bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSUN176 Fructosamine as a screening test for gestational diabetes
Authors: Kabadi Udaya , Exley Sarah , Illian Michelle , Lindell Larry 
Published: November 2022

Abstract

Background
All organizations use variable glucose criteria for diagnosis of gestational diabetes (GDM). However all involve OGTT. American college of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing; 1) 1 hour glucose level on 50 gm glucose ingestion at any time during the day (1 hour OGTT) and 2) 3 hour OGTT with 100 gm glucose ingestion after overnight fast in pregnant women with glucose &gt; 140 mg/dl during 1 hour. OGTTs require preparation with least daily intake of carbohydrate 150 gm for 3 days before testing. Many women are hesitant getting tested because of nausea, vomiting on glucose ingestion. Thus, none of the tests is convenient.

Objective
We examined utility of serum Fructosamine level as a screening test for diagnosis of GDM.

Methods
Random serum glucose and Fructosamine (mcM/l) levels as well as HbA1c (%) were determined at 24-30 weeks in 206 pregnant women, ages 24-40 years along with 1 hour OGTT and then again with 3 hour OGTT in 46 pregnant women with abnormal 1 hour OGTT and 21 age matched non-pregnant women. Continuous glucose monitoring (CGM) for 2 weeks was performed in 5 pregnant women with abnormal 3 hour OGTT and 7 non-pregnant women.

Results
Fructosamine levels (192± 4) were significantly lower (p&lt;0.01) in nondiabetic pregnant women when compared with age matched non-pregnant women (224 ± 5). Cutoff serum Fructosamine concentration between groups was 205. Glucose and HbA1c were not significantly different amongst groups. Serum Fructosamine levels in 26 pregnant with abnormal 1 hour but normal 3 hour OGTT were &lt;205, similar to nondiabetic pregnant women. Serum Fructosamine concentrations in women with abnormal 3 hour OGTT and normal CGM e.g, 70-140 mg /dl matched levels in nondiabetic pregnant women.

Conclusion
CGM may be the most accurate test for diagnosis of GDM. Random serum Fructosamine level may be as accurate as CGM and more accurate than both OGTTs. Importantly, it is a simple and convenient test without requiring fast, glucose ingestion or preparation.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN188 Evaluating Response to GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus Managed at a Veterans Affairs Hospital
Authors: Davis Clifton , Samson Kaeli , Kunwar Sandeep , Desouza Cyrus , Shivaswamy Vijay 
Published: November 2022

Abstract
Type 2 diabetes mellitus (T2DM) is a leading cause of morbidity and mortality in people of all ages worldwide. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer an innovative and unique advancement in treatment for T2DM by not only benefiting blood glucose control but also potentially impacting other diabetes-related complications. However, clinical response to GLP-1 RA is not seen in all patient populations. Our goal was to determine the response rate of GLP-1 RA add-on therapy. We performed a retrospective study of veterans with T2DM initiated on any GLP-1 RA from January 1, 2015, to December 31, 2019, for a duration of at least 6 months to assess the response in terms of hemoglobin A1c (A1c), weight, and total daily insulin dose. Baseline characteristics of 332 patients were reviewed to evaluate response rate. Treatment response thresholds included an A1c reduction of at least 0.5%, weight loss of ≥ 3% of pretreatment body weight, and a ≥ 10% reduction in total daily insulin dose (TDD). We then classified veterans into those without a response, or with 1, 2, or all 3 responses based on data 6-12 months after initiating treatment. We considered it a complete response if all 3 categories were fulfilled. Semaglutide (n=141): 10.64% showed a response to A1c alone, 3.55% had weight reduction alone, and 2.84% had insulin reduction alone. 7.09% showed A1c and weight response, 24.82% had A1c and insulin response, and 13.48% had weight and insulin response. A complete response was seen in 33.33% of veterans. Liraglutide (n=131): 18.32% showed a response to A1c alone, 4.58% had weight reduction alone, and 11.45% had insulin reduction alone. 6.11% showed A1c and weight response, 19.08% had A1c and insulin response, and 8.40% had weight and insulin response. A complete response was seen in 25.19% of veterans. Dulaglutide (n=57): 22.81% showed a response to A1c alone, 3.51% had weight reduction alone, and 12.28% had insulin reduction alone. 8.77% showed A1c and weight response, 26.32% had A1c and insulin response, and 1.75% had weight and insulin response. A complete response was seen in 15.79% of veterans. In conclusion, semaglutide's most common response, in 33.33% of patients, was having a complete response, followed by a reduction in A1c and insulin reduction for 24.82% of patients, and then weight and insulin reduction for 13.48% of patients. Liraglutide's most common response, in 25.19% of patients, was having a complete response, followed by a reduction in A1c and insulin dose for 19.08% of patients, and then reduction in A1c alone for 18.32% of patients. Unlike the others, dulaglutide's most common response was not a complete response, but rather A1c and insulin reduction, for 26.32% patients. Dulaglutide also had 22.81% of patients respond with A1c alone.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN190 Is Euglycemic Diabetic Ketoacidosis an Underrecognized Risk of SGLT2 Inhibitor Utilization?
Authors: Block Romy , Imas Polina , Hoyt Jonah 
Published: November 2022

Abstract

Introduction
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were first approved by the FDA in March of 2013 as a promising new medication in the treatment of Type II diabetes mellitus. The mechanism of action of the Sodium-glucose cotransporter-2 is in the convoluted tubule of the nephron and where it inhibits the reabsorption of glucose into the bloodstream. The utilization has increased with promising improvements in congestive heart failure and renal protection. However, as the use of these medications has risen, so have the concerns over their side effects, specifically the frequency of euglycemic diabetic ketoacidosis (euDKA). Initial trials reported an incidence of DKA among patients taking an SGLT2 inhibitor to be between 0.003% and 0.34%.

Hypothesis
As a quality initiative, we reviewed internal data at a large hospital system to evaluate the rate of euDKA. We hypothesized that the rate of euDKA from SGLT2 was higher than reported.

Methods
To test this hypothesis, a 5 year retrospective internal quality review was conducted to quantify the number of patients admitted to our institution with DKA while on an SGLT2 inhibitor medication. We used the Epic Database from 4 hospitals in our system and applied the application "Slicer Dicer". We used keywords for diabetic ketoacidosis. We then reviewed the medication lists prior to admission and upon admission for the 4 commercially available SGLT2 agents: empagliflozin, canagliflozin, dapagliflozin.

Results
1748 patients were identified with DKA from 2018-2021 were reviewed. Of this population, 164 of them were on SGLT2 medications. The data identified 9.4% of total patients admitted for DKA in our hospital system were taking SGLT2 medications on presentation. Out of this population: 41.5% were on empagliflozin, 27.4% were on canagliflozin, 29.3% were on dapagliflozin, and 1.8% were on ertugliflozin. Out of these same patients, 51.8% were taking a high dosage of SGLT2i medication, whereas 48.2% were taking a low dosage.

Conclusion/Discussion
This data supports the hypothesis that the incidence of SGLT2 induced euDKA is underreported. There was no correlation between DKA and the use of high versus low dosage of SGLT2i medications. Since DKA is a problem related to dehydration, future educational initiatives should emphasize the importance of educating providers on when to hold medications to prevent DKA. This should include how to plan for sick days and educating patients on the risks presented by their medication. We recommend that ICD codes are updated to include euglycemic DKA and side effects of SGLT2. We believe that these simple changes can reduce the incidence of euDKA in the diabetic population as the indications for therapy expand in vulnerable populations.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN196 Outcomes following SGLT-2 inhibitor use in 99 patients with type 1 diabetes: A single-centre, retrospective, chart-review study
Authors: William Jovitta , Cukier Kimberly , Harrison Natalie 
Published: November 2022

Abstract

Introduction
Despite the numerous benefits seen with the use of SGLT-2 inhibitors in patients with T1DM, the drug class has failed approval for this indication in both the US and Australia, largely due to the increased risk of ketosis and DKA. Resultantly there is limited real-world data for its use in this patient population.

Methods
We completed a retrospective medical record review of 99 patients with T1DM treated with an SGLT-2 inhibitor within a single outpatient clinic between 2014 to 2021. Our primary objective was to review the change in Hba1c and weight, as well as incidence of DKA, with secondary objectives to review the reduction in insulin dose, and reasons for cessation.

Results
Baseline characteristics demonstrated a female predominant population (63%) with a median BMI of 30kg/m2. Around half of our patients were on concurrent CSII therapy (53%) We observed an improvement in Hba1c in 72% of our patients, with a median decrease of 0.3% (P=0.001). 80% of patients noted a decrease in weight, with a median reduction of 4.2kg (P=0.10). Five patients developed DKA requiring hospitalisation, and the most common cause for SGLT-2i cessation was genital tract infection. The insulin requirement was noted to decrease by an median of 6.6 units (P=0.04).

Conclusion
SGLT-2 inhibitor class medications have a valuable role in the treatment of certain patients with T1DM. Our study is one of only a handful of real-life data sets, and unique in the number of patients involved. Future areas for review involve evaluating the effect of risk mitigation measures on the incidence of DKA.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN197 Rate of admission to the Intensive Care Unit in patients with Diabetic Ketoacidosis and its associated risk factors, a single centre experience.
Authors: Alotaibi Raghad , Samargandy Dr Shaza , Alotaibi Raghad , Alghamdi Maha , Alotaibi Rahaf , Alsulami Manar , Hijji Sumiah 
Published: November 2022

Abstract

Background
Diabetic ketoacidosis (DKA) is one of the most common admission diagnoses to the intensive care unit (ICU). This study aims primarily to identify the rate of DKA-related ICU admission, and to assess the possible leading risk factors. Secondarily, to assess the rate of ICU readmission and mortality.

Methods
This retrospective observational study took place in King Abdulaziz University Hospital and collected data from January 2018 till December 2020. Patients aged 15 years and older with DKA Related-ICU admissions were included. Association between variables such as, demographics, precipitating factor, biochemical data, ICU stay details. History of readmission, arising complications within the study period were collected. Mortality cases were identified and the direct cause of death was investigated. Statistical analysiswas performed using the SPSS program version 25. Qualitative data were expressed as numbers and percentages, and quantitative data were expressed as mean and standard deviation. Linear regression analysis was used to adjust for the predictors and their association with the admission to the ICU.
Result: ICU admissions were 28.4% of all DKA-related admissions (50 out of 176 patients), with a female predominance of 52%. Median length of ICU stay was 3 days. Medications nonadherence was the leading precipitating factor for ICU admission in 50% of the patients. Factors significantly associated with risk of ICU admission were on bivariate analysis: pH level of &lt;7.0 (p =0.001), and Patients of &gt;60 years as they had 4 times more risk of ICU admission compared to 15-20 years age group (P=0.04). Nine patients died, but none of them died primarily from DKA as the main cause of death was the DKA precipitating factor. Six patients were readmitted to the ICU (12%) during the study period, the mean duration between the two admissions was 19.74± 26.57 weeks.

Conclusion
Our findings highlight that nonadherence to medications is the most common precipitating factor to ICU-related DKA admission. Thus, educating patients and early dentification of patients at risk are crucial.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN200 Effect of carbohydrate counting education in children and adolescents with type I diabetes
Authors: Lee Hae I , Kwon Ahreum , Lee Myeongseob , Choi Han Saem , Song Kyungchul , Suh Junghwan , Chae Hyun Wook , Kim Ho-Seong 
Published: November 2022

Abstract

Background
The achievement and maintenance of normoglycemia is one of the most important goals to prevent both short and long-term complications in type 1 diabetes mellitus (T1DM). As carbohydrate acts as the primary macronutrient affecting postprandial glycemic response, carbohydrate counting is crucial in adjusting prandial insulin doses to preserve postprandial blood glucose within normal limits. The purpose of this study is to evaluate the effect of carbohydrate counting education in children and adolescents with T1DM.
Method: A retrospective chart review of 128 diagnosed T1DM patients who underwent carbohydrate counting education was conducted. All subjects were diagnosed with T1DM before December 2019, and were educated carbohydrate counting before December 2020 in pediatric endocrinology, Severance Children's Hospital, Seoul, Korea. We analyzed the data including clinical characteristics, education on carbohydrate counting, and glycated hemoglobin A1c (HbA1c) levels.

Results
In 128 T1DM subjects educated, 48 (38%) were male. Their mean age at diagnosis was 8.6 ± 4.0 (years) and mean age at the time of education was 22.6 ± 7.8 (years). Overall, HbA1c levels at 3, 6, and 12 months after education showed a significant decrease compared to the baseline. The mean ±SD(standard deviation) HbA1c level, which was 8.8 ±1.9 (%) at the baseline, decreased to 8.3 ±1.7 at 3 months, 8.3 ±1.7 at 6 months, and 8.3 ±1.7 at 12 months after education. In multivariate linear regression analyses, only the value of baseline HbA1c (P&lt;0.001) as an indicator of DM management was significantly correlated with decrease in HbA1c.

Conclusions
In our study, carbohydrate counting education seems effective in glycemic control in patients with type 1 diabetes mellitus, but the decrease in HbA1c seems not enough. The effect of education differs according to the degree of glycemic management. For patients with poor management, providing proper education of carbohydrate counting can make improvement in glycemic control. For well-managed patients, more advanced approach beyond traditional education appears to be required. With proper education, better blood glucose control can be expected to reduce complications and improve quality of life in T1DM patients.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN221 Implementation of Scheduled Mealtimes for Improved Glycemic Control among Hospitalized Patients with Diabetic Meal Plans
Authors: Thompson Owen , Lee Grace 
Published: November 2022

Abstract

Objective
To improve inpatient glycemic control through implementation of scheduled diabetic mealtimes in coordination with standardized bedside glucose checks and insulin administration times

Methods
We performed a plan-do-study-act (PDSA) trial in which we modified our standard diabetic diet from on-demand service to scheduled mealtimes with a goal to complete bedside glucose monitoring, meal delivery, and insulin administration all within a one-hour window for each meal. Both patients and clinical staff were actively educated regarding the rationale for this approach; prominent visual cues were implemented, and the menu was modified to include patient-centered information regarding mealtime practices. Low-carbohydrate snacks were offered between meals. Electronic medical record integration included defaulting to scheduled insulin dosing rather than as-needed dosing.

Results
Early PDSA analysis demonstrated a 98% rate of pre-prandial glucose measurement with a 96% rate of correctional insulin doses ordered, while 91% of overall mealtimes successfully coordinated tray delivery, glucose testing, and insulin administration within one hour. Analysis of glycemic data from before and after our intervention demonstrated decreased overall mean daily glucose (167 to 164mg/dL, p = 0.001), fewer patients with any daily glucose greater than 250mg/dL (from 51% to 47%, p=0.001), and more for whom all glucose readings were between 70 and 249mg/dL (from 43% to 47%, p=0.001). Average pre-prandial blood sugars significantly improved before breakfast (156 to 152mg/dL, p=0.003) and dinner (173 to 165mg/dL, p&lt; 0.001), while no effect was noted with pre-prandial lunchtime measurements. Evening blood sugars declined from 186 to 180mg/dL (p&lt; 0.001). Subgroup analyses demonstrated that patients who presented with baseline poor glycemic control (admission blood sugar &gt;250mg/dL) improved the percentage of patients with all glucose readings between 70 and 249mg/dL (from 12% to 19%, p=0.001), as well as the number of patients with any subsequent glucose &gt;250mg/dL (from 85% to 77%, p=0.003). Patients who presented with better initial blood glucose control still improved their mean daily glucose (161 to 158mg/dL, p=0.005). The percentage of patients who had any glucose less than 70mg/dL did not significantly change throughout the intervention overall or with any subgroup analysis.

Discussion/Conclusion
The implementation of scheduled mealtimes within a diabetic meal plan contributes to improved glycemic control when compared with on-demand meal availability by streamlining the coordination of blood glucose measurement, meal delivery, and insulin administration.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN227 A retrospective comparison of Basal Bolus using Glargine U-300 and Glulisine with Premix Insulin
Authors: Abraham Santhosh , Daniel Sonia 
Published: November 2022

Abstract

Objectives
The objective of this retrospective analysis was to compare the occurrence of Level 1 hypoglycaemia, Level 2 hypoglycaemia, nocturnal hypoglycaemia and mean HBA1C reduction in patients treated with premixed insulin 30/70 (Insulin Isophane/NPH 70% + Human Insulin/Soluble Insulin 30%) and after initiating a basal bolus regime using Glargine U-300 and Glulisine. Level 1 hypoglycaemia is blood glucose less than 70 mg/dL but above 54 mg/dL. Level 2 hypoglycaemia is blood glucose less than 54 mg/dL.

Methodology and Data Analysis
Data was collected retrospectively over 6 months on adult outpatients who were on pre mix insulin 30/70 for at least 2 years and who frequently experienced hypoglycaemic episodes and after transitioning these patients to a basal bolus regime Glargine U-300 and Glulisine. Those were having an underlying etiology which would predispose them to hypoglycaemia were excluded. The exclusion criteria included malignancy, drug induced causes except premix insulin, Chronic Kidney disease stage 4 or 5 and acute or chronic hepatic failure. Blood glucose monitoring was done by a 7 point Self Monitoring of Blood Glucose. A total of 30 cases were randomly chosen and data were sought from patients’ home glucose logs, case notes and Electronic health care records. Data were analysed by Microsoft Excel and was compared with paired-T test.

Results
The average number of Level 1 hypoglycaemic episodes per week on premix insulin dropped from 6.517 to 0.9655 (t = -10.807456, p&lt;0.00001) after initiating the basal bolus regime. The average number of level 2 hypoglycaemic episodes per week dropped from 2.034 to 0.379 (t = -8.733497, p&lt;0.00001) after changing to basal bolus regime. There was also a reduction in the occurrence of average nocturnal hypoglycaemic episodes from 2.655 on pre mix insulin to 0.2068 on the basal bolus regimen (t = -8.635475, p&lt;0.00001).The mean HbA1C reduction was 3.16% in three months after commencing the basal bolus regime (t = -27.554737, p&lt;0.00001).

Conclusions
Outpatient treatment with the basal bolus regime consisting of Glargine U -300 and Glulisine as compared to the premix insulin use showed a marked reduction in Level 1 and Level 2 hypoglycaemic episodes and nocturnal hypoglycaemic episodes per week. The decreased hypoglycaemic event rates in hypoglycaemia resulted in better compliance and adherence which was reflected as a significant reduction in HbA1C. In the future more retrospective and prospective studies will be helpful with Glargine U-300 and Glulisine.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN239 Severe Insulin Resistance and Hyperglycemia with Mild COVID-19 Infection
Authors: Azmath Misbah , Bendaram Snigdha Reddy , Ferreira Jennifer , Tafader Asiya , Luong Lucas , Velamakanni Sruti , Mirza Faryal 
Published: November 2022

Abstract

Introduction
Covid-19 infection (CI) is known to cause hyperglycemia and insulin resistance in patients with and without diabetes. Prior reports have correlated the degree of hyperglycemia to the severity of the CI. However, not much data is available regarding severe insulin resistance in patients with mild CI who are otherwise asymptomatic and not on steroids.

Case
We report a 48-year old male with type-1 diabetes, asymptomatic CI and renal failure, on dialysis who was admitted with diabetic ketoacidosis (DKA). Patient had refused insulin and hemodialysis treatments for one week and was noted to be confused by staff in his long-term facility. Upon presentation, he was initiated on intravenous (IVIT) insulin infusion therapy and transitioned to subcutaneous (SQ) insulin the following morning. That evening, hyperglycemia worsened (&gt;500 mg/dl), necessitating reinstatement of the IVIT. Hyperglycemia persisted (no excess carbohydrate intake reported by nursing) and IVIT was continued as attempts to change to SQ therapy were unsuccessful. He was dialyzed for two consecutive days after admission and then changed to alternate day schedule. On day 4, hyperglycemia worsened to &gt;500 mg/dl persistently, IVIT rate was increased to 24 units/hr but blood sugars persisted in the &gt;500 range. Work up for evaluating Covid-related inflammation and insulin resistance was sent. After 6 hours of IVIT at 24 U/hr, he was given a relatively higher dose of SQ-insulin (insulin glargine 20 units and insulin lispro 30 units SQ). IVIT rate was gradually tapered based on blood sugars and stopped 6 hours after SQ-insulin was given. Approximately eight hours after receiving SQ-insulin, he was noted to be hypoglycemic, and he received two amps of D-50. His blood sugar stabilized, and he continued to do well subsequently and was maintained on basal-bolus therapy. The on-call nurse confirmed good IV access for the IVIT access line. The IV insulin infusion fluid from bag was sent for analysis which showed that insulin was present in the infusion bag. Inflammatory markers showed high levels of cortisol, ferritin, growth hormone, C-reactive protein and sedimentation rate. Insulin antibodies were also present. D-dimer was normal, and fibrinogen was only mildly elevated.

Conclusion
This is a rare case of severe insulin resistance in a patient with mild Covid-19 infection and underlying type 1 diabetes, who developed severe insulin resistance with poor response to high doses IV insulin. He ultimately responded a combination of high dose subcutaneous insulin and high doses IV insulin infusion therapy with resolution of ketoacidosis and hyperglycemia.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.