bluuebunny/crossref_metadata_2025_split huggingface dataset:
1034-P: Access to Continuous Glucose Monitoring Systems in a Primary Care Clinic for Underserved Patients with Type 2 Diabetes—A Pilot Study
Authors: SGROI REBECCA G. , GUMIREDDY SRIKALA , YING TAN WAN , KAPLAN REBECCA , MILAMBWE YOLANDE , ROSOPH LEAH H. , SALAMA DIANA A. , FEHER CYNTHIA R. , RENNERT NANCY J. 
Published: June 2023

B-Disparities in diabetes care are well documented. Continuous Glucose Monitoring Systems (CGMs) have improved patient experience without the need for finger sticks and have been shown to effectively lower Hemoglobin A1c (HbA1c), decrease clinical inertia and decrease the number of hypoglycemic events. Medically underserved and historically marginalized persons are disproportionately affected by diabetes, yet limited data exist on use of CGMs in this population.
M-We report a pilot initiative that brought CGM access (FreeStyle Libre 2) to a Federally Qualified Community Health Center (FQHC). Patients with type 2 diabetes and an HBA1c &gt;8.0% were referred to be enrolled in CGM. Each patient had an initial nurse visit for device placement of FreeStyle Libre (FSL) and several follow up visits to review glycemic trends and make medication changes with a provider. Baseline HBA1c was collected and repeated at the end of the study. Provider and patient surveys were distributed at each visit.
R-Fifty participants were enrolled in the CGM study and had FSL placed. The CGM active time was greater than 50% in 76% of participants and those who continued with CGM had an increase in active time. Initial mean A1C for the entire cohort was 9.64% and average glucose after 2 weeks was 195 mg/dl. Hypoglycemia, especially overnight, reduced overtime. The use of CGM data was associated with clinician-initiated medication changes. Provider surveys revealed an increase in likelihood of medication changes based on glycemic trends and patients reported better understanding of their disease process.
C-This pilot study demonstrates the feasibility of utilizing diabetes technology (FreeStyle Libre 2) in underserved patients at a primary care clinic staffed with internal medicine residents, physicians, and nurse practitioners. CGM is beneficial in under resourced primary care outpatient settings to determine glycemic trends and make appropriate medication recommendations.

Disclosure
R.G.Sgroi: None. S.Gumireddy: None. W.Tan: None. R.Kaplan: None. Y.Milambwe: None. L.H.Rosoph: None. D.A.Salama: None. C.R.Feher: None. N.J.Rennert: None.
1035-P: Area Deprivation Index and Rates of Specialty Care in Monogenic Diabetes Registry Participants
Authors: SON RACHEL G. , NAYLOR ROCHELLE N. , GROUP UNIVERSITY OF CHICAGO MONOGENIC DIABETES REGISTRY STUDY 
Published: June 2023

While diabetes is one of the most common chronic medical conditions, monogenic forms of diabetes represent a rare subtype, and face barriers to timely diagnosis similar to other rare diseases (RD), which are exacerbated by low health literacy (HL) and health care access barriers. The Monogenic Diabetes Registry (MDR) follows more than 1,200 participants with molecular diagnoses of monogenic diabetes who can offer insight into diagnostic barriers and facilitators. Aim: To assess area deprivation index (ADI- a measure of neighborhood disadvantage in the US) as a proxy of HL and health care provider type (specialist versus generalist) as a proxy of health care access in a subset of MDR participants with maturity-onset diabetes of the young (MODY). Methods: Cross-sectional analysis of REDCap data for 79 participants. ADI was constructed for each participant and descriptive statistics were analyzed with RStudio. Kruskal-Wallis was used for comparisons. Results: The median ADI of MDR participants was 26 (less than expected value of 50; p&lt;0.001). Only 20% were from neighborhoods with &gt;50th %ile deprivation. Sixty-two percent were under specialty care for diabetes. The median ADI for those under specialist care was lower than for those under generalist care (23 versus 36), but did not reach statistical significance. There was no difference in median ADI between participants receiving clinical versus research genetic testing or between those referred by providers versus self-referral. Discussion: ADI inversely correlates with HL and SES. MDR participants had ADI percentiles below the national median and a majority were under the care of diabetes specialists compared to ~15% of the general US population living with diabetes. These findings suggest inequity in who finds and enrolls in the Registry, and mimics the broader RD literature. Efforts are needed to better reach populations disproportionately affected by health disparities to ensure equity in monogenic diabetes diagnosis and management.

Disclosure
R.G.Son: None. R.N.Naylor: None. S.Uiversity of chicago monogenic diabetes registry : n/a.

Funding
National Institutes of Health (R01DK104942, P30DK020595, K23DK114564, UL1TR000430)
1039-P: Examining Physician Case Studies on Success of Treatment Initiation in Patients with Type 2 Diabetes
Authors: KHOSROVANEH KATHERINE L. , KIM NOA , RAU JACQUELINE , REISS JACOB , HISAMATSU RINA , GRIAUZDE DINA H. , YOUNG LARREA A. , WEISENSEL JULIAN , AIKENS JAMES E. , DIEZ HEIDI L. , RICHARDSON CAROLINE R. , OSHMAN LAUREN 
Published: June 2023

Introduction: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan that aims to improve the treatment of diabetes through three initiatives-encouraging increased prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diet (LCD), defined as 80-130 total grams of carbohydrates per day, with patients on an SGLT2i instructed to stay &gt;100g among 264 primary care practices. The aim of this study was to evaluate physician experience prescribing LCD through case studies.
Methods: Each physician participating in MCT2D submitted a case study evaluating their experience implementing MCT2D initiatives. Close-ended questions were assessed using a 4-point scale (Yes, Somewhat, Too Early to Tell, No). Open-ended responses on intervention success were analyzed using a multi-step process of data immersion, generating initial codes, and reorganization.
Results: Physicians prescribed a LCD either alone or in combination with CGM and/or SGLT2i/GLP-1RA in 375 of 970 case studies. More than half (51.5%) reported that the intervention(s) achieved the target outcome. Case studies incorporating all three interventions were associated with greater physician satisfaction with results, as compared to diet alone (p&lt;0.01). Five major themes regarding intervention effectiveness were: glycemic control, weight loss, patient motivation, simplification of medications, and combined benefit of multiple interventions. Improvement of blood glucose was reported in 45.9% of LCD alone cases and in 69.1% of cases that involved all three interventions. An increase in patient motivation to achieve improvement in health was most frequently discussed in cases where diet and CGM were combined (67.3%).
Conclusion: LCD may have a synergistic effect with the use of CGM and newer medications. These exploratory findings require confirmation through future investigations.

Disclosure
K.L.Khosrovaneh: None. H.L.Diez: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. N.Kim: None. J.Rau: None. J.Reiss: None. R.Hisamatsu: None. D.H.Griauzde: None. L.A.Young: None. J.Weisensel: None. J.E.Aikens: None.
104-LB: Interim Analysis of a Prospective Study Investigating User Satisfaction and Metabolic Outcome of People with T1D Using an Innovative Modular Micropump System
Authors: DAIN ALEJANDRO , MOCERI SANDRA , DAGENBACH NICOLE , REES CHRISTEN , VULCANO CRISTINA , VOGT GERHARD , ETTER TOBIAS J. 
Published: June 2023

Aims: People with type 1 diabetes (T1D) can administer insulin by multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Despite proven clinical benefits, the uptake of CSII is still low. Thus, this study investigates the change in treatment satisfaction and metabolic outcome of people with T1D switching from MDI to CSII therapy using an innovative modular micropump system.
Methods: A total of 50 CSII-naive adults with T1D from Argentina were enrolled in a multi-center, prospective, single-armed study for the Accu-Chek® Solo micropump system (ACS). Change in diabetes treatment satisfaction after 13 weeks (mean 108, min 83, max 176 days) was assessed by the “Impact and Satisfaction” section of the Diabetes Technology Questionnaire (DTQ) as primary outcome. In addition, changes in the DTQ after 1 year and the HbA1c after 13 weeks and 1 year were measured.
Results: The change score of the “Impact and satisfaction” part of the DTQ was 113.37 ± 16.74 (mean ± SD, p &lt; 0.0001) after 13 weeks and 111.42 ± 14.42 (p &lt; 0.0001) after 1 year (with 90 as non-change score). Based on predefined sub-categories, the following mean DTQ change scores were measured after 13 weeks / 1 year: 3.81 ± 0.61 / 3.79 ± 0.52 for “diabetes distress and burden”, 3.96 ± 0.68 / 3.98 ± 0.60 for “hypoglycemia fear, worry and behavior”, 3.56 ± 0.71 / 3.53 ± 0.52 for “device acceptance and satisfaction” (1 = much worse, 5 = much better). The mean HbA1c decreased from 8.20 % ± 1.34 to 7.92 % ± 1.18 (-0.28 %pt, p = 0.0341) after 13 weeks and 7.87 % ± 1.26 (-0.37 %pt, p = 0.0467) after 1 year. Thereby, one event of severe hypoglycemia and diabetic ketoacidosis (DKA) was reported during 17520 device days.
Conclusion: The switch from MDI to CSII using the ACS led to a significant improvement of subjects’ treatment satisfaction and HbA1c. Effects were already measurable after 13 weeks and continued through 1 year indicating that using the ACS reduces disease burden among people with T1D.

Disclosure
A. Dain: None. S. Moceri: Employee; Roche Diabetes Care. N. Dagenbach: Employee; Roche Diabetes Care. C. Rees: Employee; Roche Diabetes Care. C. Vulcano: Employee; Roche Diabetes Care. G. Vogt: Employee; Roche Diabetes Care. T. J. Etter: None.
104-OR: Identifying Painful Diabetic Neuropathy Subtypes from Resting-State Functional Magnetic Resonance Brain Imaging—A Novel Unsupervised Machine Learning Approach
Authors: SELVARAJAH DINESH , TEH KEVIN , ANANDHANARAYANAN APARNA , SLOAN GORDON P. , TESFAYE SOLOMON 
Published: June 2023

The use of neuroimaging methods to develop biomarkers in painful DN have yielded promising results but have yet to demonstrate clear clinical utility. Our aim was to delineate the biological heterogeneity in painful DN by first defining the functional connectivity subtypes in patients then assessing the clinical significance with respect to prediction of treatment outcomes.
Methods: 82 painful-DN subjects and 36 HV underwent resting-state functional MR imaging (RS-fMRI). Painful-DN subjects were divided into training (n=48) and testing (n=34) datasets. Clinical pain subtypes were identified by analysing, via unsupervised, machine learning (k-means algorithm), the RS-fMRI functional connectivity of key somatosensory/nociceptive brain regions. Patients in our testing dataset were divided into responders (VAS&lt;4; n=23) and non-responders (VAS&gt;4; n=11).
Results: RS-fMRI functional connectivity defines two clinically relevant painful-DN subtypes. The two subtypes were characterised by strong functional connectivity differences in the postcentral (p&lt;0.001, 95%CI=0.22:0.65) and precentral (p=0.002, 95%CI=0.15:0.59) parietal cortex functional connectivity. The interhemispheric connectivity between homologous regions was also notable. RS-fMRI functional connectivity differences in the default mode network (p=0.002;95%CI=-0.35:-0.08) was also identified. The performance of our unsupervised k-means model to predict treatment response was accuracy=0.77, recall=0.83, precision=0.83 and an AUC=0.73.
Conclusion: We have identified neurobiological markers of painful DN subtypes from brain functional connectivity using an unsupervised data-driven approach. The subtype whose functional connectivity differed most from HV failed to respond to neuropathic pain treatment. External validation on a large independent dataset is now required to confirm future clinical utility.

Disclosure
D.Selvarajah: None. K.Teh: None. A.Anandhanarayanan: None. G.P.Sloan: None. S.Tesfaye: Advisory Panel; Bayer Inc., Wörwag Pharma GmbH & Co. KG, Angelini, Speaker's Bureau; Viatris Inc., Nevro Corp., Procter & Gamble, Novo Nordisk, Berlin-Chemie AG.

Funding
National Institute for Health and Care Research Efficacy and Mechanisms Evaluation; European Foundation for the Study of Diabetes
1045-P: Walking the Talk—Improving Use of the T1D Exchange Quality Improvement Portal Using QI Methodology
Authors: MUNGMODE ANN , ELISHA VICTOR , FOGEL NAOMI R. , KIESOW BECKY L. , O'MALLEY GRENYE , CLEMENTS MARK A. , SCOTT MARY L. , INDYK JUSTIN A. , PAT GALLAGHER MARY , GANDHI KAJAL , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI 
Published: June 2023

Background: The T1D Exchange QI Collaborative (T1DX-QI) is a network of over fifty endocrinology centers improving type 1 diabetes (T1D) care using QI. Participating centers have access to the QI Portal, an EMR-based data platform to chart and benchmark T1D outcomes. It is a valuable tool for population health and supports use of data to inform clinical QI projects. We aim to demonstrate the use of QI science to increase centers’ QI Portal use.
Methods: Users are classified into Tiers based on their cumulative monthly QI Portal log-ins (Tier 1 = one month or never; Tier 2 = 2 or 3 months total; Tier 3 = 4 or more months total). This measure describes regularly (monthly) use. For this analysis, new users (user accounts younger than 3 months) are not included to establish true use.
Results: The QI Portal has achieved consistent user growth through this project. As users transition from Tier 1 to Tier 3, the latter tiers expand as users consistently use the QI Portal, with a 12% increase in more experienced Tiers (Tiers 2 and 3; Figure 1a). Figure 1b depicts a ~48% increase in the percentage of Tier 3 users since the project started in July 2022 and annotates four Plan-Do-Study-Act (PDSA) cycles.
Conclusion: The T1DX-QI portal usage improved through QI science. These efforts support T1DX-QI centers in more routine use of actionable data and outcomes benchmarking for clinical process improvement.

Disclosure
A.Mungmode: None. K.Gandhi: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. V.Elisha: None. N.R.Fogel: None. B.L.Kiesow: None. G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. M.L.Scott: None. J.A.Indyk: None. M.Gallagher: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1047-P: Evaluating Discharge Prescription Errors and the Clinical Impacts in Patients with Insulin-Treated Diabetes Mellitus in a Community Hospital
Authors: KESKINKILIC AYSE N. , KORYTKOWSKI MARY T. , MON SANN 
Published: June 2023

Introduction: Transitioning patients with insulin treated diabetes (ITDM) at time of hospital discharge is identified as a source of error in how information for home management is provided that can contribute to significant adverse health outcomes. To address this, we conducted a quality improvement project investigating the safety of current discharge procedures in our hospital and the impact on glycemic control at 3 months and diabetes related readmissions at 3 and 6 months.
Methods: We retrospectively analyzed discharge prescription errors in patients with ITDM in a community hospital between January 2020 and December 2021. Errors were defined as being discharged on the wrong form of insulin (pen vs vial), and/or not being provided appropriate insulin administration devices (i.e., pen needles or syringes). Data was collected by reviewing discharge summaries, discharge medication reconciliations and pharmacy records.
Results: Among 75 patients with ITDM (62 (82%) T2DM, 12 (16%) T1DM, 1 (1%) ketosis-prone DM), errors were noted in 73 (97%) patients. 46 (63%) were discharged on wrong form of insulin and 67 (91%) were discharged without appropriate insulin administration devices. Among those 73 patients, 19 (26%) patients had an increase in HbA1c at 3 months (8.7 vs 10.03, p=0.001); 5 (25%) and 8 (24%) had 30-day and 90-day diabetes-related hospital readmissions, respectively. In 2 patients with appropriate discharge, there were no 30-day or 90-day hospital readmissions.
Conclusion: Prescription errors in patients with ITDM at discharge are common and potentially remediable and lead to hospital readmissions and poor glycemic control. These results demonstrate the need for increased awareness among providers through adoption of standardized discharge insulin order sets in EMR system including the form of insulin, insulin administration devices and supplies as well as for early post-discharge follow up with endocrinology.

Disclosure
A.N.Keskinkilic: None. M.T.Korytkowski: None. S.Mon: None.
105-LB: Safety and Performance of an Advanced Hybrid Closed-Loop (AHCL) Algorithm with Ultra-rapid Lispro (URLi) and Lispro
Authors: POLLOM ROBYN K. , NOSEK LESZEK , VEIT COESTER HANS , ZIJLSTRA ERIC , GHOSH ARITRA , HAIDAR AHMAD , JONES RICHARD , LEOHR JENNIFER , GLEISSNER STEPHANIE E. , DASSAU EYAL , KATZ MICHELLE 
Published: June 2023

Tuning a multi-model predictive control AHCL algorithm to the PK/PD properties of URLi may result in improved performance vs Lispro with no increased safety concerns.
This was a randomized, double-blind, inpatient, 2-period crossover study in 22 adults with T1D on insulin pumps. Each URLi and Lispro treatment period had a 4-day inpatient visit with insulin doses calculated using the tuned AHCL algorithm. To challenge the algorithm, tests included unannounced exercise, 1 hr delayed bolus, underbolus, and overbolus.
Participants (59% male) had mean ±SD age 43.4±13.77 years, T1D duration 25.9±9.61 yrs, and HbA1c 7.6±0.47%. Mean time in range (TIR; 70-180 mg/dL) during the overall inpatient period: URLi 79.4%; Lispro 78.7 % (p=0.80) with a trend towards decreased time &lt;70 mg/dl (1.5 vs 2.4, p=0.08) for URLi. URLi had a significant difference in Level 1 hypoglycemia (30 vs 55 events, p = 0.01) but not Level 2 (4 vs 9 events, p=0.3). TIRs were similar including during meal/challenge periods (Table) with a trend towards greater TIR during the postprandial period and reduced time &lt;70 mg/dl during exercise for URLi. There was greater TIR during overbolus with Lispro. No severe hypoglycemia events occurred.
Results suggest reduced hypoglycemia with URLi vs Lispro with comparable glycemic control. The AHCL algorithm showed promising glycemic performance in a supervised setting when used with URLi or Lispro.

Disclosure
R. Pollom: None. E. Dassau: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Katz: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. L. Nosek: None. H. Coester: None. E. Zijlstra: Other Relationship; Eli Lilly and Company, Speaker's Bureau; Gan & Lee Pharmaceuticals, Novo Nordisk A/S. A. Ghosh: None. A. Haidar: Consultant; Eli Lilly and Company, Other Relationship; Bigfoot Biomedical, Inc., Research Support; Adocia, Dexcom, Inc., Tandem Diabetes Care, Inc. R. Jones: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J. Leohr: None. S. E. Gleissner: None.
1051-P: Provider Diabetes Diagnosis Predicts Prescribing Bias towards Continuous Glucose Monitoring Devices
Authors: SCOTT MARY L. , SCHMITT JESSICA 
Published: June 2023

Methods: The EMR was queried to identify patients with type 1 diabetes identified by ICD 10 codes (E10.xx) seen in the diabetes clinic from January 2019 to Dec 2019. We defined use of a continuous glucose monitor (CGM) as documentation of ICD-10 code Z96.49 (presence of other endocrine implant) or documentation of CGM start in the EMR's health manager, the two ways staff identified CGM use in 2019. Statistical analysis performed using SAS 9.4 (R).
Results: In 2019, we analyzed our baseline CGM prescribing data in preparation for an equity project. We found that pediatric providers (MD and CRNP) who carried a diagnosis of Type 1 Diabetes were prescribing these devices to patients at a higher rate (25.41%) than those without diabetes (14.72%) at UAB. If your diabetes provider had diabetes: your odds of having a CGM prescribed were 1.7 (CI: 1.4-2.1) times higher than if your provider did not have diabetes (p&lt;0.0001). At the time, 6 of our 22 providers had T1D. Discussion: One may postulate that familiarity with the disease and its impact on everyday life as well as general experience with the use of these devices were major contributors to the prescribing bias. We discussed this data with our division and distributed it to providers via email in an effort to improve overall rates of CGM use for our patients. Hands on tutorials were also done with our pump nurses to help providers better understand the technology.

Disclosure
M.L.Scott: None. J.Schmitt: None.
1052-P: Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: O'MALLEY GRENYE , OGYAADU SELASSIE J. , LEVISTER CAMILLA , RIOLES NICOLE , HARDISON HOLLY , ROBERTS ALISSA J. , ACCACHA SIHAM , GUTTMANN-BAUMAN INES , VENDRAME FRANCESCO , BASINA MARINA , FALLURIN RESHMITHA , LEVY CAROL J. , COLLABORATIVE T1DX-QI 
Published: June 2023

Background: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception HbA1C is not uncommon and increases maternal and fetal risks. Due to limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1DX-QI survey.
Methods: The annual T1DX-QI survey was conducted August-September 2022 with a site response rate of 94% of 50 sites: 33 pediatric (66%), 17 adult (34%). Respondents answered questions relating to clinic resources and practices. Response data was cleaned and summarized.
Results: Most sites report discussing contraception (74%) and pregnancy planning (72%) once a year or more. Of pediatric sites, 42% report always asking about menstruation history compared to 6% of adult sites. Only 12% of adult and 6% of pediatric sites have a formal preconception counseling protocol. Only 12% of adult and 9% of pediatric sites estimated that &gt;80% of their patients of childbearing potential were using contraception, and all sites estimated that &lt;60% had a HbA1C under 7%.
Conclusions: Though most sites report discussing contraception and pregnancy planning, estimated rates of formal counseling programs, contraception use and attaining goal HbA1C remain low. QI efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes.

Disclosure
G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Basina: None. R.Fallurin: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. T1dx-qi collaborative: n/a. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. N.Rioles: None. H.Hardison: None. A.J.Roberts: None. S.Accacha: None. I.Guttmann-bauman: None. F.Vendrame: Consultant; Eli Lilly and Company.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust