The escalating prevalence of diabetes mellitus (DM) emphasizes the critical need for early detection of diabetic retinopathy (DR). This study assesses the performance of the autonomous AI-based diagnostic system IDx-DR in detecting DR and its associated confounders in a real-world clinical setting. This prospective cross-sectional study involved 875 diabetic patients with a mean age of 52 years (range: 8–92). Retinal images were captured by trained assistants. IDx-DR results were compared with mydriatic fundus examination (gold standard) and Ophthalmologists’ image analysis. Factors impacting image acquisition or analyzability were examined. Among all patients, 10.5% yielded no image in miosis, and 26.1% were unanalyzable by IDx-DR. Confounders affecting image acquisition were examiner, pupil size, patient age and patients’ visual acuity. When good quality images were achieved, IDx-DR performed well, particularly in detection of severe DR (sensitivity 94.4%; specificity 90.5%). IDx-DR results exactly matched Ophthalmologists’ mydriatic fundoscopy gradings in 54.2% if images of sufficient quality were obtainable. Undergrading of DR severity by IDx-DR was rare (4.8%). IDx-DR shows promise in detecting DR, especially in resource-limited settings and in detecting severe DR. One remaining challenge is good image acquisition in miotic patients.

PURPOSE:To evaluate the relative sensitivity of several available CGM metrics for the detection of the effects of clinical interventions in people with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS:Real-world data from people with poor glycemic control (hemoglobin A1c 8.2 ± 1.3%) for 120 people with T1D and 92 people with T2D, using Libre 2 CGM. Analysis of CGM data from 3 days prior to admission and 2 days immediately before discharge from ∼8 days of in-hospital care with changes in therapy as prescribed by hospital-based diabetes specialists. CGM metrics included: quality-score (Q-Score), Time in Range (TIR) (3.9-10 mmol/L), Time Above Range (>10 mmol/L), Time Below Range (<3.9 mmol/L), Mean Sensor Glucose, Glucose Management Indicator, Glycemia Risk Index, Glucose Daily Range, and Mean of Absolute Daily Differences (MODD). We evaluated the paired differences in all metrics pre- and postintervention within subjects using classical paired Student's t tests. RESULTS:The Q-Score showed the largest effects in terms of Student's t-values for T1D, for T2D, and for all (T1D and T2D) subjects after pooling, indicating better sensitivity for detection of an effect than TIR or seven other metrics. One of the five components of the Q-Score, MODD, a classical measure of stability of glucose patterns from day to day, showed the second-best sensitivity in evaluating changes within subjects specifically for people with T1D. CONCLUSION:We observed consistent differences in sensitivity for the detection of the effects of therapeutic interventions, with Q-Score being superior to eight alternatives. This study needs replication using additional patient populations and multiple types of interventions to evaluate its generalizability and applicability to both randomized controlled clinical trials and real-world clinical data.

AIMS:Studies involving the use of sensitive C-peptide assays have revealed that a significant number of persons with long-standing type 1 diabetes have measurable serum C-peptide concentrations. We investigated meal-stimulated C-peptide levels in persons with diabetes duration of more than 30 years and whether they were associated with the presence of diabetes-associated autoantibodies. METHODS:This was an observational study of 105 participants with a clinical diagnosis of type 1 diabetes and a diabetes duration ≥30 years. Participants underwent mixed-meal tolerance tests (MMTTs) with measurements of C-peptide at 0 and 90 min. The levels of autoantibodies against GAD, IA-2 and ZnT8 were measured with radio-binding assays. RESULTS:Participants were divided into tertiles of post-meal (90 min) C-peptide values as non-responders (NR), low-responders (LR) and high-responders (HR). Compared with the NRs and HRs, the LRs had significantly lower BMI values (p < 0.001), plasma triglyceride concentrations (p = 0.010) and triglyceride/HDL-cholesterol ratios (p = 0.004). Twenty-nine and eight participants were positive for one or 2-3 antibodies, respectively. The presence of antibodies was not associated with post-meal C-peptide levels, as evidenced by the fact that the proportions of antibody-positive participants did not differ between the groups. CONCLUSIONS:We conclude that a subgroup of type 1 diabetes participants with long-standing diabetes (>30 years) has residual beta-cell function. Participants with type 1 diabetes and low stimulated C-peptide concentrations are characterized by lower BMI, triglyceride concentrations and higher insulin sensitivity.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Purpose Diabetic retinopathy (DR) is a leading cause of vision loss in middle-aged adults globally. Although artificial intelligence (AI)-based screening tools like IDx-DR (classification) and Thirona RetCAD (regression) have shown high sensitivity in controlled settings, real-world screening faces challenges due to missing or low-quality images and inadequate adaptation to local healthcare needs. The objective was to compare the performance of two AI-based DR screening algorithms (IDx-DR and RetCAD) that analyse non-mydriatic images, against ophthalmologists' mydriatic fundoscopy with image analysis and the impact of customized referral threshold modification ('Greifswald modification') on screening outcomes.Methods This one-centre observational study included 1716 patients with diabetes mellitus (Clinical Trials Register: DRKS00035967). Sensitivity, specificity, the proportion of ungradable images and the reduction in ophthalmologic evaluations were assessed. Customized referral threshold modification was conducted using the Youden Index.Results In 98 patients (5.7%), no images could be acquired, and 35 patients (2.1%) had incomplete image sets for IDx-DR. IDx-DR rejected 438 patients (25.5%) due to image quality, while RetCAD flagged 134 eyes from 120 patients (6.9%) but provided output for all. Among analysable images, sensitivities ranged from 70.4% (RetCAD) to 93.6% (RetCAD with Greifswald modification). Including all patients reduced sensitivity from 52.7% (IDx-DR) to 79.9% (RetCAD with Greifswald modification). AI screening reduced ophthalmologic exam needs by 47.5% to 78.5%.Conclusions Real-world DR screening performance of AI algorithms, when including non-analysable patients, can be substantially lower than in controlled studies. The use of regression algorithms enabled the customization of referral thresholds, improving screening accuracy and reducing the clinical burden.

Objective: Recent studies have shown that at least some patients with long-standing T1D have measurable serum C-peptide concentrations. We investigated whether there is an association between C-peptide levels and diabetes antibody levels.

Objective: To compare cardiovascular risk factors between adult men and women with type 1 diabetes (T1D) in primary prevention in two European countries.

Background and aims: Q-Score is a single-number composite metric for analysis of short-term glycemic control. Q-Score rises with worsening of glycemic quality recorded by continuous glucose monitoring (CGM). Here, we evaluated the suitability of Q-Score for screening of therapeutic effects.

Zusammenfassung Diese Studie untersucht die Anwendung und Effektivität telemedizinischer Angebote für Kinder und Jugendliche mit Diabetes mellitus Typ 1 zwischen 2018 bis 2022 und den Einfluss der COVID-19-Pandemie. Der Anteil telemedizinischer Kontakte zeigt eine deutliche Korrelation mit dem Verlauf der COVID-19-Pandemie und verbleibt postpandemisch auf höherem Niveau. Jüngere Patient*innen und Anwender*innen von Diabetes-Technologien oder ihre Familien nutzen verstärkt Telemedizin. Nutzer*innen von Telemedizin zeigten eine bessere Stoffwechseleinstellung. Die Mehrheit der telemedizinischen Angebote stammt von Klinikambulanzen, welche aufgrund ihrer Größe und Ressourcen möglicherweise besser dafür ausgestattet sind.

Background and aims: The Q-Score is a single-number composite metric that is constructed based on the following components: central glycemic tendency, hyperglycemia, hypoglycemia, and intra- and interday variability. Herein, we refined the Q-Score for the screening and analysis of short-term glycemic control using continuous glucose monitoring (CGM) profiles. Methods: Continuous glucose monitoring profiles were obtained from noninterventional, retrospective cross-sectional studies. The upper limit of the Q-Score component hyperglycemia‚ that is, the time above target range (TAR), was adjusted from 8.9 to 10 mmol/L ( n = 1562 three-day-sensor profiles). A total of 302 people with diabetes mellitus treated with intermittent CGM for ≥14 days were enrolled. The time to stability was determined via correlation-based analysis. Results: There was a strong correlation between the Q-Scores of the two TARs, that is, 8.9 and 10 mmol/L (Q-ScoreTAR10 = −0.03 + 1.00 Q-ScoreTAR8.9, r = .997, p < .001). The times to stability of the Q-Score and TIR were 10 and 12 days, respectively. The Q-Score was correlated with fructosamine concentrations, the glucose management indicator (GMI), the time in range (TIR), and the glycemic risk index (GRI) ( r = .698, .887, –.874, and .941), respectively. The number of Q-Score components above the target increased as the TIR decreased, from two (1.7 ± 0.9) in CGM profiles with a TIR between 70% and 80% to four (3.9 ± 0.5) in the majority of the CGM profiles with a TIR below 50%. A conversion matrix between the Q-Score and glycemic indices was developed. Conclusions: The Q-Score is a tool for assessing short-term glycemic control. The Q-Score can be translated into clinician opinion using the GRI.

To evaluate whether cardiovascular risk factors and their management differ in primary prevention between adult males and females with type 1 diabetes (T1D) in two European countries in 2020–2022 and sex inequalities in achievement of standards of care in diabetes. We used 2020–2022 data of patients without a cardiovascular history in the Prospective Diabetes Follow-up registry (DPV) centres, in Germany, and the Société Francophone du Diabète– Cohorte Diabète de Type 1 cohort (SFDT1), in France. We included 2,657 participants from the DPV registry and 1,172 from the SFDT1 study. Body mass indexes were similar in females and males with similar proportions of HbA1c < 7

The study examines the application and effectiveness of telemedicine services for children and adolescents with type 1 diabetes in Germany and Austria from 2018 to 2022, as well as the impact of the COVID-19 pandemic. The proportion of telemedicine contacts was closely correlated with the progression of the COVID-19 pandemic and remains elevated in the post-pandemic period. Younger patients and those utilizing diabetes technologies, along with their families, were more inclined to frequently use telemedicine. Users of telemedicine exhibited improved metabolic control. The majority of telemedicine services are provided in hospital outpatient clinics, likely due to their greater resources and capacity for telemedical care.

Introduction & Objectives: To evaluate whether medical care for and level of cardiovascular risk factors differ in primary prevention between adult men and women with type 1 diabetes (T1D) in two European countries in 2020-2022. Methods: We included 2657 participants from the DPV registry (Germany, mean age 40±15, diabetes duration 23±14 years; 50.9% men) and 1172 from the SFDT1 study (France, age 39±14, diabetes duration 22±13 years; 53.2% men). Results: HbA1c levels and body mass indexes were similar in women and men with similar proportions of HbA1c<7% (DPV: 36.6 vs. 33.0%, respectively; SFDT1: 22.8 vs. 24.9%; both n.s.). Women had less overweight in DPV (55.4 vs. 61.0%, p<0.05) but not in SFDT1 (48.0 vs. 44.9%, n.s.) and were less prone to smoke (DPV: 19.7 vs. 25.8%, p<0.05; SFDT1: 21.0 vs. 26.0%, n.s.). Systolic blood pressure was lower in women than men (DPV: 124±15 vs. 129±15; SFDT1: 121±16 vs. 126±14mmHg, both p<0.05) with similar rates of antihypertensive therapy in case of systolic/diastolic blood pressure ≥140/90mmHg (DPV: 70.5 vs. 63.6%; SFDT1: 73.3 vs. 68.6%, both n.s.). In case of microalbuminuria, ACEi-ARB were less prescribed in women than men in DPV (21.4 vs 37.6%, p<0.05) but not SFDT1 (70.6 vs 62.0%, n.s.). In women compared to men, HDL-cholesterol levels were higher; triglycerides lower and LDL-cholesterol similar in DPV and SFDT1. In those with LDL-cholesterol >130 mg/dL (DPV: 19.9 vs. 23.9%; SFDT1 17.0 vs. 19.2%, both n.s.), statin therapy was less prescribed in women than men in DPV (7.9 vs. 17.0%, p<0.05), SFDT1 (18.2 vs. 21.0%, n.s.). Conclusion: Women in primary prevention have a better cardiovascular risk profile than men in both studies. We observed a high rate of therapeutic inertia, which might be higher in women for statin and nephroprotection with ACEi-ARB especially in Germany. Disclosure E. Cosson: Advisory Panel; Abbott, AstraZeneca, Lilly Diabetes, Novo Nordisk, Sanofi, Roche Diagnostics, Novartis AG, Amgen Inc. M. Auzanneau: Other Relationship; Insulet Corporation. G.A. Aguayo: None. W. Karges: None. J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. P. Augstein: None. L. Sablone: None. P.M. Jehle: None. G. Fagherazzi: Speaker's Bureau; Sanofi. Advisory Panel; Timkl, SAB Biotherapeutics, Inc., Vitalaire, Roche Diabetes Care. R.W. Holl: None.

Fragestellung: Bariatrische Chirurgie (BC) ist eine etablierte Therapieoption für Menschen mit Typ-2-Diabetes (T2D) mit einem BMI ≥ 35 kg/m2 und zeigt im Vergleich zur konservativen Therapie häufiger eine Remission des T2D, sowie nachhaltigen Gewichtsverlust. Auch bei Menschen mit Typ-1-Diabetes (T1D) nimmt die Prävalenz von Adipositas und Parametern des metabolischen Syndroms zu. Die Rolle der BC bei T1D ist jedoch unzureichend charakterisiert. Ziel dieser Analyse ist es, die derzeitige Praxis und die Auswirkungen verschiedener bariatrischer Verfahren auf die diabetische Stoffwechsellage, das Gewicht und die kardiovaskulären Risikofaktoren bei adipösen Personen mit T1D und T2D zu untersuchen.

Fragestellung Welche demografischen und klinischen Faktoren spielen die größte Rolle bei der Entstehung und Diagnose einer diabetischen Retinopathie im Erwachsenenalter in einem Random Forest Model?