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CONTINUOUS GLUCOSE MONITOR (CGM) DERIVED GLYCEMIC OUTCOMES AMONG REAL-TIME CGM VS. FLASH CGM USERS IN A MULTI-CENTER EMR DATABASE FOR PEOPLE WITH T1D [Meeting Abstract]
Noor, N; Ebekozien, O; Vendrame, F; Jacobsen, L; Weinstock, R; Gallagher, M P; Corathers, S; Accacha, S; Prahalad, P; Rapaport, R
Background and Aims: Evidence from clinical trials suggest that use of CGM devices decreases hypoglycemia, but no realworld studies have demonstrated efficacy of real-time CGM vs. flash CGM device use in improving CGM derived glycemic outcomes. A flash or intermittently scanning CGM (isCGM) provides glucose levels immediately upon scanning sensor; whereas real-time CGM (rtCGM) device automatically transmits a continuous stream of glucose data to the user. We examined efficacy of isCGM vs. rtCGM device use using real-world EMR data from 19 endocrinology clinics participating in the T1DX-QI Collaborative.
Method(s): Main outcomes were a) mean time in range (TIR: 70-180 mg/dL), b) time above range (TAR: >=250mg/dL) and c) time below range (TBR: <70 mg/dL). Patients >=6 years with T1D from 2018 to 2022 were included. Discriptive differences between isCGM and rtCGM groups were assessed using chisquare and Mann-Whitney U tests. Bootstrapped point estimates and 95% CIs were reported. Linear mixed models examined association between type of CGM and TIR adjusting for covariates.
Result(s): This analysis included 6234 people in the rtCGM group and 412 people in the isCGM group. In the overall study population, mean TIR was higher for rtCGM users relative to isCGM users (Mean(95% CI): 50 (49-51) vs. 40 (38-43)) [p = 0.0001], mean TBR was lower for rtCGM users relative to isCGM users (Mean (95% CI): 1.9 (1.8-2.0) vs. 2.6 (2.2-3.0)) [p = 0.001] and mean TAR was also lower for rtCGM users (Mean(95% CI): 19 (18-20) vs. 26 (23-30)) [p < 0.001].
Conclusion(s): We found improved CGM derived glycemic outcomes for rtCGM relative to the isCGM grroup
EMBASE:640507030
ISSN: 1557-8593
CID: 5512042
Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative
Marks, Brynn E.; Mungmode, Ann; Neyman, Anna; Levin, Laura; Rioles, Nicole; Eng, Donna; Lee, Joyce M.; Basina, Marina; Hawah-Jones, Nana; Mann, Elizabeth; O"™Malley, Grenye; Wilkes, Meredith; Steenkamp, Devin; Aleppo, Grazia; Accacha, Siham; Ebekozien, Osagie
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
SCOPUS:85150042490
ISSN: 0891-8929
CID: 5447032
Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study
Demeterco-Berggren, Carla; Ebekozien, Osagie; Rompicherla, Saketh; Jacobsen, Laura; Accacha, Siham; Gallagher, Mary Pat; Todd Alonso, G; Seyoum, Berhane; Vendrame, Francesco; Haw, J Sonya; Basina, Marina; Levy, Carol J; Maahs, David M
CONTEXT:COVID-19 morbidity and mortality are increased in type 1 diabetes (T1D), but few data focus on age-based outcomes. OBJECTIVE:This work aimed to quantify the risk for COVID-19-related hospitalization and adverse outcomes by age in people with T1D. METHODS:For this observational, multisite, cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 56 clinical sites in the United States, data were collected from April 2020 to March 2021. The distribution of patient factors and outcomes across age groups (0-18, 19-40, and > 40 years) was examined. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between age, adverse outcomes, and hospitalization. The main outcome measure was hospitalization for COVID-19. RESULTS:A total of 767 patients were analyzed. Fifty-four percent (n = 415) were aged 0 to 18 years, 32% (n = 247) were aged 19 to 40 years, and 14% (n = 105) were older than 40 years. A total of 170 patients were hospitalized, and 5 patients died. Compared to the 0- to 18-years age group, those older than 40 years had an adjusted odds ratio of 4.2 (95% CI, 2.28-7.83) for hospitalization after adjustment for sex, glycated hemoglobin A1c, race, insurance type, and comorbidities. CONCLUSION:Age older than 40 years is a risk factor for patients with T1D and COVID-19, with children and younger adults experiencing milder disease and better prognosis. This indicates a need for age-tailored treatments, immunization, and clinical management of individuals affected by T1D.
PMCID:8500098
PMID: 34581790
ISSN: 1945-7197
CID: 5131202
Fasting Serum IGFBP-1 as a Marker of Insulin Resistance in Diverse School Age Groups
Bhangoo, Amrit; Gupta, Rishi; Shelov, Steve P; Carey, Dennis E; Accacha, Siham; Fennoy, Ilene; Altshuler, Lisa; Lowell, Barbara; Rapaport, Robert; Rosenfeld, Warren; Speiser, Phyllis W; Ten, Svetlana; Rosenbaum, Michael
Introduction:The known markers of insulin resistance in obese children are well studied. However, they require serial measurements and complicated calculations. The objective is to study IGFBP-1 and its relation with other known risk measures. Materials and Methods:The study included 98 New York City school students of diverse ethnic/racial backgrounds (57 males and 41 females), 11-15 years of age. Subjects were enrolled in a cross-sectional study, and anthropometric measures were collected. They underwent fasting intravenous glucose tolerance tests (IVGTT), and glucose, insulin, lipids, IGFBP-1, adiponectin and inflammatory markers were collected. Results:The subjects were stratified into 3 groups based upon the BMI Z-score. Out of all the subjects, 65.3% were in the group with a BMI Z-score <1 SDS, 16.3% subjects were in the group with a BMI Z-score of 1 to 2 SDS, and 18.4% of the subjects were in the group with a BMI Z-score of more than 2 SDS. The group with a BMI Z-score of more than 2 SDS had increased waist circumference (WC), body fat, increased fasting insulin, and triglycerides (TG). This group had decreased levels of adiponectin and HDL and low IGFBP-1 as compared to the group with BMI <1 SDS. The group with a BMI Z-score of 1 to 2 SDS had a decreased level of IGFBP-1 as compared to the group with a BMI Z-score less than 1 SDS. IGFBP-1 inversely correlated with age, WC, BMI, body fat, TG, and insulin levels. IGFBP-1 positively correlated with adiponectin and HDL levels. Conclusion:IGFBP-1 in children can identify the presence of insulin resistance in the group with BMI 1 to 2 SDS, even before the known markers of insulin resistance such as elevated triglycerides and even before decreased HDL and adiponectin levels are identified.
PMCID:9108162
PMID: 35586622
ISSN: 1664-2392
CID: 5277472
Demographics and anthropometrics impact benefits of health intervention: data from the Reduce Obesity and Diabetes Project
Ostrowski, L; Speiser, P W; Accacha, S; Altshuler, L; Fennoy, I; Lowell, B; Rapaport, R; Rosenfeld, W; Shelov, S P; Ten, S; Rosenbaum, M
Objective/UNASSIGNED:To determine the efficacy of a 4-month school-based health, nutrition and exercise intervention on body fatness and examine possible effects of demographic and anthropometric covariates. Methods/UNASSIGNED:Â =Â 469) received a 12-session classroom-based health and nutrition educational programme with an optional exercise intervention. Results/UNASSIGNED:Â =Â 0.005). Conclusion/UNASSIGNED:A 4-month school-based health intervention was effective in decreasing measures of adiposity in middle school students, particularly in men, participants who were obese and South Asians.
PMCID:6381301
PMID: 30847225
ISSN: 2055-2238
CID: 3724582
PRO-ATHEROGENIC PROPERTIES OF PLASMA FROM PATIENTS WITH TYPE 1 DIABETES MELLITUS: EFFECTS ON MACROPHAGE LIPID HANDLING [Meeting Abstract]
DeLeon, Joshua R; Corletto, Jorge Mejia; Accacha, Siham; Voloshyna, Iryna; Siegart, Nicolle; Kasselman, Lora; Magana, Mariano Castro; Reiss, Allison
ISI:000397342302789
ISSN: 1558-3597
CID: 2677992
BLOCKADE OF THE RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS IS NOT SUFFICIENT TO PREVENT ATHEROGENIC DISRUPTION OF LIPID METABOLISM BY PLASMA FROM TYPE 1 DIABETES PATIENTS: A CLUE IN THE SEARCH FOR IMPROVED CARDIOVASCULAR HEALTH IN DIABETES [Meeting Abstract]
Accacha, Siham; Reiss, Allison B; Mejia-Corletto, Jorge; Siegart, Nicolle M; Renna, Heather A; Castro-Magana, Mariano; De Leon, Joshua; Kasselman, Lora J
ISI:000399374600045
ISSN: 1708-8267
CID: 2678062
Normal Alanine Transferase: an Independent Indicator of Adiposity Related Comorbidity Risk in Youth
Klein, Michelle; Iazzettii, Loretta; Speiser, Phyllis; Carey, Dennis; Shelov, Steven; Accacha, Siham; Fennoy, Ilene; Rosenbaum, Michael; Rapaport, Robert
BACKGROUND/AIMS: Elevated levels of alanine aminotransferase (ALT) are associated with obesity and are often a consequence of non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to assess the relationship between ALT and risk factors for adiposity-related co-morbidities in a diverse population of middle school children. METHODS: We measured height, weight, body fatness (bioelectrical impedance), waist circumference, insulin sensitivity, phase 1 insulin release (acute insulin response following intravenous glucose), beta-cell function (acute insulin response corrected for insulin sensitivity), ALT, lipid profiles, and circulating concentrations of IL-6, C-reactive protein, adiponectin, and TNF-alpha in a multi-ethnic/racial population of 106 middle school students (age 11-14 years, 45F) of varying BMI. RESULTS: ALT was significantly correlated with BMI, % body fat, fat mass, waist circumference, fasting insulin, insulin resistance, triglycerides, and was inversely correlated with HDL in children, even though all values of ALT were "normal" (range of 4.0-33.0 U/L). ALT was significantly higher in males than females even when corrected for body fatness. Significant correlations with lipids and insulin resistance persisted even when adjusted for age, gender, and body fatness. CONCLUSIONS: Even within the normative range, ALT levels were significantly correlated with anthropomorphic and biochemical risk factors for adiposity-related co-morbidities in youth. Therefore, because ALT is correlated with dyslipidemia, insulin resistance, and central fat distribution, it might also serve as a marker of risk for adiposity-related co-morbidities beyond NAFLD.
PMID: 25266069
ISSN: 1753-0407
CID: 1282802
Racial/ethnic Differences in Clinical and Biochemical Type 2 Diabetes Mellitus Risk Factors in Children
Rosenbaum, Michael; Fennoy, Ilene; Accacha, Siham; Altshuler, Lisa; Carey, Dennis E; Holleran, Steven; Rapaport, Robert; Shelov, Steven P; Speiser, Phyllis W; Ten, S; Bhangoo, Amrit; Boucher-Berry, Claudia; Espinal, Yomery; Gupta, Rishi; Hassoun, Abeer A; Iazetti, Loretta; Jacques, Fabien J; Jean, Amy M; Klein, Michelle L; Levine, Robert; Lowell, Barbara; Michel, Lesley; Rosenfeld, Warren
Objective: To examine whether peri-adolescent children demonstrate the significant racial/ethnic differences in body fatness relative to BMI and in the prevalence and relationship of body composition to risk factors for type 2 diabetes (T2DM) as in adults. Design and Methods: We examined family history of obesity and T2DM, anthropometry, insulin sensitivity and secretory capacity, lipids, and cytokines (IL-6, CRP, TNF-alpha, and adiponectin) in a cohort of 994 middle school students (47% male, 53%, female; 12% African American, 14% East Asian, 13% South Asian, 9% Caucasian, 44% Hispanic, and 8% other). Results: Fractional body fat content was significantly greater at any BMI among South Asians. There were racial/ethnic specific differences in lipid profiles, insulin secretory capacity, insulin sensitivity, and inflammatory markers corrected for body fatness that are similar to those seen in adults. Family history of T2DM was associated with lower insulin secretory capacity while family history of obesity was more associated with insulin resistance. Conclusion: Children show some of the same racial/ethnic differences in risk factors for adiposity-related co-morbidities as adults. BMI and waist circumference cutoffs to identify children at-risk for adiposity-related co-morbidities should be adjusted by racial/ethnic group as well as other variables such as birthweight and family history.
PMCID:3766484
PMID: 23596082
ISSN: 1930-7381
CID: 306552
Effects of parental origins and length of residency on adiposity measures and nutrition in urban middle school students: a cross-sectional study
Kuryan, Ranita; Frankel, David; Cervoni, Barbie; Koltun, Audrey; Lowell, Barbara; Altshuler, Lisa; Rosenbaum, Michael; Shelov, Steven P; Carey, Dennis E; Accacha, Siham; Fennoy, Ilene; Rapaport, Robert; Rosenfeld, Warren; Ten, Svetlana; Speiser, Phyllis W
BACKGROUND: The prevalence of obesity in U.S. has been rising at an alarming rate, particularly among Hispanic, African, and Asian minority groups. This trend is due in part to excessive calorie consumption and sedentary lifestyle. We sought to investigate whether parental origins influence eating behaviors in healthy urban middle school students. METHODS: A multiethnic/racial population of students (N = 182) enrolled in the ROAD (Reduce Obesity and Diabetes) Study, a school-based trial to assess clinical, behavioral, and biochemical risk factors for adiposity and its co-morbidities completed questionnaires regarding parental origins, length of US residency, and food behaviors and preferences. The primary behavioral questionnaire outcome variables were nutrition knowledge, attitude, intention and behavior, which were then related to anthropometric measures of waist circumference, BMI z-scores, and percent body fat. Two-way analysis of variance was used to evaluate the joint effects of number of parents born in the U.S. and ethnicity on food preference and knowledge score. The Tukey-Kramer method was used to compute pairwise comparisons to determine where differences lie. Analysis of covariance (ANCOVA) was used to analyze the joint effects of number of parents born in the US and student ethnicity, along with the interaction term, on each adiposity measure outcome. Pearson correlation coefficients were used to examine the relationships between maternal and paternal length of residency in the US with measures of adiposity, food preference and food knowledge. RESULTS: African Americans had significantly higher BMI, waist circumference and body fat percentage compared to other racial and ethnic groups. Neither ethnicity/race nor parental origins had an impact on nutrition behavior. Mothers' length of US residency positively correlated with students' nutrition knowledge, but not food attitude, intention or behavior. CONCLUSIONS: Adiposity measures in children differ according to ethnicity and race. In contrast, food behaviors in this middle school sample were not influenced by parental origins. Longer maternal US residency benefited offspring in terms of nutrition knowledge only. We suggest that interventions to prevent obesity begin in early childhood.
PMCID:3875353
PMID: 24134822
ISSN: 1687-9848
CID: 845002