bluuebunny/crossref_metadata_2025_split huggingface dataset:
1006-P: Distributional Cost-Effectiveness Analysis of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) and Tirzepatide Compared with Sulfonylureas (SU) in People with Inadequately Controlled Type 2 Diabetes (T2D)
Authors: LI PIAOPIAO , GUAN DAWEI , ALI MOHAMMED K. , VENKAT NARAYAN K.M. , FONSECA VIVIAN , UMPIERREZ GUILLERMO , SHI LIZHENG , BIAN JIANG , GUO YI , WINTERSTEIN ALMUT G. , GUO JINGCHUAN , SHAO HUI 
Published: June 2023

We assessed the cost-effectiveness of GLP-1 RA and tirzepatide compared with SU when added to metformin in people with inadequately controlled T2D. Using data from the National Health and Nutrition Examination Survey (2013-2018), we constructed a nationally representative T2D sample poorly controlled on metformin (A1c&gt; 7.0%). We used the BRAVO diabetes model, a validated microsimulation model, to predict individuals’ lifetime health and economic outcomes based on their current health profile and received treatment (GLP-1 RA, tirzepatide, or SU). We identified factors driving the cost-effectiveness and developed a scoring algorithm using these variables, with higher scores indicating more cost-effective. Under a willingness to pay threshold of $100,000/QALY, GLP-1 RA ($92,590/QALY) and tirzepatide (5 mg: $70,540/QALY, 10 mg: $60,700/QALY, 15 mg: $55,600//QALY) were all cost-effective compared with SU. The cost-effectiveness drivers included age, gender, smoking, diabetes duration, A1c, SBP, and cardiovascular disease history (Figure). Our scoring algorithm can stratify patients by the cost-effectiveness of using GLP-1 RA or tirzepatide, which can be used to design precision interventions to improve drug use targeting patients for whom the drug use can be cost-effective.

Disclosure
P.Li: 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. H.Shao: Consultant; Lilly Diabetes. D.Guan: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. K.Narayan: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. L.Shi: None. J.Bian: None. Y.Guo: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)
101-LB: Phase 3 Trial to Evaluate Efficacy and Safety of Gemigliptin and Dapagliflozin Dual Add-on Therapy to Metformin—SOLUTION 2 Study
Authors: SOO PARK KYONG , AH HAN KYUNG , CHEOL HWANG YOU , MOON SHINJE , CHO HOCHAN , JIN YOO HYE , CHOI SUNGHEE , CHON SUK , KIM KYOUNG-AH , NYUN KIM TAE , GOO KANG JUN , PARK CHEOL-YOUNG , CHUL WON JONG , LEE SEUNG-HWAN , HEE KIM NAN , SEOK KANG EUN , JUN KIM DONG , KIM SANGYONG 
Published: June 2023

Background: Type 2 diabetes mellitus (T2DM) patients inadequately controlled with metformin alone require an addition of other medications with complementary mechanism of action. Gemigliptin, a dipeptidyl peptidase-4 inhibitor, and Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, can be considered as additional options. In this clinical trial, efficacy and safety of treatment of gemigliptin and dapagliflozin were evaluated in T2DM patients inadequately controlled with metformin monotherapy.
Method: Total 469 T2DM patients receiving treatment with stable metformin for ≥ 8 weeks before screening were randomized to gemigliptin and dapagliflozin (n=157) or gemigliptin (n =156) or dapagliflozin (n =156), respectively. The primary endpoint was the change in HbA1c at 24 weeks from baseline.
Results: At 24-week treatment, the HbA1c change from baseline in dual add-on of gemigliptin and dapagliflozin showed a significant reduction (LS Mean -1.34%) compared to gemigliptin add on (-0.90%; difference -0.44% [95% CI -0.58% to -0.31%]) and dapagliflozin add on (-0.78%; difference -0.56% [95% CI -0.69% to -0.42%]). Most of the reported adverse events were mild with no episodes of severe hypoglycemia.
Conclusion: This study demonstrated that triple therapy of gemigliptin and dapagliflozin dual add-on to metformin was effective and well tolerated in T2DM patients.

Disclosure
K. Park: None. K. Han: None. Y. Hwang: None. S. Moon: None. H. Cho: None. H. Yoo: None. S. Choi: None. S. Chon: None. K. Kim: None. T. Kim: None. J. Kang: None. C. Park: None. J. Won: None. S. Lee: Advisory Panel; LG Chem. Speaker's Bureau; Dong-A Pharm. Advisory Panel; CKD Pharm. Speaker's Bureau; Novo Nordisk, Lilly. Advisory Panel; Daiichi Sankyo. Speaker's Bureau; Boehringer Ingelheim Inc. N. Kim: None. E. Kang: None. D. Kim: None. S. Kim: None.
1011-P: Humanistic and Economic Burden of Patients with Cardiorenal Metabolic Conditions—A Systematic Literature Review
Authors: FERDINAND KEITH , NORRIS KEITH C. , RODBARD HELENA W. , TRUJILLO JENNIFER 
Published: June 2023

Background: A comprehensive understanding of the burden of CRM conditions is needed to guide targeted interventions.
Objective: This SLR assessed the humanistic and economic burden of T2D, CVD (including HF), and CKD.
Methods: Following PRISMA guidelines, Embase and Medline databases were systematically searched to identify observational, RWE, and economic-model studies in populations ≥18 years old with CKD, T2D, and CVD. Outcomes of interest included humanistic (e.g., health related QoL, functional impairment, QALY) and economic burden. English-language studies from Jan 2011 to Jan 2022 were included. Relevant abstracts/posters also were identified from ACC, AHA, ASN, and ADA from the 2 previous years.
Results: Of 22 studies identified (13 US; 9 non-US) and included, 1 Chinese study reported QoL data (depressive symptoms of CKD and T2D), 8 reported healthcare resource utilization (HCRU), 7 reported cost, and 6 reported HCRU and cost. Multimorbidity and advanced stages of CKD were associated with higher medical costs and HCRU for patients with CRM across all studies. Increasing age was associated with more comorbidities, leading to greater economic burden among patients ≥65 years old. Higher costs and HCRU were observed in patients with all 3 conditions (T2D, CVD, CKD) compared to those with fewer comorbidities. Higher healthcare expenditures and HCRU was observed among urban insured compared with uninsured populations. Black patients had lower odds of using healthcare services compared to patients who identified as White, Asian/Pacific Islander, or Hispanic ethnicity.
Conclusions: This SLR identified a clear trend of increasing healthcare costs and HCRU commensurate with an increasing number of CRM comorbidities. Further research evaluating the economic and humanistic burden of CRM conditions, especially in patients from racial/ethnic groups, is needed.

Disclosure
K.Ferdinand: Consultant; Amgen Inc., Boehringer Ingelheim Inc., Novartis, Medtronic, Pfizer Inc. K.C.Norris: None. H.W.Rodbard: Advisory Panel; Merck Sharp & Dohme Corp., Pacira BioSciences, Inc., Research Support; Eli Lilly and Company, Medtronic, Sanofi, Novo Nordisk. J.Trujillo: Advisory Panel; Novo Nordisk, Sanofi.

