bluuebunny/crossref_metadata_2025_split huggingface dataset:
1217-P: Willingness to Deintensify in Patients with Type 2 Diabetes—The Diabetes and Aging Study
Authors: HAIDER SHANZAY , PARKER MELISSA M. , HUANG ELBERT , GRANT RICHARD W. , MOFFET HOWARD H. , LAITEERAPONG NEDA , LIU JENNIFER , LIPSKA KASIA J. , KARTER ANDREW J. 
Published: June 2023

Background: The ADA recommends treatment de-intensification be considered in older patients with poor health, on complex regimens, or experiencing side effects. We examined factors associated with older patients’ willingness to de-intensify treatment.
Methods: Cross-sectional analysis of Diabetes Preferences and Self-Care Survey responses and EHR data in adults with type 2 diabetes from Kaiser Permanente Northern California. We calculated proportions of patients who responded to the survey question “I would be willing to take less medication for my diabetes” as willing, neutral, or unwilling. Willingness was contrasted across demographic, clinical, and health status factors.
Results: Analysis included 1,337 adults prescribed glucose-lowering medications (age 74.2 ± 6.0 years, 44% women, 54.4% non-Hispanic white). The proportions of willing, neutral, and unwilling to de-intensify treatment were 51.2%, 27.3%, and 21.5%, respectively. Willingness to de-intensify varied by age (p&lt;0.001) with 54.2% of younger adults (age 65-74) willing to de-intensify compared to 38.5% of older adults (age 85+). Willingness varied by duration of diabetes (p&lt;0.001) with 61.0% of adults with diabetes for 0-4 years willing to de-intensify compared to 44.2% of adults with diabetes for longer duration (&gt;15 years). Willingness among those with good, intermediate, or poor health status (as defined by the ADA) was 54.2% vs. 47.5% vs. 55.1%, respectively. Individuals with an A1c greater than 9% were more willing to de-intensify treatment compared to individuals with A1c of 7%-9%, or &lt;7%, (57% vs 51% vs 50%, p&lt;0.001). Willingness to de-intensify decreased as number of medications increased (p&lt;0.001) and little difference was noted in willingness among patients by insulin use or hypoglycemia history.
Discussion: Patterns of patient willingness to de-intensify treatment are misaligned with clinical guideline recommendations and highlight the influence of patient experience living with diabetes over time.

Disclosure
S.Haider: None. M.M.Parker: Research Support; Dexcom, Inc. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. R.W.Grant: None. H.H.Moffet: Research Support; Dexcom, Inc. N.Laiteerapong: None. J.Liu: None. K.J.Lipska: Other Relationship; UpToDate. A.J.Karter: None.

Funding
National Institute on Aging (5R01AG063391)
1219-P: HDL Particle Concentration (HDL-P) and Cholesterol Efflux Capacity (CEC) Trajectories Relative to Age at Menopause in Women with Type 1 Diabetes
Authors: JU JINGHUI , MILLER RACHEL G. , ORCHARD TREVOR J. , COSTACOU TINA 
Published: June 2023

A previous study in the general population reported adverse changes in the concentration of HDL-P and CEC during the menopausal transition. Similar data do not exist in women with T1D. Moreover, whether changes in HDL metrics over time at a similar age also occur among men, reflecting aging processes, is not well established. We thus quantified HDL-P (calibrated differential ion mobility analysis), total and ABCA1-specific CEC in individuals with T1D and samples available at baseline (or earliest available) and the 25-year follow-up visit of the EDC study (n=155; mean baseline age 27; T1D duration 19 years). Each female participant was age and duration matched (at the time of menopause) to a male participant. Mixed models were constructed to assess the longitudinal trends in HDL-C, HDL subfractions and CEC. Plots were created depicting trajectories of HDL metrics relative to the time of the final menstrual period in women. As shown in the Figure, HDL-C and HDL-P concentrations increased significantly over time in both sexes. In addition, both CEC measures as well as CEC per HDL-P decreased over time in both men and women. Our findings in T1D point to similar trajectories of HDL metrics in men and women (increasing HDL-C and HDL-P but decreasing CEC per HDL-P) suggesting that these changes partially relate to aging and not exclusively to menopause.

Disclosure
J.Ju: None. R.G.Miller: None. T.J.Orchard: None. T.Costacou: None.

Funding
National Institutes of Health (R01HL130153, R01DK034818)
122-LB: Impact of Flash Glucose Monitoring on Behavior Modification, Quality of Life, and Treatment Satisfaction in Noninsulin Treated Patients with Type 2 Diabetes
Authors: SIMMONS MARSHA D. , SHIFFRIN ERIC J. 
Published: June 2023

Introduction: CGM's have shown efficacy in the management of patients with T1D and T2D on multiple daily injections (MDI) and insulin pumps as a way to adjust insulin dosing. However, the benefit of CGM could extend beyond the dosing of insulin and has the potential to encourage lifestyle modification in non-insulin treated patients with type 2 diabetes.
Methods: This prospective study included flash glucose monitoring-naive adult patients with T2D with and A1c &gt;7% and &lt;9%. Participants were allowed any combination of oral antidiabetic medications and glucagon-like peptide 1 (GLP-1) injections. Participants received study provided Abbott Freestyle Libre for 12 weeks. HbA1c and weight were measured, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ), Audit of Diabetes Dependent Quality of Life (ADDQoL), and Food Frequency Questionnaire were all completed at baseline and 12 weeks. The Experience with Continuous Glucose Monitoring questionnaire was completed at the end of 12 weeks.
Results: For participants (n=43) from one single diabetes center, HbA1c improved by 0.37% from 7.70%±0.56 (mean±SD) at baseline to 7.34%±0.57 at 12 weeks (paired t-test=3.65, p=0.0007). Glucose monitoring frequency improved, from 7.4 average number of fingersticks per week (SD: 7.74) to 4.7 flash glucose scans per day (SD: 3.09). Participants also demonstrated some glucose control with their blood sugar reading being within target range 79.44% of the time.
Conclusion: The study suggests that FreeStyle Libre in insulin naïve patients with T2D can influence a decrease in A1c. Participants were more aware of their blood sugar levels while using the FreeStyle Libre and were able to achieve greater glycemic control as evidenced by their percent of time in target range. Findings from this study can be used to advocate to insurance companies to cover the Freestyle Libre in T2D patients who do not use insulin.

Disclosure
M. D. Simmons: None. E. J. Shiffrin: None.

Funding
Abbott (TJU20-27)
1225-P: Biomarkers in Prediabetes Reflecting Sex Varying Pathways of Cardiovascular Risk
Authors: YOSHIDA YILIN , CHEN ZHIPENG , LI CHANGWEI , FONSECA VIVIAN , MAUVAIS-JARVIS FRANCK 
Published: June 2023

Background: Women with diabetes (DM) had higher cardiovascular risk than men, partly due to women’s higher cardiometabolic risk factors before DM. We compared sex differences in biomarkers that reflect distinct pathophysiological pathways in prediabetes (PreDM).
Method: We conducted a cross-sectional analysis of similarly designed Atherosclerosis Risk in Communities Study and the Jackson Heart Study. We used multivariable linear regressions for the associations between sex and biomarkers (log(x)) representative of inflammation, cardiac injury/stress, lipoprotein, adipokine, kidney function, and glycemia adjusted for age, race, BMI, blood pressure, total cholesterol, smoking, hypertensive meds, and statins in CVD-free individuals with PreDM. We evaluated the effect modification of menopause and validated results in those who progressed into DM in follow-up. False discovery rate adjusted multiple comparisons.
Results: In 5765 people with PreDM at baseline, the mean age was 54 y, 47% women, and 35% non-Hispanic Blacks. Inflammatory c-reactive protein (β coefficient 0.3 P=5×10-51), fibrinogen (β 0.2 P=3×10-12), and lymphocyte count (β 0.2 P=7×10-8), and cardiac NT-proBNT (β 0.6 P=1×10-104) were higher in women than men with PreDM. Lipoprotein(a) (β 0.2 P=1×10-10) and apolipoproteins A1 (Apo A1) (β 0.6 P=5 x 10-115), and adipokines, leptin (β 1.1 P=3×10-112) and adiponectin (β 0.6 P=6×10-16) were higher in women. Men with PreDM had higher random urinary creatinine (β -0.6 P=2×10-61) and reduced eGFR (β 0.3 P=5×10-29). They also had higher inflammatory homocysteine (β -0.5 P=2×10-12), triglycerides (β -0.2 P&lt;.0001), and Apo B (β -0.1 P&lt;.0001). Fructosamine, glycated albumin, and HbA1c did not differ by sex in PreDM. Menopause modifies sex differences in LDL-c, Apo B, and fibrinogen. Results were generally unchanged in people who later became DM.
Conclusion: Overall, in PreDM, women had higher vascular inflammatory markers and adipokines, while men had higher kidney dysfunction markers.

Disclosure
Y.Yoshida: None. Z.Chen: None. C.Li: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. F.Mauvais-jarvis: None.

Funding
National Institutes of Health (K12HD043451)
1228-P: Comparison between Combination of Low- or Moderate-Intensity Statin with Ezetimibe and High-Intensity Statin Monotherapy for Primary Prevention of Cardiovascular Disease and All-Cause Mortalities in Patients with Type 2 Diabetes—A Propensity-Matched Natio
Authors: CHEOL HWANG YOU , YOUNG PARK SO , JEONG IN-KYUNG , JEUNG AHN KYU , YEON CHUNG HO 
Published: June 2023

Background and Aims: Here, we compared the effects of combination therapy of low- or moderate-statin with ezetimibe and high-intensity statin monotherapy in patients with type 2 diabetes without previous cardiovascular disease (CVD) on incident CVD and all cause mortalities in a real-world setting.
Methods: Using the Korean National Health Insurance Service datasets, two cohorts comparing high intensity statin monotherapy with low- or moderate-intensity statin and ezetimibe combination therapy were constructed using a 1:1 propensity score matching procedure and were followed up for 3.4 years. The primary outcome was a composite of myocardial infarction (MI), stroke, and all-cause mortality. The secondary outcome was the occurrence of individual events.
Results: Compared to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination therapy significantly reduced the risk of composite outcomes (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.74 - 0.98, P=0.029) as well as stroke (HR 0.70, 95% CI 0.52 - 0.93, P=0.014), but not MI or all cause mortalities. However, there was no significant risk reduction in composite outcomes following low-intensity statin therapy with ezetimibe (HR 1.02, 95% CI 0.75 - 1.39, P=0.882) than that after high-intensity statin monotherapy. The statin with ezetimibe combination showed a consistent efficacy regardless of diverse patients’ baseline characteristics. Conclusions: Moderate-intensity statin with ezetimibe combination therapy was superior to high-intensity statin monotherapy for CVD primary prevention, and low-intensity statin with ezetimibe showed a comparable efficacy to high-intensity statin monotherapy in patients with type 2 diabetes.

Disclosure
Y.Hwang: None. S.Park: None. I.Jeong: None. K.Ahn: None. H.Chung: None.
1230-P: Low Real-World Use of SGLT2 Inhibitors in People with Diabetes and Heart Failure—A Population Cohort Study
Authors: BUTALIA SONIA , WEN CHUAN , SENIOR PETER A. , SIGAL RONALD J. , QUAN HUDE , LUAN CHU MANH , KAUL PADMA 
Published: June 2023

Background: One of the most striking benefits of sodium-glucose cotransporter 2 inhibitors (SGTL2is) in clinical trials has been the reduction in heart failure (HF) hospitalization. Thus, guidelines recommend SGLT2i use in people with diabetes and HF.
Objective: We assessed the real-world dispensation of SGTL2is and the factors associated with their dispensation in people with diabetes and HF.
Methods: This retrospective, population-based cohort study identified people with diabetes and HF between Jan 1, 2014 to Dec 31, 2017 in Alberta, Canada (population ~ 4.3 million). Individuals were followed until Dec 31, 2020. The index date was the date of physician or hospitalization claim for HF. The primary exposure was SGTL2i dispensation after HF index date. Demographic and clinical characteristics were summarized, and multivariate logistic regression assessed the factors associated with SGTL2i dispensation adjusting for age, sex, baseline HbA1c, diabetes duration, chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), comorbidities (Charlson Comorbidity Index (CCI) score), material deprivation, and urban/rural residence.
Results: We identified 22,025 people (43.4% female, mean age 74.7 years ± 11.8 years) with diabetes and HF. Only 10.2% (n=2,247) of individuals with diabetes and HF were dispensed an SGTL2i. Male sex (aOR 1.55; 95% CI 1.39-1.72), age &lt; 65 years (aOR 2.28; 95% CI 2.05-2.54), higher HbA1c (aOR 1.35; 95% 1.31-1.40), no CKD (aOR 3.11; 95% CI 2.78-3.49), ASCVD (aOR 1.48; 95% CI 1.33-1.64), and urban residence (aOR 1.17; 95% CI 1.05-1.31) were associated with SGTL2i dispensation while more co-morbidities were associated with less dispensation (CCI score ≥ 5 aOR 0.36; 95% CI 0.30-0.43).
Conclusions: Only 1 in 10 people with diabetes and HF were dispensed an SGTL2i. We identified several factors associated with SGTL2i dispensation and importantly this study highlights a significant opportunity to improve management in people with diabetes and HF.

Disclosure
S.Butalia: None. C.Wen: None. P.A.Senior: Advisory Panel; Novo Nordisk Canada Inc., Consultant; Novo Nordisk Canada Inc., Bayer Inc., Viatris Inc., Vertex Pharmaceuticals Incorporated, ViaCyte, Inc., Insulet Corporation. R.J.Sigal: Research Support; Novo Nordisk. H.Quan: None. M.Chu: None. P.Kaul: None.

