bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP183 Diabetic Ketoacidosis Precipitated by Ketogenic Diet and SGLT-2 Inhibitor Use in an Individual with T2DM
Authors: Mason Timothy , Ansar Sameer 
Published: November 2022

Abstract

Background
SGLT-2 inhibitors have been associated with increased risk of ketoacidosis even with normal blood glucose levels. A ketogenic diet is a low-carb, high-fat diet which has recently gained popularity for weight loss by producing a state of ketosis. We present this case to emphasize the risk of ketoacidosis in patients on SGLT-2 inhibitors and a ketogenic diet.

Clinical Case
A 48-year-old woman with a 16-year history of T2DM presented to the ER with a 3-day history of upper abdominal cramping and headaches, decreased urine output, and progressively worsening nausea and vomiting. Her glycated hemoglobin level was 9.4% (n: 4-6%) and her blood glucose readings were not elevated during this time. Other medical issues include dyslipidemia, transaminitis and hypertension. She does not smoke or drink alcohol. She takes glimepiride 0.5 mg daily and canagliflozin was added approximately 1.5 weeks prior to presentation. She was on a ketogenic diet. A few days prior to these symptoms she was in the process of moving out of her home, spending long days physically exerting herself. On exam she was in mild distress with dry mucous membranes. Vitals showed tachycardia (119BPM) but otherwise were stable. Labs revealed that she was severely acidotic with an anion gap of &gt;27 and pH &lt; 6.9 (n: 7.34-7.43), with urinalysis positive for ketones (2+, n: negative), protein (3+, n: negative), and glucose (3+, n: negative). Complete blood count showed leukocytosis (WBC: 18,000, n: 4. 00-12. 00*10 3 /mcL). Complete metabolic panel showed hyponatremia (130, n: 136-145mmol/L), elevated glucose (305, n: 70-99,g/dL), and low bicarbonate (&lt;5, n: 22-30mmol/L). A chest X-ray, lumbar puncture and CT of head and abdomen were unrevealing. She was admitted to the ICU for treatment of suspected DKA with severe acidosis and hypovolemia. She was hydrated with IV fluids and was started on an insulin drip according to DKA protocol. Her anion gap closed in 22 hours. The patient spent 3 days in the ICU and 1 day on general floor before discharge on home medications and was advised to follow up with endocrinology. At follow up 2 months later her C-peptide was 2.14 (0.78-5.19 ng/mL) and GAD65 antibody assay was 0. 00 (&lt;0. 02 nmol/L), the SGLT-2 inhibitor was discontinued, and she was instead started on a GLP-1 agonist.

Conclusion
The mechanism behind DKA with SGLT-2 inhibitor use involves glycosuria and volume depletion, lowering the insulin-to-glucagon ratio, while stimulating lipolysis. The addition of a low carbohydrate or ketogenic diet produces a state of ketosis as fat is utilized for energy and ketones are produced, further promoting DKA. With increased use of SGLT-2 inhibitors in patients with and without diabetes mellitus extreme caution should be exercised in prescribing SGLT-2 inhibiters in a patient on a low carbohydrate diet.
Presentation: No date and time listed
ODP187 Doedge-Potter syndrome and papillary thyroid carcinoma: An unusual association
Authors: Gandara Carmen , Puente Guillen , Riestra María , Veiguela Brenda , Felechosa Marta , Gutierrez Gala , Valdes Nuria , Monge Pilar , Diaz Lucia , Diaz Maria Jesus 
Published: November 2022

