bluuebunny/crossref_metadata_2025 huggingface dataset:
1144-P: Racial/Ethnic Disparities in Accessing the Latest Automated Insulin Delivery (AID) System
Authors: MARKS BRYNN E. , MEIGHAN SEEMA , BROWN ELIZABETH A. , ZEHRA ANUM , SURESH RESHMA , DOUVAS JULIA L. , WOLF RISA M.
Published: June 2023

Background: AID systems improve glycemic control in youth with type 1 diabetes (T1D). There was a full market release of the OmniPod 5 (OP5) AID system in the United States on 8/1/2022 and it was FDA approved for ages ≥2 on 8/22/22. OP5 is available through pharmacy benefits and requires users to have a smartphone. We hypothesized that disparities exist in OP5 access.

Methods: We assessed OP5 use at two pediatric diabetes centers among youth with T1D ages 2-21 who were using any version of an OmniPod (OP) insulin pump 3-months after the full market release. Differences in demographic characteristics of OP5 users compared to other OP pump users were assessed using Chi-squared and student’s independent two-sample t tests.

Results: Of 1037 youth (mean age 12.8±4.4 years, 49.5% female, mean T1D duration 5.3±3.7 years), 510 (49.2%) were using OP5. Rates of OP5 use were higher among non-Hispanic White youth than among youth of all other racial/ethnic identities (53.2% vs 38.0%, p<0.0001). Youth using OP5 were more likely to be younger (12.3±4.0 years vs 13.2±4.7 years, p=0.0001) and to have a shorter T1D duration (4.9±3.5 vs 5.8±3.9 years, p=0.0002). There was a trend towards lower rates of uptake among publicly versus privately insured youth (43.1% vs 50.7%, p=0.054). There was no difference in OP5 use by sex (48.2% female vs 51.8% males, p=0.43).

Conclusions: Minority youth were less likely to access the OP5 AID system 3-months after full-market release. Given the glycemic improvements associated with AID systems, it is important to promote equitable access to the latest diabetes technologies. Improving insurance coverage of technologies and supporting AID access without the need for a smartphone may support these goals.

Disclosure

B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. S.Meighan: Speaker's Bureau; Dexcom, Inc. E.A.Brown: None. A.Zehra: None. R.Suresh: None. J.L.Douvas: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc.

Funding

National Institutes of Health (K23DK129827)
1148-P: Glycoprotein Acetyls (GlycA) Associate with Intraglomerular Hemodynamic Dysfunction, Albuminuria, Central Adiposity, and Insulin Resistance (IR) in Youth with Type 1 Diabetes (T1D)
Authors: REINICKE TRENTON , CALDWELL-MCGEE ALYSSA , BIRZNIEKS CARISSA , CARRASCO DIEGO , LOREDANA MARCOVECCHIO M. , NADEAU KRISTEN J. , TOMMERDAHL KALIE L. , PAULEY MEGHAN E. , SNELL-BERGEON JANET K. , GROSS SUSAN , CHERNEY DAVID , VIGERS TIMOTHY B. , PYLE LAURA , DRISCOLL LYNETTE , MAHMUD FARID H. , DART ALLISON , PAVKOV MEDA E. , NELSON ROBERT G. , BJORNSTAD PETTER
Published: June 2023

GlycA is a biomarker of systemic inflammation and cardiovascular disease, yet little is known about this biomarker in T1D. We examined the associations among GlycA, central adiposity, IR, and early kidney injury in adolescents with T1D.

Glomerular filtration rate (GFR) and renal plasma flow (RPF) by iohexol and p-aminohippurate clearance, respectively, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry (DXA), and estimated insulin sensitivity (eIS) by the CACTI equation were assessed in youth with T1D (n=50, 16.0±3.0 years, 50% female, HbA1c 8.7±1.3%, T1D duration 5.7±2.6 years, UACR 6 [5-14] mg/g, GFR 189±40 mL/min). Intraglomerular pressure (PGLO) was estimated by the Gomez equations. Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed.

GlycA was higher in girls vs. boys (1.05±0.26 vs. 0.84±0.15 mmol/L, p=0.001), and in participants who were overweight or obese vs. normal weight (1.12±0.23 vs. 0.87±0.20, p=0.0004). GlycA correlated positively with estimated PGLO (r=0.52, p=0.001), UACR (r=0.53, p<0.0001) and trunk mass (r=0.45, p=0.001) and negatively with eIS (r=-0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and HbA1c.

In youth with T1D, GlycA, a biomarker of inflammation, was found to be higher in girls with T1D and those of overweight/obese habitus, compared to boys with T1D. Additionally, GlycA associated with parameters of early kidney dysfunction, central adiposity, and IR.

Disclosure

T.Reinicke: None. S.Gross: 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. T.B.Vigers: None. L.Pyle: None. L.Driscoll: None. F.H.Mahmud: None. A.Dart: None. M.E.Pavkov: None. R.G.Nelson: None. P.Bjornstad: Advisory Panel; AstraZeneca, Novo Nordisk, Lilly, Horizon Therapeutics plc, Boehringer Ingelheim (Canada) Ltd., LG Chem, Consultant; Bayer Inc., Bristol-Myers Squibb Company. A.Caldwell-mcgee: None. C.Birznieks: None. D.Carrasco: None. M.Marcovecchio: None. K.J.Nadeau: None. K.L.Tommerdahl: None. M.Pauley: None. J.K.Snell-bergeon: None.

Funding

Junior Research Fellowship Award
1158-P: Diabetes Incentive Program for Children with Type 1 Diabetes (T1D)
Authors: WARHADPANDE MAITREYI , DANELYAN HRANUSH , PATEL CHETANBABU M.
Published: June 2023

Behavioral economic interventions have been studied in adults to help improve adherence in diabetes management but have not been widely studied in children. Results from a 2020 qualitative study demonstrated that financial incentive (FI) can potentially help adolescents with type 1 diabetes (T1D) develop good self-care habits. Our objective was to determine if providing pediatric patients with incentives helps improve satisfaction about their diabetes management. Every patient with T1D coming to our endocrine clinic was given an initial satisfaction survey. Points were given when patients met goals and were rewarded with gifts based on points accumulated. They could also collect points to win a grand prize at the end of 1 year. A final satisfaction survey was distributed at the end of 1 year. Bar graphs and percentages in each group were used to determine change in patient satisfaction. After the completion of Diabetes Incentive Program (DIP), 78% patients were more satisfied with their diabetes control as compared to 64% before the DIP and 17% more patients found that the DIP motivated them to reach their goals. We concluded that there was some increase in satisfaction with diabetes control after completion of DIP. About 97% patients thought that DIP helped in achieving their goals.

Disclosure

M.Warhadpande: None. H.Danelyan: None. C.M.Patel: None.

Funding

TMC Health (202244)
1160-P: Low-Calorie Sweeteners and Quality of Life in Youth with Type 1 Diabetes
Authors: MOORE HAILEY R. , FAGUNDES GRILO MARIANA , VALLONE NATALIE , COGEN FRAN R. , STREISAND RANDI , SYLVETSKY ALLISON
Published: June 2023

Background: Low calorie sweeteners (LCSs) are often used by youth with Type 1 Diabetes (T1D), as LCS can provide added sweetness to food and beverages at a reduced glycemic load. Whether LCS consumption is helpful or harmful for T1D management among youth is debated; however, little attention has been given to potential benefits of LCS consumption on psychosocial outcomes among youth with T1D. This is important because a diabetes diagnosis pervades all aspects of a child's life and LCS use may provide children with T1D with a sense of normalcy, potentially increasing their health-related quality of life (HRQOL).

Objective: To examine associations between LCS consumption and HRQOL among youth with T1D.

Methods: Sixty youth ages 11-17 with a diagnosis of T1D (Mage 12.9±1.8, 57.1% female, 70% Non-Hispanic White) and their parents (83.3% female, 71.6% Non-Hispanic White) were recruited from the Washington Nationals Diabetes Care Complex at Children's National Hospital (DCC) in Washington D.C. (N=20) and nationally using social media (N=40). Eligible youth and their parent attended a virtual study visit, where they provided demographic information, and completed a LCS consumption questionnaire (developed by the team for a previous study), along with the validated Type 1 Diabetes and Life measure (T1DAL). Means and frequencies were used to summarize the survey data, as appropriate, and associations between LCS intake and HRQOL were examined using multivariable linear regression, with adjustment for relevant covariates.

Results: Mean LCS consumption was 3.3±2.8 servings per day. No associations between LCS consumption (total, LCS beverage consumption, LCS food consumption) and HRQOL (total and subscales) were observed.

Conclusion: In our sample of youth with T1D, LCS intake was not associated with HRQOL. These results demonstrate that LCS use may not benefit psychosocial outcomes of youth with T1D, further reiterating the need to determine their metabolic and health effects in this high-risk patient population.

Disclosure

H.R.Moore: None. M.Fagundes grilo: None. N.Vallone: None. F.R.Cogen: None. R.Streisand: None. A.Sylvetsky: Consultant; Abbott.

Funding

Milken Institute School of Public Health
1165-P: 4T Study—Changing Clinical Processes Increases Technology Use at T1D Diagnosis
Authors: CONRAD BARRY P. , BISHOP FRANZISKA K. , LEVERENZ JEANNINE , CHMIELEWSKI ANNETTE , SAGAN PIPER , SENALDI JULIANNE , MARTINEZ-SINGH ANJOLI , LIN SHANNON , LEI CHAN IAN , PRAHALAD PRIYA , MAAHS DAVID M.
Published: June 2023

Use of diabetes technology (CGM, pump) is recommended for people with T1D, and early CGM initiation leads to improved glucose values. We compare %CGM and %pump use and time to initiation from T1D diagnosis in the Historical cohort, 4T Pilot, and 4T Study 1 and the associated workflow changes to increase early technology use.

CGM initiation within 30 days of diagnosis increased from 2% in the historical cohort to 92% in Pilot 4T to 98% in 4T Study 1 (Table). Days to pump initiation from TID diagnosis decreased from 272 in the historical cohort to 144 days in Study 1.

From 2014-2016 pumps and CGM were initiated when families expressed interest or if the provider discussed them. Families were required to attend a pre-pump class where the CDCES introduced pumps and CGMs prior to starting technology. During the 4T Pilot and 4T Study 1, CGMs were introduced and started during the first month of diagnosis. In Study 1, families were encouraged to attend pump class and initiate AID. The CDCES team does the CGM teach, CGM follow-up, pre-pump classes, and insulin pump starts for the families in preferred language. In 4T Study 2 (enrolling) standard of care is to complete a pre-pump class in the first 3 months after diagnosis.

Changes in processes can lead to early implementation of diabetes technology. A structured, team-based process to introduce, reduce barriers, and encourage families to utilize diabetes technology increases early initiation.

Disclosure

B.P.Conrad: Advisory Panel; Edgepark medical supplies, Consultant; Abbott Diabetes. P.Prahalad: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. F.K.Bishop: None. J.Leverenz: None. A.Chmielewski: None. P.Sagan: None. J.Senaldi: None. A.Martinez-singh: None. S.Lin: None. I.Chan: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R18DK122422); The Leona M. and Harry B. Helmsley Charitable Trust (G-2002-04251-2); International Society for Pediatric and Adolescent Diabetes/JDRF (1P30DK, 11607401); Lucile Packard Child
117-LB: Impact of Bigfoot Unity Integrated CGM on HbA1c
Authors: HAQUE PAARSA , HALL SHARETA , WALKER PERSHELL , LATIF KASHIF
Published: June 2023

Introduction: Continuous glucose monitoring (CGM) is a preferred method of glucose monitoring. Bigfoot Unity Diabetes Management is an integrated CGM (iCGM) system that incorporates remote patient monitoring with a mobile app, smart pen caps, and CGM via Libre Freestyle 2 sensors. Smart pen caps attach to rapid-acting and long-acting insulin pens and sync with patients’ CGM sensors to provide insulin dose recommendations based on the health care provider's (HCP) instructions. The smart pen caps also allow patients to view their last insulin dose and receive alerts for possible missed doses. The mobile app allows patients to review their HCP's instructions and receive critical alerts. Likewise, HCP can more closely track data to guide clinical assessments and plans.

Objectives: Examine the efficacy of the Bigfoot Unity system in improving glycemic control.

Methods: Baseline HbA1c values were obtained from 91 patients enrolled in the iCGM system and compared with Glucose Management Indicators (GMI), or estimated future HbA1c, after at least 30 days of iCGM use.

Results: Patients were in the target blood glucose range 59.9% of the time with low incidences (0.01%) of very low blood glucose. Patients’ mean baseline HbA1c was 8.87% (SD 1.91). After at least 30 days of iCGM, patients’ mean GMI was 7.55%, (SD 1.02) indicating a statistically significant mean difference of 1.32%, (95% CI 0.86 to 1.79%, p <0. 0001).

Conclusions: Use of Bigfoot Unity improves HbA1c.

Disclosure

P. Haque: None. S. Hall: None. P. Walker: None. K. Latif: None.
1172-P: The Social Impact of COVID-19 Pandemic on Children with Diabetes
Authors: ABDUL WAHED RUBA , RONIS SARAH , MACLEISH SARAH A. , WOOD JAMIE R. , MALAY SINDHOOSHA , KUTNEY KATHERINE A.
Published: June 2023

Aims: The aim of the study was to evaluate the social impact of the COVID-19 pandemic on youth with diabetes in Northeast Ohio from March 2020 through October 2022, and assess for disparate impact on minority and socially disadvantaged groups.

Methods: An email survey was distributed to 609 families of children with diabetes who met the inclusion criteria: age 7-20 years, followed by our clinic, and T1DM (duration 2+ years) or T2DM (duration 1+ years) prior to the pandemic. The survey asked several questions in 5 categories (housing, guardian's job loss, medical care disruption, schooling disruption and death of household member from COVID-19). Responding yes to any question in a category constituted an adverse social event (ASE). COVID-19 infection, hospitalization and vaccination status were collected. Between group differences were examined with a Fisher's Exact Test.

Results: Sixty two parents (10%) answered the survey, of whom 33 (53%) reported no ASE, 22 (35%)reported one ASE, and 7 (11%) reported 2 or more ASEs. Six respondents were Black and five were Hispanic. Among Black participants 1 (17%) had 1 ASE and 1 (17%) had 2 or more ASE, which was not statistically different than White participants. Among Hispanic participants 2 (40%) had one ASE and2 (40%) had 2 or more ASEs, which was numerically higher than the rates seen in non-Hispanic participants and approached statistical significance, p=0.068. Rates of ASE did not differ by insurance type or income level. Rates of COVID-19 infection and hospitalization did not differ between racial and ethnic groups. COVID 19 vaccination occurred at similar rates for Black and White participants; however, only 20% of Hispanic children received a COVID-19 vaccination, compared to 70% of non-Hispanic participants, p=0.04.

Conclusion: Forty six percent of children with diabetes experienced one or more ASE during theCOVID-19 pandemic. Our survey suggests that rates of ASE may have been higher in Hispanicchildren, who were also less likely to receive a COVID-19 vaccine.

Disclosure

R.Abdul wahed: None. S.Ronis: None. S.A.Macleish: Speaker's Bureau; Insulet Corporation. J.R.Wood: Research Support; Insulet Corporation, Boehringer-Ingelheim, MannKind Corporation. S.Malay: None. K.A.Kutney: None.
1177-P: Maternal Insulin Intervention Improves Offspring Glucose Metabolism via Long Noncoding RNA
Authors: ZHANG QIAN , XIAO XINHUA , LI MING
Published: June 2023

Maternal high fat (HF) during pregnancy is known to have numerous adverse effects on offspring, including increased adiposity and impaired glucose tolerance later in life. The aim of this study was to determine if prebiotic early intervention could mitigate some of the negative effects of maternal HF and involved mechanism. C57BL mice were fed a HF diet, normal diet or a HF diet with prebiotic supplementation during pregnancy and lactation. At 8 weeks of age, glucose tolerance were measured in the offspring. And offspring livers were obtained to assay lncRNA and mRNA profiles to investigate the effects of early maternal inulin intervention on offspring. Offspring from HF-fed dams displayed glucose intolerance and an insulin resistance phenotype at 8 weeks of age. Early maternal inulin intervention improved glucose metabolism in male offspring of mothers fed a HF during gestation and lactation. The lncRNA and mRNA profile data revealed that compared with the offspring from HF dams, offspring from the early inulin intervention dams had 99 differentially expressed hepatic lncRNAs and 529 differentially expressed mRNAs. The differentially expressed lncRNA-mRNA coexpression analysis demonstrated that early maternal inulin intervention may change hepatic lncRNA expression in offspring. These lncRNAs are involved in metabolic pathways and the AMP-activated protein kinase signaling pathway. Importantly, the early maternal inulin intervention alleviated glucose metabolism by inhibiting the lncRNA Serpina4-ps1/let-7b-5p/Ppargc1a as a competing endogenous RNA in male offspring.

Disclosure

Q.Zhang: None. X.Xiao: None. M.Li: None.

