bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT087 Maternally Inherited Diabetes And Deafness: Support For SGLT2 Inhibitor Use
Authors: Pandya Stuti , Selk Karen 
Published: October 2023

Abstract
Disclosure: S. Pandya: None. K. Selk: None.
Introduction:  Maternally inherited diabetes and deafness (MIDD) is a rare genetic disease resulting from  a mitochondrial mutation. There is a wide phenotypic expression secondary to heteroplasmy. The clinical manifestations of MIDD are hyperglycemia, sensorineural hearing loss, maculopathy, cardiac conduction defects, myopathy/poor exercise tolerance, and neuropathy. Diabetes mellitus generally occurs during the third decade of life, and there tends to be rapid progression to insulin therapy with  reported earlier onset of microvascular complications.  Here we present a case of MIDD successfully treated long-term with empagliflozin and linagliptin.    Clinical Case: A 36-year-old male with sensorineural hearing loss presented with a 20-pound unintentional weight loss, polyphagia, and polydipsia. His blood glucose level was 300 mg/dL and HbA1c was 14.3%. His mother carried a diagnosis of type 2 diabetes mellitus and his grandmother had latent autoimmune diabetes of adulthood. Prior to presenting to endocrinology, he had been started on metformin, glipizide, and linagliptin with ongoing poor glycemic control. Given his presentation, family history, and lean habitus with BMI of 20, he was assessed for possible autoimmune diabetes. Testing for glutamic acid decarboxylase 65-kilodalton isoform antibody (GAD65), islet cell antibody, tyrosine phosphatase-related islet antigen 2 (IA2), and zinc transporter 8 antibody (ZNT8) was unrevealing. A C-peptide level was detectable but &lt;1 ng/mL. His sulfonylurea was discontinued, and he was started on basal insulin with a dramatic improvement in his glycemic control. He was later able to discontinue insulin therapy. However, given poor exercise tolerance and his known hearing loss, he was seen by genetics where he underwent testing and was found to have a m.3243 A&gt;G mutation in MT-TL1 gene  making the diagnosis of MIDD. Metformin was discontinued due to a possible risk of lactic acidosis and sitagliptin was initiated. Due to hyperglycemia,  empagliflozin was added and he was later transitioned to empagliflozin-linagliptin to reduce his pill burden. He has continued to have a1c levels of 6.5% or less for the last 3 years and periodic C-peptide measurements have been &gt;1 ng/mL.   Conclusion: Given MIDD is a rare form of monogenic diabetes, treatment tends to be individualized with many transitioning to insulin early in their disease course. Given the reported increased risk for microvascular complications, sodium-glucose cotransporter-2 (SGLT2) inhibitors are an attractive therapeutic agent. However, there is little literature on the use of these agents  in MIDD and there is concern about the risk for diabetic ketoacidosis given insulin use is required by many afflicted individuals. This case highlights the safety of long-term empagliflozin in a patient with MIDD.
Presentation: Saturday, June 17, 2023
SAT091 Genetic Investigation Of The Susceptibility To Develop Type 1 Diabetes And Diabetic Nephropathy
Authors: Brema Imad , Aljuryyan Abdullah , Bradley Benjamin , Osman Awad E 
Published: October 2023

Abstract
Disclosure: I. Brema: None. A. Aljuryyan: None. B. Bradley: None. A.E. Osman: None.
