bluuebunny/crossref_metadata_2025_split huggingface dataset:
860-P: A Territory-Wide Study of SGLT2 Inhibitor–Associated Postoperative Diabetic Ketoacidosis in Type 2 Diabetes Patients
Authors: LUI DAVID T.W. , WU TINGTING , LIU XIAODONG , AU CHI HO , LEE CHI HO , FUNG MAN HIM MATRIX , WOO YU CHO , TAN KATHRYN C. , WONG CARLOS K. 
Published: May 2022

Objective: We aimed to characterize SGLT2 inhibitor (SGLT2i) -associated post-operative diabetic ketoacidosis (DKA) in type 2 diabetes patients.
Methods: We analyzed a territory-wide cohort of type 2 diabetes patients who underwent operations during 2015-2020. Patients who had SGLT2i prescriptions within 6 months before operations were assigned to SGLT2i group while others to control group. Inverse probability treatment weighting with propensity scores was used to balance the baseline covariates between two groups. Post-operative DKA was defined by DKA within 30 days post-operatively.
Results: In total, 151488 type 2 diabetes adults undergoing elective (3260 SGLT2i users; 105540 controls) and emergency operations (1087 SGLT2i users; 416controls) were included. SGLT2i users who underwent emergency operations had higher incidence of post-operative DKA (24.5/1000 person-years) than elective operations (1.0/1000 person-years; p&lt;0.001) . SGLT2i exposure significantly elevated incidence of post-operative DKA (elective: incidence rate ratio [IRR]=5.57, p&lt;0.001; emergency: IRR=5.37, p&lt;0.001) . Among SGLT2i users, apart from emergency surgery, HbA1c&gt;8% (64mmol/mol) and baseline insulin use increased the risk of post-operative DKA. SGLT2i users who developed post-operative DKA had worse outcomes (mechanical ventilation, intensive care and length of hospitalization; p&lt;0.05) than those who did not. However, implementation of alert in Clinical Management System about perioperative precaution in SGLT2i users did not reduce the risk of post-operative DKA.
Conclusion: Preoperative SGLT2i use was associated with increased risks of post-operative DKA in type 2 diabetes, higher among patients who underwent emergency operations than elective ones. Clinicians should be vigilant regarding the high-risk group. Effective strategies to mitigate risks of SGLT2i-associated post-operative DKA are urgently needed given the associated morbidities.

Disclosure
D.T.W.Lui: None. T.Wu: None. X.Liu: None. C.Au: None. C.Lee: None. M.Fung: None. Y.Woo: None. K.C.Tan: None. C.K.Wong: None.
867-P: Favorable Kidney Outcomes Are Associated with Empagliflozin vs. DPP4i in Patients with Diabetes and Normal Kidney Function Real-World Evidence
Authors: SCHECHTER MEIR , COHEN CHELI MELZER , ROZENBERG ALIZA , YANUV ILAN , CHODICK GABRIEL , MOSENZON OFRI , KARASIK AVRAHAM 
Published: May 2022

Kidney-protective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) are supported by both randomized control trials and real world evidence in high cardiorenal risk type 2 diabetes mellitus (T2DM) patients. However, long-term efficacy studies of T2DM patients with normal kidney function and low cardiorenal risk are lacking. Using a large Israeli database we studied kidney outcomes in patients with T2DM with low baseline KDIGO risk (eGFR≥60 ml/min/1.73, UACR&lt;30 mg/g) and no cardiovascular history. Patients who initiated empagliflozin or any SGLT2i during 2015-2021 were propensity score matched to DPP4i initiators by 120 baseline characteristics and followed until an event or end of study period. The primary outcome included a composite of ≥40% sustained eGFR decline, end-stage kidney disease (ESKD) , or all cause death. Risk was calculated using cox-proportional hazard models adjusted to baseline eGFR. At baseline, 5195 matched pairs of empagliflozin or DPP4i initiators had a mean age of 60 Y, mean eGFR of 93 mL/min/1.73 m2 and were followed for a median of 35.2 months. Number of events for composite kidney outcomes was 172 (11.0 events per 1000 patient-years [PY]) in the empagliflozin group and 215 (13.7 events per 1000 PY) in the DPP4i group, HR 0.79 (95% CI 0.65-0.97; p=0.02) . Similar trends were observed for composite of ≥40% sustained eGFR decline or ESKD. Comparing all SGLT2 to DPP4i initiators (n= 6477, median FU time 37.6 months) number of events was 2 (9.9 events per 1000 PY) for SGLT2i and 266 (13.0 events per 1000 PY) in DPP4i, HR 0.77 (95% CI 0.64-0.92) .
In conclusion the benefits of empagliflozin and any SGLT2 inhibitors on kidney function are observed in T2DM patients with low cardiorenal risk. The finding supports use of empagliflozin independent of glycemic control in low cardiorenal T2DM patients.

Disclosure
M.Schechter: None. C.Melzer cohen: None. A.Rozenberg: None. I.Yanuv: None. G.Chodick: None. O.Mosenzon: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, BOL Pharma, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; AstraZeneca, Bayer AG, Eli Lilly and Company, Novo Nordisk, Sanofi. A.Karasik: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Vifor Pharma Management Ltd., Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S.

Funding
Boeheringer Ingelheim
872-P: Cardiovascular Benefits of Novel Diabetes Drugs by Baseline Cardiovascular Risk: A Meta-Regression Analysis of 17 Randomized Trials
Authors: RODRIGUEZ-VALADEZ JOSE M. , HUNINK MYRIAM , MASHARANI UMESH , YEBOAH JOSEPH , PARK MEYEON , LI LIHUA , WEBER ELLERIE , LI YAN , BERKALIEVA ASEM , MAX WENDY , FLEISCHMANN KIRSTEN , FERKET BART 
Published: May 2022

Background: Prior meta-analyses suggest that the relative cardiovascular (CV) risk reduction by sodium glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) is larger in established CV disease. We investigated heterogeneity of treatment benefits along the continuum of CV risk.
Methods: We performed meta-regression analyses of CV outcome trials (9 on SGLT2i, 8 on GLP-1RAs) using log hazard ratios and CV mortality rates in the control group as proxy for baseline risk and background treatment profile of trial populations. We evaluated effects for all-cause mortality, major adverse cardiovascular events (MACE) , and heart failure. We computed absolute risk difference (ARD) in 5-year CV mortality for each trial and studied its relationship with baseline risk.
Results: We did not find statistically significant associations between baseline risk and log hazard ratios for any outcome (slope range -.to .21; p&gt;.10) . The ARD for 5-year CV mortality increased significantly with higher baseline risk for SGLT2i, to a predicted 2.78% in high risk (Figure) . For GLP1-RA trials, this relationship was not significant likely due to less variation in baseline risk.
Conclusion: Absolute, but not relative, CV benefits of novel diabetes drugs depend on baseline risk, which is important in guiding treatment decisions based on risk stratification.

Disclosure
J.M.Rodriguez-valadez: None. W.Max: None. K.Fleischmann: None. B.Ferket: None. M.Hunink: None. U.Masharani: Advisory Panel; Ryse Health, Research Support; Clementia Pharmaceuticals. J.Yeboah: None. M.Park: Advisory Panel; Otsuka America Pharmaceutical, Inc., Reata Pharmaceuticals, Inc., Other Relationship; Merck & Co., Inc. L.Li: None. E.Weber: None. Y.Li: None. A.Berkalieva: None.

Funding
Research reported in this abstract was supported by the National Heart, Lung, And Blood Institute (NHLBI) of the National Institutes of Health under award number: R01HL153456. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
88-OR: Discordance between Glucose Management Indicator (GMI) and A1C in Well-Controlled Type 1 Diabetes (T1D) and Nondiabetic Population
Authors: SHAH VIRAL , VIGERS TIMOTHY B. , PYLE LAURA , DUBOSE STEPHANIE , CALHOUN PETER , BERGENSTAL RICHARD M. 
Published: May 2022

Glucose management indicator (GMI) was developed using a linear regression formula to estimate A1C from mean glucose. The study population that was used to develop and validate GMI had a mean A1C of 7.3 ± 0.8%. Therefore, we hypothesize that GMI may overestimate A1C in those with A1C &lt;6.5%. Non-pregnant adults (≥18 years) with T1D for ≥2 years and using Dexcom G6 for ≥6 months from Barbara Davis Center for Diabetes (n=93, 40.6 ± 12.6 years, female 58.4%, A1C 5.9 ± 0.4%) and subjects from “Glucose Sensor Profile in Healthy Non-diabetic Subjects” study (N=153, 31.2± 21.0 years, female 66.0%, A1C 5.1 ± 0.3%) were included. All participants used Dexcom G6 continuous glucose monitor (CGM) . Up to days (healthy participants) and 15 days (T1D patients) of CGM data was compared with laboratory A1C. Discordance in GMI and A1C is presented by A1C &lt;5.7% (healthy participants) and A1C between 5.7-6.4% (T1D patients) . The degree of discordance between GMI and A1C was higher in those with A1C&lt;6.5% compared to original GMI development cohort [Figure 1A]. The differences between A1C and GMI were largely negative in both A1C categories (A1C &lt;5.7% and A1C of 5.7-6.4%) . On average, GMI was 0.59% higher in the A1C &lt; 5.7% group and 0.49% higher in the A1C 5.7 - 6.4% group (both p &lt; 0.0001) [Figure 1B and 1C]. The current GMI formula may overestimate A1C and may need to be re-assessed for those with A1C &lt;6.5%.

Disclosure
V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. T.B.Vigers: None. L.Pyle: None. S.Dubose: None. P.Calhoun: None. R.M.Bergenstal: Advisory Panel; Hygieia, Medtronic, Roche Diabetes Care, Zealand Pharma A/S, Consultant; Abbott Diabetes, Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Onduo LLC, Sanofi, United HealthCare Services, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi.
889-P: Cost and Length of Stay for Department of Defense Hospitalizations Attributed to COVID-for Adults with Diabetes
Authors: MENDEZ CARLOS E. , DISMUKE CLARA , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: May 2022

Healthcare costs in 2020 increased 9.7% from the prior year reaching $4.1 trillion dollars. This increase is considered largely due to the COVID-pandemic. Since adults with diabetes were at increased risk of poor outcomes from COVID-19, the objective of this study was to investigate cost and length of stay for Department of Defense (DoD) hospitalizations attributed to COVID-for adults with diabetes. Data on hospitalizations within military facilities between 2020-2021 for patients with diabetes were investigated. 6,265 hospitalizations occurred at DoD facilities, of which 7.2% (n=458) were attributed to COVID-19. Generalized linear models using a gamma distribution for total cost and Poisson distribution for length of stay were run to investigate outcomes adjusting for age, sex, race/ethnicity, active duty status, service category (Army, Coast Guard, Marine, Air Force, or Navy) , and comorbidity count. In adults with diabetes hospitalized at military facilities, those with COVID-cost over $8,500 more than those without COVID- (8792.98, 95%CI 5850.38,11735.57) after adjustment. There were no significant differences by sex or race/ethnicity, however, active duty hospitalizations cost on average $2,200 more than not active duty (2239.26, 95%CI 738.72,3739.81) . Length of stay was over 2 days longer for COVID-hospitalizations (2.20, 95%CI 1.98,2.42) after adjustment. There were no differences by sex, however African Americans and Asian/Pacific Islanders had slightly longer lengths of stay (AA: 0.37, 95%CI 0.26,0.48; A/PI: 0.26, 95%CI 0.05,0.46) , as did those on active duty (0.24, 95%CI 0.08,0.40) . Total costs for hospitalizations attributed to COVID-were higher and length of stay longer for adults with diabetes at military facilities. Further work is needed to understand long term consequences of COVID-on cost and utilization for adults with diabetes.

Disclosure
C.E.Mendez: Advisory Panel; Monarch Medical Technologies . C.Dismuke: None. R.J.Walker: None. L.E.Egede: None.

Funding
American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede) , the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)
89-LB: COVID-19 Outcomes in Patients Who Started GLP1-RAs during Hospitalization
Authors: PROVENZANO VINCENZO , BRANCATO DAVIDE , FLERES MATTIA , PROVENZANO FRANCESCA , SALVAGGIO ANNA R. , SCORSONE ALESSANDRO 
Published: May 2022

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been hypothesized to exert beneficial effects on COVID-19 outcomes due to their anti-inflammatory properties. In our COVID-19 ward, patients admitted for severe interstitial bilateral pneumonia due to SARS-COV2 infection and having type 2 diabetes (T2D) or in-hospital hyperglycemia (IHH) were treated with GLP-1 RAs in addition to standard therapy according to usual care. Aim of the present study was to evaluate if GLP-1 RAs therapy was related with outcomes. A retrospective analysis was performed to assess if the GLP1-RAs were associated with a lower risk of a composite outcome (death or admission to intensive care unit) . During the COVID-19 pandemics, 135 patients were admitted (61.5% men, age 66.3±13.7 years, 49.6% with T2D and 50.4% with IHH) , of whom 23.1% initiated GLP1-RA during the hospitalization (39.1% of patients with T2D and 7.6% of patients with IHH) . Almost all patients were treated with once-weekly subcutaneous semaglutide, while dulaglutide was administered in 2 cases. Overall, 26.3% of patients not treated vs. 7.1% of patients treated with GLP1-RAs reached the composite outcome (p=0.03) . At multivariate analysis adjusted for age, gender, T2D, history of cardio/cerebrovascular disease, hypertension, pulmonary disease, and dementia, the use of GLP-1 RAs was associated with a reduced risk of composite outcome of 80% (OR 0.20; 95% confidence intervals 0.04-0.95) . Dementia resulted the only other independent correlate of the outcome. These preliminary results suggest that the addition of GLP1-RAs to standard care during hospitalization for SARS-CoV2 infection could play a role in improving clinical outcomes in patients with COVID-19 and T2D or IHH: at the best of our knowledge this is the first study showing such an effect when GLP1-RAs were started during hospitalization.

Disclosure
V. Provenzano: Board Member; Lilly Diabetes, Novo Nordisk, Consultant; AstraZeneca. D. Brancato: None. M. Fleres: None. F. Provenzano: None. A. R. Salvaggio: None. A. Scorsone: None.
896-P: Dapagliflozin Cost Offsets in Chronic Kidney Disease for Commercial U.S. Payers
Authors: CHANG RAYMOND , HUANG JOANNA , RECK DAN , HURST JAMIE , KHACHATOURIAN KAT WOLF , SHANNON MICHAEL H. 
Published: May 2022

One in 7 adults have chronic kidney disease (CKD) , which is associated with high mortality and costly healthcare resource utilization (HCRU) . Data from a US employer-sponsored health insurance plan show rising per-member-per-year costs for treatment of cardiac and renal complications associated with CKD. A cost-offset model (COM) was deployed to quantify the predicted clinical and economic benefits of treatment with dapagliflozin. The COM used real-world cost and member count data from a US employer-sponsored commercial payer and the phase 3 DAPA-CKD (NCT03036150) clinical trial event rates for outcomes, including ≥ 50% decline in estimated glomerular filtration rate (eGFR) , end-stage kidney disease (ESKD) , and hospitalization for heart failure (HHF) . HCRU cost-offsets were calculated over a 3-year time horizon in a population of 130 members with CKD stages 2-4 who were modeled for treatment with either dapagliflozin plus standard of care (SOC) or SOC alone. Over a 3-year period, 9 instances of ≥ 50% decline in eGFR were estimated for treatment with dapagliflozin versus (vs.) 15 with SOC (6 fewer events; number needed to treat [NNT]: 20) , amounting to estimated cumulative cost-offsets of $0.57 million (M) . Similarly, 6 ESKD events were avoided with dapagliflozin vs. SOC (8 vs. 14; NNT: 24) , resulting in $1.92 M in cumulative cost-offsets. Dapagliflozin use also avoided 20 HHF events compared with SOC (13 vs. 33; NNT: 7) , totaling $0.79 M in cumulative cost-offsets. Overall, better clinical outcomes translated into total cumulative HCRU cost-offsets of $3.89 M (36.6% reduction in favor of dapagliflozin + SOC vs. treatment with SOC alone) . Results of our COM estimate that dapagliflozin greatly decreases HCRU costs in plan members with CKD by reducing cardiac and renal clinical events over a 3-year period. Modeling these outcomes for members with CKD with and without type 2 diabetes demonstrates that dapagliflozin can be a cost-effective way to reduce HCRU costs associated with CKD for commercial payers.

Disclosure
R.Chang: Employee; AstraZeneca, UnitedHealth Group. J.Huang: Employee; AstraZeneca. D.Reck: None. J.Hurst: Employee; AstraZeneca. K.Wolf khachatourian: Consultant; Bayer AG, Xcenda. M.H.Shannon: Consultant; Bayer AG, Speaker's Bureau; Bayer AG, Novo Nordisk A/S.

Funding
AstraZeneca
897-P: Use of In-Person and E-Consults for Type 2 Diabetes in an Academic Primary Care Network
Authors: COLLING CAITLIN A. , WASFY JASON H. , WEXLER DEBORAH J. 
Published: May 2022

Objective: Electronic consults (e-consults) are asynchronous clinician-to-clinician communications within an electronic health record (EHR) . We compared characteristics of patients for whom electronic versus in-person consults for type 2 diabetes (T2D) were ordered in an academic primary care network.
Methods: E-consult and in-person consults ordered for T2D between January 1 and December 31, 20by primary care providers who ordered both referral types were included. Patient characteristics were extracted from an EHR repository. E-consult content was reviewed by a physician. Characteristics of e-consults and in-person consults were compared with chi-squared tests and t-tests.
Results: E-consults accounted for 48.4% of consults (156 of 322) . Compared with in-person consult patients, e-consult patients were older (62.1±14.1 vs. 56.7±13.9 years, p&lt;0.001) , more likely to be prescribed a sulfonylurea (37.8% vs. 23.5%, p=0.009) , and less likely to be prescribed insulin (42.3% vs. 54.2%, p=0.033) . There were no differences in sex, self-reported race/ethnicity, or the prevalence of coronary artery disease (22.4% vs. 24.1%, p=0.779) , heart failure (10.9% vs. 8.4%, p=0.575) , or chronic kidney disease (25.6% vs. 17.5%, p=0.099) in electronic and in-person consult patients. In-person consult patients had a higher hemoglobin A1c (9.3±1.7% vs. 8.8±2.0%, p=0.032) . Nearly all e-consult referrals asked for guidance on medication selection (96%) with a significant number requesting advice on newer medications (SGLT2i: 21%; GLP-1 RA: 27%) . Completed e-consults often provided guidance and education on use, cardiorenal benefits, and/or side effects of newer medications (SGLT2i: 28%; GLP-1 RA: 47%) .
Conclusions: In-person and e-consult patients had similar baseline characteristics and cardiovascular comorbidities. E-consults were often used to inquire and to educate about newer diabetes medications. E-consults hold promise as a method to disseminate new endocrine knowledge.

Disclosure
C.A.Colling: None. J.H.Wasfy: Consultant; Pfizer Inc. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate.

Funding
NIH T32 DK007028
898-P: Impact of Switching to a High-Deductible Health Plan on Patients’ Out-of-Pocket Expenditures for Glucose-Lowering Drugs
Authors: JIANG DAVID H. , HERRIN JEPH , VAN HOUTEN HOLLY , MCCOY ROZALINA G. 
Published: May 2022

High deductible health plans (HDHPs) have become increasingly common as a means of increasing access to health insurance while curbing total utilization. However, high out-of-pocket (OOP) expenditures faced by HDHP enrollees may disincentivize high value care, particularly for people with chronic but costly health conditions like diabetes. Glucose-lowering drugs are a large part of direct costs of diabetes management and contribute to cost-related non-adherence, burden of treatment, and poor health outcomes. We examined the changes in OOP expenses for a 30-day supply of each class of glucose-lowering drugs among 43,900 adults with diabetes included in OptumLabs® Data Warehouse between 20 and 2018 who switched from non-HDHPs to HDHPs, compared to 333,803 adults who did not switch. The mean OOP expenses, standardized to 20$US, were higher for HDHP beneficiaries (Table) . Switching to a HDHP significantly increased OOP expenditures for all glucose-lowering classes, ranging from 5% increase (sulfonylurea) to 48% increase (glitazone) . This increased expense for patients may hinder adherence and adversely impact glycemic management and health outcomes among HDHP enrollees. Clinicians should be aware that HDHP enrollees may be more sensitive to OOP costs when choosing medications, and policy makers should exempt evidence-based prescription drugs from high deductibles.

Disclosure
D.H.Jiang: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. H.Van houten: None. R.G.Mccoy: Consultant; Emmi.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases grant number K23DK114497
899-P: Current Patterns of Change in Medication Spending and Use for People with Type 2 Diabetes in a Commercially Insured Population
Authors: COOK DAVID J. , DEFAIL ANTHONY , THOMPSON NELS , PEDERSON DEREK 
Published: May 2022

Background: Understanding the total cost of care (TCoC) specific to type-2 diabetes (T2D) is challenging. Diabetes is a driver of multiple chronic medical conditions, each with a constellation of costs. As such, medication trends specific to T2D may help inform assessment of population health and care management.
Methods: For a population of 7,361 commercially insured persons (≥18 years old) enrolled in a virtual care accountable care organization (Level2) , we examined de-identified administrative claims in a research database for T2D medications from 12/1/2019-11/30/2021. We determined the TCoC for this population, as well as changes in spending and utilization by medication class.
Results: Among individuals enrolled in Level2, spending for T2D medications constituted 31.2% of the total spend over the period studied. Spending and utilization changes are summarized in Table 1.
Conclusion: T2D care is rapidly evolving; ongoing changes in cost and utilization are dramatic. For organizations in risk arrangements, following and projecting medication spend in T2D is a critical exercise, as is driving the guideline-directed use of these agents. There is a need for greater specificity in T2D medication guidelines that considers cost-effectiveness and tailors treatment choice to the specific patient risk.

Disclosure
D.J.Cook: None. A.Defail: Employee; Level2. N.Thompson: Employee; Level2. D.Pederson: Employee; Level2.