bluuebunny/crossref_metadata_2025 huggingface dataset:
572-P: Perspectives of People with Diabetes and Caregivers Experiencing Insulin Pump Infusion Set Failure (IPISF) : A Qualitative Study
Authors: BLANCO LUIS E. , VANENGELEN LISANNE M. , GRAY JOHN C. , WILCOX JOHN H.
Published: May 2022

Aim: IPISF can be a life-threatening complication and remains a serious issue for individuals who utilize automated insulin delivery (AID) systems. This study assessed the emotional burden of IPISF and how infusion failure affects sentiment towards insulin pump use.

Methods: 50 follow-on interviews (10/2020 - 05/2021) were performed with Caregivers (CG) and People with Diabetes (PWD) from the 2020 Diatech Diabetes - T1D Exchange Insulin Pump Infusion Set Failure Management Survey. Participants consented to a 1-hour video call interview covering topics related to insulin pump use and experiences with infusion set failures. Audio recordings were transcribed using Trint Software and qualitative interview data was analyzed using thematic analysis, R, and Python.

Results: 39 PWD and CG were interviewed (PWD age 40.1±20.9 years, CG age 46.2±6.3 years, 72% female, 72% white, 50% household income ≥$100K/year, CSII use for 11.5±8.2 years, 48% use AID, HbA1c 6.9±1.4%, TIR 69.9±18.9%, infusion set wear time 2.9±0.8 days, 62% having ≥1 IPISF/month) . Participants shared quotes on how IPISF is “a direct correlation to my level of happiness...kind of irks me and just makes me angry...because as the caregiver, it's my responsibility to make sure that it goes right” and technology that reduces IPISF and improves detection “would probably be the first step in making me even reconsider going back on the pump.” Identified themes showcase the burden of diagnosing and managing infusion failures when overcoming existing alarm fatigue, trusting care team input, and general stress of CSII therapy.

Conclusions: IPISF’s clinical impact is associated with hyperglycemia and DKA, yet IPISF can also affect the mental health of people who use CSII therapy. CSII users heavily rely on hyperglycemia to detect IPISF and can have issues identifying true IPISF from other confounding factors, thus increasing the risk of CSII therapy and justifying the need for better IPISF detection.

Disclosure

L.E.Blanco: Other Relationship; Diatech Diabetes, Inc. L.M.Vanengelen: None. J.C.Gray: Other Relationship; Diatech Diabetes, Inc. J.H.Wilcox: Other Relationship; Diatech Diabetes, Inc.

Funding

The West Coast Consortium for Technology & Innovation in Pediatrics (Indirect Support Request)
587-P: Discrepancies in Patient Perceptions of Health Care Interactions and Diabetes Empowerment Reveal Potential Impact of Weight Bias in Type 2 Diabetes Care
Authors: STEVENSON JULIA , GOWEN REBECCA , YE EMILY , WOOD RICHARD
Published: May 2022

Background: Weight bias is associated with adverse health consequences and may be experienced by people with type 2 diabetes (T2D) from multiple sources, including healthcare providers (HCPs) . This study assessed T2D patients’ sentiments surrounding their most recent visit with their HCP and psychosocial self-efficacy related to diabetes management across body mass index (BMI) range.

Methods: In September 2020, 2,975 adults with T2D in the United States completed an online questionnaire, including a series of questions about experiences at their last healthcare visit and the Diabetes Empowerment Scale-Short Form (DES-SF) to assess diabetes-related psychosocial self-efficacy. Health and demographic information were collected. BMI was calculated using patient-reported measures for height and weight.

Results: Respondents with a BMI of 40.0 or higher were more likely to feel blamed by their HCP for having diabetes (9%) compared to those with BMIs of 18.5-24.9 (4%) , 25.0-25.9 (5%) , and 30.0-34.9 (5%) , and more likely to feel as though their provider doubted their ability to manage their diabetes or follow their treatment plan (17%) compared to those with BMIs of 25.0-25.9 (11%) and 30.0-34.9 (12%) . Adults with T2D and a BMI of 35.0 or higher scored significantly lower on the DES-SF than those with BMIs of 18.5-24.9 and 25.0-29.9. Respondents with a BMI ≥40.0 were less likely to agree with the DES-SF subitem that they can ask for support surrounding having and caring for diabetes when they need it (63%) , compared to those with BMIs of 18.5-24.9 (74%) , 25.0-25.9 (68%) , and 30.0-34.9 (69%) .

Conclusions: These findings suggest that T2D patients with higher body mass index scores are more likely to feel stigma when interacting with HCPs, which may negatively impact diabetes empowerment and patient-provider relationships, emphasizing the need for increased focus on weight neutrality in diabetes care.

Disclosure

J.Stevenson: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc. R.Gowen: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Virta Health Corp. E.Ye: Employee; dQ&A. R.Wood: Other Relationship; Multiple companies and patient organizations (>10) .
595-P: Creation of a Food Insecurity Risk Score for Adults with Diabetes
Authors: EGEDE LEONARD E. , WALKER REBEKAH J.
Published: May 2022

