bluuebunny/crossref_metadata_2025_split huggingface dataset:
1206-P: Preventable and Other Emergency Department Use in Adults with and without Diabetes, 2009-2017
Authors: UPPAL TEG S. , HAW JEEHEA SONYA , SHAH MEGHA K. , TURBOW SARA , NARAYAN VENKAT K.M. , ALI MOHAMMED K. 
Published: June 2020

There are limited data comparing trends in overall and potentially preventable emergency department (ED) visits between adults with and without diabetes. We analyzed data from the Medical Expenditure Panel Survey and pooled cohorts for years 2009-12 and 2014-17. We identified adults with diabetes by self-report, diabetes-specific ICD-codes, or prescriptions for antidiabetic agents. Potentially preventable visits were identified using ICD-codes specific to Ambulatory Care Sensitive Conditions (ACSCs), a list of conditions that can be prevented by primary care interventions (e.g., Urinary Tract Infection, Heart Failure, and Bacterial Pneumonia). We used event-level data to estimate weighted age- and sex-adjusted rates of average annual ED visits per 1000 persons and calculated standardized rate ratios by years and diabetes status. Compared to 2009-12, rates of ED use were higher among adults without diabetes in 2014-17 compared to 2009-12 (RR: 1.11). Compared to 2009-12, adults with diabetes in 2014-17 had no significant change in rates of ED use. In 2014-2017, compared to adults without diabetes, those with diabetes had twice the rate of ED service use (RR: 2.07) and had a 47% higher rate of preventable visits (RR: 1.47). Further research is required to understand factors that might be associated with the higher rates of ED use among people with diabetes.

Disclosure
T.S. Uppal: None. J. Haw: None. M.K. Shah: None. S. Turbow: Research Support; Self; Gilead Sciences, Inc. K. Narayan: None. M.K. Ali: Research Support; Self; Merck & Co., Inc.
1237-P: The Type 1 Diabetes Identification Initiative: Improving the Care of Inpatients with Type 1 Diabetes
Authors: LOVERIDGE REBECCA , TORKAMANI NILOUFAR , PATTERSON SIMONE L. , CHURILOV LEONID , EKINCI ELIF I. 
Published: June 2020

Background: Specialist care may improve outcomes for inpatients with diabetes. However, research specific to type 1 diabetes (T1D) is lacking. We aimed to investigate whether automatic alerts from the Electronic Medical Record (EMR) enable prompt review of inpatients with T1D by a specialist diabetes team.
Methods: The type 1 diabetes identification (“T1DI”) initiative was established to improve identification and review of inpatients with T1D by a specialist diabetes team. A specific T1DI code was entered into the EMR of patients with T1D. On subsequent admission, the specialist diabetes team received an automatic message and generated a list of inpatients requiring review. “T1DI” admissions of more than 1-day were analysed over a 1-year period (1 January-31 December 2018). The control group was T1D admissions as coded by health information services following discharge. Analysis was performed for patients admitted to units other than endocrinology to investigate review outcomes. Data was analysed using Chi2 (categorical), Wilcoxon rank sum (continuous) and random effects logistic or negative binomial regression models.
Results: There were 136 admissions of adults with T1D over the study period (T1DI n=67, control n=69). The median age was 49 (IQR 33-64) years; 53% were females. Specialist diabetes team review was more common in the T1DI cohort compared to the control group (endocrinology review AOR 10.27, CI 2.26-46.55, P=0.003; diabetes education review AOR 7.22, CI 2.73-19.10, P&lt;0.001). Prompt endocrinology review (no later than day 2 of admission) was more likely in T1DI inpatients (AOR 2.77, CI 1.15-6.65, P=0.023).
Conclusion: The T1DI initiative was associated with improvements in occurrence and timing of specialist diabetes team review for inpatients with T1D. This initiative could be implemented in other hospitals with EMR systems, enabling more effective identification and management of T1D in the inpatient setting.

Disclosure
R. Loveridge: None. N. Torkamani: None. S.L. Patterson: None. L. Churilov: None. E.I. Ekinci: None.
1281-P: Pilot Study on the Feasibility of Weekly CGM Data Review in Youth with New-Onset Type 1 Diabetes
Authors: LEE MING YEH , LEVERENZ JEANNINE , LEVERENZ BRIANNA , PAGELER NATALIE M. , SCHEINKER DAVID , MAAHS DAVID M. , PRAHALAD PRIYA 
Published: June 2020

Despite advances in diabetes technology and treatment, many youth with type 1 diabetes (T1D) continue to have hemoglobin A1c (HbA1c) above target. Consistent use of continuous glucose monitors (CGM) improves HbA1c and time in range (TIR 70-180 mg/dl) glucose, while minimizing hypoglycemia in youth with T1D. A previous study suggested that long-term HbA1c outcomes may be determined early in the course of T1D. Thus, increased awareness of glucose trends and frequent insulin dose adjustments early in the course of T1D is hypothesized to improve long-term HbA1c and health outcomes. We have initiated CGM in the first month of T1D diagnosis. In March 2019, we added weekly remote review of CGM data by a pediatric endocrinologist or certified diabetes educator to provide dose adjustments. Data sharing is facilitated by using a custom platform including Apple HealthKit to transmit data from the Dexcom G6 mobile app to Epic MyChart. Inclusion criteria were diagnosis of T1D within the past 30 days and intention to follow in our clinic. During the initial 8 months of this study, we enrolled 43 youth (age at diagnosis 9.2±4.2 years, 57% male, 78% on private insurance, 42.5% non-Hispanic White, initial HbA1c 12.0±2.0%). Twenty-eight youth had at least 1 documented data review with an average of 15.8±8.1 reviews/patient and 5.4 dose adjustments/youth (∼1 dose adjustment every 3 weeks) via phone calls or secure MyChart messages. Based on CGM downloads, users had a high percentage of time of CGM wear (88±11% of time over 2-week periods), high percentage of TIR glucose (72.2±18.4%), and low incidence of hypoglycemia (32±54 min/day, 2.2±3.8%). This pilot study demonstrates that implementing routine data review as part of a new onset program increases the frequency of insulin dose adjustments. Tools should be developed to allow for efficient data review for population health management. Further follow up is needed to determine long-term outcomes, scalability, and sustainability of this new onset program.

Disclosure
M. Lee: None. J. Leverenz: None. B. Leverenz: None. N.M. Pageler: None. D. Scheinker: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. P. Prahalad: None.

Funding
Stanford Diabetes Research Center (P30DK116074)
1287-P: Psychosocial and Racial Predictors of Hemoglobin A1c in Teenagers with Type 1 Diabetes Mellitus
Authors: GUARNERI ALISSA , SINHA SUNIL K. , HONG K. MING , HOFFMAN ROBERT P. 
Published: June 2020

Background: Glycemic control (HbA1c) in teens with type 1 diabetes mellitus (T1DM) can be affected by several variables including race, insurance type, depression (PHQ-9 score), and diabetes distress (Paid-T score). This analysis sought to explore how these variables interact to affect HbA1c.
Methods: 301 patients with T1DM age 13 years and older were grouped by race (white = W, African American = AA, bi-racial = BR) and by insurance type (State Insurance = SI, or Private Insurance = PI). Mean HbA1c values were calculated according to race and insurance type. Analysis of Variance (ANOVA) testing was done to evaluate for any differences in HbA1c and race. Tukey’s Test was then performed to evaluate for a statistical difference between individual race variables (W, AA, BR).
Results: Mean HbA1c significantly varied by race (W 8.7 ± 0.1, AA 10.3 ± 0.5, BR 8.8 ± 0.5%, p&lt;0.001 (mean ± SEM)). Tukey’s Test proved a statistically significant difference in HbA1c in AA compared with W (p&lt;0.001) and in AA compared with BR (p=0.036), however there was not a significant difference in HbA1c in W compared with BR (p=0.976). HbA1c also differed in those with PI (8.3 ± 1.6) versus SI (9.7 ± 2.3), p&lt;0.001 (mean ± SD). Diabetes distress scores (30.4 ± 16.3 in SI, 25.1 ± 13.2 in PI) and depression scores (4.6 ± 5.0 in SI, 2.3 ± 3.5 in PI) were greater in patients with SI versus PI, however there were no racial differences. ANOVA testing showed that there is no racial difference in depression score (p=0.284) or in distress score (p=0.201). When all factors were considered together, insurance status and distress score had the highest impact on HbA1c (p&lt;0.001), depression score had a mild impact (p=0.02), and race was not significant (p=0.08).
Discussion: These results demonstrate that psychological factors such as diabetes distress and depression, and socioeconomic factors such as insurance status, have a bigger impact on HbA1c than race in teens with T1DM.

Disclosure
A. Guarneri: None. S.K. Sinha: None. K. Hong: None. R.P. Hoffman: Research Support; Spouse/Partner; Provention Bio, Inc.
1319-P: Evaluation of Engagement with an Incentivized Text Messaging (TM) Intervention in Teens with T1D and Suboptimal Glycemic Control
Authors: KAUSHAL TARA , LIPMAN TERRI , KATZ LORRAINE E. , LAFFEL LORI M. 
Published: June 2020

Background: Among digital health interventions, TM can be a useful tool in teens with T1D. However, attrition remains a major issue, with engagement decreasing over time. We aimed to describe patterns of engagement in an incentivized TM intervention and to assess impact of engagement on A1C in teens with T1D and suboptimal control randomized to the TM arm.
Methods: Of 165 teens (12-18 years old, T1D duration &gt;1 year, A1C ≥8%) recruited into a 6-month RCT, 83 were assigned to TM intervention and received daily educational/motivational TMs using the MyDiaText™ platform. Socio-demographic and clinical data were obtained from medical record review. Participants were rewarded biweekly for the most consecutive TM responses. TM response rate (RR) was defined as number of responses/total messages received. High RR was defined as &gt;50%. Paired t-tests, ANOVA, and Pearson correlation were used in statistical analysis.
Results: At entry, teens (57% males, 52% white) had a mean(±SD) age of 16±2 years, T1D duration 7±4 years; 55% were pump-treated, 65% used CGM, and A1C was 10±1.9%. Clinical concerns for depression were seen in 28%. The mean overall RR was 58.6%(±28.9%), and the high RR group included 66% of participants. High and low RR groups did not differ by sex, race, age, T1D duration, use of technology, baseline A1C, or clinical depression. Over the 6 months, A1C improved significantly to 9.2±1.8% (p=0.00), with 35% improving by ≥1%. High responders were twice as likely to improve A1C by ≥1% than low responders (p=0.18). There was a significant decline in RR over time (r2=0.9, p=0.00).
Conclusions: In teens with T1D and suboptimal control, socio-demographic factors did not predict engagement with a financially incentivized TM intervention. However, high responders tended to improve their A1C, likely due to increased engagement in self-care. There remains a need to create a digital health intervention that maintains engagement over extended periods for teens with T1D.

Disclosure
T. Kaushal: None. T. Lipman: None. L.E. Katz: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding
National Institutes of Health (P30DK036836, K12DK094721, 2T32DK063688)
1337-P: Metabolomic Profile Associated with Obstructive Sleep Apnea Severity in Obese Pregnant Women with Gestational Diabetes
Authors: REUTRAKUL SIRIMON , CHIRAKALWASAN NARICHA , CHAROENSRI SURANUT , AMNAKKITTIKUL SOMVANG , SAETUNG SUNEE , CHEN HUI , CHLIPALA GEORGE E. 
Published: June 2020

Background: Obstructive sleep apnea (OSA) is prevalent in obese women with gestational diabetes (GDM). In non-pregnant population, metabolomics profiles have been shown to differ between those with and without OSA. This study explored associations between OSA severity and metabolites in women with GDM.
Methods: Eighty-two obese women with diet-controlled GDM had OSA assessment by a home monitor (mean gestational age, GA, 28 weeks). OSA severity was assessed by apnea hypopnea index (AHI). Metabolic profile was assayed from fasting serum samples via LC-MS using an untargeted approach. The metabolites were extracted and subjected to an Agilent 1290 UPLC coupled to an Agilent 6545 Q-TOF MS. Data were acquired using electrospray ionization (ESI) in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantitate features and these LC-MS features were annotated using the Human Metabolite Database (HMDB) as a reference. The feature data were compared with OSA status, AHI, BMI and GA using limma in R. Correlation analyses of the continuous covariates (AHI, BMI, GA) were performed using Kendall’s Tau test. P-values were adjusted for multiple testing using Benjamini-Hochberg’s FDR correction.
Results: Forty-three women (52.4%) had OSA, with a median AHI of 9.4. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modeling in GA and pre-pregnancy BMI found 12 features that significantly associated with AHI. These features could be annotated to estradiols and phospholipids (e.g., Lysophospholipids, long-chain acyl carnitine, methyl-branched fatty acids) with higher levels related to higher AHI.
Conclusion: Biomarkers including estradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. Targeted approach may help further identify these metabolites to better understand their role in OSA in this population.

Disclosure
S. Reutrakul: None. N. Chirakalwasan: None. S. Charoensri: None. S. Amnakkittikul: None. S. Saetung: None. H. Chen: None. G.E. Chlipala: None.

Funding
National Center for Advancing Translational Sciences (UL1TR002003); Mahidol University
1343-P: Objectively Measured and Self-Reported Physical Activity in the First Trimester of Pregnancy, Glucose Tolerance, and Gestational Diabetes in Women with Overweight/Obesity
Authors: EHRLICH SAMANTHA F. , HEDDERSON MONIQUE M. , BROWN SUSAN D. , CROUTER SCOTT E. , HIBBING PAUL , FENG JUANRAN , TSAI AI-LIN , FERRARA ASSIAMIRA 
Published: June 2020

Data on physical activity (PA) and the risk of gestational diabetes (GDM) are inconsistent. We examined whether physical activity (PA) during the first trimester of pregnancy was associated with glucose tolerance and GDM in women with overweight/obesity. Participants (n=261) were a subsample from the GestationaL Weight Gain and Optimal Wellness (GLOW) trial conducted at Kaiser Permanente Northern California in 2014-2016 to test whether a lifestyle intervention prevents excess gestational weight gain compared to usual care. Participants wore an ActiGraph wGT3X-BT accelerometer for 7 days on the non-dominant wrist to estimate mean daily minutes of moderate to vigorous intensity PA (MVPA), and completed a pregnancy PA questionnaire assessing sports and exercise activity. Plasma glucose values from random 50-g 1-hour glucose challenge tests (GCT) and GDM diagnosed by the Carpenter and Coustan thresholds for the 100-g, 3-hour oral glucose tolerance test were obtained from electronic health records. Associations with PA, by accelerometer and questionnaire (i.e., square root transformed), were estimated by linear and logistic regression models and adjusted for age, race-ethnicity, BMI category, and GLOW randomization (i.e., intervention vs. usual care). Participants had a median 38 minutes per day (IQR= 37) of MVPA by accelerometry and self-reported a median 9 MET hours per week (IQR= 14) of sports and exercise activity on the questionnaire, both assessed at mean 11 weeks’ (SD= 1.4) gestation. Median plasma glucose on the GCT performed at 24-28 weeks’ gestation was 112 mg/dl (IQR= 35); 14 participants (5.4%) developed GDM. Neither PA variable was statistically significantly associated with GCT glucose or GDM (p &gt; .05). Objectively measured MVPA and self-reported sports and exercise activity assessed in the first trimester do not appear to impact glucose tolerance or GDM in women with overweight/obesity.

Disclosure
S.F. Ehrlich: None. M.M. Hedderson: None. S.D. Brown: None. S.E. Crouter: None. P. Hibbing: None. J. Feng: None. A. Tsai: None. A. Ferrara: None.

Funding
National Institutes of Health (K01DK105106)
137-LB: Early Performance Under SGLT2 Inhibitors in High-Risk Patients: EARLY PUSH Study: A Prospective Double-Blind Comparative Study
Authors: DUMARTIN MARINE , FRUNDI DEVINE S. 
Published: June 2020

The purpose of this study was to evaluate the changes in physical performance under new treatment with SGLT2 inhibitors during in-patient rehabilitation over 28 days.
The study included 200 patients with type II diabetes mellitus which were divided in 2 groups of 100 patients: the first group was put under SGLT2 inhibitors and the second group had other diabetic regimen without SGLT2 inhibitors. The 6-minute walk test and the modified Borg scale (Range 0 - 10) were used to assess physical performance and the rate of dyspnea.
Compared to baseline, the change in the mean distance covered in the 6 minute walk test at 14 days in the SGLT2-inhibitor group was +70.1 ± 60.9 m vs. + 55.7 ± 64.8 m in the non SGLT2 inhibitor group; p=0.16. At 28 days, change in the first group was +104.5 ± 76.7 m vs. + 80.8 ± 82.9 m in the second group; p=0.03 (Figure 1) The mean modified BORG scale in the first group at baseline was 5.2 ± 2.3 and declined to 4.8 ± 2.1 at 14 days and further declined to 4.2 ± 2.4 at 28 days; p=0.007, whereas in the second group the BORG scale at baseline was 4.4 ± 2.4 and changed to 4.8 ± 2.2 at 14 days and remained unchanged at 4.8 ± 2.4 at 28 days; p=0.23
In conclusion, the introduction of an SGLT2-inhibitor was associated with a measurable improvement in physical performance and concomitant decline in the rate of perceived exertion within the first month despite having inadequate glycemic control at baseline.

Disclosure
M. Dumartin: None. D.S. Frundi: None.
1447-P: Random Glucose May Be an Effective Tool to Screen for Undiagnosed Diabetes: The Africans in America Study
Authors: SHOUP ELYSSA M. , OSEI-TUTU NANA H. , HORMENU THOMAS , HOBABAGABO ARSENE F. , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , HORLYCK-ROMANOVSKY MARGRETHE F. , SUMNER ANNE E. 
Published: June 2020

The high prevalence of undiagnosed diabetes (DM) in Africa calls for the identification of effective, efficient, and feasible screening tests. Emerging data suggests that random plasma glucose≥100 mg/dL (RPG≥100) may be a valuable screening tool and equivalent to or better than standard ADA criteria, which requires fasting blood samples, knowledge of family history, anthropometrics and blood pressure. Since RPG≥100 as a screening tool for DM has not been tested in Africans, our goals were twofold: first, to compare the diagnostic performance of RPG≥100 to ADA criteria; second, to determine for RPG≥100 the number needed to screen to find a single case of DM. Hence, African-born blacks who self-identified as healthy and were living in America (n=469, 66% male, age: 38±10y (mean±SD), BMI: 27.6±4.5 kg/m2) had random plasma glucose levels measured. One week later, an OGTT was performed. Glucose criteria for the OGTT was used to diagnose DM. Area under the receiver operating characteristic curve (AROC) was used to assess the performance of RPG≥100 and ADA criteria (age≥45y, BMI≥25 kg/m2, HDL&lt;35mg/dL, TG&gt;250mg/dL, SBP≥140mmHg, DBP≥90mmHg, and family history of DM). The number of people needed to screen to correctly identify one case of undiagnosed DM was calculated by the formula: 1/(proportion correctly diagnosed - proportion incorrectly diagnosed). DM was identified in 7% (31/469) of the participants; whereas RPG≥100 occurred in 15% (68/469). For the prediction of DM, RPG≥100 tended to be superior to the ADA criteria (AROC 0.80 vs. 0.68, P=0.09). RPG≥100 was 71% sensitive and 89% specific. ADA criteria was 90% sensitive and 37% specific. For RPG≥100, the number needed to screen to correctly identify a single case of DM was two. Overall, RPG≥100 as a screening tool for DM is effective, more cost-efficient, and less time-consuming than ADA criteria. In short, RPG≥100 may be an important way forward for the detection of DM in Africans and further study is warranted.

Disclosure
E.M. Shoup: None. N.H. Osei-Tutu: None. T. Hormenu: None. A.F. Hobabagabo: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. M.F. Horlyck-Romanovsky: None. A.E. Sumner: None.
1457-P: Clinical, Biochemical, and Genetic Profile of Patients with Young-Onset Diabetes in North India
Authors: REDDY PAVAN K. , JEVALIKAR GANESH , SINGHAL ALKA A. , KAUR PARJEET , GUPTA ADITI , MISHRA SUNIL K. , WASIR JASJEET S. , KUCHAY MOHAMMAD S. , BANSAL BEENA , FAROOQUI KHALID , KAUR HARMANDEEP , MITHAL AMBRISH 
Published: June 2020

Background: Increasing prevalence of diabetes (type 1 and type 2) and obesity along with declining age of onset of type 2 diabetes, often create a diagnostic error in subtyping patients with young onset diabetes. Correct diagnosis of type of diabetes in this age group has clinical implications for management and longterm prognosis. In this study, we aimed to profile all consecutive young onset diabetes patients with respect to their clinical, biochemical, and genetic characteristics.
Material and Methods: In this prospective study, conducted at a tertiary facility, all patients with diabetes onset between 18-30 years and diabetes duration less than 5 years were included. Assessment included detailed clinical and biochemical evaluation, autoantibody testing, c-peptide and genetic screening.
Results: Total 100 patients were studied, out of which 80% were males and 55% were obese. Mean age of onset and median duration of diabetes were 24.98 ± 3.27 years and 18.0 months respectively. Initial clinical presentation was weight loss and osmotic symptoms in 58%, diabetic ketoacidosis in 5% and 25% patients were incidentally diagnosed. 20.8% of clinically autoimmune diabetes patients had negative antibody testing, 35.5% of clinically nonautoimmune diabetes had positive antibody testing. Overall, evidence of autoimmunity and decreased insulin secretion were found in 45% and 45% patients respectively. Ultrasound abdomen revealed small/atrophic pancreas in 9% of patients out of which nearly half did not had history of pancreatitis. Three patients were detected as MODY (1 = HNF1A and 2 = PAX4 mutations). One patient had Wolfram like syndrome (WFS1 mutation), 30 patients had variants of unknown significance.
Conclusion: Evidence of autoimmunity was seen in 45%, monogenic diabetes in 4%, obesity in 55% of the study population. Higher incidence and aggressive nature of diabetes in young individuals are probably due to contributing effect of autoimmunity accompanied by increasing prevalence of obesity.

Disclosure
P.K. Reddy: None. G. Jevalikar: None. A.A. Singhal: None. P. Kaur: None. A. Gupta: None. S.K. Mishra: None. J.S. Wasir: None. M.S. Kuchay: Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. B. Bansal: None. K. Farooqui: None. H. Kaur: None. A. Mithal: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Johnson & Johnson, Lilly Diabetes, Novo Nordisk A/S.