bluuebunny/crossref_metadata_2025_split huggingface dataset:
1435-P: Identifying the Continuing Educational Needs of U.S. Physicians in Managing Patients with T2DM and Obesity
Authors: CERENZIA WENDY , STACY SYLVIE , WILEY SHERETA 
Published: May 2022

Most people with type 2 diabetes (T2D) also have obesity and the prevalence of both continues to increase. This study sought to understand approaches of endocrinologists (ENDOs) and primary care physicians (PCPs) in managing patients with both T2D and obesity to identify areas where physicians may benefit from continued education. A patient case-based survey assessing approaches to managing patients with T2D and obesity was fielded in October 2021, with responses from US-practicing ENDOs (n=181) and PCPs (n=350) . Survey questions included free response, multiple choice, and rating scales. Descriptive analysis was performed. When presented with a patient with poorly controlled T2D, obesity, and other clinical concerns (eg, elevated blood pressure (BP) , hyperlipidemia, and cigarette use) , improving HbA1c was among the top three goals in 93% of physicians, while BP control was a top goal for just over half and weight loss was a top goal for only 45%. In another patient presenting with T2D and unchanged BMI of 37 kg/m2, despite 6 months of lifestyle intervention, 9% of ENDOs and 15% of PCPs would continue current weight management without change. If the patient’s BMI been higher at 47 kg/m2, both ENDOs and PCPs were more likely to begin a weight loss medication and PCPs were more likely to defer management to a specialist. Most physicians (63%) agreed that effectively managing T2D leads to weight loss and 83% agreed that GLP-1 receptor agonists are effective for obesity. However, only half of ENDOs and 29% of PCPs have a certain percentage of body weight loss goal when managing obesity in patients with T2D. Further, 19% of ENDOs and 30% of PCPs reported that they trial diet, exercise, and behavioral modifications for 6 months or longer. Results show physicians may benefit from continuing education focused on the importance of addressing weight in combination with glycemic control for patients with T2D and obesity, and the benefits of pharmacotherapy as a component of weight management.

Disclosure
W.Cerenzia: None. S.Stacy: None. S.Wiley: None.
192-OR: T-Type Calcium Channel Cav3.2 in GABAergic Neurons Regulates Rhythmic Glucose Metabolism
Authors: FENG BING , HARMS JERNEY , XU PINGWEN , ZHOU WENJUN , SUN ZHENG , HE YANLIN 
Published: May 2022

Systemic insulin sensitivity shows a diurnal rhythm with a peak upon waking. The GABAergic (γ-aminobutyric acid-producing) neurons in the suprachiasmatic nucleus (SCN) (SCNGABA neurons) were reported to control the diurnal rhythm of insulin-mediated suppression of hepatic glucose production in mice in earlier work1. SCNGABA neural firing activity displays a diurnal rhythm, with the intrinsic ionic mechanism underlying this temporal pattern not completely understood. Here we provided evidence supporting a role of the T type voltage-gated calcium ion channel subunit 3.2 (Cav3.2) in SCNGABA neurons in regulating rhythmic neural firing and glucose homeostasis. We found that Cav3.2 global knockout (Cav3.2KO) mice displayed disrupted diurnal rhythm of blood glucose levels. Selective deletion of Cav3.2 in the SCNGABA neurons abolished the oscillatory firing activity of SCNGABA neurons and led to glucose intolerance. Furthermore, our real-time calcium imaging data in freely moving mice showed that SCN GABA neuronal activity displayed a circadian rhythm pattern in WT control mice but not Cav3.2KO mice or mice with Cav3.2 selectively deleted in the SCNGABA neurons. These findings provide insights into how the calcium ion channel regulates the central circadian clock and glucose metabolism, with implications in the extended dawn phenomenon in type 2 diabetes.
Keywords: Type 2 diabetes, calcium channel, Cav3.2, GABA neurons, circadian rhythm
Reference: 1 Ding, G. et al. REV-ERB in GABAergic neurons controls diurnal hepatic insulin sensitivity. Nature 592, 763-767, doi:10.1038/s41586-021-03358-w (2021) .

Disclosure
P. Xu: None. W. Zhou: None. Z. Sun: None. Y. He: None.

Funding
NIH (P20 GM135002)
221-OR: Safety and Effectiveness of Insulin Aspart vs. Other Bolus Insulins in Women with Preexisting Type 1 Diabetes during Pregnancy: A Post Hoc Analysis of the EVOLVE Study
Authors: MATHIESEN ELISABETH , ALIBEGOVIC AMRA CIRIC , ANIL GAYATHRI , DUNNE FIDELMA P. , HALASA TARIQ , IVANISEVIC MARINA , MCCANCE DAVID R. , NORDSBORG RIKKE BAASTRUP , DAMM PETER ,   ON BEHALF OF THE EVOLVE STUDY GROUP
Published: May 2022

Aims: This post hoc analysis of the real-world EVOLVE study investigated safety and effectiveness of insulin aspart (IAsp) vs. other bolus insulins in pregnant women with pre-existing type 1 diabetes.
Methods: Maternal, pregnancy and infant outcomes were assessed in women receiving bolus insulins on enrolment and during pregnancy in a prospective cohort, by estimating risk differences following adjustment for potential confounders using propensity score matching.
Results: Insulin treatment in early pregnancy and maternal, pregnancy and infant outcomes are presented (Table) . In total, 1434 women were treated with IAsp and 4with other bolus insulins on enrolment. Significantly lower mean A1c values in the third trimester were observed with IAsp vs. other bolus insulins (adjusted % point difference -0.16% [95% CI -0.28;-0.05]; p=0.005) . No significant differences were seen with IAsp vs. other bolus insulins in the risk of adverse maternal-fetal outcomes including major maternal hypoglycemia, abortion, pre-term delivery, pre-eclampsia, birthweight large for gestational age, major congenital malformations and perinatal or neonatal death, in the matched dataset.
Conclusion: Compared with other bolus insulins, IAsp was associated with significantly lower A1c during the third trimester and a similar risk of adverse pregnancy outcomes.

Disclosure
E.Mathiesen: Consultant; Novo Nordisk A/S, Speaker's Bureau; Novo Nordisk A/S. On behalf of the evolve study group: n/a. A.Alibegovic: Employee; Novo Nordisk A/S, Novo Nordisk A/S. G.Anil: Employee; Novo Nordisk Global Business Services. F.P.Dunne: None. T.Halasa: Employee; Novo Nordisk A/S. M.Ivanisevic: None. D.R.Mccance: None. R.Baastrup nordsborg: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. P.Damm: Advisory Panel; Novo Nordisk A/S.

Funding
Novo Nordisk A/S
277-OR: Increased Liver Fat Is Associated with Severe Metabolic Perturbations in Men Born with a Low Birth Weight
Authors: ELINGAARD-LARSEN LINE OHRT , JUSTESEN LOUISE , VILLUMSEN SOFIE O. , THUESEN ANNE CATHRINE B. , STØRLING JOACHIM , SPARKS LAUREN M. , KIM MIN , LEGIDO-QUIGLEY CRISTINA , DANIELSEN ELSE R. , HANSEN TORBEN , BRØNS CHARLOTTE , VAAG ALLAN A. 
Published: May 2022

Background: Ectopic fat deposition resulting from impaired subcutaneous adipose tissue expandability may take center stage in the pathophysiological events linking low birth weight (LBW) with increased risk of developing Type 2 diabetes (T2D) . However, the extent to which adult LBW subjects exhibit increased hepatic fat accumulation is controversial.
Methods and Results: Using 1H MR spectroscopy, we found a significantly increased hepatic fat content (P=0.014) in 26 early middle-aged and non-obese LBW males compared with 21 BMI- and age-matched normal birth weight (NBW) controls. Interestingly, 5 LBW (20%) versus no NBW subjects, had previously unrecognized overt nonalcoholic fatty liver disease (NAFLD) with a median hepatic fat content of 9.45%. The LBW w/NAFLD displayed widespread metabolic changes compared with both NBW and LBW w/o NAFLD subjects including hepatic insulin resistance (P=0.02) , increased fasting plasma triglycerides (TGs) (P=0.03) , cholesterol (P=0.05) , leptin, C-peptide and GLP-1 levels, as well as decreased adiponectin levels (P-range: 0.02-0.007) . Among 65 distinct metabolites and 279 lipids identified by untargeted serum metabolomic and lipidomic analyses, the levels of 7 metabolites including ornithine and citrulline, were different (P&lt;0.05) between LBW w/NAFLD and NBW subjects, pointing towards increased urea cycling in the LBW w/NAFLD subjects. Moreover, the LBW w/NAFLD subjects displayed disproportionately increased levels of phosphatidylcholines and TGs (P&lt;0.05) , with both lipid species qualitatively changed in the LBW w/NAFLD subjects consisting of an increased amount of long chain fatty acids as well as fewer double bonds. These structural lipid characteristics are known to be associated with T2D.
Conclusion: The data support a role for ectopic fat deposition in the pathophysiological events and trajectories linking LBW with increased risk of developing T2D and associated cardiometabolic traits including dyslipidemia.

Disclosure
L.Elingaard-larsen: None. T.Hansen: None. C.Brøns: Stock/Shareholder; Novo Nordisk. A.A.Vaag: Stock/Shareholder; AstraZeneca. L.Justesen: None. S.O.Villumsen: None. A.B.Thuesen: None. J.Størling: None. L.M.Sparks: None. M.Kim: None. C.Legido-quigley: None. E.R.Danielsen: None.

Funding
Novo Nordisk Foundation (NNF15OC0016692) , Aase and Ejnar Danielsens Fond, Augustinus Foundation, Simon Spies Fonden, TrygFonden.
3-LB: A Free-Living Walking-Based Exercise Programme Improves HbA1c in Individuals with Obesity, with Additional Benefits of Nutritional Status on Metabolic Health
Authors: BARRETT JENNIFER S. , SHEPHERD SAM O. , WAGENMAKERS ANTON , CUTHBERTSON DANIEL , STRAUSS JULIETTE 
Published: May 2022

Background: Regular exercise improves insulin resistance and glycaemic control, but ‘real world’ programmes are not universally effective. Laboratory studies show that post-breakfast exercise improves postprandial glucose excursions with subsequent meals while pre-breakfast exercise augments whole-body fat oxidation. Whether these acute effects translate to greater changes in metabolic health with exercise training is not clear.
Aim: To investigate if exercise before/after breakfast leads to differential improvements in metabolic health and/or postprandial glycaemic response.
Methods: Thirty-four people with obesity (43±12 y, BMI 35.1±5.1 kg/m2) undertook a 12-week walking-based programme, with two continuous and two interval sessions each week (for 30-60 min, at 50% HRmax vs. alternating 3 min at 85% HRmax and 3 min 50% HRmax respectively) . Participants exercised before (FAST) or after (FED) breakfast (n=17 per group) . Body composition, HbA1c, blood lipids and liver transaminases (ALT/AST) were assessed pre- and post-intervention. Postprandial glucose responses were assessed in week 1 and 12 using flash glucose monitoring.
Results: Adherence (FAST: 93%, FED: 95%) and compliance (FAST: 85%, FED: 88%) was high in both groups. Body mass, BMI, waist-to-hip ratio and HbA1c decreased similarly between groups (all P &gt;0.001, HbA1c P=0.01) . However, ALT decreased after FAST (-16%; P=0.001) , but not FED training (-2%; P=0.720) . In week 1, continuous exercise lowered postprandial responses to lunch (FAST; P=0.064) and dinner (FED; P=0.047) versus interval exercise. In week 12, the postprandial glucose responses to lunch and dinner after interval exercise were lower compared to week 1 (P=0.008) .
Conclusions: Free living exercise, pre- or post-breakfast improved body composition, glycaemic control and enhanced the postprandial-lowering effect of interval exercise but pre-breakfast exercise had a greater impact on liver biochemistry. Exercise, pre-breakfast, may be advantageous for people with obesity and fatty liver.

Disclosure
J. S. Barrett: None. S. O. Shepherd: None. A. Wagenmakers: None. D. Cuthbertson: Other Relationship; AstraZeneca, Novo Nordisk. J. Strauss: None.
430-P: Remnant Cholesterol Predicts Major Cardiovascular Events in Patients with Coronary Artery Disease Both among Patients with Type 2 Diabetes and in Nondiabetic Individuals
Authors: MADER ARTHUR , SPRENGER LUKAS , VONBANK ALEXANDER , LARCHER BARBARA , MAECHLER MAXIMILIAN , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ , SAELY CHRISTOPH H. 
Published: May 2022

Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk. The power of remnant cholesterol to predict major cardiovascular events (MACE) in patients with established coronary artery disease is unclear and is addressed in the present study. We enrolled 1472 consecutive patients with established coronary artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 8.0±5.03 years. At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=446) than in non-diabetic subjects (27±24 vs. 21±23 mg/dl; p&lt;0.001) . During follow-up, 493 of our patients suffered MACE; the event rate was significantly higher in patients with T2DM than in non-diabetic subjects (62.5 vs. 37.5%; p&lt;0.001) . Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted MACE in the total study population (standardized adjusted HR 1.17 [1.09-1.28], p&lt;0.001) , and in patients with T2DM as well as in non-diabetic subjects (standardized adjusted HRs 1.24 [1.07-1.44], p=0.0 and 1.14 [1.02-1.26], p=0.017, respectively) . From our data we conclude that remnant cholesterol in patients with established coronary artery disease predicts MACE both among patients with T2DM and among non-diabetic subjects.

Disclosure
A.Mader: None. L.Sprenger: None. A.Vonbank: None. B.Larcher: None. M.Maechler: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None. C.H.Saely: None.
53-LB: Youth and Parents’ Experiences Using the Insulin-Only Bionic Pancreas
Authors: HOWARD KELSEY R. , GARZA KIMBERLY P. , FELDMAN MARISSA , WEISSBERG-BENCHELL JILL ,   BIONIC PANCREAS RESEARCH GROUP
Published: May 2022

The Insulin-only Bionic Pancreas (BP) Pivotal Trial compared the BP initialized only with body weight vs. standard-of-care (SC) . The BP autonomously determines all insulin doses. Meals are announced without carbohydrate counting. For youth aged 6-17 the mean adjusted difference of HbA1c at 13 weeks between BP and SC was -0.5% (95% CI: -0.7, -0.2, P&lt;0.001) : percent of time &lt;54 mg/dl was not different between groups. Focus groups with youth who used the BP and their parents were conducted at the trial’s end. Youth reported positive experiences: improved A1c, increased independence, less parent worry and texting about glucose, less family diabetes conversations, less cognitive and emotional burden, less time managing diabetes, less worries about nighttime lows, more sleep, easier mealtimes, and easier school management. Children felt parents trusted them more and parents spent less time managing glucose at night. Some reported increased lows and others less. Some found challenges with exercise while others found it managed exercise well. Some found the BP took too long to learn their body and to correct high glucose. Concerns included: not having a snack announcement, site change frequency, small insulin capacity, lack of insulin-on-board information, poor backlighting, screen timing out too fast, and not having a clip or being waterproof. Parents reported positive experiences: pride in the child’s independence, less cognitive and emotional burden, less time managing diabetes, less diabetes conversations, and better school experiences. Most reported improved sleep and easier mealtimes. Some found challenges with exercise while others found it managed exercise well. Some found improved TIR and less lows while others found more lows or delays in correcting highs. Some found the system learned their child while others felt the system struggled. Parents were concerned that the low insulin warning did not go to parents’ phones. Youth and parent perspectives highlight experiences in learning and using the BP and offer insights related to multiple psychosocial domains which can guide future innovations.

Disclosure
K. R. Howard: None. K. P. Garza: None. M. Feldman: None. J. Weissberg-benchell: None. Bionic pancreas research group: n/a.

Funding
National Institute of Diabetes Digestive and Kidney Diseases (#1UC4DK108612-01)
651-P: Continuous Glucose Monitoring in Primary Care: Explaining Characteristics Associated with CGM Prescription
Authors: OSER TAMARA , HALL TRISTEN , WARMAN MEREDITH K. , FILIPPI MELISSA K. , MANNING BRIAN , CALLEN ELISABETH , DICKINSON L. MIRIAM , MICHAELS LEANN C. , NEASE DONALD E. , OSER SEAN 
Published: May 2022

Background: Continuous glucose monitors (CGM) provide clearer, more actionable data than self-monitoring of blood glucose and are associated with improved outcomes (e.g., reduced HbA1c) . Barriers to endocrinology care create disparities in CGM access. Expanding CGM use in primary care can improve outcomes and reduce disparities. We explored barriers and facilitators to CGM use in primary care.
Methods: Mixed-methods sequential explanatory study of U.S. primary care clinicians, with survey (n=632) followed by semi-structured interviews (n=55) .
Analysis: Multivariable linear and logistic regression, followed by rapid qualitative analysis of interviews to offer a deeper understanding of quantitative data.
Results: Qualitative analysis helped explain quantitative findings that residents were less likely than others to have prescribed CGM but had greater intent to prescribe: lack of resident knowledge about CGM hindered prescribing. While quantitative analysis found clinicians &gt;40 miles from endocrinologists were somewhat more likely to prescribe CGM (coef .18, p=.041) , qualitative analysis offered nuance: results were mixed, with many interviewees noting distance as a barrier due to having no endocrinologist to help manage the CGM; for others, proximity was a barrier because they referred patients to endocrinology for CGM rather than prescribing themselves. While survey results showed an association between higher proportion of Medicare patients and greater confidence in using CGM to manage diabetes, qualitative themes around prescribing barriers included lack of public insurers covering CGM, suggesting that, for some, having Medicare may make CGM prescription more difficult.
Conclusion: Primary care clinicians can benefit from education and support for CGM use. Targeting recent trainees and clinicians in regions lacking endocrinology could increase CGM use, extending its benefits to more people with diabetes.

Disclosure
T. Oser: Advisory Panel; Cecelia Health, Dexcom, Inc. T. Hall: None. M.K. Warman: None. M.K. Filippi: None. B. Manning: None. E. Callen: None. L. Dickinson: None. L.C. Michaels: None. S. Oser: Advisory Panel; Cecelia Health, Children with Diabetes, Inc., Dexcom, Inc. Consultant; American Diabetes Association, Association of Diabetes Care & Education Specialists, Jaeb Center for Health Research. Research Support; American Academy of Family Physicians, Leona M. and Harry B. Helmsley Charitable Trust.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
775-P: Effect of Optimized Settings during Six Months of Real-World MiniMed 780G Advanced Hybrid Closed-Loop (AHCL) Therapy Use in Chile
Authors: CASTRO MATIAS , CARRASCO BONILLA CAMILA NICOLE , LEON MACEDO JOANA C. , GUTIERREZ MARIA FERNANDA , VALERA LOPEZ ZEUDI C. , DAGHERO ANDREA 
Published: May 2022

Background and Aims: The pivotal trial of the MiniMed™ 780G system showed that optimized settings of active insulin time (2 hours) and target glucose (100mg/dL) improved glycemic outcomes.1 This study analyzed real-world glycemic outcomes of individuals with T1D in Chile, 6 months after AHCL initiation with different settings.
Methods: Data from 37 MiniMed™ 780G system users (aged 5-76 years, mean±SD of 29.3±19.3 years) at 12 centers throughout Chile were prospectively collected and analyzed. Effects of active insulin time (AIT) and glucose target on mean GMI, TIR (70-180mg/dL) , time at &lt;70mg/dL (TBR) and time at &gt;180mg/dL (TAR) were determined using 14 days of sensor glucose data pre-AHCL and at 180 days post-AHCL initiation.
Results: Overall TIR increased from 74.1% to 78.4% (p&lt;0.01) , and mean TBR and GMI were 2.7% and 6.7% at study end, respectively. Individuals (N=23) with optimized settings achieved the highest TIR (80.1%) and lowest TBR (2.6%) (Figure 1) .
Conclusion: In this real-world data analysis, MiniMed™ 780G system users who optimized their active insulin time and target glucose settings achieved the highest TIR and lowest TBR.

Disclosure
M.Castro: Employee; Medtronic. C.Carrasco bonilla: Employee; Medtronic. J.C.Leon macedo: Employee; Medtronic. M.Gutierrez: Employee; Medtronic. Z.C.Valera lopez: Employee; Medtronic. A.Daghero: Employee; Medtronic.
777-P: Short-Term Continuous Subcutaneous Insulin Infusion Treatment Improves Peripheral Autonomic Neuropathy in Type 2 Diabetes
Authors: JIN JIEWEN 
Published: May 2022

Background: Short-term continuous subcutaneous insulin infusion treatment (CSII) in patients with newly diagnosed type 2 diabetes (T2DM) can improve β-cell function and insulin sensitivity, which results in long-term remission. However, the effect of CSII on peripheral neuropathy is rarely studied.
Methods: 63 T2DM patients (HbA1c&gt;9%) were hospitalized and treated with CSII for 2 weeks. Peripheral autonomic neuropathy was measured by SUDOSCAN, which provides an age adjusted electrochemical skin conductance (ESC) composite score incorporating hands/feet ESC measurements, with a score ≤60 indicating sudomotor dysfunction. Blood glucose, HbA1c, C-peptide and SUDOSCAN were measured before and after CSII. HOMA-B was used for assessment of β-cell function.
Results: The average HbA1c of included patients was 10.5% with median duration of T2DM was 3.5 years. There were 27 (42.9%) patients who had sudomotor dysfunction at baseline. After 2 weeks of CSII, the proportion of sudomotor dysfunction (42.9% vs. 31.7%, P=0.020) was significantly deceased along with significantly improved HbA1c (10.0±1.9 vs. 8.1±1.0, P&lt;0.001) and HOMA-B [22.0 (IQR 12.1-37.0) vs. 56.9 (IQR 42.4-81.8) , P&lt;0.001]. Correlation analysis revealed that higher ESC composite score was correlated with better HOMA-B after CSII (r=0.445, P=0.015) .
Conclusion: Peripheral autonomic neuropathy could be improved by CSII in T2DM. The improvement of β-cell function could be responsible for the amelioration of peripheral nerve function. Keywords: Short-term continuous subcutaneous insulin infusion treatment; peripheral autonomic neuropathy; type 2 diabetes; β-cell function

Disclosure
J.Jin:None.

Funding
National Key R&D Program of China (2018YFC1314100) ; the Key-Area Research and Development Program ofGuangdong Province (2019B020230001) ; the China Postdoctoral ScienceFoundation (2018M640871)