bluuebunny/crossref_metadata_2025_split huggingface dataset:
1014-P: The Impact of Baseline A1C and Admission Glucose on Mortality among Patients with Diabetes Hospitalized with COVID-19
Authors: BRANCALE JOSEPH , ATHONVARANGKUL DIANA , SIMONOV MICHAEL , ALAUSA JAMEEL , SUBAIR LABEEBAH K. , HAJDUK ALEXANDRA M. , KANG YU MI , ARORA TANIMA , WILSON FRANCIS P. , JASTREBOFF ANIA M. , LIPSKA KASIA J. 
Published: June 2021

We sought to determine the associations between hemoglobin A1c (A1c) and admission glucose with in-hospital mortality among patients with diabetes mellitus (DM) hospitalized with COVID-19.
Adults hospitalized between 3/5/20 and 12/1/20 in a Connecticut health care system were included if they had prior DM diagnosis, an in-hospital A1c, and a positive RT-PCR nasopharyngeal swab for SARS-CoV-2. A1c was stratified into &lt;7%, 7-&lt;9%, and ≥9%. Both bivariate and multi-variable adjusted logistic regression analyses were performed to determine the association of A1c categories and admission glucose &gt;200 mg/dL with mortality (in-hospital death or transition to hospice) and with intensive care unit (ICU) use. Models were adjusted for demographics and 8 relevant comorbidities.
Among 733 patients (median age 67 years [interquartile range, 56-77], 48.3% female, 43.11% White, 35.47% Black, 24.97% Hispanic, 1.64% Asian), 31.7% had A1c &lt;7%, 40.5% 7-&lt;9%, 27.8% ≥9%, and 38.1% admission glucose &gt;200 mg/dL. During hospitalization, 111 (15.1%) patients died or transitioned to hospice and 230 (31.4%) required ICU care. In 2 multi-variable adjusted analyses, neither A1c category nor high admission glucose were significantly associated with mortality (A1c 7-&lt;9%: OR 0.89, 95% CI 0.53-1.49; A1c &gt;9% OR 1.3, CI 0.72-2.35 compared with A1c &lt;7%; glucose &gt;200 OR 1.34, CI 0.72-2.35) or ICU care (A1c 7-&lt;9% OR 1.30, 95% CI 0.88-1.93; A1c ≥9% OR 1.35, CI 0.86-2.1 compared with A1c &lt;7%; glucose &gt;200 OR 1.26, CI 0.9-1.78). Age (per year OR 1.06, CI 1.04-1.08), male sex (OR 1.78, CI 1.14-2.81), obesity (OR 1.85, CI 1.16-2.96) and CKD (OR 1.90, CI 1.19-3.03) were significantly associated with mortality. Only female sex (OR 0.67, CI 0.48-0.93) was significantly associated with ICU care.
In our retrospective study of hospitalized patients with DM, neither A1c nor admission glucose were prognostic of COVID-19 mortality or ICU care. In those with DM, male sex, obesity and CKD predicted worse outcomes.

Disclosure
J. Brancale: None. A. M. Jastreboff: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk, Other Relationship; Spouse/Partner; Elucidata. K. J. Lipska: None. D. Athonvarangkul: None. M. Simonov: None. J. Alausa: None. L. K. Subair: None. A. M. Hajduk: None. Y. Kang: None. T. Arora: None. F. P. Wilson: Other Relationship; Self; Efference LLC, Medscape.

Funding
National Institutes of Health (1T32GM136651-01)
104-LB: Assessing Infusion Site Reactions with URLi in Continuous Subcutaneous Insulin Infusion
Authors: IGNAUT DEBRA A. , CHO JANG IK , ELPERS JOHN C. , CHIGUTSA FARAI B. , PIRAS DE OLIVEIRA CAROLINA 
Published: June 2021

Background: In phase 3 trials, ultra rapid lispro (URLi) showed superior postprandial glucose control and non-inferior HbA1c reduction compared to Humalog® (Lispro). However, infusion site reactions (combined; ISRs) were more frequent with URLi.
Methods: We examined whether occurrence of ISRs was related to any intrinsic or extrinsic factors by analyzing data from the 16-week PRONTO-Pump-2 trial in patients with T1D (URLi, N=215; Humalog, N=217) between randomization and end of treatment period.
Results: The most frequently reported adverse events (AEs) were infusion site reaction (URLi, n=41 [19.1%]; Humalog, n=15 [6.9%]) and infusion site pain (URLi, n=34 [15.8%]; Humalog, n=6 [2.8%]). ISRs were reported by 37.7% of patients on URLi and 10.1% on Humalog. Most ISRs with URLi started in the first 4 weeks after randomization, were primarily mild in severity (~76%) and lasted a median of 2-6 days, depending on the type of reaction. Individual ISRs resolved during the study, but another event could occur with a different infusion set/site. Overall, 7 (3.3%) patients discontinued URLi treatment due to ISRs, 6 within the first 4 weeks after randomization and 1 at week 6. Gender, age, BMI, ethnicity, race, infusion set model, bolus speed, total daily dose, duration of diabetes and duration of insulin pump use did not impact incidence of ISRs between treatments. However, significant treatment-by-subgroup interactions were observed for cannula length (6mm vs. &gt;6mm; p=0.070) and region (US vs. non-US; p=0.046): incidence of ISRs with cannula length &gt;6mm and incidence of ISRs in US was similar between treatments, but a higher incidence of ISRs was observed with URLi when cannula length was 6 mm or in non-US regions.
Conclusions: Infusion site reaction and infusion site pain were the most frequently reported AEs, although most were mild and resolved in less than a week. Differential treatment effects on ISR occurrence were seen with cannula length or region. Further studies are needed to confirm these findings.

Disclosure
D. A. Ignaut: Employee; Self; Eli Lilly and Company. J. Cho: None. J. C. Elpers: Employee; Self; Eli Lilly and Company. F. B. Chigutsa: None. C. Piras de Oliveira: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.

Funding
Eli Lilly and Company
1043-P: Diabetic Cardiomyopathy: A Systematic Analysis of Epidemiological Studies
Authors: PERFETTI RICCARDO , SHENDELMAN SHOSHANA 
Published: June 2021

Diabetic cardiomyopathy (DbCM) is a sequela of diabetes. DbCM is characterized by abnormal cardiac structure and/or performance in the absence of coronary artery disease or hypertensive, valvular or congenital heart disease. We aimed to determine the prevalence of DbCM in the United States and EU5. PubMed was queried for epidemiological studies on DbCM from 2010 onwards using the terms (“diabetes” AND “cardiomyopathy”) OR (“diabetic cardiomyopathy”) AND (“incidence” OR “prevalence”). 563 articles were identified, 40 of which were screened for full text review based on the abstract indicating the reporting of original data captured in a general diabetic population. Ten of these were used either directly or to inform our analysis. Four of these studies reported data on DbCM having made appropriate exclusions for atherosclerosis mediated heart failure. However, only 2 of these were ultimately included based on the representativeness of the study population and thus generalisability of results. Many studies were excluded due to heterogeneity in definition of DbCM. Some studies clearly stated DbCM as the indication of interest, taking appropriate measures to exclude cases with a history of atherosclerosis mediated precursors such as coronary artery disease, hypertension, or valvular heart disease. Other studies were not clear in the exclusion criteria and for this reason were excluded. Based on our review, estimates in the literature for DbCM in type 2 diabetes without stringent clinical diagnostic criteria range from 12% to 48%. Of the two studies included in our analysis which clinically define DbCM according to diagnostic guidelines, estimates ranged from 17% to 24%. Our final estimate based on an average of these two was 21%, with some imputations for variation by age. There are ~30 million diabetics in the United States alone and we estimate 21% of diagnosed diabetics also have DbCM, which represents a huge burden of disease for which there is very limited robust epidemiological data.

Disclosure
R. Perfetti: Stock/Shareholder; Self; Applied Therapeutics. S. Shendelman: Stock/Shareholder; Self; Applied Therapeutics.
1050-P: Rates, Characteristics, and Comparison of Readmissions for Diabetic Ketoacidosis in Patients with Psoriasis in the United States: A National Population-Based Study
Authors: EDIGIN EHIZOGIE , OJEMOLON PIUS E. , SHAKA HAFEEZ , ESEATON PRECIOUS O. , ALMANI MUHAMMAD USMAN , JAKHAR DEEPAK , ASEMOTA IRIAGBONSE R. , AKUNA EMMANUEL 
Published: June 2021

Introduction: Psoriasis is known to increase the risk of type 1 diabetes mellites. This study aims to compare rates and outcomes of 30-day readmissions following admissions for type 1 diabetic ketoacidosis (T1DKA) in patients with and without psoriasis in the United States.
Methods: We analyzed the 2018 National Readmission Database. We included index hospitalizations for all patients (aged≥18 years) with a principal diagnosis of T1DKA using ICD-10 codes. We further sub-stratified this group into those with and with a secondary diagnosis of psoriasis. Chi-square tests and regression analysis were used to compare 30-day readmission rates and readmission outcomes between both groups. We excluded elective and traumatic readmissions.
Results: A total of 94,461 index hospitalizations for T1DKA, that were discharged alive, were included in the analysis. 357 (0.4%) of these, had co-existing psoriasis. 15,614 (16.5%) readmissions occurred within 30 days. Readmission rates were similar between psoriasis and non-psoriasis group (15.0% vs. 16.5%, p=0.663). The psoriasis group had a similar mean hospital length of stay (3.3 days vs. 2.9 days, p=0.077) and total hospital costs ($8,435 vs. $7,231, p=0.055) compared to the non-psoriasis group. Readmissions for T1DKA in psoriasis patients was associated with a total of 1,191 hospital days and $3,014,844 in-hospital costs. T1DKA without coma was the most common reason for readmission in both groups.
Conclusion: Psoriasis patients admitted for T1DM have similar 30-day readmission rates and readmission outcomes compared to non-psoriasis patients admitted for TIDM.

Disclosure
E. Edigin: None. P. E. Ojemolon: None. H. Shaka: None. P. O. Eseaton: None. M. Almani: None. D. Jakhar: None. I. R. Asemota: None. E. Akuna: None.
1056-P: High Prevalence of Fatty Liver Disease in Individuals with Diabetes and Subclinical Manifestations of Liver Disease
Authors: CLAYPOOL KAJAL , PATEL CHIRAG 
Published: June 2021

The prevalence and markers of liver complications in the T2D population with poor glycemic control remains uncertain.
Using participant data from the National Health and Nutrition Examination Survey (NHANES), we examined the association of poor glycemic control with NAFLD using controlled attenuation parameter (CAP) obtained via FibroScan. We next examined 121 markers indicative of liver dysfunction associated with poor glycemic control (A1C &gt; 7%). We tested the association of each marker with A1C &gt; 7%, and used false discovery rate criteria to identify liver markers that are strongly associated with poor glycemic control. We determined the dose-response between clinical biomarkers as a function of different severity levels of poor glycemic control.
The survey-adjusted prevalence of self-reported liver disease in the diabetic population is 7.4% (95% CI: 6.4, 8.4) and it is 3.2% (95% CI: 2.8, 3.4) in the nondiabetes group. The prevalence of NAFLD in the diabetes population, in contrast, is 69.4%, 95% CI: [62.6%, 76.1%] with prevalence in the group with glycemic control at 60.3% (95% CI: 50.7, 70) and those with poor glycemic control at 82.7% (95% CI: 76.2, 89.3). In multivariate models (adjusted for sex, age, ethnicity, body mass index, the use of 0, 1, 2 or more antihyperglycemic medications and smoking), poor glycemic control (A1C above 7%) was associated with increased odds of NAFLD (OR = 3.28, 95% CI: 1.72 - 6.27, p = 0.02). We identified poor glycemic control (A1C above 7%) was associated with 13 markers of liver disease and identified a linear increase in dose-response for these markers with increased severity of poor glycemic control.
Poor glycemic control is associated with high prevalence of NAFLD in the United States. Liver dysfunction with poor glycemic control is comparable to cardiovascular and kidney dysfunction, highlighting the need for greater vigilance of liver disease in T2D patients especially in those with poor glycemic control.

Disclosure
K. Claypool: None. C. Patel: Consultant; Self; Doc. ai, Janssen Research & Development, LLC, Stock/Shareholder; Self; Xy Health, Inc.

Funding
National Institute of Allergy and Infectious Diseases (R01AI127250)
1061-P: Use of Nutrition and Behavioral Therapy for Obesity among Medicare Beneficiaries with Incident Diabetes, 2002-2016
Authors: ANDES LINDA J. , SIEGEL KAREN R. , WILLIAMS ALEXIS , IMPERATORE GIUSEPPINA , ROLKA DEBORAH B. 
Published: June 2021

Nutrition and weight loss/maintenance are important for managing blood glucose and preventing complications among individuals with diabetes (DM), and counseling for these behaviors can be particularly effective in those with newly diagnosed DM. To encourage their use in older adults - who may lack other support and thus rely on health care provider counseling- Medicare covers three types of counseling: 1. Medical nutrition therapy (MNT); 2. DM self-management training (DSMT); and 3. Intensive behavioral therapy for obesity (IBTO). We used Medicare claims data to estimate use of these three types of counseling among beneficiaries with incident DM. We included individuals with at least a) 1 inpatient claim with a DM diagnosis code in the index year or preceding 2 years, or b) 1 outpatient DM claim and 1 inpatient or outpatient claim in the 2 years following the first claim. An incident case must have an initial two year “clean period” with zero DM diagnosis codes. Therefore, participants must be at least 67 years of age to be included in the study. Use of counseling was defined as having any claims with the appropriate procedure codes in the 365 days after the first claim date with a DM diagnosis code. Among 8.6 million beneficiaries with incident DM, MNT use increased from 1.2% in 2002 to 2.8% in 2006 and then decreased to 2.4% in 2016. In contrast, DSMT use decreased from a high of 5.9% in 2002 to 3.1% in 2016. IBTO coverage began in 2011 and by 2016, IBTO use increased to 0.8%. MNT, DSMT and IBTO are under-utilized among Medicare beneficiaries with incident DM, and there is much room for improvement. Increasing health care provider and patient awareness of these Medicare benefits may help to increase the likelihood of referrals to such counseling and subsequently its use.

Disclosure
L. J. Andes: None. K. R. Siegel: None. A. Williams: None. G. Imperatore: None. D. B. Rolka: None.
1105-P: Effects of Exercise on Glycemic Control and Insulin Resistance (IR) in Individuals with Type 1 (T1D) and Type 2 Diabetes (T2D) in the NHANES Dataset
Authors: SONI PRIYA Y. , TANG QING , ISMAIL HEBA M. 
Published: June 2021

