bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBSUN288 Improved Glycemic Control Following Oophorectomy In A Post-menopausal Woman With Ovarian Hyperthecosis
Authors: Learned Brooke Noelle , Eschler Deirdre Cocks , Obici Silvana 
Published: November 2022

Abstract

Introduction
While androgens are associated with decreased risk for type 2 diabetes in males, the opposite is seen in females. Despite this, a "chicken or the egg" argument exists regarding hyperandrogenism and insulin resistance in women. Ovarian hyperthecosis, a condition that mostly affects post-menopausal women, causes androgen excess due to hyperplasia of the theca interna of the ovaries. Akin to polycystic ovarian syndrome, it is associated with obesity and insulin resistance. We describe a case of ovarian hyperthecosis in a woman with type 2 diabetes with improved glycemic control following oophorectomy.

Case
A 63-year-old post-menopausal female with a history of autoimmune hepatitis, primary biliary cirrhosis, and chronic pancreatitis presented for recently diagnosed type 2 diabetes, discovered on routine point-of-care Hemoglobin A1c (HbA1c) testing in December 2020 (HbA1c 7.1%, weight: 86 kg). In January, she started repaglinide which was titrated to 2 mg with meals, also that month started prednisone for autoimmune hepatitis. Despite tapering doses of prednisone, her hyperglycemia paradoxically worsened and persisted following completion in June. In May, HbA1c was 7.8%. In August, she endorsed hirsutism, present for 2 years but worsening over the past few months. Labs showed elevated total testosterone (508 ng/dL), free testosterone (32.7 pg/mL), and androstenedione (305 ng/dL), with normal sex hormone binding globulin. DHEA-S was low (28.9 ug/dL, range: 29.4-220.5), midnight salivary cortisol was elevated (0.12 mcg/dL; range: &lt;0. 09), and morning serum ACTH and cortisol were within normal range, with appropriate suppression to dexamethasone. Estradiol was above post-menopausal range (68.1 pg/mL; range: &lt;6. 0-54.7). FSH and LH were within the post-menopausal range, with an approximate 1: 1 ratio. A pelvic ultrasound revealed two intramural myomas and a simple cyst of the right ovary, but otherwise unremarkable. She underwent bilateral salpingo-oophorectomy in October 2021. Post-surgical total testosterone was 27 ng/dL. Surgical pathology revealed unremarkable fallopian tubes and bilateral stromal hyperplasia and hyperthecosis of the ovaries. At one month follow-up, HbA1c was 6.5%, weight decreased from 89 kg pre-surgery to 86, and she endorsed improved hirsutism but frequent hypoglycemia on repaglinide 2 mg with meals. Repaglinide was decreased to 0.5 mg with meals. Three months later, HbA1c was 6.3% with unchanged weight.

Conclusion
Improved glycemic control, corresponding with timing of oophorectomy but not discontinuation of steroids, suggests insulin resistance in this case may be due to hyperandrogenism. Though some studies and case reports suggest hyperandrogenism causes insulin resistance, others suggest the contrary. The relationship between androgens and insulin sensitivity is likely complex, and further research is necessary.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP160 ADCES7 Guidelines and Free Diabetes Apps: Do They Help Our Patients?
Authors: Wu Gloria , Xia Alexander , Zhao Weichen , Tien Katherine , Chien Daniel 
Published: November 2022

Abstract

Background
In 2020, 34.2 million US adults had diabetes and 88 million had pre-diabetes. 1 The ADCES7 guidelines are aimed at self-care and use 7 criteria: Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risk, and Problem Solving. 2 Purpose: Do Diabetes Apps Fulfill ADCES7 Guidelines to Meet Patient Needs? Methods: We used the search term "diabetes" in the Google Play store (Android/AD) and Apple App store (iOS) to compile a list of the most popular, free Android and iOS apps. Inclusion criteria: Free, English language,&gt;100,000 Android downloads(DL),&gt;1,600 iOS reviews(RE). iOS apps only provide the number of reviews and no download data. ADCES7 Parameters: 1) Goal setting; 2) Calorie counting; 3) Nutrition education; 4) Exercise reminder; 5) Medication reminder; 6) Blood glucose; 7) Weight; 8) Blood pressure; 9) HbA1c; 10) Problem solving; 11) Reducing risk; 12) Insulin information; 13) Insulin pumps information; 14) Non-English options.

