ADA Guidelines Research Articles

594-P: Telehealth Results in Increased Visit Frequency and Lower Diabetes Distress in Young Adults (YA) with Type 1 Diabetes (T1D)

Background: Managing T1D as a YA is challenging due to changing physiology, psychosocial demands, and increasing independence. Fewer than one-third of YA with T1D meet the ADA guidelines of quarterly diabetes visits and only one in seven attain the recommended hemoglobin A1c level of <7%. YA from disadvantaged ethnic, racial, and socioeconomic backgrounds face even greater T1D management obstacles. Methods: The CoYoT1 Care model was adapted for diverse, predominantly publicly insured, YA with T1D at a large urban hospital. A 15-month 4-arm randomized controlled trial collected data on 68 YA, ages 16-25. Participants received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) , prior to COVID-19; all in-person visits transitioned to TH in March 2020. CoYoT1 Care consists of patient-centered provider visits with bimonthly virtual T1D peer group sessions. Results: YA who attended >50% of study visits by TH attended more visits during the study period (3.4) than those who primarily attended in-person (2.6, p<0.0001) . Those who were seen more by TH also had stable levels of diabetes distress versus increased distress in those attending in-person visits (p=0.02) . A conjoint analysis conducted with YA found that not having to travel to clinic for visits was TH’s greatest benefit; technical problems and not always having private space were its biggest challenges. Participants also rated access to a clinic coordinator and TH visits as extremely valuable. Conclusions: TH was successfully adapted for diverse YA with T1D, resulting in increased attendance and stable diabetes distress compared to in-person care. Participants overwhelmingly indicated that the benefits associated with TH, such as saving time and money traveling and parking, outweighed any technical challenges. Larger studies with longer term follow-up, not occurring during a global pandemic, are needed to refine TH’s role in patient-centered care of YA with T1D. Disclosure J.Raymond: None. J.L.Fogel: None. M.W.Reid: None. E.Salcedo-rodriguez: None. D.Fox: None. E.Pyatak: Research Support; Abbott Diabetes. Funding Donaghue Foundation

535-P: The Effect of Starting Blood Glucose Levels on Electrolyte Balance During and After Exercise in Type 1 Diabetes

ADA guidelines recommend that people with type 1 diabetes (PWT1D) start exercise with blood glucose (BG) levels of 7-mmol/L. Those fearing hypoglycemia often start higher, which may affect kidney function and electrolyte balance. We examined serum and urine electrolyte concentration during aerobic exercise (cycling 45 min at 60%VO2peak) in PWT1D (10F/2M, mean±SD: age 29±7 years, VO2peak 37.8±7.6 mL/kg/min, A1C 7.6±0.8%) and age, sex, and fitness-matched controls. Control participants (CON) completed a single exercise session with BG in normal physiological range, while PWT1D completed two sessions with different starting BG levels: 8-mmol/l (MOD) , and 12-14 mmol/l (HI) . Urine specific gravity, glucose and potassium were higher during exercise and recovery in MOD when compared to CON (effect of treatment p<0.05) , with only urine glucose being higher in HI when compared to MOD (effect of treatment p<0.05) . Serum sodium, potassium, magnesium, and calcium increased from pre to post exercise in all sessions, with sodium being higher, and magnesium and calcium being lower in MOD versus CON (effect of treatment p<0.05) . There was no difference in these electrolytes between MOD and HI sessions (effect of treatment p>0.05) in PWT1D. Serum glucose decreased during exercise in MOD and HI sessions (effect of time p<0.05) , with serum glucose being higher during the HI session (effect of treatment p<0.05) . The lack of significant differences in electrolytes between MOD and HI sessions suggests that exercise with higher BG levels does not pose immediate risk during exercise of moderate intensity and duration. Further studies should examine the impact of hyperglycemia on electrolyte balance during longer or more intense exercise sessions. Disclosure Z.Momeni: None. N.G.Boulé: None. C.Prado: Consultant; Pfizer Inc., Other Relationship; Abbott, Fresenius Kabi, Nestle Health Science, Nutricia. J.E.Yardley: Research Support; Abbott, Dexcom, Inc., LifeScan, Speaker's Bureau; Abbott Diabetes. Funding Alberta Diabetes Institute

Hand Hygiene Awareness, Attitude and Compliance among House Officers in Public-Sector Dental Institutes- A Questionnaire-Based Study

Objective: The objectives of this study were to evaluate the compliance of hand hygiene among dental health care professionals, to access different variables associated with hand hygiene and to identify possible ways of improving hand hygiene compliance. Methods: This descriptive cross-sectional study was done to access the hand hygiene compliance, knowledge and practice of dental house officers in public dental institutes using a questionnaire developed by the authors. Descriptive statistics and chi square test were performed and a P value <0.05 was taken as significant. Results: 88 dental house officers working in different clinical departments participated in this study. 90% of the respondents believed that hand hygiene plays an important role in cross infection control. More than two-third were aware of all the steps recommended for hand washing, but more than half were not following them. 60% of the respondents wash their hands before and after touching each patient. However, 30% wash hands after each patient and 10% only wash hands before touching every patient. Fifty-five (55.8%) of the participants routinely use alcohol-based rub for hand hygiene. There was a significant difference regarding hand hygiene training among different departments. (p<0.001) Majority of house officers working in prosthodontics and surgery had not received hand hygiene training. Conclusion: Hand hygiene compliance is found to be acceptable when compared with developing countries. However, there was lack in knowledge. Dental graduates should be made aware of CDC and ADA guidelines. Better facilities and instruction for dental students should be encouraged. Hand hygiene quality needs to be improved on an urgent basis. Keywords: Hand Hygiene, Dental Health, Hand Washing, Bacteria

Burden of Type 2 Diabetes and Associated Cardiometabolic Traits and Their Heritability Estimates in Endogamous Ethnic Groups of India: Findings From the INDIGENIUS Consortium.

To assess the burden of type 2 diabetes (T2D) and its genetic profile in endogamous populations of India given the paucity of data, we aimed to determine the prevalence of T2D and estimate its heritability using family-based cohorts from three distinct Endogamous Ethnic Groups (EEGs) representing Northern (Rajasthan [Agarwals: AG]) and Southern (Tamil Nadu [Chettiars: CH] and Andhra Pradesh [Reddys: RE]) states of India. For comparison, family-based data collected previously from another North Indian Punjabi Sikh (SI) EEG was used. In addition, we examined various T2D-related cardiometabolic traits and determined their heritabilities. These studies were conducted as part of the Indian Diabetes Genetic Studies in collaboration with US (INDIGENIUS) Consortium. The pedigree, demographic, phenotypic, covariate data and samples were collected from the CH, AG, and RE EEGs. The status of T2D was defined by ADA guidelines (fasting glucose ≥ 126 mg/dl or HbA1c ≥ 6.5% and/or use of diabetes medication/history). The prevalence of T2D in CH (N = 517, families = 21, mean age = 47y, mean BMI = 27), AG (N = 530, Families = 25, mean age = 43y, mean BMI = 27), and RE (N = 500, Families = 22, mean age = 46y, mean BMI = 27) was found to be 33%, 37%, and 36%, respectively, Also, the study participants from these EEGs were found to be at increased cardiometabolic risk (e.g., obesity and prediabetes). Similar characteristics for the SI EEG (N = 1,260, Families = 324, Age = 51y, BMI = 27, T2D = 75%) were obtained previously. We used the variance components approach to carry out genetic analyses after adjusting for covariate effects. The heritability (h2) estimates of T2D in the CH, RE, SI, and AG were found to be 30%, 46%, 54%, and 82% respectively, and statistically significant (P ≤ 0.05). Other T2D related traits (e.g., BMI, lipids, blood pressure) in AG, CH, and RE EEGs exhibited strong additive genetic influences (h2 range: 17% [triglycerides/AG and hs-CRP/RE] - 86% [glucose/non-T2D/AG]). Our findings highlight the high burden of T2D in Indian EEGs with significant and differential additive genetic influences on T2D and related traits.

Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States

ABSTRACT Objective To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. Methods The most recently available (years 2016–2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes-related complications, and total days absent from school or work change from baseline. Results 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes-related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes-related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. Conclusion Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes-related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.

Co nového přinášejí ADA standardy péče o pacienty s diabetem z roku 2022?

A selection of the most important changes in recent ADA guidelines on diabetes screening, diagnosis, pharmacotherapy, or technologies in 2022.

IDF21-0061 Lipid Abnormalities in Persons Living with Type 1 Diabetes Mellitus in Sri Lanka

Background: Sri Lanka is an island nation with a multi ethnic population of approximately >21 million. No prevalence studies have been conducted on persons living with type 1 diabetes [PLWT1D]. However, it is estimated at approximately 1%-2%. The National Registry of PLWT1D is compiled at the National Diabetes Centre [NDC] at Rajagiriya, Sri Lanka. Diabetes Mellitus [DM] is associated with high cardiovascular disease (CVD) risk. Although micro vascular complications are commonly assessed in PLWT1D population, dyslipidemia which is an independent risk factor for CVD is not often assessed. Aim: The aim is to identify prevalence of dyslipidemia and its association with different risk factors namely poor glycaemic control, improper nutrition, inadequate exercise and chronic stress /depression. Method: This retrospective study was conducted using 150 [male=47%] from the National Registry of PLWT1D who are economically vulnerable subjects. The age range of the study subjects were 10–44 years with a mean age of 24.5; ±6.6. The mean duration of T1D was 6-35 years with a mean of 16.5 yrs; ±6.0. The study subjects received regular comprehensive care comprising of medical and psychological care, all laboratory tests, insulin and home glucose monitoring strips and other accessories free of charge from the NDC from 2017-2021. Diet and exercise was assessed with an interviewer administered questionnaire and depression was assessed using validated PHQ-9. The criteria of dyslipidemia considered was total cholesterol (TC) 200 mg/dl as per ADA guidelines. HbA1c levels >8% were considered as poor glycaemic control. SPSS [version 20] was used for statistical analysis Results: The total cholesterol in the study group ranged from 103-357mg/dl [mean TC 215.9; ±46.7] and poor glycemic control i.e. hba1c range from 5.5-16 mg/dl [mean 9.4 ± 2.2]. The prevalence of dyslipidemia and poor glycaemic control was seen in 60.4% and 69.3% respectively. A significant positive correlation [p<0.05] was seen in subjects with dyslipidemia and chronic stress /depression (r=0.312), poor glycemic control (r=0.074) and inadequate physical activity (p=0.018). There was no significant correlation seen in subjects with dyslipidemia and diet, age, gender or duration of illness. Discussion: Our study clearly reveals a significant correlation between dyslipidemia, a known marker of macroangiopathy, and stress and depression in PLWT1Ds. Often parents and patients are likely to experience medium to high levels of stress leading to depression due to it being a lifelong chronic illness. Often mental health and wellbeing of PLWT1Ds are overlooked due to it be a non-functional, unseen factor. It also emphasizes the importance of early intervention to prevent adverse metabolic and mental health outcomes in this group.

IDF21-0569 Periodontal disease is associated with increased risk of Diabetes and Pre-diabetes

Background: Early diagnosis of diabetes mellitus and pre-diabetes is essential for the timely management of diabetes and its complications as well as the prevention of diabetes in individuals with pre-diabetes. Periodontal disease has also been recognized as the sixth complication of diabetes although this is still under-appreciated by endocrinologists or physicians in general. Since it has been suggested that severe periodontitis might be an early complication of diabetes, therefore periodontal disease may be a useful indicator to screen for the risk of diabetes or pre-diabetes in dental patients who otherwise do not know of their glycemic status. Aim: In this study, HbA1c levels and subsequently the prevalence of diabetes and pre-diabetes in participants with and without periodontitis of various stages were investigated. Method: From 88 mild periodontitis patients, 132 moderate periodontitis patients, 210 severe periodontitis patients and 66 patients without periodontitis (control), HbA1c values were obtained by a finger-prick blood sample taken from each participant which was then tested in a point-of-care HbA1c analyzer. Differences in mean HbA1c values and prevalence of diabetes and pre-diabetes between the different periodontitis and control groups were analyzed. Multivariate analyses were performed, correcting for known risk indicators for diabetes screening. Results: In this cohort of a total of 496 participants, 29(5.8%) and 154 (31.0%) patients were identified with HbA1c levels corresponding to the ADA guideline levels for diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%), respectively. In addition, the mean HbA1c levels increases as the stage of periodontitis increases from no periodontitis to severe periodontitis. Periodontal disease of all stages have higher proportion of hyperglycaemia as compared to non-periodontitis(control) patients. However, it is the severe periodontitis group that showed a significantly higher percentage of patients with HbA1c values in the diabetes range as compared with the mild/moderate periodontitis group (p < 0.001). The prevalence of pre-diabetes was significantly higher in patients with moderate periodontitis compared with patients without periodontitis or with patients having mild periodontitis. In the severe periodontitis group, 18 (8.6%) patients had HbA1c levels in the diabetes range and 51 (24.3%) patients could be diagnosed with prediabetes according to the ADA-guidelines, whereas in the moderate periodontitis group, 59 (44.7%) subjects had HbA1c levels in the pre-diabetes range and only 2 (1.5%) of them reached HbA1c values for diabetes diagnosis. Discussion: Periodontitis is associated with increased levels of HbA1c and subsequently with an increased prevalence of those at risk for diabetes and pre-diabetes. We suggest that severe periodontal disease may be a useful risk indicator for early diabetes or pre-diabetes. This study also demonstrates the important role that dentists can play in the early referral of their patients who may already have undiagnosed diabetes and pre-diabetes to endocrinologist so as to receive timely medical diagnosis, prevent or delay progression from pre-diabetes to overt diabetes mellitus and intervention to prevent potential diabetes complications which in turn reduces disease burden.

Pharmacological Treatment of Diabetic and Non-Diabetic Patients With Coronary Artery Disease in the Real World of General Practice.

Type 2 diabetes mellitus (T2DM) severely increases the probability of developing coronary artery disease (CAD), and diabetic patients with CAD should be considered at very high cardiovascular risk. The complexity of this clinical scenario makes very hard the appropriateness of the pharmacological treatment in the real world. To investigate the implementation of guideline recommendations for the treatment of patients affected by CAD with or without T2DM, a retrospective observational study was carried out between 2018 and 2020, by using the computerized clinical medical record of 10 general practitioners (GPs) including 13,206 subjects. A total of 926 patients (7.0%) were affected by CAD and 393 (42.4%) of them were also diabetic. LDLc, SBP, DBP, and FPG were recorded in 77.4%, 65.4%, 66.5%, and 82.6% of patients, respectively. Comorbidities (median; IQR = 8; 6–10 vs. 5; 3–7: p < 0.001) were significantly high in diabetic patients. Specialist counselling has been observed in 59.9% of diabetic and 57% of non-diabetic patients (p = 0.400). Antithrombotic drugs, statins, β-blockers, or RAASs were prescribed in 67.2%, 59.6%, and 75.9% of patients, respectively. Overall, 462 (49.9%) patients used the treatment suggested by guidelines. Dyslipidemia, hypertension, atherosclerosis, and specialist counselling were predictors of suggested drugs use both in diabetic and non-diabetic patients. Diabetes was not an independent factor related to the likelihood to be properly treated, according to the guidelines. Glucose lowering drugs were prescribed in 69.5% of diabetic patients, but only 39 (14.3%) were treated with the proper GLP-1 or SGLT2-i, whereas 45 patients (16.5%) received the improper sulphonylureas. Our results showed that a “non-ideal” therapeutic approach was adopted in patients affected by diabetes and CAD. ADA and ESC guidelines recommend the use of at least one hypoglycemic agent belonging to the GLP-1 or SGLT2-i class in diabetic patients with high/very high cardiovascular risk, regardless of the glycemic target (HbA1c <7%). However, only a few diabetic patients on hypoglycemic therapy were appropriately treated. These data suggest that a closer collaboration between the GPs, clinical pharmacologist, and specialists is needed in the real world scenario of the general practice in order to effectively improve adherence to guidelines and overall management of global cardiovascular risk in diabetic patients.

Nomogram for Predicting 5-Year Diabetes Remission After Roux-en-Y Gastric Bypass Surgery in Chinese Patients with Obesity.

Roux-en-Y gastric bypass (RYGB) is widely used as an effective treatment for type 2 diabetes (T2D) patients with obesity; long-term (> 5years) diabetes remission (DR) rates have been less frequently reported. To date, there is no validated model to guide procedure selection based on long-term glucose control in patients with T2D. The purpose of this study is to establish a new tool for predicting long-term DR with a nomogram. One hundred five individuals with complete preoperative information and undergoing RYGB in a university hospital were enrolled in this retrospective study. DR criteria after bariatric surgery were defined according to the 2009 ADA guideline. Fifteen individuals were lost to 5-year follow-up. Thus, 90 individuals were available and seen at the end of follow-up. The baseline and 5-year data of these 90 individuals were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors for long-term DR, and these predictors were used to create a nomogram. Preoperative glycated hemoglobin (A1C) and diabetes duration were identified as independent influential factors that could be combined for precise prediction of long-term complete DR. We created a nomogram by using these 2 factors. The area under the curve was 0.78 (95% confidence interval 0.67-0.89). The Hosmer-Lemeshow X2 value of nomogram was 3.86 (P = 0.87) and indicated consistency between predicted and observed remission. Our nomogram was a novel and useful tool for accurate prediction of long-term DR after RYGB.

Association of hemoglobin level and packed cell volume with gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is a type of insulin resistance that develops in the second trimester of pregnancy. This type of diabetes ends after delivery. GDM poses serious health hazards to both the mother and the baby. Pathology behind this carbohydrate intolerance is insulin resistance. The previous studies have pointed out that this insulin resistance is due to oxidative stress caused by free radicals. Free radicals can be generated by iron. Since pregnancy is a condition where iron requirement rises, universal iron supplementation is given. According to the previous studies, excess iron can cause free-radical mediated injury leading on to diabetes. Supplementation of a prooxidant irrespective of body iron stores may be more harmful than beneficial. Hemoglobin and PCV are two hematological parameters that reflect body iron stores. Aims and Objectives: The aim of the study was to compare hemoglobin and PCV values in pregnant woman with and without GDM. Materials and Methods: A case–control study was done in the obstetric department of a tertiary care center in south India from August 2010 to December 2010.The study included 85 cases and 85 controls. Cases were pregnant women at 24–28 weeks of gestation with gestational diabetes who attended the obstetric OPD during the study period. GDM was diagnosed as per ADA guidelines. Controls were pregnant women at 24–28 weeks gestation without GDM as per ADA guidelines. Data for the study were collected using a preformed tested questionnaire. All subjects were provided with iron supplementation according to the national programme. Estimation of hemoglobin and PCV was done with 2 ml of blood sample obtained by venepuncture using an automated analyzer. The association of elevated hemoglobin and PCV with the risk of developing GDM was tested using Chi-square analysis. P ≤ 0.05 was taken as statistically significant. Results: Hemoglobin in cases and controls showed a significant difference by Chi-square analysis (P = 0.004). PCV in cases was significantly higher than in controls by Chi-square analysis (P = 0.003). Conclusion: The study found a statistically significant association between higher maternal hemoglobin level and PCV with GDM.

Comparison of the Four Major US Guidelines for Lipid Lowering Therapy for the Primary Prevention of ASCVD in Patients with Diabetes

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Four US organizations (AHA/ACC, ADA, NLA, and AACE/ACE) have guidelines on statin and other lipid-lowering medication use for the primary prevention of ASCVD in patients with diabetes mellitus (DM). While all four guidelines recommend moderate to high-intensity statin as first-line therapy, the NLA and AACE/ACE have LDL-C goals based on risk and advocate non-statin LDL cholesterol lowering drugs for patients who need additional LDL-C lowering. <h3>Objective/Purpose</h3> To compare the four major guidelines in a contemporary cohort of patients with DM in a large cardiology practice. <h3>Methods</h3> We identified 8,834 patients (age > 20) with DM and no history of ASCVD who had at least one office visit between December 2019 and November 2020. Patient clinical characteristics, laboratory data, and medications were extracted from their electronic health record (EHR). Patients were considered to have met the AHA/ACC and ADA guidelines if they were aged 40 to 75 and were on a moderate or high-intensity statin. Adherence to the NLA and AACE/ACE guidelines was assessed among the 7,212 patients with DM (81.6%) who had an LDL-C value recorded in the EHR. Patients were stratified into high (LDL-C goal < 100 mg/dL) and very high-risk (LDL-C goal < 70 mg/dL) groups based on additional risk factors. <h3>Results</h3> The mean age of the study patients was 67.8 +/- 12.1 years, 50.4% were female and 70.1% were white. Among the 7,212 patients with an LDL-C in the EHR, 90.2% were stratified as very high-risk by the NLA and 98.8% by the AACE/ACE guidelines. Of the very high-risk patients not at their LDL-C goal, 69.9% were not on a high intensity statin and 92.6% not on any intestinal blocking agent. <h3>Conclusions</h3> In a contemporary cohort of primary prevention patients with DM seen in a cardiology practice almost all are very high risk and almost 60% have not achieved their NLA or AACE/ACE guideline directed LDL-C goal. Although the AHA/ACC and ADA guidelines are less stringent, over 25% have not met these goals. The use of non-statin LDL-C lowering drugs was low. Strategies are needed to improve guideline directed lipid lowering therapy in these high-risk patients.

Simulations found within-subject measurement variation in glycaemic measures may cause overdiagnosis of prediabetes and diabetes

ObjectiveTo determine the impact of test measurement variation on misclassification of prediabetes and diabetes in the US adult population. Study Design and SettingData from adults with no prior diagnosis of diabetes in the 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) were used to simulate populations of US adults eligible for screening. Estimates of measurement variation were applied to each simulated individual's true values to generate observed values for up to five repeated screens. Results: UnderdiagnosisFor 100,000 people assessed according to ADA or USPSTF guidelines, no people with true values in the diabetes range would be underdiagnosed as normal after one screen, and between 64 and 138 people would be misclassified with prediabetes after five re-screens (depending on guideline and test used). OverdiagnosisFor 100,000 people assessed according to the guidelines, between 1,602 and 2,233 people with true values in the normal range would be over diagnosed with prediabetes after 3 re-screens. A further 627 to 1,672 people with true values in the prediabetes range would be over diagnosed with diabetes after 5 re-screens. ConclusionMeasurement variation may cause overdiagnosis of prediabetes and diabetes, as well as apparent “progression” or “regression” of either condition.

Flexural properties of electrospun polymethyl methacrylate microfiber-reinforced BisGMA for dental post prefabrication

Introduction: A dental post is a restoration to preserve the remaining tooth structure thus can be functioned normally. Many researchers suggested a fiber dental post due to its biomechanical properties that are similar to dentin structure. This study aims to analyse the flexural properties of electrospun polymethyl methacrylate microfiber-reinforced BisGMA for dental post prefabrication. Methods: The sample used was following the ADA guideline, as well as for the number of samples. The sample size was 25×2×2mm, which is close to the average dental post size. PMMA microfibers were prepared by dissolving heat cure PMMA powder with 99% acetone, then electrospinning with a rotary collector. Acquired PMMA microfibers were immersed into the resin matrix containing BisGMA, camphorquinone, and 2-dimethylaminoethyl methacrylate (DMAEMA) as a monomer, initiator, and co-initiator, respectively, to prepare the dental posts. Results: PMMA microfibers structure and surface fracture of dental posts were confirmed by Scanning Electron Microscopy (SEM). PMMA microfibers show unaligned fiber morphology with an approximate diameter size of 1-5 µm. A universal testing machine was used to measure the dental post's flexural properties (flexural strength and flexural modulus). Dental posts with PMMA fibers showed higher flexural strength (83.5 ± 10.7 MPa) compared to the dental post without PMMA fibers (61.7 ± 3.03 MPa) with a p-value &lt;0.05. On the other hand, PMMA fibers' addition did not significantly increase the dental post's flexural modulus. Conclusion: The PMMA microfibers can intimately adhere to the BisGMA mixture as the resin matrix. Therefore, the PMMA microfiber significantly improves the flexural strength of the BisGMA for dental post prefabrication.

Seven Lifestyles Shed Light on Exercise Timing: A Physician-Patient’s Perspective

ADA guidelines have not yet specified exercise timing. A physician-patient with type 2 diabetes for over 22 years and equipped with a glucometer and continuous glucose monitoring, I tested different evidence-based exercise options in seven lifestyles toward personalizing my routines. The only intervention during the period was the mode of exercise except in lifestyles 1 and 2, where there was also carb control. All other variables including medications were continued without any change. Not only did these lifestyles agree with the existing data on exercise timing but it accomplished an additional objective: the CGM data also helped mitigate the negative effects of pre-breakfast exercise. After avoiding pre-breakfast exercise for about 16 years CGM made me a convert: a moderate intensity pre-breakfast exercise followed by a morning snack every other day turned out to be my most valuable exercise for metabolic control.

Diagnostic Accuracy of Markers of Insulin Resistance (HOMA-IR) and Insulin Sensitivity (QUICKI) in Gestational Diabetes.

To determine the diagnostic accuracy of HOMA-IR, and QUICKI in diagnosing gestational diabetes mellitus (GDM) considering oral glucose tolerance test (OGTT) as gold standard. Cross-sectional analytical study. Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi from September 2020 to February 2021. Pregnant women with gestational age between 24 to 28 weeks, who reported to Endocrine Clinic of AFIP for OGTT, were included in the study. OGTT was performed by following ADA guidelines. Sample for fasting insulin was collected along with first fasting sample of OGTT. HOMA-IR and QUICKI were calculated simultaneously. Percentage was used for qualitative variable while median (IQR 25th-75th) was applied for quantitative variables. OGTT was used as gold standard for calculation of diagnostic accuracy of HOMA-IR and QUICKI. Out of 182 patients, 74 (40.6%) were found to have GDM on OGTT while 108 (59.4%) had normal OGTT. Women with GDM (n=74) had median values of fasting insulin 15.9 (IQR 11.2-17.77), HOMA-IR 3.5 (IQR 2.6-4.1) and QUICKI 0.31 (IQR 0.30-0.33) as compared to median values of fasting insulin 8.0 (IQR 5.9-10.3), HOMA-IR 1.60 (IQR 1.12-2.03) and QUICKI 0.35 (IQR 0.34-0.37) in patients (n=108) with normal response to OGTT, (p <0.001). On logistic regression analysis, there was a strong association of HOMA-IR and QUICKI with gestational diabetes mellitus (p <0.001, accuracy 84.6%). HOMA-IR at cutoff of ≤2 had 94.5% sensitivity, 72.2% specificity, 70% PPV, 95.1% NPV, and 81.31% overall diagnostic accuracy with 0.913 AUC. QUICKI at cutoff of 0.34 had 86.4% sensitivity, 83.3% specificity, 78.0% PPV, 90.0% NPV, and 84.61% overall diagnostic accuracy with 0.905 AUC. Fasting insulin and HOMA-IR were significantly higher while QUICKI was lower in patients of GDM as compared to non-GDM pregnant patients at 24 to 28 weeks of gestation. Being more convenient for patients, it has the potential to be used as screening tool for gestational diabetes. Key Words: HOMA IR, QUICKI, Gestational diabetes mellitus, Insulin.

SERUM URIC ACID LEVELS IN NEWLY DIAGNOSED CASES OF TYPE 2 DIABETES MELLITUS IN ASSAM: A CASE CONTROL STUDY

INTRODUCTION: T DM is a metabolic disorder characterized by hyperglycemia with disturbances of carbohydrate, 2 fats and protein metabolism. Hyperuricaemia has often been associated with diabetes mellitus. 100 patients METHOD: with T DM diagnosed according to ADA guidelines and 100 age sex matched normal healthy individuals as controls were selected. Serum Uric 2 acid and Fasting blood sugar levels were measured and the results were analyzed statistically Statistical analysis of the results shows RESULTS: signicant increase in Serum Uric acid in the cases (P&lt;0.001) the mean S CONCLUSION: erum Uric acid level was found to be signicantly higher in newly diagnosed cases of T DM

The Role of Prediabetes as a Predictive Factor for the Outcomes in Patients with STEMI. Which Is the Right Range of Glycated Hemoglobin to Adopt in This Setting?

Background: Prediabetes (preT2D) is considered a subtle adverse cardiovascular (CV) risk factor after acute myocardial infarction. Glycated hemoglobin (HbA1c) ranges to identify preT2D are different between ADA and WHO guidelines (5.7–6.4 vs. 6.0–6.4%, respectively). Aim: To evaluate the prognostic value of HbA1c different preT2D-ranges and their correlation with demographic, instrumental, and laboratory parameters in STEMI. Methods: A total of 1681 patients (mean age 67 ± 13 years; 1217 males) were enrolled. Admission HbA1c was used to identify patients with no-T2D (&lt;5.7%), HbA1c 5.70–5.99%, and WHO-preT2D with HbA1c 6–6.49%, and T2D (HbA1c ≥ 6.5). Results: HbA1c 5.7–5.99, WHO-preT2D, and T2D progressively correlated with an increasing number of CV risk factors. However, only T2D, but not preT2D, was significantly associated with adverse prognosis (in-hospital and one-year death). Conclusions: PreT2D is correlated with CV risk factors, but not with adverse prognosis as compared to no-T2D. Nonetheless, routine HbA1c testing in the STEMI population and HbA1c-5.7–5.99 patient inclusion in the preT2D category may help to identify those who may benefit from intervention and lifestyle strategies to early prevent preT2D progression.

1267-PUB: Sustained Reduction of A1C through Use of AI Digital Coach and Consumer-Friendly Glucose Measurement

Management of diabetes has always depended upon sustained self-management by the person with diabetes. Data continues to show that people do a poor job of diabetes management. Many telehealth solutions achieve short-term, but not sustained results. This investigated platform implements two unique elements to improve the ability to achieve sustained self-management. One element is an Artificial Intelligence (AI) digital coach that exists in the mobile app--keeping the right behaviors in front of people with diabetes and encouraging continual engagement. The second element is an integrated glucose meter with a dramatically more friendly user experience--defined by smaller size, discreet (no visible assembly), and less painful. The platform has been commercialized for more than 12 months. A clinical registry has been established and currently includes 50 commercial users of the platform and more than 25,000 glucose tests are included. Demographics include both type 1 and type 2, 42% male, 58% female, with ages ranging from 24 to 69 years old. With use of the platform, Figure 1 shows a significant decrease in A1C, as calculated from glucose measurements, of 1.4 points (p = 0.0001) in early use to a sustained reduction of 0.9 points (p=0.0001). These results may indicate that easier visibility of results causes immediate reduction of glucose and that this easier visibility combined with the AI coach may sustain results. These results potentially demonstrate that a simpler experience for self-management will improve sustained diabetes management results. Future studies of the registry data will include improved compliance toward ADA guidelines and glucose time in range. Disclosure T. Balder: Advisory Panel; Self; POPS Diabetes Care.

854-P: A Statewide Needs Assessment to Inform Best Practices for the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH)

Background: Funded by the Ohio Department of Medicaid, the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites the 7 medical schools in Ohio to improve outcomes and reduce disparities in hypertension and type 2 diabetes (T2D). The purpose of this needs assessment was to identify high priority educational topics for the dissemination of evidenced-based best practices. Methods: Questions surveyed collaborative members’ familiarity with guidelines, educational topics, and barriers to care. Results: A total of 111 out of 123 members completed the needs assessment (90.2% response rate). Half (49.5%, n=55) were familiar with the 2017 ACC/AHA guidelines for hypertension, whereas only 36.9% (n=41) were familiar with the 2020 ADA guidelines. The 3 topics of most interest were: 1) social determinants of health (SDOH, 55.9%, n=62), 2) lifestyle approaches to T2D (40.5%, n=45), and 3) new therapies for T2D (32.4%, n=36). Fifty-nine members (53.2%) provided direct clinical care; the others worked in research and public health. Providers estimated 25% of their T2D patients had A1C values &amp;gt;9.0%. Providers listed the 3 most common patient self-care barriers as: 1) lack of patient motivation (65.5%, n=38), 2) lack of patient education (60.3%, n=35), and 3) limited formularies and prior authorizations (41.4%, n=24). The 3 most common reasons for clinical inertia were: 1) lack of patient education (50.0%, n=29), 2) competing priorities (46.6%, n=27), and 3) lack of patient motivation (44.8%, n=26). Providers felt payers could help them with: 1) transportation (61.0%, n=68), 2) coverage of diabetes self-management education and support (DSMES, 59.4%, n=66), and 3) obtaining glucose monitors (45.9%, n=51). Conclusions: Top priorities for future evidence-based best practices are SDOH, patient engagement, and addressing complexity of care. Payers should prioritize increased coverage for DSMES and simplification of ordering monitoring supplies. Disclosure E. A. Beverly: None. G. D. Solomon: None. M. B. Holliday: None. J. Lewis: None. A. Nevar: None. S. M. Swiatkowski: None. M. W. Konstan: None. S. D. Bolen: None. K. M. Dungan: Advisory Panel; Self; Eli Lilly and Company, Tolerion, Inc., Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Elsevier, Novo Nordisk, Other Relationship; Self; UpToDate, Research Support; Self; Abbott, Sanofi-Aventis, Viacyte, Inc. J. T. Wright: None. A. Caron: None. M. Clemons: None. S. Aldrich renner: None. K. Gawlik: None. M. Sajatovic: Consultant; Self; Alkermes, Janssen Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc., Other Relationship; Self; Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate, Research Support; Self; Alkermes, Nuromate, Otsuka America Pharmaceutical, Inc. G. Rao: None. Funding Ohio Medicaid Technical Assistance and Policy Program (G-2021-05-0069)