Improvement In Glycemic Control Research Articles

The Effects of Adding Semaglutide to High Daily Dose Insulin Regimens in Patients With Type 2 Diabetes.

Escalating doses of insulin required with progression of type 2 diabetes may lead to weight gain. Weight loss associated with semaglutide may be beneficial. However, data on the use of semaglutide in patients requiring high daily doses of insulin are currently lacking. The purpose of this project was to evaluate the impact of semaglutide on total daily dose (TDD) of insulin when initiated in patients with type 2 diabetes mellitus (T2DM) on high daily doses of insulin. Secondary objectives assessed included changes in weight, body mass index (BMI), blood pressure, heart rate, and diabetes and blood pressure medications. This IRB exempt retrospective medical record review included patients with T2DM prescribed semaglutide and at least 100 units TDD of insulin between January 1, 2019, and December 31, 2019. Of the 72 patients included, the TDD of insulin decreased from baseline to 6 months (183 ± 98 units and 143 ± 99 units, P < 0.001). Average A1c and body weight also decreased from baseline to 6 months (8.9% ± 1.3% and 7.6% ± 1.5%, P < 0.001 and 123.9 ± 23.5 kg and 118.9 ± 22.9 kg, P < 0.001, respectively). Limitations included a homogenous patient population and inability to control confounding factors. Improvement in glycemic control occurred despite reductions in TDD of insulin. Improvements in A1c and body weight were clinically significant. This analysis adds to existing literature supporting the use of GLP-1 RAs in patients on high daily doses of insulin.

Impact of decreased physical activity due to COVID restrictions on cardio-metabolic risk parameters in Indian children and youth with type 1 diabetes

Background and aimsImplementation of COVID restrictions following lockdown led to changes in routines of subjects with type 1 diabetes due to closure of schools and outdoor activities. The aim of this study was to assess the impact of decreased physical activity due to COVID restrictions on cardio-metabolic risk parameters (waist circumference, laboratory and body composition parameters) in Indian children and youth with T1D. MethodsThis observational study included 312 participants (2–21 years) with T1DM having disease duration of ≥6 months. Demographic, anthropometric, body composition data and investigations were recorded at two time points (during COVID restrictions when children came for follow up, pre COVID restriction data from medical and electronic records). ResultsGlycemic control improved during COVID restrictions (Hba1c: 9.8 ± 2.0%) as compared to pre COVID restrictions (Hba1C: 10.0 ± 1.9%) (p < 0.05). However, due to significant reduction in physical activity (p < 0.05) there was significant increase in waist circumference z-scores (−0.9 ± 1.1 vs −1.6 ± 1.1), body fat percentage z-scores (−0.2 ± 1.0 vs −0.3 ± 0.9) and lipid parameters like cholesterol, low density lipid cholesterol and triglyceride concentrations (p < 0.05) without any significant change in body mass index z-scores (p > 0.05). ConclusionsProlonged COVID restrictions, although led to modest improvement in glycemic control, there was worsening of cardio-metabolic risk factors or indices of adiposity like waist circumference, body fat percentage and lipid parameters which could be attributed to decreased time spent in physical activity.

EFFECT OF STRICT GLYCEMIC CONTROL ON PERIODONTITIS IN NON INSULIN DEPENDENT PATIENTS: A QUASI EXPERIMENTAL STUDY

Objectives: To evaluate the eff ect of strict glycemic control on pocket depth (PD), bleeding on probing (BOP), fasting blood sugar (FBS), C reactive protein (CRP), and HbA1c.Methods and materials: This quasi-experimental design study was conducted from March to September 2021 taking 32 cases (A) and equal controls (B) with non-insulin uncontrolled diabetes (HbA1c more than 8, whereas the eff ect of strict glycemic control on clinical periodontitis was carried out. Pocket Depth (PD), bleeding on probing (BOP), fasting blood sugar (FBS), C reactive protein (CRP), and HbA1c levels were assessed before and after the intervention.Results: Most of the variables HbA1c (p=0.03), CRP (p=0.007), PD (p=0.006), and BOP (p=0.023) showed improvement showing a better glycemic control in the post-intervention stage; particularly for patients recruited in Group A. HbA1c levels at 3 months post-intervention showed significant reduction (p=0.03) to 8.1 ± 1.7 in Group A in comparison to 9.9 ± 2.3 in the pre-intervention stage with a mean difference of -1.8 showing improvement in the glycemic control. PD (mm) for Group A was reduced from 2.4 ± 0.5 mm to 2.2 ± 0.5. Whereas the PD ≥ 4mm (%) also showed a signifi cant reduction from 27.9 ± 28.4 in the pre-intervention to 19.4 ± 27.0 in the post-intervention stage for Group A. Group B also showed reduction but this was more prominent in group A. Bleeding on Probing (%) in group A was also signifi cantly reduced from 29.4 ± 21.4 in pre-intervention stage to 23.1 ± 23.2 in the post-intervention stage.Conclusion: The present study concludes that strict glycemic control (group A) has a role in clinically correcting/improving periodontitis in non-insulin dependent diabetic patients. It can be further concluded that periodontal treatment has a role in the improvement of glycemic control in type 2 diabetic patients at 3 months.

Glucose-lowering drug use, glycemic outcomes, and severe hypoglycemia: 18-Year trends in 0·9 million adults with Diabetes in Hong Kong (2002–2019)

SummaryBackgroundImprovements in glycemic outcomes have stalled since 2010 in several international surveys. We previously reported improvements in glycemic control in 2007-2014 in Hong Kong coinciding with primary care reforms, use of dipeptidyl-peptidase 4 inhibitors (DPP-4is) and metformin. The aim of this study was to estimate more recent trends in drug use and glycemic outcomes following introduction of newer classes of glucose-lowering drugs (GLDs).MethodsUsing population-based data from the Hong Kong Diabetes Surveillance Database, we explored age-specific trends in proportion of patients reaching glycemic targets and incidence rates of severe hypoglycemia (SH) in 963,612 adults with diabetes in 2002-2019. We further assessed patterns of GLDs utilisation by presence of atherosclerotic-cardiovascular disease (ASCVD), heart failure, and estimated-glomerular filtration rate (eGFR).FindingsFollowing rapid decline in HbA1c from 7·7% to 7·2% in 2005-2014 (annual percentage change [APC]= -0·8, 95% CI:-1·0,-0·6), standardized mean HbA1c plateaued since 2014 (HbA1c 7·2% in 2019, APC=0·0, 95% CI:-0·2, 0·2). The incidence rates of SH declined from 3·4 to 0·7 events per 100-person years, but improvements levelled off since 2014. Use of metformin steadily increased (41·1 to 58·7%), sulfonylureas decreased (52·2 to 31·1%) while insulin remained static in 2002-2019. Adoption of DPP-4is slowed following initial rapid uptake in 2007-2011. DPP-4is remained the most widely prescribed newer GLD in all ages (14·3% in 2019). Use of glucagon-like-peptide 1 receptor agonists (GLP1-RAs) and sodium glucose co-transporter-2 inhibitors (SGLT2is) increased rapidly in 2015-2019 with 0·5% and 6% of users respectively in 2019.InterpretationFollowing rapid improvement in 2007-2014, glycemic control and SH rates had plateaued despite changing patterns of newer GLDs use in Hong Kong.FundingDr. Aimin Yang was supported by a CUHK Impact Research Fellowship Scheme.

537-P: Timing of Moderate-to-Vigorous Physical Activity Is Associated with Improvements in Glycemic Control in Type 2 Diabetes in the Look AHEAD Study

Background: We examined the association of time-of-day bout-related moderate-to-vigorous physical activity (bMVPA) with changes in glycemic measures and use of antidiabetic medications in adults with type 2 diabetes. Methods: Look AHEAD participants were randomly assigned to a lifestyle intervention or a control group, in which the most intensive intervention occurred in Year 1. Among 1755 participants (age, mean ± SD 60 ± 7 years; 57% women) with 7-day waist-worn accelerometry data at Year 1, we grouped them by the timing of bMVPA (≥3 METs in ≥min bouts) : ≥50% of bMVPA during the same time period (Morning, Midday, Afternoon, or Evening; N=191-258) , &amp;lt;50% of bMVPA in any time period (Mixed; N=379) , and ≤1 day with bMVPA per week (Inactive; N=485) . Analyses were adjusted for covariates including socio-demographic factors, randomization arm, and clinics; then further adjusted for weekly bMVPA volume and intensity. Findings: Timing of bMVPA was associated with changes in HbA1c across Year 1 (P=0.01) , independent of weekly bMVPA volume and intensity. Participants in the afternoon group as compared to the inactive group had a greater HbA1c reduction (mean: -0.16%; 95%CI: -0.33% to 0%) . Among non-insulin users the odds of discontinuation vs. maintaining or initiating antidiabetic medications across Year 1 trended to differ between the bMVPA timing groups (P=0.09) , with the afternoon group having the highest odds of discontinuation (OR vs. inactive group: 1.86; 1.14 to 3.02) . Interpretation: Timing of bMVPA may be linked with improvements in glycemic control in adults with type 2 diabetes. While regular physical activity remains to be the cornerstone for blood glucose management in diabetes, our findings suggested that exercise interventions aimed to increase glycemic control in patients with diabetes can be enhanced by engaging in physical activity at specific times of the day. Experimental protocols are needed to test the causality. Disclosure J.Qian: None. R.Middelbeek: Research Support; Novo Nordisk. Q.Xiao: None. M.P.Walkup: None. M.Coday: None. M.Erickson: None. J.L.Unick: None. J.M.Jakicic: Advisory Panel; Spark360, Wondr Health, WW International, Inc. K.Hu: None. F.A.Scheer: None. Funding National Institutes of Health (K99HL148500, DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992, R01HL140574, RF1AG059867, RF1AG064312)

31-LB: Improvements in Glycemic Control following Use of an Established mHealth Program among Individuals with Diabetes

