bluuebunny/crossref_metadata_2025_split huggingface dataset:
374-P: External Validation and Clinical Application of the Risk Prediction Model for Severe Hypoglycemia in Type 2 Diabetes
Authors: AHN YU-BAE , YUN JAE-SEUNG , LEE JUNG-MIN , SONG KI-HO , KO SEUNG-HYUN 
Published: June 2020

We previously developed and internally validated a one-year risk prediction model for SH in type 2 diabetes using the National Health Insurance Service database and analyzing data from 1,173,820 subjects with type 2 diabetes. In this study, we planned external validation to verify the performance of the previously-developed risk prediction model in a tertiary hospital setting. From January 2018 to December 2018, 2,724 patients over 30 years old who visited the diabetes center were enrolled. The Harrell C-statistics were compared to identify the discrimination of the developed model. The predicted incidence and actual incidence of SH at 1 year in the development and validation cohort were compared by ranking subjects into deciles of predicted risk. External validation was performed with a total of 2,757 patients. The incidence rate of severe hypoglycemia was 12.6 per 1000 patient-year. The concordance index for SH was 0.854 in the external validation cohort. The sensitivity and specificity of this model prediction in the external validation cohort were 0.714 and 0.853, respectively. However, compared with the model for the development cohort, the incidence rate of SH in each decile group was three times higher than the predicted value. SH risk scores increased in proportion to the age and the duration of diabetes (P for trends &lt;0.001, respectively). The HbA1c distribution was distributed in the form of a J-shape according to the decile group of SH risk score. The risk score for SH was higher in the subjects with chronic kidney disease, heart failure, and dementia than those with other major comorbidities. Our SH prediction model showed excellent discrimination when applied to type 2 diabetes subjects in the tertiary hospital. The results of this study confirm that the risk of hypoglycemia can be accurately predicted using this model. The actual number of SH events is higher than expected, which might be due to the characteristics of the subjects in the tertiary hospital.

Disclosure
Y. Ahn: None. J. Yun: None. J. Lee: None. K. Song: None. S. Ko: None.
379-P: Glucagon Use by U.S. Adults with Type 1 and Type 2 Diabetes
Authors: KAHN PETER , LIU SHULING , MCCOY ROZALINA G. , GABBAY ROBERT A. , LIPSKA KASIA J. 
Published: June 2020

The American Diabetes Association recommends that patients at high risk for hypoglycemia be prescribed glucagon.
Using de-identified administrative claims from OptumLabs® Data Warehouse (OLDW) for commercial and Medicare Advantage enrollees, we examined glucagon prescriptions filled between 1/1/2014 and 12/31/2014 among pharmacologically treated type 1 and 2 diabetes patients. We examined association of glucagon fills with demographic, clinical, and laboratory-based factors. HbA1c levels were available for a subsample. Model performance was assessed with AUC and calibration plots.
Among 12,338 patients with type 1 and 323,244 with type 2 diabetes, 14.5% and 0.7% filled glucagon in 2014, respectively. Among type 1 diabetes patients, the multivariable model had poor discriminative performance (AUC=0.61). Among patients with type 2 diabetes, the model AUC was 0.89. Factors associated with glucagon use are shown in Figure. HbA1c level was not independently associated with glucagon fills.
In this national study, glucagon was rarely filled.
Among patients with type 1 diabetes, glucagon fills were unpredictable and not targeted to highest risk patients. Patients with type 2 diabetes were more likely to fill glucagon in the setting of prior hypoglycemia, higher income, and endocrinology care. These findings suggest opportunities to improve care, including better prescribing practices to target high-risk patients.

Disclosure
P. Kahn: None. S. Liu: None. R.G. McCoy: None. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. K.J. Lipska: None.

Funding
National Institutes of Health (K23AG048359)
381-P: Real-Time Ward-Level Monitoring of Nurse Performance Level Is able to Demonstrate Improved Management of Inpatient Hypoglycemia following an Education Intervention
Authors: SAINSBURY CHRISTOPHER , SKIVINGTON CHRISTINE , ROBERTSON MARIE , JONES GREGORY C. , CLELAND STEPHEN J. 
Published: June 2020

Aims: The aims of this study were (a) to demonstrate that analyses of glucometer data/metadata can reveal real-time ward-level patient-centred outcomes relevant to hypoglycemia (b) to test whether a 6-month education and mentoring intervention improved relevant performance levels.
Methods: Ward glucometer data were analysed for periods of 9 months before and after the intervention in 9 wards (256 beds) in a large Scottish teaching hospital. Results were compared with 9 control wards, matched for size, specialty and acuity. Hypoglycemia was defined as &lt;4mmol/l (72mg/dl). Process control charts were constructed for each clinical unit. At each hypoglycemic event, +1 (success) or -1 (fail) was generated for TTR (time to repeat CBG) and TTHR (time to hypo resolution). The gradient of the plot represents performance level, allowing comparison pre- and post-intervention for both ward groups.
Results: Total hypo events = 5187. Significant improvements in performance level were demonstrated in the intervention wards but not the control wards in TTR at 10, 15, 20 and 30 mins and TTHR at 10, 15 and 20 mins (Table).
Conclusions: This study demonstrates the utility of the process control charts in CBG-related patient outcomes, and quantifies the significant improvement in hypoglycemic management derived from an education intervention.

Disclosure
C. Sainsbury: Consultant; Self; MyWay Digital Health. Research Support; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca. C. Skivington: None. M. Robertson: None. G.C. Jones: None. S.J. Cleland: None.

Funding
Sanofi
387-P: Glycemic Outcomes in Baseline Hemoglobin A1c Subgroups in the International Diabetes Closed-Loop (IDCL) Trial
Authors: EKHLASPOUR LAYA , RAGHINARU DAN , LUM JOHN , BROWN SUE A. , BUCKINGHAM BRUCE A. 
Published: June 2020

Using a closed loop system significantly improves time in range (TIR) in patients with type 1 diabetes (T1D). In a 6-month RCT, 112 subjects were assigned to closed-loop control (Tandem Control-IQ) after obtaining two weeks of baseline CGM data from sensor-augmented pump therapy. We compared glycemic outcomes from baseline to end of study among subgroups classified by baseline HbA1C level. Participants’ mean age was 33±16 (range 14-71 yrs) and mean baseline HbA1C was 7.4±1.0 (range 5.4% to 10.6%). All HbA1c subgroups showed an improvement in TIR due to reduction of both hyperglycemia and hypoglycemia (Table). Those with HbA1c &lt;6.5% improved mostly by reducing nocturnal (MN to 6 AM) hypoglycemia. Those with HbA1c ≥8.5% improved mostly by reducing daytime and nocturnal hyperglycemia. Participants with lower HbA1c at baseline reduced their overnight hypoglycemia the most, likely due to the system’s automated basal insulin adjustment. For those with higher HbA1c at baseline, increased TIR came mostly from hyperglycemia reduction, likely due to automated basal insulin adjustment in day and night. These participants likely also benefitted from hourly automatic correction boluses during the day. All HbA1c subgroups benefitted from automated insulin delivery.

Disclosure
L. Ekhlaspour: None. D. Raghinaru: None. J. Lum: None. S.A. Brown: Research Support; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Tolerion, Inc. B.A. Buckingham: Advisory Panel; Self; ConvaTec Inc., Medtronic. Research Support; Self; Beta Bionics, Inc., Dexcom, Inc., Insulet Corporation, Medtronic, Tandem Diabetes Care.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (UC4108483); University of Virginia; Tandem Diabetes Care
39-LB: Progress in Diabetic Foot Ulcer Healing with Standard of Care Therapy Alone: A Meta-analysis
Authors: PARKS VIRGINIA E. , CRISOLOGO PETER , LAVERY LAWRENCE A. , BANKS JAMINELLI , LIETTE MICHAEL D. , JOHNSON LANCE 
Published: June 2020

Background: The purpose of this study was to evaluate whether or not standard of care treatment of diabetic foot ulcers has improved over the past 20 years as measured by the percentage of ulcers healed within set periods of time. Previously reported percentages of wound healing were 24% at 12 weeks and 31% at 20 weeks.
Methods: A meta-analysis was performed to review the control groups of randomized clinical trials in the treatment of diabetic foot ulcers. The mean percentage of ulcers healed at defined end points were then compared to percentages of ulcers healed at corresponding end points reported 20 years ago. A literature search was performed to identify articles published before December 30, 2019, to identify randomized controlled clinical trials that included human subjects with diabetic foot ulcers. The control arm was required to include wound debridement, dressing changes, and offloading.
Results: The literature search yielded 16 randomized clinical trials that fit the selection criteria to be included in the meta-analysis. Analysis of the percentage of wounds healed with standard of care therapy alone yielded the following results: 6 weeks (14.9% ± 13.0%), 12 weeks (33.4% ± 18.2%), 20 weeks (43% ± 0%).
Conclusions: The results of this meta-analysis of the available evidence suggest that the percentage of diabetic foot ulcers healed with standard of care therapies alone have improved over the past 20 years. However, the percentage of ulcers healed at each of these endpoints remains low and demonstrates continued challenges in healing diabetic foot ulcers.

Disclosure
V.E. Parks: None. P. Crisologo: None. L.A. Lavery: Advisory Panel; Self; Acelity, Bayer AG. Consultant; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Smith & Nephew. J. Banks: None. M.D. Liette: None. L. Johnson: None.
39-OR: Secular Trends in Glucose-Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes between 2002 and 2016 in Hong Kong
Authors: YANG AIMIN , WU HONGJIANG , LAU ERIC S. , MA RONALD C. , KONG ALICE P. , SO WING YEE , LUK ANDREA , CHAN JULIANA C. , CHOW ELAINE 
Published: June 2020

Introduction: There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined secular trends in GLDs utilization, glycemic control and rate of SH among people with diabetes, mainly type 2 diabetes, in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000.
Methods: Using population-based data from the Hong Kong Diabetes Surveillance Database consisting mainly of Chinese living a westernized lifestyle, we estimated the annual age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged ≥20 years between 2002-2016. We used Joinpoint regression to examine secular trends over time.
Results: In 2002-2016, use declined for sulfonylureas (50.7% to 28.9%) but increased for metformin (47.8% to 57.3%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 7.0%). The proportion of patients with HbA1c of 6.0-7.0% increased from 25.6% to 37.2% while the rate of SH declined from 4.4 to 1.7 per 100 person-years. The main improvement in annual mean HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.8 (1.6)% to 7.4 (1.7)% (p&lt;0·001). The 20-44 age group had the highest proportion of HbA1c&gt;9% with rising proportions not treated with any GLDs (from 4.3% to 10.5%).
Conclusion: Prescription of GLDs has changed dramatically in Hong Kong in the past 15 years in line with treatment guidelines and introduction of new drugs. The modest but important improvement in HbA1c since 2007 coincided with widening reform of diabetes services in primary care and introduction of DPP-4i. Poor glycemic control and low utilization of GLDs in the youngest age group calls for targeted treatment strategies and ongoing surveillance.

Disclosure
A. Yang: None. H. Wu: None. E.S. Lau: None. R.C. Ma: Advisory Panel; Self; AstraZeneca. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Tricida Inc. A.P. Kong: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Abbott, AstraZeneca, Sanofi. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. W. So: None. A. Luk: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc., Roche Pharma. Other Relationship; Self; Merck Sharp & Dohme Corp. J.C. Chan: None. E. Chow: None.

Funding
Chinese University of Hong Kong
390-P: Household Food Security and Fear of Hypoglycemia in Youth and Young Adults with Diabetes and Parents of Youth with Diabetes
Authors: REID LAUREN A. , ZHENG SIYU , MENDOZA JASON A. , REBOUSSIN BETH A. , SAUDER KATHERINE A. , SAYDAH SHARON , LAWRENCE JEAN M. , JENSEN ELIZABETH T. , HENKIN LEORA , FLORY KATE , KNIGHT LISA M. , PIHOKER CATHERINE , DOLAN LAWRENCE M. , LIESE ANGELA D. 
Published: June 2020

Hypoglycemia is a common acute complication in diabetes that is often treated with carbohydrate-rich snacks or drinks. For individuals with diabetes and household food insecurity (HFI), uncertain availability of food may increase fear of hypoglycemia (FOH). FOH may prevent individuals from optimal diabetes management.
We analyzed data from 1,603 adult (≥18 years, mean 23.7 years, 80% type 1 diabetes [T1D], 20% type 2 diabetes [T2D]) and 592 youth (10.0-17.9 years, mean 15.2 years, 100% T1D) participants in the SEARCH for Diabetes in Youth Study. Adult participants and parents of youth participants completed the U.S. Household Food Security Survey, where ≥3 food insecure conditions or behaviors indicate HFI. Adults, youth, and parents of youth completed the Hypoglycemia Fear Survey that provides a behavior subscale (scores 0-60), worry subscale (scores 0-72), and total score (sum of subscales). We examined the association of HFI with FOH with general linear models, adjusting for socioeconomic, demographic, and clinical covariates.
Approximately 20% of adults and 17% of youth had HFI. Adults with T1D reporting HFI (vs. no HFI) had increased FOH (+3 units for behavior, +11 units for worry, +14 units for total), after adjustment for covariates (all p&lt;0.0001). Parents of youth with T1D reporting HFI had a 3 unit increase in worry FOH (p=0.03). Adults with T2D reporting HFI had increased FOH (+8.9 units for total, +6 units for worry; all p&lt;0.01). Youth with T1D reporting HFI did not differ in FOH than those not reporting HFI.
This research suggests that among adults with diabetes and parents of youth with T1D, those with HFI are more likely to experience FOH than those without HFI. Implementation of common approaches to ameliorate risk of hypoglycemia such as carrying snacks is problematic for people who are food insecure. Providers could consider HFI when discussing hypoglycemia and fear thereof with their patients.

Disclosure
L.A. Reid: None. S. Zheng: None. J.A. Mendoza: None. B.A. Reboussin: None. K.A. Sauder: None. S. Saydah: None. J.M. Lawrence: None. E.T. Jensen: None. L. Henkin: None. K. Flory: None. L.M. Knight: None. C. Pihoker: None. L.M. Dolan: None. A.D. Liese: None.

Funding
National Institutes of Health (1UC4DK108173, 1R01DK117461-01)
391-P: Predictive Low Glucose Suspend (PLGS) Necessitates Less Carbohydrate (CHO) Supplementation to Rescue Hypoglycemia: Need to Revisit Current Hypoglycemia Treatment Guidelines
Authors: PINSKER JORDAN E. , BARTEE AMY , KATZ MICHELLE , LALONDE AMY , JONES RICHARD , DASSAU EYAL , WOLPERT HOWARD 
Published: June 2020

PLGS systems have been demonstrated to limit hypoglycemia. Reduced insulin during suspensions may avoid the need for rescue CHO or lessen the amount of CHO needed. The approximately 20-hour inpatient evaluation of the Lilly investigational AID system’s PLGS feature, including a basal up-titration period to activate the PLGS and investigator-directed administration of rescue CHO, allowed assessment of hypoglycemia prevention and treatment requirements. Ten subjects with type 1 diabetes (40% male, mean age 39.0±13.0 years, A1C 7.2±0.6%, and insulin usage 0.6±0.2 U/kg/day) were studied. There were 59 suspensions, with all subjects experiencing suspensions during which CHO were not administered. Only six suspensions were associated with rescue CHO and five suspensions were associated with hypoglycemia (CGM glucose &lt;70 mg/dL for ≥15 minutes), see Table. No rescue CHO were given during or after insulin suspension for the overnight basal up-titration. Rescue CHO consisted of median 9g CHO (range: 5-16g). No episode required repeat CHO administration. New hypoglycemia treatment guidelines for PLGS users should reflect that PLGS reduces CHO requirements for hypoglycemia rescue. This guidance will be important to minimize rebound hyperglycemia and needless calorie intake from hypoglycemia over-treatment.

Disclosure
J.E. Pinsker: Advisory Panel; Self; Medtronic. Consultant; Self; Eli Lilly and Company, Tandem Diabetes Care. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Tandem Diabetes Care. Speaker’s Bureau; Self; Tandem Diabetes Care. A. Bartee: None. M. Katz: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. A. LaLonde: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. R. Jones: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. E. Dassau: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Roche Diabetes Care. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. H. Wolpert: Employee; Self; Eli Lilly and Company.
393-P: Technology Use and Hypoglycemia in Type 1 Diabetes: Insights from the BETTER Registry
Authors: TALEB NADINE , DESJARDINS KATHERINE , HAAG SARAH , PREVOST MELINDA , RABASA-LHORET RÉMI , BRAZEAU ANNE-SOPHIE 
Published: June 2020

The BETTER registry launched in April 2019 aims to understand the burden (frequency, severity) of hypoglycemia from people with T1D’s perspective and to evaluate the role of technologies in its prevention and management.
Methods: BETTER registry includes several online surveys and is being conducted in Quebec, Canada. Preliminary results of the 2ndsurvey about technology use, CSII and FGM/CGM, in relation to hypoglycemia are reported.
Results: By Dec 2019, 457 persons with T1D (&gt; 14 y.o.) have completed the 2ndsurvey (44.0±15.7 y.o., 67.2 % females, 48.0% CSII users, 80% FGM/CGM users in past 12 months). Main reasons for opting for technology: A) CSII (n=219): glucose control with exercise (72.6%), elevated HbA1c (42.9%), nocturnal hypoglycemia (35.2%) as well as overall hypoglycemia severity and frequency (26.0%). Interestingly, 65.3% reported less hypoglycemia after adopting CSII. B) FGM/CGM (n=365): easier to follow glucose levels (77.5%), stop/reduce capillary measurements (69%), easier glucose control with exercise (68.5%). Table1 shows comparisons between technology users vs. non users: CSII and FGM/CGM users reported better glucose control, more hypoglycemia episodes (probably due to better diagnosis) that are corrected at higher BG levels.
Conclusion: This database will improve the understanding of technologies roles in hypoglycemia detection, prevention and treatment to optimize their use.

Disclosure
N. Taleb: None. K. Desjardins: None. S. Haag: None. M. Prevost: None. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc. Board Member; Self; Merck & Co., Inc., Sanofi. Research Support; Self; Eli Lilly and Company, Novo Nordisk A/S, Novo Nordisk A/S, Sanofi. A. Brazeau: None.

Funding
Canadian Institutes of Health Research (JT1-157204); JDRF (4-SRA-2018-651-Q-R)
394-P: Inpatient Hypoglycemia: Opportunity to Prevent
Authors: MEHROTRA NEHA , ATALAY HANDE , KORYTKOWSKI MARY T. , MON SANN YU 
Published: June 2020

Introduction: Inpatient hypoglycemia is commonly associated with high mortality and morbidity. Several factors contribute to hypoglycemia in patients with diabetes, and not all causes are inevitable. However, it is important to recognize the causes of hypoglycemia to prevent further episodes. We investigate the potential causes of hypoglycemic episodes in our community hospital as part of a quality improvement project. Our aim is to reduce risks of hypoglycemia by identifying potential preventable etiologies and educate providers and the nursing team.
Methods: A retrospective chart review of patients was performed for all non-critically ill diabetic patients who experienced point of care blood glucose&lt;70mg/dl testing between March to June 2019 (n=63). Potential causes of each hypoglycemia episode were reviewed retrospectively by a single endocrinologist.
Results: The mean age was 62.3 years+/-17.1, 63.5% males, BMI (mean 33.31+/-20.8kg/m2), 79.4% type 2 diabetes with mean A1C 8.2+/-1.6%. Median length of hospital stay was 6 days. 16(25.4%) patients had &gt;2 episodes of hypoglycemia and 15 patients (23.9%) had severe hypoglycemia (defined as blood glucose &lt; or = to 45 mg/dl). 8 patients (12%) were readmitted within 7 days and 20 patients (31%) had readmission within 30 days.
The most common cause of hypoglycemia was due to basal insulin excess (n=17 patients, 27%), overuse of sliding scale (n=16 patients, 25.4%), reduce food intake (n=11 patients , 25.4%), inpatient use of premixed insulin (n=6 patients, 9.5%) and use of sulfonylurea (n=2 patients, 3.2%). Two other hypoglycemic events appeared to occur when steroids dose was tapered without insulin dose adjustments.
Conclusion: The results demonstrate that several major causes of hypoglycemia are preventable and reinforce the need for determination of the cause of these events as a way of modifying therapy to prevent further episodes.

Disclosure
N. Mehrotra: None. H. Atalay: None. M.T. Korytkowski: None. S. Mon: None.