bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBODP042 Lean Type Two Diabetes: Risk Factors And Outcomes Compared To Typical Presenting Type Two Diabetes
Authors: Singer Alisse , Wilhalme Holly , Cheung Dianne 
Published: November 2022

Abstract

Background
Lean type 2 diabetes (LT2D) is a prevalent manifestation of type 2 diabetes (T2D). However, it has been an understudied subgroup of T2D.

Aim
To compare characteristics and outcomes of patients with LT2D with that of typical presenting T2D.

Methods
A retrospective review of electronic health records was performed between 2013 and 2020. The study included 254 patients with LT2D and 429 patients with typical T2D located in the South Bay of Southern California. LT2D and typical T2D were defined as having a body mass index (BMI) of 18.5 to 24.9 kg/m2 and 25 to 29.9 kg/m2, respectively. Patient-level variables included age, sex, race, ethnicity, educational level, area of deprivation index (ADI), microvascular and macrovascular comorbidities, alcohol use, tobacco use, and diabetes family history. Labs and vital signs obtained included hemoglobin A1c (HbA1c), glomerular filtration rate (GFR), creatinine, albumin, and blood pressure. Student's t-test and Chi-square tests/Fisher's exact tests were performed with SAS version 9.4 to compare differences between the LT2D and typical T2D groups.

Results
Between the diabetes subgroups, there were several statistically significant differences identified. The LT2D population was older, with a mean age of 78.2 years compared with 74.6 years in the typical T2D (p &lt; 0. 001). The LT2D group had a higher percentage of Asians at 40.6% and fewer Caucasians at 35. 0%, while the typical T2D consisted of 22.4% Asians and 46.4% Caucasians (p=0. 0007). Diastolic blood pressure was lower in the LT2D group at 71.6 compared to 73.9 in the typical T2D group (p=0. 0053). There were no differences in sex, HbA1c, systolic blood pressure, hypertension, dyslipidemia, chronic kidney disease, cardiovascular events, peripheral vascular disease, combined microvascular complications, combined macrovascular complications, substance use, education level, ADI, GFR, creatinine, albumin, or number of relatives with diabetes.

Conclusion
We identified several key differences between the LT2D and typical T2D cohort, including age, race, and diastolic blood pressure. Further investigation and large studies are warranted to explore the risk factors and long term outcomes of patients presenting with LT2D. Knowing what the key differences are may help identify appropriate diabetes medical treatments and lifestyle interventions for this particular target population rather than using T2D treatments that are used for a more general population of patients.
Presentation: No date and time listed
LBODP043 Analysis Of Plastic Surgery Websites And Their Recommendations For Diabetics
Authors: Levine Emma C , Fanning James E , McGee Shayan , Okamoto Lauren , Steinmetz-Wood Samantha , Gilbert Matthew Philip 
Published: November 2022

Abstract
Diabetic patients are predisposed to adverse complications after surgery, especially when their A1c is above 8. 0% (1). Despite the heightened risk for post-operative complications such as wound dehiscence and infection (2), no formal recommendations by the American Council of Academic Plastic Surgeons (ACAPS) exist regarding preoperative A1c thresholds. This study reviews the current online recommendations for diabetic patients undergoing plastic surgery and examines the readability and technical metrics presented on these webpages. We hypothesized that these webpages would enforce stricter preoperative A1c levels (&lt; 8%) in comparison to the 8% threshold put forth by Diabetes Care in 2014. An anonymous, depersonalized Google search with the search term "diabetes and plastic surgery" was run. The initial 50 results were analyzed and 11 webpages meeting inclusion criteria extracted. 45.45% (5/11) of the webpages stated specific A1c recommendations, with 4 of the webpages recommending an A1c &lt;7% and one webpage recommending an A1c &lt;6%. A number of the websites recommended that patients consult their primary care physician (PCP) or endocrinologist, 63.6% (7/11). 100% (11/11) of webpages discussed poor wound healing and 45% (5/11) discussed the heightened risk of postoperative infection in diabetic surgical patients. Webpage average readability scores for seven readability measures greatly exceeded the 6th grade reading level recommended for medical information. This study determined that online resources for diabetic patients undergoing plastic surgery utilized stricter than standard preoperative criteria and exceeded recommended readability levels. Standardizing requirements for diabetic patients and improving readability may help patients better understand the preoperative expectation for better surgical outcomes. References: (1) Underwood, Patricia et al. "Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures." Diabetes care vol. 37,3 (2014): 611-6. doi: 10.2337/dc13-1929(2) Goltsman, David et al. "Defining the Association between Diabetes and Plastic Surgery Outcomes: An Analysis of Nearly 40,000 Patients." Plastic and reconstructive surgery. Global open vol. 5,8 e1461. 17 Aug. 2017, doi: 10.1097/GOX. 0000000000001461
Presentation: No date and time listed
LBODP048 Barriers To Diabetic Retinopathy Screening In Hospitalized Patients With Diabetes
Authors: Kumar Monisha , Genter Pauline , Ipp Eli 
Published: November 2022

Abstract
Diabetic retinopathy (DR) is a leading cause of preventable vision loss in the in the U. S., and DR screening is essential to prevent blindness. Yet minority populations have consistently lower DR screening rates than Non-Hispanic Whites and knowledge about barriers versus facilitators for completion of DR screening in these groups remains scant. Improvement in DR Screening rates in safety net populations has been observed after placing digital retinal cameras in primary care sites to capture images where patients get their basic health care. In this study, we therefore assessed DR screening in patients at time of hospitalization as a possible additional site to capture unscreened patients with diabetes. We identified patient with diabetes admitted for any reason to a safety net hospital to evaluate perceived barriers to DR screening. We performed an anonymous survey in English or Spanish in 156 hospitalized adult patients with diabetes during hospital stays between 10/2019-12/2021, using a convenience sample. Barriers specified in the survey were derived from the literature. The study population had a mean [+SD] age of 50+10.5 years, were predominantly male [72.4%], of low-income [83.7% &lt;$25,000/year] and minority groups [Latinos 79.5% and African American [10.3%]. Diabetes duration was &gt;5years in 63.6% of patients. Reported DR screening rate in the 12 months prior to admission was only 31.4%, despite 97% of patients confirming they were aware that diabetes causes impaired vision and blindness. The main perceived barriers to DR screening identified in the survey were financial [50%], transportation [22%] and depression [17%]. There were no significant differences in the number or nature of perceived barriers in those who reported DR screening vs. those who did not. Surprisingly, the pandemic appeared to have little impact on DR screening rates. Comparison of patients surveyed before (n=96; 10/2019-03/20) and after COVID lockdown (n=60; 08/2020-12/2021), did not show any significant differences in patient demographics, number or nature of perceived barriers, or DR screening rates (32% vs 30%). However, DR screening among patients without a Primary Care Provider (PCP) was considerably lower compared to patients with a PCP, 10% vs 49% (p&lt;0. 001). In summary, this study reveals low prior outpatient DR screening rates in hospitalized patients with diabetes in low-income minorities in a safety-net hospital, and identifies potential remediable barriers associated with this. The results suggest that cost and transport barriers could be addressed by implementation of DR screening during hospitalization in safety net hospitals. These results also emphasize the significance of a having a PCP. We conclude that inpatient DR screening and facilitating PCP-patient connections might lead to improvement in DR screening rates and thus prevent blindness in this segment of the diabetes population.
Presentation: No date and time listed
LBODP054 Hypogonadism in Diabetes Mellitus: Insulin Resistance, The Connecting Link?
Authors: Singh Jaspreet , Swain Jayshree , Sahoo Dr Abhay Kumar , Mangaraj Swayamsidha , Kanwar Jayabhanu 
Published: November 2022

Abstract

Background
Hypogonadism is commonly found in men with type 2 diabetes mellitus (T2DM) and insulin resistance may play a role in its pathogenesis. There is an inverse relationship between testosterone and insulin resistance. This relationship is often confounded by effects of obesity, metabolic syndrome, sex hormone binding globulin (SHBG), treatment protocols and complication status of diabetes.

Objective
To determine the prevalence of hypogonadism in T2DM men and to evaluate the association between hypogonadism and clinical, biochemical parameters of diabetes. To look for an independent association between hypogonadism and insulin resistance.

Methods
This was a cross sectional study of 353 consecutive men aged 20 to 70 years with T2DM. Hypogonadism was defined on the symptoms as defined in the androgen deficiency in aging male questionnaire (ADAM) along with low calculated testosterone levels (calculated by Vermeulen's equation taking total testosterone, albumin and SHBG). Insulin resistance was measured by homeostasis model assessment for insulin resistance [HOMA-IR] and Quantitative insulin sensitivity check index [QUICKI].

Results
The prevalence of hypogonadism in our cohort was 17%. We found a significant correlation between calculated free testosterone and BMI (r=-0.149, p value =0. 005), HbA1c (r = -0.145, p value = 0. 006), Triglycerides (r= -0.217, p value =&lt;0. 001), HOMA IR (r=-0.207, p value =&lt;0. 001), QUIKI (r=0.148, p value=0. 005). On applying multiple linear regression, HOMA IR was significantly inversely correlated with calculated free testosterone levels independent of age, duration of diabetes, BMI and glycaemic status of diabetes. Similarly, total testosterone was significantly associated with insulin resistance independent of age, BMI, SHBG, complication status and other potential confounding variables. There was no statistically significant association between hypogonadism and diabetes complications.

Conclusions
Hypogonadism is a common finding in T2DM men. Hypogonadism is significantly associated with insulin resistance even after adjusting for age, BMI, duration of diabetes, diabetic complications, treatment regimens and other potentially confounding variables.
Presentation: No date and time listed
LBODP061 A Pilot Trial Of Continuous Glucose Monitoring Technology In The Perioperative Period
Authors: Price Catherine E , Aloi Joseph Anthony , Anzola Saskia , Fanelli Jessica , Vishneski Susan , Woody Christopher , Segal Scott B 
Published: November 2022

Abstract

Objective
To evaluate use of continuous glucose monitoring (CGM) technology in the perioperative setting by comparing CGM with concurrent point of care fingerstick blood glucose (BG) or arterial BG values, as indicated, in patients with hyperglycemia and/or diabetes mellitus undergoing surgery. To assess if grounding device correlated with loss of CGM signal as a prior study of CGM in the perioperative period noted intermittent signal loss during operative time.

Methods
A prospective cohort analysis of 94 participants with hyperglycemia and/or diabetes mellitus undergoing surgery of 3 hours duration was conducted using Dexcom G6 and/or Freestyle Libre 2. 0 CGM. CGMs were placed preoperatively and compared to standard of care BG checks in the perioperative setting. Correction insulin was administered based on fingerstick glucoses. Of those consented, 18 were excluded resulting in 76 enrolled subjects.

Results
Preliminary data for use of CGM in perioperative period analyzed 50 participants with Freestyle Libre 2. 0 CGM, 20 participants with Dexcom G6 CGM, and 6 participants with both devices worn simultaneously. Lost sensor data occurred for 3 participants wearing Dexcom G6 CGM and 10 participants wearing Freestyle Libre 2. 0 CGM, which affected 2 of the participants wearing both devices simultaneously. The absolute difference of Dexcom G6 CGM glucose readings compared to BG readings was 29.17 mg/dL (SD = 22.15). The absolute difference of Freestyle Libre 2. 0 CGM glucose readings compared to BG readings was 26.94 mg/dL (SD = 24.16). There was not a significant difference in averages of absolute change in glucose when comparing Dexcom G6 CGM to Freestyle Libre 2. 0 CGM when utilized simultaneously. Grounding devices utilized Megadyne grounding pad for use of bipolar cautery, monopolar cautery, and surgeries with da Vinci robot. Of the 13 participants with lost data, 3 patients had bipolar cautery reported as being used at least once and 10 participants with lost data utilized monopolar cautery. None of the 6 participants with surgery utilizing da Vinci robot had loss of CGM data.

Conclusion
Both Dexcom G6 and Freestyle Libre 2. 0 CGMs were able to be utilized in the perioperative setting and generally functioned well. Use of CGM provided more glycemic data and better characterized glycemic trends than individual BG readings. It is anticipated that this technology could improve prevention of hypoglycemic events and better glycemic control in the perioperative setting. Use of CGMs in the perioperative setting is a novel area of application that warrants further evaluation of this technology.
Presentation: No date and time listed
LBSUN149 Effectiveness Of Digital Twin Technology For The Improvement In Depression Among Patients Undergoing Remission Of Diabetes
Authors: Shashank Joshi , Mohammed Jahangir , Mohamed Maluk , Poon Terrence , Dharmalingam Mala , Saboo Banshi , Damodaran Suresh , Vadavi Arun , Thajudeen Mohamed , Keshavamurthy Ashok , Bhonsley Suchitra , Mohammed Sarah , Shamanna Paramesh 
Published: November 2022

Abstract

Introduction
Twin Precision Treatment (TPT): a novel whole-body digital twin enabled precision nutrition that utilises 174 health markers and 3000 daily data points from blood tests and connected devices that measure weight, physical activity, sleep and sensor glucose values, for achieving remission. The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but the impact of the diabetes reversal program on the depression has not yet been investigated.

Methods
We compared the change in the PHQ-9 scores at the baseline and at three months for the patients enrolled in the real-world study in TPT program. Contemporary consensus statement defines remission as a return of hemoglobin A1c (HbA1c) to &lt;6.5% and persists for at least three months in the absence of diabetes medication.

Results
We evaluated 96 patients of which 54.1% (n=52) had any grade of depression. 28% (n=27), 18% (n=17), 5% (n=5), 3% (n=3) had mild, moderate, moderate to severe and severe depression. Within these categories 67% (n=18) improved from mild to normal, 94% (n=16) improved in the moderate category with 10 improved to normal category, none remained as moderately severe and severe depression, respectively. There was a significant association with the improvement in the PHQ-9 scores and the number of daily oral medication count change. Out of 15 on 1 medication/day changed to 7 (46.7%) off medication. Out of 27 with 2 medications/day, 10 (37%) were off medications. Out of 22 with 3 medications/day, 5 (22.7%) were off medications. Out of 12 with 4 medications/day, 2 (16.7.7%) were off medications; p&lt;0. 005. The mean HbA1c % at baseline (8.9±2.4) changed to (6.8±9.2), p&lt;0. 001. The mean body weight (kg) at baseline (76.2±13.5) changed to (71.9±12.9), p&lt;0. 001.

Discussion
This is perhaps the first evaluation for the improvement of the PHQ-9 in patients undergoing remission by digital twin technology. Depression was highly prevalent. Higher the PHQ-9 score, greater was the degree of improvement in depression. TPT appears to be a useful tool to simultaneously address reversal of diabetes and improvement in the grade of depression.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN162 Cumulative Probability Of Heart Failure Hospitalization Among Non-Hispanic Black Compared To Non-Hispanic White Individuals With Type 2 Diabetes On Empagliflozin (EMPA-AA): Real-world Data
Authors: Mishriky Basem M , Cummings Doyle M , Fu Yuanyuan , Halladay Jacquie , Jones Schuyler , Boan Andrea , Jones Sara , Patil Shivajirao , Powell James , Adams Alyssa , Irish William 
Published: November 2022

Abstract
The results from the SGLT-2 inhibitors cardiovascular outcome trials were generalized to all, despite that non-Hispanic Black (hereafter, "Black") participants were underrepresented. Our goal was to evaluate, among patients with type 2 diabetes, the risk of heart failure hospitalizations among black vs non-Hispanic White (hereafter "White") patients initially prescribed empagliflozin. | We performed a multicenter retrospective study using clinical data derived from Electronic Medical Records (EMR's) from adults with type 2 diabetes cared for at 4 healthcare systems (UNC Health, Duke Health, MUSC, and ECU Health) who were prescribed empagliflozin between August 2014 and December 2019. Our primary outcome was time to first heart failure hospitalization. We wanted to understand if the outcomes were different in Black vs White patients with previous hospitalizations for heart failure that occurred prior to an empagliflozin prescription. Cumulative probability of heart failure hospitalization by race was estimated using the cumulative incidence function. The association of race with risk of heart failure hospitalization was evaluated using multivariable Cox hazards models. Hazard ratio (HR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. | A total of 704 patients with previous heart failure hospitalizations were eligible. Mean age by race category (Black/White) was 60.2 vs 64.3 years (p &lt; 0. 0001); 42.8% vs 61. 0% were males (p &lt; 0. 0001) and 81.2% vs 73.2% had a history of hypertension respectively. Black patients were significantly younger and predominantly female. Cumulative probability of heart failure hospitalization at 2-years post-initiation of empagliflozin was 71.7% (95% CI = 61.6%, 79.6%) vs. 70.9% (95% CI = 64. 0%, 76.7%) for Black vs White, respectively. When adjusting for age, gender, and baseline comorbidities, there was no statistically significant difference in the risk of hospitalizations for heart failure between Black vs White patients (HR = 1. 03; 95% CI = 0.85, 1.25, p = 0.79). | In patients with type 2 diabetes with a documented previous hospitalization for heart failure prior to a prescription for empagliflozin, we found no significant difference in the cumulative probability of heart failure hospitalization in Black vs White patients.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN209 A Novel Algorithm For The Management Of Inpatient Covid-19 Steroid-induced Hyperglycemia
Authors: Karol Alexander B , Viera Natalia , Ogyaadu Selassie J , Brooks Danielle , Shah Nirali A , Linker Anne S , Lam David , Levy Carol J , O’Malley Grenye 
Published: November 2022

Abstract

Objective/Background
Hyperglycemia in hospitalized patients with COVID-19 is linked to increased morbidity and mortality. With increasing use of glucocorticoid (GC) therapy for COVID-19 hypoxemia, clinicians are challenged with an increased prevalence of hyperglycemia.

Methods
We developed an insulin protocol to aid front line providers in the management of GC-induced hyperglycemia for hospitalized adults with COVID-19. The protocol was based on expert opinion and was available from March 2021 onward. Glycemic and clinical outcomes were obtained for patients treated with GC and retrospectively compared to historical controls treated with GC admitted up to 6 months prior to protocol implementation. Glycemic parameters for finger stick glucose values (FSG) were defined as hypoglycemia &lt;70 mg/dL, euglycemia 70-180 mg/dL, mild hyperglycemia 180-250 mg/dL and severe hyperglycemia &gt;250 mg/dL. To account for differences in the quantity of total FSG between groups, we adjusted for length of stay and calculated the proportion of FSG per patient.

Results
130 patients with COVID-19 and GC induced hyperglycemia from before (n=65) and after (n=65) protocol implementation were matched 1: 1 based on age, weight, and sex. There were no significant differences in other baseline patient characteristics. Significantly more patients in the protocol group had mean FSG in the euglycemic range (16.9% vs 38.5%, p=0. 006), and there was a decrease in patients with mean glucose in the mild hyperglycemia range that trended toward significance (50.8% vs 35.4%, p=0. 076). The protocol group had a significantly lower proportion of hypoglycemic FSG per patient (0. 003 vs 0. 008, p=0. 044). Patients in the protocol group had more euglycemic FSG per patient, but this did not reach significance (0.413 vs 0.350, p=0.239). Similarly, the proportion of mild hyperglycemic FSG per patient trended lower in the protocol group (0.315 vs 0.272, p=0.291). There were no significant differences in severe hyperglycemia per patient (0.311 vs 0.328, p=0.828). The protocol group had a significantly higher utilization of basal-bolus insulin regimen (n=43 vs n=63, p&lt;0. 0001) with an increase percentage of bolus insulin utilization in peak total daily dose (70.2% vs. 62.4%, p=0. 08). Total peak day insulin dose trended lower in the protocol group (0.25 vs 0.32 U/kg, p=0.36).

Conclusion
A novel insulin protocol for the management of GC-induced hyperglycemia in hospitalized COVID-19 patients is an effective tool to achieve reductions in hypoglycemic events and higher utilization of standard of care basal-bolus insulin regimens without increased hyperglycemia or total daily dose of insulin.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.