Diabetes最新文献

{"title":"1004-P: Remote Initiation of Continuous Glucose Monitoring in Older Adults Using Insulin","authors":"CATHERINE MAHONEY, CHRISTINE SLYNE, MEDHA MUNSHI, COLIN D. CONERY, HALEY BRABANT, NOA KRAKOFF, JANE D. BULGER, RUTH S. WEINSTOCK, ELENA TOSCHI","doi":"10.2337/db24-1004-p","DOIUrl":"https://doi.org/10.2337/db24-1004-p","url":null,"abstract":"Background & Objective: Initiation of continuous glucose monitoring (CGM) remotely in adults with diabetes (DM) has been shown beneficial. However, this model has not been evaluated in older adults. The objective of this study was to assess the benefit and challenges encountered by older patients on multiple daily insulin injections (MDI) initiating CGM using a virtual platform. Methods: Older adults with DM who are participating in an ongoing study on initiation CGM remotely between January-December 2023 were interviewed. Interviews were transcribed, de-identified, coded, and qualitatively analyzed. Baseline demographic characteristics were collected. Results: Interim analysis of 24 interviews was conducted: age 72 ± 4 years, duration of diabetes 30 ± 15 years, 52% female, 76% white, 52% having type 1 diabetes (T1DM), 72% CGM naïve, HbA1C 8.1 ± 1.6, 92% on MDI, and 84% utilizing Medicare as primary insurance. Overarching themes were the use of remote education, initiation of CGM remotely, and ongoing use of CGM. All 100% surveyed participants favorably rated the remote education and its ease of scheduling as well as the overall value of CGM. All participants were able to initiate and maintained CGM use successfully with remote education assistance, with 95% of participants planning to continue to use CGM after study completion. The challenges reported with the CGM use included difficulty with mobile application (33%), annoyance with alarms (50%), and concerns for Medicare coverage (42%). Conclusions: The results of this qualitative analysis show that in our cohort, remote initiation of CGM in older adults was perceived positively, despite some challenges. Disclosure C. Mahoney: None. C. Slyne: None. M. Munshi: Consultant; Sanofi. C.D. Conery: None. H. Brabant: None. N. Krakoff: None. J.D. Bulger: None. R.S. Weinstock: Research Support; Eli Lilly and Company, Tandem Diabetes Care, Inc., Diasome, Amgen Inc., MannKind Corporation, Insulet Corporation, Novo Nordisk. Other Relationship; Dexcom, Inc. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi. Funding The Leona M. and Harry B. Helmsley Charitable Trust","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"60 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730543","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":"104-OR: State-Dependent Activity in Hindbrain Glucagon-Like Peptide 1—Producing Neurons Regulates Consummatory and Valence Behavior through Functionally Interconnected Hypothalamic and Limbic Circuits","authors":"MIGUEL DURAN, SONJA VIRKUS, KYLIE A. MCMICHEN, YASLLE ANDRADE CAVALCANTE MORAES, ESHITA YADAV, JAGJOT K. SINGH, ZOE FOKAKIS, SAMANTHA Q. STOCKING, SAMUEL O. POOLE, CHAD S. HUNTER, KIRK M. HABEGGER, JAMES A. HARDAWAY","doi":"10.2337/db24-104-or","DOIUrl":"https://doi.org/10.2337/db24-104-or","url":null,"abstract":"Introduction: Glucagon-like peptide 1 (GLP-1) therapeutics have experienced a meteoric rise in adoption, but our understanding of the endogenous systems that produce GLP-1 and how they regulate behavior remain incomplete. Preproglucagon neurons in the nucleus of the solitary tract (GcgNTS neurons) are the primary source of GLP-1 in the brain. In this study, we examined the neurophysiological and causal contributions of GcgNTS neurons to consummatory and valence behavior. Methods: electrophysiology, in vivo optogenetics, fiber photometry. Results: Using electrophysiology, we observed that GcgNTS neuron neural firing and excitability is reduced in response to 24-hour food deprivation that varied by sex. Conversely, GcgNTS neurons significantly increase their firing rate after a brief 1-hour chow refeed after food deprivation. Consistent with this, GcgNTS neurons display elevated Fos levels following binge-like consumption of palatable high-fat diet. Using in vivo optogenetics, we observed that optogenetic activation of GcgNTS neurons produced anxiety and negative valence that varied by sex. High-frequency activation of GcgNTS neurons also reduced feeding and appetitive behavior. Interestingly, high-frequency activation of GcgNTS neurons produced lasting effects that persisted after cessation of laser illumination. Using a novel transgenic mouse, Gcg-IRES-FlpO, crossed to Glp1r-Cre mice combined with viral and transgenic reporters, we found that GcgNTS neurons and Glp1r neurons in the hypothalamus and amygdala make reciprocal connections. Currently, we are measuring functional connections between GcgNTS neurons and Glp1r neurons in the paraventricular nucleus of the hypothalamus and amygdala. Conclusions: GcgNTS neurons control valence and consumption, interacting with an interconnected GLP-1R-expressing network in the hypothalamus and amygdala. Disclosure M. Duran: None. S. Virkus: None. K.A. McMichen: None. Y. Andrade Cavalcante Moraes: None. E. Yadav: None. J.K. Singh: None. Z. Fokakis: None. S.Q. Stocking: None. S.O. Poole: None. C.S. Hunter: None. K.M. Habegger: Research Support; Eli Lilly and Company. Consultant; Glyscend Inc. Stock/Shareholder; Glyscend Inc. Consultant; Merck & Co., Inc. Research Support; Novo Nordisk. Advisory Panel; Abvance Therapeutics. J.A. Hardaway: None. Funding K01DK115902R03DK129561P30DK079626P30DK056336","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"150 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730550","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":"1552-P: Mutations with Residual CFTR Function Are Associated to Better Glucose Tolerance and Insulin Secretion in Patients with Cystic Fibrosis","authors":"ANDREA FOPPIANI, FABIANA CICIRIELLO, FEDERICO ALGHISI, VINCENZINA LUCIDI, FEDERICA SILEO, MARIA CRISTINA LUCANTO, FABIOLA CORTI, CARLA COLOMBO, ALBERTO BATTEZZATI","doi":"10.2337/db24-1552-p","DOIUrl":"https://doi.org/10.2337/db24-1552-p","url":null,"abstract":"People with Cystic Fibrosis (pwCF) exhibit a defect of insulin secretion[1], potentially leading to Cystic Fibrosis Related Diabetes. Little information exists about the molecular mechanism that links the defect of insulin secretion to the CF-causing variants of the CFTR gene[2,3]. We sought to describe the relationship between the CFTR function and β-cell function in pwCF. We studied 341 patients (193 (57%) females, 271 (79%) pancreatic insufficient, median (IQR) age 19 (15, 24) years) with the oral glucose tolerance test (OGTT), sampling glucose, insulin, and C-peptide before and every 30 minutes over the 2 hour OGTT, modeling β-cell function expressed by the β-cell glucose sensitivity[4]. Each patient was characterized by either having at least one allele with a residual function mutation (group 1, 85 (25%)), or a minimal function mutation on both alleles (group 2, 255 (75%) ). After adjusting for sex, pancreatic insufficiency (PI), and age, patients in group 1 displayed better glucose tolerance at all OGTT timepoint (all p=<0.05), and better β-cell glucose sensitivity (22 pmol×min⁻¹×m⁻²×mM⁻¹; 95% CI 9.6, 34; p=<0.001).Within the whole sample, 162 patients (82 (51%) females, 136 (84%) of group 2, 139 (86%) pancreatic insufficient, median (IQR) age 20 (15, 25) years) carried variants on both alleles that had been tested for chloride conductance in the Fischer Rat Thyroid cell line (http://cftr2.org). The mean chloride conductance of the most functional allele was positively related to β-cell glucose sensitivity (0.96; 95% CI 0.13, 1.8; p=0.025), with no PI interaction (interaction term -0.63; 95% CI -3.7, 2.4; p=0.7), and adjusting for differences in sex and age. In conclusion, we have shown that CFTR function is quantitatively related to β-cell function in pwCF. Even though exocrine PI is associated with worse β-cell function, the association of CFTR residual function and β-cell glucose sensitivity is not necessarily mediated by exocrine PI. Disclosure A. Foppiani: None. F. Ciciriello: None. F. Alghisi: None. V. Lucidi: None. F. Sileo: None. M. Lucanto: None. F. Corti: None. C. Colombo: None. A. Battezzati: None. Funding Cystic Fibrosis Research Foundation FFC#16/2005, FFC#21/2013, FFC#20/2016, and FFC#24/2019","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"2013 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730555","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":"1927-LB: Impact of Continuous Glucose Monitoring Use on Hospitalizations in People with Type 2 Diabetes—Real-World Analysis","authors":"SATISH K. GARG, IRL B. HIRSCH, ENRICO REPETTO, JANET K. SNELL-BERGEON, BRIAN ULMER, CHRISTOPHER PERKINS, RICHARD M. BERGENSTAL","doi":"10.2337/db24-1927-lb","DOIUrl":"https://doi.org/10.2337/db24-1927-lb","url":null,"abstract":"Introduction & Objective: The increasing prevalence of diabetes in the US continues to drive a steady rise in healthcare resource utilization. The real-world impact of continuous glucose monitoring (CGM) on hospitalizations in a broad type 2 diabetes population is not completely understood. Methods: In this retrospective analysis, we used Optum's de-identified Market Clarity data of >79 million people to evaluate CGM use in 74,264 people with type 2 diabetes who were treated with non-insulin (NIT; n=25,788), basal insulin (BIT; n=25,292), and prandial insulin therapy (PIT; n=23,184). The primary outcomes were changes in all-cause hospitalizations (ACH), acute diabetes-related hospitalizations (ADH), and acute diabetes-related emergency room visits (ADER) during the 6- and 12-months post-index period. Results: ACH, ADH, and ADER were significantly reduced in the first 6 months (post-index) in all three groups: NIT (14%, 32%, 30%), BIT (25%, 57%, 37%), PIT (25%, 54%, 36%) respectively. (Figure 1) The reductions were sustained during 6-12 months in NIT (10%, 31%, 30%), BIT (23%, 56%, 34%), and PIT (19%, 49%, 36%) respectively (all p<0.0001). Conclusion: The use of CGM in real-world across different therapeutic regimes in people with type 2 diabetes was associated with significant reductions in all-cause hospitalizations, acute diabetes-related hospitalizations and ER visits. Disclosure S.K. Garg: Research Support; Eli Lilly and Company. Advisory Panel; Medtronic. Research Support; Medtronic. Advisory Panel; Novo Nordisk. Research Support; DarioHealth Corp., Dexcom, Inc., Diasome. Advisory Panel; Roche Diabetes Care. I.B. Hirsch: Advisory Panel; Abbott. Research Support; Dexcom, Inc. Advisory Panel; Roche Diabetes Care. Research Support; MannKind Corporation, Tandem Diabetes Care, Inc. Advisory Panel; embecta. Research Support; Tandem Diabetes Care, Inc. Advisory Panel; Vertex Pharmaceuticals Incorporated. E. Repetto: Employee; Roche Diabetes Care. J.K. Snell-Bergeon: None. B. Ulmer: Employee; Roche Diabetes Care. C. Perkins: Employee; Roche Diabetes Care. 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. Funding Roche Diagnostics, Diabetes Care","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"60 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730556","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":"1970-LB: A Sugary Recipe for Adverse Outcomes? Third Trimester HbA1c and Composite Obstetric and Perinatal Adverse Outcomes, a Prospective Study","authors":"JESSICA HAO-CHEN WU, MARA ULIN, SAMREEN HASSAN, CAMILLE MAI-PHUONG TRAN QUANG, ANUSHA KARRI, DANNIE SIEBEN, FERNANDA ALVARADO, VICTORIA GERALDO, KAMLESH K. JHA, JESSICA C. BISHOP-ROYSE, EDWARD C. LAMPLEY","doi":"10.2337/db24-1970-lb","DOIUrl":"https://doi.org/10.2337/db24-1970-lb","url":null,"abstract":"Objective: to evaluate the association between elevated HbA1c levels close to delivery and the increased risks of composite obstetric and perinatal adverse outcomes. Method: women with singleton pregnancies, at 34 weeks or above admitted for delivery were invited. HbA1c levels were obtained during the admission. The composite obstetrics and perinatal adverse outcomes were collected and analyzed. Results: 609 participants were included. The PPV of HbA1c > 5.8% in diabetes is 68% and the NPV is 91%. HbA1c > 5.8% is associated with increased odds of Cesarean section, primary Cesarean section, postpartum hemorrhage, hypertensive disorders in pregnancy, macrosomia, NICU admission, hypoglycemia, respiratory morbidity, and any perinatal adverse events. The outcomes were analyzed after the adjustment for confounders with multivariable logistic regression, the elevated HbA1c levels were still associated with increased cesarean section, primary cesarean section, macrosomia, neonatal hypoglycemia, and any perinatal adverse events. Conclusion: third-trimester HbA1c > 5.8% is associated with higher odds of several major obstetric and perinatal adverse outcomes and could be a useful tool during prenatal care to improve pregnancy outcomes. Disclosure J. Wu: None. M. Ulin: None. S. Hassan: None. C. Quang: None. A. Karri: None. D. Sieben: None. F. Alvarado: None. V. Geraldo: None. K.K. Jha: None. J.C. Bishop-Royse: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"79 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730467","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":"23-PUB: Reduction of Residual Lipid Risk in Patients with Type 2 Diabetes and Mixed Dyslipidemia Treated with a Fixed-Dose Combination of Atorvastatin/Fenofibrate","authors":"JOSE G. SANDER-PADILLA, LAURA A. LUGO-SÁNCHEZ, KEVIN F. RIOS-BRITO, KARLA E. RODRIGUEZ-ROCANDIO, MARÍA M. ARGUEDAS, DIANA FLORES-HUANOSTA, ILEANA C. RODRIGUEZ-VAZQUEZ, JORGE GONZALEZ-CANUDAS, YULIA ROMERO","doi":"10.2337/db24-23-pub","DOIUrl":"https://doi.org/10.2337/db24-23-pub","url":null,"abstract":"Introduction and Objective: The persistence of a high cardiovascular risk not dependent on LDL-C levels constitutes the residual cardiovascular risk of lipid origin (RLR). Lipid-lowering treatment does not always consider the modification of RLR. The present study aimed to evaluate the changes in RRL profile in patients with T2D and dyslipidemia treated with a fixed-dose combination (FDC) of Atorvastatin/Fenofibrate. Methods: A phase IIIb, randomized, prospective, double-blind, multicenter study in the Mexican population with diagnosis of T2D and mixed dyslipidemia. Patients were randomized to the Atorvastatin/Fenofibrate 20 mg/160 mg or Atorvastatin 20 mg once daily for four months. As part of the RLR evaluation, Triglycerides/HDL-C, residual cholesterol, Total cholesterol/HDL-C, and the triglycerides-to-glucose index (TyG) were estimated. Student's t-test and McNemar test (differences within groups) χ2, and independent samples Student's t-test were applied. Results: We included 65 patients with an average age of 56.8 ± 10.4 years. After two months of follow-up, there was a triglycerides reduction of -132.7 ± 145.3 mg/dL in the FDC group and of -68.7 ± 75.7 mg/dL with Atorvastatin therapy, while for the fourth month, the reduction was -138.3 ± 123.7 mg/dL and -60.5 ± 80.1 mg/dL, respectively. When evaluating RLR, both groups experienced a reduction in this profile, after 2 and 4 months of evaluation. However, when comparing the mean change reductions between groups of Triglycerides/HDL-C ratio (-3.9 vs -1.3, p=0.020), residual cholesterol (-19 vs -9.4, p= 0.018), and TyG (-0.7 vs -0.2, p=0.002) a superior outcome was found in FDC compared with the monotherapy group. Conclusions: Patients receiving Atorvastatin/Fenofibrate FDC had a better reduction than monotherapy in non-LDL cholesterol-dependent RRL markers, which translates to a decrease in overall cardiovascular risk for this treatment group. Disclosure J.G. Sander-Padilla: Employee; Laboratorios Silanes. L.A. Lugo-Sánchez: Employee; Laboratorios Silanes S.A. de C.V. K.F. Rios-Brito: Employee; Laboratorios Silanes S.A. de C.V. K.E. Rodriguez-Rocandio: Employee; Laboratorios Silanes S.A. de C.V. M.M. Arguedas: Employee; Laboratorios Silanes S.A. de C.V. D. Flores-Huanosta: Employee; Laboratorios Silanes. I.C. Rodriguez-Vazquez: Employee; Laboratorios Silanes S.A. de C.V. J. Gonzalez-Canudas: Employee; Silanes SA CV. Y. Romero: Employee; Laboratorios Silanes. Funding Laboratorios Silanes","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"161 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730474","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":"1073-P: Trends in Guideline-Directed Medication Therapy for Type 2 Diabetes in a Statewide Quality Collaborative between 2018–2023","authors":"KARA R. MIZOKAMI-STOUT, LAUREN OSHMAN, HEIDI L. DIEZ, DINA H. GRIAUZDE, JOYCE M. LEE, KATHERINE L. KHOSROVANEH, NEHA BHOMIA, NOA KIM, JACQUELINE RAU, JACOB REISS, RODICA BUSUI","doi":"10.2337/db24-1073-p","DOIUrl":"https://doi.org/10.2337/db24-1073-p","url":null,"abstract":"Introduction and Objective: Since 2021, the Michigan Collaborative for Type 2 Diabetes (MCT2D) aims to improve guideline-directed medication therapies (GDMT) for type 2 diabetes (T2D). We examined trends in glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-glucose transport protein 2 inhibitor (SGLT2i) prescribing rates comparing primary care (PC) and endocrinology (Endo) practices enrolled in MCT2D. Methods: We analyzed pharmacy claims data from adults with T2D insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization and Medicare Advantage plans who received care in an MCT2D-participating practice (PC=300; Endo=19) between 2018-2023. Descriptive statistics were used to examine differences in pharmacy claims for anti-hyperglycemic medications. Results: From June 2022-June 2023, among 38,437 persons with T2D (PC=37,361; Endo=1,076), 26% and 41% had claims for GLP-1RA and 19% and 37% for SGLT2i, respectively. Compared to 2018 prescription rates, GLP-1RA increased by 17% and 22%, while SGLT2i prescriptions increased by 15% and 28% in PC and Endo practices respectively (Figure 1). Conclusion: Among practices participating in a statewide collaborative to improve treatment and outcomes for people with T2D, the use of GDMT has increased since 2018. SGLT2i use is similar and GLP-1RA use is 2-3-fold higher than rates reported in other studies. Disclosure K.R. Mizokami-Stout: None. L. Oshman: Stock/Shareholder; Procter & Gamble, Johnson & Johnson Medical Devices Companies, Merck & Co., Inc., AbbVie Inc., Eli Lilly and Company, Abbott. H.L. Diez: None. D.H. Griauzde: None. J.M. Lee: Board Member; GoodRx. Advisory Panel; Sanofi. Consultant; Tandem Diabetes Care, Inc. K.L. Khosrovaneh: None. N. Bhomia: None. N. Kim: None. J. Rau: None. J. Reiss: None. R. Busui: Board Member; American Diabetes Association. Consultant; Procter & Gamble, AstraZeneca, Averitas Pharma, Inc., Bayer Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Ono Pharmaceutical Co., Ltd., Novo Nordisk, Roche Diagnostics. Advisory Panel; ADA/ACC Diabetes by Heart Program.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"92 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730478","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":"197-OR: Algorithmic Identification May Improve Racial and Ethnic Diversity of Clinical Study Recruitment","authors":"SARA JANE CROMER, VICTORIA CHEN, MICAH KOSS, MELTON M. FAN, CRISTINA I. FERNÁNDEZ HERNÁNDEZ, WILLIAM G. MARSHALL, EVELYN GREAUX, MIRIAM UDLER","doi":"10.2337/db24-197-or","DOIUrl":"https://doi.org/10.2337/db24-197-or","url":null,"abstract":"Introduction: Early analyses of Rare and Atypical Diabetes Network (RADIANT) study recruitment suggested that goals to recruit underrepresented groups were not being met. We tested whether a validated electronic health record (EHR) algorithm to identify people with an atypical form of diabetes improved identification of racially and ethnically minoritized individuals who may be candidates for the RADIANT study. Methods: Individuals identified by the algorithm were reviewed by research assistants, then classified by endocrinologists as atypical diabetes, a known type of diabetes, or unable to classify (more information needed). Chi-squared tests were used to compare the proportion of self-reported non-Hispanic Black (NHB) and Hispanic or Spanish-speaking (H/SS) participants enrolled through the Mass General site prior to use of the algorithm (mainly through referral by expert clinicians) and proportion of potential individuals identified by the algorithm. Results: Prior to beginning recruitment through the EHR algorithm, 53% of participants enrolled in RADIANT from the Mass General Brigham site identified as NHW, 5% as NHB, 5% as H/SS, 20% as non-Hispanic Asian (NHA). The algorithm initially identified 539 individuals with potentially atypical forms of diabetes. Of these, 452 under the age of 85 were reviewed, and 93 (20.6%) were classified as atypical and possible RADIANT candidates (v. 65.7% with a known type of diabetes and 13.7% unable to be classified). Of those with likely atypical diabetes, 39.8% identified as NHW, 22.6% as NHB, 11.8% as H/SS, and 20.4% as NHA. The algorithm identified a higher percentage of NHB individuals (p<0.001) and H/SS individuals (p<0.001) when compared to previous recruitment methods. Conclusion: Use of a validated algorithm to identify individuals with atypical diabetes in the EHR led to improved identification of candidates for the RADIANT study who are historically underrepresented in clinical and genetic research studies. Disclosure S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. V. Chen: None. M. Koss: None. M.M. Fan: None. C.I. Fernández Hernández: None. W.G. Marshall: Employee; Abbott. E. Greaux: None. M. Udler: Other Relationship; Up-To-Date. Funding American Diabetes Association (7-21-JDFM-005); NIDDK (1U54DK118612)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"79 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730552","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":"1388-P: Risk of Diabetes among Children and Young Adults after COVID-19 Infection—The DiCAYA Study","authors":"SARAH CONDERINO, H. LESTER KIRCHNER, LORNA THORPE, JASMIN DIVERS, ANNEMARIE G. HIRSCH, CARA M. NORDBERG, BRIAN S. SCHWARTZ, BO CAI, CAROLINE RUDISILL, JIHAD S. OBEID, ANGELA D. LIESE, BRIAN E. DIXON, DANA DABELEA, ANNA BELLATORRE, HUI SHAO, JIANG BIAN, YI GUO, KRISTI REYNOLDS, MATTHEW T. MEFFORD, MANMOHAN K. KAMBOJ, ENEIDA A. MENDONCA, KATIE ALLEN, SHAWNA BURGETT, EVA LUSTIGOVA, SARAH BOST, MITCH MALTENFORT, LEVON H. UTIDJIAN, MATT M. ZHOU, TESSA L. CRUME, ANDREA TITUS","doi":"10.2337/db24-1388-p","DOIUrl":"https://doi.org/10.2337/db24-1388-p","url":null,"abstract":"Introduction & Objective: The association between COVID-19 infection and incident diabetes remains unclear despite recent research. Using a multistate electronic health record-based surveillance approach, we examined the risk of new diabetes among children (<18) and young adults (18-44) post COVID-19 infection. Methods: Pooled fixed-effects meta-analyses were performed. Patients (n=5,412,604) with no evidence of diabetes who received care in 2018-2019 were followed through diabetes diagnosis, death, or end of follow-up (12/31/22). COVID-19 infection was defined using labs or diagnoses from 6/1/20-12/31/21. Person-time was calculated from infection date for cases or a randomly selected visit date for controls. Propensity score-weighted Cox regression models were run at each site individually to estimate hazard ratios (HR) for diabetes risk for children and young adults. Results: COVID-exposed individuals were at higher risk of incident diabetes compared to those with no documented infection (Children HR = 1.85 [1.69, 2.03]; Young Adult HR = 1.37 [1.31, 1.42]). All participating sites reported elevated risk but results were more heterogeneous across young adults (range 1.3-3.7, heterogeneity I2=94% vs. range 1.6-2.0, I2=0%, Figure 1). Conclusion: These preliminary findings suggest COVID-19 infection is associated with increased risk of incident diabetes among children and young adults. Disclosure S. Conderino: None. H. Kirchner: None. L. Thorpe: None. J. Divers: None. A.G. Hirsch: None. C.M. Nordberg: None. B.S. Schwartz: None. B. Cai: None. C. Rudisill: None. J.S. Obeid: None. A.D. Liese: None. B.E. Dixon: Other Relationship; Elsevier. D. Dabelea: None. A. Bellatorre: None. H. Shao: Consultant; Eli Lilly and Company. J. Bian: None. Y. Guo: None. K. Reynolds: Research Support; Merck Sharp & Dohme Corp. M.T. Mefford: Research Support; Merck & Co., Inc. M.K. Kamboj: None. E.A. Mendonca: None. K. Allen: None. S. Burgett: None. E. Lustigova: None. S. Bost: None. M. Maltenfort: None. L.H. Utidjian: None. M.M. Zhou: None. T.L. Crume: None. A. Titus: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"79 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730553","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":"1559-P: Heterogeneity of Trajectories of Metabolic Parameters after 50% Beta-Cell Mass Loss by Pancreatectomy","authors":"ROBERTO BIZZOTTO, GIANFRANCO DI GIUSEPPE, LAURA SOLDOVIERI, FRANCESCA CINTI, SIMONA MOFFA, MICHELA BRUNETTI, GEA CICCARELLI, SERGIO ALFIERI, GIUSEPPE QUERO, ANDREA MARI, ANDREA GIACCARI, TERESA MEZZA","doi":"10.2337/db24-1559-p","DOIUrl":"https://doi.org/10.2337/db24-1559-p","url":null,"abstract":"Temporal trajectories of metabolic parameters in the onset of dysglycemia are heterogeneous. We aimed to characterize the temporal trajectories of metabolic parameters after β cell mass reduction by pancreatectomy and to study their heterogeneity. Individuals without known diabetes diagnosis (N = 83) underwent mixed-meal/oral glucose tolerance tests (MMTT/OGTT) and/or hyperglycemic/euglycemic clamp (HC/EC) procedures, before and after surgery. We performed stepwise multivariate linear regression analysis on the glucose tolerance (GT) class (treated as ordinal number, 1 to 3) after surgery, using as independent variables the baselines and changes with surgery of anthropometrics and MMTT- and HC-derived functional parameters of insulin secretion, clearance, and sensitivity (IS), imputed via missForest algorithm when missing. We used the variables selected in this analysis (p<0.01) as input for the reversed graphed embedding (RGE) framework, to identify groups of individuals with extreme combinations of the variables (archetypes). Independent associations with after-surgery GT class (cross-validated R2 = 0.57) were observed for changes in IS and β cell glucose sensitivity (GS), and for baseline IS, GS, 1st phase insulin secretion, insulin secretion at 6 mmol/L glucose, and insulin clearance. IS and the β cell function parameters showed different trajectories combinations in each of the 5 archetypes identified via RGE (median adjusted Rand index = 0.88; N = 16, 8, 15, 13, 18). After surgery, all archetypes included individuals in each of the 3 GT classes (all proportions > 0 at 95% CI). The same β cell mass reduction determines a variety of combinations in changes of IS and β cell functional mechanisms. We identified five archetypes underlying these combinations. The same final GT class can be reached by individuals in any of the archetypes, which shed light on the hidden heterogeneity of glycaemic deterioration. Disclosure R. Bizzotto: None. G. Di Giuseppe: None. L. Soldovieri: None. F. Cinti: None. S. Moffa: None. M. Brunetti: None. G. Ciccarelli: None. S. Alfieri: None. G. Quero: None. A. Mari: Consultant; Lilly Diabetes. A. Giaccari: None. T. Mezza: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"75 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730617","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}