bluuebunny/crossref_metadata_2025_split huggingface dataset:
799-P: Comparison of the Effects of Sodium-Glucose Cotransporter 2 Inhibitor and Thiazolidinedione Treatment on Risk of Atrial Fibrillation among Patients with Type 2 Diabetes
Authors: LEE SEUNG EUN , KIM YOO RI , NAM HYEWON , KIM HOSEOB , KIM JAEHWAN , KIM KYOUNG-AH 
Published: June 2021

Background: Type 2 diabetes is an independent risk factor for the development of atrial fibrillation (AF). However, whether reducing hyperglycemia can mitigate AF risk or not is elusive. Recently, SGLT-2i has been shown to decrease the incidence of AF through several mechanisms including reduction of atrial dilatation via diuresis and lowering body weight. On the other hand, the use of TZD was found to protect diabetic patients from new-onset AF in observational studies. Thus, we aimed to compare the effect of SGLT-2i and TZD on the risk of AF development.
Methods: Using the Korean National Health Insurance Service database, we included patients with type 2 diabetes who were prescribed SGLT-2i or TZD at least once from January 2014 to December 2018. Patients were followed until the outcome event, death, or 31 December 2018. The propensity score matching method was used to balance baseline characteristics between groups. Sensitivity analysis was performed only including patients who prescribed study drugs ≥ 90 days.
Results: After propensity matching, a total of 145,378 patients were included (72,689 patients in each treatment group). Baseline characteristics were well-balanced; mean age was ~57 years and 57.4% were male; mean body mass index was ~26.3kg/m2 and ~68.3% had hypertension. During follow-up, the incidence rates of AF were 4.84 and 5.23 per 1000 person-years in SGLT-2i-treated patients and TZD-treated patients, respectively. The hazard ratio (HR) of AF was 0.99 (95% confidence interval [CI]: 0.89-1.11) in SGLT-2i-treated patients compared with TZD-treated patients. The results remained consistent after sensitivity analysis (HR, 0.92; 95% CI: 0.78-1.08).
Conclusions: In this study, the risk of AF development was comparable in patients treated with SGLT-2i versus TZD. The risk of AF development across antidiabetic drugs with little risk of hypoglycemia might be similar.

Disclosure
S. Lee: None. Y. Kim: None. H. Nam: None. H. Kim: None. J. Kim: None. K. Kim: None.
800-P: Phase 3 Results of Fixed-Dose Combination of Remogliflozin Etabonate and Vildagliptin in Indian T2DM Patients
Authors: MOHAN BRIJ , CHAWLA MANOJ S. , KODGULE RAHUL R. , TANDON MONIKA , KATARE SAGAR , SURYAWANSHI SACHIN , BARKATE HANMANT V. 
Published: June 2021

Introduction: Remogliflozin Etabonate (RE) and Vildagliptin are approved in India for management of type 2 diabetes mellitus (T2DM), which were evaluated as a fixed dose combination (FDC) in this pivotal phase III study.
Methods: This 16 week, multi-centric, prospective, double blind, double dummy, parallel group, randomized controlled study compared efficacy and safety of FDC of RE 100mg + Vildagliptin 50mg (RV) given twice daily to active comparator of Empagliflozin 25mg + Linagliptin 5mg (EL) given once daily. Adult T2DM patients with HbA1c 8-11% on Metformin stable dose of ≥1500mg for ≥8 weeks before screening were randomized to either of treatment arms. The study endpoints were mean changes from baseline (CFB) in HbA1c (primary), fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), body weight (BW) and blood pressure (BP) for efficacy and adverse events (AE) monitoring for safety assessments.
Results: Of 182 eligible subjects (91 in each arm), 157 (86.3%) subjects completed the study. The baseline demographic characteristics were well balanced between 2 treatment arms. Adjusted mean (SE) change from baseline in HbA1c (%) at week 16 viz. EL arm -1.36 (0.15) vs. RV arm -1.41(0.16); (mITT population; p&lt;0.001 in each arm) was comparable between the two treatment arms (p=0.82). The mean difference of -0.05% (95%CI: -0.46, 0.36) in HbA1c demonstrated non-inferiority (NI) of RV compared to EL (p=0.016 for NI test). Similarly, significant reduction was observed in FPG, PPG, BW and BP which was found to be comparable between the two treatment arms. Drug related AEs were observed in 8.8% and 6.6% subjects of EL and RV arm respectively, with low incidence of hypoglycemia, genital and urinary tract infections (1-3%).
Conclusion: Overall, FDC of Remogliflozin Etabonate + Vildagliptin was found to be efficacious, safe and well tolerated in the treatment of patients with T2DM, and demonstrated non-inferiority to Empagliflozin 25mg + Linagliptin 5mg treatment.

Disclosure
B. Mohan: None. M. S. Chawla: Speaker’s Bureau; Self; Abbott Diabetes, Boehringer Ingelheim Pharmaceuticals, Inc., Colgate-Palmolive, Eli Lilly and Company, Glenmark Pharmaceuticals Limited, Novo Nordisk. R. R. Kodgule: Employee; Self; Glenmark Pharmaceuticals Limited. M. Tandon: Employee; Self; Glenmark Pharmaceuticals Limited. S. Katare: Employee; Self; Glenmark Pharmaceuticals Limited. S. Suryawanshi: Employee; Self; Glenmark Pharmaceuticals Limited. H. V. Barkate: None.
818-P: Barriers to Metformin Initiation and Adherence following a New Diagnosis of Type 2 Diabetes
Authors: GONG CHELSEA , GU KRISTINE , BLATCHINS MARUTA A. , MISHRA PRANITA , GRANT RICHARD W. , GOPALAN ANJALI 
Published: June 2021

Metformin is the first line treatment for type 2 diabetes (T2D). While earlier initiation is associated with achievement of glycemic targets and a delayed need for treatment escalation, metformin initiation and adherence remain suboptimal. We explored contributors to suboptimal metformin initiation and adherence during the year following a T2D diagnosis. From a population of adults diagnosed with T2D between 2014-2018, we randomly identified 100 individuals who were prescribed metformin during the year after diagnosis (starters) and 100 who were not (non-starters). Through physician review of electronic health record (EHR) notes from the year following diagnosis, we explored patient-provider discussions about metformin, reasons metformin was or was not ordered, and reasons for discontinuation. Metformin starters were younger (mean age 53.8 vs. 60.0 years, p&lt;0.001), more likely to be men (64% vs. 50%, p=0.046), and had higher initial HbA1c values (9.1% vs. 7.0%, p&lt;0.001). Though 94/100 starters filled the initial prescription, only 71 were still taking metformin at one year. The most common documented reason for stopping was side effects. Only 18/100 non-starters had a documented patient-provider discussion about metformin, with a desire to try lifestyle modification as the primary reason for not starting metformin. Among the 18 non-starters who discussed metformin, metformin treatment was only revisited with 3. Though our findings are limited by a small sample and the extent of clinical documentation in the EHR, we still captured aspects of metformin treatment not available using structured EHR variables.
In conclusion, among metformin starters, efforts to mitigate side effects, including titration strategies or long-acting formulations, may improve metformin adherence. For most non-starters, there was no documented discussion regarding metformin. Strategies that prompt providers to have this important discussion may increase early initiation of this critical medication.

Disclosure
C. Gong: None. K. Gu: None. M. A. Blatchins: None. P. Mishra: None. R. W. Grant: None. A. Gopalan: None.

Funding
Kaiser Permanente Northern California
819-P: Comparison of Two Nurse-Driven Adult Diabetic Ketoacidosis (DKA) Treatment Protocols Using a Single Bag vs. Simultaneous Two-Bag Maintenance Intravenous Fluids
Authors: HALFON REBECA , DREUCEAN DIANE , SIRIMATUROS MICHAEL , SADHU ARCHANA R. 
Published: June 2021

Objective: Evaluate safety and efficacy of a novel, simultaneous 2-bag (2B) maintenance intravenous fluid (IVF) DKA protocol compared with a conventional, single 1-bag (1B) protocol in adults.
Methods: Retrospective, observational review of patients treated with a DKA protocol from March-June 2017 (1B group) and March-June 2019 (2B group). One bag (1B) protocol: individual infusion of 1B IVF of ½ NS, ½ NS + KCL, D5W, OR D5W + KCL. Two bag (2B) protocol: simultaneous IVF infusion of 2B of D10W + KCL AND ½ NS + KCL. Safety endpoints of hypoglycemia, hyperkalemia, hypokalemia as well as efficacy endpoints of DKA resolution, incidence of rebound hyperglycemia, and hospital length of stay (LOS) were evaluated.
Results: A total of 605 patients were included (1B: n=204; 2B: n=401). Both groups had similar baseline characteristics except a higher baseline beta-hydroxybutyrate level in the 2B group than 1B (3.2 vs. 2.4; P=0.02) and differences in distribution of Body Mass Index (BMI) categories. Safety: Significantly fewer patients had hypoglycemia (BG &lt;70 mg/dL) in the 2B group than 1B (15% vs. 22%, P=0.04), but severe hypoglycemia (BG &lt; 40 mg/dL) was not different (0.5% vs. 1.5%, P=0.3). Incidence of hyperkalemia (K &gt; 5.2 mEq/L) was significantly lower in the 2B group than 1B (10% vs. 21%, P&lt;0.01), but hypokalemia (K &lt; 3.3 mEq/L) was not different (21% vs. 24%, P=0.4). Efficacy: Median time to DKA resolution was similar between the 2B and 1B (15.0 vs. 15.6 hours, P=0.6). Rebound hyperglycemia (BG &gt; 250 mg/dL) was less in 2B than 1B (29% vs. 44%, P&lt;0.01). The 2B group had a trend of decreased LOS, but the difference was not statically significant (3.7 vs. 4.3 days, P=0.06).
Conclusion: In adult patients with DKA, a 2-bag protocol performed better in hypoglycemia, hyperkalemia, and rebound hyperglycemia without changing time to DKA resolution or LOS. In addition, the 2-bag protocol offered simplicity by decreasing the number of IVF bag options for the nurse.

Disclosure
R. Halfon: Stock/Shareholder; Spouse/Partner; Pfizer Inc. D. Dreucean: None. M. Sirimaturos: None. A. R. Sadhu: None.
827-P: Pioneering a Novel Inpatient Diabetes Consult Service in the COVID Era
Authors: RIZVI ALI A. , RICH ANITA O. , ELDRIDGE RITA 
Published: June 2021

Hospitalized patients often do not reach the ADA-recommended glucose targets, which in turn increases complications, costs, length of stay, and readmission rate. The ADA supports the availability of trained specialists and teams to improve outcomes. Partly in response to the SARS CoV-2 pandemic, we instituted an inpatient “virtual care” initiative by electronic medical record (EMR) review. The ProActive Glucose Advice Team (pGAT) utilizes specialist expertise, automated computerized detection of hyperglycemia, and feedback to the primary service. The pGAT team members consist of an endocrinologist, a nurse diabetes care and education specialist, and a clinical dietician. The team reviewed a computer-generated report of inpatients with either 2 or more blood glucose values ≥180 mg/dl within the last 24 hours, and/or a hemoglobin A1c (A1c) ≥8%. We proposed to enter a brief, structured “pGAT Note” in the EMR, followed by a “gentle reminder” note the next day, including advice for a formal diabetes education and an endocrinology consultation. This proactive approach to the management of hyperglycemia would provide a summary review of the patient’s glucose state, determine the level of patient’s self-care skills, and steps to improve inpatient glycemic control. For preliminary data during the first 4-month phase after implementation of the pGAT initiative, we examined individualized discharge management and timely outpatient follow-up with endocrinology. Of 37 patients (28 males, 9 females; average age 60.4 years), 34 were treated with intensive insulin therapy with multiple daily insulin injections, 31 were seen in f/u within 2 weeks of discharge, and 25 were begun on Continuous Glucose Monitoring. The average A1c fell from an inpatient value of 11.6% to 8.4% measured between 2-4 months later. During the next pGAT phase, we intend to study inpatient therapy parameters, notably appropriate use of computerized insulin order sets, titration of basal insulin, and prandial-correction bolus insulin use.

Disclosure
A. A. Rizvi: None. A. O. Rich: None. R. Eldridge: None.
828-P: Inpatient Provider Experience with Diabetes Technology Use on General Medicine Wards: Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitors (CGM)
Authors: MADHUN NABIL Z. , GALINDO RODOLFO J. , DONATO JESSICA , HWANG PATRICIA , SHABBIR HASAN F. , FOWLER MICHAEL , MOLITCH-HOU ETHAN , UMPIERREZ GUILLERMO E. , LANSANG M. CECILIA 
Published: June 2021

In the advent of increased use of technology in diabetes care, the management of CSII and CGM devices in the inpatient setting has not been well described. We conducted a non-incentivized survey among inpatient licensed independent practitioners (LIP) at 4 large US hospital systems to assess their knowledge, comfort, and behaviors related to the use of CSII and CGM in the inpatient setting. Of 128 respondents, 83% were day and night hospitalists, 10% advanced practice providers, and 7% primary care physicians. Most LIPs worked in academic centers (68%), 18% at community teaching hospitals, with 93% having diabetes consult service, and 55% having dedicated teams to assist with use of CSII and CGM.
Most respondents (96%) rated inpatient hyperglycemia treatment as important, and 93% of LIPs agreed that CSII should be continued in the inpatient setting in the absence of contraindication. However, only half (49%) reported reviewing CSII settings on admission, and of those, only 50% were confident with interpreting those parameters to guide therapy. Almost two-thirds (64% ) of providers reported knowledge of a CSII policy at their institution. The most common barriers to continuing CSII included lack of LIP knowledge and perceived lack of nursing knowledge regarding CSII.
LIPs were less familiar with the use of CGM, with 72% being unaware or not at all familiar with their institution’s policy. Of 64 respondents who cared for a patient with CGM in the preceding 6 months, 56% reported not reviewing CGM data to guide therapy.
Most inpatient providers value glycemic control and use of DM technology; however, many reported limited in-depth knowledge of CSII and CGM devices for optimal use to guide clinical care in the inpatient setting. Educational programs and collaboration between LIPs and endocrinologists are needed to safely optimize the use of CSII and CGM in the hospital setting.

Disclosure
N. Z. Madhun: None. R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. J. Donato: None. P. Hwang: None. H. F. Shabbir: None. M. Fowler: Other Relationship; Self; AstraZeneca. E. Molitch-hou: None. G. E. Umpierrez: Research Support; Self; AstraZeneca, Dexcom, Inc., Novo Nordisk. M. Lansang: Consultant; Self; Sanofi, Research Support; Self; Dexcom, Inc.
836-P: Models to Predict Initial Insulin Requirements in Hospitalized Patients with Diabetes
Authors: CHIANG HOU-HSIEN , SURAMPUDI PRASANTH , SOOD AJAY 
Published: June 2021

Background: The quality of inpatient glycemic control is limited by unknown starting dose of insulin at hospital admission.
Aim: To evaluate and estimate the first day insulin dose requirement in hospitalized patients with diabetes mellitus.
Methods: In this retrospective cohort study, patients with previous history of diabetes mellitus, aged ≥ 18 years, and admitted to UC Davis Medical Center from January 1, 2017 to December 31, 2018 were randomly recruited. Independent factors that may affect the insulin requirement were collected. The dependent factor is corrected insulin total daily dose (CxTDD) during the first 24 hours of hospitalization, which is defined as the insulin dose actually given plus calculated correction dose to target average blood glucose 180 mg/dL. Multivariable regression analyses are used to build models to predict CxTDD.
Results: The 144 patients who were prescribed insulin before admission had higher average blood glucose and higher CxTDD during the first 24 hours of hospitalization, compared to the 97 patients who were not prescribed insulin before admission (median 201.7 vs. 171 mg/dL, 25 vs. 5 units, respectively]. The adjusted R squares of the multivariable regression models are 58.6% in patients who were on insulin before admission, and 35.5% in those who were not, with common significant independent factors including first blood glucose upon presentation, body weight, oral intake, and new glucocorticoid use. Opiate/IV pain medication and home insulin daily dose are significant predictive factors (SIRS shows trend toward significance) only in patients who were prescribed insulin before admission.
Conclusion: Models to predict the first day insulin dose requirement shows clear differences between patients who were prescribed insulin versus not prescribed insulin before admission. First blood glucose upon presentation is a strong predictor of first day insulin dose requirement after hospitalization and this has not been emphasized previously in the literature.

Disclosure
H. Chiang: None. P. Surampudi: Research Support; Self; Viacyte, Inc. A. Sood: None.
838-P: Current Provision and HCP Experiences of Remote Care Delivery and Diabetes Technology Training for People with Type 1 Diabetes in the UK during the COVID-19 Pandemic
Authors: FORDE HANNAH E. , CHOUDHARY PRATIK , HUSSAIN SUFYAN 
Published: June 2021

The covid-19 pandemic has led to rapid implementation of remote care delivery in type 1 diabetes (T1D). An understanding of current modes of care delivery and HCP experiences is required to improve care. The UK Diabetes Technology Network undertook an online survey aimed at members providing care in T1D. One hundred and forty three HCPs (47.6% diabetes physicians, 51.8% diabetes educators) from 105 UK NHS centers (51.7% university hospitals, 45.8% general/community hospitals), responded. Median (IQR) percentage of consultations and time taken via face-to-face, telephone and video were 20%(5-30), 30 minutes (20-34); 50% (30-80), 20 minutes (15-30) and 10% (0-35), 30 minutes (20-30), respectively. Sixty four percent responded that remote consultations offered an effective strategy for care delivery. Common barriers were patient familiarity with technology (72%) and access to patient device data (67.1%). Devices with smartphone based automated cloud uploads made consultations easier (73.4%), more effective (84.6%) and facilitated hospital discharges (60.9%). Median (IQR) responses on a 7-point scale for effectiveness of remote training, compared to face-to face, for new CSII starts, CSII renewals and CGM starts, were reported as 5 (4-6), 5.5 (5-6) and 6 (5-6), respectively. Common barriers included patient digital literacy (60.8%), limited HCP experience (46.2%) and time required per patient (43.6%). A reduction in new starts (72.8%) and renewals (60.9%) for CSII was highlighted by most. Variation was noted in proportion of new CSII starts being done virtually (53.9% respondents reporting &lt;20% and 32.9% reporting &gt;60%). Most (92.4%) responded that remote consultations and technology training are likely to continue post-Covid19. This survey highlights the impact of COVID-19 on access to diabetes technology and demonstrates how HCP’s have embraced remote care delivery, but digital literacy remains a barrier.

Disclosure
H. E. Forde: Consultant; Self; Dexcom, Inc. P. Choudhary: Advisory Panel; Self; Abbott Diabetes, Insulet Corporation, Lilly Diabetes, Medtronic, Sanofi-Aventis, Speaker’s Bureau; Self; Dexcom, Inc., Novo Nordisk. S. Hussain: Speaker’s Bureau; Self; Novo Nordisk.
841-P: Racial and Ethnic Disparities in Pregnant Women with Diabetes: A Review of Literature
Authors: PHONYIAM RATCHANOK , BERRY DIANE C. 
Published: June 2021

Purpose: To examine the state of the science concerning racial and ethnic disparities and social determinants of health, perinatal care, and maternal and infant health outcomes in pregnant women with diabetes.
Method: PubMed, Scopus, CINAHL, and EMBASE databases were searched using the PRISMA guidelines. The inclusion criteria were original qualitative or quantitative manuscripts published in English from January 1, 2009, to May 31, 2020. Consensus statements were excluded.
Results: This review included 16 manuscripts of women with gestational diabetes mellitus and pregestational diabetes mellitus living in the United States. This synthesis demonstrated the differences in maternal economic stability, education, and health and health care. Non-Hispanic Black, Hispanic, and Asian women had significantly higher odds of experiencing preeclampsia, spontaneous preterm, and postpartum readmission than non-Hispanic White women. Non-Hispanic Black infants had the highest hypoglycemia and intensive care unit admission rates, while Hispanic infants were more likely to have macrosomia than non-Hispanic White infants.
Discussion: Evidence highlights disproportion in maternal social determinants of health and health outcomes. Additional research is needed in disadvantaged groups who are less likely to utilize perinatal care services and be screened for type 2 diabetes after pregnancy. Little is known about the direct and indirect pathway between racial discrimination and maternal and infant health, specifically through chronic stress to glycemic control. Infants exposed to hyperglycemia in pregnancy need closer attention from infancy in assessment and management to prevent diabetes later in life.
Conclusion: There is an urgent need to improve the quality of care for women with diabetes. Health care providers should implement tailored interventions that target racial and ethnic disparities and promote health equity in pregnant women with diabetes and their offspring.

Disclosure
R. Phonyiam: None. D. C. Berry: None.