bluuebunny/crossref_metadata_2025 huggingface dataset:
585-P: Effect of Hydroxychloroquine on HbA1c and Lipid Parameters in T2DM Subjects with Diabetic Neuropathy Who Are on Statins
Authors: BAIDYA ARJUN , GUHA SHIBAL , KUMAR SUBHASH , SHANKAR ANAND
Published: June 2020

Aim: We decided to explore the effects of HCQ in combination with rosuvastatin on Lipid profile and HbA1c of patients with DKD.

Method: This is a real world study. T2DM (N=67, Age 52± 09), HbA1c ≥ 7%, with clinical evidence of DKD) were selected and alternatively divided into two groups with one group taking HCQ 400 mg in addition to their regular medications and other group without HCQ. Both groups were followed for next 3 months and changes in their serum creatinine(S.Cr), eGFR, Urine ACR, HbA1C,FPG, PPG, LDL, HDL, TG were noted. All patients were on DPP-4i and metformin along with short acting insulin with dosage modified according to daily insulin need and changes in insulin requirement with changing renal function for at least 3months prior to the study.

Results: TG levels were reduced by 25.01% and 10.69% in the HCQ and Non - HCQ Gr respectively, LDL-cholesterol levels were reduced in HCQ while it increase in the Non HCQ. TC declined more with HCQ and significant increase in HDL. SCr. was decline in HCQ Gr, while it increased in Non-HCQ. Similarly, eGFR was rising in the HCQ and decreased in the Non-HCQ. Also, Urinary ACR decreased with HCQ, but continued to increase in Non-HCQ.

Conclusion: Therefore, we concluded that HCQ can be an option in patients of early stages of DKD in such patients and it may be combined with rosuvastatin for better lowering of lipid levels and better control of HbA1c.

Disclosure

A. Baidya: None. S. Guha: None. S. Kumar: None. A. Shankar: None.
588-P: Vitamin D Status in a Bulgarian Population with Type 2 Diabetes and Diabetic Foot Ulcers
Authors: TODOROVA ANI S. , DIMOVA RUMYANA , CHAKAROVA NEVENA , SERDAROVA MINA , GROZEVA-DAMYANOVA GRETA , TSARKOVA POLINA , TANKOVA TSVETALINA , JUDE EDWARD B.
Published: June 2020

Aim: The aim of the study was to assess vitamin D status in patients with type 2 diabetes (T2D) and diabetic foot ulcers (DFU).

Material and Methods: A total of 224 patients with T2D, mean age 59.2±10.1 years, BMI 31.5±6.3 kg/m2 and eGFR ≥ 45 ml/min/1.73m2, not on vitamin D supplementation, were enrolled in a cross-sectional study. Subjects were divided in two groups - with DFU (n=61) and non-DFU (n=163). The non-DFU group was subdivided into groups with peripheral neuropathy (n=106) and without any complications (n=57). Neuropathy was assessed by standard clinical tests (10g monofilament and 128 Hz tuning fork). Serum 25(OH)D was assessed by ELISA method.

Results: 25(OH)D level was 12.7 ng/ml (IQR 9.35-18.1 ng/ml) in the studied cohort, which is below the sufficient range (sufficient > 30 ng/ml; insufficiency - 20-30 ng/ml; deficiency 10-20 ng/ml, severe deficiency < 10 ng/ml). The DFU group presented with significantly lower 25(OH)D level as compared to non-DFU group, 12.08 ng/ml (IQR 8.5-15.5 ng/ml) vs. 13.50 ng/ml (IQR 9.6-18.6 ng/ml), p=0.006; 86% of DFU patients being with vitamin D deficiency and severe deficiency. There was no difference in diabetes duration (p=0.096), whereas there was a significant difference in eGFR in DFU group as compared to non-DFU group (81±20 ml/min/1.73m² vs. 89±19 ml/min/1.73m², p=0.008). No relationship was established between 25(OH)D levels and BMI in both groups. The subanalysis of non-DFU group demonstrated significantly lower 25(OH)D level in patients with peripheral neuropathy as compared to patients without any complications - 12.5 ng/ml (IQR 9-17 ng/ml) vs. 16.2 ng/ml (IQR 10-21 ng/ml), p=0.027. There was no difference in serum calcium levels between the different groups.

Conclusion: Patients with DFU and diabetic neuropathy are at higher risk of low 25(OH)D levels probably because of poor self-care and less sunlight exposure. Therefore, this population should be screened for vitamin D deficiency as it may lead to poor wound healing.

Disclosure

A.S. Todorova: None. R. Dimova: Consultant; Self; Amgen, Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; Sanofi, Wörwag Pharma. N. Chakarova: None. M. Serdarova: None. G. Grozeva-Damyanova: None. P. Tsarkova: None. T. Tankova: Board Member; Self; Amgen, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Sanofi, Servier. E.B. Jude: Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc., Sanofi. Other Relationship; Self; Lilly Diabetes, Menarini Group.
592-P: Epidermal Nrf2 Orchestrates Tissue Regeneration through Direction Regulation of Ccl2
Authors: VILLARREAL PONCE ALVARO P. , TIRUNEH-WORKU MELAT , LEE JASMINE , DAVID JOSHUA A. , GUERRERO-JUAREZ CHRIS , DAMMEYER KRISTEN , KUHN JOSEPH , KWONG JENNIFER , CERADINI DANIEL
Published: June 2020

Diabetic ulcers are costly chronic wounds and are the leading cause of lower-extremity amputations. Dysfunctional redox balance underlies a key part of diabetic wound repair pathology that results from misregulation of master antioxidant gene regulator Nrf2. While Nrf2 regulation is relevant for wound repair, how Nrf2 onsets a regenerative response is unclear. Using in-depth analyses, we uncover Nrf2 expression in keratinocytes to be vital for physiologic wound repair. In vivo spatio-temporal analysis shows deregulated nuclear translocation of Nrf2 in diabetic wound keratinocytes (WT: 96.97%±3.6%; Db: 22.50%±16.4%; p<.005), which correlates with reduced activation of many antioxidant gene targets (p<.005). To elucidate the role of Nrf2 in the epidermis, we utilized double transgenic mice to conditionally delete Nrf2 in keratinocytes (K14 CreER; Nrf2fl/fl; cKO) in vivo. Importantly, we find loss of epidermal Nrf2 results in a significant wound repair delay that reminisces delays observed in diabetic mice (WT: 16.0±0d; Db: 32±0d; cKO: 33±2d; p<.0005). RNA-seq of cKO wound keratinocytes reveals Nrf2 regulates epidermal release of extrinsic cues that affect non-autologous responses that are critical for regeneration, most notably immune cell guidance (p<.05). The magnitude of this signaling defect is shown through failure of cKO wounds to traffic monocyte/macrophages to the injury site (WT: 130.0±15.0cells/area; cKO 35.0±2.6cells/area; p<.05). This defect results from reduced expression of Ccl2 in cKO wounds, which we find to possess a Nrf2-binding motif that exhibits dynamic Nrf2 binding upon wounding. Induced expression of Nrf2 in primary keratinocytes results in Ccl2 upregulation, and its application is sufficient for restoring physiologic wound regeneration in cKO and diabetic wounds (p<.0001). We provide evidence describing an essential role of Nrf2 in regulating critical wound healing events and provide the basis for continued investigation on its therapeutic value.

Disclosure

A.P. Villarreal Ponce: None. M. Tiruneh-Worku: None. J. Lee: None. J.A. David: None. C. Guerrero-Juarez: None. K. Dammeyer: None. J. Kuhn: None. J. Kwong: None. D. Ceradini: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-16-ACE-08 to D.C.)
603-P: A Unique, Definitive, and Durable Solution for the Chronic Diabetic Foot Ulcer
Authors: FREED LEWIS
Published: June 2020

The Problem: In spite of considerable effort and investment, definitive treatment for diabetic foot ulcers is lacking and recurrence is expected in many if not most instances. A novel treatment has been applied to this condition which employs ultrasonic energy to address the major pathophysiologic features of the condition.

Technique: An ultrasonic probe demonstrated effective in removing diseased tendon was applied to the management of the diabetic foot ulcer. Using 2-4 puncture sites the ultrasonic probe removes the thickened scar tissue that surrounds the non-healing wound crater. The probe is then introduced into the osseous prominence which is also removed using the ultrasonic probe. The scar and bone are aspirated through the hollow probe and removed from the field. The initial experience is limited to MW class 1-3 ulcers.

Materials and Methods: From Jan 2014 - Nov 2019, 105 ulcers were managed in this manner. The chronicity varied from a minimum of 3 months, to over 3 years (mean = 15 months). All patients had unsuccessfully undergone numerous traditional treatment modalities. The mean ulcer size was 20 mm and the men treatment time was 4.5 minutes. Patients were followed at weekly intervals until healed and at 3 month intervals subsequent to healing.

Results: At a mean time of 3.5 weeks (range 7- 42 days) 101/105 ulcers completely healed. At surveillance, 5 of the 101 healed ulcers recurred from 14 - 33 months. One patient developed a bacteremia and one a local cellulitis, both responding to antibiotics.

Conclusion: A single treatment with the ultrasonic probe as described has demonstrated a high rate of complete healing with a low recurrence and complication rate. The procedure is relatively inexpensive and easily learned by those experienced in managing this condition.

Disclosure

L. Freed: Stock/Shareholder; Self; Tenex Health.
62-LB: Psychosocial and Socioeconomic Well-Being as Determinants of Quality of Life and Glycemic Control in Haitian Youth with Diabetes
Authors: VINCENT ROSEMARIE , KAMAL ZAHRA , CORIOLAN BIDJINIE-STEFFY , ALTENOR KETLY , VON OETTINGEN JULIA E.
Published: June 2020

In low- and middle-income countries (LMIC), youth with diabetes suffer from poor glycemic control even if free insulin and diabetes care are provided. In Haiti, health-related quality of life (HRQL) among youth with diabetes is low. We validated depression, self-esteem and self-management scales (Table 1) in Haitian youth with diabetes and evaluated them as well as perceived health, subjective and objective social status as determinants of glycemic control and HRQL. In 85 participants (59% female, mean age 17.5±5 years, mean diabetes duration 3.7±3.5 years, mean HbA1c 11.3±2.6%, mean HRQL 61±16 out of 100, mean satisfaction score 64±20 out of 100) mild, moderate and moderately-severe depression rates were 38%, 21% and 7% respectively, self-esteem score was 61±12 on a scale of 0 to 100 and perceived self-management score was 45±17 on a scale of 0 to 100. No measure predicted glycemic control (p>0.05 for all). When adjusted for age, sex and diabetes duration, higher self-esteem (p=0.003), higher subjective SES (p=0.04) and lower depression score (p<0.05) remained significant determinants of HRQL. Higher objective SES (p=0.01) and lower depression score (p=0.04) remained determinants of satisfaction. Depression and objective SES emerge as intervention targets while subjective psychosocial health emerges as a resilience worth nurturing to improve HRQL and life satisfaction.

Disclosure

R. Vincent: None. Z. Kamal: None. B. Coriolan: None. K. Altenor: None. J.E. von Oettingen: None.
621-P: Digital Diabetes Education Program Improves Knowledge, Self-Efficacy, and Health Behaviors among People with Type 2 Diabetes
Authors: WHITE ZACHARY , WOOLLEY RYAN , AMANAT SHEILA , MUELLER KELLY
Published: June 2020

An estimated 21 million Americans, 8.6% of the U.S. population, self-report as having been diagnosed with type 2 diabetes. Diabetes is a disease that comes with confusion and uncertainties, especially at the time of diagnosis. The American Diabetes Association created a free, 12-month diabetes education program to help people with type 2 diabetes (PWD) learn more about their disease and how to improve their overall health and reduce their risk of complications. This digital program provides 6 e-booklets, monthly e-newsletters, a year subscription to the American Diabetes Association’s Diabetes Forecast magazine, and access to an online community and local events. Program content of the e-booklets includes information on diabetes management including medication, physical activity, and nutrition.

A study was conducted to assess program impact on 1) knowledge of diabetes 2) self-efficacy, and 3) health behaviors. An online survey was sent to participants at registration and again at the end of the 12-month program. Paired samples analysis was conducted to assess the individual level change across those who completed both surveys (N= 897).

After the program, an average of 58% of participants increased their knowledge of diabetes-related topics such as complications and healthy eating (p ≤ 0.001) and 46% of participants increased their confidence to manage their diabetes (p ≤ 0.001). In addition, self-reported participation in diabetes education classes increased 34% among participants (p ≤ 0.001).

This evidence demonstrates that a digital education program effectively increases PWD’s knowledge and confidence to manage their diabetes. A digital education platform can serve as an important resource for PWD, especially those who may face barriers to receiving formal diabetes education.

Disclosure

Z. White: Employee; Self; American Diabetes Association. R. Woolley: Employee; Self; American Diabetes Association. S. Amanat: None. K. Mueller: None.
623-P: Phone-Based Diabetes Education Improves Diabetes Knowledge and Patient–Provider Conversations
Authors: WOOLLEY RYAN , WHITE ZACHARY , ROBINSON SHAMERA , MANDELSON JO , MUELLER KELLY
Published: June 2020

Diabetes education and support has been shown to effectively improve health outcomes among people with type 2 diabetes (PWD). However, PWD report limited time with healthcare providers (HCPs) to have meaningful discussions about diabetes management and prevention of complications. Less than half of PWD have ever had a conversation with their HCP about their increased risk for heart attack and stroke. In addition, evidenced-based diabetes self-management education and support programs (DSMES) are considerably underutilized. A phone-based education series was created to connect PWD across the country with a new diabetes expert each month. Through the platform, listeners can ask their questions, hear the questions of others, and receive live responses. The program aims to increase knowledge of diabetes management, improve patient-provider conversations, and drive enrollment into DSMES. To assess the program’s impact, phone-based surveys were conducted one day prior to events, immediately following, and one-month post events. From November 2018 to November 2019, each event averaged 509 participants, with over 2,700 unique participants across all events. Wilcoxon signed-rank tests were performed to determine paired differences. Across events, diabetes-related knowledge increased 12% on average from before events to after events. Within a month following the program, 14% more participants had a conversation with their HCPs about the link between heart disease and diabetes. In addition, the percent of participants who enrolled in DSMES increased 10%. The evidence demonstrates that a phone-based platform provides an effective avenue for increasing diabetes knowledge and empowering PWD to have better conversations with their HCPs. The platform can serve as an important resource for reaching populations that face barriers in access to diabetes care and support. Short recordings from the live events are created into a free podcast series, further expanding program reach.

Disclosure

R. Woolley: Employee; Self; American Diabetes Association. Z. White: Employee; Self; American Diabetes Association. S. Robinson: Employee; Self; American Diabetes Association. J. Mandelson: Employee; Self; American Diabetes Association. K. Mueller: None.
627-P: Online CME Improves Knowledge and Understanding of CVOT Data for T2D Therapies
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE
Published: June 2020

We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of multiple specialties related to CVOT data for T2D therapies. The CME activity was a 30-minute online video panel discussion. A repeated pairs pre-/post-assessment study design and chi-square test (P <.05 is considered significant) assessed educational effect. The activity launched June 28, 2019 and data were collected through July 31, 2019. In total, 723 PCPs, 97 D/Es, and 130 cardiologists were included in the analysis. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: • 16% of PCPs (P=.06), 19% of D/Es (P=.24), and 26% (P<.01) of cardiologists improved at identifying differences between CVOT patient populations • 25% of PCPs (P<.001), 19% of D/Es (P=.19), and 20% (P<.05) of cardiologists improved at recognizing nuances of CVOT patient populations of an ongoing CVOT that can assist in applying the data when available • 43% of PCPs, 37% of D/Es, and 42% of cardiologists reported increased confidence in understanding CVOT data Continued educational gaps: • 41% of PCPs, 39% of D/Es, and 37% of cardiologists failed to identify nuances of a CVOT patient population • 32% of PCPs, 20% of D/Es, and 28% of cardiologists failed to recognize guideline-based treatment recommendations based on CVOT data • 41% of PCPs, 39% of D/Es, and 37% of cardiologists failed to identify nuances of a CVOT patient population

This study demonstrates the success of online CME on improving knowledge and confidence of a multi-specialty group on CVOT data. Continued gaps were identified for future educational targets.

Disclosure

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

Funding

Merck & Co., Inc.
629-P: Factors Associated with Self-Management among Nepalese Adults with Type 2 Diabetes
Authors: SHRESTHA MONIKA , NG ASHLEY , GRAY RICHARD J.
Published: June 2020

Background: Diabetes is a global public health problem. Optimal diabetes self-management is associated with decreased diabetes-related complications and improved glycemic control.

Objective: To identify the factors associated with diabetes self-management among adults with type 2 diabetes.

Methods: A hospital-based cross-sectional study was conducted among 384 adults with type 2 diabetes attending their routine outpatient appointment at Tribhuvan University Teaching Hospital in Nepal. Data was collected via face-face interviews and a medical record review. Self-management was measured using the Summary of Diabetes Self-Care Activities (SDSCA). A series of structured questionnaires were used to measure sociodemographic, clinical factors, social support, self-efficacy and depression. Multiple linear regression analysis with backward elimination method was used to assess factors associated with self-management.

Results: The participants’ mean score for diabetes self-management was 3.3 ± 1.3 on a mean range of 0 to 7. Multiple linear regression analysis showed that low (β= -0.984, 95% CI: -1.313, -0.656) and moderate perceived social support (β = -0.702, 95% CI: -0.991, -0.412), low or moderate self-efficacy (β = -0.515, 95% CI: -0.912, -0.118), rural residence (β = -0.484, 95% CI: -0.791, -0.177), poor glycemic control (β = -0.265, 95% CI: -0.504, -0.027) and presence of any diabetes complication (β = -0.248, 95% CI: -0.490, -0.006) significantly lowered the level of self-management, after adjusting for age, educational status, marital status, comorbidity, family history of diabetes, BMI, diabetes knowledge, alcohol consumption and depression.

Conclusion: The diabetes education programs should use strategies that enhance self-efficacy of people with diabetes. People with type 2 diabetes from rural areas, with diabetes complications, impaired glucose control and poor social support may need special attention from health professionals to improve their self-management.

Disclosure

M. Shrestha: None. A. Ng: Consultant; Self; Roche Diabetes Care, Ypsomed AG. R.J. Gray: None.
63-LB: Self-Reported Adherence among Cardiac Surgery Patients with Diabetes Mellitus
Authors: VELA ALYSSA , CARROLL ALLISON J. , MCCARTHY PATRICK , OSTERMAN GAIL , GRADY KATHLEEN , FEINGOLD KIM
Published: June 2020

Successful cardiac surgery and recovery typically requires significant treatment adherence. For adults who undergo cardiac surgery and have diabetes mellitus (DM), the complex nature of behavior adherence is unique and especially demanding. Thus, we hypothesized that cardiac surgery patients with comorbid DM (CSDM) would report poorer treatment adherence than cardiac surgery patients without DM (CS).

In this secondary data analysis, we assessed self-reported adherence (diet, medications, appointments) among CSDM (N=51) and CS (N=240) pre- and 3 months post-operatively. Participants were predominately male (64%), middle aged (M=63, SD=14), and presented for valve (N=137), coronary artery bypass graft (CABG; N=42), valve + CABG (N=57), or another cardiac (N=55) surgeries. Chi-square analyses assessed differences in self-reported adherence (adherent/not adherent/not applicable) by DM diagnosis (yes/no). Pre-operatively, CSDM were more likely to endorse that following any specific diet was applicable to them (70% vs. 50%), yet reported higher rates of dietary nonadherence (42%) than CS (29%), x2(2)=7.2, p=.027. Rates of medication (p=.420) or appointment (p=.875) adherence did not differ by DM diagnosis. At follow-up, a greater proportion of participants reported that dietary adherence was applicable to them (CSDM: 94%; CS: 74%), still with greater rates of non-adherence for CSDM (81%) compared to CS (55%), x2(2)=7.7, p=.021. Medication adherence (p=.570) and appointment attendance (p=.054) did not differ between groups.

In this sample, CSDM seemed more aware of the importance of healthy diet, but were less likely to adhere to a diet (low sugar, sodium) than CS. This pattern may be due to greater awareness of dietary restrictions among patients with DM, as well as additional burden. Cardiac surgery patients with comorbid DM may benefit from additional support from dieticians and psychologists to address the complex psychosocial nature of dietary adherence in comorbid health conditions.

Disclosure

A. Vela: None. A.J. Carroll: None. P. McCarthy: None. G. Osterman: None. K. Grady: None. K. Feingold: None.
632-P: Challenges and Opportunities for Patient-Centered DSME/S for Older Adults: Finding the Key to the Patient Portal
Authors: KIM MIN , KHAN UZMA Z. , BOREN SUZANNE A. , YE QING , SIMOES EDUARDO J.
Published: June 2020

Mobile apps, patient portals, and EHRs are promising tools to enhance recommended behaviors for DM. This study reports whether these technologies could effectively deliver patient-centered DSME/S for older people with DM.

We analyzed 179 of 1050 DM apps according to AADE7 self-care principles. Most DM apps included features of Monitoring (73%). Few apps supported Healthy Coping (9%), an essential principle for older adults with DM challenged with comorbid conditions. In addition, two focus groups (n=10, mean age=67) revealed a low usability score: 48/100. Participants had trouble using the apps due to poor navigation, visual and physical limitations.

We also analyzed 200 visit notes randomly selected from 2634 notes of adults with DM from an EHR that provides access to clinic notes via a patient portal. Notes were written at Flesch Kincaid level 9.6. Using AADE7 principles, we conducted a thematic analysis to determine patterns of DSME/S information. Out of 3735 codes, Monitoring (48%) was addressed most frequently, possibly due to insurance requirements. Healthy Coping (2%) was addressed least frequently, possibly due to time constraints. Generalized linear mixed models revealed no significant associations between DSME/S delivered and patient demographic/DM control measures. Many patients shared data about glycemic control (88%) and had active patient accounts (50%) allowing access to clinical data.

Our study shows that features and content of DM apps are not ideal for older adults. We found that patient notes in EHR were above NIH recommended readability levels (6th grade) and many older adults may not understand key points. We did find that older people have access to patient portals, and share information with providers. Patient portals are increasingly available through EHR. User-centered design process should be employed for patient-centered DSME/S to facilitate usability, readability, and information sharing through patient portals for older people with DM.

Disclosure

M. Kim: None. U.Z. Khan: None. S.A. Boren: None. Q. Ye: None. E.J. Simoes: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950)
638-P: Using Contact-Based Education to Improve Diabetes-Related Stigma among Medical Residents in a Military Health System
Authors: WAN WINGYEE , WARDIAN JANA L.
Published: June 2020

Introduction: Healthcare provider-related stigma against patients with diabetes is related to worse doctor-patient relationships and may contribute to worse patient self-care. A previous feasibility study showed benefit in using a contact-based education approach to improve attitudes of medical students towards patients with diabetes. This study evaluated how diabetes-related stigma of internal medicine residents in a military health system was affected by a one-hour panel of people who have personal experience with diabetes.

Methods: Panel participants included a woman with two sons who have type 1 diabetes, an active duty male soldier diagnosed with type 2 diabetes, and a veteran with type 2 diabetes. Patients were asked to discuss their personal experiences with diabetes, common misconceptions regarding diabetes, and what they wish healthcare providers understood about diabetes. The validated Diabetes Attitude Scale-3 (DAS-3) questionnaire, which assesses diabetes-related attitudes based on a 5-point Likert scale (strongly agree = 5, strongly disagree = 1), was given before and after the panel. The survey also included a short-answer section to elicit individual opinions on diabetes-related stigma. Survey responses were linked with 3 identifier questions to preserve anonymity.

Results: Twelve participants completed both the pre- and post-panel survey. Seven were female (58%), 10 were white (83%), and 8 were from suburban communities (67%). Out of the 33 questions on the DAS-3 questionnaire, there were statistically significant changes regarding the belief that “diabetes affects almost every part of a diabetic person’s life” (mean increased from 4.33 to 4.92, p=0.012) and that “the important decisions regarding daily diabetes care should be made by the person with diabetes” (mean increased from 4.08 to 4.67, p= 0.046).

Conclusion: Contact-based education can be considered as a tool for reducing diabetes-related stigma among medical trainees.

Disclosure

W. Wan: None. J.L. Wardian: None.
641-P: Relative Contribution of Individual, Community, and Health System Factors on Glycemic Control among Inner-City African Americans with Type 2 Diabetes
Authors: CAMPBELL JENNIFER A. , EGEDE LEONARD E.
Published: June 2020

Background: Health disparities are disproportionately impacting inner-city African Americans, however limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes.

Methods: A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A theoretical model was used to specify measurements across the individual level, such as age and comorbidities, community level, such as neighborhood factors and support, and health systems level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health systems factors and regressed against HbA1c.

Results: In the final adjusted model across all four approaches, individual level factors like age (β=-0.05; p<0.001); having 1-3 comorbidities (β=-2.03; p<0.05) having 4-9 comorbidities (β=-2.49; p=0.001) were associated with lower glycemic control. Similarly, male sex (β=0.58; p<0.05), being married (β=1.16; p=0.001), and overweight/obesity (β=1.25; p<0.01) were associated with higher glycemic control. However, community and health system level factors were not significantly associated with glycemic control.

Conclusion: Individual level factors are key drivers of glycemic control among inner-city African Americans. These factors should be targeted for intervention development and delivery. Further research is needed to examine the indirect pathways via community and health system factors that may explain the relationships with glycemic control.

Disclosure

J.A. Campbell: None. L.E. Egede: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 to L.E.E.)
657-P: The National Diabetes Prevention Program: Does Start Date Matter?
Authors: ELY ELIZABETH , BELL MIRIAM
Published: June 2020

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working together to build a nationwide infrastructure to deliver a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. Much variability exists in the number of days participants stay in the 12-month program. Of the 217,585 eligible participants enrolled in in-person and online organizations as of October 2019, the average length of stay in the program was 163 days (210 for in-person, 134 for online) with interquartile range of 238 (231 for in-person, 161 for online). The reasons for leaving the program are not collected; only information such as participant demographics, type of program delivery (in-person or online), and date of the first session attended can be assessed. To determine whether retention is related to the time of year a participant enters the program, a seasonal model was applied, where the response variable was the number of days a participant stayed in the program. Separate models were run for all participants, and by sex and delivery mode, to look at the impact of start date on retention. Overall, participants who started the program on day 267 (September) were predicted to stay in the program longest: 178 days (95% CI: 176, 179). The range of predicted days was 137-178. Longest predicted number of days in the program for men and women was 161 (158, 164) and 182 (180,184), respectively, and was also associated with September start dates. In-person participants who started on day 270 (September) were predicted to have the longest stay, 218 (216, 220) with range of 192-218. Estimates for online participants showed a maximum of 142 days (140, 144), which was associated with start dates in June (day 163) and had a range of 128-142. All models predicted that the shortest stay in the program was associated with starting in November. Retention is strongly associated with enrollment timing; this information may be helpful as organizations plan future classes.

Disclosure

E. Ely: None. M. Bell: None.
66-OR: Effect of Time-in-Range over 14 Days on Glycaemic Controls and Hypoglycaemia Unawareness in Patients Using Freestyle Libre
Authors: DESHMUKH HARSHAL , WILMOT EMMA G. , HERRING ROSELLE , PATMORE JANE , SATHYAPALAN THOZHUKAT , RYDER ROBERT E. , WALTON CHRISTOPHER
Published: June 2020

Objective: Time in range (TIR) is a novel measure of glucose control endorsed by an international consensus group. Given the increased use of FreeStyle Libre (FSL) in the UK, we wanted to investigate the effects of TIR over 14 days of FSL (TIR-14) use on glycaemic control, hypoglycaemia unawareness.

Methods: Clinicians from 101 National Health Service hospitals in the United Kingdom submitted FSL user data, collected during routine clinical care. TIR-14 was defined as the percentage of time the patients with type 1 diabetes spent in the individualised target range of blood sugar which ranged from 3.9 to 10 mmol/L(70-180mg/dl) over 14 days of FSL use. TIR-14 was divided into two categories <= 50%, (Group 1) and TIR-14>50% (Group 2). T-tests were used to compare the baseline and follow-up HbA1c, and GOLD score in the two groups.

Results: Data were available for 10,370 FSL users; age 38 (±18.7) years, 54% female, diabetes duration 16 (±49) years, and BMI of 25.2 (±16.5) kg/m2. TIR-14 data was available for 2191 patients who had at least one follow-up (1422 in Group 1 and 769 in Group 2). There were large variations in the individualised target TIR-14; however, more than 99% of patients had ranges in-between 3.9-10 mmol/mol with a median TIR-14 of 43%(27%-56%). The mean follow-up period was 7.6(±23) months. In Group 1 HbA1c dropped from 8.6% to 7.6% (P<0.0001) while in Group 2 the HbA1c dropped from 7.6% to 7%. (P<0.0001). In an analysis restricted to those with baseline HbA1c of >8.5%, HbA1c dropped from 9.8% to 8.8% (P<0.0001) in Group 1 while in Group 2 it fell from 9.6% to 7.7% (P<0.0001). In the Group I the GOLD score fell by 0.25 (P=0.0005) units while in Group II the GOLD score fell by 0.45 units (P<0.0001).

Conclusion: This population-based study of FSL users demonstrates that TIR-14 of more than 50% is associated with a significantly improved glycaemic control in especially in those with higher baseline HbA1c and is associated with a larger improvement in hypoglycaemia unawareness.

Disclosure

H. Deshmukh: None. E.G. Wilmot: Advisory Panel; Self; Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic. Speaker’s Bureau; Self; Abbott, Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Sanofi. R. Herring: None. J. Patmore: None. T. Sathyapalan: Research Support; Self; Amgen, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S. Other Relationship; Self; Ipsen Biopharmaceuticals. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S. C. Walton: Speaker’s Bureau; Spouse/Partner; Celgene, LEO Pharma, Novartis Pharmaceuticals Corporation.
661-P: Do Diabetes Apps Deal with Blood Pressure; Do Blood Pressure Apps Deal with Diabetes?
Authors: WU GLORIA , WONG JONATHAN , LAU CHAP-KAY K. , MOMEN DONIA , ROTTENBORN REBECCA
Published: June 2020

Background: Diabetic patients have high blood pressure and conversely, hypertensive patients have diabetes. Do eHealth apps meet the needs of these patients?

Purpose: Do Diabetes apps ask about blood pressure and do hypertension apps ask about diabetes parameters?

Methods: Using the search term “diabetes,” and “blood pressure” (BP), Google Play Store (Droid) and Apple App Store (iOS) were accessed for the most downloaded, free DM and BP mobile apps. Inclusion criteria: 1) downloads > 100,000 for Droid and ratings > 50 for iOS, 2) free. Diabetes apps were evaluated: DSMES, and ACC/AHA guidelines (120/80 mm Hg). BP apps: BP log, ACC/AHA guidelines, weight, height, BMI, medication log, and DSMES. Exclusion criteria: Apps with no data on downloads or rankings.

Results:

0/20 diabetes apps had correct ACC guidelines, 0/20 diabetes apps had podiatry guidelines. Of the 20 HTN apps, on average 3.6/11 DSME criteria were mentioned. 5/20 BP apps had medication log vs. 14/20 in DM apps. Both Droid and iOS apps are similar in the number of features offered.

Conclusion: Diabetes apps follow the DSMES guidelines more often than the Blood Pressure apps following the ACC/AHA guidelines. There is room for improvement for eHealth apps in the management of diabetes and hypertension.

Disclosure

G. Wu: None. J. Wong: None. C.K. Lau: None. D. Momen: None. R. Rottenborn: None.
667-P: Optimized Pump Utilization and Increased Pump Initiation with Zero Additional Resource Utilization
Authors: MIYSSHIRO LORI A. , HINNEN DEBORAH
Published: June 2020

By utilizing Certified Pump Trainers (CPTs) to teach patients how to best utilize their insulin pumps, our clinic has been able to provide superior care to their patients with diabetes, with zero additional clinic resources. This innovative partnership with all 3 pump companies has resulted in the doubling of the pump program in less than 1 years time. UCHealth patients treated within this program started with baseline HbA1cs as high as > 14.5%, with reductions achieved down to as low as 5.2%. Even though approximately 15% of patients did not reach glycemic goals, diabetes-related hospitalizations were reduced by 82% in that subpopulation after initiating pump therapy. These superiorA1C reductions and reduced hospitalizations outcomes are attributed in part to the advantage of having the expertise of company-trained CPT providing customized doing the insulin pump education, personalized training done in partnership between the CDE and CPT prior to training after a review of the patient’s assessment of preferred learning style(s). Additional clinical needs, educational barriers, and psychosocial issues prepare the CPT for a more comprehensive, individualized training. Easy access to care after initial training is essential, with both the CPT and the CDE providing phone support and in-person follow up in 1-2 weeks. Proper pump selection factoring in each patient’s needs, coupled with very patient-specific customization is contributing to the achievement of these superior outcomes and a doubling of our pump program without utilizing clinic resources.

Disclosure

L.A. Miysshiro: None. D. Hinnen: None.
67-LB: Clinical Cost Offset Analysis Comparing Real-Time CGM (RTCGM) with SMBG Based on the COMISAIR 3-Year Follow-Up Study
Authors: SOUPAL JAN , ISITT JOHN J. , GRUNBERGER GEORGE , PRAZNY MARTIN , PARKIN CHRISTOPHER , MINSHALL MICHAEL E. , LYNCH PETER M.
Published: June 2020

This clinical cost offset analysis compared rtCGM vs. SMBG in people with type 1 diabetes (T1D) applying results from a 3-year, nonrandomized, prospective, real-world clinical trial (COMISAIR). Clinical effects for HbA1c reduction using rtCGM vs. SMBG combined with MDI (-0.96%) or CSII (-0.71%) after 3 years were converted directly into an economic benefit and inflated ($U.S. 2020). The MDI group showed reduced 3-year event rates for severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) of 68% and 100%, respectively. The CSII group showed 50% and nearly 0% fewer SH and DKA events, respectively, using rtCGM vs. SMBG. Estimated costs for HbA1c reduction (low/high) along with SH and DKA events were taken from published literature and inflated ($U.S. 2020). Switching from SMBG to rtCGM would result in an estimated 487 and 238 fewer SH and DKA events, respectively, for the MDI group and 208 and 8 fewer SH and DKA events in the CSII group. Table 1 describes the potential economic benefit. Sustained reduction in HbA1c for rtCGM vs. SMBG represents over 95% of the potential economic value and per person savings range from $3,555-$6,747 after 3 years. Our modelling study demonstrates compelling clinical and economic benefits of sustained HbA1c control using rtCGM over SMBG in T1D.

Disclosure

J. Soupal: Advisory Panel; Self; Abbott. Consultant; Self; Medtronic, Roche Diabetes Care. Speaker’s Bureau; Self; Dexcom, Inc. J.J. Isitt: Employee; Self; Dexcom, Inc. G. Grunberger: Research Support; Self; Medtronic. M. Prazny: Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Roche Diabetes Care. Other Relationship; Self; Abbott, Boehringer Ingelheim International GmbH, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi, Teva Pharmaceutical Industries Ltd. C. Parkin: Consultant; Self; Abbott, CeQur Corporation, Dexcom, Inc., DreaMed Diabetes, Novo Nordisk Inc., Onduo, Roche Diabetes Care, Valeritas, Inc. M.E. Minshall: Consultant; Self; Dexcom, Inc. P.M. Lynch: Employee; Self; Dexcom, Inc. Stock/Shareholder; Self; Dexcom, Inc.

Funding

Dexcom, Inc.
67-OR: Benefit of Reduced Hypoglycemia with Continuous Glucose Monitoring (CGM) Is Sustained through 12 Months among Young Children with Type 1 Diabetes (T1D)
Authors: VAN NAME MICHELLE A. , MILLER KELLEE , KANAPKA LAUREN , TAMBORLANE WILLIAM V. , DIMEGLIO LINDA
Published: June 2020

The SENCE study in children < 8 yrs with T1D compared the efficacy of CGM combined with a family behavioral intervention (CGM + FBI) and CGM alone (Standard-CGM) with blood glucose monitoring (BGM) alone. Time in hypoglycemia fell in both CGM groups but was unaffected in the BGM group during the 26-week trial. After trial completion, both CGM groups extended their time on CGM for 26 weeks without additional education/behavioral intervention. This analysis assessed whether prolonged CGM use maintained durable reductions in time in hypoglycemia throughout the entire 52-week period. The extended study was completed by 45 of 50 in the CGM + FBI group and 42 of 44 in Standard-CGM. In these 87 kids, median age was 5.6 years and 31% were on insulin pumps. Differences in the two CGM groups were compared to masked baseline CGM data from run-in. Median time <70 mg/dL was reduced from baseline to 52 weeks in CGM+FBI group (3.4%,50 minutes/day to 2.0%, 29 minutes/day, p<0.001, see Figure) and with Standard-CGM (4.1%, 59 minutes/day, to 2.1%, 30 minutes/day, p<0.001). Importantly, time in hypoglycemia remained lower after conclusion of the interventions through 52 weeks in both groups. We observed similar reductions for time <54 mg/dL (data not shown).

Conclusion: Sustained CGM use results in less hypoglycemia in young children with T1D.

Disclosure

M.A. Van Name: None. K. Miller: None. L. Kanapka: None. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Sanofi US. Other Relationship; Self; Eisai Inc., MannKind Corporation. L. DiMeglio: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
673-P: Food Insecurity and Intervention Opportunities for American Indians and Alaska Natives with Type 2 Diabetes: A Qualitative Analysis
Authors: STOTZ SARAH A. , LOCKHART STEVEN , BREGA ANGELA G. , MOORE KELLY R.
Published: June 2020

Food insecurity is well documented as a social determinant of health and as a barrier to healthful eating and diabetes management. American Indians and Alaska Natives (AI/ANs) are twice as likely to experience food insecurity and type 2 diabetes (T2D) as non-Hispanic Whites. The purpose of this project was to identify themes regarding food insecurity and healthful eating in relation to diabetes management among AI/AN adults with T2D. The reported analysis used qualitative data originally collected to inform adaptation of an existing American Diabetes Association diabetes nutrition education program for AI/AN adults with T2D. Qualitative data were collected through focus groups and interviews with AI/ANs with T2D, their family members, and key stakeholders such as healthcare administrators, registered dietitians, and diabetes educators. Two coders analyzed transcripts in their entirety using the constant-comparison method for qualitative content analysis. Key themes included the following: (1) Rural and urban AI/ANs have different primary food security challenges. AI/ANs who live in rural reservation locations discussed loss of traditional foods and loss of access to land where these foods were once found. Urban-dwelling AI/ANs, on the other hand, highlighted the cost of healthful food as their primary food security challenge. (2) AI/ANs discussed logistical problems with accessing healthy food (i.e., lack of time, need for convenience, easy access to fast and processed food, high cost of healthful food, loss of traditional food) whereas nutrition educators focused on solutions, such as cooking and nutrition education. (3) When discussing the high cost of healthful foods, focus group participants concentrated almost exclusively on the high cost of fresh produce as opposed to other healthful food products. Findings from this analysis will help inform the development of food security resources for AI/ANs with T2D.

Disclosure

S.A. Stotz: None. S. Lockhart: None. A.G. Brega: None. K.R. Moore: None.

Funding

American Diabetes Association (4-18-SMSC-01 to K.R.M.); National Institutes of Health (P30DK092923); Center for American Indian and Alaska Native Diabetes Translational Research
674-P: Missed Diagnosis of Lipohypertrophy by Inspection and Palpation: Prevalence and Contributing Risk Factors
Authors: XU JINGJING , LUO DAN , WANG HONG , ZHU MIN , SHI YUN
Published: June 2020

Background: Lipohypertrophy (LH) is harmful and requires early diagnosis. While LH is typically detected by inspection and palpation (physical examination), the reliability is potentially low. We evaluated the prevalence and contributing risk factors for missed LH compared to ultrasound scanning (USS).

Methods: This was a cross-sectional study included 260 patients who had injected insulin continuously for at least 1 year. Physical examination and USS were used meanwhile. Associations between missed diagnosis and clinical, injection behavioral variables were examined.

Results: Patients were 40.4 ± 23.7 years old, 52.7% male, 50.8% type 1 diabetes. 80.8% were diagnosed with LH by USS, that three characteristics are significant thickening of the subcutaneous fat layer; increased echogenicity in diffuse areas; nodular hyperechoic foci. Physical examination resulted in a 39.0% false negative rate. By stepwise logistic regression, duration of insulin therapy modestly associated with missed diagnosis of LH (odds ratios [OR] = 0.84, P < 0.001); Higher BMI and correct site rotation showed ORs of 3.02 (P = 0.005) and 3.67 (P < 0.001), respectively.

Conclusions: Physical examination was associated with a high rate of missed LH diagnosis for patients received insulin for a short duration, higher BMI etc. Ultrasound scanning should be used as a complementary technique.

Disclosure

J. Xu: None. D. Luo: None. H. Wang: None. M. Zhu: None. Y. Shi: None.
676-P: Ideal Ketone Test Training among Type 1 Patients in Context of Risk Associated with SGLT2 Inhibitors
Authors: ROST JONATHAN B. , SUHL SARA , STONER KEATON C. , FLORISSI CATERINA , GOWEN REBECCA , WOOD RICHARD
Published: June 2020

SGLT2 inhibitors are not approved for people with type 1 diabetes in the U.S. due to elevated risk of diabetic ketoacidosis (DKA), prompting interest in ketone testing education. This study surveyed 4,612 people with type 1 diabetes across the U.S., EU, and Canada regarding their preferred method and duration of ketone testing education if they were to start a new therapy that increased DKA risk. Overall, a phone app was the preferred method of education, with some country-level differences apparent. In the U.S., Germany, and the Netherlands, 15-30 minutes was the most selected training time duration, while the remaining countries most commonly selected 1-2 hours. When considering the safety of SGLT2 therapy for type 1 patients, this data lends important insights into the feasibility and optimal composition of ketone test training.

Disclosure

J.B. Rost: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. S. Suhl: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. K.C. Stoner: Other Relationship; Self; Various companies and organizations. C. Florissi: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Gowen: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Wood: Consultant; Self; Abbott, ADOCIA, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim Pharmaceuticals, Inc., CeQur Corporation, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation. Employee; Self; dQ&A Market Research Inc.