bluuebunny/crossref_metadata_2025_split huggingface dataset:
1187-P: Patient Demographics and Clinical Outcomes among Type 1 Diabetes (T1D) Patients Using Continuous Glucose Monitors (CGMs): A Study from the Largest Cohort of T1D Patients in the U.S.
Authors: NOOR NUDRAT , RIOLES NICOLE , MAJIDI SHIDEH , CORATHERS SARAH , MCDONOUGH RYAN , POLSKY SARIT , GREENFIELD MARGARET , OBRYNBA KATHRYN , EBEKOZIEN OSAGIE , DESALVO DANIEL 
Published: June 2020

Background: CGM devices have been shown to improve glycemic control in patients with T1D. Despite existing clinical evidence and improved performance of CGM devices, only a small proportion of patients are using CGM.
Methods: The T1D Exchange QI Collaborative (T1DX-QI) is a large cohort with twelve national clinics engaged in data sharing and quality improvement to improve outcomes. This analysis used the T1DX-QI database to examine patient attributes associated with CGM device use. Patients with one or more completed clinic encounters during the years 2017-2019 were included (N=16,414) and classified as CGM users if they indicated information on a device start date, model or company within the past one year of their most recent diabetes clinic visit. We examined the frequency of CGM device use and distribution of socio-demographic factors, as well as clinical outcomes, among CGM users versus non-users.
Results: In this cohort, 27.4% of T1D patients were CGM users, with patients aged ≤26 years being more likely to use CGM. Among CGM users, 75% used a real-time device, a 3% intermittent scanning device, and 22% device type was unknown. CGM use was more likely among Non-Hispanic Whites (75%) and patients on private health insurance (72%) relative to Non-Hispanic Black patients (3%) and those on public health insurance (27%) [p&lt;0.001]. HbA1c levels among CGM users were lower relative to non-users after adjusting for age, race/ethnicity and insurance status (8.3%± 1.7% vs. 8.8%±1.9%) [p&lt;0.001].
Conclusion: This study highlights patient factors and clinical outcomes among CGM users in the T1DX-QI Collaborative, one of the largest sources of real world data for T1D available to-date. The findings shed light on socio-demographic variability in CGM uptake with implications for targeted interventions to promote device use in this subset of the T1D population.

Disclosure
N. Noor: None. N. Rioles: None. S. Majidi: Advisory Panel; Self; Companion Medical. S. Corathers: None. R. McDonough: None. S. Polsky: None. M. Greenfield: None. K. Obrynba: None. O. Ebekozien: None. D. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1196-P: Impact of Pharmacist-Driven Access to Therapy in Type 2 Diabetes Mellitus
Authors: ALLISON MARGARET 
Published: June 2020

The Diabetes Care guidelines recommend glucagon-like peptide 1 receptor agonists (GLP-1RA) as second line therapy in the setting of established atherosclerotic cardiovascular disease (ASCVD) and sodium glucose cotransporter 2 inhibitors (SGLT2i) as second line in the presence of chronic kidney disease or heart failure (HF). Formularies are often restrictive of these classes of medications and most require prior authorization (PA), which is a barrier to initiation of therapy. A pharmacist (PharmD) in the ambulatory setting is in an optimal position to navigate insurance formulary and medication cost issues. In addition, with knowledge of evidence-based medicine, a PharmD can provide the justification needed for a medication that adheres to guideline recommendations regardless of formulary status. This retrospective review evaluates if the PharmD in Endocrinology (Endo) clinic improved HbA1c through resolution of medication access problems allowing for initiation of guideline-based therapies. The PharmD documented on 190 patients with T2DM from 11/2018 to 11/2019. Average time managed by Endo was 1.4 years (median 9.4 months) and 38% of patients were previously prescribed or established on SGLT2 or GLP-1RA therapy for an average of 1.4 years (median 11.5 months). The majority of patients had Medicare or Medicaid plans (73%). ASCVD or HF was present in 30% of patients. HbA1c was &lt;7% in 17.8% of patients. The PharmD assisted with initiation of GLP-1RA or SGLT2 for 74% of the patients through test claims, education, prior authorizations and appeal letters. Of the patients with CV disease, 79% (45/57) were prescribed one of the agents with proven CV benefits with the help of the PharmD. Average HbA1c prior to PharmD was 8.9% and average most recent HbA1c was 8.05% (-0.85, p&lt;0.05). Time between HbA1c values was an average of 5.4 months. Most recent HbA1c was &lt;7% in 36% of patients. The PharmD contributed to a significant HbA1c change through navigation of formulary requirements combined with knowledge of clinical evidence.

Disclosure
M. Allison: None.
1198-P: Hospital Use and Cost among Minority Women Enrolled in the Women in Control (WIC) Virtual World Diabetes Self-Management Education (DSME) Comparative Effectiveness Trial
Authors: MITCHELL SUZANNE , BRAGG ALEXA , HOWARD JESSICA M. , GARDINER PAULA 
Published: June 2020

Background: DSME improves diabetes outcomes, however participation is low. Virtual world (VW) technology is a scalable and engaging platform for DSME. The WIC study compared the effectiveness of DSME Medical Group Visits conducted in a VW platform vs. in-person to improve diabetes outcomes for minority women with uncontrolled type 2 diabetes (T2DM).
Objective: To assess the impact of WIC DSME intervention on hospital use and associated costs (inpatient, observation stays, ED visits).
Methods: Hospital utilization and billing data of the WIC-DSME intervention was analyzed 6-months pre-to-post enrollment for the study cohort and by study arm for a subset of 142 minority women with T2DM who completed the study. The percent change in the number of hospital utilizations from pre-to-post enrollment was calculated and associated costs were estimated from billing data and compared by study arm, utilization type and for the cohort as a whole.
Results: Total utilization among all 142 WIC program completers decreased by 25% from 114 events (57 events per arm) in the 6-months prior to WIC enrollment to 86 events (n=38 in-person; n=48 VW) in the 6-months post-enrollment. Hospital charges also decreased from $767,730 to $601,446 (22%). Among VW DSME participants, there was a 16% reduction in total utilization compared to a 33% reduction in the in-person DSME arm. Among VW participants, there was a 46% decrease in the number of high cost utilizations (observations and inpatient) and a 36% decrease in Emergency Department (ED) visits post-enrollment. Among in-person participants, there was no change in total high cost utilizations and a 68% decrease in ED visits. Total hospital charges for the WIC in-person DSME arm decreased by $24,625 (-6%) and $141,659 (-37%) for the WIC virtual world arm.
Conclusion: Both in-person and VW DSME are associated with lower hospital utilization and costs among minority women with uncontrolled T2DM.

Disclosure
S. Mitchell: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; See Yourself Health, LLC. A. Bragg: None. J.M. Howard: None. P. Gardiner: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106531)
1201-P: Impact of a Nursing Strike on Glycemic Control of Hospitalized Patients with Diabetes
Authors: SHEAHAN KELSEY , TOMPKINS BRADLEY , KENNEDY AMANDA G. , REPP ALLEN B. , GILBERT MATTHEW P. 
Published: June 2020

Introduction: Inpatient maintenance of glycemic control relies heavily on nurse-directed care. In July 2018, our academic medical center experienced a nursing strike. Replacement staff were employed during the strike. The purpose of this study was to investigate the impact of a disrupted nursing workforce on glycemic control of hospitalized patients with diabetes.
Methods: This was a retrospective cohort study of glycemic control during a nursing strike. Data included three, 48-hour periods: pre-strike, strike, and post-strike. All adult hospitalized patients with diabetes were eligible. Patients were excluded if they were in the intensive care unit. The primary outcome was the frequency of hyperglycemia, defined as average percentage of point-of-care finger stick tests &gt; 180 mg/dL per patient. Hypoglycemia was defined as average percentage of tests &lt; 70 mg/dL per patient. Data were analyzed using Wilcoxon rank sum tests with P&lt;0.05 considered statistically significant.
Results: Two hundred and eleven patients were included in the analysis: 65 patients (30.8%) in the strike period and 146 patients (69.2%) during the comparative periods. There were no differences in age, sex, race, or body mass index between groups. During the strike period, a mean of 35.5% of patients’ glucose tests met criteria for hyperglycemia, versus a mean of 31.2% of tests in the comparative periods (P=0.46). A mean of 1.4% of glucose tests met criteria for hypoglycemia during the strike period, versus a mean of 0.2% during normal operations (P=0.02).
Conclusions: Hyperglycemia did not vary significantly with a short-term disruption in nursing workforce. There was a suggestion of increased hypoglycemia, however this was a rare event and should be interpreted with caution.

Disclosure
K. Sheahan: None. B. Tompkins: None. A.G. Kennedy: None. A.B. Repp: None. M.P. Gilbert: Advisory Panel; Self; Corcept Therapeutics. Consultant; Self; Novo Nordisk Inc.
1205-P: Diabetes Medical Care Quality Index (ICAD): A Nationwide Experience of Continuous Improvement in Primary Health Care Clinics
Authors: GALLARDO HECTOR , SUAREZ-IDUETA LORENA , LOMELIN-GASCON JULIETA , MONTOYA ALEJANDRA , MUJICA-ROSALES RICARDO , TAPIA-CONYER ROBERTO C. , SAUCEDO-MARTINEZ EDUARDO R. 
Published: June 2020

Digital health and robust analytics have shown to improve the quality of care by enabling data-driven decision making and accurate allocation of resources. Due to the fast-growing burden of T2D in Mexico, we created the Diabetes Medical Care Quality Index (ICAD) to favor the continuous improvement of care in primary healthcare clinics (PHC).The ICAD assesses three components: patient retention (PR), adherence with clinical guidelines (ACG), and T2D control (DMC) through a 100-point score, to estimate the percentage of patients that regularly visit their clinic, the medical actions provided each visit, and the percentage of patients with A1c &lt;7%, respectively. We monthly computed ICAD of 9,958 Mexican PHC from June 2016 to October 2018 through the NCDs Information System (SIC) with up to 537,752 T2D patients. In June 2016, the national ICAD score was 54.6, with PR of 46.6, ACG of 69.9, and DMC of 40.9. As of October 2018, after monthly emailing ICAD to each clinic in a meaningful and transparent performance report, we found a significant increase in ICAD overall score and its components: ICAD of 66.0 (+21.0% p&lt;0.001); PR of 64.0 (+37.4% p&lt;0.001), ACG of 79.3 (+13.5% p&lt;0.001), and DMC of 60.0 (+24.7% p&lt;0.001).When compared to data collected through the National Infrastructure Inventory, we found that the major determinants related to the improvement of the ICAD are: community screening programs (β = 4.06 95%CI 3.50-4.62), availability for CBG testing (β=3.08, 95%CI 2.83-3.34) and A1c point of care testing (β =2.52 95% CI 2.40-2.63); availability of insulin (β=3.05 95%CI 2.94-3.16) and oral hypoglycemic drugs (β=1.51 95%CI 1.40-1.63), as well as online continuing medical education for providers (β=0.92, 95%CI 0.79-1.1) and IT infrastructure (β=0.57, 95%CI 0.44-0.72). In sum, we creates, measured and systematically communicated ICAD, enabling interventions in PHC that improved the quality of care and health outcomes for T2D patients.

Disclosure
H. Gallardo: None. L. Suarez-Idueta: None. J. Lomelin-Gascon: Other Relationship; Self; Lilly Global Health Partnership. A. Montoya: None. R. Mujica-Rosales: None. R.C. Tapia-Conyer: None. E.R. Saucedo-Martinez: None.
121-OR: Immunosuppressant-Related Quality of Life and Lifestyle of Insulin Independent T1D Pancreas Transplant Recipients
Authors: KAUR RAVINDER JEET , REID COREY , RIZVI SHAFAQ RAZA , BATTHULA SREEDHAR , MCCRADY-SPITZER SHELLY K. , SMITH BYRON H. , KREMERS WALTER K. , DEAN PATRICK , KUKLA ALEKSANDRA , STEGALL MARK D. , KUDVA YOGISH C. 
Published: June 2020

Background: Pancreas Transplantation (PT) provides insulin independence and improves quality of life in patients with type 1 diabetes (T1D). However, PT recipients require lifelong immunosuppression resulting in immunosuppression related side-effects.
Methods: After IRB approval, we prospectively studied 15 PT recipients at least 1 year after PT. Subjects completed DEXA for body composition, actigraph for 1 week, the modified Transplant symptom occurrence and distress scale (MTSOSD) and VioFFQ - VIOCARE Food Frequency questionnaires.
Results: PT recipient were 53.1 ± 10.6 years old, 12F, BMI (Kg/m2) 30.8 ± 6, 33 ± 12.3 years of T1D and 6 ± 5 years (1-17years) time interval from PT. Lab values were HbA1c 5.4 ± 0.6 %, fructosamine 233 ± 27 µmol/L, fasting glucose 94.3 ± 17.5 mg/dl, C-peptide 2.5 ± 0.9 ng/ml and eGFR 56.3 ± 25.5 ml/min. DEXA revealed 41.1 ± 8.3 % total fat with 41.2 ± 10.2 % in Arms, 39.0 ± 9.8 % Legs and 43.7 ± 10.3 % Trunk. Actigraph revealed 1.6 ± 0.3 MET rate, 13428.7 ± 4649.0 average steps/day and 58.1 ± 12.9 % in Sedentary, 26.3 ± 7.3 % in Light and 15.6 ± 6.2 % in moderate grade physical activity respectively . Viocare revealed 81.9% calories of Estimated Energy Requirement with 44.9 ± 7.1 % CHO, 36.7 ± 5.6 % total Fat, 13.5 ± 3.2 % saturated fat and 17.9 ± 3.1 % protein calories with Omega-3 and dietary fiber intake 0.1 ± 0.11 g and 23.1 ± 9.1 g respectively. On MTSOSD, at least one side effect (SE) was reported by every subject with range varying from 1 to 53 SE out of 59 in the questionnaire. Four (33%) subjects reported at least one grade 4 symptom (high distress); 1 reported grade 4 for 24 items out of 59 in questionnaire and the other 3 grade 4 for 1.7 ± 1.2 symptoms. For grade of symptoms ranging from 0 to 3, 30 ± 14 SE were reported by the 12 subjects.
Conclusions: PT recipients that are insulin independent for long periods of time have suboptimal body composition and some immunosuppression related SE but perform better than average physical activity.

Disclosure
R. Kaur: None. C. Reid: None. S. Rizvi: None. S. Batthula: None. S.K. McCrady-Spitzer: None. B.H. Smith: None. W.K. Kremers: Research Support; Self; AstraZeneca. P. Dean: None. A. Kukla: None. M.D. Stegall: None. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.
1211-P: Real-World Use of SGLT2 Inhibitors in a Large U.S. Safety-Net Health System
Authors: GUNASEKARAN UMA , MCNULTY JACQUELINE N. , LINGVAY ILDIKO , MENEGHINI LUIGI 
Published: June 2020

SGLT2 inhibitors (SGLT2i) have demonstrated benefit in high risk populations, although clinical uptake is often delayed. We sought to assess prevalent use of SGLT2i in type 2 diabetes within our health system to inform future quality improvement (QI) initiatives. From Sep 2016 to Oct 2019 a total of 1481 patients were prescribed an SGLT2i, of which 65% had prior ASCVD or heart failure (HF). Of all patients with diabetes and a diagnosis of ASCVD or HF (N=8448), only 11% were prescribed an SGLT2i during this time. These patients were on average 59±10 years old, 46% female, 43% Hispanic (see Table for additional details). Prescribing services included Internal Medicine (55%), Cardiology (26%) and Endocrinology (13%); the large majority of these patients (45%) received charity care from the health system. Descriptively, Hispanics, those with commercial insurance and nephropathy were more likely to receive an SGLT2i, while Blacks, Medicare and presence of co-morbidities less likely.
In summary, the use of SGLT2i in a high-risk population remains low (11%), especially in certain groups, such as Blacks and Medicare recipients. In our system, cardiologists contribute substantially to targeted use of SGLT2i, which should be encouraged elsewhere. This baseline data will inform our QI strategy and efforts in increasing evidence-based use of SGLT2i across the health system while targeting identified delivery inequalities.

Disclosure
U. Gunasekaran: None. J.N. McNulty: None. I. Lingvay: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk A/S, Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Other Relationship; Self; Novo Nordisk A/S. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Applied Therapeutics, Sanofi US.
1216-P: Randomized Controlled Trial of Technology-Intensified Diabetes Education Study (TIDES) in African Americans with Type 2 Diabetes
Authors: EGEDE LEONARD E. , KNAPP REBECCA G. , WALKER REBEKAH J. , GARACCI EMMA , WILLIAMS JONI S. 
Published: June 2020

Evidence suggests multicomponent interventions are essential to improve outcomes in minority groups. This RCT tested a multicomponent intervention (TIDES) including diabetes education and skills training by telephone and a telehealth system to monitor glycemic and blood pressure control in African Americans (AA) with poorly controlled type 2 diabetes. Two hundred AA with HbA1c &gt;= 8 were randomized to TIDES or usual care with primary outcome HbA1c at 12-months in the intent to treat population. Baseline adjusted random intercept model evaluated reduction in HbA1c for TIDES compared to usual care. Per protocol samples and baseline adjusted marginal models were used as sensitivity analyses. Study maintained a 90% retention rate at 12-months. HbA1c at 3 months was marginally statistically significantly lower compared to usual care (p=0.06), however, at 12-months there was no statistically significant difference (p=0.67). See Figure 1. Per protocol samples and marginal models showed similar results. Results from a multicomponent RCT found a more immediate drop in HbA1c during the intervention period compared to usual care, but no significant differences at 12-months. Possible co-interventions occurring in the primary care clinic at the time of the study and low intensity booster sessions may explain results and have implications for future diabetes education trials.

Disclosure
L.E. Egede: None. R.G. Knapp: None. R.J. Walker: None. E. Garacci: None. J.S. Williams: None.

Funding
National Institutes of Health (R01DK098529)
1228-P: Health Care Avoidance and Diabetes-Related Care among Medicare Beneficiaries with Type 2 Diabetes
Authors: NG BOON PENG , TOWNE SAMUEL D. , LAMANNA JACQUELINE B. , PEACH BRIAN C. , PARK CHANHYUN 
Published: June 2020

Healthcare avoidance among those with type 2 diabetes (T2D) can lead to increased risk for and severity of medical complications, resulting in potentially significant health and economic burdens. We examined the association between healthcare avoidance and diabetes-related care among Medicare beneficiaries with T2D. We analyzed the nationally representative 2017 Medicare Current Beneficiary Survey Public File of 2,001 Medicare beneficiaries aged ≥65 years with reported T2D. Three dichotomous outcomes were analyzed using multivariate survey-weighted logistic models including: i) self-testing blood glucose to manage one’s diabetes; ii) having had a health professional’s examination of one’s feet in the last year; and iii) maintaining one’s A1C ≤ 7.5% or average fasting blood test of ≤ 140 mg/dL all/most of the time (defined as "proper maintenance"). Among beneficiaries with T2D, 22.3% reported healthcare avoidance or “do anything to avoid going to the doctor.” Of those with healthcare avoidance, 58.7% reported oral medication use alone, 12.2% reported insulin use alone, and 19.4% reported both insulin and oral medication use, while 9.7% reported not using any medication to manage their diabetes. Further, 13.6% reported self-testing blood glucose to manage their diabetes, 25.1% reported having a health professional examine their feet in the last year, and 72.1% reported proper maintenance of blood glucose. Those with healthcare avoidance were less likely to report proper maintenance of blood glucose (OR= 0.65; 95% CI = 0.44,0.95; p &lt; 0.026). Healthcare avoidance was not associated with the i) and ii) outcomes. This study found that those with healthcare avoidance were less likely to maintain proper blood glucose levels, making them especially at-risk of experiencing potentially preventable complications and costly care. Thus, stakeholders should target interventions (e.g., clinical outreach) to reduce the likelihood of healthcare avoidance among this vulnerable population.

Disclosure
B. Ng: None. S.D. Towne: None. J.B. LaManna: None. B.C. Peach: None. C. Park: None.
1230-P: Advantages of Network-Based Blood Glucose Team Management on Hyperglycemic Patients in Noncritical Units
Authors: ZHU YING , YANG MIAO , ZHOU HUI , XIA WEI , LI PENGQIU , YANG YAN 
Published: June 2020

Purpose: To provide a new system of in-hospital blood glucose team management combining with network blood glucose monitoring system, and analyze the effect on hyperglycemic patients’ blood glucose control lived in non-critical care units.
Methods: Hyperglycemic patients admitted to non-critical care units were divided into two groups. They were intervened actively by the hospital’s blood glucose management team and routine consultation group, respectively. A better method with shorter hospital stay and inpatient diabetes cost could be selected by comparing the two blood glucose management methods.
Results: Compared to routine consultation group, the team management group had higher detection rate of hyperglycemia (18.49% vs16.17%, P&lt;0.01) and glycosylated hemoglobin (51.53% vs. 30.97%, P&lt;0.01), lower incidence rate of hyperglycemia (59.24% vs. 61.59%, P&lt;0.01), severe hyperglycemia (3.56% vs. 5.19%, P&lt;0.01) and clinically significant hypoglycemia (0.26% vs. 0.35%, P&lt;0.05). Simultaneously, blood glucose drift (mmol/L) (2.50 (1.83, 3.25) vs. 2.76 (2.01, 3.57), P&lt;0.01), blood glucose coefficient of variation (%) (28.86 (22.70, 34.83) vs. 29.80 (23.47, 36.13), P&lt;0.01), maximum blood glucose fluctuation (mmol/L) (9.30 (6.20, 13.10) vs. 10.10 (7.00, 14.40), P&lt;0.01), nosocomial infection (5.42% vs. 8.05%, P&lt;0.05), hospitalization days (7 (3, 12) vs. 8 (4, 14), P &lt; 0.01) and hospitalization expenses (10,000 yuan) (1.62 (1.01, 3.35) vs. 1.89 (1.29, 4.47), P &lt; 0.01) of patients were managed by team management group all decreased.
Conclusion: In-hospital blood glucose team management combined network blood glucose monitoring system effectively improved the blood glucose control and fluctuation level of patients, who admitted to non-critical care units, thereby reducing hospital stay and inpatient hyperglycemia cost.

Disclosure
Y. Zhu: None. M. Yang: None. H. Zhou: None. W. Xia: None. P. Li: None. Y. Yang: None.