Glucagon Prescription Rates for Individuals With Type 1 Diabetes Mellitus Following Implementation of an Electronic Health Records Intervention

Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil

Previous studies in the UK have established that minority ethnic groups as a whole experience more ill-health and onset of morbidity at younger ages or at lower levels of risk than the ‘White British’ population. Since the Race Relations Act of 1968, the official collection of ethnic group statistics by all government bodies has been mandated as a pre-requisite for identifying and tackling ethnic inequalities. The capture of ethnicity data in routine health records across the UK National Health Service forms part of this initiative. Although the facility to record ethnicity has been available in primary care since 1991 and in secondary care since 1995, until recently, unsystematic recording resulted in poor quality of the initial data, limiting the usefulness of these data for clinical care, commissioning and research. The incentivisation of ethnicity recording in 2006 as part of the Quality and Outcomes Framework has resulted in an improvement of the quality of these data, though their suitability for use in UK-wide population-based research, at the commencement of this PhD, had not yet been explored. The studies reported in this thesis investigated the utility of electronic health records for research into ethnic differences in health and comprised three sub-studies. Firstly, the completeness, usability and generalisability of ethnicity data captured in primary and secondary care databases were assessed. Results showed that in 2012, valid ethnicity was recorded for 78.3% of patients in the Clinical Practice Research Datalink (CPRD), 79.4% of inpatients, and 50% of A&E patients and outpatients in the Hospital Episode Statistics for England (HES). Over 80% of patients with multiple ethnicities recorded had codes which either were identical or fell into the same five high-level ethnic group categorisation. The ethnic breakdown of the CPRD was found to be comparable to that of the combined censuses for England, Wales, Scotland and Northern Ireland, suggesting that studies of ethnic populations within the CPRD can be generalised to the UK population, particularly when using data from 2006 onwards, where completeness and consistency are highest. Secondly, in collaboration with the UK Biobank study, a pragmatic and comprehensive definition of diabetes mellitus for use in electronic health databases was developed. Once applied to the CPRD, the algorithms identified 34,530 individuals with type 1 diabetes and 355,717 individuals with type 2 diabetes. The incidence of type 2 diabetes was almost doubled in South Asian compared with White groups (70.7 vs 42.0 events per 10,000 person years). After adjustment for gender and age group, the risk of type 2 diabetes was over three times higher in the South Asian group compared with White the group (Hazard Ratio 3.27 95%CI 3.19, 3.35). Finally, a prospective cohort study of 860,000 patients registered with the CPRD was undertaken to quantify ethnic differences in the risk of incident coronary heart disease (CHD) and the extent to which this relationship is modified by the presence of type 2 diabetes. The presence of diabetes increased the risk of CHD by 40%, although this reduced to 22% after accounting for age, gender and deprivation (Hazard Ratio 1.22 CI95 1.20, 1.25). The excess risk associated with diabetes was markedly higher for ethnic minority groups, with an adjusted increase of 60% and 75% in South Asian and Black African/Caribbean groups respectively, compared with 28% in the White groups. Adjusted rates of CHD were consistently higher in South Asian groups and lower in Black African/Caribbean groups, with differences more pronounced amongst men than women. Ethnic differences in CHD risk were consistently more pronounced amongst patients without type 2 diabetes than in those with type 2 diabetes. The studies have generated novel results which provide valuable information about the usability and generalisability of ethnicity data available in UK electronic health records. They have replicated findings from non-database studies of the prevalence and incidence of diabetes and extended our knowledge of the patterning of ethnic differences in heart disease outcomes. They represent the first ever use of UK routine electronic health records to answer these questions in relation to ethnicity. Together, the findings reported in this thesis provide a unique insight into the ways in which routinely recorded ethnicity data can be maximised for the purposes of epidemiological research into health inequalities across the UK.

Key PointsSimple clinical decision support tools in the electronic health record can improve rates of annual kidney screening for adults with diabetes.A key component of the clinical decision support tool includes autoenrollment of all adult patients with diabetes in a screening Care Gaps tool.BackgroundClinical guidelines recommend that patients with diabetes mellitus (DM) are screened annually for kidney disease with eGFR and urine albumin-to-creatinine ratio (UACR). To improve screening, we implemented clinical decision support (CDS) at the University of Virginia Health System in April 2022. This included (1) autoenrollment of primary care patients with DM in an electronic health record–based health maintenance plan and (2) prompting one-click ordering of the kidney profile (panel including UACR and eGFR) or UACR alone, as needed.MethodsWe assessed effectiveness of the CDS using an interrupted time series approach across three periods (pre–coronavirus disease 2019 [COVID-19] control: January 2019–February 2020; post–COVID-19 control: March 2021–April 2022; post-CDS: May 2022–April 2023). All nonacute office and telehealth encounters in primary care for patients 22 years or older with DM, no coded diagnosis of CKD in the prior 4 years, and due for screening (i.e., not screened for CKD in past 365 days). Screening was assessed as orders placed for UACR within 30 days of the encounter and aggregated by calendar months.ResultsThere were 66,388 encounters (23,419 pre–COVID-19 control; 22,611 post–COVID-19 control; 20,358 post-CDS). The screening trend in both control periods was similar; therefore, only the post–COVID-19 control was considered further. Demographics, encounter types, and clinic distribution were similar in the control and post-CDS periods. There was an immediate screening difference of 3.02% (95% confidence interval, 0.37 to 5.68; P = 0.03) after the CDS, and screening acceleration with a difference in screening rate of 0.57% each month compared with 0.06% per month before the CDS (P < 0.01). The results were similar if encounters for patients with prior CKD by laboratory criteria were removed.ConclusionsRoll out of CDS coincided with immediate and ongoing improvement in annual screening for CKD among adult patients with DM. These results suggest that simple CDS may be an effective intervention to promote CKD screening.

Blended care, referring to the combination of digital health interventions (DHI) with in-person care, has proven cost-effective in promoting healthy behaviours, especially for lifestyle related conditions like type 2 diabetes mellitus. However, despite positive results, many interventions fail during the clinical implementation. A successful implementation of blended care interventions requires a systematic approach including appropriate implementation strategies that address relevant barriers and facilitators. Therefore, this study explores barriers and facilitators for implementation of lifestyle related blended care interventions for weight management and type 2 diabetes mellitus. Following PRISMA-ScR guidelines, a scoping review was conducted using PubMed, Scopus, and Web of Science, covering studies from January 1, 2000, to February 4, 2025. The search included terms related to 'overweight,' 'obesity,' 'diabetes mellitus type 2', 'eHealth', 'blended care', 'setting' and 'implementation'. Studies were included if they focused on lifestyle changes (e.g. weight loss, physical activity, or self-management) and reported barriers or facilitators for implementing blended care, defined in this review as the integration of DHI with at least one in-person care-focused interaction between a health care provider and an adult patient. No risk of bias assessment was performed. Data were extracted on study characteristics, participants demographics, DHI delivery methods, and implementation barriers and facilitators. Data was analysed using a narrative synthesis structured by the Consolidated Framework for Implementation Research (CFIR). From 1329 screened studies, nine met the inclusion criteria. The findings indicate that implementation challenges cluster around financial constraints, increased workload for healthcare providers, and disparities in digital skills, which collectively limit the feasibility and sustained use of blended DHIs. The other way around, successful implementation is supported by adequate training, user-centred design, and strong alignment with existing clinical workflows. Tailoring interventions to organisational context and ensuring regulatory compliance further strengthen adoption. Blended DHIs offer opportunities to enhance personalization, patient involvement, and continuity of care. However, their sustainable implementation requires addressing these overarching barrier and facilitator domains rather than isolated factors: Healthcare organisations can act to reduce organisational burden by providing sufficient resources, policymakers can support regulatory alignment, developers can prioritize user-centred design, and healthcare professionals can integrate blended care intro routine practice and support patients in its use.

Rationale, aims and objectives: Lifestyle dependent risk factors are associated with increased risk of chronic diseases such as type 2 diabetes and cardiovascular diseases. These risk factors are more prevalent in lower socioeconomic groups and are likely to be driven by social and physical environmental factors. To promote healthy lifestyle behaviours, a range of environmental interventions are being implemented in the Netherlands and beyond. It is, however, unknown which strategies, barriers and facilitating factors are associated with successful implementation and use of these interventions. This paper describes the rationale, design and protocol of a project set out to determine success and failure factors for implementation and use of social and physical environmental interventions aiming to improve physical activity and healthy eating in residents of deprived neighbourhoods. Its findings will be of relevance to the development of person-centered care frameworks. Method: 18 implemented environmental interventions in 3 of the 40 most deprived neighbourhoods in the Netherlands will be selected. For these 18 interventions we will assess potential determinants of successful implementation and use, as defined in an extensive implementation model. In addition, expert and target-group panels will judge the intervention’s reach, effectiveness, adoption, implementation and maintenance (RE-AIM). Linking the determinants of the implementation model with the opinions of the expert and target-group panels may identify success and failure factors for implementation and use of those interventions. Discussion: This study will contribute to the evidence base for the effective implementation of environmental interventions in low socio-economic neighbourhoods. Obtaining more insight into how interventions can be successfully implemented and used may support researchers and policymakers in the development and implementation of future environmental interventions.

There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom-based enquiry, and those positive to any symptom were referred for TB investigations. In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti-TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774/100 000) and were highest in one of the five clinics in the final quarter (804/100 000) where there was intensive in-house training, special assignment of staff for screening and colocation of services. This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient-related implications.

BackgroundThe purpose of this study was to evaluate the impact of type 2 diabetes mellitus on hospitalization costs in older patients with acute myocardial infarction (MI).MethodsRetrospective analysis of data from the case retrieval system of Qilu Hospital of Shandong University located in Jinan city of Shandong Province was done for patients with acute MI from January 1, 2011 to December 31, 2012.ResultsStenting was an important factor affecting older patients’ total hospitalization costs (β=0.685, P=0.000) and treatment costs during the follow-up period (duration of hospital stay only, β=0.508, P=0.000). Stenting was also a protective factor in the prevention of acute heart failure (HF) in older patients with acute MI during the follow-up period (odds ratio 0.189, 95% confidence interval 0.059–0.602, P=0.005). Implementation of percutaneous coronary intervention reduced the incidence of acute HF in older inpatients with acute MI (27.8% versus 4.3%, P=0.001) and without diabetes (18.2% versus 3.8%, P=0.001). Moreover, among the elderly, the incremental cost-effectiveness ratio estimate for implementing percutaneous coronary intervention in diabetic patients was higher than in nondiabetic patients.ConclusionStenting was a protective factor for preventing acute HF in the elderly during the follow-up period. From the perspective of reducing the incidence of acute HF in inpatients, implementation of percutaneous coronary intervention after an acute MI is more cost-effective in older patients with diabetes mellitus than in those without it.

Background: Diabetes mellitus is a disease that still threatens human life in the world. One of the non-pharmacological therapies to reduce blood sugar levels in patients with diabetes mellitus is cinnamon because it is a kitchen spice that is easily available.Objectives: This study is to test the effectiveness of cinnamon brew on reducing blood sugar levels in patients with type 2 diabetes mellitus in the Langsa Barat Health Center Working Area.Methods: This study used a quasi experiment method, the total sample of 88 respondents was divided into two groups, namely the intervention group giving cinnamon and the control group given education. The research was conducted in the working area of the West Langsa Health Center on May 1 - July 22, 2024. Data collection collaborated with the prolanis and PTM managers of the puskesmas to obtain data on diabetics, the implementation of interventions was carried out at the puskesmas and respondents' homes, with 2 times a day as much as 5 grams routinely for 7 days. Data were analyzed using the Paired Sample T-test.Results: : After the intervention of giving cinnamon, it was found that there was a decrease in blood sugar on day 3 (three), and after the intervention on day 7 (seven) it was found that there was a decrease in blood sugar for respondents with a p value of 0,000, while for the control group there was no decrease in blood sugar levels.Conclusion: Based on this study, cinnamon steeping intervention can have the effect of reducing blood sugar levels in patients with diabetes mellitus when consumed regularly, thus providing an option for diabetics to consume cinnamon as an alternative therapy option to lower blood glucose.

IntroductionWorldwide, hypertension and diabetes mellitus (DM) are major causes of morbidity and mortality. This study assesses the prevalence and correlates of hypertension and DM in an urban community in northwestern Nigeria.MethodsThis was a cross-sectional descriptive study. Adults aged 18 years and above, who attended a medical outreach program were interviewed and screened for hypertension and DM. Anthropometry, blood glucose and blood pressure were measured with standard instruments and methodology. Primary outcomes were hypertension and DM. Data were analyzed using STATA version 14 and presented as mean ± standard deviation and frequencies. Chi-square and Pearson's correlation co-efficient were used to identify the correlates of hypertension and DM, at 5% level of significance.ResultsThe mean age of participants was 51.0 ± 14.0 years and 87.8% were females. Prevalence of hypertension and DM were 55.9% and 23.3% respectively. Age greater than 40 years and female gender were associated with risk of hypertension and DM respectively, p < 0.05. There was a weak correlation between systolic hypertension and age (r = 0.18, p = 0.02), diastolic hypertension and body mass index (r = 0.16, p = 0.03) and blood sugar and waist circumference (r = 0.19, p = 0.02).ConclusionThe high prevalence of hypertension and DM among the study population highlights the need for the development and implementation of a community-based public health interventions aimed at reducing their risk factors.

Objective: The objectives of the present study were to evaluate the effectiveness of the instructional intervention about management of long –term complications for type II diabetes mellitus (comparative Study). Methodology: A descriptive study was carried out at National Center for Diabetes Mellitus/ Almustansria University started. Non-probability (purposive sample) of (60) diabetes mellitus type II, who visit National Center for Diabetes Mellitus/ Almustansria University. The study group received the instructional intervention. The data are collected through the use of constructed questionnaire, which consists of two parts. part 1: consists about demographic characteristics, part 2: consists of (5) items about Knowledge and management on the long-term complications for patients with diabetes mellitus type II, first item: consists of (7) items about Knowledge to patient's about the complications involving the cardiovascular system, second item: consists of (9) items about Knowledge to patient's about the complications involving the urinary system, third item: consists of (7)items about Knowledge to patient's about the complications involving the eye disease, fourth item: consists of (10) items about Knowledge to patient's about the complications involving the nervous system, fifth item: consists of (9) items about Knowledge to patient's about the complications involving the foot problems. first item: consists of (10) items about management to patient's about the complications involving the cardiovascular system, second item: consists of (7) items about management to patient's about the complications involving the urinary system, third item: consists of (8) items about management to patient's about the complications involving the eye disease, fourth item: consists of (7) items about management to patient's about the complications involving the nervous system, fifth item: consists of (15) items about management to patient's about the complications involving the foot problems. Results: The findings of the study indicate that the patient’s knowledge and management regarding long-term complications is low and poor before the implementation of the instructional intervention but after the implementation of the instructional intervention the knowledge and management of diabetes mellitus type II greatly improved. Recommendations: The study recommended that the diabetes centers in Iraq should include instructional intervention about knowledge and management of diabetes mellitus type II for long-term complications to increase awareness of diabetic patients regarding knowledge and management for diabetes mellitus type II for long-term complications.

Disclosure: J.A. Hoyt: None. E.S. Gross: None. L. Au: None. P. Imas: None. R.J. Block: Founder: Vous Vitamins LLC.Introduction: Sodium-Glucose-Cotransporter-2 inhibitors (SGLT2i) limit glucose reabsorption in the convoluted tubule of the nephron to increase glucose excretion and consequentially promote glycemia. However, diabetic ketoacidosis (DKA) is a documented risk associated with SGLT2i use, and higher prescription rates have correlated with increased frequency of DKA in NorthShore/Endeavor hospitals. Since DKA is a physiologic process of dehydration, the diuretic effect of SGLT2i during times of acute illness can precipitate DKA. Hypothesis: We hypothesized that an education program targeting SGLT2i therapy cessation during high-risk situations such as acute illness and surgery could reduce rates of DKA seen in the NorthShore/Endeavor Health hospital system. Methods: To test this hypothesis, quality improvement measures including the creation of standardized care instructions for patients and providers were implemented and the rates of DKA seen among patients actively taking an SGLT2 were compared over the year prior to intervention implementation (2021) and the year following intervention implementation (2022). Chi-squared tests were used to compare differences in DKA prevalence and prescription rates among different specialties between pre- and post-intervention periods. Results: Rates of DKA decreased from pre-intervention rates of 2.7% of patients on SGLT2i to 2.0% of patients on SGLT2 post intervention (p=0.02). Among those with Type 2 Diabetes Mellitus, DKA rates fell from 39.7% pre-intervention to 33.9% post-intervention (p<0.001). Prescription rates from endocrinology (26.1% vs. 22.7%, p<0.001) and internal medicine (40.1% vs. 35.9% p<0.001) departments decreased while prescription rates from nephrology (0.3% vs. 1.2%, p<0.001) and cardiology (10.8% vs. 19.4%, p<0.001) increased. Conclusion: These data support that education remains a critical component of providing adequate care and highlight the success of our implemented education initiatives. Further, these results highlight the importance of tailored patient education on when to withhold SGLT2s, particularly for vulnerable groups.Presentation: Saturday, July 12, 2025

Background. Diabetes mellitus (DM) is a complex chronic condition and remains a public health concern worldwide. In South Africa (SA), many patients with DM access public sector primary healthcare clinics, and those who are considered to be stable are referred to the club system, which is managed by a multidisciplinary team. Patients who have DM are often diagnosed with concurrent medical conditions, resulting in multiple medication therapies that lead to medication therapy problems (MTPs). Prescriber adherence to standard treatment guidelines (STGs) is aimed at improving glycaemic control to minimise complications and decrease healthcare costs. The pharmacist’s role in medication therapy management (MTM) for DM is underutilised in public sector healthcare facilities. Objectives. To evaluate the implementation of a pharmacist-led MTM intervention to optimise the management of stable patients with type 2 DM attending a diabetes club at a Cape Town community day centre. Methods. An evaluation study design using a case study approach was conducted over 8 months from November 2016 to June 2017. A retrospective and prospective audit was conducted from patient folders of stable patients who attended the club. Quantitative data were extracted from the folders. A trained pharmacist audited baseline (pre-intervention) data. Prescribing staff were notified of therapeutic discrepancies through written pharmacist’s pharmacotherapeutic recommendations (intervention). Pharmacist-led interventions audited prescriber adherence to SA STGs and the Essential Medicines List, and prescriber responses to the pharmacist’s recommendations (post-intervention) were recorded as accepted, partially accepted or rejected. Estimated costs were calculated for rational and irrational prescribing of aspirin during the MTM process. Results. Of 104 patient folders audited, most were for females (n=70; 67.3%). A total of 453 MTPs were identified, averaging four interventions per folder reviewed. The most common MTPs identified were the absence of basic clinical data: body mass index not documented (22.5%) in the folder, no medical indication noted (19.2%), and laboratory tests not requested (18.3%) by clinicians. Prescriber acceptance of the pharmacist’s recommendations was found to be low (26.8%), suggestive of clinical inertia. Aspirin was found to be irrationally prescribed to patients with DM (15.4%). Conclusion. Pharmacists can identify, resolve and prevent MTPs and rationalise appropriate medication therapy in patients with DM. Prescriber uptake of pharmacists’ pharmacotherapeutic recommendations seems overlooked. Pharmacist-led workshops to advocate for rational prescribing are needed to mitigate MTPs among stable patients with type 2 DM at public sector healthcare facilities.

The aim of this study was to explore the effect of pocket book and video diabetic management toward knowledge and compliance level of diabetic management and blood glucose level. Design that employed was quasy ekperimental with non equivalen control group and was conducted in the time series. There were 38 respondents distributed into two groups, one of each consist of 19 respondents. Based on the Wilcoxon statistical test, the results showed that there was a significant different in the post test 2 both in the video group group (p= 0,004) and pocket book group (p= 0.001), in the knowledge level and diabetic management (video p=0.010, pocket book p= 0.005). However, there was not significant different in the blood glucose level for the both groups ( p > 0.05). Based on the result, it is recommended that implementation of intervention both for video and pocket book diabetic management should be underwent periodically ino 7 days maximally, therefore the expected goals can be gained.

Background: The association between pre-existing diabetes mellitus (DM) and subsequent increased incidence of breast cancer (BC), as well as worse survival after BC diagnosis, is well described. However, the reverse relationship of BC or metastases to development of new onset DM is unknown. Preclinical evidence suggests that increased bone destruction due to bone metastases or endocrine therapy impairs insulin secretion via TGFβ-mediated oxidation of the ryanodine receptor in pancreatic β- cells, predisposing patients to development of new onset DM. This analysis describes the prevalence and new onset of DM in metastatic BC compared to matched, unaffected controls and non-metastatic BC. Methods: This retrospective study collected data on women from the Indiana Network for Patient Care (INPC, a multi-health system electronic health record data warehouse), and the Indiana State Department of Health Cancer Registry from 2015 to 2017. Diagnosis of BC and metastases were established using ICD codes from INPC and confirmed in the cancer registry. DM was defined using a combination of ICD codes, diabetic medication prescriptions, and hemoglobin A1c &amp;gt;6.5%. Controls without BC were matched to all BC cases by birth year and race. The prevalence of DM before, or &amp;lt; 30 days after, BC diagnosis is described for non- cancer controls, all patients with BC, and subgroups without metastases, any metastases, and with bone metastases. In patients without evidence of DM prior to or &amp;lt; 30 days after BC diagnosis, the incidence of new onset DM was compared to matched controls over the same time period. The occurrence of new DM was evaluated both including and excluding the first 6 months after BC diagnosis to account for potential DM diagnosis simply due to medical attention. Prevalence and subsequent incidence of DM was compared between cases and controls using Pearson’s chi-square tests. Variables including demographics, comorbidities, BC treatment, A1c values, and DM treatments were also collected. Results: Any DM diagnosis, pre-existing DM, and new onset DM were higher in breast cancer cases compared to controls (Table). While pre-existing DM was similar between those with metastatic and non-metastatic DM (35.0% vs. 32.2%, p=0.22), new onset DM was higher in metastatic disease compared to non-metastatic BC (14.4% vs. 7.0%, p&amp;lt;0.001). Hemoglobin A1c was higher in those with metastatic disease, particularly those with bone metastases (8.8 vs 7.5, p&amp;lt;0.001). Conclusions: Diabetes is highly prevalent in this Indiana BC cohort. Incidence of new onset DM after BC is higher in those with metastatic BC compared to both controls and BC cases without metastatic disease. Hemoglobin A1c was highest in those with bone metastases, further supporting the hypothesis that bone turnover may influence insulin secretion and glucose metabolism. Additional investigation will analyze the influence of medications (chemo-, endocrine, and bone protective therapy) on development of DM. As more patients live longer with metastatic BC, identification and management of DM will be imperative given its impact on BC survival, treatment delivery, healthcare costs, and quality of life. ControlsBreast cancer (BC) casesAllNon-metAll metBone metNon-bone metTotal n10212102129760452236216Any DM, n (%)2464 (24.1)4406 (43.1)3823 (39.2)223 (49.3)111 (47.0)112 (51.9)p-value2&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001Pre-existing DM1, n (%)2111 (20.1)3301 (32.2)3143 (32.2)158 (35.0)81 (34.3)77 (35.6)p-value2&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001New DM after BC1, n (%)353 (3.5)745 (7.3)680 (7.0)65 (14.4)30 (12.7)35 (16.2)p-value2&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001New DM &amp;gt; 6 months after BC1, n (%)336 (3.3)621 (6.1)565 (5.8)56 (12.4)27 (11.4)29 (13.4)p-value2&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001&amp;lt;0.001HgbA1c in those with DM, Mean (SD)7.6 (1.6)7.6 (1.6)7.5 (1.6)8.3 (2.1)7.5 (1.6)8.8 (2.3)p-value21.00.001&amp;lt;0.0010.40&amp;lt;0.0011- For controls, values in relation to index date. 2 - p-values versus controls. Citation Format: Tarah Ballinger, Sarah El-Azab, Ziyue Liu, Theresa Guise, Erik Imel. High prevalence and incidence of new onset diabetes in metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-11.

The primary objective of this study is to determine the effect of baseline use of angiotensin-converting enzyme inhibitor (ACE-i)/AT1 blocker (ARB) on mortality in hospitalized coronavirus disease 2019 (Covid-19) African-American patients. The secondary objectives are, to determine the effect of baseline use of ACE-i/ARB on the need for mechanical ventilation, new dialysis, ICU care, and on composite of above-mentioned outcomes in the same cohort. In this retrospective study, we analyzed data using electronic medical records from all hospitalized Covid-19 African-American patients, who either died in the hospital or survived to discharge between 2 March and 22 May 2020. Patients were divided into two groups, those on ACE-i/ARB at baseline and those not on them. We used Pearson chi-square test for categorical variables, and Student's t test for continuous variables. We performed multiple logistic regression to test the primary and secondary objectives using SAS 9.4. Out of 531 patients included in the analysis, 207 (39%) were on ACE-i/ARB at baseline. Patients in ACE-i/ARB group were older (64 vs. 57 years, P < 0.001), and had higher prevalence of hypertension (96.6 vs. 69.4%, P < 0.001) and diabetes mellitus (55.6 vs. 34.9%, P < 0.001). There was no difference in sex, BMI, other comorbidities, and presenting illness severity among the groups. After adjustment of multiple covariates, there was no difference in outcomes between the two groups including mortality, need for mechanical ventilation, new dialysis, ICU care, as well as composite outcomes. Baseline use of ACE-i/ARB does not worsen outcomes in hospitalized Covid-19 African-American patients.