bluuebunny/crossref_metadata_2025_split huggingface dataset:
492-P: Implementation of Retinal Scans in a Pediatric Diabetes Clinic to Improve Screening in a Non-commercially Insured Population
Authors: THAKUR ISHAAN , CHOUDHARY ABHA 
Published: June 2024

Background: The SEARCH for Diabetes in Youth Registry reported the prevalence of diabetic retinopathy in children with Type 1 and Type 2 diabetes as 5.6% and 9.1% respectively. The American Diabetes Association recommends annual retinopathy screening in children ≥ 11 years of age or at onset of puberty whichever is earlier, 3-5 years after diagnosis of Type 1 diabetes. The screening is recommended annually immediately after diagnosis of Type 2 diabetes. In our academic endocrinology practice, we have 2000 established patients with Type 1 diabetes and 900 patients with Type 2 diabetes. Our non-commercially insured population is around 40%.
Methods: NIDEK Navis- EX retinal scanner was installed in June 2020 in the clinic for the Medicaid population to improve screening since this group had suboptimal retinal screening. The scan was performed by the medical assistants at check-in during the diabetes clinic visit based on eligibility. The images were transferred to the ophthalmology colleagues for a reading. Once the read was completed, the results were sent back to the patient’s electronic medical records.
Results: The retinal scan screening was at 37.4% for all insurance groups prior to the implementation of the scanner. After the installation of the scanner, the screening rates increased to 48.7%, 64.8%, and 64.8% at the end of years 1, 2, and 3 respectively in the non-commercially insured group. Among the 349 patients screened in our clinic during the 1st year, 7 had non-proliferative diabetic retinopathy.
Conclusions: We improved the retinopathy screening rates in the non-commercially insured population at our center. We are working with our institution, so we can perform retinal scans in our clinic for all our patients without a huge financial burden for our families.

Disclosure
I. Thakur: None. A. Choudhary: None.
5-OR: Renal Hypermetabolism in Youth-Onset Type 2 Diabetes (T2D)—A C-11 Acetate PET Scan Analysis
Authors: LEROUX MELISSA , JI CHOI YE , NGUYEN NHUNG , PYLE LAURA , TOMMERDAHL KALIE L. , RICHARD GABRIEL , BLONDIN DENIS , VAN RAALTE DANIËL , BJORNSTAD PETTER 
Published: June 2024

Introduction & Objective: Renal hypermetabolism in youth-onset T2D presents a critical area of study due to potential metabolic implications. Prior kidney biopsy research indicated upregulated metabolic pathways, such as the TCA cycle and oxidative phosphorylation, in the proximal tubules of patients with T2D. However, the functional impact of these transcriptomic changes remains unclear. This study aims to evaluate oxidative metabolism in youth with obesity and T2D, and its clinical implications, using C-11 acetate PET scans.
Methods: This study involved 18 youths with obesity and T2D, and 11 normal weight controls (NWC). We employed C-11 acetate PET scans to measure cortical and medullary oxidative rates (k2), and cortical perfusion (F). Statistical analyses focused on comparing these rates between the two groups, along with spearman correlations between oxidative rates and urinary albumin-to-creatinine ratio (UACR).
Results: Youths with obesity and T2D exhibited significantly higher cortical (0.21 [0.15, 0.34] vs. 0.17 [0.14, 0.22] min-1, p=0.002) and medullary (0.20 [0.16, 0.35] vs. 0.14 [0.11, 0.18] min-1, p&lt;0.0001) oxidative rates compared to NWC. Cortical perfusion was lower in the T2D group, but medullary perfusion did not differ significantly. The ratio of cortical and medullary K2/F was higher in T2D, indicating a metabolic mismatch. Additionally, higher oxidative rate (k2) and cortical k2/F ratio correlated with UACR (r: 0.41, p=0.038; r: 0.47, p=0.014, respectively).
Conclusion: The study demonstrates a pronounced elevation in oxidative metabolism and a notable mismatch between oxidative metabolism and perfusion in youths with obesity and T2D, compared to NWC. This is associated with increased albuminuria. These findings corroborate the transcriptional changes observed in kidney biopsies, particularly in the transcripts of TCA and oxidative phosphorylation, underscoring the functional relevance of these molecular alterations.

Disclosure
M. Leroux: None. Y. Choi: None. N. Nguyen: None. L. Pyle: None. K.L. Tommerdahl: None. G. Richard: Research Support; Eli Lilly and Company. D. Blondin: None. D. van Raalte: Consultant; Eli Lilly and Company. Research Support; Eli Lilly and Company, Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim. Research Support; Merck & Co., Inc. Advisory Panel; Merck & Co., Inc. Consultant; Bayer Inc. P. Bjornstad: Consultant; AstraZeneca, Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes, Novo Nordisk, Bayer Inc., Horizon Therapeutics plc.

Funding
NIH/NIDDK
5-PUB: Retrospective Study of Patients with Dyslipidemia With and Without Type 2 Diabetes Mellitus Treated with a Fixed-Dose Combination of Rosuvastatin/Ezetimibe
Authors: RODRIGUEZ VAZQUEZ ILEANA C. , RIOS-BRITO KEVIN F. , SANDER-PADILLA JOSE G. , RODRIGUEZ-ROCANDIO KARLA E. , LUGO-SÁNCHEZ LAURA A. , ARGUEDAS MARÍA M. , FLORES-HUANOSTA DIANA , GONZALEZ-CANUDAS JORGE , ROMERO YULIA 
Published: June 2024

Introduction and Objective: Currently, dyslipidemia is one of the most common comorbidities in patients with Type 2 Diabetes Mellitus (T2DM), for which cardiovascular risk (CVR) is usually underestimated, being this the case where the use of combined therapy of statins and ezetimibe is considered one of the best options. The aim of the study was to evaluate a cohort of patients with dyslipidemia with and without T2DM treated with a fixed-dose combination (FDC) of rosuvastatin/ezetimibe.
Methods: Retrospective study, in patients with dyslipidemia with and without T2DM treated with FDC rosuvastatin/ezetimibe (10/10 or 20/10 mg once daily). Information was collected retrospectively, from patients' clinical records, including complete biochemical results and lipid profile from three visits (baseline, 2 and 4 months). Mann Whitney U and chi-square tests were performed for comparisons between groups, with SPSS 29v. statistical program.
Results: Data from 103 patients was collected (55.4% men), mean age of 56 years and body mass index (BMI) of 28.4 Kg/m2. Patients' median baseline glucose was 145mg/dL (IQR: 118; 228), and 138 mg/dL (IQR: 112.6; 191.5) for final follow-up visit for the group with T2DM (n=33), 90mg/dL (IQR: 86.2; 97.6) and 93mg/dL (IQR: 89.0; 97.0) for the no T2DM group (n=57), respectively. For the observed target values, by the end of follow-up 29% of patients without T2DM and 20% with T2DM had achieve triglyceride levels &lt;150mg/dL (p= 0.001), while 36.8% vs 50.5%, respectively had achivied LDL-C levels &lt;100mg/dL (p= 0.056) at the final visit. FDC treatment exhibited an appropriate safety profile.
Conclusion: FDC rosuvastatin/ezetimibe has shown a significant clinical impact on lipid profile biomarkers in patients with dyslipidemia with and without T2DM, mainly in the achievment of LDL-C reduction of &lt;100mg/dL.

Disclosure
I.C. Rodriguez Vazquez: Employee; Laboratorios Silanes S.A. de C.V. K.F. Rios-Brito: Employee; Laboratorios Silanes S.A. de C.V. J.G. Sander-Padilla: Employee; Laboratorios Silanes. K.E. Rodriguez-Rocandio: Employee; Laboratorios Silanes S.A. de C.V. L.A. Lugo-Sánchez: Employee; Laboratorios Silanes S.A. de C.V. M.M. Arguedas: Employee; Laboratorios Silanes S.A. de C.V. D. Flores-Huanosta: Employee; Laboratorios Silanes. J. Gonzalez-Canudas: Employee; Silanes SA CV. Y. Romero: Employee; Laboratorios Silanes.

Funding
Laboratorios Silanes S.A. de C.V.
524-P: Diabetic Foot Ulcer Wound Dressings May Serve as an Untapped Source of Predictive and Monitoring Biomarkers of Healing Outcome
Authors: JOZIC IVAN 
Published: June 2024

Introduction and Objective: The purpose of our study was to utilize discarded wound dressings from diabetic foot ulcers (DFUs) in order to identify potential predictive and diagnostic biomarkers by the proteomic analysis of cells and exosomes captured from wound exudate.
Methods: DFU patients were followed weekly for 4 weeks and change in wound size measured by EKARE inSight imaging equipment at each visit, at which point the wound dressing was collected. Cells from each dressing were then isolated, number of viable cells quantified and immunophenotyped by flow cytometry. Differential centrifugation was then used to isolate exosomes from each specimen, with exosomes purified using magnetic beads and validated by western blotting and FACS flow cytometry. Next, all samples were subject to trapped ion mobility spectrometry analysis of cellular and exosomal proteome. Lastly, we utilized m/z to identify and quantify relative peptide species, followed by analysis of hierarchical clustering of samples and functional annotation of identified clusters.
Results: From cellular immunophenotyping, we were able to determine those wounds which exhibited higher levels of gamma/delta T-cells (CD45+CD3+TCRg/d+) also exhibited trends towards reductions in wound size. Next, we were able to validate previous proteomic profiling reports of wound exudate that associated with poor healing outcomes (CTSG, LCN2, DEF1, MMP9, HBA, HBB, CAMP, VTN, among others). Lastly, our data suggests that healing wounds exhibit higher levels of ALB, SERPING1, CERU, CO3, POSTN, FN1, FGA (among others) in their week 1 dressings, and may act to serve as potential predictive biomarkers of healing wounds.
Conclusions: Together, our innovative approach to proteomic profiling of DFU wound dressings has demonstrated reproducible and encouraging results and we anticipate that higher recruitment will shed light on variability in healing outcomes and identify other potential biomarkers.

Disclosure
I. Jozic: None.

Funding
American Diabetes Association (11-22-JDFPM-07); National Institutes of Health (1R21AR083526-01)
529-P: Diagnosis Approach of Suspected Osteitis in Diabetic Foot Ulcer—The Multicentric French 2023 Survey
Authors: KEVORKIAN JEAN-PHILIPPE , FÉRON FLORINE , RIVELINE JEAN-PIERRE , GAUTIER JEAN-FRANÇOIS 
Published: June 2024

Bedside Blind Bone Biopsy (B4) through healthy skin is a valid alternative to bone biopsy usually performed in the operating (OR) or radiology (RR) room for the diagnosis of diabetic foot ulcer osteitis (DFU) (IWGDF/IFDSA 2023 guidelines). From 12.17.2015 to 12.31.2023, in our Diabetology unit, 451 B4 have been carried out in 1434 patients admitted with a DFU (31%). B4 rate and performance increased with skill over time (B4 rate: 2023, 55% vs 2016, 15%, proven osteitis: 2023, 68% vs 2016, 50%).
A 19 items quiz has been emailed to the 159 DFU centers (10.22.23-11.07.23 request) in order to assess the diagnosis procedures habits in France in case of DFU suspected osteitis. Respondent rate is 47% (75/159, diabetology units 77%). Microbiological sampling is performed in 92% (samples other than bone biopsy or probabilistic treatment 8%). If bone biopsy performed, B4 is the procedure of choice in 42%, done in various circumstances (conventional hospitalization 79%, ambulatory 62%, consultation 41%). A &gt;2 years experiment is declared in 72%, ≥2 B4/month 55%, ≥2 samples/B4 69%, specific bone biopsy trocar 38%, through healthy skin 79%, systematical post-B4 blood cultures 21%. Conventional bone biopsy (58%) is performed exclusively in the OR (58%) or in the RR (12%), in one or the other (30%). Treatment of DFU osteitis is based on non validated procedures in 16%. A DFU multidisciplinary team is available in 44% of the centers practicing B4. Despite its proven feasibility and valuable help for the diagnosis of DFU osteitis, B4 is poorly and imperfectly used in french DFU centers.

Disclosure
J. Kevorkian: None. F. Féron: None. J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. J. Gautier: Board Member; Sanofi. Other Relationship; Sanofi. Speaker's Bureau; AstraZeneca, Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc.
537-P: Community-Based Diabetes Management—Evaluating the Efficacy of Do Right! Diabetes Challenge
Authors: TRICHY NITHYA S. , MAHAFFEY HARRIS RENEE 
Published: June 2024

Introduction & Objective: The Do Right! Diabetes Challenge is a comprehensive lifestyle intervention program designed for African Americans diagnosed with Type-2 Diabetes or Prediabetes in the Greater Cincinnati area. Recognizing the unique challenges faced by under-resourced communities, the ultimate goal of this intervention is to generate a sustainable impact on overall health and improve diabetes control.
Methods: We enrolled 22 participants for a 12-week intervention. Participants aged 18 or older with HbA1C ≥ 5.6 mg/dL, residing in the Greater Cincinnati area, were eligible for inclusion. The intervention consisted of weekly exercise sessions with a personal trainer, nutrition education classes, and life-coaching sessions. Key health metrics for diabetes, including HbA1C, total cholesterol, blood pressure, Body Mass Index (BMI), and waist circumference (in.) were measured before and after the intervention. Statistical analyses were conducted using a Wilcoxon Signed-Rank Test since all variables were matched, continuous, and nonparametric per the Shapiro-Wilk Test.
Results: Enrolled participants had a 1.47 mg/dL (p&lt; 0.007) reduction in HbA1C levels after participating in the program compared to baseline. Additionally, there was a reduction of 12.72 mmHg (p&lt; 0.002) in diastolic blood pressure and a reduction of 6.6 in. (p&lt; 0.005) of waist circumference compared to baseline. However, no significant change in cholesterol levels, systolic blood pressure, or BMI was observed.
Conclusion: The Do Right! Diabetes Challenge significantly improved participant’s health measures including HbA1C, diastolic blood pressure, and waist circumference. The findings of the study underscore the potential benefit of targeted, comprehensive interventions for improving diabetes care in disadvantaged communities. In the future, a larger cohort will be enrolled to further investigate the longitudinal impact of community-based diabetes management for at-risk patient populations.

Disclosure
N.S. Trichy: None. R. Mahaffey Harris: None.
547-P: Success of Virtual Patient Simulation at Improving Comprehensive Management of Obesity in Patients with Prediabetes or Glucose Intolerance
Authors: LARKIN AMY , LACOUTURE MICHAEL 
Published: June 2024

Background: We sought to assess the impact of online, virtual patient simulation (VPS)-based continuing medical education (CME) on performance of physicians (MDs) related to obesity in patients with prediabetes or glucose intolerance.
Methods: The intervention comprised two different patient scenarios in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) using a McNemar’s test. Data was collected November, 2022 through February, 2023.
Results: MDs (n=549) who completed at least 1 case were included (n=20 in practice &lt;5 years, n=246 in practice &gt;5 years).
Ordering obesity pharmacotherapy: MDs in practice &gt;5 years had 28%-40% absolute improvement (P&lt;.01; baseline 13%-15%) compared to MDs in practice &lt;5 years had 20%-25% absolute improvement (P&lt;.05; baseline 13%-15%).
Nonpharmacologic therapy: MDs in practice &gt;5 years had 13%-19% absolute improvement (P&lt;.01; baseline 48%-70%) compared to MDs in practice &lt;5 years had 25%-30% absolute improvement (P&lt;.05; baseline 50%-75%).
Continued Gaps: MDs in practice &lt;5 years had the largest continued gaps in ordering obesity pharmacotherapy (60%-62%). MDs in practice &gt;5 years had the largest continued gaps in nonpharmacologic approaches (17%-33%).
Conclusion: VPS can improve evidence-based clinical decisions related to comprehensive management of obesity in patients with prediabetes or glucose intolerance. This simulation was more effective at closing gaps in physicians in practice &lt;5 years regarding nonpharmacologic options, but more effective in physicians in practice &gt;5 years at pharmacologic therapy.

Disclosure
A. Larkin: None. M. LaCouture: None.

Funding
Developed through an independent educational grant from Novo Nordisk, Inc.
552-P: Barriers and Enablers to Diabetic Ketoacidosis (DKA) Prevention in Adults with Type 1 Diabetes—An Implementation Science Study
Authors: VERHOEFF NATASHA , CHEEMA WAJEEHA , MOJDEHI SARA , GAD HODA Y. , MUMFORD DOUG , ORSZAG ANDREJ , IVERS NOAH , BUDHRAM DALTON R. , BAKHSH ABDULMOHSEN M.K. , ABUABAT MOHAMMAD I. , WEISMAN ALANNA , PERKINS BRUCE A. 
Published: June 2024

Introduction & Objective: DKA prevention depends strongly on patient knowledge and self-management skills, but educational tools are inconsistent and complex. To co-create a new tool with people living with T1D, we first aimed to determine key barriers and enablers to DKA prevention through identification of the perspectives of people living with T1D, their caregivers, and healthcare providers.
Methods: We conducted a qualitative study involving three independent focus groups. The focus group design and analysis were informed by the Action, Actor, Context, Target, and Time Framework (AACTT) to carefully define the key targeted behaviours for change and the Theoretical Domains Framework (TDF) to understand their determinants. The targeted behaviours related to testing ketone levels, acting upon ketone testing results, and seeking emergency medical care. Deductive coding and thematic analysis were used to categorize and describe barriers and enablers for each targeted behaviour.
Results: A total of 9 people living with T1D, 1 caregiver, and 12 healthcare providers participated in our focus groups. Five key themes relating to six TDF domains emerged that influenced one’s ability to engage in the targeted behaviours. Key barriers included: 1) a fundamental lack of understanding of the clinical relevance of ketones and DKA (knowledge, beliefs about consequences); 2) negative experiences with the healthcare system and lack of access to supplies (environmental context and resources); 3) inability to retain ketone knowledge among numerous self-management burdens (memory). Key enablers included: 1) reminders from physicians and/or technology (reinforcement); 2) community supports and accessible resources (social influences).
Conclusion: These key barriers and enablers to DKA prevention will inform the development of an educational tool co-created with people living with T1D designed to more effectively prevent DKA than do existing resources.

Disclosure
N. Verhoeff: None. W. Cheema: None. S. Mojdehi: None. H.Y. Gad: Consultant; Procter & Gamble. D. Mumford: None. A. Orszag: None. N. Ivers: Speaker's Bureau; Novo Nordisk. Consultant; Merck & Co., Inc. D.R. Budhram: None. A.M.K. Bakhsh: None. M.I. Abuabat: None. A. Weisman: None. B.A. Perkins: Advisory Panel; Abbott. Other Relationship; Novo Nordisk. Advisory Panel; Insulet Corporation, Nephris. Other Relationship; Medtronic. Advisory Panel; Sanofi, Vertex Pharmaceuticals Incorporated, Dexcom, Inc.

Funding
Diabetes Canada (Operating Grant OG-3-21-5572-BP)
562-P: A Social Media Intervention Shows Promise to Improve Health Outcomes in Low-Income Immigrants with Type 2 Diabetes—Evidence from a Pilot RCT
Authors: SHI YUN , ANN SEVICK MARY , TANG HAO , YANG XIMIN , JIANG YULIN , LIN NELSON , ONG IRIS H. , SU LIWEN , BAI YUJIE , HU LU 
Published: June 2024

Objectives: To pilot test a social media-based intervention on glycemic control among low-income Chinese immigrants with Type 2 Diabetes (T2D).
Methods: We conducted a pilot RCT with 60 Chinese immigrants with T2D with 30 randomly assigned to the intervention group and 30 to the wait-list control group. The intervention group received two culturally and linguistically tailored videos per week for 12 weeks, covering diabetes knowledge, healthy eating, physical activity, medication adherence, glucose monitoring, and behavioral changes. In addition, they also received bi-weekly support calls from study community health workers to set goals, problem-solve, and address social determinants. HbA1c, dietary intake, and physical activity were assessed at baseline, 3, and 6 months.
Results: Most participants (mean age 54[11.5] years) were male (60%), employed (58%), had a high school education or less (70%), annual household income &lt; $25,000 (50%), and limited English proficiency (88.3%). The two groups were comparable at baseline, except for employment status, which we adjusted for in our analysis. At 6 months, the intervention group had a significantly greater increase in fruit intake than the control group (0.19 cups vs. -0.27 cups, p=0.044). For other outcomes, despite no between-group differences, the intervention group had significant within-group reductions in HbA1c (1.4%, p&lt;0.001), increased vegetable intake (0.53 cups, p=0.02), and reduced starchy food intake (-0.34 cups, p=0.012) at 6 months.
Conclusions: The notable improvement in HbA1c and dietary intake within the intervention group suggests the potential efficacy of the intervention. However, due to the limited sample size of this study, a larger-scale RCT with sufficient power is warranted to determine the efficacy conclusively.

Disclosure
Y. Shi: None. M. Sevick: None. H. Tang: None. X. Yang: None. Y. Jiang: None. N. Lin: None. I.H. Ong: None. L. Su: None. Y. Bai: None. L. Hu: None.

Funding
National Insitutes of Health (K99MD012811, R00MD012811)
563-P: How Continuing Education (CE) Supported Guideline-Based Treatment among Patients with Diabetes
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 therapies compared to a control group of non-learners for the treatment of diabetes
Methods: Med Learning Group (MLG) conducted 37 CE activities in 2023 as part of an educational initiative supported by an independent educational grant from Novo Nordisk. The education focused on diabetes and treatment options with glycemic and extra-glycemic effects. 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 knowledge of the role of GLP-1 RAs in diabetes care based on pre-/post-test questions (N=4738). 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. The therapeutic landscape included GLP-1 RAs, SGLT2 inhibitors and GLP-1-GIP combination therapies. Learners selected 521,111 new guideline-recommended pharmacologic interventions for diabetes in the study period. This is 15,578 more (new) guideline-recommended treatments than the control group (p=0.0006).
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