Background: Patients with hyperglycemia often seek care in the emergency department (ED). Hyperglycemia is associated with longer hospital stays and increased risk of mortality. Methods: Using electronic health record data from patients ≥18 seen at an academic medical center ED (11/1/2015-12/31/2020), we described presentation of non-emergent hyperglycemia (blood glucose (BG) 180-600mg/dL) and examined associations between insulin receipt in ED and in-hospital mortality and hospitalization. We excluded patients with initial BG >600mg/dl, decompensated diabetes, stroke, myocardial infarction, pregnancy, or sepsis, and calculated National Early Warning Score to control for illness severity. We examined associations between insulin receipt and hospitalization and mortality in patients with BG 180-600mg/dL using logistic regression, and stratified analyses by diabetes diagnosis and BG value to assess for effect modification. Results: Of 177,176 eligible patients, 10.9% (19,378) had BG 180-600mg/dL (mean (SD) age=54.6 (15); 52.5% male). Of these patients, 6.8% (1,312) received insulin, 41.8% (8,097) were hospitalized, and 0.3% (278) died. Regression results appear in Figure 1. Conclusions: Hyperglycemia in the ED was common. Treatment with insulin, though uncommon, yielded lower odds of mortality but not hospitalization. Diabetes diagnosis and severity of hyperglycemia modified this association. Disclosure K.Murphy: None. M.E.Lacy: None. K.Heier: None. S.A.Claas: None. J.Keck: None. Funding National Institutes of Health (UL1TR001998)

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Background Adverse childhood experiences (ACEs) are an independent risk factor for chronic diseases, including type 2 diabetes, stroke and ischemic heart disease. However, the effect of ACEs considering sex and race are not often reported in cohorts showing multiracial composition, with power to evaluate effects on underrepresented populations. Aim To determine how sex and race affected the association of combined and individual ACEs with metabolic health biomarkers in the Southern Community Cohort Study (2012–2015). Methods Self-reported data were analyzed from ACE surveys performed during the second follow-up of a cohort comprised by over 60% of Black subjects and with an overall mean age of 60 years. Results BMI steadily increased with cumulative ACEs among Black and White women, but remained relatively stable in White men with ≥ 4 ACEs. Contrary, Black men showed an inverse association between ACE and BMI. Secondary analysis of metabolic outcomes showed that physical abuse was correlated with a 4.85 cm increase in waist circumference in Black subjects. Total cholesterol increased among individuals with more than 4 ACEs. In addition, increases in HbA1c were associated with emotional and maternal abuse in Black women and sexual abuse in White women. Conclusions BMI is strongly associated with cumulative ACEs in women regardless the race, while waist circumference is strongly associated with ACEs in Black individuals, which combined with reduced BMI may indicate increased central adiposity in Black men. Our study suggests that sex and race influence the contribution of certain ACEs to impair metabolic health.

Introduction: Lesbian, gay, and bisexual (LGB) adults have CVD risk and outcome inequities compared to heterosexual peers. With upwards of 7 million sexual minority adults aged >50 by 2030, assessing and addressing their cardiovascular health is critical for clinicians and public health practitioners. However, few electronic health record (EHR) cohorts have been used to study this association. Methods and Results: In this analysis, we used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort, excluding transgender individuals to avoid conflating sexual orientation with gender identity. The baseline date was the first primary care appointment on or after October 1, 2009. Sexual orientation of 1,108,990 veterans was identified via a natural language processing tool with 88.2% sensitivity, 91.5% specificity, and 85.9% PPV; 185,788 veterans were classified as LGB. Prevalent CVD (history of AMI, ischemic stroke, or revascularization in the year preceding the baseline date) was present among 19,887 veterans (4,684 LGB). We calculated sample statistics stratified by sex and sexual minority status; results are displayed in the Table . We used logistic regression analyses to assess the association between sexual minority status and prevalent CVD. Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.12 [1.16, 1.24] times the odds of prevalent CVD compared to non-sexual minority veterans. Upon additional adjustment for BMI, diabetes, hypertension, lipids, substance use, anxiety, and depression, this association remained significant (OR [95% CI]: 1.08 [1.04, 1.12]). Conclusion: This is one of the first studies to examine cardiovascular health within a veteran population stratified by sexual orientation. Addressing the cardiovascular health of marginalized populations requires further exploring the mechanisms by which stress results in CVD risk and outcomes and the inequitable distribution of both.

Adverse childhood experiences (ACEs) are an independent risk factor for chronic disease, including obesity and metabolic syndrome. Therefore, we sought to determine the association of ACEs with BMI and plasma metabolic biomarkers affecting a multiracial cohort. Total ACE score was calculated in 38,353 non‐Hispanic Black and White men and women who participated in the second follow‐up of the Southern Community Cohort Study (2012‐2015). We used regression analyses to assess whether total ACE score or individual ACE components were associated with BMI and included interaction terms to evaluate if the association differed by sex or race, and for female participants, we accounted for menopause status. Total ACE score was associated with BMI (non‐linear p‐value=0.0026) and differed by sex and race (interaction p‐value<0.0001), but not menopause status. BMI steadily increased with cumulative ACEs among Black women. Among White women, BMI sharply increased from 0 to 1 ACEs, and steadily increased thereafter. In White men, BMI increased as ACEs increased from 0 to 3 and remained relatively stable among individuals with >4 ACEs. In Black men, BMI decreased with cumulative ACEs. Among Black women, emotional and sexual abuse were associated with higher BMI (p<0.05). Including both Black women and men, having an incarcerated family member was associated with lower BMI. Physical abuse was associated with increased BMI in Black and White men, while emotional neglect was associated with increased BMI in White women (p<0.05). In addition, regression analysis revealed an association between total ACE score and waist circumference, total cholesterol, the ratio of leptin to adiponectin, HbA1c, and insulin. Furthermore, with increasing number of ACEs, Black men were the most affected in waist circumference, showing a 6 cm overall increase; however, they showed reduced BMI. This data indicates increased visceral fat deposition which is an indicator of metabolic syndrome and insulin resistance. Using a mouse model of postnatal neglect, and in line with this data, we have found that female mice, and not male mice, develop exacerbated adiposity. Specifically, female mice display increased whitening of adipose tissue via the actions of the mineralocorticoid receptor on lipid storage and adipocyte differentiation. Overall, ACEs are associated with BMI, but each ACE component has a unique contribution to this effect that varies based on sex and race. Future pre‐clinical studies should aim to model sex‐ and race‐specific effect of ACE on the development of obesity to provide insights on potential personalized therapies for people undergoing these health disparities.