bluuebunny/crossref_metadata_2025_split huggingface dataset:
1083-P: Interventions to Improve Equity of CGM Use for Pediatric Patients with Type 1 Diabetes
Authors: TURNER JOEL , NELSON GRACE , ADAMS BLAKE V. 
Published: June 2023

Background: Continuous Glucose Monitors (CGMs) have been shown to improve outcomes for patients with T1D. However, various obstacles prevent some patient groups from utilizing these technologies. This was evident by the discrepancy in non-Hispanic black patients using CGMs (25%) vs non-Hispanic white patients (60%) in our clinic. Our goal is to identify and overcome these obstacles in order to increase the number of patients using CGMs and create equity in CGM use between groups.
Methods: An initial barrier for many patients is getting CGM approved by insurance. In response we created a “CGM champion”, a member of the team who created a streamlined process for initiating CGMs. She was able to build relationships with DME companies and provide appropriate information to insurance companies to make the process more efficient. We also created patient education folders with up-to-date information for our families. We worked with staff to increase CGM knowledge, and utilized EMR functionality to make sure all orders were entered, trackable, and documented in a standardized fashion. Finally, we used surveys to gauge the interest of each patient in trying CGMs and other technology.
Results: As of December 2022, we have helped 54% of our interested patients navigate the process of obtaining a CGM. Equity was also improved, with ~65% of our non-Hispanic black patients now using CGM vs ~80% of non-Hispanic white patients.
Conclusions: We have seen improvement in both the total number of patients which are utilizing CGMs as well as equity between patient groups. We are continuing to adjust our processes in an effort to make CGMs more accessible and equitable.

Disclosure
J.Turner: None. G.Nelson: None. B.V.Adams: None.
11-LB: The Efficacy and Safety of Abelmoschus manihot for Reduction of Microalbuminuria in Patients with Type 2 Diabetes and Diabetic Nephropathy—A Multicenter, Randomized, Open-Label, Parallel-Controlled Clinical Trial
Authors: YIN JUN , CHEN SI , WEI LI , JIA WEIPING 
Published: June 2023

Objective: Huangkui capsule, an extract from the flowers of Abelmoschus Manihot, has been proved clinically effective in improving chronic kidney disease. This study aimed to evaluate the efficacy and safety of Huangkui capsule in patients with stage 3 diabetic nephropathy.
Methods: This multicenter, randomized, open-label, parallel-controlled trial was conducted in six hospitals. The inclusion criteria were 30 mg/g ≤ albumin creatinine ratio (ACR) &lt;300 mg/g, eGFR ≥ 60 mL/min/1.73 m2, and type 2 diabetes with glycosylated hemoglobin ≤ 9%. We enrolled 239 patients who were randomly assigned to the two groups in a 1:1 ratio. They were treated with Huangkui capsule 2.15 g three times a day, or losartan potassium tablets 100 mg/day for 24 weeks. The primary outcome was the change in ACR from baseline and the secondary outcome was the change in eGFR.
Results: The ACR in the losartan group was 119.47±78.16 mg/g at baseline and 90.51±136.12 mg/g after 24 weeks of treatment, with a decrease of 30.46±134.16 mg/g (P=0.049). In the Huangkui group, the ACR decreased from 121.98±84.31 mg/g to 88.13±76.66 mg/g, with a drop of 31.94±91.66 mg/g (P=0.002). The change in eGFR was -3.58±10.35 mL/min/1.73 m2 and -3.82±13.05 mL/min/1.73 m2 in the losatan and Huangkui groups, respectively. In subgroup analysis of patients with baseline ACR ≥ 100 mg/g, losatan and Huangkui lowered ACR by 56.83 mg/g (P=0.044) and 78.72 mg/g (P&lt;0.001), respectively. There were no significant differences between the two groups (P&gt;0.05).
Conclusions: Huangkui capsule significantly reduced ACR of patients with type 2 diabetes and microalbuminuria and is a promising medicine for diabetic nephropathy.

Disclosure
J. Yin: None. S. Chen: None. L. Wei: None. W. Jia: None.

Funding
National Natural Science Foundation of China (82070885); Shanghai Municipal Education Commission (20172025); Xuhui Joint Research Projects on Important Diseases (XHLHGG202110)
1100-P: Real-World Use of GLP-1 Agonists in Youth with Type 2 Diabetes Is Associated with Improvements in Hemoglobin A1c—A Multicenter Analysis
Authors: SAMUELS STEPHANIE , CHAJECKI ANASTASIA , HU PAMELA , KAYSER MICHELLE , WEYMAN KATE , PAN BERNARD , BROWN ELIZABETH A. , VAN NAME MICHELLE A. , WOLF RISA M. 
Published: June 2023

Background: Despite the high risk of diabetes complications at an early age in youth with type 2 diabetes (T2D), there are limited pharmacologic options to manage T2D in youth. The first Glucagon-like-peptide-1 agonist (GLP-1a) was approved for pediatric T2D treatment in 2019. However, little is known on the real-world use and effectiveness of GLP-1a for management of T2D in the pediatric population.
Objectives: To assess the real-world use and effectiveness of GLP-1a (exenatide, dulaglutide, liraglutide, semaglutide) in managing T2D in a diverse cohort of youth. Methods: This multicenter retrospective analysis included adolescents and young adults (ages 11-25y) from two academic pediatric diabetes centers who were prescribed a GLP-1a for management of T2D. Patient HbA1c, weight, and BMI within 12 months of follow-up after GLP-1a prescription were compared to baseline using Signed Rank tests. Secondary outcomes included insulin and metformin use after GLP-1a initiation and were compared using McNemar's test.
Results: A total of 153 patients (median age 16.1 years (IQR 13.9-17.8), 57% female, 59% non-Hispanic Black, 23% Hispanic or Latino, 76% with public insurance) were prescribed GLP-1a and 36 patients discontinued the GLP-1a. At a median follow-up of 8.2 months, 117 patients were taking GLP-1a and were included in pre-post analyses. From baseline to follow-up, HbA1c decreased from 8.3% to 7.5% (p&lt;0.007), while weight and BMI remained stable. At baseline, 48% of patients were taking prandial insulin, compared to 36% at follow-up (p=0.001), 71% were taking basal insulin compared to 62% at follow-up (p = 0.025), and 85% were prescribed metformin at baseline compared to 74% at follow-up (p=0.005).
Conclusion: Real-world use of GLP-1a in youth with T2D is associated with decreased HbA1c levels. GLP-1a treatment may reduce doses of insulin and other medications for diabetes in youth, which can mitigate the burden of daily diabetes management.

Disclosure
S.Samuels: None. A.Chajecki: None. P.Hu: None. M.Kayser: None. K.Weyman: None. B.Pan: None. E.A.Brown: None. M.A.Van name: Research Support; Provention Bio, Inc. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc.

Funding
American Diabetes Association (7-22-JDFN-03 to S.S.); National Institutes of Health (R01DK134955)
112-OR: Low Carbohydrate vs. Mediterranean Diets in Adolescents with Type 1 Diabetes—A Randomized Control Trial
Authors: LEVRAN NERIYA , LEVEK NOAH , MAZOR-ARONOVITCH KINERET , MONSONEGO-ORNAN EFRAT , PINHAS-HAMIEL ORIT 
Published: June 2023

Objective: To compare glycemic parameters and metabolic health of a low carbohydrate diet (LCD) versus a Mediterranean diet (MED) in adolescents with type 1 diabetes.
Research Design and Methods: In an open-label, randomized, non-inferiority trial, 40 individuals with type 1 diabetes, aged 12 to 22 years, were randomly assigned (1:1) to LCD (50-80g of carbohydrates per day) or MED for 24 weeks. Glycemic outcomes included time in range (TIR), time below range (TBR) time above range (TAR), and glycosylated hemoglobin (HbA1c).
Results: Baseline characteristics were similar between the two groups. After 6 months intervention, the median (IQR) TIR70-180 mg/dL increased from 47% (35;55) to 58% (51;72) in the LCD and from 52% (38;60) to 67% (50;73) in the MED group (p=0.21, p=0.86, respectively). There was no difference in %TBR&lt;54 mg/dL. The delta %TAR&gt;250 mg/dL was significantly greater in the LCD (-11.0 (-5.0; -16) than the MED group (-3.1 (0.0; -9.4)) (p=0.008). HbA1c level improved in both groups, after correcting for gender, age, diabetes duration, and, maternal education; the delta HbA1c was significantly greater in LCD than MED after 6 months -0.8 (-1.3; -0.3) and -0.1 (-0.8;0.2) respectively (p=0.02). Median daily carbohydrate intake was 60gr (45;88) for the LCD and 128gr (IQR 104;155) for the MED group. Delta BMI Z-score was greater in the LCD -0.1 (-0.3-0.1) than the MED group 0.0 (-0.1-0.1) (p=0.08). Lipid levels did not differ between the groups.
Conclusions: Non-inferiority (13% relative margin) of LCD versus MED was demonstrated on %TIR70-(primary endpoint) among adolescents with type 1 diabetes, with no increased risk for hypoglycemia and no effect on cardiovascular risk factors.

Disclosure
N.Levran: None. N.Levek: None. K.Mazor-aronovitch: None. E.Monsonego-ornan: None. O.Pinhas-hamiel: None.
1122-P: Disparities in Glycemic Outcomes in High Technology–Using Youth with Type 1 Diabetes
Authors: NATH MERYL C. , ATCHISON JOYCELYN , SCHMITT JESSICA 
Published: June 2023

Introduction: Socioeconomic status (SES) is associated with health disparities in youth with T1D. We aimed to evaluate SES and glycemic metrics in youth with T1D using continuous glucose monitors (CGM).
Methods: This IRB approved study included demographics, insulin administration type (pump/injections), and glycemic data from HbA1c and corresponding 14 day (d) and 90 d CGM metrics. Analysis was performed in MiniTab®.
Results: A total of 205 patients, 161 Non-Hispanic White (NHW) and 44 Non-Hispanic Black (NHB), were included. A minority (n=45, 22.0%) were publicly insured. Half (49.7%) used an insulin pump. There was no significant difference between sex, age, age at diagnosis, diabetes duration, or pump use between NHB and NHW patients. A higher proportion of NHB patients were on public insurance (45.5 vs 15.5%, p&lt;0.0001). No difference in pump use was seen based upon insurance. Glycemic metrics for NHW and NHB patients differed including: HbA1c (median (med) 7.6 vs 9.2, p&lt;0.001), 14 d mean glucose (mg/dL) (189.6 vs 207.4, p=0.038), 14 d standard deviation (SD) (67.2 vs 77.7, p=0.006), 14 d time in range (TIR) (51.8 vs 42.0%, p=0.016), 14 d time &lt; 250 (med 52.9 vs 37.3%, p=0.005), 90 d mean glucose (181.0 vs 220.0, p&lt;0.001), 90 d SD (69.5 vs 79.4, p=0.006), 90 d TIR (50.7 vs 37.9%, p=0.001) and 90 d time &lt; 250 (med 16.4 vs 34.7%, p&lt;0.001). Similar differences were seen between public and privately insured patients including: HbA1c (med 8.7 vs 7.6%, p=0.003), 14 d mean glucose (214.0 vs 183.5, p=0.019), 14 d TIR (43.2 vs 51.7%, p=0.034), 14 d time &lt; 250 (med 30.6 vs 17.9%, p=0.031), 90 d mean glucose (219.5 vs 181.0, p&lt;0.0001), 90 d SD (77.6 vs 70.0, p=0.023), 90 d TIR (39.1 vs 50.4%, p=0.004) and 90 d time &lt; 250 (med 35.4 vs 16.3%, p&lt;0.0001).
Discussion: Disparities in glycemic control were seen in NHB and publicly insured patients despite CGM use and a high and equitable use of insulin pumps. While access to technology for diabetes is important, in this cohort it was not adequate to reduce disparities in glycemic outcomes based on SES.

Disclosure
M.C.Nath: None. J.Atchison: None. J.Schmitt: None.
1127-P: 4T Study—Early CGM Initiation and Tighter Glucose Targets Improves A1C in Youth with T1D
Authors: PRAHALAD PRIYA , DING VICTORIA , ZAHARIEVA DESSI P. , ADDALA ANANTA , BISHOP FRANZISKA K. , SCHEINKER DAVID , JOHARI RAMESH , DESAI MANISHA , HOOD KOREY K. , MAAHS DAVID M. , STUDY GROUP 4T 
Published: June 2023

Methods to optimize care after T1D diagnosis are needed. We hypothesized lowering A1c targets to &lt;7% would further lower A1c in the 4T Study in which CGM with asynchronous remote patient monitoring (RPM) is initiated after T1D diagnosis. All youth with newly diagnosed T1D (June 2020-March 2022) were offered CGM and RPM after diagnosis (Study 1, n=133). We compared A1c at 1-year in Study 1 with the 4T Pilot (2018-20) and Historical cohorts (2014-16). We visualized population-based A1c trajectories using locally estimated scatter plot smoothing (Fig) and % meeting A1c targets. Mean A1c at diagnosis was similar in Pilot (12.2%±2.1%) and Study 1 (12.2±2.4%) and higher than the Historical cohort (10.7±2.5%). In Study 1, the median age of diagnosis was 10.8 years, 55% male, 40% non-Hispanic White, and 38% with public insurance. CGM initiation occurred within 30 days of diagnosis in 98.5%. At 3, 6, 9, and 12 months post-diagnosis, the Study 1 cohort had LOESS-based mean A1c differences of 0.16%, 0.24%, 0.31%, and 0.58% lower than the Pilot and 0.04%, 0.60%, 0.83%, and 1.06% lower than the Historical cohort. A1c target &lt;7% was met by 61% of youth in Study 1, 51% in the Pilot and 28% in the Historical cohort. Time &lt;70mg/dl was ≤2.3%. The 4T program which emphasizes early CGM initiation, RPM, tighter glucose targets, and consistent team messaging was associated with lower A1c. These data support implementation of the 4T program in youth with T1D.

Disclosure
P.Prahalad: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. 4t study group: n/a. V.Ding: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. A.Addala: None. F.K.Bishop: None. D.Scheinker: None. R.Johari: None. M.Desai: None. K.K.Hood: Consultant; Cecelia Health.

Funding
National Institutes of Health (P30DK116074), (R18DK122422 to D.M.M.); Dexcom, Inc.; Lucile Packard Children’s Hospital Auxiliaries Endowment; Stanford Maternal and Child Health Research Institute
1129-P: Continuous Glucose Monitoring (CGM) Initiation Shortly after Diagnosis Does Not Worsen Psychosocial States
Authors: ADDALA ANANTA , RITTER VICTOR , SHAW BLAKE , PANG ERICA , CORTES-NAVARRO ANA L. , BALISTRERI ILENIA , LOYOLA ALONDRA , ALAMARIE SELMA A. , SCHNEIDER-UTAKA AIKA , BISHOP FRANZISKA K. , ZAHARIEVA DESSI P. , PRAHALAD PRIYA , DESAI MANISHA , MAAHS DAVID M. , HOOD KOREY K. 
Published: June 2023

Psychosocial impacts of early CGM initiation in youth soon after T1D diagnosis are underexplored. We report parent/guardian (PG) and youth trends in Patient Reported Outcomes (PROs) for families in the 4T Study 1.
Of the 133 participants in the 4T Study 1, 125 PG and 60 youth (≥11 years) were eligible for PROs. PROs included Diabetes Distress Scale - Parent (mean DDS-P) for PG and for youth, Diabetes Distress Scale (DDS sum), PROMIS Pediatric Global Health (PGH sum), Diabetes Technology Attitudes (DTA sum), and CGM Benefits/Burden (BenCGM and BurCGM sum). Kruskal Wallis rank sum test evaluated temporal trends and sociodemographics were evaluated (Numerical: Wilcoxon rank; Categorical: Fisher's if n&lt;5, Chi-squared if n≥5).
PROs completion rates were higher for PG than youth at baseline (74% v 59%), 3 months (70% v 53%), and 6 months (66% v 50%). PG DDS-P remained low throughout the study (Table). Youth had favorable psychosocial trends (low DDS and high PGH), and perceived technology positively (high DTA and BenCGM with low BurCGM). Age, DKA at diagnosis, gender, ethnicity, insurance status, and language spoken were not associated with PROs scores in PG or youth.
CGM initiation shortly after T1D diagnosis is not associated with poor or worsening PROs for PG and youth. These data suggest that early CGM initiation does not adversely impact psychosocial states for families and youth with T1D.

Disclosure
A.Addala: None. F.K.Bishop: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. P.Prahalad: None. M.Desai: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health. V.Ritter: None. B.Shaw: None. E.Pang: None. A.L.Cortes-navarro: None. I.Balistreri: None. A.Loyola: None. S.A.Alamarie: None. A.Schneider-utaka: None.

Funding
National Institutes of Health (K23DK13134201, R18DK122422)
113-LB: Daytime Time in Range Is Associated with Weight Loss Success in Patients with Prediabetes or Moderately Controlled Type 2 Diabetes
Authors: BARUA SOUPTIK , UPADHYAY DHAIRYA A. , POPP COLLIN , HU LU , CURRAN MARGARET , BERUBE LAUREN , LI HUILIN , WANG CHAN , LOU POMPEII MARY , MOTTERN MEREDITH , ST-JULES DAVID , SEGAL ERAN , BERGMAN MICHAEL , ALEMAN JOSE O. , MARIE SCHMIDT ANN , ANN SEVICK MARY 
Published: June 2023

Objective: We quantified the association of overall and daytime time in range (TIR, 70-140 mg/dL) with weight change in a behavioral weight loss intervention.
Methods: Data for this study came from the Personal Diet Study, a 6-month weight loss trial in adults with prediabetes or moderately controlled T2D (HbA1c&lt;8%) involving remote behavioral counseling and dietary self-monitoring via a smartphone app. Participants wore blinded Abbott Freestyle Libre Pro CGMs for ≤2 weeks at baseline and 6 months. Based on clinically meaningful changes in two TIR metrics: “All-TIR” (all CGM readings) and “Day-TIR” (6am-midnight CGM readings), participants were categorized as “Improved” (&gt;5%), “No Change” (-5 to 5%), or “Declined” (&lt;-5%). Associations between TIR change categories and %weight change were determined using one-way ANOVAs.
Results: We analyzed baseline and 6-month CGM data from 66 participants (age 63±8 years, 62% female, 64% White, 20% African American, BMI 31.5±5.0 kg/m2, HbA1c 5.8±0.5%). When stratified by Day-TIR change, Improved had greater weight loss compared to No Change and Declined (p=0.006) (Figure 1). When stratifying using All-TIR, no significant weight change differences were observed across groups (p=0.15).
Conclusion: Improved daytime TIR, but not overall TIR, was associated with greater weight loss in a behavioral weight loss intervention.

Disclosure
S. Barua: None. M. Mottern: None. D. St-jules: Consultant; Ardelyx, Inc. E. Segal: None. M. Bergman: None. J. O. Aleman: Advisory Panel; Intellihealth, Consultant; Novo Nordisk, Employee; Veterans Administration, Research Support; NIH - National Institutes of Health, Veterans Administration. A. Schmidt: None. M. Sevick: None. D. A. Upadhyay: None. C. Popp: None. L. Hu: None. M. Curran: None. L. Berube: None. H. Li: None. C. Wang: None. M. Pompeii: None.

Funding
American Heart Association (17SFRM33590133)
117-OR: Provider Perspectives on Diabetes Education for Emerging Adults (EAs)
Authors: MEHROTRA NEHA , KRALL JODI S. , NG JASON , SIMINERIO LINDA M. 
Published: June 2023

Emerging adulthood, the developmental stage between 18 to 25 years, is a critical time when individuals with type 1 diabetes mellitus (T1DM) assume self-care responsibility and transfer to adult care. Current diabetes self-management education and support (DSMES) has been cited for not meeting the needs of EAs. Models addressing this problem need to be explored. This study was designed to gain perspectives on current DSMES delivery from DM providers.
Methods: Health care professionals (HCPs, n=52, 40% endocrinologists, 34% diabetes care and education specialists) who provide adult care to EAs with T1DM completed an online survey designed to gain insights on the provision of DSMES to EAs.
Results: Most HCPs (60%) were unsure or disagreed that EAs with T1DM received sufficient DSMES while in pediatric care. 74% felt strongly that their patients had not received adequate education to successfully transfer to adult care. In terms of frequency of DSMES, when asked 52% HCPs answered at every visit, 35% said annually, and 13% when a change in care was identified. Most HCPs (80%) agreed that one-to-one, in person visits are the best format for DSMES, but also agreed that telehealth (73%) could be used to augment DSMES delivery. Interestingly, 93% HCPS agreed that there was a role for a peer support. In considering use of CGM data and self-management, uniformly HCPs (99%) felt confident in their ability to interpret CGM data and reported reviewing downloads with EA at every visit (98%), however HCPs (92%) were not confident that EAs can self-manage diabetes in response to their CGM data.
Conclusion: Efforts to engage EAs for improved participation in DSMES need to be explored for effective self-management.

Disclosure
N. Mehrotra: None. J.S. Krall: Research Support; Sanofi, Becton, Dickinson and Company. J. Ng: Research Support; Sanofi-Aventis U.S. L.M. Siminerio: Advisory Panel; Abbott. Research Support; Becton, Dickinson and Company, Sanofi.
1195-P: Is Gestational Diabetes by IADPSG Criteria Associated with Risk of Autism in Offspring?
Authors: XIANG ANNY , CARTER SARAH A. , LIN JANE C. , CHOW TING , MARTINEZ MAYRA P. , PAGE KATHLEEN A. , KLARA FELDMAN R. 
Published: June 2023

We assessed whether only one abnormal value from the OGTT screening during pregnancy, which qualify as GDM by the IADPSG criteria (GDM_IADPSG), was associated with risk of offspring autism spectrum disorders (ASD). The cohort included 590,001 singletons from a large integrated healthcare system with electronic medical records. GDM was largely screened by two-steps and Carpenter-Coustan criteria (GDM_CC). We excluded those exposed to pre-existing diabetes or 1-hr 50g glucose challenge test ≥ 200mg/dl. OGTT glucose levels were used to define GDM_IADPSG. Cox models with hazard ratio (HR) were used to assess associations. Among the cohort, 7.6% were exposed to maternal GDM_CC, an additional 5.9% to GDM_IADPSG with only one abnormal OGTT value. Within GDM_CC, 41.3% had abnormal fasting, 30.5% were diagnosed at ≤ 26 wks and 30.7% prescribed medications. Within GDM_IADPSG, 28.4% had abnormal fasting alone, 27.0% at ≤ 26 wks and none received medications. Table 1 shows the HRs (95% CI). GDM_IADPSG was associated with increased risk of ASD, with risk slightly lower compared to GDM_CC. However, the risk appeared greater if abnormal fasting presented at diagnosis. The risk of ASD associated with GDM_IADPSG by abnormal fasting alone was comparable to GDM_CC treated with medications. Studies are needed to assess whether diabetes management for pregnancies with only elevated fasting will reduce adverse effect on offspring.

Disclosure
A.Xiang: None. S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. K.A.Page: None. R.Feldman: None.