bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU376 Isotretinoin Related DKA In Type 2 Diabetes
Authors: Radovanovic Natasa , Comi Richard J , Crawford Andrew 
Published: October 2023

Abstract
Disclosure: N. Radovanovic: None. R.J. Comi: None. A. Crawford: None.
Introduction: Isotretinoin is a well-established treatment for acne, known to have a wide variety of adverse effects including hypertriglyceridemia, decreased HDL, and, as per some reports, increased insulin resistance. Rapid worsening of underlying diabetes after treatment with isotretinoin has been described in the literature in patients with type 1 diabetes. Clinical Case: A 45-year-old man was referred to the Endocrinology clinic in February 2022 for an urgent consultation due to rapidly worsening hyperglycemia, acidosis, hypertriglyceridemia and refusal to be evaluated in ED as recommended by his PCP. He was diagnosed with pre-diabetes in April 2021 with an HgbA1c of 6.4% and instructed to make lifestyle changes. He presented 6 months later with HgbA1c of 7.3% and the diagnosis of diabetes prompted him to initiate earlier proposed lifestyle changes. He joined an online weight loss program and was very pleased to achieve a rapid weight loss of 80 lbs within 4 months. Upon initial telephone consultation with the patient, he reported feeling well and refused our recommendations to go to the ED, but agreed to come to our clinic the next day. Upon initial in-person assessment, he denied nausea, vomiting, abdominal pain, or change in mentation but reported polyuria and polydipsia worsening in the months prior. He reported being started on isotretinoin for the treatment of acne 4 months prior. On physical exam, he was mildly tachycardic with stable blood pressure, and signs of dehydration including dry mucous membranes. Labs prior to this visit confirmed hyperglycemia, hypertriglyceridemia, elevated anion gap, low bicarbonate, and elevated ketones concerning for underlying DKA which finally convinced the patient to present to ED where he met the criteria for hospitalization. Isotretinoin was stopped immediately after admission. In spite of a low c-peptide level (0.8 ng/ml) during hospitalization, immunology testing for type 1 diabetes was negative. However, 4 months later a fasting c-peptide increased to a normal level (3.4 ng/ml). Treatment with basal-bolus insulin in the subsequent months markedly improved his diabetes and he was able to achieve HgbA1c of 5.7%. Conclusion: Rapid worsening of diabetes and presentation with DKA is usually associated with a natural course of type 1 diabetes. In the case of our patient who presented with rapid worsening of diabetes, was asymptomatic while in DKA, had negative type 1 diabetes-related antibodies, and presented with marked hypertriglyceridemia. We suspect isotretinoin to be the culprit in the setting of underlining type 2 diabetes. In contrast to reports of isotretinoin increasing insulin resistance, in our case, there was apparently suppression of insulin release. We would like to bring attention to this case with a proposal for close monitoring of the glycemia and lipid levels in patients with underlying diabetes started on isotretinoin.
Presentation: Thursday, June 15, 2023
FRI627 Lost In The Striato-sphere: Diabetic Striatopathy In An Elderly Patient Who Was Lost To Follow-up
Authors: Loughner Chelsea L , Mahmood Ejaz , Sheharyar Ali 
Published: October 2023

Abstract
Disclosure: C.L. Loughner: None. E. Mahmood: None. A. Sheharyar: None.
Introduction: Diabetic striatopathy (DS) represents a spectrum of central nervous system derangements associated with uncontrolled hyperglycemia.1 The most common site of brain involvement is the putamen but can involve any region of the striatal nuclei. The exact mechanism behind DS remains unclear, but current theories postulate hyperosmolarity-related ischemic events that lead to breakdown in the blood-brain barrier and mineral deposition2. We present a case of DS demonstrating a rare neurologic complication resulting from uncontrolled diabetes mellitus. Clinical Case: An 82-year-old female was admitted for workup following new-onset left-sided involuntary jerking movements. On exam, there were choreiform movements in the left upper and lower extremities. Initially, Levetiracetam was started for possible focal motor seizures but with no improvement. MRI brain showed T1 hyperintensity of the right lentiform nucleus, consistent with DS. She had moved recently from out of state and had inconsistent follow-up for type 2 diabetes mellitus for years. Her HbA1c was 13.8%. She was non-compliant with glucose monitoring and insulin therapy. With a comprehensive treatment plan including Haloperidol, physical therapy, improved CGM compliance, and four-times-daily insulin regimen, her chorea improved and resolved completely over a few weeks. Clinical Lesson: DS can present with a variety of neurologic manifestations, including chorea. While choreiform movements can severely impact a patient’s life, they are rarely permanent if treated with either glycemic control or anti-chorea medications. This case highlights the importance to recognize rarer complications of diabetes and the impact of good glycemic control for successful treatment of diabetic striatopathy.
References: 1. Chua CB, Sun CK, Hsu CW, Tai YC, Liang CY, Tsai IT. "Diabetic striatopathy": clinical presentations, controversy, pathogenesis, treatments, and outcomes. Sci Rep. 2020;10(1):1594. Published 2020 Jan 31. doi:10.1038/s41598-020-58555-w 2. Dubey S, Biswas P, Ghosh R, Chatterjee S, Kanti Ray B, Benito-León J. Neuroimaging of Diabetic Striatopathy: More Questions than Answers. Eur Neurol. 2022;85(5):371-376. doi:10.1159/000524936
Presentation: Friday, June 16, 2023
FRI628 Subnormal Fructosamine Levels In Non Diabetic Pregnant Women
Authors: Kabadi Udaya M , Exley Sarah 
Published: October 2023

