bluuebunny/crossref_metadata_2025_split huggingface dataset:
1909-LB: Patient Preferences for Continuous Glucose Monitoring Devices—A Discrete Choice Experiment Study of People Living with Type 2 Diabetes
Authors: LAI TIM C. , WHITLEY HEATHER P. , NGORSURACHES SURACHAT 
Published: June 2024

Introduction & Objective: While continuous glucose monitoring (CGM) devices have received approval for use in eligible patients, there remains limited evidence regarding patient preferences for these devices. This study aims to determine the important attributes of CGM devices for patients with type 2 diabetes (T2D).
Methods: A cross-sectional, web-based, discrete choice experiment (DCE) survey was conducted. Seven attributes of CGM devices, including the approach to access data, alarm function, information on receiver screen (including measurement frequency and prediction arrow), accuracy, calibration frequency, sensor lifespan, and out-of-pocket cost, were identified through a literature review and consultation with five clinical experts. A D-efficient design was used to generate DCE choice sets. Data were collected from 242 American adults living with T2D who were proficient in English. A mixed logit model was used to determine the preference weights of all attributes. Conditional relative importance was calculated by differentiating each attribute’s highest and lowest level of its preference weights.
Results: A total of 182 patients were included in the analysis. The preference weights of all attributes, except the information on receiver screen, were statistically significant and in the expected direction (e.g., patients prefer lower out-of-pock cost). The conditional relative importance of out-of-pocket cost was the greatest (3.19, SE=0.75), followed by accuracy (1.40, SE=0.37), calibration frequency (1.01, SE=0.27), alarm function (0.94, SE=0.27), sensor lifespan (0.60, SE=0.22), and approach to access data (0.26, SE=0.13).
Conclusion: While patients with T2D considered various attributes when selecting CGM devices, out-of-pocket cost was their primary concern. Notably, information on receiver screen was not a significant attribute, underscoring the need for further investigation into its implications.

Disclosure
T.C. Lai: None. H.P. Whitley: None. S. Ngorsuraches: Research Support; Bristol-Myers Squibb Company.
1934-LB: Evaluating the Efficacy of Decentralized Trials and Digital Marketing Tactics in Diabetes Management in Habitual’s DIGEST Study
Authors: GOROBZOV MELANIE 
Published: June 2024

Introduction/Rationale: Advances in diabetes remission programs have markedly improved type 2 diabetes (T2D) management, addressing glycemia, blood pressure, and microvascular health. However, the high demand for in-person medical consultations increases costs and decreases patient engagement. Recognizing these challenges, the DIGEST study by Habitual explores the efficiency of a remote-delivered diet replacement and digital therapy for T2D remission and weight loss, circumventing the traditional clinical visit model. The study employed Lindus Health for a fully virtual trial, navigating strict recruitment criteria through digital outreach and a primary care network.
Methods: Lindus Health executed a fully virtual design, enabling remote monitoring for six months. The approach utilized digital marketing and referrals from ten GP sites to attract participants, directing them to a study website for initial screening. Eligible individuals underwent a virtual assessment by Lindus Health nurses for deeper engagement and informed consent.
Results: Lindus Health's strategies enabled Habitual to reach its recruitment goal of 100 patients in five months, significantly ahead of the initial 12-month prediction. The trial's decentralization allowed for UK-wide participant inclusion, reaching over 16,000 people through online advertising. Remote monitoring facilitated home-based study participation, allowing real-time tracking of patient progress and enhancing the trial's patient-centric approach.
Conclusion: The DIGEST study demonstrates the potential of fully decentralized trials in T2D management, showcasing the Habitual Remission Program's efficacy. The model's success, driven by virtual designs and strategic recruitment, highlights a shift towards more accessible, efficient clinical research, suggesting a scalable and patient-friendly future for digital health solutions in disease management.

Disclosure
M. Gorobzov: None.
1943-LB: The Fresh Start Program—Refreshing Management of Type 2 Diabetes Mellitus
Authors: GRDINOVAC KRISTINE , DAVIES GAGE , STEGER FELICIA 
Published: June 2024

Objective: Intensive type 2 diabetes mellitus (T2DM) intervention programs can improve clinical outcomes for patients and reduce costs to patients, insurance providers, and health care systems. We piloted an intensive T2DM intervention program consisting of a multidisciplinary team of diabetes providers. We tested feasibility of our program and examined its impact on hemoglobin A1c (HbA1c) and glycemic time in range (TIR).
Methods: The program was piloted at a large, urban, academic hospital. Adults with T2DM and HbA1c &gt;9% were enrolled in a 24-week program consisting of regular visits with a Nurse Practitioner, Certified Diabetes Care and Education Specialist, pharmacist, and social worker (if needed). There were a total of 12 individual provider visits and nine group T2DM lifestyle education classes. All participants were given continuous glucose monitors (CGMs).
Results: Ten participants were enrolled. Eight patients completed 12 weeks and seven patients completed the 24 week program (70% retention). Participants were 50% female and 80% Caucasian, with mean HbA1c 11.4 ± 1.4%. Mean HbA1c after 12 weeks was significantly reduced by 3.3 ± 2.5% (n=7; p=0.02). Change in HbA1c at 24 weeks approached statistical significance (-2.5 ± 3.4%, n=8, p=0.06). CGM TIR increased by 24 ± 26% after 24 weeks (n=6, p=0.03) and average glucose decreased by 23 ± 20 mg/dL (n=6, p=0.03).
Conclusion: We demonstrated the feasibility of a 24-week multidisciplinary diabetes intervention program for patients with uncontrolled T2DM. Overall time in range and average glucose via CGM improved. Future studies should evaluate sustained improvements in glycemic measure with intensive behavior change programs as well as their impact on health system utilization.

Disclosure
K. Grdinovac: Consultant; AmalgamRx. G. Davies: None. F. Steger: None.
1946-LB: Patterns of Insulin Discontinuation in Youth with New-Onset Type 2 Diabetes
Authors: HAO SHUAI , WESTBROOK ADRIANNA , SINHA CYNTHIA B. , HSIA DANIEL S. , VELLANKI PRIYATHAMA 
Published: June 2024

Heterogeneity in the clinical course of T2D in youth presenting with and without diabetic ketoacidosis (DKA) at diagnosis is not well described. In this study, we aimed to characterize if presentation with DKA affects rates of insulin discontinuation compared to T2D without ketosis (non-DKA). This single-center retrospective cohort study included patients (BMI 33.7 IQR 29.1,38.6) with mean age 15 years (IQR 13,16), admitted for new-onset DKA (n= 77) or non-DKA (n=361) from 2019-2021 with 1-year follow-up. All patients were initiated on insulin and titrated per their care team. Type 1 diabetes was excluded by presence of autoimmune antibodies. Primary outcomes were discontinuation of insulin therapy and maintenance of discontinuation 1 year after diagnosis. There were no differences in the proportion of (p=0.63) or time to insulin discontinuation (p=0.20) between DKA and non-DKA. Trajectory analyses identified 3 insulin discontinuation groups: early (within 2 months), late (within 6 months), and never (Figure 1). Multinomial regression shows that DKA at presentation is not associated with early (p=0.60) or late insulin discontinuation (p=0.59) compared to never discontinuation. We identified heterogeneity in duration of insulin treatment in youth with new-onset T2D with and without DKA at presentation. Prospective studies are needed to characterize differences in β-cell function that may predict insulin dependence.

Disclosure
S. Hao: None. A. Westbrook: None. C.B. Sinha: None. D.S. Hsia: None. P. Vellanki: Consultant; Eli Lilly and Company.
195-OR: Efficacy and Feasibility of a Telemedicine Program for Institutionalized Elderly People with Insulin-Treated Diabetes Using Continuous Glucose Monitoring and a Connected Insulin Pen Cap—The Trescasas Study
Authors: GOMEZ-PERALTA FERNANDO , ABREU CRISTINA , MAZO ESTEFANIA S. 
Published: June 2024

Introduction & Objective: Investigate the feasibility and efficacy of a telemedicine program in institutionalized elderly people with insulin-treated diabetes.
Methods: This multicenter, prospective study comprised of three two-week phases: Phase 1 (baseline): blind CGM (Freestyle Libre Pro®); Phase 2a: CGM (Freestyle Libre2®) without alarms; Phase 2b: CGM with alarms for hypo and hyperglycemia. Two telemedicine visits from the reference diabetes units to adjust the treatment before phases 2a and 2b. The insulin treatment was tracked using the Insulclock® connected insulin pen cap. The caregivers’ opinion about the program was measured. Feasibility criteria included the number of eligible patients, recruitment, attrition and the capture of glucose readings. The insulin or antidiabetic drugs changes were recorded.
Results: From 82 eligible residents (87.7 +7.1, 68-102 y, 56% women, baseline HbA1c 6.9 &lt;u&gt;+&lt;/u&gt;1.6) at 7 nursing homes, 54 completed all the procedures. The caregivers expressed an overall positive view of the program (3.8 out of 4 points); greater convenience (4.5 out of 5 points) and potential to reduce hypoglycemia (3.7 out of 5 points) by using Freestyle Libre2® over glucometer. The rate of glucose events &lt;70 mg/dl in every phase (mean +SD) decreased: 4.9 +6.2, 3 +3.8, and 2.1 +3.1 (p 0.036). GMI and TIR 70-180 increased: 7.1 +1.2, 7.2 +1.4, 7.5 +1.7 (p 0.01); 65.6 +24.8, 65.1 +25.2, 60.4 +26.4 (p 0.02), respectively. The number of insulin injections (mean +SD): (1.2 +0.9 to 0.9 +0.8; p 0.02), and basal insulin dose (median) (16 to 14 IU; p 0.0003) decreased. The number of rapid insulin doses increased: 1.6 +3.8 to 2.9 +4.3 (p 0.02).
Conclusion: A telemedicine program using CGM is well-perceived by caregivers and achieves a safer and more adequate glycemic profile in the challenging population of institutionalized older people with diabetes treated with insulin.

Disclosure
F. Gomez-Peralta: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Advisory Panel; Insulcloud S.L. Speaker's Bureau; Medtronic. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Advisory Panel; Sanofi. C. Abreu: None. E.S. Mazo: None.

Funding
Abbott Diabetes Care Investigator Initiated Study (ADC-OUS-IIS-20-55)
1954-LB: Health Care Resource Utilization in Newly Diagnosed Children with Type 1 Diabetes in U.S. Clinical Practice
Authors: STOKES MICHAEL E. , LI QIAN , CAGLE ANDREW , WILSON LAURA 
Published: June 2024

Introduction & Objective: There are limited contemporary data available on healthcare resource utilization (HCRU) in children newly diagnosed with type 1 diabetes (T1D). This study estimated HCRU in newly diagnosed pediatric patients with T1D in US clinical practice.
Methods: Merative MarketScan® data were retrospectively analyzed for newly diagnosed pediatric patients with T1D enrolled in Commercial or Medicaid health plans (January 1, 2014-June 30, 2019). Included patients had ≥2 T1D claims ≥30 days apart (first claim was index date), ≥12 months of pre-index enrollment, ≥1 month of follow-up, and were aged &lt;18 years at index. Outcomes included T1D-related inpatient care, TD1-related outpatient visits, and emergency room (ER) visits and hospitalizations for hypoglycemia.
Results: We identified 4092 patients in Commercial and 1153 patients on Medicaid plans (mean [SD] age: 10.5 [4.3] vs 11.1 [4.1] years; 44.5% vs 51.4% female); median (range) follow-up was 27.9 (1.2-54.0) versus 24.7 (1.2-54.0) months. Almost all patients experienced T1D-related outpatient care (Commercial 99.3%; Medicaid 97.3%). T1D-related inpatient care (42.3% vs 36.0%) and use of insulin pumps (45.8% vs 30.5%) and continuous glucose monitoring (66.1% vs 51.9%) appeared higher for patients on Commercial versus Medicaid plans. ER visits for hypoglycemia occurred in 4.4% of patients on Commercial plans and 7.3% of patients on Medicaid plans. Few patients were hospitalized for hypoglycemia (Commercial 0.7%; Medicaid 1.0%).
Conclusion: Newly diagnosed T1D in children was associated with generally high rates of T1D-related HCRU. Distinct disparities in HCRU were identified between Commercial and Medicaid plan participants. Patients in Medicaid plans had higher ER visits for hypoglycemia compared to those with Commercial plans. Medicaid plan participants had lower use of continuous glucose monitoring and insulin pumps.

Disclosure
Q. Li: None. A. Cagle: Employee; Sanofi-Aventis U.S. L. Wilson: Employee; Sanofi. Stock/Shareholder; Sanofi.

Funding
Sanofi
1957-LB: Transition between Pediatric and Adult Diabetes Services—The Experiences and Perceptions of Health Care Professionals Worldwide
Authors: JAMES STEVEN , CUDIZIO LAURA , NG SZE M. , LYONS SARAH , ARASZKIEWICZ ALEKSANDRA , GOMBER APOORVA , MARUTHUR NISA M. , SNOEK FRANK J. , TOFT EVA H. , WEISSBERG-BENCHELL JILL , DE BEAUFORT CARINE 
Published: June 2024

Introduction: Youth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. International diabetes specific consensus guidelines are currently lacking. We sought to identify the experiences of healthcare professionals (HCPs) providing transition care, around readiness planning, policies, and the actual transfer to adult services, plus their perceptions around barriers in offering a good transition experience.
Methods: Data were collected via an online global survey (seven language options), broadly advertised by ISPAD, EASD, team members and research partners, via newsletters, websites, e-mails and social media.
Results: Respondents (n=372) were mainly physicians (74.5%), practicing in government funded (59.4%), pediatric (54.0%), metropolitan settings (85.8%) in Europe (44.9%); 37.1% in low or middle-income countries (LMICs). Youth were typically introduced to transition between 15-17 years (49.2%) and adult diabetes teams at ≥18 years (62.4%). Few centers used a transition readiness checklist (31.7%), written transition information (29.6%), or had a dedicated staff member (23.7%). Similarly, few involved a psychologist (25.8%), had combined (35.2%) or transition/young person only clinics (34.9%), or a structured transition education program (22.6%); 49.8% advised youth to use technology to assist the transfer. Most (91.9%) respondents reported barriers in offering a good transition experience; additional staffing (72.0%) and a structured protocol (71.5%) were perceived to improve the transition process. A greater proportion of respondents from LMICs sought more funding (p=0.01), a structured protocol (p&lt;0.001) and education (p&lt;0.001).
Conclusion: HCPs’ experiences and perceptions related to transition between pediatric and adult diabetes services vary widely. There is a pressing need for international consensus transition guidelines.

Disclosure
S. James: None. L. Cudizio: Other Relationship; Novo Nordisk. S. Lyons: None. A. Araszkiewicz: Other Relationship; Sanofi, Novo Nordisk, Eli Lilly and Company, Ascensia Diabetes Care, Boehringer-Ingelheim. A. Gomber: None. N.M. Maruthur: Other Relationship; Johns Hopkins Health Care Solutions. F.J. Snoek: Advisory Panel; Abbott, Sanofi, Eli Lilly and Company, Roche Diabetes Care. J. Weissberg-Benchell: Consultant; Beta Bionics, Inc. Advisory Panel; American Diabetes Association. Research Support; Juvenile Diabetes Research Foundation (JDRF), National Institute of Diabetes and Digestive and Kidney Diseases. C. de Beaufort: None.
1973-LB: Postpartum Dysglycemia Screening with Continuous Glucose Monitoring
Authors: CABRERA CAMILA , OGYAADU SELASSIE J. , KAPLAN LEAH , IPEK ASLIHAN , LEVY CAROL J. , O'MALLEY GRENYE 
Published: June 2024

Introduction & Objective: Up to one third of birthing persons with gestational diabetes (GDM) will have persistent dysglycemia, and more than half do not complete the recommended postpartum oral glucose tolerance test (OGTT). This study assessed the feasibility of postpartum continuous glucose monitoring (CGM) to detect dysglycemia by assessing sensor return rates and participant experience and calculated the predictive power of CGM to predict OGTT results.
Methods: CGM was placed on postpartum day 1-3 after pregnancy complicated by GDM and worn at home for up to 10 days. Participants were encouraged to undergo standard of care 6-week OGTT. CGM data was analyzed according to time-above cutoffs. Analysis with removal of data within 4 half-lives of steroid administration was also performed.
Results: Fifty women (36±6 years; 40% non-Hispanic White, 24% non-Hispanic Black, 22% Asian, 14% Hispanic; 34% Medicaid insured) were consented; 86% returned CGM and 66% completed OGTT. All CGM downloads included at least 72 hours of data, and 19% provided data after recent steroid administration. Fasting data was available on 88% of CGM and 42% of OGTT. Mean CGM glucose was 122±14 mg/dL. Median time &gt;140, &gt;180, and &gt;200 mg/dL was 17%, 1.9%, and 0.6%, respectively; and 91%, 21%, and 33% had time &gt;140 mg/dL of &gt;5%, &gt;180 mg/dL of &gt;5%, and &gt;200 mg/dL of &gt;1%. Mean fasting CGM glucose was 113±15 mg/dL and was 100-125 mg/dL in 51% and &gt;125 mg/dL in 23%. Dysglycemia on OGTT (7 impaired glucose tolerance, 1 diabetes) was well predicted by percent time &gt;180 of &gt;4% (sensitivity 86%, specificity 85%, positive predictive value 60%, negative predictive value 96%). Removal of steroid affected data did not improve performance. CGM and OGTT were considered burdensome by 7% and 52%, respectively.
Conclusion: Completion rates and acceptability scores were better for CGM than OGTT. Percent time &gt;180 mg/dL had strong predictive power for OGTT. Time above range for this population was also found to be higher than reported for people without diabetes.

Disclosure
C. Cabrera: None. S.J. Ogyaadu: None. L. Kaplan: None. A. Ipek: None. C.J. Levy: Research Support; Dexcom, Inc. Consultant; Dexcom, Inc. Research Support; MannKind Corporation, T1D Exchange, Tandem Diabetes Care, Inc., Abbott, Insulet Corporation. G. O'Malley: Research Support; Dexcom, Inc., Insulet Corporation, Abbott, Tandem Diabetes Care, Inc., MannKind Corporation.

Funding
Product and research support for this investigator initiated study provided by Dexcom, Inc.
1975-LB: A Randomized Trial of Real-Time Continuous Glucose Monitoring in Gestational Diabetes
Authors: EHRHARDT NICOLE M. , FAY EMILY , ABDALLA GHADA , MANDAVA PATALI , FONDA STEPHANIE J. 
Published: June 2024

Background: Gestational diabetes is common. Real-time continuous glucose monitoring (RT-CGM) may improve glycemia during pregnancy, but data is lacking.
Methods: We conducted a randomized controlled study in which patients with GDM performed SMBG with RT or blinded CGM. This analysis compares CGM metrics at EGA 32 and 36 weeks (+/-10 days). Outcomes included CGM metrics (see table), A1c and diabetes medication use.
Results: 107 participants with GDM enrolled (RT-CGM: N=53; SMBG: N=54). 35 SMBG participants withdrew, reporting desire for RT-CGM. Average EGA at CGM start was 30.2 (+/-1.7) weeks, age was 33.8 (+/-4.8) years, and 31% (RT-CGM) and 14% (SMBG) groups were on diabetes medication at screening. The 32-week CGM metrics for the groups were similar except mean glucose (RT-CGM=106.7 +/- 9 and SMBG=97.7 +/- 13, P=.01) and TBR54 (0.1 +/- 0.2) and 0.6 (+/- 1.2), P=0.08). 36-week mean glucose decreased for the RT-CGM group but increased for the SMBG group, and TBR54 was lower for the RT-CGM group (P=.03). A1c was similar between groups. Diabetes medication use at study end was 69% for RT-CGM and 32% for SMBG.
Conclusions: RT-CGM and SMBG group indices were similar despite higher initial mean glucose and diabetes medication use. Glucose changes were slight when CGM was started at EGA of 30 weeks but desire for CGM was high. More studies are needed to evaluate if earlier RT-CGM use will significantly affect glycemic indices.

Disclosure
N.M. Ehrhardt: Advisory Panel; Bayer Inc., Dexcom, Inc. Research Support; Dexcom, Inc., Novo Nordisk. Advisory Panel; Novo Nordisk. Research Support; Merck & Co., Inc. E. Fay: None. G. Abdalla: None. P. Mandava: None. S.J. Fonda: None.

Funding
Investigator initiated grant DexcomIIS-2019-101
1984-LB: Secretagogin—A Potential Circulating Biomarker of Acute Pancreatic ß-Cell Injury
Authors: QI XIAO-YAN , ZHANG MEILIN , WANG XIN , YANG JING 
Published: June 2024

Introduction & Objective: Beta cell dysfunction is the fundamental pathogenesis of type 1 diabetes mellitus (T1DM), but there are few clinical biomarkers available to assess β-cell injury. Secretagogin, a protein enriched in pancreatic islets, demonstrates protective effects on β-cell function in animals. However, its potential as a circulating biomarker released from injured islet β-cell has not been studied.
Methods: Streptozotocin (STZ) induced diabetes mouse model and 21 T1DM patient were recruited to explore secretion and expression of secretagogin in relation to the T1DM pathology. Secretagogin expression was detected by western blotting and immunofluorescence staining while circulating secretagogin levels was measured by ELISA kit.
Results: Secretagogin was abundantly expressed in mouse and human islets, specifically co-localized with insulin positive β-cell. STZ administration induced loss of β-cell and progressive depletion of pancreatic secretagogin. There’s a sharp peak in mouse plasma secretagogin level 24 h after STZ injection and declined gradually. Western blot analysis also revealed a notable reduction in secretagogin levels within the pancreas 1 week following the STZ treatment. Furthermore, T1DM patients exhibited a significant decrease in plasma secretagogin levels compared to matched healthy controls. Interestingly, 4 subjects with fulminant type 1 diabetes (FT1DM) displayed considerably higher plasma secretagogin concentrations during the early stage of disease onset, in comparison to the average levels observed within the cohort. However, a clinical follow-up study revealed a significant reduction in plasma secretagogin levels among all FT1DM subjects during the observation period.
Conclusion: Our findings indicate that secretagogin is a potential novel biomarker reflecting acute pancreatic β-cell injury.

Disclosure
X. Qi: None. J. Yang: None.

Funding
National Natural Science Foundation of China (82170852); The Major Project of Science and Technology in the Health System of Nanshan District, Shenzhen (NSZD2023044).