Abstract
Hypoglycemia can occur in non-diabetic individuals. Doege-Potter is a rare paraneoplastic syndrome presented as a hypoinsulinemic hypoglycemia caused by ectopic secretion of insulin-like growth factor-2 (IGF-2) from a solitary fibrous tumor. There is recent evidence of the involvement of the IGF system in different malignancies as papillary thyroid carcinoma, being exceptional. A 69-year-old female was brought to Emergency after a routine analysis uncovered severe hypoglycemia. She mentioned a history of morning sickness, dizziness, and confusion for the last week that reverted after breakfast, and dry cough for three months. She had a 25-pack-year history of smoking, no history of alcohol use, no other antecedent of interest, no history ofdiabetes mellitus or weight loss surgery, nor chronic treatments. Physical examinations revealed diminished breath sounds in the left middle lung. A thorax radiography showed a submassive left pleural effusion and toracocentesis revealed a hemorrhagic exudate. Laboratory data showed normal GH, and cortisol levels. Despite marked hypoglycemia, insulin level was 0.4 μIU/mL (2,6-24,9), C-peptide 0.11ng/ml (1,1-4,4) and hydroxy butyrate &lt;0.1 mg/dl. The serum IGF-2 level was 428μg/dL (350-1000), and the IGF-1 level was 55.4 μg/L(161-384). Anti-insulin antibodies and sulfonylureas concentration were negative. CT showed a solid mass concerning parietal pleura with areas of necrosis and calcifications, measuring 14.6×15.4×20cm. Low blood glucose with suppressed insulin, C-peptide and IGF-1 levels, elevated IGF-2/IGF-1 ratio (7,7, normal&lt;3) and CT findings suggested the possibility of non-islet cell tumor hypoglycemia (NICTH). Corticoid treatment was initiated to manage the hypoglycemia. Biopsy of the mass showed a malignant solitary fibrous tumor, positive for CD34 and BCL2. After surgery, glucose and IGF-2 levels returned to normal, the patient didn't experience further episodes of hypoglycemia, and corticoid treatment was gradually suspended. A FDG-PET scan, part of extension study, found a PET-positive thyroid nodule. A thyroid ultrasound confirmed a solid, taller than wide thyroid nodule, measuring 6.7×6.4×9,5mm and fine-needle aspiration biopsy was suggestive of papillary thyroid carcinoma. Hemithyroidectomy was performed. The patient is with no evidence of disease. Doege-Potter syndrome is a rare cause of hypoglycemia, resulting from a tumor producing elevated levels of IGF-2. Diagnosis is suggested by low insulin, C-peptide and IGF-1 levels, normal or elevated IGF-2, and elevated IGF2/IGF1 ratio. High levels of ''big-IGF-2'' are associated with high risk papillary thyroid carcinoma, suggesting the relation between the IGF-system and tumor growth, nevertheless there are few cases reported describing this association. Surgical resection of the tumor is the treatment of choice.
Presentation: No date and time listed
ODP189 Effects of Exercise Initiation and Smoking Cessation after New-Onset Type 2 Diabetes Mellitus on Risk of Mortality and Cardiovascular Outcomes
Authors: Yoo Soon Jib , Kwon Prof Hyuk-Sang , Kim Mee Kyoung , Han Kyungdo 
Published: November 2022

Abstract
Lifestyle changes after a diagnosis of type 2 diabetes mellitus (T2DM) can affect vascular health outcomes. The objective of this study was to investigate the effects of changes in smoking and exercise on the risk of cardiovascular disease (CVD) and mortality in patients with newly diagnosed T2DM. Data were analyzed for 181,591 people with newly diagnosed T2DM who underwent 2 serial health examinations within 2 years before and after diagnosis of diabetes. The study population was followed from the baseline to the date of death or cardiovascular events, or until December 31, 2018 and median follow-up was 6. 07 years. Based on the change in status from before to after the diagnosis of T2DM, participants were grouped into smoking groups (continuous smokers, quitters, new smokers, and nonsmokers) and exercise groups (constant exercisers, new exercisers, exercise dropouts, and non-exercisers). Compared with the non-exercisers, those who initiated exercise after their diagnosis had a lower risk of myocardial infarction (MI), stroke, and all-cause mortality: the hazard ratio (HR; 95% confidence interval [CI]) was 0.85 (0.76–0.94) for MI, 0.86 (0.78–0.94) for stroke, and 0.84 (0.89–0.90) for all-cause mortality. Quitters had a higher risk of MI, stroke, and all-cause mortality than nonsmokers, but their risk level was much lower than that in continuous smokers. Whenthe group ofcontinuous smokers and non-exercisers was considered as the reference group,participants who quit smoking and remained non-exercisers had a 21% lower risk of CVD (HR 0.79; 95% CI 0.70–0.90). Those who quit smoking and started exercising had a 46% reduced risk of CVD (HR 0.54; 95% CI 0.41–0.71) and a 22% reduced risk in all-cause mortality (HR 0.78; 95% CI 0.63–0.96). Smoking cessation and exercise initiation after a diagnosis of new-onset T2DM was associated with a reduced risk of CVD and all-cause mortality.
Presentation: No date and time listed
ODP190 Efficacy of Esaxerenone on Hypertensive Patients with Type 2 Diabetes or Those with Impaired Glucose Tolerance
Authors: Kuwabara Saki , Kameda Hiraku , Miya Aika , Nomoto Hiroshi , Yong Cho Kyu , Nakamura Akinobu , Koyanagawa Naohide , Takeuchi Jun , Nagai So , Miyoshi Arina , Wada Norio , Taneda Shinji , Kurihara Yoshio , Miyoshi Hideaki , Atsumi Tatsuya 
Published: November 2022

Abstract
Patients with diabetes may develop mineralocorticoid receptor (MR) related hypertension due to abnormal activation of MR, thusMR blocker (MRB) is used for the treatment of hypertensionin patients with diabetes. Although theselective MRB esaxerenone (Esax)approved for hypertension, the effectiveness of Esax in daily clinical practice has not provenin hypertensive patients with type 2 diabetes (T2D) or those withimpaired glucose tolerance (IGT). The aim of this study is to clarifythe efficacy of Esax in these patients. In this retrospective study, patientswho initiated Esax from May 2019 to February 2020 and thosewho initiated amlodipine (Amlo) were screened. After excluding patients with a history of hypersensitivity to these drugs, K &gt; 5. 0 mEq/L at the baseline and severe renal dysfunction (eGFR &lt; 30 mL/min/1.73m 2), and patients receiving potassium preparations, 35 and 70 patients were enrolled in the Esax and Amlo group, respectively. After propensity score matching with the parameters including gender, age, body mass index (BMI), concomitant use of angiotensin receptor blocker, systolic blood pressure (SBP), diastolic blood pressure (DBP), K, AST, ALT, TG and eGFR, finally each 24 cases were analyzed. Primary endpoints were changes (Δ) in SBP and DBP from the baseline to 6 months after the initiation of the drugs. Secondary endpoints comprised changes in liver enzymes and those in lipid metabolism markers. Unpaired t-test was used for statistical analysis. The dose of Esax and Amlo were 2.2±0.5 mg and 4.1±1.2 mg at the baseline, and 3.4±1.3 mg and 5.3±1.2 mg at 6 months, respectively. SBP was more decreased in the Esax group compared with the Amlo group (ΔSBP: -27± 20 mmHg vs -11± 14 mmHg, p&lt;0. 05). DBP was not significantly different between the two groups (ΔDBP: -11± 10 mmHg vs -9± 14 mmHg). In the Esax group, ALT and TG were significantly decreased (ΔAST: -7.3 ± 11.5 U/L vs +0.9 ± 9.5 U/L, p&lt;0. 05,ΔTG: -14.3 ± 51. 0 mg/dL vs +33.5 ± 59.4 mg/dL, p&lt;0. 05), and HDL-C significantlyincreased (ΔHDL: +1.8 ± 6.1 mg/dL vs -3.8 ± 4.8 mg/dL, p&lt;0. 05). Severeadverse events were not observed in any subjects. These results suggest the efficacy of Esax for controlling blood pressure as well as the plausible benefit in liver disease and lipid metabolism in hypertensive patients with T2D or IGT.
Presentation: No date and time listed
ODP192 Empagliflozin associated Euglycemic Diabetic Ketoacidosis and the Terrible Triad
Authors: Nievera Karl Homer , Uy Melissa Claire 
Published: November 2022

Abstract

Background
Among diabetic patients, newer drug classes such as SGLT2i have been reported to present with Euglycemic Diabetic Ketoacidosis (eDKA), wherein these patients are without signs of elevated glucose levels. However, this condition can coexist with acute pancreatitis (AP) and hypertriglyceridemia (HTG), which is also known as the terrible triad.

Clinical Case
We were presented with a 31-year old diabetic male maintained on empagliflozin 25mg OD and metformin 500mg OD, discontinued his medication four months ago, and recently started retaking empagliflozin one week ago. He presented with drowsiness, severe abdominal pain rated as 9/10, and vomiting. An NGT was inserted and on further workup, acidosis was present on ABG with an anion gap of 28 mEq/L. AP was noted on abdominal ultrasound with an amylase of 768 U/L. CBG was 167mg/dL, Hba1c of 7.4%, Creatinine of 1. 05mg/dL, with ketonuria on urinalysis. Hydration was started with referral to endocrinology service. Insulin drip was started, and CBGs ranged from 145-229mg/dL while on drip. Hydration was increased accordingly, considering the patient's intake and output. Further workup was done, and lipid profile revealed severe hypertriglyceridemia at 1724.78mg/dL and elevated VLDL at 342mg/dL. Statin was prescribed, and eventually, insulin drip was titrated down with resolution of acidosis. Insulin was then shifted to subcutaneous regimen. Diet was also transitioned to clear liquids and eventually into diabetic diet. The patient was sent home and was uneventful after. eDKA develops due to increased glucagon secretion and decreased insulin production, promoting glucose to fat metabolism and ultimately stimulating ketogenesis. These agents decrease the blood glucose level by increasing urinary glucose excretion leading to a reduction in insulin secretion from the pancreatic β-cells. The terrible or enigmatic triad consisting of AP, HTG, and DKA/eDKA has been well reported but has a complex process. HTG results as a product of the reduced lipoprotein lipase activity in peripheral tissues, which decreases the removal of VLDL from the plasma. In AP cases, HTG only accounts for a minority (2-7%) of cases, but the risk was increased with levels above 1000mg/dL, such as in our patient. In the study by Simons-Linares et al., having the said triad had higher odds of having SIRS, shock, sepsis, and parenteral nutrition when compared to AP patients alone. eDKA patients can present with non-specific signs and symptoms such as nausea, vomiting, and abdominal pain, which can delay the diagnosis in patients. Fortunately, it was recognized early on, and there was a quick response in managing the case.

Conclusion
To date, there is scarcity among reports of the terrible triad, especially with empagliflozin use. Therefore, we can stress the importance of keen assessments and history taking in detecting the triad for an early aggressive approach to prevent adverse outcomes.
Presentation: No date and time listed
ODP201 Fyn regulates sarcopenia via autophagy
Authors: Yamada Eijiro , Uehara Ryota , Bastie Claire C , Horiguchi Kazuhiko , Ishida Emi , Matsumoto Shunichi , Yoshino Satoshi , Osaki Aya , Okada Shuichi , Yamada Masanobu 
Published: November 2022

Abstract
Sarcopenia is an important element that impairs daily activity. Sarcopenia is also linked to insulin resistance, and the number of diabetic patients also presenting sarcopenia is increasing. In recent years, autophagy has been identified as one of the novel mechanisms associated with sarcopenia. We previously reported that Fyn not only participates in the metabolic syndrome but also that autophagy-regulating sarcopenia was decreased in muscle specific Fyn transgenic mice through STAT3 regulation (Cell metabolism 2010, Cell Rep. 2012). More recently, we revealed Fyn-dependent STAT3 phosphorylation by IL6, which is involved in chronic inflammation and metabolic syndrome, using mouse C2C12 myotube cells expressing shRNA for Fyn. Furthermore, using WT mice with both the denervated and the hind limb suspension (HS) that promotes disuse atrophy by suspending the hind limb, not only both Fyn and IL6 gene expressions were increased but the expression and phosphorylation levels of STAT3 were also augmented, while the autophagic activity was decreased. To confirm those regulations are Fyn dependent, we took advantage of Fyn null mice (FynKO) with HS. Compare to WT mice with HS, all the muscles of FynKO were resistant for the loss of muscle mass induced by HS. The expressions of bothatrogin-1 and muRF-1,the key muscle specific E3 ubiquitin ligases as well as the markers for sarcopenia, were not changed in the muscles of FynKO with HS. Moreover, the STAT3 phosphorylation on tyrosine 705 was decreased in the muscle of FynKO compared to WT mice after hind limb suspension, while expression levels of STAT3 were not changed. IL-6mRNA expression levels were increased in the HS muscle of control mice, but were not changed in FynKO HS muscle. Finally, the autophagic activity, examined by both LC3-2 protein levels after intraperitoneal administration of colchicine andSQSTM1/p62 immunofluorescence in muscles, was retained in FynKO after HS. These results strongly suggest that Fyn is involved not only in the metabolic syndrome but also in the pathogenesis of sarcopenia, and may lead to a better understanding of the pathology of sarcopenia-associated obesity and the development of therapeutic methods.
Presentation: No date and time listed
ODP203 Health Questionnaires are a Positive Behavioral Modifier In Patients with Impaired Blood Sugar In the African American Population.
Authors: Patel Krish , Patel Ishan , Patel Sunil 
Published: November 2022

Abstract

Type 2 diabetes and its complications have a higher incidence in African Americans as compared to other racial groups (1). As per the American Diabetes Association, the prevalence of diabetes in non-Hispanic African American patients is 11.7% compared to 7.5% in non-Hispanic white patients. However, few studies have explored what can be done to spark a positive behavioral change leading to lower blood sugar. The purpose of this study is to evaluate if a patient filling out a health questionnaire has any impact on his or her habits by enhancing self-management and awareness to reduce HbA1c.

Methods
In an outpatient urban clinic, a prospective randomized study was conducted with African American patients with prediabetes with HbA1c 5.6 to 6.7. Patients were randomly assigned to either a survey group or a control group who did not take a survey. The survey included demographic information, weight, diabetes mellitus complication awareness, exercise frequency 3-5 days/week, eating habits, and self-perception. The patients in the survey group filled a follow-up survey 3-6 months later.

Results
The survey group had 50 respondents and 46 respondents who took the post-survey compared to the control group for which there were 50 respondents with 47 respondents in the control follow-up. In the survey group, 54% were males with an average age of 57 years. In the survey group, on followup HbA1c decreased (6.1 vs 5.7 p&lt;0. 021), BMI decreased (32 vs 29.1 p&lt;0.562), exercise frequency 3-5 days/week increased (10% to 35% p=0. 041), awareness of diabetic complication improved (15 to 74% p=0. 029), willingness to see a dietician increased (28% to 60% p=0. 038), and probability of reading nutrition labels increased (16% to 38% p=0. 058). In the control group, 58% were males with an average age of 56 years. In the control group, on followup HbA1c increased (6.1 vs 6.2), BMI increased (32 vs 33), exercise frequency 3-5 days/week increased (13% to 19% p=0.820), awareness of diabetic complication improved (12%to 16% p=0.673), willingness to see a dietician increased (29% to 38% p=0.340), and probability of reading nutrition labels increased (14% to 19% p=0.646).

Conclusion
Health questionnaires served as a positive behavioral modifier and helped patients identify and correct their harmful lifestyle habits. Patients in the survey group showed larger amounts of positive change compared to patients in the control group. Reference: (1) Marshall MC Diabetes in African Americans. Postgraduate Medical Journal2005;81: 734-740.
Presentation: No date and time listed
ODP222 Liragluitde Increased IL-1RA Concentrations in Obese Type 2 Diabetes: A Small Randomized Controlled Trial
Authors: Sathavarodom Nattapol , Roongjiraroj Thanasate , Pinphanichakarn Verapon 
Published: November 2022

Abstract

Background
Therapy with exenatide, exendin-4-based glucagon liked peptide-1 receptor agonist (GLP-1 RA) increased plasma interleukin-1 receptor antagonist (IL-1RA), an endogenous anti-inflammatory protein which protected pancreatic ß cells independent of glycemic and weight controlled. We hypothesized that liraglutide, long-acting GLP-1 analogue might contribute to a potential protective effect on ß cells in diabetes.

Methods
Twenty-four obese patients with type 2 diabetes receiving oral hypoglycemic agents with insulin therapy, except pioglitazone or incretin-based therapy, were randomly assigned to receive either maximum tolerate dose of liraglutide (n=12) or standard therapy (n=12) for twelve weeks.

Results
Among 24 participants who completed over 12 weeks of this study, median change was +258.7% (78.7, 656.6) and +101. 0% (-3.3, 189.4) of IL-1RA; P&lt;0. 04, and -1.2% (-1.7, -0.8) and -0.4% (-1. 0, 0.3) of A1c; P&lt;0. 03 in liraglutide and standard group, respectively. Percent changes of fasting plasma glucose, body weight, neck circumference and body mass index were all not statistically significant, when comparing between group. Pearson correlation between percent change of IL-1RA and percent change of A1c response to therapy were also not statistically significant.

Conclusion
Liraglutide might have anti-inflammatory effect independent of the glycemic control during initial short-term duration. Keywords: Liraglutide, Interleukin-1 receptor antagonist, obese type 2 diabetes.
Presentation: No date and time listed
ODP226 MONITORING THE INCIDENCES OF ALLERGIC CONTACT DERMATITIS AND OTHER SKIN REACTIONS ASSOCIATED WITH CONTINUOUS GLUCOSE MONITORING SYSTEMS
Authors: Lightstone Hodaya , Murphy Margaret 
Published: November 2022

Abstract
The CDC reports 1 in 10 Americans have Diabetes and that number only continues to rise each year. Diabetes is a lifestyle altering condition that requires those diagnosed to monitor their blood sugar daily. Traditionally finger prick blood draws were the only method to do this and it put many at increased risk for infection and reduced digit sensation, until Continuous Glucose Monitoring (CGM) was later developed. CGM's are unique because they can attach to any part of the body and upload data to smart devices. Unfortunately, CGM's brought about new issues for diabetics. As CGM use increased, as did incidences of allergic and irritant contact dermatitis (ACD & ICD), preventing many from continuing its use. The purpose of this Literature Review is to assess current articles focused on ACD, ICD, and other skin conditions related to CGM use and consider how diabetics can prevent and treat these side effects to safely resume CGM use.
Presentation: No date and time listed