bluuebunny/crossref_metadata_2025_split huggingface dataset:
1236-P: Hospitalizations Rates among Homeless Children with Diabetes Mellitus in New York
Authors: SAKAI-BIZMARK RIE , YEE JENNIFER K. 
Published: June 2019

Background: Diabetes mellitus (DM) is increasing in prevalence among U.S. children. Disparity across race and socioeconomic status for DM incidence as well as DM outcomes have been reported. Homeless youth live under unique circumstances that may lead to challenges in self-care. We hypothesized that homelessness may be associated with difficulties in blood glucose management, and therefore would lead to increased healthcare utilization. The aim of this study was to assess healthcare utilization related to DM among homeless youth.
Methods: This secondary data analysis identified homeless and non-homeless pediatric patients (&lt;18 years) with a primary diagnosis of DM from the New York statewide inpatient database between 2009 and 2014. Hospitalization rates, readmission rates, hospitalizations with ketoacidosis, admissions through the emergency department (ED), and hospitalization costs and lengths of stay (LOS) were used as outcomes.
Results: We identified 11,202 DM-related hospitalizations, yielding 4.26 and 0.41 hospitalizations per 1,000 homeless and non-homeless children, respectively. Readmissions accounted for 21.0% of homeless and 14.6% of non-homeless hospitalizations (p&lt; .01). Compared with non-homeless patients, homeless patients were more likely to be admitted from ED: Odds Ratio (OR) 1.53, p&lt;.01. Stratified analyses by DM type revealed that homeless patients with DM1 had longer LOS than non-homeless patients: Incidence Rate Ratio (IRR) 1.23, p&lt;.01, whereas a difference in LOS was not detected among patients with DM2. No other outcomes were associated with homelessness.
Conclusions: Homeless youth experience 10.4 times higher DM hospitalization rates than non-homeless youth, with higher rates of readmission. Healthcare utilization was especially high for homeless youth with DM1. Further studies are needed to examine the factors contributing to increased healthcare utilization in order to develop tailored management strategies for homeless youth with diabetes.

Disclosure
R. Sakai-Bizmark: None. J.K. Yee: None.
1244-P: Diabetes Screening to Appropriate Follow-Up: Are Patients Getting Timely Diagnoses and Treatment?
Authors: STEMPNIEWICZ NIKITA , CIEMINS ELIZABETH L. , RATTELMAN CORI R. , CUDDEBACK JOHN K. 
Published: June 2019

Objective: To measure time from positive diabetes screening test to appropriate follow-up action, i.e., diagnosis, pharmacologic treatment, or negative confirmatory test, using a large, geographically diverse clinical dataset.
Study Design: Retrospective descriptive analysis in a clinical database with over 25 million patient records.
Population Studied: From 2013-2017, 61,162 patients aged 18-75 from 23 health care organizations (HCOs) with ≥ 1 outpatient visit in last 12 months of data, a laboratory finding of HbA1c ≥ 6.5 or fasting plasma glucose (FPG) ≥ 126 in the last 12-24 months, and no prior diabetes diagnosis or prescriptions (except metformin).
Principal Findings: Positive diabetes tests were indicated by HbA1c (28%), FPG (61%), or both (11%). A total of 5.7% of patients had an FPG ≥ 200, and 6.9% had an HbA1c ≥ 8.0. Sixty-five percent (range 55-77% across 23 HCOs) had appropriate action in 3 months following a positive screening: 35% had a diagnosis or prescription for an antidiabetes medication; 30% had neither diagnosis nor prescription but had a subsequent negative diabetes test result. The remaining 35% had no diagnosis nor prescription, and either re-tested positive for diabetes or had no follow-up. By 12 months, 83% of all patients received appropriate follow-up. Among patients with HbA1c ≥ 8.0, 92% and 96% had appropriate follow-up within 3 and 12 months, respectively. Most initial prescriptions were for metformin (84%) with variation in use of 2nd or 3rd line diabetes medications: sulfonylurea, 1-12%; DPP-4, 0-10%; SGLT2, 0-10%; GLP-1, 0-3%; and insulin, 1-12%.
Conclusions: Within a year of a positive diabetes screen, most patients received appropriate action. Those with higher lab values were more likely to receive appropriate action sooner. Among those with prescriptions, most were for metformin. The proportion of patients with appropriate action, time to action, and type of action, e.g., use of 2nd and 3rd line agents, all varied considerably across HCOs.

Disclosure
N. Stempniewicz: None. E.L. Ciemins: None. C.R. Rattelman: None. J.K. Cuddeback: None.

Funding
Novo Nordisk
1256-P: Assessing Truck Drivers with Diabetes: The Clinician's Role
Authors: LORBER DANIEL , HATHAWAY KATIE 
Published: June 2019

In 2018 the Department of Transportation (DOT) published a new rule on the requirements for medical certification of commercial motor vehicle (CMV) drivers with insulin-treated diabetes mellitus. This rule eliminates significant obstacles for those drivers, thus potentially enabling thousands of drivers to pursue careers that had previously been unavailable to them.
This poster reviews the process of CMV medical certification for drivers with insulin-treated diabetes and provides resources and guidance for the assessment process. The new rule requires an assessment by a treating clinician (defined as a healthcare professional who manages, and prescribes insulin for, treatment of the individual’s diabetes mellitus as authorized by the healthcare professional’s applicable state licensing authority). The components of this assessment include:
• A minimum of 3 months of blood glucose self-monitoring records measured with a glucometer that stores all readings from which data can be downloaded.
• Hypoglycemia history.
• Hemoglobin A1C measurements.
• Complications of diabetes.
The treating clinician completes an assessment form to determine whether the driver meets the physical qualification standards of the Federal Motor Carrier Safety Administration (FMCSA) to operate a CMV. Additional assessment by the treating clinician may be required if the driver has recently experienced a motor vehicle accident or severe hypoglycemic episode. The treating clinician is required to attest the driver maintains a “stable insulin regimen” and “proper control of his/her diabetes mellitus.” The American Diabetes Association provides a useful online calculator to assess the risk of a diabetes related motor vehicle accident (professional.diabetes.org/RADD)
Although the rule requires an opinion from a treating clinician, the final decision on medical certification for any individual CMV driver is made by a certified medical examiner listed on the National Registry of Certified Medical Examiners.

Disclosure
D. Lorber: None. K. Hathaway: None.
1257-P: Quality Improvement Project to Increase Insulin Pump Use in Pediatric Type 1 Diabetes
Authors: LYONS SARAH , CANADA NICKI L. , HERNANDEZ KEVIN , SEGOVIA JAMIE E. , BARTZ SARA K. , DESALVO DANIEL J. , MCKAY SIRIPOOM , SONABEND RONA 
Published: June 2019

Background: Insulin pump therapy in type 1 diabetes (T1D) has been associated with lower hemoglobin A1c than multiple daily injections. In the T1D Exchange, 63% of pediatric patients &lt;18 years old in 2013-14 used pumps. However, pump use at our institution in 2015 was much lower at 39.4% (551 of 1399 patients &lt;18 years old with T1D duration ≥1 year attending clinic at least twice yearly). A multidisciplinary team of pediatric endocrinologists, diabetes educators, and hospital leaders implemented a QI initiative aimed to increase pump use to ≥50%.
Methods: Pump use was extrapolated from diabetes providers’ visits in the electronic medical record (EMR) and tracked via a run chart. A series of plan-do-study-act (PDSA) cycles were implemented, including:
1. Creation of introductory and advanced pump handouts for patients.
2. Quarterly technology sessions for providers and clinic staff to improve pump knowledge.
3. Creation of pump start orders in the EMR.
4. Certification of the clinic’s diabetes educators in all commonly used pumps.
5. Scheduled diabetes educator visits for all patients after pump initiation.
Results: Pump use increased from 39.4% (551 of 1399 patients) in 2015 to 50.6% (730 of 1442 patients) in 2018 (Image 1).
Conclusion: The aim of increasing pump use to ≥50% of our clinic’s population was achieved over 3 years. Building on this success, future direction is to evaluate impact on bolus frequency and association with HbA1c.

Disclosure
S. Lyons: None. N.L. Canada: None. K. Hernandez: None. J.E. Segovia: Consultant; Self; Insulet Corporation. S.K. Bartz: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. S. Mckay: None. R. Sonabend: None.
1287-P: Demographics, Socioeconomic Characteristics, and Quality of Life Accompaniments of Pain in Diabetic Polyneuropathy
Authors: LAPIN BRITTANY , MORRISON SHANNON , SCHUSTER ANDREW , JOHNSON KRISTEN , BOULOS FERNANDA , THAKORE NIMISH J. , MILINOVICH ALEX 
Published: June 2019

A subset of patients with diabetic polyneuropathy (DPN) have significant pain. There is little information on how patients with painful diabetic polyneuropathy (DPN+P) differ from those with DPN without pain (DPN-P). The objective was to determine differences in demographics, socioeconomic characteristics, and patient-reported quality-of-life (QoL) between DPN+P and DPN-P patients. We used an algorithm of high sensitivity (90%) and moderate specificity (60%) to electronically classify patients within our institution between 2009 and 2016 as no DPN, DPN+P, or DPN-P. QoL was assessed as part of standard of care using PROMIS Global Health mental and physical summary scores, and PHQ-9 depression screen. We report clinically and statistically significant (p&lt;0.05) differences between DPN+P and DPN-P. Independent associations with DPN+P were evaluated using multivariable logistic regression models.Of 43,945 patients with type 2 diabetes, 13,910 (32%) had DPN, of whom 9,104 patients had DPN+P (65%) and 4,806 had DPN-P (35%). Patients with DPN+P were significantly younger than DPN-P (68±13 vs. 66±13), and more likely to be female (55% vs. 44%). Compared to DPN-P, DPN+P patients were less frequently white (67% vs. 72%), less frequently married (47% vs. 54%), had lower median household income ($50.6k vs. $55.5k), and were more likely to be covered by Medicaid (14% vs. 7%) and less likely to have private health insurance (21% vs. 29%). QoL measures, PROMIS and PHQ-9 scores, were significantly worse for patients with DPN+P vs. DPN-P. Younger age, female sex, and worse QoL remained independently associated with DPN+P after adjustment. Demographic, socioeconomic, and QoL associations could be causative of pain, perhaps mediated through poorer diabetes care, and could be consequences of pain, mediated through loss of productivity. This reciprocal effect and the economic magnitude of the problem warrant longitudinal study of the risk factors and natural history of pain in DPN.

Disclosure
B. Lapin: None. S. Morrison: None. A. Schuster: None. K. Johnson: Employee; Self; Novartis Pharmaceuticals Corporation. F. Boulos: Employee; Self; Novartis Pharmaceuticals Corporation. N.J. Thakore: Research Support; Self; Novartis Pharmaceuticals Corporation. A. Milinovich: Research Support; Self; Amgen Inc., Celgene Corporation, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Otsuka Pharmaceutical Co., Ltd.
129-OR: Diabetes Prevention through Yoga-Based Lifestyle: A Pan-India Randomized Controlled Trial
Authors: NAGARATHNA RAGHURAM , VENKATA S. RAM C. , RAJESH SASIDHARAN K. , SINGH AMIT , MAJUMDAR VIJAYA , PATIL SUCHITRA , NAGENDRA HONGASANDRA R. 
Published: June 2019

Objective: The study tested the potency of yoga-based intervention on risk reduction of diabetes.
Research Design and Methods: This study is an offshoot of a large, 2 group cluster randomized, translational research trial on 11,212 individuals, aged &gt;20 years, with high-risk (&gt;60) for diabetes on IDRS (Indian diabetes risk score) and type 2 diabetes. The present study included a subgroup of 3,366 prediabetes individuals [A1C range of 5.70-6.49% (39-47 mmol/mol)]. Eligible individuals were selected by community-based (rural and urban) screening from 29 states/union Indian territories and were cluster randomized. The wait list control group received lifestyle advice. The experimental group performed a validated yoga-based lifestyle intervention developed by a group of 16 yoga and diabetes experts using the Delphi method. The study outcomes, diabetes incidence/prediabetes remission were obtained by respective A1c values &gt;6.5% (48 mmol/mol) or &lt;5.7% (38 mmol/mol) (normoglycemia) at 3 months of follow-up.
Results: At 3 months of follow-up, 11.2% of the yoga-intervention group and 21.6% of the control group developed diabetes (p&lt;0.05); the relative risk reduction (RRR) was 47% (95% CI: 26-70). Interestingly, the intervention resulted in an effective shift to a normal range of A1c values in 52.0% of individuals as compared to only 39.9% in the control (p&lt;0.05). Yoga-intervention was found to be beneficial for both the normal BMI (&lt;23 Kg/m2) and the overweight/obese sub-groups (≥23 Kg/m2), as indicated by the respective RRRs of 69% (95% CI: 52-85) and 51% (95% CI: 32-70).
Conclusion: This is the first report on the effectiveness of a yoga-based life style intervention for remission of prediabetes and prevention of diabetes. The intervention was adequately effective for normal and overweight/obese subgroups. The short-term findings demand the need for longer follow-up. We speculate positive long-term outcomes based on the reported effects of yoga on self-control and feeding behavior.

Disclosure
Raghuram Nagarathna: None. C. Venkata Ram: None. Sasidharan Rajesh: None. Amit Singh: None. Vijaya Majumdar: None. Suchitra Patil: None. Hongasandra Nagendra: None.

Funding
The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy; Government of India Ministry of Health and Family Welfare
1290-P: Achieving and Sustaining Inpatient Glycemic Goals by Employing Targeted Strategies that Include Daily Surveillance and Real-Time Communication
Authors: THOMPSON ELAINA L. , EVERHART BRIDGET 
Published: June 2019

Background: Approximately 30% of inpatient admissions require glycemic management at our 680 bed academic hospital. The Inpatient Diabetes (DM) Program created internal glycemic goals, employed targeted strategies to meet and sustain these goals, and began participation in a national database for comparative benchmarking.
Purpose: The purpose of the Inpatient Diabetes Program is to lead evidence-based diabetes care to achieve glycemic outcomes for hospitalized patients.
Method: The DM Program uses targeted strategies to meet glycemic outcomes, including daily surveillance, real-time communication with providers, maximization of the Electronic Health Record (EHR), provision of varied educational formats, and empowerment of front line staff in decision making. Daily real-time communication occurs with the prescribing provider (e.g., resident/advanced practice provider and the attending provider regarding recurrent hypoglycemia and persistent hyperglycemia. Follow-up surveillance is completed to evaluate if there was a treatment change. Maximization of the EHR has facilitated standardization of care with the creation of order sets, reports and real-time surveillance. Staff education is provided using various platforms including focused courses, a DM share-point site, videos, and a DM newsletter.
Results/Outcomes: The rate of hyperglycemia (BG &gt;180 mg/dL) has decreased in the previous 3 years from 25% to 20% for point of care glucose values, without an increase in hypoglycemia. The hypoglycemia rate has consistently remained at 2% with a severe hypoglycemia rate of 0.1%. Day weighted mean BGs in both critical care and non-critical care meet the national benchmark targets.
Implications for Practice: Using targeted interventions that are “active” strategies like frequent surveillance and real-time communication helps achieve inpatient glucose goals.

Disclosure
E.L. Thompson: None. B. Everhart: None.
1294-P: Detection and Intervention of Prediabetes in a Large Urban Health System: Systematic Failure or Looming Opportunity?
Authors: NEWBOLD EMILY , CARLSON SUSAN E. , SULLIVAN DEBRA K. , ROBBINS DAVID C. , BELTRAMO ALVIN , LOWRANCE MAREN , WAITMAN LEMUEL R. 
Published: June 2019

Efficient early detection of prediabetes is critical in order to intervene and reduce conversion to T2DM since lifestyle interventions and/or metformin are proven to reduce progression. Retrospective data from a nationally-ranked tertiary academic medical center were analyzed to determine diagnosis rates, frequency of lifestyle and prescription interventions, and to assess characteristics of patients who were most likely to be clinically identified or treated.
Data from the EpicCare EMR were analyzed using the University of Kansas Medical Center i2b2-based clinical data repository (HERON). Data were collected for 69,781 patients established in academically affiliated primary care clinics between 2015 and 2017. After excluding for previous diabetes/prediabetes diagnoses or use of glucose lowering agents, 46,855 patients remained to assess for incident prediabetes (ADA criteria). Clinical recognition of the prediabetes diagnosis, nutrition or weight management referral, and metformin prescription were assessed.
Incident prediabetes occurred in 2,581 patients (5%). Thirty eight percent of those received a charted prediabetes diagnosis, 9% received either a referral to nutrition or weight management, and 4% received a metformin prescription. Females (OR 1.57) or those who had higher BMI (OR 1.02) or A1c values (OR 5.67) had higher odds of receiving clinical recognition (p&lt;0.0001).
We conclude that relatively few people with prediabetes are clinically noted and even fewer receive interventions that may reduce the conversion to T2DM. There are gender and weight biases; patients with higher BMI, higher A1c values, and females were more likely to have documentation for diagnosis and treatment for prediabetes. These low rates of recognition and treatment are likely to be similar among health care systems across the country. The low rates of recognizing, documenting, and intervening are opportunities to better utilize the EMR and reduce conversion to T2DM.

Disclosure
E. Newbold: None. S.E. Carlson: Advisory Panel; Self; DSM. Other Relationship; Self; MeadJohnson Nutrition (RB). D.K. Sullivan: None. D.C. Robbins: None. A. Beltramo: None. M. Lowrance: None. L.R. Waitman: None.
1297-P: Mortality and Glycemic Control among Patients with Endometrial Cancer and Diabetes Mellitus: A Case-Control Study
Authors: KARLIN NINA , VERONA PATRICIA M. , BURAS MATTHEW R. , KOSIOREK HEIDI E. , COOK CURTISS 
Published: June 2019

Background: The aim of this study was to examine the impact of diabetes mellitus (DM) on survival in endometrial cancer patients, and the impact of endometrial cancer on glycemic control in DM.
Methods: Patients with newly diagnosed endometrial cancer with DM (n=48) were identified from the Institutional Cancer Registry and matched to 48 endometrial cancer patients without DM according to age, gender and year of cancer diagnosis (2006 to 2016). The electronic medical record provided information on DM, cancer therapies and laboratory results. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method and compared by Cox regression analysis using stratification for matched pairs. Mixed models were used to compare hemoglobin A1c (HbA1c) and glucose during the year following cancer diagnosis.
Results: Mean age of the entire cohort was 67 years, 85% were white, and 76% had stage I disease. BMI was significantly different between DM and non-DM patients (39.6 versus 29.3; p&lt;0.001). More patients without DM were treated with chemotherapy (33% versus 13%; p=0.04). Among those with DM, mean HbA1c during the year following cancer diagnosis was 7.2%. For glucose, DM group status was significant (p&lt;0.001) as DM pts had higher glucose overall compared to non-DM pts (147 mg/dL vs. 106 mg/dL, p&lt;0.001) and there was a time effect (p=0.03) as well. In both groups, glucose decreased during the year following diagnosis. Median follow-up time was 47 months (range 1.2 - 115.6 months) in living patients. 5-year survival estimated at 91% for DM patients versus 95% in non-DM pts by Kaplan Meier method (p=0.25 log rank test). OS Hazard ratio was 1.50 (95% CI: 0.25 - 8.98; p=0.66). 5-year PFS was estimated at 89% for both groups PFS Hazard ratio was 0.75 (95% CI: 0.17 -3.35; p=0.71).
Conclusions: Endometrial cancer and its treatment did not affect glycemic control. DM did not adversely impact survival in patients with endometrial cancer.

Disclosure
N. Karlin: None. P.M. Verona: None. M.R. Buras: None. H.E. Kosiorek: None. C. Cook: None.
13-LB: Nasal vs. Injected Glucagon: User Experience Results of a Simulated Severe Hypoglycemia Study
Authors: SETTLES JULIE , CHILD CHRISTOPHER J. , BAJPAI SANJAY K. , SPAEPEN ERIK , SUICO JEFFREY G. 
Published: June 2019

Injectable glucagon (IG) is challenging to use for caregivers of a person with diabetes (PWD) in stressful severe hypoglycemia (SH) rescue. We evaluated user preference for nasal glucagon (NG) and IG devices after treating simulated SH. The PWD trained arm was adult PWDs trained to use NG or IG, then PWDs trained their caregivers how to use it; 1 week later, caregivers administered the device to a life-like manikin exhibiting SH in a simulated real life setting with distractions creating urgency. The untrained arm was adults not associated with a PWD, but willing to assist - not trained, but shown the device just presimulation. After 1 week, the process was repeated with the other device. We assessed perceptions of simulation participants and PWDs via comparative device questionnaires, completed after videos of both simulations were viewed after the 2nd simulation (no confirmation of success provided). NG was rated more preferred by those with successful doses of NG or IG. PWDs indicated that they felt safer with NG even with successful IG dosing (Table). Untrained users were as successful as PWD-trained in dosing NG, while there were no IG successes without training. None of the few who preferred IG gave a successful IG dose, whereas the few successful IG-users preferred NG or stated no preference. Being PWD-trained was not critical for success with NG, and ease of preparation and use likely contributed to overall preference.

Disclosure
J. Settles: Employee; Self; Eli Lilly and Company. C.J. Child: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. S.K. Bajpai: Employee; Self; Eli Lilly and Company. E. Spaepen: Consultant; Self; Eli Lilly and Company. J.G. Suico: Employee; Self; Eli Lilly and Company.

Funding
Eli Lilly and Company