bluuebunny/crossref_metadata_2025_split huggingface dataset:
804-P: Empagliflozin Reduces Inflammation and Bioenergetics in Proinflammatory Human Macrophages: Clues to Mechanisms of Blood Vessel Protection?
Authors: SPIGONI VALENTINA , CINQUEGRANI GLORIA , FANTUZZI FEDERICA , LORUSSO SIMONA , CAS ALESSANDRA DEI , BONADONNA RICCARDO C. 
Published: June 2021

SGLT-2 inhibitors (SGLT2i) reduce cardiovascular (CV) risk in people with type 2 diabetes and atherosclerotic CV diseases. The inflammatory function of macrophages (Mφ) - which play a pivotal role in atherosclerosis - is strictly dependent on their metabolism.
Aim: To determine whether empagliflozin (EMPA) reduces inflammation and modifies bioenergetic metabolism in proinflammatory human Mφ (M1).
Methods: M1 were differentiated from healthy donors’ monocytes and incubated with/without EMPA 100 µM for 16h. Biomarkers of inflammation and oxidative stress were quantified by qPCR. Steady-state energetic metabolism (fluxes: pmol/min for 5x104 cells) was measured by indirect microcalorimetry [oxidations of lipids (LipOX,) glucose and amino acids; anaerobic glycolysis (AnaerGlyc); tricarboxylic acid cycle (TCA); energy expenditure (EPR); maximum estimate of ATP production (ATPflux)] which is based on the integration of measured O2 and H+ (Agilent Seahorse), lactate and NH4 (enzymatic method) fluxes with the stoichiometric equations of metabolic pathways.
Results: In M1, EMPA reduces (≈50%) inflammation (IL1β, IL8, TNFα and MCP1; p&lt;0.05-0.001) and oxidative stress (GPX and HO-1; p &lt;0.05). EMPA lowers OCR (133±9.7 vs. 153±10.3, p&lt;0.001), LipOX (1.15±0.1 vs. 1.33±0.1; p&lt;0.005), TCA (45±3 vs. 52±4; p&lt;0.001), AnaerGlyc (210±23 vs. 268±24; p&lt;0.01), ATPflux (1097±94 vs. 1313±94; p&lt;0.005) and EPR (83±7 vs. 98±7 µJ/min; p&lt;0.001). After dissipating mitochondrial membrane potential and forcing maximal OCR with FCCP, TCA (77±11 vs. 97±12, p=0.001), LipOX (1.7±0.3 vs. 2.2±0.4, p&lt;0.005) and EPR (125±17 vs. 153±17; p&lt;0.005), but not AnaerGlyc, remain inhibited by EMPA.
Conclusions: EMPA alters M1 inflammation along with cytosolic (AnaerGlyc) and - to a greater extent - mitochondrial (TCA) bioenergetics. EMPA-induced metabolic dysfunction of M1 in vivo might result into reduced metaflammation and contribute to SGLT2i-dependent CV protection.

Disclosure
V. Spigoni: None. G. Cinquegrani: None. F. Fantuzzi: None. S. Lorusso: None. A. Dei cas: Other Relationship; Self; Novo Nordisk. R. C. Bonadonna: Advisory Panel; Self; Sanofi, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company.

Funding
Italian Diabete Ricerca Foundation; Eli Lilly Italy
813-P: Demonstrating the Economic Health Benefit of Using the PromarkerD In Vitro Diagnostic Test in the Prediction of Diabetic Kidney Disease
Authors: BURCHENAL WILL , DATAR MANASI , PETERS KIRSTEN E. , FERNANDEZ GARETH C. , MORRISON JOHN C. , LIPSCOMBE RICHARD J. 
Published: June 2021

Diabetic kidney disease (DKD) develops in 1 in 3 people with type 2 diabetes (T2D) and is the leading cause of end-stage renal disease (ESRD). DKD currently costs the US healthcare system USD 50 billion annually. PromarkerD is a simple biomarker-based blood test that can predict future renal function decline in T2D patients who have no or mild existing DKD (eGFR &gt;30).
This study estimated the net savings to US payers from covering the PromarkerD test versus current standard of care (SOC). Model inputs included costs and frequency of testing, costs associated with changes to patient medication strategies, and cost-savings from slowed DKD progression and averted ESRD interventions (dialysis and kidney transplants). All estimates and inputs for the model were collected from recent peer-reviewed literature, established insurance payment rates, and PromarkerD clinical studies.
Results showed that over ten years the net savings for US payers by adopting PromarkerD testing for T2D patients (KDIGO DKD category G1-3b) would exceed USD 14 billion and the equilibrium point (costs equal savings) can be achieved after two years. Primarily, savings arise from slower DKD stage progression, with contributions from delayed dialysis and transplants, and also from fewer unplanned dialyses.
This economic study demonstrates that improved management of T2D patients through the use of early, accurate and cost-effective prognosis with the PromarkerD test could result in substantial savings to US payers in the treatment of DKD. Employing this alternative PromarkerD testing regime over the current SOC would enable early interventions for at-risk patients, thereby decreasing the need for expensive interventions such as dialysis and transplants, or unnecessary adoption of new therapeutic treatments.

Disclosure
W. Burchenal: Research Support; Self; Proteomics International. M. Datar: Research Support; Self; Proteomics International. K. E. Peters: Employee; Self; Proteomics International, Stock/Shareholder; Self; Proteomics International. G. C. Fernandez: Employee; Self; Proteomics International, Stock/Shareholder; Self; Proteomics International. J. C. Morrison: Consultant; Self; Proteomics International. R. J. Lipscombe: Employee; Self; Proteomics International.
816-P: Diabetes Education and Cost Savings with Telemedicine Delivery in Rural Communities
Authors: GAMMOH EMILY , JOHNSON PATRICIA A. , KRALL JODI S. , NG JASON , SIMINERIO LINDA M. , BANDI ARCHANA 
Published: June 2021

The high prevalence of diabetes mellitus (DM) and shortage of Diabetes Care and Education Specialists (DCES) in rural communities requires providers and patients to travel long distances to access care. This burden impedes optimal DM management and increases cost. Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support (TREAT-ON) is a Diabetes Education and Support (DSMES) model, where a DCES provides DSMES to patients identified as high risk (A1c &gt;9% or unplanned care). TREAT-ON was initiated in February 2020, where DSMES was provided via telemedicine (TM) visits, previously delivered face-to-face (F2F) to high-risk patients. In this retrospective study, the DCES overall costs (fuel, tolls, and postage), travel time for care delivery, and number of patients seen over a 6-month period (March-August 2019) was compared to (March-August 2020) after TM practices were adopted.
From March to August 2019, 59 of 91 patient referrals were completed, compared to 110 of 167 referrals from March to August 2020. The percentage of successful referrals were similar in both groups (64.8% vs. 65.9%). However, the percent of referrals declined by patients were higher in 2019 (18.7%) vs. 2020 (9.0%). Of 59 referrals completed in 2019, 54 were F2F and five TM whereas in 2020 twelve were F2F and 98 TM. Lower average cost per patient was noted in 2020 ($38.85 vs. $6.20). A similar reduction in average travel time per patient was seen, 99 min vs. 16 min in 2020. TREAT-ON model translated to a direct cost savings of $1,606 and reduction of DCES travel time of 67.6 hours equating to a gain of 8.4 workdays opening care opportunities for an additional 67 new referrals.
DSMES is a pillar of DM care and alternative methods to expand DSMES services remain imperative. Our early TREAT-ON data shows that telemedicine offers a time and cost-effective approach to DSMES with potential to reach a larger population when compared to traditional F2F visits, and helps to address a current DSCES shortage.

Disclosure
E. Gammoh: None. P. A. Johnson: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. J. Ng: Research Support; Self; Sanofi-Aventis. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. A. Bandi: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1R34DK123370-01)
821-P: A Retrospective Chart Review and Comparison of HbA1c Goals to Proposed Calculator Models
Authors: ZUZEK ALEONA C. , KELLY CLARE , KASSEM LAURE SAYYED , RAJPAL AMAN 
Published: June 2021

Setting individualized goals for glycemic control is widely accepted as standard of care in the management of diabetes mellitus. This requires integration of numerous factors into the goal HbA1c, many of which can be subjective. Few tools are available to assist in goal-setting, including an online calculator based on work by Cahn et al (1). We aimed to evaluate the current practice of setting personalized HbA1c targets at an academic medical center and compare the targets to those derived from the calculator model and the VA/DoD (Department of Defense) DM guidelines (2). A chart review of outpatient diabetes visits in both primary care and diabetes specialty clinics was performed from 11/2019-12/2020. Documentation of HbA1c goals was assessed. All patient factors that contribute to goal-setting were gathered and a proposed HbA1c goal via calculator model and VA/DoD guidelines was set for each patient. A comparison between these HbA1c goals was conducted. Of the 100 patient charts reviewed, only 25% (25/100) included a specified goal HbA1c. Of those, 88% (22/25) of the clinicians’ goals matched the calculated HbA1c goal, whereas only 32% (8/25) matched the estimated HbA1c based on VA/DoD guidelines. Documentation of individualized glycemic targets in the management of DM is not routinely practiced. When HbA1c goals are specified, they tend to correlate well with suggested goals obtained via a comprehensive calculator and less so with guidelines that rely heavily on a clinician’s subjective assessment. These findings suggest an opportunity to provide further education on setting individualized goals of care in the management of DM, as well as the utility of calculator models in assisting clinicians in daily practice.
Cahn A, et al. Clinical Assessment of Individualized Glycemic Goals⋯ Diabetes Care. 2015;38(12):2293-2300.VA/DoD Clinical Practice Guideline for the Management of Type 2 DM in Primary Care. https://www.healthquality.va.gov/guidelines/CD/diabetes/VADoDDMCPGFinal508.pdf.

Disclosure
A. C. Zuzek: None. C. Kelly: None. L. Sayyed kassem: None. A. Rajpal: None.
829-P: Improving Diabetes Self-Management with a Peer-to-Peer Mentoring Program: Final Results of a Pilot Program at a Safety Net Health Care System
Authors: MARCELLO ROOPA KALYANARAMAN , DOLLE JOHANNA , KAUR SHARANJIT , PATTERSON SAWKIA R. , DAVIS NICHOLA 
Published: June 2021

New York City Health + Hospitals (NYC H+H) is the largest safety net healthcare system in the nation, serving more than one million patients each year. Most of NYC H+H’s patients are low-income and people of color, who, in NYC as in the rest of the nation, bear a disproportionate burden of chronic diseases. At NYC H+H, 18% of patients have diagnosed diabetes, and nearly 23,000 (39%) of the 59,000 patients monitored in NYC H+H’s diabetes registry have poorly controlled diabetes (A1c ≥ 8). In an effort to support these patients’ diabetes management between their regular visits, NYC H+H launched a pilot program of InquisitHealth, a one-on-one peer mentoring service that matches patients with mentors who have controlled their own diabetes and received training to become peer coaches. Several small, randomized, controlled trials have demonstrated the program’s effectiveness in reducing A1c, but there is limited evidence of its effectiveness in a real-word setting. The key aims of this pilot program were to: 1) bridge the gap between patients and providers outside of clinic visits, 2) increase patient education on and support for diabetes self-management, and 3) improve patients’ diabetes outcomes as evidenced by reductions in A1c. The pilot program enrolled 336 patients at two NYC H+H facilities for a twelve-month intervention. Among the first 180 patients enrolled at one large acute care hospital, the mean reduction in A1c from baseline to six months following enrollment was 1.08. As compared to propensity score-matched control patients at a similar non-participating hospital in the NYC H+H network, participants experienced a greater reduction in A1c of 0.61 (-1.08 vs. -0.47, p&lt;0.01). Results from the 12-month final analysis of all participants will be presented.

Disclosure
R. Kalyanaraman marcello: None. J. Dolle: None. S. Kaur: None. S. R. Patterson: None. N. Davis: None.

Funding
National Institutes of Health (UL1TR001445)
835-P: Characteristics, Comorbidities, and Tobacco Cessation Outcomes in an Underserved Community with and without Diabetes and Health Disparities
Authors: WANG FEI , ALLOTEY PRINCE A. , VESTERGAARD MAI , VERGARA CUNEGUNDO M.D. , WILKEN JOEL L. , HAREL OFER 
Published: June 2021

Background: Current smoking in the U.S. disproportionately affects low-income populations with healthcare disparities. Diabetes independently confers substantial atherosclerotic cardiovascular disease risk, and those who smoke have worse health outcomes.
Purpose: To increase screening and cessation services in a priority population through a systems level change.
Methods: A cross-cultural cohort of staff in large safety net health system were trained as tobacco treatment specialists. A bi-lingual (Spanish-English) program coordinator provided outreach to increase awareness and referrals to the tobacco treatment program. Optimization of an electronic medical record enabled an ambulatory smoking cessation framework. Baseline characteristics and abstinence rates at 7-months were compared between the intervention and usual care cohorts. Dichotomous or categorical variables are presented as percentages and compared between groups using Chi-square. Continuous variables are presented as means with standard deviations and compared using independent t-tests using R software version 3.6.1.
Results: From 2018 through 2020, there were 400 referrals. Two-hundred opted into the tobacco cessation program (intervention cohort) and 200 opted out to usual care (control cohort). The average age was 54 years with a mean use of 17 cigarettes per day. Most participants were female (53%), predominantly Hispanic (61%), and received public insurance (88%). In subgroup analyses, 34% and 27% of patients had diabetes in the intervention and usual care cohorts, respectively. The 7-month abstinence rate was 30% versus 5% (p value 0.000) in the intervention versus usual care cohorts, respectively.
Conclusion: Creating a sustainable tobacco cessation pathway within a large health-system improves population health access and quit rates in underserved communities with health disparities.

Disclosure
F. Wang: None. P. A. Allotey: None. M. Vestergaard: None. C. M. D. Vergara: None. J. L. Wilken: None. O. Harel: None.

Funding
Connecticut Department of Public Health Tobacco and Health Trust Fund (DPH2017-0097)
852-P: Improving the Quality of Health Care Transitions for Young Adults at an Adult Endocrinology Clinic
Authors: GILBERT MATTHEW P. , DEVOE STEPHEN G. , KENNEDY AMANDA G. , OGELBY MONICA , CONSIGLI ALYSSA , ZIMAKAS PAUL JAMES , REPP ALLEN B. , ROBINSON KEITH J. 
Published: June 2021

Background: Young adults, transitioning from pediatric to adult endocrinology clinics, are at risk for adverse events. As these patients assume responsibility for their care, ensuring an effective process for health care transition (HCT) and integration into an adult clinic is imperative. Yet, there is a scarcity of data on implementing HCT best practice guidelines into adult endocrinology care using QI methodology.
Objective: To improve the quality of HCTs for young adult patients (18-26 years of age) diagnosed with a variety of endocrinologic conditions by implementing Got Transition’s Six Core Elements of Health Care Transition 2.0 and utilizing the Integrating Young Adults into Adult Health Care toolkit.
Methods: A team of pediatric and adult endocrinology clinicians, QI experts, and patient and family advisors (PFAs) was established to guide implementation of the Six Core Elements. Got Transition measurement tools (Current Assessment of Health Care Transition Activities-CAHCTA; Health Care Transition Process Measurement Tool-HCTPMT) were used to establish baseline scores and track progress on a quarterly basis. The team developed a “Welcome Packet” to orient and integrate young adults into adult endocrinology care. QI tools were used to identify current clinical processes and opportunities for system changes through Plan-Do-Study-Act (PDSA) cycles.
Results: From October 2019 to July 2020, baseline scores improved on both the CAHCTA by 84.6% (Baseline: 13; Q1: 15; Q2: 23; Q3: 24) and the HCTPMT by 1,250.0% (Baseline: 2; Q1: 16; Q2: 25; Q3: 27). PFAs provided feedback about the Welcome Packet. PDSA Cycle 1 included a “pre-visit” during new patient visits to orient patients to adult endocrinology care using the Welcome Packet. PDSA Cycle 2 focused on piloting the Endocrine Society Patient Self-assessment.
Conclusion: The implementation of HCT best practice guidelines using rigorous QI methodology can significantly improve young adults’ integration into adult health care.

Disclosure
M. P. Gilbert: Consultant; Self; Novo Nordisk. S. G. DeVoe: None. A. G. Kennedy: None. M. Ogelby: None. A. Consigli: None. P. Zimakas: None. A. B. Repp: None. K. J. Robinson: None.
863-P: Diagnostic and Care Gaps for Nonalcoholic Fatty Liver Disease in Poorly Controlled Type 2 Diabetes: A Role for Endocrinology?
Authors: ALEXOPOULOS ANASTASIA-STEFANIA , DUFFY RYAN , KOBE ELIZABETH A. , MOYLAN CYNTHIA A. , JEFFREYS AMY S. , COFFMAN CYNTHIA , SOLIMAN DIANA , GERMAN JASHALYNN , CROWLEY MATTHEW 
Published: June 2021

Nonalcoholic fatty liver disease (NAFLD) and its complications disproportionately impact individuals with T2DM. NAFLD prevalence is thought to be 60-70% in T2DM. In response to this, guidelines now recommend additional liver testing and risk stratification of NAFLD in patients with T2DM who have elevated liver enzymes or steatosis seen on ultrasound. In this secondary analysis of data from a randomized trial of a telehealth intervention, we investigated NAFLD testing and care patterns in a cohort of Veterans with poor T2DM control across two VA sites (n=244) over a 2-year period (2018-2020). Mean HbA1c and BMI were 9.8% (SD 1.5%) and 35.0 kg/m2 (SD 6.3), respectively. Only 6.6% (n=16) had a documented diagnosis of NAFLD. Excluding those with known NAFLD or other liver diseases (i.e., hepatitis B/C [n=14], alcohol overuse [n=6]), the majority of patients had documented liver enzyme (87%, n=184) and platelet (89%, n=187) testing. Based on established lab criteria for NAFLD diagnosis (i.e., at least two ALT ≥ 40 IU/mL in men, ≥ 31 IU/mL in women, ≥ 6 months apart), 17% (n=36) had undiagnosed NAFLD. Despite available lab data, no patients had a lab-based risk stratification score (such as the fibrosis-4 index or NAFLD fibrosis score) documented in clinical notes or electronic problem lists. Only 7% of patients had undergone liver ultrasound (n=15) and 2.4% Fibroscan (n=5), which are the usual first-line imaging modalities for diagnosis and risk stratification of NAFLD, respectively. Of patients with persistently elevated liver enzymes (n=36), only 14% (n=5) were referred to Hepatology.
In summary, this study highlights the underrecognition of NAFLD in T2DM, even in patients with poor glycemic control and obesity who are exceedingly high risk of NAFLD complications. Since Endocrinologists commonly see patients with high metabolic risk, this study also highlights an important role for Endocrinologists in the proactive detection and risk stratification of NAFLD in T2DM.

Disclosure
A. Alexopoulos: None. R. Duffy: None. E. A. Kobe: None. C. A. Moylan: None. A. S. Jeffreys: None. C. Coffman: None. D. Soliman: None. J. German: None. M. Crowley: None.
868-P: The Efficacy of Personalized Diabetes Management Using an Electronic Medical Record-Integrated Mobile Application
Authors: YUN JAE-SEUNG , LIM SUN-YOUNG , CHA SEON-AH , YOON KUN-HO , AHN YU-BAE , LEE EUN YOUNG , KO SEUNG-HYUN 
Published: June 2021

Background: We aim to evaluate the efficacy of personalized intervention based on a mobile phone application in patients with type 2 diabetes (T2DM).
Methods/Design: This is a 26-week randomized controlled, open-label, and parallel group trial. A total of 275 patients with T2DM having HbA1c ≥7.5% were recruited from two medical centers. Participants were randomized 1:1:1 and assigned to three groups: 1) usual care, 2) mobile diabetes management, or 3) mobile diabetes management with personalized feedback from health care professionals every two weeks. In groups 2 and 3, a mobile application integrated with the hospital electronic medical record (EMR) system is used to support diabetes management in addition to usual care. The primary outcome is change in HbA1c from baseline to 26 weeks; there are ten additional secondary outcomes, including insulin resistance, and lifestyle changes.
Results: Of the 275 initial participants, 20 (7.3%) dropped out. Mean participant age is 52.2±12.4 years, females comprise 56.4%, and the mean duration of diabetes is 11.5±8.6 years. Baseline characteristics including HbA1c are not significantly different between the groups. During the first 12 weeks, significant reduction in % change of HbA1c was observed in both mobile app-based intervention groups relative to the control group (group 1, -6.0±11.1% vs. group 2, -9.2±13.3% vs. group 3, -10.7±12.0%; P value=0.041). Participants in the intervention group measured their blood glucose more frequently, but occurrence of hypoglycemia was not different among the three groups. The majority (87.4%) of app-using participants were satisfied with the app, indicating that it was easy to use and made them adherent to their diabetes care.
Discussion: This trial is currently ongoing and will evaluate the clinical efficacy, features promoting clinical efficacy and patient engagement, and cost effectiveness of diabetes management using an EMR-integrated mobile application in patients with T2DM.

Disclosure
J. Yun: None. S. Lim: None. S. Cha: None. K. Yoon: None. Y. Ahn: None. E. Lee: None. S. Ko: None.

Funding
Korea Health Industry Development Institute (HI19C0784)