bluuebunny/crossref_metadata_2025_split huggingface dataset:
1050-P: Comorbid Alcohol Use Disorder Is Associated with Increased Acute Care Utilization in Patients with Diabetes and Chronic Kidney Disease
Authors: GREBLA REGINA , STRAND LAUREN P. , ZHOU SUMMERA , ZHAO XIN , KESHISHIAN ALLISON , MCCLAIN MONICA , SPRINGER SANDRA 
Published: June 2024

Introduction: Alcohol use disorder (AUD) is associated with adverse health outcomes in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). This study examined healthcare resource use (HRU) and costs associated with comorbid AUD in patients with DM and CKD.
Methods: This retrospective cohort study identified adults with ≥1 inpatient or ≥2 outpatient claims for DM or CKD (MarketScan® and Medicare [1/1/2016-12/31/2020], Medicaid [1/1/2016-12/31/2019] databases), and ≥1 y of continuous healthcare enrollment before diagnosis (baseline period) and 3 mo after. Moderate-to-severe AUD was verified during baseline. HRU and costs were compared between propensity-score matched AUD and non-AUD patients in the DM and CKD cohorts, accounting for baseline demographics and other characteristics.
Results: 1,580,531 patients with DM and 1,155,142 patients with CKD were identified. Before matching, patients with AUD and DM (n=12,340) or CKD (n=14,472) were more likely to be younger, male, and have a higher comorbidity burden than patients without AUD. In matched cohorts, patients with DM and AUD had higher rates of inpatient (54%) and ED visits (27%), and longer inpatient stays (59%) vs non-AUD patients. Patients with CKD and AUD also had higher rates of inpatient (60%) and ED visits (35%), and longer inpatient stays (65%) vs non-AUD patients. Patients with AUD in both cohorts had slight increases in outpatient visits, fewer outpatient pharmacy claims, lower pharmacy costs, and higher total costs vs non-AUD patients.
Conclusion: Among patients with DM or CKD, comorbid AUD was associated with increased acute care utilization and total healthcare costs. Patients with comorbid AUD had lower outpatient pharmacy utilization which may increase the risk of suboptimal health outcomes in this population. These findings highlight the importance of effective AUD screening as part of a comprehensive care plan in patients with DM or CKD.

Disclosure
R. Grebla: Employee; Alkermes, Inc. Stock/Shareholder; Alkermes, Inc. L.P. Strand: Employee; Alkermes, Inc. Stock/Shareholder; Alkermes, Inc. S. Zhou: Consultant; Alkermes, Inc. X. Zhao: None. A. Keshishian: Consultant; Alkermes, Inc. M. McClain: Consultant; Alkermes, Inc. S. Springer: Research Support; National Institutes of Health, Veterans Administration. Other Relationship; Indivor Pharmaceuticals, Alkermes, Inc. Consultant; Alkermes, Inc.

Funding
This study was supported by Alkermes Inc.
1051-P: Cost-Effectiveness of Flash CGM Compared with SMBG—A Canadian Private-Payer Perspective
Authors: HARRIS STEWART B. , CIMINO SAL , THANH YEN NGUYEN THI , POON YEESHA , SZAFRANSKI KIRK 
Published: June 2024

Introduction & Objective: For people living with diabetes, effective glucose monitoring is recognized as a key component in diabetes care to reduce disease burden, complications, and healthcare utilization. This study aimed to assess the cost-effectiveness of flash CGM, compared with SMBG, from the perspective of a Canadian private payer.
Methods: A recently developed patient-level microsimulation model was used to compare flash CGM with SMBG. Time horizons of 40 years (T1DM) and 25 years (T2DM) were used, reflecting the period of typical private payer coverage. Costs and utilities were discounted at 1.5%. Population characteristics, treatment outcomes, and utilities were based on RCTs and RWE studies. Mean age at model entry was 23 years for T1DM and 40 years for T2DM. T2DM treatment assumptions were: 84% non-insulin; 10% basal insulin; and 6% MDI. Costs were taken from Canadian sources, and included flash CGM and SMBG acquisition costs, the costs to private payers of treating diabetes complications, and absenteeism costs. The primary outcome was cost per quality-adjusted life year (QALY).
Results: For both T1DM and T2DM, flash CGM provided more QALYs than SMBG while reducing costs (Table). Scenario analyses were consistent with the base-case results.
Conclusions: From a Canadian private payer perspective, flash CGM is cost effective compared with SMBG for all people living with diabetes.