Funding
Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance
1019-P: Implementation Analysis of Pharmacist-Managed Insulin Dosing in an Acute Care Hospital
Authors: HADIPRODJO ALICIA G. , SCOTT EVELYN M. , WENG RENEE 
Published: June 2023

Hyperglycemia is associated with negative health outcomes such as increased infection, increased thrombosis, decreased wound healing and prolonged hospitalization. The 2022 ADA guidelines for hospitalized patients recommend targeting blood glucose (BG) 140-180 mg/dL in both critically and non-critically ill patients and managing persistent hyperglycemia with insulin. Data evaluating the impact of a pharmacist-managed insulin dosing protocol is currently lacking. The objective of this study was to evaluate the safety and efficacy of a pharmacist-managed basal-bolus (BB) insulin dosing protocol for inpatient hyperglycemia management. This single-center, retrospective, observational study included patients &gt; 18yo with three consecutive BG concentrations 180-350mg/dL admitted to the critical care, telemetry, and medical/surgical floors. The insulin per pharmacy dosing protocol was implemented in December 2020. A total of 494 patients were included in the pre-implementation group (January-November 2020) and 668 patients in the post-implementation group (July-December 2021). No significant difference in baseline characteristics were observed between the two groups. For primary outcome, post-implementation group had a statistically significant higher percentage of normoglycemia defined as BG 70-180 mg/dL (63.4% vs. 50.2%, p&lt;0.01) and a statistically significant lower percentage of hyperglycemia defined as BG &gt;180 mg/dL (35.1% vs. 48.2%, p&lt;0.01). No difference in hypoglycemia rate between the two groups were observed (1.6% vs. 1.5%, p&gt;0.1) confirming protocol safety. For secondary outcome, no difference in average length of stay between the two groups, although goal BG&lt;180 mg/dL was achieved on day 2 in post-implementation group vs. day 6 in pre-implementation group. This study suggests that pharmacists can effectively and safely manage inpatient hyperglycemia in both critically ill and non-critically ill patients utilizing a standardized BB insulin dosing protocol.

Disclosure
A.G.Hadiprodjo: None. E.M.Scott: None. R.Weng: None.
1038-P: Evaluation of an Outpatient Pathway for Management of Pediatric Patients with New-Onset Diabetes
Authors: AZOVA SVETLANA , BASKARAN CHARUMATHI , EINIS SARA , FORTIN JENNIFER A. , SILVA MARISA , AAMODT KRISTIE , ETHIER BENJAMIN G. , NANAVATI SONAL , GARVEY KATHARINE , RHODES ERINN 
Published: June 2023

Background: Education and management for new onset diabetes (NOD) does not always require hospitalization. A pathway for outpatient management of pediatric NOD patients after initial evaluation and long-acting insulin dose in the emergency department was developed at a tertiary academic medical center.
Methods: A multidisciplinary team identified key initial eligibility criteria for outpatient NOD management including absence of DKA, age ≥3 years, and beta-hydroxybutyrate (BOHB) &lt;1 mmol/L. Data tracking, chart review, and endocrine provider surveys determined reasons for exclusion or non-participation. Control charts tracked and analyzed monthly utilization. Refinement of the pathway occurred through iterative PDSA cycles.
Results: The pathway launched in September 2020. To date, 58 eligible children (33%) have completed the pathway (monthly median 33%). One patient was hospitalized after newly identified social concerns. Increase of BOHB cut-off to 1.5 mmol/L and option of rapid-acting insulin bolus for borderline BOHB resulted in significant shift in utilization from mean 23% to 41%. Barriers to participation include limited space availability, weekend presentation, and patient/family refusal.
Conclusion: Data suggest that outpatient management is feasible for select patients with NOD but requires flexible resources and supportive patient messaging regarding outpatient education.

Disclosure
S.Azova: None. E.Rhodes: None. C.Baskaran: None. S.Einis: None. J.A.Fortin: None. M.Silva: None. K.Aamodt: None. B.G.Ethier: None. S.Nanavati: None. K.Garvey: None.
1041-P: Health Care Transition Practices in the T1D Exchange Quality Improvement Collaborative
Authors: MALIK FAISAL , CASES-VILLABLANCA JESSE , HILLIARD MARISA E. , LYONS SARAH , JACOBSEN LAURA M. , ROBERTS ALISSA J. , MUCCI ANDREA , AGARWAL SHIVANI , DEMETERCO-BERGGREN CARLA , ALONSO GUY T. , EBEKOZIEN OSAGIE , CORATHERS SARAH , COLLABORATIVE T1DX-QI 
Published: June 2023

Background: Implementation of a structured health care transition (HCT) process is associated with positive outcomes in population health, experience of care, and health care utilization.
Objective: To describe pediatric and adult clinic HCT practices in the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
Methods: Got Transition’s Six Core Elements of HCT offer a structured approach to the phases of transition support: 1) transition and care policy, 2) tracking and monitoring, 3) transition readiness, 4) transition planning, 5) transfer of care, and 6) transfer completion. T1DX-QI institutions (n=53) were surveyed to examine the integration of the Six Core Elements into diabetes HCT practices.
Results: The survey response rate was 94.3% (n=50 clinics; 33 pediatric, 17 adult). A majority of T1DX-QI pediatric clinics (72.7%, n=24) report having a HCT policy compared to 29.4% (n=5) of adult clinics. Among pediatric institutions, 45.4% (n=15) maintain a tracking system to identify transition-aged youth, 39.4% (n=13) formally assess HCT readiness, 52% (n=17) document and update a plan of care for transition and 27.3% (n=9) have a process in place to confirm successful transfer of care completion with adult diabetes providers. Approximately two-thirds of T1DX-QI pediatric institutions (63.6%, n=21) have a formal structured HCT program and 29% (n=6) of these HCT programs report incorporating all 6 elements.
Conclusions: Data from T1DX-QI centers highlight opportunities to further enhance transition preparation and receivership for emerging adults with type 1 diabetes. The Six Core Elements offer a potential avenue to structure improvement initiatives since many diabetes clinics only partially incorporate these elements in current practice. Partnerships between pediatric and adult diabetes centers should be considered as part of quality improvement efforts to facilitate incorporation of challenging HCT elements such as transfer of care completion.

Disclosure
F.Malik: None. G.T.Alonso: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. S.Corathers: None. T1dx-qi collaborative: n/a. J.Cases-villablanca: None. M.E.Hilliard: None. S.Lyons: None. L.M.Jacobsen: None. A.J.Roberts: None. A.Mucci: None. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. C.Demeterco-berggren: Speaker's Bureau; Glooko, Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1053-P: VDOP (Virtual Diabetes Optimization Program) for High-Risk Veterans with Uncontrolled Diabetes
Authors: ADEL THOMAS , HANSEN JILL M. , REESER KELLY , TAXMAN JILLIAN , JOHNSON CHRISTOPHER , WHITTLE JEFF , MENDEZ CARLOS E. 
Published: June 2023

Type 2 diabetes is 2.5 times more prevalent in veterans compared to the general population. VDOP (Virtual Diabetes Optimization Program) set out to examine the effectiveness of a multifaceted, virtual intervention program aimed to improve diabetes control in high-risk veterans. Patients referred to VDOP had uncontrolled diabetes (A1c ≥ 8%, or on high insulin doses (≥ 1 unit/kg), or experiencing repeated hypoglycemia), and at least one of the following comorbidities: obesity, cardiac, kidney, liver disease, or sleep apnea. Once enrolled in the program, veterans had glucose monitors and activity trackers connected to a cloud platform, and met weekly with the dietician, occupational therapist, and clinical pharmacist in staggered visits. The VDOP care team conducted weekly huddles under the supervision of a physician diabetologist. Intended program duration is 12-24 weeks. To date, 11 veterans have completed participation with a mean duration of 16 weeks. Most participants were older males (10 male, mean 62 years old). Veterans completing the program showed on average significant improvement in glycemic control (-2.5% A1c), weight loss (-18.8 lbs. or -7.8%), and decreased total daily insulin doses (-72.8%). With ongoing recruitment, we plan to monitor sustainability of improved metrics, cost, and impact on quality of life of the VDOP program on high-risk veterans with uncontrolled diabetes.

Disclosure
T.Adel: None. J.M.Hansen: None. K.Reeser: None. J.Taxman: None. C.Johnson: None. J.Whittle: None. C.E.Mendez: Speaker's Bureau; Siemens.

Funding
U.S. Department of Veterans Affairs Office of Connective Care
1054-P: A Physician Survey Focusing on Dose Escalation for Type 2 Diabetes Medications
Authors: BOYE KRISTINA , JORDAN JESSICA , MALIK RALEIGH , CYR ROBYN A. , MATZA LOUIS S. 
Published: June 2023

Objectives: T2D medications often require dose escalation to optimize effectiveness. Physician perceptions of treatment characteristics of type 2 diabetes (T2D) medications have previously been examined, but little is known about perceptions of escalation to the optimal dose. This study examined physicians’ perceptions of dose escalation for medications used to treat T2D.
Methods: Data on dose escalation and other factors influencing decision-making for T2D treatment were collected via an online survey of US physicians in 2022.
Results: The sample included 501 physicians (348 primary care, 153 endocrinologists). Dose escalation was not frequently considered a primary factor keeping patients’ from reaching treatment goals (mentioned as a factor by only 7.6% of the sample) or a barrier to prescribing T2D medication (16.2%). Factors more likely to keep patients from reaching treatment goals included unhealthy diet (86.6%) and medication adherence (77.4%). The most common reasons that physicians reported for escalating dose levels with their patients are presented in Table 1.
Conclusions: Although common with T2D treatments, dose escalation was not perceived to be a significant barrier to prescribing medication or attainment of treatment goals. Multiple factors contribute to the decision to escalate a dose.

Disclosure
K.Boye: Employee; Eli Lilly and Company. J.Jordan: None. R.Malik: Employee; Eli Lilly and Company. R.A.Cyr: None. L.S.Matza: Research Support; Eli Lilly and Company.

Funding
Eli Lilly and Company
1059-P: Spotlight-AQ RCT and AI Results—Improving Physical and Mental Health Outcomes for Adults with Type 1 or Type 2 Diabetes
Authors: BARNARD KATHARINE , KELLY RYAN C. , COHEN LAUREN , BARNARD ETHAN , LIU YUFAN , PHIRI PETER , MENDEZ OSCAR , PRICE HERMIONE 
Published: June 2023

Background: Existing therapeutic interventions are well known, yet most people with diabetes do not consistently achieve blood glucose targets for optimal health, despite the large range of treatment options available.
Aim: To explore the efficacy of a novel clinical intervention addressing physical and mental health within routine consultations across healthcare settings.
Methods: A multi-centre, parallel group, individually randomised trial comparing consultation length in adults with T1D or T2D for ≥6 mths to the Spotlight Consultations platform compared to usual care. Secondary outcomes: HbA1c and validated measures of depression, diabetes distress, anxiety, functional health status and HCP burnout. Results: n=98 adults with T1D or T2D; any HbA1c and receiving any diabetes treatment participated (n=49 intervention). Consultation duration for intervention participants was reduced in intervention consultations by 0.5-4.1 mins (3-14%) versus no change in the control group (-0.9 - +1.28 mins) across 15 and 30 consultations. HbA1c improved in the intervention group by 6mmol/mol (range 0-30) versus control group 3mmol/mol (range 0-8). Moderate improvements in psychosocial outcomes observed in intervention group: functional health status; reduced anxiety, depression and diabetes distress; improved well-being. None were statistically significant. HCPs reported improved communication and greater focus in consultations. Artificial Intelligence examination highlighted therapy and psychological burden were most important in predicting HbA1c levels.
Conclusion: Spotlight-AQ was associated with shorter, more useful consultations; with improved HbA1c and moderate benefits on psychosocial outcomes. Results reflect the importance of a biopsychosocial approach to routine care visits. Spotlight-AQ is viable across healthcare settings for improved outcomes.

