bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Liraglutide Usage for Treatment of Type 2 Diabetes at a Veterans Affairs Medical Center
Authors: RYCHEL RIKKI L. , LOW MARY BETH , WATTS SHARON A. , FALCK-YTTER CORINNA , PASCUZZI KRISTINA M. , LYMAN ALESSANDRA 
Published: June 2018

Approximately 25% of Veterans have diabetes. Both the American Diabetes Association (ADA) and Department of Veterans Affairs/Department of Defense (VA/DoD) guidelines recommend treatment with glucagon-like peptide-1 (GLP-1) agonists, such as liraglutide, as second line options after metformin. In May 2016, the Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives updated criteria for use of GLP-1 agonists, increasing prescribing of this drug class. This coincided with recent data demonstrating cardiovascular benefit of liraglutide and led to increased usage at the Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC). A medication use evaluation was conducted to assess adherence to the criteria for use and to describe the characteristics of liraglutide usage at LSCVAMC. Sixty-two patients with T2DM and a prescription for liraglutide initiated between July 1, 2016 and January 30, 2017 were included. Patients were predominantly male (97%), had a baseline hemoglobin A1c (HgbA1c) of 9.2% and were prescribed metformin (82%). Adherence to the criteria for use was 90%. Follow-up HgbA1c after three to six months was obtained in 87% of patients. Average HgbA1c reduction of 0.76% was achieved in 72% of patients, while 28% were without improvement. Given the less than expected reduction in HgbA1c seen with liraglutide and the pharmacoeconomic impact of this medication, facility changes were implemented to ensure more appropriate prescribing of liraglutide at the LSCVAMC.

Disclosure
R.L. Rychel: None. M. Low: None. S.A. Watts: None. C. Falck-Ytter: None. K.M. Pascuzzi: None. A. Lyman: None.
Physician-Targeted Education for Management of Chinese T2DM Patients Receiving Basal Insulin—BEYOND II Study Results
Authors: WENG JIANPING , ZHAO JIAJUN , ZHOU ZHIGUANG , GUO XIAOHUI , ZHENG XUEYING , LUO SIHUI ,   THE BEYOND II STUDY GROUP
Published: June 2018

BEYOND II was a multicenter, single-arm, observational study in which physicians received education based on T2DM treatment guidelines and effective patient education, reinforced by self-audit and peer-to-peer review over a 6-month period. The primary outcome measure was the proportion of study centers meeting individual improvement goals set by the Study Committee, based on HbA1c &lt;7.0%. Two cohorts of ∼100 patients (baseline and post-education) with T2DM who had received basal-insulin (BI)-based treatment for ≥3 months were enrolled at each center. Of 71 centers that completed the study, 35 (49.3%) achieved improvement targets. Patients in the post-education cohort had improved glycemic control vs. the baseline cohort (Table). At centers meeting improvement targets, a higher proportion of physicians (n=356) self-rated as ’confident in most cases’ about insulin initiation (89.9% vs. 78.9%), titration (87.4% vs. 80.9%), and hypoglycemia management (89.0% vs. 80.6%) post education vs. baseline, but there was no change at centers not meeting improvement targets. In a multivariate regression, completion of education (yes vs. no) had the strongest positive association with achievement of HbA1c &lt;7% (OR=1.55, p&lt;0.001). Physician-targeted education was effective at around 50% of study centers for improving glycemic control in patients with T2DM receiving BI-based treatment.
TableVariableBaseline cohort (N=6386)Post-education cohort (N=6353)P-valueProportion of centers meeting individual improvement targets, n/n (%; 95% CI)--35/71 (49.3%; 37.2 to 61.4%)--Mean HbA1c, % (SD)8.10 (1.732)7.72 (1.579)&lt;0.001Mean FPG, mmol/L (SD)9.10 (3.580)8.44 (3.172)&lt;0.001HbA1c &lt;7%, % (n/N)27.2 (1740/6386)36.5 (2322/6353)&lt;0.001FPG &lt;6.1 mmol/L, % (n/N)15.6 (994/6386)19.6 (1247/6353)&lt;0.001Hypoglycemia (blood glucose ≤3.9 mmol/L or symptomatic hypoglycemia without confirmation), % (n/N)4.4 (282/6386)3.8 (241/6353)0.077

Disclosure
J. Weng: None. J. Zhao: None. Z. Zhou: None. X. Guo: None. X. Zheng: None. S. Luo: None.
An Innovative Cost-Effective Model of Using Advanced Care Practitioners (ACPs) in Improving Glycemic Control and LOS in a Large Hospital System
Authors: JOSHI RENU , HELMUTH AMY 
Published: June 2018

In 2001 healthcare systems identified issues related to increased length of stay and suboptimal outcomes associated with poor inpatient glycemic control. Diabetes clinical initiative (DCI) team was created and the physician champion developed protocols and restructured the delivery of diabetic care across the healthcare system. However it was difficult to provide uninterrupted service due to shortage of Endocrinologists.
An innovative care model was designed in 2009 using specialty trained Endocrinology ACPs’ to improve Glycemic control across system and to provide uninterrupted service including weekends. The ACP’s were trained by the physician champion both with didactic teachings and ongoing case discussions. Automatic consults to ACPS’ were initiated for specific criteria identified by lead physicians .These criteria included HbA1C more than 8.5,Blood Glucose (BG) greater than 200 X4 in 24 hours, BG greater than 300 x2 in 24 hours and Hypoglycemia less than 40x2 in 24 hours .The ACPs’ were always supported by the endocrinology team .
For the last 8 years the glycemic control across the hospital has further improved from average blood glucose of 160-153mg/dl. The rate of mild hypoglycemia remains low at 2% and severe hypoglycemia at &lt; 0.4% . This has resulted in continuation of improved LOS and patient satisfaction as well. Much improved results in Coronary artery bypass surgery (CABG) population have been shown with no deep sternal wound infections in last 6 years. The model remains cost effective for the whole system.
Summary: Innovative model of Glycemic control using specialty trained ACPS’ is cost effective and improves glycemic control and LOS. The ongoing education and support is critical to the success of the program.

Disclosure
R. Joshi: None. A. Helmuth: None.
Feasibility of Shared Telemedicine Appointments for Low SES Adolescents and Young Adults with T1D
Authors: FLORES GARCIA JAQUELIN J. , REID MARK W. , RAYMOND JENNIFER 
Published: June 2018

Background: Shared medical appointments (SMA) via home telemedicine may improve clinic attendance and adherence to care recommendations in adolescent and young adult patients (AYA) with type 1 diabetes (T1D). Participation in home telemedicine requires basic health literacy, reliable access to high-speed Internet on a compatible device, and a private location for attending appointments. AYA from households with lower socioeconomic status (SES) may encounter barriers to participation in home telemedicine due to limited resources.
Objective: Evaluate the feasibility of conducting SMA via home telemedicine for low SES AYA with T1D.
Methods: We conducted baseline patient and family assessments as part of a prospective study on the use of SMA and telemedicine for AYA with T1D who attend a pediatric outpatient endocrinology clinic. We calculated SES for each family using a modified version of the Hollingshead index, and dichotomized patients into low and high SES groups.
Results: AYA reported nearly equal interest in attending SMA (Low: 76%; High: 66%), and in completing appointments online (Low: 41%; High: 45%), regardless of SES. Patients reported having access to high-speed Internet (100%), favored home appointments (Low: 35%; High: 42%), and reported having private space (Low: 83%; High: 88%). Low SES patients were younger than high SES patients (15 vs. 17 years, p = 0.01), and reported shorter disease duration (6 vs. 9 years, p &lt; 0.01). Low SES patients reported needing help reading medical information at least sometimes more frequently (76%) than high SES patients (56%, p = 0.05). However, this effect was attenuated in multiple regression analysis, where variations in patients’ health literacy were associated with age (p &lt; 0.05) instead of SES.
Conclusions: Low SES AYA with T1D are equally equipped and interested in utilizing shared telemedicine as high SES patients. Home telemedicine may be a feasible format for diabetes care and psychosocial support for all patients, regardless of SES.

Disclosure
J.J. Flores Garcia: None. M.W. Reid: None. J. Raymond: None.
Impact of Family-Centered Tailoring of Pediatric T1D Self-Management Resources
Authors: FIALLO-SCHARER ROSANNA V. , RAJAMANICKAM VICTORIA P. , CHEWNING BETTY A. , PALTA MARI , WETTERNECK TOSHA B. , WYSOCKI TIM , COX ELIZABETH D. 
Published: June 2018

Background: Experts recommend family-centered self-management approaches that address specific T1D self-management barriers for each child and family. However, no system-level method currently exists to identify and address these barriers.
Objectives: To assess the impact on glycemic control and QoL for the child and parent of a family-centered approach to the delivery of diabetes self-management resources.
Methods: Children 8-16 years old with T1D and their parent(s) were randomized to receive either tailored self-management resources (intervention) or usual care. Our intervention 1) identified families’ self-management barriers with a validated survey, 2) tailored self-management resources to identified barriers, and 3) delivered these resources as group sessions coordinated with diabetes visits to optimize convenience, efficiency, and sustainability. Mixed effects models with repeated measures were used to examine the intervention’s impact on A1c and parent and child QoL during the 9-month intervention period and for a year thereafter.
Results: Among 363 potentially eligible families, 267 (74%) consented to participate. Randomization allocated 1families to usual care and 1to the intervention. Participants were children (8-12 years, 44%) and teens (13-16 years, 56%). Mean diabetes duration was 5.4 years (sd 3.3) and 14% had an A1c &lt;7.5%. Most families (69%) attended at least 3 of the 4 intervention sessions. No overall intervention effect on A1c or QoL for the child or parent was shown. However, at one site, mean A1c in the year post-intervention declined by 0.059% more per month for intervention group teens than for those receiving usual care (p=0.02). At this same site, mean parent QoL increased by 0.61 points per month more during the intervention for parents of intervention group children than parents of those receiving usual care (p=0.03).
Conclusions: Findings can inform healthcare organizations’ decisions about ways to best deliver diabetes self-management resources.

Disclosure
R.V. Fiallo-Scharer: None. V.P. Rajamanickam: None. B.A. Chewning: None. M. Palta: None. T.B. Wetterneck: None. T. Wysocki: None. E.D. Cox: None.
Longitudinal Changes in Amino Acid (AA) Turnover in Pregnancy in Women with Normal Glucose Tolerance (NGT) and GDM—Relationship to Fetal Growth
Authors: CATALANO PATRICK , PRESLEY LARRAINE , DE MOUZON SYLVIE HAUGUEL , KALHAN SATISH 
Published: June 2018

GDM have decreased glucose insulin sensitivity vs. NGT. However, there are less data on the impact of GDM on AA metabolism or relationship to fetal growth. Ten NGT and 8 GDM (≥ 1 abnormal value, 3 hour OGTT) were evaluated at 18-22 and 32-36 weeks for 2 potent amino acid secretogogues, Phenylalanine (PHE) and Leucine (LEU). PHE and LEU turnover was estimated (D5 PHE and 13C LEU) under basal and euglycemic hyperinsulinemic clamp conditions. Neonatal body composition was estimated using anthropometrics. There were no significant difference in maternal age, race, education, tobacco use, weight or body composition between GDM and NGT at 18-22 weeks. The was a higher family hx of diabetes in GDM (p=0.05). Basal LEU but not PHE turnover increased over time and was greater in GDM, Table. Glucose disposal decreased over time and was lower in GDM. During the clamp LEU but not PHE turnover increased over time and was greater in GDM. Clamp PHE turnover (µmol/kg/hour) at 18-22 weeks correlated with neonatal lean mass (r=0.48, p=0.048) and there was a trend for fat mass (r=0.47, p=0.058). Omitting 1 outlier there remained a trend for PHE turnover and neonatal lean mass (r=0.43, p=0.09). Leu turnover increased over time and was greater in GDM vs. NGT. In contrast, there were no significant changes in PHE turnover over time or between groups but PHE turnover in early pregnancy was related to fetal lean mass.Metabolic ResultsNGT (n=10)GDM (n=8)ANOVABasal Leucine turnover (umol/kg*ffm/hr)12-16 weeks129.8 ± 19.8155.6 ± 20.1p=0.00532-36 weeks134.1 ± 20.8157.0 ± 22.9pgroup = 0.001Leucine turnover (umol/kg*ffm/hr)12-16 weeks108.5 ± 18.5126.8 ± 20.8p=0.0232-36 weeks123.0 ± 19.8136.2 ± 21.8pgroup = 0.03mean ± SDpgroup difference between NGT & GDM

Disclosure
P. Catalano: None. L. Presley: None. S. Hauguel de Mouzon: None. S. Kalhan: None.
Are Changes in Whole-Body Insulin Sensitivity during Pregnancy Related to Changes in Ectopic Fat Stores?
Authors: VESCO KIMBERLY , MARSHALL NICOLE E. , ROONEY WILLIAM , LEO MICHAEL C. , BAETSCHER ERIC , FRANCISCO MELANIE , PURNELL JONATHAN Q. 
Published: June 2018

Background: Our study is one of the first to assess relationships between changes in ectopic lipid stores [intrahepatic (IHL), intramyocellular (IMCL), and extramyocellular (EMCL)] from early to late pregnancy and changes in whole-body insulin sensitivity.
Methods: We evaluated 31 women without diabetes and enrollment BMI’s 18.5-38 kg/m2 in early (mean [min-max] 15.6 [12.9-17.3] weeks) and late (34.2 [32.3-37.3] weeks) gestation. Women with pregestational diabetes or multifetal pregnancies were excluded. Participants underwent insulin clamps to assess whole-body insulin sensitivity (M-value), 1H magnetic resonance spectroscopy to assess IHL, IMCL, and EMCL content, and BODPOD to assess % body fat, fat mass, and lean mass.
Results: Women were primarily white (90%) with mean (min-max) age of 30.5 (19 -39) years. M-value declined 27% between early and late visits (p&lt;.001) and IHL, IMCL, and EMCL increased (p&lt;.05). M-value was not significantly correlated with any total or ectopic fat in late pregnancy. Changes in these body composition variables from early to late pregnancy were not significantly associated with changes in M-value.
Conclusion: Whole-body insulin sensitivity declines from early to late pregnancy but was unrelated to changes in ectopic and total fat. Non-body composition factors appear to be the primary determinant of gestation-related insulin resistance.Table. Means, standard deviations, and Pearson’s correlation coefficients for insulin sensitivity (M-value), weight, and total and ectopic fat measures at late pregnancy and from early to late pregnancy.MeasureMean (SD) Late pregnancyCorrelation with M-valueMean (SD) change from early to late pregnancyCorrelation of change in measure with change in M-ValueM Value275.7 (69.8)--100.3 (112.6)*--Weight (kg)82.9 (12.3).3210.5 (3.3)-.01BMI (kg/m2)28.7 (3.8).153.6 (1.1)-.01Body fat (%)33.3 (6.4).18-0.8 (3.6).00Fat mass (kg)28.2 (8.7).253.0 (3.2).05Lean mass (kg)54.7 (5.9).297.5 (2.6)-.08IHL (% water peak)0.6 (0.3).120.1 (0.2)*-.18IMCL (% water peak)1.2 (0.6).010.3 (0.6)*-.02EMCL (% water peak)2.3 (1.4).290.5 (1.2)*-.06*p&lt;.05

Disclosure
K. Vesco: None. N.E. Marshall: None. W. Rooney: None. M.C. Leo: None. E. Baetscher: None. M. Francisco: None. J.Q. Purnell: Advisory Panel; Self; Novo Nordisk Inc..
A Reduction in Sedentary Behavior in Obese Women Reduces Neonatal Adiposity—The DALI Randomized Controlled Trial
Authors: POPPEL MIREILLE VAN , SIMMONS DAVID , DESOYE GERNOT ,   DALI CORE INVESTIGATOR GROUP
Published: June 2018

Background: Maternal obesity and gestational weight gain are implicated in the development of childhood obesity tracking from neonatal adiposity. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity.
Methods: In the Vitamin D And Lifestyle Intervention (DALI) Lifestyle trial, 436 women with a body mass index ≥ 29 kg/m2 were randomly assigned to counseling on Healthy Eating (HE), Physical Activity (PA), HE&PA, or to usual care (UC). Neonatal outcomes were head, abdominal, arm and leg circumference, skin folds, estimated fat mass, fat percentage, fat free mass, and cord blood leptin. Intervention effects on neonatal outcomes were assessed in multilevel analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed.
Results: Outcomes were available from 334 neonates. A reduction in sum of skin folds (-1.8 mm; 95% CI, −3.5 to -0.2; p=0.03), fat mass (-63 g; 95% CI, -124 to -2; p=0.04), fat percentage (−1.2%; 95% CI -2.4 to -0.04; p=0.04), and cord blood leptin (-3.80 µg/l; 95% CI -7.15 to -0.45; p=0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (-5.79 µg/l; 95% CI, -11.43 to -0.14; p=0.05) compared to UC. Reduced sedentary behavior, but not gestational weight gain, mediated intervention effects on leptin in the HE&PA and PA group.
Conclusion: The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary behavior seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity of the offspring need to be elucidated.

Disclosure
M. van Poppel: None. D. Simmons: Speaker's Bureau; Self; Roche Diabetes Care Health and Digital Solutions, AstraZeneca, Novo Nordisk Inc., Medtronic. G. Desoye: None.
Management of GCK-MODY in Pregnancy—Does Clinical Practice Follow Current Recommendations?
Authors: DICKENS LAURA T. , LETOURNEAU LISA R. , PHILIPSON LOUIS H. , GREELEY SIRI ATMA W. , NAYLOR ROCHELLE N. 
Published: June 2018

Recommendations for management of GCK-MODY during pregnancy are based on fetal genotype. Women with GCK-MODY should not be treated with insulin prior to conception and insulin should not be given if normal fetal growth is observed. Women should be treated with insulin if fetal ultrasound monitoring starting at 26 weeks shows macrosomia, suggesting the fetus is wild type for the GCK gene. There is limited data about management of GCK-MODY in pregnancy.
The aim of this study was to examine clinical management and pregnancy outcomes amongst women with a known diagnosis of GCK-MODY. A survey was distributed via Redcap to 94 women &gt;/= 18 years enrolled in the University of Chicago Monogenic Diabetes Registry. All or part of the survey was completed by 59% of women.
GCK-MODY diagnosis was known at the time of pregnancy for 14 women with a total of 18 pregnancies, including 2 women who were currently pregnant. There were 13 term births and 3 premature births. Glucose-lowering therapy was used preconceptually in 33% of cases, including insulin use in 3 women. Insulin was started in 7 pregnancies; in 4 cases the fetus measured normal for dates and in 3 cases measured large. Insulin was started between 5-32 weeks (average 16.4 weeks). Insulin treatment was not started in 1 pregnancy where the baby measured large for dates and early induction was required. This offspring was WT for GCK.
In our study, contrary to current recommendations, one-third of pregnancies were treated with glucose-lowering medication prior to pregnancy, including insulin. Insulin initiation occurred early in gestation (average 16.4 weeks), rather than being based on fetal size on ultrasound monitoring. These observations suggest that for many pregnancies affected by GCK-MODY, management does not reflect current guidelines. Further studies to confirm the safety and efficacy of the current recommendations may improve provider confidence in deferring insulin treatment in cases where ultrasound monitoring shows normal fetal growth.

Disclosure
L.T. Dickens: None. L.R. Letourneau: Other Relationship; Self; Novo Nordisk Inc. L.H. Philipson: Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc. S.W. Greeley: Research Support; Self; Novo Nordisk Inc.. R.N. Naylor: None.
Is Gestational Weight Gain below That Recommended by IOM for Obese Women with Insulin Treated Gestational Diabetes Safe?
Authors: BOGDANET DELIA , O'SHEA PAULA M. , DUNNE FIDELMA P. 
Published: June 2018

The Institute of Medicine (IOM) recommends gestational weight gain (GWG) of 5-9 kg in women with a body mass index of &gt;/=30. Debate continues as to whether GWG less than that recommended is safe. Concern relates to whether this would result in an increase in small for gestational age (SGA) infants, or an increase in rates of prematurity. We examined pregnancy outcomes for mothers with a BMI &gt;/=30 and their offspring in 473 women. All women recorded on our Atlantic DIP database with a singleton pregnancy treated with insulin and a BMI&gt;/=30 were included. Women were categorised into 3 groups as follows (1) those with weight loss, N = 97 (2) weight gain 0-5kg, N = 49 (3) weight gain &gt;5kg N = 327, from first antenatal visit to delivery. Rates of maternal outcomes (pregnancy induced hypertension (PIH), preeclampsia (PET), antepartum (APH) and postpartum haemorrhage (PPH), week of delivery, caesarean section (CS) delivery) and neonatal outcomes (birth weight, large for gestational age (LGA), SGA, macrosomia, prematurity, neonatal morbidities) were compared. Mean maternal booking BMI was 38, 37.6 and 36 kg/m2 (p&lt;0.01) and mean maternal age was 34.7, 34.1 and 33.3 years in groups 1,2 and 3 respectively (p=0.04). Rates of PIH PET APH PPH and CS were similar between groups. Glycaemic control prior to delivery was better in women in group 1 compared to groups 2 and 3 (HbA1C 37.2 vs. 38.4 vs. 39 mmol/mol; p = 0.02). Infant birth weight was lower in group 1 compared to groups 2 and 3 (3545g vs. 3645g vs. 3703g; p&lt;0.01) Rates of LGA, macrosomia. SGA and prematurity (&lt;37 gestational weeks) were similar between groups. Rates of neonatal hypoglycaemia were less in group 1 compared to groups 2 and 3; (2.1% vs. 14.3% vs. 4%; p&lt;0.01), while all other morbidities were similar between groups. Gestational weight change for GDM women treated with insulin below that recommended by the IOM appears safe. In addition, it is associated with better maternal glycaemic control and lower infant birth weight.

Disclosure
D. Bogdanet: None. P.M. O'Shea: None. F.P. Dunne: None.