bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU285 Predictive Factors Of Response To Liraglutide In Long-standing Type 2 Diabetes: A Real-life Study
Authors: Romero Fabiola , Ferreira Dahiana , Galiana Rodriguez Maria , Escurra Clara , Muller Alejandra , Rodriguez Roque , Valinotti Elizabeth 
Published: October 2023

Abstract
Disclosure: F. Romero: None. D. Ferreira: None. M. Rodriguez: None. C. Escurra: None. A. Muller: None. R. Rodriguez: None. E. Valinotti: None.
Introduction: Liraglutide demonstrated efficacy, safety and cardioprotective effects in DM2 in RCT and real-life studies. Benefits across diverse spectrum of patients, but the degree of HbA1c improvement differs within groups with different demographics and clinical characteristics.Objectives: To evaluate the effect of the addition of liraglutide on metabolic control and weight in patients with DM2 treated with oral antidiabetics (OADS) and/or insulin, who do not achieve good control and to identify predictive factors for a greater decrease in HbA1c.Materials and methods: Prospective study, at the Endocrinology Service of the Social Security Institute in 2019, which included patients with DM2 and HbA1c greater than 7%, on treatment with OADS, basal insulin ± OADS or basal/bolus insulin ± OADS, in who were added liraglutide 1.8 mg/day SC. At 6 months, the reduction in HbA1c and body weight was evaluated.Results: 103 patients with DM2 of 59.6 ± 10 years old, 66.3% women and 12.5 ± 6 years of duration of DM2 were included. 18.3% treated only with OADS and 81.7% with insulin (47.1% basal insulin ± OADS and 34.6% basal/bolus insulin ± OADS) initial weight 99.1 ± 23.5 kg, BMI 37.4 ± 8.2 kg/m2, basal glycemia 182.7 ± 65 mg/dl and HbA1C 9.2 ± 1.6%. At 6 months of addition of liraglutide, weight loss of 3.2 ± 3.8 kg, 23.12% decreased &gt; 5%, and 5.8% &gt; 10%. The decrease in HbA1c was 1.1 ± 1.3%, 58.7% decreased &gt; 1%, and 21.2% &gt; 2%, the final glycemia was 145.7 ± 52.3 mg/dl. 38% managed to suspend insulin (basal 8.3%, rapid 10.9%) or reduce the dose of basal insulin (10%). The initial mean values were compared: age, years of DM duration, weight, BMI, glycemia and HbA1c among the patients who achieved a reduction of 1 or more % of HbA1c, finding significant differences for initial BMI (p 0.02), basal glycemia (p 0.010), initial HbA1c (p 0.022). In addition, the proportions of patients in terms of sex, different initial treatment groups and weight reduction were compared, and a significant difference was observed only in the latter (p 0.036). Conclusion: In this study of patients with long-standing diabetes, mostly treated with insulin and poor metabolic control, the addition of liraglutide achieved a reduction in HbA1C of 1% or more in almost two thirds, especially in those with higher initial values of BMI, glycemia and HbA1c and in those who achieved weight reduction. An important group achieved the suspension or reduction of the insulin dose.
Presentation: Thursday, June 15, 2023
THU287 Comparison Of Renal Protective Effects Between SGLT2 Inhibitors And DPP4 Inhibitors In Real-World Clinical Practice
Authors: Park Hyeong-Kyu , Park Sang-Joon , Kwon Soon-Hyo , Kim Hye-Jung , Byun Dong-Won 
Published: October 2023

Abstract
Disclosure: H. Park: None. S. Park: None. S. Kwon: None. H. Kim: None. D. Byun: None.
Recent prospective randomized studies have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors had renal protective effects compared to placebo. In this study, we compared the renal composite outcomes between patients with diabetes treated with SGLT2 inhibitors and those treated with dipeptidyl peptidase 4 (DPP4) inhibitors using real-world clinical data. This retrospective observational study used the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) database at four different university hospitals (Soonchunhyang university hospitals in Seoul, Bucheon, Chunan, and Gumi) in Korea. Subjects prescribed SGLT2 inhibitors or DPP4 inhibitors for at least 90 days were included in the SGLT2 inhibitor or DPP4 inhibitor group, respectively. Subjects prescribed GLP-1 receptor agonist or insulin were excluded in both groups. Renal composite outcomes included a 30% decline in estimated glomerular filtration rate (eGFR) compared to baseline or creatinine doubling or dialysis or death from any cause. After propensity score matching, clinical characteristics in each group at each hospital were well balanced at baseline. Our results from hospitals in Seoul, Bucheon, and Gumi have shown that SGLT2 inhibitor decreased renal composite outcomes compared to DPP4 inhibitor (hazard ratio (HR) 0.644, p=0.020; HR 0.560, p&lt;0.001; HR 0.657, p=0.010, respectively). Furthermore, when all the data were combined, renal composite outcomes were significantly lower in the SGLT2 inhibitor group compared to the DPP4 inhibitor group (HR 0.659, p&lt;0.001). In conclusion, SGLT2 inhibitors effectively reduce renal composite outcomes compared to DPP4 inhibitors in real-world clinical practice.
Presentation: Thursday, June 15, 2023
THU304 Diabetic Ketoacidosis In Pregnancy: A Nationwide Analysis Of Trend In Hospitalizations, Comorbidities And Outcomes
Authors: Master Vidisha , Faisaluddin Mohammed , Fatima Samia , Parekh Dhruv , Charatz Seth 
Published: October 2023

Abstract
Disclosure: V. Master: None. M. Faisaluddin: None. S. Fatima: None. D. Parekh: None. S. Charatz: None.
Introduction: Diabetic Ketoacidosis (DKA) is an obstetric emergency associated with high materno-fetal morbidity and mortality. Aim: To analyse the trend of DKA hospitalizations among pregnant women, and to evaluate the comorbidities and in hospital outcomes associated with DKA events in United States. Methods: A national population- based study was conducted in the US. Hospitalizations during pregnancy from 2015 - 2020 were identified using ICD- 10 codes (E101) from Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS) database. Pregnant women with DKA and without DKA formed the two comparison cohorts. Demographic characteristics, baseline comorbidities, and outcomes such as maternal mortality, fetal mortality, length of stay (LOS), and cost of hospitalization were compared. A two- tailed p-value of p&lt; 0.05 was used to determine the statistical significance. Results: 11,215 out of 14,613,248 hospitalizations during pregnancy were identified with DKA from 2015 - 2020. An increasing trend in DKA hospitalizations per 100,000 pregnancy related hospitalizations was noted, highest in 2017 and 2020. Demographic distribution was similar in both groups. Comorbidities such as pre-eclampsia, eclampsia, gestational hypertension, tobacco and alcohol use were more common in the DKA group (p&lt;0.0001). DKA was associated with higher maternal (0.18% vs 0.01%) and fetal mortality rates (2.9% vs 0.7%) compared to non-DKA group (p&lt;0.0001). The median length of hospital stay was higher (3 days vs 2 days), along with the median cost of hospitalization ($25,248 vs $18,306) among pregnant DKA patients. Other in hospital outcomes such as need for mechanical ventilation, cardiac arrest, cardiac arrhythmias, acute kidney injury, need for dialysis, and septic shock, were all higher in DKA patients (p&lt;0.0001). Conclusion: DKA in pregnancy is associated with high maternal and fetal mortality, longer LOS, higher cost of hospitalizations, and other maternal morbidities, as compared to non-DKA hospitalizations during pregnancy. A high index of suspicion for DKA should be maintained in all pregnant women, along with prompt evaluation and treatment.
Presentation: Thursday, June 15, 2023
THU316 Relatively Rare And Increasingly Fatal; A Case Of Euglycemic DKA In A Patient With Gestational Diabetes
Authors: Dimech Christina , Rabiei-Flori Elham , Lynn Bononi Patricia 
Published: October 2023

Abstract
Disclosure: C. Dimech: None. E. Rabiei-Flori: None. P.L. Bononi: None.
Diabetic ketoacidosis (DKA) is an endocrine emergency and can be a catastrophic event during pregnancy, increasing both maternal and fetal mortality. Euglycemic DKA (EDKA) during pregnancy is a rare, acute, life-threatening emergency characterized by euglycemia, metabolic acidosis and ketosis. EDKA has been reported in pregnancies complicated by Type 1 diabetes, Type 2 diabetes and gestational diabetes. Unlike DKA, the diagnosis of EDKA is often overlooked because of the absence of hyperglycemia. The incidence of DKA and EDKA are higher during pregnancy due to physiologic changes of increasing insulin resistance from human placental lactogen, placental insulinase, and progesterone which result in a relative insulin deficiency as the pregnancy progresses. Additionally, tocolytic therapy to delay preterm labor and antenatal corticosteroids given to promote fetal lung development, pose unique triggering factors in pregnancy which can further precipitate DKA. We report a case of EDKA in a 37-year-old G2P0010 Caucasian female at 29 week 6 day gestation with recently diagnosed gestational diabetes on diet therapy (HbA1c 6.3%), who was admitted for atypical preeclampsia. Initial laboratory studies revealed an anion gap metabolic acidosis (anion gap=24, arterial pH 7.242) with euglycemia (blood glucose 123mg/dL). She underwent emergent C-section 24 hours after admission due to development of pre-eclampsia with severe features. Despite delivery, she had persistent and worsening high anion gap metabolic acidosis (HAGMA). The Endocrinology service was consulted and ordered a beta hydroxybutyrate level which was elevated at 6.18mmol/L (0.02-0.30mmol/L) with 3+ ketonuria. Intravenous insulin and dextrose were instituted with gradual improvement in acidosis. EDKA is an easily missed diagnosis that should always be considered during pregnancy in a patient with high anion gap metabolic acidosis. Prompt recognition and treatment is essential to minimize complications to mother and fetus.
Presentation: Thursday, June 15, 2023
THU324 Euglycemic Diabetic Ketoacidosis Coinciding With COVID-19 Infection During Pregnancy
Authors: Alkhathlan Mujahed , Siddiqui Ayesha 
Published: October 2023

Abstract
Disclosure: M. Alkhathlan: None. A. Siddiqui: None.
Background: Pregnancy is well known to be a diabetogenic and ketogenic state. When coinciding with an acute illness like COVID-19 infection, it can lead to full-blown DKA requiring intervention to reverse ketoacidosis. Complete restoration of normal glycemic status can be achieved after treatment of COVID-19 infection. Clinical case: A 34-year-old, G3 P2 woman who was at 26 weeks gestation with triplet pregnancy presented to the ED with fever, shortness of breath, nausea and vomiting for 3 days. She had gestational hypertension and impaired glucose tolerance during her previous pregnancy, but none during her current pregnancy. She had tested positive for COVID-19 infection at an outpatient evaluation for mild upper respiratory symptoms, two days prior to her presentation. Vital signs in the ER were T 35.3 °C, RR 22, HR 103, BP 121/70, and O2 sat 95% on 4 L/min nasal cannula. Initial laboratory testing showed sodium 132 (135-145), potassium 4.4 (3.5-5.5), bicarb 9 mmol/L (22-29), anion gap 18 mmol/L (5-14), BUN 3 mg/dL (6-23), creatinine 0.43, eGFR &gt; 60, glucose 113 mg/dL (74-109), serum ketones 3.13 mmol/L (0.02-0.27) and lactate 1.6 mmol/L (0.5-2.5). ABG confirmed acidosis with pH of 7.29, and PCO2 was 22. She was diagnosed with euglycemic DKA after ruling out other possible etiologies of high anion gap metabolic acidosis. She received betamethasone by the Obstetrics team and fetal monitoring was initiated. DKA treatment was started with IV insulin, dextrose and close glucose monitoring. She had complete resolution of metabolic acidosis after 34 hours and did not require subcutaneous insulin treatment post-DKA resolution. She was able to tolerate oral diet with significant improvement of all her symptoms. She required only supportive treatment for COVID-19 infection and tested negative on the third day of hospitalization. Conclusion: Pregnancy is a ketogenic state and when superimposed with a significant acute illness of COVID-19, can lead to euglycemic DKA even in the absence of gestational diabetes. Early detection and treatment of ketoacidosis with COVID-19 is critical to avoid fetal and maternal complications or premature delivery.
Presentation: Thursday, June 15, 2023
THU325 Covid-19 Outcomes In Cancer Patients With Diabetes
Authors: Tan Ngo Emmeline Monique , Thosani Sonali 
Published: October 2023

Abstract
Disclosure: E.T. Ngo: None. S. Thosani: None.
Diabetes mellitus and cancer are risk factors for poor outcomes in patients with Covid-19 (Covid). In this study, we compare Covid outcomes in patients with diabetes and cancer in relation to their inpatient glucose control.
We conducted a retrospective review of cancer patients with diabetes hospitalized at our institution from 12/1/2020-7/31/2021 for Covid (n=117). Readmissions were excluded (n=13). Apart from demographic data, other variables reviewed included cancer type, stage, treatment, comorbidities, laboratory data for glucose and inflammatory markers, and Covid-related management. Utilizing average daily glucose for each patient, we calculated percentage of inpatient days with glucose values with euglycemia (average daily glucose within target range of 70-180 mg/dL) and hyperglycemia (average daily glucose values above target of 180 mg/dL). Wilcoxon rank-sum test for contiguous variables and Fisher’s exact test for categorical variables were done to compare the distribution of variables between groups. Kaplan-Meier curve was generated for survival analysis.
Of the 104 patients, 73% were age ≥60, 54.8% were male, 49% had BMI &gt;30, and majority (88.5%) were not vaccinated for Covid. 81.7% had type 2 diabetes, 14.4% had drug-induced (i.e. steroid) diabetes, and the remaining had type 1 diabetes. The most common comorbidities were hypertension (56.7%) and heart failure (8.65%). Hematologic malignancies (40.4%) were the prevailing cancer diagnosis. Of patients with cancer staging available (n=50), 33.7% were stage 4, and 66.3% were on active cancer treatment at the time of hospitalization. 49% of the entire cohort had severe Covid on presentation; 21% (n=22) died during hospital stay. Comparison of Covid-related variables and inflammatory markers between euglycemic (n-18) vs. hyperglycemic (n=86) group noted significant differences in LDH, Hba1c and use of steroids which was significantly higher in hyperglycemic group. There was no difference in overall survival (p=0.46) and non-ICU length of stay (p=0.06) noted between groups.
Our study confirms high mortality rate from Covid in hospitalized patients with diabetes and cancer. As noted, inpatient glycemic control to achieve targets in this patient population was not associated with reduction in mortality or improvement in Covid-related outcomes, which is in alignment with previously published studies.
Presentation: Thursday, June 15, 2023
THU326 Subcutaneous Insulin Aspart Every 4 Hours In the Treatment Of COVID-19 Patients With Diabetic Ketoacidosis: A Retrospective Study
Authors: Chiewchalermsri Dararat , Wanittansirichok Chayanin , Sriphrapradang Chutintorn 
Published: October 2023

Abstract
Disclosure: D. Chiewchalermsri: None. C. Wanittansirichok: None. C. Sriphrapradang: None.
SUBCUTANEOUS INSULIN ASPART EVERY 4 HOURS IN THE TREATMENT OF COVID-19 PATIENTS WITH DIABETIC KETOACIDOSIS: A RETROSPECTIVE STUDY
Introduction: COVID-19 infection increases the risk of diabetic ketoacidosis (DKA). To limit the healthcare workers’ exposure when taking care of the COVID-19 patients, treatment of DKA with subcutaneous (SC) rapid-acting insulin analogs every 4 hours was suggested in many professional recommendations. However, the evidence to support this strategy is lacking. We aimed to report the efficacy and safety of SC insulin aspart every 4 hours in the management of DKA in COVID-19 patients. Methods: We retrospectively reviewed all confirmed COVID-19 patients aged &gt;15 years who developed mild-moderate DKA between July 2020 and October 2021 in our institution. Insulin aspart was delivered 0.4 units/kg SC every 4 hours. When blood glucose (BG) decreased to &lt;250 mg/dL, the dose of insulin aspart was reduced to 0.2 units/kg every 4 hours until resolution of DKA. SC Basal insulin 0.15-0.2 units/kg was also initiated at the time of DKA diagnosis. Result: A total of 7 patients had mean age of 67.43±13.19 years with body mass index of 25.49±3.42 kg/m2. Most was 71.4% of female and all had pre-existing type 2 diabetes mellitus. All patients received high-dose steroid for COVID-19 treatment. Initial biochemical parameters were BG of 449±157.3 mg/dL, hemoglobin A1c of 10.58±2.81%, pH of 7.34±0.07, beta-hydroxybutyrate of 4.0±1.51 mmol/L, and HCO3 of 15.5±2.17 mmol/L. Time to resolution of DKA were 12.7±5.82 hours. Conclusion: From our cohort, SC rapid-acting insulin administered every 4 hours could be applied in the selected COVID-19 patients with mild-moderate DKA.
Presentation: Thursday, June 15, 2023
THU348 Thyroid Dysfunction And Diabetes In Pregnancy - Is There A Link?
Authors: Kumar Sahay Rakesh , Abdul Kalam Sumayya , Kudugunti Neelaveni , Togarla Srujana 
Published: October 2023

Abstract
Disclosure: R.K. Sahay: Speaker; Self; Novo Nordisk, Roche Diagnostics. S.A. Kalam: None. N. Kudugunti: Speaker; Self; Novo Nordisk. S. Togarla: None.
Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and diabetes complicating pregnancy when compared to the Western population. The association between both has been studied in multiple small studies which have however shown discordant results. Hence the need for exploring this further. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: 150 pregnant women with gestational/pregestational diabetes were enrolled in this cross sectional study and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using antiTPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with diabetes in pregnancy was evaluated along with maternal and perinatal outcomes. The same tests were done on 26 pregnant women without diabetes who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. 56% were diagnosed with GDM and the rest had pre-GDM. 26.6% of the study population were diagnosed with hypothyroidism. Of these,45% were newly diagnosed during the current pregnancy. The prevalence of antiTPO antibody positivity was found to be 9.33% whereas that of anti-thyroglobulin antibody was 3.33%. Maternal and perinatal complications were higher in the group with combined endocrinopathy with gestational hypertension and preterm delivery showing statistically significant increase among the latter group. Among those women with combined endocrinopathy who developed gestational hypertension,76.9% had GDM. All of them were found to have subclinical hypothyroidism which was newly diagnosed in third trimester. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes is higher than the prevalence in normal pregnancy. Undiagnosed subclinical hypothyroidism was found to be strongly associated with development of gestational hypertension. Our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy.
Presentation: Thursday, June 15, 2023
THU355 Tingling Over Cheek, An Atypical Presentation Of Invasive Fungal Sinusitis In An Ambulatory Patient With Type 2 Diabetes
Authors: Udayasankar Jayalakshmi , Vaezeafshar Reza , Patel Natalie 
Published: October 2023

Abstract
Disclosure: J. Udayasankar: None. R. Vaezeafshar: None. N. Patel: None.
A 61 year old female with uncontrolled type 2 Diabetes, A1c over 11% for over 3 years was seen in Diabetes clinic for follow up after a 2 year hiatus. She happened to mention an isolated 1 inch area of tingling over Right (R) cheek. She was previously seen in ED and discharged home on Benadryl. She had also seen an acupuncturist, a dentist and family physician, latter 2 providers treated her with 2 different antibiotics without change in symptoms. She denied fever, headaches, visual acuity changes, diplopia or nasal discharge. Exam in clinic revealed hypoesthesia below eye and towards nasal dorsum, no changes in skin warmth or color noted, eye movements were intact and mild tenderness was elicited on pressure over R maxillary sinus. Atypical presentation of Invasive fungal sinusitis (IFS) was suspected clinically. Seen by ENT and CT and MRI of Sinuses and Orbits showed R maxillary sinusitis, mild enhancement and enlargement of the inferior rectus muscle and infraorbital nerve / foramen present with stranding within the extraconal fat of the R inferior orbit thought to be related to extension of inflammation. Endoscopic sinus surgery showed R maxillary sinusitis with necrotic mucosa along orbital floor and orbital floor dehiscence concerning for invasive infection. Frozen section showed necrotic, inflammatory tissue. Discharged home from ED. Surgical pathology showed necrotic tissue and fungal hyphae with acute angle branching on GMs and PAS stains. Presence of crystals and pigmentation raised possibility of Aspergillus Niger infection. She was readmitted to hospital for repeat surgery - R medial maxillectomy and R pterygopalatine fossa dissection - biopsy of R maxillary sinus walls, right periorbital area and pterygopalatine fossa showed presence of fungal organism. Mold PCR panel showed Aspergillus niger. She received therapy with IV Amphotericin B and was discharged home on Oral Voriconazole. She is doing well and her diabetes control improved on insulin therapy. Patients with uncontrolled Diabetes are immunocompromised and vulnerable to atypical infections that can be potentially lethal if not diagnosed and treated timely. Patient presented with isolated tingling over R cheek for months. Lack of symptom improvement despite two courses of antibiotics and A1c over 11% raised clinical suspicion of IFS . Interestingly frozen path did not reveal hyphae that led to her first discharge from hospital. Surgical pathology and PCR of biopsied material made the diagnosis of IFS - Aspergillus sinusitis and treatment with antifungal medication prevented orbital and cerebral complications of IFS and death. Therefore, awareness of this disease entity in ambulatory patients is important and could be life saving for patients.
Presentation: Thursday, June 15, 2023