bluuebunny/crossref_metadata_2025_split huggingface dataset:
1069-P: Digital Platform Users Managing Three Chronic Conditions—Diabetes, Hypertension, and Overweight—Experience Better Outcomes than Those Who Manage One Condition, after Six Months
Authors: HERSHCOVITZ YIFAT , BUDMAN SOFIA , YANIV NOGA , MANEJWALA OMAR 
Published: June 2023

The coexistence of diabetes, hypertension, and overweight increases the risk for macrovascular and microvascular complications. This study followed users who managed multiple chronic conditions measures, blood glucose (BG), blood pressure (BP) and weight with a single integrated digital platform. The objective was to investigate BG levels and engagement to blood glucose monitoring system (BGMS) in users managing BG, BP and weight on a single platform compared to users managing only BG on the same platform. A retrospective data analysis was performed on users who were active during 2019-2022 and measured BG using Dario platform at least six months. The test group included users who measured BP and weight within 6 months from their first BG measurement; a matched control group was generated of users who measured BG only. BG levels were assessed by average BG (BG avg) and BGMS engagement was assessed by counting BG measurements per month. High-risk users were defined as those who started BG avg&gt;180mg/dL in Month 1. The test group of 2,154 users showed significantly greater (1.7-fold) BGMS engagement than the control group of 14,954 users in Month 1 and Month 6 (p&lt;0.01) (N=17,108). A test subgroup of 343 high-risk users who measured 3 conditions demonstrated significantly greater reduction versus matched control subgroup of 1,579 high-risk users measured BG only, after 6 months (17% vs.11%) (p&lt;0.01). Moreover, the ratio of population that reduced their BG avg to lower than 180 mg/dL after 6 months (equivalent to A1C 8.0; HEDIS measure) was significantly higher in the test subgroup versus control subgroup in high-risk (by 30%; p&lt;0.01). Monitoring several conditions may have the potential to offer a greater means for person with diabetes effectively manage glycemia. This study can illuminate the relative contribution of multi chronic conditions management driving behavioral change to successful diabetes outcomes.

Disclosure
Y.Hershcovitz: Employee; DarioHealth Corp. S.Budman: Employee; DarioHealth Corp. N.Yaniv: Employee; DarioHealth Corp. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.
107-LB: Clinical Performance of Extended Mio 30 Infusion Set
Authors: COHEN OHAD , COHEN YAEL , CHATTARAJ SARNATH , ZHANG GINA , ANSELMO EVAN , TIROSH AMIR 
Published: June 2023

Objective: Medtronic Mio™ 30 infusion set (M30IS) is a single use IS for pump users with pre-loaded inserter, a 30° insertion angle, and labeled for 3-day use. The M30IS wear duration is impacted by initial local trauma caused by insertion and sustained inflammation by cannula & insulin infusion (insulin aggregates & other impurities in the infusate), with the latter being predominant. An extended Mio™ 30 infusion set (EM30IS) was developed by improving insulin formulation stability in the fluid path. This study reports on the performance of the EM30IS in persons with T1D during an early feasibility trial (ClinicalTrials.gov: NCT05544643).
Method: This is a X over study of EM30IS and M30IS on 21 subjects with type 1 diabetes. Each subject wore both sets 4-5 times each on a preferred site that was continuously infused with insulin lispro or aspart subcutaneously via a Medtronic 780G pump for 3 days (M30IS), 7 days (EM30IS) or until failure. Endpoints of safety and effectiveness (failure rate due to unexplained hyperglycemia &lt;16%) were evaluated. Exploratory analyses related to performance and glycemic control were also evaluated.
Results: The EM30IS survival rate at 6 days (70%) was comparable to M30IS survival rate at 3 days (63%). Glycemic control outcomes were equivalent (see Table 1) and there were no episodes of EM30IS-related severe hypoglycemia or DKA.
Conclusion: The EM30IS was safe and its performance at 6 days was equivalent to the performance of M30IS at 3 days.

Disclosure
O. Cohen: Employee; Medtronic. Y. Cohen: None. S. Chattaraj: Employee; Medtronic. G. Zhang: Employee; Medtronic. E. Anselmo: Employee; Medtronic. A. Tirosh: Advisory Panel; Medtronic. Research Support; Medtronic. Speaker's Bureau; Medtronic. Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Research Support; Sanofi. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company.

Funding
Medtronic
1072-P: Incidence of Inpatient Hypoglycemia by Specialty Area—A Case for Targeted Inpatient CGM
Authors: LEWIS GEMMA A. , CARDWELL JANET , BUJAWANSA SUMUDU , HARDY KEVIN J. 
Published: June 2023

Inpatient hypoglycemia is traumatic for people with diabetes and increases length of stay, hospital costs and subsequent mortality (at least in the elderly). We report inpatient hypoglycemia by specialty ward in an 800-bed, acute hospital serving a largely deprived population (350,000) with diabetes prevalence 8%. Over 1 year, 21,089 inpatients with diabetes had 176,603 point of care (POC) tests (median 8.4, ward range 1.1-29.2, POC tests/person/stay); and 9.2 (ward range 2.1-24.7)% of subjects experienced hypoglycemia (CBG &lt;72 mg/dl). Patients who experienced hypoglycemia had 2.6 (range 1.2-5.8) episodes of hypoglycemia either from early persistence (failure of protocol-driven hypoglycemia treatment) or late recurrence. There was a strong correlation between POC testing frequency and detection of hypoglycemia (Chi-square, Yates’ correction = 8.4374, p=0.004). Compared with the whole hospital (index 1.0), specialty wards hypo index ranged 10-fold from 0.2 to 5.1.

A recent RCT demonstrated CGM superiority over POC testing in preventing recurrent inpatient hypoglycemia. Consistent with this RCT, our data suggest that increased POC testing is associated with increased hypoglycemia detection and our approach might guide initial targeting of CGM to highest risk specialty wards for hospitals unable to deploy CGM simultaneously in every inpatient specialty ward area.

Disclosure
G.A.Lewis: None. J.Cardwell: None. S.Bujawansa: Stock/Shareholder; Merck & Co., Inc., GlaxoSmithKline plc. K.J.Hardy: Other Relationship; Sanofi, Speaker's Bureau; Napp Pharmaceuticals Limited.
1078-P: Codesigning Diversity, Equity, and Inclusion Communication Tools for Diabetes Management
Authors: CHAO EDWARD C. , RATAJ HEIDI , PAI DEYSHNA J. , NAGRA HARPREET 
Published: June 2023

Only 29% of African-Americans and 39% of Latinx persons living with type 1 diabetes mellitus (T1DM) use insulin pumps, compared with 61% of white individuals. Social determinants of health contribute to suboptimal access to and use of DM devices. We applied a design thinking process to better understand these barriers, and created a publication that both persons living with DM (PWD) and health care professionals (HCP) could use to provide information and spark a dialogue on DM devices and management.
The Double Diamond Process is a human-centered design framework that discovers, then defines a problem, to develop and deliver a prototype. After diversity, equity, and inclusion training with a consultancy, we interviewed 6 PWD, and 4 HCP (1 dietitian, 1 psychologist, and 2 physicians). We identified 3 key challenges: PWD feel that their contexts, experiences, and needs are often not well-represented or addressed by DM information resources; HCP may not discuss devices; and PWD may not feel fully seen or heard during clinic visits.
User testing helped refine a low-fidelity prototype for an online and print publication, Humans of Diabetes (HOD), with two checklists. The first guides the PWD and HCP through key topics to discuss during clinic visits. The second invites the PWD to reflect on the interaction with the HCP. Both checklists increase PWD's and HCP's awareness of implicit bias and suggest talking points. Compiled with help from advocates of color in the DM communities, HOD features images and stories of people of color living well with DM; as well as resources on DM, devices, medications, and community support. PWD can easily tear off and keep the print version's checklists. HOD could be distributed widely in primary care and DM clinics.
HOD grew out of the design thinking process. This patient-centered collaboration with individuals from diverse perspectives could better start and enhance important conversations, to further optimize access and engagement with devices and care.

Disclosure
E.C.Chao: None. H.Rataj: None. D.J.Pai: None. H.Nagra: Employee; One Drop.
1088-P: Glycemic Control Trajectories among Individuals with Gestational Diabetes Are Associated with Risk of Childhood Obesity in the Offspring
Authors: CHEHAB RANA F. , FERRARA ASSIAMIRA , GREENBERG MARA , LEE CATHERINE , NGO AMANDA , ZHU YEYI 
Published: June 2023

Gestational diabetes (GDM) increases offspring risk of childhood obesity, but the role of glycemic control (GC) is unclear. We examined the association of GC trajectories, which profile longitudinal GC patterns from GDM diagnosis to delivery, with childhood obesity risk. Among 26774 individuals (78% from minority groups) enrolled in Kaiser Permanente Northern California (KPNC)'s GDM care program (2007-2017), we derived four GC trajectories: stably optimal, rapidly improving to optimal, slowly improving to near optimal and slowly improving to suboptimal. Offspring weight and height were collected at well-child visits until 2022. We calculated adjusted relative risk (aRR) and 95% CI of childhood obesity (i.e., sex-specific BMI-for-age ≥95th percentile using CDC growth charts) in association with GC trajectories using modified Poisson regression models adjusted for sociodemographic factors, parity, pre-pregnancy BMI, smoking and alcohol use, birthweight, preterm birth and breastfeeding. Obesity prevalence was 21.9% at 2-5 years, 28.6% at 6-11 years and 30.2% at 12-16 years. Compared to offspring of individuals in stably optimal trajectory who achieved GC shortly after GDM diagnosis, their counterparts in rapidly improving to optimal, slowly improving to near optimal and slowly improving to suboptimal trajectories had an increasing gradient of obesity risk at 2-5 years (aRR [95% CI]: 1.04 [0.98, 1.10], 1.06 [0.99, 1.14] and 1.16 [1.07, 1.25], respectively) and 6-11 years (1.08 [1.02, 1.15], 1.07 [0.99, 1.15] and 1.15 [1.07, 1.24], respectively); both P-for-trend&lt;0.001. A similar yet weaker pattern was observed at 12-16 years (0.98 [0.88, 1.10], 1.03 [0.90, 1.18] and 1.13 [0.97, 1.30], respectively; P-for-trend=0.11). These associations were stronger in girls than boys (all P-for-interaction&lt;0.05). Early GC achievement after GDM diagnosis and throughout pregnancy may be associated with lower offspring obesity risk in childhood.

Disclosure
R.F.Chehab: None. A.Ferrara: None. M.Greenberg: None. C.Lee: None. A.Ngo: None. Y.Zhu: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924); The Permanente Medical Group
1089-P: Gestational Glucose Intolerance and Risk of Childhood Overweight and Obesity
Authors: MAYA JACQUELINE , HSU SARAH , SCHULTE CAROLIN C.M. , JAMES KAITLYN , THAWEETHAI TANAYOTT , HIVERT MARIE-FRANCE , POWE CAMILLE E. 
Published: June 2023

Infants of individuals with gestational glucose intolerance (GGI, abnormal glucose loading test [GLT] without gestational diabetes [GDM]) have increased risk of large for gestational age birthweight, but an association between GGI and childhood adiposity has not been consistently observed.
We studied the risk of overweight and obesity in 2-5-year-old children exposed to varying degrees of maternal glycemia in utero in a retrospective hospital-based cohort. We defined normal glucose tolerance (NGT) as a GLT &lt;140 mg/dl, GGI as GLT ≥ 140 mg/dl and zero (GGI-0) or 1 (GGI-1) abnormal values on a 3-hour 100-gram oral glucose tolerance test (OGTT), and gestational diabetes (GDM) as ≥2 abnormal values. We used logistic regression to investigate the risk of obesity, defined as body mass index (BMI) &gt; 95th percentile, in children born to individuals with GGI and GDM as compared to NGT. In model 1, we adjusted for maternal age, gestational weight gain, parity, insurance, race/ethnicity, marital status, gestational age at delivery and infant sex; in model 2, we further adjusted for maternal 1st trimester BMI.
Of n=12728 children, 48.5% were female, the mean (SD) gestational age at delivery was 39.4 (1.7) weeks, and the mean birthweight was 3341 (519) grams. A total of 10567 children were exposed to NGT in utero, 1156 to GGI-0, 428 to GGI-1, and 577 to GDM. Obesity was present in 12.9% of children exposed to NGT, 12.5% exposed to GGI-0, 16.6% exposed to GGI-1, and 18.5% exposed to GDM, respectively. In model 1, there was an increased odds of obesity in those exposed to GGI-1 (1.37 [1.04, 1.78], P=0.02) and GDM (1.61 [1.28, 2.02] P&lt;0.001). After maternal BMI adjustment, we did not find a significant increased risk of obesity in any group compared to NGT (GGI-1: 1.15 [0.86, 1.51] P=0.33; GDM 1.24 (0.97, 1.57), P=0.08).
After accounting for maternal BMI, children exposed to GGI and GDM in utero have a similar risk of obesity in early childhood to those born to NGT pregnancies.

Disclosure
J.Maya: None. S.Hsu: None. C.C.M.Schulte: None. K.James: None. T.Thaweethai: None. M.Hivert: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health.

Funding
National Institutes of Health (T32DK007028-47S1)
109-LB: Quality of Life Benefits for Insulin-Using Adults with Type 2 Diabetes after Six Months of Pump Therapy—A Quasi-experimental Approach
Authors: POLONSKY WILLIAM H. , SORIANO EMILY C. 
Published: June 2023

While an increasing number of adults with type 2 diabetes (T2D) on multiple daily insulin injections (MDI) are initiating insulin pump therapy, little is known about how, or if, pump therapy may contribute to quality of life (QoL) gains.
Adults with T2D on MDI who contacted Insulet about starting a tubeless insulin pump (Omnipod DASH® Insulin Management System) completed two self-report surveys: one before pump start (baseline) and one 6 months later. The surveys assessed self-reported HbA1c, and a series of QoL measures, including overall well-being (WHO-5), diabetes distress (T2-DDAS Core), diabetes impact (DIDP), and perceived restrictions due to T2D. We compared 6-month outcomes in participants who started and remained on Omnipod DASH vs. those who never started on pump therapy and remained on MDI.
Of N=435 who completed the baseline survey, 220 (51%) completed the 6-month survey. Of these, the majority (80%) were current pump users, and 20% remained on MDI. There were no significant differences between pump users and continuing MDI (c-MDI) users in any baseline demographics, HbA1C or QoL measures. At 6 months, pump users evidenced a significantly greater rise than c-MDI users in overall well-being (+8.3 vs. -3.1) and greater drops in diabetes distress (-0.97 vs. -0.30), diabetes impact (-0.29 vs. +0.20), and perceived restrictions, including feeling less limited regarding food and exercise and feeling freer to live life as they might want (in all cases, p &lt; 0.005). Also, both pump and c-MDI groups reported a significant HbA1C improvement from baseline, though the difference between groups was not significant (-1.1% vs -0.9%; p=0.10).
In this sample of T2D adults, the introduction of pump therapy was associated with broad improvement in QoL after 6 months, compared to those who were interested in, but never started pump therapy. These results provide initial evidence of significant psychosocial benefits of pump therapy for adults with T2D.

Disclosure
W. H. Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., MannKind Corporation, Provention Bio, Inc., Sanofi-Aventis U. S., Vertex Pharmaceuticals Incorporated. E. C. Soriano: None.

Funding
Insulet Corporation
1090-P: Association between Organ Fat and Type 2 Diabetes Risk Factors among High-Risk Latino Youth
Authors: OWOLABI EYITAYO O. , OLSON MICAH , HU HOUCHUN H. , PENA ARMANDO , PITUCH KEENAN A. , BAILEY SMITA , KNOWLER WILLIAM C. , SHAIBI GABRIEL Q. 
Published: June 2023

Obesity is a well-established risk factor for type 2 diabetes (T2D) in youth. However, the contribution that organ fat plays to the pathophysiology of T2D among high-risk youth is sparsely documented. The purpose of this study was to determine the independent associations between hepatic and pancreatic fat fractions with insulin sensitivity and beta-cell function among Latino youth with obesity and prediabetes. This cross-sectional analysis involved 117 Latino adolescent boys (n=70) and girls (n=47), mean (±SD) age:14±1 years, fasting glucose: 102±8mg/dL, 2-hour glucose: 144±30mg/dL, and with obesity (BMI percentile: 98.52±1.13). Total body composition was assessed by DEXA, while hepatic and pancreatic fat contents were assessed using quantitative fat fraction magnetic resonance imaging at 3 Tesla. T2D risk factors included insulin sensitivity (Matsuda index) and beta-cell function (product of insulin sensitivity and insulinogenic index), estimated from a multi-sample 2-hour oral glucose tolerance test. Associations between organ fat and T2D risk factors were examined using Pearson correlation and multiple linear regression, adjusting for age, sex, and total body fat percentage (BF%). Insulin sensitivity significantly correlated with only BF% (r =-0.236, p=0.015), fat mass (r=-0.227, p=0.020), and hepatic fat fraction (r=-0.255, p=0.024), whereas beta-cell function significantly correlated with only BF% (r=-0.241, p=0.013). In multiple regression models, hepatic fat fraction (B= -0.045, p=0.041, Δr2=.034) but not pancreatic fat fraction (B= 0.058, p=0.179, Δr2= .015) was independently associated with insulin sensitivity, whereas neither measure of organ fat was associated with beta-cell function (each Δr2 &lt;.01, each p&gt;.38). Hepatic fat content was an independent predictor of insulin sensitivity among Latino youth with prediabetes. Further studies are needed to understand how adiposity contributes to beta-cell dysfunction among high-risk youth.

Disclosure
E.O.Owolabi: None. M.Olson: Advisory Panel; Rhythm Pharmaceuticals, Inc. H.H.Hu: None. A.Pena: None. K.A.Pituch: None. S.Bailey: None. W.C.Knowler: None. G.Q.Shaibi: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK107579, F31DK125037)
1092-P: sRAGE—A Biomarker of Kidney Disease in Youth-Onset Type 2 Diabetes (T2D)
Authors: BACHA FIDA , URBINA ELAINE M. , GIDDING SAMUEL , MONNIER VINCENT M. , EL GHORMLI LAURE , DREWS KIMBERLY , BRAFFETT BARBARA H. 
Published: June 2023

The circulating soluble receptor for advanced glycation end products (sRAGE) has been proposed as a biomarker of diabetes complications in adults. In the TODAY study of youth with T2D, we measured sRAGE 3 times at: randomization (T1), glycemic failure (HbA1c≥8%) on randomized treatment or midpoint in study (T2), and end of follow-up (T3). Of TODAY subjects, 165 lost glycemic control with HbA1c ≥ 8% (G1) and 135 maintained HbA1c &lt; 8% (G2)]. Controls [n=99, HbA1 5% (4.9, 5.2), with similar obesity, sex (60% female), race-ethnicity, median age 24 (21, 27) years as the TODAY cohort at T3] had sRAGE measured once. Multivariable models examined the relationship of sRAGE with nephropathy [urine albumin: creatinine (UACR) ≥30 mg/g, hyperfiltration (eGFR ≥135 ml/min/1.73m2)] and vascular measures [pulse wave velocity (PWV), augmentation index (AI)], adjusting for treatment, diabetes duration, HbA1c, BMI, age, sex, and race-ethnicity. At T1, the T2D youth groups had similar age (13.9 yrs), diabetes duration (0.7 yrs), and sex (60% female). sRAGE concentrations were lower in T2D vs. controls (752.8±308.3 vs. 954.4 ± 356.7 pg/ml, p&lt;0.0001) at T3. By T3 (mean duration 7 yrs), sRAGE levels decreased compared with T1 and T2 in G1 vs. G2 (p&lt;0.05). sRAGE concentrations were 711.9±294.1 vs. 802.7±318.9 pg/ml, p=0.0032 in G1 vs. G2 at T3, with no significant difference by treatment. HbA1c was inversely related with sRAGE. Higher sRAGE concentrations were associated with a lower risk of hyperfiltration (HR=0.93, 95% CI 0.86-0.99, p=0.03) and inversely related to eGFR (p&lt;0.001); no relationships were observed with UACR, PWV, or AI. sRAGE levels decline overtime in youth with T2D, are inversely related to glycemia, and may serve as a biomarker of kidney function.

Disclosure
F.Bacha: Other Relationship; Takeda Pharmaceutical Co., Ltd., AstraZeneca. E.M.Urbina: Advisory Panel; Astellas Pharma Inc., Other Relationship; Targus Medical, Inc. S.Gidding: Consultant; ESPERION Therapeutics, Inc. V.M.Monnier: None. L.El ghormli: None. K.Drews: None. B.H.Braffett: None.

Funding
National Institutes of Health (5U01DK061230-16)
1098-P: Association of Sleep with ß-Cell Response and Insulin Sensitivity in Youth
Authors: TEMPLE KARLA A. , TJADEN ASHLEY H. , MANCHANDA SHALINI , EHRMANN DAVID , NADEAU KRISTEN J. , EDELSTEIN SHARON , HANNON TAMARA S. , MOKHLESI BABAK , CONSORTIUM RISE 
Published: June 2023

Poor sleep may be associated with reduced β-cell response or decreased insulin sensitivity in youth. We explored whether sleep duration, sleep quality or obstructive sleep apnea (OSA) risk factors were associated with measures of β-cell response or insulin sensitivity in youth. At baseline, 88 youth (10-19 yrs of age) with recently diagnosed T2D or prediabetes completed validated questionnaires (Sleep Disturbances Scale and Cleveland Adolescent Sleepiness) in the Restoring Insulin Secretion (RISE) Study. Hyperglycemic clamps measured insulin sensitivity (steady state glucose infusion rate/insulin [M/I]) and β-cell responses: acute (0-10 min) C-peptide response to glucose (ACPRg), steady-state C-peptide at a glucose of 11.1 mmol/L (SSCP), and arginine-stimulated maximum C-peptide responses at glucose &gt;25 mmol/L (ACPRmax). Linear regression models explored the independent association between sleep variables and clamp measures, adjusted for age, race/ethnicity, sex, Tanner stage, metformin use and BMI. Models including β-cell responses were adjusted for M/I to account for the role of insulin sensitivity in β-cell function. The cohort was 70% female, 28% white, 25% black, 36% Hispanic; age 14.3±2.0 yrs and BMI 36.9±6.4 kg/m2 (mean±SD). Using ADA criteria, 60% had prediabetes and 40% had T2D; 27% reported metformin use. Sleep duration &lt;8 h was reported in 59%; 57% reported daytime sleepiness; 28% reported poor sleep quality; 29% had high risk for OSA. Low sleep duration (&lt;8 h) was associated with a trend for lower ACPRg (p=0.069). No sleep variables (sleep duration or quality, OSA risk) were associated with clamp-derived outcomes in unadjusted or adjusted linear regression models. In youth with prediabetes or T2D, subjective measures of sleep quantity, sleep quality and OSA risk were not independently associated with β-cell response or insulin sensitivity. Further research using objective measures of sleep may better delineate the relationship between sleep and β-cell function in youth.

Disclosure
K.A.Temple: None. A.H.Tjaden: None. S.Manchanda: Advisory Panel; Inspire. D.Ehrmann: None. K.J.Nadeau: None. S.Edelstein: None. T.S.Hannon: Advisory Panel; Eli Lilly and Company. B.Mokhlesi: None. Rise consortium: n/a.

Funding
American Diabetes Association (1-20-RISE-01 to S.E.); National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute