bluuebunny/crossref_metadata_2025_split huggingface dataset:
1058-P: The Relationship between Health Insurance Coverage and Clinical Outcomes among People with Diabetes in Saudi Arabia
Authors: AL-SOFIANI MOHAMMED , ALZAMIL YARA 
Published: June 2024

Objectives: &lt;u&gt;&lt;/u&gt;To study the relationship between social determinants of health (SDH), including health insurance status; accessibility to novel diabetes medications and technology; and health outcomes in people with diabetes (PWD).
Methods: A retrospective analysis of data from 311 PWD, who visited the same endocrinologist at either his public clinic (King Saud University) or private clinic (AlHabib Group) between Nov 2021 & Nov 2022 in Saudi. Metrics of glycemic control, cardiometabolic health, and utilization of diabetes medications and technology were compared by health insurance status.
Results: The median (IQR) age of the study participants was 40 (24, 60) years. Of them, 40.2% were insured. Most insured PWD (85.60%) were seen at the private clinic; and 97.85% of uninsured PWD were seen at the public clinic. Use of GLP-1 RA, SGLT-2 inhibitors, and combined diabetes medications were more prevalent among insured PWD (21.6%, 18.4%, and 15.2%, respectively) than uninsured PWD (8.60%, 5.38%, and 2.15%, respectively, all p&lt;0.01). The insured group had a higher proportion of PWD with A1C of ≤8% compared to the uninsured group (64.66% vs 31.84%, respectively, p&lt;0.01). Being insured was associated with greater odds of achieving an A1C of ≤8% [OR (95% CI): 6.07 (1.85, 19.91)] after adjusting for potential confounders, including sociodemographics, select SDH, and utilization of novel diabetes medications and technology. Among the 163 people with type 1 diabetes (PWT1D), use of insulin pumps was more common in insured versus uninsured PWT1D (28.57% vs 2.80%, respectively, p&lt;0.01). The use of insulin pump was associated with greater odds of achieving an A1c of ≤8% in PWT1D [OR (95% CI): 4.28 (1.44, 12.72)].
Conclusion: Social determinants of health, including health insurance, play a key role in determining the health outcomes of PWD in Saudi. Differences in health outcomes by insurance status are likely driven by differences in availability of healthcare resources and other SDHs

Disclosure
M. Al-Sofiani: Consultant; Eli Lilly and Company. Speaker's Bureau; Medtronic, Insulet Corporation, Abbott, Sanofi. Consultant; Medtronic. Y. Alzamil: None.
1067-P: Neural Network to Identifying Type 2 Diabetes (T2D) Progression Subphenotypes
Authors: HUANG YU , FAN ZHENGKANG , DONAHOO WILLIAM T. , GUO JINGCHUAN , BIAN JIANG 
Published: June 2024

T2D is a heterogeneous disease with variations in presentation, progression, and response to treatments across individuals. We developed a novel GNN-based framework to identify distinct T2D progression pathways using electronic health records (EHR) data.We identified T2D patients using 2015-2020 EHR data from the University of Florida Health System. We extracted (1) demographics, labs, medications, and comorbidities; and (2) social determinants of health via natural language processing from clinical notes. Our novel GNN-based framework, including: (1) modeling T2D progression graphs based on the encounters in longitudinal EHRs, (2) learning outcome-oriented (i.e., glycemic control via HbA1c over time) latent T2D progression representations, and (3) learning T2D progression subphenotypes using Hierarchical Clustering algorithm.Of the 2,415 T2D patients, mean age was 59 (sd: 13) years, and 60 % were females. We identified 5 distincT2D progression subphenotypes (Figure, C1-C5). and they exhibited distinct sociodemographic and clinical characteristics. C1 had the slowest progression of T2D, with the lowest burden of hypertension. Compared to C1, C5 had a faster progression and suffered more from renal declines.C2 had the fastest progression, with the highest burden of obesity and neuropathy.Our GNN-based T2D progression subphenotypes may support precision treatment and disease management.

Disclosure
Y. Huang: None. Z. Fan: None. W.T. Donahoo: None. J. Guo: None. J. Bian: None.
1070-P: How Continuing Education (CE) Supported Guideline-Based Treatment among Patients with Obesity
Authors: ALLEN RUSSIE , WELCH LAUREN K. 
Published: June 2024

Goal: To determine whether learners in a 2023 CE initiative increased their use of approved and recommended pharmacotherapies compared to a control group of non-learners for the medical management of obesity
Methods: Med Learning Group (MLG) conducted 34 CE activities in 2023 as part of an educational initiative supported by an independent educational grant from Novo Nordisk. The education focused on diagnosis of obesity and the multidimensional management of patients with obesity who would benefit from evidence-based pharmacotherapies. Learners in each activity completed pre-/post-tests. MLG also provided identifying data on 11,119 learners (primary care physicians, cardiologists and advanced practitioners) to IQVIA, who then compared 11,084 of these learners to non-learners as a matched pair control. Control match criteria included geography, specialty, and prescribing behavior. IQVIA used claims data from pre- and post-education to identify change in the use of guideline recommended and evidence-based therapies for patients among learners compared to control.
Results: Learners achieved a 31% gain in ability to identify patients who would benefit from evidence-based pharmacotherapies on pre-/post-test questions (N=3952). Via the claims analysis, learners also demonstrated increased appropriate application of guideline-recommended therapies in practice, with incremental new prescriptions of recommended therapies increasing significantly among learners compared to the matched control group of non-learners. Learners selected 290,322 new guideline-recommended pharmacologic interventions for obesity in the study period. This is 11,189 more (new) guideline-recommended treatments than the control group (p=0.002).
Conclusion: Learners enhanced their use of guideline-recommended therapies post-education compared to carefully matched controls, demonstrating how CE can positively impact real-world medical practice.

Disclosure
R. Allen: None. L.K. Welch: None.

Funding
Novo Nordisk
1071-P: Association of Race and Ethnicity with Net Promoter Score and Hemoglobin A1c in a Virtual Diabetes Management Program
Authors: JOHNSON HOPE , LIN JENNY J.Y. , KUMMARI ANJANA , BONACA MARC P. , TIBBELS JASON , LOEHRER SARANYA 
Published: June 2024

Virtual solutions to chronic care management including care for diabetes mellitus hold promise for greater convenience, access, and scalability. Better understanding of the association of race and ethnicity on engagement, experience, and outcomes will offer opportunities to optimize health equity. Self-reported race and ethnicity was collected in the Teladoc Virtual Diabetes management program. Bayesian imputation was used to assign race and ethnicity where unreported. Rates of enrollment, net promoter score (NPS), and blood glucose measurements were systematically collected. The Nathan method was used to estimate HbA1c which includes at least 14 blood glucose readings within a 90-day period. Changes in HbA1c were adjusted for baseline. A total of 530,222 participants enrolled were available for analysis with race/ethnicity available in 444,716 (84%) after Bayesian imputation. Of those with available race/ethnicity, 70% were non-Hispanic white, 15% were Hispanic, 10% were black/African American, and 5% were American Indian, Alaskan Native, or Asian Pacific Islander. Overall enrollment was similar across groups. The proportion reporting a positive NPS was numerically higher in patients reporting as Hispanic, Black/African American, or Asian Pacific Islander. Baseline hemoglobin A1C was ~8.5% and similar by Race/Ethnicity. Over a 90-day period, A1C was observed to be lower in all groups and with the greatest numerical change in those reporting as Asian Pacific Islanders followed by Black/African American. In a virtual diabetes management program including 530,222 participants, 70% were non-Hispanic white. Participants had similar rates of enrollment and similar baseline HbA1C measures across reported race/ethnicity. Differences in Net Promoter Score and change in HbA1C were observed by race/ethnicity. These results highlight the importance of considering race/ethnicity in the design and content of virtual programs.

Disclosure
H. Johnson: None. J.J.Y. Lin: None. A. Kummari: None. M.P. Bonaca: Other Relationship; CPC Clinical Research. J. Tibbels: Employee; Teladoc Health. S. Loehrer: None.
1128-P: Diabetes and Cardiovascular Disease Hospital Recognition Program Associated with Rapid Improvement in Guideline-Directed Medical Therapy
Authors: FONAROW GREGG C. , SEDNEW RENEE M. , OVERTON KATHERINE , PRESSLEY BIANCA , CONGDON MICHELLE 
Published: June 2024

Background: Rapid implementation of guidelines is a challenge in health care. Recognition programs are a proven strategy to drive hospital performance. This analysis reviews guideline-directed utilization of sodium glucose cotransporter-2 (SGLT-2) and glucagon-like peptide-1 (GLP-1) therapies in eligible patients with diabetes hospitalized with heart failure (HF) or stroke, comparing the period when the measure was used for quality feedback only or quality feedback and award.
Methods: Hospitals participating in American Heart Association’s (AHA) Get With The Guidelines® (GWTG)-Stroke and GWTG-HF document guideline adherence, including appropriate prescribing of SGLT-2 or GLP-1 in patients with type 2 diabetes prior to discharge. AHA established Target: Type 2 Diabetes (TT2D) to recognize guideline adherence for diabetes and cardiovascular disease.
Results: While hospitals have been able to review performance of appropriate SGLT-2 or GLP-1 prescribing since TT2D launched, this measure was not part of award eligibility for the first 2 years of the program.

Conclusion: These findings show improvement from when the measure was used for quality feedback alone compared to use for recognition. Despite improvement, there remain significant opportunities to improve diabetes care and outcomes for patients hospitalized with diabetes along with HF or stroke.

Disclosure
G.C. Fonarow: None. R.M. Sednew: None. K. Overton: None. B. Pressley: None. M. Congdon: None.
1157-P: Facilitators, Attitudes, Barriers, and Behaviors (FABB) Related to Transition Diabetes Care in Emerging Adults
Authors: GLAROS SOPHIA B. , THOTA GEETHIKA P. , DIXON SYDNEY A. , CHOWDHURY ARUBA , DAVIS FAITH , KRENEK ANDREA , MALANDRINO NOEMI , MABUNDO LILIAN , MONAGHAN MAUREEN , CHUNG STEPHANIE T. 
Published: June 2024

Introduction & Objective: Emerging young adults (YA) with diabetes have unique needs but there is few data on transition readiness to guide clinical programs. We assessed transition readiness, mood, and behaviors in YA at a multi-disciplinary diabetes transition clinic.
Methods: Adults ≥18y&lt;30y with diabetes (78% youth-onset type 2 diabetes, 11% type 1 diabetes, 11% other) at a single center were invited at their initial visit to complete Endocrine Society “Self-assessment of Worries, Concerns, and Burdens Related to Diabetes and Transitioning”, Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) forms to assess transition readiness, depressive mood, and anxiety.
Results: In 37 YA (20.6±2.7y, 60% female, 58% Black, BMI:35.8±8.9 kg/m2, hemoglobin A1c 7.4±2.4%), 81% reported adequate diabetes knowledge. One in 4 YA had diabetes-related challenges (Table). PHQ-9 scores were &gt;9 (moderate depression) in 27%; 50% had anxiety causing difficulty with activities of daily living. Transition or PHQ-9 scores did not differ by diagnosis or sex. Black YA had the lowest GAD scores (P=0.01). There were no relationships between transition scores with PHQ-9, GAD-7, or HbA1c.
Conclusion: YA reported adequate diabetes knowledge, but high rates of diabetes burdens distinct from mood symptoms. Social and supportive care resources are needed to improve transition care.

Disclosure
S.B. Glaros: None. G.P. Thota: None. S.A. Dixon: None. A. Chowdhury: None. F. Davis: None. A. Krenek: None. N. Malandrino: None. L. Mabundo: None. M. Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases. S.T. Chung: None.

Funding
Intramural Research Program of National Institute of Diabetes & Digestive & Kidney Diseases
1159-P: CGM Use in Adolescents and Young Adults with Type 2 Diabetes
Authors: FENSKE RACHEL , MANN ELIZABETH A. 
Published: June 2024

Introduction & Objective: There is a growing body of evidence supporting continuous glucose monitor (CGM) use in adults with Type 2 Diabetes (T2D), and recent evidence to suggest CGM use could also be beneficial to adolescents and young adults (AYA) with T2D. CGM use is presently limited in this population and a deeper assessment is needed to understand barriers to use. The objective of this study was to determine baseline CGM use in AYA with T2D cared for by the UW Health Pediatric Diabetes Clinic.
Methods: All individuals with T2D seen at least once by the UW Health Pediatric Diabetes Clinic since 2016 were included in this observational study. Electronic medical records were reviewed to collect pertinent demographic, laboratory, and diagnosis information, as well as, any documentation regarding barriers to receiving or using CGM. Parameters were compared between groups using t-test or nonparametric test, as appropriate.
Results: Of the AYA with T2D seen, 156 had complete information and were included. Per chart review, 17 of the 156 AYA were using CGM. There was no statistical difference in mean hemoglobin A1C at diagnosis between groups. When considering insurance coverage, 54% of those using CGM and 66% of those not using CGM reported having Medical Advantage (MA) or other managed plan. AYA with T2D reported various barriers to starting and using CGM including not wanting to wear something that would draw attention to themselves, prohibitive costs, and difficulty obtaining insurance coverage. Notably, for some AYA with T2D who were using CGM, the aforementioned issues continued after CGM initiation.
Conclusion: CGM use in AYA with T2D is limited for a variety of reasons. Understanding individual’s personal feelings around CGM will be helpful to determine how CGM use can be incorporated into their diabetes care. Insurance coverage of CGM for AYA with T2D was found to be variable. The role of CGM in the care and management of T2D in AYA continues to evolve; further exploration is needed to understand and address perceived barriers.

Disclosure
R. Fenske: None. E.A. Mann: None.
1160-P: Continuous Glucose Monitoring in Youth-Onset Type 2 Diabetes—Interim Results from Pilot Randomized Controlled 12-Week Trial
Authors: PATEL TEJAL , ESTRADA DORIS E. , MEYERS ABBY , MACKEY ELEANOR , CHUNG STEPHANIE T. 
Published: June 2024

Introduction: Continuous glucose monitors (CGM) may improve diabetes self-management in youth-onset type 2 diabetes (Y-T2D), but feasibility in Y-T2D on infrequent self-monitoring blood glucose (SMBG) regimens and device burden is unclear. This is an interim analysis of primary aims to assess CGM feasibility (recruitment &gt;60%) and acceptability (wear time &gt;60%) and explore diabetes burden and adverse events.
Methods: This is an active 12-week randomized 2:1, two arm parallel pilot trial of CGM vs fingerstick monitoring (Con) in Y-T2D prescribed SMBG &lt;3 times daily (not on multiple insulin injections). Diabetes distress was measured with Diabetes Distress and CGM benefit/burden scale.
Results: Between August-December 2023, recruitment rate was 60% [40 screened, 24 enrolled (14 CGM, 10 Con; 77% female, 69% Black, 14.9±3.8y, BMI: 36.2±7.7 kg/m2, HbA1c: 7.3± 2.6% (mean±SD))]. Most cited reasons for declining were reluctance to wear a device (31%) or study participation (25%). 45% (6 CGM, 5 Con) completed the study; one Con was lost to follow-up. Among CGM, wear time was 62% at 1st 6 weeks [n=11], 49% at 2nd 6 weeks [n=6], and 61% at 12 weeks [n=6], P=0.11. Among Con, blood glucoses were reported in 66% at 1st 6 weeks [n=6] and 20% at 12 weeks [n=5]. 75% of CGM users had sensors dislodged. Diabetes distress score did not change: CGM:1.8 ±0.9 to 1.3±0.1 and control: 1.2±0.2 to 1.2±0.1. No difference in mean CGM burden scale; 17±4.8 to ±7.6.
Conclusion: CGM use in Y-T2D may be feasible but device-related events were common. There is no increase in disease burden with technology use.

Disclosure
T. Patel: None. D.E. Estrada: None. A. Meyers: None. E. Mackey: None. S.T. Chung: None.

Funding
Endocrine Fellows Foundation 2023; Dexcom, Inc
1163-P: Type 2 Diabetes Remission Persists Ten Years after Adolescent Metabolic and Bariatric Surgery
Authors: SISLEY STEPHANIE , SHAH AMY S. , NADEAU KRISTEN J. , KELSEY MEGAN M. , COURCOULAS ANITA , MICHALSKY MARC , JENKINS TODD M. , RYDER JUSTIN R. , INGE THOMAS 
Published: June 2024

Introduction: Metabolic and bariatric surgery (MBS) is a safe and efficacious weight loss treatment for children and adolescents with severe forms of obesity. However, there are limited long-term data on treatment effectiveness of MBS for youth-onset type 2 diabetes (YO-T2D). We examined 10-year weight and T2D outcomes among adolescents undergoing MBS.
Methods: We analyzed longitudinal data from 21 individuals who prior to MBS (67% Roux-en-Y gastric bypass, 33% vertical sleeve gastrectomy [VSG]) were &lt; 19 years of age, had ≥ Class 2 obesity and YO-T2D, and were prospectively enrolled in the multi-center, Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.
Definitions: T2D remission= no prescribed glucose lowering medication and normoglycemia (HbA1c &lt;5.7%); partial remission= no medications and HbA1c 5.7%-&lt;6.5%; no remission= current glucose lowering prescription and/or HbA1c ≥ 6.5%. A fasting blood glucose of &lt;100 mg/dL was substituted for one missing follow-up HbA1c. Data presented as mean±SD or percentage.
Results: At the time of MBS, the cohort was 76% female, 57% non-Hispanic white, and had a mean age of 16.7±1.2 years, BMI 53.9±9.2 kg/m2, and HbA1c 6.8±2.0%. At 10-years post-MBS, 71% of individuals (15/21) experienced remission of T2D and had a 29±18% BMI reduction. Remission rates were similar between surgical types. Twenty-nine percent (6/21) did not experience T2D remission by 10 years post-MBS, and only experienced 4±14% BMI decrease. Of the six individuals without remission at 10 years post-MBS, 3/6 previously had remission (in the interim data collection periods) and one had partial remission 1-year post-MBS, with a return of T2D-range HbA1c in subsequent years.
Conclusion: T2D resolution occurred in a high proportion of adolescents post-MBS, and was durable to 10-years of follow-up. Further study is needed to better understand outcomes in diverse populations of YO-T2D, underlying mechanisms of remission and reasons for low weight loss/lack of remission.

Disclosure
S. Sisley: Speaker's Bureau; Rhythm Pharmaceuticals, Inc. A.S. Shah: None. K.J. Nadeau: None. M.M. Kelsey: Other Relationship; Rhythm Pharmaceuticals, Inc., Lilly Diabetes. A. Courcoulas: Research Support; Allurion, Eli Lilly and Company. M. Michalsky: Stock/Shareholder; Intuitive Surgical. Other Relationship; Intuitive Surgical. Advisory Panel; Lilly USA, LLC. T.M. Jenkins: None. J.R. Ryder: None. T. Inge: Consultant; Medtronic, Eli Lilly and Company, Brainstorm Therapeutics. Stock/Shareholder; Standard Bariatrics. Consultant; Teleflex.

Funding
National Institutes of Health (UM1DK072493)
1167-P: Immunological Landscape of Early-Onset Type 1 Diabetes—Cellular Dynamics and Molecular Pathways
Authors: PAN LANXIN , SHI YU , YUE TONG , TAN HUILING , DING YU , LUO SIHUI , GUO CHUANG , ZHENG XUEYING , WENG JIANPING 
Published: June 2024

Background: Type 1 Diabetes (T1D) is an autoimmune disease affecting mainly children and young adults. Early-stage immunological understanding is crucial for diagnosis and treatment. This study explores the immune environment in T1D patients' peripheral blood, focusing on early disease phases.
Methods: The study involved 10 T1D patients under 7 years, diagnosed within 1 year, and 10 age- and sex-matched healthy controls. Single-cell RNA sequencing was utilized to analyze peripheral blood samples for disease-related characteristics.
Results: The analysis revealed a distinct immunological profile in T1D, with increased CD14Mono, CD4TEM, and CD4Treg cells and decreased CD4T naïve cells compared to controls. CD14Mono cells in T1D were enriched in stress pathways linked to viral infection and substance transport. Besides immunological and inflammatory traits, CD4TEM cells were associated with enzyme activity and metabolism, while CD4Treg cells focused on cell adhesion pathways. Cell interactions and trajectories indicated transformations among CD4T cells, suggesting CD4Tregs' role in early-stage self-repair, with CXCR4 as a key chemotactic factor.
Conclusion: This study offers a detailed immunological perspective of early-onset T1D, emphasizes the complexity of T1D's immune response and the importance of cellular dynamics and signaling pathways.

Disclosure
L. Pan: None. Y. Shi: None. T. Yue: None. H. Tan: None. Y. Ding: None. S. Luo: None. C. Guo: None. X. Zheng: None. J. Weng: None.

Funding
the National Natural Science Foundation (82100822); the Strategic Priority Research Program of Chinese Academy of Sciences (XDB38000000); the Program for Innovative Research Team of The First Affiliated Hospital of USTC (CXGG02); and the Anhui Provincial Natural Science Foundation (2008085MH248, 2008085MH278)
1212-P: Multiomics Assessment of Transcripts and Genes Associated with Gestational Diabetes
Authors: LONGORIA KAYLA D. , JELLIFFE-PAWLOWSKI LAURA L. , RYCKMAN KELLI K. , BAER REBECCA , OLTMAN SCOTT P. , ASAM KESAVA , FLOWERS ELENA 
Published: June 2024

Introduction and Objective: Gestational diabetes (GDM) occurs in 2-10% of pregnant persons annually and is associated with increased morbidities for birthing people and infants. GDM etiology is multifactorial, resulting in diverse risk profiles due to interindividual differences among biological and environmental/behavioral factors. The purpose of this study was to explore transcriptomic and genetic risk factors associated with GDM.
Methods: To examine differential gene expression between pregnant persons with and without GDM (n=16), we analyzed a public dataset (GSE9772) using Deseq2 and a false discovery rate (p-adjusted &lt;0.05). Using data from CA1000 (N = 913), we extended these findings by exploring single nucleotide polymorphism (SNP) prevalence in the solute carrier family 6-member 6 (SLC6A6) gene using Chi-square or Fisher’s exact tests in pregnant persons with and without GDM.
Results: A total of 522 transcripts were differentially expressed (p&lt;0.05) in those with GDM compared to those without, but only SLC6A6 remained significant after correction for multiple comparisons (p-adjusted&lt;0.05). SNP prevalence in the SLC6A6 gene indicated six loci that differed in those with GDM compared to those without (rs13058781 (position 14469836), rs4685160 (position 14476887), rs73030137 (position 14477940), rs9683047 (positions 14486407), rs55957528 (position 14488225), rs17039625 (position 14500806)).
Conclusion: The SLC6A6 gene codes for the taurine transporter protein, and taurine deficiency has been associated with GDM, type 2 diabetes, and poor fetal health and delivery outcomes. Our findings suggest an association between taurine biology and GDM. Future studies are needed to advance understanding of the role of taurine biology in GDM and potential implications of genotype-phenotype interactions in GDM risk.

Disclosure
K.D. Longoria: None. L.L. Jelliffe-Pawlowski: None. K.K. Ryckman: None. R. Baer: None. S.P. Oltman: None. K. Asam: None. E. Flowers: None.