bluuebunny/crossref_metadata_2025_split huggingface dataset:
The CGM Experience of Minority Adults With Type 1 Diabetes in the South Bronx
Authors: Lozada Orquera Faustina Alejandra , Leung Vivien , Ortega Susel Rodriguez 
Published: May 2021

Abstract
Objective: To describe the state of type 1 diabetes (T1D) in minority adults in the South Bronx, and their experience with continuous glucose monitoring (CGM). Introduction: In a recent analysis of data from the Type 1 Diabetes Exchange Registry, one notable finding was the difference in metabolic control and use of diabetes technology in patients of different socioeconomic status and racial/ethnic backgrounds. With limited data available on Hispanic and Black patients, we sought to examine the use of and experience with continuous glucose monitoring (CGM) in our hospital system, which primarily serves a low-income, minority population in the South Bronx. Methods: 68 adults with T1D who attended the Endocrinology clinic at our hospital from 2017 to 2019 were identified. Patients were contacted by telephone to complete a questionnaire regarding CGM use and satisfaction. A retrospective chart review was conducted to obtain additional demographic and clinical information. Results: Out of 68 patients with T1D in the hospital database who were contacted, 47 patients completed the questionnaire. The age range was 23 to 63 years. 42.6% were male. 59.6% were Hispanic, 19.1% Black/African American (AA), 4.3% Caucasian, and 17% not specified. 87.2% had public insurance. Overall, 48.9% of patients were actively using CGM, 19.1% had discontinued use of CGM, and 31.9% had never used CGM. In Hispanic patients using CGM, mean HbA1C was 8.2% compared to 10.1% in Hispanic non-users. In Black/AA patients using CGM, mean HbA1C was 9.2% compared to 9.9% in Black/AA non-users. Hospitalizations for acute diabetes complications were lower in CGM users (4.3%) compared to non-CGM users (16.7%). Among active CGM users, 74% rated their satisfaction as “extremely satisfied” or “very satisfied.” Perceived benefits included the prevention of hypoglycemia and awareness of inappropriate food intake. Discussion: Our study population, mainly comprised of Hispanic and Black T1D adults, showed a higher CGM utilization rate than previously reported. After stratification by socioeconomic status, CGM utilization was reported to be as low as 16% in Hispanic and 10% in Black patients with household income &lt;$50,000/year in the T1D Exchange Registry. By comparison, 49% of our studied population possessing similar demographics was actively using CGM. This study demonstrated that CGM acceptance was high in this largely minority, low-income population in the South Bronx, and was associated with lower A1C levels, high degree of patient satisfaction and reduction in diabetes-related hospitalizations. However, glycemic control remained suboptimal overall despite CGM access. Additional strategies to optimize the utility of CGM are needed to improve clinical outcomes such as HbA1C levels in minority T1D patients.
Virtual Pump Trainings for the t:slim X2 Insulin Pump With Control-IQ Advanced Hybrid Closed-Loop Technology: Real World Patient Experience
Authors: Singh Harsimran , Manning Michelle , McElwee-Malloy Molly , Habif Steph 
Published: May 2021

Abstract
The COVID-19 pandemic led to a digital evolution in the healthcare industry by necessitating widespread adoption of telehealth and other remote services to enable engagement with patients. Diabetes management is well suited for telehealth utilization if patients employ technology that efficiently generates, captures, and shares data with providers. Traditionally, training for automated insulin delivery devices is provided in-person to allow for a thorough understanding of the device and its use. However, during COVID-related quarantine regulations, most of these trainings needed to be conducted virtually. We performed a retrospective analysis of patient reported outcomes in people with diabetes who completed their training for the t:slim X2 pump with Control-IQ technology between April and September, 2020 and had uploaded 30 days of pump usage data to Tandem’s t:connect® web application. Most participants were adults (90%), female (54%), and had type 1 diabetes (89.9%). Mean age of the sample was 46 years (SD=18.7). Of all 1,686 participants, 1,256 had received virtual pump training while the remaining were trained in-person (n=430). Most participants reported completing their training in 1 to 2 hours (61.5%). After concluding training, participants completed an online questionnaire evaluating their training experience (8 items). Item response options included a 5-point Likert scale with higher values reflecting greater satisfaction and better experience with training. Multivariate analysis of variance indicated a significant effect of training method (virtual vs. in-person) on training-related experience (p=.020). Specifically, participants receiving virtual pump training reported greater overall satisfaction with their training (4.78 vs. 4.65, p=.012) and with the time when their training was conducted (convenient scheduling) (4.74 vs. 4.56, p=.008) compared to their counterparts who underwent in-person training. There were no significant differences between virtually trained and in-person participants on pace of training (4.71 vs. 4.57), trainer’s pump knowledge (4.82 vs. 4.74), trainer’s ability to answer their questions (4.77 vs. 4.70), and participants’ confidence to use the pump after training (4.62 vs. 4.53). In conclusion, all participants irrespective of their training method (virtual or in-person) reported a positive experience with their training for using the t:slim X2 pump with Control-IQ technology. Participants’ high scores on items evaluating their training method also reflects that their expectations of their training session were either met or exceeded. State-of-the-art technologies supporting diabetes management may benefit from patient-centric training methods to enable widespread optimal use. For future studies, it will be interesting to evaluate adherence to therapy by training method and relationship with glycemic outcomes.
Accuracy of a Point-of Care Hemoglobin A1c Assay - A Community Outreach Project
Authors: Semreen Noura , Otuonye Gene , Pena Angelica Medina , Rastogi Natasha 
Published: May 2021

Abstract
Glycated hemoglobin (HbA1c) is an invaluable tool in diabetes mellitus (DM) management. Conventionally obtained via venous blood sampling, point-of-care (POCT) capillary HbA1c measurement offers an opportunity for immediate treatment modification, reduced cost & increased patient satisfaction. While previous studies using the POCT HbA1c test A1cNow+ have shown accuracy within a 0.5% range from the gold standard venous HbA1c, we noted discrepancy in our community health clinic & sought to evaluate the accuracy of POCT HbA1c levels compared to venous HbA1c levels to guide our clinical decision-making.
In this 2-part study, we compared POCT HbA1c levels measured via a single use A1CNow+ HbA1c monitoring device & venous HbA1c samples measured by a standardized lab. Part1: after retrospective chart review, we identified 262 patients with prediabetes, Type1 or Type2 DM based on ADA guidelines who attended our clinic from January 2019-June 2019 & received POCT HbA1c with A1cNow+ testing during their visit. Of those cases, 47 patients also had a venous HbA1c at a standardized laboratory within 1 month of having their POCT HbA1c performed in our clinic. Part2: We noted variability in the temperature storage of A1CNow+ test strips. Storage was standardized to room temperature as per device instructions in June 2019. We subsequently reviewed charts from June 2019-December 2019 & identified 118 patients who had both POCT HbA1c & venous HbA1c measurement within a 1 month period.
Patients was categorized into subgroups per ACP guidelines for DM control: prediabetic (HbA1c 5.7–6.4%), controlled DM (HbA1c 6.5 to 8.0%) & uncontrolled DM (HbA1c &gt;8.0%). The average difference between POCT & venous HbA1c tests was calculated & analyzed for statistical significance using paired t test analysis. Part1: For patients in prediabetic, controlled & uncontrolled DM subgroups, the mean difference between A1cNow+ & standardized venous HbA1c testing was 0.68% (p= 0.004), 1.15% (p= &lt;0.0001) and 1.36% (p= 0.0003) respectively. Part2: After standardization of test strip storage, the mean difference between A1cNow+ & venous HbA1c testing for prediabetic, controlled & uncontrolled DM patients was 0.33% (p= 0.002), 0.41% (p= 0.011) and 1.26% (p= &lt;0.0001) respectively.
POCT HbA1c provides a unique opportunity to immediately address glycemic control. Its advantages are especially apparent in a patient population with limited resources & poor follow up, as in our clinic. Although standardizing test storage improved overall concordance between A1cNow+ HbA1c testing & venous HbA1c, there was still a statistically significant larger mean difference in uncontrolled DM patients. In prediabetic & controlled DM patients, however, POCT HbA1c was accurate within previously published reports of a 0.5% range when compared to venous HbA1c. An algorithm has since been developed to guide our clinical decision making with these findings.
Effects of Evogliptin as Add on in Type 2 Diabetes (T2DM) Subjects Inadequately Controlled With Metformin and Glimepiride Combination
Authors: Guha Shaibal 
Published: May 2021

Abstract
Objective: To achieve targeted glycemic control people with diabetes required multiple drug therapy. We retrospectively studied effect of adding newly approved DPP4i evogliptin in T2DM subjects having high HbA1c value despite being on tolerable stable doses of Metformin and Glimepiride. Methods: We retrospectively analysed the effects of evogliptin 5 mg OD over 6 month preriod when added to patients who were initially having HbA1c ≥ 7.5% on on stable fixed dose combination of Metformin (1000 -2000 mg/day) and glimiperide (2 - 4 mg/day) at least from 3 months prior. Any patients who were other OHA drugs or in Insulin of have been up or down titrated of the studied drug were excluded. We compared HbA1c, fasting (FPG), postprandrial (PPG) plasma glucose, total cholesterol (TC), triglyceride (TG), HDL, LDL at baseline and after 6months of evogliptin initiation. Self-monitored blood glucose (SMBG) was performed using the patients’ own BG meter. Physicians gave all patients training to ensure they could perform SMBG correctly and accurately. Results: Data of 185 subjects [85(46%) females, Mean age 52.3±2.8 years, mean duration of diabetes 8.2±1.9], who met the inclusion criteria were extracted for analysis from the hospital and clinics records. A drop in HbA1c from 8.8±1.1 to 7.8±0.5% (p&lt;0.05) were resulted after addition of evogliptin. FPG decreased from 159.2±13.5 to 128.3±11.2 and PPG from 238.2±28.7 to 188.1±22.6 respectively (p &lt;0.05). Total cholesterol (TC), triglyceride (TG) were significantly improved after addition of evogliptin, whereas little effect on LDL and HDL. There was no incidence of severe hypoglycemia, though 7 (3.8%) cases of suspected hypoglycemia were managed at home. Conclusion: Evogliptin is a suitable add-on option for those with high HbA1c values as it offer low risk of hypoglycemia despite significant improvement in glycemic parameters.
Incidence and Factors Associated With Genitourinary Infections Among Type 2 Diabetes Mellitus Patients on SGLT2 Inhibitors: A Single-Center Retrospective Cohort Study
Authors: Caro Marilyn Katrina C , Cunanan Elaine Cheeay , Kho Sjoberg Ang 
Published: May 2021

Abstract
Background: The efficacy of SGLT2 inhibitors for diabetes is consistent across several studies; however, the risk of genitourinary infection due to these drugs has also been cited.
Objective: To determine the incidence and factors associated with genitourinary infection among type 2 diabetes mellitus patients on SGLT2 inhibitor seen at the University of Santo Tomas Hospital
Methodology: The study utilized a retrospective cohort design. Participants included 253 Type 2 diabetes mellitus patients who started SGLT2 inhibitor treatment from January 1, 2014 to June 30, 2019. Data collection via medical charts review was performed from April 1 to October 1, 2020. Multiple logistic regression analysis was performed to determine the factors associated with genitourinary infection. Stata MP version 14 software was used for data analysis.
Results: The 3-month and 6-month incidence of genitourinary infection among patients treated with SGLT2 inhibitors are 2.37% and 21.78%, respectively. A significant difference in the probability of genitourinary infection across the three drugs was observed (p=0.0019). Pairwise analysis showed lower probability of infection among patients treated with canagliflozin compared to empagliflozin and dapagliflozin. Factors associated with genitourinary infection include high HbA1c at the time of treatment initiation and SUR and insulin use. The same set of factors were recorded for males. Among females, only HbA1c and eGFR at the time of SGLT2 inhibitor initiation were significantly associated with genitourinary infection.
Conclusion: The study results revealed that genitourinary infection is common among patients taking SGLT2 inhibitors, especially dapagliflozin and empagliflozin. Several factors were associated with urinary and genital infection, and risk factors vary by sex. These factors include high BMI, high HbA1c levels at the time of treatment initiation, longer duration of diabetes, low eGFR, and concomitant use of insulin and/or SUR.
Role of Bariatric Surgery in Managing Metabolic Syndrome
Authors: Iqbal Iqra , Khan Muhammad Atique Alam , Tariq Shafaq , Slusser Jonathan 
Published: May 2021

Abstract
Background: Lifestyle modifications provide a limited control of diabetes mellitus type 2 (DM2), especially in patients with morbid obesity and uncontrolled DM. Compared with non-surgical treatment, bariatric surgery achieved more sustained weight loss and higher remission rates of DM2. Roux-en-Y gastric bypass (RYGB) has been the most common procedure in the past but sleeve gastrectomy (SG) with duodenal switch (DS) is gaining more popularity now. Objective: To compare the significant differences in the outcomes of these procedures; such as the reduction in hemoglobin A1c (HbA1c), weight, basic metabolic index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk score of the patients at our community hospital.
Methods: This was a retrospective observational study consisting of a chart review of 151 patients during 2016 to 2019. Patients included were &gt;18 years old, and underwent one of the three types of bariatric surgeries, including RYGB, SG and sleeve with DS. Comparison between different continuous variables was made using analysis of variance. Chi square analysis was used to determine associations between different outcomes and various categorical variables.
Results: Among all, 33.1% had SG, 33.8% had RYGB and 33.1% had DS. The median age was 66 years and 71.5% were females. Median height was 63 inches. 84.8% were white, 14.6% were African American and 0.7% were Asian. The associated comorbidities were asthma, hypertension, dyslipidemia, DM, smoking and coronary artery disease. Median weight prior to surgery was 280 pounds (lb) and reduced to a median weight of 240 lb. Median BMI before surgery was 44 kg/m2 and reduced to 39 kg/m2. Median blood pressure (BP) was 128/74 mmHg and reduced to 120/68 mmHg. Patients with elevated BP reduced from 70% to 20% in SG, 66.7% to 49% in RYGB and 82% to 54% in DS. Fasting blood sugar reduced from a median of 98 mg/dl to 87 mg/dl. HbA1c reduced from a median of 6 to 5.4. ASCVD risk score reduced from 4 to 2. Mean difference in HbA1c reduction was 0.81 for SG, 1.44 for RYGB and 2.19 for DS. Prior to surgery, 43% patients had DM, 16.6% had prediabetes and 40.4% were nondiabetic. Three months later, patients with DM2 reduced to 14.8% and prediabetes reduced to 10.7%. Patients with DM in SG group reduced from 14% to 12.2% and prediabetics reduced from 12 to 6%. In RYGB group, DM reduced from 56.9% to 16% and prediabetics increased from 13.7% to 24%. In DS group, DM reduced from 58% to 16% and prediabetics reduced from 24% to 2%. Insulin users reduced from 4% to 2 % in SG, 21.6% to 3.9% in RYGB and 22% to 6% in DS. Median number of DM2 medications reduced from 1 to 0. Conclusion: Our study demonstrates the differences in the reduction of HbA1c, weight, BMI and ASCVD risk score among various bariatric surgery procedures. It suggests that DS leads to a greater reduction in the HbA1c and ASCVD risk scores as compared to RYGB, although the risks of malabsorption complications are considerable.
The Use of Cultural Competency in Decreasing Diabetes Outcomes Disparities in a Community Health Care Setting
Authors: Toth David W , Vittini Radairy M 
Published: May 2021

Abstract
In the United States, the prevalence of diabetes in the Latnix population is roughly 70% higher than in non-Latinx whites. Along with this, many studies have shown that the rate of complications, both macro- and microvascular, in this population is also disproportionately higher. Given that complication rates mirror glycemic control, as evidenced by studies such as the DCCT and UKPDS, the increased rate of poor glycemic control is likely one of the most important factors contributing to this. Most efforts at controlling diabetes in a population have aimed at a heterogeneous cohort in terms of race and ethnicity, yet poor control disproportionately affects the Latinx groups. North Shore Community Health Center is a Federally Qualified Health Center located around the communities of Salem, Peabody, and Gloucester, MA. These areas are ethnically diverse, and the vast majority of the Latinx population are Dominican. In fact, roughly 50% of the clinic population is Latinx. After prioritizing glycemic control as a goal for 2019, we utilized a population health strategy to identify patients with A1c &gt;9% (poor control as defined by UDS measurements). These patients were given an appointment with the only endocrinologist in the clinic, who, through a Dominican Spanish translator and using joint decision making, decided on appropriate medication. They were then followed at least weekly at first by a nurse who also was Dominican and lived in the community. She counseled patients on culturally-appropriate diet recommendations, activity, screening, monitoring, and provided access to other specialties (e.g. podiatry, ophthalmology) as needed. The rate of A1c &gt;9% in the clinic had been 35–40% prior 2019. At the end of 2019, the rate was 27%, with a disproportionaltly lower rate in the Latinx population (23%). Our conclusion is that a culturally sensitive diabetes program will eliminate these health disparities
Type 2 Diabetes Management in Older Adults: A Personalized Approach
Authors: Miles Cristy , Ali Rabia , Nathan Aviva , Cui Michael , Zhu Mengqi , Pusinelli Mariko , Press Valerie , Huang Elbert 
Published: May 2021

Abstract
Aging is considered a significant risk factor for diabetes, and over the next decade, the largest increase in diabetes prevalence is expected to be in older adults. Our study aimed to investigate the challenges in managing type 2 diabetes in older adults and its multifactorial components that affect diabetes goal setting. “My Diabetes GOAL” hypothesized that a nursing intervention, along with a collaborative approach to management, education, and care, can engage older patients in personalized goal setting and address barriers to quality of life. A total of 88 patients with type 2 diabetes mellitus were included in this 6-month randomized controlled trial, with 42 patients enrolled in the intervention arm and 46 patients in the delayed-start control arm. Patients were required to complete a survey delivered through the patient portal to initiate personalized goal setting and care management support. Patients in the intervention arm received their first telephonic care management call by a study team nurse within five business days of the initial survey completion. The nurse discussed survey responses, barriers, and concerns the patient may have involving their care. Barriers included hypoglycemia, medication, co-morbidity, and physical activity. For this abstract, we report the frequency of care management topics for all 88 patients. The majority of our patient population identified as African American (68%) and female (68%). The average A1c at baseline was 7 %. For every monthly call, A1c goal setting and education was a required discussion topic and did not vary significantly throughout the intervention (73% month one, 74% month six). During the first call, hypoglycemia was addressed among 56% of participants, and education on medication was provided to 64%. Co-morbidities (heart failure, incontinence, depression, chronic pain, falls, lung conditions, malignancies) were highly prevalent, with 68% having one or more. Physical activity was discussed in 42% of conversations with participants, and a referral (diabetes education, physical therapy) was needed by 25%. After six months, discussions regarding hypoglycemia (14%), medication (19%), co-morbidities (56%), physical activity (22%), and referrals (6%) were reduced. These results suggest that personalized telephonic care management for older adults can positively impact patient outcomes. Diabetes care management is not a one size fits all. Personalized goal setting was successfully discussed based on an individual’s risk factor, which took into consideration co-morbidities and physical mobility barriers. Future studies should evaluate long-term clinical outcomes with a randomized control design.
A Novel Peptide Antagonist of the Human Growth Hormone Receptor
Authors: Basu Reetobrata None , Kopchick John Joseph 
Published: May 2021

Abstract
The human growth hormone (GH) secreted by the anterior pituitary, binds to its cognate growth hormone receptor (GHR) and regulates longitudinal growth, organ development, metabolism of carbohydrate, protein, and lipid, as well as disease states like diabetes and cancer. GH action has also found to be a critical determinant of human lifespan. Consequently, there is considerable interest around developing an inhibitor of the GH action. The first and only antagonist of the GHR - pegvisomant - was developed at our lab more than 20 years back and is currently an FDA approved prescription drug for treating acromegaly, a condition of GH excess. Here we present the design, development, and initial characterization of a novel peptide antagonist of the human GHR. The novel antagonist termed ‘S1H’ is a 16-amino-acid peptide designed as a direct sequence mimetic of a unique fragment of the site-1 binding helix of the human GH molecule. To this end we have characterized S1H with mass spectrometry, circular dichroism spectropolarimetry, and in vitro biological assays using human cell lines expressing GHR. S1H inhibited GH induced STAT5 phosphorylation, a hallmark of GH induced intracellular signaling, in a dose-dependent manner in multiple cell lines. Furthermore, using alanine scanning mutagenesis studies, we identified a strong correlation between the helical propensity and biological activity of S1H. Taken together, our results confirm that S1H is a novel GHR inhibitor with prospective applications in human disease conditions on one hand, and also is a valuable molecular tool to study the nature of human GH-GHR interactions. We currently continue to characterize S1H for binding kinetics and in vivo effects on suppressing GH action.