bluuebunny/crossref_metadata_2025_split huggingface dataset:
1252-P: Readmission Risk and Risk Factors of Hospitalizations with a Primary Diagnosis of Diabetes Differ from Discharges with a Secondary Diagnosis of Diabetes
Authors: RUBIN DANIEL J. , ZHAO HUAQING , MILLER ELI 
Published: June 2019

Whether the risk of hospital readmission within 30 days of discharge (early readmission, ER) varies by primary or secondary discharge diagnosis of diabetes (DcDxDM) is unknown.
In a retrospective cohort study of adults with diabetes discharged from an academic medical center, we analyzed 4,027 discharges with a primary DcDxDM and 4,027 discharges with a secondary DcDxDM. A total of 49 characteristics were evaluated for association with ER by multivariable logistic regression models.
The ER rate of discharges with a primary DcDxDM was significantly higher than the ER rate of discharges with a secondary DcDxDM (22.2% vs. 16.2%, p&lt;0.01). Discharges with a primary DcDxDM were significantly different from discharges with a secondary DcDxDM in 44 characteristics (all p&lt;0.04). Among both primary and secondary DcDxDM discharges, lack of an outpatient visit within 30 days of discharge, length of stay, being unemployed, being discharged within 90 days before admission, and anemia were associated with higher ER risk, and being uninsured was associated with lower ER risk (all p&lt;0.05). Among only primary DcDxDM discharges, lower education, gastroparesis, and higher serum creatinine were associated with higher ER risk, and inpatient diabetes consultation, thiazolidinedione use, and higher hematocrit were associated with lower ER risk (all p&lt;0.02). Among only secondary DcDxDM discharges, urgent/emergent admission, abnormal serum sodium or albumin, discharge against medical advice, and pancreatitis were associated with higher ER risk (all p&lt;0.05). C-statistics for the multivariable models of ER were similar between primary and secondary DcDxDM discharges (0.834 vs. 0.822, p=0.15).
Risk factors for ER after a primary DcDxDM discharge differ from risk factors after a secondary DcDxDM discharge. Patients with a primary DcDxDM are at a higher risk of ER and may benefit from dedicated effort to reduce their ER risk.

Disclosure
D.J. Rubin: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. H. Zhao: None. E. Miller: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK102963 to D.J.R.)
1255-P: Overcoming Obstacles for Insulin-Treated Commercial Drivers: A Multidisciplinary Approach
Authors: LORBER DANIEL , HATHAWAY KATIE 
Published: June 2019

Background: The prevalence of diabetes in the United States commercial motor vehicle (CMV) driver population is more than twice that of other adults in the U.S. working population. This population is at high risk for type 2 diabetes and for requiring insulin. With the development of the federal highway system and the dramatic increase in interstate commercial driving, in 1970 the Department of Transportation (DOT) put in place safety regulations that included an absolute blanket ban on insulin use. The impact of these regulations for CMV drivers with diabetes was to eliminate an entire career path or choose to avoid insulin with the resulting increased hyperglycemia and long-term sequelae of uncontrolled diabetes.
Interventions: In response to this blanket ban, the American Diabetes Association (ADA), including representation from its advocacy and scientific and medical arms began a strategy of multi-year, multi-disciplinary interventions to address and reverse the blanket ban. From “grassroots” to “grasstops” advocates, every level of the ADA lobbied for this important change. Two diabetes expert panels reviewed relevant data and provided recommendations to both Congress and the DOT. In 2010 ADA convened an expert panel to develop a position statement on Diabetes and Driving. It was necessary for ADA to overcome objections from both a DOT medical review board and other interested parties. The process was characterized by ever-changing obstacles requiring ADA to stay the course for over a decade.
Results: In 2018 the DOT published a new rule on diabetes eliminating the ban against insulin use and simplifying the process of CMV licensure for thousands of insulin-treated drivers.
Conclusions: The ADA’s unique structure and position enabled it to take the lead in dramatically improving the lives of CMV drivers with diabetes. This achievement provides a model for future interdisciplinary collaboration to overcome barriers to employment for people with diabetes.

