bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP243 Severe Sustained Hyperglycemia in Setting of Simultaneous Dobutamine and Insulin Infusions - Drug Interaction
Authors: Arora Gunjan , Eshan Shayet Hossain , Qureshi Faisal 
Published: November 2022

Abstract

Case
A 55 year old female with a history of congestive heart failure, type 1 diabetes mellitus and chronic kidney disease stage IV presented to the ED for acute on chronic progressive shortness of breath. She was admitted to the telemetry unit and treatment with diuretics was initiated. During the course of hospitalization, she was noted to have atrial fibrillation with rapid ventricular response and dronedarone was started. However, her heart rate remained elevated along with borderline hypotension and thus, she was transferred to the ICU for amiodarone infusion and continued diuresis with dobutamine support via central line. Since the day of admission, she was being managed on a subcutaneous insulin regimen; however, while in the ICU her blood glucose levels continued to rise and remained elevated at 400-500 mg/dL (normal range 70 - 99 mg/dL). As per Endocrinology, insulin drip was started. The patient had poor peripheral vasculature and it was difficult to obtain and maintain peripheral intravenous (IV) access. Therefore, the same right internal jugular central line was used to infuse both dobutamine and insulin. The insulin drip was continued on and off for just short of 3 days and with an average rate of &gt;10 units insulin per hour, and the highest rate of insulin infusion running at 15 units/hour for more than 7 hours. Her insulin requirement declined as dobutamine was weaned off, and ultimately, she was transitioned back to a basal-bolus regimen.

Discussion
Hyperglycemia is a common occurrence in critically ill patients for which insulin drip is a powerful tool. There is paucity of data on insulin and its incompatibility with vasopressors, another class of very commonly used agents in the intensive care unit (ICU) setting. Research has shown that vasopressors can cause insulin resistance if infused via the same vascular channel by rendering insulin ineffective. A previously published case report detailed a patient requiring Insulin infusion as high as 450 units/hr while norepinephrine and insulin were being administered via the same central line and upon switching them to different IV access sites, the insulin requirement decreased to 14 units/hour. Another study demonstrated reduction in insulin efficacy by 70% in patients receiving simultaneous norepinephrine. There are no such studies available on interactions of insulin with dobutamine. This case report calls attention to the risk of deleterious interactions between commonly used medications in the ICU setting running through the same channel. This is an important entity to recognize as standard treatment protocols for IV insulin treatments do not typically account for other simultaneous IV medications which can have profound consequences in regards to dosing and wide range of variation from hyperglycemia to hypoglycemia if the titration based on medication interaction is not accounted for.
Presentation: No date and time listed
OR29-1 The Association of Aldosterone and Endothelin-1 With Incident Diabetes Among African Americans: The Jackson Heart Study
Authors: Puthankovilakam Divya 
Published: November 2022

Abstract

Introduction
African Americans (AAs) have the highest prevalence of hypertension among United States racial/ethnic groups. Regulators of blood pressure, such as aldosterone and endothelin-1 (ET-1), increase risk of hypertension. Higher aldosterone levels have been associated with higher insulin resistance and increased risk of diabetes. Similarly, ET-1 is known to cause insulin resistance by reducing glucose uptake. However, it is poorly understood how aldosterone and ET-1, which primarily regulate the blood pressure, together are involved in diabetes pathophysiology among AAs.

Aim
To examine the individual and combined longitudinal associations of aldosterone and ET-1 with incident diabetes among AAs in the Jackson Heart Study (JHS).

Methods
Among 3,914 AA participants without prevalent diabetes in the JHS, linear regression models were used to examine cross-sectional associations of exposures (aldosterone, endothelin-1, and a combined aldosterone-endothelin-1 score [2–8]) with glycemic measures (fasting plasma glucose [FPG], HbA1c, HOMA-IR, and HOMA-β). Longitudinal associations of exposures with incident diabetes were examined using Cox proportional hazard models. Models were adjusted for age, sex, education, occupation, systolic blood pressure, smoking, physical activity, dietary intake, alcohol use and adiponectin.

