bluuebunny/crossref_metadata_2025_split huggingface dataset:
503-P: Distinct Effects of a Novel GCK-MODY Mutation on Lipid Profiles and Diabetic Complications
Authors: HUANG YADI , FAN YUXIN , LI XIN , JI SHUHUI , CHEN SHANSHAN , CUI JINGQIU , FENG WENLI , SHU HUA , LIU MING 
Published: June 2023

Glucokinase (GK) encoded by glucokinase gene (GCK) is the first rate-limiting enzyme in glucose metabolism. The heterozygous inactivating mutations of GCK cause maturity-onset diabetes of the young (GCK-MODY). Unlike other types of diabetes, GCK-MODY is not associated with increased risks of diabetic complications in young patients. However, the long-term effects of mutant GK on lipid profiles and chronic complications in elder patients remain unknown. Herein, we established a knock-in mouse model heterozygeously expressing a novel GCK mutation encoding GK-Q26L that was identified in a Chinese family with early onset diabetes. GK-Q26L mice developed mild early onset diabetes with moderate elevated blood glucose and decreased serum insulin, confirming diabetogenes of GK-Q26L. To determine age- and diet-related diabetic complications and lipid profiles, we have fed the mice with either chow diet or high-fat diet (HFD) for 28, 40, or 60 weeks. We found that, after 28 week of HFD, GK-Q26L alleviated abnormal lipid profiles in plasma and liver, suggesting beneficial effects of GK-Q26L on lipid metabolism. Surprisingly however, those protective effects were disappeared at 40 weeks, and at 60 weeks of HFD, GK-Q26L mice exhibited even more severe abnormal lipid profiles. Consistent with the distinct trends of lipid profiles, HFD-induced kidney injury (increased urinary albumin/creatinine ratio and renal fibrosis) was also alleviated in GK-Q26L mice at 28 weeks of HFD, but aggravated at 60 weeks of HFD. Similar effects on diabetic retinopathy were observed in GK-Q26L mice. These data reveal for the first time that although inactivating GCK mutations have beneficial effects on HFD-induced abnormal lipid metabolism and diabetes related damages of kidney and retina in short-term, it is strongly associated with long-term diabetic nephropathy and retinopathy. This study suggests that more attention should be paid on the long-term chronic complications in elder patients with GCK-MODY.

Disclosure
Y.Huang: None. Y.Fan: None. X.Li: None. S.Ji: None. S.Chen: None. J.Cui: None. W.Feng: None. H.Shu: None. M.Liu: None.

Funding
National Natural Science Foundation of China (81830025, 82220108014, 82100865, 81800733, 81900720, 82000796, 82070854); National Key R&D Program of China (2019YFA0802502, 2022YFE0131400); Tianjin Key Medical Discipline Construction Project (TJYXZDXK-030A)
511-P: Is It Reasonable to Treat Infected Diabetic Foot Ulcers by Autologous Cell Therapy in Patients with Severe Ischemia?
Authors: DUBSKY MICHAL , HUSÁKOVÁ JITKA , FEJFAROVA VLADIMIRA , SUTORIS KAROL , SOJÁKOVÁ DOMINIKA , JAROŠÍKOVÁ RADKA , KAHLE MICHAL 
Published: June 2023

Aim: Autologous cell therapy (ACT) using bone marrow-derived mononuclear cells is an alternative treatment approach for patients no-option chronic limb-threatening ischemia (NO-CLTI). Diabetic foot infection (DFI) could negatively influence healing and amputation rates in patients with NO-CLTI. The aim of our study was to analyze the impact of DFI on the clinical outcomes of cell therapy in diabetic patients with NO-CLTI.
Methods: One-hundred-forty-nine ACT applications was performed in 124 patients with NO-CLTI who were treated in our foot clinic over 15 years were included in the study. ACT applications were divided in 2 groups - DFI group with the presence of clinical signs of infection (n=46) and non-DFI group (n=103). Both groups were compared in baseline values and the changes in transcutaneous oxygen pressure (TcPO2) were evaluated after 6 months. Major amputation, amputation-free-survival (AFS) and ulcer healing were assessed during the whole follow-up after ACT (3 months to 14.3 years).
Results: Median AFS in the non-DFI group was 4.6 years CI95=(3.7, 6.3), significantly higher compared to 1.4 years CI95=(0.5, 3.0) in the DFI group. Ulcer healing was significantly better in the non-DFI group with median time to heal 0.9 years CI95=(0.7, 1.1) compared to the DFI group where less than 40% of ulcers healed and lower bound of mean time to heal CI95=6.6 years. TcPO2 in DFI and no-DFI groups was without a significant difference at baseline. At 6 months it increased by 21.7 mmHg CI95=(18.0, 25.3) in the non-DFI group and by 29.8 mmHg CI95=(22.5, 37.2) in the DFI group. The difference between groups was significant (p=0.032).
Conclusions: Our study showed that patients with NO-CLTI and baseline presence of DFI treated by ACT had significantly lower AFS and significantly worse ulcer healing. Therefore, the indication of ACT in patients with clinical signs of infection should be carefully considered.

