bluuebunny/crossref_metadata_2025_split huggingface dataset:
1004-P: Association of Social Needs with 30-Day Readmission and Length of Stay
Authors: BHANDARI SANJAY , WALKER REBEKAH J. , DAWSON APRILL Z. , WILLIAMS JONI S. , EGEDE LEONARD E. 
Published: June 2023

Introduction: The objective of this study was to investigate if social needs are associated with inpatient quality metrics (30-day readmission [30DR], length of stay [LOS]) and if the relationship differed for individuals with and without diabetes.
Methods: We used the data from electronic medical records at a tertiary academic hospital in Southern Wisconsin for patients aged 18 years or older with inpatient encounters during which data on social needs were collected between February 2021 to December 2021. Patient demographics including age, gender, race, and insurance along with comorbidities, social needs, LOS and readmission information were extracted for the index inpatient encounter. The social needs items included financial strain, food insecurity, housing insecurity, and transportation need. Appropriate models were run to assess the association of social needs with the outcomes, overall and with interaction for DM status
Results: Overall, 13,010 patients were included in our study. Only 7.2% reported presence of any social needs with financial strain as the most frequently reported need (5.3%) and 24% of the sample had diabetes. Overall, there was no significant association of the presence of any social needs with either 30DR or LOS. In addition, there were no significant interactions for DM status indicating relationship was similar for individuals with and without DM.
Conclusion: The overall prevalence of any material needs was much lower than national estimates. Presence of social needs was not associated with 30RR and LOS. Investigation is needed for best practices in collecting social needs in inpatient setting.

Disclosure
S.Bhandari: None. R.J.Walker: None. A.Z.Dawson: None. J.S.Williams: None. L.E.Egede: None.
1009-P: Cost-Effectiveness of MiniMed 780G Therapy Compared with Multiple Daily Injections (MDI) with Intermittently Scanned Continuous Glucose Monitoring (isCGM) in People with Type 1 Diabetes (T1D)—A Singapore Perspective
Authors: GARDNER DAPHNE , LAKKAD MRINMAYEE , QIU ZHIYU , INOUE YUTA , RAMA CHANDRAN SURESH , WHERRY KAEL 
Published: June 2023

Objective: To assess cost-effectiveness of the MiniMed™ 780G (MM780G) system compared to MDI paired with isCGM when used by people with T1D in Singapore, in a simulation study.
Methods: The IQVIA Core Diabetes Model was used to estimate complications, costs, and quality of life over a lifetime among a cohort of people with T1D in Singapore. Change in HbA1c was sourced from a 6-month randomized controlled trial (ClinicalTrials.gov, NCT04235504). Demographic characteristics and baseline HbA1c were gathered from local databases. Cost inputs were derived from the literature and localized data. The cohort assumed a mean age of 32.2±15.9 years, was 76% female and had a HbA1c of 8.4%±1.84% at baseline. HbA1c was reduced by 1.5±0.7% with MM780G and by 0.2±0.8% with MDI + isCGM, after 6 months. Rates of hypoglycemia and diabetic ketoacidosis were taken from the literature for the MDI + isCGM group and were assumed to be 0% in MM780G patients based on trial results. Probabilistic sensitivity analysis was conducted to assess the impact of parameter uncertainty and model assumptions.
Results: MM780G was associated with increased quality-adjusted life years (QALY) compared to MDI + isCGM (13.03±0.16 years for MM780G vs. 12.00±0.14 for MDI + isCGM), alongside increased costs (SGD 256,289 ± SGD 4,525 for MM780G vs. SGD 209,237 ± SGD 4,217 for MDI + isCGM). The incremental cost-effectiveness ratio (ICER) in the base case was SGD 45,483 per QALY. The probabilistic sensitivity analysis indicated a 60.0% probability that MM780G is cost-effective compared to MDI + isCGM in T1D, at a willingness-to-pay (WTP) threshold of SGD 45,000 (USD $33,300) per QALY.
Conclusions: At a WTP threshold of SGD 45,000 per QALY, MM780G is cost-effective compared to MDI + isCGM in a population of people with T1D in Singapore.

