bluuebunny/crossref_metadata_2025 huggingface dataset:
518-P: Advanced Glycation End Products Impair HDL Particles' Function of Cholesterol Efflux Capacity in Newly Diagnosed Type 1 Diabetes (InLipoDiab1 Study)
Authors: URUSKA ALEKSANDRA , GRZELKA-WOZNIAK AGATA , ROHATGI ANAND , FLOTYNSKA JUSTYNA , ZOZULINSKA-ZIOLKIEWICZ DOROTA
Published: June 2024

Introduction: Type 1 diabetes (T1DM) is characterized by high serum HDL, which does not translate into a better cardiovascular (CVD) prognosis. It is probably related to the impaired function of HDL particles. One of the main functions of HDL is the anti-atherosclerotic role related to reverse cholesterol transport from macrophages in arterial walls (cholesterol efflux capacity-CEC). CEC is a proven CVD risk factor. The dysfunction of HDL particles may be the result of glycation. Metabolic memory phenomena revealed that glycation status at the onset of T1DM may be crucial for future prognosis. Objective: To evaluate the influence of advanced glycation end products (AGE) at the onset of T1DM on HDL CEC in adults with newly diagnosed T1DM.

Methods: The analysis comprised 164 patients (110 men, 67%) with newly diagnosed T1DM confirmed by the presence of autoantibodies, recruited to the Insulin Therapy and Lipoproteins' Profile in Type 1 Diabetes (InLipoDiab1) study. CEC was assessed by measuring the efflux of radiolabelled cholesterol from murine J774 macrophages to apolipoprotein B-depleted serum. AGE in the skin was measured by autofluorescence using an AGE Reader. The endpoint was the assessment of CEC at one year after diagnosis.

Results: After one year of observation, a significant negative correlation was demonstrated between AGE at onset and CEC at one year (Rs=-0.33, p<0.001). Moreover, the multiple linear regression revealed an independent relationship between AGE at onset and HDL function at one year (beta=-0.25, p=0.02), adjusted for age, BMI, and smoking.

Conclusions: The higher glycation expressed as AGE at the onset, the worse CEC, a key anti-atherosclerotic HDL function in adults with T1DM, after a year of T1DM duration. These results support the need for early T1DM diagnosis, preferably before the glycation process develops, to improve the future CVD prognosis of people with T1DM.

Disclosure

A. Uruska: Other Relationship; Ascensia Diabetes Care, Novo Nordisk, Lilly Diabetes, Boehringer-Ingelheim, AstraZeneca. A. Grzelka-Wozniak: Consultant; Novo Nordisk. Other Relationship; Boehringer-Ingelheim, Novo Nordisk, AstraZeneca, Roche Diabetes Care, Sanofi. A. Rohatgi: Research Support; CSL Behring, Quest Diagnostics. Consultant; Johnson & Johnson Medical Devices Companies, Raydel. J. Flotynska: None. D. Zozulinska-Ziolkiewicz: Advisory Panel; Abbott, BIOTON. Speaker's Bureau; Boehringer-Ingelheim, Eli Lilly and Company, Ascensia Diabetes Care, Novo Nordisk, Medtronic, Sanofi, Servier Laboratories. Advisory Panel; Eli Lilly and Company.

Funding

Kosciuszko Foundation, National Agency Academic Exchange (NAWA)
520-P: Plasma Sphingolipid Profiles Correlate with Circulating Lipoproteins and Adiposity
Authors: MANDAL NAWAJES , GRAMBERGS RICHARD , ALIYE FETO NASER , WAN JIM Y. , STENTZ FRANKIE B. , DAGOGO-JACK SAMUEL
Published: June 2024

Objective: Dysregulation of cholesterol and sphingolipids (SPL) is associated with metabolic diseases. This study tested the correlation between plasma sphingolipids and plasma cholesterols (Chl), triglycerides (TG), and adiposity factors in normoglycemic individuals.

Methods: We assayed plasma levels of 58 species of SPL, including ceramides (Cer), monohexosylceramides (MHC), sphingomyelins (SM), from 240 normoglycemic Black and White participants. SPL profiles were analyzed by LC-MS/MS and correlated with plasma profiles of high-density Chl (HDL), low-density Chl (LDL), TG, and total Chl, along with participants’ biometric indicators of adiposity (BMI, waist circumference, total fat mass, total lean mass, and trunk fat mass).

Results: The subjects’ mean age was 43.08 ± 12.02 y from 150 females and 90 males, 129 Black and 111 White, with BMI 29.44 ± 6.23 kg/m2, fasting glucose 91.35 ± 6.91 mg/dl and 2-hr plasma glucose 122.77 ± 26.32. We found the total plasma Cer, MHC, and SM correlated positively with total Chl (r=0.3, p<0.001; r=0.23, p<0.01; and r=0.22, p<0.01) and LDL (r=0.3, p<0.01; r=0.22, p<0.01; and r=0.21, p<0.05). Strong positive correlations were observed with MHC C26:1 and total Chl (r=0.34, p<0.0001) and LDL (r=0.36, p<0.0001), and total and very-long-chain (VLC) SM species with HDL (r=0.2, p<0.05 and r=0.38, p<0.0001). Strong negative correlations were observed with MHC C32:0 and SM C26:0/C26:1 ratio with HDL (r= -0.3, p<0.001 and r= - 0.36, p<0.0001), and in SM C16:0/C18:0 ratio with LDL (r= -0.3, p<0.001). VLC-SM species and SM C16:0/C18:0 ratio correlated negatively with BMI (r=-0.2, p<0.01; r= -0.25, p<0.000), waist circumference (r= -0.2, p<0.01; r= -0.2, P<0,01), and trunk fat mass (r= -0.2, p<0.05; r= -0.2, p<0.05).

Conclusions: This study demonstrates novel associations between adiposity and circulating levels of certain SPL and lipoproteins. Thus, plasma SPL may provide additional insights, beyond routine lipid profile, on metabolic pathophysiology.

Disclosure

N. Mandal: None. R. Grambergs: None. N. Feto: None. J.Y. Wan: None. F.B. Stentz: None. S. Dagogo-Jack: Consultant; Merck Sharp & Dohme Corp., Medtronic, Bayer Inc. Stock/Shareholder; Aerami.

Funding

National Institute of Health (R01 DK128129)
53-PUB: Impact of Diabetes on Perinatal Outcomes in Mexico—A MIDO Early Childhood Analysis
Authors: ALBERTO MARTINEZ-JUAREZ LUIS , GALLARDO-RINCÓN HECTOR , MARTÍNEZ-SILVA GISELA , MONTOYA ALEJANDRA , ÁLVAREZ-HERNÁNDEZ DIEGO-ABELARDO , CAMACHO-MORE DIANA G. , ALBERTO DIAZ-MARTÍNEZ DANIEL , JAVIER MAGOS-VAZQUEZ FRANCISCO , OSWALDO VARGAS EDWIN , MORENO GUADALUPE E. , AGUILAR JUAN P. , SOFÍA DOMIT ANA , TAPIA-CONYER ROBERTO
Published: June 2024

Understanding the impact of gestational and pregestational diabetes on perinatal outcomes is imperative given the high prevalence of type 2 diabetes and obesity in Mexico. This study delves into the effects on pregnancies and neonates in this demographic using MIDO® Early Childhood data, focusing on children under five.

We analyzed data from 5,436 children, comparing perinatal and neonatal parameters across three groups: pregnancies with no diabetes (PND), pregnancies with gestational diabetes (PGDM), and pregnancies with pregestational diabetes (PPD). The Kruskal-Wallis test was used for statistical significance. To assess associations, a multinomial logistic regression model was utilized.

Vaginal eutocic deliveries were most common in PND (53.4%), but cesarean sections were more frequent in PPD (76.2%) and PGDM (54.5%). Preeclampsia was more observed in PGDM (13.7%) and PPD (15.9%), versus PND (5.8%). The occurrence of polyhydramnios was also higher in PGDM (2.8%) and PPD (1.6%) compared to PND (0.6%). Neonates weighing below 1500 kg were significantly higher in PPD (4.8%) than in PND (1.1%) and PGDM (0.4%). NICU admissions at birth were elevated in PGDM (22.2%) and PPD (6.7%) relative to PND (5.2%). Analyzing the odds ratio for preeclampsia, we found an OR of 2.59 in PGDM and 3.06 in PPD, compared to PND. The OR for NICU admissions was 5.23 for neonates from PPD pregnancies (P<0.0001).

These findings underscore substantial differences in perinatal and neonatal outcomes among the groups. Further research is vital to fully grasp the implications and costs, emphasizing the need for policy changes in prenatal and perinatal care.

Disclosure

L. Martinez-Juarez: None. H. Gallardo-Rincón: None. G. Martínez-Silva: None. A. Montoya: None. D. Álvarez-Hernández: None. D.G. Camacho-More: None. D. Diaz-Martínez: None. F. Magos-Vazquez: None. E. Vargas: None. G.E. Moreno: None. J.P. Aguilar: None. A. Domit: None. R. Tapia-Conyer: None.

Funding

Eli Lilly Global Health Partnerships
534-P: Structured CGM Education Delivered via Mobile Phone Is Associated with Increased Time in Range—Proof-of-Concept Study Results
Authors: HOLLOWAY MELISSA P. , GRACE THOMAS , PARKIN CHRISTOPHER
Published: June 2024

Introduction & Objective: SmartStart CGM is a structured educational program for current users of continuous glucose monitoring (CGM) designed for use on a mobile phone. It presents basic and advanced information about using CGM and interpreting CGM data. We assessed the effects of SmartStart CGM on CGM knowledge level and time in range vs. baseline.

Methods: This proof of concept study enrolled 20 adults with type 1 diabetes on intensive insulin therapy (n=15 on hybrid closed-loop insulin pump therapy, n=5 on multiple daily injections). After enrollment, participants answered 20 "welcome check" questions to assess baseline knowledge. Upon completion of 7 interactive content modules, they answered the same 20 questions as a “final check.” Participants’ time in range 70-180 mg/dL (%TIR) and time below range <70 mg/dL (%TBR) were obtained at baseline and 6 weeks post-completion. Changes from baseline in CGM knowledge and time in range were measured.

Results: Average duration of CGM use prior to enrollment was 31.5+/-19.3 months. The mean CGM knowledge score rose from 38% to 88%. At 6 weeks post-completion, 72.7% of participants with %TIR of <70% at baseline (n=11) showed a clinically meaningful increase of at least 5%. Among participants with baseline %TIR of at least 70% (n=9), 77.8% maintained/increased %TIR up to 4%; 22.2% showed an increase of at least 5%. The proportion of participants reaching %TBR of <4% rose from 70% to 100%. The percentage of participants reaching both %TIR of at least 70% and %TBR of <4% increased from 25% to 65%.

Conclusion: The results of this proof of concept study strongly suggest that completion of SmartStart CGM was associated with increased CGM knowledge, increased %TIR and reduced %TBR.

Disclosure

M.P. Holloway: Other Relationship; Dexcom, Inc. Consultant; Insulet Corporation. T. Grace: Speaker's Bureau; Sanofi, Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Employee; Dexcom, Inc. C. Parkin: Consultant; Abbott, embecta, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Roche Diabetes Care, PharmaSens, MannKind Corporation, Provention Bio, Inc.

Funding

Diabetes Center Berne; Dexcom Inc (MED00032)
535-P: Success of Interactive, Online, Case-Based Education Related to Use of CGM for Type 2 Diabetes
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE
Published: June 2024

Objective: We sought to determine if interactive, case-based, online continuing medical education (CME) could improve the competence and confidence of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es).

Methods: Educational design included a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design and a McNemar’s test (P <.05 is considered significant) assessed educational effect, with Cohen’s d assessing impact (<0.2 modest effect, 0.2-0.49 small effect, 0.5-0.79 moderate effect and >0.8 extensive effect). The activity launched September 28, 2023, data were collected through November 7, 2023.

Results: In total, 300 PCPs and 51 D/Es were included in the analysis. Matched learner data indicate that overall, 77% of PCPs and 82% of D/Es improved their competence from pre-to-post (both P<.001 with extensive overall impacts in both groups 1.32-1.67). On a question-level: 20% of PCPs (P<.01) improved at recognizing effective strategies for patient education related to T2D technology, and 65% of PCPs (P<.01) and 82% of D/Es (P<.01) improved at identifying TIR goals for a given patient with T2D. Overall, 46% of PCPs and 35% of D/Es reported increased confidence in initiating CGM devices in patients with T2D.

Conclusion: This study demonstrates the success of interactive, case-based, online CME on improving competence and confidence of PCPs and D/Es related to using CGM to manage T2D. Additionally, baseline competence levels were higher among D/Es related to identification patients for whom to recommend CGM (baseline gap 29% for PCPs and 6% for D/Es), and recognizing effective patient education strategies when initiating CGM (baseline gap 36% for PCPs and 16% for D/Es), resulting in larger improvements among PCPs. Baseline gaps were similar among both groups related to TIR goals, resulting in larger improvement and clinical understanding in D/Es.

Disclosure

A. Larkin: None. J. Schrand: None. A. Le: None.

Funding

Developed through an independent educational grant from Dexcom.
54-OR: Feasibility of a Multidisciplinary Pilot Intervention for Parent/Caregiver Diabetes Distress
Authors: ALKHATIB EINAS , SEGAWA MAI , DANNER ALYSSA , KASPER HANNAH , FRYMARK EMILY , ROBERTS SARAH , CLARY LAUREN , STREISAND RANDI , MAJIDI SHIDEH
Published: June 2024

Introduction: Caregiver diabetes distress (DD) consists of negative emotions about a child’s T1D diagnosis, associated with increased A1c and family conflict. We aimed to identify the feasibility of a multidisciplinary pilot intervention for caregiver DD in a diverse academic pediatric diabetes center.

Methods: We held 3 monthly, 1 hour educational/support group virtual sessions per cohort (6-8 caregivers) on Nutrition, Fear of Hypoglycemia, and Parent/Child Collaboration. Sessions were led by an endocrinologist and social work, dietician, and/or diabetes educator. Target enrollment was 30 caregivers with DD (PAID-PR/Problem Areas in Diabetes - Parent Revised score >56/100) of youth 5-17yo with T1D for > 6mo. Data include demographics, pre-/post- PAID-PR scores, and session satisfaction.

Results: Caregiver participants (table 1) were 85% female, ages 42.5 + 11.3y; child characteristics: 38% female, ages 10.9 + 2.1y, 47.6% Black, 33.3% Caucasian, 9.5% Hispanic, 9.6% other, 43% public insurance, Mdiabetes duration 4.3 + 0.18y, and MA1c 8.5 + 0.7 %. PAID-PR scores (Table 1) improved from 68 to 51 (p<.05). Satisfaction feedback included “No one has ever offered support like this in the 10 years since my son was diagnosed.”

Discussion: The pilot intervention was feasible, with 2/3 attending >2 sessions. PAID-PR scores improved. Limitations are a small sample; future goals are incorporating into the clinical setting.

Disclosure

E. Alkhatib: None. M. Segawa: None. A. Danner: None. H. Kasper: None. E. Frymark: None. S. Roberts: None. L. Clary: None. R. Streisand: None. S. Majidi: Other Relationship; Sanofi.

Funding

(10300-30200-37600-30007021-2) Dauber-GenMed AWD2735
54-PUB: Exploring Categories of Controlled Cardiovascular Risk Factors in the Elderly—Insights from the Costa Rican Longevity and Healthy Aging Study
Authors: CALVO MARIN JAVIER , TORREALBA-ACOSTA GABRIEL , ERNEST-SUAREZ KENNETH
Published: June 2024

Introduction: The prospective cohort Costa Rican Longevity and Healthy Aging Study (CRELES) offers comprehensive data on the lifestyle of elderly Costa Ricans enrolled in 2005, with survival status up to 2019. We aimed to describe the characteristics of the participants based on the number of controlled cardiovascular risk factors (CVRFs).

Methodology: We recruited 1943 participants and categorized the number of CVRFs meeting targets from 0 to 5 (A1c, blood pressure, exercise, BMI, and smoking). Descriptively, we report proportions and means with SD for each variable categorized according to the number of controlled CVRFs. We used ANOVA for continuous and chi-square tests for categorical variables to establish differences between groups.

Results: The distribution of CVRFs varied among participants, with 35.8% successfully managing three CVRFs. Notably, only 3.0% of participants attained control over all five CVRFs. The global prevalence of diabetes was 20.3%, exhibiting variations between groups. The mortality rate for all participants was 51.1% (see Table 1).

Conclusions: The categorization of participants based on the number of CVRFs highlights variations in sociodemographic and clinical parameters across different subgroups. This stratification allows a better understanding of the cohort’s distribution of risk factors in the elderly.

Disclosure

J. Calvo Marin: Speaker's Bureau; Novo Nordisk, AstraZeneca. G. Torrealba-Acosta: None. K. Ernest-Suarez: Advisory Panel; Janssen Pharmaceuticals, Inc. Consultant; Janssen Pharmaceuticals, Inc. Speaker's Bureau; Janssen Pharmaceuticals, Inc. Advisory Panel; Pfizer Inc. Speaker's Bureau; Pfizer Inc. Advisory Panel; AstraZeneca. Consultant; AstraZeneca. Speaker's Bureau; AstraZeneca. Advisory Panel; Takeda Canada. Speaker's Bureau; Sandoz.
544-P: Early Evidence from a Pragmatic Trial to Increase Uptake of Diabetes Self-Management Education and Support Services in Rural Health Care Systems in Kentucky
Authors: LACY MARY E. , KECK JAMES , ELLIOTT JESSICA , WRIGHT LAURA , DRAKEFORD VANCE H. , MCKUNE BRENT , KRUSE-DIEHR AARON J. , DOUTHITT KEY
Published: June 2024

Introduction & Objective: Diabetes self-management education and support (DSMES) is recommended for persons with diabetes (PWD) and is associated with a range of improved outcomes, but it is underutilized (<10% of patients complete). In this study we present interim findings from a pragmatic trial that integrates health information technology and a quality improvement learning collaborative framework based on the Institute for Healthcare Improvement model to increase DSMES referrals among PWD.

Methods: Two healthcare systems from rural Kentucky participated in the study; within each system, two clinics were assigned to be intervention clinics and one clinic served as the control clinic. At the midpoint of the intervention (4.5 of 9 total months), we assessed preliminary effectiveness of the intervention on the primary outcome - percent change in DSMES referrals from baseline.

Results: Across the two healthcare systems, a total of 956 PWD were served by intervention clinics and 489 by control clinics. At the intervention midpoint, all intervention clinics had participated in ~16 hours of education plus monthly coaching calls with a quality improvement advisor and had completed four Plan-Do-Study-Act cycles to optimize their DSMES referral process. At baseline, 0% of PWD at both intervention and control clinics had been referred to DSMES in the prior 12 months. At study midpoint, 0% of PWD from control (0/489) and 19.4% (185/956) of PWD from intervention clinics were referred to DSMES.

Conclusion: Preliminary evidence suggests the effectiveness of our multipronged intervention to increase DSMES referrals among clinics in rural Kentucky. Rates of DSMES attendance among PWD that were referred and implementation outcomes, including feasibility, acceptability, scalability and sustainability, will be assessed.

Disclosure

M.E. Lacy: None. J. Keck: None. J. Elliott: None. L. Wright: None. V.H. Drakeford: None. B. Mckune: None. A.J. Kruse-Diehr: None. K. Douthitt: None.

Funding

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (R34DK132548)
551-P: A Tailored Approach to Increase Engagement in Lifestyle-Change Programs in Women with Previous Gestational Diabetes
Authors: PIKE JULIE M. , HABERLIN-PITTZ KATHRYN , MACHUCA LUZ A. , MCKINNEY BRETT M. , YAZEL LISA , KOTARSKI ARIC , HANNON TAMARA S.
Published: June 2024

Women with pGDM are at high risk for T2D. Yet, engagement of this population in lifestyle change programs (LCPs) is low. We evaluated the effect of a tailored diabetes prevention approach on engagement and health outcomes.

This unrandomized cohort study engaged women with pGDM in an informed decision-making process to discuss T2D risk, explore preferences for a LCP, and select a LCP aligned with priorities. Seven evidence-based LCPs with a variety of delivery modes, duration, time of day, and childcare availability were offered free of charge. The primary outcome was LCP engagement. Secondary outcomes were psychosocial questionnaires and clinical measures at baseline, 6 months, and 12 months. Paired t-tests compared changes over time.

We consented 116 women (34.9 ± 5.7 y). Ninety-six participants were included in data analysis after exclusions due to pregnancy (n=9) and BMI <25 (n=11). Engagement was 78 percent at 6 months and 71 percent at 12 months. Psychosocial and clinical measures were stable at all time points.

A tailored diabetes prevention strategy is feasible and acceptable in women with pGDM, even during the COVID-19 pandemic and shutdown, which impacted the outcomes. LCPs that meet the unique priorities of women with pGDM are needed to optimize engagement and outcomes.

Disclosure

J.M. Pike: None. K. Haberlin-Pittz: None. L.A. Machuca: None. B.M. McKinney: None. L. Yazel: None. A. Kotarski: None. T.S. Hannon: Advisory Panel; Eli Lilly and Company.

Funding

Funding was provided by the Indiana University Grand Challenge Precision Health Initiative grant
56-PUB: Understanding the Patient Experience of Heart Failure with Preserved Ejection Fraction (HFpEF) and Obesity—Qualitative Insights from Patients and Clinicians
Authors: KANU CHISOM , AL-ZUBEIDI TAMARA , SHINDE SHRADDHA , AL-JASSAR GEMMA , LING POON JIAT , MILLER JORDAN , MARSHALL CHRIS , CARMICHAEL CHLOE
Published: June 2024

Introduction & Objective: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous clinical syndrome. Individuals living with HFpEF and obesity display a distinct phenotype that places considerable burden on their health-related quality of life. This study explored signs, symptoms, and impacts most relevant to individuals living with HFpEF and obesity. Clinician interviews provided a clinical perspective on the patient experience.

Methods: Qualitative interviews were conducted virtually with adults in the US diagnosed with HFpEF and obesity (body mass index ≥30.0 kg/m2). Clinicians in the US, China, and Germany with ≥3 years of experience treating HFpEF were also interviewed. Patient interviews were conducted until conceptual saturation was achieved. Content analysis was conducted using ATLAS.ti v9.0 software. A conceptual model (CM) of the lived experience of HFpEF and obesity based on patient and clinician feedback was developed.

Results: Twenty-two patients and 6 clinicians participated in the interviews. The CM demonstrated that living with HFpEF impacts many facets of life, with participants and clinicians reporting impacts on their (or their patients’) physical functioning (e.g., walking), activities of daily living (e.g., household chores) and work. Participants also reported impacts on their emotional well-being (e.g., feeling anxious or worried), social lives, relationships, and sleep. Shortness of breath and fatigue were spontaneously noted as salient and bothersome symptoms by most participants with edema noted by most on probing; this was further corroborated by clinicians who also considered these symptoms as the most bothersome symptoms of HFpEF.

Conclusion: This study highlighted the substantial burden of living with HFpEF and obesity. The resultant conceptual model highlights the key concepts that should be considered in patient-focused drug development.

Disclosure

C. Kanu: None. T. Al-Zubeidi: Consultant; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Edgewise Therapeutics, Alimentiv. Employee; Clarivate Analytics. Consultant; Pfizer Inc. S. Shinde: None. G. Al-Jassar: None. J. Poon: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. J. Miller: Employee; Clarivate. Other Relationship; Clarivate. C. Marshall: None. C. Carmichael: Employee; Clarivate. Stock/Shareholder; Clarivate. Other Relationship; Clarivate.
565-P: Baseline Findings from the Dulce Digital 2.0 Trial—Innovative Diabetes Self-Management in the Digital Age
Authors: SAN DIEGO EMILY ROSE N. , RUIZ MONICA , ORENDAIN NATALIA , MILLAR KRISTA L.C. , SAENZ SHIRLEY M. , DE JESUS-GONZALEZ JOSELYN , SHAIKH HANI A. , PHILIS-TSIMIKAS ATHENA
Published: June 2024

Introduction: Telehealth delivery of diabetes self-management education and support (DSMES) has been widely adopted, yet lower participation is occurring in Hispanics who are disproportionately impacted by type 2 diabetes (T2D). Objective: Describe baseline and recruitment characteristics in an in-progress 3-way RCT that will compare the effectiveness of the Dulce Digital text messaging program and live in-person and virtual delivery (video telehealth classes) of Project Dulce DSMES in improving glycemic management of 150 Hispanic adults with T2D and A1C of ≥ 8%.

Methods: Descriptives statistics.

Results: There were 612 patients approached after EHR review. After recruitment screening, 69% did not meet the eligibility criteria, 8% were eligible and interested, and 24% were eligible but not interested. Reasons for disinterest were inconvenient class times (48%), concerns about study demands (e.g., length of study; 23%), distrust in research or health professionals (20%), lack of access to study location (6%), and limited access/knowledge of technology (2%). Enrolled participants (n=46) were on average 55 ± 11.3 years old, and 50% were female, 44% were born in the US, 70% had English as the preferred language, 54% were employed full-time, 49% had ≤ high school education, and 38% had an annual household income of ≥ $55K. Mean baseline A1C was 9.5% ± 1.5. Mean scores for Summary of Diabetes Self-Care Activities subscales were diet = 3.8 ± 1.9, exercise = 3.2 ± 2.4, glucose management = 3.8±2.6, and foot care = 3.5 ± 2.5 (range = 0-7); and Brief Measure of Healthy Literacy scale was 2.4 ± 1.5 (range = 0-10).

Conclusion: The average baseline A1C was high while mean scores for self-care behaviors were low-to-moderate and low for health literacy. Healthcare systems should consider addressing multilevel barriers to in-person and telehealth DSMES delivery to enhance engagement and improve diabetes outcomes, especially in high-risk Hispanic adults with limited health literacy.

Disclosure

E.N. San Diego: None. M. Ruiz: None. N. Orendain: None. K.L.C. Millar: None. S.M. Saenz: None. J. De Jesus-Gonzalez: None. H.A. Shaikh: None. A. Philis-Tsimikas: Advisory Panel; Dexcom, Inc., Lilly Diabetes, Novo Nordisk, Sanofi, Medtronic, Bayer Inc.

Funding

Merck (IIS#60691); National Institutes of Health (K12 TR004410); National Institutes of Health (KL2 TR001112); National Institutes of Health (P50MD017344)
568-P: Living With Diabetes—A Hands-on Workshop
Authors: JENKINS ALEX , TODD JENNIFER N.
Published: June 2024

Background: Diabetes affects 37.3 million people, with a total estimated cost of $327 billion. Studies have shown significant knowledge gaps in resident education regarding diabetes management, resulting in medical errors and inappropriate care. Although studies show that hands-on diabetes education is beneficial, most curricula are delivered as online, self-paced, or case-based learning, without insight into the day-to-day management of diabetes.

Description: Using personal experience of living with diabetes as a unique educational tool, we created an education session to share the patient experience of daily diabetes tasks, teach diabetes management skills, and foster peer teaching. The hour-long interactive session included an introduction about the presenter’s experience with diabetes and three 15-minute hands-on sessions, where participants counted their own carbohydrates for a meal, tested their blood sugar and/or tried on a Dexcom G7 sensor, and put on an insulin pump site.

Methods: We presented the session to pediatric residents and clerkship students, and surveyed participants on their understanding of diabetes care before and after the session and their overall rating of the session.

Results: A total of 17 participants answered the pre-session survey and 7 answered the post-session survey. Prior to the session, the proportion of participants indicating they somewhat or strongly agreed they knew what it felt like to check a blood glucose, give an insulin injection or pump insertion, or to perform the work of carbohydrate counting was 53%, 18%, and 29%; post-session these proportions increased to 100%, 100%, and 86% respectively. All the post-session respondents somewhat or strongly agreed they found the session valuable and would recommend to other residents.

Discussion: The session increased participants’ understanding of daily tasks of diabetes management and was perceived as a valuable part of residency education. Future directions include expanding to internal medicine and family practice residents.

Disclosure

A. Jenkins: None. J.N. Todd: None.
576-P: Adherence to Recommended Dietary Self-Care Behaviors and Its Related Factors for Patients with Type 2 Diabetes
Authors: OUYANG CHUNG-MEI
Published: June 2024

Diabetes mellitus is a leading cause of disability and a major contributor to healthcare costs in most countries. Patient education to facilitate diabetes self-care is a cornerstone of the quality of diabetes care. Adherence to diabetes dietary self-care helps achieve a sense of general well-being and minimize diabetes complications. Patients with type 2 diabetes were surveyed to evaluate demographic, psychological, and environmental factors affecting perceived six dietary self-care behaviors to their prescribed regimens. A cross-sectional evaluation was performed in adult outpatients aged 40 years and older with type 2 diabetes who had received at least one individualized dietitian-led nutrition session. Adherence to six dietary self-care behaviors was assessed by using the Diabetes Self-Care Behavior (DSCB) questionnaire and the influencing factors of each behavior were investigated by using the Factors Affecting Diabetes Self-Care (FADSC) questionnaire. Odd ratios derived from logistic regression analysis were used to identify predictive factors resulting in adherence to dietary self-care behaviors and related factors. A total of 200 patients were completed in this study and the average age was 60.2±12.1 years old. We found that women were more likely to follow reducing fat intake (237 %) and eating more fiber foods (192 %). Patients who received more than 4 nutrition education sessions had better adherence to four different dietary self-care behaviors. Patients with more family support were more likely to have lower fat and more fiber foods. Patients with more self-efficacy showed following meal plans better. Patients’ adherence to six dietary self-care behaviors prescribed for diabetes varied. Many factors are important for supporting adherence to dietary self-care behaviors. The need for individualization of patient characteristics in diabetes nutrition education is the key point to adherence to recommended dietary self-care behaviors.

Disclosure

C. Ouyang: None.
577-P: Employee Diabetes Program Effects on Time to Reach Glycemic Goals and Improved Care in the Ambulatory Care Setting
Authors: HABIB HELEN A. , SAAD NASSER , HUGHES LUCILLE
Published: June 2024

Introduction & Objective: Employer based diabetes programs have been created to maximize diabetes related outcomes and increase value based care. The aim of this program is to provide sustained multidisciplinary diabetes education enforcing the ADA Standards of Care to those with our employer based health plan. Waived copays on diabetes medications and supplies was incorporated to increase engagement.

Methods: This ambulatory diabetes program included those 18 years of age or older with diabetes and our employer based health plan. The program is a voluntary, opt-in program. Persons with diabetes included those who enrolled between November 2022 and October 2023. Interventions with recommendations were communicated to the person with diabetes’ providers related to their diabetes and cardiovascular related management. Outcomes related to mean changes in person weight and A1C for those actively engaged in the program were evaluated.

Results: A total of 247 adults were initially enrolled in the employee diabetes program. The baseline A1C was 116 with A1C <7%, 59 with A1C ≥7- ≤ 8%, 30 with A1C > 8- ≤ 9%, and 42 persons with A1C >9% respectively. There were 1,131 initial interventions made in relation to their diabetes and cardiovascular medications/supplies, immunization, preventative medication, laboratory and referral recommendations. In the final outcome analysis, 208 persons were included due to continued active engagement in the program. The mean change in weight from baseline was found to be -1.75 kg (-1.73%) and the mean change in A1C from baseline was -0.94 (-9.71%).

Conclusion: Our employee diabetes program showed a trend toward improved persons with diabetes outcomes with active engagement up to one year. The waived copay financial incentive related to diabetes medications and supplies motivated follow-up engagement and numerically lead to a reduction in weight and A1C values. Further examination is planned for new and those with continued enrollment.

Disclosure

H.A. Habib: None. N. Saad: None. L. Hughes: Advisory Panel; embecta.
580-P: Dialogues in Diabetes—Addressing Knowledge and Behavior Gaps among Clinicians Who Care for Patients with Diabetes and Obesity
Authors: ROBINSON KATIE , FREDERICK JENNIFER , ESGRO ROBERT A. , COLLIER HANNAH
Published: June 2024

Rationale: While obesity management may be beneficial in the treatment of type 2 diabetes (T2D), achieving weight loss required to achieve these benefits is difficult. New incretin-based options can help treat both conditions, but clinicians lack awareness of and comfort in using these agents.

Methods: Vindico provided a continuing education (CE) e-monograph designed for primary care providers (PCPs) and endocrinologists who treat patients with diabetes. Baseline knowledge and behaviors as well as educational impact were assessed via pre- and post-test.

Results: A total of 1,692 PCPs and 535 specialists read the monograph. Baseline knowledge was low (average 36% correct) on all topics and was similar between cohorts, except regarding multi-receptor agonism and the impact on weight and A1C, on which specialists scored higher than PCPs (54% vs. 41%). Both cohorts scored lowest regarding the use of incretin-based therapies. Despite this, baseline reported use of incretin-based therapies was high, suggesting that while providers think they are practicing the latest evidence-based care, they may not be. Post-learning, there was 44% relative increase in knowledge, demonstrating large gains in knowledge across cohorts and topics. These knowledge gains translated into 72% of endocrinologists and 70% of PCPs having high levels of post-education confidence regarding the use of new incretin-based options as well as increased preparedness to implement new incretin-based options into practice. Because of the education provided, over 12,000 patients with diabetes and overweight or obesity per week are 56% more likely to receive the latest evidence-based care.

Conclusion: In our dataset, providers had inadequate baseline knowledge regarding the burden of obesity in patients with diabetes and new strategies for weight loss. The findings illustrate the benefit of targeted CE on clinician knowledge, behaviors, and confidence towards improved patient outcomes.

Disclosure

K. Robinson: None. J. Frederick: None. R.A. Esgro: None. H. Collier: None.

Funding

This activity was supported by an educational grant from Lilly.
581-P: Effects of Recommending Clinic Visit to People with Diabetes Detected during Health Checkups on Remission—A Cluster Randomized Trial
Authors: KIMURA DAICHI , KATO KIMINORI , FUJIHARA KAZUYA , SONE HIROHITO
Published: June 2024

Our recent study revealed that diabetes remission is more likely to occur when disease duration is short and HbA1c is low. We conducted a cluster randomized trial to determine whether encouraging people with diabetes to visit a clinic after a health checkup is effective for remission.

A total of 1,185 people (51y, 78% male) who diagnosed as diabetes at a workplace health checkup by any of three criiteria (HbA1c≥6.5%, FPG≥126 mg/dL, or postprandial PG ≥200 mg/dL) were cluster-randomized into two groups by workplaces.

While those in the control group received only the checkup results, those in the intervention group was additionally given a referral letter to a clinic.

In addition, those who still did not visit the clinic were encouraged to do so through health checkup centers, and the remission rates were compared between the groups. Remission was defined as no longer meeting the above three conditions. The remission rate at one year was significantly higher in the intervention group, 32%, compared to 25% in the non-intervention group (p=0.007). Significant predictors of remission by multivariate logistic analysis were age, exercise and the intervention. The intervention significantly increased remission by 1.4-fold, even after adjusted by initiation of diabetes medications.

These results suggest that the intervention increased remission through lifestyle modification.

Disclosure

D. Kimura: None. K. Kato: None. K. Fujihara: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
59-OR: Improving Diabetic Kidney Disease Screening in a Veterans Affairs Primary Care Clinic
Authors: HARRIS ANDREW T. , FRANGELLA KRISTINA P. , SANTIAGO LUIS R. , EROSSY PETER J. , FALCK-YTTER CORINNA , DESAI NIRAJ , EDMISTON ELIZABETH
Published: June 2024

Introduction & Objective: Diabetic Kidney Disease (DKD) is a major cause of end stage renal disease. Up to half of Americans with DKD are unaware of the diagnosis and community screening rates for albuminuria varies widely. Using Lean quality improvement methods, we aimed to improve our DKD screening rate to greater than 60%.

Methods: An interdisciplinary team was formed in December 2022 at a large, urban VA medical center serving approximately 20,000 Veterans with diabetes. Successful DKD screening was defined as annual serum estimated glomerular filtration rate (eGFR) and urine albumin-to-creatine ratio (UACR). Sequential interventions included provider education, system-wide monthly population health reports, elimination of ability to select incorrect lab orders, electronic reminders in EMR, and templated EMR notes to capture outside testing.

Results: Screening rates for DKD improved from 54.8% to 71.3% in November 2023. Baseline drivers of poor screening included unawareness of need for UACR screening, ordering urine albumin without urine creatinine, failure to inform Veterans that a urine test was ordered, and Veterans’ inability to produce a urine sample.

Conclusion: Lean methodology combined with strong change management increased UACR screening rates for DKD. Education can be effective when combined with timely supportive system interventions and regular feedback on outcomes.

Disclosure

A.T. Harris: None. K.P. Frangella: None. L.R. Santiago: None. P.J. Erossy: None. C. Falck-Ytter: None. N. Desai: None. E. Edmiston: None.
593-P: Glycemic Effect of Free-Living Activities in Adults with Type 1 Diabetes
Authors: DHALIWAL MEHAK P. , TANG KENAN , AIELLO ELEONORA M. , QIN YAO
Published: June 2024

Introduction: This work analyzes data from the free living exercise sessions of the T1DEXI study to evaluate the effect of several factors on the change in glucose levels (ΔCGM) of Type-1 diabetes (T1D) subjects during physical activity.

Methods: We calculate ΔCGM as the difference in glucose readings 10 minutes before and after each exercise session. We use the Analysis of Variance (ANOVA) method for measuring the statistical significance of the impact of various relevant factors on ΔCGM.

Results: We analyzed 11,743 free living exercise sessions, comprising 48 different activity types, for 502 T1D patients.

Overall, there was an average drop in glucose of 19.98 ± 48.48 mg/dL after the free-living exercise sessions. Figure 1 shows the variation of ΔCGM after exercise with different factors.

Figure 1 shows a greater ΔCGM for increasing session durations (p<0.01), for higher initial glucose at the start of the session (p<0.01), for age group (p=0.01) and HbA1c group (p=0.06). Figure 1 also shows that carb intake before the session leads to a smaller glucose drop (p < 0.01) but during the session indicates a significantly higher glucose drop (p<0.01). Male participants had a larger drop than female participants (p=0.06).

Conclusion: The results obtained suggest that session duration increases the drop in glucose, while the CHO intake attenuates it, and individual-level factors (HbA1c, gender, age) have a significant impact on the ΔCGM.

Disclosure

M.P. Dhaliwal: Consultant; Tidepool. K. Tang: Consultant; Tidepool. E.M. Aiello: Other Relationship; Tidepool. Y. Qin: None.

Funding

The Leona M. & Harry B. Helmsley Charitable Trust (2404-06905)
6-PUB: Prevention of Severe Lower Extremity Artery Disease in Patients with Diabetes—Analysis of Factors Using a Large Database
Authors: HORII TAKESHI , MIHARA KIYOSHI
Published: June 2024

Lower extremity artery disease (LEAD) leading to comprehensive chronic lower limb ischemia has been reported to increase the risk of lower limb amputation and death from macrovascular disease in patients with type 1 diabetes(T1D) and type 2 diabetes(T2D). Due to the lack of large-scale studies on LEAD in Asians with diabetes, we investigated factors that may reduce LEAD severity. This cross-sectional study was performed using data from the Medical Data Vision administrative claims database. Wound care was defined as the severity of LEAD. Factors associated with reducing the severity of LEAD was analyzed using logistic analysis with the presence of wound care as the objective variable and patient background, presence and frequency of diabetes educational hospitalization, and concomitant medications as explanatory variables. The study population consisted of 282,353 patients with LEAD disease. Wound care was performed on 32,978 patients (5.4%). Multivariate analysis was performed, and the results were as follows: once (OR: 0.26), twice (OR: 12.6), three or more times (OR: 8.3) with no diabetes education hospitalization as the reference. As <65 years of age as reference, patients aged 65-74 years (OR: 0.60), ≥75 years (OR: 0.38), and T1D as reference, T2D (OR: 1.68). SUs, metformin, SGLT2is, GLP-1s, DPP-4is, CCBs, angiotensin receptor-neprilysin inhibitors, statins, and fibrates significantly reduced OR. This study also allowed us to identify patient backgrounds predisposed to LEAD severity and medications that may reduce severity of LEAD. In addition to the implementation of educational hospitalization, this study will help in the selection of drugs to reduce the severity of LEAD.

Disclosure

T. Horii: None. K. Mihara: None.
60-PUB: Simultaneous Analysis of Serum Monosaccharides Levels among Adults of Self-Reported Diabetes Status using Non-Derivatized LC-MS/MS Method
Authors: TSE CHUI , ZHANG LI , DANILENKO ULIANA , DAHYA KOMAL , SUGAHARA OTOE , POKUAH FIDELIA , VESPER HUBERT
Published: June 2024

Introduction and Objective: Glucose is the major biomarker for diagnosis and management of diabetes. Fructose is sometimes used to replace glucose and reduce glucose intake. Increased consumption of fructose was shown to contribute to non-alcoholic fatty liver disease (NAFLD). To better understand the associations between monosaccharides levels in blood and metabolic diseases in human, a high-throughput LC-MS/MS method was developed for simultaneous measurement of monosaccharides.

Methods: In this study, we measured serum monosaccharides concentrations in 100 non-fasting adult donors with self-reported diabetes status using a LC-MS/MS method for glucose, fructose, mannose, and galactose. We evaluated the correlations among monosaccharide concentrations, self-reported age, gender, BMI, and diabetes status in donors.

Results: All monosaccharides, except for galactose, were detected in all blood samples. The mean glucose concentration from donors with self-reported diabetes was significantly higher than the donors without diabetes (164.53 mg/dL vs 90.23 mg/dL, p <0.001). The same distribution was observed for mannose concentration between the two groups (2.25 mg/dL with diabetes vs 1.30 mg/dL without diabetes, p <0.001). No significant difference for fructose concentration was observed between both groups. However, the mean ratios of fructose to glucose concentrations were significantly lower in donors with self-reported diabetes than those without (0.004 vs 0.014, p <0.001).

Conclusion: The use of our recently developed high-throughput LC-MS/MS can simultaneously measure concentrations of multiple monosaccharides in human serum. The method can be used to investigate for the roles of these monosaccharides in metabolic diseases in large epidemiological studies.

Disclosure

C. Tse: None. L. Zhang: None. U. Danilenko: None. K. Dahya: None. O. Sugahara: None. F. Pokuah: None. H. Vesper: None.
606-P: Mitigating Type 2 Diabetes Risks—A 12-Week At-Home Physical Activity Intervention for Improving Metabolic Health in the Growing Asian Immigrant Community
Authors: KUERBAN ALIYA
Published: June 2024

Introduction & Objective: As the immigrant community experiences rapid growth in the U.S., Asians encounter diverse health challenges, with a notable focus on addressing type 2 diabetes (T2D). Enhancing muscle mass has been identified as a means to alleviate insulin resistance and, consequently, enhance metabolic health. This study aims to evaluate the effectiveness of a 12-week structured at-home physical activity program on the metabolic health of Asian adults, acknowledging its potential to reduce T2D risks by promoting overall metabolic well-being.

Methods: Participants, aged 18 to 80, were selected through convenient sampling from a local church with a predominantly Chinese ethnic congregation. Inclusion criteria focused on age, while individuals with a BMI over 70 or serious medical conditions hindering participation in the physical activity program (twice a week for 12 weeks) and a 30-minute weekly aerobic exercise were excluded.

Results: Out of 18 recruited individuals (mean age 50.4), 16 adhered to the exercise regimen throughout the 12 weeks, with four completing 85% or more of the program. Fourteen individuals returned for the final assessment. A majority (84.6%) demonstrated increased sit-down and stand-up rates in 30 seconds, while half exhibited improved hand grip strength, notably in the left hand. Other metabolic measurements did not show significant changes.

Conclusion: This study reveals that a cost-effective, convenient at-home structured physical activity program significantly enhances lower extremity strength and handgrip strength among Asian adults over 12 weeks, offering valuable insights for addressing health challenges, particularly T2D, in this demographic.

Disclosure

A. Kuerban: None.