bluuebunny/crossref_metadata_2025_split huggingface dataset:
7049 DUNNIGAN LIPODYSTROPHY AND SUCCESSFUL USE OF AID WITH U200
Authors: Kader T , Seltzer S , Williams A 
Published: October 2024

Abstract
Disclosure: T. Kader: None. S. Seltzer: None. A. williams: None.
Our patient is a 60 year old female with dunnigans partiallipodystrophy diagnosed after her niece was diagnosed and was sent to genetics; She was found to have a mutation in LMNA geneand had a heterozygous sequence variant.She was diagnosed with partial lipodystrophy and had macrovascular complications including carotid stenosis requiring surgical intervention.She was treated originally with insulin pump therapy that was sensor augmented along with glp1 agonist and sglt2 inhibitor but she developed recurrent pancreatitis and glp1 agonist was stopped. The pancreatitis was not induced by hypertriglycidemia as her levels were normal.Since then she had poorly controlled diabetes with a1c 8.7 percent and was having some hypoglycemia.;After consultation with the patient about off□ label use of AID pump technology for type 2 diabetes and off□ label use of u200 in AID pump she was willing to try and results were quite impressive with a1c falling close to 7 and time in range up to 70 percent with no lows. Her total insulin dosages were approximately 200 units q day but with u 200 she was changing every 2 days .Despite insulin resistance and dunnigan lipodystrophy this case exemplifies safety of u200 in AID pump in a patient with dunnigans lipodystrophy. It is the first of such report and more studies should be done using this technology in this rare group of patients with insulin resistance and poorly controlled diabetes.
Presentation: 6/1/2024
12314 Effectiveness Of Continuous Glucose Monitors In Patients With Type 2 Diabetes On Washington Medicaid Or Financial Assistance
Authors: Deng Alexandra , Thirumalai Arthi , Lin Jenny , Weber Marianne , Zuo Silu 
Published: October 2024

Abstract
Disclosure: A. Deng: None. A. Thirumalai: None. J. Lin: None. M. Weber: None. S. Zuo: None.
Continuous glucose monitors (CGMs) have become more accessible for patients with type 2 diabetes mellitus (T2DM) on one insulin injection per day who have either commercial or Medicare plans. However, there are still strict requirements for patients with Washington State Medicaid, creating disparities in diabetes care for vulnerable populations. The aim of this study is to assess the effectiveness and adherence of CGMs in patients with T2DM on Washington State Medicaid plans or institutional financial assistance who are prescribed at least one insulin injection daily, similar to Medicare requirements. This ongoing prospective cohort study enrolled 40 adult patients with T2DM, baseline A1C greater than 7%, and prescribed at least one insulin injection per day from three Harborview Medical Center clinics. Through grant funding, patients were provided with Freestyle Libre 2 CGMs for 6 months. Since this is an ongoing study, we present preliminary results of patients who completed 3 months of CGM use. Effectiveness was measured by the change in A1C from baseline to 3 months after initiation of the CGM (primary outcome) and change in CGM glycemic metrics on ambulatory glucose profile (AGP) from baseline to 3 months after initiation of CGM (secondary outcomes). Assessment of adherence to the CGMs involved tracking the percentage of CGM data captured from the AGP reports recorded at each visit and monitoring dispense history. Twenty patients reached the 3-month follow-up with a median age of 59 years; 60% female, 70% non-English speaking; 45% with Medicaid, and 55% with Harborview Financial Assistance as insurance coverage. Median baseline A1C was 9.2%, duration of diabetes was 10 years, number of diabetes medications was 3, daily insulin injections of 2, and number of blood glucose checks per day was 1. At first CGM download (2 weeks), the median time in range (TIR, glucose 70-180 mg/dL) was 53.5%, coefficient of variation was 35.3% and percent of data captured was 80%. At 3-month follow-up, the median reduction in A1c was –1.2% (IQR -1.8, -0.5). On CGM, the median TIR had increased to 60.5%, coefficient of variation had improved to 31.5% and percent of data captured was 79%. In this ongoing study, preliminary findings show encouraging early evidence of improved glycemic control after CGMs were initiated and patients sustained greater than 70% CGM data captured at 3 months. These results should be interpreted with caution given the small number of participants with results at 3 months. Nonetheless, once the study is complete, the outcomes may be used to inform eligibility requirements for continuous glucose monitors in patients with Washington Medicaid or Harborview Financial Assistance.
Presentation: 6/3/2024
8753 Efficacy and safety of bempedoic acid for patients with type 2 diabetes and hypercholesterolemia: a meta-analysis of randomized trials and post-hoc studies
Authors: Godoi A , Silva C H , Hespanhol L C , Romeiro P , Silva C , Balieiro C A , Texeira T 
Published: October 2024

Abstract
Disclosure: A. Godoi: None. C.H. Silva: None. L.C. Hespanhol: None. P. Romeiro: None. C. Silva: None. C.A. Balieiro: None. T. Texeira: None.
Background: Statins, the primary treatment for lowering LDL cholesterol and cardiovascular risk, have been associated with a worsened glycemic control. Moreover, several patients with hypercholesterolemia, including those with type 2 diabetes mellitus (T2DM), are unable to meet treatment goals with statins. Bempedoic acid (BA) has shown promising results in trials with patients with high cholesterol and cardiovascular disease, however, its efficacy in a population restricted to patients with T2DM remains unclear. Purpose: To perform a systematic review and meta-analysis comparing the therapeutic efficacy and safety of BA versus placebo in patients with T2DM and hypercholesterolemia. Methods: PubMed, Cochrane Central and Embase were systematically searched up to January 2024 include randomized controlled studies (RCTs) and post-hoc studies assessing the use of BA in a population of patients with T2DM on prior lipid-lowering therapy. Efficacy outcomes assessed were mean change in low-density lipoprotein C (LDL-C), high-density lipoprotein C (HDL-C), and non-HDL, as well as an increase in HbA1c. Safety outcomes included incidence of hyperglycemia, gout, myalgia and treatment discontinuation due to adverse events. Outcomes were pooled using risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Statistical analysis was performed with RevMan 5.4.1 and R Studio software. Heterogeneity was assessed with I² statistics. The protocol was registered in PROSPERO. Results: A total of seven RCTs with 7475 patients with T2DM were included, of whom 3842 (51.4%) were allocated to use BA and 3633 (48.6%) were allocated to placebo. Follow-up time ranged from 2 to 52 weeks. The use of BA was associated with a significantly lower LDL-C (MD -30.19mg/dL; -37.56 to -22.82 95% CI; p&lt;0.001), and non-HDL (MD -20.05mg/dL; -20.15 to -19.95 95% CI; p&lt;0.001), although with a lower HDL-C (MD -5.00mg/dL; -5.01 to -4.99 95% CI; p&lt;0.001) compared to placebo. Furthermore, BA use results in significantly lower rates of myalgia (RR 0.74; 0.60 to 0.91 95%CI; p=0.004). There were no differences regarding HbA1c increase (p=0.13), treatment discontinuation (p=0.51), hyperglycemia (p-0.57), or gout (p=0.05) between groups. Conclusion: In this meta-analysis of randomized trials and post-hoc studies, the use of BA was associated with an improved lipid profile without worsening glycemic control or causing significant adverse events, although at the cost of a lower HDL-C.
Presentation: 6/1/2024
12582 Electronic-cigarette Exposure Induces Hyperglycemia With A Fibrotic Phenotype In Skeletal Muscle In Mice Subjected To A High-fat Diet
Authors: Rivera Juan Carlos , Chavez Jennifer , Espinoza-Derout Jorge , Hasan Kamrul M , Shao Xuesi M , Sinha-Hikim Amiya P , Friedman Theodore C 
Published: October 2024

Abstract
Disclosure: J. Rivera: None. J. Chavez: None. J. Espinoza-Derout: None. K.M. Hasan: None. X.M. Shao: None. A.P. Sinha-Hikim: None. T.C. Friedman: None.
Obesity and electronic cigarette (e-cigarette) use are highly prevalent among youth in the USA. Indeed, young e-cigarette users report less physical activity, leading to a decline in quality of life. Recent studies show e-cigarettes reduce skeletal muscle (SkM) performance in mice; however, the underlying metabolic and SkM cellular effects are unclear. E-cigarettes plus a high-fat diet (HFD) increase mice lipolysis and plasma-free fatty acids. These harmful changes in the liver and heart are prevented by the lipolysis inhibitor Acipimox (Acip). As SkM plays a crucial role in metabolic and chronic disease prevention, understanding the impact of e-cigarettes and HFD on SkM is essential.We exposed C57BL6 mice to e-cigarette inhalation in a free-moving system to deliver 2.4% nicotine in a similar way to humans. Mice were fed with an HFD and divided into 3 groups: Saline (control), e-cigarette (bluCig), and e-cigarette plus Acip (rescue group) for 12 weeks. SkM uptakes 70-80% of the postprandial glucose, so we performed a glucose tolerance test. We found higher glycemia in the e-cigarette compared to the Saline group, while the e-cigarette plus Acip group showed improved glycemia. Histological analysis of SkM with Hematoxylin and eosin (HE) staining revealed large extracellular fibrotic structures in the group with e-cigarettes, suggesting fibrosis. Sirius Red (SR) stain identified collagen deposition. The SR quantification showed an increase in the collagen in the e-cigarette to the saline-exposed group without recovery in the e-cigarette plus Acip group. Fibrosis restricts the SkM hypertrophy. So we analyzed the insulin-like growth factor-1 (IGF-1) (a key anabolic factor) by RT-qPCR. The mRNA levels of IGF-1 were reduced in the SkM of e-cigarettes compared to the Saline group, without recovery of the Acip group. In SkM hypertrophy, Satellite cells (SCs) are stimulated by IGF-1 and SkM fibrosis can affect SCs by restricting them. So we analyzed by western blot the SCs through the transcriptional factor PAX7 (SC marker). We found PAX7 levels were lower in the e-cigarette compared with the Saline group without recovery in the Acip group. These findings suggest the detrimental effects of e-cigarettes on glycemia and SkM health in mice, with implications for long-term health outcomes, particularly among obese individuals and e-cigarette users. Further research is necessary for understanding these adverse effects and promoting youth health. GRANT SUPPORT: U54MD007598, SC2GM135127, U54MD007598-14S2, PR190942, DA050723, and R25DA050723 grants.
Presentation: 6/3/2024
6366 Elevated Baseline Triglycerides As an Independent Risk Factor For Coronary Artery Disease
Authors: Askar Esraa , Moran Heberth , Yuksel Simge , Bleich David 
Published: October 2024

Abstract
Disclosure: E. Askar: None. H. Moran: None. D. Bleich: None.
Introduction: Diabetes is considered a coronary artery disease (CAD) risk equivalent. Studies have shown that the baseline level of triglycerides plays a role in cardiovascular risk independent of LDL levels lowered with statins. Numerous studies demonstrate that, in the general population, coronary artery calcium (CAC) scoring predicts and reclassifies cardiovascular disease (CVD) events, even in the absence of other risk factors. Here, we present a case of a 65 -year-old Caucasian male with elevated baseline triglycerides and a high CAC score, increasing his CVD risk despite the normalization of his triglycerides with statin therapy.Case presentation: A 65-year-old Caucasian male with a history of hypertension, hyperlipidemia, and diabetes presented to our endocrinology clinic for the management of hyperlipidemia and diabetes. His medications included empagliflozin 10 mg daily, repaglinide 1 mg three times a day, atorvastatin 20 mg daily, and amlodipine 10 mg daily. He had no complaints, and the physical examination was unremarkable. His recent HbA1c was 7.4%. Six months prior to presentation, he was found to have elevated triglycerides of 253 mg/dL (normal range: 10-149 mg/dL), low HDL of 34 mg/dL (normal range: &gt;39 mg/dL), LDL of 84 mg/dL (normal range: 0-99 mg/dL), and total cholesterol of 167 mg/dL (normal range: 100-200 mg/dL). At that time, he was started on atorvastatin, and his recent triglycerides and HDL levels normalized. He was referred for CAC scoring, and the result was 2733 , which is above the 90th percentile for men between the ages of 65 and 69. As a result, he was further referred to a coronary angiogram. Conclusion: McGarry at the University of Texas Southwestern Medical Center was the first to describe the elevated triglyceride along with low HDL phenotype associated with insulin resistance. They explained this phenotype as a result of hepatic insulin resistance. Elevated insulin levels reduce the activity of lipoprotein lipase (LPL). As a result of that, the VLDL triglycerides rise, forming small dense LDL with a strong atherogenic potential.In the 2010 published ACCORD study, the effects of simvastatin alone versus simvastatin and fenofibrate were compared in 5500 Patients with type 2 diabetes. The experimental group did not exhibit any significant adverse cardiovascular events after eight years. However, the mean triglyceride was only 162 mg/dL. Consequently, no assumptions about the impact of the treatment on cardiovascular events in a more pertinent subset of people with greater baseline triglycerides could be made.While there has been controversy on the role of triglycerides in CVD, the idea of lowering triglycerides in diabetes patients with high triglycerides and low HDL to lower the risk of CVD is well supported.
Presentation: 6/2/2024
8433 Elucidation of the Molecular Basis of Human and Mouse Pancreatic β-Cell Senescence Induced by Hyperglycemia
Authors: Iwasaki Kanako , Carapeto Priscila , Aguayo-Mazzucato Cristina 
Published: October 2024

Abstract
Disclosure: K. Iwasaki: None. P. Carapeto: None. C. Aguayo-Mazzucato: None.
Background and AIM: Senescent cells accumulate with age and contribute to the development of chronic diseases, including Type 2 Diabetes (T2D). Whereas senescence is an important pathogenic mechanism in diabetes, the role of hyperglycemia as a metabolic driver of pancreatic β-cells has not been clarified. The aim of this study is to elucidate the molecular basis of hyperglycemia-induced pancreatic β-cell senescence using human and rodent islets. Methods: 1) Human islets were cultured for 2 weeks in 20.2 mM high (HG) or 2.8mM low glucose (LG), and analyzed by qPCR and glucose-responsive insulin secretion (GSIS) to explore the molecular basis of senescence in ex vivo. To test the effects of senescent cell removal, senolytics Dasatinib (1μM) and Quercetin (20μM) (DQ) were used. 2) To evaluate the effects of hyperglycemia in vivo, we transplanted mouse and human islets under the kidney capsule of normoglycemic (NG) or streptozocin-induced hyperglycemic (Stz-Db) immunodeficient mice for two weeks. Graft function was evaluated by intraperitoneal glucose tolerance test and cellular identity using qPCR or immunohistochemistry. DQ (5mg/kg/day + 50mg/kg/day) was used to evaluate the effects of removing senescent cells in transplantation (Tx). To investigate the effect of specific removal of p16-positive senescent β-cells in transplanted islets, INK-ATTAC mice islets (p16Ink4a-mediated apoptosis by targeted activation of caspases) were transplanted into Stz-Db and treated with BB homodimer (BB) to remove p16+ cells or vehicle. Results: (1) Human islets from 5 healthy donors cultured in HG had an increased senescence index (mean of senescence markers p16, p21 and HMGB1 mRNA) when compared to LG islets (p&lt;0.05) and lost glucose responsiveness as evaluated by ex vivo GSIS compared to LG (p&lt;0.05). 2) Human islets (1000IEQ) were transplanted to Stz-Db or NG mice. In Stz-Db graft, P21 mRNA significantly increased with decreased expression of β-cell genes when compared to NG. Stz-Db mice treated with DQ (Db-DQ) for 5 days after Tx, significantly decreased expression of senescence index (p&lt;0.05) and increased in β-cell index (mean of β-cell hallmark genes) (p&lt;0.05) at mRNA levels. Stz-Db mice transplanted with INK-ATTAC mice islets had lower fed glucose levels, decreased p16 mRNA, increased expression β-cell hallmark genes and improved insulin secretion ex vivo after removal of p16+ cells. Conclusion: Sustained exposure of human islets to hyperglycemia induced cellular senescence, leading to pancreatic β-cell dysfunction and loss of cellular identity. Furthermore, elimination of senescent cells may protect pancreatic β-cells from hyperglycemia-induced functional decline, which may have potential clinical application in both Type 1 Diabetes and T2D.
Presentation: 6/2/2024
8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes
Authors: Terry David 
Published: October 2024

Abstract
Disclosure: D. Terry: Employee; Self; Valendo Health.
Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM & PCM), Continuous Glucose Monitoring (CGM & RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.&lt;1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors & staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits.
Presentation: 6/1/2024
7311 Endoplasmic reticulum (ER) stress and its associated signaling modulate incretin receptor signaling in pancreatic β cells
Authors: Lee J 
Published: October 2024

Abstract
Disclosure: J. Lee: None.
Pancreatic β-cell dysfunction and eventual loss are key steps in the progression of type 2 diabetes (T2D), and endoplasmic reticulum (ER) stress and its associated signaling have been implicated in these β-cell pathologies. However, the precise molecular events surrounding ER stress and its signaling responses in β-cell dysfunction remain unknown. A notable β-cell dysfunction during obesity and T2D progression is an impaired β-cell response to incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Despite the fact that GIP loses most of its insulinotropic efficacy, GLP-1 receptor (GLP-1R) agonists remain effective owing to GLP-1R’s signaling switch from Gs to Gq. Here, we discovered that ATF4, an ER stress-associated signaling factor, promotes the expression of PDE4D, which disrupts β-cell function, including incretin action, via a downregulation of cAMP signaling. We found that β-cell-specific transgenic expression of ATF4 led to early β-cell dysfunction and loss, a phenotype similar to accelerated T2D. Also, we revealed that nuclear localization of ATF4 and PDE4D expression was increased β cells of obese and diabetic (db/db) mice. Accordingly, pharmacological inhibition of the ATF4 or PDE4 activity in the islets alleviated β-cell dysfunction and promoted incretin-simulated insulin secretion in db/db mice. ER stress also induced GLP-1R’s signaling transition from Gs to Gq in mouse islets. Intriguingly, chemical chaperones known to alleviate ER stress, such as 4-PBA and TUDCA, enforced GLP-1R’s Gq utilization rather than reversing GLP-1R’s signaling switch induced by ER stress or obesity. In addition, the activation of XBP1 or ATF6, two other key ER stress-associated signaling factors, promoted Gs utilization in GLP-1R signaling, whereas they had no effect on Gq employment under ER stress conditions. Our findings show that ER stress and its associated signaling events alter incretin receptor signaling, which could be a therapeutic target for protecting β-cell function during the progression of T2D.
Presentation: 6/3/2024
8075 Euglycemic Diabetic Ketoacidosis Associated With Cocaine Use
Authors: Solanki Naisargee Nilesh , Kiani Amna Nadeem , Feldman Marc 
Published: October 2024

Abstract
Disclosure: N.N. Solanki: None. A.N. Kiani: None. M. Feldman: None.
Euglycemic diabetic ketoacidosis (EDKA) is characterized by increased anion gap metabolic acidosis, ketonemia or ketonuria, and normal blood glucose levels (&lt;200 mg/dL). Due to the absence of hyperglycemia, it commonly presents as a diagnostic and therapeutic dilemma. EDKA is commonly associated with decreased caloric intake, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, recent use of insulin, heavy alcohol consumption, chronic liver disease, glycogen storage disorders, and drug-induced intoxication. Cocaine use is a lesser-known etiology for EDKA. We present a case of a 64-year-old female with a history of type 2 diabetes mellitus who presented with complaints of decreased oral intake for two days secondary to nausea and vomiting and productive cough for one week, along with cocaine use. Despite an extensive history of diabetes and no recent SGLT-2 inhibitor use, her labs were consistent with euglycemic DKA. Her imaging and further investigations revealed respiratory syncytial virus pneumonia. The patient was initially managed for starvation ketoacidosis with fluid resuscitation with no improvement in acidosis and later treated with DKA protocol with rapid correction of her anion gap metabolic acidosis. This case highlights the challenges associated with diagnosing and treating EDKA. Early initiation of DKA protocol should be considered in diabetic patients presenting with euglycemia with high anion gap metabolic acidosis with a clinical picture of starvation and cocaine use.
Presentation: 6/3/2024