1454-P: Major Adverse Cardiovascular Events, Advanced Foot Complications, and Subsequent Risk of Diabetic Ketoacidosis in Type 1 Diabetes
Bibliographic record
Abstract
Introduction & Objective: People with type 1 diabetes and diabetes-related complications, including cardiovascular disease, are at increased risk of morbidity and mortality. We aimed to determine if major adverse cardiovascular events (MACE) and microvascular complications independently predict the risk of subsequent diabetic ketoacidosis (DKA). Methods: We accessed previously-collected data from the DCCT/EDIC Study through the NIDDK Central Repository. We used Multivariable Cox Proportional Hazard models with time-varying exposures and co-variates to examine associations of MACE and microvascular complications (early- and late-stages of neuropathy, nephropathy, and retinopathy) as the exposure, with the subsequent occurrence of DKA as the outcome. Results: Of 1441 participants, 297 individuals experienced 488 DKA events over 34 years of follow-up. MACE [hazard ratio (HR) 3.11, 95% confidence interval (CI) 1.56-6.17, p=0.001] and late-stage neuropathy, which comprised of foot ulcer or amputation, (HR 1.61, 95% CI 1.06-2.45 p=0.026) were independently associated with higher risk of DKA. Higher DKA risk was also associated with insulin pump use (HR 3.01, 95% CI 2.28-3.98, p<0.001), higher insulin dose (HR for 1 unit/kg/day 2.39, 95% CI 1.72-3.33, p<0.001), female sex (HR 2.01, 95% CI 1.58-2.56, p<0.001), and higher time-updated HbA1c (HR for 1 percent 1.41, 95% CI 1.32-1.51, p<0.001). Conclusion: In those with type 1 diabetes, a major cardiovascular event, foot ulcer or amputation confers the greatest risk of future DKA independent of previously-recognized risk factors. These findings imply a need to target patients with these events for DKA prevention interventions such as self-management skills for metabolic control, management of depression, and education around DKA. Disclosure P. Bapat: None. D.R. Budhram: None. A.M.K. Bakhsh: None. M.I. Abuabat: None. N. Verhoeff: None. D. Mumford: None. A. Orszag: None. M. Fralick: Consultant; singal1, proofdx. A. Weisman: None. L. Lovblom: None. B.A. Perkins: Advisory Panel; Abbott. Other Relationship; Novo Nordisk. Advisory Panel; Insulet Corporation, Nephris. Other Relationship; Medtronic. Advisory Panel; Sanofi, Vertex Pharmaceuticals Incorporated, Dexcom, Inc. Funding Diabetes Canada (Operating Grant OG-3-21-5572-BP)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".