bluuebunny/crossref_metadata_2025_split huggingface dataset:
62-OR: Fostering Sustainability through Diabetes Self-Management Support in African-American Churches: Results of the Praise Diabetes Project
Authors: PIATT GRETCHEN , PROVENZANO ANTHONY M. , NWANKWO ROBIN , HALL DIANA , KLOSS KATHERINE A. , HAWKINS JACLYNN M. , FUNNELL MARTHA M. 
Published: June 2021

A gap exists between diabetes self-management education (DSME), DSMS practices, and the infrastructure needed to foster sustainability of improved outcomes, particularly in low-resource communities. We determined the relative effectiveness of 3 parallel DSMS approaches in improving A1c and diabetes distress (DD). Moderate DD was 2.0-2.9 and high DD was ≥ 3.0. 370 individuals [mean age: 64.6 years, 74% female, 100% African American (AA), mean A1c: 7.7%±1.9, 22.8% with moderate DD] from 21 AA churches in southeast Michigan and northwestern Ohio, took part in a cluster randomized trial from 2016-2020. Data were collected at baseline, 6, 9, 21, and 33 months. Churches were randomized to one of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS (n=123), PL DSMS (n=127), or PN DSMS (n=109)]. Twenty-one PNs and 28 PLs were trained to facilitate DSMS at each church. Sustained reduction in A1c was observed in all groups (PNPL: -0.2%, p=0.68; PN: -0.2%, p=0.13). PL had borderline statistically significant reductions (-0.3%, p=0.08). The proportion of participants with A1c &lt; 7% also improved over time in each group (PNPL: 57.3 vs. 60.7%, p=0.21; PL: 57.3 vs. 62.7%, p=0.44; PN: 40.9 vs. 44.1%, p=0.66), but not significantly. Of those who achieved A1c &lt; 7% following DSME (9-month follow-up), 81.3% of participants, across all groups, sustained the goal at 33 months. PN had the most participants with sustained glycemic control (PNPL: 81.6%, PL: 76.7%, PN: 86.9%). Significant improvements in mean DD scores were observed from baseline to 33 months in all groups (PNPL: 2.1 vs. 1.8, p=0.05; PL: 2.0 vs. 1.7, p=0.004). Moreover, there was a 50% reduction in the proportion of participants with moderate DD in PL (31.7% vs. 12.2%) and PN (27.5% vs. 15%) and severe DD in PN (10% vs. 5%). Varied approaches to DSMS within the context of existing community infrastructures (AA churches) fostered the sustainability of improvements in diabetes-related outcomes.

Disclosure
G. Piatt: None. A. M. Provenzano: None. R. Nwankwo: None. D. Hall: None. K. A. Kloss: None. J. M. Hawkins: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association.

Funding
National Institutes of Health (R01DK103733)
631-P: Reliability of the Freestyle Libre Continuous Monitoring System in the Inpatient Setting: Implications for the COVID-19 Surge
Authors: MURRAY-BACHMANN RENEE , ZISKOVICH KARINA , SARBANES MULUGETA , LEUNG TUNG MING , MYERS ALYSON , MURTHI SWETHA , PORETSKY LEONID 
Published: June 2021

Introduction: Standard point of care capillary blood glucose testing (POCT) is commonly used in hospitalized patients to monitor their glucose levels. This technique is associated with increased staff/patient contact and patient discomfort. We examined the correlation of the capillary blood glucose results obtained by the POCT device (Accuchek Inform II) with the serum glucose values obtained by the hospital laboratory and with the glucose readings obtained by the FDA-waived for in-patient use (because of COVID-19 pandemic) Freestyle Libre continuous glucose monitoring system (CGMS).
Methods: For this prospective cohort study fifty-two adult participants who were diagnosed with diabetes mellitus and admitted to non-critical units were recruited. Among them, 41 (79%) were male, 50 (96%) had type 2 diabetes mellitus. CGMS sensors were placed on patients’ arms, POCT and serum glucose measurements were taken as ordered. Descriptive statistics were calculated and linear mixed models were used to determine correlation.
Results: There were a total of 467 Accuchek-Libre pairs with a highly statistically significant association between pairs, p&lt;0.0001. There were also 44 serum glucose -Libre pairs, with a highly statistically significant association, p&lt;0.0001. On average, for each unit increase in Libre glucose level, there was a 0.92 unit increase in Accuchek glucose level as well as a 1.05 unit increase in serum glucose level.
Conclusion: These findings indicate excellent correlation between the standard POCT and the CGMS as well as between serum glucose and the CGMS values. Because of the advantages of the CGMS glucose readings over blood capillary glucose testing (reduced patient discomfort and reduced staff exposure to patients during the pandemic) hospitals should consider replacing capillary blood glucose testing with CGMS.

Disclosure
R. Murray-bachmann: None. K. Ziskovich: None. M. Sarbanes: None. T. Leung: None. A. Myers: None. S. Murthi: None. L. Poretsky: None.
632-P: Flash Glucose Monitoring in Hypoglycemia Monitor in Type 1 Diabetes
Authors: LI JUNXIAN , LIU FANG 
Published: June 2021

Aims: Hypoglycemia is an acute complication of patients with type 1 diabetes. This study investigated flash glucose monitoring in hypoglycemia monitor in patients with type 1 diabetes.
Methods: A total of 120 patients with type 1 diabetes were recruited and randomly divided to implement FreeStyle LibreTM as flash glucose monitoring group (n=60) and retrospective continuous glucose monitoring system (CGMS) as control group (n=60). Both groups carried out CGMS at least two times a year and filled three questionnaires including Diabetes Monitoring and Treatment Satisfaction Questionnaire (DMTSQ), Diabetes Specific Quality of Life (DQoL) and Chinese Version Hypoglycemia Fear Survey II (CFH II). Clinical Data, CGM metrics and Questionnaire scores were collected at first visit and one year follow up.
Results: The result showed that the time below range (TBR) and the glucose coefficient of variation (CV) were significantly higher in flash glucose monitoring group than control group (all P &lt;0.05). TBR was prolonged with the increase of CV (P &lt;0.05) and low blood glucose index (LBGI) (P &lt;0.05) in both two groups. After multiple stepwise linear regression, CV and LBGI were independent risk factors for TBR (Standardized Coefficients β=0.665, β=0.762, respectively, All P&lt;0.001 ). After one year followed up, the scores of DQoL and DMTSQ had no significant difference, but number of hypoglycemia times per month and scores of behavior part of CFH II significantly decreased in flash glucose monitoring group compared with a year ago (all P&lt;0.05).
Conclusions: Glucose CV and LBGI were independent risk factors for TBR. And Flash glucose monitoring decreased number of hypoglycemia times per month and fear behavior of hypoglycemia in patients with type 1 diabetes after one year.

Disclosure
J. Li: None. F. Liu: None.

Funding
National Key Research and Development Program of China (2017YFC1309601)
646-P: Efficacy and Safety of Evogliptin plus Metformin Added to Insulin Therapy in Elderly Indian Patients with Type 2 Diabetes
Authors: GUHA SHAIBAL , RANJAN RAJEEV , GAURAV AMIT , RANJAN PRAKASH 
Published: June 2021

Objective: The combination of evogliptin plus metformin and insulin has known to be effective for the treatment of type 2 diabetes (T2D). However, longitudinal efficacy and safety for elderly patients have not been established. Here, we evaluated whether Evogliptin plus metformin added to insulin therapy safely improved glycemic control for T2D patients older than 65 years of age.
Method: Thirty two T2D patients (male/female 20/12; age 76.2± 6.3 years, HbA1c 8.4±0.8%, DOD 6.9±2.1 years) who were administrated insulin were recruited and Evogliptin (5 mg) plus Metformin (500 mg) was added to their treatment regimen. Before and 6 months after adding Lira, we assessed metabolic parameters and the data from CGM.
Result: Six months after adding evogliptin plus metformin, HbA1c ( from 8.4±0.8% to 7.2±1.2%; P=0.003) and body weight ( from 62.8±8.3 kg to 61.2±4.6 kg, P=0.006) were significantly improved despite the daily dose ( from 58.5±11.2 IU/day to 45.63±14.4 IU/day, P=0.005) and number of insulin injections per day being reduced. CGM analysis revealed that SD and ≥180 mg/dL AUC were significantly decreased and hypoglycemic events were not increased. Furthermore, 22% of patients with suboptimal glycemic control (A1C&gt;7%) achieved a composite outcome consisting of improvement in A1C, weight loss and insulin dose reduction.
Conclusion: These results suggest that the administration of evogliptin plus metformin could safely improve glycemic control and reduce body weight in elderly patients with T2DM undergoing insulin therapy. The reduction of glucose fluctuation and number of insulin injections may improve the quality of life of elderly T2D patients, especially those who require social support.

Disclosure
S. Guha: None. R. Ranjan: None. A. Gaurav: None. P. Ranjan: None.
671-P: Liraglutide Possibly Prevents Progression of Dementia in Patients with Type 2 Diabetes
Authors: YOSHIDA MAMI , YOSHIDA AI , OH ERIKO , YAMAMOTO NAOMUNE , SASAKI EUN , YOSHIDA SHIGERU , OHSAWA NAKAAKI , SUGINO MASAKAZU , KOYAMA IKUO 
Published: June 2021

Purpose: The purpose of this study is to assess the usefulness of liraglutide in elderly patients with type 2 diabetes to prevent progression of dementia.
Methods: We retrospectively reviewed 31 outpatients with 65 years of age or older, who have been treated with liraglutide for 6 years (Group G; 12 males/19 females, 73.1 ± 8.6 years-old, HbA1c 7.5 ± 0.4%, 9 patients with cerebrovascular diseases, 8 patients with cardiovascular diseases, 16 patients with insulin therapy). Daily dose of liraglutide was 0.9 mg except 2 patients (0.6 mg). We examined Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD) on MRI, max-IMT measured by carotid artery ultrasonography, visceral fat area, concentrations of HbA1c and FPG, serum levels of CRP, HDL/LDL cholesterol, and TG, both before and after the treatment. Age, HbA1c, and VSRAD values-matched 16 patients who were treated with linagliptin were analyzed as a control (Group D).
Results: After 6 years, VSRAD was significantly deteriorated in Group D (1.06±0.98→1.39±1.05 (p&lt;0.01)) but not in Group G (1.28±0.80→1.39±1.1 (NS)). Max IMT and visceral fat are was significantly improved in Group G (2.41±1.50→2.09±0.84 (p&lt;0.05), 141.1±57.2→127.2±52.9 (p&lt;0.01)), but not in group D (2.04±1.01→1.99±0.68 (NS), 102.4±66.5→106.6±62.7cm2 (NS)). CRP was decreased in Group G (0.12±0.11→0.09±0.12mg/dl (p&lt;0.01)). HbA1c (7.5±0.4 → 7.0±0.5 vs. 7.3±0.3 → 6.8±0.4%), FPG (137±19 → 121±11 vs. 129±12→110±15mg/dl), were significantly improved in both groups (p&lt;0.01). No hypoglycemia requiring medical intervention was observed. Only TG in Group G (167±53→147±34mg/dl (p &lt;0.01)) was improved in lipid parameters. During the 6 years, antidementia drugs were prescribed for 2 patients in both groups. A stroke event was found in a patient of Group D.
Conclusion: Liraglutide possibly prevent progression of dementia. The reduction of visceral obesity may contribute to this beneficial effect through anti-arteriosclerosis.

Disclosure
M. Yoshida: None. A. Yoshida: None. E. Oh: None. N. Yamamoto: None. E. Sasaki: None. S. Yoshida: None. N. Ohsawa: None. M. Sugino: None. I. Koyama: None.
687-P: ß-Cell Function and Glycemic Response to Dulaglutide in Patients with Type 2 Diabetes
Authors: HASEBE MASASHI , YOSHIJI SATOSHI , IWASAKI YORIHIRO , KIMURA SADAHITO , SENO YOHEI , KEIDAI YAMATO , HARAGUCHI TAKUYA , IWASAKI KANAKO , WADA YOSHIHARU , HONJO SACHIKO , FUJIKAWA JUN , HAMASAKI AKIHIRO 
Published: June 2021

Aims: The effect of β-cell function on glycemic response to dulaglutide (DU) is not fully understood in clinical settings. We explored a suitable clinical marker of β-cell function to predict glycemic response to DU in patients with type 2 diabetes (T2D).
Methods: We retrospectively analyzed 141 patients who commenced once-weekly DU 0.75 mg after undergoing a meal tolerance test (MTT) with a standardized meal from September 2015 to December 2019 at our hospital. β-cell function was assessed by fasting and 2h postprandial serum C-peptide immunoreactivity (CPR) as well as increment of CPR (dCPR) in the MTT. We analyzed the suitability of each measurement as a marker for β-cell function and its association with glycemic response to DU using linear and logistic regression with adjustment for baseline HbA1c.
Results: In 141 patients, 2h postprandial CPR (PCPR) and dCPR showed significant inverse correlation with baseline HbA1c (r = -0.25 and -0.33, respectively; P &lt; 0.01 for both), while fasting CPR (FCPR) did not (r = 0.02; P = 0.853). Given the association of high baseline HbA1c and impairment of meal-stimulated insulin secretion measured with PCPR and dCPR, we adopted FCPR as a marker for β-cell function with less influence from baseline HbA1c in the following analysis. Of the 141 patients, 59 patients continued DU without initiating any additional glucose-lowering agents for more than 6 months. The baseline mean ± SD HbA1c, fasting plasma glucose, and FCPR of the 59 patients were 8.9 ± 1.2%, 9.2 ± 2.3 mmol/L, 0.50 ± 0.29 nmol/L, respectively. The mean ± SE change in HbA1c 0-6 months was -1.2 ± 0.2%. FCPR was significantly associated with a reduction in HbA1c (P = 0.031). Furthermore, FCPR was a significant predictor for achieving a reduction in HbA1c ≥ 1% over 6 months (OR, 1.40; 95% CI, 1.14-1.71; P = 0.039) with the area under the receiver operating characteristics curve of 0.83.
Conclusions: FCPR is less affected by baseline HbA1c than PCPR and dCPR, and can be a useful marker for predicting glycemic response to DU.

Disclosure
M. Hasebe: None. S. Honjo: None. J. Fujikawa: None. A. Hamasaki: None. S. Yoshiji: None. Y. Iwasaki: None. S. Kimura: None. Y. Seno: None. Y. Keidai: None. T. Haraguchi: None. K. Iwasaki: None. Y. Wada: None.
689-P: Association of Preoperative Glycemic Response to GLP-1 Receptor Agonists (GLP-1RA) and Outcomes of Bariatric Surgery
Authors: AMUSIN DANIEL , KUCHTA KRISTINE , EWING TATUM , TUCKER LYNN , CAMPBELL MICHELLE , UJIKI MICHAEL , BILLINGS LIANA K. 
Published: June 2021

Background: GLP1RAs are an increasingly common treatment in the setting of type 2 diabetes mellitus (T2DM). One hypothesized mechanism by which bariatric surgery contributes to T2DM remission is by increasing intestinal GLP-1 secretion. We aimed to evaluate the association of the response to GLP1RA pre-operatively on hemoglobin A1c (HbA1c) level and weight loss after bariatric surgery.
Methods: The NorthShore bariatric surgery database was retrospectively queried for patients with T2DM who had taken a GLP1RA prior to Roux-en-Y gastric bypass (N=38) or gastric sleeve surgery (N=9). GLP1RA response was measured by change in HbA1c from initiation of therapy to 6mo. Outcomes included HbA1c level and percent total body weight loss (TBWL) at 6mo, 1 and 2yr post-op. The association between GLP1RA response and post-operative outcomes was evaluated with partial correlation coefficients adjusted for baseline HbA1c with/without baseline weight.
Results: The average HbA1c at initiation of therapy was 8.3±1.4% and decreased by 1.1±1.5% on GLP1RA treatment with liraglutide being most commonly prescribed (44.7%). A greater decrease in HbA1c from GLP1RA was correlated with a lower HbA1c at 6mo (r=0.38, p=0.02), and 2yr (r=0.43, p=0.03), but not 1yr (r=0.35, p=0.06) or TBWL. After adjustment for baseline weight, the association remained at 6mo (r=0.37, p=0.02). Stratification by procedure noted a strong association between GLP1RA response and reduced post-operative HbA1c at 6mo (r=0.99, p&lt;0.01) and TBWL at 1yr (r=0.82, p=0.02) and 2yrs (r=0.99, p=0.01) for patients who had undergone gastric sleeve, but not gastric bypass.
Conclusion: To our knowledge, this is the first study examining the association of GLP1RA response on glycemic and weight outcomes post-bariatric surgery in people with T2DM. Despite a number of limitations, results from this small cohort suggest the need for further evaluation of this relationship as a potentially useful predictor of surgical outcomes.

Disclosure
D. Amusin: None. K. Kuchta: None. T. Ewing: None. L. Tucker: None. M. Campbell: None. M. Ujiki: Advisory Panel; Self; Boston Scientific Corporation, Consultant; Self; Cook Medical, Speaker’s Bureau; Self; Medtronic. L. K. Billings: Advisory Panel; Self; Bayer Inc., Lilly Diabetes, Novo Nordisk, Sanofi.
70-LB: Continuous Glucose Monitoring Data Sharing in Older Adults with Type 1 Diabetes and Their Care Partners
Authors: ALLEN NANCY A. , LITCHMAN MICHELLE L. , CHAMBERLAIN JAMES , GRIGORIAN ERNEST , IACOB ELI , BERG CYNTHIA 
Published: June 2021

Background: Family members of older adults with type 1 diabetes (T1D) regularly become part of the diabetes care team yet often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Real-time continuous glucose monitoring (RT-CGM) with data sharing could facilitate diabetes management among older adults with T1D and their family members.
Methods: Older adults with T1D (n=20) and their care partners (n=20) received a RT-CGM data sharing intervention called SHARE. SHARE included dyadic communication strategies, problem-solving strategies, and action planning. People with diabetes (PWD) wore the RT-CGM for 12 weeks while sharing their glucose data with a care partner. Feasibility data were obtained on intervention dose, implementation processes, satisfaction, and diabetes-related quality of life using RT-CGM. Descriptive statistics were used to examine feasibility, satisfaction, and demographic data.
Results: The SHARE intervention was feasible, had high self-reported satisfaction for PWD and their care partner, and high adherence (96±6.8%) with wearing the RT-CGM. We found broad improvements in diabetes-related quality of life using RT-CGM in PWD and their care partners. Although the majority of PWD were willing to share hyperglycemia data (55%), several chose not to. The majority of PWD were willing to talk about glucose numbers with a care partner (n=70%). For this feasibility study, the SHARE intervention was not targeted at improving glucose levels but rather on communication and problem-solving strategies. There were no significant trends in the RT-CGM data (e.g., time in range) between baseline and 12 weeks.
Conclusion: Older adults with T1D diabetes and their care partners identified the positives of RT-CGM with SHARE as having someone else aware of glucose levels and working together with a partner on diabetes self-management. SHARE may improve dyadic communication and problem-solving around glucose management in older adults.

Disclosure
N. A. Allen: Research Support; Self; Dexcom, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. J. Chamberlain: Speaker’s Bureau; Self; Abbott Diabetes, Dexcom, Inc. E. Grigorian: None. E. Iacob: None. C. Berg: None.

Funding
University of Utah Center on Aging; University of Utah One U Caregiving Initiative; Dexcom, Inc.
725-P: Low Fasting Glucose and Insulin Deficiency Were Related with Superiority of Insulin Degludec/Aspart Compared with Basal Insulin in Patients with Type 2 Diabetes
Authors: JANG HAN NA , YANG YE SEUL , OH TAE JUNG , KOO BO KYUNG , LEE SEONGOK , JUNG HYE SEUNG 
Published: June 2021

Objective: In spite of expected benefit of insulin degludec/aspart (IDegAsp), efficacy of once-daily IDegAsp compared to basal insulin has not been established. We searched for clinical factors associated with efficacy of once-daily IDegAsp.
Methods: We collected medical records of adults with type 2 diabetes under basal insulin of 3 hospitals. From the basal insulin cohort, patients were enrolled who switched to once-daily IDegAsp and continued over 6 months. Those who maintained basal insulin were selected as a control group, by Propensity-score matching with HbA1c, insulin doses, etc.
Results: The basal insulin cohort was comprised of 324 patients, and the IDegAsp group and the control were 87 patients, respectively. Baseline clinical variables and HbA1c were comparable between two groups (8.7±0.9 vs. 8.6±0.9%). After 6 months with comparable changes in insulin doses, HbA1c in the IDegAsp group was lower than that in the control (8.1±1.0 vs. 8.4±1.1%, p=0.029). With the comparable HbA1c, baseline FPG was lower in the IDegAsp (124±38 vs. 148±51 mg/dL, p&lt;0.001). A regression analysis between FPG and HbA1c in the basal insulin cohort revealed that most participants in the IDegAsp group had lower FPG than predicted from their HbA1c. Then subgroup analysis was done according to the difference (ΔFPG) between measured FPG and predicted FPG. When compared to each control group further matched for baseline FPG, the favorable effects of IDegAsp on the reduction of HbA1c changes was significant only in the subgroup where measured FPG was severely lower than predicted FPG (98±19 vs. 140±11 mg/dL). ΔFPG was significantly correlated with fasting C-peptide (r=0.19) and glucose increment at postprandial 2 hours (r=-0.514).
Conclusion: Once-daily IDegAsp was effective than basal insulin on reduction of HbA1c in patients with lower FPG than predicted from their HbA1c, which suggested severe insulin deficiency and marked postprandial hyperglycemia.

Disclosure
H. Jang: None. Y. Yang: None. T. Oh: None. B. Koo: None. S. Lee: None. H. Jung: Research Support; Self; Novo Nordisk.

Funding
National Research Foundation of Korea (2019R1A2C1007397); Korean Diabetes Association (2019F-10)
751-P: First-in-Human, Single and Repeated Dose Study of SCO-267, a GPR40 Full Agonist, in Healthy Adults and Subjects with Glucose Intolerance
Authors: NISHIZAKI HARUNOBU , MATSUOKA OSAMU , ACHIRA MEGURU , KAGAWA TOMOYA , WATANABE MASANORI , MORITOH YUSUKE 
Published: June 2021

The clinical potential of SCO-267, an orally available allosteric full agonist against GPR40 that regulates islet and gut hormone secretion, is largely unknown. Here, we present the first clinical study using the GPR40 full agonist. A randomized, single-center, double-blind, placebo-controlled, phase 1 study was conducted to investigate safety, tolerability, and pharmacokinetics as primary endpoints and pharmacodynamics as secondary endpoints of single (5-320 mg) and repeated doses (80 and 160 mg, Q.D.) of SCO-267 in healthy adults and subjects with glucose intolerance (HbA1c range 6.6-8.8%). SCO-267 was generally safe and well tolerated at all doses up to 4 days. The plasma SCO-267 concentration increased generally dose-dependently and its pharmacokinetic profiles suggests the potential for once-daily oral dosing in a clinical setting. The pharmacokinetic profiles of SCO-267 was similar between Japanese and Caucasian subjects, and healthy subjects and those with glucose intolerance. Pharmacokinetic profiles of SCO-267 in healthy adults were unaltered with repeated doses. SCO-267 was hardly detected in urine, suggesting that it is eliminated by non-renal mechanisms. SCO-267 single dose (40 and 80 mg) stimulated secretion of insulin, glucagon, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and peptide YY (PYY), and normalized glucose intolerance during an oral glucose tolerance test in subjects with glucose intolerance. SCO-267 repeated dose (80 and 160 mg) stimulated secretion of insulin, glucagon, GLP-1, GIP, and PYY in healthy adults.
In conclusion, SCO-267 was safe, well tolerated, and pharmacokinetic profiles support a once-daily dosing regimen. SCO-267 further stimulated islet and gut hormone secretion and normalized glucose tolerance in humans. These findings support the further development of SCO-267 for diabetes, obesity, and nonalcoholic steatohepatitis.

Disclosure
H. Nishizaki: Employee; Self; Scohia Pharma Inc. O. Matsuoka: None. M. Achira: Employee; Self; PRA Health Sciences KK. T. Kagawa: Employee; Self; Scohia Pharma Inc. M. Watanabe: Employee; Self; Scohia Pharma Inc. Y. Moritoh: Employee; Self; Scohia Pharma Inc.