bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP221 Late-Onset Hypoglycemia in a Patient with Fatty Acid Oxidation Disorder
Authors: Pessoa Carolina Mendes , Faisal Sobia , Madhavan Parvathy 
Published: November 2022

Abstract

Background
Multiple acyl-CoA dehydrogenase deficiency (MADD) is a disorder of fatty acid and protein metabolism due to a defect in electron transfer flavoprotein or in electron transfer flavoprotein dehydrogenase, and can present with hypoglycemia as a component of its clinical phenotype. We describe a rare case of hypoglycemia due to MADD with unusually late onset at age of 63 years. Clinical case: 63-year-old female with history of hypertension and depression, admitted to the hospital with a several month history of progressive weakness resulting in inability to walk, lightheadedness, unintentional 40-pound weight loss and oropharyngeal dysphagia to solids. On exam, she was noted to have predominant cranial neuropathies and proximal muscle weakness. Patient was found to be hypoglycemic to 47 mg/dL [75-200], with a lactic acidosis of 2.1 mmol/L [0.5-1.9], elevated CK of 630 U/L [22-269], elevated aldolase of 12.7 U/L [1.5-8.1], and increased beta-hydroxybutyrate of 2.9 mmol/L [&lt;0.3] along with transaminitis without cholestatic pattern. Fasting insulin level was 6 uIU/mL [3-19], C-peptide was low normal 1.1 ng/dl [0.8-3.5] with corresponding glucose of 57 mg/dl. Proinsulin level and sulfonylurea panel were unremarkable, and insulin antibodies were negative. Adrenal insufficiency was ruled out with normal cosyntropin stimulation test. IGF-1 and IGF-2 levels were also within normal limits. CT scan of the head, abdomen and pelvis did not evidence any issues. Furthermore, prior to this admission, patient had extensive work-up done for generalized weakness including evaluation for myasthenia gravis, myositis, HIV, thyroid disease, and other autoimmune conditions which was unrevealing. A muscle biopsy was performed with patology suggestive of a lipid storage disorder. Genetic testing only demonstrated variants of uncertain significance in LARGE1, PLEC and TTN genes. Additional testing revealed elevated serum concentrations of short, medium and long chain acylcarnitine species. Urinary organic acids were also increased with predominant elevation of 2-hydroxy-glutaric, ethylmalonic, adipic and suberic acids. This pattern, along with increased plasma acylcarnitine is typically associated with multiple acyl-CoA dehydrogenase deficiency. Serum free fatty acids were also high, supportive of MADD as previously reported in some cases. She was started on high-dose riboflavin replacement and advised to ingest a low-fat, low-protein diet, with frequent feeding and blood glucose monitoring.

Conclusion
MADD is a rare cause of hypoglycemia in adults. It is important to consider this condition as a differential diagnosis of hypoglycemia associated with generalized weakness even in older individuals.
Presentation: No date and time listed
ODP223 Metabolic efficacy of Very Low Carbohydrate Diet in DKD patients
Authors: Zainordin Nur Aisyah , Wee Chen Xin , Ghani Rohana Abdul , Ismail Nafeeza Mohd , Ismail Nazrul Hadi 
Published: November 2022

Abstract

Introduction
Obesity is strongly linked to the development of diabetic kidney disease. Very low carbohydrate diets (VLCBD) were associated with a reduction in weight but there is little evidence of its effects on diabetic kidney disease (DKD) patients. The aim of the randomized controlled trial study is to determine the metabolic effects of VLCBD in addition to low protein diet (LPD) in DKD patients.

Materials and Methods
30 patients with type 2 diabetes aged 40-75 years and a HbA1c 7-10.5% were randomly allocated to receive VLCBD (&lt;20g daily intake) versus standard low protein (0.8g/kg/day) diet. The patients received consultations every two weeks for 12 weeks. Metabolic profiles, glycemic control, inflammatory markers and visceral adipose tissue mass effects of the dietary interventions were compared. Result: The VLCBD group demonstrated significant reductions in weight (-4. 0 IQR 3.9 vs 0.2 IQR4.2 kg, p=&lt;0. 001) and BMI (-1.5 IQR 1.18 vs 0. 074 IQR 1.54, p=&lt;0. 001) in comparison to LPD group. There was reduction in waist circumference within both groups (- 4. 0 IQR 5.25, p= 0. 003 and -2. 0 IQR 3.6, p=0. 009) respectively. Estimated visceral adipose tissue mass and volume were significantly reduce in VLCBD group. There was significant reduction in ALT and GGT in both group. However, there is no significant changes in improvement in liver US in both groups. However, both group also showed significant reduction in HbA1c (-1.3 IQR 1.1% vs -0.7 IQR1.25%, respectively, p=NS). There is significant increment in LDL in VLCBD group which not present in LPD group. The VLCBD group showed a significant reduction in IL-6 levels with a contrasting rise within the LPD group (-1.53 IQR3.35 vs 0.46 IQR 1.95, p= 0. 028). Patients in VLCBD appeared to have improvement in physical activity score in comparison to LPD group.

Conclusion
After short term intensive VLCBD intervention in DKD patients, improvement were observed in metabolic markers, diabetes status and inflammatory markers with improvement of physical activity score.
Presentation: No date and time listed
ODP224 Metformin Associated Lactic Acidosis in a Nondiabetic Young Female
Authors: Saberi Elnaz , Izkhakov Neriy , Radpour Omid , Vernetti Nicholas , Nakhle Sameer 
Published: November 2022

Abstract

Background
Metformin is the first line of treatment for patients with Diabetes Mellitus type 2. Despite multiple benefits, metformin is contraindicated in stage 4 renal disease due to an increased risk of metformin associated lactic acidosis (MALA). MALA is estimated to have a high mortality rate of 30-50%. The presentation of MALA can mimic sepsis and organ failure.

Clinical Case
We report a case of a 32 year old female who presented with generalized weakness and shortness of breath. She was found to have severe metabolic acidosis (PH 7. 04, PCO2 40 mmHg, Bicarb 15 mmol/L, anion gap 14 mmol/L, lactic acid 8.7 mmol/L), hypotension (82/46 mmHg), pancytopenia, moderate transaminitis, severe acute kidney injury (creatinine 3.2 mg/dL, GFR 17 mL/min/1.73 m2), and profound hypoglycemia (serum glucose 42 mg/dL). Endocrinology was consulted due to hypoglycemia and suspected adrenal insufficiency. During the encounter the patient was alert and oriented, but reported severe nausea and appeared in significant distress. On review of medications, she reported taking phentermine and metformin for weight loss, hydrochlorothiazide for hypertension, and fluoxetine for depression. She denied taking other supplements. She denied any history of diabetes mellitus or prediabetes. Computed tomography (CT) of the chest and abdomen were unremarkable. The patient's potassium was normal. Lactic acidosis continued to increase (16.1 mmol/L) despite intravenous fluids, empiric broad spectrum antibiotics, and stress dose steroids. Approximately 19 hours after the arrival, she underwent dialysis due to suspected MALA. Her lactic acid improved after dialysis transiently (6.1 mmol/L), but later worsened again (11.3 mmol/L). Urine and blood cultures returned positive for Klebsiella Pneumoniae (pan-sensitive). She was treated appropriately for sepsis since presentation to the emergency room, but her clinical condition (and lactic acid) continued to deteriorate. On the second day of admission, the patient developed respiratory failure requiring intubation and mechanical ventilation. Her hypotension persisted and she required multiple pressors. Sustained low-efficiency dialysis was restarted due to worsening of metabolic acidosis. Patient then became unresponsive on hospital day 4. Sedation was stopped and CT of the brain revealed significant edema and mild bilateral subarachnoid hemorrhage. Patient was confirmed brain dead by perfusion study.

Conclusion
This case illustrated a constellation of factors that led to a poor outcome. Off label use of metformin for weight loss, late diagnosis of acute severe renal failure, and delayed diagnosis of MALA all contributed to the poor outcome in this patient. Even though MALA has a relatively low estimated incidence rate, this case emphasizes the importance of medication reconciliation and the need for recognition that MALA can present as sepsis.
Presentation: No date and time listed
ODP225 Mixed Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome with recent diagnosis of Diabetes Mellitus.
Authors: Adyanthaya Sindhoora , Anila Fnu , Jackson Bethany 
Published: November 2022

Abstract

Background
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia syndrome (HHS) are often discussed as two distinct clinical entities but can present in the same patient. Combined DKA and HHS is associated with higher mortality than either DKA or HHS alone. Clinical case: A 68 years old female diagnosed with type 2 diabetes 3 months prior to hospitalization was brought into the hospital with severe hyperglycemia and altered mental status. On exam she was unresponsive with grimace only to sternal rub. Pulse was elevated at 113, RR 31, temperature 100.3, and blood pressure 130/80. Initial labs showed severe hyperglycemia with glucose of 1454 (74-106 mg/dL), elevated beta-hydroxybutyrate of 8.6 (0. 02-0.27 mmol/L), sodium 138 (135-145 mmol/L), potassium 5.3 (3.6-5.2 mmol/L), serum bicarbonate 16 (21-32 mmol/L), anion gap 31 (6-18), plasma osmolality 353 (273-304 osm/kg), pH 7.33 (7.35-7.45) and lactic acid 4 (0.7-1.9 mmol/L). DKA protocol with normal saline, intravenous insulin infusion, and potassium replacement initiated and patient was transferred to ICU for further management. Sequential labs revealed development of hypernatremia with calculated free water deficit of 8.8 liters. Fluids changed to ½ normal saline. On Day 2 of hospitalization, she became responsive. She had resolution of acidosis but continued to have severe hypernatremia with peak sodium level of 163 on day 3. Urine studies showed urine osmolality of 700 mOsm/kg ruling out diabetes insipidus; urine sodium level was 5 mmol/L. Fluids were again changed to ¼ Normal saline with careful monitoring of serum sodium and glucose at 2 hour intervals. Hypernatremia resolved with aggressive fluid resuscitation. Her A1c prior to discharge was found to have increased to 13.3% from 6.5% (&lt; 5.6%), 3 months prior. Prior to discharge she had measurable C-peptide, insulin autoantibodies and negative GAD antibodies making autoimmune diabetes unlikely.

Conclusion
Individuals with concomitant DKA and HHS may have normal sodium or even hyponatremia at presentation due to the pseudo-hyponatremia induced by severe hyperglycemia. However, actual sodium concentration may be markedly elevated due to the osmotic diuresis induced by severe hyperglycemia. Aggressive fluid resuscitation is required to treat the profound dehydration found in HHS but the serum sodium concentration must be monitored carefully. A switch from normal saline to hypotonic fluids may be necessary to treat hypernatremia in HHS but overly rapid correction of serum sodium must be avoided for volume overload especially in elderly, owing to heart failure and due to higher mortality. The incidence of hypernatremia is noted in 14% of children and 27% of adults, however degree of hypernatremia is variable from mild to moderate and in rare instances is severe.
Presentation: No date and time listed
ODP233 Predicting Hospital Readmission for Patients with Diabetes: A Comparison of Models
Authors: Rubin Daniel , Hai Ameen Abdel , Obradovic Zoran , Brown Jeremiah , Paranjape Anuradha , Livshits Alice , Weiner Mark 
Published: November 2022

Abstract
In patients with diabetes, current models for predicting the risk of readmission within 30 days of hospital discharge vary in performance. We previously published the Diabetes Early Readmission Risk Indicator (DERRI TM), a logistic regression (LR) model based on 10 simple features with modest predictive performance (C-statistic 0.69). The current study aims to develop a more accurate model using deep learning on electronic health record (EHR) data. We electronically abstracted data from 36,563 patients with diabetes and at least 1 hospitalization at an urban, academic medical center between 7/1/2010 and 12/31/2020. One hospitalization per patient (index hospitalization) was randomly selected for analysis. A deep learning long short-term memory Recurrent Neural Network (RNN) was developed and compared to traditional linear and non-linear models: LR, AdaBoost, and Random Forest (RF). Models to predict unplanned, all-cause readmission were developed using demographics, vital signs, diagnostic and procedure codes, medications, laboratory tests, and administrative data as defined by the National Patient-Centered Clinical Research Network (PCORnet) Common Data Model. Unplanned readmissions were identified according to the Centers for Medicare and Medicaid (CMS) definition. A look-back time of 1 year before the index hospitalization and up to 60 previous ambulatory and hospital visits were used for learning and inference. Data dimensionality was reduced to 3,000 features by Singular Value Decomposition. The RNN model C-statistic is significantly greater than those of the traditional models (RNN 0.78, AdaBoost 0.71, RF 0.73, and LR 0.71, p&lt;0. 0001). Likewise, the F1-score is numerically greater for the RNN model (RNN 0.76, AdaBoost 0.75, RF 0.75, LR 0.72). Direct comparison to the DERRI TM is limited by lack of EHR data on two of the component variables (employment status and zip code). The deep learning RNN model outperforms the DERRI TM and is based on more generalizable EHR data. This new model may provide the basis for a more useful readmission risk prediction tool for patients with diabetes. Deep learning models may outperform traditional models at predicting readmission risk in this population.
Presentation: No date and time listed
ODP238 RELATIONSHIP BETWEEN BODY COMPOSITION, POST PRANDIAL GLUCOSE AND INSULIN FOR EARLY PREDICTION OF TYPE 2 DIABETES AND CARDIOVASCULAR RISK.
Authors: Moya Elena Amoroso , Nicollade Marcelo , Cellery Herbarth Torres 
Published: November 2022

