bluuebunny/crossref_metadata_2025_split huggingface dataset:
232-LB: Cardiovascular Complications in T1D and T2D Patients Show More Similarities than Differences
Authors: ERIKSSON JAN W. , BODEGARD JOHAN , NORHAMMAR ANNA , THURESSON MARCUS , NATHANSON DAVID , NYSTROM THOMAS 
Published: June 2019

The aim was to describe baseline and compare CVD risks between full populations of T1D vs. T2D patients. All T1D and T2D patients in Sweden were identified in nationwide health care registries and followed from year 2013 until death or year 2016, 3 years. The following CVD diagnoses were explored: myocardial infarction (MI), heart failure (HF), stroke and CV mortality and chronic kidney disease (CKD). First, age stratified categories were used to compare baseline CVD and CKD in T1D vs. T2D. Second, age stratified event rates were compared for CVD and CKD in T1D vs. T2D. In total 47,424 T1D and 364,293 T2D patients were identified. Crude baseline showed that T1D patients were younger (40.6 vs. 67.0 years), had less CVD (11.7% vs. 31.0%), and more CKD (3.6% vs. 3.3%) and severe hypoglycaemia (1.7% vs. 0.5%). First, age-stratification at baseline showed that T1D vs. T2D had similar CVD prevalence, where HF prevalence increased markedly from 60 years and older, and MI/stroke from 55 years. CKD prevalence was higher at all ages in T1D vs. T2D. Second, age-stratified CV event rates were similar for T1D vs. T2D, slightly higher for HF and MI in T1D (Figure). CKD event rates were higher in T1D vs. T2D.
In summary, CVD showed similar prevalence and risks in T1D compared to T2D patients. A slightly increased HF and MI risk at younger age was observed in T1D. CKD was both more prevalent and showed greater risk in T1D across all ages.

Disclosure
J.W. Eriksson: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Research Support; Self; AstraZeneca, Novo Nordisk A/S. J. Bodegard: Employee; Self; AstraZeneca. A. Norhammar: Advisory Panel; Self; Merck Sharp & Dohme Corp. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Foundation. Research Support; Self; AstraZeneca. M. Thuresson: Consultant; Self; AstraZeneca. D. Nathanson: None. T. Nystrom: Board Member; Self; Amgen Inc., Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; AstraZeneca.

Funding
AstraZeneca
2320-PUB: Effects of Sequential Therapy Using Metformin plus Pioglitazone following Short-Term Intensive Insulin Therapy in Patients with Newly Diagnosed T2DM
Authors: LIU LIEHUA , HAI LI , KE WEIJIAN , LI YANBING 
Published: June 2019

Aims: Short-term intensive insulin therapy (SIIT) reverses β cell dysfunction in early T2DM, but this effect vanes overtime. This study aimed to investigate the effects of metformin plus pioglitazone sequential therapy on maintenance of the effect of SIIT.
Methods: SIIT were applied in 50 patients with newly diagnosed T2DM to normalize blood glucose for 2 weeks. Patients were then randomly assigned to receive either sequential therapy (metformin 0.5g bid plus pioglitazone 15mg bid) or lifestyle change alone for 3 months. OGTTs were performed with plasma glucose and insulin measured.
Results: As showed in the figure, plasma glucose profiles and insulin response during OGTT were improved similarly by SIIT in both groups. At 3 months of follow-up, GHbA1c (6.2±0.6% vs. 6.5±0.4%, P=0.12) in the sequential treatment group was slightly lower though without statistical significance. In OGTT, blood glucose 30, 60 and 90 minutes was significantly lower in the sequential treatment group, which led to lower AUCglucose (1456.1±266.3 vs. 1644.8±184.5 mmol/L*min, P=0.03) and higher AUCinsulin to AUCglucose ratio (2.5±1.9 vs. 1±1.1, P=0.01). HOMA B, HOMA IR, Mesuda index and ISSI-2 were all similar between the two groups.
Conclusion: Metformin plus pioglitazone as sequential therapy might improve glycemic control and β cell function after SIIT in newly diagnosed T2DM.

Disclosure
L. Liu: None. L. Hai: None. W. Ke: None. Y. Li: None.

Funding
National Key Research and Development Program of China (2018YFC1314102)
2321-PUB: Improved Glycemic Control among Patients Newly Prescribed IDegLira across Various Background Therapies in U.S. Real-World Practice
Authors: EGEDE LEONARD E. , BOGDANOV ALINA , FISCHER LAUREN , DA ROCHA FERNANDES JOAO DIOGO , KALLENBACH LEE 
Published: June 2019

IDegLira is a fixed-ratio combination of degludec and liraglutide indicated for the treatment of type 2 diabetes (T2D). This is the first real world study describing change in glycated hemoglobin (HbA1c) among U.S. patients initiating IDegLira. The primary objective was to observe the effect in metabolic control of initiating IDegLira in adult T2D patients previously on basal insulin (Basal), glucagon-like peptide-1 receptor agonist as only injectable (GLP-1), and no injectable therapy (N-INJ) between March 2017 and June 2018 (index date). Patients with HbA1c data 6 months prior to and 6m post index date were included from the Practice Fusion Electronic Health Record database. Of the 1,384 IDegLira patients, 206 patients had baseline, and follow-up HbA1c (180 ± 45 days) data. Changes in clinical outcomes were evaluated by paired t-test. Overall there was significant change in HbA1c of -0.9% (p&lt;.001), and there was an HbA1c reduction in all three background therapy groups, ranging from -0.7 in the Basal to -1.0 in N-INJ (p&lt;0.001). There was no significant change in weight in the overall group despite initiating or intensifying insulin therapy with IDegLira, as expected weight in the GLP-1 subgroup increased (3.0 lb; p&lt;.05). Consistent with previous real-world studies, IDegLira is effective at lowering HbA1c across different background therapies with minimal impact on weight.

Disclosure
L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. A. Bogdanov: None. L. Fischer: None. J. da Rocha Fernandes: Employee; Self; Novo Nordisk A/S. L. Kallenbach: Employee; Self; Veradigm.

Funding
Novo Nordisk
2338-PUB: Metformin Administration Attenuates Dipeptidyl Peptidase-4 Inhibitor-Induced KL-6 Level Elevation
Authors: SHIMODA YOKO , OKADA JUNICHI , YAMADA EIJIRO , OKADA SHUICHI , YAMADA MASANOBU 
Published: June 2019

Given the lack of clarity regarding the benefits of metformin in patients with type 2 diabetes mellitus who were prescribed DPP-4 inhibitors (DPP-4is), we compared KL-6 levels in patients who were prescribed DPP-4is and in patients who were prescribed both DPP-4is and metformin. 54 patients were prescribed DPP-4is and KL-6 levels were measured in all of these patients. 25 patients were prescribed metformin. Thus, the patients were categorized into two groups: DPP-4i (DPP-4i without metformin; N = 29) and DPP-4i and met (DPP-4i with metformin; N = 25). The KL-6 levels in the DPP-4i was significantly higher than that of DPP-4i and met groups (300.76 ±155.39 vs223.96 ±73.83 U/mL, mean ±standard deviation, reference range: &lt;500 U/mL, p= 0.0281). Transient elevation in KL-6 levels beyond the upper limit of normal range was observed in four patients in the DPP-4i group only. KL-6 levels were not elevated in any patients in the DPP-4i and met group. Despite the small sample size, this clinical study provides important information. One strength of the current study is that the KL-6 level was measured in all patients with type 2 diabetes mellitus who were prescribed DPP-4is. We confirmed that KL-6 levels were in the normal range before initiating DPP-4i administration. Moreover, KL-6 levels were transiently elevated and normalized after DPP-4i termination. The frequency of KL-6 level elevation due to DPP-4i administration was 7.4% although all of participated patients showed normal study on chest X-ray examination. This incidence was higher than that of statin-induced interstitial pneumonia. Metformin may prevent or delay interstitial lung diseases due to DPP-4i administration. However, KL-6 level in patients with metformin alone needs to be estimated.

Disclosure
Y. Shimoda: None. J. Okada: None. E. Yamada: None. S. Okada: None. M. Yamada: None.
2373-PUB: Overcoming the Challenges in Discovering Celiac Disease in Type 1 Diabetes Mellitus Focusing on Provider Education
Authors: EPPS MICHELLE , FOX MARISSA , JAFARI JASMINE , FIREK ANTHONY 
Published: June 2019

Background: Patients with type 1 diabetes mellitus (DM1) are at risk for having autoimmune conditions such as Celiac Disease (CD). Although uncommon, the presence of CD in a patient with DM1 may result in poor glycemic control, gastrointestinal complaints, nutritional deficiencies, osteoporosis and lymphoma. Recognizing CD is problematic as it is often asymptomatic or presents in an atypical fashion. Despite recommendations from both the ADA and the American College of Gastroenterology our experience suggests there is a general lack of recognition of screening recommendations and presentation in CD particularly in patients with DM1.
Methods: Our objectives were three-fold. We first developed a novel on-line assessment program to determine existing knowledge on CD in both medical and family practice residents and faculty. We then developed on-line and direct education to improve knowledge on screening, presentation and diagnosis of CD. Lastly, we have determined the screening rate of adults with a diagnosis of DM1.
Results: Our screening rate of at-risk adults with DM1 is less than 20% indicating a poor recognition of CD as a recognized risk. In addition, we determined that CD is rarely considered in patients with DM1 with poorly controlled diabetes even in the context of GI complaints. Our preliminary survey of residents’ knowledge on screening, diagnosis and complications of CD was poor with less than 35% having adequate knowledge status.
Conclusion: Screening for CD in our DM1 patients is poor due to lack of knowledge of criteria and screening strategy of providers. This may reflect a significant deficit in resident and faculty knowledge of CD. In addition, CD is rarely considered in symptomatic adults with DM1. We propose our education program aimed at both residents and our faculty will overcome our lack of an organized education program addressing CD and is predicted to improve screening, diagnosis and treatment of adults with DM1 suffering from CD within our population.

Disclosure
M. Epps: None. M. Fox: None. J. Jafari: None. A. Firek: None.
2376-PUB: Glycemic Control after Decline of Insulin Therapy by Patients
Authors: FLOREZ LUISA , TURCHIN ALEXANDER 
Published: June 2019

Recent evidence shows that many patients with type 2 diabetes (T2DM) initially decline insulin treatment. For some patients this could lead to poor glycemic control, whereas others may be able to lower blood glucose by alternative means. However, it is not currently known what factors affect achievement of glycemic control after decline of insulin therapy by patients.
We conducted a retrospective cohort study to determine patient characteristics predictive of glycemic control after they decline insulin treatment. We studied adults with T2DM treated at two academic medical centers between 1993 and 2014 who rejected insulin therapy recommended by their providers. We compared 150 randomly selected patients whose A1c subsequently decreased to 150 patients whose A1c increased or stayed the same.
Patients whose A1c decreased had a significantly higher baseline A1c (9.5% vs. 8.5%; p &lt; .001), were more likely to implement lifestyle changes (27.3% vs. 7.3%; p &lt; .001) and less likely to be non-adherent to diabetes medications (1.3% vs. 26.7%; p &lt; .001) or to discontinue a non-insulin diabetes medication (8.0% vs. 16.0%; p = 0.03) after they declined insulin therapy.
In a multivariable analysis adjusted for demographics, comorbidities and clustering within providers, higher baseline A1c (OR 1.85; 95% CI 1.41 to 2.42; p &lt;.001) and lifestyle changes (OR 8.49; 95% CI 3.31 to 21.78; p &lt;0.001) were associated with greater, while non-adherence to diabetes medications (OR 0.015; 95% CI 0.0025 to 0.088; p &lt;.001) and discontinuation of a non-insulin diabetes medication (OR 0.30; 95% CI 0.12 to 0.78; p =0.013) were associated with lower probability of A1c decrease after initial decline of insulin therapy by the patient.
We identified patient characteristics and treatment strategies associated with success and failure of glycemic control after insulin therapy decline by the patient. This information can help guide care and assist in design of rigorous interventional studies to evaluate optimal therapeutic approaches for these individuals.

Disclosure
L. Florez: None. A. Turchin: Advisory Panel; Self; Monarch Medical Technologies. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Brio Systems.
2380-PUB: Factors Associated with Successful Implementation of an Inpatient Glycemic Management Program to Improve Glucose Control for Patients Needing Subcutaneous Insulin
Authors: FREEMAN RASHAYE , GAY WENDY E. , GARTHWAITE THOMAS L. , HOLLIS LAURA , MCCANNON (BUSH) JAMEE , SPENCER-SMITH CAREN , SAMUELSON ERIN E. , MEHTA PRANAV 
Published: June 2019

Deployment and maturation of computerized medical records has improved insight into the unintended variability of glucose management in hyperglycemic inpatients. We used expert panels and extensive field testing to design a Glycemic Management Program to simultaneously reduce mean glucose levels and the frequency of hypoglycemic events. Factors observed as contributing to glucose control variation included over-use of sliding scale insulin; inconsistencies in timing, type and dose of insulin; and the alignment of blood glucose testing with meal tray delivery.
We designed our Glycemic Management Program to address these factors with four distinct components: 1) Change management via targeted education; 2) Standardization of the ordering process for nutrition, blood glucose monitoring frequency, and a single subcutaneous insulin order set with decision support; 3) Standardization of workflow, including the timing and coordination of glucose testing and meal tray delivery; and 4) Patient specific, customized ongoing insulin dosing recommendations through FDA-approved decision support software.
We implemented our Glycemic Management Program pilot in a 325 bed community hospital in the southeastern United States. Since its launch, 2277 patients have been managed on the program. By six months post-implementation, the rate of severe hypoglycemia (&lt;54mg/dL) decreased 32.2% and basal-bolus insulin usage increased 135%. Average daily glucose values decreased without increasing the rate of hypoglycemia. Decreases were observed in overall length of stay (79%), complication rate (25.3%) and ICU length of stay (60%).
A comprehensive program that incorporates decision support with attention to workflow, provider engagement, and education can result in improved glucose management in an inpatient setting. Feedback has led to programmatic changes to maximize positive outcomes and ensure sustainability.

Disclosure
R. Freeman: None. W.E. Gay: None. T.L. Garthwaite: Advisory Panel; Self; Ondine Biomedical. L. Hollis: None. J. McCannon (Bush): None. C. Spencer-Smith: None. E.E. Samuelson: None. P. Mehta: None.
2383-PUB: Improved Medication Adherence among Diverse Participants in a Virtual Behavioral Therapy Program for Adults with Diabetes
Authors: GREENBERGER HEIDI M. , ANDREOPOULOS EVIE , BELL SOPHIE A. , PANDE REENA L. 
Published: June 2019

Background: Virtual cognitive behavioral therapy (i.e., delivered by telephone or video) increases access to mental health treatment, but few studies describe the impact of virtual therapy on medication adherence among individuals with diabetes. We aimed to evaluate changes in medication adherence among adults with diabetes and common behavioral health issues such as depression or anxiety participating in a nationally available 8-week treatment program (AbleTo).
Methods: This retrospective cohort study included 524 participants consecutively enrolled between 1/1/2017-12/31/2017 of which 369 had complete adherence data for inclusion in the analytic sample (59% female, 43% non-white race/ethnicity, mean age 54+10 years). Prescription medications were documented at baseline (week 1); polypharmacy was defined as &gt;5 medication types. Adherence was measured at weeks 1 and 8 using the standardized question, “Did you miss any doses this week?”; non-adherence was defined as missing any doses. Associations between adherence and participant characteristics (medication count, sex, race/ethnicity, age) were assessed using logistic regression. Change in medication adherence from weeks 1 to 8 was evaluated by McNemar’s test for paired nominal data.
Results: Baseline medication adherence was 86%. Adherence was lower among participants with polypharmacy (82% vs. 91%; p=.02), but did not differ by sex, race/ethnicity (white vs. non-white) or age group (&gt;55 vs. &lt;55 years). Non-adherence significantly improved from 14% to 8% at week 8 (-42%; p=.005). Improvements were observed in all subgroups and were statistically significant among participants with polypharmacy, females, and non-whites (p&lt;.05).
Conclusion: Medication adherence was improved among participants in an 8-week virtual behavioral therapy program supporting the positive clinical impact of novel care delivery models for adults with diabetes and behavioral health conditions.

Disclosure
H.M. Greenberger: Employee; Self; AbleTo. E. Andreopoulos: None. S.A. Bell: None. R.L. Pande: Employee; Self; AbleTo, Inc. Stock/Shareholder; Self; AbleTo, Inc.
2387-PUB: Effect of Pre-op Carb-Loaded Beverage in Bariatric Surgery Patients with Pre-DM and DM as Part of ERAS Protocol
Authors: BARTHELMESS KRISTI L. , TALAVERA LAURA , PHILIS-TSIMIKAS ATHENA 
Published: June 2019

The enhanced recovery after surgery (ERAS) protocol is a perioperative care pathway adopted in health systems across the nation as part of quality improvement efforts. A bundle of 20 elements demonstrated improved clinical and financial outcomes. A key element promotes carbohydrate loading a few hours before surgery using beverages such as Boost or ClearFast. There is limited data on pre-DM and DM patients and no clear guidelines on use in these populations.
Scripps Health, a large health system in Southern California, adopted the ERAS protocol as a systemwide approach for care improvement in the perioperative process in 2018. Pre-DM and DM patients were represented more commonly in the bariatric surgery group thus providing an opportunity to compare outcomes in these patients receiving a carbohydrate loaded beverage pre and post implementation of the standardized ERAS protocol.
We compared N=97 bariatric pre-DM and DM patients who did not receive Clearfast from Jan-Sept 2017 to N=64 bariatric pre-DM and DM patients who received Clearfast from Jan-Sept 2018. See Table 1.
Interestingly, in patients with pre-DM and DM, there was a substantial increase in pre-op hyperglycemia but a post-op decrease was noted when a carb-loaded beverage-Clearfast was given to patients prior to bariatric surgery when compared to the previous year when ERAS and carb loading were not part of the perioperative preparation process.

Disclosure
K.L. Barthelmess: None. L. Talavera: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc.
2388-PUB: App-Based Diabetes Management Plan: An Analogy between Diabetes Awareness and Plan Adoption
Authors: MISHRA SWATI , KANODIA LALIT , GUPTA VARUN , VERMA PRATEEK , AGARWAL GAURAV , TANDON PRASHANT , GUPTA UTKARSH 
Published: June 2019

Background: A Government-led screening of Indian population mentions that 70% Indians have no clue that they have diabetes. This lack of awareness can act as a serving point for digital healthcare platforms to provide understandable and accessible self-care. Aim: This study was conducted to explore if diabetes awareness acts as a motivation to employ patient-centric diabetes management plans on digital healthcare platforms.
Methods: A diabetes management product, Diabetes Care Plan (DCP) was developed by 1mg Technologies Pvt. Ltd. Post three months of launch, a targeted survey with 12 question items (covering general information, diet, and monitoring) was pushed to all users (DCP and non-DCP) on 1mg mobile app. Responses were collated over three consecutive days and analyzed.
Results: A total of 3,168 users took the survey (visitors) with 2,533 users completing it (responders). Of these responders, the overall awareness was significantly higher in DCP users (90%) as compared to non-DCP users (64%). Also, DCP users seemed to have higher awareness regarding diabetes (91%), effects of diet (70%), and monitoring (90%) as compared to non-DCP users.
Conclusion: An aware user is more receptive to choose digital diabetes care plans. Empowering consumers with relevant information and structured program can create a one-stop solution for their health needs, improved self-care, and pursuit of better clinical outcomes

Disclosure
S. Mishra: Employee; Self; 1mg Technologies Pvt. Ltd. L. Kanodia: Employee; Self; 1MG Technologies Pvt. Ltd. V. Gupta: Employee; Self; 1MG Technologies Pvt. Ltd. P. Verma: Employee; Self; 1mg Technologies Pvt Ltd. G. Agarwal: Board Member; Self; 1MG Technologies Pvt. Ltd. P. Tandon: Board Member; Self; 1MG Technologies Pvt. Ltd. U. Gupta: Employee; Self; 1mg Technologies Pvt. Ltd.