bluuebunny/crossref_metadata_2025_split huggingface dataset:
6745 Complete Remission of Type 1 Diabetes and the Honeymoon Phase: A Case Report
Authors: Krinsky Dana , Brutsaert Erika , Mullally Jamie Ann 
Published: October 2024

Abstract
Disclosure: D. Krinsky: None. E. Brutsaert: None. J.A. Mullally: None.
Introduction: Type 1 Diabetes (T1D) is a chronic autoimmune disease resulting in insulin deficiency from pancreatic beta-cell destruction. Recent evidence suggests that it can be a partially relapsing and remitting disease, with some patients with T1D being able to briefly discontinue insulin early in the disease course. This phenomenon has been referred to as the “honeymoon phase.” While this period tends to be short, on the order of weeks to months, we describe a unique case of a patient with T1D with a long remission, lasting about five years. Clinical Case A 21-year-old Mexican-American male (BMI 26) with past medical history of T1D presented with polyuria and a 50-pound unintentional weight loss over a 6-month period. He was first diagnosed with T1D at age 14 years when his Hemoglobin A1c (HbA1C) was 13.3% (normal range 4.0-5.6%) in the setting of hospitalization for diabetic ketoacidosis (DKA). All antibody testing done at that time was negative, but islet cell antibodies were later found to be positive. Insulin therapy was started, weaned, and then completely discontinued at age 16 when the patient’s HbA1c was normal at 5%. The patient had no symptoms of diabetes until 6 months prior to presenting, seven years after his original diagnosis. He was found to be in DKA with a HbA1c &gt;14%. Additionally, insulin (&lt; 3.0; normal range 6-27) and c-peptide (0.43; normal range 0.81-3.85) were low with an elevated glucose of 366. Insulin autoantibody, GAD-65 antibody, and islet cell antibody were negative. His DKA resolved and he was discharged on basal and nutritional insulin. Conclusion: The physiology of the honeymoon phase is not well understood and there is not a clear definition, although stimulated C-peptide levels, insulin requirements, and calculating insulin dose adjusted A1c (IDAA1c) have been commonly used. There is variability in reports of the prevalence of partial remission (PR), estimated to occur in 22-60% of patients, with an average duration of 9 months. Our case is unique in that the patient was diagnosed with T1D at the age of 14 years but was able to discontinue all insulin for five years. His presentation is consistent with a complete remission with insulin independence and normal glycemic control (HbA1C &lt;6%) without the use of hypoglycemic agents. Complete remission has a prevalence of only 6.5%. Prior data has shown factors associated with diabetes remission include male sex, postpubescent age of diabetes onset, and fewer than two positive antibodies; factors seen with our patient. Our case highlights a very long remission of T1D, and a better understanding of the immunologic and metabolic factors at play in the honeymoon phase may pave the way for novel T1D prevention and treatment strategies.
Presentation: 6/2/2024
8189 Demographics and Healthcare Utilization of Diabetic Versus Non-Diabetic Gastroparesis hospitalization in the United States Using the National Inpatient Sample database
Authors: Khan Shahryar , Zia Laila , Khan Mashal Alam , Amin Muhammad Kashif , Khan Muhammad Atif , Sattar Farhan 
Published: October 2024

Abstract
Disclosure: S. Khan: None. L. Zia: None. M. Khan: None. M. Amin: None. M. Khan: None. F. Sattar: None.
Background: Gastroparesis is commonly associated with neuropathy secondary to Diabetes and Non-Diabetic causes such as Idiopathic, Post-Viral and Surgical with a wide spectrum of clinical manifestations impairing quality of life, worsening morbidity, and mortality. The purpose of this study is to assess Demographic disparities and utilization of healthcare services between Diabetic (DG) Versus Non-Diabetic Gastroparesis (NDG) admissions. Methods: Data were extracted from the National Inpatient Sample Database for the year 2020. It comprises discharge data obtained from a 20% stratified sample of community hospitals across the country. We conducted a retrospective cohort study focusing on admissions of patients aged 18 years and above with diagnosis of DG and NDG were identified using ICD-10 codes. Multivariate regression analysis was used to estimate the Mean difference of the Average length of hospital stay (LOS), and total hospital charges (THC). Multivariate logistic and linear regression was used accordingly to adjust for confounders. Analysis was performed using STATA 18. Results: Our study identified 10330 patients hospitalized due to gastroparesis, among them 1446 (14%) had DG. Hospitalizations with DG in comparison with NDG had lower number of women (65% Vs 80.7%, P≤0.05), a higher proportion of black adults (36.5% Vs 17%), a lower proportion of white adults (46.4% Vs 70%), and a higher Charlson Comorbidity Index. In DG, 104(7.19%) patients had EGD and non-diabetic gastroparesis, 977 (11%) had EGD during admission. The mean LOS in hospital was 4.72 days and mean total hospital charges were 51327 USD. Comparing both cohorts, there was statistically significant decrease in the mean LOS in DG, Adjusted Mean difference of 1.27 days (P = 0.006). In addition, there was significant decrease in the total cost of hospitalization with an adjusted Mean difference of 13832 (P=0.001). Thirty patients with NDG died during hospital course and none with Diabetic gastroparesis. Conclusion: According to our findings, majority of admissions with gastroparesis are related with non-diabetic causes with higher healthcare utilization and mortality rate. Gastroparesis is a relatively frequent and poorly understood condition which needs considerate effort to have a better understanding of disease.
Presentation: 6/2/2024
7252 Difference between interstitial and blood glucose during glucose loading is associated with the degree of insulin resistance in subjects with prediabetes and type 2 diabetes
Authors: Kim Doohwa , Ryang Soree , Im Myungsoo , Kim Jeongmi , Kim Yeongjin , kim Youngjin , ha Joon , Kim Jinmi , Kim Sangsoo 
Published: October 2024

Abstract
Disclosure: D. Kim: None. S. Ryang: None. M. Im: None. J. Kim: None. Y. Kim: None. Y. kim: None. J. ha: None. J. Kim: None. S. Kim: None.
Background and Aims: This study investigated the main factors responsible for the differences between blood glucose (BG) and interstitial fluid glucose (ISF) during glucose loading. Methods: A total of 204 Korean subjects without history of type 2 diabetes were enrolled. The subjects were categorized into three groups according to diabetes criteria by American Diabetes Association; NGT (normal glucose tolerance, n=36), PreDM (prediabetes, n=130) and T2D (undiagnosed type 2 diabetes, n=38). For glucose monitoring, a CGM (continuous glucose monitoring) system (Dexcom G6, Dexcom, San Diego, USA) was attached for 10 days. 75g oral glucose tolerance test (OGTT) was performed during applying CGM with stabilization (after wear of 3 days). Blood sample collected at t=0, 30, 60, 90 and 120 min for glucose and insulin concentration. Two parameters [insulin sensitivity (mIS) and beta-cell function (mBCF)] were derived novel mathematical model. Results: Among NGT, PreDM and T2D, there are heterogeneity in the difference and pattern between BG and ISF in this study. We identified the probability density function of BG - ISF across glucose tolerance, there is a trend that the means of BG - ISF with G60, 90, and 120 move to the right, as glucose tolerance status changes NGT to PreDM and DM. BG - ISF is significantly associated with insulin resistance (R=0.32, p&lt;0.001), not diminished beta cell function. Conclusions: Because individuals vary in their degree of insulin resistance as a primary pathophysiology of type 2 diabetes, the caution should be needed in interpreting the glycemic response of CGM after a glucose load.
Presentation: 6/3/2024
9390 Does Znt8a Have An Association With The Duration Of Diabetes? Case Series And Literature Review
Authors: Rivera Vargas Natalie Marie , Botero Suarez Carlos S , Suryanarayanan Sowmya K , Saad-Omer Suhail 
Published: October 2024

Abstract
Disclosure: N.M. Rivera Vargas: None. C.S. Botero Suarez: None. S.K. Suryanarayanan: None. S. Saad-Omer: None.
Context: Latent autoimmune Diabetes of adults (LADA) is a form of autoimmune diabetes with features of Type 2 Diabetes but positive autoantibodies resembling Type 1 Diabetes. Latent autoimmune diabetes in adults (LADA), has a mixed phenotype with positive islet-cell antibodies (ICA), glutamic acid decarboxylase autoantibodies (GADA), protein tyrosine phosphatase autoantibodies (IA2A), insulin autoantibodies (IAA), or zinc transporter-8 autoantibodies (ZnT8A). Since the discovery of ZnT8A, the relevance and clinical utility of this marker has sparked interest. Although ZnT8A is used as a complementary diagnostic aid in children, its utility in adults seems to be unclear. Objective: We report a case series of 26 subjects referred to the Orlando VA Endocrine clinic with measured ZnT8A. We hypothesize that higher ZnT8A will be found in adult autoimmune diabetes with newly diagnosed diabetes rather than those with a longer duration of diabetes. We also explore the association between ZnT8A and family history, duration of diabetes, diabetes complications, and C-peptide levels. Method: A case series of 26 adult patients with diabetes mellitus with a positive ZnT8A (≥15 U/mL). We reviewed medical records of these cases to include ZnT8A levels, years of diabetes diagnosis, C-peptide levels, and diabetes complications. Patients were classified into subgroups based on ZnT8A levels into &lt; 350 U/mL or ≥ 350 U/mL. Results: The 26 patients reviewed had a mean (SD) age of 46 (13) years. The mean (SD) duration of diabetes was 16 (12) years, and HbA1C was 8.4 (1.1) %. Poisson regression analysis showed a statistically significant inverse relationship between ZnT8A and years of diabetes (regression coefficient: -0.028; 95% confidence interval: -0.03 to -0.25; p-value &lt;0.001). Diabetic ketoacidosis was present in 35% of subjects, while diabetic neuropathy was noted in 58% of subjects with positive ZnT8A. Patients with a high ZnT8Ab above 350 U/mL displayed a weak trend towards a lower C-peptide mean (p-value 0.42), and lower prevalence of DKA (p-value 0.42) which was not statistically significant. Conclusion: In this case series of patients with adult-onset diabetes, there seems to be a statistically significant inverse relationship between ZnT8A levels and duration of diabetes suggesting a reduction of ZnT8A levels over time. Although limited by a small number of subjects, this may suggest the need for screening with autoantibodies in the setting of diabetes earlier in the disease process.
Presentation: 6/2/2024
12239 Effect Of Nano2, A Donor Of Nitric Oxide, On Glucose Mediated Oxidative Stress In Pancreaticb-cells
Authors: Islam Kazi Nazrul , Islam Rahib K , Rashid Mohammod B , Smith Branson , Islam Safa K 
Published: October 2024

Abstract
Disclosure: K.N. Islam: None. R.K. Islam: None. M.B. Rashid: None. B. Smith: None.
Diabetes is a leading cause of morbidity and mortality. Elevation of oxidative stress is a common cause in diabetic patients because of higher levels of blood sugar concentration. Nitric oxide (NO) is a gasotransmitter that has many health benefits for many disease conditions. NO also has an antioxidant property. The pancreatic β-cells are insulin-secreting cells. The present study was undertaken to investigate the effects of NaNO2, a donor of NO on glucose-induced oxidative stress in pancreatic β-cells (HIT) from a Chinese hamster. First, we determined the effects of dose responses of glucose (25, 50, 75, 100, and 150 mM) on the induction of oxidative stress as it was measured by the formation of thiobarbituric acid reactive substances (TBARS) in serum starved β-cells. We observed marked oxidative stress in the serum starved β-cells by the treatment with 75 mM of glucose. Later, we tested the effects of NaNO2 on glucose-induced oxidative stress in serum starved β-cells, and we found that NaNO2 markedly inhibited glucose-induced oxidative stress in serum starved β -cells. Treatment with NaNO2 caused significant induction of cell viability and a marked reduction of cellular cytotoxicity in β-cells under serum starvation incubated without or with glucose. In addition, NaNO2 treatment of β-cells antagonized expression levels of inflammatory cytokines, TNF-α and inhibited the activation of the transcription factor, NF-κB signaling pathway. Our findings suggest that NO or NO donors may be used as therapy to cure diabetes via inhibiting oxidative stress thereby decreasing blood sugar levels in diabetic patients.
Presentation: 6/3/2024
12521 Electrical Impedance Myography And Muscle Health In Older Adults With Type 1 Diabetes
Authors: Fremaint A , Jung G , Yu E , Bouxsein M 
Published: October 2024

Abstract
Disclosure: A. Fremaint: None. G. Jung: None. E. Yu: None. M. Bouxsein: None.
Introduction: Recent studies indicate that individuals with Type 1 diabetes mellitus (T1D) develop skeletal muscle health impairments which might contribute to falls and explain their high fracture risk. A novel handheld Electrical Impedance Myography (EIM) device (mScan model 1301, Myolex) has been developed to assess muscle quality by calculating tissue impedance. We hypothesized that mScan could identify individuals with worse strength and body composition outcomes among older adults with and without T1D. Methods: We studied participants of the T1D Bone Health Connection (BEACON) Study who were aged 50+ and who had undergone EIM testing (n=63 T1D, n=50 non-diabetic controls). We analyzed EIM-derived phase angle [Phase = arctan(reactance/resistance)] at 100 kHz in 3 upper extremity muscles (biceps brachii, lateral deltoid, and wrist extensors), where lower phase values indicate poorer muscle quality. Correlations of EIM data were performed with grip strength measured by a handheld dynamometer and appendicular lean mass/height2 (ALM/ht2) and visceral adipose tissue (VAT) from whole-body DXA scans. Pearson’s correlations were used for all statistical analyses. Results: Mean age (63±7 years), sex (54% female), and BMI (26.5 kg/m2) were similar between T1D and control groups. Adults with T1D had a nonsignificant trend towards lower muscle quality at the biceps brachii than controls (8.9±5.4 vs 10.9 ±6.0 degrees, p=0.078). There were no differences between groups in phase angle for lateral deltoid nor wrist extensors. Higher muscle quality at the biceps brachii was associated with higher grip strength (r=0.28, p=0.005) in the full cohort as well as in the T1D group (r=0.40, p &lt;0.001). In the full cohort, greater VAT was associated with lower muscle health at the biceps brachii (r = -0.34, p=0.003) and lateral deltoid (r = -0.23, p&lt;0.014), with similar patterns in both T1D and controls. There were no correlations of muscle quality with ALM/ht2. Conclusion: Our data suggest that mScan holds promise for detection of skeletal muscle health impairments in older adults, including those with T1D, potentially aiding in the diagnosis and prevention of related falls and fractures. Further research is required to investigate the association between VAT and muscle health and to validate the effectiveness of mScan in T1D and other populations.
Presentation: 6/3/2024
6920 Engagement and Mood assessments in Emerging Adults Attending a Multi-disciplinary Diabetes Transition Clinic
Authors: Thota G P , Glaros S , Dixon S , Chung S T 
Published: October 2024

Abstract
Disclosure: G.P. Thota: None. S. Glaros: None. S. Dixon: None. S.T. Chung: None.
Introduction & Objective: Transitioning to adult diabetes care can be challenging and associated with interruption in care, worsening glycemic control, and social stress. However, most studies have been conducted in emerging adults (YA) with type 1 diabetes (T1D), and contemporary data in multi-disciplinary clinics designed with supportive resources, especially for YA with youth-onset type 2 diabetes (Y2D) is lacking. Our objectives were to assess mood and engagement in psychology therapy services within a structured multidisciplinary diabetes clinic. Methods: This was a single-center observational analysis of YA (18-30y) attending a research diabetes transition clinic supported by clinical coordinators, social navigators, a certified diabetes educator, and a nutritionist between January 2021 and December 2023. All YA were offered free transportation to and from visits. Clinical coordinators communicated regularly for appointment reminders. Mood was assessed with Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) at each visit and Endocrine Society Transition Readiness Form at initial visit. In January 2023, all YA were given the option to meet with a clinical psychologist during the diabetes visit. Student t-test were used to compare groups using STATA v.18. Results: In 62 YA (73% Y2D, 10% T1D, 17% other) aged 20.2±2.7y, BMI:37.3±9.6 kg/m2, all engaged in nutrition counseling and 52% (32/62) utilized transportation services. A diagnosed psychiatric disorder was present in 16% (10/62). At initial visit, PHQ-9 scores were 6.1±6.3, n=62 and39% (24/62) had score &gt;8 (moderate depression). Within the last 2 weeks, 13% (10/62) reported suicidal ideation. GAD-7 scores were 6.0±6.3 and 54% had anxiety that interfered with activities of daily living. Psychology services were accepted in 61% (38/62) with higher initial GAD-7 scores in those who saw psychologist (8.2±6.8 vs. 4.1±5.3, P=0.02) but no difference in PHQ-9 scores (7.2±6.6 vs. 5.1±5.9, P=0.2). Most YA (81%) reported adequate diabetes knowledge while 25% YA reported diabetes-related challenges including feeling burned out, not knowing how to navigate specialty diabetes care, challenges with medication insurance, transportation, and insurance coverage. Conclusion: Approximately 50% of emerging adults with diabetes reported moderate depression and anxiety scores and were interested in engaging in psychology services. Transition diabetes care programs should focus on increasing access to routine integrated mental health services and social support.Such an initiative could potentially ameliorate psychological stressors associated with diabetes management during the transition to adult care.
Presentation: 6/1/2024
6538 Find me if you can! A Case of a "Well Placed Solitary Insulinoma" in "The Center" of an SACST
Authors: Kennedy Randol , D’Alessio David A , Vella Adrian V 
Published: October 2024

Abstract
Disclosure: R. Kennedy: None. D.A. D'Alessio: None. A.V. Vella: None.
Introduction: Selective arterial calcium stimulation testing (SACST) can be utilized in patients to localize solitary insulinomas when imaging is non diagnostic. While a heterogenous stimulation pattern suggests NIPHS, or multiple insulinomas this case uniquely demonstrates such a pattern with a solitary insulinoma. Clinical Case: The patient is a 48 year old female who presented to the emergency department (ED) for bizarre behavior which resolved with a sweetened drink. Serum glucose was 62 mg/dL, she was treated with IV dextrose and was discharged from the ED. She was referred to outpatient endocrinology for further evaluation where continuous glucose monitoring confirmed predominantly fasting hypoglycemia. Adrenal insufficiency was excluded. She was admitted for a 72 hour inpatient fast where the patient achieved hypoglycemia within 24 hours, with glucose 46 mg/dL (associated with neuroglycopenic symptoms), beta hydroxybutyrate &lt; 0.18 mmol/L, insulin 3.9 mcIU/mL, proinsulin 157pmol/L, c-peptide 1.4 ng/mL and a glucose rise greater than 25mg/dL after glucagon administration. Sulfonylurea screen and insulin antibodies were negative; IGF1 within normal limits. These labs were consistent with hyperinsulinemic hypoglycemia. An MRI pancreas however did not reveal an insulinoma. The patient therefore underwent a SACST, demonstrating a 10 fold response in the territory of the gastroduodenal artery and splenic artery, as well as a 3 fold response in the superior mesenteric artery. This heterogenous pattern in addition to the marked response in each arterial territory raised the possibility of multiple insulinomas. However as there were no tumors present on imaging, medical management was initiated with close follow up. She was trialed with months of somatostatin analogs and diazoxide with minimal improvement in the frequency and severity of her hypoglycemia. About a year after her initial diagnosis, repeat abdominal imaging (CT and MRI) revealed an 8 mm arterial hyper-enhancing lesion in the body of the pancreas concerning for neuroendocrine tumor. Repeat SACST was performed, this time showing a greater than 10 fold response in all three arterial territories. Angiography showed a tumor blush that was visible when each of the three major arteries were injected sequentially. She underwent laparoscopic pancreatic enucleation. The lesion was located on the body of the pancreas, with histology confirming an insulinoma. The patient responded promptly post operatively; her symptoms resolved without further need of medical management. Conclusion: Our case shows that the interpretation of an SACST should take into account the arterial anatomy before ascribing a non-focal response to multiple territories of insulin hypersecretion.
Presentation: 6/1/2024
12491 Follow Up Of Glycemic Control In Patients Users Of Sensor Augmented Insulin Pump (sap) After Multi Dairy Injection (mdi) Or Change Of Technology
Authors: Medina A , Tabares S , Coronado C , Burgos L , Ely A L 
Published: October 2024

Abstract
Disclosure: A. Medina: None. S. Tabares: None. C. Coronado: None. L. Burgos: None. A. Ely: None.
Introduction: Sensor augmented insulin pump (SAP) is considered an efective therapy in type 1 diabetes (T1D) that combines continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM). A new metric of glycemic control is the time in range (TIR). More time in the expected range means less severe highs and lows. Objective: To describe glycemic control of a cohort of patients treated with multi-daily injection (MDI) or sensor-augmented insulin pump (SAP) VEO /640G who switched to a new therapy with 640G, 670G and 780G at 3 and 6 months. Methodology: A cohort study was analyzed with patients with T1D receiving SAP therapy in an university hospital. Patients with insulin therapy with MDI or SAP (VEO /640G) prior to SAP (670G /780G) were included and were followed up with glycemic control trough A1c, time in range (TIR), time in hypoglycemia and hyperglycemia, glycemic variability (GV) using continuous glucose monitoring (CGM) for 14 days, at 3 and 6 months after starting a new technology. Results: 40 patients were analyzed from 2022 to 2023, who attended check-ups every 3 months. The median age was 32 y and 65% were male. At baseline data, 40%, 22.5%, 37.5% were on MDI, VEO and 640G respectively, before changing therapy to 670G or 780G. The TIR increased by 97.6% of the patients and 75% reached the TIR (&gt;70% between 70 and 180 mg/dl of glucose).Hypoglycemia decreased in 75% of patients, and of 27 patients in hyperglycemia, only 3, did not decrease glucose levels due to: lack of follow-up, sensor failure and misuse of the pump. In this cohort were included 12 patients in special conditions. The average initial GV was 37,2%, the normal being &lt;36%, with an improvement at 3 and 6 months of 32,8 and 32,9%, respectively.The mean basal A1c was 7,32% . A1c decreased to 6,8 and 6,9% at 3 and 6 months after new therapy. Discusion: Regardless of the basal therapy (MDI, SAP), an improvement in TIR and A1c as measures of glycemic control is observed, as well as a decrease in the time in hypo and hyperglycemia and GV. The few patients who did not experience improvement had poor pump management, inappropriate carbohydrate counting, or poor adherence at checkups. Conclusion: SAP is an effective therapy in patients with (T1D) to reach metabolic goals, without increasing the rate of hypoglycemia. The most recent technologies in insulin pumps demonstrate better glycemic control.
Presentation: 6/1/2024