Background: Level2’s virtual specialty clinic, offered across the United States to people with type 2 diabetes on participating insurance plans, combines providers, coaches, continuous glucose ...monitors (CGM), and fitness trackers to help members gain insight, and focus on long-term behavior change. We retrospectively assessed differences in glycemic outcomes following one year of participation in Level2.
Methods: People joining Level2 between 01/01/21 and 07/31/21 with 15 months of Level2 participation and 3 prior months of continuous enrollment in a participating commercial health plan were included in the analysis. We used CGM-derived GMI and A1c values available from a database of de-identified administrative claims to determine baseline and 12-month follow-up glycemic outcomes. Wilcoxon signed-rank tests were used to test for pair-wise improvements in glycemic measures between baseline and follow-up overall and stratified by baseline A1c.
Results: Of the 3,440 people identified for the analysis, a subset (N = 200) had both baseline A1c and valid GMIs during follow-up. This subset was 53% (N = 106) male with mean age of 55.4 (SD = 8.5) years and had mean baseline A1c of 7.97% (SD = 1.02). The median difference between baseline A1c and follow-up GMI was -0.83% (p < 0.001) overall, with significant differences of -0.82% (p < 0.001) and -2.41% (p < 0.001) in those with baseline 7% < A1c < 9% and A1c > 9%, respectively. Over 50% of people had a decrease in glycemic outcome of more than 0.5%, with 67% and 95% of people improving by more than 0.5% in the 7-9% and > 9% groups respectively. There were 87 people that also had an A1c at 12-month follow-up; the median difference in A1c was -0.65% (p < 0.001), 50% had a decrease of more than 0.5%, and median difference between GMI/A1c follow up values was 0.13 (p = 0.11).
Conclusion: Level2 members with baseline A1c and follow-up GMI saw significant improvements in glycemic control over one year of engagement. These improvements were observed for measures of both follow-up A1c and GMI.
Disclosure
S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. D.Ferrell: Stock/Shareholder; Level2, Medexpress Urgent Care. J.Fung: Employee; Level2.
Glycemic trends in type 2 diabetes (T2D) participants from Indian metropolitan and non-metropolitan cities have been less studied and hence, were evaluated in the LANDMARC trial (a 3-year nationwide ...prospective observational study; CTRI/2017/05/008452). A total of 5273 of 6222 evaluable participants with T2D taking ≥2 antihyperglycemic medications (with/without glycemic control) completed the 3-year follow-up visit. Age, T2D duration, and baseline A1C were comparable across participants from metropolitan and non-metropolitan cities. At 3-years, a decrease in all glycemic parameters was noted. FPG levels from baseline improved more in participants from metropolitan than non-metropolitan cities (mean 95% CI: −21.6 mg/dL −25.2, −18.0 vs. −15.8 mg/dL −18.8, −12.8; p=0.0149). No significant difference in change from baseline between metropolitan and non-metropolitan cities was noted for A1C (p=0.2070) and PPG (p=0.3592) (Table). Almost one third of the participants in metropolitan (492/1534 32.07%) and non-metropolitan (864/2166 39.89%) cities achieved glycemic control (A1C <7%). Overall, participants from both metropolitan and non-metropolitan cities showed marked improvement in all glycemic parameters from baseline to the end of 3 years. These results help compare the longitudinal glycemic patterns among participants with T2D in cities across India.
Disclosure
A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.K.Das: n/a. S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. K.Kumar: None. H.Thacker: None. B.Sethi: None. S.Chowdhury: None.
Funding
Sanofi India
Over the past 2 decades, nonalcoholic fatty liver disease (NAFLD) has grown from a relatively unknown disease to the most common cause of chronic liver disease in the world. In fact, 25% of the ...world’s population is currently thought to have NAFLD. Nonalcoholic steatohepatitis (NASH) is the subtype of NAFLD that can progress to cirrhosis, hepatocellular carcinoma (HCC), and death. NAFLD and NASH are not only found in adults—there is also a high prevalence of these diseases in children and adolescents. Because of the close association of NAFLD with type 2 diabetes (T2DM) and obesity, the latest models predict that the prevalence of NAFLD and NASH will increase, causing a tremendous clinical and economic burden and poor patient‐reported outcomes. Nonetheless, there is no accurate noninvasive method to detect NASH, and treatment of this disease is limited to lifestyle modifications. To examine the state of NAFLD among different regions and understand the global trajectory of this disease, an international group of experts came together during the 2017 American Association for the Study of Liver Diseases Global NAFLD Forum. We provide a summary of this forum and an assessment of the current state of NAFLD and NASH worldwide.
Objective: Despite advances in treatment strategies, many individuals with T2D treated with insulin still struggle with inadequate glycemic control. The aim was to describe CGM-derived metrics and ...HbA1c for adults with T2D and HbA1c ≥7.5% (≥58 mmol/l) using different insulin treatment regimens; basal insulin only or multiple daily injections (MDI).
Methods: Baseline characteristics of participants with T2D entering a randomized controlled trial on the efficacy of using CGM were analyzed including CGM-derived metrics from 10 days blinded CGM (Dexcom G6).
Results: Included were 96 adults (men 61.5%, age 61 (54-67) years and BMI 30.7 (26.7-35.7) kg/m2, all median (+IQR)). Compared to adults on basal insulin only, the MDI treated had a longer diabetes duration of 22 (19-25) vs 18 (14-22) years, a higher HbA1c 9.2 (8.6-9.7) vs 8.3 (7.8-9.1) % and a lower C-peptide 396 (217-630) vs 745 (504-1178) pmol/l. There were no differences in time in range or mean sensor glucose. In contrast, the MDI treated had less time above range (28 (21-32) vs 33 (25-42) %) but a higher coefficient of variation (32 (26-36) vs 26 (23-31)%) and a higher time below range (<3.0 mmol/l).
Conclusion: These results suggest that while MDI treatment may be associated with higher HbA1c levels and greater glycemic variability, this is not consistently reflected in all CGM-derived metrics.
Disclosure
N.Lind: None. M.B.Christensen: Speaker's Bureau; Novo Nordisk A/S, Sanofi. K.Nørgaard: Advisory Panel; Medtronic, Novo Nordisk, Research Support; Medtronic, Dexcom, Inc., Novo Nordisk, Zealand Pharma A/S, Speaker's Bureau; Medtronic, Novo Nordisk, Stock/Shareholder; Novo Nordisk.
Intro: SGLT2 inhibitors (SGLT2) and GLP1 agonists (GLP1) both reduce major adverse cardiovascular events (MACE) in patients with T2D and MI. We characterize the pattern of prescriptions for these ...medications in an urban safety net teaching hospital which provided these medications to low income patients at nominal cost.
Methods: Using the hospital EHR, we reviewed medication lists for patients with T2D who were hospitalized with type 1 MI between 2018-2019.
Results: There were 178 patients with one-year follow-up data, of which 75 (42.1%) were uninsured. We summarized the distribution of diabetes therapies in Table 1. SGLT2 and GLP1 were prescribed in 39% and 8% of patients at 1-year, respectively. Likelihood of having an active SGLT2 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 2.6; 95% CI 1.9-3.4). Likelihood of having an active GLP1 prescription at 1-year was higher for patients prescribed it at discharge compared to those who were not (RR 10.9; 95% CI 4.9-24.5).
Conclusions: Rates of prescription of MACE-reducing therapies (SGLT2 and GLP1) after MI are low compared to metformin and insulin, which have no proven MACE benefit. Prescribing SGLT2 and GLP1 at index discharge can significantly increase the likelihood that patients will be prescribed these medications one year later.
Disclosure
N.Sumarsono: None. S.Das: None. C.L.Malladi: None. A.A.Dweik: None. P.L.Della-penna: None. K.Geurink: None. C.Mathew: None. E.Moss: None. K.Peykova: None. L.Mack-boyd: None.
Background: Multiple pivotal and post market studies have confirmed the safety and accuracy of implantable Eversense CGM Systems. A post market study was initiated to compare Eversense 90-day and ...180-day systems to SMBG in CGM naïve patients. Methods: This post market study is a prospective, multicenter, one year comparison of SMBG to Eversense in CGM naïve adults with diabetes in US sites (up to 925 users). After baseline assessment including HbA1c, patients used SMBG for 6 months (phase 1) followed by Eversense for 6 months (phase 2). Sensors were inserted at the start of phase 2. Visits occurred q 90 days to collect SMBG or CGM data and assess adverse events. HbA1c was measured at 6 and 12 months. Glucometrics were calculated in both phases. Enrollment and follow-up visits are ongoing.
Results: In 15 sites, 84 users have completed the study (mean 47.6% male, 90.5% type 2 diabetes, 57.2 years age). In the initial users, reductions in HbA1c were seen in both phases and improvements in glucometrics were observed (Table) with CGM compared to SMBG.
Conclusion: In a CGM naïve population, 6 months of SMBG use reduced HbA1c. There was a further significant reduction after 6 months of using Eversense CGM, as well as significant improvement in glucometrics - an increase in Time in Range (70-180 mg/dL) with no increase Time below Range. These data suggest that Eversense CGM improves glucose management compared to SMBG.
Disclosure
K.S.Tweden: Employee; Senseonics. B.Romarowski: Employee; Senseonics. C.Mdingi: Employee; Senseonics. F.R.Kaufman: Consultant; MannKind Corporation, Twin Health, Stock/Shareholder; Senseonics.
Rationale: Drug prescribing studies can suggest modifications in the current prescribing practices, which in turn will reduce the treatment cost, non-compliance and complications.
Purpose: To ...identify the prescription patterns in patients with type 2 diabetes mellitus with respect to the duration of the disease.
Methods: Patients with type 2 diabetes mellitus seeking regular care at twelve of the locations in Western India were included in the study. Using MEDEVA (EMR), an integrated research platform, information on medical history, laboratory values and medications was recorded. Data collected from 1st December 2022 to February 25th 2023 was considered for the analysis.
Results: Of the 920 patients enrolled in the study, 607 had a duration of diabetes and prescribed medications recorded. Patients with a duration ≤ 5 years are about 53.0%, 5-10 years are 28.8% and >10 years are 18.1%. Biguanides and Sulfonylureas, followed by DPP-4, are the most common drug classes prescribed in patients with ≤ 5 years duration and Insulins in patients with a duration of more than 10 years.
Conclusion: This study offers valuable information on the trends in oral antidiabetic medications and insulins in diabetic patients. As the duration of the disease increases insulin is the most prescribed medication.
Disclosure
V. Chavda: None. B. D. Saboo: None. V. Abhichandani: None. S. Desai: None. V. Patadia: None. B. S. Mori: None. S. Patel: None. A. M. Prajapati: None. M. N. Parekh: None. F. Vora: None. T. Vora: None. D. Hasnani: None.
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