Diagnosis Of T2DM Research Articles

‘It’s a Dance Between Managing Both’: a qualitative study exploring perspectives of persons with knee osteoarthritis and type 2 diabetes mellitus on the impact of osteoarthritis on diabetes management and daily life

ObjectivesType 2 diabetes (T2DM) and knee osteoarthritis (OA) commonly co-occur and epidemiologic studies suggest concomitant symptomatic knee OA increases the risk of T2DM complications. We sought to explore the experiences...

PSUN263 Diagnosis of Latent Autoimmune Diabetes of Adulthood Unveiled After Initiation of an SGLT2 Inhibitor

Abstract SGLT2-inhibitors have revolutionized treatment for Type II diabetes (T2DM) due to their numerous benefits including improved glycemic control, cardioprotective properties, reduction of high blood pressure, and mitigation of disease progression in CKD.ew studies have investigated the benefits of this medication class on patients with Type 1 DM (T1DM). Herein we describe a case in which the diagnosis of latent autoimmune diabetes of adulthood (LADA) was unmasked following the use of an SGLT2-inhibitor. A 56-year-old female with a history of T2DM diagnosed 10 years ago presented to the endocrine clinic for management of her poorly controlled diabetes. Her medications then included insulin detemir, insulin lispro, metformin, and repaglinide, but she still had an HbA1c of 11.3% (n<5.7%). She was tried on glipizide early in her disease course but it was discontinued due to fluid retention. She had a sedentary lifestyle with a BMI of 31.27 kg/m2. She was requiring increased doses of insulin over time with minimal improvement in her HbA1c. Two years later she was started on liraglutide with increasing dosages. Her HbA1c continued to decrease down to 8.7% and her BMI had decreased to 26.83 kg/m2. Over the next year, her HbA1c began to again increase up to 9.8%. At this time canagliflozin was added to her medication regimen. She responded very well to this medication initially with a drop in her HbA1c to 7.5% and a decrease in her BMI to 24.01 kg/m2. Unfortunately, one year after initiation of the SGLT2-inhibitor she was hospitalized for DKA and pancreatitis. At this time all her medications, except for insulin and metformin, were discontinued. A GAD65 antibody (>250 IU/mL; n<5.0 IU/mL) and c-peptide (<0.1 ng/mL; n = 1.1-4.4 ng/mL) levels were checked at this time which revealed the diagnosis of LADA approximately 16 years after her initial diagnosis of T2DM. She was transitioned to an insulin pump and managed according to protocol. SGLT2 inhibitors have been studied as an adjuvant treatment with insulin for T1DM due to their ability to increase urinary glucose excretion but are currently not approved for T1DM. Despite their recorded benefits, they have also been shown to significantly increase the risk of DKA when used in patients with T1DM. Our patient, who was mistakenly treated as T2DM for almost two decades, was diagnosed with LADA after initiation of an SGLT2 inhibitor led to hospitalization for DKA. Further research is needed to assess the safety of SGLT2 inhibitors in T1DM, and caution must be taken when prescribing this medication to patients who may have underlying LADA. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

ODP185 Diabetic Retinopathy Prevalence in Pediatric Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract Type 2 diabetes mellitus (T2DM) is on the rise in children and adolescents. Diabetic retinopathy (DR) is a leading cause of blindness in adult patients with diabetes. However, the exact prevalence of DR and its determinants in pediatric patients with T2DM are unknown. Understanding the burden of DR in pediatric T2DM can help inform screening and management clinical practice guidelines. This systematic review and meta-analysis aimed to determine the prevalence and determinants of DR in pediatric T2DM. The main outcome was the pooled prevalence of DR in pediatric T2DM. Other important outcomes included the assessment of the impact of diabetes duration, method of retinopathy diagnosis, sex, race, and obesity on prevalence. We searched MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and the grey literature from inception until April 4, 2021 for relevant data. No language restrictions were applied, and searches were limited to human studies. Two reviewers independently screened for studies of T2DM patients diagnosed <21 years of age with observational study design and ≥10 participants. Risk of bias evaluation was performed and level of evidence analysis was conducted using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was used to pool the results. Out of 1849 screened studies, 24 studies met the inclusion criteria. The overall prevalence of DR in pediatric T2DM was 6.58% (95%CI 3.46-10.46, I 2 =96%,n=9026). Most cases were classified as minimal or mild non-proliferative DR. Six cases were sight-threatening. Prevalence was higher in studies using fundoscopy than fundus photography to evaluate DR (0.47% [95%CI 0. 00-3.30, I 2 =0%,n=135] vs. 18.20% [95%CI 7.92-31.28, I 2 =89%,n=718]), suggesting that fundus photography was more sensitive in detecting DR than fundoscopy. The risk of DR rose progressively post-diagnosis; while1.25% (95%CI 0. 00-4. 01, I 2 =13%,n=213) of patients had DR <3 years post T2DM diagnosis, this figure rose to33. 03% (95%CI 25.79-40.66, I 2 =0%,n=162) >5 years after diagnosis. Obesity and sex did not impact DR prevalence. White/Middle Eastern patients had a DR prevalence of 7.43% (95%CI 0. 00-31.37; I 2 =97%,P <0. 001, n=4419),while Asians had a higher prevalence of 14.85% (95%CI 0.91-39.16; I 2 =93%,P <0. 001, n=501). In conclusion, DR is a frequent complication in children and adolescents in the early years post T2DM diagnosis. Screening for DR at diagnosis and annually thereafter using fundus photography is critical to allow early detection and management to prevent visual impairment in these patients. Presentation: No date and time listed

Circulating microRNA-126 in patients with ischemic heart disease with type 2 diabetes mellitus and its relationship with glucometabolic disorders

The aim of the study was to investigate circulating microRNA-126-3p levels and its relationships with glucometabolic indices in patients with ischemic heart disease (IHD) and type 2 diabetes mellitus (Т2DM). Materials and methods. The study included 68 patients with stable coronary artery disease (CAD) and T2DM, 25 CAD patients without diabetes and 18 healthy individuals as a control. MiRNA126-3p was determined in blood plasma by real time polymerase chain reaction. Small nuclear RNA U6 was used as an endogenous control. Results. Circulating miRNA-126-3p levels in CAD patients both with T2DM (50.32 [19.54; 93.82]) and without diabetes (109.46 [49.52; 211.11]) were higher than in the controls (17.95 [13.74; 35.01]) (P = 0.018 and P < 0.001). But in patients with T2DM, miRNA126-3p level was decreased in comparison with patients without diabetes (P < 0.001). In patients with T2DM, miRNA-126-3p displayed a significant negative correlation with blood glucose level (R = -0.259, P = 0.037) and was correlated negatively with glycosylated hemoglobin (R = -0.246, Р = 0.056) and insulin resistance index HOMA-IR (R = -0.229, P = 0.082) reaching boundary level of statistical significance. In diabetic patients, lower miRNA-126-3p level (the 1st tertile) was associated with a significant increase in blood glucose level and HOMA-IR in comparison with the 3rd tertile (P = 0.011 and P = 0.041). According to the ROC-analysis, the decrease in miRNA-126-3p levels was significantly associated with the presence of T2DM in patients with САD: AUC was 0.734 (95 % CI: 0.631–0.822, P < 0.001). Conclusions. Circulating miRNA-126-3p levels in CAD patients both with and without T2DM were increased compared to the controls, possibly due to compensatory mechanisms. However, in patients with T2DM, miRNA-126-3p expression was significantly lower than in patients without T2DM. The lowest miRNA-126-3p level in CAD patients with T2DM was associated with the significant elevation of blood glucose level and the increase in insulin resistance. MiRNA-126-3p may serve as potential biomarker for predicting and early diagnosis of T2DM in patients with CAD.

Free, bioavailable 25-hydroxyvitamin D levels and their association with diabetic ketoacidosis in children with type 1 diabetes at diagnosis.

Considering the roles of 25-hydroxyvitamin D (25OHD) in glucose homeostasis and immune modulation, vitamin D deficiency may be related to the development of type 1 diabetes (T1DM) and diabetic ketoacidosis (DKA). We evaluated the total, free, bioavailable 25OHD levels and vitamin D binding protein (VDBP) levels and genotypes between T1DM patients and controls. This retrospective, cross-sectional study included 84 children with T1DM (38 boys and 46 girls, 8.0 ± 3.6 years) and 1:1 age- and sex-matched healthy controls. A multiplex liquid chromatography-tandem mass spectrometry-based assay was used to simultaneously measure vitamin D metabolites. Patients with T1DM had lower levels of total 25OHD (16.3 ± 5.1 vs. 19.9 ± 6.5 ng/mL, P< 0.001) and VDBP (146.0 ± 27.8 vs. 224.9 ± 36.1 µg/mL, P = 0.001), but higher free 25OHD (8.0 ± 2.5 vs. 6.5 ± 2.3 pg/mL, P< 0.001) than controls. Patients who presented with DKA had lower levels of 25OHD in the total (15.0 ± 4.6 vs. 17.6 ± 5.2 ng/mL, P = 0.020), free (7.5 ± 2.6 vs. 8.4 ± 2.4 pg/mL, P = 0.059), and bioavailable (2.3 ± 0.9 vs. 2.8 ± 0.8 ng/mL, P = 0.014) forms than those without DKA at the T1DM diagnosis. The lower the total, free, and bioavailable 25OHD levels at diagnosis, the lower the pH and HCO3-. The proportions of the VDBP genotypes did not differ between the patients and controls. Patients with T1DM had higher levels of free 25OHD than healthy children, despite lower levels of total 25OHD. However, patients with DKA exhibited lower levels of bioavailable 25OHD than those without DKA at the T1DM diagnosis. The lower the concentrations of free and bioavailable 25OHD, the more severe the acidosis at the initial T1DM presentation.

Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol

IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating...

Increased frequency of CD14+HLA-DR-/low cells in type 2 diabetes patients with poor glycemic control

AimsType 2 diabetes (T2DM) is associated with alterations of the immune response and T2DM patients have an increased risk for infections and certain sorts of cancers. Although CD14+HLA-DR-/low cells have emerged as important mediators of immunosuppression in several pathologies, including cancer and non-malignant diseases, the presence of these cells in T2DM is not fully characterized. MethodsIn this study, we evaluated the frequency of CD14+HLA-DR-/low cells in non-obese T2DM patients and their association with glycemic control. Peripheral blood mononuclear cells were isolated from healthy controls (HC, n = 24) and non-obese T2DM patients (n = 25), the population was evaluated by flow cytometry, and an analysis of correlation between cell frequencies and clinical variables was performed. ResultsCD14+HLA-DR-/low monocytes were expanded in patients with T2DM compared to HC regardless of weight. Among the subjects with T2DM, the frequency of CD14+HLA-DR-/low was higher in patients with poor glycemic control (HbA1c > 9%) compared to those with better glycemic control (HbA1c < 9%) and, positively correlated with the years since the diagnosis of T2DM, the age of the patients and the glycemic index. ConclusionsAn increased frequency of CD14+HLA-DR-/low cells in the blood of T2DM patients was recorded. The influence of hyperglycemia seems to be independent of obesity, but related to glycemic control and age.

Predicting incident heart failure among patients with type 2 diabetes mellitus: The DM-CURE risk score.

Early identification and prediction of incident heart failure (HF) is important because of severe morbidity and mortality. This study aimed to predict onset of HF among patients with diabetes. A time-varying Cox model was derived from ACCORD clinical trial to predict the risk of incident HF, defined by hospitalization for HF (HHF). External validation was performed on patient-level data from the Harmony Outcome trial and Chronic Renal Insufficiency Cohort (CRIC) study. The model was transformed into an integer-based scoring algorithm for 10-year risk evaluation. A stepwise algorithm identified and selected predictors from demographic characteristics, physical examination, laboratory results, medical history, medication and health care utilization, to develop a risk prediction model. The main outcome was incident HF, defined by HHF. The C statistic and Brier score were used to assess model performance. In total, 9649 patients with diabetes free of HF were used, with median follow-up of 4 years and 299 incident hospitalization of HF events. The model identified several predictors for the 10-year HF incidence risk score 'DM-CURE': socio-Demographic [education, age at type 2 diabetes (T2DM) diagnosis], Metabolic (glycated haemoglobin, systolic blood pressure, body mass index, high-density lipoproteins), diabetes-related Complications (myocardial infarction, revascularization, cardiovascular medications, neuropathy, hypertension duration, albuminuria, urine albumin-to-creatinine ratio, End Stage Kidney Disease), and health care Utilization (all-cause hospitalization, emergency room visits) for Risk Evaluation. Among them, the strongest impact factors for future HF were age at T2DM diagnosis, health care utilization and cardiovascular disease-related variables. The model showed good discrimination (C statistic: 0.838, 95% CI: 0.821-0.855) and calibration (Brier score: 0.006, 95% CI: 0.006-0.007) in the ACCORD data and good performance in the validation data (Harmony: C statistic: 0.881, 95% CI: 0.863-0.899; CRIC: C statistic: 0.813, 95% CI: 0.794-0.833). The 10-year risk of incident HF increased in a graded fashion, from ≤1% in quintile 1 (score ≤14), 1%-5% in quintile 2 (score 15-23), 5%-10% in quintile 3 (score 24-27), 10%-20% in quintile 4 (score 28-33) and ≥20% in quintile 5 (score >33). The DM-CURE model and score were useful for population risk stratification of incident HHF among patients with T2DM and can be easily applied in clinical practice.

An adapted behavioural activation intervention (DiaDeM) for people with diabetes and depression in South Asia: A feasibility study protocol

Background: The burden of depression is a rapidly growing problem worldwide. Its prevalence is particularly high among individuals with chronic physical conditions such as Type 2 Diabetes (T2DM), precipitating poorer health outcomes. There is a lack of evidence around treatments that can work among such groups, particularly in Low and Middle-Income Countries (LMICs). This study aims to test the feasibility and acceptability of a culturally adapted Behavioural Activation (BA) intervention (DiaDeM) for people with T2DM and depression in two LMICs in South Asia. Methods: A multicentre, randomised-controlled feasibility trial will be conducted from March 2022 to February 2023. We will recruit 128 adults from health facilities in Bangladesh and Pakistan with a diagnosis of T2DM and depression. Using a 1:1 allocation ratio, consenting individuals will be randomised to either optimised usual care or the DiaDeM intervention. The latter will involve six face-to-face or remotely delivered BA sessions conducted by non-mental health facilitators over six to twelve weeks. Participants will be followed up at three and six months post-randomisation. Feasibility outcomes include the feasibility and acceptability of recruitment and retention, the feasibility of intervention delivery and the feasibility of data collection at baseline and follow-up (including economic data). An embedded mixed-methods process evaluation will also be carried out to inform the main trial. Conclusions: BA is a low resource intervention for depression treatment that can be optimised for delivery in LMIC settings such as South Asia. The planned feasibility trial will directly inform a larger trial to assess the effectiveness and cost-effectiveness of such an intervention in people with T2DM and depression. It will also contribute to the wider evidence base around BA in patients with chronic physical illnesses, with particular relevance to South Asian, as well as wider LMIC regions and populations. Trial registration: ISRCTN 75501608

Impaired Fasting Glucose (IFG) Prevalence Among Hypolipidemic Treatment- naïve Patients with Hypertension.

Impaired fasting glucose (IFG) predisposes to the future development of type 2 diabetes mellitus (T2DM) and may also be associated with increased cardiovascular disease (CVD) risk. Hypertension is an established CVD risk factor. This study aimed to assess the prevalence of IFG and the associated anthropometric and metabolic disturbances in patients with hypertension. Consecutive hypertensive patients not on any hypolipidemic treatment and without a diagnosis of T2DM were included. IFG was defined as serum glucose ≥100 mg/dl according to the American Diabetes Association criteria. The total sample consisted of 1381 participants; between them, 78 patients were diagnosed to have T2DM and they were excluded from the analyses, leaving a final sample of 1303 hypertensive patients [41.0% men; median age 58 (range: 15-90) years] not on any hypolipidemic treatment and without a diagnosis of T2DM. IFG was identified in 469 patients (36%). IFG was more prevalent in males than in females (42.4% vs. 31.8%, p<0.001). Patients with IFG had greater body mass index (BMI), waist-to-hip ratio, systolic blood pressure, pulse pressure, triglycerides, alanine aminotransferase, gamma-glutamyl transferase, and uric acid serum levels compared with patients with normal serum glucose levels. This study reveals that in a sample of patients with hypertension, one out of three has IFG. This is more prevalent among men. IFG is associated with the presence of a more aggravated anthropometric and biochemical profile, possibly associated with an increased CVD risk.

Salidroside Affects Gut Microbiota Structure in db/db Mice by Affecting Insulin, Blood Glucose and Body Weight.

PurposeThe purpose of this study was to investigate the regulatory effect of salidroside on the intestinal flora of mice with type 2 diabetes (T2DM) and its protective effect in the body.Patients and MethodsWe acclimated 8-week-old mice for 7 days, divided them into 4 groups, and continued dosing for 8 weeks. We recorded weekly blood glucose levels and body weight for each mouse. After the completion of the feeding cycle, the 16S rRNA of the intestinal flora in the mice was sequenced, and the insulin and C-peptide levels in each group of mice were measured. Four samples were taken from each group for liver and kidney section staining.ResultsOur results showed that gut microbiota diversity and function were significantly different between the diabetic mice and healthy mice and that insulin levels, body weight, and blood glucose levels could significantly influence gut microbiota changes at the genus level. The gut microbiota diversity and function of db/db mice were also altered after salidroside administration. Salidroside could attenuate inflammatory damage, lipid accumulation and inflammatory changes in the diabetic liver, as well as diabetic kidney damage. Candidatus arthromitus and Odoribacter are important species of the microbiota during diabetes and may serve as potential therapeutic targets.ConclusionOur investigation of the associated pathological conditions and fecal microbiota in db/db mice provides new insights into the pathogenesis of T2DM and provides implications for the diagnosis and treatment of T2DM.

Health Needs Assessment: Chronic Kidney Disease Secondary to Type 2 Diabetes Mellitus in a Population without Social Security, Mexico 2016-2032.

Health needs assessment is a relevant tracer of planning process of healthcare programs. The objective is to assess the health needs of chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (T2 DM) in a population without social security in Mexico. The study design was a statistical simulation model based on data at the national level of Mexico. A stochastic Markov model was used to simulate the progression from diabetes to CKD. The time horizon was 16 years. The results indicate that in 2022, kidney damage progression and affectation in the diabetic patient cohort will be 34.15% based on the time since T2 DM diagnosis. At the end of the 16-year period, assuming that the model of care remains unchanged, early renal involvement will affect slightly more than twice as many patients (118%) and cases with macroalbuminuria will triple (228%). The need for renal replacement therapy will more than double (169%). Meanwhile, deaths associated with cardiovascular risk will more than triple (284%). We concluded that the clinical manifestations of patients with CKD secondary to T2 DM without social security constitute a double challenge. The first refers to the fact that the greatest health need is early care of CKD, and the second is the urgent need to address cardiovascular risk in order to reduce deaths in the population at risk.

Allopurinol Use and the Risk of Type 2 Diabetes Mellitus: A Meta-Analysis of Cohort Studies.

ObjectiveTo assess whether there is a relation between allopurinol use and the probability of type 2 diabetes mellitus (T2DM) in persons with gout and/or hyperuricemia.MethodsAccording to the PRISMA 2020 guidelines, a meta-analysis was performed by searching literature published from 2000 to 2021 in two electronic databases (Ebscohost and PubMed). The end point was set as a new diagnosis ofT2DM between people with the use of allopurinol and people with non-use of allopurinol. The random-effects model was performed to evaluate the pooled hazard ratio (HR) with 95% confidence interval (CI) for T2DM associated with allopurinol use.ResultsThree cohort studies could meet the inclusion criteria in the meta-analysis. There was a high heterogeneity of the outcome between studies (I2 = 99%). The research duration ranged from 13 to 16 years. The subject number in each work ranged from 1114 to 138,652. A meta-analysis disclosed that there was not an association between allopurinol use and the risk of developing T2DM (pooled HR = 1.01 and 95%CI = .55–1.84).ConclusionsThe meta-analysis shows that no correlation is detected between allopurinol use and the risk of T2DM in individuals with gout and/or hyperuricemia. Because there are not enough eligible studies, the strength of evidence in our meta-analysis is weak. More cohort studies are needed to determine an association between use of allopurinol and the probability of T2DM for individuals with gout and/or hyperuricemia.

1266-P: Random C-Peptide Testing Identified One-Tenth of Thai Adult Patients Misdiagnosed with Type 1 Diabetes Mellitus

Background: A C-peptide testing carried out several years after a clinical diagnosis of T1DM could uncover a misdiagnosis in some cases. T1DM in Asian population are extremely low in prevalence and display some unique features. This study aims to determine the prevalence and characteristics of Thai adult patients with clinically misdiagnosis with T1DM. Materials and Methods: A cross-sectional study of Thai patients diagnosed with T1DM registered at the Theptarin Hospital, Thailand was performed. Random plasma C-peptide were measured in all cases and mixed meal tolerance test (MMTT) were performed if random plasma C-peptide was in between 0.1-0.5 ng/mL. Clinically misdiagnosis with T1DM defined by preserved endogenous insulin secretion (random C-peptide ≥ 0.6 ng/mL or stimulated C-peptide after MMTT ≥ 0.6 ng/mL) after at least 3 years after onset of DM. Results: A total of 73 patients (females 52.1%, mean age 42.2±12.5 years, BMI 23.2±3.3 kg/m2, A1C 7.8±1.3%) with duration of diabetes 20.3±11.3 years were studied. Only 42.5% of patients had measurement of pancreatic auto-antibodies. The prevalence of anti-GAD and anti-IA2 were 53.3% and 20.8%, respectively. Preserved endogenous insulin secretion (random C-peptide ≥ 0.6 ng/mL) were found in 8 patients. The overall prevalence of clinically misdiagnosis with T1DM was 11.0%. When compared with truly T1DM, misdiagnosed patients had higher prevalence of hypertension and diabetic complications. Five were reclassified as having T2DM and 3 patients were suspected to have monogenic diabetes. Conclusions: Our results were consistent with previous studies from Caucasian patients that about 10-15% of clinically diagnosed T1DM had been wrongly diagnosed. In clinical practice, positivity for pancreatic auto-antibodies was less helpful than a simple random C-peptide measurement. C-peptide testing a few years after a diagnosis of T1DM should be a routine procedure to identify some patients who might have been misdiagnosed. Disclosure Y. Thewjitcharoen: None. S. Krittiyawong: None.

Impact of metformin on clinical outcomes in advanced hepatocellular carcinoma treated with immune checkpoint inhibitors.

4118 Background: Non-alcoholic steatohepatitis (NASH) is an emerging etiology for hepatocellular carcinoma (HCC) and contributes to the increasing incidence of HCC worldwide. Patients with NASH often have risk factors of metabolic syndrome including hypertension, obesity, and type 2 diabetes (T2DM). NASH induced HCC has been shown to be associated with less response to immune check point inhibitors (ICIs) in HCC. Anti-diabetic agent metformin has been shown to be associated with improved outcomes in patients treated with ICIs in melanoma and non-small cell lung cancer. However, the impact of metformin on the efficacy of ICIs is not well defined in HCC. The main purpose of this study was to examine the effect of metformin on clinical outcomes in patients with advanced HCC treated with ICIs. Methods: We performed a retrospective analysis of patients with advanced HCC treated with ICIs in first and later-line settings between 2015 and 2021. The primary endpoints were overall survival (OS), progression free survival (PFS), and objective response rate (ORR) as assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Patients were stratified based on their usage of metformin. OS and PFS were analyzed using Cox proportional hazard models and Kaplan-Meier analysis with log-rank test. Results: A total of 111 patients met inclusion criteria, 18 patients in the metformin group and 93 patients in the non-metformin group. Most common cause of HCC was viral hepatitis (52%), followed by NASH (29%), alcohol (8%) and other (11%). Baseline characteristics between the two groups were similar except all patients in the metformin group had a diagnosis of T2DM. ORR was 5.6%. (1 partial response) in the metformin group vs 22.6% (5 complete responses, 16 partial responses) in the non-metformin group. Median OS was 45.9 months in the non-metformin group vs 10.8 months in metformin group (HR 1.99, 95% CI 0.95-4.21, p = 0.064). Median PFS of 6.6 months vs 2.5 months (HR 1.75, 95% CI 0.93-3.29, p = 0.077). Moreover, metformin usage was associated with shorter median OS of 10.8 months (HR 1.96, 95% CI 0.75-5.09, p = 0.16) vs 20.9 months among patients with T2DM. OS was significantly worse in patients with poor ECOG performance status 2-3, MELD score 10-23, higher grade tumor histology, AFP &gt; = 400, and use of IO in later lines of therapy. Conclusions: In this retrospective study metformin use was associated with worse clinical outcomes in advanced HCC patients treated with ICIs.

1132-P: Classification and Prediction of Diabetes Using Electronic Health Records and Wearable Devices for Clinical Decision Support

Introduction: Diagnosis of T2DM necessitates clinical tests that are time-consuming and expensive. Machine learning (ML) techniques can accelerate the diagnosis and classification of T2DM and allow clinicians to personalize treatments based on blood glucose concentrations (BGC) , physical fitness (PF) , and diabetes distress patterns observed in daily life. Analyzing electronic health records (EHR) , physiological variables collected with wearable devices, and patient-reported outcomes (PROs) using ML techniques can lead to the development of clinical decision support tools that provide a comprehensive picture of an individual’s diabetes management needs. Methods: Clinical experimental data (n=85, F:40/M:45, HbA1c: 7.83±2.16; age: 57±7.72: BMI: 33.kg/m2±6.72; means and SDs) were used to identify clusters of subjects based on medical tests, and ML models were developed using readily measured data to classify new subjects to the identified clusters. Latent variable methods and k-means clustering were used to identify clusters based on HbA1c, physical performance tests, and PROs. ML models, including logistic regression (LR) and support vector machines (SVM) , were developed to assign new subjects to the identified clusters using the readily measured input variables from wearable devices, EHR and PROs. Results: Three distinct subject clusters were identified within the study cohort based on the descriptive variables. New subjects were assigned to the identified clusters with 87% and 91% accuracy for LR and SVM, respectively. Conclusion: EHRs, wearable device data, and PROs can be used to accurately and conveniently identify a person’s overall BGC, PF, and diabetes distress to aid in clinical decision-making. In the future, clinical decision support tools can be developed for personalized treatment suggestions based on cluster membership. Disclosure A.Shahidehpour: None. C.Fritschi: None. M.Rashid: None. A.Cinar: None. L.T.Quinn: n/a.

128-LB: Real-World A1C Changes and Prescribing Provider Types among T2DM Patients Initiating Treatment with Once-Weekly (OW) Semaglutide

Purpose: Characterize A1c changes and characteristics among patients with T2DM initiating OW semaglutide (sema) , by baseline A1c ≥9% and &amp;lt;9%. Methods: Retrospective analysis using medical and pharmacy claims data between 01/01/2017-12/31/2020 from commercial and Medicare Advantage with Part D insurance enrollees, age 18+. Patients had ≥1 claim for OW sema (first claim=index date) , ≥1 T2DM diagnosis, continuous enrollment for 12 months before and including index (baseline) and 12 months after (follow-up) and were excluded if pregnant. Results were stratified by whether patient’s last baseline A1c value was ≥ or &amp;lt;9%. Results: Patients initiating OW sema with ≥1 baseline A1c value (n=7,653) had a mean age of 59 years, 51.4% were female, and 62.5% had commercial coverage. Among patients with baseline and follow-up A1c value (n=6,042) , mean A1c change was -0.8 (1.6) . Among a subset of patients with ≥90 days of continuous OW sema treatment and at least 1 A1c value after 90 days of treatment (n=3,456) , the A1c ≥9% group had a mean A1c reduction -2.5%. While many study patients had index claims prescribed by primary care and internal medicine providers (46.1% overall) , a higher percentage of patients with A1c &amp;lt;9% had OW sema prescribed by an endocrinologist (28.5% vs. 25.5%; p=0.008) . Conclusions: Results suggest that OW sema is an effective T2DM treatment in the real-world, especially among patients with A1c ≥9% prior to treatment initiation. Additionally, patients with T2DM in this study were more often prescribed OW sema by primary care physicians than by endocrinologists. Disclosure M. S. Frazer: None. C. Swift: Employee; Novo Nordisk. A. Sargent: None. M. Leszko: None. E. Buysman: None. S. B. Alvarez: Employee; Novo Nordisk, UnitedHealth Group. J. Noone: Employee; Novo Nordisk. C. L. Gamble: Employee; Novo Nordisk.

1012-P: Neighborhood Disadvantage, Childhood Opportunity Index, and Glycemic Control for Children with Type 1 Diabetes?

Background: Disparities in outcomes for children with type 1 diabetes (T1DM) are associated with poverty and race. However, little is known regarding the impact of systemic racism. Objective: This aim of this study is to determine if neighborhood concentrated disadvantage index (NCDI) or Childhood Opportunity Index (COI) are associated with HbA1c and diabetes ketoacidosis (DKA) in children ≤ 18 years of age with type 1 diabetes. Methods: The retrospective secondary data analysis included data from children ≤ 18 years of age with a diagnosis of T1DM for ≥ 6 months seen in 2017 who reside in Kentucky (n=675) . NCDI scores were calculated based on the NIH PhenX Toolkit protocol. The tool was developed from a principal components analysis of six variables at the census tract level. COI was obtained from diversitydatakids.org. Univariate analyses were performed using Kruskal-Wallis test or Pearson’s correlation. Multiple linear regression analysis was conducted to to evaluate HbA1C and multivariate Poisson model was used for DKA. Results: Prior to controlling for age, race, and insurance type, NCDI (p&amp;lt;0.001) and COI (p&amp;lt; 0.001) were significant predictors for HbA1c. For every 1 unit increase in COI, the predicted value of AIc level decreased by 8.66 (p=0.0004) . NCDI and COI were not significant when controlling for age, race, and insurance. NCDI and COI were not significant predictors of DKA episodes. Conclusions: This study identified NCDI and COI as predictors of HbA1c in children and adolescents with T1DM only in univariate analysis. While NCDI and COI have been shown to correlate with structural racism, these findings suggest that more research is needed in larger and more diverse samples to disentangle the complex relationships among race, racism, and poverty. Understanding the mechanisms through which racism impacts outcomes for children with T1DM is essential to improving health equity. Disclosure M.B.Coriell: None. K.S.Jawad: None. Y.B.Feygin: None. S.Watson: None. M.D.Stevenson: None. B.A.Wattles: Research Support; Merck &amp; Co., Inc. V.F.Jones: None. J.Porter: None. D.W.Davis: None.

DIABETIC STATUS AND NIGHT-TIME SYSTOLIC BLOOD PRESSURE PREDICT EARLY MYOCARDIAL DAMAGE IN NEWLY DIAGNOSED DIABETES MELLITUS TYPE 2 PATIENTS AS THIS IS DEPICTED BY GALECTIN-3 LEVELS

Objective: Long standing Diabetes Mellitus Type 2 (T2DM) shows a high frequency of cardiovascular events. However, it is not known if newly diagnosed patients with T2DM present early signs of cardiovascular dysfunction. On the other hand, galectin has been introduced as a novel biomarker of myocardial fibrosis. The aim of the study was to evaluate levels of galectin-3 in patients with a very recent diagnosis of T2DM without established cardiovascular disease. In addition, hemodynamic parameters as well as their possible correlation with galactin-3 levels were studied. Design and method: Patients with a recent diagnosis of T2DM (&lt;6 months) and non-T2DM volunteers were studied. A thorough medical history with emphasis on hypertension and relevant comorbidities, somatometric measurements and blood tests was obtained from all participants. Serum levels of galectin-3 were determined by ELISA. Myocardial function and hemodynamic profile were noninvasively assessed with impedance cardiography. Furthermore, Atherosclerotic Cardiovascular Disease Risk (ASCVD) was calculated. Results: We studied 135 subjects, 79 T2DM patients with a median disease duration of 1 month (IR: 5) and 56 controls matched by age, sex and hypertension. T2DM patients had significantly higher values of galectin-3 (90 ± 88ng/dl vs 32.92 ± 6.32ng/dl, p &lt; 0.001), Cardiac Output (CO), ASCVD Risk compared to controls. Galectin-3 was associated with T2DM (p &lt; 0.001), fasting glucose (p &lt; 0.001), glycosylated hemoglobin (p &lt; 0.001). Furthermore, galectin-3 was associated with CO (p = 0.023), nighttime systolic blood pressure (SBP) (p = 0.03) and ASCVD Risk (p = 0.001). In multiple linear regression analysis, T2DM (Beta: 0.406, p &lt; 0.001) and nighttime SBP (Beta: 0.196, p = 0.028), were identified as independent predictors of galectin-3, after adjustment for age, sex, Body Mass Index and CO. Conclusions: Galectin-3 is elevated in patients with early stage T2DM even in the absence of established cardiovascular disease, and is independently correlated with T2DM and nighttime SBP. In this group of patients galectin may be used as a biomarker of early myocardial damage. Nighttime SBP emerge as an important mediator in early target organ damage in cardiovascular diseases.

Conocimiento del cardiólogo clínico sobre diabetes mellitus tipo 2 de alto riesgo. ¿Qué sabemos y cómo podemos mejorar?

Introduction and objectivesType 2 diabetes mellitus (T2DM) is mainly a cardiovascular disease. The objective of this study was to assess the knowledge of clinical cardiologists about the diagnosis and management of T2DM in patients with ischemic heart disease or high/very high risk of cardiovascular disease. MethodsThe “self-audit” methodology was used. A scientific committee designed a questionnaire that was answered by the participants before and after viewing 4 training videos. The results between both moments were compared. ResultsA total of 140 clinical cardiologists non-expert in T2DM participated. Knowledge about the diagnosis and treatment of T2DM in patients with ischemic heart disease or high/very high risk of cardiovascular disease was good in some points, such as considering the body mass index to decide treatment, or the oral glucose load test in case of a glycosylated hemoglobin value of 5.8%-6.4%. After the training, establishing a control value of abdominal perimeter<88cm in women and<102cm in men, and a stricter control of arterial hypertension were significantly more valued, as did low-density lipoprotein cholesterol. Other aspects represent training opportunities, such as assessing the lipid profile more thoroughly or differentiating the cardiovascular protection profile of the different treatments of T2DM. ConclusionsThe clinical cardiologist's knowledge about the diagnosis and treatment of T2DM in patients with ischemic heart disease or high /very high risk of cardiovascular disease is high, but it presents opportunities for improvement and training.