bluuebunny/crossref_metadata_2025 huggingface dataset:
1907-LB: Estimating Optimal CGM Wear Time for Individuals with Type 2 Diabetes Not on Insulin
Authors: BARUA SOUPTIK , UPADHYAY DHAIRYA A. , CURRAN MARGARET , BERUBE LAUREN , POPP COLLIN , LOU POMPEII MARY , WANG JOSEPHINE C. , VANEGAS SALLY M. , DORCELY BRENDA , HU LU , ST-JULES DAVID , BERGMAN MICHAEL , SEGAL ERAN , ANN SEVICK MARY
Published: June 2024

Objective: Continuous glucose monitoring (CGM) consensus guidelines, developed using large CGM datasets in type 1 and insulin-treated type 2 diabetes, recommend 14 days of wear time with at least 70% (~10 days) complete data. We sought to examine whether fewer days could reliably capture glycemic variability measures such as time in range (TIR) in individuals with type 2 diabetes (T2D) not on insulin.

Methods: The NIH-funded DiaTeleMed study is a 6-month randomized controlled trial comparing three different dietary strategies in adults diagnosed with T2D managed using diet alone or diet and metformin. We analyzed blinded Freestyle Libre Pro CGM data collected for up to 14 days before the intervention started. For participants with at least 10 complete days of data, we computed their time in 70-140 mg/dL (TIR140) and 70-180 mg/dL (TIR180) range using a cumulative approach starting from the first day and successively adding each day of data until their final day. We then identified the minimum number of days it took for the cumulative TIR metrics to stabilize within a clinically meaningful ±2% of their final values.

Results: We analyzed 80 participants (age 60±12 years, 63% female, 47% non-White, 14% Hispanic/Latino, BMI 30±6 kg/m2, HbA1c 6.7±0.6%, 66% on metformin) who had at least 10 days of complete CGM data. Participants’ cumulative TIR stabilized within ±2% of final values in 70±20% of days worn for TIR140 and in 50±23% of days worn for TIR180. Extrapolating these percentages to 14 days of wear, effectively 10±3 days and 7±3 days would be sufficient to estimate TIR140 and TIR180 respectively in this population.

Conclusion: Fewer than the 14 recommended days may be sufficient to estimate important CGM-derived metrics such as the TIR in individuals with T2D managed with diet alone or diet plus metformin. CGMs worn for less than the mandated 14-day period due to issues such as device fall-off, discomfort, or malfunction may still provide reliable glycemic variability information.

Disclosure

S. Barua: None. M. Curran: None. L. Berube: None. C. Popp: None. M. Pompeii: None. J.C. Wang: None. S.M. Vanegas: None. B. Dorcely: None. L. Hu: None. D. St-Jules: None. M. Bergman: None. E. Segal: None. M. Sevick: None.

Funding

National Institutes of Health (R01-NR018916 )
1911-LB: Developing CGM Knowledge Survey for Non-endocrinologists
Authors: FANCHIANG SHANPIN , BOUCHONVILLE MATTHEW F. , SHAHINIAN SUNSHINE S. , GARG RAJESH K. , LO YU-CHIEH , PETERS ANNE L.
Published: June 2024

Introduction: Optimal use of continuous glucose monitoring (CGM) is essential for healthcare professionals (HCPs), including primary care practitioners and allied health professionals, to enhance diabetes care. We designed the CGM Knowledge Survey (CGM KS) as an assessment and learning tool to support non-endocrinologists using CGM as an improvement project. We hypothesized that HCPs (P) participating in either of the two scheduled CGM education activities (I), the CGM seminar and the Diabetes Technology Workshop, would lead to a significant improvement (C) in CGM KS scores (O) among HCPs.

Methods: A multidisciplinary diabetes care team developed a 13-item CGM KS. The HCPs completed the CGM KS anonymously both before and after participating in one of two educational activities. A group of CGM ECs, mostly certified diabetes educators with experience in helping patients using CGM, were asked to fill out the CGM KS to provide a benchmark. Non-parametric statistical methods were used to analyze the data.

Results: The CGM KS was completed by HCPs pre-education (n=16), post-education (n=12), and CGM ECs (n=18). No significant difference was found between the scores of the CGM KS pre-education among the HCPs attending the two education activities. The CGM KS scores showed a significant improvement from 4.69 (± 1.92) to 7.00 (± 2.17) (P=0.008) pre- and post-education. Prior to education, the scores of CGM KS were significantly higher among CGM ECs compared to HCPs, with scores of 8.56 (± 2.23) versus 4.69 (± 1.92) (P=0.002). However, post-education, the CGM KS scores among CGM ECs were not found to be significantly different from those among the HCPs, with scores of 8.56 (± 2.23) versus 7.00 (± 2.17) (P=0.053).

Conclusion: The CGM KS has good potential to evaluate the impact of educational interventions aimed at building expertise in the use of CGM in diabetes care.

Disclosure

S. Fanchiang: None. M.F. Bouchonville: None. R.K. Garg: None. Y. Lo: None. A.L. Peters: Advisory Panel; Lilly Diabetes, Vertex Pharmaceuticals Incorporated, Medscape. Research Support; Abbott, Insulet Corporation.
1920-LB: Strong Correlation between More Readings in Tight Range and Greater Engagement with the OneTouch Reveal Diabetes App in a Real-World Dataset of 23,147 People with Type 1 Diabetes
Authors: HOLT ELIZABETH H. , CAMERON HILARY , GRADY MIKE
Published: June 2024

Background: Time in tight range (TITR) is a new metric applied to continuous glucose monitoring (CGM) data. We investigated the relationship between readings in tight range (RITR) and readings in range (RIR) using blood glucose meter (BGM) data in people with type 1 diabetes (PwT1D) using the OneTouch Reveal® diabetes app.

Methods: Anonymized glucose and app analytics were extracted from our server for 23,147 PwT1D. Glycemic data from their first 14 days using the app and meter were compared to the 14 days prior to a 180-day timepoint using paired within-subject differences.

Results: Glucose RITR (70-140 mg/dl) improved by +5.3 percentage points (%pts) (from 36.5 to 41.8%) in PwT1D performing 1 to 2 app sessions per week and this increased to +11.2 %pts (from 41.9 to 53.0%) in those performing >4 to 10 app sessions. Those performing 1-2 app sessions spent 9 minutes per week on the app compared to 38 minutes in those performing >4-10 sessions. Trends in % RITR with increasing app engagement were mirrored by improving % RIR, lower mean glucose, and reductions in % hyperglycemic readings (see Figure 1, P<0.001 for all).

Conclusion: Real-world data from 23,147 people with type 1 diabetes found improved percent readings in tight range with increasing engagement with the OneTouch Reveal® diabetes app.

Disclosure

E.H. Holt: Employee; LifeScan Inc. H. Cameron: Other Relationship; Lifescan Scotland. M. Grady: Employee; Lifescan Scotland.
1929-LB: Calculating Postmeal Interstitial Fluid Glucose (IFG) Appearance Using FreeStyle Libre CGM
Authors: MELISH JOHN S.
Published: June 2024

Introduction: CGM and carbohydrate counting (CC) have been proven to improve glucose control in type 1 and 2 diabetic patients. Those who continuously use CGM in diabetes management review the data frequently, make changes based on that data, and improve insulin related glucose control. Current CGM data summaries are considered useful to both patients and providers who adjust therapy to reduce glucose (G) variability and hypoglycemia with resulting improvements in A1c. The following describes the immediate use of CGM data for a pharmacokinetic analysis of meal related interstitial fluid glucose changes determined by the amount and timing of insulin administration.

Method: It requires the use of industry developed mobile phone software (LibreLinkUp) to immediately and quantitatively evaluate the meal related glucose excursion. A specific meal related glucose/insulin ratio results which confirms (and can replace) carbohydrate counting when carb counting is difficult or impossible to assess. Interstitial fluid glucose is evaluated from the time of pre-meal insulin injection to the return to baseline. IFG is adjusted to plasma glucose values using an adjusted Volume of Distribution (Vd) based on Kg body weight and hematocrit. The glucose concentration peak is deconvoluted and the lowest post meal baseline change is subtracted. The difference is multiplied by the adjusted volume of distribution to obtain an estimate of the ingested carbohydrate presenting as interstitial fluid glucose.

Results: Examples of identical meals and timed insulin dosing are evaluated and compared. Reference: breakfast bagel 56 g CHO. Variables: Vd=157 dL; Peak Post Meal G = 128 mg/dL; Calculation: 128*e*157 = 54,627 mg rounded to 55 g. I = 16 unit. CHO/I ratio =3.4 g/unit. Same breakfast another day: Calculated: 53 g; third breakfast: 54 g.

Conclusion: Meal related CC compares well with the calculated ISF glucose appearance using real-time CGM data.

Disclosure

J.S. Melish: None.
1930-LB: A Randomized Trial of Real-Time Continuous Glucose Monitoring (RT-CGM) with Culturally Tailored Education for Latino Patients with Type 2 Diabetes (DM)
Authors: EHRHARDT NICOLE M. , WRIGHT LORENA , MONTOUR LAURA , BERBERIAN PETER , JONES EVELIN , GIL MENCHACA DARINKA D. , GABRIELA VASCONCELOS ANA , COMSTOCK BRYAN A.
Published: June 2024

Background: Culturally tailored diabetes education and RT-CGM both support patients living with DM. However, data on education delivered virtually is limited in the Latino population and few studies have assessed the effect of RT-CGM combined with DM education.

Methods: We conducted a study of Latino patients diagnosed with Type 2 DM who were not on intensive insulin therapy. Patients were randomized (1:1) to virtually delivered sessions (12) of education only or education with cyclic RT-CGM over 12 weeks. The primary outcome was A1c at 12 weeks.

Results: 120 participants were randomized to education (59) or education + RT-CGM (61) with 33 in each arm completing 12 weeks of intervention. The mean age was 46 years, 44% were female, 98% preferred Spanish language, 30% had income <$25,000, and 30% had health insurance. Most participants (70%) attended >50% of 12 educational sessions. Mean A1c at baseline was 10.5 with 74% having A1c >9.0. A1c improved at 12 weeks by 1.3mg/dL with education and by 2.5mg/dL with education + RT CGM, with a difference of 1.3 (p=0.012) between groups.

Conclusions: Virtually delivered culturally tailored education improved A1c at 12 weeks in both groups, with RT-CGM conferring even greater improvement in A1c over education alone. The use of RT-CGM should be considered as an adjunctive therapy to education early in diabetes.

Disclosure

N.M. Ehrhardt: Advisory Panel; Bayer Inc., Dexcom, Inc. Research Support; Dexcom, Inc., Novo Nordisk. Advisory Panel; Novo Nordisk. Research Support; Merck & Co., Inc. L. Wright: None. P. Berberian: None. E. Jones: None. A. Vasconcelos: None. B.A. Comstock: None.

Funding

American Diabetes Association (11-21-ICTSHD-51)
1935-LB: Integrated Model of Digital Health and Clinic Care Pathway—A Prospective Observational Study to Manage HbA1c Levels and Time in Range among Indian Type 2 Diabetes Mellitus
Authors: JOSHI ARATI K. , SABOO BANSHI D. , SINGHAL TAVISHI , CHAKRABARTY SUJIT , GATTANI MANSI , NERKAR PRAJWAL , BANERJEE TRIJA , GODSE ANAND S.
Published: June 2024

Aim: To assess the impact of Smit.fit’s CGM-powered Diabetes Care program on reducing HbA1c levels and increasing Time in Range (TIR) for T2DM patients at health clinics.

Method: A single group design study of repeated measures evaluated Smit.fit’s 4-month Diabetes Care program deployed at partner health clinics across 50 cities in India. The intervention included glucose monitoring by CGM and HbA1c tests with data-driven behavioural changes facilitated by Smit.fit’s certified health experts tracked on Smit.fit’s app.

Results: Of 808 adults, at baseline, 35.1% had severely uncontrolled T2DM (A1c > 9%), 41.5% had uncontrolled T2DM (7% < A1c ≤ 9%) and 23.4% had controlled T2DM (A1c ≤ 7%). The mean age of subjects was 52.34 ± 11.99 yrs, BMI 26.53 ± 4.68, and duration of DM 7.99 ± 7.53 yrs. With Smit.fit’s integrated intervention, a significant difference was observed from baseline HbA1c (8.62 ± 1.95%) to post-program (7.55 ± 1.51%)(p<0.001), CGM Est. A1c (week 1: 8.12 ± 2.54%, week 2: 7.47 ± 2.24%)(p<0.001), and TIR (week 1: 40.32 ± 30.95%, week 2: 47.48 ± 30.79%)(p<0.001). In baseline and Est. A1c, reductions of 1.07, 0.65 respectively, and a 7.16 increase in TIR were observed. Baselining HbA1c levels and HbA1c impact showed a significant positive correlation (r=0.647, p<0.001). In participants with severely uncontrolled T2DM (A1c > 9%), HbA1c reduction of 2.18 ± 1.72% was seen with 72.2% users showing more than 1.0% HbA1c reduction and 19.7% users showing 0.1-1.0% HbA1c reduction. Additional factors like duration of DM, complications and comorbidities lacked significant correlation with HbA1c impact.

Conclusion: Smit.fit’s comprehensive approach of data-driven monitoring and coaching led to significant reductions in HbA1c levels and improved glucose control, especially with uncontrolled baseline HbA1c (A1c>7%) where 71.92% users showed >0.5% HbA1c reductions.

Disclosure

A.K. Joshi: None. B.D. Saboo: None. T. Singhal: None. S. Chakrabarty: None. M. Gattani: None. P. Nerkar: None. T. Banerjee: None.
1938-LB: Improving Screening for Retinopathy in Youth with Diabetes Mellitus
Authors: RHODES ERINN , STERNS OLIVIA R. , MOYNIHAN JENNIFER L. , HIRSCH REBECCA , NANAVATI SONAL , GONZALEZ EFREN , GARVEY KATHARINE
Published: June 2024

Introduction & Objective: Despite the rare occurrence of retinopathy in youth with diabetes (DM), routine screening is required. For type 1 diabetes (T1DM), screening starts at age 10 yrs. and DM duration of 5 yrs.; for type 2 diabetes (T2DM), at diagnosis.

Methods: Retinopathy screening with non-mydriatic fundus photography with Welch Allyn RetinaVue 700 Imager (RV) was offered to eligible DM patients at a pediatric, tertiary care center. Completed scans were reviewed by an ophthalmologist at the same center. Completion and reasons for incomplete testing were tracked. Control charts analyzed monthly completion. Refining implementation and uptake occurred through iterative PDSA cycles.

Results: From 10/20 to 12/23, 449 RV scans were completed (71% T1DM), and 4 (<1%) patients had retinopathy. There was a significant shift in completion in 1/23 from 49.9% to 73.5% among eligible patients, who attended a visit with a RV order. In 2023, the most common reason for incomplete testing among eligible patients was a scheduled ophthalmology appointment (32%). Observation showed RV added ~5 minutes to clinic time. Overall, biannual retinopathy screening between CY19 and CY23 increased from 33 to 37% among eligible T1DM patients and from 25 to 55% among T2DM patients.

Conclusion: Data suggest that non-mydriatic fundus photography with RV is a feasible method for increasing screening for retinopathy especially among pediatric patients with T2DM.

Disclosure

E. Rhodes: None. O.R. Sterns: None. R. Hirsch: None. S. Nanavati: None. E. Gonzalez: None. K. Garvey: Advisory Panel; Sanofi.
1939-LB: Improving Capacity for Quality Improvement in Type 2 Diabetes Primary Care Centers
Authors: RIOLES NICOLE , MUNGMODE ANN , ODUGBESAN ORI , WRIGHT TREVON , PASUPNETI TEJASVI , GARG RAJESH K. , HAFT HOWARD M. , GANGUPANTULA GOPIKA , EBEKOZIEN OSAGIE
Published: June 2024

Background: Primary healthcare centers (PHCs) caring for people with diabetes are often overwhelmed and burdened by operational challenges and low resources. The aim of this study was to increase the capacity for PHCs to implement evidence-based quality improvement (QI) projects.

Methods: American Diabetes Association (ADA) recruited four PHCs into this project. T1D Exchange coached PHC from August 2023 - March 2024 on QI and change management. The PHCs selected QI metrics for the pilot phase; increasing HbA1c testing, kidney health screening, and statin prescribing for people with type 2 diabetes (PwT2D). PHCs identified barriers and tested improvement changes through Plan-Do-Study-Act cycles; PCPs reported aggregate monthly data for almost 8,000 people with type 2 diabetes.

Results: Three of the four participating centers completed the pilot phase. Demonstrating overall improvement in QI capacity, all centers improved in at least one clinical outcome measure. One of the centers improved statin prescribing by 7% (Fig.1). A1c screenings increased by 14%.

Conclusion: Common challenges observed across PHCs include fewer staff with dedicated time for QI, data reporting challenges, limited QI resources, constraints implementing workflow change, and lack of dedicated QI leadership. Providing external assistance through QI coaching and support can improve capacity to make robust practice transformation. Fig. 1

Disclosure

N. Rioles: None. A. Mungmode: None. O. Odugbesan: None. T. Wright: None. T. Pasupneti: None. R.K. Garg: None. H.M. Haft: None. G. Gangupantula: None. O. Ebekozien: Advisory Panel; Sanofi, Medtronic. Research Support; Vertex Pharmaceuticals Incorporated. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; Medtronic, Lilly Diabetes, Abbott, Dexcom, Inc.

Funding

Statement of Work, executed with ADA for the Know Diabetes By Heart program (2023)
194-OR: Improved Linkage to the Health System and Better Diabetes Control Due to Community-Based m-Health–Enabled Screening and Follow-up in India
Authors: MOHAN SAILESH , JARHYAN PRASHANT , DUBEY MANISHA , SRINIVASAPURA VENKATESHMURTHY NIKHIL , PRABHAKARAN DORAIRAJ
Published: June 2024

Introduction: India faces a huge burden of undiagnosed and uncontrolled diabetes, resulting in a significant challenge to the healthcare system.

