bluuebunny/crossref_metadata_2025_split huggingface dataset:
1010-P: Cost and Utilization of Health Care Services for Persons with Diabetes
Authors: REYNOLDS EVAN L. , MIZOKAMI-STOUT KARA R. , PUTNAM NATHANIEL , BANERJEE MOUSUMI , ALBRIGHT DANA , LEE JOYCE M. , BUSUI RODICA , FELDMAN EVA L. , CALLAGHAN BRIAN C. 
Published: June 2023

Objective: To describe and compare healthcare costs and utilization for persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and those without diabetes.
Methods: Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and those without diabetes using a propensity score quasi-randomization technique. In each year between 2009-2018, we summed costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to healthcare providers, hospitalizations, and emergency room (ER) visits. Costs and utilization were scaled using total patient follow-up in each year.
Results: In 2018, we found that out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $950, total: $10,626), followed by persons with T2D (out-of-pocket: $670, total: $7,516), and persons without diabetes (out-of-pocket: $447, total: $4,483). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 78.2%, T2D: 76.2%, control: 70.5%). From 2009-2018, utilization of hospitalizations (T1D: +23.7%, T2D: +17.3%, controls: +22.0%) and ER visits (T1D: +54.9%, T2D: +56.0%, controls: +50.1%) increased regardless of diabetes status, and use of diabetes-related supplies (+22.1%) were increasing for persons with T1D.
Conclusions: Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from these healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a focus on medication related costs.

Disclosure
E.L.Reynolds: None. K.R.Mizokami-stout: None. N.Putnam: None. M.Banerjee: None. D.Albright: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. E.L.Feldman: None. B.C.Callaghan: None.

Funding
National Institutes of Health (K99DK129785 to E.V.L.), (1K23DK13129601A1 to K.R.M-S.), (D300P30, 12959224, UH3HD087979, UH3HD087979-04S1 to J.M.L.), (R01DK115687 to B.C.C.), (R01DK129320, R01DK107956, R01DK130913 to E.L.F.); National Institute of Diabetes
1013-P: LGBTQ+ Supportive and Inclusive Care Practices in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: RAYMOND JENNIFER , MUNGMODE ANN , CASES-VILLABLANCA JESSE , FLORES GARCIA JAQUELIN J. , BUTLER ASHLEY , DEMETERCO-BERGGREN CARLA , RIOLES NICOLE , OCHOA-MAYA MARGARITA , MANUKYAN MAKAILA , MAAHS DAVID M. , MCDONOUGH RYAN , MAJIDI SHIDEH , COLLABORATIVE T1DX-QI 
Published: June 2023

Background: Individuals with gender-expansive identities and diverse sexual orientations are more likely to experience health disparities and psychosocial stressors when compared to their non-LGBTQ+ peers. It is uncertain if these identities are included in diabetes care discussions. We sought to understand LGBTQ+ supportive and inclusive care practices across the T1DX-QI.
Methods: Thirty-three pediatric (66%) and 17 adult (34%) T1DX-QI centers that serve patients from less than one year old to 99 years old completed a survey about their LGBTQ+ supportive and inclusive care practices in mid-2022. Significance testing was conducted using Fisher’s exact test.
Results: Most pediatric (88%) and adult (76%) centers reported gender-affirming care was legal in their state. Almost 90% of pediatric and adult centers document patients’ self-identified gender identity, but more pediatric (82%) than adult (65%) document pronouns used by patients with diabetes. A majority of pediatric and adult centers (97% and 82%, respectively) document sex assigned at birth (SAAB), but less than half of the institutions (39% pediatric and 24% adult) change SAAB in their electronic health record. Only 44% of pediatric and 47% of adult centers document sexual orientation, but 64% of pediatric and 53% of adult centers have implemented strategies to support asking about gender identity and sexual orientation within their clinics. The results for documented patient self-identified gender identity, and documented pronouns were both significant, with p-values less than 0.05.
Conclusion: Most T1DX-QI centers document gender identity and pronouns. Fewer centers document sexual orientation. Although these are promising first steps, more is needed to support and empower the LGBTQ+ community with diabetes. Additionally, further research is needed to understand how implementing supportive and inclusive care practices impacts outcomes for LGBTQ+ patients with diabetes.

Disclosure
J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. R.Mcdonough: None. S.Majidi: None. T1dx-qi collaborative: n/a. A.Mungmode: None. J.Cases-villablanca: None. J.J.Flores garcia: None. A.Butler: None. C.Demeterco-berggren: Speaker's Bureau; Glooko, Inc. N.Rioles: None. M.Ochoa-maya: None. M.Manukyan: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1017-P: Association between Early-Pandemic Primary Care Telemedicine Exposure and Ongoing HbA1c Outcomes
Authors: REED MARY , HUANG JIE , MILLMAN ANDREA 
Published: June 2023

Objective: Telemedicine helped maintain primary care access for patients with diabetes when in-person health visits were restricted early in the COVID-19 pandemic. There is little known about the longer-term impact of pandemic telemedicine on patient outcomes.
Method: In an integrated health care system that temporarily shifted all patient-initiated primary care visits to telemedicine during the early pandemic, we used EHR data to compare patients with diabetes exposed to a primary care video or telephone telemedicine visit during the first year of the pandemic (4/2020-03/2021), and examined two outcome variables in second year of the pandemic (04/2021-03/2022): any HbA1c measured, and HbA1c &lt;8%. Using multivariate logistic regression to examine the association between telemedicine exposure and outcomes, we adjusted for patient age, sex, race, language, neighborhood SES and internet, video visit and patient portal history, other comorbid chronic conditions, and baseline HbA1c, then calculated multivariate adjusted outcome rates.
Results: Among 242,848 patients with diabetes, 49.8% were age 65+, 59.9% were of non-White race/ethnicity. During the first year of pandemic, 42% were exposed to a primary care video visit, 32% had only telephone visits (25% had no visits). The adjusted rate of HbA1c testing in the outcome period was 91% among those with a video or telephone visit, compared to 87% for those with no visit (p&lt;0.05). Similarly, an adjusted 69% of those with a video visit had HbA1c &lt;8% compared to 67% among patients with no visit (p&lt;0.05), with stronger associations among patients with baseline HbA1c 8+.
Conclusion: In patients with diabetes, primary care telemedicine exposure during the initial pandemic period was associated with downstream higher rates of HbA1c testing and greater rates of HbA1c’s within target range. Telemedicine primary care access likely supported continuity in diabetes management during the pandemic.

Disclosure
M.Reed: None. J.Huang: None. A.Millman: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085070)
1022-P: Trends in Glucagon Fill Rates among U.S. Adults with Diabetes and End-Stage Kidney Disease on Dialysis
Authors: GALINDO RODOLFO J. , INSELMAN SHEALEIGH , MOAZZAMI BOBAK , ALI MOHAMMED K. , UMPIERREZ GUILLERMO , MCCOY ROZALINA G. 
Published: June 2023

Patients with diabetes (DM) and end-stage kidney disease (ESKD) on dialysis have a high risk of severe hypoglycemia and more than 70% are treated with insulin therapy. While not all hypoglycemic events can be prevented, glucagon is recommended for patients at high risk for hypoglycemia to revert and prevent hospitalization with severe hypoglycemic events. Prior studies have shown low rates of glucagon utilization, but excluded patients with ESKD who are at highest risk for these events. We used the USRDS, the most comprehensive nationwide database of patients with ESKD in the US, to examine the quarterly rates of glucagon fills among U.S. adults with DM and ESKD receiving dialysis. Among 254,195 adults (≥18 years) with ESKD and type 1 DM (N=27,538) or type 2 DM (N=226,657), with 76.9% using insulin therapy, between 2013-2017. Fewer than 2% of patients with type 2 DM and fewer than 4% of patients with type 1 DM filled a glucagon prescription, with declining fill rates over time among patients with type 2 DM and stable rates among patients with type 1 DM. Clinical Characteristics and trends in glucagon prescriptions are shown in Table 1. Our findings suggest an urgent and critical need for education of clinicians, patients, and caregivers to improve the prescribing and use of glucagon: a life-saving rescue medication.

