bluuebunny/crossref_metadata_2025_split huggingface dataset:
1117-P: Variability in Glycemia Measured by CGM in Children and Young Adults with Acute Recurrent or Chronic Pancreatitis
Authors: PARRA VILLASMIL MARIA G. , BELLIN MELENA , PINNARO CATHERINA , ODE KATIE L. 
Published: June 2023

Post pancreatitis diabetes mellitus is an underrecognized disorder. Children with pancreatitis are at elevated risk for development of diabetes (DM) in the near term (approximately 9%), and lifetime risk of DM approaches 50%. Unfortunately, there is limited data regarding pathophysiology and disease course. This pilot study was undertaken to investigate glycemic physiology in the free-living state in children with acute recurrent (ARP) or chronic pancreatitis (CP).
Methods: Children (&lt;21 years of age) with an established diagnosis of CP or ARP, and participants of INSPPIRE-2 (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) were invited to participate. Pancreatitis type, demographics and growth parameters were extracted from the INSPPIRE-2 database. HbA1c was collected. A continuous glucose monitor was placed (CGM, Dexcom Pro). Glycemic variability metrics were calculated at the participant level using EasyGV software. The relationship between HbA1c and CGM variables was evaluated via multiple linear regression.
Results: 12 children were enrolled, age 10-20.8 years (mean 17.2; 66% female). One subject had known DM prior to enrollment. Participants had normal mean height (0.19+/- 0.72 SD), weight (1.1 +/- 0.98SD) and BMI (0.98 +/- 0.81 SD) z-scores. Mean A1c was 5.73% (range 5.0-8.9) with the known diabetic and 5.42% (5.0-6.1) without. Mean CGM glucose was 121.8 mg/dl +/- 21.4. Of the 11 subjects without DM, 2 had CGM glucose &gt;180 mg/dl &gt; 10% time and 1 had CGM glucose &lt;55 mg/dl &gt; 1% time. HbA1c correlated with mean CGM glucose in univariate analysis and when controlled for age and BMI (p = 0.02, r2 = 0.47).
Conclusions: In this small study, A1c correlated well with average CGM glucose in children with ARP and CP, and some had abnormal glycemic excursions on CGM. More research is needed on the use of CGM in children with CP and ARP.

Disclosure
M.G.Parra villasmil: None. M.Bellin: Consultant; Insulet Corporation, Vertex Pharmaceuticals Incorporated, Research Support; Dexcom, Inc., ViaCyte, Inc. C.Pinnaro: None. K.L.Ode: None.
1118-P: Accuracy of Dexcom G6 Continuous Glucose Monitor in Pediatric Diabetic Ketoacidosis Admissions
Authors: WATERMAN LAUREN A. , PYLE LAURA , TOWERS LINDSEY , JOST EMILY , KARAMI ANGELA J. , BERGET CARI , FORLENZA GREGORY P. , PAUL WADWA R. , COBRY ERIN C. 
Published: June 2023

Continuous glucose monitors (CGMs) are an integral part of care for youth with type 1 diabetes (T1D) though lack FDA labeling for inpatient use. While some adult data on CGM use in inpatient settings is available, pediatric data are minimal.
This retrospective chart review evaluated the accuracy of Dexcom G6 CGM versus point of care (POC, Nova Biomedical StatStrip [MARD 6%])) blood glucose values from pediatric inpatient encounters. Blood glucose data, diagnosis codes, and initial labs were collected from the medical record. CGM values were obtained from Dexcom Clarity CSV files.
Paired glucose values (N=1191) from 83 patients with T1D (median age 12 yrs, 54% male, 69% non-Hispanic White) were used to calculate mean absolute relative difference (MARD) and Clarke Error Grid. Data from DKA admissions (N=665) had a MARD of 11.1% with 97.8% of values within A&B zones, compared to 11.4% and 98.5% for non-DKA admissions (N=526). Values from severe DKA admissions (N= 307) (pH &lt;7.15 and/or bicarbonate &lt;5 mmol/L) had a lower MARD compared to non-severe admissions (N=358) (8.4% vs 13.4%, p=0.01).
In summary, CGM accuracy is comparable between DKA and non-DKA admissions. The accuracy of CGMs, even in severe DKA, suggests potential usability during pediatric hospital encounters. Further analysis will differentiate POC versus lab glucose and the effect of medications, including IV insulin infusions.

Disclosure
L.A.Waterman: None. L.Pyle: None. L.Towers: None. E.Jost: Other Relationship; Tandem Diabetes Care, Inc. A.J.Karami: None. C.Berget: Consultant; Insulet Corporation, Dexcom, Inc., Other Relationship; Tandem Diabetes Care, Inc. G.P.Forlenza: Advisory Panel; Medtronic, Consultant; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Lilly Diabetes, Research Support; Medtronic, Abbott, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. R.Wadwa: Consultant; Eli Lilly and Company, Other Relationship; Dexcom, Inc., Eli Lilly and Company, Research Support; Dexcom, Inc., Eli Lilly and Company, Beta Bionics, Inc., Tandem Diabetes Care, Inc. E.C.Cobry: None.

Funding
National Institutes of Health (5T32DK063687)
1123-P: Pilot Study of Early Adoption of Automated Insulin Delivery in Under-Resourced Youth
Authors: YEN KEVIN , BELAPURKAR SONALI , HICKEY JEANNIE G. , YGLECIAS LOREN , BAL KAVENPREET S. , LYBECK CARELLI LOIS , LOUCEL CRYSTAL M. , LODISH MAYA , WONG JENISE C. 
Published: June 2023

Background: Disparities in glycemic outcomes and technology use in children with type 1 diabetes (T1D) from under-resourced backgrounds are well-documented. The feasibility of initiating automated insulin delivery (AID) soon after diagnosis of T1D is unknown in this population. This pilot study assessed the feasibility and acceptability of providing access to the Tandem Control-IQ Hybrid Closed-Loop (HCL) system to children with public insurance soon after diagnosis of T1D.
Methods: Publicly insured child ren aged 6-17 years within 3 months of T1D diagnosis were eligible for the study. Participants were randomized 2:1 to HCL or control for 6 months. Continuous glucose monitoring data for both groups were collected at baseline, 3 months, and 6 months after enrollment. Caregivers and adolescents completed a closing survey on safety and user experience.
Results: Seventeen participants were enrolled, 12 in the intervention group and 5 in the control group. The mean age was 11.5 ±2.5 years, 47% were female, 88% were from underrepresented racial or ethnic groups, 94% of caregivers did not have a college level degree, and 41% of families reported some degree of food insecurity. All families had access to smartphones, but 42% did not have access to a home computer. Of those who completed the study, a larger proportion of the intervention group compared to the control group achieved ADA benchmark of greater than 70% time in range (62% vs 0%, respectively, at 3 months, p=0.038; 37% vs 0% at 6 months, p=0.16). All caregivers in the intervention group reported satisfaction with HCL system and wished to continue using HCL technology.
Conclusion: Early initiation of AID is feasible and acceptable in youth with recently diagnosed T1D from historically marginalized racial and ethnic groups and with social risk factors associated with lower technology adoption and less optimal glycemic outcomes. Clinicians should provide education and support for AID to these families early in diagnosis to promote equity in diabetes care.

Disclosure
K.Yen: None. S.Belapurkar: Other Relationship; T1D Exchange, Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Medtronic. J.G.Hickey: None. L.Yglecias: None. K.S.Bal: None. L.Carelli: None. C.M.Loucel: None. M.Lodish: None. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc.
1131-P: Gut Microbial Differences in Youth with Obesity and Type 1 Diabetes (T1D)
Authors: ISMAIL HEBA M. , PERERA DIMUTHU , MANDAL RABINDRA K. , JAVORNIK CREGEEN SARA , DIMEGLIO LINDA , HANNON TAMARA S. , EVANS-MOLINA CARMELLA , SCHMIDT NATHAN 
Published: June 2023

Gut microbial differences are associated with and thought to contribute separately to obesity and to type 1 diabetes development. Obesity is increasingly prevalent in type 1 diabetes, creating management problems and higher rate of diabetes complications. To test how obesity may influence the gut microbiome, we analyzed stool samples for gut microbial and metabolite differences in lean (n=27, BMI: 5-85%) and obese (n=21, BMI: ≥95%) youth with type 1 diabetes. Participants were aged 15.3±2.2 y (42% female, 94% White), with A1c 7.8±1.3% and diabetes duration 5.1±4.4 y. Bacterial community analysis using metagenomic shotgun sequencing showed that within each BMI group, there were no differences in within sample species (α) diversity. There were significant dissimilarities in species (β) diversity between BMI groups (Fig 1A). Linear Discriminant Analysis Effect Size (LEfSe) showed a differential distribution of significantly abundant taxa in either the lean or obese groups (Fig. 1B). Functional profiling showed specific pathways are differentially enriched in the groups (Fig. 1C-D). Interestingly, stool short chain fatty acids (beneficial microbial metabolites) were higher in the obese compared to the lean group (p&lt;0.05). This is a paradoxical finding that warrants further investigation.
In summary, our findings show links between the microbiome and metabolite composition, and obesity in type 1 diabetes and could lead to therapeutic targets in the gut.

Disclosure
H.M. Ismail: Consultant; Rise Therapeutics. D. Perera: None. R.K. Mandal: None. S. Javornik Cregeen: None. L. DiMeglio: Consultant; Abata Therapeutics, Vertex Pharmaceuticals Incorporated. Advisory Panel; Merck & Co., Inc. T.S. Hannon: Advisory Panel; Eli Lilly and Company. C. Evans-Molina: Advisory Panel; Provention Bio, Inc., DiogenX, Avotres Inc., Neurodon, MaiCell Therapeutics. Other Relationship; Isla Technology, Bristol-Myers Squibb Company, Nimbus Therapeutics. Research Support; Lilly, Astellas Pharma Inc. N. Schmidt: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK129799-01A1)
1135-P: Screening for Disordered Eating Behaviors in Youth with Type 1 Diabetes—Feasible and Necessary
Authors: SASTRY SHRUTI , COREN MORGAN , SCHREIBER JUSTIN , LIBMAN INGRID 
Published: June 2023

The American Diabetes Association (ADA) recommends screening adolescents with type 1 diabetes (T1D) for disordered eating behaviors (DEB) using the Diabetes Eating Problem Survey-Revised (DEPS-R) tool, however this is not routinely done in clinical practice. We implemented screening for DEB in a large academic pediatric diabetes center as part of clinical care as well as to evaluate the prevalence of DEB and identify clinical factors (in particular, use of pumps and continuous glucose monitors (CGM)) associated with a positive screen. Youth with T1D between 13-19 years, seen in our pediatric diabetes clinic from 02/09/2022 - 06/07/2022, were given the survey. A total of 580 subjects were eligible for the screening, 368 (64%) completed it and 282 (~50%) had analyzable data (49% female, 83% white, 11% black, 3% reporting food insecurity (FI), mean (SD) age 16.4±1.9 years, HbA1c 8.2±1.9%, BMI percentile 71.2±26.9). The majority were on CGM (77%) and 45% on pump therapy (including 5% on hybrid close loop systems). A total of 43 (15%) had a positive screen (score≥ 20) for DEB. There was a higher proportion of females, (67 vs 45%, p=0.007) lower proportion of white (70 vs 85%) and higher proportion of black youth (20 vs 8%) (p=0.02) in those that screened positive vs negative. Those with a positive screen also had a higher HbA1c (9.9±2.1 vs 8±1.7, p&lt;0.001) and BMI percentile (83.1±21.1 vs 68.9±27.3, p&lt;0.001). There was no difference in age (16.5±1.9 vs 16.4±1.9 years, p=0.82), report of FI (4.6 vs 2.1%, p=0.76), use of CGM (72 vs 78%, p=0.35), or pump therapy (35 vs 44%, p-0.26) between the two groups. None of those on hybrid close loop had a positive screen, however the numbers were small (n=7). Almost 1 in 5 adolescents with T1D had a positive screen for DEB. There was no difference in the use of diabetes technology. Our findings stress the importance of screening for DEB in youth with T1D and implementation of strategies to improve response rate in order to make timely referrals to reduce associated morbidity.

Disclosure
S.Sastry: None. M.Coren: None. J.Schreiber: None. I.Libman: Advisory Panel; Novo Nordisk.
1139-P: Use of Degludec to Reduce DKA Recurrence—A QI Initiative
Authors: VAKHARIA MILI , HUANG XIAOFAN C. , MINARD CHARLES G. , LYONS SARAH , MCKAY SIRIPOOM 
Published: June 2023

Background: As part of a larger QI initiative to decrease rate of recurrent DKA events, a large pediatric diabetes center initiated a QI project to switch 80% of youth with established T1D on treatment with glargine admitted with DKA to longer acting degludec (iDeg) during 2017 to 2020.
Methods: A series of PDSA cycles were implemented: training physicians, nurses, diabetes educators and patients/families; adding iDeg to electronic order set; and developing an insurance approval process. DKA event rate pre-iDeg and post-iDeg with predictors including race/ethnicity (R/E), HbA1c, gender and insurance type were explored.
Results: iDeg prescriptions increased from 5.6% in 2017 to 63% by the end of 2020. Of the 255 patients admitted with DKA in 2017 - 2020, 97 patients not previously on iDeg were prescribed iDeg within 21 days of hospitalization. The mean age of the iDeg group was 14.2 years (SD=3.4), 62.9% on public insurance, 40% African American (AA), 30% Hispanic (H) and 29% non-Hispanic White (NHW). The median (IQR) DKA event rates were 0.5 (0.3, 1) pre-iDeg and 0.4 (0, 1) events per year post-iDeg. The median change from pre-iDeg to post-iDeg was -0.2 (-0.5, 0.4) (Wilcoxon sign-rank p=0.25). Racial/ethnic (p=0.02) and insurance (p=0.01) were associated with change in DKA event rates in a multiple regression model. Hispanic patients taking iDeg had a decrease in DKA of -1.29 events per year compared with increases of -0.29 for AA and -0.52 for NHW (adj P=0.032 and 0.026, respectively). Patients with private insurance had a mean decrease in DKA event rates of -0.63 events per year compared to those on public insurance (mean increase of 0.66, p=0.01).
Conclusion: iDeg was not associated with a decrease in DKA rate in the full population. Risk factors for DKA recurrences are multi-factorial including R/E and insurance types. The association of iDeg and decreased rate of repeat DKA in H patients' needs to be explored in a larger cohort.

Disclosure
M.Vakharia: None. X.C.Huang: None. C.G.Minard: None. S.Lyons: None. S.Mckay: None.
114-LB: Early Time-Restricted Feeding Reduces Time in Elevated Glucose Range in Adults With Prediabetes
Authors: BARUA SOUPTIK , BRUNO JOANNE , NASSERIFAR SHABNAM , VANEGAS SALLY M. , POPP COLLIN , WALKER JEANNE M. , ALEMAN JOSE O. 
Published: June 2023

Objective: Early time-restricted feeding (eTRF) is an intermittent fasting strategy restricting caloric intake to the first 6-8 hours of the day. While previous studies have shown that eTRF improves glycemia, it is unclear if the effect is due to associated weight loss or metabolic benefits of the feeding strategy itself. In this study, we evaluated the weight-independent effects of eTRF on glycemia using multiple CGM-based time in range (TIR) metrics.
Methods: We conducted a randomized 7-day isocaloric crossover supervised feeding study comparing eTRF (80% of calories consumed between 8am-1pm) to a usual feeding pattern (UFP, 50% of calories consumed after 4pm) among participants with prediabetes and BMI &gt; 28 kg/m2 in a metabolic ward. Participants were randomized 1:1 to eTRF or UFP for days 1-7, then crossed over to the other arm on days 8-14. Food intake was tailored to meet weight stable caloric needs. Participants also wore blinded Abbott Freestyle Libre CGMs throughout the study period. We evaluated time spent below 70 mg/dL (TBR&lt;70), in 70-140 mg/dL (TIR70-140), and in 140-180 mg/dL (TIR140-180) glucose range per arm. Further, we compared TIR140-180 between arms stratified by time of day: Daytime and Overnight (6am-12am and 12am-6am CGM readings, respectively) using linear mixed effect regression adjusting for type and order of intervention.
Results: We analyzed data from 10 participants (age 58 (10) years, 50% female, 80% Black, BMI: 37.3 (5.4) kg/m2, HbA1c: 5.8 (0.1)%). Weight change over the study period was not significant (p=0.08). Compared to UFP, eTRF was associated with a decrease in TIR140-180 overall (3.3%, p=0.01) and during Daytime (4.3%, p=0.02) but not Overnight (0.4%, p=0.73). We observed no significant differences in TBR&lt;70 (p=0.28) and TIR70-140 (p=0.88) between arms.
Conclusion: eTRF may improve glucose control in adults with prediabetes and high BMI by reducing daytime excursions into the elevated 140-180 mg/dL range.

Disclosure
S. Barua: None. J. Bruno: None. S. Nasserifar: None. S. M. Vanegas: None. C. Popp: None. J. M. Walker: None. J. O. Aleman: Advisory Panel; Intellihealth, Consultant; Novo Nordisk, Employee; Veterans Administration, Research Support; NIH - National Institutes of Health, Veterans Administration.

Funding
Shapiro-Silverberg Foundation; The Rockefeller University; Doris Duke Charitable Foundation; American Heart Association (17-SFRN33490004); National Institutes of Health (K08DK117064); National Heart, Lung, and Blood Institute (5T32HL098129-12)
1143-P: Elevated Serum IgA and the Gut Microbiome in Pediatric Type 1 Diabetes (T1D)
Authors: THAKKAR AMRUTA , REDONDO MARIA J. , HAJJAR JOUD , PETROSINO JOSEPH , HOFFMAN KRISTI L. , CORMIER JUWAN , AHMED MAAZ , HUANG XIAOFAN C. 
Published: June 2023

Elevated serum IgA occurs in ~20% of children with new onset T1D, although its potential role in T1D pathogenesis is not understood. Gut dysbiosis is present at onset of T1D and is strongly associated with its pathogenesis. Mucosal IgA is well known to influence the microbiome and vice versa. In animal models, serum IgA responds to microbiome changes, thereby inducing a protective response to gut invasion by pathogens. However, the relationship between gut microbiome and serum IgA in humans with T1D is unknown. Thus, we aimed to assess if elevated serum IgA is associated with gut dysbiosis at T1D onset. We enrolled 47 children between 7/2021 and 9/2022: New onset T1D with elevated serum IgA (T1D-Hi-IgA, n=14), new onset T1D with normal serum IgA (T1D-Nl-IgA, n=18) and controls (siblings of new onset T1D, n=15). Exclusions: &lt;2 yrs age; antibiotics; probiotics; inflammatory bowel disease; celiac disease; or acute illness &lt;10 days of stool collection. Demographic and clinical variables, diet questionnaires and stool were collected. Stool microbiome was determined via 16Sv4 rDNA sequencing. Differences in alpha and beta diversity along with taxa abundance were assessed. We found that the relative abundance of members of families Oscillospiraceae and Lachnospiraceae, both of which contain butyrate producers, were significantly associated with elevated IgA irrespective of T1D status (p&lt;0.05); higher in T1D-Hi-IgA vs T1D-Nl-IgA (p&lt;0.05); yet similar in T1D-Hi-IgA vs controls. Measures of alpha diversity, including richness and evenness, were also increased in T1D-Hi-IgA vs T1D-Nl-IgA, though these differences did not reach significance (richness: p=0.074; evenness: p=0.135). Similar results were observed for beta diversity. In sum, in children with new onset T1D, elevated serum IgA is associated with beneficial microbial taxa such as butyrate producers, with a trend towards increased diversity, similar to healthy siblings. Further studies are needed to understand its involvement in T1D pathogenesis.

Disclosure
A.Thakkar: None. M.J.Redondo: None. J.Hajjar: None. J.Petrosino: None. K.L.Hoffman: Consultant; Cooper Surgical. J.Cormier: None. M.Ahmed: None. X.C.Huang: None.
1145-P: Hybrid Closed-Loop (HCL) Technology Improves Glycemic Control among Historically Marginalized Youth with Type 1 Diabetes (T1D)
Authors: MARKS BRYNN E. , GRUNDMAN JODY , MEIGHAN SEEMA , MONAGHAN MAUREEN , STREISAND RANDI , PERKINS AMANDA G. 
Published: June 2023

Background: Non-Hispanic Black (NHB) youth with T1D are more likely to have suboptimal glycemic control and less likely to use HCL systems or to be included in clinical trials. We evaluated changes in glycemic control with use of Tandem t:slim X2 insulin pump with Control-IQ technology in this historically underrepresented population in T1D research.
Methods: This prospective non-randomized pilot study enrolled 15 pump naïve, publicly insured, NHB youth (Mage 14.6 ± 3.7) with T1D and A1c ≥10% in a 6 month trial of HCL use. Changes in A1c (n=13) and CGM-measured glycemia at baseline versus the final 90 days of the study for those with &lt;70% wear time (n=12) were assessed using paired t-tests and Wilcoxon signed rank tests.
Results: Thirteen participants (87%) completed the study; one was removed after 2 episodes of diabetic ketoacidosis (DKA) and the other for protocol non-adherence. A1c decreased from 11.7±1.3% to 9.6±1.6% (p=0.001). Average sensor glucose decreased from 281±53 to 225±30 mg/dL and time in range (TIR) increased by 4.5±8.5 hours/day from 18.5±15.0% to 37.1±10.3% (p=0.007). Time above range (TAR) &lt;180 mg/dL decreased by 4.6±4.5 hours/day from 81.3±15.4% to 62.0±10.3% (p=0.007). There were no changes in time below range &lt;70 mg/dL (p=0.72). DKA did not increase (0.67 episodes/person-year pre-enrollment vs 0.58 episodes/person-year during study intervention).
Conclusions: Tandem t:slim X2 insulin pump with Control-IQ technology use in NHB youth with suboptimal T1D control was associated with improvements in average glucose, TIR, and TAR. The theoretical risk for increased risk of DKA is frequently cited as a barrier to HCL use in this population, however there was no increase in rates of DKA during the study period. These glycemic improvements without increased risk emphasize the importance of supporting equitable access to diabetes technology among all people with T1D.

Disclosure
B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc.

Funding
National Institutes of Health (K23DK129827); Tandem Diabetes Care, Inc. (TDC20210226); Dexcom, Inc.