bluuebunny/crossref_metadata_2025 huggingface dataset:
1037-P: Evaluating the Impact of Telemedicine Care Coordination on Access to Care in Oregon’s Pediatric Type 1 Diabetes Population
Authors: MITCHELL EMILY S. , ANDREA SARAH B. , GUTTMANN-BAUMAN INES
Published: June 2023

Background: Children with type 1 diabetes (T1D) require close monitoring with visits every 3-4 months. COVID-19-induced telemedicine expansion (TE) may alleviate the challenge of high visit frequency that children with type 1 diabetes (T1D) face. However, telemedicine’s impact on access to care may be limited if patients lack adequate support for telemedicine.

Purpose: The study objective was to evaluate the impact of telemedicine care coordination services (CCS) on visit frequency in an urban medical center without CCS versus a rural outreach program with established CCS.

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

Results: Just prior to TE, patients receiving CCS were 25.6% less likely to receive ATMC (95% CI: 51.6%, 114%). Following TE, likelihood of ATMC increased from 28.8% to 58.2% among those receiving CCS and decreased from 38.7% to 22.0% among those not receiving CCS; increases in ATMC were 3.55 times greater in patients receiving CCS relative to those not (95% CI: 2.10, 6.01).

Conclusions: Telemedicine may only increase the number of T1D patients meeting goal visit frequency when paired with CCS.

Disclosure

E.S.Mitchell: None. S.B.Andrea: Research Support; Eli Lilly and Company. I.Guttmann-bauman: None.
1042-P: Qualitative Study—Provider Awareness and Attitudes towards Type 1 Diabetes Antibody Screening
Authors: OSPELT EMMA L. , HARDISON HOLLY , RIOLES NICOLE , NOOR NUDRAT , NELSON GRACE , LEVY CAROL J. , MCKEE ALEXIS M. , ANTAL ZOLTAN , WONG JENISE C. , OBRYNBA KATHRYN , EBEKOZIEN OSAGIE
Published: June 2023

Background: This study explores awareness and attitudes of endocrinology providers toward type 1 diabetes (T1D) autoantibody screening and identifies perceived benefits and barriers to screening.

Methods: Three focus groups were conducted with thirteen eligible endocrinology providers recruited from the T1D Exchange Quality Improvement Collaborative. Focus groups were transcribed, coded, and analyzed using NVivo qualitative software. A force field analysis was conducted, analyzing high, medium, and low impact forces that were identified in the study.

Results: All providers considered themselves “pro-screening” and comfortable discussing autoantibody screening with patients. High impact driving forces included early diabetes management, DKA prevention at diagnosis, and clinical guidance and diagnosing abilities. Medium and low impact forces included awareness and clarity of diagnosis, opportunity to get involved in research, and results for insurance approval. High impact restraining forces included anxiety of diagnosis for patients and family members, cost of screening, and staffing or clinic limitations. Medium and low impact forces included time and coordination for patients and families, mildly invasive procedure, and insurance coverage.

Conclusion: Findings highlight perceived benefits and barriers to autoantibody screening, illustrating provider insight and awareness.

Disclosure

E.L.Ospelt: None. K.Obrynba: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. H.Hardison: None. N.Rioles: None. N.Noor: None. G.Nelson: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. A.M.Mckee: Advisory Panel; Medtronic, Novo Nordisk. Z.Antal: None. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc.
1046-P: ELEGANT-DM2—Early Intervention Addressing Therapeutic Inertia in Diabetes Mellitus-2
Authors: BANDI ARCHANA , BECKER DANYA , SODDERS STEPHANIE , ZUPA MARGARET , MCCOY JENNIFER L. , PERTINACI NADINE M. , BOUDREAUX-KELLY MONIQUE Y.
Published: June 2023

Primary care (PC) models for DM2 care driven by clinical pharmacists (CPs) have shown benefits, while access to a diabetologist (DCS) for patients with complex DM2 is limited. A prospective observational study at VA Pittsburgh Healthcare System studied the impact of a novel collaborative care model: ELEGANT-DM2 used a diabetes dashboard (DD) to identify patients with clinical therapy inertia (CTI) and weekly virtual huddles linking CPs in PC with a DCS for case review and recommendations. Using a DD, 103 patients with DM2 and A1c>9% were enrolled between 09/2020 to 03/2021 and received the collaborative care intervention over 12 months. Patient demographics, comorbidities, A1c at 12-months (PRE-12) pre-enrollment, enrollment (E), and 12 months (PS-12) post-enrollment, and diabetes medications at E and PS-12 were extracted. A non-parametric test was used to compare continuous outcome measures (Mean+/-SD); categorical measures as percentages. McNemar test was used to conduct pre-post proportion comparisons in specific cohorts for SGLT-2i and GLP-1RA medications. The study cohort was mostly male (94%), white (90%), with a mean age of 69.3 years, had pre-existing CVD (91%), obesity (89%), HTN (87%), CKD (16%), and CHF (10%). A significant rise in A1c was noted from 9.3% (+/-1.4) at Pre-12 to 10.8% (+/-1.5) at E (p=.008). A significant decline was noted in A1c from 10.8% (+/- 1.5) at E to 8.2% at PS-12 (p=<0.001). In patients with DM2 and CVD, use of SGLT-2i and GLP-1RA increased significantly (SGLT-2i: 16.5% at E to 29% at PS-12, p=0.009; GLP-1A: 20% at E to 36% at PS-12, p=.003). In patients with DM2 and obesity, GLP-1RA use increased from 18.2 % at E to 39.4% at PS-12 (p=.0008). A non-significant increase in the use of SGLT-2i was seen in cohorts with CKD and CHF. ELEGANT-DM2 identified CTI using DD, eliminated the traditional referral process, led to therapy optimization via virtual huddles between PC CPs and DCS, and delivered sustained improvement in DM2 control and uptake of new medications

Disclosure

A.Bandi: None. D.Becker: None. S.Sodders: None. M.Zupa: None. J.L.Mccoy: None. N.M.Pertinaci: None. M.Y.Boudreaux-kelly: None.

Funding

Office of Health Equity (SPRV-OHEA160)
1048-P: Assessing the Quality of Life of People with Diabetes Adhering to Telemedicine over 15 Years
Authors: KESAVADEV JOTHYDEV , SHANKAR ARUN , JOTHYDEV KRISHNADEV , KRISHNAN GOPIKA , BASANTH ANJANA , CHANDRAN GOPIKA B. , SANAL GEETHU , JOTHYDEV SUNITHA
Published: June 2023

T2D is associated with personal, familial, social, and financial issues that substantially affect the quality of life (QoL). Telehealth interventions have ranked top at improving the QoL in patients with chronic illnesses. DTMS® (Diabetes Tele-Management System), developed in 1997, involves unique software & trained multidisciplinary diabetes team, communicating with patients via phone/email for slow, steady titration of drugs combined with frequent tele-counseling apart from 2-3 physical visits to the hospital. We assessed and compared QoL in T2D adhering and not-adhering to telemedicine over 15 years (Y).

A total of 451 T2D, (62.91 ± 11.64 Y; 37.8% females, duration of diabetes: 8.41 ± 2.78 Y) were de-identified. The treatment group [TG- 63.41±11.73 Y; 62.92% males; 8.04±1.82 Y of T2D] included T2D with ≥1F-F and ≥5 TM consultations per year. The propensity score-matched control group [CG-62.17±11.50 Y; 58.69% males; 7.98±2.96 Y of T2D] included T2D who were not on regular follow-up with compromised F-F and TM visits.

EQ-5D questionnaire (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) was administered annually as part of clinic SOP. The response collected at 15±5 Y was statistically analyzed and compared.

TG experienced a higher score for all the domains of QoL than CG (p<0.001) (Figure 1).

With improvements in QoL, TM deserves more acceptance as an add-on to in-person visits.

Disclosure

J.Kesavadev: None. A.Shankar: None. K.Jothydev: None. G.Krishnan: None. A.Basanth: None. G.B.Chandran: None. G.Sanal: None. S.Jothydev: None.
1049-P: Pros and Cons of Telemedicine in Diabetes—Survey among Doctors and Allied HCPs
Authors: KESAVADEV JOTHYDEV , SHANKAR ARUN , SABOO BANSHI D. , JOSHI SHASHANK R. , BASANTH ANJANA , KRISHNAN GOPIKA , JOTHYDEV SUNITHA
Published: June 2023

An acceleration in the adoption and use of telemedicine (TM) was necessitated by the COVID-19 pandemic. A more nuanced view emerged, including the importance of accommodating patient choice, appropriately matching encounter type to visit the platform, acknowledging the hazards associated with care delivered remotely, and adapting existing models of advanced team-based care. We have been practicing TM in diabetes since 1997. Diabetes Tele Management System, [DTMS®] is a structured diabetes management program integrated with electronic medical records, that enables telecommunication via telephone, email, and internet. To study the pros and cons of TM across a wider group a web-linked survey was conducted among doctors, allied healthcare professionals (aHCPs). The link was sent to doctors, aHCPs across India (Sept 2022-December 2022) via email and WhatsApp. The survey received 654 responses, 65% being doctors and HCPs out of which 89% had not received training prior to engaging in telemedicine consultations. Summary of responses from doctors and HCPs in Table 1. Though the majority of patients may be satisfied with TM, the prevailing practices should be periodically evaluated and upgraded incorporating the feedback from the users. It is essential to understand both pros and cons of TM in the view of doctors and aHCPs, to enable the policymakers to devise policies that enhance the scope of quality patient care.

Disclosure

J.Kesavadev: None. A.Shankar: None. B.D.Saboo: None. S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Basanth: None. G.Krishnan: None. S.Jothydev: None.
105-OR: Omega-3 Polyunsaturated Fatty Acids in the Treatment of Diabetic Peripheral Neuropathy—Is the Source Important?
Authors: YOREK MARK A.
Published: June 2023

Introduction: We have shown that omega-3 polyunsaturated fatty acids (PUFA) derived from fish oil (FO) was an effective treatment for diabetes vascular and neural complications. However, is FO the best source of omega-3 PUFA for treating diabetic peripheral neuropathy (DPN)?

Methods: To address this question we used a rat model of type 2 diabetes and a late intervention protocol. After 10 weeks of hyperglycemia, diabetic rats were treated for 12 weeks via diet with omega-3 PUFA derived from a variety of sources including menhaden (fish) oil (MO), krill oil (KO), oils derived from algae that produce primarily eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or combination of EPA and DHA, or commercial ethyl esters of EPA, DHA or combination of EPA and DHA. Primary endpoints were motor (MNCV) and sensory (SNCV) nerve conduction velocity, intraepidermal and cornea nerve fiber density, thermal and cornea sensitivity, and vascular reactivity of epineurial arterioles that provide circulation to the sciatic nerve. The omega-3 index, and serum fatty acid levels were also determined.

Results: The dose of each omega-3 PUFA supplement was customized to create a healthy omega-3 index. Defined as the sum of EPA and DHA as a percentage of total fatty acids in red blood cells, range for healthy level 8 - 12%. Following 22 weeks of untreated diabetes neural and vascular endpoints were significantly impaired compared to control rats. Treatment with MO provided the greatest improvement for all neural endpoints followed by KO and algal oils or ethyl esters containing a combination of EPA and DHA. Algal oil or ethyl ester of EPA alone was the least effective. The greatest improvement in vascular reactivity of epineurial arterioles to acetylcholine was realized following treatment with MO with less benefit from the other omega-3 PUFA sources.

Conclusion: These pre-clinical studies suggest that in a clinical trial for DPN the best outcome may be obtained by using FO as the source for omega-3 PUFA.

Disclosure

M.A.Yorek: Consultant; Novo Nordisk.

Funding

U.S. Department of Veterans Affairs (RX003826-01)
1050-P: Implementation of Professional Continuous Glucose Monitoring in VA Primary Care Clinics
Authors: SAREN KATHLEEN , RAULERSON APRIL L. , FINCH SYLVIA , LEEY JULIO A.
Published: June 2023

Background: Professional continuous glucose monitoring (proCGM) can be used sporadically for patients who do not meet criteria for Personal CGM. The interdisciplinary nature of primary care teams from Veterans Affairs Community Based Outpatient Clinics (CBOCs) represents a good opportunity for implementation of proCGM technology to improve glycemic control. Objectives: To assess treatment changes prompted by proCGM implementation.

Methods: Veterans with suboptimal glycemic control (A1c >7.5% or hypoglycemia) who did not qualify for a personal CGM had a proCGM placed during office visit. Two weeks later, the proCGM was downloaded during a follow-up visit and changes were implemented as needed.

Results: Thirty-eight sensors were placed in 36 patients (two patients repeat after sensor fell off) seen by clinical pharmacists from 5 CBOCs from North Florida/South Georgia VA Health System. Baseline A1c was 8.1% (SD 1.3), proCGM data was available in 91% of patients. Mean duration of sensors was 13 days (SD 3.3). In 36% of patients, there was insulin de-intensification, mainly because of hypoglycemic events. In 6% of patients, an oral agent was discontinued because their time in range was above 90% and side effect profile (weight gain). About 18% of veterans needed insulin intensification, either adding short acting insulin or increasing basal insulin. Overall, significant treatments changes were implemented in 60% of patients, thus, avoiding clinical inertia. High glucose variability (% coefficient of variation >33%) was present in 45% of veterans and two thirds of them required de-intensification of their insulin regimen due to hypoglycemia.

Conclusions: Implementation of proCGM in primary care clinics led to treatment changes in 60% of patients. This improvement project demonstrated feasibility of deploying new diabetes technologies in primary care setting.

Disclosure

K.Saren: None. A.L.Raulerson: None. S.Finch: None. J.A.Leey: None.

Funding

U.S. Department of Veterans Affairs Office of Rural Health
1056-P: Impact of Individualized HbA1c Target Setting on Diabetes-Distress, Self-Efficacy, Well-Being, and HbA1c
Authors: WESTALL SAMUEL J. , WATMOUGH SIMON , PRAKASH NARAYANAN RAM , IRVING GREG , FURLONG NIALL J. , LEWIS GEMMA A. , HARDY KEVIN J.
Published: June 2023

American Diabetes Association guidelines emphasize the importance of individualized HbA1c target setting in glycemic management, but little is known of the impact of target-setting on patient well-being. We randomized 50 adults (type 1 or 2) to receive HbA1c targets 5 mmol/mol (0.5%) above or below current value and evaluated impact on health-related quality of life: EQ-5D-5L, EQ-VAS, diabetes distress: Problem Areas in Diabetes, PAID, self-efficacy: Diabetes Empowerment Scale Long Form, DES-LF, well-being: Wellbeing Questionnaire-12, W-BQ12 and HbA1c (%) at baseline and 3 months; with thematic analysis of semi-structured interviews in a subset of 14 people. Tabulated results for 33 completers:

We hypothesized that individualized target-setting, especially stretch targets, might worsen diabetes distress and compromise wellbeing. Multiple validated questionnaires and thematic analysis of semi-structured interviews showed no evidence of any significant deterioration. Indeed, the process of explicit individualized target setting was associated with improvements in all wellbeing measures except EQ-5D-5L and there were significant improvements in diabetes distress and psychosocial efficacy in the relaxed target group. Our data suggest that the process of setting explicit individualized HbA1c targets is a positive one, regardless of whether the target is ‘relaxed’ or ‘stretch’.

Disclosure

S.J.Westall: None. S.Watmough: None. R.Narayanan: None. G.Irving: Research Support; Graphnet, Takeda Pharmaceutical Co., Ltd. N.J.Furlong: None. G.A.Lewis: None. K.J.Hardy: Other Relationship; Sanofi, Speaker's Bureau; Napp Pharmaceuticals Limited.
1057-P: Improvement in Hypoglycemia Rates with EndoTool IV
Authors: ALOI JOSEPH , PRICE CATHERINE E. , USOH CHINENYE O. , DUNN KELLI
Published: June 2023

Health systems are utilizing insulin dosing algorithms (IDA) within the EMR to adjust IV insulin (IVI). EndoTool IV (ETIV) is IDA software for blood glucose (BG) management which evaluates BG values to recommend IV insulin/dextrose doses to adjust the BG level within a target range. ETIV was integrated with our EMR as part of a quality project to reduce hypoglycemia in IVI patients. The tool was started in two of our ICUs that treat our DKA admissions. Dashboards capture BG values defined as hypoglycemia BG less than 70 mg/dL, severe hypoglycemia BG less than 40 mg/dL, and length of hospital stay for diabetic ketoacidosis (DKA LOS). Dosing modalities were available for hyperglycemia, HHS or DKA; 90% of ordering providers selected the hyperglycemia mode. We report results on the first 437 patient runs. The population was 60 % type 2 DM, 16 % type 1 and the remainder unknown. Average BG at IVI start was 221.5 mg/dL with an average time to goal of 4.7 hours. This translated to an average time on IVI of 15.5 hours for the group studied. Adoption of ETIV was associated with an approximate 5-fold reduction in hypoglycemic BG values, elimination of observed severe hypoglycemic BG values and a reduction in length of stay for DKA LOS. We conclude that ETIV is effective in reducing hypoglycemic events in persons treated with IVI and may reduce DKA LOS. Hospital systems considering a quality improvement project to reduce inpatient hypoglycemia for IVI should consider adopting an IDA.

Disclosure

J.Aloi: Research Support; Abbott Diabetes, Medtronic. C.E.Price: None. C.O.Usoh: None. K.Dunn: None.
106-OR: Degludec-Like Insulin Analog Improves Peripheral Neuropathy More than Control Insulin Independent of Glycemic Control in a Rat Model of Type 2 Diabetes
Authors: ÅKERSTRÖM THORBJÖRN C.A. , JUL ANDREASEN LAURA , NISHIMURA ERICA , YOREK MARK A.
Published: June 2023

Current treatments for type 2 diabetes fail to prevent the development of peripheral neuropathy. To examine insulin degludec’s effect on peripheral neuropathy in rats, we tested insulin 700, an analog identical to insulin degludec with the same pharmacokinetic (PK) and pharmacodynamic (PD) characteristics, but with the absence of the terminal threonine on the B-chain. Rats were fed a high fat diet for 8 weeks and then treated with a low dose of streptozotocin to induce hyperglycemia. After 2 weeks, diabetic rats were treated with I700 or a control basal insulin (IC) with similar PK twice daily for 18 weeks. A healthy reference group fed a chow diet and not subjected to streptozotocin treatment was also included. The endpoints evaluated included sensory and motor nerve conduction velocity, allodynia using von Frey’s test, thermal sensitivity using Hargreaves test and corneal sensitivity. We evaluated innervation of sensory nerves using corneal confocal microscopy and, in the skin, using histological methods. We also tested vascular reactivity of epineurial arterioles using pressure myography. The insulin analogues were equally effective at correcting hyperglycemia as determined by HbA1C levels of 4.1±0.1 and 4.1±0.1% for I700 and IC, respectively. Both insulin analogues improved all neuropathy related parameters. However, I700 was more effective in that by the end of the treatment period there was no difference in thermal sensitivity, corneal sensitivity, corneal nerve fiber length and sensory and motor nerve conduction velocity between the group treated with I700 and the healthy reference rats. Interestingly, vascular relaxation to acetylcholine improved more with IC treatment. In conclusion, this study demonstrates that I700 (a degludec-like insulin analog) is a more effective treatment for diabetic peripheral neuropathy than a comparable control insulin, independent of glycemic control.

Disclosure

T.C.A.Åkerström: Employee; Novo Nordisk. L.Andreasen: Employee; Novo Nordisk. E.Nishimura: Employee; Novo Nordisk A/S. M.A.Yorek: Consultant; Novo Nordisk.
1061-P: Food Recording and HbA1c Improvement —GluCare.Health Remote Monitoring Program Compared with Traditional Care in Patients with Obesity
Authors: DEMIRCAN BEGUM , CACCELLI MILENA , SAID YOUSEF , MUNIRATHINAM VISWANATHAN , PALSKY CAROLYN , ALMARZOOQI IHSAN , HASHEMI ALI
Published: June 2023

Introduction: Technology is intended to assist with diagnosing, treating, and monitoring patients remotely. All studies reported positive findings between technology and weight loss. Food record has been used to monitor patients with obesity, but its impact on outcomes is still little known (1). The GluCare Health care model is centered on the use of Continuous Metabolic Monitoring (CMM) and behavioral change to address metabolic diseases in a continuous manner. The app also allows for nutrition intervention through meal logging and feedback from dietitians to improve understanding of macronutrient quality and quantity. Overall, the GluCare CMM program aims to provide continuous patient supervision and support through personalized lifestyle coaching and behavioral change.

Material and Methods: Thirty participants were enrolled during 2022 at GluCare Health, Dubai (UAE). Participants were male and female aged 18 years or older with a starting body mass index (BMI) of >25kg/m². All the participants were on treatment using the GLP-1 analogue. Fifteen participants opted for the GluCare Health program and fifteen opted for traditional care.

Outcomes: BMI and HbA1c reduction in each group after 3 months follow-up and description of number of food logs per opt-in patient. Results : On opt-in GluCare program, BMI average reduction was 2.89 kg/m² and mean HbA1c reduction was statistically significant (p= 0.002) with mean difference of 17% of reduction meanwhile on the opt-out group, BMI average reduction was 1.21 kg/m² and the HbA1c reduction was not statistically significant (p= 0.117) with 3.4% of reduction. The average of food records per opt-in patient/monthly was 71.29.

Conclusion: Food monitoring and personalized dietary remote orientation by specialist healthcare providers are relevant tools to reduce HbA1c and manage obesity effectively.

Disclosure

B.Demircan: None. M.Caccelli: None. Y.Said: None. V.Munirathinam: None. C.Palsky: None. I.Almarzooqi: None. A.Hashemi: None.
1062-P: Impact of COVID-Related Clinic Disruption in Patients with Type 2 Diabetes
Authors: WILLIAMS VANESSA , THIEDE JILL , BOTCHWAY ALBERT , BUHNERKEMPE MICHAEL , JAKOBY MICHAEL G.
Published: June 2023

State of Illinois stay-at-home orders March 21-August 31, 2020 required a shift to telehealth appointments. Behaviors during COVID lockdowns adverse to glycemic management are documented, but studies of clinic disruptions on glycemic control are lacking. This is a retrospective study of adults (N = 171, age ≥ 18 y) with insulin-treated type 2 diabetes mellitus managed for at least one year prior to stay-at-home orders. Patients were seen at least once in the following intervals: Baseline 1 (March 21-August 31, 2019, 1-y before lockdown), Baseline 2 (September 1-November 30, 2019, 1-y before end of lockdown), Study 1 (March 21-August 31, 2020, lockdown), and Study 2 (September 1-November 30, 2020, immediately after lockdown). Primary endpoint was glycemic control measured by HbA1c. Nearly all appointments (97.6%) during Baseline 1, Baseline 2, and Study 2 were in-person, and appointments during Study 1 were both in-person (67.8%) and telehealth (32.2%) [P < 0.0001 for comparison of Baseline 1, Baseline 2, and Study 2 to Study 1]. HbA1c improved from Baseline 1 (8.9 ± 1.7%) to Baseline 2 (8.5 ± 1.8%) to Study 1 (8.3 ± 1.6%), with P = 0.004 for the trend. HbA1c increased to 8.6 ± 1.9% during Study 2 (P = 0.07 compared to Study 1). Study 1 in-person and telehealth appointment subgroups had equivalent increases in HbA1c from Study 1 to Study 2. There was no difference in insulin dose adjustments or use of non-insulin therapeutics between the Study 1 subgroups. Other clinical parameters were similar between subgroups; however, systolic blood pressure (SBP) during Study 2 was significantly lower for patients seen in-office during Study 1 compared to Study 1 telehealth patients (128.9 ± 17.7 mm Hg vs. 137.0 ± 18.1 mm Hg, P = 0.008). There was no significant effect of telehealth appointments during pandemic lockdown on glycemic control compared to patients seen in-office, though patients seen in-office had significantly better control of SBP than telehealth patients.

Disclosure

V.Williams: None. J.Thiede: None. A.Botchway: None. M.Buhnerkempe: None. M.G.Jakoby: None.
1069-P: Digital Platform Users Managing Three Chronic Conditions—Diabetes, Hypertension, and Overweight—Experience Better Outcomes than Those Who Manage One Condition, after Six Months
Authors: HERSHCOVITZ YIFAT , BUDMAN SOFIA , YANIV NOGA , MANEJWALA OMAR
Published: June 2023

The coexistence of diabetes, hypertension, and overweight increases the risk for macrovascular and microvascular complications. This study followed users who managed multiple chronic conditions measures, blood glucose (BG), blood pressure (BP) and weight with a single integrated digital platform. The objective was to investigate BG levels and engagement to blood glucose monitoring system (BGMS) in users managing BG, BP and weight on a single platform compared to users managing only BG on the same platform. A retrospective data analysis was performed on users who were active during 2019-2022 and measured BG using Dario platform at least six months. The test group included users who measured BP and weight within 6 months from their first BG measurement; a matched control group was generated of users who measured BG only. BG levels were assessed by average BG (BG avg) and BGMS engagement was assessed by counting BG measurements per month. High-risk users were defined as those who started BG avg>180mg/dL in Month 1. The test group of 2,154 users showed significantly greater (1.7-fold) BGMS engagement than the control group of 14,954 users in Month 1 and Month 6 (p<0.01) (N=17,108). A test subgroup of 343 high-risk users who measured 3 conditions demonstrated significantly greater reduction versus matched control subgroup of 1,579 high-risk users measured BG only, after 6 months (17% vs.11%) (p<0.01). Moreover, the ratio of population that reduced their BG avg to lower than 180 mg/dL after 6 months (equivalent to A1C 8.0; HEDIS measure) was significantly higher in the test subgroup versus control subgroup in high-risk (by 30%; p<0.01). Monitoring several conditions may have the potential to offer a greater means for person with diabetes effectively manage glycemia. This study can illuminate the relative contribution of multi chronic conditions management driving behavioral change to successful diabetes outcomes.

Disclosure

Y.Hershcovitz: Employee; DarioHealth Corp. S.Budman: Employee; DarioHealth Corp. N.Yaniv: Employee; DarioHealth Corp. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.
107-LB: Clinical Performance of Extended Mio 30 Infusion Set
Authors: COHEN OHAD , COHEN YAEL , CHATTARAJ SARNATH , ZHANG GINA , ANSELMO EVAN , TIROSH AMIR
Published: June 2023

Objective: Medtronic Mio™ 30 infusion set (M30IS) is a single use IS for pump users with pre-loaded inserter, a 30° insertion angle, and labeled for 3-day use. The M30IS wear duration is impacted by initial local trauma caused by insertion and sustained inflammation by cannula & insulin infusion (insulin aggregates & other impurities in the infusate), with the latter being predominant. An extended Mio™ 30 infusion set (EM30IS) was developed by improving insulin formulation stability in the fluid path. This study reports on the performance of the EM30IS in persons with T1D during an early feasibility trial (ClinicalTrials.gov: NCT05544643).

Method: This is a X over study of EM30IS and M30IS on 21 subjects with type 1 diabetes. Each subject wore both sets 4-5 times each on a preferred site that was continuously infused with insulin lispro or aspart subcutaneously via a Medtronic 780G pump for 3 days (M30IS), 7 days (EM30IS) or until failure. Endpoints of safety and effectiveness (failure rate due to unexplained hyperglycemia <16%) were evaluated. Exploratory analyses related to performance and glycemic control were also evaluated.

Results: The EM30IS survival rate at 6 days (70%) was comparable to M30IS survival rate at 3 days (63%). Glycemic control outcomes were equivalent (see Table 1) and there were no episodes of EM30IS-related severe hypoglycemia or DKA.

Conclusion: The EM30IS was safe and its performance at 6 days was equivalent to the performance of M30IS at 3 days.

