Improvement In Glycemic Control Research Articles

The Efficacy of Tele-Monitoring in Maintaining Glycated Haemoglobin Levels in Patients with Type 2 Diabetes Mellitus: A Systematic Review.

It is well documented that telemedicine offers effective accessibility and consistency which are useful in overcoming the barriers associated with the traditional delivery of chronic disease management. Furthermore, home-based telemonitoring approach for managing chronic disease conditions has been shown to break geographical barriers and facilitate provider-to-patient communication. However, the efficacy of telemedicine in reducing HbA1c is debatable. This systematic review aims to evaluate the effect of telemedicine on glycaemic control in patients with type 2 diabetes. This systematic review has been conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searches were primarily conducted using the EBSCOhost database. Other search engines such as Cochrane Library and Google scholar were also used and search of grey literature was performed using google, NHS.uk website, WHO websites, and gov.uk website. Nine articles were included in this review. Three themes were identified in this review including diabetes education/telemonitoring technology and glycaemic control, the attitude of participants, and cost effectiveness of tele-medicine. While three studies reported improved glycaemic control with statistically significant improvement in HbA1c compared to the control group, three other studies did not find significant improvement in glycaemic control. In addition, the findings suggest that participants' positive attitude to self-care can lead to an improved HbA1c, and finally, several of the selected studies found that telemonitoring is not cost-effective. The findings of this review show that telemedicine may be effective in managing blood glucose in patients with type 2 diabetes. However, factors such as educational level of patients, attitude and costs may limit its application in primary care. More studies are required to fully establish the effectiveness of Telemonitoring in managing patients with type 2 diabetes.

Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study

Several barriers to diabetes treatment and care exist, particularly in underserved medical communities. This study aimed to evaluate a novel, culturally adapted, Spanish-language mHealth diabetes program for glycemic control. Professional Spanish translators, linguists, and providers localized the entirety of the Vida Health Diabetes Management Program into a culturally relevant Spanish-language version. The Spanish-language Vida Health Diabetes Management Program was used by 182 (n=119 women) Spanish-speaking adults with diabetes. This app-based program provided access to culturally adapted educational content on diabetes self-management, one-on-one remote counseling and coaching sessions, and on-demand in-app messaging with bilingual (Spanish and English) certified health coaches, registered dietitian nutritionists, and certified diabetes care and education specialists. Hemoglobin A1c (HbA1c) was the primary outcome measure, and a 2-tailed, paired t test was used to evaluate changes in HbA1c before and after program use. To determine the relationship between program engagement and changes in glycemic control, a cluster-robust multiple regression analysis was employed. We observed a significant decrease in HbA1c of -1.23 points between baseline (mean 9.65%, SD 1.56%) and follow-up (mean 8.42%, SD 1.44%; P<.001). Additionally, we observed a greater decrease in HbA1c among participants with high program engagement (high engagement: -1.59%, SD 1.97%; low engagement: -0.84%, SD 1.64%; P<.001). This work highlights improvements in glycemic control that were clinically as well as statistically significant among Spanish-preferring adults enrolled in the Vida Health Spanish Diabetes Management Program. Greater improvements in glycemic control were observed among participants with higher program engagement. These results provide needed support for the use of digital health interventions to promote meaningful improvements in glycemic control in a medically underserved community.

Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom.

Clinical trials have shown that bariatric surgery (BS) is associated with better glycemic control and diabetes remission in patients with type 2 diabetes (T2D) compared with routine care. We conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D. This was a retrospective, matched, controlled cohort study conducted between January 1, 1990, and January 31, 2018, using IQVIA Medical Research Data, a primary care electronic records database. Adults with body mass index (BMI) ≥30 kg/m2 and T2D who had BS (surgical) were matched for age, sex, BMI, and diabetes duration to two controls (with T2D and no BS). A total of 1126 patients in the surgical group and 2219 patients in the control group were analyzed. Mean (standard deviation) age was 50.0 (9.3) years, 67.6% were women, baseline glycocylated hemoglobin (HbA1C) was 7.8% (1.7 mmol/mol), and diabetes duration was 4.7 years (range, 2.0-8.4 years). Over a median (interquartile range) follow-up of 3.6 years (1.7-5.9 years), a higher proportion of patients in the surgical group achieved an HbA1C of ≤6.0% than the control group (65.8% versus 22.8%). The surgical group showed a decrease in mean HbA1C of 1.5% (95% confidence interval [CI]: 1.4%-1.7%), 1.4% (1.2%-1.5%), and 1.3% (1.1%-1.5%) at 1-, 2-, and 3-year follow-up, respectively, whereas HbA1C increased in the control group. The proportion of patients receiving glucose-lowering medications decreased in the surgical group (92.2% to 66.5%) but increased in the control group (85.3% to 90.2%). BS is associated with significant improvement in glycemic control, achievement ofnormal HbA1C levels, and reduced need for glucose-lowering therapy in patients with T2D.

Sustained Improvement in Glycemic Control in Emerging Adults with Type1 Diabetes 2Years After the Start of the COVID-19 Pandemic.

Although there were initial concerns that the public health response to the COVID-19 pandemic would adversely affect glycemic control in people with type1 diabetes, several early continuous glucose monitor (CGM) studies reported an unexpected slight improvement in glucose metrics. Early emerging adulthood (roughly spanning the ages of 18-24years) is often a vulnerable time in the life of a person with type1 diabetes. Here, we set out to determine how the care and glucose management of emerging adults with type1 diabetes changed over a period of approximately 2years from the start of the COVID-19 pandemic. This was a retrospective study of a tertiary referral, multidisciplinary young adult diabetes clinic, spanning before and after the 777-day state of emergency in the City of Toronto. Of 130 emerging adults with type1 diabetes (80 male, 50 female; mean age 21.0 ± 2.1years), baseline pre-pandemic HbA1c values were available for 120 individuals. During 24.9 ± 5.4months of follow-up before and after the start of the COVID-19 pandemic, HbA1c fell from 8.5 ± 1.7% (69.3 ± 18.8mmol/mol) to 8.1 ± 1.9% (65.2 ± 20.5mmol/mol) (P < 0.05), with change in HbA1c from pre-lockdown levels being sustained throughout the second year of the pandemic. Over the same period, CGM use rose from 43% to 83%, primarily through increased uptake of intermittently scanned CGM, which is covered through the Ontario Drug Benefit program. Change in HbA1c was most evident in DexcomG6 real-time CGM users -0.7 ± 1.2% (-9.8 ± 17.1mmol/mol) (P < 0.01 vs. self-monitoring of blood glucose). Among emerging adults with type1 diabetes attending a multidisciplinary clinic in a high-income country, glycated hemoglobin levels are on average 0.4% (4.1mmol/mol) lower than they were before the pandemic. This reduction in HbA1c is unlikely to be a consequence of early strict lockdowns given the length of time of follow-up. Rather, improved glycemic control coincided with increased utilization of wearable diabetes devices.

Exploratory study on glycemic control improvement for patients with diabetes mellitus by appropriate re-education on insulin self-injection technique during COVID-19 pandemic

AimsTo conduct a study on glycemic control improvement by appropriate re-education on the self-injection technique (SIT) in patients with diabetes mellitus undergoing insulin therapy. MethodsPatients who received appropriate SIT and were treated with insulin for more than a year were re-educated. For the observation period of six months, the subjects’ SIT was checked, and hemoglobin A1c (HbA1c) levels were measured at each visit. HbA1c levels, insulin doses, and behavioral changes in SIT were investigated at baseline and at the end of the observation period. ResultsIn the per-protocol set population, the HbA1c level decreased by 0.2 % (2.0 mmol/mol) on average, showing a significant difference (p = 0.009). No significant difference was observed in the proportion of subjects with decreased HbA1c levels, changes in total daily insulin doses, or blood glucose levels. Four of the six SIT items covered by re-education were improved. ConclusionsProviding re-education on insulin SIT was considered effective in reducing HbA1c levels and improving adherence to proper SIT.

A personalized multi-interventional approach focusing on customized nutrition, progressive fitness, and lifestyle modification resulted in the reduction of HbA1c, fasting blood sugar and weight in type 2 diabetes: a retrospective study

BackgroundType 2 diabetes (T2D) is a chronic, progressive lifestyle disease and the most rapidly growing health challenge of the twenty-first century. The American Diabetes Association recommends that T2D reversal can be achieved through an organized, and systematic approach focusing on nutrition, fitness, and lifestyle management.AimThis study aimed to evaluate the effectiveness of a comprehensive and multi-interventional diabetes care program called Sugar. Fit Diabetes Reversal Programme (SDRP) on glycosylated haemoglobin (HbA1c), fasting blood sugar (FBS), and body weight for T2D reversal.MethodologySDRP is a personalized intervention study that uses technology-enabled medical management, dedicated coach-led diabetes, and nutrition experts. The study involved 150 patients living with type 2 diabetes in the age group of 20 to 80 years and having HbA1c of > 6.5%. In SDRP, the participants were assigned personal medical doctors specializing in diabetes, along with health coaches for providing customized nutrition, personalized fitness routines, relevant lifestyle modifications to holistically reverse type 2 diabetes. The HbA1c level, fasting blood sugar, and weight of the participants were measured at baseline and the end of the study (90th day). The effectiveness of SDRP was analyzed by comparing it with a control group that involved 110 individuals with type 2 diabetes managed by conventional pharmacotherapy and regular dietary advice but not participating in the SDRP.ResultsAll 150 participants adhered to the program for 90 days. The analysis was performed on participants and represented as mean ± standard deviation (mean ± SD). At the end of SDRP, a significant reduction in HbA1c level, FBS, and weight was observed as compared to the control group. The results showed that Hba1c levels dropped from 9.0 ± 1.5% to 7.1 ± 1.3% with a mean change of 1.9 ± 1.5%; FBS levels decreased from 178.3 ± 57.1 mg/dL to 116.1 ± 24.2 mg/dL with a mean loss of 62.2 ± 51.8 mg/dL, and the weight decreased from 76.7 ± 12.7 kg to 73.8 ± 11.8 kg with a mean weight loss of 2.8 ± 1.6 kg. The results also showed that participants between 20 to 35 years showed the highest drop in HbA1c, FBS, and weight.ConclusionThe findings indicate that a comprehensive and multi-interventional diabetes care program involving personalized nutrition, fitness, and lifestyle modification such as SDRP, help in significant and sustained improvements in HbA1c level, glycaemic control, and weight loss in adults with type 2 diabetes.