Results
Aldosterone and the combined aldosterone-endothelin score were positively associated with FPG, HOMA-IR, and HOMA-β. Endothelin-1 was negatively associated with FPG but positively associated with HOMA-β. Only the aldosterone-endothelin score was positively associated with HbA1c. A 1-SD higher serum aldosterone and endothelin-1 were associated with a 22% and 14% higher risk of incident diabetes, respectively, while a 1-point higher aldosterone-endothelin score was associated with a 13% higher risk of incident diabetes after adjustment for diabetes risk factors.

Conclusions
The study indicates both aldosterone and ET-1 are risk factors for the development of diabetes among AAs, thus future studies should consider aldosterone and ET-1 modulation to improve glucose metabolism.
Presentation: Tuesday, June 14, 2022 9:45 a.m. - 10:00 a.m.
OR29-4 Prevention of Type 2 Diabetes by Testosterone in the T4DM Trial: Analysis of Effect Mediation
Authors: Wittert Gary 
Published: November 2022

Abstract

Background
In men aged 50+ years at high risk of, or with newly diagnosed type 2 diabetes (T2D) testosterone (T) treatment reduced the risk T2D at 2-years by 40% beyond lifestyle change alone (Wittert et al Lancet Diabetes and Endocrinol 2021).

Aim
Determine whether changes in total fat mass (kg), abdominal fat mass (%), lean mass (kg), and non-dominant handgrip (kg) mediate the effect of T treatment on glycaemia.

Hypothesis
The effect of testosterone on glycaemia is mediated by changes in fat and functional skeletal muscle mass Methods: A randomised placebo-controlled trial enrolled 1007 men, 50–74 years, waist circumference (WC) ≥ 95cm, serum total T ≤ 14nmol/L (chemiluminescent RIA) and either impaired glucose tolerance or newly diagnosed T2D on an oral glucose tolerance test (OGTT). Participants were enrolled in a lifestyle program (WW) and randomised 1: 1 to 3 monthly IM injections of 1gm testosterone undecanoate or placebo. The primary outcome of T2D at 2-yrs (OGTT&gt;=11.1mmol/L) was assessed by binomial regression with a log-link function. Mediators of interest were fat mass % abdominal fat, lean mass (dual x-ray absorptiometry) and non-dominant hand-grip strength (handgrip dynamometry). Mediation was determined by including the baseline and change at two years for each of the 4 factors of interest in the model. Significance: P&lt; 0.05. There was no imputation for missing data.

Results
There were complete data for 775 men (77.5%). For the outcome of T2D at 2-yrs, the unadjusted RR for treatment was 0.59 (95% CI: 0.43–0.80), which became 0.66 (95% CI: 0.51–0.87) after adjustment for baseline values of the proposed treatment mediators and OGTT. After inclusion of changes in body composition (total fat mass, abdominal fat percentage, lean mass) and grip strength, the effect of treatment was attenuated, RR 0.85 (95% CI: 0.61–1.19). The individual effects for changes in fat mass, abdominal fat, lean mass, and grip strength were 0.88 (0.64–1.19), 0.79 (0.59–1.07), 0.52 (0.38–0.71) and 0.64 (0.48–0.86) respectively.

Conclusion
After including change in fat mass the RR increased and the effect of T was no longer significant indicating the decrease in fat mass mediates the effect of T. This did not however, entirely explain the effect of T to decrease risk for T2D. Although lean mass and hand grip strength increased, neither mediated the effect of testosterone on T2D.
Presentation: Tuesday, June 14, 2022 10:30 a.m. - 10:45 a.m.
PSAT035 COVID-19 Infection Increases DKA and mortality- A Harbinger for Increased Acute Diabetes Emergencies in the Future?
Authors: Firek Anthony , Firek Matthew , Garcia Jayvani , Munir Iqbal , Tran Anh , Yang Almira 
Published: November 2022

Abstract
DM patients infected with COVID-19 are at risk for developing severe complications including DKA and/or HHS, with a more severe disease course and higher mortality compared to those without DM or hyperglycemia. As COVID-19 is evolving into an endemic risk for the population, it is important to determine patients at risk for COVID-19 complications and outcomes. The Riverside University Health System Medical Center (RUHS-MC)-DKA Outcomes Group (RUDOG) initiated a study to characterize patients admitted for fatal DKA and/or HHS before and during the pandemic.
This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from Mar 2020 to Feb 2021 ("pandemic") compared to the 3 preceding years ("pre-pandemic"). The descriptive statistics were used to determine the clinical characteristics of hospitalized adult patients with DKA and/or HHS. Information of patient characteristics was extracted from chart reviews. Categorical data were compared using Fisher's Exact Test. Numerical variables were assessed using Mann-Whitney Test.
The mortality rate during the pandemic was 8.4% (30/335) versus 1.7% (5/285) in the pre-pandemic period. Most of the deaths (24/30) were COVID infected. On average, the cases of deaths during pandemic had DM for a longer duration. There was no difference regarding age, race, HgbA1c on admission, insulin use history, and rate of micro- or macrovascular complications comparing these periods. More patients had HTN (80%) and HF (23%) during pandemic compared to pre-pandemic (69.2% and 7.7%, respectively). Infection was the cause of death for 63% and 31% of patients admitted for DKA and/or HHS during the pandemic versus pre-pandemic.
There is a clear global concern that COVID-19 will be an endemic infectious disease placing people with pre-existing conditions such as DM at increased risk for morbidities and death. Our study has clearly demonstrated that contracting COVID is a risk for increased incidence of DKA and/or HHS and mortality compared to pre-pandemic levels. In addition, we have shown that certain pre-existing comorbidities are associated with the mortality of DKA and/or HHS including HTN and HF with COVID infection. The duration of DM was longer among patients that died during pandemic, regardless of age, race, or HgbA1c on admission. This finding is intriguing as we did not see increased DKA and/or HHS based on the number of micro- or macrovascular complications suggesting duration alone may be a new risk determinant.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN137 Suppression of endogenous insulin secretion during euglycemic hyperinsulinemia – effects of obesity
Authors: Eyupoglu Nesrin Damla , Laurenti Marcello , Vella Adrian , Jensen Micheal 
Published: November 2022

Abstract
Hyperinsulinemia is strongly linked with excessive body fat. However, with the exception of plasma glucose concentrations, the other factors regulating insulin secretion are under-studied. We examined the effects of hyperinsulinemia itself on beta cell insulin secretion during exogenous insulin and glucose infusions in adults with insulin-resistant upper body (UBO), insulin-sensitive lower body obesity (LBO) and non-obese controls.
Data from the euglycemic, hyperinsulinemic clamp studies of 33 volunteers (9 controls, 5 LBO, 19 UBO) was analyzed; basal and insulin-suppressed (residual) insulin secretion rates were determined using deconvolution of C-peptide concentrations. Obesity phenotype was determined using waist: hip ratio and body composition was assessed with dual-energy X-ray absorptiometry and abdominal computed tomography. Plasma insulin concentrations were log transformed to achieve a normal distribution before statistical analysis.
The plasma glucose concentration change during the clamp was 0.3 (SD: 3) mg/dl, and similar among groups (p=0.7). Median, achieved serum insulin concentrations was 66 (IQR: 45-105) mIU/mL, and greater in participants with obesity. Fasting insulin secretion rates were 0.093 (SD: 0.029), 0.158 (SD: 0.036), and 0.216 (0.078) nmol/min in controls, LBO and UBO, respectively (UBO p&lt;0.001 vs. other groups). Insulin secretion was suppressed by 28% during hyperinsulinemia with no between group differences (p= 0.69). The ratios of insulin secretion rate (from C-peptide deconvolution) to serum insulin concentration (nmol/min per mIU/mL) was 0.058 (SD: 0.015) in controls, 0.090 (SD: 0.016) in LBO and 0.111 (SD: 0.039) in UBO (UBO vs. other groups P = 0.001). The ratio of insulin secretion rates to plasma insulin concentrations was correlated with BMI (r=0.69, P &lt;0.001).
We conclude that adults with obesity have greater residual insulin secretion during an exogenous insulin infusion and that this is related to upper body fat distribution. However, because the proportional suppression of endogenous insulin secretion is similar in these groups, this could indicate the primary abnormality is fasting insulin secretion.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN140 “Awakening of the Beta Cell©”
Authors: Jasper Josephine , Schauer Jasmin 
Published: November 2022

Abstract

Background
Endocrinologists often manipulate hormones by adding medication or replacing hormones that are no longer being produced. However, replacing hormones artificially causes hormone producing cells that are still viable to become suppressed and ultimately shut down. For example, with estrogen, testosterone, or cortisol replacements, the cells responsible for the production become inactive. This study tries to show that the same process affects the beta cells in the pancreas. The more insulin given, the further these beta cells become suppressed, and block natural insulin production. Rather than insulin resistance, our results showed that high dose artificial insulin inhibits the beta cells and prevents natural production.

Methods
To perform this study, we took a random sample of 13 type 2 diabetics on high doses of insulin. Prior to the study, they were taking over 20 units of bolus prandial insulin 3x daily, and over 50 units of basal insulin 1-2x daily. We reduced their insulin by half, monitored them closely, instructed them to change their lifestyle and follow a proper diabetic diet.

Results
Out of the 13 patients, 10 of them showed significant improvement on follow-up evaluation. The HbA1c and finger sticks had remained consistent or improved with the reduced dose. This showed the beta cells had been suppressed and were now becoming more responsive. Overall, the patients responded well to the reduction in their high doses of insulin, and it appeared that the pancreas’ beta cells began to naturally produce insulin.

Conclusion
The results showed that a lifestyle change along with the reduction in insulin was successful in treating patients with Type 2 Diabetes. Like any other hormone, prescribing large doses of insulin has been indirectly suppressing the action of beta cells. This suggests that patients may not be developing insulin resistance, rather their beta cells are losing their functionality. To control their Type 2 diabetes, patients should focus on pursuing a healthy lifestyle and lowering their insulin. Limitations to the study were that the threshold where the beta cells no longer function has not yet been quantified, and patient non-compliance with monitoring and lifestyle changes, resulting in the need for increased insulin.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN148 Disparities in COVID-19 Mortality in Hispanic and Non-Hispanic Patients with Metabolic Syndrome in a Community-Based Hospital
Authors: Ho Erwin , Samudrala Santhosi , Adams John , Su Kaihong 
Published: November 2022

Abstract
In Hispanic populations, rates of metabolic comorbidities such as obesity are higher than that of non-Hispanic White in the United States. Despite having higher comorbidity rates, Hispanic populations have a lower total risk of mortality compared to non-Hispanic counterparts. In this study, we explore whether this paradox exists for COVID-19 related deaths in Hispanic patients with Metabolic Syndrome (MetS). MetS is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, diabetes, hypertriglyceridemia, and low levels of HDL. A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients, 55.4% were male, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this cohort was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. Odds ratios and confidence intervals for the relationship between MetS and mortality were calculated separately among patients who were either Hispanic or non-Hispanic. Multivariable logistic regressions accounting for interactions between MetS and Hispanic patients were assessed. In our cohort, 49 (18.2%) patients died of COVID-19. Hispanic patients had a lower probability of mortality (16.0%; 95% CI 11.1-21.0) than non-Hispanic patients (26.3%; 95% Cl 14.9-37.7). Hispanic patients with MetS had a higher risk of mortality from COVID-19 ([OR] 1.57; 95% Cl 0.74-3.33) compared to Hispanic patients without MetS. Non-Hispanic patients with MetS also had a higher risk of mortality from COVID-19 ([OR] 4.38; 95% Cl 1.19-16.03) compared to non-Hispanic patients without MetS. The MetS effect on mortality in Hispanic was 64% lower than that in non-Hispanic patients, although this result did not reach statistical significance (p value=0.18.) Our data suggests that MetS is a risk factor for COVID-19 mortality and MetS may have a lower impact on COVID-19 related death in the Hispanic population than non-Hispanic counterparts. Studies with larger sample sizes will be required to confirm these relationships.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN156 Circulating thrombospondin-2 level as a novel biomarker of heart failure in type 2 diabetes
Authors: Lee Chi-Ho , Wu Mei-zhen , Lui David , Fong Carol , Yuen Michele , Chow Wing-Sun , Xu Aimin , Yiu Kelvin , Lam Karen 
Published: November 2022

Abstract

Introduction
Circulating thrombospondin-2 (TSP2) has been associated with adverse cardiovascular outcomes in patients with heart failure (HF). Type 2 diabetes (T2D) increases HF risk and induces TSP2 tissue expression. Here, we investigated prospectively the role of circulating TSP2 as a novel biomarker of incident HF hospitalization (HHF), and its associations with longitudinal changes of echocardiographic parameters in T2D.

Methods
Baseline serum TSP2 level was measured in 4949 T2D patients from the Hong Kong West Diabetes Registry to determine its association with incident HHF using multivariable Cox regression analysis. In the echocardiographic study, baseline serum TSP2 level was measured in another 146 T2D patients without cardiovascular diseases who underwent detailed transthoracic echocardiography at baseline and after 1 year.

Results
Over a median follow-up of 7.8 years, 330 of 4949 patients (6.7%) developed incident HHF. Baseline serum TSP2 level was independently associated with the development of HHF (HR 1.31, 95%CI 1.06–1.62, p=0.014) after adjustments for conventional cardiovascular risk factors, atrial fibrillation, estimated glomerular filtration rate, albuminuria and high-sensitivity C-reactive protein level at baseline, as well as use of medications including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, frusemide, aspirin, insulin, metformin and sodium-glucose co-transporter 2 inhibitors. In the echocardiographic study, baseline serum TSP2 level was independently associated with increase in average E/e' and left atrial volume index (p=0.04 and &lt;0.01, respectively).

Conclusion
Serum TSP2 level was independently associated with both incident HHF and deterioration in diastolic function in T2D, suggesting its potential to be developed as a novel HF biomarker in T2D.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN157 SILENT MYOCARDIAL ISCHEMIA IN ELDERLY DIABETIC PEOPLE IN GOOD PHYSICAL CONDITION AND CARDIORESPIRATORY FITNES
Authors: Madrigal-Campos David , Madrigal Beatriz 
Published: November 2022

Abstract
Every year, the INAPAM (National Institute for Elderly People, in México) hosts a "mini olympic games" event with accesible adaptation exercises. In preparing for such "games" the public health institutions hold medical exams to all participants to reduce the risk of any injuries. This study reports the data found on the medical exams performed in one of aforementioned institution. (Pensiones Civiles del Estado de Chihuahua).
The medical exams were performed on 46 women and 16 men with an average age of 67 (60 to 79 years of age) including medical history, physical examination and laboratory exams. The subjects were part of a no medical supervising cardiorespiratory fitnes program.
The effort perceived during the walking was 4 on the VAS scale (Visual Analogue Scale). We found 29 (46.7%) persons with high blood pressure (BP), 25 (40.3%) with diabetes, 20 (32.3%) smokers, and 15 (24.1%) with hypercholesterolemia. We found on electrocardiogram (EKG) inespecific abnormalities in 24 patients (38.7%), left bundle branch block in 25 patients (40.3%) and left ventricular hypertrophy in 13 patients (20.9%).
In 10 persons with high BP did not tolerate to be in guideline target. In 9 diabetic persons had acceptable glycemic levels but slightly elevated A1Cs (glycated hemoglobin). These patients with high BP and diabetes were the older ones in the group. In medical histories of the group it was found, that more than 60% of their doctor's visits the persons were on target lipid levels.
On ecocardiogram, ventricular hypertrophy was found in 49 (79%) persons, dyastolic dysfunction in 45 (72%), insignificant valve abnormalities in 50 (80.6%) and no body with wall motion abnormalities of the left ventricle.
The stress test reported good physical capability on all persons but was positive with no symptoms in 4 (6.4%). These 4 patients were diabetic and older than 75 years of age. Coronariography was performed on these 4 patients, 3 of whom had revascularization surgery and 1 had a coronary angioplasty. Among of them 4, one who has won first place in these "mini olympic games" previosly.
The silent myocardial ischemia reported was similar as in the general literature, depending on the number of risk factors. An altered treshold in the perception of cardiac ischemic pain between diabetic patients and older age patients is to be considered. Due to the persons's cardiovascular fitnes as being part of the walking training program, their BP and heart rates, we thought, contributed to the lack of cardiac ischemic pain.
These study is one of the first to report silent myocardial ischemia in people with very good physical and cardiorespiratory fitnes.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.