bluuebunny/crossref_metadata_2025_split huggingface dataset:
1065-P: Utilizing a Novel Telemedicine Clinic for Managing Patients with Type 2 Diabetes
Authors: SOTOMAYOR FIORELLA , GOTHONG CHIKARA , HERNANDEZ REYNIER , ASH GARRETT I. , SCOTT WILLIAM H. , PINAULT LILLIAN , GOMEZ-PERALTA FERNANDO , SINGH LAKSHMI G. , SORKIN JOHN D. , (ELIAS) SPANAKIS ILIAS 
Published: June 2023

Objective: To examine whether a new Diabetes Telemedicine (DT) clinic can lead to improved glycemic control compared to standard of care (SoC).
Design: Pilot RCT of patients with type 2 diabetes (T2D) randomized to DT clinic or SoC. DT intervention comprised of continuous glucose monitoring, “connected” insulin pens/caps, telecommunication systems (i.e. video conferencing, online messaging and telephone) and promoting physical activity (PA) by providing brief counseling and exercise physiologist consultation. SoC was managed using point of care glucometer, traditional insulin pens, in-person visits and provider counseling on PA. Primary outcome was change in HbA1c. Secondary outcomes were time in range (TIR) 70-180 mg/dl, time above range (TAR)&gt;180 mg/dl and time below range (TBR)&lt; 70 mg/dl. Patients also completed senior fitness test, assessed by Hedge’s g effect size.
Results: A total of 18 patients (17 male) have been recruited, 11 patients were black and 7 white, all non-Hispanic. 14 completed 90 days in the trial. Non statistically significant differences were seen. DT had an 1.6% (mean SE 0.60) HbA1c reduction vs 0.4 (0.69) in SoC [difference -1.2% (0.92), p=0.19]. TIR 70-180 mg/dl increased 8.5% (13.6) (DT) vs 4.4% (15.8) (SoC) [difference +4.1% (20.8), p=0.84]. DT had a decrease in TAR&gt;180 mg/dl of 8.7% (13.7) compared to 4.4% (15.8) in SoC [difference -4.3% (21.0), p=0.85] and TBR&lt;70 mg/dl 0.16% (0.60) (DT) vs 0.13% (0.69) (SoC) [difference of 0.03% (0.92), p=0.97]. DT had improved aerobic capacity (6-minute walk test 402±62 to 418±69m, g=0.53) and strength in the lower- (30-second chair stand 9.0±2.6 to 11.5±2.6 stands, g=0.91) and upper-body (30-second weighted arm curl 17.4±5.3 to 21.0±6.3 curls, g=0.72). SoC had no meaningful changes in aerobic capacity or lower/upper-body strength (g=-0.05 to 0.18).
Conclusion: Patients with T2D managed with DT had a non-statistically significant improvement of glucose control and improved physical fitness performance compared to patients in SoC.

Disclosure
F.Sotomayor: None. I.Spanakis: Research Support; Dexcom, Inc. C.Gothong: None. R.Hernandez: None. G.I.Ash: None. W.H.Scott: None. L.Pinault: None. F.Gomez-peralta: Advisory Panel; Abbott Diabetes, Insulcloud S.L., Speaker's Bureau; A. Menarini Diagnostics, Boehringer Ingelheim and Eli Lilly Alliance, Lilly Diabetes, Novartis, Novo Nordisk. L.G.Singh: None. J.D.Sorkin: None.
1066-P: Gaps in Guideline-Indicated Prescribing of GLP1RA/SGLT2i in Patients with T2DM and Cardiorenal Disease according to ADA Standards of Care
Authors: LINGVAY ILDIKO , BOWEN MICHAEL E. , MAI CHRISTINE , MARBLE KELSEA , PAK JONATHAN , BASIT MUJEEB A. 
Published: June 2023

We evaluated the treatment gap in prescribing guideline-directed therapies in patients with T2DM and cardiorenal disease using EHR data from a large academic medical center. Eligible patients had T2DM and an outpatient encounter after January 1, 2019 in either endocrinology, cardiology, nephrology, or primary care. Eligibility subgroups were defined using ADA 2022 Standards of Care: ASCVD (N=1,962) - ‘SGLT2i or GLP1RA’; HFrEF or HFpEF or CKD stage 3 (N=5,537) - ‘SGLT2i Only’; ASCVD and HF or CKD stage 3 (N=1,773) - ‘SGLT2i primary’; CKD stage 4/5 (N=1,547) - ‘GLP1RA Only’. We extracted prescriptions for any GLP1RA or SGLT2i since 2006 to characterize ever prescribed and currently prescribed. The treatment gap for patients (N=10,819) ever prescribed ranged from 45.5% for those who should have been prescribed either an SGLT2i or GLP1RA to 71.9% for those eligible for GLP1RA only (Panel A). The treatment gap was &gt;20% higher for currently prescribed across all subgroups, ranging from 73.5% to 92.1% across the subgroups (Panel B). Large treatment gaps in prescribing of guideline-directed cardiorenal protective agents in high-risk patients with type 2 diabetes exist. While all subgroups were sub-optimally treated, those with CKD stage 4/5 had the largest gap. These findings will inform multi-faceted interventions geared to improve the care of such high-risk patients.

Disclosure
I.Lingvay: Advisory Panel; Novo Nordisk A/S, Lilly Diabetes, Boehringer-Ingelheim, Sanofi, Consultant; Carmot Therapeutics, Inc., Merck Sharp & Dohme Corp., Janssen Scientific Affairs, LLC, Pfizer Inc., Intercept, Intarcia, Valeritas, TargetRWE, Shionogi, Zealand Pharma, Structure, Bayer, Research Support; Novo Nordisk A/S, Boehringer-Ingelheim. M.E.Bowen: Research Support; Boehringer-Ingelheim. C.Mai: None. K.Marble: None. J.Pak: None. M.A.Basit: Research Support; Boehringer Ingelheim Inc., Verily Life Sciences.

Funding
Boehringer Ingelheim
1071-P: Impact of the GluCare Health Model of Care in Diabetics with NAFLD as Measured Using Shear Wave Ultrasound—A Three-Month Outcomes Study
Authors: CACCELLI MILENA , SAID YOUSEF , ALEABOVA SOFIA , PALSKY CAROLYN , HASHEMI ALI , ALMARZOOQI IHSAN 
Published: June 2023

Introduction: Type 2 diabetes (T2D) and obesity are risk factors for nonalcoholic fatty liver disease (NAFLD). Newer and non-invasive imaging techniques of transient elastography and shear wave elastography provide the opportunity to measure liver stiffness (1). Shear Wave Ultrasound (SWU) is a non-invasive imaging technique that has been increasingly used in the management of patients with diabetes (2). Continuous monitoring and engagement approach, such as the one utilized by GluCare.health, has been proven to effectively improve metabolic conditions associated with diabetes in trials (3). This integrated care model uses data-driven personalization of interventions to increase patient's access and engagement with health provider to surpass outcomes of traditional care methods (4). Methods: Retrospective review of medical records of 47 patients, evaluated at GluCare (Dubai, UAE), from 18 to 70 years old with T2D and body mass index (BMI) over 25. All the patients were under anti diabetic drugs. BMI and data from a SWU model FT100 were collected and compared between the first visit and after 3 months GluCare.health intervention. Correlations between 3-month changes in BMI, liver ultrasound attenuation parameter (UAP) and stiffness were explored using statistical analysis. Results: Average changes in BMI over the first three months of treatment were statistically significant (p&lt;0.001). The average UAP decrease was significant at 10 % level (p=0.086) and every unit decreased in BMI was associated with 7.23 dB/m reduction in UAP (p&lt;0.05). The average change in liver stiffness was not statistically significant (p&gt;0.1). The analysis also found a significant correlation between changes in BMI and stiffness at the 5% significance level, with a moderately strong correlation (r=0.38). Conclusion: The study suggests that the GluCare.Health intervention may be effective in reducing BMI in patients with diabetes, and it may also have some effect on NAFLD.

