bluuebunny/crossref_metadata_2025_split huggingface dataset:
1804-LB: Serum Spexin Level Is Negatively Associated with Peripheral Neuropathy and Sensory Pain in Type 2 Diabetes
Authors: LIU RUI 
Published: June 2024

Background: Spexin is a novel peptide hormone and has shown anti-nociceptive effects in experimental mice. This study aimed to evaluate the association of serum spexin level with diabetic peripheral neuropathy (DPN) and related pain in a Chinese population.
Methods: We enrolled 167 type 2 diabetes mellitus (T2DM) including 56 patients without DPN (non-DPN), 67 painless DPN, and 44 painful DPN. Serum spexin was measured using ELISA. Logistic regression models were performed to analyze the independent effects of spexin on prevalence of DPN and painful DPN. In streptozotocin-induced diabetic mice, mechanical pain threshold was measured using electronic von Frey anethesiometer. Human peripheral blood mononuclear cells (PBMCs) were isolated and further stimulated with lipopolysaccharide without or with spexin. The gene expression was assayed by qPCR.
Results: Compared with non-DPN, serum spexin level decreased in painless DPN and further decreased in painful DPN. The odds of DPN was associated with low spexin level in T2DM, which was similar by age, sex, BMI, and diabetes duration, but attenuated in smokers. The odds of having pain was associated with decreased spexin level in DPN, which was similar by age, sex, smoking status, and diabetes duration, but attenuated in normal weight. Furthermore, we observed that mechanical pain threshold increased in spexin-treated diabetic mice. We also found that lipopolysaccharide treatment increased the mRNA level of TNF-α, IL-6, and MCP-1 in human PBMCs, while spexin treatment prevented this increase.
Conclusions: These results suggested that spexin might serve as a protective factor for diabetes against neuropathology and pain-related pathogenesis.

Disclosure
R. Liu: None.
181-OR: Declining eGFR over Time Predicts the Risk of a Composite of Primary or Secondary Major Adverse Cardiovascular Events or Heart Failure Hospitalization, in People with Type 2 Diabetes—EXSCEL Post Hoc analysis
Authors: OULHAJ ABDERRAHIM , SULIMAN ABUBAKER E. , ELLER KATHRIN , AZIZ FAISAL , COLEMAN RUTH L. , BENTOUMI RACHID , VON LEWINSKI DIRK , HOLMAN RURY R. , SOURIJ HARALD 
Published: June 2024

Introduction and Objective: Declining estimated glomerular filtration rate (eGFR) is a predictor for the development and progression of chronic kidney disease and incident cardiovascular disease (CVD). We used a novel statistical approach to investigate the role of eGFR decline in predicting CVD events in people with type 2 diabetes, in both primary and secondary CVD prevention settings.
Methods: Bayesian joint modelling of eGFR repeated measures and time to CVD event was applied to the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) to examine the association between declining eGFR and the incidence of MACEhF (non-fatal myocardial infarction, non-fatal stroke, cardiovascular death, or hospitalization for heart failure), adjusting for age, sex, smoking, hypertension, antihypertensive medication, hyperlipidemia, lipid lowering medication, diabetes duration, atrial fibrillation, HDL-C, total cholesterol, HbA1c and treatment allocation (once-weekly exenatide or placebo).
Results: Data from 11374 trial participants with (n=8135) and without (n=3239) previous history of CVD were analyzed. The mean (SD) eGFR slope/year in participants without and with a history of CVD was -0.69 (1.73) and -0.97 (2.04) respectively. The corresponding 5-year MACEhF incidences were 7.6% (95% CI 6.3-8.9%) and 21% (95% CI 19-22%). A 1 SD decrease in the eGFR slope was associated with increased MACEhF risks of 64% (HR 1.64, 95% CI 1.15-2.28, p=0.007) and 22% (HR 1.22, 95%CI 1.03-1.45, p=0.026), respectively.
Conclusion: Declining eGFR over time is a significant predictor of incident MACEhF events in people with type 2 diabetes, both those with and without existing CVD, with a higher hazard ratio for MACEhF in the latter group.

Disclosure
A. Oulhaj: None. A.E. Suliman: None. K. Eller: Advisory Panel; Alexion Pharmaceuticals, Inc., AstraZeneca, Vifor Pharma Management Ltd. Speaker's Bureau; Boehringer-Ingelheim, Sanofi, CSL Behring. Advisory Panel; Takeda Pharmaceutical Company Limited. F. Aziz: None. R.L. Coleman: None. R. Bentoumi: None. D. von Lewinski: Speaker's Bureau; AstraZeneca. Research Support; Novo Nordisk. R.R. Holman: Advisory Panel; Anji Pharmaceuticals, AstraZeneca, Novartis AG. H. Sourij: Advisory Panel; Amarin Corporation. Speaker's Bureau; Amgen Inc., Amarin Corporation, Bayer Inc. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company. Research Support; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Advisory Panel; Novartis AG. Speaker's Bureau; Novartis AG. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Sanofi. Speaker's Bureau; Sanofi. Consultant; K:Businesscom.
1813-LB: Serum 25-hydroxyvitamin D Levels in Relation to the Risk of Diabetic Foot Ulcer in Chinese Patients with Type 2 Diabetes
Authors: ZHANG QI , LIU ZHENYU , GU YAN , ZHANG LEI , DONG YANHU 
Published: June 2024

Vitamin D deficiency is not only related to bone-related diseases but also associated with cardiovascular disease, diabetes, cancer and autoimmune diseases. Previous studies show that vitamin D deficiency increases risk of macrovascular diseases and different type of infections in patients with diabetes. Data on the relationship between vitamin D and diabetic foot ulcer (DFU) is limited among Chinese patients with type 2 diabetes. In this retrospective cross-sectional study, we enrolled 5483 patients (2378 men and 3105 women aged 30 to 89 yrs) with type 2 diabetes at Qingdao Endocrine and Diabetes Hospital from Jan 1, 2017 to Oct 31, 2019. Serum 25-hydroxyvitamin D (25(OH)D) level was measured by electrochemiluminescence assay. Vitamin D deficiency was defined as Serum 25(OH)D level &lt; 20 ng/mL according to the Endocrine Society Clinical Practice Guideline 2011. DFU was diagnosed according to guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019).The prevalence of DFU was 8.1% in this cohort. Patients with DFU had lower serum 25(OH)D concentration (15.33±4.51 ng/mL v.s 18.54±3.82 ng/mL, P&lt;0.05) compared with those without DFU. The prevalence of vitamin D deficiency was higher in patient with DFU than those without the complication (84.5% v.s 70.1%, P&lt;0.05). We did not find gender difference on the prevalence of vitamin D deficiency. In the logistical regression model, vitamin D deficiency was associated with increased risk of DFU, after adjustment of age, gender, duration of diabetes, smoking, body mass index, systolic blood pressure, fasting glucose, HbA1c, fasting C-peptide, and total cholesterol, the corresponding odds ratio (95% CI) was 1.36 (1.01-3.37) (P&lt;0.05). Vitamin D deficiency, a common hypovitaminosis in Chinese patients with type 2 diabetes, is independently associated with increased risk for DFU. Whether vitamin D supplementation improves healing of DFU deserves further study.

Disclosure
Q. Zhang: None. Z. Liu: None. Y. Gu: None. L. Zhang: None. Y. Dong: None.

Funding
IDF Bridges Researchnet Grant (rn13-016)
1823-LB: DiaLOG—A Personalized and Interactive Diabetes Education Platform Empowered with Risk Assessment AI Algorithms and ChatGPT
Authors: LU JIQIAO , LU SHUYA , ZHAO YUBO , TSANG HILDA , HE DAIHAI , LI XIANG , YANG LIN 
Published: June 2024

Introduction & Objective: The latest breakthrough of large language models offers a great opportunity to create personalized and interactive education tools for self-management of chronic conditions.
Methods: In this study, we developed an individualized and interactive diabetes education platform for Chinese populations with prediabetes, which consists of three key components: 1) a dashboard with individual records; 2) the AI algorithms for individualized risk prediction of type 2 diabetes mellitus (T2DM) incidence that were constructed and validated with 17-year territory-wide electronic health records (EHR) in Hong Kong; 2) a Chatbot empowered by chatGPT.
Results: We developed the clinically explainable prediction models using machine learning (ML) and deep learning (DL) techniques, for two-, five- and ten-year risk predictions in the sub-cohorts of 187,785, 99,853 and 17,301 patients, respectively. We found the Dense Layer Neural Networks (DNN) models achieved the best performance, with the area under receiver-operating curve (AUC) of 81.1%, 79.9%, 75.03% for two-, five- and ten-year risk prediction, respectively. The most significant predictors were fasting glucose and HbA1c, followed by creatinine, age at baseline, sex, potassium, triglyceride, and HDL-C. The DNN models achieved satisfactory performance in external validation. The developed models were then integrated into a web-based prediabetes self-management platform, named DiaLOG, as part of prompt engineering for interaction with ChatGPT.
Conclusion: Validated risk prediction models based on EHR data could be integrated into an AI-powered diabetes self-management platform, together with a ChatGPT-powered chatbot, to facilitate clinical decision and empower patients with self-risk assessments and individualized self-management advice.

Disclosure
J. Lu: None. S. Lu: None. Y. Zhao: None. H. Tsang: None. D. He: None. X. Li: None. L. Yang: None.
1829-LB: Cardiorenal-Metabolic Educational Program for Family Medicine Residents (CARE ME)
Authors: PESQUEIRA JUAN P. , SINGH PRABHPREET , VELEZ-DALLA TOR MAILI 
Published: June 2024

Introduction and Objective: Cardio-renal-metabolic (CRM) diseases are prevalent among patients in family practice, yet primary care residents lack a specific curriculum on this new emerging topic. Addressing this gap and preventing practice inertia is crucial.
Methods: A prospective study compared two cohorts from family medicine residency programs with similar demographics, focusing on the effect of 25 one-hour CRM-focused lectures versus a standard curriculum. Lectures included Q&A sessions and case studies, delivered by specialists and residents. Using pre and post-questionnaires, the study primary endpoint aimed to determine the impact of an educational intervention on resident’s knowledge and patient care. The secondary endpoint aimed to determine the acceptance of the curriculum to drive future curricular changes and implementation.
Results: Analysis using a score-based model showed the intervention group improved significantly. Fisher's exact method was used in performing statistical analysis. The intervention group had a Total Pre-Score of 941 and a Total Post Score of 1258, an increase of 317 points. Important improvement scores rose by 25.2% (p-value 0.000), and overall positive response shifted by 33.4% (p-value 0.000) with 91.4% of respondents. Acceptance of the new curriculum was nearly 100%, indicating achievement of primary and secondary endpoints.
Conclusions: The study successfully met the primary and secondary endpoints. The curriculum significantly enhanced residents’ knowledge and confidence in managing CRM conditions, showing a preference for the new curriculum. This suggests potential benefits for patient outcomes and supports future curriculum implementation. The collaboration between programs promises to enhance education and patient care in primary care residents.

Disclosure
J.P. Pesqueira: None. P. Singh: None. M. Velez-Dalla Tor: None.
1843-LB: Prioritizing Representativeness—Recruiting before “Lost to Follow-up” Youth Living with Type 1 Diabetes (T1D) for a Virtual Family-Based Transition Readiness Intervention
Authors: SUHS MADELEINE C. , O'DONNELL ALEX , ELLIS JULIA , WEISSBERG-BENCHELL JILL , HARRIS MICHAEL A. , PAPADAKIS JACLYN L. 
Published: June 2024

Introduction & Objective: Transition-aged youth with T1D represent a vulnerable population. Recruiting representative samples of these youth for psychosocial interventions is challenging and requires strategic efforts. Behavioral Family Systems Therapy for Diabetes Transition (BFST-DT) is an adapted, virtual, family-based intervention for improving transition readiness, and is currently being evaluated through a pilot intervention trial. The objective of this study is to (1) evaluate the representativeness of the recruited sample, and (2) compare recruitment strategies between those who consented and declined.
Methods: Thirty adolescents (16-18 years) with T1D and their parent(s) were recruited from a large urban hospital. Differences in demographic and health-related variables were assessed between the patient population and those who enrolled, declined, or were unresponsive.
Results: There were no differences between those enrolled, were unresponsive, and the patient population in age, gender, race, ethnicity, zip code-based income, A1c, CGM use, insulin delivery method, or comorbidities. Patients who declined were more likely to live in the city (versus suburban/rural areas) [X2 (1, N=41) = 5.8, p=.02]. Those who enrolled did so via phone (57.1%), email (23.8%), mailings (9.5%), and patient portal (4.8%). Those who declined did so via phone (85.4%), email (9.8%), and patient portal (4.9%), commonly citing no interest (41.5%) and lack of time (19.5%).
Conclusion: Recruitment strategies were effective in recruiting a representative sample of transition-aged youth with T1D. Findings have implications for recruiting and retaining populations that are challenging to engage in intervention research. Future research should prioritize the stratification of historically underrepresented groups during recruitment.

Disclosure
A. O'Donnell: None. J. Ellis: None. J. Weissberg-Benchell: Consultant; Beta Bionics, Inc. Advisory Panel; American Diabetes Association. Research Support; Juvenile Diabetes Research Foundation (JDRF), National Institute of Diabetes and Digestive and Kidney Diseases. J.L. Papadakis: None.

Funding
JDRF (4-SRA-2023-1287-M-B)
1844-LB: Community Engaged Research—Lessons Learned from a Pediatric Type 1 Diabetes Study
Authors: YANG CHIA-LUN , THOMAS COURTNEY , PRICE JULIA 
Published: June 2024

Introduction and Objectives: Community engaged research (CER) involves partnering with community stakeholders (e.g., patients, families, providers) who are experts on their “lived experience” rather than only considering the researchers’ perspectives. However, pediatric type 1 diabetes (T1D) studies with a CER approach are limited. The current study employs CER to develop strategies to increase engagement of underrepresented families in T1D research. This abstract focuses on the lessons learned about the process of engaging with community partners on research.
Methods: Four CER expert consultants guided the recruitment of community partners, as well as development of partner meeting agendas and execution of meetings. Five adolescents with T1D and their caregivers and four T1D providers (1 endocrinologist, 2 advanced practice nurses, 1 pediatric psychologist) agreed to partner in this research project. During separate monthly meetings, family and provider partners provided feedback on research recruitment and data collection strategies.
Results: CER requires unique skills and ongoing support from experts across five areas, (1) recruitment of partners (clarity on time demand, nature of partner role), (2) planning meetings (creating clear, accessible meeting materials), (3) conducting meetings (supporting inclusive and respectful environment), (4) incorporating partner feedback in research strategy (interpreting partner comments, balancing feedback with science), and (5) maintaining partner engagement (responding to partner requests, sharing how feedback is or is not used).
Conclusion: Keys to successfully engaging and maintaining relationships with community partners in pediatric T1D research include consulting with CER experts, clearly sharing the purpose and intentions of partnerships, and highlighting how feedback is improving the project. Employing a CER approach is critical to increase the inclusivity and relevance of pediatric T1D research.

Disclosure
C. Yang: None. C. Thomas: None. J. Price: None.

Funding
National Institute of General Medical Sciences (P20GM144270)
1879-LB: Automated Self-Adjusting Subcutaneous Insulin Algorithm (SQIA) Improves Glycemic Control in Hospitalized Patients—Three-Year Experience
Authors: LEE GWENDOLYN , KOHN MICHAEL A. , ROV-IKPAH ESTHER , MEHTA PARAS , SAN LUIS CRAIG , JOHNSON CRAIG , KOLIWAD SUNEIL K. , RUSHAKOFF ROBERT J. 
Published: June 2024

Introduction: Achieving inpatient glycemic control remains challenging. To meet this challenge, 3 years ago we implemented system wide use of our SQIA for patients who were NPO, on continuous tube feeds (TF), or on total parenteral nutrition (TPN). We previously showed in year 1, the number of orders a physician had to place while a patient was on the SQIA was reduced by a factor of more than 12, when compared with while a patient was on conventional insulin (CI) dosing. We now report the glycemic results from the first 3 years.
Methods: Our retrospective cross-sectional analysis at UCSF from 9/3/2020 to 9/2/2023 compares glucose measurements in adult, non-OB inpatients who were NPO, on TF, or on TPN and ordered for SQIA versus conventional physician-driven insulin adjustments. The 3-year study interval was divided into 3 periods defined by the dates of major optimization updates to the algorithm and programming. The ordering physicians were free to assign patients to SQIA or conventional insulin orders. We used Poisson regression with number of glucose measurements as the offset.
Results: Table 1
Conclusion: Selected now for 80% of eligible hospitalizations, SQIA, compared to CI, was associated with decreased hypoglycemia without an increase in hyperglycemia. With the SQIA, glucose improvements have continued while dramatically reducing burden for rewriting orders.

Disclosure
G. Lee: None. M.A. Kohn: None. E. Rov-Ikpah: None. P. Mehta: None. C. San Luis: None. C. Johnson: None. S.K. Koliwad: Other Relationship; National Institutes of Health. Advisory Panel; Signos. Stock/Shareholder; Signos. R.J. Rushakoff: None.
1884-LB: Real-World Impact of Once-Weekly Injectable Semaglutide (sema OW) vs. Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) on HbA1c, Weight, and Health Care Resource Utilization (HCRU) Outcomes in Type 2 Diabetes (T2D)—An Observational Study (PAUSE)
Authors: AMAMOO JAMES , DOSHI RIDDHI P. , NOONE JOSHUA , XIE LIN , GAMBLE CORY L. , GUEVARRA MICO , DIVINO VICTORIA , CHEN JUSTIN , KING AARON A. 
Published: June 2024

Introduction & Objective: This study aimed to assess the real-world impact of sema OW vs SGLT2i on HbA1c, weight and HCRU outcomes among patients (pts) with T2D in the US.
Methods: This observational study of adults with uncontrolled T2D (HbA1c ≥7%) initiating sema OW or SGLT2i (Jan 2018—Feb 2022; first prescription = index) used data from IQVIA PharMetrics® Plus and Ambulatory Electronic Medical Records databases. Changes in HbA1c, weight, BMI and all-cause medical HCRU outcomes after 1 year were compared among inverse probability of treatment weighting (IPTW) adjusted cohorts.
Results: Post-IPTW (sema OW: n=416; SGLT2i: n=1093) a significantly higher proportion of pts in the sema OW cohort had combined reductions in HbA1c/weight outcomes vs SGLT2i (Figure). The sema OW cohort had significantly greater mean decreases in HbA1c (-1.6 vs -1.2%, p&lt;0.0001), weight (-4.4 vs -3.4 kg, p&lt;0.0001) and BMI (-1.5 vs -1.1 kg/m2, p=0.013) vs SGLT2i. Over 1-yr follow-up, all-cause HCRU was similar between both cohorts (≥1 hospitalization: 6.0 vs 5.7%, p=0.8190; ≥1 ER visit: 15.2 vs 17.6%, p=0.2658; ≥1 physician office visit: 99.7 vs 99.1%, p=0.2134).
Conclusion: Sema OW was associated with greater improvements in HbA1c and weight vs SGLT2i, but with similar HCRU after 1 year.

Disclosure
J. Amamoo: None. R.P. Doshi: None. J. Noone: Employee; Novo Nordisk. L. Xie: None. C.L. Gamble: Employee; Novo Nordisk. M. Guevarra: Stock/Shareholder; Novo Nordisk. V. Divino: Employee; IQVIA Inc. J. Chen: None. A.A. King: Speaker's Bureau; Abbott, MannKind Corporation, Novo Nordisk. Advisory Panel; Novo Nordisk. Speaker's Bureau; Lilly Diabetes. Advisory Panel; Lilly Diabetes. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc. Speaker's Bureau; Astellas Pharma Inc.

Funding
Novo Nordisk
1890-LB: Assessment of Clinical Practice Gaps Resulting in Clinical Inertia When Managing Type 2 Diabetes
Authors: LARKIN AMY 
Published: June 2024

Introduction: Half of people with T2D meet treatment goals of A1c &lt;7%. Understanding physician knowledge gaps and barriers to overcome clinical inertia with T2D is critical to improve training. Methods: A 25 multiple choice, knowledge- and case-based survey allowed participants to assess their clinical knowledge and performance. The survey was available online to physicians without monetary compensation or charge. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Data was collected October 2023 to February 2023. Results: In total, 771 PCPs, 386 NPs, and 210 PAs completed the assessment. These treaters were mostly in private practice (20%-32%) or in a multi-provider clinic (22%-34%) and estimate 26%-50% of their patients are currently meeting glycemic and weight management goals (27%-33%). Conclusion: This assessment of T2D treaters clinical knowledge and competence yielded important insights into gaps related to T2D treatment intensification. This activity was the 1st component of a larger initiative aimed at improving T2D treatment among first line (primary care) providers and ultimately improve patient outcomes, which will be measured with longitudinal knowledge, competence and performance assessments, and finally a real-world outcomes analysis of claims data for learners of the curriculum, which will be reported later in 2024 or early 2025.

Disclosure
A. Larkin: None.

Funding
Developed through independent educational grant from Lilly.