bluuebunny/crossref_metadata_2025 huggingface dataset:
1007-P: Improvements in Glycemic Outcomes among Level2 Members Are Sustained after 24 Months
Authors: BACON SAM , FERRELL DAVID
Published: June 2024

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

Methods: People joining Level2 between 01/01/21 and 07/31/21 who wore a CGM and had enrollment in a participating commercial health plan 24 months after and for at least 6 months prior to joining were included in the analysis. We used CGM-derived GMI (with ≥ 90% data sufficiency over 14 days) and A1c values available from a database of de-identified administrative claims to determine baseline, 12-month, and 24-month follow-up glycemic outcomes. Student t-tests were used to test for pair-wise differences in glycemic measures between baseline and follow-up periods overall and stratified by baseline A1c.

Results: Of the 2,035 people identified for the 2-year analysis, a subset (N = 161) had baseline A1c > 7.0% and valid GMIs during both follow-up periods. This subset was 48% (N = 78) male with mean age of 54.0 (SD = 8.4) years and had mean baseline A1c of 8.77% (SD = 1.38). The mean differences from baseline A1c to 12- and 24-month GMI were -1.39% (p < 0.001) and -1.36% (p < 0.001), respectively. The mean change from 12- to 24-month GMI (0.02%, p = 0.70) was not statistically significant. After 12 months, 38.5% achieved a target GMI ≤ 7% and 60% of these people continued to achieve this target after 24 months. In those with baseline A1c ≤ 9.0%, 58% had improved by more than 0.5% at 12 months and 80% maintained this reduction at 24 months. In those with A1c > 9.0%, 97% improved by more than 0.5% at 12 months and 95% maintained this reduction at 24 months.

Conclusion: Level2 members with baseline A1c and follow-up GMIs saw significant and sustained improvements in glycemic control after one and two years of engagement.

Disclosure

S. Bacon: Employee; UnitedHealth Group. Research Support; Level2. Stock/Shareholder; UnitedHealth Group. Employee; Optum Labs. Consultant; Level2. D. Ferrell: None.
1009-P: Assessing Patterns of CGM Use and Metrics of Glycemic Control in Type 1 Diabetes and Type 2 Diabetes Patients in the Veterans Healthcare System—Integrating CGM Device Data with EHR Data
Authors: OKUNO TOMOKI , MACWAN SHARON , MILLER DONALD R. , NORMAN GREGORY J. , REAVEN PETER , ZHOU JIN
Published: June 2024

Introduction & Objective: To integrate long-term daily continuous glucose monitoring (CGM) device data with electronic health records (EHR) for type 1 and type 2 diabetes patients in the Veterans Affairs Healthcare System to assess real-world patterns of CGM use and the reliability of EHR-based CGM information.

Methods: This observational study used Dexcom CGM device data linked with EHR (from 2015-2020) for a large national cohort of diabetes patients. We tracked the initiation and consistency of CGM use, assessed the concordance of CGM use and measures of glucose control between CGM device data and EHR records, and examined results by age, ethnicity, and diabetes type.

Results: The time from pharmacy release of CGM to patients to initiation of uploading CGM data to Dexcom servers averaged three weeks but demonstrated wide variation among individuals; importantly, this delay decreased markedly over the later years. The average daily wear time of CGM exceeded 22 hours over nearly three years of follow-up. Patterns of CGM use were generally consistent across age, race/ethnicity groups and diabetes type. There was strong concordance between EHR-based estimates of CGM use and Dexcom CGM wear time and between estimates of glucose control from both sources.

Conclusions: The study demonstrates our ability to reliably integrate CGM devices and EHR data to provide valuable insights into CGM use patterns. The results indicate in the real-world environment that CGM is worn consistently over many years for both type 1 and type 2 patients and is similar across major race/ethnicity and age groups.

Disclosure

T. Okuno: None. S. Macwan: None. D.R. Miller: None. G.J. Norman: Employee; Dexcom, Inc. P. Reaven: Research Support; Dexcom, Inc. J. Zhou: None.

Funding

This work was supported by the Veterans Affairs Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development. Additional support was received from the National Institutes of Health R01-067690 and 5R01-094775 to P.D.R., and the American Diabetes Association to P.D.R.; J.J.Z was supported by NIH (K01DK106116, R21HL150374, R01HG006139), and National Science Foundation (DMS-2054253, IIS-2205441).
1010-P: In Vivo Evaluation of Novel Long-Term Intravascular Implantable Continuous Blood Glucose Monitor in a Chronic Ovine Model—A Glucotrack Inc. Investigation
Authors: TAPSAK MARK A. , GOODE PAUL , THROWER JP , TALCOTT MICHAEL R. , GARCIA JOSE , ROUTH TIMOTHY , TAPSAK STEPHEN
Published: June 2024

Introduction & Objective: This study provides the first in vivo assessment of Glucotrack's long-term implantable Continuous Blood Glucose Monitor (CBGM) in an ovine model. The primary objectives were to evaluate device performance, assess and refine implantation techniques, and examine chronic gross biocompatibility through explant and necropsy.

Methods: Two adult male sheep were selected for the study, each receiving 2 intravascular device implants—one each in the left and right jugular vein. MARD (CBGM-BGM) scores were calculated at 30 and 60 days post-implantation. Regular blood glucose measurements were performed twice weekly. Glucose excursions were conducted twice during the study and compared against conventional blood glucose monitoring values measured in triplicate. Comprehensive blood analyses were performed at the beginning and end of the study.

Results: The results demonstrated successful intravascular implantation (~20 minutes) without sophisticated techniques or tools. During the study, no serious adverse events were observed. Notably, MARD improved over time, indicating sustained accuracy of the Glucotrack CBGM. MARD average across the 4 devices was 8.1% at Day 30 and 4.5% at Day 60.

Conclusion: Glucotrack’s CBGM may be a reliable and accurate long-term solution for humans managing diabetes mellitus.

Disclosure

M.A. Tapsak: Employee; Glucotrack Inc. P. Goode: Employee; Glucotrack Inc. J. Thrower: Employee; Glucotrack Inc. M.R. Talcott: Employee; AbbVie Inc. Consultant; Stereotaxis, GlucoTrack, Medibeacon. J. Garcia: Consultant; Glucotrack. T. Routh: Employee; GlySens Incorporated, Biolinq. Consultant; GlucoTrack Incorporated. S. Tapsak: Employee; Glucotrack, Inc.
1024-P: Remote Continuous Glucose Monitoring following Hospital Discharge
Authors: FOLK SARA , SOBOL TREVOR , GATTI THAINA , HARRIS CARA , FAULDS EILEEN R. , BUSCHUR ELIZABETH , WYNE KATHLEEN , DUNCAN PHILICIA , DUNGAN KATHLEEN M.
Published: June 2024

Introduction & Objective: Hospital discharge is a vulnerable period for persons with type 2 diabetes (T2D). We assessed the feasibility and efficacy of remote (RM) vs. manual (MM) monitoring using a continuous glucose monitor (CGM).

Methods: In this prospective cohort study, persons with T2D, A1c >8%, and basal insulin use received a Dexcom G6 following discharge. This analysis includes 14-day CGM reports at 4 weeks after discharge for the first 100 participants. Key outcomes were stratified by either RM vs MM of CGM data and include % time in range (70-180 mg/dl, TIR).

Results: Among the 100 participants, 52 were RM and 48 were MM. Barriers in the MM group included incompatible cell phone (48%), no smartphone (46%), or other (4.2%). The RM group was younger, more likely to be employed, and had higher numeracy compared to the MM group. CGM data were available at 4 weeks in 62% of RM vs 56% of MM, p=0.69, and time in use was >95% in both groups. Median glucose was 176 (IQR 143, 215) vs 203 (IQR 183, 248, p=0.02) mg/dL in the RM vs MM group. Median TIR was 53% (IQR 33, 82) vs 40% (IQR 20, 49, p=0.04) in the RM vs. MM group and % time <70 mg/dl was <1% for both groups.

Conclusion: Early findings suggest that CGM with RM is associated with higher TIR compared to CGM with manual downloads following hospitalization. Overcoming technological barriers to RM may improve glycemic outcomes post-discharge.

Disclosure

S. Folk: None. T. Sobol: None. T. Gatti: None. C. Harris: None. E.R. Faulds: Advisory Panel; Dexcom, Inc. Research Support; Dexcom, Inc., Insulet Corporation. Other Relationship; A1Control. E. Buschur: Research Support; Dexcom, Inc. K. Wyne: None. P. Duncan: None. K.M. Dungan: Advisory Panel; Eli Lilly and Company, Dexcom, Inc. Research Support; Dexcom, Inc. Advisory Panel; Elsevier. Research Support; Abbott, ViaCyte, Inc., Sanofi, Omnipod. Advisory Panel; Omnipod. Other Relationship; Up-To-Date. Speaker's Bureau; Med Learning Group, Medscape, Cardiometabolic Health Congress. Consultant; Oppenheimer & Co. Speaker's Bureau; Integritas.

Funding

Dexcom
1030-P: Feature Selection of Gait Measures Discriminating Prediabetes from Healthy Controls Using Machine Learning
Authors: SHAH VRUTANGKUMAR V. , MUZYKA DANIEL F. , CARLSON-KUHTA PATRICIA , MANCINI MARTINA , SOWALSKY KRISTEN , HORAK FAY B.
Published: June 2024

Introduction & Objective: Key challenges in using body-worn inertial sensors to monitor gait characteristics are an excessive number of measures. This study aimed to determine the best combination of gait measures to discriminate prediabetes from healthy control (HC) subjects.

Methods: In this study, 108 individuals with prediabetes (age: 71.20 ± 5.11 years) and 63 healthy controls (age: 70.40 ± 6.25 years) undertook a 400-meter fast walk test. Wearing Opals inertial sensors from APDM Wearable Technologies, participants had six sensors attached to their feet, wrists, sternum, and lumbar regions. Employing the best subset selection method with forward stepwise regression, 70% of the training dataset was used for feature selection, validated with the remaining 30% for testing the model's performance, assessed by the area under the curve (AUC), accuracy, and F1 score on the validation dataset.

Results: From a pool of 37 gait measures, the best subset identified three measures from the training dataset: Cadence, total number of turns, and transverse range of motion of the trunk. A logistic regression model was built with these three gait measures using the training dataset and tested on the validation dataset. The logistic regression model on validation dataset showed AUC=0.77 (sensitivity=0.65 and specificity=0.85), accuracy=0.78 and F1 score=0.68. The performance of the proposed model with these 3 gait measures is similar to performance of model train and tested using all 37 gait measures.

Conclusion: The optimal combination of gait measures distinguishing prediabetes from HC gait involves three measures from Feet and Lumbar locations. These insights deepen our understanding of prediabetes-related gait deficits, aiding informed clinical decisions and intervention assessments.

Disclosure

V.V. Shah: None. D.F. Muzyka: None. P. Carlson-Kuhta: None. M. Mancini: Consultant; Clario. K. Sowalsky: None. F.B. Horak: Employee; Clario.

Funding

This study was supported by VA Clinical Sciences Research & Development (NCT01804049).
1038-P: National Trends in Antidiabetes Drug Spending for U.S. Adults with Diabetes—2000–2021
Authors: ZHANG PING , WANG YU , ZHOU XILIN , TANG SHICHAO
Published: June 2024

Introduction & Objective: The number of drugs for diabetes has been increasing and spending on prescriptions has become the largest part of total medical spending in adults with diabetes. We assessed national trends on anti-diabetes drugs spending in adults with diabetes.

