bluuebunny/crossref_metadata_2025_split huggingface dataset:
1083-P: Barriers to Insulin Pump Use in Adults with Type 1 Diabetes
Authors: ERARDI JOSEPH , LORA MATOS ALEJANDRO D. , WELLS BETH A. , ROMEISER JAMIE L. , OWUSU-BARNIE JERUSHA , WEINSTOCK RUTH S. 
Published: June 2024

Introduction: Hybrid closed loop systems (HCL) reduce hypoglycemia and increase time in range in adults with type 1 diabetes (T1D). In Sept. 2023, 62.9% of our T1D adults were using insulin pumps, of which a majority were using HCL.
Objective: To understand current barriers for insulin pump use in T1D adults.
Methods: A survey was sent electronically, in Oct. 2023, to T1D adults ages ≥ 22 yrs, with ≥ 1 visit, in-person or virtual, from 9/1/2022 - 9/1/2023 with an email address (n=1517).
Results: The overall response rate was 22.9% [263 pump users responded, response rate 29.9%; 85 non-pump users responded, response rate 13.3%). Median age of respondents vs non-respondents was 54 years (range 22 -94) vs. 40 years (22 yrs-100). 60.9% of respondents were female vs. 47.5% of non-respondents. Respondents/non-respondents were 94%/88.2% non-Hispanic white (n=328/1031), 2.6%/6.2% non-Hispanic Black (n=9/72) and 1.1%/2.4% Hispanic (n=4/28). 59.2% of respondents had private insurance, 39.1% public insurance. CGM was used by more pump users (n=879; 91.9%) vs non-pump users (n=638; 79.3%). Median A1c of respondents was 7.0% (CGM use 89.1%), vs non-respondents median A1c 7.8% (CGM use 85.5%). Survey results are shown in table below.
Limitations: Low response rate and low diversity
Conclusion: More education, including addressing beliefs and understanding potential benefits of insulin pump therapy, is needed for the ~1/3 of T1D adults not currently using a pump.

Disclosure
J. Erardi: None. A.D. Lora Matos: None. B.A. Wells: None. J.L. Romeiser: None. J. Owusu-Barnie: None. R.S. Weinstock: Research Support; Eli Lilly and Company, Tandem Diabetes Care, Inc., Diasome, Amgen Inc., MannKind Corporation, Insulet Corporation, Novo Nordisk. Other Relationship; Dexcom, Inc.
1086-P: Rural Residence Is Associated with a Lower Likelihood of Dipeptidyl Peptidase 4 Inhibitor Use for Treatment Intensification
Authors: NAGY DANIELLE K. , BRESEE LAUREN , EURICH DEAN , SIMPSON SCOT H. 
Published: June 2024

Introduction: Several drug therapy management strategies exist when treatment intensification is required in type 2 diabetes, however, an understudied factor influencing drug therapy choice is an individual’s location of residence along the rural-urban continuum. The objective of our study was to explore the association between location of residence (rural, urban, metropolitan) and the use of dipeptidyl peptidase 4 inhibitors (DPP-4i) for first treatment intensification of type 2 diabetes.
Methods: We conducted a retrospective cohort study from 2008 to 2019 using administrative data from Alberta, Canada. Cohort entry was established when an individual became a new metformin user and at this time, location of residence was defined using postal codes. Individuals were followed until a dispensation for treatment intensification occurred (classified as DPP-4i or non-DPP-4i-based therapy). A multivariable logistic regression analysis was performed to determine the association between location of residence and likelihood of DPP-4i dispensation, adjusting for clinically relevant confounders.
Results: Of 66,064 new metformin users experiencing treatment intensification, 15,467 (23%) were intensified with a DPP-4i. At the beginning of the observation period, proportion of DPP-4i dispensations were similar (7% metropolitan, 6% urban, 5% rural). However, over time a maximum 10% difference was noted between rural and metropolitan/urban (32% metropolitan, 27% urban, 22% rural). After adjusting for potential confounders, we determined that rural-dwellers are 36% less likely to have a DPP-4i dispensed, compared to metropolitan (aOR:0.64;95%CI:0.61-0.67) and over time, uptake in rural areas is slower.
Conclusion: Our study sheds light on the impact of location of residence on drug therapy management in type 2 diabetes. The differential management experienced by rural-dwellers demonstrates a substantial gap in health equality across our jurisdiction.

Disclosure
D.K. Nagy: None. L. Bresee: None. D. Eurich: None. S.H. Simpson: Research Support; Merck & Co., Inc.
1095-P: Value-Based Incentive Programs to Improve Diabetes Care 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 rural disparities. The goal of Diabetes On Track is to improve outcomes for people living with pre-diabetes and type 2 diabetes in rural Nebraska. One intervention has been a value-based incentive model for primary care providers (PCPs) in two communities, with aims to improve diabetes-related quality metrics and encourage health systems to recognize benefits of joining value-based contracts and achieving shared savings.
Methods: Two rural communities were identified, and primary care clinic leadership was engaged in each community. Individual provider dashboards were created for diabetes-related metrics, allowing PCPs to monitor progress. Baseline data was collected for each site, and target and stretch goals were created for 6-month periods over 2 years. Data were collected on a1c monitoring and control (A1c &lt;9%), as well as screening for dyslipidemia, nephropathy, and retinopathy over a rolling 12-month period.
Results: Clinic A incentivized PCPs directly; Clinic B did not. After 6 months, Clinic B showed small improvements in nephropathy and retinopathy screening, while other metrics remained stable. Clinic A showed improvement in all metrics and is on track to achieve stretch goals set for the entire 2-year program. Some of this improvement is due to resolving lab mapping issues and purchasing a retinal camera. Clinic A improved both A1c completion and control by 6% from baseline (ending at 94% and 84%, respectively). Nephropathy and retinopathy screening improved by 270% and 38%, respectively. Lipid monitoring increased by 25%. Clinic A is joining an accountable care organization in 2024.
Conclusion: Providing real-time patient panel data and incentivizing PCPs contributed to improved diabetes-related quality metrics. This pilot is a critical component of a comprehensive diabetes program, allowing rural health systems to recognize the importance of the shift towards value-based care.

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.
11-PUB: Transitioning from Dulaglutide to Tirzepatide Improves Glycemic Control in Patients Undergoing Hemodialysis with Type 2 Diabetes—An Assessment by Continuous Glucose Monitoring
Authors: OTSUKA EMIKO , KITAMURA MINEAKI , FUNAKOSHI SATOSHI , NISHINO TOMOYA 
Published: June 2024

Introduction & Objective: Tirzepatide is a dual glucose-dependent insulinotropic peptide and glucagon-like peptide-1 receptor agonist. However, the efficacy and safety in patients undergoing hemodialysis remain unclear.
Methods: We conducted a single-center retrospective study of patients with type 2 diabetes undergoing hemodialysis who were transitioned from dulaglutide to tirzepatide. We analyzed glucose levels using CGM.
Results: Fourteen patients (61.9 ± 9.9 years, male: female=11:3) were included. After switching to tirzepatide, time in range increased to 50.8% from 42.7% (p=0.02) (Figure), time above range decreased to 37.8% from 48.4% (p=0.02), and mean glucose levels decreased to 137.4 mg/dL from 156.6 mg/dL (p=0.006). In contrast, there was no significant difference in time below range (11.3% and 8.9%) (p=0.75). Four patients experienced dyspnea (28.6%), and one patient experienced nausea (7.1 %); however, no critical adverse events were reported.
Conclusion: Transitioning from dulaglutide to tirzepatide improved glycemic control without hypoglycemia in patients undergoing hemodialysis with type 2 diabetes.

Disclosure
E. Otsuka: None. M. Kitamura: None. S. Funakoshi: None. T. Nishino: None.
1101-P: Patient-Centered Weight Management Clinical Decision Support—A Proof-of-Concept Study
Authors: SCHWARTZ JESSICA L. , ALMAZAN ERIK , OLSSON KELLY , GUDZUNE KIMBERLY 
Published: June 2024

Introduction & Objective: Over 40% of U.S. adults have obesity; however, primary care practitioners (PCPs) face challenges treating obesity (e.g., lack of training, time). Clinical decision support (CDS) tools can aid obesity counseling, but most lack a patient-centered care focus. The study objective was to develop and test an innovative weight management CDS for the primary care setting.
Methods: The CDS design promoted a patient-centered experience, supported evidence-based obesity treatment, and integrated with PCPs’ workflows in the electronic health record. Patients completed a pre-visit questionnaire via the patient portal, which then activated PCP elements (decision/counseling, orders, documentation). A 3-month proof-of-concept study was conducted among 10 PCPs at 5 clinics to determine usefulness, usability, and acceptability through validated surveys (mean score ≥2.5 signified positive outcome; max value 5). Using t-tests, pre-post differences in frequency of self-reported obesity-related clinical practices (Never-1 to Always-5) were also examined.
Results: Most PCPs were physicians with mean 10.8 years (SD 7.5) of primary care experience. Overall, mean score for usefulness, usability, and acceptability was 3.2 (SD 0.8), 3.5 (SD 0.9), and 3.6 (SD 0.9), respectively. PCPs highly rated recommending the CDS to a colleague (mean 3.9 (SD 1.0)), found the CDS easy-to-use (mean 3.7 (SD 0.9)), and suitable for the primary care setting (mean 4.1 (SD 1.0)). PCPs reported significant increases in three key clinical practices - counseling on behavioral interventions (3.1 vs 3.9 (p&lt;0.01)), referring to weight-loss programs (2.8 vs 3.5 (p&lt;0.01)), and discussing anti-obesity medications (3.3 vs 3.8 (p=0.02)).
Conclusion: A patient-centered weight management CDS was useful and usable to PCPs and improved obesity-related practice habits. Future studies need to evaluate CDS use in other outpatient settings and its impact on patient outcomes.

Disclosure
J.L. Schwartz: Research Support; Novo Nordisk, Ardmore Institute. E. Almazan: None. K. Olsson: Employee; Novo Nordisk. K. Gudzune: Advisory Panel; Eli Lilly and Company, Novo Nordisk. Research Support; Novo Nordisk. Employee; American Board on Obesity Medicine. Other Relationship; Johns Hopkins ACG System.

Funding
Novo Nordisk
1103-P: The Mobile Insulin Titration Intervention to Transition from Basal Insulin to a GLP1-RA (MITI-GLP1)—Using Daily SMS Text Messages and Weekly Phone Calls to Transition Primary Care Patients with Well-Controlled Type 2 Diabetes Mellitus from Basal Insulin to a GLP1-RA at Bellevue Hospital
Authors: LEVY NATALIE , NERLINO KATIE , SONUBI OLUBUNMI , BONGALOS SHERLANE , DASILVA ALEX , UZOR CHINYE , LIANG YINGJIE 
Published: June 2024

Introduction: While basal insulin lowers blood sugar, it increases the risk of hypoglycemia and weight gain and doesn’t offer the potential cardiovascular benefits of GLP1-RAs. Transitioning a person with well-controlled T2DM from basal insulin to a GLP1-RA can be labor intensive and short-term may lead to hypoglycemia. The objective of this pilot program is to determine if MITI-GLP1 can lower basal insulin and increase GLP1-RA without hypoglycemia.
Methods: MITI-GLP1 uses basic cell phone technology available to our safety-net patients and sends a daily text message asking ‘What was your fasting blood sugar this morning?’ Patients text values daily and are advised over-the-phone weekly on if/how to lower their basal insulin and if/how to adjust their GLP1-RA. The process continues until the patient is on the max-tolerated GLP1-RA dose. Eligible patients in this cohort study have well-controlled T2DM, use once-daily basal insulin and are not on max-dose GLP1-RA. Use of meal-time insulin excludes patients. The primary outcome is % of patients with basal insulin lowered &gt;50%. Secondary outcomes include the % of patients with basal stopped completely, the % with GLP1-RA raised &gt;1 dose level, and the % of hypoglycemia during the transition. MITI-GLP1 is co-run by internists and nurses.
Results: Forty-six people were enrolled. The average age is 53 (SD +/- 11), 59% are men, 74% are Hispanic, 63% are uninsured. Five people were lost to f/up. Of the 41 people who graduated, 35 (85%) had basal dose lowered by &gt; 50%, 30 (73%) had basal stopped completely, 37 (90%) had GLP1 raised &gt;1 dose level and 1 of the 2023 text messages (0.05%) had a blood glucose &lt; 70mg/dL.
Conclusion: A MITI-GLP1 program using basic cell phone technology can safely and effectively transition primary care patients with well-controlled T2DM from basal insulin to a GLP1-RA.

Disclosure
N. Levy: None. K. Nerlino: None. O. Sonubi: None. S. Bongalos: None. A. Dasilva: None. C. Uzor: None. Y. Liang: None.
1104-P: A Quality Improvement Project to Improve Provider and Health Care Student Adherence to American Diabetes Association Care Guidelines in a Free Clinic Outpatient Setting
Authors: CASOLA MARISA C. , BRAR TANVI , RYE LEE GHEE , COYNE MACKENZIE , PURDY NAJHEE L.J. 
Published: June 2024

Background: The Columbus Free Clinic (CFC) is a student-run free clinic providing care to underserved residents in Central Ohio. Type 2 diabetes is the most common chronic condition diagnosed at CFC. Historical data shows CFC provides suboptimal diabetic preventative care, evidenced by non-compliance with American Diabetes Association (ADA) laboratory testing guidelines. Due to volunteer providers and students rotating weekly, a quality improvement (QI) project was developed to improve the quality of medical care for patients with diabetes by increasing volunteer adherence to a subset of ADA guidelines: documented hemoglobin A1c (HbA1c) within the past 6 months, micro-albumin/creatinine ratio (ACR) in the past 12 months, and lipid panel in the past 12 months.
Methods: In March 2023, a chart review was conducted to obtain baseline data on ADA guideline measures. A QI intervention plan to improve adherence to ADA guidelines was developed and implemented April 2023. A dot phrase in CFC’s electronic health record system was programmed with questions about laboratory testing to prompt providers to ask patients to increase adherence. In December 2023, post-intervention data was collected for patients with type 2 diabetes who were seen at CFC pre and post-intervention.
Results: Out of the 175 patients who were identified with type 2 diabetes, a subset of 71 patients visited CFC for treatment pre and post-intervention. Prior to implementation, 57.7% of patients had a recorded HbA1c in the past 6 months, 33.8% had an ACR recorded in the previous 12 months, and 67.6% had a lipid panel recorded in the past 12 months. Post intervention, these percentages increased to 66.2% (+8.5%, p=0.30), 84.5% (+16.9%, p=&lt;0.05) and 69.0% (+35.2%, p=&lt;0.001), respectively.
Conclusion: Findings highlight that our intervention successfully increased adherence to ADA care guidelines in a student-run, free clinic setting.

Disclosure
M.C. Casola: None. T. Brar: None. G. Lee: None. M. Coyne: None. N.L.J. Purdy: None.
1105-P: Evolution of Hospital Glycemic Care Knowledge among Faculty and Trainees in an Academic Center—A Comparative Analysis
Authors: MAREBOINA MANVITA , MILLER THEODORE J. , LEHMAN ERIK , KEARCHER KALEN , GONG JASON , PICHARDO-LOWDEN ARIANA 
Published: June 2024

Introduction & Objective: Knowledge and decision-making can be determinants of practice performance and quality of patient care rendered. Gaps exist in those competencies among healthcare practitioners. This study aimed to determine changes in faculty and trainees in an academic center after implementation of an inpatient diabetes clinical decision support (CDS) tool in the electronic health record (EHR).
Methods: We compared proportions of correct glycemic management responses to equivalent questions from two surveys conducted about eight years apart in an academic medical center using the Chi-square test. The first survey represented a baseline needs assessment. The second was a follow-up questionnaire presented in context of an inpatient practice supported by an EHR CDS program across hospital settings.
Results:
Conclusion: Improved knowledge of glucose goals for different inpatient populations is relevant as it can enable adequate management. Responses about the complex topic of insulin transition to maintain control did not show improvement, but it had a high score at baseline. Lower knowledge on follow-up among trainees reflect the need for reinforcing concepts for learners who join training programs with variable decision-making skills. Some modalities of CDS can enhance knowledge when presenting biomedical information in the context of clinical practice.

Disclosure
M. Mareboina: None. T.J. Miller: None. E. Lehman: None. K. Kearcher: None. J. Gong: None. A. Pichardo-Lowden: None.

Funding
National Institute of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health (R01DK130992)
111-OR: Vascular Endothelium-Specific ROCK2 Deficiency Inhibits the Progression of Obesity via Adipocyte Browning
Authors: OHASHI SHINJI , MATOBA KEIICHIRO , SEKIGUCHI KENSUKE , MITSUYOSHI ETSUKO , NAGAI YOSUKE , NISHIMURA RIMEI 
Published: June 2024

Introduction and Objective: The vascular endothelium has evolved anatomical and functional network between adipocytes in adipose tissue, secreting several bioactive substances to orchestrate energy homeostasis. However, when compared with other organs, relatively little is known about the molecular machinery that directly governs the crosstalk system in adipose tissue. Although previous studies have defined Rho-associated, coiled-coil-containing protein kinase 2 (ROCK2) as an inducer of vascular inflammation, a direct role for the endothelium-adipocyte network in physiological and pathophysiological states has not been previously established.
Method: To clarify the tissue-specific role of ROCK2, we generated mice lacking vascular endothelial ROCK2. Normal adipocytes were incubated with a conditioned medium obtained from ROCK2-deficient human adipose tissue vascular endothelial cells.
Result: We show in normal adipose tissue samples that ROCK2 is expressed in vascular endothelial cells. Mice lacking vascular endothelial ROCK2 were resistant to adipose tissue expansion and insulin resistance in a high-fat diet-induced obese model. In these mice, heat production and food intake were greater after an overnight fast. Genetic analysis of adipose tissue and proteome analysis of conditioned medium obtained from ROCK2-deficient endothelium demonstrated that ROCK2 is an essential regulator of adipocyte browning. An important mechanism by which ROCK2 mediates adipocyte phenotype shifting is via the regulation of macrophage polarization. In particular, ROCK2 serves as a inducer of tumor necrosis factor α, which rewires adipose tissue-resident macrophage towards M2 phenotype.
Conclusion: This study establishes endothelial ROCK2 as a key regulator of adipose tissue function and implicates ROCK2 as a novel modulator of obesity progression.

Disclosure
S. Ohashi: None. K. Matoba: None. K. Sekiguchi: None. E. Mitsuyoshi: None. Y. Nagai: None. R. Nishimura: Speaker's Bureau; Abbott. Advisory Panel; Abbott Japan Co., Ltd. Speaker's Bureau; Boehringer-Ingelheim, Mitsubishi Tanabe Pharma Corporation, Kowa Company, Ltd., Medtronic, Sanofi, Taiho Pharmaceutical Co. Ltd., Sumitomo Dainippon Pharma Co., Ltd., Teijin Pharma Limited, Eli Lilly and Company, Novo Nordisk A/S. Consultant; Terumo Corporation.
1124-P: It Takes a Village—Enhancing the Nurse–Physician Communication on Inpatient Glycemic Control
Authors: BYRD LATONYA , STEWART ALYSSA , OBISESAN OLAWUNMI 
Published: June 2024

Introduction & Objective: Inpatient glycemic management for patients living with diabetes can be challenging due to complex, interrelated factors. Therefore, as patient advocates, nurses must be able to identify what clinical data warrants a call to the physician to facilitate timely decisions and interventions. The purpose of this study was to examine the effectiveness of a two-hour comprehensive diabetes education course in improving nurses’ understanding of glucose trends and causative factors, basal-bolus insulin regimens, and what information to communicate with the physician using the SMILE (Sugar Trend, Medications, IV Fluid, Labs, and Eating) SBAR (Situation Background Assessment Recommendation) approach.
Methods: Data was collected from a purposive sample of 28 registered nurses from a single general medicine unit. A t-test was used to examine nurses’ perceptions of knowledge and self-efficacy in nine content areas. Kruskal-Wallis H analysis was also conducted on the unit’s monthly patients’ blood glucose values over four months (July, August/intervention, September, and October 2023).
Results: The results suggest the class was effective in improving nurses’ perceived knowledge and self-efficacy in all nine content areas. The mean differences between the pre-and post-test ranged from .61 ± 1.26 (I feel confident when calling the physician and providing adequate information to advocate for the appropriate treatment) to 1.11 ± 1.20 (I have sufficient knowledge regarding the SMILE SBAR and use it as a tool for communicating with the physician), p&lt;.05. Patients’ median blood glucose values were statistically significantly different across four months (July, August, September, October), χ2(3)=21,088, p&lt;.0001.
Conclusion: Continued efforts to prevent and manage inpatient glycemic control should focus on enhancing nurse-physician communication and teamwork with simple yet effective tools such as the SMILE SBAR.

Disclosure
L. Byrd: None. A. Stewart: None. O. Obisesan: None.