Abstract

Different studies report that visceral fat percentage, visceral adiposity index (VAI) and body mass index (BMI) are considered markers of dysfunction and adipose tissue distribution, which are considered early detection tools and indirect expression of cardio metabolic risk; however it is also reported that post prandial glucose and insulin are abnormalities that detect early type 2 diabetes and cardiovascular risk, due to their toxic effect on the vascular endothelium. The objective of the research was to evaluate the association of body composition, glucose and insulin postprandial for early prediction of diabetes and cardiovascular risk. It is a non-experimental study of cross-sectional design, in a total population of 271 adults between the ages 19 and 65 years, without diabetes, in a non-random sample calculated with 95% confidence level of patients attending outpatient clinics of private and IESS hospitals of Riobamba. Descriptive statistics were performed for all variables. With the variables related to cardio metabolic risk such as age, sex, abdominal circumference, mean arterial pressure, BMI, visceral fat and biochemical measures of HbA1c, fasting glucose, postprandial glucose and insulin, HOMA-IR index, and HDLC, triglycerides, cardio vascular risk index given by the ratio triglycerides/HDLc cholesterol over 3.5. These variables were grouped by a multivariate cluster analysis, kmeans, and two homogeneous groups were obtained, different from each other and different from the others, and then the average cardiovascular risk in each group was calculated. A 9: 1 ratio of women/men was found, for cluster 1 the average age was 49, and in cluster 2 it was 48 years, TAM: 87.5 mmHg, BMI: 27.12, PAB: 109 cm, visceral fat 12.79 and cardiovascular risk 4.78. In group 2 with predominance in cluster 2 the average values of the variables studied were significantly higher with a statistically significant p value for the differences between groups of postprandial glucose and insulin (p less than 0. 05).

Conclusions
postprandial glucose and insulin are early predictors of cardiovascular risk and diabetes. Key words: postprandial glucose, postprandial insulin, cardiovascular risk, body composition.
Presentation: No date and time listed
ODP240 Routine Glucose-lowering Therapies and Risk of Adverse Outcomes in COVID-19 Patients with Diabetes: a Network Meta-analysis
Authors: Zhu Zheng , Chen Gang 
Published: November 2022

Abstract

Background
We aimed to evaluate the mortality of eight glucose-lowering therapies for COVID-19 patients with diabetes prior to diagnosis of COVID-19.

Methods
We searched PubMed, Embase, Cochrane Central Register, Web of Science, and ClinicalTrials.gov through June 2021. COVID-19 patients with diabetes while receiving glucose-lowering therapies for at least 14 days prior to COVID-19 confirmed were included. The Newcastle Ottawa scale (NOS) was used to assess the risk of bias in nonrandomized studies. Bayesian network meta-analyses were performed.

Results
Eleven distinct observational studies (3,631,682 COVID-19 patients with diabetes mellitus) were included. Compared with insulin, DPP4i, secretagogues, glucosidase inhibitors, and thiazolidinediones, the incidence of adverse outcomes in diabetics who took SGLT2i was relatively lower: OR 0.30 (95% CrI 0.17-0.55); 0.42 (0.24-0.83); 0.43 (0.24-0.83); 0.32 (0.16-0.70); 0.47 (0.23-0.95). The SUCRA value of SGLT2i was the lowest (1.8%), followed by GLPIRA (22.1%) and biguanides (33.3%).

Conclusion
SGLT2I may be an optimal choice for diabetics before COVID-19 infection. GLP1RA and guanidine can also be a good choice for the protection of diabetics during COVID-19 pandemic times.
Presentation: No date and time listed
ODP242 Safety of SGLT2-Inhibitors in Patients with Multiple Myeloma and Diabetes
Authors: Shyu Margaret , Rosa Tracey , Mazori Alon , Gallagher Emily 
Published: November 2022

Abstract

Background
An estimated 10-20% of patients with multiple myeloma (MM) have type 2 diabetes (T2DM). About half of patients with MM will experience renal insufficiency,the risk of which increases in the setting of T2DM. While sodium-glucose cotransporter 2 inhibitors (SGLT2i) are beneficial in patients with chronic kidney disease (CKD) due to diabetic or hypertensive nephropathy, the role of SGLT2i in MM-related CKD is unknown. Moreover, as MM therapies target the immune system, concurrent use with SGLT2i may increase the risk of adverse events such as infections. The current work is the first to examine the potential benefit and safety of SGLT2i in patients with MM and T2DM.

Methods
This study was approved by the Institutional Review Board. A retrospective cohort study was performed on patients aged 18 years or older with MM who received SGLT2i therapy between March 2013 and December 2020 at a quaternary academic medical center. Electronic medical records were reviewed for the following data: demographics, comorbidities, MM parameters, medication and medical history, SGLT2i usage and duration, and hemoglobin A1c(HbA1c) and serum creatinine pre- and post-SGLT2i initiation. Data are presented as mean ± standard deviation or counts and percentages, and was analyzed using SPSS software (version 25. 0, IBM Corp).

Results
In total, 50 patients were identified. Patients who were diagnosed with MM after initiation of SGLT2i (n= 12), did not have any MM data available (n=1), or for whom SGLT2i usage could not be verified (n= 4) were excluded. Thirty-three patients were included in the final analysis. The mean age was 63 (±7.8) years, 63.6% were male, and 87.9% had active MM or MM in remission. Most had received stem-cell transplantation (55. 0%) and multiple lines of chemotherapy (63.6%) prior to SGLT2i initiation. The average HbA1c was 7.4% (±1.2%) and 20% of patients had CKD prior to SGLT2i initiation. The overall SGLT2i discontinuation rate was 42.4%, and the mean duration of therapy was 2.2(±1.5) years. Notably, 21.4% of discontinuation events were due to an increase in creatinine; however, for the entire cohort, there were no statistically significant changes in serum creatinine, total body weight, HbA1c, or 24-hour urine protein at 15 months’ follow-up. Other reasons for SLGT2i discontinuation included loss to follow-up, change of health insurance coverage for SGLT2i, and unrelated hospital admission. Genitourinary infection was not cited as a reason for any SGLT2i discontinuation.

Conclusion
SGLT2i therapy may be safe in patients with MM and T2DM, but no benefit was found with respect to serum creatinine, HbA1c, or 24-hour urine protein. Prospective research is required to further evaluate the potential benefit and safety of SGLT2i therapy in this population.
Presentation: No date and time listed
ODP253 Utilizing EMR Optimization to Streamline Inpatient Blood Glucose Management and Improve Clinician Efficiency
Authors: Mathews Tony 
Published: November 2022

Abstract

Introduction
Diabetes mellitus is a common disease that is prevalent in over 30.3 million people in the US. The annual cost of diabetes related inpatient care is over $97 billion. Poor glycemic control has been associated with increase hospital length of stay, increased cost and increased mortality. One of the challenges faced by clinicians in managing inpatient blood glucose is the lack of easy access to necessary data. The various pieces of information needed for comprehensive inpatient blood glucose management were in different parts of the EMR and required multiple clicks to access. The glucose flowsheet 2. 0 was created to remedy this problem. The flowsheet aggregated data necessary onto one screen and displayed it in a context specific manner. The flowsheet aimed to decrease the amount of time spent and the number of clicks needed to gather data clinicians need to manage blood glucose in inpatients. Method/Quality Improvement action: Glucose flowsheet 2. 0 aggregates the following information. Blood Glucose, Fingerstick Glucose, A1c, Dextrose infusions, Steroid (name/dosing), Tube feeds (name/rate), Nutritional Supplement (name//frequency), Percentage of Meal eaten, Vasopressors and Creatinine/GFR. After the flowsheet went live inpatient providers and nursing staff were sent an email educating them about the changes to diabetes flowsheet and how to access it. Six Months after the diabetes flowsheet went live a 6-question survey was sent to approximately 300 residents and advanced practitioners taking care of inpatients and received 69 responses.

Results
The survey had a response rate &gt;20% with a confidence interval of 90% and less than 10% margin of error between the survey responders and the population of clinicians involved in adult inpatient management. 90.7% of survey respondents agreed/strongly agreed "flowsheet 2. 0 gives me relevant and up to date information needed manage blood glucose for hospitalized patients." 87.7% of respondents agreed/strongly agreed that "allows me to view more relevant diabetes and blood glucose related data than on one screen compared to glucose flowsheet 1. 0." 80% and 85% of participants agreed/strongly agreed that the flowsheet 2. 0 improved efficiency by reducing time needed and clicks required to gather necessary data for inpatient blood glucose management. 80.6% of respondents agreed/strongly agreed that "Glucose Flowsheet 2. 0 helps me to save time without compromising quality of diabetes care." 80.6% of respondents agreed/strongly agreed that "the changes implemented in the Glucose flowsheet 2. 0 makes it more likely for me to minimize, prevent, identify or correct errors". Clinicians found the optimization of EMR to be a net positive that saves time without compromising quality of care. This quality improvement project shows that data presented in EMR can be optimized in a context specific manner to improve clinicians’ sense of efficiency.
Presentation: No date and time listed