Funding
Diabetes Canada (OG-3-22-5662-SB)
1234-P: Derivation of a Claims-Computable Major Adverse Cardiovascular Event Estimator (ACME) in Adults with Type 2 Diabetes
Authors: MCCOY ROZALINA G. , SWARNA KAVYA , DENG YIHONG , HERRIN JEPH , ROSS JOSEPH , KENT DAVID M. , BORAH BIJAN , CROWN WILLIAM , MONTORI VICTOR M. , UMPIERREZ GUILLERMO , GALINDO RODOLFO J. , BRITO JUAN , MICKELSON MINDY , POLLEY ERIC 
Published: June 2023

Major adverse cardiovascular events (MACE) are a major cause of morbidity and mortality among adults with type 2 diabetes. Currently available risk prediction models estimate long-term risk (typically 10-year) and require clinical data not routinely available in real-world data sources, which limit their use on population level. Using de-identified claims data from OptumLabs® Data Warehouse for enrollees in private and Medicare Advantage health plans linked to 100% sample of Medicare fee-for-service beneficiaries between 2014 and 2021, we derived ACME to estimate annualized risk of non-fatal myocardial infarction, non-fatal stroke, or all-cause mortality in patients with type 2 diabetes aged ≥21 years (N=6,623,526). The Cox proportional hazards model, combined with an estimate of the baseline hazard using the Nelson-Aalen estimator to allow conditional survival predictions, included 28 covariates available in claims (age, sex, cardiovascular comorbidities, and cardiovascular medications). The study population had mean age 68.1 (SD, 10.6) years, 49.8% were women, and 73.0% were non-Hispanic White. ACME’s concordance index was 0.74 (se = 0.0002) and it performed comparably in all racial and ethnic groups. Strongest predictors of MACE were acute myocardial infarction and stroke within the past 3 months, heart failure hospitalization within the past year, and end-stage kidney disease. Overall, 4.2% of patients were predicted to have low (&lt;1%) annualized MACE risk, 62.8% were predicted to have moderate (≥1 to &lt;5%) annualized risk, and 33.0% were predicted to have high (≥5%) annualized risk. Other thresholds can be chosen for individualized applications. ACME can support population risk stratification and health management efforts at the health system and payer levels, participant identification for decentralized pragmatic clinical trials of cardiovascular disease and its prevention, and risk-stratified observational studies using real-world data.

Disclosure
R.G.Mccoy: Consultant; Emmi. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. M.Mickelson: None. E.Polley: None. K.Swarna: None. Y.Deng: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. J.Ross: Research Support; Johnson & Johnson. D.M.Kent: Research Support; W.L. Gore. B.Borah: Consultant; Boehringer Ingelheim Inc., Exact Sciences. W.Crown: Consultant; Janssen Scientific Affairs, LLC, UnitedHealth Group, Viatris Inc. V.M.Montori: None.

Funding
Patient-Centered Outcomes Research Institute (DB-2020C2-20306)
1236-P: Patients with Diabetes Mellitus and Chronic Kidney Disease Affected by Nonalcoholic Fatty Liver Disease Have Greater Risk of Mortality and Worse Clinical Outcomes
Authors: KHOKHLOV LEONID , THAPA USHA , PEREIRA LEANNE , FATUYI MICHAEL , ALI MEHNAAZ , ABDULRAHMAN HUSSAIN FATIMA , ABOELNASR AMR , BROWN AMANDA C. , EERHART MICHAEL , AMIN ESHGHABADI MOHAMMAD , CONTRERAS CYNTHIA , SHEMISA KAMAL 
Published: June 2023

Background: DM & CKD are affecting million patients worldwide. Nonalcoholic Fatty Liver Disease (NAFLD) is emerging disease predisposing to adverse outcomes. There is limited evidence of clinical outcomes of NAFLD in patients with DM&CKD. We sought to investigate this population.
Methods: We queried NIS 2017-2020 for adults hospitalized with DM&CKD & NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, GIB, intubation, LOS & total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes.
Results: There were 11,254,722 hospitalizations with DM&CKD and 542,140 (4.8%) had NAFLD. NAFLD & non-NAFLD cohorts were with mean age of 53.3 vs. 54.0 yrs; males 53.3% vs 54.0%; Caucasians 58.7% vs 57.7%; HF 49.4% vs 49.5%; PH 11.4% vs 9.0%; AKI 51.9% vs 43.7%; obesity 24.9% vs 27.0%; HLD 47.0% vs 61.1%; anemia 23.6% vs 20.1%; ACS 10.6% vs 10.3%; stroke 1.8% vs 3.0%, respectively.
Conclusion: DM&CKD cohort showed significantly higher mortality, worse clinical outcomes & resource utilization (Table 1). They were younger, obese, female, Caucasian, & with more PH, AKI, anemia, ACS. NAFLD is associated with greater risk for MACE, GIB, & ICU care. NALFD is an important risk factor among patients with DM&CKD that predicts adverse outcomes.

Disclosure
L. Khokhlov: None. U. Thapa: None. L. Pereira: None. M. Fatuyi: None. M. Ali: None. F. Hussain: None. A. Aboelnasr: None. A.C. Brown: None. M. Eerhart: None. M. Eshghabadi: None. C. Contreras: None. K. Shemisa: Speaker's Bureau; Pfizer Inc., Boehringer Ingelheim (Canada) Ltd., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Amarin Corporation, Bayer Inc.
1241-P: Examination of Direct and Indirect Pathways between Food Insecurity and ABC’s of Diabetes
Authors: WALKER REBEKAH J. , AMJAD RABIA , EGEDE LEONARD E. 
Published: June 2023

Background: Food insecurity is associated with health outcomes in adults with diabetes. The goal of this study was to investigate pathways through which food insecurity influences the ABC’s of diabetes (HbA1c, blood pressure, and cholesterol-lipids) in an effort to inform intervention development.
Methods: National Health and Nutrition Examination Survey (NHANES) from 2011-2018 was used. Adults who self-reported a health professional telling them they had diabetes were included in the analysis (n=4,058). HbA1c, blood pressure, and cholesterol-lipids were measured by NHANES and analyzed as continuous measures. Food insecurity was scored based on the USDA scale. Preliminary analyses investigated indicators for body composition, anthropometrics, and healthy eating. Structural equation modeling using Stata v17 with standardized estimates was used to investigate direct and indirect relationships for the hypothesized pathway of food insecurity leading to lower healthy eating, higher waist circumference, and ultimately higher HbA1c, blood pressure, and cholesterol-lipids.
Results: For the pathway with HbA1c, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p&lt;0.001), higher waist circumference (B=0.03, p&lt;0.03), and higher HbA1c (B=0.09, p&lt;0.001). For the pathway with lipids, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p&lt;0.001), higher waist circumference (B=0.05, p=0.002), and higher lipids (B=0.06, p&lt;0.001). Significant indirect effects also existed for the hypothesized pathway for both HbA1c and lipids. However, significant pathways did not exist for the relationship between food insecurity and blood pressure.
Conclusions: Food insecurity appears to exert its effect via healthy eating and anthropometrics. Strategies that optimize dietary intake and lifestyle modification for weight management will be most beneficial in improving ABC’s for food insecure adults with diabetes.

Disclosure
R.J.Walker: None. R.Amjad: None. L.E.Egede: None.

Funding
National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)
1242-P: Obesity Disparities in a Multiracial Sample of Asian American and Pacific Islander (API) Adults
Authors: BACONG ADRIAN M. , GIBBS SOPHIA L. , FRANKLAND TIMOTHY B. , LI JIANG , DAIDA YIHE G. , FORTMANN STEPHEN P. , PALANIAPPAN LATHA 
Published: June 2023

Background: Asians have higher diabetes rates than Non-Hispanic white (NHW) people, despite having lower BMI. Studies on Asians often present monoracial groups. We examined obesity rates among mono- and multiracial APIs.
Methods: We examined obesity and other factors by self-reported race using case-control data from two integrated healthcare systems with large API populations.
Results: Obesity varied by race, ranging from 8.5% (Chinese) to 53.5% (Other Pacific Islander) (Table 1). Obesity was high for multiracial API. Demographic, behavioral, and clinical factors explained some, but not all the differences in obesity rates (Table 2).
Conclusion: Multiracial API people had higher obesity rates than monoracial API and NHW people. Robust data on multiracial people are needed to understand health disparities among this group.

Disclosure
A.M.Bacong: None. S.L.Gibbs: None. T.B.Frankland: Research Support; Pfizer Inc., Stock/Shareholder; AbbVie Inc., Pfizer Inc., CVS Health Corp, Regeneron Pharmaceuticals Inc. J.Li: None. Y.G.Daida: Research Support; GlaxoSmithKline plc. S.P.Fortmann: Research Support; Pfizer Inc. L.Palaniappan: None.

Funding
National Heart, Lung, and Blood Institute (R01HL126172)