Current measurement of food insecurity in the US has largely focused the USDA scales. However, these scales do not capture multidimensional risk associated with food insecurity, account for stigma associated with being considered food insecure, or adequately capture the idea of nutrition security which is particularly important for individuals with diabetes. We aimed to create a more comprehensive set of questions allowing identification of an individual as being food insecure without reliance on questions only focused on food quantity and cost. We used data collected from 614 adults with type 2 diabetes recruited for a cross-sectional study on social determinants of health in Milwaukee, Wisconsin. The mean age of the sample was 55 years with mean duration of diabetes diagnosis of 9 years. The 6-item USDA food insecurity scale was used as the outcome with a variety of questions capturing social risk used to create a risk score for food insecurity. A series of questions were tested with the final risk score ranging from 0-7 based on questions including: 1) income less than $25,000, 2) going without food, clothing, or housing due to needing funds for medical care, 3) being worried or stressed about paying rent or mortgage, 4) being worried or stressed about money to buy nutritious meals, 5) not seeing a doctor due to cost, 6) not filling prescriptions due to cost, and 7) neighborhood being unsafe due to crime. In the full sample of adults with diabetes, those indicating 2 risks were 3.5 times more likely to be food insecure, those indicating 3 risks were 10.8 times more likely to be food insecure, and those indicating 4+ items were 54.2 times more likely to be food insecure. Use of this tool can identify food insecure adults in a way that captures food and nutrition security while being inclusive of individuals who may feel stigma associated with food insecurity. In addition, it can identify levels of risk capturing multiple facets of the underlying issue of poverty to screen more comprehensively.

Disclosure

L.E.Egede: None. R.J.Walker: None.

Funding

American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede) , the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)
597-P: Diabetes Stigma, Sociodemographics, and Psychosocial Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study
Authors: EITEL KELSEY B. , ROBERTS ALISSA J. , DAGOSTINO RALPH , BELL RONNY A. , BELLATORRE ANNA , BARRETT CATHERINE E. , CRISTELLO ANGELICA , DABELEA DANA , DOLAN LAWRENCE M. , JENSEN ELIZABETH T. , LIESE ANGELA D. , MARCOVINA SANTICA M. , MAYER-DAVIS ELIZABETH J. , REYNOLDS KRISTI , PIHOKER CATHERINE
Published: May 2022

We examined the association between diabetes stigma, sociodemographic and psychosocial variables in AYAs with type 1 (T1D) and type 2 diabetes (T2D) in the SEARCH for Diabetes in Youth study, 2016-2019. A 5-question survey assessed frequency of perceived stigma experience, from which we created a total stigma score. We used multivariable modeling to examine these associations adjusting for sex, race/ethnicity, age, clinic site, diabetes duration, education level, health insurance type, treatment regimen, and HbA1c levels. Analyses were stratified by diabetes type. Of the 1,6AYAs who completed the stigma survey, 78% had T1D, 56% were female, and 48% were non-Hispanic White. Mean (SD) age at study visit was 21.7 (5.1) years (range - 24.9 years) . Mean (SD) HbA1c level was 9.2% (2.3) . Participants with T1D with lower household income had higher stigma scores compared to those with higher household income (p=0.03) . Among AYAs with T1D or T2D, higher stigma score was associated with food insecurity (p< 0.01) , disordered eating behaviors (p < 0.01) , depressive symptoms (p < 0.01) , and decreased AYA (p<0.01) and diabetes quality of life (p < 0.01) scores. Diabetes stigma is associated with food insecurity and decreased psychosocial functioning and therefore is important to address in providing comprehensive diabetes care.

Disclosure

K.B.Eitel: None. E.T.Jensen: Consultant; Regeneron Pharmaceuticals Inc. A.D.Liese: None. S.M.Marcovina: None. E.J.Mayer-davis: None. K.Reynolds: Research Support; Amgen Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation. C.Pihoker: None. A.J.Roberts: None. R.Dagostino: Consultant; Aetion, Inc., AstraZeneca, Biogen, Bristol-Myers Squibb Company, Daiichi Sankyo, Merck & Co., Inc. R.A.Bell: None. A.Bellatorre: None. C.E.Barrett: None. A.Cristello: None. D.Dabelea: None. L.M.Dolan: None.

Funding

The SEARCH for Diabetes in Youth Cohort Study (1R01DK127208-01, 1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention.
6-OR: Vascular Endothelial ROCK2 Deficiency Promotes Browning and Burning of White Adipose Tissue
Authors: TAKEDA YUSUKE , MATOBA KEIICHIRO , UKICHI RIKAKO , SEKIGUCHI KENSUKE , NAGAI YOSUKE , KANAZAWA YASUSHI , UTSUNOMIYA KAZUNORI , NISHIMURA RIMEI
Published: May 2022

The accumulation of visceral fat is associated with multiple coronary risk factors such as glucose intolerance, dyslipidemia, and hypertension. We have previously demonstrated that Rho/Rho-associated protein kinase (ROCK) signaling is activated in animal models of diabetes and is involved in the pathogenesis of vascular complications. Specifically, ROCK is implicated in the molecular basis of inflammation- and ischemia-induced tissue damage through the actions on NF-κB dynamics. These findings support the hypothesis that ROCK signaling could be one of the important therapeutic targets for preventing cardiorenal events. However, isoform-specific roles of ROCKs have not been clarified yet. In this study, we aimed to determine the tissue-intrinsic roles of ROCK2 in the setting of obesity. To this end, we generated vascular endothelium-specific ROCK2 knockout mice (ER2KO) by crossing ROCK2 floxed mice with VE-Cadherin-Cre mice. ER2KO mice were fertile and had the same lifespan as wild type mice. Notably, ER2KO gained weight at a slower rate than wild type mice under high-fat diet feeding. Fat composition, as assessed by magnetic resonance imaging, was significantly lower in ER2KO, even though ER2KO displayed increased food intake. The gene expression analysis revealed increased expression of PPARα, a browning-inducing factor, and its downstream components, CIDEA, IL-4, and IL-10, in white adipose tissue obtained from ER2KO mice. ER2KO mice also showed an elevation in body temperature after fasting, suggesting that endothelial ROCK2 may negatively regulate fat browning.

In summary, vascular endothelial ROCK2 negatively regulates fat accumulation through the mechanism of browning inhibition.

Disclosure

Y. Takeda: None. K. Matoba: None. R. Ukichi: None. Y. Nagai: None. Y. Kanazawa: None. K. Utsunomiya: None. R. Nishimura: Speaker's Bureau; Abbott Diabetes, Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Merck & Co., Inc., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi, Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Terumo Corporation.

Funding

a Grant-in-Aid for Scientific Research from Japan Society for the Promotion of Science, the MSD Life Science Foundation, the Takeda Science Foundation, the Suzuken Memorial Foundation, Sanofi KK, Tanabe Pharma, and Takeda Pharmaceutical., Kazunori Utsunomiya has received research support from Terumo, Novo Nordisk Pharma, Taisho Pharmaceutical, Böehringer Ingelheim, Kyowa Hakko Kirin, Sumitomo Dainippon Pharma, and OPharmaceutical as, Rimei Nishimura has received speaker honoraria from Astellas Pharma, Nippon Boehringer Ingelheim, Eli Lilly Japan KK, Kissei Pharmaceutical, Medtronic Japan, MSD, Novartis Pharma KK, Novo Nordisk Phar.
60-OR: High Prevalence of Multiorgan Steatosis and Fibroinflammation, Identified by Multiparametric Magnetic Resonance Imaging, in People with Type 2 Diabetes
Authors: EICHERT NICOLE , GIBBONS KARYNA , HAMID AZLINDA , RAMKHELAWON RAJESHWAR , WOOLGAR VIRGINIA E. , SURIANO ROBERT , THOMAIDES-BREARS HELENA B. , BANERJEE RAJARSHI , KEMP GRAHAM , ALI SARAH , THANABALASINGHAM GAYA , CUTHBERTSON DANIEL
Published: May 2022

Type 2 diabetes (T2D) is a multi-system disease characterised by a high prevalence of co-morbidities and micro- and macro-vascular complications. The aim of this study was to provide --comprehensive assessment of multi-organ health and pre-clinical detection of diabetes-related organ damage with a single, non-contrast MRI scan. We recruited 138 adults with T2D (median 62 yrs, 60 % male; BMI 31 kg/m2, 92 % on metformin [NCT04114682]) . MRI data were acquired to derive organ-specific measures of size, fat deposition, fibroinflammation, body composition and aortic distensibility (CoverScan®, Perspectum Ltd.) . Reference values of MRI metrics were based on 92 healthy volunteers and published literature. Statistical significance of co-prevalence was assessed by simulation assuming that values were independently binomially distributed. There was a high prevalence of abnormality in individual organs (Figure, left) . Prevalence of low skeletal muscle index and elevated pancreatic fat were associated with T2D duration. There was further evidence of co-prevalence of organ abnormalities (Figure right; 86 % with at least 2 organs affected) . Aortic stiffness was frequently associated with organ steatosis. MRI assessment can enrich the current blunt assessment of multi-organ abnormalities in T2D to inform earlier intervention and treatments.

Disclosure

N.Eichert: Employee; Perspectum Ltd. S.Ali: Other Relationship; NICE committee for diabetes. G.Thanabalasingham: Speaker's Bureau; Boehringer Ingelheim International GmbH. D.Cuthbertson: Other Relationship; AstraZeneca, Novo Nordisk. K.Gibbons: None. A.Hamid: None. R.Ramkhelawon: Other Relationship; NICE committee. V.E.Woolgar: None. R.Suriano: None. H.B.Thomaides-brears: Employee; Perspectum Ltd, Stock/Shareholder; Perspectum Ltd. R.Banerjee: Employee; Perspectum Ltd., Other Relationship; Perspectum Ltd., Stock/Shareholder; Perspectum Ltd. G.Kemp: None.

Funding

Innovate UK (Digital Health Technology Catalyst scheme) ; Perspectum Ltd.
613-P: Rural Caregiver Perceptions of an Occupation-Based Coaching Telehealth Intervention to Improve Child Diabetes Management and Quality of Life
Authors: JEWELL VANESSA D. , FUNK KATIE J. , CURRIE ALEXIS , SHIN JULIA , KNEZEVICH EMILY , VALDEZ ANDREA D. , BUNSNESS MAGGIE
Published: May 2022

Caregiver diabetes training and psychosocial support after a child’s type 1 diabetes diagnosis is critical for successful diabetes management and family quality of life. Disruption to family routines and increased stress are frequently reported after a child’s type 1 diabetes diagnosis. However, limited services exist that blend both caregiver medical training and psychosocial support. After the implementation of a 12-week, novel occupational therapy coaching telehealth intervention designed to promote rural caregiver independence with their child’s type 1 diabetes management and improve caregiver psychosocial well-being, we interviewed rural caregivers to explore their perceived quality of life. Utilizing a phenomenological design, 8 caregivers completed a semi-structured interview. Zoom interviews were recorded, transcribed verbatim, and coded using a phenomenological analysis. Caregiver ages ranged from 34-50 years, 86% were married, and all held a minimum of an associate degree. Their children were diagnosed with type 1 diabetes at 12 months to 9 years and time since diagnosis ranged from months to 8.5 years. Three distinct themes emerged related to caregivers’ experiences after diagnosis: occupational deprivation and decreased well-being; longing for connection with social supports; and desire for knowledgeable, relatable, and accessible providers. Two themes emerged related to after receipt of the telehealth coaching intervention: satisfaction with diabetes management and psychosocial support and hope for childhood normalcy. Overall, the caregivers reported satisfaction with the intervention as it provided validation of their lived experience of raising a child with diabetes in a rural community. The caregivers also reported a sense of hope that their children can successfully participate in important everyday activities, which ultimately improved the caregivers’ quality of life.

Disclosure

V.D.Jewell: Research Support; Dexcom, Inc. K.J.Funk: None. A.Currie: None. J.Shin: Research Support; Dexcom, Inc. E.Knezevich: Research Support; Dexcom, Inc. A.D.Valdez: None. M.Bunsness: None.

Funding

Creighton University Health Science Strategic Faculty Investment Fund
617-P: Ten Years of the National Diabetes Prevention Program: Organizational Strategies to Adjust Program Delivery due to the COVID-Pandemic
Authors: BELL MIRIAM , ELY ELIZABETH
Published: May 2022

The National Diabetes Prevention Program (National DPP) is a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay onset of type 2 diabetes. As a result of the COVID-public health emergency (PHE) declared in March 2020, in April 2021, the National DPP distributed a brief survey to approximately 2,000 CDC-recognized organizations to assess how they adjusted program delivery, including actions and strategies taken to navigate delivery during the PHE. 412 responses were received between April and June 2021. 148 paused delivery and 62 remained paused at the time of response. Of those that paused, 1 (74%) reported applying strategies such as phone calls, emails, and texts to keep in contact with participants. Of these, 64% reported they had resumed or restarted their cohorts at the time of response. When asked what influenced the decision to pause cohorts, 63% of organizations that normally deliver in-person, paused due to participant hesitancy toward use of or lack of access to technology. Of the 360 organizations that normally use in-person delivery, 260 reported switching to virtual delivery during the PHE. Of these, more than half reported difficulties in making that transition, mainly due to participant hesitancy to use or lack of access to technology. When asked if any support was provided to participants outside the scope of the LCP, 61% responded no. Of the 39% that did provide support, 84% of responding organizations indicated providing COVID-related support to participants; these were mainly organizations classified as Hospitals/Healthcare Systems/Medical Groups/Physician Practices. Many CDC-recognized organizations may have paused delivery at some point during the PHE, but based on these survey results, plans for future delivery remains strong. With the help of technology and strategies employed, 225 of the 412 organizations that responded indicated they would be starting new cohorts during the PHE.

Disclosure

M.Bell: n/a. E.Ely: None.
621-P: Disrupted Sleep in a Diverse Sample of Young Adults with Type 1 Diabetes (T1D)
Authors: CARREON SAMANTHA A. , MINARD CHARLES G. , DESAI KISHAN R. , LEVY WENDY , LYONS SARAH , DURAN BRENDA , STREISAND RANDI , TANG TRICIA S. , MCKAY SIRIPOOM , ANDERSON BARBARA , DEVARAJ SRIDEVI , BUTLER ASHLEY , HILLIARD MARISA E.
Published: May 2022

Introduction: T1D management, age-related stressors and the COVID-pandemic may impair sleep for young adults with T1D. Disparities in A1c and exposure to life stressors may contribute to poorer sleep among people from minoritized racial/ethnic groups. We aimed to describe sleep, correlations with A1c, and sleep patterns across racial/ethnic groups in young adults with T1D during the pandemic.

Methods: Young adults with T1D (n=37, M age=20.2±1.6 yrs, 57% female, M A1c=8.9±2.4%) completed an adapted Pittsburgh Sleep Quality Index and 1 sleep-related question from a COVID-questionnaire at baseline of a behavioral trial.

Results Overall, 41% endorsed worse sleep during the pandemic, which was correlated with poorer sleep quality (r=-.69, p<.001) and shorter sleep duration (r=-.35, p=.04) . Higher A1c was linked with less frequent T1D management-related sleep disruptions (r=-.44, p=.007) . There were no significant differences in sleep variables among racial/ethnic groups. See Table for sleep descriptions for each racial/ethnic group.

Conclusions: Young adults with T1D experienced disrupted sleep, worsened by the pandemic. Clinicians should counsel patients about optimizing sleep and overnight diabetes management, especially those with higher A1c. While small sizes reduced power to detect group differences, initial patterns suggest a need for future research examining disparities in sleep for young adults with T1D.

Disclosure

S.A.Carreon: None. B.Anderson: None. S.Devaraj: None. A.Butler: None. M.E.Hilliard: None. C.G.Minard: None. K.R.Desai: None. W.Levy: None. S.Lyons: None. B.Duran: None. R.Streisand: None. T.S.Tang: None. S.Mckay: None.

Funding

NIDDK RDK119246 (PI Hilliard) ; NIH/NIDDK Research Supplement to Promote Diversity in Health-Related Research (3R01DK119246-03S1, PI: Hilliard, Mentee: Carreon)
627-P: Comparison of Attitudes of Physcians, Parents, and People with Diabetes towards Digitalization and New Technologies in Diabetes
Authors: KULZER BERNHARD , HERMANNS NORBERT , EHRMANN DOMINIC , ROOS TIMM , HEINEMANN LUTZ
Published: May 2022

Aims: Are there differences in the attitudes of physicians, parents and people with diabetes (PwD) towards digitalization and new technologies in diabetes and how do these change from 20- 2021?

Methods: In 20 and 2021, PwD and diabetologists in Germany were asked via online surveys about their attitudes and assessment of digitalization and new technologies in diabetology. 2019: 324 diabetologists (43% female, average age 52.2 years) and 3.427 PwD (47.7% female, 56.6% type 1 diabetes (T1D) , 25.5% type 2 diabetes (T2D) , 8.1% parents of children with diabetes; Ø 49.2±19.3 years) . 2021: 3diabetologists (48% female, average age 53.7 years) and 2.417 PwD (47.5% female, 57.8% type 1 diabetes (T1D) , 20.7% type 2 diabetes (T2D) , 19.0% parents of children with diabetes; Ø 47.7 years) .

Results: Parents (T1D) (2019: 89.5% positive; 2021: 91.7%) PwD-TD1 (2019: 85.3%; 2021: 91.1%) have more positive attitudes towards digitalization than PwD-T2D (2019: 73.3%; 2021: 87.1%) or diabetologists (2019: 75.8%; 2021: 81.9%) . Within 2 years, positive attitudes increased in all 4 groups. There was a great agreement between all 4 groups regarding the most important topics for the future of diabetology: AID systems were in first place in the ranking, followed by interoperability of systems, software for analysing glucose data and artificial intelligence.

Conclusions: PwD have very positive attitudes towards digitalization and new technologies in diabetes with only very small differences between TD1 and TD2. These are significantly higher than those of physicians. All groups have very high expectations for the further development of AID systems in particular.

Disclosure

B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care. N.Hermanns: Advisory Panel; Abbott Diabetes, Research Support; Becton, Dickinson and Company, Roche Diagnostics, Speaker's Bureau; Berlin-Chemie AG, Novo Nordisk, Sanofi. D.Ehrmann: Advisory Panel; Dexcom, Inc., Consultant; mySugr, Roche Diabetes Care, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. L.Heinemann: Board Member; Lifecare, Inc., Consultant; Becton, Dickinson and Company, Roche Diabetes Care, Stock/Shareholder; Profil Institut für Stoffwechselforschung GmbH, Science Consulting in Diabetes GmbH.
632-P: Youth with T1D and High Social Risk Enrolled in an Intensive Community-Based Intervention: Two-Region Comparison of Risk
Authors: WAGNER DAVID V. , WONG JENISE C. , REED ALISON , YGLECIAS LOREN , OSPINA ANDREA BONILLA , NARANJO DIANA , NOYA CAROLINA E. , VIANA JULIA , JENISCH CELESTE , CRUZ CRISTIAN , HARRIS MICHAEL A.
Published: May 2022

Objective: Novel Interventions in Children’s Healthcare (NICH) , a program for youth with T1D who experience high rates of avoidable health problems (e.g., DKA) , has been newly implemented in a second region. This study examines how youth with T1D referred for combined health problems and social risk compare to similarly referred youth in another region.

Methods: Participants (Oregon=51; Bay Area=24) were referred by medical providers due to avoidable ED visits, hospitalizations and/or chronically elevated A1C values. Caregivers reported on 15 social risks (e.g., housing insecurity, domestic violence) .

Results: Social risk prevalence was high at both sites, with an average of 7.6 in Oregon and 5.6 risks endorsed in the Bay Area. Oregon youth and their parents were significantly (p<.05) more likely to have a mental health diagnosis and domestic violence exposure, while Bay Area youth were significantly more likely to identify as Black or Hispanic, and to have experienced parental incarceration.

Conclusions: While there are some differences in social risk distribution across sites, the rate of risk is extremely high across sites, highlighting the importance of interventions specifically designed to target social factors for this population. Likewise, rethinking standard diabetes care for this subgroup is warranted given the impact of social factors on diabetes outcomes.

Disclosure

D.V.Wagner: None. C.Cruz: None. M.A.Harris: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. L.Yglecias: None. A.Bonilla ospina: None. D.Naranjo: None. C.E.Noya: None. J.Viana: None. C.Jenisch: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
639-P: Readiness to Change in Rural Adults at High Risk for Diabetes
Authors: WAGNER KATHERINE A. , SAMRA HAIFA ABOU , FERNANDES JESSIE , PUUMALA SUSAN
Published: May 2022

Despite evidence that the Montana Diabetes Prevention Program halts the progression from prediabetes to type II diabetes, individuals who live in rural areas can face unique challenges associated with their rurality. The purpose of this study was to examine the relationships between readiness to change and attrition rates, blood glucose, hemoglobin A1C, and weight among a sample of 38 rural dwellers enrolled in one site of the Montana Diabetes Prevention Program. Based on a concept analysis for the purposes of this study, readiness to change measured behavioral commitment and motivation to engage in cognitions and tasks associated with sustainable behavior change leading to an expected outcome. Readiness to change scores, demographic information, and clinical variables were measured at baseline and six-months into the program utilizing a validated readiness to change instrument. A bivariate analysis and logistic regression were used to analyze attrition and outcomes data. Results indicated that the covariates of income and geography significantly modified the relationship between readiness to change and attrition (Pr > ChiSq = 0.04) , but did not appear to be related to clinical outcomes. Based on these results, measurement of readiness to change should be considered an important baseline measure at intake in the Montana Diabetes Prevention Program to better understand the target population for the program and support participant engagement.

Disclosure

K.A.Wagner: None. H.Abou samra: None. J.Fernandes: None. S.Puumala: None.
67-OR: Measures of Social Determinants of Health and Risk of Incident Type 2 Diabetes
Authors: RAMM KATE , JACKSON NICHOLAS , CHUNG UN YOUNG , DURU O. KENRIK , SHEDD KELLY , SOETENGA SAMANTHA , LOEB TAMRA B. , ELASHOFF DAVID , HAMILTON ALISON B. , MANGIONE CAROL , MOIN TANNAZ
Published: May 2022

Introduction: Social determinants of health (SDOH) impact well-being. We tested the association between incident diabetes risk and SDOH using 2 measures, the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) .

Methods: We examined 2015-2021 medical and claims data from the UC Data Warehouse for overweight/obese adults (age>18 yrs; BMI>25 kg/m2; >23 if Asian) . We ran 4 cox proportional hazards regression models with an outcome variable of incident diabetes; 1) base model with age, sex, race, ethnicity, income, BMI, prediabetes and comorbidities, 2) base model + ADI, 3) base model + SVI, and 4) base model + ADI and + SVI. Since SDOH indices were missing for ∼17%, we added them using an interaction term with an indicator variable.

Results: Among 36,946 adults, 33,587 (91%) had >1 follow-up assessment. Among these, mean age was 43 yrs, BMI 28 kg/m2, ADI 3.9 (SD 2.4) , SVI 0.34 (SD 0.24) ; 14% had prediabetes. Over 4.6 (SD 3.3) mean follow-up yrs, 715 (2%) developed diabetes. In the base model, incident diabetes risk significantly increased with each additional yr of age (HR 1.03) , unit BMI (HR 1.09) , prediabetes (HR 2.2) , and in Asian (HR 1.5) or other/multi-racial groups (HR 1.6) compared to Whites; risk decreased with hyperlipidemia (HR 0.72) . These associations were significant in all SDOH models (base +ADI, +SVI or +both) . In our SDOH models, incident diabetes risk was not associated with the degree of area deprivation or social vulnerability. However, diabetes risk decreased if ADI estimates (HR 0.54 95%CI 0.38, 0.77) or SVI estimates (HR 0.48 95%CI 0.36, 0.63) were present (vs. undetermined/unknown) . In the SDOH model with both ADI/SVI, diabetes risk decreased if SVI was present (HR 0.49 95%CI 0.34, 0.70) .

Conclusion: In our real-world cohort of overweight/obese adults, the degree of area deprivation or social vulnerability was not associated with risk of incident diabetes when traditional risk factors were available. More studies of SDOH measures are needed to inform national diabetes prevention efforts.

Disclosure

K.Ramm: None. C.Mangione: n/a. T.Moin: None. N.Jackson: None. U.Chung: None. O.Duru: None. K.Shedd: None. S.Soetenga: None. T.B.Loeb: None. D.Elashoff: None. A.B.Hamilton: None.

Funding

NIH/NIDDK 1R01DK124503
673-P: Successful Use of Dexcom G6 in Neonate with SGA and Chromosome 6q24-Related Transient Neonatal Diabetes Mellitus
Authors: LOS EVAN A. , ARTZ EVELYN , SAUNDERS CASSANDRA , WISE KAITLYN , WELSH JOHN
Published: May 2022

Blood glucose in neonates with diabetes is variable due to frequent feeding, inexact exogenous insulin dosing and dynamic physiology. Rapid glucose fluctuation makes continuous glucose monitoring (CGM) ideal. We describe the successful use of CGM in an infant with small for gestational age (SGA) and chromosome 6q24-related transient neonatal diabetes mellitus, diagnosed by methylation study. A term male weighing 2650g (5th%) was born following uncomplicated pregnancy and delivery. Glucose checked per SGA-protocol revealed rising glucoses from initial 78 to >300 mg/dL over 24 hours. Hyperglycemia managed with insulin drip until transitioned to subcutaneous dilute regular insulin (U-concentration) administered q6 hours (every other feed) . Trial of sulfonylurea titrated to maximum dose was ineffective.Initially glucoses checked hourly while on insulin drip and transitioned to every 3 hours once on subcutaneous insulin. Dexcom G6 placed in lateral thigh without incident on DOL and impermeable dressing applied to prevent soiling.CGM values were generally within 10% of heelstick POC values though specific MARD was not calculated. In the 7 days prior to CGM placement, there were POC glucoses <80 mg/dL; in the 7 days after placement, there were none. Anecdotally, numerous times the CGM trend provided advanced notice of impending hypoglycemia and was able to be treated proactively (treatment decisions based on confirmatory heelstick) . The subject was discharged home on DOL 20.In followup, insulin degledec 0.5 unit/day was added and total prandial insulin requirements varied from 0-1 unit per day (total daily insulin dose approx. 0.1-0.3 units/kg/day) . By age 2.5 months weight was 6.1 kg (38th%) . CGM ambulatory glucose profile demonstrated mean glucose 185 mg/dL, <70 mg/dL <1%, 71-250 88%, >250 11%.

In summary, Dexcom G6 CGM was successfully used in an infant with SGA and neonatal diabetes to optimize glucose control while minimizing hypoglycemia risk.

Disclosure

E.A. Los: Advisory Panel; Medtronic. K. Wise: None. J. Welsh: Employee; Dexcom, Inc.
675-P: DiabetesWise.org: An Innovative and Equitable Approach to Promote Diabetes Device Uptake
Authors: WONG JESSIE J. , HANES SARAH , NELMES SIERRA , HOOD KOREY K.
Published: May 2022

Aim: To identify correlates of device uptake in people with insulin-requiring diabetes before and after interacting with DiabetesWise.org, a free, unbranded online resource.

Methods: The sample included 458 participants (Mage=37.1, SD=9.73; 66% female; 81% type 1) with minimal diabetes device use at enrollment. Participants used DiabetesWise.org, had their activity tracked, and completed online surveys. Chi-square and t-tests evaluated factors associated with past device use and new device (CGM/pump) uptake and prescriptions at 1- and 3-months post-use.

Results: Less than half (41%) the sample reported past CGM use. Past CGM use was associated with being female, younger age, type 1 (vs. type 2) diabetes, and receiving care in a large/academic medical center. By 1 month, 11% reported new prescriptions and 5% of participants reported new device uptake (all CGM starts) , which was associated with younger age. By 3 months, 16% reported new uptake and 20% reported new prescriptions (93% for CGM) , which were more common among those with type 1 diabetes.

