bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP199 Full Implementation of Automated Self-Adjusting Subcutaneous Insulin Algorithm
Authors: Mehta Paras , Kohn Michael , Rov-Ikpah Esther , Luis Craig San , Johnson Craig , Rushakoff Robert 
Published: November 2022

Abstract

Background
- We programmed a self-adjusting subcutaneous insulin algorithm (SQIA) in the electronic medical record for patients who are NPO, on total parenteral nutrition (TPN), or on continuous tube feedings (CTF). The SQIA only requires a nurse to enter a patient's current glucose value and then calculates the next insulin dose based on previous dose, and current and previous glucoses. The SQIA titrates for a goal glucose of 120 -180 mg/dL. The advantage of this automated algorithm is that no new orders are required, even if insulin is added to TPN or tube feeding rate is changed. We previously reported results of a pilot study with 67% of blood glucoses in the 80-180 mg/dL range without any hypoglycemia (glucose &lt; 60 mg/dL).

Hypothesis
- Following the successful pilot, the SQIA was instituted in September 2020 at our institution's three adult hospitals. We hypothesized that glucose control with the SQIA will be non-inferior to previous inpatient glycemic management and successfully maintain blood glucoses in the goal range.

Methods
- The SQIA was implemented on September 3, 2020 for patients who were NPO, on TPN, or on CTF. Any clinician placing insulin orders could select the SQIA as an alternate to ordering standard fixed aspart dosing or a sliding scale at four-hour intervals. We performed a prospective analysis on all patients managed with the SQIA during the first year of implementation (9/3/2020–9/2/2021) to evaluate use of the SQIA and resulting glycemic control. Results were compared to patients during the preceding one-year period (9/3/2019-9/2/2020) who were ordered for standard subcutaneous insulin aspart dosing while being NPO, on TPN, or on CTF.

Results
During the study period, the SQIA was utilized during 2691 time intervals within 1774 hospitalizations. The average duration for each interval was 56.4 hours and glucoses were checked every 3.9 hours while on the SQIA. Average point-of-care blood glucose while on SQIA was 157.5 ± 52.6 mg/dL. In a similar set of 1987 hospitalized patients in the preceding year who were on standard subcutaneous insulin orders, the average blood glucose was 159.4 ± 55.1 mg/dL.

Conclusions
- A self-adjusting SQIA effectively maintained glucose within the goal inpatient range during our first year of implementation and was non-inferior to prior glycemic control using standard dosing protocols. The SQIA provided an avenue for effective glycemic control while eliminating the need for insulin dosage titration by clinicians. Hospitals and health systems should consider pursuing similar innovations to improve the ease of inpatient glycemic control while continuing to meet glycemic targets.
Presentation: No date and time listed
ODP227 Nivolumab Induced Type 1 Diabetes
Authors: Lim Jonea , O’neal Katherine , Henderson Jeffrey , Skaggs Joanne 
Published: November 2022

Abstract

Introduction
Nivolumab is a treatment option used for renal cell carcinoma (RCC). It is reported to have high response rate to renal cancer cells with rare adverse events to the endocrine system including type 1 diabetes mellitus (DM1). Our case reports the use of nivolumab and ipilimumab in a patient with RCC with timeline of hyperglycemia following initiation of the regimen.

Clinical Case
A 71-year-old woman with RCC metastasized to the lungs experienced adverse effects leading discontinued sunitinib therapy. Her imaging showed increased pulmonary nodules with tumor extension into left superior and inferior pulmonary veins. Therapy with Ipilimumab 56 mg plus nivolumab 169 mg initiated shortly. Pre-treatment labs were within normal limits. Labs remained within normal limits (plasma glucose 82 mg/dL) before second treatment. Less than a week following 2 nd treatment, she presented with generalized rash and was sent to the emergency room (ER). She was treated with one dose IV and a course of PO steroids for total 5 days. Infusions were put on hold. Despite rash resolving, she continued to have low-grade fever (99.1°F). She also reported 10 lbs. weight loss and polydipsia. Three weeks follow-up lab noted plasma glucose level of 559 mg/dL. She was instructed to go to the ER. ER labs: HbA1c: 9.1%,, plasma glucose 525 mg/dL, B-hydroxybutyrate 10.47 mmol/L; UA 3+ glucose; 2+ ketones. She met criteria for diabetes ketoacidosis (DKA). She was admitted, started and later discharged on insulin therapy with referral to see outpatient diabetes providers. Labs obtained during outpatient follow up include: C-peptide 0.3 ng/ml & paired plasma glucose of 246 mg/dl. Nivolumab monotherapy re-initiated later. With insulin therapy, HbA1c improved with most recent HbA1c at 7.7%. Clinical Lesson: There is evidence of anti-PD-1-monoclonal-antibody-induced diabetes mellitus throughreduced activity of PD-1 which is common to both traditional onset type 1 diabetes or antiPD-1 therapy-related diabetes. PD-1 reduction may cause inappropriate activation of T cells causing autoimmune response against pancreatic beta cells. Clotman et al reports 42 cases of PD-1 inhibitor–induced DM1. Half of tested case subjects (22/39 or 56%) had detectable diabetes-related autoantibodies; however, no clear pattern of diabetes-related autoantibodies. Additionally, median interval from immunotherapy initiation to diagnosis of diabetes was 5 weeks in GADA-positive subjects vs 9 weeks in GADA negative subjects. Li Zhang et al reports 735 cases of immune checkpoint inhibitors (ICI) DM: 25% presented fulminant DM1; 45% presented in DKA. Of these, 25% had severe case and 5.5% resulted in deaths. Because immunotherapy use will continue to increase, raising awareness of ICI DM induced by anti–PD-1 therapy is essential. Although incident is rare, missing or delaying diagnosis can not only significantly impact a patient's life but be potentially life-threatening.
Presentation: No date and time listed
ODP228 Obesity Induced a Down-Regulation of nNOS in Intrapancreatic Nervous System
Authors: Huang Zhihui , Wang Yiqiao , Chen Meiling , Sha Prof Lei 
Published: November 2022

Abstract

Objective
Obesity has become a serious global public health problem. Obesity is frequently preceding and the most important risk factor of type 2 diabetes. Pancreas regulates glucose metabolism and glucose homeostasis, and abnormality of pancreas play an important role in insulin resistance and diabetes. Intrapancreatic nerve innervation modulates insulin release and is tightly linked to the onset and development of diabetes. However, it is not known whether the activity of the intrapancreatic nervous system has been altered before the onset of diabetes. In this study, we examined the intrapancreatic nervous system in rats with obesity looking for the changes induced by obesity.

Methods
Obese Sprague-Dawley rats were developed with feeding high fat diet for 10 weeks. Using Immunofluorescence method, choline acetyl transferase (ChAT) and nNOS positive neurons in intrapancreatic ganglia were counted. ChAT and nNOS expression in pancreas were also measured with western blot method.

Results
(1) There was no significant difference in fasting blood glucose between obese rats and normal rats, but oral glucose tolerance test showed that the oral glucose tolerance was impaired in obese rats. (2) In rats fed with normal diet, 80.2%±1.5 neurons in intrapancreatic ganglia were ChAT positive, and in the obese rats, 79.3%±1.8 neurons were ChAT positive. There was no significant difference between the two groups (p&gt;0. 05, n=5). In intrapancreatic ganglia of obese rats, 40%±1.4 neurons were nNOS positive, which was significantly lower than that (60.5%±1.2) of rats fed with normal diet (p&lt;0. 01,n=5). (3) In pancreatic tissue, the relative expression level of ChAT protein was 1. 02±0. 03 in rats fed with normal diet and 0.98±0. 05 in obese rats (p&gt;0. 05, n=5). The relative expression level of nNOS protein was 1.70±0. 08 in normal rats and 1.10±0. 05 in obese rats (p&gt;0. 01, n=5).

Conclusion
The cholinergic nerves in intrapancreatic nervous system was not altered in obese rats, however, nNOS nerves was down-regulated in obese rats. The down-regulation of nNOS would induce a hyperactivity in intrapancreatic nervous system and this would cause an enhancement of insulin release, which has been observed in obese individuals.
Presentation: No date and time listed
ODP245 Syndrome of Diabetic Ketoalkalosis due to Severe Hypercortisolemia: A Case Series
Authors: Uwaifo Gabriel , Varughese Amy G 
Published: November 2022

Abstract

Introduction
Decompensated diabetes (DM) precoma/comas states are major causes of hospital morbidity and mortality. These commonly include diabetic ketoacidosis (DKA), diabetic hyperglycemic hyperosmolar syndrome (DHHS), diabetic hypoglycemia coma (DHC) and diabetic lactic acidosis (DLA). Another less common decompensated DM precoma/coma state to be aware of is Diabetic ketoalkalosis (DKAL). We present two cases of DKAL due to severe hypercortisolemia (HCS) from ectopic Cushing's syndrome (ECS). Clinical cases; Case 1 was a 61 yr old AA woman with suboptimally managed type 2 DM who had been admitted for DKA 2 months before. She had marked hyperglycemia (blood glucose &gt;500mg/dl) on repeated measures (RMs) and chronic diarrhea with tachypnea and altered mental status (AMS). She had heavy tobacco abuse and work up revealed a right lung mass biopsy of which showed a malignant neuroendocrine tumor presumed to be malignant bronchial carcinoid. Her initial lab tests showed marked metabolic alkalosis with severe hypokalemia and elevated anion gap, ketonemia and ketonuria. Presentation was typical of DKAL and subsequent work up showed ECS with serum cortisol &gt; 110 (n; 4.3-22.4ug/dl) on RMs and serum ACTH 377-480 (n; 0/46pg/ml). Her metabolic derangements were corrected and HCS managed with mild impact using ketaconazole and octreotide but she died within a month of admission with intractable septic shock despite parenteral antimicrobials. Case 2 was a 46 yr old Hispanic man with heavy tobacco abuse admitted on account of AMS, tachypnea and upper abdominal pain. He had severe hyperglycemia (blood glucose &gt;750mg/dl on RMs) though not known to have DM. HBA1c was &gt; 15% indicating undiagnosed DM. Initial lab tests showed marked respiratory and metabolic alkalosis, marked hyponatremia, hypokalemia, hypo-osmolality but with ketonemia and ketonuria. Presentation was consistent with DKAL. Work up showed a left lung lesion with pleural effusion shown to be small cell carcinoma of the lung. He was also found to have profound HCS (serum cortisol &gt;150ug/d; on RMs) confirmed due to ECS with serum ACTH, 1500-1800pg/ml. Metabolic derangements were corrected and he was started on ketoconazole and etomidate to correct HCS with little response. Elective bilateral adrenalectomy was planned but patient abruptly discharged himself AMA. He was readmitted ∼ 3 weeks later with a massive pulmonary embolism and acute respiratory failure from which he never recovered. He died ∼ 2 months later.

Discussion + Conclusions
DKAL is an uncommon but important potential acute presentation of decompensated DM. Early recognition and management requires close attention to the acid-base and electrolyte derangements that often accompany it. Among the many possible causes of DKAL severe HCS is an important possibility to be consider. Rapid diagnosis and institution of aggressive therapy of HCS is crucial as it often has high morbidity and mortality potential.
Presentation: No date and time listed
ODP249 The Effects of Rice From Starch-removing Rice Cooker on Postprandial Glucose And Insulin Levels in Healthy Adults: A Randomized, Double-blind, Crossover Study
Authors: Bhekasuta Apanaree , Siriwan Chonpiti 
Published: November 2022

Abstract

Background
The starch-removing rice cooker (SRR) is an innovative kitchen appliance which uses multiple water drainage techniques passing the rice to reduce starch from rice. Many manufacturers claimed their success in starch reduction from the rice. We hypothesized that the rice from SRR cooker might have a lower postprandial glucose than normal rice cooker.

Objective
To assess acute glycemic and insulin responses after ingesting rice from SRR versus normal rice cooker in healthy adults.

Material and Methods
We conducted a first pilot randomized crossover study to compare the postprandial glucose and insulin levels between rice from SRR versus normal rice cooker in healthy adults. This randomized crossover study was done in healthy volunteers aged 18 years and older. The participants were instructed to ingest 150 grams of rice which were randomly assigned to ingest rice from SRR or rice from normal rice cooker. Plasma glucose and insulin measurements were taken at 30, 60 and 120 minutes. After 1 week, the participants were cross over to another rice and plasma glucose and insulin levels were obtained as the same. The other metabolic parameters, satisfaction score and fullness were recorded to compare between SRR and normal rice.

Results
Plasma glucose at 30 minutes was significantly lower in the SRR group compared with the control group (120.45 ± 14.48 vs 137.27 ± 22.21; p &lt;0. 05). And Likewise, Plasma glucose at 60 minutes was also significantly lower in the SRR group compared with the control group (110.82 ± 18. 08, 122.64 ± 21. 08; p &lt;0. 05). However, There is no statistically significant difference in insulin and triglyceride levels between the SRR and control groups. Furthermore, there was no significant difference in appetite survey between SRR and control groups.

Conclusion
Lower post prandial glucose has been observed in rice from SRR compared with normal rice in healthy volunteers Keyword: starch-removing rice cooker, Type 2 diabetes, rice consumption, postprandial glucose
Presentation: No date and time listed
ODP250 The Role of Urine Renal Injury Markers in Obese Children and Adolescents with Diabetes Mellitus
Authors: Bae Ahn Moon , Suh Jin-Soon , Cho Kyoung Soon 
Published: November 2022

Abstract

Backgrounds
Diabetic children especially who are obese lead to poor glycemic control thus are at higher risk for early microvascular complications. Renal tubulointerstitial markers play integral role in the evaluation of diabetic nephropathy and various biomarkers have been proposed. Yet, their role in obese pediatric population is uncertain. The aim of this study is to investigate renal injury markers in children with diabetes mellitus (DM) in relation with obesity and determine their role for early predictor of diabetic complications.

Methods
Fifty-three children and adolescents diagnosed with either type 1 or 2 DM and 44 controls aged 7-18 years were included. Clinical and laboratory characteristics including renal injury markers among subjects were compared with respective to body mass index (BMI), presence and type of DM.

Results
Urine neutrophil gelatinase associated lipocalin and kidney injury molecule-1 were lower whereas beta-2 microglobulin and n-acetylglucosamine (NAG) concentrations were higher in controls compared to diabetic children. None of renal injury markers showed significant difference between normoweight and obese children. In multiple regression analyses, urine NAG was associated with HbA1c and the presence of DM while high homeostatic model assessment of insulin resistance was identified as a risk factor of for increased urine NAG in type 2 diabetic children.

Conclusion
Urine NAG could be a marker associated not only with diabetic nephropathy, but also with insulin resistance regardless of BMI.
Presentation: No date and time listed
ODP260 New Type of Autoimmune Diabetes
Authors: Kumar Surina , Sargis Robert , Syed Uzma 
Published: November 2022

Abstract
Immune checkpoint inhibitors (ICIs) are an emerging therapy that has revolutionized the management of certain cancers. Data on long-term side effects of these drugs are now showing a risk for development of new endocrinopathies. In this case report, a patient with new Type I diabetes (DMI) is discussed. The patient is a 67 year old male with past medical history of metastatic renal cell carcinoma with multiple recurrences of disease. A brief review of the patient's oncologic history revealed multiple surgeries, including complete nephrectomy, multiple drugs, including ICIs, and radiation therapy. Over the course of his treatment, he received Nivolumab (anti-PD1 agent) for 5 cycles with HbA1c increased from 5.4% to 6.9% from pre-treatment to post-treatment, but the HbA1c improved to 5.8% one year after drug cessation. Later he was started on Pembrolizumab (anti-PD1) and has had 10 cycles of therapy to date. Random blood glucose frequently exceeded 200 after start of pembrolizumab therapy. Ipilimumab (anti CTLA-4) was started in combination with pembrolizumab six months later, but it was held after the second cycle due to development of diabetes with HbA1c of 11.1%. He was also found to have persistent, severe hyperglycemia noted during routine bloodwork. Autoimmune DM was confirmed with a positive glutamic acid decarboxylase antibody (GAD65) of 8 nmol/L. Consequently, the patient had multiple hospital admissions for glucose exceeding 400. His condition was exacerbated by the fact that he had difficulty coming to terms with his diagnosis, and he was noncompliant with medication. At that time, the patient stated that he had not done anything wrong and did not understand why this had happened to him. He was resistant to starting therapy and had difficulty understanding insulin dosing, blood glucose monitoring, and the consequences of hyperglycemia/hypoglycemia. After extensive education during a 2 week hospitalization, the patient was eventually place on an appropriate dose of basal-bolus insulin therapy and is currently doing well. It is important to note some emerging challenges to treating this new population of patients with DM1 due to ICI therapy. Firstly, many patients in this scenario live alone and have poor support systems. They have difficulty learning new technology (glucometer, insulin pen, etc.) and self adjusting medication (sliding scale). Older patients can also be more resistance to change in diet and lifestyle. They may have pre-existing insulin resistance that makes initial insulin dosage difficult. Finally, noncompliance is dangerous due to risk of hypoglycemia, diabetic ketoacidosis, and exacerbation of other comorbidities. Clinicians should also consider the patient's psychosocial ability to understand and manage this condition.
Presentation: No date and time listed
ODP565 Success of CME at Improving Knowledge and Confidence Related to CGM Use in Patients with T2D
Authors: LaCouture Michael , Larkin Amy , Le Anne 
Published: November 2022

Abstract

Introduction
We sought to determine if an online continuing medical education (CME) activity could improve knowledge and competence of diabetologists/endocrinologists (D/Es) and primary care physicians (PCPs) related to interpreting and applying ambulatory glucose profile (AGP) data to patient management regimens for type 2 diabetes (T2D).

Methods
Education design included a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. The activity launched May 11, 2021, and data were collected through August 12, 2021.

Results
Matched learner data indicate that overall, 29% D/Es learners’ responses and 36% of PCPs learners’ responses improved from pre-to-post.

Conclusions
This study demonstrates the success of interactive, case-based, online CME on improving competence and confidence of D/Es and PCPs, related to interpretation and application of AGP data. Case-based education with interactive polling questions and detailed explanations related to best choices should be employed more often to help clinicians apply knowledge/data into practice to improve patient management and care.
Presentation: No date and time listed
ODP567 Success of CME at Improving Knowledge and Confidence Related to Hyperglycemia Associated with Cushing Disease and Acromegaly
Authors: Carothers Ann , Larkin Amy , Maeglin John 
Published: November 2022

Abstract

Introduction
We sought to determine if an online continuing medical education (CME) activity could improve knowledge and confidence of primary care physicians (PCPs) and endocrinologists (endos) related to hyperglycemia associated with cushing disease (CD) and acromegaly.

Methods
The effect of an online, 30-minute, CME-certified roundtable discussion among 3 faculty was analyzed to determine efficacy. The activity posted April 29, 2021, and data were collected through July 7, 2021.

Results
Overall, 51% of PCP learners and 55% of endo learners improved their knowledge.

Conclusions
This study demonstrates the success of an online, 30-minute roundtable discussion on improving knowledge and confidence regarding hyperglycemia associated with CD or acromegaly, with gaps identified for future education.
Presentation: No date and time listed
ODP620 A Cross-over Trial Using Insulin Glargine And Neutral Protamine Hagedorn Insulin For The Poorly Controlled Patients With Type 2 Diabetes Who Refused Multiple Daily Insulin Injections
Authors: Odhaib Samih Abed , Alibrahim Nassar Taha Y , Ayad Alidrisi Haider , Mansour Abbas Ali 
Published: November 2022

Abstract

A Cross-Over Trial Using Insulin Glargine and Neutral Protamine Hagedorn insulin for the Poorly Controlled Patients with Type 2 Diabetes Who Refused Multiple Daily Insulin Injections Background: Data in the literature describing the comparison between Neutral Protamine Insulin of Hagedorn (NPH) and glargine insulins are conflicting. While some studies revealed the superiority of Glargine, others had shown comparable results and even NPH superiority figures. We have many patients on NPH basal therapy in our clinical practice and another good number on Glargine. We did observe adverse effects in both groups, but local data and real numbers comparing both regimens are lacking.

Objective
To compare basal insulin regimen using NPH or Glargine in efficacy, hypoglycaemic events, and weight gain. Design and setting: A prospective interventional crossover study was conducted in Faiha Specialized Diabetes, Endocrine and Metabolism Center from 2018 through 2021, involving patients less than 65 years old with uncontrolled Type 2 Diabetes Mellitus whose HbA1c &gt;10% on oral antidiabetic drugs (OAD); randomized into two groups (G1 & G2), 70 patients in each group had completed the study, one group received NPH and the other received Glargine in addition to their OAD for one year, then they were crossed over for another one year after a period of washout.

Results
The mean age was 48.9±5.5 and 45.9±4.1 years for G1 and G2, respectively. 36(51.4%) in G1 were women versus 27(38.6%) in G2. In the first phase of the study, HbA1c reduction was 5.5±1.1% for the NPH group and 5.3±1.1% for the Glargine group (p=0.418), there was 1.7±2.7 versus 1.1±2.9 Kg weight gain (p=0.209), 27(39.7%) hypoglycemic event versus 26(37.7%) (p=0.883) and 5 patients(7.4%) achieved HbA1c &lt;7% versus 8(11.6%) (p=0.397) for the patients in NPH and Glargine groups respectively. While in the crossover phase, the data comparing Glargine and NPH groups are as following: 0.6±0.8 versus 0.5±0.9% reduction in HbA1c (p=0.413), 1.7±3.1 versus 0.6±2.2 Kg weight loss (p=0. 035) although the final weight was not much different 77.3±12. 0 versus 77.7±11.5 (p=0.841), 16(27.1%) versus 23(36.5%) hypoglycemic events (p=0.493) and 17(29.8%) versus 11(17.7%) achieved HbA1c&lt;7% (p=0.121) respectively.

Conclusion
In our study, there was no significant difference in HbA1c reduction, Hypoglycemic events, and weight gain between patients using NPH or Glargine basal insulin regimen. Keywords: Diabetes; Glargine; NPH.
Presentation: No date and time listed