bluuebunny/crossref_metadata_2025 huggingface dataset:
SAT079 A Novel Variant In The Carboxyl Ester Lipase (CEL) Gene Causing MODY
Authors: Medavarapu chalapathi Rao , McNutt Markey
Published: October 2023

Disclosure: C.R. Medavarapu: None. M. McNutt: None.

Introduction: Maturity-onset diabetes of the young (MODY) is a group of autosomal dominantly inherited disorders of non-autoimmune diabetes mellitus. Here, we report a patient initially diagnosed with type 2 DM and later found to have carboxyl ester lipase (CEL)-MODY. Case: A 51 year-old female was diagnosed with DM at the age of 44 and initially categorized as having type 2 DM based on normal GAD-65 antibodies. The patient’s DM was well controlled on semaglutide. The patient, however, reported chronic diarrhea/steatorrhea and intermittent dull abdominal pain which was not associated with semaglutide. The patient continued to have GI symptoms despite stopping the semaglutide. Abdominal imaging was unremarkable with a normal-appearing pancreas. Interestingly, the patient's daughter had similar gastric inflammatory symptoms and multiple members of the family have early-onset DM. Due to this symptom complex and similar presentation in the family, an inflammatory pathologic syndrome was suspected. A monogenetic auto-inflammatory syndrome was also considered in differential and the whole exome was analyzed. Genetic testing identified a novel, likely pathogenic heterozygous variant in CEL(NM_001807.5): c.1875del. Pathogenic variants in CEL are associated with MODY, type VIII. Discussion: Single-base deletions in the CEL gene can cause exocrine and endocrine pancreatic dysfunction. Our patient presented with a novel c.1875del variant in CEL that has not been reported in the literature as causative of disease nor as a variant in the general population. This variant lies in the variable number of tandem repeats (VNTR)-containing exon 11 of CEL. Two other single nucleotide deletions in this exon were described in the original report of CEL-MODY. The c.1875del variant results in the deletion of one nucleotide at position c.1875 of the CEL gene, causing a frameshift in the protein reading frame. Loss of normal protein function either through protein truncation or nonsense-mediated mRNA decay is expected. The c.1875del CEL variant is classified as likely pathogenic, and it correlated with our patient's clinical and biochemical findings. Typically, patients with CEL-MODY develop pancreatic exocrine dysfunction in early childhood and later develop DM in their 40s. A genetic diagnosis helps in determining the choice of treatment, managing associated complications, and the need for further genetic counseling for the family. Insulin is the most appropriate treatment in CEL-MODY; however, other anti-DM drugs can also be used as seen in our patient. The risk of DM complications from CEL-MODY is unknown but patients can develop pancreatic cysts and clinicians should watch for these complications. Our case highlights the need for high suspicion for possible CEL-MODY and considering genetic testing in the setting of coexistent endocrine and exocrine pancreatic insufficiency.

Presentation: Saturday, June 17, 2023
SAT081 Maturity Onset Diabetes Of The Young (MODY) Due To A New BLK Gene Mutation
Authors: Taha Doris , Thirunagari Rajeev , Adhikari Amita
Published: October 2023

Disclosure: D. Taha: None. R. Thirunagari: None. A. Adhikari: None.

Background: The BLK gene is a tyrosine protein kinase involved in cell proliferation and differentiation. It has been identified as a modulator of beta cell function and plays a role in the regulation of insulin synthesis and secretion. We describe the case of a patient presenting with prediabetes associated with a heterozygous c.1366 C>T of the BLK gene. Case Report: We report a 10 year old Asian female who presented with a hemoglobin A1c (HbA1c) level of 6.1% (4.0-5.7), within prediabetes range. Her weight was 44 kg (Z score 1.34), height 148.2 cm (Z score 1.52) and BMI was 20 kg/m2 (85th percentile; Z score 1.06). She had no acanthosis nigricans by exam and she was at early Tanner stage 2 of puberty. Initial evaluation revealed normal C-Peptide level of 2.1 ng/mL (0.9-6.9), normal insulin level of 21.1 mcUnits/mL (3 - 25). She had normal complete blood count and comprehensive metabolic profile, and normal thyroid function tests. Glutamic acid decarboxylase (GAD65) antibodies and islet cell antibodies were negative. She had an oral glucose tolerance test which revealed a fasting glucose level of 101 mg/dL and a 2-hour glucose level of 158 mg/dL. Lipid profile was normal. She was advised regarding healthy lifestyle changes and her HbA1c level was stable. She was lost to follow-up until 16 years of age when she presented with irregular menstrual cycles and was diagnosed with polycystic ovary syndrome. Her HbA1c was elevated at 6.3% with a normal insulin level. Cortisol and thyroid function tests were normal. Pancreatic antibodies including GAD65, IA-2, insulin antibodies, islet cell antibodies, and zinc transporter 8 antibodies, were negative. C-peptide level was normal at 4.3 ng/mL (1.1-4.4). Family history was significant for patient’s father and paternal grandmother having diabetes and taking Metformin. Patient’s father was diagnosed with diabetes at 13 years of age. Maturity onset diabetes of the young (MODY) panel/ sequencing and deletion/duplication analysis was performed at GeneDx and revealed that she is heterozygous for a c.1366 C>T; p.Arg456Cys (R456C) variant in exon 13 of the BLK gene. This variant has not been previously published as a pathogenic or benign variant to our knowledge. No additional variants were identified in any of the MODY genes on this panel (ABCC 8, APPL1, CEL, GCK, GLUD1, HADH, HNF1A, HNF 1B, HNF4A, INS, KCNJ11, KLF11, NEUROD1, PAX4, PDX1). Conclusion: Variants of the BLK gene have been reported in association with autosomal dominant MODY, type 11. We report a pediatric patient presenting with MODY prediabetes associated with a heterozygous c.1366 C>T; p.R456C variant in the BLK gene. To our knowledge, this variant has not been previously reported in MODY patients. We propose that this is a pathogenic variant and review this rare MODY form.

