bluuebunny/crossref_metadata_2025 huggingface dataset:
1082-P: Online Clinician Education Results in Performance Changes in Clinical Practice Related to Obesity Management in Patients With and Without Type 2 Diabetes
Authors: LARKIN AMY , LE ANNE
Published: June 2024

Background: This study examined if online continuing medical education (CME) assessed if obesity evidence-based best practices would result in adoption of new clinical practices.

Methods: Clinicians participated in an online patient simulation CME activity, comprised of two different patient scenarios similar to practice. Performance was assessed with a survey 30-60 days post-education, identifying practice changes and the degree to which clinicians experience barriers to those changes. The data were collected from 3/2/2023 to 9/15/2023.

Results: There were 28 primary care physician (PCP) learners who completed the survey. Analysis showed that 96% of learners made a practice change or had practices reinforced due to education. Top 3 practice changes modified or implemented as a result of education included: Identifying patients with obesity who may benefit from anti-obesity medication (68%); Initiating anti-obesity medication early in patients meeting diagnostic criteria for obesity (68%); and screening patients for obesity (64%). Some of the main barriers to implementing practice changes identified by the learners include: Identifying patients with obesity who may benefit from anti-obesity medication; Implementing diet and exercise into practice for management of obesity; Initiating anti-obesity medication early in patients meeting diagnostic criteria for obesity; and Correctly dosing anti-obesity medication in patients meeting diagnostic criteria for obesity.

Conclusions: The practice changes identified in this assessment provide compelling evidence that participation in online CME prompts adoption of changes in practice related obesity management in patients with and without T2D.

Disclosure

A. Larkin: None. A. Le: None.

Funding

This education was supported by an independent educational grant from Lilly.
1084-P: Digital Twin Technology for Improvement in Extraglycemic Parameters—Eighteen-Months Results of the Prospective Randomized Controlled Clinical Trial
Authors: JOSHI SHASHANK , DHARMALINGAM MALA , VADAVI ARUN , KESHAVAMURTHY ASHOK , BHONSLEY SUCHITRA , THAJUDEEN MOHAMED , SHA ASMIN , SHAMANNA PARAMESH
Published: June 2024

Utilizing the Digital Twin (DT) technology, which integrates Artificial Intelligence (AI) and the Internet of Things (IoT), this study aimed to improve extra glycemic parameters in patients with Type 2 Diabetes (T2D). The DT platform processed multidimensional data to provide individualized nutrition and health recommendations via a mobile application. Analysis was conducted on data from 218 of the 233 participants who completed a 18 months intervention with DT, showing marked improvements. The mean age and duration of diabetes were 44 years (±8.6) and 3.7 years (±2.7), respectively. Significant changes (p<0.0001) were observed from baseline to 18 months in key non-glycemic parameters: Systolic BP (from 127.4 mmHg ± 11.5 to 121 mmHg ± 12.8), Diastolic BP (from 84.7 ± 7.2 to 81.6 ± 10), hs-CRP (from 2.9 mg/dl ± 4.5 to 2.2 mg/dl ± 3.1), TG/HDL ratio (from 7.9 ± 16.8 to 4.6 ± 3.6), NAFLD Fibrosis Score (from -2.3 ± 1.1 to -2.9 ± 1), and NAFLD Liver Fat Score (from 1.2 ± 2 to -0.6 ± 1.7). The integration of AI and IoT in the DT platform significantly enhanced extra glycemic parameters in T2D patients over eighteen months, indicating its transformative potential beyond traditional glycemic management.

Disclosure

S. Joshi: None. M. Dharmalingam: None. A. Vadavi: None. A. Keshavamurthy: None. S. Bhonsley: None. M. Thajudeen: None. A. Sha: None. P. Shamanna: None.
1087-P: AI as a Clinical Advisor—Benchmarking AI’s Recommendations against Clinicians’ Practices in Type 2 Diabetes Management
Authors: YOUNG CLIPPER F. , WONG SHIRLEY
Published: June 2024

Objective: To compare clinical recommendations on type 2 diabetes management based on the ADA’s Standards of Medical Care - 2021 generated by two generative artificial intelligent (AI) platforms for internal consistency (vertically within a platform) and external consensus (horizontally between platforms and with clinicians’ clinical decisions).

Methods: A complex clinical case was chosen because the patient has developed comorbid conditions related to type 2 diabetes (e.g., myocardial infarction, stroke, chronic kidney disease). Before entering the case into each AI platform for analysis, the clinical note - chief complaint, subjective, and objective information - was edited and organized to maximize clarity and standardize the language. Following the analyses by the two AI platforms, the outcomes was analyzed qualitatively by comparing the assessment and plan written by a clinician.

Results:

Conclusion: The two generative AI platforms achieved a similar internal consistency. Regarding external consensus, both platforms focused on key points in the effectiveness theme for secondary cardiovascular prevention. Although this abstract shows one pilot case, this qualitative approach sets a foundation for future analyses as the clinical recommendations from the two generative AI platforms exhibited alignment with the notes written by clinicians (diabetes specialists).

Disclosure

C.F. Young: Other Relationship; Abbott. S. Wong: None.
1094-P: Practice Ownership and Adherence to Diabetes Guidelines
Authors: KOSTRUBSKY NICK , HARMAN JEFFREY
Published: June 2024

Introduction & Objective: Hospital systems have recently been acquiring privately owned physician practices, converting them into vertically integrated practices. The purpose of this study is to observe if ownership of a medical practice influences adherence to clinical guidelines for management of type 1 and type 2 diabetes.

Methods: This is an observational study using pooled cross-sectional data (2014-2016, 2018-2019) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. A total of 7499 chronic routine follow ups and preventative care visits to non-integrated (solo and group physician practices) and integrated practices were analyzed to see whether guideline concordant care was provided. Measures included seven services that are recommended annually for individuals with type 1 and type 2 diabetes (HbA1c, lipid panel, serum creatinine, depression screening, influenza immunization, foot examination, BMI).

Results: Compared to non-integrated physician practices, vertically integrated practices had higher rates of hemoglobin A1C testing (odds ratio 1.59 [95% CI 1.8-2.34], P<0.05), serum creatine testing (odds ratio 1.57 [95% CI 1.04-2.35], P<0.05), foot examinations (odds ratio 2.14 [95% CI 1.05-4.36], P<0.05), and BMI measuring (odds ratio 1.73 [95% CI 1.11-2.68], P<0.05). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations.

Conclusion: Our results show that integrated medical practices have a higher adherence to diabetes practice guidelines than non-integrated practices, suggesting they may be more effective at treating chronic conditions. However, rates of services provided regardless of ownership were low. More research needs to be done on ways to improve adherence to guidelines.

Disclosure

N. Kostrubsky: None. J. Harman: None.
1117-P: Comparison between Glucose Management Indicator (GMI) with HbA1c among Patients in a Hybrid Therapeutics Care Model
Authors: CACCELLI MILENA , OZKAN CIGDEM , ZAKARIA HALA , KATTAN JOUDY , SULTAN RANA , SAID YOUSEF , HASHEMI ALI , ALMARZOOQI IHSAN
Published: June 2024

GMI is frequently used as a substitute for HbA1c, especially when using remote monitoring, and the difference between them has a clinical relevance¹. In this study, GMI and Hba1c, along with other glycemic parameters, are examined in patients with Type 1 diabetes, Type 2 diabetes (T2D), and prediabetes using the Freestyle libre sensor during hybrid (both physical and continuous remote monitoring) therapeutic care (GluCare.Health).A retrospective observational study included 45 adults who used CGM > 70 % in 3 months. Time in range (TIR), average glucose (AG), GMI, and percentage coefficient of variation (% CV) were collected from each patient's 90-day Libreview report, along with their HbA1c. Patients were monitored in-clinic and remotely through GluCare.health. HbA1c and GMI were calculated and categorized into four categories: <0.1, 0.1-0.4, 0.5-0.9, and > 1.Mean patient's age was 41.7 ± 16.8 years. HbA1c and GMI were different in 86.4 % of the patients. Significant differences in AG, TIR, %CV, HbA1c and GMI were observed among the 3 groups (p<0.001) (Table 1). Significance between categories of HbA1c - GMI across all cohorts, with T1D showing a higher proportion of variation compared to T2D and prediabetes (p = 0.034).

HbA1c-GMI can be used in immediate decision making to manage diabetes when practicing a hybrid care model that uses continuous remote monitoring together with physical visits.

Disclosure

M. Caccelli: None. C. Ozkan: None. H. Zakaria: None. J. Kattan: None. R. Sultan: None. Y. Said: None. A. Hashemi: None. I. Almarzooqi: None.
112-OR: A Novel Function of Endothelial Insulin-Like Growth Factor-1 Receptor—Regulation of Gastrointestinal Microbiota as a Defensive Mechanism against Obesity-Induced Metabolic Dysfunction
Authors: HAYWOOD NATALIE J. , LUK CHEUKYAU , FUTERS TIMOTHY S. , REAY MELANIE , MAKAVA NATALLIA , SKROMNA ANNA , CUBBON RICHARD , KEARNEY MARK
Published: June 2024

The gastrointestinal tract serves as an intricate ecosystem hosting trillions of microbes, known as the microbiota, and plays a crucial role in maintaining metabolic balance. Previously, we have demonstrated that mice genetically modified with endothelial IGF-1R over-expression (hIGFREO) and subjected to 8-weeks high-fat diet (HFD), exhibited reduced adipose mass, improved glucose homeostasis, and a modified microbiota compared to wildtype (WT) littermates. Therefore, our aim was to investigate the effect of transplanting microbiota from hIGFREO into C57BL/6J obese mice on glucose tolerance and insulin sensitivity. We employed fecal microbiota transplantation (FMT) to investigate the impact of the hIGFREO microbiota. Briefly, donor mice (hIGFREO and WT) were subjected to 8-weeks HFD, after this fecal pellets were collected, homogenized in 20% glycerol in PBS supplemented with 0.05% l-cysteine-HCl. Recipient obese C57BL/6J mice underwent a week of antibiotic-supplemented water to deplete the gut microbiota, followed by gavage of fecal slurry from either hIGFREO or WT donors. Obese C57BL/6J mice, subjected to hIGFREO FMT, exhibited enhanced glucose tolerance and insulin sensitivity compared to those that received WT FMT. There was no difference in body weight or circulating insulin, IGF-1, adiponectin, leptin, triglycerides or free fatty acids between the FMT groups. However, after successful FMT engraftment, the microbial biodiversity was significantly different including an increase in akkermansia muciniphila, in those mice that received hIGFREO FMT. To the best of our knowledge, this is the first study revealing the endothelium's capacity to influence the gut microbiota. Additionally, we demonstrate the involvement of endothelial IGF-1R in the beneficial remodelling of the gut microbiota, which leads to improved whole body glucose tolerance and insulin sensitivity.

Disclosure

N.J. Haywood: None. C. Luk: None. T.S. Futers: None. M. Reay: None. N. Makava: None. A. Skromna: None. R. Cubbon: Speaker's Bureau; Janssen Pharmaceuticals, Inc. M. Kearney: None.

Funding

British Heart Foundation
1120-P: Diabetestal—Danish Diabetes Dashboard—A Tool to Monitor and Improve the Quality of Diabetes Treatment
Authors: CAYUELAS MATEU NURIA , THYBO TANJA
Published: June 2024

Introduction & Objective: No publicly accessible and highly updated database on diabetes treatment and outcomes has been available before in Denmark. The aim is to provide data to help improve the health of people living with diabetes.

Methods: Diabetestal, developed by the Danish Diabetes Association, is a quarterly updated quality database of all people living with diabetes in Denmark. Diabetestal links individual health records from several registers that are internationally recognized for their high validity and quality, e.g. the Patient Register, The Clinical Laboratory Information Register and The Prescription Registry. Data includes lab measurements, drug purchases, accessories, diabetes-related complications, glycemic control separately for demography, diabetes duration and residence etc.

Results: Diabetestal integrates clinical practice guidelines through an open, intuitive, chart-based, customizable user experience, enabling the analysis of geographical inequalities in treatment across time, e.g. therapeutic inertia in Danmark has improved while regional inequalities in treatment persist, as depict in the graph.

Conclusion: Diabetestal may help health professionals highlight trends or problems and enable them to make informed decisions and thereby improve adherence to quality guidelines and help improve outcomes for people living with diabetes. www.diabetestal.nu

Disclosure

N. Cayuelas Mateu: Research Support; Novo Nordisk A/S, Bayer Inc., Boehringer-Ingelheim, Sanofi, AstraZeneca, Abbott, Abbott Diagnostics. T. Thybo: Research Support; Novo Nordisk A/S, Bayer Inc., Boehringer-Ingelheim, Sanofi, AstraZeneca, Abbott, Abbott Diagnostics.
1122-P: Post-discharge Scheduled Appointments and Clinical Outcomes in Patients with Diabetes and Low Socioeconomic Status Community
Authors: TEHRANIAN SHAHRZAD , MON SANN
Published: June 2024

Introduction and Objective: Diabetes mellitus (DM) management presents significant healthcare challenges, and optimizing post-hospitalization care is crucial. This study explores the impact of scheduled follow-up appointments with an endocrinologist on the glycemic status of diabetic patients discharged from the hospital.

Methods: We retrospectively included adult patients with DM who were admitted to UPMC McKeesport Hospital for any reason from March 2018 to September 2022. The patients were divided into group A, who were provided with scheduled follow-up appointments, and group B, the patients who were given contact information to schedule their own appointments.

Results: Forty patients, median age of 60 years (IQR: 50.2-66.0), male 25 (62%) were included. In group A, the median A1C levels at admission and 90-day post-discharge were 10.9% (IQR: 7.9-13.9) and 7.6% (IQR: 5.4-9.4), respectively. In group B, the corresponding characteristics were 10.6% (IQR: 8.2-12.1) and 7.5% (IQR: 5.8-9.4). There was no relation between post-discharge scheduled appointments and readmission rate in 90 days (P > 0.05). There was a significant relation between readmission rate and A1C level in 90 days (P < 0.05). Among those attending follow-up visits with an endocrinologist, 56% experienced an improvement in A1C levels of at least 0.5% in 90 days.

Conclusion: Follow-up appointment with endocrine clinic has the potential to lead to improved clinical outcomes as evidenced by reduction in A1C level.

Disclosure

S. Tehranian: None. S. Mon: None.
1155-P: Association of NT-proBNP and CA125 with Cardiometabolic Markers in Indigenous Argentinean Children Living in the Andes Foothills
Authors: HIRSCHLER VALERIA , CASTANO LUIS , FLORES LUIS E.
Published: June 2024

Background: We have shown that children living in the Andes exhibit dyslipidemia and reduced cardiac size, suggesting that these children may develop adaptive mechanisms associated with changes in biomarkers such as NT-proBNP and CA125.

Objective: To determine the associations between NT-proBNP and CA 125 and variables such as age, sex, BMI, BP, hemoglobin, leucocytes, and lipids in indigenous Argentinean children living at high altitudes.

Methods: Cross-sectional data were gathered from 73 children attending two schools in the villages of Cobres and Cerro Negro, at 4,500 m above sea level in La Poma, Salta (Argentina). Age, sex, BP, BMI, triglycerides (TG), HDL-C, complete blood count, CA 125, and NT-proBNP were obtained. Univariate and multivariate analyses were performed to assess the associations between LnNT-proBNP and LnCA 125 and metabolic markers.

Results: Seventy-three children (38 M) aged 8.5±3.1 y were included; 11 (15.1%) were overweight, and 5 (6.8%) were obese (per CDC). Mean values were as follows: BMI 17.8±3.0 kg/m2, z-BMI 0.4±0.8, systolic BP 81 ±11 mmHg, diastolic BP 56±8 mmHg, hemoglobin 13±1g/dL, leucocytes 6672±1387, HDL-C 39 ±6 mg/dL, TG 122±45 mg/dL, NT-proBNP 66.7±52.8 pg/ml, and CA125 18.4±6.9 U/ml. Mean levels of HDL-C and TG suggested dyslipidemia. Multiple linear regression analyses showed that LnCA125 was inversely associated with age and directly with leukocytes (R20.23), whereas LnNT-proBNP was inversely associated with age, heart rate, and HDL-C and directly with diastolic BP (R20.30); adjusted for confounding variables.

Conclusion: This study showed NT-proBNP and CA125 were associated with cardiometabolic and inflammatory markers in indigenous children living at high altitudes. Further longitudinal studies should be performed to confirm these findings.

Disclosure

V. Hirschler: None. L. Castano: None. L.E. Flores: None.
1180-P: Blood Pressure and Hormonal Factors in Adolescent with Type 1 Diabetes
Authors: MOHAMMAD EMAAD , LENHERR-TAUBE NINA , MAHMUD FARID H. , MOINEDDIN RAHIM , SOCHETT ETIENNE B.
Published: June 2024

Introduction & Objective: Hypertension is common in type 1 diabetes (T1D). Renin-angiotensin aldosterone system (RAAS) and calcium-phosphate metabolism modulate blood pressure (BP). This study aimed to investigate the association of these factors with BP in adolescents with T1D.

