bluuebunny/crossref_metadata_2025_split huggingface dataset:
8261 Achievement of Diabetes Treatment Goals in Mexico from 2016 to 2022
Authors: Garcia Daniel Ramirez , Fermin Martinez Carlos Alberto , Mendez Labra Padme Nailea , Antonio Villa Neftali Eduardo , Seiglie Jacqueline A , Bello-Chavolla Omar Yaxmehen 
Published: October 2024

Abstract
Disclosure: D. Ramirez Garcia: None. C.A. Fermin Martinez: None. P.N. Mendez Labra: None. N.E. Antonio Villa: None. J.A. Seiglie: None. O.Y. Bello-Chavolla: None.
Background: Optimal diabetes care involves achieving goals with treatment in key metabolic parameters including HbA1c, blood pressure (BP), low density lipoprotein cholesterol (LDL-C) levels, and smoking cessation. Evaluation of diabetes care in Mexico has been incomplete, with previous studies focusing primarily on glycemic control, but not on a comprehensive analysis of combined treatment targets. Objective: To estimate achievement of diabetes treatment goals (HbA1c [A], BP [B], LDL-C [C], smoking cessation [N], and combined targets [AB, BC, AC, ABC, ABCN]) using data from nationally representative surveys from 2016-2022 among individuals with diagnosed diabetes in Mexico. Methods: We analyzed serial cross-sectional National Health and Nutrition Surveys from 2016-2022. A total of 2,689 adults with diagnosed diabetes ≥20 years were identified amongst 21,248 adults ≥20 years. Weighted prevalence estimates were obtained for glycemic control (HbA1c &lt;7% in those &lt;65 years, and &lt;7.5% in those ≥65 years), BP control (&lt;130/80 mmHg), LDL-C control (&lt;70 mg/dL), smoking cessation, and combined targets. We also fitted logistic regression models to estimate the odds of achieving treatment targets according to age, sex, educational level, indigenous identity, and survey cycle. Results: In 2022, the prevalence of HbA1c, BP, and LDL-C control among individuals with diagnosed diabetes in Mexico was 41.2% (95% CI 30.5-52.0%), 46.0% (95% CI 36.5-55.5%), and 17% (95% CI 10.2-25.2%), respectively. Non-smoking prevalence was 92.4% (95% CI 88.6-96.2%). Combined target achievement was low, with a prevalence of 10.8% (95%CI 6.2-15.5%) for BC and 4% (95% CI 1.7-6.3%) for ABCN. The proportion of goal achievement was relatively stable across 2016-2022 for every parameter analyzed, except for LDL-C. LDL-C had the lowest proportion of control across all cycles, although a gradual increase was observed: 8.1% (95% CI 4-12.3%) in 2016 to 17% (95% CI 10.2-25.2%) in 2022. The increase in LDL-C control coincides with greater prevalence of statin use across survey cycles. Men had lower odds of achieving ABCN combined control (OR 0.49, 95%CI 0.45-0.54) than women. Similarly, compared with individuals &lt;45 years, participants 45-64 years (OR 0.36, 95%CI 0.32-0.40) and ≥65 years (OR 0.41 95%CI 0.35-0.47) had lower odds of achieving composite control. Conclusions: Achievement of diabetes treatment goals in Mexico is suboptimal. Less than half of individuals with diagnosed diabetes achieve HbA1c or BP goals, less than a fifth achieve LDL-C control, and only 1 in 20 individuals achieve ABCN control. Greater efforts are needed to the improve the comprehensive care of individuals with diabetes in Mexico.
Presentation: 6/3/2024
7643 Acute blindness due to Metformin associated lactic acidosis
Authors: Pereira K N , Desai K , Khan T , Yong S 
Published: October 2024

Abstract
Disclosure: K.N. Pereira: None. K. Desai: None. T. Khan: None. S. Yong: None.
Metformin, one of the most commonly prescribed oral hypoglycemic agents, effectively lowers basal and postprandial blood glucose. However, Metformin carries a black box warning for lactic acidosis, which is more common in setting of liver and kidney dysfunction. With an incidence rate of ∼ 4.3 cases per 100,000 patient-years, Metformin associated lactic acidosis (MALA) can present with nausea, vomiting, diarrhea, encephalopathy, hypothermia, respiratory failure and hypotension. Blindness is a rarely reported outcome of MALA. We present a case of a 48 year old intellectually disabled female with a history of type 2 diabetes (on Metformin) who presented with progressive encephalopathy insetting of intractable nausea and vomiting with poor oral intake, since starting lisinopril & rosuvastatin for newly diagnosed hypertension and hyperlipidemia. She was encephalopathic, hypothermic, hypotensive, tachycardic and tachypneic. Labs were notable for leukocytosis, AKI, hyperkalemia, elevated anion gap metabolic acidosis with a lactate of 13.6 and elevated lipase. She also tested positive for Influenza A. CT head showed no acute intracranial abnormality. CT chest, abdomen & pelvis was concerning for aspiration, multifocal pneumonia or a combination of both as well as acute interstitial pancreatitis. She was admitted to the ICU for further management including hemodialysis. She continued to have improving but persistent lactic acidosis despite multiple dialysis sessions. On day 5 of ICU stay, with resolution of her encephalopathy, she reported new onset complete bilateral painless vision loss. General eye and neurologic exam was unrevealing except for sluggishly reactive pupils to light. MRI brain showed an new acute 2 mm lacunar infarct in the right temporal lobe. Neurology ruled out stroke as the cause for her vision loss. Emergent ophthalmology evaluation revealed no retinopathy, macular edema, acute glaucoma or thromboembolic event. The new onset vision loss was suspected to be due to MALA due to persistent metabolic disturbances. Some animal studies have shown that retinal horizontal cells are sensitive to low pH, resulting in interruption of signal transmission to the visual neurons and consequent blindness. The presence of factors like metformin metabolites may contribute to impaired function of retinal cells.On extensive literature review it was noted that only 5 cases of vision loss associated with MALA have been reported. However, in these cases, vision loss was transient and reversed following correction of acidosis with dialysis. Our case highlights a rare consequence of MALA, which can be irreversible and cause lifelong disability.
Presentation: 6/1/2024
8503 Analyzing Prescription Practices for Back-up Insulin and Glucagon in Type 1 Diabetes Patients Using Insulin Pumps: Findings From Cleveland Clinic
Authors: Iqbal Anira , Ambalavanan Jayachidambaram , Alkwatli Kenda , Rao Pratibha P R 
Published: October 2024

Abstract
Disclosure: A. Iqbal: None. J. Ambalavanan: None. K. Alkwatli: None. P.P. Rao: None.
Background: It is estimated that about 400,000 patients with type 1 diabetes (T1D) in the U.S. are using insulin pumps1. This number has been steadily increasing with expanding insurance coverage and newer, more convenient, user-friendly technology. Though these devices remarkably improve patients’ glycemic control, failure of these pumps, due to reasons such as clogging or kinking of tubing, air bubbles, pump display issues, site reaction/infection, is a frequently encountered problem. During these events, having a backup plan in the form of injectable insulin is essential to prevent severe hyperglycemia and diabetic ketoacidosis (DKA). Increasing insulin pump use also predisposes patients to severe hypoglycemia. In these cases, at-home glucagon administration can be lifesaving. Methods: Using the EPIC Cogito extracts and reporting service, data was extracted for adult patients seen at the Cleveland Clinic main campus between January 1, 2021, to January 1, 2023, using ICD codes for T1D and insulin pump status. Data collected included age, sex, prescription status for basal insulin, type of basal insulin, glucagon prescription, and current medication list.ResultsWe were able to analyze 86 patients (67% females, n=58; 33% male, n=28) with T1D utilizing an insulin pump. The average age was 48.6+18.18 years. Of the 86 patients, 51 (59%) had prescriptions for long-acting backup insulin. Only 21 patients (24%) had a prescription for glucagon. Discussion: Insulin pump failure is one of the most common causes of DKA in patients with T1D2. Educating patients on the use of long-acting injectable insulin in the event of pump failure and ensuring active prescription for every patient using an insulin pump at each visit can decrease the risk of DKA and prevent hospitalizations. Similarly, the use of a continuous subcutaneous insulin infusion (CSII) puts patients at high risk of hypoglycemia. Per Standards of Care in Diabetes 2024, glucagon should be prescribed in all patients using insulin3. Our analysis reveals that the practice of prescribing backup insulin and glucagon at Cleveland Clinic Institute needs significant improvement to potentially prevent DKA and severe hypoglycemia requiring hospitalization. References: 1Umpierrez GE, Klonoff DC. Diabetes Technology Update: Use of Insulin Pumps and Continuous GlucoseMonitoring in the Hospital. Diabetes Care. 2018 Aug;41(8):1579-1589. 2Doyle EA, Weinzimer SA, Tamborlane W. DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice. Sci Diabetes Self Manag Care. 2022. 3American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111-S125.
Presentation: 6/1/2024
7456 Artifactual Hypoglycemia Leading To the Diagnosis of Monoclonal Gammopathy
Authors: Ha L T , Maximous M , LaValley C K , Lado J 
Published: October 2024

Abstract
Disclosure: L.T. Ha: None. M. Maximous: None. C.K. LaValley: None. J. Lado: None.
Background: Low glucose readings in the absence of classic hypoglycemic symptoms are not unusual, especially among diabetic patients with unaware hypoglycemia. Discrepant measurements between capillary and venous blood are well-described, mostly due to poor reagent quality or circulatory deficits causing interference with the former. Less commonly, monoclonal gammopathies have been observed to cause true or artifactual hypoglycemia in venous blood sampling related to the presence of insulin antibodies or interference with chemistry assays, respectively. Because this interference is rare and occurs unpredictably with different testing modalities, detection is challenging and often preceded by extensive workup for underlying causes of true hypoglycemia. Clinical Case: A 69-year-old man with Parkinson’s disease, hypertension, dyslipidemia, chronic kidney disease stage 3, and obesity was referred to us for evaluation of hypoglycemia. His fasting venous glucose was consistently measured as undetectable (&lt;10 mg/dl) on serial routine bloodwork (using the hexokinase method on Beckman-Coulter AU 5800 analyzer). He remained asymptomatic, with normal home and in-office fasting fingerstick levels. A thorough medication review did not reveal a clear etiology for this recurrent hypoglycemia. Initial workup by his primary care physician was notable for elevated total protein of 9.0 g/dl (n 6.1-8.1 g/dl), elevated globulin of 4.5 g/dl (n 1.9-3.7 g/dl), and elevated erythrocyte sedimentation rate of 111 mm/h (n&lt;20 mm/h). Hemoglobin A1c, proinsulin, beta-hydroxybutyrate, insulin, and C-peptide were within normal range. On repeat evaluation at our institution (using the hexokinase method on Roche cobas 8000 c702 analyzer), his sample was flagged for a high lipemic index but displayed no evidence of lipemia upon visual inspection, suspicious for paraprotein presence. Protein electrophoresis was performed on the same plasma sample, revealing hypergammaglobulinemia (1.5 g/dl) subsequently characterized by serum immunofixation as a monoclonal IgM kappa. Conclusion: Recurrent “hypoglycemia” in an asymptomatic patient without other metabolic abnormalities should prompt clinicians to consider etiologies of falsely measured low glucose, including hyperleukocytosis, prolonged specimen delivery time, and paraproteinemia. In the appropriate clinical context, such as an elevated serum or plasma lipemic index, these cases should be further investigated with protein electrophoresis to rule out an underlying gammopathy. As the hexokinase method relies on optical parameters susceptible to interference by paraprotein-induced turbidity, an alternative sampling device utilizing amperometry (point-of-care glucometer or blood gas analyzers) may be employed to differentiate between true hypoglycemia as a rare complication of monoclonal gammopathy versus laboratory artifact.
Presentation: 6/1/2024
9232 Assessing the Risk of Recurrence in Acute Pancreatitis Among Patients with Type 2 Diabetes Initiating GLP-1 Receptor Agonists Therapy
Authors: Nassar Mahmoud , Abosheaishaa Hazem , Dandona Paresh , Ghanim Husam , Chaudhuri Ajay 
Published: October 2024

Abstract
Disclosure: M. Nassar: None. H. Abosheaishaa: None. P. Dandona: None. H. Ghanim: None. A. Chaudhuri: None.
Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recognized therapeutic agents for patients with type 2 diabetes mellitus and obesity. However, due to concerns about pancreatitis, clinicians do not recommend these agents for patients with a history of pancreatitis. Existing research presents conflicting evidence about this association. Our primary aim was to evaluate the risk of recurrence of acute pancreatitis (AP) associated with initiating GLP-1 RAs in patients with a history of AP. Methods: Our retrospective cohort study deployed the TriNetX platform, leveraging a large dataset from 106 healthcare organizations and approximately 127 million patients across 15 countries. We obtained data specific to our research on September 21, 2023. Using the ICD-10-CM code, we identified groups of adults with AP. We investigated the effect of GLP-1 RA vs. SGLT2i, DPP4i, and no medication (GLP-1 RA, SGLT2i, and DPP4i) on the recurrence of AP within 5 years of starting treatment. We ensured comparability between cohorts by employing propensity score matching, which focused on critical variables such as age, gender, body mass index (BMI), cholelithiasis, tobacco use, serum triglyceride, and HbA1c levels. Results: We matched the GLP-1 and SGLT2i cohorts, which initially had 4,680 and 7,212 patients, respectively, down to 3,926 in each group. Similarly, the GLP-1 vs. DPP4i comparison matched both cohorts to 3,324 patients from initial counts of 4,680 and 5,723 patients. In the matched cohorts, the GLP-1 group showed a lower AP recurrence risk (15.2%) than the SGLT2i group (24%). This difference was significant (-8.9%, 95% CI: -0.106, -0.071), with a notable risk ratio of 0.630 and an odds ratio of 0.564. For the GLP-1 vs. DPP4i comparison, the GLP-1 group's AP recurrence risk was 14.4%, lower than the 23.3% in the DPP4i group. This difference (-8.9%, 95% CI: -0.108 to -0.071) was also significant, with a risk ratio of 0.616 and an odds ratio of 0.552. For the GLP-1 vs. no medication (GLP-1RA, DPP4i, and SGLT2i) comparison, the GLP-1 group's AP recurrence risk was 14.5%, lower than the 51.6% in the comparison group. This difference (-37.1%, 95% CI: -0.388 to -0.353) was also significant, with a risk ratio of 0.282 and an odds ratio of 0.16. Conclusion: Our research showed that starting GLP-1 RA therapy in people who have had a history of AP does not increase and may potentially lower the risk of recurrence of AP than starting SGLT2i or DPP4i therapy and no medication group. These findings highlight the potential of GLP-1 RA therapy as a safer therapeutic option in this patient population, which requires further investigation.
Presentation: 6/1/2024
7201 Association of Chronotype and Glycemic Control Among Patients with Diabetes Mellitus: A Single Center Study
Authors: Nunez Noemi Angela D , Dampil Oliver Allan C , Ong Lopez Albert Macaire C 
Published: October 2024

Abstract
Disclosure: N.D. Nunez: None. O.C. Dampil: None. A.C. Ong Lopez: None.
Chronotype preference is an emerging risk factor to the development of diabetes mellitus and poor glycemic outcomes. This study aims to determine the association of chronotype based on the Munich Chronotype questionnaire among patients with diabetes mellitus and their level of glycemic control. This is a cross sectional analytical research study conducted at the outpatient department at St. Luke’s Medical Center Quezon City from June 1 to October 31, 2023. Inclusion criteria were adults above 18 years of age who were diagnosed with diabetes, and on oral hypoglycemic medication and/or insulin therapy for at least 6 months. Excluded were those with diagnosed sleep wake disorders, obstructive sleep apnea, pregnant or lactating women, night-shift workers, and those on medications that affect sleep patterns. Among the 290 participants evaluated, majority had early chronotypes (n=250) compared to late chronotypes (n=40). There was no statistical difference between the two groups in terms of the demographic, clinical and laboratory data. Chi-square was done to compare the groups in terms of HBA1c level, and the result was not significant (p=0.3124), indicating that the early and late chronotype groups have the same likelihood of having controlled or uncontrolled HBA1c. The Breslow-day test for homogeneity of odds ratio was done to compare the groups in terms of HBA1c level and use of two or more oral medications and insulin, and the result was not significant (p=0.9281), indicating that the relationship between Hba1c level and use of two or more oral medications and insulin is relatively the same for both chronotypes. In conclusion, there appears to be no influence of chronotype on glycemic control among diabetes mellitus treated Filipino patients.
Presentation: 6/3/2024
8152 Benefits of Inpatient Diabetes Management by a Specialized Diabetes Team
Authors: Bojarian M , Ohri A , Buettner C 
Published: October 2024

Abstract
Disclosure: M. Bojarian: None. A. Ohri: None. C. Buettner: None.
Background: Inpatient dysglycemia is associated with poor clinical outcomes such as prolonged length of stay (LOS), increased risk of ICU admission, and in-hospital mortality. The benefits of managing diabetic patients in the hospital with a dedicated diabetes team, as opposed to standard care on episodes of hypoglycemia or hyperglycemia, reduction in LOS, and 30-day readmission rates, remain uncertain. A potential confounder is the likelihood that patients receiving a diabetes consult may be sicker than those without a consult. Given the growing evidence supporting the role of specialized diabetes teams in improving care for diabetes patients, we sought to examine these benefits at our hospital. We plan to address confounding variables through propensity score matching. Objective: To assess whether diabetes patients experience reduced LOS, hypoglycemia, hyperglycemia, and 30-day readmission rates when managed by a specialized diabetes team compared to inpatients managed by a hospitalist team. Material and Methods: This quality improvement study compared LOS, hypoglycemia (glucose &lt;70 mg/dL), hyperglycemia (glucose &gt;180 mg/dL), and 30-day readmission rates in diabetes patients managed by a specialized diabetes team versus a hospitalist team at our hospital between June 2022 and December 2022. Results: 5676 patients with diabetes were admitted between June and December 2022 at our hospital, and a specialized diabetes team managed 417 patients (7.34%). In a preliminary analysis in which no propensity matching was performed yet, the 30-day readmission rate was significantly lower (87,16.6%) in patients who received a diabetes consult compared to patients who did not receive a diabetes consult (320,17.9%). The rate of hypoglycemia was higher (24.4%) in the specialized diabetes consult group than in the non-diabetes consults group (19.9%). Additionally, LOS was longer in patients with a specialized diabetes consult (7.1 vs. 3.1 days), and hyperglycemia (glucose &gt;180 mg/dL) was more prevalent in the specialized diabetes consult group (78.9%) compared to the non-diabetes consult group (39.2%). Conclusion: In this retrospective analysis, patients managed by a specialized diabetes team showed lower readmission rates despite longer hospitalization and increased dysglycemic episodes. This could be attributed to sicker patients receiving diabetes consults, influencing dysglycemia rates. To account for such confounders, ongoing propensity score matching aims to provide a clearer understanding. Reduced readmission rates suggest improved care transitions, potentially resulting in significant cost savings for the healthcare system.
Presentation: 6/1/2024
7481 Beyond the Operation Room: A Retrospective Study on Diabetes and Post-Operative Hyperglycemia Outcomes
Authors: Aron Polina , Zaihra Rizvi Tasneem , Hodge Mary Beth , Jean Karen St , Upadhyay Jagriti 
Published: October 2024

Abstract
Disclosure: P. Aron: None. T. Zaihra Rizvi: None. M. Hodge: None. J. Upadhyay: None.
Introduction: Optimal, evidence based intraoperative and postoperative glycemic management may reduce poor surgical outcomes. Research design: This is a retrospective study from a single center to estimate quality gaps in perioperative glycemic management in patients with diabetes undergoing major surgery requiring general anesthesia between Oct 2022 and Dec 2022. Study Cohort: Patients &gt; 18 years old, who underwent major surgery (&gt;3 hrs) under general anesthesia, had diabetes mellitus based on Hba1c &gt; 6.5% within last 1 year or as listed diagnosisThis is an ongoing study. We have currently looked at 79 patients of which 61 were in the hyperglycemic group (glucose &gt; 180 mg/dL) and 18 in normoglycemic group (glucose &lt; 180mg/dL) post-operatively. Methods: Baseline characteristics, perioperative outcomes, and operative details between the hyperglycemic and normoglycemic groups were compared using Kruskal-Wallis's rank sum test for continuous variables and χ2 or Fisher's exact tests using categorical variables. Results: Patients who were found to have hyperglycemia in the first 24 hours after surgery had a higher preop A1c of 7.4% vs 6.7% in the normoglycemia group (p-value = 0.047). They also had a higher BMI of 32 as compared to 30 respectively and a reduced GFR of 60 vs 73 in the normoglycemic group (P=0.069). 24 hours leading into surgery, the hyperglycemia group had a high average glucose of 196 mg/dL as compared to 135 mg/dL (p-value = 0.001). During the intraoperative period which lasted on average of 350 minutes (5.5 hours) there was an average glucose check of 3.2 times averaging 221 mg/dL for the hyperglycemia group compared to 2.2times averaging 174 mg/dL (P = 0.017). 62% of patients with intraoperative hyperglycemia DIDNOT receive IV insulin treatment in the hyperglycemic group. Steroid use was equal in both groups. 24 hours after surgery, patients in the hyperglycemia group had an average glucose reading of 252 mg/dL compared to 145 mg/dL in the normoglycemia group (P &lt; 0.001).Endocrinology was not consulted in 87% of patients with hyperglycemia. Looking at our endpoints, readmission rate was 23% in the hyperglycemia group as opposed to 11% in normoglycemia. There were 4 patients who had a 90-day mortality from the hyperglycemia group compared to no patients in normoglycemia. 37% of patients had post-op complications in the hyperglycemia vs 22% in the euglycemia group (P 0.269). The hospital stay was the same for both groups averaging 8 days. Conclusions: Intraoperative hyperglycemia leads to poor outcomes. Formulating policy around insulin administration, frequency and monitoring of blood sugars during major surgeries and endocrine consultation in patients with Type 2 DM can achieve better glycemic management and postoperative outcomes.
Presentation: 6/2/2024