bluuebunny/crossref_metadata_2025_split huggingface dataset:
1034-P: Targeted Automatic eConsults (TACos) to Enhance Care for Individuals with Diabetes—A Payor–Provider Partnership
Authors: KARSLIOGLU-FRENCH ESRA , KANTER JUSTIN , WINGER MARY E. , WILLIAMS KELLY R. , GRUMSKI TAMMI , SCHUSTER JAMES , BECKJORD ELLEN 
Published: June 2024

Introduction: Most people with Type 2 DM receive care directed by their PCP and do not access endocrinologists. TACos are proactive e-consults that provide therapeutic treatment recommendations. Diabetes TACos have been implemented at University of Pittsburgh Medical Center (UPMC) PCP practices by a collaborative team of the Division of Endocrinology, Clinical Analytics, UPMC PCPs, and UPMC Health Plan. Our previous analysis showed significant HbA1c reduction 6 months following TACos. A 12-month evaluation of a larger patient population demonstrates even more positive outcomes.
Methods: The analysis included 574 individuals who received a TACos (intervention) matched to 1722 controls based on clinical and demographic criteria. The intervention and control groups were matched using 3:1 optimal propensity score matching. Twelve-month changes in HbA1c and health care costs per member per month (PMPM) were evaluated using an observational matched design and intention-to-treat (ITT) analysis.
Results: Sixty-five percent of the TACos recommendations were implemented by PCPs. Percent change in HbA1c in 12 months after TACos was significantly higher in the intervention group (-13.9%, p=0.0003) vs the control group (-10%). Median total cost PMPM in 12 months after TACos was significantly lower in the intervention group (-24%, p&lt;0.001) vs the control group. Inpatient hospital and observation utilization were significantly lower and SGLT2/GLP1 utilization was significantly higher in the intervention group.
Conclusion: Members who received TACos had higher percent reduction in HbA1c; lower total cost; lower inpatient admission and 30-day readmissions; and higher SGLT2/GLP1 utilization compared to comparison group. TACos can improve diabetes control and decrease medical costs for people with Type 2 DM whose care is managed by their PCP.

Disclosure
E. Karslioglu-French: Research Support; Abbott, Pfizer Inc. J. Kanter: None. M.E. Winger: None. K.R. Williams: None. T. Grumski: None. J. Schuster: None. E. Beckjord: None.
1042-P: Long-Term Complications after Add-on Treatment to Metformin—UK Real-World Progression in Diabetes (RAPIDS) Model
Authors: ADLER AMANDA I. , CARROLL ORLAGH , BIDULKA PATRICK , BASU ANIRBAN , GRIEVE RICHARD 
Published: June 2024

Introduction & Objective: Policy makers must take a long view when deciding which treatments to reimburse. Clinical trials may not provide data for long-term complications, nor capture treatment duration or sequences observed in practice. In this study, we predict probabilities of complications for people initiating add-on treatment to metformin monotherapy with sulfonylureas (SU) vs. dipeptidyl peptidase-4 inhibitors (DPP4i) vs. sodium-glucose co-transporter-2 inhibitors (SGLT2i).
Methods: We used data from the UK Clinical Practice Research Datalink (2011 to 2020) to find people with type 2 diabetes prescribed 2nd-line treatment with a SGLTi, DPP4i or SU. We used the US-based RAPIDS microsimulation model updated to reflect trial evidence and calibrated to the UK. We predicted counterfactual outcomes for the alternative second-line treatments for ‘real-world’ durations and subsequent treatment switching. From these predicted outcomes, we estimated between-treatment differences in the mean probabilities of MI, stroke, diabetic eye disease (DED), eGFR, end-stage renal disease (ESRD) or amputation (LEA) over 5 years.
Results: Starting 2nd-line treatment with SGLTi compared to either SU or DPP4i reduced the predicted probability of long-term complications over 5 years. The probability of MI or stroke were similar across the 2nd-line treatments. For SGLTi, the model predicted an increase in the mean eGFR (mL/min/1.73m2) of 0.4 (95% CI 0.1, 0.7) vs SU, and of 0.6 (0.5, 0.7) vs DPP4i. Following starting SGLTi, the model predicted a reduced probability of ESRD of -0.0025 (-0.002,-0.003) vs SU and -0.0025 (-0.03,-0.02) vs DPP4i; for DED the corresponding reductions were -0.011 (-0.012,-0.01) vs. SU and -0.003 (-0.004, -0.002) vs DPP4i. SGLTi and DPP4i lowered LEA risk compared with SU.
Conclusion: The RAPIDS-UK model, based on real-world treatment use, shows that 2nd-line therapy with SGLTi reduces the probability of complications up to 5 years compared to SU or DPP4i.

Disclosure
A.I. Adler: None. O. Carroll: None. P. Bidulka: None. A. Basu: None. R. Grieve: None.

Funding
NIHR
1044-P: A Best Practice Advisory (BPA) Alert within the EHR Reduces Hypoglycemia Related to Insulin Administration in a Real-World Hospital Setting
Authors: PATHAM BHARGAVI , SALDIVAR VIDYA , YARLAGADDA SRI LAKSHMI L. , SADHU ARCHANA R. 
Published: June 2024

Basal bolus insulin regimen (BB) is standard practice for managing hyperglycemia. For optimal outcomes with BB, the nursing workflow of timing the point of care glucose (POC-G) measurement with insulin pharmacokinetics is essential. In real-world hospital settings, this is a challenge and can result in iatrogenic hypoglycemia and hyperglycemia. We aimed to improve hypoglycemia by changing nursing practice to reduce the time interval between POC-G measurement and insulin administration. A best practice advisory (BPA) was created to fire within the EHR at the time of insulin administration to alert the nurse to repeat a POC-G if the prior measurement was over 30 minutes for fast acting (FA) or intermediate acting (IA) or over 60 minutes for long acting (LA) insulin. Retrospective data was collected from our hospital system in all hospitalized patients receiving subcutaneous insulin for four months before and after implementation of the BPA. Of total insulin administrations (n=300,462), BPA was fired on 90% (n=270,370) with 94% (n=253,551) acknowledgment rate. The median length of time (LoT) between POC-G and insulin administration pre-BPA to post-BPA decreased from 42 min to 23 min for FA and IA, and from 52 min to 29 min for LA insulin. Concurrently, the median patient days with hypoglycemia defined as POC-G &lt;70 mg/dL reduced from 4.8% to 4.3%, a relative reduction of 10.4%. A real-time EHR based BPA for nurses improved timing of POC-G with insulin administration and resulted in reduction of hypoglycemia in a real-world hospital setting.

Disclosure
B. Patham: None. V. Saldivar: None. S.L. Yarlagadda: None. A.R. Sadhu: Advisory Panel; Abbott Diagnostics.
1046-P: Cost-Effectiveness of Insulin Icodec for the Treatment of Type 2 Diabetes (T2D) in Canada
Authors: GARCIA DAVID A. , MAU GODFREY , VUONG VIVIAN , SINGH SUMEET , JENSEN MORTEN S. , GOLDENBERG RONALD 
Published: June 2024

Objective: To assess the cost-effectiveness of insulin icodec (IIco), the first once-weekly basal insulin, for the treatment of T2D from the Canadian public payer perspective using the Institute for Health Economics - Diabetes Cohort Model.
Three T2D patient groups were analyzed: insulin naïve (IN), basal insulin experienced (BExp), and basal-bolus insulin experienced (BBExp). Comparators included basal insulin analogs currently reimbursed in Canada: insulin glargine (IGlar) U100 & U300, insulin degludec (IDeg) U100 & U200, and insulin detemir (IDet). Comparative data were derived from IIco phase 3 ONWARDS trials and network meta-analyses. Three price points for IIco were considered: equal to originator IGlar U100, equal to IDeg, and 10% higher than IDeg. Outcomes were expressed as quality-adjusted life-years (QALYs), and cost-effectiveness as incremental cost utility ratios (ICUR [cost/QALY]).
Results: For the IN and BExp populations, IIco is either dominant or associated with an ICUR ≤ $28,824 in all analyses. For the BBExp population, IIco is either dominant or associated with an ICUR ≤ $45,433 in all analyses, except for the comparison versus IGlar U100 when IIco price is ≥ IDeg, and versus IGlar U300 when IIco price is = IDeg +10%.
At a willingness-to-pay threshold of $50,000/QALY gained, IIco is a cost-effective treatment option for T2D versus once daily basal insulin analogues currently reimbursed in Canada.

Disclosure
D.A. Garcia: Other Relationship; Novo Nordisk Canada Inc. G. Mau: Employee; Novo Nordisk Canada Inc. V. Vuong: Other Relationship; Novo Nordisk Canada Inc. S. Singh: Other Relationship; EVERSANA. M.S. Jensen: Employee; Novo Nordisk A/S. R. Goldenberg: Speaker's Bureau; Bayer Inc., Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company, HLS Therapeutics Inc., Novo Nordisk, Sanofi.
1061-P: Interdisciplinary Approach to Outpatient Diabetes Management with Pharmacist-Led Interventions
Authors: HAJOU CHRISTOPHER , ZHOU APRIL , WOODLEY JOHN , POLICEPATIL SEEMA M. 
Published: June 2024

Introduction and Objective: Diabetes mellitus impacts 37.3 million individuals in the U.S., and Fresno, California, has a higher prevalence of 11.4% among adults compared to the state average of 10.5%. With 45 primary care physicians per 100,000 patients, ensuring consistent follow-up and monitoring is challenging. This study assesses the impact of pharmacist-led interventions on glycemic control in diabetes patients at a Federally Qualified Health Center (FQHC) in California's Central Valley.
Methods: This single-center cohort study assesses type I and type II diabetic patients in Primary Care and Endocrinology Clinics. Participants were grouped into standard care or standard care with pharmacist-led interventions. The primary endpoint measured average HbA1c change from baseline, and secondary endpoints included adjustments in anti-diabetic agents, attendance and referrals to multidisciplinary professionals. Average A1c change between groups was assessed using an unpaired t-test, and A1c change was analyzed with a generalized linear model.
Results: The intervention group showed a significant average HbA1c reduction of 1.96% in 12 weeks, exceeding the standard group's 0.88% reduction. Additionally, the intervention group received 77 more referrals to various guideline recommended specialties regarding diabetes care. Appointments typically occurred every 2-3 weeks for 12 weeks with significant improvements in HbA1c for those who attended at least 3 visits.
Conclusion: This study highlights how a collaborative approach to treating diabetes in an underserved patient population may lead to meaningful outcomes and allow physicians to spend more time treating acute issues necessitating less time spent on chronic disease. Implementing a proactive interprofessional model involving ambulatory care pharmacists may also enable precise identification and intervention for high-risk populations in need of meticulous diabetes monitoring and management.

Disclosure
C. Hajou: None. A. Zhou: None. J. Woodley: None. S.M. Policepatil: None.
1063-P: A Carbohydrate-Restricted Intervention and Continuous Remote Care Improves Health Outcomes across All Socioeconomic Groups at Two Years
Authors: VOLK BRITTANIE M. , ATHINARAYANAN SHAMINIE J. , ADAMS REBECCA N. , ROBERTS CAROLINE G.P. , ZOLLER ALISON R. , MCKENZIE AMY L. 
Published: June 2024

Socioeconomic conditions of one’s community have been attributed to disparities in type 2 diabetes (T2D). Prior research has shown no difference between levels of socioeconomic disadvantage in glycemic outcomes after one year of a carbohydrate-restricted nutrition therapy delivered via continuous remote care (CRNT-CRC). This retrospective analysis explored the likelihood of meeting glycemic targets and changes in cardiometabolic markers over 2 years among people with T2D (n= 10859; 49% female; enrollment mean age 55, BMI 35.7, weight 231.8 lbs, HbA1c 7.7%) utilizing a CRNT-CRC by area deprivation index quintiles. Upon enrollment, patients in more disadvantaged areas had lower odds of meeting glycemic targets than those in the least disadvantaged areas. HbA1c significantly improved at 2 years in all groups, and the disparity was eliminated, where at least 80% in each achieved A1c&lt;8% and at least 60% achieved A1c&lt;7%. Weight, triglycerides, HDL-C, and liver enzymes also significantly improved across groups with no changes in total and LDL-C. This demonstrates that a CRNT-CRC can reduce health disparities of people living with T2D.

Disclosure
B.M. Volk: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S.J. Athinarayanan: Employee; Virta Health Corp. R.N. Adams: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. C.G.P. Roberts: Other Relationship; Virta Health Corp. A.R. Zoller: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. A.L. McKenzie: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. Employee; Abbott.
1064-P: Order Set Design and "Nudges" to Change Care in Diabetes—Towards a Novel Pragmatic Clinical Trial Design
Authors: FLORY JAMES , ANCKER JESSICA , KIM SCOTT Y. , VICKERS ANDREW , AUSTRIA MIA , MARTIROSOVA HELEN , DIAZ RUBEN , HIESTAND AMY , KUPERMAN GILAD 
Published: June 2024

Introduction and Objective: When there are multiple reasonable treatment approaches, electronic health record (EHR) design can ‘nudge’ providers to choose one: for example, a default drug selected on an order set may be more likely to be used. Our group has proposed use of such nudges in a pragmatic trial design called a Decision Architecture Randomization Trial (DART).
Methods: Retrospective analysis of how 3 modifications to an inpatient electronic health record ‘nudged’ prescribing practices: 1) introduction of an order set to facilitate use of nutritional + correction insulin (as opposed to sliding scale); 2) phased rollout of an order set change to encourage long-acting insulin use by adding a radio button to facilitate ordering; and 3) introduction of default diabetes orders pre-checked in order sets for patients undergoing colorectal surgery.
Results: The first nudge increased use of nutrition-correction insulin; the second nudge actually decreased rates of long-acting insulin use; and the third nudge increased glucose monitoring and insulin use for surgery patients (Figure).
Conclusion: EHR design offers opportunities to improve care and power innovative randomized trials. These findings support the feasibility of the DART clinical trial design, but research plans should take into account the potential for unpredictable nudge effects.

Disclosure
J. Flory: None. J. Ancker: Other Relationship; Ambry Genetics. S.Y. Kim: None. A. Vickers: None. M. Austria: None. H. Martirosova: None. R. Diaz: None. A. Hiestand: None. G. Kuperman: None.

Funding
Patient Centered Outcomes Research Institute (ME-2022C1-26378)
1069-P: Regular Insulin vs. NPH Insulin for Controlling Hyperglycemia in Hospitalized Patients on Continuous Enteral Tube Feeding
Authors: KALANGI SREEVASTAV T. , KENT DEVON , GARG RAJESH K. 
Published: June 2024

Hyperglycemia in the hospital setting is associated with adverse clinical outcomes. Enteral tube feed (TF), required for many acutely ill patients, often worsens glycemic control. Different insulin regimens have been proposed to manage hyperglycemia during TF. However, no data are comparing one insulin regimen Vs another. This study was conducted to evaluate the differences in glycemic control between NPH insulin Vs regular insulin, two regimens frequently used for continuous TF at our hospital. Patients who received continuous TF between June 2022 and May 2023 were identified retrospectively. Baseline demographic and POC blood glucose (BG) data were obtained from the electronic databases while all other data were collected using manual chart review. All BG values and insulin data (scheduled and correctional injections) were collected for 7 days after the start of TF. Glucometerics were derived as per the Society of Hospital Medicine. The results of the study are shown in the adjoining Table 1. Mean daily BG levels were similar in the two groups but the number of days with hyperglycemia (&gt;180mg/dl) was fewer in the regular insulin group. Average number of insulin injections were also fewer in the regular insulin group. The study shows that in hospitalized patients on continuous TF, regular insulin achieves better glycemic control with fewer injections as compared to NPH insulin.

Disclosure
S.T. Kalangi: None. D. Kent: None. R.K. Garg: None.
1074-P: Exploring Real-World Outcomes of Virtual Obesity Programs Integrated into Primary Care and Community Practices, With and Without AOM, in Patients with Type 2 Diabetes
Authors: RAMI BAILONY M. 
Published: June 2024

Background: This study evaluates the effectiveness of virtual obesity programs in Type II Diabetes patients, with a focus on those treated with and without Anti-Obesity Medications (AOM) over 12 months. The integration of telehealth and remote patient monitoring in community clinics is examined as a method to enhance obesity management.
Methods: Participants were adults (≥18 years) with BMI ≥30 kg/m² and starting A1c &gt;6.5, enrolled in an Enara affiliated digital obesity program before March 1st, 2022. Exclusions were made for pregnancy during the study. Patients were categorized based on AOM use, assessing weight change and cardiometabolic markers at 12 months.
Findings: The cohort of 134 patients (92 non-AOM, 42 AOM users) showed no significant difference in weight loss between groups (AOM: -11.15%; non-AOM: -11.19%). Key improvements included A1C (mean reduction: -0.93, p &lt; 0.001), fasting glucose (-30.13, p &lt; 0.001), HDL (+4.3, p &lt; 0.001), and Triglycerides (-48.55, p &lt; 0.001). Notably, AOM users had greater changes in A1C (-1.34 vs -0.61), glucose (-38.77 vs -23.01), HDL (+5.15 vs +3.58), and triglycerides (-54.63 vs -43.59).
Conclusion: Virtual obesity programs in community practices are effective, producing significant weight loss and improved cardiometabolic markers in patients, regardless of AOM use. The addition of AOM showed marginal extra weight loss benefit but notably better cardiometabolic improvements. This underscores the potential of digital health interventions in diabetes and obesity management in primary care and community settings.

Disclosure
M. Bailony: None.
109-OR: GIP Acutely Blunts Insulin- and GLP-1–Induced Muscle Microvascular Perfusion
Authors: LIU JIA , AYLOR KEVIN W. , LIU ZHENQI 
Published: June 2024

Glucose-dependent insulinotropic polypeptide (GIP) is an incretin hormone with extrapancreatic effects beyond glycemic control. Though vascular endothelium expresses GIP receptors, GIP’s vascular action has not been well defined. To assess the effect of GIP on muscle microvascular perfusion, adult male rats were fed either a chow or high-fat diet (HFD) for 2 weeks, fasted overnight, and randomly assigned to one of the following subgroups: 1) saline or GIP (4 pmol/kg/min) infusion for 120 min; 2) euglycemic hyperinsulinemic clamp (3 mU/kg/min) plus saline or GIP infusion for 120 min; 3) glucagon-like peptide 1 (GLP-1, 30 pmol/kg/min) plus saline or GIP infusion for 120 min. Compared to chow rats, HFD-fed rats exhibited increased visceral adiposity and higher fasting levels of serum insulin, GIP, and GLP-1. Hindlimb muscle microvascular perfusion was measured using contrast-enhanced ultrasound. Neither saline nor GIP infusion altered muscle microvascular perfusion in chow or HFD-fed rats. Insulin and GLP-1 infusion each significantly enhanced muscle microvascular perfusion in chow rats within 30 min and this effect lasted during the entire infusion period. GLP-1, but not insulin, also enhanced muscle microvascular perfusion in HFD-fed rats. Superimposing GIP infusion to either insulin or GLP-1 infusion completely abolished insulin-mediated microvascular perfusion in chow rats or GLP-1-induced microvascular perfusion in either chow- or HFD-fed rats, without altering serum levels of insulin or GLP-1. In cultured primary microvascular endothelial cells isolated from rat hindlimb muscle, GIP incubation for 24 h does-dependently increased ET-1 and inhibited GLP-1 (1 ng/mL)-induced nitric oxide (NO) production. We conclude that microvascular endothelium is a direct target of GIP action, and GIP modulates insulin’s and GLP-1’s vascular actions partly through the ET-1 and NO signaling pathways.

Disclosure
J. Liu: None. K.W. Aylor: None. Z. Liu: None.

Funding
National Institutes of Health (R01DK125330)
110-OR: Paternal Metabolism Modulates the Metabolome of Offspring during the Early Embryonic Period
Authors: FERRAZ-BANNITZ RAFAEL , OZTURK BERKCAN , EFTHYMIOU VISSARION , PATTI MARY-ELIZABETH 
Published: June 2024

Introduction & Objective: Obesity in females and males of reproductive age may impact health of offspring. Data indicate that paternal metabolism can contribute to intergenerational disease risk, likely via epigenetic modification. This study investigated the impact of paternal obesity and hyperglycemia on metabolomes of pre-implantation embryos.
Methods: C57BL/6J male mice (6 weeks) were fed low fat diet (LFD; 10% calories from fat) or high fat diet (HFD; 60% from fat) ad lib to induce obesity. After 4 weeks, HFD-fed mice were separated, creating 4 groups: (1) continued LFD, (2) continued HFD, (3) HFD with SGLT2i canagliflozin (CANA, 25 mg/kg/day), or (4) HFD with 15-30% caloric restriction (CR) to achieve weight matched to HFD-CANA (n=16/group). HFD-CANA and HFD-CR had lower weight and glucose vs. HFD (P&lt;0.05). At 16 weeks, males were bred with chow-fed females. After pregnancy confirmation, day 3.5 blastocysts were isolated, and pools from each of the 4 groups were analyzed using mass spectrometry; metabolomic data were analyzed using Metaboanalyst.
Results: Blastocysts derived from HFD males had reductions in acetyl-CoA, α-ketoglutarate (α-KG), and S-adenosyl-L-methionine (SAM) (P&lt;0.05), while decarboxylated-SAM (dc-SAM) (P&lt;0.05) was increased vs. LFD. This pattern was largely reversed in blastocysts derived from HFD-CANA males, with increased acetyl-CoA, α-KG and SAM and decreased dc-SAM (P&lt;0.05) vs. HFD. Changes in HFD-CR shared some features with HFD-CANA, including reduced dc-SAM (P&lt;0.05) and increased spermidine and spermine (P&lt;0.05).
Conclusion: Paternal HFD and interventions to improve paternal metabolism can modulate the blastocyst metabolome. Top-ranking regulated metabolites are key constituents of one-carbon metabolism and cofactors for epigenetic regulation including DNA methylation and histone modification; thus, changes in the early-embryo metabolome could contribute to sustained differences in epigenetic control and offspring phenotypes.

Disclosure
R. Ferraz-Bannitz: None. B. Ozturk: None. V. Efthymiou: None. M. Patti: Research Support; Dexcom, Inc. Consultant; Hanmi Pharm. Co., Ltd., MBX Biosciences. Other Relationship; Fractyl Health, Inc. Consultant; AstraZeneca, Spruce Biosciences.