bluuebunny/crossref_metadata_2025_split huggingface dataset:
7313 Impact of Day of Admission on Hyperosmolar Hyperglycemic State Outcomes- a National Inpatient Sample Study
Authors: Neupane Binita , Karki Sunita , Bhandari Abhishek , Rajamani Krishnakumar 
Published: October 2024

Abstract
Disclosure: B. Neupane: None. S. Karki: None. A. Bhandari: None. K. Rajamani: None.
Introduction: Hospital mortality and results are significantly influenced by the day of admission (weekend vs. weekday). Studies have shown there is an increase in rates of adjusted hospital mortality in various diseases. Hyperosmolar hyperglycemic state (HHS), or Hyperosmotic hyperglycemic nonketotic state (HHNK), is a serious complication associated with type 2 diabetes mellitus. There have been limited studies on how the day of admission impacts outcomes in HHS. Objective:To investigate if there are differences in weekend vs. weekday admission with the diagnosis of HHS on hospital outcomes. Methods: Retrospective data on adult patients (age &gt;18) with a primary diagnosis of HHS was taken between 2017 and 2020 using the National Inpatient Sample (NIS). The data analysis tool utilized was STATA. Diseases and outcome codes were selected using the International Classification of Diseases (ICD-10). Multivariate regression analysis was used to adjust for potential variables and determine the adjusted odds ratio (aOR). The Fisher exact test was used to compare proportions, while the student t-test was used to compare continuous variables. The study's primary outcome was mortality; additional secondary outcomes included length of stay (LOS), total hospitalization costs, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Between 2017 and 2020, the mortality rates, LOS, and total hospitalization charges of weekend and weekday admissions were analyzed. Results:181,720 patients were diagnosed with HHS; 46,100(25.36%) were admitted on the weekend. Weekend admission had increased rates of ARF (aOR =1.2, 11.15% vs. 9.57%, p&lt;0.01) and mechanical ventilation (aOR =1.24, 7.04% vs. 5.79%, p&lt;0.01) compared to the weekday admission. There was no difference in the outcomes of the two groups in the mortality rate, mean LOS, total hospital charges, ACS, septic shock, pulmonary edema, AKI, CVA, and ARDS. In weekend admission, there was an increase in trends of LOS and total hospitalization charges, but there were no significant outcomes in the mortality rates over the years. In weekday admission, there was an increase in mortality rate trends, LOS, and total hospitalization charges. Conclusion: There was an increase in ARF and mechanical ventilation rates on weekends compared to weekday admission. When the two groups were compared, there were no significant outcomes in mortality rate, LOS, hospital charges, and other hospital outcomes. In both weekend and weekday admissions, there was an increase in trends of LOS and total hospitalization charges; however, only admissions during the weekday showed a significant increase in mortality rate trends.
Presentation: 6/1/2024
6607 Impact of Day of Admission on Hypoglycemia
Authors: Neupane Shila , Neupane Binita , Karki Sunita , Bhandari Abhishek , Quartuccio Michael 
Published: October 2024

Abstract
Disclosure: S. Neupane: None. B. Neupane: None. S. Karki: None. A. Bhandari: None. M. Quartuccio: None.
Introduction: The day of admission, whether on a weekend or a weekday, plays a pivotal role in hospital mortality and outcomes, with studies indicating increased adjusted hospital mortality rates across various diseases. Hypoglycemia, a common complication seen in hospitalized patients, has not been extensively studied concerning its association with weekend admissions. Objective of the study: This research aims to investigate and compare the impact of weekend versus weekday admissions on mortality rates, length of hospital stays, total hospitalization costs, and various other outcomes related to hypoglycemia. Methods: Utilizing the National Inpatient Sample (NIS) for the years 2017 through 2020, we conducted a retrospective cohort study of adult patients (age &gt;18) diagnosed with hypoglycemia. Disease and outcome codes were determined through the International Classification of Diseases (ICD-10), and data analysis was performed using STATA. Multivariate regression analysis adjusted for potential variables while the student t-test and Fisher exact test were employed for comparing continuous and proportional variables, respectively. The primary outcome of the study was mortality, with secondary outcomes encompassing length of stay (LOS), total hospitalization costs, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Results: Among 804,164 hypoglycemia patients, 199,474 were admitted on weekends. Significant findings included higher mortality rates (adjusted odds ratio (aOR) = 1.08, 10.58% vs. 9.81%, p &lt; 0.001), reduced mean LOS (adjusted mean difference = -0.32, 6.94 days vs. 7.3 days, p &lt; 0.001), and lower total hospitalization charges (adjusted mean difference= -$3713, $81,026 vs. $84,471, p &lt; 0.001) in weekend admissions. Additionally, weekend admissions exhibited increased rates of septic shock, ARF, mechanical ventilation, and AKI. There were no differences in the rates of ACS, pulmonary edema, ARDS, and CVA. Trends indicated rising mortality rates, longer hospital stays, and increased costs for weekend and weekday admissions over the three-year study period. Conclusion: Weekend admissions for hypoglycemia are associated with unfavorable outcomes, including higher mortality rates, septic shock, mechanical ventilation rates, AKI, and ARF compared to weekday admissions. However, weekend admissions showed a decrease in the mean length of hospital stay and total hospitalization charges. Ongoing analysis of the underlying causes driving these outcomes is imperative for informing state and federal planning strategies aimed at mitigating these issues.
Presentation: 6/1/2024
7306 Impact of Hypoglycemia in Heart Failure: National Inpatient Sample Analysis
Authors: Neupane Binita , Karki Sunita , Bhandari Abhishek , Farooq Umer , Rajamani Krishnakumar 
Published: October 2024

Abstract
Disclosure: B. Neupane: None. S. Karki: None. A. Bhandari: None. U. Farooq: None. K. Rajamani: None.
Introduction:Hypoglycemia is one of the frequently encountered phenomena in hospitalized patients, mainly with diabetes mellitus; however, it is sometimes seen in patients without diabetes mellitus. Risk factors like advanced age, comorbid diseases, aggressive hyperglycemia therapy, etc., can play a role in the contribution of hypoglycemia. Heart failure is a significant healthcare burden in the United States; mortality due to heart failure has been increasing, and the lifetime risk of heart failure has risen to 24%. There are limited studies investigating how hypoglycemia affects outcomes in heart failure. Methods: We conducted a retrospective analysis using a national inpatient sample from 2017 to 2020. For diseases/comorbidities, International Classification of Disease (ICD-10) codes were used. Data analysis was done using STATA. Multivariate regression analysis was used to calculate the adjusted odds ratio. The primary outcomes of the study were mortality, and secondary outcomes were length of stay (LOS), total cost of hospitalization, septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Results: There was a total of 21,258,175 patients with a diagnosis of heart failure. There were 158,175 patients with a diagnosis of hypoglycemia. There were significant outcomes in patients with hypoglycemia on rates of mortality (adjusted mean difference=3.64, 14.55% vs. 4.91%, p&lt;0.001), LOS (adjusted mean difference =2.03, 8.50% vs. 6.22%, p&lt;0.001), the total cost of hospital stays (adjusted mean difference=$21530, $103,773 vs. $77057, p&lt;0.001), septic shock( aOR=4.05, 14.22% vs. 3.84%, p&lt;0.001), ARF(aOR =1.75, 24.71% vs. 15.88%, p&lt;0.001), mechanical ventilation (aOR=2.84, 14.84% vs. 5.21%, p&lt;0.001), ARDS( aOR=2.15, 0.57% vs. 0.24%,p&lt;0.001), and AKI(aOR=1.65, 41.38% vs. 29.89%,p&lt;0.001) compared to patients without hypoglycemia. There were no significant outcomes in the rate of pulmonary edema (aOR=1.09, 0.54% vs.0.46%, p=0.24). Conclusion: Hypoglycemia increases mortality, duration of hospital stays, health care cost, and health care burden. Hypoglycemia nevertheless results in worse hospital outcomes and higher expenses as compared to non-hypoglycemia due to higher mortality rates, LOS, cost, and hospital outcomes. Blood sugar levels should be monitored frequently to minimize hospitalization complications and improve outcomes.
Presentation: 6/1/2024
8394 Increased alpha cells mass in surrounding pancreatic islet in insulinoma patients
Authors: Kim Byung Joon , Park Hee Kyung , Shin Jun-Seop , Kim Kwang-Won 
Published: October 2024

Abstract
Disclosure: B. Kim: None. H. Park: None. J. Shin: None. K. Kim: None.
Background: Insulin is an essential treatment for controlling blood sugar in diabetic patients. However, research on the direct or indirect effects of hyperinsulinemic states on pancreatic islets cell population is limited. We need to determine the morphology of surrounding pancreatic islets in insulinoma patients and changes in the pancreatic islet after insulin administration in mice model. Methods: Insulinoma and pancreatic tissue surrounding the insulinoma were obtained after surgery of a patient diagnosed with insulinoma due to frequent hypoglycemia. For mouse model, we administered short acting insulin for 7 days to 50% pancreatectomized mice, and then removed remnant pancreatic tissue. We performed insulin and glucagon immunofluorescent staining of the patient's insulinoma and surrounding pancreatic tissue and the mouse's pancreatic tissue. Results: In the insulinoma patients, persistent hyperinsulinemia and hypoglycemia was observed in prolonged fasting test. Alpha cells mass was increased in the surrounding pancreatic islets in insulinoma. Also, in the islets of insulin-treated mice, the number of alpha cells were increased, and the number of cells co-stained for both insulin and glucagon increased, and proliferation of alpha cells was observed. Conclusion: Although more research is needed to confirm the mechanism of effects of hyperinsulinemia on the proliferation of alpha cells, hyperinsulinemia is thought to play a role in the stimulation of increasing alpha cell mass and contributing to hyperglucagonemia in early diabetes.
Presentation: 6/2/2024
6712 Intractable Hypoglycemia: A Clue to Tumor Diagnosis
Authors: Chengappa N Kharkongor , Krug E I 
Published: October 2024

Abstract
Disclosure: N. Kharkongor Chengappa: None. E.I. Krug: None.
Background: Non-Islet Cell Tumor Hypoglycemia (NICTH) known as Doege-Potter syndrome, is a rare paraneoplastic syndrome of hypo-insulinemic hypoglycemia caused by excessive production of partially processed IGF-II from a solitary fibrous tumor (SFT).We present a case of a patient admitted with intractable hypoglycemia leading to the diagnosis and treatment of a large pelvic SFT. Clinical Case: A 59-year-old male with type 2 Diabetes Mellitus on metformin mono therapy, was admitted after he collapsed at work and was found to have blood glucose (BG) of 22 mg/dl. He was previously in his usual state of health except for an increase in his shoe size over the past year. Physical examination revealed coarse thick skin, large coarse bullous nose, enlarged fingers and a non-tender, firm abdomen with no obvious organomegaly. Laboratory results including CBC, CMP and thyroid function were normal. ACTH stimulation test revealed normal adrenal function. Hypoglycemic drug screen and insulin antibodies were negative. During a hypoglycemic event (BG of 45mg/dl) he had C-peptide level &lt; 0.1ng/ml, beta-hydroxybutyrate levels of &lt;0.05 and insulin level &lt;0.4uIU/ml, indicating non-insulin mediated hypoglycemia. IGF-I and IGF-II levels were ordered. Due to a concern for paraneoplastic etiology of hypoglycemia. CT scan revealed a 20 cm solid mass, filling most of the pelvis and extending into the lower abdomen. Further investigations revealed normal PSA, CEA, CA19-9 and undetectable hCG and AFP levels. MRI confirmed a presence of 23 cm pelvic mass with few areas of central necrosis, extending into the lower abdomen. CT-guided biopsy revealed spindle cell neoplasm consistent with SFT. The patient underwent pelvic mass resection. Postoperatively, hypoglycemia resolved with BG readings of 138mg/dl to 178mg/dl. Surgical pathology results confirmed malignant SFT with positive STAT 6 and CD34 markers. IGF-II level obtained prior to surgery was markedly elevated at 2029 ng/ml (38-267 ng/mL). Conclusion: NICTH was described in 1930 by KW Doege and RP Potter. Less than 5% of patients with SFTs develop NICTH. Diagnosis requires manifestation of Whipple's triad, low insulin, pro-insulin and C-peptide levels, elevated IGF-II levels, or an IGF-I/IGF-II ratio&gt;2, and the identification of the tumor. Positive immunohistochemical stain of the tumor for STAT6 confirms the diagnosis. Management involves resection of the tumor when feasible or debulking. For higher-risk tumors, radiation therapy may be considered. In inoperable cases, glucocorticoids, recombinant hGH and glucagon are recommended for palliation of hypoglycemia. Octreotide and Diazoxide are ineffective in NICTH. References: Soumerai TE et al. Case 20-2023: A 52-Year-Old Man with a Solitary Fibrous Tumor and Hypoglycemia. N Engl J Med 2023;388:2467-77. DOI: 10.1056/NEJMcpc2300899
Presentation: 6/1/2024
6985 Intravenous Immunoglobulin induced Type 1 diabetes remission
Authors: Shahid Nabiha , Newbern Dorothee 
Published: October 2024

Abstract
Disclosure: N. Shahid: None. D. Newbern: None.
Introduction: Intravenous immunoglobulin [IVIG] is an immunomodulatory agent used for treatment of autoimmune and inflammatory conditions. However, it is not indicated in patients with type 1 diabetes [T1D] as its efficacy has not been established. Clinical Case: A 9-year-old previously healthy boy presented to the Emergency Department with several days of unexplained bruising and mucosal bleeding with no prior history of trauma, bleeding disorders or other systemic symptoms. Physical examination showed generalized petechiae, ecchymosis and purpura. Vitals were normal including weight and BMI. Initial labs confirmed Immune thrombocytopenic purpura [ITP] as his platelets were less than 1K/µL with otherwise normal peripheral blood cell counts and smear. Concomitantly, labs showed significant hyperglycemia [260mg/dL] with glycosuria and trace ketonuria. Glycated hemoglobin [Hba1c] was elevated at 10.5% and ultimately Pancreatic autoantibodies [GAD65, Zinc transporter-8 and islet cell antibody] came back positive confirming T1D. Other autoimmune disorders such as adrenal insufficiency, thyroiditis, and celiac disease were ruled out. For the treatment of ITP, he the patient received 1 dose of IVIG 1g/kg and responded well with a rise in platelets to 6K/µL. The morning following the infusion, due to fasting hyperglycemia, the patient was started on basal-bolus insulin regimen. By 2nd day post IVIG, he had hypoglycemia, so insulin was discontinued with normalization of blood sugars. He is now 7 months post IVIG with no recurrent episodes of thrombocytopenia. He also remains off insulin with Hba1c in the 5.9-6.5% range. He eats a regular diet with avoidance of simple carbohydrates. He wears onwears a a continuous glucose monitor, which shows that blood sugars are in range 93% of the time He remains euglycemic overnight with transient self-resolving mild post-prandial hyperglycemia. Pancreatic autoantibodies have been reassessed and remain positive Conclusions: This case demonstrates that IVIG used for the treatment of ITP has induced a state of remission in our patient with newly diagnosed with T1D. IVIG is not a standard of treatment for T1D, however, when given for other autoantibody- or T-cell-mediated autoimmune conditions, it may reduce the insulin need in patients with known diabetes or induce remission in patients with newly diagnosed diabetes. References: 1. Colagiuri S, Leong GM, Thayer Z, et al. Intravenous immunoglobulin therapy for autoimmune diabetes mellitus. Clin Exp Rheumatol. 1996;14 Suppl 15:S93-S97.2.Vvan Megen KM, Spindler MP, Keij FM, et al. Relapsing/remitting type 1 diabetes. Diabetologia. 2017; 60(11):2252-2255. doi:10.1007/s00125-017-4403-3
Presentation: 6/2/2024
7672 Ketosis-Prone Diabetes - A Case Series
Authors: Ismail T , Farooq A , Acharya G , Snitzer J 
Published: October 2024

Abstract
Disclosure: T. Ismail: None. A. Farooq: None. G. Acharya: None. J. Snitzer: None.
Introduction Ketosis-prone diabetes (KPD) is a syndrome that primarily affects African Americans. It is characterized by ketoacidosis, which is like Type 1 Diabetes Mellitus (T1DM). KPD is unique because it lacks identifiable autoimmunity and has a relative insulin deficiency, resembling Type 2 Diabetes Mellitus (T2DM). Therefore, KPD is informally classified as Type 1.5 Diabetes Mellitus. However, the clinical course and outcomes of KPD are like those of T2DM, and managing blood sugar levels is possible through non-insulin antidiabetic medications and dietary interventions. Case Series: Our study involved six patients who were all of African-American ethnicity. There were an equal number of male and female patients, with ages ranging from 21 to 61 years. One patient had a BMI of 27.2, which is considered overweight, while the rest had a BMI in the obese category ory(BMI&gt;30). Two out of six patients had a pre-existing diagnosis of type 2 diabetes mellitus (T2DM) before the initial diabetic ketoacidosis (DKA) event. One patient had prediabetes. All patients required hospitalization for ketoacidosis and hyperglycemia and were found to have a glycated hemoglobin (HbA1c) level of more than 10% during these DKA events. All patients received intravenous hydration and insulin drip treatment and were discharged with a combination of long and rapid-acting insulin regimens. Following the resolution of the first episode of diabetic ketoacidosis (DKA), all six patients experienced a decrease in their insulin requirements for optimal glycemic control. Currently, four patients have discontinued insulin entirely. Moreover, all six patients tested negative for the presence of GAD-65, insulin, and islet antigen-2 antibodies. Among the patients, only one had a previously established autoimmune disease, i.e., inflammatory bowel disease. None of the patients experienced a repeat episode of diabetic ketoacidosis. Conclusion: It is important to note that not all patients who present with Diabetic ketoacidosis have Type 1 Diabetes Mellitus (T1DM). Hence, checking auto-antibodies for T1DM before making a final diagnosis is crucial. C-peptide levels may not accurately reflect the degree of relative permanent insulin deficiency in this population if measured during or immediately after an episode of diabetic ketoacidosis due to glucose toxicity and other factors. Given its prevalence in obese individuals, weight loss through dietary modifications and GLP-1 receptor analogs may be beneficial.
Presentation: 6/3/2024
12248 Leptin Signaling Deficiency At The Central Nervous System Reduces Hepatic Glucagon Sensibility Disturbing Liver Amino Acid Metabolism Leading To Hyperaminoacidemia And Hyperglucagonemia In Male Adult Rats
Authors: Pintado Losa Cristina , Mazuecos Fernández-Pacheco Lorena , Gómez Torres Óscar , Artigas Jerónimo Sara , Burgos Ramos Emma , Ramos Inés , Poveda Colado Justa , Arribas Mocoroa Carmen , Andres Antonio , Gallardo Nilda 
Published: October 2024

Abstract
Disclosure: C. Pintado Losa: None. L. Mazuecos Fernández-Pacheco: None. Ó. Gómez Torres: None. S. Artigas Jerónimo: None. E. Burgos Ramos: None. I. Ramos: None. J. Poveda Colado: None. C. Arribas Mocoroa: None. A. Andres: None. N. Gallardo: None.
Leptin regulates glucagon secretion, but the contribution of central leptin resistance to circulating glucagon levels and hepatic glucagon signaling is poorly studied. To analyze the effects of deficient hypothalamic leptin signaling on glucagon levels and hepatic glucagon signaling, we infused intracerebroventricularly a rat-specific leptin receptor antagonist SLA (0,2 µg/day) for 21 days to male 3-month-old Wistar rats (n=12) or PBS (n=12). At day 21 of treatment and 30 min before sacrifice, a glucagon challenge (100 µg/kg) was performed in 16h fasted rats. After sacrifice, blood and liver samples were collected for analysis. Serum hormones, urea, and total and branched-chain amino acids (BCAA) levels were determined using commercial kits and by RP-HPLC. Hepatic neutral lipid was extracted and quantified using an enzymatic kit and the hepatic content of mRNA and proteins involved in lipid and amino acid metabolism were measured by RT-PCR and Western-Blot. Additionally, the HOMA-IR and glucagon-alanine index were determined in all rats. Blocking central leptin signaling led to impaired fat oxidation and triglyceride export capacity in the liver, resulting in a 50% increase in hepatic triglyceride content in SLA-treated rats. Glucagonemia increased in SLA-treated rats, indicating impaired hepatic glucagon sensitivity. In fact, in response to exogenous glucagon, the hepatic phosphorylation of CREB was reduced by 55% in SLA-infused compared to control rats. Importantly, SLA treatment significantly decreases the expression and the activity of BCKDH (branched-chain alpha-keto acid dehydrogenase) in the liver, leading to a reduction in the BCAA degradation in SLA-treated rats, hyperaminoacidemia, and decreased serum urea levels. In conclusion, deficient hypothalamic leptin signaling alters glucose, lipid, and amino acid homeostasis, highlighting the relevance of central leptin action in the control of peripheral metabolism and glucagon sensitivity. Funding: Work supported by Ministerio de Ciencia, Innovación y Universidades under project grants RTI2018-098643-B-I00, PID2021-128243OB-I00, and from the University of Castilla-La Mancha and the European Regional Development Fund (FEDER) under project grant 2023- GRIN-34280.
Presentation: 6/1/2024