bluuebunny/crossref_metadata_2025_split huggingface dataset:
1027-P: Assessment of Glycemic Control by CGM during Hospitalization and Post-discharge in Insulin-Treated Older Adults
Authors: IDREES THAER , KANTIPUDI SRIYA , ZABALA ZOHYRA , MOAZZAMI BOBAK , URRUTIA MARIA A. , ZHOU SIYU , VELLANKI PRIYATHAMA , PENG LIMIN , UMPIERREZ GUILLERMO 
Published: June 2024

Background: Few studies have reported glycemic control in the hospital and post-discharge period in older adults using CGM. Thus, we combined data from 2 RCTs using CGM in 141 insulin-treated participants in the hospital and after discharge. We compared CGM glycemic metrics in 33 participants ≥65 years (mean 70±4) to 108 adults &lt;65 years (mean 52±9 years) with CGM data during hospitalization and for 10 days after discharge.
Results: Participants had similar BMI and total insulin use during hospitalization. Older adults had lower admission HbA1c and blood glucose (BG) compared to younger adults. When assessing CGM glycemic metrics, older adults spent a greater percentage of time in range (TIR, 70-180 mg/dL) during hospitalization (p=0.009) and post-discharge (p=0.02) compared to participants &lt;65. Comparing CGM versus POCT in older adults, CGM exhibited higher detection of hypoglycemic events (&lt;70 and &lt;54 mg/dl, p &lt;0.0001). In addition, older adults had lower glycemic variability (GV) during admission, but similar GV during the post-discharge period.
Conclusion: Compared to younger adults, older adults have better glucose control during hospitalization and post-discharge periods. CGM usage was associated with higher detection of hypoglycemia during hospitalization and post-discharge when compared to POCT in older adults which might improve diabetes care in this population.

Disclosure
T. Idrees: None. S. Kantipudi: None. Z. Zabala: None. B. Moazzami: None. M.A. Urrutia: None. S. Zhou: None. P. Vellanki: Consultant; Eli Lilly and Company. L. Peng: None. G. Umpierrez: Research Support; Abbott, Bayer Inc., Dexcom, Inc., AstraZeneca. Advisory Panel; Dexcom, Inc.
1059-P: Excess Body Weight Contributes to an 8.3 Year Premature Health Economic Aging Equivalent to an Additional Annual Healthcare Expenditure of $306B—Results of a U.S. Population Study
Authors: EVANS MARC , PADGETT THOMAS , MCEWAN PHILIP 
Published: June 2024

Introduction: Premature ageing is a recognized feature of chronic disease. As healthcare expenditure increases with age, the concept of health economic (HE) aging can be used to quantify the economic burden of disease. There is limited evidence regarding the effect of excess body weight on HE aging and the impact this may have on healthcare expenditure. This study sought to evaluate the effect of body weight on a measure of HE age and associated healthcare resource use.
Methods: Using US population-level data, we applied published age and body mass index (BMI) direct healthcare cost data to estimate the impact of excess BMI on measures of HE age. Using NHANES (2017-2020) we extracted the adult population who were overweight/obese and related their costs to the optimal age-adjusted BMI in order to derive a measure of HE age and healthcare resource implications.
Results: Compared to an ideal body weight (24 BMI kg/m2), living with excess body weight resulted in a premature ageing of 1.5 billion years across the adult overweight/obese population, representing an average increase in HE age of 8.3 years per person per year (4.2 years in males and 10.4 years for females). The greatest HE aging occurred in the 40-60-year age group with average increase in HE age of 11.2 years. Total BMI attributable premature ageing accounted for $306 billion in direct healthcare expenditure per year. The cost saving associated with achieving ideal body weight, while maintaining current levels of US health care expenditure, would enable the treatment of an additional 45 million 60-years old adults with ideal body weight.
Conclusion: Compared to an ideal body weight, excess weight in the US population contributes to significant premature health economic ageing and excess resource use. Efforts to achieve an ideal body weight may result in cost saving translating into significant additional healthcare capacity at current expenditure levels.

Disclosure
M. Evans: Consultant; Novo Nordisk A/S, AstraZeneca, Eli Lilly and Company, Boehringer-Ingelheim, Sanofi. T. Padgett: Stock/Shareholder; GlaxoSmithKline plc, Novo Nordisk A/S. P. McEwan: Consultant; AstraZeneca, Novo Nordisk A/S, Boehringer-Ingelheim, GlaxoSmithKline plc, Bristol-Myers Squibb Company, Rocket Pharmaceuticals Inc.
1079-P: Assessing Clinical Inertia on Implementing Guideline Recommendations in Patients with Type 2 Diabetes—The ACTION Study
Authors: WILLEY VINCENT , STEPHENSON JUDITH J. , SEMAN LEO J. , WITKOWSKI NANCY , WONG ANNY C.Y. , SMITH JOSEPH L. , BENGTSON LINDSAY 
Published: June 2024

Current ADA standards of care (SOC) include recommendations for T2D patients with cardiorenal conditions. Research shows clinical inertia towards implementation of evidence-based guidelines. The study aimed to gain insight into clinician attitudes, knowledge and behavior related to the ADA SOC. Eligible clinicians (PCPs, Endos and PA/NPs) caring for T2D patients were identified from the Healthcare Integrated Research Database based on claims submitted for &lt;u&gt;&gt;&lt;/u&gt;5 T2D patients during the study period, 11/30/2019 - 11/30/2021. A survey assessed clinician attitudes and knowledge. ADA SOC behavior was determined by 6 claims-based therapeutic management (TM) measures including A1c and eGFR/UACR testing; statin, GLP-1 and SGLT2 prescribing. High knowledge was defined as answering ≥80% of knowledge questions correctly; high TM metric attainment was defined as ≥75th percentile attainment for each measure. Survey responses and claims-based TM metrics were linked for each respondent. Of 402 respondents, 260 (65%) were PCPs, 44 (11%) Endos and 98 (24%) PA/NPs. Clinician attitudes regarding cardiorenal aspects of the ADA SOC were positive and did not vary by clinician type. High knowledge scores were reported by 58% of PCPs, 77% of Endos and 60% of PA/NPs. Correlation coefficients between attitudes and TM metric attainment ranged from -0.04 - 0.15 and between knowledge and TM metric attainment ranged from -0.03 - 0.14. The most common pattern observed between knowledge and TM metric attainment was high knowledge/low TM measure attainment, followed closely by a low/low pattern. Clinician attitudes were positive and showed adequate knowledge of the cardiorenal ADA SOC. Correlation between ADA SOC attitudes and knowledge and claims-based TM metric attainment were low. Opportunities exist to provide guideline-focused medical education for PCPs and PA/NPs coupled with interventions at the point of care to translate guideline knowledge into improved evidence-based care.

Disclosure
V. Willey: Other Relationship; Carelon Research. J.J. Stephenson: None. L.J. Seman: None. N. Witkowski: Employee; Boehringer-Ingelheim. A.C.Y. Wong: Employee; Boehringer-Ingelheim. J.L. Smith: Employee; Elevance Health. Stock/Shareholder; Elevance Health. L. Bengtson: Employee; Boehringer-Ingelheim, Optum.
108-OR: Insulin Resistance Is Associated with Alterations in the Dynamics of Incretin Secretion
Authors: DI GIUSEPPE GIANFRANCO , SOLDOVIERI LAURA , CICCARELLI GEA , BRUNETTI MICHELA , CINTI FRANCESCA , MOFFA SIMONA , HOLST JENS J. , GIACCARI ANDREA , MEZZA TERESA 
Published: June 2024

GIP and GLP-1 exert a fundamental role in glucose homeostasis, but it is still debated if modifications in GIP and GLP-1 secretion can affect the metabolic state, as well as their contribution to the dynamics of incretin-induced insulin secretion. In this study we aimed to explore the relative effect of GIP and GLP-1 secretion on glucose metabolism and beta-cell function. 41 subjects with no previous diagnosis of T2DM were divided into 3 groups according to OGTT-derived glucose tolerance: NGT (12) IGT (12) DM (17). All subjects underwent a mixed meal test (MMT) with glucose, insulin, c-peptide, GIP and GLP-1 levels assessment. Further, we calculated the GIP/GLP-1 Secretion Ratio (GIP/GLP-1 SR) for each timepoint normalized for basal levels and the AUC of the ratio of GIP and GLP-1 secretion. Further, all subjects underwent a euglycemic hyperinsulinemic clamp (EHC) to assess insulin sensitivity. During MMT we observed higher glucose levels in DM subjects compared to NGT and IGT (p&lt;0.01), while insulin and c-peptide secretion showed a non-significant decreasing trend in DM subjects compared to NGT and IGT (p=0.10 and p=0.21). Further, we observed a non-significant decreasing trend in GIP secretion in IGT and DM subjects (p=0.08). No differences in GLP-1 secretion were detected among the 3 groups (p=0.65). Interestingly, IGT and DM groups showed a reduced GIP/GLP-1 SR compared to NGT (p=0.02 for interaction). Further, we found that the AUC of GIP/GLP-1 SR was positively correlated with the EHC-derived M-value (R=0.45, p=0.01). Our data show that, rather than an altered secretion of the incretin hormones per se, insulin resistance leads to an imbalance in the dynamics of incretin secretion overall: the GIP/GLP-1 SR appears to be an early marker of impaired glucose homeostasis. Further studies are needed to investigate whether the altered GIP/GLP-1 secretion is the cause or the effect of altered beta-cell incretin sensitivity and the potential metabolic effects of unbalanced incretin secretion.

Disclosure
G. Di Giuseppe: None. L. Soldovieri: None. G. Ciccarelli: None. M. Brunetti: None. F. Cinti: None. S. Moffa: None. J.J. Holst: Advisory Panel; Novo Nordisk A/S, Merck Sharp & Dohme Corp., Kallyope. Board Member; Antag Therapeutics. A. Giaccari: None. T. Mezza: None.

Funding
This study was supported by grants from the Universita Cattolica del Sacro Cuore (Fondi Ateneo Linea D.3.2, Fondi Ateneo Linea D.1, anno 2019, and Fondi Ateneo Linea D.1, anno 2020); the Italian Ministry of Education, University, and Research (MIUR; GR-2018-12365577 and RF-2019û12369293); the European Foundation for the Study of Diabetes award supported by Astra Zeneca and MIUR and MUIR (PRIN 2020SH2ZZA)
1080-P: Continuous Glucose Monitor Integration into Primary Care Clinics
Authors: ZADEL ALYSSA , CHIAMPAS KATIA , MAKTAZ KATRINA , EIMER MICAH J. , KELLER JOHN G. , SZMUILOWICZ EMILY , O'GARA KATHY W. 
Published: June 2024

Introduction & Objective: Continuous glucose monitoring (CGM) has been historically used by endocrinologists to assess glycemic trends and guide therapeutic changes for people with diabetes. We increased access to this tool by equipping primary care physicians (PCPs) to integrate CGM into their practice via a multidisciplinary team approach.
Methods: 18 PCPs were offered a one-hour video training by endocrinology on CGM interpretation. Referred patients were &gt;18yo with A1c &gt; 8% without past CGM use or an endocrinology visit in the past year. Patients saw a Diabetes Care and Education Specialist (DCES) and/or a pharmacist (PharmD) for diagnostic CGM placement and education on nutrition, medication administration, and physical activity goals. DCES or PharmD reviewed the data with patients and sent recommendations to the PCP. Individuals with data post-intervention for A1c and time in range (TIR) were included.
Results: CGM users (n=41) were [mean (SD)] 62.05 (14.54) years of age and 26.83% female. TIR increased by 29.13% from 42.31% (33.25) at baseline to 71.44% (25.79) at 3 months (p &lt;0.001), due to reduced hyperglycemia (Table 1). The proportion of CGM users meeting the consensus target of TIR ≥70% increased from 21.95% to 58.54% (p&lt;0.001). Post-intervention, A1c decreased 2.45% from 9.62 (1.65) to 7.17 (1.08) (p&lt;0.001).
Conclusion: Integration of CGM into primary care clinics is feasible and effective using a multidisciplinary approach.

Disclosure
A. Zadel: None. K. Chiampas: None. K. Maktaz: None. M.J. Eimer: Stock/Shareholder; Agitated Solutions. J.G. Keller: None. E. Szmuilowicz: None. K.W. O'Gara: None.

Funding
Northwestern Medicine North Region Quality and Innovation Funds Award
1081-P: Success of Curriculum-Based Online Education at Improving Knowledge, Competence, and Confidence Related to Staging and Managing Type 1 Diabetes
Authors: LARKIN AMY , LE ANNE 
Published: June 2024

Introduction: The goal of continuing medical education (CME) is professional growth and improved patient care. We sought to determine if a curriculum of CME activities could improve the clinical knowledge, competence, and confidence of diabetologists/endocrinologists (D/Es), pediatricians and primary care physicians (PCPs) related to T1D.
Methods: The educational curriculum consisted of 3 online activities, all of which used repeated pairs pre-/post-assessment study design and McNemar’s test (P &lt;.05 is considered significant) to assess educational effect. The activities launched from March to May, 2023, and data were collected for up to 12 weeks for each activity.
Results: The education reached over 24,000 clinicians, including &gt;1,600 D/Es, &gt;1,700 pediatricians, and &gt;2,900 PCPs. Overall, improvements were seen across all target audiences and in all topics, including overall relative improvements of 45% among D/Es, 60% among pediatricians, and 78% among PCPs. Additionally, the proportion of learners who demonstrated improvements/reinforcement of knowledge/competence, the education positively impacted 96% of D/Es, 89% of pediatricians, and 83% of PCPs. This resulted in significant improvements in confidence. Knowledge/competence improvement related to staging T1D: 118% D/Es, 152% pediatricians, and 179% PCPs (relative changes, all P&lt;.001).
Knowledge/competence improvement related to treating T1D: 17% D/Es, 38% pediatricians, and 45% PCPs (relative changes, all P&lt;.001). Knowledge/competence improvement related to educating patients about T1D: 88% D/Es, 65% pediatricians, and 88% PCPs (relative changes, all P&lt;.001).
Conclusion: This curriculum demonstrated success in educating on this topic, with significant increases in knowledge, competence, and confidence of clinicians related to staging, treating and educating patients about T1D.

Disclosure
A. Larkin: None. A. Le: None.

Funding
Developed through an independent educational grant from Provention Bio, a Sanofi Company.
1088-P: Exploring Generative AI’s Clinical Potential in Type 1 Diabetes Management—An ADA Standards-Based Approach
Authors: YOUNG CLIPPER F. , WONG SHIRLEY 
Published: June 2024

Objective: To compare clinical recommendations on type 1 diabetes management based on the ADA’s Standards of Medical Care - 2022 generated by two generative artificial intelligent (AI) platforms for internal consistency (vertically within a platform) and external consensus (horizontally between platforms and with clinicians’ clinical decisions).
Methods: A complex clinical case with type 1 diabetes was selected; the patient has a history of severe hypoglycemia and diabetic ketoacidosis (DKA). Before entering the case into each AI platform for analysis, the clinical note - chief complaint, subjective, and objective information - was edited and organized to enhance clarity and to standardize the language. The case was analyzed by two AI platforms three times; all AI responses were reviewed and compared to the clinician’s assessment and plan, thus taking a qualitative data analysis approach.
Results:

Conclusions: Although this initial step only included one case, both AI platforms could generate clinical recommendations with high internal consistency, especially in the effectiveness measures. For external consensus on the safety measures, ChatGPT emphasized the specific safety recommendations that aligned closer with the standards of care. Further analyses are warranted to include more cases, ensuring this approach can potentially augment clinician’s care practices in type 1 diabetes.

Disclosure
C.F. Young: Other Relationship; Abbott. S. Wong: None.
1096-P: The Diabetes On Track Model—Creating a Framework for Improving Diabetes in Rural Nebraska
Authors: EILAND LESLIE A. , MOHRING STEPHEN M. , KEEGAN SARAH , NYGAARD STEPHANIE , PULLYBLANK KRISTIN , DESOUZA CYRUS 
Published: June 2024

Introduction & Objective: Outcomes for people with diabetes in rural areas are worsening, widening disparities between urban and rural populations. The objectives of Diabetes on Track are to improve outcomes for people at risk for or living with pre-diabetes and type 2 diabetes in rural Nebraska.
Methods: Investigators engaged health departments and primary care clinics in two rural communities. Community coalitions were developed with a focus on improving screening rates. Clinical interventions include a Project ECHO curriculum to disseminate evidence-based education via case-based learning, funding of RN health coach positions, and support for clinical pharmacy time. Individual provider dashboards were developed, along with a value-based incentive program tied to diabetes-related quality metrics (A1c monitoring and control; screening for dyslipidemia, nephropathy, and retinopathy). A patient pathway team aims to increase clinician awareness of community resources and improve referral workflows.
Results: Project ECHO sessions have been regularly attended with good participation. Clinics are increasing use of team-based care for people with diabetes. Over 8 months, the enhanced team approach generated 18 referrals to pharmacy, 89 to Diabetes Education, and 134 to Health Coaching. A prediabetes registry was created and thus far, 225 patients have been contacted about their risk. All diabetes-related quality metrics have improved, primarily at the site where clinicians were given visibility to the incentive program. One location has joined an ACO.
Conclusion: Improving diabetes at a community level requires a multi-pronged approach. Our model utilizes community interventions, healthcare team interventions, and a patient pathway to improve communication between health departments and local clinics. Understanding local relationships and developing trust takes time but is vital. The most impactful intervention to date has been the value-based incentive program.

Disclosure
L.A. Eiland: Advisory Panel; Provention Bio, Inc., Cecelia Health. S.M. Mohring: None. S. Keegan: Consultant; Tandem Diabetes Care, Inc. S. Nygaard: None. K. Pullyblank: None. C. Desouza: Advisory Panel; Novo Nordisk, Bayer Inc., Madrigal Pharmaceuticals, Inc. Other Relationship; ADA/ACC Diabetes by Heart Program. Advisory Panel; Asahi Kasei.

Funding
Private gift received through the University of Nebraska Foundation from the Diabetes Care Foundation.
1098-P: A Longitudinal Look at SGLT-2i/GLP-1RA Prescription Records in Evaluation of a Primary Care Quality Improvement Education Initiative
Authors: MAKIN VINNI , RAO PRATIBHA , MURRAY SUZANNE , DENNIS FRAMPTON BETHANY , LAZURE PATRICE , KAWCZAK STEVEN , PANTALONE KEVIN M. 
Published: June 2024

Introduction & Objective: A longitudinal analysis was performed to evaluate a systems-based Quality Improvement Educational intervention (QIEi), designed to enhance disease management of T2D patients with/or at risk of CVD/CKD. This analysis aimed to assess if the QIEi increased SGLT-2i/GLP-1RA prescriptions for eligible patients.
Methods: The QIEi was deployed at 2 primary care sites from a USA integrated delivery system (IDS) and included baseline EHR data review to inform gaps; webinars on best practices; case-based group discussions; and team-designed process improvements and enhanced communication strategies. To assess impact, along with a practice assessment quantitative questionnaire, qualitative interviews and post-webinar quantitative assessments, EHR data were pulled and analyzed from the 2 implementation sites and IDS remaining sites at baseline and 6, 12, and 18 months.
Results: No clinically significant differences in prescription of SGLT-2i/GLP-1RA were observed post-intervention for T2D patients with/or at risk of CVD/CKD, and no differences observed between implementation and non-implementation sites (Table 1).
Conclusion: Persistent challenges in translating education into practice among HCPs needs to be identified and addressed to improve the quality of disease management for T2D patients with/or at risk of CVD/CKD.

Disclosure
V. Makin: Speaker's Bureau; Bayer Inc. P. Rao: None. S. Murray: None. B. Dennis Frampton: None. P. Lazure: None. S. Kawczak: None. K.M. Pantalone: Speaker's Bureau; AstraZeneca. Consultant; AstraZeneca. Board Member; Bayer Inc. Research Support; Bayer Inc. Speaker's Bureau; Corcept Therapeutics. Consultant; Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc. Speaker's Bureau; Merck & Co., Inc. Research Support; Merck & Co., Inc. Consultant; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Twin Health. Consultant; Sanofi.

Funding
Eli Lilly and Company; Merck
1102-P: Quality Improvement Intervention to Improve Premeal Insulin Administration in Young Children with Type 1 Diabetes
Authors: HICKS KELLY A. , MACALUSO ERIN N.P. , KELLY SARAH R. , UYSAL SERIFE , DESALVO DANIEL 
Published: June 2024

Introduction: Young children with T1D have unpredictable eating habits, which lead to post-meal insulin administration and resultant hyperglycemia. We designed a quality improvement (QI) project to promote pre-meal bolusing in young children (≤ 6 years old) with T1D.
Methods: A series of bundled Plan-Do-Study-Act (PDSA) cycles were implemented over a 1-yr period from Oct 2022-Sep 2023, including: a. Development of EMR-based parental questionnaire to assess pre-meal bolus behaviors b. Creation of a run chart in QlikView analytics platform to assess real-time progress at the population level c. Development of family-facing educational resources with strategies to enable consistent pre-meal bolusing d. Tailored education for pre-meal bolusing delivered by CDCES and RD in clinic and telemedicine encounters e. Efforts to expand CGM and automated insulin delivery system use in young children f. Psychology support for parents with fear of hypoglycemia and/or diabetes distress
Results: The rate of pre-bolusing increased by 36% over a 1-yr period from a baseline of 50% in Oct 2022 to 86% in Sep 2023 (Figure 1).
Conclusion: This QI intervention led to an increase in pre-meal bolusing in young children with T1D, which may have direct clinical benefit in optimizing glycemic outcomes (e.g., HbA1c and time-in-range). Figure 1: Control chart indicating rate of pre-meal bolusing in children ≤ 6 years

Disclosure
K.A. Hicks: None. E.N.P. Macaluso: None. S.R. Kelly: None. S. Uysal: None. D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc.