bluuebunny/crossref_metadata_2025_split huggingface dataset:
88-LB: Kidney and Metabolic Benefits by Adding GLP-1 Agonists and/or SGLT2 Inhibitors on Metformin in Obese Type 2 Diabetes (T2DM) Patients: 24-Month Real-World Data from Both Urban and Rural Clinics
Authors: ZOUPAS IOANNIS , PAPAZAFIROPOULOU ATHANASIA , XENOU MARIA , LYGNOS DIMITRIOS , FOUSTERIS EVANGELOS 
Published: June 2021

Objective: Assessment of the nephro-metabolic effects of GLP-1 agonists (Group A), SGLT-2 inhibitors (Group B) and both (Group C) in obese patients under metformin therapy with inadequate glycemic control.
Materials and Methods: 253 patients with T2DM on metformin with a HbA1c &gt; 7.0%.
Results: Group A: reduction of HbA1c at 5.9±0.4% (95% C.I. of difference 1.63-3.03, p&lt;0.001), reduction in body weight 7.1±5.5Kg (95% C.I. 4.98-9.26, p&lt;0.001), ALT (mg/dL) reduced by 8.7±3.1, (p=0.04), reduction of Urine Albumin to Creatinine Ratio (UACR) by 25.0±40.8 (p=0.003) and increase of the estimated GFR (CKD-EPI formula) by 10.4±10.6, (p&lt;0.001). Group B: reduction of HbA1c at 6.26±0.42% (95% C.I. of difference 0,59- 1.04 (p&lt;0.001), reduction in body weight by 3.9±2.2Kg (95% C.I. 2.93-4.89 p&lt;0.001), ALT reduced by -9.6±17.3 (p=0.02), UACR reduction by 36.2±70.2 (p=0.025) and eGFR increase 4.2±14.0 mL/mgCreat (p=0.18). Group C: major reduction of HbA1c by 1.9±1.0% (95% C.I. 1.10-2.09, p&lt;0.001), body weight reduction by 10.6±5.7Kg 995% C.I. 7.97-13.28 p&lt;0.0010, ALT reduction by -15.9±14.8 (p=0.04), UACR reduction by -29.9±31.9 (p&lt;0.001) and eGFR increase by 8.3±10.5 (p=0.002).
Conclusions: Triple combination therapy with metformin - GLP1-analog - SGLT2-inhibitor has the greatest effectiveness in weight loss and in improving liver biochemistry. The renal improvement seen with these drugs appears to be driven by a decrease in UACR for SGLT-2-inhibitors and an increase in eGFR for GLP1-analogues in this retrospective 24-month study.

Disclosure
I. Zoupas: None. A. Papazafiropoulou: None. M. Xenou: None. D. Lygnos: None. E. Fousteris: None.
911-P: New-Onset Diabetes and Cerebellar Ataxia in a Child: What Does GAD-65 Have to Do with It?
Authors: CHAN KAREN , SWEAT MARIE , ZIMBRIC MICHAEL R. , NEWFIELD RON S. 
Published: June 2021

Glutamic acid decarboxylase isotype 65 (GAD-65) antibodies have been associated with several conditions including type 1 diabetes (T1D), stiff-man syndrome and autoimmune cerebellar ataxia. GAD-65 antibody-associated cerebellar ataxia has been described in multiple case reports, mostly in adult women, but rarely in children, as reported here.
An 11-year-old female presented with two weeks of polyuria and polydipsia and one week of abnormal speech and difficulty walking. Labs were consistent with new onset diabetes with mild ketoacidosis. Neurological exam localized her lesion to the cerebellum. Several type 1 diabetes-related antibodies were positive, including zinc transporter 8, GAD-65, and ICA512. Insulin autoantibody was negative. Serum Pediatric Autoimmune Central Nervous System Disorders Evaluation (Mayo Clinic) showed only elevated levels of GAD-65 antibody to 41.6 nmol/L (≤ 0.02). CSF studies showed oligoclonal bands, without evidence of infection. CSF GAD-65 antibody testing (Mayo Clinic) was elevated to 13.7 nmol/L (≤ 0.02). MRI showed no cerebellar pathology. Thyroglobulin and thyroid peroxidase antibodies were normal. Because of the constellation of findings, she was diagnosed with GAD-65 antibody-associated cerebellar ataxia. Her symptoms improved after a short course of steroids and IVIG. She is planned for monthly IVIG for at least 6 months.
Elevated serum GAD-65 antibody levels are found in the majority of patients newly diagnosed with T1D. GAD-65 CSF levels are noted to be higher in patients that develop autoimmune cerebellar ataxia, stiff-man syndrome or autoimmune polyendocrine syndromes (≤20 nmol/L), as seen in this patient (41.6 nmol/L). Patients presenting with new onset T1D and cerebellar ataxia should prompt evaluation for GAD-65 antibody-associated cerebellar ataxia.

Disclosure
K. Chan: None. M. Sweat: None. M. R. Zimbric: None. R. S. Newfield: Consultant; Self; Merck Sharp & Dohme Corp.
918-P: Predicting the Onset of APECED Diabetes
Authors: PALDANIUS PAIVI M. , MAKITIE OUTI , LAAKSO SAILA 
Published: June 2021

Background: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare monogenic autosomal recessive disorder and diabetes (DM) one of its rare and less studied manifestations. Determinants of time to onset and clinical progression to DM seem currently unpredictable.
Materials and Methods: We explored change in pre-diagnosis (dg) glycemic parameters (glucose, insulin, C-peptide), including 60’ intravenous glucose tolerance tests (ivGTT) and homeostasis indices (HOMA-β, -IR) over 20 years (y) with descriptive statistics. Fractional glucose turnover rate (KG) during ivGTT was calculated as 0.693/T1/2Gluc*100 with Pearson correlation coefficient (r) and 2-sided p value.
Results: Between 1972 and 1996, 68 ivGTTs were conducted in 13 pediatric and adult individuals with APECED and DM. The mean age (SD) at DM dg was 27.78y (11.73) among those 22% of our cohort (n=100) with DM. Including one man with ‘latent DM’, with no clinical DM symptoms 20y post-dg. HbA1c was rarely measured, fasting plasma glucose (FPG) values were normoglycemic prior and up to DM dg: mean (SD) FPG 4.4 (0.6) mmol/l (-20y to -6 months [m]) and 5.7 (0.9) mmol/l (&lt;6m to dg). Mean 60’ glucose values were only elevated for those with &lt;6m to dg: 12.1 (0.7) mmol/l. Hyperinsulinemia was present 5-20y prior to dg while rapid 1st phase insulin secretion (combined 1+3 min value; normal &gt;46 mIU/ml) was lost or delayed in some, but not all, 5y prior to dg. Up to and at dg, adequate fasting insulin (&gt;2 mIU/ml) and C-peptide (&gt;0.5 ng/ml) production was observed in most (85%) patients. KG displayed intra- and inter-individual variability, was normal (&gt;1.2%/min) in latent DM, while it predicted DM onset over time (-20y to dg): r= -0.568 (p= 4E-06). Neither HOMA indices were sensitive enough to detect any change over time.
Conclusion: Identification of reduced glucose removal rate over time, indicative of increased peripheral insulin resistance in the presence of pre-diagnostic hyperinsulinemia, provides first insights into progression of atypical diabetes in APECED patients.

Disclosure
P. M. Paldanius: Consultant; Self; UPM Biomedicals, Speaker’s Bureau; Self; Novartis AG. O. Makitie: None. S. Laakso: None.
922-P: Experiences and Difficulties in Transitioning from Pediatric to Adult Diabetes Clinical Care
Authors: LORTON ELEANOR G. , YOUNGKIN ERIN M. , MAJIDI SHIDEH 
Published: June 2021

Young adults with type 1 diabetes (T1D) undergoing transfer from pediatric to adult care are at an increased risk of acute and chronic health complications due to challenges associated with transitioning healthcare. This study aims to highlight patient-focused areas of improvement that could be used to optimize transition of care.
Thirteen patients with T1D between ages 17-25 who had completed a pediatric transfer visit and had an adult diabetes appointment scheduled or completed were randomly selected to complete a telephone questionnaire that included open-ended questions regarding experiences transitioning to adult diabetes care. Interviews were analyzed for themes.
Thirteen young adults with T1D (Mage 22.8 ± 1.5 years; Mduration 13.0 ± 5.4 years; 46% female; 69% private insurance; 69% Caucasian, 23% Hispanic, 8% “Other”) completed the interview. Two primary themes emerged regarding “the easiest part of transfer”: streamlined process (77%) and clinic familiarity (23%). Three themes related to transition challenges were: provider compatibility (31%), lack of guidance (23%), and difficulty changing providers (23%). In those who suggested areas of improvement, two main themes emerged: distance to clinic (23%) and scheduling (15%). Patients described three support systems themes (family, significant other, friend) and three themes of support type (financial, emotional, and diabetes-care related).
The majority of patients highlighted that a streamlined process and previous familiarity with the clinic made transferring care easier, while provider compatibility and lack of guidance in the transfer process were barriers. This may indicate areas where pediatric providers can help improve the transfer to adult care. Young adults also highlighted the continued need for financial, emotional, and diabetes-care support as they transition care. These findings are valuable considerations for creating a patient-centered and effective transition program.

Disclosure
E. G. Lorton: None. E. M. Youngkin: None. S. Majidi: Advisory Panel; Self; Companion Medical.
93-LB: Comparison of Glycemic Control between Multiple Daily Injections and Hybrid Closed-Loop System in Children and Adolescents during the Restrictions Due to COVID-19
Authors: PETROVSKI GORAN , CAMPBELL JUDITH , HUSSAIN KHALID ,   ALKHALAF AND CONSULTANTS/EDUCATORS
Published: June 2021

Introduction: The COVID-19 pandemic forced health authorities to issue restrictive measures on daily activities from March 12th to June 15th, 2020 (‘lockdown’) in Qatar, which may have influenced the glycemic control in patients with type 1 diabetes (T1D). The aims of the study was to evaluate glycemic control between Multiple Daily Injections (MDI) and Hybrid Closed Loop (HCL) system in children and adolescent with T1D during the lockdown.
Methods: This single-center analysis included 168 patients with T1D, using MDI or HCL system MiniMed 670G (Medtronic, Northridge, USA) at least 3 months before the study. Glycemic control from face-to-face visits, three months before lockdown were analyzed and compared to face to face or remote visits during the lockdown of 3 months. Data was collected through the electronic medical record system and reports generated by Carelink Therapy Management Software. HbA1c, glucose and insulin data were analyzed before and 3 months after restrictions.
Results: Patients were analyzed in two groups: 1) 92 patients (age 12.4±3.1 years, female:51) on MDI and 2) 76 patients (age 11.2±2.6 years, female:36) HCL system. HbA1c in patients on MDI increased from 8.3±1.5% (67±16.4 mmol/mol) before lockdown to 8.9±1.7% (74±18.6 mmol/mol) during the lockdown, compared to patients on HCL system, where HbA1c remained stable (7.0±0.9% (53±9.8 mmol/mol) to 7.1±1.2% (54±13.1mmol/mol) respectively). No significant difference on DKA events were found in MDI group, before and after lockdown, while no DKA was noted in HCL group during the study. No severe hypoglycemia was observed in both groups. Remote visits were 54% in patients on HCL system, compared to 38% in patients on MDI during the lockdown.
Conclusion: Children and adolescents using HCL system maintained stabile glycemic control during the lockdown compared to patient on MDI, where the glycemic control deteriorated.

Disclosure
G. Petrovski: None. J. Campbell: None. K. Hussain: None. Alkhalaf and consultants/educators: n/a.
930-P: Improving Access and Communication through Telehealth for Pediatric Type 1 Diabetes (T1D): Twelve-Month Outcomes
Authors: RASBACH LISA E. , PAGE LAURA C. , FREEMARK MICHAEL , PURRINGTON VIRGINIA , GRIFFIS MONA , ANNAS ANGELA , HALL RACHEL , BENJAMIN ROBERT 
Published: June 2021

Improving access for diabetes care may help youth with poor glycemic control. Telehealth can expand access to care.
Youth with T1D, Medicaid, and initial A1c 9-12% had quarterly diabetes goal setting and monthly telehealth glucose review/goal reinforcement. Over 12 mo we measured A1c q 3mo and assessed diabetes empowerment (1-5; higher=greater self-efficacy), diabetes distress (1-6; higher=greater), and intervention satisfaction (1-5; higher=greater).
Youth (N=32, 56% male, 53% AA), aged 5-22 yr, had T1D for 5.1±3.5 years, baseline mean A1c 10.7±1.5%; 19% on CSII and 34% on CGM. At baseline, participants reported low levels of distress (mean 1.9 youth, 2.1 parents) and high self-efficacy (mean 4.2). There were no effects of intervention on distress or self-efficacy at 12-months for youth (p=0.11) or parents (p=0.36). There was no correlation between youth/parent distress scores.
Baseline A1c correlated positively with youth burden and negatively with motivation: “takes too much mental/physical energy”(r=0.65, p=0.02); “controls my life” (r=0.70, p=0.008); “I can find ways to feel better about diabetes” (r=-0.67, p&lt;0.02); “I know what helps me stay motivated” (r=-0.69, p=0.01). In contrast, baseline A1c correlated negatively with parental frustration and worry: “I’m the only one who takes responsibility” (r=-0.46, p&lt;0.05); “worrying others will blame me if diabetes not well-controlled” (r=-0.57, p=0.03).
A1c did not change and there were no differences in ED/hospitalizations compared to 2 years prior. However, participants reported satisfaction with the intervention (mean 4.3).
While well received by families, a monthly telehealth intervention failed to impact A1c. Parental worry and frustration was higher in children with better A1c levels. Identifying ways to maintain parent involvement in diabetes care and enhance mental health support may help diabetes control and burden of disease. Future work should explore the long-term impact of telehealth support.

Disclosure
L. E. Rasbach: None. L. C. Page: None. M. Freemark: Advisory Panel; Self; Rhythm Pharmaceuticals, Inc., Research Support; Self; Rhythm Pharmaceuticals, Inc. V. Purrington: None. M. Griffis: None. A. Annas: None. R. Hall: None. R. Benjamin: None.

Funding
Duke University School of Medicine
937-P: Mealtime Insulin in New-Onset Type 1 Diabetes Mellitus: Fixed Dose vs. Insulin:Carbohydrate Ratio
Authors: REYES DIAZ JACQUELINE V. , FELNER ERIC 
Published: June 2021

Over the past 20 years, advances in diabetes technology and along with carbohydrate counting (CC) to determine insulin dose, has provided an opportunity for improvement in glycemic control and quality of life for children and adolescents with type 1 diabetes (T1D). These advances, however, have not translated into improved outcomes. This may be due to the stress and anxiety the child and family experience with the large amount of information taught during diabetes education sessions at diagnosis. A simplified teaching approach may reduce stress for the child and family. This study assessed the effects of two approaches to mealtime insulin delivery on parental stress. In the fixed dose (FD) regimen, the same dose of insulin is delivered for a set range of carbohydrates. In the insulin:carbohydrate ratio (ICR) regimen, insulin delivery varies based on the exact number of carbohydrates.
Twenty-four subjects (8-15-yrs) with new-onset T1D were randomized to the FD or ICR group. The primary endpoint was parental stress using the Parental Stress Survey, at 1-month and 4-months after diagnosis. Secondary endpoints included glycemic variability (% of values within target range) and HbA1C (%), at 1-month and 4-months after diagnosis.
The FD group experienced less stress than the ICR group at 1-month (27 ± 2.29 vs. 37.28 ± 2.57)and 4-months (27.62 ± 2.34vs. 35.14 ± 2.57) (interactive p = 0.04). The FD group had similar glycemic variability and HbA1C levels as the ICR group at 1-month (67.5% vs. 63.2% and 9.76 ± 0.53vs. 9.2 ± 0.58) and 4-months (63.3% vs. 69.0% and 7.27 ± 0.55 vs. 7.71 ± 0.58). Complications (severe hypoglycemia or DKA) did not occur in either group during the study.
The additional stress associated with learning CC at the onset of T1D education may be reduced with a simple mealtime insulin and carbohydrate regimen. A simple insulin regimen that does not adversely affect glycemic control may alleviate the stress that many patients and families experience when a child is diagnosed with new-onset T1D.

Disclosure
J. V. Reyes diaz: None. E. Felner: None.
949-P: Reasons for Nonelective Readmissions among Hospitalizations with Diabetes Complicating Pregnancy and the Perinatal Period: Insights from the U.S. National Readmission Database for 2018
Authors: AGUILERA MARIA C. , SHAKA HAFEEZ , CORPUZ CARLOS GABRIEL D. , RAMIREZ MARCELO , YAP SARA ELIZABETH T. , ESEATON PRECIOUS O. , MURTHI MUKUNTHAN 
Published: June 2021

Introduction: With the increasing prevalence of diabetes mellitus (DM), there is an increasing burden of DM among pregnant women. Gestational DM (GDM), is a known complication of pregnancy which could affect the outcome for mother and child. This study looked into the burden of DM related gestations and readmissions.
Methods: Data was obtained from the US National Readmissions Database for 2018, the largest database for readmissions in the US, which approximates yearly estimates. Index hospitalizations for DM complicating pregnancy and the postpartum period were obtained using ICD-10 codes. Hospitalizations less than 18 years of age and elective admissions were excluded. Outcomes included the rate of 30-day readmission (30DR) as well as identifying the commonest reasons for readmission among the studied cohort.
Results: A total of 61,675 hospitalizations were included in the study as index admissions. Of these hospitalizations, 2,768 (4.50%) were readmitted within 30 days of discharge. The top reasons for readmission included severe pre-eclampsia, gestational DM, pre-existing DM type 1 in pregnancy, maternal care for scar from previous cesarean delivery, pre-existing DM type 2 in pregnancy and endometritis following delivery. Readmission was associated with increased healthcare utilization.
Conclusion: Among pregnancies complicated by DM that led to hospitalization, a small proportion of patients get readmitted within 30 days for known complications of pregnancy. These could be associated with mortality, hence, research into factors and predictors of readmission in this population should be encouraged.

Disclosure
M. C. Aguilera: None. H. Shaka: None. C. D. Corpuz: None. M. Ramirez: None. S. T. Yap: None. P. O. Eseaton: None. M. Murthi: None.
957-P: Characteristics and Pregnancy Adverse Outcomes in Women with Hyperglycemia in Pregnancy According to Insulin Resistance
Authors: COSSON EMMANUEL , NACHTERGAELE CHARLOTTE , VICAUT ERIC , SAL MERIEM , BERKANE NARIMANE , PINTO SARA , TATULASHVILI SOPIO , VALENSI PAUL , CARBILLON LIONEL , BIHAN HELENE 
Published: June 2021

Recent studies have shown that pregnancies complicated by hyperglycemia in pregnancy (HIP) and insulin resistance had the highest risk of poor outcomes as compared to normoglycemic pregnancies. This study aimed to determine, only among women with HIP, the characteristics and pregnancy outcomes by increasing insulin resistance. We included from a prospective cohort study 1,423 women with HIP whose insulin resistance was evaluated using the homeostasis model assessment for insulin resistance (HOMA-IR) when HIP care begun. We compared characteristics and pregnancy outcomes by tertiles of HOMA-IR (intertertile range: 1.9 and 3.3). Increasing tertiles of HOMA-IR were positively associated with plasma glucose levels during screening for HIP; preconception BMI; family history of diabetes; previous pregnancy with HIP, macrosomia and hypertensive disorders; and non-European ethnicity (p&lt;0.05 to 0.001). Gestational weight gain was similar but insulin rate increased by tertile of HOMA-IR (tertile 1, 2 and 3: 34.8, 49.0 and 62.7% respectively, p&lt;0.0001). So were Caesarean section (23.5, 26.3 and 32.1%, respectively, p=0.01), pregnancy-induced hypertension (1.3, 3.0 and 6.6%, p&lt;0.0001), preeclampsia (1.5, 3.0 and 4.6% respectively, p&lt;0.05), large-for-gestational-age infant (4.1, 6.4 and 11.2% respectively, p&lt;0.001) and neonatal hypoglycemia (0.6, 1.5 and 3.3% respectively, p&lt;0.01). The risk for large-for-gestational-age infant was higher in women with HOMA-IR in the 3rd tertile as compared to 1st-2nd tertiles (aOR 1.43 [95% confidence interval 1.01-2.03]) in multivariable logistic regression analysis adjusting for BMI, HIP subtypes (early-diagnosed GDM, GDM, diabetes in pregnancy), ethnicity, HOMA-B, parity and gestational weight gain. To conclude, among women with HIP, higher insulin resistance is associated with a more adverse metabolic profile and greater risk of adverse outcomes, although insulin therapy is more often used.

Disclosure
E. Cosson: None. H. Bihan: None. C. Nachtergaele: None. E. Vicaut: None. M. Sal: None. N. Berkane: None. S. Pinto: None. S. Tatulashvili: None. P. Valensi: None. L. Carbillon: None.
959-P: Mothers’ Weight Class in Pregnancy and Beta-Cell Function in Their Infants
Authors: STAIMEZ LISA R. , DUTTA ANUBRATI , BEYH YARA S. , VYAKARANAM SAPNA , NOULE HARI K. , KOTHAPALLY DEEPA , NARAYAN K.M. VENKAT , GUPTA RUBY , PRABHAKARAN DORAIRAJ , BETHA KALPANA , PRABHAKARAN POORNIMA 
Published: June 2021

Background: Poor nutritional status in pregnant women can impact the risk of diabetes in their children. The Asian Indian Beta Cell function (ABCs) in Infants Study examined the association of maternal weight class and pregnancy weight gain on infant pancreatic beta-cell function during the first year of life.
Methods: A convenience sample of 150 pregnant women ages 18-35 years were recruited in Hyderabad, India. Women were classified by 1st trimester (a) underweight (UW), i.e., BMI&lt;18.5kg/m2 or (b) non-underweight (N-UW), i.e., BMI=18.5-27.4kg/m2. At 8 months postpartum, infants had a newly developed oral glucose tolerance test (OGTT, 1.75g glucose/kg, 33% w/v) after a 3-hour fast. Maternal BMI groups were examined for 30-min C-peptide by ANOVA.
Results: In the first trimester, UW (n=62) and N-UW mothers (n=69) were similar in mean age (22 years) with differing mean BMI (UW: 17.0 ± SD 1.2, N-UW: 22.4 ± 2.6 kg/m2). At the time of birth, % female and mean gestational age were similar (half female; 38 weeks). UW-infants had lower birthweight (2.7± 0.4 kg) than N-UW (2.9 ± 0.4 kg, p&lt;0.008), but not length (UW: 47.0 ± 2.3, N-UW: 47.1 ± 3.1cm, p=0.2). During OGTT, infants had similar fasting glucose (UW: 79.8 ± 9.5, N-UW: 82.8 ± 13.7 mg/dL, p=0.16) and fasting C-peptide (UW: 157.7 ± 161.7, N-UW: 201.7 ± 166.4 pmol/L, p=0.13). Although mean differences were not statistically significant, 30-min glucose was 6% lower in UW vs. N-UW (UW: 106.1 ± 21.9, N-UW: 113.0 ± 21.9 mg/dL, p=0.08), whereas 30-min C-peptide was 27% lower in UW vs. N-UW (UW: 397.0 ± 233.2 vs. N-UW: 543.9 ± 270.0 pmol/L, p=0.20).
Conclusions: While Asian Indian infants from underweight mothers had similar basal C-peptide and glucose levels to infants from normal- and overweight mothers, first phase insulin secretion may be lower in infants from underweight mothers. The results from this pilot study warrant further examination of intergenerational risk of beta cell dysfunction and support ongoing antenatal care strategies to improve nutritional status in pregnancy.

Disclosure
L. R. Staimez: None. K. Betha: None. P. Prabhakaran: None. A. Dutta: None. Y. S. Beyh: None. S. Vyakaranam: None. H. K. Noule: None. D. Kothapally: None. K. Narayan: None. R. Gupta: None. D. Prabhakaran: None.

Funding
Emory Global Health Institute; Emory Global Diabetes Research Center