Acute Complications Of Diabetes Research Articles

Study of ketoacidosis and its determining factors of mortality among the diabetic patients admitted in a tertiary hospital

Introduction: Ketoacidosis is one of the acute metabolic complications of diabetes. It is more common and has a higher death rate in India &south Asia. To our knowledge, there are very few studies done on diabetic ketoacidosis in Madhya Pradesh. The aim of our study was to determine the hospital prevalence of diabetic ketoacidosis, to describe their epidemio-clinical features as well as to look for determinants of hospital mortality in patients attending Bundelkhand Medical college tertiary hospitalMethods: This is a descriptive retrospective study of diabetics admitted to this unit for ketoacidosis, over a period of 15 months (from January 1, 2021, to March 30, 2022). Results: Sixty-four patients were selected for the study. The hospital prevalence of ketoacidosis was 5.61%. The mean age of the patients was 46.3 years with a sex ratio of 0.94. Type 2 diabetes predominated in terms of frequency (62.5%). In 37.5% of cases, ketoacidosis was the inaugural diabetes. For patients known to be diabetic before admission, infection was the most common etiologic factor (48.44%), followed by discontinuation of treatment (31.25%).

Multi-Timepoint Metabolic Fingerprinting of a Post-Episode Period of Hypoglycemia and Ketoacidosis Among Children With Type 1 Diabetes.

Background: Acute complications of type 1 diabetes mellitus such as diabetes ketoacidosis (DKA) and hypoglycemia (HG) are detrimental in a short- and long-term perspective. Restoration of normoglycemia and correction of pH do not mean that all metabolic disturbances caused by HG or DKA are immediately reversed. Aim: This study aimed to identify serum metabolic changes caused by an episode of DKA and HG that may indicate the mechanisms contributing to long-term consequences of DKA/HG. Materials and methods: Four groups of children with type 1 diabetes were recruited. The first two study groups included patients after an episode of DKA or HG, respectively. Additionally, two comparative groups were recruited—children with established type 1 diabetes (EDM) and patients with newly diagnosed diabetes without diabetes ketoacidosis (NDM). Serum samples were collected in three group-specific time points (since the hospital admission): HG 0h-12h–48h; DKA or NDM 0h-24h–72 h; and one random fasting sample from patients with EDM. Two batches of 100 samples each were created: for DKA batch 20 × 3 DKA patients, 10 × 3 NDM and 10 EDM; for HG batch: 10 × 3 HG patients, 25 EDM and 15 × 3 NDM. All patients within the batches were age and sex matched. Metabolic fingerprinting was performed with LC-QTOF-MS. Results: Four metabolites were associated with a DKA episode occurring in the preceding 72 h: three were found higher after the DKA episode versus comparative groups: lysophosphatidylcholine (LPC) (18:1), sphingomyelins (SM) (34:0 and d18:0/15:0), and one was found lower: LPC (18:0). Similarly, four metabolites were identified for the HG episode in the last 48 h: three were found higher after the HG episode versus comparative groups: two lysophosphatidylethanolamines (LPE) (18:2 and 20:3) and one LPC (18:2); and one was found lower after the HG episode: oxy-phosphatidylocholine (PC O-34:4). Conclusions: We found eight metabolites whose levels may be traced in the serum, indicating the DKA or HG episode for up to 72 h and 48 h, respectively. Acute complications of diabetes may cause persistent metabolic disturbances long after pH and glucose level normalization.

178-LB: Prevalence of Vitamin D Deficiency among Patients with Type 2 Diabetes in Qingdao, China

The aim of the current study is to investigate the prevalence of vitamin D deficiency among patients with type 2 diabetes (T2DM) in a Chinese cohort. We enrolled 3025 patients with T2DM (aged 30-91 yrs) who were hospitalized in Qingdao Endocrine and Diabetes Hospital from Jan 2018 to Jan 2019. The exclusion criteria were as follows: (1) with other types of diabetes; (2) pregnant or lactating females; (3) with acute complications of diabetes or other stress states, such as surgery and trauma; (4) with rheumatologic, serious hepatic, cardiac, renal failure, malignancy, and endocrine diseases that affect the metabolism of vitamin D. Serum level of 25-OH-vitamin D ≥ 30 ng/mL was defined as normal, 20 ng/mL ≤ 25-OH-vitamin D < 30 ng/mL as vitamin D insufficiency (VDI) , and serum 25-OH-vitamin D < 20 ng/mL as vitamin D deficiency (VDD) . The chi-square test was used for group comparison of VDD or VDI prevalence. In all subjects, the prevalence of VDI was 35%. Male patients had higher prevalence of VDI than female patients (40.0% vs. 28.9%, P<0.05) . The prevalence of VDD was 48.8% in total while female had higher prevalence than male patients (57.2% vs. 41.8%, P<0.001) . We found a clear trend toward decreasing serum vitamin D concentration with rising HbA1c levels (P<0.001 in male and P<0.003 in female) . Dividing the HbA1c into deciles showed a linear association. In conclusion, VDI and VDD is prevalent in patients with type 2 diabetes. Poor glucose control is related to lower serum level of vitamin D. Future studies are required to verify if vitamin D supplementation could be beneficial in patients with diabetes. Disclosure L. Zhang: n/a. J. Wang: None. Y. Yang: None. Y. Dong: None.

1162-P: Clinical Characteristics and Outcomes in Patients Hospitalized with Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes that is associated with increased morbidity and mortality. Objective: We aimed to examine clinical characteristics and care outcomes for patients hospitalized for DKA. Methods: We reviewed the hospital database for patients who were admitted with DKA from 2015 to 2020 in government hospitals in Qatar. Clinical characteristics, laboratory data, the severity of DKA, complications, need for admission to the intensive care unit, length of hospital stay, time to resolution of DKA, and mortality rates were evaluated in patients with type 1 diabetes (T1DM) compared to those with type 2 diabetes (T2DM) . Results: A total of 1613 episodes of DKA in 1330 patients (39.3% with T1DM and 60.7% with T2DM) were evaluated. Non-adherence to therapy was the commonest cause (40.5%) of DKA in patients with T1DM, while infection was the commonest cause (32.9%) in those with T2DM. There was no difference in the severity of DKA, mean serum glucose, mean serum sodium, and arterial pH on presentation in both groups of patients. Both groups had poorly controlled glucose (mean HbA1c of 10.1% and 10.5% in T1DM and T2DM groups respectively) . There was no difference in the time to resolution of DKA (18 hours in the T1DM group and 20 hours in the T2DM group) . Patients with T2DM had higher rates of admission to the intensive care unit (39.1% vs. 26.9% for T1DM, p<0.001) , longer hospital stay (mean 5 days vs. 2 days in the T1DM group, p<0.001) , while patients with T1DM had higher rates of recurrent DKA (35.6% vs. 21.2% in the T2DM group, p<0.001) . Mortality rates were significantly higher in patients with T2DM compared to those with T1DM patients (7.6% vs. 0.95%, respectively, p<0.001) . Conclusion: In this cohort study, poorly controlled glucose was prevalent among patients admitted with DKA. Despite higher rates of recurrent DKA in patients with T1DM, those with T2DM had more complicated hospital course and higher mortality. Disclosure M.Eledrisi: None. S.A.Beshyah: None. M.K.Aboawon: None. H.M.Alkabbani: None. A.A.Ali: None. I.Alabdulrazzak: None. M.Elhaj: None. A.O.E.Ahmed: None. H.Alqahwachi: None. J.Daghfal: None.

1256-P: Lower Diabetes Technology Adoption and Worse Glycemic Control in Minorities with Type 1 Diabetes

Introduction: Poorer outcomes in acute and late complications of type 1 diabetes (T1D) persist among racial/ethnic minorities, and technology adoption may be lower in these groups. Technologies such as continuous glucose monitors (CGM) and insulin pumps (CSII) enhance diabetes management and improve glycemic control. We examined differences in use of diabetes technology by race/ethnicity among patients 12 and older followed at the Barbara Davis Center who had T1D for at least 1 year. Methods: Use of CGM and/or CSII vs. neither was examined in 5,539 patients by racial/ethnic groups: Non-Hispanic White (NHW, n=3,945) , Black (n=161) , Hispanic (n=719) and Other racial groups (OR, n=714) . General liner models compared HbA1c and technology use by race/ethnicity. Results: Black, Hispanic and OR patients were younger, had shorter T1D duration, higher HbA1c and less use of technology. In linear models adjusted for age, diabetes duration and visits over the past year, use of technology was associated with lower HbA1c in each race/ethnic group. However, among technology users, minority patients had higher HbA1c compared to NHW patients. Conclusion: HbA1c was highest and diabetes technology use lowest among Blacks and Hispanics. Efforts to increase technology use for diabetes management in these populations may result in greater glycemic control and ultimately the reduction of acute and late complications of diabetes. Disclosure B.Conway: None. V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. C.Geno rasmussen: None. A.Gerard gonzalez: n/a. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. Funding NIH grant P30-DK116073

131-OR: Effect of a Value-Based Medication Benefit on Acute Preventable Diabetes Complications and Related Disparities

Employers are increasingly purchasing "preventive drug list" (PDL) insurance plans that make cardiometabolic medications $0. PDL designs improve adherence, but effects on health outcomes are unknown. We analyzed 2004-2017 commercial health insurance claims using a large, national data set. The intervention group included 12,853 commercially-insured diabetes patients aged 12-64 years who experienced employer-mandated PDL switches; the control group included 12,989 matched counterparts whose employers offered no PDL. We defined the index date as the day the intervention group received the PDL, and matched controls had a contemporaneous index date. Both groups had a 1-year baseline and 1-year follow-up study period. We measured monthly rates of aggregated acute preventable diabetes complication episodes (e.g, hyperglycemic coma, angina, and pneumonia) presenting to (1) the outpatient setting or (2) the emergency department, observation, or inpatient settings ("high acuity") . We constructed cumulative interrupted time series plots of these two measures and conducted segmented regression analysis and marginal effects estimation. Low-income members were a subgroup of interest. Annual outpatient and high-acuity complication episodes decreased by -13.5% (-15.2%, -11.7%) and -13.9% (-15.3%, -12.5%) , respectively, in the PDL group relative to controls. Low-income PDL members also experienced decreased outpatient (-27.2% [-32.1%, -22.4%]) and high-acuity complication episodes (-4.4% [-6.5%, -2.4%]) . This rigorous, quasi-experimental study is the first to demonstrate that a value-based medication benefit is associated with improved health outcomes and reduced disparities. Employer adoption of PDLs thus represents a relatively expedient approach to improving health and equity, and our results support a strategy of incentivizing such targeted cost sharing reductions for vulnerable diabetes populations. Disclosure J.Wharam: None. F.Zhang: Research Support; GlaxoSmithKline plc. M.Lakoma: None. L.F.Garabedian: None. S.Argetsinger: None. D.Ross-degnan: None. Funding CDC and NIDDK

1157-P: Mortality among People with Diabetes Experiencing Hypoglycemic and Hyperglycemic Crises

Severe hypoglycemia and hyperglycemia (ketoacidosis, hyperglycemic hyperosmolar state) are common yet potentially preventable acute complications of diabetes. Our objectives were to use national data from OptumLabs® Data Warehouse, 2011-2020, to 1) characterize trends in all-cause mortality among adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) experiencing emergency department visits or hospitalizations for hypoglycemia and hyperglycemia;2) extend analyses through 2020 to assess the impact of the COVID-pandemic; and3) examine racial/ethnic and gender disparities in subsequent mortality adjusted for relevant patient characteristics. Among 4,164 adults with T1DM experiencing hypoglycemia, 30-day and 1-year mortality increased from 0.5% to 0.9% and 4.7% to 6.1%. Among 49,931 adults with T2DM experiencing hypoglycemia, 30-day and 1-year mortality were stable at 2.1-2.0% and 16.2-16.1%. Among 4,698 adults with T1DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 0.4% to 1.0% and 2.7% to 5.9%, respectively. Among 17,123 adults with T2DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 2.5% to 3.0% and 11.5% to 13.1%. Table shows differences in mortality rates by age, race/ethnicity, gender. These results call for proactive engagement of high risk individuals experiencing severe hypoglycemia and hyperglycemia to reduce their risk of death. Disclosure R.G.Mccoy: Consultant; Emmi. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. K.Swarna: None. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. S.Golden: Advisory Panel; Abbott Diabetes, Medtronic. P.J.O'connor: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases grant number K23DK114497

Maternal Diabetes Mellitus and Risk of Congenital Heart Defects in Offspring: A Cohort Study

Objective: To assess whether maternal diabetes mellitus (MDM) is associated with an increased risk of congenital heart defects (CHD) in offspring. Research design and methods: A population based cohort study was conducted by using information from the National Health Services and long term care of Punjab (Pakistan) health care administrative databases. The researcher identified all women with a MDM diagnosis with a live birth singleton delivery between June 2020 and May 2022. MDM was defined based on laboratory test results and diagnosis coding. Results: A total of 17,335 people with CHD remained allocated to embryologically relevant heart phenotypes. CHD recurrence was 328 per 11,500 live births (n=236) in offspring of women having gestational diabetes mellitus, associated to a baseline danger of 81 per 11,500; attuned comparative danger for CHD remained 5.01 (96 percent confidence range, 4.52–5.54). The connection was unaffected by birth year, maternal age at diabetes beginning, or diabetes extent, in addition CHD dangers associated with type 1 and DM type-2 were not substantially different. Individuals born to females who had previously experienced acute exacerbations had a higher risk of CHD than just those born to women who had not previously experienced acute diabetes complications (hazard ratio, 8.63; 96 percent confidence interval, 6.24–11.7, and relative risk, 4.48; 96 percent confidence interval, 3.92–5.14, respectively; P=0.0005). Maternal gestational DM remained related to all particular CHD phenotypes (adjusted hazard range, 3.75–15.9). Conclusion: In a large observational study, MDM was associated with an increased risk of CHD. Therefore, diabetes screening during pregnancy is suggested to identify women at risk for CHD. Keywords: Maternal diabetes mellitus, Congenital Heart defects and Offspring

Insulin Degludec Versus Insulin Glargine on Glycemic Variability in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/AimsCurrently, glycemic variability has more deleterious effects than sustained hyperglycemia and is closely associated with acute and chronic complications of diabetes. Reducing glycemic excursion is becoming another vital goal of glycemic control in clinical practice. This study aimed to determine whether insulin degludec (IDeg) or insulin glargine (IGla) was more beneficial for reducing glycemic fluctuations.Materials and MethodsThis research was constructed according to the PRISMA guidelines. We searched eight databases and ClinicalTrials.gov from their inception to 30 November 2021. All randomized controlled trials comparing the efficacy of glucose variability between IDeg and IGla in diabetic patients were included.ResultsFourteen trials with 8,683 participants were included. In patients with T1DM, IDeg was associated with a lower mean (MD: −16.25, 95% CI −29.02 to −3.07, P = 0.01) and standard deviation (P = 0.03) compared to IGla in fasting blood glucose (FBG); in people with T2DM, IDeg was related to a lower mean of FBG versus insulin glargine 100 U/ml (IGla100) (P <0.001) and had a more extended time in the range (TIR) than IGla100 (SMD: 0.15, 95% CI 0.02 to 0.27, P = 0.02) but not longer than insulin glargine 300 U/ml (IGla300). Moreover, IDeg had a lower coefficient of variation of FBG than IGla (P = 0.0254). For other indicators of glycemic variability, namely, standard deviation of blood glucose for 24 h, the mean of 24-h blood glucose, mean amplitude of glycemic excursion, the coefficient of variation for 24 h, the mean of daily differences, area under the glucose curve, and M-value, no significant differences were identified between IDeg and IGla, regardless of T1DM or T2DM.ConclusionsBased on the current studies, there was comparable efficacy between IDeg and IGla from multiple aspects of glycemic variability, regardless of T1DM or T2DM. However, IDeg may be superior to IGla in reducing FBG variability in T1DM and T2DM. Nonetheless, due to the limitations of the original studies, it is still unclear whether IDeg is superior to both IGla100 and IGla300. In T2DM, IDeg had more extended TIR than IGla100 but not longer than IGla300. Additionally, more well-designed randomized controlled trials comparing IDeg with IGla300 for different indicators of glycemic variability are still warranted.Systematic Review RegistrationPROSPERO, CRD42021283203.

MO111: Hyperuricaemia and Risk of Simple Renal Cysts

Abstract BACKGROUND AND AIMS The relationship between hyperuricaemia and renal cysts is still insufficient. Simple renal cysts (SRCs) are the most common non-hereditary type of benign renal cysts in adults. The prevalence of SRC varies by population, geographic region and the imaging modality used. The overall prevalence of SRC is 4–12% in general populations. Most SRCs are asymptomatic, being accidentally detected by abdominal ultrasonography or computed tomography during a medical check-up. However, some cysts tend to increase in size and can be sufficiently large to cause pain, haematuria and/or urinary obstruction. The aim of this study is to compare the risk of SRC in patients with and without hyperuricaemia. METHOD We retrospectively collected data on 246 non-smoking males (age 30–70 years) with SRC without hypertension, obesity and renal stones. In this study, patients with previous therapy with uric acid-lowering medication; patients with current acute complications of diabetes or urinary tract infections; and patients with cancer, blood disease, polycystic kidney disease, solitary kidney, urinary tract stenosis or kidney diseases were excluded. Albuminuria was defined as 24-h urine microalbuminuria of 30 mg and higher. SRCs were detected by ultrasonography. The sonographic criteria for the diagnosis of SRC included absent internal echoes, a smooth, sharply defined wall and posterior acoustic enhancement, indicating posterior through transmission that was not suspicious for a malignant renal mass. SPSS 22 for windows was used for analysing the study data. Chi-square and exact Fisher's tests were utilized, while continuous variables were assessed by Student's t-test. A P value of less than .05 was considered statistically significant. RESULTS SRC prevalence was significantly higher in hyperuricaemic (174 patients) than normouricemic subjects. Age (OR 1042, 95% CI 1032–1061, P &amp;lt; .001) and albuminuria (OR 1189, 95% CI 1176–1892, P &amp;lt; 05) are independent risk factors for SRC development. Patients with SRC and hyperuricaemia were more likely to be elderly males, and exhibited a longer duration of lower eGFR and higher serum uric acid, γ-glutamyl transferase, low-density lipoprotein cholesterol and plasma glucose level compared with those without SRC. The risk of SRC increased when the serum uric acid is more 460 μmol/L. CONCLUSION Of the 246 non-smoking males with SRC, 176 have hyperuricaemia. Patients who had a SRC were significantly older than patients without SRC (mean 58.27 versus 43.18 years), with lower glomerular filtration rate, more often suffer from coronary heart disease. Therefore, even asymptomatic hyperuricaemia requires standardized uric acid-lowering treatment to prevent the occurrence of SRC. According to our results, SRC patients should be careful to use uricosuric drugs.

Impact of the COVID-19 Pandemic on Diabetes Care for Adults With Type 2 Diabetes in Ontario, Canada

ObjectivesThe COVID-19 pandemic and related public health prevention measures have led to a disruption of the delivery of routine care and may have had an impact on the quality of diabetes care. Our aim in this study was to evaluate the extent to which structure, process and outcome quality measures in diabetes care changed in the first 6 months of the pandemic compared with previous periods. MethodsA before-and-after observational study was conducted of all community-living Ontario residents >20 years of age and living with diabetes. The patients were divided into 3 cohorts: a pandemic cohort, alive March to September 2020 (n=1,393,404); reference cohort 1, alive March to September 2019 (n=1,415,490); and reference cohort 2, alive September 2019 to February 2020 (n=1,444,000). Outcome measures were in-person/virtual visits to general practitioners and specialists, eye examinations, glycated hemoglobin (A1C) and low-density lipoprotein (LDL) testing, filled prescriptions, and admissions to emergency departments (EDs) and hospitals for acute and chronic diabetes complications. ResultsThe probability of an in-person visit to a general practitioner decreased by 47% (95% confidence interval [CI], 47% to 47%) in the pandemic period compared with both previous periods. The probability of having an eye exam was lower by 43% (95% CI, 44% to 43%), an A1C test by 28% (95% CI, 29% to 28%) and an LDL test by 31% (95% CI, 31% to 31%) in the pandemic period compared with the same 6-month period the year before. There were very small decreases in drug prescriptions and decreases of 18% and 16% in ED and hospital visits for complications. ConclusionsWe observed disruptions to both structure and process measures of diabetes care in Ontario during the first wave of the pandemic.

Abstract #1175506: Impact of Different Infection Sources on Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome Hospitalizations Outcomes

Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic syndrome (HHS), are two acute complications of diabetes that can result in significant morbidity and mortality. Many patients present with combined features of DKA and HHS. Infection from different sources is one of the most common causes of DKA/HHS precipitations in patients with diabetes mellitus. In this study we aim to analyze the impact of different sources of infections (pneumonia, urinary tract infection, cellulitis) on DKA/HHS hospitalizations.

Early vs late histological confirmation of coeliac disease in children with new-onset type 1 diabetes

AimScreening for coeliac disease in asymptomatic children with new-onset type 1 diabetes is controversial. The aim of this study was to analyse whether the confirmation of coeliac disease in children with new-onset type 1 diabetes and positive screening results can be postponed.MethodsThis was a multicentre population-based cohort study based on the German/Austrian/Swiss/Luxembourgian Prospective Diabetes Follow-up Registry (Diabetes Patienten Verlaufsdokumentation [DPV]). Participants aged ≤18 years diagnosed with type 1 diabetes between 1995 and June 2021 and with elevated IgA tissue transglutaminase antibodies (anti-tTGA) at diabetes onset on screening for coeliac disease were included. We compared outcomes of participants with a diabetes duration of more than 1 year between those in whom coeliac disease was confirmed histologically within the first 6 months and those in whom coeliac disease was confirmed between 6 and 36 months after diabetes diagnosis.ResultsOf 92,278 children and adolescents with a diagnosis of type 1 diabetes, 26,952 (29.2%) had documented anti-tTGA data at diabetes onset. Of these, 2340 (8.7%) had an elevated anti-tTGA level. Individuals who screened positive were younger (median age 9.0 vs 9.8 years, p<0.001) and more often female (53.1% vs 44.4%, p<0.001). A total of 533 participants (22.8% of those who screened positive) had a documented biopsy, of whom 444 had documented histological confirmation of coeliac disease. Of 411 participants with biopsy-proven coeliac disease within the first 36 months of diabetes and follow-up data, histological confirmation was performed in 264 (64.2%) within the first 6 months and in 147 (35.8%) between 6 and 36 months after diabetes onset. At follow-up (median diabetes duration 5.3 years and 5.1 years, respectively), estimated median HbA1c levels (62.8 mmol/mol vs 62.2 mmol/mol [7.9% vs 7.8%]), cardiovascular risk markers (lipids, rate of microalbuminuria, blood pressure), rates of acute diabetes complications (diabetic ketoacidosis, severe hypoglycaemia) and the proportions of participants reaching anti-tTGA levels within the normal range did not differ between groups. Participants with delayed histological confirmation of coeliac disease showed no negative effects on growth or weight gain during the observation period.ConclusionsOur study suggests that the histological confirmation of coeliac disease in asymptomatic individuals with new-onset type 1 diabetes could be postponed.Graphical abstract

IDF21-0157 Trends in Severe Hypoglycemia, Hyperglycemia, and Diabetic Ketoacidosis among American Indian and Alaska Native Peoples

Background: American Indian and Alaska Native peoples (AI/ANs) suffer daunting disparities in diabetes and its complications. Little is known about rates of and changes in acute diabetes complications among AI/ANs. Aim: Here we investigate the time trends of hospital admissions and emergency department (ED) visits for hypoglycemia, hyperglycemia, and diabetic ketoacidosis (DKA) from 2009 to 2013 among AI/AN diabetes patients. Method: Data were extracted from the Indian Health Service’s (IHS) National Data Warehouse and related electronic health record databases. A total of 48,871 AI/AN adults with diabetes who used IHS services during any of the fiscal years 2009-2013 were included. Observed rates of hospitalizations or ED visits due to each complication were calculated for each year. Generalized estimating equation models with a binomial distribution and logit link were fitted to examine the time trend of each complication. Results: The proportions of AI/AN diabetes patients with severe hypoglycemia (1.35% in 2009 vs. 0.70% in 2013), hyperglycemia (1.72% vs. 1.44%), and DKA (0.54% vs. 0.43%) that led to hospitalizations or ED visits all declined gradually. Male patients and those with Medicaid enrollment had substantially higher rates of these complications across five years, while patients with private insurance had significantly lower rates of them. Discussion: AI/AN adults with diabetes had significant improvements in both hypoglycemic and hyperglycemic crises from 2009-2013. Our findings further support the effectiveness of the systematic diabetes management approach implemented by the IHS in the past few decades.

IDF21-0238 Socioeconomic Factors And Type 1 Diabetes Outcomes In A Universal Health Care System Context: A Better Registry Analysis

Background: Lower socioeconomic status (SES) disparities resulting from the unequal distribution of social, environmental, and economic conditions, may add to the inherent challenges of type 1 diabetes (T1D) management. A Universal Health Care System (UHCS) offers the opportunity to address these disparities thus improving health outcomes. Aim: This study aims to evaluate the association between SES and diabetes management and acute complications in adults living with T1D. We hypothesize that even in a UHCS context; lower SES will be associated with a higher risk for suboptimal diabetes management and acute diabetes complications. Method: A cross-sectional analysis of self-reported data from a registry of people living with T1D (PWT1D) in Québec (Canada) to describe differences in SES factors; education (university level, associate degree, or ≤ highschool diploma), income (<30,000$, 30,000 to 60,000$, 60,000 to 100,000$, 100,000 to 150,000$ or >150,000$ CAD/year), employment (full time, part time, retired, unemployed, and other), insurance coverage (public, private, or a combination); and acute T1D outcomes (HbA1c levels, level 3-hypoglycemia (severe), and diabetes ketoacidosis (DKA) events in the past year; using χ2 tests and regression analysis (adjusted for age, sex, diabetes technology use, and SES factors). Results: Participants (n=1344; 62% women; 91% caucasian) aged 43±15 years; diabetes duration of 23±15 years and 71% reporting HbA1c ≤8.0%. The majority worked full time (57%), had private insurance (68%), at least an associate (38%) or a university degree (34%), and an average income between 30 and 60 000$ (20%) and 60 to 100 00$ CAD/year (26%). After adjustment, higher education level (university degree; OR: 0.468, 95% CI [0.322, 0. 816]; p=0.001) and yearly income (100 to 150 000$, OR: 0.496, 95% CI [0.318, 0.774]; p=0.002 and >150 000$, OR: 0.422, 95% CI [0.248, 0.718]; p=0.001) both remained associated with lower HbA1c levels when compared to ≤ Highschool diploma and lower income (≤30 000$). Participants with private insurance were less likely to report a history of DKA compared to participants using public coverage (adjusted OR: 0.250, 95% CI [0.143, 0.436], p<0.001). After adjustment, being employed (OR: 0.525, 95%CI [0.280, 0.986], p=0.045) and public insurance coverage (OR: 0.606, 95%CI [0.397, 0.926], p=0.021) remained significantly associated with decreased likelihood of having a severe hypoglycemia episode. Discussion: In a sample of relatively well-controlled PWT1D, HbA1c levels, severe hypoglycemia, and DKA incidence were lowest amongst participants with higher SES (employed, higher education, and income), compared to participants from lower SES. These findings, thus reflect a more challenging control in lower SES indicating that even in the context of a UHCS, which aims to improve access to healthcare, there are still areas to address to improve access to the same level of care for all.

251 Sociodemographic and clinical variation in rates of hospitalization for diabetic ketoacidosis

OBJECTIVES/GOALS: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. Though largely preventable, DKA is one of the most common acute complications of diabetes. In the US, rates of DKA hospitalization and associated costs have been increasing over the past two decades. METHODS/STUDY POPULATION: In this study, we used the Kentucky Statewide Inpatient Database (2010-2019) and the Nationwide Readmission Database (2010-2018) to explore variation in rates of DKA hospitalization across key sociodemographic subgroups (age, sex, race/ethnicity, rural/urban, insurance coverage, and county-level poverty index) and identify clinical predictors of DKA hospitalization. The primary outcome was hospitalization with a first diagnosis of DKA identified using ICD-9 and -10 codes. Crude rates were calculated using state- and county-level population estimates obtained from the US Census Bureau and are presented as the total number of events per 10,000 people. Regression models will be used to examine the associations between DKA hospitalization and clinical predictors. RESULTS/ANTICIPATED RESULTS: In Kentucky, from 2010-2019, rates of DKA hospitalization increased by 45% (from 65.5 to 94.8 per 100,000). The largest variation was observed by age, race/ethnicity, and insurance. In those aged 15-44, rates of DKA hospitalization were three times higher than rates in the youngest (&lt;15) and oldest (&gt;75) groups (&gt;130 vs &lt;45 per 100,000). Non-Hispanic Blacks experienced rates of DKA hospitalization that were 2x higher than rates observed in non-Hispanic Whites (183.9 vs 92.6 per 100,000). Those covered by Medicaid had the highest rates of DKA hospitalization (171.3 vs 32.4 per 100,000 in commercially insured). Small, but consistent, disparities were observed in rural vs urban counties and higher poverty rates. Predictors of DKA hospitalization are being examined in the Nationwide Readmission Database. DISCUSSION/SIGNIFICANCE: Our findings underscore significant variation in DKA risk across key sociodemographic subgroups and will examine and confirm previously identified clinical predictors of DKA. Because DKA is largely preventable, identifying individuals at higher risk and targeting interventions and services to these individuals may help reduce DKA rates.

Hypokalemia in Diabetes Mellitus Setting.

Diabetes mellitus is a public health problem that affects millions of people worldwide regardless of age, sex, and ethnicity. Electrolyte disturbances may occur as a consequence of disease progression or its treatment, in particular potassium disorders. The prevalence of hypokalemia in diabetic individuals over 55 years of age is up to 1.2%. In patients with acute complications of diabetes, such as diabetic ketoacidosis, this prevalence is even higher. Potassium disorders, either hypokalemia or hyperkalemia, have been associated with increased all-cause mortality in diabetic individuals, especially in those with associated comorbidities, such as heart failure and chronic kidney disease. In this article, we discuss the main conditions for the onset of hypokalemia in diabetic individuals, briefly review the pathophysiology of acute complications of diabetes mellitus and their association with hypokalemia, the main signs, symptoms, and laboratory parameters for the diagnosis of hypokalemia, and the management of one of the most common electrolyte disturbances in clinical practice.

Management of acute proliferative diabetic retinopathy related complications during the first COVID-19 wave

BackgroundRoutine hospital eye services (HES) across the National health service (NHS), and diabetic eye screening (DES) in Scotland were paused during the COVID-19 lockdown in March 2020. Alternate pathways for managing acute ophthalmic pathology were devised in NHS Grampian covering the North-East of Scotland. Emergency eye treatment centres (EETC) manned by community optometrists were set up to treat and triage referrals to HES.MethodsRetrospective study analysing consecutive patients referred to a tertiary eye centre (Aberdeen Royal Infirmary) with proliferative diabetic retinopathy (PDR) related complications between March and August 2020. General demographical data, diabetic history, visual acuity, ocular complication, type of management, time to follow-up, and any appointment cancellations were extracted for analysis.ResultsFifty two eyes of 46 patients with PDR related complications were identified. HES appointment had been delayed or cancelled in 22 patients (48%) due to COVID-19. Mean age was 54.5 years (±15.1), 21 (46%) were female, 21 (46%) had type 1 diabetes; mean HbA1c was 78 mmol/l (±18.7). Vision ranged from 6/6 to perception of light. 36 (78%) patients had unilateral vitreous haemorrhage (VH), 6 (13%) bilateral, 2 (4%) tractional retinal detachments and 3 (6.5%) had neovascular glaucoma.Of 48 acute PDR presentations, 18 (38%) were given anti-VEGF within 72 h and two (4%) had PRP the same day. 16 (33%) were rebooked into the laser clinic, 13 (27%) referred for urgent surgical review, and 17 (35%) advised observation and review in clinic. After a median follow-up of 6 months, 12 eyes (23%) of 11 patients progressed to have vitrectomy.ConclusionDespite lockdown, hospital appointment cancellations and recommended footfall reduction limiting capacity due to COVID-19, patients reaching out with PDR complications were promptly referred to HES and appropriate treatments carried out with COVID-19 precautions as recommended.

Associations Between Socioeconomic Status and Patient Experience With Type 1 Diabetes Management and Complications: Cross-sectional Analysis of a Cohort From Québec, Canada

BackgroundLow socioeconomic status (SES) may add to the challenges of type 1 diabetes (T1D) management and be an independent risk factor for chronic and acute diabetes complications. Our aim in this study was to evaluate the association between SES and TID management and risk of complications in a universal health-care system using data from a registry of people living with T1D (PWT1D) in Québec, Canada (the BETTER registry). MethodsThis study was a cross-sectional analysis describing the association between SES factors (education, income, employment and insurance coverage) and T1D outcomes (glycated hemoglobin [A1C], acute and chronic complications and comorbidities), using chi-square tests and regression analyses (adjusted for diabetes duration, sex, ethnicity and diabetes technology use). ResultsIn a sample of 1,333 PWT1D, lower education level was associated with cardiovascular disease (odds ratio [OR], 2.44; p=0.002), depression (OR, 1.56; p=0.020), nephropathy (OR, 2.10; p=0.001) and higher A1C (OR, 1.79; p<0.001). Low-income groups were more likely to report higher A1C (OR, 2.16; p=0.001), retinopathy (OR, 1.84; p=0.038), neuropathy (OR, 1.89; p=0.043), nephropathy (OR, 2.23; p=0.024), severe hypoglycemia (OR, 1.87; p=0.022) and depression (OR, 1.87; p=0.012). Unemployment was associated with retinopathy (OR, 2.37; p=0.009) and neuropathy (OR, 1.96; p=0.035). Diabetic ketoacidosis (OR, 2.81; p=0.001) and neuropathy (OR, 1.67; p=0.020) were more likely to be reported by participants with public insurance. ConclusionsPWT1D from lower SES, particularly those with low income and low education, were more likely to report T1D-related complications and comorbidities. Further longitudinal investigations are needed to better understand the nature and directionality of these associations.

Characteristics and Clinical Course of Diabetes of the Exocrine Pancreas: A Nationwide Population-Based Cohort Study.

The natural course of diabetes of the exocrine pancreas (DEP) is not well established. We aimed to compare the risk of insulin initiation, diabetic complications, and mortality between DEP and type 2 diabetes. Using the Korean National Health Insurance Service-Health Screening Cohort between 2012 and 2017, we divided patients with diabetes into those with diabetes without prior pancreatic disease (indicated type 2 diabetes, n = 153,894) and diabetes with a prior diagnosis of pancreatic disease (indicated DEP, n = 3,629). ICD-10 codes and pharmacy prescription information were used to define type 2 diabetes, DEP, and acute and chronic diabetes complications. Kaplan-Meier curves were produced to compare insulin use over time between groups. We created logistic regression models for odds of progression to diabetic complications and mortality. DEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% CI 1.30-1.47], P < 0.0001). Individuals with DEP showed higher risks of hypoglycemia (odds ratio 1.85 [1.54-2.21], P < 0.0001), diabetic neuropathy (1.38 [1.28-1.49], P < 0.0001), nephropathy (1.38 [1.27-1.50], P < 0.0001), retinopathy (1.10 [1.01-1.20], P = 0.0347), coronary heart disease (1.59 [1.48-1.70], P < 0.0001), cerebrovascular disease (1.38 [1.28-1.49], P < 0.0001), and peripheral arterial disease (1.34 [1.25-1.44], P < 0.0001). All-cause mortality was higher in those with DEP (1.74 [1.57-1.93], P < 0.0001) than in those with type 2 diabetes. DEP is more likely to require insulin therapy than type 2 diabetes. Hypoglycemia, micro- and macrovascular complications, and all-cause mortality events are higher in DEP compared with type 2 diabetes.