Disclosure
S.B. Harris: Consultant; Abbott. Research Support; Boehringer-Ingelheim. Consultant; Dexcom, Inc. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Novartis AG. Consultant; Bayer Inc. S. Cimino: Consultant; Abbott, Boehringer-Ingelheim, Eisai Inc., Eli Lilly and Company, Merck & Co., Inc., Novartis Canada, Novo Nordisk Canada Inc., Takeda Canada. T. Nguyen: None. Y. Poon: Employee; Abbott. K. Szafranski: Consultant; Abbott, Novo Nordisk, Novartis Canada, CSL Behring, AbbVie Inc., Sanofi.
107-OR: Brain GLP-1R Is Likely Required for Peripheral Liraglutide Treatment on Stimulating Hepatic FGF21
Authors: NUO FENG JIA , SHAO WEIJUAN , JIN TIANRU 
Published: June 2024

Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are therapeutic agents for Type 2 Diabetes (T2D) and chronic weight management. We reported previously that peripheral GLP-1RA (liraglutide, Lira) administration stimulates hepatic fibroblast growth factor 21 (FGF21) in wild type but not GLP-1R-/- mice, and GLP-1R is not expressed in the liver tissue. Here we aim to determine the underlying mechanisms for such stimulatory effect via organ-organ communications. Firstly, we asked whether acute intraduodenal (i.d.) GLP-1RA administration stimulates hepatic FGF21; and if so, whether the stimulation requires GLP-1R. We revealed that i.d. administration of GLP-1RA in WT mice significantly elevated hepatic Fgf21 levels by 5-fold compared to WT mice received i.d. PBS, whereas such effect was virtually lost in GLP-1R-/- mice. Secondly, we investigated the central role of GLP-1R. We antagonized brain GLP-1R activity via i.c.v. Ex9-39 injection after peripheral Lira treatment in HFD-challenged mice. Mice received peripheral Lira treatment and i.c.v. Exendin 9-39 treatment show impaired stimulatory effect on serum FGF21 compared to the i.c.v. PBS counterpart, suggesting that brain GLP-1R is likely required for peripheral GLP-1RA to stimulate hepatic FGF21. Together, we further demonstrated that peripheral GLP-1RA administration stimulates hepatic FGF21, and revealed that such beneficial effect likely requires brain GLP-1R. Our study will aid the understanding of metabolic hormones and pave the way for determining their underlying mechanisms in metabolic homeostasis

Disclosure
J. Feng: None. W. Shao: None. T. Jin: None.

Funding
Canadian Institutes of Health Research (PJT159735) Guarantor: Tianru Jin
1072-P: Identifying Disparities in Diabetes Care for Minority Racial Groups—Evaluating an Enhanced Primary Care Practice Model
Authors: HERGES JOSEPH , COLE KRISTIN , MCCOY ROZALINA G. 
Published: June 2024

Purpose: The Enhanced Primary Care Diabetes (EPCD) model is an innovative nurse-led care delivery model which leverages multidisciplinary support including clinical pharmacist expertise which has been previously found to improve diabetes quality indicators. The purpose of our study was to assess the effectiveness and engagement of the EPCD model among different minority groups.
Methods: We utilized a retrospective cohort design to evaluate the time to meeting a publicly reported diabetes care quality measure (D5) following enrollment into the EPCD model for different minority groups. We included adult patients (18-75) with diabetes from 13 primary care practices in an integrated health care system that were enrolled in the model from 1/1/2020 to 12/31/2020 and followed through 8/1/2022. Associations with meeting D5 criteria were assessed using survival methods.
Results: The EPCD program enrolled 1,749 patients and 1,061 patients (60.7%) met the composite D5 outcome. Black patients were significantly less likely to meet the D5 composite measure compared to white patients (adjusted HR 0.68, CI 0.52-0.90; P= 0.007). There were no other statistically significant differences among other race/ethnicities compared to white patients. White patients had fewer nurse touch points per year (median 1.1; IQR 0.4, 2.7) compared to non-white patients (median 1.5; IQR 0.5, 3.4) (P= 0.003).
Conclusions: Overall time to meeting D5 indicators was longer for black patients compared to white patients in the EPCD model, despite more engagement in non-white patients. Further research is warranted to identify driving factors for these disparities and solutions to improve performance in the black population.

Disclosure
J. Herges: None. K. Cole: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.
1078-P: The Impact of Telemedicine Use on Subsequent Glycemic Control in Patients with Diabetes
Authors: THURBER EMILIA G. , LAN ZHOU , TURCHIN ALEXANDER 
Published: June 2024

Introduction & Objective: Telemedicine visits increased significantly during the COVID-19 pandemic, particularly in endocrinology. While many providers continue to use telemedicine, its impact on patient outcomes remains uncertain. This study sought to determine the effect of varying levels of telemedicine use on clinical outcomes in patients with diabetes.
Methods: In this retrospective observational study, we examined the relationship between telemedicine use and glycemic control in patients seen by endocrinology for diabetes at an integrated health system. Patients were included if they had a baseline HbA1c in 2020, at least two visits for diabetes in 2021, and an outcome HbA1c in 2022.
Results: The study population (n=9,195) was 51.3% female with a mean age 63.9 (SD 13.7) years and baseline HbA1c 7.7% (SD 1.5). Patients had a mean of 34.8% (SD 39.0) telemedicine visits in 2021. Between 2020 and 2022, HbA1c decreased by a mean of 0.17% (SD 1.39). In univariate ANOVA analysis, HbA1c decreased by 0.19% (SD 1.37) in patients with no telemedicine use, 0.18% (SD 1.39) in patients with both telemedicine and in-person visits, and 0.09% (SD 1.4) in patients with only telemedicine visits (p = 0.047). In a multivariable linear regression model adjusted for patient demographics, baseline HbA1c and renal function, diabetes type, insulin use, and comorbidities, a higher percentage of telemedicine use was associated with a lower decrease in HbA1c (coefficient = 0.11, 95% CI 0.03 - 0.18, p = 0.003). Older age and insulin use were also associated with a lower decrease in HbA1c, while being partnered, completing at least some college, public insurance, Type 1 DM, higher BMI, and higher baseline HbA1c were associated with a greater HbA1c decrease.
Conclusion: Patients with a high percentage of telemedicine use may have worse glycemic control. Additional research is needed to determine the possible causes for this finding and strategies for delivering effective telemedicine care for patients with diabetes.

Disclosure
E.G. Thurber: None. Z. Lan: None. A. Turchin: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Novo Nordisk, Proteomics International. Research Support; AstraZeneca.

Funding
National Institutes of Health (T32DK007529)
1097-P: Implementation Science and Pediatric Diabetes—A Scoping Review of the State of the Literature and Guidance for Future Research
Authors: PRICE JULIA , HAWKINS JACLYNN M. , AMANTE DANIEL J. , JAMES RICHARD , HAIRE-JOSHU DEBRA 
Published: June 2024

Introduction & Objective: Implementation science (IS) offers rigorous methods to increase use of evidence-based practices (EBPs) in standard care. It is unclear how much and what types of IS research have been conducted in pediatric type 1 (T1D) and type 2 diabetes (T2D). The current scoping review aimed to identify IS-focused research in pediatric diabetes, evaluate integration of IS theory, methods, and terminology, and offer guidance to expand implementation research in pediatric diabetes medical, psychosocial, and education care.
Methods: Following the JBI guidelines and PRISMA-ScR checklist for scoping reviews, a search of PubMed, Scopus, PsychINFO, Emcare, CINAHL, and Cochrane Trials Register databases was conducted on 1/31/2023 for English language articles and repeated in 11/2023. Identified articles were uploaded into Covidence. Two independent reviewers screened articles and completed data extraction.
Results: 156 studies were identified in the initial search, 62 reached full-text review, and 23 were included in analyses. Of the 23 included papers, 19 were published between 2017 and 2023 and 21 focused on T1D. Most studies involved medical EBPs (n=15), whereas fewer focused on psychosocial (n=7) and diabetes education (n=2) EBPs. Most studies (n=11) identified barriers and facilitators of implementing an EBP or were implementation trials (n=11); fewer studies documented gaps in use of an EBP in standard clinical practice (n=7). Only one paper detailed development of an implementation strategy. Five papers employed implementation science theories/models/frameworks.
Conclusions: This scoping review identified a young literature examining implementation of EBPs in pediatric diabetes. Few studies employed IS theory and terminology and few described implementation strategies. Guidance for future work to increase use of EBPs across medical, psychosocial, and education care for pediatric diabetes is offered.

Disclosure
J. Price: None. J.M. Hawkins: None. D.J. Amante: None. R. James: None. D. Haire-Joshu: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (5K23DK125666); National Institute of Diabetes and Digestive and Kidney Diseases (5K01DK131318)
1099-P: Diabetes Collaborative Care for Young Adults (DCCYA) Is a Feasible Care Model for Young Adults with Diabetes
Authors: VAKHARIA JANAKI D. , THEODORAKAKIS MARIA , SCHULTE CAROLIN C.M. , O'DONNELL ELLEN , WEXLER DEBORAH J. 
Published: June 2024

Young adults (YAs) with diabetes mellitus (DM) have a high prevalence of depressed mood, diabetes-related distress (DRD), and competing demands that contribute to uncontrolled DM, especially during the transition from pediatric to adult care. We piloted the Diabetes Collaborative Care for Young Adults (DCCYA) model that incorporates a behavioral health provider during office visits to facilitate care of psychosocial determinants of DM management for YAs with DM after transition to adult care. We determined DCCYA feasibility compared to usual care (UC), defined by visit retention rate, over a 9-month period. YAs with type 1 or type 2 DM were assigned based on whether their initial visit to the adult DM clinic was scheduled with the DCCYA care team (DCCYA, n=16) or not (UC, n=29). Baseline mean HbA1c differed between groups (8.5 ± 2.4% DCCYA vs. 7.1 ± 1.2% UC, p=0.03) but baseline prevalence of mental health disorders, engagement in mental health treatment, and patient-reported outcomes of DRD and depressed mood did not (Table 1). DCCYA patients had more scheduled visits during the 9-month period than UC patients (3.9 ± 1.5 vs. 2.4 ± 1.3, p=0.02). DCCYA mean visit retention rate (0.62 ± 0.24) was comparable to that of UC (0.52 ± 0.36) (p=0.4), demonstrating feasibility. Future studies will aim to assess DCCYA impact on DM care parameters and psychosocial determinants of health in a larger cohort.

Disclosure
J.D. Vakharia: None. M. Theodorakakis: None. C.C.M. Schulte: None. E. O'Donnell: None. D.J. Wexler: Other Relationship; Novo Nordisk.

Funding
National Institutes of Health (T32DK007028)
11-OR: Combined DPNCheck and SUDOSCAN as a Screening Tool for DPN—The Sheffield Prospective Study
Authors: SHAAN GOONOO MOHUMMAD , SELVARAJAH DINESH , SLOAN GORDON P. , TESFAYE SOLOMON 
Published: June 2024

Introduction & Objective: Diabetic peripheral neuropathy (DPN) is often diagnosed late. Point-of-care-devices (POCDs, ‘DPN-Check’ a handheld device which measures sural-nerve conduction-velocity/amplitude and SUDOSCAN a test of sudomotor-function) are objective, quick tests that when combined; accurately diagnose DPN. However, the ability of POCDs to predict incident DPN is unknown, and was examined in this prospective study.
Methods: 229 consecutive participants with diabetes who attended one-stop microvascular screening service were re-called for follow-up evaluation at 7 years. Baseline assessments were repeated including: clinical and neurophysiological assessments of DPN [Toronto Clinical Neuropathy Score (TCNS),10g monofilament (10g-MFT), POCDs and nerve conduction studies (NCS). Risk of developing incident DPN was assessed using the odds-ratio for the diagnosis of DPN using clinical (TCNS, 10gMFT) and NCS.
Results: 90 participants have completed follow up visits. Patients attending follow up were significantly younger [57.8(11.9)vs62.5(14.2)years; (p&lt;0.001(95%CI 4.1:11.4)] than those who did not (n=139), and had lower number of co-morbidities [3.0vs5.5; P&lt;0.001] and Q-risk (20.3(13.1)vs29.3(13.5); p&lt;0.001). Thirty-four (37.8%) patients had incident 10g MFT abnormality at follow-up. Patients with abnormal POCDs had a OR 7.1(p&lt;0.001;95%CI:2.3:22.8) times greater risk of 10g-MFT abnormality compared to those with normal POCDs at baseline. Similar increased risk of incident DPN were found when DPN was diagnosed using TCNS [OR 4.0(95%CI1.0:15.2, p=0.03)] and NCS [OR 11.9(95%CI:1.5:96.0, p=0.005)].
Conclusions: We have demonstrated significantly increased risk of incident clinical DPN in patients with abnormal baseline POCDs (microalbuminuria equivalent). These findings support the use of POCDs as a screening tool for early DPN diagnosis, when cardio-metabolic control may halt the progressive neuropathic process.

Disclosure
M. Goonoo: None. D. Selvarajah: Research Support; Abbott. Speaker's Bureau; Grunenthal. Research Support; Impeto medical. G.P. Sloan: Other Relationship; Procter & Gamble, Lilly Diabetes. S. Tesfaye: Advisory Panel; Angelini Pharma, AstraZeneca, Bayer Inc., Worwag Pharma, Nevro Corp. Other Relationship; GlaxoSmithKline plc, Novo Nordisk Foundation. Speaker's Bureau; Procter & Gamble, Viatris Inc. Research Support; Withings, Viatris Inc., Procter & Gamble.

Funding
Proctor & Gamble Health (STH SPONSOR ID STH22196)
1109-P: Diabetes Technology Education Processes among Centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: WOLF RISA M. , OSPELT EMMA L. , GOLDEN LAUREN , EBEKOZIEN OSAGIE , ANTAL ZOLTAN , GUARNERI ALISSA , STEENKAMP DEVIN W. , NELSON GRACE , CROSSEN STEPHANIE , KELLIS MARY V. , AGARWAL SHIVANI , COLLABORATIVE T1DX-QI 
Published: June 2024

Background: With increasing use of diabetes technologies in type 1 diabetes care, we sought to describe prescribing practices and education processes for initiating diabetes technologies across T1DX-QI centers.
Methods: A survey was administered from July to September 2023 to 55 centers participating in the T1DX-QI on diabetes technology prescription and education processes. Descriptive analysis was completed.
Results: Of 55 centers, 50 (91%) completed the survey. Across centers, the endocrinologist is most likely to initiate prescriptions for continuous glucose monitors (CGM), and 64% routinely prescribe CGM at the time of diagnosis. Medical assistants are most likely to manage prior authorizations, and diabetes educators are most likely to provide standardized education once devices are received (Figure 1a). For all technology types (insulin pumps, CGM, automatic insulin delivery (AID), and smart insulin pens (SIP)), the majority of centers provide device education in an outpatient setting (93%), in person by a clinic staff member (61%), and done once the patient receives the device (62%).
Conclusions: The majority of endocrinologists prescribe CGM at time of diagnosis. Offering standardized training for diabetes technology is not universal, and differs among pediatric and adult centers (Figure 1b).

Disclosure
R.M. Wolf: Research Support; Dexcom, Inc., Boehringer-Ingelheim, Novo Nordisk. E.L. Ospelt: None. L. Golden: None. O. Ebekozien: Advisory Panel; Sanofi, Medtronic. Research Support; Vertex Pharmaceuticals Incorporated. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; Medtronic, Lilly Diabetes, Abbott, Dexcom, Inc. Z. Antal: Consultant; Bayer Inc. A. Guarneri: None. D.W. Steenkamp: Consultant; Abbott. Research Support; Novo Nordisk A/S, MannKind Corporation, Tandem Diabetes Care, Inc. G. Nelson: None. S. Crossen: None. M.V. Kellis: None. S. Agarwal: Research Support; Dexcom, Inc. Advisory Panel; Medtronic. Consultant; Beta Bionics, Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1116-P: KnovaSolutions Diabetes Client Case—Improving Diabetes Management and Lowering Treatment Costs
Authors: ARCHER LINDA L. , BRENNEMAN PAULA , LLOYD SARAH , CHAPLIK ANNETTE , VANNETT JULIE , SZELC KELLEY A. 
Published: June 2024

Introduction & Objective: Workpartners’ KnovaSolutions diabetes program takes a holistic approach. The services equip and empower individuals with diabetes to navigate complexity, improve their health, and make better-informed healthcare decisions. This, in turn, improves their quality of life, reduces waste, and lowers benefit costs.
Methods: A client case study was conducted using our proprietary data analysis; we identified individuals with a diabetes diagnosis and stratified them according to their risk. The individuals completed an initial assessment to identify gaps and areas of focus. The client offered medication and diabetes supply incentives to Health Plan-enrolled individuals with a diabetes diagnosis. The individuals received the incentive based on quarterly interaction with the CDCES. The goals of the program were to reduce complications and medical costs by removing barriers to self-management.
Results: The results revealed marked improvements in overall average cost reduction of $3,219 for individuals with type 2 diabetes, 50 percent reported a reduction in weight and average blood sugar (HbA1c), 36 percent had a reduction in LDL cholesterol, and medication adherence increased by as much as 6 percent.
Conclusion: Workpartners’ KnovaSolutions diabetes program is unique. The CDCES uses motivational interviewing to elicit the person’s desire to change and clinical expertise to empower people with the knowledge and skills to improve their diabetes self-management. After one year of the KnovaSolutions diabetes program, there was an improvement in key health risk indicators and a considerable average cost reduction per participant.

Disclosure
L.L. Archer: None. P. Brenneman: None. S. Lloyd: None. A. Chaplik: None. J. Vannett: None. K.A. Szelc: None.