RETROSPECTIVE STUDY OF VITAMIN D DEFICIENCY IN RHEUMATOLOGIC PATIENTS DURING THE COVID-19 PANDEMIC IN POLAND

BackgroundBefore the COVID-19 pandemic it was estimated that nearly 70% of the population is deficient in vitamin D - 25(OH)D <20ng/ml in Poland [1]. The percentage was expected to increase due to indoor isolation during the COVID-19 pandemic. Vitamin D has a positive effect on the condition of the bones, affects the course of autoimmune diseases, the course of neurological diseases, in type 2 diabetes, vitamin D supplementation improves glucose tolerance and reduces insulin resistance [2,3,4].ObjectivesThe aim of the retrospective study was to determine what percentage of rheumatology clinic patients suffer from vitamin D deficiency and whether this condition is effectively treated.MethodsIn January 2023, a retrospective analysis of the documentation of 172 patients treated at the Rheumatology Outpatient Clinic in Bełżyce (Poland) in 2022 was conducted.ResultsResults: The mean age of the 172 patients whose documentation was analyzed was 60.43 years (min 19, max 88). There were 132 women (76.8%) and 40 men (23.2%) in this group. The mean concentration of vitamin D was 25.57ng/ml±SD11.9 (min 5.7, max 75, Me 22.8). Vitamin D deficiency was found in 44% (serum concentration <20mg/ml), suboptimal concentration (20-30ng/ml) in 31%, optimal concentration (30-50ng/ml) in 21%, and high concentration (>50ng/ml) ml) in 4%. All those with a deficit or deficiency (75 people) were prescribed cholecalciferol in a dose of 20,000 units orally, 1 capsule twice a week after breakfast for 2 months [5]. Patients with optimal vitamin D levels were advised to take a dose of 2,000 units per day. Among the patients with deficit or deficiency, 48 people came for a follow-up visit to check the level of vitamin D (64% of the group with too low vitamin D concentration;28% of the entire group whose documentation was analyzed). In the follow-up examination, the mean concentration of vitamin D was 37.14±9.8ng/ml (min 28, max 84, Me 35.3). Therefore, a statistically significant increase in the concentration of vitamin D in the blood was noted (p<0.05). In the group of people who came for the follow-up examination, there were 35 women, whose mean age was 60.7 years and 13 men (mean age 68.2 years).Conclusion:1. During the COVID-19 pandemic in the group of outpatient rheumatology patients, 75% had a deficiency or suboptimal level of vitamin D.2. Treatment with cholecalciferol in a dose of 20,000 IU twice a week orally for 2 months is effective treatment of vitamin D deficiency.3. Too low percentage of patients diagnosed with vitamin D deficiency come for visits and check-ups.References[1]Hilger J., Friedel A., Herr R.. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 2013;9: 1023.[2]Karczmarewicz E., Czekuć-Kryskiewicz E., Płudowski P. Effect of vitamin D status on pharmacological treatment efficiency-impact on cost- effective management in medicine. Dermatoendocrinology, 2013;5: 299-304.[3]Zhu J., Bing C., Wilding J.P.H. Vitamin d receptor ligands attenuate the inflammatory profile of IL-1β-stimulated human white preadipocytes via modulating the NF-κB and unfolded protein response pathways Biochemical and Biophysical Research Communications 2-18, 503: 1049-1056.[4]Luan W., Hammond L.A. Vuillermot S. Maternal vitamin d prevents abnormal dopaminergic development and function in a mouse model of prenatal immune activation. Scientific Reports 2018;8 (1) article numer 9741.[5]Płudowski P., Karczmarewicz E. i wsp. Witamina D: Rekomendacje dawkowania w populacji osób zdrowych oraz w grupach ryzyka deficytów.Wytyczne dla Europy Środkowej 2013 r. Standardy Medyczne/Pediatria 2013, 10, 573-578 (in Polish).Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Facial ageing . . . and other stories

When high quality photographs of the faces of 2700 middle aged and older participants in a longitudinal study were assessed by a panel without knowledge of their chronological age and medical history, people whose perceived age was lower than their chronological age were less likely to have osteoporosis, chronic obstructive pulmonary disease, hearing loss, or cataracts. Energy expenditure and incident type 2 diabetes Data from 90 000 participants in the UK Biobank study who wore an accelerometer for seven days reveal a linear relation between the amount of energy expended during physical activity and the subsequent incidence of type 2 diabetes—even after adjusting for body mass index. A study using data for 1.5 million prescriptions of PPIs in UK general practice found an increased risk of diagnosis of an inflammatory bowel disease in the first two years after treatment started.

Patient Engagement in Diabetes Care: Missed Appointments Among Adults Living with Type 2 Diabetes

OBJECTIVES/GOALS: Missed appointments (MAs) negatively impact the health outcomes of adults living with type 2 diabetes mellitus (T2DM), causing disruptions in clinic operation and added financial cost to healthcare providers and systems. This study aimed to identify risk factors for MAs in both in-person and telehealth settings among adults living with T2DM. METHODS/STUDY POPULATION: Using a sequential multi-method design guided by the modified Quality-Caring Model, the quantitative phase of this study used electronic health records (EHR) data in Calendar Years 2019 and 2020 with 7,276 encounters made by 2,235 patients with T2DM from four diabetes clinics within a tertiary academic medical center in Baltimore, MD. Multivariable random effect logistic regression were used to examine the association between MAs and included predictors (i.e., patient characteristics [e.g., age, race, health status], health provider factors [e.g., types of provider], and health system factors [e.g., scheduling lag]). Based on the results of the quantitative phase, a purposive sample of 23 adults with T2DM and 10 providers were then interviewed individually via phone or zoom. RESULTS/ANTICIPATED RESULTS: The EHR data found that the following variables decreased the odds of MAs: having an activated patient portal account, patients with age over 46 or with white race. Telehealth was associated with 50% decreased odds of MAs during COVID (after 3/23/2020). On the other hand, longer scheduling lag increased the odds of MAs. Qualitative interviews revealed that MAs were often related to social needs, such as lack of/limited health-related transportation and its associated financial burden. Telehealth helped break these barriers for some adults with T2DM, but technical challenges in telehealth persisted for those with low digital health literacy and people who did not have a digital device and/or with unstable internet connection. Providers worried that these challenges might undermine the quality of diabetes care. DISCUSSION/SIGNIFICANCE: Disparities in MAs by age and race were noted, which might reflect the impact of unmeasured social needs in EHR. Perceived convenient telehealth may reduce MAs in T2DM care. However, the persistent technical challenges of telehealth should be addressed to optimize the quality of diabetes care and to promote care continuity for underserved populations.

Discovering the positives in healthcare

There are nonetheless grounds for some optimism that advances are being made, not least in the progress made by research funders in cracking down on unpublished clinical trials (doi:10.1136/bmj.p840).7 Two new research papers also carry some good news. Denosumab use for osteoporosis in adults may simultaneously reduce the risk of type 2 diabetes (doi:10.1136/bmj-2022-073435).8 And discussion with patients, using a prognostic algorithm, and providing information could help GPs identify patients with respiratory tract infections who are at lower risk and do not need immediate antibiotic treatment (doi:10.1136/bmj-2022-072488).9 Finally, Helen Salisbury writes about not just good news but "something so positive, so joyful and life affirming”—an initiative in which medical students mentor asylum seekers and support them through the healthcare system (doi:10.1136/bmj.p919).10 A junior doctor who helped coordinate the work spoke of finding focus and purpose and "falling in love with medicine again.” BMJ 2023;381: e073435. 10.1136/bmj-2022-073435 37072150 9 Blair PS Young G Clement C. Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial.

Recognising value

Conducted in the US Veterans Affairs system, this large study shows benefits from the antiviral drug nirmatrelvir when used early in patients with SARS-CoV-2 (doi:10.1136/bmj-2022-073312).3 Deaths and hospital admissions were reduced in patients who received treatment. Ma and colleagues followed more than 15 000 US nurses and health professionals with type 2 diabetes for several decades, updating information on beverage intake every two to four years (doi:10.1136/bmj-2022-073406).5 The onset of cardiovascular disease and death from diabetes, as well as overall mortality, were higher in those who consumed more sugar sweetened beverages. For patients with diabetes, for example, one disease and climate friendly recommendation might be to "use your feet for transport.” Since 2021 patients in the US have had free and immediate access to their medical records, thanks to passage of the 21st Century Cures Act.

Diabetes-Related Excess Mortality in Mexico: A Comparative Analysis of National Death Registries Between 2017–2019 and 2020

OBJECTIVE To estimate diabetes-related mortality in Mexico in 2020 compared with 2017–2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic. RESEARCH DESIGN AND METHODS This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017–2020 period. Diabetes-related death was defined using ICD-10 codes listing diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017–2019 rates. RESULTS We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017–2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017–2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018–2019 data, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, rates of COVID-19 hospitalization, and prevalence of HbA1c ≥7.5%. CONCLUSIONS Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.

A single centre retrospective analysis of new patients presented to the hepatology clinic with non-alcoholic fatty liver disease post-covid era

OP06 Table 1Demographics of patients Valid (n=) Missing (n=) Mean Std. Deviation Minimum Maximum Age (years) 134 0 55.522 15.111 17 87 Metabolic risk factors BMI in kg/m2 129 5 34.875 7.168 21.5 59.3 HbA1c (mmol/mol) 118 16 47.398 14.793 27 94 Total cholesterol (mmol/L) 119 15 4.646 1.195 1.9 7.4 Triglyceride level (mmol/L) 104 30 2.117 1.211 0.6 7.1 Blood tests AST U/L 116 18 48.621 36.672 14 318 ALT U/L 134 0 61.515 49.304 8 367 Bilirubin umol/L 134 0 11.261 9.398 3 59 Albumin g/L 133 1 44.12 4.624 21 53 Platelet count (x10*9/L) 134 0 229.343 83.631 23 509 INR 98 36 1.052 0.22 0.9 2.5 Fibrosis assessment Enhanced liver fibrosis (ELF) 16 118 9.671 0.754 8.31 11.06 Elastography (kPa) 79 55 10.944 7.049 2.5 39 CAP score 78 56 315.808 59.388 104 400 ConclusionOur study showed that patients with underlying metabolic risk factors were treated in 80% of cases. TE is not performed in all patients due to social isolation limitation imposed by covid-19 infection. In those who had TE;the index diagnosis of cirrhosis was seen in around 20% at the time of TE.

Stroke, diabetes, . . . and other stories

In Denmark, time trends of ischaemic stroke in people with type 2 diabetes are showing a striking decline. Between 1996 and 2015, the incidence of stroke dropped by around 50%. The fall coincided with an increase in the use of prophylactic cardiovascular medications, especially statins (where the prevalence of use increased from 5% to 50%) and multiple antihypertensive drugs (where the prevalence of use increased from 18% to 33%) (Diabetes Care doi:10.2337/dc22-0440).

European Safety Analysis of mRNA and Viral Vector COVID-19 Vaccines on Glucose Metabolism Events: An International Journal of Medical Toxicology and Drug Experience

Introduction: COVID-19 is a complex disease with several clinical phases of progression, affecting many organs apart from the respiratory tract that has shown a worst prognosis in both patients with type 1 and type 2 diabetes mellitus [1]. Based on these considerations, the vaccination for COVID-19 is a priority for this subpopulation [2]. However, few data have been published on the effects of impaired glucose metabolism induced by COVID-19 vaccines. Objective: We decided to perform a study to describe Individual Case Safety Reports (ICSRs) of impaired glucose metabolism events reported in the European database (Eudravigilance, EV). Methods: ICSRs were retrieved for the period from January 1st, 2021 to December 11th, 2021. An ICSR related to events of impaired glucose metabolism was identified by using selected preferred terms (PTs) from Standardized MedDRA Queries "Hyperglycaemia/new onset diabetes mellitus" and "Hypoglycaemia". Impaired glucose metabolism events were described and analyzed based on the Diabetologists' classification into nine groups: "diabetes in pregnancy", "acute complications of diabetes", "pre-diabetes", "type 1 diabetes mellitus", "type 2 diabetes mellitus", "high glucose levels", "diabetes mellitus inadequate control", "diabetes melli-tus not specified", and "hypoglycaemia". The reporting odds ratios were computed to assess the reporting frequency for COVID-19 mRNA vaccines compared to COVID-19 viral vector-based vaccines. Results: During the study period, 3,917 ICSRs with a COVID-19 vaccine as suspected and at least an event of impaired glucose metabolism were retrieved from the EV, of which 2,027 (51.75%) referred to Pfizer-BioNTech vaccine, 586 (14.96%) to Moderna vaccine, 1,163 (29.70%) to Oxford-AstraZeneca vaccine, and 141 (3.59%) to Janssen vaccine. From 3,917 ICSRs, we observed 4,275 impaired glucose metabolism events (1.09 adverse events per ICSR). Most adverse events were classified as serious (2,694;63.02%), and the most reported events were related to "high glucose levels" (2,012;47.06%). The mRNA vaccines were associated with an increased reporting frequency of "type 1 diabetes mellitus" (ROR 1.86;95% CI 1.33-2.60), "type 2 diabetes mellitus" (ROR 1.58;95% CI 1.03-2.42), "high glucose levels" (ROR 1.16;95% CI 1.06-1.27), "diabetes mellitus inadequate control" (ROR 1.63;95% CI 1.25-2.11), and "hypoglycemia" (ROR 1.62;95% CI 1.41-1.86) compared to viral vector-based vaccines. The highest reporting rate per 100,000 was observed for Oxford-AstraZeneca vaccine (1.87;95% CI 1.77-1.97). Conclusion: In conclusion, mRNA COVID-19 vaccines were associated with an increased reporting frequency of alterations of glucose homeostasis compared to viral-vector COVID-19 vaccines. Clinicians should be aware of these events to better manage glycaemic perturbations. Larger nationwide studies are warranted to verify these findings.