Methods: Data were from 2000-2021 U.S. Medical Expenditure Panel Surveys. Medications were grouped as insulin and noninsulin. The noninsulin medications included metformin, other conventional [sulfonylurea, thiazolidinedione, alpha-glucosidase inhibitor, meglitinide], newer [dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 agonist, sodium-glucose cotransporter-2 inhibitor, amylin analog], and combination drugs. Costs were in 2021 US dollars. We used the join-point regression to identify trend changes (Figure).

Results: Total per person drug spending increased 400% from $677 in 2000 to $3,448 in 2021 or an average annual increase of $138.5. By group, the average annual spending increased $56.5 for insulin, $108 for the newer drugs (since 2006), and decreased $8.5 for the older drugs. Over time, we observed different trends by drug group. Spending on the newer drugs exhibited an upward trend from 2006 to 2013 and the trend was more accelerated after 2014.

Conclusion: Trends in spending of different anti-diabetes drug groups have changed in the last two decades. Future studies could examine reasons associated with these changes.

Disclosure

P. Zhang: None. Y. Wang: None. X. Zhou: None. S. Tang: None.
1048-P: A Financially Sustainable "Pharmacist Plus" Care Model Shows Superior Diabetes Outcomes
Authors: MALKANI SAMIR , HAAS RICHARD A. , SHAH VRUSHALI , MCELNEA WILLIAM , PIZ LILLIAN , BARRY CHERYL , SHARMA HINAL , PUGLIESE GABRIELLA , LEBEL (SHNAYDERMAN) STELLA
Published: June 2024

Introduction: Individuals with persistently uncontrolled diabetes (Hemoglobin A1C ≥9) frequently face socioeconomic, behavioral, or other barriers to treatment plans despite optimal medical and education interventions. Despite demonstrated efficacy of one-on-one coaching, it is often not reimbursed by health insurance.

Objective: At the UMass Memorial Diabetes Center of Excellence, we evaluated the financial sustainability and efficacy of a “Care Coach” program to provide additional services to these patients.

Methods: Pharmacists from the UMass Specialty Pharmacy, trained in diabetes care, delivered high-frequency, individualized comprehensive coaching covering medication management, nutrition and lifestyle counseling, refill coordination, SDOH screening/referrals and mental health referrals.

Results: Notable outcomes are A1C reduction averaging 2% (sustained at month 15) and over 50% lower rates of diabetes-related ER visits and hospitalizations (Table). The medical center investment of $2,666 per coach patient annually is offset by a combination of patients filling prescriptions through the Specialty Pharmacy and the 340B drug pricing program.

Conclusion: With a third of Coach patients on Medicaid, the program showcases the potential of leveraging the 340B program to enhance care for the economically vulnerable, while reducing diabetes-related ER visits and hospitalizations.

Disclosure

S. Malkani: None. R.A. Haas: None. V. Shah: None. W. McElnea: None. L. Piz: None. C. Barry: None. H. Sharma: None. G. Pugliese: None. S. Lebel (Shnayderman): None.
1068-P: Reassessing Insulin Therapy In Diabetes of the Exocrine Pancreas—A Pilot Study
Authors: CICCARELLI GEA , DI GIUSEPPE GIANFRANCO , BRUNETTI MICHELA , SOLDOVIERI LAURA , DI GIORGI NICOLETTA , IACOMINI CHIARA , MASCIOCCHI CARLOTTA , PATARNELLO STEFANO , CAPECE UMBERTO , MORCIANO CASSANDRA , GUGLIANDOLO SHAWN , AVOLIO ADRIANA , MOFFA SIMONA , CINTI FRANCESCA , GIACCARI ANDREA , MEZZA TERESA
Published: June 2024

Cohort studies have demonstrated that subjects with diabetes of the exocrine pancreas (DEP) are mostly treated with basal bolus insulin. To reassess insulin therapy in subjects affected by DEP, we evaluated the prevalence of insulin therapy in our cohort and investigated the role of other glucose-lowering drugs.We first conducted a retrospective study on DEP subjects referred to our hospital over three years (2021 - 2023). We then conducted an intervention study on 13 subjects with diabetes and acute or chronic pancreatitis, treated with basal bolus insulin. All patients suspended rapid insulin and started a combination of glucose-lowering drugs, chosen according to standard of care. Subjects used a flash glucose monitoring (FGM) system. FGM parameters and quality of life (DQOL) were reported at baseline and after one and three months.We found that 381/490 subjects with DEP were treated with basal bolus insulin. In the intervention study, all subjects had high cardiovascular risk. Basal insulin was titrated during follow-up (10±1 UI vs 16±2 UI; p=0.036) and oral therapy prescribed as follows: metformin 11/13, pioglitazone 5/13, GLP-1RA 3/13, DPP-4i 5/13, SGLT2i 9/13. At one month FGM parameters showed Time In Range (TIR) 64±4 vs 77±7%, Time Above Range (TAR) 35±4 vs 21±8%, Time Below Range (TBR) 1±0.4 vs 1.2±0.7%, Glucose Management Indicator (GMI) 7.2±0.2 vs 6.4±0.2% (p=0.031). At three months we found improved glycemic control (TIR 64±4 vs 86±4%, p=0.009; TAR 35±4 vs 10±8%; p=0.009; TBR 1±0.4 vs 1±0.6% ns; GMI 7.2±0.2 vs 6.1±0.3%; p=0.042) and quality of life (2.5±0.6 vs 1.3±0.6; p=0.041). No DKA or acute pancreatitis recurrence occurred. Combination of basal insulin and oral glucose-lowering drugs significantly improved glycemic control and quality of life compared to basal-bolus insulin therapy. Therapies used in type 2 diabetes may be useful in DEP to improve metabolic control and reduce cardiovascular risk. Larger studies are warranted to assess safety and efficacy of these drugs in DEP.

Disclosure

G. Ciccarelli: None. G. Di Giuseppe: None. M. Brunetti: None. L. Soldovieri: None. N. Di Giorgi: None. C. Iacomini: None. C. Masciocchi: None. S. Patarnello: None. U. Capece: None. C. Morciano: None. S. Gugliandolo: None. A. Avolio: None. S. Moffa: None. F. Cinti: None. A. Giaccari: None. T. Mezza: None.
1075-P: Evaluating the Safety of Basal Insulin for the Management of Type 2 Diabetes in the Emergency Room Setting
Authors: HERRERA AZUCENA M. , TABASSUM HUMERA , RAHMAN SHAZIA , MAITY ALOKE , BARON SARAH , MANAVALAN ANJALI , LEE HANNA
Published: June 2024

Background: Evidenced based guidelines for hyperglycemia management in the emergency room (ED) are lacking. Basal plus bolus with correction insulins are the preferred treatment in noncritically ill hyperglycemic inpatients. We aimed to study if basal plus correction insulins can be safely and effectively initiated earlier in the hospitalization course in the ED.

Methods: Inclusion criteria: triage glucose >300 mg/dL, age > 18, type 2 diabetes (T2D), boarded for admission. Exclusion criteria: DKA, HHS, critically ill or simultaneous cirrhosis with pancreatitis. 23 patients received basal plus correction insulins according to the intervention. 259 patients received standard therapy. Intervention: The lower of glargine 0.1U/kg or 10 U was administered if the last dose of basal insulin was > 24 hours ago. A lispro correction of 2 U was administered every 6 hours if the last dose of basal was <24 hours ago or if the glucoses remained >300 mg/dL. Outcomes: Time to target glucose was defined as time from triage to two successive glucose values < 300 mg/dl at least 4 hours apart. Hypoglycemia was defined as glucose < 80 mg/dl.

Results: The control group comprised of 53% males, 47% females, 40% black and 42% who identified as Hispanic/Latino with an average age of 61.2, GFR 55.8, A1c 11.2% and mean BMI of 26.9. The intervention group comprised of 42% males, 58% females,48% black and 48% who identified as Hispanic/Latino with an average age of 65.4, GFR 48.2, A1c 11.5% and a mean BMI of 25.62. Time to target glucose was 23.3 hours in the intervention vs 21.6 hours in the control group. No hypoglycemia occurred in the intervention group; however, the incidence of hypoglycemia was 12.7% in the control group.

Conclusion: Basal plus correction insulins can be safely initiated, in the ED with less hypoglycemia, in noncritically ill T2D patients boarded for admission.

Disclosure

A.M. Herrera: None. H. Tabassum: None. S. Rahman: None. A. Maity: None. S. Baron: Stock/Shareholder; Extend Fertility. A. Manavalan: None. H. Lee: None.
1076-P: Online Presence and Accessibility of the National Diabetes Prevention Program in Socially Vulnerable Communities
Authors: MASSEY MCKAYLA , NGUYEN JORDAN , PENG NG BOON
Published: June 2024

Introduction & Objective: Prediabetes affects an estimated 98 million adults in the United States, yet there exists a relative underutilization of diabetes prevention programs, such as the CDC National Diabetes Prevention Program (NDPP). Given the widespread internet and social media use among US adults, effective online dissemination of information concerning the NDPP is key to heightening awareness and fostering enrollment in such programs. This study sought to assess the content of the NDPP organizations’ websites, evaluating their ability to provide pertinent information that motivates individuals to enroll and actively participate in the program.

Methods: Using data from the NDPP registry and the CDC Social Vulnerability Index, we identified and systematically reviewed 368 organizations delivering in-person NDPP in socially vulnerable communities.

Results: Of these, 21.7% (n=80) listed a web address for their DPP, of which only 59 were functional. Among these functional websites, 39% provided a comprehensive description of the NDPP, with 5% specifying cultural objectives. Additionally, 54% provided information on class schedules, 15% allowed online enrollment, and 39% maintained an active presence on social media platforms.

Conclusion: Approximately 84% of NDPP organizations in socially vulnerable communities are without a functioning website, despite the disproportionate impact of diabetes on these populations. Only 5% of organizations with operational websites reported offering culturally and racially specific programs. These findings underscore a critical gap in the current online presence of NDPP information in socially vulnerable areas for individuals seeking diabetes prevention resources. Targeted efforts should focus on enhancing website accessibility with relevant information and social media engagement to effectively communicate the availability of the NDPP to vulnerable communities.

Disclosure

M. Massey: None. J. Nguyen: None. B. Ng: None.
1083-P: Barriers to Insulin Pump Use in Adults with Type 1 Diabetes
Authors: ERARDI JOSEPH , LORA MATOS ALEJANDRO D. , WELLS BETH A. , ROMEISER JAMIE L. , OWUSU-BARNIE JERUSHA , WEINSTOCK RUTH S.
Published: June 2024

Introduction: Hybrid closed loop systems (HCL) reduce hypoglycemia and increase time in range in adults with type 1 diabetes (T1D). In Sept. 2023, 62.9% of our T1D adults were using insulin pumps, of which a majority were using HCL.

Objective: To understand current barriers for insulin pump use in T1D adults.

Methods: A survey was sent electronically, in Oct. 2023, to T1D adults ages ≥ 22 yrs, with ≥ 1 visit, in-person or virtual, from 9/1/2022 - 9/1/2023 with an email address (n=1517).

Results: The overall response rate was 22.9% [263 pump users responded, response rate 29.9%; 85 non-pump users responded, response rate 13.3%). Median age of respondents vs non-respondents was 54 years (range 22 -94) vs. 40 years (22 yrs-100). 60.9% of respondents were female vs. 47.5% of non-respondents. Respondents/non-respondents were 94%/88.2% non-Hispanic white (n=328/1031), 2.6%/6.2% non-Hispanic Black (n=9/72) and 1.1%/2.4% Hispanic (n=4/28). 59.2% of respondents had private insurance, 39.1% public insurance. CGM was used by more pump users (n=879; 91.9%) vs non-pump users (n=638; 79.3%). Median A1c of respondents was 7.0% (CGM use 89.1%), vs non-respondents median A1c 7.8% (CGM use 85.5%). Survey results are shown in table below.

Limitations: Low response rate and low diversity

Conclusion: More education, including addressing beliefs and understanding potential benefits of insulin pump therapy, is needed for the ~1/3 of T1D adults not currently using a pump.

Disclosure

J. Erardi: None. A.D. Lora Matos: None. B.A. Wells: None. J.L. Romeiser: None. J. Owusu-Barnie: None. R.S. Weinstock: Research Support; Eli Lilly and Company, Tandem Diabetes Care, Inc., Diasome, Amgen Inc., MannKind Corporation, Insulet Corporation, Novo Nordisk. Other Relationship; Dexcom, Inc.
1086-P: Rural Residence Is Associated with a Lower Likelihood of Dipeptidyl Peptidase 4 Inhibitor Use for Treatment Intensification
Authors: NAGY DANIELLE K. , BRESEE LAUREN , EURICH DEAN , SIMPSON SCOT H.
Published: June 2024

Introduction: Several drug therapy management strategies exist when treatment intensification is required in type 2 diabetes, however, an understudied factor influencing drug therapy choice is an individual’s location of residence along the rural-urban continuum. The objective of our study was to explore the association between location of residence (rural, urban, metropolitan) and the use of dipeptidyl peptidase 4 inhibitors (DPP-4i) for first treatment intensification of type 2 diabetes.

Methods: We conducted a retrospective cohort study from 2008 to 2019 using administrative data from Alberta, Canada. Cohort entry was established when an individual became a new metformin user and at this time, location of residence was defined using postal codes. Individuals were followed until a dispensation for treatment intensification occurred (classified as DPP-4i or non-DPP-4i-based therapy). A multivariable logistic regression analysis was performed to determine the association between location of residence and likelihood of DPP-4i dispensation, adjusting for clinically relevant confounders.

Results: Of 66,064 new metformin users experiencing treatment intensification, 15,467 (23%) were intensified with a DPP-4i. At the beginning of the observation period, proportion of DPP-4i dispensations were similar (7% metropolitan, 6% urban, 5% rural). However, over time a maximum 10% difference was noted between rural and metropolitan/urban (32% metropolitan, 27% urban, 22% rural). After adjusting for potential confounders, we determined that rural-dwellers are 36% less likely to have a DPP-4i dispensed, compared to metropolitan (aOR:0.64;95%CI:0.61-0.67) and over time, uptake in rural areas is slower.

Conclusion: Our study sheds light on the impact of location of residence on drug therapy management in type 2 diabetes. The differential management experienced by rural-dwellers demonstrates a substantial gap in health equality across our jurisdiction.

Disclosure

D.K. Nagy: None. L. Bresee: None. D. Eurich: None. S.H. Simpson: Research Support; Merck & Co., Inc.
1095-P: Value-Based Incentive Programs to Improve Diabetes Care in Rural Nebraska
Authors: EILAND LESLIE A. , MOHRING STEPHEN M. , KEEGAN SARAH , NYGAARD STEPHANIE , PULLYBLANK KRISTIN , DESOUZA CYRUS
Published: June 2024

Introduction & Objective: Outcomes for people with diabetes in rural areas are worsening, widening rural disparities. The goal of Diabetes On Track is to improve outcomes for people living with pre-diabetes and type 2 diabetes in rural Nebraska. One intervention has been a value-based incentive model for primary care providers (PCPs) in two communities, with aims to improve diabetes-related quality metrics and encourage health systems to recognize benefits of joining value-based contracts and achieving shared savings.

Methods: Two rural communities were identified, and primary care clinic leadership was engaged in each community. Individual provider dashboards were created for diabetes-related metrics, allowing PCPs to monitor progress. Baseline data was collected for each site, and target and stretch goals were created for 6-month periods over 2 years. Data were collected on a1c monitoring and control (A1c <9%), as well as screening for dyslipidemia, nephropathy, and retinopathy over a rolling 12-month period.

Results: Clinic A incentivized PCPs directly; Clinic B did not. After 6 months, Clinic B showed small improvements in nephropathy and retinopathy screening, while other metrics remained stable. Clinic A showed improvement in all metrics and is on track to achieve stretch goals set for the entire 2-year program. Some of this improvement is due to resolving lab mapping issues and purchasing a retinal camera. Clinic A improved both A1c completion and control by 6% from baseline (ending at 94% and 84%, respectively). Nephropathy and retinopathy screening improved by 270% and 38%, respectively. Lipid monitoring increased by 25%. Clinic A is joining an accountable care organization in 2024.

Conclusion: Providing real-time patient panel data and incentivizing PCPs contributed to improved diabetes-related quality metrics. This pilot is a critical component of a comprehensive diabetes program, allowing rural health systems to recognize the importance of the shift towards value-based care.

Disclosure

L.A. Eiland: Advisory Panel; Provention Bio, Inc., Cecelia Health. S.M. Mohring: None. S. Keegan: Consultant; Tandem Diabetes Care, Inc. S. Nygaard: None. K. Pullyblank: None. C. Desouza: Advisory Panel; Novo Nordisk, Bayer Inc., Madrigal Pharmaceuticals, Inc. Other Relationship; ADA/ACC Diabetes by Heart Program. Advisory Panel; Asahi Kasei.

Funding

Private gift received through the University of Nebraska Foundation from the Diabetes Care Foundation.
11-PUB: Transitioning from Dulaglutide to Tirzepatide Improves Glycemic Control in Patients Undergoing Hemodialysis with Type 2 Diabetes—An Assessment by Continuous Glucose Monitoring
Authors: OTSUKA EMIKO , KITAMURA MINEAKI , FUNAKOSHI SATOSHI , NISHINO TOMOYA
Published: June 2024

Introduction & Objective: Tirzepatide is a dual glucose-dependent insulinotropic peptide and glucagon-like peptide-1 receptor agonist. However, the efficacy and safety in patients undergoing hemodialysis remain unclear.

Methods: We conducted a single-center retrospective study of patients with type 2 diabetes undergoing hemodialysis who were transitioned from dulaglutide to tirzepatide. We analyzed glucose levels using CGM.

Results: Fourteen patients (61.9 ± 9.9 years, male: female=11:3) were included. After switching to tirzepatide, time in range increased to 50.8% from 42.7% (p=0.02) (Figure), time above range decreased to 37.8% from 48.4% (p=0.02), and mean glucose levels decreased to 137.4 mg/dL from 156.6 mg/dL (p=0.006). In contrast, there was no significant difference in time below range (11.3% and 8.9%) (p=0.75). Four patients experienced dyspnea (28.6%), and one patient experienced nausea (7.1 %); however, no critical adverse events were reported.

Conclusion: Transitioning from dulaglutide to tirzepatide improved glycemic control without hypoglycemia in patients undergoing hemodialysis with type 2 diabetes.

Disclosure

E. Otsuka: None. M. Kitamura: None. S. Funakoshi: None. T. Nishino: None.
1101-P: Patient-Centered Weight Management Clinical Decision Support—A Proof-of-Concept Study
Authors: SCHWARTZ JESSICA L. , ALMAZAN ERIK , OLSSON KELLY , GUDZUNE KIMBERLY
Published: June 2024

Introduction & Objective: Over 40% of U.S. adults have obesity; however, primary care practitioners (PCPs) face challenges treating obesity (e.g., lack of training, time). Clinical decision support (CDS) tools can aid obesity counseling, but most lack a patient-centered care focus. The study objective was to develop and test an innovative weight management CDS for the primary care setting.

Methods: The CDS design promoted a patient-centered experience, supported evidence-based obesity treatment, and integrated with PCPs’ workflows in the electronic health record. Patients completed a pre-visit questionnaire via the patient portal, which then activated PCP elements (decision/counseling, orders, documentation). A 3-month proof-of-concept study was conducted among 10 PCPs at 5 clinics to determine usefulness, usability, and acceptability through validated surveys (mean score ≥2.5 signified positive outcome; max value 5). Using t-tests, pre-post differences in frequency of self-reported obesity-related clinical practices (Never-1 to Always-5) were also examined.

Results: Most PCPs were physicians with mean 10.8 years (SD 7.5) of primary care experience. Overall, mean score for usefulness, usability, and acceptability was 3.2 (SD 0.8), 3.5 (SD 0.9), and 3.6 (SD 0.9), respectively. PCPs highly rated recommending the CDS to a colleague (mean 3.9 (SD 1.0)), found the CDS easy-to-use (mean 3.7 (SD 0.9)), and suitable for the primary care setting (mean 4.1 (SD 1.0)). PCPs reported significant increases in three key clinical practices - counseling on behavioral interventions (3.1 vs 3.9 (p<0.01)), referring to weight-loss programs (2.8 vs 3.5 (p<0.01)), and discussing anti-obesity medications (3.3 vs 3.8 (p=0.02)).

Conclusion: A patient-centered weight management CDS was useful and usable to PCPs and improved obesity-related practice habits. Future studies need to evaluate CDS use in other outpatient settings and its impact on patient outcomes.

Disclosure

J.L. Schwartz: Research Support; Novo Nordisk, Ardmore Institute. E. Almazan: None. K. Olsson: Employee; Novo Nordisk. K. Gudzune: Advisory Panel; Eli Lilly and Company, Novo Nordisk. Research Support; Novo Nordisk. Employee; American Board on Obesity Medicine. Other Relationship; Johns Hopkins ACG System.

Funding

Novo Nordisk
1103-P: The Mobile Insulin Titration Intervention to Transition from Basal Insulin to a GLP1-RA (MITI-GLP1)—Using Daily SMS Text Messages and Weekly Phone Calls to Transition Primary Care Patients with Well-Controlled Type 2 Diabetes Mellitus from Basal Insulin to a GLP1-RA at Bellevue Hospital
Authors: LEVY NATALIE , NERLINO KATIE , SONUBI OLUBUNMI , BONGALOS SHERLANE , DASILVA ALEX , UZOR CHINYE , LIANG YINGJIE
Published: June 2024

Introduction: While basal insulin lowers blood sugar, it increases the risk of hypoglycemia and weight gain and doesn’t offer the potential cardiovascular benefits of GLP1-RAs. Transitioning a person with well-controlled T2DM from basal insulin to a GLP1-RA can be labor intensive and short-term may lead to hypoglycemia. The objective of this pilot program is to determine if MITI-GLP1 can lower basal insulin and increase GLP1-RA without hypoglycemia.

Methods: MITI-GLP1 uses basic cell phone technology available to our safety-net patients and sends a daily text message asking ‘What was your fasting blood sugar this morning?’ Patients text values daily and are advised over-the-phone weekly on if/how to lower their basal insulin and if/how to adjust their GLP1-RA. The process continues until the patient is on the max-tolerated GLP1-RA dose. Eligible patients in this cohort study have well-controlled T2DM, use once-daily basal insulin and are not on max-dose GLP1-RA. Use of meal-time insulin excludes patients. The primary outcome is % of patients with basal insulin lowered >50%. Secondary outcomes include the % of patients with basal stopped completely, the % with GLP1-RA raised >1 dose level, and the % of hypoglycemia during the transition. MITI-GLP1 is co-run by internists and nurses.

