bluuebunny/crossref_metadata_2025_split huggingface dataset:
1173-P: Use of Patient-Centered Medical Homes (PCMH)–Related Care Management Processes to Improve Glycemic Control in Medicaid Patients and Non-Medicaid Patients
Authors: FU HELEN N. , WOLFSON JULIAN , SOLBERG LEIF , GREY MARGARET , PETERSON KEVIN A. 
Published: June 2020

Background: Care management processes are meant to improve care quality, but there is little information about their effectiveness in socioeconomically disadvantaged individuals. This study was aimed to test if systematic care management processes are as effective in controlling diabetes among Medicaid as in non-Medicaid patients.
Methods: This cross-sectional study used standardized performance measures (glycemic control, BP control, statin drug use, aspirin use, smoking cessation) matched to a 2017- clinic survey on the use of diabetes-related care management processes (62 items in Physician Practice Connections-Research Survey). A mixed effect multi-level regression model with fixed clinic- and patient-level independent variables and random clinic-level intercepts was used to test the association between clinic use of care management processes (index of 0-100%) and glycemic control of glycated hemoglobin (A1C) level while adjusting for patient covariates (age, sex, comorbid conditions, diabetes type 1 or 2, residence rurality) and clinic covariates (PCMH certification, medical group size, federally qualified health center).
Results: The overall mean index of care-management processes usage was 86% (IQR of 76-97%). Every 10% increase in the use of care management processes was associated with a decrease of 0.57 in A1C (p&lt;.001). Among Medicaid patients, every 10% increase in the use of care-management was associated with a decrease of 0.72 in A1C (p&lt;.001), while for non-Medicaid patients the associated decrease was 0.53 (p&lt;.001). The 0.2 difference between Medicaid and non-Medicaid groups was also statistically significant (p&lt;.001).
Conclusions: Clinic utilization of PCMH care management processes had a larger effect on diabetes control for patients on Medicaid than for other patients. Improving and implementing these processes may be an important strategy for reducing disparities in diabetes outcomes.

Disclosure
H.N. Fu: None. J. Wolfson: None. L. Solberg: None. M. Grey: None. K.A. Peterson: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110732)
1174-P: Reducing Lost to Follow-Up Rates in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: MCDONOUGH RYAN , THOMAS SARAH , RIOLES NICOLE , EBEKOZIEN OSAGIE , CLEMENTS MARK A. , CORATHERS SARAH , LEE JOYCE M. , GARRITY ASHLEY , PRAHALAD PRIYA , KAMBOJ MANMOHAN K. , BUCKINGHAM DON A. , ALONSO GUY T. 
Published: June 2020

The ADA recommends quarterly follow-up for routine diabetes care, however, this is not consistently achieved. This gap represents an opportunity to improve care. The T1D Exchange Quality Improvement Collaborative (T1DX-QI) aims to improve T1D care in the U.S. through structured sharing of best practices. To reduce the lost to follow-up (LTFU) rate, five pediatric centers identified key change concepts, designed iterative testing cycles, and used data visualization to inform future interventions. Patients &lt;18 years were considered LTFU if their last visit was 180-365 days ago without a future visit scheduled. The following interventions were developed during monthly workgroup calls: establishing standard work, outreach between visits, offering patient portal self-scheduling, scheduling future visits at registration, scheduling multiple follow-ups, and improving adult care transition. Analysis included 14,790 patients across the five sites. Successful application of QI methodologies resulted in improvement across all ages. With a reduction to &lt; 4%, 156 youth were proactively reengaged with diabetes care. Continued follow-up of this population will focus on identifying and overcoming barriers to LTFU and assess which interventions had the biggest impact. We are developing a “Change Package” with successful interventions to share with other diabetes centers.

Disclosure
R. McDonough: None. S. Thomas: None. N. Rioles: None. O. Ebekozien: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. S. Corathers: None. J.M. Lee: Advisory Panel; Self; Goodrx. Consultant; Self; T1D Exchange. Research Support; Self; Lenovo. A. Garrity: None. P. Prahalad: None. M.K. Kamboj: Research Support; Self; Type 1 Diabetes TrialNet, Unitio, Inc. D.A. Buckingham: None. G.T. Alonso: None.
1175-P: Racial Difference in Diabetes Medication Initiation
Authors: WINN AARON N. , KARTER ANDREW J. , STAAB ERIN M. , LIU JENNIFER , WAN WEN , SKANDARI REZA , KNITTER ALEXANDRA C. , MOFFET HOWARD H. , MILLER DONALD R. , PEEK MONICA E. , HUANG ELBERT , LAITEERAPONG NEDA 
Published: June 2020

Objective: We examined how diabetes medication initiation after first diagnosis varied by race/ethnicity.
Method: We conducted a retrospective cohort study of 66,939 patients with newly diagnosed diabetes using data from a large integrated healthcare system. We classified patients into 12 race/ethnicity groups (see Table) and assessed their associations with diabetes medication initiation within 1, 12 and 18 months after diagnosis. We used a modified Poisson regression to estimate risk ratios adjusted for pre-diagnosis demographics and clinical characteristics.
Results: Medications were started in 30%, 43% and 48% of patients within 1, 12 and 18 months, respectively. Within 1 month of diagnosis, Chinese, Filipino, and Native Hawaiian/Pacific islander were less likely to initiate a medication compared to whites. Results were consistent at 12 and 18 months, except that Japanese and blacks/African Americans were less likely to initiate compared to whites and that there was no difference between Native Hawaiian/Pacific islanders and whites at 18 months.
Conclusions: We observed persistent racial differences between patients receiving any medication following initial diabetes diagnosis, with the largest differences for several Asian populations.

Disclosure
A.N. Winn: None. A.J. Karter: Research Support; Self; Dexcom, Inc. E.M. Staab: None. J. Liu: None. W. Wan: None. R. Skandari: None. A.C. Knitter: None. H.H. Moffet: None. D.R. Miller: None. M.E. Peek: Research Support; Self; Merck Foundation. E. Huang: None. N. Laiteerapong: None.
1177-P: Impact of Proactive Strategies by a Large Self-Insured Employer on Engagement in the Diabetes Prevention Program (DPP)
Authors: MCEWEN LAURA N. , JOINER KEVIN , BERGMANS RACHEL , HURST THOMAS E. , HERMAN WILLIAM H. 
Published: June 2020

Since 2015, the University of Michigan has offered the DPP at no out-of-pocket cost to its employees, dependents, and retirees with prediabetes (pDM). We assessed the yield of 3 proactive engagement strategies. In strategy A, 6,734 adults with no previous diagnosis of diabetes (DM) but with a claims diagnosis of pDM or A1c 5.7-6.4% were identified and mailed letters encouraging them to enroll in a DPP. In strategy B, 5,219 adults with no previous diagnosis of DM or pDM who were at high-risk for pDM or DM based on age, sex, and claims data on obesity, hypertension, and dyslipidemia were identified and mailed letters encouraging them to get an A1c test. In strategy C, 29,878 employees not targeted by strategies A or B were sent emails encouraging them to take an online risk test and, if positive, to get an A1c test. In general, individuals identified by strategies A and B were older, had higher BMIs, and were more likely to have cardiovascular (CV) risk factors or CV disease than those identified by strategy C. Of those targeted by strategy A, 649 (10%) enrolled in a DPP. Those who enrolled were more likely to be older, female, and to have a higher BMI than those who did not enroll. Of those targeted by strategies B and C, 1,402 (27%) and 3,768 (13%), respectively, had A1c tests or received new diagnoses of pDM or DM within 1-year of receiving the letter/email. In general, those who had A1c tests or were diagnosed with pDM or DM were more likely to be female, non-White, to have a higher BMI, and to have more CV risk factors or CV disease than those not tested or diagnosed. Of individuals tested in response to strategies B and C, 561 (40%) and 583 (15%) were diagnosed with pDM and 68 (12%) and 5 (1%) enrolled in a DPP. Together, these 3 complimentary strategies to encourage engagement in a DPP had a yield of 9% among individuals with pDM, which is substantially greater than the ∼0.0001% yield observed when passive strategies are employed, but not high enough to have a substantial impact on the population incidence of DM.

Disclosure
L.N. McEwen: None. K. Joiner: None. R. Bergmans: None. T.E. Hurst: None. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp.

Funding
National Institutes of Heath (1R01DK109995)
118-OR: HLA Matching and Clinical Outcomes in Islet Transplantation
Authors: FUENMAYOR VIRGINIA , CHAVEZ CARMEN , BAIDAL DAVID , ALVAREZ ANA M. , PADILLA NATHALIA , RICORDI CAMILLO , ALEJANDRO RODOLFO 
Published: June 2020

Islet cell transplantation (ITx) is a treatment option for selected patients with type 1 diabetes mellitus (T1D) affected by severe hypoglycemia. In whole organ transplantation, HLA mismatching has been shown to negatively impact transplant outcomes. However, this has not been studied in ITx and currently, HLA matching is not a criteria for donor selection. The aim of this study was to determine whether HLA matching has an impact on islet allograft survival. We evaluated 50 ITx recipients at the Diabetes Research Institute, University of Miami, who have been followed from 2000 to 2019. Out of the 50 subjects, 7 underwent islet after kidney transplantation and 43 islet transplantation alone. Subjects received an average of 2 islet infusions from 1 to 5 donors. We evaluated whether the number of HLA-A, -B, and -DR matches were associated with Graft Dysfunction and Graft Failure events using Kaplan-Meier Analysis, including log-rank and Wilcoxon tests statistics. Analyses did not show a significant association between HLA matching and allograft survival (p&gt;0.05). Nevertheless, our study is limited by the small sample size, use of multiple donors as well as differences in immunosuppression regimens and use of GLP-1 analogs and DPP-4 inhibitors which may have affected outcomes. HLA mismatching did not affect ITx outcomes in our study cohort. Further studies are necessary to determine if HLA matching plays a significant role in ITx graft survival.

Disclosure
V. Fuenmayor: None. C. Chavez: None. D. Baidal: None. A.M. Alvarez: None. N. Padilla: None. C. Ricordi: None. R. Alejandro: None.

Funding
Diabetes Research Institute Foundation; The Leona M. and Harry B. Helmsley Charitable Trust; University of Miami Clinical and Translational Science Institute
1181-P: Glycemic Relapse: Major Threat to Ongoing Improvement in Diabetes Care
Authors: SPERL-HILLEN JOANN M. , VAZQUEZ-BENITEZ GABRIELA , HAAPALA JACOB , DESILVA MALINI B. , O’CONNOR PATRICK J. 
Published: June 2020

Purpose: Adequate glycemic control is a cornerstone of high quality diabetes care. Improvement in glycemic control is the net of two vectors: the number of patients who newly achieve glycemic control (improvement vector), minus the number of patients who relapse from adequate to inadequate glycemic control (relapse vector). The purpose of this analysis s to quantify the improvement and relapse vector in a single large care delivery system.
Methods: We identified all T2D patients having at least one visit and A1c between 1/1/2017 and 5/31/2018. We selected as the index date the first visit with an A1c &lt; 8% for the controlled cohort; and the first visit with an A1c ≥ 8% for the uncontrolled cohort. We followed patients for 12 months after the index date and selected the first A1c that shifted their glucose status.
Results: Although the percent of patients with base A1c &gt;=8% who improved (59%) far exceeded the percent of those with baseline A1c &lt;8% who relapsed (20%), the absolute number of patients relapsing (5,109) exceeded the number improving (4,132), with a 30 per 1,000 episodes net worsening in quality of diabetes control (Table 1).
Conclusions: In this high-performing care system the relapse vector now exceeds the improvement vector, accounting for recent overall deterioration in population levels of glucose control. Strategies to proactively identify and manage patients at high risk for glycemic relapse are urgently needed.

Disclosure
J.M. Sperl-Hillen: None. G. Vazquez-Benitez: None. J. Haapala: None. M.B. DeSilva: None. P.J. O’Connor: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098246)
1184-P: Factors Associated with HbA1c of Less Than 8% among Patients Initiated with Metformin and SGLT2 Inhibitor Dual Therapy in the United States
Authors: LAUTSCH DOMINIK , YANG LINGFENG , RAJPATHAK SWAPNIL , BANSAL NEHA , KATHE NIRANJAN 
Published: June 2020

Background: Metformin is the first line treatment for type 2 diabetes mellitus. Sodium glucose cotransporter 2 inhibitors (SGLT2i) are a novel class of oral antidiabetic agents. We aimed to understand factors associated with attaining the HbA1c threshold of &lt;8% in the United States.
Methods: Observational, retrospective cohort study in adult type 2 diabetes mellitus patients from IQVIA EMR database. Observation period was June 2015 to June 2018. Patients needed to initiate SGLT2i and metformin without other antihyperglycemic agents. The impact of sociodemographic factors on achievement of HbA1c &lt;8% was tested using multivariable logistic regression with backward stepwise selection using SAS 9.4.
Results: Of 3491 patients in the final cohort, 2176 (62.3%) achieved HbA1c &lt;8%. The remaining patients had a median distance to goal of 1.1% (IQR 0.5-2.3%). Mean age was 56.5 year. 52.6% were male. Black patients had lower odds to attain HbA1c &lt;8% than white patients [OR 0.69 (0.57, 0.85)], while patients &lt;65 years of age had non relevant higher odds [OR 1.01 (1.01, 1.02)], Table 1.
Conclusion: In the real world in the U.S., 62% of patients treated with metformin and an SGLT2i had an HbA1c &lt;8%. Black patients had lower odds to attain this threshold.

Disclosure
D. Lautsch: Employee; Self; Merck & Co., Inc. L. Yang: Employee; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Menarini Group. N. Bansal: None. N. Kathe: None.

Funding
Merck & Co., Inc.
1186-P: Effectiveness of a Community-Based Approach Towards the Treatment and Prevention of Diabetes Mellitus in Rural India
Authors: SHAH SHIVESH , PRASAD KRANTHI , SABOO BANSHI D. , SHAH SHAILIN , HASNANI DHRUVI , CHAVDA VIPUL , HCB KALACHAR , MERUVA RAVI K. 
Published: June 2020

Background: High rates of diabetes have been reported throughout urban India, though limited data exists concerning the prevalence of diabetes in rural areas, where 70% of the population resides. Socioeconomic and cultural differences may necessitate a different approach towards the treatment and prevention of diabetes in rural as opposed to urban areas.
Objective: The aim of this study was to evaluate the efficacy of a novel, community-centered model in rural villages of Hyderabad, India over the course of 6 months and compare results to traditional methods currently used by rural clinics in Ahmedabad, India.
Methods: As opposed to traditional methods that rely on direct patient-provider interaction, our community-centered method relied on a four-tier system consisting of providers, leaders of each village, “ambassadors” within each village, and patients. A total of 1,013 individuals aged ≥ 25 years (mean age 47.2 years) were sampled at random gender and age from 12 villages in Hyderabad and Ahmedabad. Vitals were taken and blood glucose was measured in all participants using a GlucoSpark glucometer. Baseline statistics were similar for both populations.
Results: In villages surrounding Hyderabad, the prevalence of diabetes was 9.6% (95% CI 7.2-11.9), of which 6.2% (5.1-7.3) were known cases and 3.4% (2.2-4.6) had not previously been diagnosed. The prevalence of diabetes in Ahmedabad was determined to be 12.9% (10.8-15.1), with 5.2% (3.8-6.6) diagnosed and 7.7% (6.2-8.2) previously undiagnosed. Notably, average glucose levels in the Hyderabad population were significantly lower than in the Ahmedabad population after 6 months (t=3.3, p&lt;0.001).
Conclusion: While this study is not representative of rural India as a whole, it highlights the importance of community-centered health in rural settings. Findings suggest that approaches towards diabetes treatment, prevention, and education should vary with patient populations and be considered carefully.

Disclosure
S. Shah: None. K. Prasad: None. B.D. Saboo: None. S. Shah: None. D. Hasnani: None. V. Chavda: None. K. Hcb: None. R.K. Meruva: None.
119-LB: Metformin Prescriptions in Chronic Kidney Disease Patients after the Revised FDA Recommendations in 2016
Authors: MIN JEA YOUNG , WU XIAN , ORLOFF JEREMY , MUSHLIN ALVIN I. , FLORY JAMES 
Published: June 2020

Background: In 2016, metformin’s prescribing label was revised to permit it to be started with estimated glomerular filtration rate (eGFR) 45-60 ml/min and continued with eGFR 30-44 ml/min. We examined whether subsequent metformin prescribing in these groups increased.
Methods: We conducted an interrupted time series study using data from the New York City Clinical Data Research Network. We identified episodes from 2014-2017 in which adult patients with HbA1c ≥6.5% received outpatient antidiabetic prescriptions ≤7 days after an eGFR measurement. Trends in the proportion of episodes that included metformin were examined using linear regression in 4 eGFR subgroups: ≥60 (reference), 45-59, 30-44, and &lt;30 ml/min. Sensitivity analysis examined episodes with no antidiabetic prescription in the prior 180 days.
Results: We identified 10,608 prescribing episodes among 6,505 patients. Lower eGFR was associated with less metformin prescribing. In the eGFR 30-44 ml/min group, there were significant increases in metformin prescribing after the label change (p&lt;0.001). In sensitivity analysis, an increasing trend in metformin prescriptions in the 45-59 ml/min eGFR group started before the label change (p=0.04) and leveled off.
Conclusion: Metformin prescribing for patients with eGFR 30-60 ml/min was increasing prior to the label change. Rates of metformin use at eGFR 30-45 ml/min remain relatively low.

Disclosure
J. Min: None. X. Wu: None. J. Orloff: None. A.I. Mushlin: None. J. Flory: None.

Funding
Patient-Centered Outcomes Research Institute (CER-9230)
1194-P: Unbinding Constraints on Clinical Inertia and Improving Practices: A Novel Comprehensive Primary Care Approach that Grew a Single Practice of 2,000 Patients to 40,000 Patients in Less than 4 Years
Authors: AGUILAR RICHARD B. , OSORIO MERLIN , MCGOOHAN JOHN , HERNANDEZ MARLOW , HERMAN MARY , MILLER EDEN , CONGER MORGAN 
Published: June 2020

Background: Cano Health (CH) employs a full risk model for their Medicare Advantage (MA) enrollees. In 2014, CH deployed a multipronged practice care management processes (CM) devised to overcome clinical inertia, streamline administration of care, and, standardize performance.
Description and Outcomes: CH approach builds on supporting physicians through decision aids, protocols. and larger coordination enabled through technology. Selected components and metrics and ’hard’ outcomes of CH’s approach is detailed in [Table 1].
Conclusions/Lessons Learned: Stand-out results were attained with strategic e-medicine and human resource processes and touchpoints. CH providers were enabled to expeditiously intensify care where clinical inertia persists.
CH model has proven reproducible, enduring and scalable; CH met or surpassed U.S. averages for metrics and ’hard’ endpoints for MA enrollees for management of diabetes and other conditions, growing CH from 1 to 52 PC facilities, 14 to 135 MDs, and, 2k to 40k patients in &lt;4Y.

Disclosure
R.B. Aguilar: None. M. Osorio: None. J. McGoohan: None. M. Hernandez: None. M. Herman: None. E. Miller: None. M. Conger: None.
12-OR: Participation in a Virtual Diabetes Clinic and Reduced Diabetes-Related Distress in Individuals with Type 2 Diabetes
Authors: POLONSKY WILLIAM H. , LAYNE JENNIFER E. , PARKIN CHRISTOPHER G. , KUSIAK COCO , BARLEEN NATHAN A. , MILLER DAVID P. , ZISSER HOWARD , DIXON RONALD F. 
Published: June 2020

Diabetes-related distress affects a significant proportion of adults with type 2 diabetes (T2D) and is associated with poor glycemic control and more problematic self-management. The Onduo Virtual Diabetes Clinic (VDC) is a telehealth program for people with T2D that combines mobile App technology, remote personalized lifestyle coaching, connected BG meters, real-time continuous glucose monitoring (rtCGM) devices and clinical support from board-certified endocrinologists.
This exploratory analysis evaluated change in diabetes distress among 228 program participants who reported moderate distress (score 2.0-2.9) or severe distress (score ≥3.0) on the diabetes distress scale (DDS17) at enrollment. Change in diabetes-related distress was also compared for rtCGM vs. non-rtCGM user groups. Participants were age 51.8±9.5 years, 73.2% female and 39.5% were on insulin. During program participation, 94.7% used a connected BG meter and 33.8%, deemed to be high risk, used rtCGM intermittently. Participants reported significant reductions in overall DDS17 score, from 3.0±0.8 at baseline to 2.5± 0.9 (p&lt;0.001) at an average of 6 months follow-up. Significant reductions in all DDS subscale scores were observed; most notable were reductions in the regimen-related and emotional distress subscales (-0.9 and -0.4, respectively; both p&lt;0.001). Diabetes-related distress improved significantly in both CGM and non-rtCGM users. However, greater reductions in overall DDS17 score, -0.7 ± 0.8 vs. -0.4±0.9 (p=0.012), and regimen-related distress, -1.3±1.2 vs. -0.7±1.3 (p&lt;0.001), were reported by participants who were prescribed and used intermittent rtCGM (n=77) vs. non-users (n=151).
These findings suggest that the VDC program, which includes ongoing individualized lifestyle, clinical support and use of connected devices, may be an effective approach to support individuals with T2D and clinically relevant diabetes distress.

Disclosure
W.H. Polonsky: Advisory Panel; Self; Intarcia Therapeutics, Roche Diabetes Care. Consultant; Self; Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Onduo, Sanofi US, Xeris Pharmaceuticals, Inc. J.E. Layne: Employee; Self; Onduo. C.G. Parkin: Consultant; Self; Abbott, CeQur Corporation, Dexcom, Inc., DreaMed Diabetes, Novo Nordisk Inc., Onduo, Roche Diabetes Care, Valeritas, Inc. C. Kusiak: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. N.A. Barleen: Employee; Self; Onduo. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.F. Dixon: Employee; Self; Onduo.