bluuebunny/crossref_metadata_2025_split huggingface dataset:
926-P: Improving Glycemic Control in Adolescents and Young Adults (AYA) with Diabetes: The University of Washington (UW) AYA Diabetes Program
Authors: MALIK FAISAL , HIRSCH IRL B. , PIHOKER CATHERINE , TAPLIN CRAIG , ROBERTS ALISSA J. , LOWRY SARAH J. , YI-FRAZIER JOYCE , MOSS ASHLEY , HUANG ALYSSA , EHRHARDT NICOLE M. , PAGET ALIA , HOCH KATRINA , WEAVER KATHRYN W. 
Published: May 2022

Background: The UW AYA Diabetes Program is a partnership between Seattle Children’s Hospital and UW Medicine designed to meet AYA health care transition and mental health needs.
Objective: To evaluate the impact of the UW AYA Diabetes Program on glycemic control.
Methods: The study included 453 AYA with diabetes (baseline visit: mean age 20.8 years, 51% male, 70% Non-Hispanic White, 27% public insurance, 95% type 1 diabetes, 55% continuous glucose monitoring (CGM) use, 55% pump/automated insulin delivery use) who have received diabetes care within the UW AYA Diabetes Program for ≥6 months. Mixed-effects linear regression with a random effect for individual to account for repeated measures was used to evaluate change in A1C over time. Regression model was adjusted for age, race, ethnicity, diabetes technology use, and health insurance.
Results: Mean adjusted A1C decreased steadily with increasing time in the UW AYA Diabetes Program (Figure) . The difference was statistically significant compared to baseline A1C levels by the time participants had been in the program for 2 years (8.1%, 95% CI: 7.8-8.4 vs. 8.8%, 95% CI: 8.6-9.0) . A1C improvement did not vary by age, diabetes technology use, or health insurance (all p&gt;0.05) .
Conclusion: The UW AYA Diabetes Program offers a promising approach to improve glycemic control in AYA transitioning from pediatric to adult diabetes care.

Disclosure
F.Malik: n/a. N.M.Ehrhardt: Advisory Panel; Dexcom, Inc., Novo Nordisk, Research Support; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk. A.Paget: None. K.Hoch: None. K.W.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Bigfoot Biomedical, Inc., GWave, Roche Diabetes Care, Research Support; Beta Bionics, Inc., Insulet Corporation, Medtronic. C.Pihoker: None. C.Taplin: Advisory Panel; Insulet Corporation, Speaker's Bureau; Medtronic. A.J.Roberts: None. S.J.Lowry: None. J.Yi-frazier: None. A.Moss: None. A.Huang: None.

Funding
Forest Foundation, Sequoia Foundation
933-P: Maternal Choices and Preferences for Screening Strategies of Gestational Diabetes Mellitus: A Discrete Choice Experiment
Authors: XU TINGTING 
Published: May 2022

Aims: This study aimed to investigate maternal preferences for gestational diabetes mellitus (GDM) screening options in China to identify an optimal GDM screening strategy.
Methods: Pregnant women at 24−28 gestational weeks were recruited from Shandong province, China. A discrete choice experiment (DCE) was conducted to elicit pregnant women’s preferences for GDM screening strategy defined by five attributes: number of blood draws, out-of-pocket costs, screening waiting-time, number of hospital visits, and positive diagnosis rate. A mixed logit model was employed to quantify maternal preferences, and to estimate the relative importance of included attributes in determining pregnant women’s preferences for two routinely applied screening strategies (“one-step”: 75g oral glucose tolerance test [OGTT] and “two-step”: 50g glucose challenge-test plus 75g OGTT) . Preference heterogeneity was also investigated.
Results: N=287 participants completed the DCE survey. All five predefined attributes were associated with pregnant women’s preferences. Diagnostic rate was the most influential attribute (17.5% vs. 8.0%, OR: 2.89; 95%CI: 2.10−3.96) . When changes of the attributes of “two-step” to “one-step” strategies, the changes of women’s uptake probability from full “two-step” to “one-step” was positive with 71.3% (95%CI:52.2%-90.1%) , but no significant difference with the first step of “two-step” (-31.0%,95%CI:-70.2%-8.1%) .
Conclusion: Chinese pregnant women preferred the “one-step” screening strategy to the full “two-step” strategy, but were indifferent between “one-step” and the first step of "two-step" strategies. A careful consideration of maternal preferences can assist clinical practitioners and healthcare policymakers in promoting GDM screening acceptability and compliance in rural China to achieve better health outcomes for mothers and babies.

Disclosure
T.Xu: None.
949-P: Pharmacist Interventions within a Collaborative Enhanced Primary Care Team Process Improves Diabetes Care
Authors: HESS DANIELLE , MCCOY ROZALINA G. , MATULIS JOHN , KESSLER MAYA , MARA KRISTIN , HERGES JOSEPH 
Published: May 2022

Purpose: An enhanced primary care diabetes model (EPCD) was implemented to provide proactive longitudinal care to adult patients with diabetes, grounded in close partnership between primary care providers (PCP) , registered nurses (RN) , and Medication Management Services (MMS) pharmacists. In this model, care team RNs could request pharmacist support through chart review for comprehensive diabetes management. The purpose of this study is to evaluate the impact of the MMS pharmacist in the EPCD model for patients with diabetes.
Methods: All adults with diabetes paneled to a PCP in six primary care clinics in the Midwest U.S. were eligible for the EPCD model. We compared the change in diabetes care quality between patients who received pharmacist chart review and care recommendations to matched patients who did not. The index date was defined as the date of MMS pharmacist review after referral from the care team RN or date of RN review and no subsequent pharmacist consult. The primary outcome was the change in the proportion of patients meeting the composite of four diabetes treatment goals (D4) , including hemoglobin A1c control (HbA1c less than 8%) , blood pressure control (less than 140/90 mmHg) , aspirin use if indicated, and statin use if indicated at six months from the index date. Secondary outcomes were each of the four indicators individually.
Results: The proportion of patients meeting the D4 after 6 months increased with pharmacist chart reviews (N=85) compared to matched patients with no review (N=170) (27% vs. 7%, p&lt;0.001) . The change in patients meeting treatment goals of HbA1c (12.9% vs. 4.1%, p=0.020) , blood pressure (9.4% vs. 2.4%, p=0.023) , aspirin use (10.6% vs. 2.9%, p=0.018) , and statin use (17.6% vs. -1.2%, p&lt;0.001) were increased with a pharmacist review.
Conclusions: Pharmacist engagement in the EPCD model improved diabetes care quality. This supports the inclusion and utilization of pharmacists in multidisciplinary efforts to improve diabetes care.

Disclosure
D.Hess: None. R.G.Mccoy: Consultant; Emmi. J.Matulis: None. M.Kessler: None. K.Mara: None. J.Herges: None.
95-OR: Impact of Flash Glucose Monitoring in People with Type 2 Diabetes Inadequately Controlled with Noninsulin Antihyperglycemic Therapy: IMMEDIATE study
Authors: BROWN RUTH E. , ARONSON RONNIE 
Published: May 2022

Continuous glucose monitoring (CGM) has been shown to improve glycemic outcomes in people with diabetes using insulin therapies. In this multi-site, randomized trial, we studied adults with T2D inadequately controlled with non-insulin antihyperglycemic therapy to evaluate the impact of flash glucose monitoring (FGM) on glycemic and patient-reported outcomes. Participants received FGM + diabetes self-management education (DSME) or matched DSME alone for 16 weeks. Primary outcome was assessed by a blinded CGM device worn at baseline and at outcome. Among 116 participants enrolled (age 58.4 ± 10.1 years; T2D duration 10.1 ± 6.1 years; HbA1c 8.6 ± 1.1%) , the initial 82 completers (41 FGM + DSME, 41 DSME) showed time in range significantly greater in the FGM + DSME arm (76.1 ± 16.9%) compared to DSME arm (64.3 ± 23.2%) (p&lt;0.01) . Time above range was similarly lower in the FGM + DSME arm (21.5 ± 17.8% vs. 31.3 ± 25.6%, p=0.03) . Hypoglycemia was rare in both arms. Glucose monitoring satisfaction scores improved in the FGM + DSME arm only (0.6 ± 0.5 vs. 0.0 ± 0.5, p&lt;0.01) . Change in HbA1c was also greater in the FGM + DSME arm (-0.9 ± 0.9% vs. -0.5 ± 0.9%, p=0.03) . In this interim analysis, FGM users with T2D using non-insulin therapies had significantly greater time in range, satisfaction with glucose monitoring, and a greater reduction in HbA1c.

Disclosure
R.E.Brown: None. R.Aronson: Consultant; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Gilead Sciences, Inc., HTL Strefa, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; AstraZeneca, Bausch Health, Canada, Bayer AG, Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Kowa Pharmaceuticals America, Inc., Medpace, Novo Nordisk, Sanofi, Tandem Diabetes Care, Inc., Xeris Pharmaceuticals, Inc., Zealand Pharma A/S.

Funding
Abbott Diabetes Care, Inc.
955-P: Glucagon Prescription Rates in Insulin-Treated Patients with Diabetes at a Teaching Outpatient Clinic
Authors: ABDULWAHID TIBA , LLOYD JACOB , SELK KAREN 
Published: May 2022

Introduction: Hypoglycemia is a major barrier to optimal glycemic control and is a significant cause of morbidity and mortality in patients with diabetes. Additionally, hypoglycemia accounted for 235, 000 emergency department visits in 2016 according to the CDC. The ADA recommends that glucagon should be prescribed for all patients at increased risk of level 2 or 3 hypoglycemia so that it is available should it be needed. We hypothesize that glucagon is under-prescribed in patients with diabetes who are on prandial or premixed insulin at a tertiary center teaching hospital.
Methods: We performed a retrospective observational study of patients seen at an outpatient clinic at a tertiary center teaching hospital from February 2020 to July 2021. We chart audited 482 patients seen at least 3 times at the clinic with the diagnosis of diabetes on their electronic medical record. We included only patients who were on prandial or premixed insulin. We performed an analysis looking at the rate of glucagon prescription in the clinic.
Results: A total of 1patients were included in our final analysis with mean age [standard deviation] of 56.86[13.13], 44.1% Female, 66.6% African American, BMI of 33.62[9.92], HbA1C of 9.07[2.08], and 96.4% had health insurance. Only 5 patients (4.5%) of the qualified cohort were prescribed glucagon at our clinic.
Conclusion: Glucagon is under-prescribed at our clinic, with only 4.5% of the qualified cohort being prescribed glucagon. This rate is significantly lower than a previously published study showing a rate of 28%. Health insurance is unlikely to be a contributing factor. This could be due to a knowledge gap among providers about the standards of diabetes care guidelines. An educational intervention to help improve the prescription rate of glucagon and potentially decrease the hypoglycemia burden is warranted.

Disclosure
T.Abdulwahid: None. J.Lloyd: None. K.Selk: None.
957-P: A Community–Academic Practice Partnership to Optimize Outcomes in High-Risk Underserved Patients with Diabetes
Authors: FOWLER TERRI O. , STERRETT JAMES , COLLINS LASHONDA T. , POOLE ANTHONY D. , WEEDA ERIN , DUBOSE-MORRIS RAGAN A. , ROEVER KARI 
Published: May 2022

Background: The project aims to establish an interprofessional diabetes team within a Federally Qualified Health Center (FQHC) to increase patient access and improve the health of underserved patients with diabetes.
Methods: The program is a community-academic practice partnership implemented in a FQHC in the Southeastern United States. The program utilizes an interprofessional diabetes care model (in-person and telehealth) with a nurse practitioner, pharmacist, population health specialist, certified medical assistant, dietician, and primary care team to provide comprehensive diabetes care focused on treatment optimization, self-management, and identification of medical and community resources.
Results: A total of 175 patients were seen from November 2020 to October 2021. The median (IQR) A1C at baseline was 9.6% (8.4-11.5%) versus 8.6% (7.0-10.0%) at follow-up (p&lt;0.001) . The median BMI decreased by 0.4 kg/m3. Improvements were noted in diabetes quality metrics (Table 1) . Patient, primary care provider, and student surveys demonstrate 100% satisfaction with the diabetes team.
Conclusions: A community-academic practice partnership supports comprehensive diabetes management and improved health outcomes. Next steps include expansion of the program to additional practice sites and continued data analysis on patient outcomes, cost, and satisfaction.

Disclosure
T.O.Fowler: None. J.Sterrett: None. L.T.Collins: None. A.D.Poole: None. E.Weeda: None. R.A.Dubose-morris: None. K.Roever: None.

Funding
The Duke Endowment (6878-SP)
96-OR: Adverse Micro- and Macrovascular Outcomes in Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH and TODAY Studies
Authors: MOTTL AMY K. , ISOM SCOTT , TRYGGESTAD JEANIE B. , GUBITOSI-KLUG ROSE , DOLAN LAWRENCE M. , DAGOSTINO RALPH , DREWS KIMBERLY 
Published: May 2022

We sought to determine incidence rates for micro- and macrovascular events in youth-onset type 1 (T1D) and type 2 (T2D) diabetes in the SEARCH (T1D: N=564; T2D: N=149) and TODAY (T2D: N=495) studies. At study visits, we ascertained self-reported ophthalmologic, kidney, neuropathy, cardiac, and peripheral and cerebrovascular events , obtained medical records for these events, and adjudicated each event using predetermined standardized and harmonized criteria. Data were available from more than 6,000 person-years in T1D and more than 8,000 person-years in T2D. Incidence rates (events per 10,000 person-years) were calculated. As shown in the table, despite similar mean diabetes duration of 10-13 years and mean HbA1c &gt;9%, the incidence of reported complications was higher in the youth with T2D than those with T1D, with rates 2.5-fold higher for microvascular and 4.0-fold higher for macrovascular disease. These data support the aggressive nature of youth-onset T2D.

Disclosure
A.K.Mottl: Advisory Panel; Bayer AG, Board Member; Bayer AG, Research Support; Alexion Pharmaceuticals, Inc., Aurinia, Bayer AG, Boehringer Ingelheim International GmbH, Pfizer Inc. S.Isom: None. J.B.Tryggestad: None. R.Gubitosi-klug: None. L.M.Dolan: None. R.Dagostino: Consultant; Aetion, Inc., AstraZeneca, Biogen, Bristol-Myers Squibb Company, Daiichi Sankyo, Merck & Co., Inc. K.Drews: None.

Funding
National Institutes of Health DK061230; R01DK127208 Center for Disease Control
961-P: The Effect of Obesity on HbA1c among Adults with Type 1 Diabetes: A U.S. Based Multicenter Study
Authors: NOOR NUDRAT , AKTURK HALIS K. , DESIMONE MARISA , BASINA MARINA , RIOLES NICOLE , ROMPICHERLA SAKETH , HAW JEEHEA SONYA , GOLDEN LAUREN , EBEKOZIEN OSAGIE 
Published: May 2022

Background: The primary objective of this U.S. based multi-center study was to determine if obesity is associated with an increase in A1c levels among adults with T1D. Additionally, we also examined patient and clinical profile across all BMI groups in the adult T1D population.
Methods: Electronic health record data from the T1D Exchange Quality Improvement (T1DX-QI) Collaborative for adult patients aged 21 years and older, between 2017-2021 was analyzed. BMI (kg/m2) was categorized into: Underweight (&lt;18.5 kg/m2) , normal weight (18.5-24.9 kg/m2) , overweight (25.0-29.9 kg/m2) , obese (30.0-39.9 kg/m2) , and severely obese (≥ 40 kg/m2) . HbA1c levels were taken from patients’ most recent clinic visit. Multivariable regression analysis was used to examine the association between obesity and HbA1c levels.
Results: This analysis included 7,496 T1D adult patients, of which 3% were underweight, 42% normal weight, 33% overweight, 21% obese and 2% severely obese. Compared with normal weight people with T1D, the obese group were older (Mean (SD) , yrs: 36 (15) vs. 43 (15) ; p&lt;0.001) , and less likely to use a CGM (72% vs. 66%; p&lt;0.001) or insulin pump device CGM (63% vs. 57%; p&lt;0.001) . Compared to normal weight individuals, obese people had higher HbA1c levels (B (SE) :0.17; p=0.002) adjusted for age, gender, insurance status and race/ethnicity.
Conclusion: In this large real-world study, we found obese adults were more likely to have higher A1c levels than normal weight adults with T1D.

Disclosure
N.Noor: None. H.K.Akturk: Research Support; Dexcom, Inc., Eli Lilly and Company, REMD Biotherapeutics. M.Desimone: None. M.Basina: None. N.Rioles: None. S.Rompicherla: None. J.Haw: None. L.Golden: None. O.Ebekozien: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
968-P: Improvement in Glycaemic Control and Cost of Diabetes Care Using Diahome, a Smartphone Application
Authors: RAGHAVAN ARUN , NANDITHA ARUN , SATHEESH KRISHNAMOORTHY , SUSAIRAJ PRISCILLA , VINITHA RAMACHANDRAN , NAIR DHRUV , JEYARAJ SANTHOSH , SHARAD VAJPAYEE , RAMACHANDRAN AMBADY 
Published: May 2022

Digital healthcare is on the rise. Paucity of clinical data exists on the efficiency and effectiveness of the applications in diabetes management. We compared glycaemic outcomes at 4 months among type 2 diabetes (T2DM) patients opting virtual care using Diahome® app and in-person hospital visits. Data of 173 (91 app-users, 82 non app-users) were analysed. The two groups were similar by age, gender distribution and duration of T2DM. At follow-up, fasting plasma glucose significantly reduced among app-users alone (156 ± 70 vs.129 ± 40 mg/dl, p&lt;0.02) . There was a significant change in HbA1c in both groups; improvement was better among app than non-app users (15.8% vs.10.4% p=0.004) . The app was overall acceptable. Cost of treatment per visit reduced ($57 vs. $112) . Diahome® app was superior to hospital visits for routine diabetes care.

Disclosure
A.Raghavan: None. A.Nanditha: None. K.Satheesh: None. P.Susairaj: None. R.Vinitha: None. D.Nair: None. S.Jeyaraj: None. V.Sharad: None. A.Ramachandran: None.
972-P: DKA: Comparing Care in Medical ICU vs. Stepdown in a Community Hospital
Authors: AHMAD TAHREEM , MEHROTRA NEHA , ALI WAQAS , REN DIANXU , ARNOLD JONATHAN , KORYTKOWSKI MARY T. , MON SANN YU 
Published: May 2022

Background: Although DKA has been traditionally managed in intensive care units (ICU) , some studies suggest that DKA can be safely treated in non-critical care areas.
Objective: To compare safety & efficacy of a DKA IV insulin protocol in ICU with stepdown unit (SDU) .
Methods: A retrospective chart review of all DKA patients (Age &gt;yrs) admitted to ICU (N=45) & SDU (N=23) from January 20to August 2020. The admission to SDU was based on our hospital protocol (pH&gt;7.2 without organ failure) . We analyzed the compliance to the DKA protocol (Table) and adverse outcomes. Mann-Whitney U & Chi-square/Fishers exact tests were used to compare continuous & categorical variables respectively.
Results: ICU & SDU groups were demographically similar: mean age (36.2 ± 15.2 vs. 37.6 ± 18.9 yrs) , sex (F 67% vs. 70%) & BMI (21.2 vs. 21.8 kg/m2) . As expected, ICU group had severe DKA as compared to SDU group with higher mean BG & lower mean serum Bicarb (p&lt;0.05) . There was a trend towards stricter adherence to protocol in ICU. Length of stay (78 vs. 63 hrs) , hypoglycemia (9 vs. 13) , reoccurrence of DKA within 72 hrs (8 vs. 4.3) & 30-day readmission (53% vs. 65.2%) were similar in both groups (p&gt;0.05) .
Conclusions: Our study suggested that a DKA IV insulin can be safely managed in SDU in selected patients, which can help avoid ICU overcrowding. The observed trend toward less strict compliance with the DKA protocol can be overcome with nurse education and optimal nurse to patient ratio.

Disclosure
T.Ahmad: None. N.Mehrotra: None. W.Ali: None. D.Ren: None. J.Arnold: None. M.T.Korytkowski: None. S.Mon: None.
98-LB: Outcomes from the Insulin-Only Bionic Pancreas Pivotal Extension Study
Authors: LYNCH JANE L. 
Published: May 2022

The bionic pancreas (BP) is initialized with body weight only, makes all insulin dosing decisions autonomously, and uses meal announcements without carbohydrate counting. After completing a Pivotal RCT, 90 of the 107 (aged 6-71) participants who were randomized to the 13-week baseline standard-care (SC) arm in the RCT participated in the 13-week Insulin-Only BP Pivotal Extension Study (ES) . Visit completion rate was 100%. During the baseline SC period, 1 adult participant had 2 severe hypoglycemia (SH) events; the same participant had 2 additional SH events during the ES. During the baseline SC period there were no DKA events; 1 pediatric participant had a DKA event due to infusion set failure during the ES. A decrease of HbA1c, mean CGM glucose, percent of time &lt;70 mg/dl, percent of time &gt;180 mg/dl, and glucose coefficient of variability (CV) , and increased percent of time in range (TIR) occurred in the Extension Study when compared to the baseline SC period. Changes from baseline were similar in adult (N=42) and pediatric (N=48) participants, except for reductions in time &lt;70 mg/dl and CV, which were statistically significant in the pediatric but not adult sub-groups (Table) . The 90 participants who randomized to a 13-week baseline SC period and transitioned to the 13-week ES had statistically significant improvements in HbA1c and CGM outcomes following transition to the Insulin-Only BP without increases in hypoglycemia.

Disclosure
J. L. Lynch: Consultant; Novo Nordisk, Novo Nordisk, Novo Nordisk, Research Support; Beta Bionics, Inc., Beta Bionics, Inc., Beta Bionics, Inc., Jaeb Center for Health Research, Jaeb Center for Health Research, Jaeb Center for Health Research.

Funding
Funding from National Institute of Diabetes and Digestive and Kidney Diseases (grant #1UC4DK108612-01) Funding and bionic pancreas devices from Beta Bionics, Inc. Fast-acting insulin aspart and insulin aspart provided by Novo Nordisk Insulin lispro by Eli LillyBlood glucose meters and test strips (Contour?Next One Blood Glucose Monitoring System) provided by Ascensia Diabetes Care, Basel, CH. Continuous glucose monitor sensors and transmitters were purchased from Dexcom, Inc. at a discounted price.
981-P: Gut Microbiome Profile of American Indian Children with Obesity and Comparison with Industrialized and Preindustrialized Microbiomes
Authors: KOSTIC ALEKSANDAR , HANSON ROBERT L. , SINHA MADHUMITA 
Published: May 2022

Gut microbial composition is associated with metabolic risk and differs markedly between industrialized (IND) and non-industrialized (non-IND) populations.
Objective: To characterize the gut microbiome of American Indian (AI) children with overweight/obesity relative to IND and non-IND individuals (including ancient AI gut microbiomes) .
Methods: Stool samples were from 7-10-year-old AI children with overweight/obesity enrolled in a lifestyle intervention trial on diabetes risk factors (2019-21) . Metagenomic analysis was performed on 39 samples from 25 individuals and compared to samples from age-matched (5-12-year-old) non-AI children in IND (N=380) or non-IND (N=90) populations.
Results: Mean age was 8.4 years (SD 1.11) , 44% were male. Mean age-sex-adjusted BMI z-score was 2.12 (SD 0.45) . By principal coordinates analysis, AI samples clustered in an intermediate position between the IND and non-IND samples (Figure 1) . AI children shared microbes with non-IND children that are rare in IND populations but common in ancient AI individuals (Prevotella copri, Coprococcus catus) .
Conclusions: The gut microbiome in a subset of AI children is distinct from the non-AI American gut microbiome. Further, AI children may have "inherited" gut microbes from their AI ancestors, which may contribute to differences in their metabolism relative to non-AI children.

Disclosure
A.Kostic: None. R.L.Hanson: None. M.Sinha: None.

Funding
American Diabetes Association (1-17-INI-13) ; National Institutes of Health (P30DK036836)