Long-term treatment with roflumilast improves learning of fear extinction memory and anxiety-like response in a type-1 diabetes mellitus animal model

Diabetic encephalopathy is related to serious damage to the Central Nervous System leading to several disturbances in memory processing and emotions. It is known that the cyclic adenosine 3′,5′-monophosphate (cAMP) responsive element-binding protein (CREB) pathway participates in neuronal plasticity and prevention of neuroinflammation, as well as the mediation of learning/memory processes and emotions in brain areas such as the hippocampus (HIP) and prefrontal cortex (PFC). We aimed to investigate the effect of acute (one injection) and long-term treatment (21 days) with roflumilast (ROF; i.p.; 0, 0.01, 0.03, 0.1 mg/kg), a drug able to inhibit the enzyme phosphodiesterase-4 (PDE-4) responsible for cAMP hydrolysis, on parameters related to the acquisition of fear extinction memory and anxiety-like responses in animals with type-1 diabetes mellitus (T1DM) induced through one injection of streptozotocin (60 mg/kg; ip; STZ animals). When we performed acute treatment, no difference was observed between all the groups when resubmitted to the same context paired with an aversive stimulus (footshock) or to a neutral context. In contrast, long-term treatment was able to improve learning of extinction fear memory and discriminating between a conditioned and neutral context. Moreover, this treatment decreased the pronounced anxiety-like response of STZ animals. In addition, there was an increase in the product of the CREB signaling pathway, the pro brain-derived neurotrophic factor, in the HIP and PFC of these animals. The treatment did not impair glycemic control, whereas it decreased the animal’s blood glucose levels. To conclude, these findings suggest that ROF treatment repositioning has potential for future translational investigations involving diabetic patients considering its beneficial effects on emotional processes related to fear memory and anxiety, in addition to improvement of glycemic control.

Long-term effectiveness of advanced hybrid closed loop in children and adolescents with type 1 diabetes.

Advanced hybrid closed loop (AHCL) systems are the newest tool to improve metabolic control in type 1 diabetes (T1D). Long-term glycemic control of children and adolescents with T1D switching to MiniMed™ 780G in a real clinical setting was evaluated. Time in range (TIR) and in different glucose ranges, glycemic variability indexes, HbA1c and basal-bolus insulin distribution were evaluated in 44 subjects (mean age 14.2 ± 4.0 years, 22 males) during manual mode period, first 14 days (A14d) and first month after auto-mode activation (A1M), first 14 days after 3 months (A3M) and 6 months (A6M) in auto-mode. Mean TIR at A14d was 76.3 ± 9.6% versus 69.3 ± 12.6% in manual mode (p < 0.001), and this improvement was maintained over 6 months. Subjects with TIR >70% and >80% in manual mode were 45% and 23%, respectively, and increased to 80% (p=0.041) and 41% (p=0.007) at A14d. Basal-bolus distribution changed in favor of bolus, and auto-correction boluses inversely correlated with TIR. HbA1c was 7.2 ± 0.7% (55 mmol/mol) at baseline and significantly improved after 3 months (6.7 ± 0.5%, 50 mmol/mol, p < 0.001) and 6 months (6.6 ± 0.5%, 49 mmol/mol, p < 0.001). TIR was higher in individuals >13 years at all time periods (p < 0.001). Glycemic target <120 mg/dl was associated with better TIR. AHCL MiniMed™ 780G allowed rapid and sustained improvement of glycemic control in young T1D patients, reaching recommended TIR. Teenagers showed good technology adherence with optimal TIR, maintained better over time compared to younger children. Stricter settings were associated with better metabolic control, without increase in severe hypoglycemia occurrence.

