bluuebunny/crossref_metadata_2025_split huggingface dataset:
1058-P: Pharmacist-Based Coaching within a Specialty Diabetes Center Improves Outcomes for Uncontrolled Diabetes
Authors: MALKANI SAMIR , HAAS RICHARD A. , SHAH VRUSHALI , SHARMA HINAL , PUGLIESE GABRIELLA , BARRY CHERYL , PIZ LILLIAN , MCELNEA WILLIAM 
Published: June 2023

Coaching programs have been shown to improve diabetes outcomes. We investigate a novel approach where pharmacists, trained in diabetes care, provide coaching for patients in poor control. Coaches addressed all aspects of diabetes care, yet the program was cost-neutral to clinical operations. The UMass Memorial Diabetes Center of Excellence clinic follows ~10,000 patients. We provide interdisciplinary team-based care by endocrinologists, NPs, CDCESs and nutritionists. Those with HbA1c ≥9% over two consecutive visits, despite best efforts by the team, were referred to the “Care Coach” program. Coaches had an initial in-person visit followed by weekly (or where appropriate less frequent) phone visits. Benefits from frequent interaction with the Coaches (Table) came from: 1) Medication management: improved medication adherence and rapid adjustments between visits; 2) Assistance with lowering drug costs; 3) Diabetes technology: greater adoption of CGM and fingerstick testing; 4) Motivational support for dietary and exercise goals; 5) Efficient modification of care plans by integrating the Coach within the care team; 6) Better patient engagement in their care plan. The program is financially self-sustaining as coaches are employed by the hospital associated Shields Health Solutions Specialty Pharmacy and funding for Coach salaries is generated via patient prescriptions and 340B program.

Disclosure
S.Malkani: None. R.A.Haas: None. V.Shah: None. H.Sharma: None. G.Pugliese: None. C.Barry: None. L.Piz: None. W.Mcelnea: None.
1063-P: Impact of Mobile Messaging on Follow-up and Glycemic Control in the Indian Population
Authors: SABOO BHARAT , SABOO SHWETA , CHAVDA VIPUL , HASNANI DHRUVI 
Published: June 2023

Introduction: Diabetes treatment requires the involvement of people with diabetes in the form of regular clinical follow-up for good Glycaemic control and Metabolic health. Newer Communication techniques, such as mobile messaging are now finding their way into diabetes care and treatment. It can assist diabetes patients to maintain a regular follow-up routine and can assist in glycemic control.
Materials and Methods: A total of 326 patients were selected by random sampling. They were of age 15-65 years with T1DM and T2DM.
Inclusion Criteria: 1. Known case of DM 2. Consent to receive messages
Exclusion criteria: 1. Not consenting for messaging 2. Reading Disability. Randomly allocated to two groups of 163 persons each. In the first group, the participants were sent regular messages to remind them of their follow-up dates. The other group was treated as usual and was allowed to come for follow-up on their own. The participants were monitored for follow-up frequency, meeting testing deadlines and resultant glycemic control measured by Hba1c at 3 months and 6 months. The results were tabulated and analysed using SPSS.
Result: 17 patients each dropped out from the messaging group and 16 patients dropped out from routine care groups, out of the remaining 297 patients the analysis of data shows: in the messaging group, 63 % maintained their follow-up dates as compared to 42 % in the other group. The number of patients achieving the target goal of 7% HBA1C was better in the messaging group (54%) as compared to the routine group (31%). Blood sugar testing frequency was better in the messaging group as compared to other group.
Discussion: With the advent of newer modalities of communication, the ways and means to communicate with patients has improved. These tools if used correctly can not only improve follow-ups but at the same time increase the connection between caregivers and patients. This also can result in better patient outcomes and will lead to reduced complications and financial implications.

Disclosure
B.Saboo: None. S.Saboo: None. V.Chavda: None. D.Hasnani: None.
107-OR: Association of Diabetic Retinopathy with A1C and Glucose Management Indicator Discordance
Authors: BOVEE LAURA , PERLMAN JORDAN , GOOLEY TED , HIRSCH IRL B. 
Published: June 2023

Background: Past analyses have shown significant discordance between glycated hemoglobin (A1C) and glucose management indicator (GMI). This study uses a glycation ratio (GR) defined as GMI/A1C and evaluates the association of this ratio with microvascular complications in 661 patients with diabetes.
Methods: A retrospective review was done of patients with diabetes using CGM who were seen at the University of Washington (UW) Diabetes Care Center from 2012-2019. All patients had A1C and sensor data obtained fewer than 4 weeks apart. Positive discordance was defined as GMI/A1c &lt;0.9.
Results: This study included 661 patients of whom 90% had type 1 diabetes with a mean duration of current CGM use of 24.7 days (+/- 7.9 days). Positive discordance was found in 29.9% of participants and was associated with retinopathy (OR 2.05, CI 1.33-3.14) and nephropathy (OR 2.83, CI 1.68-4.77). The data were modeled as a continuous nonlinear function revealing an inverse relationship between GMI/A1C and diabetic retinopathy.
Discussion: In this study positive discordance conferred a more than two-fold increased risk for diabetic retinopathy and nephropathy. Modeling of GMI/A1C as a continuous variable upheld this relationship for diabetic retinopathy. These data suggest that GMI/A1C ratios may allow for identification of patients at increased risk for microvascular complications.

Disclosure
L.Bovee: None. J.Perlman: None. T.Gooley: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc.
1073-P: Intensive Management of Poorly Controlled Type 2 Diabetes Using a Multidisciplinary Approach and Continuous Glucose Monitoring
Authors: BEHNKE ANDREW , WOODFIELD DAVID 
Published: June 2023

Aims: The purpose of this study was to examine the effects of a weekly monitoring and interaction program using continuous glucose monitoring in a population of poorly controlled patients with type 2 diabetes.
Methods: This study was conducted in the outpatient clinical setting and examined levels of hemoglobin A1C and time in range glucose levels for 16 patients with poorly controlled type 2 diabetes as indicated by a hemoglobin A1C level of greater than 75 mmol/mol (10%). The intervention included use of a continuous glucose monitor (CGM)and weekly interactions either virtually or by telephone by one of the team members.
Results: After a 3 month period, hemoglobin A1C levels reduced from 95 mmol/mol (11.79%) to 52 mmol/mol (7.88%) (p&lt;001) with 100% of the subjects achieving hemoglobin A1C of less than 75 mmol/mol (10%). There was no significant changes in the amount of additional diabetes medication or insulin dose.
Conclusions: The combination of continuous glucose monitoring and frequent interaction in a brief (three months) time frame may be a significant tool to improve glucose control in this high risk population.

Disclosure
A.Behnke: None. D.Woodfield: None.
1076-P: Weight Loss, Patient Activation Measure (PAM) Change, and Outpatient Medical Utilization after a Telephonic DPP-Adapted Lifestyle Intervention for Older Adults
Authors: VENDITTI ELIZABETH M. , KANTER JUSTIN , WILLIAMS KELLY R. , CWENAR ELIZABETH , LIANG QINGFENG 
Published: June 2023

Diabetes Prevention Program (DPP)-adapted interventions reduce cardiometabolic risk in adults 60+ with overweight/obesity and prediabetes. Healthcare systems have increasingly adopted such programs and are interested in whether program induced patient activation (normalized PAM® score change) and/or weight loss impacts outpatient medical utilization. After a 6-month telephonic DPP lifestyle program, claims data were examined for N = 81 participants with obesity/prediabetes [71% female, 88% non-Hispanic white, mean baseline age (SD) 68.0 (5.1) and BMI 39.5 (6.7)] covered by a large, regional payer. Linear regression models, adjusted for participant sex, estimated 0-6-month changes in weight and normalized PAM score with the number of primary care (PC) and specialty care (SC) visits over the next 12 months for members with &gt;9 months of payer coverage. No relationship was shown between PAM change and number of PC or SC visits or weight loss and PC visits. A non-significant trend (p=0.079) was observed for greater weight loss [median kg (IQR) -6.25 (-3.55, -9.7)] being associated with fewer SC visits [median visits (IQR) 5 (2,10)]. These pilot data have limitations but suggest further investigation of DPP-adapted weight program outcomes and patterns of healthcare service use is warranted given the potential for lower utilization and costs.

Disclosure
E.M.Venditti: None. J.Kanter: None. K.R.Williams: None. E.Cwenar: None. Q.Liang: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114115)
108-OR: Clinical and Biochemical Factors Are Inversely Correlated in Diabetic Retinopathy and Age-Related Macular Degeneration
Authors: FICKWEILER WARD , MARTIN JACOBA CRIS , VISHVA TEJA JANGOLLA SURYA , GAUTHIER JOHN , ZIEMNIAK NOLAN A. , WU I-HSIEN , CAVALLERANO JERRY D. , AIELLO LLOYD P. , SUN JENNIFER , KING GEORGE L. 
Published: June 2023

