bluuebunny/crossref_metadata_2025_split huggingface dataset:
2215-PUB: Impact of Continuous Positive Airway Pressure Compliance on Complications in Patients with Type 2 Diabetes and Obstructive Sleep Apnea
Authors: REUTRAKUL SIRIMON , PRASAD BHARATI , SAHNI ASHIMA , MATANI SARA , SHETH URMI , DANIELSON KIRSTIE K. , MONSON REBECCA S. , CARLUCCI MELISSA , MERCADO TOMAS , SMITH MAUREEN 
Published: June 2020

Continuous positive airway pressure (CPAP) treatment has been shown to be beneficial to patients with obstructive sleep apnea (OSA) by reducing blood pressure and possibly slowing progression of chronic kidney disease. However, there is a dearth of research on the effects of CPAP treatment, especially compliance, on these outcomes in patients with type 2 diabetes (T2D) in a real world setting.
Methods: A single-center, retrospective chart review was conducted on patients with T2D who were diagnosed with OSA between 2010 and 2018. The first available CPAP report following the polysomnography was used to determine compliance (CPAP usage for &gt;4 h/night for &gt;70% of nights). Data such as estimated glomerular filtration rate (eGFR), A1C, blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events (CVD, PVD and CVA) were extracted from the charts. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for incident events. All models were controlled for age, sex, body mass index (BMI), medications, and baseline levels of outcomes.
Results: Of the 1,295 patients, 239 (18.4%) were compliant and 339 (26.2%) were non-compliant with CPAP, while 717 (55.3%) had insufficient data. Compared to those who were CPAP non-compliant, those who were compliant had a significantly lower systolic blood pressure (β=-2.28 mmHg, p=0.0002), lower diastolic blood pressure (β=-2.52 mmHg, p&lt;0.0001), and higher HDL (β=3.81 mg/dL, p=0.03). There were no significant differences between the two groups in eGFR, total cholesterol, LDL, triglycerides, A1C, incident CVD, PVD or CVA.
Conclusion: T2D patients with OSA who were compliant with CPAP had significantly lower blood pressure as well as higher HDL. However, eGFR, A1C, or cardiovascular events did not significantly differ by CPAP compliance in this study.

Disclosure
S. Reutrakul: None. B. Prasad: None. A. Sahni: None. S. Matani: None. U. Sheth: None. K.K. Danielson: None. M. Carlucci: None. T. Mercado: None. M. Smith: None.
2217-PUB: Remogliflozin in Indian T2DM Patients: A Real-World Study
Authors: BHATTACHARYA SUPRATIK , KATARE SAGAR 
Published: June 2020

Introduction: Remogliflozin is new SGLT2i approved in India. It is prudent to evaluate its effectiveness and tolerability in real world setting.
Methods: In this observational study, retrospective data from EMR of tertiary care hospital in Kolkata, India was retrieved. The records of patients who were uncontrolled (HbA1c&gt;7.5) on dual therapy (Metformin + DPP-4 inhibitors/Sulphonylureas) and subsequently treated with Remogliflozin for period of at least 6 months were selected. The records with evidence of active UTI at baseline, receiving injectable antidiabetic drugs or recorded eGFR &lt;45 mL/min were excluded. The effectiveness was assessed in terms of change in HbA1c, FBS, PPBS, body weight after 3 and 6 months of treatment. The safety was assessed by adverse events recorded in medical records in terms of abnormal symptoms, signs or laboratory reported values. The data was analysed using appropriate statistical techniques.
Results: Medical records of 120 adult patients (56.7% male) with T2DM was selected. The mean baseline characteristics of the patients in terms of Age, HbA1c levels, FBS, PPBS, weight and BMI was 58±13 years, 8.2±0.6%, 132.8±12.4 mg/dL, 204±28.2 mg/dL, 71.8±5.4 kg and 28.2±2.6 kg/m2 respectively At end of 6 months of add on Remogliflozin treatment , the mean change from baseline in HbA1c, FBS, PPBS, Body weight and BMI was -1.3±0.4%, -17.2±9.2 mg/dL, -56.4±18.4 mg/dL, -4.2±1.8 kg, -1.8±0.6 kg/m2 (P&lt;0.05 for all parameters). The reduction in body weight was more in patients on SUs as compared to DPP-4 inhibitors (-5.2 vs. -2.9kg). At end of 6 months, HbA1c reduced &lt;8% in all patients while 66% achieved target HbA1c of 7%. No events of hypoglycaemia or electrolyte disturbances were reported. Combined incidence of UTI and GTI was 5.8% which were mild. In none of the patients Remogliflozin was discontinued for adverse events.
Conclusion: In real world clinical practice, add on therapy of Remogliflozin to existing OHA regimen is observed to be an effective, safe and tolerable option in management of Indian patients with type 2 diabetes mellitus.

Disclosure
S. Bhattacharya: None. S. Katare: Employee; Self; Glenmark Pharmaceuticals Limited.
2218-PUB: Initiation of SGLT2 Inhibitors in Hospitalized Patients with CVD
Authors: PALERMO NADINE E. , GOODBERLET MELANIE , CROMWELL GRACE , SMITH COLLEEN M. , CHANG LEE-SHING , BILODEAU AMY , PLUTZKY JORGE , SZUMITA PAUL M. , HULME OLIVIA , CANNON CHRISTOPHER , MCDONNELL MARIE E. 
Published: June 2020

Recent data have shown significant benefit from SGLT2 inhibitors (SGLT2i) in patients with diabetes (DM) and cardiovascular disease (CVD) but experience with use in the acute care setting is limited and feasibility of initiating in the hospital is unclear. A multidisciplinary team of cardiology, endocrinology, and pharmacy developed a pilot to assess the feasibility of initiating SGLT2i in the hospital and subsequent transition of care. From 5/4/19 to 10/6/19, patients with DM on the cardiology service were identified and initiated on therapy with an SGLT2i if there were no contraindications. All patients were offered education via fact sheet, video, and/or focused consultation from the inpatient diabetes team. All prescriptions were either filled or verified as covered by insurance prior to discharge. An electronic communication was sent to notify the PCP and recommend basic metabolic labs be done at 2 weeks after initiation. 24 patients were eligible and 23 (96%) filled the prescription at discharge. 54.2% had CAD while 75% had CHF: 45.8% HFrEF and 29.2% HFpEF. The median GFR was 54 mL/min (44-64) and mean A1c was 8.1%. At 1 month, 71% remained on SGLT2i (n=17) and 63% completed recommended labs (n=15). 79% had outpatient follow up by 30 days (N=24) and 91% by 90 days (N=12). One patient died of respiratory failure within 30 days. 33% were readmitted within 90 days due to non-CHF cardiac illness (50%), respiratory problem (25%), lightheadedness (13%, n=1), or urinary tract infection (13%, n=1), and none for diabetes or CHF. There were no cases of metabolic acidosis or electrolyte disturbance. There was both a significant decrease in estimated GFR at 1 month (-6.95 mL/min, p= &lt;0.01) and in systolic blood pressure of -4.62 mmHg (p=0.04). 6 patients had &gt;30% reduced GFR and 1 advanced from CKD stage 4 to 5.
In conclusion, initiation of SGLT2i therapy in select patients with CVD and DM in the acute care setting appears to be feasible. Guidance is needed to ensure appropriate patient selection and medication adjustment in these patients.

Disclosure
N.E. Palermo: None. M. Goodberlet: None. G. Cromwell: None. C.M. Smith: None. L. Chang: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Other Relationship; Self; Applied Therapeutics, Fractyl Laboratories, Inc., Novo Nordisk Inc., Sanofi. A. Bilodeau: None. J. Plutzky: Consultant; Self; Amgen, AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. P.M. Szumita: None. O. Hulme: None. C. Cannon: None. M.E. McDonnell: None.
222-OR: A Call for a New Limb Salvage Paradigm for Patients with Diabetes
Authors: ZOLPER ELIZABETH G. , FAN KENNETH L. , MESHKIN DEAN , BEKENY JENNA C. , HILL CHRISTINE , MISHU MARK D. , CONNOLLY PATRICK , EVANS KAREN , ATTINGER CHRISTOPHER 
Published: June 2020

Five-year mortality rates for patients with diabetes who undergo lower extremity amputation (LEA) have long been regarded as high and inevitable. Accepted five-year mortality rates exceed 50%. The aim of this study was to assess 5-year mortality after LEA performed with a multidisciplinary approach focused on function. We retrospectively enrolled all patients (n=312) with diabetes who underwent primary non-traumatic LEA at our institution from 2010-2013. Patients were stratified by LEA type: minor (toe, ray, TMA, Lisfranc, Chopart, Symes) or major (BKA, AKA). Surgical technique optimized biomechanics via tendon rebalancing with repurposing plantar skin for anterior coverage for minor LEA and myodesis of residual muscles with posterior myocutaneous flap closure for major LEA. Our multidisciplinary team, consisting of wound care, reconstructive, podiatric, vascular, and prosthetic specialists, ensures recovery and post-LEA function. Mortality was established via medical records and a commercial database then analyzed with Kaplan-Meier estimates. Five-year mortality was 31% (Figure); Charlson Comorbidity Index was 5.5±2.2. Five-year mortality was not significantly different for minor versus major LEA.
In conclusion, we have demonstrated improved 5-year mortality after LEA with multidisciplinary care focused on functional outcomes. Successful “limb salvage” is evaluated by preservation of function instead of limb length.

Disclosure
E.G. Zolper: None. K.L. Fan: None. D. Meshkin: None. J.C. Bekeny: None. C. Hill: None. M.D. Mishu: None. P. Connolly: None. K. Evans: None. C. Attinger: Consultant; Self; Acelity, Integra LifeSciences.

Funding
MedStar Diabetes
2227-PUB: The Experience of Spanish Speakers in the Real Health Study
Authors: CROMER SARA , RODRIGUEZ ANTHONY R. , BISSETT LAURIE , DUSHKIN AMY , GOLDMAN VALERIE M. , MCCARTHY JEANNA , DELAHANTY LINDA M. , WEXLER DEBORAH J. 
Published: June 2020

The REAL HEALTH Diabetes study was a pragmatic trial of an intensive lifestyle intervention (ILI) for patients with type 2 diabetes (T2DM) adapted from Look AHEAD for delivery in routine primary care settings in English and Spanish. Given the high prevalence of T2DM in the Latino population, underrepresentation of this population in research, and disparities in outcomes, we evaluated the experience of Spanish speakers, as compared to English speakers, screened for and enrolled in REAL HEALTH. The trial screened 715 patients who spoke Spanish as a primary language, of whom 17 subjects (8.1% of enrollees, 2.4% of screened Spanish speakers) enrolled in the study. Compared to English speakers, Spanish speakers were less likely to decline participation due to lack of interest (OR 0.43, p&lt;0.01) and equally likely to attend a screening visit (p=0.54) but more likely to be lost to recruitment due to inability to contact the patient for a phone screen (OR 2.0, p&lt;0.01). Engagement of Spanish speakers was lower than among English speakers, with lower rates of completion of the ILI (OR 0.22, p=0.04) and a trend for lower attendance for medical nutrition therapy. Despite this, Spanish-speakers had higher increases in (p=0.01) and final levels of (p=0.03) self-reported physical activity. Weight loss at 12 months in the ILI did not significantly differ between groups (2.8kg among Spanish-speakers vs. 4.8kg among English speakers, p=0.11). It is important to recognize barriers to clinical trial and ILI engagement, as well as the nuances of experiences and outcomes within clinical trials. Enrollment of Spanish speakers was limited by difficulty contacting potential subjects, despite extensive recruitment efforts by study staff. Enrolled participants engaged differently but had similar weight loss compared to English speakers in the ILI. Spanish-speakers represent a unique group who may benefit from tailored interventions.

Disclosure
S. Cromer: Employee; Spouse/Partner; Johnson & Johnson. A.R. Rodriguez: None. L. Bissett: None. A. Dushkin: None. V.M. Goldman: None. J. McCarthy: None. L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Weight Watchers International, Inc. D.J. Wexler: Other Relationship; Self; Novo Nordisk A/S.

Funding
National Institutes of Health (T32DK007028)
223-OR: Preliminary Evidence that "Structured Eating" (SE) May Be Acceptable and Promote Glycemic Control in Type 1 Diabetes (T1D)
Authors: CRISTELLO ANGELICA , KAHKOSKA ANNA R. , SMART CARMEL E. , COUCH SARAH C. , IGUDESMAN DARIA , KAGER LAUREN , MAYER-DAVIS ELIZABETH J. 
Published: June 2020

Research on eating patterns in T1D is scarce, especially in youth. This population is in particular need of effective behavioral strategies during adolescence when HbA1c peaks and lifelong behaviors form. Case studies from pediatric T1D clinics suggest SE (consistent frequency, timing and spacing of meals, snacks and macronutrients throughout the day) is helpful for meeting glycemic targets, yet the health impacts and feasibility of SE as a clinical guideline are not well documented. We developed SE variables and used linear mixed effects models to explore associations between individual SE behaviors and CGM metrics in 24-hr dietary recall and 7-day CGM data of adolescents (n=319, 13-16 yrs, HbA1c 8-13%) from the Flexible Lifestyles Empowering Change (FLEX) intervention. We also conducted a small pilot (n=9, 13-16 yrs, HbA1c 8-13%), “MyPlan”, to explore acceptability of SE. In FLEX, SE behaviors were associated with favorable CGM profile, including time in range (Table 1). In MyPlan, acceptability of SE (scale 0-8) was high among adolescents (mean: 6.8; SE:1.6) and their parents (mean: 7.1 SE: 1.2). Our preliminary evidence suggests benefit and feasibility of SE in adolescents. To inform future trials and ultimately, clinical guidelines, further analyses in diverse samples are needed to more specifically characterize SE patterns and understand their role in T1D health outcomes.

Disclosure
A. Cristello: None. A.R. Kahkoska: Other Relationship; Self; Novo Nordisk A/S. C.E. Smart: None. S.C. Couch: None. D. Igudesman: None. L. Kager: None. E.J. Mayer-Davis: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK101132)
2230-PUB: A Portrait of HbA1c Levels amongst Adults Diagnosed with Diabetes Mellitus in Suburban Ahmedabad
Authors: SHAH SHIVESH , SABOO BANSHI D. , SHAH SHAILIN , HASNANI DHRUVI , CHAVDA VIPUL , KESAVADEV JOTHYDEV , SHAH HARSHAL B. , PATEL KARNIK J. 
Published: June 2020

Background: Many studies have estimated the prevalence of type 2 diabetes in suburban regions of India, such as Ahmedabad, Gujarat. However, there are few studies that examine the progression of HbA1C levels in patients diagnosed with diabetes over multiple visits to healthcare facilities.
Objective: The primary aims of this study were to assess the efficacy of patient treatment at a diabetes care center in Gujarat, India and determine factors that may affect the progression of HbA1C levels over multiple visits.
Methods: A total of 2,037 individuals aged ≥25 years (mean age 53.7 years) were included in this retrospective study. All individuals were previously diagnosed with diabetes and received treatment at the Dia Care Advanced Diabetes Care Center in Ahmedabad. Patient data was acquired from the clinic’s HealthPlix EMR.
Results: Of those meeting inclusion criteria, males constituted 69.1%. The average BMI of all subjects was 29.7 kg/m2. Of all 2,037 subjects, only 22.0% (n=442) patients were tested for HbA1C levels multiple times. On average, these subjects underwent blood tests for HbA1C values 3.3 times in a one-year period and HbA1C levels dropped by 0.51 mg/dl (95% CI 0.70-0.31). There was a substantial correlation between the number of clinic visits and the decrease in HbA1C values (R = 0.71). Over the course of one year, 22.6% (19.9-25.1) of subjects who returned to the clinic saw a drop in HbA1C to levels not indicative of diabetes (≤6.5 mg/dl). A significant correlation was observed between RBS measurements and HbA1C levels. Notably, there was also a slight negative correlation between BMI and the number of clinic visits (R = 0.74).
Conclusion: Results from this study reinforce the conventional wisdom that frequent visits to one’s physician help achieve glycemic control. More importantly, these results also reflect the success of suburban clinics such as Dia Care and call for physicians to stress the importance of clinic visits and address improvement in metabolic status regularly.

Disclosure
S. Shah: None. B.D. Saboo: None. S. Shah: None. D. Hasnani: None. V. Chavda: None. J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. H.B. Shah: None. K.J. Patel: None.
2231-PUB: Perioperative Glucose Control Protocol: Hip and Knee Arthroplasty
Authors: PICK ANTHONY , BARALLI JENNIFER D. , SANDHU HARJYOT , KHORZAD REBECA 
Published: June 2020

Diabetes and stress hyperglycemia is associated with surgical site infections and other complications. Glucose control may be a modifiable risk factor. Our hospital and healthcare system did not have a standardized protocol for perioperative glucose management. There was variability in pre-surgery diabetes medication adjustments, no proactive glucose monitoring, no glucose control metrics and variable approaches to peri-operative glucose management. We, therefore, initiated a pilot quality improvement project. The population selected were total hip and knee replacement patients as diabetes (∼25%) is a common co-morbidity and there was a signal that diabetes (40% of cases) was associated with deep surgical site infections. The project was an opportunity to implement a population health approach to peri-operative and inpatient glucose management; decrease practice variability and foster a multi-disciplinary team approach. We standardized the recommended adjustments of diabetes medications prior to surgery (e.g., basal insulin decreased 20% the day before surgery); established a uniform A1c threshold of 8% (changed to 7.5%) to postpone surgery and started routine glucose monitoring on the day of surgery in all joint surgery cases. We implemented a standardized correction insulin protocol to be used by anesthesiology and encouraged the use of basal-meal-correction insulin, rather than sliding scale insulin, after surgery, in suitable patients by the hospitalists. The quality project showed a dramatic decrease in hypoglycemia on the day of surgery (∼95% decrease), significantly increased A1c monitoring (3 fold), detected unrecognized diabetes (13%), prediabetes (37%) and stress hyperglycemia and increased the use of correction insulin. Although suggestive, the small sample size and short intervention duration (6 months) were insufficient to detect a significant drop in infection rates. This project is in sustain phase and expanding to other high risk surgeries and can be a model for the entire system.

Disclosure
A. Pick: None. J.D. Baralli: None. H. Sandhu: None. R. Khorzad: None.
2237-PUB: Diabetes Inside: Regional Collaborative to Improve DM and CVD Care Quality
Authors: FURMAN ROY E. , HILL-BRIGGS FELICIA , IWAMAYE AMY , KNIGHT COLETTE , KOUVATSOS TASHA , LEV YAIR , LORINCZ ILONA , MARELLA WILLIAM M. , RUBIN DANIEL J. , SCHUTTA MARK H. , SWAVELY DEBORAH A. , WARD LAWRENCE , FURMAN ELISE C. , LIPTAK GREG 
Published: June 2020

The American Diabetes Association (ADA) and the American Heart Association launched a multi-faceted national partnership in 2018, Know Diabetes by Heart™, to reduce cardiovascular disease (CVD) deaths, heart attacks and strokes in people living with type 2 diabetes.
To support this initiative, the ADA’s Diabetes INSIDE® (DI) program formed a mid-Atlantic quality improvement (QI) collaborative of five academic medical centers and a health information exchange (HIE) with partners from primary care, endocrinology, cardiology, nephrology, nursing, pharmacy, health IT, diabetes education, population health and industry. The collaborative’s goal is to accelerate clinical adoption of recent CVD findings using population health analytics, care system redesign, shared learning, provider and patient training, education, and community resources.
DI works with each partner to identify, design and monitor quantifiable QI programs to address care quality gaps. The collaborative shared their initial findings and goals at a November 2019 meeting.
Three systems identified opportunities to improve low use of SGLT2 inhibitors and GLP-1 agonists in eligible patients (∼12%) or departmental prescribing gaps between primary care and cardiology vs. endocrinology (SGLT2 5% vs. 11%; GLP-1 7.5% vs. 24.6%). Other gaps included coordinating care teams and communication between inpatient and outpatient settings both within and across overlapping health systems, a gap the HIE aims to address. Other systems are implementing DM screening in cardiology clinics or training cardiologists to assume a larger role in managing patients with DM and CVD. A system with a large racial/ethnic minority population is qualitatively evaluating the social, cultural, economic, and literacy factors that facilitate or inhibit optimal care. This regional collaborative across overlapping health systems offers increased opportunity to accelerate improvement of DM and CVD care for all patients and may serve as a model for other regions.

Disclosure
R.E. Furman: None. F. Hill-Briggs: None. A. Iwamaye: None. C. Knight: None. T. Kouvatsos: None. Y. Lev: None. I. Lorincz: None. W.M. Marella: None. D.J. Rubin: None. M.H. Schutta: Employee; Spouse/Partner; Merck & Co., Inc. D.A. Swavely: None. L. Ward: None. E.C. Furman: None. G. Liptak: Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc.

Funding
Know Diabetes By Heart™; Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance; Novo Nordisk; Sanofi; AstraZeneca; Bayer
2245-PUB: Insulin Pump Access to Low-Income Pediatric Patients with Type 1 Diabetes Living in Massachusetts
Authors: BONETTI IVANA , SEGAL ALISSA R. , MARCUS GAIL 
Published: June 2020

Purpose: To evaluate whether low-income pediatric patients with type-1 diabetes living in Massachusetts experience disparities in access to insulin pumps and if there are disparities, what are the root causes.
Methods: The first part of this study was a literature review to identify access disparities and any barriers experienced by the population. The second part of this study was interviewing stakeholders in Massachusetts who have insight on this topic. Stakeholders in this study are defined as experts who have an impact or interaction with the investigated population. A snowballing method of sampling method was used where stakeholders were asked to refer someone. The stakeholders consisted of physicians (33%), nurses/educators (33%), pump representatives/trainer (17%), and health insurance workers (17%). A transcription tool, NVivo™, was used to search for common themes among the interviews.
Results: Common barriers were identified as: economics, social factors, developmental stage, education level and patient-provider assessment. Economically, patients encountered unaffordable copays and extensive paperwork. Socially, patients feared embarrassment and admission of their diagnosis. Younger patients, usually children under an adolescent age, are commonly denied a pump due to the lack of management control and physical discomfort with pump attachment. Lack of education from guardians and/or patients operating a pump limited access and influenced opting out. Provider assessment of the patient’s glycemic control also determined pump access.
Conclusion: Findings from this study have confirmed that there is an access gap for this population in Massachusetts. Access to pumps have been found to be influenced by the following barriers: economics, social factors, developmental stage, education level and patient-provider assessment.

Disclosure
I. Bonetti: None. A.R. Segal: None. G. Marcus: None.

Funding
Massachusetts College of Pharmacy and Health Sciences