bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI139 Identification Of Robust Aldosterone-Producing Adenomas-related Genes Using Adrenal Genome-wide Transcriptome Analysis
Authors: Lee Seunghyun , Lee Taesic , Yoo Gilsung , Soo Lim Jung 
Published: October 2023

Abstract
Disclosure: S. Lee: None. T. Lee: None. G. Yoo: None. J. Lim: None.
Primary aldosteronism (PA), the most common cause of secondary hypertension, is caused by aldosterone overproduction in one or two adrenal glands. It carries a higher risk of cardiovascular disease and mortality compared to essential hypertension. In an effort to identify the underlying molecular mechanisms regarding aldosterone secretion and cell proliferation in aldosterone-producing adenomas (APA), genome-wide transcriptome analyses have been conducted; however, there are still some limitations that need to be addressed since a relatively small number of samples were analyzed at a single center in most studies. In this study, we performed integrative and systematic analysis using adrenal transcriptome datasets to verify candidate genes robustly associated with APA and obtain more generalized signatures involved in the pathophysiology of PA. Three mRNA datasets for adrenal tissues (GSE8514, GSE60042, and GSE64957) were obtained from the Gene Expression Omnibus Database. For the first two datasets, normal adrenal samples from patients with renal cell carcinoma and adrenal tissue samples adjacent to APA were included as controls, respectively. In GSE64957, zona glomerulosa (ZG) and zona fasciculata (ZF) samples were analyzed separately in the current study (GSE64957ZG and GSE64957ZF). Differentially expressed gene (DEG) investigation and comparative analysis were conducted using the limma method. The selection criteria for APA-related genes were as follows: those that are significantly dysregulated in more than three of the four datasets and show a consistent trend of up- or down-regulation in four datasets. 5,375 genes were present in all transcriptome datasets; for the GSE64957ZG, 57 DEGs were identified in the APA group, among which 14, 7, and 37 genes were also dysregulated in the APA group of GSE64957ZF, GSE8514, and GSE60042, respectively. All comparisons among four lists of DEGs exhibited significant enrichment results. The highest degree of overlap was shown in the DEG pair of GSE64957ZG-GSE60042. As a result, approximately 20 genes (12 upregulated and 12 downregulated DEGs), including CYP11B2, PCP4, and ATP2A3, were selected as the final APA-related genes. This study demonstrated several candidate genes that are strongly relevant to APA by examining whole genome disease-related signatures. Besides CYP11B2, it seems that alteration in PCP4 and ATP2A3 genes would be much more involved in the pathogenesis of PA, which warrants further investigation along with validation for the role of the remaining genes.
Presentation: Friday, June 16, 2023
FRI154 Saline Suppression Testing And Acute Hypocalcemia: Impacts On Diagnostic Testing For Primary Aldosteronism
Authors: Warachit Parksook Wasita , Michelle Brown Jenifer , Milks Julia , Moore Anna , Niebuhr Yvonne , Honzel Brooke , Vaidya Anand 
Published: October 2023

Abstract
Disclosure: W.W. Parksook: None. J.M. Brown: Consulting Fee; Self; Bayer, Inc. J. Milks: None. A. Moore: None. Y. Niebuhr: None. B. Honzel: None. A. Vaidya: Consulting Fee; Self; HRA Pharmaceuticals, Mineralys.
Background: Calcium ion signaling is a critical factor required for the physiologic production of aldosterone. Emerging evidence has revealed that the majority of cases of primary aldosteronism involve pathogenic somatic mutations that ultimately increase calcium signaling and autonomous aldosterone production. Therefore, testing for primary aldosteronism that modulates calcium homeostasis may influence the diagnostic interpretation of the results. Method: Overweight to obese participants with metabolic risk factors and pre-hypertension or stage 1 hypertension (n=56) underwent a standard seated saline suppression test (SSST). Measurement of blood pressure, plasma aldosterone, serum calcium, as well as other factors, was performed at times 0, 120, and 240 minutes during SSST. Linear regression models were used to analyze the association between changes in calcium and each parameter. Results: Following 2 liters of saline infusion during SSST, all 56 participants (100%) had a significant decrease in serum calcium levels from baseline, with 26 (47%) developing new-onset frank hypocalcemia (calcium &lt;8.6 mg/dL). The mean baseline serum calcium was 9.2 ± 0.3 mg/dL, which declined to 8.9 ± 0.4 mg/dL at 120 mins (P&lt;0.001), and to 8.6 ± 0.4 mg/dl (P&lt;0.001) at 240 mins when the SSST concluded. Consistent with the known vasopressor effect of calcium, greater drops in serum calcium levels were associated with lower blood pressure at 240 minutes (β;= 13.5, P&lt;0.01 for DBP; β;= 10.7, P= 0.06 for SBP). Among those with post-SSST aldosterone levels &lt;10 ng/dl (a categorical threshold used to exclude primary aldosteronism), greater reductions in serum calcium levels were associated with larger drops in aldosterone levels (β;= 9.9, P&lt;0.05). Conclusion: The standard SSST induced a substantial decline in serum calcium levels in 100% of participants, with nearly half of all participants developing frank hypocalcemia at the end of saline infusion. Since calcium is known to play a critical role in physiologic and pathophysiologic production of aldosterone, these findings raise the question whether hypocalcemia induced by the acute loading of 2 liters of saline may confound the interpretation of aldosterone changes. Further research should focus on better understanding the diagnostic implications of these results and potential limitations of the SSST to exclude primary aldosteronism.
Presentation: Friday, June 16, 2023
THU006 Exploring Primary Care Resident Perspectives On Diabetes Education In Training
Authors: Francis Nnenia , Cardillo Serena , Nandiwada Deepa R 
Published: October 2023

Abstract
Disclosure: N. Francis: None. S. Cardillo: None. D.R. Nandiwada: None.
Background: The training residents gain in Family Medicine (FM) and Internal Medicine (IM) residency programs provide a critical foundation for their knowledge in diabetes (DM) management. It is one of the most common diagnoses physicians-in-training will encounter in their residency training programs and in clinical settings. However, a 2012 study compared diabetes care in resident clinics versus private physicians and found significant decrease in patient satisfaction (56.5% vs. 71.3%) in resident clinics. A 2020 study surveying primary care (PC) residency program directors showed that most FM and IM residency training programs focus on the core diabetes care and management topics with much less focus on emerging topics, such as 2nd generation insulin analogs and digital health technologies. The purpose of our survey was to better assess current resident perceptions and attitudes towards their DM education and their perceived comfort level in comprehensive DM counseling, evaluation, and management. Methods: A 12 item survey was designed using the Qualtrics program. The survey link was sent via email to IM- PC and FM residents at a major academic medical center. Data was collected from September 13th, 2022 to present. The survey included a combination of multiple choice, Likert scale and ranking questions. Results: 14 residents responded to the survey to date with the majority (71%) belonging to the IM-PC group and the remainder (29%) family medicine. Residents felt most comfortable managing diabetes related complications and counseling on foot and eye care and hypoglycemia. Respondents reported being most uncomfortable in prescribing non-insulin medication (50%) and initiating an insulin regimen (43%) and less comfortable counseling patients on continuous glucose monitoring systems (83%) and insulin administration (66%). While majority of residents (72%) found their DM curriculum clinically relevant, 85% of residents reported there was not enough time allotted. Respondents felt a more longitudinal lecture series, with increased access to treatment frameworks and on-site feedback on their DM counseling and care would best supplement their DM curriculum. Conclusion: This survey data explores specific areas that residents have identified as being least comfortable and also expresses what they identified as the most preferable ways to modify and design an educational intervention. This information allows for tailored curricular intervention highlighting diabetes technologies, insulin and non-insulin prescribing practice in a longitudinal lecture style format that provides access to DM treatment frameworks and incorporates direct on-site feedback to the residents. This provides evidence for the development of a novel clinically integrated DM curriculum.
Presentation: Thursday, June 15, 2023
THU248 Screening For Heart Failure In Patients With Diabetes Mellitus - A SwissDiab Study
Authors: Brandle Michael , Knaus Laura , Quarella Marino , Maeder Micha , Buser Marc , Renstrom Frida 
Published: October 2023

Abstract
Disclosure: M. Brandle: None. L. Knaus: None. M. Quarella: None. M. Maeder: None. M. Buser: None. F. Renstrom: None.
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been shown to significantly reduce the risk of hospitalization for heart failure (HF) and death from cardiovascular causes in patients with diabetes and HF. Since the diagnosis of HF is challenging, the condition often remains undetected, and the prevalence in diabetes patients is unclear. The aim of this study was to evaluate the prevalence of HF in patients with diabetes enrolled in the Swiss Diabetes Registry (SwissDiab) and the proportion prescribed SGLT2i, to help to determine the need to reinforce clinical treatment guidelines and establish regular screening of HF.SwissDiab is a multicenter longitudinal observational study of outpatients with diabetes in tertiary care. The current study was conducted at the Cantonal Hospital of St.Gallen, Switzerland. All patients with a SwissDiab study visit between 28.09.2020 and 31.03.2022 were screened for HF according to a standardized protocol based on the diagnostic algorithm established by the European Society of Cardiology. Patients with ≥1 risk factor and/or symptoms of HF and a NT-proBNP ≥125 ng/L were referred to the Division of Cardiology for echocardiography and a clinical evaluation of HF, further stratified by HFpEF, HFmrEF, and HFrEF. The study was approved by the regional Ethics Committee East Switzerland (EKOS, PB_2016-01449) and all SwissDiab participants provided written informed consent. Out of 555 patients with diabetes, 530 had data available for analysis: 168 with type 1 diabetes (T1DM); 315 with type 2 diabetes (T2DM), and 47 with other forms of diabetes n=47. The median (IQR) age was 60.9 (49.0-69.0) years, n=162 (30.6%) were females, diabetes duration 14.0 (8.0-21.0) years, HbA1c 7.1 (6.6-7.8)%, low-density lipoprotein cholesterol 2.6 (2.1-3.2) mmol/L, and n=114 (21.5%) were current smokers. In total, HF was present in n=59 (11.1%) (T1DM, n=4 [2.4%]; T2DM, n=50 [15.9%]; other, n=5 [10.6%]) of which 35 (59.3%) were newly diagnosed. 34 of 59 patients presented with HFpEF (57.6%), 7 with HFmrEF (11.9%), and 18 with HFrEF (30.5%). Of the 59 patients with HF, n=19 (32.2%) were prescribed SGLT2i (HFpEF, n=7 [36.8%]; HFmrEF, n=2 [10.5%]; HFrEF, n=10 [52.6%]). Of the 24 patients with a previously known diagnosis of HF, 50% were treated with SGLT2i (2 out of 3 patients with HFmrEF and 10 out of 15 patients with HFrEF). All of the patients with HF that were treated with SGLT2i had T2D.The results indicate that roughly one in ten patients enrolled in SwissDiab have HF, and one in six patients with T2D. Patients with HFrEF (around 30% of cases) primarily have T2D, of which &gt;50% were prescribed SGLT2i, as compared to 32% overall.
Presentation: Thursday, June 15, 2023
THU257 Retrospective Analysis Of Hemoglobin A1c Utility At A SafetyNet County Hospital
Authors: Joseph Jonathan , Hashim Ibrahim A 
Published: October 2023

Abstract
Disclosure: J. Joseph: None. I.A. Hashim: None.
Background: Diabetes remains a prevalent chronic health condition. Measurement of glycated hemoglobin (A1c) is central to both diagnosis and to monitoring response to therapy and hence the extent of diabetes control. Use of A1c continues to increase in compliance with recommendations by the American Diabetes Association. The utility of A1c measurement at a large SafetyNet county hospital was assessed. In this analysis, our goal is to help guide utilization of A1c testing. Method: All A1c values performed over a period of 14 months between January 2021 to March 2022 were retrieved from the electronic health records system (Beaker, EPIC®). Statical analysis of all A1c data were performed using Excel Microsoft® and NCSS statistical software. A1c data were analyzed for prevalence of abnormalities (&gt;6.5%). Results: A total of 28,760 A1c measurements were performed during the study period. Overall values ranged from 0.06% to &gt;17.6% (Median 6.1%). Patients with A1c &lt;5.7% (n=9535) representing 33% of tested patients. Patients with A1c values between 5.7% and 6.5% (n=7619) representing 26% of patients. Patients with A1c values between 6.5% and 11.0% (n = 10,001) representing 35% of patients. Patient in control with A1c values between 6.5% and 7.5% (n=1350) represented 35.8% of the diabetic population. Those poorly controlled A1c &gt;9% (n=734) represented 19.4% of patients. The remaining patients (n=1605) representing 6% of patients had A1c values &gt;11%. Conclusion: A1c testing is widely practiced with 35 % of patients being diabetic. A1c measurement identified 26% of patients in the pre-diabetic stage and that 33% were non-diabetic. The high HbA1c among some patients indicate a need for more proactive approach to their management. The high percentage of the measured population had A1c below 5.7% and thus raises the question of whether routine screening of A1c is cost-effective. Additional analysis for diabetic patients for degree of control and for assessment of urinary albumin levels is required.
Presentation: Thursday, June 15, 2023
THU266 Lowered HbA1c In Individuals With Long-term Type 1 Diabetes Undergoing BCG Bladder Cancer Therapy
Authors: Dias Hans , Kühtreiber Willem , Faustman Denise L 
Published: October 2023

Abstract
Disclosure: H. Dias: None. W. Kühtreiber: None. D.L. Faustman: None.
Originally developed for the prevention of tuberculosis, the bacillus Calmette-Guérin (BCG) vaccine has shown benefit in diverse human diseases, including infection resistance, allergies, multiple sclerosis and autoimmune diabetes. BCG has also been approved in the United States and Europe since 1972 for early-stage bladder cancer, where it is administered commonly as 6 doses via intravesical therapy for 6 weeks (“high-dose intravesical BCG”). We analyzed three large databases-the Management Science Associates database (with Quest Diagnostics data) (N=263 million adults), the Research Patient Data Registry (RPDR) from the Massachusetts General Brigham (MGB) system (N=6.5 million), and data from Optum Labs (OL)(N=45 million) -for a correlation between high-dose intravesical BCG and HbA1c levels in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D). We identified subjects with documented T1D (N=19) or T2D (N=106) undergoing BCG therapy for bladder cancer, and then retrospectively assessed BCG’s subsequent year-by-year impact on blood sugar trends. T1D records were identified by searching for T1D diagnosis and insulin usage; records showing any history of oral hypoglycemic agents (e.g., metformin) were excluded. T2D records were searched for using T2D diagnosis and exclusion of any T1D diagnosis. No patients had a history of BCG treatment/vaccination other than for bladder cancer. Patients with T1D in the datasets showed downward trends in HbA1c values after high-dose intravesical BCG, but not patients with T2D. The data suggests that high-dose intravesical BCG therapy may contribute towards a drop in HbA1c values in T1D, but not T2D. This is consistent with earlier interventional trials of the BCG vaccine in longstanding T1D.
Presentation: Thursday, June 15, 2023
THU282 Improved Fournier’s Gangrene Outcomes With Prior SGLT2i Or Metformin Usage
Authors: Venugopal Sharini , Patel Suraj , Wu Zhengbo , Galbiati Francesca , Oh Jessica , Manroa Pooja , Morariu Elena , Stefanovic-Racic Maja 
Published: October 2023

Abstract
Disclosure: S. Venugopal: None. S. Patel: None. Z. Wu: None. F. Galbiati: None. J. Oh: None. P. Manroa: None. E. Morariu: None. M. Stefanovic-Racic: None.
Introduction: Fournier’s gangrene (FG) is a rare, necrotizing fasciitis of the external genitalia with high mortality up to 30% that is more prevalent in males, diabetes, HIV, and immunocompromised states. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been linked with FG. Interestingly, multiple studies have found no significantly increased risk of FG with SGLT2i use. However, these studies have very large confidence intervals due to the rarity of the observed event. Methods: A retrospective study between 3/1/2013-6/12/2020 was performed at four different tertiary hospitals within the University of Pittsburgh Medical Center (UPMC) system to compare the severity and outcome of FG between type 2 diabetes patients who were treated with SGLT2is, metformin, and insulin prior to admission. Results: 202 patients were admitted for FG (8 on SGLT2is, 80 on Metformin, and 88 on insulin). Baseline characteristics such as age, sex, and HbA1c were generally similar. Duration of diabetes was longer in subjects on insulin vs not on insulin (p&lt;0.001). Creatinine(Cr) on admission was lower in SGLT2i vs not on SGLT2i (p=0.056) and metformin vs not on metformin (p=0.037), but was higher in the insulin vs non-insulin group (p=0.004). The SGLT2i group had a shorter hospital stay (p=0.045), a lower rate of ICU admission (p=0.0093), and a trend toward a shorter ICU stay than the non-SGLT2i group (p=0.053). In the metformin group, the cases of amputation were lower compared to the non-metformin group (p=0.026). In the insulin group, there was a trend toward a longer hospital stay (p=0.057) and ICU stay (p=0.052) vs the non-insulin group. Conclusion: The use of SGLT2i does not appear to worsen the clinical course or outcome of FG and may actually improve it based on our data showing decreased ICU admissions and length of stay. Metformin usage may dampen the severity of FG by significantly decreasing cases of amputation. Noteworthy is that Cr was lower in the SGLT2i and metformin groups. Further analysis of baseline characteristics such as renal function, HbA1c, and duration of diabetes will determine whether they may affect the severity of FG.
Presentation: Thursday, June 15, 2023
THU286 Role Of Carb Counting For Glycemic Control In People With Type 1 Diabetes During The Month Of Ramadan
Authors: Naseem Raheela 
Published: October 2023

Abstract
Disclosure: R. Naseem: None.
AbstractTitle: Role of carb counting for glycemic control in people with type 1 diabetes during the month of RamadanPresenting Author: Raheela NaseemCo-authors: Rabia Imtiaz, Musarrat Riaz, Muhammad Yakoob AhmedaniBackground: Carbohydrate counting is a part of meal planning for individuals with type 1 diabetes (T1D), although not widely used in Asian countries like Pakistan.Aim: To evaluate the effect of carbohydrate counting in individuals with type 1 diabetes mellitus who intended to fast during the month of Ramadan.Methodology: This prospective case-control study was conducted in the Diet& Education Department of Baqai Institute of Diabetology and Endocrinology from April to May 2021. Thirty already registered individuals with T1D, aged ≥ 15 years (who intended to fast), were equally divided into case and control groups. The control group was educated on Ramadan-specific management and a T1D general diet plan, followed by the advised insulin regimen protocol. The case group attended carbohydrate counting sessions for better glycemic control and was provided with the book “Matching Carbs with Insulin” for insulin dosage guidance for different daily meals. A 24/7 telephonic support was provided, along with individual WhatsApp groups; managed by a clinical dietitian and a trained diabetes educator, under the supervision of their physicians. Results: A total of 25 individuals (5 being drop out) with a mean age of 22.56±6.5 years participated. A significant mean glucose level before iftar was found in the case and control groups as 149.78±41.4 mg/dl and 206.05 ± 65.43 mg/dl, respectively. Whereas, the mean glucose levels for non-fasting hours were also significant at 158.45±25.31 mg/dl (case) and 194.87±54.23 mg/dl (control). Overall, 257 episodes of hyperglycemia in the control group while, only 177 in the case group were observed. No hospitalization was needed in both groups. Conclusion: By implementing the carbohydrate counting method, safe fasting was feasible with significant improvement in overall glycemic control without significant major complications.
Table 1. Baseline characteristics of subjects
Table 2. Comparison of SMBGs at different timings
Fig. 1- Mean self-monitoring of blood glucose (SMBG) profile of people with type 1 diabetes
Fig. 2- Frequency of hyperglycemia
Presentation: Thursday, June 15, 2023