bluuebunny/crossref_metadata_2025_split huggingface dataset:
7137 The Sugar Saga: A Profound Case Of Diabetic Ketoacidosis Due To Enfortumab Vedotin
Authors: Aron Polina , Connell Brendan , Longo Rebecca , St. Jean Karen , Upadhyay Jagriti 
Published: October 2024

Abstract
Disclosure: P. Aron: None. B. Connell: None. R. Longo: None. J. Upadhyay: None.
This is a case of severe hyperglycemia with the use of Enfortumab Vedotin (EV) in the setting of advanced urothelial cancer. EV is a nectin-4-directed antibody-drug conjugate with a microtubule inhibitor approved for treating advanced/recurrent disease. It is the first of its class that is an antibody-drug conjugate (ADC), targeting nectin, but not the first ADC to cause hyperglycemia. Here we present a case of severe insulin resistance requiring insulin infusion at 50 units/hour in addition to subcutaneous insulin all in the setting of EV use.74 year old male with BMI of 28 and HbA1c of 7.5%, managed only with diet was started on EV for metastatic urothelial cancer. Patient received one cycle (3 doses) of EV (on days 1, 8, 15) and thereafter noticed worsening of hyperglycemia with blood glucose of 533 mg/dL, requiring subcutaneous insulin. Patient’s blood glucose readings remained elevated and he was admitted to the hospital as he was found to be in DKA with a pH of 7.2, bicarbonate 14 mmol/L, anion gap of 16 mmol/L and a glucose of 558 mg/dL. The patient was started on intravenous insulin (IV) infusion using insulin infusion protocol titrated up to 14 units an hour with an additional 30 units of glargine. Patients’ clinical condition continued to worsen and he was in septic shock with pressors and on insulin infusion exceeding 55 units/hour, NPH at 50 units, and regular insulin 30 units with glucose persistently above 400 mg/dL. Patient was started on hydrocortisone 50mg every 6h and his blood glucose readings eventually normalized over a span of 1 week. Patient eventually was able to be discharged to rehabilitation with just a correctional humalog insulin. Our case demonstrates DKA as a consequence of severe insulin resistance seen as a side effect of EV. Hyperglycemia is seen in 8% of patients using this medication, but severe cases are mostly seen with high BMI and uncontrolled diabetes. This case illustrates the fact that one needs to be cautious in ALL patients with diabetes when using this drug and warrants screening for DKA/severe insulin resistance if blood glucose is running &gt;250mg/dL. The exact mechanism for hyperglycemia is unknown but it is likely immunomodulatory and therefore treatment with pulse dose steroids may help with overcoming insulin resistance in this setting like in our patient. More research needs to be done to understand mechanisms and establish treatment guidelines for severe insulin resistance and hyperglycemia caused by this medication.
Presentation: 6/1/2024
6631 A Week With Diabetes: Using Real-Time Continuous Glucose Monitoring In A Simulation Activity With Residents And Fellows
Authors: Gallagher Thomas , Donelly Colin , Amori Renee E 
Published: October 2024

Abstract
Disclosure: T. Gallagher: None. C. Donelly: None. R.E. Amori: None.
Background: Continuous glucose monitor (CGM) use in managing diabetes mellitus is increasing rapidly. Fellows and residents often prescribe these devices, but most do not themselves have diabetes mellitus and do not use these devices personally. A real-time simulation activity can help physicians in training learn about using the technology in diabetes management and the patient experience living with diabetes mellitus. Objective: Assessing learner’s experiences using a one week real-time CGM simulation. Methods: A real-time simulation using CGM and elements of role playing can enhance knowledge of CGM use and overall diabetes care. Voluntary participants included endocrinology fellows, internal and family medicine residents, and one health professions student. One common structured learning task per day was assigned to all participants over a single seven day period of use in academic year 2022-23. Assessment of each task occurred via personal observations and reflections. Data was collected in an anonymous form and in a group debrief. Results: Eight of 10 participants completed the deidentified post simulation survey and 8/10 participated in the live debrief. Participants reported ease of CGM placement and use. They reported improved insight into the impacts of diabetes on daily activities and increased awareness of diet and exercise impact on glucose levels. Insulin dose calculations were largely correct but errors were seen. All felt the activity was beneficial to their learning. Conclusions: Real-time CGM simulation improves student, resident, and fellow knowledge of the technology and allows the learner to gain insight into a patient’s diabetes self-management.
Presentation: 6/3/2024
7877 Adipose Depot Differences In Regenerative Properties Of Exosomes Derived From Human Adipose Stem Cells
Authors: Krause-Hauch Meredith A , Patel Rekha , Osborne Brenna , Albear Paul , Patel Niketa A 
Published: October 2024

Abstract
Disclosure: M.A. Krause-Hauch: None. R. Patel: None. B. Osborne: None. P. Albear: None. N.A. Patel: None.
Many patients struggle with chronic recalcitrant wounds that are the result of delayed healing. Underlying inflammation is one major risk factor for impaired dermal wound healing that may lead to pathologies such as infection and scarring. Adult human adipose stem cells (hASCs) have shown tremendous potential in regenerative medicine. The regenerative potential of hASCs is dependent on secreted bioactive material which is packaged and released in extracellular exosomes. We previously showed that hASC exosomes from the subcutaneous depot (sc) promoted repair in human dermal fibroblasts using in vitro assays. In this study, we evaluated exosomes derived from the omental depot (om) of hASC and compared its efficacy with sc-hASC. Our results show differences in levels of the long noncoding RNA (lncRNA) cargo between om-hASCexo and sc-hASCexo. Next, we evaluated their repair potential in a wound model in vivo. Male and female F344 rats were dorsally wounded via punch biopsy and silicone scaffolding was attached to prevent contraction. The wounds were then either not treated (control) or treated with 50μg om-hASCexo or sc-hASCexo every alternate day when each wound size was measured for 1 week to monitor healing progress. After 7 days, wounds treated with either om-hASCexo and sc-hASCexo closed significantly faster than untreated control wounds. While no difference was observed in closure percentage after 7 days for wounds treated with either om-hASCexo and sc-hASCexo, sc-hASCexo appeared to act faster earlier (1-2 days post wound) in the wound healing process while om-hASCexo acts faster during later stages (2-4 days post wound) of wound healing. The wound tissue was collected for biochemical and histological analysis. qPCR analysis on day 7 revealed that both om-hASCexo and sc-hASCexo treatment resulted in increased levels of Collagen 1 & 3 and MMP9, while levels of TGF-β decreased with treatment. These results indicate that om-hASCexo and sc-hASCexo enhanced the wound healing process while decreasing inflammation of the wound. To determine the differences between om-hASCexo and sc-hASCexo treatments on wound healing pathways, RNAseq was performed. Results show specificity in pathway activation and gene expression between the om-hASCexo and sc-hASCexo treatments. In conclusion, we have demonstrated that the regenerative mechanisms differ between the hASC depots from which exosomes are secreted. At a broader level, this finding may shed light on the body’s organ health and repair processes in normal or disease states.
Presentation: 6/3/2024
8707 Are We Adequately Prescribing Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) Or Glucagon-Like Peptide 1 Receptor Agonist (GLP-1 RA) In Patients With Type 2 Diabetes Mellitus (T2DM) And Established Atherosclerotic Cardiovascular Disease (ASCVD) Or Chronic Kidney Disease (CKD) In An Outpatient Setting: A Community Center Experience
Authors: Maan R K , Sawhney A , Hayat A , KC S , Madan A , K C S , Williams L , Zweben A , Rana A 
Published: October 2024

Abstract
Disclosure: R.K. Maan: None. A. Sawhney: None. A. Hayat: None. S. Kc: None. A. Madan: None. S. K c: None. L. Williams: None. A. Zweben: None. A. Rana: None.
Introduction: The American Diabetes Association (ADA) recommends prescribing Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i) or Glucagon-Like Peptide 1 Receptor Agonist (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and established Atherosclerotic Cardiovascular Disease (ASCVD) or Chronic Kidney Disease (CKD) for its cardiovascular benefits. Methods: Our retrospective study analyzed data from 511 T2DM patients who visited the outpatient clinic between 7/1/22 to 6/30/23. Using Microsoft Excel, we assessed adherence to ADA guidelines by collecting data for SGLT2i, GLP-1 RA and statin prescriptions, urine microalbumin creatinine ratio measurements, and appropriate management of albuminuria. The study also investigated patients on dipeptidyl peptidase-4 inhibitors (DPP-4i) who were eligible for SGLT2i or GLP-1 RA. Results: Out of the 511 patients, 478 were eligible for SGLT2i or GLP-1 RA, and only 60% were prescribed these medications. Out of 479 patients eligible for statin prescription, only 85% were on it. Albuminuria was appropriately managed in 76% of eligible patients with Angiotensin-Converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs). Additionally, 8 out of 11 patients on DPP-4i were eligible for SGLT2i or GLP-1 RA. Conclusion: We concluded that 60% of the patients eligible for SGLT2i or GLP-1 RA were prescribed the medication in our outpatient settings. The barriers identified were issues with insurance prior authorization and knowledge gaps. We aim to improve adherence to guidelines through multifaceted education strategies combined with audits and feedback. References:Diabetesjournals.org/care/article/46/Supplement_1/S158/148038/10-Cardiovascular-Disease-and-Risk-ManagementMarso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311-322. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375:1834-1844Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019;394:121-130 Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-2128Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019;380:347-357
Presentation: 6/3/2024
7056 Can ChatGPT Educate Multicultural Patients About Metabolic Syndrome?
Authors: Wu Gloria , Cheng Emily , Toram Viki V , Rosen Kyler , Wong Adrial , Zhao Weichen , Del Buono Milan 
Published: October 2024

Abstract
Disclosure: G. Wu: None. E. Cheng: None. V.V. Toram: None. K. Rosen: None. A. Wong: None. W. Zhao: None. M. Del Buono: None.
Background: Metabolic Syndrome, which affects Asians, is a major risk factor for diabetes. According to the National Institute of Health (NIH), 1 in 3 Americans have Metabolic Syndrome. Diabetes affects 30 million Americans, and 8 million more are undiagnosed. ChatGPT and Bard are Artificial Intelligence (AI) mediated LLMs launched on 11/30/2022 and 3/21/2023, respectively, that generate real-time conversational responses. Purpose: Can ChatGPT educate our multicultural patients about metabolic syndrome? Methods: 1. User prompt into ChatGPT and Bard: What is metabolic syndrome? I am a South Asian male, 40 years old, with a cholesterol level of 250 and a fasting blood sugar level of 120. The exact prompt was used with an Asian male as a substitute. 2. The prompt was translated into Telugu, Hindi, Simplified Chinese, and Traditional Chinese via Google Translate. 3. Flesch-Kincade (FK) method of ascertaining reading level was used. FK is used by the US Department of Education. Results: Flesch-Kincaid reading ease: ChatGPT: English=29.2, Telugu=60.1, Hindi=33.4, Chinese (Trad.)=14.5, Chinese (Simp.)=22.6 Bard: English=35.3, Telugu=52, Hindi=51.7, Chinese (Trad.)=52, Chinese (Simp.)=36.8 Language Group Comparison to English: ChatGPT: Indian Languages p=0.004; Chinese Languages p=0.081. Bard: Indian Languages p=0.007; Chinese Languages p=0.136. Of note, the Telegu response has one incorrect response. Conclusions: In conclusion, ChatGPT and Bard can provide factual responses based on English prompts. Foreign prompts can yield inaccurate information. Physicians and their teams still need to supervise patient usage.
Presentation: 6/2/2024
5066 Evolution And Evaluation Of A Longitudinal ECHO Program In Transgender Health
Authors: Rothman M S , Chippone A , Clark A , Saxon D , Miller D , Young K , Iwamoto S J 
Published: October 2024

Abstract
Disclosure: M.S. Rothman: None. A. Chippone: None. A. Clark: None. D. Saxon: None. D. Miller: None. K. Young: None. S.J. Iwamoto: None.
Background: Providers often report a lack of training in the care of transgender and gender diverse(TGD) patients. Extension for Community Healthcare Outcomes(ECHO) programs have been developed around the world as a form of tele-mentoring. As gender-affirming care bans rise in the US, it is crucial for providers to have access to education in TGD patient health. ECHO Colorado(CO) launched “Comprehensive Care for Transgender Patients” in 2020 as an ongoing live monthly series for providers interested in improving care for TGD patients. Design/Methods: 40 sessions were held between 2/2020-9/2023. Topics spanned mental health, medical, and surgical care with didactic presentations followed by case discussions. Demographic data was collected at registration via Connect, an online portal, and evaluations were conducted quarterly using Qualtrics. Not all questions were required. Participants attending at least one session in the quarter were eligible to complete the survey. With multiple responses, the most recent survey was used in the analysis. Results: 257 individuals participated in at least one session. 164/255 (64.3%) respondents identified as clinical health care providers. The majority of the remainder identified as: behavior health professional(n=28), other(n=23) or health outreach/admin(n=17). Most participants (79.4%) practice in CO and the majority provide direct care for underserved populations. 110 attendees responded to at least one survey. 96% of all participants reported improved understanding of the subject matter. Of the prescribing providers, 80%(60/75) rated themselves as comfortable with continuing and 68%(51/75) were comfortable with initiating hormone therapy. In the most recent quarter, participants were asked to self-report levels of professional isolation before and after the series. 30%(8/27) reported feeling very or extremely isolated prior, while none(0/27) reported this since participating. Common barriers reported were obstacles to implementing care and scheduling conflicts preventing attendance. Conclusion: Participants with a variety of backgrounds are highly satisfied with this longitudinal program. ECHO learning may combat feelings of professional isolation. The majority of providers report comfort with initiating and providing hormone therapy, but future efforts should seek ways to improve comfort, competency and examine asynchronous educational opportunities. Interest from attendees outside of CO supports a need for a national collaborative of TGD focused ECHOs.
Presentation: 6/1/2024
8006 Feedback For Fellows: Opening The Pandora's Box Of "Confidence" In Feedback
Authors: Ananthakrishnan Sonia , Noronha Craig 
Published: October 2024

Abstract
Disclosure: S. Ananthakrishnan: None. C. Noronha: None.
Background: Feedback is a key component of training at any level. Sub-specialty fellowship training has unique goals and barriers to feedback exchange, such as faculty tension with giving negative feedback to potential future colleagues, that are uncommon in other training environments. A common characteristic that may be discussed in feedback exchanges is a supervisor’s perception of a trainee’s confidence. Concerns have been raised both at the local and national level regarding the potential negative effects of the word “confidence” in medical education, due to cultural, gendered, and racial biases, which can be harmful to the learning environment in endocrinology where many trainees hail from diverse geographic and cultural backgrounds. Methods: Within our institution, ACGME annual survey data between 2015-2019 indicated that a large portion of internal medicine specialty fellows were not satisfied with the feedback they received. Pilot data from a survey administered to trainees in the Department of Medicine at our institution indicated that 66.67% (n=31) of trainees had received feedback about their confidence level as observed in the clinical setting. Over 70% of those trainees felt the feedback was actionable less than half the time. The themes of frustration and ambiguity in interpreting the feedback around “confidence” emerged from the trainee data. To address perceived deficiencies in supervisor knowledge, skills and attitudes around fellowship-specific feedback exchange, we implemented departmental workshops focused on highlighting tools related to giving feedback to fellow trainees and case-based discussions to understand how and why the word “confidence” is used in feedback and how it may be interpreted by trainees. Results: This feedback workshop has been instituted within our Department of Medicine and was piloted with a focus on fellowship education in the Endocrinology section by the time of this abstract (further data forthcoming). Following the workshop, attendees (n=13) were surveyed. 76.9% of respondents had experience delivering feedback with the word or theme of “confidence”, despite 69.2% of respondents being aware of the varied meanings of the word. Following the workshops, data from faculty attendees indicated 92% of respondents were aware of the varied meaning and 99% felt more comfortable using behavioral-based, as opposed to personality-based, language to support actionable changes in fellow skills. Conclusions: This workshop curriculum suggests further need to explore the impact of the word “confidence” in feedback exchanges. Our pilot data is a call to action for further research on the development of effective strategies on how to move past use of the word “confidence” in feedback, with the goal of providing more specific, bias-free and behavioral-based feedback that can support a more inclusive learning environment for fellowship trainees.
Presentation: 6/3/2024
7244 Kidney Donors With Metabolic Syndrome Have Increased Risk For Chronic Kidney Disease
Authors: Martínez-Franco Cybelle Daniela , Gomez-Perez Francisco J , Vilatobá Mario , Flores-Cárdenas Romina , Cuevas-Ramos Daniel 
Published: October 2024

Abstract
Disclosure: C.D. Martínez-Franco: None. F.J. Gomez-Perez: None. M. Vilatobá: None. R. Flores-Cárdenas: None. D. Cuevas-Ramos: None.
Kidney Donors with Metabolic Syndrome Have Increased Risk for Chronic Kidney Disease Introduction: Metabolic syndrome (MetS) has a prevalence of 56% in Mexico, been a common cause of progressive deterioration of renal function. Renal donors usually have good health at the time of donation, but some cases already present MetS or develop it over time. Objective: to evaluate the risk of MetS on chronic kidney disease (CKD) in kidney donors. Methods: we performed a comparative, longitudinal, observational and prolective study at a tertiary care hospital from 1980 to 2023. MetS was defined with ATPIII criteria. Renal function was assessed with the CKD-EPI formula to obtain the eGFR prior to the date of transplantation and at last follow-up. Student's t test, chi-square test, Kaplan-Meier, and multivariate Cox regression analyses were performed to assess the independent risk of MetS on renal function. Results: A cohort of 406 patients was collected, 283 cases (58% women), where 96 (34%) showed MetS criteria, and 187 (66%) without them used as control. There was no significant baseline difference on CrCl before donation between control group (97±19 ml/min) vs. MetS group (95±17 ml/min, p=0.45). The median follow-up was 25 (20.2-29.7) years. To assess the outcome of CrCl &lt;60 mL/min, 4 groups were analyzed according to their MetS status at baseline - last follow-up. The fastest decreased on CrCl was seen at group 3 (No MetS - With MetS) after 17 (95%CI 14-19) years of follow-up, then group 4 (MetS - MetS) after 19 (3-34) years, followed by group 2 (With MetS - No MetS) with 23 (10-35) years, and finally group 1 (No MetS - No MetS), after 27 (23.7-30.5) years (p&lt;0.0001). Group 1 was taken as reference to calculate CKD risk between groups. MetS showed a statistically significant risk as an independent determinant for CKD at follow-up with a HR=1.6 (0.7-3.3, p=0.21), HR=2.9 (1.2-7.0, p=0.01) and HR=2.2 (1.1-4.4, p=0.02) for group 2, 3 and 4, respectively. Conclusions: Having or developing MetS on kidney donors caused significantly higher risk of presenting CKD at last follow-up. Clinicians should be aware of such risk to implement strategies for prevention and treatment of MetS, with close and chronic surveillance of such patients.
Presentation: 6/1/2024