Total Daily Insulin Dose Research Articles

FRI641 Assessing Insulin Prescription Adequacy At Hospital Discharge And Its Association With Characteristics Of Diabetic Patients

Abstract Disclosure: T. Akcan: None. S. Sharma: None. J. Liu: None. A. Jayarangaiah: None. M. Gilani: None. A. Surendran: None. N. Imamudeen: None. R. Gabor: None. R.D. Pathak: None. Diabetes is becoming increasingly prevalent, and appropriate insulin therapy during the post-discharge period is essential to improve glycemic control and reduce readmissions. Despite extensive research on insulin use during hospitalization, little is known about insulin dosing at discharge and patient factors that affect post-discharge needs. Therefore, this retrospective study aimed to evaluate the adequacy of insulin dosing at hospital discharge for diabetic patients and identify patient characteristics impacting post-discharge insulin requirements. Using a retrospective study design, we identified 350 patients meeting the inclusion criteria. The results showed that 19.1% of patients required a decrease in insulin total daily dose (TDD) at follow-up, 50.9% experienced no change, and 30.0% necessitated an increase. Factors found to impact insulin dose adjustments post-discharge include BMI, CKD, discharge TDD, and HbA1c levels. The multivariate analysis revealed that CKD was associated with a decrease in insulin TDD at follow-up (95% CI: -9.65- -0.47, p=0.031). Additionally, insulin TDD at discharge was negatively associated with follow-up dose, with a 0.37 unit decrease (95% CI: -0.44- -0.30, p<0.001) in insulin TDD for each additional unit prescribed. Finally, there was a marginal significance observed in the discharge regimen. Patients on a premixed regimen had a decrease in insulin TDD at follow-up compared to those on a basal-bolus regimen (95% CI: -21.85- 0.27, p=0.057). Our study findings suggest the need for improved estimation of insulin doses at discharge and emphasize the importance of short-term follow-up for insulin titration post-discharge. Patient factors such as body weight, kidney disease, insulin dose at discharge, and HbA1c levels influence these changes. These findings have significant implications for optimizing patient outcomes and reducing hospital readmissions, underscoring the importance of carefully evaluating these factors when tailoring individualized insulin regimens. Presentation: Friday, June 16, 2023

THU328 Appropriate Initial Insulin Dosage For Management Of Steroid-induced Hyperglycemia In Hospitalized COVID-19 Patients

Abstract Disclosure: N. Ketaroonrut: None. S. Kiertiburanakul: None. C. Sriphrapradang: None. Introduction: Steroid was recommended for the treatment of severe COVID-19 infection. There are limited studies on the management of steroid-associated hyperglycemia in hospitalized COVID-19 patients. We aimed to determine the appropriate initial insulin dosage to control hyperglycemia in hospitalized COVID-19 patients who received steroid therapy. Methods: We conducted a retrospective single-center analysis of electronic medical records of COVID-19 patients with steroid-induced hyperglycemia who had been treated with insulin. We divided the patients into 4 groups according to the total daily dose (TDD) of subcutaneous insulin therapy at the initiation of dexamethasone ≥6 mg/day or an equivalent dose of glucocorticoid. Glycemic outcomes were compared between groups. Results: A total of 156 patients [age 64±14 years; 50% men; body mass index 26.9±6.9 kg/m2; initial TDD of insulin (units/kg/day): group A, <0.29 (n=79); group B, 0.3-0.49 (n=33); group C, 0.5-0.69 (n=27); group D, >0.7 (n=17)] were included. Most patients (62%) had pre-existing type 2 diabetes. Mean admission blood glucose (BG) and HbA1c were 233±112 mg/dL and 7.8±2.3%, respectively. HbA1c was lowest in group A (6.7±1.2%) and highest in group D (9.8±2.5%). The average daily dexamethasone dosage or equivalent was 49.49±45.4 mg and there were no significant differences between the groups in the dexamethasone dose. The proportion of treatment failure (mean BG >280 mg/dL after the first day of insulin therapy or BG >400 mg/dL for at least 1 time/day) was lowest in group A. Among patients who received TDD >0.3 units/kg/day, group D had the lowest in both the percentage of treatment failure (B (52%) vs C (37%) vs D (29.4%), p=0.006) and mean BG during the 3 days of insulin therapy (B (246.0± 56.7 mg/dL) vs C (246.9±59.0 mg/dL) vs D (228.5±64.4 mg/dL), p=0.21). Three patients had severe hypoglycemia (BG <54 mg/dL) in this study (A: n=1 vs B: n=1 vs C: n=0 vs D: n=1, p=0.51). Conclusions: In the patients who require TDD >0.3 units/kg/day, the treatment failure of hyperglycemia was lowest in the patients who received TDD >0.7 units/kg/day without increasing severe hypoglycemia. This initial insulin dosage may guide physicians to achieve better glycemic control among hospitalized COVID-19 patients who received steroid therapy. Presentation: Thursday, June 15, 2023

FRI631 Insulin Antibody Mediated Extremely Insulin Resistant In Pregnancy

Abstract Disclosure: Z. Liu: None. D. James: None. S. Dagogo-Jack: None. Background: Insulin antibodies can rarely complicate diabetes management during pregnancy. Here, we report a patient with extreme insulin resistance during pregnancy associated with positive insulin antibodies. Clinical Case: A 40-year-old primigravida with Type 2 Diabetes (T2DM) was admitted at week 32 for uncontrolled Hypertension (HTN) and extremely high insulin requirement. T2DM was diagnosed 8 years ago and treated with basal insulin 50 units/d, dulaglutide, metformin, and glimepiride. Her HbA1c was 14% one month prior to pregnancy. During pregnancy, patient’s regimen was changed to basal bolus insulin, and oral agents were discontinued. Total daily insulin dose average 740 units (5.6 units/kg/day) at week 32. Patient’s weight was 112 kg at the beginning of pregnancy, increasing to 131 kg in the third trimester. On the high insulin regimen, her HbA1c was 5.6% at week 32. Due to the extreme insulin requirement (indicative of severe insulin resistance), we ordered insulin antibody (IAA), which came back positive at 15 µU/ml (NR <5 µU/ml). Diabetes control remained suboptimal, with frequent post-prandial hyperglycemia followed by hypoglycemia during hospitalization. Insulin regimen was optimized using U-500 in divided doses, starting with 112 units tid. At 34 weeks (hospital day 14), patient underwent cesarean section with delivery of a viable infant (weight 1450 grams, Apgar score 5 and 9 at 1 and 5 minutes). Shortly after delivery, the patient’s insulin requirement plummeted to 62 units daily and she was successfully discharged home. Diabetes control has been stable, with HbA1c ranging between 5.7% and 7% one year after delivery on total insulin dose of 60 units or less per day. Attempts to schedule patient for repeat antibody testing were unsuccessful. Conclusion: Despite the lack of data on repeat antibody testing, this is a compelling case of pregnancy associated extreme insulin resistance likely induced by insulin antibodies. Our conclusion is supported by the dramatic decrease in insulin requirement following postpartum. Presentation: Friday, June 16, 2023

Investigation of The Effect of Combined Exercises on Glycemic Control in Individuals with Type 1 Diabetes

The aim of the present study was to investigate the effect of the combined physical exercise protocols on the blood glucose (BG) of children with T1D. The study was conducted over four weeks using self-controlled clinical trials. The first two weeks were control period and the last two weeks were the experimental period. A total of 6 exercise sessions were performed 3 days a week during the experimental period. The exercise program consisted of aerobic, stretching, and resistance exercises. Each exercise session was performed for 40 minutes. A total of 15 children with T1D, whose mean age was 13.3±SD, were included in the study. The blood glucose and insulin dose data of the participants were recorded in both periods through the continuous glucose measurement system and the registry. It was determined that aerobic exercises provided a significant decrease in blood glucose (p < .05). There was no statistically significant difference between the mean BG values in the control (211.7±37.3) and experimental (208.7±40.4) periods (p >0.05). On the other hand, a statistically significant decrease was found in the total daily insulin doses used by participants during the experimental (31.6±20.8 Unit) period (p < 0.001). Physical exercises had an acute positive effect on blood glucose in children with T1D. However, the effect of exercise alone is not sufficient for chronic glycemic control in T1D. For chronic glycemic control, first of all, the injected insulin doses should be carefully regulated according to carbohydrates and exercise.

Assessing Time in Range with Postprandial Glucose-Focused Titration of Ultra Rapid Lispro (URLi) in People with Type1 Diabetes.

To assess time in range (TIR) (70-180mg/dL) with postprandial glucose (PPG)-focused titration of ultra rapid lispro (URLi; Lyumjev®) in combination with insulin degludec in people with type1 diabetes (T1D). This phase2, single-group, open-label, exploratory study was conducted in 31 participants with T1D on multiple daily injection therapy. Participants were treated with insulin degludec and Lispro for an 11-day lead-in and then URLi for a 46-day treatment period consisting of 35-day titration and 11-day endpoint maintenance period. Glucose targets for the titration period were PPG < 140mg/dL or < 20% increase from premeal, fasting glucose 80-110mg/dL, and overnight excursion ± 30mg/dL or less. Participants used the InPen™ bolus calculator and Dexcom G6 continuous glucose monitoring (CGM). Primary endpoint mean TIR (70-180mg/dL) with URLi during the maintenance period was 70.2%. TIR (70-180mg/dL) and times below/above range were not significantly different with URLi (maintenance) versus lispro (lead-in). HbA1c decreased from 7.1% at screening to 6.8% at endpoint (least squares mean [LSM] change from baseline, - 0.36%; P < 0.001). Fructosamine and 1,5-anhydroglucitol improved (P < 0.001). Mean hourly glucose using CGM was reduced from 8:00AM to 4:00PM with URLi. Overall highest PPG excursion across meals was significantly reduced at URLi endpoint compared with lispro lead-in (mean 56.5 vs 72.4mg/dL; P < 0.001). Insulin-to-carbohydrate ratio (U/Xg) was reduced (more insulin given) at breakfast at URLi endpoint vs lead-in (LSM 9.0 vs 9.7g; P = 0.002) and numerically decreased at other meals. Total daily insulin dose (TDD) was higher at URLi endpoint compared with lispro lead-in (mean 50.2 vs 47.0U; P = 0.046) with similar prandial/TDD ratio (mean 52.1% vs 51.2%). There were no severe hypoglycemia events during the study. URLi in a basal-bolus regimen focusing on PPG targets demonstrated improved overall glycemic control and reduced PPG excursions without increased hypoglycemia in participants with T1D. ClinicalTrial.gov, NCT04585776.

Safety Event Outcomes and Glycemic Control with a Hybrid Closed-Loop System Used by Chinese Adolescents and Adults with Type 1 Diabetes Mellitus.

Background: While evidence supports glycemic control benefits for individuals with type 1 diabetes mellitus (T1DM) using hybrid closed-loop (HCL) systems, HCL automated insulin delivery therapy in China has not been assessed. This study evaluated safety events and effectiveness during HCL system use by Chinese adolescents and adults with T1DM. Methods: Sixty-two participants (n = 12 adolescents with a mean ± standard deviation [SD] of 15.5 ± 1.1 years and n = 50 adults [mean ± SD of 37.6 ± 11.1 years]) with T1DM and baseline A1C of 7.1% ± 1.0% underwent a run-in period (∼2 weeks) using open-loop Manual Mode (sensor-augmented pump) insulin delivery with the MiniMed™ 770G system with the Guardian™ Sensor (3) glucose sensor, followed by a study period (4 weeks) with HCL Auto Mode enabled. Analyses compared continuous glucose monitoring data and insulin delivered during the run-in versus study period (Wilcoxon signed-rank test or t-test). Safety events included rates of severe hypoglycemia and diabetic ketoacidosis (DKA). Results: Compared to baseline run-in, overall Auto Mode use increased time in range (TIR, 70-180 mg/dL) from 75.3% to 80.9% (P < 0.001) and reduced time below range (TBR, <70 mg/dL) from 4.7% to 2.2% (P < 0.001). Subgroup analysis demonstrated that participants (n = 29) with baseline A1C <7.0% had TBR that reduced from 5.6% to 2.0%, while participants (n = 21) with baseline A1C ≥7.5% had time above range (TAR, >180 mg/dL) that reduced from 31.6% to 20.8%. Auto Mode use also increased the percentage achieving combined recommendations for time at sensor glucose ranges (i.e., TIR of >70%, TBR of <4% and TAR of <25%) from 24.2% at baseline to 77.4% at study end. Total daily insulin dose reduced from 42.8 ± 19.8 to 40.7 ± 18.9 U (P = 0.013). There were no severe hypoglycemic, DKA, or serious adverse events. Conclusions: Chinese adolescents and adults, some of whom met target A1C at baseline, safely achieved significantly improved glycemia with 1 month of MiniMed 770G system use when compared to open-loop insulin delivery. ClinicalTrials.gov ID: NCT04663295.

Correlation between Skinfold Thickness and Total Daily Dose of Insulin in Patient with Type 2 Diabetes Mellitus in Dr Soetomo General Hospital

Introduction: Type 2 diabetes mellitus (T2DM) is a non-communicable disease with a high prevalence in Indonesia. T2DM is caused by insulin resistance and relative insulin deficiency. One of the therapy for T2DM is insulin administration which is injected into the subcutaneous tissue. The absorption of insulin in the subcutaneous tissue is influenced by many factors, one of which is the thickness of subcutaneous fat. This study aimed to determine the correlation between the skinfold thickness of T2DM patients with the total daily dose of insulin needed every day. Methods: This was an observational analytic study using a cross-sectional design to analyze the correlation between subcutaneous fat thickness represented by skinfold thickness and the total daily dose of insulin of T2DM patients. Measurement of skinfold thickness was carried out on the triceps using a skinfold caliper. Data on the patient's total daily dose of insulin were obtained from medical records.Results: A total of 53 patients were included in this study. The patient's mean triceps skinfold thickness was 26.29±8.72 mm. The mean total daily dose of insulin was 40.96±18.01 IU. The results of the Spearman Rank correlation test showed a significant correlation between skinfold thickness on the triceps and the patient's total daily dose of insulin (p&lt;0.05). Conclusion: The higher the skinfold thickness, the greater the dose of insulin needed by the patient.

Antibodies to Glutamic Acid Decarboxylase-65 is Associated with Total Daily Dose of Insulin Requirement in Children with Type 1 Diabetes

BACKGROUND: Type 1 diabetes (T1D) mostly occurs due to the destruction of pancreatic beta cells due to autoimmune processes. Diagnosis of T1D can be established by examining the c-peptide levels and the markers of pancreatic autoantibodies, including glutamic acid decarboxylase 65 autoantibodies (GAD-65). However, the association between c-peptide and anti-GAD-65 toward patients’ clinical manifestations needs to be further explored. Hence, the aim of current study was to identify the association of anti-GAD65 with c-peptide and clinical characteristics in children with T1D.METHODS: Case-control study involving 47 T1D children (T1D group) and 41 healthy children (control group) younger than 18 years old was conducted. Secondary data regarding subjects’ demographic characteristics and medical history were collected from subjects, and serum blood was drawn from each subject for the anti-GAD65 and c-peptide measurement. Anti-GAD65 and c-peptide levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) methods.RESULTS: Anti-GAD65 antibody was detected in 78.7% T1D group, while only 2.43% were detected in control group subject (p=0.0000). The c-peptide level of T1D group was 0.07±0.19 nmol/L and control group was 1.5±0.77 nmol/L (p=0.0000). The total daily dose of insulin in subjects with positive anti-GAD65 was greater than in the negative anti-GAD65 (p=0.012). The sensitivity and specificity of the anti-GAD65 were 85.4% was 66.7%, respectively.CONCLUSION: The results of this study show that anti-GAD65 was associated with total daily dose of insulin requirement in children with T1D.KEYWORDS: diabetes mellitus, type 1 diabetes, anti-GAD65, c-peptide

The effects of large-scale social restriction during the covid-19 pandemic on glycemic control and occurrence of complications in children with type-1 diabetes mellitus

Background The global pandemic of severe acute respiratory syndrome caused by the coronavirus-2 (SARS-CoV-2) infection has resulted in a national large-scale social restriction (LSSR) to limit the spread of the virus.&#x0D; Objective To determine the impacts of LSSR on glycemic controls and the occurrence of complications in type-1 diabetes mellitus (T1DM) children. &#x0D; Methods A retrospective longitudinal study was carried out in Dr. Sardjito Hospital, Yogyakarta. Subjects were 0-18 years old T1DM patients diagnosed before the LSSR with at least six months of disease. Data on demographics, T1DM status, HbA1c level, and complications pre-LSSR, and during LSSR were taken from medical records. Paired T-tests were used to assess the difference in HbA1c level between the two-time points&#x0D; Results: We included information on 21 children based on the inclusion and exclusion criteria. Their median (range) age was 13.9 (1.42-17.3) years, with a median (range) diabetes duration of 2.6 (0.0-10.92) years. Glycemic control improved in 76% of the children. The mean HbA1c before and during LSSR was 10.9 (SD 2.7) and. 9.7 (SD 2.3), respectively; P&lt;0.05. The glycemic control was not associated with sex, age, duration of diabetes, travel time to the clinic, or a total daily insulin dose. There was also no significant difference in the occurrence of complications.&#x0D; Conclusion Despite limitations during LSSR, glycemic control improved in most patients with T1DM. This might be related to improved health awareness during the pandemic, more regular meals, and better parental control.

Hand grip strength is inversely associated with total daily insulin dose requirement in patients with type 2 diabetes mellitus: a cross-sectional study.

Short-term (2 weeks to 3 months) insulin intensive therapy using continuous subcutaneous insulin infusion (CSII) can improve islet beta cell function and prolong glycemic remission in patients with newly diagnosed type 2 diabetes mellitus (T2DM). However, the total daily insulin dose (TDD, IU/kg/d) required to achieve near-normoglycemic control with CSII still needs to be frequently adjusted based on blood glucose monitoring. Although real-time continuous glucose monitoring (rtCGM), which measures the interstitial fluid glucose concentration continuously without much difficulty, facilitates the adjustment of insulin dosage, its adoption in the T2DM population is strictly limited by insurance coverage and lack of awareness of rtCGM among clinicians. Thus, it is of clinical significance to identify easy-to-use parameters that may allow a more rapid and accurate prediction of TDD requirement. This study aimed to explore the association between hand grip strength (HGS) and TDD requirement in patients with T2DM receiving CSII therapy. A total of 180 eligible patients with T2DM were enrolled in the study and divided into three groups based on their HGS: low (L), medium (M), and high (H). The TDD requirement was calculated on day 7 or 8 of CSII treatment. Anthropometric parameters, including HGS, skeletal muscle mass, skeletal muscle index (SMI) and 6-m gait speed, and laboratory data, were collected on the morning of the second day after admission, within the first 24 h of CSII therapy. These parameters were used to identify significant predictors of TDD requirement using Pearson or Spearman correlation test, and stepwise multiple regression analysis. There were no significant differences in age, duration of T2DM, waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, liver function, estimated glomerular filtration rate, triglyceride, total cholesterol, glycosylated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment of beta cell function (HOMA-β) among the groups. The H group had higher body muscle mass-to-fat ratio (BMFR), skeletal muscle mass-to-fat ratio (SMFR), SMI, 6-m gait speed, and lower TDD requirement than the M and L groups. The HGS negatively correlated with TDD requirement (r = -0.33, p < 0.001) after adjusting for sex, age, BMI, WHR, HbA1c, Ln (HOMA-β), Ln (HOMA-IR), Ln (BMFR), Ln (SMFR), SMI, and 6-m gait speed. Multivariate stepwise regression analysis indicated that HGS was an independent predictor of TDD requirement in patients with T2DM (β = -0.45, p < 0 001). Lower HGS is associated with an increased TDD requirement in T2DM patients. HGS may facilitate the prediction of TDD requirement in T2DM patients receiving CSII therapy.

Association of Smartphone-Based Activity Tracking and Nocturnal Hypoglycemia in People With Type 1 Diabetes.

Nocturnal hypoglycemia (NH) remains a major burden for people with type 1 diabetes (T1D). Daytime physical activity (PA) increases the risk of NH. This pilot study tested whether cumulative daytime PA measured using a smartphone-based step tracker was associated with NH. Adults with T1D for ≥ 5 years (y) on multiple daily insulin or continuous insulin infusion, not using continuous glucose monitoring and HbA1c 6 to 10% wore blinded Freestyle Libre Pro sensors and recorded total daily carbohydrate (TDC) and total daily dose (TDD) of insulin. During this time, daily step count (DSC) was tracked using the smartphone-based Fitbit MobileTrack application. Mixed effects logistic regression was used to estimate the effect of DSC on NH (sensor glucose <70, <54 mg/dl for ≥15 minutes), while adjusting for TDC and TDD of insulin, and treating participants as a random effect. Twenty-six adults, with 65.4% females, median age 27 years (interquartile range: 26-32) mean body mass index 23.9 kg/m2, median HbA1c 7.6% (7.1-8.1) and mean Gold Score 2.1 (standard deviation 1.0) formed the study population. The median DSC for the whole group was 2867 (1820-4807). There was a significant effect of DSC on NH episodes <70 mg/dl. (odds ratio 1.11 [95% CI: 1.01-1.23, P = .04]. There was no significant effect on NH <54 mg/dl. Daily PA measured by a smartphone-based step tracker was associated with the risk of NH in people with type 1 diabetes.

Switching from Multiple Insulin Injections to a Fixed Combination of Degludec and Liraglutide in Patients with Type 2 Diabetes Mellitus: Results from the Simplify Study After 6Months.

This study aimed to evaluate the effectiveness and safety of switching from basal bolus insulin treatment (BBIT) to a fixed combination of insulin degludec and liraglutide (IDegLira) in patients with type 2 diabetes mellitus (T2DM) who had preserved insulin secretion but inadequate glucose control. The study also aimed to assess the feasibility of implementing this therapeutic approach in common clinical practice settings. This was a non-randomized, open-label, multicenter, prospective, single-arm study involving 234 patients with T2DM who were receiving BBIT. Inclusion criteria were duration of diabetes mellitus > 60months, stable total daily dose of insulin (TDDI) ranging from > 20 to < 70IU/day (approx. > 0.3 to < 0.7IU/kg body weight/day), C-peptide levels > 10% above the lower limit, HbA1c levels > 7% and < 10% (Diabetes Control and Complications Trial), and body mass index > 25kg/m2. The primary endpoints were changes in glycated hemoglobin (HbA1c) and body weight at week 28 after treatment switching. Secondary endpoints included changes in the 7-point glycemic profile, hypoglycemia frequency, blood pressure, blood lipids, liver enzymes, insulin dose, and a patient questionnaire focusing on treatment satisfaction, concerns and impact on daily activities. A subgroup of 55 patients underwent continuous glucose monitoring (CGM) with the evaluation of CGM-derived parameters, such as time in range (TIR), time above range (TAR), time below range (TBR), hypoglycemia, and glucose variability. A significant decrease in HbA1c (8.6% vs. 7.6%; p < 0.0001) and body weight (97.8 vs. 94.0kg; p < 0.0001) was observed at week 28 after treatment switching. Significant improvements were also seen in all measurements of the 7-point glycemic profile (p < 0.0001), reduction in the number of hypoglycemia episodes per patient, and the proportion of patients with at least one hypoglycemia event (p < 0.001). Furthermore, there was a significant decrease in daily insulin dose (55.6 vs. 32.7IU/day; p < 0.0001), as well as improvements in blood pressure, blood lipids, and liver enzymes (gamma glutamyl transferase and alanine aminotransferase). The subgroup of patients who underwent CGM showed a significant increase in TIR (57.9% vs. 69.0%; p < 0.01) and a decrease in TAR (40.1% vs. 28.8%; p < 0.01), while TBR, hypoglycemia (number of episodes per patient and proportion of patients), and glucose variability did not change significantly. The results of this study suggest that switching from BBIT to IDegLira in patients with T2DM and preserved insulin secretion can simplify treatment without compromising glycemic control. The switch to IDegLira was associated with significant improvements in various glucose control parameters, including HbA1c, glycemic profile, hypoglycemia, insulin doses, and CGM-derived parameters TIR and TAR. Additionally, it led to significant reductions in body weight, blood pressure, lipid profile, and liver enzyme levels. Switching to IDegLira may be considered a safe and beneficial approach in clinical practice settings, offering metabolic and individual advantages.

Combined CFTR modulator therapies are linked with anabolic benefits and insulin-sparing in cystic fibrosis-related diabetes

AimsCombined CFTR modulator therapies have dramatically altered pulmonary outcomes in patients with cystic fibrosis (CF). Their impact on glucose metabolism requires further investigations. This study aims to evaluate insulin requirements after initiation of combined CFTR modulator therapy in patients with CF-related diabetes (CFRD) and HOMA indices changes in CF patients without diabetes. MethodsWe retrospectively analyzed: 1) the effects of tezacaftor + ivacaftor and elexacaftor + tezacaftor + ivacaftor on FEV1, weight, BMI, HbA1c, and daily insulin dose, in 17 CFRD patients and 2) the impact of tezacaftor + ivacaftor on HOMA indices in 15 CF patients without diabetes. ResultsAge was 37±12y in the CFRD group (70% men), 88% of whom were homozygous for F508del mutation. Diabetes duration was 15±10y. Median duration of combined CFTR modulator therapy was 16 months (IQR: 4) Thirteen patients received tezacaftor + ivacaftor, of whom 9 were switched to elexacaftor + tezacaftor + ivacaftor. Four patients received elexacaftor + tezacaftor + ivacaftor up front. A decrease in insulin needs was noticed in 88% of patients (0.85±0.3 vs 0.71±0.3U/kg/day; p = 0001). Total daily insulin dose decreased from 50±16 to 44±20U/day (p = 0.017). BMI improved (20.9 (IQR: 1.90) vs 22.1 kg/m2 (IQR: 3.70); p = 0.014). HbA1c went from 7.3±1.1 to 7.7±1.6% (p = 0.072). Median age was 22y (IQR: 11) in the CF group without diabetes (67% men), 93% of whom were homozygous for F508del mutation. Duration of combined CFTR modulator therapy was 10±5 months. HOMA-B changes were not significant (129.2 (IQR: 84.8) vs 103.5% (IQR: 66.3) nor were HOMA-S changes (from 94±64 to 95±49%). HOMA-BxS decreased from 112±45 to 104±29% (NS). BMI rose from 21.9±3 to 23.1±3.5 kg/m2 (p = 0.047). HbA1c was unchanged (5.0±0.5%). FEV1 improved in both groups (+11% and + 7% of predicted value; p < 0.001; p = 0.013). ConclusionCombined CFTR modulator therapies are correlated with a decrease in insulin doses and positive effects on BMI and FEV1. HOMA indices did not change on tezacaftor + ivacaftor among CF patients without diabetes.

1851-PUB: Intractable Diabetic Ketoacidosis with Enfortumab Vedotin

Enfortumab Vedotin (EV) is an antibody-drug conjugate for metastatic urothelial carcinoma. Hyperglycemia and diabetic ketoacidosis (DKA) have been reported in patients using EV. The incidence increases with higher BMI. The one case report available on the association between EV and DKA resulted in development of multiorgan failure and death. This case, however, describes a positive outcome with recovery from DKA. We present a case of a 59 year-old Caucasian woman with morbid obesity, prediabetes and recurrent metastatic urothelial cell carcinoma who presented with hyperglycemia after 2 doses of EV. Labs were indicative of DKA without an infectious etiology. She was admitted to the ICU for intravenous insulin drip treatment. Hyperglycemia and ketosis persisted despite using a maximum insulin drip rate of 60 units/hour. Starvation ketosis was a factor, so a diet was started. On day 2, NPH insulin and prandial lispro were added along with the insulin drip, resulting in a total daily insulin dose of 1660 units. Nevertheless, hyperglycemia persisted. U-500 regular insulin was initiated and by day 4, the patient received a total of 2940 units of insulin in one day with normalized serum ketones. Insulin drip requirements decreased with blood glucose controlled solely on subcutaneous insulin. She remained euglycemic, so U-500 insulin was switched to daily glargine. Eventually, she was off all insulin and maintained blood glucose below 130 mg/dL. Work up for insulin resistance included a C-peptide of 42.6 ng/mL (normal 1.1-4.4) with glucose of 230 mg/dL, negative glutamic acid decarboxylase 65 and insulin antibodies, and a glucagon level of 213 pg/mL (normal ≤80) with glucose of 220 mg/dL. Although the mechanism by which EV causes hyperglycemia is not known, this case illustrates that hyperglycemia was due to severe insulin resistance associated with EV. Understanding this, along with glycemic effects of targeted therapies with Vedotin are necessary to investigate the causal mechanism and treatment for EV related hyperglycemia/DKA. Disclosure A.Elahi: None. J.Duron: None. T.Porter: None.

606-P: The Effect of a Dietary Intervention on Insulin Requirements in Type 1 Diabetes—A 12-Week Randomized Clinical Trial

Background and Objective: A plant-based has been shown to improve glycemic control and insulin resistance in people with type 2 diabetes. The aim of this study was to test the effect of this diet in people with type 1 diabetes. Methods: Fifty-eight people with type 1 diabetes were randomly assigned to follow a low-fat vegan diet (vegan group, n=29), or a standard portion-controlled diet (control group, n=29) for 12 weeks. All meals were tracked, using the Cronometer mobile application. Insulin sensitivity was assessed, using the carbohydrate to insulin ratio, which was calculated as the number of grams of total dietary carbohydrate to total units of insulin administered. Total insulin dose was calculated as a sum of basal and bolus insulin units injected per day. Results: The consumption of carbohydrates increased in the vegan group by an average of 118 g/day (p=0.002), compared with no significant change in the control group (−18 g/day; p=0.11; treatment effect +137 [95% CI, +65 to +208]; p&amp;lt;0.001). Insulin sensitivity, assessed by the carbohydrate to insulin ratio, increased in the vegan group by 6.2 on average (p=0.002), compared with no significant change in the control group (−0.8; p=0.32; treatment effect +7.0 [95% CI, +3.1 to +10.9]; p=0.001). Total daily dose of insulin decreased by 12.1 units/day in the vegan group (p=0.007), compared with no significant change in the control group (−18 units/day; p=0.66; treatment effect −10.7 [95% CI, −21.3 to −0.2]; p=0.046). Conclusions: This study suggests that a low-fat vegan diet may have beneficial effects on insulin sensitivity and insulin requirements in people with type 1 diabetes. Larger trials are needed to confirm these findings. Trial Registration: ClinicalTrials.gov, NCT04944316 Disclosure H.Kahleova: None. Funding Physicians Committee for Responsible Medicine (330072)

161-LB: Diagnosis and Treatment of Diabetes Mellitus in Pediatric Patients with Pancreatitis Followed in a Multidisciplinary Clinic

Children with recurring acute or chronic pancreatitis are at risk for pancreatitis related diabetes mellitus (DM). Pancreatic endocrine and exocrine concerns are managed by different subspecialists. Our center has a unique pediatric pancreatitis multidisciplinary clinic (MDC) with pediatric gastroenterology, endocrinology, pain, and nutrition experts. We obtain point-of-care (POC) HbA1c during clinic check-in for immediate DM screening. Our study describes the utility of POC HbA1c testing in our MDC. We analyzed a retrospective chart review of MDC patients from 2018-2023 with a diagnosis of pancreatitis and DM (n=27). Twelve were diagnosed with DM prior to presentation and 2 presented after total pancreatectomy with islet autotransplantation (TPIAT). Eight patients eventually developed DM and 5 later underwent TPIAT resulting in DM. We evaluated baseline characteristics at presentation to our MDC and longitudinal follow up. Of the 12 patients with previously diagnosed DM, 42% were Hispanic/Latino, 50% were female. On presentation to the MDC, patients were 15.4±2.1 years old with BMI 23.2±4.0 kg/m2 and HbA1c 9.6±2.9%. Eight patients developed DM within 1.1±1.2 years of follow up. Six were diagnosed by POC HbA1c in our MDC. Of all whom developed DM, 88% were Hispanic/Latino, 88% were female. DM was diagnosed at 14.3±1.6 years old with BMI 34.5±4.8 kg/m2 and HbA1c 8.5±2.5%. Of our 27 patients with DM, 4 had type 1 DM autoantibodies. At most recent visit HbA1c was 8.9±3.2%. DM treatment involved oral agents (15%), insulin (85%) and nutrition counseling for all patients. Total daily dose of insulin was 0.75±0.53 u/kg/day and 48% of patients used continuous glucose monitors. Instituting POC HbA1c screening in pancreatitis clinic identifies patients with new onset DM, supporting multidisciplinary care. Despite intensive care, HbA1c for these patients remains above guideline goals. More research is needed in providing DM care for children with pancreatitis. Disclosure E. Vargas: None. J. Mark: None. G. P. Forlenza: Advisory Panel; Medtronic, Consultant; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Lilly Diabetes, Research Support; Medtronic, Abbott, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. T. M. Triolo: None.

888-P: Urinary Albumin Levels Prior to SGLT2 Inhibitors Initiation Predict Increased TIR after 12 Months in Patients with Type 1 Diabetes on Sensor-Augmented Pump Therapy

Purpose: SGLT2 inhibitors (SGLT2i) have been shown to improve glycemic control in patients with type 1 diabetes (T1D). Predictors of SGLT2i efficacy in patients with T1D on sensor-augmented pump (SAP) therapy were investigated. Methods: Patients with T1D on SAP therapy attending our hospital who were newly initiated on SGLT2i between 2019-2020 and followed for at least one year, were included in the study. Data on BMI, blood tests, and continuous glucose monitors were compared before and 12 months after SGLT2i initiation. The predictors of time in range (TIR) change (ΔTIR) were determined by multiple regression analysis. The cutoff values for predictors of ΔTIR above the median at the end of the study were determined using ROC curve analysis. Results: 17 patients (70.6% females, median age 44.0 years) were included in the analysis, except for three patients who discontinued SGLT2i due to side effects. Median BMI and eGFR decreased significantly from 25.3 kg/m2, and 79.0 ml/min/1.73m2 at baseline to 23.9 kg/m2, and 73.0 ml/min/1.73m2 (p = 0.013, p = 0.002, respectively), while total daily dose of insulin, basal-to-total insulin ratio, and urinary albumin-to-creatinine ratio (UACR) showed no significant change (40.1 vs 41.0 units [p = 0.084], 40.1 vs 38.5% [p = 0.266], 7.0 vs 2.0 mg/g [p = 0.285], respectively). HbA1c, TIR, and TAR improved significantly (8.2 vs 7.8% [p = 0.004], 53.0 vs 61.0% [p = 0.003], and 47.0 vs 36.0% [p = 0.003], respectively), while TBR showed no significant change (0.4 vs 0.8% [p = 0.309]). Predictors of increased ΔTIR were overweight and high UACR at baseline (p = 0.026) and the cutoff value for UACR that predicted ΔTIR above the median was 28.0 mg/g (AUC = 0.82 [95%CI, 0.61-1.03]; p = 0.003). Conclusion: SGLT2i improved glycemic control of patients with T1D on SAP therapy without increasing TBR. It was also suggested that patients with UACR above 28.0 mg/g could have greater impact on TIR improvement after 12 months. Disclosure Y.Suganuma: None. H.Takahashi: Speaker's Bureau; Eli Lilly Japan K.K., Boehringer Ingelheim Japan, Inc., Medtronic, Novo Nordisk. T.Ohno: None. R.Nishimura: Speaker's Bureau; Sanofi K.K., Medicure Inc., Boehringer Ingelheim Inc., Takeda Pharmaceutical Company Limited, Kissei Pharmaceutical Co., Ltd., Novartis Pharma K.K., Eli Lilly Japan K.K., Novo Nordisk, Merck &amp; Co., Inc., Abbott Japan Co., Ltd., Astellas Pharma Inc., Teijin Pharma Limited, Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., AstraZeneca.

1371-P: Factors Influencing the Development of Polycystic Ovary Syndrome in Premenopausal Women with Type 1 Diabetes

Objective: Polycystic ovary syndrome (PCOS) is common in women with type 1 diabetes (T1D). Reported prevalence rates vary according to diagnostic criteria used for PCOS. However, not all women with T1D develop hyperandrogenic traits and factors that influence the occurrence of PCOS have not been well stablished yet. We aim to assess the factors associated to the occurrence of PCOS in premenopausal women with T1D. Methods: Cross-sectional study. For this analysis, we included 110 patients with T1D, 24 diagnosed with PCOS by ESHRE/ASRM-Rotterdam criteria (prevalence: 22%, 95%CI: 15-30%). Women aged 18 to 45 years were consecutively recruited from a Diabetes Clinic at a tertiary hospital in Madrid, Spain. All participants were under intensive insulin treatment, had been diagnosed with T1D at least 1 year ago, and had a gynecological age of at least 2 years. A comparison between both groups T1D-PCOS and T1D-without PCOS was performed. We used Stata software v23 (StataCorp LLC) for statistical analysis. Results: Mean age was 30.3 ± 8.7 yrs and mean HbA1c was 7.31 ± 1.4%. Three-quarters (75%) of these patients were on multiple insulin doses. Women with T1D and PCOS were younger than those without PCOS (26.3 ± 7.4 in DM1-PCOS vs 31.2 ± 8.7, P &amp;lt; 0.05). Total daily insulin dose (TDI) was higher in T1D-PCOS group compared to T1D-without PCOS (0.71 ± 0.35 vs 0.58 ± 0.19, P = 0.025). There was a trend towards a more common premenarcheal diagnosis of T1D in T1D-PCOS (62.5% vs 46.5%, P = 0.116). Age (OR: 0.93, P = 0.016) and TDI (OR: 7.84; P = 0.043) were significant predictors of PCOS in the univariate logistic regression analysis. After introducing these variables in a multivariate regression analysis, only age was retained as a significant predictor factor of PCOS in women with T1D (OR: 0.93; P = 0.040). Conclusions: In this study, premenopausal women with T1D and PCOS were younger, used higher daily insulin doses and tend to have a more common premenarcheal diagnosis of T1D as compared to T1D women without PCOS. Disclosure A.Bayona: None. L.Nattero-chávez: None. M.De la calle de la villa: None. E.F.Durán: None. B.Dorado avendaño: None. M.Luque-ramírez: None. H.F.Escobar-morreale: None.

921-P: Improved Glycemic Control in Pregnancy Using Continuous Subcutaneous Infusion of Concentrated Insulin

Maternal and fetal complications are high in preexisting uncontrolled type 2 diabetes mellitus (T2DM). There is limited data on the use of concentrated insulin in continuous subcutaneous insulin infusion (CSII) during pregnancy. We report a case of 22-year-old woman G4P0030 with T2DM since 10 years of age who was admitted for preterm premature rupture of membrane at 26 weeks gestation. Preconception HbA1c was 12.1% on metformin, and basal bolus insulin. Severe hyperglycemia following betamethasone administration for fetal lung maturity required insulin drip initially which was transitioned to basal bolus insulin. Despite total daily insulin dose &amp;gt;480 units, glucose control was suboptimal. Decision was made to initiate CSII with basal U-500 concentrated regular insulin and U-100 prandial insulin injections. She was started on Dexcom for CGM and Omnipod Dash with basal rate 1.3 units/hour (6.5 units/hour U-500), insulin sensitivity factor 27 mg/dl (5.4 mg/dl with U-500), carb ratio 1 unit lispro to 2 g. Glycemic control improved as noted in CGM even after adjusting the pregnancy target (70-140mg/dl). Patient delivered a male infant (2090 grams) by emergency C-section at 30 weeks gestation due to preterm labor with fetal malpresentation. She was discharged home with U-100 basal bolus insulin regimen on day 3 postpartum. Concentrated insulin in CSII is effective for uncontrolled T2DM in pregnancy. Disclosure N.Mon: None. S.Krishnasamy: None.

330-OR: Healthy Eating Index Correlates with Better Glycemic Control among People with Type 1 Diabetes

The amount and type of food consumed impacts glycemic response and insulin needs of people with type 1 diabetes (T1D). Day to day variation in types of foods consumed or diet quality may acutely impact glycemic levels and insulin needs within an individual with T1D. As part of the Type 1 Diabetes Exercise Initiative (T1Dexi), we examined the impact of overall daily diet quality on glycemic control. Diet quality was assessed by the Healthy Eating Index-2015 (HEI) where a score of 100 indicates highest quality diet characterized by intake of more vegetables, fruits, and whole grains and less intake of saturated fat and added sugar. Dietary intake was captured on up to 12 different days per participant during the one-month study via food photography with the T1Dexi app. Food photos were analyzed for nutrient intake by the Remote Food Photography Method. Mean HEI score for all participants was 57, similar to the general US population. Each day of dietary intake was classified as low (HEI≤57) or high (HEI&amp;gt;57) within a participant and only participants with at least two low and two high HEI days were included in the analysis. CGM and insulin metrics were compared using a linear mixed effect model with a random subject effect. Participants (n=223) were 19-68 years (37±14 years), 76% identified as female, had a mean HbA1C of 6.6±0.7 and a mean body mass index of 25.1±3.6. On high HEI days (mean score: 66±4), total time in range (70-180 mg/dl) was greater (77.2±14% vs 75.7±14% p=0.01), while time above 180 mg/dl (19±14% vs 21±15%, p=0.01) and mean glucose (143±22 vs 145±22 mg/dl, p=0.02) were lower compared to low HEI days (mean score: 47±5). Total daily insulin dose was lower on high HEI days (0.52±0.18 vs 0.54±0.18 U/kg/day p=0.01). Higher diet quality correlates with improved glycemia and lowered insulin needs during that 24-hour period of time within an individual T1D participant but the impact of diet quality was smaller than the impact of exercise and represents an incremental improvement among well-controlled subjects. Disclosure M.B.Gillingham: None. T1dexi study group: n/a. C.Marak: None. P.Calhoun: None. K.E.Neubig: None. S.R.Patton: None. J.R.Castle: Advisory Panel; Novo Nordisk, Zealand Pharma A/S, Research Support; Dexcom, Inc., Stock/Shareholder; Pacific Diabetes Technologies. P.G.Jacobs: Board Member; Pacific Diabetes Technologies, Other Relationship; Pacific Diabetes Technologies, Research Support; Dexcom, Inc. R.L.Gal: None. C.K.Martin: Board Member; EHE Health, Wondr Health, Other Relationship; ABGIL, Research Support; Pack Health, Evidation Health, Lilly, WW International, Inc. Funding The Leona M. and Harry B. Helmsley Charitable Trust; Verily Life Sciences; Dexcom, Inc.