bluuebunny/crossref_metadata_2025 huggingface dataset:
LBODP043 Analysis Of Plastic Surgery Websites And Their Recommendations For Diabetics
Authors: Levine Emma C , Fanning James E , McGee Shayan , Okamoto Lauren , Steinmetz-Wood Samantha , Gilbert Matthew Philip
Published: November 2022

Diabetic patients are predisposed to adverse complications after surgery, especially when their A1c is above 8. 0% (1). Despite the heightened risk for post-operative complications such as wound dehiscence and infection (2), no formal recommendations by the American Council of Academic Plastic Surgeons (ACAPS) exist regarding preoperative A1c thresholds. This study reviews the current online recommendations for diabetic patients undergoing plastic surgery and examines the readability and technical metrics presented on these webpages. We hypothesized that these webpages would enforce stricter preoperative A1c levels (< 8%) in comparison to the 8% threshold put forth by Diabetes Care in 2014. An anonymous, depersonalized Google search with the search term "diabetes and plastic surgery" was run. The initial 50 results were analyzed and 11 webpages meeting inclusion criteria extracted. 45.45% (5/11) of the webpages stated specific A1c recommendations, with 4 of the webpages recommending an A1c <7% and one webpage recommending an A1c <6%. A number of the websites recommended that patients consult their primary care physician (PCP) or endocrinologist, 63.6% (7/11). 100% (11/11) of webpages discussed poor wound healing and 45% (5/11) discussed the heightened risk of postoperative infection in diabetic surgical patients. Webpage average readability scores for seven readability measures greatly exceeded the 6th grade reading level recommended for medical information. This study determined that online resources for diabetic patients undergoing plastic surgery utilized stricter than standard preoperative criteria and exceeded recommended readability levels. Standardizing requirements for diabetic patients and improving readability may help patients better understand the preoperative expectation for better surgical outcomes. References: (1) Underwood, Patricia et al. "Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures." Diabetes care vol. 37,3 (2014): 611-6. doi: 10.2337/dc13-1929(2) Goltsman, David et al. "Defining the Association between Diabetes and Plastic Surgery Outcomes: An Analysis of Nearly 40,000 Patients." Plastic and reconstructive surgery. Global open vol. 5,8 e1461. 17 Aug. 2017, doi: 10.1097/GOX. 0000000000001461

Presentation: No date and time listed
LBODP048 Barriers To Diabetic Retinopathy Screening In Hospitalized Patients With Diabetes
Authors: Kumar Monisha , Genter Pauline , Ipp Eli
Published: November 2022

Diabetic retinopathy (DR) is a leading cause of preventable vision loss in the in the U. S., and DR screening is essential to prevent blindness. Yet minority populations have consistently lower DR screening rates than Non-Hispanic Whites and knowledge about barriers versus facilitators for completion of DR screening in these groups remains scant. Improvement in DR Screening rates in safety net populations has been observed after placing digital retinal cameras in primary care sites to capture images where patients get their basic health care. In this study, we therefore assessed DR screening in patients at time of hospitalization as a possible additional site to capture unscreened patients with diabetes. We identified patient with diabetes admitted for any reason to a safety net hospital to evaluate perceived barriers to DR screening. We performed an anonymous survey in English or Spanish in 156 hospitalized adult patients with diabetes during hospital stays between 10/2019-12/2021, using a convenience sample. Barriers specified in the survey were derived from the literature. The study population had a mean [+SD] age of 50+10.5 years, were predominantly male [72.4%], of low-income [83.7% <$25,000/year] and minority groups [Latinos 79.5% and African American [10.3%]. Diabetes duration was >5years in 63.6% of patients. Reported DR screening rate in the 12 months prior to admission was only 31.4%, despite 97% of patients confirming they were aware that diabetes causes impaired vision and blindness. The main perceived barriers to DR screening identified in the survey were financial [50%], transportation [22%] and depression [17%]. There were no significant differences in the number or nature of perceived barriers in those who reported DR screening vs. those who did not. Surprisingly, the pandemic appeared to have little impact on DR screening rates. Comparison of patients surveyed before (n=96; 10/2019-03/20) and after COVID lockdown (n=60; 08/2020-12/2021), did not show any significant differences in patient demographics, number or nature of perceived barriers, or DR screening rates (32% vs 30%). However, DR screening among patients without a Primary Care Provider (PCP) was considerably lower compared to patients with a PCP, 10% vs 49% (p<0. 001). In summary, this study reveals low prior outpatient DR screening rates in hospitalized patients with diabetes in low-income minorities in a safety-net hospital, and identifies potential remediable barriers associated with this. The results suggest that cost and transport barriers could be addressed by implementation of DR screening during hospitalization in safety net hospitals. These results also emphasize the significance of a having a PCP. We conclude that inpatient DR screening and facilitating PCP-patient connections might lead to improvement in DR screening rates and thus prevent blindness in this segment of the diabetes population.

Presentation: No date and time listed
LBODP054 Hypogonadism in Diabetes Mellitus: Insulin Resistance, The Connecting Link?
Authors: Singh Jaspreet , Swain Jayshree , Sahoo Dr Abhay Kumar , Mangaraj Swayamsidha , Kanwar Jayabhanu
Published: November 2022

Background

Hypogonadism is commonly found in men with type 2 diabetes mellitus (T2DM) and insulin resistance may play a role in its pathogenesis. There is an inverse relationship between testosterone and insulin resistance. This relationship is often confounded by effects of obesity, metabolic syndrome, sex hormone binding globulin (SHBG), treatment protocols and complication status of diabetes.

Objective

To determine the prevalence of hypogonadism in T2DM men and to evaluate the association between hypogonadism and clinical, biochemical parameters of diabetes. To look for an independent association between hypogonadism and insulin resistance.

Methods

This was a cross sectional study of 353 consecutive men aged 20 to 70 years with T2DM. Hypogonadism was defined on the symptoms as defined in the androgen deficiency in aging male questionnaire (ADAM) along with low calculated testosterone levels (calculated by Vermeulen's equation taking total testosterone, albumin and SHBG). Insulin resistance was measured by homeostasis model assessment for insulin resistance [HOMA-IR] and Quantitative insulin sensitivity check index [QUICKI].

Results

The prevalence of hypogonadism in our cohort was 17%. We found a significant correlation between calculated free testosterone and BMI (r=-0.149, p value =0. 005), HbA1c (r = -0.145, p value = 0. 006), Triglycerides (r= -0.217, p value =<0. 001), HOMA IR (r=-0.207, p value =<0. 001), QUIKI (r=0.148, p value=0. 005). On applying multiple linear regression, HOMA IR was significantly inversely correlated with calculated free testosterone levels independent of age, duration of diabetes, BMI and glycaemic status of diabetes. Similarly, total testosterone was significantly associated with insulin resistance independent of age, BMI, SHBG, complication status and other potential confounding variables. There was no statistically significant association between hypogonadism and diabetes complications.

Conclusions

Hypogonadism is a common finding in T2DM men. Hypogonadism is significantly associated with insulin resistance even after adjusting for age, BMI, duration of diabetes, diabetic complications, treatment regimens and other potentially confounding variables.

Presentation: No date and time listed
LBODP061 A Pilot Trial Of Continuous Glucose Monitoring Technology In The Perioperative Period
Authors: Price Catherine E , Aloi Joseph Anthony , Anzola Saskia , Fanelli Jessica , Vishneski Susan , Woody Christopher , Segal Scott B
Published: November 2022

Objective

To evaluate use of continuous glucose monitoring (CGM) technology in the perioperative setting by comparing CGM with concurrent point of care fingerstick blood glucose (BG) or arterial BG values, as indicated, in patients with hyperglycemia and/or diabetes mellitus undergoing surgery. To assess if grounding device correlated with loss of CGM signal as a prior study of CGM in the perioperative period noted intermittent signal loss during operative time.

Methods

A prospective cohort analysis of 94 participants with hyperglycemia and/or diabetes mellitus undergoing surgery of 3 hours duration was conducted using Dexcom G6 and/or Freestyle Libre 2. 0 CGM. CGMs were placed preoperatively and compared to standard of care BG checks in the perioperative setting. Correction insulin was administered based on fingerstick glucoses. Of those consented, 18 were excluded resulting in 76 enrolled subjects.

Results

Preliminary data for use of CGM in perioperative period analyzed 50 participants with Freestyle Libre 2. 0 CGM, 20 participants with Dexcom G6 CGM, and 6 participants with both devices worn simultaneously. Lost sensor data occurred for 3 participants wearing Dexcom G6 CGM and 10 participants wearing Freestyle Libre 2. 0 CGM, which affected 2 of the participants wearing both devices simultaneously. The absolute difference of Dexcom G6 CGM glucose readings compared to BG readings was 29.17 mg/dL (SD = 22.15). The absolute difference of Freestyle Libre 2. 0 CGM glucose readings compared to BG readings was 26.94 mg/dL (SD = 24.16). There was not a significant difference in averages of absolute change in glucose when comparing Dexcom G6 CGM to Freestyle Libre 2. 0 CGM when utilized simultaneously. Grounding devices utilized Megadyne grounding pad for use of bipolar cautery, monopolar cautery, and surgeries with da Vinci robot. Of the 13 participants with lost data, 3 patients had bipolar cautery reported as being used at least once and 10 participants with lost data utilized monopolar cautery. None of the 6 participants with surgery utilizing da Vinci robot had loss of CGM data.

Conclusion

Both Dexcom G6 and Freestyle Libre 2. 0 CGMs were able to be utilized in the perioperative setting and generally functioned well. Use of CGM provided more glycemic data and better characterized glycemic trends than individual BG readings. It is anticipated that this technology could improve prevention of hypoglycemic events and better glycemic control in the perioperative setting. Use of CGMs in the perioperative setting is a novel area of application that warrants further evaluation of this technology.

Presentation: No date and time listed
LBSUN149 Effectiveness Of Digital Twin Technology For The Improvement In Depression Among Patients Undergoing Remission Of Diabetes
Authors: Shashank Joshi , Mohammed Jahangir , Mohamed Maluk , Poon Terrence , Dharmalingam Mala , Saboo Banshi , Damodaran Suresh , Vadavi Arun , Thajudeen Mohamed , Keshavamurthy Ashok , Bhonsley Suchitra , Mohammed Sarah , Shamanna Paramesh
Published: November 2022

Introduction

Twin Precision Treatment (TPT): a novel whole-body digital twin enabled precision nutrition that utilises 174 health markers and 3000 daily data points from blood tests and connected devices that measure weight, physical activity, sleep and sensor glucose values, for achieving remission. The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but the impact of the diabetes reversal program on the depression has not yet been investigated.

Methods

We compared the change in the PHQ-9 scores at the baseline and at three months for the patients enrolled in the real-world study in TPT program. Contemporary consensus statement defines remission as a return of hemoglobin A1c (HbA1c) to <6.5% and persists for at least three months in the absence of diabetes medication.

Results

We evaluated 96 patients of which 54.1% (n=52) had any grade of depression. 28% (n=27), 18% (n=17), 5% (n=5), 3% (n=3) had mild, moderate, moderate to severe and severe depression. Within these categories 67% (n=18) improved from mild to normal, 94% (n=16) improved in the moderate category with 10 improved to normal category, none remained as moderately severe and severe depression, respectively. There was a significant association with the improvement in the PHQ-9 scores and the number of daily oral medication count change. Out of 15 on 1 medication/day changed to 7 (46.7%) off medication. Out of 27 with 2 medications/day, 10 (37%) were off medications. Out of 22 with 3 medications/day, 5 (22.7%) were off medications. Out of 12 with 4 medications/day, 2 (16.7.7%) were off medications; p<0. 005. The mean HbA1c % at baseline (8.9±2.4) changed to (6.8±9.2), p<0. 001. The mean body weight (kg) at baseline (76.2±13.5) changed to (71.9±12.9), p<0. 001.

Discussion

This is perhaps the first evaluation for the improvement of the PHQ-9 in patients undergoing remission by digital twin technology. Depression was highly prevalent. Higher the PHQ-9 score, greater was the degree of improvement in depression. TPT appears to be a useful tool to simultaneously address reversal of diabetes and improvement in the grade of depression.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN162 Cumulative Probability Of Heart Failure Hospitalization Among Non-Hispanic Black Compared To Non-Hispanic White Individuals With Type 2 Diabetes On Empagliflozin (EMPA-AA): Real-world Data
Authors: Mishriky Basem M , Cummings Doyle M , Fu Yuanyuan , Halladay Jacquie , Jones Schuyler , Boan Andrea , Jones Sara , Patil Shivajirao , Powell James , Adams Alyssa , Irish William
Published: November 2022

The results from the SGLT-2 inhibitors cardiovascular outcome trials were generalized to all, despite that non-Hispanic Black (hereafter, "Black") participants were underrepresented. Our goal was to evaluate, among patients with type 2 diabetes, the risk of heart failure hospitalizations among black vs non-Hispanic White (hereafter "White") patients initially prescribed empagliflozin. | We performed a multicenter retrospective study using clinical data derived from Electronic Medical Records (EMR's) from adults with type 2 diabetes cared for at 4 healthcare systems (UNC Health, Duke Health, MUSC, and ECU Health) who were prescribed empagliflozin between August 2014 and December 2019. Our primary outcome was time to first heart failure hospitalization. We wanted to understand if the outcomes were different in Black vs White patients with previous hospitalizations for heart failure that occurred prior to an empagliflozin prescription. Cumulative probability of heart failure hospitalization by race was estimated using the cumulative incidence function. The association of race with risk of heart failure hospitalization was evaluated using multivariable Cox hazards models. Hazard ratio (HR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. | A total of 704 patients with previous heart failure hospitalizations were eligible. Mean age by race category (Black/White) was 60.2 vs 64.3 years (p < 0. 0001); 42.8% vs 61. 0% were males (p < 0. 0001) and 81.2% vs 73.2% had a history of hypertension respectively. Black patients were significantly younger and predominantly female. Cumulative probability of heart failure hospitalization at 2-years post-initiation of empagliflozin was 71.7% (95% CI = 61.6%, 79.6%) vs. 70.9% (95% CI = 64. 0%, 76.7%) for Black vs White, respectively. When adjusting for age, gender, and baseline comorbidities, there was no statistically significant difference in the risk of hospitalizations for heart failure between Black vs White patients (HR = 1. 03; 95% CI = 0.85, 1.25, p = 0.79). | In patients with type 2 diabetes with a documented previous hospitalization for heart failure prior to a prescription for empagliflozin, we found no significant difference in the cumulative probability of heart failure hospitalization in Black vs White patients.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN209 A Novel Algorithm For The Management Of Inpatient Covid-19 Steroid-induced Hyperglycemia
Authors: Karol Alexander B , Viera Natalia , Ogyaadu Selassie J , Brooks Danielle , Shah Nirali A , Linker Anne S , Lam David , Levy Carol J , O’Malley Grenye
Published: November 2022

Objective/Background

Hyperglycemia in hospitalized patients with COVID-19 is linked to increased morbidity and mortality. With increasing use of glucocorticoid (GC) therapy for COVID-19 hypoxemia, clinicians are challenged with an increased prevalence of hyperglycemia.

Methods

We developed an insulin protocol to aid front line providers in the management of GC-induced hyperglycemia for hospitalized adults with COVID-19. The protocol was based on expert opinion and was available from March 2021 onward. Glycemic and clinical outcomes were obtained for patients treated with GC and retrospectively compared to historical controls treated with GC admitted up to 6 months prior to protocol implementation. Glycemic parameters for finger stick glucose values (FSG) were defined as hypoglycemia <70 mg/dL, euglycemia 70-180 mg/dL, mild hyperglycemia 180-250 mg/dL and severe hyperglycemia >250 mg/dL. To account for differences in the quantity of total FSG between groups, we adjusted for length of stay and calculated the proportion of FSG per patient.

Results

130 patients with COVID-19 and GC induced hyperglycemia from before (n=65) and after (n=65) protocol implementation were matched 1: 1 based on age, weight, and sex. There were no significant differences in other baseline patient characteristics. Significantly more patients in the protocol group had mean FSG in the euglycemic range (16.9% vs 38.5%, p=0. 006), and there was a decrease in patients with mean glucose in the mild hyperglycemia range that trended toward significance (50.8% vs 35.4%, p=0. 076). The protocol group had a significantly lower proportion of hypoglycemic FSG per patient (0. 003 vs 0. 008, p=0. 044). Patients in the protocol group had more euglycemic FSG per patient, but this did not reach significance (0.413 vs 0.350, p=0.239). Similarly, the proportion of mild hyperglycemic FSG per patient trended lower in the protocol group (0.315 vs 0.272, p=0.291). There were no significant differences in severe hyperglycemia per patient (0.311 vs 0.328, p=0.828). The protocol group had a significantly higher utilization of basal-bolus insulin regimen (n=43 vs n=63, p<0. 0001) with an increase percentage of bolus insulin utilization in peak total daily dose (70.2% vs. 62.4%, p=0. 08). Total peak day insulin dose trended lower in the protocol group (0.25 vs 0.32 U/kg, p=0.36).

Conclusion

A novel insulin protocol for the management of GC-induced hyperglycemia in hospitalized COVID-19 patients is an effective tool to achieve reductions in hypoglycemic events and higher utilization of standard of care basal-bolus insulin regimens without increased hyperglycemia or total daily dose of insulin.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN288 Improved Glycemic Control Following Oophorectomy In A Post-menopausal Woman With Ovarian Hyperthecosis
Authors: Learned Brooke Noelle , Eschler Deirdre Cocks , Obici Silvana
Published: November 2022

Introduction

While androgens are associated with decreased risk for type 2 diabetes in males, the opposite is seen in females. Despite this, a "chicken or the egg" argument exists regarding hyperandrogenism and insulin resistance in women. Ovarian hyperthecosis, a condition that mostly affects post-menopausal women, causes androgen excess due to hyperplasia of the theca interna of the ovaries. Akin to polycystic ovarian syndrome, it is associated with obesity and insulin resistance. We describe a case of ovarian hyperthecosis in a woman with type 2 diabetes with improved glycemic control following oophorectomy.

Case

A 63-year-old post-menopausal female with a history of autoimmune hepatitis, primary biliary cirrhosis, and chronic pancreatitis presented for recently diagnosed type 2 diabetes, discovered on routine point-of-care Hemoglobin A1c (HbA1c) testing in December 2020 (HbA1c 7.1%, weight: 86 kg). In January, she started repaglinide which was titrated to 2 mg with meals, also that month started prednisone for autoimmune hepatitis. Despite tapering doses of prednisone, her hyperglycemia paradoxically worsened and persisted following completion in June. In May, HbA1c was 7.8%. In August, she endorsed hirsutism, present for 2 years but worsening over the past few months. Labs showed elevated total testosterone (508 ng/dL), free testosterone (32.7 pg/mL), and androstenedione (305 ng/dL), with normal sex hormone binding globulin. DHEA-S was low (28.9 ug/dL, range: 29.4-220.5), midnight salivary cortisol was elevated (0.12 mcg/dL; range: <0. 09), and morning serum ACTH and cortisol were within normal range, with appropriate suppression to dexamethasone. Estradiol was above post-menopausal range (68.1 pg/mL; range: <6. 0-54.7). FSH and LH were within the post-menopausal range, with an approximate 1: 1 ratio. A pelvic ultrasound revealed two intramural myomas and a simple cyst of the right ovary, but otherwise unremarkable. She underwent bilateral salpingo-oophorectomy in October 2021. Post-surgical total testosterone was 27 ng/dL. Surgical pathology revealed unremarkable fallopian tubes and bilateral stromal hyperplasia and hyperthecosis of the ovaries. At one month follow-up, HbA1c was 6.5%, weight decreased from 89 kg pre-surgery to 86, and she endorsed improved hirsutism but frequent hypoglycemia on repaglinide 2 mg with meals. Repaglinide was decreased to 0.5 mg with meals. Three months later, HbA1c was 6.3% with unchanged weight.

Conclusion

Improved glycemic control, corresponding with timing of oophorectomy but not discontinuation of steroids, suggests insulin resistance in this case may be due to hyperandrogenism. Though some studies and case reports suggest hyperandrogenism causes insulin resistance, others suggest the contrary. The relationship between androgens and insulin sensitivity is likely complex, and further research is necessary.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP160 ADCES7 Guidelines and Free Diabetes Apps: Do They Help Our Patients?
Authors: Wu Gloria , Xia Alexander , Zhao Weichen , Tien Katherine , Chien Daniel
Published: November 2022

Background

In 2020, 34.2 million US adults had diabetes and 88 million had pre-diabetes. 1 The ADCES7 guidelines are aimed at self-care and use 7 criteria: Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risk, and Problem Solving. 2 Purpose: Do Diabetes Apps Fulfill ADCES7 Guidelines to Meet Patient Needs? Methods: We used the search term "diabetes" in the Google Play store (Android/AD) and Apple App store (iOS) to compile a list of the most popular, free Android and iOS apps. Inclusion criteria: Free, English language,>100,000 Android downloads(DL),>1,600 iOS reviews(RE). iOS apps only provide the number of reviews and no download data. ADCES7 Parameters: 1) Goal setting; 2) Calorie counting; 3) Nutrition education; 4) Exercise reminder; 5) Medication reminder; 6) Blood glucose; 7) Weight; 8) Blood pressure; 9) HbA1c; 10) Problem solving; 11) Reducing risk; 12) Insulin information; 13) Insulin pumps information; 14) Non-English options.

Results

AD(DL): 1-mySugr(1M),2-OnetouchReveal(1M),3-DiabetesBloodSugar(1M),4-BloodGlucoseTracker(500K),5-Diabetes(500K),6-Health2Sync(500K),7-DiabetesM(500K), 8-GlucoseBuddy(500K), 9-BeatDiabetes(100K), 10-DiabetesDiary(100K); iOS(RE): 1-OnetouchReveal(87K), 2-GlucoseBuddyDiabetesTracker(21K), 3-Onedrop(20K), 4-GlucoseBloodSugarTracker(17K), 5-Livongo(13K), 6-mySugr(9.6K), 7-Sugarmate(9.4K),8-Klinio(3K), 9-Glooko(2.2K), 10. Diabetes Logs (1.6K). Features: Goal setting=9/20 apps (AD=4, iOS=5); Calorie counting=10/20 apps (AD=5, iOS=5); Nutrition education=9/20 apps (AD=3, iOS=6); Exercise reminder=7/20 apps (AD=2, iOS=5); Medication reminder=11/20 apps (AD=5, iOS=6); Blood glucose=18/20 apps (AD=10, iOS=8); Weight=9/20 apps (AD=6, iOS=3); Blood pressure=10/20 apps (AD=6, iOS=4); HbA1c=11/20 apps (AD=6, iOS=5); Problem solving=12/20 apps (AD=8, iOS=4); Reducing risk=7/20 apps (AD=5, iOS=2); Insulin info=7/20 apps (AD=3, iOS=4); Insulin pumps info=1/20 apps (AD=0, iOS=1); Non-English options=12/20 apps (AD=3, iOS=9) Conclusion: Current apps use some ADCES7 guidelines. 2 As healthcare providers, we can provide guidance and oversight when our patients use current apps for diabetes self-care and diabetes . References: CDC. National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed January 17, 2022. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html ADCES7 Self-Care Behaviors- The Framework for Optimal Self-Management. Accessed January 17, 2022. https://www.diabeteseducator.org/practice/practice-tools/app-resources/the-aade7-self-care-behaviors-the-framework-for-optimal-self-management

Presentation: No date and time listed
ODP167 Bell's Palsy As A Possible Post-Covid-19 Complication In Patient With Type 2 Diabetes
Authors: Kostitska Iryna , Matkovska Nataliya , Hutsuliak Nadiia , Zherdova Nadiia , Piddubna Antonina , Zhurakivska Oksana , Zhurakivska Olga
Published: November 2022

Background

Diabetes is associated with increased risk of post COVID-19 infection complications which has been postulated to be due to uncontrolled carbohydrate, fat metabolism and raised insulin resistance. Bell's palsy (BP) is an idiopathic unilateral facial paralysis that constitutes the most common cause immune response after a viral infection.

Clinical Case

A 48- years-old male with type 2 diabetes (BMI-35,3 kg/m 2,HbA1C- 7.6%). He was on regular treatment with metformin(daily doses (DD)– 1500 mg)for the last five years. Before 4 months for hospitalization in the patient was positive nasopharyngeal polymerase chain reaction (PCR) test for SARS-CoV-2 and he didn't develop clinical symptoms of COVID-19, that confirmed asymptomatic coronavirus disease. The male had no history of trauma or systemic infection, and presented no skin eruptions compatible with herpes zoster infection. There were asymmetric wrinkling of the forehead inability to raise the right eyebrow, failure to close the right eyelid, and right deviation of the angle of the mouth (right-sided droop), suggesting right seventh cranial nerve palsy of lower motor neuron type. Signs of meningeal irritations were absent. The neurologist confirmed the diagnosis of right unilateral BP. On hospital stay the patient was treated: metformin (DD – 2000 mg), dapagliflozin (DD – 10 mg), and subcutaneous insulin degludec (DD – 22 units); oral prednisolone at 40 mg/day for one week, which was subsequently tapered to 35 mg/day for 7 days and 30 mg/day for the next 7 days, with a total of 2 months of treatment and assigned to 15 sessions of acupuncture treatments during 10 minutes 5 times/week. The result discussion of clinical studies that diabetes was not a poor prognostic indicator if treated with corticosteroids in diabetic BP patients. Facial palsy started improving after 15 days of admission, and throat swab PCR for SARS-CoV-2 came negative during hospitalization. He was discharged on the 23th day of admission. After3 months, the treating team contacted the patient by phone and realized that he was in good condition, and his facial weakness had improved significantly. However, there are still some residual weaknesses. The sixth months therapy resulted in patient's recovery functions of right seventh cranial nerve and compensation of type 2 diabetes was achieved (HbA1C-7. 0%).

Conclusion

We assume that our patient got BP secondary to post-COVID-19 complication. These findings support the use of corticosteroids and sessions of acupuncture when necessary for treatment of post-COVID-19 neurological complications in subjects with diabetes. We believe that further research should be conducted to clarify the pathogenic association between COVID-19 and BP in patients with type 2 diabetes and improve algorithm of treatment.

Presentation: No date and time listed
ODP185 Diabetic Retinopathy Prevalence in Pediatric Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Authors: Cioana Milena , Deng Jiawen , Nadarajah Ajantha , Hou Maggie , Qiu Yuan , Chen Sondra Song Jie , Rivas Angelica , Toor Parm Pal , Banfield Laura , Thabane Lehana , Chaudhary Varun , Constantine Samaan M
Published: November 2022

Type 2 diabetes mellitus (T2DM) is on the rise in children and adolescents. Diabetic retinopathy (DR) is a leading cause of blindness in adult patients with diabetes. However, the exact prevalence of DR and its determinants in pediatric patients with T2DM are unknown. Understanding the burden of DR in pediatric T2DM can help inform screening and management clinical practice guidelines. This systematic review and meta-analysis aimed to determine the prevalence and determinants of DR in pediatric T2DM. The main outcome was the pooled prevalence of DR in pediatric T2DM. Other important outcomes included the assessment of the impact of diabetes duration, method of retinopathy diagnosis, sex, race, and obesity on prevalence. We searched MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and the grey literature from inception until April 4, 2021 for relevant data. No language restrictions were applied, and searches were limited to human studies. Two reviewers independently screened for studies of T2DM patients diagnosed <21 years of age with observational study design and ≥10 participants. Risk of bias evaluation was performed and level of evidence analysis was conducted using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was used to pool the results. Out of 1849 screened studies, 24 studies met the inclusion criteria. The overall prevalence of DR in pediatric T2DM was 6.58% (95%CI 3.46-10.46, I 2 =96%,n=9026). Most cases were classified as minimal or mild non-proliferative DR. Six cases were sight-threatening. Prevalence was higher in studies using fundoscopy than fundus photography to evaluate DR (0.47% [95%CI 0. 00-3.30, I 2 =0%,n=135] vs. 18.20% [95%CI 7.92-31.28, I 2 =89%,n=718]), suggesting that fundus photography was more sensitive in detecting DR than fundoscopy. The risk of DR rose progressively post-diagnosis; while1.25% (95%CI 0. 00-4. 01, I 2 =13%,n=213) of patients had DR <3 years post T2DM diagnosis, this figure rose to33. 03% (95%CI 25.79-40.66, I 2 =0%,n=162) >5 years after diagnosis. Obesity and sex did not impact DR prevalence. White/Middle Eastern patients had a DR prevalence of 7.43% (95%CI 0. 00-31.37; I 2 =97%,P <0. 001, n=4419),while Asians had a higher prevalence of 14.85% (95%CI 0.91-39.16; I 2 =93%,P <0. 001, n=501). In conclusion, DR is a frequent complication in children and adolescents in the early years post T2DM diagnosis. Screening for DR at diagnosis and annually thereafter using fundus photography is critical to allow early detection and management to prevent visual impairment in these patients.

Presentation: No date and time listed
ODP191 Efficacy of Protocol Based Insulin Dosing in Post-Surgical Hyperglycemia Management of Kidney Transplant Recipients
Authors: Zia Maryam , Ullal Jagdeesh , Donihi Amy , Sood Puneet , Wu Christine , Delisi Kristin , Hlasnik Deborah
Published: November 2022

Background

Post-operative renal transplant recipients with diabetes mellitus are managed by ad hoc insulin regimen which is highly variable among providers and transplant centers. We implemented a standardized insulin dosing protocol after renal transplantation based on several key variables particularly post-transplant steroid use.

Methods

The standardized insulin dosing protocol was implemented on July 1st, 2020. Patients with a history of diabetes mellitus who underwent renal transplants from July 2020-July 2021 were reviewed. After being seen by the endocrinology consultation service, a weight-based insulin dosing protocol based on corticosteroid dose was started and continued for 5 days postoperatively. As a control, data from patients who underwent renal transplantation between January 2019 to December 2019, and were seen by endocrinology for post-op hyperglycemia management, was collected in an identical fashion.

Results

The post protocol implementation group (N=39) had an average age of 59.6 and of BMI 31 kg/m2 with the majority being type II diabetes mellitus (84%). The control group (N=40) had an average age of 60.4 and BMI of 33 kg/m2. Type II diabetes mellitus similarly represented at 82%. Post-op inpatient target blood glucose was 101-180. Fasting and postprandial blood glucose (BG) data were gathered after chart review. Five hundred fifty-five fasting blood glucose (FSBG) checks were included for post protocol group vs 628 for the control group. Blood glucose was within the target range 37.8% for the protocol group and 28.9% for the control group. There were 8 (1.4%) hypoglycemic episodes (BG <70) in intervention group vs 5 (0.79%) in control group. Hyperglycemia was stratified into 3 tiers: 181-220, 221-300, >300. Hyperglycemia (BG 241-300) was observed 14.9% in the post protocol group vs 22.7%. Severe hyperglycemia (BG>300)was documented in 7.3% post protocol vs 15.6%. Among the post protocol group, no patient was started on insulin drip whereas 5 patients were started on insulin drip in the control groups.

Conclusion

Renal transplantation patients are susceptible to hypo- and hyperglycemic events leading to poor graft outcomes. Glycemic control is central in reducing event rates. Post renal transplantation diabetes management using a graded insulin protocol in accordance with steroid dosing was highly efficacious in our academic medical center. Using a standardized insulin protocol patients demonstrated superior glucose control and less IV insulin usage.

Presentation: No date and time listed
ODP200 Fyn is involved in the development of diabetic kidney disease by modulating autophagy
Authors: Uehara Ryota , Yamada Eijiro , Horiguchi; Kazuhiko , Yamada Masanobu
Published: November 2022

Diabetic kidney disease (DKD) is one of the major diabetic complications and the leading cause of the end stage renal disease. Recently autophagy was shown to regulate DKD. Previously we reported that Fyn regulates muscle mass by suppressing autophagy through Fyn-STAT3 signaling pathway. More recently, we demonstrated that Fyn also inhibits autophagy in HK2 cells, in vitro cell model of renal proximal tubular epithelial cells (RPTC). Moreover, we found Y369 of Tgm2, a known inhibitor of autophagy, is directory phosphorylated by Fyn both in vitro and in cells and Fyn-dependent phosphorylation of Tgm2 regulates autophagy in RPTC. It has been reported that Tgm2 forms complexes with p53 and p62 (a known autophagy regulator) to mediate the degradation of p53 at autophagosomes in cancer cells. To note is that p53 could function as a DKD inducer. We found that p53 expression was decreased in Tgm2 knock-downed HK2 cells, suggesting that Tgm2-p62-p53 complex also modulates autophagy in RPTC. Since these were only in vitro studies, we proceeded with those in vivo. In HFD fed mice, diet-induced rodent models of metabolic disorders, we found that protein expression of p53 was increased due to decreased levels of autophagy implicated by decreased p62 punctuations in RPTC. To confirm the role of Fyn in autophagy and p53 expression we took advantage of a diabetic mouse model of FynKO mice induced by Streptozocin(STZ). While p53 was increased in the kidney of diabetic WT mice induced by STZ, it was not the case in the kidney of diabetic FynKO, indicating that Fyn could regulate autophagic activity and p53 expression. Taken together, these data suggest that the metabolic status may regulate Fyn to phosphorylate Tgm2 and modulate Tgm2-p62-p53 complex leading to the development of DKD. This regulatory mechanism is not mediated by blood glucose and may lead to the new therapeutic targets for diabetic kidney disease regardless of control of diabetes.

Presentation: No date and time listed
ODP211 Impact of Race and Chronic Kidney Disease on the Correlation between HbA1c and Continuous Glucose Monitoring (CGM) Glycemic Measures
Authors: Kaplan Leah , Anwar Kanwal , Pittas Anastassios
Published: November 2022

Objective

To determine whether the correlation between hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) derived glycemic measures differs by patient race and stage of chronic kidney disease (CKD).

Methods

Two hundred thirty patients with type 1 or type 2 diabetes and a minimum of 10 days of CGM data collected with the Freestyle Libre CGM (personal or professional) immediately before measurement of HbA1c were included in this clinic-based observational study. The correlation between HbA1c and CGM derived glycemia was analyzed by race and by CKD stage. Similar analysis was performed between HbA1c and CGM derived time-in-range (TIR, glucose 70-180 mg/dL).

Results

Mean age ± SD of patients was 63 ± 14 years. 45.7% of patients self-identified as White, 31.3% as Asian, and 15.7% as Black; 84.3% of patients had type 2 diabetes and mean HbA1c was 7.9%. The mean [range] number of CGM days was 40.5 [10-90]. Correlation between HbA1c and CGM mean glycemia for all patients was r=0.75. Correlations for White, Asian and Black patients were 0.84, 0.75, and 0.54 respectively. Correlation between HbA1c and CGM mean glycemia among CKD stage 1, 2 and 3 was 0.894, 0.723 and 0.717, respectively (all patients, regardless of race). Correlation between HbA1c and TIR was r=-0.71 for all patients. Correlations between HbA1c and TIR for White, Asian, and Black patients were -0.78, -0.73 and -0.42, respectively.

Conclusions

The correlation between HbA1c and CGM mean glycemia appears to differ by race and CKD stage. These results have implications when using correlations between HbA1c and CGM mean glycemia to derive equations for the Glucose Management Indicator.

Presentation: No date and time listed
ODP215 Insulinoma Evaluation Before and After Development of End Stage Renal Failure: A Case Report
Authors: Pattison Jillian , Merrill Jennifer
Published: November 2022

Introduction

Fasting hypoglycemia in chronically ill patients with kidney disease is frequently multifactorial. Patients with chronic kidney disease are prone to hypoglycemia due to decreased renal clearance of insulin, impaired renal gluconeogenesis and increased prevalence of other medical problems and medications. However, ruling out the presence of an insulinoma can be difficult in this patient population due to the impact of kidney disease on laboratory evaluation of hypoglycemia.

Case

A 43-year-old male with history of paraplegia from gunshot wound, neurogenic bladder, colostomy, chronic osteomyelitis, frequent polymicrobial bacteremia was noted to have persistent, asymptomatic hypoglycemia during multiple inpatient hospitalizations dating back to 2007. He was taking no medications associated with hypoglycemia. Following normal ACTH stimulation and thyroid testing, he underwent a 72-hour fast in 2017 when his creatinine was 1.32 mg/dL and GFR was >60; BMI was 22.32 kg/m 2 with prealbumin of 15 mg/dL. The fast was concluded after 23.5 hours with serum glucose of 46 mg/dL, insulin level of 3.1 uIU/mL, c-peptide of 2.4 ng/mL, undetectable proinsulin, and beta-hydroxybutyrate of 0.62mmol/L and a negative sulfonylurea screen. Administration of glucagon at time of fast completion improved glucose to 65 mg/dL. He was started on diazoxide 85mg every 8 hours during that hospitalization, which he discontinued without medical recommendation in 2018. He developed end stage renal disease requiring hemodialysis in 2019. During an admission in 2020, serum fasting glucose as low as 30mg/dL. Further laboratory evaluation at that time revealed glucose of 47 mg/dL, with insulin level 39.1 uIU/mL, c-peptide 18.2 ng/mL, and proinsulin of 20.1 pmol/L. Multiple CT abdomen imaging studies confirmed normal pancreas. Diazoxide 110mg every 8 hours was resumed and patient had decreased frequency of hypoglycemia episodes. Diazoxide has since the tapered to 80mg twice daily without increase in hypoglycemia frequency, with goal to taper further in the future.

Conclusion

Here we present the case of an individual patient who underwent laboratory evaluation of hypoglycemia before and after development of end stage renal disease with profound differences in lab results despite similar degree of hypoglycemia. It has been demonstrated previously that c-peptide and insulin levels are elevated in patients with end stage renal disease and that these labs decrease with hemodialysis while remaining above normal range. The elevation of c-peptide in this population is thought to be due to the kidney being the main site of beta-cell polypeptide degradation. Additionally, this case suggests successful use of diazoxide therapy in patients without classic endogenous hyperinsulinism.

Presentation: No date and time listed
ODP221 Late-Onset Hypoglycemia in a Patient with Fatty Acid Oxidation Disorder
Authors: Pessoa Carolina Mendes , Faisal Sobia , Madhavan Parvathy
Published: November 2022

Background

Multiple acyl-CoA dehydrogenase deficiency (MADD) is a disorder of fatty acid and protein metabolism due to a defect in electron transfer flavoprotein or in electron transfer flavoprotein dehydrogenase, and can present with hypoglycemia as a component of its clinical phenotype. We describe a rare case of hypoglycemia due to MADD with unusually late onset at age of 63 years. Clinical case: 63-year-old female with history of hypertension and depression, admitted to the hospital with a several month history of progressive weakness resulting in inability to walk, lightheadedness, unintentional 40-pound weight loss and oropharyngeal dysphagia to solids. On exam, she was noted to have predominant cranial neuropathies and proximal muscle weakness. Patient was found to be hypoglycemic to 47 mg/dL [75-200], with a lactic acidosis of 2.1 mmol/L [0.5-1.9], elevated CK of 630 U/L [22-269], elevated aldolase of 12.7 U/L [1.5-8.1], and increased beta-hydroxybutyrate of 2.9 mmol/L [<0.3] along with transaminitis without cholestatic pattern. Fasting insulin level was 6 uIU/mL [3-19], C-peptide was low normal 1.1 ng/dl [0.8-3.5] with corresponding glucose of 57 mg/dl. Proinsulin level and sulfonylurea panel were unremarkable, and insulin antibodies were negative. Adrenal insufficiency was ruled out with normal cosyntropin stimulation test. IGF-1 and IGF-2 levels were also within normal limits. CT scan of the head, abdomen and pelvis did not evidence any issues. Furthermore, prior to this admission, patient had extensive work-up done for generalized weakness including evaluation for myasthenia gravis, myositis, HIV, thyroid disease, and other autoimmune conditions which was unrevealing. A muscle biopsy was performed with patology suggestive of a lipid storage disorder. Genetic testing only demonstrated variants of uncertain significance in LARGE1, PLEC and TTN genes. Additional testing revealed elevated serum concentrations of short, medium and long chain acylcarnitine species. Urinary organic acids were also increased with predominant elevation of 2-hydroxy-glutaric, ethylmalonic, adipic and suberic acids. This pattern, along with increased plasma acylcarnitine is typically associated with multiple acyl-CoA dehydrogenase deficiency. Serum free fatty acids were also high, supportive of MADD as previously reported in some cases. She was started on high-dose riboflavin replacement and advised to ingest a low-fat, low-protein diet, with frequent feeding and blood glucose monitoring.

Conclusion

MADD is a rare cause of hypoglycemia in adults. It is important to consider this condition as a differential diagnosis of hypoglycemia associated with generalized weakness even in older individuals.

Presentation: No date and time listed
ODP223 Metabolic efficacy of Very Low Carbohydrate Diet in DKD patients
Authors: Zainordin Nur Aisyah , Wee Chen Xin , Ghani Rohana Abdul , Ismail Nafeeza Mohd , Ismail Nazrul Hadi
Published: November 2022

Introduction

Obesity is strongly linked to the development of diabetic kidney disease. Very low carbohydrate diets (VLCBD) were associated with a reduction in weight but there is little evidence of its effects on diabetic kidney disease (DKD) patients. The aim of the randomized controlled trial study is to determine the metabolic effects of VLCBD in addition to low protein diet (LPD) in DKD patients.

Materials and Methods

30 patients with type 2 diabetes aged 40-75 years and a HbA1c 7-10.5% were randomly allocated to receive VLCBD (<20g daily intake) versus standard low protein (0.8g/kg/day) diet. The patients received consultations every two weeks for 12 weeks. Metabolic profiles, glycemic control, inflammatory markers and visceral adipose tissue mass effects of the dietary interventions were compared. Result: The VLCBD group demonstrated significant reductions in weight (-4. 0 IQR 3.9 vs 0.2 IQR4.2 kg, p=<0. 001) and BMI (-1.5 IQR 1.18 vs 0. 074 IQR 1.54, p=<0. 001) in comparison to LPD group. There was reduction in waist circumference within both groups (- 4. 0 IQR 5.25, p= 0. 003 and -2. 0 IQR 3.6, p=0. 009) respectively. Estimated visceral adipose tissue mass and volume were significantly reduce in VLCBD group. There was significant reduction in ALT and GGT in both group. However, there is no significant changes in improvement in liver US in both groups. However, both group also showed significant reduction in HbA1c (-1.3 IQR 1.1% vs -0.7 IQR1.25%, respectively, p=NS). There is significant increment in LDL in VLCBD group which not present in LPD group. The VLCBD group showed a significant reduction in IL-6 levels with a contrasting rise within the LPD group (-1.53 IQR3.35 vs 0.46 IQR 1.95, p= 0. 028). Patients in VLCBD appeared to have improvement in physical activity score in comparison to LPD group.

Conclusion

After short term intensive VLCBD intervention in DKD patients, improvement were observed in metabolic markers, diabetes status and inflammatory markers with improvement of physical activity score.

Presentation: No date and time listed