Diagnosis Of Type 2 Diabetes Mellitus Research Articles

Application of Metabolomics and Traditional Chinese Medicine for Type 2 Diabetes Mellitus Treatment.

Diabetes is a major global public health problem with high incidence and case fatality rates. Traditional Chinese medicine (TCM) is used to help manage Type 2 Diabetes Mellitus (T2DM) and has steadily gained international acceptance. Despite being generally accepted in daily practice, the TCM methods and hypotheses for understanding diseases lack applicability in the current scientific characterization systems. To date, there is no systematic evaluation system for TCM in preventing and treating T2DM. Metabonomics is a powerful tool to predict the level of metabolites in vivo, reveal the potential mechanism, and diagnose the physiological state of patients in time to guide the follow-up intervention of T2DM. Notably, metabolomics is also effective in promoting TCM modernization and advancement in personalized medicine. This review provides updated knowledge on applying metabolomics to TCM syndrome differentiation, diagnosis, biomarker discovery, and treatment of T2DM by TCM. Its application in diabetic complications is discussed. The combination of multi-omics and microbiome to fully elucidate the use of TCM to treat T2DM is further envisioned.

Association between seaweed intake and risk of type 2 diabetes mellitus: a prospective cohort study.

This study aimed to identify the longitudinal association between seaweed and type 2 diabetes mellitus (T2DM) in the Korean population. Data from 148404 Korean adults aged 40 years and older without a history of T2DM, cardiovascular disease or cancer at baseline were obtained from the Korean Genome and Epidemiology Study data. The participants' seaweed intake was obtained using a validated semi-quantitative food frequency questionnaire, and the diagnosis of T2DM was surveyed through a self-reported questionnaire during follow-up. The hazard ratio (HR) and 95 % confidence interval (CI)for T2DM were calculated using the Cox proportional hazard regression, and the dose-response relationship was analysed using a restricted cubic spline regression. Participants had a mean follow-up period of 5 years. Participants with the highest seaweed intake had a 7 % lower risk of T2DM compared with the group with the lowest intake (95 % CI (0·87, 0·99)). Interestingly, this association was stronger in those with normal weight (HR: 0·88, 95 % CI (0·81, 0·95)), while no association was observed in participants with obesity. Spline regression revealed an inverse linear relationship between seaweed intake and T2DM risk in participants with normal weight, showing a trend where increased seaweed intake is related to lower instances of T2DM (Pfor nonlinearity = 0·48). Seaweed intake is inversely associated with the onset of T2DM in Korean adults with normal weight.

From control to remission: Empowering change in type 2 diabetes care

Madam, Pakistan currently ranks third globally in terms of its diabetic population, with approximately 33 million diagnosed cases of Type 2 Diabetes Mellitus (T2DM). Additionally, there are 11 million individuals living with impaired glucose tolerance and 8.9 million people in Pakistan are unaware that they have diabetes1. Poor dietary habits and sedentary lifestyles are the major factors contributing to Pakistan's high prevalence of diabetes2. Metformin is commonly prescribed as the leading therapeutic choice for type 2 diabetes, either as a standalone treatment or combined with insulin or other glucose-lowering therapies3. However, despite adherence to guidelines-based practices, a significant number of individuals fail to achieve remission in T2DM which has led to the exploration of alternative approaches. The DiRECT trial, which primarily involved ethnically white participants, aimed to reverse the diagnosis of T2DM and restore normal metabolic features through a weight-loss protocol. Within 12 months, nearly 50% of the participants achieved remission to a non-diabetic state and discontinued antidiabetic medications. The trial also highlighted the significant role of visceral fat in the development and remission of T2DM 4. However, the trial's lack of South Asian participants and the well-documented variations in disease severity and average body fat levels between South Asians and other populations raised concerns about its relevance to this particular group. To address this, the STANDby trial was conducted which showed that the remission rates observed in UK-based South Asians were similar to those in white cohorts5. These trials have demonstrated the possibility of achieving T2DM remission, particularly within the first six years following diagnosis. Given these findings, we propose that implementing this weight management program in Pakistan could be a suitable alternative to the current guidelines. This program effectively targets the key factors contributing to the high prevalence of diabetes in the country and emphasizes the importance of facilitating the remission of T2DM rather than just disease control. By addressing dietary habits, promoting physical activity, and targeting visceral fat reduction, this protocol can potentially bring about significant improvements in T2DM outcomes in Pakistan.

Sotagliflozin: Efficacy, Safety, and Potential Therapeutic Applications in Heart Failure.

To describe the pharmacology, clinical efficacy, and safety evidence of sotagliflozin, the first approved dual inhibitor of sodium-glucose cotransporter (SGLT) 1 and SGLT2, in heart failure (HF) management. A literature search of studies published between January 2012 and September 2023 were identified using PubMed, MEDLINE, and clinicaltrials.gov with search terms of "sotagliflozin," "Inpefa," or "LX4211." All available studies in English were considered. Studies were included if they investigated drug pharmacology, efficacy, or safety information. Two phase 3 trials of sotagliflozin, SOLOIST-WHF and SCORED, evaluated sotagliflozin compared with placebo in patients with type 2 diabetes mellitus (T2DM). SOLOIST-WHF reported a statistically decreased rate of cardiovascular and HF events with sotagliflozin (hazard ratio [HR] = 0.67, 95% CI = 0.52-0.85), while SCORED found a statistically significant decrease in incidence of cardiovascular events in patients with T2DM, chronic kidney disease (CKD), and risk factors for cardiovascular disease in patients in the sotagliflozin group (HR = 0.74, 95% CI = 0.63-0.88). While approval of sotagliflozin expands treatment options for patients with HF, the SGLT2 inhibitors, dapagliflozin and empagliflozin, have more data supporting their use in HF, additional risk reduction benefits in patients with CKD, and approval for use in T2DM. Landmark trials of sotagliflozin required a previous diagnosis of T2DM, despite the broader approved indication. Where sotagliflozin will be adopted into the treatment of HF is unclear due to the evidence and benefits of already established SGLT2 inhibitors and the need for comparison with SGLT2 inhibitors. Given the limitations of currently available evidence, including difficulty in fully interpreting the trial results due to changes in primary endpoints, not adjudicating the events, and not reaching the original power calculations, more investigation is warranted to determine the benefit of sotagliflozin compared with SGLT2 inhibitors.

Relationship between genetic ancestry and metabolic syndrome in community-dwelling old adults

Genetic ancestry may contribute to ethnic differences in the risk of metabolic disorders. Aging leads to a worse ability for homeostasis maintenance, favoring the establishment of metabolic disorders. PurposeThis study aimed to evaluate the relationship between the degree of genetic ancestry (European, African, and Amerindian) with the Metabolic Syndrome (MetS) diagnosis and its diagnostic components separately, in community-dwelling old adults. One hundred and sixty-one community-dwelling old adults volunteered in this study. Sociodemographic data and health history were recorded. Venous blood samples were withdrawal for biochemical analysis and DNA extraction aiming to obtain genetic ancestry estimates (Amerindian [AME], European [EUR], and African [AFR]), which was done from 12 loci. MetS diagnosis followed the NCEP-ATPIII criteria. Additionally, the sample was stratified according to the presence or absence of each criterion used for MetS diagnosis (i.e., Type 2 diabetes mellitus (T2DM), hypertension, hypertriglyceridemia, dyslipidemia [low HDL], and central obesity (elevated waist circumference)). Comparisons of genetic ancestry estimates were performed using the Mann-Whitney test, with the significance level set at p < 0.05. The prevalence of MetS was 40.4%. The degree AME, EUR and AFR genetic ancestry was not different between volunteers with or without MetS (p > 0.05). However, AME ancestry was significantly higher among diabetic volunteers (non-diabetics: 13.7% (6.3–35.8) x Diabetics: 26.1% (10.6–48.5); p < 0.05). Community-dwelling old adults with a higher percentage of Amerindian ancestry seem to be prone to T2DM diagnosis.

Time to act: the challenge of high incidence of diabetes and prediabetes in patients admitted with different cardiovascular diseases phenotypes

Abstract Background Limited studies have focused on diagnosing type 2 diabetes mellitus (T2DM) and prediabetes in hospitalized patients with cardiovascular diseases (CVD) with their different phenotypes. In addition, HbA1c levels in patients admitted for cardiovascular reasons may be lower than in patients with symptoms of hyperglycemia. Purpose To assess the incidence of newly and previously diagnosed T2DM and prediabetes among patients hospitalized with CVD, depending on the reasons for admission. Methods In the single-center prospective study (registry) we enrolled 773 patients ≥40 years with established CVD and arterial hypertension (HTN) without type 1 diabetes mellitus, except for previously diagnosed T2DM and prediabetes who were admitted to the City Clinical hospital. We also assessed the reasons for admission. From 06.01.2018 to 03.01.2020 275 (35.6%) patients hospitalized with acute coronary syndrome (ACS), 163 (21.1%) with acute decompensated heart failure (ADHF), 157 (20.3%) with HTN, 75 (9.7%) with atrial fibrillation or flutter (AF), 67 (8.7%) with chronic coronary syndrome (CCS) and 36 (4.7%) with newly diagnosed T2DM. All of them screened for T2DM and prediabetes using HbA1c and fasting plasma glucose by ADA Guidelines. Results Screening results are shown in Picture 1. The overall incidence of T2DM or prediabetes in hospitalized patients with CVD was 55.9%, and before the screening, only 25.7% were diagnosed with T2DM or prediabetes. The highest incidence of T2DM or prediabetes, including previously diagnosed, was among patients admitted with ADHF – 71.2%, and the lowest, 46.2%, in those hospitalized with ACS. Picture 2 presents mean levels of HbA1c in patients with newly and previously diagnosed T2DM, depending on the reasons for admission. The highest HbA1c levels were identified in patients with CVD who were hospitalized with symptoms of hyperglycemia and in whom the diagnosis of T2DM was confirmed (р&amp;lt;0,001). However, patients hospitalized with ADHF, AF and CCS had a HbA1c level almost twice lower than in patients hospitalized with newly diagnosed T2DM and lower than in those hospitalized with ACS and HTN (р&amp;lt;0,001). At the same time, HbA1c levels in previously diagnosed T2DM did not differ significantly between groups. Conclusion Thus, about 1 out of 2 patients hospitalized with CVD have a T2DM or prediabetes, and more than a third of patients without a T2DM or prediabetes (41%) were previously undiagnosed. In addition, patients admitted with ADHF, AF, and CCS with newly diagnosed T2DM had lower levels of baseline HbA1c than patients with overt symptoms of hyperglycemia, ACS, and HTN. All this has a potential impact on the target groups of screening and initial therapy of T2DM, including new classes of drugs.Picture 1Picture 2

Use of machine learning to predict mortality in patients with type 2 diabetes mellitus, according to socioeconomic status

Abstract Introduction Patients with Type 2 diabetes mellitus (T2DM) are at increased risk of developing cardiovascular disease (CVD) that adversely affects prognosis. Socioeconomic deprivation may be associated with lifestyle choices that contribute to adverse outcomes. The influence of social deprivation on the prognosis of T2DM is rarely investigated in large cohorts. Therefore, we assessed the associations between socioeconomic status and survival in patients with T2DM by applying conventional statistical methods and state-of-the-art, machine learning (ML) models. Methods We obtained routinely collected, linked administrative data for individuals with T2DM aged &amp;gt;50 years from the National Health Service (NHS) Scotland, including demographic data, laboratory measurements, prescriptions, death records and primary and secondary care diagnostic codes. We developed a random survival forest model for predicting all-cause mortality, overall and for each quintile of socioeconomic status using the Scottish Index of Multiple Deprivation (SIMD), which is based on postcodes that reflect a combination of income, employment, local crime rates, education, housing and health. We used Cox proportional hazards models to investigate the risk between the most and least deprived quintiles. Subsequently, we applied Shapely Additive Explanations (SHAP), a state-of-the-art ML interpretability method, to identify key prognostic factors that influence the survival probability prediction score for each sub-group. Results 30,495 people had a newly recorded diagnosis of T2DM between 2009-2019, of whom 4,300 died within 10 years. Table 1 shows the c-index (global assessment of model discrimination) and time-brier score (measure of calibration for time-dependent probability prediction) for the whole cohort and for each SIMD quintile: use of loop diuretics, older age, lower serum concentrations of albumin and alanine transaminase (ALT) and estimated glomerular function rate (eGFR) were strong predictors of death for all quintiles. Prevalence of chronic obstructive pulmonary disease (COPD) was strongly associated with mortality for the most deprived quintile (Q1, whilst strokes were strongly associated with mortality for the most affluent (Q5). A history of heart failure, in addition to use of loop diuretics, predicted a higher risk, in 3 of the 5 quintiles. Overall Q1 had a 36% higher mortality than Q5 (HR: adjusted for age and sex 1.36 [95% CI 1.24 – 1.50 (&amp;lt;0.005)]). Conclusion Greater socioeconomic deprivation is associated with a worse prognosis in patients with T2DM. Results of commonly measured blood tests, allied to readily available patient characteristics (including heart failure and use of loop diuretics) predict mortality risks across all deprivation groups for people with T2DM.Table:Predictors of Mortality in T2DM

Prevalence of target organ disease and its relation with HbA1c at the point of detection of type 2 diabetes mellitus – A cross sectional study from a tertiary care hospital in Odisha

Introduction and Aim: HbA1c is not only a valid indicator of chronic hyperglycaemia but also coincides with the increased risk of diabetic complications in the long term. This study focuses on the prevalence of target organ disease (TOD) and its relation with HbA1c at the point of detecting Type 2 Diabetes Mellitus(T2DM). Materials and Methods: This is a single-centre cross-sectional study done in the Department of General medicine at IMS and SUM Hospital, Odisha, between November 2020 and June 2022, including all newly diagnosed Type-2 Diabetes Mellitus patients aged &gt; 30 years. Besides all the biochemical parameters, the demographic profile was noted in an excel sheet, and later on, using SPSS version 26, the data was analysed categorically. Results: 148 newly diagnosed Type 2 DM patients were enrolled in the study with male predominance (54.72%). The mean age was found as 52.49±9.40 years. There were 29 (19.5%) cases of diabetic retinopathy, 39 (26.3%) diabetic neuropathy, 32(21.6%) diabetic nephropathy and 23(15.54%) left ventricular diastolic dysfunction, with a minimal number of RWMA [7 (4.72%)], Concentric left ventricular hypertrophy [9 (6.08%)] and Ischemic DCM [1(0.67%)] found as complications of newly diagnosed Diabetes mellitus patients. The prevalence of coronary artery disease (CAD) is higher in our study than in other diabetic complications, i.e., 40 (27.02%).A statistically significant (p&lt;0.05) correlation exists between newly diagnosed Diabetes patients with higher HbA1C and serum creatinine, serum urea, microalbuminuria, and positive monofilament test. Conclusion: This study underscores the significance of assessing target organ damage (TOD) prevalence for Type 2 Diabetes Mellitus (T2DM) detection, highlighting the utility of HbA1c testing. HbA1c, a rapid and precise diagnostic tool, holds promise, especially in resource-limited settings, aiding in timely T2DM diagnosis and improved patient care amid the global diabetes epidemic.

Abstract 13186: Factors Associated With Dysglycemia and Type 2 Diabetes Mellitus Onset in Familial Hypercholesterolemia

Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant monogenic disorder characterized by high blood LDL-C and cardiovascular disease (CVD). Type 2 diabetes mellitus (T2DM) is an independent cause of CVD and there is evidence that FH is associated with a lower frequency of its development. On the other hand, lipid lowering therapy (LLT) may increase T2DM risk. Goals: Evaluate the risk of dysglycemia and T2DM development in a cohort of molecularly proven FH individuals. Methods: This is a prospective analysis of a population enrolled on a genetic cascade screening program evaluated from March 2011 to January 2022. FH diagnosis was confirmed by molecular testing of variants in LDLR, APOB and PCSK9. Dysglycemia and T2DM diagnoses were done according to the ADA Criteria or use of any antidiabetic drugs. Results: 790 FH patients were included (age 45.5±15.0 years, 56.8% female, baseline LDL-C 198±74 mg/dL), 96.6% had LDLR variants. The prevalence of T2DM was 13.3% and 67.4% were taking LLT at baseline . There were 206 (26%) new cases of T2DM or dysglycemia after a median 51-month follow-up . In multivariate Cox regression analysis age (HR:1.026, CI95%: 1.014-1.038, p=0.000) , body mass index (HR: 1.062, CI95%: 1.035-1.090, p=0.000) and current smoking (HR: 2.005, HR: 1.337-3.008, p=0.001) were independently associated with T2DM and dysglycemia, while metformin use was associated with a lower risk (HR: 0.147, CI95%: 0.076-0.284, p=0.000). History of previous CVD, use of lipid lowering therapy at baseline, high intensity LLT , or type of molecular defect were not associated with higher T2DM/dysglycemia risk. Conclusions: In this cohort of molecularly proven FH subjects, T2DM affected more than 1 in 10 people at baseline. Previous CVD and classical risk factors but neither molecular defects nor lipid lowering therapy were associated with T2DM/dysglycemia onset.

Abstract 14605: Association of SGLT-2 Inhibition With Size of Myocardial Infarction in Patients With Type 2 Diabetes Mellitus

Introduction: Preclinical data suggest that sodium-glucose-cotransporter-2 inhibitors (SGLT-2i) reduce the size of myocardial infarction (MI). This study aimed to assess the association of SGLT-2i use with the size of MI and clinical outcome. Methods: In a retrospective single center cohort study, patients with diagnosed diabetes mellitus type 2 who were admitted for MI and treated with PCI between November 2015 and November 2022 were analyzed and grouped according to SGLT-2i use. Following PCI, serial high sensitivity troponin T (cTn, Roche) measurements were performed according to in-house protocol. The primary outcome was the size of MI determined by the peak cTn normalized on the endangered myocardial area (EMA) calculated according to culprit lesion localization and coronary arterial dominance. Secondary outcomes were in-hospital adverse events (i.e. in-hospital death or stroke) and length of intensive care unit (ICU) treatment. The propensity score method was used to assess the association with outcomes. Results: 631 patients were identified: 85 with ongoing SGLT-2i therapy and 537 with other antidiabetic medication. Patients using SGLT-2i were younger (median age [years]: 67 [interquartile range, IQR 59-73] vs. 73 [64-79], p&lt;0.01) and had a higher eGFR at admission (75 [57-91] vs. 68 [49-88] ml/min/1.73m 2 , p=0.03). The median cTn samples per patient was 6 (5-8). There was no significant difference in the peak cTn levels between the two groups (SGLT-2i use vs. no SGLT-2i use: 53 (12-173) vs. 65 (20-174) х the upper limit of normal [ULN], p=0.26). After augmented inverse-probability weighted propensity score matching, ongoing SGLT-2i therapy was significantly associated with a reduced MI size (difference between means: -2.19 [95% confidence interval, -4.07 to -0.31] x ULN/EMA (1/%), p=0.02). SGLT-2i use was associated with less in-hospital adverse events (-4.69 [-8.70 to -0.69] %, p=0.02) and with less days on ICU (-0.27 [-0.53 to -0.01] days, p=0.045). Conclusion: In this retrospective cohort study of patients with DM presenting with MI, prior prescription of SGLT-2i was associated with reduced MI size and fewer adverse events during hospitalization. This might indicate that SGLT2i reduces the size of MI.

Recreational handball-based training for people with type 2 diabetes: a feasibility trial

Introduction Type 2 diabetes mellitus (T2DM) is recognized as a serious public health concern with a considerable impact on people suffering from the disease and the society. The benefit of physical activity in the prevention and treatment of T2DM are well documented, however, a considerable proportion of individuals with T2DM have an inactive and sedentary lifestyle. Although most people with T2DM are aware of the importance of exercise, many are not interested in joining traditional exercise options, and long-term adherence is poor for those who do. Thus, we aim to investigate the feasibility of recreational handball-based training (HBT) for people diagnosed with T2DM. Methods This single-arm feasibility trial included adults (over 30 years) with a clinical diagnosis of T2DM. They were invited to participate in a 12-week HBT consisting of two weekly 60-minute exercise sessions. The outcome was feasibility, determined by adherence, exercise intensity, adverse events, dropout rate, and metabolic parameters. Results From September to December 2021, 10 people were included in the study. One participant dropped out because of illness and one participant dropped out due to suspected atrial fibrillation. Eight participants concluded the intervention and participated on average 86% (range 14–23) of the HBT sessions exercising with a mean heart rate of 73.4% (standard deviation (SD) 10.2) of individual maximum heart rate. Conclusions HBT for people diagnosed with T2DM was found feasible with a high attendance rate and clinically relevant exercise intensities. However, future randomized controlled trials about the effects of the handball intervention are needed. Trial registration This trial was registered in ClinicalTrials.gov (NCT05015946) on 23/08/2021.

Association between sodium-glucose cotransporter 2 inhibitors and pancreatic cancer in the Japanese working-age population.

Pancreatic cancer-related mortality is increasing worldwide, and prevention methods and effective novel therapies are required. In pancreatic cancer, sodium-glucose cotransporters (SGLT) are involved in glucose uptake. This study aimed to clarify the association between SGLT2 inhibitors and pancreatic cancer development. A nested case-control study was conducted using the JMDC administrative claims database (January 2005 to June 2020). Patients newly diagnosed with type 2 diabetes mellitus (T2DM) were included, and cases were defined as patients who developed pancreatic cancer. Patients with outcomes were randomly matched to a maximum of 20 controls according to age (± 5 years), sex, and calendar date (month and year) of the first T2DM diagnosis through risk set sampling. Of the 181,107 T2DM patients, 363 cases and 7,043 controls were selected with 14 and 457 patients prescribed SGLT2 inhibitors, respectively. Cumulative administration of SGLT2 inhibitors for > 180 days was significantly inversely associated with the development of pancreatic cancer (adjusted odds ratio: 0.58, 95% confidence interval: 0.31-0.99). SGLT2 inhibitors may reduce the risk of developing pancreatic cancer in T2DM patients. The number of patients over 65 years of age was small in this study due to the nature of the data source. Further studies with larger sample sizes including older patients are needed.

Abstract 262: National Trends of 90‐day Readmission Rates and Etiologies among Diabetics following Transient Ischemic Attack

Introduction Transient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction. Type 2 Diabetes Mellitus (T2DM) is a rapidly growing global health problem with increasing prevalence. Currently, data are lacking regarding the trends of 90‐day readmission rates and etiologies among diabetic patients with TIA. Methods We used the Nationwide Readmission Database (NRD) to identify patients with a primary diagnosis of TIA (ICD‐10 code: G45.9) from 2016‐2019 and secondary diagnosis of T2DM. The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates. Results We identified 426,549 patients who were admitted with a primary diagnosis of TIA between 2016 and 2019. Of those patients, 35.43% (n=273,993) were diabetic and 64.57% (n=151,112) were non‐diabetic. Diabetics were more likely to be younger (70.43 vs 70.71 years, p&lt;0.001) and male (46.62% vs 42.89%, p&lt;0.001) compared to non‐diabetics. All‐cause 90‐day readmission was higher among diabetics compared to non‐diabetics (15.22% vs 12.03%, p&lt;0.001). Nearly half of 90‐day readmissions occurred within 30 days. There was no significant difference in the rate of 90‐day readmission between 2016 and 2019 (13.19% in 2016 and 12.95% in 2019). Among diabetics, readmitted patients were more likely to be older (71.87 vs 70.18 years, p&lt;0.001) and male (47.96% vs 46.38%, p&lt;0.001). Readmitted diabetics had a higher prevalence of valvular disease (10.12% vs 7.94%), chronic renal failure (33.40% vs 23.98%), coronary artery disease (40.20% vs 32.86%), heart failure (23.88% vs 16.07%), atrial fibrillation (24.02% vs 18.88%), dementia (13.87% vs 11.13%), cancer (4.18% vs 2.44%), and prior VTE (5.24% vs 4.44%) (p&lt;0.001 for all). The most common etiologies of 90‐day readmission among diabetics were cardiovascular (28.98%), neurological (12.92%), and infectious (7.72%). Conclusion Diabetics had higher 90‐day readmission following TIA than non‐diabetics. Cardiovascular conditions were the most common cause of readmission followed by neurological and infectious causes. Further studies are needed to improve risk stratification for diabetic patients following TIA and prevent all‐cause readmission.

Association between initial continuity of care status and diabetes-related health outcomes in older patients with type 2 diabetes mellitus: A nationwide retrospective cohort study in South Korea

Background and aimTimely and continuous care is necessary for patients with diabetes to prevent hospitalization and complications. This study investigated the association between initial Continuity of Care Index (COCI) status after diagnosis of type 2 diabetes mellitus (T2DM) and short- and long-term diabetes-related health outcomes. MethodsIt targeted elderly patients aged 60 years and above diagnosed with T2DM and used the National Health Insurance Service Senior cohort data from 2008 to 2019. The outcome measures were diabetic avoidable hospitalization and diabetic complication incidence for a five-year period. The main independent variable was the first-year COCI status after T2DM diagnosis. Survival analyses were performed using the Cox proportional hazards model. ResultsParticipants with a good COCI status within the first year of being diagnosed with T2DM experienced a reduced risk of diabetes-induced avoidable hospitalization (five years: Hazard ratio (HR) 0.39, 95 % Confidence interval (CI) 0.27–0.57; overall period: HR 0.56, 95 % CI 0.43–0.72) and diabetic complications (five years: HR 0.74, 95 % CI 0.68–0.80; overall period: HR 0.77, 95 % CI 0.71–0.82). ConclusionsIn the short- and long-term, there is a need for early management and improved healthcare accessibility of diabetes to prevent diabetes-avoidable hospitalization and diabetes-related complications.

Urate-lowering therapy and the risk of developing type 2 diabetes mellitus in patients with gout (results of a prospective study)

Objective: to analyze the association between medications intake and the development of type 2 diabetes mellitus (T2DM) in patients with gout. Material and methods. The study included 444 patients with gout without T2DM. The median follow-up time was 5.9 [2.9; 8.7] years. The primary end point was the diagnosis of T2DM. At baseline, therapy was initiated or adjusted according to current guidelines. Medication use was recorded: allopurinol, febuxostat, diuretics, glucocorticoids (GC), canakinumab, for which the odds ratio (OR) of developing T2DM was calculated. Results and discussion. T2DM occurred in 108 (24.3 %) patients enrolled in the study. 405 patients completed the study. 311 (76.7 %) patients were taking urate-lowering drugs: 263 (90.7 %) allopurinol, 48 (9.3 %) febuxostat. The mean dose of allopurinol was 153.4 ± 28.4 mg/day, and that of febuxostat was 91.6 ± 12.1 mg/day. During treatment with febuxostat, the probability of developing T2DM was lower: OR 0.433 (95 % confidence interval, CI 0.188–0.996; p = 0.044). When diuretics were used OR was 2.212 (95 % CI 1.303–3.753; p = 0.003), GC – 1.566 (95 % CI 1.003–2.445; p = 0.048). Conclusion. Febuxostat use is associated with a lower likelihood of developing T2DM.

Type 2 Diabetes Comorbidity and Cognitive Decline in Patients with Alzheimer's Disease.

Although insulin dysregulation and resistance likely participate in Alzheimer's disease (AD) etiologies, little is known about the correlation between type 2 diabetes mellitus (T2DM) and the progression of cognitive decline in patients with AD. To determine whether AD patients with T2DM experience more rapid cognitive decline than those without T2DM. All cognitive performance data and the presence or absence of T2DM comorbidity in patients with AD were derived from the US National Alzheimer's Coordinating Center's (NACC) Uniform Data Set (UDS). A search of the UDS identified 3,055 participants with AD who had more than one epoch completed. The data set culled clinically diagnosed AD dementia patients who were assessed for diabetes type identified during at least 1 visit. These patients were divided into 2 groups based on whether they had a diagnosis of T2DM. The data from these groups were then analyzed for differences in cognitive decline based on neuropsychological test battery scores and a Clinician Dementia Rating using a general linear model. Comparisons of the mean scores for 16 selected tests from the neuropsychological test battery showed no significant differences in baseline scores and scores at subsequent visits between the T2DM and nondiabetic groups. The results revealed no differences in cognitive decline metrics over the course of 5 visits in either study group. These data indicate that the presence of T2DM does not increase the rate of cognitive decline in AD. This finding contradicts expected disease burden and will need to be explored further.

SAT122 The Barriers Of Insulin Access In A Case Of Wolfram Syndrome

Abstract Disclosure: D.H. Sacoto: None. C.A. Villavicencio: None. R. Belokovskaya: None. A.A. Franco-Akel, MD: None. Wolfram syndrome (WS) is a rare and fatal condition with a median age of death of about 39 years and affecting around 1 of 100,000 people in North America. Insulin is the mainstay of treatment in WS though, access to it may affect adherence and glycemic control which is correlated with neurodegenerative progression. We present a patient with WS whose complications exacerbated due to insulin access. A 19-year-old African American male with a history of type 1 diabetes mellitus (T1DM), presented to the ED with a 2 day-history of general malaise and emesis. Diabetic ketoacidosis (DKA) (blood glucose 802 mg/dL, pH 7.2, positive serum ketones) was diagnosed upon arrival. Right optic nerve atrophy was diagnosed at age of seven. At age of eight, patient was diagnosed with bilateral sensory-neuronal hearing loss (SNHL) which led to school withdrawal. It was then when suspicion of WS arose. Single nucleotide polymorphism microarray confirmed homozygosity from the region of linkage on chromosome 4p16.1, where the WFS1 gene lies. At the age of eighteen, patient was diagnosed with neurogenic bladder for which he requires frequent self-catheterization. Since his T1DM diagnosis, patient has faced multiple barriers accessing insulin secondary to insurance issues and lack of social support resulting in multiple hospital admissions for DKA and urinary retention episodes. WS is an autosomal recessive disorder resulting from WFS1 or WFS2 gene mutation on chromosome 4p. WS commonly presents as childhood-onset diabetes mellitus, optic atrophy, SNHL, and neurogenic bladder. Insulin is the first line treatment for optimal glycemic control in WS. Despite optimal glycemic control, WS symptoms and neurodegenerative progression may be influenced by other factors. First, treatment access for rare diseases has shown to be impacted by medical unconscious bias, in addition to systemic, linguistic, and socioeconomic challenges patients may face. Furthermore, Medicaid insurance covering rare diseases still varies widely between 15-67%, and in those insured, there is still a 61% chance of delay or denial due to pre-approval requirements. In addition, poor glycemic control has been correlated with lower socioeconomic status, lack of access to devices such as insulin pumps, migratory status, social support and environment, food security, and ethnic background. Since diabetes control in WS patients is paramount to a better quality of life, additional studies are needed to understand the full scope of barriers that can contribute to policies that facilitate better treatment access for patient and families living with WS. Presentation: Saturday, June 17, 2023

THU141 Clinical Characteristics Of Korean Youth-onset Type 2 Diabetes Patients With Remission

Abstract Disclosure: S. Shin: None. H. Kim: None. S. Kim: None. J. Kim: None. Backgrounds: Improvement of beta cell function can occur in some patients with type 2 diabetes mellitus (T2DM). However, studies on remission of youth-onset T2DM with pharmacotherapy are sparse. We aimed to identify the clinical characteristics of pediatric patients experiencing remission. Methods: Medical records of pediatric patients with T2DM who were followed up for at least 1 year at Seoul National Bundang Hospital (2015-2022) were retrospectively reviewed. Remission of T2DM was defined as a return of HbA1c to &amp;lt;6.5% that persists for at least 3 months after discontinuation of glucose-lowering pharmacotherapy. Clinical characteristics between the remission and non-remission groups were compared at three time points (at diagnosis, 3 months after diagnosis, and remission). Results: Among 66 patients with T2DM (46 males, 69.7%), the mean age at diagnosis was 14.6±0.5 years, and the mean follow-up duration was 3.0±0.5 years. One (1.5%) patient underwent lifestyle modification only, 13 (19.7%) were treated with oral hypoglycemic agents only, and 52 (78.8%) were combined with insulin therapy at diagnosis. Twelve patients (18.2%) attained remission after a mean of 1.4±0.4 years from the time of diagnosis (at a mean age of 16.1±1.1 years). The remission group showed a higher proportion of males (100.0% vs. 63.0%, P = 0.012). At diagnosis of T2DM, urinary microalbumin-to-creatinine ratio (ACR) was lower in the remission group than in the non-remission group (2.0±1.6 mg/g vs. 11.2±2.9 mg/g, P = 0.010). There were no significant differences between the groups in the presence of initial diabetic ketoacidosis, HbA1c levels at diagnosis, and type of initial treatment. At the time of remission, HbA1c levels were significantly decreased (from 11.8% to 5.4%), while high-density lipoprotein cholesterol levels were increased (from 40.1 mg/dL to 45.7 mg/dL) than those at the time of diagnosis (both P &amp;lt;0.05). Recurrence occurred in three of 12 (25.0%) patients after a mean of 1.9±1.7 years from the time of remission. Conclusion: In Korean youth with T2DM, remission was observed in 18.2% after a mean of 1.4 years of intervention with lifestyle and pharmacotherapy. Youth with T2DM remission showed male predominance, and lower ACR at the time of diagnosis. Further studies about underlying pathophysiology and long-term outcomes after remission are warranted. Presentation: Thursday, June 15, 2023

FRI073 Use Of Obesogenic Medications Among Patients With Type 2 Diabetes In The Dominican Republic

Abstract Disclosure: S.P. Agramonte Villar: None. C.R. Gil Vega: None. J.M. Reynoso Ortiz: None. L.R. Sosa Pinedo: None. R.A. Vasquez Morel: None. C.M. Polanco Santos: None. V.T. San Martin: None. Background: Obesity is a major risk factor for the development and progression of type 2 diabetes mellitus (T2DM). Among the modifiable factors that can promote weight gain is the use of obesogenic medications (OM). The prevalence of the use of OM in patients with T2DM in the Dominican Republic (DR) is unknown. Objective: This study aimed to evaluate the use of OM among patients with T2DM in the DR. Methods: Cross-sectional study based on patient surveys and anthropometric measurements obtained in an outpatient primary care clinic in Santo Domingo, DR between October 2022 and November 2022. Patients aged ≥18 years with a known diagnosis of T2DM were included. Weight status was categorized according to body mass index (BMI). OM were defined according to the study by Hales et al1. Results: A total of 220 patients were surveyed and analyzed. Overall, 57.7% (127/220) of the patients reported a current use of one or more OM; 50.0% (110/220) were using one OM, 6.4% (14/220) were using two OM, and 1.3% (3/220) were using three OM. Among the patients using at least one OM, 45.7% (58/127) had overweight (BMI 25.0-29.9 kg/m2) and 40.9% (52/127) had obesity (BMI &amp;gt;30 kg/m2). The most frequently used antidiabetes OM was insulin [any type] (n=83), followed by glyburide (n=17) and glimepiride (n=13). The most commonly used non-antidiabetes OM was metoprolol (n=8), followed by atenolol (n=6) and pregabalin (n=6). Conclusion: More than half of the patients with T2DM were using at least one OM. The use of OM can contribute to weight gain and may hinder weight loss efforts in these patients, thus potentially negatively impacting the management of their underlying chronic disease. Reference: 1. Hales CM et al. Use of prescription medications associated with weight gain among US adults, 1999-2018: A nationally representative survey. Obesity (Silver Spring). 2022;30:229-239. Presentation: Friday, June 16, 2023

SAT124 GRADE-adolopment Of Adult Diabetes Mellitus Management Guidelines For A Pakistani Context

Abstract Disclosure: A. Pervez: None. R. Martins: None. M. Masood: None. O. Mahmud: None. N. Rizvi: None. A. Sheikh: None. N. Islam: None. A. Khowaja: None. N. Ram: None. S. Furqan: None. M. Mustafa: None. S. Aamdani: None. A. Haider: None. S. Nadeem: None. Background: Pakistan has the highest national prevalence (1 in 4 adults) of type 2 diabetes mellitus (T2DM) in the world. Most T2DM clinical practice guidelines (CPGs) originate from high-income countries and are evidence based. Due to the lack of research infrastructure and financial resources, lower-middle income countries face challenges in the de novo creation of CPGs. Thus, we aimed to develop a comprehensive, high-quality CPG with a local context for adult outpatient T2DM management in Pakistan based on the GRADE-ADOLOPMENT process. Methods: In collaboration with the GRADE working group, an adaptation of the GRADE-ADOLOPMENT approach was followed. Adolopment is a combination of adoption, adaptation, and de novo development. The American Diabetes Association (ADA) Standards of Medical Care in Diabetes - 2021 was utilized as the source CPG by local endocrinology experts in Pakistan. Recommendations from the source CPG were either adopted as is, excluded, or adapted. Adaptation was done using the evidence-to-decision framework with a panel of experts. Results: The source CPG contained 243 recommendations, 219 of which were adopted without change. 5 recommendations were adopted with minor changes related to cost effectiveness to minimize cost-related nonadherence. 18 recommendations were excluded due to reasons including but not limited to the scope being beyond the initial aim of our guideline centers’ objective (such as recommendations related to pediatric or inpatient care), unavailability of medication, or inapplicability to the existing health-care system of Pakistan. One recommendation was adapted pertaining to the screening age for the diagnosis of T2DM. This was recommended to be lowered from the age of 45 years to 30 years due to the higher prevalence of T2DM in younger Pakistanis. This will enable the early detection and management of T2DM. Earlier screening highlights the opportunity to intervene early on and reduce complications. This, coincidentally, was also addressed by the ADA in their 2022 guideline, where the screening age was revised from 45 years to 35 years. Conclusion: Our GRADE-ADOLOPED CPG for T2DM management comprises of 225 recommendations. We recommend earlier screening for T2DM in Pakistan. We additionally suggest careful consideration of cost to promote adherence while also recommending CGM use in the management plan of people with T2DM who can afford it. Our modified methodology provides an excellent resource efficient method to create locally contextualized evidence-based CPGs. Our goal is to publish and disseminate this CPG to improve the quality of T2DM care in Pakistan. Rigorous expanded research exploring the effectiveness of earlier screening for T2DM in Pakistan should be conducted in the future. Presentation: Saturday, June 17, 2023