bluuebunny/crossref_metadata_2025_split huggingface dataset:
906-P: Audit of Technologies Used for Glucose Monitoring and Insulin Delivery in Patients with Type 1 Diabetes at a Single Diabetes Center during 2019–2022—Real-World Data
Authors: BEM ROBERT , VÁVRA DAVID , SOCHOROVA KLARA , MÜLLEROVÁ MARTINA , HALUZIK MARTIN 
Published: June 2023

The new NICE guidelines recommend that all adults with type 1 diabetes (T1D) should have access to either Continuous Glucose Monitoring (CGM) orIntermittently Scanned CGM (isCGM). The latest treatment modality for T1D is represented by the hybrid closed-loop systems (HCL), which consist of an insulin pump (CSII), a CGM and a smart algorithm. The aim of the study was to evaluate the effect of methods used for glucose monitoring and insulin delivery on diabetes control in patients with T1D treated during 2019-2022. We analyzed 2132 patients with T1D (48.9% males, mean age 43, 6 years) registered in our Diabetes Centre, 1165 (54.6 %) with multiple daily injections and 967 (45.4 %) using CSII, including 354 (36.6%) using HCL in 2022. A significant increase in the proportion of patients using CGM or isCGM in comparison to Blood Glucose Monitoring (BGM) during the years 2019-2022 was noted (14%/21%/65% in 2019 vs 43%/30%/27% in 2022; p&lt;0.001). There was a significant improvement in diabetes control in CGM and isCGM users between 2019-2022, but not in the BGM group (CGM: 2019 7.9±1.2 % vs. 2022 7.5±1.1 %; p&lt;0.0001; isCGM: 8.1±1.4 % vs. 7.8±1.3 %; p&lt;0.001; BGM: 7.7±1.5 % vs. 7.6±1.5 %; NS). Patients using CGM had better diabetes control than patients with isCGM in 2022 (p&lt;0.001). HbA1c significantly decreased during the past 2 years in all patients using CSII (2020: 8±1.2 % vs. 2022 7.7±1.1 %, p&lt;0.001). In 2022, patients using HCL reached better glycemic control than only CSII users (HCL 7.5±1.2 % vs. CSII 7.8±1.1 %; p˂0.05). Patients using HCL had a significantly more pronounced decrease of glycated hemoglobin between 2020 to 2022 as compared to CSII users (2022: 7.5±1.2 % vs. 2020: 8±1.3 %; p&lt;0.001). Our study demonstrated that more than 2/3 of patients meet the NICE guidelines for glucose monitoring in 2022, and this ratio is improving every year. CGM, isCGM and CSII treatment, especially with HCL are associated with better diabetes control.

Disclosure
R.Bem: None. D.Vávra: None. K.Sochorova: Advisory Panel; Ypsomed AG, Consultant; Medtronic. M.Müllerová: None. M.Haluzik: Advisory Panel; Novo Nordisk, Lilly Diabetes, Boehringer-Ingelheim, Research Support; Sanofi, Speaker's Bureau; Abbott, AstraZeneca.

Funding
National Institute for Research of Metabolic and Cardiovascular Diseases (EXCELES LX22NPO5104)
909-P: Predictors of Successful Fasting and Attaining Glycemic Targets during the Month of Ramadan among People with Type 1 Diabetes
Authors: AL-SOFIANI MOHAMMED , ALHARTHI SAHAR , ALBUNYAN SARAH , ALZAMAN NAWEED , KLONOFF DAVID C. , ALGUWAIHES ABDULLAH M. 
Published: June 2023

Introduction: Muslims abstain from eating and drinking from dawn to dusk during Ramadan. We aim to evaluate the fasting experience of people with type 1 diabetes (PwT1D) and identify predictors of successful fasting and attaining glycemic targets during Ramadan.
Methods: We included the 149 PwT1D who attempted to fast during Ramadan 2022, were seen in our Endocrine clinics during the month preceding Ramadan, and were using a continuous glucose monitor (CGM). They were categorized, based on their treatment modality, into 3 groups: a) Hybrid closed loop (HCL) pump (n=39); b) Open loop pump (n=12); and c) Multiple daily injections (MDI) (n=98). CGM Reports for Ramadan and the month preceding Ramadan and self-administered surveys about fasting experience were evaluated. Predictors for attaining the “double target” of: a) breaking fast ≤2 days and b) maintaining glucose time in range (TIR) ≥70% during Ramadan were analyzed using uni- and multi-variable logistic regression.
Results: The “double target” of a) breaking fast ≤2 days and b) maintaining TIR≥70% during Ramadan was attained by 21.5% of PwT1D. Users of the HCL therapy, compared to the open loop and MDI users, had a significantly lower glycemia risk index (GRI), glucose management indicator (GMI), time below range (TBR), time above range (TAR), and average glucose during Ramadan (all p&lt;0.05). Those with health insurance and better “pre-Ramadan” glycemic control (i.e. lower GRI, TAR, and coefficient of variation and higher TIR) were more likely to attain the “double target” during Ramadan. Users of the HCL pumps were more likely to attain the “double target” compared to the users of MDI + CGM [OR (95% CI): 25.47 (4.72, 137.49)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration.
Conclusion: Using HCL pump therapy and having better pre-Ramadan CGM metrics predict attainment of the double target of fasting most of days and having TIR ≥70% during Ramadan among PwT1D.

Disclosure
M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.
917-P: Treatment Satisfaction with Omnipod DASH System vs. Usual Care in Adults with Type 1 Diabetes in Australia
Authors: KONG YEE W. , YI YUAN CHENG , KIBURG KATERINA V. , BROWN KATRIN , TRAWLEY STEVEN , PARTOVI ANDISHEH , ROEM KERRYN L. , HARRISON NATALIE , FOURLANOS SPIROS , EKINCI ELIF I. , O'NEAL DAVID N. 
Published: June 2023

Background: Conventional insulin pumps can be inconvenient and increase diabetes distress in people with type 1 diabetes (T1D). A tubeless insulin pump discreetly controlled by a handheld device, may be more acceptable. This is the first randomized controlled trial on patient-reported outcomes with tubeless insulin pumps.
Aim: To compare treatment satisfaction with Omnipod DASH® Insulin Management System (Insulet, Acton MA) vs. usual care (MDI or conventional IPT) in T1D adults self-monitoring with fingerstick blood glucose.
Methods: T1D adults were randomized to 12-weeks of Omnipod DASH System (intervention) or usual care (control). At study-end, treatment satisfaction was assessed by the difference in Diabetes Technology Questionnaire current score (DTQ-current). Secondary outcomes included patient-reported measures assessed through six other questionnaires and HbA1c.
Results: Baseline characteristics were similar between both groups. Those on Omnipod DASH System expressed significantly higher treatment satisfaction, better sleep quality, reduced fear of hypoglycemia and diabetes distress than those on usual care. HbA1c reduction was clinically relevant in the intervention group.
Conclusion: This study demonstrated that Omnipod DASH System is associated with better treatment satisfaction and patient-reported outcomes whilst maintaining glycemia in T1D adults.

Disclosure
Y.W.Kong: None. E.I.Ekinci: Advisory Panel; Eli Lilly Australia Pty Limited, Research Support; Eli Lilly Australia Pty Limited, Novo Nordisk, Boehringer Ingelheim and Eli Lilly Alliance, Insulet Corporation, Medtronic. D.N.O'neal: None. C.Yuan: None. K.V.Kiburg: None. K.Brown: None. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). A.Partovi: None. K.L.Roem: None. N.Harrison: None. S.Fourlanos: Advisory Panel; Viatris Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance.

Funding
Insulet Corporation
922-P: Improved Satisfaction while Maintaining Safety and High Time in Range (TIR) with a Medtronic Investigational Enhanced Advanced Hybrid Closed-Loop System (eAHCL)
Authors: YI YUAN CHENG , KONG YEE W. , AMOORE TESS , BROWN KATRIN , GROSMAN BENYAMIN , JENKINS ALICIA , JONES HANNAH , KURTZ NATALIE , LEE MELISSA H. , MACISAAC RICHARD , NETZER EMMA , PALDUS BARBORA , ROBINSON LESLEY , ROY ANIRBAN , SIMS CATRIONA M. , TRAWLEY STEVEN , VOGRIN SARA , O'NEAL DAVID N. 
Published: June 2023

Background: Hybrid closed loop (HCL) systems are evolving. We aimed to assess treatment satisfaction and glucose control with an investigational eAHCL system.
Methods: Adults with type 1 diabetes (T1D) received sequentially the MiniMed™ 780G /Guardian™ Sensor 3 AHCL system, and a Medtronic investigational eAHCL system each for 12 weeks. The eAHCL system incorporates updated software, a new simple to use, no calibration, all-in-one sensor, and 7 day extended wear infusion set. The primary outcome was difference in treatment satisfaction measured using “current” and “change” versions of the Diabetes Technology Questionnaire (DTQ) following each 12 week period. Secondary outcomes included time spent changing infusion sets and sensors recorded on a phone app and CGM metrics.
Results: Twenty-one adults (11 men, mean [SD] age 48 [12.4] years) completed the trial. DTQ “current” score improved on eAHCL, and 86% of participants reported less “Effort to keep low blood sugar from happening” on DTQ “change”. There was less fear of hypoglycemia; more time in Auto Mode; fewer alarms; less time spent changing infusion sets and sensors; reduced CGM hypoglycemia and glycemic variability (Table 1).
Conclusions: Transition to eAHCL in T1D adults resulted in a better user experience and reduced fear of and time in hypoglycemia while maintaining safety and &gt;80% TIR.

Disclosure
C.Yuan: None. R.Macisaac: None. E.Netzer: None. B.Paldus: None. L.Robinson: None. A.Roy: Employee; Medtronic. C.M.Sims: Stock/Shareholder; Medtronic. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). S.Vogrin: None. D.N.O'neal: None. Y.W.Kong: None. T.Amoore: None. K.Brown: None. B.Grosman: Employee; Medtronic. A.Jenkins: Advisory Panel; Insulet Corporation, Board Member; Insulin for Life, Research Support; Abbott Diabetes, Medtronic, Hemsley Charitable Trust, Juvenile Diabetes Research Foundation (JDRF), National Institutes of Health. H.Jones: None. N.Kurtz: Employee; Medtronic. M.H.Lee: Speaker's Bureau; Medtronic.
927-P: Robustness of MiniMed Advanced Hybrid Closed-Loop (AHCL) Algorithm on a Spectrum of Glycemic Control
Authors: SHIN JOHN , DAI ZHENG , NIU FANG 
Published: June 2023

Objective: To evaluate effectiveness of MiniMed™ AHCL on outcomes of study participants with different glycemic management challenges.
Methods: Adults (N=128, ≥18 years) with T1D from 16 investigational sites, underwent baseline run-in (~2wks) of continuous subcutaneous insulin infusion (CSII), sensor-augmented pump (SAP) or HCL therapy, followed by study period (3 months) with MiniMed™ AHCL. In this exploratory analysis, participants with different baseline glycemic characteristics (mean SG and SD of SG) were identified using Hierarchical Clustering Analysis with Ward’s method and stratified into 5 cohorts. AHCL glycemic outcomes were evaluated and compared to run-in outcomes.
Results: After AHCL initiation, overall glycemic control improved regardless of baseline glycemic characteristics (i.e., low-to-high mean SG and SD of SG) (Table). As expected, those from Cluster 5 with highest baseline mean SG and SD of SG improved the most. While those from Cluster 1 with lowest baseline mean SG and SD of SG achieved the highest TIR. Although those from Cluster 2 achieved better glycemic outcomes compared to their baseline, they didn’t outperform those from Cluster 3, possibly due to their higher SD of SG and less aggressive carb ratio.
Conclusion: Improved glycemic control was observed with MiniMed™ AHCL regardless of glycemic conditions at baseline.

Disclosure
J.Shin: Employee; Medtronic. Z.Dai: Employee; Medtronic. F.Niu: None.
93-OR: Hepatic Acyl-Protein Thioesterases Prevent Insulin Resistance
Authors: SPECK SARAH L. , ZHANG QIANG , BHATT DHAVAL P. , ADAK SANGEETA , DONG GUIFANG , WEI XIAOCHAO , SEMENKOVICH CLAY F. 
Published: June 2023

Elevated fatty acids in the context of metabolic disease are associated with insulin resistance. Fatty acids covalently and reversibly modify proteins through a process known as palmitoylation. We hypothesized that depalmitoylation by acyl-protein thioesterases 1 and 2 (APT1 and APT2) in the liver regulates glucose metabolism. The hepatic roles of APT1 and APT2 are unknown. We deleted APT1 and/or APT2 from the livers of mice, followed by high-fat diet (HFD) feeding. We performed acyl resin-assisted capture (acyl-RAC) to isolate palmitoylated proteins from APT KO livers followed by mass spectrometry. APT1 primarily depalmitoylated proteins linked to mitochondrial function and amino acid metabolism, including glutamine and branched-chain amino acid metabolism. To identify direct substrates of APT1 and APT2, we determined the protein-protein proximity network of each APT by fusing each enzyme to the highly efficient biotin ligase, miniTurbo (mT). We expressed these APT-mT constructs in human hepatocellular carcinoma HepG2 cells, followed by purification of biotin-labeled proteins and analysis by mass spectrometry. The APT proximity networks demonstrated that both APT1 and APT2 interact with mitochondrial proteins. APT1 and APT2 were also proximal to several glutamine transporters including Slc1a5 (also known as ASCT2), the only glutamine transporter known to localize to mitochondria. Male mice with dual but not single deletion of APT1 and APT2 from the liver (DLKO mice) had impaired insulin sensitivity independent of p-Akt levels or expression of Pck1 and G6pc. Elevated overnight fasting glucose in DLKO mice was associated with increased glutamine-driven gluconeogenesis and decreased liver mass. These data suggest that APT1 and APT2 regulate hepatic glucose metabolism, insulin signaling, and amino acid flux in a functionally redundant manner. These novel findings are the first to illustrate the hepatic depalmitoylation substrates and protein-protein proximity networks of APT1 and APT2.

Disclosure
S.L.Speck: None. Q.Zhang: None. D.P.Bhatt: None. S.Adak: None. G.Dong: None. X.Wei: None. C.F.Semenkovich: Consultant; Alnylam Pharmaceuticals.

Funding
National Institutes of Health (T32GM007200, F30DK131830, R01HL157154, P30DK020579)
935-P: Racial and Ethnic Disparities in the Application of Continuous Glucose Monitoring in Real-World Clinical Settings
Authors: ZHENG YAGUANG , ITURRATE EDUARDO , WU BEI , FLETCHER JASON , MELKUS GAIL D. , JOHNSON STEPHEN B. 
Published: June 2023

Background: The use of continuous glucose monitoring (CGM) has improved glycemic control. Disparity in CGM use has been reported; however, the utilization of CGM across a health system in real-world clinical settings remains unknown. We aimed to characterize patients who use CGM and compare them to patients with diabetes who do not use CGM in a large health system.
Methods: We retrospectively reviewed the electronic health record (EHR) of patients who received care at NYU Langone Health from 2015. CGM users were those whose EHR records had at least one uploaded CGM report, while CGM non-users were those who had at least one outpatient encounter in which a diabetes diagnosis was documented and who did not have any CGM files uploaded into Epic.
Results: We identified 10,515 CGM users and 108,395 CGM non-users. CGM use significantly increased in patients with type 2 diabetes (T2D) after 2019, with higher use of CGM in patients with T2D than those with type 1 diabetes (T1D) (63.6% vs. 36.4%; p&lt;.001). The rate of CGM use was significantly different across racial/ethnic groups: 9.9% of Whites, 7.8% Hispanics/Latinos, 7.5% African Americans, 7.2% Asian, and 7.1% Native Americans. When comparing CGM user among racial groups, CGM user was higher (than non-use) among Whites (60.4% vs 53.1%) and Filipinos (0.68% vs 0.55%), but less frequent among African Americans (13.0% vs 15.6%), Chinese (0.71% vs 1.7%), and Koreans (0.19% vs 0.45%) (p&lt;.001). Regarding the ethnicity, more CGM users were Salvadoran (0.83% vs 0.45%), while less were Puerto Rican (3.3% vs 3.6%), Dominican (1.2% vs 1.4%), and Mexican (0.55 vs 1.4) (p&lt;.001).
Conclusions: Using a large real-world clinical setting dataset, our study identified disparity in the CGM use in patients with T1D compared to T2D. Further we noted racial/ethnic disparities in the CGM use and heterogeneity within Hispanics and Asian Americans. Researchers and clinicians should consider interventions to reduce disparities in CGM prescription patterns.

Disclosure
Y.Zheng: None. E.Iturrate: None. B.Wu: None. J.Fletcher: None. G.D.Melkus: None. S.B.Johnson: None.

Funding
National Institutes of Health (P30DK111022)
936-P: Three-Month Interim Analysis from the Prospective Bigfoot Unity Real World Study (BURST)
Authors: MALONE JAMES K. , BECK ROY , TILLMAN JOHN , CALHOUN PETER , MOUSE THOMAS J. , BAILEY RYAN , OLSON BYRON P. , VAUGHAN SARAH , NAUREEN SHEIKH F. 
Published: June 2023

Background: The Bigfoot Unity® System is an FDA-cleared smart pen cap system incorporating CGM data (Abbott FreeStyle Libre 2), real-time alerts, and clinician-directed insulin dose recommendations. The objective was to analyze real world, 3-month data for System users.
Methods: We conducted a per-protocol 3-month interim analysis (N=54, 15 clinics) from the prospective, BURST study (NCT05088265). Participants reported baseline demographics and completed adverse event surveys every 2 weeks. For A1C data, an at-home kit or electronic medical record was used for baseline and 3-month values; CGM metrics were collected post System initiation.
Results: Most (85%) had T2D and median age was 57 years; 58% were Caucasian and 58% were female. Mean A1C decreased from 9.2±1.8% at baseline to 7.9±1.3% at 3 months (mean difference −1.2%, 95%CI −1.6 to −0.8, p&lt;0.001). Four severe hypoglycemia events in 3 participants and 1 DKA occurred and were not related to the System. Percent time below range and other 3-month glycemic outcomes and System use data are shown (Table).
Discussion: In this cohort, consisting primarily of older adults with T2D using MDI and suboptimal glycemic control, durable glycemic improvement occurred using Bigfoot Unity at 3 months. The observed reduction in A1C in this older cohort does not compromise them in meeting established hypoglycemia targets of &lt;4 and &lt;1% for percent time below 70 and 54 mg/dL, respectively.

Disclosure
J.K.Malone: Employee; Bigfoot Biomedical, Inc. R.Beck: Consultant; Eli Lilly and Company, Novo Nordisk, Diasome, Insulet Corporation, Research Support; Tandem Diabetes Care, Inc., Beta Bionics, Inc., Dexcom, Inc., Bigfoot Biomedical, Inc., Medtronic, Ascensia Diabetes Care, Roche Diabetes Care, Eli Lilly and Company, Novo Nordisk. J.Tillman: Employee; Bigfoot Biomedical, Inc. P.Calhoun: None. T.J.Mouse: None. R.Bailey: None. B.P.Olson: Employee; Bigfoot Biomedical, Inc. S.Vaughan: Employee; Bigfoot Biomedical, Inc. F.Sheikh: Employee; Bigfoot Biomedical, Inc.

Funding
Bigfoot Biomedical, Inc.
94-LB: Pharmacological Intensification in Patients with Type 2 Diabetes in a Low-Cost Diabetes Care Center (CAD)
Authors: VIOLANTE RAFAEL , FERNANDEZ NORMA , SALGUERO DULCE , GUTIERREZ HANNIA 
Published: June 2023

Pharmacological intensification is one of the most important factors needed to get more patients to reach goals in type 2 diabetes mellitus (DM2). The objective of this research protocol is to demonstrate the degree of metabolic control in patients with DM2 and their glycemic control at 3, 6 months and 1 year after their pharmacological intensification in a Low Cost Diabetes Care Center (CAD). Descriptive, cross-sectional and retrospective study from 2019 to 2022, an HbA1c ≤ 7% was considered a meta control. Of the 422 patients studied, 66.8% (n=282/422) were women and 33.2% men. 33.2% comprised the 3-month cohort, 20.4% at 6 months, and 46.4% at 1 year. At the start of treatment in CAD, 81% of the patients were outside the goals, of these, 31.5% had an A1C between 7.1-9%, 49.4% between 9.1-12% and 19% ≥12.1%. Regarding treatment, 12.6% had no drug treatment, 34.6% monotherapy, 45.7% double oral therapy, 6.6% triple and 0.5% quadruple. 20.1% of the participants used insulin and 0.9% GLP-1. 78.9% were taking metformin, 36.7% sulfonylureas, 15.4% IDPP4, 6.2% ISGLT2, 5.9% acarbose, and 4.7% TZDs. During pharmacological intensification there was an increase in the use of medications: Metformin +18.3%, IDPP4 +26.1%, iSGLT2 +25.8% and TZD +12.4%. Glibenclamide was reduced to -6%, all of them statistically significant (p=0.000). Patients without treatment decreased from 12.6 to 1.4% (p= 0.005) and in monotherapy from 34.6 to 15.9% (p= 0.000), dual therapy increased from 45.7 to 50.9%, triple from 6.6 to 27% and quadruple from 0.5 to 4.7% (p=0.003). The use of insulin doubled from 20.81 to 44.3%, likewise GLP-1 from 0.9 to 6.4%; both were statistically significant (p=.000). According to glycemic control, at 3 months 89.3% improved their glucose levels and 35% of the participants reached control goals, at 6 months 94.2% improved their glucose levels and 53. 5% achieved their control goals. At one year, 90.3% improved their glucose levels and 71.4% reached control goals.

Disclosure
R. Violante: None. N. Fernandez: None. D. Salguero: None. H. Gutierrez: None.

Funding
None
941-P: Improved Glycemic Control with Real-Time CGM in Adults with Type 2 Diabetes Not Treated with Insulin
Authors: JEPSON LAUREN H. , WELSH JOHN , GREEN COURTNEY R. , THOMAS ROY , LAYNE JENNIFER E. 
Published: June 2023

Background: Little is known about real-time continuous glucose monitoring (rt-CGM) in adults with T2D who are not using insulin. We analyzed real-world data to evaluate the association of rt-CGM use and glycemic control in this population.
Methods: Data from US-based adults who reported a T2D diagnosis, age ≥18 years, not using insulin and who first uploaded Dexcom G6 data from the Dexcom app between 9/2021 and 6/2022 were analyzed. Individuals with follow-up data at 3 months and baseline time in range (TIR, 70-180 mg/dL) &lt;70% were included. Outcomes included change in CGM metrics and percentage of users with TIR ≥70% at follow-up.
Results: CGM users (n=3,505) were [mean (SD)] 52.2 (11.2) years of age and 46% female. TIR increased by 16.2 percentage points from 40.2% (21.7) at baseline to 56.4% (28.2) at 3 months (p &lt;0.001), which was largely attributable to reduced hyperglycemia (Table). The proportion of CGM users meeting the consensus target of TIR ≥70% increased from 0% to 37%. Over the course of 3 months, CGM was worn 91.7% of the time. Most CGM users (77.6%) accessed Clarity summary reports of CGM data and most (80.2%) enabled the optional high glucose alert.
Conclusion: In adults with T2D not using insulin and not meeting treatment targets, use of rt-CGM was associated with clinically meaningful improvements in glycemic control. Ongoing use of rt-CGM may result in further improvements in glycemic control.

Disclosure
L.H.Jepson: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. C.R.Green: Employee; Dexcom, Inc. R.Thomas: Employee; Dexcom, Inc. J.E.Layne: Employee; Dexcom, Inc., Verily Life Sciences.

Funding
Dexcom, Inc.