bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSAT216 Turner Syndrome and Congenital Hypoparathyroidism
Authors: Jovanovic Filip , Lane Chelsea , Sudhakar Aboorva 
Published: November 2022

Abstract

Background
Patients with Turner syndrome may have multiple associated metabolic comorbidities, some of which are rare. We present a case report with Turner syndrome and congenital hypoparathyroidism.

Clinical Case
A 30-year-old Caucasian female with Turner syndrome and primary ovarian insufficiency was referred for evaluation of osteopenia and elevated TSH. On her initial visit, the patient was asymptomatic, physical exam was significant only for short stature. The DEXA scan showed a T-score of -2 at the lumbar spine and -1.8 at the femoral neck. TSH was elevated at 4.81 (0.5–5.0 mIU/L), with normal serum levels of free T3 and free T4 consistent with subclinical hypothyroidism. Patient previously underwent aortic root imaging with no evidence of dilatation. Her only home medication was a combination oral contraceptive tablet (Yaz; drospirenone and ethinyl estradiol) for primary amenorrhea. The patient was started on calcium 500 mg daily and vitamin D3 400 IU. On her next visit, patient's calcium was 8.7 mg/dL (8.6–10.6 mg/dL), phosphorus 4.4 mg/dL (3–4.3 mg/dL), albumin 3.9 g/dL (3.4–5.4 g/dL), 25-hydroxy vitamin D 63.2 ng/dL (30-100 ng/dL), 24-hour urine calcium 93 mg/day (100-300 mg/day), and PTH 20 pg/mL (15–65 pg/mL) suggestive of hypoparathyroidism. There have only been a few case reports of congenital hypoparathyroidism in patients with Turner syndrome. (1) The patient was started on calcitriol 0.25 mcg daily and her calcium was increased to 500 mg twice daily. Repeat serum calcium was 9.1 and 25-hydroxy vitamin D 75.6 ng/dL showing that the patient responded appropriately to calcium and calcitriol supplementation. In the absence of a history of neck surgery or autoimmune diseases, the etiology behind hypoparathyroidism in this patient with Turner syndrome appears to be secondary to genetic mutation.

Conclusion
We highlight the importance of measuring parathyroid hormone level in patients with Turner syndrome who exhibit symptoms or signs of osteopenia as part of diagnostic workup.

Reference
(1) Suzuki Y, Watanabe H, Haeno S, Omori T, Hiramatsu R, Asada M, Tanaka F, Maeda T, Okada M, Suzuki T, et al. Primary hypoparathyroidism in Turner's syndrome. Intern Med. 1995 Nov;34(11): 1071-3.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
LBODP033 The Compliant Patient - When Adherence Hurts
Authors: Cheah Zhen Fung , Kuan Yueh Chien 
Published: November 2022

Abstract
Metformin is a biguanide oral antidiabetic agent which lowers blood glucose by decreasing hepatic gluconeogenesis. In the absence of contraindications, it is the initial treatment in most patients with type 2 diabetes along with lifestyle modifications. This drug however is commonly associated with gastrointestinal side effects especially diarrhoea which could be potentially life-threatening if prolonged. We report a case of chronic severe painless diarrhoea with weight loss over 8 months in a 40-year-old man after starting metformin for his newly diagnosed type 2 diabetes. Although the diarrhoea resolved when the patient temporarily stopped taking metformin, he decided to resume the medication to ensure his blood glucose is optimally controlled. He suspected metformin to be the cause of his diarrhoea but did not report this to his doctor during follow-up. The patient was later admitted for hypovolemic shock and severe metabolic acidosis with acute kidney injury when his diarrhoea worsened with acute gastroenteritis. He required mechanical ventilation, inotropic support and Continuous Renal Replacement Therapy in the ICU. This was further complicated by left eye ischemic optic neuropathy attributed to the acute volume loss as radiological investigations were unremarkable. Multiple laboratory and radiological investigations were done to look for the cause of the diarrhoea with no underlying pathology found. Metformin was discontinued upon admission and his diarrhoea subsequently resolved 8 days later. Upon follow-up a month later, the patient continued to be diarrhoea free without metformin. This case highlights the importance of patient education on the side effects of a medication like metformin upon commencement of the drug and to encourage the patient to notify their healthcare provider timely if they experience those side effects. This not only empowers patients to participate in their own healthcare but would avoid severe drug-related adverse events that can result in unwanted long-term sequelae.
Presentation: No date and time listed
LBODP039 Glycogenic Hepatopathy- An Underrecognized Complication Of Diabetes
Authors: Chamakkala Tess , Silparshetty Santh 
Published: November 2022

Abstract

Introduction
Glycogenic hepatopathy (GH) is an infrequently described complication of predominantly type 1 diabetes characterized by liver dysfunction and hepatomegaly. This condition is different from the more common nonalcoholic fatty liver disease (NAFLD) which is clinically indistinguishable. Liver biopsy is currently the only way to differentiate the two conditions. We present a 19 year old female with persistent transaminasemia secondary to glycogenic hepatopathy associated with poorly controlled type 1 diabetes.

Case Description
A 19 year old female was admitted with DKA secondary to facial cellulitis. She had a past history of poorly controlled type 1 DM since age 9, proteinuria, and transaminasemia since age 14. Initial labs showed elevated plasma glucose 365 mg/dL, bicarbonate 15 mEq/L, anion gap 22, positive betahydroxybutyrate, AST 208 mmol/L, ALT 136 mmol/L, and HbA1c 12. 0%. She was successfully resuscitated from DKA. Repeat liver function tests showed further elevation of AST 819 mmol/L and ALT 346 mmol/L. Ultrasound of liver showed increased echotexture reported as steatosis. Further history revealed significant financial difficulty due to which patient was using different kinds of basal and bolus insulins interchangeably. She would sometimes use bolus insulin to cover for lack of basal insulin. Prior gastroenterology workup showed ANA positivity in a speckled pattern but was otherwise unrevealing for infective, autoimmune, or alcoholic hepatitis. Liver biopsy was therefore recommended by inpatient gastroenterology. Liver biopsy revealed spotty mild lobular hepatitis and focal portal fibrosis consistent with glycogenic hepatopathy. Features of autoimmune hepatitis were not seen in liver biopsy.

Discussion
Glycogen hepatopathy seems to represent an acquired form of glycogen storage disorder. Pathophysiology is suspected to be a combination of hyperglycemia and hyperinsulinemia leading to increased glycogen accumulation in hepatocytes while glycogenolysis is suppressed. This mechanism seems to correlate with our patient who reported use of large doses of short acting insulin followed by glucose administration to counteract hypoglycemia. Abnormal glucagon activity or enzymes deficiencies in glycogenolysis pathway (as reported with congenital glycogenstorage disorders) have not been elucidated. Recent data has also questioned reversibility and long term safety as liver biopsies of patients with glycogenic hepatopathy have demonstrated varying degrees of fibrosis. Newer MRI protocols seem to be able to distinguish GH from NAFLD, and this is important as these are pathophysiologically distinct and will have different management strategies. This case highlights glycogenic hepatopathy as an underrecognized complication of diabetes that will require improved recognition and further investigation to evaluate long term consequences.
Presentation: No date and time listed
LBODP040 Positive Early Glucola Screening: Who Has Gestational Diabetes?
Authors: Class Madelyn , Sharma Ankita , Durgham Ryan , Anasti James N 
Published: November 2022

Abstract
This study set out to determine risk factors most predictive of early GDMA review was conducted of patients with positive early 1HR glucola screenings (≥135 mg/dL and reflex 3hr GTT before 20 weeks). Characteristics (comorbidities, family history, demographics) of patients who were diagnosed with early GDM were compared to those who were not. A multiple logistic regression model was constructed to compute adjusted odds ratios (aORs) for each covariate. Among 189 early GDM positive (BMI 36.1 ± 8.27; Age 32.7 ± 5.50) and 153 GDM negative (BMI 33.8 ± 7.24; Age 30.8 ± 5.45) patients were identified, the adjusted odds of developing GDM increases by: 6.7% (CI 1. 01-1.12; p 0. 01) or 4.5% (CI 1. 01-1. 08; p 0. 02) with a one unit increase in age or BMI, respectively. The aORs of developing GDM are 2. 0 (CI 1.24-3.26, p 0. 005), 3. 0 (CI 1.64-5.66; p 0. 0005), and 3.7 (CI 1.96-8.78, p 0. 0003) with family history of diabetes, prior history of GDM, or history of hypertension, respectively. This study was unique in that hypertension had the highest association with early GDM. Thus, individuals with HTN regardless of age, BMI, prior GDM, family history should receive an early glucola screen.
Presentation: No date and time listed
LBODP044 Effects Of Dietary Supplementation On Progression To Type 2 Diabetes Single Center Randomized Double-blind Placebo-controlled Trial An Interim Analysis At 24 Weeks
Authors: Chattieng Preeyapat , Nasomphan Tiersidh , Sathirakul Korbtham , Niramitmahapanya Sathit 
Published: November 2022

Abstract

Objectives
To examine the effect of dietary supplements on diabetic risk, blood glucose level and lipid profiles.

Methods
A randomized, double-blinded, placebo-controlled study was conducted at Rajavithi Hospital. Participants with prediabetes were randomly allocated to three arms of dietary supplements: placebo (PL) or curcumin plus fish oil and vitamin D (CFD), or curcumin plus fish oil (CF) for 24 weeks. Primary outcomes of the trial were progression to overt diabetes and glycemic indices (fasting plasma glucose, 75-g OGTT 2-h plasma glucose or HbA1C). Secondary outcomes were body weight change, BMI and lipid profiles.

Results
A total of forty-seven participants (PL, n = 16; CFD, n = 15; CF, n = 16) were included in the study. At 24 weeks, the intervention groups significantly lowered the progression of type 2 diabetes among prediabetes individuals, the interventions groups -0.77 ± 1.17, and 0.19 ± 1.28, the placebo group 0.64 ± 1.82, P value = 0. 046 (P&lt;0. 05). However, the results failed to demonstrate the effect of dietary supplements on weight, BMI and blood chemistries.

Conclusion
The combined dietary supplements which contained curcumin-fish oil-vitamin D, lowered the risk of prediabetes progression to overt diabetes at six months follow up and well-tolerated among the participants. Keywords: dietary supplements, curcumin, fish oil, vitamin d, prediabetes
Presentation: No date and time listed
LBODP046 Reduction In "Cardiovascular Death Or Hospitalisation For Heart Failure" With Sglt-2is Is Dependent On Weight Reduction: A Meta-regression Analysis
Authors: Ghosal Samit , Sinha Binayak , Kar Partha 
Published: November 2022

Abstract

Aims
The modern management of type 2 diabetes (T2D) has shifted focus from a "glucocentric" approach to one that focuses on outcomes reduction. As a result, the aim of management is skewed toward specific molecules like sodium glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide receptor agonists (GLP1-RAs) associated with microvascular and macrovascular benefits. The aim of this meta-regression analysis is to assess whether these molecule specific results are dependent or independent of associated metabolic benefits.

Methods
A web-based search identified five citations for the analysis. The meta-analysis was conducted on a pooled population of 46,969 patients with 26,765 patients in the SGLT-2is arm and 20,204 participants in the placebo arm. A two-step approach to analysis was planned. The first step included a meta-analysis of the cardiovascular death or hospitalization due to heart failure (CV death or hHF) end point using the random effects model to identify significant heterogeneity of the effect size. If identified, the second step would involve conducting a meta-regression analysis using three moderators (HbA1c, weight, and systolic blood pressure) to identify the co-variate explaining this heterogeneity.

Results
The pooled effect size of the CV death or hHF endpoint was associated with significant heterogeneity (Q: 8. 06, df: 4, I2: 50.44, p=0. 09). The model using HbA1c difference (p=0.17) between the two groups or difference in SBP (p=0.86) did not explain the variance in the observed effect size. However, the difference in weight between the SGLT-2is and placebo group correlated significantly with the variance in CV death or hHF effect size (95% CI 0. 05-0.32, p=&lt;0. 01). The relationship between weight differential and CV death of hHF reduction is given by the formula, Y=-0.5441+0.1883*Weight difference.

Conclusion
The reduction in CV death or hHF with SGLT-2is is not an exclusive molecule-specific effect but dependent on weight reduction.
Presentation: No date and time listed
LBSUN206 Provider Prescribing Habits And Use Of Newer Agents For Type 2 Diabetes In A Large Multicenter Health Care System
Authors: Yaseen Aseel , Lahiri Sharon 
Published: November 2022

Abstract

Introduction
Type 2 diabetes (T2D) management approaches have evolved, with current algorithms recommending early use of newer agents such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) when cardiovascular (CV) and renal disease are present. National prescribing data indicate stable metformin use and a decline in sulfonylurea use; prescriptions for newer agents have increased but remain low. High cost, difficulty with prior authorization, and insufficient experience have been proposed as reasons why newer agents are not prescribed more often. Our aims were to determine providers’ prescribing habits and use of newer agents for T2D in our health care system and to identify the factors influencing prescribers’ choice of medications and the barriers to prescribing GLP-1 RAs and SGLT2i.

Methods
This study was conducted at a large multicenter health care system. Health care providers were asked to complete an anonymous online survey. The survey was sent to 515 providers (357 primary care physicians, 26 nephrologists, 113 cardiologists, and 19 endocrinologists).

Results
There were 125 respondents (24%): 81 (64.8%) in primary care, 22 (17.6%) in cardiology, 13 (10.4%) in endocrinology, and 9 (7.2%) in nephrology. All respondents in endocrinology and primary care, 45.5% in cardiology, and 66.7% in nephrology prescribed T2D medications. Metformin, SGLT-2i, and insulin were prescribed most frequently (76.8%, 78.4%, and 73.4%, respectively), followed by GLP-1 RAs (66.9%), DPP-4 inhibitors (43.9%), sulfonylureas (35.5%), and thiazolidinediones (8.9%). After metformin, SGLT-2i (57.6%) and GLP-1 RAs (55.2%) were most frequently chosen as second-line T2D medications. The top perceived benefits of using GLP-1 RAs and SGLT2i were improvement of hemoglobin A1c and decreased comorbidity risks. Most respondents also chose "to minimize weight gain/promote weight loss" as a benefit of GLP-1 RA use and "mortality benefit" as a benefit of SGLT-2i use. High cost and problems with prior authorization were the primary perceived barriers to prescribing GLP-1 RAs and SGLT-2i. Over half felt that the need to inject was a barrier to GLP-1 RA use, and concern for adverse reactions was a barrier to SGLT-2i use. Cardiology and nephrology specialists viewed limited experience as a barrier to prescribing GLP-1RAs.

Conclusions
At our health system, practices for prescribing T2D therapies were in accordance with published algorithms that recommend early use of GLP-1 RAs and SGLT-2i. High cost and need for prior authorization were the main perceived barriers to prescribing newer agents. Limited experience with newer agents was a barrier for nephrologists and cardiologists. Education on patient assistance programs, insurance formularies, and how to incorporate GLP-1RAs and SGLT-2i for CV and renal benefits may increase the use of these agents.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN215 Evaluation Of Glycemic Control By Continuous Glucose Monitoring Among Hospitalized Older Adults With Type-2 Diabetes And Frailty
Authors: Idrees Thaer , Zabala Z E , Moreno E M , Gerges A , Urrutia M A , Ruiz J G , Vaughan C , Vellanki P , Pasquel F J , Peng L , Umpierrez G E 
Published: November 2022

Abstract

Recent observational and meta-analyses have reported a frailty prevalence between 10% and 25% in people with diabetes, in particular in those older than 60 years of age. The impact of frailty on hospital glycemic control and glycemic variability (GV) by continuous glucose monitoring (CGM) in insulin-treated older adults with type 2 diabetes (T2D) is not known. Accordingly, we reviewed data from 3 inpatient randomized clinical trials using CGM in insulin-treated patients with T2D. The validated laboratory-based frailty index (FI-LAB) scale was used for frailty assessment, and participants were categorized into three groups [non-frail: (0-&lt;0.1), pre-frail (≥0.1-&lt;0.21), and frail (≥0.21)] in 84 older adults. | There were no differences on admission clinical characteristics between the non-frail/pre-frail older adults and the frail older adults except for Creatinine (BMI: 32.4 ± 9 vs. 36.83± 13, p=0.21; HbA1c%: 9.3 ± 2 vs. 8.72± 2, p=0.18; Admission BG: 227 ± 114 vs. 194. 07± 75 mg/dl, p=0.26; Cr: 1.16 ± 1 vs. 1.65± 1. 0). There were no differences in GV by coefficient of variation (CV), amplitude of glucose excursion (MAGE), and standard deviation (SD) between the two groups. The correlation between FI-LAB score and percent time with CGM &lt;70 was 0.204 (p=0. 064) and the correlation between FI-LAB score and percent time with percent time with CGM&lt;54 was 0.217 (p=0. 049). Results from standard linear regression and zero-inflated Beta regression further suggest that frail old patients with higher frailty scores may be associated with larger percent time with CGM below range &lt;70 and CGM &lt;54 mg/dL.

Conclusion
Our results indicate that older adults with T2D with higher frailty score experience more time in hypoglycemia during their hospital stay despite having comparable mean daily blood glucose, time in range and glycemic variability compared to non-frail or pre-frail older adults. A larger prospective study is needed to confirm these findings and determine the impact of frailty on clinical outcome. Providers should be vigilant when using insulin or insulin secretagogues in hospitalized older adults with diabetes and frailty.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP179 Development of Derivatization-free ID-LC/MS/MS Method for Simultaneous Measurement of Human Serum Monosaccharides
Authors: Tse Chui , Zhang Li , Dahya Komal , Pokuah Fidelia , Sugahara Otoe , Danilenko Uliana , Vesper Hubert 
Published: November 2022

Abstract
According to the CDC's National Diabetes Statistics Report for 2020, it is estimated that 34.2 million, 10.5% of the U. S. population, have diabetes. High fructose intake has also been associated with increased de novo lipogenesis in the liver leading to non-alcoholic fatty liver disease (NAFLD). Emerging evidence suggests that measuring fructose, galactose, and other saccharides in addition to glucose may be helpful for diagnosis of metabolic disorders and other diseases. Therefore, there is a need for an accurate and precise laboratory method for measuring serum monosaccharide panels. Traditional monosaccharide assays used in patient care often can only quantitate one monosaccharide at a time. We aim to develop a high-throughput analytical method for simultaneous measurement of serum monosaccharides that is suitable for large scale epidemiologic studies. Our assay is based on a derivatization-free ID-LC/MS/MS procedure. Certified primary reference materials of monosaccharides from NIST (Gaithersburg, MD) were used for assay calibration. The serum samples were spiked with 13 C labeled internal standards. The monosaccharides were isolated from serum matrix by acetonitrile protein precipitation and filtration in 96-well filter plate (0.2um, porous PTFE). Aliquot of the acetonitrile filtrate was applied on an AB SCIEX Triple Quad™ 6500 LC/MS/MS system for analysis. The monosaccharides including glucose, galactose, fructose, mannose, and potential interferences were resolved from each other on Unison UK Amino column (3×250mm) eluted with acetonitrile and water gradient. Selective reaction monitoring in negative electrospray ionization mode was used for quantitation of monosaccharides in the samples. The measurement ranges covered 10–402 mg/dL for glucose, which is sufficient to monitor the serum glucose levels in normal, hypo-, and hyperglycemia patient samples. Using 4 levels of NIST SRM 965b (values assigned using GC-MS based reference measurement procedure), the method demonstrated excellent measurement accuracy of over 98% for serum glucose. The imprecision of serum glucose measurement was within 3%. Imprecision and accuracy of lower abundant serum monosaccharides were lower than 6% and above 96%, respectively. The application of 96-well format filter plate and automated liquid handler system significantly improves the throughput of sample preparation. The current analytical method can be used to simultaneously measure the concentrations levels of a panel of serum monosaccharides with appropriate accuracy and precision. Free of derivatization, simple sample procedure and application of automation system significantly improves throughput of the assay which are suitable for routine serum monosaccharides assay in clinical laboratories and for large biomonitoring studies.
Presentation: No date and time listed
ODP180 Diabetes Apps: Do They Help Our Patients?
Authors: Xia Alexander , Wu Gloria , Zhao Weichen 
Published: November 2022

Abstract

Background
The CDC in 2020 stated that 34.1 million US adults have diabetes and 88 million have pre-diabetes. The Association of Diabetes Care and Education Specialists (ADCES) published self-care behaviors in Feb 2021 highlighting 7 characteristics (ADCES7): Healthy Coping Healthy Eating Being Active Taking Medication Monitoring Reducing Risk Problem Solving Purpose: To determine if mobile diabetes apps fulfill ADCES7 guidelines to meet patient needs.

Methods
Google search engine to find the top 10 free apps using the search term "diabetes." Inclusion criteria: Free, English, USA accessible,&gt;100K downloads. Exclusion criteria: &lt;100K downloads Using the ADCES7 self-care behaviors, we investigated these criteria in the apps: (1) Healthy coping: Goal setting, online peer support, mental health status, (2) Healthy eating: calorie counting, lessons in nutrition, (3) Being Active: exercise reminder, step counting, heart rate, (4) Taking Medication: reminder for medication, push notification, (5) Monitoring: blood glucose, weight, blood pressure, (6) Reducing Risk: general education, (7) Problem Solving: Data export Results The top apps (by most downloads(DL) to fewer): 1. mySugr(1M), 2. OneTouch Reveal® mobile app for Diabetes(1M), 3. Blood Sugar(1M), 4. Blood Glucose Tracker(0.5M), 5. Diabetes(0.5M), 6. Health2Sync - Diabetes Care(0.5M),7. Diabetes: M(0.5M),8. Glucose Buddy Diabetes Tracker(0.5M), 9. Beat Diabetes(0.1M), 10. Diabetes Diary(0.1M). 3/10 apps have goal setting, 0/10 have online peer support, 3/10 monitor mental health status, 5/10 have calorie counting, 4/10 have lessons in nutrition, 2/10 have exercise reminders, 6/10 have reminders for medication, 8/10 monitor blood glucose, 6/10 monitor weight, 6/10 monitor blood pressure, 8/10 have data exports, 5/10 have general education. None have heart rate or step counting.

Conclusion
The free apps fulfill some ADCES7 guidelines, with emphasis on monitoring but not for healthy coping. However, they may be useful in medication compliance and diabetes care for our diabetic patients. As physicians, we can continue to help our patients navigate the mobile health space.
Presentation: No date and time listed