Prescribed Diabetes Medications Research Articles

Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients With and Without Substance Use Disorders.

Individuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs. To compare rates of undiagnosed hypertension and diabetes among patients with and without an SUD. Cross-sectional analysis using electronic health record (EHR) data from 58 primary care clinics at a large, urban, healthcare system in New York. Patients who had at least two primary care visits from 2019-2022 were included in our patient sample. Patients without an ICD-10 hypertension diagnosis or prescribed hypertension medications and with at least two blood pressure (BP) readings ≥ 140/90mm were labeled 'undiagnosed hypertension,' and patients without a diabetes diagnosis or prescribed diabetes medications and with A1C/hemoglobin ≥ 6.5% were labeled 'undiagnosed diabetes.' We calculated themean number of patients with and without an ICD-10 SUD diagnosis who were diagnosed and undiagnosed for each condition. We used multivariate logistic regression to assess the association between being undiagnosed for each condition, and having an SUD diagnosis, patient demographic characteristics, clinical characteristics (body mass index, Elixhauser comorbidity count, diagnosed HIV and psychosis), the percentage of visits without a BP screening, and the total number of visits during the time period. The percentage of patients with undiagnosed hypertension (2.74%) and diabetes (22.98%) was higher amongst patients with SUD than patients without SUD. In multivariate models, controlling for other factors, patients with SUD had significantly higher odds of having undiagnosed hypertension (OR: 1.81; 95% CI: 1.48, 2.20) and undiagnosed diabetes (OR: 1.93; 1.72, 2.16). Being younger, female, and having an HIV diagnosis was also associated with significantly higher odds for being undiagnosed. We found significant disparities in rates of undiagnosed chronic diseases among patients with SUDs, compared with patients without SUDs.

SMR transporters meet the challenge of metformin metabolites.

JGP study (Lucero et al. http://www.doi.org/10.1085/jgp.202313464) shows that members of the SMRGdx subtype can export the degradation products of metformin, helping bacteria adapt to high environmental levels of the commonly prescribed diabetes medication.

Adherence of Type 2 Diabetic Patients to Antidiabetic Medications and its Associated Factors in Najran Armed Forces Hospital, Saudi Arabia

Background: Adherence to antidiabetic medications is crucial for optimum glycemic control and decreasing complications. This study aimed to assess adherence to antidiabetic medications and the associated factors among individuals with type-2 diabetes mellitus (T2DM) attending chronic illness clinics at Najran Armed Forces Hospital (NAFH), Najran Region, Saudi Arabia. Methods: A cross-sectional study was conducted. A systematic sampling technique was used. Morisky Medication Adherence Scale (MMAS) scores were used for labeling patients as adherent or non-adherent. Data were entered and analyzed using SPSS version 20. To see the association of variables logistic regression with OR and 95% CI was done. Results: A total of 288 study participants were interviewed with a response rate of 100%. The level of adherence was found to be 85%. Factors found to be significantly associated with antidiabetic medication adherence were level of education (AOR = 14.27, 95% CI = 3.0, 67.82), duration of diabetes (AOR = 6.10, 95% CI = 2.03, 18.34), and knowledge about DM and its medications (AOR = 28.05, 95% CI = 8.96, 87.8). Conclusions and Recommendations: Our study, a family medicine-based cross-sectional study, found high medication adherence by patients with T2DM regarding their prescribed diabetes medication. Low adherence was significantly associated with educational status, duration of diabetes, and knowledge. We recommend improving T2DM patients’ knowledge related to diabetes and note the importance of compliance with the medication regimen through several health education sessions at diabetic educators, coaches, and other healthcare facilities. These sessions can be delivered by physicians and other healthcare providers, namely, nurses and community pharmacists. Keywords: Type 2 diabetes, adherence to medications, Najran Armed Forces Hospital, Najran Region.

Factors Associated with Diabetic Complication Index among Type 2 Diabetes Patients: Focusing on Regular Outpatient Follow-up and HbA1c Variability

Preventing diabetic complications involves regular outpatient follow-up and maintaining low variability in hemoglobin A1c (HbA1c) levels. This study investigated the factors associated with diabetic complications, with a specific focus on the impact of regular outpatient follow-up and HbA1c variability, among patients with type 2 diabetes. The study design was secondary data analysis of electronic medical records from a university hospital in Korea. It included patients aged 40-79 with type 2 diabetes who were prescribed diabetes medication within three months of their first HbA1c test by an endocrinologist and were followed up for at least five years. Follow-up regularity, adjusted standard deviation of HbA1c levels, and diabetic complication indices were collected. Data were analyzed using the Chi-square test, independent t-test, repeated measures analysis of variance, and multiple regression analysis. The study included 1566 patients. Lower follow-up regularity was observed in patients of older age, with comorbidities, diabetic complications, insulin treatment, a history of hospitalization, lower baseline estimated glomerular filtration rate (eGFR) and total cholesterol (TC), and higher HbA1c variability. Higher HbA1c variability was observed in younger patients without comorbidity but with insulin treatment, a history of hospitalization, higher baseline blood glucose (BG), HbA1c, TC, and triglyceride levels. HbA1c variability had the strongest influence on BG and HbA1c levels at the five-year follow-up. Baseline eGFR and TC were the most influential factors for their respective levels at the five-year follow-up. Follow-up regularity significantly affected BG, HbA1c, eGFR, and TC at five-year follow-up. It has been shown that several variables besides regular follow-up and HbA1c variability have an influence. However, these are the two that can be corrected through nursing intervention and are important, so intervention on these is important.

Studi of In Vivo Antidiabetic Activity of Namnam Leaves (Cynometra cauliflora) Extract in Sprague Dawley Rat

Various treatments for Type 2 Diabetes Mellitus (T2DM) aim to alleviate hyperglycemia. Although natural products have been extensively utilized, their mechanism of action and efficacy as antidiabetic agents, particularly for T2DM, has not been extensively assessed in vivo. In this research, the leaves of the Namnam (Cynometra cauliflora) were extracted and tested for their activity as an antidiabetic agent. Sprague Dawley rats aged 3.5-4 months, weighing 200-250 g, were used as the experimental model, with a total of 30 individuals. The rats were induced with a high-fat diet and 30% sucrose until their blood glucose concentration reached ≥ 120 mg/dL. Subsequently, the rats were divided into four groups (groups 1, 2, 3, and 4). Over 21 days, changes in blood glucose, triacylglycerol, glycogen, and blood plasma insulin levels were assessed. The results demonstrated that the methanol extract of Namnam leaves (NLME) effectively reduced blood glucose levels by 23-34%, decreased plasma triglyceride levels by 13-30%, and increased liver glycogen levels by 68-96% compared to the control group (Diabetes). Among all the parameters assessed, NLME exhibited similar performance to metformin, a commonly prescribed diabetes medication (p<0.05). Furthermore, the study revealed that NLME exerted antidiabetic effects, particularly for T2DM, by promoting liver glycogen formation, enhancing insulin secretion control, facilitating glucose absorption by muscles, and restricting fat metabolism in the blood

Abstract #1409761: Weight Change in Patients with New-Onset Type 2 Diabetes and its Association with Spontaneous Remission – A Comprehensive Real-World Data

This is a population-based cohort study aimed to understand on weight change in new-onset type 2 diabetes patients receiving standard medical therapy and how much weight loss contributes to diabetes remission. From the Korean National Health Insurance Service, type 2 diabetes patients who were newly prescribed diabetes medication two or more times within one year were screened. Remission was defined as cases where the fasting glucose was less than 126 mg/dL at two or more consecutive health examinations after stopping medication. A total of 114,874 new-onset type 2 diabetes patients was analyzed. Of these, 23,156 (20.2%) lost more than 5% of their body weight, and 2,429 (2.1%) acheived remission. The adjusted odds ratio for reaching remission of weight loss group was 2.56 (95% confidence interval 2.35-2.79) compared to the group with stable body weight. The effects of weight loss on remission were significantly greater in subgroups of age younger than 65 years, male sex, and body mass index greater than 25. Losing more than 5% of body weight may increase the likelihood of diabetes remission. We suggest that physicians pay more attention to weight management in new-onset type 2 diabetes, especially for young and obese patients.

Diabetes medication recommendation system using patient similarity analytics

Type-2 diabetes mellitus (T2DM) is a medical condition in which oral medications avail to patients to curb their hyperglycaemia after failed dietary therapy. However, individual responses to the prescribed pharmacotherapy may differ due to their clinical profiles, comorbidities, lifestyles and medical adherence. One approach is to identify similar patients within the same community to predict their likely response to the prescribed diabetes medications. This study aims to present an evidence-based diabetes medication recommendation system (DMRS) underpinned by patient similarity analytics. The DMRS was developed using 10-year electronic health records of 54,933 adult patients with T2DM from six primary care clinics in Singapore. Multiple clinical variables including patient demographics, comorbidities, laboratory test results, existing medications, and trajectory patterns of haemoglobin A1c (HbA1c) were used to identify similar patients. The DMRS was evaluated on four groups of patients with comorbidities such as hyperlipidaemia (HLD) and hypertension (HTN). Recommendations were assessed using hit ratio which represents the percentage of patients with at least one recommended sets of medication matches exactly the diabetes prescriptions in both the type and dosage. Recall, precision, and mean reciprocal ranking of the recommendation against the diabetes prescriptions in the EHR records were also computed. Evaluation against the EHR prescriptions revealed that the DMRS recommendations can achieve hit ratio of 81% for diabetes patients with no comorbidity, 84% for those with HLD, 78% for those with HTN, and 75% for those with both HLD and HTN. By considering patients’ clinical profiles and their trajectory patterns of HbA1c, the DMRS can provide an individualized recommendation that resembles the actual prescribed medication and dosage. Such a system is useful as a shared decision-making tool to assist clinicians in selecting the appropriate medications for patients with T2DM.

Differences in the Use of Covid-19 Comorbid Drugs in Before and Early Of Pandemic

Comorbid patients with Covid 19 affect the severity of the infection. This study aims to examine the utilization of generic medications in the treatment of comorbid Covid-19. Data were retrieved retrospectively from Al Ihsan Hospital's medical records. The data summarize the use of generic medicines for comorbid Covid-19 in the year preceding and in the first year of the pandemic. Metformin is the most commonly recommended medication for type 2 diabetes management.In contrast, Acarbose was the most extensively used medicine before the epidemic. Pioglitazone is the least prescribed diabetes medication. Before the pandemic, Amlodipine 10 mg was the most commonly prescribed medication for cardiovascular disease management. This is distinct from the pre-pandemic period when Ramipril was the most frequently used medication. Verapamil was the least prescribed medication prior to and throughout the epidemic. Three of the eleven medicine names analyzed in the Diabetes Comorbid group indicated that there was a significant variation in use between before and during the pandemic. Thirteen of the twenty-one medicine names analyzed in the Cardiovascular Comorbid group showed a substantial variation in usage between before and during a pandemic.

832-P: Five-Year Weight and Glycemic Outcomes following a Very-Low-Carbohydrate Intervention Including Nutritional Ketosis in Patients with Type 2 Diabetes

Objective: We previously reported long term effectiveness of a very low carbohydrate intervention including nutritional ketosis (VLCI) delivered via continuous remote care (CRC) for improving weight and glycemia at 2 years in people with type 2 diabetes (T2D) . We assessed 5-year changes to determine if the intervention is sustainable, durable, and effective over a longer period of time. Research Design and Methods: Patients with T2D who were initially enrolled in a 2 year non-randomized, controlled clinical trial received a CRC emphasizing a VLCI. These patients were offered to continue for an additional 3 years of prospective follow-up. Of the 200 patients completing 2 years, 169 (84.5%) patients consented to the extension and 122 (72.2%) were retained at 5 years. Among those who extended, baseline versus 5 year differences in weight and glycemic outcomes were assessed using linear mixed effects models in an intent-to-treat analysis. P-values were adjusted using Holm-Bonferroni correction. Results: At five years, there were persistent improvements in weight from 116.4 to 107.6 kg (-8.8 kg, 95%CI [-11.0, -6.6]) , fasting insulin from 25.8 to 24.5 mIU/L (-7.9 mIU/L, 95%CI [-10.0, -5.8]) , and HOMA-IR from 9.1 to 6.6 (-2.5, 95%CI [-3.5, -1.5]) (all adjusted p-values <0.05) . Total diabetes medications were reduced 46.6%, and 59.9% excluding metformin were deprescribed. The percent of patients prescribed diabetes medications significantly decreased at 5 years (from 85.2% to 71.3%; p<0.01) , including patients taking sulfonylureas (from 27.0% to 4.9%) , insulin (from 26.2% to 13.1%) , and SGLT2i (from 10.7% to 2.5%) . Despite less medication use, HbA1c improved from 7.5 to 7.2% (-0.3%, 95%CI [-0.6, 0.0], unadjusted p-value<0.05) . Conclusions: Over 5 years follow-up, the VLCI with CRC showed excellent retention, sustained clinically significant weight loss, and stable glycemic control with reduced dependency on antidiabetes medications. Disclosure S.J.Athinarayanan: Employee; Virta Health Corp. S.Phinney: Employee; Virta Health Corp. M.Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.Hallberg: Advisory Panel; Atkins Nutritionals Inc., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. R.E.Ratner: Employee; Virta Health Corp. J.Volek: Advisory Panel; Abbott Diagnostics, Simply Good Foods, Stock/Shareholder; Virta Health Corp.

Type 2 Diabetes Mellitus in Latinx Populations in the United States: A Culturally Relevant Literature Review.

Type 2 diabetes mellitus (T2DM) affects a large number of the American population. When compared to their representation in the general American population, a disproportionate number of Latinx individuals are affected. Within the Latinx American population, T2DM prevalence rates vary among individuals based on their country of origin. Deaths from T2DM among Latinx American population are also more compared to other ethnicities. This disparity underlines the importance of understanding the cultural considerations of T2DM disease presentation and management in Latinx communities, including risk factors, socioeconomic variables, and other social determinants of health such as access to care. There are various modifiable and non-modifiable risk factors for the development of T2DM, regardless of race. Staple foods in the diet of Latinx American communities, such as tortillas, rice, and beans, can cause spikes in blood sugar levels and can lead to obesity, which predisposes patients to develop T2DM. Latinx American populations suffer from lower access to healthcare than the general population due to many reasons, including language proficiency, immigration status, socioeconomic status, and level of acculturation. This study utilized the format of a commentary, while incorporating elements of a scoping review for data collection, to further explore these disparities and their impact on these populations. Understanding the cultural beliefs of Latinx individuals and how these beliefs contribute to the perceived development of T2DM is essential to properly treat these unique populations. Despite high rates of T2DM affecting Latinx individuals, non-adherence to prescribed diabetes medications is high among these populations. Interventions in the form of culturally tailored preventative education, in addition to active T2DM management, are necessary to combat the toll of this disease on Latinx Americans. Generic interventional techniques and methods should be replaced entirely by those that acknowledge, highlight, and utilize the sociocultural characteristics of Latinx Americans.

Knowledge and self-management practices among type II diabetes patients: a study in Gatundu town in Kiambu, Kenya

Background: Type-2 diabetes mellitus is recognized as a key non-communicable disease affecting over 425 million world-wide, with only half of them currently diagnosed. The most crucial risk factor for mortality associated with type-2 diabetes is poor adherence to the prescribed medication.Methods: A cohort study design was used to study 98 type 2 diabetes patients in Kiambu County. Consecutive sampling method was used. The collection of data utilized a pre-designed and piloted structured questionnaire. Quantitative data analysis was conducted using SPSS version 26.0 and correlation between the total count of the remaining diabetic medication and the blood sugar after one month follow-up was assessed. Univariate logistic regression was conducted in assessing the association between each of the predictor variables and the two main outcome variables (adherence to medication and glycemic control). A multiple logistic regression model was constructed for each of the two outcome variables.Results: 31 (31.6%) of the study subjects were between 60-69 years, 70 (71.4%) were married and 66 (67.3%) were female. In addition, 37 (37.8%) had diabetes for more than 8 years, 70.6% had hypertension and 83.7% were prescribed oral hypoglycaemic agents as initial treatment. Majority of the respondents constituting 80.7% had high adherence to prescribed diabetes medication regimen, knowledge on diabetes treatment (p=0.009) and detecting low blood sugar levels through signs and symptoms and manage (p=0.001) had significantly association with adherence to antidiabetic.Conclusions: Diabetic patients who have knowledge on diabetes and its management, those who stop alcohol and cigarette smoking and those who understand hypertension are more likely to adhere to diabetic treatment.

The Low Carb Program for people with type 2 diabetes and pre-diabetes: a mixed methods feasibility study of signposting from general practice.

BackgroundEvidence shows type 2 diabetes mellitus (T2DM) can be effectively treated with a reduced-carbohydrate diet to support weight loss. Digital apps are increasingly used to support weight loss, yet little is known about their use as part of general practice diabetes care.AimDetermine the feasibility of signposting from routine NHS general practice to a digital weight management tool (Low Carb Program) for patients with T2DM and pre-diabetes.Design & settingMixed-methods feasibility study implemented within routine general practice consultations at four practices in the Midlands, England.MethodGeneral practices offered signposting to eligible patients attending consultations of any type during a 4-week recruitment period. Rates of offering and accepting signposting were recorded, with program registration, program completion, and self-reported health outcomes (weight, haemoglobin A1C [HbA1c]).ResultsSignposting was offered to 351 patients; 160 (45.6%) accepted, 103 (29.3%) registered with the intervention and 43 (26.9% of patients accepting signposting) completed the programme. GPs reported that signposting added between 1–4 minutes to the consultation length. Patients completing the programme reported greater weight loss (7.2kg versus 1.6kg, P<0.001) and HbA1c improvements (-9.1mmol/mol versus 1.7mmol/mol, P<0.001) compared to those who did not, and were more likely to reduce the number of prescribed diabetes medications in general practice.ConclusionsSignposting from real-world general practice to the Low Carb Program is feasible and can potentially improve diabetes outcomes. Further research should explore whether the process of signposting can be enhanced to increase registration, identify whether additional practice-led support leads to increased programme completion, and confirm the intervention’s clinical and cost-effectiveness.

Prevalence and incidence of type 2 diabetes in Iceland 2005-2018

The number of people with type 2 diabetes has increased in Iceland in the last few decades. We utilized the national database on prescribed medication from the Directorate of Health to estimate the prevalence and incidence of type 2 diabetes in Iceland and made prediction on the prevalence of type 2 diabetes in Iceland in 10 and 20 years. Prevalence and incidence of type 2 diabetes for the period 2005-2018 was estimated based on prescriptions of diabetes medication in the national prescription database containing all prescriptions in Iceland during the period. The result was compared to the result from the REFINE-Reykjavik study (prospective, population-based cohort study) from 2004 to 2011 and published data from the USA from 1980 to 2016. The prevalence of type 2 diabetes more than doubled in near all age groups in both men and women in the period 2005-2018. The incidence increased by 2.8% annually (in 18-79 years old). The number of people in Iceland with type 2 diabetes was 10600 in 2018 and had increased from 4200 in the year 2005. Comparison with the results of the REFINE-Reykjavik study showed an underestimation (29% in men and women) of the prevalence of type 2 diabetes. If the increase in type 2 diabetes continues at a similar rate as in the years 2005-2018 the number of people with diabetes in Iceland could be near 24000 in the year 2040. Linear increase was seen in incidence and prevalence of people with type 2 diabetes in the years 2005-2018. Similar evolution was seen in USA from 1984. In order to counteract the increase of type 2 diabetes following the same path as has been seen in the USA, targeted measures are needed.

Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure, hospitalization and worsening of diabetes: an observational study using medical, dental and pharmacy claims data in Japan

To investigate the effects of regular periodontal management for people with type 2 diabetes on total healthcare expenditure, hospitalization and the introduction of insulin. We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. We fitted generalized linear models that had sex, age, comorbidities and the status of periodontal management during the previous two years as predictors. A total of 16,583 individuals were enrolled. The annual healthcare expenditure in the third year was 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92-1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82-0.98). The aOR of introducing insulin in the third year for those who had not been prescribed insulin during the previous two years (n=13,222) was 0.77 (95% CI: 0.64-0.92) in the group receiving periodontal management every year. Regular periodontal management for diabetic people was associated with reduced healthcare expenditure, all-cause hospitalization and the introduction of insulin therapy.

Time trends in diabetes medication prescription and factors associated with metformin discontinuation in people with newly diagnosed type 2 diabetes: A national population-based study.

To describe, based on the French National Health Insurance (NHI) data, time trends in diabetes medications after treatment initiation in two consecutive cohorts of people newly treated for type 2 diabetes (T2D) in 2008 (1st cohort) and 2013 (2nd cohort). People, aged 45years and older, newly treated for T2D in 2008 and 2013 were identified in the French NHI Data System. Treatment changes were collected for each year of follow-up. Logistic regression was performed to identify factors associated with metformin discontinuation. Respectively, 157 940 and 160 670 beneficiaries (mean age: 63 and 64years; men proportion: 53 and 52%) of the French NHI general scheme initiated a diabetes treatment in 2008 and 2013. Metformin was the first monotherapy and increased in use: 67% of monotherapies in 2008 versus 77% in 2013. Monotherapy percentage decreased from the second year onwards in both cohorts. A marked increase in metformin-DPP4i combination therapy was observed (14% of dual therapies in 2008 vs. 46% in 2015 in the first cohort), replacing the metformin-sulfonylureas combination as a second-line treatment. Metformin discontinuation was statistically associated with female gender, social deprivation, age and anti-diabetic polypharmacy. Discontinuation of diabetes treatment was observed after 5years for, respectively, 10% and 13% in the first and second cohorts. Descriptive analysis of two consecutive national cohorts showed an evolution in the prescription patterns of anti-diabetic treatments over a short period. With early treatment intensification, increasing rate of metformin monotherapy, and changes in dual-therapy strategy.

SUN-LB113 A Continuous Remote Care Intervention Utilizing Carbohydrate Restriction Including Nutritional Ketosis Improves Markers of Metabolic Risk and Reduces Diabetes Medication Use in Patients With Type 2 Diabetes Over 3.5 Years

Novel lifestyle, pharmaceutical, and/or surgical therapies for type 2 diabetes (T2D) are under study to assess lasting impact on metabolic risk. Among them, carbohydrate restriction including nutritional ketosis (CR) has emerged as a safe and effective nutrition therapy for reducing hyperglycemia in patients with T2D1, yet longer term effects are unknown. At the conclusion of a 2-year study assessing a continuous remote care intervention utilizing CR (CCI) among patients who selected this therapy, intervention participants were offered the opportunity to consent to participate in a 3-year extension assessing outcomes at 3.5- and 5-y following initial enrollment. 143 of 169 extension-consented participants provided data at 3.5-y follow up. Among 3.5-y completers, linear mixed effects models were used to assess change over time in diabetes-related outcomes and McNemar’s tests were used to assess for a difference in the proportion of participants meeting certain criteria at baseline compared to follow-up. At enrollment, 3.5-y completers were (mean±SE) 55±1 y of age, 40.8±0.7 kg/m2, and 8±1 y since diagnosis. Following treatment with the CCI for 3.5 y, significant improvements compared to baseline were observed in HbA1c (-0.6±0.1 from 7.4±0.1%; P = 1.9x10-5), weight (-10.9±1.1 from 117.4 kg; P = 6.9x10-17), nonHDL-C (-10±4 from 139±3 mg/dL; P = 0.005), triglycerides (-41±11 from 189±10 mg/dl; P = 2.1x10-4), and HDL-C (+9±1 from 43±1 mg/dl; P = 3.0x10-11); total cholesterol and LDL-C were statistically unchanged. The percentage of participants prescribed diabetes medication decreased from 84.6 to 67.1% (P = 5.0x10-6), while 50.2% of diabetes medications and 71.4% of diabetes medications other than metformin were discontinued. The percentage of participants treated with no pharmaceuticals or monotherapy increased from 52.5 to 81.9% (P = 1.3x10-8). 45.5% (65/143) of participants achieved HbA1c <6.5% with either no medication (34/65, 52%) or only metformin (31/65, 48%) at 3.5 y; 37.8% of participants maintained this status from 1 through 3.5 y of treatment. 22% of participants achieved diabetes remission at 3.5 y, and 17.5% of participants maintained remission status from 2 through 3.5 y of treatment. This demonstrates that clinically meaningful improvements across multiple markers of metabolic risk can be sustained in patients with T2D who selected treatment with this CCI for 3.5 y. Improvements in metabolic risk markers reduced the need for diabetes medication, allowing some patients to achieve and sustain diabetes remission. This ongoing trial will assess 5-y effects.1. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2020; 43(Supplement 1): S48-S65. 2. Athinarayanan SJ, et al. Front Endocrinol. 2019; 10:348.

Indicators of Quality of Clinical Care for Type 2 Diabetes Patients in Primary Health Care Centers in Qatar: A Retrospective Analysis.

Background Despite the high prevalence of type 2 diabetes mellitus in Gulf countries, standards of diabetes care at the primary care level have not been widely studied. Aim To compare the results of diabetes clinical indicators from the American Diabetes Association (ADA) 2017 guidelines to the reference benchmarks in the Behavioral Risk Factor Surveillance System. Materials and Methods A cross-sectional analysis of electronic medical records in 643 randomly selected adult patients with type 2 diabetes was undertaken. A checklist enabled the collection of sociodemographic, clinical, biochemical, and quality measurement data. Data were analyzed using Stata 9.0. The chi-squared test was used to compare two or more proportions. Results There were 643 patients (male = 60.3%; female = 39.7%), and the majority (71.7%) aged between 40 and 64 years. Common comorbidities were dyslipidemia (72.3%), hypertension (70%), obesity (50.1%), and preobesity (overweight) (37.9%). Over 15% were smokers. The most commonly prescribed diabetes medications were metformin (89.9%), dipeptidyl peptidase-4 inhibitors (61.1%), and sulfonylureas (49.3%). Only 35.5% (p < 0.0001) of patients met the reference glycated hemoglobin (HbA1c) cutoff level of 7.0%. The reference level for blood pressure control was met by 70.2% (p < 0.0001) and for low-density lipoprotein cholesterol, 73.8% (p < 0.0001). Albuminuria was present in 39.2%, and very low vitamin D level (<20 ng/ml) in 39.1%. Most patients had annual foot (89.6%, p < 0.0001) and eye (72.3%, p < 0.0001) examinations. Only 39.9% had referrals for dietary counseling, and there were lower rates of referrals and uptake for pneumococcal, influenza, and hepatitis B vaccines. Most (76.2%) did not have screening for depression. Conclusion The majority of the results met the ADA standards, while glycemic control, dietary counseling, and screening for depression were poor in comparison to the standards. Continuing education for clinicians, patient education for self-management, and targeted weight management are recommended.

Prevalence of hypertension and diabetes in Finland by different data sources

Abstract Background Population level information on the prevalence of hypertension and diabetes is needed to support planning and evaluation of preventive activities and care. Population based health examination surveys (HES) can provide valid information, but they are time consuming and expensive. Administrative registers on hospitalizations and out-patient visits could provide information faster and at less cost. The aim of this study is to estimate how comparable prevalence estimates of type 2 diabetes (T2D), hypertension and their combination are based on data from the Finnish national health examination survey (FinHealth 2017) and data from administrative hospital and primary care registers in Finland. Methods Survey data were linked to care registers using personal identity codes. Survey based hypertension was defined as SBP≥140 mmHg or DBP≥90 mmHg or self-reported use of antihypertensive medications; and T2D as HbA1c ≥48 mmol/mol or self-reported us of diabetes medications. Corresponding indicators from care registers were: hypertension and T2D as a reason for care or visit or having received prescription for diabetes medication (using ICD-10, ICPC and ATC codes). Results For hypertension, survey data provided the prevalence of 43 % while only 12 % of individuals were identified as hypertensives in the register data. The prevalence of T2D was 9 % in both data sources. The prevalence of having both hypertension and T2D was 7 % based on survey data and 3 % based on register data. Agreement between survey and register data was lower for hypertension (Cohen’s kappa 0.23) than for T2D (0.84). Conclusions Register data provided lower prevalence for hypertension than the survey data. For diabetes, similar prevalences were observed. As there are limitations in the coverage of register data more reliable population level information can be obtained from HES. Key messages Health examination surveys cover persons with undiagnosed problems and conditions omitted in national registers. Hypertension and T2D should be monitored with both register and survey data.

1676-P: Racial and Ethnic Disparities in Type 1 (T1D) and Type 2 (T2D) Diabetes Incidence in Young Adults: The Diabetes in Young Adults (DiYA) Study

Data on the incidence of T1D and T2D among racially and ethnically diverse young adults are sparse. To fill this gap, we conducted surveillance in a diverse population of 2.3 million members (15.3% Asian, 7.0% black, 34.6% Hispanic, 33.2% white, 9.9% other) of Kaiser Permanente California, in 2017, aged 20-45 years without recognized diabetes as of 12/31/2016. Incident cases were identified through electronic health records based on the following criteria: a) ≥2 ICD-10 diagnosis codes for diabetes, b) 1 ICD-10 diagnosis for diabetes plus ≥1 prescription for diabetes medication, or c) 1 ICD-10 diagnosis plus ≥2 glucose or HbA1c values diagnostic of diabetes according to the ADA criteria. T1D was defined based on &amp;gt;50% of ICD-10 codes indicating T1D. We identified 7,862 incident diabetes cases in 2017: 122 (1.6%) T1D and 7,713 (98.1%) T2D. Age- and sex-standardized T1D and T2D incidence rates per 100,000 person-years are reported in the Table. The incidence of T1D was highest in white and black, followed by Hispanic and Asian individuals. The incidence of T2D was highest among Hispanic followed by black, Asian and white individuals. In young adults, there are large racial and ethnic disparities in the incidence of T1D and T2D. Targeted disease management strategies are needed. Further research into possible etiological factors may identify targeted prevention strategies. Disclosure A. Ferrara: None. J.G. Alexander: None. S.B. Sridhar: None. J. Ritchie: None. J. Slezak: None. H.S. Takhar: None. L.I. Vega-Daily: None. S. Saydah: None. G. Imperatore: None. C. Quesenberry: None. J.M. Lawrence: None. Funding Centers for Disease Control and Prevention (1U18DP006289)

The confounding role of common diabetes medications in developing acute renal failure: A data mining approach with emphasis on drug-drug interactions

Longstanding diabetes mellitus is today known as the primary reason for kidney failure in the patients having that condition. While the prior research has studied the confounding role of some frequently prescribed diabetes medications in developing acute renal failure, some rarely prescribed medications are still under-studied in this regard. In addition, even for those drugs studied in the past, inconsistent findings have been reported. In the present study, by extending a data mining framework from the prior research and equipping that with some standard statistical metric from the medical literature we investigate the general confounding role of the common diabetes medications in developing acute renal failure in a large group of patients with diabetes mellitus (Type II). In addition, we assess the stability of the identified confounding roles by taking into account the potential drug-drug interactions between those diabetes medications with a group of drugs already known to have negative effect on the kidney function. Our results suggest the general dominant confounding role for each of the diabetes medications, but also suggests that these roles are unstable across various prescription combinations due to potential drug-drug interactions, thereby provide an explanation for the inconsistent findings in the literature.