bluuebunny/crossref_metadata_2025_split huggingface dataset:
1123-P: Wellness and Empowerment for Women —A Primary Care Approach to Treatment of Diabetes in Patients of Childbearing Age
Authors: AMIDON JOEL , KNAPP JESSICA L. , JINDAL MEENU 
Published: June 2024

Introduction and Objectives: The rate of diabetes in pregnancy is increasing at a rapid rate increasing risks for adverse perinatal and maternal health outcomes in the peripartum period and beyond. This cycle is exacerbated by historically low rates of preconception counseling and low rates of post-partum follow-up with primary care for patients with Type 1, Type 2, and Gestational Diabetes. Thoughtful coordinated transitions of care for this patient population are needed to address this rising concern.
Methods: Through a facilitated transfer of care from a previously existing program for pregnant patients with diabetes into the primary care setting we aimed to continue glycemic control postpartum, completion of testing to confirm resolution of gestational diabetes, provide glycemic control prior to conception, and offer general primary care services. A team-based approach consisting of physicians, diabetic educators, clinical pharmacists, and clinical navigators was utilized.
Results: Patients with Type 1, Type 2 and gestational diabetes enrolled in our year long program showed decreased A1c and average of 8.7 to 8.2, decreased BMI from 37 to 33, and an increased attrition with a primary care team. Increased access to healthy food options, exercise programs, and diabetes technologies (continuous glucose monitors) was achieved.
Conclusion: Through a team-based approach and increased coordination of care we have demonstrated avenues to utilize existing structures within our healthcare system to provide meaningful care to patients of childbearing age with diabetes. This intervention not only benefits the patient but their children and ultimately the general health of the state of South Carolina.

Disclosure
J. Amidon: None. J.L. Knapp: None. M. Jindal: None.

Funding
BlueCross BlueShield of South Carolina Foundation (2022-07)
1126-P: Does the Use of a Case Manager Matter in Diabetes Care?
Authors: GATTI SARAH , BENNETTI MADELINE , JUTRAS ASHLEY A. , TOSCHI ELENA 
Published: June 2024

Introduction & Objective: Navigating the health-care system is challenging and can impact diabetes care. Case managers (CM) hold expertise in accessing and navigating social services. However, there is limited information on the use and impact of CM in diabetes care.
Methods: A quality improvement project to assess impact of CM intervention was run over an 8-month period. Adult clinicians could refer any patient to CM for support. Retrospective analysis of demographic characteristics, reasons for referral, and number of visits the year prior (pre-CM) compared to during CM intervention were reviewed.
Results: Data of 72 patients referred showed an increase number of visits during CM compared to pre-CM. When patients were stratified by age as young adult (YA, ≤35 years) or adult (&gt;35 years), YA required greater ongoing support and mental health services compared to adults that required more one-time tasks (see table).
Conclusion: Use of CM resulted in an increased number of clinical visits. Services provided by CM differed based on age. Further investigation on impact of CM use in adult clinic is warranted.

Disclosure
S. Gatti: None. M. Bennetti: None. A.A. Jutras: None. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi.

Funding
Joslin Young Adult Charitable Fund
1131-P: Successful Strategies to Reduce Delays in Quality Data Reporting
Authors: MUNGMODE ANN , WIRSCH ANTON , DAWSON JAMES , ACCACHA SIHAM , BASINA MARINA , COSSEN KRISTINA , SONYA HAW JEEHEA , HERRICK CYNTHIA J. , MANN ELIZABETH A. , MIYAZAKI BRIAN , PRAHALAD PRIYA , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI 
Published: June 2024

Introduction: Collecting quality diabetes data can be burdensome and difficult. Benchmarking across multiple hospital systems is challenging due to unstandardized data collection and interoperability issues in electronic health records. T1D Exchange Quality Improvement Collaborative centers complete a comprehensive data mapping process for quality improvement and population health analysis. Between 2018 and 2020, this process took 20 months on average. This study summarizes results to expedite the T1DX-QI data mapping process.
Method: In 2021, the T1D Exchange implemented strategies to decrease mapping completion time: expanding data integration capacity with staff resources and cross-training, offering project management services (i.e., recurring project meetings and milestones tracking) and resources (i.e., electronic medical record templates and examples, step-by-step guides). Data is compared by centers that initiated mapping between 2018-2020 (pre; N=17) and 2021-2023 (post; N=13) overall, by center size, and population served.
Results: The average time to complete data mapping decreased from 20 to 13 months from pre- to post-implementation. There was also a reduction in variation between the two time periods (from 62 to 22 months, Figure 1).
Conclusion: This study highlights the ability to expedite the collection of quality diabetes data by supporting centers to improve patient care and process improvement.

Disclosure
A. Mungmode: None. A. Wirsch: None. J. Dawson: None. S. Accacha: Speaker's Bureau; Azurity. M. Basina: None. K. Cossen: None. J. Haw: None. C.J. Herrick: Consultant; Teladoc Health. Other Relationship; Eli Lilly and Company, Merck & Co., Inc. E.A. Mann: None. B. Miyazaki: None. P. Prahalad: None. O. Ebekozien: Advisory Panel; Sanofi, Medtronic. Research Support; Vertex Pharmaceuticals Incorporated. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; Medtronic, Lilly Diabetes, Abbott, Dexcom, Inc.

Funding
The Helmsley Charitable Trust
1153-P: Prevalence of Overweight/Obesity in a Largely Hispanic Pediatric Cystic Fibrosis Center
Authors: PILLAI RADHIKA , KOEK WOUTER , RAYAS MARIA S. 
Published: June 2024

Background: Historically, cystic fibrosis (CF) has been characterized by malnutrition and pulmonary decline. Recent advances in CF care, including genetic modulator therapies such as elexacaftor/tezacaftor/ivacaftor (ETI), have improved nutrition and lung function. An unexpected consequence has been the rise in overweight/obesity among patients with CF. Although Hispanics are at greater risk of developing overweight/obesity compared to non-Hispanic whites (NHW), ethnic differences regarding the prevalence in CF are unknown.
Methods: To determine the prevalence of overweight and obesity in Hispanics and NHW, we performed a cross-sectional retrospective chart review of patients 2-18 years of age at our CF center. Demographics, socioeconomic status, CF-related variables, and cardiometabolic risk factors were extracted from the medical record. Overweight/obesity data were analyzed by logistic regression using the following independent variables: ethnicity, age, sex, income, ETI therapy, supplemental feeding, and pancreatic sufficiency.
Results: Sixty-eight children with CF (46% Hispanic, 51% female, ages 11 ± 4 years, 74% on ETI) were assessed. Twenty-four (35%) children were overweight/obese (11 Hispanic). No ethnic differences were apparent. When analyzed univariably, overweight/obesity was associated with less supplemental feedings (odds ratio [OR] 0.19, 95% CI 0.063 to 0.58, P = 0.003) and more pancreatic sufficiency (OR 10.50, 95% CI 2.01 to 54.84, P = 0.005). Multivariable analysis revealed overweight/obesity was only associated with decreased odds of supplemental feedings (OR 0.098, 95% CI 0.018 to 0.54, P = 0.008).
Conclusion: In our ethnically diverse CF center, overweight/obesity is prevalent in 1 in 3 children. Prospective, longitudinal multicenter studies performed in diverse CF populations are warranted to identify factors associated with the development of overweight/obesity and to inform management and obesity-related screening for children with CF.

Disclosure
R. Pillai: None. W. Koek: None. M.S. Rayas: None.
1166-P: Impact of Food Insecurity on Risk Prediction of DKA in Youth with Type 1 Diabetes
Authors: DESALVO DANIEL , SCHWARTZ DAVID D. , ERRAGUNTLA MADHAV , SONABEND RONA Y. , LYONS SARAH 
Published: June 2024

Introduction: Food insecurity (FI) in youth with type 1 diabetes (T1D) has been associated with high-risk glycemic levels (A1c &gt;9%) and more emergency department utilization (Mendoza et al., Diabetes Res Clin Prac, 2018). At our diabetes center, we routinely assess for FI using the Hunger Vital Sign™, a validated 2-question screening tool. The goal of the present work was to examine the contribution of FI on DKA risk prediction in youth with T1D.
Methods: Multiple logistic regression models were used to predict the probability of severe DKA (pH &lt;7.0 and/or HCO3 &lt;5 mEq/L) and multiple DKA events in the next year based on demographic and glycemic features from the previous two years in youth with T1D screened for FI (n=761, age 12.93.2y, 53%F, A1c 8.92.1%, 49% public health insurance, 9.6% with positive FI screen).
Results: Predictive model performance with and without incorporation of the FI feature is characterized using receiver operating curves in Figure 1. A positive food insecurity screen was a significant covariate in the model for predicting the risk of severe DKA (p=0.003) and multiple DKA events (p=0.025).
Conclusion: Diabetes clinics should incorporate FI screening into clinical care and future studies are needed to assess whether addressing FI with tailored resources such as SNAP benefits, food prescriptions, connection to local food banks, and/or home-delivery of healthy foods reduces future risk of DKA.

Disclosure
D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc. D.D. Schwartz: None. M. Erraguntla: None. R.Y. Sonabend: None. S. Lyons: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (2206-05307)
1186-P: Considerations for a Community Health Worker Enhanced Strategy to Address Racial Disparities in Youth Use of Diabetes Technology
Authors: MACLEISH SARAH A. , MCALEER SARAH , MASOTYA MARIE , RONIS SARAH 
Published: June 2024

Introduction: Disparities by race in the use of diabetes technology by youth with T1DM risk exacerbating inequities in health outcomes among Black youth with T1DM. In preparation for a feasibility trial of an intervention to increase use of diabetes technology by Black youth, the purpose of this analysis was to define expectations for how a community health worker (CHW) might promote facilitators and address barriers to sustained adoption of diabetes technology.
Methods: Semi-structured interviews followed by 3 focus groups were conducted January-June 2023 with patients, caregivers, and healthcare workers in Ohio who had at least some experience with diabetes technology and/or CHWs. Content analysis was used to summarize participants’ perceptions regarding general barriers and facilitators to adoption of diabetes technology, and also specific feedback regarding the proposed intervention.
Results: Participants were 7 young adults with T1DM, 10 parents of a child with T1DM, and 11 healthcare workers. All young adults and parents plus 4 healthcare stakeholders identified as Black. Participants were favorable toward the proposed CHW intervention, emphasizing that CHWs should have similar lived experience to families in terms of both racial background and personal familiarity with T1DM. Stakeholder recommendations for the proposed intervention included: (1) CHW function -provide social and technical support to families, liase between family/community and healthcare team; (2) CHW tasks - identify and trouble shoot common barriers to wearing devices, acquisition of supplies, digital connectivity, and/or parent-child conflict regarding diabetes management; (3) CHW workflow - foster family-centeredness through flexibility in encounter location, format, frequency and duration.
Conclusion: CHW integration into the proposed intervention may promote equity for Black youth with T1DM by liaising between patient, clinical team, and community.

Disclosure
S.A. MacLeish: Speaker's Bureau; Insulet Corporation. Advisory Panel; Prevention Bio. S. McAleer: None. M. Masotya: None. S. Ronis: None.

Funding
National Institutes of Diabetes and Digestive and Kidney Diseases (R01 DK134953)
1194-P: Racial and Socioeconomic Differences in Technology Access in Children with Type 1 Diabetes (T1D)
Authors: AL NOFAL ALAA , RAJJO TAMIM , BASMACI RAMI , HEIEN HERBERT , MCCOY ROZALINA G. 
Published: June 2024

Background: While prior studies demonstrated disparities in access to diabetes technology based on race and socioeconomic status (SES) in children with T1D, few examined these differences in nationwide studies or in children with access to commercial health insurance.
Aim: To examine the difference in fill rates of insulin pumps and continuous glucose monitors (CGMs) among insured children with T1D from differential racial and SES groups.
Methods: Using medical and pharmacy claims from OptumLabs® Data Warehouse between 2011-2021, we calculated the proportion of children and adolescents &lt;18 years with T1D with a fill for pump or CGM at cohort entry, overall and stratified by race/ethnicity and annual household income.
Results: We identified 13,267 children with T1D, of which 36% had CGMs and 30.1% had insulin pumps. In this population, non-Hispanic Whites (NHW) had higher rates of access to CGMs and insulin pumps than non-Hispanic Blacks (NHB) (CGMs: 35.7% vs 22.4%. Pumps: 31.8% vs 21%, p &lt;0.001). Children whose household income was &lt;$40k had lower rates of access to CGMs and pumps than those whose household income was &gt;$200k (CGM 25.3% vs 43.7%. Pumps: 22.4% vs. 38.7%, p &lt;0.0001). Within similar household incomes of &lt;$40k, NHB were had CGM and insulin pump less often than NHW (CGM: 15.2% vs. 27.9%, p value 0.006. Pumps: 12.9% vs 25.5%, p 0.004). This racial difference disappeared with household income &gt;$200k (CGMs: 47.5% for NHB vs. 43.1% for NHW and pumps: 45.9% for NHB and 38.2% for NHW, p 0.45 and 0.57 respectively).
Conclusion: In a cohort of commercially insured pediatric patients with T1D, race and income play a role in access to diabetes technology. The racial disparity becomes less prominent as household incomes increase, and virtually disappeared when household incomes exceeded $200k. NHB with household income &lt;$40k are at the highest risk of being excluded from access to these critical technologies. Greater effort is needed at the systems and individual levels to mitigate these disparities.

Disclosure
A. Al Nofal: None. T. Rajjo: None. R. Basmaci: None. H. Heien: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institute of Health (NIH) (K23DK114497)
1202-P: Trends in Body Mass Index in Latin American Children with New-Onset Type 1 Diabetes over Three Years
Authors: HIRSCHLER VALERIA , MOLINARI CLAUDIA , STUDY GROUP CODIAPED 
Published: June 2024

Objective: To determine the trends in BMI z-score (z-BMI) and its correlation with insulin dose and HbA1c in children with new-onset type 1 diabetes (T1DM) from several Latin American centers over 3 years.
Methods: A retrospective chart review investigated the z-BMI trends in children aged 6 m-18 y with T1DM onset across 18 centers from 2019-2020 through 2023 in 5 Latin American countries: Argentina, Chile, Uruguay, Paraguay, and Peru. Anthropometric measures, insulin dose (U/kg/day), and Hb A1c (%) were collected at 3 months post-diagnosis and annually thereafter. Follow-up curves for z-BMI, HbA1c, and insulin dose were generated using the ANOVA method with repeated measures.
Results: A total of 421 children (48.9% females) aged 8.72 ± 3.75 years were included. The prevalence of obesity (OB) was 8.6%, overweight (OW) was 12.1%, and underweight (UW) was 10.0%. UW children increased their mean z-BMI by 2.28, whereas OW decreased by 0.29, and OB decreased by 0.94 at 3 years follow-up (P&lt;0.01). Mean z-BMI values increased significantly over the 3-year follow-up compared with the initial year: year 0 (0.03) vs. year 1-2-3 (0.42, 0.43, 0.46). Concurrently, there was a significant increase in the insulin dose (U/kg/d) across each year: year 0 (0.56) vs. year 1 (0.62) vs. year 2 (0.70) vs. year 3 (0.74). Interestingly, the mean HbA1c in year 1 (8.52%) was significantly lower than in year 0 (8.98%), year 2 (8.74%), and year 3 (8.70%). The repeated measures model for the follow-up of the z-BMI over 3 years, adjusted for the differences in insulin dose and HbA1c (year 0 vs. year 3), showed a significant increase in z-BMI at the onset compared with years 1, 2, and 3, with insulin dose as a significant covariate.
Conclusion: We observed a significant increase in the z-BMI from T1DM onset through the 3-year follow-up in Latin American children, with insulin dose as a significant covariate. Although the insulin dose steadily increased, the impact on HbA1c (8.7%) does not appear to be close to optimal levels.

Disclosure
V. Hirschler: None. C. Molinari: None.
1214-P: Prepregnancy Use of Glucagon-Like Peptide 1 Receptor Agonists and Gestational Weight Gain in Type 2 Diabetes
Authors: MAYA JACQUELINE , PANT DEEPTI , JAMES KAITLYN , MICHALOPOULOS CHLOE , HSU SARAH , SHOOK LYDIA , THAWEETHAI TANAYOTT , HIVERT MARIE-FRANCE , POWE CAMILLE E. 
Published: June 2024

Objective: The prevalence of type 2 diabetes (T2D) in pregnancy has tripled over the last two decades. Use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in pregnancy is contraindicated. Effects of pre-pregnancy GLP-1 RA use on pregnancy outcomes, including gestational weight gain (GWG), are poorly understood.
Methods: In a retrospective cohort of singleton pregnancies (2016 to 2022) in people with pre-existing T2D, we used propensity score matching on pre-pregnancy body mass index (BMI), maternal age, gestational age at delivery, race/ethnicity, and health insurance status to compare pregnancies with pre-pregnancy exposure to GLP-1 RA to unexposed pregnancies. We identified exposed pregnancies using prescription records and electronic chart searches. The primary outcome, GWG, was defined as the weight prior to delivery minus the pre-pregnancy weight, as documented in electronic medical record. A secondary outcome, excess GWG, was determined based on pre-pregnancy BMI, GWG, and clinical guidelines. We matched each GLP-1 RA exposed pregnancy to 3 unexposed pregnancies. We fit linear and logistic mixed models to evaluate associations between GLP-1 RA exposure and GWG.
Results: We included 188 pregnancies (47 exposed and 141 unexposed). Mean [SD] maternal age was 34.5 [5.3] years and mean [SD] pre-pregnancy BMI was 35.5 [7.6] kg/m2. GLP-1 RA exposed pregnancies had greater GWG (mean [SD]: 24.9 [12.0] lbs.) than unexposed pregnancies (19.1 [17.3] lbs., β= 5.9 lbs., 95% CI [0.60, 11.1], P=0.03). The proportion of pregnancies that exceeded recommended GWG was greater in GLP-1 RA-exposed than in unexposed pregnancies (61.7% vs 41.1%, P=0.02).
Conclusion: GWG in T2D-affected pregnancies with pre-pregnancy exposure to GLP-1 RA is greater than in matched pregnancies without pre-pregnancy GLP-1 RA exposure. Better understanding of the benefits and risks of pre-pregnancy use of GLP-1 RA is necessary to optimize care of T2D in pregnancy.

Disclosure
J. Maya: None. D. Pant: None. K. James: None. C. Michalopoulos: None. S. Hsu: None. L. Shook: None. T. Thaweethai: None. M. Hivert: None. C.E. Powe: Consultant; Mediflix. Other Relationship; Wolters Kluwer Health.

Funding
National Institutes of Health (T32DK007028-47S1)
1221-P: Optimal Delivery Timing in Pregnancies Complicated by Gestational Diabetes
Authors: BUCKLEY DEIRDRE , KHANUJA KAVISHA , AL-KOUATLY HUDA B. , MCLAREN RODNEY 
Published: June 2024

Objective: To assess neonatal and maternal morbidity at birth for each week of gestation among pregnancies complicated with gestational diabetes (GDM) to evaluate optimal timing of delivery.
Design: This was a population-based cohort study of non-anomalous, singleton, live births between 36 and 40 weeks complicated by GDM using data from the U.S. Natality Vital Statistics Database from 2015 to 2022. Planned delivery group included births at each completed week from 36 to 40 weeks that had a labor induction or scheduled cesarean delivery, excluding spontaneous labor. Expectant management group included all births that delivered on or after the following week (i.e., planned birth at 36 0/7-36 6/7 compared to all births ≥37 0/7 weeks). The primary outcomes were a neonatal and maternal adverse composite, compared between groups at each week using multivariable analyses.
Results: There were 1,324,559 births included. After adjusting for the differences between groups, planned delivery ≥39 0/7 had lower odds of composite neonatal morbidity than the expectant management group. After 39 weeks, planned delivery and expectant management had similar odds of maternal morbidity.
Conclusion: In pregnancies complicated by GDM, planned delivery after 39 weeks was associated with lower odds of neonatal morbidity compared to expectant management. This data suggests that providers should be cautious about expectant management past 39 weeks.

Disclosure
D. Buckley: None. K. Khanuja: None. H.B. Al-Kouatly: None. R. McLaren: None.
1237-P: IADPSG Criteria of Gestational Diabetes—Is It Optimized across Ethnicities?
Authors: BIN TAN YU , LING PHAIK , QUAH ELAINE , HIAN TAN KOK 
Published: June 2024

Introduction: Gestational Diabetes Mellitus (GDM) affects ~20% of Asian pregnancies, presenting substantial maternofetal risks. Despite the widespread adoption of International Association of Diabetes and Pregnancy Study Groups (IADPSG) GDM criteria, ethnic variations in insulin regulation, evidenced by unique oral glucose tolerance test (OGTT) profiles, have been noted. Our study investigates the relationship between three Asian ethnic groups (Chinese, Malay, Indian) and distinct OGTT phenotypes in GDM diagnosis within a multi-ethnic cohort.
Method: A retrospective review of 3,027 patients without pre-existing diabetes from KK Women's and Children's Hospital (2019) was conducted. GDM was diagnosed using the IADPSG criteria at 24-28 weeks. Adjusted multivariate analyses using a multinomial logistic regression with robust variances were used to estimate the relative risk ratios (RRR) between the ethnic-specific relative risk ratios and OGTT phenotypes, accounting for maternal age, parity, and first-trimester body mass index as potential confounders.
Results: GDM prevalence was highest among Indians (21.5%), followed by Chinese (18.4%) and Malays (14.2%). Compared to Malays, the Chinese and Indians were significantly associated with a higher risk of surpassing the OGTT threshold at 0h with a RRR of 2.33 (95% CI: 1.01-5.38, p&lt;0.05), and RRR of 3.05 (95% CI: 1.23-7.56, p&lt;0.05 respectively, with Indians being at the highest risk. Only the Chinese ethnic group was associated with an RRR of 2.88 (95% CI: 1.51-5.47, p&lt;0.01) for surpassing the OGTT threshold at 2h, compared to the Malays.
Conclusion: Indians were at higher risk of exceeding the 0h-only OGTT threshold, while Chinese were at higher risk of surpassing both the 0h-only and 2h-only OGTT thresholds. These patterns highlight inherent ethnic variations in glucose metabolism, underpinning the diverse OGTT phenotypes observed. These metabolic distinctions call for the development of an ethnic-sensitive diagnostic criteria.

Disclosure
Y. Tan: None. P. Quah: None. K. Tan: None.

Funding
Singhealth Medical Student Talent Development Award