bluuebunny/crossref_metadata_2025_split huggingface dataset:
1327-P: The Association between Adherence to Mediterranean Dietary Pattern and Nephropathy in Long-Duration Type 1 Diabetes
Authors: HAYES AMANDA , VISHVA TEJA JANGOLLA SURYA , GAUTHIER JOHN , ZIEMNIAK NOLAN A. , WU I-HSIEN , HEI KAREN LAU KA , ADAM ATIF , HU FRANK , TABUNG FRED K. , KING GEORGE L. , SHAH HETAL 
Published: June 2023

Vascular complications contribute to the high morbidity and mortality in type 1 diabetes (T1D), necessitating a search for new therapeutic measures. The Alternative Mediterranean diet score (aMED), high in vegetable, fruits, legumes, whole grains, nuts, and low in red and processed meat and uses olive oil as the main fat source, has been shown to improve glycemic control and reduce cardiovascular disease (CVD) risk in type 2 diabetes, but has not been examined for relationships to vascular complications in T1D. We examined the cross-sectional relationships between aMed adherence and vascular complications among 645 individuals of the Joslin 50-year Medalist study having T1D &gt; 50 years and food frequency histories captured. In multivariable logistic regression models adjusting for age and sex, a higher adherence to a Mediterranean diet was associated with a 17% reduced odds of diabetic nephropathy (DN, eGFR &lt;60 ml/min/1.73m2) [OR 0.83, 95% Cl 0.72-0.95, p=0.008], and this remained significant (p&lt;0.05) after further adjustments for HbA1c, diabetes duration, lipids and blood pressure. There were no significant associations between aMed and CVD, diabetic retinopathy or neuropathy. Among the specific aMED components, higher intake of nuts, higher ratio of monounsaturated fat to saturated fat and lower intake of red and processed meats were all associated with significantly (p&lt;0.05) reduced odds of DN. Triglycerides, HDL and albumin-creatinine ratio (ACR) were significant effect modifiers (p for interaction &lt;0.05) such that, more DN-protective effects of aMed were observed among those with higher triglycerides, lower HDL, and higher ACR. To conclude, our findings suggest that greater adherence to a Mediterranean diet in individuals with long duration T1D is associated with lower risk of DN, independent of traditional risk factors. Further studies are warranted to validate its potential as an effective therapeutic approach against DN in people with T1D.

Disclosure
A.Hayes: None. G.L.King: Research Support; Janssen Research & Development, LLC. H.Shah: None. S.Jangolla: None. J.Gauthier: None. N.A.Ziemniak: None. I.Wu: None. K.Lau: None. A.Adam: None. F.Hu: None. F.K.Tabung: None.

Funding
Nunnally Foundation Inc.; Thomas J. Beatson, Jr. Foundation
1340-P: Complications 30 Years from Diagnosis amongst Participants in the Cognition and Longitudinal Assessment of Risk Factors over 30 Years (CLARiFY) Study
Authors: BROWN AMY , REYNOLDS EVAN L. , GBADEYAN OYETUNDE , MORAN CHRIS , SAKOWSKI STACEY A. , SRIKANTH VELANDAI , NORTHAM ELISABETH A. , CAMERON FERGUS , BEARE RICHARD , FELDMAN EVA L. 
Published: June 2023

There are few longitudinal cohort studies in type 1 diabetes that originate in the immediate post-DCCT era. We recruited participants who had initially presented with childhood onset type 1 diabetes (&lt;15 yr age) to a tertiary hospital in Australia between 1990-1992 into the Cognition and Longitudinal Assessment of Risk Factors over 30 Years (CLARiFY) Study. Microvascular co-morbidity outcomes were measured using a clinical neuropathy screening tool and spot urinary albumin to creatinine ratios (ACR). In this interim study, 56 participants had complete neuropathy screening. 7/56 (12.5%) met the criteria for neuropathy with the mean (SD) HbA1c of 8.57 (1.49) compared to 8.04 (1.46) in the non-neuropathy participants (p-value=0.41). Pearson's correlation coefficients were calculated to assess pairwise associations between HbA1c and continuous neuropathy outcomes and observed non-significant negative correlations between HbA1c and vibration (r=-0.12, P=0.38). Of the 56 participants with neuropathy measurements, 40 also had urine albumin-creatinine ratios (ACR). 27/40 (67.5%) had normal ACR (ACR&lt;3 mg/mmol) with HbA1c of 7.8 (1.3); 10/40 (25.0%) had microalbuminuria (3 mg/mmol&lt;ACR&lt;30 mg/mmol) with HbA1c of 10.3 (2.3); and 3/40 (7.5%) had macroalbuminuria (ACR&gt;30 mg/mmol) with HbA1c of 10.3 (2.3). Using a one-way ANOVA test, HbA1c was significantly different between the three groups (p-value = 0.01.). Using the ACR as a continuous variable, the Pearson's correlation coefficient with A1c was 0.49 (p-value= 0.001). Collectively, these data show that in a cohort of type 1 adults diagnosed in childhood, elevations of ACR are more common and associate with glycemic control when compared to measures of neuropathy.

