bluuebunny/crossref_metadata_2025_split huggingface dataset:
2333-PUB: CPL207-280, a Potent and Safe GPR40 Agonist for the treatment of Type 2 Diabetes
Authors: BAZYDLO-GUZENDA KATARZYNA , BUDA PAWEL , KOZLOWSKA IZABELA , MACH MATEUSZ , TESKA-KAMINSKA MALGORZATA , STELMACH FILIP , WASINSKA-KALWA MALGORZATA , GALAZKA KINGA , DUBIEL KRZYSZTOF K. , PIECZYKOLAN JERZY S. , WIECZOREK MACIEJ 
Published: June 2019

Targeting GPR40 receptor has been proposed as novel modality for patients with insufficient blood sugar control or in tolerating popular drugs. It belongs to G-protein coupled receptors family and is highly expressed in pancreatic β-cells where it mediates free fatty acid-induced insulin secretion. Although several synthetic GPR40 agonists have been generated none of them found use in the clinic predominantly due to safety issues. Therefore, the greatest interest in the field has been focused on safety and favorable pharmacokinetics. In previous study we showed a new, effective GPR40 agonist, which displayed promising safety profile in vitro. Here we show the safety, biological and pharmacological effects of CPL207-280 in rats and non-human primate (NHP) T2D models.
Pharmacokinetic studies in rats and NHP showed very high bioavailability (F) (80% and 87% in rats and monkeys, respectively) of the compound CPL207-280 and favorable half-time (t1/2kel): 4,75 h in rats and 3,95 h in monkeys which can protect against compound accumulation (especially in the liver) during long term administration. CPL207-280 increased insulin secretion and showed dose-dependent improvement (at a dose range of 3-100 mg/kg) in GTT test in ZDSD rats and at a dose 15 mg/kg in diabetic NHP study. During toxicology study the maximum tolerated dose (MTD) for CPL207-280 was found at a dose of 1000 mg/kg and 500 mg/kg in rats and monkeys, respectively. In the 14-days (dose range finding) DRF study the (no observable adverse effect level) NOAEL was found at the level of 300 mg/kg and 100 mg/kg in rats and monkeys, respectively. Additionally, during a 28-days study in diabetic NHP at dose 15 mg/kg administrated p.o., no significant side effects were observed and all haematology and biochemical parameters including: total bile acids (TBA), total bilirubin (TB), ALT, AST, GGT were not changed compared to control group. This clearly demonstrates that CPL207-280 has a great potential to become a safe and effective candidate for treatment of T2D.

Disclosure
K. Bazydlo-Guzenda: Employee; Self; Celon Pharma S.A. P. Buda: Employee; Self; Celon Pharma S.A. I. Kozlowska: Employee; Self; Celon Pharma S.A. M. Mach: Employee; Self; Celon Pharma S.A. M. Teska-Kaminska: Employee; Self; Celon Pharma S.A. F. Stelmach: Employee; Self; Celon Pharma S.A. M. Wasinska-Kalwa: Employee; Self; Celon Pharma S.A. K. Galazka: Employee; Self; Celon Pharma S.A. K.K. Dubiel: Employee; Self; Celon Pharma S.A. J.S. Pieczykolan: Employee; Self; Celon Pharma S.A. M. Wieczorek: Other Relationship; Self; Celon Pharma S.A.

Funding
National Centre for Research and Development
2344-PUB: Predictors of the Glucose-Lowering or Weight-Loss Effects of Ipragliflozin and Sitagliptin
Authors: TSURUTANI YUYA , NAKAI KAZUKI , SAITO JUN , OMURA MASAO , NISHIKAWA TETSUO 
Published: June 2019

Sodium-glucose cotransporter 2 inhibitor and dipeptidyl peptidase-4 inhibitor are widely used in Japan, but only a few studies have directly compared the effects of these two drugs. We have reported that ipragliflozin (Ipra) had beneficial effects on fat reduction, insulin resistance, and lipid metabolism, while sitagliptin (Sita) had beneficial effects on β-cell function in a randomized controlled study. In this subanalysis study, we screened for predictors of the glucose-lowering effects of Ipra and Sita, and the weight-loss effects of Ipra. The participants were 119 patients aged 20-75 years with type 2 diabetes, HbA1c ≥ 6.5%, and BMI ≥ 23 kg/m2, and were randomly assigned to 12 weeks of treatment with 50 mg of either Ipra or Sita. We analyzed the correlations between the change in glycated hemoglobin HbA1c (ΔHbA1c) or body weight (ΔBW) and multiple clinical variables at the baseline. In the Ipra group, the mean ΔHbA1c was -1.1% and ΔBW was -2.2 kg. There was no significant correlation between ΔHbA1c and ΔBW (ρ = 0.22, p = 0.095). ΔHbA1c had a significant positive correlation with age (ρ = 0.41, p = 0.001) and negative correlation with the HbA1c level (ρ = -0.68, p &lt; 0.001), HOMA-IR (ρ = -0.36, p = 0.011), and ALT level (ρ = -0.34, p = 0.014), while ΔBW had a significant negative correlation with the total ketone concentration at the baseline (ρ = -0.31, p = 0.041). In the Sita group, the mean ΔHbA1c was -0.81%; no significant change in BW was seen. ΔHbA1c had a significant negative correlation with HbA1c level at the baseline (ρ = -0.42, p = 0.0016), but no significant correlation with other variables at the baseline.
In conclusion, our results suggest that the glucose-lowering effects of Ipra were more prominent in younger patients with increased insulin resistance accompanied by fatty liver, while its weight-loss effects were more prominent in patients with high total ketone concentration at the baseline. Meanwhile, the glucose-lowering effects of Sita may be exhibited regardless of the patient pathology.

Disclosure
Y. Tsurutani: Research Support; Self; Astellas Pharma Inc. K. Nakai: None. J. Saito: None. M. Omura: None. T. Nishikawa: None.
2346-PUB: Clinical Characteristics of SGLT2 Inhibitor User in Type 2 Diabetes with Atherosclerotic Cardiovascular Disease or Heart Failure in a Real-World Setting
Authors: JEONG SU JIN , PARK IE BYUNG , LEE SEUNG EUN , SHIN DONGHYUN , KIM KYOUNG-AH 
Published: June 2019

The treatment approach to type 2 diabetes (T2D) should begin with an assessment of atherosclerotic cardiovascular disease (ASCVD). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should be considered in T2D with established ASCVD or heart failure (HF). In this study, we analyzed the prescription patterns of ant-diabetic treatment in T2D with ASCVD or HF in real-world clinical practice. During 1-year period (2018), we reviewed 1553 consecutive T2D patients with ASCVD or HF visiting an endocrinology outpatient clinic from four teaching hospitals in Seoul Capital Area after excluding patients aged ≥85 years or estimated glomerular filtration rate (eGFR) ≤30 ml/min/1.73m2. Mean age was 65 years, duration of diabetes 11 years, and duration of ASCVD 7 years; HbA1C 7.5%, eGFR 80 ml/min/1.73m2, and body mass index (BMI) 25.6 kg/m2. ASCVD characteristics were stroke 27%, coronary artery disease (CAD) 59%, stroke+CAD 5%, peripheral arterial occlusive disease 1%, and heart failure 8%. Over four years, the initiation of SGLT2i has increased (2015=9% vs. 2018=42%). Compared with SGLT2i non-users (80%, n=1249), SGLT2i users (20%, n=304) tended to be younger (60 vs. 67) and with significantly lower stroke (16% vs. 30%). They also had higher BMI (27 vs. 25), worse HbA1C levels (8.1 vs. 7.4), and higher eGFR (88 vs. 78). Non-users with HbA1C 8 ∼9% (n=245) who might be eligible for switching to SGLT2i showed a longer duration of diabetes (14 vs. 11 years) or ASCVD (7.4 vs. 6.5 years) compared to users. The most common prescription pattern in non-users was triple oral glucose-lowering drugs (OGLD) followed by dual OGLD while in users, dual OGLD followed by triple OGLD. Interestingly, 0.5% were on GLP-1RA in this study. In contrast to clinical guidelines, a small proportion of T2D with ASCVD or HF is currently treated with SGLT2i in real-world clinical practice. The limiting factors for failing to initiate SGLT2i are age, stoke, eGFR, and clinical inertia.

Disclosure
S. Jeong: None. I. Park: None. S. Lee: None. D. Shin: None. K. Kim: None.
2349-PUB: Long-Term Efficacy and Safety of Canagliflozin in Type 2 Diabetes: A 52-Week Indian Experience
Authors: MAHAPATRA HARIBALLAV , KHUNTIA MONALISA , MAHAPATRA LAXMINARAYAN , DAS SREEYA , JENA BISWARANJAN , MISHRA SUSANT , PADHI RAJESH K. , JENA APURBA RANJAN , KHATUA RANJIT KUMAR , PATWARI AJAY , PRADHAN SANTOSH KUMAR , BISWAL SOUBHAGYA , NAYAK SAURABHA , MISHRA UMA SHANKAR , SAHOO ABHAY KUMAR 
Published: June 2019

Introduction: SGLT2 inhibitors are a new class of drugs approved for type 2 diabetes (T2DM) and have been placed high in treatment algorithm following the robust data supporting their use.
Aim: We studied the long term efficacy and safety of Canagliglozin (CANA) versus placebo in Indian adults with type 2 diabetes who were inadequately controlled with metformin (MET) monotherapy.
Methods: The study was undertaken at Sevayan Diabetes Centre, India with due consent from participants. Patients (HbA1c 8-12%) on MET were invited to participate. Those on other antidiabetic drugs or insulin were excluded. The CANA arm was administered CANA 100mg OD in addition to MET. The other group received placebo (PBO) and MET. Doses of MET were kept unchanged throughout the study. Antihypertensive, statin and antiplatelets were continued unchanged. Participants were compared after 52 weeks of enrollment.
Result: Data of 96 (M/F 62/34) subjects were available for analysis (n=46 on CANA, n=50 on PBO). Groups were similar at baseline. Pre-enrollment HbA1c (%), FPG (mg%) and PPG (mg%) in CANA and PBO arm were 9.94±1.04 and 9.89±1.1, 193.2±26.1 and 193.6±33.0 and 261.3±28.1 and 260.5±30.3 in order (p=NS for all). After 52 weeks of treatment, CANA arm showed clinically meaningful 1.61±1.05% reduction in HbA1c from baseline (p= 0.0048), whereas the PBO arm witnessed a non-significant elevation in HbA1c. Use of CANA significantly decreased FPG by 60.05±17.75mg% and PPG by 62.35±21.92 mg%, whereas the PBO group noticed no appreciable changes in those glycemic parameters. Mycotic infections were common in CANA users (n=6 vs. n=3 in PBO), but improved with personal hygiene. Incidences of documented hypoglycemia were similar in both groups (12 in each).
Conclusion: In Indian diabetics uncontrolled with metformin monotherapy, addition of canagliflozin resulted in statistically significant and durable reductions in HbA1c, FPG and PPG over 52 weeks period. Participants tolerated CANA well without any additional risk of hypoglycemia.

Disclosure
H. Mahapatra: None. M. Khuntia: None. L. Mahapatra: None. S. Das: None. B. Jena: None. S. Mishra: None. R.K. Padhi: None. A.R. Jena: None. R.K. Khatua: None. A. Patwari: None. S.K. Pradhan: None. S. Biswal: None. S. Nayak: None. U.S. Mishra: None. A.K. Sahoo: None.

Funding
Jyoti Foundation
2351-PUB: Influence of Short-Term Improvements in Glycemic Control with Intensive Insulin Therapy on Pancreatic a-Cell Function and the Relationship between Concurrent SGLT2 Inhibitor Therapy and Insulin Withdrawal
Authors: MATSUI MAKIKO , TAKAHASHI HIROSHI , SAWANO SHOUKO , MORI YUTAKA , UTSUNOMIYA KAZUNORI 
Published: June 2019

Objective: We investigated the relationship between insulin withdrawal (IW), endogenous insulin recovery, and concurrent SGLT2 inhibitor (SGLT2i) therapy.
Patients and Methods: Of the 78 type 2 diabetic patients admitted for glycemic control and subjected to meal tolerance tests (MTT) on the next day after admission and immediately before discharge using the same diabetes diet while off treatment, 39 patients who had received intensive insulin therapy after admission were subjected to retrospective analysis. Of these, 26 patients in whom insulin withdrawal had been achieved during admission were divided into those who had received concurrent SGLT2i therapy (n=19) and those who had not (n=7). Insulin secretion in terms of ΔCPR/ΔPG 0-30 min and AUC-CPR 0-2 h during the MTT was compared at admission and discharge.
Results: 1) While there was no significant difference between those with IW and those without IW in their age, BMI, HbA1c, C-peptide index and urinary CPR excretion at admission, significantly more patients with IW had received SGLT2i than those without IW (P &lt; 0.001). Again, ΔCPR/ΔPG 0-30 min and AUC-CPR 0-2 h were significantly (p&lt;0.001) increased in those with IW but not in those without IW. 2) In those with IW, while ΔCPR/ΔPG 0-30 min and AUC-CPR 0-2 h were significantly (p&lt;0.05) increased in both of those with SGLT2i and those without, the time to IW was shown to be significantly shorter (p&lt;0.01), the maximum daily insulin dose lower, and the duration of hospital stay shorter, in those with SGLT2i therapy than in those without.
Conclusions: Study results confirmed that endogenous insulin secretion was significantly restored in those with IW and that the time to IW was significantly shorter in those with concurrent SGLT2i therapy than in those without, suggesting a role for SGLT2i in achieving IW.

Disclosure
M. Matsui: None. H. Takahashi: None. S. Sawano: None. Y. Mori: None. K. Utsunomiya: None.
2354-PUB: Estimating Improvement of TGF Mechanism from Changes of Urinary Glucose and Sodium Excretion by SGLT2 Inhibitors
Authors: WATANABE CHIZURU , MORI YASUMICHI 
Published: June 2019

The renoprotective effect through the tubuloglomerular feedback mechanism (TGF) with the Sodium-glucose cotransporter2 inhibitor (SG) attracts attention. We investigated whether the improvement of TGF can be estimated from urinary glucose (UG) and urinary sodium (UNa) excretion, and from other parameters by assessing the changes of urinary findings in patients using SG (Dapagliflozin, Canagliflozin, Empagliflozin). Type 2 diabetes patients with SG who UG and UNa excretion were measured regularly were enrolled in this study. To correct for a postprandial increase of UG due to elevated plasma glucose(PG) levels, the creatinine-corrected UG (cUG: mg/mgCr) was calculated as follows. (The average PG level (AG mg/dl) = 28.7 × HbA1c- 46.7 (Diabetes Care 2008 Aug; 31(8): 1473-1478), the estimated UG (eUG) = UG × AG/PG). Then cUG was corrected for urinary creatinine excretion.) We analyzed these data at before, after 1, 3, 6, and 12 months (M) of SG treatment. Eighteen patients (14 men and 4 women, aged 54.9 ± 6.9 years, eGFR &gt; 100 in 3 and &lt; 60 in 2 patients) were investigated these parameters. Uric acid (UA), urine pH(pH) decreased after treatment, eGFR remained below baseline throughout the study period (p&lt; 0.05). About the mean (SE) UNa/cUG ratio, no differences were observed in this study(1M 2.9 (0.5)/3M2.6 (0.5)/6M2.3 (0.5)/12M 2.6 (0.4)). The UNa/cUG ratio was negatively correlated with HbA1c and eGFR. eGFR decreased more markedly in the patients with a baseline eGFR&gt;100. eGFR was negatively correlated with the UNa/cUG ratio and UA(p&lt;0.05). The renoprotective effect according to TGF improvement might be obtained in the patients whom cUG excretion increased remarkably, furthermore UA decreased and pH was lower. If the UNa/cUG ratio exceeds 2.6, the intraglomerular pressure cannot be improved sufficiently because salt intake is higher and UNa excretion increases independently of UG excretion. The UNa/UG ratio can be used to estimate improvement of TGF by SG in clinical practice.

Disclosure
C. Watanabe: None. Y. Mori: None.
2358-PUB: Efficacy and Safety of Tofogliflozin on 24-hr Glucose Profile Based on Continuous Glucose Monitoring—Crossover Study of Sodium-Glucose Cotransporter 2 Inhibitor
Authors: KUROZUMI AKIRA , OKADA YOSUKE , GOSHIMA YUKIKO , OTSUKA TAKASHI , NARISAWA MANABU , TORIMOTO KEIICHI , TANAKA YOSHIYA 
Published: June 2019

Background: Tofogliflozin (TOFO) has the highest selectivity to sodium-glucose co-transporter 2 (SGLT2) relative to SGLT1 (2900 times) and does not promote urinary glucose excretion at hypoglycemia compared with phlorhizin and does not enhance further lowering of glucose. To compare the impact of TOFO and ipragliflozin (IPR) on hypoglycemia in patients with T2DM, treated with sulfonylureas.
Methods: 30 patients were allocated to either 20 mg TOFO or 50 mg IPR and wore a continuous glucose monitoring (CGM, ipro2®) for 5 days at 3 times in a cross-over manner. The primary outcome measure was proportion of time over 24 hours with glucose less than 70 mg/dl detected by CGM and this was compared between two SGLT2 inhibitors.
Results: The percent time spent at glucose less than 70 mg/dl was 0.48, 2.77 and 0.06%, before treatment with SGLT2 inhibitors and treatment with IPR and TOFO (p=0.1135, between SGLT2 inhibitors). The addition of either IPR or TOFO to sulfonylureas markedly and significantly improved other CGM-derived parameters including average glucose, standard deviation of glucose, mean postprandial glucose excursion, percent time with glucose &gt;140, &gt;180 and &gt;200 mg/dl, area over the curve &lt;70, area under the curve &gt;140, &gt;180 and &gt;200, maximum glucose. However, there were no significant differences in these parameters between the SGLT2 inhibitors. We also conducted a sub-analysis in 16 patients who received DPP-4 inhibitors. The results showed the percent time at glucose level &lt;70 mg/dl (p=0.1118, between SGLT2 inhibitors) and the area over the curve &lt;70 (p=0.0631, between SGLT2 inhibitors), tended to be lower in patients treated with TOFO.
Conclusion: Based on the CGM the addition of TOFO to sulfonylureas tended to decrease the percent time spent in hypoglycemia in T2DM. The addition of SGLT2 inhibitors to sulfonylureas improved the average glucose level and reduced glucose fluctuations without increasing hypoglycemia.

Disclosure
A. Kurozumi: None. Y. Okada: None. Y. Goshima: None. T. Otsuka: None. M. Narisawa: None. K. Torimoto: None. Y. Tanaka: None.
2359-PUB: Clinical Effectiveness of Canagliflozin 100mg in T2DM Patients—A Real-World Study
Authors: CHAKRAVORTY SAIBAL , PATEL VIKAS KUMAR 
Published: June 2019

Objectives: To evaluate the clinical effectiveness of canagliflozin 100 mg (cana 100) in type 2 diabetes mellitus (T2DM) patients in an actual practice setting and to determine the effect of Canagliflozin on determinants of adiposity like body weight and body mass index (BMI).
Methods: In this retrospective cohort study, we used the private clinic medical records database. We included individuals with T2DM who were initiated Canagliflozin 100 mg at any time before 24 weeks (± 2 weeks). Changes in HbA1c, fasting plasma glucose (FPG), post-prandial glucose (PPG), body weight, BMI, occurrence of adverse effects/events at 12 and 24 weeks from baseline were evaluated.
Results: We identified 50 individuals with T2DM who were initiated with Cana 100 mg 24weeks (± 2 weeks) prior to collection of data. Individuals were, on average 53.3 ± 6.23 years old and 28% were female. Mean HbA1c, FPG, PPG, SBP, DBP, weight, BMI at baseline were 8.4%, 158.7 mg/dl, 236.5 mg/dl, 124.9 mm Hg, 82.3 mm Hg, 71.1 kg and 27.2 kg/m2 respectively. At 12 weeks, mean HbA1c decreased by 0.9%, PPG reduced by 53.6 mg/dl, weight decreased by 1.4 kg, BMI reduced by 0.5 kg/m2. At 24 weeks, outcomes were improved further: 1.6% reduction in HbA1c, 30.4 mg/dl reduction in FPG, 76.1 mg/dl reduction in PPG, 2.1 kg reduction in weight, 0.8 kg/m2 reduction in BMI. 6 patients reported incidence of genital infections and was treated symptomatically.
Discussion: In clinical trials, Canagliflozin 100 mg has shown efficacy in reducing HbA1c, FPG, PPG, SBP, DBP and body weight. The present study demonstrated efficacy of Cana 100 mg in T2DM patients under real world setting with similar reductions in HbA1c and body weight but slightly higher reductions in FPG and PPG than those shown in clinical trials. The study also showed reductions in determinants of adiposity like body weight and BMI.
Conclusion: The real-world data suggests that Cana 100 mg improved parameters of glycemic control, adiposity and body weight in T2DM patients in line with clinical trial outcomes.

Disclosure
S. Chakravorty: None.
2363-PUB: The Efficacy of Low vs. High FDA-Approved SGLT2 Inhibitor Dose Compared with DPP-4 Inhibitors: A Meta-analysis
Authors: UHRIG JARROD , MISHRIKY BASEM M. , PAGE STEPHANIE O. , SEWELL KERRY , POWELL JAMES R. , PATIL SHIVAJIRAO P. , CUMMINGS DOYLE M. 
Published: June 2019

All FDA-approved SGLT2 inhibitors (SGLT2i) are currently available in two doses. While most SGLT2i have demonstrated CV benefit, there may be a difference in hemoglobin A1c (A1c) reduction between both doses. We performed a meta-analysis to evaluate the efficacy of both SGLT2i doses compared to maximum DPP-4 inhibitor (DPP-4i) dose.
We searched MEDLINE, EMBASE, CENTRAL, and CINAHL for randomized trials comparing at least one FDA-approved SGLT2i dose to maximum DPP-4i dose in type 2 diabetes and reporting a change in A1c. We performed two separate analyses according to dose (low SGLT2i dose vs. DPP-4i and high SGLT2i dose vs. DPP-4i).
We included 12 trials. There was a significantly greater A1c reduction favoring lower SGLT2i dose compared to DPP-4i at ≥52 weeks (w) but not at ≤26 w (MD [95% CI] = -0.12% [-0.23, -0.02] and 0.00% [-0.06, 0.07] respectively) with an absolute A1c reduction of -0.76% vs. -0.75% at ≤26 w and -0.71% vs. -0.58% at ≥52 w respectively. When comparing higher SGLT2i dose vs. DPP-4i, there was a significantly greater A1c reduction for SGLT2i at ≤26 and ≥52 w (MD [95% CI] = -0.13% [-0.20, -0.05] and -0.26% [-0.36, -0.16] respectively) with an absolute A1c reduction of -0.91% vs. -0.77% at ≤26 w and -0.83% vs. -0.55% at ≥52 w respectively.
We conclude that low SGLT2i dose had similar A1c reduction as DPP-4i in early treatment but became significant as treatment was prolonged. Higher SGLT2i dose is favored over DPP-4i.

Disclosure
J. Uhrig: None. B.M. Mishriky: None. S.O. Page: None. K. Sewell: None. J.R. Powell: None. S.P. Patil: Research Support; Self; Novo Nordisk Inc. D.M. Cummings: None.
2369-PUB: The Type 1 Diabetes Care Index: A Novel Metric to Assess Overall Performance of a Pediatric Diabetes Program
Authors: OBRYNBA KATHRYN , INDYK JUSTIN A. , GANDHI KAJAL , BUCKINGHAM DON A. , KRAMER ALYSSA M. , HONG K. MING , GLICK BETHANY , WELLS TRAVIS , BARNARD-KIRK TOYETTA C. , SMITH MICHAEL-JOHN L. , MOFFETT AMY M. , KAMBOJ MANMOHAN K. 
Published: June 2019

Objective: Performance in providing optimal type 1 diabetes care has historically focused on only one metric, HbA1c. Our objectives were to design and test a metric that evaluated overall quality of care and to use this metric to drive improvement within our diabetes program.
Methods: The Type 1 Diabetes Care Index (T1DCI) aggregates missed opportunities for best practices into a composite score that reflects overall program performance. Elements of optimal care that should be reliably delivered were compiled into 14 domains over three areas: (1) Delivery of patient care, (2) Preventative Screening, (3) Psychosocial support. The T1DCI is the aggregate number of missed opportunities to provide quality care over a given time period. A lower T1DCI reflects better care and overall improved system performance.
Results: The T1DCI was easy to calculate and implement, and was well accepted by our diabetes team. The annual T1DCI progressively decreased from 5,338 at baseline to 3,821 after 10 months of utilization, a 14% reduction. Improvements in care were realized across some index domains and areas for focusing improvement efforts were recognized in others. New initiatives to provide optimal care were created.
Conclusions: The T1DCI is a useful metric to evaluate the ability of our program to deliver optimal care, and to document performance improvement across a broad range of domains.

Disclosure
K. Obrynba: Consultant; Self; Dexcom, Inc. J.A. Indyk: None. K. Gandhi: None. D.A. Buckingham: None. A.M. Kramer: None. K. Hong: None. B. Glick: None. T. Wells: None. T.C. Barnard-Kirk: None. M.L. Smith: None. A.M. Moffett: None. M.K. Kamboj: None.