OR03-6 Further Clinical Evaluation of Stem Cell-Derived Islet Replacement Therapy (VC-02) Demonstrates Production of C-Peptide with Improvements in Glycemic Control Parameters in Multiple Patients with Type 1 Diabetes and Hypoglycemia Unawareness

Abstract VC-02 combination product (PEC-Direct) is a clinical-stage regenerative medicine therapy being developed for patients with type 1 diabetes and hypoglycemia unawareness intended to restore homeostatic glycemic control. It is comprised of stem cell-derived pancreatic progenitors (PEC-01) loaded into a macroencapsulation device that facilitates the in-growth of blood vessels into the device lumen, supporting the maturation and differentiation of the graft into hormone-positive islet cells comprising glucose-responsive beta cells. Initial data from one patient (2021, Keymeulen) demonstrated clinically-relevant levels of stimulated C-peptide and corresponding improvements in glycemic control within six months after subcutaneous implantation. These improvements now include a time-in-range consistently &amp;gt;90% and a persistent HbA1C &amp;lt;7%.Enrollment of additional patients with negligible C-peptide levels in the ongoing VC02-101 study implanted with the same device configuration has now resulted in multiple patients demonstrating C-peptide levels ≥0.3 ng/mL. All patients are challenged with a mixed-meal tolerance test at baseline and post-implantation to detect and monitor increases in plasma C-peptide levels. In some cases, the increased C-peptide levels are observed to occur as soon as two months post-implant with subsequent increases resulting as the patients progress further into the treatment period as high as 0.4 ng/mL by five months with additional time points at longer periods of exposure pending. This progressive rise in beta cell function is consistent with preclinical findings showing time-dependent differentiation of the pancreatic progenitors into beta cells and subsequent increases in beta cell mass.The increases in plasma C-peptide levels also correlate with trends toward improved glycemic control parameters. Relative to baseline levels, improvements are observed in time-in-range data captured from continuous glucose monitoring, as well as substantial decreases in HbA1C by as much as 1.5%. These positive trends also correlate with decreases in the amount of exogenous insulin required by as much as 70%. Importantly, these data and observations have been obtained at separate clinical sites involving different surgeons, indicating that the achievement of functional engraftment of PEC-Direct is reproducible with proper product handling, surgical training, and patient compliance with an adjunctive immunosuppression regimen. These data provide further proof-of-concept that continued optimization of PEC-Direct can result in a functional cure for T1D. Presentation: Saturday, June 11, 2022 12:45 p.m. - 1:00 p.m.

Effect of low dose allopurinol on glycemic control and glycemic variability in patients with type 2 diabetes mellitus: A cross-sectional study

BackgroundType 2 diabetes mellitus (DM), gout, and asymptomatic hyperuricemia are inter-connected pathologies. Glycemic control (GC), involving a range of treatments is central to the management of DM, whereas allopurinol continues to be the most widely recommended urate lowering agent. Allopurinol has been shown to possess anti-oxidant properties: this study explores the potential effect of allopurinol on glucose homeostasis. MethodsThis is an observational study with a cross-sectional design performed on patients with type 2 diabetes mellitus (DM), recruited from centers in Saudi Arabia. Patients were divided into two groups; allopurinol users; (for gout or asymptomatic hyperuricemia) and a matching disease control group. Patient demographics, co-morbid conditions, biochemical tests, and pharmacological treatments were extracted from electronic records to investigate the effect of allopurinol therapy on Glycemic control (GC), as assessed by glycated haemoglobin (HbA1c as primary endpoint), and on parameters of glycaemic variability (GV) (secondary endpoints). ResultsA total of 194 patients with type 2 DM were recruited (97 in both groups). The two groups were matched for age, sex, and duration of DM: mean age: 59.4 years, 73% males, and 122 months in the allopurinol group vs 59.6 years, 73% males, and 113 months in the control group. Antidiabetic medications were matched between the two groups. In the allopurinol group, it was prescribed with a daily dose of 100 mg, for 77% of the patients, with median duration of 39.5 months. HbA1c values were; 6.90% (6.20, 7.80) in the allopurinol group vs 7.30% (6.60, 8.40) in the control group (P = 0.010). Parameters of GV were calculated from 3 consecutive fasting blood sugar (FBS) readings: variability independent of the mean (VIM) was 0.140 in the allopurinol group vs 0.987 in the control group (P < 0.001). ConclusionConcomitant low-dose allopurinol therapy in patients with type 2 DM was associated with modest but significant improvements in GC and GV.

PSUN246 Pilot Study: Impact of discharge follow up care at endocrine clinic on glycemic control and re-admission rate in a community hospital

Abstract Introduction The burden of diabetes among hospitalized patients is growing and 30-day readmission rates for those with DM are reported to be 5.9 to 9.2% higher than the rate for all hospitalized patients. We offered follow-up care at a community hospital-based endocrine clinic within 30 days after discharge for those with uncontrolled DM and analyzed its impact on glycemic control and 30 days re-admission rate. Methods This is a single-centered, retrospective study of 29 patients with DM who were hospitalized in our community hospital and were offered a follow-up Endocrine clinic appointment. Results We analyzed a total of 29 discharged patients’ chart with predominantly male (65.51%), T2DM (93%), mean age 58.9±15.7 yrs, BMI 31.35±-9.5 kg/m2, 72.4% on insulin therapy, 79.3% with at least one microvascular complication, and 37.9% with at least once macrovascular complication. A1C 3 8% on admission was observed in 27 patients (93.1%). Although all patients were offered a follow-up appointment, only 23 patients (79.3%) showed up for their follow-up appointments (G1) and 6 patients did not show up (G2).In G1, 4 out of 16 patients (25%) who were on insulin therapy were able to discontinue insulin therapy after endocrine clinic follow-up appointments.In G1, 15 patients (65.21%) achieved A1C &amp;lt; 8% at 3 months. In G1, mean A1C on admission was 11.8 ± 2.8% and improved to 7.7±2.5% whereas mean A1C remained the same for G2. (P= 0.6)The 30 days readmission rate was 21.73% in G1 although reasons for readmission were not directly related to diabetes, whereas no readmission was observed in G2. Conclusion Although our study failed to prove a reduction in 30 days of hospitalization by offering endocrine outpatient care, it has shown improvement in glycemic control. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PSUN200 Effect of carbohydrate counting education in children and adolescents with type I diabetes

