bluuebunny/crossref_metadata_2025_split huggingface dataset:
925-P: Using Machine Learning to Predict Dynamic Cardiovascular Risks and Identify the Treatment Responses of Canagliflozin in Type 2 Diabetes Mellitus
Authors: HUANG QI , ZOU XIANTONG , BOYKO EDWARD J. , JI LINONG 
Published: June 2024

Evaluating cardiovascular risks and choosing the right pharmacotherapy is crucial for personalized treatment in patients with type 2 diabetes. Our study aims to dynamically estimate cardiovascular risks in patients with type 2 diabetes and predict their heterogeneous treatment responses to canagliflozin. We employed data from ACCORD and CANVAS for model derivation and CANVAS-R and CREDENCE for external tests. The ML-CVD model used baseline clinical features and interim factors to predict 4-year major adverse cardiovascular events (MACE). ML-HF for heart failure were also developed. Complication-specific XGBoost survival models were applied. Our model included 13,961 patients for development and 9,609 for testing. The area under the receiver operating characteristic curve of ML-CVD to predict MACE was 0.75 (95%CI 0.71-0.78) in the testing cohort of ACCORD and CANVAS, 0.75 (0.65-0.84) in CREDENCE, and 0.71 (0.65-0.76) in CANVAS-R. This model outperformed traditional models Framingham, ASCVD, ADVANCE, and model using only baseline features (ML-CVD (base)). ML-CVD more effectively distinguished the cardiovascular risk reduction between canagliflozin and placebo in patients with higher baseline risks. Patients who were treated with canagliflozin and showed a greater risk reduction than the median of the placebo group at one year, as predicted by ML-CVD, were identified as "SGLT2i responders." Those who did not meet this criterion were labeled as 'non-responders'. The actual hazard ratio (HR) for MACE, assessed by Cox regression, significantly decreased in SGLT2i responders compared to non-responders in both derivation and testing cohorts (p-values: CANVAS &lt;0.001, CREDENCE 0.03, CANVAS-R 0.004). Applying ML-HF showed comparable effects on heart failure outcomes, respectively. Machine-learning models for dynamic cardiovascular outcome prediction yield innovative strategies for risk assessment and drug response identification.

Disclosure
Q. Huang: None. X. Zou: None. E.J. Boyko: None. L. Ji: None.

Funding
The National Natural Science Foundation of China (81970708 to LJ); Beijing Nova Cross program (Z211100002121169) (to XZo) and Beijing Nova Program of Science and Technology (Z191100001119026), Peking University People's Hospital Research And Development Funds (RDH2021-10 to XZo); Clinical Medicine Plus X - Young Scholars Project, Peking University, the Fundamental Research Funds for the Central Universities (PKU2022LCXQ004 to XZo) and Beijing Municipal Science and Technology Commission (Z201100005520013 to LJ).
931-P: Real-World Study on the Effect of SGLT2 Inhibitors in Patients with Type 2 Diabetes in China
Authors: XUE YAOMING , SHI LIXIN , YU XUEFENG , WANG YANGANG , HONG TIANPEI , LI XIAOYING , MA JIANHUA , ZHU DALONG , MU YIMING 
Published: June 2024

Introduction & Objective: Chronic kidney disease (CKD) represents a significant complication in patients with type 2 diabetes (T2D), leading to increased morbidity and mortality. SGLT2 inhibitors (SGLT2i) have shown promise for improving renal outcomes. This prospective observational study (NCT05047471) aimed to evaluate the influence of SGLT2i, alone or in combination with other antidiabetic agents, on the progression of renal dysfunction.
Methods: Rate ratios and their confidence intervals were used to evaluate the results.
Results: A total of 9,672 patients with T2D were evaluated at baseline at 45 hospitals, with 6,707 reaching the 26-week endpoint. The SGLT2i group showed a significantly higher HbA1c improvement rate compared to the non-SGLT2i group with a rate ratio (RR) of 1.09 (95% CI 1.03-1.15). In addition, the SGLT2i group showed a significantly lower risk of eGFR decrease (RR 0.83, 95% CI 0.78-0.87) and urinary albuminine ratio increase (RR 0.93, 95% CI 0.88-0.98). The combined endpoint of HbA1c reduction with stable renal function showed a significantly higher RR in the SGLT2i group at 1.17 (95% CI 1.11-1.23) compared to the non-SGLT2i group. Various hierarchical and results can be found in Figure 1.
Conclusion: These results highlight the potential benefits of SGLT2i in the treatment of CKD and support consideration of these agents in the treatment of patients with T2D and renal complications.

Disclosure
Y. Xue: None. L. Shi: None. X. Yu: None. Y. Wang: None. T. Hong: None. X. Li: None. J. Ma: None. D. Zhu: None. Y. Mu: None.
939-P: Safety of Newer Glucose Medications in Adults with Type 2 Diabetes and Low to Moderate CV Risk
Authors: PAIK JULIE M. , TESFAYE HELEN , JANE CROMER SARA , DICESARE ELYSE O. , ALIX CAROLINE , WEXLER DEBORAH J. , PATORNO ELISABETTA 
Published: June 2024

Introduction & Objective: The safety profile of the newer diabetes medications in patients with type 2 diabetes (T2D) at low-to-moderate cardiovascular (CV) risk, who represent most people with T2D, remains unexplored. We investigated the association between the use of sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1RA), or dipeptidyl peptidase-4 inhibitors (DPP4i) and the risk of several previously reported drug-related harms: diabetic ketoacidosis (DKA), non-vertebral fracture (NVF), lower limb amputation (LLA), urinary tract infection (UTI), and mycotic genital infection (MGI), in this population.
Methods: Using claims data from 2 private health plans and Medicare (2013-2023), we identified pairs of 1:1 propensity score (PS)-matched adults initiating an SGLT2i versus a GLP1RA or a DPP4i. We estimated hazard ratios (HRs) and 95% confidence intervals (CI), adjusting for baseline covariates in the PS model.
Results: Over a mean follow-up of ~11 months, SGLT2i were associated with an over 2-fold increase in risk of DKA and MGI, a slightly higher risk of LLA, a lower risk of UTI, and no difference in NVF risk, vs. GLP1RA or DPP4i (Table).
Conclusion: Compared with GLP1RA or DPP4i, SGLT2i were associated with a higher risk of DKA and MGI, a numerical increase in LLA risk, a lower risk of UTI, and a similar risk of NVF in adults with T2D and low-to-moderate CV risk.

Disclosure
J.M. Paik: None. H. Tesfaye: None. S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. E.O. DiCesare: None. C. Alix: None. D.J. Wexler: Other Relationship; Novo Nordisk. E. Patorno: Research Support; Boehringer-Ingelheim, Food and Drug Administration (FDA), National Institutes of Health, Patient-Centered Outcomes Research Institute.

Funding
Patient Centered Outcomes Research Institute (DB-2020C2-20326)
954-P: Effect of Automated Insulin Delivery on Diabetes Distress in People with Type 1 Diabetes—A Systematic Review and Meta-analysis
Authors: CANHA DULCE , MCMAHON VIRGINIA K. , SCHMITZ SUSANNE , ALZAID FAWAZ , REZNIK YVES V. , RIVELINE JEAN-PIERRE , FAGHERAZZI GUY , AGUAYO GLORIA A. 
Published: June 2024

Introduction & Objective: Diabetes distress (DD) is prevalent among people with diabetes (PwD). While automated insulin delivery systems (AID) improve glycemic control and are expected to alleviate diabetes burden, their impact on DD is unclear.
Methods: Adhering to PRISMA guidelines, we focused on PwD using AID versus other insulin delivery systems, with DD as the outcome. Our review included randomized controlled trials (RCTs), before-after studies (BAS), and observational studies. We employed a random effects model meta-analysis by population (adult/pediatric/caregiver) and study design.
Results: Of 828 articles initially, 27 were included in the systematic review, comprising 3297 participants (1884 adults, 787 children, 626 caregivers). Seventeen studies were selected for the meta-analysis. In adults, six BAS and three RCTs indicated a significant DD reduction post-AID initiation (standardized mean difference (95% confidence intervals) -0.32 (95% CI: -0.39, -0.25) and (-0.18 (-0.30, -0.05)). No significant changes in DD were observed in the pediatric population or caregivers post-AID initiation, though three RCTs in caregivers nearly reached significance (-0.28 (-0.62, 0.05)).
Conclusion: This work suggests that AID does improve DD in adults but not in younger PwD. More RCTs and systematic DD assessments are now needed, especially in the pediatric population.

Disclosure
D. Canha: None. V.K. McMahon: None. S. Schmitz: None. F. Alzaid: None. Y.V. Reznik: Board Member; Insulet Corporation, TIMKL, France, embecta. Consultant; Vitalaire, France. Speaker's Bureau; Eli Lilly and Company. J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. G. Fagherazzi: Speaker's Bureau; Sanofi. Advisory Panel; Timkl, SAB Biotherapeutics, Inc., Vitalaire, Roche Diabetes Care. G.A. Aguayo: None.
965-P: Data Driven Dosing Formulas in Early Childhood Type 1 Diabetes
Authors: TABATABAI IDEEN , FORLENZA GREGORY P. 
Published: June 2024

Intro: As T1D technology use expands for children down to age 2, fine tuning dosing has become easier. Traditional dosing formulas for insulin-carb ratios (ICR) and insulin sensitivity factor (ISF) are derived from older patients prior to intro of AID. We seek to determine how ICR and ISF differ between patients on AID v MDI, and demonstrate what dosing tuning formulas are used in a large pediatric clinic.
Methods: Retrospective data was collected on all T1D patients under age 7 years old at a tertiary care center’s diabetes clinic. 230 subjects were seen below age 7 in our clinic in the last 12 months (age 1.1 years to 6.8 years). Data was stratified by AID versus MDI use and by A1c. ICRs were grouped by meal. ICR from each time period was multiplied by TDD to determine a formula starting point for these patients. ISF was multiplied by total daily dose for ISF formulas.
Result: ICR is more aggressive for breakfast in all users, and even more so for those on MDI. ISF is more aggressive in MDI users. When divided by A1c, only breakfast ICR was significantly different (p&lt;0.05). Of note, TBR was below 3% in both MDI and AID use; however it was significantly lower in AID use (TBR &lt;70: 2.6% MDI vs 1.9% AID, p&lt;0.05).
Conclusion: In young children with T1D on both MDI and AID at a large pediatric diabetes clinic, ICR is more aggressive than the often cited 450 or 400 rule in clinical settings among a large pool of providers. Conversely ISF is more conservative compared to 1800 rule in AID but not MDI use.

Disclosure
I. Tabatabai: None. G.P. Forlenza: Research Support; Abbott, Dexcom, Inc. Consultant; Dexcom, Inc. Research Support; Insulet Corporation. Consultant; Insulet Corporation. Research Support; Medtronic. Advisory Panel; Medtronic. Research Support; Tandem Diabetes Care, Inc. Consultant; Tandem Diabetes Care, Inc.
968-P: Factors Associated with the Decision to Use an Implantable AID System
Authors: EHRMANN DOMINIC , FINKE-GROENE KATHARINA , KULZER BERNHARD , HERMANNS NORBERT 
Published: June 2024

Aim of the EU project FORGETDIABETES (supported by H2020-FETPROACT, n.951933) is to develop a fully implantable AID system. To assess and address attitudes and barriers to implantable AID solutions, a new assessment tool was developed. Associations of attitudes and barriers with the readiness to use an implantable AID solution were analyzed. The newly developed questionnaire consists of four subscales assessing “glycemic benefits” (e.g. protection from complications), “mental benefits” (e.g. less thinking about diabetes), “technical barriers” (e.g. side effects), and “emotional barriers” (e.g. loss of control). A total of 366 people with type 1 diabetes (45.9% insulin pump, 27.0% AID) completed the questionnaire and indicated whether they would use an implantable AID system. Associations of the four subscales with the decision to use an implantable AID were analyzed via a logistic regression. A one-point increase in emotional and technical barriers reduced the readiness to use an implantable AID by 49% and 60%, respectively. A one-point increase in mental and glycemic benefits increased the readiness by 30 and 100%, respectively (Figure 1). Human factors assessed via the newly developed assessment tool have an impact on the readiness to use an implantable AID system. These human factors can be systematically assessed via the assessment tool and should be addressed when implantable AID are available.

Disclosure
D. Ehrmann: Advisory Panel; Dexcom, Inc. Speaker's Bureau; Dexcom, Inc., Sanofi-Aventis Deutschland GmbH. Advisory Panel; Roche Diabetes Care. Speaker's Bureau; Roche Diabetes Care, Berlin-Chemie AG. K. Finke-Groene: None. B. Kulzer: Advisory Panel; Abbott Diagnostics, Berlin-Chemie AG, Dexcom, Inc., Sanofi, embecta, Novo Nordisk, Roche Diabetes Care. Speaker's Bureau; Bayer Inc., Insulet Corporation, Lilly Diabetes. N. Hermanns: Speaker's Bureau; Berlin-Chemie AG, Sanofi-Aventis Deutschland GmbH. Research Support; Sanofi-Aventis Deutschland GmbH. Speaker's Bureau; Roche Diabetes Care. Research Support; Roche Diabetes Care. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Abbott Diagnostics, Ypsomed AG.

Funding
This project has received funding from the European Union’s Horizon 2020 research and innovation programme (No 951933)
978-P: Impact of Hybrid Closed-Loop System on Glycemic Control and Quality of Life among Japanese Individuals with Type 1 Diabetes
Authors: MOCHIZUKI SHOTA , MIURA JUNNOSUKE , BABAZONO TETSUYA 
Published: June 2024

Introduction & Objective: The effectiveness of the hybrid closed-loop (HCL) system in managing type 1 diabetes (T1D) has been reported. While insulin pump therapy has also been shown to improve quality of life (QOL) more than multiple daily insulin injections, the integration of HCL functionality is anticipated to further improve QOL. This study investigated the changes in continuous glucose monitoring (CGM) metrics and QOL during 6-month treatment with the automode function of the HCL system in individuals with T1D.
Methods: In this single-center, single-arm, retrospective observational study, 35 Japanese individuals with T1D (9 men, mean age 46 ± 13 years) were evaluated over the 6 months of treatment with automode use of Minimed 770G pump (Medtronic Japan K.K.). CGM metrics including time in range (TIR), time below range (TBR), time above range (TAR), and coefficient of variation (CV) were measured at baseline, 1, 3, and 6 months. QOL was assessed using 4 questionnaires (PAID, DTSQ, ITR-QOL, and SF36) at baseline, 3, and 6months. Mixed-model repeated measures (MMRM) analysis was conducted for time-series data comparison.
Results: HbA1c levels remained stable, with the mean levels of 7.4 ± 0.7% (mean ± SD) at both baseline and after 6 months of automode use. TIR significantly increased from 65.3 ± 12.5% at baseline to 70.6 ± 8.7% at 6 months (p = 0.0001), while TBR and TAR significantly decreased (p = 0.019, and 0.007, respectively). CV also significantly decreased at 6 months (p = 0.0022).Significant improvement was observed in ITR-QOL from baseline to 3 months (p = 0.0001) and maintained at 6 months (p = 0.0191).
Conclusion: This study observed favorable changes in CGM metrics, with an increase in TIR and decreases in TBR, TAR and CV, as well as improvement in ITR-QOL among Japanese individuals with T1D patients after 6 months of automode use in the HCL system.

Disclosure
S. Mochizuki: None. J. Miura: None. T. Babazono: None.
979-P: Real-World Use of the Advanced Hybrid Closed-Loop System Camaps FX with Two Different CGM Systems in Pregnancy and Young Children
Authors: BEATO-VÍBORA PILAR I. , GIL-POCH ESTELA , JAVIER ARROYO-DIEZ FRANCISCO 
Published: June 2024

Background and aims: The Advanced Hybrid Closed-Loop systems (AHCL) improve glucose control in people with type 1 diabetes (T1D). The aim was to evaluate the performance of the CamAps AHCL in indications only approved for this AHCL.
Methods: A prospective evaluation included subjects with T1D who initiated the CamAPS system for pregnancy or age &lt;6 years.
Results: 14 T1D individuals were included: 8 women (6 planning pregnancy, 2 ongoing pregnancies, age: 44 ± 34 years), 6 children (1 female, age: 4 ± 1 years (2-5)). HbA1c: 7.45 ± 1.22%, treatment: 5 MDI + CGM/FGM, 5 pump + CGM, 4 AHCL. Time of AHCL use: 7 [3-8] months. The glucose target was initially set at 100-110 mg/dl in women and 150 in all children. At the end of follow-up, the glucose target was set at 85-110 mg/dl in women and 90-198 in children. Up to 3 different glucose targets were set during the 24h profile. Six women and 1 child were using FreeStyle Libre 3, and the rest Dexcom G6. No episodes of DKA or severe hypoglycaemia were observed. One child stopped using the system after 2 months for inability to adapt to the pump. One of the pregnancies was completed and a newborn was delivered at 37 weeks (AGA), with no neonatal hypoglycaemia.
Conclusion: The CamAps AHCL system allows for an improvement in glucose control and the possibility of personalization of glucose targets, use of different modes and CGM systems according to the user´s preferences.

Disclosure
P.I. Beato-Víbora: Advisory Panel; Abbott. Speaker's Bureau; Abbott, Ascensia Diabetes Care, Lilly Diabetes, Novo Nordisk, Medtronic. E. Gil-Poch: Advisory Panel; Medtronic, Novo Nordisk, Abbott. F. Arroyo-Diez: Advisory Panel; Abbott, Metronics. Speaker's Bureau; Novo Nordisk.
997-P: Empowering CGM Users with Multi-horizon Glucose Forecasting Capabilities—The Accu-Chek SmartGuide Predict App
Authors: HERRERO PAU , BABION NILS , BOS HANS , KLOPFENSTEIN YANNICK , KOEHLER MATTHIAS , LEPPÄAHO EEMELI , LUSTENBERGER PATRICK , PEAK AJANDEK , RINGEMANN CHRISTIAN , GLATZER TIMOR 
Published: June 2024

Introduction & Objective: Despite the significant increase in the utilization of CGM technology, the prevalence of diabetes distress and fear of hypoglycemia remains high, and many users continue to face challenges in achieving their glycemic targets. To tackle this issue, we present scientific data on the Accu-Chek SmartGuide Predict app, a CGM digital companion that provides glucose forecasts and notifies users about upcoming glycemic events.
Methods:The app's functionalities, powered by three machine learning-enabled algorithms, include a 2-hour glucose forecast, a low glucose detection within 30 min, and nighttime low glucose prediction for bedtime interventions. The evaluation of the algorithms encompassed three datasets, which included people with T1D on MDI (n=21) and pump therapy (n=201), as well as real-world data from people with T2D (n=59). In total, the evaluation covered ~73K subject days.The development of the app relied on collecting objective user feedback through usability studies.
Results: Across the three datasets, the 2-hour forecast algorithm, at a prediction horizon of 30, 60, and 120 min, achieved a Consensus Error Grid A&B of 99.8%, 98.8%, and 96.6%, respectively. The low glucose detection algorithm achieved a sensitivity, specificity, and mean lead time of 94.5%, 97.5% and 19.3 min, respectively. The nighttime low glucose detection algorithm achieved an accuracy, sensitivity, and specificity of 89.1%, 53.1%, and 94.8%, respectively.Usability studies showed understanding of the app's functionalities and willingness to use its features. Task completion rate was 98.1%, indicating high success.
Conclusion: The consistent performance of the predictive algorithms on different cohorts offers reassurance for real-life efficacy. Usability studies suggest high user satisfaction, engagement, and retention with the app. However, verification is needed once the app is deployed and used over an extended duration.

Disclosure
P. Herrero: Employee; Roche Diabetes Care. N. Babion: None. H. Bos: Consultant; Roche Diabetes Care. Y. Klopfenstein: None. M. Koehler: Employee; Roche Diabetes Care. E. Leppäaho: Consultant; Roche Diabetes Care. P. Lustenberger: Consultant; Roche Diabetes Care. A. Peak: Consultant; Roche Diabetes Care. C. Ringemann: Employee; Roche Diabetes Care. T. Glatzer: Employee; Roche Diabetes Care. Stock/Shareholder; Roche Diabetes Care.
Eksplorasi Jenis-Jenis Mamalia di Hutan Lembah Kebar pada Kawasan Cagar Alam Pegunungan Tambrauw Utara
Authors: Abram Gabriel Orlando , Fatem Sepus Marten , Worabay Meliza Sartje , Boseren Melanesia Brigite , Ayomi Adomina , Jitmau Anjela M 
Published: June 2024

Penelitian ini bertujuan untuk mengetahui jenis dan karakteristik morfometrik satwaliar mamalia, penelitian ini dilakukan di Hutan Lembah Kebar Pada Kawasan Cagar Alam Pegunungan Tambrauw Utara dan berlangsung selama 3 minggu terhitung tanggal 7 – 28 April 2022. Metode yang digunakan dalam penelitian ini adalah metode deskriptif dengan Teknik observasi lapangan, Hasil dari penelitian ditemukan tiga belas individu dan delapan jenis satwa liar mamalia yaitu Bandikut (Echymipera kalubu), Bandikut (Echymipera rufescens), Rusa timor (Rusa timorensis), Babi hutan (Sus scrofa), Kuskus cokelat (Phalanger orientalis), Kuskus totol (Spilocuscus maculatus), Kelelawar codot kecil (Microglossus minimus), Kelelawar kalong besar (Pteropus neohibernicus). Dari kedelapan jenis satwaliar mamalia yang ditemukan terdapat dua mamalia yang termasuk satwa dilindungi yaitu Kuskus totol (Spilocuscus maculatus) dan Rusa timor (Rusa timorensis).
Integrative Review: Benefits, Challenges, and Perspectives Of Kangaroo Care in Neonatal Care
Authors: Vasco-Morales Santiago , Quinde-Arce Andrea , Males-Jácome Fabiola , Verdesoto-Jácome Catalina , Almeida-Torres Catalina , Toapanta-Pinta Paola 
Published: June 2024

Objective: Review the current scientific evidence on the physiological effects of kangaroo care, explore the barriers and facilitators to its implementation, and identify areas of knowledge that have not yet been explored.

Theoretical Framework: The kangaroo care method, despite its benefits for premature and low birth weight babies, faces implementation challenges. Its acceptance and application vary due to various factors, including cultural and institutional ones, as well as the lack of support for mothers and families.

Method: Integrative review of quantitative and qualitative studies. The critical appraisal of the studies was conducted using the Joanna Briggs Institute tool.
Principio del formulario

Results and Discussion: Evidence supports the effectiveness of kangaroo care in improving physiological parameters of the neonate such as heart rate, body temperature, and oxygen saturation. The main barriers to its implementation include: visiting hour restrictions, healthcare staff workload, negative cultural beliefs, lack of information and empowerment of mothers, and limited involvement of fathers.

Research Implications: Provides information on how the implementation of kangaroo care benefits the care of premature newborns, as well as aspects that influence its implementation.

Originality/Value: This study contributes to the literature by providing a comprehensive assessment of the effectiveness, safety, and applicability of kangaroo care in neonatal care. It allows for the visualization of barriers and facilitators to its implementation, providing identification of areas for improvement and gaps that may require future studies.