bluuebunny/crossref_metadata_2025 huggingface dataset:
115-OR: Improving Glycemic Outcomes through Virtual Diabetes Self-Management Education Pathway
Authors: SOLIMAN ELIGIO DAVID P.
Published: June 2023

The purpose of this quality improvement project was to implement and evaluate if a virtual diabetes self-management education (DSME) pathway is a cost-effective intervention in improving glycemic control for adult patients with type 2 diabetes (T2D). A one group pre and post-test design was utilized. Total of 41 participants completed the 4-week diabetes self-management pathway. The virtual curriculum integrated spaced education through a mobile health app called Calcium©. Primary outcome measure was change in HbA1c levels three months after intervention. Wilcoxon signed-rank test was used to analyze the difference before and after the DSME intervention. There was a 1.6% mean reduction of HbA1c levels (P=<0.001). There was also statistically significant improvement of other metabolic markers including blood sugar averages, body weight, BMI and systolic blood pressure (P=<0.005). Mean comparison of HbA1c shows that those who significantly utilized the virtual pathway were found to have greater improvement in glycemic control (-2.55% vs -0.43%). This quality improvement project implemented evidence-based interventions to improve patient outcomes, lower healthcare cost and hopefully influence health care policy. Moving this body of knowledge forward with attention to developing and implementing DSME initiatives and exploring novel practice models open doors for building this body of evidence further.

Disclosure

E.P.Soliman: None.
1152-P: COVID-19 Vaccination Status and Attitudes of Adolescents with T1D and Their Caregivers
Authors: OKONKWO NKEMJIKA , JASER SARAH S.
Published: June 2023

People with type 1 diabetes (T1D) have an increased risk for adverse COVID-19 outcomes, but few studies have explored the current rates of vaccination in families of youth with T1D. We examined the vaccination status and attitudes toward the vaccine in this high-risk population. We conducted semi-structured interviews with adolescents with T1D (n=12; mean age =14.2 ± 5.9 years; 25% female; 75% non-Hispanic White; mean HbA1c =9.2± 1.9%) and maternal caregivers (n=19; mean age =42.9 ± 5.9 years) participating in an ongoing clinical trial in the Southeastern United States. Interviews were conducted from May-November 2022, after vaccine approval for children ≥5 years. Participants were asked how COVID-19 affected diabetes management, including an optional question about their household's vaccination status. Interviews were transcribed and coded, establishing inter-reliability (κ=.78). The vaccination question was answered by 71% of adolescents and 95% of caregivers. More than half of adolescents (58%) reported being unvaccinated, with many not viewing the vaccine as an immediate necessity. Most inoculated teens (60%) reported getting vaccinated because of parental influence. Among caregivers, 32% reported being unvaccinated. They cited the vaccine's novelty and limited data on long-term side effects, particularly for those with T1D, as reasons for their hesitancy. Many also doubted their child's risk for adverse outcomes, so they did not see the vaccine as crucial. Most immunized caregivers (62%) recalled receiving the vaccine within a few months after its approval. They reported having faith in the vaccine's effectiveness, especially when encouraged by medical professionals, as motivation for getting vaccinated. Our findings highlight the persistently low vaccination rates among youth with T1D and the importance of caregivers’ trust and buy-in. These results indicate the need for focused education and public health messaging to promote vaccination in families of children with T1D.

Disclosure

N.Okonkwo: None. S.S.Jaser: None.

Funding

National Institutes of Health (1R01DK115545-S1)
1155-P: Seasonal Impact on Sleep and Glycemia in Adolescents with Type 1 Diabetes
Authors: FIVEKILLER EMILY , SAKAMOTO CASEY , KARAMI ANGELA J. , MELTZER LISA J. , PYLE LAURA , COBRY ERIN C.
Published: June 2023

Sleep is a key component in health maintenance. Adolescents often struggle to obtain sufficient sleep, and those with T1D are at increased risk for diabetes-related sleep disruptions and shorter sleep duration. We sought to examine sleep quality and glycemic outcomes between youth aged 11-17 with T1D, comparing summer (free schedule) and fall (school schedule). Twenty youth (mean 13.8 yrs, 65% female, 90% Non-Hispanic White), ten each during summer and fall, participated in an observational study. Participants were age matched due to sleep recommendation variations. Actigraphy data (sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset) and glycemic data from CGM (TIR, time hyperglycemic (>180mg/dL), time hypoglycemic (<70mg/dL)) were collected simultaneously for one week. No significant differences were found between summer and fall participants for demographics or sleep outcomes. Statistically significant differences were found for time hypoglycemic (p=0.034) and mean sensor glucose (p=0.021) and clinically notable differences were seen with higher TIR and lower hyperglycemia during summer. This study highlights that insufficient sleep is obtained in adolescents with T1D, regardless of season, and seasonal differences appear to exist in glycemic measures. Further research is needed to elucidate the extent of these differences and methods to improve both sleep and glycemia throughout the year.

Disclosure

E.Fivekiller: None. C.Sakamoto: None. A.J.Karami: None. L.J.Meltzer: Consultant; Egetis Therapeutics, Harmony Biosciences. L.Pyle: None. E.C.Cobry: None.

Funding

JDRF (5-ECR-2022-1179-A-N to E.C.C.)
1156-P: Diabetes Technology in the Pediatric Inpatient Setting
Authors: RAJAGOPAL NITYA , BAILEY ABBY , NGO CHLOE , HENDRIX-DICKEN AMY D. , MERCER SHELLY , CONDREN MICHELLE
Published: June 2023

Introduction: Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) improve glycemic control and quality of life for children with diabetes. This study assessed the existence and content of pediatric inpatient diabetes technology policies in U.S. hospitals.

Methods: A cross-sectional survey was distributed to the Pediatric Pharmacy Association listserv. The survey had multiple-choice and open-ended items related to hospital practices on insulin pump and CGM use in the pediatric inpatient setting.

