bluuebunny/crossref_metadata_2025_split huggingface dataset:
1037-P: Telehealth Use among Medicare Beneficiaries with Diabetes—2020–2023
Authors: SHAO YIXUE , WANG YU , ZHOU XILIN , LUMAN ELIZABETH , HOLLIDAY CHRISTOPHER S. , ZHANG PING 
Published: June 2024

Introduction & Objectives: Telehealth use increased among Medicare beneficiaries with diabetes during the initial phase of the COVID-19 pandemic. To determine whether these changes have persisted, we examined monthly telehealth use from 01/2020 to 02/2023.
Methods: Using 100% Medicare 2020-2023 claims, we identified beneficiaries with diabetes using International Classification of Diseases codes (E10, E11) and examined their use of telehealth eligible services (TES). We defined telehealth users as beneficiaries who accessed a TES through telehealth. We calculated the monthly percentage of telehealth use (the number of telehealth users divided by the number of TES users) overall and by race/ethnicity, age, sex, rurality, and clinician specialty.
Results: Telehealth use among Medicare beneficiaries with diabetes who used TES increased from ≤10% per month prior to the pandemic to ≥ 40% in March 2020. The percentage gradually decreased with some fluctuations but has stabilized around 27% since March 2022. Although this trend was similar across groups by race/ethnicity, age, sex, and rurality, level of telehealth use varied by race/ethnicity, age, sex, rurality, and clinician specialty (Figure).
Conclusions: Telehealth use has stabilized at more than twice the pre-COVID pandemic level, implying that telehealth has been integrated as a part of routine diabetes care in older U.S. adults.

Disclosure
Y. Shao: Employee; Biogen. Y. Wang: None. X. Zhou: None. E. Luman: None. C.S. Holliday: None. P. Zhang: None.
1053-P: Enhancing Accessibility—Assessing the Impact of Expanded CGM Coverage on CGM Adoption
Authors: ZENG ALISON , BELTRAN ALAN , BELL TREVOR , WOOD RICHARD 
Published: June 2024

In April 2023, the Center for Medicare and Medicaid Services (CMS) expanded continuous glucose monitoring (CGM) coverage to people with diabetes (PWD) on Medicare and basal insulin only. This study examines the impact of these guidelines on CGM accessibility.
From May-Oct. 2023, 177 non-CGM-using PWD on Medicare and basal insulin only, 270 primary care physicians (PCPs), and 187 endocrinologists were surveyed on their awareness of CMS’ expanded coverage. Physicians also reported the impact of the new guidelines on prescribing behavior. CGM usage among PWD was tracked every three months from Sep. 2022 - Sep. 2023.
While most endocrinologists were aware of the new guidelines (78%), awareness showed room for improvement among PWD (31%) and PCPs (44%). Among those aware, 76% of endocrinologists and 64% of PCPs reported increasing the number CGM prescriptions written due to the guideline change. Indeed, since April 2023, CGM usage has increased significantly among PWD on Medicare and basal insulin only (p&lt;.05), rising from 15% in Mar. 2023 to 24% in Sep. 2023 (Fig. 1). By contrast, CGM usage remained stagnant around 15% from Sep. 2022 to Mar. 2023.
The research underscores the notable impact of CMS’ expanded CGM coverage in enhancing access for Medicare recipients on basal insulin only. To promote wider CGM adoption, increasing knowledge of the guidelines among PWD and PCPs, where awareness is particularly low, may be beneficial.

Disclosure
A. Zeng: Employee; dQ&A. Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health. A. Beltran: Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health. T. Bell: Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health. R. Wood: Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health.
106-OR: Semaglutide Reduces Tumor Burden in the GAN Diet-Induced Obese and Biopsy-Confirmed Mouse Model of MASH with Advanced Fibrosis and HCC
Authors: FEIGH MICHAEL , TOZZI MARCO , HANSEN HENRIK H. 
Published: June 2024

Introduction & Objective: Metabolic dysfunction-associated steatohepatitis (MASH) ncreases the risk for the development of hepatocellular carcinoma (HCC). The present study aimed to evaluate the efficacy of semaglutide, a glucagon-like-receptor (GLP1R) agonist, on disease progression in the translational GAN diet-induced obese (DIO) and biopsy-confirmed mouse model of MASH with advanced fibrosis and HCC.
Methods: Male C57BL/6J mice were fed the GAN diet high in fat, fructose, and cholesterol for 54 weeks (DIO-MASH-HCC mice) prior to treatment intervention. Only mice with liver biopsy-confirmed NASH and advanced fibrosis were included and stratified into study groups. DIO-MASH-HCC mice (n=15-16 per group) received vehicle or semaglutide (30 nmol/kg) once daily for 14 weeks. Untreated DIO-NASH-HCC mice (n=10) were terminated at baseline. Endpoints included within-subject change in nonalcoholic fatty liver disease activity score (NAS), fibrosis stage, quantitative histology, tumor classification and macroscopic tumor count/diameter.
Results: DIO-MASH-HCC mice demonstrated progressive liver tumor burden over the 14-week study period. Tumors showed consistent architectural, cytologic and molecular features of poor prognostic HCC. Semaglutide promoted ≥2-point improvement in NAS, supported by beneficial changes in quantitative histological markers of steatosis and inflammation. While not improving fibrosis, semaglutide substantial reduced tumor numbers, tumor size and histological markers of proliferation (Ki67) and progenitor cell activation (CK19).
Conclusion: Consistent with a recent clinical trial, semaglutide improves MASH while not promoting fibrosis regression in GAN DIO-MASH-HCC mice. Notably, semaglutide markedly lowers HCC burden in the model. Collectively, our data highlights the suitability of GAN DIO-MASH-HCC mice for profiling novel drug therapies targeting MASH-driven HCC.

Disclosure
M. Feigh: Employee; Gubra. M. Tozzi: None. H.H. Hansen: Employee; Gubra.
1060-P: MOMs—Improved Glycemic Control and Diabetes Self-Management for Underserved Pregnant Patients
Authors: SCHELLINGER MEGAN M. , BRITT JESSICA , PASKO DANIEL N. , KEISER SHARON , WEBER SANDRA L. , WHITE HANNAH , ODOM JESSICA , STANCIL MICHELLE D. , SCHULT PAMELA L. , HUNT KATHRYN , FIOCCHI CASEY J. , FINCHER KATHLEEN , CART COURTNEY U. , KELLY ALEXIS , LONDONO DAVID , PEREZ-CANO LINDA , FU DONGXU , LEYVA MISTI J. , LYONS TIMOTHY 
Published: June 2024

Background: Management of Maternal Diabetes (MOMs) program provides comprehensive, single-site team care for pregnant patients who are for medically-complex.
Objective: To determine whether MOMs improves glycemic control through specialized care and patient engagement in diabetes self-management (DSMES). Methods: General linear models compared longitudinal A1c and time in range (TIR) to pre-enrollment baseline values for patients delivering June 2020 through March 2023. Surveys were conducted on patient satisfaction, diabetes self-management.
Results: Among 482 patients, 26% were Black, 30% Hispanic, 39% White, 5% Other. For preferred language, 27% cited Spanish. Insurance included 54% Medicaid and 31% Uninsured with Medicaid only for delivery. At baseline, 44% were obese and 28% morbidly obese. Diabetes type comprised 9% Type 1, 35% Type 2, 45% Gestational-A2, 10% Other. Type 1 patients had A1c decrease (p &lt; 0.01) across all trimesters. Type 2 patients had A1c decrease (p &lt; 0.01) in the 2nd and 3rd trimester. Patients using CGMs increased (p = 0.01) TIR from 64% to 77% to 81% across trimesters. Patient surveys showed 93% were very satisfied/satisfied with the availability of multiple providers and services at a single visit; 91% strongly agreed/agreed that MOMs helped them develop healthier lifestyles.
Conclusion: MOMs improved glycemic control and demonstrated a high degree of patient engagement.

Disclosure
M.M. Schellinger: None. J. Britt: None. D.N. Pasko: None. S. Keiser: None. S.L. Weber: None. H. White: None. J. Odom: None. M.D. Stancil: None. P.L. Schult: None. K. Hunt: None. C.J. Fiocchi: None. K. Fincher: None. C.U. Cart: None. A. Kelly: None. D. Londono: None. L. Perez-Cano: None. D. Fu: None. M.J. Leyva: None. T. Lyons: None.

Funding
BlueCross BlueShield of South Carolina Foundation, Diabetes Free SC (2020-09)
1091-P: Decreasing DKA Admissions in High-Risk Youth Using Wrap-Around Services
Authors: IGHALO FULFILLED , RAKHRA PAVANDEEP , BUTLER REBECCA , MARTINEZ AMELIA L. , CRAVEN MEGHAN , DEI-TUTU SELORM A. 
Published: June 2024

Background: Recurrent DKA is a major cause of morbidity in children with T1D. In January 2022, we developed a quality initiative to reduce DKA hospitalizations by providing extra support via wrap around services to children at highest risk of DKA. Secondary aims included increased clinic visits, increased technology use and decreased HbA1c.
Methods: Between January and June 2022, patients &gt; 2 years from diagnosis with RI-DKA scores &gt; 9 were identified and provided with wrap around services by a social worker and nurse. Services included a 2-week post DKA follow up and monthly phone calls to facilitate diabetes education, prescription management and psychosocial care. The team also provided appointment reminders, facilitated transportation to clinic and provided psychosocial support during visit. Quarterly DKA admissions as well as secondary measures were compared to baseline utilizing QI methodology.
Results: 24 patients participated in the initial cohort. There was a decrease from 9 DKA admissions per quarter to 3. There was a notable increase in technology use from 62% to 88%, an increase in clinic visits per quarter from 15 to 19, a decrease in average HbA1c from 13.6% to 12.3% and a decrease in RI-DKA from 9.4 to 8.0.
Conclusions: Targeted wrap around services achieved a decrease DKA admissions in the high-risk cohort. Further longitudinal data is needed to determine if change is sustained.
Keywords: Type 1 Diabetes, DKA, High Risk

Disclosure
F. Ighalo: None. P. Rakhra: None. R. Butler: None. A.L. Martinez: None. M. Craven: None. S.A. Dei-Tutu: None.
1100-P: Impact of Best Practice Advisories (BPA) on Therapeutic Inertia of Glycemic Management in Hospitalized Patients
Authors: LINN AUNG NAY , LAPE MEGAN E. , WIN KHAING , KHINE HNINN E. , DUENAS LIZETH , NI HNIN AYE NWE , D'ACCURZIO ALBERT D. 
Published: June 2024

Despite increased mortality and morbidity in hospitalized patients with poor glycemic control, therapeutic inertia (TI) exists among them. Best Practice Advisories (BPA) for hospitalized patients with hyperglycemia (BG &gt; 250) or hypoglycemia (BG &lt; 70) were implemented in 2022 in our institution to alert providers and prompt them to act accordingly. In this pilot study, we aim to find out if BPA implementation had an impact on TI and glycemic control. The study involved a non-random sample of patients with diabetes (Inclusion criteria in demographic table) admitted during June 2021 (n = 390) and June 2023 (n=470). Data analysis was performed using SPSS 25. Results showed TI (both rates of intensification and de-intensification) reduced after BPA implementation. And hyperglycemia and hypoglycemia rates also improved.

Disclosure
N. Aung: None. M.E. Lape: None. K. Win: None. H.E. Khine: None. L. Duenas: None. N. Aye: None. A.D. D'Accurzio: None.
1115-P: Differences in Clinical Outcomes by Sociodemographic Characteristics in Adults with Diabetes Receiving Care at a Federally Qualified Health Center
Authors: SAN DIEGO EMILY ROSE N. , VINCENT LAUREN , ORENDAIN NATALIA , SPIERLING BAGSIC SAMANTHA R. , GORDON CHRIS , PHILIS-TSIMIKAS ATHENA 
Published: June 2024

Introduction: Racial and ethnic minority and socioeconomically disadvantaged populations are disproportionately burdened by type 2 diabetes (T2D). Federally Qualified Health Centers (FQHCs) provide health services to over 30 million medically underserved populations, with 63% racial and ethnic minorities and 90% at/below the federal poverty threshold.
Objective: Examine data from 35,092 adults with diabetes receiving care from an FQHC offering Diabetes Specialty Care services in San Diego, CA between 2017-2022.
Methods: Linear regression models examined clinical outcomes while controlling for sociodemographic characteristics (age, sex, race, education) and whether an endocrinologist was part of the care team.
Results: Patients were on average 60±13.1 years old, and 51% were women, 54% were Hispanic/Latino, 57% had ≤ high school education, and 7% were seen by an endocrinologist. Mean A1C was 7.9%±2.0 and systolic blood pressure (BP) was 114 mmHg±45. A1C was lower among older patients (β = -0.03, p &lt; .0001), females (β =-0.26, p &lt; .0001), and individuals with a college (β = -0.14, p = .001) or postgraduate (β = -0.40, p &lt; .0001) degree. A1C was higher among patients identifying as Black (β = 0.21, p &lt; .0001), Native American (β = 0.45, p = .011), Pacific Islander (β = 0.46, p = .0001), and Hispanic (β = 0.45, p &lt; .0001) compared to White. BP was lower among females (β = -4.26, p &lt; .0001) and higher among older patients (β = 0.40, p &lt; .0001) and those identifying as Black (β = 6.94, p &lt; .0001), Asian (β = 4.63, p &lt; .001), and Pacific Islander (β = 6.93, p = 0.013) compared to White. While not significant, BP was lower in individuals with higher education compared to those with lower education.
Conclusion: Poorer clinical outcomes were observed in racial and ethnic minorities and individuals with lower education. Targeted strategies for different populations are needed to address disparities in groups that are disproportionately burdened by diabetes.

Disclosure
E.N. San Diego: None. L. Vincent: None. N. Orendain: None. S.R. Spierling Bagsic: None. C. Gordon: None. A. Philis-Tsimikas: Advisory Panel; Dexcom, Inc., Lilly Diabetes, Novo Nordisk, Sanofi, Medtronic, Bayer Inc.

Funding
National Institutes of Health (K12 TR004410); National Institutes of Health (KL2 TR001112)
1118-P: Engaging Data Teams in Electronic Medical Record Data Extraction for Diabetes Real-World Data and Improvement Projects
Authors: WIRSCH ANTON , MUNGMODE ANN , DAWSON JAMES , RIOLES NICOLE , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI 
Published: June 2024

Introduction: The electronic medical record (EMR) is rich in valuable information, however extracting the data for real world insights is challenging and difficult for comparison studies. This study’s aim is to identify some of the common challenges and perspectives from 18 data teams participating in the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
Method: T1DX-QI centers share patient-level, de-identified, individual-level EMR data with the coordinating center for real world studies, benchmarking, and quality improvement studies. Centers’ data teams liaise with T1DX-QI to map and extract over 120 pre-specified T1DX-QI data fields. T1DX-QI invited 22 centers that have recently completed the mapping process to participate in this assessment. Data teams responded to an online survey and participated in focus groups. T1DX-QI’s coordinating center reviewed data samples to identify common errors with significant deviation from the expected variable.
Results: Most centers (18 out of 22,82% response rate) participated in the study. The majority (61%) of the data teams conduct 6 or more EMR data extraction projects annually. Nearly half (45%) of centers reported that the diabetes data extraction and mapping process was about the same level of effort as other disease area extraction process. Most of these experienced centers thought the T1DX-QI mapping process was efficient (73%). The most common errors from the extraction process were incorrect values, incomplete documentation, missing variables, and incorrect formats. All errors were readily addressed in iterative review cycles and by implementing a comprehensive best practice checklist.
Conclusion: EMR data extraction for diabetes quality improvement and population health collaboration is feasible and achievable, as demonstrated by the T1DX-QI network.

Disclosure
A. Wirsch: None. A. Mungmode: None. J. Dawson: None. N. Rioles: 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
1125-P: Provider Experience Caring for Elderly Patients with Uncontrolled Type 2 Diabetes and Hospitalization
Authors: CHEPP VALERIE , MASIANO STEVEN P. , MILINOVICH ALEX , FOX JACQUELINE , PANTALONE KEVIN M. , MISRA-HEBERT ANITA D. 
Published: June 2024

Introduction & Objective: Hospitalization may serve as an opportune time to address uncontrolled type 2 diabetes (T2D) in elderly patients. Our objective was to examine hospitalist and primary care provider (PCP) experience caring for patients &gt; age 65 with T2D during or after hospitalization.
Methods: Utilizing the electronic medical record, we identified patients age &gt;65 with T2D and A1c&gt; 8%, with hospital discharge November 2022-April 2023 and identified the hospitalists and PCPs caring for these patients. Sixteen semi-structured interviews were conducted with providers within 90 days of patient discharge. Interviews were audio recorded, transcribed, and transcripts were thematically analyzed using an inductive approach.
Results: Hospitalists and PCPs both viewed hospitalization as an opportunity to make therapeutic changes for patients with uncontrolled T2D. A hospitalist described “an opportunity to ‘reassess’ medications previously set "on cruise control." Providers use blood sugar and A1c to inform decisions, but reported variation in data prompting medication change. Hospitalists expressed trepidation around “making drastic changes,” or one stating “⋯ I might tweak things a little bit and say⋯ ‘follow up with your PCP,” while PCPs draw upon their relationships with patients and see “the outpatient setting [as] where the care of diabetic patients takes place most of the time.” Yet PCPs may appreciate when changes are made in the hospital, one stating "It’s psychologically a little easier, if they’ve already started [medicines prescribed by hospitalists]."
Conclusion: PCPs and hospitalists both appreciate hospitalization as an opportune time to make T2D therapeutic changes but therapeutic inertia was identified among both provider types. Efforts to improve hospitalist-PCP communication about diabetes treatment as well as standardized protocols for treatment adjustment should be explored for older patients with uncontrolled T2D at the time of discharge.

Disclosure
V. Chepp: None. S.P. Masiano: None. A. Milinovich: Research Support; Novo Nordisk, Bayer Inc., Merck & Co., Inc., Twin Health, National Institutes of Health, Eli Lilly and Company, Pfizer Inc. J. Fox: None. K.M. Pantalone: Speaker's Bureau; AstraZeneca. Consultant; AstraZeneca. Board Member; Bayer Inc. Research Support; Bayer Inc. Speaker's Bureau; Corcept Therapeutics. Consultant; Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc. Speaker's Bureau; Merck & Co., Inc. Research Support; Merck & Co., Inc. Consultant; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Twin Health. Consultant; Sanofi. A.D. Misra-Hebert: Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk.
1134-P: Randomized Controlled Trial Assessing PBI-4547's Impact on Glycemic Control, Diabetic Nephropathy, and Obesity in Type 2 Diabetes Mellitus Patients
Authors: AHMAD KHAWAJA A. , PRAKASH AKHOURI S. , CHANDRA ABHISHEK , JHA RAJESH K. 
Published: June 2024

Introduction: The rising prevalence of diabetes and its complications, including diabetic nephropathy and obesity, demands innovative therapeutic strategies. PBI-4547, a novel antidiabetic and antifibrotic compound, offers potential benefits in this realm. This study investigates the efficacy and safety of oral PBI-4547 in managing diabetes, diabetic nephropathy, and obesity.
Methods: In this randomized, double-blind, placebo-controlled experiment, 150 patients with T2DM, diabetic nephropathy, and obesity were included. The participants were divided into three groups: low-dose, high-dose, and placebo. The study examined HbA1c, albuminuria, eGFR, and body weight during six months. Safety was assessed through the recording of adverse events.
Results: Significant improvements in glycemic control were observed in both PBI-4547 groups compared to the placebo, with a mean HbA1c reduction of 1.2% in the high-dose group and 0.8% in the low-dose group (p&lt;0.01). Albuminuria decreased by 30% in the high-dose group and 20% in the low-dose group (p&lt;0.05). The high-dose group also exhibited an average weight loss of 5%, and the low-dose group reported moderate but significant weight loss. PBI-4547 was well-tolerated, with no serious adverse events reported.
Conclusion: Oral PBI-4547 significantly improved glycemic control, lessened albuminuria, and induced weight loss in obese T2DM patients, indicating its potential as an all-encompassing diabetes therapy. Further large-scale, long-term studies are needed to verify these outcomes and determine its safety profile.

Disclosure
K.A. Ahmad: None. A.S. Prakash: None. A. Chandra: None. R.K. Jha: None.
1137-P: Childhood Obesity Risk Increased with Increasing Neighborhood Deprivation Index during the Prenatal Period
Authors: CHEHAB RANA F. , FERRARA ASSIAMIRA , GREENBERG MARA , LEE CATHERINE , NGO AMANDA , ZHU YEYI 
Published: June 2024

Childhood obesity is a growing epidemic with long-term sequelae including diabetes. Obesity is challenging to reverse, highlighting an urgent need to target upstream in utero risk factors. We examined associations of prenatal neighborhood deprivation index (NDI) with risk of childhood obesity from 2-10 years and the role of gestational diabetes (GDM) in modifying this association.
In a racially diverse cohort of livebirths (n=258,060) from 2011-2017 in Kaiser Permanente Northern California, we assessed risk of childhood obesity (sex-specific BMI-for-age ≥95th percentile using CDC growth charts) by quartiles (Q) of prenatal NDI (a validated census-based socioeconomic status measure) using modified Poisson regression.
Obesity affected 15.4%, 16.0%, and 21.7% of children aged 2-4, 5-7, and 8-10 years; respectively (Figure). Obesity risk at all ages increased with increasing prenatal NDI Q (P-for-trend &lt;.0001). Specifically, the adjusted relative risk (95% CI) of obesity in children exposed prenatally to more (Q4) compared to less (Q1) deprived neighborhoods was 1.36 (1.31-1.42) at 2-4 years, 1.46 (1.39-1.53) at 5-7 years, and 1.47 (1.37-1.58) at 8-10 years. Similar yet stronger associations were observed in children of individuals with vs. without GDM.
The prenatal neighborhood environment may inform early risk stratification and targeted interventions to prevent childhood obesity.

Disclosure
R.F. Chehab: None. A. Ferrara: None. M. Greenberg: None. C. Lee: None. A. Ngo: None. Y. Zhu: None.

Funding
Diabetes Research for Equity through Advanced Multilevel Science Center for Diabetes Translation Research (DREAMS-CDTR) pilot and feasibility program supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [P30-DK092924]; Kaiser Permanente Northern California, Central Research Committee, Community Health project [RNG212200]; National Heart, Lung, and Blood Institute R01 grant [R01HL157666]