Disclosure
M. Caccelli: None. Y. Said: None. S. Aleabova: None. C. Palsky: None. A. Hashemi: None. I. Almarzooqi: None.
1074-P: Multicenter Quality Improvement Project—Increasing Social Determinants of Health (SDOH) Screening across Six Diabetes Centers in the United States
Authors: ODUGBESAN ORI , WRIGHT TREVON , YAYAH JONES NANA-HAWA , PAT GALLAGHER MARY , ILKOWITZ JENIECE , DEI-TUTU SELORM A. , DEWIT EMILY L. , IZQUIERDO ROBERTO , DESIMONE MARISA , HESS EMILIE J. , RIOLES NICOLE , EBEKOZIEN OSAGIE 
Published: June 2023

Background: Social Determinants of Health (SDOH) are strongly associated with outcomes for patients with diabetes. Incorporating widespread clinic SDOH screening programs is challenging. We aim to demonstrate the use of Quality Improvement (QI) interventions in expanding SDOH screening practices across 5 pediatric and 1 adult diabetes center in the T1D Exchange Improvement Collaborative (T1DX-QI).
Method: The centers applied QI principles to design iterative plan-do-study-act (PDSA) cycles to develop and expand interventions to improve screening rates. The interventions include staff training, creating a social risk index, using EHR patient-facing portal, partnership with community organizations, referral to clinic, and community resources. The centers shared monthly aggregate data with the coordinating center. Statistical Process Control charts were created and analyzed for significant shifts.
Result: All centers successfully implemented SDOH screening, and improvement ranged from 41% to 68%. Overall screening increased from baseline by 56% in 24 months.

Disclosure
O.Odugbesan: None. E.J.Hess: None. N.Rioles: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T.Wright: None. N.Yayah jones: Consultant; Medtronic. M.Gallagher: None. J.Ilkowitz: None. S.A.Dei-tutu: None. E.L.Dewit: None. R.Izquierdo: None. M.Desimone: None.
1079-P: Implementation of Diabetes E-consult Service Eliminates Barriers to Specialty Expertise
Authors: MITRI JOANNA , CIBOTTI GRANOF NANCY , HERZLINGER BOTEIN SUSAN , MEHTA SANJEEV N. 
Published: June 2023

Background: Electronic physician consultations (e-consults) with endocrinologists represent a safe and effective alternative to many referrals for diabetes care. E-consults represent an important, but underutilized, modality to address the shortage of endocrinologists. Aim: To implement a scalable diabetes e-consult service for a large network of primary care practices in the United States.
Methods: Primary care providers (PCPs) from 40 practices used a designated email to consult endocrinologists based at a diabetes center. Endocrinologists also had remote access to the electronic health records used by consulting PCPs. E-consults provided individualized recommendations for management, evaluation, targeted education or referral to the diabetes center in addition to targeted education. Provider experience surveys were completed online by PCPs and specialists after each consult.
Results: Between Feb-Sep 2022, 55 e-consults were completed; 86% within 2 business days. The service was positively reviewed by PCPs; 96% reported the e-consult was helpful, 86% reporting more confidence in diabetes care; and 64% reported the e-consult saved them time. A majority of e-consults (PCP, 79%; endocrinologist, 77%) required &lt;10 mins to complete. Specialists made no recommendations for a patient referral to the diabetes center.
Conclusions: A diabetes e-consult service can be rapidly implemented with minimal administrative support. It has the potential to bring greater diabetes expertise to primary care practices and save the PCPs time while avoiding unnecessary referrals to endocrinology practices. Future analyses will address the clinical impact of the e-consult service.

Disclosure
J.Mitri: Other Relationship; Novo Nordisk, Research Support; Kowa Company, Ltd. N.Cibotti granof: None. S.Herzlinger botein: None. S.N.Mehta: None.
11-OR: Fetal Renal Hypoxia Response to Maternal Overnutrition
Authors: TAKIYAMA TAKAO , TAKIYAMA YURI , BESSHO RYOICHI , KITSUNAI HIROYA , TAKIYAMA YUMI 
Published: June 2023

Currently, 50% of women of reproductive age are obese, and one in seven live births is affected by hyperglycemia in mothers with gestational diabetes. To examine the impact of intrauterine overnutrition on the kidneys of the offspring, we generated a novel mouse model by feeding female C57BL6J mice with either control diet (CD) or high-fat diet (HFD, 60% Lipid) during gestation and feeding the male offspring with CD after weaning, allocated to two groups of male offspring, CD and HFD. CD and HFD had similar body weights, blood pressure and urinary albumin levels, but lower serum creatinine levels in HFD (CD; n=17, HFD; n=11, p&lt;0.001), which might be due to renal hyperfiltration. Histologically, HFD presented renal tubular vacuolation at 4 weeks of age and glomerulosclerosis and intrarenal arteriosclerotic lesions at 15 weeks of age. Moreover, perirenal beige fat phenotype was lost in HFD at 4 week of age, presenting white adipose cells unlike the small adipose cells in CD, suggesting that maternal overnutrition induced systemic metabolic abnormality in offspring. Synchrotron phase-contrast micro-CT showed that HFD at 14.5 dpc showed asignificant increase in total kidney volume (CD; n=4, HFD; n=6, p&lt;0.001). On the contrary, no significant difference in renal artery diameter was observed (p=0.52). Blood flow is determined by the supplying vascular diameter due to Murrays’ minimum energy hypothesis. Therefore, we studied the ratio of blood flow as the 3rd power of the diameter of fetal renal artery per renal volume, indicating no significant difference between CD and HFD (p=0.42). Despite of preserved blood supply, the protein expression of HIF-1α, the key hypoxic transcription factor, was higher in HFD than that in CD, suggesting increased oxygen demand due to maternal overnutrition-induced renal metabolism. Maternal overnutrition induces supply-demand mismatch leading to renal hypoxia in the fetus, which persists into adulthood in the offspring, which might promote susceptibility to diabetic nephropathy.

Disclosure
T.Takiyama: None. Y.Takiyama: None. R.Bessho: None. H.Kitsunai: None. Y.Takiyama: Research Support; Boehringer Ingelheim Japan, Inc., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Abbott Japan Co., Ltd., Roche Diabetes Care, MSD Life Science Foundation, Japan Society for the Promotion of Science, Teijin Pharma Limited, Kyowa Kirin Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Eli Lilly Japan K.K.
111-LB: Smart Insulin Pen Correction Doses Delivered within Three Hours of a Previous Insulin Dose Improve Glycemia
Authors: HEUNGYONG IM GLEN , SMITH MADISON , MACLEOD JANICE , VIGERSKY ROBERT A. 
Published: June 2023

Background: An important feature of the InPen™ Smart Insulin Pen (SIP) is its ability to track active insulin, enabling opportunities to safely calculate correction doses any time after a bolus. This study investigated the frequency of users delivering correction doses and its impact on glycemia when delivered within 3 hours of a previous dose in both adult and pediatric InPen users with T1D or T2D.
Methods: A retrospective cohort analysis was performed using deidentified sensor glucose (SG) data from N=857 individuals with sufficient SG data (at least 70% of SG data each day), ≥3 boluses per day, and ≥1 correction dose per day on average in the 60-to-90th day period after starting InPen-use Jan 2022-Dec 2022. Each user's proportion of corrections delivered within 3 hours of a previous dose (notated PC3) was calculated, and users were split into two groups based on the median of PC3. Glycemic outcomes including percentage TIR, 70-180 mg/dL), TBR, &lt;70 mg/dL and TAR, &gt;180 mg/dL and average SG were determined from the latest 14 days of device use. Comparisons between groups were conducted using t-tests (Mann Whitney U test when data were non-normal) at ≤0.05. Duration of insulin action (DIA) distributions were also described.
Results: The median PC3 of the overall group was 32.5% (range 0-100%). The upper half of the group (≥32.5%) showed significantly higher TIR (57.8% vs 50.5%, p&lt;0.0001), lower TAR (40.2% vs 47.8%, p&lt;0.0001), and lower SG (175.7 mg/dL vs 190.8 mg/dL, p&lt;0.0001), compared with the lower half (&lt;32.5%). There was no significant change in TBR (1.9% vs 1.8%, p=0.77). Of the 857 users, 55.2% had DIA &gt;3 hours (3.6±0.84; range 2-8). The average DIA of the upper half and the lower half were 3.4±0.8 hours and 3.8±0.8 hours, respectively (NS).
Conclusion: InPen™ SIP users who delivered at least 1 correction dose a day within 3 hours of a previous dose achieved overall higher TIR without an increase in TBR, when compared to those who administered correction insulin &gt;3 hours after their previous dose.

Disclosure
G. Im: Employee; Medtronic. M. Smith: Employee; Medtronic. J. Macleod: Employee; Medtronic. R. A. Vigersky: Employee; Medtronic.
1114-P: Patient-Reported Outcomes (PROs) during a Study of Feasibility of Continuous Glucose Monitor (CGM) Use in Publicly Insured Youth with Type 2 Diabetes (T2D)
Authors: TANENBAUM MOLLY L. , HANES SARAH , HOOD KOREY K. , MAAHS DAVID M. , SHAH SEJAL 
Published: June 2023

Publicly insured youth of minority and lower SES backgrounds are disproportionately impacted by the burden of T2D. The role of CGM use in this population is understudied, and patient-reported outcomes are important to assess while examining feasibility and acceptability of CGM adoption. This study assessed PROs during a feasibility study of CGM use. Youth were provided or prescribed flash CGM using established clinic workflows; PROs were collected from youth and parents at baseline, 3 and 12-month visits using age-appropriate measures (PAID-diabetes distress; PedsQL-health-related quality of life; PROMIS Global Health; DTA-diabetes technology attitudes). Baseline and 3-month data are presented. Participants at baseline included 30 youth with T2D (M age 15.1 years; 53% female; 90% Hispanic; 60% Spanish-speaking; 87% using insulin; M HbA1C 10.2%); 19 parents completed PROs at baseline. Parents and youth had moderate-to-positive attitudes about diabetes technology. Youth endorsed fair levels of global health; and youth and parents endorsed fair general and diabetes-related health-related quality of life. These PROs point to potential areas for future study to understand sources of lower self-reported health and quality of life, and to develop tailored interventions to address PROs while supporting CGM use in publicly-insured youth with T2D.

Disclosure
M.L.Tanenbaum: None. S.Hanes: None. K.K.Hood: Consultant; Cecelia Health. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. S.Shah: Research Support; Boehringer-Ingelheim, Takeda Pharmaceutical Co., Ltd.
1132-P: It Takes 6!—Recruiting Marginalized Youth with T1D for Shared Medical Appointments (SMA) Pilot Study
Authors: GRUNDMAN JODY , MAJIDI SHIDEH , PERKINS AMANDA G. , STREISAND RANDI , MONAGHAN MAUREEN , MARKS BRYNN E. 
Published: June 2023

Introduction: Minority youth are underrepresented in diabetes technology trials. An ongoing pilot study is recruiting 20 publicly insured, insulin pump naive youth ages 8-12 with T1D who identify as NHB or Latinx with recent HbA1c &gt;8% to participate in a study using SMAs to improve T1D self-management and sustained CGM use. We aimed to identify the most successful recruitment strategies.
Methods: Potentially eligible youth are identified through weekly review of diabetes appointments. Families are then contacted in-person at a clinic visit, by phone, or text-message. We reviewed the number of in-person, phone, and text-message attempts for all eligible participants, as well as the number of youth who enrolled, refused, or who have not yet been successfully contacted.
Results:79 youth were identified as potentially eligible. 56% (n=44, 16±13 contact attempts) have been successfully contacted; 18% (n=14, 6±4 contact attempts) enrolled. 64% (n=9/14) of enrolled and 18% (n=12/65) of non-enrolled were approached at a clinic visit, 14% (n=2/14) of enrolled and 40% (n=26/65) of non-enrolled via phone, and 50% (n=7/14) of enrolled and 46% (n=30/65) of non-enrolled via text-message (p&lt;0.001). 38% (n=6/16) of those who scheduled an enrollment visit after being contacted by phone/text attended the visit versus 63% (n=10/16) contacted at a clinic visit (p&lt;0.001). 38% (n=30, 10±9 contact attempts) refused to participate; 27% (n=9) did not want to travel to the study site, 17% (n=5) refused CGM, and 53% (n=16) declined research participation. 46% (n=35, 12±5 contact attempts) have not yet been successfully contacted.
Conclusions: Historically marginalized youth enrolling in this SMA study required an average of 6 contact attempts for study participation. Purposeful in-person recruitment strategies, being mindful of the low rates of technology use among this community and mistrust in the healthcare system, is needed to promote diversity and inclusion in T1D research.

Disclosure
J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Majidi: None. A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. R.Streisand: None. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic.

Funding
American Diabetes Association (7-21-PDFHD-09 to J.G.)
1137-P: Improvements in Diabetes-Related Quality of Life (DRQL) and Emotional Distress with Hybrid Closed-Loop (HCL) Technology in Marginalized Families with Suboptimally Controlled Type 1 Diabetes (T1D)
Authors: PERKINS AMANDA G. , GRUNDMAN JODY , MEIGHAN SEEMA , MONAGHAN MAUREEN , STREISAND RANDI , MARKS BRYNN E. 
Published: June 2023

Background: Prior HCL studies enrolling participants with well-controlled T1D and limited financial, racial-ethnic, and socioeconomic diversity have shown limited success in improving patient-reported outcomes (PROs). We evaluated changes in PROs among marginalized youth with T1D and their parents after 6 months of Tandem t:slim X2 insulin pump with Control-IQ technology use.
Methods: This non-randomized 6-month pilot study enrolled 15 publicly insured, non-Hispanic Black (NHB) youth with T1D and hemoglobin A1c (HbA1c) ≥10% (Mage 14.6 ± 3.7 yrs, MT1Dduration 8.5 ± 4.8 yrs, MA1c11.9±1.4%). Youth and parent PROs at baseline and 6-months were compared using paired t-tests. The following constructs were assessed using validated PROs: DRQL using T1D and Life (T1DAL), emotional distress using Problem Areas in Diabetes (PAID), positive expectancy of technology using INSPIRE, and self-management behaviors using Diabetes Management Questionnaire (DMQ).
Results: Thirteen participants completed the study. HbA1c decreased from 11.7±1.3% to 9.6±1.6% over 6 months (p=0.001). TIDAL scores increased among parents and youth (p-T1DAL +7.1 to 70±13, p=0.01; y-T1DAL +8 to 69±12, p=0.03). PAID scores decreased among parents and youth (p-PAID -25 to 43±30, p=0.01; y-PAID -19.4 to 23±19, p=0.02). There were no changes in parent or child INSPIRE (p=0.23, p=0.88) or DMQ scores (p=0.44, p=0.16).
Conclusions: Six months of Tandem t:slim X2 insulin pump with Control-IQ technology in marginalized youth with T1D improved HbA1c, DRQL, and diabetes-related distress among parents and youth despite no change in diabetes self-management behaviors or decrease in positive expectancy of HCL. Including diverse populations in T1D research and supporting equal access to HCL technology for all people with T1D may demonstrate psychosocial benefits with no additional burden for youth and their parents.

Disclosure
A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic.

Funding
Tandem Diabetes Care, Inc. (TDC20210226); National Institutes of Health (K23DK129827); Dexcom, Inc.