Disclosure
A.Brown: None. E.L.Feldman: None. E.L.Reynolds: None. O.Gbadeyan: None. C.Moran: None. S.A.Sakowski: None. V.Srikanth: None. E.A.Northam: None. F.Cameron: None. R.Beare: None.

Funding
National Institutes of Health (R01DK129320)
139-LB: Use of Digital Diabetes Solution Is Associated with Improved Glycemic Control without Increased Risk of Severe Hypoglycemia in Adults with Type 2 Diabetes Mellitus in the United States—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 blood glucose (BG) monitoring system with a smartphone app, allowing tracking of BG levels in real time. This study assessed effects of DDS on HbA1c levels in adults with type 2 diabetes mellitus (T2DM) with baseline (BL) HbA1c ≥8% and on severe hypoglycemia (SH).
Methods: This retrospective cohort analysis included adults with T2DM who used DDS (users) and nonusers from 1JAN2017 to 31OCT2021. BL period was 1 year before index date (users, first DDS registration; nonusers, first claim date in the quarter); follow up was 6 months. DDS users and nonusers were sequentially matched 1:3 using exact and propensity score matching. Secondary endpoints included SH (event requiring medical intervention) rates for all patients (pts) and for pts with BL HbA1c ≥8% who achieved predefined target HbA1c &lt;8%. SH incidence in users vs nonusers was examined.
Results: Overall cohort included 568 DDS users and 1699 nonusers: mean age, 57.5±11.3 years; mean BL HbA1c, 9.14±1.83%; oral antidiabetic drugs, 51%; insulin, 6%. BL SH was rare (users, 7/568; nonusers, 12/1699). There were 387 users and 1089 nonusers with BL HbA1c ≥8% (mean BL HbA1c, 10.0±1.7%). In this subgroup, HbA1c &lt;8% was achieved by 9% more DDS users (174/387 [45%]) vs nonusers (393/1089 [36%]) at 6 months; P=0.002. At 6 months, overall SH rate was 38.8 (users) vs 10.6 (nonusers) events/1000 pts per year (incidence rate ratio, 0.9; P=0.9). No observed increase in SH risk was associated with DDS in this population. SH was rare in pts who achieved HbA1c &lt;8% (users, 1/174; nonusers, 3/393).
Conclusions: In this retrospective study, a larger proportion of adults with uncontrolled T2DM (BL HbA1c ≥8%) achieved HbA1c &lt;8% after using DDS vs nonusers, with no increased risk of SH.

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
1398-P: Contribution of New-Onset Diabetes after Organ Transplantation on the Incident Cardiovascular Disease and Malignancy in Korea—A Nationwide Population-Based Study
Authors: KYUNG KOO BO , KYONG MOON MIN , SHIN PARK SEUNG , HAN KYUNGDO 
Published: June 2023

Background: In Korea, the number of solid organ transplantation (TPL) has been markedly increased; however, there has been limited data on the adverse effect on the cardiovascular disease and malignancy of new onset diabetes after transplantation (NODAT) in solid organ TPL other than kidney.
Methods: Using the National Health Insurance Service (NHIS) database which covers the claims of 97.0% of the population in Korea, the recipients of kidney, liver, and heart TPL in 2009-2015 were identified and categorized into 3 groups: without NODAT (reference), with NODAT, and pre-existing diabetes mellitus (DM). The incidence of myocardial infarction (MI), stroke, and malignancy till December 2018 in each group were compared using Cox-regression analysis.
Results: Among the entire 18,763 cases of TPL identified, NODAT was detected in 29.8% (27.2% [2,903 out of 10,687], 43.4% [3,247 out of 7,747], and 41.5% [250 out of 602] in kidney, liver, and heart TPL, respectively); and 77.3% of NODAT cases were detected within 3 months after TPL. NODAT increased the risk of MI, but not of stoke, by 2.3 times compared to the reference group after adjustment for age, sex, hypertension, dyslipidemia, and immunosuppressants (hazard ratio [HR], 2.34; 95% CI, 1.61-3.51), which was observed only in kidney TPL (HR, 2.44; 95% CI, 1.52-3.91) but not in liver TPL. A significant increment of the risk of malignancy by NODAT was found only in kidney TPL (HR, 1.30; 95% CI, 1.04-1.64), whose statistical significance was lost after adjusting confounders. During the same period, no association between pre-existing DM and malignancy was found, neither.
Conclusion: NODAT independently increased the risk of MI after organ transplantation, which was more evident in the recipient of kidney TPL. There was no additional increased risk of stroke or malignancy by NODAT in solid-organ TPL.

Disclosure
B.Koo: None. M.Moon: None. S.Park: None. K.Han: None.
140-OR: Adoption of State-Level Complete Streets Legislations and U.S. Prevalence of Obesity
Authors: LINDE SEBASTIAN , EGEDE LEONARD E. 
Published: June 2023

Background: The US obesity prevalence has increased from 30.5% in 1999 to 41.9% in 2020, and the medical cost of obesity is estimated at $173 billion annually. Given the health and cost implications of obesity and its direct relationship with the growing prevalence of diabetes, there is a need to identify policy levers that can ameliorate these public health burdens. Complete Streets policies aim to strengthen transportation systems, promote physical activity and improve health outcomes related to obesity and in turn diabetes. It addresses issues like sidewalks, bicycle lanes, bus lanes, public transportation stops, crossing opportunities, median islands, accessible pedestrian signals, curb extensions, modified vehicle travel lanes, streetscape, and landscape treatments. This study examines the effect of state adoption of Complete Streets policies on prevalence of obesity.
Methods: We combined data on state obesity rates from America's Health Ranking database with legal information on state's adoption of Complete Streets policies from the PHACCS Initiative. Using the data we estimated overall average, as well as state specific, policy effects due to Complete Streets policy adoption. Our approach utilized a generalized difference-in-difference design and additional testing of model assumptions.
Results: Our analysis sample consisted of a panel of 1,479 state-year observations (across 50 US States and the District of Columbia, for the period of 1990-2018). This corresponds to 22 exposed states (with Complete Streets policies), and 29 control states (without Complete Streets policies). Preliminary analyses indicate significant reduction of obesity prevalence (-0.5%; 95%CI: -0.9 to -0.1; p=0.006) in exposed vs. control states, with heterogenous policy effects across states.
Conclusions: Complete Streets policy adoption is associated with reduced obesity rates. Given these associations, Complete Street policy adoption is also likely to result in reductions in prevalence of diabetes.

Disclosure
S.Linde: None. L.E.Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Disease (K24DK093699, R01DK118038, R01DK120861 to L.E.E.); National Institute for Minority Health and Health Disparities (R01MD013826 to L.E.E.)
141-LB: Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (rt-CGM) vs. Intermittent-Scanning Continuous Glucose Monitoring (is-CGM) from a U.S. Payer Perspective in Patients with Type 2 Diabetes on Multiple Daily Injections of Insulin (PwT2D on MDI)
Authors: ALSHANNAQ HAMZA , NORMAN GREGORY J. , LYNCH PETER M. 
Published: June 2023

Diabetes management for PwT2D on MDI requires access to timely glucose readings to inform treatment decisions and avoid acute events like severe hypoglycemia (SHE) and Diabetic Ketoacidosis (DKA). CGM systems have different features that can impact glycemic outcomes and disease complications and costs. There is a gap in the literature on the cost-effectiveness of rt-CGM vs is-CGM systems. We conducted lifetime projections of disease outcomes and costs from a US payer perspective using the IQVIA Core Diabetes Model v9.5+. Cohort characteristics and clinical inputs were sourced from the DIAMOND T2D and REPLACE RCTs. Applying Bucher's adjusted indirect comparison method resulted in an HbA1c effect of -0.33 favoring rt-CGM, SHE incidence rates of 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and DKA rates were estimated using Time-Above-Range (0.0313 and 0 PPY, respectively). The cost of both CGM systems is based on Medicare pricing and 80% reimbursement (HCPCS code A4239). A utility for fear of hypoglycemia (FoH) reduction was applied from the ALERTT1 RCT. The model associates rt-CGM use with reduced eye (-5.64%), renal (-7.42%), neural (-4.08%), and cardiovascular (-2.56%) complications compared to is-CGM. It projects rt-CGM users to have higher quality-adjusted life years (QALYs) by 0.454 with cost savings of -$1,355, and an incremental cost-effectiveness ratio of -$2,983/QALY. Rt-CGM remained cost-effective under the $50,000 willingness-to-pay threshold even when its cost was increased by 70% (+$1,713). Scenario analysis with 50% lower FoH utility, SHE, and DKA rates reduced QALYs gained to 0.264. Our analysis suggests that rt-CGM is cost-saving and cost-effective vs is-CGM in PwT2D on MDI in the US and can inform US payers of the economic value of different CGM systems.

Disclosure
H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. P. M. Lynch: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.
142-LB: Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (rt-CGM) vs. Intermittent-Scanning Continuous Glucose Monitoring (is-CGM) in Patients with Type 2 Diabetes on Multiple Daily Injections of Insulin (T2D MDI) in Canada
Authors: ALSHANNAQ HAMZA , NORMAN GREGORY J. , WILLIS MICHAEL , NILSSON ANDREAS 
Published: June 2023

Rt-CGM systems provide real-time glucose values, hypo- and hyperglycemia alerts, and predictive “urgent low soon” alerts that have been shown to improve glycemic outcomes and reduce severe hypoglycemic events (SHEs) in patients with T2D, without the need for periodic scanning. The economic value of rt-CGM vs is-CGM is unknown for patients with T2D MDI in Canada. We conducted a cost-effectiveness analysis comparing the two systems for this patient population using the INESSS Canadian payer perspective. ­ A 30-year analysis was performed using the validated ECHO-T2DM. Patient characteristics were sourced from Karter (2021). Efficacy and safety were derived from the DIAMOND T2D and REPLACE RCTs. The HbA1c difference of -0.33 (favoring rt-CGM) was derived using Bucher's adjusted indirect comparison, SHE rates were 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and severe hyperglycemia/DKA rates were proxied by the difference in time above range (0.0313 and 0 PPY, respectively). Costs and disutility weights were sourced from published Canadian literature and discounted at 1.5% annually. A reduction in fear of hypoglycemia (FOH) utility was sourced from the ALERTT1 RCT. Sensitivity analyses were performed. Rt-CGM was associated with quality-adjusted life year gains of 0.346 and incremental costs of CAD 5,737, with an incremental cost-effectiveness ratio (ICER) of CAD 16,598. No DKA events for is-CGM and a 50% reduction in FOH utility increased the ICERs to CAD 30,987 and CAD 29,116, respectively. ICER was CAD 2,278 when both CGM costs were reduced by 50% and rt-CGM became cost-saving (dominant) at a 65% reduction. These results suggest rt-CGM is cost-effective vs is-CGM in patients with T2D MDI in Canada. These findings can inform government and commercial healthcare decision-makers when considering reimbursement of CGM systems.

Disclosure
H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. M. Willis: None. A. Nilsson: None.

Funding
Dexcom, Inc.
143-OR: Prevailing Glucose Levels Alter Left Ventricular Contractions Pattern, Myocardial Performance, and Myocardial Energy Efficiency
Authors: ANDREASEN CHRISTINE R. , ANDERSEN ANDREAS , HAGELQVIST PER G. , MAYTHAM KAISAR , SENGELØV MORTEN , KNOP FILIP K. , OLSEN FLEMMING J. , VILSBØLL TINA 
Published: June 2023

Mechanical dispersion (MD) describes heterogeneity in ventricular contraction patterns, and myocardial work (MW) indices quantify ventricular performance. Investigating the myocardial and functional response to acute hypoglycemia and hyperglycemia may aid in identifying putative mechanisms linking glycemia and cardiovascular disease (CVD). From echocardiography performed during euglycemic, hyperglycemic and hypoglycemic clamps, we explored the relationship between glycemia and MD and MW indices in individuals with type 1 diabetes, type 2 diabetes and without diabetes. MD was measured by speckle-tracking echocardiography, and MW measures were derived from pressure-strain loop analyses. We analyzed data (mean±SD) from 84 individuals: 20 young individuals with type 1 diabetes (age: 30±8 years); 24 middle-aged individuals with type 1 diabetes (age: 53±12 years); 21 older individuals with type 2 diabetes (63±7 years), and 21 controls (62±8 years). Results for MD and MW indices are illustrated in Figure 1. In conclusion, acute hyperglycemia leads to an energy-effective myocardium with homogeneous left ventricular contractions. Hypoglycemia increases constructive myocardial work, followed by a less energy-efficient myocardium and more heterogeneous left ventricular contractions, perhaps alluding to a possible link between hypoglycemia and CVD.

Disclosure
C.R.Andreasen: None. A.Andersen: None. P.G.Hagelqvist: None. K.Maytham: None. M.Sengeløv: None. F.K.Knop: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Novo Nordisk, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Lundbeck. F.J.Olsen: None. T.Vilsbøll: Consultant; AstraZeneca, Boehringer Ingelheim Inc., Gilead Sciences, Inc., Eli Lilly and Company, Mundipharma, Merck & Co., Inc., Novo Nordisk A/S, Sanofi, Sun Pharmaceutical Industries Ltd., Bristol-Myers Squibb Company.

Funding
Danish Diabetes Academy (17SA0031406); Novo Nordisk Foundation (16230)
144-LB: Assessment of Drug Prescription Patterns of Patients with Type 2 Diabetes Mellitus in India
Authors: CHAVDA VIPUL , SABOO BANSHI D. , ABHICHANDANI VK , DESAI SANDEEP , PATADIA VIPUL , MORI BIRJU S. , PATEL SUSHIL , PRAJAPATI AAKASH M. , PAREKH MALAY N. , VORA FALGUNI , VORA TANISHA , HASNANI DHRUVI 
Published: June 2023

Rationale: Drug prescribing studies can suggest modifications in the current prescribing practices, which in turn will reduce the treatment cost, non-compliance and complications.
Purpose: To identify the prescription patterns in patients with type 2 diabetes mellitus with respect to the duration of the disease.
Methods: Patients with type 2 diabetes mellitus seeking regular care at twelve of the locations in Western India were included in the study. Using MEDEVA (EMR), an integrated research platform, information on medical history, laboratory values and medications was recorded. Data collected from 1st December 2022 to February 25th 2023 was considered for the analysis.
Results: Of the 920 patients enrolled in the study, 607 had a duration of diabetes and prescribed medications recorded. Patients with a duration ≤ 5 years are about 53.0%, 5-10 years are 28.8% and &gt;10 years are 18.1%. Biguanides and Sulfonylureas, followed by DPP-4, are the most common drug classes prescribed in patients with ≤ 5 years duration and Insulins in patients with a duration of more than 10 years.
Conclusion: This study offers valuable information on the trends in oral antidiabetic medications and insulins in diabetic patients. As the duration of the disease increases insulin is the most prescribed medication.

Disclosure
V. Chavda: None. B. D. Saboo: None. V. Abhichandani: None. S. Desai: None. V. Patadia: None. B. S. Mori: None. S. Patel: None. A. M. Prajapati: None. M. N. Parekh: None. F. Vora: None. T. Vora: None. D. Hasnani: None.
145-LB: Consistent Care of Teens and Young Adults with Diabetes during the COVID-19 Pandemic
Authors: HSIA DANIEL S. , BEYL ROBBIE A. , RUMSEY RENEE 
Published: June 2023

The transition period from pediatric to adult care is associated with worsening glycemic control and poor attendance with adult providers, which has only been complicated by the COVID-19 pandemic. Diabetes transition clinics and model programs may improve outcomes, but they remain few in number and underutilized. The aim of our cross-sectional, retrospective study was to compare diabetes control in our diabetes transition clinic (DTC) patients versus those who remained in pediatric endocrine care (non-DTC) over a 5 year period. A random sample of 82 patients ages 16 to 25 years seen in clinic from 9/11/2017 to 9/10/2022 were included. Each patient had at least one visit before and after 3/11/2020, when COVID-19 was declared a global pandemic. Those who attended DTC were similar to the non-DTC group except for insurance status (Table). The DTC group had a mean HbA1c of 8.8% vs. 9.0% (p=0.80) and a mean of 4.1 vs. 3.8 visits (p=0.69); whereas, the non-DTC group had a mean HbA1c of 10% vs. 9.6% (p=0.27) and a mean of 5.2 vs. 4.2 visits (p=0.19) before versus after 3/11/2020. Telehealth visits consisted of 15.7% of the visits in the DTC group versus 13.3% in the non-DTC group after 3/11/2020 (p=0.56). Despite the challenges of the COVID-19 pandemic, patients who moved to DTC during this time maintained glycemic control and continued to attend clinic visits consistently similar to those who remained in pediatric endocrine care.

Disclosure
D. S. Hsia: None. R. A. Beyl: None. R. Rumsey: None.

Funding
National Institute of General Medical Sciences (U54GM104940)