bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP171 Choosing GLP-1RA Over Insulin for Patients with Type 2 Diabetes and Severe Hyperglycemia
Authors: Mamtani Raashi , Cobrinik Dora , Simon Barbara 
Published: November 2022

Abstract

Introduction
Although insulin remains the recommended treatment in type 2 diabetes for hyperglycemia with catabolic symptoms, it is also the generally recommended treatment for persistent hyperglycemia or hemoglobin A1c (HbA1c) values above 10% 1 . Recent data has suggested that glucagon like peptide 1 receptor agonists (GLP-1RAs) are also powerful at glucose lowering while additionally offering extra-glycemic benefits such as weight loss with minimal risk of hypoglycemia. Unfortunately, data on initial use of GLP-1RA is limited in patients with very high hemoglobin A1cs. Our objective was to evaluate outcomes in patients with type 2 diabetes and a baseline HbA1c of 10% or greater treated with GLP-1RAs instead of insulin.

Methods
This study is a small retrospective case series of insulin-naïve patients with uncontrolled type 2 diabetes who were prescribed an injectable GLP-1RA. Patients included had a baseline hemoglobin A1c ≥ 10% without signs of catabolism (weight loss, ketosis, significant polyuria), a minimum of one follow-up visit after initiating GLP-1RA, and at least one HbA1c measurement within six months of initiating treatment. Patients were excluded if they had previously been on insulin or a GLP-1RA in the past 1 year. The primary endpoint was change in HbA1c after 3-6 months of GLP-1 RA use.

Results
Of the patients initially screened, 7 patients fulfilled criteria and were included in the final analysis. The age range was 45-73 with 4 female patients and 3 male patients. The number of years patients had been diagnosed with type 2 diabetes ranged from 0 to 13 with 1 patient having newly diagnosed diabetes not previously on medications. Of the 6 patients who were on medical treatment at baseline, 3 patients were on monotherapy with either metformin or a sulfonylurea and 3 patients were on 2-4 oral hypoglycemic agents. Patients were continued on their initial medication regimen with the exception of DPP-4 inhibitors which were stopped at the time of GLP-1RA initiation. Mean baseline HbA1c prior to initiation of GLP-1RA was 11.9%. Following 3-6 months of GLP-1RA use, mean HbA1c significantly improved to 7.5% (p value= 0. 0005). All patients showed improvement of HbA1c in response to GLP-1RA initiation (mean HbA1c reduction = 4.4, minimum = 1.9, maximum = 7.5). All patients remained on GLP-1RA without significant side effects.

Conclusion
In this limited case series of patients with HbA1c ≥ 10%, GLP-1RAs were well tolerated and resulted in significant improvement in HbA1c. Our results suggest that GLP-1RAs should be considered as an alternative treatment option to insulin in non-catabolic patients with very high hemoglobin A1cs. References: 1. Committee ADAPP. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2021;45(Supplement_1): S125-S143. doi: 10.2337/dc22-S009
Presentation: No date and time listed
ODP182 Diabetes types and risk of severe COVID-19
Authors: Kazlauskaite Rasa , Liu Yuanqing , Desai Pankaja , Jackson-Morris Angela M , Ngongo Carrie , Nugent Rachel 
Published: November 2022

Abstract

Background
Associations of diabetes (DM) types with severe COVID have not adequately been investigated in clinical databases.

Methods
Analytical cohort of n=5713 patients with diabetes was selected from the electronic medical record-based COVID Registry in the urban academic health care system from March 2020 to March 2021. All cases in the registry tested positive for SARS-CoV-2 infection on the clinical assessments. Severe COVID was defined in cases requiring hospitalization or if fatal outcome. Demographics variables, clinic visits, vaccination status, multi-morbidity, ambulatory medication data, biochemical markers, and other diabetes characteristics were collected on or before the date of COVID diagnosis. After excluding pregnancy-related diabetes, cases were classified into type 1 (DM1), type 2 (DM2) and other/hybrid DM based on disease coding and clinical variables. Univariable and multivariable logistic regression models were used to assess the association of the three diabetes types with severe COVID after adjustment for age, sex, race/ethnicity. FindingsDiverse cohort included 37.6% Latino, 37.5% Black, 19.5% White, and 5.3% other; 53.7% were women. DM1 was identified in n=141 cases, Type 2 diabetes in n=2749, and other/hybrid diabetes in n=2823. The diabetes subtypes could not be reliably explored due to limitations of the clinical database. Compared to DM2, the odds of severe COVID were similar in DM1 (1.11, 95%CI 0.65, 1.81, p=0.700), but higher in other/hybrid DM (1.53, 95%CI 1.34, 1.76), after adjustment for sex, age, and race/ethnicity.

Summary
Other and hybrid diabetes types are not rare and are associated with a higher risk of severe COVID-19. The diabetes subtypes could not be reliably explored due to limitations of the clinical database.
Presentation: No date and time listed
ODP186 Difficulties in diagnosing MODY: clinical case
Authors: Volkova Natalya , Davidenko Ilya , Dzherieva Irina , Ganenko Lilia , Zibarev Alexander , Reshetnikov Igor , Degtyareva Julia , Brovkina Snezhana , Panenko Stanislav , Ignatiadi Anastasia 
Published: November 2022

Abstract

Background
MODY is one of the monogenic forms of diabetes mellitus, which includes 14 subtypes with different course and clinical picture. Final clinical diagnosis involves a molecular genetic study and is a key factor in successful treatment. Clinical case. Patient P., 33 years old, complained of aggravation of the condition after and during the dialysis procedure: general weakness, blood pressure rose to 220 mmHg, after the procedure a drop to 110-120 mmHg, lack of effect from hypertensive drugs, headaches. In 2004, type 1 diabetes mellitus was diagnosed based on complaints of polydipsia, polyuria, and fasting glycemia up to 9 mmol/l. Basic bolus insulin therapy was prescribed. Patient noted a frequent development of hypoglycemic conditions and independently canceled insulin therapy. For a long time the patient went without hypoglycemic therapy. In 2016, baseline insulin therapy was prescribed again, which resulted with frequent episodes of hypoglycemia resuming. In 2019, a diagnosis of MODY type 3 was made without medical and genetic counseling. Due to the high level of C-peptide 3057.1 pmol /L (160-1100), Repaglinide 0.5 mg was prescribed to be taken 3 times a day. Against the background of this treatment, compensation and stabilization of the condition has been observed. Family history: the mother has diabetes mellitus since the age of 22, manifested during pregnancy; receives Glibenclamide with a positive effect. Since 2011, diabetic distal sensorimotor polyneuropathy of the upper and lower extremities, diabetic foot syndrome, neuropathic form have been identified. Ulcerative defect of the I degree. Long-term non-healing trophic ulcer of the right foot for 6 years. In 2016, chronic kidney disease C5 A3 was detected. At the moment, the patient is on program dialysis. Complications of nephropathy were verified – secondary hyperparathyroidism, osteoporosis, moderate nephrogenic anemia, symptomatic nephrogenic arterial hypertension of grade 3, risk 4. In 2018, proliferative diabetic retinopathy of both eyes was detected. Total recurrent hemophthalmos of the right eye, subtotal hemophthalmos of the left eye. In 2021, autonomic neuropathy, gastrointestinal form and autonomic cardiovascular form were verified. The patient underwent a molecular genetic study for the identification of pathogenic mutations in the HNF1A gene, however, according to the study, mutations in the HNF1A gene were not detected. Thus, the diagnosis of MODY type 3 has not been confirmed. It is necessary to conduct a further diagnostic search for the type of MODY in order to make a final diagnosis.

Conclusion
This clinical case demonstrates the importance of a personalized approach to each patient, as well as conducting a molecular genetic study to make a final clinical diagnosis and prescribe timely pathogenetic therapy.
Presentation: No date and time listed
ODP188 Does Introduction of Oral Dextrose Gel Pathway Decrease the Length of stay in Neonates with Asymptomatic Hypoglycemia?
Authors: Beckett Omar , Kogelman Yelena , Bhutada Alok , Likourezos Antonios 
Published: November 2022

Abstract

Background
Neonatal hypoglycemia has been associated with various forms of neurological impairment including developmental delay, seizures, visual processing problems, and cognitive difficulties [1]. Consensus guidelines have been created to expedite the identification and resolution of hypoglycemic episodes. Interventions, such oral dextrose gel, have been shown to quickly and effectively reverse episodes of severe hypoglycemia [2]. However, more research needs to be conducted to quantify potential effects of oral glucose gel pathways on prevention of hypoglycemia in the neonatal period.

Objective
We evaluated the effects of introducing a clinical pathway for improving hypoglycemia with oral dextrose gel. We hypothesized a decrease in the length of stay of neonates with hypoglycemia after the introduction of the clinical pathway.

Design/Methods
We conducted a retrospective chart review evaluating neonates born ≥ 35 weeks gestational age, who exhibited asymptomatic hypoglycemia within 48 hours of life (HOL) while receiving exclusive oral feeds. The primary outcome was overall length of hospital stay. We extracted data from charts of children born prior and after the implementation of this oral dextrose gel pathway in both the well-baby nursery and Neonatal Intensive Care Unit (NICU) of a single medical center over a one-year period.

Results
385 total neonates who fit the aforementioned criteria were included, with 175 neonates representing the historical control group and 210 neonates in the intervention group receiving oral dextrose gel. Analysis demonstrated no significant difference in the overall length of stay, as well as the total episodes of hypoglycemia and number of days the neonate received intravenous fluid therapy with dextrose.

Conclusion(s)
Our study demonstrates that the introduction of oral dextrose gel pathway did not have a significant effecton the overall length of hospital stay, as well as the total episodes of hypoglycemia and number of days the neonate received intravenous fluid therapy with dextrose at our institution. Further research is needed to evaluate whether response to oral dextrose gel can be used as a predictor of severe hypoglycemia in the neonatal period.
Presentation: No date and time listed
ODP196 Evaluation of effectiveness of vitamin E on nonalcoholic fatty liver disease in type 2 diabetic patients without advanced fibrosis
Authors: Miranda Gonzalo , Rodriguez Karen Evelyn Ramos 
Published: November 2022

Abstract

Objective
To determine effectiveness of vitamin E on nonalcoholic fatty liver disease in type 2 diabetic patients without advanced fibrosis.

Background
Alcoholic hepatic steatosis is widely distributed worldwide, especially in industrialized countries, where the incidence of diabetes, metabolic syndrome and dyslipidemia are more common. All this fatty liver disease is more common in Western society. Most studies on hepatic steatosis have excluded patients with diabetes from which they call attention, given that this specific group of patients is affected to a large extent by this disease. Therefore, it is urgent to establish guidelines at the same level of solid evidence regarding the treatment of the EHGNA within the high risk populations as for the patients with DM-2. Material and methods: Quasi experimental study performed in Dos de Mayo National Hospital, Lima, Peru from August 2016 to January 2017. One experimental group received vitamin E at a dose of 400 IU in addition to conventional management and another control group with conventional management were formed. The study included 71 patients in each group of Dos de Mayo National Hospital. The development of the present study counted with approval of the ethics committee of Dos de Mayo National Hospital Both groups were submitted to calculation of liver fibrosis scores as part of the evaluation of fibrotic activity by means of Non-alcoholic fatty liver disease (NAFLD) score, liver ultrasound evaluation and measurement of TGP at the beginning and after 6 months. To compare concentrations of the NAFLD fibrosis score and TGP values within a same group, the Wilcoxon and Mann-Whitney U test was used to assess differences between the experimental and control group. To compare severity of fatty liver on ultrasound, Wilcoxon test was used. Also, we performed logistic regression analysis Results: The results showed that vitamin E was effective in reducing level of transaminases and severity of fatty liver on ultrasound statistically significant (Z=-4,727 and p&lt;0. 05) not related to confounding variables.

Conclusion
It is concluded that vitamin E at a dose of 400 IU is an effective intervention to control the progression of hepatopathy that can be quantified by means of the NAFLD score and to achieve a decrease in transaminase levels as well as an improvement in the ultrasound valuation after 6 months of follow-up in a defined group of diabetic patients recently diagnosed with NAFLD without significant fibrosis. Implications: One of the contributions of the present study is the importance of early intervention such as vitamine E in a diabetic population that does not have significant fibrosis in whom an early diagnosis and timely intervention can reverse or slow down the process
Presentation: No date and time listed
ODP204 Hemochromatosis and endocrine dysfunctions – a case report
Authors: Carvalho Davide , Gonçalves Juliana , Neves Celestino , Neves João Sérgio 
Published: November 2022

Abstract

Introduction
Hemochromatosis is characterized by iron overload that can lead to deposit in various organs such as liver, pancreas, pituitary gland, resulting in endocrine dysfunction. Pancreatic iron deposition can lead to diabetes mellitus, and pituitary deposition to hypopituitarism. Liver is the principal affected organ and that can lead to various complications like hepatomegaly, cirrhosis, and hepatocellular carcinoma.

Case report
A 67 years-old caucasian man was diagnosed with hemochromatosis at 30 years old. At that time, undergoing periodic phlebotomies. After 3 years, he was diagnosed with diabetes mellitus and started basal-bolus insulin therapy. In 2006 he submitted to laser photocoagulation due developed to non-proliferative retinopathy. At the present presents microalbuminuria with urine albumin to creatinine ratio of 65. 0 mg/g. The pituitary function reveals hypogonadotropic hypogonadism with no other axis affected. He was medicated with 250 mg enanthate testosterone injection monthly. He also developed cirrhosis Child-Pugh A and in 2018 was diagnosed with multicentric hepatocarcinoma. He was submitted at radioembolization of hepatic lesions in 2019 and in 2021. Due to disease progression, he started treatment with tyrosine kinase inhibitors (sorafenib 800 mg daily) in 2021. Recently, atrial fibrillation was diagnosed, and he started anticoagulation with apixaban 5. 0 mg twice a day.

Conclusion
Secondary causes of endocrinopathies such as diabetes mellitus and hypogonadism are relatively infrequent. This case alerts to diseases associated with hemochromatosis at long term, such as diabetes mellitus, hypogonadism, cirrhosis and hepatocarcinoma.
Presentation: No date and time listed
ODP210 Impact of Continuous Glucose Monitoring (CGM) in the Intensive Care Units (ICUs): Accuracy, Reliability, Feasibility and Nurse Acceptance
Authors: del Rincon Juan , Veeramachaneni Ravali , Amir Maryam , Calles-Escandon Jorge 
Published: November 2022

Abstract

Background
The COVID-19 pandemic led to crisis-level shortage of hospital beds and staff, predominantly in the ICUs. Minimization of patient contact moved the FDA to issue a statement that allowed CGMs in hospitals, which were quickly adopted by ICUs. We conducted a study to better understand the use of CGM in ICUs and test for accuracy, reliability feasibility, and acceptance by care providers.

Methods
Patients were eligible for CGM if they had diabetes mellitus and concomitant COVID-19 infection that required ICU level of care. CGM signals were received by smart phones that were placed in a transparent biohazard bag outside patients’ rooms. Nurses were educated on the interpretation of glucose trends, alerts, and calibration. CGM alerts were set for glucose readings below 100mg/dL and above or equal to 250mg/dL. Nursing staff could obtain point-of-care (POC) glucose as scheduled and for CGM alarms. Mean Absolute Relative Difference (MARD) values were calculated for accuracy. Nurses were invited to respond to a questionnaire with 5-point Likert scales to assess their perception of CGM use, and the potential decrease in the amount of personal protective equipment (PPE) needed in the care of patients on CGM. A question on the estimated time it takes to donn and doff PPE was also included.

Results
26 patients were included in the study; average age 60.8 + 13.5 years, 7 were female and 12 belonged to underrepresented minorities (Hispanic, non-Hispanic Black, or Asian); mean HbA1c was 9.2 + 2.6%. 7 patients were on intravenous insulin infusion, 6 were intubated and 5 received vasopressors. Average duration on CGM was 6 + 3.75 days.168 paired serum glucose-CGM measurements and 259 paired POC-CGM measurements were used. MARD between serum glucose and CGM measurements was 11.2%; MARD between POC glucose and CGM measurement was 11.6%. Questionnaires from 33 nursing staff were analyzed; the most frequent answer (mode) for time to donn and doff PPE was 10 minutes. The vast majority of answers were "agree" (21.2%) or "strongly agree" (78.8%) to the statements that CGM was easy to use and interpret and during the pandemic staff felt protected with use of CGM. Likewise, the answers were "agree" (18.8%) or "strongly agree" (81.8%) that CGMs could replace POC glucose in COVID-19 patients and that there was a lower need for PPE.

Conclusion
There is not an established acceptable MARD for patients with COVID-19 in an ICU setting. Wollersheim et al. suggested that CGM with a MARD of &lt;14% is acceptable for ICU patients. The MARD we found in our study was well within this range. We concluded that use of CGM in the ICU setting has acceptable accuracy and is reliable, feasible and well accepted by the nursing staff.
Presentation: No date and time listed
ODP213 Insulin Autoimmune Syndrome a rare case report
Authors: Paladugu Sridevi 
Published: November 2022

Abstract

Background
Insulin autoimmune syndrome IAS is cause of endogenous hyperinsulinemic hypoglycemia. Insulin autoimmune syndrome has been described with various drugs. Here we describe a case of IAS with use of Proton pump inhibitors, PPIs.

Case report
49year old man came with complaints of recurrent documented hypoglycemia for the past 3months. He was a diagnosed as having Gastroesophageal reflux GERD 6 months back and has been on treatment with Pantoprazole with which his symptoms have subsided. Since past 3 months he started having episodes of excess sweating, tremulousness and palpitations. He was diagnosed as having hypoglycemia during one such episode using a glucometer value &lt;60 mg/dl. After this he started monitoring his blood glucose values on glucometer and had recorded values as low as 50mg/dl, 55mg/dl, 47mg/dl. There was no specific association with meal intake. Every time his symptoms subsided with intake of diet. He was not a diabetic nor did he have any access to anti diabetic agents. With these complaints he was admitted and put on prolonged fasting, after 6 hours of fasting his blood glucose levels dropped to 42mg/dl. His critical sample revealed RBS- 42mg/dl, C peptide -15.7ng/ml (reference range 0.9-7.1ng/ml), serum insulin &gt;300 µIU/ml (1.9-23µIU/ml fasting state) and serum cortisol 20.65 ug/dl(5-25ug/dl). His Sulphonyl urea screen was negative. Biochemically Endogenous hyperinsulinemia was thus proved but on imaging ultrasound examination was normal, CT scan abdomen did not reveal any pancreatic lesions. His endoscopic ultrasound also did not reveal any lesion in the pancreas. Insulin antibodies test showed positive antibodies &gt;300 U/ml (reference range - &lt;12U/ml). He is a known case of hypothyroidism on regular treatment. His thyroid profile was normal. There was no history of usage of methimazole, carbimazole, ALA, captopril, diltiazem, procainamide, Isoniazid, Imipenem, penicillin, Interferon, clopidogrel, gliclazide etc. He was treated with Diazoxide, Prednisolone and Acarbose. His blood glucose levels stabilized and he did not have a recurrence of hypoglycemia. Gradually he was tapered off diazoxide and prednisolone over a period of 6 months. His repeat insulin antibodies after 6 months showed 43.23U/ml (reference range&lt;12). He is asymptomatic and is on follow up. IAS with PPI's is described 1 . Detailed history and physical examination did not reveal any other cause for IAS.

Conclusion
PPIs are commonly prescribed agents used ubiquitously. Here we wanted to highlight the importance of IAS with PPIs. There is no specific regimen used to treat IAS. Our patient showed good response to a combination of prednisolone, diazoxide and acarbose. This triple combination addresses the multiple mechanisms of hypoglycemia in IAS. References: Simone Censi et al Insulin autoimmune syndrome: diagnosis to clinical management. Annals of Translational medicine 2018 sep;6(17): 335.
Presentation: No date and time listed