bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBODP063 The Benefits Of Using Cgm For Intravenous Insulin Therapy
Authors: Bublik Evgeniya , Udovichenko Oleg , Olga Vinogradskaya , Aleksandr Farmanov , Salima Deunezheva , Irina Tobianskaya , Popova Yadviga , Frolova Nadezhda 
Published: November 2022

Abstract

Modern glycemic monitoring systems make it easier for doctors and nurses to manage diabetic patients on intravenous insulin therapy in hospital wards and intensive care units (ICU). But one of the most important questions - is it safe for inpatients and usable and cost-effective for hospitals?In our study, we included 1,684 glucometer measurements and 72 cycles (1 cycle = 6 days) of the glycemic monitoring system (Guardian Connect Enlite, Medtronic) in patients on intravenous insulin therapy. Most of them were after pancreatectomy. The mean discrepancy between CGM and glucometer values was -4.1%. According to our study, 77.48% of patients were within the target glycemic range (77.4 mg/dL to 189 mg/dL / 4.3 mmol/L to 10.5 mmol/L), hypoglycemia below 50.4 mg/dL / 2.3 mmol/L was recorded in only 2 cases out of 1648. Results confirm safety and usefulness of glucose monitoring systems in-hospital even in the most severe patients, such as those who were in several days after total pancreatectomy. We compared the cost glucose control using of CGM during of one cycle (6 days) and cost glucose control using glucometer during the same period (6 days) for diabetic patients on intravenous insulin therapy in the inpatient department. We account the cost of the CGM system, batteries, smartphone, glucometer, lancets, test strips, sensors, gloves, antiseptic wipes.

Results
6 days glucose control for diabetic patients on intravenous insulin therapy of using CGM (including 3 times a day using glucometer for calibration of CGM) cost 5422 rubles (68.2 $ / 62.7 €), using only glucometer (18 times a day) cost 6696 rubles. But the most interesting results were after comparing the nurse's time, spent on the glucose control for diabetic patients on intravenous insulin therapy. During 6 days of using of CGM for this patients nurse spends (including 3 times a day using glucometer for calibration of CGM) - 71 minutes. During 6 days of using only glucometer (18 times a day) for this patients nurse spends - 324 minutes. In that way using of CGM for diabetic patients on intravenous insulin therapy save for nurse 253 minutes (nearly 4 hours) during 6 days. The cost of 1 hour of nurse for private hospitals in Moscow in ICU an average 661 rubles (8.3 $ / 7.65 €), in inpatient department - 544 rubles (6.85 $ / 6.3 €). In finally results show a significant cost-effective of using CGM. Nevertheless, well-known the other one of the most important benefit of using CGM devices is that glycemic control with CGM systems improves the quality of life of patients, because no routine finger pricking is required.
Presentation: No date and time listed
LBSAT236 A Case of Immune Checkpoint Inhibitor Pembrolizumab Induced Simultaneous Rare Endocrinopathies, Type 1 DM (presenting As DKA) And Grave's Thyrotoxicosis, With Evidence Of Autoimmunity Development.
Authors: Arora Gunjan , Patel Toral 
Published: November 2022

Abstract

Introduction
Pembrolizumab is a novel immunotherapeutic monoclonal antibody directed against PD-1 (programmed death receptor 1), which has been linked to endocrinopathies. We present a rare case of type 1 DM and Grave's disease noted in setting of Pembrolizumab use.

Case presentation
A 56 year old female with history of Hodgkin's lymphoma (being treated with Pembrolizumab), heart failure and type 2 DM was sent to the ED from oncology infusion clinic for labs concerning for DKA. She endorsed fatigue, light-headedness, polydipsia and polyuria. She had moderate to severe DKA with bicarbonate 9 mmol/L (22 - 31), anion gap 29 mmol/L (7 -17), venous Ph 7.16 (7.30 - 7.40), beta hydroxybutyrate 9.4 mmol/L (0 - 0.3) and blood glucose 451 mg/dL (70 - 100). She was admitted to the ICU and started on insulin drip. She had a 20 year history of type 2 DM and prior to this episode had been managed on Metformin 500 mg daily alone with good glycemic control (HbA1c 5.7 - 7.1%) and had never had DKA before. Of note, she also reported recent 75 pound weight loss which she attributed to lifestyle changes. GAD65 antibody assay was positive 5.49 nmol/L (&lt;=0. 02 nmol/L). She was discharged on a basal bolus insulin regimen and continues to follow up with Endocrinology. On admission, she had thyrotoxicosis with TSH 0. 06 uIU/mL (0.50 - 5.70), fT4 1.8 ng/dL (0.9 - 1.7), and total T3 99 ng/dL (80 -200) while clinically euthyroid. Repeat TFTs in one week were consistent. TSI was elevated 1.8 (&lt;=1.3 TSI Index). 10 days later, labs showed improvement TSH 0. 09 uIU/mL, fT4 1.2 ng/dL and total T3 130 ng/dL. As she was clinically euthyroid and noted to have improving levels, she was managed conservatively. However, one additional one month later, tests were repeated and showed progression to hypothyroid state - TSH 44.23 uIU/mL and fT4 0.4 ng/dL. She was started on Levothyroxine supplementation. Repeat testing showed normalization of TSH.

Discussion
Our patient had long standing history of well controlled Type 2 DM and no history of thyroid abnormalities yet presented with moderate to severe DKA and thyrotoxicosis due to Grave's disease shortly after initiating immune checkpoint inhibitor therapy. GAD65 antibody and TSI panel were positive indicating development of autoimmunity. Although rare, development of rare endocrinopathies such as insulin deficient diabetes and Grave's disease are important side effects of immunotherapy. Patients being treated with immunotherapeutic agents should be monitored closely with serial metabolic panel testing for the first twelve weeks after starting therapy. In addition, a low threshold should be maintained for testing for additional thyroid related endocrinopathies.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
LBSUN205 Clinical Practice Guidelines With Education Make A Difference
Authors: Mohieldin Mohamed Elfatih 
Published: November 2022

Abstract
Diabetic ketoacidosis is a serious acute complication of diabetes. Despite the advances in management of type 1 diabetes, unfortunately there is still frequent hospital admission with it. The management of diabetic ketoacidosis was variable with no clear standards of care. We implemented clinical guidelines in September 2019. Staff education was done when the guideline was launched in the hospital. We audited our work a year after implementing the guidelines and we found issues with adherence to the fluid management (66%), fixed rate insulin infusion (69%). The overall result showed average resolution time of 27 hours. There was no mortality or serious complication reported. Extensive reeducation of staff was done. A reaudit was done which showed Signiant improvement in adherence to the guidelines. Fluid management improved (66% to 95%) and fixed rate insulin (88% to 100%). This has resulted in improvement in resolution time from 27 hours to 12.9 hours. The good outcome of this audit is reflecting the importance of proper staff education when we implement new guidelines.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN208 Patient Education And Addressal Of Social Determinants Of Health: Key To Improvement In Diabetes Care
Authors: Manas F N U , Jaiswal Pooja , Pamula John 
Published: November 2022

Abstract
As per American Diabetes Association, diabetes is a 'complex chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control'. In 2018, the prevalence of diabetes mellitus in the US population was 10.5% (34.2 million people). It is the seventh leading cause of death in the United States. The average healthcare expenditure is 2.3 times higher for diabetics than non-diabetics. The goal of diabetes care as per the American Diabetes Association and the American College of Cardiology is HbA1c less than 7%, blood pressure less than 140/90mmHg, and LDL cholesterol less than 100mg/dl. Only 19.2% of diabetic population meet all these criteria. At the Guthrie-Robert Packer Hospital, we use the 'Diabetic Bundle' as a quality metric for the standard of care for diabetic patients. It is a metric with diabetic patients seen in the past 2 years who have an active Guthrie PCP, with A1C less than 8 in the past 6 months, LDL less than 70 mg/dl (or currently prescribed a moderate or high dose statin) in the past year and age 40-75, and medical attention for nephropathy (a microalbumin test in the past year, or a nephrology visit, or are on an ACE/ARB, or have ESRD/CKD Stage 4) as a system numerator and total diabetes patients seen in the last 2 years who have an active Guthrie PCP as a system denominator. For the past few years, the resident's clinic has had lower compliance with the diabetic bundle. Multiple factors were responsible. Lack of awareness about the quality metric, discontinuity of care, failure to educate patients, poor patient involvement in diabetes care, socio-economic barriers like lack of insurance, poor family and social support, lack of transportation, poor patient compliance, and low health literacy were some of the identified factors. We conducted the prospective study to improve diabetes care by assessing 'diabetic bundle' compliance. Key interventions were focused on creating a multidisciplinary care team of the clinic director, care coordinator, informatics, nurse, resident, and faculty. Resident education regarding the diabetic bundle, patient education and involvement in diabetes care, outreach calls and mails to the non-compliant, involving the care coordinator in addressing social needs, and regular updating of the diabetes registry were some of the main interventions done during the study period. All these interventions contributed to improvement in the diabetic bundle but we believe that the most important factor in improving diabetes care was educating the patients, involving them in their diabetes care, and addressing their social determinants of health.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN210 Efficacy And Safety Profile Of Insulin Icodec Versus Insulin Glargine U100 In Type 2 Diabetes Mellitus: A Meta-Analysis Of Randomized Controlled Trials
Authors: Dimayuga Diana Colleen , Villa Michael L , Maningat Maria Patricia Deanna 
Published: November 2022

Abstract
In the context of diabetes, clinical inertia is defined as the failure to initiate insulin therapy or its intensification when treatment goals have not been met. Patient-related factors that contribute to this phenomenon include inability to follow complex regimens, cost of treatment and drug side effects. Icodec is a novel, investigational, ultra-long acting, once-weekly insulin analog with a potential for better treatment adherence. However, early evidence from phase 2 trials on icodec in type 2 diabetes mellitus (T2D) is conflicting. To study the efficacy and safety of insulin icodec, we conducted a meta-analysis of published randomized controlled trials (RCTs) on weekly icodec vs. daily glargine U100 in patients with uncontrolled T2D (HbA1c &gt; 7%). A systematic search in major online databases was done to identify and review relevant RCTs. Two authors independently performed the study selection and extracted study data. Data on glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), time-in-range of 70-180 mg/dL (TIR), adverse events and hypoglycemia events were noted. Significance level of 95% was used to provide pooled estimates. Random effects model was used for analysis with significant heterogeneity (I2&gt;50%). Three trials with 606 patients were included. Pooled analysis of available data showed that icodec resulted in a significantly greater mean reduction of HbA1c (mean difference (MD)=0.18%[0.13,0.22], p&lt;0. 00001, I2=84% in 2 studies), mean reduction of FPG (MD=3.87mg/dl [3.18, 4.57],p&lt;0. 00001, I2=0%), longer TIR (MD=4.39% [3.94, 4.85], p&lt;0. 00001, I2=0%), but had significantly greater propensity to lead to level 1 hypoglycemia (Odds Ratio (OR)=1.59 [1.11,2.28], p=0. 01, I2=29%) when compared to glargine U100. Funnel plot analysis on the propensity for icodec to lead to any hypoglycemia event decreased the I2 statistic from 78% to 0% and showed significantly greater hypoglycemia events with icodec (OR=2.59 [1.67,4. 01], p&lt;0. 001). There was no significant difference in the number of patients with end-of-trial HbA1c &lt;7%, and any adverse event, or hypoglycemia level 2 or 3. Of note, only one hypoglycemia level 3 event was noted (patient on icodec). Once-weekly icodec had significantly better glycemic control compared to daily glargine U100, but had significantly greater hypoglycemia events. Data from ongoing trials on this novel drug can be added to the analysis as they become available.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN289 Ketonuria — A Possible Early Indicator Of Impending Euglycemic DKA In Setting Of Recent SGLT-2 Inhibitor Use And Acute Stress
Authors: Arora Gunjan , Gerais Yasmin 
Published: November 2022

Abstract

Introduction
- Euglycemic DKA is a notorious entity; previously thought to be primarily afflicting type 1 diabetics and rarely type 2 diabetics in a state of relative insulin deficiency, it has now become a major cause of concern and lead to the issuance of FDA warning in 2015 with regards to its link with SGLT-2 inhibitors. Although DKA is characterized by hyperglycemia, metabolic acidosis and ketogenesis, euglycemic DKA poses a diagnostic challenge as it remains disguised under the cover of euglycemia. Moreover, in the setting of recent SGLT-2 inhibitor use, this definition becomes even more of a paradox as SGLT-2 inhibitors, by the virtue of their action, promote ketogenesis thereby further adding to this enigma.

Case presentation
- A 67 year old male with hypertension and diabetes mellitus type 2 (on Metformin and Empagliflozin) presented to the emergency room with dizziness. He woke up to go to the bathroom that day and felt weak, dizzy and like he was going to fall. He endorsed nausea and vomiting but denied headache, fever, chills, chest pain, shortness of breath, abdominal pain, and problems with urination/bowel movements. He was afebrile and hemodynamically stable. On examination, left sided dysmetria, loss of coordination, and axial imbalance were noted. No motor/sensory deficits. Labs were significant for WBC count 10 k/mm cu (4 - 11), Creatinine 0.78 mg/dL (0.7 - 1.3), Glucose 279 mg/dL (70 - 99), Bicarbonate 21 mmol/L (21 -31), Anion gap 19 mmol/L (6 - 14), and Lactate 3.2 mmol/L (0.7 - 2). Urinalysis showed glucosuria (glucose &gt;500 mg/dL) and ketonuria (ketones 20 mg/dl). CT head was negative but MRI brain showed left inferior cerebellar peduncle acute ischemic infarct. Stroke protocol was initiated and he transferred to telemetry. The next day, labs showed Glucose 166, Bicarbonate 13, Anion gap 21, and Ketones 5.6 mmol/L (&lt;0.6). Since blood glucose levels remained less than 250 mg/dl with concurrent anion gap metabolic acidosis in the setting of recent Empagliflozin use, he was transferred to ICU for insulin infusion for management of euglycemic diabetic ketoacidosis. Subsequently, he was transitioned to a basal-bolus insulin regimen and transferred to the floors.

Discussion
- SGLT-2 inhibitors reduce renal tubular glucose reabsorption, causing glycosuria, and promote ketonemia directly by enhancing ketogenesis via glucagon secretion from the pancreatic alpha cells and indirectly by decreasing the renal clearance of ketone bodies. In the setting of acute stress, such as stroke in our patient, and recent SGLT-2 inhibitor use, the presence of ketonuria should be recognized as an early ominous warning sign for euglycemic DKA. A targeted approach detailing diagnostic and therapeutic interventions should be designed to halt its progression in its track before it transforms into the dreaded euglycemic DKA.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN290 A Rare, Sordid Tale Of The Two Most Dreaded Adverse Effects Of SGLT-2 Inhibitors Occurring Concurrently - Acute Pancreatitis And Euglycemic Diabetic Ketoacidosis - Within Days Of Initiating Empagliflozin Therapy.
Authors: Arora Gunjan , Gerais Yasmin 
Published: November 2022

Abstract

Introduction
Empagliflozin is an anti-diabetic agent belonging to the class of SGLT-2 inhibitors, which was approved by the U. S. Food and Drug Administration (FDA) in 2013. It has emerged as a popular choice of second line diabetic therapy owing to benefits of reduction in cardiovascular adverse events and delayed progression of kidney disease. However, in 2015, FDA issued a safety warning in connection to its use with euglycemic ketoacidosis and subsequently in 2016, started investigating its link with pancreatitis. We present a case of a type 2 diabetic started on Empagliflozin therapy 4 days prior to his presentation to the ER with nausea, vomiting and diarrhea when he was found to have concurrent euglycemic DKA and acute pancreatitis.

Case presentation
A 49 year old male with a history of diabetes mellitus type 2 presented to the ER with nausea, vomiting, diarrhea and fatigue. He reported these symptoms since starting a new anti-diabetic agent Empagliflozin four days ago. He denied fever, chills, chest pain, shortness of breath, abdominal pain, and urinary symptoms. He denied heavy alcohol use or binge drinking. Lab tests showed: WBC count 18.7 k/mm cu (4 -11), Glucose 229 mg/dL (70 - 99), Bicarbonate 7 mmol/L (21 - 31), Anion gap 30 mmol/L (6 -14), Lactate 1.8 mmol/L (0.7 - 2.5), Serum beta hydroxybutyrate level &gt;4 mM (0. 02 - 0.27), Lipase 866 IU/L (11 - 82) and Venous blood pH 6.98 (7.30 - 7.45). Repeat blood glucose measurements remained &lt; 250 mg/dl. Urinalysis showed &gt; 500 mg/dl glucose. CT abdomen and pelvis showed moderate fat stranding consistent with acute pancreatitis. He was started on insulin infusion and admitted to the intensive care unit. He was subsequently discharged on a basal-bolus regimen with instructions to discontinue Empagliflozin.

Discussion
Acute pancreatitis and euglycemic DKA are grave clinical entities, associated with significant mortality. Our patient presented with nausea, vomiting, diarrhea and fatigue; he denied the characteristic abdominal pain yet was noted to have pancreatitis by laboratory and imaging studies. It is extremely important that pancreatitis be considered and ruled out in patients presenting with non-specific symptoms while on SGLT-2 inhibitor therapy. In addition, a high radar of suspicion should be maintained in both inpatient and outpatient settings for euglycemic DKA in patients on SGLT-2 inhibitor therapy presenting with non-specific symptoms, even in the absence of a classic identifiable triggering event, especially as there is evidence to suggest that pancreatitis may actually serve as a triggering factor for euglycemic DKA suggesting that, due to a cause-effect phenomenon, these two conditions may co-exist more often than expected.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN332 A Novel Drug To Modulate Auto-inflammation And Promote Glucose Control In Type 1 Diabetes Mellitus
Authors: Wagner David , Vaitaitis Gisela , Waid Dan , Webb Craig , Webb Tracy 
Published: November 2022

Abstract
Canine Diabetes (CD) is identical to human T1DM. Helper T cells expressing the CD40 receptor (TH40) are prominent in human T1DM. TH40 cell expansions occur regardless of HLA haplotype or auto-antibody status and remain elevated throughout disease. TH40 cells from T1DM respond to human islets, TH40 from healthy controls do not. At a Veterinary Hospital 6 female and 2 male dogs that met clinical criteria for T1DM were recruited. Physical exam, blood panels and CBC were done. Dogs were dosed with a OPT501 a drug targeting CD40 mediated inflammation by IV infusion. Doses were 2 and later 4 mg/kg, given on days 1, 4, 7, then weekly for 8 weeks. Diabetic dogs had significantly elevated TH40 numbers compared to non-diabetic dogs (p &lt; 0. 0001). OPT501 reduced TH40 cell numbers to normal, following which insulin requirements reduced on average by 75% and up to 90%. The canine equivalent of HbA1c reduced 40.2% on average; 3 subjects were normal range. Daily blood glucose reduced significantly, 3 subjects maintained normal glucose levels. Time-in-range (TIR) increased to up to 90%, from a previous 10%. Increased c - peptide levels were universally detected after 8 weeks of treatment.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP158 A Pilot Trial on the Efficacy of 5-Aminolevulinic Acid on Glucose Tolerance in Patients with Maternally Inherited Diabetes and Deafness
Authors: Nakamura Yuta , Haraguchi Ai , Shigeno Riyoko , Horie Ichiro , Abiru Norio , Kawakami Atsushi 
Published: November 2022

Abstract

Objective
Maternally inherited diabetes and deafness (MIDD) is characterized by progressive insulin secretory disorder caused by impairment of mitochondrial adenosine triphosphate (ATP) production in pancreatic beta-cells. The amino acid 5-aminolevulinic acid (5-ALA) is the first heme biosynthetic precursor and the administration of 5-ALA combined with sodium ferrous citrate (SFC) enhance heme production, leading to improvement of mitochondrial function and ATP production. Several studies showed that the treatment with 5-ALA/SFC improved glycemic tolerance in both patients with prediabetes and those with type 2 diabetes. However, no previous studies investigated the efficacy of 5-ALA in patients with MIDD. We carried out the pilot trial to investigate whether the administration of 5-ALA/SFC can improve insulin secretion and glucose tolerance in patients with MIDD.

Methods
We enrolled five patients with MIDD receiving multiple daily injections of insulin. The patients were administered 5-ALA/SFC 100 mg twice a day (200 mg per day) for 24 weeks as adjunctive to insulin treatment. The patients underwent a 75-g oral glucose tolerance test (OGTT) twice before (1 st -OGTT) and 24 weeks after the initiation of 5-ALA/SFC (2 nd -OGTT). We measured levels of plasma glucose, insulin, and glucagon at fasting (0 min), and 30, 60 and 120 min after glucose load (Study protocol: Nakamura Y et al. Medicine (Baltimore). 2021; 100: e25100).

Results
The mean levels of HbA1c tended to decrease from 8.3% to 7.9% (p = 0.36) even though total insulin doses had not changed during the 24 weeks of 5-ALA/SFC administration. In the 2nd -OGTT comparing to the 1 st -OGTT, four of the five patients showed a tendency of improvement in glucose levels with a certain degree of insulin increase, but one patient did not show any improvement. The means of area under the curve (AUC) of serum insulin from fasting to 120 min during 2nd -OGTT was 30% larger but not significant compared to that during 1st -OGTT (p = 0. 077). The late phase of glucose excursion during OGTT determined by AUC of plasma glucose from 60 to120 min during 2nd -OGTT showed 10% reduction compared to that during 1st -OGTT (p = 0. 041). The glucagon levels during OGTT were comparable between before and after 5-ALA/SFC administration. The indexes of insulin sensitivity calculated by the homeostasis model assessment of insulin resistance or Matsuda index were not significantly changed between before and after 5-ALA/SFC administration. None of the patients experienced any adverse events during the study.

Conclusions
The administration of 5-ALA/SFC as adjunctive to insulin therapy might be a novel effective treatment for MIDD that improves insulin secretion via amelioration of mitochondrial function.
Presentation: No date and time listed