bluuebunny/crossref_metadata_2025_split huggingface dataset:
1271-P: Impact of Physician-Pharmacist Collaboration on A1C in an Interprofessional Endocrinology Clinic
Authors: ISAACS DIANA , ZIMMERMAN ROBERT S. , LANSANG M. CECILIA 
Published: June 2019

Background: Comprehensive medication management (CMM) ensures an individualized plan for medication appropriateness, effectiveness, safety, and adherence. It is most often performed by pharmacists within a pharmacist-physician collaborative agreement. Published studies on CMM are few and mostly conducted in primary care settings. The aim of our study was to determine the impact of CMM on the proportion of patients that achieve ≥ 1% A1c reduction in an interprofessional specialty clinic.
Methods: This is a retrospective study comparing 2 groups: group 1-without pharmacist collaboration, group 2-with pharmacist collaboration. Subjects were adults with diabetes and most recent A1c ≥ 8.5% with at least one visit in the interprofessional endocrinology clinic between 1/2016-12/2017. Exclusion criteria were pregnancy, no A1c within 6 weeks of initial visit, and no follow-up A1c. The 2 groups were matched for initial A1c, type of diabetes, age, and BMI.
Results: A total of 162 participants were included. Baseline characteristics were similar between groups: Group 1: (mean age: 57.6 ± 15.8 years, BMI: 34.3 ± 8.1 kg/m2, A1c: 10.2 ± 1.2%, T1DM: 26%), Group 2 (mean age: 56.0 ±16.4 years, BMI: 32.6 ± 8.1 kg/m2, A1c: 10.1± 1.3%, T1DM: 26%). The percentage of subjects achieving ≥1% A1c reduction at 6 months was 58.0% in Group 2 compared to 40.7% in Group 1, p=0.041. More subjects achieved A1c &lt; 8% in group 2 (32.1%) vs. Group 1 (18.5%), p=0.047. The frequency of endocrinologist visits was more in group 1 (2.37/patient) vs. group 2 (1.89/patient), p=0.01. Group 2 averaged 3.0 pharmacist visits per patient.
Discussion: Physician-pharmacist collaboration led to greater A1c reduction compared to usual endocrinologist care in patients with uncontrolled A1c. However, frequency of total provider visits may account for some differences. Overall, utilizing pharmacists within diabetes health care models may reduce frequency of endocrinologist visits while improving glycemic control.

Disclosure
D. Isaacs: Advisory Panel; Self; BD, Sanofi-Aventis. R.S. Zimmerman: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Merck & Co., Inc., Novo Nordisk Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute, Merck & Co., Inc. M. Lansang: None.
1280-P: Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care
Authors: MARTENS THOMAS W. , BERGENSTAL RICHARD M. , JOHNSON MARY L. , DAVIDSON JANET L. , SIMONSON GREGG 
Published: June 2019

Background: Very little data exists regarding the impact of CGM in the primary care management of type 2 diabetes (T2D). We initiated a QI project in a large health care system to determine the effect of pCGM on glucose management. We evaluated a MD model, and an RN/Certified Diabetes Educator (CDE) model.
Methods: Patients (pts) with T2D for &gt;1 year, A1C ≥7.0 and &lt;11.0%, managed with any T2D regimen, and willing to use pCGM were included. Baseline A1C was collected and pts wore a pCGM (Libre Pro) up to 2 weeks followed by a visit with MD or RN/CDE (MD consultation if needed) to review CGM data including Ambulatory Glucose Profile (AGP). Shared decision making was used to modify lifestyle and medication regimen. Clinic follow-up in 3-6 months included an A1C and in a subset a repeat CGM.
Results: Sixty-eight pts average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8 ± 1.2% to 8.2 ± 1.3% (n=68, p=0.006). The time in range (TIR) and time in hyperglycemia improved along with slightly more hypoglycemia in the subset of 37 pts who wore a second pCGM (Table). Glycemic improvement was largely due to lifestyle counseling (68% of pts) and intensification of current therapy (65% of pts), and not due to addition of medications.
Conclusion: Using pCGM in a primary care setting, with an MD or RN/CDE model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia.

Disclosure
T.W. Martens: Research Support; Self; Abbott Laboratories, Dexcom, Inc., Medtronic, Novo Nordisk Inc. R.M. Bergenstal: Research Support; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Glooko, Inc., Hygieia, JDRF, Johnson & Johnson Medical Devices Companies, Lilly Diabetes, Medtronic MiniMed, Inc., Merck & Co., Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk Inc., Roche Diabetes Care, Sanofi. Other Relationship; Self; Abbott, Helmsley Charitable Trust, Hygieia, Lilly Diabetes, Novo Nordisk Inc., Onduo LLC, Sanofi, UnitedHealth Group Inc. M.L. Johnson: Research Support; Self; Abbott, Calibra Medical, CeQur Corporation, Dexcom, Inc., Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk Inc., Sanofi. J.L. Davidson: None. G. Simonson: Advisory Panel; Self; Merck & Co., Inc. Research Support; Self; Abbott.

Funding
Abbott Laboratories
1300-P: Hyperglycemia Is Associated with Worse Outcomes in Neurosurgery Only in Patients without Diabetes
Authors: GRECO GIAMPAOLO , MOSKOWITZ ALAN J. , LAM DAVID W. 
Published: June 2019

Hyperglycemia is associated with adverse outcomes in critically ill surgical patients with increasing recognition that those without preexisting DM (NODM) are more affected. As the brain acts as a major regulator of glucose and exclusively depends on it for its high energy needs, we examined the association between hyperglycemia and outcomes in ICU patients undergoing elective or emergent neurosurgery (NSGY) with and without DM. Patients (N 864) were grouped as NODM, pre-existing DM on (DMTR) and not on medications (DMNT) (NODM 637 DMNT 80 DMTR 147). Postop glucose (BG) and time weighted average BG (TWAg) 24 hours postop, postop length of stay (pLOS), hospitalization cost and adverse outcomes (death, respiratory failure, infection, stroke, MI) were obtained retrospectively from admissions between May 2011 - January 2015. Those in DMTR had higher TWAg than in DMNT and NODM (188 vs. 166, 145 mg/dL p&lt;0.005). After adjustment for demographics, comorbidities and surgical characteristics, NODM patients with hyperglycemia (mean of 2 consecutive BG &gt; 180 mg/dL) had higher costs and pLOS while those in DMTR had lower cost and shorter pLOS. Those in NODM with hyperglycemia had more adverse events than those without; this was not seen in DMNT and DMTR (Figure). We found in NSGY patients, hyperglycemia’s association with adverse events depends on DM status and stresses the need to understand underlying mechanisms.

Disclosure
G. Greco: None. A.J. Moskowitz: None. D.W. Lam: Research Support; Self; Novo Nordisk A/S.
1313-P: Comparison of Diabetes Health-Care Quality between Endo ECHO and the Academic Medical Center
Authors: PAUL MARGARET M. , SAAD ANDREA DAVILA , BILLINGS JOHN , BLECKER SAUL , BOUCHONVILLE MATTHEW F. , HAGER BRANT , ARORA SANJEEV , BERRY CAROLYN 
Published: June 2019

Background: Patients receiving diabetes specialty care experience higher quality care, fewer complications and improved survival; however, access to specialists is limited in medically underserved areas. The Endo ECHO program connects specialists at academic medical centers with PCPs through virtual clinics. We report the comparability of quality measures between Endo ECHO patients and those receiving diabetes specialty care.
Methods: Patients with complex diabetes from 10 Endo ECHO clinics in NM completed surveys assessing healthcare quality one year after program enrollment. Patients at the University of New Mexico Diabetes Comprehensive Care Center (DCCC) served as a comparison group and completed the same survey.
Results: Five hundred thirty-three ECHO patients and 139 DCCC patients completed surveys. ECHO patients were much less likely to identify English as their primary language (69% ECHO vs. 91% DCCC, p&lt;0.0001) and reported lower levels of educational attainment (40% ECHO with at least some college vs. 60% DCCC, p&lt;0.0001). DCCC patients were more likely to report a positive overall health status (42% ECHO vs. 68% DCCC, p&lt;0.0001), yet there was no difference in overall concern about health across groups. ECHO patients reported more frequent visits to their usual source of diabetes care (72% ECHO with 4 or more annual visits vs. 58% DCCC, p&lt;0.0001). There were no differences in the frequency of A1C testing or feet checks by a provider; however, more DCCC patients reported regular eye exams (69% ECHO vs. 87% DCCC, p&lt;0.0001) and that their provider had assessed smoking status (70% ECHO vs. 82% DCCC, p&lt;0.0001).
Conclusions: Endo ECHO patients faced greater medical literacy barriers yet reported similar outcomes for several, but not all, diabetes care quality measures as compared to those reported by patients at the DCCC. Endo ECHO may be a suitable alternative to specialty care for patients in medically underserved areas; ongoing evaluation will determine its impact on clinical outcomes.

Disclosure
M.M. Paul: None. A. Davila Saad: None. J. Billings: None. S. Blecker: Advisory Panel; Self; Medtronic. M.F. Bouchonville: None. B. Hager: None. S. Arora: None. C. Berry: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1314-P: Co-creating Gestational Diabetes Education: Using Web Analytics to Assess Learning Interests
Authors: BOISVENUE JAMIE , GHNAIM SARAH A. , KAUL PADMA , RYAN EDMOND A. , YEUNG ROSEANNE O. 
Published: June 2019

Objectives: Gestational diabetes mellitus (GDM) education is the foundation for self-care management. This study aims to improve the GDM learning experience using the narrative and care experiences of women with GDM and their healthcare providers.
Methods: A working group of women with GDM and their health care providers used iterative dialogic priming (key quotes from previous sessions) to frame five sessions. Through a deliberative priority-setting process, participants decided to update www.diabetes-pregnancy.ca, an existing website that addresses GDM education priorities of the group. Participants contributed to the website organization, videos, and text content. Google analytics was used to evaluate site uptake.
Results: Five women with GDM and 7 diabetes healthcare providers were involved in updating the content of the website. Following the website re-launch, an analytics assessment of a 50-day average (Nov 14/18 - Jan 3/19) was compared to a previous period with its earlier design (Sept 24 - Nov 13/2018). A total of 490 users visited the site and the majority (n=224) resided in Alberta compared to 546 users (200 from Alberta) in the previous 50-day period. Amongst the recent users with an identified gender (n=166), there were 133 females and 33 males. Bounce rate (visitors immediately leaving website) decreased from 78.4% to 42.4% post-redesign. The pages viewed per user session increased from 1.86 to 3.91, and the average duration of sessions increased by 30.6% (7:23 to 9:39 minutes). Behavior flow of the site showed user navigation to the “GDM” homepage (n=382), followed by the “For Providers” page (n=122), and “Additional Resources” (n=112).
Conclusions: Co-creation of online education materials informed uptake of the website. Web analytics suggest that although the audience is more likely female, there are males seeking information. An online GDM resource provides a novel method to support continuous improvement of GDM education.

Disclosure
J. Boisvenue: None. S.A. Ghnaim: None. P. Kaul: None. E.A. Ryan: None. R.O. Yeung: Advisory Panel; Self; Sanofi. Consultant; Self; Novo Nordisk Inc. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi.

Funding
AstraZeneca Canada
1330-P: Ethnic Differences in Insulin Clearance: Relationship with Admixture Scores, Diet, and Physical Activity
Authors: PICCININI FRANCESCA , GOWER BARBARA , FERNANDEZ JOSE R. , BERGMAN RICHARD N. 
Published: June 2019

Recent studies showed that hepatic insulin clearance is lower in African Americans (AA) than European Americans (EA). The aim of this work is to elucidate the possible genetic/epigenetic versus lifestyle causes. The frequently-sampled intravenous glucose tolerance test (FSIGT) was performed in 142 children [38 AA, 69 EA, 28 HA (Hispanic Americans), both sexes, age 7-13 years, mean BMI = 19 kg/m2, basal plasma glucose = 99 mg/dL, insulin = 78 pmol/L, C-peptide = 511 pmol/L]. Mathematical modeling provided hepatic (FEL) and extra-hepatic (CLP) insulin clearance values. Two-way analysis of covariance was done (groups: sex and ethnicity, covariates: age, Tanner stage and body fat from DXA). Data are mean (standard error). FEL was lower in AA than EA (18% (2%) vs. 31% (3%), p=0.001), but no difference was observed in HA. CLP was not different among ethnicities. Partial correlation was calculated between FEL, CLP and 1) diet composition (energy intake, % of calories from carbohydrate, fat, protein), 2) physical activity (PA: light, moderate, hard, very hard), 3) admixture scores (African, European, Amerindian). FEL was positively correlated with the European admixture score (r=0.3, p&lt;0.01), and negatively with the African one (r=-0.3, p=0.001); FEL was negatively associated with moderate PA in all the subjects (r=-0.2, p=0.01), and with hard PA in EA (r=-0.4, p&lt;0.01). CLP was positively correlated with moderate PA in AA (r=0.4, p=0.02). Concerning diet, FEL was only correlated with % of calories from fat in EA (r=0.3, p=0.01). Because of its negative association with the African admixture, but positive with the European one, the lower hepatic insulin clearance might be genetic in origin, possibly resulting in hyperinsulinemia and diabetes risk. Our data also suggest that detrimental effects of lower insulin clearance might be mitigated by lifestyle changes such as exercise: moderate PA in AA could lead to a normalization of insulinemia by increasing extra-hepatic insulin clearance.

Disclosure
F. Piccinini: None. B. Gower: None. J.R. Fernandez: None. R.N. Bergman: Consultant; Self; Zafgen, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (DK067426); Nutrition Obesity Research Center (DK56336); National Institutes of Health (M01RR00032)
1334-P: Structural Brain Differences between Adolescents with Type 2 Diabetes and Obese Controls
Authors: REDEL JACOB M. , DIFRANCESCO MARK W. , LEE GREGORY R. , DOLAN LAWRENCE M. , SHAH AMY SANGHAVI 
Published: June 2019

Recent studies have shown differences in brain structure between adolescents with type 2 diabetes (T2D) and their nondiabetic peers. Compared to obese controls (OCs), global white matter (WM) and regional gray matter (GM) differences have been found. Our aim was to evaluate further for global and regional differences in GM, WM, and parenchymal (GM and WM combined) brain volume between youth with T2D and nondiabetic OCs. We compared 11 youth with T2D (mean age 17.1 ±2.0 years, mean HbA1c 8.6 ±2.5%) and 11 age, race and sex similar OCs (mean HbA1c 5.3 ±0.2%). Participants underwent high-resolution T1-weighted MRI scans, analyzed using voxel-based morphometry. Tissue volumes were normalized across participants by dividing by each individual’s intracranial volume (ICV). The normalized global volumes were compared between the two groups, and statistical significance was determined at p&lt;0.05. For regional analyses, statistical significance for each voxel was established at p &lt;0.05 using a family-wise error rate procedure, reporting only clusters with ≥200 contiguous voxels. Compared to OCs, adolescents with T2D had significantly lower parenchymal brain volume (parenchymal/ICV ratio 0.843 in T2D vs. 0.856 in OC, p=0.04). There were no significant differences in global GM (GM/ICV ratio 0.514 in T2D vs. 0.517 in OC, p=0.76) or global WM (WM/ICV ratio 0.329 in T2D vs. 0.340 in OC, p=0.10), although global WM did trend toward significance. In addition, there were 3 brain regions in the T2D group that had lower GM volume than OCs, and 2 regions in which the T2D group had greater GM volume. Adolescents with T2D show significantly lower parenchymal brain volume compared to age, race, and sex similar OCs. This difference may be attributable to lower WM volume, but a larger sample size is needed. No global GM differences were found between groups, but regional differences in GM were identified. These data support the hypothesis that, independent of obesity, structural brain differences may exist in adolescents with T2D.

Disclosure
J.M. Redel: None. M.W. DiFrancesco: None. G.R. Lee: None. L.M. Dolan: None. A.S. Shah: None.

Funding
Endocrine Fellows Foundation; Cincinnati Diabetes and Obesity Center; Cincinnati Children's
1341-P: Association of NAFLD with Diabetes and the Impact of Waist Circumference and BMI Changes in Subjects with Prediabetes
Authors: LEE JIWOO , KANG YU MI , PARK JOONG-YEOL , LEE WOO JE 
Published: June 2019

Background: Nonalcoholic fatty liver disease (NAFLD) and prediabetes are well-known risk factors for diabetes. However, few studies have been performed about the risk of diabetes in subjects with prediabetes in the presence of NAFLD. In addition, little information was known about the impact of waist circumference (WC) and body mass index (BMI) changes on the development of diabetes. In this study, we examined the association of NAFLD with diabetes and the impact of WC and BMI changes in subjects with prediabetes.
Methods: We enrolled 6,240 subjects with prediabetes who underwent general routine health evaluations in 2007 and returned for follow-up examinations in 2008 -2013 at least one time. Subjects were stratified by WC and BMI changes into three groups. The relative ratios (RRs) of NAFLD for diabetes was evaluated.
Results: The prevalence of NAFLD in study participants was 45.4% (2,830/6,240). Subjects with NAFLD had higher BMI, WC, HbA1c levels, blood pressure levels, blood lipid levels, and also higher ALT levels (P &lt; 0.001). During the follow-up, the total incidence of diabetes was 8.093%. Subjects with NAFLD at baseline had a higher incidence of diabetes and the adjusted RRs were 2.181 [95% confidence interval (CI), 1.778 to 2.674]. Furthermore, the RRs were closely related to WC changes. The adjusted RRs for diabetes according to WC change (≤ 0.0 cm, 0 cm to 3.0 cm, and &gt; 3.0 cm) were 1.953 (95% CI, 1.365 to 2.794), 1.996 (95% CI, 1.407 to 2.833), and 2.302 (95% CI, 1.598 to 3.314), respectively. Furthermore, the RRs were also closely related to BMI changes and the adjusted RRs for diabetes according to BMI change (&lt; -0.35 kg/m2, -0.35 kg/m2 to 0.35 kg/m2, and &gt; 0.35 kg/m2) were 1.633 (95% CI, 1.121 to 2.380), 1.995 (95% CI, 1.415 to 2.811), and 2.924 (95% CI, 2.053 to 4.165), respectively.
Conclusion: There was a strong and independent association between NAFLD and diabetes in Korean subjects with prediabetes, and this relationship was closely related to WC and BMI changes.

Disclosure
J. Lee: None. Y. Kang: None. J. Park: None. W. Lee: None.
1364-P: Parent and Physician Preferences for Screening in Type 1 Diabetes (T1D)
Authors: DUNNE JESSICA L. , SUTPHIN JESSIE , BUSHMAN JESSE S. , FONTANALS-CIRERA BARBARA , COULTER JOSHUA R. , HUTTON CAMPBELL T. , KORALOVA ANNE , ERVIN CLAIRE M. , MANSFIELD CAROL 
Published: June 2019

Purpose: Qualitative interviews were conducted and a survey instrument was developed to inform the implementation of a general population screening program for T1D in children and to quantify screening-test attributes relevant to parents and physicians in the United States.
Methods: Semi-structured qualitative interviews were conducted with parents and physicians to understand views on general population screening for T1D and identify important attributes of screening programs. Using the results, a discrete-choice experiment (DCE) survey instrument was developed to quantify preferences over multiple options. The survey was pretested using interviews to confirm attribute relevance and respondent comprehension.
Results: In the qualitative interviews (10 parents, 10 physicians), test accuracy and the availability of treatments to delay onset or lessen T1D-associated health risks ranked as important. Parents’ concerns included the need for venipuncture and the cost of the test. Physicians’ concerns included the emotional impact of positive results on families and test reimbursement. A DCE survey was developed with 5 attributes covering when, where, and how the sample for screening is obtained; cost; monitoring and education to reduce the risk of DKA; and availability of an optional treatment to delay T1D. In the pretest interviews (15 parents, 15 pediatricians), the relevance of the attributes was confirmed. The pretest sample placed the most value on reducing the risk of DKA and the availability of a treatment to delay T1D onset. Low cost and convenience were considered key to widespread adoption by pediatricians.
Conclusions: Two sets of interviews confirmed an interest in general population T1D screening, but follow-up treatment for a positive result was the key driver for acceptance. The survey will be administered to 1,000 parents and 500 pediatricians to quantify the importance of screening attributes with the goal of informing the implementation of a general population T1D screening program.

Disclosure
J.L. Dunne: None. J. Sutphin: Other Relationship; Self; Multiple Companies. J.S. Bushman: None. B. Fontanals-Cirera: None. J.R. Coulter: Other Relationship; Self; Multiple companies. C.T. Hutton: None. A. Koralova: Research Support; Spouse/Partner; Bristol-Myers Squibb Company. C.M. Ervin: Other Relationship; Self; Multiple companies. C. Mansfield: Other Relationship; Self; Multiple companies.

Funding
JDRF; The Leona M. and Harry B. Helmsley Charitable Trust
137-OR: The Selective Human Beta 3 Adrenergic Receptor Mirabegron Potently Activates Lipolysis in Human White Adipocytes
Authors: CERO CHERYL , JOHNSON JAMES W. , O’MARA ALANA , LINDERMAN JOYCE D. , CYPESS AARON M. 
Published: June 2019

Human obesity is an increasing burden worldwide. Lipids stored as metabolic fuel in white adipose tissue (WAT) can be rapidly mobilized through lipolysis. In rodent adipocytes, activation of the β3-adrenergic receptors (β3-ARs) leads to lipolysis. The physiological role of the β3-AR in human adipocytes remains controversial due to its reported low expression and previous access only to partial β3-AR agonists. Mirabegron, an FDA-approved drug for overreactive bladder, is a highly-selective human β3-AR agonist. In clinical trials, mirabegron treatment led to activation of human brown adipose tissue (BAT) thermogenesis and increased plasma NEFA’s. Therefore, we investigated if mirabegron directly mediates lipolysis in human white adipocytes. We found similar gene expression of the three β-ARs in human immortalized and primary white adipocytes, with β2-AR being the most expressed, followed by β1-AR and β3-AR. Next, to assess the functionally of the β3-AR in human adipocytes, we established dose-response curves and found that mirabegron increased the release of glycerol, a lipolytic product, in the picomolar range. To identify the molecular mechanism controlling mirabegron-induced lipolysis, we assessed the regulation of key downstream lipolytic proteins. Mirabegron mediated lipolysis by rapidly phosphorylating hormone sensitive lipase (HSL), as well as the mitogen activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK). Moreover, acute inhibition of either the PKA or MAPK/ERK pathways decreased lipolysis.
In summary, we identify a major role played by the β3-AR in the regulation of human WAT lipolysis. Mirabegron acts as a potent pro-lipolytic effector, signaling through the canonical adrenergic receptor pathway as well as the MAPK/ERK pathway. Due to the comparatively minimal effects previously reported of mirabegron on the cardiovascular system, mirabegron may be the optimal choice for targeted lipid mobilization in human WAT.

Disclosure
C. Cero: None. J.W. Johnson: None. A. O’Mara: None. J.D. Linderman: None. A.M. Cypess: None.

Funding
National Institutes of Health