Higher A1c Levels Research Articles

Correlates of sleep-disordered breathing and Cheyne-Stokes respiration in patients with atrial fibrillation who have undergone pulmonary vein isolation.

Sleep disordered breathing (SDB) is a common comorbidity in patients with atrial fibrillation (AF). Patients undergoing pulmonary vein isolation (PVI) for AF have a high prevalence of SDB. In previous studies, some patients with AF had Cheyne-Stokes respiration (CSR). The aim of the present study was to assess the prevalence of SDB and the correlates of SDB severity and CSR in AF patients who have undergone PVI. The study was conducted using a single-center observational design. All participants underwent a home sleep apnea test (ApneaLink Air, ResMed, Australia), which could determine the severity of SDB as assessed by the apnea-hypopnea index (AHI) and the percentage of CSR (%CSR) pattern. 139 AF patients who underwent PVI were included in the study. Overall, 38 (27.3%) patients had no SDB (AHI < 5), 53 (38.1%) had mild SDB (5 ≤ AHI < 15), 33 (23.7%) had moderate SDB (15 ≤ AHI < 30), and 15 (10.8%) had severe SDB (AHI ≥ 30). Correlates of the increased AHI included male sex (β = 0.23, p = 0.004), age (β = 0.19, p = 0.020), high body mass index (β = 0.31, p < 0.001), and β blockers usage (β = 0.18, p = 0.024). Conversely, correlates with the %CSR rate included male sex (β = 0.18, p = 0.020), age (β = 0.19, p = 0.015), non-paroxysmal AF (β = 0.22, p = 0.008), and high glycohemoglobin A1c (β = 0.36, p < 0.001) and N-terminal pro-brain natriuretic peptide (β = 0.24, p = 0.005) levels. SDB is prevalent in patients with AF who have undergone PVI; predisposing factors for SDB include male sex, older age, and obesity. CSR occurs in patients with AF who have undergone PVI; predisposing factors for CSR include male sex, older age, high left ventricular filling pressure, and abnormal blood glucose level.

A Real-world Study Evaluating the Clinical Factors Associated with the Initial SGLT2 Inhibitor Prescription

Abstract: The American Diabetes Association (ADA) guidelines prioritize Sodicum-glucose transporter-2-inhibitors (SGLT2i) given cardio-renal and glycemic benefits. This study was conducted to observe clinical factors associated with initial SGLT2i prescription in type 2 diabetes patients eligible for SGLT2i by the ADA. Methods. A retrospective case-control study was performed in a safety-net clinic and consisted of the initial SGLT2i prescriptions group and the group without. The data from the electronic medical records between July 2021 and December 2022 were analyzed in the regressional models. Results. There was a significant association between A1c ≥8% (OR 3.7, p=.01), heart failure (OR 19.3, p&lt;.0001), a history of hypotension (OR 11.9, p=.01), and sulfonylureas (OR 6.5, p=.003) with the SGLT2i prescription. Conclusion. Patients with high A1c levels, heart failure, a history of hypotension, and sulfonylureas were more likely than their counterparts to receive SGLT2i prescriptions. Future research should investigate adherence and provider prescribing behaviors related to SGLT2i to further assess optimal drug use.

Basal Insulin Initiation in Adults With Type 2 Diabetes Mellitus: A Retrospective Cohort Study Using Administrative Health Data in Alberta, Canada

ObjectivesPharmacologic treatment of type 2 diabetes mellitus (T2DM) follows a stepwise approach. Typically, metformin monotherapy is first-line treatment, followed by other noninsulin antihyperglycemic agents (NIAHAs) or progression to insulin if glycated hemoglobin (A1C) targets are not achieved. We aimed to describe real-world patterns of basal insulin initiation in people with T2DM and A1C not at target despite treatment with at least 2 NIAHAs. MethodsA retrospective cohort study was conducted using administrative health data from Alberta, Canada, among adults with T2DM, indexed on the first test with 7.0% < A1C < 9.5% (April 1, 2011, to March 31, 2019), with at least 2 previous NIAHAs but no insulin. Kaplan–Meier (KM) methodology was used to analyze time to basal insulin initiation, with stratification by index A1C. Annual patient status was categorized into 5 groups: basal insulin initiation, death, NIAHA intensification, no change in therapy (subgroups of A1C <7.1% and A1C ≥7.1% [clinical inertia]), or discontinuance. ResultsThe cohort included 14,083 individuals. The KM cumulative probability of initiating basal insulin was 7.7% (95% confidence interval [CI] 7.3% to 8.2%) at 1 year, increasing to 43.1% (95% CI 42.1% to 44.1%) at 8 years of follow-up. Higher A1C levels were associated with greater proportions of basal insulin initiation. By year 8, proportions with NIAHA intensification and clinical inertia were 12.1% and 19.3%, respectively, relative to year 7. ConclusionsDespite current clinical practice guidelines recommending achieving A1C targets within 6 months, less than half of the individuals with T2DM and clear indications for basal insulin initiated treatment within 8 years. Efforts to reduce delays in basal insulin initiation are needed.

Myopia risk factors. Update 2023

The aetiology of myopia has been extensively studied in the past decades. It is estimated that almost 30% of uncorrectable vision impairment could be attributable to myopic related disease. The latest research confirms that several environmental risks factors are important myopia determinants. More evidence was published on the effect of COVID‐19 lockdown on myopia. Increased near work and digital screen time and decreased outdoor time remained after the lockdowns and changes in myopia prevalence and progression were reported. Behaviours that contribute to a higher risk of myopia persisted post lockdowns leading to children with higher myopic risk profiles. Outdoor programmes remain as an important strategy to reduce myopia incidence. Recent evidence does not support the role of near work breaks such as 20‐20‐20 rule as a treatment option to reduce digital eye strain. Nevertheless, there is insufficient evidence to determine if this can be an effective treatment to reduce myopia incidence or myopia progression. Research into the influence of diet on myopia development has been mixed. New factors have emerged from genetic studies showing that increased adiponectin levels are protective against myopia. High haemoglobin A1c (HbA1c) levels may be associated with increased risk of myopia. Thus, the role of regular exercise and healthy diet should be further explored as potential strategies to prevent myopia onset or delay the age of myopia onset in future research studies. There is a growing body of evidence on the role of sleep and body mass index as risks factors for myopia, although further research is still necessary to confirm those factors and its association with myopia. Ongoing research should continue to identify risk factors for myopia development. Better‐designed studies are necessary to identify more efficient ways to prevent myopia and decrease myopia progression.

Glycemic Control and Metabolic Parameters in Children and Adolescents With Type 1 Diabetes.

The association between glycemic control and metabolic status is poorly defined in children and adolescents with T1D, besides being biologically plausible. We aimed to evaluate the association between glycemic control and body mass index (BMI), blood pressure (BP), and lipid profile in children and adolescents with T1D. Observational cross-sectional study including children and adolescents (5-18 years old) followed in our outpatient clinic with the diagnosis of T1D for at least a year. We used linear regression models (unadjusted and adjusted to sex and age) to evaluate the association between glycated hemoglobin (A1c) and time in range (TIR), several prespecified metabolic parameters, and prespecified demographic and clinical characteristics. We considered a p-value of <0.05 to be statistically significant. A total of 144 patients were included, 51% of whom were female. The population had a mean age of 12.7±3.4 years old. We report a positive association between A1c and BMI, systolic and diastolic BP, total- and LDL-cholesterol and triglycerides. Females and patients diagnosed at a younger age presented with higher A1c values. There is a tendency for a negative association between TIR and the former parameters. Higher A1c levels and lower TIR were associated with higher glycemic variability and were treated with a higher basal insulin per Kg dose. Our results support an important association between worse glycemic control and an unhealthier metabolic profile in children and adolescents with T1D. We can hypothesize that a good glycemic profile is needed to achieve good metabolic control at a young age.

Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus

ObjectivePoor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. MethodsA 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. ResultsOf the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). ConclusionApproximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.

1791-PUB: Implementation of a Food Pharmacy into a Pediatric Diabetes Clinic

Introduction: Social Determinants of Health (SDOH) is an essential focus in providing equitable diabetes care. Food and nutrition are integral parts of T1D and T2D management. Food insecurity (FI) increases the risk for T2D and is associated with higher A1C levels and hospitalization in those with diabetes. Children’s National Hospital and Capital Area Food Bank (CAFB) collaborated to create a Food Pharmacy within the diabetes clinic. Methods: The Food Pharmacy Program was implemented October 2021. Groceries, including grains, vegetables, fruit, dairy, and protein, are provided by the CAFB and stored in clinic. Each set of bags weighs about 50 lbs and serves a family of 4 for 3 days. A FI questionnaire is provided to diabetes patient families during their clinic visit. If positive, families qualify to receive supplemental groceries from the clinic, which are provided to families before they leave. Menus change on a quarterly basis based on feedback from patients and the dietetic team. Results: To date, 62% screened positive for FI. Approximately 20% of our diabetes patient population (496 families) have received groceries (46% male; mean age 14.4±3.9 years; 46% T1D; 51% prediabetes or T2D; mean diabetes duration 3.4 years; Ethnicity: 32% Hispanic; Race: 55% Black; 5% Caucasian). Over the initial 6 months of the program, an average of 49 families per month were receiving groceries. Since then, an average of 117 families per month are receiving groceries. A total of 24,800 pounds of food have been provided through the Food Pharmacy. Conclusions: A Food Pharmacy was successfully implemented within a diabetes clinic, showing the benefits of a partnership between a hospital and local food bank focusing on SDOH to improve patient care. A research project is being developed to study diabetes, psychosocial, cost analysis, and health utilization outcomes with a more intensive food intervention in youth with prediabetes or T2D. Disclosure E. Frymark: None. A.M. Richardson: None. H. Kessenich: None. S.L. Holly: None. O. Odimayomi: None. S. Topping: None. J. Leon: None. S. Majidi: None.

876-P: Effectiveness and Tolerability of Intensification of Canagliflozin Dose from 100 mg to 300 mg Daily In Patients with Type 2 Diabetes in Real Life—The INTENSIFY Study

There is a paucity of data evaluating the strategy of intensification of canagliflozin therapy by increasing the dose from canagliflozin 100 mg/d (CANA100) to canagliflozin 300 mg/d (CANA300), since all clinical trials compared both doses separately. The aim of this multicentric study was to assess in real life the effectiveness and tolerability of the intensification of canagliflozin to 300 mg/d in patients with T2DM and suboptimal metabolic control with CANA100. The primary outcome variables were changes in A1c and weight at the end of the follow-up. 317 patients met the inclusion criteria (age 62.2 years, A1c 7.55%, weight 88.6 kg). Median time of treatment with CANA300 was 20.8 months. Switching to CANA300 induced a significant decrease in A1c (-0.47%) and weight (-2.9 kg), both p&amp;lt;0.0001. The percentage of patients with A1c &amp;lt;7% increased significantly from 26.7% with CANA100 to 51.6% with CANA300 (p&amp;lt;0.0001). In those individuals with poor glycemic control (A1c &amp;gt;8%, mean 9.0%), A1c was significantly reduced by -1.24% (p&amp;lt;0.0001). There were significant improvements in FPG (-14.8 mg/dl), SBP (-5.3 mmHg) and DBP (-3,1 mmHg), all p&amp;lt;0.05. Serum liver enzymes and albuminuria also decreased significantly. Considering the entire treatment period (initial treatment with CANA100 and later switch to CANA300), with a median follow-up of 38.8 months, patients achieved a statistically significant overall reduction in A1c (-1.30%), weight (-5.8 kg), SBP (-9.6 mmHg) and DBP (-4.7 mmHg), all p&amp;lt;0.0001. 7.9% of patients discontinued CANA300; the most frequent causes of withdrawals were genital mycotic infections (1.9%) and urinary tract infections (0.9%). In summary, intensification of canagliflozin therapy to CANA300 achieved further significant and clinically relevant reductions in A1c, weight, and BP in patients with T2DM. The effectiveness of the switch was particularly relevant in those patients with higher A1c levels. Disclosure J.J. Gorgojo-Martinez: Advisory Panel; AstraZeneca, Bayer Inc., Novo Nordisk. Research Support; Eli Lilly and Company, Mundipharma, Novo Nordisk. Speaker's Bureau; AstraZeneca, Boehringer Ingelheim Inc., Eli Lilly and Company, Mundipharma, Novo Nordisk, Amarin Corporation. P.J. Ferreira-Ocampo: None. A. Galdon-Sanz Pastor: None. J.J. Cárdenas-Salas: Speaker's Bureau; Novo Nordisk, Mundipharma, Lilly, AstraZeneca. Other Relationship; Mylan, Amgen Inc., Almirall, S.A. T. Antón-Bravo: Speaker's Bureau; Abbott Nutrition, AstraZeneca, Eli Lilly and Company. Advisory Panel; Fresenius Kabi. Speaker's Bureau; Novo Nordisk, Daiichi Sankyo. Advisory Panel; Sanofi. Other Relationship; Mundipharma. M. Brito: Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Mundipharma, Novo Nordisk, Sanofi. Advisory Panel; Sanofi. Speaker's Bureau; Almirall, S.A., Boehringer-Ingelheim, Esteve. Advisory Panel; Esteve, AstraZeneca. Research Support; Mundipharma. F. Almodovar-Ruiz: None. Funding Mundipharma International Limited

Advanced Glycation End Products and Bone Metabolism in Patients with Chronic Kidney Disease.

Advanced glycation end products (AGEs) accumulation may be involved in the progression of CKD-bone disorders. We sought to determine the relationship between AGEs measured in the blood, skin, and bone with histomorphometry parameters, bone protein, gene expression, and serum biomarkers ofbone metabolism in patients with CKD stages 3 to 5D patients. Serum levels of AGEs were estimated by pentosidine, glycated hemoglobin (A1c), and N-carboxymethyl lysine (CML). The accumulation of AGEs in the skin was estimated from skin autofluorescence (SAF). Bone AGEs accumulation and multiligand receptor for AGEs (RAGEs) expression were evaluated by immunohistochemistry; bone samples were used to evaluate protein and gene expression and histomorphometric analysis. Data are from 86 patients (age: 51 ± 13 years; 60 [70%] on dialysis). Median serum levels of pentosidine, CML, A1c, and SAF were 71.6pmol/mL, 15.2ng/mL, 5.4%, and 3.05 arbitrary units, respectively. AGEs covered 3.92% of trabecular bone and 5.42% of the cortical bone surface, whereas RAGEs were expressed in 0.7% and 0.83% of trabecular and cortical bone surfaces, respectively. AGEs accumulation in bone was inversely related to serum receptor activator of NF-κB ligand/parathyroid hormone (PTH) ratio (R=-0.25; p=0.03), and RAGE expression was negatively related to serum tartrate-resistant acid phosphatase-5b/PTH (R=-0.31; p=0.01). Patients with higher AGEs accumulation presented decreased bone protein expression (sclerostin [1.96 (0.11-40.3) vs. 89.3 (2.88-401) ng/mg; p=0.004]; Dickkopf-related protein 1 [0.064 (0.03-0.46) vs. 1.36 (0.39-5.87) ng/mg; p=0.0001]; FGF-23 [1.07 (0.4-32.6) vs. 44.1 (6-162) ng/mg; p=0.01]; and osteoprotegerin [0.16 (0.08-2.4) vs. 6.5 (1.1-23.7) ng/mg; p=0.001]), upregulation of the p53 gene, and downregulation of Dickkopf-1 gene expression. Patients with high serum A1c levels presented greater cortical porosity and Mlt and reduced osteoblast surface/bone surface, eroded surface/bone surface, osteoclast surface/bone surface, mineral apposition rate, and adjusted area. Cortical thickness was negatively correlated with serum A1c (R=-0.28; p=0.02) and pentosidine levels (R=-0.27; p=0.02). AGEs accumulation in the bone of CKD patients was related to decreased bone protein expression, gene expression changes, and increased skeletal resistance to PTH; A1c and pentosidine levels were related to decreased cortical thickness; and A1c levels were related to increased cortical porosity and Mlt. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Factors Associated With Improved A1C Among Adults With Type 1 Diabetes in the United States.

Many adults with diabetes do not reach optimal glycemic targets, and, despite advances in diabetes management, diabetes technology use remains significantly lower in racial/ethnic minority groups. This study aimed to identify factors associated with achieving the recommended A1C target of <7% using data on 12,035 adults with type 1 diabetes from 15 centers participating in the T1D Exchange Quality Improvement Collaborative. Individuals attaining the target A1C were more likely to be older, White, have private health insurance, and use diabetes technology and less likely to report depressive symptoms or episodes of severe hypoglycemia or diabetic ketoacidosis than those with higher A1C levels. These findings highlight the importance of overcoming inequities in diabetes care.

DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice.

This purpose of the study was to describe recent diabetic ketoacidosis (DKA) incidence data in youth with type 1 diabetes using insulin pumps and the impact of continuous glucose monitors (CGMs) on DKA rates. DKA data were obtained through a retrospective chart review of insulin pump users (ages <26 years) between December 2019 and June 2021 in an academic pediatric endocrinology practice where 68% of patients were pump users. Among 591 pump patients, 28 events occurred (3.16 events per 100 patient-years). Mean age was 13.6±3.4 years; 85.7% ranged from 12 to 19 years. Mean A1C was 10.2±2.3%, diabetes duration was 6.1±4.0 years, and 57.1% used CGM. Admission pH levels ranged between 7.0 and 7.31, with 28.6% of events classified as "moderate" and 46.4% "severe." There was no significant difference in the DKA severity between those who wore a CGM and those who did not (ie, pH, serum bicarbonate, mentation alteration, length of stay, intensive care unit admission, and hospital admission). DKA events were attributed to concurrent illness (10.7%), insulin omission (14.3%), pump site failure (57.1%), or other pump malfunctions (14.3%). DKA events in pump-treated patients were relatively uncommon; most episodes occurred in adolescents with higher A1C levels, and notably, most events could have been avoided if users followed standard troubleshooting guidelines. Thus, DKA prevention education should be reinforced at each encounter, particularly for teens with higher A1C levels. Moreover, more than 50% of those with DKA episodes wore a CGM, suggesting that pump users using CGM require frequent reinforcement of this education and that the development of such educational materials is critical.

Measurement and Validation of the Comprehensive Score for Financial Toxicity (COST) in a Population With Diabetes.

The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is a validated instrument measuring financial distress among people with cancer. The reliability and construct validity of the 11-item COST-FACIT were examined in adults with diabetes and high A1C. We examined the factor structure (exploratory factor analysis), internal consistency reliability (Cronbach α), floor/ceiling effects, known-groups validity, and predictive validity among a sample of 600 adults with diabetes and high A1C. COST-FACIT demonstrated a two-factor structure with high internal consistency: general financial situation (7-items, α = 0.86) and impact of illness on financial situation (4-items, α = 0.73). The measure demonstrated a ceiling effect for 2% of participants and floor effects for 7%. Worse financial toxicity scores were observed among adults who were women, were below the poverty line, had government-sponsored health insurance, were middle-aged, were not in the workforce, and had less educational attainment (P < 0.01). Worse financial toxicity was observed for those engaging in cost coping behaviors, such as taking less or skipping medicines, delaying care, borrowing money, "maxing out" the limit on credit cards, and not paying bills (P < 0.01). In regression models for the full measure and its two factors, worse financial toxicity was correlated with higher A1C (P < 0.01), higher levels of diabetes distress (P < 0.01), more chronic conditions (P < 0.01), and more depressive symptoms (P < 0.01). Findings support both the reliability and validity of the COST-FACIT tool among adults with diabetes and high A1C levels. More research is needed to support the use of the COST-FACIT tool as a clinically relevant patient-centered instrument for diabetes care.

961-P: The Effect of Obesity on HbA1c among Adults with Type 1 Diabetes: A U.S. Based Multicenter Study

Background: The primary objective of this U.S. based multi-center study was to determine if obesity is associated with an increase in A1c levels among adults with T1D. Additionally, we also examined patient and clinical profile across all BMI groups in the adult T1D population. Methods: Electronic health record data from the T1D Exchange Quality Improvement (T1DX-QI) Collaborative for adult patients aged 21 years and older, between 2017-2021 was analyzed. BMI (kg/m2) was categorized into: Underweight (&amp;lt;18.5 kg/m2) , normal weight (18.5-24.9 kg/m2) , overweight (25.0-29.9 kg/m2) , obese (30.0-39.9 kg/m2) , and severely obese (≥ 40 kg/m2) . HbA1c levels were taken from patients’ most recent clinic visit. Multivariable regression analysis was used to examine the association between obesity and HbA1c levels. Results: This analysis included 7,496 T1D adult patients, of which 3% were underweight, 42% normal weight, 33% overweight, 21% obese and 2% severely obese. Compared with normal weight people with T1D, the obese group were older (Mean (SD) , yrs: 36 (15) vs. 43 (15) ; p&amp;lt;0.001) , and less likely to use a CGM (72% vs. 66%; p&amp;lt;0.001) or insulin pump device CGM (63% vs. 57%; p&amp;lt;0.001) . Compared to normal weight individuals, obese people had higher HbA1c levels (B (SE) :0.17; p=0.002) adjusted for age, gender, insurance status and race/ethnicity. Conclusion: In this large real-world study, we found obese adults were more likely to have higher A1c levels than normal weight adults with T1D. Disclosure N.Noor: None. H.K.Akturk: Research Support; Dexcom, Inc., Eli Lilly and Company, REMD Biotherapeutics. M.Desimone: None. M.Basina: None. N.Rioles: None. S.Rompicherla: None. J.Haw: None. L.Golden: None. O.Ebekozien: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

510-P: DKA Prevention on Insulin Pumps: Lessons Learned from a Large Pediatric Pump Practice

While the Type 1 Diabetes Exchange data noted that diabetic ketoacidosis (DKA) is more common in those utilizing injection regimens than insulin pumps, DKA remains a risk for pump users, as it can precipitously develop if insulin infusion is interrupted. We sought to obtain more recent DKA admission data in T1D youth using insulin pumps and the impact of CGM on DKA rates. Methods: We characterized DKA data in insulin pump users from episodes between 12/20 and 6/2021 in an academic pediatric endocrine practice in which 68% were pump users. Results: Among 591 pump patients aged &amp;lt;25 years (y) , 28 events occurred (3.16 events per 100 patient-y. Mean age was 13.6±3.4y; 85.7% were 12-19y old. More events were in males (60.7%) , 53.6% were white, 71.4% non-Hispanic. Mean HbA1c was 10.22.3%, diabetes duration 6.1±4.0y, and 57.1% used CGM; 28.6% of patients were new to pump therapy (&amp;lt;1y) .Admission pH levels ranged between 7.0-7.31, with 28.6% of events classified as “moderate” and 46.4% as “severe.” Average length of stay was 2.0±0.7 days. While there was no significant difference in pH levels, CGM wearers had higher admission bicarbonate values (11.8 vs. 9.3, p=0.04) . Clinicians assessed the cause of DKA to be related to concurrent illness (10.7%) , insulin omission (14.3%) , pump infusion site failure (57.1%) or other pump malfunctions (14.3%) . For most (60.7%) , this was the first documented DKA event. Alcohol consumption was a contributing factor in only one event. Conclusions: DKA events were relatively uncommon; most episodes occurred in adolescents in poor diabetes control. Notably, most events could have been avoided if users followed standard trouble shooting guidelines. Thus, education on DKA prevention should be reinforced at each visit, particularly for teens on pumps with higher A1c levels. Moreover, while CGM wearers had higher admission bicarbonate values, over 50% of those hospitalized for DKA wore a CGM, suggesting even pump users using CGM require frequent reinforcement of DKA prevention education. Disclosure E.Doyle: None. S.A.Weinzimer: Consultant; Dompé, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. W.V.Tamborlane: Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Medtronic, Novo Nordisk, Sanofi, Takeda Pharmaceutical Company Limited.

135-LB: Implementation of Depression Screening in a Pediatric Diabetes Clinic with Limited Mental Health Support

Objective: Depression is common in adolescents with type 1 (T1D) and type 2 diabetes (T2D) , and for those with T1D, is associated with suboptimal health outcomes, including higher A1c levels and increased rates of hospitalizations. The ADA standards of care recommend integration of depression screening into routine medical care, but follow-up for positive screens is challenging in settings with limited mental health support. Here, we describe our latest PDSA cycle results from a quality improvement (QI) project for implementing depression screening in adolescents with diabetes. Methods: This QI project took place in a pediatric diabetes center without access to mental health support as part of routine diabetes care. Our goals were to 1) increase depression screening via the PHQ-9 from 0% to 80% over 2 years in all patients with T1D or T2D &amp;gt;11 yrs old and 2) refer 100% of patients who screened positive to behavioral health by the end of the 2-year period (Dec 2019-Dec 2021) . Our QI project included 4 Plan-Do-Study-Act (PDSA) cycles ranging from trialing PHQ-9 screening with a single provider (Cycle 1) to implementing screening across all providers (Cycle 4) . This abstract focuses on the last 6 months of PDSA Cycle 4 (previous cycles were presented at 2021 ADA Scientific Sessions) . Results: From July-Dec. 2021, a total of 68% of eligible patients completed PHQ-9 screening. Screening rates ranged from 46-90% across 5 different providers; 2 providers achieved screen rate goal of &amp;gt;80%. Of the 68%, 28% screened positive and 86% of them were referred to behavioral health. Referral rates for positive screens ranged from 83-100% per provider; 2 providers achieved refer rate goal of 100%. Conclusions: Although we did not achieve our PHQ-9 screen rate goal of 80% or our behavioral health refer rate goal of 100% by the end of 2 years, we found a major discrepancy in rates among providers. This prompted us to add an additional PDSA Cycle 5, which focuses on improving screening and refer rates for all providers. Disclosure S. Gurnurkar: None. A. Y. Kulasingham: None. J. Pierce: None.

Follow-Up Mental Health Care in Youth and Young Adults With Type 1 Diabetes After Positive Depression Screen and/or Suicidal Ideation.

Individuals with type 1 diabetes have higher rates of depression and suicidal ideation than the general population, and symptoms of depression are often associated with higher A1C levels and complications. This study evaluated mental health follow-up rates in youth and young adults with type 1 diabetes who screened positive for depressive symptoms or suicidal ideation and identified differences between those who obtained follow-up mental health care and those who did not. Specifically, males were less likely to obtain follow-up, and those who had mental health follow-up had decreasing A1C over the following year. These findings suggest increased assistance and monitoring are needed to ensure follow-up mental health care is obtained.

A call for further research on the relation between type 2 diabetes and oral candidiasis

This study aimed to evaluate the relationship between oral candidiasis with salivary features, neutrophil function, and glycemic control in type 2 diabetes (T2D). Twenty-nine individuals were included, 16 with T2D and 13 without the disease. The participants underwent clinical examination, neutrophilic function tests, fasting glycemia and glycated hemoglobin (A1c), stimulated and unstimulated saliva collection, and swab and exfoliative cytology. Salivary flow, pH, and total fungi count were evaluated on saliva, and identification of the Candida species was performed in saliva and swab samples. There was no difference in unstimulated salivary flow and pH of the stimulated and unstimulated saliva for participants with T2D and controls (P > .05). Individuals from both groups presented no candidal lesions. The salivary fungal growth in the T2D group was higher than that in controls (P < .05). Only individuals with T2D presented alterations in the neutrophilic functions (14/16; 87.5%; P < .05). There was no relationship between high A1c values and neutrophil dysfunction with the presence of Candida spp. in both saliva and mucosa (P > .05). High A1c level, reduction in neutrophil activity, salivary flow and pH, and increase in total salivary Candida spp. counts were not related to oral candidiasis in patients with T2D.

The effect of leisure boredom and A1C level on diabetes eating problems in adolescents with type 1 diabetes

PurposeEating out of boredom, the changes in daily routine, physical inactivity and longer exposure to screens have made glycemic control difficult at home during the COVID-19 pandemic among adolescents with Type 1 Diabetes Mellitus. Adolescents with diabetes are at higher risk of developing eating problems than are their healthy peers. The aim of this study is to examine the effects of leisure time boredom and A1C level on eating problems in adolescents with Type 1 Diabetes Mellitus. Design and methodsA descriptive, correlational, and cross-sectional design was used in this study. The study was conducted in Turkey, with the participation of 173 adolescents diagnosed with Type 1 Diabetes Mellitus. Convenience sampling was used to recruit patients from pediatric endocrinology outpatient clinics of hospitals. ResultsIt was determined that the diabetes eating problems of adolescents with Type 1 Diabetes were mostly affected by the level of leisure time and A1C, respectively. In the overall model, 58% (F = 4119.701, p < .001) of the factors affecting diabetes eating problems could be explained by the level of leisure boredom and A1C level. ConclusionIt has been found that the adolescents with diabetes with high A1C levels and who cannot use their leisure time and have boredom are more at risk in terms of diabetes eating problems. Practice implicationsIt should be determined how the adolescents with diabetes spend their lesiure time by diabetes health care team, which should be supported to develop leisure time skills. Effective use of leisure time and strategies to cope with boredom should also be included in diabetes education.

Clinically significant depressive symptoms and high diabetes distress in adults with type 1 and type 2 diabetes in Appalachian Ohio.

In rural southeastern Ohio, the prevalence of diabetes is 19.9%, nearly double the national average of 10.5%. Despite the high rate of diabetes, its impact on the region is understudied; one such understudied topic is psychosocial difficulties. People with diabetes experience disproportionately higher rates of major depressive disorder (MDD), clinically significant depressive symptoms, and diabetes distress. Diabetes distress refers to the negative emotional experience of living with diabetes. It reflects an individual's worries, concerns, and fears about living a chronic and progressive disease. To assess the prevalence of diabetes distress as well as comorbid, clinically significant depressive symptoms and diabetes distress among patients in southeastern Ohio; and to assess impact of depressive symptoms and diabetes distress on A1C levels, diabetes self care behaviors, and diabetes quality of life (DQOL). In this cross sectional survey study, individuals aged 18years and older, diagnosed with type 1 (T1D) or type 2 (T2D) diabetes, who were able to read and speak English, and living in southeastern Ohio were invited to participate. Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Self Care Inventory-Revised, and the DQOL Scale as part of the study survey. Participants completed the survey via an online questionnaire service or mailed packets. Chi square tests determined the comorbidity of clinically significant depressive symptoms and high diabetes distress levels by type of diabetes. Multiple regression models examined the relationships among clinically significant depressive symptoms, diabetes distress scores, A1C levels, self care behaviors, and DQOL scores. Statistical significance was defined as a p<0.05. A total of 325 adults participated (mean±standard deviation [SD] age, 41.6±19.2years; 131 (40.7%) with T1D; 194 (59.7%) with T2D; mean±SD A1C, 7.5±1.6%; mean±SD duration, 12.4±9.6years). Of the 325 participants, 70 (21.5%) indicated clinically significant depressive symptoms, with 29 (22.3%) T1D participants and 41 (21.0%) T2D participants reporting clinically significant depressive symptoms. A total of 92 (28.3%) participants reported high diabetes distress (39 (30.5%) T1D participants and 53 (27.5%) T2D participants). Forty-eight participants (15.0%) screened positive for both clinically significant depressive symptoms and high diabetes distress. Regression models showed that higher diabetes distress scores were associated with fewer self care behaviors (T1D, b=-0.268, p=0.030; T2D, b=-0.312, p<0.001) and lower DQOL (T1D, b=0.726, p<0.001; T2D, b=0.501, p<0.001). Further, more depressive symptoms were associated with lower DQOL in participants with T2D (b=0.363, p<0.001). Higher diabetes distress scores were not associated with higher A1C levels in participants with T1D or T2D; however, increased depressive symptoms were associated with higher A1C levels in participants with T2D (b=0.390, p<0.001). Findings showed that adults in southeastern Ohio experienced high levels of diabetes distress and co-occurring clinically significant depressive symptoms that were within range of data from previous studies. These findings highlight the importance of routine screening for both clinically significant depressive symptoms and diabetes distress. Future longitudinal research is needed to confirm these findings and examine the evolution of these relationships over time.

T1D Exchange Quality Improvement Collaborative: A Learning Health System to Improve Outcomes for All People With Type 1 Diabetes.

Medical advances, including the development of new medications and advanced technologies, have the potential to improve outcomes for youths and adults with type 1 diabetes, but that potential has not yet been fully realized, particularly in minority groups and those with low socioeconomic status (SES). The report by Majidi et al. in this issue (1) adds to the growing literature exposing racial and ethnic inequities in type 1 diabetes. These data, derived from a mostly young cohort (76% <26 years of age), show that non-Hispanic Blacks experienced higher rates of diabetic ketoacidosis (DKA), higher A1C levels, and lower use of technology compared with non-Hispanic Whites. Non-Hispanic Black patients with type 1 diabetes who are hospitalized with coronavirus disease 2019 are also more likely to present in DKA (2). There is a crucial need to address barriers to care and provide resources to overcome unjust and avoidable health disparities that persist within nondominant racial and ethnic groups (3). Understanding and addressing these barriers can be achieved by understanding our current state and implementing interventions to decrease barriers and improve outcomes. In 2016, the T1D Exchange established the T1D Exchange Quality Improvement Collaborative (T1DX-QI). This collaborative started with 10 pilot sites, which were primarily well-respected, academic pediatric diabetes centers. Its initial focus was on children and adolescents/emerging adults with type 1 diabetes, the group who has the highest A1C levels (4,5). Since then, the T1DX-QI has continued to expand, now encompassing 30 centers across the United States (Figure 1), and is beginning to direct attention to adults as well as youths with type 1 diabetes. Participating centers strive to improve care delivery and health outcomes and reduce barriers to care for everyone with type 1 diabetes by sharing best practices and data benchmarking (6). FIGURE 1 Geographical distribution of T1DX-QI sites. …