bluuebunny/crossref_metadata_2025_split huggingface dataset:
845-P: Unmanaged Diabetes as a Poor Prognostic Factor in the Severity of Infection and Recovery Time of Hospitalized COVID-19 Patients
Authors: MOSSAYEBI ALI , KREIT HELEN , CHERUKURI SUNDAR V. , MANDANIA ROSHNI A. , CONCHA JEANNIE B. , JUNG HYEJIN , WAGLER AMY E. , GUPTE AKSHAY A. , DEOKER ABHIZITH , BAJPEYI SUDIP 
Published: June 2021

Diabetes is considered as one of the comorbidities with COVID-19 infection and indicated to influence the severity and the rate of recovery in COVID-19 patients. However, it is not known whether the lack of diabetes management may magnify COVID-19 severity and the rate of recovery in patients with diabetes.
Purpose: The purpose of this study was to determine the effect of diabetes management on the severity and length of hospitalization in hospitalized COVID-19 patients.
Methods: This retrospective study used medical records from patients admitted to the University Medical Center, El Paso, TX with COVID-19 (n=369; Age 60.0 ± 0.8 years; BMI 30.3 ± 0.4 Kg/m2). Glycemia was assessed by glycated hemoglobin (A1c) level at the time of hospitalization. The severity of the COVID-19 outcome was assessed by quick sepsis-related organ failure assessment (qSOFA) and length of hospitalization was determined by the number of days spent in the hospital. Patients were categorized into normoglycemic (N: A1c &lt;5.7%), prediabetes (Pre: 5.7% ≤ A1c &lt; 6.5%), and diabetes mellitus (DM: A1c ≥ 6.5%) groups. DM group was further categorized for diabetes management with medication. One-way ANOVA and unpaired t-test were used to determine the statistical differences among/between groups as appropriate.
Results: There was no significant difference among groups in severity of COVID-19 infection (qSOFA: N 0.24 ± 0.08, Pre 0.38 ± 0.07, D 0.28 ± 0.03; p&gt;0.05) and length of hospitalization (N 5.6 ± 0.8, Pre 9.3 ± 1.0, DM 8.9 ± 0.6 days; p&gt;0.05). However, patients with unmanaged diabetes (no medication) showed significantly greater severity (qSOFA: 0.44 ± 0.08 vs. 0.22 ± 0.03; p&lt;0.05) and length of hospitalization (10.8 ± 1.6 vs. 8.2 ± 0.6 days; p&lt;0.05) compared to patients who managed diabetes with medication.
Conclusion: Unmanaged diabetes shows worsened severity and the rate of recovery in COVID-19 patients. Diabetes management should be considered in the treatment of COVID-19 patients.

Disclosure
A. Mossayebi: None. S. Bajpeyi: None. H. Kreit: None. S. V. Cherukuri: None. R. A. Mandania: None. J. B. Concha: None. H. Jung: None. A. E. Wagler: None. A. A. Gupte: None. A. Deoker: None.
846-P: Basal Insulin Management in Inpatients Who Are Not Eating: Is There a Difference between Medical and Surgical Patients?
Authors: SACDAL JOHN PAUL , HABIB HELEN A. , CHEON EUNAH , OH ERIN 
Published: June 2021

Background: Guidelines from the 2021 American Diabetes Association recommend basal or basal plus correctional insulin dosing for non-critically ill hospitalized patients with poor oral intake or are nil per os (NPO). The recommended adjustment is 75-80% of long-acting basal insulin administered perioperatively. The aim of this study was to build on the current data available to determine the optimal management of insulin detemir dosing between medicine and surgery patients who were unable to eat.
Methods: This was a retrospective single-center observational study between January and December 2019 that included patients with type 2 diabetes and confirmed NPO status receiving insulin detemir. To determine best practices of long-acting insulin management, 100%, 80-33%, and 0% insulin detemir dosing in medical and surgical patients were evaluated. The primary endpoint was incidence of hypoglycemia (&lt;70 mg/dL) after insulin dose adjustment. Secondary endpoints were incidence of severe hypoglycemia (&lt;40 mg/dL) and hyperglycemia (&gt;180 mg/dL) after insulin dose adjustment.
Results: Of the 100 adult patients who met the criteria, there were no incidences of hypoglycemia or severe hypoglycemia regardless of insulin detemir dose adjustment in either medical or surgical patients. In the medicine group, hyperglycemia occurred in 23/67 (34.3%), 2/6 (33.3%), 4/12 (33.3%) for 100%, 80-33%, and 0% insulin dose adjustments, respectively. In the surgery group, hyperglycemia occurred in 8/12 (66.7%) in patients receiving 100% insulin detemir dosage with no notable outcomes in the remaining 3 patients.
Conclusions: There was no incidence of hypoglycemia or severe hypoglycemia between medical and surgical patients, regardless of insulin detemir dose adjustment. A numerically higher incidence of hyperglycemia was observed in patients receiving 100% insulin detemir in both medicine and surgery patients. Further education is planned to reduce hyperglycemia.

Disclosure
J. Sacdal: None. H. A. Habib: None. E. Cheon: None. E. Oh: None.
847-P: Goal-Setting Behavior for Physical Activity in Diabetics: A Quality Improvement Project
Authors: NGUYEN-VASELAAR HANH T. 
Published: June 2021

Low levels of physical activity are strongly associated with increased mortality and numerous health issues which increase health care costs. Diabetes is one disorder that is known to require physical activity for the best control of symptoms. Use of SMART (Specific, Measurable, Attainable, Relevant, Time-bound) goals is one approach to assist patients with behavioral changes. They are of little to no cost to patients and help integrate the patient as an active participant in the health care plan. Patients set their own goals, and the health care team provides coaching. In this quality improvement project, we introduced SMART Goals as a patient-centered, self-motivating strategy to increase type II diabetics’ physical activity and thereby decrease their HbA1c (hemoglobin A1c) levels. Coaching was done via telephone for 3 to 4 months. We assessed pre- and post-intervention physical activity levels and gathered HbA1c at routine diabetic follow ups. A total of 29 participants were enrolled in the study, six were lost to follow up. Although no changes were statistically significant in this small sample, the final cohort of 23 patients generally showed an increase in walking and moderate physical activity, a decrease in self-reported sedentary behavior, and overall improvement in HbA1c. On average, greater HbA1c improvements were seen in patients who met their activity goal and change in physical activity level was positively correlated with reduced HbA1c. Findings suggest that HbA1c improvements and increased physical activity levels are possible if patients are encouraged to set actionable SMART goals. This approach can be applied to any clinical setting and could help motivate patients to increase their physical activity levels.

Disclosure
H. T. Nguyen-vaselaar: None.
849-P: Outreach Method Predicts Patient Engagement during Sustained Care Disruption
Authors: CROMWELL GRACE , HUDSON MARGO , MCKITRICK CHARLES K. , DONAHUE MARINA , SMITH COLLEEN M. , FOWLER KRISTEN M. , DEL VALLE KAYLA L. , SIMONSON DONALD C. , MCDONNELL MARIE E. 
Published: June 2021

The COVID-19 pandemic has caused sustained disruptions in access to usual diabetes care. In response to the high number of cancelations, an academic, urban diabetes program transitioned to virtual visits and launched an initiative to provide outreach to patients who canceled an appointment between Mar 16 and Jun 19, 2020. Members of the diabetes team used a standardized approach to prevent delayed care or disengagement. Method of contact was defined as Reached (two-way communication between clinician and patient by phone or EHR portal message), Message Left (e.g., voicemail) and No Contact. Engagement was defined as booking a follow up appointment and keeping the appointment. A total of 787 patients were determined to have canceled visits due to the pandemic. Mean (SD) age was 61.7 yrs (14.2), 53.7% female, 67.3% white, baseline A1c 7.96% (1.81). Of the 648 visits booked, 519 (80%) were kept. Patients who were reached were more likely to book (OR = 2.43, p&lt;0.001) and keep an appointment (OR = 2.39, p&lt;0.001) compared to no contact or message left. Older age was a significant predictor of booking (OR = 1.014 for each year older, p=0.037). Patients on insulin were more likely to keep their appointment (OR = 1.70, p=0.008), while patients with higher HbA1c were less likely to (OR = 0.87 for each 1.0% increase in HbA1c, p=0.011). These findings suggest that for systems designed to optimize engagement during care disruption, one-way communication is no better than no contact, and two-way communication increases the likelihood that patients will maintain access to care. In addition, while higher risk patients (e.g., older age or on insulin) may be more incentivized to stay engaged, targeted outreach may be needed for those with chronic poor glycemic control.

Disclosure
G. Cromwell: None. M. Hudson: None. C. K. Mckitrick: None. M. Donahue: None. C. M. Smith: None. K. M. Fowler: None. K. L. Del valle: None. D. C. Simonson: Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. M. E. Mcdonnell: Stock/Shareholder; Spouse/Partner; Abbott Diabetes.
858-P: Online Clinician and Aligned Patient Education Improves Both Clinicians’ and Patients’ Ability to Manage T2D with GLP-1 RAs
Authors: LARKIN AMY , LE ANNE 
Published: June 2021

We sought to measure the impact of aligned, online education for clinicians and patients on knowledge and real-life changes. For clinicians, a live-streamed virtual symposium was held as part of the Metabolic and Endocrine Disease Summit (MEDS) Fall meeting in October 2021. Pre/post questions assessed changes in knowledge and practice. For patients, an online activity was comprised of text, integrated visuals, and a clinician commentary. Demographic questions were asked prior to the education. A pre/post knowledge question assessed learning gains. Intent to change and confidence questions were asked at the end. Absolute improvements were calculated for pre/post questions. The patient activity launched in June and data collected through November. Clinician Activity: Of 464 learners: 41% were nurse practitioners, 19% physician assistants, and 19% physicians; 32% specialized in diabetes and 20% in family medicine; 22% see 11-20 patients with T2D per week and 21% see greater than 30 per week. Increased knowledge was observed in patient education related to how to appropriately take an oral GLP-1 RA. 58% reported an animation video demonstrating the mechanism of action of a new oral GLP-1 RA to be very helpful in increasing their clinical knowledge. After the education, 47% reported being confident in patient selection for GLP-1 RA therapy, demonstrating a need for more education on this topic. Patient Activity (“Tips for Taking GLP-1 RAs for T2D?"): To date, 13,237 learners. Knowledge changes: 42% improvement in recognizing how you should take an oral GLP-1 RA (45% pre to 87% post). Intent-to-act: 66% plan to talk to their HCP about if an oral GLP-1 RA is right for them. Confidence changes: 73% reported increased confidence in taking a GLP-1 RA so it’s easier and has less side effects. The metrics and outcomes gathered in this assessment are a strong indicator that aligned clinician and patient activities are successful at improving ability to manage T2D with GLP-1 RAs.

Disclosure
A. Larkin: None. A. Le: None.

Funding
Novo Nordisk
86-OR: Primary Results from Two Phase 3 Trials of Faricimab for Diabetic Macular Edema (DME): YOSEMITE and RHINE
Authors: HU ALLEN , WILLIS JEFFREY R. , HASKOVA ZDENKA , SILVERMAN DAVID , IVES JANE , BASU KAREN , LIN HUGH 
Published: June 2021

The leading cause of vision loss in people with diabetic retinopathy (DR) is DME. Intravitreal anti-VEGF therapy is the standard of care for DME; however, optimal vision outcomes are difficult to achieve, and the need for ongoing, often monthly injections is burdensome for patients, caregivers, and the health care system. Upregulation of both VEGF-A and angiopoietin-2 has been shown to synergistically induce vascular destabilization characteristic of DME; therefore, dual inhibition with faricimab, the first bispecific antibody designed for intraocular use, may improve outcomes beyond anti-VEGF monotherapy. YOSEMITE (NCT03622580) and RHINE (NCT03622593) are identical, randomized, phase 3 trials to assess the efficacy, durability, and safety of faricimab in DME. Patients were randomized 1:1:1 to faricimab 6.0 mg every 8 weeks (Q8W) after 6 initial Q4W doses; faricimab 6.0 mg per personalized treatment interval (PTI) after 4 initial Q4W doses; or aflibercept 2.0 mg Q8W after 5 initial Q4W doses. Dosing intervals in the PTI arm were adjusted based on treatment response using prespecified vision and anatomic criteria. Safety and efficacy will be assessed Q4W through week 100. The primary endpoint was mean change in best-corrected visual acuity at 1 year, averaged over weeks 48, 52, and 56. Secondary endpoints included changes in anatomic outcomes over time, such as DR severity and central subfield thickness; and the proportion of patients on Q4W, Q8W, Q12W, or Q16W PTI dosing at 1 year. Safety endpoints were the incidence and severity of adverse events. Both studies met their primary endpoint and showed that faricimab dosed Q8W or per PTI demonstrated non-inferior visual acuity gains compared to aflibercept Q8W. More than half of all patients in the faricimab PTI arms had extended time between treatments to 16 weeks at 1 year - the first time this level of durability has been achieved in a phase 3 DME study. Faricimab was generally well-tolerated, with no new safety signals identified.

Disclosure
A. Hu: Advisory Panel; Self; Roche Pharma. J. R. Willis: Employee; Self; Genentech, Inc., Stock/Shareholder; Self; Roche Pharma. Z. Haskova: Employee; Self; Genentech, Inc. D. Silverman: Employee; Self; Roche Pharma. J. Ives: Employee; Self; Roche Pharma. K. Basu: Employee; Self; Genentech, Inc., Roche Pharma, Stock/Shareholder; Self; Genentech, Inc., Roche Pharma. H. Lin: Employee; Self; Genentech, Inc., Employee; Spouse/Partner; Genentech, Inc.

Funding
F. Hoffmann-La Roche, Ltd.
869-P: Patient-Provider Video Visit Use and HbA1c Control among Patients with Diabetes
Authors: REED MARY , GOPALAN ANJALI , GRAETZ ILANA , HSUEH LORETTA , HUANG JIE , MUELLY EMILIE 
Published: June 2021

Video telemedicine can offer patients direct real-time convenient access to clinicians without arranging transportation or work time-off, improving access to diabetes care and self-management support. We examined the association between video visit use and hemoglobin A1c (HbA1c) among patients with diabetes.
In a longitudinal study, within a large integrated delivery system where patients were first able to self-schedule real-time physician video visits in 2016, we used the clinical registry to identify patients with diabetes (2015), and followed their video visit use and subsequent HbA1c values over time (2016-2019). Using linear regression with patient-level fixed effects (within-patient changes), adjusting for calendar year and month and time-changing patient mobile portal access, we measured the association between use of video visits as a time-changing variable and the patient’s yearly HbA1c values (in subsequent calendar years after video visit use). We then stratified analyses by baseline HbA1c value: &lt;8%, ≥8%, no value (defined as lower patient engagement).
Among 204,301 patients with diabetes, 50% were 65 years or older, 48% were women, and 45% were of white race/ethnicity. Overall, 95% of patients had a baseline HbA1c value, 24% had HbA1c values ≥8%. Patient use of video visits was associated with an overall statistically significant reduction in HbA1c value by 0.15% (95% CI: 0.11%-0.19%). Among those with baseline HbA1c values ≥8%, using video visits was associated with a HbA1c value reduction of 0.22% (95% CI: 0.12%-0.32%), and among patients with lower baseline engagement (i.e., no baseline HbA1c measurement), using video visits was associated with a HbA1c reduction of 0.39% (95% CI: 0.07%-0.71%).
Use of video visit was associated with improved glycemic control among patients with diabetes, with greater improvements found among patients with worse baseline control and lower engagement. Video visits may offer convenient health care access to improve diabetes management.

Disclosure
M. Reed: None. A. Gopalan: None. I. Graetz: None. L. Hsueh: None. J. Huang: None. E. Muelly: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085070)
870-P: Patient Factors and Engagement of Care in Type 2 Diabetes in Phnom Penh, Cambodia
Authors: VICENCIO JASMINE M. , PENG SOVANN , MENH PHANAVARINE , CURRAN PETER G. , HUDSON MARGO 
Published: June 2021

Cambodia is developing its response to non-communicable diseases including the increasing prevalence of diabetes. Third party payment for care is limited therefore much of the financial burden is left to the patient. The Community Medical Center (CMC) is an NGO-sponsored outpatient clinic in Phnom Penh which started a diabetes specialty clinic in 2013 in the absence of endocrinologists by relying on a corps of internists. This corps plays a critical role in monitoring and treating patients over time given the chronic nature of the disease. Multiple visits annually are considered standard of care in the developed world. The CMC team launched a database tracking all patients in 2015 and had enrolled 3634 patients with T2DM as of January, 2019. Complete data sets were available for 3570. We performed a fixed effects regression analysis to identify patient characteristics at the initial visit that might impact engagement in care (ENC), defined as fully engaged if patient had at least 2 follow-up visits within the first year of enrollment (FENC), or partially engaged (one f/u visit) PENC. Of the patients enrolled, 2,019 met criteria for FENC, 420 met criteria for PENC, and 1,131 were not engaged. In a fully adjusted model, receiving financial assistance for health expenses had the greatest impact (β = 0.382, p&lt;.001) on ENC. Taking antihypertensive medication was also associated with ENC (β = 0.141, p&lt;.001). BMI &gt; 35 was negatively associated with ENC (β = -0.280, x p&lt;.05). Proximity of residence to CMC, presence of complications, A1C level, and use of insulin were not significantly associated with ENC. This is the first large longitudinal study of its type in Cambodia. Assistance with cost of care to the patient had the strongest positive correlation with ENC. Further research is needed to better understand the factors that lead to ENC in resource challenged environments such as Cambodia as well as guide what modifications can be made to programs.

Disclosure
J. M. Vicencio: None. S. Peng: None. P. Menh: None. P. G. Curran: None. M. Hudson: None.

Funding
Peco Foundation
876-P: Is Telemedicine the Preferred Visit Modality in Patients with Type 1 Diabetes?
Authors: KIRZHNER ALENA , ZORNITZKI TAIBA , OSTROVSKY VIVIANA , KNOBLER HILLA , SCHILLER TAL 
Published: June 2021

Background: The COVID-19 pandemic limits access to diabetes clinics. Remote communication by phone calls and WhatsApp messages became available in the past years. However, the current need to avoid face-to-face meetings necessitates further expansion of telemedicine services. There are limited data whether the option of virtual meetings is a preferred therapeutic modality for patients with type 1 diabetes (T1D).
Objective: To assess in a cohort of T1D patients, their preference and perception of telemedicine.
Methods: T1D patients who are followed in a hospital-affiliated diabetes clinic were asked to fill a structured questionnaire aimed to determine their attitude towards telemedicine and their preference of virtual versus conventional visits. The questionnaire was offered to consecutive T1D patients who visited the clinic between August to October 2020.
Results: Seventy one T1D patients that fulfilled the questionnaire were included. Mean age was 42±15 years, 39% were male, and the mean duration of diabetes was 21±14 years. Fourteen percent of the participants preferred only virtual visits, 24% only conventional visits and 62% preferred a combination of these modalities. Sex, origin, education, duration of diabetes, mode of insulin treatment and distance from the clinic were not associated with patients’ preference, but older patients (≥ 61 years) tended to prefer conventional visits. Sixty-seven percent felt confident in their ability to download data from their personal medical devices.
Conclusions: Patients from a wide range of treatment modalities are willing to use telemedicine. However, virtual meetings cannot fully replace conventional visits in T1D especially in the older age group.

Disclosure
A. Kirzhner: Speaker’s Bureau; Self; Novo Nordisk. T. Zornitzki: Speaker’s Bureau; Self; Novo Nordisk. V. Ostrovsky: None. H. Knobler: None. T. Schiller: Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc.
877-P: Video Visit: A New Tool for Diabetes Post-hospitalization Follow-up
Authors: KARSLIOGLU-FRENCH ESRA , SISTLA DIVYA , MEYER ANNA C. 
Published: June 2021

Background: UPMC Diabetes Inpatient Service has been offering follow-up appointments to patients in endocrine clinic one week after discharge as an intervention to decrease readmissions. Unfortunately, these appointments have a very high no show rate and are only offered to a select group of patients who can show up to clinic in person. During COVID19 public health emergency as CMS started to reimburse video visits, our clinic switched to offer video visits one week following hospital stay. Whether video visits are effective for post-hospital follow-up is not known.
Objective: The aim of this study is to understand the impact of post-hospital video visits in diabetic population outcomes and clinic utilization.
Methods: We completed a retrospective chart review of patients with diabetes who had a follow-up appointment one week after discharge in 2019(August, September and October) and 2020(August, September and October). We compared no-show rates, utilization of physicians versus APPs, reduction in A1c between two groups.
Results: August to November 2019, 42 office appointments were scheduled. 24/42 appointments were completed, and the no show rate was at 42%. Previsit (hospital) average A1c was 8.03%, which improved to an average of 7.4% 3 months following appointment. 92% of all appointments were completed by physicians, and 8% were completed by an APP. August to November 2020, 100 posthospital appointments were scheduled for diabetes service patients. 70 of 100(70%) agreed to complete video visits, 29/100 preferred office appointments. In video visit group, no show rate was only (8/70) 11%. Video visit group had a previsit (hospital) average A1c: 8.3%, 3 months after video visit average A1c improved to 6.3%. 32% of post-discharge visits were completed by a physician, 67% of were completed by an APP.
Conclusion: In patients with diabetes, post-discharge video visits decreased no show rates, increased utilization of APPs while achieving to improve A1c.

Disclosure
E. Karslioglu-french: None. D. Sistla: None. A. C. Meyer: None.