bluuebunny/crossref_metadata_2025_split huggingface dataset:
1140-P: Increasing Insulin Pump Use in Youth with New-Onset T1D
Authors: VAKHARIA MILI , BUCKINGHAM DON A. , LYONS SARAH , DESALVO DANIEL , SONABEND RONA Y. , KIM GRACE K. 
Published: June 2023

Background: Insulin pump therapy is associated with enhanced quality of life (QoL) and lower HbA1c levels in youth with T1D. At our institution, we noted underutilization of insulin pumps and variability in prescribing practices. Thus, we led a quality improvement initiative to increase insulin pump use in youth age &lt;18 years with new-onset T1D (duration &lt;1 year) from baseline of 17% to &gt;25% from January 2021 to November 2022.
Methods: A series of Plan-Do-Study-Act cycles began at one of our three campuses with spread to all locations, including education of diabetes educators and providers about a newly created pump initiation algorithm with action plan for sick day management, standardized prescribing recommendations with intent to mitigate prescribing biases, early introduction of pumps by 90 days from diagnosis, and advanced scheduling of post-pump follow ups.
Results: P-Chart (Figure 1) shows an increase in percentage of patients with new onset T1D on insulin pump therapy from a process average of 17% to 21%.
Conclusion: Our QI efforts on standardizing the approach to pump therapy initiation and multidisciplinary education led to an increase in insulin pump uptake in our new-onset T1D cohort. We plan to evaluate improvement in HbA1c levels, pump related hospitalization rates, and impact on QoL in our patient cohort.

Disclosure
M.Vakharia: None. D.A.Buckingham: None. S.Lyons: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. R.Y.Sonabend: None. G.K.Kim: None.
1144-P: Racial/Ethnic Disparities in Accessing the Latest Automated Insulin Delivery (AID) System
Authors: MARKS BRYNN E. , MEIGHAN SEEMA , BROWN ELIZABETH A. , ZEHRA ANUM , SURESH RESHMA , DOUVAS JULIA L. , WOLF RISA M. 
Published: June 2023

Background: AID systems improve glycemic control in youth with type 1 diabetes (T1D). There was a full market release of the OmniPod 5 (OP5) AID system in the United States on 8/1/2022 and it was FDA approved for ages ≥2 on 8/22/22. OP5 is available through pharmacy benefits and requires users to have a smartphone. We hypothesized that disparities exist in OP5 access.
Methods: We assessed OP5 use at two pediatric diabetes centers among youth with T1D ages 2-21 who were using any version of an OmniPod (OP) insulin pump 3-months after the full market release. Differences in demographic characteristics of OP5 users compared to other OP pump users were assessed using Chi-squared and student’s independent two-sample t tests.
Results: Of 1037 youth (mean age 12.8±4.4 years, 49.5% female, mean T1D duration 5.3±3.7 years), 510 (49.2%) were using OP5. Rates of OP5 use were higher among non-Hispanic White youth than among youth of all other racial/ethnic identities (53.2% vs 38.0%, p&lt;0.0001). Youth using OP5 were more likely to be younger (12.3±4.0 years vs 13.2±4.7 years, p=0.0001) and to have a shorter T1D duration (4.9±3.5 vs 5.8±3.9 years, p=0.0002). There was a trend towards lower rates of uptake among publicly versus privately insured youth (43.1% vs 50.7%, p=0.054). There was no difference in OP5 use by sex (48.2% female vs 51.8% males, p=0.43).
Conclusions: Minority youth were less likely to access the OP5 AID system 3-months after full-market release. Given the glycemic improvements associated with AID systems, it is important to promote equitable access to the latest diabetes technologies. Improving insurance coverage of technologies and supporting AID access without the need for a smartphone may support these goals.

Disclosure
B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. S.Meighan: Speaker's Bureau; Dexcom, Inc. E.A.Brown: None. A.Zehra: None. R.Suresh: None. J.L.Douvas: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc.

Funding
National Institutes of Health (K23DK129827)
1148-P: Glycoprotein Acetyls (GlycA) Associate with Intraglomerular Hemodynamic Dysfunction, Albuminuria, Central Adiposity, and Insulin Resistance (IR) in Youth with Type 1 Diabetes (T1D)
Authors: REINICKE TRENTON , CALDWELL-MCGEE ALYSSA , BIRZNIEKS CARISSA , CARRASCO DIEGO , LOREDANA MARCOVECCHIO M. , NADEAU KRISTEN J. , TOMMERDAHL KALIE L. , PAULEY MEGHAN E. , SNELL-BERGEON JANET K. , GROSS SUSAN , CHERNEY DAVID , VIGERS TIMOTHY B. , PYLE LAURA , DRISCOLL LYNETTE , MAHMUD FARID H. , DART ALLISON , PAVKOV MEDA E. , NELSON ROBERT G. , BJORNSTAD PETTER 
Published: June 2023

GlycA is a biomarker of systemic inflammation and cardiovascular disease, yet little is known about this biomarker in T1D. We examined the associations among GlycA, central adiposity, IR, and early kidney injury in adolescents with T1D.
Glomerular filtration rate (GFR) and renal plasma flow (RPF) by iohexol and p-aminohippurate clearance, respectively, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry (DXA), and estimated insulin sensitivity (eIS) by the CACTI equation were assessed in youth with T1D (n=50, 16.0±3.0 years, 50% female, HbA1c 8.7±1.3%, T1D duration 5.7±2.6 years, UACR 6 [5-14] mg/g, GFR 189±40 mL/min). Intraglomerular pressure (PGLO) was estimated by the Gomez equations. Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed.
GlycA was higher in girls vs. boys (1.05±0.26 vs. 0.84±0.15 mmol/L, p=0.001), and in participants who were overweight or obese vs. normal weight (1.12±0.23 vs. 0.87±0.20, p=0.0004). GlycA correlated positively with estimated PGLO (r=0.52, p=0.001), UACR (r=0.53, p&lt;0.0001) and trunk mass (r=0.45, p=0.001) and negatively with eIS (r=-0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and HbA1c.
In youth with T1D, GlycA, a biomarker of inflammation, was found to be higher in girls with T1D and those of overweight/obese habitus, compared to boys with T1D. Additionally, GlycA associated with parameters of early kidney dysfunction, central adiposity, and IR.

Disclosure
T.Reinicke: None. S.Gross: None. D.Cherney: Other Relationship; Boehringer Ingelheim-Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi-Tanabe, Abbvie, Janssen, Bayer, Prometic, BMS, Maze, Gilead, CSL-Behring, Otsuka, Novartis, Youngene, Lexicon and Novo-Nordisk, Research Support; Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca, CSL-Behring and Novo-Nordisk. T.B.Vigers: None. L.Pyle: None. L.Driscoll: None. F.H.Mahmud: None. A.Dart: None. M.E.Pavkov: None. R.G.Nelson: None. P.Bjornstad: Advisory Panel; AstraZeneca, Novo Nordisk, Lilly, Horizon Therapeutics plc, Boehringer Ingelheim (Canada) Ltd., LG Chem, Consultant; Bayer Inc., Bristol-Myers Squibb Company. A.Caldwell-mcgee: None. C.Birznieks: None. D.Carrasco: None. M.Marcovecchio: None. K.J.Nadeau: None. K.L.Tommerdahl: None. M.Pauley: None. J.K.Snell-bergeon: None.

Funding
Junior Research Fellowship Award
1158-P: Diabetes Incentive Program for Children with Type 1 Diabetes (T1D)
Authors: WARHADPANDE MAITREYI , DANELYAN HRANUSH , PATEL CHETANBABU M. 
Published: June 2023

Behavioral economic interventions have been studied in adults to help improve adherence in diabetes management but have not been widely studied in children. Results from a 2020 qualitative study demonstrated that financial incentive (FI) can potentially help adolescents with type 1 diabetes (T1D) develop good self-care habits. Our objective was to determine if providing pediatric patients with incentives helps improve satisfaction about their diabetes management. Every patient with T1D coming to our endocrine clinic was given an initial satisfaction survey. Points were given when patients met goals and were rewarded with gifts based on points accumulated. They could also collect points to win a grand prize at the end of 1 year. A final satisfaction survey was distributed at the end of 1 year. Bar graphs and percentages in each group were used to determine change in patient satisfaction. After the completion of Diabetes Incentive Program (DIP), 78% patients were more satisfied with their diabetes control as compared to 64% before the DIP and 17% more patients found that the DIP motivated them to reach their goals. We concluded that there was some increase in satisfaction with diabetes control after completion of DIP. About 97% patients thought that DIP helped in achieving their goals.

Disclosure
M.Warhadpande: None. H.Danelyan: None. C.M.Patel: None.

Funding
TMC Health (202244)
1160-P: Low-Calorie Sweeteners and Quality of Life in Youth with Type 1 Diabetes
Authors: MOORE HAILEY R. , FAGUNDES GRILO MARIANA , VALLONE NATALIE , COGEN FRAN R. , STREISAND RANDI , SYLVETSKY ALLISON 
Published: June 2023

Background: Low calorie sweeteners (LCSs) are often used by youth with Type 1 Diabetes (T1D), as LCS can provide added sweetness to food and beverages at a reduced glycemic load. Whether LCS consumption is helpful or harmful for T1D management among youth is debated; however, little attention has been given to potential benefits of LCS consumption on psychosocial outcomes among youth with T1D. This is important because a diabetes diagnosis pervades all aspects of a child's life and LCS use may provide children with T1D with a sense of normalcy, potentially increasing their health-related quality of life (HRQOL).
Objective: To examine associations between LCS consumption and HRQOL among youth with T1D.
Methods: Sixty youth ages 11-17 with a diagnosis of T1D (Mage 12.9±1.8, 57.1% female, 70% Non-Hispanic White) and their parents (83.3% female, 71.6% Non-Hispanic White) were recruited from the Washington Nationals Diabetes Care Complex at Children's National Hospital (DCC) in Washington D.C. (N=20) and nationally using social media (N=40). Eligible youth and their parent attended a virtual study visit, where they provided demographic information, and completed a LCS consumption questionnaire (developed by the team for a previous study), along with the validated Type 1 Diabetes and Life measure (T1DAL). Means and frequencies were used to summarize the survey data, as appropriate, and associations between LCS intake and HRQOL were examined using multivariable linear regression, with adjustment for relevant covariates.
Results: Mean LCS consumption was 3.3±2.8 servings per day. No associations between LCS consumption (total, LCS beverage consumption, LCS food consumption) and HRQOL (total and subscales) were observed.
Conclusion: In our sample of youth with T1D, LCS intake was not associated with HRQOL. These results demonstrate that LCS use may not benefit psychosocial outcomes of youth with T1D, further reiterating the need to determine their metabolic and health effects in this high-risk patient population.

Disclosure
H.R.Moore: None. M.Fagundes grilo: None. N.Vallone: None. F.R.Cogen: None. R.Streisand: None. A.Sylvetsky: Consultant; Abbott.

Funding
Milken Institute School of Public Health
1165-P: 4T Study—Changing Clinical Processes Increases Technology Use at T1D Diagnosis
Authors: CONRAD BARRY P. , BISHOP FRANZISKA K. , LEVERENZ JEANNINE , CHMIELEWSKI ANNETTE , SAGAN PIPER , SENALDI JULIANNE , MARTINEZ-SINGH ANJOLI , LIN SHANNON , LEI CHAN IAN , PRAHALAD PRIYA , MAAHS DAVID M. 
Published: June 2023

Use of diabetes technology (CGM, pump) is recommended for people with T1D, and early CGM initiation leads to improved glucose values. We compare %CGM and %pump use and time to initiation from T1D diagnosis in the Historical cohort, 4T Pilot, and 4T Study 1 and the associated workflow changes to increase early technology use.
CGM initiation within 30 days of diagnosis increased from 2% in the historical cohort to 92% in Pilot 4T to 98% in 4T Study 1 (Table). Days to pump initiation from TID diagnosis decreased from 272 in the historical cohort to 144 days in Study 1.
From 2014-2016 pumps and CGM were initiated when families expressed interest or if the provider discussed them. Families were required to attend a pre-pump class where the CDCES introduced pumps and CGMs prior to starting technology. During the 4T Pilot and 4T Study 1, CGMs were introduced and started during the first month of diagnosis. In Study 1, families were encouraged to attend pump class and initiate AID. The CDCES team does the CGM teach, CGM follow-up, pre-pump classes, and insulin pump starts for the families in preferred language. In 4T Study 2 (enrolling) standard of care is to complete a pre-pump class in the first 3 months after diagnosis.
Changes in processes can lead to early implementation of diabetes technology. A structured, team-based process to introduce, reduce barriers, and encourage families to utilize diabetes technology increases early initiation.

Disclosure
B.P.Conrad: Advisory Panel; Edgepark medical supplies, Consultant; Abbott Diabetes. P.Prahalad: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. F.K.Bishop: None. J.Leverenz: None. A.Chmielewski: None. P.Sagan: None. J.Senaldi: None. A.Martinez-singh: None. S.Lin: None. I.Chan: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK122422); The Leona M. and Harry B. Helmsley Charitable Trust (G-2002-04251-2); International Society for Pediatric and Adolescent Diabetes/JDRF (1P30DK, 11607401); Lucile Packard Child
117-LB: Impact of Bigfoot Unity Integrated CGM on HbA1c
Authors: HAQUE PAARSA , HALL SHARETA , WALKER PERSHELL , LATIF KASHIF 
Published: June 2023

Introduction: Continuous glucose monitoring (CGM) is a preferred method of glucose monitoring. Bigfoot Unity Diabetes Management is an integrated CGM (iCGM) system that incorporates remote patient monitoring with a mobile app, smart pen caps, and CGM via Libre Freestyle 2 sensors. Smart pen caps attach to rapid-acting and long-acting insulin pens and sync with patients’ CGM sensors to provide insulin dose recommendations based on the health care provider's (HCP) instructions. The smart pen caps also allow patients to view their last insulin dose and receive alerts for possible missed doses. The mobile app allows patients to review their HCP's instructions and receive critical alerts. Likewise, HCP can more closely track data to guide clinical assessments and plans.
Objectives: Examine the efficacy of the Bigfoot Unity system in improving glycemic control.
Methods: Baseline HbA1c values were obtained from 91 patients enrolled in the iCGM system and compared with Glucose Management Indicators (GMI), or estimated future HbA1c, after at least 30 days of iCGM use.
Results: Patients were in the target blood glucose range 59.9% of the time with low incidences (0.01%) of very low blood glucose. Patients’ mean baseline HbA1c was 8.87% (SD 1.91). After at least 30 days of iCGM, patients’ mean GMI was 7.55%, (SD 1.02) indicating a statistically significant mean difference of 1.32%, (95% CI 0.86 to 1.79%, p &lt;0. 0001).
Conclusions: Use of Bigfoot Unity improves HbA1c.

Disclosure
P. Haque: None. S. Hall: None. P. Walker: None. K. Latif: None.
1172-P: The Social Impact of COVID-19 Pandemic on Children with Diabetes
Authors: ABDUL WAHED RUBA , RONIS SARAH , MACLEISH SARAH A. , WOOD JAMIE R. , MALAY SINDHOOSHA , KUTNEY KATHERINE A. 
Published: June 2023

Aims: The aim of the study was to evaluate the social impact of the COVID-19 pandemic on youth with diabetes in Northeast Ohio from March 2020 through October 2022, and assess for disparate impact on minority and socially disadvantaged groups.
Methods: An email survey was distributed to 609 families of children with diabetes who met the inclusion criteria: age 7-20 years, followed by our clinic, and T1DM (duration 2+ years) or T2DM (duration 1+ years) prior to the pandemic. The survey asked several questions in 5 categories (housing, guardian's job loss, medical care disruption, schooling disruption and death of household member from COVID-19). Responding yes to any question in a category constituted an adverse social event (ASE). COVID-19 infection, hospitalization and vaccination status were collected. Between group differences were examined with a Fisher's Exact Test.
Results: Sixty two parents (10%) answered the survey, of whom 33 (53%) reported no ASE, 22 (35%)reported one ASE, and 7 (11%) reported 2 or more ASEs. Six respondents were Black and five were Hispanic. Among Black participants 1 (17%) had 1 ASE and 1 (17%) had 2 or more ASE, which was not statistically different than White participants. Among Hispanic participants 2 (40%) had one ASE and2 (40%) had 2 or more ASEs, which was numerically higher than the rates seen in non-Hispanic participants and approached statistical significance, p=0.068. Rates of ASE did not differ by insurance type or income level. Rates of COVID-19 infection and hospitalization did not differ between racial and ethnic groups. COVID 19 vaccination occurred at similar rates for Black and White participants; however, only 20% of Hispanic children received a COVID-19 vaccination, compared to 70% of non-Hispanic participants, p=0.04.
Conclusion: Forty six percent of children with diabetes experienced one or more ASE during theCOVID-19 pandemic. Our survey suggests that rates of ASE may have been higher in Hispanicchildren, who were also less likely to receive a COVID-19 vaccine.

Disclosure
R.Abdul wahed: None. S.Ronis: None. S.A.Macleish: Speaker's Bureau; Insulet Corporation. J.R.Wood: Research Support; Insulet Corporation, Boehringer-Ingelheim, MannKind Corporation. S.Malay: None. K.A.Kutney: None.
1177-P: Maternal Insulin Intervention Improves Offspring Glucose Metabolism via Long Noncoding RNA
Authors: ZHANG QIAN , XIAO XINHUA , LI MING 
Published: June 2023

Maternal high fat (HF) during pregnancy is known to have numerous adverse effects on offspring, including increased adiposity and impaired glucose tolerance later in life. The aim of this study was to determine if prebiotic early intervention could mitigate some of the negative effects of maternal HF and involved mechanism. C57BL mice were fed a HF diet, normal diet or a HF diet with prebiotic supplementation during pregnancy and lactation. At 8 weeks of age, glucose tolerance were measured in the offspring. And offspring livers were obtained to assay lncRNA and mRNA profiles to investigate the effects of early maternal inulin intervention on offspring. Offspring from HF-fed dams displayed glucose intolerance and an insulin resistance phenotype at 8 weeks of age. Early maternal inulin intervention improved glucose metabolism in male offspring of mothers fed a HF during gestation and lactation. The lncRNA and mRNA profile data revealed that compared with the offspring from HF dams, offspring from the early inulin intervention dams had 99 differentially expressed hepatic lncRNAs and 529 differentially expressed mRNAs. The differentially expressed lncRNA-mRNA coexpression analysis demonstrated that early maternal inulin intervention may change hepatic lncRNA expression in offspring. These lncRNAs are involved in metabolic pathways and the AMP-activated protein kinase signaling pathway. Importantly, the early maternal inulin intervention alleviated glucose metabolism by inhibiting the lncRNA Serpina4-ps1/let-7b-5p/Ppargc1a as a competing endogenous RNA in male offspring.

Disclosure
Q.Zhang: None. X.Xiao: None. M.Li: None.

Funding
National Natural Science Foundation of China (82170854, 81870579, 81870545, 81570715, 81170736); Beijing Natural Science Foundation (7202163); Beijing Municipal Science & Technology Commission (Z201100005520011); National High Level Hospital Clinical Research Funding (2022-PUMCH-C-019); National Key Research and Development Program of China (2018YFC2001100); CAMS Innovation Fund for Medical Sciences (CIFMS2021-1-I2M-002, CIFMS2017-I2M-1-008)
1194-P: Impact of COVID-19 on Gestational Diabetes Mellitus (GDM) Screening and Outcomes
Authors: LIYANAGE VICHY , BARRETT OLESYA , NGWEZI DELIWE P. , SAVU ANAMARIA , YEUNG ROSEANNE O. , BUTALIA SONIA , KAUL PADMA 
Published: June 2023

Background: To minimize COVID-19 exposure, a modified 1-step strategy (MS) option was offered in addition to the standard (SS) GDM screening strategies (definitions in Fig 1A).
Objectives: To assess the use of, and obstetrical and neonatal outcomes associated with, modified GDM screening during COVID-19.
Methods: Primiparous pregnancies in Alberta, Canada (N=35,836; Jan 1, 2020 to Dec 31, 2021) were categorized by GDM screening status.
Results: 87.4% underwent SS, 10.1% MS, and 2.5% had no GDM screening. MS use was highest in 2020-Q3 (second wave; Fig 1B). There was no difference in GDM rates between SS (11.1%) and MS (12.7%). MS screened women with GDM had worse outcomes than those screened using SS (Table).
Conclusions: GDM screening rates were not impacted by COVID-19. The uptake of MS was low to modest and appeared to identify higher-risk GDM women.

Disclosure
V.Liyanage: None. O.Barrett: None. D.P.Ngwezi: None. A.Savu: None. R.O.Yeung: Research Support; Novo Nordisk Foundation, Abbott, Canadian Institutes of Health Research, Alberta Agriculture and Forestry, Alberta Canola. S.Butalia: None. P.Kaul: None.
12-LB: Clinical Impact of Risk Profiling with KidneyIntelX on DKD Progression in a Large Integrated Health Care System
Authors: TOKITA JOJI , SINFIELD CATHERINE , DONOVAN MICHAEL J. , MCNICHOLAS TONY , KATTAN MICHAEL , LAM DAVID W. 
Published: June 2023

KidneyIntelXTM combines 3 plasma biomarkers with clinical variables to categorize adults with DKD stages 1-3b for risk of a progressive decline in kidney function over 5 years. We previously demonstrated that using KidneyIntelX to assess risk and guide treatment does lead to optimized medication use, lifestyle changes, and specialist referrals. We now report the one-year pre and posttest clinical impact on eGFR slope and hemoglobin A1C (HbA1c) in the Mount Sinai Health System. Among the 1087 patients with follow-up data, the median age was 69 years, 52% were women, 32% self-identified Black, baseline eGFR 59 ml/min/1.73m2, baseline HbA1c was 7.2%, and 146 (13%), 439 (40%), and 502 (46%) were scored as high, intermediate, and low risk by KidneyIntelX. In high-risk patients, median eGFR slope slowed from -5.7 ml/min/year pre-test to -2.1 ml/min/year post-test (p&lt;0.001), and from -1.8 ml/min/year to -1.0 ml/min/year in intermediate-risk (p=0.005) (Table). The median HbA1c decreased from 8.4 to 7.7% (p&lt;0.001) in high risk, and from 7.5 to 7.2% (p&lt;0.001) in intermediate risk.
In conclusion, deployment and risk stratification by KidneyIntelX was associated with reduced rate of kidney function decline and improved glycemic control, particularly in those scored as high risk.

Disclosure
J. Tokita: Other Relationship; Renalytix. C. Sinfield: None. M. J. Donovan: Employee; Renalytix. T. McNicholas: Employee; Renalytix. M. Kattan: Research Support; Novo Nordisk. Consultant; Renalytix, Verici. Research Support; Bayer Inc. D. W. Lam: None.