Tinospora cordifolia induced liver injury during covid-19 pandemic

IDDF2022-ABS-0185 Table 1Clinical characteristics of patients with Giloy-induced liver injuryCharacteristics Number of patients (Total-16 patients) Gender Male 7 (43.75%) Female 9 (56.25%) Age (mean ± SD) 48.3±14 years Presentation type Acute hepatitis 6 (37.5%) ACLF 10 (62.5%) Mean duration for symptom onset after consumption of giloy 84.3±35 days Mean BMI 23.23±3 kg/m2 Comorbidities Type 2 diabetes 9 (56.25%) Interstitial lung disease (on inhalational steroids) 2 (12.5%) Hypertension 1 (6.25%) None 5 (31.25%) NAFLD 2 (6.25%) Symptoms Jaundice 16 (100%) Ascites 8 (50%) Fatigue 12 (75%) Pruritus 4 (25%) Liver function tests Peak total bilirubin (Mean ± SD) 17 ± 9.4 mg/dl Peak ALT (mean ± SD) 365± 219 U/L Peak AST (mean ± SD) 558 ± 475 U/L Peak ALP (mean ± SD) 186 ± 114 U/L Peak serum IgG (mean ± SD) 2400 ± 1213 mg/dl Peak INR (mean ± SD) 2.63 ± 1.05 AIH serology ANA 1(6.25%) ASMA - Anti LKM1 - AMA - Seronegative (biopsy proven) - Liver biopsy 10 (62.5) Drug induced liver injury 5 (31.25%) Features of AIH 5 (31.25%) Treatment N-Acetyl Cysteine infusion+Ademetionine 3 (18.75%) Steroids 10 (62.5%) Plasma Exchange 3 (18.75%) Outcome Alive 16 (100%) One listed for liver transplant Mean duration for recovery 37 ± 16 days IDDF2022-ABS-0185 Figure 1ConclusionsGiloy, a commonly used immunity booster, can produce drug-induced liver injury, which often mimics autoimmune hepatitis and responds to steroids.

Understanding the Interaction between Type 2 Diabetes and COVID-via Extracellular Vesicle Proteomic and Phosphoproteomic Signatures

Evidence supporting the involvement of EVs in the pathogenesis/severity of SARS-CoV-2 infection is starting to accumulate. However, little is known about their specific associations in the context of COVID-and type 2 diabetes interaction. Our study included 48 plasma samples (N=12/group) obtained from COVID-patients with and without diabetes and from patients with non-COVID-acute respiratory diagnosis (RSP) with and without diabetes. Participants were identified from a set of 494 patients hospitalized at AdventHealth in June-August 2020. Important efforts were made to ensure the homogeneity of the study cohort. Patients with type 1 diabetes, or pregnant, or that went directly into the ICU were excluded, and 4 balanced groups were identified after 10,000 random cohorts were generated and differences in age, gender, race, and ethnicity statistically assessed. EVs were isolated using EVTRAP (Tymora) . Mass spectrometry-based methods were used to detect the global EV proteome and phosphoproteome. Differentially expressed features, enriched pathways, and enriched tissue-specific protein sets were identified. Multidimensional scaling of all EV proteomic and phosphoproteomic data and unsupervised clustering of differentially expressed (absolute fold change ≥ 2, P < 0.05, FDR < 0.05) EV proteins and phosphoproteins successfully distinguished the 4 study groups with close to 100% accuracy. Importantly, we detected enriched pathway networks that suggest the potential therapeutic utility of PKC inhibitors such as bisindolylmaleimide IX, sotrastaurin, and enzastaumn, and inhibitors of ROCK1 such the isoquinoline derivative Fasudil. In conclusion, we characterized the proteomic landscape of the interaction between type 2 diabetes and COVID-and defined disease-specific EV proteomic signatures that provide insight into the disease pathobiology and druggable targets with potential clinical utility.

Risk Factors Associated with In-Hospital Mortality In Patients with COVID-and Type 2 Diabetes in Chile

Background: Risk factors associated with in-hospital mortality (IHM) have been identified among patients with T2D hospitalized for COVID-19, including male sex, elderly, impaired renal function and poor metabolic control. At a local setting, data regarding the impact of these variables are lacking. Aim: To assess the association between risk factors and IHM in patients with T2D admitted for COVID-19. Methodology: This is a descriptive observational study. We used electronic health records data provided by a tertiary-level hospital in Chile, between April to July 2020. Included demographic, clinical, and laboratory variables of inpatients with T2D and a positive PCR for SARS-CoV-2. Multiple logistic regression analysis was used to identify predictors of IHM. Results: We identified 200 individuals. Mean age was 63.0±13.6 years, 59.5% (n=119) were adults aged ≥60 years and 58% were male (n=116) . Mean admission glycemia and A1C were 216±120 mg/dl and 8.8±2.4%, respectively. Median admission serum creatinine was 0.8 mg/dL (p25-p75: 0.6-1.1 mg/dL) . A total of 38 patients (19%) died during hospitalization, of these 26.3% (n=10) died within the first week, 63.2% (n=24) between 2-4 weeks, and 10.5% (n=4) after the first month. Age ≥60 years (OR 2.9, 95%CI [1.3-6.7], p=0.01) and elevated admission serum creatinine (OR 1.28, 95%CI [1.04-1.58], p=0.01) were identified as independent predictors of IHM in multiple logistic regression analysis. No association was identified for sex, admission glycemia or A1C, however 37% of our sample lacked an A1C measurement, which could imply a bias. Conclusion: Our study confirms that older age and elevated admission serum creatinine are risk factors for IHM in patients with T2D hospitalized for COVID-19. These results reinforce the importance of identifying risk factors to improve outcomes related to COVID-during in-hospital stay of patients with T2D. We must promote A1C measurement at admission for all patients with diabetes or hyperglycemia.

Cross-Sectional Study of the Impact of the COVID-Pandemic on Diabetes Management in Primary Care in Ontario, Canada

Background: This study describes the impact of the pandemic on the management of people with type 2 diabetes (PwT2D) in a primary care network with existing virtual care capabilities in Ontario, Canada. Methods: Using de-identified primary care electronic medical records, PwT2D who had at least one healthcare touchpoint between March 1, 2018 and February 28, 2021 were analyzed by time period (baseline: 2018-19, pre-COVID-19: 2019-20, COVID-19: 2020-21) . The primary outcome measures include the number of people with at least one visit, number of people with vital measurements or lab tests, and the vital or lab results. Results: The three time periods had a similar average age and gender distribution (Table 1) . Compared to the pre-COVID-period, fewer people had any healthcare touchpoint (17% reduction) . In-person visits were reduced while more people had virtual visits. Fewer people had test results recorded during the COVID-vs. two pre-COVID-time periods, however, average results were similar across all three time periods. Conclusion: Our study described the immediate impact of the COVID-pandemic on patterns of primary care for PwT2D. While the total number people getting tests remains below pre-pandemic levels, of those who sought care, the mean A1c, LDL-c and eGFR were comparable across the three time periods.

The Impact of Diabetes on Mortality and Clinical Outcomes in Hospitalized Patients with COVID-in the Capital Region of Denmark

During the COVID-pandemic, patients diagnosed with diabetes have been overrepresented among patients admitted to hospital with COVID-19. We explored the impact of diabetes on mortality and clinical outcomes in hospitalized patients with COVID-in the Capital Region of Denmark. All patients from the Capital Region of Denmark admitted to hospital with COVID-in the period from February 2020 to March 2021 were included. Patients with a diabetes diagnosis were compared to patients without a diabetes diagnosis in multivariable adjusted analyses. The primary outcome was death within 30 days from hospitalization. Secondary outcomes included time to discharge, use of oxygen treatment, referral to intensive care unit, and use of respirator. Among 3,997 hospital admitted patients, 1,186 had diabetes (1,090 type 2 diabetes;96 type 1 diabetes) . The patients with diabetes were 59% men, 72±13 years (mean±standard deviation) with BMI 28±6.4 kg/m2, while patients without diabetes were 51% men, 67±years with BMI 26±5.8 kg/m2. Within 30 days, 292 (24.6%) patients with diabetes died compared to 521 (18.5%) without diabetes (adjusted odds ratio (aOR) 1.28 (95% CI 1.02-1.6) for death) . Patients with diabetes were 24% less likely to be discharged alive at any given time compared to patients without diabetes with a hazard ratio of 0.76 (0.70-0.81) . aOR for oxygen treatment was 1. (0.97-1.47) , for referral to intensive care unit 1.37 (1.01-1.85) , and for use of respirator 1. (0.86-1.65) . We found that hospitalized COVID-patients with diabetes had a 28% higher risk of dying within 30 days and were 19% more likely to receive intensive care treatment than hospitalized COVID-patients without diabetes.

Distinct Phenotypes of Multiorgan Abnormalities in Long COVID and Type 2 Diabetes Identified by Multiparametric Magnetic Resonance Imaging

Introduction: Both long COVID and Type 2 Diabetes (T2D) are multi-system conditions requiring multi-organ assessment to monitor organ health and detect co-morbidities earlier. Here, we defined multi-organ abnormalities in both patient groups with a rapid, non-contrast MRI scan. Methods: We recruited 135 long COVID patients (NCT04369807) and 135 T2D patients (NCT04114682) . MRI data were acquired for organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.) . Reference values were based on 92 controls and published literature. Results: There was a high prevalence of organ abnormality in both patient groups (Figure, left) , including increased fat deposition (steatosis) in liver, pancreas, and kidney (Figure, right) . 35% of T2D patients had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver and renomegaly were more common in T2D than in long COVID. Considering only obese patients, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID. Conclusion: Multi-organ MRI assessment can enrich the current blunt assessment of multi-system abnormalities in diverse disease states to inform earlier intervention and treatments.

Prognostic Factors in Type 2 Diabetic Patients Diagnosed with COVID-in a Latin American Hospital

Background: To determine the factors associated with mortality in adult patients diagnosed with type 2 diabetes hospitalized for COVID-in a hospital of Latin America. Methods: Prospective cohort study from June 2020-june 2021. Patients with a diagnosis of type 2 diabetes older than 18 years with a confirmed diagnosis of COVID-infection were included. Results: A total of 813 adults were included. The mean age was 61.2 years, 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%) . A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the Intensive Care Unit and 377 (46.4%) died. The requirement for ventilatory support, increased lung involvement, comorbidities and inflammatory markers were associated with mortality. Admission to the intensive care unit and the need for mechanical ventilation increased 1.39 (95% CI: 1.13 to 1.69) and 1.97 (95% CI: 1.69 to 2.29) the mortality. Those patients whose glycosylated hemoglobin on admission was greater than 10%, for every 1% increase above 10%, this increased the risk of death by 32% (RR: 1.32 95% CI: 1.25 to 1.38) . Conclusion: The mortality found in our study was associated with age, poor control of type 2 diabetes and respiratory compromise. Ensuring a satisfactory metabolic control of the patient with type 2 diabetes would decrease complications related to COVID-infection.

Mortality among People with Diabetes Experiencing Hypoglycemic and Hyperglycemic Crises

Severe hypoglycemia and hyperglycemia (ketoacidosis, hyperglycemic hyperosmolar state) are common yet potentially preventable acute complications of diabetes. Our objectives were to use national data from OptumLabs® Data Warehouse, 2011-2020, to 1) characterize trends in all-cause mortality among adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) experiencing emergency department visits or hospitalizations for hypoglycemia and hyperglycemia;2) extend analyses through 2020 to assess the impact of the COVID-pandemic;and 3) examine racial/ethnic and gender disparities in subsequent mortality adjusted for relevant patient characteristics. Among 4,164 adults with T1DM experiencing hypoglycemia, 30-day and 1-year mortality increased from 0.5% to 0.9% and 4.7% to 6.1%. Among 49,931 adults with T2DM experiencing hypoglycemia, 30-day and 1-year mortality were stable at 2.1-2.0% and 16.2-16.1%. Among 4,698 adults with T1DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 0.4% to 1.0% and 2.7% to 5.9%, respectively. Among 17,123 adults with T2DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 2.5% to 3.0% and 11.5% to 13.1%. Table shows differences in mortality rates by age, race/ethnicity, gender. These results call for proactive engagement of high risk individuals experiencing severe hypoglycemia and hyperglycemia to reduce their risk of death.

No "Honeymoon" for Youth, in Particular Blacks, Diagnosed with Diabetes during the First Year of the COVID-Pandemic

Racial differences at onset of type 1 diabetes (T1D) in youth during the COVID-pandemic have been documented in the US. Limited data are available in type 2 diabetes (T2D) . No data are available to our knowledge at follow up (FU) . We compared characteristics at onset and 1 year FU in white vs. black children diagnosed with diabetes mellitus (DM) in 2020 at a large pediatric academic center. A total of 276 youth (53% male, 81% white, mean age at onset 10.8±4.5 years, mean HbA1c 12.1±2.7%, 45% with BMI ≥ 85th percentile, 43% presenting in DKA) , were identified via retrospective chart review. 78% were diagnosed with T1D, 21% with T2D and 1% with MODY. Age (10.8±3.9 vs. 10±4.5 years, p=0.5) , prevalence of BMI ≥ 85thile (47 vs. 28%, p=0.12) and mean HbA1c (12.3±2.5 vs. 12.1±2.7, p=0.84) were similar in blacks vs. whites at onset of T1D. In those diagnosed with T2D, blacks compared to whites had a higher mean HbA1c (11.9±2.9 vs. 9.7±2.3%, p=0.04) as well as prevalence of DKA (26 vs. 0% respectively, p=0.02) . Characteristics at 1 year FU by race and type of DM are presented below.

BMI Changes in Youth with Type 2 Diabetes during COVID-Shelter-in-Place: The Role of Neighborhood Risk Factors

The California government imposed a shelter-in-place (SIP) order on 3/15/2020 to slow the spread of COVID-19. For many children and adolescents, particularly youth with type 2 diabetes (T2D) , school closures led to major changes in daily routines, affecting physical activity levels and dietary choices. We performed a retrospective descriptive study on youth ages 7 to 21 years with T2D who were seen at our health care system at least one time in the year preceding SIP and again in the year after, allowing us to calculate change in BMI over time during SIP. Utilizing databases from the United States government, we examined the effects of living in an area with at least one risk factor ("food deserts" with a paucity of healthy food, "food swamps" with an abundance of unhealthy food, or rural regions) on BMI change compared to low-risk neighborhoods. We included 78 youth with T2D and 46% lived in at-risk areas. Overall, youth had a slight increase in BMI during SIP (0.± 0.2 kg/m2/month) . Youth living in at-risk areas had a rise in BMI during this time period (0.02 ± 0.2 kg/m2/month) , whereas youth in low-risk areas had a small drop in BMI (-0.± 0.2 kg/m2/month) . As this study was not powered to detect group differences, further investigation of neighborhood risk factors is needed to aid in tailoring community-level interventions to combat obesity in youth with T2D.

Perfect Storm in Mississippi: High Rate of Obesity Leading to Surge in Pediatric Diabetes during the COVID-Pandemic

Background: Mississippi ranks second for childhood obesity prevalence (22%) above the national average of 16 % with significant racial and health disparities. Since March 2020, stay-at home orders, virtual learning, stress, and poor lifestyle may have provided a perfect setup leading to new diagnosis of diabetes and accounting for record high hospitalizations. Objective: To determine the impact of the COVID-pandemic on the rate and clinical characteristics of newly diagnosed pediatric diabetes at University of Mississippi Medical Center. Methods: Chart review and data comparison completed for patients with new-onset-diabetes between January 20-February 2020 (pre pandemic) ;and between March 2020-October 2020 (pandemic) . Results: Table 1. African Americans were disproportionately diagnosed with diabetes (64%) . Eighty percent of obese patients had type 2 diabetes with 38% presenting in DKA, 3 patients in HHS. Four patients were COVID-positive on admission. Conclusions: Our observations corroborate the steep rise in the number of new-onset type 1 and type 2 diabetes, particularly in African Americans, in a highly prevalent obese pediatric population. Additional studies are required to determine the detailed effects of SARS-CoV-2 infection and pandemic associated psychosocial, clinical and biochemical effects on development of diabetes in the pediatric population.