bluuebunny/crossref_metadata_2025 huggingface dataset:
1021-P: Targeting Lower LDL Levels in Patients with Diabetes and ASCVD through a Novel Healthy Heart Program
Authors: ANTUNEZ EFRAIN , KENNEY ROBERT E. , AGUILAR RICHARD , MCCLOSKEY VERONICA , RIVERA JUAN
Published: June 2023

The US prevalence of ASCVD with DM in the elderly has been reported to be 50%. This population is at significant risk for future CV complications. (1) Aggressive management of dyslipidemia in the primary care setting should be a central focus to reduce associated morbidity and mortality. (2) Current US LDL targets for pts with DM are < 70 mg/dl. Recent ESC/EAS Guidelines in pts with DM and ASCVD, defined as a very high risk (VHR) population, target LDL levels at <55 mg/dl. (3) This study evaluates the impact of a protocol driven program, Healthy Heart (HH), in achieving lower LDL levels in elderly Medicare Advantage pts with DM and ASCVD in the primary care setting. The HH program is a pre-defined intervention protocol administered by specially trained APRNs in primary care offices, with cardiology oversight. Continuity with PCP directed care was maintained. At each visit, ASCVD risk factors were measured and managed along with recommended lifestyle modification. In the first year, 421 pts referred to HH had DM with established ASCVD. Baseline and final LDL values along with high intensity statin (HIS) use are reported. Demographics: Mean age 75+/-5.9 YO, 69% F, 84% Hispanic/Latino, <1% AA, BMI 30.0+/-5.3 kg/m², previous CABG 38%, CHF 24%, Carotid AD 23%, and prior stroke/TIA 3%. Mean time between baseline and final LDL was 320+/-107 days. The average number of HH visits was 3.5+/-1.7. Results: At baseline, 12.5% of the cohort had an LDL of <70 mg/dl, significantly improving to 55.1% after intervention. For the lower LDL target of <55 mg/dl, 10.6% of the cohort were at target improving to 29.2%, the use of HIS therapy improved from 40.3% at baseline to 84.3%. All findings were significant (P< 0.0001).

Conclusion: Using a pre-defined protocol administered by APRNs in a primary care setting significantly improved the percentage of VHR patients achieving LDL targets of <70 and <55 mg/dl. The use of HIS more than doubled. Additional study to evaluate clinical outcomes is warranted.

Disclosure

E.Antunez: None. R.E.Kenney: None. R.Aguilar: None. V.Mccloskey: None. J.Rivera: None.
1026-P: Impact of Online CME on Planned and Actual Practice Changes Related to CGM Use
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE
Published: June 2023

Objective: Assess impact of online education to prompt changes in practice of diabetologists/endocrinologists (D/Es), PCPs and CDEs related to use of real-time continuous glucose monitoring (rtCGM) in practice.

Method: Online summary of a symposium presented at the ADA 2021 Conference. Faculty presentation was reinforced with synchronized slides presenting supportive data. The impact of the education measured with a survey immediately post-education to assess planned changes in clinician practice as a result of participation in CME activity. Survey participants were contacted 8 weeks later to assess self-reported actual changes in practice. The activity launched August 3, 2021 and data were collected through June 29, 2022. Results: A total of 324 clinicians in the target audience completed the survey immediately post-education. • 74 D/Es, 141 PCPs, and 109 CDEs • 33% of D/Es, 10% of PCPs, and 17% of CDEs treat more than 30 patients per week with diabetes • 92% of respondents indicated an average of 3.1 planned practice changes each When re-engaged with the follow up survey, 15 completed the survey. • 6 D/Es and 9 PCPs • 67% of D/Es and 56% of PCPs treat more than 30 patients per week with diabetes • Of those, 93% reported making an average of 4.8 changes in practice as a result of this activity • Changes in practice include: o Recommending CGM in patients who want to improve time in range and minimize hypoglycemia (100% D/Es and 78% PCPs) o Recommending CGM in patients with diabetes on insulin (100% D/Es and 67% PCPs) o Increasing familiarity with clinical trial data related to CGM use (83% D/Es and 67% PCPs) o Target time in range with diabetes-related treatment goals (83% D/Es and 44% PCPs) Conclusion: The outcomes gathered in this assessment provide compelling evidence that participation in online CME prompts both planned and actual changes in practice related to CGM use. Future education is needed for PCPs regarding time in range goals as part of a diabetes treatment plan.

Disclosure

A.Larkin: None. J.Schrand: None. A.Le: None.

Funding

Dexcom, Inc.
1027-P: Lower Admission HbA1c Is Associated with Lower Likelihood of SGLT-2 Inhibitor or GLP-1 Agonist Prescription in Patients with Type 2 Diabetes after Myocardial Infarction
Authors: MALLADI CHAITANYA L. , SUMARSONO NATHAN , DELLA-PENNA PAIGE L. , DWEIK ASEEL A. , GEURINK KYLE , MATHEW CHRIS , MOSS ELIZABETH , PEYKOVA KREMENA , MACK-BOYD LISA , DAS SANDEEP
Published: June 2023

Introduction: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We examined prescription rates of these medications stratified by hemoglobin A1c at time of index MI admission in a large urban safety net teaching hospital which provided these medications to low income patients at nominal cost.

Methods: Using the hospital EHR, we reviewed medication lists one year after discharge for all patients with T2D who were hospitalized with type 1 MI between 2018-2019.

Results: There were 178 patients with one-year follow-up data, of which 75 (42%) were uninsured. As shown in Figure 1, proportions of patients prescribed SGLT2 and GLP1 at one year increased with higher admission A1c (p = 0.009 and p = 0.07, respectively). Median A1c at time of index MI was higher in those prescribed SGLT2 (9.3 vs 8.0, p = 0.03) and GLP1 (10.1 vs 8.1, p = 0.07) at one year versus those were not.

Conclusion: Patients with higher A1c at the time of MI were statistically significantly more likely to be prescribed SGLT2 and numerically more likely to be prescribed GLP1 one year after MI. These results suggest that a focus on glycemic control may be contributing to suboptimal use of these MACE-reducing medications in patients who would be expected to benefit from them.

Disclosure

C.L.Malladi: None. S.Das: None. N.Sumarsono: None. P.L.Della-penna: None. A.A.Dweik: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.
103-LB: Impact of Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) in COVID-19 Patients with Preexisting Type 2 Diabetes (T2D) and Cardiovascular Disease (CVD)
Authors: NGUYEN CHI , CROWE CHRISTOPHER L. , KUTI EFFIE , DONATO BONNIE M.K. , DJARAHER RACHEL L. , SEMAN LEO J. , GRAETER NANCY , POWER THOMAS P. , WILLEY VINCENT
Published: June 2023

Objective: CVD is the leading cause of death and disability among individuals with T2D. National guidelines recommend an SGLT2i or GLP-1 RA in patients with T2D who have or are at high risk for CVD. This study examined the impact of SGLT2i or GLP-1 RA on clinical outcomes in patients with pre-existing T2D+CVD who developed COVID-19.

Methods: Adult patients with T2D+CVD who developed COVID-19 during 03/01/20-05/31/22 and had ≥1 year of health plan enrollment before the COVID-19 diagnosis were identified from the Healthcare Integrated Research Database (HIRD®). Eligible patients were classified as guideline concordant or not based on SGLT2i or GLP-1 RA prescription fills in the year before COVID-19 infection. COVID-19 related and all-cause hospitalization, ICU admission, and mortality were compared between SGLT2i or GLP-1 RA users and non-users. Propensity score (PS) matching and multivariable analyses were performed.

Results: A total of 42,646 COVID-19 patients with T2D+CVD were identified with a mean follow-up of 8.6 months. The use of SGLT2i or GLP-1 RA was low (n=8,498; 20%). Patients receiving SGLT2i or GLP-1 RA were younger, had fewer comorbidities, took more CVD prevention medications, and were less likely to be hospitalized during the year before COVID-19 infection than non-users. After PS matching and multivariable adjustment, T2D+CVD patients with COVID-19 who received SGLT2i or GLP-1 RA were 12% less likely to be hospitalized and 10% less likely to be admitted to the ICU due to COVID-19 compared to those who did not (n=8,479 each group; both p<0.05). Reductions were also observed for all-cause hospitalization (6%), ICU admission (7%), and mortality (10%), but the results were not statistically significant.

Conclusion: The findings suggest that SGLT2i and GLP-1 RA may improve outcomes in T2D+CVD patients with COVID-19 and support existing national guidelines.

Disclosure

C. Nguyen: Employee; HealthCore Inc. C. L. Crowe: Employee; HealthCore Inc. E. Kuti: Employee; Boehringer Ingelheim Inc. B. M. K. Donato: Employee; Boehringer Ingelheim Pharmaceuticals Inc. R. L. Djaraher: None. L. J. Seman: Employee; Boehringer Ingelheim Pharmaceuticals Inc. N. Graeter: None. T. P. Power: None. V. Willey: Other Relationship; Novo Nordisk A/S.

Funding

Boehringer Ingelheim
1040-P: Feasibility and Performance of Continuous Glucose Monitoring (CGM) to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit (CV-ICU)
Authors: ANG LYNN , AKANBI FOLAKE , SCHROEDER LEE F. , KUEI LIN YU , DEGEORGE CHRISTINA A. , ARNOLD PATRICK , KNOTTS SHARON , DUBOIS ELIZABETH , DESBROUGH NICOLE , QU YUNYAN , FREEMAN REGI , ESFANDIARI NAZANENE H. , BUSUI RODICA , GIANCHANDANI ROMA
Published: June 2023

We evaluated the utility of real-time CGM for titrating intravenous (IV) insulin via a validated institutional computerized insulin infusion (CII) algorithm in the CV-ICU. We used a hybrid approach of combining CGM with periodic point-of-care blood glucose (POC-BG) tests to validate the continued accuracy of CGM. We also surveyed nurses on this care change. Dexcom G6 CGMs were applied to 61 post-surgical patients with hyperglycemia (34% with diabetes) receiving IV insulin. CGM values were validated with POC-BG every(Q) 1-2 h per the CII protocol. Once validated (i.e., within 20% of POC-BG values if BG ≥100 mg/dL or within 20 mg/dL if BG <100 mg/dl), sensor values were then used to titrate IV insulin doses per CII algorithm. POC-BG checks were then reduced to Q6h validation. Among 857 paired POC-BG and CGM values analyzed, the mean and median average relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.6% of paired CGM and POC-BG were in Zone A and B of the Clarke Error Grid (Figure). Thirty nurse respondents found CGM very or quite convenient (n=28; 93%) and favored it over POC-BG testing (n=28; 93%). This pilot study demonstrates that using CGM via a hybrid approach for CII titration protocol is feasible, has high accuracy, and higher nursing convenience.

Disclosure

L.Ang: None. Y.Qu: None. R.Freeman: None. N.H.Esfandiari: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. R.Gianchandani: None. F.Akanbi: None. L.F.Schroeder: None. Y.Lin: None. C.A.Degeorge: None. P.Arnold: None. S.Knotts: None. E.Dubois: None. N.Desbrough: None.
1064-P: Pharm2Home Initiative—The Impact on Diabetes Management and Behavioral Changes
Authors: YOUNG CLIPPER F. , WONG SHIRLEY , MYUNG CHERRY
Published: June 2023

Objective: To evaluate whether the intervention program (telehealth and home visit) focusing on chronic disease management induces changes in clinical, psychological, and behavioral measures.

Methods: This program evaluation utilizes a pre-and-post-intervention comparison design. For detecting whether differences exist between the baseline data and the follow-up data for the various measures, paired t-test (for parametric data) and Wilcoxon signed-rank test (for non-parametric data) are used.

Results: Paired HbA1c data from 57 individuals (out of 122 enrolled participants) have been collected. 55% of the participants were non-White, and 88% were Medicaid recipients. The table below summarizes some of the evaluation measures (most data are collected at the end of the intervention period).

Conclusion: Our preliminary analyses show that program participants have achieved a significant HbA1c reduction with a significant increase in perceived self-efficacy in chronic disease management. In addition, the available behavioral data with statistical significance reveal that participants have changed their behaviors during the intervention relating to diabetes management. The preliminary analyses show some early signals that our intervention program has the potential to help participants better manage diabetes.

Disclosure

C.F.Young: Other Relationship; Abbott Diabetes. S.Wong: None. C.Myung: None.

Funding

Sutter Health
1067-P: The Association between Appointment Modality and Medication Management Discussions in High-Risk Older Adults with Type 2 Diabetes
Authors: DEGRACE SHANE , PETERSON ILANA , BOARD CHRISTINE , GRANT RICHARD W.
Published: June 2023

In older adults with type 2 diabetes (T2D), treatment with sulfonylureas (SUs) or insulin is associated with increased risk for severe hypoglycemia leading to falls, cognitive decline, lower quality of life, and death. Safe medication management in older adults requires effective and ongoing doctor-patient communication about self-management, glucose control, and other factors associated with hypoglycemia. In recent years, health care systems have increasingly relied on virtual appointments for chronic disease management. However, research has suggested that at-risk older populations may be less comfortable navigating these virtual spaces. We tested the hypothesis that older adults with T2D on SUs or insulin would be less likely to have conversations with their doctor about changes to diabetes medications during virtual visits (e.g., by video or telephone). Using data from an ongoing clinical trial (NCT04585191), we examined the association of visit modality with patient-reported medication discussions during the visit. We studied 180 Kaiser Permanente Northern California members (age = 81.1±3.8 years, Hba1c = 7.0±0.6%, 56% women, 73% on SUs). Visit modalities included in-person (n = 110, 61%), video (43, 24%), or telephone (27, 15%) appointments with their primary physician. We found that self-reported diabetes medication discussion did not differ by visit modality (48% vs. 44% vs 41%, p = 0.79). These results were unchanged after adjusting for demographic and clinical variables in a logistic regression model (p = 0.82). Qualitative analysis of open-ended surveys found that most adults (59/85, 69%) who engaged in these conversations considered them to be positive experiences that increased confidence in their treatment plan and satisfaction with their physician. Our results suggest that the ongoing expansion of virtual visit options does not deter older adults from discussing diabetes care with their doctor.

Disclosure

S.Degrace: None. I.Peterson: None. C.Board: None. R.W.Grant: None.

Funding

Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)
1075-P: Therapeutic Inertia of Glycemic Management in Hospital Setting
Authors: LINN AUNG NAY , BAPANA MARY J. , WIN KHAING , MAUNG ERICA , HANANI CHRISTOPHER , JHAVERI SAMEER , AMOS ASHTON , COVACI ANDREA , MARQUESS ALEXIS , LAPE MEGAN E.
Published: June 2023

Among hospitalized patients, glycemic variability, hyperglycemia and hypoglycemia are associated with increased mortality and other adverse outcomes. Therapeutic inertia, defined as failure to intensify or de-intensify when treatment goal is not met, is found as one of the major obstacles in achieving appropriate glycemic control in the outpatient setting. However, there are very scare data on therapeutic inertia among hospitalized patients with hyperglycemia. Our study looked at hyperglycemia (BG>200) and hypoglycemia (BG<70) rate in hospitalized patients with diabetes admitted in June of 2021 as well as the rate of intensification and de-intensification of insulin within 8 hours of abnormal BG level as defined above. Our study showed that there were treatment adjustment in only 20% of the day with abnormal BG level.

Disclosure

N.Aung: None. M.E.Lape: None. M.J.Bapana: None. K.Win: None. E.Maung: None. C.Hanani: None. S.Jhaveri: None. A.Amos: None. A.Covaci: None. A.Marquess: None.
1080-P: Missed Opportunities to Address Hypoglycemia Risk in Older Adults with Type 2 Diabetes during Symptom-Driven Primary Care Visits
Authors: TANG EMILY , PETERSON ILANA , BOARD CHRISTINE , GRANT RICHARD W.
Published: June 2023

Older adults with type 2 diabetes (T2D) treated with insulin and/or sulfonylureas (SUs) are at increased risk for hypoglycemia-related adverse events (e.g. falls, decreased quality of life, and death). Because aging is associated with changes in physiology, visual acuity, and dietary habits, diabetes treatment regimens require regular re-assessment. However, despite the importance of ensuring safe diabetes care in older adults, prior research has shown that diabetes is often not addressed during primary care visits due to limited time and competing demands. We tested the hypothesis that diabetes management in primary care occurs less frequently during visits scheduled for acute symptoms/concerns (i.e., “reactive visits”) vs. pre-scheduled annual/physical exam visits intended for health maintenance (i.e., “proactive visits”). We conducted structured chart abstraction for 123 older adults with T2D prescribed insulin and/or SUs to examine the association of visit context (reactive vs proactive) with physician-documented diabetes management, defined as any documentation of diabetes control, blood sugar levels, or diabetes-related medications. Patients were 78.6 ± 3.65 years old, 52.8% were women, pre-visit HbA1c was 7.4% ±0.9%. We found that diabetes documentation in these patients was much less frequent in reactive vs. proactive visits (50.7% vs. 69.8%, p = 0.02). In a logistic model, this association remained significant after controlling for demographic differences (aOR 2.4, 95% CI = 1.1-5.3). In this model, HbA1c ≥8% was also independently associated with diabetes documentation (aOR 3.3 [1.1-10.1]). Treatment with insulin or SUs exposes aging adults to a high risk of hypoglycemia, especially during times of change. Although chart documentation may underestimate actual visit interactions, our results suggest that visits made to discuss acute concerns are a missed opportunity to review and address diabetes care in high-risk patients.

Disclosure

E.Tang: None. I.Peterson: None. C.Board: None. R.W.Grant: None.

Funding

Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)
1085-P: Defragmenting Patient Care via a Multidisciplinary Diabetes Clinic
Authors: IQBAL ANIRA , CECILIA LANSANG M. , ZIMMERMAN ROBERT S. , ISAACS DIANA , BENA JAMES F. , MORREN JOHN , SINGH RISHI , THOMAS GEORGE , GRIEBELER MARCIO L. , PARKER MARCIE , SMITH-COLEMAN ARI , MARQUARDT ROBERT J. , MAIER MICHAEL A.
Published: June 2023

Aim : Diabetes mellitus (DM) care delivery is often fragmented because of logistical constraints. We examined if cohesive short-term multidisciplinary care improves diabetes-related outcomes.

Methods: This was a prospective, non-randomized pilot study. Adults with type 2 DM, A1C ≥8% and ≥1 comorbidity attended either 1) a multidisciplinary clinic (endocrinologist, pharmacist, diabetes educator/nutritionist and at least one specialty e.g. cardiology, nephrology, ophthalmology on the same/next day), or 2) conventional visits spread apart. A1C (primary outcome) and other variables were collected at baseline, 6 months (exit from active part of study), and 12 months (6 months from exit).

Results: There were 20 patients per arm (55.3% female, mean ± SD age 53.8 ± 11.3 y, BMI 40.1 ± 10.0 kg/m2, A1C 10.1 ± 2.1%). Of the patients that have reached the 6-mo mark so far, intervention group showed a significant decrease in A1C (n=14, from 10 ± 1.4 to 8.7 ± 1.8, delta -1.4 ± 1.4; p=0.003), while there was no significant change in the control group (n=6, from 9.6 ± 2.5 to 7.6 ± 1.3, delta -2.0 ± 2.9; p=0.15) (Figure 1).

Conclusion: The ADA endorses an evidence-based model of a collaborative, multidisciplinary team to provide care for people with diabetes. However, achieving this can be difficult in a large, progressively subspecialized healthcare system. Initial data from our study shows defragmenting patient care can improve A1C over a conventional model.

Disclosure

A.Iqbal: None. M.Parker: None. A.Smith-coleman: None. R.J.Marquardt: None. M.A.Maier: Speaker's Bureau; Smith+Nephew. M.Lansang: Research Support; Dexcom, Inc., Abbott, Alertgy Inc. R.S.Zimmerman: Speaker's Bureau; Xeris Pharmaceuticals, Inc. D.Isaacs: Speaker's Bureau; Dexcom, Inc., Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk. J.F.Bena: None. J.Morren: None. R.Singh: Consultant; Genentech, Inc., Iveric Bio, Alcon Research, LLC, Regeneron, Novartis, REGENXBIO Inc. G.Thomas: None. M.L.Griebeler: None.

Funding

Cleveland Clinic Healthcare Delivery & Implementation Science Center
1087-P: Managing Diabetes in the Delta—Effect of Access to Endocrinology Services in an Underserved Area
Authors: BRINDLEY CLAIRE , JAMES WESLEY , BENNETT JONATHAN R. , MATTHEWS KAREN F.
Published: June 2023

Background: The Mississippi Delta has one of the highest rates of diabetes in the nation, but patients in these rural, minority-majority counties have lower access to specialty care. At the start of a hybrid diabetes management program at two rural health clinics in the Delta, 53.1% of patients with diabetes had uncontrolled HbA1c levels. We analyze the specific effect of integrating endocrinology specialists into this intervention. Patients could access this care via telemedicine or in-person.

Methods: We conducted a quasi-experimental study with clinical data from electronic health records for patients diagnosed with diabetes or prediabetes (aged ≥ 18). We followed two cohorts of the same patients over time for the first 18 months of the program, each matched on elevated HbA1c levels (≥8% at baseline). The treatment group comprised program participants; the control group comprised general clinic patients at-risk of diabetes. We also followed patients in the treatment group who received endocrine services in addition to other program benefits.

Results: Among the control group, HbA1c increased an average of 0.04 points; the treatment group saw an average decrease of 0.42 points. The treatment group's endocrinology subset saw an even greater decrease of 0.85 points. The average HbA1c score for this group went down three points in a two-year period (7/20-7/22).

Conclusions: The study results indicate that receiving coordinated endocrinology services has been especially effective in reducing HbA1c levels among program participants. As care continuity is associated with better glycemic control for diabetic patients, sustained program participation will likely help the patient population best manage their diabetes and avoid further adverse health outcomes. Additionally, as this diabetes program takes place in a rural, low-income minority area with low access to specialty care, the results demonstrate promising practices for strengthening the rural health care system.

Disclosure

C.Brindley: None. W.James: None. J.R.Bennett: None. K.F.Matthews: None.

Funding

Health Resources and Services Administration, Federal Office of Rural Health Policy (HRSA-20-025, D06RH37500)
1093-P: Incretins and Cardiac Autonomic Function in Youth with Obesity across the Glycemia Spectrum
Authors: EL AYASH HEBA , BACHA FIDA
Published: June 2023

Incretins, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) have been related to vascular function with variable effects depending on obesity status in adults. The relationship of incretins to vascular function in youth is unclear. We hypothesized that endothelial and cardiac autonomic dysfunction (CAD) are related to lower GLP-1 and GIP in response to glucose ingestion in youth with dysglycemia compared with those with overweight (OW) or normal weight (NW) and normal glucose tolerance (NGT). Adolescents [50 male/52 female; 15.6±1.8 yrs; 24 NW-NGT, 22 OW-NGT, 27 prediabetes and 29 with type 2 diabetes (T2D)] underwent assessment of body composition (DXA scan), 2-hour oral glucose tolerance test (OGTT) with calculation of whole body insulin sensitivity index (WBISI), area under the curve (AUC) of glucose (BG), GLP-1 and GIP. Reactive hyperemia index (RHI), and heart rate variability (HRV), were measured by peripheral arterial tonometry. For HRV, a higher LF/HF (low frequency to high frequency ratio) is indicative of CAD with loss of parasympathetic tone and decreased HRV. The ratios of AUC-GLP-1 and AUC-GIP to AUC-BG were lower in the groups with dysglycemia compared NGT groups (p=0.016 and 0.001, respectively). GLP-1 and GIP were not related to RHI. Fasting and AUC-GLP-1, but not GIP, negatively related to LF/HF (r=-0.37, p=0.002 and r=-0.43, p<0.001 respectively). In a linear regression model with LnLF/HF as the dependent variable, AUC-BG (β=0.31, p=0.04) and AUC-GLP-1 (β=-0.44, p=0.002) contributed to the variance in LnLF/HF independent of %body fat, hs-CRP, WBISI, age, sex, race-ethnicity and Tanner stage (R2= 0.27, p=0.04). Youth with obesity and dysglycemia have impaired incretin response. Glycemia is negatively, whereas GLP-1 is positively associated with HRV after accounting for adiposity, WBIS and inflammation. GLP-1 may be an important determinant of CA function in youth with obesity across the glycemia spectrum.

Disclosure

H.El ayash: None. F.Bacha: Other Relationship; Takeda Pharmaceutical Co., Ltd., AstraZeneca.

Funding

U.S. Department of Agriculture-Agricultural Research Service
110-OR: Autonomous Artificial Intelligence Diabetic Eye Exams to Mitigate Disparities in Screening Completion
Authors: ZEHRA ANUM , BROMBERGER LEE A. , PAN BERNARD , SHEHADEH ALIYAH , PATEL DHRUVA , BROWN ELIZABETH A. , CHANNA ROOMASA , ALVIN LIU T.Y. , LEHMANN HAROLD , ABRÀMOFF MICHAEL D. , WOLF RISA M.
Published: June 2023

Diabetic retinopathy (DR) is a complication of diabetes that can result in vision loss, but early detection and treatment through screening can prevent this. Few individuals with diabetes meet recommended DR screening guidelines, and racial/ethnic minority youth are less likely to undergo recommended screening. We sought to determine if implementing point of care (POC) autonomous artificial intelligence (AI) screening could mitigate disparities in diabetic eye exam completion.

In a preregistered prospective study, ACCESS2, youth with type 1 and type 2 diabetes meeting American Diabetes Association criteria for needing DR screening underwent point of care autonomous AI diabetic eye exams at diabetes clinic visits. Completion rates of diabetic eye screening exams were compared prior to and after implementation of autonomous AI using chi-square tests.

A total of 152 youth with T1D (69.7%) and T2D (30.3%) were enrolled, mean age 15.5y, 45.4% non-Hispanic (NH) White, with duration of diabetes of 5.7y, and median HbA1c of 8%. A greater percentage of NH White participants reported any prior diabetic eye exam compared to non-white and Hispanic participants (92.8% v 65.1%, p<0.001). Multivariable analysis demonstrated that even when controlling for age, sex, HbA1c, Medicaid insurance, diabetes type and duration of diabetes, non-white youth are less likely to have had a prior diabetic eye exam (OR 0.26, CI: 0.07-0.93, p=0.04). After undergoing POC autonomous AI diabetic eye exams, completion rates were 99% for participants in all subgroups.

Implementation of autonomous AI at the point of care increases access to and completion of diabetic eye exams, and promotes health equity for minority youth with diabetes.

Disclosure

A.Zehra: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. L.A.Bromberger: None. B.Pan: None. A.Shehadeh: None. D.Patel: None. E.A.Brown: None. R.Channa: None. T.Liu: None. H.Lehmann: None.

Funding

National Eye Institute (R01EY033233, 5K23EY030911-03)
1108-P: Physical Activity in Adolescents and Young Adults (AYA) with Type 2 Diabetes (T2D) or Prediabetes—The Role of Motivation
Authors: ELLEN VAJRAVELU MARY , RODRIGUEZ GONZALEZ ADRIANA , HEWITT BRIANNA , KRISKA ANDREA , MITCHELL JONATHAN , HELGESON VICKI , AMARAL SANDRA , ARSLANIAN SILVA A.
Published: June 2023

Background: Adolescents with T2D engage in little moderate-to-vigorous PA. Although autonomous (internally driven) motivation is associated with PA engagement in healthy individuals, whether this is true for AYA with T2D or prediabetes is unknown.

Methods: Participants were 13-22 years old with T2D or prediabetes who were enrolled in an ongoing trial (NCT04874415) to promote PA. Prior to randomization, we assessed autonomous motivation to exercise (Relative Autonomy Index, RAI) using the Behavioral Regulation to Exercise Questionnaire-3. To assess PA, AYA completed PACE+ survey (days active <60 min in last and typical weeks) and used a wrist-worn activity tracker for 14 days. Associations between RAI and PA were assessed using Pearson correlation and linear regression.

Results: Participants (n=33; 19F; 19 T2D, 14 prediabetes) were 15.9 ± 2.0 years and racially diverse (57% non-White). Correlation between RAI and step count was strong (r=0.5, p=0.001), and the highest RAI quartiles achieved <3000 more steps/day than the lowest (p<0.05). RAI also correlated with PACE+ days active/week (r=0.4, p=0.01). Relationships persisted after adjustment for age, sex, race, and T2D.

Conclusion: Greater autonomous motivation to exercise was associated with higher objective and subjective PA. Autonomous motivation may be a target for behavioral intervention in AYA with T2D or prediabetes.

Disclosure

M.Vajravelu: None. A.Rodriguez gonzalez: None. B.Hewitt: None. A.Kriska: None. J.Mitchell: None. V.Helgeson: None. S.Amaral: Advisory Panel; Bristol-Myers Squibb Company. S.A.Arslanian: Advisory Panel; Novo Nordisk, Eli Lilly and Company, Consultant; Société des Produits Nestlé SA,, Other Relationship; Eli Lilly and Company, AstraZeneca, Research Support; Novo Nordisk, Eli Lilly and Company.

Funding

National Institutes of Health (K23DK125719, UL1TR001857)
1110-P: Role of Ethnicity in Weight Gain after 12 Months of Exacaftor/Tezacaftor/Ivacaftor in Children with Cystic Fibrosis
Authors: VAVRINA KAY , PILLAI RADHIKA , RAYAS MARIA S.
Published: June 2023

Malnutrition, fat malabsorption/vitamin D deficiency, and pulmonary decline traditionally characterize cystic fibrosis (CF). Fortunately, >90% of patients with CF ≥ 6 yrs old are now eligible for exacaftor/tezacaftor/ivacaftor (ETI) therapy which vastly improves lung function and nutrition by partially correcting the CF mutation. However, overweight/obesity is a rising concern. Although previously rare conditions of high blood pressure (BP) and dyslipidemia are also emerging in adults, pediatric CF data is limited. Moreover, data is lacking in minoritized groups such as Hispanics, who in the non-CF population are more prone to obesity when compared to non-Hispanic whites (NHW). To evaluate the impact of ethnicity on changes in body mass index (BMI) and obesity-related conditions, we performed a retrospective chart review of patients ≤18yrs old treated with ETI for at least 12 mo at our CF Center. Demographics including self-reported ethnicity (Hispanic vs NHW) and BMI, BP, A1c, liver profile, Vitamin D, lipids, and lung function (FEV1) at baseline and 12 mo post-ETI initiation were extracted from the medical record. Thirty-five children with CF [54% Hispanic, 57% male, age 13±3 yrs] were assessed. At baseline, Hispanics were more likely to have Medicaid, higher FEV1, and lower Vitamin D (all p<0.05). Nine (26%) children [7 Hispanic, 2 NHW] were overweight/obese. Post-ETI, BMI and FEV1 (both p<0.001) increased similarly in Hispanics and NHW, and Vitamin D improved in Hispanics (interaction, p<0.05). Lipid data was limited to 3 patients, therefore excluded from analyses. Post-ETI, 13 (37%) children were overweight/obese [8 Hispanic, 5 NHW]. Overweight/obesity is a rising complication in our ethnically diverse CF center. Both Hispanic and NHW children experienced increases in BMI after 12 mo of ETI therapy. Obesity research is imperative to inform CF nutrition guidelines and obesity-related screening (i.e., lipids) for children receiving ETI therapy.

Disclosure

K.Vavrina: Speaker's Bureau; AbbVie Inc., Chiesi USA, Inc., Alcresta Therapeutics. R.Pillai: None. M.S.Rayas: None.

Funding

National Institutes of Health (KL2TR002646)
1111-P: Arterial Change Determinants in Children and Adolescents with T1DM and T2DM
Authors: JOO EUNYOUNG , KIM SUJIN , LEE JIEUN
Published: June 2023

Introduction) The Carotid Intima Media Thickness (cIMT) and Brachial-ankle pulse wave velocity (baPWV) are good measurement of arterial change. But Few studies have been conducted about the relative factors of those two markers of children and adolescents with DM. We evaluated factors associated with IMT levels and PWV levels in adults to children and adolescents.

Methods) Retrospective cohort study of children and adolescents (10-19yrs) with diabetes performed cIMT and/or baPWV at a single center from December 2007 to August 2021 was conducted. Subjects were submitted demographic variables (age, sex, height, weight, duration of illness, presence of metabolic syndrome and microvascular complications), Blood pressure, laboratory data (HbA1, lipid panel, creatinine), cIMT, PWV.

Result) Of 212 participants studied, 101 had type 1 diabetes (mean age15.5±2.1 years, M:F =46:54) and 111 had type 2 diabetes (mean age 14.2±2.2yrs, M:F =62:48). The mean duration of diabetes was 6.2 (±3.8) years in T1DM patients and 2.1 (±2.4) years in T2DM patients. Mean PWV was 934.1 (±121.5) cm/sec and mean cIMT max was 0.50 (±0.05)mm in T1DM. Mean PWV was 942.3 (±120.7)cm/sec and mean cIMT max was 0.55 (±0.06) mm in T2DM. Overall, cIMT and PWV were increased with age.(pearson r= 0.556, p<0.001) cIMT and PWV in patients with T1DM were high, but there was no association with height, systolic BP, HbA1c, BMI-Z, TG, duration of illness. In patient with Type 2 DM, cIMT (linear regression analysis, r2=0.294, β=0.223, P=0.001) and PWV increased with duration (r2=0.140, β=0.239, P=0.05), systolic BP increased cIMT (p=0.02)and PWV (p =0.042)

Discussion) Adolescents with T1DM have high level of PWV and cIMT level but there was no association with diabetes control state, hyperlipidemia, blood pressure and duration. But there was association with duration in T2DM. Further research is needed to establish pediatric model for predicting outcome in pediatric diabetes.

Keyword: T1DM, T2DM, Pulse wave velocity, carotid Intima Media Thickness

Disclosure

E.Joo: None. S.Kim: None. J.Lee: None.
1115-P: Advanced Medical Therapy (AMT) for Youth-Onset Type 2 Diabetes (T2D)—Early Results from the Run-in Phase of ST2OMP
Authors: SHAH AMY S. , KELSEY MEGAN M. , JENKINS TODD M. , SCHAAF LISA R. , XANTHAKOS STAVRA , TROUT ANDREW T. , BAUMGARTNER AMY , RIEGLER ALLEN , KRISHNAN NISHA , BAILEY ALEXANDER , INGE THOMAS , HELMRATH MICHAEL , NADEAU KRISTEN J.
Published: June 2023

The Surgical or Medical Treatment for Pediatric Type 2 Diabetes (ST2OMP) study is a prospective open label clinical trial comparing metabolic bariatric surgery (MBS) to AMT for teens with youth-onset T2D. Prior to study group assignment, youth participate in a 6-month run-in period and receive AMT defined as multidrug, treat-to-target medical therapy to achieve an HbA1c <6.5%. Here, we examine the effects of AMT on metabolic parameters during run-in on the initial 51 participants. Participants in ST2OMP (57% female, 30% Black, 38% Hispanic, 25% White) were a mean age of 16.8 years, median diabetes duration 1.1 years, and median HbA1c 6.5% at screening (49% with HbA1c <6.5%). During run-in, metformin or pioglitazone use alone decreased (35.3% to 31.4%), as did insulin use (37.3% to 31.4%), while use of SGLT-2 inhibitors or GLP-1 agonists alone, or dual or triple therapy without insulin increased (21.6% to 31.4%). There was a small decrease in BMI, triglycerides and ALT, but a small increase in systolic and diastolic BP and total cholesterol, and decrease in HDL. At completion of run-in, 49% had an HbA1c of <6.5%. During a 6-month run-in period, AMT, using alternatives to insulin resulted in reduced need for insulin with favorable effects in some metabolic parameters, without worsening glycemic control. Full cohort recruitment and two-year follow-up in ST2OMP will determine the benefits of AMT vs. MBS.

Disclosure

A.S.Shah: None. A.Bailey: None. T.Inge: None. M.Helmrath: None. K.J.Nadeau: None. M.M.Kelsey: Other Relationship; Boehringer Ingelheim Inc., Janssen Pharmaceuticals, Inc., Rhythm Pharmaceuticals, Inc., Lilly. T.M.Jenkins: None. L.R.Schaaf: None. S.Xanthakos: None. A.T.Trout: Consultant; Lantheus, General Electric Co., Research Support; Canon America Medical Systems, Siemens, Perspectum Ltd. A.Baumgartner: None. A.Riegler: None. N.Krishnan: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK119450)
1116-P: Increase in the Incidence of Type 2 Diabetes in Children <11 Years during the COVID-19 Pandemic
Authors: SASIDHARAN PILLAI SABITHA , HAS PHINNARA , TOPOR LISA S. , FREDETTE MEGHAN E.
Published: June 2023

Objectives: To analyze the incidence and characteristics of new-onset type 2 diabetes (T2D) in youth < 11years prior to and during the COVID-19 pandemic, and to compare the metabolic parameters at presentation in younger (< 11 years) versus older youth (11-21 years). Study methods: We performed a retrospective chart review of newly diagnosed T2D among youth < 21 years at Hasbro Children's Hospital between 1/1/2017 and 12/31/2021. We analyzed the incidence of cases presenting at < 11 years pre (1/1/2017 to 2/29/20) and during (3/1/20-12/31/21) the COVID-19 pandemic. We compared metabolic parameters of those presenting < 11years to ≥ 11 years during the pandemic. Results:Eight youth < 11 years (8/145, (5.5 %)) presented with new-onset T2D during the study period (Table1), and all presented during the pandemic (8/89, 9%). Compared to older youth, those < 11years had higher BMI percentile (166% of the 95th%tile ± 38.4 vs. 139.4% ± 42.6, p=0.03), and were more likely to have diastolic hypertension (62.5% vs. 23.8%, p=0.03).

Conclusions: We report an abrupt rise in the incidence of new-onset T2D in children < 11 years during the COVID-19 pandemic. Compared to older youth, younger children were more obese, and were more likely to have diastolic hypertension. Further study is needed to elucidate contributing factors to this concerning finding, and to further aid in pediatric T2D prevention.

Disclosure

S.Sasidharan pillai: None. P.Has: None. L.S.Topor: None. M.E.Fredette: None.
1117-P: Variability in Glycemia Measured by CGM in Children and Young Adults with Acute Recurrent or Chronic Pancreatitis
Authors: PARRA VILLASMIL MARIA G. , BELLIN MELENA , PINNARO CATHERINA , ODE KATIE L.
Published: June 2023

Post pancreatitis diabetes mellitus is an underrecognized disorder. Children with pancreatitis are at elevated risk for development of diabetes (DM) in the near term (approximately 9%), and lifetime risk of DM approaches 50%. Unfortunately, there is limited data regarding pathophysiology and disease course. This pilot study was undertaken to investigate glycemic physiology in the free-living state in children with acute recurrent (ARP) or chronic pancreatitis (CP).

Methods: Children (<21 years of age) with an established diagnosis of CP or ARP, and participants of INSPPIRE-2 (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) were invited to participate. Pancreatitis type, demographics and growth parameters were extracted from the INSPPIRE-2 database. HbA1c was collected. A continuous glucose monitor was placed (CGM, Dexcom Pro). Glycemic variability metrics were calculated at the participant level using EasyGV software. The relationship between HbA1c and CGM variables was evaluated via multiple linear regression.

Results: 12 children were enrolled, age 10-20.8 years (mean 17.2; 66% female). One subject had known DM prior to enrollment. Participants had normal mean height (0.19+/- 0.72 SD), weight (1.1 +/- 0.98SD) and BMI (0.98 +/- 0.81 SD) z-scores. Mean A1c was 5.73% (range 5.0-8.9) with the known diabetic and 5.42% (5.0-6.1) without. Mean CGM glucose was 121.8 mg/dl +/- 21.4. Of the 11 subjects without DM, 2 had CGM glucose >180 mg/dl > 10% time and 1 had CGM glucose <55 mg/dl > 1% time. HbA1c correlated with mean CGM glucose in univariate analysis and when controlled for age and BMI (p = 0.02, r2 = 0.47).

Conclusions: In this small study, A1c correlated well with average CGM glucose in children with ARP and CP, and some had abnormal glycemic excursions on CGM. More research is needed on the use of CGM in children with CP and ARP.

Disclosure

M.G.Parra villasmil: None. M.Bellin: Consultant; Insulet Corporation, Vertex Pharmaceuticals Incorporated, Research Support; Dexcom, Inc., ViaCyte, Inc. C.Pinnaro: None. K.L.Ode: None.
1118-P: Accuracy of Dexcom G6 Continuous Glucose Monitor in Pediatric Diabetic Ketoacidosis Admissions
Authors: WATERMAN LAUREN A. , PYLE LAURA , TOWERS LINDSEY , JOST EMILY , KARAMI ANGELA J. , BERGET CARI , FORLENZA GREGORY P. , PAUL WADWA R. , COBRY ERIN C.
Published: June 2023

Continuous glucose monitors (CGMs) are an integral part of care for youth with type 1 diabetes (T1D) though lack FDA labeling for inpatient use. While some adult data on CGM use in inpatient settings is available, pediatric data are minimal.

This retrospective chart review evaluated the accuracy of Dexcom G6 CGM versus point of care (POC, Nova Biomedical StatStrip [MARD 6%])) blood glucose values from pediatric inpatient encounters. Blood glucose data, diagnosis codes, and initial labs were collected from the medical record. CGM values were obtained from Dexcom Clarity CSV files.

Paired glucose values (N=1191) from 83 patients with T1D (median age 12 yrs, 54% male, 69% non-Hispanic White) were used to calculate mean absolute relative difference (MARD) and Clarke Error Grid. Data from DKA admissions (N=665) had a MARD of 11.1% with 97.8% of values within A&B zones, compared to 11.4% and 98.5% for non-DKA admissions (N=526). Values from severe DKA admissions (N= 307) (pH <7.15 and/or bicarbonate <5 mmol/L) had a lower MARD compared to non-severe admissions (N=358) (8.4% vs 13.4%, p=0.01).

In summary, CGM accuracy is comparable between DKA and non-DKA admissions. The accuracy of CGMs, even in severe DKA, suggests potential usability during pediatric hospital encounters. Further analysis will differentiate POC versus lab glucose and the effect of medications, including IV insulin infusions.

Disclosure

L.A.Waterman: None. L.Pyle: None. L.Towers: None. E.Jost: Other Relationship; Tandem Diabetes Care, Inc. A.J.Karami: None. C.Berget: Consultant; Insulet Corporation, Dexcom, Inc., Other Relationship; Tandem Diabetes Care, Inc. G.P.Forlenza: Advisory Panel; Medtronic, Consultant; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Lilly Diabetes, Research Support; Medtronic, Abbott, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. R.Wadwa: Consultant; Eli Lilly and Company, Other Relationship; Dexcom, Inc., Eli Lilly and Company, Research Support; Dexcom, Inc., Eli Lilly and Company, Beta Bionics, Inc., Tandem Diabetes Care, Inc. E.C.Cobry: None.

Funding

National Institutes of Health (5T32DK063687)
1123-P: Pilot Study of Early Adoption of Automated Insulin Delivery in Under-Resourced Youth
Authors: YEN KEVIN , BELAPURKAR SONALI , HICKEY JEANNIE G. , YGLECIAS LOREN , BAL KAVENPREET S. , LYBECK CARELLI LOIS , LOUCEL CRYSTAL M. , LODISH MAYA , WONG JENISE C.
Published: June 2023

Background: Disparities in glycemic outcomes and technology use in children with type 1 diabetes (T1D) from under-resourced backgrounds are well-documented. The feasibility of initiating automated insulin delivery (AID) soon after diagnosis of T1D is unknown in this population. This pilot study assessed the feasibility and acceptability of providing access to the Tandem Control-IQ Hybrid Closed-Loop (HCL) system to children with public insurance soon after diagnosis of T1D.

Methods: Publicly insured child ren aged 6-17 years within 3 months of T1D diagnosis were eligible for the study. Participants were randomized 2:1 to HCL or control for 6 months. Continuous glucose monitoring data for both groups were collected at baseline, 3 months, and 6 months after enrollment. Caregivers and adolescents completed a closing survey on safety and user experience.

Results: Seventeen participants were enrolled, 12 in the intervention group and 5 in the control group. The mean age was 11.5 ±2.5 years, 47% were female, 88% were from underrepresented racial or ethnic groups, 94% of caregivers did not have a college level degree, and 41% of families reported some degree of food insecurity. All families had access to smartphones, but 42% did not have access to a home computer. Of those who completed the study, a larger proportion of the intervention group compared to the control group achieved ADA benchmark of greater than 70% time in range (62% vs 0%, respectively, at 3 months, p=0.038; 37% vs 0% at 6 months, p=0.16). All caregivers in the intervention group reported satisfaction with HCL system and wished to continue using HCL technology.

Conclusion: Early initiation of AID is feasible and acceptable in youth with recently diagnosed T1D from historically marginalized racial and ethnic groups and with social risk factors associated with lower technology adoption and less optimal glycemic outcomes. Clinicians should provide education and support for AID to these families early in diagnosis to promote equity in diabetes care.

Disclosure

K.Yen: None. S.Belapurkar: Other Relationship; T1D Exchange, Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Medtronic. J.G.Hickey: None. L.Yglecias: None. K.S.Bal: None. L.Carelli: None. C.M.Loucel: None. M.Lodish: None. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc.