Mean A1C Research Articles

Reducing Inequity in the Use of Automated Insulin Delivery Systems by Adults With Type 1 Diabetes: Key Learnings From a Safety Net Diabetes Clinic Program

BackgroundRecent advancements in diabetes technology have significantly improved Type 1 diabetes (T1D) management, but disparities persist, particularly in the adoption of automated insulin delivery (AID) systems within minoritized communities. We aimed to improve patient access to AID system training and overcome clinical inertia to referral. MethodsWe report on a transformative program implemented at Boston Medical Center, the largest safety-net hospital in New England, aimed at reducing disparities in AID system utilization. We employed a multidisciplinary team and quality improvement principles to identify barriers and develop solutions. Strategies included increasing access to diabetes educators, creating a referral system, and developing telemedicine education classes. We also made efforts to raise clinician awareness and confidence in recommending AID therapy. ResultsAt baseline, 13.5% of our clinic T1D population was using an insulin pump. The population referred included 97 people with T1D (49% female, mean A1c 8.7%, 68% public insurance beneficiaries, 25% Hispanic and 25% non-Hispanic Black). Results from the first year showed a 166% increase in AID system use rates, with 64% of referred patients starting on AID. Notably, 78% of patients with A1c >8.5% adopted AID systems, addressing a gap in representation observed in clinical efficacy trials. The initiative successfully narrowed disparities in AID use among minoritized populations. ConclusionsThe program's success among minoritized patients underscores the significance of tailored, collaborative, team-based care and targeted educational initiatives. Our experience provides a foundation for future efforts to ensure equitable access to diabetes technologies, emphasizing the potential of local quality improvement interventions.

Evaluation of Growth-differentiation Factor-15 Level and few Physiological Parameters Patients with Diabetes Mellitus Type 2

The study included 90 subjects and is divided into two groups: The first group is the patient group, which consists of 45 patients with diabetes mellitus type two; 45 patients with diabetes mellitus type two were identified by specialized diabetes doctors by samples collection in outpatients clinic at Diabetes and Endocrine Center in Marjan Medical City in Hilla city, Babylon province from 1 November 2022 till 31 Januray 2023. The blood samples of this study were obtained from patients and controlled through drug 5 mL of blood by using medical sterile syringes from a brachial vein and placed in a gel tube and ethylenediaminetetraacetic acid (EDTA) tube. Then the gel tube was placed at room temperature for 30 minutes to coagulate the blood, and samples were centrifuged (3000 rpm/min) for 5 minutes to separate the serum from other components of the blood. The serum was withdrawn by micropipette and then placed in the eppendorf tubes in two repeaters and kept frozen at -20℃ for the determination of growth differentiation factor 15 (GDF 15), lipid profile and fasting blood glucose. The whole blood in the EDTA tube to determine HbA1C. The mean fasting blood sugar and hemoglobin A1c of diabetes patients is significantly higher at (p-value < 0.001) than that of controls. Diabetes patients had a significantly higher of serum lipid profile than the controls. Therefore, the mean of cholesterol, triglyceride, and low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) was highly significant (p < 0.001). The mean concentration of GDF-15 of patient groups was significantly increased than those matched groups of healthy control at (p < 0.001). In addition, the results also showed a highly significant increase (p < 0.001) in the mean of GDF-15 for the patient’s males and females in comparison with the control’s males and females. The correlation results indicated a statistically significant positive correlation in diabetic group between GDF-15 vs. FBS (r = 0.572, p = < 0.001) and HbA1c (r = 0.576, p = < 0.001). Positive non-significant correlations were demonstrated between GDF-15 vs. cholesterol (r = 0.131, p = > 0.05), triglyceride (TG) (r = 0.167, p = > 0.05), LDL (r = 0.38, p = > 0.05) and VLDL (r = 0.136, p = > 0.05). Negative non-significant correlation was between GDF-15 and high-density lipoprotein (HDL) (r = 0.137, p = > 0.05).

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been demonstrated to decrease cardiovascular adverse events. However, there is little real-world clinical evidence regarding a direct comparison between dapagliflozin and empagliflozin in patients with diabetes mellitus (DM). A difference in the cardiovascular efficancy of dapagliflozin versus empagliflozin in DM patients was anticipated, aiming to guide the optimal choice of SGLT2 inhibitors based on cardiovascular outcomes. From 2014 to 2020, a total of 1549 patients with DM who were prescribed SGLT2 inhibitors such as dapagliflozin or empagliflozin were retrospectively enrolled. We categorized the study population into two groups: dapagliflozin (n = 981) and empagliflozin group (n = 568). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HF) over a 3-year period. Propensity-score matching was performed (537 patients in each group). The mean age and hemoglobin A1c were 58.2 ± 13.0 years and 8.4 ± 1.7%, respectively. There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73-2.35; p = 0.349). Furthermore, there were no differences between the two groups in secondary endpoints including all-cause death, MI, stroke, and hospitalization for HF. Prior MI and history of HF were independent predictors of MACE. Dapagliflozin and empagliflozin showed no significant difference of real-world clinical cardiovascular outcomes in patients with DM over a 3-year period. Further large randomized clinical trials will be warranted for better evaluation.

Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study.

Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.

Prevalence of Non-diabetic Hyperglycemia in Young Adults and Its Impact on Periodontal Health.

Background Non-diabetic hyperglycemia is a transitional phase of hyperglycemia that poses a hidden risk for the development of diabetes mellitus and related complications, including periodontal destruction. The current study sought to determine the prevalence of non-diabetic hyperglycemia in young adults and any possible links to periodontal health. Methods A total of 400 participants in this cross-sectional study were evaluated for non-diabetic hyperglycemia between the ages of 18 and 35 years. Group I consisted of non-diabetic hyperglycemic participants. Group II comprised an equal number of matched, healthy subjects. The groups' hyperglycemic and clinical periodontal characteristics were contrasted. Using a one-sample t-test and logistic regression analysis, the acquired data were subjected to statistical analysis. Results The prevalence of non-diabetic hyperglycemia was 19%, with men (13%) having a higher prevalence than women (6%). The mean fasting plasma glucose and hemoglobin A1c (HbA1c) levels were 114.47 ± 6.40 mg/dL and 6.10 ± 0.21%, respectively, for group I, and 85.72 ± 7.24 mg/dL and 4.38 ± 0.70% for group II. When compared to healthy controls, all periodontal parameters, including plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment loss, were significantly higher in group I non-diabetic hyperglycemic patients. The regression analysis revealed statistically significant links between hyperglycemic and periodontal parameters. Conclusion The prevalence of non-diabetic hyperglycemia among young adults is a serious concern similar to that of older adults with the risk for periodontal diseases. Non-diabetic hyperglycemic considerations in young adults should be emphasized in dental and medical clinics to reduce the risk of developing diabetes mellitus and to avoid irreversible periodontal tissue damage.

Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study

IntroductionMaternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes.Research design and methodsThis paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration.ResultsThe quantitative results found that women achieved “at target” glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery.ConclusionsThe achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women’s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.

Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes.

Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in kidney transplant patients with diabetes. To investigate the safety and efficacy of SGLT2i use on stability of renal function in adult kidney transplant recipients (KTR) with type 2 diabetes mellitus (DM2) or New Onset Diabetes After Transplantation (NODAT). We performed a single center, retrospective cohort study pre- and post-SGLT2i exposure. Adults with DM2 or NODAT who received a living or deceased kidney transplant (Tx) and started on an SGLT2i post-Tx were reviewed. Patients who had type 1 diabetes were excluded. The baseline was the SGLT2i start date. We reviewed available data from 24 months (M) before and after SGLT2i initiation. The primary endpoints were the effects of SGLT2i use on stability of renal function using serum creatinine and eGFR, change in urine albumin excretion(uACR), and glycosylated hemoglobin (A1C). Secondary endpoints compared blood pressure, body mass index and adverse reactions at baseline and quarterly after SGLT2i initiation. 125 KTRs were included in cohort: NODAT (52, 42%), DM2 (73, 58%); female (33, 27%); mean age at Tx 55 years (25-75); LD (56, 45%), DD (69, 55%); mean duration of Tx (6.8 years, 0.1-42.5); study follow-up (1.8 years, 0.3-4.9).The mean eGFR remained stable pre-SGLT2i at 64.6 mL/min/1.73m2, vs post at 64.3 mL/min/1.73m2. There was no difference in mean A1C after SGLT2i initiation. The slope of uACR using natural log transformation pre-SGLT2i compared with post-SGLT2i slope reduced from +0.7 (0.03, 0.11) to -0.04 (-0.01, -0.35) mg/mmol/3mths (P = .002). The risk of developing new genital mycotic infections among all patients was 4% (95% CI 1.3%-9.1%) While there was no significant difference in UTI before (13.6%) and after (12%) SGLT2i use (P = .68), there was a higher risk of UTI seen in patients with a previous history of UTI (23.5%) vs no previous history (10.2%) post initiation. There was no significant increase in AKI pre 8%, post 10.4%, P = .51. There was a single DKA event pre- and post-SGLT2. The limitations of this study include its retrospective nonrandomized nature. In this retrospective analysis, SGLT2i use in KTR appears to be safe and efficacious with stable renal function and glycemic control, alongside improvements in uACR. There was a low risk of new genital yeast infections after SGLT2i start. UTI occurrence was higher in patients with a previous history of UTI compared with those with no previous history.

Development of a Continuous Glucose Monitoring Service by Clinical Pharmacists in a Medically Underserved Population.

Background: Continuous glucose monitoring (CGM) is an evolving technology that provides a wealth of information to aid in managing diabetes. Professional CGM (ProCGM) is recommended when personal CGM is not desired or available. Patients in medically underserved areas may have limited access to personal CGM devices, thus ProCGM devices can be used for short-term monitoring and medication adjustment. Clinical pharmacists are well-positioned to help set up and establish personal and professional CGM management services. Objectives: To determine the effect of ProCGM in patients with persistently uncontrolled type 2 diabetes in a medically underserved population (MUP). Methods: Pre-post intervention analysis of a single cohort of patients in a public health center. Patients with persistently uncontrolled (A1c > 9%) and taking at least one daily dose of insulin were included. Included participants wore a ProCGM sensor and met with the clinical pharmacist at least once for ProCGM data interpretation and education. The primary analysis evaluated patients who achieved an A1c <9% 1-6 months after intervention. The change in A1c was also evaluated. Participants completed a pre- and post-survey about their experience. Results: Twenty-two patients were included in the final analysis. Ten patients achieved an A1c <9% (45%). The mean A1c pre- and post-ProCGM was 11.0% and 9.8% respectively, with a decrease of -1.2% (p=0.055) overall and a decrease of -1.7% for patients who wore the sensor for at least 10 days (p=0.012; n=15). Using the CGM data 91% of participants had a change to their medication regimen and 45% achieved an A1c <9%. Six participants experienced hypoglycemia per the CGM report, but only two were aware of it. After reviewing their glucose report with the pharmacist, 95% of the respondents agreed or strongly agreed to feeling more knowledgeable about blood sugar patterns after reviewing the report with a pharmacist. Conclusion: Almost half of the patients in the study achieved an A1c <9%. This study demonstrated glycemic benefit in patients in a MUP who wore a ProCGM for at least 10 days and met with a clinical pharmacist. Data from ProCGM enabled patients to better understand glucose patterns in those with persistently uncontrolled type 2 diabetes.

1982. GLP-1 Receptor Agonists Promote Weight Loss Among People with HIV

Abstract Background Weight gain and associated metabolic complications are increasingly prevalent among people with HIV (PWH), especially those initiating second-generation integrase strand transfer inhibitors (INSTIs). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are incretin-based therapies for diabetes that have been shown to result in substantial weight loss; however, studies of their efficacy in PWH are limited. We aimed to describe the prescribing practices and clinical outcomes of GLP-1 RA use among PWH. Methods We conducted a retrospective cohort study among PWH who were prescribed GLP-1 RAs at University of California, San Diego between 2/1/2021and 2/1/2023. Patients who were prescribed but never took GLP-1 RAs or those for whom weight data were not available after GLP-1 RA initiation were excluded. We collected baseline clinical data and calculated changes in weight, body mass index (BMI), and hemoglobin A1C (A1C) before and during receipt of GLP-1 RA. We conducted logistic regression to identify variables associated with more than 5% of total body weight loss. Results 227 patients met our inclusion criteria. Baseline characteristics are shown in Table 1. Ninety-nine patients (43%) were prescribed GLP-1 RAs for weight management alone without concurrent diabetes. Patients had received on average 15.2 months of GLP-1 RA therapy, with 92 (40.5%) achieving the maximum GLP-1 RA dose. On average, GLP-1 RA therapy resulted in a loss of 12 pounds, decrease in BMI by 1.8, and decrease in A1C by 0.5 among all patients and by 1.2 among patients with an A1C &amp;gt; 6.5 at baseline. In the multivariable analysis, higher baseline BMI [OR 1.07 (1.02-1.3)] and longer treatment duration of GLP-1 RA therapy [OR 1.04 (1.01-1.07)] were significantly more likely to be associated with &amp;gt;5% weight loss, whereas receipt of dulaglutide significantly decreased the likelihood of &amp;gt;5% weight loss compared to other GLP-1 RAs [OR 0.33 (0.17-0.66)]. Age, sex assigned at birth, race, ethnicity, ART regimen, baseline CD4 cell count, HIV viral load, and presence of diabetes were not predictive of weight change.Table 1.Baseline Patient Characteristics (N = 227)Table 2.Mean weight, BMI, and A1C before and during GLP-1 RA therapy for PWH Conclusion Use of GLP-1 RAs led to improvements in weight, BMI, and hemoglobin A1C among PWH and offers an additional strategy to address weight gain and related metabolic complications. Disclosures All Authors: No reported disclosures

SAT105 Frequent Monitoring Of Blood Glucose Levels Via A Remote Patient Monitoring System Helps Improve Glycemic Control

Abstract Disclosure: I. Sachmechi: None. M. Amini: None. S. Salam: None. R. Khan: None. A. Spitznogle: None. T. Belen: None. Objective: This study aims to evaluate the effectiveness of the Vivovitals telehealth platform on improving glycemic control and reducing A1C in patients with uncontrolled type II diabetes mellitus by providing more accessible and frequent patient care under the monitoring by their physician. Methods: This 12-week, prospective, pragmatic, single-center, double-arm study assessed the impact of the Vivovitals diabetes platform on glycemic control among 78 adults ≥ 18 years of age, with A1C ≥ 7.5% (58 mmol/mol) at baseline. The participants were randomized into two groups. The control group received standard care, while the intervention group was assisted to install the application on their smartphones and connect it to a Bluetooth Glucometer, and access to an online data portal. Blood glucose measurements were transmitted to the provider daily. Patients were contacted twice weekly regardless of their blood sugar measurements and additional call was made if blood glucose levels were &amp;lt;70 mg/dL or &amp;gt;180 mg/dL and modifications were made to diet and medication. The control group was allowed to call the provider if they have questions regarding their blood sugar levels or their medications. The two groups were compared at baseline and 12 weeks using nonparametric tests with p&amp;lt;0.05 considered statistically significant. Results: The mean A1C in the intervention group (n=39) was 9.53 (81 mmol/mol) +1.68 at baseline. Post-trial, mean A1C decreased to 7.99 (64 mmol/mol) + 1.40 (p &amp;lt; 0.001). In comparison, the mean A1C in the control group (n=39) was 9.63 (64 mmol/mol) + 1.47 at baseline with little change in post-trial mean A1C averaging 9.16 (77 mmol/mol) + 1.51 (p = 0.87). Discussion: In this study, patients who utilized the Vivovitals platform saw a significant decrease in A1C at an average of 1.56% compared to the non-significant 0.47% A1C reduction in the control group participants. We believe the A1C-reducing effect in the intervention group was due to the more frequent interactions with the physician and subsequent medication adjustments based on the data provided. The Vivovitals platform allows an affordable closer monitoring of blood glucose levels, identification of the direction of glycemic trends, and earlier intervention. While not explored in this study, it is reasonable to believe that the use of the Vivovitals diabetes platform could reduce Emergency Department visits and inpatient hospitalizations for hypoglycemia or hyperglycemia as the clinician can intervene before a patient becomes symptomatic. Conclusion: We conclude that the Vivovitals platform may help to reduce A1C in adults with uncontrolled type 2 diabetes mellitus in conjunction with lifestyle modifications and anti-diabetic medications. Presentation: Saturday, June 17, 2023

THU281 Real-World Survey Of Adherence To Guidelines Regarding Type 1 Diabetes And Aerobic Exercise

Abstract Disclosure: J.A. Henske: None. G. Beach: None. A. Albashaireh: None. Background: Managing hyperglycemia and hypoglycemia before, during, and after aerobic exercise remains one of the greatest challenges for those living with type 1 diabetes. Several publications offer guidelines and recommendations but it is not well established to what extent these are followed by those living with diabetes. In order to assess the implementation and awareness of these guidelines and in particular guidelines around risk of hypoglycemia and safety recommendations, we created an online survey which was posted to focused social media groups limited to adults with type 1 diabetes who run, jog, or walk for exercise. Results: The entire 96-question survey was completed by 102 adults with a mean age of 42 and a mean duration of diabetes of 20 years. The self-reported average HbA1c of respondents was 7.1%. 68% of respondents reported exercise 4 or more days per week. Average mileage was 23 miles per week. The respondents were predominantly female (69%), Caucasian (94%), and from the United States (78%). There was a high rate of technology use as 97% of respondents report using CGM and 75% are using insulin pumps. 80% reported learning about diabetes and exercise mostly from trial and error, 46% from social media, 32% from their medical team, 28% from online searches, some using multiple methods. 27% of respondents reported fear of hypoglycemia as a significant barrier to exercise and 36% reported increased glucose variability as a result of exercise. 19% of respondents reported having hypoglycemia unawareness. 3% reported never having symptoms of hypoglycemia at any glucose level, 21% feel first symptoms with BG &amp;lt;50mg/dL, 26% at 50-60 mg/dL, and 40% at 60-70mg/dL. Despite published guidelines, 73% reported that they exercise even if severe hypoglycemia &amp;lt;50mg/dL in the last 24 hours, 74% do not check for ketones even if unexplained hyperglycemia &amp;gt;250mg/dL prior to exercise. 11% reported exercising with ketones present in blood or urine. 10% reported developing DKA after exercise. 86% experienced the need to stop exercise due to hypoglycemia and 18% reported a severe hypoglycemic event during exercise. 49% report not wearing diabetes identification during exercise. 41% reported difficulty with overnight hypoglycemia after exercise. Conclusion: In a real-world survey of 102 individuals with relatively well-controlled type 1 diabetes (mean A1c 7.1%) who walk, run, or jog extensively for exercise (23 miles per week), hypoglycemia awareness and management is a significant concern and barrier for them. Implementation science efforts and increased awareness of current guidelines and development of an educational curriculum surrounding type 1 diabetes and exercise may prove helpful to improve outcomes. Presentation: Thursday, June 15, 2023

SAT082 Utility Of A MODY Probability Calculator As A Systemwide Surveillance Tool

Abstract Disclosure: D. Awad: None. S. Kunwar: None. C.V. Desouza: None. Introduction: Maturity-onset diabetes of the young (MODY) is often misdiagnosed as type 1 or type 2 diabetes and is estimated to occur between 1-3% of all cases of diabetes. This leads to unnecessary treatments. There are no systemwide surveillance tools to identify these patients.Methods: This is a single center, cross sectional probable prevalence study of MODY in University of Nebraska medical center (UNMC). The medical records for all outpatients seen at UNMC within the past 5 years with the diagnosis of type 2 DM were reviewed. We included those with a diagnosis of type 2 DM who were &amp;lt;35 years old at the time of diagnosis, had A1C of &amp;lt; 7.6% and had a body mass index (BMI) &amp;lt; 30. We identified a total of 129 patients. 61 were excluded as they did not meet criteria. On the 68 remaining patients, the risk of MODY was calculated using the MODY probability calculator, which was developed by Exeter university. The calculator has the following variables: Age at diagnosis, current age, A1C, BMI, current diabetes treatment, time to insulin treatment, family history of diabetes, ethnicity, other associated features like renal cysts, deafness, lipodystrophy or other syndromic features. Results: Of the 68 included patients, 48% were females and 52% were males. Mean A1C was 6.3%, mean age at diagnosis was 28, mean BMI was 27. Thirty-four had at least one parent with diabetes. 54 were on diabetes treatment (17 on insulin and 37 on oral hypoglycemic agents). On the MODY calculator, 10 patients had a probability score of 75.5%, 3 had a score of 62.4%, 2 had a score of 58%, 3 had a score of 49%, and 3 had a score of 45.5%. The rest had a low probability score. The primary care physicians were informed of these results. The next step is to see how many of the primary care physicians utilize this information to screen patients. Conclusion: The MODY probability calculator is a good systemwide surveillance tool to identify patients with possible MODY and thereby inform providers taking care of those patients, which may result in management changes. Presentation: Saturday, June 17, 2023

THU315 Sleep And Circadian Regulation, And Intrinsically Photosensitive Retinal Ganglion Cells Function In Diabetic Retinopathy

Abstract Disclosure: S. Reutrakul: None. J.J. McAnany: None. J.C. Park: None. F.Y. Chau: None. K.K. Danielson: None. P. Bharati: None. S. Pannain: None. E. Van Cauter: None. E.C. Hanlon: None. Background: Diabetic retinopathy (DR) is associated with a dysfunction of intrinsically photosensitive retinal ganglion cells (ipRGCs), a crucial component of the entrainment of the circadian system and of the photic entrainment of melatonin secretion. We explored ipRGC function, sleep, 24-h melatonin and cortisol profiles in patients with and without DR. Methods: Type 2 diabetes patients with DR (n=10) and without DR (n=7,) participated. ipRGC function was inferred from the post illumination pupil response (PIPR). Sleep was assessed by 14-day actigraphy. Serum was sampled at hourly intervals for 24hrs for melatonin and cortisol measurement. Results: Mean (SD) age (53.8 (8.1) vs (54.0 (8.6) yr) and mean A1C (7.5 (1.7) vs. 7.1 (0.9)%) did not differ between DR and no-DR patients. PIPR was significantly smaller in DR than no-DR patients (0.14 (0.16) vs. 0.33 (0.10), p=0.001). Nightly sleep duration and efficiency were similar, but sleep variability (standard deviation of daily sleep duration over 7 nights) tended to be larger in DR than no-DR patients (84.1 (29.8) vs. 59.5 (21.8) minutes), p=0.08. Twenty four-hour serum melatonin output was significantly lower in DR than no-DR patients (103.1 (95.4) pg/ml vs. 231.1 (131.3) pg/ml, p=0.034). All no-DR patients exhibited the classical 24-h profile of melatonin with consistently low levels during the day time and a clear nocturnal rise peaking around the middle of the night. In contrast, a normal melatonin rhythm was observed only in 3 of the 10 patients with DR. Six DR patients had 24-h mean melatonin level under 3 pg/ml, five without any evident day-night pattern. One DR patient had a shift in melatonin timing. There was a significant correlation between PIPR and 24-h melatonin output, r= 0.726, p&amp;lt;0.001, but not with sleep variability. In contrast, mean 24-h cortisol profiles and levels, however, were not significantly different between the two groups (mean levels DR 6.18 (1.23) vs no-DR 6.18 (0.73) μg/dL), Conclusion: DR is associated with ipRCGs dysfunction, irregular sleep, and with major disruptions of the 24-hour melatonin rhythm while cortisol rhythm was maintained, suggesting circadian dysfunction in those with type 2 diabetes and retinopathy. Whether melatonin supplementation is beneficial in type 2 diabetes with DR should be explored. Presentation: Thursday, June 15, 2023

FRI648 GLP-1RA And SGLT2i Treatments May Show Improved Depression Metrics In Diabetes Treatment

Abstract Disclosure: A. Jain: None. L. Esper: None. J. Powell: None. K. Meyer: None. S. Sen: None. Background: Depression is a widespread condition that develops due to a multitude of etiologies. Type 2 Diabetes (T2DM) is associated with several comorbidities, including depression. A class of T2DM medication, Glucagon-Like-peptide-1 receptor agonists (GLP1RA), acts on the hypothalamus, pancreas, and other systems to reduce weight and control blood sugar. GLP1RAs may play a positive role in improving depression by improving satiety and acting on brain centers responsible for anxiety and depression. We hypothesized that patients on GLP1RA would have lower depression scores than those on insulin/metformin standard regimen, or on SGLT2 inhibitors ( which serves as an active comparator) due to localized effects of SGLT2i in the renal cortex. This research will add to ongoing studies in our lab that examine different classes of diabetes medication in treating patients with increased cardiovascular or renal risk, with the goal of increasing the specificity by which endocrinologists prescribe particular classes of glycemic control medications. Methods: We conducted a retrospective observational chart analysis at the Washington DC VA Medical Center and compared the PHQ-9 scores of 50 T2DM patients selected at random over 6 weeks maintaining a consistent diabetes care regimen for 6 months. We observed n=9 GLP1RA, n=7 SGLT2i, and n=31 control subject records. 3 subjects on both medications were excluded from this analysis. We noted the PHQ-9 scores of subjects on active psychotropics, but those were not excluded from the study at this time. Results: Our cohort had a mean age of 61.8±12.5 years and mean A1C of 8.04±2.13%. These factors were evenly distributed between analysis groups. Our analysis showed that T2DM subjects on GLP1RA had PHQ-9 scores of 5.00±1.51. This wasn’t significantly lower than the control cohort (6.21±1.22, p=0.53), or SGLT2i cohort (3.85±1.24, p=0.57). Conclusion: Our preliminary analysis in a real-life clinical setting shows a trend indicating subjects on neither GLP1RA nor SGLT2i have higher depression scores than those on either one. However, we plan to continue reviewing records to see if this trend or differences between classes is significant. With a larger sample size, we also plan to include correlations between depression scores and efficacy of treatment. Continuing this research, particularly in a VAMC cohort at higher risk of depression, may provide insight into clinical decision making in T2DM patients with history or high risk for depression and related disorders. Presentation: Friday, June 16, 2023

Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017.

Glycated hemoglobin is an adjunct tool in early pregnancy to assess glycemic control. We examined trends and maternal predictors for those who had A1c screening in early pregnancy using hospital discharge and vital registry data between 2009 and 2017 linked with the New York City A1C Registry (N = 798,312). First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017. The likelihood of screening became less targeted to high-risk patients over time, with a decrease in mean A1c values from 5.8% (95% confidence interval [CI]: 5.8, 5.9) to 5.3 (95% CI: 5.3, 5.4). The prevalence of gestational diabetes mellitus increased while testing became less discriminate for those with high-risk factors, including pregestational type 2 diabetes, chronic hypertension, obesity, age over 40 years, as well as Asian or Black non-Hispanic race/ethnicity. KEY POINTS: · First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017 in New York City.. · The likelihood of screening became less targeted to high-risk patients over time.. · The prevalence of gestational diabetes mellitus increased, while testing became less discriminate..

Enhancing Self-Management Skills of Patients With Existing Diabetic Foot Ulcerations: A Quality Improvement Project.

The purpose of this quality improvement initiative was to determine the impact of a nurse-administered foot care intervention bundle (NA-FCIB) upon self-management knowledge, skills, and outcomes in patients with diabetic foot ulcerations. The sample comprised 39 patients being treated for diabetic foot ulceration at a wound care clinic in a tertiary care hospital in Arlington, Virginia. The project was conducted from August 2017 to February 2018. This quality improvement project used the Johns Hopkins Plan-Do-Study-Act Method supplemented by self-regulation theory for diabetic patient education and evidence in clinical literature. The 12-week-long intervention included one-on-one teaching in the prevention of ulcerations and optimal care of the diabetic foot, blood glucose level tracking logs, patient "teach-back" and skills demonstration, and free foot care tools. From baseline to post-NA-FCIB, the number of participants knowing the reasons for temperature foot protection increased by 92%, those knowing major factors leading to diabetic foot ulceration by 85%, those knowing what to look for in the foot self-exam by 85%, and those able to demonstrate correct foot self-exam by 84%. The number of participants understanding proper footwear increased by 74%, and those identifying ways to avoid/decrease the likelihood of diabetic foot ulcers by 72%. Mean serum hemoglobin A1c (HgbA1c) levels decreased from baseline to postintervention (8.27%; SD 2.05% vs 7.46%; SD 1.58%; P = .002). The NA-FCIB intervention was successfully incorporated into routine clinic care as the standard of care. Our experience suggests that the NA-FCIB may be feasible and effective for use at comparable wound care clinics and may have secondary benefits for HgbA1c regulation.

A retrospective comparison between intensive and nonintensive insulin regimens in type 2 diabetes mellitus.

This study compared the outcomes between intensive and nonintensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type-2-diabetes-mellitus (T2DM) patients requiring insulin therapy. A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and nonintensive insulin therapy (79 patients) were conducted. No significant differences were found when the intensive and nonintensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the nonintensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively. Both intensive and nonintensive insulin therapies improved the baseline glycemic parameters but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.

Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes.

Objective: To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). Research Design and Methods: A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An "index date" was identified as the start of CGM. The closest hemoglobin A1c (A1c) 6 months or more after the index date was identified as the "follow-up date." The primary outcome of this study was to compare the percentage of individuals meeting the MN Community Measure (MNCM) D5 HbA1c goal of <8% at the follow-up date versus the index date. Results: Seventy-two patients were identified after the exclusion criteria were applied. Approximately one-third of patients required utilization of an interpreter and 76% of patients were of a racial or ethnic minority. The mean HbA1c prior to CGM use was 9.8%, with 16.7% of the population meeting the MNCM D5 A1c goal of <8%. At the follow-up date, the mean A1c was 8.4% (mean difference -1.4%; p < 0.001), with 41.7% of the population meeting goal (mean difference +25%; p < 0.001). Subgroup analyses affirm that the results of the primary outcome were sustained despite insulin use status. Conclusion: A diverse population with T2D had a significant reduction in A1c and was more likely to meet the MNCM D5 A1c goal of <8% after an average of 6 months using personal CGM.

Diabetes Mellitus in the Elderly Adults in Korea: Based on Data from the Korea National Health and Nutrition Examination Survey 2019 to 2020.

We evaluated the prevalence and management of diabetes mellitus (DM) in elderly Korean patients based on data from the Korea National Health and Nutrition Examination Survey (KNHANES). A total of 3,068 adults aged 65 years and older (19.8% of total population) were analyzed using KNHANES from 2019 to 2020. Prevalence, awareness, treatment, and control rates, and comorbidities were analyzed. Lifestyle behaviors and energy intake were also measured. The prevalence of DM and prediabetes was 29.6% and 50.5%, respectively. The awareness, treatment and control rates were 76.4%, 73.3%, and 28.3%, respectively. The control rate was 77.0% if A1C <7.5% criteria was used. The mean A1C value of individuals with known DM was 7.1%, and 14.5% of the known DM patients had A1C ≥8.0%. Abdominal obesity, hypertension, and hypercholesterolemia were combined with DM in 63.9%, 71.7%, and 70.7%, respectively, and the rate of integrated management was 36.0% (A1C <7.5% criteria). A total of 40.1% of those with DM walked regularly. The percentage of energy intake from carbohydrates was higher in those with DM than in those without DM (P=0.044), while those of fat (P=0.003) and protein (P=0.025) were lower in those with DM than in those without DM in women. In 2019 to 2020, three of 10 adults aged 65 years and older in Korea had DM, and approximately 70% of them had comorbidities. A strategy for more individualized comprehensive care for the elderly patients with DM is urgently needed.

Racial and Ethnic Differences in the Association Between Mean Glucose and Hemoglobin A1c.

Background: Studies have reported significantly higher hemoglobin A1c (A1C) in African American patients than in White patients with the same mean glucose, but less is known about other racial/ethnic groups. We evaluated racial/ethnic differences in the association between mean glucose, based on continuous glucose monitor (CGM) data, and A1C. Methods: Retrospective study among 1788 patients with diabetes from Kaiser Permanente Northern California (KPNC) who used CGM devices during 2016 to 2021. In this study population, there were 5264 A1C results; mean glucose was calculated from 124,388,901 CGM readings captured during the 90 days before each A1C result. Hierarchical mixed models were specified to estimate racial/ethnic differences in the association between mean glucose and A1C. Results: Mean A1C was 0.33 (95% confidence interval: 0.23-0.44; P < 0.0001) percentage points higher among African American patients relative to White patients for a given mean glucose. A1C results for Asians, Latinos, and multiethnic patients were not significantly different from those of White patients. The slope of the association between mean glucose and A1C did not differ significantly across racial/ethnic groups. Variance for the association between mean glucose and A1C was substantially greater within groups than between racial/ethnic groups (65% vs. 9%, respectively). Conclusions: For African American patients, A1C results may overestimate glycemia and could lead to premature diabetes diagnoses, overtreatment, or invalid assessments of health disparities. However, most of the variability in the mean glucose-A1C association was within racial/ethnic groups. Treatment decisions driven by guideline-based A1C targets should be individualized and supported by direct measurement of glycemia.