bluuebunny/crossref_metadata_2025_split huggingface dataset:
1015-P: Impact of Social Vulnerability on Resources for CGM Initiation across Michigan Primary Care Practices
Authors: KHOSROVANEH KATHERINE L. , AIKENS JAMES E. , OSHMAN LAUREN , RAU JACQUELINE , REISS JACOB , YOUNG LARREA A. , WEISENSEL JULIAN , OKEKE PRECIOUS , MIZOKAMI-STOUT KARA R. , BUSUI RODICA , JAMISON CORNELIUS D. , RICHARDSON CAROLINE R. , DIEZ HEIDI L. 
Published: June 2023

Objective: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan. MCT2D aims to improve type 2 diabetes care by encouraging prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diets. The study’s purpose was to describe clinic-level resources and barriers to CGM initiation in counties with high and low social vulnerabilities.
Methods: We surveyed primary care practice providers about practice-level CGM patient education and barriers, and providers’ understanding of insurance coverage. 169 of 264 practices (64%) completed the survey. We classified practices as high vulnerability (HV; quartile 4), or low vulnerability (LV; quartiles 1-3) using the county-level CDC Social Vulnerability Index.
Results: Among HV practices, the main CGM education was prescriber instruction (61.5%), while for LV it was printed material (69.8%). For both HV and LV practices the second most common educational resource was web links (53.9% and 51.6%, respectively). For both practice types, the most common barrier to CGM was patients’ lack of smartphone (60.5%, 62.4%, respectively), followed by patients’ lack of internet (55.3%) for HV practices and patients’ ability to use CGM (38.5%) for LV practices. Provider understanding of Michigan Medicaid CGM coverage policy was similar across practices with most reporting incorrectly that it was akin to Medicare (≥3 injections daily) (35.3% (HV) and 44.0% (LV)) or reporting lack of awareness of coverage (32.4% (HV) and 24.1% (LV)).
Conclusions: There is a mismatch between practices’ educational approaches and patients’ access to technology. Improved transparency of CGM coverage criteria would enhance provider understanding and promote equitable access for patients. Limitations include that the data is county-level and further analysis evaluating other practice level social determinants of health is needed.

Disclosure
K.L.Khosrovaneh: 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. C.D.Jamison: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. H.L.Diez: None. J.E.Aikens: None. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. J.Rau: None. J.Reiss: None. L.A.Young: None. J.Weisensel: None. P.Okeke: None. K.R.Mizokami-stout: None.
1016-P: Prescribing SGLT2 and GLP-1 for Patients with Type 2 Diabetes at Time of Discharge after MI Increases Their Likelihood of Having Active Prescriptions at One Year
Authors: SUMARSONO NATHAN , MALLADI CHAITANYA L. , DWEIK ASEEL A. , DELLA-PENNA PAIGE L. , GEURINK KYLE , MATHEW CHRIS , MOSS ELIZABETH , PEYKOVA KREMENA , MACK-BOYD LISA , DAS SANDEEP 
Published: June 2023

Intro: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) both reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We characterize the pattern of prescriptions for these medications in an 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 for 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 (42.1%) were uninsured. We summarized the distribution of diabetes therapies in Table 1. SGLT2 and GLP1 were prescribed in 39% and 8% of patients at 1-year, respectively. Likelihood of having an active SGLT2 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 2.6; 95% CI 1.9-3.4). Likelihood of having an active GLP1 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 10.9; 95% CI 4.9-24.5).
Conclusions: Rates of prescription of MACE-reducing therapies (SGLT2 and GLP1) after MI are low compared to metformin and insulin, which have no proven MACE benefit. Prescribing SGLT2 and GLP1 at index discharge can significantly increase the likelihood that patients will be prescribed these medications one year later.

