bluuebunny/crossref_metadata_2025_split huggingface dataset:
962-P: Impact of Digital Diabetes Solution on Glycemic Control in Adults with Type 2 Diabetes Mellitus in the United States—A Retrospective Cohort Study
Authors: THINGALAYA NITA , KERR DAVID , KUMAR POTUKUCHI PRAVEEN , WILSON LAURA , LEE KENI C. , HAN-BURGESS EDWARD JONATHAN K. , EDWARDS ALISON , YU XINYAN , KENNEDY ADEE , LEE FELIX 
Published: June 2023

Background: Dario Diabetes Solution (DDS) is a digital health application (app) that combines a blood glucose (BG) monitoring system with a smartphone app, allowing tracking of BG levels in real time. This study evaluated effectiveness of DDS on HbA1c between DDS users and matched nonusers.
Methods: This retrospective cohort study included adults with type 2 diabetes mellitus (T2DM) with a baseline (BL) HbA1c ≥7% who used DDS (users) or received usual care (nonusers) between January 1, 2017, to October 31, 2021. BL period was 1 year before index date (first DDS registration [users] or first claim date in the quarter [nonusers]); follow-up period was 6 months. DDS user and nonuser cohorts were matched 1:3 using exact and propensity score matching. Primary endpoint was change in HbA1c from BL to 6 months, with subgroup analyses of patients (pts) with BL HbA1c &gt;7.5%, &gt;8%, &gt;9%, and ≥1% drop from BL. Difference-in-difference results are reported using least squares (LS) means from linear models.
Results: The study included 568 DDS users and 1699 nonusers. For all 2267 pts, mean ± SD age was 57.5±11.3 years and HbA1c was 9.14±1.83% at BL. At 6 months, LS mean difference between groups was −0.23% (mean HbA1c change vs BL: users, −1.02% [95% CI, −1.15, −0.89]; nonusers, −0.79% [−0.87, −0.71]; P=0.004). HbA1c drop ≥1% from BL to 6 months was achieved by 47% of users vs 37% nonusers (difference: 10%; P&lt;0.001). Subgroup analysis at all BL HbA1c showed users achieved more significant HbA1c reductions vs nonusers (P&lt;0.05). For pts with BL HbA1c &gt;9%, the healthcare effectiveness data and information set performance measure, mean difference between groups was -0.47% (users, -2.25% [-2.50, -1.99]; nonusers, -1.78% [-1.92, -1.63]; P=0.002).
Conclusions: Adults with uncontrolled T2DM using DDS had better outcomes at 6 months, with more significant HbA1c reductions than matched nonusers across various BL HbA1c levels, showing incremental improvements to usual care.

Disclosure
N.Thingalaya: None. F.Lee: Employee; Sanofi, Stock/Shareholder; Sanofi. D.Kerr: Consultant; Sanofi-Aventis U.S. P.Potukuchi: None. L.Wilson: Employee; Sanofi. K.C.Lee: Employee; Sanofi. E.K.Han-burgess: Employee; Sanofi. A.Edwards: Employee; Symphony Health, an ICON plc company, Other Relationship; Sanofi. X.Yu: None. A.Kennedy: None.

Funding
Sanofi
965-P: The Related Factors Affecting the Relationship between HbA1c and Glucose Management Indicator in Adult T2D Patients with Good Glycemic Control
Authors: LIU ZHIGU , LIN BEISI , CHEN DANRUI , LIN HUIMIN , YANG DAIZHI , YAN JINHUA , YAO BIN , XU WEN 
Published: June 2023

Aim: Glucose Management Indicator (GMI) is correlated with HbA1c, while studies reported the discrepancy between them. Factors affecting this discrepancy, especially in patients with good glycemic control, remain unclear. This study was designed to explore the related factors affecting the relationship between HbA1c and GMI in adult T2D patients with good glycemic control.
Methods: Adult T2D patients with good glycemic control who received HbA1c test and CGM were retrospectively analyzed. GMI and glycemic variability (GV) indices including SD and MAGE were derived from CGMS. The absolute value of hemoglobin glycation index (HbA1c minus GMI) (|HGI|) was used to quantify the difference between HbA1c and GMI. Linear regression and correlation analyses were used to analyze the correlation between GV indices and |HGI|, HbA1c and GMI and whether GV affected their relationship.
Results: Eighty-four patients (median HbA1c 6.6%, median GMI 6.4%) were included. |HGI| was higher than 0.5% in 40% of the patients (n=34). |HGI| was linearly correlated with SD and MAGE (β = 0.291 and 0.294, P&lt;0.05). HbA1c was linearly correlated with GMI (β=0.525, P&lt;0.001). This correlation remained after adjusting for sex, age, diabetes course, BMI, hemoglobin level and with chronic diabetic complications or not (Model 1, β=0.496, P&lt;0.001). Further adjusting for SD (Model 2) or MAGE (Model 3) based on Model 1, the correlation between HbA1c and GMI became weaker (β=0.398 and 0.425, respectively). The correlation between HbA1c and GMI was closer in the patients with normal SD (&lt;1.4mmol/L) than those with abnormal SD (r=0.563 vs. r=0.505). A similar result could be found in patients with normal MAGE (&lt;3.9mmol/L) and abnormal MAGE (r=0.579 vs. r=0.514).
Conclusion: HbA1c was positively correlated with GMI. But even in adult T2D patients with good glycemic control, the correlation between HbA1c and GMI was significantly affected by GV. SD or MAGE accounted for this discrepancy.

Disclosure
Z.Liu: None. B.Lin: None. D.Chen: None. H.Lin: None. D.Yang: None. J.Yan: None. B.Yao: None. W.Xu: None.
984-P: Importance and Use of Smart Insulin Pens with Connectivity for Diabetes Management
Authors: HEINEMANN LUTZ , EHRMANN DOMINIC , HERMANNS NORBERT , ROOS TIMM , KULZER BERNHARD 
Published: June 2023

Smart insulin pens have the potential to fulfill some of the unmet needs of people with diabetes through the accurate administration of bolus doses, the simplification of documentation relating to diabetes therapy, the improvement of communication and the quality of advice given to patients. 305 (2021) and 336 diabetologists in Germany (2022; 38% female, average age 55.2 years) were asked via an online survey about the importance and use of smart insulin pens. In 2022, only 4.8% of all people with type 1 diabetes and 1.5% of all people with type 2 diabetes used a smart pen. The total estimated utilization in 5 years is 18.3% (2021: 23.9%). The importance of smart pens is currently estimated by diabetologists at 8.0%, which is not very high and lower than in 2021 (15.5%). This also applies to the estimated relevance in 5 years (2022: 24.7 %; 2021: 37.9 %). However, 29.7% of all people with type 1 diabetes are considered to have an indication for a smart pen, 30.8% of people with type 2 diabetes and basal insulin therapy, and 37.6% with multiple injection therapy. The main barriers to smart pens identified were patient preference for prefabricated pens (54.6% agreement), low added benefit (49.4%), lack of interoperability with glucose analysis software (44.3%), lack of interoperability with apps (35.6%), too little choice (need to change insulin), and too high cost (33.9%). Despite a very positive attitude towards digitization of diabetes therapy among physicians (2021: 81.9%; 2022: 86.3%), smart pens are currently used only very rarely and their importance for diabetes therapy is considered rather low. Better, simpler, and patient-friendly solutions are needed so that all types of smart insulin devices can be read easily by glucose management software and users experience perceivable benefits.

Disclosure
L.Heinemann: Consultant; 9am.health. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. T.Roos: None. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care.
985-P: Is Insulin Titration Supported by a Titration App Safe? Safety Results of an RCT
Authors: KULZER BERNHARD , EHRMANN DOMINIC , ROOS TIMM , FINKE-GROENE KATHARINA , HERMANNS NORBERT 
Published: June 2023

A multicenter RCT in people with type 2 diabetes has shown that the use of a basal insulin titration app (myDose Coach) reduced A1c levels by 0.35 percentage points compared to titration without an app. Is the use of such a titration app associated with safety issues? We used negative binomial regressions to analyze the occurrence of adverse and serious adverse events (AE, SAE) and exposure to dangerously low (&lt;54 mg/dl) or high (&gt;250 mg/dl) glucose levels in 251 participants (age 60.0 years IQR 56.0 - 66.5; HbA1c 8.2 IQR 7.7 - 9.1%) randomized equally to the control and intervention groups. A total of 30 AEs (16 vs. 14 events) occurred in the control and intervention groups, of which 14 were SAEs (7 vs. 7 events). No event was judged to be associated with study participation or the interventions. The rates of dangerous low and high glucose in the control and intervention group were 0.12% vs. 0.10% for %&lt; 54 mg/dl and 4.9% vs. 3.6% for %&lt; 250 mg/dl, respectively (see Figure 1 for IRR and p values for superiority). A post-hoc non-inferiority test for the occurrence of %&lt; 54 mg/dl and &gt;250 mg/dl with non-inferiority margins of &lt; 1% and &lt; 5%, respectively, showed significant non-inferiority regarding the intervention group (both p &lt; 0.01) with a post-hoc power by 75% respectively 55%. The results did not indicate an increased risk for insulin titration by the evaluated app compared to the control condition in terms of AE or extreme glucose excursions.

Disclosure
B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. K.Finke-groene: None. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG.

Funding
Sanofi
987-P: Digital Signals from Continuous Glucose Monitors Predict 90-Day Median Glucose in Type 2 Diabetes
Authors: YUAN LI ZE , CLARK CALLAHAN , SAHA SANKALITA 
Published: June 2023

The use of continuous glucose monitors (CGMs) among people with type 2 diabetes continues to expand beyond those treated with insulin or at high-risk for hypoglycemia. Defining precision CGM utilization strategies and augmenting A1c monitoring approaches is increasingly important to inform the application of episodic or continuous wearable data in clinical, payer, and digital health settings. We offer a method to predict 90-day glucose from 30 days of CGM data, offering an accelerated intervention window for people with T2D at low risk of hypoglycemia and no insulin treatment.
We used linear regression to predict 90-day glucose from initial median glucose and glycemic variability (Fig1A - eq 2). Of 5516 people with T2D in a digital diabetes program with rtCGM and no insulin use (2019 - 2022), 497 had sufficient data for inclusion (age 56.5 +/- 8.9; 49.5% F, 75% with &gt; 81 days CGM wear in the first 90 days). The data was 80/20 train/test split. The model predicted median glucose at 77 - 90 days with MAE +/- 14.7 mg/dL, RMSE 21.9 mg/dL and adj R2 =0.424 for training; and MAE +/- 16.7 mg/dL, RMSE +/- 26.0 mg/dL for testing. Fig 1B shows the distribution of the MAE of full dataset across different initial median glucose levels. Hence, based on the plot, error IQR and outlier boundary increase beyond 177.6 mg/dL, the model may be best used with initial glucose level &lt; 177.6 mg/dL.

Disclosure
Z.Li: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. S.Saha: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
99-OR: Outcomes of Patients With and Without Severe Renal Impairment Admitted with Moderate and Severe Diabetic Foot Infections
Authors: COYE TYLER L. , CRISOLOGO PETER , SULUDERE MEHMET A. , LAVERY LAWRENCE A. 
Published: June 2023

Renal impairment considerations have largely been absent diabetic foot literature, despite evidence that people with severe renal impairment are at elevated risk complications following diabetic foot infections. We evaluated clinical outcomes in patients who were admitted to hospital with diabetic foot infections with severe renal impairment compared with patients without a disability. This was a retrospective study of patients with diabetes mellitus who had been hospitalized at a level 1 trauma center with moderate and severe diabetic foot infections. Patients were grouped according to their Glomerular Filtration Rate (GFR). Patients with severe renal impairment were defined as having a GFR &lt; 30mL/min. Primary outcomes were mortality, wound healing and reinfection rates. Primary and secondary outcomes were compared using multivariable regression RStudio. A total of 307 patients with diabetic foot infections (62 patients with SRI and 245 patients without SRI) were included in the analysis. Multivariate analysis revealed that patients with severe renal impairment had higher rates of peripheral arterial disease (87% vs 66.9%; p = 0.003) and lower hemoglobin levels (9.8 vs 12.0; p &lt;0.001). We found that patients with diabetes and severe renal impairment at admission had significantly lower glycosylated hemoglobin levels (7.2% vs 9.2%; p &lt; 0.001). There was no difference in severity of infections between the two groups. We found that diabetic patients with severe renal impairment had higher mortality rates (8.1% vs 2.0%; p = 0.044) and higher rates of re-admission of new infections at different sites (51.6% vs 22.9%; p &lt; 0.001). There was no significant difference between the other outcomes of interest (wound healing and reinfection). In conclusion, patients with severe renal impairment who were admitted to hospital moderate and severe diabetic foot infections had higher mortality rates and elevated readmission risk than those without severe renal impairment.

Disclosure
T.L.Coye: None. P.Crisologo: None. M.A.Suludere: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.
990-P: Estimating the National Costs of T2DM in the UK within the Context of Contemporary Guidelines
Authors: MCEWAN PHILIP , FOOS VOLKER , MARTIN REBECCA , CHEN JIELING 
Published: June 2023

Background: The updated National Institute for Health and Care Excellence (NICE) type 2 diabetes (T2D) guidelines extend the recommendation of SGLT2 inhibitors (SGLT2i) for hyperglycaemia management to include their use in those with atherosclerotic cardiovascular disease (ASCVD), chronic heart failure (HF), chronic kidney disease (CKD) or high CVD risk. Our study estimates the potential cost consequence in the UK of the broad positioning of SGLT2i within updated guidelines (NG28-2022) versus previous guidelines (NG28-2015).
Methods: The Cardiff T2D model was used to project lifetime outcomes and costs for T2D patients across established UK treatment pathways including metformin, sulfonylurea, DPP-4 inhibitors and NPH insulin with or without SGLT2i combination to reflect former vs. updated guidelines. Analyses were conducted in four subgroups (ASCVD, HF with reduced ejection fraction (HFrEF), CKD, high CVD risk). Projected outcomes were extrapolated to national level using population estimates from NICE’s guideline companion resource impact report.
Results: Predicted lifetime costs for 1.7 Mn SGLT2i eligible T2D patients in the UK were estimated at £87.1 Bn with NG28-2022 compared to £101.7 Bn with NG28-2015. Net savings associated with NG28-2022 management of £14.56 Bn were attributable to comorbid CKD (£5.09 Bn), high CVD risk (£4.77 Bn), ASCVD (£3.96 Bn) and comorbid HFrEF (£0.74 Bn). Overall net savings were predicted despite an increase in pharmacy costs of £5.57 Bn. Changes in metabolic parameters and reduction in cardiovascular and kidney progression rates were predicted to prevent 20183 myocardial infarction events, 66651 HF events and 140303 events of end stage kidney failure. The magnitude of savings was a combination of event reductions and the number of eligible patients in subgroups.
Conclusion: Our study indicates that uptake of SGLT2 inhibitors in line with NICE guidelines has the potential to improve health and be cost saving despite an increase in pharmacy costs.

Disclosure
P.Mcewan: Other Relationship; AstraZeneca. V.Foos: Other Relationship; AstraZeneca. R.Martin: Employee; AstraZeneca. J.Chen: Employee; AstraZeneca, Eli Lilly and Company.
992-P: Coronary Artery Calcium Scoring to Improve Statin Use in Adults with Type 2 Diabetes Not on Statin Therapy—Anticipated Cost Utility
Authors: LAU DARREN , PEARSON GLEN J. , RAGGI PAOLO , KLARENBACH SCOTT 
Published: June 2023

Background: Statin use in adults with diabetes is sub-optimal. Coronary artery calcium (CAC) scoring can provide a visual quantification of CV risk and may improve statin initiation and long-term use. Objective: Estimate the cost-utility of CAC scoring compared to traditional CV risk counselling only, for improving statin use in adults with diabetes who have not previously had a CV event, and are not on statin therapy.
Methods: Probabilistic Markov model from a health system perspective, over a 10-year time horizon. The effectiveness of CAC scoring was obtained from the EISNER trial. Outcomes included acute coronary syndrome (ACS), stroke, heart failure, mortality, and radiation-induced cancer. Outcome rates and costs were obtained from an analysis of Alberta administrative data, and from publicly available sources. The base population modeled was men age 60, with additional analyses for other age, sex-groups and scenarios.
Results: CAC scoring increased statin use to 44% vs 25% with traditional CV risk counselling only. There were 8.4 fewer ACS, 5.5 fewer strokes, and 1.6 fewer deaths / 1000 individuals. Costs were slightly lower (-$14, 95% CI [-$402-(+$208)]) (CAD), for a small benefit in quality-adjusted life years (+0.01, [0.00-0.02]), with mean ICER of $7,132 (-$27,828-(+$65,513)) / QALY. At a willingness-to-pay of $50,000 / QALY, CAC was cost-effective in 95% of trials. CAC scoring was not cost-effective in younger men or in women, but could be cost-effective or cost savings in men (age ≥ 40) and older women (age ≥ 60) who refuse statin therapy, but would be persuaded by personalized evidence of coronary artery disease (CAC score &gt; 10).
Conclusion: CAC scoring may be cost-effective in older men not receiving statins, and in men or older women who agree to use statins if shown personalized evidence of coronary artery disease.

Disclosure
D.Lau: None. G.J.Pearson: Advisory Panel; HLS Therapeutics Inc., Novartis Pharmaceuticals Corporation, Pharmacience, Consultant; Trimedic Therapeutics. P.Raggi: None. S.Klarenbach: Research Support; Bayer Inc., Allergan, GlaxoSmithKline plc., CSL Behring, Lundbeck, University Hospital Foundation (University of Alberta), Purdue Canada.
The Future of Philosophy
Authors: Gabriel Susan Krantz 
Published: June 2023

In the past, philosophy, as it was brought to life originally by the ancient Greeks, was based on the audacious premise that the cosmos is intelligible, that human reason can come to understand reality at least in part. In the early to mid-twentieth century, however, philosophy was declared dead on both sides of the analytic-continental divide, so it seems appropriate to ask whether philosophy has a future and, if so, what sort of future this could and should be. In this essay, I first look at the claims of philosophy’s demise and their philosophical milieu, focusing on Martin Heidegger, Bertrand Russell, and Ludwig Wittgenstein. Then I suggest a reason for the dire forecast, namely, the aftermath of what has been called the “Second Thirty Years’ War,” and respond to objections that can be raised against this explanation. Finally, I indicate the sort of future that I think we should envision for philosophy.
Исследования безопасности технологии MPLS VPN
Authors: Зольников Константин , Чтинзюинь Ли 
Published: June 2023

MPLS использует метки, направляющие новую технологию высокоскоростной и эффективной передачи данных в открытой коммуникационной сети. Технология QoS, основанная на MPLS VPN, может сделать голос, видео и другие ключевые виды обеспечения качества обслуживания в режиме реального времени, вполне может решить «Triple Play». В этом документе представлена теория MPLS VPN, затем обсуждаются безопасность и характеристики MPLS VPN. Схема с MPLS VPN состоит из ограничений безопасности, использует шифрование группы доступа VPN и аутентификацию на основе PKI для обеспечения безопасности VPN-подключения и маршрутизации. Наконец, используя программное обеспечение OPNET, проведите имитационные эксперименты для доступа к сайту членов группы VPN, иначе вы не будете захватывать или заливать потоки данных передачи VPN на сайт, который может быть вызван только действительными членами группы VPN.
Ключевые слова: MPLS; VPN; PKI
Vers un modèle théorique interdisciplinaire de Didactique d’Éducation à la Citoyenneté numérique
Authors: Tadlaoui-Brahmi Ania , Alvarez Lionel , Buttier Jean-Charles 
Published: June 2023

L’institution scolaire de Suisse romande place l’éducation à la citoyenneté numérique et le développement d’une culture numérique comme nouvelles finalités éducatives. Les contours de ces concepts, ainsi que leur opérationnalisation dans les pratiques enseignantes, restent à définir plus précisément.
Faisant suite à une analyse des concepts de « citoyenneté » et « culture » numériques, les représentations de 14 enseignant·e·s romand·e·s du cycle 2 ont été interrogé·e·s. Leurs propos rapportent un flou conceptuel et un besoin de clarification à la lumière de la littérature scientifique. En conséquence, un modèle théorique de Didactique de l’Éducation à la Citoyenneté numérique est proposé afin de participer à un premier pas vers une transposition didactique d’éléments conceptuels.
Les enjeux de l’enseignement-apprentissage de la transformation chimique au secondaire I : regards croisés sur les prescriptions officielles et ressources formelles en Suisse romande et en France
Authors: Sudriès Marie , Ligozat Florence , Cross David 
Published: June 2023

Cet article propose d’interroger les conditions d’enseignement-apprentissage du concept de transformation chimique par des élèves de 13-15 ans, en Suisse romande et en France. L’analyse des prescriptions officielles et des ressources formelles nous montrent que, si ce concept est au cœur du curriculum de chimie dès le secondaire I, il est également présent en biologie/géographie/SVT, via la notion de « cycle du carbone », objet au cœur de questions complexes en lien avec le réchauffement climatique. Au-delà de l’enseignement-apprentissage de la transformation chimique dans le cadre strictement disciplinaire de la chimie, il s’agit donc de comprendre comment ce concept peut soutenir le traitement de questions complexes et d’ainsi contribuer à la formation des citoyen·ne·s.
Guarding information’s Other: Theorising beyond information and communications technologies for disinformation
Authors: NicolaÏ Joseph M. 
Published: June 2023

ABSTRACT
If Plato’s allegory of information trouble occurred within a torchlit cave, the scale and scope of technical developments in information and communication technologies have not superseded his perennial concerns. Drawing from the sociology of knowledge and objectivity in news, in this article, I examine a set of cases of contested information within American communication. Beyond reductionist approaches to objectivity and falsehood in information, these cases bring to light political and cultural contestation over the presentation, omission, and selection of information, as well as value in speculative information. Taken together, these highlight the need for a framework to cover a range of informational issues. The proposed meta-classification of information’s Other opens an analytical space not only to account for today’s alleged information disorder, but also to address long-standing concerns with information order.