Conclusions: DiabetesWise.org promotes diabetes device uptake and starts are unhindered by the personal, medical, or system-level barriers to prior device use. One in five users reported new prescriptions/uptake of diabetes devices. These findings support DiabetesWise.org as an effective avenue to promote device access and equity.

Disclosure

J.J.Wong: None. S.Hanes: None. S.Nelmes: None. K.K.Hood: Consultant; Cecelia Health, Havas Health, Insulet Corporation, LifeScan Diabetes Institute.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust; NIH K23-DK121771
683-P: TBR (Time Below Range) in Routine Clinical Practice: A Retrospective Analysis of Routine CGM in Outpatient Care
Authors: CHAWLA PURVI M. , CHAWLA MANOJ S.
Published: May 2022

Background: Patients with diabetes need monitoring to achieve good glucose control and avoid complications . Assessing the time in range (TIR) metrics is a novel way to identify glycaemic variability (GV) , Time above range (TAR) , Time in Range (TIR) and Time below range (TBR) .

Aim: To identify TBR- hypoglycemia (< 70 mg/dl) in routine clinical practice through continuous glucose monitoring (CGM)

Methodology: This was a single centre analysis of Flash Glucose Monitoring (FGM libre pro) used as a means of CGM in type 1 & 2 DM patients as part of routine care in a specialty clinic over last one year. 227 adult participants were categorized based on their Hba1c levels. Time In Range metrics in different groups was determined. Statistical analysis was done to calculate the significance by p value.

Results: 17.6 % of participants had good glycemic control (HbA1c below 7 %) , 22.5 % had HbA1c levels of 7 to 8 %, 33.5 % had HbA1c within 8 to 9 %, and 26% had poor glycemic control with HbA1c above 9 %. Patients with HbA1c levels below 7% spent maximum time below range compared with those in other groups (p= 0.0016) . Those having HbA1c levels of 7 to 8 (p= 1.00) and 8 to 9 (p= 0.0008) spent nearly % of their time below range . No statistical differences in TBR was found between male and female participants and based on treatment regimen. 77.5 % of patients having A1C levels below 7 %, 54 % of patients with A1C levels between 7 to 8 %, 61.8 % patients with A1C levels between 8 to 9% and 40.6 % of patients with A1C levels above 9 %, spent more than 5 % of their time below range.

Conclusion: Our study found that although individuals with HbA1c levels < 7 % were at maximum risk of hypoglycemia spending significantly more than 5 % of their time below range, patients with poor glycemic control also spent a large amount of time below range. Thus patients with DM are at an increased risk of hypoglycemia regardless of their levels of glycemic control and treatment regimen, and CGM and TIR evaluation should be used routinely.

Disclosure

P.M.Chawla: Speaker’s Bureau; Biocon, Boehringer Ingelheim International GmbH, Eris Lifesciences Ltd., Novo Nordisk, Sanofi. M.S.Chawla: Speaker’s Bureau; Biocon, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi.
69-LB: Targeting Equity in Type 1 Diabetes (T1D) Technology—Effect of Practice Transformations on Provider Prescribing Patterns of Continuous Glucose Monitors (CGM)
Authors: MATHIAS PRIYANKA M. , MAHALI LAKSHMI PRIYANKA , AGARWAL SHIVANI
Published: May 2022

Background: CGM use is associated with improved outcomes in T1D, but racial-ethnic disparities in prescribing exist. We examined whether diabetes practice transformations could change prescribing behaviors to improve CGM prescription rates.

Methods: From January 2019 to December 2021, our diabetes center underwent a practice transformation targeted towards equity that included hiring clinicians to develop a specialty T1D clinic; training support staff to place trial devices at the point of care; improving prescribing workflows; and educating providers on CGM and inequity in practices. To examine effect, we collected monthly aggregate data from the electronic medical record and measured CGM prescription rates. We performed linear regression to examine change in prescriptions over time.

Results: We included 1,357 adults with T1D [mean age 38 years (±18) , 45% Hispanic (n=612) , 30% non-Hispanic Black (n=406) , 12% non-Hispanic White (n=164) ; and 74% publicly insured]. Over the practice transformation period, CGM prescription rates quadrupled (p<0.001) with the largest improvement in non-Hispanic Black and Hispanic groups (Figure 1) .

Conclusions: Diabetes practice transformations can change prescribing behaviors to improve equity in CGM. Continued focus is needed on upstream interventions that effect downstream determinants of CGM use.

Disclosure

P. M. Mathias: None. L. Mahali: None. S. Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc.

Funding

Helmsley Charitable Trust (T1D Exchange Quality Improvement Collaborative)
694-P: Effects of Acceptance and Commitment Therapy on Self-Management in People with Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis
Authors: WANG MIAOMIAO , CHENG LI , GUO XIAODI , ZHU ZHENGRONG
Published: May 2022

Background: Patients with type 2 diabetes mellitus always face various challenges of self-management which leads to disproportionately high rates of psychological problems. Acceptance and commitment therapy has the potential to enhance psychological well-being and promote self-management engagement.

Objectives: This review aimed to provide a comprehensive examination of the effectiveness of ACT among patients with T2DM and identify the key characteristics of effective interventions. Design: Systematic review and meta-analysis

Methods: Nine English and Chinese databases were searched to identify the eligible randomized controlled trails which investigated the effectiveness of ACT from inception to November 2021. The eligibility of studies, quality appraisal, and data extraction were performed by two reviewers independently. The risk of bias and the quality of evidence were assessed respectively. Mata-analysis were performed using the Review Manager 5.3.

