bluuebunny/crossref_metadata_2025_split huggingface dataset:
1191-P: GDM in Twin Pregnancies—Maternal Characteristics and Pregnancy Outcomes
Authors: DAS DEVIKA M. , VELLA ADRIAN , EGAN AOIFE M. 
Published: June 2023

The incidence of both gestational diabetes mellitus (GDM) and twin pregnancies have increased over the past two decades. While the same GDM diagnostic criteria and treatment targets are used for singleton and twin pregnancies, data on outcomes for twin pregnancies with GDM are limited. The aim of this retrospective cohort study is to present comprehensive data on maternal characteristics and pregnancy outcomes for individuals with a twin pregnancy who were diagnosed with GDM and attended our center for prenatal care from 2002-22. In total 185 individuals were identified with a mean age of 32 (± 5) years and a mean prepregnancy body mass index of 31.3 (± 7) kg/m2. The majority were dichorionic diamniotic (n=146, 79%), 32 (17%) had a prior diagnosis of GDM and 63 (34%) had prepregnancy fertility treatment. Women underwent universal screening with a 50g glucose challenge test (normal &lt;140mg/dL) and Carpenter and Coustan Criteria were used to diagnose GDM. Pharmacological therapy was required to treat GDM in 68 (37%) cases. Hypertensive disorders of pregnancy were common (n=55, 30%), as was Cesarean delivery (n= 133, 72%). Assessment of pregnancy outcomes (n=370) revealed 360 (97%) livebirths, 8 (2%) stillbirths and 2 (0.6%) neonatal deaths. Among livebirths and neonatal deaths, premature delivery &lt; 37 weeks was recorded in 225 (62.2%) and &lt;34 weeks in 57 (15.7%). Neonatal macrosomia (birthweight &gt;4.0kg) was rare (n=4, 1%), but low birthweight (&lt;2.5kg) occurred in 168 (46%). Neonatal hypoglycemia was documented in 89 (25%) infants. Maternal attendance at the postpartum glucose tolerance test was low (n=47, 25.5%) individuals, and 38 had a subsequent pregnancy with GDM diagnosed in 18 (47%). In summary, the standard GDM diagnostic criteria applied to twin pregnancies identify a maternal cohort at high risk of pregnancy complications and future GDM. Future work should address the optimal nutritional and glycemic goals for this population, particularly considering the high risk of low birthweight and premature neonates.

Disclosure
D.M.Das: None. A.Vella: Advisory Panel; Rezolute, Inc., Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None.

Funding
National Institutes of Health (DK092721, HD065987)
1192-P: Risk Factors Associated with Preeclampsia in Pregnant Patients with Diabetes
Authors: BRADY MATTHEW , CARTER EBONY B. , PAUL RACHEL , RAGHURAMAN NANDINI , GARR BARRY VALENE , ZHANG FAN , KELLY JEANNIE 
Published: June 2023

To determine risk factors associated with pre-eclampsia (PreE) among pregnant patients with diabetes. We performed a case-control study of PreE among pregnant patients with pre-existing and gestational diabetes at a tertiary referral center from 2007-2017. Inclusion criteria were age ≥18 years and English speaking. Lethal anomalies, delivery &lt;23 weeks, and multiple gestations were excluded. Clinical characteristics including advanced maternal age (AMA) ≥35 years old, chronic hypertension (CHTN), diabetes type, insulin use, and HbA1c ≥ 6.5% at any point during pregnancy were compared between groups using univariate regression. A multivariable logistic regression model was used to adjust for potential confounders, including AMA and obesity (BMI ≥30 kg/m2). A total of 503 patients met study criteria: 40 (8.0%) with type 1 DM, 200 (39.8%) with type 2 DM, and 263 (52.3%) with GDM. PreE was diagnosed in 102 (20.3%) patients in the sample. Demographics were similar except patients with PreE were older and more likely to be obese than those without PreE. Compared to patients with diabetes who did not have preE, those with preE were significantly more likely to have type 2 DM (64.7% PreE vs. 33.4% no PreE; aOR 6.78; 95% CI 3.08-14.94), CHTN (60.8% PreE vs. 24.9% no PreE; aOR 7.74; 95% CI 3.63-16.50), insulin use (76.5% PreE vs. 57.5% no PreE; aOR 3.70; 95% CI 1.63-8.42), and HbA1c≥6.5% (PreE 61.8% vs. no PreE 38.2%; aOR 4.49; 95% CI 2.18-9.26). Those with PreE were less likely to have GDM (27.5% PreE vs. 58.6% no PreE; aOR 0.19; 95% CI 0.09-0.41). There was no difference among patients with AMA or type 1 DM. Patients with PreE are more likely to have pregestational diabetes, co-existing CHTN and have worse glycemic control. This finding underscores the importance of glycemic control as a potentially protective factor against PreE.

Disclosure
M.Brady: None. E.B.Carter: None. R.Paul: None. N.Raghuraman: Other Relationship; HCFocus. V.Garr barry: None. F.Zhang: None. J.Kelly: None.

Funding
American Diabetes Association (1-19-ACE-02 to E.B.C.)
1196-P: Offspring Being Overweight and Born Preterm Are More Common in Women Treated with Insulin Pump Compared with Multiple Daily Injections—A Large Prospective Cohort Study
Authors: THORIUS IDA H. , HUSEMOEN LISE LOTTE N. , BAASTRUP NORDSBORG RIKKE , CIRIC ALIBEGOVIC AMRA , GALL MARI-ANNE , DAMM PETER , PETERSEN JANNE , MATHIESEN ELISABETH R. 
Published: June 2023

Aims: Investigate glycemic control and risk of perinatal complications in women with type 1 diabetes (T1D) treated with insulin pump vs. multiple daily injections (MDI) during pregnancy.
Methods: A secondary analysis of a prospective cohort of 2003 pregnant women. Odds ratios (OR) were estimated by logistic regression in crude and adjusted models for potential confounders.
Results: In total, 723 women were treated with pump and 1280 were treated with MDI. At baseline (gestational weeks 8.6 (IQR: 7-10)) pump users had significant lower mean HbA1c (51.0 (10.2) mmol/mol (6.8 (0.9) %) vs. 54.2 (14.5) mmol/mol (7.1 (1.3) %), P &lt; 0.001), longer diabetes duration (mean (SD) 18.3 (7.8) vs. 14.5 (8.3) years, p &lt; 0.001) and higher prevalence of retinopathy (35.5% vs. 24.8%, p &lt; 0.001). HbA1c in late pregnancy was similar (46.2 (9.4) mmol/mol (6.4 (0.9) %) vs. 46.4 (10.8) mmol/mol (6.4 (1.0) %), P=0.7458). Proportion of offspring being large for gestational age (LGA) was 59.0% (pump) vs. 52.2% (MDI) (adjusted OR 1.33 [95%CI 1.07;1.65], P=0.009) and born preterm 39.6% vs. 32.1% (adjusted OR 1.52 [95%CI 1.23;1.87], P=0.0001) (Table). No statistically significant difference was observed for other endpoints.
Conclusion: Insulin pump treatment in pregnant women with T1D was associated with higher risk of LGA offspring and preterm delivery compared with MDI.

Disclosure
I.H.Thorius: Employee; Novo Nordisk A/S. L.N.Husemoen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. R.Baastrup nordsborg: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. A.Alibegovic: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. M.Gall: Employee; Novo Nordisk A/S. P.Damm: Other Relationship; Novo Nordisk A/S. J.Petersen: Research Support; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Vertex Pharmaceuticals Incorporated, Gilead Sciences, Inc. E.R.Mathiesen: Advisory Panel; Novo Nordisk, Research Support; Novo Nordisk, Speaker's Bureau; Novo Nordisk.
1207-P: Gestational Diabetes Mellitus (GDM)—Outcomes for Normal-Weight Individuals
Authors: MOAZZAMI MITRA , VENKATESAN NANDITHA , SANKARAN RAJAGOPALAN KAMALNATH , VELLA ADRIAN , EGAN AOIFE M. 
Published: June 2023

Excess body weight is associated with GDM, and BMI ≥ 25kg/m2 is often used as a criterion in risk factor-based screening programs. However, individuals with a normal BMI account for a significant proportion of those diagnosed with GDM (20-60% depending on the population studied), and comparative clinical outcome data are limited. Our aim was to assess pregnancy outcomes for people with GDM and a baseline BMI &lt; 25kg/m2, compared to a reference group with GDM and a BMI of 25-30kg/m2. Included subjects attended our institution for prenatal care from 2018-22 and GDM was diagnosed using universal screening and Carpenter and Coustan criteria. We identified 524 individuals with a BMI &lt; 25kg/m2 and 705 with a BMI 25-30kg/m2. Those with a BMI &lt;25 kg/m2 were younger (22 v 28 years, p&lt;0.001), and a higher proportion identified as Asian (15.5% v 9.22%; p=0.04). Table 1 contains pregnancy outcomes. Those with a BMI &lt;25kg/m2 were less likely to receive pharmacological GDM therapy, but their infants had a higher rate of neonatal ICU admission. Postpartum, those with a BMI &lt;25kg/m2 were less likely to have an oral glucose tolerance test but were at similar risk of glucose intolerance. These findings suggest that normal weight women with GDM may experience higher risk of adverse outcomes compared to their overweight counterparts. These data support universal screening and will be used to inform patients on their risk profile and improve postpartum screening.

Disclosure
M.Moazzami: None. N.Venkatesan: None. K.Sankaran rajagopalan: None. A.Vella: Advisory Panel; Rezolute, Inc., Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None.

Funding
National Institutes of Health (DK092721, HD065987)
1208-P: Modifiable Risk Factors during Pregnancy in Pregestational Diabetes—A 12-Year Analysis
Authors: RHOU YOON JI J. , WAH CHEUNG N. , PADMANABHAN SUJA 
Published: June 2023

Aim: Pregestational diabetes is associated with adverse outcomes. Preconception care is beneficial but unplanned pregnancy is common. We aimed to determine predictors of outcomes and factors modifiable during pregnancy in women with pregestational diabetes.
Methods: Retrospective analysis of pregnancies complicated by pregestational diabetes at a tertiary center from 2010–2022. Baseline characteristics, longitudinal glycemic, weight and microvascular complication assessment per trimester, and outcomes were collected and binary logistic regression performed.
Results: Of 445 pregnancies, 116 (25%) had type 1 diabetes. Mean age was 32.6 ± 5.8 years with prepregnancy BMI 30.0 ± 7.0 kg/m2. The cohort was diverse with 315 (71%) of non-Caucasian ethnicity and 141 (32%) in the most disadvantaged socioeconomic quintile. Planned pregnancy comprised 147 (43%). Women with type 1 compared to type 2 diabetes had increased preeclampsia (28 [26%] vs 48 [15%], p=0.02), preterm (46 [39%] vs 66 [20%], p&lt;0.001), large for gestational age (LGA) (57 [49%] vs 82 [25%], p&lt;0.001), neonatal hypoglycemia (53 [46%] vs 117 [37%], p=0.047), respiratory distress (47 [42%] vs 65 [20%], p&lt;0.001) and neonatal intensive care admission (NICU) (48 [41%] vs 84 [26%], p=0.003). Small for gestational age was more common in type 2 diabetes (5 [4%] vs 32 [10%], p=0.045). Adjusting for diabetes type and baseline features, HbA1c&gt;6.5% in 1st and &gt;6% in 2nd and 3rd trimesters and &gt;15% insulin decrease in 3rd trimester were associated with preeclampsia, 3rd trimester HbA1c&gt;6% an independent predictor (OR 4.7) irrespective of 1st trimester HbA1c. Excessive gestational weight gain (GWG) (OR 3.4) and 3rd trimester HbA1c&gt;6% (OR 3.6), irrespective of 1st trimester HbA1c, were independent predictors of LGA. Third trimester HbA1c&gt;6% was associated with NICU (OR 3.7). Conclusion: Type 1 and 2 diabetes have distinct risk profiles for adverse outcomes. Early and late pregnancy glycemic control and GWG are modifiable targets during pregnancy.

Disclosure
Y.J.Rhou: None. N.Cheung: None. S.Padmanabhan: None.
121-LB: Effect of Using the mySugr App on Glycemic Control in T1D patients—A Real-World Analysis from Mexico
Authors: VULCANO CRISTINA , MIKULSKI HEATHER , MITTER MICHAEL , RUCH BERNHARD 
Published: June 2023

Objectives: Describe Mexican patients with T1DM and find out if blood glucose (BG) testing frequency impacts glycemic targets (mean BG & estimated HbA1c [eHbA1c]).
Methods: Included mySugr users with a self-reported diagnosis of T1DM and had at least 2 BG logs in at least 14 days (G2D14) in the month prior to their first log entry. G2D14 is the lowest adherence needed to calculate eHbA1c. Users were stratified as low (G2D14 + G3D14) and high testing (G4D14 + G5D14). Subgroup analysis according to baseline eHbA1c was performed. Using a logistic regression model, an exploratory analysis to identify factors associated with BG decrease was also considered.
Results: 118,210 users (13% T1DM) were considered. Users in the highest testing subgroup (G5D14; n=276) in the first month before mySugr usage had a significantly lower baseline eHbA1c (-0.8 %; p &lt; 0.01) compared with users in the lowest category (G2D14; n=254). For all users in the group G2D14 or above, eHbA1c decreased from baseline (1 mo. prior to mySugr usage) and stayed below baseline levels for the entire period of 5 mo. (n=253; mean differences: -0.3% at the first month of mySugr usage, -0.2% at the fourth month of mySugr usage; both changes significantly different from 0 with p &lt; 0.05). No statistically significant difference in eHbA1c between the logging subgroups after 4 months of mySugr use was found. Nevertheless, high logging users with baseline eHbA1c &gt; 8% had a non-significant higher reduction. In the logistic regression model, the factor with the strongest association with BG decrease was the baseline mean BG (log OR: 2.4).
Conclusion: in our RwD setting, the use of mySugr was associated with reduced eHbA1c. Baseline BG was statistically associated with BG reduction intensity. Although no significant difference in eHbA1c improvement between the high and low logging groups was found during mySugr usage, the baseline analysis suggests that users with increased logging had significantly better glycemic control before starting mySugr.

Disclosure
C. Vulcano: Employee; Roche Diabetes Care. H. Mikulski: Employee; Roche Diabetes Care. M. Mitter: Employee; Roche Diabetes Care. B. Ruch: Employee; Roche Diabetes Care.
1210-P: Associations of Community-Level Social Determinants of Health and Hypertensive Disorders of Pregnancy
Authors: CAROLINE BANK TRACY , GROBMAN WILLIAM , WU JIQIANG , LYNCH COURTNEY , VENKATESH KARTIK K. 
Published: June 2023

Objective: To determine whether community-level social determinants of health are associated with hypertensive disorders of pregnancy (HDP).
Methods: This is a secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. We evaluated three community-level exposures using home addresses geocoded at the census-tract level: 1) socioeconomic disadvantage by the 2015 Area Deprivation Index (ADI); 2) food insecurity by the USDA Food Access Research Atlas; and 3) less walkability by the EPA National Walkability Score. The outcome was new onset HDP. Poisson regression was used to estimate adjusted relative risks (aRR).
Results: Of 9,062 individuals, 33.6% were in the highest tertile of ADI, 24.5% lived with food insecurity, and 66.3% lived in a less walkable neighborhood. 13.0% were diagnosed with HDP. Individuals living in a community with higher socioeconomic disadvantage, (aRR T2: 1.26; 95% CI: 1.10, 1.44; and T3: 1.19; 95% CI: 1.02, 1.38), food insecurity (aRR: 1.15; 95% CI: 1.02, 1.29), and less walkability (aRR: 1.21; 95 CI: 1.07, 1.36) were at higher risk of developing HDP compared with those who did not.
Conclusions: Community-level social determinants of health, including socioeconomic disadvantage, food insecurity, and low walkability, were associated with increased risk of HDP among nulliparous individuals.

Disclosure
T.Bank: None. W.Grobman: None. J.Wu: None. C.Lynch: None. K.K.Venkatesh: None.
1221-P: Hypoglycemia in Nursing Home Residents Often Co-occurs with Hyperglycemia
Authors: LEE ALEXANDRA K. , SHI YING , LEE SEI J. 
Published: June 2023

During the transitional period following admission to a nursing home (NH), the primary diabetes management goal is to avoid hypoglycemia and hyperglycemia. However, the frequency and severity of hypo- and hyper-glycemic episodes in this population are unclear. Using the Veterans Affairs NH electronic health records, we examined Veterans aged ≥65 years with diabetes, insulin use, and a NH stay ≥7 days from 1 Jan 2016 to 30 Sept 2019. From fingerstick glucose values from Days 1 through 7, we calculated the proportion of Veterans with Level 1 (&lt;70mg/dL) and Level 2 (&lt;54mg/dL) hypoglycemia and with hyperglycemia ≥250mg/dL (recommended upper limit for NH residents) and severe hyperglycemia ≥400mg/dL. Of 12,031 Veterans, mean age was 74.4, 98% were male, 17% were Black and 77% were White. During Days 1-7 of NH stay, the majority (51%) had only hyperglycemia &gt;250mg/dL. Almost one-third (30%) had neither hypo- nor hyper-glycemia, 6% had only hypoglycemia &lt;70mg/dL, and 13% had both hypo- and hyper-glycemia. Among Veterans with Level 1 hypoglycemia, over two-thirds also had hyperglycemia &gt;250mg/dL, and only one-third had Level 2 hypoglycemia. Of Veterans with hyperglycemia ≥250mg/dL, only 16% had hyperglycemia ≥400mg/dL. In conclusion, most hypoglycemia in NH residents using insulin is mild (54-69mg/dL) and often co-occurs with hyperglycemia ≥250mg/dL, suggesting any deintensification in response to hypoglycemia should be coupled with monitoring for worsening hyperglycemia. Future research is needed to determine whether hypoglycemia 54-70mg/dL or hyperglycemia 250-400mg/dL is associated with adverse outcomes in NH residents.

Disclosure
A.K.Lee: Other Relationship; GRAIL (acquired by Illumina in 2021). Y.Shi: None. S.J.Lee: None.

Funding
National Institutes of Health
1222-P: An Examination of Frailty as Measured via Deficit Accumulation in African American Adults with Diabetes and Prediabetes
Authors: SIMPSON FELICIA , BERTONI ALAIN 
Published: June 2023

Type 2 diabetes increases the accumulation of health deficits and has been described to be connected to accelerated biological aging. We utilized a frailty index (FI) in African Americans with prediabetes and diabetes modeled after the deficit accumulation index approach used in the Action for Health in Diabetes (Look AHEAD) Trial. This metric of frailty is comprised of 32 functional, behavioral, and clinical characteristics using the Jackson Heart Study (JHS) public access dataset. JSH is a large, community-based, observational study investigating the causes of cardiovascular disease (CVD) in 5301 African-Americans from Jackson, MS. Our study included 1339 adults aged 40-84 with prediabetes and diabetes who had over 12 years of follow-up for incident CVD events. Obese individuals, older individuals, those with poorer diabetes control, and hypertension had significantly higher mean FI scores than those without these characteristics. Approximately 34% of this sample was frail and 66% not frail. Compared with non-frail participants, stroke, heart failure, and coronary heart disease incidence of frail participants were increased. Frailty was an independent predictor of 12-year stroke (adjusted hazard ratio (HR): 6.84; 95% confidence interval (CI): 3.09 to 15.12), heart failure (adjusted HR: 3.00; 95% CI: 1.77 to 5.09), and coronary heart disease (adjusted HR: 2.48; 95% CI: 1.44 to 4.15) after adjusting for age and gender. Frailty is prevalent among African Americans with diabetes and prediabetes and is a predictor cardiovascular outcome. Frail adults with diabetics have an even higher risk of CVD, compared to non-frail adults with diabetes.

Disclosure
F.Simpson: None. A.Bertoni: None.
1224-P: Glucagon Secretion Increases with Age in People with Type 2 Diabetes
Authors: KANEKO SHIZUKA , MOTOHASHI KAZUYA , UEBA YOKO , TOKUMOTO SHINSUKE 
Published: June 2023

It has been shown that the decline in the number of pancreatic beta cells and the insulin-secreting capacity of individual pancreatic beta cells progressively decreases with age, and this functional decline is accelerated by the addition of hyperglycemia. While, glucagon (GCG) is elevated in diabetes, and elevated GCG not only increases blood glucose levels (GLUs), but also decreases muscle mass due to protein metabolism leading to decrease in muscle glucose uptake, making blood glucose control more difficult. However, there are no reports yet regarding to age-related changes in GCG secretion. In this study, we analyze the age-related changes in GCG secretion in people with type 2 diabetes (T2D) after insulin treatment to remove glucose toxicity. A retrospective analysis was performed on people with T2D hospitalized for a period of 5 years from December 2017 in whom a test meal load (carbohydrate 75.5-70g, protein 8.5g, fat 28.5g) was performed before and after insulin treatment, and GLUs and GCG were measured. Insulin (IRI) and/or C-peptide (CPR) were also measured. A total of 121 patients (70 males, age 64.2 ± 11.6 years) were included in the analysis. After insulin treatment, GCG secretion was almost all lower than before treatment. GCG secretion increased with age (P=0.014). Insulinogenic Index decreased with age (R=-0.286 P=0.004), and IRI/GLU and CPR/GLU at 120 minutes after the test meal load also decreased with age (R=-0.314 P=0.001, R=-0.324 P=0.001). We confirmed that there is an increase in GCG secretion with aging in people with T2D. This might be one of the reasons for the decrease in muscle mass and physical activity in elderly people with T2D. Further studies are needed to expand the number including people with normal glucose and impaired glucose tolerance. Acknowledgments:The Cookie Testing Study Group provided support.

Disclosure
S.Kaneko: Advisory Panel; Lilly Diabetes, Speaker's Bureau; AstraZeneca, Novo Nordisk, Sumitomo Dainippon Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Lilly Diabetes, Bayer Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd. K.Motohashi: None. Y.Ueba: None. S.Tokumoto: None.

Funding
Cookie Testing Study Group