Methods: To improve linkage to the primary healthcare system and blood glucose control among diabetics, we conducted a large community-based screening and follow-up study of individuals’ ≥ 30 years led by trained non-physician health workers (NPHWs) enabled with an m-health enabled screening and follow-up system on a tablet device, in rural and urban areas of North and South India. NPHWs collected data using an interviewer-administered questionnaire, measured random capillary blood glucose (RBG) during the screening and follow-up and collected data on health facility visits during subsequent follow-up visits. Diabetes was defined according to standard definitions. NPHWs also provided tailored lifestyle modification education.

Results: 147828 individuals were screened at their homes, of which 53.1% were from rural areas. The mean age of participants was 48.1 (SD ±13.8) years and prevalence of self-reported diabetes was 7.9% (95% CI: 7.8 % - 8.1%). The proportion of diabetics visiting any health facility increased significantly [visit 1: 32.1% (31.2%-32.9% %), visit 4: 52.2% (50.1%-54.3%] between the first and the fourth follow-up visits. There was an increase in proportion of those who had their blood glucose measured at the health facility between the two visits. Overall, there was a decrease in the mean RBG [visit 1: 215.4 (SD:86.6) mg/dl Vs visit 4: 191.5 (SD 63.9) mg/dl. There was a significant increase in proportion of diabetics with controlled blood glucose in the fourth follow-up visit, 59.2% (56.9%-61.5%) as compared to the first visit, 45.2% (43.4%-47.0%).

Conclusion: Our tailored screening and follow-up program indicates that non-physician health worker led m-health enabled screening significantly improved the health service utilization and blood glucose control among diabetics.

Disclosure

S. Mohan: None. P. Jarhyan: None. M. Dubey: None. N. Srinivasapura Venkateshmurthy: None. D. Prabhakaran: None.

Funding

An unrestricted grant under the Lilly NCD Partnership programme.
1944-LB: Control of Impatient Hyperglycemia Using a Decision Support System
Authors: CARDIM THALITA M. , FERNANDES ADRIANA M. , INAOKA RIGUEL J. , RIZZO ARIEL , MUNHOZ ANA PAULA A. , SREDOJA THAIS L. , FIEDLER DANIELA B. , OLIVEIRA ANDREA , ROZZINO TATIANNA P.
Published: June 2024

Introduction: Hyperglycemia is an independent marker of hospital mortality, regardless of the previous diagnosis of diabetes. insulin is the clear choice for the hospitalized patient. Insulin should be administered using validated protocols that allow predefined adjustments in insulin doses based on glycemic fluctuations.

Objective: P = High rate of hyperglycemia in hospitalized patients; I = Use of a decision support tool; C = Patients routinely treated without using the tool; O = Better control of hyperglycemia rates and outcomes.

Methods: After a broad discussion on the relevant aspects of hyperglycemia, the construction of Carepathway began in the electronic medical record (Cerner Millennium) with 13 different scenarios that guide the physicians towards best practice. Each scenario triggers a warning with guidelines and the possibility of prescribing insulin doses according to the protocol.

Results: After the implementation of the Pathway, February 2022, we could notice a sustained drop in the rates of hyperglycemia and severe hyperglycemia and better adherence to institutional protocols.

Conclusion: The decision support tool is providing excellent care to patients with glycemic disorders, in addition to facilitating and standardizing the conduct of non-specialist doctors.

Disclosure

T.M. Cardim: None. A. Rizzo: None.
1945-LB: Evaluation of Proactive Targeting Models Used to Identify People with Diabetes at Risk of Being Uncontrolled during Participation in a Digital Diabetes Management Program (DDMP)
Authors: KHALILNEJAD ARASH , KOMPALA TEJASWI , JAMES ROBERTA , PAINTER STEFANIE , WANG YAJUAN
Published: June 2024

Introduction & Objective: Predictive machine learning models were developed for each month during DDMP to predict individual risk of having an estimated A1c (eA1c) ≥7.5% at 12 months for personalized Health Nudges to be deployed for improved fingerstick blood glucose monitoring (FBGM) and program engagement associated with improved glycemic control. This study evaluated short-term impact on FBGM and reduction in eA1c after 9 months on program.

Methods: Deployment of models and personalized Health Nudges launched in May 2023 to a population allowing for comparison to two control groups of DDMP participants without (C1) and randomly assigned Health Nudges (C2). Participants were selected for treatment group if they had a self-reported A1c at program initiation and adequate BG checks to eA1c at 9 months using a modified Nathan Method developed by Teladoc Health. Repeated measures ANOVA analysis was used to evaluate differences between treatment and control groups adjusting for diabetes type.

Results: Treatment (n=526) and control groups (C1 n=73, C2 n=55) were similar in age [years: 55 (11.7), 56 (8.8) and 56 (12.5)], gender [female: 48%, 44%, 51%], and diabetes type [type 2: 91.2%, 86%, 91.8%], respectively. At Month-9, average 30-day FBGM checks were 32, 30, and 28, for treatment, C1, and C2. Treatment group’s eA1c at Month 9 was 7.8% while C1 and C2 were 8.2%. Statistical analysis showed personalized Health Nudges led to significant reduction in eA1C levels from baseline (P < 0.001). C2 group showed reduction as well, although not as pronounced as the treatment group (P = 0.038). Conversely, the C1 group did not demonstrate a significant reduction in eA1C levels (P = 0.070).

Conclusion: Preliminary evaluation of machine learning models supports the ability to target DDMP users in early months on program with Health Nudges aimed at increasing program engagement that was associated with improved clinical outcomes.

Disclosure

A. Khalilnejad: Employee; Teladoc Health. Stock/Shareholder; Teladoc Health. T. Kompala: None. R. James: Employee; Teladoc Health. Stock/Shareholder; Teladoc Health. S. Painter: Employee; Teladoc Health. Y. Wang: Employee; Teladoc Health. Stock/Shareholder; Teladoc Health.
1951-LB: Impact of Discontinuation of Automated Insulin Delivery Systems in the Emerging Adult with Type 1 Diabetes
Authors: WATERMAN LAUREN A. , COBRY ERIN C. , SAKAMOTO CASEY , PYLE LAURA , FORLENZA GREGORY P. , SHAH VIRAL N. , ALONSO GUY T.
Published: June 2024

Introduction & Objectives: Automated insulin delivery (AID) systems can improve HbA1c in people with type 1 diabetes (T1D). Data are limited on rates and impact of discontinuation of newer AID in the emerging adult population.

Methods: Retrospective chart review was performed on 14-30 year olds with T1D of ≥ 1 year duration, started on an AID system (Medtronic 770G, Control-IQ, Omnipod 5) after 2018. HbA1c prior to and quarterly for 24 months after initiation were collected. Discontinuation of AID (≥ 1 visit without use) was noted. Mixed model was fit for HbA1c values and time, adjusting for age, sex, diabetes duration, race/ethnicity, and insurance. Contrasts generated to compare HbA1cs at each time point.

Results: In 613 emerging adults with T1D (mean age 21.1±4.2 years, diabetes duration 10.8±6.0 years, male 44.5%, non-Hispanic White 76.8%), 3109 HbA1c values were collected. Mean HbA1c decreased from 8.5% at baseline to 7.7% by 24 months (p<0.001). Discontinuation was associated with higher HbA1c (p<0.001). AID was discontinued at least temporarily by 15.3% of patients (N=94), with highest rates in 19-22 year olds (38 of 174, 21.8%). AID discontinuation reasons included supply (25.5%) or cost/insurance issues (15.3%).

Conclusion: Consistent AID usage in emerging adults is associated with sustained improvements in HbA1c levels. Further study on strategies to reduce discontinuation is required.

Disclosure

L.A. Waterman: None. E.C. Cobry: Advisory Panel; Dexcom, Inc. Other Relationship; Dexcom, Inc. C. Sakamoto: None. L. Pyle: None. G.P. Forlenza: Research Support; Abbott, Dexcom, Inc. Consultant; Dexcom, Inc. Research Support; Insulet Corporation. Consultant; Insulet Corporation. Research Support; Medtronic. Advisory Panel; Medtronic. Research Support; Tandem Diabetes Care, Inc. Consultant; Tandem Diabetes Care, Inc. V.N. Shah: Consultant; Dexcom, Inc., Insulet Corporation. Research Support; Insulet Corporation. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Sanofi, Medscape. Consultant; embecta, Tandem Diabetes Care, Inc. G.T. Alonso: Advisory Panel; MannKind Corporation.

Funding

National Institutes of Health (5T32DK063687)
1976-LB: Sleep Characteristics in Association with the Risk of Progression from Gestational Diabetes to Type 2 Diabetes—A Prospective Cohort Study
Authors: YIN XIN , BAO WEI , YANG JIAXI , YU GUOQI , LIU PEIPEI , ZHANG CUILIN
Published: June 2024

Introduction & Objective: Sleep is a crucial lifestyle factor associated with cardiometabolic health, yet its role in the progression from gestational diabetes mellitus (GDM) to type 2 diabetes (T2D) is underexplored. Our study investigated the associations between sleep, T2D risk, and metabolic biomarkers in these high-risk women.

Methods: We followed 2,999 women with a history of GDM in the Nurses’ Health Study II for incident T2D between 2001 and 2019. Sleep characteristics, health-related and other lifestyle factors were ascertained in 2001 questionnaire. Glucose metabolic biomarkers were measured in a subset of participants with available fasting blood samples collected between 2012 and 2014 (n=536). Cox regression models were used to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of T2D. Least-squares means (95% CIs) of metabolic biomarker levels were estimated according to sleep characteristics.

Results: During a mean of 14.8 years of follow-up, 520 women developed T2D. Compared to sleeping 7-8 hours per day, shorter sleep duration (≤6 hours/day) was significantly associated with a higher risk of T2D, with an adjusted HR of 1.28 (95% CI = 1.03-1.58). Compared with rarely snoring, occasional and regular snoring were significantly associated with a higher T2D risk, with adjusted HR of 1.44 (95% CI = 1.11-1.86) and 1.52 (95% CI = 1.16-2.00), respectively. The highest risk of T2D was observed in obese women who experienced shorter sleep duration (HR=6.99, 95% CI = 4.62 - 10.6), compared with non-obese women who sleep 7-8 hours per day. Furthermore, significant positive associations were observed between more frequent snoring and increased levels of HbA1c, C-peptide, and insulin (all P-values<0.05).

Conclusion: Among women with a history of GDM, shorter sleep duration and more frequent snoring were significantly associated with increased risk of T2D and unfavorable cardiometabolic profile.

Disclosure

X. Yin: None. W. Bao: None. J. Yang: None. G. Yu: None. P. Liu: None. C. Zhang: None.
1977-LB: Successful Occurrence of Two Separate Pregnancies in a Patient with Congenital Generalized Lipodystrophy Due to Homozygous AGPAT2 Mutations without Recombinant Leptin Therapy
Authors: SANTOMAURO JUNIOR AUGUSTO C. , FRANCO PEDRO C. , COSTA-RIQUETTO ALINE D. , JORGE ALEXANDER A. , TELES MILENA G.
Published: June 2024

Introduction and Objective: Congenital generalized lipodystrophy (CGL) is a rare genetic disorder with a prevalence of approximately 1/2 million people, characterized by the absence of adipose tissue and associated with significant metabolic and hormonal complications that adversely affect fertility and pregnancy outcomes. We aim to report on two distinct successful pregnancies in a patient with CGL, attributed to homozygous mutations in the AGPAT2 gene, which were managed without the intervention of recombinant leptin.

Results: A 34-year-old woman diagnosed with CGL, bearing homozygous AGPAT2 mutations (c.299 G>A and c.493 -1G>C), displayed typical symptoms of the disorder, such as diabetes mellitus from the age of 15, pancreatitis secondary to hypertriglyceridemia at age 25, polycystic ovary syndrome, hepatic steatosis, and signs of muscular pseudohypertrophy, among others. After her diagnosis, she began a stringent low-carbohydrate diet. Her medication regime included solely metformin, 1500mg daily. The first pregnancy occurred naturally at 27y and was managed without complications with dietary measures alone and underwent a vaginal delivery of a 3500g baby. She is currently progressing well through her second pregnancy, expected in April 2024, with no complications thus far and only required insulin therapy in the third trimester to maintain optimal glycemic and lipid profiles.

Conclusions: Given the typically impaired fertility associated with CGL, the occurrence of pregnancies in this population is notably rare. The literature predominantly features cases that necessitate the use of recombinant leptin for metabolic management during pregnancy. However, this case study, suggests that despite the presence of homozygous mutations, CGL can manifest with less severe metabolic disruption, which may have implications for fertility and pregnancy prognosis in affected individuals.

Disclosure

M.G. Teles: None.
1979-LB: Factors Predicting Elevated LDL Cholesterol in a Type 1 Diabetes Cohort—A Cross-Sectional Study
Authors: LOVE KAITLIN , DART MARINA
Published: June 2024

Introduction & Objective: Type 1 diabetes (T1D) confers substantial cardiovascular disease (CVD) risk. Major U.S. guidelines recommend statin use in all people with T1D ages 40-75, with target low density lipoprotein (LDL) cholesterol level < 100 mg/dL. The objective of this study was to assess frequency of LDL above target and to examine demographic and socioeconomic characteristics associated with LDL above target in individuals with T1D.

Methods: We conducted a cross-sectional analysis of individuals with T1D ages 55-75 using Premier Healthcare Database (PHD) outpatient encounter data from January 2020 to December 2022. The outcome variable was LDL ≥ 100 mg/dL. Predictor variables included age, sex, race, ethnicity, CVD diagnosis, and insurance payor (Medicare/other government payor, Medicaid, Commercial, Managed Care, self-pay or other). Using SAS 9.4, a logistic regression model was used to determine covariates associated with LDL≥100 mg/dL after adjusting for other covariates.

Results: Of 5,344 individuals in the cohort (51.5% women, mean age 65.3 ± 5.9 years, and 6.3% with CVD diagnosis), 34.9% had LDL ≥100 mg/dL. Female sex (OR 1.59, 95% CI 1.42-1.77, p < 0.0001) and insurance coverage by Medicaid (OR 1.74, 95% CI 1.94-2.53, p < 0.01) were independently associated with increased odds of LDL above target. Older age (OR 0.98, 95% CI 0.97-0.99, p = 0.01) and CVD diagnosis (OR 0.60, 95% CI 0.46-0.77, p < 0.0001) were independently associated with reduced odds of LDL above target. Race and ethnicity were not associated with LDL above target.

Conclusion: A large percentage of this cohort at high-risk for CVD had elevated LDL, and factors independently associated with elevated LDL levels were female sex, Medicaid insurance, younger age, and lack of CVD diagnosis. Female sex or Medicaid insurance increased odds of elevated LDL by 59% and 74% respectively adjusting for other covariates. Further study to understand cause of these disparities is needed.

Disclosure

K. Love: None. M. Dart: None.

Funding

National Institutes of Health (K23DK131327-01A1)
1985-LB: Assessing the Impact of Diabetes on Gastrointestinal Symptom Severity in Exocrine Pancreatic Insufficiency (EPI/PEI)—A Diabetes Subgroup Analysis of EPI/PEI-SS Scores
Authors: LEWIS DANA M.
Published: June 2024

Introduction & Objective: Exocrine pancreatic insufficiency (known as EPI or PEI) has a high symptom burden and is present in as many as 3 of 10 PWD. A new symptom tool, the Exocrine Pancreatic Insufficiency Symptom Score (EPI/PEI-SS), has been evaluated in the general population to assess real-world symptom burden in individuals with (n=155) and without (n=169) EPI. A large cohort of PWD were analyzed to evaluate whether diabetes contributes to a difference in EPI/PEI-SS score.

Methods: EPI/PEI-SS scores were analyzed and compared between PWD (n=118), with EPI (T1D: n=14; T2D: n=20) or without EPI (T1D: n=78; T2D: n=6), and people without diabetes (n=206) with and without EPI.

Results: People with diabetes had statistically significant higher mean EPI/PEI-SS scores (102.62 out of 225, SD: 52.46) than did people with diabetes without EPI (33.64, SD: 30.38), irrespective of presence of other GI conditions (all group comparisons p<0.001). T1D and T2D subgroups were similar.

Conclusion: EPI has a high symptom burden, irrespective of diabetes. High scores using the EPI/PEI-SS among people with diabetes can distinguish between EPI and other GI conditions. The EPI/PEI-SS should be further studied as a possible screening method for EPI and assessed as a tool to aid PWD in tracking changes to EPI symptoms over time based on PERT titration.

Disclosure

D.M. Lewis: None.
1989-LB: High Serum Ketone Emergencies and Diabetic Ketoacidosis (DKA) in People with Type 2 Diabetes, Prediabetes, and Obesity on Carbohydrate Restricted Nutrition Therapy (CRNT)
Authors: ROBERTS CAROLINE G.P. , ATHINARAYANAN SHAMINIE J. , RATNER ROBERT E.
Published: June 2024

CRNT including nutritional ketosis is increasingly used by people with Type 2 diabetes (PWT2D), prediabetes (PWPreD), and obesity (PWO) for weight loss and glycemic control. The characteristics of high ketone emergencies in people on CRNT are not known. DKA is a known complication of diabetes; triggers include very low carbohydrate diet and SGLT2-inhibitors (SGLT2i). We reviewed all in-person medical assessments for high fingerstick beta hydroxybutyrate (BHB) readings self-reported by patients at a telemedicine clinic. From 2017 to 2023, 85 PWT2D (1.7/1k person-years) sought medical care for high BHB. Mean age was 55 years (SD 9), 35 (42%) were female, mean diabetes duration was 16 years (SD 9), 38 (45%) were on SGLT2i, and 32 (38%) were on insulin. The incidence of severe high ketone emergencies was extremely low (0.8/1k person-years). Home glucose and home BHB levels did not distinguish severe from mild conditions. Higher laboratory glucose (p<0.001), lower pH and bicarbonate (p<0.001), and greater anion gap (p<0.001) were seen more often in more severe disease. Moderately abnormal values were common in both severe and moderate disease. These findings underscore CRNT’s potential as a remarkably safe and effective tool for metabolic disease management in the setting of remote biomarker monitoring.

Disclosure

C.G.P. Roberts: Other Relationship; Virta Health Corp. S.J. Athinarayanan: Employee; Virta Health Corp. R.E. Ratner: Stock/Shareholder; Abbott, AbbVie Inc. Other Relationship; American Diabetes Association, Juvenile Diabetes Research Foundation (JDRF). Advisory Panel; National Committee for Quality Assurance, National Institute of Diabetes and Digestive and Kidney Diseases, Virta Health Corp.
1992-LB: Area Deprivation Index of Participants in the Rare and Atypical Diabetes Network (RADIANT)
Authors: SON RACHEL G. , LETOURNEAU-FREIBERG LISA R. , POLLIN TONI I. , NAYLOR ROCHELLE N. , STUDY GROUP RADIANT
Published: June 2024

Introduction & Objective: RADIANT is a multicenter, US-based study of the causes of atypical diabetes and how it informs overall understanding of diabetes etiology and heterogeneity. A key goal is equitable inclusion so that knowledge gained will be broadly applicable. Populations at risk for underrepresentation in research include those with low socioeconomic status. We assessed area deprivation index (ADI), a census-based socioeconomic index, of RADIANT participants. We evaluated the relationship of ADI with participant characteristics.

Methods: Participants with valid U.S. addresses and available ADI ranking were included in the study. Participant characteristics were summarized; 2021 ADI values were constructed based on participant address. ADI values were compared to the expected value of 50th percentile via the Wilcoxon test and compared among groups via the Kruskal-Wallis test.

Results: There were 892 RADIANT participants included in the analysis. The median U.S. ADI of participants was 28, lower than the expected value of 50 (p<0.001). Only 24.5% of participants had ADI >50th percentile. Median ADI differed by race, but not ethnicity, with Asian participants having the lowest median ADI (13), compared to Blacks (29) and Whites (29) (p<0.01). Median ADI did not differ by referral source (e.g., provider vs. self-referral). ADI compared across ~3 consecutive years was statistically different (Median ADI 24, 30, 29; p<0.05), driven by an increase from year 1 to year 2.

Conclusion: This study found that a low number of RADIANT participants live in areas of high deprivation, suggesting ascertainment bias in enrollment and highlighting the need for continued development of recruitment practices that will engage individuals likely to face barriers to research participation and who simultaneously carry a higher disease burden from diabetes.

Disclosure

L.R. Letourneau-Freiberg: None. T.I. Pollin: None. R.N. Naylor: None.

Funding

National Institute of Health (DK118638); National Institute of Health (U54 DK118612)
20-OR: Digital Twin (DT) Technology in Type 2 Diabetes Remission and Glycemic Improvement—Eighteen Months Results from a Randomized Controlled Trial
Authors: SHAMANNA PARAMESH , DHARMALINGAM MALA , VADAVI ARUN , KESHAVAMURTHY ASHOK , BHONSLEY SUCHITRA , THAJUDEEN MOHAMED , SHA ASMIN , JOSHI SHASHANK R.
Published: June 2024

This study assesses the impact of Digital Twin (DT) technology, utilizing AI for postprandial glucose prediction, on T2D remission. Of the 233 participants using DT, 18 months' results were available for 218, showing significant improvements. Key metrics included reductions in HbA1c levels, body weight, HOMA2-IR, and HOMA2B. The mean age and duration of diabetes were 44 years (±8.6) and 3.7 years (±2.7), respectively. Notable changes from baseline to eighteen months in these 218 participants included HbA1c (from 8.9 ± 1.9, 95% CI 8.7-9.2 to 6.4 ± 0.9, 95% CI 6.3-6.5), body weight (from 78.1 kg ± 14.3 to 72.8 kg ± 13.7), BMI (from 27.2 ± 4.3 to 25.2 ± 4.1), waist circumference (from 97.4 cm ± 11 to 88.1 cm ± 10.5), HOMA2-IR (from 1.9 ± 0.9 to 1.5 ± 0.8), and HOMA2B (from 51.9 ± 30.8 to 70.9 ± 32.9). Remission was defined as A1C levels less than 6.5% without medication for over 3 months. Out of the initial 233 DT participants, 207 completed a minimum of six months of the intervention, qualifying them for remission evaluation. Of these, 64.3% (133/207) achieved sustained remission at eighteen months. The standard care participants showed minimal HbA1c change (from 8.5 ± 1.8 to 8.3 ± 1.6). These findings underscore the potential of DT as a transformative tool in diabetes management, with significant correlations observed between reductions in A1c, body weight, and HOMA2B.

Disclosure

P. Shamanna: None. M. Dharmalingam: None. A. Vadavi: None. A. Keshavamurthy: None. S. Bhonsley: None. M. Thajudeen: None. A. Sha: None. S.R. Joshi: Consultant; Twin Health, Marico, Franco Indian, Zydus Cadila, Glenmark Pharmaceuticals. Other Relationship; Novo Nordisk, Sanofi, MSD, Abbott Nutrition, Abbott, Biocon, Alkem, USV Private Limited, Boehringer-Ingelheim.
200-OR: Postpartum Islet-Cell Function in Individuals With and Without Gestational Diabetes
Authors: EGAN AOIFE M. , CHRISTIE HANNAH E. , MOHAN SNEHA , VELLA ADRIAN
Published: June 2024

Gestational diabetes mellitus (GDM) affects approximately 10% of pregnancies. Although >60% individuals with GDM develop a disorder of glucose metabolism by 10 years postpartum, preventive care is lacking as the mechanisms leading to overt diabetes following pregnancy remain elusive. As part of a series of studies to understand the pathogenesis of GDM, we examined islet function at 3, 6 and 12 months postpartum. We included women with (n=10), and without (n=10) GDM in the preceding pregnancy. There were no differences in age, body mass index, or lean body mass between groups. At each study visit, subjects presented following an overnight fast and ingested a 75g oral glucose solution at time 0. Venous blood was drawn fasting and at frequent intervals over 180 minutes for measurement of glucose and hormone concentrations. At 3 months postpartum, those with GDM had higher fasting glucose (4.9 ± 0.1 v 4.5 ± 0.1 mmol/L, GDM vs normal respectively, p=0.04) but no differences in peak / integrated glucose compared to those without. Fasting insulin (31 ± 6 vs 14 ± 1 pmol/L, p=0.01) and C-peptide (0.64 ± 0.09 vs 0.44 ± 0.02 mmol/L, p=0.04) were higher in those with GDM with no differences in peak / integrated concentrations. Fasting (4.9 ± 0.4 vs 3.4 ± 0.3 pmol/L, p=0.01) and area under the curve (398 ± 21 v 340 ± 11pmol / 180 min, p=0.03) glucagon were higher in those with GDM. At 6 and 12 months postpartum, these differences were no longer evident with similar glucose and hormone concentrations between groups. These data suggest that both α- and β-cell dysfunction likely contribute to GDM with residual dysfunction present at 3 months postpartum. This is no longer evident by 6 months postpartum. Further longitudinal work is needed to determine progression of fasting and post-challenge islet cell function throughout pregnancy and postpartum to understand how those with GDM are primed for early onset type 2 diabetes.

Disclosure

A.M. Egan: None. H.E. Christie: None. S. Mohan: None. A. Vella: Research Support; Novo Nordisk. Consultant; Hanmi Pharm. Co., Ltd., Crinetics Pharmaceuticals, Inc. Advisory Panel; Rezolute, Inc.

Funding

National Institutes of Health (K23DK134767)
2001-LB: Small RNA-seq Identifies Distinct miRNAs Involved in Familial and Sporadic Type 1 Diabetes Cases from Kuwait
Authors: NIZAM RASHEEBA , ZUBBAIR MALIK MD. , JACOB SINDHU , KOISTINEN HEIKKI A. , TUOMILEHTO JAAKKO , ALKANDARI HESSA , ALMULLA FAHD , THANGAVEL ALPHONSE T.
Published: June 2024

Clinical diagnosis of Type 1 Diabetes (T1D) has been hallmarked by the presence of serum biomarkers such as circulating autoantibodies and c-peptide; however, identification of additional biomarkers associated with T1D is crucial for better diagnosis of the disease and for developing effective therapeutic strategies. Epigenetic modifications, such as dysregulated expression of miRNAs, have also been shown to have a major impact on diabetes and related metabolic complications. In the present study, we aimed to identify the key miRNAs involved in T1D by screening familial and sporadic cases using Next-generation sequencing (NGS) methodology, followed by quantitative real time PCR. The major questions addressed in this study include, what are the key microRNAs, their target genes and molecular pathways involved in T1D. Blood samples were collected from a total of eight families consisting of 18 people with T1D and 18 unaffected first-degree relatives and tested by NGS, followed by validation of key markers in a cohort of 110 sporadic T1D cases and 15 controls without T1D. Our study highlights 23 miRNAs that are differentially expressed in individuals with T1D compared to controls. Functional enrichment analysis of differentially expressed miRNAs highlighted PI3K-AKT as one of the key pathways involved in T1D. We validated the highest order network motif comprising miRNA, key transcription factors and the key miRNA target genes using quantitative real time PCR. Our study portrays hsa-miR-320a, CAV1, GSK3B and MYC as novel transcriptional biomarkers with diagnostic potential for T1D and may lay the foundation for further in-depth research catering better outcome and treatment of T1D.

Disclosure

R. Nizam: None. M. Malik: None. S. Jacob: None. H.A. Koistinen: Other Relationship; AstraZeneca, Novo Nordisk. J. Tuomilehto: Stock/Shareholder; Orion Pharma, Aktivolabs, Digostics. F. Almulla: None.

Funding

This study was supported by institutional funding from the Kuwait Foundation for the Advancement of Sciences to Dasman Diabetes Institute.
2014-LB: Association between Variants in Genes Involved in the Metabolism of Uric Acid and the Risk of Type 2 Diabetes
Authors: TSEKMEKIDOU XANTHIPPI , KOUFAKIS THEOCHARIS , PAPAVASILEIOU MARIA , TSETSOS FOTIOS , GEORGITSI MARIANTHI , GRAMMATIKI MARIA , ROUMELIOTIS ATHANASIOS , PAPANAS NIKOLAOS , PAPAZOGLOU DIMITRIOS , PASCHOU PERISTERA , KOTSA KALLIOPI
Published: June 2024

Introduction & Objective: Epidemiological and experimental evidence suggests that hyperuricemia is involved in the pathophysiology of type 2 diabetes (T2D), inducing insulin resistance or beta cell failure. Therefore, our objective was to investigate a possible association between variants in genes related to uric acid metabolism and T2D in a case-control study design.

Methods: Our sample consisted of 624 T2D patients from Greece and 356 normoglycemic, ancestry-matched controls. In the control group, individuals over 65 years of age were included to minimize the probability that T2D will present at a later stage in their life. The samples were genotyped on Illumina Human PsychArray 24 v1.1. We focused our investigation on 30 genes involved in the metabolism of uric acid. We conducted allelic and genotypic tests using PLINK v1.9. The significance of the association was determined using permutation for each type of test. Furthermore, we performed haplotypic tests using BEAGLE v3.2.3. SNPs with association P-values <0.05 were selected for permutation analysis.

Results: In the allelic tests our top hit was a rare variant, rs35008345 residing on the SLC22A1 gene, which was detected only in the control group, suggesting a potential protective role against the development of T2D (p<0.001). Genotypic tests revealed significant associations in the REN and ABCG4 genes, with ABCG4 harboring four markers (rs4301800: OR 1.269; 95% CI 1.053-1.530, p=0.012, rs643423: OR 1.210; 95% CI 1.001-1.463, p=0.048, rs4245191: OR 1.213; 95% CI 1.004-1.467, p=0.045, rs7234: OR 0.801; 95% CI 0.666-0.963, p=0.018) and REN harboring one marker (rs6693954: OR 0.748; 95% CI 0.613-0.914, p<0.01).

Conclusion: Our results suggest a potential role for variants in uric acid genes in the pathogenesis of T2D. Further studies are needed to validate these findings and clarify whether the detected associations are causal.

Disclosure

X. Tsekmekidou: None. T. Koufakis: Speaker's Bureau; Novo Nordisk, Lilly Diabetes, AstraZeneca, Boehringer-Ingelheim. M. Papavasileiou: None. F. Tsetsos: None. M. Grammatiki: None. A. Roumeliotis: None. N. Papanas: None. D. Papazoglou: None. P. Paschou: None. K. Kotsa: None.

Funding

This research was supported by the European Social Fund and Greek funds through the Operational Programme 'Education and Lifelong Learning' of the National Strategic Reference Framework-Research Funding Programme: THALES. Investing in knowledge society through the European Social Fund (MIS 380273).