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Background: Gestational diabetes (GDM) is glucose intolerance detected for the first time during pregnancy. Women with a history of GDM have a 7-fold higher lifetime risk of developing type 2 diabetes (DMII) compared to women without a history of GDM. Women with a history of GDM should be screened for DMII 6 to 12 weeks postpartum with a 2-hour 75-g oral glucose tolerance test (OGTT) and then again one year after delivery. The long-term goal of this project is to improve screening for DMII in women with a history of GDM. This report establishes the prevalence of GDM, determines the postpartum screening rate, and assesses for barriers to screening at an urban safety-net hospital. This information will be used to design interventions to improve postpartum screening. Methods: We conducted a retrospective chart review of women who had a delivery at Truman Medical Center between January 1, 2017 to December 31, 2019 and had a diagnosis of GDM. Charts were reviewed for demographic data, management of GDM, postpartum appointments, and screening for DMII. Results: There were 9569 deliveries during the three-year period. Of the total deliveries, 537 (5.6%) had a diagnosis of GDM. Of the patients with GDM, 426 (79%) had a postpartum visit scheduled, 354 (66%) attended a 6-week postpartum appointment, 219 (41%) had the recommended test ordered, and 49 (9%) completed the test. The data revealed a significant association with ethnicity, language, insurance type, and site of prenatal care with attending the postpartum appointment (p<0.05) as well as with insurance status on completing the screening test (p<0.05). Conclusion: There is gap in the number of women with GDM and those who are screened for DMII in the postpartum period. There appears to be a disconnect in the ordering of the recommended 2-hour OGTT and the completion of the test. The baseline data supports a multi-prong approach including patient education, system changes, and advocacy for extended insurance benefits to cover screening. Disclosure V. Rakhra: None. M. Riley: None. S. Jordan: None. S. Bulchandani: None. J. Allsworth: None. B. Drees: None.

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Background New-onset diabetes after transplantation (NODAT) is a serious complication after a solid organ transplant. NODAT occurs in 2% to 53% of all solid organ transplant recipients.1 Tacrolimus is an immunosuppressive agent associated with diabetogenic potential which predominantly is a result of suppression of insulin secretion from pancreatic beta cells. Diabetic ketoacidosis as the first presentation of new onset tacrolimus induced diabetes is rare. We report a case of diabetic ketoacidosis (DKA) in a patient without prior history of diabetes mellitus and receiving tacrolimus as part of immunosuppressive regime post-renal transplant. Clinical Case A 62-year-old female with past medical history of autosomal polycystic kidney disease status-post deceased donor renal transplant and hypertension presented with weakness and fatigue. She had undergone transplant 8 months prior to this presentation and her immunosuppressive regime consisted of mycophenolate mofetil and tacrolimus. The patient was encephalopathic on arrival with normal vitals. Laboratory evaluation was significant for blood glucose of 673, bicarbonate of <10, anion gap of 24, Beta-hydroxybutyrate >8 and a pH of 7.19 on arterial blood gas analysis thus confirming diagnosis of diabetic ketoacidosis (DKA). Tacrolimus level was elevated at 35.7. Intravenous fluids and insulin were initiated with resolution of symptoms and DKA. She was transitioned to a basal-bolus insulin regimen. Further labs revealed Hemoglobin A1C of 11.6% (no previous value), negative insulin antibodies and glutamic acid decarboxylase antibody, and a low C-peptide level at 0.47 (when blood glucose was 150mg/dl). Her tacrolimus dose was adjusted, and she was discharged on a basal-bolus insulin regimen. On follow up, the patient had lower insulin requirements with improvement in C-peptide level to 1.8, thus, indicating beta cell dysfunction in setting of supratherapeutic tacrolimus levels. Conclusion Tacrolimus remains the preferred immunosuppressive agent after kidney transplantation given lower incidence of acute rejections and better tolerance. However, due to its toxic effects on pancreatic beta cells it is imperative blood sugar levels should be routinely monitored in patients on tacrolimus. Appropriate monitoring can lead to timely diagnosis and successful outcomes. Further studies are required to investigate risks factors associated with tacrolimus induced DKA. References 1. Pham PT, Pham PM, Pham SV, Pham PT, Pham P. New onset diabetes after transplantation (NODAT): an overview. Diabetes Metab Syndr Obes. 2011;4: 175-186, https://doi.org/10.2147/DMSO.S19027 Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

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