bluuebunny/crossref_metadata_2025_split huggingface dataset:
9-OR: ADA Presidents' Select Abstract: m6A mRNA Methylation Regulates the Innate Immune Response in Human Beta Cells
Authors: DE JESUS DARIO F. , ZHANG ZIJIE , BROWN NATALIE K. , BASILE GIORGIO , XIAO LING , KAHRAMAN SEVIM , MATHEWS CLAYTON E. , POWERS ALVIN C. , ATKINSON MARK A. , EIZIRIK DECIO L. , KULKARNI ROHIT 
Published: May 2022

Innate immunity is directly associated with Type 1 diabetes (T1D) . Recently, N6-methyladenosine (m6A) has been shown to modulate human β-cell biology and innate immunity. Here, we focused on the contribution of m6A in modulating T1D development. RNA-seq. in β-cells revealed downregulation of the m6A writers (Mettl3, Mettl14, and Wtap) in pre-diabetic NOD mice. Consistently, pancreases from female NOD mice and human T1D showed downregulation of METTL3 protein levels in insulin-positive cells as the disease progressed. m6A-sequencing in human T1D versus control islets and intersection with differentially expressed genes (DEGs) in T1D β-cells from a single-cell RNA seq. dataset, revealed enriched pathways associated with ER function, T1D, and apoptosis. Pro-inflammatory cytokines are directly linked to β-cell autoimmunity and are considered a useful tool to study T1D onset. We applied m6A-sequencing in cytokine-treated human islet preparations, and in parallel studies, treated EndoC-βH1 cells with cytokines followed by RNA-sequencing. Intersection of m6A-decorated and common DEGs in human islets and EndoC-βH1 cells revealed enrichment in pathways associated with the innate immune response. METTL3 silencing in EndoC-βH1 impacted several innate immune mediators upon cytokine challenge. Incubation of human islets from multiple donors with ER-stress inducers, ROS donors, NO donors, and ROS or NO scavengers revealed that pre-existing ER stress and ROS decrease METTL3, while physiological levels of NO upregulate METTL3. We conclude that ROS drives METTL3 downregulation associated with T1D. Exploring therapeutic relevance by AAV-8 mediated gene delivery showed that β-cell specific upregulation of Mettl3 leads to a decrease in hyperglycemia during early stages of T1D in female NOD mice. Together, these results demonstrate a novel layer of regulation in human β-cells in the context of T1D and point to targeting METTL3 as a therapeutic approach to promote β-cell survival and improve glycemia.

Disclosure
D.F.De jesus: n/a. D.L.Eizirik: None. R.Kulkarni: Advisory Panel; Biomea, Novo Nordisk, REDD Pharma, Consultant; Relay Therapeutics, Research Support; Inversago, SerPlus. Z.Zhang: Research Support; SinoVac. N.K.Brown: None. G.Basile: None. L.Xiao: None. S.Kahraman: Employee; Boehringer Ingelheim International GmbH. C.E.Mathews: None. A.C.Powers: None. M.A.Atkinson: None.

Funding
American Diabetes Association (7-21-PDF-140) ; R01 DK067536R01 DK103215R01 DK117639
906-P: Lost Workdays from Treating Type 2 Diabetes–Related Complications in Hong Kong: A Population-Based Cohort Study
Authors: KWOK HARLEY H.Y. , NG CARMEN , QUAN JIANCHAO 
Published: May 2022

To estimate the lost workdays associated with type 2 diabetes and related complications in Hong Kong in 2017 and inform productivity loss and indirect costs. Using population-representative data of 540,370 people with type 2 diabetes managed in the public sector, we fitted a negative binomial regression model to investigate the association of diabetes complications on length of stay. Model fit was assessed by Akaike information criterion. A total of 4.28 million workdays (mean 7.93, 95% CI 7.88-7.97) was lost in 2017. Table 1 shows the regression coefficients: interpreted as the expected log (length of stay) increase for each one-unit increase in the corresponding variable. For example, the adjusted length of stay for 60-year male without any complication is 6.82 days (95% CI 5.52-8.43) . Hemodialysis contributed to the longest length of stay, followed by renal failure, skin ulcer, amputation, heart failure, cerebrovascular disease, atrial fibrillation, neuropathy, peripheral vascular disease, cataract, myocardial infarction, retinopathy, and ischemic heart disease. Enrolment in the multidisciplinary Risk Assessment and Management Programme was associated with reduced length of stay. This lost workday analysis helps to inform the indirect costs of diabetes in terms of lost productivity, and is essential for estimating the total economic loss from diabetes.

Disclosure
H.Kwok: None. C.Ng: None. J.Quan: None.

Funding
Research Grants Council of the Hong Kong SAR, China [27112518].
913-P: The Relationship between ASK12 Patient-Reported Medication Adherence Scores and Objective Measures of Adherence among Patients with Type 2 Diabetes
Authors: PAWLOSKI PAMALA , ZIEGENFUSS JEANETTE , O'CONNOR PATRICK J. , DEHMER STEVEN P. , EKSTROM HEIDI , HAAPALA JACOB , SPERL-HILLEN JOANN M. , BECKER MARY , TRUITT ANJALI , PANKONIN MELISSA , REHRAUER DANIEL , FRAIL CAITLIN , ANDERSON JEFFREY , CHUMBA LILIAN 
Published: May 2022

Background: Medication adherence may be measured either by (a) patient-reported measurement or (b) objective measurement using medication dispense data. Proportion of days covered (PDC) is an objective measure of adherence becoming more readily available in the electronic health record (EHR) and a threshold of &lt; 80% is commonly used to identify a potential adherence problem. Using PDCs may be more efficient and clinically practical than using longer patient-reported adherence questionnaires. However, it is unknown how well the PDC and patient reported measures correlate.
Methods: As part of a pragmatic randomized trial to evaluate an intervention designed to improve medication adherence in a Midwest health care system, 1,423 adults with type 2 diabetes (T2D) were identified at an index visit in primary care based on suboptimal diabetes control (AIC &gt;8%) and at least one oral diabetes medication with PDC &lt; 80%. They were surveyed shortly after the index visit to assess adherence using a validated 12 question ASK-12 instrument, with a response rate of 29% (80/280) . We evaluated the relationship between PDC and ASK-12 total/subscale scores using linear regression.
Results: There were no significant associations found between PDC scores and the total ASK-12 score (β=-0.4, p=0.47) , or ASK-12 subscales of inconvenience/forgetfulness (β=-1.1, p=0.42) , treatment beliefs (β=-0.4, p=0.77) , behavior (β=-0.7, p=0.55) , or barriers (β=-0.7, p=0.44) .
Conclusions: For patients above recommended A1C goal with a medication PDC &lt; 80%, there was no correlation between PDC scores and patient-reported measures of adherence using ASK-12 total or component scores. This analysis raises questions about the validity and usefulness of EHR-derived PDC scores to identify poor medication adherence for patients with T2D.

Disclosure
P.Pawloski: None. M.Pankonin: None. D.Rehrauer: None. C.Frail: None. J.Anderson: None. L.Chumba: None. J.Ziegenfuss: None. P.J.O'connor: None. S.P.Dehmer: None. H.Ekstrom: None. J.Haapala: None. J.M.Sperl-hillen: None. M.Becker: None. A.Truitt: None.

Funding
NHLBI #R01HL136937
915-P: Annual Wellness Visits and Preventive Care Utilization among Medicare Beneficiaries in the Diabetes Belt and Surrounding Areas
Authors: SOHN MIN-WOONG , MCMURRY TIMOTHY L. , KANG HYOJUNG , KIM SOYOUN , LOBO JENNIFER M. 
Published: May 2022

Objective: Medicare beneficiaries are eligible to receive free Annual Wellness Visits (AWVs) for assessing preventive care needs, identifying care resources, and scheduling visits. We previously reported that AWVs are associated with increased use of preventive care for patients with diabetes. In this study, our objective is to conduct a case-control study to examine whether AWVs are associated more strongly with preventive care use in the Diabetes Belt than in surrounding areas.
Methods: We used a sample of ∼900,000 Medicare Fee-for-Service beneficiaries who lived in the Diabetes Belt and surrounding areas in 2014 - 2015. We identified patients who have used an annual foot exam, eye exam, A1c test, and microalbuminuria (MA) test and those who did not in 2015. We used the dates of service receipt and the last day of the year (12/31) as the event date for users and non-users, respectively. We looked one full year before the event date to identify any AWVs. We used propensity-score stratification to estimate log odds of 4 preventive care use of annual foot exam, eye exam, A1c test, and MA test.
Results: For all four services, AWV users had significantly higher preventive care use compared to non-users. In 3 preventive services, AWVs were more strongly associated with preventive care use in the Belt than in the surrounding areas (foot exam, ORs = 2.38 vs 2.16, p &lt; 0.001; A1c test, ORs = 1.44 vs. 1.36, p = 0.002; MA test, ORs = 1.70 vs. 1.44, p &lt; 0.001; eye exam, ORs 1.22 vs. 1.19, p=0.063) .
Discussion: AWVs appear to have stronger effects on preventive care use for patients with diabetes in the more healthcare resource-poor Diabetes Belt than in the surrounding areas. AWVs may help to reduce disparities in the use of recommended preventive care for patients with diabetes.

Disclosure
M.Sohn: None. T.L.Mcmurry: None. H.Kang: None. S.Kim: None. J.M.Lobo: n/a.

Funding
NIDDK R01DK113295
917-P: Race/Ethnic Disparities in Insulin and Sulfonylurea Use in Older Patients with Type 2 Diabetes
Authors: ABDELGADIR DANA , BOARD CHRISTINE , RANATUNGA DILRINI K. , GRANT RICHARD W. 
Published: May 2022

Background: Risk of severe hypoglycemia increases markedly with age in type 2 diabetes (T2D) . For many older patients, discussion of safe de-prescribing strategies is indicated to reduce iatrogenic overtreatment. We examined differences in insulin and sulfonylurea (SU) prescription prevalence among older adults (age ≥ 75 years) by race/ethnicity. Because race/ethnic disparities among Black patients have been attributed to doctor-patient communication barriers, we tested the hypothesis that older Black patients were more likely to be prescribed medicines that can induce severe hypoglycemia.
Methods: We studied 18,149 adults (≥75 years) with T2D and a last measured HbA1c ≤ 8.0% between 2019-2021 in Kaiser Permanente Northern California. Electronic health records were used to identify prescription of insulin, SUs, or both. Medication treatment prevalence was stratified by race/ethnicity (Non-Latino White [NLW], Black, Latino, Asian, Other) and compared using chi-square tests.
Results: Mean age was 80.5 (±4.8) years; 54% were women; mean HbA1c was 6.9% (±0.7%) , with 42% prescribed insulin, 72% prescribed SUs and 13% prescribed both. Elderly Black and NLW patients had a higher insulin prevalence (both at 45%, p&lt;0.001) , while Asians had the lowest (31%, p=&lt;0.001) . Conversely, Blacks had the lowest SU prevalence (66%, p&lt;0.001) , and Asians had the highest (79%, p&lt;0.001) . A similar pattern was observed in patients with the tightest HbA1c control (&lt; 7.0%; n=8,794) : Black patients had the highest insulin (39%, p&lt;0.001) and lowest SU prevalence (69% p&lt;0.001) , while Asians had the lowest insulin (26%, p&lt;0.001) and highest SU prevalence (81%, p&lt;0.001) .
Conclusion We found significant variation in use of high-risk medicines by race/ethnicity. Older Black patients had higher insulin use while older Asian patients had the highest SU use. Efforts to promote safe de-prescribing practices in older adults may need to be tailored to the unique physiologic and cultural needs of different patient groups.

Disclosure
D.Abdelgadir: None. C.Board: None. D.K.Ranatunga: None. R.W.Grant: None.

Funding
National Institute on Aging (R01AG068133-S1)
918-P: Improved Glycemic Control from a Remote Patient Monitoring Program across Primary Care Practices Integrating Home Monitoring, Mobile Health, Nutrition/Lifestyle Coaching, and Telemedicine For Diabetes Management
Authors: WANG LI , XU HANG , LIU ZHIYU , WONG NATHAN D. 
Published: May 2022

Objective: There is interest in current care delivery models for diabetes (DM) management that utilize mobile technologies as a new standard, especially during and following the COVID-pandemic. The objective of this study was to examine the impact of a digital health program (iHealth Unified Care model) which integrates remote patient monitoring (RPM) and nutrition/lifestyle coaching in primary care settings for patients with DM.
Methods: Primary care physicians (PCPs) across primary care practices enrolled patients with DM into the iHealth Unified Care program during 2019-2021. Bluetooth connected devices with a mobile app were provided to monitor blood glucose and other vital signs . PCPs and their supervised care team including registered dietitians and certified diabetes educators provided the initial assessment and nutrition consultations to set up personalized treatment and behavioral goals. PCPs' care team had regular follow up visits with the patients every 3-6 months virtually and provided vitals monitoring and dietary coaching on a daily basis via the iHealth Unified Care platform which connects the patient's mobile app, bluetooth devices, and data analytics engine in real-time.
Results: 691 patients with DM (66 ± years old, 47% female) were enrolled in the program and stayed ≥3months. Compared to the baseline, the HbA1c decreased from 7.35% ± 1.75 (Mean,SD) , to 6.77% ± 1.17 at 3 months (n=691, P&lt;0.01) and 6.78% ± 1.at 6 months (n=262, P&lt;0.01) . The average HbA1C reduction was 0.57 (CI:0.48-0.67) after 3months. The HbA1c poor control (≥9%) rate was 17.2% at baseline, 5.6% at 3 months and 4.2% at 6 months.
Conclusions:The iHealth Unified Care model significantly improved the glycemic control of patients with DM after 3 months and 6 months compared to baseline. Randomized control trials are needed to further confirm the long-term effectiveness.

Disclosure
L.Wang: Employee; iHealth Labs, Inc. H.Xu: Employee; iHealth Labs. Z.Liu: Employee; iHealthlabs Inc. N.D.Wong: Consultant; I Health, Research Support; Amarin Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk.
919-P: Trends in Glycemic Control during the COVID-Pandemic in a Large Academic Health Care System
Authors: UMPIERREZ GUILLERMO E. , ADIGA ANIL , WYLDE BJAY , GURTU MONICA , GALINDO RODOLFO J. , THOMPSON TINAANN , MASI CHRISTOPHER M. , CASTELLANO PENNY A. , TURTON FREDERICK E. 
Published: May 2022

The Emory Diabetes Management Program is a chronic care management model aimed to reduce the proportion (%) of adult patients with HbA1c &gt;9% within the Emory Healthcare System. We report the proportion of patients with poor glycemic control (HbA1c &gt;9% or missing values for 6 months) before and during the Covid-pandemic, from 02/01/18 to 10/30/2021.Among 27,061 patients with diabetes before COVID-pandemic, the % of patients with poor glycemic control decreased from 19.5% to 14.35% in 12/2019. During the COVID-pandemic, the % of patients with poor control rapidly increase to 21.70% (Fig 1A) by 2/1/21, primarily due to a 275% increased of patients with missing HbA1c testing and a minor increase in % of patients with HbA1c &gt;9% (Fig 1B) . Expansion of telemedicine programs, access to care and resource implementation to identify and facilitate HbA1c testing reduced the % of patients with poor control to pre-pandemic levels. Conclusion: At a population-health level, COVID-pandemic had a significant negative impact in % of patients with poor control primarily due to HbA1c testing (3-fold increase) rather than worsening A1c values. Innovative solutions to increase access to A1C testing in future pandemics may help to maintain undisrupted glucose monitoring and control in individuals with diabetes in large academic health systems.

Disclosure
G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. A.Adiga: None. B.Wylde: None. M.Gurtu: None. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. T.Thompson: None. C.M.Masi: None. P.A.Castellano: None. F.E.Turton: None.
920-P: Factors Associated with Weight Loss in the National Diabetes Prevention Program (National DPP)
Authors: NG BOON PENG , ELY ELIZABETH , SMITH BRYCE , CANNON MICHAEL 
Published: May 2022

CDC’s National DPP aims to make the lifestyle change program (LCP) available to an estimated 88 million US adults who have prediabetes. Since 2015, CDC’s Diabetes Prevention Recognition Program (DPRP) has recognized four delivery modes: in-person, online (i.e., asynchronous delivery) , distance-learning (DL) (i.e., synchronous delivery) , and combination. To evaluate factors associated with weight loss, we analyzed data collected under the DPRP from 1/1/2012-12/31/20for those who attended at least two sessions with reported weight and physical activity (PA) minutes. Of the study population, 135,496 were associated with in-person delivery organizations, 214,239 with online, 3,553 with DL, and 11,3with combination. The majority of participants were female (across delivery modes: 73.2-80.4%) . Over half of participants were 45-64 years (52.9-59.5%) ; for in-person and online, 29.1% and 4.0%, respectively, were 65+ years. Participants were racially/ethnically diverse (Hispanic: 7.9-31.7%; non-Hispanic Black (NHB) : 10.5-15.4%; other non-White: 11.0-25.2%) . Of in-person, online, DL, and combination participants, 50.6%, 35.5%, 50.2%, and 40.9%, respectively, met the 150 mins/week PA goal for their last PA entry, while 36.2%, 20.2%, 33.2%, and 19.3%, respectively, met the 5% weight loss goal. In general, the 5% weight loss goal was met by higher proportions of participants who were male than female (e.g., in-person, 40.6% vs. 35.2%) , older than younger (e.g., in-person, 42.6% for 65+ years vs. 28.4% for 18-44 years) , non-Hispanic White (NHW) than other race/ethnicities (e.g., in-person, 41.5% for NHW vs. 28.0% for Hispanic and 27.3% for NHB; except for DL with 42.4% for Hispanic vs. 34.3% for NHW) , and met the 150 PA goal (e.g., in-person, 44.1% for PA ≥ 150 mins/week vs. 29.3% for 60 ≤ PA &lt;150 mins/week) . These results show promise for reducing risk of developing type 2 diabetes through the LCP, but also identify opportunities for improved program implementation.

Disclosure
B.Ng: None. E.Ely: None. B.Smith: None. M.Cannon: None.
922-P: Pilot of a Strategy to Sustain A1C Improvement among Diverse Adults with Type 2 Diabetes (T2DM) Completing a Diabetes Management Program (DMP)
Authors: MAGEE MICHELLE F. , NASSAR CARINE M. , BOURGES CLAYTON J. , MONTERO ALEX R. 
Published: May 2022

Strategies are needed to maintain outcomes following DMPs. We examined the impact of a sustaining strategy (SS) on A1C among T2DM completers of a 3-mos diabetes education and medications management program. From 3/2019-7/2021, DMP completers (Medicare or system insured) enrolled in a 9-mos sustaining strategy (SS) . Mos 1-3 offered remote monitoring calls for Hi &gt;350/Lo &lt;80mg/dL blood glucose (BG) alerts, and Mos 1-9 monthly diabetes check-in calls with BG review by a medical assistant who also addressed supplies/drug needs and self-care behaviors. Escalation to a nurse practitioner occurred for BG trends &gt;200/&lt; 80mg/dL or A1C &gt; 9.0%. Reports were sent to PCPs. A1Cs were compared for DMP-alone versus DMP-plus SS. Summary statistics used frequency with percentage for categorical variables and mean with standard deviation for continuous variables. Bivariate analyses utilized the Student T test. Pre-post A1C was available for 620 completers and 175 joined the SS. Mean age was 56.2±11.9 yrs; 58.1% female; 66% Black; 25.9% Medicare, 26.6% Medicaid, & 42.4% private insured. Serial A1C outcomes by group are shown.Adults with previously uncontrolled type 2 diabetes who completed a diabetes management program and who participated in a 9-mos sustaining strategy maintained their A1C under 8% when compared to those who did not participate in the follow-up program.

Disclosure
M.F.Magee: None. C.M.Nassar: None. C.J.Bourges: None. A.R.Montero: None.
932-P: Impact of Carbohydrate-Restricted Nutrition Therapy Delivered via Continuous Remote Care on Prevalence of Glycemic Target Achievement and Type 2 Diabetes Remission among Veterans: A Nationwide, Real-World Study
Authors: MCKENZIE AMY L. , VANTIEGHEM MICHELLE , FELL BRANDON , RATNER ROBERT E. 
Published: May 2022

About one in four Veterans lives with type 2 diabetes (T2D) , and nationwide, only 50% of Veterans meet the ADA glycemic target of A1c &lt;7%. In a pilot program, the Veterans Health Administration partnered with Virta Health to deliver carbohydrate restricted nutrition therapy via a continuous remote care model to Veterans with T2D prescribed at least one diabetes medication other than metformin. This retrospective, real-world, descriptive study assessed the proportion of Veterans who met glycemic targets using laboratory and prescription data from medical records. Veterans retained in the treatment at least two years at time of analysis were included (n=254, 58.5% of 434 eligible enrolled, 60±8 years, 12% female, 50% above HEDIS target) . A greater percentage of Veterans met glycemic targets defined by AACE (A1c ≤ 6.5%) , ADA (A1c &lt; 7%) , and HEDIS (A1c &lt; 8%) following one and two years of treatment compared to enrollment (Table 1) . About two thirds of Veterans with A1c ≤6.5% achieved this with no medication or only metformin. Further, 6.7% and 4.5% achieved the 2021 consensus definition of remission at one and two years, respectively. These findings suggest this nutrition therapy and care model may be a useful tool to improve population health among Veterans with respect to glycemic targets.

Disclosure
A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. M.Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.Fell: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.E.Ratner: Employee; Virta Health Corp.
938-P: Implementation of Psychosocial Screening in the Type 1 Diabetes Exchange Quality Improvement (T1DX-QI) Network
Authors: CORATHERS SARAH , OSPELT EMMA L. , ROMPICHERLA SAKETH , PRAHALAD PRIYA , ROBERTS ALISSA J. , MUÑOZ CYNTHIA E. , BASINA MARINA , SMITH LAURA B. , WILLIFORD DESIREÉ N. , KICHLER JESSICA C. , EBEKOZIEN OSAGIE 
Published: May 2022

T1DX-QI is a network of over 40 pediatric and adult centers that share best practices to improve outcomes for people with T1D. Guidelines for comprehensive diabetes care recommend integration of psychosocial screening; however, variable resources and clinical structures influence the degree to which practices can implement these recommendations.
A 22-item survey was administered to T1DX-QI sites in 2021 (n= 25 pediatric and 8 adult) . Data from items relevant to psychosocial screening were analyzed with Rstudio. Fisher tests were used to compare the percentage of psychosocial domains assessed by pediatric vs. adult clinics.
Overall, 96% of pediatric centers report using at least one screening tool, 79% report &gt; 2; 43% of adult centers use one or more screening tools. The most common psychosocial domain in both settings is depression; pediatric (96%) , adult (38%) (Figure) . Screening for social determinants of health and diabetes-related distress were reported in both settings, and unique to pediatric is assessment of readiness to transition to adult care.
Varying degrees of psychosocial screening is present in the T1DX-QI network. Centers endorse benefits, as well as common challenges, including time constraints, integration into workflow, and how best to follow up responses. T1DX-QI sites are working together to overcome barriers that contribute to gaps between guidelines and practice.

Disclosure
S.Corathers: None. J.C.Kichler: None. O.Ebekozien: None. E.L.Ospelt: None. S.Rompicherla: None. P.Prahalad: None. A.J.Roberts: None. C.E.Muñoz: None. M.Basina: None. L.B.Smith: None. D.N.Williford: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust