bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU368 A Rare Case Of Glycogenic Hepatopathy With Persistent Lactic Acidosis
Authors: Shah Mauli , Challagulla Sabita 
Published: October 2023

Abstract
Disclosure: M. Shah: None. S. Challagulla: None.
Background: Glycogenic hepatopathy (GH) is an under-recognized complication of poorly controlled diabetes. It is caused by abnormal glycogen accumulation in hepatocytes leading to hepatomegaly and transient elevation of liver transaminases. Diagnosis is often delayed as liver biopsy is needed to distinguish it from other causes of liver injury. Complete resolution can be achieved with intensive glucose control. We present a case of GH diagnosed in a patient who developed increasing liver transaminases and persistent lactic acidosis after resolution of DKA. Clinical Case: We present a 21-year-old female with uncontrolled Type 1 diabetes who presented with fatigue, nausea, and generalized body aches. Patient was hemodynamically stable. Laboratory work up on admission showed a serum glucose of 834 mg/dL, serum bicarbonate less than 5 mEq/L, beta hydroxybutyrate was elevated to 8.7 mmol/L (normal &lt;0.4 mmol/L), lactic acid was also elevated to 7.9 mmol/L (normal &lt;2.0 mmol/L). She was diagnosed with DKA and treated with IV fluids and insulin drip. Over the next five days the patient’s symptoms improved and DKA resolved with beta hydroxybutyrate falling to &lt;0.1 mmol/L. Her lactic acidosis however persisted, she had no apparent infection and no episodes of hypotension to explain this finding. CT scan of the abdomen revealed hepatomegaly not compatible with steatosis. Liver enzymes on admission were mildly elevated AST 57 IU/L and ALT 61 IU/L however values continued to rise and peaked at AST 2372 IU/L and ALT 681 IU/L five days later. Further laboratory studies revealed no evidence of viral hepatitis, no presence of drugs or toxins. Chronic liver disease work up revealed normal ANA, AMA, SPEP, ceruloplasmin, and iron levels. Patient ultimately underwent liver biopsy which revealed glycogenic hepatopathy, mild steatosis, and mild fibrosis. Patient’s lactic acidosis eventually improved with supportive care, and she was discharged. On follow up 3 months later the patient's liver enzymes had returned to normal. Discussion: Glycogenic hepatopathy is a rare diagnosis usually seen in patients with uncontrolled diabetes and elevated liver transaminases. It is hypothesized that pathogenesis of GH involves insulin increasing glycogen synthesis in the liver resulting in congested hepatocytes. Persistent lactic acidosis can also be seen; it has been proposed that increased insulin and dextrose administration prevents gluconeogenesis in the liver, therefore decreased conversion of pyruvate to glucose and increased lactate production. GH is important to understand and differentiate from other causes of liver injury and disease as treatment and prognosis is unique. Prompt liver biopsy should be pursued to elucidate diagnosis of GH. If patients are treated with aggressive glycemic control, hepatopathy can completely resolve.
Presentation: Thursday, June 15, 2023
THU369 A Rare Case Of IgG4-related Autoimmune Pancreatitis And Diabetes Mellitus
Authors: Zahid Maleeha , Shakil Jawairia 
Published: October 2023

Abstract
Disclosure: M. Zahid: None. J. Shakil: None.
Introduction: IgG4 related disease (IgG4-RD) is a rare multiorgan inflammatory condition characterized by dense lymphoplasmacytic infiltrates, presence of IgG4+ plasma cells and fibrosis. Here we present a case of young male with painless jaundice and hyperglycemia diagnosed with IgG4 related autoimmune pancreatitis and DM. Clinical Case: 46-year-old male with no significant history presented to outpatient clinic for pruritis and dark-colored urine of 2-week onset. He reported 17-pounds weight loss in the preceding month. While undergoing outpatient workup, patient developed epigastric pain prompting visit to the hospital. On examination, patient was afebrile, tachycardiac, icteric and had epigastric tenderness. Labs revealed normal electrolytes and renal function. LFTs were significant for total protein 7.6 g/dl (n=6.3-8.3 g/dl), AST 77 U/L (n = 10-50 U/L), ALT 127 U/L (n = 5-50 U/L), alkaline phosphatase 458 U/L (n = 40-129 U/L) and direct bilirubin &gt;10.0 (n = 0-0.3 mg/dl). Lipase was 99 U/L (n - 13-60 U/L), blood glucose was 292 mg/dl and A1C was 6.5% (n = 4.0-5.6%). US abdomen revealed diffuse gallbladder wall thickening with moderate sludge and intrahepatic and extrahepatic distal biliary obstruction and dilatation. MRCP showed common bile duct and intrahepatic biliary ductal dilation. Pancreas was diffusely irregular with areas of hemorrhagic pancreatitis. ERCP showed dilatation of upper and middle third of main bile duct, left and right hepatic ducts and all intrahepatic branches with a stricture in distal bile duct. Biliary sphincterotomy and placement of temporary plastic biliary stent was performed and ampullary biopsies were taken. IgG4 level was checked due to suspicion for IgG4-RD and was 293 mg/dl (n: 1-123 mg/dl). Pathology revealed mucosa with epithelial reactive changes. CD138 stain showed several mature plasma cells within the inflammatory infiltrate. In addition, immunostain for IgG4 shows several IgG4 positive plasma cells forming small clusters confirming diagnosis of IgG4-RD. Post procedure, his abdominal pain and LFTs started improving. Patient was started on prednisone for IgG4-RD and insulin for persistent hyperglycemia. His prednisone dose was later tapered after starting methotrexate. Patient’s most recent LFTs have normalized except mildly elevated ALT and A1C improved to 6.2%. Conclusion: Autoimmune pancreatitis and cholangiopathy are the pancreatobiliary manifestation of IgG4-RD and most often present as painless jaundice mimicking pancreatic cancer. Endocrine insufficiency usually manifests as diabetes mellitus/pre-diabetes and may also lead to autoimmune hypophysitis and Reidel’s fibrosis. Other organ systems that may also get involved include lacrimal and salivary glands, lungs, kidneys, nervous system, and lymphatic/vascular system. Early recognition and ongoing surveillance are key to appropriate management of this condition.
Presentation: Thursday, June 15, 2023
FRI636 Sleep Architecture In Diabetic Patients With Sleep Apnea On Metformin
Authors: Varma Madhu , Eghbali Mason , Hung Derek , Sahai Anurag 
Published: October 2023

Abstract
Disclosure: M. Varma: None. M. Eghbali: None. D. Hung: None. A. Sahai: None.
Background: Metformin, commonly used medication to treat Type II Diabetes Mellitus (DM) improves insulin sensitivity, reduces glucose production in liver and absorption by intestines. Type II DM patients often have higher BMI with increased incidence of sleep apnea. Metformin consuming patients sometimes report insomnia. Blood glucose levels affect sleep duration; therefore Metformin-related changes in blood glucose levels may affect sleep. Metformin prescriptions grew from 40 million in 2004 to 90 million in 2020. This has improved long term vascular complications outcomes in diabetics. Coincidentally the number of patients using sleeping aids has increased. Melatonin sales have doubled since 2004, approximating 821 million USD in sales in 2020. With diabetes and Metformin each causing significant changes in sleep, we aimed to examine sleep architecture in known diabetic patients on Metformin presenting with excessive daytime sleepiness and fatigue. Hypothesis: We hypothesize that Metformin affects sleep and influences sleep architecture in diabetic patients. Methods: Sleep architecture in 29 Type II DM patients taking Metformin, with symptoms of excessive daytime sleepiness, snoring, and fatigue was examined. Patients underwent overnight polysomnography which included six channel EEG, Electrooculogram, Electromyogram EKG, and pulse oximetry, respiratory and flow monitoring in a sleep lab. Sleep staging done using AASM guidelines. Data on age, gender, BMI, medications and sleep stages N1, N2, N3 and REM was collected. Data analyzed and shown as mean + SD, t test p&lt;0.05 significant. Results: All patients had OSA diagnoses per AASM guidelines. The average age of patients with DM and OSA on Metformin therapy was 63 years, average BMI was 36. AASM stage distribution was N1 2.69 % + 0.02, N2 59.31% + 0.15, N3 12.22 % + 0.09, (Normal 25%) with 5.71% +0.06 REM sleep (normal 25%). All stages of sleep were reduced with significant reduction in deep sleep (N3) and REM sleep. Conclusion: Diabetic patients on Metformin had alterations in sleep architecture with significantly reduced restorative phases of deep and REM sleep. Sleep apnea reduces N3 and REM sleep, but diabetic pts had a more significant decrease. Although Metformin improves long term outcomes in diabetes associated complications, it alters sleep patterns. Altered sleep patterns further modify insulin release and over prolonged periods worsen glycemic control. Often patients on Metformin need additional medication like insulin for metabolic control. In part the progression of insulin resistance can be from altered sleep. Better understanding the effects of Metformin on sleep is needed to prevent long-term deteriorating effects on sleep while maintaining effective metabolic control.
Presentation: Friday, June 16, 2023
FRI642 The Effect Of Early Basal Insulin Administration On Diabetic Ketoacidosis (DKA) Management
Authors: Al-Marsumi Hadeel , Pollack Simcha Z , Simon Nicole 
Published: October 2023

Abstract
Disclosure: H. Al-Marsumi: None. S.Z. Pollack: None. N. Simon: None.
Background: DKA and HHS are considered serious acute complications of diabetes and constitute endocrine emergencies. Management of DKA and HHS consists of fluid, potassium replacement and weight-based adjusted rate intravenous insulin infusion, with close monitoring of capillary glucose, serum electrolytes, venous PH, and Beta-hydroxybutyrate. Current Standard DKA management protocols introduce and overlap subcutaneous insulin with intravenous insulin infusion after anion gap closure. In United states, few studies looked at different outcomes after early administration of basal insulin (i.e. before anion gap closure) during DKA management. Objective: The purpose of this research is to study the effect of early administration of basal long-acting insulin in addition to intravenous insulin on the time to anion gap closure, incidence of rebound hyperglycemia, hypoglycemia, transitional failure, length of ICU stays and length of Hospital stays, compared to intravenous insulin infusion only. Methods: This was a single-center, retrospective chart review study of adults 21 years or older admitted to the hospital with DKA diagnosis between September 2020 and May 2022. The patients were divided into two groups (Study group which includes those with early administration of basal long-acting insulin in addition to intravenous insulin infusion and Standard group which includes patients who received intravenous insulin infusion only). The primary outcome was the time to anion gap closure. The other outcomes included incidence of rebound hyperglycemia, hypoglycemia, transitional failure, length of ICU stay, as well as the length of hospital stay. Results: A total of 231 admissions were included for analysis; 29 patients were included in the (Study group) and 202 in the (Standard group). The mean time ± standard deviation for hours till anion gap closure in the study group and standard group were (21.3938 ± 25.2603 and 12.7679 ± 9.3512) respectively showing no statistical difference between the two groups with a P value of 0.0789. The incidence of hypoglycemia was 21% in the study group and 24% in the standard group with P value of 0.8173. There was no statistical difference in length of ICU stays, length of hospital stays, incidence of rebound hyperglycemia, transitional failure between the study and control groups with a p value of (0.3867, 0.7207, 0.7758 and 0.1387) respectively. Conclusion: There was no statistical difference in time to anion gap closure, length of ICU stays, length of hospital stays, incidence of rebound hyperglycemia, hypoglycemia, transitional failure between the study and Standard groups. Further Studies are needed to evaluate the effect of early basal insulin administration on DKA management.
Presentation: Friday, June 16, 2023
FRI649 ADMIRE: Assessing Dapagliflozin And Metformin As An Initial Regimen In Diabetes Mellitus For Enhanced Glucose Control
Authors: Phadke Dr Uday , Gopal Dr Jayashree , Biswas Dr Kaushik , Birla Dr Ashish , Prasad Ashish , Joshi Priyanka 
Published: October 2023

Abstract
Disclosure: D. Phadke: None. D. Gopal: None. D. Biswas: None. D. Birla: None. A. Prasad: None. P. Joshi: None.
Introduction: Early aggressive glucose lowering in type 2 diabetes mellitus (T2DM) has shown improved outcomes, and combination oral antidiabetic agents (OAAs) on top of lifestyle therapy are necessary. In India, most T2DM patients receive combination therapy with two or more OAAs to achieve glycemic targets more rapidly. The fixed dose combination (FDC) of dapagliflozin and metformin is widely used in India, as it improves glycemia, reduces weight and blood pressure (BP), and has good tolerability. This study aimed to evaluate physician practices, efficacy, and tolerability of dapagliflozin and metformin FDC as initial therapy for T2DM patients in a real-world setting. Methods: This multicenter, retrospective, observational study enrolled 481 T2DM patients across 49 clinical units for a period of 6 months. The study aimed to evaluate physician practices, efficacy, and tolerability of dapagliflozin and metformin FDC as the initial choice FDC in T2DM. The study was conducted in compliance with the principles of the Declaration of Helsinki, good clinical practice, and regulatory guidelines. Ethical approval for the study was obtained on August 6, 2022, and the study was conducted from August 15, 2022, to January 20, 2023. Results: The study demonstrated that dapagliflozin and metformin FDC significantly reduced weight by 4.2 kg (p &lt; 0.0001), fasting plasma glucose by 21.4 mg/dL (p &lt; 0.0001), and improved estimated glomerular filtration rate (eGFR) by 1.9 m²/1.73 ml/min (p &lt; 0.0001). Additionally, systolic BP was reduced by 10.7 mmHg (p &lt; 0.0001), and diastolic BP was reduced by 6.6 mmHg (p &lt; 0.0001), which is in combination with the concomitant medications. Incidence of genito-urinary tract infection was 8.9%. Conclusion: In a real-world setting, dapagliflozin and metformin FDC can be used as initial therapy for T2DM with good efficacy, tolerability, and safety. Physicians preferred this combination due to its ability to promote weight loss, reduce cardiovascular events, and decline in renal function. The excellent safety and efficacy reported by physicians for this FDC of dapagliflozin and metformin has contributed to improved compliance with the treatment. Thus, in the Indian population, dapagliflozin and metformin FDC is effective, safe, and has good tolerability as an initial therapy for T2DM.
Presentation: Friday, June 16, 2023
SAT098 Method For Predicting Time-below-range From Ambulatory Glucose Profile
Authors: Takeishi Soichi , Inoue Tatsuo 
Published: October 2023

Abstract
Disclosure: S. Takeishi: None. T. Inoue: None.
Time-below-range (TBR) for target duration is described in ambulatory glucose profile (AGP) reports of continuous glucose monitoring (CGM). However, for a method to reduce hypoglycemia, it is necessary to determine the frequency of hypoglycemia and the time zone when hypoglycemia occurs. Thus, in this study, we evaluated a method for predicting TBR from AGP. This is a cross-sectional study. We analyzed glucose levels (GL) measured using CGM (FreeStyle Libre Pro) over 24 hours for 13 days (from 00:00 on Day 2 to 00:00 on Day 15 [CGM attachment: Day 1]) for 100 outpatients with type 2 diabetes, whose diabetic treatment did not change through the CGM-wearing duration. We proposed the metric, “eTBR&lt;70AGP” as follows: ① when 95 percentile values were &lt;70 mg/dL, GL&lt;70 mg/dL were defined to exist at 100% (percentages were defined as “hypoglycemia existing rate [HER]”). When 95 percentile values were not &lt;70 mg/dL, and 75 percentile values were &lt;70 mg/dL, GL&lt;70 mg/dL were defined to exist at 95%. When 75 percentile values were not &lt;70 mg/dL and 50 percentile values were &lt;70 mg/dL, GL&lt;70 mg/dL were defined to exist at 75%. When 50 percentile values were not &lt;70 mg/dL and 25 percentile values were &lt;70 mg/dL, GL&lt;70 mg/dL were defined to exist at 50%. When 25 percentile values were not &lt;70 mg/dL and 5 percentile values were &lt;70 mg/dL, GL&lt;70 mg/dL were defined to exist at 25%. However, when 5 percentile values were not &lt;70 mg/dL, GL&lt;70 mg/dL were defined as nonexistent for convenience. ② We applied the definition mentioned in ① to the percentile values in the 13 days for each 96 timepoint of measurement every 15 minutes over 24-hours and determined the HER. ③ We calculated the eTBR&lt;70AGP as the average of HER of the 96 timepoint. We also calculated “TBR (&lt;70 mg/dL)” [TBR&lt;70] for the 13 days. In patients overall (n=100), eTBR&lt;70AGP correlated to TBR&lt;70 (r=0.997, p&lt;0.001). The optimal cutoff value of TBR&lt;70 for “eTBR&lt;70AGP - TBR&lt;70 &gt; 0” was 1.0% with sensitivity of 97% and specificity of 91% in receiver operating characteristic analysis [Area under the curve (AUC): 0.98, p&lt;0.001]. In patients with TBR&lt;70&gt;1% (n=34), eTBR&lt;70AGP was clinically equivalent to TBR&lt;70 as values (11.3% vs 9.0%). However, eTBR&lt;70AGP was statistically significantly higher than TBR&lt;70 (p&lt;0.001). In patients with TBR&lt;70&lt;1% (n=66), eTBR&lt;70AGP was clinically equivalent to TBR&lt;70 as values (0.04% vs 0.08%). However, eTBR&lt;70AGP was statistically significantly lower than TBR&lt;70 (p=0.02). eTBR&lt;70AGP may be substituted for TBR&lt;70 without underestimating the risk of hypoglycemia. Thinking in the calculation process of eTBR&lt;70AGP may be utilized for assessment of the risk of hypoglycemia at each time zone.
Presentation: Saturday, June 17, 2023
SAT130 Examining Rates Of Post-hospital Discharge Follow-up In An Endocrinology Clinic
Authors: Khan Talha , Kumar Ajay M , Champion Amber , Izuora Kenneth E 
Published: October 2023

Abstract
Disclosure: T. Khan: None. A.M. Kumar: None. A. Champion: None. K.E. Izuora: None.
Introduction: Outpatient follow up following hospital discharge is a critical factor in improving overall health outcomes especially among patients with chronic medical conditions. Previous research has demonstrated improved patient outcomes and lower readmission rates in patients with outpatient follow up after hospital discharge. In this single center QI project, we sought to understand the follow-up rate and the reasons for not following up among our patient population. Methods: This study is a root cause analysis following the Plan-Do-Study-Act cycle. All the patients seen by the UNLV inpatient endocrinology consult service in June and July 2022 were recorded. Patients discharged to hospice or discharged after July 31, 2022 were excluded from the study. After December 1, 2022 the number of patients that followed up at UNLV endocrinology clinic from the list was recorded. All patients that met inclusion criteria for the study and did not follow up at UNLV endocrinology clinic were contacted by phone and reason for not following up was recorded. Results: Over the 2 months of recruitment, 74 patients were consulted on by the endocrinology service and 67 met study inclusion criteria. From this group, only 13 patients had established follow-up care at the UNLV endocrinology clinic. From the remaining 54 patients, 5 had died. The 49 remaining patients who met criteria for the study but did not follow up were contacted via telephone (3 attempts). Of this, 8 patients either did not answer phone calls three separate times or did not have an active listed phone number.
Of the 41 patients contacted, the most frequent reason for not following up was inability to contact the clinic (6 patients, 14.6%), unawareness of need for follow-up (5 patients, 12.2%), prior established endocrinology care outside of UNLV (5 patients, 12.2%), no indication for follow-up (5 patients, 12.2%), and PCP managing the condition (5 patients, 12.2%). Of the remaining, 4 patients were not instructed to follow up, 3 patients had insurance not accepted at the UNLV endocrinology clinic, 2 patients were unable to get a convenient appointment and 2 patients established care at other endocrine clinics. The following reasons for not following up were given by one patient per category: leaving the city, discharge to prison, appointment canceled by the clinic, and refusing to answer any questions. Conclusion: From these responses, we can formulate methods to improve clinic follow-up after clinic discharge. The primary method to improve clinic follow-up after hospital discharge is to improve ease of contact with the clinic such as ensuring phone lines are adequately attended. An additional measure would be to stress need for follow-up at time of hospital discharge in addition to having printed instructions for clinic follow-up in the discharge paperwork.
Presentation: Saturday, June 17, 2023
Exploring the Association Between Thyroid Function and Oral Microbiome Diversity: An NHANES Analysis
Authors: Zheng Liang , Yang Rui , Li Ruixia , Chen Wanna , Zhang Jing , Lv Weiming , Lin Bo , Luo Jiajun 
Published: October 2023

Abstract

Objective
To investigate the association between thyroid functions and the oral microbiome diversity.

Method
Data from the US National Health and Nutrition Examination Survey (NHANES; 2009-2012) were analyzed. Thyroid functions were defined using thyroid hormones and related biomarkers. Oral microbiome was measured using the observed number of amplicon sequence variants (ASVs) and the Bray-Curtis dissimilarity. Linear regression was used to estimate the average change (β) and 95% CI for the number of ASVs against thyroid functions, adjusted for sociodemographic variables, health conditions, urinary iodine status, and periodontitis. Non-metric multidimensional scaling (NMDS) was used to analyze the Bray-Curtis dissimilarity.

Results
A total of 2943 participants were analyzed. The observed number of ASVs has a weighted mean of 128.9. Self-reported thyroid disease was associated with reduced number of ASVs (β = −9.2, 95% CI: −17.2, −1.2), if only adjusted for sociodemographic variables and health conditions. In the fully adjusted model, compared to normal thyroid function, both subclinical and clinical hyperthyroidism were associated with reduced number of ASVs (β = −59.6, 95% CI: −73.2, −46.0; β = −28.2, 95% CI: −50.0, −6.5, respectively). Thyroid peroxidase antibody level higher than the reference range was associated with higher observed ASV (β= 9.0, 95% CI: 1.2, 16.9). NMDS analysis suggested significant difference in oral microbiome composition between free triiodothyronine groups (P = .002), between free thyroxine groups (P = .015), and between thyroglobulin groups (P = .035).

Conclusion
Hyperthyroidism was associated with reduced oral microbiome diversity. Free triiodothyronine, free thyroxine, and thyroglobulin levels may alter the oral microbiome composition.