Abstract Background The achievement and maintenance of normoglycemia is one of the most important goals to prevent both short and long-term complications in type 1 diabetes mellitus (T1DM). As carbohydrate acts as the primary macronutrient affecting postprandial glycemic response, carbohydrate counting is crucial in adjusting prandial insulin doses to preserve postprandial blood glucose within normal limits. The purpose of this study is to evaluate the effect of carbohydrate counting education in children and adolescents with T1DM. Method: A retrospective chart review of 128 diagnosed T1DM patients who underwent carbohydrate counting education was conducted. All subjects were diagnosed with T1DM before December 2019, and were educated carbohydrate counting before December 2020 in pediatric endocrinology, Severance Children's Hospital, Seoul, Korea. We analyzed the data including clinical characteristics, education on carbohydrate counting, and glycated hemoglobin A1c (HbA1c) levels. Results In 128 T1DM subjects educated, 48 (38%) were male. Their mean age at diagnosis was 8.6 ± 4.0 (years) and mean age at the time of education was 22.6 ± 7.8 (years). Overall, HbA1c levels at 3, 6, and 12 months after education showed a significant decrease compared to the baseline. The mean ±SD(standard deviation) HbA1c level, which was 8.8 ±1.9 (%) at the baseline, decreased to 8.3 ±1.7 at 3 months, 8.3 ±1.7 at 6 months, and 8.3 ±1.7 at 12 months after education. In multivariate linear regression analyses, only the value of baseline HbA1c (P&amp;lt;0.001) as an indicator of DM management was significantly correlated with decrease in HbA1c. Conclusions In our study, carbohydrate counting education seems effective in glycemic control in patients with type 1 diabetes mellitus, but the decrease in HbA1c seems not enough. The effect of education differs according to the degree of glycemic management. For patients with poor management, providing proper education of carbohydrate counting can make improvement in glycemic control. For well-managed patients, more advanced approach beyond traditional education appears to be required. With proper education, better blood glucose control can be expected to reduce complications and improve quality of life in T1DM patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

LBODP037 Acute Foot Drop In An Adolescent With Type 1 Diabetes Mellitus At Onset: A Case Report

Abstract Background The incidence of type 1 diabetes (T1D) among youth is on the rise worldwide. Diabetic neuropathy is often a late manifestation of diabetes and usually results from the exposure to prolonged hyperglycemia, oxidative and inflammatory stress, and dyslipidemia. Here, we report a case of painless diabetic mononeuropathy as the presenting symptom of T1D that improved shortly after the improvement in glycemic control. Clinical case A previously healthy 15-year-old boy, presented to the emergency department (ED) with left foot weakness and dragging for 1 week. This was preceded by numbness over the left lateral leg and dorsum of the left foot. There was no history of trauma. The patient reported a history of polyuria, polydipsia, and significant weight loss for 3 months, for which he did not seek medical care. There was no family history of diabetes, hereditary neuropathy, or autoimmune diseases. Upon presentation to the ED, a general physical examination was unremarkable with a weight of 60 Kg (BMI= 20 Kg/m2), neurological examination revealed weakness in the dorsiflexion of the left foot (3/5), eversion (4/5), and normal sensation and reflexes. The remainder of the neurological examination including the right foot, upper extremities, cerebellar functions, cranial nerves and monofilament and vibration sensory testing was normal. Fundoscopic exam showed no evidence of retinopathy. The initial laboratory investigations revealed mild DKA (PH 7.28, HCO3 16mmol/L, Na 137 mEq/L, random blood glucose of 306 mg/dl, positive blood ketones) and normal kidney function. A nerve conduction study showed moderate left peroneal motor axonal neuropathy, with normal sensory nerve action potentials. Brain CT scan was unremarkable. Further tests to rule out secondary causes of neuropathy (ANA, B12 level, and thyroid function) were within normal. The diagnosis of diabetes-related mononeuropathy was confirmed by the neurology team and the patient underwent physiotherapy. After the resolution of DKA, the patient continued to use basal/bolus insulin therapy and was discharged home with close follow-up of blood glucose readings. His glycemic control has improved, and the patient reported a significant improvement in the foot drop 3 weeks later. A repeated examination by the neurology team 3 months later confirmed a complete recovery of the left foot drop. Conclusion Acute diabetic mononeuropathy can be an unusual presenting feature of T1D and may pose a diagnostic challenge. Although diabetic mononeuropathy is often a late complication of diabetes, our patient presented with acute mononeuropathy at the onset of T1D. This case highlights the importance of early diagnosis and management of diabetes to prevent and sometimes reverse diabetic neuropathy. It also shows that a complete recovery of acute diabetic mononeuropathy can be achieved by improving glycemic control in patients with newly diagnosed T1D. Presentation: No date and time listed

RF34 | PMON263 Study of Testosterone Replacement in Hypogonadal Men With Uncontrolled Type 2 Diabetes – a Randomised Double Blinded Placebo Controlled Trial (STRIDE Study)

Abstract Objective This RCT set out to test the effect of testosterone on glycaemic control, parameters of metabolic control and quality of life(QoL) in a cohort of people with poorly-controlled type 2 diabetes and hypogonadism. Research design and methods: This is a randomised double-blinded placebo-controlled add-on trial of intramuscular testosterone undecanoate (Nebido®) administered every 12 weeks in 65 hypogonadal men with poorly-controlled type 2 diabetes. Phase 1 patients were randomly assigned to either treatment or placebo arm for 6 months of TRT. Phase 2 was an open-labelled phase for 6 months and patients on placebo moved on to the treatment group wherein patients in the treatment group continued. Anthropometric measurements, questionnaires and biochemical parameters were recorded at baseline and every three months for a year. Results Mean age of the cohort was 59±8.98 years(mean±SD). Mean duration since diagnosis of diabetes was 8.6 years. 17(26%) were on insulin. Baseline cohorts were comparable. There was no improvement in mean HbA1c or fasting plasma glucose(FBG) between the active and placebo groups after 6 months of TRT. No difference was found in HbA1c or FBG at 12 months compared to baseline in the active group either. Our study also showed a significant decrease in serum triglycerides (-0.497±0.213mmol/l, p=0.023) and improvement in left hand grip strength (p=0.025) at 6 months post treatment in the active group compared to placebo group. There was no significant difference in the mean weight, BMI, WC, WHR, fat mass, fat percentage or fat free mass between the groups. Our study is the first ever RCT to show a significant improvement in total AMS (aging male symptom) scores from baseline after 6 months of TU treatment compared to placebo group (p&amp;lt;0.05) in a cohort with poorly-controlled type 2 diabetes and hypogonadism. Another key finding from our study substantiating the clinical argument of treatment of patients with hypogonadism in diabetes cohort is that the proportion of patients with severe symptoms moving to a less severe category (low/mild/moderate severity) was 46% in the active vs only 28% in placebo group(p=0.0024). Conclusions Our study concludes that testosterone therapy did not have a significant improvement in glycaemic control at 6 months between the active and placebo groups and at 12 months within the in the active group and may need longer duration to see the positive effects especially in cohort of people who have had long duration of diabetes. There was a significant reduction in triglyceride levels and increase muscular strength after 6 months of TRT. STRIDE study is the first ever RCT to show a significant improvement in clinical symptoms and symptom severity following testosterone treatment in patients with hypogonadism and type 2 diabetes after 6 months of testosterone treatment. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:42 p.m. - 12:47 p.m.

PSUN145 Nursing Perception of Implementation of Continuous Glucose Monitoring Technology in Patients with Hyperglycemia During the COVID-19 Pandemic

Abstract Introduction During the COVID-19 pandemic, the FDA began allowing hospitals to use continuous glucose monitoring (CGM) on a "non-objection" basis in the inpatient setting to decrease direct patient contact and preserve personal protective equipment while increasing the availability of glucose date to inform patient management decisions in April of 2020. Our institution deployed CGM technology (Dexcom ™) in 55 patients across four inpatient hospital units beginning September 2020, with a median use of 6.5 days per patient. Objective To explore perceptions and experience of nursing staff related to the use of CGM technology in patients with hyperglycemia admitted for COVID-19. Methods A qualitative survey was distributed to 29 critical care nurses who routinely utilized CGM technology to obtain and interpret glucose trends impacting clinical decisions for patients during their admission with COVID-19. The survey included eight questions that used a 1 to 5 scale format, where 1 corresponds to "strongly disagree" and 5 corresponds to "strongly agree", and two open-ended questions (advantages and concerns). Results 100% of the respondents "agree" or "strongly agree" that CGM technology is useful in glucose management and prefer when their patient has a CGM. 97% "agree" or "strongly agree" that CGM technology is user-friendly and its use minimized direct patient interaction or contact, thereby reducing utilization of personal protective equipment (PPE). 93% "agree" or "strongly agree" that they feel confident operating a CGM device and consider the CGM data reliable and accurate. 90% "agree" or "strongly agree" that the technical aspects of CGM technology are easy to manage and would like to see this technology offered to patients without COVID. The most significant benefits of CGM as rated by the survey participants include: fewer fingersticks, decreased COVID exposure, convenience, PPE preservation, continuous glucose monitoring, and improved glycemic management. Concerns include: calibration time, accuracy, potential malfunction, extended warm-up period, and protocol education. Discussion This survey demonstrates that CGM technology previously primarily used in the outpatient setting can be easily adapted for inpatient use.Nurses eagerly accepted and competently integrated CGM technology into routine patient care, which, in turn, decreased exposure time in COVID-19 rooms and subsequently decreased PPE use. Proper education related to inpatient use of CGM technology and open communication between the nursing staff, the primary care team, and the endocrine consulting team have been identified as critical elements for a successful deployment and continued utilization.The use of inpatient CGM technology holds promise for improved glycemic control in hospitalized patients while increasing the safety of healthcare workers. Further studies demonstrating decreased exposure times and infection rates among healthcare workers caring patients with COVID-19, and measurable improvements in glycemic control in patients utilizing CGM technology should be explored to further demonstrate the benefits of inpatient CGM use. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

ODP322 Impact of Mifepristone on Liver Function and Resolution of Liver Steatosis in Patients with Cushing Syndrome – A Case Study

Abstract Background Hypercortisolism is a recognized cause of non-alcoholic fatty liver disease (NAFLD). Mifepristone (Korlym®, Corcept Therapeutics), a glucocorticoid receptor (GR) antagonist, is FDA-approved for the treatment of hyperglycemia in patients with endogenous Cushing syndrome (CS). Mifepristone has also shown beneficial effects in preclinical models of fatty liver disease, including reduced liver injury, improved insulin sensitivity, and increased plasma adiponectin concentrations. Here, we report the case of a patient with CS and liver steatosis who was treated intermittently with mifepristone. Clinical Case A 36-year-old woman with CS associated with uncontrolled type 2 diabetes mellitus, obesity, major depressive disorder, hyperlipidemia, hypertension, and liver steatosis was intermittently treated with mifepristone for 3 years. Abdominal imaging was performed several times for abdominal pain. Before treatment with mifepristone was initiated, the patient had a body weight of 198 lbs, BMI of 32kg/m 2, HbA1c of 11.5%, and liver steatosis as noted on abdominal imaging with normal liver function tests (ALT: 40 U/L [normal: 6-42 U/L], AST: 30 U/L [normal: 8-36 U/L]). After 16 months, treatment with mifepristone was discontinued secondary to abnormal uterine bleeding. Imaging performed around the time of discontinuation showed resolution of liver steatosis, which was accompanied by significant reductions in LFTs to levels typically seen in healthy volunteers without liver steatosis (ALT: 10 U/L, AST: 17 U/L). The patient's HbA1c had decreased to 6.8%. Imaging performed 7months after mifepristone discontinuation showed recurrence of liver steatosis, LFTs had returned to pre-treatment values (ALT: 42 U/L, AST: 31U/L), and HbA1c had increased to 9.3%. The patient underwent hysterectomy and restarted mifepristone treatment. One year after resumption of mifepristone, imaging showed that liver steatosis had resolved once again, along with a similar reduction in LFTs as observed before (ALT: 16 U/L, AST: 12 U/L). Fourteen months after restart, mifepristone was discontinued again. Labs and imaging performed 10 months after discontinuation showed, as previously, recurrence of liver steatosis along with elevated LFTs (ALT: 100 U/L, AST: 56 U/L). Data from mifepristone's prospective pivotal study (SEISMIC, NCT00569582) of 50 patients with CS also showed a similar reduction in ALT throughout the study, which was reversed during the 6-week discontinuation follow-up phase of the study. This was followed by a repeat reduction when mifepristone was restarted in the extension study (NCT00936741). Conclusion These results suggest that mifepristone is effective in improving liver function and decreasing liver steatosis in patients with endogenous CS, a trend that is also accompanied by improvement in insulin resistance and glycemic control. Presentation: No date and time listed

Quali target glicemici nelle donne con diabete gestazionale?

For glucose-lowering drugs inducing hypoglycemia, a marginally protective effect on the risk of MACE was observed for HbA1c 48-58 mmol/mol, whereas a significant reduction of microvascular complications was observed for HbA1c&lt;49 mmol/mol, but with higher risk of severe hypoglycaemia. Drugs not inducing hypoglycaemia were associated with a reduction of MACE, renal adverse events, and all-cause mortality, for HbA1c&lt;7% (no data for lower targets). Conclusions: the present paper illustrates the recommendations of the Italian guidelines for the treatment of type 2 diabetes on therapeutic targets for HbA1c. In synthesis, the improvement of glycemic control with drugs not inducing hypoglycemia is associated with a reduction in the risk of long-term chronic vascular and renal complications, and all-cause mortality suggesting an HbA1c target of 53 mmol/mol. When the reduction of HbA1c is achieved with drugs inducing hypoglycemia, a progressive reduction of complications and an increase in the risk of severe hypoglycemia is observed suggesting higher HbA1c thresholds (49-58 mmol/mol).

Improvement in glycaemic control in patients with type 2 diabetes with treatment using an interactive mobile application – A pilot study from India

AimsWe studied the outcome of glycaemic management using Diahome, a smart-phone application compared to conventional treatment. Overall acceptability of the application among users was also assessed. MethodsThis is a retrospective, case-control study of patients on virtual diabetes care using the Diahome app (n = 441) and those visited the hospital out-patient services (n = 446) between April and June 2021. Men and women aged 45–60 years with type 2 diabetes (T2DM) were selected. ResultsA total of 173 records with initial and follow-up visits were analyzed (app users n = 91, non-app users n = 82). Participants were aged 59 ± 12 years and were obese. The two groups were similar by age, gender distribution and duration of T2DM. Fasting blood glucose significantly reduced only among the app-users from a baseline level of 156 ± 70 mg/dl to 129 ± 40 mg/dl at follow-up (p < 0.02). Reduction in HbA1c levels was observed in both groups (p < 0.0001); percentage improvement was better among app (15.8%) than in non-app users (10.4%), p = 0.004. Triglycerides level were higher at both time points among app-users (p < 0.05) as compared to the other group. More than 56% of the users rated the performance of Diahome app as excellent; virtual consultation was rated the highest (71.5%) among the Diahome services. DiscussionGlycaemic management of diabetes using a dedicated mobile application was superior to in-person hospital visits. Its long-term effectiveness and cost savings need to be ascertained.

Use of a bio-electronic device comprising of targeted dual neuromodulation of the hepatic and celiac vagal branches demonstrated enhanced glycemic control in a type 2 diabetic rat model as well as in an Alloxan treated swine model.

There is an unmet need for new type 2 diabetes treatments providing improved efficacy, durability and customized to improve patient's compliance. Bio-electronic neuromodulation of Vagus nerve branches innervating organs that regulate plasma glucose, may be a method for treating type 2 diabetes. The pancreas has been shown to release insulin during Vagus stimulation. The hepatic vagal branch, innervating the liver, has been shown to decrease glucose release and decrease insulin resistance following ligation. However, standalone stimulation of the Vagus nerve has shown mixed results and Vagus nerve ligation has undesirable effects. Little is known; however, of the effect on plasma glucose with combined neuromodulation consisting of stimulation of the celiac branch innervating the pancreas with simultaneous high frequency alternating current (HFAC) blockade of the hepatic branch. This study tested the effects of this approach on increasing glycemic control in rat a model of type 2 diabetes and Alloxan treated swine. Zucker obese (fatty) male rats (ZDF fa/fa) were used as a model of type 2 diabetes as well as glucose intolerant Alloxan treated swine. In ZDF rat experiments glycemic control was accessed with an intravenous glucose tolerance test during HFAC-induced hepatic branch block with concurrent celiac stimulation (HFAC + stimulation). In swine experiments glycemic control was accessed by an oral glucose tolerance test during HFAC + stimulation. Insulin measurements were taken prior to and following swine experiments giving insight into beta cell exhaustion. Histopathology was conducted to determine safety of HFAC + stimulation on Vagal branches. Zucker rats demonstrated a significant improvement to an intravenous glucose tolerance test during HFAC + stimulation compared to sham. There was no significant difference from sham compared to hepatic vagotomy or celiac stimulation. In Alloxan treated swine, when subjected to HFAC + stimulation, there was a significant improvement in glycemic control as measured by an improvement on oral glucose tolerance tests and a decrease in fasting plasma glucose. Insulin responses were similar prior to and following HFAC + stimulation experiments. Histopathology demonstrated healthy swine Vagus nerves. Electrical blockade of the hepatic Vagus branch with simultaneous stimulation of the celiac Vagus branch may be a novel, adjustable and localized approach for a treatment of type 2 diabetes.

An Unexpected Post-ocrelizumab Improvement in Glycaemic Control in a Patient with Multiple Sclerosis

Ocrelizumab, a novel member of disease-modifying therapies for multiple sclerosis (MS), is a humanised monoclonal antibody against the CD20 molecule on the surface of B cells. Reports on possible effects of this molecule in MS therapy have attracted a lot attention since its approval in 2017. The authors present a 31-year-old female patient who was diagnosed with MS in 2008, with a concomitant disease of Type 1 diabetes (T1D). The patient’s MS treatment included interferon-β1a and fingolimod prior to ocrelizumab initiation in 2019. In regard to the patient’s T1D course, they had poor glycaemic control despite regular follow-ups and strict treatment plans. Subsequent to the commencement of ocrelizumab therapy, a significant improvement was observed in their glycaemic control. The authors’ case study aims to raise motivation for further investigation and studies to evaluate this unexpected potential impact of ocrelizumab on T1D control.