Disclosure
D. Lorber: None. K. Hathaway: None.
126-LB: Improved Insulin Adherence after Introduction of a Smart Connected Insulin Pen
Authors: ADOLFSSON PETER , HARTVIG NIELS V. , KAAS ANNE , KNUDSEN NIKOLINE NYGÅRD , MÅRDBY ANN-CHARLOTTE , MøLLER JONAS B. , HELLMAN JARL 
Published: June 2019

An association between missed insulin injections and its impact on HbA1c levels has been established. The smart connected NovoPen® 6 captures and allows visualization of insulin injections (date and time of injection and number of units) and thus has the potential to move dialog between patients and healthcare professionals (HCPs) away from guessing about doses taken, missed doses and optimal injection time in relation to meals. This non-interventional study investigated whether the use of NovoPen® 6 influenced the behavior of patients with type 1 diabetes (T1D) in terms of missed bolus dose (MBD) injections. Patients were recruited from 12 Swedish diabetes clinics. At baseline they received a NovoPen® 6 for bolus insulin injections. At each HCP visit, pen data were downloaded at the clinic. Follow-up was after ≥5 HCP visits. Adults with T1D (n=81) using continuous glucose monitoring (CGM) and NovoPen® 6 for bolus injections were included in the analyses. The frequency of MBD was analyzed using the GRID algorithm to detect meals from the CGM signal. MBD was defined as meals with no bolus injection within -15 to +60 minutes from the start of the meal, as detected by the algorithm. The change in number of MBD from baseline to ≥5 HCP visits was analyzed using a mixed model. A significant decrease of 43% in the average daily number of MBD was observed from baseline to after ≥5 HCP visits (median time in study 6 months) from 0.74 (95% CI [0.62; 0.88]) to 0.42 (95% CI [0.30; 0.60]) (p=0.002). Based on the assumption that patients have three main meals per day, this corresponded to a decrease from 25% to 14% in MBD. The results indicated that patients achieved more well-dosed meals, even though these are not detected by the GRID algorithm, because of a lower CGM response.
These real-world findings confirm that MBD is a problem for patients with T1D and that a smart connected pen can support good injection behavior, with fewer missed and more well-dosed mealtime injections. This could subsequently lead to better glycemic control.

Disclosure
P. Adolfsson: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Roche Pharma. Employee; Self; Region Halland. Research Support; Self; Region Halland. N.V. Hartvig: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. A. Kaas: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. N. Nygård Knudsen: Employee; Self; Novo Nordisk A/S. A. Mårdby: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J.B. Møller: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J. Hellman: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi.

Funding
Novo Nordisk
1270-P: Improving ABC Targets through a Quality Improvement Initiative in China
Authors: KAREN LAU KA HEI , YUNXIA LIU , YI LI , LI CHUNRUI , ZHENGGUO YANG , POBER DAVID M. , ZHANG LINDA (YAN) , GABBAY ROBERT A. , HSU WILLIAM C. 
Published: June 2019

Strong scientific evidence supports the benefits of ABC control (A1c &lt;7%, blood pressure &lt;140/80 mmHg, and LDL cholesterol &lt;100 mg/dL) in reducing complications. A recent national multicenter study in China showed that the percentage of Chinese patients with type 2 diabetes who met recommended targets for A1c, BP and LDL in 2010 was 5.4%.
A diabetes clinic in a Chinese tertiary hospital conducted a pilot quality improvement project from January to November 2018 to enhance ABC outcomes. Doctors and nurses from the clinic participated in biweekly video case conferences with Joslin Diabetes Center clinicians (endocrinologist and a certified diabetes educator). They also received bi-monthly on-site training, each lasting 10 days, from visiting U.S. clinicians.
A1c, blood pressure and cholesterol levels collected from patients receiving routine care in the diabetes clinic from the first half of 2018 were compared with those collected in the second half of 2018. There were 1,036 patients who had at least one visit at each of these periods, and 683 patients of them (65.9%) had A1c, BP and LDL measured during these two periods. Paired comparisons were done by paired t-test (continuous variables) or McNemar’s test (dichotomous variables) using SAS version 9.4.
The mean age of the patients was 54.7±11.9 years, with 53.8% female, and 95.3% with T2DM. There was a significant increase in the patients who achieved composite A1c, BP and LDL goal from 6.8 to 10.0% (p=0.048). The percentage of patients attaining the BP goal increased from 54.6 to 63.5% (p=0.0016). The systolic pressure decreased from 137.8 ± 20.2 to 133.3 ± 19.4 mmHg (p&lt;0.0001). The LDL cholesterol decreased from 107.5 ± 34.0 to 97.5 ± 34.4 mg/dL (p&lt;0.0001), and resulted in an increase in the percentage of individuals meeting the LDL goal, from 24.5% to 32.9% (p=0.0012).
Interventions through regular case-based video conferences, complemented by live coaching from diabetes specialists, have the potential to improve clinical outcomes for patients with diabetes in China.

Disclosure
K. Lau: None. L. Yunxia: None. L. Yi: None. C. Li: None. Y. Zhengguo: None. D.M. Pober: None. L. Zhang: None. R.A. Gabbay: Advisory Panel; Self; HealthReveal, Hygieia, Lark, Onduo LLC. Consultant; Self; Sanofi. W.C. Hsu: Consultant; Self; Onduo LLC.
1272-P: Population Modeling of Clinical and Economic Impact of the Removal of Sulfonylurea Therapy
Authors: EILERMAN BRADLEY , TESTA LEONARD J. , CANOS MICHAEL 
Published: June 2019

Introduction: Advances in decision support have allowed for simulated medical decision making on a population. These models allow for simulation of policy implementation in disease management. Avoidance of high insulin therapy is frequently mentioned as a preferred strategy for the management of type 2 diabetes.
Methods: Using the GlucosePATH decision support software, a sample of 368 patients drawn from the software’s database was clinically and economically optimized for scenarios matching the full therapeutic options, a scenario excluding sulfonylurea and glinides (NoSU), and a scenario excluding high dose insulin, sulfonylurea and glinides (LowInsulin).
Results: Baseline patient data showed an A1c of 8.7% with mean monthly cost of $28 on standard commercial insurance, $84 on basic commercial insurance, and $354 on Medicare. Optimized with full options resulted in an estimated A1c 7.0% on standard, 7.2% on basic, and 7.5% on Medicare. Monthly cost was on $73 on standard, $168 on basic, and $371 on Medicare. Both the NoSU and LowInsulin scenarios did not show significant difference for basic or standard commercial insurance in terms of cost and A1c. In Medicare, A1c was unchanged for the NoSU model, but increased to 7.8% (+0.3%, p=0.01) in the LowInsulin model. Cost increased to $412 in NoSU model(+$41, p=0.004) and $445 in LowInsulin model (+$64, p=0.015). In the basic commercial and Medicare plan, TZD and insulin use increased. Use of incretin and SGLT2 agents did not demonstrate significant change.
Discussion: Traditional commercial models allow for near ideal implementation of modern diabetes strategies in terms of patient cost, challenges develop when coinsurance or shared-risk models are implemented. It will be important to be able to measure benefit in longitudinal economic terms in addition to laboratory markers.

Disclosure
B. Eilerman: Advisory Panel; Self; Dexcom, Inc., Medtronic. Speaker's Bureau; Self; AbbVie Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Corcept Therapeutics, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc. Stock/Shareholder; Self; PATH Decision Support Software LLC. L.J. Testa: Stock/Shareholder; Self; PATH Decision Support Software LLC. M. Canos: None.
1273-P: Outpatient Diabetes Encounter Visit Frequency in the T1D Exchange Quality Improvement Collaborative
Authors: ALONSO GUY T. , THOMAS SARAH , GAREY COLLEEN , BUCKINGHAM DON A. , CABRERA ALYSSA B. , CLEMENTS MARK A. , CORATHERS SARAH , DESALVO DANIEL J. , GARRITY ASHLEY , LEE JOYCE M. , MCDONOUGH RYAN , MOSTAJABI FARIDA , YEE CURTIS , KAMBOJ MANMOHAN K. 
Published: June 2019

Less than 20% of pediatric patients with type 1 diabetes (T1D) in the U.S. achieve target A1c values, with rising A1c trends between age 6 to 17 years. The International Society of Pediatric and Adolescent Diabetes recommends outpatient clinic visits at least every 3 months, while the American Diabetes Association recommends every 3-6 months. The T1D Exchange Quality Improvement Collaborative aims to improve the quality of T1D care in the U.S. by identifying variations in care and sharing best practices.
Six pediatric diabetes clinics in the Collaborative reported the mean number of days between outpatient diabetes clinic visits for patients with T1D aged 0-6, 7-12, 13-17, and 17-26 years for each month from 11/2017-10/2018. Patients with new onset T1D were excluded, as were those with visit interval &gt;13 months.
Analysis included 31,358 patients. Age group and clinic site (both p&lt;.001) were associated with interval between clinic visits (Figure 1), but month was not (p=.87). Mean number of days was &gt;90 for each age group.

The majority of patients attended clinic less often than required to meet 4 encounters per year. Older age was associated with longer interval between visits. Improving outcomes will require a combination of increasing the perceived value of clinic attendance, increasing access to outpatient encounters, and innovative methods of care delivery outside regular clinic attendance.

Disclosure
G.T. Alonso: None. S. Thomas: None. C. Garey: None. D.A. Buckingham: None. A.B. Cabrera: None. M.A. Clements: Advisory Panel; Self; Glooko, Inc. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Medtronic. S. Corathers: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. A. Garrity: None. J.M. Lee: Consultant; Self; Taiho Oncology, Inc. R. McDonough: None. F. Mostajabi: None. C. Yee: None. M.K. Kamboj: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1275-P: Cost Effectiveness of Using DPP-4i and SGLT2i Combination Therapy vs. Switching to GLP-1 Therapy for the Management of Type 2 Diabetes
Authors: PAWASKAR MANJIRI , BILIR S. PINAR , DAVIES GLENN M. 
Published: June 2019

Background and Aims: Metformin (met) plus [dipeptidyl peptidase-4 inhibitors (DPP-4i), is a commonly used dual therapy among type 2 diabetes (T2D) patients while drug classes such as glucagon-like peptide 1 receptor agonists (GLP-1)] and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are often used as third line agents. We evaluated the long-term cost-effectiveness of a treatment pathway that included 3rd line met+DPP-4i+SGLT2i therapy (pathway 1) vs. switch to met +GLP-1 (pathway 2) in T2D patients not at goal on met+DPP-4i.
Materials and Methods: The validated IQVIA CORE Diabetes Model was used to perform cost-effectiveness analysis over a lifetime for a cohort of T2D patients in the U.S. Treatment effect data were obtained from randomized clinical trials and economic data were obtained from multiple published sources. Several scenario analyses including changes in clinical parameters were performed to assess the robustness of base case results.
Results: Pathway 1 with met+DPP-4i+SGLT2i tripe therapy resulted in increased total life years (Δ=0.049) and quality-adjusted life years (QALY) (Δ=0.026) vs. to pathway 2 (i.e., switching to met+GLP-1). Total medical costs (including drug costs, cost of complications and adverse events (Δ =-$9,511) were lower for patients in pathway 1 vs. pathway 2. Pathway 1 dominates pathway 2, as it is more effective (measured in terms of QALYs) and less costly. Scenario analyses results assessing changes in treatment effect, body mass index, adverse event profiles and different drug cost estimates consistently showed that pathway 1 was either dominant or cost-effective (Incremental cost effectiveness ratio = $76,000/QALY for the most conservative drug costs assumption for DPP-4i plus SGLT2i).
Conclusion: Among patients not at goal on met&ormin and DPP-4i therapy in the U.S., triple therapy wit& met+DPP-4i+SGLT2i was likely to be a cost-effective alternative compared to switching to met+GLP-1.

Disclosure
M. Pawaskar: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Bilir: Employee; Self; IQVIA. G.M. Davies: Employee; Self; Merck & Co., Inc.
1276-P: Effect of Trial Participation on Metabolic Parameters in People with Progressive Diabetic Complications
Authors: PALDÁNIUS PÄIVI M. , STRAIN WILLIAM D. 
Published: June 2019

Multiple randomized controlled trials (RCTs) in people with diabetes have demonstrated a substantial placebo effect, as a result of enhanced patient-physician interaction time. In RCTs focused on glycemic control, the non-pharmacological component of clinical inertia was independent of age and presence of microvascular complications. Here we explore if trial participation per se improves metabolic parameters in people with diabetic complications, independent of trial focus. Participants from a clinical development program focusing on progression of diabetic macular edema (DME) randomized to receive either a sham intravitreal injections or laser therapy were pooled. The primary 12-month outcomes were changes in retinal parameters while for this analysis we assessed the least square (LS) mean change in metabolic parameters, HbA1c and fasting plasma glucose (FPG). Participants were stratified by age (&lt;70/≥70 years) and change in eGFR (an internal standard for monitoring disease progression). Participants (n=288, 46% women) had a mean±SD age of 62.9±9.2 years, diabetes and DME durations 12.6±9.0 and 1.5±2.2 years, respectively. The baseline HbA1c was well controlled, 7.4±1.1% and FPG was 8.9±3.3 mmol/l. The mean eGFR was 84.1±25.1 ml/min/1.73m2 and most subjects were at a normotensive target of mean BP 137/78 mmHg. At 12 months, the LS mean HbA1c change ±SEM from baseline was 0.1±0.1 and FPG 0.5±0.2 mmol/l. While no difference was seen between the age groups for HbA1c (0.1% for both), FPG reduction was numerically higher in elderly (0.8 vs. 0.4 mmol/l). The mean decline in eGFR was −6.5±0.8 ml/min/1.73m2 in both age groups. Trial participation per se does not improve metabolic parameters of people with diabetes, where the trial focus is not on metabolic control. This implies providing unfocused time for people with diabetes will not improve metabolic control, suggesting focused consultations between people with diabetes and healthcare providers for management of diabetes.

Disclosure
P.M. Paldánius: Employee; Self; Novartis AG. Stock/Shareholder; Self; Novartis AG. W.D. Strain: Research Support; Self; Bayer AG, Takeda Development Centre Europe Ltd. Speaker's Bureau; Self; NAPP Pharmaceuticals Limited, Novartis AG, Novo Nordisk A/S.

Funding
Novartis AG
1277-P: Diabetes Management Supplies in Youth with Type 1 Diabetes: Don’t Leave Home Without Them!
Authors: QUINN MARYANNE , BAILEY RYAN , FOSTER NICOLE C. , SIMMONS JILL , EYTH EMILY , RODRIGUEZ HENRY , CORATHERS SARAH , LEVY CAROL J. , SHEANON NICOLE M. , WASSERMAN RACHEL M. , SPARLING DAVID , ADKINS DEANNA , ALBANESE-O'NEILL ANASTASIA , DESALVO DANIEL J. 
Published: June 2019

Youth with type 1 diabetes (T1D) require 24/7 access to T1D management supplies. This study aims to characterize access to T1D supplies when youth are away from home. We emailed a comprehensive survey to 4756 parents of T1D Exchange participants &lt;18 years old; 752 respondents completed the survey (83% completed by parents). Results were age-stratified: &lt;6 (N=21), 6-12 (N=271) and 13-18 (N=459). The majority of youth carry rapid-acting insulin most of the time or always, yet the proportion decreases as age increases (Table 1). ≥80% of injection users carry an extra pen or syringe, while &gt;55% of pump users carry an extra infusion set. Among CGM users, 100% of ≤6 years old vs. 67% of adolescents carry a receiver or phone; 33% of 13-18 years old never carry an extra sensor. 38% of youth ≤6 years old vs. 27% of teens carry blood or urine ketone testing supplies. In total, 64% reported carrying glucose tablets or gel; 87% carry another rapid acting carbohydrate. 64% of respondents carry glucagon, again decreasing across adolescence. Over 2/3 carry at least one form of T1D identification. Technology to optimize glycemic control and detect/prevent acute complications of T1D have improved. Yet, adolescents are less likely than younger T1D-affected youth, to carry supplies to detect, prevent and/or treat acute events. These findings call for novel and ongoing T1D emergency preparedness training to strike a balance between supervision and autonomy of adolescents.

Disclosure
M. Quinn: None. R. Bailey: None. N.C. Foster: None. J. Simmons: None. E. Eyth: None. H. Rodriguez: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Daiichi Pharm Corp, MannKind Corporation, Medtronic MiniMed, Inc. Research Support; Spouse/Partner; Medtronic MiniMed, Inc. Research Support; Self; Takeda Pharmaceutical Company Limited. Other Relationship; Self; Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc. S. Corathers: None. C.J. Levy: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Allergan. N.M. Sheanon: None. R.M. Wasserman: None. D. Sparling: None. D. Adkins: None. A. Albanese-O'Neill: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust