bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP197 Familial Hypertriglyceridemia Initially Presenting with Hypertriglyceridemia-induced Pancreatitis: A Case Report
Authors: Arora Gunjan , Laskova Anna , Kim Keun Young 
Published: November 2022

Abstract

Case Presentation
A 28 year old male with a past medical history of diabetes mellitus type 2 (T2DM) and hypertension presented to the emergency room with acute onset, progressive epigastric pain associated with nausea. The pain suddenly started earlier that day after a large meal. He denied alcohol use. He was previously on insulin Glargine 55 units nightly but was not using it for several months. Vitals signs were within normal limits, BMI was 38.5 kg/m 2 . Physical examination revealed marked epigastric tenderness and multiple yellow papules on the abdomen and extensor surfaces of extremities. Lab findings revealed WBC 14.3 k/mm cu, lipase 437 IU/L, triglycerides greater than 3000 mg/dl with VLDL greater than 3000 mg/dl. Computerized tomography of the abdomen was consistent with acute pancreatitis. He was diagnosed with familial hypertriglyceridemia presenting with hypertriglyceridemia-induced pancreatitis and was admitted to the intensive care unit (ICU). Treatment with regular insulin infusion was started. On day 3, triglyceride levels decreased to 543 mg/dl and insulin infusion was stopped. He reported symptomatic improvement and was able to tolerate oral diet. He was counseled on significance of lifestyle modifications and medication compliance and was discharged on Niacin, Omega 3, Fenofibrate, Ezetimibe, and Pravastatin with plans to follow up with an Endocrinologist.

Discussion
This case of a young male presenting with hypertriglyceridemia-induced pancreatitis due to underlying familial hypertriglyceridemia emphasizes the significance of comprehensive history taking and work up for patients initially presenting to the clinic with risk factors such as obesity and insulin resistance. Our patient classically had a history of T2DM, and as cardiovascular complications are the leading cause of mortality in diabetic patients, screening for and managing dyslipidemia is pivotal. Eruptive xanthomas are erythematous-yellow papules typically located on extensor surfaces which appear when triglyceride levels exceed 1500-2000 mg/dl. This characteristic skin finding led to a prompt suspicion for familial hypertriglyceridemia in our patient. Our patient was stabilized in the ICU and subsequently discharged on multiple oral agents. The current consensus is that single statin therapy is not recommended; however, further research is indicated to specify the optimal combination of triglyceride lowering agents based on the severity of hypertriglyceridemia.
Presentation: No date and time listed
ODP207 Histone methylase MLL attenuates insulin secretion by reducing glucose sensitivity in mouse pancreas
Authors: Yoshino Satoshi , Horiguchi Emi Ishida Kazuhiko , Matsumoto Shunichi , Yamada Eijiro , Yamada Masanobu 
Published: November 2022

Abstract

Background
Myeloid / Lymphoid or Mixed-lineage leukemia gene (MLL) is translocated to chromosome 11 long arm q23 region (11q23) and the MLL fusion gene expressed as a result of translocation reconstruction plays an important role in MLL-related leukemia development. It has also been reported that MLL and MLL protein play an important role in tumor development as a Menin-binding protein in Multiple Endocrine Neoplasia Type I (MEN1). More recently, normal MLL protein has been shown to have histone H3 lysine 4-methylation (H3K4-HMT) activity and to be an epigenetic transcriptional regulator. In addition, the function of MLL protein as a histone methylase has been reported in the gene region involved in metabolism regions. Here, we analyzed the involvement of MLL in glucose metabolism in the pancreas using MLL knockout mice.

Methods
Glucose metabolism in MLL knockout mice and the function of MLL in cultured cells were analyzed. Result: Since the homozygotes of MLL knockout mice are embryonic lethal, we analyzed them using Heterozygous mice. MLL heterozygous mice showed significantly weight loss compared to the wild type mice. MLL heterozygous mice showed no difference in food intake compared to wild type mice. IPGTT showed impaired glucose tolerance in MLL heterozygous mice. However, ITT showed no insulin resistance and decreased insulin secretion during glucose loading. In GSIS tests, Islets isolated from heterozygous mice pancreas have been observed to decrease insulin secretion in the response to glucose stimulation. In comprehensive gene analysis using Microarray analysis of mRNA extracted from mice islet, the gene expression changes related insulin secretion and apoptosis have been revealed in MLL heterozygous mice. Histological search showed no decrease in β-cell number, and immunohistological search showed no difference in insulin, glucagon, and TUNEL staining between heterozygous and wild type mice. And also, MLL knockdown was performed in a cultured cell line. Insulin secretion was decreased to glucose stimulation in MLL knockdown cell line same as in MLL knockout mice. In addition, RNA microarrays were performed to these cell lines, several same genes that have confirmed in MLL mouse islets were observed in MLL knockdown cell. In common to both MLL knockout mice and MLL knockdown cell line, the expression levels of GLUT1 and GLUT2 were decreased. In conclusion, MLL knockout mice showed decreased insulin secretion. It was suggested that MLL may be involved in insulin secretion through decreased expression of the GULT1 gene and GLUT2 genes in islets.
Presentation: No date and time listed
ODP216 Interventional Study To Reduce The Readmission Rate In Type 1 Diabetics Hospitalized For Diabetic Ketoacidosis
Authors: Hashmi Syed Salman Hamid , Bahtiyar Gul , Rodriguez Giovanna , Bagar Darin Daw , Sadiq Nazia , Milla Cristian , Gorbonos Allen 
Published: November 2022

Abstract

Introduction
Diabetic ketoacidosis (DKA) is an emergency associated with a high mortality rate. 25% of DKA readmissions in the U. S. A are preventable and they lead to an increase in the mortality rate and the length of the hospital stay with each new admission. In our study, we set out to decrease the DKA readmission rate at our hospital which is a community teaching hospital by assessing the predictors of readmission in adults with type 1 diabetics hospitalized for DKA.

Methods
The study was an interventional study conducted between February 2021 and May 2021. All the type 1 diabetics who were on insulin and had DKA admissions in the past three months were included in the study. After a literature review of the risk factors of DKA readmission, a questionnaire was designed to gather information from the patients. The ABCD (A: age; B: behavioral health; C: coverage; D: drug/alcohol abuse) score was used for DKA readmission risk assessment on admission. The insulin delivery technique of the patients was assessed and proper training on the technique was given before discharge. All the DKA admissions received mandatory endocrinology consult and the note template of the endocrinology consult note in the electronic medical record system was modified to let the primary team know about the discharge instructions, medications, and follow-up appointments in detail. Patients were followed up with a telehealth visit in a week and physical endocrinology clinic follow-up 3 weeks after discharge.

Results
Our study included 69 patients admitted with a diagnosis of DKA. The average HbA1C in the study was 11.8. Predictors of readmission were female sex (Hazard Ratio [HR]: 1.74, 95% CI: 1.64 - 1.80, p&lt;0. 001), hypertension (HR: 1.98, 95% CI: 1.80 - 1.95, p&lt;0. 001), discharge against medical advice (HR: 1.74, 95% CI: 1.53 - 1.96, p&lt;0. 001). The readmission rate at the hospital was 20.8% initially and dropped to 13.7% after the interventions. 78% of the population were administering insulin the wrong way. The 'ABCD' score of the patients had a statistically significant correlation with the readmission rate. A difference in difference study model was used to assess the significance of the interventions on the readmission rate. Linear regression was run with significant R square, F- test values.

Conclusions
The study revealed that the major risk factors for readmission were lower socioeconomic status, co-morbidities, poor health literacy, and drug abuse. The study highlighted the importance of inpatient education, specialty care, better discharge instructions, coordination of care, and post-discharge support to reduce the DKA readmission rate.
Presentation: No date and time listed
ODP219 Laparoscopic Gastrostomy tube (LGT) Placement for Management of Post Bariatric Surgery Hypoglycemia Syndrome (PBSHS).
Authors: Uwaifo Gabriel , Juneau Andrea Kate , Gridley Asahel 
Published: November 2022

Abstract

Introduction
Bariatric surgery is currently the most effective long term management for morbid obesity. Laparoscopic bariatric surgery whether gastric banding (LGB), sleeve gastrectomy (LSG) or gastric bypass (LRYGB) are now more commonly done. One major complication that can follow these procedures are the hypoglycemic syndromes; post bariatric surgery hypoglycemia syndrome (PBSHS). PBSHS is a spectrum ranging from mild reactive hypoglycemia to hypoglycemia with dumping syndrome to the most severe being post bariatric surgery nesidioblastosis (PBSN). Clinical case; The patient is a 33 yr old Caucasian lady with past history of morbid obesity who had LSG in 2012 with poor weight loss response. This was converted to LRYGB in 2016 with much better weight loss response. Within 1.5 yrs of the LRYGB however she started having recurrent hypoglycemic episodes which were initially mild and mostly postprandial (PP) but rapidly escalated to both fasting and PP states. Work up revealed that she had both reactive and fasting hypoglycemia and despite dietary interventions the episodes escalated and with "defensive eating" she progressively gained weight. Her hypoglycemic spells were confirmed as insulin mediated and consistent with PBSN. Medical therapy escalated to maximum dose acarbose, octreotide and high dose diazoxide. The frequency and severity of the hypoglycemic spells worsened and in 2021 she had over 7 hospital admissions from severe hypoglycemia with additional ED visits despite medication use including emergent glucagon use and CGMS monitoring with a DEXCOM device. She had hypoglycemia unawareness with progressively declining quality of life. Rather than possible attempted reversal of the LRYGB a LGT was placed to see if this would ameliorate her symptoms. She now drinks only non-caloric fluids per oral and all caloric intake is via the LGT. The clinical response has been swift and dramatic. Since LGT placement over 3 mths now she has had no symptomatic hypoglycemic episode and no ED nor hospital admissions. Post LGT placement CGMS profile demonstrated marked improvements in glycemic profile and post LGT mixed meal tests (MMT). A dichotomy was demonstrated between her glycemic profile on MMT for oral vs LGT caloric intake providing confirmation of the therapeutic effect of the LGT placement.

Discussion
With the increasing utilization of bariatric surgery for management of obesity and diabetes, the prevalence of PBSHS is expected to increase. This complication can be difficult and expensive to manage while negatively impacting weight loss and quality of life. Our case provides proof of principle evidence to suggest LGT placement as a management consideration in severe cases of PBSN.

Conclusions
LGT placement should be considered as an option in patients with severe PBSN that is poorly controlled with maximal medical and lifestyle interventions.
Presentation: No date and time listed
OR03-5 Identification of Four New Glucotypes during the First Year after Type 1 Diabetes Onset Using Continuous Glucose Monitoring Metrics
Authors: Delfosse Antoine , den Brinker Marieke , Gatto Laurent , Gies Inge , Lebrethon Marie-Christine , Louis Jacques , Lysy Philippe , Martin Manon , Mouraux Thierry , Seret Nicole , Polle Olivier 
Published: November 2022

Abstract
Current markers of β-cell function poorly reflect glucose homeostasis after diabetes onset, mainly because of the lack of integration of parameters of insulin sensitivity and β-cell responsiveness to glucose. Recently, the widespread use of continuous glucose monitoring (CGM) helped stratify glucose control in patients with long-term diabetes in new clinically relevant glucotypes. In our DIATAG study, we investigated how CGM metrics may help to segregate patients with new-onset type 1 diabetes (T1D) entering or not in partial remission (PR). We collected data from 66 pediatric patients with T1D (10.4±4.7 yo) during the first year after diabetes onset (Δ). Clinical parameters (i.e. A1C, insulin daily dose, insulin-dose adjusted A1c [IDAA1C]) and CGM data were collected at Δ+3, +6, +9, +12 months (n=168, 57% remitters [IDAA1C &lt;9]). A panel of 46 CGM metrics was calculated on an hourly and daily basis using iglu package (1). Using unsupervised hierarchical clustering based on daily CGM metrics and clinical parameters, we identified four clusters of glucose metrics that differed from each other (p&lt;0.05). Cluster 1 was characterized by an increased glucose stability (coefficient of variation [CV] 32±5%) within time in target (TIT [63-140 mg/dL], 83±6%) with 9% of sensor values in 63-70 mg/dL range in the early morning period. Cluster 2 exhibited a progressive decrease of TIT (60±14%) and an increase of target above range (TAR [&gt;180 mg/dL], 20±9%) especially during the day while target in range (TIR [70-180 mg/dL]) was nearly equivalent to Cluster 1 (80±8%). Notably, CV remained low (32±5%) with little time spent below range (TBR [&lt;70 mg/dL], 5±2%). Cluster 3 demonstrated a net increase of CV during all the nycthemere (46±7%) concomitantly to an increase of TBR (14±7%). Interestingly, TIT and TAR remained close to values from Cluster 2 (55±11%; 23±10%). Finally, Cluster 4 demonstrated major hyperglycemias (TAR, 55±13%) with increased CV (47±9%) and decreased TBR (8±6%). Interestingly, clustering allowed clinically relevant segregation of intermediate values of IDAA1C (i.e. 7.5-10) between Cluster 2 and Cluster 3, independently of the remission status. Moreover, participants at Δ+3 months distributed across all clusters (with respectively 38% in Cluster 1, 26% in Cluster 2, 29% in Cluster 3 and 7% in Cluster 4) highlighting the usefulness of CGM in characterizing disease heterogeneity from diabetes onset. In our study, a combination of CGM metrics and clinical parameters unraveled key clinical milestones of glucose homeostasis and remission status during the first year of T1D. 1. Broll et al, 2021;16(4): e0248560.
Presentation: Saturday, June 11, 2022 12:30 p.m. - 12:45 p.m.
OR28-2 Assessing Longitudinal Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes
Authors: Bell Ronny Antonio , Bellatorre Anna , Divers Jasmin , Kahkoska Anna , Liese Angela , Mayer-Davis Elizabeth , Mendoza Jason , Pihoker Catherine , Williams Adrienne , Wisk Lauren , Wright Davene , Everett Estelle 
Published: November 2022

Abstract

Background
Insulin pump use provides many advantages for the management of type 1 diabetes (T1D), but studies have shown racial, ethnic, and socioeconomic inequities in the use of this technology. As the prevalence of insulin pump use has increased over the past two decades, we aimed to determine whether these inequities have increased or diminished over time.

Methods
We used data from the population-based SEARCH for Diabetes in Youth study to perform a serial cross-sectional analysis to evaluate changes over time in insulin pump use in participants &lt;20 years old with T1D by racial and ethnic group, health insurance, household income, and formal parental education across 4 phases of the study (Phase 1: 2001-2005, Phase 2: 2006-2010, Phase 3: 2011-2015 and Phase 4: 2016-2019). Data from the last study visit were analyzed for those with multiple visits within a phase. Multivariable generalized estimating equations with a binomial distribution were used to assess probability of insulin pump use, and models were further adjusted for the other predictors–age at visit, diabetes duration, sex and clinic site--with clustering for individuals. An interaction effect between each primary predictor (race and ethnicity, health insurance, household income, education) and the phase variable was used to assess temporal changes.

Results
The prevalence of insulin pump use increased from 30% in Phase 1 to 58.3% in Phase 4 . Compared to those of non-Hispanic (NH) white race, odds of pump use in Hispanic participants was 0.08 (95% CI 0.01-0.63) in Phase 2 and 0.65 (95% CI 0.48-0.87) in Phase 4 with significantly reduced disparities over time (p=0.05). The disparities for Black participants and those of other races did not change over time, but was significantly lower than for white participants in all periods (0.28 (95%CI 0.21-0.37) and 0.43 (95%CI 0.26-0.71), respectively). Across all time periods, T hose with some high school/high school degree and those with some college had lower odds of pump use compared to those with at least a bachelor's degree 0.38 (95%CI 0.30-0.48) and 0.69 (95%CI 0.57-0.82). T hose with public insurance had lower odds for pump use compared to those with private insurance 0.84 (0.68-1.03). T hose with an income of &lt; $25K, $25K-$49K, and $50K-74K had lower odds of pump use of 0.43 (95%CI 0.34-0.54), 0.57 (95%CI 0.46-0.71) and 0.80 (95%CI 0.65-0.97) compared to those with household incomes ≥ $75,000.

Conclusion
Over the past two decades, there have been no improvements in the ethnic, racial, and socioeconomic inequities in insulin pump use among youth with T1D. Studies that evaluate barriers or test interventions to improve technology access are needed to address the persistent inequities in diabetes care.
Presentation: Tuesday, June 14, 2022 10:00 a.m. - 10:15 a.m.
PSAT232 Understanding the Duration of Zinc 8 Transporter Antibody Seropositivity
Authors: Chavez Hilda Merino , Pena Ernesto Munoz , Suryanarayanan Sowmya , Yau Hanford , Paniagua Gabriela Zuniga , Botero Suarez Carlos S 
Published: November 2022

Abstract

Background
Since their recent discovery of zinc transporter 8 antibodies (ZnT8A) by Wenzlau et al. in 2007, the relevance and clinical utility of this marker has been in question. Some recent reports have shown a wide potential for both diagnostic as well as prognostic clinical applications in T1DM as they can be found years before clinical symptoms appear. Understanding the timing of the seropositivity of antibodies such as ZnT8A can help us understand how to utilize this marker for the diagnosis and prognosis of T1DM. Up to 20% of T1DM patients are reported to have ZnT8A positive with negative GAD-65 and IAA autoantibodies. The duration of seropositivity of ZnT8A is unclear. We describe 2 cases from our endocrine clinic with significant zinc 8 transporter antibody titers over 8 - 26 years after their initial diagnosis.

Clinical Cases
CASE 1: 34-year-old man diagnosed initially with T2DM 9 years prior and later re-classified as T1DM. He was treated initially with oral agents and switched over to Multiple Daily Injection (MDI) insulin about 3-4 years later. He has no family history of diabetes. Approximately 8 years after his initial diagnosis, his autoantibodies profile showed a positive zinc transporter 8 antibody of 28 U/mL (reference of &lt; 15 U/mL), but negative GAD-65 antibodies (reference &lt;5 IU/mL) and negative Islet cell antibodies.
CASE 2: 47-year-old man diagnosed with T2DM in 1995 and was initially started on oral hypoglycemic medications. He was later evaluated at our endocrinology clinic and reclassified as type 1 DM after his serologic testing showed a low C peptide &lt; 0.1 ng/mL, positive zinc transporter 8 antibody of 32 U/mL (reference of &lt; 15 U/mL), and negative islet cell antibody screen negative, and negative GAD-65 antibodies (reference &lt;5 IU/mL). He was transitioned to continuous glucose monitoring and an insulin pump, but was too difficult for the patient to manage. He was ultimately transitioned to a basal-bolus regimen of insulin with MDI. His latest serologic testing showed a HgA1C of 9.2%.

Conclusions
Zinc 8 transporter antibody can help differentiate type 1 from type 2 diabetes and initiate insulin therapy for better glycemic control as well as aid in prognosis and stratification strategies. The duration of seropositivity of ZnT8A has not been clearly established. Previous reports have shown that ZnT8A can be detected at an age around 3 years of age, but peaks around late adolescence and does not have a significant decline in seropositivity rates in older adults, as does IAA. This emphasizes the use of ZnT8A as a useful marker in adult and elderly patients. We describe 2 case reports which indicate that ZnT8 antibodies can remain positive for at least 8 - 26 years in the absence of other autoantibodies.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN164 Feasibility of a telehealth-delivered diabetes foot care educational program
Authors: Ju Hsiao-Hui , Cron Stanley , Jularbal Jed , Alford Jeffery , Momin Rashmi , Johnson Constance 
Published: November 2022

Abstract

Background
Diabetes-related nerve damage, foot ulcerations, and amputations occur as consequences of type 2 diabetes mellitus that is prevalent worldwide.

Aims
The study aims to investigate the preliminary effects and the feasibility of a telehealth educational program in patients with type 2 diabetes.

Methods
We conducted a single-arm, pre-mid-post measure study in two primary care practices in Texas. A total of 29 participants who met eligibility criteria (type 2 diabetes, Internet access, and English speaking) met with the research team once a month for 3 months via Zoom. The intervention involved telehealth visits with a board-certified family nurse practitioner/nurse educator for diabetes foot care and counseling, diabetes education, and discussion of self-management behaviors. Diabetes foot care behaviors, knowledge, and self-management activities were measured at baseline, 1.5 months, and 3 months.

Results
Initially, the mean score of the Diabetes Foot Self-Care Behavior Scale (DFSBS) was 17.75. The mean score of DFSBS increased to 21.59 at 1.5 months and rose to 25.46 at 3 months, indicating an improved frequency of foot care behaviors. Knowledge of diabetes was 70.48% correct at baseline and increased to 75.92% at 1.5 months and 83.89% at 3 months. At 1.5 months, the mean scores of the Summary of Diabetes Self-Care Activities improved by 0.4 days/week (d/w) for general diet, 0.29 d/w for exercise, 0.21 d/w for blood glucose testing, and 0.69 d/w for foot care. At 3 months, these values increased by 1.4 d/w for general diet, 1.13 d/w for exercise, 2.02 d/w for blood glucose testing, and 1.71 d/w for foot care compared with baseline. Of those enrolled, 87.18% completed the first telehealth visit, while 74.36% completed the second and third telehealth visits. Overall, 74.36% completed all three telehealth visits.

Conclusions
In two large primary care practices in Texas, a telehealth educational program that was centered on diabetes foot self-care management led to an improvement in self-care behaviors and knowledge for patients with type 2 diabetes. Clinical Implications: The promising results from this pilot study demonstrated the feasibility of a telehealth-delivered diabetes foot care educational program for patients with type 2 diabetes. Innovative strategies such as incorporating telehealth visits with in-person examinations may improve diabetes monitoring and prevent diabetes-related foot complications. Further research is needed to determine the long-term effects of a multi-disciplinary and personalized telehealth approach for monitoring diabetes foot care and self-management behaviors.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.