A1c Values Research Articles

Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study.

This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12-4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33-5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23-6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46-8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.

Factors Associated With Improved A1C Values Among People Using High-Dose Insulin With Uncontrolled Type 2 Diabetes.

Uncontrolled diabetes negatively affects millions of people in the United States and contributes to significant health burden. Many people with diabetes require high insulin doses to achieve glycemic control, but glycemia in this group has historically been difficult to manage. This retrospective, case-control study evaluated which therapeutic interventions and patient factors were associated with an improvement in A1C in people with type 2 diabetes using high-dose insulin at a county health system serving primarily low-income patients. Medication nonadherence was found to be the most influential factor affecting glycemic control in these individuals.

Glycemic Control and Metabolic Parameters in Children and Adolescents With Type 1 Diabetes.

The association between glycemic control and metabolic status is poorly defined in children and adolescents with T1D, besides being biologically plausible. We aimed to evaluate the association between glycemic control and body mass index (BMI), blood pressure (BP), and lipid profile in children and adolescents with T1D. Observational cross-sectional study including children and adolescents (5-18 years old) followed in our outpatient clinic with the diagnosis of T1D for at least a year. We used linear regression models (unadjusted and adjusted to sex and age) to evaluate the association between glycated hemoglobin (A1c) and time in range (TIR), several prespecified metabolic parameters, and prespecified demographic and clinical characteristics. We considered a p-value of <0.05 to be statistically significant. A total of 144 patients were included, 51% of whom were female. The population had a mean age of 12.7±3.4 years old. We report a positive association between A1c and BMI, systolic and diastolic BP, total- and LDL-cholesterol and triglycerides. Females and patients diagnosed at a younger age presented with higher A1c values. There is a tendency for a negative association between TIR and the former parameters. Higher A1c levels and lower TIR were associated with higher glycemic variability and were treated with a higher basal insulin per Kg dose. Our results support an important association between worse glycemic control and an unhealthier metabolic profile in children and adolescents with T1D. We can hypothesize that a good glycemic profile is needed to achieve good metabolic control at a young age.

ƩexcessA1C index, the sum of yearly excess HbA1c values during the total period of diabetes, may have the potential to predict retinopathy by a linear regression setting regardless of duration in type 1 diabetes: a subgroup analysis of DCCT/EDIC data.

To find an index of glycemic exposure that predicts retinopathy by a simple regression setting regardless of duration in type 1 diabetes which might be useful for the care of diabetes. To exclude the possible disturbing effect of metabolic memory, we examined a subgroup of patients with glycohemoglobin A1c (A1C) data for the total period of type 1 diabetes selected from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications data. Three indices-(1) mean value of yearly A1C (mA1C), (2) sum of yearly A1C values (ƩA1C), and (3) sum of yearly A1C values above 6.5% (ƩexcessA1C)-were assessed as potential candidates. Development of retinopathy was defined by ≥ 3-steps' progression of retinopathy from baseline. The areas under the receiver operating characteristics curves of the indices for development of retinopathy at years 5, 9, and 13 after the onset of diabetes were the same: 0.8481, 0.8762, and 0.8213, respectively, indicating that each index was substantially capable of predicting development of retinopathy at each timepoint. Linear regression analyses showed that each index had significant and substantial linear relations to retinopathy at each timepoint: all P < 0.0001 for slopes; contribution rate R2 = 0.21 (year 5), 0.46 (year 9), and 0.48 (year 13) for each index. But only ƩexcessA1C index appeared to have similar linear relations to retinopathy at all three timepoints (interactions by timepoint: for slopes: P = 0.1393; for intercepts: P = 0.9366). ƩexcessA1C may have the potential to predict retinopathy by just one linear regression setting regardless of duration in type 1 diabetes.

Diabetes Mellitus in the Elderly Adults in Korea: Based on Data from the Korea National Health and Nutrition Examination Survey 2019 to 2020.

We evaluated the prevalence and management of diabetes mellitus (DM) in elderly Korean patients based on data from the Korea National Health and Nutrition Examination Survey (KNHANES). A total of 3,068 adults aged 65 years and older (19.8% of total population) were analyzed using KNHANES from 2019 to 2020. Prevalence, awareness, treatment, and control rates, and comorbidities were analyzed. Lifestyle behaviors and energy intake were also measured. The prevalence of DM and prediabetes was 29.6% and 50.5%, respectively. The awareness, treatment and control rates were 76.4%, 73.3%, and 28.3%, respectively. The control rate was 77.0% if A1C <7.5% criteria was used. The mean A1C value of individuals with known DM was 7.1%, and 14.5% of the known DM patients had A1C ≥8.0%. Abdominal obesity, hypertension, and hypercholesterolemia were combined with DM in 63.9%, 71.7%, and 70.7%, respectively, and the rate of integrated management was 36.0% (A1C <7.5% criteria). A total of 40.1% of those with DM walked regularly. The percentage of energy intake from carbohydrates was higher in those with DM than in those without DM (P=0.044), while those of fat (P=0.003) and protein (P=0.025) were lower in those with DM than in those without DM in women. In 2019 to 2020, three of 10 adults aged 65 years and older in Korea had DM, and approximately 70% of them had comorbidities. A strategy for more individualized comprehensive care for the elderly patients with DM is urgently needed.

Diabetes Self-Care Activities and Their Relationship With Glycemic Control in Patients Visiting Hayatabad Medical Complex, Peshawar.

Background A significant portion of the Pakistani population is affected by diabetes, which has emerged as a global healthcare concern. Objective This study aimed to assess the correlation between glycemic control in diabetes patients and their engagement in diabetes self-care activities (DSCA). Methodology Cross-sectional research was conducted at Hayatabad Medical Complex in Peshawar between June 2019 and May 2020. A total of 280 carefully selected patients with type 2 diabetes mellitus (T2DM) were included. Data collection involved an interviewer-administered questionnaire encompassing sociodemographic information, diabetes-related data, and the summary of the Diabetes Self-Care Activities (SDSCA) scale. Descriptive statistics and Pearson's chi-square test were employed for data analysis. Results The study observed that the majority of participants (40.36%) were females, and the age range of the participants was between 42 and 53 years (68.22%).According to the study, 55.00% of participants had a normal body mass index (BMI), and 71.08% of participants had diabetes in their family. Regarding glycemic control, 55.71% of individuals exhibited good control based on fasting blood sugar (FBS) levelswhile 74.64% showed poor control according to hemoglobin A1C (HbA1c) values. HbA1c was substantially linked with a general diet (healthy eating plan), physical activities, and adherence to medication ((odds ratios (OR): 3.12), (95% confidence interval (CI): 1.02 - 8.78), (P value: 0.031)); ((OR: 2.19, 95%), (CI:1.18 - 3.79), (P value: 0.003)); ((OR: 2.85), (95% CI: 1.22 - 6.59), P value: 0.021)). Conclusion The findings indicated that health professionals need to create health education programs on DSCA in order to increase DSCA adherence in people with T2DM while maintaining glycemic control.

The prevalence of Dupuytren’s disease in patients with diabetes mellitus

BackgroundDupuytren’s disease (DD) is a fibroproliferative hand disorder associated with various medical conditions, including diabetes mellitus (DM). The reported prevalence of DM among DD patients varies widely, primarily due to small sample sizes in previous studies.MethodsThis was a retrospective cohort study using data from the TriNetX Research Database. We analyzed the overall prevalence of DD between 2010 and 2020, comparing the DM, type 1 diabetes mellitus (T1DM), and type 2 diabetes mellitus (T2DM) cohorts. Within the DM group, patients were further categorized based on hemoglobin A1c (HbA1c) values and prescribed anti-diabetic agents (insulin or metformin). We compared the prevalence of DD diagnosis in each group using prevalence ratios and differences.ResultsThere is a higher prevalence of DD in patients with T2DM than in patients with T1DM (relative risk [RR]: 1.641; 95% confidence interval [CI]: [1.356, 1.986]). Among patients with diabetes, there is a higher prevalence of DD in those taking insulin compared to those taking metformin (RR: 0.801, 95% CI: [0.774, 0.83]). The prevalence of DD varies depending on HbA1c levels, with a prevalence of 0.463% in patients having levels within the diabetic range, while lower prevalences of 0.392% and 0.416% are found in patients with prediabetes or uncontrolled diabetes, respectively.ConclusionsThis study provides further insight into the relationship between DM and DD. These findings may be attributed to the increased accumulation of advanced glycosylated end products (AGEs) in patients with diabetes. Future research exploring the connection between AGE accumulation and DD development may enhance our understanding of the relationship between DD and DM.

Case Study: Hashimoto’s Thyroiditis and Increased HbA1C

Several metabolic problems and clinical symptoms are caused by hypothyroidism. According to some research, hypothyroidism may cause blood sugar levels to rise. It has been shown that people with diabetes who also have hypothyroidism may have higher Hemoglobin A1C values (HBA1C). This test is used to diagnose and monitor diabetes patients' blood sugar control. A high HBA1C typically implies poor diabetes management. Patient was suffering from Hashimoto’s Thyroiditis, which was diagnosed through blood investigations and was given treatment as per functional medicine approach. HbA1c was seen high in start, which reduced significantly after functional medicine treatment and therapies. Our study suggests that we should be cautious while interpreting HbA1c values in patients with hypothyroid and treating patients while observing all their symptoms and treating them by working on their root cause i.e., functional medicine approach.

The Effects of Hemoglobin A1c on Complications in Implant-Based Breast Reconstruction

Background Given the prevalence of diabetes and high complication rate of breast reconstruction, it is prudent to ascertain if there is an association between hemoglobin A1C levels and outcomes in patients undergoing implant-based breast reconstruction. This may help guide clinical decision making and also inform patients of their relative risk of complications. Methods A retrospective review of 203 patients that underwent implant-based breast reconstruction at a single institution was conducted. All patients required a documented pre-operative A1C. Patients were then categorized by A1C level into three groups: normal (&lt;5.7%), prediabetic (5.7% to 6.4%), or diabetic (&gt;6.5%). Patient demographics and postoperative complications were evaluated in relation to A1C values during both the initial tissue expander placement and subsequent exchange operations. Data was evaluated using a two-sample t-test for continuous variables, chi-squared for categorical variables and univariate logistic regression models were performed. Results 203 patients were divided into normal (n=135), pre-diabetic (n=40), and diabetic (n=28) cohorts. Patients in the diabetic and pre-diabetic group were generally older (p=0.011), Caucasian (p=0.007), higher weight (p=0.002) with elevated BMI (p&lt;0.001), and a higher percentage of hypertension (p&lt;0.001). The prediabetic and diabetic groups had a higher percentage of overall complication rate (57.5% and 53.8% respectively), when compared to the normal cohort (31.3%) (p=0.003). The percentage of patients that sustained a loss of their tissue expanders was also increased in the prediabetic (10%) and diabetic groups (22.2%) (p= 0.029). The diabetic population was more likely to have a complication (OR=2.56, 95% CI [1.09,6.00]) and to have tissue expander loss (OR 4.5, 95% CI [1.42,14 .28]) after their tissue expander placement when compared to the normal population. There was no increased complications or tissue expander loss associated with A1C levels for the subsequent surgery for permanent implant placement. Conclusion Patients with elevated A1C are at an increased risk for overall complications and diabetic patients are at increased risk for tissue expander loss during the first stage of implant-based breast reconstruction. There were no associated risks for the implant exchange procedure. A preoperative hemoglobin A1C should be considered for patients seeking implant-based tissue expander breast reconstruction to discuss surgical risk.

Optimal glycated hemoglobin A1c value for prediabetes and diabetes in patients with pancreatic diseases.

Some articles suggest that using HbA1c alone for diabetes diagnosis is inappropriate. It requires considerable researches to explore the efficacy of HbA1c for diagnosing hyperglycemia in patients with pancreatic disease. This study analyzed 732 patients, comprising of 331 without pancreatic disease and 401 patients diagnosed with pancreatic diseases. All participants underwent the HbA1c assay and oral glucose tolerance test. Kappa coefficients were calculated to assess agreement between the HbA1c and glucose criteria. The receiver operating characteristic curve (ROC) was used to calculate the optimal HbA1c value. DeLong test was analyzed to compared the aera under curves (AUCs). There were 203 (61.3%) patients with NGT, 78 (23.6%) with prediabetes, and 50 (15.1%) with diabetes in patients without pancreatic diseases. In patients with pancreatic disease, 106 participants were diagnosed with NGT (36.4%), 125 with prediabetes (31.2%), and 130 with diabetes (32.4%). Patients with pancreatic disease exhibited elevated levels of bilirubin, transaminase enzymes, aspartate transaminase, high density lipoprotein cholesterol and total bile acid. The sensitivity and specificity of the HbA1c (6.5%) for diagnosing pancreatic diabetes were 60.8% (95% CI 52.3, 69.3) and 92.6% (95% CI 89.5, 95.7). In prediabetes, the sensitivity and specificity of HbA1c (5.7%) is 53.2% (44.3, 62.0) and 59.6 (51.5, 67.6). The optimal HbA1c value for diagnosing diabetes was 6.0% (AUC = 0.876, 95% CI 0.839, 0.906), with the sensitivity of 83.8% and the specificity of 76.8%. The optimal HbA1c value for the diagnosis of prediabetes was 5.8% (AUC = 0.617, 95% CI: 0.556, 0.675), with the corresponding sensitivity and specificity of 48.0% and 72.6% respectively. The combined tests (HbA1c, 6.0% or FPG, 7.0mmol/L) presented the sensitivity of 85.7% (95% CI 79.1, 91.3)and the specificity of 92.6% (95% CI 87.6, 97.3) in pancreatic diabetes. From our results, the recommended HbA1c by ADA criterion may not be sufficiently sensitive to diagnose hyperglycemia in pancreatic disease. The optimal value of 5.8% and 6.0% improved the accuracy for diagnosing prediabetes and diabetes and should be considered to be applied. Besides, we advocate the combination of HbA1c and FPG test for the diagnosis of diabetes in patients with pancreatic diseases.

Corneal Endothelial Morphological Alterations in Type 2 Diabetes: Associations with Glycemic Control, Disease Duration, and Diabetic Retinopathy Severity—A Cross-Sectional Study in Benghazi, Libya

Background The corneal endothelium is essential for maintaining corneal transparency and fluid regulation, and its dysfunction can lead to corneal edema and decreased visual acuity. Corneal specular microscopy is used to detect corneal disorders early. Aim This study aimed to evaluate morphological changes in the corneal endothelium of patients with type 2 diabetes mellitus (DM) using specular microscopy. Methods This study enrolled 50 individuals with type 2 diabetes and 50 nondiabetic individuals as control subjects. Patients with certain ocular and systemic conditions were excluded. The collected data included demographic information, medical history, recent hemoglobin A1c (HbA1c) values, visual acuity, ophthalmological examination, and diabetic retinopathy (DR) staging. The corneal endothelial morphology was evaluated using a noncontact specular microscope, which measured corneal endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation of cell size (CV), and hexagonality. The data were analyzed using SPSS software, and the results were presented as mean ± standard deviation, numbers, and percentages. An unpaired t-test was used to compare different means, and a p-value less than 0.05 was considered statistically significant. Results A majority of diabetic patients (62%) had diabetes for more than 10 years, and 58% of them had higher than 7.5% HbA1c levels. In terms of DR severity, 46% of patients had mild nonproliferative diabetic retinopathy (NPDR), 36% had moderate NPDR, and 10% had severe NPDR. There were significant differences between diabetic and nondiabetic groups in corneal ECD (2480 ± 223 cells/mm2 for DM group vs. 2652 ± 234 cells/mm2 for non-DM), hexagonality (39.6 ± 2.8% for DM group vs. 47 ± 2.1% for non-DM), CV (42 ± 2.9% for DM group vs. 35.5 ± 2.3% for non-DM), and CCT (550 ± 14.8 µm for DM group vs. 530 ± 9.6 µm for non-DM). Patients who had diabetes for more than 10 years had significantly lower ECD (2356 cells/mm2 vs. 2689 cells/mm2), lower hexagonality (39 vs. 41%), and higher CV (43 vs. 41%) and higher CCT (553.9 ± 4.6 vs. 545.5 ± 4.0) than those with less than 10 years of diabetes. As the severity of DR increased, there was a significant decrease in ECD (from 2641 ± 194 cells/mm2 for mild NPDR to 2310 ± 82 cells/mm2 for severe PDR), a decrease in hexagonality (from 40.9 ± 3.2% for mild PDR to 37.4 ± 1.1% for severe PDR), an increase in CV (from 40.1 ± 2.3% for mild PDR to 44 ± 2.9% for severe PDR), and an increase in CCT (from 543.7 ± 13.8 for mild PDR 563.8 ± 2.9 for severe PDR). Conclusion This study revealed that type 2 diabetes is associated with significant reductions in ECD and hexagonality, as well as an increase in CV and CCT. The severity of DR and the duration of diabetes were correlated with changes in these parameters. These findings underscore the need for a comprehensive evaluation of corneal health in diabetic patients.

The effect of type 2 diabetes mellitus on spontaneous bacterial peritonitis among patients with decompensated liver cirrhosis

Abstract Background Type 2 diabetes mellitus (T2DM) is a common comorbidity among liver cirrhosis cases. However, there are few data indicating the effect of DM on spontaneous bacterial peritonitis (SBP). Aim To evaluate the effect of DM and glycosylated hemoglobin A1c (HbA1c) values on the prevalence of SBP in cases with liver cirrhosis and ascites. Patients and methods A total of 120 cases with liver cirrhosis and ascites were evaluated. The presence of DM and HbA1c was measured at the time of the first paracentesis. Cases were followed for 1 year. SBP development was the primary outcome. Results During follow-up, DM cases had an elevated chance of developing SBP [hazard ratio (HR): 1.767; P=0.026]. Cases with HbA1c values more than or equal to 8.5% had a greater risk for development SBP within 90 days than DM cases with values less than 8.5% (HR: 1.478; P=0.271). Cases with HbA1c values more than or equal to 8.5% had a greater chance of getting SBP within 90 days than non-DM cases (HR: 1.738; P=0.119). DM cases with HbA1c values less than 8.5% had an increased chance of having SBP within 90 days than non-DM cases (HR: 1.188; P=0.687). Conclusions Cases with both liver cirrhosis and T2DM have an increased chance of developing SBP. HbA1c readings may be beneficial for stratifying the risk of SBP among DM cases, hence identifying individuals who might benefit from antibiotic prophylaxis.

Investigation the impact of liraglutide on the thyroid function tests

Aim: Liraglutide is a once-daily glucagon-like peptide-1 receptor agonist (GLP‑1 RA) which is an incretin hormone secreted from intestinal L cells in response to nutritional intake and stimulates glucose-dependent insulin secretion, decreases hepatic glucagon secretion, slows gastric emptying, provides a feeling of satiety and is the first GLP‑1 RA to be indicated for weight loss treatment for obesity. The impact of liraglutide on thyroid function tests is unknown and to the best of our knowledge, there are no studies on this regard. Our aim is to compare thyroid function tests, other biochemical and hemogram parameters before and 6 months after liraglutide treatment.&#x0D; Material and Methods: The patients, 18-65 years old, who used liraglutide for at least 6 months due to obesity treatment between January 2021 and January 2023 in Burdur State Hospital were included.&#x0D; Results: There were 51 patients (39 female, 12 male) using liraglutide without thyroid disease during the study period. Twelve patients discontinued liraglutide use before the 6th month of treatment was completed. Weight, body mass index (BMI), fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), low-density lipoprotein (LDL), triglyceride and thyroid-stimulating hormone (TSH) values were significantly lower at the 6th month of treatment. Free thyroxine (FT4) and free triiodothyronine (FT3) values were similar. and there was no difference other biochemical and hemogram parameters between before and 6 months after treatment&#x0D; Conclusion: We found a significant decrease in TSH values and improvement in metabolic parameters, but no change in thyroid hormone levels.

54-LB: The Kids Are Not Alright—Capturing the Need for Effective Intervention for Adolescents with Elevated A1C

Background: Adolescents with T1D and elevated A1c are at high risk of acute and chronic complications. While behavioral health interventions have demonstrated promise in optimizing A1c, real-life clinical practice indicates uncertainty regarding which youth will show improvement, extent of improvement, and factors predicting complications over time. Methods: This 5-site longitudinal study enrolled caregivers (n=218) of youth aged 12-17 yrs (M=14.6 ±1.6 yrs) with T1D for &amp;gt;1 year and ≥ one A1c &amp;gt;10% in past year. Data included admissions, ED visits, and A1c one year pre- through 6 months post-enrollment. Family members reported on baseline functioning across multiple domains. Inferential tests (e.g., chi square, nonparametric) examined change over time in A1c and utilization as well as predictors of future ED visits. Results: Acute utilization did not change over time. A1c post enrollment significantly decreased from 11.1% ±1.5% to 10.9% ±2.1% (p=.03), but absolute change was minimal. 40.2% of youth did not have an A1c value available post enrollment. Caregiver reports of higher diabetes distress, higher conflict with healthcare providers, and lower social support were associated with risk of future ED visits (p&amp;lt;.01). Conclusion: Findings indicate strong need for systematic psychosocial screening and more intensive tailored behavioral intervention efforts for this youth with elevated A1c. Disclosure D. V. Wagner: None. A. Bonilla ospina: None. M. E. Hilliard: None. M. A. Harris: None. M. A. Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. J. Raymond: None. J. C. Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D. Naranjo: None. A. Reed: None. K. A. Torres: None. S. Melnick: None. J. Flores garcia: None. Funding JDRF

943-P: Improved Glycemic Outcomes after One Year among Level 2 Members

Background: Level2’s virtual specialty clinic, offered across the United States to people with type 2 diabetes on participating insurance plans, combines providers, coaches, continuous glucose monitors (CGM), and fitness trackers to help members gain insight, and focus on long-term behavior change. We retrospectively assessed differences in glycemic outcomes following one year of participation in Level2. Methods: People joining Level2 between 01/01/21 and 07/31/21 with 15 months of Level2 participation and 3 prior months of continuous enrollment in a participating commercial health plan were included in the analysis. We used CGM-derived GMI and A1c values available from a database of de-identified administrative claims to determine baseline and 12-month follow-up glycemic outcomes. Wilcoxon signed-rank tests were used to test for pair-wise improvements in glycemic measures between baseline and follow-up overall and stratified by baseline A1c. Results: Of the 3,440 people identified for the analysis, a subset (N = 200) had both baseline A1c and valid GMIs during follow-up. This subset was 53% (N = 106) male with mean age of 55.4 (SD = 8.5) years and had mean baseline A1c of 7.97% (SD = 1.02). The median difference between baseline A1c and follow-up GMI was -0.83% (p &amp;lt; 0.001) overall, with significant differences of -0.82% (p &amp;lt; 0.001) and -2.41% (p &amp;lt; 0.001) in those with baseline 7% &amp;lt; A1c &amp;lt; 9% and A1c &amp;gt; 9%, respectively. Over 50% of people had a decrease in glycemic outcome of more than 0.5%, with 67% and 95% of people improving by more than 0.5% in the 7-9% and &amp;gt; 9% groups respectively. There were 87 people that also had an A1c at 12-month follow-up; the median difference in A1c was -0.65% (p &amp;lt; 0.001), 50% had a decrease of more than 0.5%, and median difference between GMI/A1c follow up values was 0.13 (p = 0.11). Conclusion: Level2 members with baseline A1c and follow-up GMI saw significant improvements in glycemic control over one year of engagement. These improvements were observed for measures of both follow-up A1c and GMI. Disclosure S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. D.Ferrell: Stock/Shareholder; Level2, Medexpress Urgent Care. J.Fung: Employee; Level2.

1253-P: Differences in Screening-Detected Type 2 Diabetes—Evidence from Two Campaign Setups in Denmark

Background: Early detection of type 2 diabetes mellitus (T2DM) increases life expectancy of T2DM patients and reduces societal health care costs. Targeted screening campaigns are used for early detection of T2DM, but different campaign setups may yield different detection results. Methods: Between June and November 2022, the Danish Diabetes Association offered free capillary A1c tests to individuals at high risk of developing diabetes based on the Leicester’s Risk Score questionnaire (score ≥ 16 points). Two campaign setups were applied: a) an event-based community screening campaign in 20 of the largest Danish cities using a portable Point of Care Testing analyzer and b) a social media campaign offering at-home self-sampling tests using mailed Hemoglobin Capillary Collection System. Results: A total of 1,337 and 2,655 individuals at high risk were tested through the community and the social media setup, respectively. The proportion of men and women in both setups were evenly balanced across all age groups. However, compared to the social media setup, in the community setup the proportion of individuals aged below 60 years was 14 percentage points lower, while the proportion of individuals aged 70 years or older was 14 percentage point higher. While 2.6% of the participants in both setups had A1c values ≥ 48 mmol/mol, 8.8% in the community setup and 15.6% in the social media setup had A1c values of 42-47 mmol/mol. The relative difference in the proportion of participants with A1c values of 42-47 mmol/mol was balanced across all age groups. Conclusions: Targeted community and social media screening campaigns are complementary. While older individuals (70 years or above) tend to participate in the community screening campaign, younger individuals (below 60) tend to participate in social media screening campaign. However, social media campaigns for at-home self-sampling prove highly efficient in detecting individuals with A1c values of 42-47 mmol/mol compared to community campaigns. Disclosure N.Cayuelas mateu: Other Relationship; Abbott Diagnostics. T.Thybo: Other Relationship; Abbott Diagnostics.

272-OR: The Efficacy of Sotagliflozin on Heart-Failure Related Outcomes Is Independent of Baseline A1C

Background: SGLT inhibitors reduce the risk of cardiovascular (CV) events in patients with heart failure (HF) and chronic kidney disease regardless of diabetes status. Although the SOLOIST-WHF and SCORED trials enrolled high CV risk patients with T2DM, participants had a wide range of baseline A1C values. Thus, the present analysis evaluated the effects of sotagliflozin relative to placebo on cardiovascular (CV) death and total HF-related outcomes by baseline A1C range. Methods: SOLOIST-WHF had no baseline A1C entry criteria (baseline median = 7.1%, range = 4.5, 15.0%), while SCORED randomized patients with T2DM and an A1C ≥7% at screening (8.3%, 6.5, 17.3%). Natural cubic splines from Poisson regression models estimated the relationships between continuous A1C and the primary endpoint for both studies: total number of CV deaths, hospitalizations for HF, and urgent visits for HF. Results: Within each trial, patients with higher baseline A1C experienced higher event rates (spline effect p=0.0349 and 0.0014 for SOLOIST-WHF and SCORED, respectively). Sotagliflozin reduced the primary outcome in each trial (p for treatment &amp;lt;0.0001 for both SOLOIST-WHF and SCORED) and this did not differ across A1C (p for interaction &amp;gt;0.10; Figure). Conclusion: Sotagliflozin was effective in reducing the risk of CV death and HF-related events independent of baseline A1C. Disclosure R.Aggarwal: None. D.L.Bhatt: Board Member; Bristol-Myers Squibb Company, Research Support; Lexicon Pharmaceuticals, Inc., Sanofi, Lilly, Boehringer Ingelheim Inc., AstraZeneca, Novo Nordisk. M.Szarek: Consultant; Amarin Corporation, ESPERION Therapeutics, Inc., Other Relationship; Janssen Pharmaceuticals, Inc., Research Support; Lexicon Pharmaceuticals, Inc., Regeneron, Sanofi, Bayer Inc. M.J.Davies: Employee; Lexicon Pharmaceuticals, Inc. P.L.Banks: Employee; Lexicon Pharmaceuticals, Inc. B.Pitt: Consultant; Bayer Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Vifor Pharma Management Ltd., Lexicon Pharmaceuticals, Inc., PhaseBio Pharmaceuticals, Inc., KBP Bioscience, Merck &amp; Co., Inc. P.G.Steg: Advisory Panel; Merck &amp; Co., Inc., Consultant; Sanofi, Amarin Corporation, Amgen Inc., BMS, PhaseBio Pharmaceuticals, Inc., Idorsia Pharmaceuticals Ltd., Novartis AG, Janssen Pharmaceuticals, Inc., AstraZeneca, Research Support; Lexicon Pharmaceuticals, Inc.

932-P: Impact of a Titration App for Basal Insulin on Glycaemic Outcomes in People with Type 2 Diabetes on an Oral-Basal Insulin Regimen—Results of an RCT

A multicenter RCT analyzed the efficacy of a basal insulin titration app (myDose Coach; MDC) in people with type 2 diabetes and newly initiated or existing basal insulin treatment. We randomized 251 participants in a 1:1 ratio to either the intervention arm (insulin titration with MDC) or the control arm (insulin titration without App). The primary outcome was A1c reduction after 3-month. Baseline data (median age 60.0 years IQR 56.0 - 66.5; HbA1c 8.2 IQR 7.7 - 9.1%) showed no significant differences. After a median follow-up of 91.0 days, the intervention group showed a reduction in HbA1c of 0.93, IQR 0.40 - 1.57 percentage points compared to the control group (0.6; IQR 0.10 -1.40); adjusted difference between groups 0.35; 95% CI 0.35 0.01 - 0.69; p=0.0064. Improvements in follow-up A1c were evident across the range of A1c values (Figure 1). The respective differences between groups in glucose level (19.3; 95% CI 9.10 - 29.97 mg/dl; p=0.0012), fasting glucose (10.5; 95% CI 1.5 - 19. 0 mg/dl) and % &amp;lt; 180 mg/dl (12.2; 95% CI 3.8 - 20.5; p=0.0065) all favored the intervention group, while % &amp;lt; 70 mg/dl (−0.2; 95% CI −1.0 - 0.6; p=0.8778) did not differ substantially. Titration of basal insulin with the MDC app significantly improved glycemic management, without increasing exposure to low glucose values substantially. Thus, titration with the MDC app has a medical benefit beyond usual care. Disclosure N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. K.Finke-groene: None. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. Funding Sanofi

Blood DNA methylation biomarkers for cognitive decline in older adults with type 2 diabetes

AbstractBackgroundIndividuals with type 2 diabetes (T2D) are at particularly high risk for cognitive decline and dementia. Finding early, pre‐clinical biomarkers for detecting and tracking cognitive impairment and dementia in this population is important for personalized medicine approach. Our study aims to find blood DNA methylation biomarkers for cognitive decline among elderly T2D patients.MethodTwo groups of 30 T2D subjects each, from the Israel Diabetes and Cognitive Decline (IDCD) cohort, were included. One group (converters) was cognitively normal at baseline, yet at 36‐54 months follow‐up deteriorated from a Clinical Dementia Rating scale CDR = 0 (no dementia) to CDR≥0.5 (questionable dementia or frank dementia). The control group (non‐converters) was cognitively normal at baseline and maintained normal cognition during the follow‐up period (CDR = 0). We performed an epigenome‐wide association study, using the Illumina Infinium MethylationEPIC microarray, and searched for differentially methylated positions (DMPs) with significant methylation alterations (≥ 2 fold and FDR corrected p value &lt;0.05) between the baseline and the follow‐up time points for each of the two groups.ResultParticipants were 65‐83 years of age (mean‐73.6 ± 4.1), 72% were men. The mean hemoglobin A1C value was 6.9 ± 0.8%, and T2D duration was 9.4 ± 4.7 years. Converters and non‐converters did not differ in any of these characteristics. Results show significant changes in multiple DMPs among the converters, but only in a few DMPs in the non‐converters. Gene ontology analyses indicates primarily involvement of central nervous system‐related pathways, mainly neurodevelopmental disorders.ConclusionThese preliminary results, employing a high‐throughput approach for methylation profile in blood, suggest methylomic alterations as a potential biomarker for cognitive decline in T2D elderly. A priori identification of patients at risk for cognitive decline may lead to early intervention in modifiable risk factors in this population, which is highly susceptible to dementia.

Modifiable Risk Factors for Prevention in Dupuytren Disease: A UK Biobank Case-Control Study.

Dupuytren disease is associated with significant comorbidity and mortality, and it has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren disease, and to investigate associations with other diseases. Using UK Biobank data, this case-control study analyzed the association between phenotypic variables and Dupuytren disease through multivariable logistic regression. Exposures assessed were age, sex, body mass index, waist-to-hip ratio, Townsend deprivation index, smoking status, alcohol intake, diabetes mellitus, hypertension, cancer, liver disease, respiratory disease, rheumatoid arthritis, epilepsy, psoriasis, and gout. There were 4148 cases and 397,425 controls. Male sex (OR, 3.23; 95% CI, 2.90 to 3.60; P = 1.07 × 10 -100 ), increasing age (OR, 1.08; 95% CI, 1.07 to 1.08; P = 6.78 × 10 -167 ), material deprivation (OR, 1.01; 95% CI, 1.00 to 1.02; P = 0.0305), high-density lipoprotein cholesterol (OR, 1.76; 95% CI, 1.58 to 1.96; P = 3.35 × 10 -24 ), smoking exposure, and alcohol intake were all associated with increased odds of Dupuytren disease. With increasing obesity class, there was approximately 25% decreased odds (OR, 0.774; 95% CI, 0.734 to 0.816; P = 4.71 × 10 -21 ). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren disease (OR, 2.59; 95% CI, 1.92 to 3.44; P = 1.92 × 10 -10 ). Within this group, increasing hemoglobin A1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR, 1.31; 95% CI, 1.13 to 1.51; P = 2.19 × 10 -4 ). Diabetes and poor glycemic control are major risk factors for Dupuytren disease, which present an opportunity for prevention. Risk, III.