bluuebunny/crossref_metadata_2025_split huggingface dataset:
66-OR: Diabetes Quality of Care among Medicaid Patients and Variation by Medicaid State Spending: A Natural Experiments for Translation for Diabetes 2 Study
Authors: MOIN TANNAZ , HARWOOD JESSICA , DURU O. KENRIK , TSENG CHIHONG , MANGIONE CAROL 
Published: May 2022

Background: Medicaid patients have high rates of diabetes complications. We examined quality of diabetes care among Medicaid patients and variation by Medicaid state spending.
Methods: Using 2015-16 United Healthcare claims (eligibility, medical, pharmacy) and lab data, we identified Medicaid patients with diabetes &gt;21 yrs of age receiving care in practices with &gt;1000 Medicaid patients (diabetes defined by diagnostic codes, A1c &gt;6.5% or glycemic prescriptions) . Over an 18-month study period, we examined A1c testing, statin use, retinal and nephropathy screening rates. Logistic regression covariates included a categorical variable for per-beneficiary Medicaid spending terciles by state (low, middle or high) , age, gender, race, ethnicity, language, Medicaid eligibility category, indicator for type 1 vs. 2 diabetes, indicator for chronic eye diseases, comorbidity indicators, and a count of number of enrolled months. We adjusted for clustering at the 3-digit zip code level and excluded states with vision care carve-outs.
Results: Among 46,5Medicaid patients with diabetes, the overall unadjusted completion rates for individual diabetes care measures varied from 39% (retinal screening) to 86% (nephropathy screening) ; 27% (7,540) of patients completed all 4 care measures. Adjusted completion rates for all 4 measures did not vary by Medicaid spending level. As compared to Whites, Asian/Pacific Islanders and patients with missing race were more likely to complete all 4 measures (5.1% and 3.7% higher respectively, p=0.00) , while Native Americans were less likely (-6.1%, p=0.04) . Medicaid patients with dual Medicare were more likely to complete all 4 measures than TANF members (4.8%, p=0.00) .
Conclusions: Only 1 in 4 Medicaid patients with diabetes received all 4 diabetes care measures in our study. Interventions are needed to increase adherence to diabetes processes of care for underserved Medicaid patients with diabetes.

Disclosure
T.Moin: None. J.Harwood: None. O.Duru: None. C.Tseng: None. C.Mangione: n/a.

Funding
CDC/NIH/NIDDK U18DP006128
667-P: Impact of Direction of Long-Haul Travel on Glycemic Control in Adults with Type 1 Diabetes (T1D) Using Multiple Daily Injections (MDI) of Insulin
Authors: BEVIER WENDY C. , LIU HANQING , CASTORINO KRISTIN N. , KERR DAVID 
Published: May 2022

Long-haul travel (flights &gt;6 hours) can be very disruptive for people living with type 1 diabetes (T1D) . As part of a study comparing long-acting basal insulins during long-haul travel (Bevier & Castorino, et al) , we evaluated the impact of direction of travel on glucosecontrol (Abbott Freestyle Libre Pro) . Each journey began in Honolulu (HI) with a non-stop flight to New York (NY) lasting hours with a 6-hour time difference. After 72 hours, participants returned non-stop to HI. Each subject completed round trips (using either Glargine or Insulin Degludec as the basal insulin) . Participants traveled in the same direction for either basal insulin. To assess the impact of direction of travel, data using either basal insulin were combined. Overall, 21 participants (13 women, age 34.2±15.2 years, HbA1c 7.5±1.2%) completed both journeys. CGM-derived metrics comparing (a) initial 72 hours at each destination, (b) during each flight and (c) for the total journey are shown below. During sleep, TIR70-180 was 56±26% travelling East to West and 66±26% going from West to East. Although there were no significant differences in CGM-derived metrics irrespective of direction of travel, the data suggest that achieving the recommended time in range between 70-180 mg/dl is elusive for adults with T1D using MDI when travelling across multiple time zones.

Disclosure
W.C.Bevier: Research Support; Abbott Diabetes. H.Liu: Employee; Abbott Diabetes. K.N.Castorino: Consultant; Lilly Diabetes, Research Support; Abbott Diabetes, Dexcom, Inc., Drawbridge Health, Inc., Eyenuk, Inc., Laxmi Therapeutic Devices, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Speaker's Bureau; Dexcom, Inc. D.Kerr: Advisory Panel; Abbott Diabetes, Novo Nordisk A/S, Sanofi, Consultant; Evidation Health, Research Support; Novo Nordisk A/S, Stock/Shareholder; Glooko, Inc., Hi.Health.

Funding
Novo Nordisk Investigator Sponsored Study - ISS-001227
668-P: Increased Step Count but No Improvements in Glucose Control: Using CGM as Visualization Tool in Adults with T2D
Authors: CRAWFORD MARGARET A. , CHERÑAVVSKY DANIEL R. , BARNARD KATHARINE , WANG XIAOHAN (ARIA) , GENGE PAUL , GREENAWALD KENNETH , TRESSLER MICHELLE 
Published: May 2022

Background: Physical inactivity is common in people with T2D and behavior modification can be difficult due to lack of timely and knowledgeable feedback. Real-time CGM (rtCGM) visualization of impact of efforts on glucose can highlight opportunities for medication and behavior modification to clinicians and individuals.
Methods: Glucose and step data in an observational study were collected with Dexcom G6 rtCGMs and activity trackers for 12 weeks in US adults with T2D. Participants did not receive education beyond standard of care. Paired T-tests were used to evaluate changes in step count, % time in range, peak glucose, and hyper- and hypoglycemic events between first and last weeks. Results are presented for the full T2D population (n=183) and a subgroup who increased average daily step count by ≥ 1000 steps (n=63) .
Results: Morning steps significantly increased across all participants and steps in all meal-related time periods significantly increased for subgroup (Table 1) . There was not a sustained, significant glucose impact.
Conclusion: Adding steps alone, supported by rtCGM, did not result in improvements in glucose. Such visualization provides information for individuals and clinicians to understand opportunities for therapy optimization, including activity and medication regimen. This is promising preliminary data and further research with prescribed intervention is required.

Disclosure
M.A.Crawford: Employee; Dexcom, Inc. D.R.Cherñavvsky: Employee; Dexcom, Inc. K.Barnard: Advisory Panel; Roche Diabetes Care, Sanofi, Research Support; Dexcom, Inc., Novo Nordisk. X.Wang: None. P.Genge: Employee; Dexcom, Inc. K.Greenawald: None. M.Tressler: Employee; Dexcom, Inc.
674-P: Benchmarking Continuous Glucose Monitor Use across T1D Exchange Quality Improvement Pediatric Clinics
Authors: GARRITY ASHLEY , MUNGMODE ANN , COSSEN KRISTINA , GALLAGHER MARY PAT , FEUER ALEXIS J. , BRIMBERRY DANIEL , PRAHALAD PRIYA , SCOTT MARY L. , NELSON GRACE , EBEKOZIEN OSAGIE , ENG DONNA 
Published: May 2022

Background: The T1D Exchange Quality Improvement Collaborative (T1Dx-QI) is a learning network of over forty US type 1 diabetes clinics. Clinics share best-practice ideas for quality improvement and use data for population health research. This study benchmarks continuous glucose monitor (CGM) use across pediatric clinics in the T1Dx-QI.
Method: T1Dx-QI clinics report monthly on critical metrics, including the percentage of patients with hemoglobin A1c (HbA1c) &lt;7% or using CGM. Median values for each site were calculated using Lahey P run charts between July 2020 and June 2021. These results are shared non-anonymized internally among participating T1Dx-QI clinics.
Results: Across 17 T1Dx-QI clinics, the percentage of patients using CGM ranged from 23% to 85% (Figure 1; mean and median CGM use were 61.3% and 61.7%, respectively) . Median HbA1c values ranged from 7.4% to 9.2%. There were no observed differences in CGM use by patient population size.
Conclusion: The T1Dx-QI benchmarks key clinical metrics to support quality improvement, share best practices, and promote learning across clinics.

Disclosure
A. Garrity: None. A. Mungmode: None. K. Cossen: None. M. Gallagher: None. A.J. Feuer: None. D. Brimberry: None. P. Prahalad: None. M.L. Scott: None. O. Ebekozien: None. D. Eng: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
678-P: Racial and Ethnic Disparities in CGM Use among Adults with Diabetes
Authors: ALJEDAANI SAMIA M. , SIDDIQUI AYESHA S. , RAJA-KHAN NAZIA 
Published: May 2022

Introduction: Continuous glucose monitoring (CGM) is increasingly being used in the management of diabetes. Racial disparities in use of CGM may contribute to disparities in health outcomes. Studies have shown disparities in use of CGM among different races. However, most of these studies were done in the pediatric population.
Objectives: To determine whether there are racial differences in the use of CGM in adults with type 1 or type 2 diabetes.
Methodology: In this cross-sectional study, the TriNetX query tool was used to search electronic medical records of patients seen at Penn State Health Hershey Medical Center. Inclusion Criteria were age 18 to 80 years old, and type 1 or type 2 diabetes. Patient measures collected include age, gender, race, ethnicity, using CGM or not, using insulin or not, and A1c.
Results: The total number of patients with type 1 or type 2 diabetes was 73,210. Among those, 1,330 patients were using CGM, including 1,090 White patients (1.88% of Whites with type 1 or type 2 diabetes) , 80 Black patients (1.39% of diabetic Blacks) , 79 Hispanic patients (1.82 % of diabetic Hispanics) , and 26 Asian patients (1.77% of diabetic Asians) . In patients with type 2 diabetes who are on insulin, CGM use was as the following: 2.03% of White patients, 1.% of Black patients, 1.09% of Hispanic patients, and 1.89% of Asian patients. Among insulin-treated patients with type 2 diabetes, mean A1c was 7.76% in those using CGM, compared to 7.89% in those not using CGM. Among patients with type 1 diabetes, 9.13% of White patients, 6.84% of Black patients, 7.57% of Hispanic patients and 8.82% of Asian patients were using CGM. In patients with type 1 diabetes, mean A1C was 8.43% in those using CGM and 8.36% in those not using CGM.
Discussion: Only patients who were billed for CGM during visits were included as CGM users in the study, which could result in fewer patients identified as CGM users. Rates of CGM use were lowest in Black and Hispanic adults indicating that racial and ethnic disparities exist in the use of CGM among adults with diabetes.

Disclosure
S.M.Aljedaani: None. A.S.Siddiqui: Advisory Panel; Alexion Pharmaceuticals, Inc. N.Raja-khan: None.
679-P: Costs and Cost-Effectiveness of the FreeStyle Libre System vs. Blood Glucose Self-Monitoring in Patients with Type 2 on MDI Insulin Treatment in Israel
Authors: GREENBERG DAN 
Published: May 2022

Introduction: Frequent glucose monitoring is essential to obtaining glucose control. We assessed the costs and cost-effectiveness of using the FreeStyle Libre® Flash Continuous Glucose Monitoring system (FSL) compared to self-monitoring of blood glucose (SMBG) in people with type 2 diabetes treated with multiple daily insulin injections (T2D MDI) from a healthcare payer perspective in Israel.
Methods: We calculated the incremental cost per quality adjusted life year (QALY) gained. Glucose monitoring costs are based on actual costs of FreeStyle Libre®, strips and lancets, assuming full adherence to monitoring. Severe hypoglycemic events (SHE) and diabetic ketoacidosis (DKA) costs are based on real-world data from Israel and the Israeli Ministry of Health list price. Costs are presented in Israeli Shekel (ILS) and $US. The incidence rates of SHE and DKA are based on real-world data from a large cohort of patients in France. Due to the short time horizon of this analysis, we assumed no mortality differences between the two monitoring alternatives. Utility increments for the use of CGM vs. SMBG, decrease in HbA1C and disutility for SHE and DKA events are based on estimates from the literature. The analysis was conducted over a 5-year time horizon, applying an annual discount rate of 3% on costs and outcomes. One way sensitivity analyses were performed on difference in costs.
Results: FreeStyle Libre® use is associated with a cost increase of ILS 27,021 ($US 8,444) and an increase of 0.26 QALYs, generating an incremental cost-effectiveness ratio of ILS 103,977 ($US 32,493) per QALY gained. These results are highly sensitive to changes in costs of glucose monitoring.
Conclusion: Assuming a willingness to pay threshold of $US 43,600 per QALY gained (GDP per capita in Israel in 2020) , the FreeStyle Libre® system is a highly cost-effective glucose monitoring alternative to SMBG for T2D MDI patients in Israel.

Disclosure
D.Greenberg: Advisory Panel; Abbott Diabetes, Consultant; Geffen Medical, Israel.
68-LB: The First Real-World Experience with Bigfoot Unity—A Three-Month Retrospective Analysis
Authors: BALIGA BANTWAL , TILLMAN JOHN , OLSON BYRON P. , VAUGHAN SARAH , SHEIKH F. NAUREEN , MALONE JAMES K. 
Published: May 2022

Background: In the US, approximately 10 million people with diabetes require insulin; the vast majority using MDI therapy. Diabetes is associated with sustained daily burdens due to complex, demanding, and often confusing self-care directives, which may be more pronounced with MDI. Bigfoot Unity is a unique, interconnected smart pen cap diabetes management system designed to address an unmet medical need to support MDI therapy, incorporating CGM data (Abbott FreeStyle Libre 2) , real-time alerts and clinician-directed dose recommendations.
Methods: The Bigfoot Unity System received FDA clearance in May 2021. We report a retrospective analysis on an initial cohort (N=49 at 11 clinics) with insulin-requiring diabetes managing MDI with Bigfoot Unity for 90 days. Deidentified data were evaluated to analyze glycemic metrics during use, and HbA1c obtained from medical records prior to use.
Results: Within the cohort, mean age was 60 years and 40 (82%) had T2D. The mean HbA1c prior to Bigfoot Unity use was 8.5±2.0% (N=43) . Mean GMI was 7.5±0.9% after 3 months use.
Discussion: These data show that for people using MDI with suboptimal glycemic control, using the Bigfoot Unity System has the potential for rapid and durable improvement in glycemic control. Considering the mean age of the cohort, results demonstrate close adherence to established glycemic targets including a short time spent in the hypoglycemia range. Further studies are planned to investigate this hypothesis.

Disclosure
B. Baliga: Speaker’s Bureau; Abbott Diabetes, Amarin Corporation, AstraZeneca, Bigfoot Biomedical, Inc., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Intuity Medical, Inc., Merck & Co., Inc., Novo Nordisk, Stock/Shareholder; Amarin Corporation, Insulet Corporation, Merck & Co., Inc., Moderna, Inc., Senseonics. J. Tillman: Employee; Bigfoot Biomedical, Inc. B. P. Olson: Employee; Bigfoot Biomedical, Inc. S. Vaughan: Employee; Bigfoot Biomedical, Inc. F. Sheikh: Employee; Bigfoot Biomedical, Inc. J. K. Malone: Consultant; Eli Lilly and Company, Insulet Corporation, Thermalin Inc., Employee; Bigfoot Biomedical, Inc.

Funding
Bigfoot Biomedical
681-P: Evaluation of Data Processing Performance for Subcutaneous Glucose Monitoring with an Optical Investigational Device
Authors: MADER JULIA K. , SIEGL REBECCA , REINHARD ANNA K. , KOPANZ JULIA , SIMIC AMRA , HARTMANN MATTHIAS , GAMSEY SOYA J. , BANERJEE SAYANTI , KAMECKE ULRIKE , REBRIN KERSTIN 
Published: May 2022

Background and Aims: Lumee Glucose is a small soft glucose-sensitive hydrogel (5.0 x 0.75 x 0.65mm hydrated) currently in clinical development and intended for permanent subcutaneous placement by injection to continuously monitor glucose. The sensor is comprised of a hydrogel scaffold containing fluorescent molecules that produce near infrared light proportional to glucose concentration when interrogated by an optical skin reader placed over the hydrogel. The reader utilizes a set of LEDs to excite the fluorophores within the hydrogel and communicates wirelessly with a tablet. Machine learning and quality data processing algorithms are also being assessed to establish monitoring accuracy using MARD.
Methods: Glucose monitoring including a carbohydrate-rich meal was conducted during 8-hour in-clinic visits in 28 subjects with insulin-treated diabetes (female, 48 yrs [20-82], BMI 26.2kg/m2 [19.7-40.3]) over a 3-month period. Frequent venous blood glucose measurements were obtained as reference (Super GL analyzer) . Sensor signals from a total of 188 monitoring traces and 3030 paired values were subjected to retrospective data processing with 3-point glucose reference calibration using machine learning and quality filters to remove potentially compromised optical signals.
Results: The average MARD for all 3030 paired values during the 6 to 91-day monitoring period was 12.3%. The MARD was 11.8% when applying additional signal quality filters.
Conclusions: Following injection, the hydrogel is suitable for long-term non-invasive glucose monitoring for a minimum period of three months. Projected performance parameters are within the range of currently available glucose monitoring devices. Quality signal processing algorithms revealed marginal performance improvements and should be further optimized with respect to compensating for signal perturbations resulting from motion, temperature, and ambient light changes.

Disclosure
J.K.Mader: Advisory Panel; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Speaker’s Bureau; Abbott Diabetes, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Servier Laboratories, Stock/Shareholder; decide Clinical Software GmbH. K.Rebrin: Stock/Shareholder; Profusa, Inc. R.Siegl: None. A.K.Reinhard: None. J.Kopanz: None. A.Simic: None. M.Hartmann: None. S.J.Gamsey: None. S.Banerjee: None. U.Kamecke: Consultant; Profusa, Inc.
697-P: Inpatient Glycemic Control and Glucose Variability by Continuous Glucose Monitoring in Older Adults with Type 2 Diabetes
Authors: IDREES THAER , GALINDO RODOLFO J. , URRUTIA MARIA A. , CASTRO-REVOREDO IRIS A. , MORENO EMMELIN MARIE , MIGDAL ALEXANDRA L. , DAVIS GEORGIA M. , VELLANKI PRIYATHAMA , FAYFMAN MAYA , PASQUEL FRANCISCO J. , PENG LIMIN , UMPIERREZ GUILLERMO E. 
Published: May 2022

Few studies have reported on differences in glycemic control and glucose variability by continuous glucose monitoring (CGM) in hospitalized insulin-treated older adults with type 2 diabetes (T2D) . Accordingly, we combined data from 3 inpatient randomized clinical trials using CGM in insulin-treated patients with T2D. Glycemic parameters were compared in 103 older adults (≥60 years) and 160 younger adults (&lt;60 years) . Older adults, as compared to younger adults, had significantly lower HbA1c and blood glucose (BG) upon admission, and had lower overall mean daily CGM glucose values and higher percent time in range between 70-180 mg/dl during hospital stay. Glycemic variability (GV) did not differ between the two groups when assessed through direct univariate comparisons using coefficient of variation (CV) , mean amplitude of glucose excursion (MAGE) , and standard deviation (SD) ; however, a multivariate analysis adjusted for GFR, BMI, admission BG and HbA1c, indicated that older adults have higher GV during the hospital stay compared to younger adults. Conclusion: Our study indicates that older adults with T2D have better glycemic control on admission (BG and HbA1c) and had higher % time in range (70-180 mg/dl) , no difference in hypoglycemia, but greater GV during hospitalization compared to younger adults.

Disclosure
T.Idrees: None. F.J.Pasquel: Consultant; AI Health LLC, Boehringer Ingelheim International GmbH, Dexcom, Inc., Research Support; Dexcom, Inc., Insulet Corporation, Merck & Co., Inc. L.Peng: None. G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. M.A.Urrutia: None. I.A.Castro-revoredo: None. E.Moreno: None. A.L.Migdal: None. G.Davis: Consultant; Medscape, Research Support; Insulet Corporation. P.Vellanki: n/a. M.Fayfman: None.
698-P: Parental Education and Family Income Associated with Increased CGM Use in Adolescents with Type 1 Diabetes
Authors: PARMAR ANGELEE , JASER SARAH S. , DATYE KARISHMA 
Published: May 2022

Introduction: Consistent continuous glucose monitor (CGM) use has been shown to improve glycemic control in patients with T1D; however, adolescents use CGMs less than any other age group. We utilized data originating from an ongoing trial at two urban diabetes centers to compare CGM use across different demographic factors.
Methods: Surveys were completed by parents (N = 150, 83% female) of adolescents with T1D (Mage 15.4 ± 1.3, MT1D duration 6.5 ± 3.7 years, MA1c 9.1 ± 2.1, 58% female, 59% White, Non-Hispanic, 19% Black, Non-Hispanic, 8% Biracial/Multicultural, 5% Hispanic, 4% Asian, 5% Other) participating in a clinical trial of a positive psychology intervention. Descriptive analyses and regression analyses were employed to compare CGM usage across different demographics. Rural communities were defined as &lt;5,000 residents.
Results: Of the parents surveyed, 81% indicated that their adolescents currently used CGMs. There were no significant differences in adolescent CGM use related to race, X2 = 4.46, p = .49, ethnicity, X2 = 1.79, p = .18, or residence in a rural community, X2 = 0.10, p = .76. CGM use was significantly higher in teens of parents who graduated from college (87%) than those without a college degree (70%) , X2 = 6.19, p = .013. Adolescents from families with an annual income ≥ $90,000 also had higher CGM use (88%) than lower income families (72%) , X2 = 5.56, p = .018. In a multivariable model, parental education and income emerged as the significant predictors of CGM use.
Conclusions: These findings highlight significant associations between parent educational level/income and adolescent CGM use, which may reflect parents with higher SES having greater familiarity with technology. Moreover, while the diverse sample is a strength of this analysis, we did not observe previously reported differences in CGM use related to race/ethnicity. Therefore, future studies with larger samples and qualitative work with stakeholders are needed to identify predictors of CGM use.

Disclosure
A.Parmar: None. S.S.Jaser: None. K.Datye: None.

Funding
National Institutes of Health (R01DK121316) Vanderbilt Katherine Dodd Faculty Scholars Program