrose gel pathway in both the well-baby nursery and Neonatal Intensive Care Unit (NICU) of a single medical center over a one-year period.

Results

385 total neonates who fit the aforementioned criteria were included, with 175 neonates representing the historical control group and 210 neonates in the intervention group receiving oral dextrose gel. Analysis demonstrated no significant difference in the overall length of stay, as well as the total episodes of hypoglycemia and number of days the neonate received intravenous fluid therapy with dextrose.

Conclusion(s)

Our study demonstrates that the introduction of oral dextrose gel pathway did not have a significant effecton the overall length of hospital stay, as well as the total episodes of hypoglycemia and number of days the neonate received intravenous fluid therapy with dextrose at our institution. Further research is needed to evaluate whether response to oral dextrose gel can be used as a predictor of severe hypoglycemia in the neonatal period.

Presentation: No date and time listed
ODP196 Evaluation of effectiveness of vitamin E on nonalcoholic fatty liver disease in type 2 diabetic patients without advanced fibrosis
Authors: Miranda Gonzalo , Rodriguez Karen Evelyn Ramos
Published: November 2022

Objective

To determine effectiveness of vitamin E on nonalcoholic fatty liver disease in type 2 diabetic patients without advanced fibrosis.

Background

Alcoholic hepatic steatosis is widely distributed worldwide, especially in industrialized countries, where the incidence of diabetes, metabolic syndrome and dyslipidemia are more common. All this fatty liver disease is more common in Western society. Most studies on hepatic steatosis have excluded patients with diabetes from which they call attention, given that this specific group of patients is affected to a large extent by this disease. Therefore, it is urgent to establish guidelines at the same level of solid evidence regarding the treatment of the EHGNA within the high risk populations as for the patients with DM-2. Material and methods: Quasi experimental study performed in Dos de Mayo National Hospital, Lima, Peru from August 2016 to January 2017. One experimental group received vitamin E at a dose of 400 IU in addition to conventional management and another control group with conventional management were formed. The study included 71 patients in each group of Dos de Mayo National Hospital. The development of the present study counted with approval of the ethics committee of Dos de Mayo National Hospital Both groups were submitted to calculation of liver fibrosis scores as part of the evaluation of fibrotic activity by means of Non-alcoholic fatty liver disease (NAFLD) score, liver ultrasound evaluation and measurement of TGP at the beginning and after 6 months. To compare concentrations of the NAFLD fibrosis score and TGP values within a same group, the Wilcoxon and Mann-Whitney U test was used to assess differences between the experimental and control group. To compare severity of fatty liver on ultrasound, Wilcoxon test was used. Also, we performed logistic regression analysis Results: The results showed that vitamin E was effective in reducing level of transaminases and severity of fatty liver on ultrasound statistically significant (Z=-4,727 and p<0. 05) not related to confounding variables.

Conclusion

It is concluded that vitamin E at a dose of 400 IU is an effective intervention to control the progression of hepatopathy that can be quantified by means of the NAFLD score and to achieve a decrease in transaminase levels as well as an improvement in the ultrasound valuation after 6 months of follow-up in a defined group of diabetic patients recently diagnosed with NAFLD without significant fibrosis. Implications: One of the contributions of the present study is the importance of early intervention such as vitamine E in a diabetic population that does not have significant fibrosis in whom an early diagnosis and timely intervention can reverse or slow down the process

Presentation: No date and time listed
ODP204 Hemochromatosis and endocrine dysfunctions – a case report
Authors: Carvalho Davide , Gonçalves Juliana , Neves Celestino , Neves João Sérgio
Published: November 2022

Introduction

Hemochromatosis is characterized by iron overload that can lead to deposit in various organs such as liver, pancreas, pituitary gland, resulting in endocrine dysfunction. Pancreatic iron deposition can lead to diabetes mellitus, and pituitary deposition to hypopituitarism. Liver is the principal affected organ and that can lead to various complications like hepatomegaly, cirrhosis, and hepatocellular carcinoma.

Case report

A 67 years-old caucasian man was diagnosed with hemochromatosis at 30 years old. At that time, undergoing periodic phlebotomies. After 3 years, he was diagnosed with diabetes mellitus and started basal-bolus insulin therapy. In 2006 he submitted to laser photocoagulation due developed to non-proliferative retinopathy. At the present presents microalbuminuria with urine albumin to creatinine ratio of 65. 0 mg/g. The pituitary function reveals hypogonadotropic hypogonadism with no other axis affected. He was medicated with 250 mg enanthate testosterone injection monthly. He also developed cirrhosis Child-Pugh A and in 2018 was diagnosed with multicentric hepatocarcinoma. He was submitted at radioembolization of hepatic lesions in 2019 and in 2021. Due to disease progression, he started treatment with tyrosine kinase inhibitors (sorafenib 800 mg daily) in 2021. Recently, atrial fibrillation was diagnosed, and he started anticoagulation with apixaban 5. 0 mg twice a day.

Conclusion

Secondary causes of endocrinopathies such as diabetes mellitus and hypogonadism are relatively infrequent. This case alerts to diseases associated with hemochromatosis at long term, such as diabetes mellitus, hypogonadism, cirrhosis and hepatocarcinoma.

