Guthrie Robert Packer Hospital

Strict and life-long gluten-free diet (GFD) is the standard of care for patients with celiac disease (CeD). Maintenance of adherence to GFD is the key to the success of GFD; however, a proportion of patients are unable to maintain strict adherence to GFD. We performed a systematic review and meta-analysis to estimate the pooled prevalence of adherence of GFD, as assessed by celiac dietary adherence test, BIAGI score, standardized dietitian evaluation or self-reported adherence to GFD, in patients with CeD after at least 1 year of initiating GFD. Electronic reference databases were searched from January 1, 1990 to April 30, 2025. Overall, 69 studies including 27,641 subjects were found eligible for pooling estimates by objective assessment methods. The pooled effect size (95% confidence interval [CI]) was calculated using a random effect model. Most of the studies had low risk of bias and there was no publication bias. The pooled prevalence of adherence to GFD as assessed by objective methods of assessment and self-reported adherence were 64% (95% CI 59%-69%) and 74% (95% CI 69%-79%), respectively. Specifically adherence rates were 65% (95% CI 57%-73%) with standardized dietitian evaluation, 57% (95% CI 50%-64%) with celiac dietary adherence test and 75% (95% CI 65%-83%) with BIAGI score. Highest adherence rates were reported from European and North American countries. There was no significant difference in the adherence rates with time or age of the participants. On univariate metaregression, method of assessment of adherence affected the rate of adherence to GFD. One in 3 patients with CeD is unable to maintain a good adherence to GFD. There is need to develop strategies to improve the adherence to GFD.

Background: Zilebesiran, a novel small interfering RNA (siRNA) therapeutic targeting hepatic angiotensinogen (AGT), has demonstrated promising antihypertensive effects in recent phase 2 trials. This meta-analysis aimed to quantify the pooled reduction in systolic blood pressure (SBP) following zilebesiran treatment, assess dose-response effects, and explore the association between AGT suppression and SBP reduction. Methods: A random-effects meta-analysis was conducted using data from six treatment arms across the KARDIA-1 and KARDIA-2 trials, evaluating zilebesiran monotherapy and add-on therapy in adults with mild to moderate hypertension. Pooled mean SBP reduction and 95% confidence intervals (CIs) were estimated. Meta-regression was performed using dose (mg) as a continuous moderator. Additionally, a linear regression model was used to examine the relationship between percentage AGT suppression and SBP reduction. All analyses were performed in R (version 4.3.2) using the metafor package. Results: The pooled analysis demonstrated a significant SBP reduction of –11.80 mmHg (95% CI: –15.70 to –7.89; p < 0.0001), with high heterogeneity (I 2 = 81.6%). Meta-regression did not reveal a significant dose-dependent trend (β = 0.0127 mmHg per mg, p = 0.231; R 2 = 13.2%), indicating that SBP reductions were not linearly associated with zilebesiran dose across the 150–600 mg range. Furthermore, no significant correlation was found between AGT suppression and SBP change (β = –0.23, p = 0.491), despite a moderate R 2 of 0.51, limited by small sample size (n = 3). Conclusions: Zilebesiran significantly reduces 24-hour systolic blood pressure across dosing regimens. However, no clear dose-response relationship or direct link between AGT suppression and SBP reduction was observed. These findings highlight the need for further trials with harmonized dosing and biomarker reporting to clarify predictors of response.

Disclosure: S. Zahra: None. H. Marasandra Ramesh: None. P. Wulandari: None. P. John: None.Background: Diabetes is increasing at an alarming rate in the US. Diabetes is the eighth leading cause of death in the US. About 15.9 million or 29.2% of Americans aged 65 or above had diagnosed or undiagnosed diabetes. 38.2 million physician office visits were reported to have a primary diagnosis of diabetes [1]. The national cost of diabetes in the U.S. in 2017 was more than $327 billion up from $245 billion in 2012. The ADA and the ACC started to raise public awareness about the “ABCs of Diabetes”, namely A1C, BP, and cholesterol. The recommended target of A1C is <7% (except for pregnant patients, patients with limited life expectancy, and patients with significant glycemia risk), blood pressure <140/80 mmHg, and LDL <100 mg/dl. As per Standards of Medical Care in Diabetes 2021, A1C should be measured at least twice yearly in patients with stable glycemic control and at least quarterly in patients not meeting glycemic goals. At our institution, we use a composite score, the Diabetic bundle. It consists of diabetic patients seen in the past 2 years who have an active PCP, with an A1C <= 8 in the past 6 months, and who have currently been prescribed a moderate or high-intensity statin (or a statin exemption code), and a negative diabetic eye exam in the past 2 years or a positive exam in the past year, as a system numerator and total diabetic patients seen in the last 2 years who have an active Guthrie PCP, as a system denominator. Goals: Maintain the system goal of bundle compliance >45%. Identify barriers contributing to low diabetic bundle compliance rates in the resident clinic. Interventions: Providing handouts to educate clinical staff about the diabetic bundle quality metrics. Actively participating in morning huddles to address gaps at multiple levels. Identifying the non-complaint patients and attempting to reach them to increase the follow-up rate. Biweekly analysis of compliance; and diabetic registry to be updated regularly. Sending text reminders to patients who are overdue for an ordered A1c. Results: Overall, the diabetic bundle compliance rate remained above 45%. The post-intervention rate was 45.5%. The diabetic retinopathy screening rate increased from 73% to 76.3%. Statin use in the target population increased from 93% to 94.2%. HbA1c screening rates decreased from 63.1% to 58.9%. Conclusion: Patient calls and message reminders were the most useful intervention. Multiple barriers to improving diabetic bundle compliance rates were identified. The compliance rates were noted to drop when residents were posted on busy inpatient rotations. Substantial reluctance was expressed by diabetic patients with no other comorbidities to initiate statin therapy, as part of the diabetic bundle. Most patients performed POCT HbA1c at their endocrinologist's office and data were not automatically uploaded on EPIC from outside facilities, due to which overall bundle rates could have been falsely compromised.Presentation: Saturday, July 12, 2025

ABSTRACT Background Acute limb ischemia (ALI) is a critical vascular emergency marked by a sudden reduction in blood flow to the limb, significantly increasing amputation risk. Revascularization outcomes in urban versus rural areas have not been examined. Research design and methods The National Inpatient Sample from 2016 to 2021 identified patients with ALI who underwent revascularization. Propensity score matching compared outcomes, analyzed using STATA version 18. Results Of 85,760 hospitalizations for ALI receiving percutaneous revascularization 81,880 (95.5%) were in urban centers and 3,880 (4.5%) in rural facilities. Patients in urban hospitals showed higher mortality (4% vs. 2.7%), myocardial infarction (MI) (3.4% vs. 2.7%), cardiogenic shock (1.6% vs. 0.6%), cardiac arrest (6.5% vs. 5.9%), major adverse cardiovascular and cerebrovascular events (MACCE) (7.5% vs. 5.3%), mechanical circulatory support (1.1% vs. 0.5%), and acute kidney injury (18.5% vs. 15.4%). However, urban patients had lower intravascular ultrasound (IVUS) (3.4% vs. 6.5%), major amputation (6.3% vs. 7.8%), fasciotomy (1.8% vs. 2.2%), and major adverse limb events (MALE) (46.4% vs. 49.1%), with a significant difference of p < 0.01 compared to rural hospitals. Conclusions Urban hospitals in the United States report elevated mortality rates and significant cardiovascular events in comparison to their rural counterparts.