bluuebunny/crossref_metadata_2025_split huggingface dataset:
1048-P: Fasting C-Peptide as a Predictor for Hypoglycemia Risk and HbA1c Reduction in Chinese T2DM Patients Switching from Premixed to Basal Insulin: A Post Hoc Analysis from the Optimization Study
Authors: YANG WENYING , RUAN PENGFEI , ZHANG XIA , CUI NAN 
Published: June 2020

Objective: To explore the predictive effect of baseline fasting C-peptide (FCP) on hypoglycemia risk, HbA1c reduction, and treatment satisfaction in Chinese T2DM individuals switching from premixed to basal insulin.
Methods: Post-hoc analysis of the single-arm, 16 weeks, phase IV OPTIMIZATION study. At 16 weeks, the study showed a mean reduction in HbA1c of 0.51% with basal insulin treatment after switching from premix. Study completers with baseline FCP testing (n=297) were stratified according to HbA1c &lt;7.5% achievement or actual decrease at 16 weeks. In addition, hypoglycemia and patient feelings during treatment using DTSQ score were assessed. Different FCP thresholds were analyzed with Chi-square test and multivariate logistic regression analysis to test whether baseline FCP could be used to predict clinical results.
Results: When looking at efficacy alone, FCP &gt;1.0 nmol/L could be used for predicting a higher probability to reach HbA1c &lt;7.5% (OR=3.83, 95%CI 1.89, 7.73) and higher probability to achieve a HbA1c decrease &gt;0.4% (OR=3.19, 95%CI 1.54, 6.59). By dividing participants using FCP dichotomy, similar results were obtained in people with FCP &gt;0.59 nmol/L. When combined with overall hypoglycemia, both thresholds of FCP &gt;1.0 nmol/L (OR=2.78, 95%CI 1.36, 5.68) and &gt;0.59 nmol/L (OR=1.83, 95%CI 1.01, 3.30) predicted HbA1c &lt;7.5% achievement without hypoglycemia. Similar results were also obtained for predicting both HbA1c&lt;7.5% and better DTSQ score results.
Conclusion: Baseline fasting C-peptide could be used as a biomarker to predict greater HbA1c reduction, less hypoglycemia and better satisfaction in Chinese T2DM people switching from premixed to basal insulin.

Disclosure
W. Yang: Speaker’s Bureau; Self; AstraZeneca, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck and Servier, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi-Aventis. P. Ruan: Employee; Self; Sanofi. X. Zhang: None. N. Cui: None.
1063-P: Effects of Bromocriptine Quick-Release (BCQR) Therapy on Glycemic Control, Insulin Sensitivity, and Vascular Function in Type 1 Diabetes (T1D)
Authors: TELL SHOSHANA , SNELL-BERGEON JANET K. , VIGERS TIMOTHY B. , BAUMGARTNER AMY , LYON ELLEN , GROSS SUSAN , SCHÄFER MICHAL , POLSKY SARIT , NADEAU KRISTEN J. , SCHAUER IRENE E. 
Published: June 2020

BCQR is approved for adjunct therapy in type 2 diabetes (T2D). BCQR improves glycemic control and appears to reduce cardiovascular events in T2D. People with T1D have decreased insulin sensitivity (IS), correlating with vascular dysfunction. We evaluated the effects of BCQR on glycemic control, estimated IS, and vascular function in a random order, placebo-controlled crossover study of a 4-week intervention with BCQR in adolescents (12-21 yrs) and adults (22-60 yrs) with T1D. Outcomes included: insulin total daily dose (TDD), urine albumin to creatinine ratio (UACR), vascular markers using Dynapulse and EndoPAT, CGM, estimated IS scores (from CACTI and RESISTANT study models), and a mixed meal tolerance test (MMTT). Treatment effect was examined in mixed models and reported as LS mean ± SE adjusted for age, sex, phase, and treatment order. Interactions were examined by age and diabetes duration (DD).
Participants‡ (n=84) were 50% adult, age 28.6 ± 14.5 yrs, 44% male, and 49% lean, with HbA1c 7.8% [7, 8.5] and DD 14.2 ± 11.7 yrs. Insulin TDD, log UACR, and CGM outcomes (average glucose, SD, % time BG&gt;180 or &lt;70 mg/dL) did not differ by treatment. SBP was lower on BCQR (114 ± 1.2 vs. 118 ± 1.2, p=0.0001). DBP was lower on BCQR in those with DD&gt;5 yrs (68 ± 1.2 vs. 72 ± 1.2, p=0.0038). Reactive hyperemia index (endothelial function estimate) was lower on BCQR in adolescents (2.03 ± 0.12 vs. 2.32 ± 0.12, p=0.0039), and systemic vascular resistance (SVR) was lower on BCQR in adults (1408 ± 62 vs. 1479 ± 63, p=0.006). Dynapulse cardiac output and brachial artery distensibility did not differ by treatment. MMTT triglyceride (TG) peak minus baseline was lower on BCQR (22 ± 3.0 vs. 27 ± 2.9, p=0.0360). IS measured by MMTT fasting and AUC glucose/insulin, and by CACTI and RESISTANT scores, did not differ by treatment. In sum, BCQR did not affect CGM glycemia or estimated IS, but it improved cardiovascular measures such as SBP, DBP, SVR, and TG.
‡Mean ± SD or Median [Interquartile Range].

Disclosure
S. Tell: None. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. T.B. Vigers: None. A. Baumgartner: None. E. Lyon: None. S. Gross: None. M. Schäfer: None. S. Polsky: None. K.J. Nadeau: None. I.E. Schauer: None.

Funding
JDRF (3-SRA-2015-125-M-R)
1069-P: Effect of Sacubitril/Valsartan Combination Therapy in Type 2 Diabetes Mellitus Patients with Elevated NT-proBNB and Preserved Ejection Fraction
Authors: GUPTA VISHAL , TELI VAISHALI 
Published: June 2020

Aim: study the effect of Sacubitril/valsartan (SV) combination therapy on cardio-renal (CR) biomarkers in T2DM with preserved ejection fraction (pEF); diastolic dysfunction and or LVH on 2D echocardiogram (E) and elevated N-terminal prohormone B-type natriuretic peptide (NT-proBNP) &gt;125.
Methodology: between July and Sept 2018, 109 T2DM patients aged 18-75 yrs, irrespective of baseline A1c, receiving SV were identified. Patients were analysed every 2-3months for CR biomarkers (body mass index (BMI), A1c, systolic (S) BP, diastolic (D) BP, Lipid profile (TC, LDL, TG, HDL), Hs-CRP, NT-ProBNP, creatinine, eGFR and microalbumin/creatinine ratio {UACR} and data presented at 1 yr. T2DM with H/O IHD, reduced EF(&lt;50%) or wall motion abnormalities on E, malignancy, major surgery, hyperkalemia &gt;5.5Meq/L and eGFR&lt;45 were excluded. Baseline characteristics were analyzed using descriptive statistics. Continuous variables were analysed using paired and unpaired t-test expressed as mean ± standard error. For interaction between drug class, ANOVA was used and p value &lt;0.05 was considered significant (S).
Results: Baseline characteristics: Male 43%, Female 66%. Avg (age 63.16 ±8.325yrs, BMI 30.45±5.52, A1c% 7.1±1.2, egfr 90.31±30.45, UACR mg/gm 180.07±553.4, hs-CRP mg/dl 2.53±3.41, NT-proBNP 370.07±543.30 Ng/L). 64.2% received canagliflozin, 11.9% liraglutide, 94.5% Metformin, 61.5% gliptins, 65.1% gliclazide, 44% calcium channel blockers and 100% statin (rosuvastatin) Baseline (B) to 1yr: There was S reduction in SBP, DBP, A1c, TC, LDL, HDL, UACR, hs-CRP and NT-ProBNP NT-proBNP: there was S reduction from B to 3 mths (84.26±31.86, p-0.009), 6mth - 12 mths (39.95±17.40,p-0.024) and B-12mths (155.69±744.10,p-0.001). There was no diff seen 3-6mths (38.09±38.03, p-0.320). There was an interaction seen with Liraglutide in terms of NT-proBNP and UACR.
Conclusion: SV may be effective in reducing NT-ProBNP in T2DM with pEF

Disclosure
V. Gupta: None. V. Teli: None.
109-LB: Early Detection of Cutaneous Complications of Insulin Therapy in Type 1 and Type 2 Diabetes
Authors: ARORA SAURABH 
Published: June 2020

Objective: Our objective was to assess the prevalence of cutaneous complications including insulin derived amyloidosis in insulin-injecting diabetes patients and to study the role of ultrasonography (in comparison to gel-assisted palpation) in early diagnosis of lipohypertrophy.
Methods: This was a cross-sectional study conducted at a tertiary care center in India. A total of 500 patients injecting insulin for two or more years were enrolled and subjected to ultrasonographic examination of abdominal wall to look for presence of lipohypertrophy (LH). All cases with radiological evidence of LH were given the option of punch biopsy of the skin and subcutaneous tissue to look for insulin associated amyloidosis.
Results: Clinical examination detected LH in 44.6% of patients. Ultrasonography diagnosed additional 13.4% of patients with LH which were missed on clinical examination. Incorrect rotation of sites (P &lt; 0.001) and insulin syringe reusage for more than five times (P &lt; 0.001) significantly increased the risk of LH . Skin biopsy was performed in 100 cases, of which two patients showed apple green birefringence and positive staining with anti-insulin antibody suggestive of insulin derived amyloidosis.
Conclusion: Ultrasonography is more objective and reliable method of detecting LH. Insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought.

Disclosure
S. Arora: None.
1090-P: MSDC-0602k, a New Oral Insulin Sensitizer in Insulin Resistant NASH Patients with and without Type 2 Diabetes (T2D)
Authors: COLCA JERRY R. , LEE BO HYUN , IWASHITA JULIE S. , DITTRICH HOWARD C. , HARRISON STEPHEN A. 
Published: June 2020

Use of the first-generation insulin sensitizer pioglitazone is limited by PPARγ-driven side effects. MSDC-0602K was designed to maintain pioglitazone’s effects on the mitochondrial pyruvate carrier (MPC), but with minimal direct PPARγ binding. A 12-month Phase 2b dose-ranging study in NASH (Harrison et al, 2019) demonstrated insulin sensitizing pharmacology without dose-limiting issues. Here we describe ongoing analysis of these data. Steady state exposures of drug and active metabolite at the highest doses averaged 4 to 7 micromolar, 1/10thof the affinity to PPARγ, but within the range for modulation of the MPC in intact cells. The effects on fasting plasma insulin (FPI), fasting plasma glucose, and hemoglobin A1c (HbA1c) plateaued at the mid-dose (125 mg), while adiponectin continued to increase 1.7, 2.5, and 4.1x vs. placebo across the 62.5, 125, and 250 mg doses. Glycemic reductions and the reduction of FPI levels were similar in subjects with or without T2D. The treatment-induced decrease in HbA1c was proportional to the baseline HBA1c and was more than 1% in subjects with a baseline above 7%, including those not well-controlled on GLP-1 agonists. In patients with or without diabetes, baseline mean FPI levels exceeded 20 μU/ml (139 pmol/L), levels in the upper quartile of historical T2D studies, and continued to increase in placebo-treated subjects but decreased on treatment with MSDC-0602K. Treatment with MSDC-0602K decreased FPI more than C-peptide. The ratio of C-peptide/FPI increased vs. placebo at end of study (8.54 ± 0.49, 9.69 ± 0.44, 10.45 ± 0.43, and 10.9 ± 0.53 for placebo and the three dose groups, respectively) suggesting both decreased need for secreted insulin and increased clearance of insulin. These data suggest that the new generation insulin sensitizer MSDC-0602K, focused toward MPC and away from PPAR, may be useful to treat patients suffering from combined fatty liver disease and T2D and highlight the importance of FPI.

Disclosure
J.R. Colca: Stock/Shareholder; Self; Cirius Therapeutics, Metabolic Solutions Development Company. B. Lee: Employee; Self; Cirius Therapeutics. J.S. Iwashita: Employee; Self; Cirius Therapeutics. H.C. Dittrich: Employee; Self; Cirius Therapeutics. S.A. Harrison: Consultant; Self; Akero, Altimmune, Axcella, Cirius, Cirius Therapeutics, Genentech, Inc., Hightide Bio, HistoIndex, Intercept Pharmaceuticals, Inc., Madrigal.
11-LB: A Phase 2 Study of Liquid Stable Glucagon to Treat Hypoglycemia-Associated Autonomic Failure
Authors: PETTUS JEREMY , NAKHLE SAMER , OVALLE FERNANDO , JUNAIDI MOHAMMED K. , CLOSE NICOLE C. , CONOSCENTI VALENTINA , NGUYEN ANH 
Published: June 2020

Objective: To evaluate a novel, ready-to-use, liquid stable, continuous subcutaneous (SC) glucagon infusion (CSGI; Xeris Pharmaceuticals) for the treatment of Hypoglycemia Associated Autonomic Failure (HAAF) in adults with type 1 diabetes (T1D).
Method: This was a Phase 2 double-blind, randomized, placebo-controlled parallel trial in T1D adults with HAAF (Gold Score ≥4). Subjects were randomized to receive 1 month of high-rate CSGI (HCSGI, 80 μg/hour), low-rate CSGI (LCSGI, 20 μg/hour), or placebo. Epinephrine hormone response to hypoglycemia (assessed during stepwise hypoglycemia clamp procedure) and Gold Scores were measured at baseline, end of treatment, and both 3- and 6-months post-treatment.
Results: Forty-nine subjects were randomized to receive treatment (HCSGI n=15; LCSGI n=18; placebo n=16). No statistically significant differences in mean epinephrine hormone response or Gold Scores were observed across treatment arms at end of treatment. Long-term follow-up of the subjects was stopped early.
For completed follow-up clamps (31 subjects, 3 months; 22 subjects, 6 months), LCSGI did not exhibit differences to placebo. However, HCSGI 3 and 6 month mean epinephrine hormone responses were greater (p=NS) and Gold Scores improved [(-1.1±1.5 vs. 0.5±1.5; 3 months, p=NS) and (-1.2±1.5 vs. -0.6±0.9; 6 months, p=NS)].
The administration of CSGI was associated with mild to moderate nausea (5.9% for LCSGI and, 20% for HCSGI,) and vomiting (11.8% for LCSGI and 13.3% for HCSGI,). CSGI was not associated with pain, injection site reactions, or necrolytic migratory erythema. No related SAEs were reported.
Conclusion: Compared to placebo in a small group of T1D adults with HAAF, HCSGI may exhibit improvements in Gold Score at both 3 and 6 months. Mean serum epinephrine may be a suboptimal biomarker of HAAF. CSGI was safely used with concomitant insulin, and there were no related SAEs.

Disclosure
J. Pettus: Consultant; Self; Diasome Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk Inc., Sanofi. S. Nakhle: None. F. Ovalle: Research Support; Self; Gan & Lee Pharmaceuticals, Gilead Sciences, Inc., Lilly Diabetes, Novo Nordisk A/S, Sanofi, Xeris Pharmaceuticals, Inc. M.K. Junaidi: Employee; Self; Xeris Pharmaceuticals, Inc. N.C. Close: Employee; Self; EmpiriStat, Inc. V. Conoscenti: None. A. Nguyen: None.
1109-P: Blood Pressure (BP) Lowering Effect of Empagliflozin Is Related to Decreased L-Arginine Clearance in Diabetic Rats
Authors: KHEMAIS-BENKHIAT SONIA , VEYEL DANIEL , SCHINI-KERTH VALERIE , KRAWCZYK BARTLOMIEJ , PIEPER MICHAEL , MARK MICHAEL , MAYOUX ERIC 
Published: June 2020

Introduction: The availability of L-arginine is the rate-limiting factor in Nitric Oxide (NO) synthesis, a potent vasodilatory factor. L-arginine plasma levels are blunted in diabetes, thus L-arginine supplementation decreases BP in animal diabetic models, and type 2 diabetic patients. Renal reabsorption of filtered L-arginine in the proximal tubule is mainly sodium dependent. Higher filtered glucose load in diabetes may alter sodium gradient via higher glucose reabsorption by sodium-glucose cotransporters (SGLTs).
Purpose: The mechanism by which SGLT2 inhibitors, such as Empagliflozin, decrease BP in type 2 diabetic patients, is still unknown. We hypothesize that SGLT2 inhibitors could decrease the urinary excretion of L-arginine, by restoring sodium gradient necessary for L-arginine reabsorption in the proximal tubule.
Methods: Male obese Zucker diabetic fatty/Spontaneously hypertensive heart failure hybrid (ZSF1) rats and their lean littermates (CTR) received either Empagliflozin or vehicle for 6 weeks. Levels of L-arginine in urine and plasma were quantified via Liquid Chromatography-Mass Spectrometry. Plasmatic cGMP level, a marker of NO production and urinary 8-hydroxydeoxyguanosine (8-OHdG) level, a marker of oxidative stress, were measured.
Results: The urinary level of L-arginine was higher in ZSF-1 rats compared to CTR ones, and plasmatic concentrations of L-arginine were lower in ZSF-1 rats compared to CTR ones. Both parameters were significantly reversed by Empagliflozin. Empagliflozin treatment increased plasmatic cGMP and decreased urinary 8-OHdG in diabetic rats.
Conclusion: Empagliflozin decreased urinary excretion of L-arginine, associated with an increased plasmatic concentration of L-arginine and cGMP, and decreased oxidative stress in diabetic rats. This suggests that Empagliflozin increased NO production and bioavailability. Such effects might contribute to the BP lowering effect of Empagliflozin in diabetics.

Disclosure
S. Khemais-Benkhiat: Employee; Self; Boehringer Ingelheim International GmbH. D. Veyel: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. V. Schini-Kerth: Research Support; Self; Boehringer Ingelheim International GmbH. B. Krawczyk: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Pieper: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Mark: Employee; Self; Boehringer Ingelheim International GmbH. E. Mayoux: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.
115-LB: Oral Insulin–Induced Reduction in Liver Fat Content in T2DM Patients with Nonalcoholic Steatohepatitis
Authors: KIDRON MIRIAM , PERLES SHARON , KALOTI REEM , GHANTOUS RAMI , SANDOUKA SUHA F. , MALAABI YASMINE , SAFADI RIFAAT 
Published: June 2020

Nonalcoholic fatty liver disease (NAFLD) and subsequent nonalcoholic steatohepatitis are leading causes of chronic liver disease, with disease progression directly associated with insulin resistance and T2DM. In light of the common risk factors, pathogenesis and complications with T2DM, direct insulin intervention has been suggested for T2DM patients with NAFLD. Recently, salient metabolic effects of oral insulin have been suggested, owing to first pass metabolism and local insulin availability and concentration in liver fat cells. This pilot study assessed the safety, tolerability and early effects on liver fat content of an oral insulin formulation (ORMD-0801), preprandially administered once-daily (2x8 mg capsules) for 12 consecutive weeks, to 8 T2DM patients with NASH. The 12-week ORMD-0801 treatment proved safe and tolerable in all patients, with no serious or severe adverse events recorded throughout the study period. The 12-week treatment induced a mean -6.9±6.8% reduction in liver fat content (sign test p value: 0.035), as measured by magnetic resonance imaging proton density fat fraction (MRI-PDFF). In parallel, concentrations of gamma-glutamyltransferase (GGTP), a key marker of chronic hepatitis, were significantly lower after 12 weeks of treatment as compared to baseline (-14.6±13.1 U/L; sign test p value: 0.008), as were fasting insulin levels (-96.5±206.0 pmol/L; sign test p value: 0.035). Taken together, these preliminary observations suggest a palliative effect of oral insulin on NASH in T2DM patients, as shown by reductions in liver fat content and chronic hepatitis. These encouraging findings will require further validation in large-scale, randomized clinical trials.

Disclosure
M. Kidron: Employee; Self; Oramed Pharmaceuticals. Stock/Shareholder; Self; Oramed Pharmaceuticals. S. Perles: Employee; Spouse/Partner; Haddassah Medical Center. Employee; Self; Oramed Pharmaceuticals. R. Kaloti: None. R. Ghantous: None. S.F. Sandouka: None. Y. Malaabi: None. R. Safadi: None.
115-OR: Early Insulin Pump Use in Pediatric Post–Total Pancreatectomy Islet Auto Transplantation Management
Authors: TELLEZ SIOBHAN E. , HORNUNG LINDSEY , COURTER JOSHUA D. , ABU-EL-HAIJA MAISAM , NATHAN JAIMIE D. , LAWSON SARAH , ELDER DEBORAH A. 
Published: June 2020

Objective: Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure for patients with chronic pancreatitis who experience debilitation and poor quality of life. Glucose targets are critical for islet survival. We hypothesized that early transition from intravenous insulin to insulin pump therapy would improve glucose control and impact hospital duration.
Research Design and Methods: We performed a retrospective analysis of 40 patients who underwent TPIAT. Prior to 2016, post-operative insulin was delivered intravenously and transitioned to multiple daily injections (MDI) followed by pump administration (n=14). After 2016, post-operative insulin was delivered intravenously followed by early transition to pump therapy (n=26). Outcomes analyzed between groups included: percentage of blood glucoses in target (80-120 mg/dL), hypoglycemia (&lt;60 mg/dL) and hyperglycemia (&gt;140 mg/dL), blood glucose variability, and length of stay after transition off intravenous insulin.
Results: Patients with early transition to pump therapy had a higher proportion of glucose values in target range (p=0.0003), a lower proportion of hyperglycemia (p=0.04), and a lower proportion of hypoglycemia, though not significant (p=0.33). In patients with early pump transition, variability in glucose values decreased over the first 10 days post-intravenous insulin (p=0.001) and post-transition median length of stay was shorter by 5 days (p=0.005).
Conclusions: Early pump therapy in this population achieved tighter glycemic control and reduced duration of stay.

Disclosure
S.E. Tellez: None. L. Hornung: None. J.D. Courter: None. M. Abu-El-Haija: None. J.D. Nathan: None. S. Lawson: None. D.A. Elder: None.
1163-P: Cost Effectiveness of Oral Semaglutide 14mg vs. Empagliflozin 25mg in Canada
Authors: LIU AIDEN R. , BECH PETER G. , FRIDHAMMAR ADAM , NILSSON ANDREAS , WILLIS MICHAEL , NUHOHO SOLOMON 
Published: June 2020

Background: A1C lowering was significantly greater for oral semaglutide 14 mg than empagliflozin 25 mg for patients with type 2 diabetes mellitus (T2DM) uncontrolled on metformin in the 52-week, randomized, open-label PIONEER 2 trial (NCT02863328). We estimated the cost effectiveness of oral semaglutide vs. empagliflozin in Canada from the payer and societal perspectives.
Methods: Modeling methods were used to extrapolate benefits observed in PIONEER 2 to long-term costs and outcomes, including quality-adjusted life-years (QALYs), for patients treated with oral semaglutide or empagliflozin. As with analysis in other settings, the IHE-Diabetes Cohort Model (IHE-DCM) was used. The analysis was also run using the Economic and Health Outcomes microsimulation model (ECHO-T2DM). Patient baseline characteristics and treatment effects were sourced from PIONEER 2. In the model simulations, both agents were assumed discontinued and insulin initiated when A1C was &gt;8.0%. Unit costs (CAD$) and utilities were sourced from the literature.
Results: Oral semaglutide was associated with more QALYs than empagliflozin over 40 years (0.39 with IHE-DCM and 0.34 with ECHO-T2DM). The gains came with increased costs (CAD$8,202 with IHE-DCM and CAD$9,255 with ECHO-T2DM), yielding incremental cost-effectiveness ratios (ICERs) of CAD$21,115 and CAD$27,496/QALY gained, respectively, below the often-cited willingness-to-pay threshold of CAD$50,000/QALY. When productivity costs and the full societal perspective are considered, the ICERs were CAD$18,239 and CAD$19,112, respectively. Sensitivity analyses that included cost, treatment effect, time horizon and biomarker rebound assumptions generally confirmed the results.
Conclusion: Two models independently found oral semaglutide to be cost-effective compared to empagliflozin over 40 years for the treatment of patients with T2DM uncontrolled on metformin in Canada. While uncommon, the use of two models can reduce decision-making uncertainty.

Disclosure
A.R. Liu: Employee; Self; Novo Nordisk Canada Inc. P.G. Bech: Employee; Self; Novo Nordisk Inc. Stock/Shareholder; Self; Novo Nordisk Inc. A. Fridhammar: None. A. Nilsson: None. M. Willis: Board Member; Self; The Swedish Institute for Health Economics. Consultant; Self; Janssen Global Services, LLC., Mundipharma International, Novo Nordisk A/S. Stock/Shareholder; Self; The Swedish Institute for Health Economics. S. Nuhoho: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Johnson & Johnson.

Funding
Novo Nordisk Canada Inc.