Background: The prevalence of diabetes continues to rise worldwide. mHealth programs with 24/7 app access and frequent interaction with remote providers ease the learning, practice, application, and daily integration of self-care skills and health improvement behaviors for people diagnosed with diabetes, especially those at high risk for cardiometabolic and mental health complications. This study aimed to evaluate the effectiveness of an established mHealth program on measures of glycemic control in a population at high risk for the development of diabetes-related complications (hemoglobin A1c (HbA1c) ≥ 8.0%) . Methods: This study protocol employed a single-arm, retrospective design. Participants were offered the app-based Vida Health Diabetes Management program as part of their medical insurance benefit. This intervention utilized one-to-one remote sessions with Registered Dietitians and Certified Diabetes Care and Education Specialists as well as structured lessons and tools related to diabetes management. Participants were included if they had a valid laboratory HbA1c completed between 365 to 21-days of enrollment and a follow-up laboratory HbA1c value within 90 to 365-days following enrollment. Two-tailed paired t-tests were used to evaluate changes in HbA1c between baseline and follow-up. Results: Participants with HbA1c ≥ 8.0% at baseline (n=1023) demonstrated a decrease in HbA1c of -1.37 points between baseline (mean: 9.84, SD: 1.64) and follow-up (mean: 8.47, SD: 1.77, p&amp;lt;0.001) . Additionally, we observed a decrease in HbA1c of -1.94 points between baseline (mean: 10.77, SD: 1.48) and follow-up (mean: 8.83, SD: 1.94, p&amp;lt;0.001) among participants with HbA1c ≥ 9.0% (n = 618) . Conclusion: This study demonstrated clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Digital Diabetes Management Program. Future work should aim to identify mechanisms of this, and other mHealth interventions, most associated with glycemic control. Disclosure G. Zimmermann: Employee; Vida Health. A. Venkatesan: Employee; Vida Health. K. Rawlings: Employee; Vida Health. R. S. Frank: Employee; Vida Health. C. Edwards: Employee; Vida Health. Funding Vida Health

338-OR: Tirzepatide Reduces Appetite, Energy Intake, and Fat Mass in People with T2D

Tirzepatide (TZP) , a dual GIP and GLP-1 receptor agonist (RA) has shown superior improvement in glycemic control and body weight than selective GLP-1 RA. Rodent models indicate that GIP RA augments GLP-1 RA induced food intake suppression and causes body weight loss, mainly by reducing fat mass. This randomized, double-blind, parallel study compared the effects of TZP 15 mg (N=45) , semaglutide (SEMA) 1 mg (N=44) and placebo (PBO) (N=28) on energy intake (assessed by an ad libitum lunch) , appetite (visual analog scale [VAS] ratings of hunger, satiety, prospective food consumption [PFC], and fullness) and body composition (air displacement plethysmography) at baseline and at 28 weeks of treatment. At 28 weeks, reductions in body weight from baseline were observed with TZP 15 mg (-11.2 kg) and SEMA 1 mg (-6.9 kg) , and significantly differed between treatment groups (-4.3 kg [95% confidence interval [CI]: -6.8, -1.9]; p&amp;lt;0.001) . Reductions in fat mass from baseline were also observed with TZP 15 mg (-9.7 kg) and SEMA 1 mg (-5.9 kg) , and significantly differed between treatment groups (-3.8 kg [95% CI: -6.2, -1.4]; p=0.002) . Energy intake reductions from baseline observed with TZP 15 mg (-348.4 kcal) and SEMA 1 mg (-284.1 kcal) did not differ between treatment groups (-64.3 kcal [95% CI: -160.3, 31.7]; p=0.187) . TZP reduced overall appetite by increasing satiety with decreased PFC (all p&amp;lt;0.05) . Appetite ratings did not differ between TZP and SEMA. In conclusion, TZP achieved greater weight loss than selective GLP-1 RA, mostly driven by fat mass loss. Significant and clinically meaningful reductions in appetite and energy intake were observed with both TZP and selective GLP-1 RA. However, these effects could not totally explain the additional weight loss with TZP. As appetite and energy intake reduction were not significantly different between treatments; additional mechanisms might contribute to the weight loss with TZP. Ongoing studies will further elucidate the mechanism of weight loss with TZP. Disclosure T.Heise: Advisory Panel; Novo Nordisk A/S, Research Support; ADOCIA, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Crinetics Pharmaceuticals, Inc., Eli Lilly and Company, Gan &amp; Lee Pharmaceuticals, Genova, Nestlé, Neuraly Inc., Novo Nordisk A/S, Sanofi, Zealand Pharma A/S, Speaker's Bureau; Eli Lilly and Company, Gan &amp; Lee Pharmaceuticals, Novo Nordisk A/S. A.Haupt: Employee; Lilly, Stock/Shareholder; Lilly. Z.Milicevic: Employee; Eli Lilly and Company. J.De vries: Advisory Panel; ADOCIA, Novo Nordisk A/S, Zealand Pharma A/S, Speaker's Bureau; Novo Nordisk A/S. T.Coskun: Employee; Eli Lilly and Company. S.Urva: Employee; Eli Lilly and Company. J.Li: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. E.J.Pratt: Employee; Eli Lilly and Company. M.K.Thomas: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. K.J.Mather: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J.P.Dunn: Employee; Eli Lilly and Company, Eli Lilly and Company. Funding Eli Lilly and Company

49-LB: Use of Financial Incentives to Promote Adolescent Type 1 Diabetes Self-Management—A Pilot Randomized Controlled Trial

Background: Providing individuals with immediate, consistent inducements for health behaviors that do not provide proximal tangible benefits may promote adherence to diabetes self-management behaviors. Objective: To evaluate whether financial incentives lead to improvement in glycemic control and self-management behaviors in adolescents with type 1 diabetes. Methods: We conducted a randomized controlled crossover study with 12-18 year olds with type 1 diabetes. Adolescents self-selected target self-management behaviors (e.g., increase continuous glucose monitor [CGM] sensor wear time) and outcome goals (e.g., improve time in range [TIR]) and could earn up to $180 in each 3-month intervention cycle. Adolescents cycled through 3 study arms every 3 months: gain-framed payment where adolescents earned money for meeting behavioral goals, loss-framed payment where adolescents lost a portion of a weekly payment for not meeting behavioral goals, and usual care. Adolescents earned or lost $1.75 per day in the financial incentives arms, and a $2.75 weekly bonus for meeting their outcome-based goal. Goals were modeled against study arms with generalized linear mixed models to account for the longitudinal nature of the crossover design. Results: Out of 39 participants (mean age 16.1 years, 54% male, mean baseline HbA1c 9.42%, 38% insulin pump use, 95% CGM use) , 34 completed the trial. Mean HbA1c aggregated over all interventions was lower compared to baseline at 9.07% (p=0.13) and there was no difference in HbA1c among the 3 arms. Compared to the mean TIR for those under usual care of 39%, mean TIR under gain- and loss-frames were 45% (p&amp;lt;0.01) and 43% (p&amp;lt;0.01) , respectively. Compared to a mean 41% behavioral goal attainment within usual care, mean behavioral goal attainment under gain- and loss-frames were 50% (p&amp;lt;0.01) and 45% (p&amp;lt;0.01) , respectively. Conclusions: Financial incentives can improve adolescent self-management behaviors and time in range in the short term and merits further longitudinal study to evaluate the effects on glycemic control and health care utilization. Disclosure F. Malik: n/a. T. Chen: None. M. Manzueta: None. J. Yi-frazier: None. C. Pihoker: None. J. L. Leblanc: None. S. K. Shah: None. D. Wright: None. Funding American Diabetes Association (1-18-ICTS-100)

THE EFFECT OF DAPAGLIFLOZIN ON THE LEVEL OF SYSTOLIC BLOOD PRESSURE AND GLYCEMIC CONTROL IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES

Objective: to determine the influence of dapagliflozin (D) on the level of blood pressure (BP) in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). Design and method: A total of 57 patients with AH, stage II and concomitant non-severe T2DM were examined (fasting plasma glucose &lt; 9 mmol/L, glycosylated hemoglobin (HbA1c) - 7.45 ± 1.3%, mean age 52.4 ± 2.8, mean BP 162/102 ± 3.5/2.3 mm Hg, BMI 28.3 ± 2.7 kg/m2, disease duration 6.6 ± 1.7 years,). Patients were divided into 2 groups: the comparison group included 23 patients who received metformin 850 mg 2/day, lisinopril 10 mg 1/day and amlodipine 10 mg 1/day. Patients of the main group (D-group, n = 34), received dapagliflozin 10 mg in addition to standard therapy. Results: 6 months after beginning of therapy, the following results were obtained: HbA1C in the D-group was 6.28 ± 0.6%, in the comparison group – 6.56 ± 0.48% (p &lt; 0.05). A slight decrease of BMI was observed in both groups (26.3 ± 1.2 kg/m2 and 27.4 ± 1.3 kg/m2, respectively), however, the changes were insignificant. Systolic blood pressure (SBP) in the D-group was 132 ± 7.24 mm Hg., and in the comparison group - 145.5 ± 9.17 mm Hg., (p &lt; 0.05). The diastolic blood pressure (DBP) was 83.5 ± 3.8 mm Hg and 89,6 ± 4.2 mm Hg, respectively. Conclusions: the obtained data demonstrate that adding of dapagliflozin to a standard therapy of hypertension and concomitant type 2 diabetes leads both to significant decrease of SBP and improvement of glycemic control. The outcomes of our research suggest that dapagliflozin has a potential to reduce cardiovascular risk in hypertensive patients with type 2 diabetes.

1016-P: Equitable Glycemic Improvement in Youth with T1D during COVID-19

Aim: Despite disruptions caused by the COVID-pandemic, prior studies suggest some improvements in glycemic control. We investigated whether this improvement was equitable and seen across socioeconomic status (SES) groups in youth with T1D. Method: Using EHR-extracted visit and CGM data, we geocoded patient addresses linked with census-tract derived education from the 20American Community Survey and a composite measure of SES, the Neighborhood Deprivation Index (NDI) . Analyses included youth ≤18 years old using CGM with T1D duration ≥6 months (age &amp;lt;6 yrs) or ≥1 yr (age ≥6 yrs) . We performed t-tests and regressions comparing SES and CGM metrics during the pandemic (4/1/20-3/15/21) with pre-pandemic (4/1/19-3/15/20) . Results: The pre-pandemic sample had 641 youth (52% female, age 12.5±3.5, T1D 6.2±3.5 yrs) and the pandemic sample had 650 youth (52% female, age 13.5±3.6, T1D 6.8±3.8 yrs) ; 86% were common to both samples. Addresses allowed for geocoding of 98%; 44% of youth lived in low education census tracts where ≥30% of adults in the census tract had no more than a high school education. Mean CGM-derived glucose management indicator (GMI) improved during the pandemic for both those living in lower (8.07±0.05% pre vs. 7.91±0.% during, p&amp;lt;0.05) and higher SES education tracts (7.82±0.% pre vs. 7.69±0.% during) . There was similar improvement in GMI in lower vs. higher SES education tracts (0.16±.vs. 0.13±.06) . Other CGM metrics similarly improved during the pandemic, mean CGM glucose decreased by 6.7 mg/dL and 5.4 mg/dL in low and high SES education tract patients respectively (both p&amp;lt;.05) . Those living in the most deprived NDI areas had the highest GMI both pre and during the pandemic (p&amp;lt;0.05) and demonstrated similar or greater improvements than those from Iess deprived areas. Conclusion: Equitable improvements in CGM metrics during the pandemic was evident in youth with T1D. Future studies can assess how changes in healthcare delivery during the pandemic can reduce disparities and sustain benefits to all patients. Disclosure S.Ojukwu: None. A.Adam: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. C.Chen: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (K12DK094721, P30DK036836)

703-P: Significant Weight Reduction and Improvement in Glycemic Control among People with T2D after Participation in Diabefly Digital Therapeutics Program

Background: Digital therapeutics platforms provide accessible and multidisciplinary care for the management of T2D. The current study explored the effectiveness of the Diabefly program for improving glycemic control in people with T2D. Methods: Diabefly program provides a combination of mobile application, remote lifestyle coaching, live video consultations by experts (psychologist, physiotherapist and nutritionist) , and digital logging of parameters. The outcome of the study was to evaluate the change in HbA1c, fasting blood sugar (FBS) , postprandial blood sugar (PPBS) , weight, and body mass index (BMI) at the beginning and end of the program. All the outcomes were evaluated using paired t-test with P&amp;lt;0.considered as significant. Results: A significant mean reduction in HbA1c levels by 1.69 ± 1.91% from a baseline of 8.66 ± 2.05% was observed (P&amp;lt;0.001) . Among all the participants, 93.02% (160/172) showed a reduction in their HbA1c, out of which 56.25% (90/160) showed a HbA1c reduction of more than 1%. Similarly, weight and BMI were also significantly reduced by 2.59 ± 3.31 kg and 0.92 ± 1.15 kg/m2 from a baseline of 75.94 ± 16.24 kg and 27.49 ± 4.71 kg/m2 respectively (P&amp;lt;0.0for both) . Among all the participants, 70.34% (121/172) reduced their weight, out of which 32.23% (39/121) showed a weight reduction of at least 5 kg. Among participants (n=42) with complete FBS and PPBS data, a significant mean reduction by 51.44 ± 58.87 mg/dL and 90.90 ± 78.96 mg/dL from a baseline of 164.87 ± 63.83 mg/dL and 227.95 ± 82.34 mg/dL was observed respectively (P&amp;lt;0.0for both) . Conclusion: Effective glycemic control and significant weight reduction was achieved at the end of the program. Thus, Diabefly program can help in providing continuous support to implement lifestyle changes between quarterly doctor visits and greater usage of a remote lifestyle coaching can be a useful adjunct to doctor’s prescription for holistic management of diabetes. Disclosure R. Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. M.A. Khader: Employee; Fitterfly HealthTech Pvt Ltd. T. Lathia: Advisory Panel; Abbott, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Novartis Pharmaceuticals Corporation, Novo Nordisk, Sanofi. S. Guntur: Employee; Fitterfly Health Tech Pvt. Ltd. A.K. Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd.

Mean platelet volume and glycaemic control in patients with new-onset Type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with vascular complications that are attributable to dysregulated platelet reactivity as measured by mean platelet volume (MPV). This study aimed at determining a relationship between MPV and glycaemic control in new-onset T2DM. This was a prospective study conducted on 236 new-onset T2DM patients divided in two groups as group A, glycosylated haemoglobin A1c (HbA1c < 7.9%; n = 70) and group B, HbA1c ⩾ 8% (n = 107) who were followed up for 6 months for change in platelet and glycaemic parameters. At 6-month follow-up, there was a significant decrease in HbA1c and MPV (group A (HbA1c: 7.40 ± 0.40 vs 7.03 ± 0.23%, p < 0.03; MPV: 9.65 fl ± 0.74 vs 9.46 fl ± 0.71, p < 0.001) and group B (HbA1c: 10.59 ± 1.89% vs 9.29 ± 1.50%, p < 0.001; MPV: 10.89 fL ± 1.29 vs. 10.23 fL ± 1.40, p< 0.001)). The percentage decline in HbA1c was more in group B (11.81 ± 5.87 vs 4.76 ± 4.58, p < 0.01). There was a positive correlation between ΔMPV and ΔHbA1c in group B; however, we did not observe significant correlation for group A. We interpret that in people with diabetes with baseline HbA1c ⩾ 8%, with improvement in glycaemic control, there is a significant decrease in MPV. We propose that a routine MPV testing can be used as a potential marker for glycaemic control in T2DM.

968-P: Improvement in Glycaemic Control and Cost of Diabetes Care Using Diahome, a Smartphone Application

Digital healthcare is on the rise. Paucity of clinical data exists on the efficiency and effectiveness of the applications in diabetes management. We compared glycaemic outcomes at 4 months among type 2 diabetes (T2DM) patients opting virtual care using Diahome® app and in-person hospital visits. Data of 173 (91 app-users, 82 non app-users) were analysed. The two groups were similar by age, gender distribution and duration of T2DM. At follow-up, fasting plasma glucose significantly reduced among app-users alone (156 ± 70 vs.129 ± 40 mg/dl, p&amp;lt;0.02) . There was a significant change in HbA1c in both groups; improvement was better among app than non-app users (15.8% vs.10.4% p=0.004) . The app was overall acceptable. Cost of treatment per visit reduced ($57 vs. $112) . Diahome® app was superior to hospital visits for routine diabetes care. Disclosure A.Raghavan: None. A.Nanditha: None. K.Satheesh: None. P.Susairaj: None. R.Vinitha: None. D.Nair: None. S.Jeyaraj: None. V.Sharad: None. A.Ramachandran: None.

574-P: Meta-analysis Shows Mind- and Body-Based Interventions Improve Glycemic Control in Patients with Type 2 Diabetes

Only 57% of type 2 diabetes (T2D) patients achieve HbA1c &amp;lt;7%. Mind and body practices (MBP) are increasingly used to improve glycemic control inT2D, but individual studies show inconsistent efficacy. We performed a meta-analysis of MBP to assess their overall effect to improve glycemia in patients with T2D. We identified 489 articles with 25 having required HbA1c or fasting glucose measures and meeting other inclusion criteria. Interventions included yoga (n=16) , meditation (n=2) , Qigong (n=2) , guided imagery (n=1) , and mindfulness-based stress reduction (n=4) . We used restricted maximum likelihood random effects modeling to combine individual study results and estimate weighted means and 95% confidence intervals. Heterogeneity was assessed Cochran's Q and I2, bias assessed by funnel plots, and potential sources of heterogeneity assessed using meta regression. Overall, there was a statistically significant and clinically relevant mean reduction in HbA1C (‑0.94%; 95% CI: (-1.23%, -0.65%) ; p=5.4x10-10) . We observed a similar significant mean reduction in fasting glucose (-22.4 mg/dl; 95% CI: (-33.4, -11.6 mg/dl) ; p=5.4x10-5) . Funnel plots revealed no evidence for bias. Significant heterogeneity was observed (Q=71.2; p=2.3x10-9) , which could not be accounted for by variation in duration of the individual interventions (p=0.32) . We conclude MBP results in clinically significant improvement in glycemic control and may be an effective tool to treat patients with T2D. Disclosure F.Sanogo: None. K.Xu: None. V.K.Cortessis: None. M.Weigensberg: None. R.M.Watanabe: None.

652-P: Gaps Remain in Achieving Target T1D Glycemic Goals Despite Advanced Technologies

Continuous glucose monitoring (CGM) metrics and self-reported disease characteristics (severe hypoglycemic events [SHEs], HbA1c) warrant further description in people with T1D using CGM and pumps, including hybrid closed-loop systems (HCLS) . We conducted a one-time online survey of adults with T1D in the T1D Exchange Registry or online communities, where ∼50% of participants contributed up to 1 year of CGM data. Patients were asked about their medical history (SHEs, HbA1c) , while glucose management indicator (GMI) , prolonged hypoglycemic events (&amp;lt;54 mg/dL) , time in and below range (TIR/TBR) , and coefficient of variation (CV) were derived from CGM data. Patients who completed the survey and contributed CGM data (N=926) had a mean age of 42 y and T1D duration of 25 y; 73% were female; 96% were white; 94% had ≥1 year of CGM use. Mean HbA1c was 6.6% (69.0% had HbA1c &amp;lt;7%) . While most patients met consensus glycemic targets (HbA1c, GMI, TIR, TBR, and CV) , with higher proportions observed in those using HCLS pumps than in those using pump + CGM (not HCLS) and MDI + CGM (Table) , patients continued to have significant hypoglycemia based on CGM data and an average of 1.1 SHEs in the prior year. Despite improvements in glycemic control (TIR, TBR, and self-reported HbA1c) with advanced technologies, many patients still cannot achieve clinical targets and experience significant hypoglycemia, highlighting the unmet need for novel T1D treatments. Disclosure L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. K.S.M.Chapman: None. D.Finan: None. R.M.Bergenstal: Advisory Panel; Hygieia, Medtronic, Roche Diabetes Care, Zealand Pharma A/S, Consultant; Abbott Diabetes, Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur SA, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Onduo LLC, Sanofi, United HealthCare Services, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk, Sanofi. J.Liu: None. L.Titievsky: Employee; Intercept Pharmaceuticals, Inc., Pfizer Inc., Vertex Pharmaceuticals Incorporated, Stock/Shareholder; Intercept Pharmaceuticals, Inc., Pfizer Inc., Vertex Pharmaceuticals Incorporated. K.Hagan: Employee; Vertex Pharmaceuticals Incorporated. T.Liu: Employee; Takeda Pharmaceutical Company Limited, Vertex Pharmaceuticals Incorporated, Stock/Shareholder; Seattle Genetics, Inc. K.Chandarana: Employee; Vertex Pharmaceuticals Incorporated. J.L.Gaglia: Advisory Panel; Dompé, Regeneron Pharmaceuticals Inc., Consultant; Vertex Pharmaceuticals Incorporated, Research Support; Avotres Inc., Dompé, Janssen Research &amp; Development, LLC, Provention Bio, Inc., Stock/Shareholder; Vertex Pharmaceuticals Incorporated. W.Wolf: None. J.Bispham: Employee; PPD Inc., T1D Exchange.

82-LB: Improvement of Glycemic Control in People with Type 2 Diabetes Using Basal Insulin (PwT2D-BI) and Continuous Glucose Monitoring (CGM) —U.S. Study Using Machine Learning (ML)

Background: CGM provide real-time glucose data that allows users to manage their diabetes holistically. This study aimed to assess the association between glycemic control and CGM use in PwT2D-BI. Methods: This retrospective study used IBM MarketScan® 2015 - 2019 Databases to identify PwT2D-BI with (CGM) and without (control) use of CGM. CGM users were followed from first BI until CGM initiation, defined as index date (ID) . The ID of non-CGM controls were randomly assigned based on time between first BI and ID of CGM. . Comparison CGM use for 6 and 12 months were performed using Frequentist Model Averaging (FMA) in a ML framework adjusting for baseline characteristics. Model strategies were applied including matching, weighting, stratification and regression. Results: A total of 5,934 PwT2D-BI (251 CGM; 5,683 control) were included in the study (Table 1) . Observed A1c reduction from baseline to 12 months was 0.87%, 0.95% for 6 and 12 months of CGM use, respectively vs. 0.32% for controls. FMA analyses found CGM users had a statistically significantly greater reduction in A1c both at 6 months (treatment difference 0.30 [0.13,0.48]) and 12 months (0.50 [0.37, 0.72]) . Conclusion: Findings suggest that CGM use for at least 6 months in PwT2D-BI has clinical benefit as demonstrated by A1c reduction in the real-world setting. Disclosure C. Chinthammit: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A. J. M. Brnabic: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Perez-nieves: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

661-P: Use of a Sequential Continuous Glucose Monitoring with or without Exercise Tracker on Glycaemic Control in Middle-Aged Patients with Diabetes Mellitus

This study examined if a sequential continuous glucose monitoring (CGM) program using a Freestyle Libre would improve glycaemic control with or without an exercise tracker among middle-aged (50 to 65 years) patients with type 2 diabetes. We randomized 94 subjects (mean 57±4 years and HbA1c 10.1±1.6%) into a group wearing CGM alone (CGM-alone, n=52) and another group wearing CGM and an exercise tracker (CGM-Fit, n=42) . We measured HbA1c at pre-randomization, at 4 months and 6 months from randomization. All subjects wore the CGM every 2 weekly sequentially for the first 6 weeks and received diabetes counselling and professional dietary advice based on the CGM profile. Diabetes treatment was adjusted by the diabetes educator as appropriately. Those in the CGM-Fit group received a Fitbit watch with app-based guidance on an exercise regime. At baseline (pre-randomization) , there was no between-group difference in the HbA1c levels. At 4-month post-randomization, the HbA1c improved by 1.6±1.5% in CGM-alone (p&amp;lt;0.05) and 1.9±1.7% in CGM-Fit group (p&amp;lt;0.05) . Compared to baseline, at 6-month post-randomization, the HbA1c improved by 0.8±1.7% in CGM-alone (p&amp;lt;0.05) and 1.6±1.6% in CGM-Fit group (p&amp;lt;0.05) group) . Between the 4-month and 6-month post-randomization, the HbA1c had increased by 0.8±1.1% in CGM-alone (P &amp;lt;0.05) but only 0.2±0.8% in CGM-fit group (P &amp;gt;0.05) . Overall, 42.4% of subjects had an increase and 39.4% a decrease in diabetes medication when reviewed by the diabetes nurse educator. In summary, the use of sequential CGM (for 6 weeks) with DM counselling and dietary advice improved HbA1c significantly by a mean of 1.7%. However, this does not appear sustainable at 6 months of follow up. The use of an exercise tracker might be helpful to sustain the improvement in glycaemic control. The use of CGM can guide management in titrating diabetes medication to improve glycaemia. Disclosure C.Khoo: None. K.Htike: None. Y.Dan: None. Funding NUHS AHS Mission Fund

Comparative effectiveness of Glargine 300 U/mL vs. Degludec 100 U/mL in patients with type 2 diabetes switching from 1° generation basal insulins

Background and aimsData on second generation basal insulin (2BI) in people with type 2 diabetes (T2D) generated by clinical trials still need confirmation in real-world clinical settings. This study aimed at assessing the comparative effectiveness of 2BI [Glargine 300 U/mL (Gla-300) vs. Degludec 100 U/mL (Deg-100)] in T2D Italian patients switching from first generation basal insulins (1BI). Methods and resultsThis was a retrospective, non-inferiority, multicenter study. Patients switching to Gla-300 or Deg-100 from 1BI were 1:1 propensity score matched (PSM). Changes during 6 months in continuous endpoints were assessed through linear mixed models. Incidence rates (IR) of hypoglycemia (episodes per patient-months) were compared using Poisson regression.Each PSM cohort included 593 patients. HbA1c decreased from baseline (8.7%) to 6 months by −0.58% (95%CI -0.69;-0.47) in Gla-300 group and −0.50% (95%CI -0.61;-0.39) in Deg-100 group, confirming the non-inferiority of Gla-300 vs. Deg-100. No between-group differences emerged: FBG was reduced by about 20 mg/dl with both 2BI, mean dose of 2BI (24.5 U, 0.3 U/Kg at the first prescription) was suboptimally titrated during 6 months (+1.34 U in Gla-300 and + 1.76 U in Deg-100), body weight showed minor changes.IR of hypoglycemia <54 mg/dl was 0.32 (95%CI 0.21; 0.49) in Gla-300 group and 0.19 (95%CI 0.11; 0.33) in Deg-100 group (p = 0.14). ConclusionIn subjects with T2D, switching to 2BI from 1BI was associated with similar improvements in glycemic control, low hypoglycemia rates and no weight gain in real-life setting. Clinical inertia, represented by late treatment intensification and suboptimal titration, represents a major issue in Italy.

767-P: Changes in Ambulatory Glucose Profile (AGP) in Patients with Type 1 Diabetes Mellitus after Switching from Sensor-Augmented Insulin Pump Therapy to a Do-it-Yourself Artificial Pancreas System: A Retrospective Data Analysis of Real-World Data

Background: Many patients with type 1 diabetes mellitus are switching from sensor-augmented insulin pump therapy to an artificial pancreas system for various reasons. Since there are no suitable approved Automated Insulin Delivery -AID system in Austria, open-source systems are increasingly being used. The question arises, how does glycemic control change after switching? Methods: This monocentric retrospective data analysis from 20to 2021 will compare sensor-augmented pump therapy with the open-source AID system using AGP profiles from 25 patients with type 1 diabetes mellitus. The AGP are generated from sensor data 4 weeks with pump therapy AGP1 and 4 weeks with open-source AID system AGP2. AGP is generated with Dexcom application. Results: Comparing AGP1 and 2 shows a significant reduction of mean glucose from 143mg/dl to 125mg/dl and glucose variability from 50mg/dl to 40mg/dl. The time in target range can be increased from 74% to 84% without changing the time in hypoglycemia. Time in hyperglycemia above 180 and 250 mg/dl and GMI decreased significantly. Conclusion: Open-source AID system can achieve an improvement in glycemic control. In this data analysis, the open-source AID systems can be considered safe due to the lack of increase in hypoglycemia. Disclosure M. Mueller-Korbsch: Research Support; Dexcom, Inc.

75-LB: Use of Continuous Glucose Monitoring (CGM) and Its Association with Economic Outcomes in the Real-World Setting

Background: CGM is increasingly used as tool in the management of diabetes, supporting improvements in glycemic control and quality of life. Objectives: The aim of this retrospective study was to evaluate the association between CGM use and healthcare resource utilization (HCRU) and cost. Methods: Using medical claims from Clarivate™ Real-World Evidence repository and CGM data from Glooko®, US people with diabetes (≥18 years) (PwD) and on insulin were assigned to mutually exclusive cohorts based on CGM usage status and matched in terms of age, gender, and diabetes type. First CGM use (index) was required to occur within January 1, 2015 - July 30, 2019. HCRU and costs were assessed 12 months post-index. Results: After matching, 3,918 PwD were assigned into each cohort. Significantly more CGM vs. non CGM users (p&amp;lt;0.0001) were on insulin pump, treated with bolus insulin only, and commercially insured. Mean pre-index Charlson Comorbidity Index (CCI) scores were lower (p&amp;lt;0.00001) and most diabetes-related comorbidities were less prevalent (p&amp;lt;0.01) in the CGM vs. non-CGM cohort. After adjusting for demographics, diabetes type, CCI, and insurance, the use of CGM vs. no CGM was associated with a 27-70% and 32-76% reduction in HCRU and costs (p&amp;lt;0.0001) , respectively. Conclusion: The use of CGM (vs. no CGM use) was associated with lower HCRU and costs, which may result in lower healthcare burden for PwD and payers. Disclosure M. Perez-nieves: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. E. R. Hankosky: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. L. Fan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. F. Gelsey: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. E. L. Eby: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. T. J. Sims: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. E. Umeh: None. R. Juneja: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company