Presentation: No date and time listed
ODP210 Impact of Continuous Glucose Monitoring (CGM) in the Intensive Care Units (ICUs): Accuracy, Reliability, Feasibility and Nurse Acceptance
Authors: del Rincon Juan , Veeramachaneni Ravali , Amir Maryam , Calles-Escandon Jorge
Published: November 2022

Background

The COVID-19 pandemic led to crisis-level shortage of hospital beds and staff, predominantly in the ICUs. Minimization of patient contact moved the FDA to issue a statement that allowed CGMs in hospitals, which were quickly adopted by ICUs. We conducted a study to better understand the use of CGM in ICUs and test for accuracy, reliability feasibility, and acceptance by care providers.

Methods

Patients were eligible for CGM if they had diabetes mellitus and concomitant COVID-19 infection that required ICU level of care. CGM signals were received by smart phones that were placed in a transparent biohazard bag outside patients’ rooms. Nurses were educated on the interpretation of glucose trends, alerts, and calibration. CGM alerts were set for glucose readings below 100mg/dL and above or equal to 250mg/dL. Nursing staff could obtain point-of-care (POC) glucose as scheduled and for CGM alarms. Mean Absolute Relative Difference (MARD) values were calculated for accuracy. Nurses were invited to respond to a questionnaire with 5-point Likert scales to assess their perception of CGM use, and the potential decrease in the amount of personal protective equipment (PPE) needed in the care of patients on CGM. A question on the estimated time it takes to donn and doff PPE was also included.

Results

26 patients were included in the study; average age 60.8 + 13.5 years, 7 were female and 12 belonged to underrepresented minorities (Hispanic, non-Hispanic Black, or Asian); mean HbA1c was 9.2 + 2.6%. 7 patients were on intravenous insulin infusion, 6 were intubated and 5 received vasopressors. Average duration on CGM was 6 + 3.75 days.168 paired serum glucose-CGM measurements and 259 paired POC-CGM measurements were used. MARD between serum glucose and CGM measurements was 11.2%; MARD between POC glucose and CGM measurement was 11.6%. Questionnaires from 33 nursing staff were analyzed; the most frequent answer (mode) for time to donn and doff PPE was 10 minutes. The vast majority of answers were "agree" (21.2%) or "strongly agree" (78.8%) to the statements that CGM was easy to use and interpret and during the pandemic staff felt protected with use of CGM. Likewise, the answers were "agree" (18.8%) or "strongly agree" (81.8%) that CGMs could replace POC glucose in COVID-19 patients and that there was a lower need for PPE.

Conclusion

There is not an established acceptable MARD for patients with COVID-19 in an ICU setting. Wollersheim et al. suggested that CGM with a MARD of <14% is acceptable for ICU patients. The MARD we found in our study was well within this range. We concluded that use of CGM in the ICU setting has acceptable accuracy and is reliable, feasible and well accepted by the nursing staff.

Presentation: No date and time listed
ODP213 Insulin Autoimmune Syndrome a rare case report
Authors: Paladugu Sridevi
Published: November 2022

Background

Insulin autoimmune syndrome IAS is cause of endogenous hyperinsulinemic hypoglycemia. Insulin autoimmune syndrome has been described with various drugs. Here we describe a case of IAS with use of Proton pump inhibitors, PPIs.

Case report

49year old man came with complaints of recurrent documented hypoglycemia for the past 3months. He was a diagnosed as having Gastroesophageal reflux GERD 6 months back and has been on treatment with Pantoprazole with which his symptoms have subsided. Since past 3 months he started having episodes of excess sweating, tremulousness and palpitations. He was diagnosed as having hypoglycemia during one such episode using a glucometer value <60 mg/dl. After this he started monitoring his blood glucose values on glucometer and had recorded values as low as 50mg/dl, 55mg/dl, 47mg/dl. There was no specific association with meal intake. Every time his symptoms subsided with intake of diet. He was not a diabetic nor did he have any access to anti diabetic agents. With these complaints he was admitted and put on prolonged fasting, after 6 hours of fasting his blood glucose levels dropped to 42mg/dl. His critical sample revealed RBS- 42mg/dl, C peptide -15.7ng/ml (reference range 0.9-7.1ng/ml), serum insulin >300 µIU/ml (1.9-23µIU/ml fasting state) and serum cortisol 20.65 ug/dl(5-25ug/dl). His Sulphonyl urea screen was negative. Biochemically Endogenous hyperinsulinemia was thus proved but on imaging ultrasound examination was normal, CT scan abdomen did not reveal any pancreatic lesions. His endoscopic ultrasound also did not reveal any lesion in the pancreas. Insulin antibodies test showed positive antibodies >300 U/ml (reference range - <12U/ml). He is a known case of hypothyroidism on regular treatment. His thyroid profile was normal. There was no history of usage of methimazole, carbimazole, ALA, captopril, diltiazem, procainamide, Isoniazid, Imipenem, penicillin, Interferon, clopidogrel, gliclazide etc. He was treated with Diazoxide, Prednisolone and Acarbose. His blood glucose levels stabilized and he did not have a recurrence of hypoglycemia. Gradually he was tapered off diazoxide and prednisolone over a period of 6 months. His repeat insulin antibodies after 6 months showed 43.23U/ml (reference range<12). He is asymptomatic and is on follow up. IAS with PPI's is described 1 . Detailed history and physical examination did not reveal any other cause for IAS.

Conclusion

PPIs are commonly prescribed agents used ubiquitously. Here we wanted to highlight the importance of IAS with PPIs. There is no specific regimen used to treat IAS. Our patient showed good response to a combination of prednisolone, diazoxide and acarbose. This triple combination addresses the multiple mechanisms of hypoglycemia in IAS. References: Simone Censi et al Insulin autoimmune syndrome: diagnosis to clinical management. Annals of Translational medicine 2018 sep;6(17): 335.

Presentation: No date and time listed
ODP243 Severe Sustained Hyperglycemia in Setting of Simultaneous Dobutamine and Insulin Infusions - Drug Interaction
Authors: Arora Gunjan , Eshan Shayet Hossain , Qureshi Faisal
Published: November 2022

Case

A 55 year old female with a history of congestive heart failure, type 1 diabetes mellitus and chronic kidney disease stage IV presented to the ED for acute on chronic progressive shortness of breath. She was admitted to the telemetry unit and treatment with diuretics was initiated. During the course of hospitalization, she was noted to have atrial fibrillation with rapid ventricular response and dronedarone was started. However, her heart rate remained elevated along with borderline hypotension and thus, she was transferred to the ICU for amiodarone infusion and continued diuresis with dobutamine support via central line. Since the day of admission, she was being managed on a subcutaneous insulin regimen; however, while in the ICU her blood glucose levels continued to rise and remained elevated at 400-500 mg/dL (normal range 70 - 99 mg/dL). As per Endocrinology, insulin drip was started. The patient had poor peripheral vasculature and it was difficult to obtain and maintain peripheral intravenous (IV) access. Therefore, the same right internal jugular central line was used to infuse both dobutamine and insulin. The insulin drip was continued on and off for just short of 3 days and with an average rate of >10 units insulin per hour, and the highest rate of insulin infusion running at 15 units/hour for more than 7 hours. Her insulin requirement declined as dobutamine was weaned off, and ultimately, she was transitioned back to a basal-bolus regimen.

Discussion

Hyperglycemia is a common occurrence in critically ill patients for which insulin drip is a powerful tool. There is paucity of data on insulin and its incompatibility with vasopressors, another class of very commonly used agents in the intensive care unit (ICU) setting. Research has shown that vasopressors can cause insulin resistance if infused via the same vascular channel by rendering insulin ineffective. A previously published case report detailed a patient requiring Insulin infusion as high as 450 units/hr while norepinephrine and insulin were being administered via the same central line and upon switching them to different IV access sites, the insulin requirement decreased to 14 units/hour. Another study demonstrated reduction in insulin efficacy by 70% in patients receiving simultaneous norepinephrine. There are no such studies available on interactions of insulin with dobutamine. This case report calls attention to the risk of deleterious interactions between commonly used medications in the ICU setting running through the same channel. This is an important entity to recognize as standard treatment protocols for IV insulin treatments do not typically account for other simultaneous IV medications which can have profound consequences in regards to dosing and wide range of variation from hyperglycemia to hypoglycemia if the titration based on medication interaction is not accounted for.

Presentation: No date and time listed
OR29-1 The Association of Aldosterone and Endothelin-1 With Incident Diabetes Among African Americans: The Jackson Heart Study
Authors: Puthankovilakam Divya
Published: November 2022

Introduction

African Americans (AAs) have the highest prevalence of hypertension among United States racial/ethnic groups. Regulators of blood pressure, such as aldosterone and endothelin-1 (ET-1), increase risk of hypertension. Higher aldosterone levels have been associated with higher insulin resistance and increased risk of diabetes. Similarly, ET-1 is known to cause insulin resistance by reducing glucose uptake. However, it is poorly understood how aldosterone and ET-1, which primarily regulate the blood pressure, together are involved in diabetes pathophysiology among AAs.

Aim

To examine the individual and combined longitudinal associations of aldosterone and ET-1 with incident diabetes among AAs in the Jackson Heart Study (JHS).

Methods

Among 3,914 AA participants without prevalent diabetes in the JHS, linear regression models were used to examine cross-sectional associations of exposures (aldosterone, endothelin-1, and a combined aldosterone-endothelin-1 score [2–8]) with glycemic measures (fasting plasma glucose [FPG], HbA1c, HOMA-IR, and HOMA-β). Longitudinal associations of exposures with incident diabetes were examined using Cox proportional hazard models. Models were adjusted for age, sex, education, occupation, systolic blood pressure, smoking, physical activity, dietary intake, alcohol use and adiponectin.

Results

Aldosterone and the combined aldosterone-endothelin score were positively associated with FPG, HOMA-IR, and HOMA-β. Endothelin-1 was negatively associated with FPG but positively associated with HOMA-β. Only the aldosterone-endothelin score was positively associated with HbA1c. A 1-SD higher serum aldosterone and endothelin-1 were associated with a 22% and 14% higher risk of incident diabetes, respectively, while a 1-point higher aldosterone-endothelin score was associated with a 13% higher risk of incident diabetes after adjustment for diabetes risk factors.

Conclusions

The study indicates both aldosterone and ET-1 are risk factors for the development of diabetes among AAs, thus future studies should consider aldosterone and ET-1 modulation to improve glucose metabolism.

Presentation: Tuesday, June 14, 2022 9:45 a.m. - 10:00 a.m.
OR29-4 Prevention of Type 2 Diabetes by Testosterone in the T4DM Trial: Analysis of Effect Mediation
Authors: Wittert Gary
Published: November 2022

Background

In men aged 50+ years at high risk of, or with newly diagnosed type 2 diabetes (T2D) testosterone (T) treatment reduced the risk T2D at 2-years by 40% beyond lifestyle change alone (Wittert et al Lancet Diabetes and Endocrinol 2021).

Aim

Determine whether changes in total fat mass (kg), abdominal fat mass (%), lean mass (kg), and non-dominant handgrip (kg) mediate the effect of T treatment on glycaemia.

Hypothesis

The effect of testosterone on glycaemia is mediated by changes in fat and functional skeletal muscle mass Methods: A randomised placebo-controlled trial enrolled 1007 men, 50–74 years, waist circumference (WC) ≥ 95cm, serum total T ≤ 14nmol/L (chemiluminescent RIA) and either impaired glucose tolerance or newly diagnosed T2D on an oral glucose tolerance test (OGTT). Participants were enrolled in a lifestyle program (WW) and randomised 1: 1 to 3 monthly IM injections of 1gm testosterone undecanoate or placebo. The primary outcome of T2D at 2-yrs (OGTT>=11.1mmol/L) was assessed by binomial regression with a log-link function. Mediators of interest were fat mass % abdominal fat, lean mass (dual x-ray absorptiometry) and non-dominant hand-grip strength (handgrip dynamometry). Mediation was determined by including the baseline and change at two years for each of the 4 factors of interest in the model. Significance: P< 0.05. There was no imputation for missing data.

Results

There were complete data for 775 men (77.5%). For the outcome of T2D at 2-yrs, the unadjusted RR for treatment was 0.59 (95% CI: 0.43–0.80), which became 0.66 (95% CI: 0.51–0.87) after adjustment for baseline values of the proposed treatment mediators and OGTT. After inclusion of changes in body composition (total fat mass, abdominal fat percentage, lean mass) and grip strength, the effect of treatment was attenuated, RR 0.85 (95% CI: 0.61–1.19). The individual effects for changes in fat mass, abdominal fat, lean mass, and grip strength were 0.88 (0.64–1.19), 0.79 (0.59–1.07), 0.52 (0.38–0.71) and 0.64 (0.48–0.86) respectively.

Conclusion

After including change in fat mass the RR increased and the effect of T was no longer significant indicating the decrease in fat mass mediates the effect of T. This did not however, entirely explain the effect of T to decrease risk for T2D. Although lean mass and hand grip strength increased, neither mediated the effect of testosterone on T2D.

Presentation: Tuesday, June 14, 2022 10:30 a.m. - 10:45 a.m.
PSAT035 COVID-19 Infection Increases DKA and mortality- A Harbinger for Increased Acute Diabetes Emergencies in the Future?
Authors: Firek Anthony , Firek Matthew , Garcia Jayvani , Munir Iqbal , Tran Anh , Yang Almira
Published: November 2022

DM patients infected with COVID-19 are at risk for developing severe complications including DKA and/or HHS, with a more severe disease course and higher mortality compared to those without DM or hyperglycemia. As COVID-19 is evolving into an endemic risk for the population, it is important to determine patients at risk for COVID-19 complications and outcomes. The Riverside University Health System Medical Center (RUHS-MC)-DKA Outcomes Group (RUDOG) initiated a study to characterize patients admitted for fatal DKA and/or HHS before and during the pandemic.

This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from Mar 2020 to Feb 2021 ("pandemic") compared to the 3 preceding years ("pre-pandemic"). The descriptive statistics were used to determine the clinical characteristics of hospitalized adult patients with DKA and/or HHS. Information of patient characteristics was extracted from chart reviews. Categorical data were compared using Fisher's Exact Test. Numerical variables were assessed using Mann-Whitney Test.

The mortality rate during the pandemic was 8.4% (30/335) versus 1.7% (5/285) in the pre-pandemic period. Most of the deaths (24/30) were COVID infected. On average, the cases of deaths during pandemic had DM for a longer duration. There was no difference regarding age, race, HgbA1c on admission, insulin use history, and rate of micro- or macrovascular complications comparing these periods. More patients had HTN (80%) and HF (23%) during pandemic compared to pre-pandemic (69.2% and 7.7%, respectively). Infection was the cause of death for 63% and 31% of patients admitted for DKA and/or HHS during the pandemic versus pre-pandemic.

There is a clear global concern that COVID-19 will be an endemic infectious disease placing people with pre-existing conditions such as DM at increased risk for morbidities and death. Our study has clearly demonstrated that contracting COVID is a risk for increased incidence of DKA and/or HHS and mortality compared to pre-pandemic levels. In addition, we have shown that certain pre-existing comorbidities are associated with the mortality of DKA and/or HHS including HTN and HF with COVID infection. The duration of DM was longer among patients that died during pandemic, regardless of age, race, or HgbA1c on admission. This finding is intriguing as we did not see increased DKA and/or HHS based on the number of micro- or macrovascular complications suggesting duration alone may be a new risk determinant.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN137 Suppression of endogenous insulin secretion during euglycemic hyperinsulinemia – effects of obesity
Authors: Eyupoglu Nesrin Damla , Laurenti Marcello , Vella Adrian , Jensen Micheal
Published: November 2022

Hyperinsulinemia is strongly linked with excessive body fat. However, with the exception of plasma glucose concentrations, the other factors regulating insulin secretion are under-studied. We examined the effects of hyperinsulinemia itself on beta cell insulin secretion during exogenous insulin and glucose infusions in adults with insulin-resistant upper body (UBO), insulin-sensitive lower body obesity (LBO) and non-obese controls.

Data from the euglycemic, hyperinsulinemic clamp studies of 33 volunteers (9 controls, 5 LBO, 19 UBO) was analyzed; basal and insulin-suppressed (residual) insulin secretion rates were determined using deconvolution of C-peptide concentrations. Obesity phenotype was determined using waist: hip ratio and body composition was assessed with dual-energy X-ray absorptiometry and abdominal computed tomography. Plasma insulin concentrations were log transformed to achieve a normal distribution before statistical analysis.

The plasma glucose concentration change during the clamp was 0.3 (SD: 3) mg/dl, and similar among groups (p=0.7). Median, achieved serum insulin concentrations was 66 (IQR: 45-105) mIU/mL, and greater in participants with obesity. Fasting insulin secretion rates were 0.093 (SD: 0.029), 0.158 (SD: 0.036), and 0.216 (0.078) nmol/min in controls, LBO and UBO, respectively (UBO p<0.001 vs. other groups). Insulin secretion was suppressed by 28% during hyperinsulinemia with no between group differences (p= 0.69). The ratios of insulin secretion rate (from C-peptide deconvolution) to serum insulin concentration (nmol/min per mIU/mL) was 0.058 (SD: 0.015) in controls, 0.090 (SD: 0.016) in LBO and 0.111 (SD: 0.039) in UBO (UBO vs. other groups P = 0.001). The ratio of insulin secretion rates to plasma insulin concentrations was correlated with BMI (r=0.69, P <0.001).

We conclude that adults with obesity have greater residual insulin secretion during an exogenous insulin infusion and that this is related to upper body fat distribution. However, because the proportional suppression of endogenous insulin secretion is similar in these groups, this could indicate the primary abnormality is fasting insulin secretion.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN140 “Awakening of the Beta Cell©”
Authors: Jasper Josephine , Schauer Jasmin
Published: November 2022

Background

Endocrinologists often manipulate hormones by adding medication or replacing hormones that are no longer being produced. However, replacing hormones artificially causes hormone producing cells that are still viable to become suppressed and ultimately shut down. For example, with estrogen, testosterone, or cortisol replacements, the cells responsible for the production become inactive. This study tries to show that the same process affects the beta cells in the pancreas. The more insulin given, the further these beta cells become suppressed, and block natural insulin production. Rather than insulin resistance, our results showed that high dose artificial insulin inhibits the beta cells and prevents natural production.

Methods

To perform this study, we took a random sample of 13 type 2 diabetics on high doses of insulin. Prior to the study, they were taking over 20 units of bolus prandial insulin 3x daily, and over 50 units of basal insulin 1-2x daily. We reduced their insulin by half, monitored them closely, instructed them to change their lifestyle and follow a proper diabetic diet.

Results

Out of the 13 patients, 10 of them showed significant improvement on follow-up evaluation. The HbA1c and finger sticks had remained consistent or improved with the reduced dose. This showed the beta cells had been suppressed and were now becoming more responsive. Overall, the patients responded well to the reduction in their high doses of insulin, and it appeared that the pancreas’ beta cells began to naturally produce insulin.

Conclusion

The results showed that a lifestyle change along with the reduction in insulin was successful in treating patients with Type 2 Diabetes. Like any other hormone, prescribing large doses of insulin has been indirectly suppressing the action of beta cells. This suggests that patients may not be developing insulin resistance, rather their beta cells are losing their functionality. To control their Type 2 diabetes, patients should focus on pursuing a healthy lifestyle and lowering their insulin. Limitations to the study were that the threshold where the beta cells no longer function has not yet been quantified, and patient non-compliance with monitoring and lifestyle changes, resulting in the need for increased insulin.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN148 Disparities in COVID-19 Mortality in Hispanic and Non-Hispanic Patients with Metabolic Syndrome in a Community-Based Hospital
Authors: Ho Erwin , Samudrala Santhosi , Adams John , Su Kaihong
Published: November 2022

In Hispanic populations, rates of metabolic comorbidities such as obesity are higher than that of non-Hispanic White in the United States. Despite having higher comorbidity rates, Hispanic populations have a lower total risk of mortality compared to non-Hispanic counterparts. In this study, we explore whether this paradox exists for COVID-19 related deaths in Hispanic patients with Metabolic Syndrome (MetS). MetS is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, diabetes, hypertriglyceridemia, and low levels of HDL. A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients, 55.4% were male, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this cohort was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. Odds ratios and confidence intervals for the relationship between MetS and mortality were calculated separately among patients who were either Hispanic or non-Hispanic. Multivariable logistic regressions accounting for interactions between MetS and Hispanic patients were assessed. In our cohort, 49 (18.2%) patients died of COVID-19. Hispanic patients had a lower probability of mortality (16.0%; 95% CI 11.1-21.0) than non-Hispanic patients (26.3%; 95% Cl 14.9-37.7). Hispanic patients with MetS had a higher risk of mortality from COVID-19 ([OR] 1.57; 95% Cl 0.74-3.33) compared to Hispanic patients without MetS. Non-Hispanic patients with MetS also had a higher risk of mortality from COVID-19 ([OR] 4.38; 95% Cl 1.19-16.03) compared to non-Hispanic patients without MetS. The MetS effect on mortality in Hispanic was 64% lower than that in non-Hispanic patients, although this result did not reach statistical significance (p value=0.18.) Our data suggests that MetS is a risk factor for COVID-19 mortality and MetS may have a lower impact on COVID-19 related death in the Hispanic population than non-Hispanic counterparts. Studies with larger sample sizes will be required to confirm these relationships.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN156 Circulating thrombospondin-2 level as a novel biomarker of heart failure in type 2 diabetes
Authors: Lee Chi-Ho , Wu Mei-zhen , Lui David , Fong Carol , Yuen Michele , Chow Wing-Sun , Xu Aimin , Yiu Kelvin , Lam Karen
Published: November 2022

Introduction

Circulating thrombospondin-2 (TSP2) has been associated with adverse cardiovascular outcomes in patients with heart failure (HF). Type 2 diabetes (T2D) increases HF risk and induces TSP2 tissue expression. Here, we investigated prospectively the role of circulating TSP2 as a novel biomarker of incident HF hospitalization (HHF), and its associations with longitudinal changes of echocardiographic parameters in T2D.

Methods

Baseline serum TSP2 level was measured in 4949 T2D patients from the Hong Kong West Diabetes Registry to determine its association with incident HHF using multivariable Cox regression analysis. In the echocardiographic study, baseline serum TSP2 level was measured in another 146 T2D patients without cardiovascular diseases who underwent detailed transthoracic echocardiography at baseline and after 1 year.

Results

Over a median follow-up of 7.8 years, 330 of 4949 patients (6.7%) developed incident HHF. Baseline serum TSP2 level was independently associated with the development of HHF (HR 1.31, 95%CI 1.06–1.62, p=0.014) after adjustments for conventional cardiovascular risk factors, atrial fibrillation, estimated glomerular filtration rate, albuminuria and high-sensitivity C-reactive protein level at baseline, as well as use of medications including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, frusemide, aspirin, insulin, metformin and sodium-glucose co-transporter 2 inhibitors. In the echocardiographic study, baseline serum TSP2 level was independently associated with increase in average E/e' and left atrial volume index (p=0.04 and <0.01, respectively).

Conclusion

Serum TSP2 level was independently associated with both incident HHF and deterioration in diastolic function in T2D, suggesting its potential to be developed as a novel HF biomarker in T2D.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN157 SILENT MYOCARDIAL ISCHEMIA IN ELDERLY DIABETIC PEOPLE IN GOOD PHYSICAL CONDITION AND CARDIORESPIRATORY FITNES
Authors: Madrigal-Campos David , Madrigal Beatriz
Published: November 2022

Every year, the INAPAM (National Institute for Elderly People, in México) hosts a "mini olympic games" event with accesible adaptation exercises. In preparing for such "games" the public health institutions hold medical exams to all participants to reduce the risk of any injuries. This study reports the data found on the medical exams performed in one of aforementioned institution. (Pensiones Civiles del Estado de Chihuahua).

The medical exams were performed on 46 women and 16 men with an average age of 67 (60 to 79 years of age) including medical history, physical examination and laboratory exams. The subjects were part of a no medical supervising cardiorespiratory fitnes program.

The effort perceived during the walking was 4 on the VAS scale (Visual Analogue Scale). We found 29 (46.7%) persons with high blood pressure (BP), 25 (40.3%) with diabetes, 20 (32.3%) smokers, and 15 (24.1%) with hypercholesterolemia. We found on electrocardiogram (EKG) inespecific abnormalities in 24 patients (38.7%), left bundle branch block in 25 patients (40.3%) and left ventricular hypertrophy in 13 patients (20.9%).