Disclosure
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. S.Inselman: None. B.Moazzami: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.G.Mccoy: Consultant; Emmi.
1023-P: Current Practices in Racial Equity—Findings from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) in 2022
Authors: SANCHEZ JANINE , CASES-VILLABLANCA JESSE , ADDALA ANANTA , MUNGMODE ANN , WRIGHT TREVON , WOLF RISA M. , AHMANN ANDREW , MATHIOUDAKIS NESTORAS N. , NG JASON , ZUPA MARGARET , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI 
Published: June 2023

Background: Medical racism contributes to adverse health outcomes. T1DX-QI is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in type 1 diabetes care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity.
Methods: The annual T1DX-QI survey was administered to participating clinics fall 2022 and had a 94 % response rate. There were 50 responses consisting of 66% pediatric (P) and 34% adult (A) institutions. Questions concerned clinic resources, LGBTQ+ practices, racial equity, patient transition, and reproductive health. Response data were aggregated, summarized and stratified by P/A institutions.
Results: Only 21% P and 33% A institutions felt all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, DEI offices/committees, patient resources and hiring practices. Patient resources include interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Majority of institutions have offered anti-racism training in the last year (P 85%, A 72%) and annually (P 64%, A 56%). Pediatric teams felt that their anti-racism training was effective more often (P 60%, A 45%) and more commonly were provided resources (67% P vs 47% A) to help address inequities.
Conclusion: Despite increased offering in anti-racism training, insufficient institutional support and perceived subeffective training still represent obstacles especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.

Disclosure
J.Sanchez: None. M.Zupa: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. J.Cases-villablanca: None. A.Addala: None. A.Mungmode: None. T.Wright: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. A.Ahmann: Advisory Panel; Medtronic. N.N.Mathioudakis: None. J.Ng: Research Support; Sanofi-Aventis U.S.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1028-P: Rates of GLP1 Prescription in Patients with T2D after MI Are Poor Even among Patients Willing to Inject Insulin
Authors: DWEIK ASEEL A. , DELLA-PENNA PAIGE L. , SUMARSONO NATHAN , MALLADI CHAITANYA L. , GEURINK KYLE , MATHEW CHRIS , MOSS ELIZABETH , PEYKOVA KREMENA , MACK-BOYD LISA , DAS SANDEEP 
Published: June 2023

Introduction: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) both reduce major adverse cardiovascular events (MACE) in patients with T2D after MI. To test whether prescription rates of these medications are associated with willingness to take injectable therapies, we examined prescription rates stratified by co-prescription of insulin in a large urban safety net teaching hospital which provided SGLT2 and GLP1 to low income patients at nominal cost.
Methods: Using data from the hospital EHR for all patients with T2D and eGFR &gt; 30 hospitalized with type 1 MI between 2018-2019, we determined rates of prescription of GLP1 and SGLT2 at one year.
Results: Of the 55 patients prescribed insulin at the time of index MI admission, 9 (16%) were prescribed GLP1RA and 26 (47%) were prescribed SGLT2i at one year follow-up. In contrast, of the 68 patients not prescribed insulin at time of index MI admission, 4 (6%) were prescribed GLP1RA and 39 (57%) were prescribed SGLT2i at one year follow-up.
Conclusion: Even among patients with demonstrated willingness to take injectable medications, rates of GLP1 prescription are poor overall and lower than SGLT2 prescription rates.

Disclosure
A.A.Dweik: None. S.Das: None. P.L.Della-penna: None. N.Sumarsono: None. C.L.Malladi: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.
1029-P: Building Diabetes Care Capacity in Rural Underserved Communities—A Comparison of Cardiorenal Risk Factor Outcomes in Patients Treated by ECHO-Trained Providers vs. an Academic Medical Center
Authors: BOUCHONVILLE MATTHEW F. , ERHARDT ERIK B. , LEYVA YURIDIA L. , MYASKOVSKY LARISSA , UNRUH MARK L. , ARORA SANJEEV 
Published: June 2023

Background: National trends in diabetes outcomes, particularly in rural communities, do not mirror the significant benefits seen in clinical trials with emerging therapeutics and technologies. This disconnect is partly attributable to therapeutic inertia around uptake of clinical practice guidelines that have prioritized cardiorenal risk reduction. Project ECHO is a workforce development program that supports implementation of guidelines in under-resourced areas through virtual communities of practice and case-based learning. We hypothesized that the care of patients with diabetes treated by rural ECHO-trained providers would be non-inferior to those treated by specialists at an academic medical center (AMC).
Methods: A multidisciplinary team from a minority-majority state-funded AMC launched a weekly 2-hour diabetes ECHO program to mentor care dyads consisting of a primary care provider and community health worker at 10 rural primary care clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the AMC. Multiple regression models were adjusted for age, sex, baseline A1c and BMI, baseline risk factor outcome, and interactions with site. All model assumptions were satisfied.
Results: The mean follow-up duration was 21 months in the ECHO cohort and 18 months in the AMC cohort. Compared to the AMC cohort (n=151), patients in the ECHO cohort (n=856) experienced a greater A1c reduction (-1.4% vs -0.3%; P=0.017) and were more likely to achieve an A1c&lt;8% (20.1% vs. 0.3% increase in those achieving A1c&lt;8%; P&lt;0.001). Changes from baseline in BP, LDL, and urine microalbumin were similar between groups (P&gt;0.05).
Conclusions: ECHO may be a suitable intervention for improving diabetes and cardiorenal risk factor outcomes in rural, under-resourced communities where access to a specialist is limited.

Disclosure
M.F.Bouchonville: None. E.B.Erhardt: None. Y.L.Leyva: None. L.Myaskovsky: None. M.L.Unruh: None. S.Arora: None.
1030-P: Large-Scale Implementation of a Digital Solution to Support Management of Gestational Diabetes
Authors: VARNFIELD MARLIEN , BUTTEN KALEY 
Published: June 2023

Introduction: Gestational Diabetes Mellitus (GDM) is one of the most common medical conditions of pregnancy and its incidence is rising. The MoTHer system, an App and web-based portal, was developed to support GDM management. It enables multidisciplinary care co-ordination by providing shared access to healthcare professionals involved in GDM care.
Methods: MoTHer was developed through co-design with users at an urban Australian hospital and tested in a feasibility study (n=40) in 2017-18. An implementation trial commenced in June 2020 and is currently underway in 5 Australian hospitals of varying sizes.
Results: More than 5000 women have utilised the MoTHer app. Care models differ at participating hospitals, some offering MoTHer as business as usual to all women with GDM, others providing MoTHer as an alternative to the traditional paper-based blood glucose diary, and one hospital only offering MoTHer to GDM patients on insulin. Each site has different implementation requirements and experiences, yet feedback from surveys administered (&gt;300 responders) is positive, suggesting long-term adoption. Initial economic evaluation indicates a modest saving to health services. However, cost savings for the woman are estimated to be considerable (≈US$400 per patient) after accounting for lost wages, childcare, and travel expenses avoided. Comparing pre- and post-implementation groups, maternal (onset, mode of birth) and neonatal (birthweight, nursery admission) outcomes suggest MoTHer is clinically equivalent to traditional care.
Discussion: The MoTHer system has been created to see greater efficiencies for both healthcare providers and for expectant mothers. This multi-site study highlights the adaptability of a digital solution to different GDM health services. Moreover, re-imagining GDM patient care by introducing a digital based model of care is promising substantial positive cost implications for patients without compromising their clinical outcomes.

Disclosure
M.Varnfield: None. K.Butten: None.
1032-P: A System-Based Approach to Advancing Care Delivery in High-Risk Patients with T2D—Findings from a Quality Improvement Educational Intervention (QIEi)
Authors: RAO PRATIBHA , MAKIN VINNI , KAWCZAK STEVEN , LAZURE PATRICE , BENA JAMES F. , MCFADDEN PAM , JACOBS GINNY , PANTALONE KEVIN M. 
Published: June 2023

Background: A Quality Improvement Educational Intervention (QIEi) was developed to improve disease management for T2D patients with CVD/CKD who may benefit from SGLT-2i/GLP-1RA. An aim was to assess the change in the number of prescriptions of these two medication classes.
Methods: The QIEi was deployed at two practice sites of a large Integrated Health Care System. A team was formed comprising of endocrinologists and 3 PCPs at each site. EHR data review confirmed the gaps and guided QI project discussions. Process improvements and communication strategies were implemented. All the PCPs at the practice sites (N=18 each) received education on these two medication classes. Cased-based and didactic CME accredited webinars designed to help improve knowledge, decision-making and implement best practices were made available for on-demand participation across the health care system.
Results: Prescription rates of SGLT-2i and GLP-1RA at the intervention (N=4247 baseline, 4033 follow up) and non-intervention sites (N=98637 baseline, 91923 follow up) were obtained pre- and 6 months post QIEi. Odds of GLP-1RA prescription dropped by 2% (p=0.75) at the intervention sites and by 6% (p&lt;0.001) at the non-intervention sites. The decrease was not significantly different across sites (p=0.41). There was a small increase in SGLT2i prescription at the intervention sites (p=0.90), while the odds of use decreased by 3% (p=0.017) at non-intervention sites. This was not significantly different across sites (p=0.54).
Conclusion: No meaningful change in prescriptions post-QIEi at the two intervention sites was observed. While it did improve knowledge and engagement, it did not translate into prescription increases. Perhaps more time is needed to observe system-wide changes and/or other factors need to be considered to increase prescriptions for this patient population. Further studies investigating prescribing barriers are warranted.

Disclosure
P.Rao: None. V.Makin: Speaker's Bureau; Bayer Inc. S.Kawczak: None. P.Lazure: None. J.F.Bena: None. P.Mcfadden: None. G.Jacobs: None. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk.

Funding
Eli Lilly and Company; Merck & Co., Inc.
1033-P: Improving T2D Collaboration and Patient Communication at the Primary Care Level—Findings from Team-Designed Quality Improvement Education Initiative
Authors: MAKIN VINNI , JACOBS GINNY , DENNIS FRAMPTON BETHANY , PANTALONE KEVIN M. , KAWCZAK STEVEN , MURRAY SUZANNE , MCFADDEN PAM , RAO PRATIBHA 
Published: June 2023

Background: A system-based Quality Improvement Education intervention (QIEi) was developed to improve disease management for T2D patients with/at-risk of CVD/CKD who may benefit from SGLT-2i/GLP-1RA. The QIEi aimed to improve competencies of PCPs, team collaboration and patient communications.
Methods: The QIEi was deployed to PCPs at 2 sites from a USA integrated delivery system. Practice Assessments (PrA) and a pre-intervention EHR data review confirmed the gaps and guided QI team discussions. Team leaders designed webinars on best practices (recorded for later view), and the groups discussed cases, designed process improvements and communication strategies (EHR Smart phrases, clinical reinforcement materials explaining treatments, and enhanced After Visit Summary). Evaluation included PrA (pre=140; post=55), EHR data, smart phrase usage, and qualitative interviews (n=10).
Results: PCPs’ comfort discussing treatment with patients increased (Table 1). Interviewees reported an increase in patient interface, confidence educating patients and team engagement. The QIEi led to system-based changes and sustained clinical reinforcement material adoption.
Conclusion: A team based QIEi can result in effective design, pilot/adoption of patient materials/EHR tools, supporting patient conversations and fostering informed decisions.

Disclosure
V.Makin: Speaker's Bureau; Bayer Inc. G.Jacobs: None. B.Dennis frampton: None. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. S.Kawczak: None. S.Murray: None. P.Mcfadden: None. P.Rao: None.

Funding
Eli Lilly and Company; Merck & Co., Inc.