bluuebunny/crossref_metadata_2025 huggingface dataset:
PENSAMENTO COMPUTACIONAL: UMA OFICINA PEDAGÓGICA PARA PROFESSORES DE CIÊNCIAS
Authors: Teixeira Risiberg Ferreira , Cardoso Giovana da Silva , Jesus Vitor Luiz  Bastos de , Oliveira Alexandre  Lopes de
Published: June 2024

O desenvolvimento do Pensamento Computacional pode ser uma abordagem eficaz que possibilita o aprendizado de uma variedade de disciplinas, como as ciências, além de aprimorar as habilidades do raciocínio lógico para criação de jogos educacionais. Devido a isso, foi elaborado e executado uma oficina pedagógica para vivenciar os fundamentos do Pensamento Computacional para o público-alvo formado por licenciandos e professores da educação básica. O objetivo da oficina foi levantar os requisitos de informações que podem fundamentar a elaboração de um curso de extensão para formação de professores.  O estudo utilizou uma metodologia qualitativa de abordagem interpretativa e observação participativa. Para a coleta de dados, formulários foram preenchidos pelos participantes para determinar suas percepções sobre a oficina. Os resultados da oficina apontaram o caminho para a elaboração do curso de extensão sobre Pensamento Computacional.
Competências para o atendimento multiprofissional da PCR em pediatria: percepções da equipe de enfermagem
Authors: Camilo Mayara Benevides Alonso , Barros Fabiane Frigotto de
Published: June 2024

Descriptive, quantitative exploratory study, carried out in a philanthropic pediatric hospital, with the objective of understanding the nursing professional competencies in the care of cardiorespiratory arrests in pediatrics, besides investigating. 30 professionals from the nursing team participated and data was collected using a closed questionnaire. The results, analyzed using descriptive statistics, showed that the majority of nursing professionals had knowledge about the care of the investigated emergency. In relation to their perceptions about the necessary technical skills, the majority of participants perceived themselves to be confident in resuscitation maneuvers and the administration of medications during care. However, when approaching the handling of the defibrillator and performing a venipuncture, most of the sample stated that they did not feel complete confidence for these activities. Study concluded that the majority of participants had theoretical-practical knowledge to perform the service.
Research on chemical composition of Actinidia arguta berries growing in Primorsky krai
Authors:   Far Eastern Federal University, Medvedeva Daria A.
Published: June 2024

The relevance of the work is due to the need to determine the commodity characteristics of varieties of Actinidia arguta berries growing in the Primorsky krai with rational use. The objects of research were Actinidia arguta berries of "Ananasnaya", "Primorskaya", "Ganiber" and "Issai" varieties picked on farm plantations in Spassky district of Primorsky krai in 2020–2022. The work used standard methods of research and processing of experimental data. The weight of berries of different varieties of Actinidia arguta ranged from 3.0 to 10.0 g. Berries of different varieties are close in terms of the onset of phenotypic phases and organoleptic properties, content of dry matter, sugars, vitamin C. Berry picking should be carried out simultaneously in the form of a variety mixture without separating pomological varieties and sent for sale or industrial processing.
Creating and evaluating new potato genotypes using traditional breeding methods
Authors:   Federal Scientific Center of Agricultural Biotechnology of the Far East named after A. K. Chaika, Anikina Oksana V. , Kim Irina V. ,   Federal Scientific Center of Agricultural Biotechnology of the Far East named after A. K. Chaika
Published: June 2024

The paper presents a comparative evaluation of economically important traits of potato variety collection. Selected genotypes were included in directed crossbreeding. New hybrid combinations with the most significant parameters were created for potato breeding. The research was carried out in a breeding field plot of Federal Scientific Center of Agricultural Biotechnology of the Far East named after A. K. Chaika, Putsilovka, Ussuriysk district, Primorsky krai. The research was based on the methodology developed by Federal Potato Research Center named after A. G. Lorkh and the All-Russian Institute of Plant Genetic Resources named after N. I. Vavilov. The biochemical analysis of tubers (the content of dry matter and starch) was performed by the method of the specific weight using a digital scale PW-2050 (UK). The content of protein, vitamin C, and reduced sugars was determined by the Laboratory of Agrochemical Analysis. In a collection nursery 368 potato varieties of Russian and foreign breeding were studied. The conducted research allowed the selection of genotypes with high productivity indicators, biochemical parameters, taste qualities and processing profitable. Such genotypes included varieties Ariel, Varyag, Zhemchuzhina Kamchatki, Kumach, Merlot, Nikulinskii, Tretyakovka and hybrids 4634-34 Krepysh × Bora Valley, 14-11-8, 17K10-2, and 55-10-38. The selected genotypes were used to obtain hybrid combinations characterized by correct tuber shape and resistance to diseases: Ocharovanie × Reggi, Charoit × Darnitsa, Charoit × Manifest, Barin × Reggi, Ocharovanie × Lyuks, Koroleva Anna × Kazachok, Avrora × Darnitsa, and Irbitskii × Kazachok.
Los tratados de libre comercio para los empresarios en Colombia
Authors: Narváez María Mercedes , Villalobos Clara Viviane , Camacho Rodríguez Luz Dary
Published: June 2024

Desde mediados de los años 90 Colombia inicio su proceso de apertura económica firmando diferentes acuerdos y convenios comerciales como oportunidades para beneficiar a los pequeños y medianos empresarios. Es así como surge el interés de hacer una revisión de los aportes que generan éstos al sector manufacturero. Es un estudio de tipo exploratorio mediante la revisión de datos académicos, con el objetivo de construir un panorama del contexto de los acuerdos de libre comercio para los empresarios del sector manufacturero y si éstos proporcionan beneficios para la actividad productiva. Los acuerdos de libre comercio brindan oportunidades significativas para los empresarios amplíen sus negocios y accedan a mercados extranjeros. Al eliminar las barreras comerciales y los aranceles, estos acuerdos crean un campo de juego más equitativo para las empresas de todos los tamaños; es relevante hoy en día reconocer la importancia de los empresarios que aprovechan estas oportunidades para hacer crecer sus negocios y aumentar sus ganancias de manera exponencial. El aumento de la competencia y la innovación son otros beneficios que los tratados de libre comercio ofrecen a los empresarios; cuando las empresas tienen acceso a mercados más grandes, se enfrentan a una mayor competencia, lo que puede generar una mayor innovación y una mejor calidad del producto, esta competencia puede conducir a precios más bajos para los consumidores, lo que puede aumentar la demanda de productos y servicios. Ante las exigencias de un mercado global, el éxito de los empresarios depende de su capacidad de innovación y de adaptación.
Análisis de las MiPymes Turísticas en el Sector de Alojamiento, en Marco del Balanced Scorecard del Distrito de Santa Marta, Magdalena
Authors: Baquero Márquez Vladimir Jhosmell , Fandiño Isaza Jesús Rafael , Pinzón Varela Merlis Emerita , Caraballo Castro Carmenza María , Ortiz Paz Arnellys Yarith
Published: June 2024

Se presenta una propuesta que consiste analizar las Micro, Pequeñas y Medianas Empresas (MiPymes) que ofrecen servicios de alojamiento en el Distrito de Santa Marta, para esto se utilizó la herramienta del Balanced Scorecard, que determinó como los factores internos y externos influyen en los procesos y actividades que desarrollan están empresas, afectando la dinámica organizacional. Este proyecto evidencio que la actividad de alojamiento se ve alterada por la alta informalidad en los servicios de hospedaje y alojamiento, siendo uno de los factores de mayor riesgo que deben de afrontar las MiPymes legalmente constituidas, afectado los ingresos, utilidades y competividad de las mismas. La investigación es de alcance descriptivo cuantitativo y cualitativo, para la recolección se datos se utilizaron encuestas y entrevistas que permitieron conocer las actividades y estrategias que desarrollan las MiPymes para sostenibilidad en el mercado, competitividad y generación de ingresos. Al final, mediante la aplicación del Balanced Scorecard se establecieron unas recomendaciones que le permitan a las MiPymes del Sector de alojamiento, fortalecer la gestión administrativa y organizacional que facilite su crecimiento y mejoren sus utilidades y rentabilidad.
Unlocking the formate utilization of wild-type Yarrowia lipolytica through adaptive laboratory evolution
Authors: chen qian , Yang Xue , Chen Yunhong , Ma Yuyue , Huang Jianfeng , zhang Zhidan , Chen Yefu , Zhang Yanfei , Zhao Guoping
Published: June 2024

Synthetic biology is contributing to the advancement of the global
net-negative carbon economy, with emphasis on formate as a member of the
one-carbon substrate garnering substantial attention. In this study, we
employed base editing tools to facilitate adaptive evolution, achieving
a formate tolerance of Yarrowia lipolytica to 1 M within two months.
This effort resulted in two mutant strains, designated as M25-70 and
M25-14, both exhibiting significantly enhanced formate utilization
capabilities. Transcriptomic analysis revealed the up-regulation of nine
endogenous genes encoding formate dehydrogenases when cultivated
utilizing formate as the sole carbon source. Furthermore, we uncovered
the pivotal role of the glyoxylate and threonine-based serine pathway in
enhancing glycine supply to promote formate assimilation. The full
potential of Yarrowia lipolytica to tolerate and utilize formate
establishing the foundation for pyruvate carboxylase-based carbon
sequestration pathways. Importantly, this study highlights the existence
of a natural formate metabolic pathway in Yarrowia lipolytica.
Investigation of the Upper Crustal Structure in the NW Dinarides Using Local Earthquake Tomography
Authors: Rajh Gregor , Stipčević Josip , Živčić Mladen , Herak Marijan , Gosar Andrej , Group the AlpArray Working
Published: June 2024

The area of the NW Dinarides lies in the northeastern corner of the
Adriatic microplate – a promontory of the African plate – which plays
a major role in the collision processes occurring in the peri-Adriatic
region. Taking advantage of the greatly increased amount of data due to
the modernization of the Slovenian seismological network, improved
cross-border data exchange, and the tempoprary deployments within the
large pan-european AlpArray project, we performed 3-D simultaneous
hypocenter–velocity inversions with routinely picked arrival times of
P- and S-waves from 502 local earthquakes. The resolution analysis
showed that the resulting 3-D P-velocity and vP/vS model could be
successfully recovered at least up to a depth of 15 km. Our results are
consistent with previous studies, but provide better resolution in the
upper crust and, for the first time, a uniform and simultaneously
computed vP/vS model for the entire study area. The final 3-D models
show two distinct velocity anomalies with a narrow transition zone in
between. The velocity anomaly in the west of our study area reflects the
thrust structure that formed due to the underthrusting of the Adriatic
microplate, while the anomaly in the east marks the transition to the
Pannonian basin. The recovered velocity distribution also appears to
correlate spatially with seismicity, which is tied to the Moho
topography at depth. The seismicity relocated with the computed models
is on average shallower and has better determined locations than the
seismicity located with the 1-D velocity model used in the daily
earthquake analysis.
PyIRTAM: A New Module of PyIRI for IRTAM Coefficients
Authors: Forsythe Victoriya , Galkin Ivan A , McDonald Sarah E , Dymond Kenneth F. , Fritz Bruce Aaron , Burrell Angeline Gail , Zawdie Katherine Anne , Drob Douglas
Published: June 2024

A novel Python module called PyIRTAM was developed in addition to the
previously released PyIRI model. The PyIRI computational approach was
extended to work with Real-Time Assimilative Model (IRTAM) coefficients.
This enables global approach to the density specification, utilizing
computation of the global and diurnal functions and their multiplication
with coefficients in the matrix form. PyIRTAM tool is made publicly
available through PyPI and GitHub.
Iris recognition based on local grey extremum values with CNN-based approaches
Authors: Malinowski Kamil , Saeed Khalid
Published: June 2024

One of the most important steps in the operation of biometric systems based on iris recognition of the human eye is pattern comparison. However, the comparison of the recorded pattern with the pattern stored in the database of the biometric system cannot function properly without effective extraction of key features from the iris image. In the presented work, we propose an iris recognition system based on image feature extraction and extreme grey shade analysis. Harris-Laplace, RANSAC and SIFT descriptor algorithms were used to find and describe key points. In the experimental part, two methods were used to compare descriptors: the Brute Force method and the Siamese Network method. IIT Delhi Iris Database (version 1.0), MMU v2 database, UBIRIS v1, UBIRIS v2 image databases were used for the study. The proposed method utilizes a different approach when using the generalized corner extraction algorithm (Harris-Laplace algorithms) for comparing iris patterns. In addition, we prove that the use of the descriptor and the Siamese neural networks significantly improves the results obtained in the original method based on paths alone in the case of well contrasted infrared images with very low resolutions.
1-PUB: Impaired Kidney Function in Diabetic Patients—A Warning
Authors: SABOO BANSHI D. , GUPTA AMIT , JOSHI SHASHANK R. , KESHAVDEV JOTHYDEV , JOSHI RAJA , PANCHOLI MANN N. , PATEL RIA , KALOO SUPRIYA , VERMA GARIMA
Published: June 2024

Introduction & Objective: Diabetic patients contribute to the major burden of DKD and there is a severe dearth of testing for the renal parameters responsible for the development and progression among diabetic patients. In this study, we studied the screening results of the investigations patients underwent testing.

Methods: Data extracted from HealthPlix EMR (https://healthplix.com/) was studied.

Results: In 2022, only 25% of the 1.7 million diabetic patients got tested and the overall average for testing was 24% across the time period of 2018-2022. 37% of the patients who got themselves tested for one or more renal parameters (creatinine or ACR or eGFR or albumin) at least once a year didn’t fall within the prescribed ranges (Figure 1). Creatinine levels were seen to be elevated in approximately 29% (average) of the patients (22% of the diabetic population who tested for creatinine levels). It was observed that out of 21% of the diabetic patients who got eGFR investigated in 2022, 25% had decreased eGFR. 3% of diabetic patients got themselves tested for ACR in 2022. Of this pool, 37% of the patients had a ratio beyond 30 mg/g.

Conclusion: Among the patients who got themselves tested, there is a significant proportion of patients who don’t fall within the prescribed limits. These numbers would have been significantly higher than now if there had been no gap between expectations and reality. Hence, regular screening is important to prevent future complications.

Disclosure

B.D. Saboo: None. A. Gupta: 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. J. Keshavdev: None. R. Joshi: None. M.N. Pancholi: None. R. Patel: None. S. Kaloo: None. G. Verma: None.
1017-P: Experience of Using Continuous Glucose Monitor among Chinese Americans with Type 2 Diabetes
Authors: ZHENG YAGUANG , GREENLEE MICHAELA D. , CHEN KEER , SUN MINGUI , WU BEI , ZWEIG SUSAN , JIA WENYAN , MELKUS GAIL D.E. , PAREKH NIYATI , WYLIE-ROSETT JUDITH
Published: June 2024

Background & Objective: Growing evidence has shown continuous glucose monitoring (CGM) has improved glycemic control. However, culturally-relevant facilitators and barriers to CGM use is unclear among Chinese Americans with type 2 diabetes (T2D), although they face high T2D prevalence with disparities in diabetes care. Thus, we aimed to evaluate the feasibility of using CGM for diabetes care among Chinese Americans with T2D.

Methods: This is a one-group prospective study. Participants wore a CGM for 2 weeks and kept a diary recording food, medication, and physical activity. Individual interviews were conducted after 2-week use to discuss their experience. Two independent and trained research assistants applied ATLAS.ti software to thematically analyze the transcription of the interview data.

Results: The Chinese Americans (N=11) aged 42-77 years with 3 females. Facilitators of using CGM included (1) CGM was comfortable and easy-to-use compared to finger sticks; (2) CGM made Chinese Americans with T2D mindful of meal choices (e.g., highlighting the need to reduce portion size even for commonly consumed foods related to Chinese culture, such as rice, noodles, and steam buns, debunking the misperceptions that one needs to only reduce sugar intake); and (3) CGM motivated them to change eating behaviors by informing their food portion size decisions. The most common barriers include the sensor falling off, getting trapped in clothes, followed by skin sensitivity.

Conclusions: Our findings suggest that it is feasible for Chinese Americans with T2D to use CGM in their diabetes care. Using CGM to reduce routine food intake with high carbohydrates may be particularly beneficial for Chinese Americans, as CGM can help Chinese Americans to understand how their culturally-related diet impacts their glucose response. Future study needs to apply CGM in a larger sample for a longer duration to inform effective diabetes management, which may improve health equity and reduce diabetes care disparity.

Disclosure

Y. Zheng: None. M.D. Greenlee: None. K. Chen: None. M. Sun: None. B. Wu: None. S. Zweig: None. W. Jia: None. G.D.E. Melkus: None. N. Parekh: None. J. Wylie-Rosett: None.

Funding

NIH/NCATS (UL1TR001445); CTSI Collaborative Translational Pilot Project Award (P30DK111022-08); New York Regional Center for Diabetes Translation Research (NY-CDTR); Pilot and Feasibility (P&F) Program Funding
1039-P: Insurance Type, Income, and Risk for Cost-Related Barriers to Care in a National Sample of Adults with Diabetes
Authors: TORRES HUGO A. , MOIN TANNAZ
Published: June 2024

Objective: Out-of-pocket costs for insured patients have soared in recent years. Medicaid insurance for low-income individuals has minimal cost sharing but private insurance and Medicare have rising levels of cost-sharing that vary widely. We compared cost barriers and out-of-pocket expenditures among a national sample of adults with diabetes.

Methods: We used 2018-21 Medical Expenditure Panel Survey data to examine cost barriers. We categorized adults with diabetes into 3 groups: 1) low income (<250% federal poverty level [FPL]) on Medicaid; 2) low income on private insurance or Medicare; 3) high income (>250% of FPL) on private insurance or Medicare. Logistic regression adjusted for age, sex, race, ethnicity, region, income (% of FPL), number of chronic conditions, self-rated health status, limitation of activities, and insulin use.

Results: We included a national sample of 6,219 adults with diabetes. Compared to low-income Medicaid recipients, low income and privately or Medicare-insured adults had higher reporting of delays or forgoing of medical care (OR=1.78, p=0.001) and medications (OR=1.45, p=0.01) due to cost. The high-income group had significantly higher odds of reporting delays and/or forgoing medication use (OR=1.58, p=0.005) but not medical care (OR=1.35, p=0.1). Out-of-pocket expenditures were significantly higher for private and Medicare insured adults compared to those in the low-income Medicaid group (low income, private or Medicare insurance group paid $267 more for medications and $755 more for care; high income group paid $315 and $967 more, respectively).

Conclusion: We found most adults with diabetes face cost barriers to care but low-income, privately or Medicare-insured adults are at highest risk of delaying or forgoing care and medication use due to cost. As the gap between rich and poor Americans widens, affordability of diabetes care will be harder to achieve, especially among low income privately or Medicare-insured adults.

Disclosure

H.A. Torres: None. T. Moin: None.
1043-P: Screening for Presence of High-Risk Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) In the U.S. Primary Care Is Cost Effective
Authors: YOUNOSSI ZOBAIR , PAIK JAMES M. , HENRY LINDA , STEPANOVA MARIA , NADER FATEMA
Published: June 2024

Introduction & Objective: Scientific associations recommend a sequential combination of non-invasive tests (NITs) to identify high-risk MASLD patients in primary care, but their cost-effectiveness is unknown.

Methods: Cost-utility model including a decision tree and Markov model was developed to compare nine screening strategies with FIB-4 followed by Enhanced Liver Fibrosis (ELF) or Vibration Controlled Transient Elastography (VCTE) to no-screening. The decision tree distributes patients between true and false positive and negative diagnoses based on the sensitivity and specificity of the diagnostic pathways. The Markov model updated disease state and mortality status over 20-years. Per patient costs, health utilities, and incremental cost-effectiveness ratios (ICERs) were calculated per strategy and reported as quality-adjusted life years (QALYs). The model simulated patients seen at primary care (type 2 diabetes (T2D), prediabetes (Pre-D), or nondiabetic ≥1 cardiometabolic risks (≥1-CMR) without other causes of liver disease). Additional scenario analysis was simulated considering the availability of VCTE and ELF in the U.S.

Results: After 20-years, all 9 screening strategies provided lower cumulative mortality (4.1% to 5.8% reduction), reduction in advanced fibrosis (24.7% to 30.9% reduction) and were cost-effective as compared to no screening [ICERs ranging between $22,119 to $28,778 per QALY gained in T2D, $69,289 to $79,260 in Pre-D, and $69,686 to $80,034 in ≥1-CMR (willingness-to-pay threshold of $100,000 per QALY)]. The cost-effectiveness of screening strategies was consistent with scenario and sensitivity analyses.

Conclusions: Recently published guidelines for high-risk MASLD screening are cost-effective and should be considered in primary care.

Disclosure

Z. Younossi: Consultant; Gilead Sciences, Inc., Bainan Biotech, AbbVie Inc., Bristol-Myers Squibb Company, Abbott, Novo Nordisk, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Siemens Healthcare Diagnostics, Intercept Pharmaceuticals, Inc. J.M. Paik: None. L. Henry: None. M. Stepanova: None. F. Nader: None.
105-OR: Single-Cell Multiomic Analysis of the Effect of GIP and GIP-1 Mono- and Multi-agonism on the Hypothalamus and Hindbrain
Authors: GUTGESELL ROBERT M. , MAITY-KUMAR GANDHARI , GARCIA CACERES CRISTINA , TSCHÖP MATTHIAS H. , MÜLLER TIMO D.
Published: June 2024

The discovery of incretin mimetics represents a major turning point in obesity and diabetes medicine. These small molecules are agonists of one or more receptors of glucagon, GLP-1, and GIP. Despite their efficacy and widespread use, the mechanism for the reduction in bodyweight has not been elucidated. Energy homeostasis is regulated in the hypothalamus and hindbrain, where incretin receptors are also expressed, leading to the hypothesis that incretin mimetics act in these brain regions to exert their appetite suppressing effects. The aim of this study is to identify mechanisms of action in the hypothalamus and hindbrain of GLP-1 and GIP agonists.Adult, diet-induced obese male CL57BL/6-J mice were injected IP with vehicle, GLP-1R agonist, GIPR agonist, GIPR antagonist, and MAR709, a mouse and human GLP-1R/GIPR dual-agonist, n=6. 8h after injection, the hypothalamus and hindbrain were collected and single-nuclei RNA and ATAC (assay for transposase-accessible chromatin) sequencing was performed, yielding 211537 hypothalamic and 57844 hindbrain nuclei after pre-processing (removal of low-quality nuclei & doublets).Cell type annotations from the Allen Institute mouse brain atlas were transferred to this data using correlation mapping. To identify cell types acted on by the incretin agonists, cell types were ranked by transcriptional and accessible chromatin changes between groups using Pertpy. Differences in intercellular communication were identified using a novel atlas-informed cell-cell communication method.We have generated the largest single-cell multiome dataset in the hindbrain and hypothalamus to date and identified gene expression and gene regulatory changes by which GIP and GLP-1 mimetics act to exert their anti-obesity effects. These data and analysis identified candidate mechanisms of action of incretin-mediated weight loss.

Disclosure

R.M. Gutgesell: None. G. Maity-Kumar: None. C. Garcia Caceres: None. M.H. Tschöp: Consultant; Boeher Inglehim. T.D. Müller: Stock/Shareholder; Novo Nordisk, Eli Lilly and Company. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk, Merck & Co., Inc., Eli Lilly and Company, Novo Nordisk.
1050-P: Comorbid Alcohol Use Disorder Is Associated with Increased Acute Care Utilization in Patients with Diabetes and Chronic Kidney Disease
Authors: GREBLA REGINA , STRAND LAUREN P. , ZHOU SUMMERA , ZHAO XIN , KESHISHIAN ALLISON , MCCLAIN MONICA , SPRINGER SANDRA
Published: June 2024

Introduction: Alcohol use disorder (AUD) is associated with adverse health outcomes in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). This study examined healthcare resource use (HRU) and costs associated with comorbid AUD in patients with DM and CKD.

Methods: This retrospective cohort study identified adults with ≥1 inpatient or ≥2 outpatient claims for DM or CKD (MarketScan® and Medicare [1/1/2016-12/31/2020], Medicaid [1/1/2016-12/31/2019] databases), and ≥1 y of continuous healthcare enrollment before diagnosis (baseline period) and 3 mo after. Moderate-to-severe AUD was verified during baseline. HRU and costs were compared between propensity-score matched AUD and non-AUD patients in the DM and CKD cohorts, accounting for baseline demographics and other characteristics.

Results: 1,580,531 patients with DM and 1,155,142 patients with CKD were identified. Before matching, patients with AUD and DM (n=12,340) or CKD (n=14,472) were more likely to be younger, male, and have a higher comorbidity burden than patients without AUD. In matched cohorts, patients with DM and AUD had higher rates of inpatient (54%) and ED visits (27%), and longer inpatient stays (59%) vs non-AUD patients. Patients with CKD and AUD also had higher rates of inpatient (60%) and ED visits (35%), and longer inpatient stays (65%) vs non-AUD patients. Patients with AUD in both cohorts had slight increases in outpatient visits, fewer outpatient pharmacy claims, lower pharmacy costs, and higher total costs vs non-AUD patients.

Conclusion: Among patients with DM or CKD, comorbid AUD was associated with increased acute care utilization and total healthcare costs. Patients with comorbid AUD had lower outpatient pharmacy utilization which may increase the risk of suboptimal health outcomes in this population. These findings highlight the importance of effective AUD screening as part of a comprehensive care plan in patients with DM or CKD.

Disclosure

R. Grebla: Employee; Alkermes, Inc. Stock/Shareholder; Alkermes, Inc. L.P. Strand: Employee; Alkermes, Inc. Stock/Shareholder; Alkermes, Inc. S. Zhou: Consultant; Alkermes, Inc. X. Zhao: None. A. Keshishian: Consultant; Alkermes, Inc. M. McClain: Consultant; Alkermes, Inc. S. Springer: Research Support; National Institutes of Health, Veterans Administration. Other Relationship; Indivor Pharmaceuticals, Alkermes, Inc. Consultant; Alkermes, Inc.

Funding

This study was supported by Alkermes Inc.
1051-P: Cost-Effectiveness of Flash CGM Compared with SMBG—A Canadian Private-Payer Perspective
Authors: HARRIS STEWART B. , CIMINO SAL , THANH YEN NGUYEN THI , POON YEESHA , SZAFRANSKI KIRK
Published: June 2024

Introduction & Objective: For people living with diabetes, effective glucose monitoring is recognized as a key component in diabetes care to reduce disease burden, complications, and healthcare utilization. This study aimed to assess the cost-effectiveness of flash CGM, compared with SMBG, from the perspective of a Canadian private payer.

Methods: A recently developed patient-level microsimulation model was used to compare flash CGM with SMBG. Time horizons of 40 years (T1DM) and 25 years (T2DM) were used, reflecting the period of typical private payer coverage. Costs and utilities were discounted at 1.5%. Population characteristics, treatment outcomes, and utilities were based on RCTs and RWE studies. Mean age at model entry was 23 years for T1DM and 40 years for T2DM. T2DM treatment assumptions were: 84% non-insulin; 10% basal insulin; and 6% MDI. Costs were taken from Canadian sources, and included flash CGM and SMBG acquisition costs, the costs to private payers of treating diabetes complications, and absenteeism costs. The primary outcome was cost per quality-adjusted life year (QALY).

Results: For both T1DM and T2DM, flash CGM provided more QALYs than SMBG while reducing costs (Table). Scenario analyses were consistent with the base-case results.

Conclusions: From a Canadian private payer perspective, flash CGM is cost effective compared with SMBG for all people living with diabetes.

Disclosure

S.B. Harris: Consultant; Abbott. Research Support; Boehringer-Ingelheim. Consultant; Dexcom, Inc. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Novartis AG. Consultant; Bayer Inc. S. Cimino: Consultant; Abbott, Boehringer-Ingelheim, Eisai Inc., Eli Lilly and Company, Merck & Co., Inc., Novartis Canada, Novo Nordisk Canada Inc., Takeda Canada. T. Nguyen: None. Y. Poon: Employee; Abbott. K. Szafranski: Consultant; Abbott, Novo Nordisk, Novartis Canada, CSL Behring, AbbVie Inc., Sanofi.
107-OR: Brain GLP-1R Is Likely Required for Peripheral Liraglutide Treatment on Stimulating Hepatic FGF21
Authors: NUO FENG JIA , SHAO WEIJUAN , JIN TIANRU
Published: June 2024

Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are therapeutic agents for Type 2 Diabetes (T2D) and chronic weight management. We reported previously that peripheral GLP-1RA (liraglutide, Lira) administration stimulates hepatic fibroblast growth factor 21 (FGF21) in wild type but not GLP-1R-/- mice, and GLP-1R is not expressed in the liver tissue. Here we aim to determine the underlying mechanisms for such stimulatory effect via organ-organ communications. Firstly, we asked whether acute intraduodenal (i.d.) GLP-1RA administration stimulates hepatic FGF21; and if so, whether the stimulation requires GLP-1R. We revealed that i.d. administration of GLP-1RA in WT mice significantly elevated hepatic Fgf21 levels by 5-fold compared to WT mice received i.d. PBS, whereas such effect was virtually lost in GLP-1R-/- mice. Secondly, we investigated the central role of GLP-1R. We antagonized brain GLP-1R activity via i.c.v. Ex9-39 injection after peripheral Lira treatment in HFD-challenged mice. Mice received peripheral Lira treatment and i.c.v. Exendin 9-39 treatment show impaired stimulatory effect on serum FGF21 compared to the i.c.v. PBS counterpart, suggesting that brain GLP-1R is likely required for peripheral GLP-1RA to stimulate hepatic FGF21. Together, we further demonstrated that peripheral GLP-1RA administration stimulates hepatic FGF21, and revealed that such beneficial effect likely requires brain GLP-1R. Our study will aid the understanding of metabolic hormones and pave the way for determining their underlying mechanisms in metabolic homeostasis

Disclosure

J. Feng: None. W. Shao: None. T. Jin: None.

Funding

Canadian Institutes of Health Research (PJT159735) Guarantor: Tianru Jin
1072-P: Identifying Disparities in Diabetes Care for Minority Racial Groups—Evaluating an Enhanced Primary Care Practice Model
Authors: HERGES JOSEPH , COLE KRISTIN , MCCOY ROZALINA G.
Published: June 2024

Purpose: The Enhanced Primary Care Diabetes (EPCD) model is an innovative nurse-led care delivery model which leverages multidisciplinary support including clinical pharmacist expertise which has been previously found to improve diabetes quality indicators. The purpose of our study was to assess the effectiveness and engagement of the EPCD model among different minority groups.

Methods: We utilized a retrospective cohort design to evaluate the time to meeting a publicly reported diabetes care quality measure (D5) following enrollment into the EPCD model for different minority groups. We included adult patients (18-75) with diabetes from 13 primary care practices in an integrated health care system that were enrolled in the model from 1/1/2020 to 12/31/2020 and followed through 8/1/2022. Associations with meeting D5 criteria were assessed using survival methods.

Results: The EPCD program enrolled 1,749 patients and 1,061 patients (60.7%) met the composite D5 outcome. Black patients were significantly less likely to meet the D5 composite measure compared to white patients (adjusted HR 0.68, CI 0.52-0.90; P= 0.007). There were no other statistically significant differences among other race/ethnicities compared to white patients. White patients had fewer nurse touch points per year (median 1.1; IQR 0.4, 2.7) compared to non-white patients (median 1.5; IQR 0.5, 3.4) (P= 0.003).

Conclusions: Overall time to meeting D5 indicators was longer for black patients compared to white patients in the EPCD model, despite more engagement in non-white patients. Further research is warranted to identify driving factors for these disparities and solutions to improve performance in the black population.

Disclosure

J. Herges: None. K. Cole: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.
1078-P: The Impact of Telemedicine Use on Subsequent Glycemic Control in Patients with Diabetes
Authors: THURBER EMILIA G. , LAN ZHOU , TURCHIN ALEXANDER
Published: June 2024

Introduction & Objective: Telemedicine visits increased significantly during the COVID-19 pandemic, particularly in endocrinology. While many providers continue to use telemedicine, its impact on patient outcomes remains uncertain. This study sought to determine the effect of varying levels of telemedicine use on clinical outcomes in patients with diabetes.

Methods: In this retrospective observational study, we examined the relationship between telemedicine use and glycemic control in patients seen by endocrinology for diabetes at an integrated health system. Patients were included if they had a baseline HbA1c in 2020, at least two visits for diabetes in 2021, and an outcome HbA1c in 2022.

Results: The study population (n=9,195) was 51.3% female with a mean age 63.9 (SD 13.7) years and baseline HbA1c 7.7% (SD 1.5). Patients had a mean of 34.8% (SD 39.0) telemedicine visits in 2021. Between 2020 and 2022, HbA1c decreased by a mean of 0.17% (SD 1.39). In univariate ANOVA analysis, HbA1c decreased by 0.19% (SD 1.37) in patients with no telemedicine use, 0.18% (SD 1.39) in patients with both telemedicine and in-person visits, and 0.09% (SD 1.4) in patients with only telemedicine visits (p = 0.047). In a multivariable linear regression model adjusted for patient demographics, baseline HbA1c and renal function, diabetes type, insulin use, and comorbidities, a higher percentage of telemedicine use was associated with a lower decrease in HbA1c (coefficient = 0.11, 95% CI 0.03 - 0.18, p = 0.003). Older age and insulin use were also associated with a lower decrease in HbA1c, while being partnered, completing at least some college, public insurance, Type 1 DM, higher BMI, and higher baseline HbA1c were associated with a greater HbA1c decrease.

Conclusion: Patients with a high percentage of telemedicine use may have worse glycemic control. Additional research is needed to determine the possible causes for this finding and strategies for delivering effective telemedicine care for patients with diabetes.

Disclosure

E.G. Thurber: None. Z. Lan: None. A. Turchin: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Novo Nordisk, Proteomics International. Research Support; AstraZeneca.

Funding

National Institutes of Health (T32DK007529)
1097-P: Implementation Science and Pediatric Diabetes—A Scoping Review of the State of the Literature and Guidance for Future Research
Authors: PRICE JULIA , HAWKINS JACLYNN M. , AMANTE DANIEL J. , JAMES RICHARD , HAIRE-JOSHU DEBRA
Published: June 2024

Introduction & Objective: Implementation science (IS) offers rigorous methods to increase use of evidence-based practices (EBPs) in standard care. It is unclear how much and what types of IS research have been conducted in pediatric type 1 (T1D) and type 2 diabetes (T2D). The current scoping review aimed to identify IS-focused research in pediatric diabetes, evaluate integration of IS theory, methods, and terminology, and offer guidance to expand implementation research in pediatric diabetes medical, psychosocial, and education care.

Methods: Following the JBI guidelines and PRISMA-ScR checklist for scoping reviews, a search of PubMed, Scopus, PsychINFO, Emcare, CINAHL, and Cochrane Trials Register databases was conducted on 1/31/2023 for English language articles and repeated in 11/2023. Identified articles were uploaded into Covidence. Two independent reviewers screened articles and completed data extraction.

Results: 156 studies were identified in the initial search, 62 reached full-text review, and 23 were included in analyses. Of the 23 included papers, 19 were published between 2017 and 2023 and 21 focused on T1D. Most studies involved medical EBPs (n=15), whereas fewer focused on psychosocial (n=7) and diabetes education (n=2) EBPs. Most studies (n=11) identified barriers and facilitators of implementing an EBP or were implementation trials (n=11); fewer studies documented gaps in use of an EBP in standard clinical practice (n=7). Only one paper detailed development of an implementation strategy. Five papers employed implementation science theories/models/frameworks.

Conclusions: This scoping review identified a young literature examining implementation of EBPs in pediatric diabetes. Few studies employed IS theory and terminology and few described implementation strategies. Guidance for future work to increase use of EBPs across medical, psychosocial, and education care for pediatric diabetes is offered.

Disclosure

J. Price: None. J.M. Hawkins: None. D.J. Amante: None. R. James: None. D. Haire-Joshu: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (5K23DK125666); National Institute of Diabetes and Digestive and Kidney Diseases (5K01DK131318)
1099-P: Diabetes Collaborative Care for Young Adults (DCCYA) Is a Feasible Care Model for Young Adults with Diabetes
Authors: VAKHARIA JANAKI D. , THEODORAKAKIS MARIA , SCHULTE CAROLIN C.M. , O'DONNELL ELLEN , WEXLER DEBORAH J.
Published: June 2024

Young adults (YAs) with diabetes mellitus (DM) have a high prevalence of depressed mood, diabetes-related distress (DRD), and competing demands that contribute to uncontrolled DM, especially during the transition from pediatric to adult care. We piloted the Diabetes Collaborative Care for Young Adults (DCCYA) model that incorporates a behavioral health provider during office visits to facilitate care of psychosocial determinants of DM management for YAs with DM after transition to adult care. We determined DCCYA feasibility compared to usual care (UC), defined by visit retention rate, over a 9-month period. YAs with type 1 or type 2 DM were assigned based on whether their initial visit to the adult DM clinic was scheduled with the DCCYA care team (DCCYA, n=16) or not (UC, n=29). Baseline mean HbA1c differed between groups (8.5 ± 2.4% DCCYA vs. 7.1 ± 1.2% UC, p=0.03) but baseline prevalence of mental health disorders, engagement in mental health treatment, and patient-reported outcomes of DRD and depressed mood did not (Table 1). DCCYA patients had more scheduled visits during the 9-month period than UC patients (3.9 ± 1.5 vs. 2.4 ± 1.3, p=0.02). DCCYA mean visit retention rate (0.62 ± 0.24) was comparable to that of UC (0.52 ± 0.36) (p=0.4), demonstrating feasibility. Future studies will aim to assess DCCYA impact on DM care parameters and psychosocial determinants of health in a larger cohort.

Disclosure

J.D. Vakharia: None. M. Theodorakakis: None. C.C.M. Schulte: None. E. O'Donnell: None. D.J. Wexler: Other Relationship; Novo Nordisk.

Funding

National Institutes of Health (T32DK007028)
11-OR: Combined DPNCheck and SUDOSCAN as a Screening Tool for DPN—The Sheffield Prospective Study
Authors: SHAAN GOONOO MOHUMMAD , SELVARAJAH DINESH , SLOAN GORDON P. , TESFAYE SOLOMON
Published: June 2024

Introduction & Objective: Diabetic peripheral neuropathy (DPN) is often diagnosed late. Point-of-care-devices (POCDs, ‘DPN-Check’ a handheld device which measures sural-nerve conduction-velocity/amplitude and SUDOSCAN a test of sudomotor-function) are objective, quick tests that when combined; accurately diagnose DPN. However, the ability of POCDs to predict incident DPN is unknown, and was examined in this prospective study.

Methods: 229 consecutive participants with diabetes who attended one-stop microvascular screening service were re-called for follow-up evaluation at 7 years. Baseline assessments were repeated including: clinical and neurophysiological assessments of DPN [Toronto Clinical Neuropathy Score (TCNS),10g monofilament (10g-MFT), POCDs and nerve conduction studies (NCS). Risk of developing incident DPN was assessed using the odds-ratio for the diagnosis of DPN using clinical (TCNS, 10gMFT) and NCS.

Results: 90 participants have completed follow up visits. Patients attending follow up were significantly younger [57.8(11.9)vs62.5(14.2)years; (p<0.001(95%CI 4.1:11.4)] than those who did not (n=139), and had lower number of co-morbidities [3.0vs5.5; P<0.001] and Q-risk (20.3(13.1)vs29.3(13.5); p<0.001). Thirty-four (37.8%) patients had incident 10g MFT abnormality at follow-up. Patients with abnormal POCDs had a OR 7.1(p<0.001;95%CI:2.3:22.8) times greater risk of 10g-MFT abnormality compared to those with normal POCDs at baseline. Similar increased risk of incident DPN were found when DPN was diagnosed using TCNS [OR 4.0(95%CI1.0:15.2, p=0.03)] and NCS [OR 11.9(95%CI:1.5:96.0, p=0.005)].

Conclusions: We have demonstrated significantly increased risk of incident clinical DPN in patients with abnormal baseline POCDs (microalbuminuria equivalent). These findings support the use of POCDs as a screening tool for early DPN diagnosis, when cardio-metabolic control may halt the progressive neuropathic process.

Disclosure

M. Goonoo: None. D. Selvarajah: Research Support; Abbott. Speaker's Bureau; Grunenthal. Research Support; Impeto medical. G.P. Sloan: Other Relationship; Procter & Gamble, Lilly Diabetes. S. Tesfaye: Advisory Panel; Angelini Pharma, AstraZeneca, Bayer Inc., Worwag Pharma, Nevro Corp. Other Relationship; GlaxoSmithKline plc, Novo Nordisk Foundation. Speaker's Bureau; Procter & Gamble, Viatris Inc. Research Support; Withings, Viatris Inc., Procter & Gamble.

Funding

Proctor & Gamble Health (STH SPONSOR ID STH22196)
1109-P: Diabetes Technology Education Processes among Centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: WOLF RISA M. , OSPELT EMMA L. , GOLDEN LAUREN , EBEKOZIEN OSAGIE , ANTAL ZOLTAN , GUARNERI ALISSA , STEENKAMP DEVIN W. , NELSON GRACE , CROSSEN STEPHANIE , KELLIS MARY V. , AGARWAL SHIVANI , COLLABORATIVE T1DX-QI
Published: June 2024

Background: With increasing use of diabetes technologies in type 1 diabetes care, we sought to describe prescribing practices and education processes for initiating diabetes technologies across T1DX-QI centers.

Methods: A survey was administered from July to September 2023 to 55 centers participating in the T1DX-QI on diabetes technology prescription and education processes. Descriptive analysis was completed.

Results: Of 55 centers, 50 (91%) completed the survey. Across centers, the endocrinologist is most likely to initiate prescriptions for continuous glucose monitors (CGM), and 64% routinely prescribe CGM at the time of diagnosis. Medical assistants are most likely to manage prior authorizations, and diabetes educators are most likely to provide standardized education once devices are received (Figure 1a). For all technology types (insulin pumps, CGM, automatic insulin delivery (AID), and smart insulin pens (SIP)), the majority of centers provide device education in an outpatient setting (93%), in person by a clinic staff member (61%), and done once the patient receives the device (62%).

Conclusions: The majority of endocrinologists prescribe CGM at time of diagnosis. Offering standardized training for diabetes technology is not universal, and differs among pediatric and adult centers (Figure 1b).

Disclosure

R.M. Wolf: Research Support; Dexcom, Inc., Boehringer-Ingelheim, Novo Nordisk. E.L. Ospelt: None. L. Golden: 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. Z. Antal: Consultant; Bayer Inc. A. Guarneri: None. D.W. Steenkamp: Consultant; Abbott. Research Support; Novo Nordisk A/S, MannKind Corporation, Tandem Diabetes Care, Inc. G. Nelson: None. S. Crossen: None. M.V. Kellis: None. S. Agarwal: Research Support; Dexcom, Inc. Advisory Panel; Medtronic. Consultant; Beta Bionics, Inc.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1116-P: KnovaSolutions Diabetes Client Case—Improving Diabetes Management and Lowering Treatment Costs
Authors: ARCHER LINDA L. , BRENNEMAN PAULA , LLOYD SARAH , CHAPLIK ANNETTE , VANNETT JULIE , SZELC KELLEY A.
Published: June 2024

Introduction & Objective: Workpartners’ KnovaSolutions diabetes program takes a holistic approach. The services equip and empower individuals with diabetes to navigate complexity, improve their health, and make better-informed healthcare decisions. This, in turn, improves their quality of life, reduces waste, and lowers benefit costs.

Methods: A client case study was conducted using our proprietary data analysis; we identified individuals with a diabetes diagnosis and stratified them according to their risk. The individuals completed an initial assessment to identify gaps and areas of focus. The client offered medication and diabetes supply incentives to Health Plan-enrolled individuals with a diabetes diagnosis. The individuals received the incentive based on quarterly interaction with the CDCES. The goals of the program were to reduce complications and medical costs by removing barriers to self-management.

Results: The results revealed marked improvements in overall average cost reduction of $3,219 for individuals with type 2 diabetes, 50 percent reported a reduction in weight and average blood sugar (HbA1c), 36 percent had a reduction in LDL cholesterol, and medication adherence increased by as much as 6 percent.

Conclusion: Workpartners’ KnovaSolutions diabetes program is unique. The CDCES uses motivational interviewing to elicit the person’s desire to change and clinical expertise to empower people with the knowledge and skills to improve their diabetes self-management. After one year of the KnovaSolutions diabetes program, there was an improvement in key health risk indicators and a considerable average cost reduction per participant.

Disclosure

L.L. Archer: None. P. Brenneman: None. S. Lloyd: None. A. Chaplik: None. J. Vannett: None. K.A. Szelc: None.