OBJECTIVES:Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may improve outcomes in AP. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients. METHODS:Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until May 2024 for RCTs comparing EA with other pain strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed random-effects the Mantel-Haenszel method and I 2 statistic was used for heterogeneity. RESULTS:Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR, 0.69; 95% CI [0.29-1.65]; P  = 0.40), mechanical ventilation (RR, 0.82; 95% CI [0.61-1.10]; P  = 0.19), sepsis (RR, 0.88; 95% CI [0.42-1.86]; P  = 0.74), hospital/ICU stay (WMD, 0.49 days; 95% CI [-1.13 to 2.10]; P  = 0.55), and pain score (WMD, 1.49; 95% CI [-0.42 to 3.40]; P  = 0.13). Opioid requirements were significantly lower, with one study reporting MME of 15 mg/d compared to 52 mg/d in the control group ( P  = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score ( I2  = 92%). Small number of studies, risk of bias, and sample size limited overall certainity. CONCLUSIONS:EA did not significantly improve in-hospital outcomes in AP patients. However, findings suggested potential benefits in pain management. High-quality randomized trials are needed to understand the potential benefits of EA in this population.

Objective: To evaluate whether continuous glucose monitoring (CGM) could assist providers in intensifying glycemic management in hospitalized patients with type 2 diabetes. Research Design and Methods: At 6 academic hospitals, adults with type 2 diabetes hospitalized in a non-intensive care setting were randomly assigned to either standard therapy with a glucose target of 140-180 mg/dL (Standard group) or intensive therapy with glucose target of 90-130 mg/dL guided by CGM (Intensive group). The primary outcome was mean glucose measured with CGM (blinded in Standard group) and the key secondary outcome was CGM glucose <54 mg/dL. Results: Of the 110 participants included in the primary analysis, mean age was 61± 12 years and mean HbA1c was 8.9 ± 2.3% (73.8 ± 1.6 mmol/mol). During the study, CGM-measured mean glucose was 170 mg/dL in the Intensive group (N=60) versus 175 mg/dL in the Standard group (N=50, risk-adjusted difference -7 mg/dL; 95% confidence interval -19 to +5; p = 0.25). Only 7% of the Intensive group achieved the mean glucose target range of 90 to 130 mg/dL. CGM readings below 54 mg/dL were infrequent (0.2% for Intensive and 0.4% for Standard; adjusted treatment group difference = -0.1%, 95% CI -0.6% to 0.3%). One severe hypoglycemia event occurred in the Standard group. Conclusions: The study’s glucose management approach using CGM did not improve glucose levels compared with standard glucose management in the non-ICU hospital setting. A glucose target of 90-130 mg/dL may not be realistic in the current environment of insulin management in the hospital.

Predictive Value of Admission Plasma Glucose and Hemoglobin A1c on Inpatient Glycemic Control Assessed by Continuous Glucose Monitoring (CGM) in Medicine and Surgery Persons with Diabetes To determine the predictive value of admission blood glucose (BG) and A1C on inpatient glycemic control assessed by CGM in general medicine and surgery persons with T2D, we combined data from two randomized controlled trials of insulin-treated patients wearing a Dexcom G6 CGM. The primary outcome was optimal glycemic control defined as the percent time in range (TIR, 70-180 mg/dL) ≥70% without hypoglycemia (<70 mg/dL). Logistic regression models were used to evaluate the predictive role of admission BG < 180, 181-250, and >251 mg/dL as well as A1C (<7, 7-9, and >9%). Among 262 persons (medicine 73%, admission BG 222.4±121 mg/dL, A1C 9.4±2.4%), good glycemic control was achieved in 24%, 7.7%, and 7.5% of patients with admission BG <180, 181-250 and >251 mg/dL; and in 26%, 19%, and 8.6% in those with admission A1C <7%, 7-9%, and >9%, respectively. There were no differences in the rate of hypoglycemia, length of hospital stay (LOS), or hospital complications, Table. Conclusion: Persons with higher admission BG and HbA1c levels had lower odds of achieving good glucose control (TIR 70-180 mg/dL ≥70% without hypoglycemia); however, there were no differences in hypoglycemia, LOS, or hospital complications compared to those with admission glucose <180 mg/dl or HbA1c <7%. Table. Hospital glycemic control according to admission glucose and A1C values. *Good Control: Mean daily glucose 70-180 mg/dL, without hypoglycemia < 70 mg/dLTIR: Time in range; TAR: time above range; TBR: time below range; LOS: length of stay I.A. Castro-Revoredo: None. S. Zhou: None. M.A. Urrutia: None. P. Vellanki: Consultant; Eli Lilly and Company. T. Idrees: None. Z. Zabala: None. R.J. Galindo: Consultant; Abbott. Other Relationship; Dexcom, Inc. Consultant; Bayer Inc. Other Relationship; Novo Nordisk, Eli Lilly and Company. Consultant; Boehringer-Ingelheim, AstraZeneca. L. Peng: None. G. Umpierrez: Research Support; Abbott, Bayer Inc., Dexcom, Inc., AstraZeneca. Advisory Panel; Dexcom, Inc.