Results: Forty-six people were enrolled. The average age is 53 (SD +/- 11), 59% are men, 74% are Hispanic, 63% are uninsured. Five people were lost to f/up. Of the 41 people who graduated, 35 (85%) had basal dose lowered by > 50%, 30 (73%) had basal stopped completely, 37 (90%) had GLP1 raised >1 dose level and 1 of the 2023 text messages (0.05%) had a blood glucose < 70mg/dL.

Conclusion: A MITI-GLP1 program using basic cell phone technology can safely and effectively transition primary care patients with well-controlled T2DM from basal insulin to a GLP1-RA.

Disclosure

N. Levy: None. K. Nerlino: None. O. Sonubi: None. S. Bongalos: None. A. Dasilva: None. C. Uzor: None. Y. Liang: None.
1104-P: A Quality Improvement Project to Improve Provider and Health Care Student Adherence to American Diabetes Association Care Guidelines in a Free Clinic Outpatient Setting
Authors: CASOLA MARISA C. , BRAR TANVI , RYE LEE GHEE , COYNE MACKENZIE , PURDY NAJHEE L.J.
Published: June 2024

Background: The Columbus Free Clinic (CFC) is a student-run free clinic providing care to underserved residents in Central Ohio. Type 2 diabetes is the most common chronic condition diagnosed at CFC. Historical data shows CFC provides suboptimal diabetic preventative care, evidenced by non-compliance with American Diabetes Association (ADA) laboratory testing guidelines. Due to volunteer providers and students rotating weekly, a quality improvement (QI) project was developed to improve the quality of medical care for patients with diabetes by increasing volunteer adherence to a subset of ADA guidelines: documented hemoglobin A1c (HbA1c) within the past 6 months, micro-albumin/creatinine ratio (ACR) in the past 12 months, and lipid panel in the past 12 months.

Methods: In March 2023, a chart review was conducted to obtain baseline data on ADA guideline measures. A QI intervention plan to improve adherence to ADA guidelines was developed and implemented April 2023. A dot phrase in CFC’s electronic health record system was programmed with questions about laboratory testing to prompt providers to ask patients to increase adherence. In December 2023, post-intervention data was collected for patients with type 2 diabetes who were seen at CFC pre and post-intervention.

Results: Out of the 175 patients who were identified with type 2 diabetes, a subset of 71 patients visited CFC for treatment pre and post-intervention. Prior to implementation, 57.7% of patients had a recorded HbA1c in the past 6 months, 33.8% had an ACR recorded in the previous 12 months, and 67.6% had a lipid panel recorded in the past 12 months. Post intervention, these percentages increased to 66.2% (+8.5%, p=0.30), 84.5% (+16.9%, p=<0.05) and 69.0% (+35.2%, p=<0.001), respectively.

Conclusion: Findings highlight that our intervention successfully increased adherence to ADA care guidelines in a student-run, free clinic setting.

Disclosure

M.C. Casola: None. T. Brar: None. G. Lee: None. M. Coyne: None. N.L.J. Purdy: None.
1105-P: Evolution of Hospital Glycemic Care Knowledge among Faculty and Trainees in an Academic Center—A Comparative Analysis
Authors: MAREBOINA MANVITA , MILLER THEODORE J. , LEHMAN ERIK , KEARCHER KALEN , GONG JASON , PICHARDO-LOWDEN ARIANA
Published: June 2024

Introduction & Objective: Knowledge and decision-making can be determinants of practice performance and quality of patient care rendered. Gaps exist in those competencies among healthcare practitioners. This study aimed to determine changes in faculty and trainees in an academic center after implementation of an inpatient diabetes clinical decision support (CDS) tool in the electronic health record (EHR).

Methods: We compared proportions of correct glycemic management responses to equivalent questions from two surveys conducted about eight years apart in an academic medical center using the Chi-square test. The first survey represented a baseline needs assessment. The second was a follow-up questionnaire presented in context of an inpatient practice supported by an EHR CDS program across hospital settings.

Results:

Conclusion: Improved knowledge of glucose goals for different inpatient populations is relevant as it can enable adequate management. Responses about the complex topic of insulin transition to maintain control did not show improvement, but it had a high score at baseline. Lower knowledge on follow-up among trainees reflect the need for reinforcing concepts for learners who join training programs with variable decision-making skills. Some modalities of CDS can enhance knowledge when presenting biomedical information in the context of clinical practice.

Disclosure

M. Mareboina: None. T.J. Miller: None. E. Lehman: None. K. Kearcher: None. J. Gong: None. A. Pichardo-Lowden: None.

Funding

National Institute of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health (R01DK130992)
111-OR: Vascular Endothelium-Specific ROCK2 Deficiency Inhibits the Progression of Obesity via Adipocyte Browning
Authors: OHASHI SHINJI , MATOBA KEIICHIRO , SEKIGUCHI KENSUKE , MITSUYOSHI ETSUKO , NAGAI YOSUKE , NISHIMURA RIMEI
Published: June 2024

Introduction and Objective: The vascular endothelium has evolved anatomical and functional network between adipocytes in adipose tissue, secreting several bioactive substances to orchestrate energy homeostasis. However, when compared with other organs, relatively little is known about the molecular machinery that directly governs the crosstalk system in adipose tissue. Although previous studies have defined Rho-associated, coiled-coil-containing protein kinase 2 (ROCK2) as an inducer of vascular inflammation, a direct role for the endothelium-adipocyte network in physiological and pathophysiological states has not been previously established.

Method: To clarify the tissue-specific role of ROCK2, we generated mice lacking vascular endothelial ROCK2. Normal adipocytes were incubated with a conditioned medium obtained from ROCK2-deficient human adipose tissue vascular endothelial cells.

Result: We show in normal adipose tissue samples that ROCK2 is expressed in vascular endothelial cells. Mice lacking vascular endothelial ROCK2 were resistant to adipose tissue expansion and insulin resistance in a high-fat diet-induced obese model. In these mice, heat production and food intake were greater after an overnight fast. Genetic analysis of adipose tissue and proteome analysis of conditioned medium obtained from ROCK2-deficient endothelium demonstrated that ROCK2 is an essential regulator of adipocyte browning. An important mechanism by which ROCK2 mediates adipocyte phenotype shifting is via the regulation of macrophage polarization. In particular, ROCK2 serves as a inducer of tumor necrosis factor α, which rewires adipose tissue-resident macrophage towards M2 phenotype.

Conclusion: This study establishes endothelial ROCK2 as a key regulator of adipose tissue function and implicates ROCK2 as a novel modulator of obesity progression.

Disclosure

S. Ohashi: None. K. Matoba: None. K. Sekiguchi: None. E. Mitsuyoshi: None. Y. Nagai: None. R. Nishimura: Speaker's Bureau; Abbott. Advisory Panel; Abbott Japan Co., Ltd. Speaker's Bureau; Boehringer-Ingelheim, Mitsubishi Tanabe Pharma Corporation, Kowa Company, Ltd., Medtronic, Sanofi, Taiho Pharmaceutical Co. Ltd., Sumitomo Dainippon Pharma Co., Ltd., Teijin Pharma Limited, Eli Lilly and Company, Novo Nordisk A/S. Consultant; Terumo Corporation.
1124-P: It Takes a Village—Enhancing the Nurse–Physician Communication on Inpatient Glycemic Control
Authors: BYRD LATONYA , STEWART ALYSSA , OBISESAN OLAWUNMI
Published: June 2024

Introduction & Objective: Inpatient glycemic management for patients living with diabetes can be challenging due to complex, interrelated factors. Therefore, as patient advocates, nurses must be able to identify what clinical data warrants a call to the physician to facilitate timely decisions and interventions. The purpose of this study was to examine the effectiveness of a two-hour comprehensive diabetes education course in improving nurses’ understanding of glucose trends and causative factors, basal-bolus insulin regimens, and what information to communicate with the physician using the SMILE (Sugar Trend, Medications, IV Fluid, Labs, and Eating) SBAR (Situation Background Assessment Recommendation) approach.

Methods: Data was collected from a purposive sample of 28 registered nurses from a single general medicine unit. A t-test was used to examine nurses’ perceptions of knowledge and self-efficacy in nine content areas. Kruskal-Wallis H analysis was also conducted on the unit’s monthly patients’ blood glucose values over four months (July, August/intervention, September, and October 2023).

Results: The results suggest the class was effective in improving nurses’ perceived knowledge and self-efficacy in all nine content areas. The mean differences between the pre-and post-test ranged from .61 ± 1.26 (I feel confident when calling the physician and providing adequate information to advocate for the appropriate treatment) to 1.11 ± 1.20 (I have sufficient knowledge regarding the SMILE SBAR and use it as a tool for communicating with the physician), p<.05. Patients’ median blood glucose values were statistically significantly different across four months (July, August, September, October), χ2(3)=21,088, p<.0001.

Conclusion: Continued efforts to prevent and manage inpatient glycemic control should focus on enhancing nurse-physician communication and teamwork with simple yet effective tools such as the SMILE SBAR.

Disclosure

L. Byrd: None. A. Stewart: None. O. Obisesan: None.
113-OR: Lipocalin-2, a Mitokine That Mediates White–to–Brown Fat Cross Talk
Authors: WANG FENFEN , HUYNH PHU M. , AN YU
Published: June 2024

Introduction & Aim: Metabolic dysfunction, exemplified by obesity, often results from dysregulated crosstalk among metabolically active tissues. Brown adipose tissue (BAT) undergoes whitening during obesity, yet understanding the underlying white adipose tissue (WAT) to BAT crosstalk and the factors driving BAT whitening remains a significant gap.

Methods: Using our reported amyloid precursor protein (APP) overexpression-induced mitochondrial distress model in adipocytes (APP AOE), we identified lipocalin-2 (LCN-2) through in vivo, ex vivo, and in silico screenings as a key mitokine mediating the WAT to BAT crosstalk. To further investigate the role of LCN-2, we utilized recombinant LCN-2 protein treatment in vitro and in vivo and generated the adipocyte-specific deletion of Lcn2 mouse model (Lcn2 AKO).

Results: Mitochondrial distressed adipocytes from APP AOE model induced BAT whitening, and white fat pad transplant studies confirmed that stressed WAT alone induces BAT whitening through a putative crosstalk. LCN-2, identified as a potential mitokine through a comprehensive screening (in vivo, ex vivo, and in silico), downregulates BAT browning markers following an LCN-2 recombinant protein treatment. Lcn2 AKO mice on a high-fat diet maintain similar body weights but exhibit elevated mRNA levels of Ucp1 and Pgc1a in BAT, preserving BAT characteristics.

Conclusion: Our project highlights a novel mechanism for white-to-brown fat crosstalk, whereby WAT under mitochondrial stress secretes a mitokine, LCN-2, which mediates the crosstalk from WAT to BAT, leading to BAT whitening. This study further implies LCN-2 as a promising target for preventing BAT whitening and treating obesity.

Disclosure

F. Wang: None. P.M. Huynh: None. Y. An: None.

Funding

This work is supported by National Institutes of Health (NIH) (K01-DK125447, R03-DK135783, and P30-DK056338 (Pilot Award)) to Y.A.A., and American Diabetes Association (ADA) Postdoctoral Fellowship Award (11-23-PDF-23 to F.W.)