bluuebunny/crossref_metadata_2025 huggingface dataset:
1131-P: Gut Microbial Differences in Youth with Obesity and Type 1 Diabetes (T1D)
Authors: ISMAIL HEBA M. , PERERA DIMUTHU , MANDAL RABINDRA K. , JAVORNIK CREGEEN SARA , DIMEGLIO LINDA , HANNON TAMARA S. , EVANS-MOLINA CARMELLA , SCHMIDT NATHAN
Published: June 2023

Gut microbial differences are associated with and thought to contribute separately to obesity and to type 1 diabetes development. Obesity is increasingly prevalent in type 1 diabetes, creating management problems and higher rate of diabetes complications. To test how obesity may influence the gut microbiome, we analyzed stool samples for gut microbial and metabolite differences in lean (n=27, BMI: 5-85%) and obese (n=21, BMI: ≥95%) youth with type 1 diabetes. Participants were aged 15.3±2.2 y (42% female, 94% White), with A1c 7.8±1.3% and diabetes duration 5.1±4.4 y. Bacterial community analysis using metagenomic shotgun sequencing showed that within each BMI group, there were no differences in within sample species (α) diversity. There were significant dissimilarities in species (β) diversity between BMI groups (Fig 1A). Linear Discriminant Analysis Effect Size (LEfSe) showed a differential distribution of significantly abundant taxa in either the lean or obese groups (Fig. 1B). Functional profiling showed specific pathways are differentially enriched in the groups (Fig. 1C-D). Interestingly, stool short chain fatty acids (beneficial microbial metabolites) were higher in the obese compared to the lean group (p<0.05). This is a paradoxical finding that warrants further investigation.

In summary, our findings show links between the microbiome and metabolite composition, and obesity in type 1 diabetes and could lead to therapeutic targets in the gut.

Disclosure

H.M. Ismail: Consultant; Rise Therapeutics. D. Perera: None. R.K. Mandal: None. S. Javornik Cregeen: None. L. DiMeglio: Consultant; Abata Therapeutics, Vertex Pharmaceuticals Incorporated. Advisory Panel; Merck & Co., Inc. T.S. Hannon: Advisory Panel; Eli Lilly and Company. C. Evans-Molina: Advisory Panel; Provention Bio, Inc., DiogenX, Avotres Inc., Neurodon, MaiCell Therapeutics. Other Relationship; Isla Technology, Bristol-Myers Squibb Company, Nimbus Therapeutics. Research Support; Lilly, Astellas Pharma Inc. N. Schmidt: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK129799-01A1)
1135-P: Screening for Disordered Eating Behaviors in Youth with Type 1 Diabetes—Feasible and Necessary
Authors: SASTRY SHRUTI , COREN MORGAN , SCHREIBER JUSTIN , LIBMAN INGRID
Published: June 2023

The American Diabetes Association (ADA) recommends screening adolescents with type 1 diabetes (T1D) for disordered eating behaviors (DEB) using the Diabetes Eating Problem Survey-Revised (DEPS-R) tool, however this is not routinely done in clinical practice. We implemented screening for DEB in a large academic pediatric diabetes center as part of clinical care as well as to evaluate the prevalence of DEB and identify clinical factors (in particular, use of pumps and continuous glucose monitors (CGM)) associated with a positive screen. Youth with T1D between 13-19 years, seen in our pediatric diabetes clinic from 02/09/2022 - 06/07/2022, were given the survey. A total of 580 subjects were eligible for the screening, 368 (64%) completed it and 282 (~50%) had analyzable data (49% female, 83% white, 11% black, 3% reporting food insecurity (FI), mean (SD) age 16.4±1.9 years, HbA1c 8.2±1.9%, BMI percentile 71.2±26.9). The majority were on CGM (77%) and 45% on pump therapy (including 5% on hybrid close loop systems). A total of 43 (15%) had a positive screen (score≥ 20) for DEB. There was a higher proportion of females, (67 vs 45%, p=0.007) lower proportion of white (70 vs 85%) and higher proportion of black youth (20 vs 8%) (p=0.02) in those that screened positive vs negative. Those with a positive screen also had a higher HbA1c (9.9±2.1 vs 8±1.7, p<0.001) and BMI percentile (83.1±21.1 vs 68.9±27.3, p<0.001). There was no difference in age (16.5±1.9 vs 16.4±1.9 years, p=0.82), report of FI (4.6 vs 2.1%, p=0.76), use of CGM (72 vs 78%, p=0.35), or pump therapy (35 vs 44%, p-0.26) between the two groups. None of those on hybrid close loop had a positive screen, however the numbers were small (n=7). Almost 1 in 5 adolescents with T1D had a positive screen for DEB. There was no difference in the use of diabetes technology. Our findings stress the importance of screening for DEB in youth with T1D and implementation of strategies to improve response rate in order to make timely referrals to reduce associated morbidity.

Disclosure

S.Sastry: None. M.Coren: None. J.Schreiber: None. I.Libman: Advisory Panel; Novo Nordisk.
1139-P: Use of Degludec to Reduce DKA Recurrence—A QI Initiative
Authors: VAKHARIA MILI , HUANG XIAOFAN C. , MINARD CHARLES G. , LYONS SARAH , MCKAY SIRIPOOM
Published: June 2023

Background: As part of a larger QI initiative to decrease rate of recurrent DKA events, a large pediatric diabetes center initiated a QI project to switch 80% of youth with established T1D on treatment with glargine admitted with DKA to longer acting degludec (iDeg) during 2017 to 2020.

Methods: A series of PDSA cycles were implemented: training physicians, nurses, diabetes educators and patients/families; adding iDeg to electronic order set; and developing an insurance approval process. DKA event rate pre-iDeg and post-iDeg with predictors including race/ethnicity (R/E), HbA1c, gender and insurance type were explored.

Results: iDeg prescriptions increased from 5.6% in 2017 to 63% by the end of 2020. Of the 255 patients admitted with DKA in 2017 - 2020, 97 patients not previously on iDeg were prescribed iDeg within 21 days of hospitalization. The mean age of the iDeg group was 14.2 years (SD=3.4), 62.9% on public insurance, 40% African American (AA), 30% Hispanic (H) and 29% non-Hispanic White (NHW). The median (IQR) DKA event rates were 0.5 (0.3, 1) pre-iDeg and 0.4 (0, 1) events per year post-iDeg. The median change from pre-iDeg to post-iDeg was -0.2 (-0.5, 0.4) (Wilcoxon sign-rank p=0.25). Racial/ethnic (p=0.02) and insurance (p=0.01) were associated with change in DKA event rates in a multiple regression model. Hispanic patients taking iDeg had a decrease in DKA of -1.29 events per year compared with increases of -0.29 for AA and -0.52 for NHW (adj P=0.032 and 0.026, respectively). Patients with private insurance had a mean decrease in DKA event rates of -0.63 events per year compared to those on public insurance (mean increase of 0.66, p=0.01).

Conclusion: iDeg was not associated with a decrease in DKA rate in the full population. Risk factors for DKA recurrences are multi-factorial including R/E and insurance types. The association of iDeg and decreased rate of repeat DKA in H patients' needs to be explored in a larger cohort.

Disclosure

M.Vakharia: None. X.C.Huang: None. C.G.Minard: None. S.Lyons: None. S.Mckay: None.
114-LB: Early Time-Restricted Feeding Reduces Time in Elevated Glucose Range in Adults With Prediabetes
Authors: BARUA SOUPTIK , BRUNO JOANNE , NASSERIFAR SHABNAM , VANEGAS SALLY M. , POPP COLLIN , WALKER JEANNE M. , ALEMAN JOSE O.
Published: June 2023

Objective: Early time-restricted feeding (eTRF) is an intermittent fasting strategy restricting caloric intake to the first 6-8 hours of the day. While previous studies have shown that eTRF improves glycemia, it is unclear if the effect is due to associated weight loss or metabolic benefits of the feeding strategy itself. In this study, we evaluated the weight-independent effects of eTRF on glycemia using multiple CGM-based time in range (TIR) metrics.

Methods: We conducted a randomized 7-day isocaloric crossover supervised feeding study comparing eTRF (80% of calories consumed between 8am-1pm) to a usual feeding pattern (UFP, 50% of calories consumed after 4pm) among participants with prediabetes and BMI > 28 kg/m2 in a metabolic ward. Participants were randomized 1:1 to eTRF or UFP for days 1-7, then crossed over to the other arm on days 8-14. Food intake was tailored to meet weight stable caloric needs. Participants also wore blinded Abbott Freestyle Libre CGMs throughout the study period. We evaluated time spent below 70 mg/dL (TBR<70), in 70-140 mg/dL (TIR70-140), and in 140-180 mg/dL (TIR140-180) glucose range per arm. Further, we compared TIR140-180 between arms stratified by time of day: Daytime and Overnight (6am-12am and 12am-6am CGM readings, respectively) using linear mixed effect regression adjusting for type and order of intervention.

Results: We analyzed data from 10 participants (age 58 (10) years, 50% female, 80% Black, BMI: 37.3 (5.4) kg/m2, HbA1c: 5.8 (0.1)%). Weight change over the study period was not significant (p=0.08). Compared to UFP, eTRF was associated with a decrease in TIR140-180 overall (3.3%, p=0.01) and during Daytime (4.3%, p=0.02) but not Overnight (0.4%, p=0.73). We observed no significant differences in TBR<70 (p=0.28) and TIR70-140 (p=0.88) between arms.

Conclusion: eTRF may improve glucose control in adults with prediabetes and high BMI by reducing daytime excursions into the elevated 140-180 mg/dL range.

Disclosure

S. Barua: None. J. Bruno: None. S. Nasserifar: None. S. M. Vanegas: None. C. Popp: None. J. M. Walker: None. J. O. Aleman: Advisory Panel; Intellihealth, Consultant; Novo Nordisk, Employee; Veterans Administration, Research Support; NIH - National Institutes of Health, Veterans Administration.

Funding

Shapiro-Silverberg Foundation; The Rockefeller University; Doris Duke Charitable Foundation; American Heart Association (17-SFRN33490004); National Institutes of Health (K08DK117064); National Heart, Lung, and Blood Institute (5T32HL098129-12)
1143-P: Elevated Serum IgA and the Gut Microbiome in Pediatric Type 1 Diabetes (T1D)
Authors: THAKKAR AMRUTA , REDONDO MARIA J. , HAJJAR JOUD , PETROSINO JOSEPH , HOFFMAN KRISTI L. , CORMIER JUWAN , AHMED MAAZ , HUANG XIAOFAN C.
Published: June 2023

Elevated serum IgA occurs in ~20% of children with new onset T1D, although its potential role in T1D pathogenesis is not understood. Gut dysbiosis is present at onset of T1D and is strongly associated with its pathogenesis. Mucosal IgA is well known to influence the microbiome and vice versa. In animal models, serum IgA responds to microbiome changes, thereby inducing a protective response to gut invasion by pathogens. However, the relationship between gut microbiome and serum IgA in humans with T1D is unknown. Thus, we aimed to assess if elevated serum IgA is associated with gut dysbiosis at T1D onset. We enrolled 47 children between 7/2021 and 9/2022: New onset T1D with elevated serum IgA (T1D-Hi-IgA, n=14), new onset T1D with normal serum IgA (T1D-Nl-IgA, n=18) and controls (siblings of new onset T1D, n=15). Exclusions: <2 yrs age; antibiotics; probiotics; inflammatory bowel disease; celiac disease; or acute illness <10 days of stool collection. Demographic and clinical variables, diet questionnaires and stool were collected. Stool microbiome was determined via 16Sv4 rDNA sequencing. Differences in alpha and beta diversity along with taxa abundance were assessed. We found that the relative abundance of members of families Oscillospiraceae and Lachnospiraceae, both of which contain butyrate producers, were significantly associated with elevated IgA irrespective of T1D status (p<0.05); higher in T1D-Hi-IgA vs T1D-Nl-IgA (p<0.05); yet similar in T1D-Hi-IgA vs controls. Measures of alpha diversity, including richness and evenness, were also increased in T1D-Hi-IgA vs T1D-Nl-IgA, though these differences did not reach significance (richness: p=0.074; evenness: p=0.135). Similar results were observed for beta diversity. In sum, in children with new onset T1D, elevated serum IgA is associated with beneficial microbial taxa such as butyrate producers, with a trend towards increased diversity, similar to healthy siblings. Further studies are needed to understand its involvement in T1D pathogenesis.

Disclosure

A.Thakkar: None. M.J.Redondo: None. J.Hajjar: None. J.Petrosino: None. K.L.Hoffman: Consultant; Cooper Surgical. J.Cormier: None. M.Ahmed: None. X.C.Huang: None.
1145-P: Hybrid Closed-Loop (HCL) Technology Improves Glycemic Control among Historically Marginalized Youth with Type 1 Diabetes (T1D)
Authors: MARKS BRYNN E. , GRUNDMAN JODY , MEIGHAN SEEMA , MONAGHAN MAUREEN , STREISAND RANDI , PERKINS AMANDA G.
Published: June 2023

Background: Non-Hispanic Black (NHB) youth with T1D are more likely to have suboptimal glycemic control and less likely to use HCL systems or to be included in clinical trials. We evaluated changes in glycemic control with use of Tandem t:slim X2 insulin pump with Control-IQ technology in this historically underrepresented population in T1D research.

Methods: This prospective non-randomized pilot study enrolled 15 pump naïve, publicly insured, NHB youth (Mage 14.6 ± 3.7) with T1D and A1c ≥10% in a 6 month trial of HCL use. Changes in A1c (n=13) and CGM-measured glycemia at baseline versus the final 90 days of the study for those with <70% wear time (n=12) were assessed using paired t-tests and Wilcoxon signed rank tests.

Results: Thirteen participants (87%) completed the study; one was removed after 2 episodes of diabetic ketoacidosis (DKA) and the other for protocol non-adherence. A1c decreased from 11.7±1.3% to 9.6±1.6% (p=0.001). Average sensor glucose decreased from 281±53 to 225±30 mg/dL and time in range (TIR) increased by 4.5±8.5 hours/day from 18.5±15.0% to 37.1±10.3% (p=0.007). Time above range (TAR) <180 mg/dL decreased by 4.6±4.5 hours/day from 81.3±15.4% to 62.0±10.3% (p=0.007). There were no changes in time below range <70 mg/dL (p=0.72). DKA did not increase (0.67 episodes/person-year pre-enrollment vs 0.58 episodes/person-year during study intervention).

Conclusions: Tandem t:slim X2 insulin pump with Control-IQ technology use in NHB youth with suboptimal T1D control was associated with improvements in average glucose, TIR, and TAR. The theoretical risk for increased risk of DKA is frequently cited as a barrier to HCL use in this population, however there was no increase in rates of DKA during the study period. These glycemic improvements without increased risk emphasize the importance of supporting equitable access to diabetes technology among all people with T1D.

Disclosure

B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc.

Funding

National Institutes of Health (K23DK129827); Tandem Diabetes Care, Inc. (TDC20210226); Dexcom, Inc.
116-LB: iCoDE Project Final Recommendations for CGM-EHR Integration
Authors: ESPINOZA JUAN C. , YEUNG ANDREA , HUANG CYNTHIA , KLONOFF DAVID C.
Published: June 2023

Background: he Integration of Continuous Glucose Monitoring Data into the Electronic Health Record (iCoDE) Project is a consortium whose purpose is to facilitate efficient integration of continuous glucose monitor (CGM) data into the Electronic Health Record (EHR) through standards and best practices.

Methods: A Planning Committee, Steering Committee, and six Working Groups (Data Standards; Account Linkage; Integration and Interoperability; Analytics and Visualizations; Clinical Workflows; and Partnerships and Business Models) were organized to tackle different technical, clinical, and operational aspects of CGM-EHR integration. Participants were recruited from industry, academia, healthcare, government agencies, and patient advocacy groups. Groups met regularly and got feedback from the Steering Committee. Each Working Group created a final summary of their group's thoughts, research, and recommendations. The iCoDE Co-Chairs then synthesized the six summaries into a final report, and derived formal Recommendation Statements (RS). These RS were then sent to the iCoDE Steering Committee for feedback and revisions. The feedback was incorporated, and a ballot was sent to all voting members.

Results:130 individuals from more than 60 organizations participated in iCoDE over the course of 11 months. 54 RS were developed (7 Introductory RS, 27 Technical Standards RS, 20 Clinical Implementation RS). 93.8% of eligible steering committee members submitted their ballots. After the first round of voting, 13 statements underwent minor revisions and 2 underwent major revisions. A revised and final ballot was prepared and sent out to the Steering Committee. All 54 RS were adopted as Strong Recommendations (defined as >80% approval); average approval rate was 98%, range 91%-100%.

Conclusion: The 2022 iCoDE Report and Recommendations provide comprehensive yet practical standards-based guidance for manufacturers and healthcare organizations interested in CGM-EHR integration.

Disclosure

J. C. Espinoza: Consultant; Sanofi, Research Support; NIH - National Institutes of Health, FDA, Speaker's Bureau; Glooko, Inc. A. Yeung: None. C. Huang: None. D. C. Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc.

Funding

U.S. Food and Drug Administration (P50FD006425 to J.C.E.)
116-OR: Changing How We Talk about DSMES—Applying an Audience-Driven Approach
Authors: WILLIAMS ALEXIS , RODRIGUEZ BETSY , PELLECHIA KATHLEEN
Published: June 2023

How would you describe diabetes self-management education and support (DSMES) services to a neighbor? Would they understand and want to learn more? DSMES services are cost-effective and proven to help improve health behaviors and outcomes. However, according to the Centers for Disease Control and Prevention (CDC), every year, only 1 million of the more than 37 million adults with diabetes receive DSMES services. Between 2019 and 2021, CDC, the Association of Diabetes Care & Education Specialists, the American Diabetes Association, and other partners collaborated on a new approach to talk about and facilitate better understanding of DSMES services. Through application of health marketing best practices, the group developed messaging, including a plain-language description which aims to communicate its value in a common and compelling voice. The multi-phase process was informed by the insights of people with diabetes, diabetes care and education specialists, and other health care providers. Participants were recruited nationally from diverse locations, backgrounds, and levels of experience with diabetes education to participate in focus groups and interviews, an online card sort, and a confirmatory online survey of 500 people in which 70% of people with diabetes surveyed shared that they would be likely to look for more information on DSMES services after seeing the messages, and 84% of health care providers reported they would be likely to use the messages. The process culminated with a pilot project in four varied sites: a network of community clinics, a pharmacy, a state health department, and a Federally Qualified Health Center. Pilot participants shared positive impressions of the content and design of the promotional tools. Next steps are to move from concept to final materials and to launch a digital “playbook” to help guide use of the messages. In this session, presenters will detail the research, offer audience insight data, and highlight next steps.

Disclosure

A.Williams: None. B.Rodriguez: None. K.Pellechia: None.
1161-P: Patterns of Diabetes Distress (DD) and Glycemic Outcomes in Teens with Type 1 Diabetes (T1D)
Authors: WENTZELL KATHERINE , TINSLEY LIANE J. , VOLKENING LISA K. , MCGILL DAYNA E. , ANDERSON-THOMAS BARBARA J. , LAFFEL LORI M.
Published: June 2023

Background: DD distracts from T1D self-management, contributing to suboptimal glycemia. Yet, DD can change day-to-day and over time. We compared A1c trends in teens with increasing vs. decreasing DD over time.

Methods: At baseline, 6, 12, and 18 months, participants (N=301) ages 13-17 years completed the Problem Areas in Diabetes Survey—Pediatric scale; higher scores indicate more DD with ≥41 indicating elevated DD. We identified three trajectories: participants with low baseline DD, who then reported persistent high DD; participants with high baseline DD, who then had persistent low DD levels; all others. Mean A1c levels were compared at baseline and 18 months.

Results: At baseline, participants (49% male, 78% white) were 15.0±1.3 years old with T1D duration 6.5±3.7 years; 59% used insulin pumps; 12% used CGM; A1c was 8.5±1.1%. Twenty-six participants (9%) had elevated DD at baseline and then low DD at subsequent time points; A1c did not change significantly from 0 to 18 months for these participants (p=.33). Thirty-five participants (12%) had low DD at baseline and then elevated DD at subsequent time points; A1c increased significantly from 0 to 18 months for these participants (p=.01). The remaining participants (n=240) had varying levels of DD with no significant change in A1C (p=.05).

Conclusion: Adolescents who initially had low DD and reported increasing DD over time may be at risk for worsening glycemic outcomes.

Disclosure

K.Wentzell: None. L.J.Tinsley: None. L.K.Volkening: None. D.E.Mcgill: Employee; Vertex Pharmaceuticals Incorporated. B.J.Anderson-thomas: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape.

Funding

National Institutes of Health (T32DK007260); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095273); JDRF (2-SRA-2014-253-M-B)
1163-P: The Arrival of a New Sibling May Be Associated with a Deterioration in Glycemic Control for Children with Type 1 Diabetes
Authors: LOPEZ PRUDENCE E. , KING BRUCE R. , SMART CARMEL E. , SINCLAIR ANNE , NEYLAN MICHELLE , SECKOLD ROWEN , PATERSON MEGAN A.
Published: June 2023

Introduction: Caring for young children with Type 1 diabetes comes with significant burden for parents. We hypothesised that pregnancy and the arrival of a new sibling may be associated with a deterioration in control of type 1 diabetes for older siblings with type 1 diabetes.

Research Design and Methods: We identified young children currently under the care of the John Hunter Children's Hospital Paediatric Diabetes team who had welcomed a younger sibling since their diagnosis using our prospective Paediatric Diabetes database. We reviewed the HbA1c pre and post the arrival of a new sibling.

Results: 38 children (20 male) had become older siblings since diagnosis of type 1 diabetes. 5 children were excluded as no data were available prior to pregnancy. Mean age of children at diagnosis was 3.5 years. Mean age at arrival of sibling was 6years with mean duration of diabetes at that time of 3.4 years. 15 of eligible participants were using insulin pump therapy. Mean HbA1c during pregnancy was 51mmol/mol (6.8%) compared to 54mmol/mol (7.1%) following delivery (p<0.05). 67% of children had HbA1c <53mmol/mol (7%) during pregnancy compared to 53% following delivery.

Conclusion: The arrival of a new sibling was associated with a significant increase in HbA1c. This may be due to the high care burden of type 1 diabetes on parents which cannot be met when also attempting to attend to the needs of a newborn. Programs to assist new parents may help children with young siblings to continue to meet glycaemic targets. Despite the young age of the cohort of children prior to delivery of a new sibling, 67% were able to meet the ADA glycaemic target of <7%. This indicates that the goals of intensive management of diabetes are achievable even in the toddler, preschool and early primary school years.

Disclosure

P.E.Lopez: None. B.R.King: None. C.E.Smart: None. A.Sinclair: None. M.Neylan: None. R.Seckold: None. M.A.Paterson: None.
1167-P: “I don't know if I can call it discrimination, but…”—Perceived Discrimination in Provision of Pediatric Type 1 Diabetes (T1D) Care
Authors: MEDINA PENARANDA RICARDO , BONILLA OSPINA ANDREA , ORTEGA HECTOR , PENA DIANA , SHAW GARY M. , CHAMBERLAIN LISA , NARANJO DIANA , RAYMOND JENNIFER , MAAHS DAVID M. , HOOD KOREY K. , ADDALA ANANTA
Published: June 2023

Discrimination impacts health outcomes but is underexplored in pediatric T1D. In this pilot qualitative study, we evaluate perceived discrimination in provision of diabetes care for parents/guardians (PG) of youth with T1D and public insurance.

PG (n=21, 39±8 yrs, youth 8±2 yrs, 67% Hispanic, 48% speak Spanish, 69% make <$50K) completed focus groups/interviews (FGI). FGI were conducted, transcribed, and coded in English (n=11) or Spanish (n=10), per PG preference. FGI transcripts were analyzed inductively by a five member bilingual team.

While not always referred to as discrimination, PG reported differences in diabetes care by language, race/ethnicity, and insurance. Reported themes organically organized into the social ecological model (Figure). Systemic inequities via insurers, and institutional inequities via clinicians and schools were reported. Insurers required frequent advocacy from PG to navigate unequal treatment. Community was identified as protective through normalization and education of T1D, familial and communal support, and cultural and linguistic congruency.

PG frequently described experiences in diabetes care consistent with the definition of discrimination, but not all readily adopt the terminology “discrimination”. Clinicians and researchers should be aware of this phenomenon to devise meaningful solutions to address diabetes equity.

Disclosure

R.Medina penaranda: None. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. A.Bonilla ospina: None. H.Ortega: None. D.Pena: None. G.M.Shaw: None. L.Chamberlain: None. D.Naranjo: None. J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc.

Funding

Maternal & Child Health Research Institute; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK13134201)
1169-P: A Systematic Review of the Effects of Provider Bias on Outcomes in Youth and Young Adults with Type 1 Diabetes
Authors: WETTER SARA E. , HIMELHOCH ALEXANDRA C. , DRISCOLL KIMBERLY A.
Published: June 2023

Background: There are significant and pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D). This review sought to examine 1) child and caregiver demographic and biopsychosocial variables associated with provider bias and outcomes (e.g., HbA1c; blood glucose values and range; diabetes technology use; burnout, stress, anxiety associated with T1D care); 2) evidence for associations between experiences of provider bias and patient physical and psychological outcomes; and 3) evidence for mediators or moderators (e.g., socioeconomic status, race/ethnicity) contributing to the association between provider bias and patient outcomes.

Methods: A systematic review of the literature was conducted across five public electronic databases: PubMed, PsycINFO, CINAHL, Web of Science, Embase. Studies included youth/young adults with T1D with a mean age between 12-35 years that investigated the effects of provider bias on physical and psychological health outcomes.

Results: Fourteen articles were included in the review. Results suggest experiences of provider bias (e.g., shaming, criticism) negatively affect individuals’ self-esteem, relationships with medical providers, and mood. Provider bias also impacts recommendations about diabetes technology use, insulin regimen intensity, and risk for life-threatening T1D complications.

Conclusions: Evidence from the current review suggests that provider bias plays a role in adverse physical and mental health. Varying study methodology in definitions and assessment of provider bias signals a need for comprehensive measure development to account for diverse experiences and interpretations of bias in healthcare. More research is necessary to investigate intervening factors that may affect the association between provider bias and overall health outcomes in youth and young adults with T1D.

Disclosure

S.E.Wetter: None. A.C.Himelhoch: None. K.A.Driscoll: None.
1188-P: Plasma ANGPTL4 Is Higher in Women with Advanced Maternal Age and Is Associated with Metabolic Disorders during Pregnancy and the Risk of Adverse Pregnancy Outcomes
Authors: WENG YEN I , LI HUNG-YUAN
Published: June 2023

Background: Advanced maternal age (AMA) is correlated with a higher risk of metabolic disorders during pregnancy, including gestational diabetes (GDM), gestational hypertriglyceridemia (GHTG), pregnancy-induced hypertension (PIH), and preeclampsia while the pathophysiology remains unclear. Angiopoietin-like protein 4 (ANGPTL4) is a lipoprotein lipase inhibitor which participates in the pathophysiology of metabolic disorders in non-pregnant population. We explored the role of ANGPTL4 in the link between AMA and metabolic disorders during pregnancy.

Method: We recruited 571 pregnant women from November 2013 to April 2018 in National Taiwan University Hospital, Taiwan. ANGPTL4 expression level in placenta and maternal plasma ANGPTL4 level were measured. The correlations among age, plasma ANGPTL4 level, metabolic disorders during pregnancy, and adverse pregnancy outcome were analyzed.

Result: Compared with women aged <30 years, women aged ≥40 years had higher body mass index (BMI), fasting plasma glucose, hemoglobin A1c, insulin resistance index, plasma triglyceride, blood pressure, and plasma ANGPTL4 level in the first trimester. The expression level of ANGPTL4 were higher in the placenta of women with AMA than in the placenta of women aged <30 years. The pregnant women with the highest quartile of plasma ANGPTL4 level had more metabolic disorders during pregnancy. Besides, higher plasma ANGPTL4 was associated with a higher risk of delivering neonates with large for gestational age and the presence of adverse pregnancy outcomes.

Conclusion: Plasma ANGPTL4 is higher in women with AMA and is associated with metabolic disorders during pregnancy and the risk of adverse pregnancy outcomes.

Disclosure

I.Yen: None. H.Li: None.
1199-P: Timing of Postprandial Peak CGM Glucose in Gestational Diabetes
Authors: O'MALLEY GRENYE , KONONENKO MARIYA , OGYAADU SELASSIE J. , LEVISTER CAMILLA , ELLIS EMILY , ARUMUGAM DUSHYANTHY , VIEIRA LUCIANA , LEVY CAROL J.
Published: June 2023

Background: Current guideline recommendations for management of gestational diabetes mellitus (GDM) recommend capillary testing of blood glucose levels fasting and one-two hours postprandial. Use of intermittently-scanned continuous glucose monitors (isCGM) during pregnancy in women with GDM has the potential to improve fetal outcomes, however there are limited recommendations for their use. Optimal timing of postprandial testing is unknown.

Methods: Women with GDM diagnosed after 24 weeks gestation were recruited and randomized to adjunctive use of isCGM versus capillary testing with blinded CGM. In this subanalysis of 8 participants, timing of peak CGM glucose value is compared to recommended 1-hour postprandial capillary value. Food logs and/or meter data from the first two weeks of participation were used for analysis.

Results: A total of 265 meals were analyzed. Gestational age at analysis was 29±1.2 weeks. One participant was treated with insulin. Three participants used blinded CGM; 5 used isCGM. Mean peak CGM glucose was 100±11 mg/dL. Mean time to peak was 96±14 minutes. Seventy-four percent of peak glucoses were after one hour.

Conclusions: Current recommendations for glucose monitoring may need to be adapted to use of new technology with isCGM. Our data found that if a user only scanned at one hour postprandial, they could miss the peak glucose for the majority of meals. Repeat scanning or retrospective review of isCGM data may be required to determine the timing of a user’s postprandial peaks in relation to glycemic goals. Factors like the lag in CGM glucose compared to capillary testing and meal content should be considered with isCGM use.

Disclosure

G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Kononenko: None. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. E.Ellis: None. D.Arumugam: None. L.Vieira: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange.

Funding

Abbott Diabetes Care
120-LB: Sharing Dexcom G6 Data and Glycemic Outcome—A Comparative Analysis
Authors: SADEK BATOUL , HASHEM MOHAMED , SEETHA MALAVIKA , RAJ RISHI
Published: June 2023

Introduction: In recent years the use of Continuous Glucose Monitoring (CGM) has significantly increased. The Dexcom G6 CGM sends real-time glucose readings automatically to a smart device. The Dexcom Clarity app allows users to share up-to-date glucose data with providers, enabling remote monitoring of patients' glycemic control. Although studies have shown better glucose control in patients who use CGM, it is unexplored if glucose metrics are further improved in those who share CGM data with providers. In this study, we compared glycemic outcomes in patients who share their data with their providers via the Dexcom G6 sensor to those who do not.

Method: We conducted a single-center cross-sectional study in a community hospital with patients who use Dexcom G6 CGM. Data was obtained from Dexcom Clarity for Healthcare Professionals, an online platform for clinicians to review patient trends. The following data was collected for each patient: date of last upload, data sharing status, average glucose, standard deviation, glucose management indicator, glucose range, sensor usage, and coefficient of variation. Two-tailed unpaired Student's t-tests were used to analyze CGM metrics based on data sharing status. Significance was defined as a p-value < 0.05.

Results: 123 (61.19%) out of 201 participants shared data with their provider. Participants with sharing data ‘on’ were significantly younger (49±15 years,) and had increased sensor usage (90±21%) compared to those with sharing off. Participants who shared data also spent more time in range (57±24 %), indicating a higher percentage of readings with glucose levels in a healthy range (70-180 mg/dL). Lastly, average glucose was lower in participants who shared data, although not statistically significant.

Conclusion: The data-sharing feature on Dexcom G6 was utilized more by younger people and was associated with a higher percentage of time in range. Using the data-sharing feature of the Dexcom G6 could lead to clinically meaningful improvement in glycemic control.

Disclosure

B. Sadek: None. M. Hashem: None. M. Seetha: None. R. Raj: None.
1200-P: A1C and Neonatal Outcomes Improved with Real-Time Continuous Glucose Monitoring in Pregnant Women with Preexisting Type 2 Diabetes
Authors: NUNLEE-BLAND GAIL , COFIE PRINCESS-LISA
Published: June 2023

Preexisting type 2 diabetes (T2D) in pregnancy is increasing and confers significant health risks to the mother and fetus. Continuous glucose monitoring (CGM) systems provide real-time feedback for patients and allow for remote monitoring and therapeutic adjustments. CGM is ideal for pregnancy where insulin requirements and glucose levels are rapidly changing throughout the pregnancy and postpartum. Previous studies have demonstrated improved maternal and neonatal outcomes with the use of CGM in the context of T1D. This study used the Dexcom G6 CGM in pregnant women with preexisting T2D to determine if there is a reduction of A1C and neonatal hypoglycemia compared to preexisting T2D in women using self-monitored blood glucose (SMBG) to manage their diabetes. Women aged 18-40 years with preexisting T2D, using multiple daily insulin injections, and <14 weeks pregnant were enrolled in the study. Participants were randomly assigned to use G6 or SMBG during pregnancy. Mann Whitney U Test, Wilcoxon Signed Rank Test, and Chi-square tests were used to analyze gestational age (GA), A1C at baseline and at 34 weeks, and occurrence of neonatal hypoglycemia. Fourteen participants completed the study. In the G6 group (n=7, median age 28 years, GA 37 weeks), A1c decreased from 7.0% to 6.1% (p=0.045). In the SMBG group (n=7, median age 36 years, GA 38 weeks), A1c decreased from 6.3% to 6.1% (p=NS). There was no significant difference in the GA between the groups. None of the 7 infants in the G6 group had perinatal hypoglycemia compared to 4 out of 7 infants in the SMBG group (p=0.005). This study suggests that use of the DexcomG6 CGM in preexisting T2D during pregnancy can lower A1C and reduce neonatal hypoglycemia.

Disclosure

G.Nunlee-bland: Research Support; Dexcom, Inc. P.Cofie: None.

Funding

Dexcom, Inc. (11S-2019-037)
1214-P: Trends in the Use of Glycemic Testing for Diabetes among Medicare Fee-for-Service Beneficiaries, 2001–2018
Authors: ANDES LINDA J. , BENOIT STEPHEN R. , ROLKA DEBORAH B. , IMPERATORE GIUSEPPINA , HOLLIDAY CHRISTOPHER S.
Published: June 2023

Glycemic tests are an important tool in screening patients for diabetes and prediabetes but there is little literature describing changes in patterns of glycemic testing over time. Using claims data for Medicare Fee-for-Service (FFS) beneficiaries without diabetes, we examined trends and demographic variation in the use of glycemic screening tests. Beneficiaries with diabetes were identified by ICD diagnosis codes while tests were identified with HCPCS/CPT procedure codes.

The number of fully enrolled Medicare FFS beneficiaries without diagnosed diabetes ranged from 17.1 million in 2001 to 14.6 million in 2018. The total number of tests ranged from 2.7 million in 2001 to 4.8 million in 2018, and after 2009, the majority administered were HbA1c tests. The rate of glycemic testing was calculated as the percent of beneficiaries without diagnosed diabetes having at least one of any glycemic test per year. Testing rates were calculated by sex, age, race/ethnicity and state. The annual percentage of beneficiaries without diabetes who had any glycemic test increased from 10.6% in 2001 to 22.5% in 2018. Testing rate varied little across sex, age and race/ethnicity groups with 2 exceptions: beneficiaries age 85+ had a much lower testing rate (17.8% in 2018) than other age groups (23.6%); and beneficiaries of Asian or Pacific Islander descent had a much higher testing rate (31.7% in 2018) than other race/ethnicity groups (between 22.0–24.8%). However, testing rates did vary considerably among states: in 2018, ranging from a low of 11.1% in Wyoming to a high of 33.9% in Hawaii.

Glycemic testing for diabetes has increased steadily since 2010, largely due to increased use of HbA1c tests. However, fewer than 1 in 4 Medicare FFS beneficiaries were tested in 2018, suggesting that opportunities remain to improve screening and diagnosis of diabetes among older adults.

Disclosure

L.J.Andes: None. S.R.Benoit: None. D.B.Rolka: None. G.Imperatore: None. C.S.Holliday: None.
1215-P: Attitudes towards Diabetes Technology in Older Adults with Diabetes
Authors: ZENG ALISON , XU EMILY , BELL TREVOR , BRISTOW TRACY L.
Published: June 2023

Diabetes technology such as insulin pumps and continuous glucose monitors (CGMs) have been shown to improve glycemic control and reduce the burden of diabetes. Despite these benefits, however, there remain challenges to technology adoption in the aging population. This study aimed to explore older people with diabetes' (PWD) attitudes towards technology and understand barriers to its implementation.

In December 2022, 2,585 PWD aged 65 or older (24% type 1, 61% female) in the United States took an online survey assessing how aging affects their ability to manage diabetes as well as how beneficial they believe diabetes technology to be. Those who did not view diabetes technology as very or extremely beneficial (n=737) further elaborated on their hesitations towards adopting technology in open-ended responses (5% type 1, 69% female). Results were analyzed both quantitatively and qualitatively.

The most common aging-related challenges with managing diabetes were difficulty exercising (39%), reduced hypoglycemia awareness (11%), and forgetting to take medication/insulin (8%). Interestingly, technology was of little concern; only 1% had difficulties using diabetes technology and the majority (66%) rated diabetes technology as very or extremely beneficial for diabetes management. CGM users (92% vs. 51%, p<.001) and pump users (96% vs. 59%, p<.001) in particular were more likely to view diabetes technology as beneficial than non-users. Qualitative analysis identified main barriers to adopting technology among older PWD, which included cost/insurance coverage (18%), satisfaction with current treatment options (14%), and time and effort spent learning how to use the device (12%).

This research reveals that negative actual and perceived benefits of diabetes technology likely do not serve as barriers to their implementation among older PWD. Rather, barriers to adoption stem primarily from cost-related factors and concerns about training, suggesting the need to invest in more in-depth education for older PWD.

Disclosure

A.Zeng: Employee; dQ&A. E.Xu: Employee; dQ&A. T.Bell: Employee; dQ&A. T.L.Bristow: Employee; dQ&A.
1218-P: All-Cause Mortality in Individuals Aged 65+ Years with Type 2 Diabetes With and Without Frailty—Clinical Utility of Electronic Frailty Index to Individualise HbA1c Targets
Authors: CRABTREE THOMAS S.J. , VINOGRADOVA YANA , ALDAFAS RAMI , GORDON JASON , IDRIS ISKANDAR R.
Published: June 2023

Frailty and type 2 diabetes (T2D) is fast becoming a clinical challenge especially in the elderly population. Despite clear guidance on the need to evaluate individualised HbA1c targets in connection with frailty status with mortality risk, there is a lack of formal evidence on these associations. To guide healthcare professionals in setting appropriate HbA1c targets, this study aimed to investigate the association between mortality in connection with electronic frailty index (eFI) and HbA1c, as well as exploring the clinical utility of eFI as a tool to individualise HbA1c targets in frail patients with T2D.

Methods: We included patients with T2D aged 65+ within UK primary care electronic database (the Clinical Practice Research Datalink) and Hospital Episode Statistics from 2014-19. All-cause mortality (ACM) risk associated with 4 frailty groups (non-frail; mild; moderate and severe) (defined by electronic frailty index scores, eFI) and seven HbA1c groups at 1.0% intervals were assessed using multivariate Cox regression analysis adjusted for demographic and clinical characteristics. The reference group was defined as “non-frail” individuals with HbA1c 6.5-7.5%.

Results: 179,723 individuals (mean±SD; age 74.8±7.6years, diabetes duration 7.3±6.1years, HbA1c 55.7±15.8mmol/mol) were followed for mean 1.7 years. Within all frailty groups, the risk of ACM was greatest at HbA1c<5.5%, with highest risk observed in moderate (HR 3.34; 95%CI 2.80, 3.99) and severe frailty (HR 3.27; 95%CI 2.73, 3.91) groups. In all groups, ACM risk increased with higher HbA1c levels compared to HbA1c 6.5-7.5% (a “U-shaped” curve).

Conclusion: Both high and low HbA1c levels increase the risk of ACM for people 65+ with T2D and frailty in a “U-shaped” association between HbA1c and ACM. This study supports eFI as a useful tool to facilitate HbA1c target setting in older patients with T2D and to manage ACM risk.

Disclosure

T.S.J.Crabtree: Speaker's Bureau; Abbott Diabetes, Novo Nordisk, Lilly, Sanofi, Insulet Corporation. Y.Vinogradova: None. R.Aldafas: None. J.Gordon: Employee; Health Economics and Outcomes Research Ltd. I.R.Idris: None.
1220-P: Age Differences in the Effects of Multicomponent Periodontal Treatments on Oral and Metabolic Health among People with Diabetes Mellitus—A Meta-epidemiological Study
Authors: ZHU ZHENG , QI XIANG , ZHENG YAGUANG , PEI YAOLIN , WU BEI
Published: June 2023

Objectives: To explore the age differences in the effect of multi-component periodontal treatment on oral and metabolic indicators in people with periodontitis and diabetes.

Methods: Six databases (PubMed/Medline, Embase, CINHAL, Web of Science, Cochrane Library, and ProQuest) were searched from database inception to August 2022. Trials reporting the effects of multi-component periodontal treatment on oral and metabolic indicators in people over 18 years old with periodontitis and diabetes were included. We used bivariate and multivariate meta-regression models to examine the association between age and treatment effect size. The primary outcomes were changes in pocket depth (PD), clinical attachment level (CAL), and hemoglobin A1c (HbA1c).

Results: A total 115 trials (119 articles) met the inclusion criteria. Pooled evidence demonstrated that multi-component periodontal treatment significantly reduced PD (g=0.929, 95% CI [0.689-1.169], I2=94.1%), CAL (g=0.879, 95% CI [0.669-1.089], I2=92.1%), and HbA1c (g=0.603, 95% CI [0.443-0.763], I2=87.5%). There was a significant decreasing trend in the effect size for PD (P for trend = 0.020) and CAL (P for trend = 0.028) as age increases. Results from multivariate meta-regression showed that age was associated with smaller effects of PD (β [standard error] = -0.123 [0.041], P=0.004) and CAL (-0.159 [0.055], P=0.006). The effect size for HbA1c was smaller in participants older than 55 years compared to their younger counterparts (-0.792 [0.322], P=0.017).

Conclusions: The effect size of multi-component periodontal treatments on PD and CAL may decrease as people with periodontitis and diabetes age increases. The treatment effect on HbA1c is significantly lower in people older than 55 compared to their younger counterparts. The components of periodontal treatment should be adjusted to the individual’s periodontal and glycemic control levels.

Disclosure

Z.Zhu: None. X.Qi: None. Y.Zheng: None. Y.Pei: None. B.Wu: None.

Funding

National Institutes of Health (P30AG059304, P50MD017356)
1231-P: Influence of Diabetes on the Progression of Preclinical Stage B Heart Failure Phenotypes to Heart Failure
Authors: ECHOUFFO TCHEUGUI JUSTIN , NDUMELE CHIADI E. , ZHANG SUI , MATSUSHITA KUNIHIRO , NAMBI VIJAY , SKALI HICHAM , SELVIN ELIZABETH
Published: June 2023

Introduction: The extent to which diabetes influences progression from preclinical heart failure (HF) stage B phenotypes (2021 Universal Definition) to overt HF or death is unknown.

Methods: We included 4,264 adults with preclinical HF (stage A [n = 1,174] or B [n = 3,090]) who attended the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 (2011-2013). Stage A was defined by HF risk factors only. Stage B1: echocardiographic abnormalities but no biomarker elevation; Stage B2: elevated NT-pro-BNP ≥125 pg/mL and/or hscTnT>14 ng/L but no echocardiographic abnormality; Stage B3: echocardiographic and biomarker abnormalities. We assessed the associations of diabetes and each preclinical stage B phenotype with incident HF and HF or death.

Results: Among the participants (mean age 76 years, 62% women, 24% Black), there were 383 HF events and 730 deaths during 8.6 years of follow-up. Diabetes conferred a high absolute risk of HF across all preclinical stages B HF, but more so for the Stage B3 phenotype (Table). In cross-categories of preclinical HF stages (A and B) and diabetes status, participants with diabetes and Stage B3 had the highest risks of HF or HF and death combined, compared to those in stage A without diabetes.

Conclusion: Addressing diabetes appears to be critical in stage B individuals with both echocardiographic and biomarkers abnormalities for preventing the progression to HF.

Disclosure

J.Echouffo tcheugui: None. C.E.Ndumele: None. S.Zhang: None. K.Matsushita: Consultant; Fukuda Denshi, Akebia Therapeutics, Inc., AMGA, Other Relationship; Kowa Company, Ltd. V.Nambi: Research Support; Amgen Inc., Kowa Pharmaceuticals America, Inc. H.Skali: Consultant; Astellas Pharma Inc., Elsevier, Wolters Kluwer Health, APM Tunisia / Hikma. E.Selvin: None.

Funding

National Institutes of Health (K23HL153774)