Diabetic Nephropathy (DN) is one of the leading causes of end-stage renal disease (ESRD) worldwide and is a major cause of morbidity and mortality in subjects with type 1 diabetes (T1DM). Several single nucleotide polymorphisms (SNP) have been found in various gene variants such as the ACE, NOS 3, and FRMD 3 genes that play a major role in genetic susceptibility to DN, however, there is lack of wide replication of these studies, particularly in non-Caucasian ethnic groups. Therefore, the aim of this study was to identify SNPs that increase the susceptibility to develop T1DM as well as microalbuminuria (the hallmark of DN) in a Saudi cohort of subjects with T1DM. We conducted a case-control study in 179 subjects with T1DM and 180 healthy normal controls comparing genotype frequency of 11 SNPs that have been shown to increase the susceptibility to develop DN in subjects with T1DM, namely, rs1799983, rs2070744 (NOS3 gene); rs560807, rs 1059982 (CAT gene), rs1888747, rs10868025, rs361525, rs1800629 (FRMD3 gene), rs182052, rs 17300539 (ADIPOQ gene) and rs1799752(ACE gene). We report that the A/G rs361525 (FRMD3) genotype has significantly higher frequency in controls compared to subjects with T1DM (9 % vs 0), p value 0.01) and it seems to be protective against the risk of T1DM development. Moreover, the A/A rs17300539 (ADIPOQ gene) genotype has significant higher frequency in controls compared to subjects with T1DM (7 % vs 0.5), p value 0.02) and seems to be protective against type 1 development as well. We did not detect any further associations between the remaining 9 genotype SNPs and the risk of T1DM. On the other hand, we report no association between all the 11 studied SNPs referenced above and the risk of developing diabetic nephropathy. We have studied several DN susceptibility SNPs that have been shown to increase the risk of albuminuria and ESRD development in Caucasians with T1DM , however, we were unable to replicate previous findings in this Saudi cohort of patients with T1DM. Future larger multicenter studies are needed in larger numbers of patients to replicate the findings of the studies that were done in Caucasians and other ethnic groups, ideally Genome-wide association studies.
Presentation: Saturday, June 17, 2023
SAT094 Closed-Loop Insulin Delivery Versus Standard Care In Type 1 Diabetic Adult Patients: A Meta-analysis Of Randomized Controlled Trials
Authors: Godoi Amanda , Marques Isabela R , Mahesh Ashwin , Oommen Christi , MH Padrao Eduardo , CS Moreira Vittoria , Silva Ariadne C , Hespanhol Larissa C , Silva Caroliny H , AF Souza Isabela , Gomes Cintia , Miyawaki Isabele A , Loyola Júnior José E R , De Sa Joao Roberto 
Published: October 2023

Abstract
Disclosure: A. Godoi: None. I.R. Marques: None. A. Mahesh: None. C. Oommen: None. E.M. Padrao: None. V.C. Moreira: None. A.C. Silva: None. L.C. Hespanhol: None. C.H. Silva: None. I.A. Souza: None. C. Gomes: None. I.A. Miyawaki: None. J.E. Loyola Júnior: None. J. De Sa: None.
Background: Optimal glycemic control of Type 1 Diabetes Mellitus (T1DM) remains a clinical challenge instigated by hypoglycemic episodes and the burden of insulin self-management. Remarkable advancements have been made with the development of automated insulin devices, particularly closed-loop systems (CL). Yet, previous meta-analyses have not focused on the long-term use and effects of CL systems, and their potential to improve glycemic outcomes in this population remain controversial. Purpose: To compare the therapeutic efficacy of long-term use of CL insulin delivery systems to standard care (SC) in adult patients with T1DM. Methods: PubMed, Cochrane and EMBASE were systematically searched in October 2022 to include randomized controlled studies (RCTs) comparing CL systems (automated pancreas, hybrid CL and advanced hybrid CL) versus SC (daily insulin injections, sensor augmented pump and continuous glucose monitoring) with at least 12 weeks of duration. Outcomes assessed were percentage time in range (% TIR) 70-180mg/dL and change in HbA1c. Statistical analysis was performed with RevMan 5.4.1 and R software. Heterogeneity was assessed with I² statistics. The protocol was registered in PROSPERO (ID: CRD42022366710). Results: A total of 13 randomized studies with 1082 patients with T1DM were included, of whom 586 (54.2%) used automated devices and 496 (45.8%) continued their usual care. The %TIR was higher in the CL systems when compared to SC (MD 11.91%; 95% CI 8.66 to 15.17; p &lt; 0.001; I² = 81%). The HbA1c significantly higher in the CL systems when compared to SC (MD -0.42; 95% CI -0.70 to -0.14; p = 0.003; I² = 78%). The %TIR was significantly higher in patients using CL (MD 9.25; 95% CI 6.79–11.72; p &lt; 0.0001; I² = 34%), hybrid CL (MD 8.20; 95% CI 3.32–13.09; p=0.001; I² = 66%) and advanced hybrid CL (MD 25.38; 95% CI 21.30–29.46; p &lt; 0.0001; I² = 0%). A greater decrease in HbA1c was also found with the use of CL (MD -0.24; 95% CI -0.47 to -0.010.14; p = 0.04; I² = 0%), hybrid CL (MD -0.26; 95% CI -0.43 to -0.10; p=0.002; I² = 3%) and advanced hybrid CL (MD -0.90; 95% CI -1.86 to -0.06; p = 0.07; I² = 83%). Conclusion: In this meta-analysis of randomized trials, the use of CL insulin delivery systems was associated with a higher proportion of time in the optimal glucose range and greater decrease of HbA1c relative to standard care in the adult diabetic population.
Presentation: Saturday, June 17, 2023
SAT095 Utilizing Continuous Glucose Monitoring Post Open Heart Surgery
Authors: Chen Yi-Ju , Cuevas Velazquez Adan , Abdul Wahab Mhd Majed , Aljassani Khaldoon , Rajak Kripa , Halder Anupam , Atrash Anas , Renu Joshi 
Published: October 2023

Abstract
Disclosure: Y. Chen: None. A. Cuevas Velazquez: None. M.A. Wahab: None. K. Aljassani: None. K. Rajak: None. A. Halder: None. A. Atrash: None. J. Renu: None.
Introduction: It is a standardized practice to monitor blood glucose (BG) levels while on insulin infusion therapy in patients who undergo open heart surgery regardless of their diabetes status. Hyperglycemia was often noted in these patients due to catecholamine surge induced by intraoperative stress. This study is to investigate whether using Continuous Glucose Monitoring (CGM) is a safer option compared to traditional finger stick (FS) glycemic monitoring in postoperative patients. Methods: This is a prospective randomized controlled trial. Patients planned for open heart surgery including coronary artery bypass surgery, valvular repair, or replacements at UPMC Harrisburg hospital from May 2021 to August 2022 were voluntarily involved and randomized by 2:1 ratio into CGM or FS glycemic monitoring methods during the first 48-hour postoperative period on insulin infusion therapy and in the intensive care unit (ICU). Patient demographics, comorbidities, diabetes (DM) status, and glycemic data within the first 48 hours after surgery were compared between the two groups. Results: A total of 42 patients were recruited, including 31 males (81.6%). Four patients were excluded due to missing data, 22 were randomized to the CGM group, and 16 to the FS group. There was no difference in demographics between the two groups. The mean glucose level of the CGM group (123.09 mg/dL) was no different from the FS group (116.31mg/dL) (p=0.09). The CGM group detected significantly more events of level 2 hypoglycemia (BG &lt;54 mg/dL, p=0.01) and hyperglycemia (BG&gt;=180 mg/dL, p=0.01) compared to the FS group. In the CGM group, the mean time of normoglycemia (BG 70-179 mg/dL), hypoglycemia, and hyperglycemia in all 22 patients was 91.1%, 2.58%, and 6.34% respectively. Time in normoglycemia was longer in non-DM patients (95.8%) than in DM patients (87.1%). Discussions: CGM signatures the convenience of frequent BG checks, enabling the reduction of glucose variability and improvement of glycemic control. In this study, although no difference was noted in the mean BG between CGM and FS groups, CGM was noted to be especially effective in hypoglycemia detection. Our findings suggest that CGM brings in the potential benefit of improving patient safety compared to traditional glucose monitoring. To conclude, CGM is probably non-inferior as a glucose monitoring method compared to FS and it might bring the additional benefit of improving patient safety by higher sensitivity of detecting significant hyper/hypoglycemic events for postoperative population on insulin drip in the ICU setting.
Presentation: Saturday, June 17, 2023
SAT108 What A Simple Switch Can Achieve; A Case Of Severe Insulin-induced Lipohypertrophy
Authors: Ayub Tooba , Robles Lydia A , Guntupalli Saroja , Guillen Lopez Claudia E 
Published: October 2023

Abstract
Disclosure: T. Ayub: None. L.A. Robles: None. S. Guntupalli: None. C.E. Guillen Lopez, MD: None.
Introduction: Lipohypertrophy, a benign “tumor-like” swelling of the fatty tissue, is a common dermatological complication of subcutaneous insulin therapy. Here, we describe a case of severe skin lipohypertropy causing poorly controlled glycemic control requiring high insulin doses. However, after rotating the injection sites, followed a significant decrease in total daily dose (TDD) of insulin. Clinical Case: A 69-year-old female with a past medical history of type 2 diabetes mellitus (DM) for the last 16 years presented with uncontrolled blood glucose and gradually increasing insulin requirements. Hemoglobin A1c was 9.3%. Body mass index (BMI) of 32.59kg/m2. Home regimen insulin included long-acting insulin (Levemir), 50 units in the morning and 150 units at night, plus short-acting insulin (Humalog), 62 units with meals. Exenatide, Insulin Glargine, and Metformin were not tolerated in the past due to GERD-like side effects. An insulin pump was offered, but she preferred insulin injections. Patient endorsed good injection technique and adequate rotation between the inner and outer thighs. Surprisingly, physical examination revealed skin discoloration with hypertrophy on both thighs’ bilateral medial and later surfaces. Based on the history and skin examination, a clinical diagnosis of insulin-induced Lipohypertrophy was made. Patient was instructed to switch injection sites to the buttocks and provided with a new insulin regimen. Three months after initial visit, hemoglobin A1c dropped to 7.2%, and TDD of insulin was reduced by 48%, to Levemir 46 units twice daily, Humalog 30 units with breakfast/lunch, and 34 units with dinner. After seven months, her hemoglobin A1c dropped to 7% without further changes to the insulin regimen. Despite these changes, the lipohypertrophy had minimal changes. Discussion: The pathophysiology of lipohypertrophy is linked to a direct anabolic effect of insulin on local skin, inducing fat and protein synthesis. Risk factors include failure to rotate injection sites, needle reuse, female gender, high BMI, and long disease duration. Insulin injection in the lipohypertrophy areas can delay insulin absorption, causing glucose variability with unpredictable hyper and hypoglycemia episodes. There is no established therapeutic method to treat severe lipohyperthohy; avoiding further injection into that area is crucial, then surgical intervention can be considered. Currently, the best preventative and therapeutic strategies for insulin-induced lipohypertrophy include rotating injection sites and a single use of needles. Conclusion: This case emphasizes the importance of detailed inspection and palpation of insulin injecting sites regularly and how early intervention can lead to significant improvement in glycemic control, as described in our case.
Presentation: Saturday, June 17, 2023
SAT113 Reducing The Frequency Of Ordering Hemoglobin A1c In Patients With Well-controlled Diabetes - A Quality Improvement Project
Authors: Umarji Gunjan , Swedish Kristin , Tabatabaie Vafa 
Published: October 2023

Abstract
Disclosure: G. Umarji: None. K. Swedish: None. V. Tabatabaie: None.
Introduction: “Let’s check an A1c” is a sentence heard often in primary care setting. Is it truly required each time? According to Standards of Care 2021 by American Diabetes Association, hemoglobin A1c should be tested every six months for patients with well-controlled diabetes. The cost of hemoglobin a1c test ranges $28 to $245, with an average of $85.20 without insurance. Unnecessary blood tests cause discomfort and anxiety to patients and increase healthcare costs. We conducted a quality improvement project whose aim was to decrease the frequency of unnecessary hemoglobin A1c testing by 50% from March 2022 to March 2023 at an internal medicine residency clinic. Methods: Our discovery phase included a survey of all providers in the residency clinic and a chart review. The goal of the survey was to understand how clinicians identified well-controlled diabetes. The survey was sent to 86 providers (attendings and residents) with a response rate of 43%. Results showed a shortcoming to define goal A1c for adults &gt;65 years of age. Less than half knew that a patient with well-controlled diabetes should have A1c checked every 6 months. A chart review was conducted for all patients seen by attendings and residents as primary care providers in clinic with hemoglobin A1c between 6.5 and 8.5. Of the 462 total patients, a representative sample revealed that 38% of the patients with well-controlled diabetes (defined with goal A1c from standards of care 2021) had A1c ordered sooner than recommended. Three interventions have been planned to reduce this occurrence. The first intervention was an educational session with attendings, as they act as point regulators for every plan made for clinic patients. Results: Eight weeks after the first intervention, a similar chart review was conducted, which demonstrated a decrease in patients with well-controlled diabetes having A1c sent sooner than recommended from 38% to 33%. Discussion: The second intervention, an educational session with the residents, was performed and data is being gathered to determine the efficacy of that intervention. The third planned intervention will be to post information about A1c ordering in the precepting room at the clinic. We know that training is the least effective method to obtain change, an ideal intervention would be to introduce a hard stop in the electronic medical record (EMR) asking if the physician truly wanted to order another A1c since the last was ordered x months ago with the result of y%. However, despite being a more effective method of change, it is very expensive and difficult to introduce new measures into our EMR. Following our third intervention, we will reassess to determine if further interventions would benefit our goal of decreasing unnecessary A1c testing in patient with well-controlled diabetes.
Presentation: Saturday, June 17, 2023
SAT117 Diabetes And Vision: Can Chatgpt Educate Our Diabetic Patients?
Authors: Wu Gloria , Cheng Emily , Zhao Weichen , Wong Adrial , Mansubi Nikki , Dorado Perla , Gim Heidi 
Published: October 2023

Abstract
Disclosure: G. Wu: None. E. Cheng: None. W. Zhao: None. A. Wong: None. N. Mansubi: None. P. Dorado: None. H. Gim: None.
Background: Diabetic retinopathy is the leading cause of blindness in working-age Americans. Nearly 4.1 million U.S. adults are affected by retinopathy, but over 50% of the patients do not receive an eye examination and diagnosis before vision loss. ChatGPT is a new Artificial Intelligence (AI) trained model launched on 11/30/2022 that generates real-time comprehensive responses. Purpose: Can ChatGPT educate our patients about Diabetic retinopathy? Methods: A retina specialist created a scoring system of Keywords per question to assess ChatGPT responses, maximum score of 6 points per question: 1) I am diabetic and I have a hemoglobin/A1C of 6.5. I still cannot read my book. Why? Keywords: eye MD/optometrist, kidney complications, neuropathy, macular edema/diabetic retinopathy, stroke, healthcare team 2) I am diabetic and my fasting blood sugar is 200 but I suddenly lost vision in one eye. Why? Keywords: eye MD/optometrist, retinal detachment, retinal vein/artery occlusion, vitreous hemorrhage, stroke, healthcare team 3) I am a new diabetic and when I look in the mirror I am missing one part of my face. Why? Keywords: eye MD/optometrist, retinal detachment, kidney complications, neuropathy, diabetic retinopathy/macular edema, stroke, healthcare team 4) My hemoglobin/A1C is 8 and my striped dress looks wavy. Why? Keywords: eye MD/optometrist, diabetic retinopathy, macular edema, metamorphopsia, stroke, healthcare team 5) I have high cholesterol, my pants became too tight, and my blood sugar is borderline at 120-150 but now I cannot see to read. Why? Keywords: eye MD/optometrist, diabetic retinopathy, metabolic syndrome, macular edema, vitreous hemorrhage, healthcare team. Results: Keyword Scores: Qn 1 = 2/6 (diabetic retinopathy, health care team); Qn 2 = 3/6 (retinal detachment, vein occlusion, health care team); Qn 3 =1/6 (healthcare team); Qn 4 = 2/6 (diabetic retinopathy, health care team); Qn 5 = 2/6 (diabetic retinopathy, health care team). For all of the answers: None mention macular edema which is an important part of visual loss in diabetes. Qn 4 describes metamorphopsia (wavy dress) which is pathognomonic for macular edema and it is missing from the answer. High blood sugar=3/5 diabetic retinopathy=4/5; blindness/loss of vision=3/5; Stroke, eye MD/optometrist, American Academy of Ophthalmology, nephropathy/kidney, macular edema, foot/nerve neuropathy, ADA/Endocrine Society, or ACC/AHA=0/5. Conclusions: ChatGPT is the newest Artificial Intelligence mediated chatbot. It provides basic responses to questions about the eye in readable text and it is a good starting point for future AI chatbots.
Presentation: Saturday, June 17, 2023
SAT120 Effects Of Long Term Diabetes Education Program On HBA1C In Patients With Type 2 Diabetes Mellitus
Authors: Dash Kalpana , Kumari Nalini , Harpal Malhotra , Surekha Tippisetty , T Bapuji A 
Published: October 2023

Abstract
Disclosure: K. Dash: None. N. Kumari: None. M. Harpal: None. T. Surekha: None. B. A. t: None.
Introduction: As per IDF 2022, 537 million adults (20-79 years) are living with diabetes & the number is increasing in an alarming way. 1in 10 people are suffering from diabetes and over 3 in 4 adults with diabetes live in low and middle-income countries. Adequate control of the disease is required by educating patients and developing their skills to manage their treatment to prevent complications through continue diabetic education program (DEPs). Aim & Objectives: To measure the change in HBA1C, FBG & PPBG (primary end point) value, who are in continue DEPs [ Sugar 360 (long term, 1 year sugar plan), Sugar 90 (long term-6 months sugar plan) vs. conventional method (SA-1- short term sugar plan, only one visit )with normal follow up] along with standard of care treatment. Secondary end points such as total cholesterol and body weight were also taken into consideration. Methods: Data of 100 type 2 diabetes mellitus patients who had attended diabetes OPD & had at least two follow ups having knowledge about diabetes were included in the study. Visual impairment, psychological impairment and newly diagnosed DM patients were excluded from the study. Data on biochemical parameters of metabolic control such as FBG, PPBG, HBA1c, total cholesterol, TG & BMI were collected. Within subjects design non-parametric and for quantitative data repeated measures ANOVA was used. Results: Mean age is 51.32 years in DEPs patients and mean age is 57.29 years in conventional treatment patients. Significant decrease in HBA1c (9.1% vs. 7.2%), FBG (161.2 mg/dl vs. 119.1 mg/dl), PPBG (244.6 mg/dl vs. 172.2 mg/dl), total cholesterol (175.8mg/dl vs. 159.8mg/dl) & triglyceride (217.5 mg/dl vs. 182.1 mg/dl) were noted in the follow up visit in both groups. However patients on DEPs has better adherence to the follow-up visits and better understanding of disease, blood glucose control measures and lifestyle change. Conclusion: Intensive DEPs was found useful & effective as regards to biochemical than compared with normal conventional treatment in terms of adherence knowledge & control of disease.
Presentation: Saturday, June 17, 2023