bluuebunny/crossref_metadata_2025_split huggingface dataset:
905-P: Simulation Model Estimating Lifetime Health and Economic Outcomes of Prediabetes Screening by One-Hour Plasma Glucose
Authors: ANDELLINI MARTINA , MANCO MELANIA , ESPOSITO MARIA TERESA , TOZZI ALBERTO EUGENIO , BERGMAN MICHAEL , RITROVATO MATTEO 
Published: May 2022

Background: One of the current methods to diagnose prediabetes and predict diabetes incidence is based on 2-h plasma glucose (2-hPG) value following 75-g oral glucose tolerance test. Evidence demonstrates that 1-hour post-load plasma glucose (1-hPG) ≥ 155 mg/dl (8.6 mmol/L) in those with normal glucose tolerance at 2-hPG is highly predictive for T2D incidence. We conducted a health economic analysis to estimate long-term cost-effectiveness of using 1-hPG as compared to 2-hPG to screen and assess diabetes risk.
Methods: The main outcome of the study was cost per quality-adjusted life-year (QALY) gained. We used a Monte Carlo-based Markov simulation model to simulate long-term effects of the two screening strategies on clinical and cost-effectiveness outcomes. The base case model included 20.000 simulated patients over 35-years. Transition probabilities were retrieved from landmark studies. Direct medical costs were sourced from the literature and inflated to 20Euros.
Results: In the lifetime analysis, 1-hPG was projected to increase the number of years free from disease (2yr/patient) ; to delay the onset of T2D (1yr/patient) ; to reduce the incidence of T2D complications (0.6 Relative Risk/patient) and to increase the QALY gained (0.58/patient) . Though testing the 1-hPG resulted in higher initial costs owing to a larger number of preventive treatments, long-term diabetes and complications costs were reduced leading to -31,225,719.82€ saving over a lifetime as compared to 2-hPG. The incremental cost-effectiveness ratio was -8,214.7€ per each QALY gained for the overall population.
Conclusions: Screening prediabetes by using 1h-PG is feasible and cost-effective resulting in QALYs gained and reduced costs. Notwithstanding the higher initial costs of 1-hPG compared to 2-hPG, due to the incremental number of preventive treatments, long-term diabetes and complications costs were reduced expecting an overall cost saving of -8,214.7€ per each QALY gained.

Disclosure
M.Andellini: None. M.Manco: None. M.Esposito: None. A.Tozzi: None. M.Bergman: None. M.Ritrovato: None.
907-P: Michigan Collaborative for Type 2 Diabetes: Mixed Methods Change Readiness Assessment of Provider Organizations and Clinical Champions
Authors: RAU JACQUELINE , REISS JACOB , OSHMAN LAUREN , DIEZ HEIDI L. , AIKENS JAMES E. , RICHARDSON CAROLINE R. 
Published: May 2022

Optimal glycemic control and avoiding cardiovascular, renal, and metabolic complications are important treatment goals in Type 2 Diabetes (T2D) . The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide collaborative quality initiative launched in 2021 and supported by Blue Cross Blue Shield of Michigan. A total of 27 physician organizations (POs) enrolled 238 primary care practices along with collaborating specialists across the state with the goal of improving T2D care. MCT2D has identified optimizing use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) , low carbohydrate diets (LCD) , and continuous glucose monitoring (CGM) as initial quality initiatives. We conducted a mixed methods study of POs and practices to understand factors that will influence successful implementation.
We conducted qualitative interviews with leaders from all 27 POs using the Consolidated Framework for Implementation Research (CFIR) to assess anticipated barriers and needs. We then surveyed clinical champions at each participating practice on confidence for implementing these initiatives. Of the 238 practices, 202 consented to de-identified use of their responses.
Qualitative results identified common barriers: patient activation, motivation, and engagement; clinician engagement and change fatigue; busy physician schedules; clinician education needs; lack of resources; access to dieticians for LCD counseling; access to diabetes education; cost of GLP1-RAs and SGLT2is; CGM insurance coverage limitations; and impact to risk sharing contracts. The percentage of clinical champions who responded as moderately, mostly or very confident that their practice could increase use were, 88.1% for GLP1-RAs and SGLT2is, 86.1% for CGMs, and 89.6% for LCDs. Several practical barriers will need to be addressed to successfully implement MCT2D’s initial quality initiatives.

Disclosure
J.Rau: None. J.Reiss: n/a. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Johnson & Johnson, Lilly, Merck & Co., Inc., Procter & Gamble. H.L.Diez: None. J.E.Aikens: None. C.R.Richardson: n/a.
923-P: Benefits of Electronic Consultations (E-Consults) in Improving Diabetes Care within a Safety-Net Health System
Authors: GUNAWAN FELONA , AJAZ SYED , MENEGHINI LUIGI , GUNASEKARAN UMA 
Published: May 2022

Timely access to diabetes specialty care is often limited by resources, especially within a safety-net health system serving a large under/un-insured and ethnically diverse patient population. Implementation of a diabetes electronic consultation (e-consult) service offers several potential benefits, including timely access to diabetes specialists’ input, improvement in patients’ glycemic control, decreased need for in-person referral or visit (a potential benefit to patients and providers) , and an opportunity to support primary care providers with targeted education. We performed a retrospective electronic medical record review of completed diabetes e-consults within a 3-year period (2018-2021) at a large safety-net health system in Dallas, TX to determine the effectiveness of e-consult service. A total of 277 e-consult encounters were completed for 266 patients (age 52.8±12 years, 65% female, 46% Hispanic, 56% Caucasian, 39% Black, 91% with type 2 diabetes) . The average specialist response time following an e-consult request was 2 days, with recommendations fully or partially implemented for 78% of the e-consults. For the 145 patients with reliable hemoglobin A1c (HgbA1c) data at baseline and within 6 months, the HgbA1c improved from an average of 10.1±2.1% to 9.3±1.8% (paired t-test, p=&lt;0.05) , with an average HgbA1c change of -0.7±1.8%. Only 51% of these patients were subsequently referred for in-person diabetes clinic visit. Moreover, review of the e-consults questions helped identify common knowledge gaps in diabetes care among the primary care providers, and led to the development of monthly educational webinar series for primary care providers.
In conclusion, implementation of diabetes e-consult service improved timely access to diabetes specialty care as well as patients’ glycemic control, and also created an educational opportunity to improve overall diabetes care within a large safety-net health system.

Disclosure
F.Gunawan: None. S.Ajaz: None. L.Meneghini: Employee; Sanofi. U.Gunasekaran: None.
929-P: Person-First Language in Diabetes and Obesity Scientific Publications: Are We Making Progress?
Authors: BIALONCZYK DAMIAN , DICKINSON JANE K , REECE JESSICA D. , KYLE THEODORE K. , NADGLOWSKI JOSEPH F. , JOHNSON KATIE , GARZA MATTHEW , PASH ELIZABETH , CHIQUETTE ELAINE , CLOSE KELLY L. 
Published: May 2022

Several professional societies endorse the use of person-first language (PFL) in communication involving people with diabetes or obesity. The purpose of this analysis was to determine the extent to which scholarly articles focusing on diabetes or obesity use PFL.
We reviewed existing guidelines and constructed separate lists of PFL and condition-first language (CFL) terms for diabetes and obesity (e.g., diabetic, obese) . Exact phrase searches were conducted using PubMed from 2011-2020 and resultant articles were categorized as PFL, CFL, or both. Journal-specific factors (e.g., scope, PFL policy) were extracted from a manual review of author guidelines.
The searches yielded 56048 scholarly articles for diabetes and 45584 for obesity. Among diabetes articles, 42.8% used PFL, 40.1% used CFL, and 17.2% contained both (p&lt;0.0PFL vs. CFL) . Among obesity articles, 0.5% used PFL, 99.3% used CFL, and 0.2% used both (p&lt;0.0PFL vs. CFL) . Use of PFL increased by 3.1% per year for diabetes articles, compared to 117.0% for obesity articles (p=0.002) . The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to years prior (p=0.970) . PFL was more likely to be used in diabetes articles published in a diabetes-focused journal (OR 1.66; p&lt;0.001) and in journals with a PFL policy (OR 2.97; p&lt;0.001) . Obesity articles were more likely to use PFL if published in a US journal (OR 2.34; p=0.002) and in journals after implementation of a PFL policy (OR 32.11; p&lt;0.001) . Obesity-focused journals were not more likely to use PFL than non-specialized journals (p=0.12) .
Although the use of person-first language in diabetes articles has increased over the past years, progress has slowed despite the recent publication of PFL guidelines. Fewer than 1% of obesity articles used person-first language, suggesting a widespread lack of recognition of the importance of PFL in obesity. The strongest predictor of the use of person-first language was if the article was published in a journal with a PFL policy.

Disclosure
D.Bialonczyk: Employee; Gelesis. K.L.Close: Other Relationship; Abbott, ADOCIA, Amarin Corporation, American Association of Clinical Endocrinologists, American Diabetes Association, American Medical Association, Ascensia Diabetes Care, Astellas Pharma Inc., AstraZeneca. J.Dickinson: Consultant; DiaNavi, Vivify. J.D.Reece: None. T.K.Kyle: Advisory Panel; Nutrisystem, Inc., Consultant; Gelesis, Johnson & Johnson. J.F.Nadglowski: Employee; Obesity Action Coalition. K.Johnson: None. M.Garza: None. E.Pash: Employee; Gelesis. E.Chiquette: Employee; Gelesis.
930-P: Care Management Practices for Diabetes and Other Chronic Conditions during COVID
Authors: PETERSON KEVIN A. , SOLBERG LEIF , CARLIN CAROLINE 
Published: May 2022

Background: Diabetes outcomes in primary care settings depend on specific care management processes (CMPs) provided by practices. CMPs have been tracked in Minnesota since 2017 using a practice survey that measures the presence of 1CMPs in primary care, including CMPs focused on patients with diabetes.
Method: Secondary data analysis of CMP data collected in 2017, 2019, and 2021, with a COVID supplement in 2021. The 2021 survey was conducted in February and March, between the peaks in COVID cases observed in Minnesota.
Results: Response rates for the three waves were 71%, 72% and 69%, respectively. Our analysis focuses on the 269/556 practices participating in all three waves. Overall prevalence of CMPs for this subset was not significantly different (p=0.069) than for practices that participated in only one or two waves. Among continuously participating practices, overall prevalence of CMPs increased significantly (p=0.005) in 2021. This increase was driven by CMPs focusing on chronic disease management (p=0.011) , patient self-management (p=0.013) , and development of care plans (p=0.004) . Diabetes-specific CMPs had the highest prevalence in all years relative to CMPs focused on cardiovascular disease, depression or asthma. Nearly 90% of respondent practices described moderate to extreme disruption in disease management practices during the pandemic peak. Prior to the pandemic in 2019, virtual visits (phone, video) comprised less than 20% of the total visits for almost all practices. During the 2020 peak, 29% of practices conducted 60% or more of their visits virtually, and an additional 50% of practices conducted 20%-59% of visits virtually. By early 2021, nearly all practices reported less than 40% of visits being conducted virtually.
Conclusions: Despite significant practice disruption due to the pandemic, primary care practices in Minnesota reported continued increase in CMPs supporting care for patients with diabetes and other chronic conditions.

Disclosure
K.A.Peterson: Board Member; Treatment. L.Solberg: None. C.Carlin: None.

Funding
National Institutes of Health R18DK110732
936-P: Improving Decision Making by Clinicians for Initiation of Insulin in Adults with Type 2 Diabetes Using Simple Python Program
Authors: LAKHANI OM J. 
Published: May 2022

Introduction: The initiation of insulin is significantly delayed in patients with type 2 diabetes. To facilitate primary care doctors for decision making we have written a simple computer program using Python.
Methods: The program incorporates evidence based recommendations for insulin initiation in insulin naive, outpatient, non-pregnant, adult participants with type 2 diabetes. The program modules answer three questions: 'Does your patient need insulin?’, 'Which insulin should you initiate ?' & 'What dose of insulin to initiate ?'
Ten clinicians volunteered for the study. The program was retrospectively deployed on the Electronic health record (EHR) data of 500 patients treated by the clinicians. The decision making regarding insulin initiation by the computer was compared with the decision made by the clinicians. The clinicians were then asked to use the program in the subsequent 500 eligible patients.
Results: When the computer program was deployed on the EHR data, we found insulin was initiated in 112 of 500 patients by the clinicians, while the computer recommended insulin initiation in 163 patients. There were no cases in which the clinician initiated insulin, and the computer recommended against it.
When used prospectively, the clinicians initiated insulin in 159 patients while the computer recommended insulin initiation in 164 patients. The clinicians made a manual override of the decision only in 5 patients. There was a 28% improvement in insulin initiation when the clinicians used the program. The improvement in insulin initiation using the computer program compared to the same prior to using the program was statistically significant. (p=0.037)
Conclusion: A simple python program can potentially improve insulin initiation by clinicians.

Disclosure
O.J.Lakhani: Advisory Panel; FITTERFLY, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk Global Business Services, Sanofi, Stock/Shareholder; Zydus Cadilla.
950-P: Point-of-Care Glucose Testing in the Preoperative Area prior to Surgery: Is It Useful?
Authors: AHMAD SUSHMA , EDMISTON KIRSTEN K. , GOOD BRITTANY , JEFFERY MICHELLE W. , CLOUGHERTY PATRICK W. , CLEMENT STEPHEN 
Published: May 2022

Background: Maintaining perioperative glycemic control is important for patients undergoing a surgical procedure to prevent postoperative complications.
Methods: The authors conducted a pilot project designed to detect and manage perioperative hyperglycemia in a women’s hospital in Virginia. Point of Care (POC) fasting blood glucose tests were performed on the day of surgery in high risk patients. Criteria for screening were: known diabetes, BMI &gt;30 and age &gt; 45. Patients with hyperglycemia were treated according to a protocol using a bolus of intravenous insulin and/or insulin infusion.
Results: Of the 1478 patients undergoing surgery, 1187 (80%) met criteria for POC glucose testing during the 12 week pilot. Forty-eight percent had fasting blood glucose values of either impaired glucose/prediabetes (100 mg/dL-125mg/dl) or higher (see figure) . Seven patients had a fasting glucose of &gt; 200 mg/dl and met criteria to receive insulin in the O.R. Six of these seven patients had known diabetes. A single patient with previously undiagnosed diabetes qualified for insulin therapy. In no circumstance was surgery delayed or cancelled due to hyperglycemia.
Conclusion: Screening for hyperglycemia in the preoperative area is a valuable tool for identifying patients who may benefit from intraoperative insulin therapy. The vast majority of patients who require rescue insulin therapy in the operating room have known diabetes.

Disclosure
S.Ahmad: None. K.K.Edmiston: None. B.Good: None. M.W.Jeffery: Other Relationship; Medtronic. P.W.Clougherty: None. S.Clement: Research Support; Novo Nordisk.

Funding
Division of Endocrinology, Medicine Service Line, Inova Health System
951-P: Racial and Ethnic Disparities in Diabetes Management, Hospitalization Risk, and Physical Health Status Associated with Cognitive Impairment among Older Adults with Diabetes
Authors: LI PIAOPIAO , ZHANG PING , TANG SHICHAO , GUO JINGCHUAN , BROWN JOSHUA D. , JIAO TIANZE , SHAO HUI 
Published: May 2022

Cognitive impairment (CI) is associated with adverse health outcomes, but little is known about whether this varies across different racial and ethnic subgroups. We compared health outcomes associated with CI across racial and ethnic groups among adults aged ≥ 60 years old with diabetes in the US. Adults with diabetes were identified from the 2011-2014 National Health and Nutrition Examination Survey based on self-report and HbA1c labs. Those with the cognitive score (measured by Cognitive Functioning Assessment scale) in the lowest quartile were defined as having CI. We used regression models to compare diabetes management (HbA1c, SBP, and BMI) ; hospitalization; and poor physical health associated with CI across racial and ethnic subgroups, adjusting for age, sex, complications, insurance, income, and education. Of 1465 (357 with CI) adults ≥60 years with diabetes, CI was associated with a higher SBP (adjusted difference (aDifference) : 5.91, 95% CI: 3.25-8.57) in non-Hispanic White individuals and non-Hispanic Black individuals (aDifference: 12.07, 95% CI: 4.94-19.2) . CI was not associated with an increase in Hispanic individuals (aDifference: 3.16, 95% CI: 1.52-4.57) and decrease in non-Hispanic Black individuals (aDifference: -1.79, 95% CI: -0.72,-3.11) . For hospitalization, CI was associated with an increase risk in non-Hispanic Black individuals (adjusted odds ratio (aOR) : 1.78, 95% CI: 1.11-2.37) and a decrease risk in Hispanic individuals (aOR: 0.63, 95% CI: 0.36-0.95) . CI was associated with an increase in the risk among non-Hispanic Black individuals (aOR: 1.83, 95% CI: 1.03-2.14) and Hispanic individuals (aOR: 2.91, 95% CI: 1.45-3.8) . The impact of CI on older adults with diabetes varied across racial and ethnic subgroups, with non-Hispanic Black and Hispanic adults experiencing mostly adverse health outcomes compared to non-Hispanic White individuals.

Disclosure
P.Li: None. P.Zhang: None. S.Tang: None. J.Guo: None. J.D.Brown: None. T.Jiao: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.
954-P: Barriers to Enrollment in a Continuous Glucose Monitoring Pilot Program for Medicaid Patients
Authors: CHEN WENJING , BLANCHETTE JULIA E. , MACWILLIAMS JESSICA , HATIPOGLU BETUL 
Published: May 2022

Background: CGM usage is associated with lower A1c and decreased diabetes-related hospitalizations and emergency room visits. However, there are still many barriers to accessing CGM, with the most prominent being cost and cumbersome insurance eligibility criteria. We aimed to explore and describe barriers to enrollment in a pilot CGM program for Ohio Medicaid patients.
Methods: Patients seen at a large academic medical center in the past year, a diabetes diagnosis and A1c &gt;8.5% were identified by Medicaid. The pilot CGM program removed the need for the common CGM coverage requirements of prior authorizations, multiple daily injections, and glucose logs. Patients had to use a mobile CGM application to participate. Patients were contacted via phone and agreeable participants saw a diabetes care and education specialist for CGM education and initiation and an ambulatory care pharmacist for follow-up. Baseline characteristics were obtained via chart review and data were analyzed using descriptive analyses.
Results: N=43 were contacted for enrollment (mean age 43.4±10.8 years; 88.4% female; 93.0% African American; mean A1c 10.2±2.0%; 58.1% on multiple daily injections) . In total, n=16 (37.2%) agreed to participate, n=17 (39.5%) were unable to be contacted, n=8 (18.6%) were already actively using CGM and n=2 (4.7%) declined to participate. Older age predicted agreeance to participate (β=0.350, p=.022) . Those who agreed to participate were more likely to see primary care over endocrinology for diabetes care X 2 (1, N=43) = .62, p=0.018. At one-month post-program enrollment, only n=2 (4.7%) patients successfully started CGM.
Discussion: Although over one-third of participants agreed to enroll in the CGM pilot, there was low CGM initiation. Removal of cost and insurance coverage requirements alone did not result in high CGM adoption. Patients were difficult to reach via phone and offering CGM initiation and education during primary care appointments may improve CGM access and utilization.

Disclosure
W.Chen: None. J.E.Blanchette: Advisory Panel; Cardinal Health, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Insulet Corporation, Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists. J.Macwilliams: None. B.Hatipoglu: None.
959-P: Improving Continuous Glucose Monitor Use: Success Strategies from the T1D Exchange Collaborative
Authors: MUNGMODE ANN , DEWIT EMILY L. , GREENFIELD MARGARET , ILKOWITZ JENIECE T. , ODUGBESAN ORI , DEI-TUTU SELORM A. , THOMAS SARAH , YEE CURTIS , EBEKOZIEN OSAGIE , MCNAMARA KIMBERLY , BYER-MENDOZA CHRISTINE , SCHMITT JESSICA 
Published: May 2022

Background: Continuous glucose monitors (CGMs) support patients with type 1 diabetes to maintain optimal glycemic targets and health outcomes. The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is a network of over forty endocrinology centers working to improve health outcomes by implementing QI science. We aim to demonstrate the use of QI methodology in expanding CGM use across seven T1DX-QI clinics.
Method: Clinics initiated iterative plan-do-study-act cycles to test changes and sustain improvements. Interventions included patient education and involvement through print or electronic materials, device troubleshooting, and data downloads. Sites enhanced clinic processes by optimizing paperwork requirements for new devices and standardizing a referral process for patients who faced body image challenges. Clinics shared monthly aggregate data with T1D Exchange coordinating center.
Results: All participating clinics were successful in improving CGM use. Cumulatively, CGM use increased from 66% to 71% over 14 months (Figure 1) . Clinic-level improvement ranged from 5% to 18%, with an average improvement of 9%.
Conclusion: Efficiently implemented QI science can support teams to improve patient health outcomes, including meaningful device access to support glycemic control in patients with type 1 diabetes.

Disclosure
A. Mungmode: None. E.L. DeWit: None. M. Greenfield: None. S.A. Dei-Tutu: None. S. Thomas: None. O. Ebekozien: None. K. McNamara: None. C. Byer-Mendoza: None. J. Schmitt: None.

Funding
Helmsley Charitable Trust