Weight Watchers Research Articles

Twelve-month analysis of real-world evidence from a telehealth obesity-treatment provider using antiobesity medications.

The objective of this study was to describe weight changes in members of a large-scale telehealth obesity-treatment provider who were using antiobesity medications (AOMs). This retrospective observational study analyzed real-world data from adults who initiated AOM treatment with the WW International, Inc. (formerly Weight Watchers) Clinic telehealth program between January 2022 and July 2023 (n = 53,590). The main outcomes were changes in body weight over 12 months, side effects over follow-up, and medication usage patterns. The 53,590 patients who initiated treatment were predominantly female (88.6%), with a mean BMI of 36.9 kg/m2. Mean (SD) treatment duration was 5.3 (4.3) months. Program retention rates based on the number of patients whose time from enrollment was at least 3, 6, 9, and 12 months were 78% (n = 39,907/51,247), 63% (n = 25,515/40,203), 58% (n = 15,472/26,794), and 77% (n = 6459/8394), respectively. Average weight loss was 8.9% at 3 months (n = 37,565), 14.1% at 6 months (n = 24,140), 17.7% at 9 months (n = 15,169), and 19.4% at 12 months (n = 6089). Glucagon-like peptide-1 receptor agonist (GLP-1-RA)-based treatments were predominant. Side effects were consistent with the classes of medications used, and frequency declined over time. This real-world analysis of a telehealth-delivered obesity-treatment program demonstrated outcomes consistent with recent phase 3 clinical trials of AOMs, suggesting generalizability beyond clinical trial and in-person settings.

7700 Two Years Of Testosterone Therapy Reduces Glycemia In Males At High Risk Of Type 2 Diabetes Without Affecting Beta Cell Function: Results From A Randomised Controlled Trial And Cellular Model

Abstract Disclosure: M. Umapathysivam: None. S. Nawaz: None. K. Robledo: None. C.A. Allan: None. K. Bracken: None. M. Grossmann: None. D.J. Handelsman: None. W.J. Inder: None. D. Jesudason: None. B. Stuckey: None. B. Yeap: None. A. Januszewski: None. A. Jenkins: None. A. Conway: None. B. Hastoy: None. G.A. Wittert: Consulting Fee; Self; I-Nova. Grant Recipient; Self; Lawley pharmaceuticals, Bayer, Weight Watchers, Eli Lilly & Company. Speaker; Self; Bayer, Inc., Amgen Inc, Besin Health Care. Background: In the Testosterone for the prevention of type 2 diabetes (T4DM) Study, treatment with testosterone (T)-undecanoate (1000 mg IM 3 monthly) vs placebo decreased fat mass and reduced the risk of T2D by 40% after 2 years. However, the mechanism(s) by which T therapy prevents or reverts T2D remain unclear. Aim: To assess (1) the impact of T treatment on insulin resistance (IR) and beta-cell function in the T4DM study and (2) the in-vitro effect of graded T exposure on glucose stimulated insulin secretion (GSIS) from the human beta-cell line EndoC-βH1. Methods: (1) T4DM study: Men (n= 1007) from the T4DM study aged, 50-74 years, waist circumference (WC) >95cm, with prediabetes, or newly diagnosed T2D (by OGTT) and serum testosterone (T) ≤ 14 nmol/L (chemiluminescent assay) treated with T-undecanoate (1000 mg IM 3 monthly) or placebo for 2 years. Men were included if they had fasting bloods at baseline, weeks 18, 66, and 102 (N=743). We compared the change in glycated albumin, and derived measures of beta-cell function (HOMA2-B) and insulin resistance (HOMA-IR) using fasting glucose and c-peptide in T and placebo treated men using linear regression models.(2) EndoC-βH1 were incubated with T 5nM, 10nM and 15nM for 20 min and 15nM T for 2-days. Insulin secretion and content were measured at baseline (1mM glucose) and after 20 min exposure 20mM glucose. Results: Treatment with T compared to placebo reduced glycated albumin (-3.4 umol/L; 95%CI:1.4-5.4, p<0.001) maximally at week 66, along with C-peptide (corrected for baseline C-peptide and change in fasting glucose) (-0.12 nmol/L;-0.22,-0.02; p=0.01), HOMA2-B (-6.1; 95%CI: -16, 3.7; p=0.2) and HOMA-IR (-0.20; 95%CI: -0.59,0.20; p=0.3). In-vitro, acute exposure of EndoC-βH1 to 5nM and 10nM of T had no effect on GSIS, and 15nM T reduced GSIS (<20%, p=0.002). T, at 15nM for 2 days was without effect on GSIS. EndoC-βH1 insulin content was not altered at any concentration or timeframe of T exposure. Conclusion: In men with pre-diabetes or early T2D, T treatment reduces glycemia without evidence either in vivo or in-vitro of an affect to increase insulin secretion. Presentation: 6/1/2024

Family functioning and the implications for adult weight management.

Strong support for family-based interventions in child and adolescent weight management exists. However, family-based interventions have not been as well documented in adult populations. Given that many adults operate within family systems that could influence their weight management behaviors, research is needed to establish possible family-level variables as intervention targets for adult weight loss programs. This study tested the relationship between family functioning (defined as support and bonding), chaos (defined as disorder in the home), and weight loss in adults with overweight or obesity participating in a behavioral weight-loss program. Participants (N = 118; baseline mean body mass index 33.8 ± 3.7; 69.5% female; 97.5% White; 67.8% with a combined annual income of $75k or above; 90.7% completed some college or above) were from a randomized controlled trial examining weight loss ripple effects (Gorin et al., 2018) in individuals assigned to either 6 months of WW (formerly Weight Watchers) or a self-guided approach. Higher family support and bonding at baseline were associated with greater percent weight loss at 6 months. Family support and bonding at baseline were associated with lower chaos in the home at 6 months. However, this was moderated by condition such that this association was significant in the WW but not the self-guided group. Results provide theoretical support that targeting family dynamics may improve weight loss outcomes in behavioral weight loss programs for adults. Future research should test whether family support, bonding, chaos, or other related variables such as family cohesion and adaptability-focused interventions improve weight loss outcomes for adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cross-model validation of public health microsimulation models; comparing two models on estimated effects of a weight management intervention

BackgroundHealth economic modelling indicates that referral to a behavioural weight management programme is cost saving and generates QALY gains compared with a brief intervention. The aim of this study was to conduct a cross-model validation comparing outcomes from this cost-effectiveness analysis to those of a comparator model, to understand how differences in model structure contribute to outcomes.MethodsThe outcomes produced by two models, the School for Public Health Research diabetes prevention (SPHR) and Health Checks (HC) models, were compared for three weight-management programme strategies; Weight Watchers (WW) for 12 weeks, WW for 52 weeks, and a brief intervention, and a simulated no intervention scenario. Model inputs were standardised, and iterative adjustments were made to each model to identify drivers of differences in key outcomes.ResultsThe total QALYs estimated by the HC model were higher in all treatment groups than those estimated by the SPHR model, and there was a large difference in incremental QALYs between the models. SPHR simulated greater QALY gains for 12-week WW and 52-week WW relative to the Brief Intervention. Comparisons across socioeconomic groups found a stronger socioeconomic gradient in the SPHR model. Removing the impact of treatment on HbA1c from the SPHR model, running both models only with the conditions that the models have in common and, to a lesser extent, changing the data used to estimate risk factor trajectories, resulted in more consistent model outcomes.ConclusionsThe key driver of difference between the models was the inclusion of extra evidence-based detail in SPHR on the impacts of treatments on HbA1c. The conclusions were less sensitive to the dataset used to inform the risk factor trajectories. These findings strengthen the original cost-effectiveness analyses of the weight management interventions and provide an increased understanding of what is structurally important in the models.

Promoting dietary self-efficacy through social support: An application to online weight-loss communities

An increase in the number of individuals trying to lose weight has enabled the development of online weight-loss support communities (Weight Watchers, Dukan, etc.). This research aims to study whether and how social support in these communities affects dietary self-efficacy to improve individuals’ food well-being. After an initial qualitative study with 25 community users, we formulated hypotheses and tested them in a quantitative study involving 335 users. The results show that social support contributes to dietary self-efficacy through two sequential mediators: identification with community members and motivation to comply with group norms. Our analyses also show that nutritional knowledge moderates the relationship between motivation to comply and dietary self-efficacy. The results of these two studies enrich the literature on online communities and allow us to suggest managerial recommendations for administrators of these communities and health professionals.

1643. Journey Mapping Penicillin Allergies in Children: Parental Experiences, Care Gaps, and Suggestions Offered by Parents to Address Unmet Needs

Abstract Background Penicillin allergies are commonly reported in children but rarely true and perpetuate the use of alternative antibiotics. Leading allergy societies recommend a proactive approach to penicillin allergy delabeling. We use patient journey mapping to identify opportunities to improve the delabeling of penicillin allergies in children before, during, and after a child’s initial reaction to penicillin. Methods Mapping was conducted via a secondary analysis of a qualitative study consisting of 18 interviews with parents recruited via social media reporting a penicillin allergy in their child. Two researchers coded interviews using a directed content analysis to capture parent’s experiences before, during, and after their child’s penicillin reaction. We describe the common experiences of parents ( >9 participants). Results Pre-reaction, parents reported a lack of awareness regarding potential reactions children may experience when taking penicillin. Intra-reaction, parents reported their child’s provider suspected their child’s reaction was due to a penicillin allergy, wrote the child’s reaction in the medical record, and suggested or advised that penicillin be avoided in the future without mention of the availability of penicillin allergy testing. Post-reaction, parents remained unaware of the availability of penicillin allergy testing and uninformed of the implications of penicillin allergies on their child’s care. To better engage parents in penicillin allergy testing, participants suggested that providers inform parents of: 1) potential reactions their child may experience at the time of penicillin prescription (pre-reaction); 2) the availability of penicillin allergy testing to confirm the presence of true allergy (intra-reaction); and 3) penicillin allergy testing procedures and the benefits of penicillin allergy testing for their child’s health (post-reaction), see Table 1. Conclusion Using patient journey mapping, we describe the common experiences of parents concerning their child’s penicillin allergy, gaps in care parents experienced, and suggestions offered by parents to address their unmet care needs. These findings may inform future efforts to improve the delabeling of penicillin allergies in children. Disclosures Sherry Pagoto, PhD, Astellas Pharmaceuticals: Scientific Advisor|Weight Watchers, International,: Scientific Advisor

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498-P: Prevalence and Impact on Quality of Life of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease on Hemodialysis

Background: The prevalence, severity, and quality of life (QoL) impact of diabetic retinopathy (DR) among African Americans (AA) with end-stage-kidney disease (ESKD) receiving dialysis are unknown. Methods: We conducted a prospective cross-sectional study in 93 AA adults with type 1 (n=9) and type 2 (n=84) diabetes with ESKD on hemodialysis. The diagnosis of DR was based on a review of medical records and/or having a positive photograph with a portable hand-held device (Optomed Aurora retinal camera) reviewed by both artificial intelligence software (AEYE Health’s retinal screening system) and a retinal specialist. Visual acuity was assessed with the Snellen Chart. Associations with QoL (ascertained using kidney disease QoL and depression questionnaires), physical disability (ascertained using visual impairment questionnaire), and social determinants of health (SDoH) including personal and household income, marital status, health insurance, education, food insecurity, or employment status assessed by standardized questionnaires. Results: The overall prevalence of DR was 75%, with 33% of patients having mild, 9.6% moderate and 57.4% severe DR. A total of 43% had normal visual acuity, 45% had moderate and 12% severe visual impairment. We found high burden of disease, multiple SDoH challenges, and low QoL among all patients, with most unemployed or disabled, living below poverty line, mainly receiving public health insurance, reporting poor general health, and substantial time spent dealing with kidney disease interfered with daily and family activities. However, the presence of DR had no significant impact on physical health and QoL compared to subjects without DR. Conclusion: DR is present in 75% of AA patients with diabetes and ESKD on hemodialysis. ESKD has a significant burden on general health and QoL; however, DR has a minor additional impact on the overall physical health and QoL in people with ESKD and diabetes. Disclosure Z.E.Zabala: None. B.Moazzami: None. M.Egeolu: None. R.L.Caleon: None. A.Y.G.Gerges: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

647-P: Patient Preferences Informing Choice of Second-Line Type 2 Diabetes Medications

Available second-line glucose-lowering medications for type 2 diabetes (T2D) have variable efficacy and side effect profiles, administration requirements, and impacts on short-term and long-term health outcomes. Therefore, medication choice is informed by each patient's clinical needs and personal preferences. However, patient rationale for selecting a second-line medication for T2D is not well understood. In this mixed methods study, 40 adults with T2D across 2 health systems in the U.S. completed an individual ranking activity, sorting 16 health outcomes and 8 medication attributes by relative importance and providing context on ranking decisions. Participants were between 45-64 years old (38%), non-Hispanic White (50%) or Black (38%), 15% Hispanic, and 55% women. For health outcomes, the highest proportion of patients ranked blindness (63%), death (60%), heart attack (48%), or heart failure (48%) as very important. For medication attributes, most participants indicated that greater efficacy with respect to lowering hemoglobin A1c was very important (68%), followed by oral administration (45%) and absence of gastrointestinal side effects (38%). Combinations of outcomes and attributes ranked as very important were highly heterogeneous across individual participants, with only 2/40 patients ranking the same combination. Qualitative findings indicated that outcome importance is a function of perceived severity, susceptibility, personal relevance, preventability, and potential life impacts. For medication attributes, most participants emphasized the primary importance of lowering blood glucose and hemoglobin A1c, while treatment processes and side effects were secondary and largely idiosyncratic to the patient's lifestyle, prior experiences, and preferences. Findings underscore the importance of engaging patients in conversations about goals and preferences for care and contextualizing therapeutic decisions in patient-described priorities for T2D management. Disclosure E.Golembiewski: None. A.E.Garcia: None. E.Polley: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. V.M.Montori: None. M.Mickelson: None. R.G.Mccoy: Consultant; Emmi. Funding Patient-Centered Outcomes Research Institute (DB-2020C2-20306)

782-P: Efficacy of Tirzepatide in People with Young-Onset T2D in the SURPASS Program

Young-onset T2D, defined as diagnosed before age 40, presents with a more aggressive disease course, faster beta-cell deterioration and reduced response to diabetes treatment compared to later-onset T2D. Tirzepatide (TZP), a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptor agonist, was recently approved for the treatment of type 2 diabetes (T2D). This post-hoc analysis assessed the effect of tirzepatide on glycemic control, body weight (BW) and cardiometabolic markers in participants with young-onset T2D from the SURPASS program. Changes from baseline in mean HbA1c, BW, waist circumference (WC), and cardiometabolic markers including lipids, and blood pressure (BP) were compared in participants with young-onset (N=873, 20.5%) vs later-onset T2D (N=3394, 79.5%) at Week 40 (SURPASS-1, -2, -5) or Week 52 (SURPASS-3). No differential treatment effect was observed for participants with young- vs later-onset T2D. Tirzepatide treatment led to similar improvements in HbA1c and BW in both subgroups at Week 40/52 for all TZP doses (Figure). Furthermore, TZP (all doses) improved WC, lipids (triglycerides and HDL) and systolic BP similarly between the two groups. In conclusion, tirzepatide treatment led to similar improvements in HbA1c, BW and cardiometabolic markers (WC, lipids, SBP) in participants regardless of having young-onset or later-onset T2D. Disclosure P.Zeitler: Consultant; Eli Lilly and Company, Boehringer Ingelheim Inc., Johnson & Johnson. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.J.Davies: Advisory Panel; Lilly, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Lexicon Pharmaceuticals, Inc., Pfizer Inc., Medtronic, ShouTi Pharma Inc., Consultant; Lilly, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Research Support; AstraZeneca, Novo Nordisk, Sanofi-Aventis U.S., Boehringer-Ingelheim, Janssen Pharmaceuticals, Inc., Speaker's Bureau; Lilly, Boehringer-Ingelheim, Novo Nordisk, AstraZeneca, Napp Pharmaceuticals Limited, Novartis, Sanofi. B.Bergman: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. V.Thieu: None. C.Nicolay: Employee; Eli Lilly and Company. S.Allen: None. C.Lee: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

360-OR: Continuous Glucose Monitoring–Guided Insulin Administration in Subjects with Type 2 Diabetes in Long-Term Care Facilities—A Randomized Clinical Trial

The efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF) has not been evaluated. Accordingly, we randomized 100 insulin-treated subjects with T2D in LTCF. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with treatment adjusted based on POC results; while in the rt-CGM group (Dexcom G6), treatment adjustment was based on daily CGM profile. Treatment adjustment was performed by the LTC medical team, with a target glucose of 140-180 mg/dL, and a duration of intervention up to 60 days. Primary endpoint was difference between groups in time in range (TIR, 70-180 mg/dL). Results: There were no significant differences in TIR (53.38%±30.16 vs 48.81%±28.03, p=0.40), mean daily glucose (185±44 vs 191 ±47 mg/dL, p=0.72), patients with % CGM values <54 mg/dL (0.23±0.8% vs 0.56±2.2 %, p=0.88), with a trend in reducing time below range (TBR <70 mg/dL) (0.83±2.6 % vs 1.18±3.5%, p= 0.51), between CGM and POC group. Conclusion: The results of this pilot randomized study indicate that the use of Dexcom G6 rtCGM is safe and effective in guiding diabetes therapy in long-term care facilities, resulting in a similar improvement in glycemic control (TIR) without differences in hypoglycemia. Disclosure T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. H.Oh: None. M.D.Gavaller: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None. Funding Dexcom, Inc. (IIS-2020-119_6X)

961-P: Comparison of Glucose Metrics by Capillary Blood Glucose and Continuous Glucose Monitoring among People with Type 2 Diabetes on Hemodialysis

Background: Reliability of HbA1c in subjects with end-stage kidney disease treated with hemodialysis is poor. Capillary blood glucose (CBG) is widely used, but is limited to 2-4 values/day. Clinical guidelines recommend using continuous glucose monitoring (CGM) to assess glycemic control in this population, but there is limited data. Methods: Prospective observational study of insulin treated adults with type-2 diabetes (T2D) receiving hemodialysis. Subjects were instructed to wear a Dexcom G6-Pro and perform Nova StatStrip CBG at least 2-4/d for 10-days. We compared mean glucose, hypoglycaemia, and hyperglycaemia rates, time-in-target range (TIR), time above range (TAR), and time below range (TBR) between testing methods. Results: Glucose metrics are shown in Table 1. Conclusion: Compared to CBG, CGM provides a comprehensive glycemic evaluation in insulin-treated subjects with T2D on hemodialysis. CGM was superior in assessing glycemic control (TIR), detection of severe hyperglycemia and hypoglycemic excursions, particularly nocturnal and prolonged events. Safer treatment options assessed by CGM metrics are needed for this high-risk population. Disclosure R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. A.Y.G.Gerges: None. B.Moazzami: None. L.Peng: None. K.R.Tuttle: Consultant; Lilly, AstraZeneca, Gilead Sciences, Inc., Research Support; Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Novo Nordisk, Goldfinch Bio, Inc., Traveere Pharmaceuticals. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

957-P: Continuous Glucose Monitoring in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

Patients with long-standing type 2 diabetes and end-stage kidney disease (ESKD) on dialysis may experience resolution of their hyperglycemia, as defined by an HbA1c < 6.5%, without antidiabetic therapy. This phenomenon is known as “burnt-out diabetes”. Because HbA1c may be falsely low in patients with ESKD/dialysis therapy, we conducted a prospective study to compare glycemic control as measured by Dexcom G6 CGM in patients with ESKD and burnt-out diabetes and those without history of diabetes. We hypothesize that the use of CGM may provide better assessment of glycemic control than HbA1c (standard-of-care) in these patients and clarify the glycemic characteristics of burnt-out diabetes. We included adults with ESKD on dialysis, with (n=20) and without (n=10) a known history of diabetes, and with HbA1c <6.5% without antidiabetic therapy for > 6 months. All subjects wore a blinded Dexcom G6 CGM for 10 days. Their clinical characteristics and CGM metrics are shown in Table 1. Conclusion: CGM provides better assessment of glycemic excursions, compared to HbA1c, in patients with ESKD and diabetes. Most patients with burnt-out diabetes (HbA1c <6.5%, off therapy) have frequent and significant hyperglycemic excursions as detected by CGM. Further research will need to examine whether these excursions require pharmacotherapy. Disclosure C.Kaminski: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Z.E.Zabala: None. B.Moazzami: None. A.Y.G.Gerges: None. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob's Fund for Education

947-P: Glycemic Control Utilizing Continuous Glucose Monitoring vs. Point-of-Care Testing in Older Adults with Type 2 Diabetes in Long-Term Care Facilities

We compared the efficacy of continuous glucose monitoring (CGM) and point of care (POC) testing (standard of care) in assessing glycemic control in older adults with T2D treated with either basal insulin or insulin secretagogues plus sliding scale in long-term care facilities (LTCF). All 97 subjects underwent POC testing before meals and bedtime and wore a Dexcom CGM. Treatment adjustment was performed by the primary care team, with a target glucose of 140-180 mg/dL, and for a duration of intervention up to 60 days. Study endpoints included differences in hypoglycemia < 70 and 54 mg/dL and hyperglycemia > 180 and 250 mg/dL by POC and CGM. Participants baseline characteristics (age: 74.7±11 years, BMI: 29.6±7.9, HbA1c: 8.06±2.2%) admitted to skilled nursing care/subacute rehab (80%) or long-term care (20%) facilities with a median length of participation of 17 (interquartile range 11, 29) days. The mean daily glucose by POC was lower than CGM (171±45 vs. 188±45 mg/dL, p<0.01). CGM detected significant greater proportions of subjects with hypoglycemia <70 mg/dL (40% vs. 14%) and <54 mg/dL (21% vs. 1.0%); as well as hyperglycemia >250 mg/dL (77% vs. 56%) compared to POC testing, all p<0.001. Conclusion: In older adults with T2D admitted to long-term care facilities, the use of CGM significantly improved detection of hypoglycemic and hyperglycemic events compared to POC. Disclosure T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. M.D.Gavaller: None. H.Oh: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None. Funding Dexcom, Inc. (IIS-2020-119_6X)

784-P: Characteristics of People with Young-Onset T2D in the SURPASS Program

Young-onset T2D, defined as diagnosed before age 40, is increasing around the world. Recent data suggest a faster deterioration in beta-cell function and earlier development of complications in this population, compared to later-onset T2D. This post-hoc analysis evaluated the baseline characteristics of people with young-onset vs later-onset T2D in the SURPASS clinical trial program. Baseline demographics and clinical characteristics were compared in participants with young-onset vs later-onset T2D from the SURPASS-1, -2, -3, and -5 clinical trials (N=4267). Analyses were performed by study. Across the SURPASS program, which included participants at various stages of T2D management, participants with young-onset T2D were younger, had longer duration of diabetes, worse glycemic control, higher mean body weight and BMI, and a worse lipid profile at baseline vs patients with later-onset T2D. Data from SURPASS-1 and SURPASS-2 also showed participants with young-onset T2D had greater insulin resistance (HOMA2-IR) at baseline. Despite their younger age at baseline, participants with young-onset T2D in the SURPASS program had an overall worse health status as compared to patients with later-onset T2D. Early intervention in young-onset T2D may be important to optimize long-term outcomes. Disclosure R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. P.Zeitler: Consultant; Eli Lilly and Company, Boehringer Ingelheim Inc., Johnson & Johnson. M.J.Davies: Advisory Panel; Lilly, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Lexicon Pharmaceuticals, Inc., Pfizer Inc., Medtronic, ShouTi Pharma Inc., Consultant; Lilly, Boehringer-Ingelheim, Novo Nordisk, Sanofi, Research Support; AstraZeneca, Novo Nordisk, Sanofi-Aventis U.S., Boehringer-Ingelheim, Janssen Pharmaceuticals, Inc., Speaker's Bureau; Lilly, Boehringer-Ingelheim, Novo Nordisk, AstraZeneca, Napp Pharmaceuticals Limited, Novartis, Sanofi. C.Lee: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. V.Thieu: None. C.Nicolay: Employee; Eli Lilly and Company. S.Allen: None. B.Bergman: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

1022-P: Trends in Glucagon Fill Rates among U.S. Adults with Diabetes and End-Stage Kidney Disease on Dialysis

Patients with diabetes (DM) and end-stage kidney disease (ESKD) on dialysis have a high risk of severe hypoglycemia and more than 70% are treated with insulin therapy. While not all hypoglycemic events can be prevented, glucagon is recommended for patients at high risk for hypoglycemia to revert and prevent hospitalization with severe hypoglycemic events. Prior studies have shown low rates of glucagon utilization, but excluded patients with ESKD who are at highest risk for these events. We used the USRDS, the most comprehensive nationwide database of patients with ESKD in the US, to examine the quarterly rates of glucagon fills among U.S. adults with DM and ESKD receiving dialysis. Among 254,195 adults (≥18 years) with ESKD and type 1 DM (N=27,538) or type 2 DM (N=226,657), with 76.9% using insulin therapy, between 2013-2017. Fewer than 2% of patients with type 2 DM and fewer than 4% of patients with type 1 DM filled a glucagon prescription, with declining fill rates over time among patients with type 2 DM and stable rates among patients with type 1 DM. Clinical Characteristics and trends in glucagon prescriptions are shown in Table 1. Our findings suggest an urgent and critical need for education of clinicians, patients, and caregivers to improve the prescribing and use of glucagon: a life-saving rescue medication. Disclosure R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. S.Inselman: None. B.Moazzami: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.G.Mccoy: Consultant; Emmi.

1234-P: Derivation of a Claims-Computable Major Adverse Cardiovascular Event Estimator (ACME) in Adults with Type 2 Diabetes

Major adverse cardiovascular events (MACE) are a major cause of morbidity and mortality among adults with type 2 diabetes. Currently available risk prediction models estimate long-term risk (typically 10-year) and require clinical data not routinely available in real-world data sources, which limit their use on population level. Using de-identified claims data from OptumLabs® Data Warehouse for enrollees in private and Medicare Advantage health plans linked to 100% sample of Medicare fee-for-service beneficiaries between 2014 and 2021, we derived ACME to estimate annualized risk of non-fatal myocardial infarction, non-fatal stroke, or all-cause mortality in patients with type 2 diabetes aged ≥21 years (N=6,623,526). The Cox proportional hazards model, combined with an estimate of the baseline hazard using the Nelson-Aalen estimator to allow conditional survival predictions, included 28 covariates available in claims (age, sex, cardiovascular comorbidities, and cardiovascular medications). The study population had mean age 68.1 (SD, 10.6) years, 49.8% were women, and 73.0% were non-Hispanic White. ACME’s concordance index was 0.74 (se = 0.0002) and it performed comparably in all racial and ethnic groups. Strongest predictors of MACE were acute myocardial infarction and stroke within the past 3 months, heart failure hospitalization within the past year, and end-stage kidney disease. Overall, 4.2% of patients were predicted to have low (<1%) annualized MACE risk, 62.8% were predicted to have moderate (≥1 to <5%) annualized risk, and 33.0% were predicted to have high (≥5%) annualized risk. Other thresholds can be chosen for individualized applications. ACME can support population risk stratification and health management efforts at the health system and payer levels, participant identification for decentralized pragmatic clinical trials of cardiovascular disease and its prevention, and risk-stratified observational studies using real-world data. Disclosure R.G.Mccoy: Consultant; Emmi. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. M.Mickelson: None. E.Polley: None. K.Swarna: None. Y.Deng: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. J.Ross: Research Support; Johnson & Johnson. D.M.Kent: Research Support; W.L. Gore. B.Borah: Consultant; Boehringer Ingelheim Inc., Exact Sciences. W.Crown: Consultant; Janssen Scientific Affairs, LLC, UnitedHealth Group, Viatris Inc. V.M.Montori: None. Funding Patient-Centered Outcomes Research Institute (DB-2020C2-20306)

960-P: Hemodialysis-Related Glycemic Patterns among People with Insulin-Treated Type 2 (T2D) Diabetes—Role of Continuous Glucose Monitoring (CGM)

Background: Hemodialysis (HD) impacts glucose and insulin metabolism and increases hypoglycaemia rates. Glucose-containing dialysate decreases the risk, but studies using CGM metrics are lacking. Methods: Prospective observational study of insulin-treated adults with T2D, receiving hemodialysis (dialysate glucose 100mg/dl), at least thrice weekly. Subjects were instructed to wear a Dexcom G6-Pro for 10 days. We assessed CGM metrics (mean glucose, %TIR, %TAR, %TBR, and hypoglycemic and hyperglycemic rates) during three time periods: 20-hours before (PreHD), during (HD, ~4 hours), and 20-hours after (PostHD) hemodialysis sessions. Results: Among 56 subjects (mean age 57.3±9, HbA1c 7.2±1.4), mean glucose, %TAR, %TIR and rates of hypoglycaemia <70mg/dl were significantly better during HD. %TAR >180mg/dl and > 250mg/dl were significantly higher after HD, see Table 1. Other hypoglycaemia metrics were overall low, and not different in relation to HD timing. Conclusion: CGM patterns demonstrated improved glycemic control during dialysis, with tendency for higher glucose metrics before HD. Hypoglycaemia metrics were low, while severe hyperglycemia excursions are common across all HD-related periods. Future studies using newer CGM technology and providing longer duration of CGM monitoring are needed for subjects with T2D treated by HD. Disclosure R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. B.Moazzami: None. A.Y.G.Gerges: None. L.Peng: None. K.R.Tuttle: Consultant; Lilly, AstraZeneca, Gilead Sciences, Inc., Research Support; Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Novo Nordisk, Goldfinch Bio, Inc., Traveere Pharmaceuticals. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter.

812-P: Tight vs. Standard Inpatient Glycemic Targets in Non–Critical Care Settings—A Propensity Scored–Matched Analysis of Insulin-Treated Patients with Type 2 Diabetes

Differing blood glucose (BG) targets are recommended by professional organizations in noncritical care settings. Previous Endocrine Society and ADA guidelines recommended a target BG of 70-140 and 140-180 mg/dl; however, the 2023 ADA Standards of Care recommends a target of 100-180 mg/dl. The lack of consensus is due to the lack of randomized clinical trials (RTC) to support a tight vs relaxed BG target. We performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated subjects with T2D targeting BG 70-140 mg/dL vs. 140-180 mg/dL. Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dL. Propensity score matching was used to reduce the bias including sex, HbA1c, and home insulin use, for a final count of 1,146 patients (573 subjects in each target group). Patients in the tight BG target group had lower mean BG (163.73±39.79 vs 170.15±39.94 mg/dL, p=0.004), less hyperglycemia (BG >180: 86% vs 92%, p=0.003; BG >240: 51% vs 62%, p<.001), similar rates of hypoglycemia (BG <70: 12% vs 15%, p=0.11; BG <54: 2.5% vs 4.0%, p=0.14). The intensive target resulted in a shorter length of stay (4.0 vs 6.0 days, p<.001) and lower composite of complication rate (acute kidney injury, infection, myocardial infarction, respiratory failure and stroke) (3.7% vs 6.8%, p=0.02) than the relaxed BG target, with similar mortality rates (0.9% vs 0.3%, p=0.36). There were no differences in glycemic variability (GV) between groups with greater GV in those experiencing hypoglycemia <70 mg/dL or hyperglycemia >200 mg/dL. Our results indicate that lower BG target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia and glycemic variability, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Disclosure J.Saling: None. A.L.Migdal: None. M.A.Urrutia: None. Z.Zabala: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.Fayfman: None. A.A.Rashied: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob Family Funds

638-P: Social Media as a Source of Personalized Weight-Loss Information

People with obesity may seek clinical, nutritional, activity, and psychosocial guidance, but recommendations they receive in clinical settings may be inadequate or lack sufficient personalization to be implemented into their lives. Understanding unmet information needs may enable more tailored weight guidance. We used health narratives posted in a weight loss forum to research topics of information being sought. Public posts (N=52,576) from 1/2020-1/2022 were extracted from r/LoseIt, a Reddit weight loss forum of 3.8M members. From these, 63,006 questions were extracted using a research-purpose BERT language model tested and fine-tuned on 500 hand-annotated questions. Extracted questions were clustered into distinct topics by Top2Vec and hierarchical clustering. Excluding 2 uninterpretable topics, 27 of 28 (96%) topics represented requests for personalized recommendations. Topics focused on diet (7%), exercise (7%), sensemaking (11%), how to implement a behavior change or solve a weight-loss problem (11%), tips for specific stages of weight loss (beginning, plateau) (7%), and comparing weight loss experiences (11%). Weight-loss forum users requested personalized recommendations to support sensemaking of frustrating weight loss problems and ask for help choosing and deploying behavior change. Results call for interventions customized to individuals’ weight loss stage, process, experiences, and motivations. Disclosure C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. J.Stremmel: None. R.G.Mccoy: Consultant; Emmi. M.Jarvis: Employee; Optum Labs, UnitedHealth Group, Stock/Shareholder; Oramed Pharmaceuticals, UnitedHealth Group, Dexcom, Inc., Apple, Hologic Inc., Intuitive Surgical. J.D.Ard: Advisory Panel; Novo Nordisk, Consultant; Eli Lilly and Company, Intuitive Surgical, Regeneron, Other Relationship; Optum Labs, Weight Watchers International, Research Support; Nestlé Health Science, Boehringer Ingelheim Inc., Epitomee, KVK Tech. N.Lambert: Employee; Optum Labs.