bluuebunny/crossref_metadata_2025 huggingface dataset:
1029-P: Building Diabetes Care Capacity in Rural Underserved Communities—A Comparison of Cardiorenal Risk Factor Outcomes in Patients Treated by ECHO-Trained Providers vs. an Academic Medical Center
Authors: BOUCHONVILLE MATTHEW F. , ERHARDT ERIK B. , LEYVA YURIDIA L. , MYASKOVSKY LARISSA , UNRUH MARK L. , ARORA SANJEEV
Published: June 2023

Background: National trends in diabetes outcomes, particularly in rural communities, do not mirror the significant benefits seen in clinical trials with emerging therapeutics and technologies. This disconnect is partly attributable to therapeutic inertia around uptake of clinical practice guidelines that have prioritized cardiorenal risk reduction. Project ECHO is a workforce development program that supports implementation of guidelines in under-resourced areas through virtual communities of practice and case-based learning. We hypothesized that the care of patients with diabetes treated by rural ECHO-trained providers would be non-inferior to those treated by specialists at an academic medical center (AMC).

Methods: A multidisciplinary team from a minority-majority state-funded AMC launched a weekly 2-hour diabetes ECHO program to mentor care dyads consisting of a primary care provider and community health worker at 10 rural primary care clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the AMC. Multiple regression models were adjusted for age, sex, baseline A1c and BMI, baseline risk factor outcome, and interactions with site. All model assumptions were satisfied.

Results: The mean follow-up duration was 21 months in the ECHO cohort and 18 months in the AMC cohort. Compared to the AMC cohort (n=151), patients in the ECHO cohort (n=856) experienced a greater A1c reduction (-1.4% vs -0.3%; P=0.017) and were more likely to achieve an A1c<8% (20.1% vs. 0.3% increase in those achieving A1c<8%; P<0.001). Changes from baseline in BP, LDL, and urine microalbumin were similar between groups (P>0.05).

Conclusions: ECHO may be a suitable intervention for improving diabetes and cardiorenal risk factor outcomes in rural, under-resourced communities where access to a specialist is limited.

Disclosure

M.F.Bouchonville: None. E.B.Erhardt: None. Y.L.Leyva: None. L.Myaskovsky: None. M.L.Unruh: None. S.Arora: None.
1030-P: Large-Scale Implementation of a Digital Solution to Support Management of Gestational Diabetes
Authors: VARNFIELD MARLIEN , BUTTEN KALEY
Published: June 2023

Introduction: Gestational Diabetes Mellitus (GDM) is one of the most common medical conditions of pregnancy and its incidence is rising. The MoTHer system, an App and web-based portal, was developed to support GDM management. It enables multidisciplinary care co-ordination by providing shared access to healthcare professionals involved in GDM care.

Methods: MoTHer was developed through co-design with users at an urban Australian hospital and tested in a feasibility study (n=40) in 2017-18. An implementation trial commenced in June 2020 and is currently underway in 5 Australian hospitals of varying sizes.

Results: More than 5000 women have utilised the MoTHer app. Care models differ at participating hospitals, some offering MoTHer as business as usual to all women with GDM, others providing MoTHer as an alternative to the traditional paper-based blood glucose diary, and one hospital only offering MoTHer to GDM patients on insulin. Each site has different implementation requirements and experiences, yet feedback from surveys administered (>300 responders) is positive, suggesting long-term adoption. Initial economic evaluation indicates a modest saving to health services. However, cost savings for the woman are estimated to be considerable (≈US$400 per patient) after accounting for lost wages, childcare, and travel expenses avoided. Comparing pre- and post-implementation groups, maternal (onset, mode of birth) and neonatal (birthweight, nursery admission) outcomes suggest MoTHer is clinically equivalent to traditional care.

Discussion: The MoTHer system has been created to see greater efficiencies for both healthcare providers and for expectant mothers. This multi-site study highlights the adaptability of a digital solution to different GDM health services. Moreover, re-imagining GDM patient care by introducing a digital based model of care is promising substantial positive cost implications for patients without compromising their clinical outcomes.

Disclosure

M.Varnfield: None. K.Butten: None.
1032-P: A System-Based Approach to Advancing Care Delivery in High-Risk Patients with T2D—Findings from a Quality Improvement Educational Intervention (QIEi)
Authors: RAO PRATIBHA , MAKIN VINNI , KAWCZAK STEVEN , LAZURE PATRICE , BENA JAMES F. , MCFADDEN PAM , JACOBS GINNY , PANTALONE KEVIN M.
Published: June 2023

Background: A Quality Improvement Educational Intervention (QIEi) was developed to improve disease management for T2D patients with CVD/CKD who may benefit from SGLT-2i/GLP-1RA. An aim was to assess the change in the number of prescriptions of these two medication classes.

Methods: The QIEi was deployed at two practice sites of a large Integrated Health Care System. A team was formed comprising of endocrinologists and 3 PCPs at each site. EHR data review confirmed the gaps and guided QI project discussions. Process improvements and communication strategies were implemented. All the PCPs at the practice sites (N=18 each) received education on these two medication classes. Cased-based and didactic CME accredited webinars designed to help improve knowledge, decision-making and implement best practices were made available for on-demand participation across the health care system.

