bluuebunny/crossref_metadata_2025_split huggingface dataset:
1811-LB: Improvement in Diabetic Retinopathy and Achieving Remission of Type 2 Diabetes Mellitus through Digital Twin Technology—A One-Year Intervention Study
Authors: JOSHI SHASHANK , DHARMALINGAM MALA , VADAVI ARUN , KESHAVAMURTHY ASHOK , BHONSLEY SUCHITRA , MOHAMED MALUK , SHAH LISA , THAJUDEEN MOHAMED , PANANDIKAR MAHIKA , SHAMANNA PARAMESH 
Published: June 2024

Introduction and Objectives: Digital twin (DT) platform uses Artificial Intelligence (AI) and Internet of Things, to integrate multi-dimensional data to give precision nutrition and health recommendations via the mobile app and by coaches. Remission was defined as A1C levels less than 6.5% without medication for over 3 months. Status of diabetic retinopathy (DR) was assessed in patients on DT platform.
Methods: We monitored 181 T2DM patients, across 4 centers, for remission of T2DM, assessing changes in DR and HbA1c levels, with a focus on participants with initial DR. Validated handheld fundus camera facilitated retinal imaging. Statistical analysis, including the Pearson correlation coefficient, explored the link between HbA1c levels and DR progression or regression.
Results: Mean age, duration of diabetes, were 44 years (±8.6) and 3.7 years (±2.7). Mean HbA1c decrease was 3.03 (8.9% to 5.8), indicating significant glycemic control improvements from baseline to Day 360. 75.69% of the participants (n=137) achieved remission. Among those initially diagnosed with DR (n=16), 43.75% (n=7) showed regression, with no evidence of DR. 55.25% of the participants (n=100), continued, with absence of the evidence of DR. There was a weak negative correlation between remission of T2DM and retinopathy reversal (r=-0.0867) which indicates that remission of T2DM might not be a strong predictor of retinopathy improvement.
Conclusion: DT which leads to remission of T2DM has potential for regressing diabetic retinopathy in a significant subset of patients. The remarkable percentage of individuals moving from DR to absence of DR emphasizes the potential for positive retinopathy outcomes. However, the minimal correlation with remission of T2DM suggests the importance of comprehensive diabetic care strategies, extending beyond glycemic management to include specific retinopathy interventions.

Disclosure
S. Joshi: None. M. Dharmalingam: None. A. Vadavi: None. A. Keshavamurthy: None. S. Bhonsley: None. L. Shah: Employee; Twin Health. M. Panandikar: None. P. Shamanna: None.
1830-LB: Diabetes and Safe Driving—Latvian Medical Doctors Knowledge
Authors: ELINA BERZINA KATRINA , RASA INGVARS 
Published: June 2024

Introduction & Objective: Diabetics may experience disorientation and cognitive impairment when their blood glucose levels fall below 4.0 mmol/L a condition known as hypoglycemia. Driving in such a state can be dangerous. MDs must be educated and inform patients to ensure their safety.
Methods: An anonymous questionnaire with 17 questions was sent to MDs from 2022 to February 2024. The survey was completed by 165 MDs. Results were analyzed using IBM SPSS 29.0.
Results: Of the respondents, 8.5% (n=14) were endocrinologists, 91.5% (n=151), internists or GPs. 16% (n=26) did not think diabetes mellitus (DM) is a risk for car accidents. Of those 84% (n=139) who believed that DM is a risk factor 66.9% (n=93) educated their DM patient about safe driving. 97% (n=160) believe that having frequent and severe hypoglycemia episodes makes driving unsafe, but 42% (n=67) of them had advised their DM patients not to drive. 89% (n=147) believed that not recognizing hypoglycemia is a contraindication for driving of whom 38.8% (n=57) recommended DM patients to measure their blood glucose levels before driving.
Conclusion: Less than half of the MDs educate their DM patients about safe driving. MDs must receive education on DM and safe driving to inform their patients properly.

Disclosure
K. Berzina: None. I. Rasa: None.
1834-LB: Different Effects of Occupation and Leisure-Time Physical Activity on Long-Term Glucose Variability in Type 2 Diabetes
Authors: YU HUI-I 
Published: June 2024

Introduction: Occupational Physical Activity (OPA) and Leisure Time Physical Activity (LTPA) can both help prevent diabetes. A Finnish study revealed OPA, LTPA reduced total and cardiovascular disease mortality among type 2 diabetes mellitus (DM). Few studies examined the metabolic effect of OPA and LTPA on type 2 DM, but some suggest LTPA can reduce short-term glycemic variability. However, few have assessed the impact of physical activity on long-term glycemic variability.
Method: We recruited patients with type 2 DM, aged 20-75, from our outpatient clinic from August 2014 to July 2021. We evaluated glycemic variability using the HbA1c Variability Score (HVS). We categorized metabolic equivalent of task (MET). min. wk-1 &gt; 3000 as high activity, 600-3000 as moderate activity, and &lt; 600 as low activity. We divided both leisure and occupational activities into thirds based on these activity levels.
Results: We enrolled 758 patients who had at least 3 years of follow-up for final analysis. Younger patients had significantly higher total physical activity (P = 0.019). Their micr- and macro-vascular complications, and oral antidiabetic agents (OAD), insulin use did not differ significantly. High LTPA patients showed significantly lower body mass index (P = 0.004), lower HSV score (P = 0.005), and less statin usage (P = 0.027). A1C was marginally better (P = 0.060). High OPA patients were younger (P &lt; 0.001), predominantly male (P &lt; 0.001), shorter DM duration (P &lt; 0.001) and more biguanide usage (P = 0.026), but HVS did not reduce. Linear regression analysis found that LTPA reduced HVS in crude analysis, but the significance disappeared after adjusting other factors. In high OPA, we found it significantly increased HVS after adjusting other factors.
Conclusion: LTPA and OPA might have different effects in long-term glycemic variability in patients with type 2 diabetes.

Disclosure
H. Yu: None.
1835-LB: Understanding Hypoglycemia Risk in Unstructured Real-World Physical Activities in Adults with Type 1 Diabetes
Authors: DHALIWAL MEHAK P. , TANG KENAN , AIELLO ELEONORA M. , ZAHARIEVA DESSI P. , LAL RAYHAN , SUMMERS CAMERON , ARBITER BRANDON , WATSON KELLY , FIGG LAUREN , BALISTRERI ILENIA , KINGMAN RYAN S. , SUH BAILEY , QIN YAO 
Published: June 2024

Introduction & Objective: We analyzed the unstructured real-world physical activity (PA) sessions from the T1DEXI study to evaluate hypoglycemia risk in terms of change in CGM (ΔCGM) readings and percentage of time below range (%TBR) of T1D participants.
Methods: For each session, we calculated the ∆CGM as the difference in glucose readings within 5 mins before and after PA and, %TBR as the percentage of readings &lt;70 mg/dL during PA. ANOVA was used to measure variation in ΔCGM and %TBR associated with activity durations, starting glucose, insulin on board (IOB), and individual factors, i.e. age, sex, and A1c.
Results: We analyzed 9,322 sessions, with 46 activity types, for 404 participants (open and closed loop pump users, age 36.6 ± 14.0 yrs, 75.3% female, BMI 25.5 ± 3.9 kg/m2, A1c 6.6 ± 0.7%, T1D duration 18.5 ± 13.0 yrs, total daily dose 40.1 ± 16.2 U), with an average of 24 sessions in 4 weeks.
Table 1 shows larger ΔCGM and higher %TBR for increasing activity durations, and IOB (all p&lt;0.01), lower %TBR for increasing starting glucose (p&lt;0.01). %TBR differed significantly for age, A1c, and sex groups (all p&lt;0.03), while ΔCGM only for age (p&lt;0.01). Carbohydrate (CHO) intake correlated with a higher %TBR due to a lower starting glucose for sessions with CHO.
Conclusion: Hypoglycemia risk during PA is impacted by population and individual factors, which are important when tailoring glucose management strategies around PA.

Disclosure
M.P. Dhaliwal: Consultant; Tidepool. K. Tang: Consultant; Tidepool. E.M. Aiello: Other Relationship; Tidepool. D.P. Zaharieva: Research Support; Leona M. and Harry B. Helmsley Charitable Trust. Advisory Panel; Dexcom, Inc. Research Support; Insulet Corporation. Speaker's Bureau; Dexcom, Inc. Research Support; International Society for Pediatric and Adolescent Diabetes. Board Member; Juvenile Diabetes Research Foundation (JDRF). R. Lal: Consultant; Abbott, Adaptyx Biosciences, Biolinq, Capillary Biomedical, Inc., Deep Valley Labs, Gluroo, PhysioLogic Devices, Portal Insulin, Tidepool. Advisory Panel; Lilly Diabetes. C. Summers: Consultant; Tidepool. B. Arbiter: Stock/Shareholder; Eli Lilly and Company. Employee; Tidepool. Stock/Shareholder; Dexcom, Inc. K. Watson: Employee; Tidepool. Other Relationship; Luna Diabetes. Stock/Shareholder; Tandem Diabetes Care, Inc. L. Figg: None. I. Balistreri: None. R.S. Kingman: None. B. Suh: None. Y. Qin: None.

Funding
The Leona M. & Harry B. Helmsley Charitable Trust (Grant #2404-06905).
1837-LB: Designer Protein Sweelin, a Novel Hypersweet, Extremophile Protein as a Sugar Substitute
Authors: SAMISH ILAN , LESMES URI , LIFSHITZ YAEL 
Published: June 2024

Introduction and Objective: sweelin®, a novel sweet protein, ~3,000 sweeter than sugar enables up to 70% sugar reduction in numerous applications without compromising taste as assessed by professional sensory panels. The protein was designed using Agile-Integrative Computational Protein Design (AI-CPD) to improve stability and sensory profile of the monellin protein found in African fruits. It is produced via precision fermentation resulting with highly purified protein. Unlike small-molecule sweeteners, the protein is not expected to exhibit adverse effects, yet its digestibility required elucidation which was conducted via in vitro digestion models recreating gastric and intestinal proteolysis.
Methods: Digestibility of sweelin® was studied using a computer controlled in vitro semi-dynamic digestion model that mimics the gastrointestinal conditions of a healthy adult via 2 consecutive steps, a dynamic gastric phase and a small intestinal (duodenal) phase that rely on an adjusted version of the INFOGEST in vitro digestion protocol. Digesta samples were collected at different timepoints of gastric and intestinal digestion and subsequently analyzed by SDS PAGE, with Coomassie Blue stain or Western blotting. Bioaccessible peptides were analyzed by LC-MS/MS.
Results: sweelin® was readily digestible under intestinal conditions where bile and pancreatic secretions were added. In fact, the presence of physiological levels of trypsin and chymotrypsin led to the degradation of &gt;95% of sweelin®. LC-MS/MS analysis of bioaccessible peptides reaffirmed that sweelin® is readily digested in the intestine into very short peptides. After 2h of intestinal digestion undigested protein levels were estimated to be &lt;3% of the total ingested dose.
Conclusions: sweelin® is a novel hyper-sweet designer protein shown to be effectively digested in the small intestine, much like commonly consumed proteins. Clinical trials are in progress to demonstrate no effect on diabetes-related biomarkers.

Disclosure
I. Samish: Other Relationship; Amai Proteins. U. Lesmes: None. Y. Lifshitz: Employee; Amai Proteins.
1841-LB: Glycemic Management Patterns of Participants in a Diabetes Integrated Behavioral Health Program
Authors: ESPINOSA DE LOS MONTEROS KARLA , SPIERLING BAGSIC SAMANTHA R. , SORIANO EMILY C. , FORTMANN ADDIE L. , NOUHI NUSHA , PHILIS-TSIMIKAS ATHENA 
Published: June 2024

Introduction: In 2016, a large Southern CA health system launched the Diabetes Behavioral Health Integration Program (BeHIP), which co-locates psychological support with clinical diabetes care. Objective: To describe the glycemic management patterns of participants in the BeHIP program. Methods: Patients referred to the BeHIP via warm hand-off or through their EHR undergo an individualized assessment followed by short-term psychotherapy when indicated. Data was collected via EHR extraction. For those with ≥ 1 visit, the change in HbA1c was examined as follows: 1) a linear mixed effects model testing a time by program (i.e., pre vs. post initiation) interaction captured change over time relative to first BeHIP visit; 2) a paired t-test compared individual-level mean change pre- versus post- initiation of BeHIP. Results: BeHIP participants with ≥ 1 visit (N=430) had a mean age of 55.4±17.1; most were female (72.6%), Non-Hispanic White (75.1%), and married (54%). Plots show HbA1c change over time and paired differences (Fig 1A & B); and the difference in average HbA1c between those who engage in multiple BeHIP visits and those who only attend one consultation or are referred but do not engage (Fig 1C). Conclusion: Psychosocial and behavioral support embedded in a real-world clinical program improves glycemic outcomes.

Disclosure
K. Espinosa de los Monteros: None. E.C. Soriano: None. A.L. Fortmann: None. N. Nouhi: None. A. Philis-Tsimikas: Advisory Panel; Dexcom, Inc., Lilly Diabetes, Novo Nordisk, Sanofi, Medtronic, Bayer Inc.
1845-LB: “I’ve Tried Really Hard to Back Off, But…”—The Influence of Type 1 Diabetes on Mothers’ Quality of Life during the Transition to Adulthood
Authors: NESS MICHELLE , SAYLOR JENNIFER 
Published: June 2024

Research indicates that continued parental involvement in T1D management is paramount during the transition to adulthood, yet there is a paucity of information about the needs of mothers during this time. To ensure family-centered care throughout the lifespan, this research seeks to gain a better understanding of the influence of T1D on the mother’s quality of life during their adolescent’s transition to adulthood. Participants were recruited from the Parents of Diabetics Facebook page, JDRF, and the Children with Diabetes newsletter. Twelve mothers of adolescents with T1D (average age of adolescent=19.42, SD=1.44, average age at T1D diagnosis=11.14, SD=3.3 years) were interviewed. Interviews were audio and video recorded, transcribed verbatim, and analyzed by two independent researchers using the Family Management Style Framework. Mothers reported continued feelings of anxiousness and uncertainty related to lack of control of their adolescent’s T1D management. Involvement in T1D management ranged from a “hands-off” approach to high levels of involvement, including daily blood glucose monitoring and communication regarding T1D. Management of T1D had a profound influence on mothers' ability to work outside the home, with many mothers reporting that they chose not to work to care for their children full time. Mothers also reported receiving limited support from family and friends as well as strained relationships related to lack of understanding about T1D and its management. Isolation, anxiety, and continued worry about T1D and its ever-present impact on their children led to diminished quality of life for mothers during the adolescents’ transition to adulthood. The needs of mothers of adolescents transitioning to adulthood with T1D are largely ignored. This study highlights the long-term consequences of T1D on mothers as well as the need for continued professional support for mothers during the adolescent's transition to adulthood and beyond.

Disclosure
M. Ness: None. J. Saylor: None.

Funding
Towson University (FDRC funding)
1856-LB: Efficacy and Safety of Mazdutide in Chinese Participants with Overweight or Obesity (GLORY-1)
Authors: JI LINONG , JIANG HONGWEI , LI HUA , TIAN JUNHANG , LIU DEXUE , ZHAO YUZHU , GU JIEYU , LIU ZIHAN , DENG HUAN , WANG YANQI , LI LI , QIAN LEI , GLORY-1 INVESTIGATORS THE 
Published: June 2024

Introduction & Objective: To evaluate the efficacy and safety of mazdutide, a once-weekly GLP-1 and glucagon receptor dual agonist, in Chinese participants with overweight or obesity.
Methods: In this phase 3 randomized, double-blind, placebo-controlled trial (NCT05607680), we assigned 610 Chinese adults with a BMI of 28 kg/m2 or more, or 24 kg/m2 or more and at least one weight-related comorbidity, in a 1:1:1 ratio to receive once-weekly, subcutaneous mazdutide 4 mg, 6 mg or placebo for 48 weeks. Co-primary endpoints were the percentage change in weight from baseline and a weight reduction of 5% or more at week 32.
Results: At baseline, the mean body weight was 87.2 kg, the mean BMI was 31.1 kg/m2, and 83.1% of participants had a BMI of 28 kg/m2 or more. Mazdutide met co-primary endpoints and all key secondary endpoints, demonstrating superiority to placebo on body weight changes, weight-loss targets, and improvements on multiple cardiometabolic risk factors (Table). Mazdutide was well tolerated, with adverse events leading to treatment discontinuation reported in 1.5% of participants with mazdutide 4 mg, 0.5% with mazdutide 6 mg and 1.0% with placebo. The most frequently reported adverse events were gastrointestinal, mostly mild to moderate in severity.
Conclusion: In Chinese adults with overweight or obesity, mazdutide provides significant reductions in body weight and cardiometabolic risk factors.

Disclosure
L. Ji: None. H. Jiang: None. H. Li: None. J. Tian: None. D. Liu: None. Y. Zhao: None. J. Gu: None. Z. Liu: Employee; Innovent Biologics. H. Deng: Employee; Innovent. Y. Wang: Employee; Innoventbio. L. Li: Employee; innovent biologics. Stock/Shareholder; innovent biologics. L. Qian: Employee; Innoventbio.
1866-LB: A Phase 2 Study of Mazdutide 9 mg in Chinese Adults with BMI of 30 kg/m2 or more
Authors: JIANG HONGWEI , JI LINONG , ZHANG YAWEI , CHENG ZHIFENG , PANG SHUGUANG , LI XIAOLI , QIU WEI , MA QINGYANG , LIU ZIHAN , WANG YANQI , DENG HUAN , QIAN LEI 
Published: June 2024

Introduction & Objective: To evaluate the efficacy and safety of 9 mg mazdutide, a once-weekly GLP-1 and glucagon receptor dual agonist, in Chinese participants with obesity.
Methods: In a randomized, double-blind, placebo-controlled phase 2 trial (NCT04904913), 80 Chinese adults with a BMI of 30 kg/m2 or more (mean baseline body weight: 96.9 kg; mean baseline BMI: 34.3 kg/m2) were randomized to receive once-weekly, subcutaneous mazdutide 9 mg (n=60) or placebo (n=20) for 24 weeks. Subsequently, participants voluntarily chose to participate in an extended 24-week double-blind treatment period. The primary endpoint was the percentage change in weight from baseline at week 24.
Results: At week 24, mean percentage change in weight from baseline were −13.3% (SE 0.8) with mazdutide 9 mg and 2.1% (1.5) with placebo (estimated treatment difference: −15.4% [95%CI: −18.8, −12.0], P &lt;0.0001); 81.7%, 65.0% and 31.7% of participants with mazdutide achieved weight reduction of 5% or more, 10% or more, and 15% or more, respectively, while no participant with placebo achieved weight reduction of 5% or more. Furthermore, compared with placebo, greater improvements were observed with mazdutide at week 24 in multiple cardiometabolic risk factors, most notably in triglycerides (−43.5% with mazdutide, −1.7% with placebo), alanine aminotransferase (−32.8%, 12.7%) and serum uric acid (−102.2 µmol/L, −16.1 µmol/L). In participants with baseline liver fat content (as measured by MRI-PDFF) of 5% or more, the liver fat content was reduced by 73.3% after 24-week treatment of mazdutide. Mazdutide 9 mg was well tolerated, with no adverse event leading to treatment discontinuation reported. The most frequently reported adverse events were gastrointestinal, and most were mild to moderate in severity.
Conclusion: In Chinese adults with a BMI of 30 kg/m2 or more, mazdutide 9 mg showed robust body weight reduction and prominent hepatic benefits.

Disclosure
H. Jiang: None. L. Ji: None. Y. Zhang: None. Z. Cheng: None. S. Pang: None. X. Li: None. W. Qiu: None. Q. Ma: Employee; Innovent Biologics (Suzhou) Co., Ltd. Z. Liu: Employee; Innovent Biologics. Y. Wang: Employee; Innoventbio. H. Deng: Employee; Innovent. L. Qian: Employee; Innoventbio.
1902-LB: Evaluating Need for Larger Insulin Reservoir in Patch Pumps—Leveraging Retrospective Dose Data for U.S. Adults with Type 2 Diabetes on MDI
Authors: WRIGHT EUGENE E. , SHAH VIRAL N. , THACH ANDREW V. , JAVADI PASHA , DAVIES SHAWN , SIERADZAN RAY 
Published: June 2024

Introduction & Objective: People with T2D may require higher total daily doses (TDD) of insulin with progression to MDI. Study aim was to examine impact of different insulin reservoir sizes for adults with T2D on MDI transitioning to a patch pump.
Methods: Adults (≥18 yr) with T2D on MDI (≥3 daily insulin injections) were included from the US IQVIA ambulatory electronic medical record dataset (01/2017 - 07/2022). Using mean TDD per person, we estimated number (%) of people for whom 200-unit (u) and 300u insulin reservoirs would be sufficient for different wear times and the number of patch pumps needed over time.
Results: Mean ±SD TDD was 96±58u (median 80u) among 41,215 adults with T2D on MDI (52% women; mean age 58±13 yr, mean BMI 34±7 kg/m2). For 72-hr wear, 200u and 300u reservoirs were sufficient capacity for 15,612 (38%) and 26,290 (64%) adults, respectively (Figure). For 48-hr wear, 200u and 300u were sufficient for 64% and 85%, respectively, and for 24-hr wear, 94% and 99%. Number of patches needed with 200/300u reservoirs were estimated at 15/10 per mo, 176/122 per yr at mean TDD of 96u; 12/10 per mo, 147/122 per yr at median TDD of 80u; 23/15 per mo, 274/183 per yr at TDD 150u; 30/20 per mo, 366/244 per yr at TDD 200u.
Conclusions: Findings provide a solid rationale for larger insulin reservoir size, providing longer wear times and fewer patches for adults with T2D on MDI transitioning to a patch pump.

Disclosure
E.E. Wright: Advisory Panel; Abbott. Consultant; Abbott. Speaker's Bureau; Abbott. Consultant; Abbott Diagnostics. Advisory Panel; ADA/ACC Diabetes by Heart Program, Bayer Inc. Consultant; Bayer Inc. Speaker's Bureau; Bayer Inc. Advisory Panel; Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes. Consultant; Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Advisory Panel; embecta. Consultant; embecta, GlaxoSmithKline plc. Speaker's Bureau; GlaxoSmithKline plc. Advisory Panel; Medtronic, Renalytix. Consultant; Renalytix. Speaker's Bureau; Renalytix. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Advisory Panel; Stability Health. Consultant; Up-To-Date. V.N. Shah: Consultant; Dexcom, Inc., Insulet Corporation. Research Support; Insulet Corporation. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Sanofi, Medscape. Consultant; embecta, Tandem Diabetes Care, Inc. A.V. Thach: Employee; embecta. Research Support; dQ&A. Employee; AbbVie Inc., Sunovion Pharmaceuticals Inc. P. Javadi: Employee; embecta, Insulet Corporation. S. Davies: None. R. Sieradzan: Employee; embecta. Stock/Shareholder; embecta.