bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT077 Association Of Mitochondrial DNA With Type-2-diabetes, Glucose Level, And Insulin Resistance
Authors: Heydarpour Mahyar , Pojoga Luminita , Romero Jose R , Williams Gordon H , Williams Jonathan S 
Published: October 2023

Abstract
Disclosure: M. Heydarpour: None. L. Pojoga: None. J.R. Romero: None. G.H. Williams: None. J.S. Williams: None.
Background: Mitochondrial dysfunction leads to decreased Adenosine-3-phosphate (ATP) production and increased ROS production, leading to insulin resistance, and diabetes (T2D). Mutations in mitochondrial DNA (mtDNA) have been associated with increased ROS production. Current studies have shown a role for mtDNA variants in the pathogenesis of both T2D and insulin resistance. Despite both of these disorders are controlled by many features involving interplay between genetic and environmental factors, however amongst genetic factors, variations in mtDNA have shown a potential role in the risk of T2D. We analyzed the genomic influence of mtDNA on T2D, insulin resistance, and fasting plasma glucose in humans. Methods: Participants (113 cases with T2D and 303 controls) from the HyperPATH Cohort were selected and genotyped using a Multi-Ethnic-Genotyping-Array. Individuals consumed two study diets containing high (&gt;200mEq/day) and low (&lt;10mEq/day) sodium content for 7 days each. The Homeostasis Model Assessment (HOMA-IR) index was used to assess insulin resistance. We performed association analyses between 275 mitochondrial genetic markers (SNVs) and three outcomes (T2D, insulin resistance, and fasting plasma glucose) using PLINK program. Results: We identified 2 significant SNVs within mtDNA that associated with T2D after adjusting the model for sex, age, study site, and BMI. One SNV (rs2248727, OR=3.15, P=0.00035) was within the coding region of Cytochrome C Oxidase III (COX3) and another (rs2857284, OR=3.13, P=0.00037) within the coding region of NADH Dehydrogenase subunit 4 (ND4). Further, we identified 2 SNVs associated with fasting plasma glucose; rs28359176, beta=22.7, P=0.0006 in the coding region of NADH Dehydrogenase subunit 5 (ND5), and rs367951226 beta=22.7, P=0.0006) in the region of ATP Synthase membrane subunit 6 (ATP6). We also identified a significant signal (rs376888742, beta=5.61, P=6.09E-06) associated with insulin-resistance in the coding region of Cytochrome B (CYB). Conclusion: These results show a significant association between mitochondrial ND4 and COX3 gene variants with T2D and CYP with insulin resistance. Gene variants of mitochondrial ND5 and ATP6 were associated with increase plasma glucose.
Presentation: Saturday, June 17, 2023
SAT086 Early-onset HNF1B-MODY With Persistent Insulin Requirement In A 2-year-old Female
Authors: Ighalo Fulfilled , Renee Kelly Sarah , Tosur Mustafa , Elizabeth Craven Meghan 
Published: October 2023

Abstract
Disclosure: F. Ighalo: None. S.R. Kelly: None. M. Tosur: None. M.E. Craven: None.
Introduction: Diabetes related to HNF1B pathogenic variants or deletions (maturity-onset diabetes of the young 5 [MODY 5]) typically presents in adolescence or early adulthood, with a median age of 20 years. Bustamante et al. previously described two patients with 17q12 deletion encompassing HNF1B presenting with diabetes and pre-diabetes before the age of 3, who were managed with dietary intervention alone without insulin requirement. This case describes a 2-year-old diagnosed with HNF1B-MODY after developing hyperglycemia in the setting of an acute illness, who continued to require insulin therapy following recovery. Clinical Case: A 2-year-old female with a history of recurrent viral infections and failure to thrive was admitted to the intensive care unit in hypovolemic shock due to hemolytic uremic syndrome due to Shiga toxin. On hospital day 7, while on supraphysiologic steroid doses, she developed hyperglycemia with glucoses above 600 mg/dL. She required an insulin drip to maintain blood glucoses between 100 and 200 mg/dL. Her four-month hospital stay was complicated by cardiogenic shock requiring extracorporeal mechanical oxygenation, renal failure requiring hemodialysis, respiratory failure resulting in a tracheostomy, and dysphagia resulting in a gastrostomy tube. During this time, she continued to require insulin despite being weaned off steroids and transitioning from total parenteral nutrition to gastrostomy tube feeds. Her hemoglobin A1c one month post-diagnosis was 4.9%, and continued to rise to 6.6% and 7.6% at 3 and 4 months post-diagnosis, respectively. Testing for islet autoantibodies was negative. A chromosomal microarray analysis revealed a micro-deletion in chromosome 17q12 that included the HNF1B gene. MRI showed a near total absent pancreas, and multiple small cysts scattered throughout both kidneys. She also had fecal elastase levels in the insufficient range (135 mcg/g, normal &gt;200 mcg/g). Six weeks after the start of insulin drip, she was transitioned from an insulin drip to subcutaneous insulin injections, and eventually placed on an insulin pump prior to discharge. With continued clinical improvement, her insulin doses decreased, but she was not able to come off insulin completely. She had gradual decline in her insulin requirements from 1.0 units/kg/day down to 0.1 units/kg/day at time of discharge. Her current insulin requirement at 6 months post-diagnosis is 0.2 units/kg/day. Conclusion: This case represents the rare development of diabetes before adolescence in HNF1B-MODY, and one of the most severe presentations seen in a prepubertal child requiring persistent insulin therapy at 6 months post-diagnosis. Potential contribution of complicated hospital course on persistent insulin requirement in the setting of 17q12 micro-deletion cannot be excluded.
Presentation: Saturday, June 17, 2023
SAT099 Should We Use HbA1c Or Continuous Glucose Monitoring (CGM) For Treatment Adjustment In Type 2 Diabetes Non-insulin Treated Patients?
Authors: Totomirova Tzvetelina , Arnaudova Mila 
Published: October 2023

Abstract
Disclosure: T. Totomirova: None. M. Arnaudova: None.
Current recommendations include treatment changes in type 2 non-insulin patients to be based preferably on HbA1c. HbA1c shows insufficiency as glucose control assessment tool omitting glucose fluctuations and hypoglycemic episodes. Continuous glucose monitoring (CGM) was mostly used for insulin dose adjustment in type 1 and type 2 diabetes patients on insulin. In our study we compared the retrospective CGM data with HbA1c to find out their usefulness for treatment decision in patients with type 2 diabetes. We studied 62 patients with type 2 diabetes non-treated with insulin (28 women, 34 men; age 59.35±11.0г years, disease duration 8.06±5.86г years). All of them performed retrospective Continuous Glucose Monitoring by using iProTM for seven days and HbA1c was measured at the end of this period. We found HbA1c level to show good significant correlation with percentage of time in range be similar in three groups (7.13±0.85 vs 55.65±25.99%, r=-0.48), with maximum CGM glucose level (r=0.47, p&lt;0.01) and minimum CGM glucose level (r=0.44, p&lt;0.01) as well as with the mean CGM glucose level (7.15±1.80mmol/l, r=0.74, p&lt;0.01). Patients estimated to be well controlled are the same percentage based on HbA1c as well based on TIR. HbA1c does not show any correlation with the number of excursions, with AUC below the limit and percentage of time below the limit. Our conclusion is that CGM gives more precise data about glycemic control and thus could be much more useful for treatment adjustment in non-insulin treated patients.
Presentation: Saturday, June 17, 2023
SAT100 Management Of Post-exercise Hyperglycemia In A Patient Using Control IQ Artificial Pancreas System - A Case Report
Authors: Sharma Pranjali , Ramirez Berlioz Ana 
Published: October 2023

Abstract
Disclosure: P. Sharma: None. A. Ramirez Berlioz: None.
Introduction: The automated insulin delivery (AID) Tandem Control IQ (CIQ) system has improved glycemic control with increased time in range (∼10%) & decreased hypoglycemic events (∼1%) through automatic basal rate modifications & correction bolus administration. The sleep & exercise activity (EA) decrease hypoglycemia risk. The CIQ EA decreases basal rate for predicted glucose =&lt;140 mg/dl, increases basal rate for predicted glucose &gt;160 mg/dl, and suspends insulin delivery for glucose =&lt;80 mg/dl. It is designed for mild-moderate physical activity and is aggressive for high-intensity aerobic exercise or endurance training. High-intensity activity can cause post-exercise hyperglycemia. There is minimal data regarding management of post-exercise hyperglycemia when using AID systems. Case Report: A 40 year old female with uncomplicated type 1 diabetes mellitus managed by Tandem CIQ system reported post-exercise hyperglycemia after starting a new exercise routine. Previous routine included cardio and weight training on 4 days of the week. She had recently started a stationary cycling routine lasting 15-45 minutes with varying intensity. She would start the CIQ EA 1.5 hours prior to exercise and stop after completion. The pump report revealed hyperglycemia between 200-300 mg/dl occurring within 1 hour after exercise, lasting several hours after. Patient attempted using normal mode during exercise, manual bolusing immediately after exercise, and post-exercise insulin sensitivity factor modification without effect. Stopping EA 10-15 mins before completion led to elimination of post-exercise hyperglycemia. Discussion: The CIQ EA is designed to decrease exercise-induced hypoglycemia. After high-intensity exercise, the CIQ algorithm can exaggerate the hyperglycemia. High-intensity routines such as sprints, weight-lifting, intensive cycling, are associated with varying degrees of hyperglycemia. Our patient's new cycling routine was higher-intensity compared to what she previously did, leading to persistent hyperglycemia. Some recommendations to avoid post-exercise hyperglycemia in patients on AID systems include using CIQ normal mode during exercise, utilization of a temporary basal rate, or administration of a manual correction bolus. However, the use of normal mode or temporary basal rates can lead to glycemic variations during exercise. A manual correction bolus administered after exercise may be too late to avoid the hyperglycemia and leads to subsequent hypoglycemia due to enhanced insulin sensitivity post-activity. We tried stopping EA a few minutes before routine completion and found that 10 minutes was appropriate. We suggest that discontinuation of the EA 10 minutes before completion of exercise routine can alleviate post-exercise hyperglycemia. Additional studies are required to confirm whether this method would work on a larger scale.
Presentation: Saturday, June 17, 2023
SAT104 Evaluation Of Glucose Variability By Continuous Glucose Monitoring In Patients With Diabetes Mellitus And History Of Stroke
Authors: Musurakis Clio , Poudel Bidhya , Chitrakar Solab , Qureshi Faisal , Gilden Janice L 
Published: October 2023

Abstract
Disclosure: C. Musurakis: None. B. Poudel: None. S. Chitrakar: None. F. Qureshi: None. J.L. Gilden: None.
Background: Data has now emerged that use of continuous glucose monitors (CGM) is associated with improvements in HbA1c, and patient reported outcomes. Hypothesis: In this study we assessed whether data obtained from personal CGM is associated with chronic complications of patients with diabetes mellitus (DM) and whether HbA1c was able to predict diabetic chronic complications. Methodology: A retrospective chart review of 69 DM patients [(59% T2: 8% T1: 5% of LADA) (91% with hyperlipidemia; 68% with hypertension; 59% obese )(average age= 61.47) (85% males; 15% female) (73% white: 21% black:&lt;2% Asian; &lt;2% Hispanic: &lt;1% Native American) (Average HbA1c 7.74 ± 1.21) (Duration of DM &gt;10 years =63%)(30% used insulin pumps)], from two community care-based healthcare facilities was performed. Data obtained from CGM were collected for a three-month period of time. IBM SPSS Statistics software was utilized for analysis. Results: Percentages of patients with chronic diabetic complications were as follows: 30% with urine microalbumin/cr ratio between 30-300 mg/day and 8% had &gt;300 mg/day, 8% CKD stage III-IV, 4% ESRD, 1.4% autonomic neuropathy, 2% history of amputations, 5% history of diabetic foot infections, 34% hypoglycemia unawareness, 24% CAD, 5% had history of stroke, 7% PVD, 33% retinopathy, and 40% peripheral neuropathy. Averages ± SD of data obtained from CGM were: % time in range =52.55 ± 21.17; % high= 29.60 ± 10.89; % Very High= 15.64 ± 14.36; % very low =0.51± 1.02 and % low= 0.13 ± 0.38. The Average GMI was 7.70 % ± 0.82, with % CV 52.73 ± 18.82. A positive correlation was observed between a history of stroke and % CV, as well as GMI. AUC for %CV was 0.690 (SD 0.093, 95% CI 0.507-0.873) (p&lt;0.05), AUC for GMI was 0.697 (SD 0.101, CI 0.499-0.895) (p=0.05). AUC for HbA1c was 0.572 (SD 0.078, CI 0.419-0.724) (NS). The % CV of 38.5 had 71% specificity and 20% sensitivity to predict stroke with a cutoff of 55.5 with 80% sensitivity and 35% specificity. The GMI of 7.65 had 80% sensitivity and 53% specificity of stroke history and a cutoff or 9.45 with 100% sensitivity and 96% specificity. HbA1c did not reach statistical significance. There were also no significant associations between HbA1c and GMI, or % CV, and other chronic complications Conclusions: Our study demonstrates that large variations of blood glucose levels, as indicated by higher than goal %CV (n&lt;=36%), and GMI are both predictive for history of stroke. Further studies are needed to explore the pathophysiology of these associations. Furthermore, there were no associations between HbA1c and history of stroke, indicating that GMI and glucose variability, as measured by % CV, are more accurate diagnostic tools.
Presentation: Saturday, June 17, 2023
SAT106 Use Of Data Sharing Feature Of Dexcom G6 Sensor Is Associated With Improved Glycemic Control: A Comparative Analysis
Authors: Sadek Batoul 
Published: October 2023

Abstract
Disclosure: B. Sadek: None.
Introduction: The use of Continuous Glucose Monitoring (CGM) sensors has significantly increased in part due to the seamless integration with smartphones. The Dexcom G6 CGM automatically sends real-time glucose readings to a compatible smart device. Moreover, the Dexcom Clarity app provides analytic tools and allows users to continuously share glucose data with their healthcare professionals, enabling remote monitoring of patients' glycemic control. Although multiple studies have shown better glucose control in patients who use CGM systems, what remains unexplored is if glucose metrics are further improved in those who share CGM data with healthcare providers. In this study, we compared glycemic outcomes among patients who use the sharing feature of the Dexcom G6 sensor to share their data with their healthcare providers to those who do not. Method: We conducted a single-center cross-sectional study in a community hospital with patients who use the Dexcom G6 CGM (n=201). Data was obtained from Dexcom Clarity for Healthcare Professionals, an online platform for clinicians to review patients' glucose patterns and statistics through interactive reports. The following data was collected for each patient: date of the last upload, data sharing status, average glucose, standard deviation, glucose management indicator (GMI) (%), glucose ranges (categorized as very high, high, in range, low, very low), sensor usage, and coefficient of variation (%). Two-tailed unpaired Student's t-tests were used to analyze the CGM metrics based on data sharing status. Significance was defined as a p-value less than 0.05. Results: 123 (61.19%) of the study participants shared data with healthcare providers. Participants with sharing data 'on' were significantly younger (49±15 years, p-value = 0.0007) and had increased sensor usage (90±21%, p-value = 0.0012), compared to those with sharing off. Participants who shared data spent more time in range (57±24 %, p-value = 0.0435), indicating a higher percentage of readings with glucose levels in a healthy range (70-180 mg/dL). Lastly, average glucose was lower in participants who shared data, although not statistically significant (179 ±44 mg/dL, p=0.08). Conclusion: The data-sharing feature on Dexcom G6 was utilized more frequently by younger people and was associated with a higher percentage of sensor usage. In addition, using the data-sharing feature of the Dexcom G6 could lead to a clinically meaningful improvement in glycemic control.
Presentation: Saturday, June 17, 2023
SAT119 Artificial Intelligence Mediated Assistants: Will They Educate The Public About Health Disparities In Diabetes?
Authors: Zhao Weichen , Wu Gloria , Cheng Emily , Lee Jay Yong , Wong Adrial 
Published: October 2023

Abstract
Disclosure: W. Zhao: None. G. Wu: None. E. Cheng: None. J. Lee: None. A. Wong: None.
Background: In 2022, 37 million US adults had diabetes and 96 million had pre-diabetes. Diabetes and prediabetes affect 49.3% population in America. In the diabetic population, 12.1% are non-Hispanic blacks, 11.8% of Hispanics, and 9.5% of Asian Americans. 54% of Americans read at or below the sixth-grade level. ChatGPTTM, launched 11/30/22, has the newest Artificial Intelligence (AI) software versus Google AssistantTM, launched 05/2016. Purpose: Can ChatGPT use its natural language software to educate the lay public about diabetes and health disparities? Methods: Evaluate the readability of responses after five questions were posed to ChatGPTTM and Google AssistantTMQuestions: 1. Do African Americans have a higher risk of complications with Type 2 Diabetes? 2. Do Hispanic Americans have a higher risk of complications with Type 2 diabetes? 3. Do Asian Americans have a higher risk of complications with Type 2 diabetes? 4. Do women get Type 2 diabetes more than men? 5. What is pre-diabetes vs diabetes? Word count and Dale-Chall score assessed the readability level of both ChatGPT and Google Assistant responses. The Dale-Chall readability formula is calculated based on the percentage of difficult words and average sentence length in words. The U.S. Department of Education used the Dale-Chall formula to adjust the text to grade-level readability. Result: Word count: CHAT:Q1=104; Q2=135; Q3=136; Q4=133; Q5=232 vs GOOGLE: Q1=38, Q2=49, Q3=16; Q4=50; Q5=42. CHAT Word Count Avg=148, SD=48.81; GOOGLE Word Count Avg=39, SD=13.7; P-value=0.003908 Dale-Chall: CHAT: Q1=8.4; Q2=8.6; Q3=9.8, Q4=8.6, Q5=8.7 vs. GOOGLE: Q1=6.7, Q2=9, Q3=9.4, Q4=6.3, Q5=9.1. CHAT Dale-Chall Score Avg=8.82, SD=0.56; GOOGLE Dale-Chall Score Avg=8.1, SD=1.47; P-value=0.1306. ChatGPT has nearly the same grade level of comprehension as Google Assistant, including statistics about health disparities. However, ChatGPT was trained using information and transforming it into paragraphs, and google assistant extracts the data from websites and the variability is higher with a higher standard deviation than ChatGPT. Conclusion: ChatGPT with its artificial intelligence software is able to provide answers to our patients. While the answers may require a high school reading level and beyond, this is an excellent beginning for health education.
Presentation: Saturday, June 17, 2023
SAT123 Treatment Satisfaction And Barriers To Diabetes Care In Patients With Uncontrolled Diabetes Mellitus: A Cross-Sectional Study
Authors: Alghrid Sarah , Refadah Omnia , Alharbi Danah , Aljuhani Najla , Albalawi Shouq , Aljuhani Sammar , Alaradi Rahaf , Yzeed Almslmani , Albalawi Shouq , Amirthalingam Palanisamy , Alqifari Saleh F 
Published: October 2023

Abstract
Disclosure: S. Alghrid: None. O. Refadah: None. D. Alharbi: None. N. Aljuhani: None. S. Albalawi: None. S. Aljuhani: None. R. Alaradi: None. A. Yzeed: None. S. Albalawi: None. P. Amirthalingam: None. S.F. Alqifari: None.
Background: Diabetes prevalence is reaching 25% in Saudi Arabia. Although diabetes care is provided free of charge, barriers to care and treatment satisfaction among patients remain unknown. Objectives: This study aims to examine diabetes patients’ treatment satisfaction and barriers to care in Saudi Arabia. Methods: We utilized the validated Diabetes Treatment Satisfaction Questionnaire (DTSQ) survey tool to assess diabetes treatment satisfaction among 782 adult Arabic-speaking patients with type 2 diabetes. An additional survey construct was utilized to assess patients’ perspectives on possible barriers to receiving diabetes care. Multivariate linear regression, r Pearson regression, and U Mann-Whitney tests were analyzed. Results: Of the 782 participants interviewed, 55.3% were females. The mean age of the study sample was 59.4 years. The average DTSQs value was 13.5. A strong correlation was observed between DTSQs score and glycemic control, female gender, and utilization of governmental healthcare. Patients of primary healthcare centers had higher satisfaction than tertiary care. Among the barriers to care reported, living in a rural area, transportation, and availability of appointments were the most frequent. Conclusion: Diabetes treatment satisfaction correlated well with glycemic control. The degree of treatment satisfaction in patients with type 2 diabetes was higher in female patients receiving government healthcare. Logistics constituted the most frequent barriers to care reported including living in rural areas, availability of transportation, and appointments.
Presentation: Saturday, June 17, 2023
SAT125 Promoting Habitual Exercise In People With Diabetes By Using Mission Certification Via App
Authors: Kim Mi-kyung , Park Jeong Hyun 
Published: October 2023

Abstract
Disclosure: M. Kim: None. J. Park: None.
Regular exercise is very important for blood glucose control and overall health in patients with diabetes. Many guidelines recommend that diabetes should engage in 150 min or more of moderate-to-vigorous intensity activity weekly, spread over at least 3 days/week, with no more than 2 consecutive days without activity. However, one big problem is that it is not easy to maintain everyday exercise. We used “mission certification“ through SNS (social network service) for promoting habitual exercise. BAND of NAVER Corp. is the most popular grouping platform in Korea provides “mission certification” program to do same mission among group members. About 20 billion mission certifications in Korea nationwide until now. We made our BAND mission for everyday exercise and thirty patients joined to certificate mission for 12 weeks. We assessed their adherence and maintenance of exercise. We compared their glycemic control, body weight, lipid profile and body composition before and after mission program. We defined 100% mission completion as posting certification everyday without missing. At the first 4-week follow-up, the number of patients of 100% mission completion was 14(47%). The proportion was increased to 87% at 12 weeks. Their HbA1c was significantly decreased in patients with 100% mission completion (P&lt;.05). Their body weight, LDL cholesterol and fat/muscle ratio showed the tendency to decrease, but not statistically significant. Unexpected positive findings were that patients actively posted encourage messages to other’s mission certification and recruited their friends and family to mission certification program. Mission certification via app increased adherence and maintenance of everyday exercise in diabetes. This intervention promoted habitual exercise and improved glycemic control. Future work is needed in more patients with diabetes for longer term.
Presentation: Saturday, June 17, 2023