bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBODP037 Acute Foot Drop In An Adolescent With Type 1 Diabetes Mellitus At Onset: A Case Report
Authors: Albasri Eman Ebrahim , Al-Sofiani Mohammed E 
Published: November 2022

Abstract

Background
The incidence of type 1 diabetes (T1D) among youth is on the rise worldwide. Diabetic neuropathy is often a late manifestation of diabetes and usually results from the exposure to prolonged hyperglycemia, oxidative and inflammatory stress, and dyslipidemia. Here, we report a case of painless diabetic mononeuropathy as the presenting symptom of T1D that improved shortly after the improvement in glycemic control. Clinical case A previously healthy 15-year-old boy, presented to the emergency department (ED) with left foot weakness and dragging for 1 week. This was preceded by numbness over the left lateral leg and dorsum of the left foot. There was no history of trauma. The patient reported a history of polyuria, polydipsia, and significant weight loss for 3 months, for which he did not seek medical care. There was no family history of diabetes, hereditary neuropathy, or autoimmune diseases. Upon presentation to the ED, a general physical examination was unremarkable with a weight of 60 Kg (BMI= 20 Kg/m2), neurological examination revealed weakness in the dorsiflexion of the left foot (3/5), eversion (4/5), and normal sensation and reflexes. The remainder of the neurological examination including the right foot, upper extremities, cerebellar functions, cranial nerves and monofilament and vibration sensory testing was normal. Fundoscopic exam showed no evidence of retinopathy. The initial laboratory investigations revealed mild DKA (PH 7.28, HCO3 16mmol/L, Na 137 mEq/L, random blood glucose of 306 mg/dl, positive blood ketones) and normal kidney function. A nerve conduction study showed moderate left peroneal motor axonal neuropathy, with normal sensory nerve action potentials. Brain CT scan was unremarkable. Further tests to rule out secondary causes of neuropathy (ANA, B12 level, and thyroid function) were within normal. The diagnosis of diabetes-related mononeuropathy was confirmed by the neurology team and the patient underwent physiotherapy. After the resolution of DKA, the patient continued to use basal/bolus insulin therapy and was discharged home with close follow-up of blood glucose readings. His glycemic control has improved, and the patient reported a significant improvement in the foot drop 3 weeks later. A repeated examination by the neurology team 3 months later confirmed a complete recovery of the left foot drop.

Conclusion
Acute diabetic mononeuropathy can be an unusual presenting feature of T1D and may pose a diagnostic challenge. Although diabetic mononeuropathy is often a late complication of diabetes, our patient presented with acute mononeuropathy at the onset of T1D. This case highlights the importance of early diagnosis and management of diabetes to prevent and sometimes reverse diabetic neuropathy. It also shows that a complete recovery of acute diabetic mononeuropathy can be achieved by improving glycemic control in patients with newly diagnosed T1D.
Presentation: No date and time listed
LBODP055 Discrimination Effectiveness Of Radiofrequency Echographic Multispectrometry As Non Invasive Method For Osteoporosis Diagnosis Applied To Elderly Women With Type 2 Diabetes
Authors: Caffarelli Carla , Pitinca Maria Dea Tomai , Refaie Antonella A , Giglio Elisa , Lombardi Fiorella Anna , Gonnelli Stefano 
Published: November 2022

Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fracture, although bone mineral density (BMD) is unaltered or higher in diabetic patients, measured by Dual-energy X-ray absorptiometry (DXA). This paradox could be explained from compromise bone microarchitecture that induce abnormal bone cell function and matrix structure, with increased osteoblast apoptosis, diminished osteoblast differentiation, and enhanced osteoclast-mediated bone resorption.1 In this context, a non-invasive method for assessing the bone density and quality on the axial reference sites (lumbar spine and proximal femur) called Radiofrequency Echographic Multi Spectrometry (REMS), has been introduced and clinically validated. This study aimed to evaluate whether the use of the REMS technique may improve the identification of osteoporosis in T2DM patients. A cohort of ABOUT 100 elderly women with T2DM and mean age 70.5 (± 7.6) years, and 100 healthy age-matched controls underwent DXA and REMS scans on the same anatomical sites (lumbar spine and proximal femur). DXA measurements were all higher in T2DM than controls; instead, all REMS​​ measurements were lower in T2DM than controls. Moreover, the percentage of T2DM women classified as "osteoporotic", on the basis of BMDREMS was markedly higher with respect to those classified by BMDDXA (47. 0% vs 28. 0%, respectively). On the contrary, the percentage of T2DM women classified as osteopenic or normal by BMDDXA was higher with respect by BMDREMS (48.8% and 23.2% vs 38.6% and 14.5%, respectively). T2DM women with fragility fractures presented lower values of both BMDDXA and BMDREMS at the lumbar spine with respect to those without fractures; however, the difference was significant only for BMDREMS (p&lt;0. 05). In conclusion, BMDDXA, as expected, were higher in women with T2DM, while BMDREMS were lower in women with T2DM with respect to controls. Therefore, the data suggest that REMS could be a good diagnostic tool in demonstrating the diabetes-associated bone disease, due to its ability to assess bone quality2 and that may represent a useful approach to enhance the diagnosis of osteoporosis in patients with T2DM.1. Sanches, C. P., et al. The impact of type 2 diabetes on bone metabolism. Diabetol. Metab. Syndr. 9, 1-7 (2017).2. Adami, G. et al. Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures: A 5-year follow-up study. Bone 134, 115297 (2020).
Presentation: No date and time listed
LBODP056 Factors That Associate With Under-diagnosing Prediabetes In Primary Care: A Retrospective Study
Authors: Nguyen An V , Nguyen Quoc , Fujioka Ken 
Published: November 2022

Abstract
Diabetes is the leading risk factor for cardiovascular diseases and other comorbidities that significantly reduce the quality of life. Prediabetes is the preceding condition that increases the risk of Type 2 Diabetes Mellitus (T2DM). The Diabetes Prevention Program Outcomes Study (2002-2014) shows that regression from prediabetes to normoglycemic level is associated with a reduction in cardiovascular risk, while such reduction going from diabetes to normal glucose was not statistically significant. As such, it is critical that patients are screened, diagnosed, and counseled for the treatment of prediabetes. This study investigates how well a large hospital system in suburban San Diego, California diagnoses prediabetes and determines if patient demographics could help explain the missed diagnoses. Patient records from five outpatient clinics under Scripps Health who qualified for the diagnosis of prediabetes determined from either more than one fasting blood glucose (FBG) 100-125 mg/dL, or Hemoglobin A1c (HbA1c) 5.7-6.4% between 2018-2020 were reviewed. Factors such as age, race, sex, body mass index (adjusted for different races), and comorbidities were compared between the correctly diagnosed and missed diagnosed. Only 37% of the qualifying patients were diagnosed with prediabetes or impaired fasting blood glucose; of these patients 93% qualified by HbA1c. Of the factors reviewed, overweight and obesity, female sex, Asian race, comorbidities including lipid disorders, and conditions requiring systemic steroids are positively correlated with a correct diagnosis of prediabetes. Factors like male sex, Black/African American race, comorbidities requiring immunosuppressants, antineoplastics, and iron replacements are negatively correlated with a correct diagnosis. This study demonstrates that prediabetes was grossly underdiagnosed, and the diagnosis seems to be made primarily by HbA1c. These data suggest that the convenience of HbA1c and patients’ BMI, race, gender and comorbidities play a role in healthcare providers’ screening for and making the diagnosis of prediabetes.
Presentation: No date and time listed
LBODP060 Abnormal Endothelial Dysfunction Is Already Present Among Individuals With Pre-impaired Glucose Tolerance (Pre-IGT)
Authors: Salmon Jeannine Ann O , Magbuhat Ann Lorraine B , Guerrero-Sali Ruby Jane , Purino Francis Marie C , Macindo John Rey B , Mercado-Asis Leilani Basa 
Published: November 2022

Abstract
Pre-impaired glucose tolerance (pre-IGT) is the stage of compensated hyperinsulinemia and the earliest stage of dysmetabolism in the pathophysiology of type 2 diabetes mellitus (DM). Endothelial dysfunction is a critical pathogenic process for the development of macrovascular and microvascular complications due to uncontrolled hyperglycemia among patients with type 2 diabetes mellitus. In pre-IGT, the main problem is hyperinsulinemia on a background of normal blood sugar. C-peptide, a segment cleaved off from pro-insulin and is equimolar to insulin has been shown to cause intima media thickening when present in increased amount. We hypothesize that in high risk individuals with prolonged hyperinsulinemia, endothelial dysfunction is already present in the prediabetes state. This study was undertaken to determine the following: (1) prevalence of endothelial dysfunction among individuals with pre-IGT and (2) correlation of FMD with levels of blood sugar, serum insulin, HbA1c, BMI, systolic BP and diastolic BP. This is a cross-sectional analytical study of adult patients with risk factors for developing diabetes [first-degree relative with type 2 DM, obesity, history of gestational diabetes, and polycystic ovary syndrome (PCOS)]. Patients diagnosed with pre-IGT underwent brachial artery flow-mediated dilatation. Statistical analysis were conducted using STATA 13.1. Of the 40 high risk individuals, 25 (62.5%) was diagnosed with pre-IGT. Of the 25 individuals with pre-IGT, 19 underwent brachial FMD and abnormal FMD was already demonstrated in four. Although statistically not significant, FMD had positive correlation with 2-hr serum insulin levels and systolic and diastolic blood pressure levels, and no correlation with BMI and blood sugar values. However, as previously shown, the mean 2-hour blood sugar of the individuals with pre-IGT had statistically higher levels than those with normoinsulinemic normoglycemia (NN) (pre-IGT; 107.40 vs. NN; 75 mg/dL, p=0. 001). Our study has shown that as early as the pre-IGT stage, endothelial dysfunction has already developed. This calls for a robust early identification and management of high-risk individuals for type 2 diabetes mellitus.
Presentation: No date and time listed
LBODP062 SGLT2 Inhibition Ameliorates Cognitive And Physical Impairment In Patients With HFpEF And Diabetes
Authors: Mone Pasquale , Lombardi Angela , Frullone Salvatore , Santulli Gaetano 
Published: November 2022

Abstract

Aim
The aim of this study was to assess whether the inhibitor of sodium-glucose cotransporter-2 (SGLT2) empagliflozin improves cognitive impairment in frail older adults with diabetes mellitus (DM) and Heart Failure with Preserved Ejection Fraction (HFpEF).

Methods
We designed a prospective study to assess cognitive and physical function in consecutive frail older adults with DM and HFpEF, comparing the effects of empagliflozin, metformin, and insulin.

Results
A total of 162 frail elders with HFpEF and DM successfully completed the study. The Montreal Cognitive Assessment (MoCA) score was measured at baseline and after 1-month: 19.80±3.77 vs. 22.25±3.27 (p&lt;0. 001) in the empagliflozin group; 19.95±3.81 vs. 20.71±3.56 (p: 0.26) in the metformin group; 19. 00±3.71 vs. 19.1±3.56 (p: 0.81) in the insulin group. A multivariate regression analysis confirmed the beneficial effects of empagliflozin. Additionally, we observed a marked amelioration of physical impairment, assessed by the 5-meter gait speed test, in the empagliflozin and in the metformin arms, but not in patients receiving insulin.

Conclusions
To the best of our knowledge, this is the first study to show significant beneficial effects of empagliflozin treatment on cognitive and physical impairment in frail subjects with HFpEF and DM.
Presentation: No date and time listed
LBSUN152 The Warburg Effect And Complex Thermomics Inform Phenotypic Expression
Authors: Fredericks Robert S 
Published: November 2022

Abstract

Introduction
As technology reveals biological complexity, integration of vast clinical and multi-omic data utilizing artificial intelligence promises to clarify confusion. We have utilized challenge tests to inform algorithmic graphs recognizing heat as foundational for understanding phenotypic variation. Thermomics, describing complex thermic influences that are difficult to objectively quantify thereby compromising application to AI, are readily included in practice-derived models.

Methods
For the past 45 years cases have been evaluated with oral calcium challenge and immersion in water while observing changes in urinary composition. Between 2001 and 2010 respiratory gas exchange following a high carbohydrate meal combined with pulsatile insulin revealed metabolic variance that combined with basic, translational and clinical data of others informed generation of algorithmic graphs. COVID 19 served to clarify the effect of ACE2 disruption by predicting divergent phenotypic expression mediated by calciotropic hormones.

Results
Extraction of O2 from glucose, a consequence of fatty acid synthesis producing R/Q &gt; 1 is modeled as foundational for metabolic evolution. This Warburg effect, recognized in proliferating malignant cells, was observed at the systemic level in humans and, modeled as mediated by hypoxia inducible factors regulating glucose uptake and suppression of beta-oxidation. Higher order orchestration is governed by a signaling structure including PTH, PTHrP, FGF23, Klotho, prolactin, growth hormone, IGFs, insulin, SGLT2, thyroid, adrenal and vit D while salt inducible kinase contributes to understanding of terrestrial adaptation. Inclusion of thermomics leads to prediction of a favorable effect of sub-cutaneous adipose beiging on CNS function mediated by circulating Klotho as a constraint on FGF23 in amelioration of Long COVID by phentermine that is also effective in hypophosphatasia where the exercise induced beiging, induced by irisin is known to be dependent upon alkaline phosphatase. The post-exertional malaise of Myalgic Encephalomyelitis, where exercise induces elevation in R/Q and reduced work capacity, has informed modeling of the systemic Warburg effect. The models are further validated with mechanistic explanation for recent reports of marked increases of R/Q in human Paget's disease and CEBPb expression dependence mimicking Alzheimer's and limiting life span in mice.

Conclusions
The value of practice is demonstrated by the ability to model thermomics even when difficult to quantify. The work is validated by explanation of old conundrums, discovery of treatment for unresolved problems, facilitation of case-based discovery and integration of emerging data from basic sciences. The Warburg effect when recognized as foundational to biology, contributes to a General Theory of Metabolism applicable to effective personalization of care.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN291 Fournier's Gangrene In A Diabetic Male Taking Dapagliflozin
Authors: Patel Janki M , Shah Parth , Shah Love S 
Published: November 2022

Abstract

Background
Fournier's gangrene (FG) is a form of necrotizing fasciitis characterized by polymicrobial infection of the perineal, perianal or genital areas; risk factors include diabetes mellitus and male gender. Dapagliflozin is one of four sodium-glucose cotransporter 2 (SGLT2) inhibitors FDA-approved for the treatment of Type 2 diabetes mellitus (T2DM). SGLT2 inhibitors decrease serum glucose and increase glycosuria by binding to renal tubular SGLT2 receptors, and inhibiting reabsorption of glucose from urine in the proximal convoluted tubule. Since their introduction in 2013, SGLT2 inhibitors have been shown to protect against decline in GFR, to improve LVEF in HFrEF, and to improve survival in T2DM. However, due to associated glycosuria, SGLT2 inhibitors are commonly associated with candidiasis, and are rarely associated with life-threatening adverse effects including FG, and euglycemic diabetic ketoacidosis. | Clinical case: A 57-year-old male with T2DM, diabetic neuropathy and hypertension presented to the ED with left testicular swelling, penile discharge and dysuria of several days duration. He was afebrile and vital signs were in normal ranges. Examination disclosed left-sided scrotal swelling surrounding a 1 cm black eschar, induration, erythema and discharge. WBC 15.1 with 79% neutrophils and HbA1c 10.4%. Dapagliflozin 4 mg daily had been added to insulin degludec one month earlier. He denied previous history of scrotal/genital infections. Ultrasound of the scrotum showed wall thickening on the left, a small hydrocele and heterogenous echogenicity suggesting an abscess. Pelvic CT scan with contrast revealed multiple small air bubbles in the scrotal wall. Findings were consistent with FG. He was treated promptly with IV piperacillin / tazobactam and vancomycin. Urological debridement of necrotic scrotal skin was carried out the morning after admission; cultures obtained at surgery grew Gram neg rods and Diphtheroids. Tissues within the scrotum were not gangrenous. Primary closure with a Penrose drain was attempted, but the skin surrounding the sutures necrosed and a second urological procedure was done to remove the sutures and allow the scrotal wall to heal by secondary intention. He was discharged after 5 days and I. V. ampicillin/sulbactam was continued for a total of 14 days with resolution of infection and healing of the skin.

Conclusion
SGLT2 inhibitors decrease mortality and increase quality of life in T2DM compared to older treatments with exogenous insulin and its secretagogues. Optimal utilization of SGLT2 inhibitors in the management of patients with T2DM will entail 1) quantifying risk specifically attributable to SGLT2 inhibitors since T2DM is a known risk factor for FG, and 2) routinely informing/reminding patients with T2DM to promptly report skin infections of the groin, perineum or perianal region.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN309 The Effect Of Prebiotics In Newly Diagnosed Youth With Type 1 Diabetes (T1D)
Authors: Ismail Heba , Evans-Molina Carmella , DiMeglio Linda A 
Published: November 2022

Abstract
Acetylated and butyrylated high amylose starch (HAMS-AB) is a prebiotic that is effective in T1D prevention in mouse models. It alters the gut microbiome profile towards bacterial fermenters with increases short chain fatty acids (SCFA) production which improves glycemia, insulin sensitivity and secretion. The objective of this pilot study is to assess the effect of oral HAMS-AB for 4 weeks on glycemia, microbial metabolite and SCFA production in newly diagnosed (&lt;2 years of diagnosis) youth with T1D. Thus far, we have enrolled 7 subjects with 1 early drop out due to nausea secondary to the prebiotic. The mean±SD age in the remaining 6 was 14.4±1.8 yrs, diabetes duration 18.6±6.3 months, 4/6 were female and White, all with BMI of &lt;85th%. The prebiotic was safe and well-tolerated in all 6 who remained in the study. We assessed glycemia changes pre and post-intervention and the percent time in range (TIR) from continuous glucose monitoring data over a 4 week period increased significantly: 61. 0% vs. 71.8%, X2 18.2, p=0. 001. Stool SCFA levels were measured in 4 subjects, and butyrate levels increased post-prebiotic (8.1±9.8 vs 22.6± 6.4mmol SCFA/kg fecal material, p=0. 047). Serum and plasma Hippurate levels (a microbial metabolite associated with increased gut bacterial diversity and improved glycemia) increased significantly after 4 weeks of prebiotic consumption compared to before in all 6 individuals (p=0. 028 for serum and p=0. 033 for plasma, respectively). In summary, the prebiotic HAMS-AB was safe in adolescents with T1D. It significantly increased the percent TIR, serum and plasma Hippurate levels and stool butyrate levels. Enrollment continues as collection of samples from more participants should allow for a more conclusive analysis.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP612 Inverse Association Between Healthy Diet Status and Non-Alcoholic Fatty Liver Disease Among Patients With Diabetes Mellitus
Authors: Gu Xiao , Hu Xiang , Zhang Xingxing , Yang Lijuan , Zheng Yinfeng , Zhou Jingzong , Du Linjia , He Zhiying , Yang Bo , Gu Xuejiang 
Published: November 2022

Abstract

Objective
Aimed to investigate the associations between healthy diet status and non-alcoholic fatty liver disease (NAFLD) among patients with diabetes mellitus.

Methods
This study enrolled 2,404 participants (1,504 males and 900 females; mean age 50.18 ± 12. 06). Healthy diet status was defined based on the number of healthy diet scores and classified into three categories. Multivariate-adjusted logistic regression analyses were performed to explore the association between healthy diet status and NAFLD, presented by odds ratio (OR) with 95% confidence intervals (CI).

Results
Participants with the most healthy diet had a lower odds of NAFLD than those with the least healthy diet (OR: 0.66, 95% CI: 0.50,0.88, P = 0. 004), no significant interactions were showed between healthy diet status and strata (gender, age, diabetes duration, metabolic status). Linear regression analyses showed the most healthy diet was negatively associated with FLI (β: -4.70, 95% CI: -7.61, -1.79, P = 0. 002).

Conclusions
The most healthy diet was independently and inversely associated with NAFLD prevalence and FLI among Chinese patients with diabetes mellitus.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.