bluuebunny/crossref_metadata_2025 huggingface dataset:
872-P: Cardiovascular Benefits of Novel Diabetes Drugs by Baseline Cardiovascular Risk: A Meta-Regression Analysis of 17 Randomized Trials
Authors: RODRIGUEZ-VALADEZ JOSE M. , HUNINK MYRIAM , MASHARANI UMESH , YEBOAH JOSEPH , PARK MEYEON , LI LIHUA , WEBER ELLERIE , LI YAN , BERKALIEVA ASEM , MAX WENDY , FLEISCHMANN KIRSTEN , FERKET BART
Published: May 2022

Background: Prior meta-analyses suggest that the relative cardiovascular (CV) risk reduction by sodium glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) is larger in established CV disease. We investigated heterogeneity of treatment benefits along the continuum of CV risk.

Methods: We performed meta-regression analyses of CV outcome trials (9 on SGLT2i, 8 on GLP-1RAs) using log hazard ratios and CV mortality rates in the control group as proxy for baseline risk and background treatment profile of trial populations. We evaluated effects for all-cause mortality, major adverse cardiovascular events (MACE) , and heart failure. We computed absolute risk difference (ARD) in 5-year CV mortality for each trial and studied its relationship with baseline risk.

Results: We did not find statistically significant associations between baseline risk and log hazard ratios for any outcome (slope range -.to .21; p>.10) . The ARD for 5-year CV mortality increased significantly with higher baseline risk for SGLT2i, to a predicted 2.78% in high risk (Figure) . For GLP1-RA trials, this relationship was not significant likely due to less variation in baseline risk.

Conclusion: Absolute, but not relative, CV benefits of novel diabetes drugs depend on baseline risk, which is important in guiding treatment decisions based on risk stratification.

Disclosure

J.M.Rodriguez-valadez: None. W.Max: None. K.Fleischmann: None. B.Ferket: None. M.Hunink: None. U.Masharani: Advisory Panel; Ryse Health, Research Support; Clementia Pharmaceuticals. J.Yeboah: None. M.Park: Advisory Panel; Otsuka America Pharmaceutical, Inc., Reata Pharmaceuticals, Inc., Other Relationship; Merck & Co., Inc. L.Li: None. E.Weber: None. Y.Li: None. A.Berkalieva: None.

Funding

Research reported in this abstract was supported by the National Heart, Lung, And Blood Institute (NHLBI) of the National Institutes of Health under award number: R01HL153456. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
88-OR: Discordance between Glucose Management Indicator (GMI) and A1C in Well-Controlled Type 1 Diabetes (T1D) and Nondiabetic Population
Authors: SHAH VIRAL , VIGERS TIMOTHY B. , PYLE LAURA , DUBOSE STEPHANIE , CALHOUN PETER , BERGENSTAL RICHARD M.
Published: May 2022

Glucose management indicator (GMI) was developed using a linear regression formula to estimate A1C from mean glucose. The study population that was used to develop and validate GMI had a mean A1C of 7.3 ± 0.8%. Therefore, we hypothesize that GMI may overestimate A1C in those with A1C <6.5%. Non-pregnant adults (≥18 years) with T1D for ≥2 years and using Dexcom G6 for ≥6 months from Barbara Davis Center for Diabetes (n=93, 40.6 ± 12.6 years, female 58.4%, A1C 5.9 ± 0.4%) and subjects from “Glucose Sensor Profile in Healthy Non-diabetic Subjects” study (N=153, 31.2± 21.0 years, female 66.0%, A1C 5.1 ± 0.3%) were included. All participants used Dexcom G6 continuous glucose monitor (CGM) . Up to days (healthy participants) and 15 days (T1D patients) of CGM data was compared with laboratory A1C. Discordance in GMI and A1C is presented by A1C <5.7% (healthy participants) and A1C between 5.7-6.4% (T1D patients) . The degree of discordance between GMI and A1C was higher in those with A1C<6.5% compared to original GMI development cohort [Figure 1A]. The differences between A1C and GMI were largely negative in both A1C categories (A1C <5.7% and A1C of 5.7-6.4%) . On average, GMI was 0.59% higher in the A1C < 5.7% group and 0.49% higher in the A1C 5.7 - 6.4% group (both p < 0.0001) [Figure 1B and 1C]. The current GMI formula may overestimate A1C and may need to be re-assessed for those with A1C <6.5%.

Disclosure

V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. T.B.Vigers: None. L.Pyle: None. S.Dubose: None. P.Calhoun: None. R.M.Bergenstal: Advisory Panel; Hygieia, Medtronic, Roche Diabetes Care, Zealand Pharma A/S, Consultant; Abbott Diabetes, Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Onduo LLC, Sanofi, United HealthCare Services, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi.
889-P: Cost and Length of Stay for Department of Defense Hospitalizations Attributed to COVID-for Adults with Diabetes
Authors: MENDEZ CARLOS E. , DISMUKE CLARA , WALKER REBEKAH J. , EGEDE LEONARD E.
Published: May 2022

