bluuebunny/crossref_metadata_2025_split huggingface dataset:
8088 Connecting the Dots: Semaglutide, Constipation, and Diverticulitis - A case report
Authors: Tiwari K , Sajid F , Karam J G 
Published: October 2024

Abstract
Disclosure: K. Tiwari: None. F. Sajid: None. J.G. Karam: None.
Introduction: Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the treatment of type 2 diabetes mellitus and weight management. Common side effects, primarily gastrointestinal (&gt;10%), include nausea, vomiting, diarrhea, and constipation. Here, we present a case of acute sigmoid diverticulitis with an adjacent abscess in a patient who was recently initiated on GLP-1 receptor agonist therapy. Case presentation: A 76-year-old female with a medical history of type 2 diabetes mellitus on metformin and empagliflozin, hypertension, chronic kidney disease stage 3A, obesity (BMI: 43), and no known history of diverticulosis was started on semaglutide for additional glycemic, renal, and weight loss benefits, given suboptimal control of her obstructive sleep apnea, blood pressure, and knee arthritis. She received semaglutide subcutaneously at a dose of 0.25 mg weekly for 4 weeks, followed by an increased dosage of 0.5 mg for one week. However, she experienced a slight worsening of underlying constipation as a side effect. On the sixth week of therapy, she started having progressive lower abdominal pain with nausea, chills, and diarrhea, for which she presented to the Emergency Department. She was found to have leukocytosis, and a Computed Tomography (CT) of the abdomen/pelvis revealed peri-colonic fat stranding in the mid-ascending colon, wall thickening in the distal sigmoid colon, and a low-density fluid collection abutting the sigmoid/descending colonic wall, indicative of diverticulitis with a small abscess. She was admitted to the hospital for six days and was treated conservatively with Intravenous (IV) antibiotics, and her diet was slowly advanced as tolerated. Semaglutide was discontinued, and the patient was discharged home with outpatient endocrinology and gastrointestinal follow-up. A post-discharge colonoscopy showed diffuse diverticulosis. Conclusion: Constipation and old age are common risk factors for diverticulitis. While GLP1-1 receptor analogs have proven significant and multiple benefits, more knowledge about associated gastrointestinal complications resulting from slower food transit in the gastrointestinal tract is emerging. Older patients with underlying constipation and/or diverticulosis should particularly be monitored and treated for worsening constipation to avoid complications such as acute diverticulitis. Vigilance and awareness in recognizing and managing this potential complication are crucial with the wider indications and use of GLP-1 receptor analogs.
Presentation: 6/3/2024
6521 Continuation of Continuous Glucose Monitors in Hospitalized Diabetic Patients Decreased the Incidence of Hypoglycemia
Authors: DeClue Cory E , Bao Shichun 
Published: October 2024

Abstract
Disclosure: C.E. DeClue: None. S. Bao: None.
Objective: Glycemic control improves patient outcomes in hospitalized patients, and this is generally achieved by monitoring point-of-care (POC) capillary glucose levels. In the outpatient setting, continuous glucose monitoring (CGM) devices have shown improved glycemic control in diabetic patients, but their evidence in hospitalized patients is lacking. Methods: To evaluate CGM accuracy and safety of use in the inpatient setting, 567 consults were analyzed in a single-center inpatient diabetes service between November 2022 and January 2023. Patients were included if managed with multiple daily injections or insulin pump therapy and separated into four groups based on CGM continuation and type of diabetes. POC glucose and incidence of hypoglycemia were recorded over 72 hours from the time of consultation. Results: Forty-six Type-1 (T1DM) and 72 Type-2 (T2DM) diabetic patients were included in this study, with average hemoglobin A1c of 8.6% and 9.0%, respectively. Both diabetic groups showed an average POC glucose that was not statistically different based on CGM continuation (185 mg/dL for T1DM and 187 mg/dL for T2DM continued on CGM versus 183 mg/dL for T1DM and 188 mg/dL for T2DM not using CGM). However, only 2 of the 18 T1DM patients continued on CGM experienced hypoglycemia, whereas 17 of the 28 T1DM patients not using CGM experienced at least 1 hypoglycemic event. Similarly, only 2 of the 20 T2DM patients continued on CGM experienced hypoglycemia, whereas 13 of the 52 patients not using CGM experienced at least 1 hypoglycemic event. Additionally, less glucose variability was observed in both T1DM and T2DM patients continued on CGM (average standard deviation of 64 mg/dL and 55 mg/dL, respectively) compared to those not using CGM (average standard deviation of 84 mg/dL and 62 mg/dL, respectively). Conclusion: CGM has great potential to improve patient care and nursing workload in the hospital, but the safety and accuracy are not yet well-established. In this study, there seemed to be a statistically insignificant trend to less glycemic variability for CGM users despite no glycemic difference on average POC testing. Importantly, significantly fewer hypoglycemic events were observed in patients continued on CGM devices regardless of type of diabetes or baseline glycemic control. This study adds further evidence to the growing body of work supporting improved safety of CGM utilization in hospitalized diabetic patients.
Presentation: 6/1/2024
12395 Continuous Glucose Monitoring In Pseudohypoparathyroidism Type 1a
Authors: Tamaroff Jaclyn , Lee Andrea E , Shoemaker Ashley Hall 
Published: October 2024

Abstract
Disclosure: J. Tamaroff: None. A.E. Lee: None. A.H. Shoemaker: None.
Background: Pseudohypoparathyroidism type 1A (PHP1A), due to heterozygous mutations in GNAS, is a rare disorder that leads to multi-hormone resistance, cognitive impairment, and early-onset obesity. Individuals with PHP1A have dysglycemia on oral glucose tolerance tests and increased rates of type 2 diabetes (T2DM). Individuals with rare diseases, like PHP1A, may travel significant distances for specialized clinical or research care. Wearable technology may alleviate barriers and provide useful information for clinical care or for use as potential biomarkers. The objective of this study is to evaluate glycemia in individuals with PHP1A and feasibility of utilizing continuous glucose monitors (CGMs) in this population. Methods: Observational study of individuals with PHP1A (3R01DK118407-03S1). CGMs (Dexcom Pro, Dexcom Inc, San Diego, CA) were placed on participants’ abdomens, typically by a family member, over secure-video call with study staff. CGMs collected data every 5 minutes for up to 10 days. Results: Seven participants (all female) with PHP1A without a diagnosis of diabetes had available data. Median age was 17 years (IQR: 14, 19; range: 8-23). Body mass index (BMI) categories (by percent of the 95th percentile for those under 18 years and BMI for adults) spanned from overweight to class 3 obesity. In terms of feasibility, 1 individual had to replace a CGM sensor due to an upcoming MRI and 1 individual had a “sensor failure” of unclear etiology. Both were able to place new CGMs. Individuals participated across 5 states in the United States. Median length of wear was 9.8 days (IQR 8.6, 9.9). Participants had a median average glucose of 104mg/dL (IQR 102, 111) and COV of 16% (15, 21). Percent of glucose &gt; 140mg/dL was 5.0% (IQR: 1.8, 10.9; range:1.2-19.4%). One individual had 3.2% of glucose values ≥ 200mg/dL despite a normal hemoglobin A1c (HbA1c) level (5.5%). This level of hyperglycemia is qualitatively higher than published CGM data in healthy individuals. One study found individuals (6-24 years of age) had median percent of glucose values over 140mg/dL ranging from 1.2 to 2.4% with IQR values ranging from 0.3 to 4.4%, based on age categories.1Conclusions: In females with PHP1A, with overweight or obesity, CGM placement at home is a feasible way to collect real-world data. Participants with rare diseases often must travel for clinical and research care and CGMs may provide insight into glycemia without requiring an in-person visit. This “real-world” data mirrors research data reporting glycemia with normal HbA1c levels. The rate of hyperglycemia is higher than expected in some individuals with PHP1A though more data is needed. Ongoing studies will evaluate matched control participants and assess drivers of glycemia including inactivity and decreased sleep duration, as measured by actigraphy. References: 1. Shah VN et al. J Clin Endocrinol Metab. 2019 PMID: 31127824
Presentation: 6/3/2024
12621 Convergence Of Sglt2 Inhibitors And Glp1 Agonists: Unveiling The Recipe For Euglycemic Diabetic Ketoacidosis
Authors: Syed Usheem , Fretes Oviedo Natalia Elizabeth , Variar Vivek 
Published: October 2024

Abstract
Disclosure: U. Syed: None. N.E. Fretes Oviedo: None. V. Variar: None.
Introduction: Euglycemic diabetic ketoacidosis (DKA) is a known adverse effect associated with the use of SGLT2 inhibitors. The concomitant initiation of GLP1 agonists with SGLT2 inhibitors presents a potential synergistic risk, precipitating metabolic acidosis without significant hyperglycemia. The individual propensity of both medication classes to contribute to metabolic disturbances highlights the necessity for heightened clinical awareness. Clinical Case: We present a case of a 34-year-old female with morbid obesity and Type 2 diabetes mellitus, receiving tirzepatide, metformin, and empagliflozin. The patient was initiated on empagliflozin 4 days prior, and tirzepatide one day prior to presentation. Shortly after commencing tirzepatide, she experienced symptoms of decreased appetite, abdominal pain, and vomiting. Workup was consistent with DKA with blood glucose &lt; 250 mg/dL. Management involved strict adherence to DKA protocols. The patient’s symptoms resolved with resolution of ketoacidosis. Conclusion: Euglycemic DKA poses a diagnostic challenge for patients on SGLT2 inhibitors. Concurrent administration of GLP1 agonists, while not directly implicated, may exacerbate this condition, by their gastrointestinal side effects and resultant metabolic abnormalities. Awareness of potential interactions and associated risk factors is crucial for timely diagnosis and management.
Presentation: 6/3/2024
7725 Could COVID-19 Be the Trigger for Type 1 Diabetes?
Authors: Ahsan E , Foo F F , Ravin A , Akula M , Hu k , Ong R , Holland S , Hossain M , Cheng J 
Published: October 2024

Abstract
Disclosure: E. Ahsan: None. F.F. Foo: None. A. Ravin: None. M. Akula: None. K. Hu: None. R. Ong: None. S. Holland: None. M. Hossain: None. J. Cheng: None.
Introduction: COVID-19 disrupts glucose homeostasis, which may result in hyperglycemia and new-onset diabetes mellitus. It has been hypothesized to be caused by an increased inflammatory response, increased insulin resistance, and a degree of acute viral pancreatic damage. A meta-analysis showed that the incidence of new-onset diabetes was found to be as high as 14.4% (95% CI: [5.9%-25.8%]). Here, we report a case of COVID-19-induced diabetes to spread awareness among healthcare providers and encourage early detection to prevent long-term complications. Clinical Case: A 54-year-old African American female with a past medical history of hyperlipidemia, obesity, and hypothyroidism presented to our endocrinology office for evaluation and management of diabetes mellitus (DM). She presented with symptoms of 66-pound weight loss, polydipsia, polyphagia, and polyuria. Her labs on diagnosis were significant for blood glucose of 550 mg/dl (70-100 mg/dl), hemoglobin A1c &gt;15.5% (&lt;5.7%), and bicarbonate 23 mmol/L (20-31 mmol/L). She started on insulin and then switched to semaglutide after six months. Her fasting glucose on the follow-up visit was 103 mg/dl, the anti-glutamic acid decarboxylase 65 (GAD-65) antibody was 8,558.9 units/ml (&lt;5 units/ml), C peptide was 1.9 ng/ml (0.5-2ng/ml), and Islet Antigen-2 (IA-2) autoantibody was &lt;7.5 U/ml (0-7.49 U/ml). Despite positive antibodies, her C-peptide suggested enough beta-cell function, and she was switched from insulin to semaglutide. The patient was diagnosed with autoimmune diabetes, which may be from the COVID-19 infection, and was educated about regular follow-up and new medications like teplizumab that may help prevent the progression to needing insulin. Clinical Lesson: The exact mechanism of new-onset COVID-19-induced diabetes is still unknown. However, multiple risk factors are theorized to play a role in COVID-induced DM. These include defects in insulin production and glucose clearance, obesity, stress hyperglycemia, insulin resistance, and steroid therapy. Our patient had a history of obesity but no history of diabetes, steroid use, or any personal or family history of autoimmune processes. Compared to COVID-19 patients with normoglycemia or hyperglycemia, patients with preexisting diabetes and newly diagnosed diabetes experienced more severe complications, such as shock, ARDS, acute kidney injury, hypoalbuminemia, and severe COVID-19 complications. Additional research is required to investigate the various pathophysiologies and treatment options, including new medications that may prevent the disease's further progression. Diabetes caused by COVID-19 should be treated cautiously, and prompt diagnosis and care are essential to preventing further complications.
Presentation: 6/3/2024
8613 Diabetes remission: experience from a randomized control trial conducted in a tertiary care hospital in India
Authors: Chakraborty Ananda Mohan , Waila Rama , Bhansali Shobhit , Bhujade Harish , Sachdeva Naresh , Bhadada Sanjay 
Published: October 2024

Abstract
Disclosure: A.M. Chakraborty: None. R. Waila: None. S. Bhansali: None. H. Bhujade: None. N. Sachdeva: None. S. Bhadada: None.
Introduction: The usual perception and interpretation of diabetes mellitus is that of an irreversible and chronic persistent disease with little scope for remission. Following the success of metabolic surgery and intensive lifestyle modification, it is time for pharmacotherapy to sept in. Methodology: It was a single-center, randomized controlled trial conducted in patients having HbA1c below 9 % at randomization and having a duration of diabetes less than 2 years. Patients with organ-threatening chronic diseases and severe diabetes-related complications have been excluded. Study populations have been randomized to 1:1 to receive pharmacotherapy with oral semaglutide, dapagliflozin, and metformin in one arm and vildagliptin, metformin, and titrated glimepiride in the control arm. Duration of therapy was 6 months including 2 months of up titration of semaglutide. Patients have been followed up for 3 months after stopping all therapy following 6 months of therapy. The primary outcome was to find out the remission rates in patients with Type 2 diabetes mellitus treated with a combination of oral Semaglutide and dapagliflozin on top of metformin monotherapy and to compare with the standard diabetes practice. The secondary outcome was to assess the anthropometric change and change in beta cell function parameters with a mixed meal tolerance test. Results: A total of 38 patients have completed therapy, 17 were in the trial arm and 21 in the control arm. Among 17 patients in the trial arm, all the patients were in remission as per the prespecified criteria. Among the patients who completed 6 months of follow-up (n-13), 11 patients (84%) maintained remission in the trial arm. The remission rate was 100% in the trial arm and 48% in the conventional arm (p&lt;0.001) after 3 months and 84% and 27.7% in the trial arm and conventional arm respectively after 6 months of follow-up (p&lt;0.05). Reduction in BMI (p &lt;0.001) and percent body fat (p&lt;0.01) and increase in disposition index after mixed meal tolerance test (p&lt;0.01) was statistically related to remission. Conclusion: Remission of diabetes as defined by ADA in the consensus statement (HbA1c &lt; 6.5 % without glucose-lowering therapy for at least 3 months) is a reality. It can be achieved by pharmacotherapy targeting body weight and adiposity. The main predictors of remission were a reduction of BMI and body fat and an increased disposition Index. Since it is an ongoing study, further follow-up is planned to determine the continuation of the remission phase among those who achieved remission with pharmacotherapy.
Presentation: 6/3/2024
9317 Diabetogenic Stress-Mediated Beta Cell Extracellular Vesicle:Autophagy Pathway Crosstalk
Authors: Roy A , Ariyaratne G , Matveyenko A , Javeed N 
Published: October 2024

Abstract
Disclosure: A. Roy: None. G. Ariyaratne: None. A. Matveyenko: None. N. Javeed: None.
Diabetogenic stressors including elevated free fatty acids (lipotoxicity), low-grade systemic inflammation, and proteotoxicity are central to the development of Type 2 Diabetes (T2D). Due to their high protein synthetic burden, β-cells employ autophagy and endo/lysosomal pathways to reduce protein aggregates, and protect β-cell mass and function. Recently, extracellular vesicles (EVs; 30-150 nm sized nanoparticles) have been shown to work in tandem with autophagy to facilitate cellular adaptation and intercellular communication. As diabetogenic stressors have been shown to perturb autophagy via lysosomal defects, our group has noted enhanced EV secretion. Thus, we hypothesize that diabetogenic factors enhance EV secretion through activation of an EV-based secretory autophagy pathway and that re-balancing of both pathways could improve β-cell function in T2D. To test this, MIN6 cells were exposed to free fatty acid palmitate (PAL; 24h), or pro-inflammatory cytokines IL-1β, TNFα, and IFNγ (CYTO; 48h). Expression of autophagic markers, LC3 and p62 were increased in CYTO and PAL conditions suggesting defects in auto/lysosomal function. Upon PAL/CYTO treatment in MIN6 cells, conditioned media EVs were isolated using differential ultracentrifugation. We noted enhanced protein expression of LC3-II and p62 in PAL- and cytoEVs, suggesting a diversion of immature autophagosome components into EVs due to lysosomal inhibition. To restore balance between autophagy:EV flux, we used EV biogenesis inhibitor, GW4869 (GW; 24h) or autophagy inducer, rapamycin (Rapa; 24h) on MIN6 cells exposed to PAL or CYTO. Isolated EVs were subjected to Nanoparticle Tracking Analysis (NTA) which showed a significant reduction in EV concentration with GW or Rapa addition (p&lt;.05). Isolated mouse islet exposed to CYTO+GW/Rapa or PAL+GW/Rapa showed significant improvements in glucose stimulated insulin secretion (vs. CYTO or PAL; p&lt;.05). Taken together, these data implicate activation of EV-based secretory autophagy in response to diabetogenic stressors and thus, potential targets to improve functional β-cell mass.
Presentation: 6/2/2024
8809 Digital Twin Technology for Remission of T2DM and Normalization of Glycemic and Extraglycemic Parameters: 18 Months Intent to Treat Analysis of the Prospective Randomized Controlled Clinical Trial
Authors: Joshi Shashank Rameshchandra , Dharmalingam Mala , Vadavi Arun , Keshavamurthy Ashok , Bhonsley Suchitra , Mohamed Thajudeen , Balasubramanian Akshaya , Shamanna Dr Paramesh 
Published: October 2024

Abstract
Disclosure: S.R. Joshi: None. M. Dharmalingam: None. A. Vadavi: None. A. Keshavamurthy: None. S. Bhonsley: None. T. Mohamed: None. A. Balasubramanian: None. D. Shamanna: None.
Objective: This study aims to evaluate the effectiveness of a comprehensive metabolic health intervention in normalizing various metabolic parameters associated with Type 2 Diabetes Mellitus (T2DM), hypertension, and Non-Alcoholic Fatty Liver Disease (NAFLD). The intervention's impact was measured by assessing changes in several key health metrics over a period of 540 days. Methods: Patients were monitored at baseline and after 540 days (D540) of the intervention. The study focused on the percentage of patients achieving normalization in various metabolic parameters at D540 compared to the baseline values. Results: Notable improvements were observed across multiple parameters. The percentage of patients with HOMA2IR within the normal range increased from 21.6% (47 patients) to 39.4% (86 patients). Similarly, the proportion of patients with HOMA2B above the normal threshold rose from 36.7% (80 patients) to 67.0% (146 patients). HbA1c normalization showed a significant increase from 7.3% (16 patients) to 65.6% (143 patients). Other parameters also showed considerable improvement: BMI normalization from 32.6% (71 patients) to 52.3% (114 patients) Waist Circumference normalization increased in males (90 cm) and females (80 cm) from 23.4% (51 patients) to 56.9% (124 patients) Fasting Plasma Glucose normalization from 24.8% (54 patients) to 64.2% (140 patients) TG/HDL ratio normalization from 27.1% (59 patients) to 56.4% (123 patients) HDL normalization in males (&gt;40) and females (&gt;50) from 17.4% (38 patients) to 49.5% (108 patients) LDL normalization (&lt;100) from 23.4% (51 patients) to 23.9% (52 patients) hsCRP normalization (&lt;3 mg/L) from 11.9% (26 patients) to 44.5% (97 patients) NAFLD Liver Fat Score normalization (&gt;-0.64) from 11.9% (26 patients) to 56.0% (122 patients) NAFLD Fibrosis Score normalization (&gt;-1.455) from 77.5% (169 patients) to 92.7% (202 patients) Urine Microalbumin to Creatinine ratio normalization (&lt;30 mg/g) from 78.4% (171 patients) to 93.1% (203 patients) SBP normalization (&lt;140) from 85.8% (187 patients) to 91.3% (199 patients) DBP normalization (&lt;90) from 76.1% (166 patients) to 84.4% (184 patients)Discussion: The significant shift towards normalization in these parameters suggests the effectiveness of the treatment protocol in managing and potentially reversing chronic metabolic diseases, including T2DM, hypertension, and NAFLD.
Presentation: 6/1/2024
8378 Disparities In Telemedicine Use In Latinx Patients With Diabetes: Real Life Observations
Authors: Kim S , Qu J , Thedki P , Wright L A 
Published: October 2024

Abstract
Disclosure: S. Kim: Consulting Fee; Self; Signos, Inc.. Grant Recipient; Self; The Diabetes Link. P. Thedki: None. L.A. Wright: None.
Background and Aims The Latinx population is disproportionately affected by diabetes and related complications and face greater challenges to accessing medical care than white patients. Telemedicine, a novel strategy for addressing such lack of access has not been evaluated in the Latinx population affected by diabetes.We aimed to assess telemedicine use in Latinx patients with diabetes compared to non-Latinx, within the same diabetes clinic (same care team and access to same digital platform). Secondary aims: HbA1c and use of CGM. Methods: All patients were offered telemedicine services and were considered users if they completed =/&gt;1 telemedicine visit during the 3-month study period. Demographics, race/ethnicity, telemedicine use, language, type of diabetes: type 1(T1D), type 2(T2D) or other; HbA1c(+/- 3 months from visit) and use of CGM at the time of visit were extracted. Results: Latinx patients: n=61, 42 Spanish speaking only; mean age 52.4; 32 female; 46 with T2D. Non-Latinx: n=81, mean age 53.2; 43 female; 43 had T1D. Telemedicine use was 22% in Latinx vs 39% in non-Latinx patients, p=0.007. Mean A1c was 7.4% in Latinx vs 7.1% in non-Latinx, p=0.04 CGM use was more common in non-Latinx patients, p=0.01. Conclusions T2D was more common and telemedicine use was lower in Latinx compared to non-Latinx patients, most were Spanish speaking only, they had higher HbA1c and less CGM use. While telemedicine has the potential to increase access to care, social determinants of health, such as digital literacy, access to device and/or reliable internet are likely barriers that contribute to health inequalities in this population.
Presentation: 6/2/2024