bluuebunny/crossref_metadata_2025_split huggingface dataset:
881-P: Heterogenous Effects of SGLT2 Inhibitors on Nephrolithiasis in Older Adults with Type 2 Diabetes
Authors: LI YUJIA , SHAO HUI , GUO YI , ZHANG YONGKANG , FONSECA VIVIAN , SHI LIZHENG , BIAN JIANG , WINTERSTEIN ALMUT G. , GUO JINGCHUAN 
Published: June 2023

Mechanistic studies suggested that sodium-glucose cotransporter-2 inhibitors (SGLT2i) may reduce the risk of nephrolithiasis. We aimed to further assess this association using a real-world population of type 2 diabetes (T2D) patients. Among a 15% random sample of 2017-2018 Medicare fee-for-service beneficiaries with T2D, we identified new initiators of SGLT2i or dipeptidyl peptidase-4 inhibitors (DPP4i). We followed the cohort until the first medical encounter with diagnosis of nephrolithiasis, death, or 12/31/2018. Inverse probability treatment weighting was used to balance the baseline covariates including sociodemographics, prior comorbidities and medications. Of 116,506 included individuals (age 72±10 years, 53% women), 0.96% developed nephrolithiasis over a median follow-up of 360 days. The crude incidence rate was 9.89 (95% confidence interval [CI] 8.49-11.52) and 11.02 (95% CI 10.34-11.73) per 1000 person-years in the SGLT2i group and DPP4i group, respectively. SGLT2i exposure was associated with a significantly lower risk of nephrolithiasis (hazard ratio 0.81 [95% CI 0.66-0.99]). This effect was more evident in men, non-Hispanic Black (NHB) individuals, and those without a history of nephrolithiasis. (Figure) SGLT2i was associated with a lower risk of nephrolithiasis, and the effect was more pronounced in men, NHB, and those without a history of nephrolithiasis.

Disclosure
Y.Li: None. H.Shao: Consultant; Lilly Diabetes. Y.Guo: None. Y.Zhang: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. L.Shi: None. J.Bian: None. A.G.Winterstein: Consultant; Bayer Inc., Genentech, Inc., Ipsen Biopharmaceuticals, Inc., Research Support; Merck Sharp & Dohme Corp. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health.
883-P: Effects of YG1699 and Sotagliflozin on Blood Glucose and Urinary Glucose Excretion in SD Rats
Authors: LI JACKY , XU ROGER W. , HE JIAOJUAN , LAPUERTA PABLO 
Published: June 2023

Background and Aims: YG1699, a dual inhibitor of SGLT1 and SGLT2, recently showed greater glucose lowering than dapagliflozin in patients with type 1 diabetes. This study examined the potential mechanism of glucose reduction in rats.
Materials and methods: Sprague Dawley rats received either 0.3, 1, 3, or 10mg/kg of YG1699, or 3, 10mg/kg of LX4211 (sotagliflozin), or vehicle by oral gavage (n=8 per group). Fifteen minutes later, 2g/kg glucose was orally administered, and blood glucose was measured at 0, 20, 40, 60, 90, 120, and 150 mins. The area under the curve (AUC) for glucose over time was calculated. In the urinary glucose excretion (UGE) test, 24-hour urine samples were collected after vehicle, 1, 3, or 10mg/kg doses of YG1699, or 3mg/kg sotagliflozin (n=5 per group). Differences between groups were evaluated by ANOVA.
Results (See Table 1): 1, 3, and 10mg/kg doses of YG1699 and 3and 10mg/kg of sotagliflozin reduced glucose AUC and increased UGE compared to vehicle.
Conclusion: Significant reductions in post-prandial glucose with YG1699 and sotagliflozin are associated with increased UGE. Glucose AUC after 10mg/kg YG1699 was less than 50% of vehicle.

Disclosure
J.Li: None. R.W.Xu: Consultant; Youngene Therapeutics. J.He: None. P.Lapuerta: Board Member; 4M Therapeutics, Consultant; Youngene Therapeutics, ViaCyte, Inc., Encuragen, Capsida, Provention Bio, Inc., Decibel Therapeutics, Crinetics, Next Phase Therapeutics.
887-P: Renal Benefit of Dapagliflozin Therapy in Hyperfiltering Type 2 Diabetes Patients
Authors: BASKOY GOZDE , QIN YUEJUAN , CERSOSIMO EUGENIO , SOLIS-HERRERA CAROLINA , ADAMS JOHN M. , DEFRONZO RALPH A. , TRIPLITT CURTIS L. 
Published: June 2023

Aim: To investigate the benefits of dapagliflozin [DAPA] on renal hemodynamics in type 2 diabetes patients [T2D] with glomerular hyperfiltration.
Design and Methods: 24 T2D with elevated [HYPER] and normal [NORMO] GFR, measured by Iohexol, randomized to either DAPA, 10mg/day [DAPA/HYPER, n=6; DAPA/NORMO, n=6] or metformin+glipizide [CON/HYPER, n=6; CON/NORMO, n=6] for 4 months. Hyperfiltration was defined as GFR&gt;125ml/min/1.73m2. Renal plasma (blood) flow [RP(B)F] measured with PAH divided by (1-Hct), mean arterial pressure [MAP], filtration fraction [FF] and renal vascular resistance [RVR] were determined before and after treatment.
Results: A1c[%] decreased similarly in DAPA/HYPER (8.3±0.2 vs. 6.8±0.2), CON/HYPER (8.7±0.3 vs. 7.2±0.1), DAPA/NORMO (8.6±0.3 vs. 7.3±0.2) and CON/NORMO (8.2±0.3 vs. 7.4±0.2). Body weight[Kg] was reduced in DAPA/HYPER (89±4 vs. 84±4) and DAPA/NORMO (90±3 vs. 87±2) but not in CON/HYPER (86±4 vs. 87±3) and CON/NORMO (87±4 vs. 91±3) (p&lt;0.05). GFR declined by 17% in DAPA/HYPER and by 8% in DAPA/NORMO (both, p&lt;0.05) but did not change in CON. FF and RVR fell in DAPA but not in CON. Renal hemodynamics at baseline [PRE-Tx] and after 4 months [POST-Tx] are shown in the table.

Conclusion These results indicate that dapagliflozin, but not metformin+glipizide therapy, normalizes glomerular hyperfiltration and reduces renal vascular resistance in hyperfiltering type 2 diabetes patients.

Disclosure
G.Baskoy: None. Y.Qin: None. E.Cersosimo: None. C.Solis-herrera: None. J.M.Adams: None. R.A.Defronzo: Advisory Panel; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Novo Nordisk, Research Support; AstraZeneca, Boehringer-Ingelheim, Merck & Co., Inc., Speaker's Bureau; AstraZeneca. C.L.Triplitt: Speaker's Bureau; Novo Nordisk.

Funding
AstraZeneca; Texas Diabetes Institute
894-P: Sodium–Glucose Cotransporter 2 Inhibitors and Risk of Dementia in People with Type 2 Diabetes—A Population-Based Cohort Study
Authors: TANG HUILIN , ELIZABETH SHAABAN C. , WU YONGHUI , MAGOC TANJA , DONAHOO WILLIAM T. , DEKOSKY STEVEN T. , BIAN JIANG , GUO JINGCHUAN 
Published: June 2023

Background: SGLT2 inhibitors show promising associations with decreased dementia risk. However, it is unclear which population subgroups would benefit the most.
Methods: Using electronic health records data from the OneFlorida+ Clinical Research Network, we identified individuals with T2D (aged ≥ 50 years) who initiated SGLT2 inhibitors or sulfonylureas from Jan 1, 2016 - Jan 31, 2022. The study outcome was incident dementia. We applied a causal machine learning approach - doubly robust learning - to estimate the conditional average treatment effects (CATE) in the overall cohort and heterogeneous treatment effect subgroups using a summary decision tree model.
Results: Among 36,756 individuals with T2D, 3.2% in the SGLT2 inhibitor group and 6.4% in the sulfonylureas group developed dementia over a 3.4-year follow-up. In the overall cohort, SGLT2 inhibitors were associated with a lower risk of dementia (Risk Difference [RD], -10.3%; 95% confidence interval [CI], -12.0% to -8.6%) compared to sulfonylureas. We identified four subgroups with varying risks for dementia, determined by traumatic brain injury, ever-smoking, and epilepsy (Figure).
Conclusion: SGLT2 inhibitors were associated with a lower risk of dementia in people with T2D compared to sulfonylureas, with significant variability across subgroups.

Disclosure
H.Tang: None. C.Shaaban: None. Y.Wu: None. T.Magoc: None. W.T.Donahoo: None. S.T.Dekosky: Advisory Panel; Acumen Pharmaceuticals, Cognition Therapeutics, Other Relationship; Biogen, Prevail Pharmaceuticals, UpToDate, Up-To-Date. J.Bian: None. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)
897-P: Real-World Glycemic Outcomes of &gt;400 Adults with Type 2 Diabetes Using the Omnipod 5 Automated Insulin Delivery (AID) System with Cloud-Based Data Management
Authors: PETERS ANNE L. , PASQUEL FRANCISCO J. , HUYETT LAUREN M. , SNOW KENNETH , MENDEZ JOSE J. , HADJIYIANNI IRENE , LY TRANG T. 
Published: June 2023

The Omnipod 5 AID System is a novel tubeless hybrid closed-loop system approved for use in people with type 1 diabetes ages 2 and up and was recently evaluated in adults with type 2 diabetes (T2D) during an 8-week outpatient feasibility study. The System allows for personalized therapy through customizable glucose targets from 110-150mg/dL in 10mg/dL increments and enables automatic upload of data for all users, facilitating unprecedented access to evaluate real-world outcomes. Continuous glucose monitoring (CGM) and insulin data from Omnipod 5 users with T2D aged ≥18y in the US with ≥90 days of data available in the cloud-based data management system were included. Data from 417 users with sufficient CGM data (≥75% of days with ≥220 readings) and using the lowest target (110mg/dL) for ≥50% of the time, aged 18 to 49y (n=108), 50 to 64y (n=156), and ≥65y (n=153), were available at the time of analysis. Users were aged mean±SD 57.9±12.8y with median 131 days of system use. Outcomes are shown in the Table. Median time in target range (70-180mg/dL) was 68.7%, 71.7%, and 74.0% for each age group, respectively. Time spent in hypoglycemia (&lt;70mg/dL) was low (median 0.3%) in each age group. These data are the first to provide valuable insights to the highly favorable impact of AID on real-world glycemic outcomes among adults with T2D using the Omnipod 5 System.

Disclosure
A.L.Peters: Advisory Panel; Abbott Diabetes, Medscape, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Stock/Shareholder; Omada Health, Inc., Livongo. F.J.Pasquel: Consultant; Dexcom, Inc., Medscape, Research Support; Dexcom, Inc., Ideal Medical Technologies. L.M.Huyett: Employee; Insulet Corporation, Stock/Shareholder; Insulet Corporation. K.Snow: Employee; Insulet Corporation. J.J.Mendez: None. I.Hadjiyianni: Employee; Insulet Corporation, Stock/Shareholder; Insulet Corporation, Eli Lilly and Company. T.T.Ly: Employee; Insulet Corporation.

Funding
Insulet Corporation
901-P: Real-World Evidence Supporting the Use of Advanced Hybrid Closed-Loop in Poorly Controlled Type 1 Diabetic Patients
Authors: RATHMES GIULIA , GRAF SOPHIE F. , CAVELTI-WEDER CLAUDIA 
Published: June 2023

Background: The advanced hybrid closed loop (a-HCL) algorithm of the MiniMed 780G includes automated basal and correction bolus insulin and offers the possibility to choose between three glucose targets. The aim was to evaluate the effectiveness of the a-HCL compared to its predecessors, the predictive low glucose suspension (PLGS, MiniMedTM 640G) and the standard hybrid closed loop (s-HCL, MiniMedTM 670G), and to assess which group of patients benefitted the most from the implementation of the a-HCL.
Methods: Type 1 diabetes patients &gt;18 years of age followed at the University Hospital Zurich (USZ), who initially used a PLGS or a s-HCL and were subsequently switched to the a-HCL until December 2021, were included in the study. Glucose metric data regarding HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), average sensor glucose (SG), and variation coefficient (VC) was retrospectively analyzed before and after the conversion to the a-HCL.
Results: 88 patients were screened, and 71 patients were included in the analyzes. After the implementation of the a-HCL, there was a significant decrease in HbA1c (pre 7.3±0.7% to post a-HCL 6.8±0.5%, p&lt;0.001), SG (8.8±1.2 mmol/L to 7.9±0.8 mmol/L, p&lt;0.001) and a significant increase in TIR (73.5% to 81%, p&lt;0.001). Additionally, a significant decrease in TAR (23% to 17%, p&lt;0.001) was observed, while TBR (1.5% to 1%, p=0.573) and the VC did not significantly change (33±6.6% to 32.4±5.8%, p=0.313). The changes in glycemic control were most pronounced in patients with a higher baseline HbA1c, a higher baseline SG, a lower baseline TIR, and a higher VC, all measures of poor glycemic control. Furthermore, patients with a body-mass index (BMI) &gt;30kg/m2 achieved the greatest changes in HbA1c and TIR.
Conclusion: In conclusion, our data support the use of a-HCL in all patients, but especially in poorly controlled type 1 diabetic patients with a high BMI.

Disclosure
G.Rathmes: None. S.F.Graf: None. C.Cavelti-weder: None.
908-P: Incorporating Shared Decision Making (SDM) to Improve Adoption of Connected Insulin Pens (CIP)
Authors: ODUGBESAN ORI , XAVIER NEENA A. , WRIGHT TREVON , NELSON GRACE , FRIEDMAN JARED , ALEPPO GRAZIA , O'MALLEY GRENYE , MCKEE ALEXIS M. , MIYAZAKI BRIAN , MYERS ALYSON K. , EBEKOZIEN OSAGIE ,   T1D EXCHANGE QUALITY IMPROVEMENT COLLABORATIVE (T1 DX-QI)
Published: June 2023

Background: CIP can improve glycemic control and quality of life for people with diabetes on multiple daily injections (MDI). Despite its benefits, providers may sub optimally prescribe CIP. The purpose of this study is to use quality improvement methods to successfully implement a validated attitude assessment to foster SDM conversations around CIP.
Method: The T1D Exchange recruited seven pediatric and adult diabetes centers to participate in this project from June - November 2022. The centers applied QI principles to implement the Diabetes Technology Attitude (DTA) questionnaire, a validated tool to facilitate SDM conversations. Positive responses prompted discussion about CIP. Each center contributed their data from a sample of people with Type 1 Diabetes (T1D) and Type 2 Diabetes on Insulin (T2D) who responded to the DTA.
Result: Eighty-eight people with diabetes and CGM but not on CIP naive completed the SDM tool. Over 70% of both T1D and T2D patients agreed that diabetes technology made their lives easier, does ‘more good than bad,’ and that they feel lucky to live in a time with so much technology (Figure 1). Sixty-nine percent of the cohort were prescribed CIP as a result of intentional SDM conversations based on the DTA results.
Conclusion: Validated SDM tools, such as DTA, can be a viable, low burden strategy to introduce conversations on the use of diabetes technology like CIP in clinical practice.

Disclosure
O.Odugbesan: None. A.K.Myers: Research Support; Neurocrine Biosciences, Inc. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. D.T1d exchange quality improvement collaborative (t1: n/a. N.A.Xavier: Employee; Eli Lilly and Company, Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance. T.Wright: None. G.Nelson: None. J.Friedman: None. G.Aleppo: Advisory Panel; Medscape, Consultant; Bayer Inc., Insulet Corporation, Research Support; Dexcom, Inc., Eli Lilly and Company, Emmes, Insulet Corporation, Fractyl Health, Inc., WellDoc, Speaker's Bureau; Dexcom, Inc. G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. A.M.Mckee: Advisory Panel; Medtronic, Novo Nordisk. B.Miyazaki: None.

Funding
Eli Lilly and Company
910-P: Real-World Clinical Data on the Extended Infusion Set
Authors: KWA TIMOTHY , ZHANG GINA , ROY ANIRBAN , LIU MARGARET , ANSELMO EVAN , SHIN JOHN , COHEN OHAD , CHATTARAJ SARNATH 
Published: June 2023

Objective: The Medtronic Extended infusion set (EIS) is the first and only infusion set approved for up to 7-day use. Prior studies established clinical safety and efficacy of the EIS. The purpose of this retrospective analysis was to assess real-world data on the EIS performance and user behaviors associated with the EIS including wear duration and asynchronous reservoir changes.
Methods: A limited launch of the EIS outside the US (OUS) included MiniMed™ 640G/670G/780G users. Due to regional legal requirements, aggregated pump data from EIS users were not separated from other user data. To identify EIS users, an algorithm was developed based on the expected behavior patterns associated with an infusion set change, e.g., tubing fills. From the same cohort, individuals using the EIS (n=108) versus regular 3-day sets (n=414) were identified by a mean or median time between substantial tubing fills. To assess synchronous and asynchronous set/reservoir changes, reservoir changes were determined based on pump rewind commands in the CareLink™ system.
Results: Mean EIS use lifetime was 6.74 days, with &gt;70% of sets used for more than 6 days. No user complaint was received during limited launch. The EIS set change rate at 7 days (168 hrs) was 48.2%, and was comparable to the 48.9% rate of 3-day sets at 3 days (72 hrs). In addition, CareLink™ data indicated that while users with a total daily dose (TDD) of insulin less than 40 U may not require an asynchronous reservoir fill, some users with higher TDD did asynchronously and successfully change their reservoirs while retaining the infusion set.
Conclusion: In the OUS limited EIS launch, the EIS performed similarly to the pivotal trial results, with no user complaints. As expected, pump users with TDD less than 40 U changed the infusion set and reservoir at the same time on the seventh day. The product has launched in the US and may potentially reduce user burden by effectively halving the number of required infusion set changes compared to standard 3-day sets.

Disclosure
T.Kwa: Employee; Medtronic. G.Zhang: Employee; Medtronic. A.Roy: Employee; Medtronic. M.Liu: Employee; Medtronic. E.Anselmo: Employee; Medtronic. J.Shin: Employee; Medtronic. O.Cohen: Employee; Medtronic. S.Chattaraj: Employee; Medtronic.
911-P: Changes in Metrics of Continuous Glucose Monitoring during COVID-19 in Children and Adolescents with Type 1 Diabetes
Authors: YOUNG KIM HWA , SHIN SOHYUN , YOUNG KIM SE , KIM JAEHYUN 
Published: June 2023

Background: Data on the changes in glucose control in pediatric patients with type 1 diabetes (T1D) affected by COVID-19 is lacking. We aimed to evaluate changes in metrics of continuous glucose monitoring (CGM) system during COVID-19 infection in children and adolescents with T1D.
Methods: We included 21 children and adolescents with T1D, aged younger than 20 years, with at least 70% of CGM readings during COVID-19. Symptoms of COVID-19 infection were investigated through a questionnaire. The effects of COVID-19 on metrics of CGM were assessed at five different time points [2 weeks before-COVID-19 (Time 1), 1 week before-COVID-19 (Time 2), 1 week during COVID-19 (Time 3), 1 week after COVID-19 (Time 4), and 2 weeks after COVID-19 (Time 5)].
Results: Of 21 patients (6 males and 15 females), mean age was 11.4 ± 4.7 years, and mean disease duration was 5.1 ± 4.8 years. All had at least one related symptoms (mean duration of symptoms of 5.2 ± 3.7 days); no one required hospitalization. Glucose management indicator (GMI) and the percentage of time spent above range (&gt; 250 mg/dL) were significantly higher at Time 3 compared to Time 5 (7.8 ± 1.4 % vs 7.2 ± 1.4 %; P = 0.001 and 18.3 ± 18.5 % vs 13.0 ± 15.7 %; P = 0.016, respectively). According to the insulin delivery methods, GMI at Time 2 was significantly higher compared to Time 5 in patients treated with multiple daily injection (MDI) (n = 13) but not in those using continuous subcutaneous insulin infusion (CSII) (n = 6).
Conclusion: Pediatric patients with T1D experience mild COVID-19 infection with worsening glycemic control during COVID-19. The use of CSII is more effective in maintaining stable glycemic control during COVID-19 infection compared to MDI therapy.

Disclosure
H.Kim: None. S.Shin: None. S.Kim: None. J.Kim: None.
914-P: Veteran Experiences with Hybrid Closed-Loop (HCL) Insulin Delivery Systems in Type 1 Diabetes (T1D)
Authors: AZZAWI SHAMS , DEJONCKHEERE MELISSA , THOMPSON HOLLY , HURREN KATHRYN , LEONE VIRGINIA A. , BUSUI RODICA , PIATT GRETCHEN , LEE JOYCE M. , MIZOKAMI-STOUT KARA R. 
Published: June 2023

While HCL systems are increasingly recommended, data regarding veteran experiences are limited. We performed semi-structured interviews to characterize veteran experiences with HCL systems at the VA Ann Arbor Healthcare System. We used qualitative description methodology to elicit participant experiences with HCL and identify factors that could improve practice. Semi-structured interviews were conducted with veterans with T1D using an HCL device for at least 6 months. The interview guide was developed based on a modified Theory of Planned Behavior, examining the domains of attitudes/knowledge, network support, and perceived behavioral control. Inductive thematic analysis of interview transcripts was performed to understand factors that contribute to the overall HCL experience. Nine HCL users (mean age 68 years, mean A1c 7.4%, mean diabetes duration 30 years, 78% Medtronic HCL users, 22% Tandem HCL users) were interviewed. Participants reported that HCL systems ease self-management burden, increase lifestyle flexibility, and enhance the perception of safety. However, challenges in alarm fatigue exist. Participants were satisfied with their outpatient multidisciplinary network support but noted significant gaps in inpatient support for HCL use. Lastly, participants reported an improved sense of confidence in diabetes management using HCL systems. Key facilitators for successful HCL use were a desire to stay healthy for their spouse and to avoid long-term diabetes complications. Our findings confirm that HCL systems improve self-management and enhance safety in veterans as well, similar with prior reports in non-veterans with T1D. Veterans felt supported in using these systems as outpatients though challenges remain for HCL systems in the inpatient setting. Future studies should focus on improving network support for inpatient use of these devices.

Disclosure
S.Azzawi: None. M.Dejonckheere: None. H.Thompson: None. K.Hurren: None. V.A.Leone: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. G.Piatt: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. K.R.Mizokami-stout: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK020572-43S1)