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Introduction and Objective: Preoperative carbohydrate loading is recommended in many surgery protocols. However, concerns remain about the impact carbohydrate loading may have on patients with diabetes. This study examines the impact of carbohydrate loading on outcomes of cardiac surgery patients with and without diabetes. Methods: This retrospective analysis included 125 cardiac surgery patients at a major Midwest hospital utilizing a maltodextrin-based carbohydrate drink as part of a quality improvement project. The protocol included consuming a drink containing 50g of a carbohydrate 2-4 hours prior to surgery. Patients’ blood glucose was measured preoperatively and at intervals of 45-120 minutes postoperatively. Blood glucose, 30-day readmissions, intensive care unit (ICU) and hospital length of stay were compared between patients with and without diabetes. Results: Patients had median age of 65 (IQR 56-72) years, 79% (n=99) were male, and 30.4% (n=38) had a diagnosis of diabetes. Median (IQR) preoperative glucose levels were 143 (112-159) mg/dL and 97 (90-160) mg/dL for patients with and without diabetes, respectively. The peak post-operative median glucose was 153 mg/dL and 137 mg/dL for patients with and without diabetes, respectively. Readmission rates were 7.9% in those with diabetes and 4.6% in those without diabetes (p=0.4). Total length of stay for ICU (in hours) and postoperative hospital stay (in days) was comparable between groups (65 vs. 64 hours, p=0.6; 5.1 vs. 6 days, p=0.4, respectively). Conclusion: Cardiac surgery patients with diabetes given maltodextrin-based carbohydrate loading drinks before surgery were able to maintain blood glucose within acceptable ranges and did not demonstrate a higher risk for 30-day readmissions or longer length of stay when compared to those without diabetes. These data add to the growing body of literature supporting the use of carbohydrate loading for cardiac surgical patients with diabetes. K.W. Kerr: Employee; Abbott Nutrition. Stock/Shareholder; Abbott. B. Cassady: Employee; Abbott Nutrition. Stock/Shareholder; Abbott. K. Robinson: Employee; Abbott Nutrition. C. Johns: None. This research was funded in part by Abbott.

Sleeve gastrectomy (SG) and Endoscopic gastroplasty, are 2 effective weight loss interventions. This study assessed the impact of these interventions on weight loss, glucose homeostasis, and behavioral and hormonal parameters in mice. Both SG and gastroplasty induced significant weight loss, with SG showing lower food intake and improved feeding efficiency (Fig1). SG also showed better glucose and insulin tolerance, lower liver triglyceride levels, and reduced agouti-related protein levels compared to gastroplasty. Despite comparable weight reduction, SG demonstrated additional molecular improvements, suggesting potential for non-invasive interventions to replicate the benefits of invasive procedures (Fig2). This study highlights the potential of less invasive procedures as alternatives for treating severe obesity. Disclosure M. Mokadem: None. Funding VA Merit Award (I01 BX004774)

Introduction: Density of sub-epithelial corneal nerves have been promoted as a surrogate marker for early diagnosis of DPN. As an alternative, we developed an objective functional test of corneal sensitivity (Invest Ophthalmol Vis Sci. 2016, 57: 2412-9). In this study we provide verification of this methodology in human subjects with DPN. Methods: Following verification of DPN, response to a drop of isotonic vs. 5% NaCl (hypertonic) solution was recorded (primary endpoint). Ratio of time that the eyelids were closed from 10s to 60s following application of each solution were quantified using an image analysis program. Results: We examined 24 subjects with type 2 diabetes and 12 age-matched controls. The presence of DPN in diabetes vs. control subjects was verified by completing the Michigan Neuropathy Screening Instrument questionnaire and lower extremity examination including amplitude and conduction velocity of the sural nerve. The presence of eye discomfort was examined for each subject by completing the DEQ5 and Ocular Surface Disease Index (OSDI) questionnaires. DPN was confirmed in all subjects with diabetes as well as presence of mild to moderate ocular surface disease. Two control subjects had mild ocular surface disease but no peripheral neuropathy. Cochet-Bonnet filament esthesiometer examination revealed significant corneal sensitivity impairment in subjects with diabetes vs. control subjects (5.64 ± 0.08 vs. 5.97 ± 0.03 cm, respectively). Corneas of subjects with diabetes were also significantly less sensitive vs. controls to application of hypertonic solution (0.18 ± 0.01 vs. 0.29 ± 0.04, respectively). Data is presented as mean ± S.E.M. There was no difference in sensitivity to the isotonic solution. Conclusion: Corneal nerves that penetrate the epithelium and sprout near the surface of the eye and are the first to exhibit the "dying-back" phenomenon associated with DPN. Clinical evaluation of the sensitivity of these nerves could be a valuable method for early detection of DPN. Disclosure M.A.Yorek: Consultant; Novo Nordisk. M.Correia: Research Support; Eli Lilly and Company, Novartis, Novo Nordisk. R.Kardon: None. P.Poolman: Stock/Shareholder; FaceX LLC. Funding U.S. Department of Veterans Affairs (RX000889)

HTN is a significant public health concern with increasing prevalence in youth. Optimizing BP control with both lifestyle counseling and antihypertensive medications improves health outcomes. However, adequate BP control remains difficult in majority of patients, in part due to a lack of understanding of how social determinants of health affect dietitian referral and initiation of antihypertensive therapy. We performed a cross-sectional analysis of baseline EHR data from the SUPERHERO Registry in youth who received initial care from sub-specialists for HTN disorders defined by ICD-10 codes from 1/1/2015-12/31/2022. We excluded those with pregnancy, kidney transplantation, and dialysis. We examined the association of individual-level social drivers (transportation, finances, food access housing) with the likelihood of antihypertensive medication prescription and dietitian referral at initial visit in youth with HTN disorders using unadjusted generalized linear models. Of our large cohort of 11,580, only 47 youth had at least one unmet social need (0.4%). Participants with at least one unmet social need were 1.81 times more likely to be prescribed antihypertensive medication (95% CL 0.94- 3.48; p= 0.08) and 6.73 times more likely to be referred to a dietitian (95% CL 3.7-12.25). We found that children with at least one unmet social need were more likely to be referred to a dietitian at the initial visit than those without an unmet social need. The small number of participants with unmet social needs might reflect poor screening or documentation practices. It is imperative that screening for unmet social needs is incorporated into clinical practice in youth with HTN disorders.

Abstract Introduction Patients with major burns suffer deficiencies in trace elements (TE), which can affect their clinical course. We established a quality improvement (QI) project to supplement TE (multivitamins with TE, vitamin C, and zinc). Herein, we assessed the impact of QI implementation on outcomes. Methods We queried the burn registry for burn patients admitted from 8/1/2019-5/31/2022 who weighed > 40 Kg and stayed >14 days. Demographics; comorbidities; injury, and hospital course information were collected. Post-implementation, TE levels (zinc, copper, and selenium) as well as C reactive protein levels were measured at 2 weeks. Analyses were performed to assess differences between the pre- and post-groups and post-group patients with major burns (≥20%TBSA) and smaller burns (< 20%TBSA). P < 0.05 was considered significant. Results We included 111 patients, 45 in the pre- and 66 in the post-group. Overall, the population was male (79.3%) with a median age of 53 years. Age and sex were not significantly different between the pre- and post-groups. The post-group had higher TBSA (p = 0.005). They were more likely to smoke (p =0.018) and have an alcohol use disorder (p = 0.035). There was no significant difference observed in mortality, complications, or LOS/TBSA (2.1 days [1.2-5.5] vs. 1.7 days [1.2-3.1], p = 0.300) between the groups. Focusing on the post-group, 37 presented with smaller burns and 29 with major burns. Patients with major burns were younger (p =0.003) and healthier than patients with smaller burns. At 14 days, 81.5% and 33.3% of patients with major burns were deficient in zinc and copper, respectively. Zinc (47.6 µg/dL vs.79.2 µg/dL p < 0.001), copper (80.2 µg/dL vs.121.9 µg/dL p < 0.001), and selenium (98.7 µg/L vs.135.5 µg/L, p = 0.003) levels were significantly lower in patients with major burns. C-reactive protein levels were high in both groups but significantly higher in patients with major burns (p < 0.001). Patients with major burns were more likely to have infectious complications (p = 0.004); however their LOS/TBSA was significantly lower than that of patients with smaller burns (1.21 days vs. 2.43 days, p < 0.001). Zinc levels of patients with major burns significantly increased overtime from 47.6 µg/dL at 14 days post-admission to 73.5 µg/dL at 53 ± 16 days (p < 0.01). Conclusions Our data show that TE supplementation was efficient in bringing zinc levels close to the normal range in patients with burns ≥20%TBSA who stayed up to 50 days in hospital. Controlled for TBSA burned, supplementation of TE significantly decreased LOS of patients with major burns compared to patients with smaller burns. Applicability of Research to Practice Further studies are needed to evaluate the correlation between supplementation of TE and improvement of patient LOS.