Although diabetic retinopathy (DR) and age-related macular degeneration (AMD) are the two most common sight-threatening conditions in the elderly population, our understanding of the associated risks for these diseases have not been studied. Thus, we examined the association between AMD and DR in people with type 1 and type 2 diabetes from the Joslin 50-Year Medalist Study, composed of individuals who have had insulin-dependent diabetes for 50 years or longer and Beetham Eye Institute. In Medalists, there was an inverse association between DR severity and the presence of AMD (N=1163, P=&lt;0.0001, AMD: 23.4%, 18.6, 7.9% for no-mild, moderate-severe, and proliferative DR, respectively). Similarly, the presence of AMD was associated with milder DR in the BEI cohort (N=58, P=0.004). There were no eyes with neovascular (severe AMD). The presence of AMD was associated with older age (P=0.03), increased diabetes duration (P&lt;0.0001), less severe DR (P&lt;0.0001), and the absence of neuropathy (P=0.003). In contrast, younger age (P=0.02) and the presence of neuropathy (P&lt;0.0001) were associated with the presence of proliferative DR. Higher vitreous retinol-binding protein 3 (RBP3) to vascular endothelial growth factor (VEGF) ratios were associated with AMD and less severe DR in both postmortem Medalist and surgical BEI samples (N=187, P&lt;0.05, all). The presence of milder DR was associated with increased risk of AMD development (24.8%, 10.0%, 5.0% for no-mild, moderate-severe, and proliferative DR, respectively, P=0.047), and risk of DR progression was decreased in eyes with versus without AMD (P=0.04) in a subset of Medalists with longitudinal follow up (22.9%). These novel findings that the inverse risk of DR and AMD is not likely due to similar pathogenic mechanisms and ageing factors. Further studies are needed to clarify the interactions between AMD and DR, that may provide new pathways to target against their development.

Disclosure
W.Fickweiler: None. G.L.King: Research Support; Janssen Research & Development, LLC. C.Jacoba: None. S.Jangolla: None. J.Gauthier: None. N.A.Ziemniak: None. I.Wu: None. J.D.Cavallerano: None. L.P.Aiello: Consultant; KalVista Pharmaceuticals, Inc., Novo Nordisk, MantraBio, Ceramedix, Research Support; Optos plc., Stock/Shareholder; KalVista Pharmaceuticals, Inc. J.Sun: Research Support; Adaptive Sensory Technology, Boehringer Ingelheim Inc., Roche Pharmaceuticals, Janssen Pharmaceuticals, Inc., Physical Sciences, Inc, Novo Nordisk, Optovue, Incorporated.

Funding
American Diabetes Association (7-21-PDF-022 to W.F.); National Eye Institute (R01EYE26080-01); National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK09433301); JDRF (17-2013-310); Dianne Nunnally Hoppes Fund; Beatson Pledge Fund
1081-P: Redesigning Diabetes Care for Treatment Inertia
Authors: HATIPOGLU BETUL , BLANCHETTE JULIA E. , OZTURK RONYA , FETZNER JILLIAN , PRONOVOST PETER 
Published: June 2023

Background: As 90% of those with diabetes see primary care, there is opportunity for collaborations to address clinician-level therapeutic inertia. The Diabetes Inertia Collaborative (DIC) is a primary and diabetes specialty care partnership to address lack of time, availability, and increase confidence in clinical recommendations. A diabetes specialty team (endocrinologists, CDCES, RN, RD, NPs) roundtable group reviewed and referred patients to Team-Based Care Pathways (Table 1).
Methods: A prospective pilot QI was conducted at an academic center with a Population Health Accountable Care Organization. Those with A1c &gt;7.0% on the employee health plan were identified through an enterprise data warehouse population health dashboard. Preliminary pre-post evaluation of clinical outcomes (A1c) over six months was conducted for the first 494 participants (N=1065 total) enrolled.
Results: N=494 were mean 54.38 (SD 10.85) years with A1c of 9.4% (1.74) at baseline. Most were White (n=307, 62.1%), non-Hispanic (n=445, 90.1%), and male sex (n=260, 52.6%). Overall, A1c decreased pre-post-intervention (-0.77%, 95% CI [-0.60,-.94]). Multiprogram (-0.55%, CI [-0.11, -0.99]), Pharmacy (-1.01%, CI [-0.61, -1.42]), Milestones (-1.52%, CI [-0.89, -2.14]) and PCP (-0.85%, CI [-0.53, -1.18]) had a significant A1c decrease.
Conclusion: The DIC was well received and adopted by primary care, resulting in program referrals as needed and improved A1c from baseline.

Disclosure
B.Hatipoglu: None. J.E.Blanchette: Advisory Panel; LifeScan Diabetes Institute, Cardinal Health/Edgepark, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists, Speaker's Bureau; Insulet Corporation. R.Ozturk: None. J.Fetzner: None. P.Pronovost: None.
1082-P: Safety of SGLT2 Inhibitors in Heart Transplant Recipients
Authors: ZAHALKA SALWA , LOW WANG CECILIA C. , CHOKSI PALAK , LAWLER HELEN M. , GRAU LAURA , JENSEN THOMAS 
Published: June 2023

Objective: The safety of SGLT2 inhibitor (SGLT2I) use in patients receiving heart transplants is unknown. We aimed to evaluate key measures of safety after initiation of SGLT2I in a cohort of heart transplant recipients.
Methods: Patients in the University of Colorado Health system who received a heart transplant between 1991 and 2022 were included if an SGLT2I was prescribed post-transplant and continued for at least 1 month. Number of urinary tract infections (UTI), urogenital yeast infections (UGI), and ED visits and hospital admissions for skin and soft tissue infections (SSTI) and euglycemic DKA (eDKA) were collected by chart review for the duration of SGLT2I use. Vital signs and lab values were collected at baseline, 3 months, and 6 months after SGLT2I initiation. Least squared means and mean differences were extracted from a random intercept mixed model with an unstructured covariance matrix for each variable.
Results: Forty-six (46) patients met criteria for analysis. Mean age was 56.1 years, 80.4% had DM, and 84.8% had CKD at the time of SGLT2I initiation. Mean time on SGLT2I was 15 months (range 1-91 months). Three patients (6.5%) developed UTI and one developed UGI. Three (6.5%) had ED visits and admissions for SSTI: 1 had a post-surgical scalp infection and 2 had lower extremity cellulitis (1 led to hallux gangrene and amputation). No patients developed eDKA. Seven patients (15.2%) discontinued their SGLT2I: 2 for UTI and 1 each for hypotension, cost, fatigue, dialysis, and unspecified. Thirty-six (36) patients with adequate data over time were included in the analysis to assess change in vital signs and labs. There were no statistically significant changes from baseline to 3 months or 6 months after SGTL2I initiation for weight, BMI, SBP, DBP, Cr, eGFR, serum Na or serum K.
Conclusions: In this sample of heart transplant recipients on SGLT2I, there were few urogenital and SSTI infections, no eDKA, and no significant change in renal function or electrolytes, which adds support for the safety of SGLT2I in this population.

Disclosure
S.Zahalka: None. C.C.Low wang: Research Support; Dexcom, Inc., Virta Health Corp., CellResearch Corporation. P.Choksi: None. H.M.Lawler: None. L.Grau: None. T.Jensen: Other Relationship; Somalogic.
1084-P: The Trend of Korean Diabetes Patients’ Foot EMG Wave Pattern Age over 65
Authors: KIM WI , SHIK PARK MOON 
Published: June 2023

Depending on the healthcare system, ethnicity, and diet, delaying complications related to diabetes differ in each country. Diabetic ulcer accompanied by neuropathy of the foot is the key indicator for the development of complications. Therefore finding the total number of impaired feet with foot muscle dystrophy may understand how the diabetes progression of the patients is controlled by public health organization structures. Korea is one of the nations which adopted a national wide government-organized healthcare insurance system compared with private. In this study, we examined how Korean diabetic feet are controlled by the Korean public health care system. To figure out this, diabetes subjects' foot EMG were examined by STEMG-2 (STUFProject EMG Device-2) by checking 3-second foot up and down movement. Age over 65 who suffered from 50 male and female diabetes patients and 50 male and female nondiabetic patients the foot EMG was tested. After finishing the test results EMG was converted into a digital signal by 1024 arbitrary units and plotted wave pattern with subtracting reference. As a result, 98% of nondiabetics showed constant wave patterns corresponding to muscle relaxation and contraction. Whereas, 86% of diabetes patients have constant EMG wave patterns and only 14% have inconsistent EMG wave patterns. 84% of male and 78% of female diabetes patients have similar wave patterns to nondiabetes individuals Also patients who are BMI less than 23 have 96% of constant patterns. 80% of patients' glucose levels below 180 mg/dl have constant wave patterns. However, 60% of patients over 180mg/dl glucose level have inconsistent patterns. In the conclusion, 86% of Korean diabetes patients are controlling muscle destruction could happen a chronic effect of diabetes. Even 13% of diabetes patients who showed abnormal wave patterns, may have some acute cramp with the foot but visually all toes are intact. This may means the progression of diabetic complications is controlled by the Korean national health system.

Disclosure
W. Kim: None. M. Park: None.

Funding
National Research Foundation of Korea (HNU X-Corps)
109-OR: Prior Cerebrovascular Disease Was Positively Associated with Severe Diabetic Retinopathy and Diabetic Macular Edema in Type 2 Diabetes
Authors: YAMAMOTO MASAHIKO , FUJIHARA KAZUYA , HASEBE HIRUMA , SHIOZAKI HARUKA , KODERA REMI , SATO TAKAAKI , YAGUCHI YUTA , OSAWA TAEKO , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMADA TAKAHO , SONE HIROHITO 
Published: June 2023

Background and Purpose: Although it is well established that diabetic retinopathy (DR) and diabetic macular edema (DME) are risk factors for incident cerebrovascular disease (CVD), whether the CVD history could be a predictor of severe DR or DME remains unknown among people with type 2 diabetes. Also, the effects of aging or systolic blood pressure on incident severe DR or DME in individuals with a history of CVD remains unknown.
Methods: Severe DR and DME were defined as vision-threatening treatment-required diabetic eye diseases (TRDED). Enrolled were 31,638 Japanese patients with type 2 diabetes. We longitudinally explored the existence of such an association not only overall but also according to various factors.
Results: The main outcome of TRDED was observed in 854 (2.7%) patients during a mean follow-up of 5.3 years (5.1/1,000 person-years). Prior CVD was present in 694 of 31,638 (2.2%) patients at baseline. In a multivariate adjusted Cox regression model, prior CVD was positively associated with incident TRDED in analysis of the study population (hazard ratio, 1.63 [95% confidence interval, 1.11-2.37] overall; 1.47 [0.54, 3.99] for age ≤49 y; 1.69 [1.12, 2.55] for age ≥50 y; 1.46 [0.89, 2.39] for SBP ≤139 mmHg; 1.97 [1.09, 3.58] for SBP ≥140 mmHg). All results, including several stratified analyses, correlated with visual inspection of the corresponding Kaplan-Meier analysis with log-rank tests indicating gaps between curves for those with and without prior CVD.
Conclusions: These results indicate that CVD is a predictor of vision-threatening severe retinopathy, and suggested that they shared a common background pathophysiology. It also contributed to preventing severe visual impairment and further deterioration of the quality of life after stroke.

Disclosure
M.Yamamoto: None. M.Iwanaga: None. T.Yamada: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. H.Hasebe: None. H.Shiozaki: None. R.Kodera: None. T.Sato: None. Y.Yaguchi: None. T.Osawa: None. Y.Matsubayashi: None.

Funding
Japan Society for the Promotion of Science (JP21K11569, JP22K16212)
1094-P: Longitudinal Trajectories of Fasting C-Peptide in Youth-Onset Type 2 Diabetes—The SEARCH for Diabetes in Youth Study
Authors: SHAPIRO ALLISON , BELLATORRE ANNA , STAFFORD JEANETTE M. , SHAH AMY S. , PIHOKER CATHERINE , MALIK FAISAL , LIESE ANGELA D. , PETTITT DAVID J. , DABELEA DANA 
Published: June 2023

In youth-onset type 2 diabetes (YO-T2D; diabetes diagnosed &lt;20 years-old) loss of glycemic control is more rapid than in adults, partly attributed to accelerated beta cell decline. However, no studies have investigated the potential heterogeneity in the longitudinal trajectories of beta cell function and whether genetic factors might contribute to heterogeneity. We derived longitudinal trajectories of fasting C-peptide (FCP) levels, a surrogate measure of beta cell function, via discrete mixture modeling of repeated measures collected over 15 years of follow-up in youth with YO-T2D (antibody negative and insulin resistant; n=266) from the SEARCH for Diabetes in Youth cohort study. We tested the association between the derived trajectories and T2D genetic risk score (GRS) using a multinomial logistic regression model with adjustment for relevant covariates. A four-trajectory model best fit the data, classifying youth with YO-T2D as having either “initial low FCP and stable over time” (32%), “initial high FCP and slow incline” (8%), “initial high FCP and slow decline” (53%), or “initial very high FCP and rapid decline” (7%) (Figure). T2D GRS was not associated with FCP trajectory membership. These data demonstrate substantial heterogeneity in trajectories of FCP in YO-T2D and suggest that genetic predisposition to T2D is not a significant determinant of this heterogeneity.

Disclosure
A.Shapiro: None. A.Bellatorre: None. J.M.Stafford: None. A.S.Shah: None. C.Pihoker: None. F.Malik: None. A.D.Liese: None. D.J.Pettitt: None. D.Dabelea: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK127208-01, 1UC4DK108173); Centers for Disease Control and Prevention (U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139)