bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Costs of Diabetic Ketoacidosis Presenting at Diagnosis of Diabetes among Privately Insured Youth, 2016
Authors: SHRESTHA SUNDAR , ZHANG PING , IMPERATORE GIUSEPPINA 
Published: June 2018

Diabetes ketoacidosis (DKA) is a potentially preventable acute and severe complication of diabetes (DM). Youth often present with DKA at DM diagnosis and having DKA predicts poor long-term glycemic control. Little is known about the medical costs associated with DKA presenting at DM diagnosis. Using 2010-2016 MarketScan claims data, we estimated the occurrence of DKA at DM diagnosis and compared medical costs 60 days prior and post DM diagnosis in youth (age &lt;20 years) with and without DKA. We identified newly diagnosed DM as having ≥1 inpatient or ≥2 outpatient claims 30 days apart with DM codes, but no DM claim or prescription of DM medications in the two years prior to DM diagnosis, no history of acute/chronic pancreatitis, and no gestational DM. Both DM and DKA were identified using ICD9 or ICD10 claim codes. We estimated medical costs (in U.S. $2016) using regression models (Table). Among 3,301 youth with newly diagnosed DM, 43% presented with DKA. As compared to youth without DKA, those with DKA were younger and more likely to be males (p&lt;0.05). Health services use and total medical costs are presented in Table. The presence of DKA at DM diagnosis was associated with large financial burden to both the health care system (&gt;$6,500) and to patients (&gt;$1,100). These data could be used for planning and evaluating interventions aimed at preventing this life-threating condition.
Table.Heath services use and medical costs among youth, 60 days prior and post diabetes diagnosis by DKA status at diagnosis.Outcomes60 Days Prior DM Diagnosis 60 Days Post DM Diagnosis With DKAWithout DKAExcess With DKAWithout DKAExcessMean Health Services use:No. of outpatient visits2.103.27-1.17***4.594.66-0.07No. of office visits1.061.38-0.32***2.362.080.28***No. of ER visits0.270.270.010.230.210.03No. of inpatient admissions1.000.650.35***1.010.670.34***Length of stay, days2.451.820.63***2.472.0060.47***Estimated Medical costs:Outpatient#$2,075$1,275$801***$2,883$1,792$1,091***Inpatient##$13,706$8,698$5,008***$13,765$9,227$4,538***Prescription drugs#$91$175-$84***$2,417$1,463$954***Total#$15,872$10,147$5,725***$19,065$12,482$6,583***Total copay#$2,099$1,193$907*** $2,588$1,453$1,135***Notes: *=p&lt;0.05, **=p&lt;0.01, ***=p&lt;0.001; ER= Emergency Room; # Estimated using a generalized linear model with log link and gamma distribution; ## Estimated using a two-part model: logistic regression and generalized linear model with log link and gamma distribution controlling for age and sex.

Disclosure
S. Shrestha: None. P. Zhang: None. G. Imperatore: None.
Improving Diabetes Outcomes in Rural Dominican Republic
Authors: WALKER ELIZABETH A. , DETHLEFS HENRY J. , DOWD RACHEL A. , SCHECHTER CLYDE , FILIPI CHARLES 
Published: June 2018

The Dominican Republic (DR) is a Caribbean country of 10 million with estimated diabetes prevalence at ∼11%. While the public health system has a diabetes program, there are few reliable surveillance data to portray diabetes outcomes in the DR. The HbA1c is not a widely available test for metabolic control in the DR. In 2010, a non-profit group, Chronic Care International (CCI), began a diabetes and hypertension program with 2 clinics in poor, rural DR. CCI developed a model of quality improvement for care and self-management with its Dominican medical team, including doctors, nurses and community health workers. We present process and outcome data collected over 6 years utilizing electronic medical records. In addition to quality improvement analyses, we fit a random-effects linear model to the data to assess trends over time. By May 2017, subjects (N=1,031) were adults: mean age 60.1 years, 45% men, 74% with T2DM. Of those with diabetes (n=758), 76% had an HbA1c &lt;9%, with 86% having had an HbA1c test done in the last 4 mos. Of 650 with hypertension, 64% had a BP &lt; 140/90mmHg. In assessing trends over time, we found the modeled HbA1c trajectory for those with diabetes showed an average decline of 0.13 percentage points per year (95% CI 0.10-0.15) over 6 years. The modeled BMI trajectory for all subjects showed an average decline of 0.kg/m2 per year (95% CI 0.04-0.08) over 6 years. For those with a dx of hypertension, the modeled BP trajectories are biphasic, showing decreases over years 1 and 2, followed by increases. Systolic BP averaged a decline of 3.5mmHg (95% CI 3.0-4.0) per year, followed by an average increase of 1.7mmHg (95% CI 1.3-2.1) per year. Diastolic BP averaged a decline of 2.4mmHg (95% CI 2.1-2.7) per year, followed by an increase of 0.27mmHg (95% CI 0.03-0.5) per year. While decline trends in HbA1c and BMI are encouraging for this model of care in rural areas of this developing country, some challenges in managing BP remain, even with access to several antihypertensive medications. Program sustainability and access to healthy food and exercise are DR priorities.

Disclosure
E.A. Walker: None. H.J. Dethlefs: None. R.A. Dowd: None. C. Schechter: None. C. Filipi: None.
Key Clinical Risk Factors Identify Adverse Glycemia in Hospitalized Patients
Authors: KYI MERVYN , REID JANE E. , GORELIK ALEXANDRA , KUMAR SHANAL S. , GALLIGAN ANNA , ROWAN LOIS M. , NANKERVIS ALISON J. , MARLEY KATIE A. , RUSSELL DAVID M. , WRAIGHT PAUL R. , COLMAN PETER G. , FOURLANOS SPIROS 
Published: June 2018

We previously showed that a proactive inpatient diabetes service decreased adverse glycemia (AG) and hospital acquired infections (RAPIDS: ADA2017, 231-OR). To further focus our proactive care on high-risk inpatients, we investigated clinical risk factors associated with AG. We analyzed multiple clinical variables in 643 consecutive inpatients with diabetes or new hyperglycemia (random BG ≥11.1mmol/L). Capillary BG from day 2 of admission until discharge (censored at day 14) were analyzed. AG was defined as BG &lt;4 or &gt;15mmol/L on any day and recurrent AG (RAG) was defined as AG on ≥2 days. A split-sample multivariable logistical regression was performed with internal validation. The patient characteristics included 87% type 2 diabetes, 33% insulin-treated and mean HbA1c 7.6%. AG and RAG occurred in 278 (43%), and 176 (27%) patients respectively. Pre-hospital factors (sulphonylurea or insulin treatment, HbA1c, Charlson index) and in-hospital factors (dysglycemia on day 1, length of stay) were independently associated with both AG and RAG (Table). Glucocorticoid treatment was associated with RAG but not AG. A model using these multiple variables accurately identified AG (ROC-AUC 0.88). Age, diabetes type, creatinine and admission unit were not associated with either AG or RAG. This study identified multiple key clinical risk factors associated with adverse glycemia, and may be used to better concentrate efforts for inpatient diabetes care.

Disclosure
M. Kyi: None. J.E. Reid: None. A. Gorelik: None. S.S. Kumar: None. A. Galligan: None. L.M. Rowan: Speaker's Bureau; Self; AstraZeneca, Sanofi, Novo Nordisk Inc.. A.J. Nankervis: None. K.A. Marley: None. D.M. Russell: None. P.R. Wraight: None. P.G. Colman: None. S. Fourlanos: None.
Documentation of Continuous Subcutaneous Insulin Infusion (CSII) Use in the Emergency Department (ED)
Authors: RUSHAKOFF ROBERT J. , ZOOK JESSICA , MACMASTER HEIDEMARIE W. 
Published: June 2018

The Institute for Safe Medication Practices recommends patients on CSII who present to the hospital (inpatient or the ED), should have CSII use and settings verified within 12 hours. Without CSII orders or scheduled glucose checks in the ED, adverse glycemic excursions from insulin pump misadventures can occur, increasing risk of DKA or severe hypoglycemia.
At University of California, San Francisco, (UCSF) 25% of admitted patients enter via the ED with an average door-to-admission of &gt; 12 hours. We have mandatory insulin pump orders for inpatients. To determine the timing of CSII orders, documentation and glucose levels, we performed a retrospective review of patients admitted from the ED who remained on CSII, from June 2012 to August 2016.
32 patients (age 54.3 ± 14.6 years) were admitted to the hospital from the ED who were continued on CSII. We were unable to capture data on ED patients not admitted or who had their CSII discontinued. 37.5% did not have CSII orders written within 12 hours of presentation to the ED. The average time to insulin pump order was 13.3 hours. 43% presented to the ED between1900-0700. The mean time to first glucose was 1.27 hours ± 1.47, and 15.6% had no glucose check within the first 2 hours. &lt;50% had CSII integrity documented (insulin reservoir, site intact, battery capacity) in the first 24 hours. Glycemic control was assessed by 6-hour periods. For these 4 periods: Glucose 80-180 mg/dl (13/32; 12/32; 15/32; 9/32); &gt;180 mg/dl (18/32; 11/32; 12/32; 12/32); &lt;80 mg/dl (0/32; 2/32; 2/32; 2/32); no glucose (0/32; 7/32; 3/32; 9/32). Continuous glucose monitor readings are not part of the patient’s medical record as not approved for clinical decision making.
We found few patients had CSII orders or documentation nor appropriate glucose monitoring in the initial 12 hours after presentation to the ED. We anticipate new ED policies, procedures, and RN protocols, with use of new ED pump order sets and early patient involvement, will improve guideline compliance and patient care.

Disclosure
R.J. Rushakoff: None. J. Zook: None. H.W. Macmaster: None.
HbA1c Screening Characterizes Undiagnosed Dysglycemia in Surgical Patients
Authors: DUGGAN ELIZABETH W. , O'REILLY-SHAH VIKAS N. , TSEGKA KATERINA G. , GALINDO RODOLFO J. , UMPIERREZ GUILLERMO E. 
Published: June 2018

Perioperative hyperglycemia is associated with increased morbidity and mortality. We analyzed the prevalence of undiagnosed dysglycemia, prediabetes (pre-DM) and diabetes (DM), in at-risk patients undergoing elective surgery at a large academic medical center.
Methods: As part of a quality improvement project, patients reporting no history of diabetes, and meeting screening criteria (age &gt; 45 years and/or BMI &gt; 25 kg/m2), had an HbA1c measured during their Anesthesia Preoperative visit from 01/2015 to 12/2017. The Emory Clinical Data Warehouse was queried for demographics and blood glucose (BG) during hospitalization. Normoglycemia, pre-DM and DM were defined as HbA1c &lt;5.7%, &gt;5.7% to 6.5%, and &gt;6.5%, respectively.
Results: Among 7,430 patients denying history of DM, 4,204 (57%) met screening criteria. Prevalence of normoglycemia, pre-DM and DM was 69%, 27.2% and 3.9% respectively. Hospital BG was measured in 92% (n = 3,878); stress hyperglycemia (BG &gt; 180 mg/dl) was observed in 6.4% of normoglycemia, 10.6% of pre-DM and 30.5% of DM patients (p &lt;0.001).
Conclusion: A universal pre-operative screening using HbA1C identified a high prevalence of undiagnosed pre-DM (27.2%) and DM (3.9%) in older and overweight adults. Dysglycemic patients were statistically more likely to experience stress hyperglycemia. Future research is needed to assess if intervention can reduce perioperative complications in this population.CharacteristicsNormoglycemiaPre-DiabetesDiabetesp-valueHbA1C, median5.3%5.9%6.7%Patients, n (%)2,892 (69%)1,148 (27.2%)164, (3.9%)Age, (years)57 ± 1461 ± 1261 ± 12P&lt;0.01BMI, (kg/m2)29.0 ± 6.531.1 ± 7.733.6 ± 8.7P&lt;0.01Female Gender, n (%)1,741 (60%)685 (60%)92 (56%)P = 0.53BG&gt; 180 mg/dl, n (%)171 (6.4%)113 (10.6%)50 (30.5%)P &lt; 0.001

Disclosure
E.W. Duggan: None. V.N. O'Reilly-Shah: None. K.G. Tsegka: None. R.J. Galindo: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..
The Pro-Diab Perioperative Study—A Structured Perioperative Diabetes Management Plan Improves Medication Usage and Glycemia in Elective Surgery
Authors: DAMIEN QI QI YANG , PEMBERTON ELIZABETH J. , KYI MERVYN , COLMAN PETER G. , FOURLANOS SPIROS 
Published: June 2018

The perioperative management of diabetes inpatients is complex, often inconsistent and frequently results in suboptimal glycemia. We designed, implemented and evaluated a structured perioperative diabetes management plan (PDMP) on appropriate diabetes medication usage and glycemia in the perioperative period, in elective non-cardiac surgery patients. A multidisciplinary team developed and implemented a novel structured PDMP at our tertiary hospital. This observational study audited perioperative diabetes management over 4 months pre-implementation (non-structured care) and 4 months post-implementation (structured PDMP care). Primary outcome was appropriate use (documented recommendation, prescription and administration) of diabetes medications in the perioperative period. Secondary outcomes included blood glucose (BG) monitoring practice and glycemia. Pre- and post-implementation groups comprised 138 and 141 patients respectively, all of whom attended preadmission clinic and were admitted on the day of the procedure. The two groups were well matched in clinical characteristics. The PDMP was completed correctly in 107 (76%) patients in the post-implementation group. The appropriate use of diabetes medications increased from 30% to 72% between pre- and post-implementation groups (p&lt;0.001). Appropriate BG monitoring also increased (25% vs. 51%, p&lt;0.001). There was improvement in glycemia with post-implementation group having lower BG in the preoperative period (mean±sd: 10.2±4.6 vs. 8.8±3.9 mmol/L, p=0.001); postoperative period (10.4±3.5 vs. 9.3±3.6 mmol/L, p=0.002); and in the entire perioperative period (10.3±4.1 vs. 9.0±3.8 mmol/L, p&lt;0.001). This practical, implementable and novel structured perioperative diabetes management plan for elective surgery patients significantly improved diabetes medication usage, BG monitoring, and glycemia in the perioperative period.

Disclosure
Q. Qi: None. E.J. Pemberton: None. M. Kyi: None. P.G. Colman: None. S. Fourlanos: None.
Application of a Cloud-Based Medication Adherence Improvement (MAI) System to Assist Diabetic Care in China
Authors: LI YINGJIE , CAO JIUMEI , WANG WEI , WANG ZHEN , LI DONGXING , ZHANG HONGGUANG , LIU KAI 
Published: June 2018

Objective: To evaluate the effects on medication adherence by employing a cloud-text messaging platform connecting to the pharmacy Enterprise Resource Planning (ERP) system and diabetic patients.
Methods: We developed a cloud engine housing a continuously growing knowledge database of 5,245 drugs. This database is broken down to 5 different categories of text messages, providing contents of each drug’s 1) indication and dosage, 2) precautions and side effects, 3) relevant disease information, 4) relevant lab test interpretation, and 5) medication reminders. This cloud-based service was offered as Software as a Service (SaaS) by connecting to pharmacies’ ERP, allowing the engine to identify the patients in real-time who filled prescriptions within the drug store and auto-send text messages at dosage-adjusted intervals. During the past 8 months, 9,802 patients at 970 pharmacies in 8 cities received this intervention and medication adherence was measured by Proportion of Days Covered (PDC).
Results: PDC of the study population was improved from 57.9% at baseline to 67.0% at last time, P&lt;0.001. PDC changes were further categorized into various groups by medications of use and intervention durations (Table 1A and 1B), and a global adherence improvement was found.
Conclusion: Text message-based knowledge delivery is an effective way to improve medication adherence for community diabetic patients.

Disclosure
Y. Li: None. J. Cao: None. W. Wang: None. Z. Wang: None. D. Li: None. H. Zhang: None. K. Liu: None.
Culturally-Specific Diabetes Care Reduces Disparities in Metabolic Control
Authors: KAREN LAU KA HEI , POBER DAVID M. , MEHTA SANJEEV N. , HSU WILLIAM C. , KING GEORGE L. 
Published: June 2018

Culturally-specific care for Asian Americans (AA) with diabetes may reduce their healthcare disparities and improve outcome. One-year outcomes of an integrated clinic for AA at a tertiary diabetes center previously showed more patients attaining A1C &lt;7% and composite A1C, blood pressure (BP) and cholesterol (ABC) goal than whites in the general Adult Diabetes clinic. In a follow-up study to observe the clinical performance over 4 years, data for patients with T2DM who came during January 1, 2013 to December 31, 2016 were compared among AA in Asian Clinic (AAC, n=162), AA in general Adult Diabetes Clinic (AAD, n=118), and whites in Adult Diabetes Clinic (WAD, n=2846). There was no significant difference in baseline A1C. Patients in AAD were younger (P=0.0003) and diagnosed at an earlier age (P=0.04). Patients in AAC had the lowest BMI of 25.6 kg/m2 (P&lt;0.0001). The majority of patients in AAC use English as a second language and had lower income. After one year, 37% of patients in AAC achieved the ABC goal, compared to 31% in AAD (P=0.29) and 28% in WAD (P=0.03). Clinical outcomes in AAC were compromised in 2014-2015 in parallel to a transient reduction in Asian Clinic providers. The percentage of AAC patients achieving the ABC goal dropped to 29% (P=0.008) and 23% (P&lt;0.001) in 2014 and 2015 respectively. With the restoration of adequate staffing in 2016, the percentage of AAC patients reaching the ABC goal in 2016 increased to 26%, which is comparable to AAD and WAD (P&gt;0.85). Percentage of patients with A1C &lt;7% was not significantly different among groups at the end of the study (P&gt;0.25). Despite financial and language difficulties, staff providing clinical care tailored to the need of AA, the AAC was able to reduce healthcare disparity in metabolic outcomes in Asian Americans with diabetes over a long duration.

Disclosure
K. Lau: None. D.M. Pober: None. S.N. Mehta: None. W.C. Hsu: Board Member; Self; Intarcia Therapeutics, Inc.. Advisory Panel; Self; Twine Health, Inc. G.L. King: Research Support; Self; Sanofi-Aventis.
Hypertension-Associated Medical Expenditures by Diabetes Status among Adult Female Medicaid Enrollees in Alabama
Authors: WANG GUIJING , NG BOON PENG , PARK CHANHYUN , FANG JING , RITCHEY MATTHEW , SOLER ROBIN , SMITH BRYCE , ZHANG PING 
Published: June 2018

Little information is available on how diabetes status affects medical expenditures associated with hypertension among Medicaid enrollees. In 2013, Alabama had the highest proportion of Medicaid enrollees who were women and the highest hypertension prevalence in the U.S. We estimated hypertension-associated medical expenditures among adult female Medicaid enrollees by diabetes status in Alabama. We used data for 15,885 female Medicaid enrollees aged 19-64 years from the 2012 Medicaid Analytic extract files. We identified persons with hypertension and diabetes using ICD-9 codes. We used General Linear Models to estimate per person total annual medical expenditures associated with hypertension by diabetes status and hypertension-related conditions including myocardial infarction, congestive heart failure, peripheral vascular disease, chronic pulmonary disease, renal disease, and stroke. Overall hypertension prevalence was 20.8%, with 60.0% and 17.5% among those with and without diabetes, respectively. Annual medical expenditure per enrollee with hypertension was $7,722. After controlling for age, race, and Charlson comorbidity index, hypertension-associated excess annual medical expenditures were $2,540 and $2,926 for persons with and without diabetes (all p&lt;0.01). For persons without hypertension-related conditions, the excess expenditures were $1,931 and $2,533 for those with and without diabetes (all p&lt;0.01). For persons with at least one hypertension-related condition, these excess expenditures increased to $4,217 and $3,264, respectively (all p&lt;0.01). Having hypertension increased medical expenditures greatly regardless of diabetes status. Having a hypertension-related condition further increased hypertension-associated medical expenditures among enrollees, especially in those with diabetes. These results can inform the development and evaluation of strategies to improve management of hypertension by diabetes status.

Disclosure
G. Wang: None. B. Ng: None. C. Park: None. J. Fang: None. M. Ritchey: None. R. Soler: None. B. Smith: None. P. Zhang: None.
Childhood Metabolic Markers Are Associated with Performance on Cognitive Tasks in Young Children—The Healthy Start Study
Authors: SHAPIRO ALLISON L.B. , WILKENING GRETA , TREGELLAS JASON R. , AALBORG JENNY , RINGHAM BRANDY , STAMATOIU ALEXANDRA V. , BANNING ALEXIS , DABELEA DANA 
Published: June 2018

A substantial body of literature has implicated metabolic health as a significant contributor to cognitive functioning in adults. However, this has not been investigated among young children whose cognitive functions are still developing. Using data from 4 to 6-year-old healthy children participating in the Healthy Start study, an ongoing pre-birth cohort, we tested the hypothesis that current metabolic parameters (fasting glucose, insulin and Homeostatic Model of Assessment for Insulin Resistance [HOMA-IR] levels) are inversely associated with performance on cognitive tasks, measured via the NIH Toolbox cognition battery. Fully corrected T-scores for inhibitory control (Flanker task), cognitive flexibility (Dimensional Change Card Sort test), and language (Picture Vocabulary test) were obtained. General linear models were used to test the associations between child metabolic markers and cognitive test scores. All models were stratified by race/ethnicity (n = 53 non-Hispanic white [NHW]; n = 45 others) and adjusted for APGAR scores at birth. Among NHW children, fasting glucose, insulin, and HOMA-IR were inversely associated with scores for inhibitory control (β = -3.16, β = -4.46; β = -3.90; p&lt;0.for all), while fasting glucose was also associated with lower language scores (β = -3.88, p&lt;0.05). Among children of other racial/ethnic groups, only fasting glucose was significantly associated with lower cognitive flexibility scores (β = -4.19, p&lt;0.05). Our data suggest that metabolic health may impact cognitive development in young children. Further work is needed to replicate these findings and explore the neural underpinnings of these associations.

Disclosure
A.L.B. Shapiro: None. G. Wilkening: None. J.R. Tregellas: None. J. Aalborg: None. B. Ringham: None. A.V. Stamatoiu: None. A. Banning: None. D. Dabelea: None.