Presentation: Saturday, June 17, 2023
SAT087 Maternally Inherited Diabetes And Deafness: Support For SGLT2 Inhibitor Use
Authors: Pandya Stuti , Selk Karen
Published: October 2023

Disclosure: S. Pandya: None. K. Selk: None.

Introduction:  Maternally inherited diabetes and deafness (MIDD) is a rare genetic disease resulting from  a mitochondrial mutation. There is a wide phenotypic expression secondary to heteroplasmy. The clinical manifestations of MIDD are hyperglycemia, sensorineural hearing loss, maculopathy, cardiac conduction defects, myopathy/poor exercise tolerance, and neuropathy. Diabetes mellitus generally occurs during the third decade of life, and there tends to be rapid progression to insulin therapy with  reported earlier onset of microvascular complications.  Here we present a case of MIDD successfully treated long-term with empagliflozin and linagliptin.    Clinical Case: A 36-year-old male with sensorineural hearing loss presented with a 20-pound unintentional weight loss, polyphagia, and polydipsia. His blood glucose level was 300 mg/dL and HbA1c was 14.3%. His mother carried a diagnosis of type 2 diabetes mellitus and his grandmother had latent autoimmune diabetes of adulthood. Prior to presenting to endocrinology, he had been started on metformin, glipizide, and linagliptin with ongoing poor glycemic control. Given his presentation, family history, and lean habitus with BMI of 20, he was assessed for possible autoimmune diabetes. Testing for glutamic acid decarboxylase 65-kilodalton isoform antibody (GAD65), islet cell antibody, tyrosine phosphatase-related islet antigen 2 (IA2), and zinc transporter 8 antibody (ZNT8) was unrevealing. A C-peptide level was detectable but <1 ng/mL. His sulfonylurea was discontinued, and he was started on basal insulin with a dramatic improvement in his glycemic control. He was later able to discontinue insulin therapy. However, given poor exercise tolerance and his known hearing loss, he was seen by genetics where he underwent testing and was found to have a m.3243 A>G mutation in MT-TL1 gene  making the diagnosis of MIDD. Metformin was discontinued due to a possible risk of lactic acidosis and sitagliptin was initiated. Due to hyperglycemia,  empagliflozin was added and he was later transitioned to empagliflozin-linagliptin to reduce his pill burden. He has continued to have a1c levels of 6.5% or less for the last 3 years and periodic C-peptide measurements have been >1 ng/mL.   Conclusion: Given MIDD is a rare form of monogenic diabetes, treatment tends to be individualized with many transitioning to insulin early in their disease course. Given the reported increased risk for microvascular complications, sodium-glucose cotransporter-2 (SGLT2) inhibitors are an attractive therapeutic agent. However, there is little literature on the use of these agents  in MIDD and there is concern about the risk for diabetic ketoacidosis given insulin use is required by many afflicted individuals. This case highlights the safety of long-term empagliflozin in a patient with MIDD.

Presentation: Saturday, June 17, 2023
SAT091 Genetic Investigation Of The Susceptibility To Develop Type 1 Diabetes And Diabetic Nephropathy
Authors: Brema Imad , Aljuryyan Abdullah , Bradley Benjamin , Osman Awad E
Published: October 2023

Disclosure: I. Brema: None. A. Aljuryyan: None. B. Bradley: None. A.E. Osman: None.

Diabetic Nephropathy (DN) is one of the leading causes of end-stage renal disease (ESRD) worldwide and is a major cause of morbidity and mortality in subjects with type 1 diabetes (T1DM). Several single nucleotide polymorphisms (SNP) have been found in various gene variants such as the ACE, NOS 3, and FRMD 3 genes that play a major role in genetic susceptibility to DN, however, there is lack of wide replication of these studies, particularly in non-Caucasian ethnic groups. Therefore, the aim of this study was to identify SNPs that increase the susceptibility to develop T1DM as well as microalbuminuria (the hallmark of DN) in a Saudi cohort of subjects with T1DM. We conducted a case-control study in 179 subjects with T1DM and 180 healthy normal controls comparing genotype frequency of 11 SNPs that have been shown to increase the susceptibility to develop DN in subjects with T1DM, namely, rs1799983, rs2070744 (NOS3 gene); rs560807, rs 1059982 (CAT gene), rs1888747, rs10868025, rs361525, rs1800629 (FRMD3 gene), rs182052, rs 17300539 (ADIPOQ gene) and rs1799752(ACE gene). We report that the A/G rs361525 (FRMD3) genotype has significantly higher frequency in controls compared to subjects with T1DM (9 % vs 0), p value 0.01) and it seems to be protective against the risk of T1DM development. Moreover, the A/A rs17300539 (ADIPOQ gene) genotype has significant higher frequency in controls compared to subjects with T1DM (7 % vs 0.5), p value 0.02) and seems to be protective against type 1 development as well. We did not detect any further associations between the remaining 9 genotype SNPs and the risk of T1DM. On the other hand, we report no association between all the 11 studied SNPs referenced above and the risk of developing diabetic nephropathy. We have studied several DN susceptibility SNPs that have been shown to increase the risk of albuminuria and ESRD development in Caucasians with T1DM , however, we were unable to replicate previous findings in this Saudi cohort of patients with T1DM. Future larger multicenter studies are needed in larger numbers of patients to replicate the findings of the studies that were done in Caucasians and other ethnic groups, ideally Genome-wide association studies.

