Diabetes最新文献

{"title":"1822-LB: Family Support for Diabetes Action (FAM-ACT) vs. Traditional Diabetes Management Education and Support—Randomized Comparative Effectiveness Trial","authors":"ANN-MARIE ROSLAND, GRETCHEN PIATT, EDITH C. KIEFFER, FELIX VALBUENA, GLORIA PALMISANO, DENISE J. DEVERTS, STEPHANIE PEREZ, JONATHAN YABES, CHRISTINA M. LALAMA, MICHELE HEISLER","doi":"10.2337/db24-1822-lb","DOIUrl":"https://doi.org/10.2337/db24-1822-lb","url":null,"abstract":"Introduction: Family support can be crucial to sustaining gains from diabetes self-management education/support (DSMES), especially for low SES Hispanic adults with diabetes (AWD). DSMES lacks structured approaches to engaging support persons (SP). Our objective was to determine the effectiveness of FAM-ACT, a DSMES program focused on AWD-SP dyads vs DSMES with individual AWD, both CHW-delivered and tailored to Hispanic AWD. Methods: Adult patients with T2D and A1C ≥7.5% at an FQHC serving a Hispanic population were enrolled with an adult SP; dyads were randomized to FAM-ACT or DSMES, then invited to 6 sessions over 6 months. Each FAM-ACT session included SP training on supporting AWD diabetes management. AWD A1C was measured at baseline, 6 and 12 months. The primary outcome was 6-month change in A1C, analyzed using linear mixed models. Results: Among 222 AWD-SP dyads enrolled, AWD were mean age 52 years (SD 10), 38% men, 82% preferred Spanish language, 39% had a high school degree or more. SPs were mean age 45 (SD 13), 47% were the AWD’s spouse/partner, 26% adult child, and 27% sibling/friend/other. AWD completed mean 3.8/6 sessions, and SP in FAM-ACT arm 2.7/6. In ITT analyses, A1C 6-month decline was greater in DSMES than FAM-ACT (-0.97% vs. -0.42%, p=0.06) but at 12 months, they were similar (DSMES -0.55%, FAM-ACT -0.65%, p=0.77). In Complier Average Causal Effect (CACE) analyses based on AWD and SP with at least average expected session attendance, FAM-ACT 6 month A1C decline was -1.32% vs DSMES -0.89%, p=0.59 and at 12 months FAM-ACT had sustained decline (-1.23% vs -0.47% DSMES, p=0.63). Conclusion: FAM-ACT was less effective at lowering 6-month A1C than traditional DSMES among low SES Hispanic adults, however FAM-ACT A1C continued to improve 6 months after the program ended while traditional DSMES gains regressed. When supporters engaged with patients in FAM-ACT, AWD had clinically significantly larger improvements that were sustained. Disclosure A. Rosland: None. G. Piatt: None. E.C. Kieffer: None. F. Valbuena: None. G. Palmisano: None. S. Perez: None. J. Yabes: Other Relationship; Bayer Inc. M. Heisler: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK116733)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"366-P: Mean Blood Glucose–Independent Racial Disparity in HbA1c and Higher Risk for Severe Hypoglycemia Is Evident among Participants in the Diabetes Control and Complications Trial","authors":"STUART CHALEW, ROBERT J. MCCARTER","doi":"10.2337/db24-366-p","DOIUrl":"https://doi.org/10.2337/db24-366-p","url":null,"abstract":"Introduction: HbA1c target levels are often used as a treatment goal for patients with diabetes. Many recent studies indicate that HbA1c overestimates mean blood glucose (MBG) among Non-Hispanic Black (NHB) patients compared to Non-Hispanic White (NHW). We hypothesized that this disparity could be associated with greater risk of hypoglycemia in NHB patients especially where management is primarily based on a treat to HbA1c target. To assess this possibility we analyzed multiyear repeated-measures data from the Diabetes Control and Complications Trial (DCCT). Methods: Publicly available DCCT data was analyzed using mixed effects general linear modeling to evaluate the differences in HbA1c vs MBG for NWB (n=29) and NHW (n=1391) patients accounting for within patient correlation of HbA1c as well as MBG across multiple assessments. The model also controlled for age, diabetes duration, visit year and quarter, body mass index, study group and stratum. as well as interactive and nonlinear effects. Risk for severe hypoglycemia by ethnicity was separately determined. Results: Over the course of the DCCT, NHB pts had higher HbA1c than NHW patients at any given level of MBG, with greatest difference at lower MBG levels (p=0.001). The difference between groups in HbA1c by MBG adjusted for covariables was 0.51 at MBG of 150 mg/dl (p<0.03) and 0.39 at MBG of 450 mg/dl (p=0.09) Severe hypoglycemia increased with decreasing HbA1c. Relative risk for severe hypoglycemia for NHB was 1.92 compared to NHW (p=0.02). Conclusions: Among patients in the DCCT, HbA1c overpredicted MBG among NHB and was associated with greater risk for severe hypoglycemia. Predominant reliance on target HbA1c for management of diabetes may contribute to higher risk for hypoglycemia among NHB patients. Disclosure S. Chalew: None. R.J. McCarter: None. Funding National Intitutes of Health (1R21DK118643-O1A1)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1904-LB: Glycemic Improvement with Use of the Omnipod 5 Automated Insulin Delivery System in Adults with Type 2 Diabetes—Results of the SECURE-T2D Pivotal Trial","authors":"FRANCISCO J. PASQUEL, GEORGIA M. DAVIS, DAVID M. HUFFMAN, ANNE L. PETERS, JOHN C. PARKER, LORI M. LAFFEL, JUSTIN MATHEW, KRISTIN N. CASTORINO, DAVIDA F. KRUGER, KATHLEEN M. DUNGAN, MARK KIPNES, EDWARD JAUCH, TAMARA OSER, VIRAL N. SHAH, BARRY HOROWITZ, ANDERS L. CARLSON, MARK L. WARREN, WASIM DEEB, JOHN B. BUSE, JOHN H. REED, JASON BERNER, THOMAS BLEVINS, CHRIS BAJAJ, CRAIG KOLLMAN, DAN RAGHINARU, TRANG T. LY, ROY W. BECK, THE SECURE-T2D STUDY CONSORTIUM","doi":"10.2337/db24-1904-lb","DOIUrl":"https://doi.org/10.2337/db24-1904-lb","url":null,"abstract":"Background: There is limited experience with automated insulin delivery (AID) in Type 2 Diabetes (T2D). Methods: We conducted a multicenter pivotal clinical trial to evaluate use of the Omnipod 5 AID System in a large diverse group of adults with T2D in the US. Adults aged 18-75y with T2D using insulin (basal-bolus, premix, or basal-only) who had screening HbA1c <12.0% were enrolled. Non-insulin agents were continued throughout. After a 14-day standard therapy phase to capture baseline glycemic management, participants initiated 13 weeks of AID. The primary endpoint was change in HbA1c from baseline to 13 weeks. Study completion occurred on March 1, 2024. Results: A total of 305 adults with T2D (mean age 57±11 years, 24% Black, 22% Hispanic/Latino) were enrolled in the study and initiated AID. Basal-bolus insulin delivery was being used by 79%, basal-only by 21%, GLP-1 receptor analogs by 55%, and SGLT1 or 2 inhibitors by 44%. Following 13 weeks of Omnipod 5 use, HbA1c decreased from 8.2±1.3% at baseline to 7.4±0.9% at study end (treatment effect= -0.8%, 95% CI: -1.0 to -0.7, p<0.001). The benefit of AID was greatest in those with the highest baseline HbA1c (Figure). Conclusion: These pivotal trial results demonstrate the substantial benefit of the Omnipod 5 AID System in a large diverse group of adults with T2D. Clinical trial registration: NCT05815342 Disclosure F.J. Pasquel: Research Support; Tandem Diabetes Care, Inc., Insulet Corporation, Dexcom, Inc., Ideal Medical Technologies, Novo Nordisk. Consultant; Dexcom, Inc., Medscape. G. Davis: Research Support; Insulet Corporation. Consultant; Medscape. A.L. Peters: Advisory Panel; Lilly Diabetes, Vertex Pharmaceuticals Incorporated, Medscape. Research Support; Abbott, Insulet Corporation. J.C. Parker: Speaker's Bureau; Novo Nordisk, Corcept Therapeutics, Insulet Corporation. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation. J. Mathew: None. K.N. Castorino: Research Support; Abbott, Dexcom, Inc. Speaker's Bureau; Dexcom, Inc. Research Support; Lilly Diabetes, Medtronic, MannKind Corporation, Insulet Corporation. Consultant; Medscape. D.F. Kruger: Advisory Panel; Abbott. Research Support; Beta Bionics, Inc., Carmot Therapeutics, Inc. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc., Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Advisory Panel; Insulet Corporation. Research Support; Insulet Corporation. Advisory Panel; MannKind Corporation, Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Provention Bio, Inc. Speaker's Bureau; Sanofi, Xeris Pharmaceuticals, Inc. Advisory Panel; Pendulum Therapeutics. Research Support; Tandem Diabetes Care, Inc. Advisory Panel; Cequr. Speaker's Bureau; Cequr. Advisory Panel; Medtro","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1162-P: Global Burden Attributable to High Body Mass Index in Young Adults from 1990 to 2019, with Projections to 2050","authors":"JINGXUAN WANG, YUE HUANG, VICTOR W. ZHONG","doi":"10.2337/db24-1162-p","DOIUrl":"https://doi.org/10.2337/db24-1162-p","url":null,"abstract":"Introduction: The global health impacts of escalating obesity burden on young adults remain insufficiently understood. We conducted a comprehensive evaluation of the disease burden attributable to high body mass index (BMI) in young adults from 1990 to 2050. Methods: Based on the Global Burden of Disease Study 2019, we analyzed deaths and disability-adjusted life years (DALYs) attributable to high BMI in young adults aged 20-44 years globally and by age, sex, year, location, and disease, between 1990 and 2019. Future projections until 2050 were further assessed. Results: The global burden due to high BMI in young adults more than doubled during 1990-2019, reaching 24,510 (20,192-28,966) thousand DALYs and 322 (258-384) thousand deaths in 2019. Males had higher burden and faster increase than females. In 2019, middle Socio-demographic Index (SDI) regions had the highest age-standardized rates of deaths and DALYs, while low-middle SDI regions witnessed the largest rise. Significant variations across different countries were observed (Figure 1). Nearly 25% of the DALYs were attributed to diabetes and kidney diseases, which showed the fastest increase. By 2050, the age-standardized DALY rate attributable to high BMI tripled that in 1990. Conclusion: Targeted weight management interventions in young adults are urgently needed to fight against the soaring disease burden caused by high BMI. Disclosure J. Wang: None. Y. Huang: None. V.W. Zhong: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"983-P: Long-Term Improvement in CGM-Measured Glycemic Control in Adults with Type 2 Diabetes Not Treated with Insulin—Real-World Data","authors":"JENNIFER E. LAYNE, LAUREN H. JEPSON, ALEXANDER CARITE, RICHARD M. BERGENSTAL","doi":"10.2337/db24-983-p","DOIUrl":"https://doi.org/10.2337/db24-983-p","url":null,"abstract":"Objectives: Emerging evidence indicates that CGM use is associated with improvements in glycemic control in adults with noninsulin treated T2D. This real-world study evaluated CGM metrics for one year after CGM initiation in this population. Methods: Data were analyzed from Dexcom G6 and G7 users who self-reported: T2D, ≥18 yr, gender, no insulin use and had baseline TIR ≤70%. Outcomes were change in CGM metrics from baseline to 6 months and 1 year, and proportion with TIR >70% at follow-up overall and for younger (<65 yr) and older (≥65 yr) cohorts. Results: CGM users (n=3,840) were: mean (SD): 52.5 (11.2) yr, 48% female, TIR 70-180 mg/dL 41.7% (21.4) and 12.4% of participants were ≥65 yr. Significant improvement was observed at 6 months with continued improvement at 1 year (Table) for all CGM metrics not at target values at baseline. The proportion of CGM users meeting TIR >70% increased from 0% to 37.9% at 6 months and to 43.1% at 1 year. CGM was worn 84.7% of days. Outcomes were very similar for younger and older adults. One exception of note was the change in the TITR 70-140 mg/dL at 1 year, <65 yr: +17.1% and ≥65 yr: +12.7%, but the <65 yr group started with a lower baseline TITR. Conclusion: In this large, real-world study of adults with suboptimally controlled T2D not using insulin, CGM use was associated with meaningful improvements in glycemic control at 6 months with ongoing improvement at 1 year. Disclosure J.E. Layne: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. Employee; Verily Life Sciences. L.H. Jepson: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. A. Carite: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. R.M. Bergenstal: Other Relationship; Abbott. Research Support; Arkray Marketing. Consultant; Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur. Other Relationship; Dexcom, Inc., Eli Lilly and Company. Consultant; embecta, Hygieia. Research Support; Insulet Corporation. Consultant; MannKind Corporation. Other Relationship; Medtronic, Novo Nordisk. Consultant; Onduo LLC, Roche Diabetes Care. Other Relationship; Sanofi. Research Support; Tandem Diabetes Care, Inc. Other Relationship; UnitedHealth Group. Consultant; Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1936-LB: The Challenge of Obtaining Diabetes Technology Supplies in Adults with Type 1 Diabetes","authors":"ANDREW A. WELCH, THOMAS KNOERL, ELIZABETH J. KOPRAS, SARAH CORATHERS, MERCEDES FALCIGLIA","doi":"10.2337/db24-1936-lb","DOIUrl":"https://doi.org/10.2337/db24-1936-lb","url":null,"abstract":"Background: Individuals with Type 1 Diabetes (T1D) face barriers to reliably obtain prescribed technology supplies (continuous glucose monitors [CGM]/insulin pump supplies). The frequency of annual supply access interruptions (ASAI) and the associated burden (emotional, financial, time) with this process are unclear. Objective: To quantify ASAI of technology supplies/insulin and associated burden in adults with T1D. Methods: A 64-question online survey was distributed to the T1D Exchange registry for US adults with T1D. ASAI was defined as total instances that individuals ran out of CGM, insulin pump supplies, and/or insulin in the past year. The burden to obtain supplies was assessed by a 1-10 scale (10 = strongly agree). Means and SD were reported. Significance of comparisons was assessed with t-tests or ANOVA for parametric data, and Mann-Whitney or Kruskal-Wallis tests for non-parametric data (significant = p<0.05). Results: Responses were completed by 2151 surveyed. Mean age was 49 years, 73% female, average A1C 6.7%, with 96% and 80% utilizing CGM and insulin pumps respectively. ASAI averaged 1.8 and varied significantly based on gender (Female = 1.9), insurance (Medicaid = 3.9), income (None = 3.23), race (Black = 3.0), and location (Rural = 2.3). Emotional burden (worry about running out of supplies) was significantly higher in women, those without insurance, lower annual income, and non-white race. A 10 was reported for “It is difficult to afford supplies” by 13% and “I spend too much time obtaining supplies” by 11%. Early CGM and insulin pump cannula failures were reported by 45% and 48% of respondents respectively. The top reason for ASAI was “Required prior authorization” in 36% of respondents. The top strategies to avoid ASAI were “Call supply company to request extra supplies” (25.9%), and “Use supply for longer than recommended” (25.5%). Conclusion: Challenges in obtaining diabetes supplies are significant and disproportionately affect certain socioeconomic groups with T1D. Disclosure A.A. Welch: None. T. Knoerl: None. E.J. Kopras: None. S. Corathers: None. M. Falciglia: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"56-OR: Impact of Delays in Statin Therapy Due to Statin Nonacceptance on Cardiovascular Outcomes in Patients with Diabetes","authors":"NISARG SHAH, ZHOU LAN, SETH S. MARTIN, C J. BROWN, ALEXANDER TURCHIN","doi":"10.2337/db24-56-or","DOIUrl":"https://doi.org/10.2337/db24-56-or","url":null,"abstract":"Introduction: Many patients with diabetes do not accept their clinicians’ statin therapy recommendations. Long-term clinical sequalae of statin non-acceptance are unknown. Methods: We conducted a retrospective cohort study of patients with diabetes without ASCVD treated at Mass General Brigham in 2000-2018. We analyzed the relationship between delay in statin therapy due to statin non-acceptance by patients and the incidence of CV events (MI or ischemic stroke). Information about statin non-acceptance and baseline characteristics was obtained from the electronic medical records and a previously validated Natural Language Processing tool. Results: The mean age of 7,239 study patients was 55.0 (SD 11.9) years; 3,769 (52.1%) were female. Their mean baseline LDL-C was 138 (SD 28) mg/dl and the mean HbA1c was 7.5% (SD 1.9). A total of 1,280 (17.7%) of patients delayed statin therapy (by a mean of 2.7 (SD 3.1) years during which they had a mean of 4.6 (SD 9.1) provider visits) due to initial non-acceptance. These patients then continued on statin therapy for a mean of 7.1 (SD 4.8) years. Over the mean follow-up time of 8.2 (SD 4.6) years, 455 (6.3%) of patients had a CV event. Accounting for all-cause death as a competing risk, 6.4% (95% CI 5.6-7.2) of patients who accepted vs. 8.5% (95% CI 6.8-10.5) of patients who initially declined statin therapy recommendation experienced a CV event at 10 years (p = 0.001). In a multivariable Cox analysis that adjusted for patients’ demographic characteristics and comorbidities and clustering within providers, initial non-acceptance of statin therapy was associated with increased risk of a CV event (HR 1.49, 95% CI 1.16-1.91, p = 0.002). Conclusions: Our study shows that patients with diabetes without ASCVD who delay statin therapy due to statin non-acceptance have an increased risk of CV events. This finding identifies a previously unexplored gap in care that increases cardiovascular burden in this already high-risk population. Disclosure N. Shah: None. Z. Lan: None. S.S. Martin: Consultant; Amgen Inc., AstraZeneca, Bristol-Myers Squibb Company, Chroma, Kaneka Inc., NewAmsterdam, Novartis AG, Novo Nordisk, Premier, Sanofi. C.J. Brown: None. A. Turchin: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Novo Nordisk, Proteomics International. Research Support; AstraZeneca. Funding PCORI (ME-2019C1-15328)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1981-LB: Modeling the Impact of Semaglutide 2.4 mg in U.S. Patients with Atherosclerotic Cardiovascular Disease and BMI ≥27 kg/m2","authors":"MADS FAURBY, MICHAEL G. NANNA, JOSHUA C. TOLIVER, QUAN V. DOAN, ALASDAIR D. HENRY, THOMAS SCASSELLATI SFORZOLINI, ALINA LEVINE, ANTHONY FABRICATORE, AZADEH S. HOUSHMAND-OEREGAARD, ANN MARIE NAVAR","doi":"10.2337/db24-1981-lb","DOIUrl":"https://doi.org/10.2337/db24-1981-lb","url":null,"abstract":"The SELECT trial demonstrated a 20% risk reduction in major adverse cardiovascular events (MACE) with semaglutide 2.4 mg in adults with atherosclerotic cardiovascular disease (ASCVD) and overweight/obesity (BMI ≥27 kg/m2). We aimed to quantify the potential population impact of this treatment in the US. National Health and Examination Survey (NHANES) data were used to characterize the US population meeting SELECT trial criteria: BMI ≥27 kg/m2, age ≥45 years, ASCVD, and no diabetes, with the number of potential treatment candidates determined using 2023 census projections. The 10-year rate of recurrent MACE events was estimated based on the SMART2 risk calculator. The potential treatment effect of semaglutide 2.4 mg on the number of MACE events in this population was estimated using results from the SELECT trial. As of 2023, 6,161,981 US adults met SELECT inclusion criteria (mean age 67.2 ± 9.9 years, 43.6% female, mean BMI 32.6 ± 5.0 kg/m2). Based on SMART2, an estimated 2,529,310 individuals (41.0%) will experience at least one MACE event in the next 10 years, with the total number of events estimated at 3,064,993. Of these, 497,631 MACE events could be avoided with semaglutide 2.4 mg treatment (Table). The possible therapeutic impact of semaglutide 2.4 mg on eligible US adults is substantial, with the potential to prevent nearly half a million CV events and deaths over the next 10 years. Disclosure M. Faurby: Employee; Novo Nordisk. M.G. Nanna: Consultant; Merck & Co., Inc., HeartFlow, Inc. J.C. Toliver: Employee; Novo Nordisk. Q.V. Doan: Consultant; Novo Nordisk, Daiichi Sankyo, Akebia Therapeutics, Inc., AbbVie Inc. A.D. Henry: Consultant; Novo Nordisk. T. Scassellati Sforzolini: Consultant; Novo Nordisk. A. Levine: Consultant; Novo Nordisk. A. Fabricatore: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk. A.S. Houshmand-Oeregaard: Employee; Novo Nordisk. Stock/Shareholder; Eli Lilly and Company, Novo Nordisk A/S. A. Navar: Consultant; ESPERION Therapeutics, Inc. Research Support; ESPERION Therapeutics, Inc. Consultant; Amgen Inc. Research Support; Amgen Inc., Bristol-Myers Squibb Company. Consultant; Bristol-Myers Squibb Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Bayer Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Pfizer Inc., New Amsterdam, Boehringer-Ingelheim, Eli Lilly and Company, Silence Therapeutics. Funding Novo Nordisk, Inc.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"17-OR: ADA Presidents' Select Abstract: Oral Bisphenol A Administration Decreased Peripheral Insulin Sensitivity in Healthy Adults","authors":"ADAM SEAL, STEVEN K. MALIN, ANDREW SCHAFFNER, MICHAEL R. HUBBARD, SARAH K. KEADLE, HANNAH BRUNNER-GAYDOS, ALIA A. ORTIZ, JANE E. NAKAMURA, CLARA MCMAHON, RACHEL BARNETT, ANITA H. KELLEHER, KELLY A. BENNION, SUZANNE PHELAN, TODD HAGOBIAN","doi":"10.2337/db24-17-or","DOIUrl":"https://doi.org/10.2337/db24-17-or","url":null,"abstract":"Introduction: Bisphenol A (BPA) is a synthetic chemical widely used in consumer goods and is linked to Type 2 diabetes progression in observational studies. No experimental studies have examined whether BPA promotes reductions in peripheral insulin sensitivity. Objective: To determine the effects of oral BPA administration on peripheral insulin sensitivity. Methods: Forty non-habitually active, healthy adults (22 F, 18 M; 21.3 ± 2.5 yr; 22.1 ± 2.3 kg/m2; 85% Non-Hispanic White) completed a 2-day baseline energy balance diet low in bisphenols during which urine, blood, and peripheral insulin sensitivity (i.e., glucose infusion rate/steady-state plasma insulin) via 120 min euglycemic hyperinsulinemic clamp technique (40 mU/m2/min; 90 mg/dL) were assessed. Participants were then randomly assigned, in a double-blinded fashion, to a 4-day energy balance diet plus oral BPA administration at 50 μg/kg body weight (BPA-50) or 4-day energy balance diet plus oral placebo (PL) administration. Outcomes were reassessed using a repeated measures ANOVA adjusting for baseline sex, BMI, physical activity, and ethnicity. Results: From baseline to 4-days, body weight was not significantly (P>0.05) different between PL (mean ± SEM; 66.7 ± 2.5, 66.2 ± 2.5 kg) and BPA-50 (66.7 ± 2.5, 66.7± 2.5 kg). From baseline to 4-days, fasting blood glucose was not significantly (P > 0.05) different between PL (95 ± 2, 88 ± 2 mg/dL) and BPA-50 (92 ± 2, 92 ± 2 mg/dL). Compared to PL urine BPA was significantly higher (P<0.05) following BPA-50. From baseline to 4-days, peripheral insulin sensitivity significantly (P=0.01) decreased in BPA-50 (0.11 ± 0.01, 0.10 ± 0.01 mg/kg/min/uU/ml) and remained stable in PL (0.09 ± 0.01, 0.10 ± 0.01 mg/kg/min/uU/ml). Conclusion: BPA administration decreased peripheral insulin sensitivity after four days. These data provide the first experimental evidence that BPA administration may increase Type 2 diabetes risk. Supported by American Diabetes Association grant #1-19-ICTS-044. Disclosure A. Seal: None. S.K. Malin: None. A. Schaffner: None. M.R. Hubbard: None. S.K. Keadle: None. H. Brunner-Gaydos: None. A.A. Ortiz: None. J.E. Nakamura: None. C. McMahon: None. R. Barnett: None. A.H. Kelleher: None. K.A. Bennion: None. S. Phelan: Research Support; Weight Watchers International. T. Hagobian: None. Funding American Diabetes Association (1-19-ICTS-044)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"142-OR: A1C and Average Glucose Discordance—Personalized A1C Improves the Discrepancy, Particularly in Black Individuals","authors":"RAMZI AJJAN, TIMOTHY DUNN, YONGJIN XU, PRATIK CHOUDHARY","doi":"10.2337/db24-142-or","DOIUrl":"https://doi.org/10.2337/db24-142-or","url":null,"abstract":"Introduction: Black individuals with diabetes have greater hypoglycemic hospitalizations, perhaps due to overtreatment of elevated laboratory A1C compared to average glucose (AG), related to altered red blood cell (RBC) biology. Our aim was to evaluate the size of the problem and improve A1C accuracy using a new glycemic marker. Methods: Continuous glucose monitoring (CGM) and bi-monthly A1C were collected in a 26-week study of adults with type 1 or type 2 diabetes across different race groups. RBC personal glycation ratio (PGR) was determined at 12 weeks and used to calculate personalized A1C (pA1C) with this new glycemic marker assessed against paired 56-day AG-derived A1C. Results: Of 811 A1C and AG-derived A1C comparisons in 245 individuals, 34% displayed greater than 0.5% disagreement. This was reduced to 13% using pA1C, with the largest improvement detected in 56 Black individuals (reducing from 42% deviation rate for A1C to 17% for pA1C, Figure). For A1C values <7%, more than 0.5% discrepancy between A1C and AG-derived A1C for the whole group and Black individuals was lowered from 27% and 34%, respectively, to 5% and 9% with pA1C. Conclusion: Clinically significant A1C and AG-derived A1C discordance is common, particularly in Black individuals. Personalized A1C addresses this discrepancy potentially improving clinical management in diabetes and reducing health disparities. Disclosure R. Ajjan: Research Support; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Abbott, AstraZeneca, Novo Nordisk. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Diabetes UK. Advisory Panel; Eli Lilly and Company, Sanofi. T. Dunn: Employee; Abbott. Y. Xu: None. P. Choudhary: Advisory Panel; Abbott, Biolinq. Speaker's Bureau; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi. Advisory Panel; Ypsomed AG, Vertex Pharmaceuticals Incorporated.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}