Introduction: People with obesity experience stigma and discrimination for their physical appearance and weight. Data is limited among stigmatization and prejudices among Hispanics (HISP) and non-Hispanic Whites (NHW) and Blacks (NHB) with obesity and diabetes in the U.S. We compare prejudices, stigma and internal negative bias in these groups. Methods: Observational study conducted at two academic centers, including adults > 18ys, and BMI ≥30 kg/m2. We assessed prejudices with Anti-Fat Attitudes (AFA), stigmatizing experiences with Brief Stigmatizing Situations Inventory (SSI-B), and internalization of negative weight bias with Weight Bias Internalization Scale (WBIS) surveys. Results: Among 233 participants (age 55.3±13 years, 62% females, BMI 37±6.4, 48% HISP, 10% NHW, 42% NHB), 73% and 22% had the perception of being individuals with overweight (OW) and obesity (OB), respectively. HISP had a higher AFA score (p<0.001) compared to NHW and NHB. SSI-B score was similar across groups. NHW had a higher WBIS score compared to HISP and NHB (p=0.01). Conclusions: Adults with obesity and diabetes in the U.S., HISP had higher aversion/prejudices towards people with obesity, NHW had higher internalization of negative bias, while stigmatizing experiences were not different across groups. Table 1. Demographic Characteristics and Surveys Scores among Adults with Obesity and Diabetes Disclosure R.J. Galindo: Consultant; Abbott. Other Relationship; Dexcom, Inc. Consultant; Bayer Inc. Other Relationship; Novo Nordisk, Eli Lilly and Company. Consultant; Boehringer-Ingelheim, AstraZeneca. Z. Zabala: None. G. Arevalo: None. B. Moazzami: None. A. Lecube: None. A.A. Rashied: None. G. Umpierrez: Research Support; Abbott, Bayer Inc., Dexcom, Inc., AstraZeneca. Advisory Panel; Dexcom, Inc. Funding National Institutes of Health (P30DK111024 (RJG, GEU), and K23DK123384 (RJG) and R03DK138255 (RJG))

ObjectivesTo evaluate the efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF).DesignProspective randomized clinical trial.Settings and ParticipantsInsulin-treated patients with type 2 diabetes (T2D) admitted to LTCF.MethodsParticipants in the standard of care wore a blinded CGM with treatment adjusted based on point-of-care capillary glucose results before meals and bedtime (POC group). Participants in the intervention (CGM group) wore a Dexcom G6 CGM with treatment adjusted based on daily CGM profile. Treatment adjustment was performed by the LTCF medical team, with a duration of intervention up to 60 days. The primary endpoint was difference in time in range (TIR 70-180 mg/dL) between treatment groups.ResultsAmong 100 participants (age 74.73 ± 11 years, 80% admitted for subacute rehabilitation and 20% for nursing home care), there were no significant differences in baseline clinical characteristics between groups, and CGM data were compared for a median of 17 days. There were no differences in TIR (53.38% ± 30.16% vs 48.81% ± 28.03%, P = .40), mean daily mean CGM glucose (184.10 ± 43.4 mg/dL vs 190.0 ± 45.82 mg/dL, P = .71), or the percentage of time below range (TBR) <70 mg/dL (0.83% ± 2.59% vs 1.18% ± 3.54%, P = .51), or TBR <54 mg/dL (0.23% ± 0.85% vs 0.56% ± 2.24%, P = .88) between rt-CGM and POC groups.Conclusions and ImplicationsThe use of rtCGM is safe and effective in guiding insulin therapy in patients with T2D in LTCF resulting in a similar improvement in glycemic control compared to POC-guided insulin adjustment.

Background: Few studies have reported glycemic control in the hospital and post-discharge period in older adults using CGM. Thus, we combined data from 2 RCTs using CGM in 141 insulin-treated participants in the hospital and after discharge. We compared CGM glycemic metrics in 33 participants ≥65 years (mean 70±4) to 108 adults <65 years (mean 52±9 years) with CGM data during hospitalization and for 10 days after discharge. Results: Participants had similar BMI and total insulin use during hospitalization. Older adults had lower admission HbA1c and blood glucose (BG) compared to younger adults. When assessing CGM glycemic metrics, older adults spent a greater percentage of time in range (TIR, 70-180 mg/dL) during hospitalization (p=0.009) and post-discharge (p=0.02) compared to participants <65. Comparing CGM versus POCT in older adults, CGM exhibited higher detection of hypoglycemic events (<70 and <54 mg/dl, p <0.0001). In addition, older adults had lower glycemic variability (GV) during admission, but similar GV during the post-discharge period. Conclusion: Compared to younger adults, older adults have better glucose control during hospitalization and post-discharge periods. CGM usage was associated with higher detection of hypoglycemia during hospitalization and post-discharge when compared to POCT in older adults which might improve diabetes care in this population. Disclosure T. Idrees: None. S. Kantipudi: None. Z. Zabala: None. B. Moazzami: None. M.A. Urrutia: None. S. Zhou: None. P. Vellanki: Consultant; Eli Lilly and Company. L. Peng: None. G. Umpierrez: Research Support; Abbott, Bayer Inc., Dexcom, Inc., AstraZeneca. Advisory Panel; Dexcom, Inc.

Background. Patients with diabetes and end-stage kidney disease (ESKD) may experience “burnt-out diabetes”, defined as having a HbA1c <6.5% without antidiabetic therapy for >6 months. Methods. This pilot prospective study assessed glycemic control by continuous glucose monitoring (Dexcom CGM), HbA1c, glycated albumin and fructosamine in patients with burnt-out diabetes (n=20) and without a history of diabetes (n=20). Results. Patients with burnt-out diabetes had higher CGM-measured daily glucose, lower % time in range 70-180 mg/dL, higher % time above range >250 mg/dL, and longer duration of hyperglycemia >180 mg/dL (hours/day) compared to patients without diabetes (all p<0.01). HbA1c and fructosamine levels were similar; however, patients with burnt-out diabetes had higher levels of glycated albumin than patients without diabetes. Conclusion. The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than HbA1c and fructosamine in patients with ESKD.

OBJECTIVE:The benefits of continuous glucose monitoring (CGM) in managing hyperglycemia in hospitalized patients with type 2 diabetes (T2D) have been documented in observation and intervention clinical studies. However, the benefits of CGMs after hospital discharge in improving the care of patients with T2D remain unknown. METHODS:This pilot randomized clinical trial aimed to compare the effectiveness and safety of using the FreeStyle Libre 2 CGM vs capillary point-of-care (POC) glucose testing (standard of care) in insulin-treated patients with T2D for up to 12 weeks after hospital discharge. We assessed safety (hypoglycemia), efficacy (mean daily glucose), and healthcare utilization (emergency room visits and hospital admissions) associated with the use of FreeStyle Libre 2 CGM compared to capillary POC testing following hospital discharge. RESULTS:Among 100 participants (mean age 54.3 ± 10.7 years, HbA1c 10.46 ± 2.24%, median diabetes duration of 9.0 years, IQR 1.0, 42), there were no significant differences in baseline clinical characteristics between the groups at discharge. We observed a trend toward improved glycemic control in the CGM group, including increased time in range 70-180 mg/dl, reduced time above range > 180 and 250 mg/dl, and decreased hypoglycemia and insulin requirements after discharge compared to the POC group. There were no differences in emergency room visits or hospitalization between the study groups. CONCLUSION:The results of this pilot study indicate that the use of CGM leads to improved glycemic control, reduced hypoglycemia, and decreased glucose variability compared to POC glucose testing after hospital discharge.