Abstract
Disclosure: U.M. Kabadi: None. S. Exley: None.
Introduction: American College of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing for diagnosis of Gestational Diabetes (GDM). The process is cumbersome and inconvenient. HbA1c levels are adopted as a screening test in nonpregnant adults but not during pregnancy. Alternatively, serum Fructosamine is not tested for diagnosis of DM in any population. We are in the process of examining utility of serum Fructosamine as a screening test for diagnosis of GDM. However, no data is available regarding Fructosamine concentrations in nondiabetic pregnant women. Therefore, we determined serum Fructosamine levels in pregnant women at 24 to 28 weeks at the time of 1 hour or 3 hour OGTT. Subjects and Methods: Random glucose (mg/dl), Fructosamine ( mcM/l) and HbA1c (%) were determined at 24-30 weeks in 200 pregnant women, age 24-40 years in whom the diagnosis of GDM was eliminated by either normal 1 hour OGTT or by normal 3 hour OGTT in presence of abnormal 1 hour OGTT according to criteria established by ACOG and ADA. 21 age matched nonpregnant women participated as controls. Normal reference ranges for all determinations were established by the local laboratory (Glucose, 60-139; Fructosamine, 200-285; HbA1c, 4.4-5.6). Statistical comparisons between 2 groups were conducted using Student’s ‘t’ test. Results: Fructosamine levels (182 ± 4) were significantly lower (p&lt; 0.01) in non diabetic pregnant women when compared with age matched non pregnant women ( 224 ± 5). Cutoff Fructosamine between groups was 182. Glucose (96 ±7) and HbA1c (5.1 ± 0.2) were not significantly different amongst groups. Conclusion: In non diabetic pregnant women, Serum Fructosamine concentrations are subnormal whereas random glucose and HbA1c levels remain within normal range noted in age matched non pregnant women. Further studies are underway to assess the utility of serum Fructosamine as a screening test in diagnosis of GDM.
Presentation: Friday, June 16, 2023
FRI629 A Mysterious Case Of Mother's Battle With Diabetic Ketoacidosis During Pregnancy
Authors: Sittirat Petchpailin D , Choi Sarah J , Gutierrez Alejandra , Bashyam Mani 
Published: October 2023

Abstract
Disclosure: P.D. Sittirat: None. S.J. Choi: None. A. Gutierrez: None. M. Bashyam: None.
Introduction: Changes in hormone regulatory mechanisms during pregnancy can increase the likelihood of diabetic ketoacidosis (DKA) in pregnant individuals. Despite the increased risk, the likelihood of DKA in pregnant individuals with diabetes mellitus is still low at around 0.5-3%. Management involves aggressive treatment following standard DKA protocols. We delve into a mysterious case of DKA in the second trimester of pregnancy. Case Presentation: A 31-year-old G1P0 woman at 24 weeks gestation with no past medical history presented with nausea, constipation associated with back and abdominal pain. Admission labs were significant for blood glucose 369 mg/dL, CO2 11 meq/L, anion gap 19 mEq/L, white blood cell 17.2 K/uL, HbA1c 9.5%, and serum ketones 3.9 mmol/L. Within 12 hours of admission into the intensive care unit for DKA, the patient was at 5-6 cm cervical dilation without signs of fetal distress. The newborn was delivered prematurely with complications of retinopathy and patent ductus arteriosus. Mother's lab studies showed negative for anti-GAD antibody, insulinoma associated 2 autoantibodies, islet cell antibody, and zinc transporter 8 antibody. C-peptide was low at 0.9 ng/mL (normal range 1.1 to 5.5 ng/mL). The patient was maintained on subcutaneous insulin which eventually tapered off at 2 months post-partum due to hypoglycemia. At 4 and 11-month follow-ups, her HbA1C was 5.8% and 5.5%, respectively. Her blood glucose was well controlled with a regular diet. She did get post-prandial spikes with a high carbohydrate diet. Discussion: Physiological changes in pregnancy make pregnant individuals more susceptible to DKA. Even so, the likelihood of DKA in pregnancy is rare. It is even rarer to have a new diagnosis of diabetes leading to DKA in pregnancy just before evaluation at the standard 28 weeks like the events precipitated in this case. DKA in pregnancy puts both the mother and fetus at risk for long-term complications. The maternal mortality rate in pregnancy with DKA is 5% to 15%, while the fetal mortality rate is 30% to 90%. The patient’s demographic background of being a young Caucasian, thin woman who presented with a new onset DKA and had a low C-peptide was more consistent with type 1 diabetes; however, all her antibodies were normal. It’s questionable if this patient has autoantibody negative new onset type 1 diabetes and is currently in remission. It's worth to mention that she had a history of mild Covid-19 infection at 8 weeks gestation but this new onset DKA developed at 24 weeks gestation. The chance of gestational diabetes was low due to low c-peptide on presentation. Annual follow-up of the patient is necessary to monitor her HbA1C while she is off diabetes medications.
Presentation: Friday, June 16, 2023
FRI630 Information Technology & Decision Support In Electronic Health Records As A Tool To Improve Care For Women With Gestational Diabetes
Authors: Derevianko Olga , Rumyantceva Tatiana , Karseladze Ekaterina , Siyuhova Zaira , Khan Stanislav , Fomin Dmitry 
Published: October 2023

Abstract
Disclosure: O. Derevianko: None. T. Rumyantceva: None. D. Fomin: None.
Background & Aims: The prevalence of gestational diabetes mellitus (GDM) in Russia is increasing and the true prevalence of GDM may be even higher because underreporting of GDM and lack of proper screening. Difficulties in documenting and reaching consensus on the prevalence of GDM exist for a number of reasons, including the use of various diagnostic criteria, past confusion about the specific criteria used to diagnose GDM, and the lack of knowledge about modern recommendations for screening and diagnosis. The aim of our study was to explore the quality of GDM care experienced by women in Russia in Fomin Clinic in 12 cities in Russia and how it could be improved with the help of Electronic Health Record with decision support. Methods: 1264 Electronic Health Records of women with GDM before and after the start of the decision support ( 613 and 651, respectively) were analyzed and rated on a 100-point scale (diagnostics, nutrition, physical activity, self-control of glycemia recommendations were evaluated). The decision support system based on Guidelines of Russian Endocrinology Association, American Diabetes Association, National Institute for Health and Clinical Excellence and Royal College of Obstetricians and Gynaecologists. Results: The average score before using decision support was 47, and after doctors started to use it the average score after 6 months of using became 81. Conclusions: Electronic Health Record with decision support is great tool which improves quality of care for women with gestational diabetes and refines the diagnosis and treatment of GDM in different cities in Russia.
Presentation: Friday, June 16, 2023
FRI631 Insulin Antibody Mediated Extremely Insulin Resistant In Pregnancy
Authors: Liu Zhao , James Deirdre , Dagogo-Jack Samuel 
Published: October 2023

Abstract
Disclosure: Z. Liu: None. D. James: None. S. Dagogo-Jack: None.
Background: Insulin antibodies can rarely complicate diabetes management during pregnancy. Here, we report a patient with extreme insulin resistance during pregnancy associated with positive insulin antibodies. Clinical Case: A 40-year-old primigravida with Type 2 Diabetes (T2DM) was admitted at week 32 for uncontrolled Hypertension (HTN) and extremely high insulin requirement. T2DM was diagnosed 8 years ago and treated with basal insulin 50 units/d, dulaglutide, metformin, and glimepiride. Her HbA1c was 14% one month prior to pregnancy. During pregnancy, patient’s regimen was changed to basal bolus insulin, and oral agents were discontinued. Total daily insulin dose average 740 units (5.6 units/kg/day) at week 32. Patient’s weight was 112 kg at the beginning of pregnancy, increasing to 131 kg in the third trimester. On the high insulin regimen, her HbA1c was 5.6% at week 32. Due to the extreme insulin requirement (indicative of severe insulin resistance), we ordered insulin antibody (IAA), which came back positive at 15 µU/ml (NR &lt;5 µU/ml). Diabetes control remained suboptimal, with frequent post-prandial hyperglycemia followed by hypoglycemia during hospitalization. Insulin regimen was optimized using U-500 in divided doses, starting with 112 units tid. At 34 weeks (hospital day 14), patient underwent cesarean section with delivery of a viable infant (weight 1450 grams, Apgar score 5 and 9 at 1 and 5 minutes). Shortly after delivery, the patient’s insulin requirement plummeted to 62 units daily and she was successfully discharged home. Diabetes control has been stable, with HbA1c ranging between 5.7% and 7% one year after delivery on total insulin dose of 60 units or less per day. Attempts to schedule patient for repeat antibody testing were unsuccessful. Conclusion: Despite the lack of data on repeat antibody testing, this is a compelling case of pregnancy associated extreme insulin resistance likely induced by insulin antibodies. Our conclusion is supported by the dramatic decrease in insulin requirement following postpartum.
Presentation: Friday, June 16, 2023
FRI633 Financial Benefits Of Renal Dose-adjusted Dipeptidyl Peptidase-4 Inhibitors For Patients With Type 2 Diabetes And Chronic Kidney Disease: A Multicenter Study Utilizing Common Data Model
Authors: Jee Choe Hun , Ko Yeh-Hee , Joon Moon Sun , Ahn Chang H , Hwa Ha Kyoung , Lee Hyeongsuk , Hyun Bae Jae , Joon Joo Hyung , Lee Hyejin , Sohn Jang-Wook , Kim Dae-Jung , Gon Kim Sin , Kim Kwangsoo , Min Cho Young 
Published: October 2023

Abstract
Disclosure: H. Choe: None. Y. Ko: None. S. Moon: None. C.H. Ahn: None. K. Ha: None. H. Lee: None. J. Bae: None. H. Joo: None. H. Lee: None. J. Sohn: None. D. Kim: None. S. Kim: None. K. Kim: None. Y. Cho: None.
Objective: To estimate the economic benefit of replacing non-renal dose adjusted (NRDA) dipeptidyl peptidase-4 (DPP4) inhibitors with renal dose adjusted (RDA) DPP4 inhibitors in patients with impaired kidney function and type 2 diabetes. Patients and Methods: This multicenter study analyzed a total of 67,964,996 prescription records of five teaching hospitals in Korea from January 1, 2012 to December 31, 2018 using a common data model. Prescription patterns of NRDA and RDA DPP4 inhibitors were subgrouped based on estimated glomerular filtration rate (eGFR) determined by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: NRDA DPP4 inhibitors were more frequently prescribed to patients with impaired kidney function than those with preserved kidney function (25.7%, 51.3%, 64.3%, and 71.6% in patients with eGFR of ≥60, &lt;60, &lt;45, and &lt;30 mL/min/1.73m2, respectively). When applying the prescription pattern of DPP4 inhibitors for patients with preserved kidney function to those with impaired kidney function, cost savings per year were 7.6% for eGFR &lt;60 mL/min/1.73m2 and 30.4% for eGFR &lt;30 mL/min/1.73m2. Assuming patients with impaired kidney function are solely prescribed with RDA DPP4 inhibitors with appropriate dose reduction, 15.4% to 51.2% per year could be saved depending on kidney impairment severity. Conclusion: NRDA DPP4 inhibitors are frequently prescribed in patients with type 2 diabetes and CKD. Prescribing RDA DPP4 inhibitors with doses adjusted to individual kidney function could alleviate the economic burden associated with medical expenditure.
Presentation: Friday, June 16, 2023
FRI659 Diabetes Management: A Retrospective Population-based Study Examining The Association Of Acculturation And Glycemic Control
Authors: Lee Messersmith Andrew , Piervil Esther , Meadows Robyn , Patel Kashyap , Griffin Edward 
Published: October 2023

Abstract
Disclosure: A.L. Messersmith: None. E. Piervil: None. R. Meadows: None. K. Patel: None. E. Griffin: None.
Diabetes disproportionately impacts racial/ethnic minorities. According to 2017-2020 National Health and Nutrition Surveys (NHANES) data, prevalence of diabetes was greater among black non-Hispanic, Asian non-Hispanic, and Hispanic populations compared to white non-Hispanic (Prevalence of Both Diagnosed, 2022). Acculturation, the process by which an individual integrates the attitudes, values, beliefs, and behaviors of a different culture, has also been associated with diabetes (Allen, 2014; O'Brien, 2014). This study incorporates 2013-2018 NHANES data to assess the association between acculturation and diabetes management. Country of birth, years living in the U.S., and primary language spoken at home will serve as proxies for acculturation. This study includes 2,442 individuals who were ever told by a doctor or health professional that they had diabetes (gestational diabetes excluded) with 784 of these participants born outside the U.S. Comparatively 492 individuals with no known history of diabetes had lab results drawn during the NHANES survey supporting newly diagnosed diabetes (A1c ≥6.5), 213 of whom were immigrants. Socioeconomic status and access to health care and health insurance are factors that likely mediate the relationship between acculturation and diabetes control. Initial data analysis found 38% of immigrants with laboratory and/or health professional diagnosed diabetes lived below the poverty level compared to 20% of U.S.-born individuals. Health insurance coverage was 81% among immigrants compared to 92% among U.S.-born individuals. This study will utilize logistic regression to explore the association between acculturation and diabetes. Compliance of individuals living with diabetes to American Diabetes Association screening recommendations will be assessed. Descriptive statistics will be summarized and include demographics, comorbid diseases, body mass index (BMI), cumulative years with diagnosed diabetes, insulin and/or oral antihyperglycemic diabetes therapy, insurance coverage, and frequency of doctor visit(s).
References:
Allen JD, Caspi C, Yang M, Leyva B, Stoddard AM, Tamers S, et al. Pathways between acculturation and health behaviors among residents of low-income housing: The mediating role of social and contextual factors. Social Science & Medicine. 2014 Dec 1;123:26-36.
O’Brien MJ, Alos VA, Davey A, Bueno A, Whitaker RC. Acculturation and the prevalence of diabetes in US Latino Adults, National Health and Nutrition Examination Survey 2007-2010. Prev Chronic Dis. 2014 Oct 9;11:E176.
Prevalence of Both Diagnosed and Undiagnosed Diabetes | Diabetes | CDC [Internet]. 2022 [cited 2022 Dec 28]. Available from: https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html
Presentation: Friday, June 16, 2023
SAT049 Goldfish LEAP2: Molecular Cloning, Functional Characterization, And Novel Regulation By IGF And Insulin At The Hepatic Level
Authors: Jin Fanming , Qin Xiangfeng , Ye Cheng , He Mulan , On-Lam Wong Anderson 
Published: October 2023

Abstract
Disclosure: F. Jin: None. X. Qin: None. C. Ye: None. M. He: None. A.O. Wong: None.
Liver-expressed antimicrobial peptide 2 (LEAP2) is a peptide highly expressed in the liver and its secretion induced by bacterial infection constitutes an integral component of innate immunity in vertebrate species. Recently, LEAP2 has been confirmed to be the endogenous antagonist of the feeding regulator ghrelin, implying that the peptide may play a role in appetite control and energy homeostasis. However, whether LEAP2 can be regulated by metabolic/endocrine signals is still unclear and the signal transduction involved is totally unknown. Using goldfish as a model, three isoforms of LEAP2, namely LEAP2a, 2b & 2c, have been cloned and phylogenetic analysis confirmed that they could be clustered into the clade of fish LEAP2. Comparative synteny also revealed that the three isoforms were derived from separated genes with similar structural organization but located in different chromosomes of goldfish genome. The a.a. sequences and 3D protein structure of LEAP2a-c were found to be highly comparable with LEAP2 of other vertebrates and tissue expression profiling by RT-PCR also showed that they were expressed at high levels in the liver but to a lower extent in other tissues. As members of antimicrobial peptides, goldfish LEAP2a-c not only could exhibit antimicrobial activity against Staphylococcus epidermidis but also play important role in fish innate immunity, which is evidenced by their transcript expression induced by LPS & cytokines at hepatic level as well as in immune tissues in goldfish naturally infected with Aeromonas hydrophila. In goldfish liver cells, transcript expression of LEAP2a-c could be up-regulated in a time- and dose-dependent manner by IGF-I, IGF-II and insulin. Using a pharmacological approach, the stimulatory effects of IGF-I/-II and insulin on the three isoforms of LEAP2 were confirmed to be mediated by IGF-I receptor (IGF1R) but not insulin receptor activation. Furthermore, the PI3K/Akt, MEK/ERK and P38 MAPK pathways were shown to be involved in IGF-I induced LEAP2a-c gene expression. Our findings for the first time demonstrate that the endocrine signals targeting the liver (insulin) or produced locally within the liver (IGF-I & -II) can play a role in regulating LEAP2 expression at the hepatic level, which may shed light on a novel aspect of the functional crosstalk between innate immunity and feeding control/energy balance in fish model.
Presentation: Saturday, June 17, 2023