bluuebunny/crossref_metadata_2025_split huggingface dataset:
1810-LB: Diagnostic Accuracy of Automated Pupillometry for Diabetic Retinopathy Screening
Authors: GAJARDO ABRAHAM I.J. , SANDOVAL DANIELA B. , VIDAL RODRIGO , BRAVO MIGUEL , ULLOA VIVIANA E. , ROJAS VERONICA , ZAMORANO NICOLLAS A. , SARAVIA GÉNESIS , GOMEZ PATRICIA C. , MORAL MACARENA , NIVELO MONICA 
Published: June 2024

Introduction: Diabetic retinopathy (DR) is a major and preventable cause of blindness. Although regular fundoscopic examination (FE) is recommended to detect DR, screening coverage remains low in Latin America, the USA, and other regions, supporting the need for new screening tools. Because pupillary reactivity to a short light stimulus is decreased in patients with DR, this study aimed to assess the diagnostic accuracy of automated pupillometry (AP), an inexpensive tool, for DR screening in type diabetes mellitus (T2DM) patients.
Methods: Diagnostic accuracy study performed prospectively in 93 adults with T2DM (186 eyes) referred for FE from three public primary care health centers in Santiago, Chile. Patients underwent a clinical evaluation, AP assessment, and FE during the same visit. AP was performed to obtain three valid trials by eye with a clinical pupilometer. For DR diagnosis, pupil-dilated eye fundus images were taken with a retinal camera and later informed by an ophthalmologist. Patients and AP/FE operators were blind to FE/AP data. The diagnostic accuracy of AP for DR was assessed by the area under the curve (AUC), sensitivity, specificity, and predictive values (PV).
Results: 50% females, 64±10 years old, 68% hypertension, 34% insulin users. Frequency of DR was 22%. All AP-derived parameters were lower in those with DR (p-value&lt;0.001). Of all eye assessments, 75% had increased the inverse of basal pupillary diameter (BPD-1), 12% had a decreased pupillary constriction (PC) and 51% had both parameters altered. The AUC, sensitivity, specificity, negative PV, and positive PV for DR were, respectively: 0.778, 95%, 32%, 27%, and 96% for BPD-1 and 0.765, 43%, 96%, 76%, and 86% for PC. Only 4% of patients with a conserved BPD-1 and 7% of those with a conserved BPD-1 or PC had DR.
Conclusion: This study proves for the first time that AP is a viable screening tool for DR, with a sensitivity and negative PV of about 95%. Further studies are needed to confirm if AP avoids FE or helps triage diabetics waiting for FE.

Disclosure
A.I.J. Gajardo: None. R. Vidal: None. M. Bravo: None. V. Rojas: None. G. Saravia: None. P.C. Gomez: None. M. Moral: None.

Funding
National Fund for Research and Development in Health, FONIS N? SA21I0148, National Agency of Investigation and Development (ANID), Government of Chile.
1814-LB: Hypertriglyceridemic-Waist Phenotype Is Associated with Diabetic Foot Ulcer in Chinese Patients with Type 2 Diabetes
Authors: LIU ZHENYU , ZHANG LEI , WANG MEILING , ZHANG QI , LIU YUQING , DONG YANHU 
Published: June 2024

It is still unclear whether the hypertriglyceridemic-waist (HTGW) phenotype is related to increased risk of diabetic foot ulcer (DFU) in Chinese patients with type 2 diabetes. A total of 2651 consecutive in-patients with type 2 diabetes (mean age 56±11 years, 58% women), with a mean duration of diabetes of 9.3 years, were included to identify the relationship. The diagnosis of HTGW was made if TG≧1.70mmol/L plus waist circumference≧90cm for men (or ≧80cm for women) according to the IDF criteria for the metabolic syndrome. The study population was then divided into HTGW subgroup and Non-HTGW subgroup. DFU was diagnosed according to guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019). Logistic regression analysis was applied to relate HTGW phenotype to DFU. The prevalence of DFU was 9.3% and 4.2% respectively in patients with and without HTGW. Compared with participants who had no HTGW, those with the HTGW phenotype had higher levels of systolic blood pressure (139.2 mmHg vs. 132.7 mmHg, p&lt;0.05), fasting plasma glucose (9.1 mmol/L vs. 8.5 mmol/L, p&lt;0.05), HbA1c [73 mmol/mol (8.83%) vs. 63 mmol/mol (7.95%), p&lt;0.05], apolipoprotein B ( 0.95 g/L vs. 0.89 g/L, p&lt;0.05), C-reactive protein (8.23 mg/L vs. 4.92 mg/L, p&lt;0.05), and TNF-α ( 26.46 pg/ml vs. 16.80 pg/ml, p&lt;0.05) but lower levels of apolipoprotein A1 (1.21g/L vs. 1.33g/L, p&lt;0.05). The hypertriglyceridemic-waist phenotype was associated with DFU (OR 1.33, 95% CI 1.03-2.71), after adjusting for age, sex, duration of diabetes, body mass index, smoking, HbA1c, apolipoprotein B and C-reactive protein. Among patients with type 2 diabetes, simultaneous measurement of waist circumference and triglycerides could be used as an inexpensive and simple approach to identify individuals with increased risk of DFU.

Disclosure
Z. Liu: None. L. Zhang: None. M. Wang: None. Q. Zhang: None. Y. Liu: None. Y. Dong: None.

Funding
IDF BRIDGES Researchnet Grant (rn13-016)
1839-LB: A Randomized Crossover Study Comparing the Effects of Diabetes-Specific Formula with Asian Breakfasts on Glycemic Control and Satiety in People with Type 2 Diabetes
Authors: TEANG KONG SING , HUYNH DIEU , SRIVANICHAKORN WEERACHAI , KHOVIDHUNKIT WEERAPAN , PAUNIKAR SWAPNIL L. , YALAWAR MENAKA , LING TEY SIEW 
Published: June 2024

Introduction & Objective: Medical nutrition therapy including diabetes-specific formula (DSF) is important for diabetes management. This study aimed to evaluate the effects of consuming a DSF in comparison to two common Asian breakfasts on postprandial glucose, insulin, and satiety in people with type 2 diabetes (T2D).
Methods: This was a randomized, crossover study with three treatments; DSF, noodle soup (NS), and glutinous rice (GR). Blood glucose, insulin, and subjective appetite were assessed at 0, 15, 30, 45, 60, 90, 120, 150, and 180 min. Sixty-four adults with T2D (7% ≤ HbA1c &lt; 10%) and taking oral glucose-lowering drug were randomized and completed this study. Each continuous variable was analyzed using parametric or nonparametric (if declared non-normal) three-treatment three-period crossover analysis. All hypothesis tests were done using 2-sided, 0.05 level tests.
Results: The mean ± SD age was 54.5 ± 1.0 years, body mass index was 27.6 ± 0.5 kg/m2, and HbA1c was 7.8 ± 0.8%. Glucose positive area under the curve from 0 to 180 min (pAUC0-180) for DSF was significantly lower than GR (LSM ± SE: DSF 354 ± 32 vs. GR 451 ± 32, p = 0.033). Insulin pAUC0-180 was significantly lower with DSF compared to GR (Median [25th, 75th percentile]: DSF 2733 [1542, 4204] vs. GR 3359 [2193, 4744]), p = 0.042). There were no significant differences in glucose and insulin pAUC0-180 between DSF and NS, and between GR and NS (both p ≥ 0.216). No significant differences were found in subjective appetite between any of the three treatments (all p ≥ 0.827). The estimated time for hunger returning to baseline was the shortest for NS (165 min), which was 20 and 30 minutes earlier than DSF (186 min) and GR (197 min).
Conclusion: DSF significantly reduced postprandial glucose and insulin responses compared with GR and had a higher satiating value when compared to NS.

Disclosure
S. Kong: Employee; Abbott Nutrition. D. Huynh: Employee; Abbott Nutrition. W. Srivanichakorn: Research Support; Abbott. Other Relationship; Merck & Co., Inc., AstraZeneca, Boehringer-Ingelheim. W. Khovidhunkit: Advisory Panel; Amgen Inc., Novartis AG. Speaker's Bureau; Novo Nordisk, AstraZeneca. Other Relationship; Abbott. Advisory Panel; Daiichi Sankyo. Speaker's Bureau; Meiji. S.L. Paunikar: Employee; Cognizant Technology Solutions Private Limited. M. Yalawar: Employee; Cognizant Technology Solutions India Private Limited. S. Tey: Employee; Abbott Nutrition.
1849-LB: Social Determinants of Health and Early-Onset Type 2 Diabetes—A Qualitative Study
Authors: JANG HYESUN , SUNG GOWOON , FAULKNER MELISSA S. , CHA EUNSEOK 
Published: June 2024

Objective: To explore how social determinants of health (SoDH) affect disease perception and diabetes care in Koreans with early-onset type 2 diabetes (T2D).
Methods: A qualitative research study included 35 Koreans (54.29% men) out of 83 contacts, diagnosed with T2D prior to 40 years of age. Interviews lasted 40 to120 minutes, occurring between June 2023 and February 2024. The verbatim transcriptions of semi-structured interview data were analyzed using conventional content analysis.
Findings: The primary means of diabetes awareness was (bi)-annual free check-ups (42.86%) provided by the Korea National Health Insurance Service, followed by recognition of symptoms (22.86%), visits to the emergency room or clinic due to acute illness (22.86%), and follow-up check-ups after gestational diabetes (8.57%). Major themes identified were doomed, self-blamed or depressed. With a family history of diabetes, the patients often felt doomed or blamed themselves for not adopting a healthier lifestyle earlier despite being aware of their risk. Others without family history reported having limited knowledge of T2D. They expressed a sense of "why me," leading to negative emotions. Connecting with peers in the eCommunity brought relief, making them feel less isolated in their experiences. Since Koreans with early-onset T2D felt flawed due to a familial risk and their diagnosis, they felt inadequate about intimate relationships, including marriage and pregnancy. The timing and extent of disease disclosure to a partner depended on the level of relationship.
Conclusions: SoDH play a significant role in early screening, diagnosis and care possibly influencing diabetes remission. Peer norms and familial risk affect diabetes perception in this population. Emphasizing weight loss or a healthy lifestyle may unintentionally deepen the stigma by reinforcing feelings of self-blame. Clinical discussion and messages need to be framed to mitigate self-blame and encourage motivation for positive change.

Disclosure
H. Jang: None. G. Sung: None. M.S. Faulkner: None. E. Cha: None.

Funding
Korea Research Foundation (NRF2023R1A2C2004541)
1854-LB: Predicting Insulin Timecourse in Prediabetes Individuals Using a Human Digital Twin Model
Authors: HOR CHENG KOH , CHAN JAMES C. 
Published: June 2024

Individuals with early prediabetes often present with slight elevations or even normal glucose level. However, their insulin profiles are often dysregulated with either hyper- or hypoinsulinemia, suggesting insulin as a more sensitive biomarker for prediabetes detection. We developed a human digital twin that can predict an individual’s insulin time course and glycaemic status from an oral glucose tolerance test (OGTT) time-course. The model incorporates homeostatic processes such as insulin secretion and glucose uptake in adipose and muscles. The model was fed with individualized data such as age, BMI and OGTT glucose time-course to predict insulin profiles. Overlay of clinical and simulated glucose and insulin profiles can be seen in Figure 1. Insulin time-course, area-under-the-curve (AUC) and Matsuda Index were accurately predicted for three Chinese males, one healthy (subject 1), one exhibiting insulin insufficiency (subject 2) and one insulin resistance (subject 3). Fold-change of predicted to actual insulin AUC and Matsuda Index were all within 1.5 times. We demonstrated high accuracy of our model in predicting difficult-to-obtain insulin data using easily obtained glucose data. We envision more validation and use of our model to predict insulin-related metrics in different ethnicities and glycaemic status.

Disclosure
K. Hor Cheng: None.
1855-LB: Metformin Mitigates Insulin Signaling Variations Induced by COVID-19 Vaccine Boosters in Type 2 Diabetes
Authors: ZHUANG MIN , ZHAI LIXIANG , BIAN ZHAOXIANG , LIN CHENGYUAN , WONG HOI KI 
Published: June 2024

Objective: Diabetes is associated with an increased risk of coronavirus disease 2019 (COVID-19) morbidity and mortality. COVID-19 vaccines substantially reduce the risks of serious COVID-19 outcomes, but the impact of COVID-19 vaccines, including their effectiveness and adverse effects in patients with diabetes, is not well known.
Methods: Firstly, we used the mRNA COVID-19 vaccine to validate the effects of glucose control in mice after 4 dorse. Then, between 1 June 2023 and 31 October 2023, we recruited 176 adults who had received two doses of the mRNA COVID-19 vaccine (BNT162b2). The participants ranged in age from 18 to 65 years (median=53.5 years, interquartile range (IQR) 12.0), and (104/176)59.09% were male. Human volunteers were recruited to determine their immune responses and glucose control before and 2 weeks after the booster shot of the COVID-19 mRNA vaccine.
Results: We showed that four doses of the COVID-19 vaccine weekly could impair insulin sensitivity in healthy mice, and this effect can still be maintained after four weeks. Following that, we showed that 65/176 patients with type 2 diabetes exhibited aggravated insulin resistance toward booster shots of the COVID-19 vaccine after 2 weeks. We found that the aggravation of insulin resistance in patients with type 2 diabetes taking metformin was significantly lower than in patients not taking metformin after the booster shots of the COVID-19 vaccine.
Conclusion: This study suggests the clinical importance of close monitoring of glycemic control in diabetes after receiving COVID-19 vaccines and indicates the beneficial action of metformin, a common antidiabetic medication, in counteracting insulin signaling variations induced by COVID-19 vaccination in diabetes.

Disclosure
M. Zhuang: None. L. Zhai: None. Z. Bian: None. C. Lin: None. K. Hoi: None.

Funding
Health@InnoHK Initiative Fund from the Hong Kong SAR Government (ITC RC/IHK/4/7 ); Key-Area Research and Development Program of Guangdong Province (2020B1111110003 ); NSFC Excellent Young Scientist Scheme (32322091); Innovation and Technology Support Programme from the Hong Kong SAR Government (ITS/058/22MS); General Research Grants from the Hong Kong SAR Government (22104123).
1876-LB: Blood Glucose Target Ranges for IV Insulin Infusions Impact Inpatient Glucose Metrics
Authors: ALOI JOSEPH , PRICE CATHERINE E. 
Published: June 2024

Inpatient hyperglycemia is associated with prolonged hospital length of stay (LOS) and morbidity. Minimizing both hypo and hyperglycemic events are an overall strategy to avoid hospital complications related to dysglycemia. Diabetic ketoacidosis (DKA) and stress related hyperglycemia are frequently managed in the critical care setting with IV insulin where guidelines recommend a blood glucose (BG) target of 140 - 180 mg/dL. Best practices regarding optimal BG targets in critical care settings are evolving. The EndoTool IV (ETIV) de-identified data base was studied for glycemic events as a function of BG ranges. ETIV is an insulin dosing algorithm that utilizes patient factors to adjust insulin dosing and allows selection of target BG values. For the calendar year 2023 73,458 patient runs with IV insulin were studied. Target BG ranges fell into 4 major groups as shown in Table 1. No significant differences in number of BG checks, use of steroids or renal function was noted among the groups. There are statistically significant differences in hypoglycemia between target ranges compared to BG 140-180.These data suggest that for a heterogeneous patient population treated with IV insulin 120-160 mg/dL offers minimal hypoglycemic and hyperglycemic events with acceptable time in goal range.
Table 1: BG target ranges mg/dL with event rates for hyper and hypoglycemia and relative risk (RR) for hypoglycemia compared to 140-180 BG

Disclosure
J. Aloi: Research Support; Abbott, Medtronic. C.E. Price: Other Relationship; American Diabetes Association.
1877-LB: Use of Faster Aspart in Pregnancy
Authors: GHOHSH MANIKANTAN NAIR SAKUNTHALA ANEESH 
Published: June 2024

Aims: The present study aimed to study the pregnancy outcomes, efficacy, and safety of faster aspart among Indian women with gestational diabetes.
Background: In several countries, fast-acting insulin aspart (faster aspart) has been approved for use in pregnancy. There is a lack of data related to maternal glycemic control and fetal and perinatal outcomes with faster aspart in gestational diabetes among the Indian population.
Objective: To compare and evaluate the efficacy and safety of faster aspart in the management of gestational diabetes.
Methods: This retrospective study evaluated the medical records of 60 pregnant women diagnosed with gestational diabetes and managed with faster aspart or insulin aspart at a tertiary care center, between March 2019 and September 2020. Self-monitored blood glucose levels recorded at 4 timepoints (fasting, and 1 hour post breakfast, lunch, and dinner) during 6 consecutive days any time before delivery but after
achieving steady state were analyzed. Pregnancy and neonatal outcomes studied in the cohort.
Results: The mean postprandial glucose value following dinner was significantly lesser in the faster aspart group compared to the insulin aspart group (123.61 +/- 2.52 mg/dL vs. 125.87 +/- 2.98 mg/dL, respectively; p=0.0024). Women in the faster aspart group had significantly lower glycemic variability (fluctuations). Lesser number of hypoglycemic events were noted in the faster aspart group (10 vs. 20; p=0.0595).Conclusion: Faster aspart was associated with better glycemic control compared to insulin aspart among women with gestational diabetes. The MAGE analysis revealed that women in the faster aspart group had significantly lower glycemic variability (fluctuations) at all three mealtimes compared to those in the insulin aspart group. The birth weight, respiratory rate, and pulse rate of the neonates born to mothers on insulin aspart were significantly higher compared to those born to mothers on faster aspart

Disclosure
A. Manikantan Nair Sakunthala: None.
1878-LB: Medication Use in Adults with Type 1 Diabetes in U.S. Clinical Practice
Authors: STOKES MICHAEL E. , LI QIAN , DEX TERRY A. , WILSON LAURA 
Published: June 2024

Introduction & Objective: Type 1 diabetes (T1D) remains associated with substantial clinical burden and long-term medication use. We assessed medication use in adults with T1D in US clinical practice.
Methods: We identified data (Merative MarketScan® Jan 1, 2014-Jun 30, 2019) for adults (≥18 years) with prevalent T1D (≥2 T1D claims ≥30 days apart, and either a T1D:T2D diagnosis code ratio &gt;0.5 with prescribed glucagon/no oral hypoglycemic agents [excluding metformin] or a prescribed urine acetone test, prior to Jan 1, 2017 [index]). Clinical characteristics and medication use during the 12-month pre-index period were recorded.
Results: Compared with patients on Commercial plans, those on Medicare and Medicaid generally had higher comorbidity burden (Table). Insulin was the most frequently used medication across health plans. Patients on Commercial plans often received atorvastatin, lisinopril and metformin, but less frequently than with other health plans. Patients on Medicare plans patients frequently received atorvastatin, furosemide, lisinopril, and amlodipine. Patients on Medicaid plans frequently received acetaminophen/hydrocodone, lisinopril, and gabapentin.
Conclusions: Compared with patients on Commercial plans, those on Medicare and Medicaid plans more frequently received non-insulin drugs relating to cardiovascular and neuropathic conditions, likely reflecting higher comorbidity in these patients.

Disclosure
Q. Li: None. T.A. Dex: Stock/Shareholder; Pfizer Inc. Employee; Sanofi. Stock/Shareholder; Viatris Inc., Teva Pharmaceutical Industries Ltd. L. Wilson: Employee; Sanofi. Stock/Shareholder; Sanofi.

Funding
Sanofi
1880-LB: Efficacy and Safety of iGlarLixi vs. IDegAsp in Non-Asian People with Type 2 Diabetes Inadequately Controlled with Basal Insulin—A Systemic Literature Review and Network Meta-analysis
Authors: HOME PHILIP , LAUAND FELIPE , DJABALLAH KHIER , BOURHIS FRANCOIS , LI XUAN , HAFIDH KHADIJA , MEHTA ROOPA , FARAOUN KHADRA , ANAFOROGLU INAN , POURRAHMAT MIR-MASOUD 
Published: June 2024

Introduction and Objective: The objective of this systematic review and network meta-analysis (NMA) was to estimate the relative treatment effect of iGlarLixi (insulin glargine 100 U/mL + lixisenatide) versus premixed insulin IDegAsp (insulin degludec + insulin aspart) in people with T2D inadequately controlled with basal insulin (BI).
Methods: A systematic review identified recently published randomized controlled trials (RCTs) by searching Embase (including congress abstracts from 2021-2023), MEDLINE, and CENTRAL in October 2023. Outcomes from RCTs for non-Asian people with T2D previously treated with BI who switched to iGlarLixi or IDegAsp were compared using an NMA. Differences in the definitions of hypoglycemia used in the included RCTs preclude secure comparisons. Data analysis was performed using R, version 4.0.2.
Results: Four RCTs were included (N=2535). iGlarLixi (n=810) demonstrated a significant reduction in HbA1c vs IDegAsp (n=454) (−0.39; 95% credible interval [CrI] −0.58, −0.21 %-points). The chance of achieving HbA1c &lt;7.0% was 42% greater with iGlarLixi (risk ratio: 1.42; 95% CrI 1.18, 1.71). iGlarLixi resulted in a significant reduction in post-prandial glucose (PPG). Weight gain and insulin dose were significantly lower with iGlarLixi vs IDegAsp with mean differences of −1.5 (95% CrI −2.3, −0.8) kg and −5.1 (95% CrI: −8.5, −1.7) U/day. The reported event rate of documented hypoglycemia (&lt;54-56 mg/dL) was 35% lower for iGlarLixi vs IDegAsp (event rate ratio 0.65; 95% CrI 0.46, 0.89).
Conclusion: Treatment with iGlarLixi versus premix IDegAsp was associated with a greater reduction in HbA1c, PPG, and morning and afternoon SMPG, with less weight gain and lower insulin dose.

Disclosure
P. Home: Consultant; Eli Lilly and Company. Research Support; Sanofi. Other Relationship; Gan & Lee. F. Lauand: Employee; Sanofi. Stock/Shareholder; Sanofi. K. Djaballah: None. F. Bourhis: Employee; Sanofi. X. Li: Employee; Sanofi. K. Hafidh: None. R. Mehta: Advisory Panel; Boehringer-Ingelheim, Eli Lilly and Company, Novo Nordisk. Speaker's Bureau; Abbott, Amgen Inc., AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Novo Nordisk, Sanofi, Silanes. K. Faraoun: None. I. Anaforoglu: None. M. Pourrahmat: Employee; Evidinno Outcomes Research Inc.

Funding
Funded by Sanofi