Results: Only 17 of the 31 responding hospitals (54.8%) allowed CGM use in the pediatric inpatient setting with 13 (76.5%) of those having written CGM policies. Primary barriers to allowing CGM use were lack of policy (n=11, 78.6%), limited policy knowledge (n=9, 64.3%), and lack of EMR integration (n=6, 42.9%). Most hospitals reported not utilizing CGM high and low blood sugar alarms (n=10, 58.8%). Hospitals typically used finger stick blood glucose testing while patients used a CGM (n=13, 76.5%).

More hospitals (n=29, 93.5%) reported an option for insulin pump use in the pediatric inpatient setting with 96.6% (n=28) having a written policy. Overall, hospitals’ reported policies did not differ for pump use in children admitted for diabetes complications versus nondiabetes diagnoses (n=24, 85.7%). Less than half had specific policies for suspected pump site failure (n=13, 46.4%). Verification of pump doses varied greatly with hospitals reporting nursing verification (n=17, 58.6%), patient report (n=10, 34.5%) and no verification policy (n=2, 6.9%).

Conclusion: Most hospital respondents had policies for inpatient insulin pump use while fewer had policies allowing CGM use. Best practice standards support having written guidelines to ensure patient safety and to guide the pediatric care team. Policy repositories may be a helpful resource for hospitals that lack written guidelines.

Disclosure

N. Rajagopal: None. A. Bailey: None. C. Ngo: None. A.D. Hendrix-Dicken: Stock/Shareholder; Catalyst Pharmaceuticals, Johnson & Johnson, AstraZeneca. S. Mercer: None. M. Condren: Consultant; Wolters Kluwer Health.
1157-P: Diabetic Ketoacidosis (DKA) Rates Do Not Differ by Insulin Pump Use vs. Nonuse in Teens with Type 1 Diabetes (T1D) and Executive Function (EF) Problems
Authors: VITALE REBECCA J. , VOLKENING LISA K. , LAFFEL LORI M.
Published: June 2023

Aim: Providers may resist offering pump therapy to teens with T1D who have challenges with EF (planning, organization) due to concerns for DKA. We evaluated rates of DKA and severe hypoglycemia according to pump use in teens with and without EF problems.

Methods: Parents of teens aged 13-17 years with T1D provided proxy reports of teen EF using the Behavior Rating Inventory of Executive Function (BRIEF). Global Executive Composite (GEC) t-score ≥60 defined risk of executive dysfunction. Families reported severe hypoglycemic episodes and ER visits/hospitalizations for hyperglycemia (including DKA) every 3 months for 18 months. Incidence rates (IR) were calculated as events/100 person-years. DKA IR includes ER visits/hospitalizations for either hyperglycemia or DKA. Poisson regressions evaluated differences in IR by pump use, CGM use, and BRIEF score.

Results: 169 teens (54% male) had baseline age 14.9±1.3 years, T1D duration 7.4±3.7 years, A1c 8.5±1.0%; 69% were pump users, 41% used CGM some time during follow-up, and 31% had GEC ≥60. During 297 person-years, severe hypoglycemia IR was 38.3/100 person-years and DKA IR was 7.7/100 person-years. There were no differences in hypoglycemia IR by pump or CGM use or GEC score. There was no difference in DKA IR by CGM use while DKA IR was lower in pump users vs non-users (4.9 vs 14.0, p=.01) and in those with GEC <60 vs ≥60 (4.9 vs 14.0, p=.01). Among those with GEC <60, DKA IR was lower in pump users vs non-users (2.0 vs 13.7, p=.003); in those with GEC ≥60, DKA IR was similar in pump users and non-users (13.7 vs 14.4, p=.94).

Conclusion: In this sample of teens with T1D, hypoglycemia IR did not differ by pump or CGM use or EF status; in the teens with EF challenges, DKA IR was not higher in pump users vs non-users. These observations suggest that hesitation by clinicians to offer insulin pump therapy to teens with clinical suspicion of executive dysfunction due to concerns for increased DKA risk may not be warranted.

Disclosure

R.J.Vitale: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape.

Funding

National Institutes of Health (P30DK036836, R01DK095273); JDRF (2-SRA-2014-253-M-B); Iacocca Family Foundation
1164-P: Evaluating the Impact of Telemedicine Expansion on Access to Care for Oregon's Pediatric Type 1 Diabetes Population
Authors: MITCHELL EMILY S. , ANDREA SARAH B. , GUTTMANN-BAUMAN INES
Published: June 2023

Background: Type 1 Diabetes (T1D) has a higher incidence in low density areas but only 1.8% of US pediatric endocrinologists are located in rural areas. The telemedicine expansion (TE) that accompanied the COVID-19 pandemic presents a novel opportunity to increase access to care for rural-residing children with T1D who may live a great distance from their provider.

Purpose: The study objective was to compare trends in visit frequency amongst our region's pediatric T1D population before and after TE by those living <100 miles versus ≥100 miles from clinic (MFC) and those residing in urban versus rural areas.

Methods: We evaluated EHR data from 790 children receiving care between July 2018 - December 2021. We estimated differences in likelihood of adequately-timed monitoring care (ATMC) over time by patient CCS status using Generalized Estimating Equations.

Results: Just prior to TE, those living ≥100 MFC were 20.6% less likely to receive ATMC compared to those living <100 MFC (RR 0.79; 95% CI: 0.57, 1.11). Following TE, likelihood of ATMC decreased from 31.0% to 24.0% in those living ≥100 MFC and decreased from 39.0% to 25.9% in those living <100 MFC; decreases in ATMC for those living ≥100 MFC were less than for those living <100 MFC (RR of interaction: 1.17; 95% CI: 0.68, 2.00). Just prior to TE, those living in rural areas were 0.1% less likely to receive ATMC (RR 1.00; 95% CI: 0.61, 1.63) compared to those living in urban areas. Following TE, likelihood of ATMC decreased from 37.2% to 20.2% in those living in rural areas and decreased from 37.3% to 25.7% in those living in urban areas; decreases in ATMC were greater for those living in rural areas versus urban areas (RR of interaction: 0.79; 95% CI: 0.31, 2.01).

Conclusions: Between July 2020 and December 2021, the likelihood of ATMC decreased across the entire pediatric T1D population. Decreases in ATMC were more substantial for those living <100 MFC and/or in rural areas, however, these discrepancies were not statistically significant.

Disclosure

E.S.Mitchell: None. S.B.Andrea: Research Support; Eli Lilly and Company. I.Guttmann-bauman: None.
1175-P: The Alteration of Serum Level and Expression of c-MET in Gestational Diabetes Mellitus (GDM)
Authors: JIN KIM HYUN , LEE JUHEE , WON JUNG YE , LEE MINA , KIM JIMIN , HYE JOUNG KYONG , JEONG KU BON
Published: June 2023

Objective: The aim of this study was to explore changes in serum levels and tissue expression of HGF and c-MET, and to determine how HGF/c-MET signaling contributes to the pathophysiology of GDM.

Methods: A total of 44 pregnant women with normal glucose tolerance (NGT) and 32 pregnant women with GDM were studied. Blood samples were taken just before delivery, and placenta and visceral adipose tissue were taken immediately after cesarean delivery. Serum levels of HGF, soluble c-MET and insulin were measured by enzyme-linked immunosorbent assay (ELISA). The mRNA expression of HGF and c-MET was measured in the placenta and visceral adipose tissue. In addition, we investigated pregnancy of high fat diet (HFD) mice as an animal model of GDM. The glucose tolerance test (GTT) was performed at GD 10, and measured the serum levels of Hgf and soluble c-Met at GD 16. After scarifying mice, we measured the weight and expression of mRNA of Hgf and c-Met in WAT, placenta, liver and muscle.

Results: Serum soluble c-MET levels were significantly higher in the GDM group (p <0.001). In multiple logistic regression analysis, soluble serum c-MET level was strongly associated with GDM (OR 9.063, p=0.027). There were more patients with increased mRNA expression of HGF and c-MET in placenta. Interestingly, the protein expression of HGF and c-MET in maternal visceral fat tissue was significantly higher in the GDM group. In mouse study, maternal serum levels of soluble c-Met in pregnant HFD (PH) mice were higher than in non-pregnant HFD (NPH) mice and pregnant chow diet (PC) mice. Relative mRNA expression of Hgf was significantly increased in eWAT of PH than PC mice. Relative c-Met mRNA expression was significantly increased in sWAT of PH than PC mice. Conclusion: We observed the differences in serum levels and expression of HGF and c-MET between GDM and control pregnant women in human and mice model. Our results suggest that HGF/c-MET signaling may be altered in GDM, which associated with insulin resistance and pathophysiology in GDM.

Disclosure

H.Kim: None. J.Lee: None. Y.Jung: None. M.Lee: None. J.Kim: None. K.Joung: None. B.Ku: Speaker's Bureau; AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Sanofi, Novo Nordisk, LG Chem.

Funding

National Research Foundation of Korea (2022R1F1A1074608)
1178-P: Interleukin-17 Signaling in Cerebrum of Offspring from Mother with Diabetes
Authors: SUGAI KEIJI , SASAKI JUNKO , ISHII KEITARO , LI GUOJIAO , ITO MARIKO , AIERKEN MAIERHABA , SUWANAI HIROTSUGU , TORII MASAAKI , HASHIMOTO-TORII KAZUE , ODAWARA MASATO , SUZUKI RYO
Published: June 2023

A number of human cohort and animal studies suggest that offspring from mother with diabetes (OMD) has an increased risk of both short- and long-term complications, including various neurological issues including learning impairment and autism spectrum disorders. However, the underlying mechanism of the neurobehavioral issues is still not elucidated. The main objective of this study is to examine their mechanisms by examining gene expression in the cerebrum of OMD during the embryonic period. Six-week-old Crl: CD1 (ICR) females were injected intraperitoneally with 150 mg/kg of STZ for generating OMD. This OMD model showed learning impairment using accelerated rotarod as we previously reported at the 81st Scientific Sessions of the American Diabetes Association. Citrate buffer was used to generate the control group. After mating the females with healthy males, both maternal and fetal cerebrums were collected at embryonic day 17.5. RNA was extracted from the collected cerebrums using TRIzol, and RNA sequencing and quantitative PCR were performed. The number of differentially expressed genes common to three types of analysis (EdgeR, Deseq2, and TCC) was 40. Enrichment analysis of these 40 genes using the KEGG pathway identified a group of genes (Lipocalin-2 (Lcn-2), S100a8, and S100a9) related to the Interleukin 17 (IL-17) pathway. Quantitative PCR revealed mRNA expression of these genes was significantly higher in OMD. In order to investigate the distribution of Lcn-2, we next intraperitoneally administered biotinylated Lcn-2 to pregnant dam at gestational day 17.5 and collect maternal and fetal samples 30 minutes after the administration. Immunohistochemical staining showed that biotin expression was observed in the maternal cortex but not in the fetal one, suggesting that maternally derived Lcn-2 does not reach the fetal cortex. Altogether, our results demonstrate that IL-17 signaling in the fetal brain may be involved in learning impairments in OMD.

Disclosure

K.Sugai: None. M.Odawara: Speaker's Bureau; Eli Lilly Japan K.K., Novo Nordisk, Sanofi K.K. R.Suzuki: Consultant; Novo Nordisk A/S, Other Relationship; Sanofi K.K., Eli Lilly Japan K.K. J.Sasaki: None. K.Ishii: None. G.Li: None. M.Ito: None. M.Aierken: None. H.Suwanai: None. M.Torii: None. K.Hashimoto-torii: None.
118-OR: From Learning to Planning for Change—How Continuing Medical Education Drives Clinician Intention to Implement Changes in Diabetes Care
Authors: CHEN PAN , MARDIS CAITLIN , GAWADE SANJAY , WIGGINS ANNETTE , OLIVER YVONNE
Published: June 2023

Objective: The effectiveness of continuing medical education (CME) in improving clinician knowledge and competence in the management of type 2 diabetes (T2DM) has been widely demonstrated. The current study builds upon existing literature by investigating the pathway by which CME drives clinician intention to implement changes in T2DM management.

Methods: Data from 6 accredited online T2DM CME programs targeting global diabetologists/endocrinologists (diab/endos) and primary care physicians (PCPs) launched in 2021 were analyzed. An objective knowledge/competence assessment was completed by a control group sampled from the target audience prior to the launch of each of the programs (n=301) and by a test group sampled from learners following participation (n=304). Post-education confidence improvement and intention to change were also measured in the test group. Significance of all between-group differences reported was tested using chi-square statistics.

Results: The education had a large effect size in improving clinician knowledge and competence managing T2DM (control vs test group correct response rate: 63% vs 92%, P < .001; Cohen’s d=1.21). Within the test group, 81% increased confidence in managing T2DM, and 73% planned to make clinical practice changes. Knowledge/competence did not directly predict intention to change, but those with improved confidence were more likely to plan for clinical practice change (79% vs 45%; P < .001). While knowledge/competence did not predict confidence improvement for diab/endos, PCPs who answered all questions correctly were more likely to report improved confidence (82% vs 56%; P < .01).

Conclusions: CME may indirectly drive clinician intention to implement practice changes via its impact on confidence for both diab/endos and PCPs. The role that knowledge and competence play in the pathway from CME to intention to change may vary for these two groups of clinicians.

Disclosure

P.Chen: None. C.Mardis: None. S.Gawade: None. A.Wiggins: None. Y.Oliver: None.

Funding

Eli Lilly and Company
1180-P: Impact of Diabetes Exposure In Utero on Mesenchymal Stem Cell Phenotype and Metabolic Function
Authors: HAN LEE WAI , REDLING DAKOTA , BROOKS OLIVIA , TEAGUE APRIL M. , JIANG SHAONING , TRYGGESTAD JEANIE B.
Published: June 2023

Fetal programming events at the level of the MSC not only direct development of fetal tissues in utero but may also impact these tissues throughout the life span. Exposure to diabetes (DM) in utero appears to affect early programming of MSC; thus, we hypothesized that the phenotype and metabolic characteristics of MSC would be altered by exposure to the diabetic milieu. MSC were isolated from umbilical cord Wharton's Jelly within 24 hours of delivery and confirmed by the presence of CD105 and CD90 and absence of CD34 and CD45. To assess the adipogenic capacity of MSC, they were stained with CD13 or isotype-control antibody. DM-exposed MSC revealed a 14% increase in CD13 abundance (p=0.12) compared to control MSC, indicating a higher propensity for adipocyte differentiation. Changes in energy expenditure were assessed using the Seahorse XF Cell Mito Stress Kit at passage 4-8. Maximal respiration and spare respiratory capacity were reduced by 66% (p=0.08) and 51% (p=0.08), respectively, in the DM MSC (N=3) compared to the control MSC (N=4) (Figure 1). Basal respiration and ATP production did not differ. In this pilot study, reductions in maximal respiration and spare capacity suggest that DM exposure alters the MSC's ability to meet metabolic demands under stress. Further work is needed to understand the exact mechanisms by which exposure to DM in utero alters MSC metabolism and phenotype.

Disclosure

W.Lee: None. D.Redling: None. O.Brooks: None. A.M.Teague: None. S.Jiang: None. J.B.Tryggestad: None.

Funding

National Institutes of Health (1K23DK106533, R03DK125626, P30GM122744)
1182-P: Low Socioeconomic Status and Pregnancy Outcomes in Women with Type 2 Diabetes
Authors: CAMPBELL SARA , TOMLINSON GEORGE , FEIG DENICE
Published: June 2023

Aims: Pregnant women with pre-existing type 2 diabetes have a high rate of social deprivation. Low socioeconomic status (SES) is associated with adverse pregnancy outcomes. Our objective was to assess the association of low SES with adverse pregnancy outcomes in women with type 2 diabetes. Materials and

Methods: We conducted an observational cohort study of women in the MiTy trial. Maternal and neonatal outcomes were compared in women with and without low SES. Low SES was described as recent immigration within the previous 5 years, low maternal education or single-parent households.

Results: A total of 502 women were included in the MiTy trial. Of the eligible women, 192 (41.60%) met criteria for low SES. Women with low SES had significantly higher HbA1c at 34 weeks gestation (6.18% vs 5.89%, p=<0.01). Low SES was associated with an increase in preterm birth (28.1% vs 19.7%, p=0.05), neonatal hypoglycemia (19% vs 9.8%, p=0.007), and NICU admission >24 hrs (27.2% vs 16.8%, p=0.01). After adjustment for confounders, low SES was associated with an increased risk of an adverse neonatal composite outcome (44.7% vs 31.8%, p=0.007; OR 1.83 (95% CI 1.16-2.92). Of the components of the low SES composite, low maternal education was most strongly associated with the composite neonatal outcome OR 1.71 (95% CI 1.03 - 2.82, p=0.04).

Conclusions: In women with type 2 diabetes, low SES was associated with poorer glycemic control and an increased risk of adverse neonatal outcomes. Special attention should be paid to low maternal education as a predictor of adverse outcomes.

Disclosure

S.Campbell: Speaker's Bureau; Novo Nordisk Canada Inc., HLS Therapeutics Inc. G.Tomlinson: None. D.Feig: Advisory Panel; Novo Nordisk Canada Inc., Speaker's Bureau; Sanofi, Novo Nordisk Canada Inc.

Funding

Canadian Institutes of Health Research
1186-P: Can an Early GCT Value and A1C Eliminate the Need for Repeat GCT Testing during Second-Trimester Pregnancy?
Authors: BEACHAM JORDAN A. , BODYCOT KATHERINE C. , HUANG RACHEL , AL-KOUATLY HUDA B. , MCLAREN RODNEY
Published: June 2023

Background: While A1c is a widely used marker for IDDM and NIDDM, its clinical use in gestational diabetes mellitus (GDM) is not well elucidated. We aimed to evaluate if an A1c and an early glucose challenge test (GCT) can be used to identify patients who may forgo repeat 2nd trimester GCT testing.

Methods: This was a retrospective cohort study of patients eligible for early GDM screening who had a negative screening at ≤20 weeks gestation and delivered at a single center between 2016-2020. The primary outcome was GDM in the 2nd trimester by Carpenter & Coustan criteria. Receiver operating characteristic (ROC) curve analyses were performed to compare the ability of early GCT value, and in combination with A1c to predict the primary outcome.

Results: Of the 2,025 patients eligible for early GDM screening, 722 met inclusion criteria. Of these, 583 had a 1-hour GCT, 178 had an A1c, and 38 had both. The prediction of GDM diagnosis in the 2nd trimester using an early GCT value, A1c, and both on a ROC plot produced an area under the curve (AUC) of 0.753, 0.659, and 0.672, respectively. The highest A1c where no patients were diagnosed with GDM in 2nd trimester was 4.5%, but of the 43 patients with A1c ≤5.1%, 1 (2.3%) was diagnosed with GDM in the 2nd trimester.

Conclusion: Early GCT value alone was a better predictor of GDM in 2nd trimester than a combination of GCT with A1c. A1c alone was a poor predictor.

Disclosure

J.A.Beacham: None. K.C.Bodycot: None. R.Huang: None. H.B.Al-kouatly: None. R.Mclaren: None.
119-OR: Sex and Diabetes Status Interact to Affect Human Skeletal Muscle Mitochondrial Function
Authors: ABUSHAMAT LAYLA , SCALZO REBECCA L. , SCHAUER IRENE E. , KNAUB LESLIE , RAFFERTY DEIRDRE , CLARK ETHAN , WHIPPLE MARY O. , HUEBSCHMANN AMY G. , REUSCH JANE E.B. , REGENSTEINER JUDITH G.
Published: June 2023

People with type 2 diabetes (T2D) have lower cardiorespiratory fitness (CRF)–a predictor of cardiovascular disease, morbidity, and mortality–than those without T2D. The impact of diabetes on CRF is greater in females than males. T2D confers worse CRF, in part, due to impairments in mitochondrial function, but it is unclear to what extent sex and T2D attenuate the expected improvements in mitochondrial function due to exercise training (ExTr). We hypothesized that female sex and T2D decrease mitochondrial response to ExTr. Mitochondrial respiration measures in vastus lateralis of physically inactive overweight adults aged 30-55 years with and without T2D were analyzed pre- and post- ExTr. We found increases in state 3 respiration (p=0.01), state 4 respiration (p=0.0002), and uncoupled respiration (p=0.02) after ExTr in all groups, suggesting a consistent effect of ExTr. Sex and T2D status interact to affect state 3 respiration (p=0.0003), State 4 respiration (p=0.003) and oxidative phosphorylation (P/E) ratio (p=0.0002) (Figure); females with T2D have lower mitochondrial respiration than males with T2D, unlike overweight control participants. Sex and T2D did not statistically interact with ExTr. These findings suggest that differences in muscle mitochondrial function due to T2D and sex persist despite improvements in mitochondrial respiration with ExTr.

Disclosure

L.Abushamat: None. J.G.Regensteiner: None. R.L.Scalzo: None. I.E.Schauer: None. L.Knaub: None. D.Rafferty: None. E.Clark: None. M.O.Whipple: None. A.G.Huebschmann: None. J.E.B.Reusch: Advisory Panel; Medtronic.

Funding

American Diabetes Association (1-21-CMF-003 to L.A.); U.S. Department of Veterans Affairs (CX001532)
1193-P: GDM Treatment, Diagnosis Timing, and Glycemic Control—Associations with Newborn Outcomes in the SWIFT Study
Authors: JOSEFSON JAMI L. , SUN BAIYANG , XIANG ANNY , GREENBERG MARA , GREENSPAN LOUISE , LO JOAN C. , DAVIS JAIMIE N. , GUNDERSON ERICA P.
Published: June 2023

Suboptimal glycemic control in GDM increases risk of adverse perinatal outcomes. We evaluated GDM treatment type (glyburide vs diet), timing of diagnosis (<20w gestation: early (E) vs. >20w: standard (S), glycemic control (optimal vs suboptimal), and perinatal outcomes. In a diverse cohort of 902 GDM mother-infant dyads (77% Hispanic, Asian, or Black; 23% White), prenatal glycemic control was measured by self-home glucose monitoring and categorized as optimal (≥80% of tests met target, fasting glucose ≤95 mg/dL and 1h post-prandial ≤140 or 2h ≤120) or suboptimal (<80% of tests met target). Compared to the S diagnosis and diet treatment group, the E diagnosis and glyburide treatment group was older, more likely to have prior GDM, and higher prepregnancy BMI and glucose levels on the 3h 100 g prenatal OGTT. Glyburide treatment was associated with suboptimal control (P<0.001). Multivariable logistic regression estimated odds ratios (OR, 95%CI) of perinatal outcomes associated with GDM treatment type, timing of diagnosis, and glycemic control vs. the referent group with S diagnosis and optimal control on diet treatment alone, adjusted for pre-pregnancy BMI, infant sex and gestational age. Among E and S diagnosis groups with suboptimal control both before and after glyburide treatment, ORs, 95%CI were higher for neonatal length of stay ≥3 days: (E 3.6, 1.6-8.1; S 2.0, 1.1-3.6), neonatal hypoglycemia (E 2.4, 1.0-5.9; S 1.9, 1.0-3.6) and large-for-gestational age (LGA) birthweight (E 4.1, 1.8-9.1; S 2.8, 1.6-4.9). For E diagnosis with suboptimal control before, and optimal control after glyburide, the odds of LGA were elevated (2.8, 1.2-6.6) similar to the S diagnosis with suboptimal control after glyburide. Associations did not affect Cesarean delivery or NICU admission. These findings show that even with post-glyburide optimal glycemic control, odds of LGA development associated with exposure to GDM from early gestation may be only partially ameliorated by glyburide treatment.

Disclosure

J.L.Josefson: None. B.Sun: None. A.Xiang: None. M.Greenberg: None. L.Greenspan: None. J.C.Lo: None. J.N.Davis: None. E.P.Gunderson: None.

Funding

National Institutes of Health (R01DK122700)
1197-P: A Pregnancy-Specific GMI Derived from Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes
Authors: LING PING , LV JING , YANG DAIZHI , WANG CHAOFAN , ZHENG XUEYING , LUO SIHUI , YANG XUBIN , DENG HONGRONG , XU WEN , YAN JINHUA , WENG JIANPING
Published: June 2023

Objective: The relationship between glycated hemoglobin (HbA1c) and glucose concentrations was widely explored in patients with diabetes, but all of them excluded pregnancies. The purpose of this study was to derive a best-fitting model to calculate glucose management indicator (GMI) from mean blood glucose (MBG) obtained from continuous glucose monitoring (CGM) among pregnant women with type 1 diabetes mellitus (T1DM).

Methods: A total of 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM in the CARNATION study were analyzed in this study. CGM data were collected to calculate MBG, time-in-range (TIR), and glycemic variability parameters. The relationships between the MBG and HbA1c during pregnancy, and postpartum were explored. Mix-effect regression analysis with polynomial terms and cross-validation method was conducted to investigate the best-fitting model to calculate GMI from MBG obtained by CGM.

Results: The pregnant women had a mean age of 28.91±3.78 years, with a diabetes duration of 8.79±6.18 years and a mean BMI of 21.07±2.48 kg/m2. The HbA1c levels were 6.13±1.02% and 6.41±1.00% during pregnancy and at postpartum (P=0.024). The MBG levels were lower during pregnancy than those at postpartum (6.49±1.11 mmol/L vs 7.11±1.46 mmol/L, P= 0.008). After adjusting the confounders of hemoglobin (Hb), BMI, trimesters, disease duration, MAGE and CV%, we developed a pregnancy-specific GMI-MBG equation: GMI for pregnancy (%) = 0.84-0.28* [Trimester]+0.08 * [ BMI in kg/m2 ] +0.01* [Hb in g/mL]+ 0.50 * [MBG in mmol/L].

Conclusion: We derived a pregnancy-specific GMI-MBG equation, which should be recommended for antenatal clinical care.

Disclosure

P.Ling: None. J.Yan: None. J.Weng: None. J.Lv: None. D.Yang: None. C.Wang: None. X.Zheng: None. S.Luo: None. X.Yang: None. H.Deng: None. W.Xu: None.

Funding

Science and Technology Planning Project of Guangzhou (202102010154); Shanghai Medical and Health Development Foundation (DMRFP_II_14); National Natural Science Foundation of China (81941022)
1198-P: Gestational Diabetes Mellitus and Childhood Neurodevelopment Disorders in Offspring—Results from a Large Multi–racial/ethnic Cohort Study
Authors: LIU XINYUE , JANZEN CARLA , SEAMANS MARISSA , NIANOGO ROCH , FEI ZHE , CHEN LIWEI
Published: June 2023

Objectives: Gestational diabetes mellitus (GDM) has been linked to a higher risk of certain neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in offspring; however, other types of NDDs are rarely studied and whether the associations vary by race/ethnicity remains unknown. Thus, we aimed to examine the association of GDM with different types of NDDs and by race/ethnicity.

Methods: This retrospective cohort study included 14,480 singletons born to mothers without pre-existing diabetes and were followed to at least 1 year old in a large medical system in the US from 3/1/2013 to 8/31/2021. We ascertained GDM using the International Classification of Disease (ICD) codes (ICD-9: 648.8x; ICD-10: O24.4x) and defined NDDs (speech/language disorder [SLD], developmental coordination disorder [DCD], ASD, and others [ADHD, behavioral disorder, intellectual disability, and learning difficulty]) using validated algorithms. We compared the risk of NDDs during the entire follow-up period between offspring born to mothers with GDM and without GDM using multivariable Cox regression models.

Results: During the median of 3.2 years (interquartile range: 2.0-4.9) follow-up period, GDM was significantly associated with a higher risk of SLD (adjusted hazard ratio: 1.62; 95% CI: 1.10, 2.40), DCD (2.35; 95% CI: 1.38, 4.02), ASD (3.28; 95% CI: 1.42, 7.58), and other NDDs (3.20; 95% CI: 1.55, 6.60) among children born to non-Hispanic White mothers. No significant association of GDM with any type of NDDs was observed among other race/ethnicity.

Conclusion: Young children born to non-Hispanic White mothers with GDM had an elevated risk of NDDs. However, the results may be affected by differential outcome misclassification by race/ethnicity.

Disclosure

X.Liu: None. C.Janzen: None. M.Seamans: None. R.Nianogo: None. Z.Fei: None. L.Chen: None.
12-OR: Urine Lactate Is a Disease Biomarker for Diabetic Kidney Disease
Authors: KUGATHASAN LUXCIA , DARSHI MANJULA , SRINIVASAN SRIDHAR VIKAS , DREL VIKTOR , TUMOVA JANA , LIU JIAN-JUN , WANG JIEXUN , PERKINS BRUCE A. , LYTVYN YULIYA , NATARAJAN LOKI , CHI LIM SU , WAIKAR SUSHRUT , OSMAN YAHYA M. , HE JIANG , VALLON VOLKER , HALLAN STEIN , CHERNEY DAVID , SHARMA KUMAR , STUDY INVESTIGATORS CRIC
Published: June 2023

As lactate (LA) elevation is associated with mitochondrial dysfunction, we examined the role of LA in diabetic kidney disease (DKD) progression. Urine LA (ULA) was measured in patients with type 2 diabetes (T2D) in three independent cohort studies (HUNT3, SMART2D, and CRIC). ULA and plasma LA (PLA) were also measured in patients with type 1 diabetes (T1D) following eu- or hyperglycemic clamp, in mouse kidney sections, and sodium-glucose cotransporter-2 (SGLT2)-deficient mice. Mitochondrial functional changes in human kidney proximal tubule (HK2) cells were assayed in response to exogenous LA. Subjects in HUNT3 with DKD (n=39) had elevated ULA levels compared to healthy controls (n=53, p=0.023) (Fig. 1). In subjects with T2D from SMART2D (n=230) and CRIC (n=889), the third tertile of ULA/creatinine ratio was associated with a greater estimated glomerular filtration rate (eGFR) decline [-1.63 mL/min/1.73m2/year, p=0.007, and -0.63 mL/min/1.73m2, p=0.042], relative to the first tertile. Acute hyperglycemia stimulated PLA (p<0.0001) and ULA (p=0.001) in patients with T1D (n=39), and in kidney sections incubated with high glucose. Compared to wild-type, SGLT2-deficient mice had lower ULA levels. LA above 2.5 mM inhibited oxygen consumption rate in HK2 cells. Elevated ULA/creatinine ratio inhibits mitochondrial function in diabetes and identifies subjects at risk of rapid renal decline independent of chronic glycemic control.

Disclosure

L.Kugathasan: None. L.Natarajan: None. S.Lim: None. S.Waikar: None. Y.M.Osman: None. J.He: None. V.Vallon: Research Support; NIH - National Institutes of Health, Gilead Sciences, Inc., Merck Sharp & Dohme Corp., Novo Nordisk, Maze Therapeutics, Boehringer-Ingelheim, Speaker's Bureau; AstraZeneca. S.Hallan: None. D.Cherney: Other Relationship; Boehringer Ingelheim-Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi-Tanabe, Abbvie, Janssen, Bayer, Prometic, BMS, Maze, Gilead, CSL-Behring, Otsuka, Novartis, Youngene, Lexicon and Novo-Nordisk, Research Support; Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca, CSL-Behring and Novo-Nordisk. K.Sharma: Advisory Panel; Reata Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc. Cric study investigators: n/a. M.Darshi: Employee; Janssen Research & Development, LLC. V.Srinivasan sridhar: Other Relationship; Merck & Co., Inc. V.Drel: None. J.Tumova: None. J.Liu: None. J.Wang: None. B.A.Perkins: Advisory Panel; Dexcom, Inc., Insulet Corporation, Novo Nordisk, Sanofi, Vertex Pharmaceuticals Incorporated, Other Relationship; Abbott, Medtronic, Sanofi, Research Support; Novo Nordisk, Bank of Montreal (BMO). Y.Lytvyn: None.
1201-P: Circulating C1q/TNF-Related Protein 6 (CTRP6) and CTRP9 as Potential Biomarkers for Early Gestational Diabetes Mellitus
Authors: LIU YUTING , CHEN YANNA , GU WENSHA , YIN LULU , CAO HUIMIN , SHI MIN
Published: June 2023

Background: The growing evidence has been verified that C1q/TNF-related protein 6 (CTRP6) and CTRP9, secreted by adipose tissue, can regulate glucose and lipid metabolism. However, the effect of CTRP6 and CTRP9 in gestational diabetes mellitus (GDM) is scarcely known. This study aimed to evaluate the potential clinical value of CTRP6 and CTRP9 in GDM.

Methods: A total of 35 GDM subjects and 37 healthy controls, between 24 and 28 weeks of gestation, were included in the study. Diagnosis of GDM was made according to American Diabetes Association criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of CTRP6 and CTRP9. Fasting insulin (FINS), IL-6, and TNF-α were detected by Luminex-xMAP technology. The main clinical characteristics, such as Anthropological data and metabolic parameters, were also obtained.

Results: Circulating CTRP6, CTRP9, IL-6 and TNF-α were significantly elevated in GDM subjects compared with controls. Pearson correlation analysis showed that CTRP6 and CTRP9 were positively correlated with FPG (r = 0.280, P = 0.017 and r = 0.559, P < 0.001, respectively) and HOMA-IR (r = 0.250, P = 0.035 and r = 0.382, P = 0.001, respectively). Moreover, CTRP9 was also positively correlated with FINS (r = 0.253, P = 0.032), IL-6 (r = 0.283, P = 0.016) and TNF-α (r = 0.266, P = 0.024). The area under the receiver operating characteristic curve (AUC-ROC) indicated that the combination of CTRP6 and CTRP9 was more effective in predicting GDM than single indicators.

Conclusion: Elevated CTRP6 and CTRP9 in GDM patients may be related to insulin resistance. And inflammatory factors may mediate the role of CTRP9 in insulin resistance. In addition, CTRP6 and CTRP9 may serve as candidate predictors in patients with early GDM.

Disclosure

Y.Liu: None. Y.Chen: None. W.Gu: None. L.Yin: None. H.Cao: None. M.Shi: None.

Funding

National Natural Science Foundation of China (81700723)
1202-P: Comparison of the Clinical Characteristics, Glycemic Control, and Pregnancy Outcomes between Wave I and III of COVID-19 Pandemic in Women with Gestational Diabetes Mellitus—A Reference Center Report
Authors: WILK MAGDALENA , KANIA MICHAL , MALECKI MACIEJ
Published: June 2023

Background: The medical care for gestational diabetes mellitus (GDM) during the COVID-19 pandemic was influenced by changing epidemiological conditions and governmental regulations. Aim To compare the clinical data of GDM women between wave I and III of COVID-19 pandemic.

Materials and methods: We performed retrospective analysis of the medical records from the GDM clinic of the University Hospital in Krakow, and compared the periods of March-May 2020 and March-May 2021, corresponding to wave I and III, respectively.

Results: GDM women during wave I (N=118) as compared to wave III (N=116) were older (33.0±4.7 vs 32.1±4.8 years; p=0.03), booked later (21.8±8.4 vs 20.3±8.5 weeks; p=0.08) and had the last visit earlier (35.5±2.0 vs. 35.7±3.2 weeks; p<0.01). The pregnancy weight gain were similar (8.9±5.6 vs 8.4±5.6 kg; p=NS). Telemedicine consultations were used more frequently during wave I (36% vs 18% of all visits; p<0.01) while insulin therapy less often (64.7% vs. 80.2%; p<0.01). The mean fasting self-control glucose did not differ (4.8±0.3 vs 4.8±0.3 mmol/l; p=0.25) but a worse postprandial glycemia during wave I was reported (6.6±0.9 vs. 6.3±0.6 mmol/l; p<0.01). Pregnancy outcome data were available from 77 and 73 pregnancies, respectively. The groups were similar for the delivery time (38.2±1.4 vs. 38.1±1.6 weeks), cesarean sections (58.4% vs. 61.3%), APGAR score (9.7±1.0 vs. 9.7±1.0 pts) and birth weight (3306.6±460.6 g vs 3243.9±500.2) (p=NS for all), slightly higher length occurred for Wave I (54.3±2.6 cm vs. 53.3±2.6; p=0.02).

Conclusions: We identified differences in many areas between GDM women booking either during wave I or III of COVID-19 pandemic, however, the pregnancy outcomes were mostly similar.

Disclosure

M.Wilk: None. M.Kania: None. M.Malecki: Advisory Panel; Abbott Diabetes, Novo Nordisk, Lilly, Sanofi, Dexcom, Inc., Bayer Inc., Research Support; Medtronic, Speaker's Bureau; AstraZeneca, AlfaSigma, Merck & Co., Inc., BIOTON S.A., Servier Laboratories, KRKA.
1203-P: Elevated HOMA-IR and IL-6 in Pregnant Women with Metabolic-Dysfunction–Associated Fatty Liver Disease and Gestational Diabetes Mellitus
Authors: CHAI THORA Y.L. , PASUPATHY DHARMINTRA , GEORGE JACOB , WAH CHEUNG N.
Published: June 2023

Background: It is uncertain whether biomarkers differ in singleton pregnant women with metabolic dysfunction-associated fatty liver disease (MAFLD) and gestational diabetes mellitus (GDM).

Methods: A prospective cohort study was conducted. A FibroScan® was performed between 10-24 weeks. A controlled attenuation parameter score ≥233.5dB/m indicated MAFLD. GDM was diagnosed with IADPSG criteria. Between 24-30 weeks, fasting blood was collected to determine serum levels of tumour necrosis factor alpha (TNF-α), interleukin 6 (IL-6), fibroblast growth factor 21 (FGF-21), high molecular weight adiponectin (HMW-APN), glucose and insulin. HOMA-IR was calculated: [insulin (mU/L) × glucose (mmol/L)]/22.5. Four groups of control (no GDM/MAFLD), MAFLD only, GDM only, MAFLD & GDM were formed. Biomarkers were analyzed by general linear models after log transformation, adjusted for age, body mass index, ethnicity and nulliparity.

Results: Of 120 women, 47 were control, 37 MAFLD only, 14 GDM only and 22 MAFLD & GDM. Compared to controls, MAFLD & GDM had 1.8-fold higher HOMA-IR and IL-6, significantly elevated over GDM only and MAFLD only (Table 1). No significant differences in TNF-α, FGF-21 or HMW-APN occurred (Table 1).

Conclusions: Significantly elevated HOMA-IR and IL-6 in pregnant women with MAFLD & GDM suggests a more insulin resistant and inflammatory phenotype.

Disclosure

T.Y.L.Chai: None. D.Pasupathy: None. J.George: None. N.Cheung: None.

Funding

Diabetes Australia Research Program (Y21GCHEW)
1206-P: Benefits of Virtual Shared Medical Appointments for Gestational Diabetes
Authors: EHRENBERG BUCHNER STACEY , HART HILLARY , BEDE KRISTEN M. , ISAACS DIANA
Published: June 2023

Background: The rate of gestational diabetes (GDM) has increased over the past decade, now effecting up to 14% of pregnancies worldwide. Studies show that these woman benefit from diabetes education, nutrition education and a maternal-fetal medicine (MFM) consultation. However, accommodating this increasing number of women, especially in the middle of a global pandemic, can be challenging.

Purpose: First, to develop a curriculum for women with GDM to empower them to optimally manage their diabetes in pregnancy. Second, to evaluate whether this curriculum could be used in a virtual shared medical appointment (SMA) to accommodate more patients while protecting their health during the COVID-19 pandemic.

Results: A virtual SMA was created in the electronic medical record using a zoom platform. Up to ten women are seen during this 2-2.5 hour visit. From 1/1/2022 through 12/31/22, 159 women participated in the program. On average, women attended the SMA within 12.9 days of the consult request. All women received a copy of the curriculum via email prior to the visit. During the visit, patients received their MFM consult, diabetes education, and nutrition counseling in a group format. The visit included a one-on-one breakout room with a MFM provider to discuss personal history, glucose levels and use of medication if necessary. Women were billed through insurance for the MFM consultation as well as group nutrition counseling. Of the 159 participants, 139 have delivered. Eighty-nine (64%) women had a vaginal delivery and 50 (36%) had a cesarean delivery.

Conclusion: A virtual SMA is an efficient and effective format for educating women with GDM during the COVID-19 pandemic and beyond. Access to these resources was faster for women in the SMA versus those who received individual MFM consultations, nutrition counseling and diabetes education. The rate of cesarean delivery was lower than the rate reported in the literature for women with GDM. Patient reported outcomes regarding this format have also been favorable.

Disclosure

S.Ehrenberg buchner: Advisory Panel; Dexcom, Inc. H.Hart: None. K.M.Bede: None. D.Isaacs: Speaker's Bureau; Dexcom, Inc., Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk.