bluuebunny/crossref_metadata_2025_split huggingface dataset:
2357-PUB: Dapagliflozin for 52 Weeks Improves Diastolic Dysfunction and Vascular Reactivity in T2D
Authors: D'IPPOLITO ILENIA , DE CARLI ELISA , ANDREADI AIKATERINI , ROMANO MARIA , GALLI ANGELICA , CAPRIA AMBROGIO , MASSARO MICHELLE , SBRACCIA PAOLO , DELLA-MORTE DAVID , BELLIA ALFONSO , LAURO DAVIDE 
Published: June 2019

Background: SGLT2i proved efficacy in reducing cardiovascular morbidity and mortality in T2D patients at high cardiovascular risk.
Aims: In real-word setting, we prospectively evaluated long-term effects of Dapagliflozin (DAPA) on left diastolic ventricular function (LDVF) and vascular reactivity in T2D patients without known cardiovascular disease.
Population, Study and Methods: 13 patients (9 male, 57± 8 years, BMI 29.6± 3.6, HbA1c 8.9±1.2%, years of T2D 9±5, fasting glucose 185±51 mg/dl) initiated DAPA 10 mg daily as add-on to metformin. Following data were collected at baseline (T0), after 12 weeks (T1) and 52 weeks (T2) of treatment: blood pressure, anthropometrics, fasting glucose, HbA1c, eGFR and lipids. Ratio of the early (E) to late (A) ventricular filling velocities (E/A) was used to evaluate LDVF. Arterial stiffness was evaluated by Pulse Wave Velocity (PWV) and Augmentation Index (AIxHR75) with radial approach (SphygmoCor System). Endothelial function was assessed by non-invasive flow mediated dilatation (FMD).
Results: We observed significant percent variation in HbA1c (T1 vs. T0 -17.9%, p=0.001; T2 vs. T0 -17.4%, p=0.01), fasting glucose (T1 vs. T0 -25.9%, p=0.002, T2 vs. T0 -31.8%, p=0.005) systolic blood pressure (T1 vs. T0 -6.7%, p=0.03; T2 vs. T0 -10.2% p=0.02) and BMI (T1 vs. T0 -3.3%, p=0.001; T2 vs. T0 -3%, p=0.02). Significant improvements from baseline of E/A ratio (T1 vs. T0 +15%, p=0.03; T2 vs. T0 +27.5%, p=0.003) and brachial FMD (T1 vs. T0 +50.7%, p=0.02; T2 vs. T0 +39.4%, p=0.04) were also seen. No significant changes in eGFR, lipids and arterial stiffness measures were seen.
Conclusions: Intensification of treatment with DAPA 10 mg was accompanied by significant improvements in LVDF and endothelial-dependent vasodilation measures, which persist after 52 weeks of treatment. These preliminary observational results shed light on potential mechanisms responsible for cardiovascular protection with SGLT2i in T2D patients, even in absence of overt cardiovascular disease.

Disclosure
I. D'ippolito: None. E. De Carli: None. A. Andreadi: None. M. Romano: None. A. Galli: None. A. Capria: None. M. Massaro: None. P. Sbraccia: None. D. Della-Morte: None. A. Bellia: None. D. Lauro: None.

Funding
University of Rome
2362-PUB: Comparative Efficacy of Ertugliflozin (ERTU) + Sitagliptin (SITA) vs. Other Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) + Dipeptidyl Peptidase-4 Inhibitor (DPP-4i) Combinations: Model-Based Meta-analysis (MBMA) of HbA1c Lowering
Authors: FEDIUK DARYL , MANDEMA JAAP , SWEENEY KEVIN , TERRA STEVEN G. , SAHASRABUDHE VAISHALI 
Published: June 2019

Background: An ERTU/SITA fixed-dose combination is approved for the treatment of adults with type 2 diabetes mellitus (T2DM). As several SGLT2i + DPP-4i combinations are commercially available, MBMA of the HbA1c-lowering effect of these combinations was undertaken to assess their comparative effectiveness.
Methods: MBMA quantified the time course of dose vs. HbA1c response of SGLT2i + DPP-4i combinations and evaluated the impact of covariates including baseline HbA1c, estimated glomerular filtration rate (eGFR) and background diabetes treatment on HbA1c efficacy. Of the 496 randomized controlled trials (RCTs) in the database, 261 RCTs representing &gt;87,000 T2DM patients were with SGLT2 inhibitors and/or DPP-4 inhibitors, including 2 RCTs for ERTU + SITA.
Results: For SGLT2i + DPP-4i combinations, the HbA1c efficacy increased with higher baseline HbA1c and decreased with declining renal function. Additionally, the HbA1c efficacy was greater on a diet background alone relative to a background of oral antidiabetic treatment.
Conclusion: This MBMA allowed an indirect comparison of SGLT2i + DPP-4i efficacy across trials (Table). Overall, ERTU 5 or 15 mg + SITA 100 mg doses were of comparable or numerically greater efficacy to other SGLT2i + DPP-4i combinations.

Disclosure
D. Fediuk: Employee; Self; Pfizer Inc. J. Mandema: Consultant; Self; Merck & Co., Inc., Pfizer Inc., Sanofi. K. Sweeney: Employee; Self; Pfizer Inc. S.G. Terra: Employee; Self; Pfizer Inc. V. Sahasrabudhe: Employee; Self; Pfizer Inc.

Funding
Pfizer Inc.; Merck Sharp & Dohme Corp.
2365-PUB: Can Baseline Hemoglobin A1c Help Guide Treatment with an SGLT2i vs. DPP-4i? A Meta-analysis
Authors: PAGE STEPHANIE O. , MISHRIKY BASEM M. , UHRIG JARROD , SEWELL KERRY , MIAN MUNA R. , POWELL JAMES R. , CUMMINGS DOYLE M. 
Published: June 2019

Both sodium glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP-4i) are effective drugs known to reduce hemoglobin A1c (A1c). While some guidelines favor SGLT2i over DPP-4i, there is no clear criteria in choosing between them. Potentially, baseline A1c could be one distinguishing factor. We performed a meta-analysis to explore the efficacy of SGLT2i compared to DPP-4i according to baseline A1c.
We searched MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL for randomized trials comparing SGLT2i to DPP-4i in type 2 diabetes and reporting a change in A1c stratified by baseline A1c. We pooled trials reporting outcomes based on baseline A1c &lt;8.5% and ≥8.5%. For trials that reported results based on baseline hemoglobin A1c &lt;8%, 8-9%, and &gt;9%, we only used outcomes for baseline hemoglobin A1c &lt;8% and &gt;9% in the main analysis. Our primary outcome was change in A1c. A subgroup analysis was performed to compare both groups.
We included 6 trials. Although there was no significant difference between SGLT2i and DPP-4i when baseline A1c was &lt;8.5%, results significantly favored SGLT2i when baseline A1c was ≥8.5% (MD [95% CI] = 0.04% [-0.09, 0.17] and -0.36% [-0.53, -0.18] respectively). Comparison between the two baseline A1c groups showed a significant difference (p=0.0004).
We conclude that baseline A1c should be considered when considering SGLT2i or DPP-4i. If A1c is ≥8.5%, SGLT2i should be favored over DPP-4i.

Disclosure
S.O. Page: None. B.M. Mishriky: None. J. Uhrig: None. K. Sewell: None. M.R. Mian: None. J.R. Powell: None. D.M. Cummings: None.
2375-PUB: The Need of Women with Type 1 Diabetes for Pregnancy-Related Care in China: An Online Questionnaire Study
Authors: WANG CHAOFAN , LUO SIHUI , ZHENG XUEYING , XIONG SHANSHAN , YAN JINHUA , YANG DAIZHI , QIU LILING , YAO BIN , WENG JIANPING 
Published: June 2019

Background: Pregnancy Related Care (PRC) could reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes (T1D). Little was known about the need of them in China. We aimed to identify their need for PRC.
Methods: It was a cross-sectional study on women with T1D by an online questionnaire based on previous in-depth interviews. The questionnaire was advertised via patient community and Wechat. The survey ended when the sample size was reached. The data were analyzed in SPSS 19.0.
Results: The survey was conducted from Dec 26, 2016 to Jan 18, 2018. We received 385 responses from 28 provinces of China. Among them, 72.7% were aged 21∼35; 53.5% with T1D for over 5 years; 84.4% had annual income less than $10,000 and 61.6% spent over 30% income on T1D management; 66.0% and 37.4% were on MDI and CSII, respectively. The results were as below. 1) Current status of PRC: only 23.4% reported HbA1c&lt;6.5%; 33.0% ever got pregnant and 48.4% with adverse pregnancy outcomes; only 12.5% thought they got enough knowledge on PRC; 90.4% had worries for pregnancy, including complications, inheritance of T1D, cost and discrimination; 94.5% were willing to attend PRC program. 2) Doctor-patient relationship: 75.0% went to tertiary hospitals for T1D; 80.5% were satisfied with the doctors; 72.5% reported less than 10 minutes per visit while 76.9% asked for over 10 minutes for better communication; 76.8% gained confidence for pregnancy after visit; 84.2% suggested PRC be provided in a multiple disciplinary team. 3) Social support: 86.2% expressed T1D influenced their decision of marriage and childbearing; 44.9% concealed T1D from their family about T1D and 30.5% didn’t think the family would support the decision of pregnancy; 80.3% longed to share experience among peers and 78.7% were more confident after sharing.
Conclusion: Women with T1D had various unmet need for PRC, but current practice of PRC was lacking in China. The role of professional and social support should be enhanced to relieve their stress on pregnancy.

Disclosure
C. Wang: None. S. Luo: None. X. Zheng: None. S. Xiong: None. J. Yan: None. D. Yang: None. L. Qiu: None. B. Yao: None. J. Weng: None.

Funding
Guangdong Province Science and Technology Program (2018A070701019); National Health and Family Planning Commission of the People's Republic of China (201502011); World Diabetes Foundation (14-921)
2377-PUB: Evaluation of Structure, Documentation, and Treatment Quality of a New Insulin Chart at Departments of Internal Medicine
Authors: KOPANZ JULIA , LICHTENEGGER KATHARINA M. , SENDLHOFER GERALD , SEMLITSCH BARBARA , RIEDL REGINA , PIEBER THOMAS R. , TAX CHRISTA , BRUNNER GERNOT , PLANK JOHANNES 
Published: June 2019

Introduction: Insulin charts are the main tool for multidisciplinary documentation of diabetes therapy in the hospital setting. Due to a high heterogeneity of 20 different insulin charts at a tertiary center, a new standardized paper-based insulin chart was developed and implemented at the Departments of Internal Medicine.
Methods: A before-after comparison was performed to evaluate structure, documentation, and treatment quality of a new insulin chart compared to old insulin charts. Structure quality of blank insulin charts was assessed by using questionnaires regarding subjective perception of health care professionals (n=237). To assess documentation and treatment quality a retrospective evaluation of 108 old and 100 new filled-in insulin charts of inpatients receiving insulin therapy by using predefined quality parameters was conducted.
Results: Patient characteristics from old and new insulin charts were comparable regarding sex (old: 47% vs. new: 42% female), age (71±11 vs. 71±12 years), diabetes type (75% vs. 87% type 2) and HbA1c (62±14 vs. 67±21 mmol/mol). The primary endpoint, the percentage of insulin charts with insulin administration errors, was with 5% significantly better on new insulin charts compared to 77% on old insulin charts (p&lt;0.001). Insulin prescription errors occurred more often on old insulin charts (100% vs. 42%), whereas insulin management errors were rare in both groups (10% vs. 8%). Correct patient identification was rather given on new insulin charts (78% vs. 90%). Both groups had an average of 4±2 good diabetes days. Structure of the new insulin chart was assessed to be more clearly arranged, to give better transparency and to have more space for documentation.
Conclusion: Improvements in structure, documentation, and treatment quality were achieved through implementation of the new insulin chart. However, as some errors still occur, further potential to enhance diabetes inpatient care should be considered.

Disclosure
J. Kopanz: None. K.M. Lichtenegger: None. G. Sendlhofer: None. B. Semlitsch: None. R. Riedl: None. T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor Limited, AstraZeneca, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S. C. Tax: None. G. Brunner: None. J. Plank: None.
2378-PUB: Barriers and Facilitators to National Diabetes Prevention Program Engagement by Women of Peak Child-Bearing Age
Authors: HARRISON CAROLINE , PHIMPHASONE-BRADY PHOUTDAVONE , DIORIO BECKY , RITCHIE NATALIE , SAUDER KATHERINE A. 
Published: June 2019

Intrauterine exposure to maternal obesity and type 2 diabetes increases chronic disease risks in offspring. The National Diabetes Prevention Program (National DPP) is an evidence-based model for promoting weight loss to prevent diabetes in adults; however, women of peak child-bearing age (18-39 years) do not engage sufficiently, limiting the program’s potential to reduce risks across generations. We assessed participation barriers and facilitators among English- or Spanish-speaking young women who enrolled in the program at an urban safety-net healthcare system. Interviewees included 30 women who enrolled but did not attend (n=10), attended few classes (n=10), or completed the program (n=10). Individual semi-structured interviews explored motivations, challenges, and successes regarding participation and suggestions for improvement. Interviews were analyzed using a grounded hermeneutic approach. Qualitative analysis revealed four primary domains (enrollment, attendance, experience, and suggestions) with multiple sub-themes. Most women were motivated to enroll per concern for health and family. Non-attending and minimally engaged women reported confusion about the program’s aim and relevancy, logistical barriers (scheduling conflicts, lack of childcare or transportation), and lack of connection with fellow participants or coaches. Highly engaged women noted persistent motivation to attend, successful weight loss, and supportive relationships in the program. Taken together, multiple barriers/facilitators arose that may be addressable in future adaptations via enhanced education and motivational support throughout the program, providing childcare and transportation, introducing a mobile app, a more flexible class format, and activities to strengthen group cohesion. Future research is needed to explore strategy implementation and effectiveness, with an ultimate goal of reducing risks prior to initial or subsequent child-bearing.

Disclosure
C. Harrison: Employee; Spouse/Partner; Virta Health Corp. P. Phimphasone-Brady: None. B. DiOrio: None. N. Ritchie: None. K.A. Sauder: None.

Funding
Centers for Disease Control and Prevention
2389-PUB: Development of the Diabetes Clinical Quality Reporting Tool to Assess Diabetes Measures across Primary Care Practices in a Health Network
Authors: PENNOCK JENNIFER , KLEIN BRIAN M. , STEVENS MARY S. , KRAEMER ELLEN 
Published: June 2019

Background: Allegheny Health Network Diabetes Support Initiate for Primary Care (AHN DSIPC) developed the Diabetes Clinical Quality Reporting Tool (DCQRT) to assess diabetes measures in primary care practices (practices).
Methods: The data for the DCQRT was accessed via PROC SQL for SAS Enterprise Guide 7.1 from the Clarity Prod Copy of our EPIC Electronic Health Record. The data was shared with practices in aggregated format with Tableau. Patients were attributed to a practice based on primary care provider designation in EPIC. Patients’ data was included if the following criteria were met: in the EPIC diabetes registry; between age 18 to 75; seen in the practice at least once within the report quarter. The DCQRT includes 7 measures shown in the Table. For the A1C measure, we risk tiered patients based on the antidiabetes medication as a surrogate for disease severity. A1C at goal was assigned as follows: no antidiabetes medication&lt;7%; oral antidiabetes medication&lt;7.5%; non-insulin injectable antidiabetes medication&lt;8%; insulin &lt;9%.
Results: See Table.
Table notes: * Performed within the last year# Age 40-75 ^data available in Q4 2016.
Conclusion: The DCQRT allowed assessment of diabetes measures in practices in a health network. The DCQRT has allowed practices to see data in an aggregate form and base quality improvement initiatives.

Disclosure
J. Pennock: None. B.M. Klein: None. M.S. Stevens: None. E. Kraemer: None.

Funding
Richard King Mellon Foundation
2390-PUB: A Diabetes Clinic in the Primary Care Setting: A Quality Improvement Initiative in a Teaching Institution—One-Year Data
Authors: MISHRIKY BASEM M. , POWELL JAMES R. , HOLOMAN CARYL E. , MIAN MUNA R. 
Published: June 2019

Diabetes remains one of the most common chronic conditions seen in primary care clinics. While it remains one of the toughest quality measures to fulfill, it is crucial since we are approaching “Pay for Performance” in healthcare that will determine physician re-imbursement rates. We therefore performed this initiative to target patients within the internal medicine clinic at East Carolina University, who have a hemoglobin A1c (A1c) &gt;9% (as this is suggested as a quality measure by Medicare’s Merit-based Incentive Payment System and the National Committee of Quality Assurance).
The 1st phase involved creating a protocol to identify/contact patients with an A1c &gt;9%. The 2nd phase was to establish a diabetes clinic via a diabetes specialist within the primary care setting with the goal of providing individualized diabetes care for high-risk patients. The 3rd phase was to educate the residents on evidence-based diabetes management through yearly didactic sessions. The 4th phase was to establish a Diabetes Fellow clinic within the primary care clinic. We divided our results according to the level of training of the patients’ primary care provider (attending vs. resident).
On Mar 9, 2017, the clinic protocol identifying/calling patients with A1c &gt;9% was initiated, the first diabetes clinic was on Sep 8, 2017, and the first diabetes fellow clinic was on July 30, 2018. Our initiative resulted in a reduction in the number of patients with A1c &gt;9% in the resident clinic (30% vs. 22.6% vs. 20.9% in Feb 2017, Nov 2017, and Dec 2018 respectively) and the attending clinic (24% vs. 19.3% vs. 17.9% in Feb 2017, Nov 2017, and Dec 2018 respectively). Our clinic’s overall number of patients with A1c &gt;9.0% improved from 21.6% in Nov 2017 to 20.02% in Dec 2018.
Our project has been successful in reducing the percentage of patients with an A1c &gt;9%. Our project also reflects real-time attempts to improve clinic-wide glycemic control while continuously establishing care with new patients in a primary care clinic.

Disclosure
B.M. Mishriky: None. J.R. Powell: None. C.E. Holoman: None. M.R. Mian: None.
2394-PUB: Addressing Diabetes Therapy Inertia during Acute Care Transition
Authors: BROWN ALEXANDER , BELALCAZAR L. MARIA 
Published: June 2019

Transition into inpatient care represents a moment of increased metabolic vulnerability for patients with diabetes. There is scant information on diabetes therapeutic inertia during patient acute care transition. We examined the prevalence of therapeutic inertia among internal medicine (IM) residents admitting adults with diabetes on insulin to the hospital, and hypothesized that lack of change in insulin prescribing behavior was associated with decreased knowledge and perceived self-efficacy and that it could be modified by a provider-based multimodal diabetes education intervention (PB-DM-EDI).
Methods: IM inpatient residents were surveyed on perceived self-efficacy and evaluated on insulin therapy knowledge. A PB-DM-EDI including group sessions and on-site one-to-one patient-based teaching addressing knowledge, skills and electronic diabetes order sets and tools (DMOST) use was implemented over 4-months. Insulin regimens were reviewed during a 3-month period prior to and after PB-DM-EDI to screen for therapeutic inertia on admission, defined by the lack of change of pre-admission insulin orders.
Results: We analyzed 51 surveys and 325 patient insulin regimens; 28 surveys and 148 patients prior to PB-DM-EDI and 23 surveys and 177 patients post PB-DM-EDI. Therapeutic inertia was identified in 49.3% and 35.6% of patients before and after PB-DM-EDI, respectively. Surveys revealed low self-efficacy and knowledge relating to insulin therapy; frequent DMOST use was only reported by 50% of residents. PB-DM-EDI increased perceived self-efficacy by 20%, basic knowledge by 5-18%; and self-reported frequent use of DMOST by 15%.
Conclusion: Therapeutic inertia is high among providers caring for patients with diabetes transitioning to the acute care setting and is associated with decreased knowledge and self-efficacy with insulin management. Education interventions that incorporate EMR DMOST may decrease therapeutic inertia, but need to be combined with other strategies to increase their effectiveness.

Disclosure
A. Brown: None. L. Belalcazar: None.
24-LB: Continuous or Transient High Level of Glucose Exposure Differentially Increases Coronary Artery Endothelial Cell Proliferation and Human Colon Cancer Cell Proliferation
Authors: OKADA JUNICHI , OKADA SHUICHI , YAMADA MASANOBU 
Published: June 2019

We studied effect of high glucose levels on coronary artery endothelial cell proliferation and human colon cancer cell proliferation. To examine the long-term effect of glucose exposure on cell growth, cells were cultured for 14 days in the absence or presence of 183 mg/dL D-glucose addition in the culture medium. Short effect of elevated glucose levels was examined by addition of 183 mg/dL D-glucose addition in the culture medium for just one hour per day followed by changing the culture to standard medium (5.5 mM D-glucose) during the next 23-hours period. Cell proliferation was estimated by 2,3-Bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carbox-anilide (XTT) assay and phosphor-Erk western blot analysis. We found that coronary artery endothelial cell proliferation was significantly increased in the culture medium with the acute one-hour addition of 183 mg/dL D-glucose compared to the absence or chronic presence of 183 mg/dL D-glucose addition in the culture medium. In contrast, colon cancer cell proliferation was significantly increased in the continuous presence of 183 mg/dL D-glucose addition in the culture medium compared to the acute one-hour addition of glucose. The extent of Erk2 phosphorylation paralleled with the relative changes in cellular proliferation in both cell types. Taken together, these results suggested that continuous or transient high level of glucose exposure differentially effects coronary artery endothelial and human colon cancer cell proliferation.

Disclosure
J. Okada: None. S. Okada: None. M. Yamada: None.
2403-PUB: Predictors of Poor Glycemic Control in a Diabetes Transition Age Cohort at the Johns Hopkins Hospital
Authors: EVERETT ESTELLE M. , LEE JASON T. , SIDHAYE ANIKET 
Published: June 2019

Introduction: Transition of care to adult endocrinology is associated with clinical deterioration in young adults with diabetes. We characterized the young adult patient population with diabetes at our institution’s adult endocrinology clinics to identify patients’ characteristics associated with poor glycemic control.
Methods: We completed a retrospective cohort study of patients aged 16-25 with diabetes, whose first visit with an adult endocrinologist at any of 4 sites within our medical system occurred between July 1st, 2011 and June 30th, 2015. The following factors were analyzed: visits with pediatric endocrinology at our center, age, race, ethnicity, gender, social deprivation index, and age of diabetes onset. The primary outcome was mean hemoglobin A1c ≥ 10% in the 2 years after establishing care with adult endocrinology.
Results: We identified 264 patients who met inclusion criteria. Our preliminary analysis shows that 107 (40%) had a mean A1c ≥ 10%, which was associated with the following patient characteristics: male gender (OR 1.95 95% CI 1.02-3.74), younger age, with every year placing patient at a 5% increased risk (OR 1.3; 95% CI 1.1-1.5), black race (OR 9.03; 95% CI 3.43-28.2) and being seen in pediatric endocrinology clinic at the same institution (OR 2.34; 95% CI 1.12-4.87). Interestingly, there was no increased risk associated with diabetes type, diagnosis age, ethnicity and area social deprivation tertile.
Conclusion: We found a high prevalence of mean A1c ≥ 10% in our population. Preliminary analysis of data suggests certain patient groups are at high risk of poor control. Additional analysis is needed to determine factors associated with this clinical deterioration. In the future, intervention strategies maybe targeted to high risk populations to improve overall outcomes in our population of young adults with diabetes.

Disclosure
E.M. Everett: None. J.T. Lee: None. A. Sidhaye: None.