Healthcare costs in 2020 increased 9.7% from the prior year reaching $4.1 trillion dollars. This increase is considered largely due to the COVID-pandemic. Since adults with diabetes were at increased risk of poor outcomes from COVID-19, the objective of this study was to investigate cost and length of stay for Department of Defense (DoD) hospitalizations attributed to COVID-for adults with diabetes. Data on hospitalizations within military facilities between 2020-2021 for patients with diabetes were investigated. 6,265 hospitalizations occurred at DoD facilities, of which 7.2% (n=458) were attributed to COVID-19. Generalized linear models using a gamma distribution for total cost and Poisson distribution for length of stay were run to investigate outcomes adjusting for age, sex, race/ethnicity, active duty status, service category (Army, Coast Guard, Marine, Air Force, or Navy) , and comorbidity count. In adults with diabetes hospitalized at military facilities, those with COVID-cost over $8,500 more than those without COVID- (8792.98, 95%CI 5850.38,11735.57) after adjustment. There were no significant differences by sex or race/ethnicity, however, active duty hospitalizations cost on average $2,200 more than not active duty (2239.26, 95%CI 738.72,3739.81) . Length of stay was over 2 days longer for COVID-hospitalizations (2.20, 95%CI 1.98,2.42) after adjustment. There were no differences by sex, however African Americans and Asian/Pacific Islanders had slightly longer lengths of stay (AA: 0.37, 95%CI 0.26,0.48; A/PI: 0.26, 95%CI 0.05,0.46) , as did those on active duty (0.24, 95%CI 0.08,0.40) . Total costs for hospitalizations attributed to COVID-were higher and length of stay longer for adults with diabetes at military facilities. Further work is needed to understand long term consequences of COVID-on cost and utilization for adults with diabetes.

Disclosure

C.E.Mendez: Advisory Panel; Monarch Medical Technologies . C.Dismuke: None. R.J.Walker: None. L.E.Egede: None.

Funding

American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede) , the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)
89-LB: COVID-19 Outcomes in Patients Who Started GLP1-RAs during Hospitalization
Authors: PROVENZANO VINCENZO , BRANCATO DAVIDE , FLERES MATTIA , PROVENZANO FRANCESCA , SALVAGGIO ANNA R. , SCORSONE ALESSANDRO
Published: May 2022

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been hypothesized to exert beneficial effects on COVID-19 outcomes due to their anti-inflammatory properties. In our COVID-19 ward, patients admitted for severe interstitial bilateral pneumonia due to SARS-COV2 infection and having type 2 diabetes (T2D) or in-hospital hyperglycemia (IHH) were treated with GLP-1 RAs in addition to standard therapy according to usual care. Aim of the present study was to evaluate if GLP-1 RAs therapy was related with outcomes. A retrospective analysis was performed to assess if the GLP1-RAs were associated with a lower risk of a composite outcome (death or admission to intensive care unit) . During the COVID-19 pandemics, 135 patients were admitted (61.5% men, age 66.3±13.7 years, 49.6% with T2D and 50.4% with IHH) , of whom 23.1% initiated GLP1-RA during the hospitalization (39.1% of patients with T2D and 7.6% of patients with IHH) . Almost all patients were treated with once-weekly subcutaneous semaglutide, while dulaglutide was administered in 2 cases. Overall, 26.3% of patients not treated vs. 7.1% of patients treated with GLP1-RAs reached the composite outcome (p=0.03) . At multivariate analysis adjusted for age, gender, T2D, history of cardio/cerebrovascular disease, hypertension, pulmonary disease, and dementia, the use of GLP-1 RAs was associated with a reduced risk of composite outcome of 80% (OR 0.20; 95% confidence intervals 0.04-0.95) . Dementia resulted the only other independent correlate of the outcome. These preliminary results suggest that the addition of GLP1-RAs to standard care during hospitalization for SARS-CoV2 infection could play a role in improving clinical outcomes in patients with COVID-19 and T2D or IHH: at the best of our knowledge this is the first study showing such an effect when GLP1-RAs were started during hospitalization.

Disclosure

V. Provenzano: Board Member; Lilly Diabetes, Novo Nordisk, Consultant; AstraZeneca. D. Brancato: None. M. Fleres: None. F. Provenzano: None. A. R. Salvaggio: None. A. Scorsone: None.
896-P: Dapagliflozin Cost Offsets in Chronic Kidney Disease for Commercial U.S. Payers
Authors: CHANG RAYMOND , HUANG JOANNA , RECK DAN , HURST JAMIE , KHACHATOURIAN KAT WOLF , SHANNON MICHAEL H.
Published: May 2022

One in 7 adults have chronic kidney disease (CKD) , which is associated with high mortality and costly healthcare resource utilization (HCRU) . Data from a US employer-sponsored health insurance plan show rising per-member-per-year costs for treatment of cardiac and renal complications associated with CKD. A cost-offset model (COM) was deployed to quantify the predicted clinical and economic benefits of treatment with dapagliflozin. The COM used real-world cost and member count data from a US employer-sponsored commercial payer and the phase 3 DAPA-CKD (NCT03036150) clinical trial event rates for outcomes, including ≥ 50% decline in estimated glomerular filtration rate (eGFR) , end-stage kidney disease (ESKD) , and hospitalization for heart failure (HHF) . HCRU cost-offsets were calculated over a 3-year time horizon in a population of 130 members with CKD stages 2-4 who were modeled for treatment with either dapagliflozin plus standard of care (SOC) or SOC alone. Over a 3-year period, 9 instances of ≥ 50% decline in eGFR were estimated for treatment with dapagliflozin versus (vs.) 15 with SOC (6 fewer events; number needed to treat [NNT]: 20) , amounting to estimated cumulative cost-offsets of $0.57 million (M) . Similarly, 6 ESKD events were avoided with dapagliflozin vs. SOC (8 vs. 14; NNT: 24) , resulting in $1.92 M in cumulative cost-offsets. Dapagliflozin use also avoided 20 HHF events compared with SOC (13 vs. 33; NNT: 7) , totaling $0.79 M in cumulative cost-offsets. Overall, better clinical outcomes translated into total cumulative HCRU cost-offsets of $3.89 M (36.6% reduction in favor of dapagliflozin + SOC vs. treatment with SOC alone) . Results of our COM estimate that dapagliflozin greatly decreases HCRU costs in plan members with CKD by reducing cardiac and renal clinical events over a 3-year period. Modeling these outcomes for members with CKD with and without type 2 diabetes demonstrates that dapagliflozin can be a cost-effective way to reduce HCRU costs associated with CKD for commercial payers.

Disclosure

R.Chang: Employee; AstraZeneca, UnitedHealth Group. J.Huang: Employee; AstraZeneca. D.Reck: None. J.Hurst: Employee; AstraZeneca. K.Wolf khachatourian: Consultant; Bayer AG, Xcenda. M.H.Shannon: Consultant; Bayer AG, Speaker's Bureau; Bayer AG, Novo Nordisk A/S.

Funding

AstraZeneca
897-P: Use of In-Person and E-Consults for Type 2 Diabetes in an Academic Primary Care Network
Authors: COLLING CAITLIN A. , WASFY JASON H. , WEXLER DEBORAH J.
Published: May 2022

Objective: Electronic consults (e-consults) are asynchronous clinician-to-clinician communications within an electronic health record (EHR) . We compared characteristics of patients for whom electronic versus in-person consults for type 2 diabetes (T2D) were ordered in an academic primary care network.

Methods: E-consult and in-person consults ordered for T2D between January 1 and December 31, 20by primary care providers who ordered both referral types were included. Patient characteristics were extracted from an EHR repository. E-consult content was reviewed by a physician. Characteristics of e-consults and in-person consults were compared with chi-squared tests and t-tests.

Results: E-consults accounted for 48.4% of consults (156 of 322) . Compared with in-person consult patients, e-consult patients were older (62.1±14.1 vs. 56.7±13.9 years, p<0.001) , more likely to be prescribed a sulfonylurea (37.8% vs. 23.5%, p=0.009) , and less likely to be prescribed insulin (42.3% vs. 54.2%, p=0.033) . There were no differences in sex, self-reported race/ethnicity, or the prevalence of coronary artery disease (22.4% vs. 24.1%, p=0.779) , heart failure (10.9% vs. 8.4%, p=0.575) , or chronic kidney disease (25.6% vs. 17.5%, p=0.099) in electronic and in-person consult patients. In-person consult patients had a higher hemoglobin A1c (9.3±1.7% vs. 8.8±2.0%, p=0.032) . Nearly all e-consult referrals asked for guidance on medication selection (96%) with a significant number requesting advice on newer medications (SGLT2i: 21%; GLP-1 RA: 27%) . Completed e-consults often provided guidance and education on use, cardiorenal benefits, and/or side effects of newer medications (SGLT2i: 28%; GLP-1 RA: 47%) .

Conclusions: In-person and e-consult patients had similar baseline characteristics and cardiovascular comorbidities. E-consults were often used to inquire and to educate about newer diabetes medications. E-consults hold promise as a method to disseminate new endocrine knowledge.

Disclosure

C.A.Colling: None. J.H.Wasfy: Consultant; Pfizer Inc. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate.

Funding

NIH T32 DK007028
898-P: Impact of Switching to a High-Deductible Health Plan on Patients’ Out-of-Pocket Expenditures for Glucose-Lowering Drugs
Authors: JIANG DAVID H. , HERRIN JEPH , VAN HOUTEN HOLLY , MCCOY ROZALINA G.
Published: May 2022

High deductible health plans (HDHPs) have become increasingly common as a means of increasing access to health insurance while curbing total utilization. However, high out-of-pocket (OOP) expenditures faced by HDHP enrollees may disincentivize high value care, particularly for people with chronic but costly health conditions like diabetes. Glucose-lowering drugs are a large part of direct costs of diabetes management and contribute to cost-related non-adherence, burden of treatment, and poor health outcomes. We examined the changes in OOP expenses for a 30-day supply of each class of glucose-lowering drugs among 43,900 adults with diabetes included in OptumLabs® Data Warehouse between 20 and 2018 who switched from non-HDHPs to HDHPs, compared to 333,803 adults who did not switch. The mean OOP expenses, standardized to 20$US, were higher for HDHP beneficiaries (Table) . Switching to a HDHP significantly increased OOP expenditures for all glucose-lowering classes, ranging from 5% increase (sulfonylurea) to 48% increase (glitazone) . This increased expense for patients may hinder adherence and adversely impact glycemic management and health outcomes among HDHP enrollees. Clinicians should be aware that HDHP enrollees may be more sensitive to OOP costs when choosing medications, and policy makers should exempt evidence-based prescription drugs from high deductibles.

Disclosure

D.H.Jiang: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. H.Van houten: None. R.G.Mccoy: Consultant; Emmi.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases grant number K23DK114497
899-P: Current Patterns of Change in Medication Spending and Use for People with Type 2 Diabetes in a Commercially Insured Population
Authors: COOK DAVID J. , DEFAIL ANTHONY , THOMPSON NELS , PEDERSON DEREK
Published: May 2022

Background: Understanding the total cost of care (TCoC) specific to type-2 diabetes (T2D) is challenging. Diabetes is a driver of multiple chronic medical conditions, each with a constellation of costs. As such, medication trends specific to T2D may help inform assessment of population health and care management.

Methods: For a population of 7,361 commercially insured persons (≥18 years old) enrolled in a virtual care accountable care organization (Level2) , we examined de-identified administrative claims in a research database for T2D medications from 12/1/2019-11/30/2021. We determined the TCoC for this population, as well as changes in spending and utilization by medication class.

Results: Among individuals enrolled in Level2, spending for T2D medications constituted 31.2% of the total spend over the period studied. Spending and utilization changes are summarized in Table 1.

Conclusion: T2D care is rapidly evolving; ongoing changes in cost and utilization are dramatic. For organizations in risk arrangements, following and projecting medication spend in T2D is a critical exercise, as is driving the guideline-directed use of these agents. There is a need for greater specificity in T2D medication guidelines that considers cost-effectiveness and tailors treatment choice to the specific patient risk.

Disclosure

D.J.Cook: None. A.Defail: Employee; Level2. N.Thompson: Employee; Level2. D.Pederson: Employee; Level2.
9-OR: ADA Presidents' Select Abstract: m6A mRNA Methylation Regulates the Innate Immune Response in Human Beta Cells
Authors: DE JESUS DARIO F. , ZHANG ZIJIE , BROWN NATALIE K. , BASILE GIORGIO , XIAO LING , KAHRAMAN SEVIM , MATHEWS CLAYTON E. , POWERS ALVIN C. , ATKINSON MARK A. , EIZIRIK DECIO L. , KULKARNI ROHIT
Published: May 2022

Innate immunity is directly associated with Type 1 diabetes (T1D) . Recently, N6-methyladenosine (m6A) has been shown to modulate human β-cell biology and innate immunity. Here, we focused on the contribution of m6A in modulating T1D development. RNA-seq. in β-cells revealed downregulation of the m6A writers (Mettl3, Mettl14, and Wtap) in pre-diabetic NOD mice. Consistently, pancreases from female NOD mice and human T1D showed downregulation of METTL3 protein levels in insulin-positive cells as the disease progressed. m6A-sequencing in human T1D versus control islets and intersection with differentially expressed genes (DEGs) in T1D β-cells from a single-cell RNA seq. dataset, revealed enriched pathways associated with ER function, T1D, and apoptosis. Pro-inflammatory cytokines are directly linked to β-cell autoimmunity and are considered a useful tool to study T1D onset. We applied m6A-sequencing in cytokine-treated human islet preparations, and in parallel studies, treated EndoC-βH1 cells with cytokines followed by RNA-sequencing. Intersection of m6A-decorated and common DEGs in human islets and EndoC-βH1 cells revealed enrichment in pathways associated with the innate immune response. METTL3 silencing in EndoC-βH1 impacted several innate immune mediators upon cytokine challenge. Incubation of human islets from multiple donors with ER-stress inducers, ROS donors, NO donors, and ROS or NO scavengers revealed that pre-existing ER stress and ROS decrease METTL3, while physiological levels of NO upregulate METTL3. We conclude that ROS drives METTL3 downregulation associated with T1D. Exploring therapeutic relevance by AAV-8 mediated gene delivery showed that β-cell specific upregulation of Mettl3 leads to a decrease in hyperglycemia during early stages of T1D in female NOD mice. Together, these results demonstrate a novel layer of regulation in human β-cells in the context of T1D and point to targeting METTL3 as a therapeutic approach to promote β-cell survival and improve glycemia.

Disclosure

D.F.De jesus: n/a. D.L.Eizirik: None. R.Kulkarni: Advisory Panel; Biomea, Novo Nordisk, REDD Pharma, Consultant; Relay Therapeutics, Research Support; Inversago, SerPlus. Z.Zhang: Research Support; SinoVac. N.K.Brown: None. G.Basile: None. L.Xiao: None. S.Kahraman: Employee; Boehringer Ingelheim International GmbH. C.E.Mathews: None. A.C.Powers: None. M.A.Atkinson: None.

Funding

American Diabetes Association (7-21-PDF-140) ; R01 DK067536R01 DK103215R01 DK117639
906-P: Lost Workdays from Treating Type 2 Diabetes–Related Complications in Hong Kong: A Population-Based Cohort Study
Authors: KWOK HARLEY H.Y. , NG CARMEN , QUAN JIANCHAO
Published: May 2022

To estimate the lost workdays associated with type 2 diabetes and related complications in Hong Kong in 2017 and inform productivity loss and indirect costs. Using population-representative data of 540,370 people with type 2 diabetes managed in the public sector, we fitted a negative binomial regression model to investigate the association of diabetes complications on length of stay. Model fit was assessed by Akaike information criterion. A total of 4.28 million workdays (mean 7.93, 95% CI 7.88-7.97) was lost in 2017. Table 1 shows the regression coefficients: interpreted as the expected log (length of stay) increase for each one-unit increase in the corresponding variable. For example, the adjusted length of stay for 60-year male without any complication is 6.82 days (95% CI 5.52-8.43) . Hemodialysis contributed to the longest length of stay, followed by renal failure, skin ulcer, amputation, heart failure, cerebrovascular disease, atrial fibrillation, neuropathy, peripheral vascular disease, cataract, myocardial infarction, retinopathy, and ischemic heart disease. Enrolment in the multidisciplinary Risk Assessment and Management Programme was associated with reduced length of stay. This lost workday analysis helps to inform the indirect costs of diabetes in terms of lost productivity, and is essential for estimating the total economic loss from diabetes.

Disclosure

H.Kwok: None. C.Ng: None. J.Quan: None.

Funding

Research Grants Council of the Hong Kong SAR, China [27112518].
913-P: The Relationship between ASK12 Patient-Reported Medication Adherence Scores and Objective Measures of Adherence among Patients with Type 2 Diabetes
Authors: PAWLOSKI PAMALA , ZIEGENFUSS JEANETTE , O'CONNOR PATRICK J. , DEHMER STEVEN P. , EKSTROM HEIDI , HAAPALA JACOB , SPERL-HILLEN JOANN M. , BECKER MARY , TRUITT ANJALI , PANKONIN MELISSA , REHRAUER DANIEL , FRAIL CAITLIN , ANDERSON JEFFREY , CHUMBA LILIAN
Published: May 2022

Background: Medication adherence may be measured either by (a) patient-reported measurement or (b) objective measurement using medication dispense data. Proportion of days covered (PDC) is an objective measure of adherence becoming more readily available in the electronic health record (EHR) and a threshold of < 80% is commonly used to identify a potential adherence problem. Using PDCs may be more efficient and clinically practical than using longer patient-reported adherence questionnaires. However, it is unknown how well the PDC and patient reported measures correlate.

Methods: As part of a pragmatic randomized trial to evaluate an intervention designed to improve medication adherence in a Midwest health care system, 1,423 adults with type 2 diabetes (T2D) were identified at an index visit in primary care based on suboptimal diabetes control (AIC >8%) and at least one oral diabetes medication with PDC < 80%. They were surveyed shortly after the index visit to assess adherence using a validated 12 question ASK-12 instrument, with a response rate of 29% (80/280) . We evaluated the relationship between PDC and ASK-12 total/subscale scores using linear regression.

Results: There were no significant associations found between PDC scores and the total ASK-12 score (β=-0.4, p=0.47) , or ASK-12 subscales of inconvenience/forgetfulness (β=-1.1, p=0.42) , treatment beliefs (β=-0.4, p=0.77) , behavior (β=-0.7, p=0.55) , or barriers (β=-0.7, p=0.44) .

Conclusions: For patients above recommended A1C goal with a medication PDC < 80%, there was no correlation between PDC scores and patient-reported measures of adherence using ASK-12 total or component scores. This analysis raises questions about the validity and usefulness of EHR-derived PDC scores to identify poor medication adherence for patients with T2D.

Disclosure

P.Pawloski: None. M.Pankonin: None. D.Rehrauer: None. C.Frail: None. J.Anderson: None. L.Chumba: None. J.Ziegenfuss: None. P.J.O'connor: None. S.P.Dehmer: None. H.Ekstrom: None. J.Haapala: None. J.M.Sperl-hillen: None. M.Becker: None. A.Truitt: None.

Funding

NHLBI #R01HL136937
915-P: Annual Wellness Visits and Preventive Care Utilization among Medicare Beneficiaries in the Diabetes Belt and Surrounding Areas
Authors: SOHN MIN-WOONG , MCMURRY TIMOTHY L. , KANG HYOJUNG , KIM SOYOUN , LOBO JENNIFER M.
Published: May 2022

Objective: Medicare beneficiaries are eligible to receive free Annual Wellness Visits (AWVs) for assessing preventive care needs, identifying care resources, and scheduling visits. We previously reported that AWVs are associated with increased use of preventive care for patients with diabetes. In this study, our objective is to conduct a case-control study to examine whether AWVs are associated more strongly with preventive care use in the Diabetes Belt than in surrounding areas.

Methods: We used a sample of ∼900,000 Medicare Fee-for-Service beneficiaries who lived in the Diabetes Belt and surrounding areas in 2014 - 2015. We identified patients who have used an annual foot exam, eye exam, A1c test, and microalbuminuria (MA) test and those who did not in 2015. We used the dates of service receipt and the last day of the year (12/31) as the event date for users and non-users, respectively. We looked one full year before the event date to identify any AWVs. We used propensity-score stratification to estimate log odds of 4 preventive care use of annual foot exam, eye exam, A1c test, and MA test.

Results: For all four services, AWV users had significantly higher preventive care use compared to non-users. In 3 preventive services, AWVs were more strongly associated with preventive care use in the Belt than in the surrounding areas (foot exam, ORs = 2.38 vs 2.16, p < 0.001; A1c test, ORs = 1.44 vs. 1.36, p = 0.002; MA test, ORs = 1.70 vs. 1.44, p < 0.001; eye exam, ORs 1.22 vs. 1.19, p=0.063) .

Discussion: AWVs appear to have stronger effects on preventive care use for patients with diabetes in the more healthcare resource-poor Diabetes Belt than in the surrounding areas. AWVs may help to reduce disparities in the use of recommended preventive care for patients with diabetes.

Disclosure

M.Sohn: None. T.L.Mcmurry: None. H.Kang: None. S.Kim: None. J.M.Lobo: n/a.

Funding

NIDDK R01DK113295
917-P: Race/Ethnic Disparities in Insulin and Sulfonylurea Use in Older Patients with Type 2 Diabetes
Authors: ABDELGADIR DANA , BOARD CHRISTINE , RANATUNGA DILRINI K. , GRANT RICHARD W.
Published: May 2022

Background: Risk of severe hypoglycemia increases markedly with age in type 2 diabetes (T2D) . For many older patients, discussion of safe de-prescribing strategies is indicated to reduce iatrogenic overtreatment. We examined differences in insulin and sulfonylurea (SU) prescription prevalence among older adults (age ≥ 75 years) by race/ethnicity. Because race/ethnic disparities among Black patients have been attributed to doctor-patient communication barriers, we tested the hypothesis that older Black patients were more likely to be prescribed medicines that can induce severe hypoglycemia.

Methods: We studied 18,149 adults (≥75 years) with T2D and a last measured HbA1c ≤ 8.0% between 2019-2021 in Kaiser Permanente Northern California. Electronic health records were used to identify prescription of insulin, SUs, or both. Medication treatment prevalence was stratified by race/ethnicity (Non-Latino White [NLW], Black, Latino, Asian, Other) and compared using chi-square tests.

Results: Mean age was 80.5 (±4.8) years; 54% were women; mean HbA1c was 6.9% (±0.7%) , with 42% prescribed insulin, 72% prescribed SUs and 13% prescribed both. Elderly Black and NLW patients had a higher insulin prevalence (both at 45%, p<0.001) , while Asians had the lowest (31%, p=<0.001) . Conversely, Blacks had the lowest SU prevalence (66%, p<0.001) , and Asians had the highest (79%, p<0.001) . A similar pattern was observed in patients with the tightest HbA1c control (< 7.0%; n=8,794) : Black patients had the highest insulin (39%, p<0.001) and lowest SU prevalence (69% p<0.001) , while Asians had the lowest insulin (26%, p<0.001) and highest SU prevalence (81%, p<0.001) .

Conclusion We found significant variation in use of high-risk medicines by race/ethnicity. Older Black patients had higher insulin use while older Asian patients had the highest SU use. Efforts to promote safe de-prescribing practices in older adults may need to be tailored to the unique physiologic and cultural needs of different patient groups.

Disclosure

D.Abdelgadir: None. C.Board: None. D.K.Ranatunga: None. R.W.Grant: None.

Funding

National Institute on Aging (R01AG068133-S1)
918-P: Improved Glycemic Control from a Remote Patient Monitoring Program across Primary Care Practices Integrating Home Monitoring, Mobile Health, Nutrition/Lifestyle Coaching, and Telemedicine For Diabetes Management
Authors: WANG LI , XU HANG , LIU ZHIYU , WONG NATHAN D.
Published: May 2022

Objective: There is interest in current care delivery models for diabetes (DM) management that utilize mobile technologies as a new standard, especially during and following the COVID-pandemic. The objective of this study was to examine the impact of a digital health program (iHealth Unified Care model) which integrates remote patient monitoring (RPM) and nutrition/lifestyle coaching in primary care settings for patients with DM.

Methods: Primary care physicians (PCPs) across primary care practices enrolled patients with DM into the iHealth Unified Care program during 2019-2021. Bluetooth connected devices with a mobile app were provided to monitor blood glucose and other vital signs . PCPs and their supervised care team including registered dietitians and certified diabetes educators provided the initial assessment and nutrition consultations to set up personalized treatment and behavioral goals. PCPs' care team had regular follow up visits with the patients every 3-6 months virtually and provided vitals monitoring and dietary coaching on a daily basis via the iHealth Unified Care platform which connects the patient's mobile app, bluetooth devices, and data analytics engine in real-time.

Results: 691 patients with DM (66 ± years old, 47% female) were enrolled in the program and stayed ≥3months. Compared to the baseline, the HbA1c decreased from 7.35% ± 1.75 (Mean,SD) , to 6.77% ± 1.17 at 3 months (n=691, P<0.01) and 6.78% ± 1.at 6 months (n=262, P<0.01) . The average HbA1C reduction was 0.57 (CI:0.48-0.67) after 3months. The HbA1c poor control (≥9%) rate was 17.2% at baseline, 5.6% at 3 months and 4.2% at 6 months.

Conclusions:The iHealth Unified Care model significantly improved the glycemic control of patients with DM after 3 months and 6 months compared to baseline. Randomized control trials are needed to further confirm the long-term effectiveness.

Disclosure

L.Wang: Employee; iHealth Labs, Inc. H.Xu: Employee; iHealth Labs. Z.Liu: Employee; iHealthlabs Inc. N.D.Wong: Consultant; I Health, Research Support; Amarin Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk.
919-P: Trends in Glycemic Control during the COVID-Pandemic in a Large Academic Health Care System
Authors: UMPIERREZ GUILLERMO E. , ADIGA ANIL , WYLDE BJAY , GURTU MONICA , GALINDO RODOLFO J. , THOMPSON TINAANN , MASI CHRISTOPHER M. , CASTELLANO PENNY A. , TURTON FREDERICK E.
Published: May 2022

The Emory Diabetes Management Program is a chronic care management model aimed to reduce the proportion (%) of adult patients with HbA1c >9% within the Emory Healthcare System. We report the proportion of patients with poor glycemic control (HbA1c >9% or missing values for 6 months) before and during the Covid-pandemic, from 02/01/18 to 10/30/2021.Among 27,061 patients with diabetes before COVID-pandemic, the % of patients with poor glycemic control decreased from 19.5% to 14.35% in 12/2019. During the COVID-pandemic, the % of patients with poor control rapidly increase to 21.70% (Fig 1A) by 2/1/21, primarily due to a 275% increased of patients with missing HbA1c testing and a minor increase in % of patients with HbA1c >9% (Fig 1B) . Expansion of telemedicine programs, access to care and resource implementation to identify and facilitate HbA1c testing reduced the % of patients with poor control to pre-pandemic levels. Conclusion: At a population-health level, COVID-pandemic had a significant negative impact in % of patients with poor control primarily due to HbA1c testing (3-fold increase) rather than worsening A1c values. Innovative solutions to increase access to A1C testing in future pandemics may help to maintain undisrupted glucose monitoring and control in individuals with diabetes in large academic health systems.

Disclosure

G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. A.Adiga: None. B.Wylde: None. M.Gurtu: None. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. T.Thompson: None. C.M.Masi: None. P.A.Castellano: None. F.E.Turton: None.
920-P: Factors Associated with Weight Loss in the National Diabetes Prevention Program (National DPP)
Authors: NG BOON PENG , ELY ELIZABETH , SMITH BRYCE , CANNON MICHAEL
Published: May 2022

CDC’s National DPP aims to make the lifestyle change program (LCP) available to an estimated 88 million US adults who have prediabetes. Since 2015, CDC’s Diabetes Prevention Recognition Program (DPRP) has recognized four delivery modes: in-person, online (i.e., asynchronous delivery) , distance-learning (DL) (i.e., synchronous delivery) , and combination. To evaluate factors associated with weight loss, we analyzed data collected under the DPRP from 1/1/2012-12/31/20for those who attended at least two sessions with reported weight and physical activity (PA) minutes. Of the study population, 135,496 were associated with in-person delivery organizations, 214,239 with online, 3,553 with DL, and 11,3with combination. The majority of participants were female (across delivery modes: 73.2-80.4%) . Over half of participants were 45-64 years (52.9-59.5%) ; for in-person and online, 29.1% and 4.0%, respectively, were 65+ years. Participants were racially/ethnically diverse (Hispanic: 7.9-31.7%; non-Hispanic Black (NHB) : 10.5-15.4%; other non-White: 11.0-25.2%) . Of in-person, online, DL, and combination participants, 50.6%, 35.5%, 50.2%, and 40.9%, respectively, met the 150 mins/week PA goal for their last PA entry, while 36.2%, 20.2%, 33.2%, and 19.3%, respectively, met the 5% weight loss goal. In general, the 5% weight loss goal was met by higher proportions of participants who were male than female (e.g., in-person, 40.6% vs. 35.2%) , older than younger (e.g., in-person, 42.6% for 65+ years vs. 28.4% for 18-44 years) , non-Hispanic White (NHW) than other race/ethnicities (e.g., in-person, 41.5% for NHW vs. 28.0% for Hispanic and 27.3% for NHB; except for DL with 42.4% for Hispanic vs. 34.3% for NHW) , and met the 150 PA goal (e.g., in-person, 44.1% for PA ≥ 150 mins/week vs. 29.3% for 60 ≤ PA <150 mins/week) . These results show promise for reducing risk of developing type 2 diabetes through the LCP, but also identify opportunities for improved program implementation.

Disclosure

B.Ng: None. E.Ely: None. B.Smith: None. M.Cannon: None.
922-P: Pilot of a Strategy to Sustain A1C Improvement among Diverse Adults with Type 2 Diabetes (T2DM) Completing a Diabetes Management Program (DMP)
Authors: MAGEE MICHELLE F. , NASSAR CARINE M. , BOURGES CLAYTON J. , MONTERO ALEX R.
Published: May 2022

Strategies are needed to maintain outcomes following DMPs. We examined the impact of a sustaining strategy (SS) on A1C among T2DM completers of a 3-mos diabetes education and medications management program. From 3/2019-7/2021, DMP completers (Medicare or system insured) enrolled in a 9-mos sustaining strategy (SS) . Mos 1-3 offered remote monitoring calls for Hi >350/Lo <80mg/dL blood glucose (BG) alerts, and Mos 1-9 monthly diabetes check-in calls with BG review by a medical assistant who also addressed supplies/drug needs and self-care behaviors. Escalation to a nurse practitioner occurred for BG trends >200/< 80mg/dL or A1C > 9.0%. Reports were sent to PCPs. A1Cs were compared for DMP-alone versus DMP-plus SS. Summary statistics used frequency with percentage for categorical variables and mean with standard deviation for continuous variables. Bivariate analyses utilized the Student T test. Pre-post A1C was available for 620 completers and 175 joined the SS. Mean age was 56.2±11.9 yrs; 58.1% female; 66% Black; 25.9% Medicare, 26.6% Medicaid, & 42.4% private insured. Serial A1C outcomes by group are shown.Adults with previously uncontrolled type 2 diabetes who completed a diabetes management program and who participated in a 9-mos sustaining strategy maintained their A1C under 8% when compared to those who did not participate in the follow-up program.

Disclosure

M.F.Magee: None. C.M.Nassar: None. C.J.Bourges: None. A.R.Montero: None.
932-P: Impact of Carbohydrate-Restricted Nutrition Therapy Delivered via Continuous Remote Care on Prevalence of Glycemic Target Achievement and Type 2 Diabetes Remission among Veterans: A Nationwide, Real-World Study
Authors: MCKENZIE AMY L. , VANTIEGHEM MICHELLE , FELL BRANDON , RATNER ROBERT E.
Published: May 2022

About one in four Veterans lives with type 2 diabetes (T2D) , and nationwide, only 50% of Veterans meet the ADA glycemic target of A1c <7%. In a pilot program, the Veterans Health Administration partnered with Virta Health to deliver carbohydrate restricted nutrition therapy via a continuous remote care model to Veterans with T2D prescribed at least one diabetes medication other than metformin. This retrospective, real-world, descriptive study assessed the proportion of Veterans who met glycemic targets using laboratory and prescription data from medical records. Veterans retained in the treatment at least two years at time of analysis were included (n=254, 58.5% of 434 eligible enrolled, 60±8 years, 12% female, 50% above HEDIS target) . A greater percentage of Veterans met glycemic targets defined by AACE (A1c ≤ 6.5%) , ADA (A1c < 7%) , and HEDIS (A1c < 8%) following one and two years of treatment compared to enrollment (Table 1) . About two thirds of Veterans with A1c ≤6.5% achieved this with no medication or only metformin. Further, 6.7% and 4.5% achieved the 2021 consensus definition of remission at one and two years, respectively. These findings suggest this nutrition therapy and care model may be a useful tool to improve population health among Veterans with respect to glycemic targets.

Disclosure

A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. M.Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.Fell: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.E.Ratner: Employee; Virta Health Corp.
938-P: Implementation of Psychosocial Screening in the Type 1 Diabetes Exchange Quality Improvement (T1DX-QI) Network
Authors: CORATHERS SARAH , OSPELT EMMA L. , ROMPICHERLA SAKETH , PRAHALAD PRIYA , ROBERTS ALISSA J. , MUÑOZ CYNTHIA E. , BASINA MARINA , SMITH LAURA B. , WILLIFORD DESIREÉ N. , KICHLER JESSICA C. , EBEKOZIEN OSAGIE
Published: May 2022

T1DX-QI is a network of over 40 pediatric and adult centers that share best practices to improve outcomes for people with T1D. Guidelines for comprehensive diabetes care recommend integration of psychosocial screening; however, variable resources and clinical structures influence the degree to which practices can implement these recommendations.

A 22-item survey was administered to T1DX-QI sites in 2021 (n= 25 pediatric and 8 adult) . Data from items relevant to psychosocial screening were analyzed with Rstudio. Fisher tests were used to compare the percentage of psychosocial domains assessed by pediatric vs. adult clinics.

Overall, 96% of pediatric centers report using at least one screening tool, 79% report > 2; 43% of adult centers use one or more screening tools. The most common psychosocial domain in both settings is depression; pediatric (96%) , adult (38%) (Figure) . Screening for social determinants of health and diabetes-related distress were reported in both settings, and unique to pediatric is assessment of readiness to transition to adult care.

Varying degrees of psychosocial screening is present in the T1DX-QI network. Centers endorse benefits, as well as common challenges, including time constraints, integration into workflow, and how best to follow up responses. T1DX-QI sites are working together to overcome barriers that contribute to gaps between guidelines and practice.

Disclosure

S.Corathers: None. J.C.Kichler: None. O.Ebekozien: None. E.L.Ospelt: None. S.Rompicherla: None. P.Prahalad: None. A.J.Roberts: None. C.E.Muñoz: None. M.Basina: None. L.B.Smith: None. D.N.Williford: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
94-OR: CGM Metrics, HbA1c, and Retinopathy Are Differentially Associated by Disease Duration in Long-Duration Type 1 Diabetes
Authors: YU MARC GREGORY , BOUMENNA TAHANI , GAUTHIER JOHN , THAM REGINA , FICKWEILER WARD , SUN JENNIFER , SHAH HETAL , KING GEORGE L.
Published: May 2022

Continuous glucose monitor (CGM) -derived metrics provide measures of glycemic variability that are not captured with the use of HbA1c alone. However, they have not been evaluated in long-duration type 1 diabetes (T1D) subjects, in whom the greater risk of glycemic excursions and comorbidities highlight the need for other glycemic markers apart from HbA1c. Among the Joslin “Medalists” with T1D≥50 years, a single consecutive 14-day block of CGM data was remotely obtained from a subset of CGM users (n=64) after a period of routine activities. Using linear regression, mean historical HbA1c associated with mean glucose (β= 17.54, p<0.0001) , glucose management indicator (GMI; β= 0.42, p<0.0001) , and time above range (TAR) >250 mg/dL (β= 3.31, p=0.0003) ; and inversely with time in range (TIR) 70-180 mg/dL (β= -8.08, p=0.0003) and time below range (TBR) <70 mg/dL (β= -2.11, p=0.0006) . While no associations were found between CGM metrics and complications in the overall subset, tertile analysis by T1D duration (tertile 1, 51-61 years; tertile 2, 62-69 years; tertile 3, 70-85 years) revealed that T1D duration modified the effect of CGM metrics on proliferative retinopathy (PDR) even after adjusting for HbA1c (p for interaction <0.05) . In subjects with the longest T1D duration (tertile 3) , PDR associated with mean glucose (β= 26.92, p=0.02) , GMI (β= 0.64, p=0.02) , and TAR (β= 6.81, p=0.03) ; and inversely with TIR (β= -12.57, p=0.04) . Tertile analysis of HbA1c and complications in the overall Medalist cohort (n=952) showed that HbA1c associated with PDR in tertile 1 (p=0.03) . Our results suggest that while HbA1c and CGM metrics are closely linked in long-duration T1D subjects, they may provide differential contributions to the temporal onset of microvascular complications, independent of each other. Additionally, as development to PDR has been demonstrated to stabilize in Medalists with the longest T1D duration, favorable values of CGM metrics may contribute to this protection.

Disclosure

M.Yu: None. T.Boumenna: None. J.Gauthier: None. R.Tham: None. W.Fickweiler: None. J.Sun: Consultant; American Diabetes Association, American Medical Association, Research Support; Adaptive Sensory Technology, Boehringer Ingelheim International GmbH, Genentech, Inc., Jaeb Center for Health Research, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Optovue, Incorporated, Physical Sciences, Inc, Roche Pharmaceuticals. H.Shah: None. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc.

Funding

American Diabetes Association (9-18-CVD1-005) ; Mary K. Iacocca Family Foundation, Thomas Beatson Jr. Foundation, National Eye Institute (R01EY026080-01)
941-P: Impact of Whatsapp-Based Monitoring on Glycemic Control and Exercise Habits in Patients with Diabetes in Indian Population
Authors: SABOO BHARAT , SHRIVASTAVA ABHISHEK , TEWARI AJOY , INAMDAR ANIKET V. , SABOO SHWETA , SABOO BANSHI D.
Published: May 2022

Introduction: Diabetes treatment requires the involvement of people with diabetes in the form of regular exercise and lifestyle measures. Exercise is an important strategy in the management of diabetes. Regular exercise is necessary for good Glycaemic control and Metabolic health. Newer methods like WhatsApp-based communication are now finding their way into diabetes care. It can assist to maintain a regular exercise program and reduce blood sugar levels.

Materials and Methods: A total of 262 patients were selected by random sampling. They were of age 15-65 years with DM. Inclusion Criteria: 1. Known case of DM 2. Consent to share data. 3. Ability to use WhatsApp. Exclusion criteria: 1. Inability to use WhatsApp 2. Any condition which impairs movement. Randomly allocated to two groups of 131 persons. The first group participants were added to a WhatsApp group and asked to send their exercise and blood glucose data to the clinic over WhatsApp. The other group was treated as usual. Participants were monitored for HBA1C at 3 and 6 months and surveyed for exercise patterns by a questionnaire at 3 and 6 months. The results were analyzed using SPSS.

Result: After excluding, 2 dropped patients from both groups remaining 258 patient data shows: HBA1C reduction in the WhatsApp group of 1.9% as compared to 1% in the routine care group. The number of patients achieving the target goal of 7% HBA1C in the WhatsApp group (74%) as compared to the routine group (56%) . 77% of patients in the WhatsApp group did regular exercise as compared to 42% in the routine group.

Discussion: With newer modalities, the ways and means to communicate with patients have improved. This has paved way for newer messaging platforms like WhatsApp for better patient-centric communication. These tools if used correctly can reduce in-person follow-ups but increase the connection between caregiver and patients and can result in better patient outcomes and will lead to reduced complications and financial implications.

Disclosure

B.Saboo: None. A.Shrivastava: None. A.Tewari: None. A.V.Inamdar: None. S.Saboo: None. B.D.Saboo: None.