Diabetes最新文献

{"title":"1904-LB: Glycemic Improvement with Use of the Omnipod 5 Automated Insulin Delivery System in Adults with Type 2 Diabetes—Results of the SECURE-T2D Pivotal Trial","authors":"FRANCISCO J. PASQUEL, GEORGIA M. DAVIS, DAVID M. HUFFMAN, ANNE L. PETERS, JOHN C. PARKER, LORI M. LAFFEL, JUSTIN MATHEW, KRISTIN N. CASTORINO, DAVIDA F. KRUGER, KATHLEEN M. DUNGAN, MARK KIPNES, EDWARD JAUCH, TAMARA OSER, VIRAL N. SHAH, BARRY HOROWITZ, ANDERS L. CARLSON, MARK L. WARREN, WASIM DEEB, JOHN B. BUSE, JOHN H. REED, JASON BERNER, THOMAS BLEVINS, CHRIS BAJAJ, CRAIG KOLLMAN, DAN RAGHINARU, TRANG T. LY, ROY W. BECK, THE SECURE-T2D STUDY CONSORTIUM","doi":"10.2337/db24-1904-lb","DOIUrl":"https://doi.org/10.2337/db24-1904-lb","url":null,"abstract":"Background: There is limited experience with automated insulin delivery (AID) in Type 2 Diabetes (T2D). Methods: We conducted a multicenter pivotal clinical trial to evaluate use of the Omnipod 5 AID System in a large diverse group of adults with T2D in the US. Adults aged 18-75y with T2D using insulin (basal-bolus, premix, or basal-only) who had screening HbA1c <12.0% were enrolled. Non-insulin agents were continued throughout. After a 14-day standard therapy phase to capture baseline glycemic management, participants initiated 13 weeks of AID. The primary endpoint was change in HbA1c from baseline to 13 weeks. Study completion occurred on March 1, 2024. Results: A total of 305 adults with T2D (mean age 57±11 years, 24% Black, 22% Hispanic/Latino) were enrolled in the study and initiated AID. Basal-bolus insulin delivery was being used by 79%, basal-only by 21%, GLP-1 receptor analogs by 55%, and SGLT1 or 2 inhibitors by 44%. Following 13 weeks of Omnipod 5 use, HbA1c decreased from 8.2±1.3% at baseline to 7.4±0.9% at study end (treatment effect= -0.8%, 95% CI: -1.0 to -0.7, p<0.001). The benefit of AID was greatest in those with the highest baseline HbA1c (Figure). Conclusion: These pivotal trial results demonstrate the substantial benefit of the Omnipod 5 AID System in a large diverse group of adults with T2D. Clinical trial registration: NCT05815342 Disclosure F.J. Pasquel: Research Support; Tandem Diabetes Care, Inc., Insulet Corporation, Dexcom, Inc., Ideal Medical Technologies, Novo Nordisk. Consultant; Dexcom, Inc., Medscape. G. Davis: Research Support; Insulet Corporation. Consultant; Medscape. A.L. Peters: Advisory Panel; Lilly Diabetes, Vertex Pharmaceuticals Incorporated, Medscape. Research Support; Abbott, Insulet Corporation. J.C. Parker: Speaker's Bureau; Novo Nordisk, Corcept Therapeutics, Insulet Corporation. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation. J. Mathew: None. K.N. Castorino: Research Support; Abbott, Dexcom, Inc. Speaker's Bureau; Dexcom, Inc. Research Support; Lilly Diabetes, Medtronic, MannKind Corporation, Insulet Corporation. Consultant; Medscape. D.F. Kruger: Advisory Panel; Abbott. Research Support; Beta Bionics, Inc., Carmot Therapeutics, Inc. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc., Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Advisory Panel; Insulet Corporation. Research Support; Insulet Corporation. Advisory Panel; MannKind Corporation, Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Provention Bio, Inc. Speaker's Bureau; Sanofi, Xeris Pharmaceuticals, Inc. Advisory Panel; Pendulum Therapeutics. Research Support; Tandem Diabetes Care, Inc. Advisory Panel; Cequr. Speaker's Bureau; Cequr. Advisory Panel; Medtro","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1162-P: Global Burden Attributable to High Body Mass Index in Young Adults from 1990 to 2019, with Projections to 2050","authors":"JINGXUAN WANG, YUE HUANG, VICTOR W. ZHONG","doi":"10.2337/db24-1162-p","DOIUrl":"https://doi.org/10.2337/db24-1162-p","url":null,"abstract":"Introduction: The global health impacts of escalating obesity burden on young adults remain insufficiently understood. We conducted a comprehensive evaluation of the disease burden attributable to high body mass index (BMI) in young adults from 1990 to 2050. Methods: Based on the Global Burden of Disease Study 2019, we analyzed deaths and disability-adjusted life years (DALYs) attributable to high BMI in young adults aged 20-44 years globally and by age, sex, year, location, and disease, between 1990 and 2019. Future projections until 2050 were further assessed. Results: The global burden due to high BMI in young adults more than doubled during 1990-2019, reaching 24,510 (20,192-28,966) thousand DALYs and 322 (258-384) thousand deaths in 2019. Males had higher burden and faster increase than females. In 2019, middle Socio-demographic Index (SDI) regions had the highest age-standardized rates of deaths and DALYs, while low-middle SDI regions witnessed the largest rise. Significant variations across different countries were observed (Figure 1). Nearly 25% of the DALYs were attributed to diabetes and kidney diseases, which showed the fastest increase. By 2050, the age-standardized DALY rate attributable to high BMI tripled that in 1990. Conclusion: Targeted weight management interventions in young adults are urgently needed to fight against the soaring disease burden caused by high BMI. Disclosure J. Wang: None. Y. Huang: None. V.W. Zhong: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"983-P: Long-Term Improvement in CGM-Measured Glycemic Control in Adults with Type 2 Diabetes Not Treated with Insulin—Real-World Data","authors":"JENNIFER E. LAYNE, LAUREN H. JEPSON, ALEXANDER CARITE, RICHARD M. BERGENSTAL","doi":"10.2337/db24-983-p","DOIUrl":"https://doi.org/10.2337/db24-983-p","url":null,"abstract":"Objectives: Emerging evidence indicates that CGM use is associated with improvements in glycemic control in adults with noninsulin treated T2D. This real-world study evaluated CGM metrics for one year after CGM initiation in this population. Methods: Data were analyzed from Dexcom G6 and G7 users who self-reported: T2D, ≥18 yr, gender, no insulin use and had baseline TIR ≤70%. Outcomes were change in CGM metrics from baseline to 6 months and 1 year, and proportion with TIR >70% at follow-up overall and for younger (<65 yr) and older (≥65 yr) cohorts. Results: CGM users (n=3,840) were: mean (SD): 52.5 (11.2) yr, 48% female, TIR 70-180 mg/dL 41.7% (21.4) and 12.4% of participants were ≥65 yr. Significant improvement was observed at 6 months with continued improvement at 1 year (Table) for all CGM metrics not at target values at baseline. The proportion of CGM users meeting TIR >70% increased from 0% to 37.9% at 6 months and to 43.1% at 1 year. CGM was worn 84.7% of days. Outcomes were very similar for younger and older adults. One exception of note was the change in the TITR 70-140 mg/dL at 1 year, <65 yr: +17.1% and ≥65 yr: +12.7%, but the <65 yr group started with a lower baseline TITR. Conclusion: In this large, real-world study of adults with suboptimally controlled T2D not using insulin, CGM use was associated with meaningful improvements in glycemic control at 6 months with ongoing improvement at 1 year. Disclosure J.E. Layne: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. Employee; Verily Life Sciences. L.H. Jepson: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. A. Carite: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. R.M. Bergenstal: Other Relationship; Abbott. Research Support; Arkray Marketing. Consultant; Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur. Other Relationship; Dexcom, Inc., Eli Lilly and Company. Consultant; embecta, Hygieia. Research Support; Insulet Corporation. Consultant; MannKind Corporation. Other Relationship; Medtronic, Novo Nordisk. Consultant; Onduo LLC, Roche Diabetes Care. Other Relationship; Sanofi. Research Support; Tandem Diabetes Care, Inc. Other Relationship; UnitedHealth Group. Consultant; Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1936-LB: The Challenge of Obtaining Diabetes Technology Supplies in Adults with Type 1 Diabetes","authors":"ANDREW A. WELCH, THOMAS KNOERL, ELIZABETH J. KOPRAS, SARAH CORATHERS, MERCEDES FALCIGLIA","doi":"10.2337/db24-1936-lb","DOIUrl":"https://doi.org/10.2337/db24-1936-lb","url":null,"abstract":"Background: Individuals with Type 1 Diabetes (T1D) face barriers to reliably obtain prescribed technology supplies (continuous glucose monitors [CGM]/insulin pump supplies). The frequency of annual supply access interruptions (ASAI) and the associated burden (emotional, financial, time) with this process are unclear. Objective: To quantify ASAI of technology supplies/insulin and associated burden in adults with T1D. Methods: A 64-question online survey was distributed to the T1D Exchange registry for US adults with T1D. ASAI was defined as total instances that individuals ran out of CGM, insulin pump supplies, and/or insulin in the past year. The burden to obtain supplies was assessed by a 1-10 scale (10 = strongly agree). Means and SD were reported. Significance of comparisons was assessed with t-tests or ANOVA for parametric data, and Mann-Whitney or Kruskal-Wallis tests for non-parametric data (significant = p<0.05). Results: Responses were completed by 2151 surveyed. Mean age was 49 years, 73% female, average A1C 6.7%, with 96% and 80% utilizing CGM and insulin pumps respectively. ASAI averaged 1.8 and varied significantly based on gender (Female = 1.9), insurance (Medicaid = 3.9), income (None = 3.23), race (Black = 3.0), and location (Rural = 2.3). Emotional burden (worry about running out of supplies) was significantly higher in women, those without insurance, lower annual income, and non-white race. A 10 was reported for “It is difficult to afford supplies” by 13% and “I spend too much time obtaining supplies” by 11%. Early CGM and insulin pump cannula failures were reported by 45% and 48% of respondents respectively. The top reason for ASAI was “Required prior authorization” in 36% of respondents. The top strategies to avoid ASAI were “Call supply company to request extra supplies” (25.9%), and “Use supply for longer than recommended” (25.5%). Conclusion: Challenges in obtaining diabetes supplies are significant and disproportionately affect certain socioeconomic groups with T1D. Disclosure A.A. Welch: None. T. Knoerl: None. E.J. Kopras: None. S. Corathers: None. M. Falciglia: None.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"56-OR: Impact of Delays in Statin Therapy Due to Statin Nonacceptance on Cardiovascular Outcomes in Patients with Diabetes","authors":"NISARG SHAH, ZHOU LAN, SETH S. MARTIN, C J. BROWN, ALEXANDER TURCHIN","doi":"10.2337/db24-56-or","DOIUrl":"https://doi.org/10.2337/db24-56-or","url":null,"abstract":"Introduction: Many patients with diabetes do not accept their clinicians’ statin therapy recommendations. Long-term clinical sequalae of statin non-acceptance are unknown. Methods: We conducted a retrospective cohort study of patients with diabetes without ASCVD treated at Mass General Brigham in 2000-2018. We analyzed the relationship between delay in statin therapy due to statin non-acceptance by patients and the incidence of CV events (MI or ischemic stroke). Information about statin non-acceptance and baseline characteristics was obtained from the electronic medical records and a previously validated Natural Language Processing tool. Results: The mean age of 7,239 study patients was 55.0 (SD 11.9) years; 3,769 (52.1%) were female. Their mean baseline LDL-C was 138 (SD 28) mg/dl and the mean HbA1c was 7.5% (SD 1.9). A total of 1,280 (17.7%) of patients delayed statin therapy (by a mean of 2.7 (SD 3.1) years during which they had a mean of 4.6 (SD 9.1) provider visits) due to initial non-acceptance. These patients then continued on statin therapy for a mean of 7.1 (SD 4.8) years. Over the mean follow-up time of 8.2 (SD 4.6) years, 455 (6.3%) of patients had a CV event. Accounting for all-cause death as a competing risk, 6.4% (95% CI 5.6-7.2) of patients who accepted vs. 8.5% (95% CI 6.8-10.5) of patients who initially declined statin therapy recommendation experienced a CV event at 10 years (p = 0.001). In a multivariable Cox analysis that adjusted for patients’ demographic characteristics and comorbidities and clustering within providers, initial non-acceptance of statin therapy was associated with increased risk of a CV event (HR 1.49, 95% CI 1.16-1.91, p = 0.002). Conclusions: Our study shows that patients with diabetes without ASCVD who delay statin therapy due to statin non-acceptance have an increased risk of CV events. This finding identifies a previously unexplored gap in care that increases cardiovascular burden in this already high-risk population. Disclosure N. Shah: None. Z. Lan: None. S.S. Martin: Consultant; Amgen Inc., AstraZeneca, Bristol-Myers Squibb Company, Chroma, Kaneka Inc., NewAmsterdam, Novartis AG, Novo Nordisk, Premier, Sanofi. C.J. Brown: None. A. Turchin: Research Support; Eli Lilly and Company, Novo Nordisk. Consultant; Novo Nordisk, Proteomics International. Research Support; AstraZeneca. Funding PCORI (ME-2019C1-15328)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1981-LB: Modeling the Impact of Semaglutide 2.4 mg in U.S. Patients with Atherosclerotic Cardiovascular Disease and BMI ≥27 kg/m2","authors":"MADS FAURBY, MICHAEL G. NANNA, JOSHUA C. TOLIVER, QUAN V. DOAN, ALASDAIR D. HENRY, THOMAS SCASSELLATI SFORZOLINI, ALINA LEVINE, ANTHONY FABRICATORE, AZADEH S. HOUSHMAND-OEREGAARD, ANN MARIE NAVAR","doi":"10.2337/db24-1981-lb","DOIUrl":"https://doi.org/10.2337/db24-1981-lb","url":null,"abstract":"The SELECT trial demonstrated a 20% risk reduction in major adverse cardiovascular events (MACE) with semaglutide 2.4 mg in adults with atherosclerotic cardiovascular disease (ASCVD) and overweight/obesity (BMI ≥27 kg/m2). We aimed to quantify the potential population impact of this treatment in the US. National Health and Examination Survey (NHANES) data were used to characterize the US population meeting SELECT trial criteria: BMI ≥27 kg/m2, age ≥45 years, ASCVD, and no diabetes, with the number of potential treatment candidates determined using 2023 census projections. The 10-year rate of recurrent MACE events was estimated based on the SMART2 risk calculator. The potential treatment effect of semaglutide 2.4 mg on the number of MACE events in this population was estimated using results from the SELECT trial. As of 2023, 6,161,981 US adults met SELECT inclusion criteria (mean age 67.2 ± 9.9 years, 43.6% female, mean BMI 32.6 ± 5.0 kg/m2). Based on SMART2, an estimated 2,529,310 individuals (41.0%) will experience at least one MACE event in the next 10 years, with the total number of events estimated at 3,064,993. Of these, 497,631 MACE events could be avoided with semaglutide 2.4 mg treatment (Table). The possible therapeutic impact of semaglutide 2.4 mg on eligible US adults is substantial, with the potential to prevent nearly half a million CV events and deaths over the next 10 years. Disclosure M. Faurby: Employee; Novo Nordisk. M.G. Nanna: Consultant; Merck & Co., Inc., HeartFlow, Inc. J.C. Toliver: Employee; Novo Nordisk. Q.V. Doan: Consultant; Novo Nordisk, Daiichi Sankyo, Akebia Therapeutics, Inc., AbbVie Inc. A.D. Henry: Consultant; Novo Nordisk. T. Scassellati Sforzolini: Consultant; Novo Nordisk. A. Levine: Consultant; Novo Nordisk. A. Fabricatore: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk. A.S. Houshmand-Oeregaard: Employee; Novo Nordisk. Stock/Shareholder; Eli Lilly and Company, Novo Nordisk A/S. A. Navar: Consultant; ESPERION Therapeutics, Inc. Research Support; ESPERION Therapeutics, Inc. Consultant; Amgen Inc. Research Support; Amgen Inc., Bristol-Myers Squibb Company. Consultant; Bristol-Myers Squibb Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Bayer Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Pfizer Inc., New Amsterdam, Boehringer-Ingelheim, Eli Lilly and Company, Silence Therapeutics. Funding Novo Nordisk, Inc.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"17-OR: ADA Presidents' Select Abstract: Oral Bisphenol A Administration Decreased Peripheral Insulin Sensitivity in Healthy Adults","authors":"ADAM SEAL, STEVEN K. MALIN, ANDREW SCHAFFNER, MICHAEL R. HUBBARD, SARAH K. KEADLE, HANNAH BRUNNER-GAYDOS, ALIA A. ORTIZ, JANE E. NAKAMURA, CLARA MCMAHON, RACHEL BARNETT, ANITA H. KELLEHER, KELLY A. BENNION, SUZANNE PHELAN, TODD HAGOBIAN","doi":"10.2337/db24-17-or","DOIUrl":"https://doi.org/10.2337/db24-17-or","url":null,"abstract":"Introduction: Bisphenol A (BPA) is a synthetic chemical widely used in consumer goods and is linked to Type 2 diabetes progression in observational studies. No experimental studies have examined whether BPA promotes reductions in peripheral insulin sensitivity. Objective: To determine the effects of oral BPA administration on peripheral insulin sensitivity. Methods: Forty non-habitually active, healthy adults (22 F, 18 M; 21.3 ± 2.5 yr; 22.1 ± 2.3 kg/m2; 85% Non-Hispanic White) completed a 2-day baseline energy balance diet low in bisphenols during which urine, blood, and peripheral insulin sensitivity (i.e., glucose infusion rate/steady-state plasma insulin) via 120 min euglycemic hyperinsulinemic clamp technique (40 mU/m2/min; 90 mg/dL) were assessed. Participants were then randomly assigned, in a double-blinded fashion, to a 4-day energy balance diet plus oral BPA administration at 50 μg/kg body weight (BPA-50) or 4-day energy balance diet plus oral placebo (PL) administration. Outcomes were reassessed using a repeated measures ANOVA adjusting for baseline sex, BMI, physical activity, and ethnicity. Results: From baseline to 4-days, body weight was not significantly (P>0.05) different between PL (mean ± SEM; 66.7 ± 2.5, 66.2 ± 2.5 kg) and BPA-50 (66.7 ± 2.5, 66.7± 2.5 kg). From baseline to 4-days, fasting blood glucose was not significantly (P > 0.05) different between PL (95 ± 2, 88 ± 2 mg/dL) and BPA-50 (92 ± 2, 92 ± 2 mg/dL). Compared to PL urine BPA was significantly higher (P<0.05) following BPA-50. From baseline to 4-days, peripheral insulin sensitivity significantly (P=0.01) decreased in BPA-50 (0.11 ± 0.01, 0.10 ± 0.01 mg/kg/min/uU/ml) and remained stable in PL (0.09 ± 0.01, 0.10 ± 0.01 mg/kg/min/uU/ml). Conclusion: BPA administration decreased peripheral insulin sensitivity after four days. These data provide the first experimental evidence that BPA administration may increase Type 2 diabetes risk. Supported by American Diabetes Association grant #1-19-ICTS-044. Disclosure A. Seal: None. S.K. Malin: None. A. Schaffner: None. M.R. Hubbard: None. S.K. Keadle: None. H. Brunner-Gaydos: None. A.A. Ortiz: None. J.E. Nakamura: None. C. McMahon: None. R. Barnett: None. A.H. Kelleher: None. K.A. Bennion: None. S. Phelan: Research Support; Weight Watchers International. T. Hagobian: None. Funding American Diabetes Association (1-19-ICTS-044)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"142-OR: A1C and Average Glucose Discordance—Personalized A1C Improves the Discrepancy, Particularly in Black Individuals","authors":"RAMZI AJJAN, TIMOTHY DUNN, YONGJIN XU, PRATIK CHOUDHARY","doi":"10.2337/db24-142-or","DOIUrl":"https://doi.org/10.2337/db24-142-or","url":null,"abstract":"Introduction: Black individuals with diabetes have greater hypoglycemic hospitalizations, perhaps due to overtreatment of elevated laboratory A1C compared to average glucose (AG), related to altered red blood cell (RBC) biology. Our aim was to evaluate the size of the problem and improve A1C accuracy using a new glycemic marker. Methods: Continuous glucose monitoring (CGM) and bi-monthly A1C were collected in a 26-week study of adults with type 1 or type 2 diabetes across different race groups. RBC personal glycation ratio (PGR) was determined at 12 weeks and used to calculate personalized A1C (pA1C) with this new glycemic marker assessed against paired 56-day AG-derived A1C. Results: Of 811 A1C and AG-derived A1C comparisons in 245 individuals, 34% displayed greater than 0.5% disagreement. This was reduced to 13% using pA1C, with the largest improvement detected in 56 Black individuals (reducing from 42% deviation rate for A1C to 17% for pA1C, Figure). For A1C values <7%, more than 0.5% discrepancy between A1C and AG-derived A1C for the whole group and Black individuals was lowered from 27% and 34%, respectively, to 5% and 9% with pA1C. Conclusion: Clinically significant A1C and AG-derived A1C discordance is common, particularly in Black individuals. Personalized A1C addresses this discrepancy potentially improving clinical management in diabetes and reducing health disparities. Disclosure R. Ajjan: Research Support; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Abbott, AstraZeneca, Novo Nordisk. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Diabetes UK. Advisory Panel; Eli Lilly and Company, Sanofi. T. Dunn: Employee; Abbott. Y. Xu: None. P. Choudhary: Advisory Panel; Abbott, Biolinq. Speaker's Bureau; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi. Advisory Panel; Ypsomed AG, Vertex Pharmaceuticals Incorporated.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"920-P: Sodium–Glucose Cotransporter 2 Inhibitor Use and Risk of Dementia and Parkinson’s disease among Patients with Type 2 Diabetes—A Longitudinal, Nationwide, Population-Based Cohort Study","authors":"HAE KYUNG KIM, GEERT J. BIESSELS, MINHEUI YU, JIHOON BAE, ARIM CHOI, MINYOUNG LEE","doi":"10.2337/db24-920-p","DOIUrl":"https://doi.org/10.2337/db24-920-p","url":null,"abstract":"The efficacy of sodium-glucose cotransporter 2 inhibitor (SGLT2i) in neurologic disorders is not well-established. This study aimed to investigate the association of SGLT2i use with risks of incident dementia and Parkinson’s disease (PD) in patient with type 2 diabetes. Subjects aged ≥ 40 years, diagnosed with type 2 diabetes, and who started antidiabetic drugs from 1 September 2014 and 31 December 2019 were evaluated, using the National Health Insurance Service Database. Propensity score matching (1:1; SGLT2i to other oral antidiabetic drugs [OAD]) produced a cohort of 358,862. Primary outcomes were a composite of dementia from any cause (Alzheimer’s disease [AD], vascular dementia [VaD], and other dementia) and PD. From the 358,862 participants analyzed (mean age, 57.8 years; 57.9% male), 6,837 incident dementia or PD events occurred. Overall, use of SGLT2i was associated with a 22% lower risk for the composite of dementia from any cause and PD than use of other OADs (adjusted HR [aHR], 0.78 [95% CI 0.73─0.83]) with a 6-month lag period. Regarding the individual endpoints, SGLT2i use was associated with reduced risks for AD (aHR, 0.81 [95% CI 0.76─0.87]), VaD (aHR, 0.69 [95% CI 0.60─0.78]), and PD (aHR, 0.80 [95% CI 0.69─0.91]). In this nationwide population-based cohort study, SGLT2i use significantly reduced the risks for dementia and PD in patients with type 2 diabetes independent of various factors including comorbidities and bioclinical parameters. Disclosure H. Kim: None. G.J. Biessels: None. M. Yu: None. J. Bae: None. A. Choi: None. M. Lee: Other Relationship; JW Pharmaceutical Corporation, Boryung Corporation, Eli Lilly and Company, Merck Sharp & Dohme Corp., HK inno.N, Servier Korea, Handok Inc., Daewoong Pharmaceutical, KUKJE PHARM CO., LTD, GC Biopharma Corporation. Funding Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HR22C141104)2); 'SENTINEL (Severance Endocrinology daTa scIeNcE pLatform)’ program funded by the 2020 Research fund of Department of Internal Medicine, Severance Hospital; Sung-Kil Lim Research Award (4-2018-1215; DUCD000002); Yonsei University College of Medicine (6-2020-0155)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"1932-LB: Cost-Effectiveness of the National Diabetes Prevention Program—A Real-World, Two-Year Prospective Study","authors":"SHIHCHEN KUO, WEN YE, DI WANG, LAURA N. MCEWEN, CLAUDIA VILLATORO SANTOS, WILLIAM H. HERMAN","doi":"10.2337/db24-1932-lb","DOIUrl":"https://doi.org/10.2337/db24-1932-lb","url":null,"abstract":"Few studies have examined the cost-effectiveness of the National Diabetes Prevention Program (NDPP) in real-world settings. We evaluated the real-world cost-effectiveness of the NDPP in people with prediabetes in a large workforce with employer-sponsored health insurance. We performed individual-level, empirical data analyses using surveys and health insurance claims for 6,179 adult employees, dependents, and retirees with prediabetes who enrolled (n=592) or did not enroll (n=5,587) in the NDPP. We assessed direct medical costs the year before NDPP enrollment/index date (baseline) through 2 years afterward, EQ-5D-5L utility scores at baseline and 2 years afterward, and quality-adjusted life-years (QALYs) over 2 years for NDPP enrollees and non-enrollees. We applied propensity score weighting to adjust for bias due to self-selection for enrollment, multiple imputations to handle missing data, and bootstrap method to produce confidence intervals (CIs). We adopted a health system perspective and discounted costs and QALYs at 3% annually. Costs were expressed in 2020 U.S. dollars. Compared to non-enrollees, the average reduction in direct medical costs per enrollee was $3,979 (95% CI: -$11,962 to $2,019) over 2 years. The cost savings were primarily related to fewer hospitalizations (-$3,016), outpatient visits (-$639), and emergency room visits (-$272) among enrollees. Each enrollee accrued 1.726 QALYs and each non-enrollee accrued 1.702 QALYs over 2 years, representing a gain of 0.024 (95% CI: -0.007 to 0.052) QALY per enrollee. The uncertainty analyses showed a high probability (75%) of cost savings, and an 89% probability of being cost-effective at a willingness-to-pay threshold of $100,000 per QALY gained, for NDPP enrollees versus non-enrollees. In this real-world population with prediabetes, enrollment in the NDPP was likely to provide cost savings and improve quality-adjusted life-expectancy. Further research is warranted to confirm these findings. Disclosure S. Kuo: None. W. Ye: None. D. Wang: None. L.N. McEwen: None. C. Villatoro Santos: None. W.H. Herman: Consultant; Merck Sharp & Dohme Corp. Advisory Panel; American Diabetes Association. Other Relationship; National Institutes of Health. Advisory Panel; National Committee for Quality Assurance. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK109995 and P30DK092926), and Centers for Disease Control and Prevention (U18DP006712)","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141448452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}