Disclosure
K.Barnard: Advisory Panel; Abbott Diabetes, Roche Diabetes Care, Sanofi, Consultant; LifeScan Diabetes Institute, Tandem Diabetes Care, Inc., Research Support; Novo Nordisk. R.C.Kelly: None. L.Cohen: None. E.Barnard: None. Y.Liu: None. P.Phiri: None. O.Mendez: None. H.Price: Consultant; AstraZeneca, Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance.

Funding
Southern Health NHS Foundation Trust
106-LB: Postprandial Glucose Management among Adults Living with Type 1 Diabetes Using Single-Hormone and Dual-Hormone Automated Insulin Delivery Systems
Authors: LEBBAR MAHA , MOLVEAU JOSÉPHINE , BOUDREAU VALERIE , RABASA-LHORET RÉMI , WU ZEKAI 
Published: June 2023

Introduction: Despite the rapid advances of diabetes technologies, postprandial glucose management remains a challenge for people living with type 1 diabetes (pwT1D). We aim to assess the efficacy of single-hormone (SH) compared to dual-hormone (DH) automated insulin delivery (AID) systems in postprandial glucose management.
Methods: Post-hoc analysis of a randomized controlled crossover inpatient trial including three standardized meals (taken at 8am, 12 pm, and 5pm) during a 24-hour period, comparing SH-AID and DH-AID among pwT1D. Data from meals of each participant was pooled. Primary outcome was time in range % (TIR%, 70 to 180 mg/dL), calculated by continuous glucose monitoring during the 4-hour postprandial period. Paired t-test was used to compare the two groups.
Results: Eighteen adult participants were included (mean age [SD] 43 [14] years, mean duration of T1D 20 [11] years, mean HbA1c 7.6% [1.0], mean daily insulin intake 26.70 [11.04] units). Postprandial TIR% was similar between SH and DH-AID (66.4% vs 70.2%, p=0.443). Less time in postprandial hypoglycemia (&lt;70 mg/dL) was observed in the DH-AID group compared to SH-AID (5.4% vs 11.9%, p=0.019). No difference was observed in postprandial time spent in hyperglycemia (&gt;180 mg/dL), glycemic variability indices or insulin intake between the two groups.
Conclusion: Compared with SH-AID, DH-AID reduces postprandial hypoglycemia, while other postprandial glucose metrics remain similar among adult pwT1D.

Disclosure
M. Lebbar: None. J. Molveau: None. V. Boudreau: None. R. Rabasa-lhoret: Consultant; Dexcom, Inc., Abbott, Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc., Sanofi, Lilly, Tandem Diabetes Care, Inc., Insulet Corporation. Z. Wu: Other Relationship; Eli Lilly and Company.
1060-P: After-Hours Nurse Line Utilization Decreased Call Burden in an Academic Pediatric Endocrinology Practice
Authors: CHOUDHARY ABHA 
Published: June 2023

Background: Optimal management of childhood diabetes benefits from access to a 24-hour support line. If staffed by on-call physicians, repeated interruptions to sleep can lead to physician burn out. Utilization, and outcomes of an after-hours nurse call service in a pediatric endocrinology practice have not been previously reported.
Methods: Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include our institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers.
Results: After we instituted our after-hours nurse triage service (September 2019), the call burden to the on-call physicians decreased by 70%. Patients who called the after-hours line before coming to the emergency room were less sick (higher pH and lower glucose) and were more likely to be discharged home. We cannot infer causality from our data. Nevertheless, given that &lt;10% of patients called first, encouraging earlier and more consistent utilization of the nurse line seems like a low-cost intervention that might reduce hospital admissions for diabetic ketoacidosis. After-hours service was utilized well by our patients of all races and insurance statuses. We noted that language was a barrier in utilization which is an opportunity for improvement.

Disclosure
A.Choudhary: None.