Disclosure
M.Dubsky: None. J.Husáková: None. V.Fejfarova: None. K.Sutoris: None. D.Sojáková: None. R.Jarošíková: None. M.Kahle: None.

Funding
National Institute for Research of Metabolic and Cardiovascular Diseases (EXCELES LX22NPO5104); European Union; Next Generation EU; MZO (00023001)
512-P: Single-Cell RNA-Sequencing Identifies Novel Molecular Targets of Endothelial MicroRNA-200b in the Diabetic Ischemic Wound
Authors: SINGH KANHAIYA , KUMAR MANISHEKHAR , MOHANTY SUJIT K. , KHANNA SAVITA , ROY SASHWATI , SEN CHANDAN K. 
Published: June 2023

Injury-induced transient downregulation of endothelial miR-200b is required to jump-start wound angiogenesis, but the underlying mechanisms remain unclear. Single cell RNA sequencing was performed on ~15000 human endothelial cells under high (mimic treated) miR-200b conditions. Unsupervised clustering using CellRanger identified five cell clusters, three of which were responsive to changes in miR-200b abundance. Stable Isotope Labelling by Amino acids in Cell culture (SILAC) based proteomic analysis was employed to look for novel potential targets of endothelial miR-200b. A total of 3818 proteins were detected which were then filtered using statistical cut-offs (p value &lt; 0.05; % change &gt; 10%) identifying 319 proteins targeted by miR-200b. To determine the potential role of these candidates in regulating vascular function, miR-200b-429fl/fl-Tie2 Cre mice were generated where endothelial miR-200b levels could be specifically depleted in vivo. The therapeutic significance of endothelial miR-200b inhibition was studied using ischemic hindlimb in these mice. The significance of miR-200b depletion was also studied in streptozotocin-induced diabetic miR-200b-429fl/fl-Tie2 Cre mice. Perfusion imaging was performed using Laser Speckle imaging (Perimed Inc.) at different time-points (d3, d7, d10, d14). Inhibition of endothelial miR-200b rescued hindlimb ischemia with improved perfusion (n=11). Such effect of miR-200b inhibition on rescuing HL-ischemia was markedly increased in diabetic animals (n =8). Such rescue was associated with increased abundance of CD31+/vWF+ vasculogenic cells (n=6). This work identified miR-200b regulated endothelial cell clusters, the functional significance of which have been experimentally validated. These findings provide insight into novel mechanisms explaining how transient inhibition of miR-200b in the endothelial compartment improves angiogenic outcomes in the diabetic ischemic limb.

Disclosure
K.Singh: None. M.Kumar: None. S.K.Mohanty: None. S.Khanna: None. S.Roy: None. C.K.Sen: n/a.

Funding
National Institutes of Health (DK128845); U.S. Department of Defense (W81XWH-22-1-0146, W81XWH-21-1-0033)
52-LB: One-Year Results from VLCD vs. Time-Restricted Eating
Authors: NIJJAR AVNEET , KIWAN RASHA , CALINAWAN TESS L. , SHUBROOK JAY H. 
Published: June 2023

There continues to be debate about eating patterns, glucose, and weight control in people with type 2 diabetes. Recently, very low carbohydrate diets (VLCD) have had success in clinical trials. Intermittent fasting or time-restricted eating (TRE) has gained community popularity. In this pilot study, we report follow-up data from a study that randomized participants to VLCD and TRE. A total of 32 participants completed the initial protocol (16 VLCD, 16 TRE). Participants were invited to participate in a 1-year observational follow-up period with phone assessment every 3 months to assess the long-term impacts of the protocol on HbA1c, lipid profile, anthropometrics, and medication regime. Twelve participants (8 VLCD, 5TRE) agreed to follow up. The mean HbA1c in the VLCD was 8.04% at baseline (N=5), mean HbA1c of 8.6% at 6 months (N=3), 8.2% at 9 months (N=1), and 8.63% at 12 months (N=3). For the VLCD group, mean weight was 262lbs at baseline (N=5), 259lbs at 3 months (N=1), 232.5lbs at 6 months (N=2), and 229.4lbs at 12 months (N=5). For the TRE group, the mean A1c was 8.65% at baseline (N=8), 8.5% at 3 months (N=2), 7.8% at 6 months (N=3), 9.4% at 9 months (N=4), and 8.25% at 12 months (N=2). The TRE mean weight was 231.25lbs at baseline (N=8), 237.4lbs at 6 months (N=2), 199.1lbs at 9 months (N=5), and 230.1lbs at 12 months (N=2). While the sample size was small, this study followed participants for 1-year after a 1-month nutritional intervention and illustrated that these dietary plans resulted in different success parameters.

Disclosure
A. Nijjar: None. R. Kiwan: None. T. L. Calinawan: None. J. H. Shubrook: Advisory Panel; AstraZeneca, Eli Lilly and Company, Nevro Corp., Consultant; Abbott Diabetes, Bayer Inc., Novo Nordisk.
52-OR: Effect of Oral Nonpeptide GLP-1 Receptor Agonist Orforglipron (LY3502970) in Participants with Obesity or Overweight—A Phase 2 Study
Authors: WHARTON SEAN , BLEVINS THOMAS , CONNERY LISA B. , ROSENSTOCK JULIO , RAHA SOHINI , MATHER KIEREN J. , HAUPT AXEL , ROBINS DEBORAH A. , PRATT EDWARD J. , KAZDA CHRISTOF M. , KONIG MANIGE 
Published: June 2023

Orforglipron (OFG) is a novel once daily oral non-peptide GLP-1 receptor agonist (RA) which can be taken with or without food, in development for chronic weight management. The objective of this Phase 2 study was to assess the efficacy, safety, and tolerability of OFG in patients with obesity or overweight with ≥1 weight-related comorbidity. Participants (N=272) were randomized to placebo or OFG (12, 24, 36, or 45 mg) treatment. OFG doses were increased to target using different dose escalation schemes in each arm. The primary endpoint was to compare percent body weight (BW) change from baseline in OFG vs placebo at Week 26, while the study continued to 36 weeks. Secondary endpoints included change from baseline in waist circumference (WC) and BMI, and the percentage of participants achieving ≥5 or ≥10% weight loss. At baseline, mean BW was 108.7 kg, BMI was 37.9 kg/m2, and 94% of participants had a BMI ≥30 kg/m2. Mean percentage BW loss, mean change in BMI and WC, and the percentage of participants achieving ≥5% or ≥10% weight loss were significantly greater with all OFG doses vs placebo (Figure). The AE profile was similar to other GLP-1 RAs; most were GI-related and mild to moderate in severity. The novel non-peptide GLP-1 RA OFG led to greater reductions in BW, BMI, and WC compared with placebo. These promising data support continued development of OFG as an oral treatment for obesity.

Disclosure
S.Wharton: Advisory Panel; Novo Nordisk, Eli Lilly and Company, Boehringer Ingelheim International GmbH, Bausch Health, Canada, Research Support; Novo Nordisk, Eli Lilly and Company, Speaker's Bureau; Novo Nordisk, Eli Lilly and Company, Bausch Health, Canada. C.M.Kazda: Employee; Eli Lilly and Company. M.Konig: None. T.Blevins: Other Relationship; Medtronic, Research Support; Lilly Diabetes, Novo Nordisk, Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Medtronic, Speaker's Bureau; Lilly Diabetes, Novo Nordisk A/S. L.B.Connery: None. J.Rosenstock: Advisory Panel; Applied Therapeutics Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Novo Nordisk, Oramed Pharmaceuticals, Sanofi, Zealand Pharma A/S, Intarcia Therapeutics, Inc., Hanmi Pharm. Co., Ltd., Research Support; Applied Therapeutics Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Merck & Co., Inc., Novartis, Novo Nordisk, Pfizer Inc., Sanofi, Intarcia Therapeutics, Inc. S.Raha: Employee; Eli Lilly and Company. K.J.Mather: Employee; Eli Lilly and Company. A.Haupt: Employee; Lilly, Stock/Shareholder; Lilly. D.A.Robins: None. E.J.Pratt: Employee; Eli Lilly and Company.

Funding
Eli Lilly and Company
524-P: Knowledge, Attitudes, and Perceptions of Respiratory Syncytial Virus (RSV) among U.S. Adults with Diabetes
Authors: LA ELIZABETH , BUNNIRAN SUVAPUN , GARBINSKY DIANA , REYNOLDS MARIA , POSTON SARA , HARRINGTON LAURIANE 
Published: June 2023

Rationale: Risk of complications and severe outcomes from respiratory syncytial virus (RSV) infection is increased in older adults and adults with certain chronic conditions in the United States (US). Among adults with diabetes, RSV hospitalization rates are ~2.4-11.4 times higher vs. adults without diabetes. Despite this burden, there are no previous evaluations of RSV knowledge, attitudes, and perceptions (KAP) among adults with diabetes. This study assessed RSV-related KAP among adults at risk of RSV infection, including adults with diabetes.
Methods: A cross-sectional, web-based survey of US adults aged 18-89 years was administered between May-June 2022 to evaluate respiratory infection and RSV-related KAP. Target survey sample sizes included ≥200 adults from 4 subgroups: adults aged 18-59 years with diabetes, ≥1 chronic pulmonary, or ≥1 cardiac condition, as well as older adults aged 60-89 years.
Results: A total of 339 adults aged 18-89 years with diabetes completed the survey (41.0%; n=339/827). Among those with diabetes, 78.2% (n=265/339) reported being knowledgeable about respiratory infections, although &gt;60% (n=206/339) had never heard of RSV. Among those aware of RSV, 69.9% (n=93/133) rarely consider RSV as a cause of their cold/flu-like symptoms. Examples of identified knowledge gaps included respiratory infection causes (bacterial vs. viral), RSV seasonality, frequency of occurrence, and symptoms. Between 28.6-60.4% perceived that their risk of contracting RSV was lower than for 5 other respiratory infections, but only 19.6-38.9% perceived a lower severity of RSV.
Conclusions: This study highlights key RSV knowledge gaps and attitudes/perceptions among US adults with diabetes. Given the increased risk of severe RSV-related outcomes among these adults, findings can be used by health care providers to inform their patient education efforts related to RSV disease awareness.
Funding: GlaxoSmithKline Biologicals SA (study: 218693/HE-RSV-004 BOD)

Disclosure
E.La: Employee; GlaxoSmithKline plc., Stock/Shareholder; GlaxoSmithKline plc. S.Bunniran: Consultant; GlaxoSmithKline plc., Stock/Shareholder; Humana. D.Garbinsky: None. M.Reynolds: None. S.Poston: Employee; GlaxoSmithKline plc. L.Harrington: Employee; GlaxoSmithKline plc.
532-P: Know Your Diabetes by Heart—DSME/S Collaboration with Project Dulce and Dulce Digital Improves Knowledge and HbA1c
Authors: RUIZ MONICA , SPIERLING BAGSIC SAMANTHA R. , SANDOVAL HALEY , CHICHMARENKO MARIYA , FORTMANN ADDIE L. , WALKER CHRISTINE , PHILIS-TSIMIKAS ATHENA 
Published: June 2023

Cardiovascular disease (CVD) and type 2 diabetes (T2D) are closely linked, yet many people with T2D are unaware of the risk. The ADA and AHA, supported the integration of Know Your Diabetes by Heart (KDBH) messaging into DSME/S programs to improve knowledge of CVD risk in T2D populations. Scripps Health, a large health system in San Diego, CA employed two distinct diabetes education methods to deliver enhanced KDBH messaging and determined change in knowledge and clinical outcomes after program delivery. Messages emphasizing the connection of CVD to T2D, and BP and cholesterol risk management were developed in English and Spanish and delivered via 1) Project Dulce (PD), an evidence-based culturally and linguistically modified 9-hour, 5-session traditional in-person and virtual telehealth DSME/S program, and 2) Dulce Digital (DD), an innovative 6-month diabetes education texting program within Scripps ambulatory clinics and partnering Federally Qualified Health Centers (FQHCs) serving diverse racial and ethnic low-income populations in California. Pre/post surveys assessed knowledge and self-management, and clinical metrics were evaluated via electronic health records. Of the N=333participants, 59% were Female, mean age 54 (SD 12.3) years and 42% were Spanish speakers, 70% were White, 54% Hispanic, 17% AA, Asian, NA, PI, and 18% other. Among those with baseline (BL, N=291) and Month 6 (M6, N=82), survey feedback demonstrated improved knowledge of the association of CVD toT2D (PD-94 -&gt;98%, DD-65-&gt;85%), the leading cause of death as CVD (PD-51-&gt;60%, DD-34-&gt;45%) and an increased willingness to discuss the link between heart disease and diabetes. Mean change in HbA1c (N=86 paired values) between BL and M6, was -0.98 [-1.35, -0.61] (-p&lt;0.0001). KDBH campaign in English and Spanish improved CVD risk knowledge and A1c with two methods of DSME/S, PD group live and DD texting in a community-based health system and FQHCs, serving low income diverse racial and ethnic communities.

Disclosure
M.Ruiz: None. S.R.Spierling bagsic: None. H.Sandoval: None. M.Chichmarenko: None. A.L.Fortmann: Employee; Dexcom, Inc. C.Walker: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health.
536-P: Psycho-behavioral and Clinical Characteristics in Koreans with Type 2 Diabetes With or Without Perceived Hypoglycemia
Authors: CHA EUNSEOK , SHIN YUN-A , HYE JOUNG KYONG , JIN KIM HYUN , JIN KIM HYUK , FAULKNER MELISSA S. 
Published: June 2023

Objective: To compare characteristics in Koreans with type 2 diabetes (T2D) with or without perceived hypoglycemia.
Methods: A cross-sectional, correlational design was used. Participants 20 years or older (N=177, men= 113 [63.8%]) were recruited from a university-affiliated diabetes clinic in Korea. Groups were divided by perceived hypoglycemia or not based on the Control Problem Scale. Socio-demographics (e.g., sex, age, years with T2D), psycho-behavioral factors including diabetes self-care activity (Summary of Diabetes Self-Care Activities Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), health-related quality of life (QoL; SF-12) and diabetes-related clinical factors (HbA1C, random glucose, blood pressure and lipids) were assessed. Body mass index [BMI], skeletal muscle mass [SMM], total body water (TBW), body fat mass [BFM], and fat free mass [FFM] were assessed by a body composition analyzer (InBody970, Korea). Statistical analyses were performed using SPSS (version 26.0) to compare group differences.
Findings: One-third (n=67, 37.9%) perceived hypoglycemia in the past month (mean age [yr]= 59.1±12.7 vs. 62.1±12.8 and 35 participants experienced severe hypoglycemic reactions (e.g., passing out, needing help) during the past year. The hypoglycemia group reported a lower SF-12 score (88.5±14.1 vs. 96.1±15.2, p=.001), especially mental health functioning (T-score: 47.0±10.2 vs. 51.9±11.6, p=.005) and poor sleep quality needing professional counseling (n=43 [64.2%] vs. n=56 [50.9%]). Frequent monitoring of blood glucose and feet was performed while no differences for diet and exercise. The hypoglycemia group showed lower BMI (p=.018) and trend for lower SMM (p=.078), TBW (p=.086), BFM (p=.086) and FFM (p=.084).
Conclusions: Perceived hypoglycemia is associated with psycho-behavioral and clinical factors. Further investigation is warranted to examine risks for hypoglycemia related to muscle and body mass decline.

Disclosure
E.Cha: None. Y.Shin: None. K.Joung: None. H.Kim: None. H.Kim: None. M.S.Faulkner: None.

Funding
National Research Foundation of Korea (HNU X-Corps)
539-P: An Integrated Electronic Health Record and Community Health Worker Intervention Shows Clinically Significant Weight Loss among South Asian Patients at Risk for Diabetes
Authors: LIM SAHNAH , WYATT LAURA , BELLI HAYLEY , MAMMEN SHINU , ZANOWIAK JENNIFER , HUSSAIN SARAH , MOHAIMIN SADIA , ISLAM NADIA 
Published: June 2023

Introduction: The DREAM Initiative is a two-arm randomized controlled trial (RCT) that analyzes the implementation and effectiveness of a community health worker (CHW) and electronic health record (EHR) intervention on weight loss promotion among South Asian Americans with prediabetes at primary care practices (PCPs) in New York City (NYC).
Methods: Participants in the intervention arm received five group-based, in-langue education sessions and follow-up phone calls; the control group was matched via sex, age, and BMI using the EHR portal and not contacted. The primary outcome was proportion of those who achieved weight loss of ≥5% between baseline and 6-months. Secondary outcomes included hemoglobin A1c, systolic and diastolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), and behavioral outcomes measured at 6 and 12 months follow-up. Generalized linear mixed effects models assessed change across groups, adjusting for baseline weight, sex, and clustering by PCP.
Results: A total of 952 individuals were randomized (476 per arm). Among treatment group participants, mean age was 48.3 years, 58% were female, all were born outside of the US, and mean years lived in the US was 11.3. In the treatment group, 87 out of 476 patients (18.3%) achieved 5% weight loss, compared to 27 out of 474 (5.7%) in the control group at 6 months (p&lt;0.001). Mean weight in the treatment group decreased from 164.9 to 160.7 lbs., while in the control group, mean weight increased from 164.9. to 165.2 lbs. between baseline and 6-months (p&lt;0.001). Secondary clinical outcomes will also be reported.
Conclusions: Results from a highly powered RCT indicate that the DREAM Initiative intervention was statistically significant in helping South Asian Americans with diabetes achieve weight loss at PCPs in NYC. Future work will test the effectiveness and scalability of the intervention across multiple sites in the eastern United States.

Disclosure
S.Lim: None. L.Wyatt: None. H.Belli: None. S.Mammen: None. J.Zanowiak: None. S.Hussain: None. S.Mohaimin: None. N.Islam: None.

Funding
National Institutes of Health (R01DK110048)
541-P: Role of Personalized Digital Lifestyle Program in Improving Outcomes in People with Diabetes—Real-World Evidence from Indian Cohort
Authors: FATEMA ZAREEN , KAMATH DEEPA , AGARWAL SAKSHI , ASWATHIAH SRINATH , SOORAGONDA BASAVARAJ 
Published: June 2023

Background: Diabetes self-management is neglected practice among people with diabetes (PwD). OneCare-IMPACT Program provides lifestyle modification through easily accessible virtual DSME program leading to a positive behavioral change.
Methods: Study was conducted in PwD (n=173) enrolled in a 12-week OneCare-IMPACT program. Data were collected at baseline and 3 months for demographics, glycemic parameters, medicines and program engagement.
Results: Mean HbA1c (%) improved significantly from 8.9 ± 2.2 to 7.1 ±1.3, p &lt;.001, effect size (d= 0.8). 56.1% had HbA1c&lt;7% at 3-month compared to 18.5% at baseline. Significant change was seen in FPG and PPPG (mg/dl) of −54.85 (±71.02) and −77.58 (±100.79) respectively. Weight reduced significantly from 76.9 ± 17.5 kg to 74.1 ±16.2 kg (p &lt;.001, d=0.7) and BMI by −0.8kg/m2, (p&lt;.001). From baseline, 31% and 8% of patients reduced weight by ≥5% and ≥10% respectively. A majority of the patients had an absolute reduction in diabetes medications. A significant correlation (r=0.3) noted between weight decline and follow-up HbA1c (p=.005). Mean attendance in program was 75% which correlated well with the outcomes.
Conclusions: OneCare-IMPACT program enhances glycemic outcomes in PwD with a significant weight reduction encouraging for further RCTs to evaluate the role of digital DSMEs in developing countries like India.

Disclosure
Z.Fatema: Employee; Wellwork Technologies Private Limited, India. D.Kamath: Employee; Wellworks Technologies Pvt Ltd. S.Agarwal: Employee; Wellworks Technologies Private Limited. S.Aswathiah: None. B.Sooragonda: None.