Disclosure
N.Sumarsono: None. S.Das: None. C.L.Malladi: None. A.A.Dweik: None. P.L.Della-penna: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.
1018-P: Disparities in Diabetes Technology Use in Youth with Diabetes
Authors: SINGH PUJA , GRISHMAN ELLEN , NARANJO DIANA , HYNAN LINDA S. , WHITE PERRIN C. , GUPTA OLGA 
Published: June 2023

Background: Diabetes technology can improve glycemic control and diabetes outcomes, but there are disparities in patient use.
Aims: Identify racial, ethnic, and socioeconomic disparities in technology utilization and determine provider, patient, and parent identified barriers to this.
Methods: Technology (continuous glucose monitors [CGM] and pump) usage and demographic data on patients at a large urban pediatric hospital were obtained from a clinical database. Providers (physicians, nurse practitioners, diabetes educators [CDEs]) completed a survey on diabetes technology prescribing habits. English and Spanish speaking patients ages 8 to 17 years with type 1 or type 2 diabetes on insulin and their guardians completed patient and parent specific surveys that assessed attitudes and perceived benefits and burdens of diabetes technology. Responses (16 physicians, 11 CDEs, 109 patients, 117 parents) were analyzed with Kruskal-Wallis tests.
Results: From August 2020-2021, independent of socioeconomic status, non-Hispanic Black (NHB) and Hispanic children were less likely to be prescribed pump (odds ratio 0.40 and 0.35 respectively) or CGM (0.50 and 0.49) compared to non-Hispanic White (NHW) children. For pump eligibility, CDEs placed higher importance on subjective factors such as parental education, health literacy, and psycho-social stability (p value &lt; 0.05) compared to physicians. Hispanic and NHB patients and parents learned about diabetes technology later after diagnosis compared to NHW group. Physicians and CDEs identified patient perceived barriers to CGM use (i.e., embarrassment and/or discomfort in wearing devices) as reasons for not discussing technology, though patients did not identify such factors as barriers.
Conclusions: There are marked disparities in diabetes technology use among youth with diabetes. Families and providers perceive different barriers to utilization. This study adds perspective of patients with T2D as well as targeted recruitment of underrepresented minorities.

Disclosure
P.Singh: None. E.Grishman: None. D.Naranjo: None. L.S.Hynan: None. P.C.White: Consultant; Provention Bio, Inc. O.Gupta: None.
102-LB: Cumulative Probability of Mortality among Non-Hispanic Black Compared with Non-Hispanic White Individuals with Type 2 Diabetes on Empagliflozin (EMPA-AA)—Real-World Data
Authors: MISHRIKY BASEM M. , CUMMINGS DOYLE M. , FU YUANYUAN , HALLADAY JACQUIE , JONES WILLIAM S. , BOAN ANDREA D. , JONES BERKELEY SARA , PATIL SHIVAJIRAO P. , POWELL JAMES R. , ADAMS ALYSSA , IRISH WILLIAM 
Published: June 2023

Authors 1, 2 & 11 participated equally. Given the underrepresentation of minorities in the CV outcome trials, guidelines encouraged investigating antihyperglycemic medications in minorities, particularly in non-Hispanic Blacks (Black). Our goal was to evaluate the incidence of all-cause mortality (ACM) among Black vs non-Hispanic White (White) patients with type 2 diabetes (T2D) who were prescribed empagliflozin (EMPA). We performed a multicenter retrospective study using EMR-derived data for adults with T2D cared for at 4 healthcare systems in North and South Carolina between Aug 2014 and Dec 2019. In patients without HF hospitalizations (hHF) prior to an initial EMPA prescription, we compared ACM in Black vs White patients. A propensity-score weighted analysis was performed to balance characteristics by race. The cumulative probability of ACM by race was estimated using the cumulative incidence function. A total of 8789 patients were eligible. Baseline characteristics and results are summarized in Table 1. After propensity-score weighted analysis adjusting for age, gender, and baseline comorbidities, there was no significant difference in the risk of ACM between Black vs White patients. In patients with T2D without hHF prior to an initial EMPA prescription, we found no significant difference in ACM in Black vs White patients.

Disclosure
B. M. Mishriky: Advisory Panel; Bayer Inc., Research Support; Lilly. A. Adams: None. W. Irish: Consultant; Eurofins Transplant Genomics, Other Relationship; CTI Clinical Trial and Consulting. D. M. Cummings: None. Y. Fu: None. J. Halladay: None. W. S. Jones: None. A. D. Boan: None. S. Jones berkeley: None. S. P. Patil: None. J. R. Powell: None.

Funding
Brody Brothers Endowment Fund (20-0922)
102-OR: Barriers to Diabetic Foot Care in Urban Safety-Net Hospital
Authors: BLANCO GERARDO , RASHIED AMMAR A. , CHIRUMAMILLA SIRI , MARIE MORENO EMMELIN , SANTAMARINA GABRIEL , SCHECHTER MARCOS , FAYFMAN MAYA 
Published: June 2023

We explored barriers to foot care in a disadvantaged population using surveys of patient perceptions on barriers and self-care. Participants were recruited from an outpatient diabetes clinic at a safety-net hospital in Atlanta, Georgia from 2021-2022 and stratified into two groups: Complications, defined as patient history of foot ulcer or amputation and No Complications, defined as no history of ulcer or amputation. The survey addressed patients' experience in daily foot care and barriers to care. A composite score was created for barriers to foot care comprised of financial and transportation barriers, access to providers, understanding of foot care, and ability to reach feet. Logistic regression was utilized to perform univariate and multivariate assessments adjusting for race, gender, age, employment, and education. Among 80 participants 39% had complications and 61% had no complications. As compared to patients without complications, those with complications were younger (55 yo vs 60, p=0.067) and more often male (63% vs 40%, p=0.04). Both groups were comprised primarily of non-Hispanic Black participants (77% and 94%). Those with complications had longer diabetes duration, &gt; 10 years (64% vs 37%, p=0.015), lower education level, no high school/GED degree or less (54% vs 20%m p=0.003) and lower employment status (p=0.003). Those with complications were more likely to have had discussions about foot care with health care providers (97% vs 74%, p=0.027) and professional examination of their feet (p&lt;0.0001). People with complications were more likely to experience delays in care due to transportation problems (68% vs 39%, p=0.0116). Patients with complications had eight fold greater odds of reporting composite of barriers to care in both unadjusted and adjusted models (unadjusted OR 8.3, 95% CI: 2.5, 27.3; adjusted OR 9.4, 95% CI 1.8, 49.2). Despite having greater focus on foot care in the healthcare setting, patients with foot ulceration or amputation experienced greater barriers to care.

Disclosure
G.Blanco: None. A.A.Rashied: None. S.Chirumamilla: None. E.Moreno: None. G.Santamarina: None. M.Schechter: None. M.Fayfman: None.
1020-P: A New Ambulatory Glucose Profile Report to Evaluate and Support Glucose Control in People after Bariatric Surgery
Authors: COSSU LUCA , CAPPON GIACOMO , HERZIG DAVID , FACCHINETTI ANDREA , BALLY LIA 
Published: June 2023

Bariatric surgery increases postprandial glucose excursions with higher peaks and lower nadirs. Etiologically linked is the phenomenon of postbariatric hypoglycaemia (PBH), an increasingly recognized metabolic disorder. Continuous glucose monitoring (CGM) has become an important tool in the diagnosis and management of PBH. The Ambulatory Glucose Profile (AGP) is an internationally recognized and standardized format that provides structured and graphical compilation of CGM data to guide treatment decisions in people with diabetes. However, its applicability to patients suffering from bariatric surgery-induced dysglycaemia, such as PBH, remains limited. Based on the collection of CGM data in healthy individuals and post-bariatric surgery patients with and without PBH, we selected a set of summary statistics that are important to diagnose the condition, decide on and evaluate the efficacy of therapeutic strategies. We propose a novel AGPr which contains the following: %time spent with non-physiological glucose values, the diurnal distribution of hypoglycaemic events (including level and duration) and information on postprandial glucose excursions by colour-coding of rate of glucose change and variability metrics. The new AGPr uses data generated by CGM to provide a rapid visual presentation of glucose dynamics and hypoglycemia burden in post-bariatric surgery individuals.

Disclosure
L.Cossu: None. G.Cappon: Consultant; Dexcom, Inc. D.Herzig: None. A.Facchinetti: None. L.Bally: Research Support; Dexcom, Inc., Ypsomed AG.

Funding
University of Padova, Italy (SID-Networking Project 2021)
1024-P: Management Algorithm of Patients with Concomitant Diabetes Mellitus and Chronic Venous Insufficiency
Authors: GASTALDI GIACOMO , BOZKURT AHMET K. , JOSEE VAN RIJN MARIE , BOUSKELA ELIETE , GLAUSER FREDERIC , RABE EBERHARD , MANSILHA ARMANDO , HALLER HERMANN , ROSAS-SAUCEDO JUAN 
Published: June 2023

Introduction: Diabetes mellitus (DM) and Chronic Venous Insufficiency (CVI) are significant burden in patient daily life. While the two diseases share common risk factors and pathophysiology, they are often assessed and managed as separate conditions.
Aim: To develop recommendations for the identification and treatment of patients with concomitant DM and CVI.
Methods: Using a modified Delphi method, a panel of experts developed 38 statements and 2 multiple choice questions. These were used to form an online survey which was disseminated through vascular and diabetes specialists across Europe, Central America, South America, and Middle East. Respondents indicated their level of agreement with each statement. The threshold for consensus was set as ≥75% of agreement.
Results: A total of 238 responses were received. Most of the statements (27/38) reached &gt;90% agreement, 9/38 attained between 75-90% agreement, and 2 failed to meet the threshold. The awareness around the impact of the two diseases was high and a gap was highlighted in the identification of patients suffering from concomitant DM and CVI. Seventy-seven (77%) respondents consider overweight (BMI &gt;30) and leg oedema as signs for assessment of the presence of DM and diabetic microvascular complications (DmVC) in patients with CVI, while 63% agreed that three parameters (skin changes, leg burden and oedema) would be required to trigger investigation for coexistent CVI in patients with DM. Treatment of patients with DmVC and CVI should be accomplished with a combination approach, including lifestyle change, non-medical and pharmacological treatments. Venoactive drugs indicated in both DmVC and CVI were recognized as treatment option in this patient population.
Conclusion: These results raised the need to consider DM and CVI as a combined therapy area. As outcome, an algorithm is proposed to help the identification of at-risk patients and to provide recommendation on the management of patients with concomitant diseases.

Disclosure
G.Gastaldi: Advisory Panel; Ascensia Diabetes Care, Insulet Corporation, Novo Nordisk, Lilly, Other Relationship; Abbott Diabetes, AlfaSigma, Research Support; Ypsomed AG, Speaker's Bureau; Dexcom, Inc., Medtronic, Roche Diabetes Care. A.K.Bozkurt: Advisory Panel; OM PHARMA. M.Van rijn: None. E.Bouskela: None. F.Glauser: Consultant; Servier Laboratories. E.Rabe: Consultant; Sigvaris Int., EUROCOM, Mylan, Speaker's Bureau; OM Pharma. A.Mansilha: None. H.Haller: None. J.Rosas-saucedo: None.

Funding
OM Pharma Ltd.
1025-P: Success of Interactive, Online Education Related to Screening and Staging Type 1 Diabetes
Authors: LARKIN AMY , LE ANNE 
Published: June 2023

Objective: Determine if interactive, case-based, online continuing medical education (CME) improves the competence and confidence of diabetologists/endocrinologists (D/Es) and pediatricians on staging T1D. Methods: Educational design included a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design and a McNemar’s test (P &lt;.05 is considered significant) assessed educational effect, with Cohen’s d being used to assess educational impact (&lt;0.2 modest effect, 0.2-0.49 small effect, 0.5-0.79 moderate effect and &gt;0.8 extensive effect). The activity launched July 29, 2022 and data were collected through October 6, 2022.
Results: 77 D/Es and 160 pediatricians were included in the analysis. Matched learner data indicate that overall, 77% D/Es and 76% of pediatricians improved their competence from pre-to-post (both P&lt;.0001 with extensive overall impacts in both groups 0.9-1.06) On a question-level: 56% of D/Es (P&lt;.001) and 48% of pediatricians (P&lt;.001) improved at appropriate screening of high-risk patients for T1D 27% of D/Es (P&lt;.001) and 31% of pediatricians (P&lt;.001) improved at educating caregivers about screening of siblings at risk of T1D 51% of D/Es (P&lt;.001) and 51% of pediatricians (P&lt;.001) improved at staging of patients with T1D based on test results Overall, 60% of D/Es and 61% of pediatricians reported increased confidence in staging patients with T1D, for an overall confidence shift of +75% in D/Es and +96% in pediatricians with increased confidence.
Conclusion: Interactive, case-based, online CME is successful at improving competence and confidence of D/Es and pediatricians related to staging of at-risk patients for T1D. Case-based education with interactive polling questions and detailed explanations related to best choices should be employed more often to help clinicians apply guidelines into practice to improve patient care.

Disclosure
A.Larkin: None. A.Le: None.

Funding
Provention Bio, Inc.
1036-P: Developing an Explainable AI Model to Identify Members with Diabetes at High Risk for Worsening Glycemic Control in a Large Accountable Care Network (ACN)
Authors: KERMANI ASRA , KOLLIPARA USHA , ACOSTA JUAN , BOWEN MICHAEL E. , ALMANDOZ JAIME P. , GOLDBERG BRENT , ROZICH ALLISON , HE MEILU , ACOSTA SUSANA V.J. , MCCALL CAROL J. , GARTNER JOSEPH A. , DECAPRIO DAVE , MUTZ JACQUELINE M. , FISH JASON S. 
Published: June 2023

People with diabetes and poor glycemic control (HbA1c ≥9%) have a greater likelihood of diabetes complications, increased healthcare utilization, and higher total cost of care (TCOC). Novel approaches to identify patients at high risk for worsening glycemic control can improve outcomes and contain costs within ACNs. We used XGBoost Decision Trees to build and validate a model predicting worsening glycemic control (HbA1c increase ≥1.5% over 12 months) using Medicare ACN administrative claims and electronic health record data. Eligible members had ≥18 mos. continuous enrollment, were age ≥18 years with Type 1 or 2 diabetes, had ≥2 HbA1c values between 6.5 and 14%, and no disability. Members were split into HbA1c outcome stratified training (80%) and validation (20%) datasets for 10-fold cross-validation. The model utilized 1,490 features including medical history, labs, demographics, SDOH, utilization, and quality of care. Of the 44,007 unique members (mean age 72 years, 51% Female, 61% Non-Hispanic White, mean HbA1c 7.2%, 9% on insulin, HTN 92%, Obesity 71%, CKD 33%, CAD 32%, Heart Failure 15% and COPD 13%), 5.23% had an HbA1c increase ≥1.5% over 12 months. Key features in the final model included duration of diabetes, last HbA1c value, treatment intensification, prescribed insulin or sulfonylureas, weight change, depression, acute renal failure, area deprivation index, and no car access. Model AUC was 0.672 (95% CI ±0.005) in the validation sample. The model was able to identify 23.5% of members with worsening glycemic control in the highest predicted decile of HbA1c progression (sensitivity 23.5% at 10% alert rate). Mean TCOC at 10% alert rate was $43,850 PMPY which was substantially higher than training population at $18,208 PMPY. Our model can identify ACN members with diabetes at high risk for worsening glycemic control that may benefit from education, medication adherence, food insecurity and transportation interventions.

Disclosure
A.Kermani: None. C.J.Mccall: None. J.A.Gartner: None. D.Decaprio: Employee; ClosedLoop.ai. J.M.Mutz: None. J.S.Fish: None. U.Kollipara: None. J.Acosta: None. M.E.Bowen: Research Support; Boehringer-Ingelheim. J.P.Almandoz: Advisory Panel; Eli Lilly and Company, Novo Nordisk. B.Goldberg: None. A.Rozich: None. M.He: None. S.V.J.Acosta: None.
1037-P: Evaluating the Impact of Telemedicine Care Coordination on Access to Care in Oregon’s Pediatric Type 1 Diabetes Population
Authors: MITCHELL EMILY S. , ANDREA SARAH B. , GUTTMANN-BAUMAN INES 
Published: June 2023

Background: Children with type 1 diabetes (T1D) require close monitoring with visits every 3-4 months. COVID-19-induced telemedicine expansion (TE) may alleviate the challenge of high visit frequency that children with type 1 diabetes (T1D) face. However, telemedicine’s impact on access to care may be limited if patients lack adequate support for telemedicine.
Purpose: The study objective was to evaluate the impact of telemedicine care coordination services (CCS) on visit frequency in an urban medical center without CCS versus a rural outreach program with established CCS.
Methods: We evaluated EHR data from 790 children receiving care between July 2018 - December 2021. We estimated differences in likelihood of adequately-timed monitoring care (ATMC) over time by patient CCS status using Generalized Estimating Equations.
Results: Just prior to TE, patients receiving CCS were 25.6% less likely to receive ATMC (95% CI: 51.6%, 114%). Following TE, likelihood of ATMC increased from 28.8% to 58.2% among those receiving CCS and decreased from 38.7% to 22.0% among those not receiving CCS; increases in ATMC were 3.55 times greater in patients receiving CCS relative to those not (95% CI: 2.10, 6.01).
Conclusions: Telemedicine may only increase the number of T1D patients meeting goal visit frequency when paired with CCS.

Disclosure
E.S.Mitchell: None. S.B.Andrea: Research Support; Eli Lilly and Company. I.Guttmann-bauman: None.