Presentation: Saturday, June 17, 2023
SAT094 Closed-Loop Insulin Delivery Versus Standard Care In Type 1 Diabetic Adult Patients: A Meta-analysis Of Randomized Controlled Trials
Authors: Godoi Amanda , Marques Isabela R , Mahesh Ashwin , Oommen Christi , MH Padrao Eduardo , CS Moreira Vittoria , Silva Ariadne C , Hespanhol Larissa C , Silva Caroliny H , AF Souza Isabela , Gomes Cintia , Miyawaki Isabele A , Loyola Júnior José E R , De Sa Joao Roberto
Published: October 2023

Disclosure: A. Godoi: None. I.R. Marques: None. A. Mahesh: None. C. Oommen: None. E.M. Padrao: None. V.C. Moreira: None. A.C. Silva: None. L.C. Hespanhol: None. C.H. Silva: None. I.A. Souza: None. C. Gomes: None. I.A. Miyawaki: None. J.E. Loyola Júnior: None. J. De Sa: None.

Background: Optimal glycemic control of Type 1 Diabetes Mellitus (T1DM) remains a clinical challenge instigated by hypoglycemic episodes and the burden of insulin self-management. Remarkable advancements have been made with the development of automated insulin devices, particularly closed-loop systems (CL). Yet, previous meta-analyses have not focused on the long-term use and effects of CL systems, and their potential to improve glycemic outcomes in this population remain controversial. Purpose: To compare the therapeutic efficacy of long-term use of CL insulin delivery systems to standard care (SC) in adult patients with T1DM. Methods: PubMed, Cochrane and EMBASE were systematically searched in October 2022 to include randomized controlled studies (RCTs) comparing CL systems (automated pancreas, hybrid CL and advanced hybrid CL) versus SC (daily insulin injections, sensor augmented pump and continuous glucose monitoring) with at least 12 weeks of duration. Outcomes assessed were percentage time in range (% TIR) 70-180mg/dL and change in HbA1c. Statistical analysis was performed with RevMan 5.4.1 and R software. Heterogeneity was assessed with I² statistics. The protocol was registered in PROSPERO (ID: CRD42022366710). Results: A total of 13 randomized studies with 1082 patients with T1DM were included, of whom 586 (54.2%) used automated devices and 496 (45.8%) continued their usual care. The %TIR was higher in the CL systems when compared to SC (MD 11.91%; 95% CI 8.66 to 15.17; p < 0.001; I² = 81%). The HbA1c significantly higher in the CL systems when compared to SC (MD -0.42; 95% CI -0.70 to -0.14; p = 0.003; I² = 78%). The %TIR was significantly higher in patients using CL (MD 9.25; 95% CI 6.79–11.72; p < 0.0001; I² = 34%), hybrid CL (MD 8.20; 95% CI 3.32–13.09; p=0.001; I² = 66%) and advanced hybrid CL (MD 25.38; 95% CI 21.30–29.46; p < 0.0001; I² = 0%). A greater decrease in HbA1c was also found with the use of CL (MD -0.24; 95% CI -0.47 to -0.010.14; p = 0.04; I² = 0%), hybrid CL (MD -0.26; 95% CI -0.43 to -0.10; p=0.002; I² = 3%) and advanced hybrid CL (MD -0.90; 95% CI -1.86 to -0.06; p = 0.07; I² = 83%). Conclusion: In this meta-analysis of randomized trials, the use of CL insulin delivery systems was associated with a higher proportion of time in the optimal glucose range and greater decrease of HbA1c relative to standard care in the adult diabetic population.

Presentation: Saturday, June 17, 2023
SAT095 Utilizing Continuous Glucose Monitoring Post Open Heart Surgery
Authors: Chen Yi-Ju , Cuevas Velazquez Adan , Abdul Wahab Mhd Majed , Aljassani Khaldoon , Rajak Kripa , Halder Anupam , Atrash Anas , Renu Joshi
Published: October 2023

Disclosure: Y. Chen: None. A. Cuevas Velazquez: None. M.A. Wahab: None. K. Aljassani: None. K. Rajak: None. A. Halder: None. A. Atrash: None. J. Renu: None.

Introduction: It is a standardized practice to monitor blood glucose (BG) levels while on insulin infusion therapy in patients who undergo open heart surgery regardless of their diabetes status. Hyperglycemia was often noted in these patients due to catecholamine surge induced by intraoperative stress. This study is to investigate whether using Continuous Glucose Monitoring (CGM) is a safer option compared to traditional finger stick (FS) glycemic monitoring in postoperative patients. Methods: This is a prospective randomized controlled trial. Patients planned for open heart surgery including coronary artery bypass surgery, valvular repair, or replacements at UPMC Harrisburg hospital from May 2021 to August 2022 were voluntarily involved and randomized by 2:1 ratio into CGM or FS glycemic monitoring methods during the first 48-hour postoperative period on insulin infusion therapy and in the intensive care unit (ICU). Patient demographics, comorbidities, diabetes (DM) status, and glycemic data within the first 48 hours after surgery were compared between the two groups. Results: A total of 42 patients were recruited, including 31 males (81.6%). Four patients were excluded due to missing data, 22 were randomized to the CGM group, and 16 to the FS group. There was no difference in demographics between the two groups. The mean glucose level of the CGM group (123.09 mg/dL) was no different from the FS group (116.31mg/dL) (p=0.09). The CGM group detected significantly more events of level 2 hypoglycemia (BG <54 mg/dL, p=0.01) and hyperglycemia (BG>=180 mg/dL, p=0.01) compared to the FS group. In the CGM group, the mean time of normoglycemia (BG 70-179 mg/dL), hypoglycemia, and hyperglycemia in all 22 patients was 91.1%, 2.58%, and 6.34% respectively. Time in normoglycemia was longer in non-DM patients (95.8%) than in DM patients (87.1%). Discussions: CGM signatures the convenience of frequent BG checks, enabling the reduction of glucose variability and improvement of glycemic control. In this study, although no difference was noted in the mean BG between CGM and FS groups, CGM was noted to be especially effective in hypoglycemia detection. Our findings suggest that CGM brings in the potential benefit of improving patient safety compared to traditional glucose monitoring. To conclude, CGM is probably non-inferior as a glucose monitoring method compared to FS and it might bring the additional benefit of improving patient safety by higher sensitivity of detecting significant hyper/hypoglycemic events for postoperative population on insulin drip in the ICU setting.

Presentation: Saturday, June 17, 2023
SAT108 What A Simple Switch Can Achieve; A Case Of Severe Insulin-induced Lipohypertrophy
Authors: Ayub Tooba , Robles Lydia A , Guntupalli Saroja , Guillen Lopez Claudia E
Published: October 2023

Disclosure: T. Ayub: None. L.A. Robles: None. S. Guntupalli: None. C.E. Guillen Lopez, MD: None.

Introduction: Lipohypertrophy, a benign “tumor-like” swelling of the fatty tissue, is a common dermatological complication of subcutaneous insulin therapy. Here, we describe a case of severe skin lipohypertropy causing poorly controlled glycemic control requiring high insulin doses. However, after rotating the injection sites, followed a significant decrease in total daily dose (TDD) of insulin. Clinical Case: A 69-year-old female with a past medical history of type 2 diabetes mellitus (DM) for the last 16 years presented with uncontrolled blood glucose and gradually increasing insulin requirements. Hemoglobin A1c was 9.3%. Body mass index (BMI) of 32.59kg/m2. Home regimen insulin included long-acting insulin (Levemir), 50 units in the morning and 150 units at night, plus short-acting insulin (Humalog), 62 units with meals. Exenatide, Insulin Glargine, and Metformin were not tolerated in the past due to GERD-like side effects. An insulin pump was offered, but she preferred insulin injections. Patient endorsed good injection technique and adequate rotation between the inner and outer thighs. Surprisingly, physical examination revealed skin discoloration with hypertrophy on both thighs’ bilateral medial and later surfaces. Based on the history and skin examination, a clinical diagnosis of insulin-induced Lipohypertrophy was made. Patient was instructed to switch injection sites to the buttocks and provided with a new insulin regimen. Three months after initial visit, hemoglobin A1c dropped to 7.2%, and TDD of insulin was reduced by 48%, to Levemir 46 units twice daily, Humalog 30 units with breakfast/lunch, and 34 units with dinner. After seven months, her hemoglobin A1c dropped to 7% without further changes to the insulin regimen. Despite these changes, the lipohypertrophy had minimal changes. Discussion: The pathophysiology of lipohypertrophy is linked to a direct anabolic effect of insulin on local skin, inducing fat and protein synthesis. Risk factors include failure to rotate injection sites, needle reuse, female gender, high BMI, and long disease duration. Insulin injection in the lipohypertrophy areas can delay insulin absorption, causing glucose variability with unpredictable hyper and hypoglycemia episodes. There is no established therapeutic method to treat severe lipohyperthohy; avoiding further injection into that area is crucial, then surgical intervention can be considered. Currently, the best preventative and therapeutic strategies for insulin-induced lipohypertrophy include rotating injection sites and a single use of needles. Conclusion: This case emphasizes the importance of detailed inspection and palpation of insulin injecting sites regularly and how early intervention can lead to significant improvement in glycemic control, as described in our case.

Presentation: Saturday, June 17, 2023
SAT113 Reducing The Frequency Of Ordering Hemoglobin A1c In Patients With Well-controlled Diabetes - A Quality Improvement Project
Authors: Umarji Gunjan , Swedish Kristin , Tabatabaie Vafa
Published: October 2023

Disclosure: G. Umarji: None. K. Swedish: None. V. Tabatabaie: None.

Introduction: “Let’s check an A1c” is a sentence heard often in primary care setting. Is it truly required each time? According to Standards of Care 2021 by American Diabetes Association, hemoglobin A1c should be tested every six months for patients with well-controlled diabetes. The cost of hemoglobin a1c test ranges $28 to $245, with an average of $85.20 without insurance. Unnecessary blood tests cause discomfort and anxiety to patients and increase healthcare costs. We conducted a quality improvement project whose aim was to decrease the frequency of unnecessary hemoglobin A1c testing by 50% from March 2022 to March 2023 at an internal medicine residency clinic. Methods: Our discovery phase included a survey of all providers in the residency clinic and a chart review. The goal of the survey was to understand how clinicians identified well-controlled diabetes. The survey was sent to 86 providers (attendings and residents) with a response rate of 43%. Results showed a shortcoming to define goal A1c for adults >65 years of age. Less than half knew that a patient with well-controlled diabetes should have A1c checked every 6 months. A chart review was conducted for all patients seen by attendings and residents as primary care providers in clinic with hemoglobin A1c between 6.5 and 8.5. Of the 462 total patients, a representative sample revealed that 38% of the patients with well-controlled diabetes (defined with goal A1c from standards of care 2021) had A1c ordered sooner than recommended. Three interventions have been planned to reduce this occurrence. The first intervention was an educational session with attendings, as they act as point regulators for every plan made for clinic patients. Results: Eight weeks after the first intervention, a similar chart review was conducted, which demonstrated a decrease in patients with well-controlled diabetes having A1c sent sooner than recommended from 38% to 33%. Discussion: The second intervention, an educational session with the residents, was performed and data is being gathered to determine the efficacy of that intervention. The third planned intervention will be to post information about A1c ordering in the precepting room at the clinic. We know that training is the least effective method to obtain change, an ideal intervention would be to introduce a hard stop in the electronic medical record (EMR) asking if the physician truly wanted to order another A1c since the last was ordered x months ago with the result of y%. However, despite being a more effective method of change, it is very expensive and difficult to introduce new measures into our EMR. Following our third intervention, we will reassess to determine if further interventions would benefit our goal of decreasing unnecessary A1c testing in patient with well-controlled diabetes.

Presentation: Saturday, June 17, 2023
SAT117 Diabetes And Vision: Can Chatgpt Educate Our Diabetic Patients?
Authors: Wu Gloria , Cheng Emily , Zhao Weichen , Wong Adrial , Mansubi Nikki , Dorado Perla , Gim Heidi
Published: October 2023

Disclosure: G. Wu: None. E. Cheng: None. W. Zhao: None. A. Wong: None. N. Mansubi: None. P. Dorado: None. H. Gim: None.

Background: Diabetic retinopathy is the leading cause of blindness in working-age Americans. Nearly 4.1 million U.S. adults are affected by retinopathy, but over 50% of the patients do not receive an eye examination and diagnosis before vision loss. ChatGPT is a new Artificial Intelligence (AI) trained model launched on 11/30/2022 that generates real-time comprehensive responses. Purpose: Can ChatGPT educate our patients about Diabetic retinopathy? Methods: A retina specialist created a scoring system of Keywords per question to assess ChatGPT responses, maximum score of 6 points per question: 1) I am diabetic and I have a hemoglobin/A1C of 6.5. I still cannot read my book. Why? Keywords: eye MD/optometrist, kidney complications, neuropathy, macular edema/diabetic retinopathy, stroke, healthcare team 2) I am diabetic and my fasting blood sugar is 200 but I suddenly lost vision in one eye. Why? Keywords: eye MD/optometrist, retinal detachment, retinal vein/artery occlusion, vitreous hemorrhage, stroke, healthcare team 3) I am a new diabetic and when I look in the mirror I am missing one part of my face. Why? Keywords: eye MD/optometrist, retinal detachment, kidney complications, neuropathy, diabetic retinopathy/macular edema, stroke, healthcare team 4) My hemoglobin/A1C is 8 and my striped dress looks wavy. Why? Keywords: eye MD/optometrist, diabetic retinopathy, macular edema, metamorphopsia, stroke, healthcare team 5) I have high cholesterol, my pants became too tight, and my blood sugar is borderline at 120-150 but now I cannot see to read. Why? Keywords: eye MD/optometrist, diabetic retinopathy, metabolic syndrome, macular edema, vitreous hemorrhage, healthcare team. Results: Keyword Scores: Qn 1 = 2/6 (diabetic retinopathy, health care team); Qn 2 = 3/6 (retinal detachment, vein occlusion, health care team); Qn 3 =1/6 (healthcare team); Qn 4 = 2/6 (diabetic retinopathy, health care team); Qn 5 = 2/6 (diabetic retinopathy, health care team). For all of the answers: None mention macular edema which is an important part of visual loss in diabetes. Qn 4 describes metamorphopsia (wavy dress) which is pathognomonic for macular edema and it is missing from the answer. High blood sugar=3/5 diabetic retinopathy=4/5; blindness/loss of vision=3/5; Stroke, eye MD/optometrist, American Academy of Ophthalmology, nephropathy/kidney, macular edema, foot/nerve neuropathy, ADA/Endocrine Society, or ACC/AHA=0/5. Conclusions: ChatGPT is the newest Artificial Intelligence mediated chatbot. It provides basic responses to questions about the eye in readable text and it is a good starting point for future AI chatbots.

Presentation: Saturday, June 17, 2023
SAT120 Effects Of Long Term Diabetes Education Program On HBA1C In Patients With Type 2 Diabetes Mellitus
Authors: Dash Kalpana , Kumari Nalini , Harpal Malhotra , Surekha Tippisetty , T Bapuji A
Published: October 2023

Disclosure: K. Dash: None. N. Kumari: None. M. Harpal: None. T. Surekha: None. B. A. t: None.

Introduction: As per IDF 2022, 537 million adults (20-79 years) are living with diabetes & the number is increasing in an alarming way. 1in 10 people are suffering from diabetes and over 3 in 4 adults with diabetes live in low and middle-income countries. Adequate control of the disease is required by educating patients and developing their skills to manage their treatment to prevent complications through continue diabetic education program (DEPs). Aim & Objectives: To measure the change in HBA1C, FBG & PPBG (primary end point) value, who are in continue DEPs [ Sugar 360 (long term, 1 year sugar plan), Sugar 90 (long term-6 months sugar plan) vs. conventional method (SA-1- short term sugar plan, only one visit )with normal follow up] along with standard of care treatment. Secondary end points such as total cholesterol and body weight were also taken into consideration. Methods: Data of 100 type 2 diabetes mellitus patients who had attended diabetes OPD & had at least two follow ups having knowledge about diabetes were included in the study. Visual impairment, psychological impairment and newly diagnosed DM patients were excluded from the study. Data on biochemical parameters of metabolic control such as FBG, PPBG, HBA1c, total cholesterol, TG & BMI were collected. Within subjects design non-parametric and for quantitative data repeated measures ANOVA was used. Results: Mean age is 51.32 years in DEPs patients and mean age is 57.29 years in conventional treatment patients. Significant decrease in HBA1c (9.1% vs. 7.2%), FBG (161.2 mg/dl vs. 119.1 mg/dl), PPBG (244.6 mg/dl vs. 172.2 mg/dl), total cholesterol (175.8mg/dl vs. 159.8mg/dl) & triglyceride (217.5 mg/dl vs. 182.1 mg/dl) were noted in the follow up visit in both groups. However patients on DEPs has better adherence to the follow-up visits and better understanding of disease, blood glucose control measures and lifestyle change. Conclusion: Intensive DEPs was found useful & effective as regards to biochemical than compared with normal conventional treatment in terms of adherence knowledge & control of disease.

Presentation: Saturday, June 17, 2023
SAT126 Relationship Between Type I Diabetes And Depression In The Pediatric Population
Authors: Greenblatt Logan Benjamin , Epelman Marina , Demissie Seleshi
Published: October 2023

Disclosure: L.B. Greenblatt: None. M. Epelman: None. S. Demissie: None.

Introduction: Type 1 diabetes mellitus (T1DM) is one of the most common chronic illnesses in children. Depression in children and adolescents with T1DM has been associated with negative diabetes related health outcomes, such as recurrent diabetes ketoacidosis. These associations can be bidirectional, where poor glycemic control can worsen symptoms of depression. Adolescents with T1DM and depression pose additional challenges to health care providers due to non-adherence to diabetes management. Objective: The aim of this study is to investigate the relationship between depression and age of onset, duration and T1DM control. We hypothesized that duration of diabetes mellitus positively correlates with depression symptoms. Patients diagnosed with T1DM in adolescence have higher depression scores compared to individuals diagnosed at a younger age. Methods: Individuals with T1DM 11 to 21 years old enrolled in the study. Patients with known psychiatric illnesses and intellectual disabilities were excluded. After obtaining informed consent and assent, participants were asked to complete age specific depression screening form PHQ-9. Forms were immediately scored by the investigator. Patients with moderate symptoms (score of 10 to 14) are provided a list of local mental health resources and individuals with severe depressive symptoms (score > 15) were referred to a pediatric psychiatrist for evaluation. Data on age, sex, ethnicity, age at diagnosis, diabetes duration, recent glycosylated hemoglobin (HbA1C), treatment methods (insulin pump vs injections) and continuous glucose monitor use were collected from patients’ electronic health records. Results: 34 patients, 61.7% female, were screened thus far. The mean age was 16 years and average age at diagnosis was 8 years. 22% of patients were on multiple daily injections and 78% on insulin pump therapy. Most patients (88%) were using continuous glucose monitors. Despite long term care, the average HbA1c was 8%. Girls had higher average PHQ-9 score (7.24) compared to boys (3.69). As expected, high PHQ-9 score was associated with poor diabetes control (r=0.35, p=0.044). There was a positive correlation between PHQ-9 score and duration of T1DM and negative correlation between PHQ-9 score and age at onset (p>0.05). Conclusion: Children and adolescents with T1DM are at risk of depression. Younger age of onset and longer duration of T1DM was associated with higher severity of depression symptoms as evident by PQH-9 score. Poor control, defined by high HbA1C, is positively correlated with depression score. Screening for depression and proper referral should be integrated into routine care for children and adolescents with T1DM.

Presentation: Saturday, June 17, 2023
SAT127 What’s Cookin’: Attitudes Towards A Healthy, Budget-friendly Meal Planning Tool In Patients With Type 2 Diabetes
Authors: Abramczyk Rachel , Sadiq Sanah , Vaz Cherie Lisa
Published: October 2023

Disclosure: R. Abramczyk: None. S. Sadiq: None. C. Vaz: None.

Background: Eating home-cooked meals has been associated with reduced risk of developing type 2 diabetes (T2DM). Additionally, nutrition counseling can aid weight loss and improve glucose levels. However, these interventions may be less effective in underserved patients as food prices can be a barrier to healthy food access. We performed a preliminary assessment of a quality improvement nutritional intervention at a university-based clinic in a medically underserved area. Aim: This analysis aimed to measure patients’ perceived levels of confidence in shopping for and preparing healthy, DM-friendly meals and interest in receiving a sample grocery list with matching recipes. Methods: Patients with T2DM seen in fellows’ clinic over 3 months were offered surveys that measured confidence levels in shopping for and preparing a healthy, DM-friendly diet. Participants were subsequently offered an ADA-compliant, Supplemental Nutritional Assistance Program-friendly sample grocery list and weekly meal plan. Results: 50 patients completed surveys. 70% were >50 years and 70% identified as African American. 98% shop for food at a supermarket, with 12% also utilizing smaller grocery and corner stores. 8% were not confident in shopping for healthy, DM-friendly foods. 30% were somewhat confident, 46% were confident, and 16% were extremely confident in shopping for DM-friendly foods. 82% of participants either did their own meal prep at home or had someone else at home who cooked. 16% were not confident in cooking DM-friendly foods, whereas 26% were somewhat confident, 50% were confident, and 8% were extremely confident. 92% were interested in receiving a 1-week shopping list for healthy groceries with corresponding recipes. Conclusion: While many patients in a low socioeconomic status neighborhood reported feeling confident shopping for healthy, DM-friendly foods, fewer felt confident in preparing and cooking these foods. Most patients were interested in a budget friendly shopping list and meal planning tool to assist in both shopping for and cooking foods that will assist in achieving improved DM control. A follow up phase study will evaluate the rate of utilization and other patient behavioral factors in response to this intervention. Further research is needed to develop and evaluate the impact that tools such as this may have on changes in behavior towards shopping for and cooking healthy, DM-friendly foods at home and its effects on glycemic control.

Presentation: Saturday, June 17, 2023
The concept of risk and its measurement in the field of built heritage conservation: critical aspects and potential improvements
Authors: Konsta Anthoula , Della Torre Stefano
Published: October 2023

The term risk has been defined in different ways in various scientific areas. As a result, there is a certain confusion over the meaning and the use of the term. In order to understand better the variety of approaches to the concept of risk and consequently its measurement, representative studies, carried out by re- searchers and professionals, are considered. Which are the most important as- pects that built heritage conservation adopted and developed and how these as- pects have led to the use of different methods of assessment and evaluation of risks? Secondly, different methods of risk assessment and evaluation, adopted in various activities of the built heritage conservation process, are selected and an- alyzed. With the aim to highlight their strengths and limitations, a comparison is drawn, permitting us to have an overall picture of the available methods and at the same time to identify the eventual gaps and the critical aspects of the re- search/practice. Lastly, based on the acknowledgment of the limits and the prob- lems of the various methods, suggestions for improvement are made.
Pro-dopaminergic pharmacological interventions for anhedonia in depression: protocol for a living systematic review of human and non-human studies
Authors: Ostinelli Edoardo G. , Chiocchia Virginia , Macleod Malcolm , Browning Michael , Harmer Catherine , Siafis Spyridon , Stansfield Claire , Friedrich Claire , Wright Simonne , Chikaura Tanatswa , Milligan Lea , Thomas James , Moreno Carmen , Furukawa Toshi A. , Seedat Soraya , Potts Jennifer , Salanti Georgia , Cipriani Andrea ,   GALENOS Team
Published: October 2023

Background:

Anhedonia is a key symptom of depression, and it has been suggested as a potential target for future individualised treatments. However, much is unknown about how interventions enhancing dopaminergic pathways may affect anhedonia symptoms in the context of depression.

Methods:

We will perform independent searches in multiple electronic databases to identify clinical and animal experimental studies on pro-dopaminergic interventions in individuals with depression or animal models for depression. The primary outcomes will be overall anhedonia symptoms and their behavioural proxies in animals. Secondary outcomes will include side effects and neurobiological measures. At least two independent reviewers will conduct the study selection, data extraction, and risk of bias assessments using pre-defined tools according to each record’s study design. We will develop ontologies to facilitate study identification and data extraction. We will synthesise data from clinical and animal studies separately. If appropriate, we will use random-effects meta-analyses, or synthesis without meta-analyses. We will investigate study characteristics as potential sources of heterogeneity. We will evaluate the confidence in the evidence for each outcome and source of evidence, considering the summary of the association, potential concerns regarding internal and external validity, and reporting biases. When multiple sources of evidence are available for an outcome, we will draw an overall conclusion in a triangulation meeting involving a multidisciplinary team of experts. We plan updates of the review every 6 months, and any future modifications to the protocol will be documented. We will co-produce this review with multiple stakeholders.

PROSPERO registration: CRD42023451821
Debtors at Play: Gaming Behavior and Consumer Credit Risk
Authors: Gong Shuaishuai , Levine Ross , Lin Chen , Xie Wensi
Published: October 2023

Exploiting a unique high-frequency, individual-level database, we (1) construct individual-level, incentive-compatible proxies of impulsivity based on video gaming behavior and (2) use these proxies to evaluate predictions concerning how impulsivity shapes individuals’ responses to a relaxation of credit constraints as captured by receiving a credit card. We discover that precard gaming intensity—as measured by the frequency and amount of game expenditures—is strongly and positively associated with (a) the probability of defaulting on credit card debt in the future, (b) postcard expenditures on luxury and addictive items, (c) surges in consumption spending immediately after receiving the credit card, and (d) rapid debt accumulation after obtaining the card. Differences in financial literacy, income, income variability, education, and demographics do not drive the results. The results are consistent with (1) neurological and psychological studies stressing that excessive gaming is associated with impulse control deficiencies and (2) behavioral theories stressing that impulsivity, i.e., time-inconsistent preferences for immediate gratification and ineffective strategies for avoiding myopic cues and temptations, substantially influence individual expenditure patterns and borrowing decisions when liquidity constraints are relaxed.

This paper was accepted by Kay Giesecke, finance.

Funding: C. Lin acknowledges the financial support from the National Natural Science Foundation of China [Project 72192841] and the Research Grant Council of the Hong Kong SAR, China [Project T35-710/20-R].

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4931 .
How the Care Quality Commission expects providers to deal with complaints
Authors: Halliwell Amanda
Published: October 2023

Amanda Halliwell explores the relevant regulation and its requirements.
The Relationship Between the Daily Use of Digital Technologies and the Reading and Information Literacy Skills of 15-Year-Old Students
Authors: Lang Vida , Špernjak Andreja , Šorgo Andrej
Published: October 2023

Digital technologies in all forms have become ubiquitous in our media-rich, modern information society, but the connection between their use and information literacy is not always clear. This paper examines the impact of daily use of digital technologies on the reading and information literacy skills of 15-year-old students in Slovenia, based on data from the Programme for International Student Assessment (PISA) 2018 study. The study examines PISA 2018 variables related to Information and Communication Technologies (ICT), as well as a reading task involving the use of ICT. The sample consists of 2612 Slovenian students with a gender distribution of 50.8% girls and 49.2% boys. The study explores students' experiences, enjoyment, self-efficacy, autonomy, and independence in using ICT and learning about its use and identifies two groups of students: one group that is curious and another that is cautious. The results of confirmatory factor analysis (CFA) and structural equation modelling (SEM) show that the constructs of enjoyment, self-efficacy, learning, autonomy, and independence are highly/strongly correlated but have a low/insignificant impact on information literacy skills.
Comparison of saddles in hippotherapy for patients with chronic low back pain
Authors:   Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand, Ruamsilp Wirintorn , Thawinchai Nuanlaor ,   Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand, Sitilertpisan Patraporn ,   Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand, Peansukmanee Siriporn ,   Department of Companion Animals and Wildlife clinics, Faculty of veterinary Medicine, Chiang Mai University, Chiang Mai 50100, Thailand, Chamnongkich Samatchai ,   Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
Published: October 2023

Chronic low back pain (CLBP) significantly impacts daily life. Currently, hippotherapy on a robotic horse has been shown to decrease pain and disability in low back pain. However, live horses and different types of saddles used during hippotherapy may have various therapeutic effects. Therefore, the purpose of this study was to compare the standard all-purpose saddle and the pad saddle used in live horse hippotherapy for individuals with CLBP. Ten participants with CLBP were assessed pain level using the visual analog scale (VAS) and lumbopelvic mobility using the Schober test and inertia measurement unit (IMU) before and after each saddle, with a one-week interval between saddles and a 20-minute hippotherapy session. The dependent t-test, with a significance level of 0.05, was conducted to compare the percentage change of each variable between two saddles. The result showed that the standard saddles significantly reduced pain levels (p <0.001) and increased pelvic range (p<0.05) greater than applied pad saddles in participants with chronic LBP. Therefore, the standard all-purpose saddle is more beneficial than the applied pad saddle for individuals with chronic LBP undergoing hippotherapy.
Effect of l-arginine and l-lysine supplementation in low-protein feeds on the growth of native chickens in the starter phase
Authors:   Department of Animal Husbandry, Faculty of Agriculture, University of Timor, East Nusa Tenggara 85614, Indonesia, Lisnahan Charles Venirius , Nahak Oktovianus Rafael ,   Department of Animal Husbandry, Faculty of Agriculture, University of Timor, East Nusa Tenggara 85614, Indonesia, Pardosi Lukas ,   Department of Biology, Faculty of Agriculture, University of Timor, East Nusa Tenggara 85614, Indonesia
Published: October 2023

Some feeds that are used as protein sources, such as fish meal and soybean meal, have a relatively high cost. Therefore, synthetic amino acids, such as arginine and lysine, can be used as alternative protein sources. This study determined the effect of L-arginine and L-lysine in low-protein feed on the growth of one- to six-week-old native chickens. A total of 250 one-week-old native chickens were divided into five treatments and five replications based on a completely randomized design. The treatments were T-2 (0.46% L-arginine + 0.42% L-lysine + 19% crude protein), T-1 (0.56% L-arginine + 0.51% L-lysine + 18% crude protein), T0 (0.66% L-arginine + 0.60% L-lysine + 17% crude protein), T+1 (0.76% L-arginine + 0.69% L-lysine + 16% crude protein), and T+2 (0.86% L-arginine + 0.78% L-lysine + 15% crude protein). The highest feed consumption occurred in the T0 and T+1 treatments (612.81±4.82 and 609.00±8.75 g/chick), and the T+1 group had the highest body weight and weight gain (296.08±1.09 kg/chick and 265.48±1.57 g/chick). The highest carcass weight and percentage at T+1 was 177.57±2.04 g/chick and 59.97±0.55%/chick, respectively. The best feed conversion was at T+1 (2.29±0.40). Statistical analysis showed that the treatment had a significant effect on feed consumption, body weight, weight gain, feed conversion, carcass weight, and carcass weight percentage (P<0.05). The levels of 0.76% arginine + 0.69% lysine increased the feed consumption, weight gain, feed conversion, and carcass percentage of native chickens. The increase in L-arginine and L-lysine of 0.76 and 0.69% from 0.46 and 0.42%, respectively, suppressed the use of crude protein by 19.00% to 16.00% in the starter phase.