bluuebunny/crossref_metadata_2025_split huggingface dataset:
116-LB: iCoDE Project Final Recommendations for CGM-EHR Integration
Authors: ESPINOZA JUAN C. , YEUNG ANDREA , HUANG CYNTHIA , KLONOFF DAVID C. 
Published: June 2023

Background: he Integration of Continuous Glucose Monitoring Data into the Electronic Health Record (iCoDE) Project is a consortium whose purpose is to facilitate efficient integration of continuous glucose monitor (CGM) data into the Electronic Health Record (EHR) through standards and best practices.
Methods: A Planning Committee, Steering Committee, and six Working Groups (Data Standards; Account Linkage; Integration and Interoperability; Analytics and Visualizations; Clinical Workflows; and Partnerships and Business Models) were organized to tackle different technical, clinical, and operational aspects of CGM-EHR integration. Participants were recruited from industry, academia, healthcare, government agencies, and patient advocacy groups. Groups met regularly and got feedback from the Steering Committee. Each Working Group created a final summary of their group's thoughts, research, and recommendations. The iCoDE Co-Chairs then synthesized the six summaries into a final report, and derived formal Recommendation Statements (RS). These RS were then sent to the iCoDE Steering Committee for feedback and revisions. The feedback was incorporated, and a ballot was sent to all voting members.
Results:130 individuals from more than 60 organizations participated in iCoDE over the course of 11 months. 54 RS were developed (7 Introductory RS, 27 Technical Standards RS, 20 Clinical Implementation RS). 93.8% of eligible steering committee members submitted their ballots. After the first round of voting, 13 statements underwent minor revisions and 2 underwent major revisions. A revised and final ballot was prepared and sent out to the Steering Committee. All 54 RS were adopted as Strong Recommendations (defined as &gt;80% approval); average approval rate was 98%, range 91%-100%.
Conclusion: The 2022 iCoDE Report and Recommendations provide comprehensive yet practical standards-based guidance for manufacturers and healthcare organizations interested in CGM-EHR integration.

Disclosure
J. C. Espinoza: Consultant; Sanofi, Research Support; NIH - National Institutes of Health, FDA, Speaker's Bureau; Glooko, Inc. A. Yeung: None. C. Huang: None. D. C. Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc.

Funding
U.S. Food and Drug Administration (P50FD006425 to J.C.E.)
116-OR: Changing How We Talk about DSMES—Applying an Audience-Driven Approach
Authors: WILLIAMS ALEXIS , RODRIGUEZ BETSY , PELLECHIA KATHLEEN 
Published: June 2023

How would you describe diabetes self-management education and support (DSMES) services to a neighbor? Would they understand and want to learn more? DSMES services are cost-effective and proven to help improve health behaviors and outcomes. However, according to the Centers for Disease Control and Prevention (CDC), every year, only 1 million of the more than 37 million adults with diabetes receive DSMES services. Between 2019 and 2021, CDC, the Association of Diabetes Care & Education Specialists, the American Diabetes Association, and other partners collaborated on a new approach to talk about and facilitate better understanding of DSMES services. Through application of health marketing best practices, the group developed messaging, including a plain-language description which aims to communicate its value in a common and compelling voice. The multi-phase process was informed by the insights of people with diabetes, diabetes care and education specialists, and other health care providers. Participants were recruited nationally from diverse locations, backgrounds, and levels of experience with diabetes education to participate in focus groups and interviews, an online card sort, and a confirmatory online survey of 500 people in which 70% of people with diabetes surveyed shared that they would be likely to look for more information on DSMES services after seeing the messages, and 84% of health care providers reported they would be likely to use the messages. The process culminated with a pilot project in four varied sites: a network of community clinics, a pharmacy, a state health department, and a Federally Qualified Health Center. Pilot participants shared positive impressions of the content and design of the promotional tools. Next steps are to move from concept to final materials and to launch a digital “playbook” to help guide use of the messages. In this session, presenters will detail the research, offer audience insight data, and highlight next steps.

Disclosure
A.Williams: None. B.Rodriguez: None. K.Pellechia: None.
1161-P: Patterns of Diabetes Distress (DD) and Glycemic Outcomes in Teens with Type 1 Diabetes (T1D)
Authors: WENTZELL KATHERINE , TINSLEY LIANE J. , VOLKENING LISA K. , MCGILL DAYNA E. , ANDERSON-THOMAS BARBARA J. , LAFFEL LORI M. 
Published: June 2023

Background: DD distracts from T1D self-management, contributing to suboptimal glycemia. Yet, DD can change day-to-day and over time. We compared A1c trends in teens with increasing vs. decreasing DD over time.
Methods: At baseline, 6, 12, and 18 months, participants (N=301) ages 13-17 years completed the Problem Areas in Diabetes Survey—Pediatric scale; higher scores indicate more DD with ≥41 indicating elevated DD. We identified three trajectories: participants with low baseline DD, who then reported persistent high DD; participants with high baseline DD, who then had persistent low DD levels; all others. Mean A1c levels were compared at baseline and 18 months.
Results: At baseline, participants (49% male, 78% white) were 15.0±1.3 years old with T1D duration 6.5±3.7 years; 59% used insulin pumps; 12% used CGM; A1c was 8.5±1.1%. Twenty-six participants (9%) had elevated DD at baseline and then low DD at subsequent time points; A1c did not change significantly from 0 to 18 months for these participants (p=.33). Thirty-five participants (12%) had low DD at baseline and then elevated DD at subsequent time points; A1c increased significantly from 0 to 18 months for these participants (p=.01). The remaining participants (n=240) had varying levels of DD with no significant change in A1C (p=.05).
Conclusion: Adolescents who initially had low DD and reported increasing DD over time may be at risk for worsening glycemic outcomes.

Disclosure
K.Wentzell: None. L.J.Tinsley: None. L.K.Volkening: None. D.E.Mcgill: Employee; Vertex Pharmaceuticals Incorporated. B.J.Anderson-thomas: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape.

Funding
National Institutes of Health (T32DK007260); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095273); JDRF (2-SRA-2014-253-M-B)
1163-P: The Arrival of a New Sibling May Be Associated with a Deterioration in Glycemic Control for Children with Type 1 Diabetes
Authors: LOPEZ PRUDENCE E. , KING BRUCE R. , SMART CARMEL E. , SINCLAIR ANNE , NEYLAN MICHELLE , SECKOLD ROWEN , PATERSON MEGAN A. 
Published: June 2023

Introduction: Caring for young children with Type 1 diabetes comes with significant burden for parents. We hypothesised that pregnancy and the arrival of a new sibling may be associated with a deterioration in control of type 1 diabetes for older siblings with type 1 diabetes.
Research Design and Methods: We identified young children currently under the care of the John Hunter Children's Hospital Paediatric Diabetes team who had welcomed a younger sibling since their diagnosis using our prospective Paediatric Diabetes database. We reviewed the HbA1c pre and post the arrival of a new sibling.
Results: 38 children (20 male) had become older siblings since diagnosis of type 1 diabetes. 5 children were excluded as no data were available prior to pregnancy. Mean age of children at diagnosis was 3.5 years. Mean age at arrival of sibling was 6years with mean duration of diabetes at that time of 3.4 years. 15 of eligible participants were using insulin pump therapy. Mean HbA1c during pregnancy was 51mmol/mol (6.8%) compared to 54mmol/mol (7.1%) following delivery (p&lt;0.05). 67% of children had HbA1c &lt;53mmol/mol (7%) during pregnancy compared to 53% following delivery.
Conclusion: The arrival of a new sibling was associated with a significant increase in HbA1c. This may be due to the high care burden of type 1 diabetes on parents which cannot be met when also attempting to attend to the needs of a newborn. Programs to assist new parents may help children with young siblings to continue to meet glycaemic targets. Despite the young age of the cohort of children prior to delivery of a new sibling, 67% were able to meet the ADA glycaemic target of &lt;7%. This indicates that the goals of intensive management of diabetes are achievable even in the toddler, preschool and early primary school years.

Disclosure
P.E.Lopez: None. B.R.King: None. C.E.Smart: None. A.Sinclair: None. M.Neylan: None. R.Seckold: None. M.A.Paterson: None.
1167-P: “I don't know if I can call it discrimination, but…”—Perceived Discrimination in Provision of Pediatric Type 1 Diabetes (T1D) Care
Authors: MEDINA PENARANDA RICARDO , BONILLA OSPINA ANDREA , ORTEGA HECTOR , PENA DIANA , SHAW GARY M. , CHAMBERLAIN LISA , NARANJO DIANA , RAYMOND JENNIFER , MAAHS DAVID M. , HOOD KOREY K. , ADDALA ANANTA 
Published: June 2023

Discrimination impacts health outcomes but is underexplored in pediatric T1D. In this pilot qualitative study, we evaluate perceived discrimination in provision of diabetes care for parents/guardians (PG) of youth with T1D and public insurance.
PG (n=21, 39±8 yrs, youth 8±2 yrs, 67% Hispanic, 48% speak Spanish, 69% make &lt;$50K) completed focus groups/interviews (FGI). FGI were conducted, transcribed, and coded in English (n=11) or Spanish (n=10), per PG preference. FGI transcripts were analyzed inductively by a five member bilingual team.
While not always referred to as discrimination, PG reported differences in diabetes care by language, race/ethnicity, and insurance. Reported themes organically organized into the social ecological model (Figure). Systemic inequities via insurers, and institutional inequities via clinicians and schools were reported. Insurers required frequent advocacy from PG to navigate unequal treatment. Community was identified as protective through normalization and education of T1D, familial and communal support, and cultural and linguistic congruency.
PG frequently described experiences in diabetes care consistent with the definition of discrimination, but not all readily adopt the terminology “discrimination”. Clinicians and researchers should be aware of this phenomenon to devise meaningful solutions to address diabetes equity.

Disclosure
R.Medina penaranda: None. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. A.Bonilla ospina: None. H.Ortega: None. D.Pena: None. G.M.Shaw: None. L.Chamberlain: None. D.Naranjo: None. J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc.

Funding
Maternal & Child Health Research Institute; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK13134201)
1169-P: A Systematic Review of the Effects of Provider Bias on Outcomes in Youth and Young Adults with Type 1 Diabetes
Authors: WETTER SARA E. , HIMELHOCH ALEXANDRA C. , DRISCOLL KIMBERLY A. 
Published: June 2023

Background: There are significant and pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D). This review sought to examine 1) child and caregiver demographic and biopsychosocial variables associated with provider bias and outcomes (e.g., HbA1c; blood glucose values and range; diabetes technology use; burnout, stress, anxiety associated with T1D care); 2) evidence for associations between experiences of provider bias and patient physical and psychological outcomes; and 3) evidence for mediators or moderators (e.g., socioeconomic status, race/ethnicity) contributing to the association between provider bias and patient outcomes.
Methods: A systematic review of the literature was conducted across five public electronic databases: PubMed, PsycINFO, CINAHL, Web of Science, Embase. Studies included youth/young adults with T1D with a mean age between 12-35 years that investigated the effects of provider bias on physical and psychological health outcomes.
Results: Fourteen articles were included in the review. Results suggest experiences of provider bias (e.g., shaming, criticism) negatively affect individuals’ self-esteem, relationships with medical providers, and mood. Provider bias also impacts recommendations about diabetes technology use, insulin regimen intensity, and risk for life-threatening T1D complications.
Conclusions: Evidence from the current review suggests that provider bias plays a role in adverse physical and mental health. Varying study methodology in definitions and assessment of provider bias signals a need for comprehensive measure development to account for diverse experiences and interpretations of bias in healthcare. More research is necessary to investigate intervening factors that may affect the association between provider bias and overall health outcomes in youth and young adults with T1D.

Disclosure
S.E.Wetter: None. A.C.Himelhoch: None. K.A.Driscoll: None.
1188-P: Plasma ANGPTL4 Is Higher in Women with Advanced Maternal Age and Is Associated with Metabolic Disorders during Pregnancy and the Risk of Adverse Pregnancy Outcomes
Authors: WENG YEN I , LI HUNG-YUAN 
Published: June 2023

Background: Advanced maternal age (AMA) is correlated with a higher risk of metabolic disorders during pregnancy, including gestational diabetes (GDM), gestational hypertriglyceridemia (GHTG), pregnancy-induced hypertension (PIH), and preeclampsia while the pathophysiology remains unclear. Angiopoietin-like protein 4 (ANGPTL4) is a lipoprotein lipase inhibitor which participates in the pathophysiology of metabolic disorders in non-pregnant population. We explored the role of ANGPTL4 in the link between AMA and metabolic disorders during pregnancy.
Method: We recruited 571 pregnant women from November 2013 to April 2018 in National Taiwan University Hospital, Taiwan. ANGPTL4 expression level in placenta and maternal plasma ANGPTL4 level were measured. The correlations among age, plasma ANGPTL4 level, metabolic disorders during pregnancy, and adverse pregnancy outcome were analyzed.
Result: Compared with women aged &lt;30 years, women aged ≥40 years had higher body mass index (BMI), fasting plasma glucose, hemoglobin A1c, insulin resistance index, plasma triglyceride, blood pressure, and plasma ANGPTL4 level in the first trimester. The expression level of ANGPTL4 were higher in the placenta of women with AMA than in the placenta of women aged &lt;30 years. The pregnant women with the highest quartile of plasma ANGPTL4 level had more metabolic disorders during pregnancy. Besides, higher plasma ANGPTL4 was associated with a higher risk of delivering neonates with large for gestational age and the presence of adverse pregnancy outcomes.
Conclusion: Plasma ANGPTL4 is higher in women with AMA and is associated with metabolic disorders during pregnancy and the risk of adverse pregnancy outcomes.

Disclosure
I.Yen: None. H.Li: None.
1199-P: Timing of Postprandial Peak CGM Glucose in Gestational Diabetes
Authors: O'MALLEY GRENYE , KONONENKO MARIYA , OGYAADU SELASSIE J. , LEVISTER CAMILLA , ELLIS EMILY , ARUMUGAM DUSHYANTHY , VIEIRA LUCIANA , LEVY CAROL J. 
Published: June 2023

Background: Current guideline recommendations for management of gestational diabetes mellitus (GDM) recommend capillary testing of blood glucose levels fasting and one-two hours postprandial. Use of intermittently-scanned continuous glucose monitors (isCGM) during pregnancy in women with GDM has the potential to improve fetal outcomes, however there are limited recommendations for their use. Optimal timing of postprandial testing is unknown.
Methods: Women with GDM diagnosed after 24 weeks gestation were recruited and randomized to adjunctive use of isCGM versus capillary testing with blinded CGM. In this subanalysis of 8 participants, timing of peak CGM glucose value is compared to recommended 1-hour postprandial capillary value. Food logs and/or meter data from the first two weeks of participation were used for analysis.
Results: A total of 265 meals were analyzed. Gestational age at analysis was 29±1.2 weeks. One participant was treated with insulin. Three participants used blinded CGM; 5 used isCGM. Mean peak CGM glucose was 100±11 mg/dL. Mean time to peak was 96±14 minutes. Seventy-four percent of peak glucoses were after one hour.
Conclusions: Current recommendations for glucose monitoring may need to be adapted to use of new technology with isCGM. Our data found that if a user only scanned at one hour postprandial, they could miss the peak glucose for the majority of meals. Repeat scanning or retrospective review of isCGM data may be required to determine the timing of a user’s postprandial peaks in relation to glycemic goals. Factors like the lag in CGM glucose compared to capillary testing and meal content should be considered with isCGM use.

Disclosure
G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Kononenko: None. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. E.Ellis: None. D.Arumugam: None. L.Vieira: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange.

Funding
Abbott Diabetes Care
120-LB: Sharing Dexcom G6 Data and Glycemic Outcome—A Comparative Analysis
Authors: SADEK BATOUL , HASHEM MOHAMED , SEETHA MALAVIKA , RAJ RISHI 
Published: June 2023

Introduction: In recent years the use of Continuous Glucose Monitoring (CGM) has significantly increased. The Dexcom G6 CGM sends real-time glucose readings automatically to a smart device. The Dexcom Clarity app allows users to share up-to-date glucose data with providers, enabling remote monitoring of patients' glycemic control. Although studies have shown better glucose control in patients who use CGM, it is unexplored if glucose metrics are further improved in those who share CGM data with providers. In this study, we compared glycemic outcomes in patients who share their data with their providers via the Dexcom G6 sensor to those who do not.
Method: We conducted a single-center cross-sectional study in a community hospital with patients who use Dexcom G6 CGM. Data was obtained from Dexcom Clarity for Healthcare Professionals, an online platform for clinicians to review patient trends. The following data was collected for each patient: date of last upload, data sharing status, average glucose, standard deviation, glucose management indicator, glucose range, sensor usage, and coefficient of variation. Two-tailed unpaired Student's t-tests were used to analyze CGM metrics based on data sharing status. Significance was defined as a p-value &lt; 0.05.
Results: 123 (61.19%) out of 201 participants shared data with their provider. Participants with sharing data ‘on’ were significantly younger (49±15 years,) and had increased sensor usage (90±21%) compared to those with sharing off. Participants who shared data also spent more time in range (57±24 %), indicating a higher percentage of readings with glucose levels in a healthy range (70-180 mg/dL). Lastly, average glucose was lower in participants who shared data, although not statistically significant.
Conclusion: The data-sharing feature on Dexcom G6 was utilized more by younger people and was associated with a higher percentage of time in range. Using the data-sharing feature of the Dexcom G6 could lead to clinically meaningful improvement in glycemic control.

Disclosure
B. Sadek: None. M. Hashem: None. M. Seetha: None. R. Raj: None.
1200-P: A1C and Neonatal Outcomes Improved with Real-Time Continuous Glucose Monitoring in Pregnant Women with Preexisting Type 2 Diabetes
Authors: NUNLEE-BLAND GAIL , COFIE PRINCESS-LISA 
Published: June 2023

Preexisting type 2 diabetes (T2D) in pregnancy is increasing and confers significant health risks to the mother and fetus. Continuous glucose monitoring (CGM) systems provide real-time feedback for patients and allow for remote monitoring and therapeutic adjustments. CGM is ideal for pregnancy where insulin requirements and glucose levels are rapidly changing throughout the pregnancy and postpartum. Previous studies have demonstrated improved maternal and neonatal outcomes with the use of CGM in the context of T1D. This study used the Dexcom G6 CGM in pregnant women with preexisting T2D to determine if there is a reduction of A1C and neonatal hypoglycemia compared to preexisting T2D in women using self-monitored blood glucose (SMBG) to manage their diabetes. Women aged 18-40 years with preexisting T2D, using multiple daily insulin injections, and &lt;14 weeks pregnant were enrolled in the study. Participants were randomly assigned to use G6 or SMBG during pregnancy. Mann Whitney U Test, Wilcoxon Signed Rank Test, and Chi-square tests were used to analyze gestational age (GA), A1C at baseline and at 34 weeks, and occurrence of neonatal hypoglycemia. Fourteen participants completed the study. In the G6 group (n=7, median age 28 years, GA 37 weeks), A1c decreased from 7.0% to 6.1% (p=0.045). In the SMBG group (n=7, median age 36 years, GA 38 weeks), A1c decreased from 6.3% to 6.1% (p=NS). There was no significant difference in the GA between the groups. None of the 7 infants in the G6 group had perinatal hypoglycemia compared to 4 out of 7 infants in the SMBG group (p=0.005). This study suggests that use of the DexcomG6 CGM in preexisting T2D during pregnancy can lower A1C and reduce neonatal hypoglycemia.

Disclosure
G.Nunlee-bland: Research Support; Dexcom, Inc. P.Cofie: None.

Funding
Dexcom, Inc. (11S-2019-037)