bluuebunny/crossref_metadata_2025_split huggingface dataset:
90-OR: FreeStyle Libre (FSL) Time in Range (TIR) and Time Below Range (TBR) : Impact on HbA1c, Diabetes-Related Distress (DRD) , and Resource Utilisation in the Association of British Clinical Diabetologists (ABCD) National Audit
Authors: DESHMUKH HARSHAL , PIERI BEATRICE , WILMOT EMMA G. , CHOUDHARY PRATIK , SHAH NAJEEB , TSATLIDIS VASILEIOS , LUMB ALISTAIR N. , RYDER ROBERT E. , WALTON CHRISTOPHER , SATHYAPALAN THOZHUKAT 
Published: May 2022

Introduction: With increasing access to intermittently scanned continuous glucose monitoring (isCGM) , with the FSL, it is essential to understand the effect of TIR and TBR on HbA1c, DRD, and resource utilisation in people living with diabetes
Methods: Clinicians from 1NHS UK hospitals submitted FSL user data for16,034 participants, (96% type 1 diabetes) of whom 6859 had follow-up data, collected during routine clinical care and submitted to a web-based secure tool. Linear regression analysis was used to estimate the age, gender and baseline HbA1c adjusted reduction in HbA1c in the TIR categories.
Results: Follow up TIR data were available for 3250 (47%) participants of which, 1241 (38%) reported TIR in line with the international consensus (3.9-mmol/l) . After adjustments for age gender, baseline HbA1c and duration of diabetes follow-up TIR ≥50% was associated with an 0.8% (8.75 mmol/mol) reduction in HbA1c (P&lt;0.0001) and -0.29 reduction in DRD (P&lt;0.0001) , while follow-up TIR ≥70% was associated with a 1.3% (14.mmol/mol) reduction in HbA1c (P&lt;0.0001) and 0.40 reduction (P&lt;0.0001) in DRD vs. those with TIR &lt;50%. With the use of FSL, there was a 67% reduction in hospital admissions due to hypoglycaemia (none in those with TIR≥50) , a 63% reduction in hospital admissions related to hyperglycaemia/DKA and an 85% reduction in paramedic outcalls. The reduction in hospital admissions for hyperglycaemia/DKA and paramedic callouts was independent of the TIR achieved during follow-up. The incidence of severe hypoglycaemia was lower in those with TBR ≤5% as compared to those with TBR &gt;5% (7% vs. 11%) but was not statistically significant (P=0.31) .
Conclusion: In a large cohort of UK FSL users, we demonstrate a significant reduction in HbA1c, diabetes-related distress and resource utilisation which was associated with improved TIR

Disclosure
H.Deshmukh: None. T.Sathyapalan: n/a. B.Pieri: None. E.G.Wilmot: Advisory Panel; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Sanofi, Research Support; Insulet Corporation, Novo Nordisk, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi. P.Choudhary: Advisory Panel; Abbott Diabetes, Lilly Diabetes, Medtronic, Research Support; Novo Nordisk, Speaker's Bureau; Dexcom, Inc., Glooko, Inc., Insulet Corporation, Sanofi. N.Shah: None. V.Tsatlidis: None. A.N.Lumb: Advisory Panel; Abbott, Dexcom, Inc., Research Support; Abbott, Novo Nordisk, Speaker's Bureau; Abbott, Dexcom, Inc., Insulet Corporation, Novo Nordisk. R.E.Ryder: None. C.Walton: None.

Funding
NIHR clinical lectureship
900-P: Patterns of Drug Utilization for Cardio- and Renal-Protective Antihyperglycemic Agents in a Commercially Insured Population
Authors: COOK DAVID J. , DEFAIL ANTHONY , MACFARLANE ELIZABETH , PEDERSON DEREK 
Published: May 2022

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium glucose cotransporter-2 inhibitors (SGLT2i) have cardioprotective and kidney-protective effects in select patients with type-2 diabetes (T2D) . Appropriate use, and cost-effectiveness, is essential to realize these benefits as well as to manage total healthcare spending.
Methods: For a commercially insured population (≥18 years old) enrolled in a virtual accountable care organization (Level2) , we examined de-identified administrative claims in a research database for Type-2 diabetes medications from 12/01/20to 11/30/2021. We determined the TCoC for this population, as well as changes in spending and utilization by medication class.
Results: Among 7,361 individuals attributed to Level2, 1,735 members (23.6%) had a cardiovascular or renal indication for an GLP-1RA or SGLT2i. In this population, 447 were prescribed a GLP-1RA and 385 were prescribed a SGLT2i, representing 25.8% and 22.2% of those with comorbidity indications for each drug, respectively. Additionally, 1,214 individuals were prescribed a GLP-1RA and 1,214 were prescribed a SGLT2i without cardiovascular or renal indications, representing 35% of these prescriptions combined.
Conclusion: In 2019-21, use of GLP-1RA and SGLT2i remained limited to approximately 1 in 4 commercially insured patients with T2D and a cardiovascular or renal indication for their selection. Further, they were commonly used in the absence of cardiovascular or renal indication for these classes of agents. While nondiabetes indications for these drugs (weight-loss and renal disease) have expanded recently (April-June 2021) , those broader indications were not in place for the majority of the study period. In a time of limited resources, guideline-concordant therapy is critical to improving the health of those with indications as well as reducing less-than-appropriate use.

Disclosure
D.J.Cook: None. A.Defail: Employee; Level2. E.Macfarlane: Employee; Level2. D.Pederson: Employee; Level2.
901-P: Population Characteristics and Spending Patterns of High-Expenditure Patients among Medicare Beneficiaries with Diabetes
Authors: WANG YU , ZHANG PING 
Published: May 2022

Knowledge of Medicare beneficiaries with high medical expenditures can help identify target populations for intervention and strategies to reduce overall Medicare expenditures. Using 100% Medicare fee-for-service claims, we examined characteristics and spending patterns of high spenders among Medicare beneficiaries with diabetes (DM) . We defined high spenders as those whose expenditures in a year were in the top 10% of beneficiaries with DM. We identified 7,321,228 high spenders in 2015 and followed them through 2017. We grouped high spenders in 2015 into three groups: those who died during 2015-2017 (group 1) , were alive and a high spender in all 3 years (group 2) , and alive but a high spender for 1/2 years (group 3) . We used regression models to identify factors associated with each group. In 2015 high spenders accounted for 48% of all medical expenditures in Medicare beneficiaries with DM. Of the high spenders, 34% were in group 1, 20% in group 2, and 46% in group 3. High spenders in group 1 had a mean annual expenditure of $110,429 and were more likely to be male, be older, have dual eligibility for Medicaid, and have a higher number of comorbid conditions compared with groups 2 and 3. Over 60% of the expenditures in group 1 were spent on either acute inpatient care (39%) or on skilled nursing facility (23%) . Groups 2 and 3 had mean annual expenditures of $83,2 and $42,527, respectively. High spenders in group 2 were more likely to be male, be older, have dual eligibility for Medicaid, and have a higher number of comorbid conditions compared with group 3. Compared to those in group 3, high spenders in group 2 spent a higher proportion on hospice (13.3% vs. 7.9%) and inpatient care (16.7% vs. 9.9%) , but less on acute inpatient care (19.5% vs. 31.3%) . High-spender Medicare beneficiaries with DM had different characteristics and spending patterns. Future studies could identify modifiable factors and develop strategies to lower Medicare expenditures among high spenders with DM.

Disclosure
Y.Wang: None. P.Zhang: None.
91-OR: Association between Complexity of Glucose Time Series and All-Cause Mortality in Patients with Type 2 Diabetes Mellitus: A Prospective Cohort study
Authors: CAI JINGHAO , LU JINGYI , SHEN YUN , LU WEI , ZHU WEI , ZHOU JIAN 
Published: May 2022

Background: Continuous glucose monitoring (CGM) can comprehensively reflect the dynamic changes of blood glucose varying with time. CGM data with more patterns of change represents glucose time series with higher complexity. However, the relationship between complexity of glucose dynamics and clinical outcomes of diabetes remains unknown.
Objective: To investigate the association between complexity of glucose time series, quantified by multiscale entropy (MSE) analysis, and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) in a prospective cohort study.
Methods: Data of 6,001 adult inpatients with T2DM included from January 2005 to December 2015 in a single center was analyzed. Complexity of glucose index (CGI) of glucose time series from CGM was measured by MSE analysis at baseline. Participants were stratified by the tertiles of CGI: &lt; 2.15,2.15∼2.99, and ≥ 3.00. Cox proportional hazards regression models were used to estimate the association between different levels of CGI and the risks of all-cause mortality.
Results: During a median follow-up of 6.8 years, 799 deaths were identified. Multivariate Cox regression analysis revealed that the increase of CGI was associated with a lower risk of all-cause mortality (P for trend = 0.021) . The multivariable-adjusted HRs for all-cause mortality at different CGI levels [&lt; 2.15 (reference group) , 2.15∼2.99, and ≥ 3.00] were 1.00, 0.49 (95%CI 0.30-0.79) , and 0.56 (95%CI 0.36-0.87) in patients with HbA1c &lt; 7.0% (P for trend = 0.015) , while the association was nonsignificant in those with HbA1c ≥ 7.0%. And a significant interaction between HbA1c and CGI (P for interaction = 0.032) was noted in the study.
Conclusion: Lower CGI is associated with an increased risk of all-cause mortality in T2DM achieving HbA1c target, which suggests that the improvement of CGI may further reduce the risk of long-term adverse outcomes in T2DM at an early stage or with good glycemic control.

Disclosure
J.Cai: None. J.Lu: None. Y.Shen: None. W.Lu: None. W.Zhu: None. J.Zhou: None.

Funding
The Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20161430)
921-P: Diabetes Preventive Care for Medicare Beneficiaries: Comparing Efficiency between the Diabetes Belt and Surrounding Areas
Authors: KANG HYOJUNG , KIM SOYOUN , LOBO JENNIFER M. , SOHN MIN-WOONG 
Published: May 2022

Objective: Evidence-based preventive care services are crucial for people with diabetes to improve their health outcomes, but the utilization of the services among older adults is suboptimal. Our objective is to compare relative performance of the Diabetes Belt and surrounding counties in the uptake of preventive services among Medicare beneficiaries with diabetes given available health care resources in the counties. The Diabetes Belt includes 644 counties in the Appalachian and deep south areas of the US that have high diabetes prevalence.
Methods: We used data envelopment analysis (DEA) to compute technical efficiency of counties for 2009-2015. Technical efficiency measures how many outputs a decision-making unit produces given a set of inputs. Inputs included the number of physicians and nurses per 1000 adults in the counties, and outputs included the number of foot exams, a1c tests, and microalbumin tests per 1000 Medicare beneficiaries with diabetes. The Diabetes Belt includes counties in the Appalachian and deep south areas of the US that have high diabetes prevalence. We performed t-tests to compare efficiency between the Diabetes Belt and surrounding counties. We excluded counties with 0 doctors or 0 nurses for &gt;1 year in 2009-2015.
Results: Of 1057 counties, 861 (496 in the Belt and 365 in surrounding areas) were included. During the study period, the average technical efficiency of the counties ranged from 79% to 83%, with only 2.- 3.4% of counties achieving 100% technical efficiency. Diabetes Belt counties had consistently lower efficiency than surrounding counties during the study period (p &lt;0.05) . The mean efficiency was 78-81% in the Diabetes Belt and 81-85% in the surrounding counties.
Discussion: Our results suggest that the degree of inefficiencies was higher in the Diabetes Belt compared to surrounding counties. Given relatively low available resources in these areas, more attention to improve diabetes preventive care is needed.

Disclosure
H.Kang: None. S.Kim: None. J.M.Lobo: n/a. M.Sohn: None.

Funding
National Institutes of Health (1R01DK113295-01A1)
93-LB: A Randomized Clinical Trial of Safety, Pharmacokinetics, and Pharmacodynamics of Weekly Dosing Supagutide in Healthy Chinese Subjects
Authors: MA ANRAN , ZHOU YUE , LOU YAN-RU , LIAO YIJING , SHAO ANNA , WANG ZHIHONG , JIANG YAOJING , CUI QIAOLI , ZHAO YING , LI JIA , PRUD’HOMME GERALD J. , ZHU DALONG , WANG QINGHUA 
Published: May 2022

Supaglutide (Supa) is a novel once-weekly, human-derived long-acting GLP-1 analogue developed for patients with type 2 diabetes. In this study, we investigated the safety, pharmacokinetics (PK) , pharmacodynamics (PD) and potential immunogenicity of single-dose subcutaneous injections of Supa in healthy subjects. In this double-blind, single dose-escalation, 14-week trial, 48 healthy subjects were randomized to subcutaneous Supa treatment (ranging from 0.375 to 9 mg) or placebo arms for 2 weeks. PK profile and safety parameters were assessed. PD parameters (glucose and insulin concentrations) were measured following an oral glucose tolerance test (OGTT) (Day 3) . The half-life of Supa was approximately 120 h with a median Tmax ranging from 48 to 72 h (Table 1) . Supa treatment significantly reduced body weight compared to placebo in a dose-dependent and time-dependent fashion. OGTT results showed that Supa at all doses investigated significantly decreased glucose levels during the test, suggesting increased glucose tolerance. Supa was safe and well-tolerated in healthy subjects with some increase in mild to moderate gastrointestinal symptoms with escalating doses. No subjects developed anti-Supa antibodies. The safety, PK and PD profiles supported Supa as a long-acting injectable medication for glycemic control and weight loss, as an alternative GLP-1 therapy.

Disclosure
A. Ma: None. J. Li: None. G. J. Prud’homme: None. D. Zhu: n/a. Q. Wang: None. Y. Zhou: None. Y. Lou: None. Y. Liao: None. A. Shao: None. Z. Wang: None. Y. Jiang: None. Q. Cui: None. Y. Zhao: None.

Funding
Ministry of Science and Technology (No. 2011ZX09102, No. 2017ZX09303001) , Shanghai Science and Technology Department (No. 2017ZX09303001)
935-P: Impact of Social Determinants of Health (SDoH) on Participation in a Remote Monitoring Diabetes Program (RDMP) to Improve Glycemic Control
Authors: KOMPALA TEJASWI , LU WEI , PAINTER STEFANIE L. , JAMES ROBERTA , SALEHI ATOUSA , LIU HAU 
Published: May 2022

Introduction: Socioeconomic and educational status impact diabetes self-management and are believed to affect utilization of digital health programs, which could widen healthcare disparities. The objective of this study was to examine SDoH within members of Livongo for Diabetes, a RDMP, and impact on program engagement and glycemic control.
Methods: Members enrolled in the RDMP for 12-18 months were surveyed to capture education level, income, and member characteristics. Zip code was used to identify area deprivation index. Program engagement assessed by self-monitoring blood glucose values (SMBG) , application access, and coaching was evaluated during 12-months prior to survey, and glycemic control was defined as an estimated A1c &lt; 7% based on mean SMBG values within 90-days of survey. Multivariable logistic regression models were used to evaluate the impact of SDoH variables on high program engagement and glycemic control.
Results: Of 1,3respondents, mean (SD) age was 51 (11) , 54% female, 13% Black, 5% Asian, 12% Hispanic, and 84% type 2 diabetes. SDoH variables (see table) were not associated with either outcome.
Conclusions: Evaluated SDoH do not appear to impact high RMDP utilization known to improve A1c by addressing individualized needs through education and coaching designed to address health literacy levels.

Disclosure
T.Kompala: Consultant; Eli Lilly and Company, Employee; Teladoc Health. W.Lu: Employee; Teladoc Health. S.L.Painter: Employee; Livongo, Teladoc Health. R.James: Employee; Livongo, Teladoc Health. A.Salehi: Employee; Livongo. H.Liu: Employee; Teladoc Health, Stock/Shareholder; Teladoc Health.
946-P: Multicenter Quality Improvement Project: Increasing Depression Screening across Six Pediatric Endocrinology Centers in the U.S.
Authors: ODUGBESAN ORI , MUNGMODE ANN , RIOLES NICOLE , BRIMBERRY DANIEL , NELSON GRACE , FEUER ALEXIS J. , ILKOWITZ JENIECE , DEI-TUTU SELORM A. , EBEKOZIEN OSAGIE 
Published: May 2022

Background: Depression contributes to the suboptimal health outcomes among people with type 1 diabetes (T1D) . American Diabetes Association recommends depression screening in individuals with T1D. We aim to demonstrate the use of QI tools in expanding depression screening in the T1D Exchange Learning Collaborative (T1DX-LC)
Method: Six clinics in the T1DX-LC participated in expanding depression screening utilizing PHQ-2, PHQ-4, or PHQ-9. The clinics applied QI principles to design plan-do-study-act cycles to develop, improve, and adapt interventions. The interventions tested include use of a screener at visits, expanding screening to age 12, pulling weekly data to flag patients that should be screened, peer support group, standardizing screening workflow, use of EHR/health information technology, provider training, monthly meetings to discuss screening protocol, and streamlining referral process. The hospitals shared monthly aggregate data with the T1DX-LC
Result: Participating clinics were successful at implementing depression screening. Screening increased from a baseline of 59% to 72% over 17 months
Conclusion: Utilizing the PHQs for depression screening is feasible and QI principles are useful in expanding screening rates. Continued expansion of depression screening is necessary to improve emotional well-being and diabetes self-care management

Disclosure
O.Odugbesan: n/a. A.Mungmode: None. N.Rioles: None. D.Brimberry: None. G.Nelson: None. A.J.Feuer: None. J.Ilkowitz: None. S.A.Dei-tutu: None. O.Ebekozien: None.

Funding
The QI learning collaborative is supported by Helmsley Charitable Trust
965-P: Factors Associated with Poor Glycemic Control in Persons with Type 2 Diabetes and Employer-Based Health Care Coverage
Authors: ROWLAND CHARLES M. , LOUIE JUDY Z. , SHIFFMAN DOV , GARG RAJESH , BERNAL-MIZRACHI ERNESTO , MCPHAUL MICHAEL J. 
Published: May 2022

Lack of healthcare insurance is an important factor for poor glycemic control in persons with diabetes. However, a large proportion of insured people also have inadequate glycemic control. This study was conducted to assess factors associated with poor glycemic control in persons with type 2 diabetics (T2D) who received full healthcare coverage through their employer.The study included employees and spouses with T2D who participated in an annual health assessment in 20 and had medical coverage ≥12 consecutive months prior to the assessment. T2D was defined from ICD codes in claims, self-reported physician diagnosis, or having fasting glucose &gt; 125 mg/dL or HbA1C &gt; 6.4%. A stepwise multinomial logistic regression model was used to assess associations of healthcare engagement, diet, smoking and socioeconomic status with glycemic control. The 2,981 participants included 16% (n=484) with HbA1C &gt; 8.5% and 27% (n=800) with HbA1C 7 to 8.5%. We found that HbA1C &gt; 8.5% was associated with age, sex, years since last physical exam, number of complications, number of medications, and physical activity. The regression model results are shown in the figure. We conclude that poor glycemic control is common among persons with T2D despite good healthcare coverage. We identified factors associated with poor glycemic control in this population that may help design strategies to improve glycemic control.

Disclosure
C.M.Rowland: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. J.Z.Louie: None. D.Shiffman: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. R.Garg: None. E.Bernal-mizrachi: None. M.J.Mcphaul: Employee; Quest Diagnostics.
97-LB: The DERMIS Study—Preliminary Evaluation of Skin Changes at Continuous Subcutaneous Insulin Infusion (CSII) Sites in Type 1 Diabetes (T1D)
Authors: BARAN JESICA D. , KHAKPOUR DORI , KALUS ANDREA , SHINOHARA MICHI , DONG XIAOFU , HIPPE DANIEL S. , HIRSCH IRL B. 
Published: May 2022

Background: CSII is used with increased frequency; however, there are no studies evaluating human skin histology related to its use. Objectives: 1) to investigate the skin histology and metabolite changes at CSII sites and 2) associate possible changes with clinical characteristics in a cohort of patients with T1D.
Methods: We conducted a cross-sectional study which included individuals with T1D using CSII. Skin and blood samples in addition to clinical data were collected. Histological, immunohistochemical (IHC) , and metabolomic analyses were performed using skin biopsies from three sites: 1) current 2) recent and 3) never used site (control) for CSII.
Results: A total of 30 participants were enrolled in the study (age 48.3 ± 17.9 years, female 66.7%, diabetes duration 30.4 ± 16.0 years, insulin pump use 15.7 ± 11.7 years, BMI 25.3 ± 3.4 kg/m2, HbA1c 6.66 ± 0.79%, mean glucose from CGM 150.7 ± 26.4 mg/dL, coefficient of variation 31.2 ± 4.4%, insulin dose 0.53 ± 0.17 IU/kg) . Histologic data showed a significant increase in inflammation, fibrin, fat necrosis, vascularity, eosinophils, and IHC staining of IGF-1 and TGFβ3 at both CSII sites compared to control sites (all p&lt;0.001) . Targeted tissue analysis demonstrated an increase in critical metabolites at current sites compared to control, including histamine (p=0.013) , uracil (p&lt;0.001) , and a trend in UDP-GlcNAc (p=0.063) . Inflammation is positively correlated with insulin dose (p=0.005) , in addition to mean glucose (p&lt;0.01) and coefficient of variation (p&lt;0.01) from the CGM.
Conclusion: Biologic changes were observed in skin histology and metabolites at CSII sites that may be associated with inflammation, oxidative stress response, protein synthesis and wound healing. These could have a clinical impact on insulin availability and diabetes control.

Disclosure
J. D. Baran: n/a. D. Khakpour: None. A. Kalus: None. M. Shinohara: Other Relationship; Aztex, Cabaletta Bio, Elorac. X. Dong: None. D. S. Hippe: Research Support; Canon America Medical Systems, GE Healthcare Systems, Philips Healthcare. I. B. Hirsch: Consultant; Abbott Diabetes, Bigfoot Biomedical, Inc., GWave, Roche Diabetes Care, Research Support; Beta Bionics, Inc., Insulet Corporation, Medtronic.

Funding
Leona M. and Harry B. Helmsley Charitable Trust