Adult Type 2 Diabetes Patients Research Articles

Prevalence of diabetic cardiomyopathy in patients with type 2 diabetes in a large academic medical center

BackgroundDiabetic cardiomyopathy (DbCM) is characterized by asymptomatic stage B heart failure (SBHF) caused by diabetes-related metabolic alterations. DbCM is associated with an increased risk of progression to overt heart failure (HF). The prevalence of DbCM in patients with type 2 diabetes (T2D) is not well established. This study aims to determine prevalence of DbCM in adult T2D patients in real-world clinical practice.MethodsRetrospective multi-step review of electronic medical records of patients with the diagnosis of T2D who had echocardiogram at UC San Diego Medical Center (UCSD) within 2010–2019 was conducted to identify T2D patients with SBHF. We defined “pure” DbCM when SBHF is associated solely with T2D and “mixed” SBHF when other medical conditions can contribute to SBHF. “Pure” DbCM was diagnosed in T2D patients with echocardiographic demonstration of SBHF defined as left atrial (LA) enlargement (LAE), as evidenced by LA volume index ≥ 34 mL/m2, in the presence of left ventricular ejection fraction (LVEF) ≥ 45%, while excluding overt HF and comorbidities that can contribute to SBHF.ResultsOf 778,314 UCSD patients in 2010–2019, 45,600 (5.9%) had T2D diagnosis. In this group, 15,182 T2D patients (33.3%) had echocardiogram and, among them, 13,680 (90.1%) had LVEF ≥ 45%. Out of 13,680 patients, 4,790 patients had LAE. Of them, 1,070 patients were excluded due to incomplete data and/or a lack of confirmed T2D according to the American Diabetes Association recommendations. Thus, 3,720 T2D patients with LVEF ≥ 45% and LAE were identified, regardless of HF symptoms. In this group, 1,604 patients (43.1%) had overt HF and were excluded. Thus, 2,116 T2D patients (56.9% of T2D patients with LVEF ≥ 45% and LAE) with asymptomatic SBHF were identified. Out of them, 1,773 patients (83.8%) were diagnosed with “mixed” SBHF due to comorbidities such as hypertension (58%), coronary artery disease (36%), and valvular heart disease (17%). Finally, 343 patients met the diagnostic criteria of “pure” DbCM, which represents 16.2% of T2D patients with SBHF, i.e., at least 2.9% of the entire T2D population in this study.ConclusionsOur findings provide insights into prevalence of DbCM in real-world clinical practice and indicate that DbCM affects a significant portion of T2D patients.

Erectile Dysfunction and Depression Prevalence Among Male Patients with Type II Diabetes.

Patients with Type 2 Diabetes (T2D) are at substantial risk for developing erectile dysfunction (ED). The primary goal of this study was to assess the prevalence of ED and depression among T2D patients and the associated risk factors. A cross-sectional study was conducted for adult T2D patients who had a routine clinic visit between January-August 2023. Structured questionnaires formed with two validated questionnaires - the International Index of Erectile Function short form (IIEF-5) and Patient Health Questionnaire (PHQ-9) - were used to screen for ED and depression, respectively. A total of 478 male patients with T2D with a mean age of 59.2 ± 10.8 years, mostly married, with long standing T2D were included. Hyperlipidemia followed by hypertension were the most reported comorbidities. Of the patients, 61.3% had reported no depression and were less likely to have ED or severe ED (p <0.001) and more likely to be physically active and to report no smoking (p <0.0001) when compared to those with depression. Fifty-two percent of the patients reported moderate and severe ED and those were older in age (p = 0.031), had longer duration of T2D diagnosis (p = 0.005), were more likely to have any comorbidities (p <0.05), were less likely to have a university degree and higher income (both p <0.001), were less likely to be on oral hypoglycemic agents (OHA) (p <0.001), had worse glycemic control parameters (p = 0.463), were more likely to have positive urine microalbuminuria (p = 0.019), and were less likely to be physically active (p = 0.048) when compared to patients with no or milder degree of ED. ED is highly prevalent in our study sample, with half of the patients having moderate to severe ED and being more likely to have depression. Older age, long-standing T2D, comorbidities, socioeconomic disadvantage, and sedentary lifestyle were all significantly associated with ED.

Association between sleep variability and time in range of glucose levels in patients with type 1 diabetes: Cross-sectional study

ObjectiveSleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. MethodsSeventy-six non–shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters. ResultsMedian (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = −9.64, 95% confidence interval [−16.29, −2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = −0.18, 95% confidence interval [−0.32, −0.04]). ConclusionGreater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research. Data availability statementData are available upon a reasonable request to the corresponding author.

Drug-related Problems Among Type 2 Diabetic Patients With Hypertension in a Tertiary Care Hospital in Lebanon: A Cross-sectional Study

Background: Patients with type 2 diabetes (T2D) often have other associated comorbidities, making them susceptible to drug-related problems (DRPs) which can adversely affect their quality of life. Understanding these problems can provide baseline data to allow informed health decisions and effective management of patients. Objectives: This study aims to investigate DRPs in T2D patients with hypertension and find the predictors of these problems. Methods: This cross-sectional study was conducted for six months in the internal medicine department of a tertiary care hospital in Lebanon. Participants were 135 adult T2D patients with hypertension who were receiving one or more anti-diabetes drugs, and at least one medication for hypertension. Pharmaceutical care network europe classification system was used to classify the DRPs. Data were collected by two clinical pharmacists using a self-report tool. Results: Most of patients were female. Most of them (94.1%) had at least one DRP (1.43±0.72 per patient). “Non-optimal drug treatment effect” was the most frequent problem (48.2%). Achieving the HbA1C target reduced the odds of this problem by 66.6%, while the increased serum creatinine level caused a two-fold increase in this problem. The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduced the odds of DRPs by 86.2% and 83.3%, respectively, while lipid-lowering and anti-anginal drug use caused a four-fold increase in DRPs. Conclusion: Early identification of DRPs in diabetic patients with hypertension and their associated factors can help improve their management and reduce the associated mortality and morbidity rates.

Ambulatory Blood Pressure Monitoring as a Useful Tool in the Cardiological Assessment of Pancreas Transplant Recipients with Type 1 Diabetes.

Having the appropriate tools to identify pancreas recipients most susceptible to coronary artery disease (CAD) is crucial for pretransplant cardiological assessment. The aim of this study is to evaluate the association between blood pressure (BP) indices provided by ambulatory blood pressure monitoring (ABPM) and the prevalence of CAD in pancreas transplant candidates with type 1 diabetes (T1D). This prospective cross-sectional study included adult T1D patients referred for pretransplant cardiological assessment in our center. The study population included 86 participants with a median age of 40 (35-46) years. In multivariate logistic regression analyses, after adjusting for potential confounding factors, higher 24 h BP (systolic BP/diastolic BP/pulse pressure) (OR = 1.063, 95% CI 1.023-1.105, p = 0.002/OR = 1.075, 95% CI 1.003-1.153, p = 0.042/OR = 1.091, 95 CI 1.037-1.147, p = 0.001, respectively) and higher daytime BP (systolic BP/diastolic BP/pulse pressure) (OR = 1.069, 95% CI 1.027-1.113, p = 0.001/OR = 1.077, 95% CI 1.002-1.157, p = 0.043/OR = 1.11, 95% CI 1.051-1.172, p = 0.0002, respectively) were independently and significantly associated with the prevalence of CAD. Daytime pulse pressure was the strongest indicator of the prevalence of CAD among all analyzed ABPM parameters. ABPM can be used as a valuable tool to identify pancreas recipients who are most susceptible to CAD. We suggest the inclusion of ABPM in pretransplant cardiac screening in type 1 diabetes patients eligible for pancreas transplantation.

Evaluating the clinical effectiveness and safety of insulin glargine 300 U/mL in individuals with type 2 diabetes uncontrolled on basal insulin: A real-world evidence study from Saudi Arabia (EVOLUTION).

To evaluate the effectiveness and safety profile of switching to insulin glargine 300 U/mL (Gla-U300) in patients with uncontrolled type 2 diabetes (T2D) on basal insulin in Saudi Arabia. We conducted a multicentre retrospective study that retrieved the medical records of adult T2D patients switched to Gla-U300 because of poor glycaemic control on their basal insulin. Data covering 6 months ± 30 days before and after the switch were retrieved. Data from 718 patients were analysed. The mean HbA1c decreased significantly 6 months after switching to Gla-U300, with a mean reduction of 0.7% (95% confidence interval [CI] 0.6%-0.9%; P < .001). The percentage of patients with HbA1c levels of less than 7% increased from 6.4% before switching to 10.3% after switching to Gla-U300. The percentage of patients achieving the predefined individualized HbA1c goal increased from 8.6% before switching to 17.3% after switching to Gla-U300. The mean daily insulin dose decreased from a baseline level of 32.2 (± 14.7) to 31.0 (± 15) U (P = .09). About 36.1 of the patients required adjustment to the initial dose. Gla-300 was well tolerated; 4.5% of the patients experienced overall confirmed or symptomatic hypoglycaemia, compared with 15.3% before switching to Gla-U300. The incidence of severe hypoglycaemia after switching was 0.6% (n = 4 patients), compared with 1% before switching. Real-world evidence supports the effectiveness of switching to Gla-U300 from first-generation basal insulin in T2D in Saudi Arabia.

159-OR: Greater Sleep Variability Is Associated with Less Time in Range of Glucose Levels in Patients with Type 1 Diabetes

Background: Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations between sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. Methods: Baseline data of 76 non-shift working adult T1D patients participating in a randomized study to optimize sleep health (NCT04506151) were analyzed. Glycemic assessments were derived from blinded 7-day continuous glucose monitoring (CGM) and A1C. Percentages of time-in-range (TIR of glucose levels between 70-180 mg/dL) and %CV were calculated from CGM. Sleep was recorded using 7-day actigraphy, yielding sleep duration and efficiency. Variability (SD) of mid-sleep time (MST) was used to represent sleep variability. Non-parametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by the Diabetes Self-Management Questionnaire (DSMQ-R). Multiple regression analyses were performed to identify independent predictors of glycemic parameters. Results: Mean (SD) age was 36.3 (11) years, 48 (63.2%) female, and median (IQR) A1C 6.8% (6.2, 7.4). Sleep duration, efficiency, and non-parametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in SD of MST was associated with 9.64 % less TIR (B= -9.64, 95% (CI) [-16.29, -2.99], p=&amp;lt;0.001). Higher DSMQ score was an independent predictor of lower A1C (B = -0.18, 95% CI -0.32, -0.04). Conclusion: Greater sleep variability is independently associated with less time spent in desirable glucose range in this modern T1D cohort, with clinically important effect sizes. Sleep optimization to reduce variable sleep schedule could potentially lead to improved metabolic control and should be explored in future research. Disclosure P.Martyn-nemeth: None. L.T.Quinn: None. M.Clark withington: None. A.H.Saleh: None. B.Loiacono: None. D.Mihailescu: None. S.Reutrakul: Speaker's Bureau; Eli Lilly and Company. G.Abu irsheed: None. M.Park: None. A.D.Steffen: None. L.Burke: None. S.Pratuangtham: None. K.Baron: Other Relationship; National Sleep Foundation, Research Support; Google. J.Duffecy: Consultant; Chorus Health, K Health, Stock/Shareholder; Healent Health, My Alloy. R.Perez: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121726)

Faster-acting insulin aspart reduces glycaemic variability in sensor-augmented pump treated type 1 diabetes patients

AimTo evaluate the effect of faster aspart over glycaemic variability in type 1 diabetes (T1D) patients treated with sensor-augmented pump (SAP) in a real-world scenario. MethodsObservational study with SAP-treated adult T1D patients treated with faster aspart for three months. The primary endpoint was the mean amplitude of glucose excursions (MAGE). ResultsFifty patients were treated with faster aspart. Eleven patients (23%) withdrew during the follow-up mainly due to worsening of diabetes control (9 patients). Mean age was 41.2 yrs. (range 21–59) and T1D duration 22.4±10.0 yrs. Mean SAP treatment duration was 3.6±3.1 yrs. We detected a reduction of -7.0 (95% CI −1.1, −12.9; p=0.021) in MAGE at the end of the study. Other glycemic variability indices were also improved: standard deviation of mean interstitial glucose (−3mg/dl; 95% CI, −1, −5; p=0.01), CONGA4 (−2.2; 95% CI −0.3, −4.2; p=0.029), CONGA6 (−2.6; 95% CI −0.6, −4.6; p=0.011), GRADE (−0.5; 95% CI −0.1, −0.9; p=0.022), HBGI (−0.7; 95% CI −0.2, −1.3; p=0.013), J-index (−2.9; 95% CI −0.7, −5.0; p=0.011) and MODD (−5.7; 95% CI −1.7, −9.7; p=0.006). A slight reduction in mean glucose management indicator was also detected (−0.14%; 95% CI, −0.02, −0.27; −1.4mmol/mol; 95% CI −0.1, −3.3; p=0.03). ConclusionsIn SAP-treated T1D patients, faster aspart insulin was associated with reduced glycaemic variability, but also a high percentage of dropouts due to worsened glycaemic control. NCT04233203.

Revisiting 'intensive' blood glucose control: A causal directed acyclic graph-guided systematic review of randomized controlled trials.

To clarify the importance of HbA1c reduction and antidiabetic drug use in preventing major adverse cardiovascular events (MACE) for patients with type 2 diabetes (T2D). We conducted an updated systematic review of contemporary large randomized controlled trials assessing the relative efficacy and safety of antidiabetic drugs with less hypoglycaemia risk in adult T2D patients. Mixed-effects meta-regression was performed to examine the associations of HbA1c reduction with subsequent risk of macrovascular and microvascular events. We evaluated the potential mediating role of HbA1c reduction in the relationship between antidiabetic drugs and MACE. Eighteen placebo-controlled trials comprising 155 610 participants were included. The effects of treatment differed among antidiabetic drug classes for most adverse outcomes with high heterogeneity (I2 : 63.7%-95.8%). Mean HbA1c reduction was lowest with dipeptidyl peptidase-4 inhibitors (0.30%), followed by sodium-glucose co-transporter-2 inhibitors (0.46%), and was highest with glucagon-like peptide-1 receptor agonists (0.58%) and thiazolidinediones (0.60%). Lower relative risks of MACE were significantly associated with larger reductions in achieved HbA1c (β -0.3182; 95% CI: -0.5366 to -0.0998; P=.0043), even after adjusting for drug classes. When considering HbA1c lowering as a mediator to be controlled, beneficial effects owing to specific antidiabetic treatment for MACE were not observed (χ2 =1.4494; P=.6940). The proportion mediated by HbA1c reduction was 50.0%-63.5% for these antidiabetic agents. The main benefits of antidiabetic agents might result from the reduction in blood sugar levels and are generally independent of drugs used. Risk reduction in MACE was proportional to the magnitude of HbA1c decrease conferred by antidiabetic agents with less hypoglycaemic hazard.

Faster-acting insulin aspart reduces glycaemic variability in sensor-augmented pump treated type 1 diabetes patients

AimTo evaluate the effect of faster aspart over glycaemic variability in type 1 diabetes (T1D) patients treated with sensor-augmented pump (SAP) in a real-world scenario. MethodsObservational study with SAP-treated adult T1D patients treated with faster aspart for three months. The primary endpoint was the mean amplitude of glucose excursions (MAGE). ResultsFifty patients were treated with faster aspart. Eleven patients (23%) withdrew during the follow-up mainly due to worsening of diabetes control (9 patients). Mean age was 41.2 yrs. (range 21–59) and T1D duration 22.4±10.0 yrs. Mean SAP treatment duration was 3.6±3.1 yrs. We detected a reduction of -7.0 (95% CI −1.1, −12.9; p=0.021) in MAGE at the end of the study. Other glycemic variability indices were also improved: standard deviation of mean interstitial glucose (−3mg/dl; 95% CI, −1, −5; p=0.01), CONGA4 (−2.2; 95% CI −0.3, −4.2; p=0.029), CONGA6 (−2.6; 95% CI −0.6, −4.6; p=0.011), GRADE (−0.5; 95% CI −0.1, −0.9; p=0.022), HBGI (−0.7; 95% CI −0.2, −1.3; p=0.013), J-index (−2.9; 95% CI −0.7, −5.0; p=0.011) and MODD (−5.7; 95% CI −1.7, −9.7; p=0.006). A slight reduction in mean glucose management indicator was also detected (−0.14%; 95% CI, −0.02, −0.27; −1.4mmol/mol; 95% CI −0.1, −3.3; p=0.03). ConclusionsIn SAP-treated T1D patients, faster aspart insulin was associated with reduced glycaemic variability, but also a high percentage of dropouts due to worsened glycaemic control. NCT04233203.

Expert consensus on personalized initiation of glucose-lowering therapy in adults with newly diagnosed type 2 diabetes without clinical cardiovascular disease or chronic kidney disease.

Since it is difficult for clinicians to make a decision among the various types of antidiabetic medications due to their great discrepancy in mechanisms, pharmacological properties, and cardiovascular/renal protection, a relatively "precision" or personalized hypoglycemic treatment suggestion is practical for type 2 diabetes (T2D) management in adults. This expert consensus makes some recommendations based on the characteristics of adult T2D patients without clinical cardiovascular disease (CVD) or chronic kidney disease (CKD) by evidence from large-scale clinical trials. The main consideration for initiating antidiabetic medications is the safety and benefits for prevention of target organ damage, such as CVD and CKD. The choice of personalized glucose-lowering therapy regarding target organ protection is based on the various effects of antidiabetic medications, patients' clinical characteristics and their key risks, as well as the sociological factors. According to the effects on glucose reduction, cardiovascular protection, renal benefit, body weight change, hypoglycemic risk, and liver function impact, the antidiabetic medications are recategorized in this consensus. Combined with the glucose control target and the different effects of hypoglycemic agents, a significant body of recommendations have been developed for optimal T2D management according to the risk factors for atherosclerotic CVD, heart failure, CKD, primary fatty liver, and hypoglycemia. This consensus gives detailed guidance on personalized antidiabetic therapy initiation in newly diagnosed T2D adults, which attaches great importance to both glucose control and target organ protection.

134-OR: Cost-Effectiveness of a Real-Time Continuous Glucose Monitoring System vs. Self-Monitoring of Blood Glucose in Type 2 Diabetes Patients on Insulin in Canada

A health economic analysis was conducted to determine the cost-effectiveness of a real-time continuous glucose monitoring (rt-CGM) system versus self-monitoring of blood glucose (SMBG) in Type 2 diabetes (T2D) patients treated with insulin. The IQVIA CORE diabetes model was utilized for the analysis. Clinical data were sourced from a US retrospective cohort study of adult T2D patients on insulin and adapted to Canada. The baseline mean age (SD) of the cohort was 61 years (13.2) and proportion of male 49%. Mean baseline HbA1c for the cohort was 8.3% (67 mmol/mol) . Patients using rt-CGM were assumed to have a reduction in HbA1c of -0.56% based on the mean difference between groups after 12-months follow-up. A quality-of-life (QoL) benefit associated with reduced finger-stick testing was applied. The analysis was conducted from the Canadian Agency for Drugs and Technologies in Health perspective over a lifetime horizon. The rt-CGM system was associated with an incremental gain of 0.97 quality-adjusted life years (QALYs) compared with SMBG (mean [SD] 10.35 [3.08] versus 9.375 [2.85] QALYs) . Total mean [SD] lifetime costs were CAN$ 17,223 higher with rt-CGM (CAN$ 206,284 [121,493] versus 189,061 [129.680]) , resulting in an incremental cost-effectiveness ratio of CAN$ 17,652 per QALY gained. Sensitivity analyses demonstrated findings were sensitive to changes in QoL, HbA1c, younger patient cohorts, and rt-CGM cost. Varying rt-CGM cost to -25% of base case yielded an ICER of CAN$ 3,512, and varying rt-CGM cost to -50% of base case the ICER becomes dominant over SMBG. For T2D patients on insulin, rt-CGM was associated with significant clinical outcomes and is a cost-effective management option relative to SMBG based on a willingness-to-pay threshold of CAN$ 50,000 per QALY gained. Disclosure J.J.Isitt: Consultant; Dexcom, Inc. S.Roze: None. G.Cogswell: None. P.M.Lynch: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.

Status of glycemic excursions and hypoglycemia in patients with type 1 diabetes 2months after first initiation of intermittently scanned continuous glucose monitoring: a pilot study.

To investigate glycemic excursions and changes in time in hypoglycemia (hyT) in Japanese type 1 diabetes (T1D) patients 2months after the first initiation of intermittently scanned continuous glucose monitoring (isCGM). We enrolled 15 adult T1D patients on insulin therapy to evaluate changes in the parameters for glycemic excursions 2months after initiating isCGM by using the Wilcoxon signed-rank test. Binomial logistic regression analyses were also used to identify predictors of hypoglycemia. A total of 14 patients were available for analysis. Median HbA1c decreased significantly from 7.6% (interquartile range, 6.9-8.3%) to 7.2% (6.7-7.8%) (P = 0.047). Mean glucose, standard deviation of glucose, time in range, and time above range were not significantly different from baseline, while time below range (from 2.2 [1.0-6.9] to 5.0 [2.0-10.8]%; P = 0.016), hyT (from 26.8 [14.5-75.5] to 56.8 [21.7-110.9] min/day; P = 0.030), and time in severe hypoglycemia (shT, from 4.3 [0.0-8.9] to 11.0 [0.0-24.3] min/day; P = 0.022) increased significantly. Additionally, shT increased significantly only during daytime. The factor associated with hyT was found to be the reduction in total insulin dose after 2months. In T1D patients with a median HbA1c of 7.6%, HbA1c was significantly decreased 2months after initiating isCGM, while hyT increased, particularly during daytime. Study results suggest that a reduction in the total insulin dose of about 0.10 U/kg may be required in some cases. These findings need to be taken into account when initiating isCGM. The online version contains supplementary material available at 10.1007/s13340-022-00585-y.

Identifying Changes in Peripheral Lymphocyte Subpopulations in Adult Onset Type 1 Diabetes.

T- and B-lymphocytes play an important role in the pathogenesis of type 1 diabetes (T1D), a chronic disease caused by the autoimmune destruction of the insulin-producing cells in the pancreatic islets. Flow cytometry allows their characterization in peripheral blood, letting to investigate changes in cellular subpopulations that can provide insights in T1D pathophysiology. With this purpose, CD4+ and CD8+ T cells (including naïve, central memory, effector memory and terminally differentiated effector (TEMRA), Th17 and Tregs) and B cells subsets (naïve, unswitched memory, switched memory and transitional B cells) were analysed in peripheral blood of adult T1D patients at disease onset and after ≥2 years using multiparametric flow cytometry. Here we report changes in the percentage of early and late effector memory CD4+ and CD8+ T cells as well as of naïve subsets, regulatory T cells and transitional B cells in peripheral blood of adult patients at onset of T1D when compared with HD. After 2 years follow-up these changes were maintained. Also, we found a decrease in percentage of Th17 and numbers of T cells with baseline. In order to identify potential biomarkers of disease, ROC curves were performed being late EM CD4 T cell subset the most promising candidate. In conclusion, the observed changes in the percentage and/or absolute number of lymphocyte subpopulations of adult T1D patients support the hypothesis that effector cells migrate to the pancreas and this autoimmune process perseveres along the disease. Moreover, multiparametric flow allows to identify those subsets with potential to be considered biomarkers of disease.

PREDICTING VISUAL PERCEPTION AND WORKING MEMORY DEFICITS AMONG PATIENTS WITH TYPE 1 DIABETES: THE IMPLICATION OF EATING ATTITUDE AND MENTAL HEALTH STATUS

Several recent studies designate that individuals with type-1-diabetes (T1D) are at higher risk for cognitive impairment than their peers without T1D. The aim of this study was to determine whether socio-demographic and clinical characteristics, eating attitude and psycho-emotional characteristics can predict visual perception (VP) and working memory (WM) impairment in the Moroccan population with T1D. A cross-sectional analysis was carried out in adult T1D patients (N=140). The Rey-Osterrieth Complex Figure test (electronical version) was used to evaluate the VP and WM. Moreover, patients also completed the 21-item Depression, Anxiety, and Stress Scale to assess their mental health state. In order to evaluate the risk of eating disorders the Eating attitudes Test-26 were used. Finally, anthropometric properties and clinical characteristics were evaluated. Predictors of cognitive dysfunction were determined using the hierarchical regression analysis. The major result was that age, long diabetes duration, glycemia, HbA1c, dieting and bulimia were the potential predictors of low scores in VP and WM. Other significant predictors were cholesterol, triglycerides for visual perception. Although psych-emotional symptoms including stress, anxiety, and depression were not a significant predictors of VP and WM impairment. Furthermore, our findings showed that the more the level of stress increases, the VP and WM scores significantly decrease. This study suggests that it can be helpful for medical practitioners to screen for disordered eating behaviors and emotional symptoms as a supplemental risk factor for cognitive impairment in T1D.

Sodium-Glucose Cotransporter-2 Inhibitors Versus Glucagon-like Peptide-1 Receptor Agonists and the Risk for Cardiovascular Outcomes in Routine Care Patients With Diabetes Across Categories of Cardiovascular Disease.

Both sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in placebo-controlled trials of patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD). To evaluate whether SGLT2 inhibitors and GLP-1 RAs are associated with differential cardiovascular benefit among T2D patients with and without CVD. Population-based cohort study. Medicare and 2 U.S. commercial claims data sets (April 2013 to December 2017). 1:1 propensity score-matched adult T2D patients with and without CVD (52901 and 133139 matched pairs) initiating SGLT2 inhibitor versus GLP-1 RA therapy. Primary outcomes were myocardial infarction (MI) or stroke hospitalization and hospitalization for heart failure (HHF). Pooled hazard ratios (HRs) and rate differences (RDs) per 1000 person-years were estimated, with 95% CIs, controlling for 138 preexposure covariates. The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with a slightly lower risk for MI or stroke in patients with CVD (HR, 0.90 [95% CI, 0.82 to 0.98]; RD, -2.47 [CI, -4.45 to -0.50]) but similar risk in those without CVD (HR, 1.07 [CI, 0.97 to 1.18]; RD, 0.38 [CI, -0.30 to 1.07]). The initiation of SGLT2 inhibitor versus GLP-1 RA therapy was associated with reductions in HHF risk regardless of baseline CVD in patients with CVD (HR, 0.71 [CI, 0.64 to 0.79]; RD, -4.97 [CI, -6.55 to -3.39]) and in those without CVD (HR, 0.69 [CI, 0.56 to 0.85]; RD, -0.58 [CI, -0.91 to -0.25]). Treatment selection was not randomized. Use of SGLT2 inhibitors versus GLP-1 RAs was associated with consistent reductions in HHF risk among T2D patients with and without CVD, although the absolute benefit was greater in patients with CVD. There were no large differences in risk for MI or stroke among T2D patients with and without CVD. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School.

711-P: Glycemic Outcomes for Adult Type 1 Diabetes (T1D) with and without DKA Treated with an Electronic Glycemic Management System

T1D accounts for 10% of all diabetes and DKA accounts for 8.1 per 1,000 hospitalizations. Glycemic outcomes have not been reported for adults with specifically T1D. We describe hospital glycemic outcomes for patients with T1D with and without DKA. Individual-level data from the Glytec Inpatient Database was examined for glycemic outcomes based on pre-specified target blood glucose (BG) ranges (Table 1). All patients were treated with Glucommander IV. Data was extracted from 154 hospitals located in 17 different states in the United States (2015-2020). T1D was determined based on ICD E10.XX. The DKA group (n=4592) included patients with age > 18 years met criteria for DKA: bicarbonate 250 mg/dl, and anion gap >12 mEq/L. The non DKA group (n=10,886) included patients who did not meet the DKA criteria. Prevalence of hypoglycemia and time to target (TTT) BG were stratified by target BG ranges. In patients with DKA, % BG This largest descriptive analysis of adult T1D patients with DKA and without DKA showed that Glucommander IV can safely get patients into prespecified target range, with minimal rates of hypoglycemia. Disclosure J. Messler: Employee; Self; Glytec, LLC. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. B. W. Bode: Advisory Panel; Self; Eli Lilly and Company, Consultant; Self; Bigfoot Biomedical, Inc., Companion Medical, Lexicon Pharmaceuticals, Inc., Medtronic, Novo Nordisk Inc., Zealand Pharma A/S, Research Support; Self; Abvance Therapeutics, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Dompe, Eli Lilly and Company, Eyenuk, Inc., Insulet Corporation, Jaeb Center for Health Research, Medtronic, Nova Biomedical, Novo Nordisk, Provention Bio, Inc., REMD Biotherapeutics, Sanofi, Senseonics, Viacyte, Inc., vTv Therapeutics, Xeris Pharmaceuticals, Inc., Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk, Sanofi, Stock/Shareholder; Self; AgaMatrix, Aseko, Inc., Glytec, LLC. R. Booth: Employee; Self; Glytec, LLC. J. Clarke: Employee; Self; Aseko, Inc., Stock/Shareholder; Self; Aseko, Inc.

38-LB: Reduced Carbohydrate and Increased Protein and Fat during Weight Loss Improve the Atherogenic Lipid Profile in Type 2 Diabetes

Objective: Elevated triglyceride-rich lipoproteins (TRL), excess small dense LDL particles (LDL5) and decreased HDL2/HDL3 ratio promote atherogenesis in type 2 diabetes (T2D). Carbohydrate restriction reduced intrahepatic triglyceride (IHTG) content beyond the positive effect of weight loss in a group of T2D patients, the present study sought to determine whether parallel improvements in lipoprotein density profiles occurred in these same patients. Research Design and Methods: Seventy-two adult T2D patients with a mean BMI of 33 kg/m2 were assigned to 6 weeks of fully-provided hypocaloric dietary treatment aimed at ~6% weight loss, either with a carbohydrate-reduced high-protein (CRHP, C30E%/P30E%/F40E%) diet or a conventional diabetes (CD, C50E%/P17E%/F33E%) diet. Density profiles of lipoproteins were determined by ultracentrifugation of fluorescently labelled plasma. Magnetic resonance spectroscopy was used to assess IHTG. Results: Body weight decreased by 5.8 kg (~6%) in both groups. Compared with the CD diet, the CRHP diet reduced TRL (mean [95% CI]) by -16 [-30;1]% (p=0.07) and LDL5 by -13 [-22;-3]% (p=0.01), and increased HDL2/HDL3 by 11 [1;22]% (p=0.04). The CRHP diet also decreased IHTG more than the CD diet (-26 [-45;0]%, p=0.05), and changes in IHTG including both groups correlated significantly with changes in TRL and LDL5 (Spearman’s ρ 0.39 and 0.38, p&amp;lt;0.01). Conclusions: Carbohydrate restriction adds to the positive effect of weight loss in T2D patients by inducing greater improvements in atherogenic lipid profile, maybe facilitated by a reduction in intrahepatic fat. Disclosure M. N. Thomsen: None. S. Madsbad: Advisory Panel; Self; AstraZeneca; Boehringer Ingelheim; Eli Lilly; Merck Sharp &amp; Dohme; Novo Nordisk; Sanofi, Research Support; Self; Novo Nordisk, Boehringer Ingelheim, Speaker’s Bureau; Self; AstraZeneca; Boehringer Ingelheim; Merck Sharp &amp; Dohme; Novo Nordisk; Sanofi. F. Magkos: None. H. S. Thomsen: None. R. Walzem: None. S. B. Haugaard: None. T. Krarup: None. M. J. Skytte: None. A. Samkani: None. A. Astrup: Consultant; Self; Groupe Éthique et Santé, France, Employee; Self; Novo Nordisk Foundation, Other Relationship; Self; Flaxslim ApS, Denmark, Gelesis, Personalized Weight Management Research Consortium ApS (Gluco-Diet. dk). J. Frystyk: None. E. Chabanova: None. B. Hartmann: None. J. J. Holst: Consultant; Self; Novo Nordisk, Other Relationship; Self; Antag Therapeutics, Bainan Biotech, MSD Corporation, Novo Nordisk, Other Relationship; Spouse/Partner; Antag Therapeutics, Bainan Biotech, Synklino ApS. T. M. Larsen: None. Funding Arla Foods; Danish Dairy Research Foundation

Use of Insulin Degludec/Insulin Aspart in the Management of Diabetes Mellitus: Expert Panel Recommendations on Appropriate Practice Patterns.

Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (IDeg), which provides long-lasting basal insulin coverage, and insulin aspart (IAsp), which targets post-prandial glucose. This expert panel aimed to provide a practical and implementable guidance document to assist clinicians in prescribing IDegAsp in the diabetes management with respect to different patient populations including children and adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) as well as pregnant, elderly and hospitalized patients and varying practice patterns (insulin-naive, insulin-treated, switching from basal, basal bolus and premix regimens). The experts recommended that IDegAsp can be used in insulin-naive T2D patients with poor glycemic control (HbA1c >8.5%) despite optimal oral antidiabetic drugs (OADs) as well as in insulin-treated T2D patients by switching from basal insulin, basal-bolus therapy or premixed insulins in relation to lower risk of nocturnal hypoglycemia, fewer injections and lower intraday glycemic variability, respectively. The experts considered the use of IDegAsp in children with T2D as a basal bolus alternative rather than as an alternative to basal insulin after metformin failure, use of IDegAsp in adult T1D patients as a simplified basal bolus regimen with lesser nocturnal hypoglycemia, fewer injections and better fasting plasma glucose control and in children with T1D as an alternative insulin regimen with fewer injection to increase treatment adherence. The proposed expert opinion provides practical information on use of IDegAsp in different patient populations and practice patterns to assist clinicians, which seems to compensate the need for easily implementable guidance on this novel insulin regimen.

884-P: Discrepancies in Key Metrics of Glycemic Control between Retrospective Continuous Glucose Monitoring System and Flash Glucose Monitoring in Adult Patients with Type 1 Diabetes

Limited data on head-to-head comparisons between the flash glucose monitoring (FGM) system (FreeStyle Libre®, FSL) and retrospective continuous glucose monitoring (CGM) system (IproTM2) were available. The study aimed to compare glycemic metrics derived from two devices in adult patients with type 1 diabetes (T1D). Adult T1D patients with HbA1c of 7 to 10% were recruited and randomized to adopt FSL or self-monitoring blood glucose in the 24-week trial (NCT03522870). In the FSL group, glucose was simultaneously measured by FSL and IproTM2s on patients’ different arms for 14 days at 12 and 24 weeks. Data collected on the day of insertion and detachment and those of insufficient quality (&amp;lt;90%) were excluded. Each FSL glucose value was aligned with the closet IproTM2 value(lag time&amp;lt;2min). Glycemic metrics were calculated via Glyculator 2.0 software and differences between them were assessed. From May 2018 to November 2019, a total of 31287 paired data collected from 27 adult T1D patients (male/female 7/20; age 30.2±8.9yrs; duration 8.9[6.2,13.1]yrs; HbA1c 7.6±0.8%) were included. The median number of days with available CGM data was 11.3(9.9,12.0). Agreement between the two devices’ measurements was satisfactory (R2=0.85, P&amp;lt;0.001). Time in range 70-180mg/dl (%, TIR) was significantly lower in FSL than that in IproTM2 (59.5[49.3,66.7] vs. 62.3[51.6,69.5] %, P=0.02). Significant difference in time spent below 70 and 54mg/dl(%) was observed with the higher ones in FSL group (&amp;lt;70mg/dl, 7.2[5.6,13.8] vs. 4.5[2.0,9.2] %, P=0.02; &amp;lt;54mg/dl, 2.6[1.3,5.3] vs. 1.4[0.4,3.0] %, P=0.04). There were no significant differences in time spent over 180 and 250mg/dl (%), and glycemic variability including CV and MAGE (all P&amp;gt;0.05). In the 14-days wearing of the different devices simultaneously, there was a close agreement between FSL and Ipro2 but significant differences were observed in TIR and time spent in hypoglycemia. Disclosure Y. Zhou: None. H. Deng: None. D. Yang: None. J. Yan: None. W. Xu: None. H. Liu: None. L. Gan: None. S. Luo: None. X. Zheng: None. H. Liang: None. B. Yao: None. J. Weng: None. Funding National Key Research and Development Program of China (2017YFC1309600); Natural Science Foundation of Guangdong Province (2018A030313251)