Differing blood glucose (BG) targets are recommended by professional organizations in noncritical care settings. Previous Endocrine Society and ADA guidelines recommended a target BG of 70-140 and 140-180 mg/dl; however, the 2023 ADA Standards of Care recommends a target of 100-180 mg/dl. The lack of consensus is due to the lack of randomized clinical trials (RTC) to support a tight vs relaxed BG target. We performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated subjects with T2D targeting BG 70-140 mg/dL vs. 140-180 mg/dL. Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dL. Propensity score matching was used to reduce the bias including sex, HbA1c, and home insulin use, for a final count of 1,146 patients (573 subjects in each target group). Patients in the tight BG target group had lower mean BG (163.73±39.79 vs 170.15±39.94 mg/dL, p=0.004), less hyperglycemia (BG >180: 86% vs 92%, p=0.003; BG >240: 51% vs 62%, p<.001), similar rates of hypoglycemia (BG <70: 12% vs 15%, p=0.11; BG <54: 2.5% vs 4.0%, p=0.14). The intensive target resulted in a shorter length of stay (4.0 vs 6.0 days, p<.001) and lower composite of complication rate (acute kidney injury, infection, myocardial infarction, respiratory failure and stroke) (3.7% vs 6.8%, p=0.02) than the relaxed BG target, with similar mortality rates (0.9% vs 0.3%, p=0.36). There were no differences in glycemic variability (GV) between groups with greater GV in those experiencing hypoglycemia <70 mg/dL or hyperglycemia >200 mg/dL. Our results indicate that lower BG target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia and glycemic variability, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Disclosure J.Saling: None. A.L.Migdal: None. M.A.Urrutia: None. Z.Zabala: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.Fayfman: None. A.A.Rashied: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob Family Funds

Patients with long-standing type 2 diabetes and end-stage kidney disease (ESKD) on dialysis may experience resolution of their hyperglycemia, as defined by an HbA1c < 6.5%, without antidiabetic therapy. This phenomenon is known as “burnt-out diabetes”. Because HbA1c may be falsely low in patients with ESKD/dialysis therapy, we conducted a prospective study to compare glycemic control as measured by Dexcom G6 CGM in patients with ESKD and burnt-out diabetes and those without history of diabetes. We hypothesize that the use of CGM may provide better assessment of glycemic control than HbA1c (standard-of-care) in these patients and clarify the glycemic characteristics of burnt-out diabetes. We included adults with ESKD on dialysis, with (n=20) and without (n=10) a known history of diabetes, and with HbA1c <6.5% without antidiabetic therapy for > 6 months. All subjects wore a blinded Dexcom G6 CGM for 10 days. Their clinical characteristics and CGM metrics are shown in Table 1. Conclusion: CGM provides better assessment of glycemic excursions, compared to HbA1c, in patients with ESKD and diabetes. Most patients with burnt-out diabetes (HbA1c <6.5%, off therapy) have frequent and significant hyperglycemic excursions as detected by CGM. Further research will need to examine whether these excursions require pharmacotherapy. Disclosure C.Kaminski: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Z.E.Zabala: None. B.Moazzami: None. A.Y.G.Gerges: None. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob's Fund for Education

We compared the efficacy of continuous glucose monitoring (CGM) and point of care (POC) testing (standard of care) in assessing glycemic control in older adults with T2D treated with either basal insulin or insulin secretagogues plus sliding scale in long-term care facilities (LTCF). All 97 subjects underwent POC testing before meals and bedtime and wore a Dexcom CGM. Treatment adjustment was performed by the primary care team, with a target glucose of 140-180 mg/dL, and for a duration of intervention up to 60 days. Study endpoints included differences in hypoglycemia < 70 and 54 mg/dL and hyperglycemia > 180 and 250 mg/dL by POC and CGM. Participants baseline characteristics (age: 74.7±11 years, BMI: 29.6±7.9, HbA1c: 8.06±2.2%) admitted to skilled nursing care/subacute rehab (80%) or long-term care (20%) facilities with a median length of participation of 17 (interquartile range 11, 29) days. The mean daily glucose by POC was lower than CGM (171±45 vs. 188±45 mg/dL, p<0.01). CGM detected significant greater proportions of subjects with hypoglycemia <70 mg/dL (40% vs. 14%) and <54 mg/dL (21% vs. 1.0%); as well as hyperglycemia >250 mg/dL (77% vs. 56%) compared to POC testing, all p<0.001. Conclusion: In older adults with T2D admitted to long-term care facilities, the use of CGM significantly improved detection of hypoglycemic and hyperglycemic events compared to POC. Disclosure T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. M.D.Gavaller: None. H.Oh: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None. Funding Dexcom, Inc. (IIS-2020-119_6X)

We compared the efficacy of continuous glucose monitoring (CGM) and point of care (POC) testing (standard of care) in assessing glycemic control in older adults with T2D treated with either basal insulin or insulin secretagogues plus sliding scale in long-term care facilities (LTCF). All 97 subjects underwent POC testing before meals and bedtime and wore a Dexcom CGM. Treatment adjustment was performed by the primary care team, with a target glucose of 140-180 mg/dL, and for a duration of intervention up to 60 days. Study endpoints included differences in hypoglycemia < 70 and 54 mg/dL and hyperglycemia > 180 and 250 mg/dL by POC and CGM. Participants baseline characteristics (age: 74.7±11 years, BMI: 29.6±7.9, HbA1c: 8.06±2.2%) admitted to skilled nursing care/subacute rehab (80%) or long-term care (20%) facilities with a median length of participation of 17 (interquartile range 11, 29) days. The mean daily glucose by POC was lower than CGM (171±45 vs. 188±45 mg/dL, p<0.01). CGM detected significant greater proportions of subjects with hypoglycemia <70 mg/dL (40% vs. 14%) and <54 mg/dL (21% vs. 1.0%); as well as hyperglycemia >250 mg/dL (77% vs. 56%) compared to POC testing, all p<0.001. Conclusion: In older adults with T2D admitted to long-term care facilities, the use of CGM significantly improved detection of hypoglycemic and hyperglycemic events compared to POC. Disclosure T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. M.D.Gavaller: None. H.Oh: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None. Funding Dexcom, Inc. (IIS-2020-119_6X)

The efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF) has not been evaluated. Accordingly, we randomized 100 insulin-treated subjects with T2D in LTCF. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with treatment adjusted based on POC results; while in the rt-CGM group (Dexcom G6), treatment adjustment was based on daily CGM profile. Treatment adjustment was performed by the LTC medical team, with a target glucose of 140-180 mg/dL, and a duration of intervention up to 60 days. Primary endpoint was difference between groups in time in range (TIR, 70-180 mg/dL). Results: There were no significant differences in TIR (53.38%±30.16 vs 48.81%±28.03, p=0.40), mean daily glucose (185±44 vs 191 ±47 mg/dL, p=0.72), patients with % CGM values <54 mg/dL (0.23±0.8% vs 0.56±2.2 %, p=0.88), with a trend in reducing time below range (TBR <70 mg/dL) (0.83±2.6 % vs 1.18±3.5%, p= 0.51), between CGM and POC group. Conclusion: The results of this pilot randomized study indicate that the use of Dexcom G6 rtCGM is safe and effective in guiding diabetes therapy in long-term care facilities, resulting in a similar improvement in glycemic control (TIR) without differences in hypoglycemia. Disclosure T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. H.Oh: None. M.D.Gavaller: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None. Funding Dexcom, Inc. (IIS-2020-119_6X)

Differing blood glucose (BG) targets are recommended by professional organizations in noncritical care settings. Previous Endocrine Society and ADA guidelines recommended a target BG of 70-140 and 140-180 mg/dl; however, the 2023 ADA Standards of Care recommends a target of 100-180 mg/dl. The lack of consensus is due to the lack of randomized clinical trials (RTC) to support a tight vs relaxed BG target. We performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated subjects with T2D targeting BG 70-140 mg/dL vs. 140-180 mg/dL. Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dL. Propensity score matching was used to reduce the bias including sex, HbA1c, and home insulin use, for a final count of 1,146 patients (573 subjects in each target group). Patients in the tight BG target group had lower mean BG (163.73±39.79 vs 170.15±39.94 mg/dL, p=0.004), less hyperglycemia (BG >180: 86% vs 92%, p=0.003; BG >240: 51% vs 62%, p<.001), similar rates of hypoglycemia (BG <70: 12% vs 15%, p=0.11; BG <54: 2.5% vs 4.0%, p=0.14). The intensive target resulted in a shorter length of stay (4.0 vs 6.0 days, p<.001) and lower composite of complication rate (acute kidney injury, infection, myocardial infarction, respiratory failure and stroke) (3.7% vs 6.8%, p=0.02) than the relaxed BG target, with similar mortality rates (0.9% vs 0.3%, p=0.36). There were no differences in glycemic variability (GV) between groups with greater GV in those experiencing hypoglycemia <70 mg/dL or hyperglycemia >200 mg/dL. Our results indicate that lower BG target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia and glycemic variability, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Disclosure J.Saling: None. A.L.Migdal: None. M.A.Urrutia: None. Z.Zabala: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.Fayfman: None. A.A.Rashied: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob Family Funds

The efficacy of real-time continuous glucose monitoring (rt-CGM) in adjusting insulin therapy in long-term care facilities (LTCF) has not been evaluated. Accordingly, we randomized 100 insulin-treated subjects with T2D in LTCF. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with treatment adjusted based on POC results; while in the rt-CGM group (Dexcom G6), treatment adjustment was based on daily CGM profile. Treatment adjustment was performed by the LTC medical team, with a target glucose of 140-180 mg/dL, and a duration of intervention up to 60 days. Primary endpoint was difference between groups in time in range (TIR, 70-180 mg/dL). Results: There were no significant differences in TIR (53.38%±30.16 vs 48.81%±28.03, p=0.40), mean daily glucose (185±44 vs 191 ±47 mg/dL, p=0.72), patients with % CGM values <54 mg/dL (0.23±0.8% vs 0.56±2.2 %, p=0.88), with a trend in reducing time below range (TBR <70 mg/dL) (0.83±2.6 % vs 1.18±3.5%, p= 0.51), between CGM and POC group. Conclusion: The results of this pilot randomized study indicate that the use of Dexcom G6 rtCGM is safe and effective in guiding diabetes therapy in long-term care facilities, resulting in a similar improvement in glycemic control (TIR) without differences in hypoglycemia. Disclosure T.Idrees: None. T.M.Johnson: Consultant; Astellas Pharma Inc., Research Support; Dexcom, Inc. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. I.A.Castro-revoredo: None. H.Oh: None. M.D.Gavaller: None. Z.Zabala: None. E.M.Moreno: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. E.Cabb: None. Funding Dexcom, Inc. (IIS-2020-119_6X)

Introduction The prevalence, severity, and quality of life (QoL) impact of diabetic retinopathy (DR) among African–Americans (AAs) with end-stage kidney disease (ESKD) undergoing dialysis are unknown.Research design and methods A cross-sectional study was conducted on 93 AA adults with diabetes and ESKD. The diagnosis of DR was based on a review of medical records and/or a positive photograph with a portable hand-held device reviewed by both artificial intelligence software and a retinal specialist. QoL, physical disability social determinants of health (SDoHs) were assessed by standardized questionnaires.Results The prevalence of DR was 75%, with 33% of participants having mild, 9.6% moderate and 57.4% severe DR. A total of 43% had normal visual acuity; 45% had moderate visual impairment; and 12% had severe visual impairment. We found a high burden of disease, multiple SDoH challenges, and low QoL and general health among patients with ESKD. The presence of DR had no significant impact on physical health and QoL compared with participants without DR.Conclusions DR is present in 75% of AA patients with diabetes and ESKD on haemodialysis. ESKD has a significant burden on general health and QoL; however, DR has a minor additional impact on the overall physical health and QoL in people with ESKD.

Background: Older adults with diabetes in the hospital are generally managed similarly to younger adults, however, it is unknown if the degree of frailty can affect glucose control among hospitalized patients.Methods: We examined glycemic parameters derived from continuous glucose monitoring (CGM) in older adults with type 2 diabetes and frailty who were hospitalized in non-acute settings. Data was pooled from 3 prospective studies using CGM including 97 patients wearing Libre CGM sensors and 166 patients wearing Dexcom G6 CGM. Glycemic parameters (time in range (TIR) 70-180; time below range (TBR) <70 and 54 mg/dl) by CGM were compared between 103 older adults >= 60 years and 168 younger adults <60 years. Frailty was assessed using validated laboratory and vital signs frailty index FI-LAB (n = 85), and its effect on hypoglycemia risk was studied.Results: Older adults, as compared to younger adults, had significantly lower admission HbA1c (8.76% +/- 1.82 vs. 10.25% +/- 2.29, p < 0.001), blood glucose (203.89 +/- 88.65 vs. 247.86 +/- 124.17 mg/dl, p = 0.003), mean daily BG (173.9 +/- 41.3 vs. 183.6 +/- 45.0 mg/dl, p = 0.07) and higher percent TIR 70-180 mg/dl (59.0 +/- 25.6% vs. 51.0 +/- 26.1%, p = 0.02) during hospital stay. There was no difference in hypoglycemia occurrence between older and younger adults. Higher FI-LAB score was associated with higher % CGM < 70 mg/dl (0.204) and % CGM < 54 mg/dl (0.217).Conclusion: Older adults with type 2 diabetes have better glycemic control prior to admission and during hospital stay compared to younger adults. Frailty is associated with longer presence of hypoglycemia in non-acute hos-pital settings.

Abstract Recent observational and meta-analyses have reported a frailty prevalence between 10% and 25% in people with diabetes, in particular in those older than 60 years of age. The impact of frailty on hospital glycemic control and glycemic variability (GV) by continuous glucose monitoring (CGM) in insulin-treated older adults with type 2 diabetes (T2D) is not known. Accordingly, we reviewed data from 3 inpatient randomized clinical trials using CGM in insulin-treated patients with T2D. The validated laboratory-based frailty index (FI-LAB) scale was used for frailty assessment, and participants were categorized into three groups [non-frail: (0-<0.1), pre-frail (≥0.1-<0.21), and frail (≥0.21)] in 84 older adults. | There were no differences on admission clinical characteristics between the non-frail/pre-frail older adults and the frail older adults except for Creatinine (BMI: 32.4 ± 9 vs. 36.83± 13, p=0.21; HbA1c%: 9.3 ± 2 vs. 8.72± 2, p=0.18; Admission BG: 227 ± 114 vs. 194. 07± 75 mg/dl, p=0.26; Cr: 1.16 ± 1 vs. 1.65± 1. 0). There were no differences in GV by coefficient of variation (CV), amplitude of glucose excursion (MAGE), and standard deviation (SD) between the two groups. The correlation between FI-LAB score and percent time with CGM <70 was 0.204 (p=0. 064) and the correlation between FI-LAB score and percent time with percent time with CGM<54 was 0.217 (p=0. 049). Results from standard linear regression and zero-inflated Beta regression further suggest that frail old patients with higher frailty scores may be associated with larger percent time with CGM below range <70 and CGM <54 mg/dL. Conclusion Our results indicate that older adults with T2D with higher frailty score experience more time in hypoglycemia during their hospital stay despite having comparable mean daily blood glucose, time in range and glycemic variability compared to non-frail or pre-frail older adults. A larger prospective study is needed to confirm these findings and determine the impact of frailty on clinical outcome. Providers should be vigilant when using insulin or insulin secretagogues in hospitalized older adults with diabetes and frailty. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Abstract Hypoglycemia and hyperglycemia are associated with poor outcomes among hospitalized patients with type 2 diabetes (T2D). Until 2012, the American Diabetes Association (ADA) and Endocrine Society hospital clinical guideline recommended a target blood glucose (BG) of 70-140 mg/dl; however, more recently a relaxed target of 140-180 mg/dl has been recommended by the ADA. Little data from randomized clinical trials (RTC) is available to support an intensive vs relaxed BG target. Accordingly, we performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated patients with T2D targeting BG 70-140 mg/dl vs. 140-180 mg/dl. Methods Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dl. Propensity score matching was used to reduce the bias due to confounding in the estimation of the effect of BG target. The propensity score dependent variables upon model selection included sex, admission HbA1c, and home insulin use. The final propensity score matched study sample consisted of 1,146 patients (573 patients in each BG target group). Results There were no differences in age, gender, BMI, diabetes duration, home insulin use or hospital admission service (medicine/surgery). Patients in the intensive target BG group had lower mean BG (day 2-10: 163.73 ± 39.79 mg/dl vs 170.15 ± 39.94 mg/dl, p=0.004), less hyperglycemia (any BG >180: 86% vs 92%, p=0.003; any BG >240: 51% vs 62%, p<.001), similar rates of hypoglycemia (BG <70: 12% vs 15%, p=0.11; BG <54: 2.5% vs 4.0%, p=0.14), and trended towards greater time in range <180 mg/dl (62.00 ± 28.14% vs 59.23 ± 27.38%, p=0.06). The composite of complication rate (acute renal failure, infection, myocardial infarction, respiratory failure and stroke) was lower (3.7% vs 6.8%, p=0.02) in the intensive control group, with similar rates of inpatient death (0.9% vs 0.3%, p=0.36). Hospital length of stay was shorter in the intensive control group (4.0 vs 6.0 days, p<.001). Conclusion Our results indicate that tighter glycemic target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. Further RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.