bluuebunny/crossref_metadata_2025_split huggingface dataset:
1043-P: Uncovering Root Causes Contributing to Persistent Gaps in Glycemic Control and Effective Weight Management in Patients with Type 2 Diabetes and Obesity
Authors: ZYBOROWICZ EMILY , HEGGEN CHERILYN , RODRIGUEZ MELISSA A. , CARTER JEFFREY D. , FRIAS JUAN P. 
Published: June 2023

This QI initiative in 2 large US-based community health systems assessed root causes hindering A1C control and weight management in people with T2D and obesity through health care provider (HCP) surveys (n = 29), baseline EMR audits (n = 100), team-based audit-feedback (AF) sessions, and patient-provider collaborative education sessions. Lack of treatment access and delayed treatment intensification were identified as factors contributing to inadequate A1C control. In the survey, 48% of HCPs reported providing treatment access support as a top barrier. Missed opportunities to escalate care were revealed through gaps in key care measures for patients not on target to achieve their A1C goal, including reevaluating current diabetes medication (77% HCPs reported routinely performing) and referring patients to a diabetes care and education specialist (49%). Following the AF intervention, the percentage of HCPs who plan to consider therapy escalation within 3 months increased from 38% to 80%. Following collaborative education, the percentage of patients who reported understanding the importance of achieving their A1C goal increased from 47% to 71% and 81% committed to taking a more active role in their diabetes management and self-care. Gaps were uncovered in weight management counseling, support, and shared decision-making (SDM). Asking patients about treatment goals was documented in 57% of charts. Reporting weight loss goal discussion every 3 months were 60% of HCPs and 33% of patients. Following AF sessions, the percentage of HCPs who plan to prioritize SDM as a top 2 goal increased from 21% to 53% and HCPs committed to updating patient materials to support more productive conversations about individual health goals. Key factors hindering attainment of A1C and weight management goals revealed through this study include gaps in treatment access, treatment intensification, SDM, and weight management counseling, support.

Disclosure
E.Zyborowicz: None. C.Heggen: None. M.A.Rodriguez: None. J.D.Carter: None. J.P.Frias: Advisory Panel; Becton, Dickinson and Company, Pfizer Inc., Sanofi, Consultant; Akero Therapeutics, Inc., 89bio, Inc., Aimmune, Boehringer Ingelheim Inc., Eli Lilly and Company, Carmot Therapeutics, Inc., Echosens, Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Employee; Ionis Pharmaceuticals, Research Support; Akero Therapeutics, Inc., 89bio, Inc., Altimmune, Axcella Health Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Intercept Pharmaceuticals, Inc., Carmot Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Oramed Pharmaceuticals, Novartis, Pfizer Inc., Sanofi, Speaker's Bureau; Eli Lilly and Company, Sanofi.

Funding
Eli Lilly and Company (A-31209)
1147-P: Disparities in Insulin Pump and CGM Use in Youth with Type 1 Diabetes
Authors: CRAIN EMILY R. , RAMPHUL RYAN , BUTLER ASHLEY , HUANG XIAOFAN C. , MINARD CHARLES G. , REDONDO MARIA J. , DESALVO DANIEL 
Published: June 2023

Youth with T1D of underrepresented race/ethnicity (URE) have lower pump/CGM use, higher A1c, and greater DKA risk; however, the correlation of social determinants of health (SDoH) and neighborhood-level factors to pump/CGM use and clinical outcomes are unknown. In this study, multivariable models were used to evaluate the association of race/ethnicity, SDoH factors, and area deprivation index (ADI, range 1-10 with 10 being most deprived neighborhood) with pump/CGM use, A1c, and DKA in 1,461 T1D youth (50% F, age 12.8 ± 3.6 yrs, A1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen over a 1-yr period. Youth were less likely to use a pump if they were Black or Hispanic, had Medicaid or were uninsured, received government assistance (i.e., SSI, Temporary Assistance for Needy Families (TANF), WIC, SNAP), or lived in a higher ADI neighborhood. Youth were less likely to use CGM if they were Black or Hispanic, had Medicaid or were uninsured, or lived in a higher ADI neighborhood. Youth had higher DKA risk in the past year if they lived in a higher ADI neighborhood or had government assistance; however, pump and CGM use were associated with lower DKA risk (Figure 1). For every 1 unit increase in ADI, A1c increased by 0.09 (95% CI: 0.05, 0.13). A1c was 0.62 lower (95% CI: -0.82, -0.42) in pump users vs. not and 0.78 lower (95% CI: -0.99, -0.56) in CGM users vs. not. Advocacy efforts and QI projects promoting technology use in T1D youth of URE and lower SES may improve A1c and decrease risk of DKA.

Disclosure
E.R.Crain: None. R.Ramphul: None. A.Butler: None. X.C.Huang: None. C.G.Minard: None. M.J.Redondo: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation.
1151-P: Predicting Adverse Events in Patients with DKA or HHS
Authors: YOUSIF MAHA , ADHIKARI SOUMYA , WHITE PERRIN C. 
Published: June 2023

Background: Management of diabetic ketoacidosis (DKA) in pediatric patients is well established, but optimal management for hyperglycemic hyperosmolar state (HHS) and mixed DKA/HHS is uncertain.
Aims: Develop a model to identify patients at increased risk of adverse events and identify management differences associated with adverse outcomes.
Methods: Retrospective chart review of 5,346 admissions from 3,104 unique patients with type 1 diabetes (T1D) or T2D at a large children’s hospital from 1/1/2010-7/1/2022 requiring IV insulin to manage DKA (pH &lt;7.3, glucose &gt; 200 mg/dl) and/or HHS (glucose &gt;600 mg/dl). An ICU stay &gt;48 hours (h) was a surrogate for severe adverse events. Risk of death or ICU stay &gt;48 h (high risk [HR] group) was modeled using generalized estimating equations on a training dataset of 3,979 admissions from 2010-2019. Admissions 2020-2022 were the test dataset. Discrimination was assessed with receiver-operator-characteristic (ROC) curves. Using this predictive model, we selected a control (C) group at similar risk of adverse events to identify outcome-related management differences.
Results: There were 810 ICU admissions; 90 were &gt;48 h. There were 8 diabetes-related deaths, 5 in 2020-2022. In the multivariate model, risk factors for severe adverse events included initial pH, glucose, absolute value of the deviation of glucose-corrected serum Na from 140, and a diagnosis of T2D. Discrimination was excellent; area under the ROC curve was 0.938 and 0.964 in the training and test datasets respectively. HR and C groups were similar for pH, glucose and sodium on admission, but altered mental status was more frequent in the HR group. Glucose and sodium corrected more slowly in the HR patients.
Conclusions: The prediction model accurately identified patients at increased risk of prolonged ICU stay or death. Rates of death and prolonged ICU stay increased during the Covid pandemic, correlated with more severe clinical presentation. Slower correction of metabolic abnormalities was associated with prolonged ICU stay.

Disclosure
M.Yousif: None. S.Adhikari: None. P.C.White: Consultant; Provention Bio, Inc.
1153-P: Postprandial Increase in Inflammation Is Not Affected by Glycemic Index in Children and Adolescent with Type 1 Diabetes
Authors: DAMILANO CECILIA P. , HOFFMAN ROBERT P. 
Published: June 2023

Patients with type 1 diabetes (T1D) have lower life expectancy than individuals without diabetes. Most of this reduction is due to cardiovascular disease, the major cause of death in patients with T1D. Post-prandial inflammation after high glycemic index (GI) meals may cause cardiovascular disease in adults. Differences in postprandial inflammatory responses between high and low GI foods have not been studied in children and adolescents with T1D. Twelve non-obese children and adolescents, 10-18 years old, with type 1 diabetes were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. Baseline blood sample were taken (plasma glucose, triglyceride, IL-6, CRP, and TNF-α), rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) after an overnight fast. Visits 1 and 2 were identical except for the GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Glucose response were significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, repeated measures ANOVA, p&lt;0.001), as expected. TNF-α (High 0 min: 0.86±0.08, 30 min: 1.83±0.08; Low 0 min: 0.82±0.06, 30 min 1.81±0.06 ng/ml) and IL-6 (High 0 min: 0.38±0.06, 120 min: 0.68±0.25; Low 0 min: 0.49±0.11, 120 min 0.71±0.14 ng/ml) increased following both high and low GI meals (p &lt;0.001 and p=0.008, respectively), but there were no statistically significant differences between the two groups. CRP did not increase with either type of meal. Children and adolescent with T1D have post prandial inflammation, as indicated by increased TNFα and IL-6 levels. The post-prandial inflammation is not different between high and low GI meals in spite of higher glucose levels with the former.

Disclosure
C.P.Damilano: None. R.P.Hoffman: None.

Funding
Abigail Wexner Research Institute; University of Ohio
1170-P: Barriers to Transition and Proposed Transition Methods from Pediatric to Adult Care—A Qualitative Study of Patients with Type 1 Diabetes in Gaborone, Botswana
Authors: REYNOLDS DANA , CRAVEN MEGHAN E. , AHMED DERARTU , BROOKS MERRIAN , JOEL DIPESALEMA , LOWENTHAL ELIZABETH D. 
Published: June 2023

Objective: The time of transition from pediatric to adult diabetes care is a high-risk period when many youth with Type 1 diabetes (T1D) have worsening glycemic control. The aim of this study was to conduct research to inform transition support for youth with T1D in low resource settings.
Methods: In-depth interviews with patients between 16-25 years old diagnosed with T1D were conducted in Botswana. The interviews discussed diabetes care and support systems, perceived or experienced barriers and facilitators to transition, readiness, and four proposed transition support systems (orientation, peer support, text messaging, and designated clinic days). Interviews were coded independently by three investigators in NVivo and analyzed using the Consolidated Framework for Implementation Research.
Results: Twenty-three patient interviews were conducted. The mean age of interviewed patients was 20.8 years (±2.88). Eight had transitioned to adult care. Among the 21 patients with a recent hemoglobin A1c, the mean was 10.4% (IQR 3.35). Patient reported inner setting factors impacting readiness included awareness and education surrounding transition, mental health resources, and relationships with providers. Outer setting themes impacting transition included acceptance and awareness of T1D in Botswana and cost of diabetes care. Of the four transition support strategies proposed, clinic orientation was universally supported. A designated clinic day was least supported due to a need for more flexibility.
Conclusions: As the number of patients with T1D increases in Botswana, a systematic approach to support the transition from pediatric to adult care that is culturally relevant and addresses the needs of transitioning adolescents to optimize health is needed. Our study highlighted youth identified barriers and facilitators to successful transition and suggested the most acceptable low-cost support strategies.

Disclosure
D.Reynolds: None. M.E.Craven: None. D.Ahmed: None. M.Brooks: None. D.Joel: None. E.D.Lowenthal: None.

Funding
Children’s Hospital of Philadelphia
122-OR: What Are the Barriers and Facilitators of Resistance Training in Mildly Frail Older Adults with Insulin-Treated Diabetes? A Qualitative Analysis Using the Capability, Opportunity, Motivation, and Behaviour (COM-B) Behavioural Science Model
Authors: STOCKER RACHEL , SHAW JAMES A. , WITHAM MILES D. , TAYLOR GUY , WEST DANIEL J. 
Published: June 2023

Background: Resistance exercise offers many benefits for those with frailty and sarcopenia and may carry less risk of exercise induced hypoglycaemia. However most older adults do not meet recommended levels of exercise. Little is known about why, especially for mildly frail older adults with insulin treated diabetes. Our aim was to investigate behavioural related influences to undertaking resistance exercise in this vulnerable group.
Methods: A phenomenological qualitative study using semi structured interviews with mildly frail adults aged ≥60 with insulin-treated diabetes (Type 1 (n=12); Type 2 (n=3)) recruited via online advert, in the UK. Frailty was assessed using the Rockwood Clinical Frailty Scale. Those with a history of myocardial infarction, stroke, renal failure, severe hypertension or liver disease in the last 12 months were excluded. Data were analysed inductively using thematic analysis, then aligned to the COM-B.
Results: Barriers to exercise centred on the physical capability, opportunity, and reflective motivation COM-B domains. Primary barriers included exacerbating existing fatigue or diabetes-related complications, exercise induced hypoglycaemia and injury, and inability to use resistance equipment. Most were unaware of the benefits of exercise on diabetes and muscle health. Many with a decades-long diagnosis were initially told that exercise was unsafe. Facilitators included an informative and flexible training environment, clarity on potential diabetes specific benefits, and having a supportive partner ideally also capable of exercise.
Conclusion: Older, mildly frail adults with insulin-treated diabetes are a vulnerable group whose beliefs may prevent them from undertaking regular exercise. They may benefit from a specific programme of awareness raising and a tailored, flexible exercise environment.

Disclosure
R.Stocker: None. J.A.Shaw: Advisory Panel; Betalin Therapeutics, Provention Bio, Inc., Consultant; Mogrify. M.D.Witham: None. G.Taylor: None. D.J.West: None.

Funding
UK Wellcome Trust
124-LB: Randomized Trial of Continuous Glucose Monitors for the Care of Pregnant People to Limit Staff Exposure
Authors: GRASCH JENNIFER , NANDAM NEEHARIKA , BUSCHUR ELIZABETH 
Published: June 2023

Introduction: During a pandemic, use of remote monitors may reduce close patient contact and decrease risk of occupational exposure. This study evaluated the impact of continuous glucose monitor (CGM) use on the number of close encounters required for diabetes management in pregnant individuals.
Methods: This study included 24 pregnant people with pregestational diabetes or medication-controlled gestational diabetes admitted for antepartum care. Participants received a Dexcom G6 CGM and were randomized to clinical use of CGM (intervention) or to standard care with fingerstick point-of-care (POC) glucose checks and a CGM device in blinded mode (control). The primary outcome was the number of POC glucose measurements per nursing shift. Secondary outcomes included glycemic control, neonatal outcomes, and patient and nursing satisfaction measured with surveys.
Results: Patients in the intervention group required fewer POC measurements per shift than the control group, but this difference did not reach statistical significance (1.56 ± 0.88 vs 2.28 ± 1.17, p=0.08). Time in the pregnancy-recommended glycemic range (63-140 mg/dL) was similar in both the intervention and the control groups (77.65% ± 22.95 vs. 73.30% ± 27.23, p = 0.89). Time above range (21.64% ± 23.49 vs. 24.84% ± 27.82, p = 0.95) and below range (0.70% ± 1.58 vs. 1.86% ± 4.93, p = 0.64) were also comparable in the intervention and control patients. Neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, hyperbilirubinemia and supplemental oxygen were less likely in the intervention group, however this difference was not significant when adjusted for gestational age at delivery. Patient and nursing satisfaction was high in both groups and not significantly different.
Conclusion: Although use of CGM's for antepartum admissions did not significantly decrease close patient contact, equivalent glycemic control was achieved as with standard care. Neonatal outcomes were also similar in both groups.

Disclosure
J. Grasch: Research Support; Dexcom, Inc., TrueRelief, LLC. N. Nandam: None. E. Buschur: Consultant; Beta Bionics, Inc., Research Support; Dexcom, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust.

Funding
Dexcom, Inc. (IIS-2020-052)
1240-P: Triglyceride Variability and Risk of Adverse Cardiovascular Outcomes—Results from the ACCORD Trial
Authors: NUYUJUKIAN DANIEL S. , ZHOU JIN , KOSKA JURAJ , REAVEN PETER 
Published: June 2023

The potential role of visit-to-visit variability of lipid parameters in risk of adverse cardiovascular events is not well established. We used data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial to examine the relationship between visit-to-visit variability in triglycerides and risk of both heart failure (HF) events and the primary CVD outcome. Variability of triglycerides was computed as coefficient of variation (CV-Trig). In both age-adjusted models and models adjusting for covariates that differed between those who did and did not develop HF, CV-Trig was associated with risk of HF (Model 2, HR = 1.13, p = 0.03) (Table). This association was somewhat attenuated when accounting for mean triglyceride level (Table). Conversely, we did not observe any relationship between CV-Trig and the primary CVD outcome in ACCORD (Model 1: HR = 1.04, p = 0.21) (Table). LDL variability was not linked to risk of HF in ACCORD. Our results suggest that variability in triglycerides may play a more important role in HF than in other cardiovascular outcomes. Studies to elucidate mechanisms which may underlie these risk patterns are warranted.

Disclosure
D.S.Nuyujukian: None. J.Zhou: None. J.Koska: None. P.Reaven: Research Support; Dexcom, Inc.

Funding
National Heart, Lung, and Blood Institute (F32HL156626, R21HL150374, R21HL150268, R01HL138969)
1251-P: Glycaemic Trajectory before Diabetes Diagnosis in People with Young-Onset and Usual-Onset Type 2 Diabetes—A Population-Based Retrospective Study in Hong Kong
Authors: FAN YINGNAN , WU HONGJIANG , LAU ERIC S.H. , YANG AIMIN , CHOW ELAINE , KONG ALICE P. , MA RONALD C. , CHAN JULIANA C. , LUK ANDREA 
Published: June 2023

Objectives: To identify distinct glycaemic trajectories before diabetes diagnosis in people with young-onset (&lt;40 years) and usual-onset type 2 diabetes (≥40 years).
Methods: Adult patients with incident type 2 diabetes diagnosed between 2002 and 2019 who had at least three HbA1c measurements before diabetes diagnosis in Hong Kong Hospital Authority electronic medical record system were included in this study. Latent class trajectory modelling was applied to identify distinct HbA1c trajectories before diabetes diagnosis, adjusted for sex and age. The shape and number of trajectory classes (one to five) were selected based on a combination of Bayesian Inclusion Criteria, model adequacy and proportion of people in each trajectory class (no less than 2% required).
Results: A total of 2,252 people with young-onset type 2 diabetes (age [mean ± SD]: 34.1 ± 4.9 years; 40.0% male) and 77,892 people with usual-onset type 2 diabetes (age [mean ± SD]: 64.9 ± 11.0 years; 51.4% male) were included in this analysis. The 2-class solution and 1-class solution were chosen as the most appropriate models for young-onset and usual-onset type 2 diabetes respectively. A stable-increase trajectory with HbA1c rising gradually before diabetes diagnosis was identified in 96% of people with young-onset type 2 diabetes, while the other 4% had an accelerated-increase trajectory with HbA1c increasing rapidly within one year before diagnosis. People with usual-onset type 2 diabetes had HbA1c value increasing gradually before diabetes diagnosis.
Conclusion: Blood glucose climbed gradually at a steady rate before diabetes diagnosis in most people with type 2 diabetes, while a small proportion of people with young-onset type 2 diabetes showed a rapid deterioration within a short period before disease onset.

Disclosure
Y.Fan: None. H.Wu: None. E.S.H.Lau: None. A.Yang: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company.
1290-P: Diabetes Provider Perceptions of Barriers and Benefits to Type 1 Diabetes Autoantibody Screening among Patients and Relatives
Authors: OSPELT EMMA L. , HARDISON HOLLY , RIOLES NICOLE , NOOR NUDRAT , CROSSEN STEPHANIE , SMEGO ALLISON , ALEPPO GRAZIA , FRIEDMAN JARED , ENG DONNA , SULLIVAN CATHERINE , MAJIDI SHIDEH , LORINCZ ILONA , EBEKOZIEN OSAGIE 
Published: June 2023

Background: This study highlights perceived benefits and barriers to type 1 diabetes (T1D) autoantibody screening rates in U.S. endocrinology practices.
Methods: Fifty eligible endocrinology providers participated in a 15-question survey distributed via Qualtrics. Participants were recruited from the T1D Exchange Quality Improvement Collaborative. Data was cleaned, sorted, and analyzed. Summary statistics, including frequencies and proportions for categorical variables were evaluated and plotted using bar charts. z
Results: Overall, 82% of providers stated interest towards autoantibody screening in their clinics. The following were ranked as benefits of autoantibody screening: opportunity for early diabetes management (90%), enrollment in research projects (84%), clinical guidance and diagnosing abilities (80%), and DKA prevention at diagnosis (76%). Providers identified multiple barriers to autoantibody screening in clinical practice including the associated cost and anxiety for patients, as well as limited staff time and resources (Figures 1, 2).
Conclusion: The majority of surveyed providers feel confident recommending autoantibody screening for patients and those at risk for diabetes. However, clinic limitations exist that may affect the feasibility of this in practice. These barriers should be targeted with specific interventions moving forward.

Disclosure
E.L.Ospelt: None. C.Sullivan: None. S.Majidi: None. I.Lorincz: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. H.Hardison: None. N.Rioles: None. N.Noor: None. S.Crossen: None. A.Smego: None. G.Aleppo: Advisory Panel; Medscape, Consultant; Bayer Inc., Insulet Corporation, Research Support; Dexcom, Inc., Eli Lilly and Company, Emmes, Insulet Corporation, Fractyl Health, Inc., WellDoc, Speaker's Bureau; Dexcom, Inc. J.Friedman: None. D.Eng: None.