bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Typical Relativistic Electron Pitch Angle Distributions: Evolution During Geomagnetic Storms
Authors: Killey Shannon , Rae I. Jonathan , Smith Andrew W , Bentley Sarah N , Watt Clare E. J. , Chakraborty Suman , Ozeke Louis Godwin , Walach Maria-Theresia , Sandhu Jasmine Kaur , Rasinskaite Dovile
Published: June 2024

Van Allen radiation belt electron dynamics are governed by a wide range
of physical processes that can simultaneously drive acceleration,
transport and loss. However, each individual process can be linked to a
specific energy-dependent pitch angle distribution (PAD). We employ a
new, unsupervised machine learning technique on 7-years of Van Allen
Probe Relativistic Electron-Proton Telescope data and discover that six
PADs, two each of: pancake, butterfly, and flattop, successfully
describe >70% of classified relativistic PADs. We
investigate the occurrence and storm-time evolution of each PAD through
45 geomagnetic storms. We find new populations of PADs, including:
“shadowing-like” and wave-particle interaction signatures at low-L,
and radial diffusion and substorm injections at higher-L, as well as
determining that wave-particle interaction dominated PADs are swamped by
radial diffusion processes through geomagnetic storms. Our results
clearly demonstrate that PAD characterisation is a key component of
understanding Van Allen radiation belt electron dynamics
Role of ocean circulation in controlling Zn-Si decoupling in the North Pacific
Authors: Sugino Kiminori , Oka Akira
Published: June 2024

Zinc (Zn) is biogeochemically significant due to its crucial role in
biological processes. In the global ocean, there is an apparent coupling
between the concentrations of zinc and silicon (Si), and there is a
consistent ratio between the two. However, this coupling is observed to
be disrupted in the North Pacific Ocean. It has been suggested that this
disruption is due to Zn that originates on the continental shelf.
However, this explanation relied on the particular circulation field
used in the model described in the relevant study. The aim of the
current study was to use more realistic circulation fields as the basis
of a more accurate evaluation of deep circulation and export production
in the North Pacific. We also aimed to analyze the impact of uptake
parameters, continental-shelf supply, and regeneration of Zn on the
observed Zn–Si decoupling in the North Pacific. Sensitivity experiments
employing two distinct circulation fields were performed. It was found
that the two circulation fields yielded different decoupling influences:
continental-shelf supply or regeneration. A comparison between the two
circulation fields also revealed discrepancies in the concentration of
regenerated Zn. The main factors causing these differences were found to
be the age of the water masses in the North Pacific and the magnitude of
export production. Greater export production and a more stagnant
circulation field in the North Pacific led to more regenerated Zn and a
higher probability of decoupling without the need for an input of Zn
from the continental shelf.
Soluciones basadas en la naturaleza para metas climáticas corporativas: opiniones sobre el uso corporativo de soluciones basadas en la naturaleza para alcanzar metas de cero
Authors: Vidal A. , Martinez G. , Drion B. , Gladstone J. , Andrade A. , Vasseur L.
Published: June 2024

Las soluciones basadas en la naturaleza (SbN) son actividades emprendidas para proteger, gestionar de manera sostenible y restaurar los ecosistemas naturales y modificados en beneficio simultáneo de las personas y la naturaleza. Las SbN son fundamentales para abordar desafíos como el cambio climático, la seguridad alimentaria e hídrica, el riesgo de desastres, la salud humana y el desarrollo social y económico. Esta publicación describe las vías disponibles para incluir SbN en las estrategias climáticas corporativas, en consonancia con la definición, los principios y el Estándar Global para SbN™. Cuando se implementan correctamente, las SbN ueden contribuir a la mitigación del clima y adaptación al mismo, al tiempo que ofrecen importantes beneficios para la biodiversidad y el bienestar humano.
100-OR: Investigating the Mechanisms of Cross Talk between Endocrine Beta Cells and Pericytes in Pancreatic Islets
Authors: MATEUS GONCALVES LUCIANA , PEREIRA ELIZABETH , ALMACA JOANA
Published: June 2024

Introduction: Islets are small endocrine organs scattered throughout the exocrine pancreas. Although endocrine and exocrine tissues share their vascular networks, a selective increase in islet blood flow is observed upon increases in glycemia. We showed that pericytes mediate changes in islet blood flow. The aim of this study was to determine whether glucose affects directly islet pericytes or indirectly by changing endocrine cell activity and stimulating the release of vasoactive factors which act on pericytes.

Methods: To manipulate (acutely and chronically) endocrine beta cells without changing systemic glycemia, we injected adeno-associated viruses encoding excitatory designer receptors exclusively activated by designer drugs (DREAAD) under the insulin promoter. Also we treated mice with multiple low doses of the beta cell toxin streptozotocin (5 days - 50 mg/kg/day) for 2 weeks, causing only glucose intolerance. We used mice that express a genetically encoded [Ca2+]i indicator in pericytes to monitor pericyte activity.

Results: We found that acute activation of beta cells with the DREAAD agonist clozapine decreased [Ca2+]i in islet pericytes in vivo (exteriorized pancreas) and ex vivo (living pancreas slices). Blocking adenosine and serotonin receptors with specific receptor antagonists rescued the inhibitory effects of clozapine. Chronic ablation of beta cells with streptozotocin abolished the glucose-dependent decrease in pericyte [Ca2+]i and dilation of islet capillaries in pancreas slices.

Conclusions: Our study indicates that beta cells participate in the acute regulation of islet blood flow. By releasing vasoactive factors, such as adenosine and serotonin, beta cell activation decreases islet pericyte activity which results in capillary dilation and increased blood flow. Endocrine cell dysfunction that occurs during the development of diabetes may affect islet pericyte and vascular responses, impairing hormone release into circulation.

Disclosure

L. Mateus Goncalves: None. E. Pereira: None. J. Almaca: None.

Funding

National Institutes of Health (5R01DK133483-02 - J.A.)Helmsley Charitable Trust George Eisenbarth Pilot Award for nPOD team Science (J.A.)2022 Stanley Glaser Award from the University of Miami (J.A.).
1033-P: Quantifying Price Elasticity of Demand for Insulin among Medicare Beneficiaries
Authors: GUAN DAWEI , LI PIAOPIAO , JIAO TIANZE , HU XIN , ZHANG YONGKANG , CHEHAL PUNEET K. , LEE JIEUN , VENKAT NARAYAN K M , ALI MOHAMMED K. , SHAO HUI
Published: June 2024

Background: Significant policy efforts have been implemented to lower the out-of-pocket payments (OOP) for insulin to lower access barriers and enhance adherence. We employed a machine learning approach to explore the relationship between OOP and insulin adherence among Medicare beneficiaries.

Methods: 48,613 Medicare beneficiaries with continuous use of long-acting insulin analog were identified from Medicare Fee-for-Service data (2017-2019). People covered by low-income subsidy programs and Medicaid were excluded. Adherence was measured by the proportion of days covered (PDC) by insulin in each year, and monthly OOP for a 30-day supply of insulin was estimated at a plan level. We used a localized fixed-effect model with recursive partitioning to depict the local response of OOP changes on PDC changes at different levels of baseline OOP.

Results: For individuals with monthly OOP exceeding $150, a 1.51% increase in PDC (95%CI: 1.03% to 1.99%) with every $10 reduction was observed, and for those with monthly OOP between $75 and $150, every $10 reduction correlated with a 0.69% increase in PDC (95%CI: 0.43% to 0.94%). For those with monthly OOP below $75, the further reduction did not impact the PDC.

Conclusion: The price elasticity of demand for insulin is non-linear. Reducing monthly OOP for insulin to levels lower than the cut points is vital to remove the financial barrier to adherence and ensure access to proper care.

Disclosure

D. Guan: None. P. Li: None. T. Jiao: None. X. Hu: Research Support; PhRMA Foundation. Y. Zhang: None. P.K. Chehal: None. J. Lee: None. K. Narayan: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. H. Shao: Consultant; Eli Lilly and Company.
1036-P: Cost-Effectiveness of Real-Time CGM vs. Self-Monitoring of Blood Glucose in People with Type 2 Diabetes on Intensive Insulin Therapy in Australia
Authors: ALSHANNAQ HAMZA , AHMED MOIN , NORMAN GREGORY J. , SIMMONS DAVID
Published: June 2024

Introduction: Clinical studies show RT-CGM systems improve glucose management in people with T2D on intensive insulin therapy (IIT). Reimbursement for RT-CGM in Australia is currently limited to people with T1D. Our analysis examines the cost-effectiveness of RT-CGM for people with T2D IIT in Australia.

Methods: We used the IQVIA Core Diabetes Model to simulate diabetes clinical outcomes and direct medical costs over a lifetime horizon from an Australian payor perspective. A large retrospective cohort study provided the cohort characteristics and treatment effects. The adjusted difference in A1C reduction was -0.56% for RT-CGM, severe hypoglycemic events rates of 0.04 and 0 Per Person-Year (PPY) for SMBG and RT-CGM, respectively, and DKA rates of 0.025 and 0 PPY, respectively. The costs of CGM are based on the Dexcom G6 RT-CGM list price in Australia. A utility for the avoidance of finger sticks (0.03) and fear of hypoglycemia reduction (0.025) were applied to users of RT-CGM.

Results: RT-CGM users are projected to have higher quality-adjusted life years (QALYs) by 0.621 with AUD 14,117 incremental costs, and an incremental cost-effectiveness ratio (ICER) of 22,736, below the AUD 50,000 willingness-to-pay threshold for Australia. Microvascular and macrovascular outcomes projections indicate that RT-CGM use results in a relative reduction in diabetes eye, renal, neuropathy, and cardiovascular complications of 17.7%, 21.1%, 8.7%, and 2.5% respectively. Sensitivity analysis scenarios of RT-CGM cost reductions of 10%, 20%, and 30% resulted in ICERs of 17,976, 13,220, and 8,464, respectively. RT-CGM remained cost-effective even when its costs were increased by 30%.

Conclusion: The use of RT-CGM systems for diabetes management in people with T2D on intensive insulin therapy results in significant cost savings due to the reduction of diabetes complications. These findings support expanding reimbursement for RT-CGM in Australia.

Disclosure

H. Alshannaq: Employee; Dexcom, Inc. Stock/Shareholder; Unicycive Therapeutics. M. Ahmed: None. G.J. Norman: Employee; Dexcom, Inc. D. Simmons: Speaker's Bureau; Abbott. Consultant; Sanofi. Speaker's Bureau; Ascensia Diabetes Care. Other Relationship; Ascensia Diabetes Care, Boehringer-Ingelheim. Research Support; Dexcom, Inc. Speaker's Bureau; Novo Nordisk. Research Support; Wests Club, NSW, Australia, Roche Diabetes Care.
1049-P: Clustering the U.S. Population into Social Determinants of Health (SDOH) Subgroups—A Machine-Learning Approach
Authors: LEE JIEUN , XUE QIAOCHU , LI PIAOPIAO , BETH WEBER MARY , XI YUANZHE , GARCIA GIAN-GABRIEL , ALI MOHAMMED K. , SHAO HUI
Published: June 2024

Introduction: An increasing emphasis has been placed on addressing SDOH needs. However, SDOH encompass a wide range of intercorrelated social constructs, and these needs often have deeper roots and correlations with one another. This study aims to leverage advanced machine learning algorithms to cluster the US population into groups with similar SDOH characteristics, providing valuable insights into the intricate landscape of SDOH needs.

Methods: Survey data on individual-level SDOH and linked electronic health records from 28,778 participants of the All of Us research program is used. An extreme gradient boosting algorithm was performed to choose and rank the forty most influential variables out of 266, and then we run the PAM-lite to determine the optimal number of variables and clusters.

Results: Clustering the pre-retirees (45-64) and the elderly (65+) revealed six distinct groups (Table). Insurance, race/ethnicity, and neighborhood safety played a dominating role in clustering pre-retirees into distinct SDOH groups. However, these factors gave way to partnerships and religion among the elderly, signifying a shift in the determinants of SDOH clusters. Clusters with higher SDOH status had substantial lower rates of T2D, Obesity (chronic), and Pneumonia (infectious).

Conclusion: Findings can inform the development of targeted SDOH screening and interventions.

Disclosure

J. Lee: None. Q. Xue: None. P. Li: None. M. Weber: None. Y. Xi: None. G. Garcia: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. H. Shao: Consultant; Eli Lilly and Company.
1052-P: Diabetes and Financial Well-Being—Differential Hardship among Vulnerable Populations
Authors: JACOBS MOLLY M. , ELLIS CHARLES , EVANS ELIZABETH
Published: June 2024

Background: The ability to meet financial obligations, known as “financial well-being,” is associated with unexpected health events and expenditures. Using the Consumer Financial Protection Bureau’s (CFPB) Financial Well-Being (FWB) Scale, we evaluated the impact of diabetes on FWB and estimated the differential effects among racial and ethnic groups.

Methods: Using the Understanding America Survey (UAS) we identified adults with self-reported diabetes diagnoses. Panel data, mixed effects regression models assessed the association between diabetes and FWBS among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index (BMI), employment, and insurance. Racial and ethnic differentials were captured using group-condition interactions.

Results: Whites [Mean (M)=67.66, Standard Deviation (SD)=22.63] and Other racial groups (M=67.99, SD=18.45) had the highest FWBS, followed by Hispanics (M=59.31, SD=22.78), and Blacks (M=55.86, SD=25.67). However, Blacks (17.06%) had the highest prevalence of diabetes followed by Whites (12.2%), Other racial groups (10.7%), and Hispanics (10.0%). The analysis showed that, compared to Whites, Blacks [β=-5.53, Standard Error (SE)=0.71] and Hispanics (β=-2.08, SE=0.63) have significantly lower FWBS. Compared to males, females (β=-4.45, SE=0.41) had lower FWBS. Additionally, those who were married (β=3.99, SE=0.41) and earning above $75,000 (β=2.87, SE=0.24) had comparatively higher FWBS. Regression results indicated that FWBS of individuals with diabetes was 3.97 points lower (SE=0.72), on average, than those without diabetes. Furthermore, the FWBS of Blacks with diabetes (β=-3.02, SE=1.25) was even lower than Blacks without diabetes.

Conclusions: Results suggest disparities in the financial ramifications of diabetes among women, Blacks, and other marginalized populations.

Disclosure

M.M. Jacobs: None. C. Ellis: None. E. Evans: None.
1055-P: Are the Direct Health Care Costs of Fractures Higher in Patients with Type 2 Diabetes?
Authors: KVIST ANNIKA V. , FROST MORTEN , BURDEN ANDREA M. , VESTERGAARD PETER , KRISTRENSEN TROELS
Published: June 2024

Introduction & Objective: Patients with type 2 diabetes (T2D) have an increased risk of sustaining a fracture, and risks of nonunion, impaired fracture healing, and post-fracture complications are higher in T2D. It is largely unknown how T2D affects the cost of fractures. This study aims to estimate the cost of fractures in T2D compared to persons without diabetes, and secondly to analyze potential drivers of fracture costs. We hypothesized that cost of fractures in patients with T2D are higher than in the nondiabetic background population.

Methods: This study analyses patients in Denmark aged 18+ with a hip, humerus, forearm, foot, or ankle fracture in the period 2011-2015. Persons with polycystic ovary syndrome (PCOS), with other types of diabetes, with T2D diagnosed after fracture, and persons emigrating within the follow-up period were excluded. Patients with T2D were matched with patients without diabetes based on fracture site, sex, age, and Charlson Comorbidity Index (CCI) Score. The direct healthcare costs of fractures for T2D and controls were estimated within the first year after a fracture, and the medians were tested using Mann-Whitney U-test.

Results: In this study 5890, 3921, 5174, 2592, and 2229 cases of hip, humerus, forearm, foot, and ankle fractures, respectively, were matched 1:1 with persons without diabetes. More females than males sustained fractures with the highest prevalence (71.8%) for hip fractures and the lowest prevalence (56.7%) for foot fractures. The median age was highest for hip fractures (80 years) and lowest for foot fractures (62 years). The direct healthcare cost within one year after fracture was higher among patients with T2D compared to controls for hip (€10,733 vs. €10,585, p=0.014), humerus (€1,389 vs. €1,138, p<0.0001), forearm (€951 vs. €947, p=0.022), foot (€565 vs. €443, p<0.0001), and ankle fractures (€1,968 vs. €1,063, p<0.0001).

Conclusion: The direct healthcare costs of fractures were higher for T2D.

Disclosure

A.V. Kvist: None. M. Frost: Research Support; Novo Nordisk A/S. Stock/Shareholder; Novo Nordisk A/S. A.M. Burden: None. P. Vestergaard: None. T. Kristrensen: None.

Funding

European Union’s Horizon 2020 research and innovation program under the H2020 Marie Skłodowska-Curie Actions grant 860898.
1056-P: Cost-Effectiveness of the MiniMed 780G System vs. Multiple Daily Injections (MDI) Used with the Dexcom G6 Continuous Glucose Monitoring (CGM) System
Authors: KOMMAREDDI MALLIKA , VIGERSKY ROBERT A.
Published: June 2024

Objective: A simulation study assessed cost-effectiveness of the MiniMed™ 780G system (MM780G) compared to MDI used with Dexcom G6 CGM (MDI+G6) in people with T1D in the United States.

Methods: The IQVIA Core Diabetes Model was used to estimate costs and quality of life over a lifetime horizon. Demographic and clinical characteristics were sourced from a 6-month randomized controlled trial1. The cohort had an age (mean±SD) of 45.4±13.3 years, was 62.5% male, and had an A1C of 8.9%±0.5% at baseline. Total daily dose (TDD) of insulin at baseline differed between groups (52.8±29.1 for MM780G vs. 79.2±47.1 for MDI+G6). After 6 months, MM780G reduced A1C by 1.7±1.0% and MDI+G6 by 0.6±1.3%. Rates of hypoglycemia with MDI + real-time CGM therapy were taken from the literature and, also, used as rates of hypoglycemia for the MM780G. One-way sensitivity analyses were performed to assess the impact of model assumptions, and cost-effectiveness acceptability curves were used to find the probability of cost-effectiveness at a commonly accepted willingness-to-pay (WTP) threshold ($150,000).

Results: The base case results show that MM780G was associated with increased quality-adjusted life expectancy (QALE) compared to MDI+G6 (11.31±0.15 years for MM780G vs. 10.34±0.13 for MDI+G6), as well as increased costs ($453,962 ± $10,858 for MM780G vs. $363,470 ± $10,736 for MDI+G6). The incremental cost-effectiveness ratio (ICER) was $92,917 per QALE, which has a 96.3% probability of being cost-effective at the WTP threshold. Assuming the same TDD between groups, analyses determined that MM780G was associated with an ICER of $136,189 per QALE and a 67.7% probability of being cost effective.

Conclusions: At a WTP threshold of $150,000, MM780G is cost effective in T1D versus therapy with MDI + Dexcom G6, in the United States.

Reference:

1. van den Heuvel T, et al. J Diabetes Sci Technol. 2023; doi:10.1177/19322968231161320.

Disclosure

M. Kommareddi: Employee; Medtronic. R.A. Vigersky: Employee; Medtronic.
1077-P: Optimizing In-Clinic Conversations Using Data Science and AI to Promote Medication Adherence
Authors: MALLABADI RAJSHRI , KALRA SANJAY
Published: June 2024

Introduction and Objective: Limited time for meaningful conversations between the healthcare providers (HCP) and persons with diabetes (PWD) results in non-adherence to prescribed treatment in 60% of the cases. We intend to deploy an artificial intelligence (AI)-based model/tool that suggests positive words/ language to promote biopsychosocial wellbeing of PWD and this improve medication adherence.

Methods: The AI model has been developed using psychologically safe words as a base. The front end of the tool is a simple interface that acts as an in-clinic companion for HCPs and can be integrated into the existing electronic health record platforms.

Results: The proof of concept suggested appropriate conversation cues for a pilot of 25 PWD. The most impactful words in the context of improving medication adherence were “vigilant,” “thrive,” “nourishing,” “conquer” and “transform.” The least impactful words included “uncontrolled,” “avoid,” “negligent,” “sedentary” and “compromise.” The game changing conversational sentence was “Your vigilance is helping you thrive in this transformative journey.” All 25 PWD agreed that a good conversation with their HCP motivated them to focus on self-care more actively.

Conclusion: Using data science and AI to optimize in-clinic conversations has the potential to solve a pressing problem in diabetes care - that of using the right language for the right PWD. The proposed AI tool has multi-lingual capabilities, is convenient and simple to use and could prove to be a significant addition to the in-clinic armamentarium for HCPs. The tool may also help in easing cognitive burden for care providers.

Disclosure

R. Mallabadi: None. S. Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi.
1085-P: Implementation of a MAR-Based Insulin Calculator at the University of California Davis Health
Authors: LEE RACHAEL O. , SCHULMEISTER CAROLINE , SCHAUER DANNIKA , BAGLEY BERIT M.
Published: June 2024

Insulin is a high-risk medication and can lead to significant morbidity and mortality, especially in young children who require smaller, weight- based dosing. It is also one of the most common medications listed in incident reports within inpatient pediatric units at University of California Davis Children’s Hospital (UCDCH) due to manual calculation and entry errors. We sought to answer, does the use of a MAR based insulin calculator reduce the number subcutaneous insulin dose errors for an inpatient children’s hospital? A MAR based insulin calculator was configured into Epic Hyperspace, insulin order sets were updated, nursing policies were updated, communication tools were delivered to advise staff of new calculator workflow, and inpatient pediatric nurses were assigned an electronic learning module. Nurse champions were trained on the calculator and were utilized for unit-based education and real time support. From January 2020 through January 2022, there were 53 subcutaneous insulin dosing errors in the inpatient pediatric setting at UCDCH. After implementation of the MAR based calculator there were 2 errors over an eight-week period. A MAR based insulin calculator reduced the number of subcutaneous insulin dose errors by 50% in a children’s hospital. A MAR based insulin calculator suggests safer inpatient use of insulin although more time is needed to evaluate the full scope of error reduction.

Disclosure

R.O. Lee: None. C. Schulmeister: None. D. Schauer: None. B.M. Bagley: None.
1089-P: Educational Intervention on the Implementation of the Six Core Elements of Health Care Transition and Teach-Back Method in Type 1 Diabetes
Authors: DE ALMAGRO CAROLINA M. , CARRILLO ADRIANA , VERME JACQUELYN S. , GOLDIN DEANA S.
Published: June 2024

Introduction & Objective: Structured healthcare transition (S-HCT), the process of moving from pediatric to adult healthcare services, promotes optimal health outcomes in adolescents diagnosed with Type 1 diabetes mellitus (T1DM). This study assessed for changes in clinicians’ knowledge, attitudes, and behaviors before and after an educational seminar that included evidence to support a S-HCT process for youth diagnosed with T1DM, the Six Core Elements of Healthcare Transition (6CEoHCT) framework, the teach-back method for communication and a roadmap to operationalize the process in a hospital’s endocrinology department.

Methods: After IRB approval, clinicians’ knowledge, attitudes, and behaviors regarding a S-HCT process were assessed using a pre-implementation survey. Then an educational seminar that included the 6CEoHCT, the teach-back method as a communication strategy and a visual guide to support clinicians was delivered. Three weeks later, post-implementation surveys were administered to those that attended the seminar. Descriptive data analysis was used to assess data. Wilcoxon test was used to assess statistical significance.

Results: Among the twenty-one (N=21) clinicians that completed both the pre- and post-test surveys, 43% reported over ten years of experience. The educational intervention was associated with significant increases in average scores from pre-surveys in clinician knowledge (M=1.43) to the post-survey (M=2.43), p < 0.05, clinician attitudes (M= 24.95) to the post-survey (M = 28.86), p < 0.05, and clinician behavior subscales (M=21.71) to the post-survey (M = 29.29), p < 0.05, respectively.

Conclusion: The results suggest that providing S-HCT education and support for clinicians was successful in increasing clinician knowledge, attitudes, and behaviors. Future research should explore sustained changes in clinicians 6-months and 1-year post-education.

Disclosure

C.M. de Almagro: None. A. Carrillo: None. J.S. Verme: None. D.S. Goldin: None.
1090-P: RCT Design Risks Excluding Key Groups in Pediatric–Adult Transition Studies
Authors: LIU YING-TING , MORGAN MARCI , SHAH SEJAL , HSU LIANA , DESAI DIMPI , SUH BAILEY , CHEN JULIE , LAL RAYHAN , HUGHES MICHAEL S.
Published: June 2024

Introduction: Importance of the patient-provider relationship in pediatric to adult clinic transitions is well recognized. Yet, there is a lack of evidence from randomized controlled trials (RCTs). We tested a new approach to moving endocrinology patients to adult care in an RCT. However, consent requirements of the RCT posed challenges. We therefore examined whether this skewed enrollment, inadvertently precluding the very patients we sought to assist.

Methods: Participants age ≥16 with a chronic endocrine condition transferring from Stanford's pediatric to adult endocrinology clinics were randomized 2:1 to "Guided Transfer" (starting care with an adult physician in the pediatric clinic before moving) or "Direct Referral" (beginning adult care in adult clinic). To identify potential biases after enrollment ceased in Nov 2023, we reviewed enrollment efforts, compared participants' demographics to the age-matched population of patients in the 4 most commonly referring clinics, and surveyed referring providers. Data collection on the primary outcome, attendance in two adult clinic visits, is ongoing.

Results: Of 119 candidates, 34% were unreachable despite 256 cumulative contact attempts. 45 enrollees were randomized to GT and 21 to DR; 82% had diabetes. Compared to the age-matched clinic population (n=2169), enrollees were significantly more white (59% vs 38%, p<0.001) and privately insured (73% vs 43%, p<0.001). Among providers (n=13), 85% felt GT provided a benefit to patients. Key themes regarding improvement areas included eliminating consent needs, including all participants in GT, and enhancing monitoring and communication methods.

Conclusion: RCTs are prone to recruitment and enrollment bias in this population, missing those who might benefit most from the intervention, such as harder to contact or underserved individuals. Providers recognized RCT challenges but still favored the GT approach. A single-arm QI-based study may reduce barriers and improve demographic representation.

Disclosure

Y. Liu: None. M. Morgan: None. S. Shah: None. L. Hsu: None. D. Desai: None. B. Suh: None. J. Chen: Advisory Panel; Bayer Inc., Immunovant, Biomarin, The Dedham Group. R. Lal: Consultant; Abbott, Adaptyx Biosciences, Biolinq, Capillary Biomedical, Inc., Deep Valley Labs, Gluroo, PhysioLogic Devices, Portal Insulin, Tidepool. Advisory Panel; Lilly Diabetes. M.S. Hughes: Consultant; Dexcom, Inc.

Funding

National Institutes of Health (5K12DK122550, 1K23DK122017, T32DK007217, P30DK116074)
1112-P: Sustaining Show Rates in the Diabetes Clinic
Authors: GUNASEKARAN UMA
Published: June 2024

The Parkland Diabetes Clinic provides specialty diabetes care to the indigent people of Dallas County with diabetes. Previously, we showed that using an internally scheduling patients, rather than a third-party call center, and personally calling scheduled patients to remind them of their appointments improved our clinic no-show rates in 2021, compared to 2019, from 32% to 22%. We have continued these interventions but questioned whether these results have been sustained. Three years later, we reviewed 1014 charts from a typical month at the clinic to determine how many patients completed their appointments compared to whether they received a reminder phone call, specifically focusing on demographic and glycemic data as mitigating factors. The average no-show rate has risen to ~26% even though the previous solutions were still in place. Approximately 66% of patients received reminder phone calls with 57% of these calls resulting in a direct conversation with the patient confirming the appointment. 30% of patients who directly spoke to a staff member confirmed attendance but did not show for their appointment. There were no statistically significant differences in demographics or visit type for patients who completed an appointment, but there was a difference in their last Hba1c prior to the scheduled appointment (9.3% in patients who completed their appointment vs. 10.0% in patient who did not attend the appointment, p = 0.003). Contrary to published data that calling patients to confirm their appointments improves show rates, the benefit of this is limited in our population. With 30% of patients confirming attendance to an appointment 1-3 days prior but not attending shows that there are other factors which can influence no-show rates. Furthermore, patient with poorer glycemic control at the prior visit tended to show less. In the indigent population, there are more complicating factors than reminder phone calls that prevent patients from attending their clinic appointment which should be researched further to address barriers to care.

Disclosure

U. Gunasekaran: None.
1127-P: Diabetes Advice Lines Prevent Emergency Room and Outpatient Attendance
Authors: LEWIS GEMMA A. , MITCHELL LESLEY J. , HARDY KEVIN J.
Published: June 2024

Introduction and Objective: Type 2 diabetes care is underpinned by patient education, evidence-based therapy, complication surveillance and timely intervention. Patients sometimes need urgent specialist advice to prevent emergency room (ER) and extra outpatient (OP) attendance and for reassurance. We offer OP care, website support, and 3 lines: Emergency Advice Line (EAL) - immediate specialist advice 8AM - 10PM weekdays and 8AM - 4PM weekends, and Non-urgent Patient/Carer (NU-P) and Non-urgent Clinician (NU-C) advice within 24-hr. Objective - to assess impact of clinical support lines on ER and extra OP attendance.

Methods: We assessed line activity and impact October 2021 to November 2023 in 5,809 contacts (mean 232 pcm): EAL (452 [7%]) - 18 pcm, NU-P (2531 [44%]) - 101 pcm and NU-C (2826 [49%]) - 113 pcm. After contact, diabetes specialists gauged whether consultation likely prevented ER or extra OP attendance. We used hospital records to test specialist judgements in 100 consecutive patients and found specialists accurately predicted 28-day ER prevention and OP referral prevention in 98% and 93% patients respectively.

Results: For EAL, 75% calls were patients and carers and 25% non-specialist clinicians. Over 25-months, EAL calls fell 17%, but NU-P and NU-C grew by 63% and 36% respectively.

Conclusion: Timely advice and reassurance are invaluable, but our experience suggests advice lines may also prevent ER and extra OP attendances.

Disclosure

G.A. Lewis: None. L.J. Mitchell: None. K.J. Hardy: Other Relationship; AstraZeneca, Sanofi.
1129-P: Effect of Discharge Day on Post-discharge Glycemic Control
Authors: KAPLAN LEAH , LEVISTER CAMILLA , SHAH NIRALI , LEVY CAROL J. , ROUVIERE MADELEINE , TAMRU ABIGAIL , IPEK ASLIHAN , OGYAADU SELASSIE J. , CHERÑAVVSKY DANIEL R. , O'MALLEY GRENYE
Published: June 2024

Introduction & Objective: Hospital readmission rates are nearly two times higher in patients with diabetes. Risk of readmission for severe dysglycemia is sixfold higher in patients with a prior hospitalization for severe dysglycemia. The DIREMOS study aimed to assess the use of continuous glucose monitoring upon hospital discharge. This subanalysis compares glycemic metrics of patients discharged on weekdays versus weekends.

Methods: Forty hospitalized patients with diabetes (type I, type II, steroid induced) who experienced inpatient dysglycemia were enrolled in a pilot feasibility study using a real time remote patient monitoring system for thirty days after hospital discharge. In this secondary analysis of thirty-nine participants (1 dropped), time in range (TIR) (70-180 mg/dl) and time with severe hyperglycemia (>250 mg/dL) for the three days post-discharge (day 0, 1, 2, 3) are compared in participants discharged on weekdays (Monday-Thursday) versus weekends (Friday-Sunday or holiday).

Results: Twenty-five participants were discharged on weekdays, and 14 participants were discharged on weekends. Mean post-discharge TIR was 47.7±26% in the weekday group and 42.0±25% in the weekend group. Median time with severe hyperglycemia was 9% (IQR 2-28%) in the weekday group and 14% (IQR 9-36%) in the weekend group. Four (16%) of weekday and 3 (21%) of weekend participants reported difficulty with medication access.

Conclusion: Three-day post-discharge average TIR was lower and time above 250 mg/dL was higher in participants discharged on weekends. This data suggests that weekend discharges have additional factors that negatively impact post-discharge glycemic control. More research and quality improvement initiatives are needed on the impact of weekday vs weekend discharges on glycemic control and the effect of time in range on readmission risk.

Disclosure

L. Kaplan: None. C. Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. N. Shah: None. C.J. Levy: Research Support; Dexcom, Inc. Consultant; Dexcom, Inc. Research Support; MannKind Corporation, T1D Exchange, Tandem Diabetes Care, Inc., Abbott, Insulet Corporation. M. Rouviere: None. A. Tamru: None. A. Ipek: None. S.J. Ogyaadu: None. D.R. Cherñavvsky: None. G. O'Malley: Research Support; Dexcom, Inc., Insulet Corporation, Abbott, Tandem Diabetes Care, Inc., MannKind Corporation.

Funding

Dexcom, Inc
1130-P: Enhancing Safety—Managing Individuals on SGLT-2 Inhibitors during the Perioperative Period
Authors: ALIMATHUNISA ABDUL KATHER FIRDHOUS , IYENGAR JENNIFER J. , ESFANDIARI NAZANENE H. , BLANK ROSS , SABERI SIMA , KUMAR SATHISH S. , GARCIA DAVID J. , BUTLER SIMONA , JANKE ELLEN L. , CIARKOWSKI SCOTT L. , ANG LYNN
Published: June 2024

Introduction & Objective: SGLT-2 inhibitors are crucial for managing diabetes, heart failure, and CKD but increase euglycemic diabetic ketoacidosis (eDKA) risk by altering insulin secretion and glucagon levels, especially during surgical stress and fasting. The FDA recommends holding SGLT-2 inhibitors for 3-4 days before surgery. Our single-center academic medical center has formulated guidelines to mitigate the risk of eDKA in high-risk individuals. Simultaneously, the guidelines strive to avoid cancellations for low-risk cases, particularly when SGLT-2 inhibitors have not been or cannot be discontinued.

Methods: A multidisciplinary team consisting of anesthesiology, endocrinology, and pharmacy was convened. A literature review was conducted to identify risk factors for DKA/eDKA to guide algorithm development and a survey was conducted of anesthesia faculty to assess baseline adherence patterns with FDA recommendations and comfort level with diagnosis and treatment of eDKA.

Results: In the past 3 months, 55% of anesthesiologists (n=55) canceled a case due to SGLT-2 inhibitor use, and 65% proceeded without holding the SGLT-2 inhibitor. Only 22% felt confident in eDKA management. Consensus recommendations were developed to 1) risk stratify an individual’s eDKA risk 2) standardize guidelines for elective and urgent procedures 3) establish robust post-operative monitoring protocols. These steps form a comprehensive framework to enhance perioperative safety in the context of SGLT-2 inhibitor usage.

Conclusion: With a multidisciplinary team, we implemented a tailored approach to managing individuals on SGLT-2 inhibitors during surgical procedures, aligning with the local care environment and emphasizing patient safety. Future work should evaluate guideline implementation/adherence and audit clinical practice and assess the effects on institutional rates of case cancellation and eDKA.

Disclosure

F. Abdul Kather: None. J.J. Iyengar: None. N.H. Esfandiari: None. R. Blank: None. S. Saberi: None. S.S. Kumar: Research Support; Edwards life sciences, PCORI grant, Hemosonics. D.J. Garcia: None. S. Butler: None. E.L. Janke: None. S.L. Ciarkowski: None. L. Ang: None.
1132-P: Understanding Patients New to Insulin—Baseline Evaluation of Participants in the “Implementation and Testing of a Diabetes Discharge Intervention to Improve Safety during Transitions of Care” Study
Authors: LEE KRISTEN , SMYRNIOTIS COLLEEN M. , CLINGAN CAROLINE A. , CARTHY KEVIN M.V. , COVENTRY CHRISTINA , DAVIS KA'DERRICKA , FREEMAN STEPHEN J. , LEE JUNGWHA J. , SONG JING , HOLL JANE L. , BAILEY STACY , WALLIA AMISHA
Published: June 2024

Objective: Describe baseline patient characteristics, needs, and stress of new to insulin at hospital discharge.

Methods: Single site RCT to evaluate a DM Discharge Toolkit on mean 30-day glucose is ongoing among English speaking patients (pts), 21 - 80 years, with expected survival > 90 days, new to insulin at discharge.

Results: Among 97 eligible, 67 approached, and 40 enrolled (consent rate 60%). Mean age was 51.9 years +11.4; 55% were male; 35% had public insurance; 52% identified as black, 30% white, and >22% Hispanic/Latino, with 23 (58%) prior DM. Mean glucose was 374 +213 and median HbA1C 11.4 [9.6, 13.3]. Nearly 30% had limited literacy (Single Item Literacy Screener, >2), though > 90% had home internet and reported its use for health information. Acceptability of research continuous glucose meter (CGM) at discharge was high (48%). Stress was also high, over 60% reported elevated perceived stress (Perceived Stress Scale >14), 35% with prior DM reported elevated DM distress (Diabetes Distress Score > 2.0). A majority (60%) had > 1 health-related social need (HRSN), 12.5% had > 3; food insecurity (22.5%), transportation (15%) and medication affordability (12.5%) were highest.

Conclusion: Our medically/socially complex cohort of DM patients consented to RCT, including many of minority race/ethnicity. These patients have high levels of disease and non-disease specific stress and multiple HRSN that could affect safe insulin delivery. Interestingly, most accessed and used technology/internet, and were open to DM technology (CGM). Achieving better glycemic control in our sickest patients demands comprehensive, multi-modal interventions which can leverage DM technology to enhance care delivery.

Disclosure

K. Lee: None. C.M. Smyrniotis: None. C.A. Clingan: None. K.M.V. Carthy: None. C. Coventry: None. K. Davis: None. S.J. Freeman: None. J.J. Lee: None. J. Song: None. J.L. Holl: None. S. Bailey: Consultant; Gilead Sciences, Inc. Research Support; Gilead Sciences, Inc., Pfizer Inc., Merck Sharp & Dohme Corp., Lundbeck. Consultant; Lundbeck. A. Wallia: Research Support; UnitedHealth Group, Novo Nordisk.

Funding

R18 HS026143, NIH/AHRQ
1141-P: Increased Predicted Risk for Fatal/Nonfatal Cardiac Events in Youth-Onset Type 2 Diabetes
Authors: DAVIS FAITH , GLAROS SOPHIA B. , MALANDRINO NOEMI , DIXON SYDNEY A. , KRENEK ANDREA , CHOWDHURY ARUBA , MABUNDO LILIAN , YANOVSKI JACK A. , MAGGE SHEELA N. , CHUNG STEPHANIE T.
Published: June 2024

Introduction/Objectives: Youth-onset type 2 diabetes (YT2D) may increase risk for cardiac disease (CVD), but the relative risk for fatal/non-fatal CVD is unknown. The International Childhood Cardiovascular Cohort (i3C) risk score was designed to predict 35-year CVD risk in healthy youth and young adults (YYA). We compared i3C risk score and high sensitivity C-reactive protein (hsCRP, an independent CVD marker in adults) in YYA with YT2D with healthy lean (HL) and overweight/obese (OWOB) peers.

Methods: In a pooled cohort analysis of 1482 YYA [1320 YYA<18y (14.7±1.5, mean±SD) and 139 18y≤YYA≤25y (21.0±2.0y)] the i3C scores and hazard ratios (HR) were derived from z-scores of systolic blood pressure, BMI, smoking history, total cholesterol, and triglycerides. Linear regression models were used to compare groups, adjusting for race/ethnicity.

Results: YT2D had higher HbA1c (YT2D:7.3±1.6 vs. OWOB:5.4±0.4 vs HL:5.2±0.4%). YT2D and OWOB had similar BMI (YT2D:37±8 vs. OWOB:35±8 vs. HL:21±3 kg/m2). The i3C score was highest in YT2D (Figure). Hazard Ratios were YT2D:1.8(1.2-2.7) vs. OWOB:1.3 (0.9-2.2) vs. HL:0.5 (0.4,0.7), P<0.01. hsCRP was higher in YT2D and OWOB vs. HL (Figure). hsCRP correlated with i3C scores, r=0.5, P<0.01.

Conclusion: YT2D had a 1.4-fold and 3.6-fold higher 35-year CVD risk compared to OWOB and HL peers, respectively. Future studies are needed to verify predicted risk in the YYA population.

Disclosure

F. Davis: None. S.B. Glaros: None. N. Malandrino: None. S.A. Dixon: None. A. Krenek: None. A. Chowdhury: None. L. Mabundo: None. J.A. Yanovski: Research Support; Rhythm Pharmaceuticals, Inc., Soleno Pharmaceuticals, Inc, Versanis Bil, Hikma Pharmaceuticals, Inc., National Institutes of Health. S.N. Magge: None. S.T. Chung: None.

Funding

Intramural Program of National Institute of Diabetes & Digestive & Kidney Diseases
1149-P: Associations of Specific Food Intake during Childhood and Adolescence with Insulin Resistance in Late Adolescence in Project Viva
Authors: HARNOIS-LEBLANC SOREN , YOUNG JESSICA , RIFAS-SHIMAN SHERYL , NICHOLS AMY R. , SWITKOWSKI KAREN , PERNG WEI , ARIS IZZUDDIN , OKEN EMILY , HIVERT MARIE-FRANCE
Published: June 2024

Introduction & Objective: Dietary behaviors are possible intervention targets for type 2 diabetes prevention in youth. We examined whether intake of specific foods across childhood and adolescence were associated with insulin resistance in late adolescence.

Methods: We used data from Project Viva, a US pre-birth cohort. We measured fruit, vegetable, whole grain (servings/d), and fast food intake (less than vs. at least once/mo) in early childhood (median age: 3.1y), mid-childhood (7.6y) and early teen (12.9y) with food frequency questionnaires. We calculated HOMA-IR using fasting blood glucose and insulin measured in late adolescence (17.4y). We fit sex-specific linear regression between foods at each visit with HOMA-IR adjusting for sociodemographics, parental type 2 diabetes, and intake at prior visits.

Results: In children with HOMA-IR data in late adolescence (median [IQR] females: 2.1 [1.5-3.0], n=187; males: 2.0 [1.4-2.9], n=169), we estimated that higher fruit, vegetable, whole grain, and lower fast food intake in early childhood were associated with lower HOMA-IR in males (Table). Estimates for exposures at older ages were of smaller magnitude and less precise, and consistently null in females.

Conclusion: Eating more fruits, vegetables, and whole grains, and less fast food in early childhood may be associated with lower insulin resistance in adolescent males.

Disclosure

S. Harnois-Leblanc: None. J. Young: None. S. Rifas-Shiman: None. A.R. Nichols: None. K. Switkowski: Consultant; Modern Fertility. W. Perng: None. I. Aris: None. E. Oken: Other Relationship; Takeda Pharmaceutical Company Limited, Up-To-Date. M. Hivert: None.

Funding

American Diabetes Association (7-23-PDFT2DY-3); NICHD R01 and R37 HD 034568
1150-P: Sexual Dimorphism in the Relationship of Obesity and Dysglycemia with Bone Microarchitecture in Youth
Authors: BACHA FIDA , SAHA PUNAM K. , VILLAREAL REINA , SHYPAILO ROMAN , CHEN XIAOJIE , PUYAU MAURICE R.
Published: June 2024

The relationship between obesity, type 2 diabetes (T2D), and bone health in youth is not clear. We examined the relationship of adiposity and glucose metabolism with bone mineral content (BMC) and microarchitecture (quality and strength) in youth across the glycemia spectrum, and evaluated sex-related differences. 75 adolescents (47 females); 27% normal weight (NW), 31% overweight-normal glucose tolerance (OW-NGT), 42% OW-impaired glucose regulation (IGR), including prediabetes (n=12) or T2D (n=20); underwent measurement of anthropometrics, body composition and BMC (DXA), bone microarchitecture (HRpQCT), and oral glucose tolerance test with determination of glucose and insulin indices. BMC and distal tibia bone quality and strength (modulus) measures were worse in OW-IGR and OW-NGT compared with NW in males but not in females (Table). Group differences in HRpQCT measures (worse in OW-IGR) were greater at the radius vs. tibia in both males and females. HOMA-IR was negatively related with vBMD (r=-.30, p=0.02), trabecular bone width (r=-0.38, p=0.003), and strength (r=-0.35, p=0.006) at the tibia and radius. There appears to be sexual dimorphism in the relationship of obesity and dysglycemia with bone quality and strength in youth, and a negative relationship between insulin resistance with bone measures. The metabolic effect of dysglycemia may be more discernable at a non-weight bearing site.

Disclosure

F. Bacha: None. P.K. Saha: None. R. Villareal: None. R. Shypailo: None. X. Chen: None. M.R. Puyau: None.

Funding

USDA/ARS National Institutes of Health
1151-P: Brain Networks Evaluated via Functional Magnetic Resonance Imaging May Underlie Cognitive Findings in Youth with Type 2 Diabetes
Authors: BRADY RYAN , SHAH AMY S. , DIFRANCESCO MARK W.
Published: June 2024

Introduction & Objective: Neurocognitive impairment is observed in adults with type 2 diabetes (T2D). Concerningly, studies of youth-onset T2D show lower neurocognitive scores than their peers without T2D. Functional magnetic resonance imaging (fMRI) provides a non-invasive manner to assess brain function and allows for the assessment of established brain networks. Elucidating alterations in brain networks that may lead to cognitive impairment in youth with T2D is critical for understanding the pathophysiology of brain related diabetes-associated complications.

Methods: 150 youth are being recruited for a study of how T2D impacts brain vasculature, structure, and cognition. We examined brain function connectivity between established brain networks using resting-state fMRI among the first 15 adolescents with T2D (mean age 16.4 years, BMI 39.4 kg/m2, 66.7% female) and 18 age, race, sex, and BMI similar controls without T2D (mean age 16.1 years, BMI 37.8 kg/m2, 66.7% female). Primary analyses were focused on the connectivity between regions of the default mode network (DMN) and the salience network (SN), two brain networks involved in cognition. Significance was determined between the T2D and controls with an effect size (Cohen’s d) exceeding 0.9.

Results: In youth with T2D, the connectivity between brain regions in the DMN (posterior cingulate and lateral parietal regions) and the SN (anterior cingulate, prefrontal cortex and supramarginal gyrus) demonstrates significantly weaker anticorrelation compared to controls.

Conclusion: Cognition requires anticorrelation between the brain networks of the DMN and SN. Given youth with T2D demonstrated weaker anticorrelation between these two brain networks compared to BMI-matched youth without T2D, cognitive impairment in youth with T2D may, in part, be explained by differences in these brain network connections.

Disclosure

R. Brady: None. A.S. Shah: None. M.W. DiFrancesco: None.

Funding

National Institutes of Health (R01 NS125316)