bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU259 Alpelisib-induced Diabetic Ketoacidosis: Call For A Multidisciplinary Approach
Authors: Kalara Niketa , Rios Paola , Vendrame Francesco 
Published: October 2023

Abstract
Disclosure: N. Kalara: None. P. Rios: None. F. Vendrame: None.
Introduction: Alpelisib is a p110a subunit phosphatidylinositol-3kinase inhibitor (PI3K) approved for treating hormone receptor-positive, human epidermal growth factor receptor 2-negative, PIK3CA mutated, advanced or metastatic breast cancer. PI3K signaling is essential for the metabolic action of insulin and the inhibition of p110a subunit is associated with hyperinsulinemia and hyperglycemia. In the combination (Alpelisib-Fulvestrant) arm of phase III SOLAR-1 study the all-grade incidence of hyperglycemia was 63%, but diabetic ketoacidosis (DKA) was also observed and reported in 0.7% of patients. To the best of our knowledge, less than 10 cases of Alpelisib-induced DKA have been reported in the literature. Here we describe an additional case. Case Description: A 62-year-old female with a history of metastatic breast cancer, hypertension, and prediabetes, presented with 3 days of nausea, vomiting, abdominal pain, weakness, polyuria, and polydipsia. Fifteen days prior to the presentation the HbA1c was 6.1% for which she was started on metformin 500 mg daily. Alpelisib 150 mg PO BID and Fluvestrant (Estrogen receptor antagonist) were also started the same day. The patient was told to stop the PIK3 inhibitor if the blood glucose increased above 200 mg/dL. The review of system was positive for fatigue, decreased appetite, malaise, 5 lbs weight loss during the previous week, and headache. She had no family history of any endocrinologic disease. The physical exam was unremarkable with no signs of insulin resistance. Laboratory tests revealed pH 7.31 (7.35-7.45), HCO3 10 mmol/L (22-26), PCO2 21 mmHg (35-45), glucose 884 mg/dL (74-106), sodium 120 mmol/L (136-145), K 5.2 mmol/L (3.5-5.1), Cl 93 mmol/L (98-107), CO2 7 mmol/L (21-32), anion gap 22 mmol/L (5-15), GFR 30 mL/min/1.73m2 (&gt;60), Cr 1.80 mg/dL (0.5-1.02), BUN 43 mg/dL (7-18), beta-hydroxybutyrate 3 mmol/L (0.4-0.5), HbA1c 9.2% (4.2-5.6). Additional testing revealed C-peptide 2.3 ng/ml (1.1-4.4) with glucose 397 mg/dL. Results suggested a combined DKA and hyperosmolar hyperglycemic state (HHS). Alpelisib was discontinued and the patient was managed with insulin drip, fluids, electrolyte replacement, and eventually transitioned to a basal-bolus regimen (0.5U/kg). The patient was discharged on metformin and Insulin glargine with the recommendation to follow up with endocrinology and oncology. Conclusion: Our case highlights the importance of blood glucose and HbA1c screening before starting Alpelisib with emphasis on a multidisciplinary approach to monitor blood glucose levels to prevent DKA.
Reference: 1. Farah SJ, Masri N, Ghanem H, Azar M. Diabetic ketoacidosis associated with alpelisib treatment of metastatic breast cancer. AACE Clin Case Rep. 2020;6(6):e349-e351. doi: 10.4158/ACCR-2020-0452
Presentation: Thursday, June 15, 2023
THU264 Enteric Activity Enhanced Ileal GLP-1 Secretion
Authors: Chen Yixin , Jiao Gege , Lei Yaru , Li Yufan , Sha Lei 
Published: October 2023

Abstract
Disclosure: Y. Chen: None. G. Jiao: None. Y. Lei: None. Y. Li: None. L. Sha: None.
GLP-1 is a multifunctional endocrine hormone secreted by intestinal L cells in gastrointestinal tract contributing to the maintenance of glucose homeostasis. The distal part of small intestine such as ileum has a great density of L cells. In this study, we provided a direct evidence that enteric activity modulated GLP-1 secretion in rat ileum. Methods: A segment of rat ileum was dissected. The proximal section of the ileum segment was used to pace the enteric activity with an intestinal electrical stimulation(IES) designed from our previous intestinal myoelectric activity analyzing mimicking the ileum activity in feeding and the adjacent distal section was perfused vascularly to collect and measure GLP-1 secretion. Ileal motility in the distal section of the ileum segment was also recorded to monitor the enteric activity. The lumen of the ileum segment was filled with saline. Results: The frequency and the amplitude of spontaneous contraction in the distal ileum section was 14.14±2.82 cycles/min and 1.58±0.46 g (n=5). The area under curve (AUC) was 180.40±61.68 g·s. The GLP-1 secretion level in the distal ileum section was 15.47±0.46 pg/mL. With IES, The frequency was increased to 18.27±2.23 cycles/min (P&lt;0.05, n = 5) and the AUC was increased to 303.64±79.75 (p&lt;0.05). The amplitude had no significant change (P&gt;0.05). The GLP-1 secretion was significantly increased to 24.71±2.47 pg/mL(p&lt;0.05) with enhanced enteric activity. we provided a direct evidence to show the enhancement of GLP-1 secretion with enteric activity. Our result indicated that with feeding-simulated enteric activity, GLP-1 secretion could be elevated by around 60 percent in rat ileum. (supported by the National Natural Science Foundation of China, Grant No.81670492)
Presentation: Thursday, June 15, 2023
THU276 The Use of Continuous Glucose Monitors for Management of Postbariatric Hypoglycemia
Authors: Jani Shivani , Bao Shichun 
Published: October 2023

Abstract
Disclosure: S. Jani: None. S. Bao: None.
Postprandial hypoglycemia is a known complication of bariatric surgery. Mixed meal tolerance test performed in these patients often revealed hypoglycemia 1-3 hours after meals. Recent clinical studies using continuous glucose monitors (CGM) have shown the incidence of postbariatric hypoglycemia is much higher than previously identified. In addition to diet modification and medication treatment, CGM has become a more popular and useful tool in managing severe cases. We present a case of using CGM to manage postbariatric hypoglycemia.
A 47 year old female with prior history of class 3 obesity treated with sleeve gastrectomy presented with hypoglycemia 2.5 years after her bariatric surgery. She complained of headache, anxiety, dizziness, and fatigue during a routine clinic visit, two hours after consuming a carbohydrate rich meal with simple sugars. Blood glucose was obtained and revealed severe hypoglycemia (glucose 38 mg/dL). This prompted an urgent referral to endocrinology. Review of glucose trends revealed multiple instances of postprandial hypoglycemia. Further labs suggested a low likelihood for insulinoma with no fasting hypoglycemia and HA1C normal at 5.3%. Postprandial hyperinsulinemic hypoglycemia was suspected clinically. Dietary modification with multiple small meals consisting of high protein, fiber and complex carbohydrates was recommended. Additionally, she was started on Libre 2 CGM for monitoring and prevention of severe hypoglycemia. Review of her CGM data during follow up visit demonstrated very low incidence of hypoglycemia and absence of severe hypoglycemia. Over time with continued use of her CGM and low incidence of hypoglycemia, she did not require medical therapy.
Postprandial hypoglycemia after bariatric surgery can be severe and lead to disabling neuroglycopenic symptoms. With increased utilization of bariatric surgery, these postoperative complications will likely become more prevalent. In a Swedish nationwide study, the prevalence of postbariatric hypoglycemia was close to 0.2% in a cohort of 5040 patients. However, a more recent prospective study with a two-year observation of 333 patients after bariatric surgery using 2-hour glucose tolerance test revealed much higher prevalence of severe postprandial hypoglycemia (25.6%). Hypoglycemia was highest after gastric bypass surgery (32.6%), followed by sleeve gastrectomy (22.6%). Currently, there is no official guideline on utilization of CGM in management of hypoglycemia in nondiabetic patients. This case highlights the role of CGM in managing postbariatric hypoglycemia. CGM provides continuous glucose data, trends and alerts that can be a critical tool for patients to monitor, anticipate and prevent hypoglycemic events. Additionally, the real time data provided by CGM’s can help clinicians identify high risk patients who may benefit from the addition of medications to treat hypoglycemia.
Presentation: Thursday, June 15, 2023
THU293 Enhancement Of Best Practices In Diabetic Ketoacidosis Management Using Standardized Order-sets vs Individual Practitioner Orders
Authors: Yim Carly , Li Qinghao , Arnason Terra G 
Published: October 2023

Abstract
Disclosure: C. Yim: None. Q. Li: None. T.G. Arnason: None.
Diabetic ketoacidosis (DKA) is a hyperglycemic emergency occurring in diabetics due to insulin deficiency. This results in urinary losses of water and electrolytes (sodium, potassium, chloride) and ultimately extracellular fluid volume depletion. Hallmark features of DKA include ketoacidosis, arterial pH &lt; 7.3, bicarbonate &lt;15 mmol/L and an anion gap of &gt;12 mmol/L.
The 2018 Diabetes Canada (DC) guidelines outline the key steps of DKA management including fluid resuscitation, resolution of ketoacidosis, correction of electrolytes and management of precipitating factors. Its detailed algorithm identifies three pillars to DKA treatment: IV fluids, serum potassium and acidosis.
A 2016 DKA outcome audit at the Royal University Hospital (RUH) in Saskatoon identified that practitioners diverged considerably from (2013) Canadian Diabetes Association guidelines. Subsequently, two standardized preprinted DKA order sets were developed incorporating the 2018 DC recommendations for i) INITIAL and ii) MAINTENANCE DKA management. Their rollout overlapped with annual academic half day sessions on DKA management for postgraduate year 1 residents in internal medicine. These order-sets were initially implemented at RUH in November 2018 and subsequently adopted by some practitioners at St. Paul’s Hospital (SPH).
To ensure the order-sets were promoting improved outcomes and adhering to best practices, a retrospective chart review was conducted of all adult DKA admissions at RUH and SPH from Nov. 13, 2018 to December 31, 2020. In total, 279 hospital admissions were reviewed: 99 used practitioners’ own orders, 115 used both initial and maintenance order-sets, 26 used only the initial order-set and 38 used only the maintenance order-set.
Use of the INITIAL order set significantly improved compliance (p &lt; 0.0001) with DC 2018 guidelines for recommended insulin dose and timing, fluid resuscitation as well as potassium, sodium and dextrose replacement. Use of the MAINTENANCE order set consistently enhanced outcomes for intravenous fluid selection, subcutaneous insulin overlap, and ensuring a closed anion gap at transition (p &lt; 0.0001).
Additionally, the chart review revealed that there were hospital differences for uptake of order sets and compliance to DC 2018 guidelines. There was a significant uptake of order sets at RUH versus SPH (p &lt; 0.0001). RUH consistently met outcomes for appropriate insulin dosing, potassium and dextrose replacement (p &lt; 0.0001). RUH also consistently overlapped IV and SC insulin and ensured a closed insulin gap. The anion gap remained consistently closed post-transition at RUH versus SPH (p = 0.035).
These results suggest that utilization of a DKA order set does significantly promote adherence to key best practices outlined in the DC 2018 guidelines.
Presentation: Thursday, June 15, 2023
THU307 Landscapes Of MaternalAnd Neonatal Bacterial And Metabolic SignaturesAnd Their Interaction In Gestational Diabetes Mellitus
Authors: Ding Lu , Liu Jieying , Zhai Xiao , Xiao Xinhua 
Published: October 2023

Abstract
Disclosure: L. Ding: None. J. Liu: None. X. Zhai: None. X. Xiao: None.
Background: Gestational diabetes mellitus (GDM) is strongly correlated with considerable risks to both the mother and the developing fetus. Although evidence indicates an association between the altered gut microbiota and GDM, the microbial and metabolic mechanisms that link the metabolic state between mothers and offspring are unknown. This study aims to characterize the maternal and neonatal bacterial and metabolic signatures and their interaction in gestational diabetes mellitus. Methods: Sixty-six mothers (39 women with GDM and 27 normal pregnant women) and eighty-nine newborns (44 from GDM mothers and 45 from normal mothers) were included in this study. Using 16S rRNA gene sequencing and untargeted metabolomic methods, we determined the gut microbiota and serum metabolomics both for mothers and newborns. Results: We found that the microbial and metabolic signatures of GDM mothers and newborns were significantly different from those of the Control group (Ctr), respectively. Intriguingly, we identified 14 genera (Phyllobacterium, etc.) that exhibited identical alterations in mothers and newborns between groups. Among the overlapped differential metabolites in mothers and newborns, 23 (Glutamyl-methionine, etc.) showed consistent alterations between groups, while 19 (Cyclotetradecane, etc.) metabolites exhibited opposite alterations. Metabolic KEGG pathway analysis revealed that 6 pathways, including fatty acid metabolism, sphingolipid metabolism, TCA cycle, transsulfuration pathway, bile acid metabolism, and carnitine metabolism were both enriched in mothers and newborns. Significantly, correlation analysis revealed the notable association between pyroglutamic acid and maternal glucose level in Ctr group was disrupted in GDM group (Ctr: r = -0.46, p = 0.02; GDM: r = 0.04, p = 0.82). Simultaneously, pyroglutamic acid was significantly correlated with neonate serum high-density lipoprotein cholesterol level, which was disrupted in newborns of GDM mothers (Ctr: r = 0.33, p = 0.03; GDM: r = -0.05, p = 0.80). Conclusion: Altogether, we demonstrated that GDM could consistently alter the microbiota and serum metabolome in mothers and newborns, which is significantly associated with their metabolic state respectively. These findings indicate that serum metabolites serve as promising targets to intervene in metabolic transmission in GDM, which needs further validation.
Presentation: Thursday, June 15, 2023
THU327 Characterization Of New Onset Diabetes Mellitus Concurrent With COVID-19; A Single Institution Experience
Authors: Haque Tania , Gaddis Monica , Asad Reda , Simon Stephen , Drees Betty M 
Published: October 2023

Abstract
Disclosure: T. Haque: None. M. Gaddis: None. R. Asad: None. S. Simon: None. B.M. Drees: None.
Objective: The global pandemic of novel SARS-COV2 virus causing Covid-19 infection, is reported to lead to development of new onset diabetes mellitus (DM). This study describes the types of DM following Covid-19 infection, the patient characteristics and the disease course up to 12 months. Methods: A database of patients with DM treated at the institution was searched for a positive PCR Covid-19 test between March 1, 2020, and November 30, 2021. Charts were manually reviewed for diagnosis of co-morbidities, laboratory results, medications, disposition, and verification of type of DM. Outcomes data were collected at 0, 6, and 12 months. Results: Among 1643 Covid-19 positive patients with DM, 96 were diagnosed with new onset DM. There were 42% Black, 24% White, and 23% Hispanic; 94 had type 2 DM and two had type 1 DM. Average age was 50; half were women. Patients with more severe Covid (inpatient and ER visits) were more likely to require insulin, multiple DM medications, and had higher HbA1c levels. Insulin use and multiple DM medications decreased over time (25% and 25% at diagnosis; 10% and 18% at 12 months, respectively). HbA1c decreased over time (9.1% at diagnosis and 7.3% at 12 months). One-year follow-up was available on 73 patients, of whom 19 were on no medications for DM. Conclusion: New onset diabetes mellitus following Covid-19 infection is common and predominantly type 2 DM. However, glucose levels tend to improve over time requiring less medication, with 26% requiring no DM medications at one year.
Presentation: Thursday, June 15, 2023
THU339 Neutrophil Gelatinase-associated Lipocalin And B2-microglobulin May Reflect Early Diabetic Nephropathy In Asymptomatic Patients With Type 1 Diabetes
Authors: Papadopoulou Nektaria , Arkoumani Maira , Papassotiriou Ioannis , Mantzou Aimilia , Chrousos George P , Tentolouris Nikolaos , Kanaka-Gantenbein Christina 
Published: October 2023

Abstract
Disclosure: N. Papadopoulou: None. M. Arkoumani: None. I. Papassotiriou: None. A. Mantzou: None. G.P. Chrousos: None. N. Tentolouris: None. C. Kanaka-Gantenbein: None.
Type 1 diabetes (T1D) is a frequent autoimmune disease in childhood, adolescence and young adulthood and may cause microvascular complications. Several studies have shown that increased serum or urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) and beta 2 microglobulin (b2-microglobulin) are associated with microvascular complications like nephropathy. Hypothesis and Underlying Question the Research Addresses: We assessed the role of serum and urine NGAL and b2-microglobulin, biomarkers of renal dysfunction, in unravelling early renal dysfunction in T1D. Overview of Experimental Design and Methodology: Two patient groups who took part in two-centers’ prospective cohorts were studied. Sixty-one patients with T1D, aged 5-17 years from the Diabetes Center of Aghia Sophia Children’s Hospital, University of Athens, Greece, and 34 patients with T1D aged 18-44 years from the Diabetes Center, 1st Propaedeutic Department Laiko of the Laikon University Hospital of Athens, Greece were recruited. Sixty age- and sex-matched apparently healthy controls were also included in the study . Along with standard blood and urine chemistry, serum and urine NGAL concentrations and serum b2-microglobulin were determined by means of immunoenzymatic techniques. Estimated glomerular filtration rate (eGFR) was calculated with CKD EPI. Both physical and laboratory examinations were obtained in 2 time-points, at baseline and 12 months later. Main Results: In both young and adult groups with T1D, urine NGAL correlated positively with microalbuminuria (r=0.33, p=0.003) and decreased eGFR (r= -0.37, p=0.0008) irrespectively of gender or age. Decreased values of eGFR were correlated with increased values of b2-microglobulin (r= -0.30, p=0.002). Interpretation of Results and Conclusions: Urine NGAL as well as serum b2-microglobulin levels, proposed biomarkers of renal dysfunction, correlated with indices of early diabetic nephropathy, characterized by both microalbuminuria and decreased eGFR in patients with T1D, showing similar results in a broad patients’ age range. Thus, this marker may unmask early reversible renal dysfunction before overt nephropathy appears. However, prior to its clinical application, this biomarker must undergo thorough validation in several cohorts.
Presentation: Thursday, June 15, 2023
THU345 SGLT2 Inhibitors Reduce Mortality In Patients With Acute Myocardial Infarction And Percutaneous Coronary Intervention: A Systematic Review And Meta-analysis
Authors: Goncalves Ribeiro Sandro Augusto , Carvalho Pedro E P , do Amaral Neto Augusto Barreto , Felix Nicole , Teixeira Larissa , Gauza Mateus Miranda , Schramm Guisso Maria Eduarda , Campelo Jorge Carlos Alberto , da Camara Pedro Matos , Costa Neto Jose Amir , do Amaral Adilaine Rosa , de Sa Joao Roberto 
Published: October 2023

Abstract
Disclosure: S.G. Ribeiro: None. P.E. Carvalho: None. A.B. Neto: None. N. Felix: None. L. Teixeira: None. M.M. Gauza: None. M.S. Guisso: None. C.C. Jorge: None. P.M. Camara: None. J.C. Neto: None. A.R. Amaral: None. J.D. Sa: None.
Background: The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the prognosis of patients with acute myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) is not well established. Objectives: We performed a systematic review and meta-analysis to compare cardiovascular endpoints in patients undergoing PCI after acute MI treated with versus without SGLT2i. Methods: Medline, Cochrane, and Embase were systematically searched for randomized and non-randomized controlled trials that reported cardiovascular outcomes after SGLT2i initiation following PCI in patients with acute MI. Odds ratio (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Risk of bias assessment was performed as outlined by Cochrane recommendations. Results: There were 6 included studies, with 2,147 patients with acute MI and PCI, of whom 597 (27.8%) received SGLT2i therapy; 1,085 (50.5%) had diabetes mellitus. Two studies were randomized, whereas 4 studies were non-randomized cohorts. Treatment with SGLT2i reduced all-cause mortality (OR 0.49; 95% CI 0.26-0.95; p=0.03; I2=0%) and severe arrhythmia (OR 0.31; 95% CI 0.12-0.79; p=0.01; I2=0%) compared with no SGLT2i therapy. In contrast, there was no difference between groups in the incidence of myocardial infarction (OR 0.47; 95% CI 20-1.10; p=0.09; I2=40%) and repeat revascularizations (OR 0.86; 95% CI 0.34-2.13; I2=61%). Conclusion: In this meta-analysis of 2,147 patients with acute MI undergoing PCI, SGLT2i significantly reduced all-cause mortality and severe arrhythmia compared to no SGLT2i therapy.
Presentation: Thursday, June 15, 2023
THU359 A Classical Case Of SGLT-2 Inhibitor Euglycemic Ketoacidosis In A Patient With Glucotoxicity
Authors: Amankwah Samuel , Bolaji Olajide Omolola 
Published: October 2023

Abstract
Disclosure: S. Amankwah: None. O.B. Olajide: None.
Background: SGLT-2 inhibitors have been demonstrated to be beneficial in protecting comorbid cardiovascular or kidney disease while providing modest improvement in glycemia. However, they are not ideal for initial therapy for patients with very poorly controlled type 2 diabetes. This is a case where SGLT-2 inhibitor monotherapy led to diabetic ketoacidosis. Clinical Case: A 68-year-old woman with type 2 diabetes for 30 years, hypertension, hyperlipidemia, and depression presented to the hospital with complaints of headache, nausea, vomiting, dizziness, fatigue for the past three days. She had no fever, cough, shortness of breath or dysuria. She had not been taking any oral hypoglycemic agents for many months as she was trying to control her diabetes with lifestyle modifications. However, after the passing of her husband three months prior, she became less motivated in managing her health. Ten days prior to her hospitalization, the patient was newly prescribed empagliflozin 10 mg daily by her primary care provider due to uncontrolled hyperglycemia. She refused to resume metformin due to her history of gastrointestinal intolerance. She was previously on glipizide, but this was not restarted as she previously had poor glycemic control on it. On arrival at the ER, her temperature was 97.9 F, heart rate 112 bpm, respiratory rate 22 bpm, blood pressure 105/63 mmHg, and pulse oximetry on room air was 97%. Physical exam was unremarkable. Her serum glucose was 228 mg/dL, anion gap 15, pH 7.1, serum bicarbonate 15 mEq/L, serum acetone 3+, urine ketones greater than 150 mg/dL, serum creatinine 1.26 mg/dL and hemoglobin A1c was 13.2%. Her chest X-ray was unremarkable and COVID 19 test was negative. Euglycemic diabetic ketoacidosis (EDKA) was suspected secondary to the use of empagliflozin. This was discontinued and the patient was treated with intravenous insulin and fluids. Her serial blood tests showed resolution of ketoacidosis within 12 hours, and she was then transitioned to subcutaneous insulin. She was discharged home after 2 days of hospitalization on insulin therapy. Discussion: This case demonstrates the potential for SGLT-2 inhibitors to cause EDKA. It is important to acknowledge this complication can happen in cases where SGLT-2 inhibitors are used as monotherapy in diabetic patients with glucotoxicity. The mechanism of action of SGLT2 inhibitors is to enhance excretion and block reabsorption of filtered glucose from the proximal convoluted tubule.  The resultant glycosuria creates a state of carbohydrate starvation and volume depletion, increasing the glucagon/insulin ratio, resulting in a state of severe dehydration and ketosis. Patients with glucotoxicity are at a higher risk to develop ketoacidosis as they have marked beta cell insufficiency. It is thus highly recommended to initially treat these patients with insulin rather than oral agents.
Presentation: Thursday, June 15, 2023