bluuebunny/crossref_metadata_2025_split huggingface dataset:
5099 Capturing the Patient Voice for Diabetes Eye Exams
Authors: Du S , Lambrechts S , Freeby M , Han M 
Published: October 2024

Abstract
Disclosure: S. Du: None. S. Lambrechts: None. M. Freeby: None. M. Han: None.
Background: Diabetic retinopathy (DR) is a leading cause of blindness among adults 20-74 years old. Ophthalmic exams are recommended every 1-2 years for type 2 diabetes patients with minimal to no DR. The 50th percentile Integrated Healthcare Association benchmark for DR screening is 49%, but at our academic medical center, the completion rate is 30%. Potential barriers to screening noted in the literature include lower levels of education, lack of knowledge about DR, and financial barriers. Objective: To understand motivating factors and barriers to DR screening among patients in our health system. Methods: We utilized the Patient Voice qualitative research method to uncover themes and identify interventions to improve care delivery. The literature was synthesized to develop a structured interview guide. From our urban academic health system, 15 patients were randomly selected for interview, six of whom had completed the “Diabetes Eye Exam” care gap and nine that had not. Interviews were transcribed and coded for thematic analysis. Results: Six opportunity areas were identified. 1) There are currently only six retinal cameras located across primary and specialty care clinics serving more than 38,000 diabetes patients. 67% of patients felt the current clinic locations were inconvenient, with distant locations and long travel times. 2) 20% of patients expressed that they would like increased flexibility of appointments offered, such as evening, weekend, and same day appointments. 3) Patients were motivated by automated diabetes eye exam specific reminder messages and appreciated the ability to self-schedule within the patient portal. 47% of patients wanted yearly reminder messages, while 40% had no preference. 4) 53% of patients expressed that they did not fully understand DR or were confused about the difference between an optometrist exam and diabetes eye exam. 5) 40% of patients completed their eye exam with their local optometrist and found this to be a more convenient option. One patient expressed that she wished her doctor had informed her that she could complete her diabetes eye exam at a local optometry clinic. 6) If patients do choose to complete their exam with their local optometrist, they would like reminders to send their records to their primary care physician or endocrinologist. A more streamlined processes to upload outside records through the patient portal would decrease this barrier. Conclusion: It is important to engage patient stakeholders and understand their needs to improve overall experience and close care gaps. Through the Patient Voice, we learned that factors such as driving distance, traffic, scheduling, and issues with uploading records are major barriers to care gap completion. Convenient clinic locations, education, and reminder messages are motivating factors. Future work will focus on developing and implementing solutions in each opportunity area.
Presentation: 6/1/2024
9250 carRNA m6A methylation regulates transcription state and chromatin accessibility in human islets in normal physiology and type 2 diabetes
Authors: Shukla Namrata , Ju Cheng-Wei , Li Han , He Chuan , Kulkarni Rohit 
Published: October 2024

Abstract
Disclosure: N. Shukla: None. C. Ju: None. H. Li: None. C. He: None. R. Kulkarni: Advisory Board Member; Self; Novo Nordisk, Biomea Fusion Inc, REDD Pharma. Grant Recipient; Self; Inversago.
Chromatin-associated regulatory RNAs (carRNA), which include promoter- and enhancer-associated RNAs as well as several non-coding repeat elements have been established in the literature as important regulators of global gene transcription. However, the regulation of carRNAs themselves has been an enigma. Recent publications from the He Lab at UChicago have shown the role of RNA N6-methyladenosine (m6A) in regulating carRNA stability and function. m6A is among the most abundant mRNA modifications in mammals. Seminal work from our lab has reported that the “writers” of m6A (e.g. methyltransferase-like [METTL3] and METTL14) are significantly downregulated in islets of humans with type 2 diabetes (T2D). Consequently, the global m6A landscape in the islets segregates the T2D from the control group significantly better than the transcriptome (n=7 for Control and n=8 for T2D islets). Hypomethylation of key transcripts in the insulin/IGF-1-AKT-PDX1 pathway led to impaired insulin secretion and decreased β-cell proliferation. We now show this decreased m6A on RNA is not limited to the mRNA but also affects chromatin-associated regulatory RNAs (carRNA). Intriguingly, downregulation of METTL3 and METTL14 in human β-cell line EndoC-βH1 differentially regulates these regulatory versus protein-coding transcripts. We observe that while METTL14 KD causes global downregulation of transcripts belonging to pathways important for β-cell identity and function (including calcium signaling, PI3K-AKT/MAPK signaling pathway, pancreatic secretion etc.), it leads to an upregulation of pathways involved in RNA processing and global gene transcription (Transcription by RNA Pol II, metabolism and splicing of mRNA, chromatin organization and modification etc.) {false discovery rate (FDR) &lt; 0.05}. Considering carRNAs have been previously reported to regulate global chromatin accessibility and transcription, our observations on their ability to get differentially regulated m6A writer proteins provide novel insights into the epigenetic regulation of human islet cells. These findings provide opportunities to develop therapeutic approaches to regulate β-cell identity and/or insulin secretion in T2D.
Presentation: 6/3/2024
7241 Catamenial Diabetic Ketoacidosis
Authors: Javed Laraib , Rehan Aiman , Hashim Laila , Lim Jonea 
Published: October 2024

Abstract
Disclosure: L. Javed: None. A. Rehan: None. L. Hashim: None. J. Lim: None.
Introduction: Diabetic ketoacidosis (DKA) is a common cause of hospitalization and readmission in patients with diabetes mellitus. Etiologies are generally due to medication non-adherence, trauma, infection, or other precipitating illness. In approximately 10% of DKA cases, no discernible precipitating cause can be determined. The word catamenial is derived from a Greek word meaning monthly. It is used to describe the monthly occurrence of menstruation. Catamenial hyperglycemia is a phenomenon in which blood glucose levels change with the different phases in the menstrual cycle. This can precipitate recurrent, unexplained episodes of DKA. Here, we present a similar case. Case description:A 19-year-old woman with type 1 diabetes, gastroparesis, hypertension, dysmenorrhea and cyclical vomiting disorder presented with unrelenting nausea and vomiting for one day. Other symptoms included abdominal & chest pain that the patient attributed to premenstrual symptoms. She is afebrile, doesn’t have any other symptoms of infection and no recent sick contacts. She is compliant with her home insulin regimen of Insulin detemir 20 units BID and pre meal 8 units insulin aspart. Further interrogation reveals she has regular menstrual cycles and has been hospitalized three times in the last three months due to DKA coinciding with premenstrual symptoms, specifically severe abdominal pain and vomiting, typically starting five days before the onset of her menstrual cycle. She is hemodynamically stable and physical exam is significant for mid epigastric tenderness. Significant labs: WBC 16.52 (N&lt;11 K/mm3), glucose 457 mg/dl, anion gap 23, K 4.1 (mmol/L), bicarbonate 18 (≥19 mmol/L), lactate 3.2 (N ≤ 1.9 mmol/L), beta hydroxybutyarate 4.0 (N ≤ 0.27 mmol/L), trop T 6 (N&lt;10 ng/L), BHCG negative . Hba1c a month ago was 9.6%. Infectious work up was negative. EKG showed no signs of ischemia. She was treated per DKA protocol which results in resolution of symptoms and normalization of labs. Since no other precipitating factors for DKA are identified, and her symptoms corresponded with her menstrual periods, she is given a diagnosis of Catamenial DKA and scheduled for regular follow up in endocrinology clinic. Conclusion: This case highlights the importance of considering the association betweenmenstrual cycle phases and blood sugar levels as a possible trigger, underscoring the role of a thorough menstrual history in patients presenting with DKA. The impact of menstrual cycle fluctuations on glycemic control varies among patients however glucose profiles seem to be consistent across cycles for each individual woman. This highlights the need for personalized management strategies including patient education and adjustment of insulin during these periods. Addressing this adequately will improve overall glycemic control, reduce hospitalizations, and help improve the quality of life.
Presentation: 6/1/2024
8083 Challenging Management of Diazoxide as a Double-Edged Sword in an Adult Patient with Recurrent Hypoglycemia
Authors: Fredrick J R , Qu J , Endo M 
Published: October 2024

Abstract
Disclosure: J.R. Fredrick: None. J. Qu: None. M. Endo: None.
Introduction: An insulinoma is a rare neuro-endocrine tumor that leads to fasting hypoglycemia with adrenergic, cholinergic, and neuroglycopenic symptoms. Diagnosis can be challenging, especially when imaging is negative for neuroendocrine tumor. To prevent recurrent hypoglycemic episodes, treatment can include dextrose and octreotide or diazoxide. We present a case of a patient who responded well to diazoxide but at higher doses, developed life-threatening side effects. Clinical Case 74-year-old female with history of osteoporosis presented with recurrent hypoglycemia with associated symptoms of dizziness, palpitations, and headaches, improved with food. TSH 1.0ulU/mL (0.4-4.7ulU/mL). Morning cortisol 14ug/dL (n&gt;14ug/dL). Patient underwent a 72-hour fasting test, which showed a point-of-care blood sugar of 47mg/dL. Labs included serum glucose 56mg/dL (70-140mg/dL), c-peptide 5.7ng/mL (0.78-5.19ng/mL), insulin 43.6ulU/mL (3-30ulU/mL), and beta-hydroxybutyrate 0.13mmol/L (0-0.5mmol/L). Screening was negative for insulin antibodies and presence of hypoglycemic agents. She became dependent on a dextrose infusion to maintain blood sugars. Magnetic resonance imaging of abdomen was negative for any lesion. Octreotide did not resolve the hypoglycemia. Diazoxide was started, with dose titrated up to 175mg three times daily with decreasing dextrose infusion requirements. However, she developed hypoxic respiratory failure, which was felt due to atelectasis or fluid overload, treated with mild diuresis and incentive spirometry. In the coming days, this escalated to requiring high-flow nasal cannula. Diazoxide was discontinued, and she returned to a dextrose infusion to prevent hypoglycemia. Dotatate scan was completed, revealing a focal intense dotatate tracer uptake within the pancreatic tail. This was followed by magnetic resonance cholangiopancreatography, which confirmed an arterially enhancing diffusion restriction lesion in the pancreatic tail and found several small hyper-vascular liver lesions, primarily hemangiomas, with two lesions indeterminate. The patient was weaned off oxygen and underwent distal pancreatectomy. Pathology confirmed a neuroendocrine tumor. She remained without a dextrose infusion after surgery with no recurrence in hypoglycemia and was discharged 3 days later. Conclusion: Diazoxide is known to improve recurrent hypoglycemia for patients evaluated for hyperinsulinemia. However, caution should be made due to life threatening side effects, including pulmonary edema and severe hypoxic respiratory failure. More expansive literature evaluating these risks would be beneficial(1). Reference 1. Chen, X., Feng, L., Yao, H., et al. Efficacy and safety of diazoxide in treating hyperinsulinemic hypoglycemia: A systemic review and meta-analysis. PLoS One. 2021 Feb 11;16(2):e0246463.
Presentation: 6/3/2024
12596 Characterizing Glycemic Variability In Novel Subphenotypes Of Individuals At Elevated Risk For Type 2 Diabetes Using Continuous Glucose Monitoring
Authors: Kretowski Adam Jacek , Konopka Paulina , Janucik Adrian , Citko Anna , Paszko Adam , Klak Mateusz , Golonko Aleksandra , Szklaruk Agata , Szczerbinski Lukasz 
Published: October 2024

Abstract
Disclosure: A.J. Kretowski: None. P. Konopka: None. A. Janucik: None. A. Citko: None. A. Paszko: None. M. Klak: None. A. Golonko: None. A. Szklaruk: None. L. Szczerbinski: None.
Background: The heterogeneity among individuals at elevated risk for Type 2 Diabetes (T2D) recently has led to the identification of six subphenotypes, each with distinct risks for developing T2D, its complications, and mortality. Our study leveraged Continuous Glucose Monitoring (CGM) to offer a detailed characterization of these subphenotypes, aiming to uncover differences in glycemic variability and control. Methods: CGM data from 616 individuals without diabetes, from the Polish Registry of Diabetes (PolReD) study, classified into six clusters, were analyzed. The PolReD used Freestyle Libre 2 (Abbott) as the CGM device. CGM-derived measures of glucose control and glucose variability were calculated using the iglu R package. We utilized Analysis of Variance (ANOVA) and Analysis of Covariance (ANCOVA), adjusting for age and sex, to identify significant differences in CGM parameters across the clusters. Results: Our analysis identified significant differences in several CGM-derived parameters among the clusters, notably in the Glycemic Risk Assessment Diabetes Equation (GRADE), Standard Deviation of weekly glucose values (SDw), Mean Amplitude of Glycemic Excursions (MAGE), Maximum glucose value, Glucose range, and Mean Absolute Glucose (MAG). Clusters 3 and 5, characterized by beta-cell dysfunction and high insulin resistance respectively, and associated with the highest risk of T2D, exhibited the greatest glucose variability, with elevated risk for glycemic excursions. In contrast, Cluster 4, indicative of a metabolically healthy obesity profile with a low risk of T2D, demonstrated the most stable glycemic control and the lowest variability among the clusters. Conclusions: This study shows that subtypes of patients at elevated risk for T2D exhibit distinct patterns in CGM-derived parameters, indicating variations in glucose control and stability that extend beyond traditional fasting and post-challenge glucose assessments. Notably, we found that subtypes facing the highest T2D risk display increased glycemic variability, despite their differing underlying mechanisms of dysglycemia. These findings highlight the utility of CGM as a tool for identifying individuals at an increased risk of T2D, reducing the need for extensive phenotyping typically required for cluster assignment.
Presentation: 6/1/2024
8177 Clinical Characteristics of Ketosis Prone Diabetes: Evaluating Diagnosis and Management Practices in a Real-Life Setting
Authors: Tariq Z , Sinha A , Shokry G , Moors K , Kodukula S S , Saeed Z I 
Published: October 2024

Abstract
Disclosure: Z. Tariq: None. A. Sinha: None. G. Shokry: None. K. Moors: None. S.S. Kodukula: None. Z.I. Saeed: None.
Aims: While evidence supports the Aß (Auto-antibody status, Beta-cell function) classification of Ketosis Prone Diabetes (KPD), its implementation by healthcare providers (HCPs) remains unclear. We examined practices in managing KPD in a tertiary-care center and compared features between Aß subgroups. Methods: A retrospective longitudinal cohort study was conducted consisting of individuals aged 18 and above with diabetes who experienced diabetic ketoacidosis (DKA) between 2016 and 2021. Demographics, causes of DKA, auto-antibody status, beta-cell function, clinical characteristics, and follow-up care were assessed. Data were analyzed using descriptive and inferential statistics. Results: Among 1557 individuals with KPD, 11.6% underwent A testing, 20.2% underwent ß testing, and only 9.8% underwent both A and ß testing. HCPs were more likely to assess Aß status among those who were young, Black, and had new-onset diabetes (p&lt;0.001). A-ß+ was the most common (53.9%), and A+ß+ was least common (5.9%) KPD. Clinical characteristics differed among subgroups, with ß- having a leaner BMI and more insulin dependence. Infection was the leading cause of DKA (37.9%), followed by unprovoked DKA (22.6%). Conclusion: Our study further validates and highlights the underutilization of Aß classification in KPD management and emphasizes the need for increased education among HCPs to improve care for people with KPD.
Presentation: 6/1/2024
7490 Comparative Clinical Analysis of DPP-4 inhibitors and SGLT2 inhibitors; Switch Study in Real-World Setting
Authors: Choe Hun Jee , Kwak Mi Kyung , Lee Ji Woo , Choi Yun Mi , Hong Eun-Gyoung 
Published: October 2024

Abstract
Disclosure: H. Choe: None. M. Kwak: None. J. Lee: None. Y. Choi: None. E. Hong: None.
Objective: Dipeptidyl peptidase-4 inhibitors (DPP-4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) represent two distinct pharmacological pathways in the management of type 2 diabetes, both aiming to improve glycemic control without risk of hypoglycemia. Metabolic implications and glycemic control associated with the interchange between SGLT2i and DPP-4i are scarce. This study aimed to evaluate the effect of switching between SGLT2i and DPP4i on various clinical parameters in Korean patients with type 2 diabetes. Methods: We conducted a retrospective cohort study at Hallym University Dongtan Sacred Heart Hospital, using clinical data warehouse. Baseline measurements and follow-up data at 3 months were collected for parameters including hemoglobin A1c (HbA1c), blood pressure, lipid profile, liver enzymes, renal function, and other metabolic markers. Results: Between 2015 and 2023, 104 participants switched from SGLT2 inhibitors to DPP4 inhibitors, while 321 switched in the opposite direction. Initially, those who switched from SGLT2 inhibitors to DPP4 inhibitors presented with lower baseline HbA1c levels (7.22 ± 0.73% versus 7.42 ± 0.76%, P = 0.017) and higher estimated glomerular filtration rates (eGFR) (95.2 ± 23.1 versus 85.9 ± 23.7 mL/min/1.73m², P = 0.001) compared to those who switched from DPP4 inhibitors to SGLT2 inhibitors. At three months of follow-up, the SGLT2 inhibitors to DPP4 inhibitors group exhibited a more significant reduction in HbA1c (adjusted β 0.22, 95% CI 0.03 to 0.40, P = 0.023), especially in patients with reduced eGFR (&lt;60 mL/min/1.73 m²) (β 1.2, 95% CI 0.30 to 2.11, P = 0.013; P for interaction = 0.005). On the other hand, the DPP4 inhibitors to SGLT2 inhibitors group showed a greater decrease in fasting glucose levels (β -9.73, 95% CI -17.6 to -1.86, P = 0.016), along with more pronounced reductions in liver enzymes AST (β -4.15, 95% CI -6.49 to -1.81, P &lt; 0.001) and ALT (β -6.42, 95% CI -9.58 to -3.27, P &lt; 0.001), and a significant increase in hematocrit (β 3.31, 95% CI 2.36 to 4.26, P &lt; 0.001) compared to the initial group. Conclusions: The study concludes that in Korean patients with type 2 diabetes, switching from SGLT2 inhibitors to DPP4 inhibitors is associated with a greater reduction in HbA1c, particularly in those with reduced renal function. Conversely, switching from DPP4 inhibitors to SGLT2 inhibitors results in more substantial improvements in fasting glucose and liver enzyme levels, suggesting differential benefits depending on the direction of the medication switch.
Presentation: 6/3/2024
8066 Compensatory Signatures of Islet Cells That Protect Obese Humans From Diabetes
Authors: Kim Hyunki , Li Yan , Zhu Houxiang , Jellas Khadija El , Shukla Namrata , Ren Ziyou , Fukuda Kazuki , Chen Mengjie , Kulkarni Rohit 
Published: October 2024

Abstract
Disclosure: H. Kim: None. Y. Li: None. H. Zhu: None. K. El Jellas: None. N. Shukla: None. Z. Ren: None. K. Fukuda: None. M. Chen: None. R. Kulkarni: Advisory Board Member; Self; Novo Nordisk, Inversago, Biomea, REDD.
The increasing prevalence of obesity and type 2 diabetes (T2D) continues to be a major global socioeconomic burden. Healthy humans adapt to metabolic stress by increasing their functional β-cell mass. Failure of this process, called decompensation, potentially triggers the development of T2D in many but not all obese humans. Furthermore, the molecular mechanism(s) underlying the ability of heterogeneous human β-cells to compensate and protect obese humans from developing T2D remain elusive. Here we report unique gene signatures of β-cell subtypes and their molecular interactions with islet stellate cells during successful compensation in human obesity. Using a single-nucleus multiomics approach, we profiled gene expression and chromatin accessibility of 160,954 islet nuclei from non-diabetic lean, overweight, obese, or T2D human donors. We identified multiple β-cell subtypes and their unique sets of genes, biological pathways, and transcription factors associated with compensation. The genome-wide association studies corroborated the compensatory genes identified in the subsets, showing significant associations with metabolic phenotypes in humans. Unbiased cell-cycle gene and ligand-receptor analyses of islet cell types revealed that activated stellate cells proliferate and interact with the β-cell subtypes that involves the extracellular matrix-integrin protein complex in non-diabetic obesity. These results highlight the physiological roles of islet stellate cells in regulating β-cell compensation and point to therapeutic opportunities in precision medicine to protect obese humans from developing T2D.
Presentation: 6/3/2024
8814 Concordance in Defining Diabetes Remission: A Comparative Analysis of HbA1c, eA1c, and FPG Criteria After One Year of Digital Twin (DT) Intervention
Authors: Shamanna P , Dharmalingam M , Vadavi A , Keshavamurthy A , Bhonsley S , Thajudeen M , Balasubramanian A , Joshi S R 
Published: October 2024

Abstract
Disclosure: P. Shamanna: None. M. Dharmalingam: None. A. Vadavi: None. A. Keshavamurthy: None. S. Bhonsley: None. M. Thajudeen: None. A. Balasubramanian: None. S.R. Joshi: None.
Introduction: This study investigates the concordance among HbA1c, estimated A1c (eA1c), and fasting plasma glucose (FPG) remission criteria following one year of Digital Twin (DT) intervention. Understanding the agreement of these criteria in a cohort of 209 patients is critical for evaluating diabetes treatment efficacy. Methods: Diabetes remission was assessed in 209 patients after one year of DT intervention, using HbA1c, eA1c, and FPG criteria. Kappa values, along with sensitivity, specificity, and p-values, were calculated for concordance. Mean, standard deviation, and p-values for age, duration of diabetes, HbA1c, fasting plasma glucose, and eA1c were also computed. Results: The study revealed substantial agreement between HbA1c and eA1c criteria (Kappa: 0.751, indicating 'substantial' agreement), HbA1c and FPG criteria (Kappa: 0.703, indicating 'substantial' agreement), and eA1c and FPG criteria (Kappa: 0.719, indicating 'substantial' agreement), post one year of DT intervention. The average age of participants was 43.89 years (±8.72), with a diabetes duration of 3.65 years (±2.66). The initial HbA1c was 9.02% (±1.90), reducing to 6.00% (±0.67) at the end of the study. Initial and final fasting plasma glucose levels averaged 170.75 mg/dL (±61.11) and 109.33 mg/dL (±30.60), respectively. Remission rates were 72.73% for HbA1c, 75.60% for eA1c, and 71.29% for FPG. Conclusion: Our findings suggest that remission using either eA1c or FPG criteria can be reliably compared to the gold standard HbA1c criteria, with all showing 'substantial' agreement post one year of DT intervention. This high concordance, reflected in the statistically significant kappa values, highlights the effectiveness of eA1c and FPG criteria as robust tools in assessing diabetes remission alongside the HbA1c criteria. These insights are crucial for clinical practice and diabetes research, offering flexibility in evaluating patient outcomes.
Presentation: 6/1/2024