Diabetes Medication Use Research Articles

Dietary intake of adults with and without diabetes: results from NHANES 2013–2016

IntroductionDiet is a critical aspect of the management of adults with diabetes. This paper aims to compare dietary intakes of key macronutrients and micronutrients of US adults with and without...

Use of Weight-Altering Diabetes Medications to Address Obesity as a Barrier to Kidney Transplant Evaluation in Patients with Type 2 Diabetes and Stage 4-5 CKD or ESKD

Use of Weight-Altering Diabetes Medications to Address Obesity as a Barrier to Kidney Transplant Evaluation in Patients with Type 2 Diabetes and Stage 4-5 CKD or ESKD

Reducing HbA1c in Type 2 Diabetes Using Digital Twin Technology-Enabled Precision Nutrition: A Retrospective Analysis.

IntroductionThe objective of this study was to examine changes in hemoglobin A1c (HbA1c), anti-diabetic medication use, insulin resistance, and other ambulatory glucose profile metrics between baseline and after 90 days of participation in the Twin Precision Nutrition (TPN) Program enabled by Digital Twin Technology.MethodsThis was a retrospective study of patients with type 2 diabetes who participated in the TPN Program and had at least 3 months of follow-up. The TPN machine learning algorithm used daily continuous glucose monitor (CGM) and food intake data to provide guidelines that would enable individual patients to avoid foods that cause blood glucose spikes and to replace them with foods that do not produce spikes. Physicians with access to daily CGM data titrated medications and monitored patient conditions.ResultsOf the 89 patients who initially enrolled in the TPN Program, 64 patients remained in the program and adhered to it for at least 90 days; all analyses were performed on these 64 patients. At the 90-day follow-up assessment, mean (± standard deviation) HbA1c had decreased from 8.8 ± 2.2% at baseline by 1.9 to 6.9 ± 1.1%, mean weight had decreased from 79.0 ± 16.2 kg at baseline to 74.2 ± 14.7 kg, and mean fasting blood glucose had fallen from 151.2 ± 45.0 mg/dl at baseline to 129.1 ± 36.7 mg/dl. Homeostatic model assessment of insulin resistance (HOMA-IR) had decreased by 56.9% from 7.4 ± 3.5 to 3.2 ± 2.8. At the 90-day follow-up assessment, all 12 patients who were on insulin had stopped taking this medication; 38 of the 56 patients taking metformin had stopped metformin; 26 of the 28 patients on dipeptidyl peptidase-4 (DPP-4) inhibitors discontinued DPP-4 inhibitors; all 13 patients on alpha-glucosidase inhibitors discontinued these inhibitors; all 34 patients on sulfonylureas were able to stop taking these medications; two patients stopped taking pioglitazone; all ten patients on sodium-glucose cotransporter-2 (SGLT2) inhibitors stopped taking SGLT2 inhibitors; and one patient stopped taking glucagon-like peptide-1 analogues.ConclusionThe results provide evidence that daily precision nutrition guidance based on CGM, food intake data, and machine learning algorithms can benefit patients with type 2 diabetes. Adherence for 3 months to the TPN Program resulted in patients achieving a 1.9 percentage point decrease in HbA1c, a 6.1% drop in weight, a 56.9% reduction in HOMA-IR, a significant decline in glucose time below range, and, in most patients, the elimination of diabetes medication use.

Presence and severity of coronary artery disease in patients who achieved intensive blood pressure reduction at the time of coronary computed tomography angiography.

Blood pressure (BP)-lowering treatment should be aimed at achieving intensive BP control. Coronary computed tomography angiography (CCTA) has become more widely available and enables the accurate noninvasive assessment of coronary artery stenosis for screening. The presence and severity of coronary artery disease (CAD) in patients who achieved intensive BP control at the time of CCTA were compared to those in patients without hypertension (HTN). Nine hundred eighty-five consecutive subjects who were clinically suspected of having CAD or who had at least one cardiac risk factor underwent CCTA. The patients were divided into four groups: patients without HTN (non-HTN group), hypertensive patients who underwent intensive BP lowering (intensive group, <130/80 mmHg), patients who underwent standard BP lowering (standard group, 130-139/80-89 mmHg) and patients with uncontrolled BP (uncontrolled group, >140/90 mmHg). Interestingly, %CAD in the Intensive group was significantly higher than that in patients without HTN. The Intensive group was older and had a higher body mass index, more significantly stenosed coronary vessels, lower levels of high-density lipoprotein cholesterol in the blood, and higher rates of dyslipidemia, diabetes, and anti-dyslipidemia and anti-diabetic medication use than the non-HTN group. The presence of CAD in the Intensive group was independently associated with age, male and smoking, whereas the presence of CAD in the non-HTN group was associated with age, male and family history. Finally, predictors of the number of VDs in the non-HTN and intensive BP-lowering groups were age, male, DL, and intensive BP lowering. In conclusion, these results suggest that hypertensive patients need more rigorous management of other coronary risk factors, despite receiving intensive BP-lowering treatment.

Successful Implementation of the Exercise First Approach for Intermittent Claudication in the Netherlands is Associated with Few Lower Limb Revascularisations

A stepped care model, in which patients are primarily treated with supervised exercise therapy (SET), is recommended as the optimal strategy for intermittent claudication (IC). The aim of this study was to determine the primary treatment (SET, endovascular revascularisation [ER], or open surgery) in relation to secondary lower limb revascularisation and survival in patients with IC. This study was a nationwide retrospective data analysis of health insurance claims of patients newly diagnosed with IC between January 2013 and December 2017. Exclusion criteria were the presence of diagnostic codes for critical limb ischaemia or for a diabetic foot. Study outcomes were distribution of primary treatment modalities, freedom from secondary lower limb revascularisation, and overall five year survival. Analysis included Kaplan-Meier method and Cox proportional hazards regression models with adjustment for multiple confounders (age, gender, socioeconomic status, use of diabetes medication, statins, platelet aggregation inhibitors or anticoagulants, presence of cardiac disease, chronic obstructive pulmonary disease, and pre-dialysis). The five year cohort included 54504 patients with IC (primary SET n=39476, primary ER n=11769, and primary open surgery n=3 259). SET as primary treatment increased from 63% in 2013 to 87% in 2017. Patients who underwent ER or open surgery as a primary treatment had a higher risk of secondary revascularisations (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.37-1.51; p<.001 and HR 1.45; 95% CI 1.34-1.57; p<.001, respectively) and a higher mortality risk compared with SET as a primary treatment (HR 1.38; 95% CI 1.29-1.48; p<.001 and HR 1.49; 95% CI 1.34-1.65; p<.001, respectively). Guideline adherence improved to 87% in Dutch patients with IC. Patients receiving primary SET had fewer lower limb revascularisations and demonstrated better survival than patients undergoing primary ER or open surgery.

Short-term impact of co-payment level increase on the use of medication and patient-reported outcomes in Finnish patients with type 2 diabetes

A new reimbursement scheme for non-insulin medications used for treatment of hyperglycemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The aim of the study was to evaluate the impact of this co-payment increase (i.e. + 35 percentage points) on patient-reported satisfaction for diabetes care, diabetes medication use, and financial difficulties. Baseline data were collected in 114 pharmacies, where patients with T2D were asked to fill in a questionnaire in November 2016. Follow-ups were conducted at 6 and 12 months. In total, 955 participants with T2D attended the baseline examination. During the follow-up, satisfaction with diabetes care decreased significantly (p < 0.001). Use of insulin increased (OR 1.16, 95 % CI 1.06–1.27) whereas use of metformin and DPP-4 inhibitors decreased (metformin: OR 0.80, 95 % CI 0.70‒0.90; DPP-4 inhibitors: OR 0.82, 95 % CI 0.73‒0.93). Financial difficulties with the purchase of diabetes medications were reported more often both at 6 (OR 2.44, 95 % CI 1.96–3.03) and at 12 months (OR 2.70, 95 % CI 2.18–3.35) than at baseline. These negative short-term effects require future studies. If persistent, the long-term effects of lower treatment satisfaction and increased financial difficulties may imply impaired metabolic control and increased diabetes complication risk and health care costs. Patient perspective should be taken into account in future policy making.

Geographic and Racial/Ethnic Variation in Glycemic Control and Treatment in a National Sample of Veterans With Diabetes.

Geographic and racial/ethnic disparities related to diabetes control and treatment have not previously been examined at the national level. A retrospective cohort study was conducted in a national cohort of 1,140,634 veterans with diabetes, defined as two or more diabetes ICD-9 codes (250.xx) across inpatient and outpatient records. Main exposures of interest included 125 Veterans Administration Medical Center (VAMC) catchment areas as well as racial/ethnic group. The main outcome measure was HbA1c level dichotomized at ≥8.0% (≥64 mmol/mol). After adjustment for age, sex, racial/ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of uncontrolled diabetes varied by VAMC catchment area, with values ranging from 19.1% to 29.2%. Moreover, these differences largely persisted after further adjusting for medication use and adherence as well as utilization and access metrics. Racial/ethnic differences in diabetes control were also noted. In our final models, compared with non-Hispanic Whites, non-Hispanic Blacks (odds ratio 1.11 [95% credible interval 1.09-1.14]) and Hispanics (1.36 [1.09-1.14]) had a higher odds of uncontrolled HBA1c level. In a national cohort of veterans with diabetes, we found geographic as well as racial/ethnic differences in diabetes control rates that were not explained by adjustment for demographics, comorbidity burden, use or type of diabetes medication, health care utilization, access metrics, or medication adherence. Moreover, disparities in suboptimal control appeared consistent across most, but not all, VAMC catchment areas, with non-Hispanic Black and Hispanic veterans having a higher odds of suboptimal diabetes control than non-Hispanic White veterans.

Heart Failure With Type 2 Diabetes Mellitus: Association Between Antihyperglycemic Agents, Glycemic Control, and Ejection Fraction.

Background: Heart failure (HF) is associated with type 2 diabetes mellitus (T2DM). Antihyperglycemic drugs have interaction with heart failure among diabetic patients. To date, the data on real world use of diabetic medication in Malaysian heart failure patients with T2DM has not been elucidated.Objective: This study aims to identify the prescribing pattern of antihyperglycemic regimens in HF patients with T2DM, and to investigate the association between glycemic control and other factors such as demographic and clinical characteristics with left ventricular ejection fraction (LVEF) in these patients.Methods: This retrospective observational study involved patients diagnosed to have HF and T2DM who were seen in the outpatient clinic in a government tertiary hospital in Malaysia. Patients receiving at least one oral antidiabetic agent and/or insulin for at least 3 months prior were included. The differences and association between study outcomes were examined and analyzed using Pearson's Chi-square test, One-Way ANOVA, Binary Logistic Regression and multiple Multinomial Logistic Regression models.Results: From July to December 2019, 194 patients were included in this study. The majority (52.1%) of the patients had HF with preserved ejection fraction (HFpEF), 20.6% had HF with mid-range EF (HFmrEF), and 27.3% had HF with reduced EF (HFrEF). Overall, metformin (59.8%) was the commonest antihyperglycemic agent prescribed, followed by insulins (54.0%), and sulphonylureas (44.9%). The most prescribed agents for HFpEF, HFmrEF, and HFrEF patients were metformin (65.3%), insulins (62.5%), and sulphonylureas (60.4%), respectively. The prescribing trend of sulphonylureas was found to be significantly associated with patients' LVEF status (p = 0.033). The odds for sulphonylurea prescription among the HFrEF patients were 2.42 times higher compared to the HFpEF patients [95% confidence interval [CI], 1.23–4.79]. There was no association found between glycemic control with patients' LVEF.Conclusion: Our findings reported metformin as the most commonly prescribed antihyperglycemic agent, sodium glucose linked transporter-2 (SGLT-2) inhibitor being under-prescribed, and detected poorly controlled diabetes in majority of patients with T2DM and HF. Understanding the prescribing pattern of antihyperglycemic agents supports the implementation of evidence-based treatment in HF patients with T2DM to improve patients' outcomes.

Elevated depressive symptoms and risk of all-cause and cardiovascular mortality among adults with and without diabetes: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

AimsTo examine the association of elevated depressive symptoms with all-cause and cardiovascular disease (CVD) mortality and determine whether these associations differ for those with and without diabetes. MethodsWe included 22,807 black and white men and women aged 45–98 years at baseline (2003–2007) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Elevated depressive symptoms were defined as a score ≥ 4 on the 4-item Centers for Epidemiologic Studies of Depression Scale. Participants were classified as having diabetes, prediabetes, or no prediabetes/diabetes based on glucose levels and diabetes medication use. All-cause mortality events were available through 2018 and adjudicated CVD mortality events were available through 2015. ResultsDuring follow-up, there were 5383 all-cause deaths, of which 1585 were adjudicated CVD deaths. The mean survival time was lower for participants with elevated depressive symptoms than those without elevated depressive symptoms for those with diabetes, prediabetes, and no prediabetes/diabetes. In multivariable adjusted models, elevated depressive symptoms increased the risk of all-cause mortality for those with diabetes (HR = 1.15; 95% CI = 1.00–1.32), prediabetes (HR = 1.56; 95% CI = 1.28–1.91), and neither prediabetes/diabetes (HR = 1.34; 95% CI = 1.19–1.50) (p for interaction = 0.0342). Findings were similar for CVD mortality. ConclusionElevated depressive symptoms increased the risk of all-cause and CVD mortality among individuals with and without diabetes, with a stronger magnitude of association observed among those with prediabetes. This underscores the need for assessing depressive symptoms across the glycemic spectrum, including those with prediabetes.

Low occupancy rate of the pedicle screw in the vertebral body leads to upper instrumented vertebral fracture

Upper instrumented vertebra (UIV) fracture in adult spinal deformity surgery leads serious complications, such as spinal cord injury in 0.5–0.8%. Although tip-apex distance is important for preventing screw cut-out in proximal femoral fracture surgery, this suggest that the screw occupancy rate for bone fragments is also important. The purpose of this study was to investigate how the occupancy rate of pedicle screws (ORPS) affects UIV fracture. Patients with UIV fracture 1 year after surgery were defined as the fracture group (F); others were defined as the no fracture group (NF). ORPS, cut-out of pedicle screw (PS), medications, and bone mineral density were evaluated. Significant differences (P < 0.05) between group F (n = 58) and group NF (n = 260) were observed in age (71 years old in group F and 65 years old in group NF), diabetes medication use (19% in group F and 4% in group NF), steroid drug use (10% in group F and 2% in group NF), and ORPS (70% in group F and 76% in group NF). The cut-off value of ORPS using receiver operator characteristic analysis was 73%. Multiple logistic regression analysis identified diabetes medication use (P = 0.026, odds ratio [OR] 4.0) and ORPS < 73% (P = 0.001, OR 3.6) as significant risk factors for UIV fracture. The surgeon can’t control use of diabetes medication. However, they can replace with longer PS when ORPS < 73% is detected on radiographs taken during surgery. Further studies will be needed to better elucidate it’s use.

Joint impact of muscle mass and waist circumference on type 2 diabetes in Japanese middle-aged adults: The Circulatory Risk in Communities Study (CIRCS).

Although evidence about skeletal muscle mass loss and type 2 diabetes risk has accumulated, little information is available on the combined effect of skeletal muscle mass and abdominal obesity on type 2 diabetes. We examined whether skeletal muscle mass and abdominal obesity were synergistically associated with the prevalence of type 2 diabetes. Skeletal muscle mass and waist circumference (WC) were measured in 1515 Japanese aged 40 to 69 years. Relative muscle mass was calculated as percentage of total skeletal muscle mass in body weight (SMM%). Type 2 diabetes was identified as fasting serum glucose ≥7.0 mmol/L (126 mg/dL), nonfasting serum glucose ≥11.1 mmol/L (200 mg/dL), glycosylated hemoglobin ≥ 6.5%, and/or diabetes medication use. The multivariable-adjusted odds ratio (OR) of prevalent diabetes from the lowest to the third quartile of SMM% compared to the highest quartile gradually increased in both sexes. The association between a high WC and prevalent diabetes was similar. The multivariable-adjusted OR (95% confidence intervals) for the prevalence of type 2 diabetes in the low skeletal muscle mass/high WC group was 3.19 (1.78-5.71) for men and 4.46 (2.09-9.51) for women compared with the high skeletal muscle mass/low WC group. The relative excess risk due to interaction was 2.2 (0.5-3.9) in men and 2.8 (0.2-5.3) in women for an excess burden of type 2 diabetes for low skeletal muscle mass and high WC. Low skeletal muscle mass and abdominal obesity were synergistically associated with presence of type 2 diabetes.

Diabetes, Glycated Hemoglobin, and Risk of Cancer in the UK Biobank Study.

Evidence suggest that diabetes and glycated hemoglobin (HbA1c) levels are associated with cancer risk. However, previous studies have been limited variably by failure to adjust for cancer-specific risk factors (e.g., body mass index), inattention to diabetes duration and use of antidiabetic medications, and failure to stratify by obesity. We examined the association between diabetes, HbA1c, and cancer risk in the UK Biobank, using data from 476,517 participants (54% women), followed for an average period of 7.1 years. Diabetes was defined on the basis of baseline self-reported diagnosis of diabetes and/or use of diabetes medication, while HbA1c measured at baseline was categorized as low (<31 mmol/mol), normal (31-<39 mmol/mol), increased risk (39-<48 mmol/mol), and high risk for diabetes (≥48 mmol/mol). Multivariable Cox proportional hazards models were used to estimate the association of diabetes and cancer at different anatomical sites, with adjustment for cancer-specific risk factors. Diabetes was associated with increased risk of cancers of the stomach, liver, bladder, endometrium, and lung among smokers, and with decreased risk of prostate cancer. Compared with the normal HbA1c category, the increased risk category was positively associated with risk of cancers of the colon, liver, bladder, and lung among smokers, and the high-risk category was associated with increased risk of cancers of the esophagus, liver, pancreas, and bladder, and with decreased risk of prostate cancer. These results suggest that both diabetes and/or elevated HbA1c are associated with risk of cancer at several anatomic sites. The associations of diabetes and HbA1c levels with cancer suggest their importance in cancer prevention.

1508-P: Predicting Stress Hyperglycemia in Patients without Diabetes Admitted to the Hospital

Stress hyperglycemia (SH) is associated with poor clinical outcomes in hospitalized patients. Delays in recognizing SH impact timing of treatment, however, the best way to identify those at risk is unclear. We assessed the value of a validated diabetes risk test, the Cambridge Risk Score (CRS), to predict SH in patients admitted to the hospital compared to using undiagnosed diabetes and prediabetes based on HbA1c. Adults admitted without diabetes or use of diabetes medication to medical and surgical services of an academic hospital over 4 years was analyzed. Patients with at least one measurement of blood glucose ≥ 140mg/dL during the stay were identified as having SH. CRS was calculated using age, sex, BMI, family history of diabetes, smoking status, and use of antihypertensives or steroids. Prediabetes was defined based on HbA1c 5.7-6.4 and undiagnosed diabetes was defined as HbA1c &amp;gt;=6.5 without ICD code of diabetes in the medical record. Multivariate regression was used to assess the association between CRS, prediabetes and undiagnosed diabetes, and risk of SH controlling for relevant covariates. 5,535 adults met inclusion criteria, 25.9% developed SH. CRS as a continuous variable was significantly associated with risk of SH after adjustment (OR 2.25, 1.84 - 2.74). Prediabetes was significantly associated with risk of SH after adjustment (OR 1.31, 1.13-1.51). However, undiagnosed diabetes was not significantly associated with SH, but many individuals were missing A1c measures which could have influenced results. In conclusion results of this study suggest CRS risk stratification and early assessment for prediabetes may allow early identification of individuals at risk for SH. Disclosure C.E. Mendez: Advisory Panel; Self; Monarch Medical Technologies. R.J. Walker: None. K. Lu: None. A.Z. Dawson: None. L.E. Egede: None.

187-OR: Randomized Clinical Trial of the IADPSG vs. Carpenter Coustan Criteria for Diagnosis of Gestational Diabetes Mellitus

No clinical consensus regarding the optimal diagnostic approach for gestational diabetes mellitus (GDM) exists. Participants were randomized to two GDM testing criteria following a blinded non-fasting 50g glucose challenge test (GCT): Carpenter Coustan (CC) or IADPSG. GDM was diagnosed in the CC arm if the 50g GCT was &amp;gt; 135 mg/dL and the fasting 100g OGTT had 2 or more abnormal values. GDM was diagnosed in the IADPSG arm if the fasting 75g OGTT had one or more abnormal values; the 50g GCT was ignored for diagnosis. Participants and providers were informed whether GDM was present but blinded to all test results and which criteria were used for diagnosis. Treatment for GDM occurred per routine clinical care. We hypothesized lower rates of LGA favoring the IADPSG arm, both overall and after restricting to women without GDM. From 2015-2019, 921 women were enrolled and randomized (CC=460; IADPSG-461); however, delivery records were available for only 878 women. Baseline characteristics were similar between groups. While GDM diagnosis (14.4% vs. 4.5%, p&amp;lt;0.001) and diabetes medication use (9.3 v 2.4%; p&amp;lt;0.001) were more common in the IADPSG arm, there were no differences in LGA, either overall (OR=0.90, 95% CI 0.51-1.58) or restricting to women without GDM (OR=0.86, 95% CI 0.47-1.57). Disclosure C.M. Scifres: None. K. Abebe: None. H. Simhan: None. P. Catalano: None. T. Costacou: None. D.M. Comer: None. S.R. Orris: None. K. Ly: None. A. Decker: None. D. Mendez: None. E. Davis: None. Funding National Institutes of Health (1R01HD079647)

1559-P: Associations of Changes in Fat-Free Mass with Risk for Prediabetes and Type 2 Diabetes in the Hispanic Community Health Study/Study of Latinos

Background: Loss of muscle mass may increase risk for type 2 diabetes (T2D), but few prospective studies have examined this association. The objective of this study was to determine whether loss of muscle mass (approximated with fat free mass [FFM]) is associated with risk for prediabetes and T2D in a population disproportionately burdened by T2D. Methods: Participants were Hispanic/Latino adults (aged 18-74 years) in the Hispanic Community Health Study/Study of Latinos (6.1-year follow-up), a multi-site, community-based cohort in the United States. Eligible participants were free of T2D at baseline (2008-2011; n=6264). Fasting glucose, HbA1c, and fasting insulin were measured. Diabetes was defined according to American Diabetes Association criteria. Analysis: Survey-weighted Poisson regression models examined the association of percent change in relative FFM (FFM/total body weight; %∆FFM) with incident prediabetes and T2D. Survey-weighted linear regression models examined associations of %∆FFM with changes in glucose and insulin measures. Models were adjusted for age, sex, Hispanic/Latino background, site, nativity, education, income, physical activity, years between visits, and diabetic medication use (for lab values only). Results: Relative FFM declined by 2.1% between visits. %∆FFM was inversely associated with incident prediabetes (p-for-trend=0.001) but not T2D. %∆FFM was inversely associated with changes in glucose and insulin measures (p-for-trend&amp;lt;0.0001). After adjustment for 1) fat mass index or 2) BMI and waist circumference, only the association with HOMA-IR remained significant. Associations were generally stronger for individuals who were overweight/obese at baseline (p&amp;lt;0.05). Conclusions: Findings suggest that muscle mass maintenance/accumulation during adulthood may reduce T2D risk (primarily insulin resistance), particularly among individuals who are overweight/obese. Disclosure M.N. LeCroy: None. S. Hua: None. R. Kaplan: None. D. Sotres-Alvarez: None. Q. Qi: None. B. Thyagarajan: None. L. Gallo: None. A. Pirzada: None. M.L. Daviglus: None. G.A. Talavera: None. C.R. Isasi: None. Funding National Heart, Lung, and Blood Institute (N01HC65233, N01HC65234, N01HC65235, HHSN268201300003I, N01HC65236, N01HC65237, T32HL144456)

1604-P: Glucose Intolerance Modifies the Association between Diastolic Blood Pressure Variability and All-Cause Mortality

Purpose: There is growing literature on the association between blood pressure variability (BPV) and mortality. We sought to determine whether the association between BPV and all-cause mortality was modified by glucose intolerance (GI). Methods: A total of 12,256 non-pregnant adults from the National Health and Nutrition Examination Surveys-III (1988-1994) were linked to the National Death Index through 2015. The primary predictors were systolic and diastolic BPV, defined as the standard deviation of 3-6 BP readings taken consecutively. Systolic and diastolic BPV were categorized into quintiles (&amp;lt;3, 3-8, 9-12, 13-15, &amp;gt;15 mmHg). We used Cox proportional hazards modeling to assess the risk of all-cause mortality, adjusting for confounders (age, sex, race/ethnicity, mean BP, BMI, lipids, kidney and liver function, c-reactive protein) and the survey design. Analyses were stratified by GI status (yes/no), defined as either a fasting glucose ≥100 mg/dl, HbA1c ≥5.7%, or diabetes medication use. Results: Of the 12,256 participants, 28% had GI. The mean follow-up time was 22.1 years, with a total 3,632 deaths (2,096 [46%] among GI and 1,536 [20%] among non-GI) from all causes. Among those with GI, the highest quintile of diastolic BPV had 60% higher risk of mortality relative to the lowest quintile (unadjusted HR [95% CI] = 1.51 [1.04, 2.23], adjusted HR = 1.60 [1.12, 2.28]). This association did not exist among those without GI (unadjusted HR [95% CI] = 0.87 [0.60, 1.26], adjusted HR = 0.80 [0.58, 1.10]). Those in the highest quintile of systolic BPV had an insignificant increase in risk of all-cause mortality among both GI and non-GI participants (GI: adjusted HR = 1.41 [0.98, 2.01], non-GI: adjusted HR = 1.09 [0.78, 1.51], interaction p=0.34). Conclusion: Only those with GI had a significant positive association between diastolic BPV and all-cause mortality. GI may play a role in modifying this association through changes in vascular autonomic regulation due to autonomic neuropathy. Disclosure A. Visaria: None. T. Dharamdasani: None. D. Lo: None. K. Wickramasinghe: None. R. Malhotra: None.

38-OR: Differences in Diabetes Medication Use between Commercial and Medicare Advantage Beneficiaries, 2013-2018

DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors have low hypoglycemia risk, do not cause weight gain, and post-marketing outcomes trials found cardiovascular and renal benefits with GLP-1RA and SGLT2i use. Using 2013-2016 data, we previously found low and delayed early adoption of SGLT2i among Medicare Advantage (MA) beneficiaries compared to commercial beneficiaries, despite similar formulary coverage. With greater experience using these medications and emerging evidence supporting their preferred use by patients with comorbidities, prescribing patterns may have changed. Using OptumLabs Data Warehouse, a de-identified dataset of commercial and MA beneficiaries, we examined the proportions of pharmacologically-treated adults with type 2 diabetes with commercial vs. MA insurance who filled a DPP-4i, GLP-1RA, or SGLT2i each quarter between 2013-2018. We found significant differences across medications and health plans (Figure). Overall, after adjusting for age, gender, race/ethnicity, baseline medications, year, prescriber specialty, and comorbidities, the odds of DPP-4i, GLP-1RA, and SGLT2i use were significantly lower for MA vs. commercial beneficiaries: OR 0.61 (95% CI 0.60-0.63), 0.45 (95% CI 0.44-0.46), and 0.31 (95% CI 0.30-0.31), respectively. These findings call for better understanding of non-clinical factors contributing to treatment decisions. Disclosure R.G. McCoy: None. H. Van Houten: None. J. Ross: Research Support; Self; Centers for Medicare and Medicaid Services, Janssen Pharmaceuticals, Inc., U.S. Food and Drug Administration. P. Karaca-Mandic: None. V.M. Montori: None. N. Shah: None. Funding National Institutes of Health (K23DK114497); Agency for Healthcare Research and Quality (1U19HS024075, R01HS025164)

1512-P: Severe Hypoglycemia and Hyperglycemia among U.S. Adults with Diabetes and ESRD on Dialysis, 2010-2015

Glycemic management in patients with diabetes and end-stage renal disease (ESRD) is challenging. There is limited evidence about the incidence of severe hypoglycemia and hyperglycemia in this population. Here, we examine rates of emergency department visits and hospitalizations for severe hypoglycemia and hyperglycemia (ascertained using validated ICD-9/10 codes) in a national cohort of adults with diabetes and incident ESRD, included in the United States Renal Data System, between 2010-2015. We then examine risk factors for these events using logistic regression. Among 678,376 patients with ESRD, 59.5% (n=403,490) had diabetes (63.6±13.0 years, 56.4% male, 26.8% Black, and 18.0% Hispanic). Rates of severe hypoglycemia and hyperglycemia were 126.2 and 35.5 per 1000 person-years, respectively. Strongest risk factors for hypoglycemia were insulin therapy (OR 4.5 [95% CI, 4.4-4.6] vs. no medications) and non-insulin diabetes medications (OR 3.7 [3.6-3.8]); Black race (OR 1.3 [1.3-1.4] vs. Caucasian); older age: 65-74 years (OR 1.2 [1.1-1.3] and ≥75 years OR 1.1 [1.1-1.1] vs. 18-44 years); and history of amputation (OR 1.4 [1.4-1.5]) or retinopathy (OR 1.2 [1.2-1.3]). Strongest risk factors for hyperglycemia were insulin (OR 7.7 [7.4-8.2]) and non-insulin diabetes medication use (OR 2.8 [2.6-3.1]) and retinopathy (OR 1.5 [1.4-1.5]). Older age was protective for hyperglycemia (OR 0.1 [0.1-0.1] for age ≥75 and 0.2 [0.2-0.2] for age 65-74 vs. 18-44 years). Patients on peritoneal dialysis had a lower risk (OR 0.8 [0.8-0.9]) of hypoglycemia, but no difference in odds of hyperglycemia, compared to patients on hemodialysis. Hypoglycemia requiring ED/hospital care was 3.6-fold more prevalent than severe hyperglycemia, greatly exceeding rates previously reported for older adults and those with non-end stage chronic kidney disease. There is a critical need for proactive interventions to reduce hypoglycemia and related ED/hospital use in this high-risk population. Disclosure R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. M.K. Ali: Research Support; Self; Merck &amp; Co., Inc. N. Shah: None. S. Funni: None. G.E. Umpierrez: None. R.G. McCoy: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)

Treatment of Hepatitis C Virus and Long-Term Effect on Glycemic Control.

Chronic hepatitis C virus (HCV) infection has been linked to worsening glycemic control in patients with diabetes due to insulin resistance. Studies have shown that treating HCV improves glycemic control in this patient population. Most studies assess glycemic control until the patient's sustained viral response at 12 weeks (SVR12). To (a) assess the sustainability of glycemic control after the SVR12 date and (b) determine the change in diabetic medication use over time. This was a retrospective chart review of patients treated at an academic medical center's hepatology clinic from 2014 through 2017. Patients were eligible for review if they were treated for hepatitis C and had type 2 diabetes mellitus (DM) or pre-DM, defined by a hemoglobin A1c (A1c) > 5.7%, at baseline. Data were collected from the EPIC database available to Temple University Hospital. Results were analyzed using a linear mixed model and descriptive statistics. Of the 1,073 patients screened, 310 met the eligibility criteria. Most patients achieved SVR12 (87.8%). A statistically significant decrease in A1c from baseline to treatment completion with direct-acting antivirals (DAAs) and until current reading was seen (P < 0.05). Overall, A1c was reduced in patients treated for HCV with DAA by -0.27% (95% CI = -0.479% to -0.055%, P = 0.014) from baseline to current reading. No statistically significant difference existed in A1c at time of SVR12 to current reading (difference in A1c = 0.07%, 95% CI = -0.26% to 0.4%, P = 0.67), indicating that the reduction in A1c achieved by treating HCV can be sustained over time. Insulin dose also decreased from baseline to current values. Overall, patients with diabetes successfully treated for the hepatitis C virus may be able to maintain improved glycemic control past SVR12. This could lead to less antidiabetic medication use and decreased insulin requirements for this patient population. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors report no conflicts of interest.

37-OR: Racial and Socioeconomic Disparities in the Use of Newer Classes of Diabetes Medications

Among patients with type 2 diabetes (T2D), racial/ethnic minorities and those of lower socioeconomic status (SES) have a higher burden of coronary artery disease, chronic kidney disease, and hypoglycemia. Therefore, these groups may especially benefit from newer diabetes medication classes (GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors), but high cost may limit access. We conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) randomized trial to assess the associations of race/ethnicity and SES with newer diabetes medication use. Look AHEAD compared an intensive lifestyle intervention to diabetes support and education among U.S. adults with obesity and T2D enrolled from 2001-2004. Medications, all prescribed outside of the study, were ascertained yearly. We used Cox proportional hazards models to estimate the association between self-reported race/ethnicity and SES factors and time to initiation of any newer diabetes medication through October 2019, adjusted for time-varying HbA1c, BMI, and number/type of diabetes medications; and baseline study arm, demographics, and comorbidities; fully-adjusted results are presented. Of 4,892 participants, 64%, 16%, 13%, and 8% were white, black, Hispanic, and other race/ethnicities, respectively. Over a median follow-up of 8.3 years, 44% initiated a newer diabetes medication. Black race was associated with significantly lower initiation of newer medications compared to whites (HR 0.81; 95% CI 0.80-0.94); there was no difference by other race/ethnic group. Yearly family income was inversely associated with the outcome: HR 0.69 (95% CI 0.55-0.87) comparing the lowest vs. the highest income group. Education, employment, and health insurance were not significantly associated with the outcome. These findings provide evidence of racial and SES disparities in use of newer diabetes medications, independent of glycemic control, that may impede access to these drugs for the individuals who need them most. Disclosure A. Elhussein: None. M. Bancks: None. W.C. Knowler: None. A.L. Peters: Advisory Panel; Self; Abbott, Bigfoot Biomedical, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medscape, Novo Nordisk Inc., Sanofi US. Consultant; Self; Livongo Health. Research Support; Self; Dexcom, Inc., vTv Therapeutics. Other Relationship; Self; Livongo Health, Mellitus Health, Omada Health, Stability Healthcare, Whole Biome Inc. E.M. Vaughan: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions. J. Clark: None. S.J. Pilla: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK057149)