Funding

National Natural Science Foundation of China (82170854, 81870579, 81870545, 81570715, 81170736); Beijing Natural Science Foundation (7202163); Beijing Municipal Science & Technology Commission (Z201100005520011); National High Level Hospital Clinical Research Funding (2022-PUMCH-C-019); National Key Research and Development Program of China (2018YFC2001100); CAMS Innovation Fund for Medical Sciences (CIFMS2021-1-I2M-002, CIFMS2017-I2M-1-008)
1194-P: Impact of COVID-19 on Gestational Diabetes Mellitus (GDM) Screening and Outcomes
Authors: LIYANAGE VICHY , BARRETT OLESYA , NGWEZI DELIWE P. , SAVU ANAMARIA , YEUNG ROSEANNE O. , BUTALIA SONIA , KAUL PADMA
Published: June 2023

Background: To minimize COVID-19 exposure, a modified 1-step strategy (MS) option was offered in addition to the standard (SS) GDM screening strategies (definitions in Fig 1A).

Objectives: To assess the use of, and obstetrical and neonatal outcomes associated with, modified GDM screening during COVID-19.

Methods: Primiparous pregnancies in Alberta, Canada (N=35,836; Jan 1, 2020 to Dec 31, 2021) were categorized by GDM screening status.

Results: 87.4% underwent SS, 10.1% MS, and 2.5% had no GDM screening. MS use was highest in 2020-Q3 (second wave; Fig 1B). There was no difference in GDM rates between SS (11.1%) and MS (12.7%). MS screened women with GDM had worse outcomes than those screened using SS (Table).

Conclusions: GDM screening rates were not impacted by COVID-19. The uptake of MS was low to modest and appeared to identify higher-risk GDM women.

Disclosure

V.Liyanage: None. O.Barrett: None. D.P.Ngwezi: None. A.Savu: None. R.O.Yeung: Research Support; Novo Nordisk Foundation, Abbott, Canadian Institutes of Health Research, Alberta Agriculture and Forestry, Alberta Canola. S.Butalia: None. P.Kaul: None.
12-LB: Clinical Impact of Risk Profiling with KidneyIntelX on DKD Progression in a Large Integrated Health Care System
Authors: TOKITA JOJI , SINFIELD CATHERINE , DONOVAN MICHAEL J. , MCNICHOLAS TONY , KATTAN MICHAEL , LAM DAVID W.
Published: June 2023

KidneyIntelXTM combines 3 plasma biomarkers with clinical variables to categorize adults with DKD stages 1-3b for risk of a progressive decline in kidney function over 5 years. We previously demonstrated that using KidneyIntelX to assess risk and guide treatment does lead to optimized medication use, lifestyle changes, and specialist referrals. We now report the one-year pre and posttest clinical impact on eGFR slope and hemoglobin A1C (HbA1c) in the Mount Sinai Health System. Among the 1087 patients with follow-up data, the median age was 69 years, 52% were women, 32% self-identified Black, baseline eGFR 59 ml/min/1.73m2, baseline HbA1c was 7.2%, and 146 (13%), 439 (40%), and 502 (46%) were scored as high, intermediate, and low risk by KidneyIntelX. In high-risk patients, median eGFR slope slowed from -5.7 ml/min/year pre-test to -2.1 ml/min/year post-test (p<0.001), and from -1.8 ml/min/year to -1.0 ml/min/year in intermediate-risk (p=0.005) (Table). The median HbA1c decreased from 8.4 to 7.7% (p<0.001) in high risk, and from 7.5 to 7.2% (p<0.001) in intermediate risk.

In conclusion, deployment and risk stratification by KidneyIntelX was associated with reduced rate of kidney function decline and improved glycemic control, particularly in those scored as high risk.

Disclosure

J. Tokita: Other Relationship; Renalytix. C. Sinfield: None. M. J. Donovan: Employee; Renalytix. T. McNicholas: Employee; Renalytix. M. Kattan: Research Support; Novo Nordisk. Consultant; Renalytix, Verici. Research Support; Bayer Inc. D. W. Lam: None.
1204-P: The Effect of Eating Behaviour, BMI, and Glycaemia in Women with Gestational Diabetes
Authors: KUSINSKI LAURA C. , TOBOLSKA PATRYCJA , JONES DANIELLE , ATTA NOORIA , OUDE GRIEP LINDA M. , GRIBBLE FIONA M. , MEEK CLAIRE L.
Published: June 2023

Introduction: Maternal obesity and poor diet choices are often attributed as the cause of gestational diabetes. Maternal eating behaviour during pregnancy and the influence of this on the disease aetiology remains poorly understood. We aimed to compare eating behaviour in women with gestational diabetes to non-pregnant adults to determine which of the eating behaviour traits are associated with BMI as well as glucose metrics.

Methods: Participants (total n=448) including men (n=67), non-pregnant women (n=181) and women with gestational diabetes during a singleton pregnancy (n=200; 29 weeks’ gestation; NICE / Covid-19 criteria) were recruited prospectively and completed a three-factor eating questionnaire (TFEQ-R18). Cross-sectional associations between continuous glucose measurement metrics and BMI with uncontrolled eating (UE), emotional eating (EE) and cognitive restraint (CR) were assessed using linear regression.

Results: Women with gestational diabetes had significantly lower UE scores compared to men (53% vs 63%; p<0.001) and non-pregnant women (53% vs 65%; p<0.001), and lower EE scores compared to non-pregnant women (60% vs 71%; p<0.001). In women with gestational diabetes, only EE scores were significantly associated with BMI (Coeff 7.8; 95%CI 3.9-11.7; p<0.001), while UE and CR scores have no association. However, EE, UE and CR were not significantly associated with glucose metrics such as average glucose levels, time above range or time below range.

Conclusions: Favourable eating behaviour was observed in women with gestational diabetes when compared to men and non-pregnant women. Data showing EE is strongly associated with BMI suggest that interventions which consider this may be more impactful for weight management in women with gestational diabetes and, as such, exploring this avenue may be an important aspect to address when considering new translational approaches.

Disclosure

L.C.Kusinski: None. P.Tobolska: None. D.Jones: None. N.Atta: None. L.M.Oude griep: None. F.M.Gribble: Other Relationship; Kallyope, Research Support; AstraZeneca, Eli Lilly and Company. C.L.Meek: Research Support; Dexcom, Inc.

Funding

Diabetes UK (17/0005712)
121-OR: Fear of Falling and Its Relation to Balance Task Performance in Individuals with Chronic Diabetes
Authors: HABASHI KIAN , IIDA THOMAS , YEE BRIANNA
Published: June 2023

Background: Older adults with type 2 diabetes mellitus (T2DM) have lower balance confidence and a higher risk and fear of falling. This may lead to fear of falling avoidance behaviors (FFAB). It has been shown that balance training may attenuate fall risk, but it is unclear how balance task performance and learning is associated with FFAB.

Methods: Participants included in the study were greater than 50 y.o., with or without T2DM, able to walk 50m, and able to stand for 5 min. FFAB was assessed using a 14-item questionnaire (FFABQ). Balance task performance was measured using a stabilometer, a wooden platform connected to a single axis to allow for bidirectional sway and a potentiometer to measure rotation of the board (±18° maximum). Participants underwent 3 days of balance training, each of which consisted of at least ten, 30 second trials. Participants were encouraged to keep the board in balance, defined as ±5° from the midline, and time in balance (TIB) was the primary outcome measure for each trial. Statistical analysis was done by independent sample T-tests through IBM SPSS software.

Results: To date, data collection has been completed for 37 patients, 17 with T2DM and 20 without. T2DM participants had a significantly higher FFABQ score than controls (12.41 ± 14.22 vs 2.59 ± 4.22; p = 0.006). The T2DM group had significantly lower TIB than the control group on day 1 (6.16 ± 1.89 vs 8.91 ± 3.05; p=0.001) and day 3 (8.099 ± 2.91 vs 12.28 ± 4.69; p=0.001). However, there was no statistically significant difference in balance task improvement between T2DM and controls (34.1% ± 34.4 vs 32.5% ± 39.5; p = 0.447). Similarly, there was a significant negative correlation between FFABQ scores and day 1 stabilometer performance but no correlation between FFABQ and balance task improvement [(day 3-day 1)/day 1)].

Conclusions: These results suggest that T2DM participants exhibited greater FFAB and poorer balance performance; however, with training they are still able to improve at the same rate as control participants.

Disclosure

K.Habashi: None. T.Iida: None. B.Yee: None.
1213-P: Artificial Intelligence–Based Body Composition Analysis Using Computed Tomography Images Predicts Both Prevalence and Incidence of Diabetes—A Cross-Sectional and Longitudinal Analysis of 10-Year Retrospective Cohort in Korea
Authors: HYUNG KIM YOO , SON HEEJUN , YOON JIWON , JEE CHOE HUN , JUNG OH TAE , MIN CHO YOUNG
Published: June 2023

Background: We aimed to assess how the ageing-related changes in body composition contribute to the prevalence and incidence of diabetes using artificial intelligence (AI)-based analysis of abdominal computed tomography (CT) images.

Methods: In this retrospective cohort study, we identified 15330 subjects age ≥18 years with abdominal CT scans at baseline, who underwent medical checkup at Seoul National University Hospital Healthcare System Gangnam Center from January 1, 2011 to September 30, 2012. Of these, 11693 subjects with available follow-up data were included in the longitudinal analysis. The volume of each body segment involved in abdominal CT images was measured by using an AI-based image analysis software.

Findings: The ratio of visceral fat to subcutaneous fat (VF/SF ratio) increased with ageing. The optimal cutoffs of VF/SF ratio to predict the prevalence of diabetes were 1.2 and 0.5 in men and women, respectively. A VF/SF ratio over the cutoff was associated with a higher prevalence of diabetes (age and BMI adjusted OR 2.1, [95% CI 1.8-2.4] in men; 3.1, [2.4-3.9] in women). The same cutoffs of VF/SF ratio were used to predict incident diabetes in ten years of follow-up. Subjects with normal glucose tolerance at baseline who had higher VF/SF ratio had increased risk of progression to prediabetes or diabetes (age and BMI adjusted HR 1.2, [95% CI 1.1-1.4] in men; 1.4, [1.2-1.6] in women). Subjects with prediabetes at baseline who had higher VF/SF ratio also more frequently progressed to diabetes (age and BMI adjusted HR 1.4, [95% CI 1.2-1.6] in men; 1.8, [1.5-2.3] in women).

Interpretation: VF/SF ratio in the abdomen change with ageing and are associated with the prevalence and future incidence of diabetes. AI-based analysis of abdominal CT images may help easily obtain body composition data to clinically assess the risk of incident diabetes.

Disclosure

Y.Kim: None. H.Son: None. J.Yoon: None. H.Choe: None. T.Oh: None. Y.Cho: Consultant; LG Chem.

Funding

Ministry of Health & Welfare, Republic of Korea
1232-P: Risk of Cardiovascular Diseases >30 Days after COVID-19 Diagnosis among U.S. Adults With and Without Diabetes
Authors: KOYAMA ALAIN , IMPERATORE GIUSEPPINA , ROLKA DEBORAH B. , LUNDEEN ELIZABETH A. , RUTKOWSKI RACHEL , JACKSON SANDRA , HE SIRAN , KUKLINA ELENA V. , PARK SOYOUN , PAVKOV MEDA E.
Published: June 2023

Growing evidence suggests an increased risk of incident chronic diseases such as cardiovascular diseases (CVDs) after COVID-19. We evaluated the risk of CVDs >30 days after a COVID-19 diagnosis and compared it to a contemporaneous control group without a COVID-19 diagnosis. We included adults ≥20 years with a COVID-19 diagnosis from March 1, 2020 through December 1, 2021 from the IQVIA insurance claims database. The contemporaneous control group comprised adults with ≥1 healthcare encounter and without diagnoses for COVID-19 or other acute respiratory infections. Control group index dates were randomly selected to match the distribution of COVID-19 diagnosis dates. All diagnoses were ascertained from ICD-10 codes. Individuals with diagnostic codes of CVDs within 2 years prior to the index date were excluded. We used Cox regression models (adjusted for age, sex, health insurance type, U.S. Census division, Charlson comorbidity score) to assess the risk of incident CVDs, stratifying by diabetes status. The analytic sample included 13,078,827 adults (mean age 49.4 years [SD: 15.7], 50.2% female, and mean follow-up 8.5 months [SD: 5.8]). Among patients with and without diabetes, COVID-19 diagnosis was significantly associated with increased risk of each CVD outcome (See Figure). Regardless of diabetes status, monitoring for incident CVD may be pertinent beyond the first 30 days of COVID-19.

Disclosure

A.Koyama: None. M.E.Pavkov: None. G.Imperatore: None. D.B.Rolka: None. E.A.Lundeen: None. R.Rutkowski: None. S.Jackson: None. S.He: None. E.V.Kuklina: None. S.Park: None.
1235-P: High Burden of Undetected Hypertension among People with Type 2 Diabetes in India
Authors: MOHAN SAILESH , JARHYAN PRASHANT , PRABHAKARAN DORAIRAJ
Published: June 2023

Purpose: Despite the huge burden of diabetes and hypertension, limited information is available on the burden of undetected hypertension and associated factors among diabetics in India.

Methods: We conducted a cross-sectional study and selected 12284 adults aged ≥ 30 years, using a multistage cluster random sampling technique, from rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples. Blood pressure was measured using standard protocols. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or treatment and the known-diabetes was defined as self-reported physician diagnosis or treatment. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥ 90 mmHg or self-reported physician diagnosis or treatment and undetected hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥ 90 mmHg without self-reported physician diagnosis or treatment.

Results: The age-adjusted prevalence of diabetes was 17.5% (16.9-18.2), known diabetes was 10.2% (9.7-10.7) and hypertension among those with diabetes was 47.3% (45.0-49.6). The age-adjusted prevalence of undetected hypertension among those with known-diabetes was 27.0% (22.0-31.9). The prevalence of undetected hypertension among known-diabetics was higher in urban area [29.4% (23.2-35.6)] than the rural area [21.5% (13.2-29.7)]. In the multinomial logistic regression, undetected hypertension among those with known-diabetes was positively associated with older age [adjusted Relative Risk Ratio (aRRR): 3.4 (1.7-6.9)], dyslipidemia [aRRR: 2.2 (1.2-4.1)] and chronic kidney disease [aRRR: 3.3 (1.2-9.2)].

Conclusions: There is a need to implement health system interventions to increase the detection of hypertension among diabetics.

Disclosure

S.Mohan: None. P.Jarhyan: None. D.Prabhakaran: None.
1239-P: The Time Point of Blood Pressure Measurement Rather than the Application of U.S. vs. European Blood Pressure Categorizations Is Important for Cardiovascular Risk Prediction in Patients with the Metabolic Syndrome
Authors: LEIHERER ANDREAS , BROZEK WOLFGANG , MUENDLEIN AXEL , ULMER HANNO , SAELY CHRISTOPH H. , PLATTNER THOMAS , VONBANK ALEXANDER , MADER ARTHUR , SPRENGER LUKAS , MAECHLER MAXIMILIAN , LARCHER BARBARA , FRAUNBERGER PETER , NAGEL GABRIELE , ZITT EMANUEL , DREXEL HEINZ , CONCIN HANS
Published: June 2023

This observation study (OS) recorded cardiovascular mortality over 21 years in a cohort of 1497 cardiovascular disease patients (median 65 years), of whom 680 had the metabolic syndrome (MetS). We analyzed the predictive value of blood pressure (BP) when measured at baseline of the OS or when measured in a health survey (HS) having enrolled the identical patients fifteen years prior to the OS, applying varying high BP categorizations from the US (ADA/ACC/AHA) and from Europe (EASD/ESC/ESH). Cardiovascular mortality risk increased with increasing BP categories when measured at HS but not when measured at OS (figure), irrespective of whether US or European BP categorizations were used. According to integrated discrimination improvement, the power of BP to predict cardiovascular mortality did not differ significantly between US and European categorizations (p=0.965), however, the power was significantly higher when using BP measurements at HS instead of at OS (p<0.001). This held true both among patients with the MetS (p=0.017) and also in those without the MetS (p<0.001). We conclude that earlier in life BP (HS) readings outperform BP readings done at a more advanced age (OS baseline) in terms of risk prediction for cardiovascular mortality both in MetS patients and in subjects without the MetS.

Disclosure

A.Leiherer: None. M.Maechler: None. B.Larcher: None. P.Fraunberger: None. G.Nagel: None. E.Zitt: None. H.Drexel: None. H.Concin: None. W.Brozek: None. A.Muendlein: None. H.Ulmer: None. C.H.Saely: None. T.Plattner: None. A.Vonbank: None. A.Mader: None. L.Sprenger: None.
1249-P: Lack of Concordance of Blood Pressure Control among Heterosexual Couples with Diabetes—An Analysis of Aging Cohorts from USA, China, and India
Authors: SAM VARGHESE JITHIN , LI CHIHUA , LU PEIYI
Published: June 2023

Background: Previous studies observed high concordance of diabetes and hypertension among married or partnered couples globally due to assortative mating and cohabitation. However, whether there is concordance in controlled blood pressure (BP) among couples with diabetes, an important risk factor for micro/macrovascular complications, is unknown.

Methods: Using cross-sectional data from Health and Retirement Study (HRS 2016-17, n = 1749) and its international partner studies from China (CHARLS 2015-16, n = 923) and India (LASI 2017-19, n = 4582), we identified couples (aged 21-97 years) among whom at least one partner had diabetes and both partners had standardized BP measurements. We defined controlled BP as systolic BP < 140 mmHg and diastolic BP < 90 mmHg. We used multiple imputation and survey-weighted modified Poisson regression to study the association of controlled BP between couples for wives and husbands respectively. We adjusted for current medication use, individual and household characteristics. We additionally examined between-country differences in the association.

Results: Our analytic sample consisted of 3802 wives and 4504 husbands with diabetes. The proportion of wives with controlled blood pressure were 76.6% [73.2, 80.1] in the USA, 67.5% [63.3, 71.8] in China and 65.1% [62.6, 67.6] in India. The proportion of husbands with controlled blood pressure were 70.8% [67.4, 74.1] in the USA, 63.6% [58.5, 68.6] in China and 60.0% [57.8, 62.3] in India. Partner’s control of BP was not associated with own controlled BP for wives (prevalence ratio, PR: 1.05 [0.97, 1.14]) and husbands (PR: 1.07 [0.94, 1.21]) with diabetes. Estimates of association were null across all countries. Estimates were similar when restricted to couples (n = 1076) when both partners had diabetes.

Conclusions: Lack of concordance in BP control among couples with diabetes suggest continuation of strategies for individualized management of high blood pressure.

Disclosure

J.Varghese: None. C.Li: None. P.Lu: None.
126-LB: Effect of a Digital Diabetes Solution on All-Cause Health Care Resource Utilization Charges for Patients with Type 2 Diabetes—A Retrospective Cohort Study
Authors: WILSON LAURA , MALONE DANIEL C. , KUMAR POTUKUCHI PRAVEEN , THINGALAYA NITA , LEE KENI C. , EDWARDS ALISON , YU XINYAN , LEE FELIX , KENNEDY ADEE , HAN-BURGESS EDWARD JONATHAN K. , BRIXNER DIANA
Published: June 2023

Background: Dario Diabetes Solution (DDS) is a digital health application (app) for type 2 diabetes mellitus (T2DM) management that combines a blood glucose (BG) meter and a mobile app, allowing patients (pts) to track BG levels in real time. This study compared all-cause healthcare resource utilization (HCRU; inpatient + ER) and charges for DDS users vs matched nonusers.

Methods: This retrospective cohort study (pt selection window: 1JAN2017 - 31APR2021) included adults (≥18 years) with T2DM receiving antidiabetic medication(s) with ≥1 inpatient or ≥2 outpatient visits ≥30 days apart during the baseline (BL) period. BL was 1 year before index date (users, 1st DDS registration; nonusers, 1st claim date in the quarter); follow up was 1 year. User and nonuser cohorts were matched 1:3 using exact and propensity score matching. Study assessed HCRU rates and charges. A 2-part gamma distribution model was used to determine 1) likelihood (odds ratio, OR) of users vs nonusers to incur charges, then 2) total charges per patient per year (PPPY) including all-cause HCRU and office visit (OV) charges.

Results: Of 9779 pts, 2445 DDS users and 7334 nonusers were matched; mean age, 58.2±10.6 and 58.3±12.5 years, respectively. At 1 year, users were 9% less likely to incur all-cause HCRU charges vs nonusers (OR, 0.91; P=0.07). All-cause HCRU charges were 26% lower for users vs nonusers (P<0.0001; $12552 [adjusted] PPPY savings). Users were more likely to incur all-cause OV charges vs nonusers (P=0.04). However, users had 19% lower all-cause OV charges vs nonusers (P<0.0001; $1790 [adjusted] PPPY savings). The percentages of pts who incurred T2DM related HCRU charges were low (users, 3.1%; nonusers, 3.0%).

Conclusions: In this retrospective cohort study, pts with T2DM who utilized DDS incurred significantly lower all-cause HCRU and OV charges vs nonusers.

Disclosure

L. Wilson: Employee; Sanofi. D. C. Malone: Consultant; Sanofi Genzyme, Avidity, Sarepta, Pear Therapeutics, Gilead Sciences, Inc., Novartis. P. Potukuchi: None. N. Thingalaya: None. K. C. Lee: Employee; Sanofi. A. Edwards: Other Relationship; Sanofi. Employee; Symphony Health, an ICON plc company. X. Yu: None. F. Lee: Employee; Sanofi. Stock/Shareholder; Sanofi. A. Kennedy: None. E. K. Han-Burgess: Employee; Sanofi. D. Brixner: Consultant; Sanofi.

Funding

Sanofi
1279-P: The INNODIA Natural History Study of Children, Adolescents, and Adults Newly Diagnosed with Type 1 Diabetes
Authors: LOREDANA MARCOVECCHIO M. , DELFIN CARL , HULSMANS MARGO , OVERBERGH LUTGART , PAZMINO SOFIA S. , PICTON DIANE E. , STEENACKERS NELE , VAN DER SCHUEREN BART , HENDRIKS ALLAIRD E.J. , MATHIEU CHANTAL ,   INNODIA CONSORTIUM
Published: June 2023

Using the INNODIA consortium European infrastructure, we aimed to discover novel biomarkers of T1D progression. Here we report clinical and biochemical characteristics of people with new-onset T1D during the first year from diagnosis. Children and adults (age 1-45 yrs) were recruited within 6 weeks from T1D onset in 11 European countries. Baseline clinical characteristics, C-peptide (fasted and mixed meal tolerance test), HbA1c, autoantibodies, and their overtime changes were assessed across 3 age groups: <10, 10-17, ≥18yrs. The study population included 655 individuals (280: <10 yrs; 274: 10-17 yrs; 101: ≥18 yrs): 57% male; age: 12.1±8.4 yrs; 96% were positive for ≥1 autoantibodies. Autoantibody frequency was IAA 77%, GAD 73%, IA-2A 69%, ZnT8A 66%. Diabetic ketoacidosis prevalence was 35%, with the highest rate in the 10-17 yrs group (44%). At baseline, median [IQR] fasting and area-under-the curve (AUC) C-peptide were 242[140-384] and 753[469-1109]pmol/L, with levels increasing with age (p<0.001; Fig). Over time C-peptide remained lower in participants <10yrs but rates of decline were similar between age groups. HbA1c significantly decreased during the first 3 months (p<0.001). In this large cohort with new-onset T1D, we identified age-related differences in clinical and biochemical parameters. Of note, C-peptide was lower in younger children but there was no age effect on its rate of decline.

Disclosure

M.Marcovecchio: None. C.Mathieu: Advisory Panel; Novo Nordisk A/S, Boehringer Ingelheim Inc., Eli Lilly and Company, Medtronic, Vertex Pharmaceuticals Incorporated, Roche Diabetes Care, Imcyse, Speaker's Bureau; Novo Nordisk A/S, AstraZeneca, Boehringer Ingelheim Inc., Eli Lilly and Company, Medtronic, Vertex Pharmaceuticals Incorporated. Innodia consortium: n/a. C.Delfin: Employee; Novo Nordisk A/S. M.Hulsmans: None. L.Overbergh: None. S.S.Pazmino: None. D.E.Picton: None. N.Steenackers: None. B.Van der schueren: None. A.E.J.Hendriks: Advisory Panel; Alira Health.

Funding

Innovative Medicines Initiative 2 Joint Undertaking (115797, 945268)
128-LB: Accessing Glucose Fluctuation—The Role of FPG, PPG, and HbA1c
Authors: MA JIANHUA , SU XIAOFEI , FENG LINGGE , DING BO , YAN RENNA , SUN RUI , ZHANG YUMEI , DUAN YANLI
Published: June 2023

Background: Time in range (TIR) has been widely used clinically to investigate the glucose fluctuation in diabetes management. Studies have been done in exploring the relationship between TIR and HbA1c to estimate TIR without multi-invasive measurements. Beyond the univariate correlation model, this study incorporated fasting plasma glucose (FPG), postprandial glucose (PPG) obtained from glucose tolerance test, which can to some extent reflect glucose fluctuations, and revealed the advantage and the potential of the multi-variate linear or no-linear model to estimate TIR.

Method: This study involved 399 Chinese T2DM patients. TIR were calculated from continuous glucose monitoring (CGM) data with a coverage of at least 70%. FPG, PPG were measured by oral or mixed-meal glucose tolerance test. Univariate, multivariate linear regression and non-linear random forest (RF) regression were used in regression analysis. Model performance was assessed using MAE, RMSE and MSE.

Results: Regression analysis between glucose tolerance test data and CGM suggests that FPG were strongly linked to trough glucose while PPG were strongly correlated with peak glucose. Regression analysis revealed a stronger correlation between TIR and a triad of FPG, PPG, HbA1c than single HbA1c variable. And the performance of RF model is superior (correlation = 0.79, MAE = 14.77), among multivariate linear (0.73, 16.67) and univariate linear (0.62, 21.29) model.

Conclusion: Our study shows that FPG and PPG are closely associated to trough and peak glucose in CGM data, as they provide a more complete picture of glucose fluctuations compared to HbA1c alone. The TIR estimation model that based on FPG, PPG, and HbA1c outperformed univariate model. However, the performance of RF based non-linear model suggests a more complex relationship between those parameters, indicating personalized models for different populations is needed in TIR estimating without long-term invasive glucose monitoring.

Disclosure

J. Ma: None. X. Su: None. L. Feng: Employee; Hua Medicine. B. Ding: None. R. Yan: None. R. Sun: None. Y. Zhang: None. Y. Duan: None.

Funding

Nanjing Municipal Health Commission (ZKX22038)
1280-P: The Maturity-Onset Diabetes of the Young (MODY) Calculator Overestimates MODY Probability in Hispanic Youth
Authors: ALARCON GUIDO , NGUYEN ANH D. , JONES ANGUS , REDONDO MARIA J. , SHIELDS BEVERLEY , TOSUR MUSTAFA
Published: June 2023

The applicability of the MODY probability calculator (Shields et al., Diabetologia, 2012) to non-European populations remains unknown. We aimed to test its utility in Hispanic youth. We performed a retrospective chart review of Hispanic youth (<23 years) with diabetes (n=2033) in a large, pediatric tertiary care center in the U.S. We calculated MODY probability for all subjects, splitting into two cohorts in line with the two equations underlying the MODY calculator: Individuals who were started on insulin within 6 months of diabetes diagnosis (Cohort 1) and those who were not (Cohort 2). MODY genetic testing was carried out on limited individuals based on clinicians’ suspicion of MODY. Cohort 1 and Cohort 2 comprised 1566 (mean age: 15.8 ± 4.7 years, 49% female) and 467 youth (mean age: 17.2 ± 3.5 years, 62% female), respectively. Of 1566 early insulin treated individuals in cohort 1, the mean MODY probability was 6% suggesting an expected 6% (94 individuals) with MODY. This is higher than previous prevalence estimates (1-4%) and much higher than the number identified from genetic testing (6 individuals out of 30 tested). For the 467 non-insulin treated individuals (cohort 2), the mean probability was 62% suggesting an expected 289 individuals with MODY, which again was much higher than previous prevalence estimates and the number identified from genetic testing (10 individuals out of 12 tested). Individuals with a confirmed pathogenic variant in a MODY-associated gene were more likely to have a younger age at diagnosis and lower non-HDL (cohort 1) or lower HbA1c (cohort 2). However, both cohorts had similar MODY probabilities compared to the remaining individuals in each cohort. The MODY calculator likely overestimates the probability of MODY in Hispanic youth, particularly those who are not early insulin treated, where young-onset type 2 diabetes is the more likely diagnosis. The calculator needs updating for use in this population.

Disclosure

G.Alarcon: None. A.D.Nguyen: None. A.Jones: None. M.J.Redondo: None. B.Shields: None. M.Tosur: Advisory Panel; Provention Bio, Inc.