Results
AD(DL): 1-mySugr(1M),2-OnetouchReveal(1M),3-DiabetesBloodSugar(1M),4-BloodGlucoseTracker(500K),5-Diabetes(500K),6-Health2Sync(500K),7-DiabetesM(500K), 8-GlucoseBuddy(500K), 9-BeatDiabetes(100K), 10-DiabetesDiary(100K); iOS(RE): 1-OnetouchReveal(87K), 2-GlucoseBuddyDiabetesTracker(21K), 3-Onedrop(20K), 4-GlucoseBloodSugarTracker(17K), 5-Livongo(13K), 6-mySugr(9.6K), 7-Sugarmate(9.4K),8-Klinio(3K), 9-Glooko(2.2K), 10. Diabetes Logs (1.6K). Features: Goal setting=9/20 apps (AD=4, iOS=5); Calorie counting=10/20 apps (AD=5, iOS=5); Nutrition education=9/20 apps (AD=3, iOS=6); Exercise reminder=7/20 apps (AD=2, iOS=5); Medication reminder=11/20 apps (AD=5, iOS=6); Blood glucose=18/20 apps (AD=10, iOS=8); Weight=9/20 apps (AD=6, iOS=3); Blood pressure=10/20 apps (AD=6, iOS=4); HbA1c=11/20 apps (AD=6, iOS=5); Problem solving=12/20 apps (AD=8, iOS=4); Reducing risk=7/20 apps (AD=5, iOS=2); Insulin info=7/20 apps (AD=3, iOS=4); Insulin pumps info=1/20 apps (AD=0, iOS=1); Non-English options=12/20 apps (AD=3, iOS=9) Conclusion: Current apps use some ADCES7 guidelines. 2 As healthcare providers, we can provide guidance and oversight when our patients use current apps for diabetes self-care and diabetes . References: CDC. National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed January 17, 2022. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html ADCES7 Self-Care Behaviors- The Framework for Optimal Self-Management. Accessed January 17, 2022. https://www.diabeteseducator.org/practice/practice-tools/app-resources/the-aade7-self-care-behaviors-the-framework-for-optimal-self-management
Presentation: No date and time listed
ODP167 Bell's Palsy As A Possible Post-Covid-19 Complication In Patient With Type 2 Diabetes
Authors: Kostitska Iryna , Matkovska Nataliya , Hutsuliak Nadiia , Zherdova Nadiia , Piddubna Antonina , Zhurakivska Oksana , Zhurakivska Olga 
Published: November 2022

Abstract

Background
Diabetes is associated with increased risk of post COVID-19 infection complications which has been postulated to be due to uncontrolled carbohydrate, fat metabolism and raised insulin resistance. Bell's palsy (BP) is an idiopathic unilateral facial paralysis that constitutes the most common cause immune response after a viral infection.

Clinical Case
A 48- years-old male with type 2 diabetes (BMI-35,3 kg/m 2,HbA1C- 7.6%). He was on regular treatment with metformin(daily doses (DD)– 1500 mg)for the last five years. Before 4 months for hospitalization in the patient was positive nasopharyngeal polymerase chain reaction (PCR) test for SARS-CoV-2 and he didn't develop clinical symptoms of COVID-19, that confirmed asymptomatic coronavirus disease. The male had no history of trauma or systemic infection, and presented no skin eruptions compatible with herpes zoster infection. There were asymmetric wrinkling of the forehead inability to raise the right eyebrow, failure to close the right eyelid, and right deviation of the angle of the mouth (right-sided droop), suggesting right seventh cranial nerve palsy of lower motor neuron type. Signs of meningeal irritations were absent. The neurologist confirmed the diagnosis of right unilateral BP. On hospital stay the patient was treated: metformin (DD – 2000 mg), dapagliflozin (DD – 10 mg), and subcutaneous insulin degludec (DD – 22 units); oral prednisolone at 40 mg/day for one week, which was subsequently tapered to 35 mg/day for 7 days and 30 mg/day for the next 7 days, with a total of 2 months of treatment and assigned to 15 sessions of acupuncture treatments during 10 minutes 5 times/week. The result discussion of clinical studies that diabetes was not a poor prognostic indicator if treated with corticosteroids in diabetic BP patients. Facial palsy started improving after 15 days of admission, and throat swab PCR for SARS-CoV-2 came negative during hospitalization. He was discharged on the 23th day of admission. After3 months, the treating team contacted the patient by phone and realized that he was in good condition, and his facial weakness had improved significantly. However, there are still some residual weaknesses. The sixth months therapy resulted in patient's recovery functions of right seventh cranial nerve and compensation of type 2 diabetes was achieved (HbA1C-7. 0%).

Conclusion
We assume that our patient got BP secondary to post-COVID-19 complication. These findings support the use of corticosteroids and sessions of acupuncture when necessary for treatment of post-COVID-19 neurological complications in subjects with diabetes. We believe that further research should be conducted to clarify the pathogenic association between COVID-19 and BP in patients with type 2 diabetes and improve algorithm of treatment.
Presentation: No date and time listed
ODP185 Diabetic Retinopathy Prevalence in Pediatric Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Authors: Cioana Milena , Deng Jiawen , Nadarajah Ajantha , Hou Maggie , Qiu Yuan , Chen Sondra Song Jie , Rivas Angelica , Toor Parm Pal , Banfield Laura , Thabane Lehana , Chaudhary Varun , Constantine Samaan M 
Published: November 2022

Abstract
Type 2 diabetes mellitus (T2DM) is on the rise in children and adolescents. Diabetic retinopathy (DR) is a leading cause of blindness in adult patients with diabetes. However, the exact prevalence of DR and its determinants in pediatric patients with T2DM are unknown. Understanding the burden of DR in pediatric T2DM can help inform screening and management clinical practice guidelines. This systematic review and meta-analysis aimed to determine the prevalence and determinants of DR in pediatric T2DM. The main outcome was the pooled prevalence of DR in pediatric T2DM. Other important outcomes included the assessment of the impact of diabetes duration, method of retinopathy diagnosis, sex, race, and obesity on prevalence. We searched MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and the grey literature from inception until April 4, 2021 for relevant data. No language restrictions were applied, and searches were limited to human studies. Two reviewers independently screened for studies of T2DM patients diagnosed &lt;21 years of age with observational study design and ≥10 participants. Risk of bias evaluation was performed and level of evidence analysis was conducted using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was used to pool the results. Out of 1849 screened studies, 24 studies met the inclusion criteria. The overall prevalence of DR in pediatric T2DM was 6.58% (95%CI 3.46-10.46, I 2 =96%,n=9026). Most cases were classified as minimal or mild non-proliferative DR. Six cases were sight-threatening. Prevalence was higher in studies using fundoscopy than fundus photography to evaluate DR (0.47% [95%CI 0. 00-3.30, I 2 =0%,n=135] vs. 18.20% [95%CI 7.92-31.28, I 2 =89%,n=718]), suggesting that fundus photography was more sensitive in detecting DR than fundoscopy. The risk of DR rose progressively post-diagnosis; while1.25% (95%CI 0. 00-4. 01, I 2 =13%,n=213) of patients had DR &lt;3 years post T2DM diagnosis, this figure rose to33. 03% (95%CI 25.79-40.66, I 2 =0%,n=162) &gt;5 years after diagnosis. Obesity and sex did not impact DR prevalence. White/Middle Eastern patients had a DR prevalence of 7.43% (95%CI 0. 00-31.37; I 2 =97%,P &lt;0. 001, n=4419),while Asians had a higher prevalence of 14.85% (95%CI 0.91-39.16; I 2 =93%,P &lt;0. 001, n=501). In conclusion, DR is a frequent complication in children and adolescents in the early years post T2DM diagnosis. Screening for DR at diagnosis and annually thereafter using fundus photography is critical to allow early detection and management to prevent visual impairment in these patients.
Presentation: No date and time listed
ODP191 Efficacy of Protocol Based Insulin Dosing in Post-Surgical Hyperglycemia Management of Kidney Transplant Recipients
Authors: Zia Maryam , Ullal Jagdeesh , Donihi Amy , Sood Puneet , Wu Christine , Delisi Kristin , Hlasnik Deborah 
Published: November 2022

Abstract

Background
Post-operative renal transplant recipients with diabetes mellitus are managed by ad hoc insulin regimen which is highly variable among providers and transplant centers. We implemented a standardized insulin dosing protocol after renal transplantation based on several key variables particularly post-transplant steroid use.

Methods
The standardized insulin dosing protocol was implemented on July 1st, 2020. Patients with a history of diabetes mellitus who underwent renal transplants from July 2020-July 2021 were reviewed. After being seen by the endocrinology consultation service, a weight-based insulin dosing protocol based on corticosteroid dose was started and continued for 5 days postoperatively. As a control, data from patients who underwent renal transplantation between January 2019 to December 2019, and were seen by endocrinology for post-op hyperglycemia management, was collected in an identical fashion.

Results
The post protocol implementation group (N=39) had an average age of 59.6 and of BMI 31 kg/m2 with the majority being type II diabetes mellitus (84%). The control group (N=40) had an average age of 60.4 and BMI of 33 kg/m2. Type II diabetes mellitus similarly represented at 82%. Post-op inpatient target blood glucose was 101-180. Fasting and postprandial blood glucose (BG) data were gathered after chart review. Five hundred fifty-five fasting blood glucose (FSBG) checks were included for post protocol group vs 628 for the control group. Blood glucose was within the target range 37.8% for the protocol group and 28.9% for the control group. There were 8 (1.4%) hypoglycemic episodes (BG &lt;70) in intervention group vs 5 (0.79%) in control group. Hyperglycemia was stratified into 3 tiers: 181-220, 221-300, &gt;300. Hyperglycemia (BG 241-300) was observed 14.9% in the post protocol group vs 22.7%. Severe hyperglycemia (BG&gt;300)was documented in 7.3% post protocol vs 15.6%. Among the post protocol group, no patient was started on insulin drip whereas 5 patients were started on insulin drip in the control groups.

Conclusion
Renal transplantation patients are susceptible to hypo- and hyperglycemic events leading to poor graft outcomes. Glycemic control is central in reducing event rates. Post renal transplantation diabetes management using a graded insulin protocol in accordance with steroid dosing was highly efficacious in our academic medical center. Using a standardized insulin protocol patients demonstrated superior glucose control and less IV insulin usage.
Presentation: No date and time listed
ODP200 Fyn is involved in the development of diabetic kidney disease by modulating autophagy
Authors: Uehara Ryota , Yamada Eijiro , Horiguchi; Kazuhiko , Yamada Masanobu 
Published: November 2022

Abstract
Diabetic kidney disease (DKD) is one of the major diabetic complications and the leading cause of the end stage renal disease. Recently autophagy was shown to regulate DKD. Previously we reported that Fyn regulates muscle mass by suppressing autophagy through Fyn-STAT3 signaling pathway. More recently, we demonstrated that Fyn also inhibits autophagy in HK2 cells, in vitro cell model of renal proximal tubular epithelial cells (RPTC). Moreover, we found Y369 of Tgm2, a known inhibitor of autophagy, is directory phosphorylated by Fyn both in vitro and in cells and Fyn-dependent phosphorylation of Tgm2 regulates autophagy in RPTC. It has been reported that Tgm2 forms complexes with p53 and p62 (a known autophagy regulator) to mediate the degradation of p53 at autophagosomes in cancer cells. To note is that p53 could function as a DKD inducer. We found that p53 expression was decreased in Tgm2 knock-downed HK2 cells, suggesting that Tgm2-p62-p53 complex also modulates autophagy in RPTC. Since these were only in vitro studies, we proceeded with those in vivo. In HFD fed mice, diet-induced rodent models of metabolic disorders, we found that protein expression of p53 was increased due to decreased levels of autophagy implicated by decreased p62 punctuations in RPTC. To confirm the role of Fyn in autophagy and p53 expression we took advantage of a diabetic mouse model of FynKO mice induced by Streptozocin(STZ). While p53 was increased in the kidney of diabetic WT mice induced by STZ, it was not the case in the kidney of diabetic FynKO, indicating that Fyn could regulate autophagic activity and p53 expression. Taken together, these data suggest that the metabolic status may regulate Fyn to phosphorylate Tgm2 and modulate Tgm2-p62-p53 complex leading to the development of DKD. This regulatory mechanism is not mediated by blood glucose and may lead to the new therapeutic targets for diabetic kidney disease regardless of control of diabetes.
Presentation: No date and time listed
ODP211 Impact of Race and Chronic Kidney Disease on the Correlation between HbA1c and Continuous Glucose Monitoring (CGM) Glycemic Measures
Authors: Kaplan Leah , Anwar Kanwal , Pittas Anastassios 
Published: November 2022

Abstract

Objective
To determine whether the correlation between hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) derived glycemic measures differs by patient race and stage of chronic kidney disease (CKD).

Methods
Two hundred thirty patients with type 1 or type 2 diabetes and a minimum of 10 days of CGM data collected with the Freestyle Libre CGM (personal or professional) immediately before measurement of HbA1c were included in this clinic-based observational study. The correlation between HbA1c and CGM derived glycemia was analyzed by race and by CKD stage. Similar analysis was performed between HbA1c and CGM derived time-in-range (TIR, glucose 70-180 mg/dL).

Results
Mean age ± SD of patients was 63 ± 14 years. 45.7% of patients self-identified as White, 31.3% as Asian, and 15.7% as Black; 84.3% of patients had type 2 diabetes and mean HbA1c was 7.9%. The mean [range] number of CGM days was 40.5 [10-90]. Correlation between HbA1c and CGM mean glycemia for all patients was r=0.75. Correlations for White, Asian and Black patients were 0.84, 0.75, and 0.54 respectively. Correlation between HbA1c and CGM mean glycemia among CKD stage 1, 2 and 3 was 0.894, 0.723 and 0.717, respectively (all patients, regardless of race). Correlation between HbA1c and TIR was r=-0.71 for all patients. Correlations between HbA1c and TIR for White, Asian, and Black patients were -0.78, -0.73 and -0.42, respectively.

Conclusions
The correlation between HbA1c and CGM mean glycemia appears to differ by race and CKD stage. These results have implications when using correlations between HbA1c and CGM mean glycemia to derive equations for the Glucose Management Indicator.
Presentation: No date and time listed
ODP215 Insulinoma Evaluation Before and After Development of End Stage Renal Failure: A Case Report
Authors: Pattison Jillian , Merrill Jennifer 
Published: November 2022

Abstract

Introduction
Fasting hypoglycemia in chronically ill patients with kidney disease is frequently multifactorial. Patients with chronic kidney disease are prone to hypoglycemia due to decreased renal clearance of insulin, impaired renal gluconeogenesis and increased prevalence of other medical problems and medications. However, ruling out the presence of an insulinoma can be difficult in this patient population due to the impact of kidney disease on laboratory evaluation of hypoglycemia.

Case
A 43-year-old male with history of paraplegia from gunshot wound, neurogenic bladder, colostomy, chronic osteomyelitis, frequent polymicrobial bacteremia was noted to have persistent, asymptomatic hypoglycemia during multiple inpatient hospitalizations dating back to 2007. He was taking no medications associated with hypoglycemia. Following normal ACTH stimulation and thyroid testing, he underwent a 72-hour fast in 2017 when his creatinine was 1.32 mg/dL and GFR was &gt;60; BMI was 22.32 kg/m 2 with prealbumin of 15 mg/dL. The fast was concluded after 23.5 hours with serum glucose of 46 mg/dL, insulin level of 3.1 uIU/mL, c-peptide of 2.4 ng/mL, undetectable proinsulin, and beta-hydroxybutyrate of 0.62mmol/L and a negative sulfonylurea screen. Administration of glucagon at time of fast completion improved glucose to 65 mg/dL. He was started on diazoxide 85mg every 8 hours during that hospitalization, which he discontinued without medical recommendation in 2018. He developed end stage renal disease requiring hemodialysis in 2019. During an admission in 2020, serum fasting glucose as low as 30mg/dL. Further laboratory evaluation at that time revealed glucose of 47 mg/dL, with insulin level 39.1 uIU/mL, c-peptide 18.2 ng/mL, and proinsulin of 20.1 pmol/L. Multiple CT abdomen imaging studies confirmed normal pancreas. Diazoxide 110mg every 8 hours was resumed and patient had decreased frequency of hypoglycemia episodes. Diazoxide has since the tapered to 80mg twice daily without increase in hypoglycemia frequency, with goal to taper further in the future.

Conclusion
Here we present the case of an individual patient who underwent laboratory evaluation of hypoglycemia before and after development of end stage renal disease with profound differences in lab results despite similar degree of hypoglycemia. It has been demonstrated previously that c-peptide and insulin levels are elevated in patients with end stage renal disease and that these labs decrease with hemodialysis while remaining above normal range. The elevation of c-peptide in this population is thought to be due to the kidney being the main site of beta-cell polypeptide degradation. Additionally, this case suggests successful use of diazoxide therapy in patients without classic endogenous hyperinsulinism.
Presentation: No date and time listed