Disclosure
D.Gardner: None. M.Lakkad: None. Z.Qiu: Employee; Medtronic. Y.Inoue: Employee; Medtronic. S.Rama chandran: Advisory Panel; Medtronic, Dexcom, Inc., Speaker's Bureau; Medtronic, Abbott, Boehringer Ingelheim Inc., Sanofi, AstraZeneca. K.Wherry: Employee; Medtronic, Stock/Shareholder; Medtronic.
1012-P: Trends in Enrollment in Medicare Advantage Plans among Older Adults with Diabetes, 2015–2020
Authors: WEINSTEIN JOSHUA M. , MUTHUKKUMAR RASHMI , YOUNG LAURA A. , KAHKOSKA ANNA R. 
Published: June 2023

Existing literature has found an increase in the proportion of older adults that enroll in Medicare Advantage (MA) plans relative to those enrolling in traditional Medicare (TMed). Similarly, previous studies have shown that individuals with diabetes are more likely to enroll in MA plans than those without diabetes. Our objective was to determine whether trends for enrollment in MA plans among adults with diabetes followed a similar trend to those without diabetes. We used the Medicare Current Beneficiary Survey (MCBS) to calculate the proportion of the Medicare-eligible population enrolling in MA vs. TMed each year from 2015 - 2020. We stratified these rates by diabetes diagnosis (any diabetes vs. no diabetes), and further by diabetes type (Type 1 vs. Type 2). Like previously published literature, we found that those with diagnosed diabetes has higher rates of MA enrollment than those without diabetes. MA enrollment trends followed a similar pattern among those with diabetes compared to those without. Among those without diabetes, MA enrollment rates increased from 34.2% in 2015 to 40.5% in 2020. Among those with Type 1 and Type 2 Diabetes, MA enrollment rates increased from 38.8% to 46.9% and from 38.4% to 45.8%, respectively. In relative terms, MA enrollment increased by 20.9% among those with Type 1 Diabetes, 13.9% among those with Type 2 Diabetes, 15.9% with other diabetes, and 18.3% without diabetes.

Disclosure
J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim. A.R.Kahkoska: None.

Funding
National Institutes of Health (KL2TR002490, UL1TR002489)
1014-P: Evaluation of Diabetic Ketoacidosis Management with a Subcutaneous Insulin Lispro PowerPlan
Authors: QUAYTMAN JACOB , KARSLIOGLU-FRENCH ESRA , DONIHI AMY 
Published: June 2023

Diabetic ketoacidosis (DKA) has traditionally been treated with a continuous intravenous insulin infusion, often requiring management in an intensive care unit (ICU) or step-down unit. There has been growing evidence supporting the use of subcutaneous rapid-acting insulin analogs to treat mild-to-moderate DKA (alert patient able to tolerate oral fluid intake, pH &gt;7.0, bicarbonate ≥10), helping to decrease costs and ICU-bed utilization. We sought to establish the efficacy and safety of a subcutaneous insulin lispro protocol developed at UPMC for the treatment of mild-to-moderate DKA. A retrospective chart review was performed on patients across 15 institutions in the UPMC network from February-October 2022 who had the adult DKA PowerPlan subcutaneous insulin lispro subphase ordered. Of 111 cases analyzed, 47 cases were included that properly used the PowerPlan to treat mild-to-moderate DKA. DKA resolution using the PowerPlan was reached in 45/47 (95.7%) cases. The two unsuccessful cases involved delayed recognition of DKA in the emergency department and premature transition to a prandial insulin regimen before DKA resolution. Hypoglycemia (defined as glucose &lt;70) occurred in 9/47 (19.1%) encounters. Only 1/47 (2.1%) encounters involved hypoglycemia directly attributable to the subcutaneous insulin lispro PowerPlan. The remaining cases of hypoglycemia were attributed to not reducing insulin doses when glucoses were &lt;250, giving insulin doses sooner than 2 hours before the prior dose, not starting dextrose-containing fluids when glucoses were &lt;250, and higher co-administered basal insulin doses (&gt;0.3 units/kg). Overall, these results suggest that a subcutaneous insulin analog can be safely and effectively used to treat mild-to-moderate DKA in non-ICU settings.

Disclosure
J.Quaytman: None. E.Karslioglu-french: Research Support; Abbott. A.Donihi: None.
1021-P: Targeting Lower LDL Levels in Patients with Diabetes and ASCVD through a Novel Healthy Heart Program
Authors: ANTUNEZ EFRAIN , KENNEY ROBERT E. , AGUILAR RICHARD , MCCLOSKEY VERONICA , RIVERA JUAN 
Published: June 2023

The US prevalence of ASCVD with DM in the elderly has been reported to be 50%. This population is at significant risk for future CV complications. (1) Aggressive management of dyslipidemia in the primary care setting should be a central focus to reduce associated morbidity and mortality. (2) Current US LDL targets for pts with DM are &lt; 70 mg/dl. Recent ESC/EAS Guidelines in pts with DM and ASCVD, defined as a very high risk (VHR) population, target LDL levels at &lt;55 mg/dl. (3) This study evaluates the impact of a protocol driven program, Healthy Heart (HH), in achieving lower LDL levels in elderly Medicare Advantage pts with DM and ASCVD in the primary care setting. The HH program is a pre-defined intervention protocol administered by specially trained APRNs in primary care offices, with cardiology oversight. Continuity with PCP directed care was maintained. At each visit, ASCVD risk factors were measured and managed along with recommended lifestyle modification. In the first year, 421 pts referred to HH had DM with established ASCVD. Baseline and final LDL values along with high intensity statin (HIS) use are reported. Demographics: Mean age 75+/-5.9 YO, 69% F, 84% Hispanic/Latino, &lt;1% AA, BMI 30.0+/-5.3 kg/m², previous CABG 38%, CHF 24%, Carotid AD 23%, and prior stroke/TIA 3%. Mean time between baseline and final LDL was 320+/-107 days. The average number of HH visits was 3.5+/-1.7. Results: At baseline, 12.5% of the cohort had an LDL of &lt;70 mg/dl, significantly improving to 55.1% after intervention. For the lower LDL target of &lt;55 mg/dl, 10.6% of the cohort were at target improving to 29.2%, the use of HIS therapy improved from 40.3% at baseline to 84.3%. All findings were significant (P&lt; 0.0001).
Conclusion: Using a pre-defined protocol administered by APRNs in a primary care setting significantly improved the percentage of VHR patients achieving LDL targets of &lt;70 and &lt;55 mg/dl. The use of HIS more than doubled. Additional study to evaluate clinical outcomes is warranted.

Disclosure
E.Antunez: None. R.E.Kenney: None. R.Aguilar: None. V.Mccloskey: None. J.Rivera: None.
1026-P: Impact of Online CME on Planned and Actual Practice Changes Related to CGM Use
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE 
Published: June 2023

Objective: Assess impact of online education to prompt changes in practice of diabetologists/endocrinologists (D/Es), PCPs and CDEs related to use of real-time continuous glucose monitoring (rtCGM) in practice.
Method: Online summary of a symposium presented at the ADA 2021 Conference. Faculty presentation was reinforced with synchronized slides presenting supportive data. The impact of the education measured with a survey immediately post-education to assess planned changes in clinician practice as a result of participation in CME activity. Survey participants were contacted 8 weeks later to assess self-reported actual changes in practice. The activity launched August 3, 2021 and data were collected through June 29, 2022. Results: A total of 324 clinicians in the target audience completed the survey immediately post-education. • 74 D/Es, 141 PCPs, and 109 CDEs • 33% of D/Es, 10% of PCPs, and 17% of CDEs treat more than 30 patients per week with diabetes • 92% of respondents indicated an average of 3.1 planned practice changes each When re-engaged with the follow up survey, 15 completed the survey. • 6 D/Es and 9 PCPs • 67% of D/Es and 56% of PCPs treat more than 30 patients per week with diabetes • Of those, 93% reported making an average of 4.8 changes in practice as a result of this activity • Changes in practice include: o Recommending CGM in patients who want to improve time in range and minimize hypoglycemia (100% D/Es and 78% PCPs) o Recommending CGM in patients with diabetes on insulin (100% D/Es and 67% PCPs) o Increasing familiarity with clinical trial data related to CGM use (83% D/Es and 67% PCPs) o Target time in range with diabetes-related treatment goals (83% D/Es and 44% PCPs) Conclusion: The outcomes gathered in this assessment provide compelling evidence that participation in online CME prompts both planned and actual changes in practice related to CGM use. Future education is needed for PCPs regarding time in range goals as part of a diabetes treatment plan.

Disclosure
A.Larkin: None. J.Schrand: None. A.Le: None.

Funding
Dexcom, Inc.
1027-P: Lower Admission HbA1c Is Associated with Lower Likelihood of SGLT-2 Inhibitor or GLP-1 Agonist Prescription in Patients with Type 2 Diabetes after Myocardial Infarction
Authors: MALLADI CHAITANYA L. , SUMARSONO NATHAN , DELLA-PENNA PAIGE L. , DWEIK ASEEL A. , GEURINK KYLE , MATHEW CHRIS , MOSS ELIZABETH , PEYKOVA KREMENA , MACK-BOYD LISA , DAS SANDEEP 
Published: June 2023

Introduction: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We examined prescription rates of these medications stratified by hemoglobin A1c at time of index MI admission in a large urban safety net teaching hospital which provided these medications to low income patients at nominal cost.
Methods: Using the hospital EHR, we reviewed medication lists one year after discharge for all patients with T2D who were hospitalized with type 1 MI between 2018-2019.
Results: There were 178 patients with one-year follow-up data, of which 75 (42%) were uninsured. As shown in Figure 1, proportions of patients prescribed SGLT2 and GLP1 at one year increased with higher admission A1c (p = 0.009 and p = 0.07, respectively). Median A1c at time of index MI was higher in those prescribed SGLT2 (9.3 vs 8.0, p = 0.03) and GLP1 (10.1 vs 8.1, p = 0.07) at one year versus those were not.
Conclusion: Patients with higher A1c at the time of MI were statistically significantly more likely to be prescribed SGLT2 and numerically more likely to be prescribed GLP1 one year after MI. These results suggest that a focus on glycemic control may be contributing to suboptimal use of these MACE-reducing medications in patients who would be expected to benefit from them.

Disclosure
C.L.Malladi: None. S.Das: None. N.Sumarsono: None. P.L.Della-penna: None. A.A.Dweik: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.
103-LB: Impact of Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA) in COVID-19 Patients with Preexisting Type 2 Diabetes (T2D) and Cardiovascular Disease (CVD)
Authors: NGUYEN CHI , CROWE CHRISTOPHER L. , KUTI EFFIE , DONATO BONNIE M.K. , DJARAHER RACHEL L. , SEMAN LEO J. , GRAETER NANCY , POWER THOMAS P. , WILLEY VINCENT 
Published: June 2023

Objective: CVD is the leading cause of death and disability among individuals with T2D. National guidelines recommend an SGLT2i or GLP-1 RA in patients with T2D who have or are at high risk for CVD. This study examined the impact of SGLT2i or GLP-1 RA on clinical outcomes in patients with pre-existing T2D+CVD who developed COVID-19.
Methods: Adult patients with T2D+CVD who developed COVID-19 during 03/01/20-05/31/22 and had ≥1 year of health plan enrollment before the COVID-19 diagnosis were identified from the Healthcare Integrated Research Database (HIRD®). Eligible patients were classified as guideline concordant or not based on SGLT2i or GLP-1 RA prescription fills in the year before COVID-19 infection. COVID-19 related and all-cause hospitalization, ICU admission, and mortality were compared between SGLT2i or GLP-1 RA users and non-users. Propensity score (PS) matching and multivariable analyses were performed.
Results: A total of 42,646 COVID-19 patients with T2D+CVD were identified with a mean follow-up of 8.6 months. The use of SGLT2i or GLP-1 RA was low (n=8,498; 20%). Patients receiving SGLT2i or GLP-1 RA were younger, had fewer comorbidities, took more CVD prevention medications, and were less likely to be hospitalized during the year before COVID-19 infection than non-users. After PS matching and multivariable adjustment, T2D+CVD patients with COVID-19 who received SGLT2i or GLP-1 RA were 12% less likely to be hospitalized and 10% less likely to be admitted to the ICU due to COVID-19 compared to those who did not (n=8,479 each group; both p&lt;0.05). Reductions were also observed for all-cause hospitalization (6%), ICU admission (7%), and mortality (10%), but the results were not statistically significant.
Conclusion: The findings suggest that SGLT2i and GLP-1 RA may improve outcomes in T2D+CVD patients with COVID-19 and support existing national guidelines.

Disclosure
C. Nguyen: Employee; HealthCore Inc. C. L. Crowe: Employee; HealthCore Inc. E. Kuti: Employee; Boehringer Ingelheim Inc. B. M. K. Donato: Employee; Boehringer Ingelheim Pharmaceuticals Inc. R. L. Djaraher: None. L. J. Seman: Employee; Boehringer Ingelheim Pharmaceuticals Inc. N. Graeter: None. T. P. Power: None. V. Willey: Other Relationship; Novo Nordisk A/S.

Funding
Boehringer Ingelheim
1040-P: Feasibility and Performance of Continuous Glucose Monitoring (CGM) to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit (CV-ICU)
Authors: ANG LYNN , AKANBI FOLAKE , SCHROEDER LEE F. , KUEI LIN YU , DEGEORGE CHRISTINA A. , ARNOLD PATRICK , KNOTTS SHARON , DUBOIS ELIZABETH , DESBROUGH NICOLE , QU YUNYAN , FREEMAN REGI , ESFANDIARI NAZANENE H. , BUSUI RODICA , GIANCHANDANI ROMA 
Published: June 2023

We evaluated the utility of real-time CGM for titrating intravenous (IV) insulin via a validated institutional computerized insulin infusion (CII) algorithm in the CV-ICU. We used a hybrid approach of combining CGM with periodic point-of-care blood glucose (POC-BG) tests to validate the continued accuracy of CGM. We also surveyed nurses on this care change. Dexcom G6 CGMs were applied to 61 post-surgical patients with hyperglycemia (34% with diabetes) receiving IV insulin. CGM values were validated with POC-BG every(Q) 1-2 h per the CII protocol. Once validated (i.e., within 20% of POC-BG values if BG ≥100 mg/dL or within 20 mg/dL if BG &lt;100 mg/dl), sensor values were then used to titrate IV insulin doses per CII algorithm. POC-BG checks were then reduced to Q6h validation. Among 857 paired POC-BG and CGM values analyzed, the mean and median average relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.6% of paired CGM and POC-BG were in Zone A and B of the Clarke Error Grid (Figure). Thirty nurse respondents found CGM very or quite convenient (n=28; 93%) and favored it over POC-BG testing (n=28; 93%). This pilot study demonstrates that using CGM via a hybrid approach for CII titration protocol is feasible, has high accuracy, and higher nursing convenience.

Disclosure
L.Ang: None. Y.Qu: None. R.Freeman: None. N.H.Esfandiari: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. R.Gianchandani: None. F.Akanbi: None. L.F.Schroeder: None. Y.Lin: None. C.A.Degeorge: None. P.Arnold: None. S.Knotts: None. E.Dubois: None. N.Desbrough: None.
1064-P: Pharm2Home Initiative—The Impact on Diabetes Management and Behavioral Changes
Authors: YOUNG CLIPPER F. , WONG SHIRLEY , MYUNG CHERRY 
Published: June 2023

Objective: To evaluate whether the intervention program (telehealth and home visit) focusing on chronic disease management induces changes in clinical, psychological, and behavioral measures.
Methods: This program evaluation utilizes a pre-and-post-intervention comparison design. For detecting whether differences exist between the baseline data and the follow-up data for the various measures, paired t-test (for parametric data) and Wilcoxon signed-rank test (for non-parametric data) are used.
Results: Paired HbA1c data from 57 individuals (out of 122 enrolled participants) have been collected. 55% of the participants were non-White, and 88% were Medicaid recipients. The table below summarizes some of the evaluation measures (most data are collected at the end of the intervention period).
Conclusion: Our preliminary analyses show that program participants have achieved a significant HbA1c reduction with a significant increase in perceived self-efficacy in chronic disease management. In addition, the available behavioral data with statistical significance reveal that participants have changed their behaviors during the intervention relating to diabetes management. The preliminary analyses show some early signals that our intervention program has the potential to help participants better manage diabetes.

Disclosure
C.F.Young: Other Relationship; Abbott Diabetes. S.Wong: None. C.Myung: None.

Funding
Sutter Health
1067-P: The Association between Appointment Modality and Medication Management Discussions in High-Risk Older Adults with Type 2 Diabetes
Authors: DEGRACE SHANE , PETERSON ILANA , BOARD CHRISTINE , GRANT RICHARD W. 
Published: June 2023

In older adults with type 2 diabetes (T2D), treatment with sulfonylureas (SUs) or insulin is associated with increased risk for severe hypoglycemia leading to falls, cognitive decline, lower quality of life, and death. Safe medication management in older adults requires effective and ongoing doctor-patient communication about self-management, glucose control, and other factors associated with hypoglycemia. In recent years, health care systems have increasingly relied on virtual appointments for chronic disease management. However, research has suggested that at-risk older populations may be less comfortable navigating these virtual spaces. We tested the hypothesis that older adults with T2D on SUs or insulin would be less likely to have conversations with their doctor about changes to diabetes medications during virtual visits (e.g., by video or telephone). Using data from an ongoing clinical trial (NCT04585191), we examined the association of visit modality with patient-reported medication discussions during the visit. We studied 180 Kaiser Permanente Northern California members (age = 81.1±3.8 years, Hba1c = 7.0±0.6%, 56% women, 73% on SUs). Visit modalities included in-person (n = 110, 61%), video (43, 24%), or telephone (27, 15%) appointments with their primary physician. We found that self-reported diabetes medication discussion did not differ by visit modality (48% vs. 44% vs 41%, p = 0.79). These results were unchanged after adjusting for demographic and clinical variables in a logistic regression model (p = 0.82). Qualitative analysis of open-ended surveys found that most adults (59/85, 69%) who engaged in these conversations considered them to be positive experiences that increased confidence in their treatment plan and satisfaction with their physician. Our results suggest that the ongoing expansion of virtual visit options does not deter older adults from discussing diabetes care with their doctor.

Disclosure
S.Degrace: None. I.Peterson: None. C.Board: None. R.W.Grant: None.

Funding
Patient-Centered Outcomes Research Institute (CDR-2019C1-16126)