Disclosure

O. Cohen: Employee; Medtronic. Y. Cohen: None. S. Chattaraj: Employee; Medtronic. G. Zhang: Employee; Medtronic. E. Anselmo: Employee; Medtronic. A. Tirosh: Advisory Panel; Medtronic. Research Support; Medtronic. Speaker's Bureau; Medtronic. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Research Support; Sanofi. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company.

Funding

Medtronic
1072-P: Incidence of Inpatient Hypoglycemia by Specialty Area—A Case for Targeted Inpatient CGM
Authors: LEWIS GEMMA A. , CARDWELL JANET , BUJAWANSA SUMUDU , HARDY KEVIN J.
Published: June 2023

Inpatient hypoglycemia is traumatic for people with diabetes and increases length of stay, hospital costs and subsequent mortality (at least in the elderly). We report inpatient hypoglycemia by specialty ward in an 800-bed, acute hospital serving a largely deprived population (350,000) with diabetes prevalence 8%. Over 1 year, 21,089 inpatients with diabetes had 176,603 point of care (POC) tests (median 8.4, ward range 1.1-29.2, POC tests/person/stay); and 9.2 (ward range 2.1-24.7)% of subjects experienced hypoglycemia (CBG <72 mg/dl). Patients who experienced hypoglycemia had 2.6 (range 1.2-5.8) episodes of hypoglycemia either from early persistence (failure of protocol-driven hypoglycemia treatment) or late recurrence. There was a strong correlation between POC testing frequency and detection of hypoglycemia (Chi-square, Yates’ correction = 8.4374, p=0.004). Compared with the whole hospital (index 1.0), specialty wards hypo index ranged 10-fold from 0.2 to 5.1.

A recent RCT demonstrated CGM superiority over POC testing in preventing recurrent inpatient hypoglycemia. Consistent with this RCT, our data suggest that increased POC testing is associated with increased hypoglycemia detection and our approach might guide initial targeting of CGM to highest risk specialty wards for hospitals unable to deploy CGM simultaneously in every inpatient specialty ward area.

Disclosure

G.A.Lewis: None. J.Cardwell: None. S.Bujawansa: Stock/Shareholder; Merck & Co., Inc., GlaxoSmithKline plc. K.J.Hardy: Other Relationship; Sanofi, Speaker's Bureau; Napp Pharmaceuticals Limited.
1078-P: Codesigning Diversity, Equity, and Inclusion Communication Tools for Diabetes Management
Authors: CHAO EDWARD C. , RATAJ HEIDI , PAI DEYSHNA J. , NAGRA HARPREET
Published: June 2023

Only 29% of African-Americans and 39% of Latinx persons living with type 1 diabetes mellitus (T1DM) use insulin pumps, compared with 61% of white individuals. Social determinants of health contribute to suboptimal access to and use of DM devices. We applied a design thinking process to better understand these barriers, and created a publication that both persons living with DM (PWD) and health care professionals (HCP) could use to provide information and spark a dialogue on DM devices and management.

The Double Diamond Process is a human-centered design framework that discovers, then defines a problem, to develop and deliver a prototype. After diversity, equity, and inclusion training with a consultancy, we interviewed 6 PWD, and 4 HCP (1 dietitian, 1 psychologist, and 2 physicians). We identified 3 key challenges: PWD feel that their contexts, experiences, and needs are often not well-represented or addressed by DM information resources; HCP may not discuss devices; and PWD may not feel fully seen or heard during clinic visits.

User testing helped refine a low-fidelity prototype for an online and print publication, Humans of Diabetes (HOD), with two checklists. The first guides the PWD and HCP through key topics to discuss during clinic visits. The second invites the PWD to reflect on the interaction with the HCP. Both checklists increase PWD's and HCP's awareness of implicit bias and suggest talking points. Compiled with help from advocates of color in the DM communities, HOD features images and stories of people of color living well with DM; as well as resources on DM, devices, medications, and community support. PWD can easily tear off and keep the print version's checklists. HOD could be distributed widely in primary care and DM clinics.

HOD grew out of the design thinking process. This patient-centered collaboration with individuals from diverse perspectives could better start and enhance important conversations, to further optimize access and engagement with devices and care.

Disclosure

E.C.Chao: None. H.Rataj: None. D.J.Pai: None. H.Nagra: Employee; One Drop.
1088-P: Glycemic Control Trajectories among Individuals with Gestational Diabetes Are Associated with Risk of Childhood Obesity in the Offspring
Authors: CHEHAB RANA F. , FERRARA ASSIAMIRA , GREENBERG MARA , LEE CATHERINE , NGO AMANDA , ZHU YEYI
Published: June 2023

Gestational diabetes (GDM) increases offspring risk of childhood obesity, but the role of glycemic control (GC) is unclear. We examined the association of GC trajectories, which profile longitudinal GC patterns from GDM diagnosis to delivery, with childhood obesity risk. Among 26774 individuals (78% from minority groups) enrolled in Kaiser Permanente Northern California (KPNC)'s GDM care program (2007-2017), we derived four GC trajectories: stably optimal, rapidly improving to optimal, slowly improving to near optimal and slowly improving to suboptimal. Offspring weight and height were collected at well-child visits until 2022. We calculated adjusted relative risk (aRR) and 95% CI of childhood obesity (i.e., sex-specific BMI-for-age ≥95th percentile using CDC growth charts) in association with GC trajectories using modified Poisson regression models adjusted for sociodemographic factors, parity, pre-pregnancy BMI, smoking and alcohol use, birthweight, preterm birth and breastfeeding. Obesity prevalence was 21.9% at 2-5 years, 28.6% at 6-11 years and 30.2% at 12-16 years. Compared to offspring of individuals in stably optimal trajectory who achieved GC shortly after GDM diagnosis, their counterparts in rapidly improving to optimal, slowly improving to near optimal and slowly improving to suboptimal trajectories had an increasing gradient of obesity risk at 2-5 years (aRR [95% CI]: 1.04 [0.98, 1.10], 1.06 [0.99, 1.14] and 1.16 [1.07, 1.25], respectively) and 6-11 years (1.08 [1.02, 1.15], 1.07 [0.99, 1.15] and 1.15 [1.07, 1.24], respectively); both P-for-trend<0.001. A similar yet weaker pattern was observed at 12-16 years (0.98 [0.88, 1.10], 1.03 [0.90, 1.18] and 1.13 [0.97, 1.30], respectively; P-for-trend=0.11). These associations were stronger in girls than boys (all P-for-interaction<0.05). Early GC achievement after GDM diagnosis and throughout pregnancy may be associated with lower offspring obesity risk in childhood.

Disclosure

R.F.Chehab: None. A.Ferrara: None. M.Greenberg: None. C.Lee: None. A.Ngo: None. Y.Zhu: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924); The Permanente Medical Group
1089-P: Gestational Glucose Intolerance and Risk of Childhood Overweight and Obesity
Authors: MAYA JACQUELINE , HSU SARAH , SCHULTE CAROLIN C.M. , JAMES KAITLYN , THAWEETHAI TANAYOTT , HIVERT MARIE-FRANCE , POWE CAMILLE E.
Published: June 2023

Infants of individuals with gestational glucose intolerance (GGI, abnormal glucose loading test [GLT] without gestational diabetes [GDM]) have increased risk of large for gestational age birthweight, but an association between GGI and childhood adiposity has not been consistently observed.

We studied the risk of overweight and obesity in 2-5-year-old children exposed to varying degrees of maternal glycemia in utero in a retrospective hospital-based cohort. We defined normal glucose tolerance (NGT) as a GLT <140 mg/dl, GGI as GLT ≥ 140 mg/dl and zero (GGI-0) or 1 (GGI-1) abnormal values on a 3-hour 100-gram oral glucose tolerance test (OGTT), and gestational diabetes (GDM) as ≥2 abnormal values. We used logistic regression to investigate the risk of obesity, defined as body mass index (BMI) > 95th percentile, in children born to individuals with GGI and GDM as compared to NGT. In model 1, we adjusted for maternal age, gestational weight gain, parity, insurance, race/ethnicity, marital status, gestational age at delivery and infant sex; in model 2, we further adjusted for maternal 1st trimester BMI.

Of n=12728 children, 48.5% were female, the mean (SD) gestational age at delivery was 39.4 (1.7) weeks, and the mean birthweight was 3341 (519) grams. A total of 10567 children were exposed to NGT in utero, 1156 to GGI-0, 428 to GGI-1, and 577 to GDM. Obesity was present in 12.9% of children exposed to NGT, 12.5% exposed to GGI-0, 16.6% exposed to GGI-1, and 18.5% exposed to GDM, respectively. In model 1, there was an increased odds of obesity in those exposed to GGI-1 (1.37 [1.04, 1.78], P=0.02) and GDM (1.61 [1.28, 2.02] P<0.001). After maternal BMI adjustment, we did not find a significant increased risk of obesity in any group compared to NGT (GGI-1: 1.15 [0.86, 1.51] P=0.33; GDM 1.24 (0.97, 1.57), P=0.08).

After accounting for maternal BMI, children exposed to GGI and GDM in utero have a similar risk of obesity in early childhood to those born to NGT pregnancies.

Disclosure

J.Maya: None. S.Hsu: None. C.C.M.Schulte: None. K.James: None. T.Thaweethai: None. M.Hivert: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health.

Funding

National Institutes of Health (T32DK007028-47S1)
109-LB: Quality of Life Benefits for Insulin-Using Adults with Type 2 Diabetes after Six Months of Pump Therapy—A Quasi-experimental Approach
Authors: POLONSKY WILLIAM H. , SORIANO EMILY C.
Published: June 2023

While an increasing number of adults with type 2 diabetes (T2D) on multiple daily insulin injections (MDI) are initiating insulin pump therapy, little is known about how, or if, pump therapy may contribute to quality of life (QoL) gains.

Adults with T2D on MDI who contacted Insulet about starting a tubeless insulin pump (Omnipod DASH® Insulin Management System) completed two self-report surveys: one before pump start (baseline) and one 6 months later. The surveys assessed self-reported HbA1c, and a series of QoL measures, including overall well-being (WHO-5), diabetes distress (T2-DDAS Core), diabetes impact (DIDP), and perceived restrictions due to T2D. We compared 6-month outcomes in participants who started and remained on Omnipod DASH vs. those who never started on pump therapy and remained on MDI.

Of N=435 who completed the baseline survey, 220 (51%) completed the 6-month survey. Of these, the majority (80%) were current pump users, and 20% remained on MDI. There were no significant differences between pump users and continuing MDI (c-MDI) users in any baseline demographics, HbA1C or QoL measures. At 6 months, pump users evidenced a significantly greater rise than c-MDI users in overall well-being (+8.3 vs. -3.1) and greater drops in diabetes distress (-0.97 vs. -0.30), diabetes impact (-0.29 vs. +0.20), and perceived restrictions, including feeling less limited regarding food and exercise and feeling freer to live life as they might want (in all cases, p < 0.005). Also, both pump and c-MDI groups reported a significant HbA1C improvement from baseline, though the difference between groups was not significant (-1.1% vs -0.9%; p=0.10).

In this sample of T2D adults, the introduction of pump therapy was associated with broad improvement in QoL after 6 months, compared to those who were interested in, but never started pump therapy. These results provide initial evidence of significant psychosocial benefits of pump therapy for adults with T2D.

Disclosure

W. H. Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., MannKind Corporation, Provention Bio, Inc., Sanofi-Aventis U. S., Vertex Pharmaceuticals Incorporated. E. C. Soriano: None.

Funding

Insulet Corporation
1090-P: Association between Organ Fat and Type 2 Diabetes Risk Factors among High-Risk Latino Youth
Authors: OWOLABI EYITAYO O. , OLSON MICAH , HU HOUCHUN H. , PENA ARMANDO , PITUCH KEENAN A. , BAILEY SMITA , KNOWLER WILLIAM C. , SHAIBI GABRIEL Q.
Published: June 2023

Obesity is a well-established risk factor for type 2 diabetes (T2D) in youth. However, the contribution that organ fat plays to the pathophysiology of T2D among high-risk youth is sparsely documented. The purpose of this study was to determine the independent associations between hepatic and pancreatic fat fractions with insulin sensitivity and beta-cell function among Latino youth with obesity and prediabetes. This cross-sectional analysis involved 117 Latino adolescent boys (n=70) and girls (n=47), mean (±SD) age:14±1 years, fasting glucose: 102±8mg/dL, 2-hour glucose: 144±30mg/dL, and with obesity (BMI percentile: 98.52±1.13). Total body composition was assessed by DEXA, while hepatic and pancreatic fat contents were assessed using quantitative fat fraction magnetic resonance imaging at 3 Tesla. T2D risk factors included insulin sensitivity (Matsuda index) and beta-cell function (product of insulin sensitivity and insulinogenic index), estimated from a multi-sample 2-hour oral glucose tolerance test. Associations between organ fat and T2D risk factors were examined using Pearson correlation and multiple linear regression, adjusting for age, sex, and total body fat percentage (BF%). Insulin sensitivity significantly correlated with only BF% (r =-0.236, p=0.015), fat mass (r=-0.227, p=0.020), and hepatic fat fraction (r=-0.255, p=0.024), whereas beta-cell function significantly correlated with only BF% (r=-0.241, p=0.013). In multiple regression models, hepatic fat fraction (B= -0.045, p=0.041, Δr2=.034) but not pancreatic fat fraction (B= 0.058, p=0.179, Δr2= .015) was independently associated with insulin sensitivity, whereas neither measure of organ fat was associated with beta-cell function (each Δr2 <.01, each p>.38). Hepatic fat content was an independent predictor of insulin sensitivity among Latino youth with prediabetes. Further studies are needed to understand how adiposity contributes to beta-cell dysfunction among high-risk youth.

Disclosure

E.O.Owolabi: None. M.Olson: Advisory Panel; Rhythm Pharmaceuticals, Inc. H.H.Hu: None. A.Pena: None. K.A.Pituch: None. S.Bailey: None. W.C.Knowler: None. G.Q.Shaibi: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK107579, F31DK125037)
1092-P: sRAGE—A Biomarker of Kidney Disease in Youth-Onset Type 2 Diabetes (T2D)
Authors: BACHA FIDA , URBINA ELAINE M. , GIDDING SAMUEL , MONNIER VINCENT M. , EL GHORMLI LAURE , DREWS KIMBERLY , BRAFFETT BARBARA H.
Published: June 2023

The circulating soluble receptor for advanced glycation end products (sRAGE) has been proposed as a biomarker of diabetes complications in adults. In the TODAY study of youth with T2D, we measured sRAGE 3 times at: randomization (T1), glycemic failure (HbA1c≥8%) on randomized treatment or midpoint in study (T2), and end of follow-up (T3). Of TODAY subjects, 165 lost glycemic control with HbA1c ≥ 8% (G1) and 135 maintained HbA1c < 8% (G2)]. Controls [n=99, HbA1 5% (4.9, 5.2), with similar obesity, sex (60% female), race-ethnicity, median age 24 (21, 27) years as the TODAY cohort at T3] had sRAGE measured once. Multivariable models examined the relationship of sRAGE with nephropathy [urine albumin: creatinine (UACR) ≥30 mg/g, hyperfiltration (eGFR ≥135 ml/min/1.73m2)] and vascular measures [pulse wave velocity (PWV), augmentation index (AI)], adjusting for treatment, diabetes duration, HbA1c, BMI, age, sex, and race-ethnicity. At T1, the T2D youth groups had similar age (13.9 yrs), diabetes duration (0.7 yrs), and sex (60% female). sRAGE concentrations were lower in T2D vs. controls (752.8±308.3 vs. 954.4 ± 356.7 pg/ml, p<0.0001) at T3. By T3 (mean duration 7 yrs), sRAGE levels decreased compared with T1 and T2 in G1 vs. G2 (p<0.05). sRAGE concentrations were 711.9±294.1 vs. 802.7±318.9 pg/ml, p=0.0032 in G1 vs. G2 at T3, with no significant difference by treatment. HbA1c was inversely related with sRAGE. Higher sRAGE concentrations were associated with a lower risk of hyperfiltration (HR=0.93, 95% CI 0.86-0.99, p=0.03) and inversely related to eGFR (p<0.001); no relationships were observed with UACR, PWV, or AI. sRAGE levels decline overtime in youth with T2D, are inversely related to glycemia, and may serve as a biomarker of kidney function.

Disclosure

F.Bacha: Other Relationship; Takeda Pharmaceutical Co., Ltd., AstraZeneca. E.M.Urbina: Advisory Panel; Astellas Pharma Inc., Other Relationship; Targus Medical, Inc. S.Gidding: Consultant; ESPERION Therapeutics, Inc. V.M.Monnier: None. L.El ghormli: None. K.Drews: None. B.H.Braffett: None.

Funding

National Institutes of Health (5U01DK061230-16)