Introduction: The rise in T1D, T2D, and obesity make it increasingly important to understand the role of BMI and lifestyle on glycemic control and IR. While it is known that weight and exercise affect these, the extent to which the effects of exercise are direct versus mediated by BMI has not been determined.
Methods: We analyzed data from the 2013-2016 NHANES dataset in participants &gt;18 yrs of age (n=1168). Those on glucose-lowering medications were classified as T2D and those on insulin only as T1D. Participant reports on physical activity intensity and duration were converted to metabolic equivalent of task (MET)-hours/week. HOMA-IR, a measure of IR, was calculated in participants with insulin measurements not receiving insulin (n=335). Linear regression models were fitted for mediation analyses to evaluate whether BMI mediated associations between MET and HbA1c or HOMA-IR.
Results: In participants with T1D (n=173) and T2D (n=995), the mean ± SE age (56.8 ± 0.8 and 61.1 ± 0.3 yrs), BMI (32.8 ± 0.8 and 33.1 ± 0.3), and MET-hours/week (38.8 ± 4.5 and 38.3 ± 3.8) were reported, respectively. Further, 48.7% and 46.3% were females and 51.3% and 53.7% were males, respectively. The majority (62.9%) were Non-Hispanic White. HbA1c was significantly different between participants with T1D (8.1 ± 0.2) and T2D (7.4 ± 0.1), p=0.0008. After adjusting for age, race, and sex, the independent effect of MET-hours/week on HbA1c was nonsignificant in both cohorts (p=0.384 and p=0.167, respectively), suggesting BMI mediation analysis was not appropriate. The same was true with the effect of MET-hours/week on HOMA-IR (p=0.265).
Conclusions: Our results show that there were no BMI mediated associations between MET and HbA1c or HOMA-IR. However, participants with high HbA1c could be actively engaging in more physical activity to improve glycemic control and there is potential for recall bias. A future prospective study with larger sample sizes may be needed.

Disclosure
P. Y. Soni: None. Q. Tang: None. H. M. Ismail: None.
1122-P: Comparing the Relative Frequency of Pediatric New-Onset Type 1 Diabetes since the Onset of COVID in the United States
Authors: ROWLAND DUSTIN , LEE NICOLE D.O. , ERGUN-LONGMIRE BERRIN 
Published: June 2021

Background: There has been a well-documented link showing that pre-existing diabetes worsens outcomes in Covid-19 infection in adults. However, researchers have postulated that this relationship is reciprocal, where infection with Covid-19 may trigger new onset diabetes. Data on pediatric new onset type 1 diabetes mellitus (T1DM) and Covid-19 remains scarce. Furthermore, the results are conflicting; some studies showed increased rate of new onset T1DM in children with Covid-19 and the others did not find any difference in 2020 compared to previous years. The aim of this study is to elucidate the relationship between pediatric new onset T1DM and diabetic ketoacidosis (DKA) with Covid-19 infection in a single center.
Methods: We conducted a retrospective chart review of 50 pediatric diabetes cases admitted to the Bronson Children’s Hospital between March 2020 and December 2020.
Results: From the total of 50 patients, 42 had new onset T1DM. Of these 42, 33 (78.6%) presented with DKA, and 17 (40.5%) met hospital criteria for Covid-19 testing, with 16 of those producing a negative result. There was only 1 (5.9% of tested, 2.4% of T1DM cases) patient with new onset T1DM associated with a positive Covid-19 test.
Conclusion: The low number of positive cases identified in this study suggests that there may be no link between Covid-19 viral illness and new onset T1DM in the pediatric population. Major limitations include the single center localization of the study and inability to test all cases for Covid-19 at this facility. Due to the scarcity of test kits and lab personnel especially early during the pandemic, only patients that met symptomatic criteria were tested. It is possible and likely that some of the patients were infected with Covid-19 but remained asymptomatic.

Disclosure
D. Rowland: None. N. D. O. Lee: None. B. Ergun-longmire: None.
113-LB: The Role of “Osmotoxicity” in Type 2 Diabetes Mellitus: A Retrospective Comparative Analysis of the Effect of Pretreatment with IV 0.9% Saline on Glycemic Control in Subcritical Hyperglycemia
Authors: SURESHKUMAR PICHAKACHERI 
Published: June 2021

Background: Experimental studies have shown that an increase in serum osmolality (Osm) of even 10 mOsm/kg significantly contributes to progressive hyperglycemia by increasing hepatic glucose output and suppressing peripheral glucose utilization. The Osm increases parallel to the increase in blood glucose (BG) and vice versa. This is not therapeutically exploited yet.
Aim: To assess the effect of pre-treatment with IV 0.9% saline (NS) on glycemic control and medication requirement in type 2 diabetes mellitus (T2DM) patients presenting with subcritical hyperglycemia (SCH) -hyperglycemia not amounting to DKA or HHS.
Method: A retrospective comparative data analysis of T2DM patients (198) with SCH, pre-treated with NS before diabetic specific therapy (group 1) and compared with those who were not pre-treated with NS (group 2). Differences in glycemic control and drug dosage were assessed.
Results: In group 1, 1500ml of NS administration reduced the BG from a baseline of 496.3±67.1 to 283.3±83.8 (mg/dL), p=0.000 with a mean reduction of 43% and reduced the Osm by 11mOsm/kg [313.8±8.1 to 302.9±8.5, p&lt;0.001]. There was a significant correlation between BG and Osm (r=0.322, p=0.001). Fluid pre-treatment enabled a better reduction in BG during 4 weeks of follow up in group 1{[FBS- 298.9±73.7 to 158.9±58.7 in group 1 v/s 265.6±70.7 to 171.48±66.5 in group 2, p=0.00] and [RBS- 496.3±67.1 to 228.3±80.7 in group 1 v/s 450.5±47 to 282±112.4 in group 2, p=0.001]}. There was a general trend of decrease in the dosages of antidiabetic medications in group 1 and increase of the same in group 2.
Conclusions: IV fluid pre-treatment reduced the BG and the drug dosage in T2DM patients presenting with SCH and the benefit persisted for a minimum of 4 weeks.

Disclosure
P. Sureshkumar: None.
1139-P: CD36/FABP4/PPAR-d Axis-Induced Inflammation Is Dependent on ACSL1 under the Influence of Acute High-Fat Feeding
Authors: ALRASHED FATEMA , MADHOUN ASHRAF AL , SINDHU SARDAR T. , AL-SAYYAR AMNAH , ALMULLA FAHD , AHMAD RASHEED 
Published: June 2021

Elevated levels of circulating inflammatory macrophages are associated with several metabolic syndrome (MetS) such as obesity and type II diabetes (T2D). The ingestion of high-fat meals was proven by several groups to act as a stimulus for systemic inflammatory responses via activation of peroxisome proliferator-activated receptors (PPARs). However, little is known about the lipid metabolism involved in macrophage-mediated inflammation under the influence of acute high fat feeding (AHFF). ACSL1 is a member of the long chain acyl-CoA synthetase (ACSL) family that plays key roles in fatty acid metabolism in various tissues. Our previous studies showed that attenuation of ACSL1 was sufficient to dampen inflammatory responses in macrophages challenged with TNF-α or LPS. In this study, we investigated the molecular mechanisms underlying AHFF-induced ACSL1 gene transcription in macrophages. In our work, we showed that four hours feeding of palmitic acid induced significant up-regulation of ACSL1 at both gene and protein levels. Both the inhibition and the deficiency of ACSL1, showed a significant impact on downregulating AHFF-induced inflammatory responses. Furthermore, the inhibition ACSL1 reduced mRNA levels of fatty acid uptake-related genes cluster of differentiation 36 (CD36) and fatty acid transport protein 4 (FATP4). However, inhibition of ACSL1 had no impact on lipogenesis related genes; SREBS, FAS and ACACA or fatty acid-oxidation genes; CPT-1a, CPT-1b and CPT2. Our data also showed that ACSL1 inhibition reduced PPARδ gene expression, while PPARα and PPARγ were not affected. Of note, macrophage intracellular lipid accumulation was attenuated during ACSL inhibition. Our findings suggest that targeting ACSL1 has a therapeutic potential to prevent AHFF-induced macrophage inflammation.

Disclosure
F. Alrashed: None. A. Al madhoun: None. S. T. Sindhu: None. A. Al-sayyar: None. F. Almulla: None. R. Ahmad: None.

Funding
Kuwait Foundation for the Advancement of Sciences (CB-2020-004)