Methods: Samples from 106 T1D (duration 7 years) and 106 healthy controls (HC) (similar age (10-17 years) and sex distribution) were analyzed for 25(OH)D, calcium, phosphate, PTH, FGF-23, klotho, plasma renin activity (PRA), aldosterone and urinary RAAS. Mean of two office blood pressure measurements, unpaired T-test, Chi-square, and linear regression (MLR) were used.

Results: Significant differences between TID and HC, were respectively: sBP (114.71 v 111.41), dBP (66.72 v 63.59), and BMI (22.16 v 20.91 kg/m2). PRA level was lower (0.21 v 1.8) and plasma aldosterone higher (444 v 65); higher urinary angiotensinogen (5.08 v 2.12) and urinary ACE2 activity (271.76 v 69.22) and lower urinary ACE activity (1.17 v 123.30); higher klotho (31.10 v 27.52) and PTH (36.42 v 24.11), lower 25(OH)D (56.94 v 88.42) and calcium (2.43 v 2.51). In T1D, unadjusted MLR; sBP was associated with BMI (p <0.005) and plasma phosphate (p <0.005); dBP with BMI (p <0.005), PTH (p = 0.026) and phosphate (p <0.005). Adjusted MLR; sBP was associated with BMI (< 0.005) and dBP with FGF 23 (0.047) and BMI (0.010).

Conclusion: Adolescents with T1D had higher BP and significant differences in RAAS, calcium and vitamin D hormones than HC, suggesting hormonal factors may modulate BP regulation pre-hypertension.

Disclosure

E. Mohammad: None. N. Lenherr-Taube: None. F.H. Mahmud: Research Support; Dexcom, Inc. R. Moineddin: None. E.B. Sochett: None.
1183-P: Integrating Schools into Diabetes Device Interventions for Underserved Youth with Type 1 Diabetes (T1D)
Authors: CHEN CHARLOTTE , DURANTE ALEXA J. , MAYNARD MARGARET G. , LAFFEL LORI M. , AGARWAL SHIVANI
Published: June 2024

Interventions that increase diabetes tech use reduce inequity in outcomes for underserved youth with T1D, but are usually clinic and not-school based, despite youth spending most of their time in school. We employed user-centered design methodology to incorporate perspectives of school-based health providers (SBHP) into future diabetes tech interventions that extend to school, that may increase efficacy, acceptability, and sustainability. We conducted 17 virtual workshops to discuss barriers and facilitators of youth device use and co-create multidisciplinary solutions to increase use. Workshops included 14 youth ages 13-17 yo; 23 parents; and 6 school-based and 11 clinic-based healthcare providers from Children’s Hospital at Montefiore and Montefiore School Health Program. Here, we report data from SBHP and clinic providers. Workshop recordings were thematically analyzed by 3 independent coders, using an inductive coding approach. Both SBHP and clinic-based providers endorsed benefits of devices, citing the need for its prioritization for medical and educational well-being, and an interest to support more device use. School-based barriers included limited communication with clinic-based providers and expertise in managing devices. Clinic-based barriers included navigating insurance coverage and having limited time to adequately introduce families to devices. Common barriers among providers included lack of time to address and help families with device or supply issues. Overall themes for co-created solutions by SBHP and clinic-based providers included the need for extra staff to help families navigate the healthcare system, specialized device troubleshooting support, and streamlined communication between clinic and school. Adding SBHP perspectives to inform the development of a device intervention for youth with T1D has defined new targets. These include enhanced communication between clinic and school and bolstering education of SBHP on devices.

Disclosure

C. Chen: None. A.J. Durante: None. M.G. Maynard: None. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation. S. Agarwal: Research Support; Dexcom, Inc. Advisory Panel; Medtronic. Consultant; Beta Bionics, Inc.

Funding

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Physician-Scientist Career Development Award (K12DK133995)
1184-P: Presence of Depressive Symptoms as a Predictor of Engagement with Diabetes Self-Management Habits in Adolescents and Young Adults with Type 1 Diabetes
Authors: KARWAL NISHA , TALLON ERIN M. , WILLIAMS DAVID D. , VANDERVELDEN CRAIG , LOCKEE BRENT , DEWIT EMILY L. , PATTON SUSANA R. , CLEMENTS MARK A.
Published: June 2024

Introduction: In type 1 diabetes (T1D), depressive symptoms (DS) can negatively impact engagement with diabetes self-management behaviors.

Objective: In adolescents and young adults (AYA) with T1D, we examined whether DS independently predicted engagement with six key diabetes self-management habits, assessed as a total habit score (THS). THS has been shown to have an inverse relationship with HbA1c.

Methods: We retrospectively analyzed electronic health record and depression screening data from 1,834 AYA (12-22 years old; T1D duration ≥1yr) receiving care from a diabetes clinic network in the Midwest USA (January 2020 - November 2023). We used mixed-effects Poisson regression to adjust for multiple encounters per AYA and examined predictors of THS (range: 0-6). The six habits comprising the THS included: (1) using a continuous glucose monitor or checking glucose ≥4 times/day; (2) giving ≥3 boluses/day; (3) using an insulin pump; (4) bolusing before meals; (5) reviewing glucose data between visits; and (6) adjusting insulin doses between visits. We defined a positive screen for DS as a Patient Health Questionnaire-2 (PHQ-2) score ≥3 (i.e., experiencing DS most days).

Results: AYA (52.5% male; 78.7% White; mean [SD] age, 15.7 [2.1] years; 60.4% private insurance) screened positive for DS at 7.6% (632/8,309) of encounters. We observed negative associations between THS and older age (incidence risk ratio, 0.98; 95% CI, 0.97-0.99), Black race (0.78; 0.72-0.84; vs. White), other minority race (0.85; 0.80-0.91; vs. White), and not having private insurance (0.88; 0.85-0.90). THS did not differ in individuals who did, versus did not, screen positive for DS (0.97, 0.93-1.02).

Conclusion: Age, race, and insurance status - but not DS - were independent predictors of THS. Future studies should evaluate whether more sensitive and specific measures of DS predict THS and whether DS impact engagement with individual self-management behaviors.

Disclosure

N. Karwal: None. E.M. Tallon: None. D.D. Williams: None. C. Vandervelden: None. B. Lockee: None. E.L. DeWit: None. S.R. Patton: None. M.A. Clements: Research Support; Abbott. Consultant; Glooko, Inc. Research Support; Dexcom, Inc.
1215-P: Maternal Glycemia Associations with Cord Blood DNA Methylation in the Hyperglycemia and Adverse Pregnancy Outcome Study
Authors: BIANCO MONICA E. , LOWE WILLIAM L. , JOSEFSON JAMI L. , SCHOLTENS DENISE , HIVERT MARIE-FRANCE , GURRA MIRANDA
Published: June 2024

Maternal hyperglycemia during pregnancy is associated with impaired offspring glycemia later in life. Differential methylation of offspring DNA could be an underlying mechanism for this association. Using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study, a large, international, mother-child cohort, we conducted an epigenome-wide association study to identify associations between maternal glucose sum of z-scores from a fasting 2-hr oral glucose tolerance test (OGTT) during pregnancy (mean 27.6 wks gestation) and offspring cord blood DNA methylation (cb DNAm). We analyzed cb DNAm with Illumina EPIC arrays (791,359 CpG sites after QC) on 3,041 HAPO samples. Using linear regression models adjusted for maternal covariates and field center, we identified 16 CpG sites after accounting for multiple testing (Bonferroni-adjusted p<0.05). The significant associations included two CpG sites near TXNIP, a gene that encodes the thioredoxin-interacting protein, which is involved in glucose-sensing. Our analyses identified new loci in addition to external validation of previous findings identifying TXNIP as a differentially methylated locus in relation to in utero exposure to hyperglycemia. These findings support DNA methylation as a potential mechanism underlying the association between maternal hyperglycemia and programming of offspring metabolic health.

Disclosure

M.E. Bianco: None. W.L. Lowe: None. J.L. Josefson: None. D. Scholtens: None. M. Hivert: None. M. Gurra: None.

Funding

National Institutes of Health (R01DK118403)
1224-P: Diabetes in Teenage Pregnancy—Prevalence and Outcomes within a Population-Based Cohort
Authors: CHRISTIE HANNAH E. , MOHAN SNEHA , PLAZA ENRIQUEZ LEIDY , VELLA ADRIAN , CREO ANA , EGAN AOIFE M.
Published: June 2024

Diabetes and low maternal age are independently associated with an increased risk of adverse pregnancy outcomes. However, population data on prevalence and outcomes of diabetes in teenage pregnancy are limited. We used the Rochester Epidemiology Project to identify Olmsted County residents with a confirmed pregnancy <20 years of age from 2013-22. We identified 696 women (19.3% Hispanic), with 790 pregnancies. The average age at pregnancy was 17.9 ± 1.3 years and BMI was 26.6 ± 6.3 kg/m2. In total, 37 pregnancies (4.7%) were affected by diabetes: 5 with type 1 (0.6%; population prevalence: 0.4%), 3 with type 2 (0.4%), 20 with GDM (2.5%; population prevalence: 18%), and 9 with impaired glucose tolerance (1.1%). Prepregnancy contraception was prescribed in 37.5% with prepregnancy diabetes versus 19.8% of those without (p=0.21), noting a prepregnancy HbA1c of 9.4 ± 3.0% in the subgroups with type 1 or 2 diabetes. Hypertensive disorders were higher in maternal diabetes (15.1 v 39.4%, nil diabetes v diabetes respectively, p<0.001). Live births occurred in 623 (82.7%) pregnancies compared to 32 (86.0%) in those with diabetes (p=0.55). Congenital anomaly rates were not higher in infants of women with diabetes (16.1 v 11.8%, p=0.52), but large for gestational age birthweights (6.2 v 15.6%, p= 0.03) and neonatal hypoglycemia were significantly higher (12.0 v 38.7%, p<0.001). Of those with GDM, 25% attended postpartum glucose testing. While the prevalence of diabetes in teenage pregnancy is relatively low, these data reveal that those affected are at significantly higher risk of adverse pregnancy outcomes and will benefit from targeted, multidisciplinary preconception and obstetric care.

Disclosure

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

Funding

National Institutes of Health (DK134767)
1232-P: Real-World Association of Race/Ethnicity with Adverse Maternal and Fetal Outcomes in Women with Diabetes
Authors: FARROKHI FARNOOSH , GUO YIAN , SCOTT ALEXANDRA , LANE RASHON , KERR DAVID
Published: June 2024

Introduction: Diabetes in pregnancy is associated with greater risk of maternal-fetal complications. However, studies exploring the impact of race and ethnicity on pregnancy outcomes using real-world data are limited. The aim of this study was to compare differences in pregnancy outcomes by diabetes status and race/ethnicity.

Methods: ICD-10 codes were used to assess maternal and fetal outcomes between 1/1/2021 and 8/31/2023 among people who gave birth at Sutter Health - a large, integrated health system in Northern California, stratified by diabetes diagnosis and race/ethnicity.

Results: A total of 67,789 deliveries included 11,916 complicated by diabetes (2.4% with type 1, 11% with type 2, 86% with gestational diabetes). A diabetes diagnosis was associated with significantly worse outcomes including prematurity, pre-eclampsia, c-section, NICU admission, neonatal respiratory distress, macrosomia, neonatal hypoglycemia, (all p< 0.001), small for gestational age (p=0.004), and shoulder dystocia (p=0.001). Black and American Indian/Alaskan Native women had worse outcomes compared with other race/ethnicity groups:

Table. Association of race/ethnicity with adverse maternal/fetal outcome in women with diabetes.

Conclusion: Using real-world data, the increased risk of serious maternal/fetal outcomes associated with diabetes, vary disproportionately by race/ethnicity.

Disclosure

F. Farrokhi: None. Y. Guo: None. A. Scott: None. R. Lane: None. D. Kerr: Advisory Panel; Abbott Diagnostics. Consultant; Sanofi, Better Therapeutics, Inc. Stock/Shareholder; Glooko, Inc.
1241-P: Pharmacologic Treatment of GDM and Perinatal Outcomes
Authors: HEDDERSON MONIQUE M. , XU FEI
Published: June 2024

Medical nutritional therapy is the recommended initial treatment for GDM, but 30-50% of patients with GDM require the addition of pharmacologic therapy. Insulin is the only pharmacologic treatment recommended by the American Diabetes Association. However, oral agents have several advantages over insulin including cheaper cost, greater ease of use, and adherence among patients. ACOG recognizes that clinical situations may necessitate the use of oral agents and suggests metformin (and possibly glyburide) as a reasonable alternative. We examined the association between GDM pharmacologic treatment and perinatal outcomes in a large and racially diverse cohort of GDM pregnancies livebirths between 2008 and 2021 (n = 19,903) in Kaiser Permanente Northern California. GDM was defined based on laboratory glucose values and/or clinician diagnosis. We used modified poisson regression to estimate risk ratios. Overall, 75% were prescribed glyburide, 8% Metformin, and 17% insulin only. Compared to GDM pregnancies initiated on Insulin, pregnancies initiated on Glyburide had a 17% reduced risk of Preterm birth [risk ratio[RR]: 0.83 (0.75 - 0.92) and a 12% reduced risk of having a small for gestational age infant [RR: 0.88 (0.77 - 0.99)] and no association with having a large for gestational age infant [0.97 (0.90 - 1.04)] adjusting for age, pre-pregnancy BMI, race/ethnicity, and parity. Compared to GDM pregnancy initiated on Insulin, pregnancies initiated on Metformin were associated with an 18% reduced risk of preterm birth [risk ratio: 0.82 (RR: 0.69 - 0.98)], a 28% reduction in large for gestational age [adjusted relative risk: 0.72 (RR: 0.63 - 0.82)], and no association with small for gestational age infant [0.97 (RR: 0.80 - 1.18)] in adjusted models. These findings suggest that oral agents may be associated with a lower risk of perinatal complications. Future work needs to address possible confounding due to disease severity.

Disclosure

M.M. Hedderson: None. F. Xu: None.

Funding

R01DK138135
1242-P: Effect of Intensity and Duration of Lactation on Postpartum Adiponectin after Gestational Diabetes
Authors: RAMOS-ROMAN MARIA , LO JOAN C. , SUN BAIYANG , WHEELER MICHAEL B. , GUNDERSON ERICA P.
Published: June 2024

Higher circulating adiponectin is associated with insulin sensitivity. Prior studies from pregnancy to 12 mo postpartum suggest that adiponectin is suppressed from mid pregnancy until 6-12 mo postpartum in women practicing exclusive lactation, regardless of glucose tolerance during pregnancy. A decrease in adiponectin during pregnancy and lactation is consistent with physiologic insulin resistance. Therefore, our objective was to determine the relationship between intensity and duration of lactation and the suppression of circulating adiponectin in women after GDM delivery. In this prospective study, we evaluated longitudinal blood samples collected during 2-h 75 g OGTTs at 6 wk (V1 baseline), 1 yr (V2) and 2 yr (V3) postpartum in women with recent GDM and without diabetes (DM) at V1 in the SWIFT study. The outcome variables were change in adiponectin from V1-V2 and V2-V3 stratified by incident DM (Y/N); 4 exposure categories for breastfeeding duration (BF current, BF recent, BF past, BF minimal); covariables: age, BMI, log HOMA-IR, and log HOMA-B at V1 in multivariable regression models. Compared with 6 wk postpartum, at 1 yr postpartum (1) adiponectin was lower in the 4 exposure categories, (2) the magnitude of the decrease in adiponectin was greatest in the BF past versus BF current within incident DM at follow up, (3) the magnitude of the decrease in adiponectin was greatest in the BF recent versus BF current in the group without DM at follow up. From 1 yr to 2 yr postpartum, BF past was the only group with incident DM with an increase in adiponectin.

In conclusion, lactation followed by weaning triggers an accelerated decrease in adiponectin that depends on current DM status. In addition, the 2-year visit captured the greater increases in adiponectin among women who lactated and stopped lactation within months from the assessment. We suggest that low adiponectin during lactation communicates to insulin-dependent tissues that a shift in the priority of glucose utilization has occurred.

Disclosure

M. Ramos-Roman: None. J.C. Lo: None. B. Sun: None. M.B. Wheeler: None. E.P. Gunderson: None.

Funding

R01 DK118409, Gunderson PI; R01 HD050625, Gunderson PI; UT Southwestern pilot and feasibility grant in biomedical research, Department of Internal Medicine, Ramos-Roman PI
1244-P: Prospective Cohort Study on the Impact of Restricted Gestational Weight Gain on Fetal Growth in Women with Gestational Diabetes Mellitus Undergoing Dietary Treatment
Authors: CHANDRA ABHISHEK , JHA RAJESH K. , AHMAD KHAWAJA A. , PRAKASH AKHOURI S.
Published: June 2024

Introduction: Managing weight gain during pregnancy is crucial, particularly for women with Gestational Diabetes Mellitus (GDM), as it significantly impacts fetal growth and development. This study investigates how restricted gestational weight gain influences fetal growth in women with GDM undergoing dietary treatment.

Methods: This prospective cohort study enrolled 200 GDM patients and divided them into two groups depending on their adherence to a gestational weight gain-restricting diet. Category A rigorously followed the food restrictions, whereas Category B relaxed. Fetal growth markers such abdomen circumference, femur length, and predicted weight were examined monthly by ultrasound. During pregnancy, maternal weight gain was recorded.

Results: Restricted gestational weight gain in Category A was associated with more optimal fetal growth parameters compared to Category B. Specifically, Category A had a significantly lower incidence of macrosomia (10% in Category A vs. 25% in Category B, p<0.05) and a reduced rate of large-for-gestational-age infants (12% in Category A vs. 30% in Category B, p<0.01). The incidence of small-for-gestational-age newborns did not significantly differ between the two groups.

Conclusion: A diet helps women with GDM avoid macrosomia and large-for-prenatal-age newborns by restricting gestational weight gain. These findings emphasize the necessity of nutritional management in managing weight increase during pregnancy for GDM women to preserve fetal health. Further research is required to optimize dietary guidelines and examine long-term maternal and child health impacts.

Disclosure

A. Chandra: None. R.K. Jha: None. K.A. Ahmad: None. A.S. Prakash: None.
1251-P: CGM-Derived Metrics and Neonatal Outcomes in Pregnant Women with Insulin-Treated Diabetes—Time for Refinement?
Authors: CITRO FABRIZIA , BIANCHI CRISTINA , ARAGONA MICHELE , MARCHETTI PIERO , BERTOLOTTO ALESSANDRA
Published: June 2024

Introduction: Pregnancy-specific thresholds for TIR, TAR and TBR have been validated. However, recommendations on other CGM-derived metrics (GMI, CV, mean glucose) are lacking. We aimed to better assess the association between CGM metrics and neonatal outcomes (NeO).

Methods: In 37 pregnant women with insulin-treated diabetes (21 T1D, 11 T2D, 5 GDM), clinical, metabolic and CGM data at each trimester were prospectively evaluated (June 2018 - September 2023). Mann-Whitney test was used to compare CGM metrics in women with and without adverse NeO. Logistic regression and ROC-curve were used to identify predictive variables.

Results: Adverse NeO were reported in 75% women (90% T1D vs 40% GDM, p=0.038). At 3rd trimester, women with adverse NeO had higher mean glucose, TAR, GMI, CV and lower TIR, with no difference in HbA1c (Table 1). At logistic regression, TAR was the strongest risk factor (OR: 1.142 [1.012-1.289], p=0.032), regardless of diabetes type and HbA1c. The ROC-curve identified an increased risk of adverse NeO for TAR ≥18% (AUC: 0.845 [0.707-0.982], p=0.03, sens 71%, spec 89%).

Conclusion: At 3rd trimester, women with adverse NeO showed higher mean glucose, TAR, GMI, CV and lower TIR, suggesting that all CGM metrics should be evaluated in pregnancy, pending proper identification and validation of pregnancy-specific thresholds. To minimize the risk of adverse NeO, TAR<18% should be targeted.

Disclosure

F. Citro: None. C. Bianchi: Consultant; Novo Nordisk, Merck Sharp & Dohme Corp., Lilly Diabetes. M. Aragona: None. P. Marchetti: Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. A. Bertolotto: None.

Funding

EC and MUR under PNRR – M4C2-I1.3. Project PE_00000019 “HEAL ITALIA”
1287-P: Unmasking the Risk Factors for Undiagnosed Diabetes among Adult Ghanaians Using Generalised Structural Equation Modeling—Insight from CarMeR Study
Authors: HORMENU THOMAS
Published: June 2024

Undiagnosed diabetes mellitus poses a global health challenge, contributing to morbidity and mortality worldwide. In Ghana, the burden of diabetes is escalating, posing substantial challenges to the healthcare system, especially during COVID-19. A considerable number of cases remain undiagnosed, resulting in delayed interventions and heightened complications. Understanding the etiology of diabetes in indigenous communities is critical for implementing early interventions for diabetes prevention and remission. Our goal was to unmask risk factors of undiagnosed diabetes among adults in Ghana. We screened 1200 ostensibly healthy adults aged 25-70 years, predominantly female (63%) across 13 indigenous communities with unique characteristics. Fasting plasma glucose (FPG) assessed glucose tolerance using ADA criteria for FPG. The results revealed overall diabetes prevalence of 3.8% (n=46) [5.2% in females, 1.2% in males; 6.4% in rural, 2.1% in peri-urban, 4.6% in urban], and prediabetes at 14.4% (n=173) [15.3% in females, 12.6% in males; 22.0% in rural, 13.3% in peri-urban, 7.6% in urban]. Body Mass Index (BMI), Triglycerides (TG), Systolic Blood Pressure (SBP), gamma GT, gender and family history directly contributed significantly to diabetes risk. Age, education and Total Cholesterol (TC) indirectly influenced diabetes development through TG. High-Density Lipoprotein (HDL), TC, childhood overweight, physical activity, gender, and occupation indirectly influenced BMI. Alcohol intake, childhood overweight, family history of diabetes, gender, and socioeconomic status influenced waist circumference (WC). WC, TG, age, physical activity, and residency indirectly influenced SBP. Alcohol intake, gender and religion indirectly influenced diabetes prevalence through gamma GT. Controlling these factors may improve diabetes prognosis within indigenous communities.

Disclosure

T. Hormenu: None.

Funding

Africa Academy of Sciences (APT-18-03)
1289-P: Longitudinal Cohort Study—Type 2 Diabetes Prevention and Genetic CAD Risk Interaction on Cardiovascular Factors
Authors: SHANKAR ANAND , GUHA SHAIBAL , DAS AMIT K. , KUMAR SUBHASH , SINHA AJAY K.
Published: June 2024

Introduction: Understanding the interaction between lifestyle interventions for Type 2 Diabetes (T2D) prevention and genetic predispositions to Coronary Artery Disease (CAD) is crucial in developing personalized strategies for reducing cardiovascular risk. This study aims to investigate how T2D prevention strategies interact with genetic determinants of CAD to influence cardiovascular risk factors over time.

Methods: A cohort of 200 high-risk individuals for T2D and CAD were followed over three years. They were categorized by genetic risk for CAD and underwent T2D prevention strategies (diet, exercise, medication). Cardiovascular risk factors were measured biannually. The study used mixed-effects models to analyze the influence of T2D prevention strategies on these factors, considering genetic CAD risk.

Results: Individuals with higher genetic CAD risk had smaller improvements in lipid profiles (mean LDL reduction of 10 vs. 20 mg/dL, p<0.01) and blood pressure (5 vs. 12 mmHg reduction, p<0.05) under the same T2D prevention strategies as those with lower risk. Notably, LDL changes showed a significant interaction with genetic risk (p<0.05), indicating that genetic predisposition might moderate T2D prevention's effectiveness in reducing cardiovascular risk.

Conclusion: The study reveals a complex relationship between T2D prevention, CAD genetics, and cardiovascular risks, advocating for intensified, personalized T2D strategies for those with high genetic CAD risk. It emphasizes precision medicine's role in T2D and CAD management, urging further research for tailored solutions.

Disclosure

A. Shankar: None. S. Guha: None. A.K. Das: None. S. Kumar: None. A.K. Sinha: None.
1318-P: Postprandial C-Peptide (pCP) in Provider-Diagnosed Pediatric Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D)
Authors: REDONDO MARIA J. , HARRALL KYLIE K. , BIRD SARAH M. , TOSUR MUSTAFA , UYSAL SERIFE , SILLER ALEJANDRO F. , VELASQUEZ HORACIO J. , MUIR ANDREW , VEHIK KENDRA , BRUSKO TODD M. , ATKINSON MARK A. , DABELEA DANA , HAGOPIAN WILLIAM , ORAM RICHARD A.
Published: June 2024

Introduction & Objective: Classification of diabetes (DM) type (T1D vs T2D) is often challenging in adolescence, especially among non-White ethnic groups. We hypothesized that pCP differentiates between provider-diagnosed T1D and T2D in ethnically diverse youth with DM. Methods: We studied 410 youth in the Diabetes Study in Children of Diverse Ethnicity and Race (DISCOVER) Study. Low C-peptide, pre-defined as pCP < 1.8 ng/ml (0.6 nmol/L) was compared between youth diagnosed with T1D and T2D using Fisher’s exact tests. Differences in the distribution of log pCP were assessed visually with histograms.

Results: There were 356 youth diagnosed with T1D (age 8.4 ± 3.1 yrs; 55% female; 36% Hispanic, 19% non-Hispanic Black) and 54 (13%) with T2D (age 11.7 ±1.7 yrs; 71% female; 70% Hispanic, 21.4% non-Hispanic Black). Low pCP was observed in 97.8% of T1D vs 27.1% of T2D youth (p<0.0001); 99.6% (T1D) vs 24.0% (T2D) (p<0.0001) in those with DM duration >4 yrs; 97.2% (T1D) vs 22.2% (T2D) (p<0.0001) in those with simultaneous glucose >115 mg/dl (6.4 mmol/L); and 99.5% (T1D) vs 11.1% (T2D) (<0.0001) in those with DM for >4 yrs and glucose >115 mg/dl (Figure).

Conclusion: In ethnically diverse youth, pCP <1.8 ng/ml can reliably identify those with provider-diagnosed T1D. Performance further improves in youth with DM duration >4 yrs and a simultaneous glucose >115 mg/dl. A sizeable subset of youth with T2D have lower pCP.

Disclosure

M.J. Redondo: None. K.K. Harrall: None. S.M. Bird: None. M. Tosur: None. S. Uysal: None. A.F. Siller: None. H.J. Velasquez: None. A. Muir: None. K. Vehik: None. T.M. Brusko: None. M.A. Atkinson: None. D. Dabelea: None. W. Hagopian: Research Support; Janssen Pharmaceuticals, Inc., Provention Bio, Inc. Consultant; Sanofi-Aventis U.S., Randox R & D. R.A. Oram: Research Support; Randox R & D. Consultant; Provention Bio, Inc., Sanofi.

Funding

National Institutes of Health (NIDDK R01DK124395)
1328-P: Exploring DNA Methylation-Based EpiMetabolic Index via Direct-to-Consumer Testing for Type 2 Diabetes Risk Assessment
Authors: ARCH ROULA , HU NICOLAS , LIU ZHENFENG , YANG XIAOJING
Published: June 2024

Introduction: Investigating new biomarkers for type 2 diabetes (T2D) risk screening, especially for non-typical high-risk groups, is essential for prevention. Direct-to-consumer (DTC) tests bypass traditional lab visits for convenience and encourage screening. This study evaluates the association between a DNA methylation-based EpiMetabolic index (eMI) DTC testing and T2D.

Methods: The EpiMetabolic indexz (eMI) was estimated through linear regression of DNA methylation at 15 regions associated with diabetes and metabolic traits (e.g., ABCG1, CPT1A, PHGDH, SREBF1). Blood samples, mainly collected at home, were sent to the CLIA facility (Pangea laboratory) for targeted next-gen sequencing. Customer medical data was self-reported online. Only adults with specific metabolic statuses and valid epi-metabolic indices were included. Independent variables: birth-assigned sex, diabetes, and medication (e.g., statins). The dependent variable was the epi-metabolic index. We studied each factor's individual effects using one-way ANOVA and combined them with sex for interaction effects using two-way ANOVA.

Results: Significant associations were found between an accelerated eMI and prediabetes/diabetes (p=0.001). Some lifestyle associations (e.g., exercise) lacked statistical significance, potentially due to self-report biases. Notably, a significant association existed between statin usage and an elevated eMI.

Conclusions: This study on the DTC cohort identifies an association between eMI and diabetes/prediabetes status, emphasizing the potential use of DNA methylation-based DTC as a practical tool for monitoring individuals at diabetes risk. This approach can benefit those lacking consistent access to care due to financial, social, cultural, or geographical barriers.

Disclosure

R. Arch: None. N. Hu: Employee; Zymo Research. Z. Liu: None. X. Yang: None.