In 10 persons with high BP did not tolerate to be in guideline target. In 9 diabetic persons had acceptable glycemic levels but slightly elevated A1Cs (glycated hemoglobin). These patients with high BP and diabetes were the older ones in the group. In medical histories of the group it was found, that more than 60% of their doctor's visits the persons were on target lipid levels.

On ecocardiogram, ventricular hypertrophy was found in 49 (79%) persons, dyastolic dysfunction in 45 (72%), insignificant valve abnormalities in 50 (80.6%) and no body with wall motion abnormalities of the left ventricle.

The stress test reported good physical capability on all persons but was positive with no symptoms in 4 (6.4%). These 4 patients were diabetic and older than 75 years of age. Coronariography was performed on these 4 patients, 3 of whom had revascularization surgery and 1 had a coronary angioplasty. Among of them 4, one who has won first place in these "mini olympic games" previosly.

The silent myocardial ischemia reported was similar as in the general literature, depending on the number of risk factors. An altered treshold in the perception of cardiac ischemic pain between diabetic patients and older age patients is to be considered. Due to the persons's cardiovascular fitnes as being part of the walking training program, their BP and heart rates, we thought, contributed to the lack of cardiac ischemic pain.

These study is one of the first to report silent myocardial ischemia in people with very good physical and cardiorespiratory fitnes.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN167 Diabetic retinopathy and diabetes-related renal disease, either isolated or both associated, and the impact on the 10-year risk of cardiovascular disease: are we dealing with similar conditions?
Authors: Maraschin Clara , Alessi Janine , Reis Mateus , Teló Gabriela , Schaan Beatriz
Published: November 2022

Diabetes complications, which includes diabetes-related renal disease (DRD) and retinopathy (DR), may result in worse quality of life, disability and premature death, mainly due to cardiovascular disease. In this context, there has been a growing focus on diabetes-related complications and their impact on chronic outcomes. To assess the association between DR, DRD and the 10-year risk of atherosclerotic cardiovascular disease in patients with diabetes. A cross-sectional study was performed including patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) under outpatient follow-up in Southern Brazil. Participants’ data were extracted from medical records between 2019 to 2020. Patients included were stratified into 4 groups: G1(no diabetes-related complications); G2 (RD only); G3 (DRD only); G4 (presence of both RD and DRD). The presence of RD was defined as any alteration related to diabetes identified using a retinal scanning device in the period. For DRD, the presence of reduced estimated glomerular filtration rateand/or albuminuria was considered. The primary outcome was the 10-year risk assessment of cardiovascular events based on the American Heart Association ASCVD score. One-way ANOVA with post hoc Tukey test was used for comparisons. A total of 571 patients were included, of which 128 had T1DM (mean age of 39.4 ± 15.1 years and 48.4% were women) and 443 had T2DM (mean age of 59.5 ± 11.9 years and 66.4% were women). Among T1DM participants, the 10-year risk of a cardiovascular event was 6.1 ± 8.9% in the G1 (124, no diabetes-related complications), 8.9 ± 11.8% in the G2 (54, with RD), 5.4 ± 8.8% in the G3 (149, with DRD), and 6.1 ± 9.5% in the G4 (n=116, with RD and DRD). The mean difference between the groups was not significant. Among T2DM participants, the 10-year risk of a cardiovascular event was 15.2 ± 14.6% in the G1, 15.7 ± 10.7% in the G2, 22.5 ± 16.7% in the G3, and 21.5 ± 15.1% in the G4, reflecting a significantly higher cardiovascular risk in the groups with renal involvement (P <0.001). Post hoc analyses showed that the G3 (with DRD) and G4 (with RD and DRD) had a higher 10-year cardiovascular risk compared to the groups without complications and with RD isolated. This difference persists even when corrected for age, sex, ACE inhibitors use and hypertension [R +4.7 (1.2 a 8.4)and R +3.8 (0.01 a 7.6) in the G3 and G4, respectively]. In T2DM, the presence of specific microvascular complications affects the 10-year cardiovascular risk differently, and the renal involvement seems to be associated with a greater theoretical cardiovascular risk when compared to the presence of RD alone.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN168 The relationship between vitamin C concentrations and reduced red blood cell deformability in diabetes
Authors: Violet Pierre-Christian , Ebenuwa Ifechukwude , Wilkins Kenneth , Parrow Nermi , Wang Yu , Levine Mark
Published: November 2022

Background

Microvascular angiopathy is a common complication for patients with diabetes. Reduced red blood cell (RBC) deformability in diabetes has been associated with micro- and macrovascular complications such as diabetic nephropathy and coronary artery disease. Preliminary studies in mice have shown an inverse relationship between RBC vitamin C concentrations and RBC deformability measures. This study investigated the relationship between RBC vitamin C concentration and cell deformability measures.

Methods

We analyzed RBC deformability and vitamin C level in a cross-sectional cohort study of individuals with diabetes (n=82) and non-diabetic controls (n=80). Subjects were studied outpatient, with samples obtained following an overnight fast. RBC rigidity parameters defined as SS1/2 (shear stress at which half of the maximum deformability occurs) was assessed using the laser diffraction viscometry ektacytometer (LORRCA, Mechatronics, Netherland). We also quantified osmotic sensitivity by measuring deformability under an osmotic gradient (osmoScan, o-hyper; osmolality corresponding to 50% of the Elmax). Vitamin C in plasma was measured using coulometric electrochemical detection with high performance liquid chromatography. We evaluated the association between these deformability parameters, vitamin C concentration.

Results

Compared to the non-diabetic cohort, the diabetes cohort had significantly lower RBC vitamin C concentration, respectively 28.1µM and 42.9µM (p=0.0013). Low RBC vitamin C concentration was significantly associated with reduce RBC deformability measured by increased SS1/2 (p=0.009). Additionally, low RBC vitamin C was associated with decreased o-hyper, suggesting a decrease dehydration of RBC (p=0.0250).

Conclusion

Our data demonstrate reduced vitamin c levels in the diabetic cohort. Reduced RBC deformability is associated with reduced RBC vitamin C concentration. Thus, reduced vitamin C levels in diabetic patients might increase red blood cell rigidity and reduce deformability.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN173 Factors determining insulin dose while transitioning from intravenous insulin infusion to subcutaneous insulin in patients with type 2 diabetes following cardiac bypass surgery.
Authors: Bansal Beena , Bansal Manish , Mehta Yatin
Published: November 2022

Introduction

In patients with type 2 diabetes undergoing cardiac bypass surgery, data regarding the factors predicting insulin dose while transitioning from intravenous insulin infusion to subcutaneous insulin are scarce. This study was therefore planned to determine the factors that predict postoperative subcutaneous insulin dose, basal-to-bolus insulin ratio and the factors determining this ratio.

Methods

This is a single centre prospective observational study in 280 consecutive cardiac bypass surgery patients with type 2 diabetes at a tertiary care facility in India.

Results

In linear regression analysis, the subcutaneous insulin dose following cardiac surgery was determined by glycated hemoglobin (HbA1c) at admission (beta 0.34, p <0.0001), insulin dose before surgery (beta 0.33, p <0.0001), sulphonylurea (beta 0.19, p = 0.002), and metformin doses (beta 0.14, p = 0.017) before surgery, and intravenous insulin dose (beta 0.11, p =0.041) after surgery. The basal-to-bolus ratio of insulin after surgery was 0.9, and was negatively predicated by serum creatinine levels and age, and positively by body weight of the patients.

Conclusions

In our study, post-surgery subcutaneous insulin dose after transitioning from intravenous insulin infusion depends on several factors, such as HbA1c and insulin dose before surgery, metformin and sulfonylurea use before surgery and intravenous insulin infusion dose during surgery.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN174 A Microbiome Targeted Nutraceutical that Induces Endogenous Glucoregulatory Peptide Hormones
Authors: Palmissano Salvator , Ruan Jingyi , Saberi Maziyar
Published: November 2022

Maintaining a narrow and healthy blood glucose range is essential for preventing the progression of microvascular and macrovascular complications associated with glucose dysregulation. It has now been established that secondary metabolites derived from colonic microbiota potentially serve as endogenous secretagogues for glucoregulatory hormone peptides. Specifically, metabolites such as short and medium-chain fatty acids and indole derivatives trigger the secretion of GLP-1 and PYY from the colonic L cells that improve gut motility, modulate insulin, and promote anorexigenic effects. However, secondary metabolites are significantly down-regulated in diets that lack complex carbohydrates and polyphenols, leading to hormonal dysbiosis. To address this need, we developed structural, chemical, and cell-based functional assays to screen a library of prebiotic fibers, polyphenols, and probiotics aimed at the induction of glucoregulatory peptides. Precisely, these ingredients were put through a series of microbiological fermentation assays to produce postbiotic secondary metabolites and subsequently tested as secretagogues on specialized human primary enteroendocrine cells. Prebiotics that significantly induced GLP-1 and PYY in these functional cells were formulated into a lead cocktail: JAN-1000. As a proof of concept, JAN-1000 was tested against an equal dose of single fibers to demonstrate superiority in secondary metabolite production and the induction of key metabolic peptides. JAN-1000 increased SCFAs by 7.9-fold (p<0.0001), indoles by 28.4% (p<0.0001), GLP-1 by 4.7-fold (p<0.0001), and PYY by 3.3-fold (p<0.0001). Furthermore, we initiated a pilot clinical study with healthy volunteers to demonstrate tolerability and efficacy on glucose and lipid homeostasis. A one-month supplementation of JAN-1000 lowered fasting glucose by 10% (p<0.001), lowered iAUC postprandial glucose by 42% (p=n.s.), reduced hypo and hyper-glycemic events, and improved HDL cholesterol by 5% (p<0.01). These results suggest that JAN-1000 is an effective and safe nutrition-based intervention that mediates communication between the gut microbiome with colonic cells and effectively improves hallmarks of diabetes complications and comorbidities. Studies are underway to confirm and expand on these results in people with type 2 diabetes and pre-diabetes.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.