bluuebunny/crossref_metadata_2025_split huggingface dataset:
1280-PUB: The Impact of Proactive and Personalized Strategies in the Self-Monitoring of Blood Glucose in Women with Diabetes in Pregnancy: The Experience of the Cohort Cuido Mi Embarazo in Mexico
Authors: MARTINEZ-JUAREZ LUIS ALBERTO , LOMELIN-GASCON JULIETA , ORTEGA-MONTIEL JANINNE , BENITEZ-HERRERA ALEJANDRO EFRAÍN , REYES-GÓMEZ DIANA , CARMONA-RAMOS MA. CONCEPCIÓN , HERNÁNDEZ-GONZÁLEZ LAURA , REYES-MUÑOZ ENRIQUE , GALLARDO-RINCÓN HECTOR , TAPIA-CONYER ROBERTO 
Published: June 2021

Women with Diabetes in Pregnancy (DP) have a higher risk of maternal-fetal complications, unfortunately in Mexico, its detection is only carried out in 1% of cases, and glucometers and glucose strips are not available for self-monitoring of blood glucose (SMBG). The cohort Cuido mi Embarazo (CME) ensures supplies for the Oral Glucose Tolerance Test (OGTT) and glucose screening through MIDO Embarazo®. Educational strategies have been implemented for health personnel focused on prevention, diagnosis and management. Patients with DP have been offered medical and nutritional counseling, and digital glucometers and glucose strips for SMBG. Up to now, 854 women are actively monitored and have performed the OGTT. 117 women have been found with diabetes, of which 96 (82.05%) are Gestational Diabetes (GDM) and 21 (17.95%) are pre-gestational diabetes, finding a prevalence of GDM of 11.2%. Regarding the SMBG in 84 women with diabetes that completed their pregnancy, 62 (73.8%) completed glucose measurements, representing a higher figure than the international literature. From those patients that completed their pregnancy with complete SMBG according to international standards, 39 (62.9%) women achieved control, 23 (37.1%) did not achieve control. No cases of children with macrosomia were detected. In the framework of the CME Cohort, it is demonstrated that: 1) Performing the OGTT and capillary glucose screening through MIDO Embarazo® allow the timely detection of DP. 2) Providing digital glucometers and glucose strips for SMBG, guarantees measurement, increases adherence and glucose control, and improves the health of the newborn and the mother. 3) The systematic approach that also includes the proactive participation of health professionals in the health center is a key element for success for the timely and adequate diagnosis of DP. These conclusions represent a significant public health lesson in Mexico.

Disclosure
L. Martinez-juarez: Research Support; Self; Lilly Global Health Partnership. R. Tapia-conyer: None. J. Lomelin-gascon: None. J. Ortega-montiel: Research Support; Self; Lilly Global Health Partnership. A. Benitez-herrera: None. D. Reyes-gómez: None. M. Carmona-ramos: None. L. Hernández-gonzález: None. E. Reyes-muñoz: Consultant; Self; Nestlé, Research Support; Self; Nestlé. H. Gallardo-rincón: None.

Funding
Eli Lilly and Company
1285-PUB: A Retrospective Observational Study to Find Out the Association between NAFLD, Diabetes, and Obesity in Indian Patients
Authors: SARAN MOHIT , SHARMA JUGAL K. , RANJAN AASTHA , DEKA SAURAV , SABHARWAL MUDIT , PALUKURI SRIVANI , CHANDOLIA BETINA 
Published: June 2021

Background: Nonalcoholic fatty liver disease (NAFLD) is present in the body with metabolic disorders such as type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease. However, no significant evidence has been found till date exhibiting their association epidemiologically in Indian patients.
Objective: To assess the association among NAFLD, T2DM, and obesity, and to validate the scoring system with grades of fatty liver (severity of liver disease) estimated by ultrasound vs. NAFLD fibrosis score, BARD score, and APRI score.
Methodology: A retrospective, observational study was conducted out in patients with NAFLD (n=316) where diagnosis and grades of fatty liver were established via ultrasound reports. The patients were divided into two groups, Group A (n=114, NAFLD with T2DM) and Group B (n=202, NAFLD without T2DM). R 4.0.0 was used for statistical analysis.
Results: The mean age (in years) of the patients was 54.08 ± 10.78 in Group A and 48.10 ± 15.36 in Group B. The mean BMI in Group A was found to be slightly higher as compared to Group B, 27.49 ± 4.94 and 26.56 ± 4.68 respectively, and the difference was found to be statistically significant (p-value &lt;0.05). The overall predictive ability of the NAFLD scoring system matched that to ultrasonography liver grading fibrosis report for approximately 53% of patients. The BARD scoring system was found to be matched with ultrasonography reported Grade-1 fatty liver (198/316). In the case of the APRI scoring system, the association was not observed with ultrasonography reports in any grades of fatty liver.
Conclusion: BMI might be an independent risk factor for NAFLD. NAFLD fibrosis score appears to be a reliable non-invasive tool to determine the severity of liver fibrosis in NAFLD patients. BARD score may predict Grade 1 liver fibrosis. However, APRI scores do not correlate with imaging evidence of fibrosis like NAFLD and BARD scores.

Disclosure
M. Saran: None. J. K. Sharma: None. A. Ranjan: None. S. Deka: None. M. Sabharwal: Employee; Self; Health Arx Technologies Pvt. Ltd. S. Palukuri: None. B. Chandolia: None.
137-LB: An Audit on the Management of Diabetic Ketoacidosis during the COVID-19 Pandemic in St. Vincent’s University Hospital, Dublin, Ireland
Authors: MCCARTHY A. MARY , CROWLEY RACHEL 
Published: June 2021

DKA is a complication of type 1 diabetes with a 5% mortality rate. Patients with diabetes who test positive for COVID-19 have a higher mortality rate than the general population.
In this audit, patients treated for DKA in SVUH in March-April 2020 were identified and their records were reviewed to assess adherance to the DKA protocol. Patients treated for DKA during March-April 2019 were used as a comparison population.
There were 10 cases of DKA in SVUH in March-April 2020. 10% were under the care of the Endocrinology team. 50% were prescribed appropriate basal insulin. 60% were prescribed appropriate fluids. 60% were admitted via the COVID pathway. 50% were prescribed appropriate fluids, compared to 75% of patients who were admitted via the non-COVID pathway. 50% of patients on both pathways were prescribed appropriate basal insulin.
In March-April 2019 there were 9 cases of DKA in SVUH. 66% were directly under the care of the Endocrinology team. 88% were prescribed appropriate insulin. 77% were prescribed appropriate fluids.
This work was re-audited to assess adherance to the DKA protocol in September-October 2020, when community rates of COVID-19 were lower and staff had been re-educated on DKA management. 8 patients were treated for DKA in September-October 2020. All of these patients were admitted via the non-COVID pathway. 87.5% were under the care of the Endocrinology team. 75% received appropriate basal insulin and 87.5% received appropriate fluids.
In conclusion, adherence to the DKA protocol was suboptimal in the early months of the COVID-19 pandemic. Adherance to the DKA protocol improved to baseline in September-October 2020. This was largely attributed to the fact that patients were not admitted through the COVID pathway, and that they were directly under the care of Endocrinology. It is imperative that patients with speciality specific problems are managed by the appropriate discipline, as COVID-19 remains a significant public health crisis.

Disclosure
A. Mccarthy: None. R. Crowley: None.
143-OR: Financial Incentives to Promote Adolescent Adherence to Type 1 Diabetes Self-Care: A Discrete Choice Experiment
Authors: WRIGHT DAVENE , CHALMERS KRISTEN , LEBLANC JESSICA L. , YI-FRAZIER JOYCE , SHAH SEEMA K. , GARVEY KATHARINE , SENTURIA KIRSTEN , PIHOKER CATHERINE , MALIK FAISAL 
Published: June 2021

Purpose: Adolescents with type 1 diabetes (T1D) often struggle with diabetes self-care tasks and achieving optimal glycemic control. Financial incentive (FI) programs may improve T1D self-care and health outcomes. We aimed to quantify adolescent preferences for the structure of FI.
Methods: We performed a discrete choice experiment with 12-18 year-olds with T1D from two pediatric hospital endocrinology clinics in Seattle (n = 185) and Boston (n = 141). We used a literature review and focus groups to identify key attributes of FI: (1) monthly value of the reward, (2) payment structure (positive vs. negative reinforcement), and (3) difficulty of behaviors being incentivized. Using these three attributes, we generated a balanced set of profiles representing hypothetical FI using a fractional factorial design. In twelve choice questions, adolescents were shown a pair of profiles and chose the FI option more likely to motivate them to increase adherence to recommended self-care. The options presented were tailored to adolescents’ modes of insulin administration and glucose monitoring and to adolescents’ individual rating of the difficulty of completing each behavior. We used a multinomial logit choice model to analyze data.
Results: The value of the reward was the primary driver of preferences, accounting for 50% of preferences. Adolescents significantly preferred FI with a positive vs. negative reinforcement payment structure ($5.17 (95% CI: $4.11, $6.25)) and preferred higher FI for performing hard vs. easier behaviors ($6.95 (95% CI: $4.57, $8.33)). Preferences were associated with respondent age and HbA1c (p&lt;0.05).
Conclusions: Adolescent stated preferences should inform the design of a T1D FI intervention, which can then be tested in randomized controlled trials to determine the impact of FI on T1D self-care adherence and health outcomes. Latent class analyses can identify subgroups with differential preferences and will explore subgroup characteristics.

Disclosure
D. Wright: None. K. Chalmers: None. J. L. Leblanc: None. J. Yi-frazier: None. S. K. Shah: None. K. Garvey: None. K. Senturia: None. C. Pihoker: None. F. Malik: None.

Funding
American Diabetes Association (1-18-ICTS-100 to D.W.)
147-OR: Use of Closed-Loop Insulin Therapy in Older Adults with Type 1 Diabetes: Real-World Experience
Authors: TOSCHI ELENA , SLYNE CHRISTINE , ATAKOV-CASTILLO ASTRID , MUNSHI MEDHA 
Published: June 2021

Background: Closed-loop control insulin delivery systems (CLC) have been available to adults with type 1 diabetes (T1D) for many years. However, for older adults with T1D, Tandem Control IQ is the first CLC available through Medicare. We evaluated the use of CLC in older adults with T1D in a real-world scenario.
Methods: We retrospectively analyzed electronic health record (EHR) data for older adults (&gt;65) with T1D started on CLC in a single tertiary center between January and December 2020. Continuous glucose monitoring (CGM) data from the 2 weeks prior (baseline) and 2 weeks post CLC system (post-CLC) initiation were analyzed. We evaluated glycemic measures, including coefficient of variation (CV) for glucose variability and glucose management indicator (GMI) for overall glycemic control. Demographic, clinical and diabetes technology data were gathered from EHR.
Results: We present interim data from 25 older adults (Mean age 69±4 yrs, duration of diabetes 43±13 yrs) who started using CLC over the 12 month period. Overall, 23/25 were prior pump users, and 23/25 were prior CGM users. Only 2/25 discontinued CLC use. Comparison of CGM metrics measured at baseline vs. post-CLC showed an increase in Time in Range (TIR) from 63±13% to 77±9% (p&lt;0.001) and a reduction in time &gt;180 mg/dL from 30±12% to 18±9% (p=0.004). While there was a trend in decrease of time &lt;70 mg/dL from baseline to post-CLC, this change was not statistically significant (2.8±2.4% vs. 2.2±2.5% (p=0.5)). CV improved from 0.33±0.04% to 0.30±0.04% (p=0.04) and GMI decreased from 7.0±0.5% to 6.7±0.4% (p=0.06). CLC use averaged 92% of the time over 2 weeks.
Conclusion: In a small cohort of older adults with T1D using CLC in a real-world scenario, the majority of the cohort was able to use the system successfully, resulting in a higher TIR and improved glycemic variability, as seen by a decrease in CV over a 3 month period. Thus, CLC has the potential to improve glycemic outcomes in this elderly population.

Disclosure
E. Toschi: Consultant; Self; Medtronic. C. Slyne: None. A. Atakov-castillo: None. M. Munshi: Consultant; Self; Sanofi.

Funding
National Institutes of Health (1DP3DK112214-01)
150-OR: Intermittently Scanned Continuous Glucose Monitoring and Automated Bolus Calculation in Type 1 Diabetes Treated with Multiple Daily Insulin Injections: A Randomized Controlled Trial
Authors: SECHER ANNA L. , PEDERSEN-BJERGAARD ULRIK , SVENDSEN OLE L. , GADE-RASMUSSEN BIRTHE , ALMDAL THOMAS P. , RAIMOND LINDA H. , VISTISEN DORTE , NØRGAARD KIRSTEN 
Published: June 2021

In a randomized controlled multicenter trial, 170 adults with type 1 diabetes ≥1 year, multiple daily insulin injections, HbA1c &gt;7.0% (53 mmol/mol), were randomized to usual care (n=42), carbohydrate counting with automated bolus calculation (ABC) (n=41), intermittently scanned continuous glucose monitoring (isCGM) (n=48), or ABC+isCGM (n=39). HbA1c, blinded CGM and patient-reported outcomes were recorded at baseline and after 26 weeks. Primary outcome was change in time in range (TIR) with isCGM vs. usual care. Baseline characteristics were comparable across intervention arms; median (Q1;Q3) diabetes duration 18 (10;28) years, HbA1c 8.1 (7.7;8.7) % (65 (61;72) mmol/mol) and mean (SD) BMI 26.7 (3.9) kg/m2. Changes in TIR, hypo- and hyperglycemia were similar in the intervention arms compared to usual care. Daytime TIR increased 22 (95% CI: 1;47) % with ABC and nighttime hyperglycemia increased 258 (40;814) % with isCGM compared to usual care. With ABC+isCGM, HbA1c was reduced 0.4 (0.1;0.7) % (4 (1;8) mmol/mol) and glucose coefficient of variation (CV) was reduced 11 (4;17) % compared to usual care. Treatment satisfaction improved with isCGM and ABC+isCGM. With ABC+isCGM, empowerment and present life quality also improved. Within the ABC and isCGM arms, we observed HbA1c reductions of 0.3 and 0.3% (4 and 3 mmol/mol), respectively, however not significantly different from usual care. Statistical significance was maintained after adjustment for multiple testing with regards to CV and treatment satisfaction with ABC+isCGM, and treatment satisfaction with isCGM only.
In conclusion, although no significant improvement in TIR was achieved, simultaneous intervention with ABC+isCGM improved the coefficient of variation and treatment satisfaction compared to usual care, and HbA1c was clinically relevant reduced, in adult technology-naïve persons with type 1 diabetes and suboptimal HbA1c.

Disclosure
A. L. Secher: None. U. Pedersen-bjergaard: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis, Consultant; Self; Abbott, Speaker’s Bureau; Self; Novo Nordisk A/S. O. L. Svendsen: None. B. Gade-rasmussen: None. T. P. Almdal: None. L. H. Raimond: None. D. Vistisen: Stock/Shareholder; Self; Novo Nordisk A/S. K. Nørgaard: Advisory Panel; Self; Medtronic, Other Relationship; Self; Novo Nordisk Inc., Zealand Pharma A/S, Speaker’s Bureau; Self; Medtronic.
153-OR: Measurement of C-Peptide at Diagnosis Informs Glycemic Control but Not Hypoglycemic Risk in Type 1 Diabetes
Authors: CARR ALICE , ORAM RICHARD A. , NARENDRAN PARTH , ANDREWS ROBERT C. 
Published: June 2021

Background and Aims: High residual C-peptide in longer duration type 1 diabetes associates with fewer hypoglycemic events and reduced glycemic variability. However, little is known about the impact of C-peptide close to diagnosis. Using continuous glucose monitoring (CGM) data from a study of newly diagnosed adults with type 1 diabetes, we aimed to explore if variation in C-peptide close to diagnosis influenced glycemic variability and risk of hypoglycaemia.
Materials and Methods: We studied newly diagnosed adults with type 1 diabetes who wore a Dexcom G4 CGM as part the EXTOD study. We examined the relationship between peak stimulated C-peptide in a mixed meal tolerance test and glycemic metrics of variability and hypoglycemia for 36 CGM traces from 23 participants.
Results: Higher levels of C-peptide associated with lower glycemic variability, more time in range and less hyperglycemia. For every 100 pmol/L increase in peak C-peptide, percentage time spent in the range 3.9-10 mmol/L was increased by 2.39% [95% CI: 0.51,4.26], p=0.012) with a reduction in time spent in level 1 hyperglycaemia (&gt; 10 mmol/L) and level 2 hyperglycemia (&gt; 13.9 mmol/L) glucose levels by 2.64% [95% CI: -4.87, -0.41, p=0.018) and 1.33% [95% CI: -2.66, -0.0057], p= 0.041) respectively. Glucose levels were on average lower by 0.19 mmol/L ([95 % CI: -0.39,0.015], p=0.06) and standard deviation reduced by 0.14 [95% CI: -0.25, -0.023], p=0.017) for every 100 pmol/L increase in peak C-peptide. Hypoglycemia was not common in this group and no association was observed between time spent in hypoglycemia (p=0.967) or hypoglycemic risk (p=0.721). There was no association between peak C-peptide and insulin dose (p=0.707), HbA1C (p=0.364) or insulin dose adjusted HbA1c (IDAA1c, p=0.452).
Conclusion: C-peptide associates with time spent in normal glucose range and with less hyperglycemia, but not risk of hypoglycemia in newly diagnosed people with type 1 diabetes.

Disclosure
A. Carr: None. R. A. Oram: Consultant; Self; Janssen Research & Development, LLC. P. Narendran: Speaker’s Bureau; Self; Novo Nordisk Inc., Sanofi. R. C. Andrews: None.
162-LB: Plasma Glycated CD59 Predicts Postpartum Glucose Intolerance after Gestational Diabetes
Authors: BENHALIMA KATRIEN , MA DONGDONG , CASTILLO MICHELLE TOTH , LAENEN ANNOUSCHKA , MATHIEU CHANTAL , HALPERIN JOSE 
Published: June 2021

pGCD59 is an emerging biomarker for diabetes and GDM. In studies of women undergoing GDM screening either early in pregnancy (week &lt;20) or at pregnancy weeks 24-28, pGCD59 classified GDM subjects with high sensitivity and specificity and was associated with the prevalence of large for gestational age (LGA) babies (Diabetes Care 2017 and JCEM 2020). GDM developed early in pregnancy imparts a seven-fold increased risk of subsequent glucose intolerance and diabetes. Since HbA1c is not sensitivity to detect glucose intolerance in early postpartum, professional organizations including ADA, recommend that women with GDM should undergo OGTT testing 6-12 weeks postpartum. However, the cumbersome nature of OGTT makes compliance with this requirement very low, highlighting the need for alternative biomarkers that can be used postpartum to test women with GDM for potential conversion glucose intolerance. To assess the ability of pGCD59 to identify postpartum conversion to glucose intolerance in women with GDM, levels of pGCD59 were measured in samples from participants in the Belgian Diabetes in Pregnancy (BEDIP-N, Diabetes Care 2018) cohort study who underwent OGTT testing 6-12 weeks postpartum. Among 105 samples from women with GDM, 36 subjects met OGTT criteria for glucose intolerance (cases) and 70 had normal OGTT (matched controls). Maternal age, race/ethnicity, and BMI were similar among Cases and Controls. pGCD59 was significantly higher in cases than in controls (1.5 ±0.6 SPU vs. 1.0 ±0.6 SPU, p &lt; 0.001) and accurately predicted the postpartum conversion to glucose intolerance as indicated by an AUCROC of 0.72 (95% CI 0.62-0.83). A 0.5-unit increase in postpartum pGCD59 was associated with an OR of 2.0 (95% CI 1.34-2.95, p&lt;0.001) for glucose intolerance. Our results indicate that pGCD59 is a simpler biomarker to assess postpartum conversion to glucose intolerance in women with GDM and represents an alternative to improve compliance with postpartum screening for glucose intolerance.

Disclosure
K. Benhalima: None. D. Ma: None. M. Toth castillo: None. A. Laenen: None. C. Mathieu: Advisory Panel; Self; Novo Nordisk, Sanofi, Merck Sharp and Dohme Ltd., Eli Lilly and Company, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Insulet and Zealand Pharma, Research Support; Self; Medtronic, Novo Nordisk, Sanofi and ActoBio Therapeutics, Speaker’s Bureau; Self; Novo Nordisk, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, AstraZeneca and Novartis. J. Halperin: Board Member; Self; Mellitus, LLC.

Funding
National Institutes of Health (R01DK118528, DK101442); Belgian National Lottery; Fund of Academic Studies of UZ Leuven; Yvonne and Jacques François-de Meurs of the King Boudewijn Foundation
168-OR: Five-Year Follow-up after Islet Transplantation in Nonuremic Patients with Type 1 Diabetes Mellitus and Hypoglycemia Unawareness: Favorable Long-Term Outcomes of Multicenter Trial at University of Chicago
Authors: BACHUL PIOTR J. , GENERETTE GABRIELA S. , BOREK PETER , PYDA JORDAN S. , ANTEBY ROI , BASTO LINDSAY , PEREA LAURENCIA , GOLAB KAROLINA , TIBUDAN MARTIN , PEREZ-GUTIERREZ ANGELICA , LUCANDER AARON C. , FUNG JOHN , WITKOWSKI PIOTR 
Published: June 2021

Introduction: Prospective randomized multicenter trial did not find advantage of CXCR1/2 blocker (Reparixin) over placebo in islet transplantation in patients with type 1 diabetes mellitus and problematic hypoglycemia at 1 year follow-up. We note favorable metabolic outcomes at 5-year follow-up in trial cohort from our center.
Material and Methods: 12 patients with type 1 diabetes and problematic hypoglycemia received a total 19 islet transplants (max 2 per patient) within one year. Eight patients were randomly assigned and received Reparixin and 4 received placebo within first week after each transplant in addition to standard immunosuppression (anti-thymocyte globulin, tacrolimus, and mycophenolate).
Results: 11/12 patients achieved insulin independence during the study period. At 5-year follow-up 4/8 (50%) remained insulin free with HbA1c &lt;6.0 % in Reparixin group vs. 1/4 (25%) in placebo group. One patient had partial islet function without severe hypoglycemic episodes (SHE). Diabetic neuropathy and renal function remained unchanged while retinopathy improved in 3/6 (50%) patients. 6/12 (50%) patients left the study: 3/6 proceeded with pancreas transplant and remain off insulin, the remaining 3/6 stopped immunosuppression with decline of islet graft function, deterioration of glucose control (HbA1c &gt; 7.0 %), and recurrence of SHE. No patients experienced any cardiovascular events nor became persistently sensitized (current PRA 0%).
Conclusions: Repeat islet transplantation led to insulin independence in 91% of patients; 50% of patients in Reparixin group and 25% in placebo. Secondary diabetic complications did not progress. No patients became persistently sensitized. Subsequent pancreas transplantation was feasible and effective in patients with decline of islet graft function.

Disclosure
P. J. Bachul: None. A. Perez-gutierrez: None. A. C. Lucander: None. J. Fung: None. P. Witkowski: None. G. S. Generette: None. P. Borek: None. J. S. Pyda: None. R. Anteby: None. L. Basto: None. L. Perea: None. K. Golab: None. M. Tibudan: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK02059); Kovler Family Fund; Dompé farmaceutici S.p.A.