bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBSUN211 The Importance Of Early Opportunities To Identify And Treat Prediabetes Or Even Change The Diagnostic Threshold For Diabetes
Authors: Schwartz Stanley S , Larson Sharon , Kjelstrom Stephanie , Beaupre Justin , Hartz William 
Published: November 2022

Abstract

Introduction
34.5% of US adults meet criteria for prediabetes, while 13% of US adults have diabetes. Diabetes increases the risk for many serious conditions. Recommendations for early screening and management of prediabetes have recently been updated.

Hypothesis
Diabetes has been associated with higher frequency use of emergency department (ED) services and inpatient admission, leading to higher costs associated with diabetes. We compare patients with diabetes or prediabetes for use of ED and inpatient care hypothesizing that prediabetic patients will have fewer visits to the ED and hospital. We additionally described differences in characteristics between these two groups to identify health inequities. Research Design: Data on people with Type 2 diabetes (DM) or prediabetes (PD) who seen in the ED March 2018 and December 2019 were extracted from an EHR. Descriptive statistics were compared between people with DM and PD using t-test or chi square tests. Linear and logistic regression analyses were conducted to compare DM to PD frequency of ED visits, high utilization of ED (3+ ED visits per year), admission to inpatient care. A p-value of 0. 05 or less is considered significant.

Major Results
PD patients were younger, and female compared to DM patients. Bivariate analysis show PD patients had fewer ED visits per year on average (1.2 v 1.5, (p&lt;. 0001) compared to DM, and were less than half as likely to have 4+ visits per year (2. 0% v 5.4%, p &lt;. 0001). Several comorbidities were examined, and all were significantly higher amongst DM patients. PD patients were more likely to have 0 or 1 comorbidities (69.6% vs. 55.3%, p &lt;. 0001) compared to DM. In the linear regression analysis, PD was negatively associated with ED visits (-0.2 (-0.3, -0.1, p &lt;. 0001) after adjusting for age, gender, race, and poverty, as well as multiple comorbidities. Similar findings emerged in a logistic regression analysis of high ED utilization, and linear regression analysis of inpatient admission.

Interpretation of Results and Conclusions
Our data suggest that adverse outcomes of hyperglycemia accrue prior to current HgA1c cut-off for the diagnosis of diabetes, deserve therapy, and even changing the threshold of diagnosis of diabetes to HgA1c= 5.7. Considering previously reported costs associated with ED visits (averaging $2200 per visit nationally) and inpatient care, early management of prediabetes represents an important health economic priority. Management of PD offers an opportunity to improve outcomes and reduce morbidity and early mortality associated with DM. Our study found that PD was associated with fewer ED visits, fewer debilitating comorbidities such as retinopathy, COPD, CKD, and CHF. PD patients were less likely to have any comorbidities in comparison to DM patients.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP604 | LBSUN287 Ketosis-prone Type 2 Diabetes (Flatbush Diabetes) In Remission: Report Of Two Cases
Authors: Ji Beisi , Suresh Sumatha Channapatna , Naher Kamrun , Banerji MaryAnn 
Published: November 2022

Abstract

Diabetic ketoacidosis (DKA) is a triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration1. Diabetic ketoacidosis (DKA) is a well-known manifestation of Type 1 diabetes2; however, there has been an increase in the incidence of DKA as the first presentation in Type 2 diabetes. This subtype of diabetes is typically seen in non-Caucasian middle-aged obese males due to non-autoimmune disruption of glucose metabolism, which requires an initial intensive insulin regimen. After initial insulin treatment for several weeks to several months, a significant percentage of people can become insulin independent with an oral hypoglycemic agent(OHA) and /or just lifestyle modification, and in remission for many years3. This hybrid form of diabetes sharing the characteristics of T1DM and T2DM is called "Flatbush diabetes", also known as "ketosis-prone T2DM4 5. This article aims to emphasize the importance of early recognition of this heterogeneous syndrome through the two representative case reports of Ketosis-prone T2DM.

Case presentation
We describe two cases of African American men (elderly and young adult) with no past medical histories, who presented to the Emergency Department with a few days history of polyphagia, polydipsia, polyuria and fatigue. New onset of Type 2 diabetes and unprovoked DKA were diagnosed. Both of them received standard treatment with intravenous fluid and insulin drip, recovered uneventfully and discharged with insulin. Both of them followed up closely in our endocrinology clinic, their GAD antibodies were 0. 00(n&lt;=0. 02nmol/L), Islet cell antibody&lt;1: 4(n&lt;1: 4) and C-peptide were 2.6ng/mL and 6ng/mL(1.1-4.4ng/mL) respectively. Their insulin was gradually withdrawn with the addition of an oral hypoglycemic agent. Both the patients are currently insulin independent for more than 15 months.

Conclusion
This is an important clinical entity to recognize ketosis-prone T2DM as insulin independence positively impacts quality of life and decreases economic burden on the health care system. For patients with suspected ketosis-prone T2DM, B-cell autoantibodies and C-peptide level should be obtained 1-3 weeks at the first outpatient visit, as it can predict patients’ prognosis. These patients should also be referred to an endocrinologist and need careful follow-up. Among all ketosis-prone T2DM patients, those with preserved B-cell function are more likely to be insulin independent and go into remission phase.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN294 Insulin-induced Abdominal Acanthosis Nigricans From High Doses Of Insulin U-500
Authors: Yap Sara Elizabeth , Gerges Amany , Oliva Joseph , Idrees Thaer 
Published: November 2022

Abstract

Introduction
Dermatological complications associated with insulin therapy include lipoatrophy, lipohypertrophy, and acanthosis nigricans. We have a rare case of severe acanthosis nigricans from repeated insulin injection.

Case
A 63-year-old man with diabetes mellitus type 2 presented with an elevated blood glucose of 584mg/dL. He reported "high" glucose levels, despite adherence to his insulin regimen. He only injected insulin in his abdomen. Over 20 years, his insulin doses increased from Lantus 65 units BID and Humalog 35 units TID to Lantus units 110 BID and Humalog 65 units TID. It was later changed to U-500 at 160 units TID. His Hba1c ranged from 10.7% to 15.4%, most recently 13.6%. Physical examination revealed hyperpigmented and thickened plaques, localized to two large areas lateral to his umbilicus. During his hospital stay, insulin was administered on his arms and thighs. Glucose levels improved on Levemir 55 units daily and Lispro 20 units TID. He was discharged on Insulin U-500 40 units TID with instructions to avoid injecting on his abdomen and to rotate injection sites.

Discussion
Acanthosis nigricans is associated with insulin resistance or hyperinsulinemia. Insulin has a similar structure to insulin-like growth factor (IGF-1). At higher insulin concentrations, it can bind to IGF-1 receptors on keratinocytes and fibroblasts, leading to skin proliferation. Other suggested mechanisms include the involvement of fibroblast and epidermal growth factor. Histopathological findings show hyperkeratosis, papillomatosis, and thickened dermis. Immunochemical findings show positive IGF-1 antibodies in basal epithelial and prickle cell layers. In patients with poor glycemic control and increasing doses of insulin, it is important to assess for insulin-related skin changes. Besides routine visual inspection, skin thickening can be assessed by stroking the skin side-to-side in a sweeping motion instead of palpation.

Conclusion
Our patient with poorly type 2 diabetes required escalating doses of insulin over the years. He developed severe acanthosis nigricans on his abdomen leading to poor absorption of insulin. This case highlights the importance of routine visual inspection and tactile examination of insulin injection sites for skin changes, as well as repeated counseling regarding insulin site rotation. References: Buzási K, Sápi Z, Jermendy G. Acanthosis nigricans as a local cutaneous side effect of repeated human insulin injections. Diabetes Res Clin Pract. 2011;94: E34-E36. Mailler-Savage EA, Adams BB. Exogenous insulin-derived acanthosis nigricans. Arch Dermatol 2008;144: 126-7. Yahagi E, Mabuchi T, Nuruki H, et al. Case of exogenous insulin-derived acanthosis nigricans caused by insulin injections. Tokai J Exp Clin Med. 2014;39: 5-9
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN307 A Randomized Controlled Pilot Study Of The Food Order Behavioral Intervention In Prediabetes
Authors: Shukla Alpana P , Karan Ampadi , Graves Maya , Steller Ian , Abel Brittany , Zecca Christina , Hayashi Lauren , O’Connor Madlen , Tils Jamie , Giannita Ashley , Truong Wanda , Casper Anthony , D’Angello Debra , Hootman Katie , Aronne Louis J 
Published: November 2022

Abstract

Background and Objectives
Ordering the ingestion of carbohydrate-rich foods after protein/vegetables (carbohydrate-last food order) significantly reduced postprandial glucose and insulin excursions over 180 min in patients with prediabetes and type 2 diabetes, compared with the reverse food order (carbohydrate-first) in previous research. We implemented a 16-week food order behavioral intervention, assessing its feasibility and impacts on glucose tolerance (GT), HbA1c, and weight (wt) in adults with prediabetes.

Methods
Participants with overweight/obesity and prediabetes (HbA1c 5.7-6.4%) were randomized to receive either standard nutritional counseling (control group) or standard nutritional counseling plus carbohydrate-last food order counseling (FO group). Participants were instructed to maintain their usual level of exercise throughout the study; this was assessed by the Godin Leisure-Time Exercise questionnaire at baseline and wk 16. Participants in both groups received 4 in-person brief counseling sessions at 1-month intervals. Due to the Covid-19 pandemic, later participants received some or all of their counseling via telemedicine. Oral GT was tested at baseline and week 16. Feasibility was assessed via a questionnaire.

Results
Of the 45 randomized subjects, 39 completed the study (control 21, FO 18). Demographics and baseline variables including wt (190.8 lbs vs 191.1 lbs) and HbA1c (6% vs 6%) were similar between groups. Exercise levels did not differ between groups at baseline and wk 16. Within FO group, body wt declined (-3.6 ±5.7 lbs, p=0. 017; -1.8% ±2.8, p=0. 012), and there was a trend towards improvement in HbA1c (-0.1 ±0.2, p=0. 054). Control group wt changed (-2.6 ±6.8 lbs, p=0.102; -1.6% ±3.5, p=0. 048) without altering HbA1c (-0. 03 ±0.3, p=0.605). Changes in wt, HbA1c, and GT were not significantly different between groups. At week 16, 17 FO group subjects (94%) reported high intervention adherence, 13 (74%) reported it was easy to eat protein/vegetables before carbohydrates, and 14 (78%) reported they would continue eating protein/vegetables before carbohydrates.

Conclusions
Carbohydrate-last food order is a feasible behavioral strategy in individuals with prediabetes. More research with a larger sample size and longer duration is needed to delineate its clinical impact.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP161 Adipose mitochondrial complex I deficiency modulates inflammation and glucose homeostasis in a sex-dependent manner
Authors: Yoon John , Choi Kyung-Mi , Ryan Karen 
Published: November 2022

Abstract
Mitochondrial dysfunction in adipose tissue has been associated with type 2 diabetes, but it is unclear whether it is a cause or the consequence. Mitochondrial complex I is a major site of reactive oxygen species generation and a therapeutic target. Here we report that genetic deletion of the complex I subunit Ndufs4 specifically in adipose tissue results in an increased propensity to develop diet-induced weight gain, glucose intolerance, and elevated levels of fat inflammatory genes. This outcome is apparent in young males but not in young females, suggesting that females are relatively protected from the consequences of adipose mitochondrial dysfunction for metabolic health. Mutant mice of both sexes exhibit defects in brown adipose tissue thermogenesis. Fibroblast growth factor 21 (FGF21) signaling in adipose tissue is selectively blunted in male mutant mice relative to wild-type littermates, consistent with sex-dependent regulation of its autocrine/paracrine action in adipocytes. Together, these findings support that adipocyte-specific mitochondrial dysfunction is sufficient to induce tissue inflammation and can cause systemic glucose abnormalities in male mice.
Presentation: No date and time listed
ODP163 Association of HbA1c and Comfort with Diabetes Self-Management Among Adolescents and Young Adults with Type 1 Diabetes
Authors: Onwukwe Obichi , Lundgrin Erika , Zimmerman Teresa N 
Published: November 2022

Abstract
Glycemic targets are not met by many individuals with type 1 diabetes (T1D), especially among adolescents and young adults (AYA). To date, research is limited regarding comfort with diabetes self-management in this vulnerable demographic preparing to transition from pediatric to adult care. The purpose of this study was to examine levels of self-reported comfort with diabetes management tasks among AYA with T1D, and to describe the relationships among comfort levels, sociodemographic factors, and HbA1c. As a part of a quality improvement initiative at an academic pediatric hospital, AYA aged 15-23 years old with T1D received a transition survey to self-assess their comfort level with sixteen different diabetes management tasks on a 5-point Likert scale during a routine diabetes care visit. A chart review was subsequently performed to obtain sociodemographic factors and HbA1c. Among 161 participants who completed the survey (median age 17, median diabetes duration 7 years, 82.3% white, 59% female, 66.5% with private insurance, and median HbA1c 8.8%), comfort with diabetes management tasks was generally rated highly (median overall comfort level of 4.5 out of 5) and did not differ by race or insurance type. Regression analysis revealed that higher self-reported comfort level with diabetes management tasks was associated with a higher HbA1c (p=0.006), after controlling for age, sex, race, insurance type, and diabetes duration. These findings suggested that self-reported comfort with independently managing T1D may not be a sufficient metric in assessing AYA patients’ need for further intervention to optimize glycemic outcomes as they transition from pediatric to adult providers, and highlighted the importance of continuity of care to optimize diabetes management during this transitional period.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:06 p.m. - 1:11 p.m.
ODP165 Atypical DKA? Think Cannabis!
Authors: Albashaireh Arwa , Henske Joseph 
Published: November 2022

Abstract

Diabetic ketoacidosis (DKA) can be life threatening if not recognized and treated promptly. DKA is characterized by hyperglycemia, acidosis, ketosis and elevated anion gap. The presence of these metabolic derangements is essential to make the diagnosis. The use of cannabis has been associated with atypical acid-base profile in DKA which may contribute to confusion in diagnosis and treatment.

Case
A 20-year-old man with type 1 diabetes since age 10 presented to the emergency department with 4 days of nausea, vomiting and elevated blood glucose (BG). Emesis occurred up to 6 times daily and started 2 days prior to hyperglycemia. He was unable to correct BG with rapid acting insulin. Moderate urine ketones were present. He denied symptoms of diarrhea, fever, sore throat, runny nose or cough and reported adherence to insulin regimen. Physical exam was remarkable for dry mucous membranes and mild epigastric tenderness. Lab evaluation showed BG of 268 (70-110mg/dL), sodium 133 (135-145 mmol/L), potassium 3.6 (3.5- 5.1 mmol/L), chloride 95 (98-107 mmol/L), bicarbonate 22 (22-32 mmol/L), creatinine 0.8 (0.6–1.2 mg/dL), Anion gap 16, beta-hydroxybutyrate 3.38 (&lt;0.27 mmol/L). He had normal white blood cell count and infectious work up was unremarkable. The patient was started on continuous IV fluids and was managed with intermittent subcutaneous rapid acting insulin in addition to basal insulin. After anion gap closure he was transitioned to his home doses of insulin. Prior to discharge, the patient discretely asked about the effects of smoking marijuana on BG and subsequently disclosed he had increased his use of marijuana recently.

Discussion
Diabetic keto-alkalosis may present as a result of recurrent vomiting that leads to gastric acid loss. Cannabis use has been linked to an increased risk of diabetic keto-alkalosis. The underlying mechanism is hypothesized to be related to cannabis effects on the stomach causing delayed gastric emptying and leading to cyclic nausea and vomiting. One study conducted to investigate acid-base parameters seen in atypical DKA in Type 1 Diabetes referred to this as "Hyperglycemic Ketosis due to Cannabis Hyperemesis Syndrome" (HK-CHS) recommending obtaining urine drug screen in patients with atypical DKA 1 . Attention should be drawn to this phenomenon as cannabis use has grown with its legalization in many states. Individuals with T1D presenting with ketosis but normal or elevated pH and/or serum bicarbonate may confuse clinicians and delay proper diagnosis. When the patient does not disclose cannabis use voluntarily, taking a thorough social history is critical to making the correct diagnosis. Reference: 1. Akturk HK, Snell-Bergeon J, Kinney GL, Champakanath A, Monte A, Shah VN. Differentiating diabetic ketoacidosis and hyperglycemic ketosis due to cannabis hyperemesis syndrome in adults with type 1 diabetes. Diabetes Care 2021 December 8,: dc211730
Presentation: No date and time listed
ODP166 Autoantibody Positivity and Random C-peptide Profile in Young Ethnic South Indian Population with Diabetes Mellitus
Authors: Kamalanathan Sadishkumar , SS Sarayu Gopal , Sahoo Jayaprakash , Naik Dukhabandhu , Negi Vir Singh 
Published: November 2022

Abstract
The islet cell autoantibody and beta-cell reserve profiles of young-onset diabetes patients in India are not only heterogeneous but also differ from those in the rest of the world. We sought to assess 3 standard islet cell autoantibodies and random C-peptide in the young ethnic South Indian population with diabetes mellitus attending the Endocrinology OPD of our tertiary care. A total of 190 young diabetes patients aged between 12-30 years were screened for inclusion in the study. Known cases of gestational diabetes and those on diabetogenic drugs were excluded. Additionally, those with clinical features suggestive of pancreatic diabetes or maturity-onset diabetes of young (MODY), or any diabetes-associated syndromic disorders were also excluded. Finally, 138 eligible young diabetes patients were included in the study. The islet cell autoantibodies against glutamic acid decarboxylase (GAD), insulinoma-associated protein-2 (IA-2), zinc transporter (ZnT8)was measured by sandwich ELISA technique using a human GAD ELISA kit (Euroimmun, Germany), human IA2 ELISA kit (Euroimmun, Germany), human ZnT8 ELISA kit (RSR diagnostics, USA) respectively. Random C-peptide was measured with chemiluminescence immunoassay analyser Advia Centaur XP. Diagnosis of T1DM was based on the requirement of immediate insulin replacement therapy for hyperglycemia with or without acute-onset ketosis with random C-peptide (&lt;0.6 ng/ml) with /without any of islet cell antibodies. Diagnosis of T2DM is based on the history of control of hyperglycemia with oral hypoglycemic agents with documentation of adequate beta-cell reserve (random C-peptide ≥ 0.6 ng/ml) while maintaining euglycemia. Based on the patient characteristics, treatment profile, islet cell antibody status, and beta-cell reserve as assessed by random C-peptide levels, 82 were classified as T1DM, and 48 were classified as T2DM. The rest 8 patients were categorized as unclassified diabetes. GAD antibody was seen in 54(66%) of 82 T1DM patients. Islet cell autoantibody negativity was documented in 21(26%) of T1DM patients. IA-2 and ZnT8 antibodies contributed to an additional 7(8%) to islet cell antibody positivity in T1DM patients. IA-2 antibody positivity was low and random C-peptide was undetectable in many cases of T1DM in our study and is probably due to prolonged duration of diabetes in many T1DM patients. Autoantibody positivity was seen in 4(8%) T2DM patients. These patients need to be followed up for possible evolution of latent autoimmune diabetes in adults. References: Sahoo SK, Zaidi G, Vipin VP, Chapla A, Thomas N, Yu L,et al. Heterogeneity in the aetiology of diabetes mellitus in young adults: A prospective study from north India. Indian J Med Res 2019; 149: 479-88.
Presentation: No date and time listed
ODP175 COVID-19 Induced Euglycemic Diabetic Ketoacidosis in a Patient taking Sodium-Glucose Cotransporter-2 Inhibitors
Authors: Alqaisi Sura , Rahman Ali 
Published: November 2022

Abstract
From the U.S., under to American Diabetes Association, diabetic ketoacidosis (DKA) is accountable for around 6.3 percent of all hospitalization and 0.4% of all mortality annually. Unregulated hyperglycemia (&gt;250 mg/dL), significant anion gaps, metabolic acidosis, and an increased plasma ketone concentration are the manifestations of diabetic ketoacidosis. Despite this, DKA can occur in the vicinity of an average bloodstream sugar level (less than 200 mg/dL); this is described as euglycemic DKA (eu-DKA). The Sodium-glucose Cotransporter-2 (SGLT2) inhibitors are being used in the management of type 2 diabetes, given its favorable side effect of weight loss and improved cardiovascular mortality. Still, at the same, can cause in rare occasions eu-DKA. The hospitalization of a patient taking Empagliflozin at home presented to the emergency department complaining of shortness of breath, fever, chills, and productive cough for one week with eu-DKA and extreme acidemia in the setting of a confirmed COVID-19 infection that had remained persistent for eight days before presentations are described in this medical abstract. Eu-DKA is uncommon in the population, which increases the possibility of misdiagnosis in patients. In light of the COVID-19 epidemic, there is an immediate demand for increased public knowledge of the condition. Keywords: COVID-19, Diabetes, Glucose Metabolism, SARS-2, SGLT2 Inhibitor, Type 2 Diabetes
Presentation: No date and time listed