Results: Prescription rates of SGLT-2i and GLP-1RA at the intervention (N=4247 baseline, 4033 follow up) and non-intervention sites (N=98637 baseline, 91923 follow up) were obtained pre- and 6 months post QIEi. Odds of GLP-1RA prescription dropped by 2% (p=0.75) at the intervention sites and by 6% (p<0.001) at the non-intervention sites. The decrease was not significantly different across sites (p=0.41). There was a small increase in SGLT2i prescription at the intervention sites (p=0.90), while the odds of use decreased by 3% (p=0.017) at non-intervention sites. This was not significantly different across sites (p=0.54).

Conclusion: No meaningful change in prescriptions post-QIEi at the two intervention sites was observed. While it did improve knowledge and engagement, it did not translate into prescription increases. Perhaps more time is needed to observe system-wide changes and/or other factors need to be considered to increase prescriptions for this patient population. Further studies investigating prescribing barriers are warranted.

Disclosure

P.Rao: None. V.Makin: Speaker's Bureau; Bayer Inc. S.Kawczak: None. P.Lazure: None. J.F.Bena: None. P.Mcfadden: None. G.Jacobs: None. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk.

Funding

Eli Lilly and Company; Merck & Co., Inc.
1033-P: Improving T2D Collaboration and Patient Communication at the Primary Care Level—Findings from Team-Designed Quality Improvement Education Initiative
Authors: MAKIN VINNI , JACOBS GINNY , DENNIS FRAMPTON BETHANY , PANTALONE KEVIN M. , KAWCZAK STEVEN , MURRAY SUZANNE , MCFADDEN PAM , RAO PRATIBHA
Published: June 2023

Background: A system-based Quality Improvement Education intervention (QIEi) was developed to improve disease management for T2D patients with/at-risk of CVD/CKD who may benefit from SGLT-2i/GLP-1RA. The QIEi aimed to improve competencies of PCPs, team collaboration and patient communications.

Methods: The QIEi was deployed to PCPs at 2 sites from a USA integrated delivery system. Practice Assessments (PrA) and a pre-intervention EHR data review confirmed the gaps and guided QI team discussions. Team leaders designed webinars on best practices (recorded for later view), and the groups discussed cases, designed process improvements and communication strategies (EHR Smart phrases, clinical reinforcement materials explaining treatments, and enhanced After Visit Summary). Evaluation included PrA (pre=140; post=55), EHR data, smart phrase usage, and qualitative interviews (n=10).

Results: PCPs’ comfort discussing treatment with patients increased (Table 1). Interviewees reported an increase in patient interface, confidence educating patients and team engagement. The QIEi led to system-based changes and sustained clinical reinforcement material adoption.

Conclusion: A team based QIEi can result in effective design, pilot/adoption of patient materials/EHR tools, supporting patient conversations and fostering informed decisions.

Disclosure

V.Makin: Speaker's Bureau; Bayer Inc. G.Jacobs: None. B.Dennis frampton: None. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. S.Kawczak: None. S.Murray: None. P.Mcfadden: None. P.Rao: None.

Funding

Eli Lilly and Company; Merck & Co., Inc.
1034-P: Access to Continuous Glucose Monitoring Systems in a Primary Care Clinic for Underserved Patients with Type 2 Diabetes—A Pilot Study
Authors: SGROI REBECCA G. , GUMIREDDY SRIKALA , YING TAN WAN , KAPLAN REBECCA , MILAMBWE YOLANDE , ROSOPH LEAH H. , SALAMA DIANA A. , FEHER CYNTHIA R. , RENNERT NANCY J.
Published: June 2023

B-Disparities in diabetes care are well documented. Continuous Glucose Monitoring Systems (CGMs) have improved patient experience without the need for finger sticks and have been shown to effectively lower Hemoglobin A1c (HbA1c), decrease clinical inertia and decrease the number of hypoglycemic events. Medically underserved and historically marginalized persons are disproportionately affected by diabetes, yet limited data exist on use of CGMs in this population.

M-We report a pilot initiative that brought CGM access (FreeStyle Libre 2) to a Federally Qualified Community Health Center (FQHC). Patients with type 2 diabetes and an HBA1c >8.0% were referred to be enrolled in CGM. Each patient had an initial nurse visit for device placement of FreeStyle Libre (FSL) and several follow up visits to review glycemic trends and make medication changes with a provider. Baseline HBA1c was collected and repeated at the end of the study. Provider and patient surveys were distributed at each visit.

R-Fifty participants were enrolled in the CGM study and had FSL placed. The CGM active time was greater than 50% in 76% of participants and those who continued with CGM had an increase in active time. Initial mean A1C for the entire cohort was 9.64% and average glucose after 2 weeks was 195 mg/dl. Hypoglycemia, especially overnight, reduced overtime. The use of CGM data was associated with clinician-initiated medication changes. Provider surveys revealed an increase in likelihood of medication changes based on glycemic trends and patients reported better understanding of their disease process.

C-This pilot study demonstrates the feasibility of utilizing diabetes technology (FreeStyle Libre 2) in underserved patients at a primary care clinic staffed with internal medicine residents, physicians, and nurse practitioners. CGM is beneficial in under resourced primary care outpatient settings to determine glycemic trends and make appropriate medication recommendations.

Disclosure

R.G.Sgroi: None. S.Gumireddy: None. W.Tan: None. R.Kaplan: None. Y.Milambwe: None. L.H.Rosoph: None. D.A.Salama: None. C.R.Feher: None. N.J.Rennert: None.
1035-P: Area Deprivation Index and Rates of Specialty Care in Monogenic Diabetes Registry Participants
Authors: SON RACHEL G. , NAYLOR ROCHELLE N. , GROUP UNIVERSITY OF CHICAGO MONOGENIC DIABETES REGISTRY STUDY
Published: June 2023

While diabetes is one of the most common chronic medical conditions, monogenic forms of diabetes represent a rare subtype, and face barriers to timely diagnosis similar to other rare diseases (RD), which are exacerbated by low health literacy (HL) and health care access barriers. The Monogenic Diabetes Registry (MDR) follows more than 1,200 participants with molecular diagnoses of monogenic diabetes who can offer insight into diagnostic barriers and facilitators. Aim: To assess area deprivation index (ADI- a measure of neighborhood disadvantage in the US) as a proxy of HL and health care provider type (specialist versus generalist) as a proxy of health care access in a subset of MDR participants with maturity-onset diabetes of the young (MODY). Methods: Cross-sectional analysis of REDCap data for 79 participants. ADI was constructed for each participant and descriptive statistics were analyzed with RStudio. Kruskal-Wallis was used for comparisons. Results: The median ADI of MDR participants was 26 (less than expected value of 50; p<0.001). Only 20% were from neighborhoods with >50th %ile deprivation. Sixty-two percent were under specialty care for diabetes. The median ADI for those under specialist care was lower than for those under generalist care (23 versus 36), but did not reach statistical significance. There was no difference in median ADI between participants receiving clinical versus research genetic testing or between those referred by providers versus self-referral. Discussion: ADI inversely correlates with HL and SES. MDR participants had ADI percentiles below the national median and a majority were under the care of diabetes specialists compared to ~15% of the general US population living with diabetes. These findings suggest inequity in who finds and enrolls in the Registry, and mimics the broader RD literature. Efforts are needed to better reach populations disproportionately affected by health disparities to ensure equity in monogenic diabetes diagnosis and management.

Disclosure

R.G.Son: None. R.N.Naylor: None. S.Uiversity of chicago monogenic diabetes registry : n/a.

Funding

National Institutes of Health (R01DK104942, P30DK020595, K23DK114564, UL1TR000430)
1039-P: Examining Physician Case Studies on Success of Treatment Initiation in Patients with Type 2 Diabetes
Authors: KHOSROVANEH KATHERINE L. , KIM NOA , RAU JACQUELINE , REISS JACOB , HISAMATSU RINA , GRIAUZDE DINA H. , YOUNG LARREA A. , WEISENSEL JULIAN , AIKENS JAMES E. , DIEZ HEIDI L. , RICHARDSON CAROLINE R. , OSHMAN LAUREN
Published: June 2023

Introduction: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan that aims to improve the treatment of diabetes through three initiatives-encouraging increased prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diet (LCD), defined as 80-130 total grams of carbohydrates per day, with patients on an SGLT2i instructed to stay >100g among 264 primary care practices. The aim of this study was to evaluate physician experience prescribing LCD through case studies.

Methods: Each physician participating in MCT2D submitted a case study evaluating their experience implementing MCT2D initiatives. Close-ended questions were assessed using a 4-point scale (Yes, Somewhat, Too Early to Tell, No). Open-ended responses on intervention success were analyzed using a multi-step process of data immersion, generating initial codes, and reorganization.

Results: Physicians prescribed a LCD either alone or in combination with CGM and/or SGLT2i/GLP-1RA in 375 of 970 case studies. More than half (51.5%) reported that the intervention(s) achieved the target outcome. Case studies incorporating all three interventions were associated with greater physician satisfaction with results, as compared to diet alone (p<0.01). Five major themes regarding intervention effectiveness were: glycemic control, weight loss, patient motivation, simplification of medications, and combined benefit of multiple interventions. Improvement of blood glucose was reported in 45.9% of LCD alone cases and in 69.1% of cases that involved all three interventions. An increase in patient motivation to achieve improvement in health was most frequently discussed in cases where diet and CGM were combined (67.3%).

Conclusion: LCD may have a synergistic effect with the use of CGM and newer medications. These exploratory findings require confirmation through future investigations.

Disclosure

K.L.Khosrovaneh: None. H.L.Diez: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. N.Kim: None. J.Rau: None. J.Reiss: None. R.Hisamatsu: None. D.H.Griauzde: None. L.A.Young: None. J.Weisensel: None. J.E.Aikens: None.
104-LB: Interim Analysis of a Prospective Study Investigating User Satisfaction and Metabolic Outcome of People with T1D Using an Innovative Modular Micropump System
Authors: DAIN ALEJANDRO , MOCERI SANDRA , DAGENBACH NICOLE , REES CHRISTEN , VULCANO CRISTINA , VOGT GERHARD , ETTER TOBIAS J.
Published: June 2023

Aims: People with type 1 diabetes (T1D) can administer insulin by multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Despite proven clinical benefits, the uptake of CSII is still low. Thus, this study investigates the change in treatment satisfaction and metabolic outcome of people with T1D switching from MDI to CSII therapy using an innovative modular micropump system.

Methods: A total of 50 CSII-naive adults with T1D from Argentina were enrolled in a multi-center, prospective, single-armed study for the Accu-Chek® Solo micropump system (ACS). Change in diabetes treatment satisfaction after 13 weeks (mean 108, min 83, max 176 days) was assessed by the “Impact and Satisfaction” section of the Diabetes Technology Questionnaire (DTQ) as primary outcome. In addition, changes in the DTQ after 1 year and the HbA1c after 13 weeks and 1 year were measured.

Results: The change score of the “Impact and satisfaction” part of the DTQ was 113.37 ± 16.74 (mean ± SD, p < 0.0001) after 13 weeks and 111.42 ± 14.42 (p < 0.0001) after 1 year (with 90 as non-change score). Based on predefined sub-categories, the following mean DTQ change scores were measured after 13 weeks / 1 year: 3.81 ± 0.61 / 3.79 ± 0.52 for “diabetes distress and burden”, 3.96 ± 0.68 / 3.98 ± 0.60 for “hypoglycemia fear, worry and behavior”, 3.56 ± 0.71 / 3.53 ± 0.52 for “device acceptance and satisfaction” (1 = much worse, 5 = much better). The mean HbA1c decreased from 8.20 % ± 1.34 to 7.92 % ± 1.18 (-0.28 %pt, p = 0.0341) after 13 weeks and 7.87 % ± 1.26 (-0.37 %pt, p = 0.0467) after 1 year. Thereby, one event of severe hypoglycemia and diabetic ketoacidosis (DKA) was reported during 17520 device days.

Conclusion: The switch from MDI to CSII using the ACS led to a significant improvement of subjects’ treatment satisfaction and HbA1c. Effects were already measurable after 13 weeks and continued through 1 year indicating that using the ACS reduces disease burden among people with T1D.

Disclosure

A. Dain: None. S. Moceri: Employee; Roche Diabetes Care. N. Dagenbach: Employee; Roche Diabetes Care. C. Rees: Employee; Roche Diabetes Care. C. Vulcano: Employee; Roche Diabetes Care. G. Vogt: Employee; Roche Diabetes Care. T. J. Etter: None.
104-OR: Identifying Painful Diabetic Neuropathy Subtypes from Resting-State Functional Magnetic Resonance Brain Imaging—A Novel Unsupervised Machine Learning Approach
Authors: SELVARAJAH DINESH , TEH KEVIN , ANANDHANARAYANAN APARNA , SLOAN GORDON P. , TESFAYE SOLOMON
Published: June 2023

The use of neuroimaging methods to develop biomarkers in painful DN have yielded promising results but have yet to demonstrate clear clinical utility. Our aim was to delineate the biological heterogeneity in painful DN by first defining the functional connectivity subtypes in patients then assessing the clinical significance with respect to prediction of treatment outcomes.

Methods: 82 painful-DN subjects and 36 HV underwent resting-state functional MR imaging (RS-fMRI). Painful-DN subjects were divided into training (n=48) and testing (n=34) datasets. Clinical pain subtypes were identified by analysing, via unsupervised, machine learning (k-means algorithm), the RS-fMRI functional connectivity of key somatosensory/nociceptive brain regions. Patients in our testing dataset were divided into responders (VAS<4; n=23) and non-responders (VAS>4; n=11).

Results: RS-fMRI functional connectivity defines two clinically relevant painful-DN subtypes. The two subtypes were characterised by strong functional connectivity differences in the postcentral (p<0.001, 95%CI=0.22:0.65) and precentral (p=0.002, 95%CI=0.15:0.59) parietal cortex functional connectivity. The interhemispheric connectivity between homologous regions was also notable. RS-fMRI functional connectivity differences in the default mode network (p=0.002;95%CI=-0.35:-0.08) was also identified. The performance of our unsupervised k-means model to predict treatment response was accuracy=0.77, recall=0.83, precision=0.83 and an AUC=0.73.

Conclusion: We have identified neurobiological markers of painful DN subtypes from brain functional connectivity using an unsupervised data-driven approach. The subtype whose functional connectivity differed most from HV failed to respond to neuropathic pain treatment. External validation on a large independent dataset is now required to confirm future clinical utility.

Disclosure

D.Selvarajah: None. K.Teh: None. A.Anandhanarayanan: None. G.P.Sloan: None. S.Tesfaye: Advisory Panel; Bayer Inc., Wörwag Pharma GmbH & Co. KG, Angelini, Speaker's Bureau; Viatris Inc., Nevro Corp., Procter & Gamble, Novo Nordisk, Berlin-Chemie AG.

Funding

National Institute for Health and Care Research Efficacy and Mechanisms Evaluation; European Foundation for the Study of Diabetes
1045-P: Walking the Talk—Improving Use of the T1D Exchange Quality Improvement Portal Using QI Methodology
Authors: MUNGMODE ANN , ELISHA VICTOR , FOGEL NAOMI R. , KIESOW BECKY L. , O'MALLEY GRENYE , CLEMENTS MARK A. , SCOTT MARY L. , INDYK JUSTIN A. , PAT GALLAGHER MARY , GANDHI KAJAL , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI
Published: June 2023

Background: The T1D Exchange QI Collaborative (T1DX-QI) is a network of over fifty endocrinology centers improving type 1 diabetes (T1D) care using QI. Participating centers have access to the QI Portal, an EMR-based data platform to chart and benchmark T1D outcomes. It is a valuable tool for population health and supports use of data to inform clinical QI projects. We aim to demonstrate the use of QI science to increase centers’ QI Portal use.

Methods: Users are classified into Tiers based on their cumulative monthly QI Portal log-ins (Tier 1 = one month or never; Tier 2 = 2 or 3 months total; Tier 3 = 4 or more months total). This measure describes regularly (monthly) use. For this analysis, new users (user accounts younger than 3 months) are not included to establish true use.

Results: The QI Portal has achieved consistent user growth through this project. As users transition from Tier 1 to Tier 3, the latter tiers expand as users consistently use the QI Portal, with a 12% increase in more experienced Tiers (Tiers 2 and 3; Figure 1a). Figure 1b depicts a ~48% increase in the percentage of Tier 3 users since the project started in July 2022 and annotates four Plan-Do-Study-Act (PDSA) cycles.

Conclusion: The T1DX-QI portal usage improved through QI science. These efforts support T1DX-QI centers in more routine use of actionable data and outcomes benchmarking for clinical process improvement.

Disclosure

A.Mungmode: None. K.Gandhi: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. V.Elisha: None. N.R.Fogel: None. B.L.Kiesow: None. G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. M.L.Scott: None. J.A.Indyk: None. M.Gallagher: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1047-P: Evaluating Discharge Prescription Errors and the Clinical Impacts in Patients with Insulin-Treated Diabetes Mellitus in a Community Hospital
Authors: KESKINKILIC AYSE N. , KORYTKOWSKI MARY T. , MON SANN
Published: June 2023

Introduction: Transitioning patients with insulin treated diabetes (ITDM) at time of hospital discharge is identified as a source of error in how information for home management is provided that can contribute to significant adverse health outcomes. To address this, we conducted a quality improvement project investigating the safety of current discharge procedures in our hospital and the impact on glycemic control at 3 months and diabetes related readmissions at 3 and 6 months.

Methods: We retrospectively analyzed discharge prescription errors in patients with ITDM in a community hospital between January 2020 and December 2021. Errors were defined as being discharged on the wrong form of insulin (pen vs vial), and/or not being provided appropriate insulin administration devices (i.e., pen needles or syringes). Data was collected by reviewing discharge summaries, discharge medication reconciliations and pharmacy records.

Results: Among 75 patients with ITDM (62 (82%) T2DM, 12 (16%) T1DM, 1 (1%) ketosis-prone DM), errors were noted in 73 (97%) patients. 46 (63%) were discharged on wrong form of insulin and 67 (91%) were discharged without appropriate insulin administration devices. Among those 73 patients, 19 (26%) patients had an increase in HbA1c at 3 months (8.7 vs 10.03, p=0.001); 5 (25%) and 8 (24%) had 30-day and 90-day diabetes-related hospital readmissions, respectively. In 2 patients with appropriate discharge, there were no 30-day or 90-day hospital readmissions.

Conclusion: Prescription errors in patients with ITDM at discharge are common and potentially remediable and lead to hospital readmissions and poor glycemic control. These results demonstrate the need for increased awareness among providers through adoption of standardized discharge insulin order sets in EMR system including the form of insulin, insulin administration devices and supplies as well as for early post-discharge follow up with endocrinology.

Disclosure

A.N.Keskinkilic: None. M.T.Korytkowski: None. S.Mon: None.
105-LB: Safety and Performance of an Advanced Hybrid Closed-Loop (AHCL) Algorithm with Ultra-rapid Lispro (URLi) and Lispro
Authors: POLLOM ROBYN K. , NOSEK LESZEK , VEIT COESTER HANS , ZIJLSTRA ERIC , GHOSH ARITRA , HAIDAR AHMAD , JONES RICHARD , LEOHR JENNIFER , GLEISSNER STEPHANIE E. , DASSAU EYAL , KATZ MICHELLE
Published: June 2023

Tuning a multi-model predictive control AHCL algorithm to the PK/PD properties of URLi may result in improved performance vs Lispro with no increased safety concerns.

This was a randomized, double-blind, inpatient, 2-period crossover study in 22 adults with T1D on insulin pumps. Each URLi and Lispro treatment period had a 4-day inpatient visit with insulin doses calculated using the tuned AHCL algorithm. To challenge the algorithm, tests included unannounced exercise, 1 hr delayed bolus, underbolus, and overbolus.

Participants (59% male) had mean ±SD age 43.4±13.77 years, T1D duration 25.9±9.61 yrs, and HbA1c 7.6±0.47%. Mean time in range (TIR; 70-180 mg/dL) during the overall inpatient period: URLi 79.4%; Lispro 78.7 % (p=0.80) with a trend towards decreased time <70 mg/dl (1.5 vs 2.4, p=0.08) for URLi. URLi had a significant difference in Level 1 hypoglycemia (30 vs 55 events, p = 0.01) but not Level 2 (4 vs 9 events, p=0.3). TIRs were similar including during meal/challenge periods (Table) with a trend towards greater TIR during the postprandial period and reduced time <70 mg/dl during exercise for URLi. There was greater TIR during overbolus with Lispro. No severe hypoglycemia events occurred.

Results suggest reduced hypoglycemia with URLi vs Lispro with comparable glycemic control. The AHCL algorithm showed promising glycemic performance in a supervised setting when used with URLi or Lispro.

Disclosure

R. Pollom: None. E. Dassau: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Katz: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. L. Nosek: None. H. Coester: None. E. Zijlstra: Other Relationship; Eli Lilly and Company, Speaker's Bureau; Gan & Lee Pharmaceuticals, Novo Nordisk A/S. A. Ghosh: None. A. Haidar: Consultant; Eli Lilly and Company, Other Relationship; Bigfoot Biomedical, Inc., Research Support; Adocia, Dexcom, Inc., Tandem Diabetes Care, Inc. R. Jones: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J. Leohr: None. S. E. Gleissner: None.
1051-P: Provider Diabetes Diagnosis Predicts Prescribing Bias towards Continuous Glucose Monitoring Devices
Authors: SCOTT MARY L. , SCHMITT JESSICA
Published: June 2023

Methods: The EMR was queried to identify patients with type 1 diabetes identified by ICD 10 codes (E10.xx) seen in the diabetes clinic from January 2019 to Dec 2019. We defined use of a continuous glucose monitor (CGM) as documentation of ICD-10 code Z96.49 (presence of other endocrine implant) or documentation of CGM start in the EMR's health manager, the two ways staff identified CGM use in 2019. Statistical analysis performed using SAS 9.4 (R).

Results: In 2019, we analyzed our baseline CGM prescribing data in preparation for an equity project. We found that pediatric providers (MD and CRNP) who carried a diagnosis of Type 1 Diabetes were prescribing these devices to patients at a higher rate (25.41%) than those without diabetes (14.72%) at UAB. If your diabetes provider had diabetes: your odds of having a CGM prescribed were 1.7 (CI: 1.4-2.1) times higher than if your provider did not have diabetes (p<0.0001). At the time, 6 of our 22 providers had T1D. Discussion: One may postulate that familiarity with the disease and its impact on everyday life as well as general experience with the use of these devices were major contributors to the prescribing bias. We discussed this data with our division and distributed it to providers via email in an effort to improve overall rates of CGM use for our patients. Hands on tutorials were also done with our pump nurses to help providers better understand the technology.

Disclosure

M.L.Scott: None. J.Schmitt: None.
1052-P: Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: O'MALLEY GRENYE , OGYAADU SELASSIE J. , LEVISTER CAMILLA , RIOLES NICOLE , HARDISON HOLLY , ROBERTS ALISSA J. , ACCACHA SIHAM , GUTTMANN-BAUMAN INES , VENDRAME FRANCESCO , BASINA MARINA , FALLURIN RESHMITHA , LEVY CAROL J. , COLLABORATIVE T1DX-QI
Published: June 2023

Background: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception HbA1C is not uncommon and increases maternal and fetal risks. Due to limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1DX-QI survey.

Methods: The annual T1DX-QI survey was conducted August-September 2022 with a site response rate of 94% of 50 sites: 33 pediatric (66%), 17 adult (34%). Respondents answered questions relating to clinic resources and practices. Response data was cleaned and summarized.

Results: Most sites report discussing contraception (74%) and pregnancy planning (72%) once a year or more. Of pediatric sites, 42% report always asking about menstruation history compared to 6% of adult sites. Only 12% of adult and 6% of pediatric sites have a formal preconception counseling protocol. Only 12% of adult and 9% of pediatric sites estimated that >80% of their patients of childbearing potential were using contraception, and all sites estimated that <60% had a HbA1C under 7%.

Conclusions: Though most sites report discussing contraception and pregnancy planning, estimated rates of formal counseling programs, contraception use and attaining goal HbA1C remain low. QI efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes.

Disclosure

G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Basina: None. R.Fallurin: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. T1dx-qi collaborative: n/a. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. N.Rioles: None. H.Hardison: None. A.J.Roberts: None. S.Accacha: None. I.Guttmann-bauman: None. F.Vendrame: Consultant; Eli Lilly and Company.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1058-P: Pharmacist-Based Coaching within a Specialty Diabetes Center Improves Outcomes for Uncontrolled Diabetes
Authors: MALKANI SAMIR , HAAS RICHARD A. , SHAH VRUSHALI , SHARMA HINAL , PUGLIESE GABRIELLA , BARRY CHERYL , PIZ LILLIAN , MCELNEA WILLIAM
Published: June 2023

Coaching programs have been shown to improve diabetes outcomes. We investigate a novel approach where pharmacists, trained in diabetes care, provide coaching for patients in poor control. Coaches addressed all aspects of diabetes care, yet the program was cost-neutral to clinical operations. The UMass Memorial Diabetes Center of Excellence clinic follows ~10,000 patients. We provide interdisciplinary team-based care by endocrinologists, NPs, CDCESs and nutritionists. Those with HbA1c ≥9% over two consecutive visits, despite best efforts by the team, were referred to the “Care Coach” program. Coaches had an initial in-person visit followed by weekly (or where appropriate less frequent) phone visits. Benefits from frequent interaction with the Coaches (Table) came from: 1) Medication management: improved medication adherence and rapid adjustments between visits; 2) Assistance with lowering drug costs; 3) Diabetes technology: greater adoption of CGM and fingerstick testing; 4) Motivational support for dietary and exercise goals; 5) Efficient modification of care plans by integrating the Coach within the care team; 6) Better patient engagement in their care plan. The program is financially self-sustaining as coaches are employed by the hospital associated Shields Health Solutions Specialty Pharmacy and funding for Coach salaries is generated via patient prescriptions and 340B program.

Disclosure

S.Malkani: None. R.A.Haas: None. V.Shah: None. H.Sharma: None. G.Pugliese: None. C.Barry: None. L.Piz: None. W.Mcelnea: None.
1063-P: Impact of Mobile Messaging on Follow-up and Glycemic Control in the Indian Population
Authors: SABOO BHARAT , SABOO SHWETA , CHAVDA VIPUL , HASNANI DHRUVI
Published: June 2023

Introduction: Diabetes treatment requires the involvement of people with diabetes in the form of regular clinical follow-up for good Glycaemic control and Metabolic health. Newer Communication techniques, such as mobile messaging are now finding their way into diabetes care and treatment. It can assist diabetes patients to maintain a regular follow-up routine and can assist in glycemic control.

Materials and Methods: A total of 326 patients were selected by random sampling. They were of age 15-65 years with T1DM and T2DM.

Inclusion Criteria: 1. Known case of DM 2. Consent to receive messages

Exclusion criteria: 1. Not consenting for messaging 2. Reading Disability. Randomly allocated to two groups of 163 persons each. In the first group, the participants were sent regular messages to remind them of their follow-up dates. The other group was treated as usual and was allowed to come for follow-up on their own. The participants were monitored for follow-up frequency, meeting testing deadlines and resultant glycemic control measured by Hba1c at 3 months and 6 months. The results were tabulated and analysed using SPSS.

Result: 17 patients each dropped out from the messaging group and 16 patients dropped out from routine care groups, out of the remaining 297 patients the analysis of data shows: in the messaging group, 63 % maintained their follow-up dates as compared to 42 % in the other group. The number of patients achieving the target goal of 7% HBA1C was better in the messaging group (54%) as compared to the routine group (31%). Blood sugar testing frequency was better in the messaging group as compared to other group.

Discussion: With the advent of newer modalities of communication, the ways and means to communicate with patients has improved. These tools if used correctly can not only improve follow-ups but at the same time increase the connection between caregivers and patients. This also can result in better patient outcomes and will lead to reduced complications and financial implications.

Disclosure

B.Saboo: None. S.Saboo: None. V.Chavda: None. D.Hasnani: None.
107-OR: Association of Diabetic Retinopathy with A1C and Glucose Management Indicator Discordance
Authors: BOVEE LAURA , PERLMAN JORDAN , GOOLEY TED , HIRSCH IRL B.
Published: June 2023

Background: Past analyses have shown significant discordance between glycated hemoglobin (A1C) and glucose management indicator (GMI). This study uses a glycation ratio (GR) defined as GMI/A1C and evaluates the association of this ratio with microvascular complications in 661 patients with diabetes.

Methods: A retrospective review was done of patients with diabetes using CGM who were seen at the University of Washington (UW) Diabetes Care Center from 2012-2019. All patients had A1C and sensor data obtained fewer than 4 weeks apart. Positive discordance was defined as GMI/A1c <0.9.

Results: This study included 661 patients of whom 90% had type 1 diabetes with a mean duration of current CGM use of 24.7 days (+/- 7.9 days). Positive discordance was found in 29.9% of participants and was associated with retinopathy (OR 2.05, CI 1.33-3.14) and nephropathy (OR 2.83, CI 1.68-4.77). The data were modeled as a continuous nonlinear function revealing an inverse relationship between GMI/A1C and diabetic retinopathy.

Discussion: In this study positive discordance conferred a more than two-fold increased risk for diabetic retinopathy and nephropathy. Modeling of GMI/A1C as a continuous variable upheld this relationship for diabetic retinopathy. These data suggest that GMI/A1C ratios may allow for identification of patients at increased risk for microvascular complications.

Disclosure

L.Bovee: None. J.Perlman: None. T.Gooley: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc.
1073-P: Intensive Management of Poorly Controlled Type 2 Diabetes Using a Multidisciplinary Approach and Continuous Glucose Monitoring
Authors: BEHNKE ANDREW , WOODFIELD DAVID
Published: June 2023

Aims: The purpose of this study was to examine the effects of a weekly monitoring and interaction program using continuous glucose monitoring in a population of poorly controlled patients with type 2 diabetes.

Methods: This study was conducted in the outpatient clinical setting and examined levels of hemoglobin A1C and time in range glucose levels for 16 patients with poorly controlled type 2 diabetes as indicated by a hemoglobin A1C level of greater than 75 mmol/mol (10%). The intervention included use of a continuous glucose monitor (CGM)and weekly interactions either virtually or by telephone by one of the team members.

Results: After a 3 month period, hemoglobin A1C levels reduced from 95 mmol/mol (11.79%) to 52 mmol/mol (7.88%) (p<001) with 100% of the subjects achieving hemoglobin A1C of less than 75 mmol/mol (10%). There was no significant changes in the amount of additional diabetes medication or insulin dose.

Conclusions: The combination of continuous glucose monitoring and frequent interaction in a brief (three months) time frame may be a significant tool to improve glucose control in this high risk population.

Disclosure

A.Behnke: None. D.Woodfield: None.
1076-P: Weight Loss, Patient Activation Measure (PAM) Change, and Outpatient Medical Utilization after a Telephonic DPP-Adapted Lifestyle Intervention for Older Adults
Authors: VENDITTI ELIZABETH M. , KANTER JUSTIN , WILLIAMS KELLY R. , CWENAR ELIZABETH , LIANG QINGFENG
Published: June 2023

Diabetes Prevention Program (DPP)-adapted interventions reduce cardiometabolic risk in adults 60+ with overweight/obesity and prediabetes. Healthcare systems have increasingly adopted such programs and are interested in whether program induced patient activation (normalized PAM® score change) and/or weight loss impacts outpatient medical utilization. After a 6-month telephonic DPP lifestyle program, claims data were examined for N = 81 participants with obesity/prediabetes [71% female, 88% non-Hispanic white, mean baseline age (SD) 68.0 (5.1) and BMI 39.5 (6.7)] covered by a large, regional payer. Linear regression models, adjusted for participant sex, estimated 0-6-month changes in weight and normalized PAM score with the number of primary care (PC) and specialty care (SC) visits over the next 12 months for members with >9 months of payer coverage. No relationship was shown between PAM change and number of PC or SC visits or weight loss and PC visits. A non-significant trend (p=0.079) was observed for greater weight loss [median kg (IQR) -6.25 (-3.55, -9.7)] being associated with fewer SC visits [median visits (IQR) 5 (2,10)]. These pilot data have limitations but suggest further investigation of DPP-adapted weight program outcomes and patterns of healthcare service use is warranted given the potential for lower utilization and costs.

Disclosure

E.M.Venditti: None. J.Kanter: None. K.R.Williams: None. E.Cwenar: None. Q.Liang: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114115)
108-OR: Clinical and Biochemical Factors Are Inversely Correlated in Diabetic Retinopathy and Age-Related Macular Degeneration
Authors: FICKWEILER WARD , MARTIN JACOBA CRIS , VISHVA TEJA JANGOLLA SURYA , GAUTHIER JOHN , ZIEMNIAK NOLAN A. , WU I-HSIEN , CAVALLERANO JERRY D. , AIELLO LLOYD P. , SUN JENNIFER , KING GEORGE L.
Published: June 2023

Although diabetic retinopathy (DR) and age-related macular degeneration (AMD) are the two most common sight-threatening conditions in the elderly population, our understanding of the associated risks for these diseases have not been studied. Thus, we examined the association between AMD and DR in people with type 1 and type 2 diabetes from the Joslin 50-Year Medalist Study, composed of individuals who have had insulin-dependent diabetes for 50 years or longer and Beetham Eye Institute. In Medalists, there was an inverse association between DR severity and the presence of AMD (N=1163, P=<0.0001, AMD: 23.4%, 18.6, 7.9% for no-mild, moderate-severe, and proliferative DR, respectively). Similarly, the presence of AMD was associated with milder DR in the BEI cohort (N=58, P=0.004). There were no eyes with neovascular (severe AMD). The presence of AMD was associated with older age (P=0.03), increased diabetes duration (P<0.0001), less severe DR (P<0.0001), and the absence of neuropathy (P=0.003). In contrast, younger age (P=0.02) and the presence of neuropathy (P<0.0001) were associated with the presence of proliferative DR. Higher vitreous retinol-binding protein 3 (RBP3) to vascular endothelial growth factor (VEGF) ratios were associated with AMD and less severe DR in both postmortem Medalist and surgical BEI samples (N=187, P<0.05, all). The presence of milder DR was associated with increased risk of AMD development (24.8%, 10.0%, 5.0% for no-mild, moderate-severe, and proliferative DR, respectively, P=0.047), and risk of DR progression was decreased in eyes with versus without AMD (P=0.04) in a subset of Medalists with longitudinal follow up (22.9%). These novel findings that the inverse risk of DR and AMD is not likely due to similar pathogenic mechanisms and ageing factors. Further studies are needed to clarify the interactions between AMD and DR, that may provide new pathways to target against their development.

Disclosure

W.Fickweiler: None. G.L.King: Research Support; Janssen Research & Development, LLC. C.Jacoba: None. S.Jangolla: None. J.Gauthier: None. N.A.Ziemniak: None. I.Wu: None. J.D.Cavallerano: None. L.P.Aiello: Consultant; KalVista Pharmaceuticals, Inc., Novo Nordisk, MantraBio, Ceramedix, Research Support; Optos plc., Stock/Shareholder; KalVista Pharmaceuticals, Inc. J.Sun: Research Support; Adaptive Sensory Technology, Boehringer Ingelheim Inc., Roche Pharmaceuticals, Janssen Pharmaceuticals, Inc., Physical Sciences, Inc, Novo Nordisk, Optovue, Incorporated.

Funding

American Diabetes Association (7-21-PDF-022 to W.F.); National Eye Institute (R01EYE26080-01); National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK09433301); JDRF (17-2013-310); Dianne Nunnally Hoppes Fund; Beatson Pledge Fund
1081-P: Redesigning Diabetes Care for Treatment Inertia
Authors: HATIPOGLU BETUL , BLANCHETTE JULIA E. , OZTURK RONYA , FETZNER JILLIAN , PRONOVOST PETER
Published: June 2023

Background: As 90% of those with diabetes see primary care, there is opportunity for collaborations to address clinician-level therapeutic inertia. The Diabetes Inertia Collaborative (DIC) is a primary and diabetes specialty care partnership to address lack of time, availability, and increase confidence in clinical recommendations. A diabetes specialty team (endocrinologists, CDCES, RN, RD, NPs) roundtable group reviewed and referred patients to Team-Based Care Pathways (Table 1).

Methods: A prospective pilot QI was conducted at an academic center with a Population Health Accountable Care Organization. Those with A1c >7.0% on the employee health plan were identified through an enterprise data warehouse population health dashboard. Preliminary pre-post evaluation of clinical outcomes (A1c) over six months was conducted for the first 494 participants (N=1065 total) enrolled.

Results: N=494 were mean 54.38 (SD 10.85) years with A1c of 9.4% (1.74) at baseline. Most were White (n=307, 62.1%), non-Hispanic (n=445, 90.1%), and male sex (n=260, 52.6%). Overall, A1c decreased pre-post-intervention (-0.77%, 95% CI [-0.60,-.94]). Multiprogram (-0.55%, CI [-0.11, -0.99]), Pharmacy (-1.01%, CI [-0.61, -1.42]), Milestones (-1.52%, CI [-0.89, -2.14]) and PCP (-0.85%, CI [-0.53, -1.18]) had a significant A1c decrease.

Conclusion: The DIC was well received and adopted by primary care, resulting in program referrals as needed and improved A1c from baseline.

Disclosure

B.Hatipoglu: None. J.E.Blanchette: Advisory Panel; LifeScan Diabetes Institute, Cardinal Health/Edgepark, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists, Speaker's Bureau; Insulet Corporation. R.Ozturk: None. J.Fetzner: None. P.Pronovost: None.