Results: A total of ten studies with 712 participants were included in this systematic review. Acceptance and commitment therapy was significantly effective for improving the patients’ glycemic control (MD: -0.95; 95%CI: -1.38 to -0.52; P<0.001; I2=62%) , acceptance for diabetes (MD: 7.80; 95%CI: 6.to 9.49; P<0.001; I2=0%) , self-efficacy (SMD: 1.00; 95%CI: 0.80 to 1.21; P<0.001; I2=14%) and anxiety (SMD: -1.15; 95%CI: -1.97 to -0.33; P=0.006; I2=90%) , but had no beneficial impact on self-care behaviors, distress, depression and psychological resilience. The certainty of evidence for outcomes were assessed as low to very low.

Conclusion: ACT may be helpful to improve patients’ psychology well-being and self-management for patients with T2DM. More rigorous studies with longer follow-up periods are warranted in view of the inconclusive findings and limited quality of evidence.

Disclosure

M.Wang: None. L.Cheng: None. X.Guo: None. Z.Zhu: None.
700-P: Use of Continuous Glucose Monitoring Does Not Alter Hypoglycemic Awareness in Patients with Type 2 Diabetes Mellitus
Authors: MEHFOOZ AYESHA , LEE YEE LIONG , WANG QI , CHOW LISA S.
Published: May 2022

Background: There is limited evidence of continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D) . CGM use improves HbA1c and quality of life, however scant evidence exists on the effect of CGM use on hypoglycemia awareness in patients with T2D. Selecting patients with T2D at high risk and low risk for hypoglycemia, we hypothesized that CGM use would improve hypoglycemia awareness.

Methods: We conducted a 16 week, single center, randomized study on patients [n=40, 50% females, mean (SD) age 59 years (12.5) , BMI 34.kg/m2 (8.1) ] with T2D [screening HbA1c 7.6% (1.2) ] who were deemed to be either high risk (n=22) or low risk (n=18) for hypoglycemia over 5 years using our previously established scoring system. Each participant wore 2 CGM sensors. Within each risk category, participants were randomized to wearing either 1 unblinded+1 blinded sensor (Freestyle Libre/Freestyle Libre Pro) or 2 blinded sensors (2 Freestyle Libre Pro) . Every 2 weeks was an in-person visit for CGM replacement. Clarke and Gold questionnaires were performed at the screening visit (week 0) , visit 4 (week 8) and visit 8 (week 16) . Participants in the unblinded CGM group were instructed to use the CGM as they wished. Participants in the blinded CGM group were instructed to continue with their usual finger stick program.

Result: At baseline, there were no differences in the Gold or Clark questionnaires between participants at high or low risk for hypoglycemia over 5 years. At end-intervention, no differences were noted in the Gold or Clark questionnaires regardless of CGM assignment or baseline hypoglycemia risk category. The trajectory of Gold or Clark scores over the study were also not significantly different between groups regardless of CGM assignment or baseline hypoglycemia risk category.

Conclusion: In patients with T2D, the use of an unblinded CGM did not affect the awareness of hypoglycemia, even in patients at high risk for hypoglycemia, as assessed by Gold and Clark scores.

Disclosure

A.Mehfooz: None. Y.Lee: None. Q.Wang: None. L.S.Chow: Other Relationship; Dexcom, Inc.
714-P: Greater Improvement in Insulin Sensitivity Per Unit Weight Loss with Tirzepatide Compared with Selective GLP-1 Receptor Agonism
Authors: MATHER KIEREN J. , MARI ANDREA , LI JING , HEISE TIM , DE VRIES J. HANS , URVA SHWETA , COSKUN TAMER , MILICEVIC ZVONKO , HAUPT AXEL , THOMAS MELISSA K.
Published: May 2022

Tirzepatide (TZP) , a novel GIP-GLP-1 dual agonist, improved fasting measures of insulin sensitivity partially attributable to weight loss in Phase 2 studies. Studies in mice demonstrated that GIP receptor agonism with TZP improved insulin sensitivity independent of weight loss. To further evaluate insulin-sensitizing actions of TZP, we measured insulin sensitivity with hyperinsulinemic euglycemic clamps (M-value) in a 28-week double-blind randomized controlled trial comparing effects of TZP 15mg with placebo or semaglutide 1mg (SEMA) , a selective GLP-1RA, all subcutaneous QW. Linear regression was used to compare relationships of change in M-value versus change in weight across treatment groups. Change in M-value was related to absolute change and % change in weight (Figure) . Slopes of linear relationships with absolute and % weight change differed between TZP and SEMA (absolute change: p=0.015; % change: p=0.03) . Larger negative slopes were observed for TZP compared with SEMA on change in M-value related to absolute change and to % change in weight. These results suggest that TZP may provide greater improvement in insulin sensitivity than a selective GLP-1RA per unit weight loss, most evident in subjects with greater weight loss.

Disclosure

K.J.Mather: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M.K.Thomas: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A.Mari: Consultant; Lilly, Research Support; Lilly. J.Li: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. T.Heise: Advisory Panel; Novo Nordisk A/S, Research Support; ADOCIA, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Crinetics Pharmaceuticals, Inc., Eli Lilly and Company, Gan & Lee Pharmaceuticals, Genova, Nestlé, Neuraly Inc., Novo Nordisk A/S, Sanofi, Zealand Pharma A/S, Speaker's Bureau; Eli Lilly and Company, Gan & Lee Pharmaceuticals, Novo Nordisk A/S. J.De vries: Advisory Panel; ADOCIA, Novo Nordisk A/S, Zealand Pharma A/S, Speaker's Bureau; Novo Nordisk A/S. S.Urva: Employee; Eli Lilly and Company. T.Coskun: Employee; Eli Lilly and Company. Z.Milicevic: Employee; Eli Lilly and Company. A.Haupt: Employee; Lilly, Stock/Shareholder; Lilly.

Funding

Eli Lilly and Company