bluuebunny/crossref_metadata_2025 huggingface dataset:
434-P: Patients Hospitalized with Diabetes Mellitus and Underlying Atrial Fibrillation Have Higher Inhospital Mortality and Greater Risk for Cardiac Arrest and Cardiogenic Shock
Authors: FATUYI MICHAEL , PEREIRA LEANNE , SHARMA VIVEK , KHOKHLOV LEONID , NAMDARIZANDI VAHID , ELABIDIN AWFA ZAIN , ORJI RICHARD T. , SHEMISA KAMAL
Published: May 2022

Introduction: Atrial fibrillation (AF) is a prevalent cardiovascular disease among patients with diabetes mellitus (DM) . Heart failure risk (HF) & In-hospital outcomes surrounding AF are poorly understood among diabetes

Methods: We queried the National Inpatient Sample from 2016 to 2018 for patients with DM as a principal diagnosis with & without underlying AF as a secondary diagnosis. The primary outcome was mortality, while secondary outcomes were cardiogenic shock (CS) , Cardiac Arrest (CA) , Mean Length of stay (LOS) , Total hospital cost (THC) , & average patient charge (APC) . Multivariable regression models were applied for outcomes

Results: A total of 1,211,870 patients with DM were admitted with 11.9% having AF. AF vs. No AF cohorts were mean age of 71.4 years vs. 59.3 years & Females (35.5% vs. 41.7%) . CAD, HF & CKD were more prevalent (51.6% vs. 25.9%) , (47.8% vs. 16.2%) , (52.5% vs. 34.6%) in DM with AF. Higher inpatient mortality, CS, CA, APC & LOS were observed in the AF group (Table 1)

Conclusion: One in nine patients hospitalized with DM has AF. Comorbid heart & kidney disease were prevalent in DM patients with AF. Higher in-hospital mortality & adverse cardiovascular outcomes were observed in these patients, with greater costs for the hospital & patient. Preventative treatment addressing HF risk in DM patients with AF maybe improve outcomes & costs.

Disclosure

M.Fatuyi: n/a. L.Pereira: None. V.Sharma: None. L.Khokhlov: None. V.Namdarizandi: None. A.Zain elabidin: None. R.T.Orji: None. K.Shemisa: Speaker's Bureau; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, ESPERION Therapeutics, Inc., Merck & Co., Inc., Pfizer Inc.
436-P: Reducing Autoinflammation: The Impact of T-Cell Deficiency on Atherosclerosis
Authors: SHEPHERD ALYSSA J. , YUSSMAN MARTIN , WAGNER DAVID H. , VAITAITIS JR., GISELA M.
Published: May 2022

Type 1 diabetes (T1D) , a prototypic autoimmune disease, creates several serious complications of which atherosclerosis is the major co-morbid condition. Atherosclerosis is defined by arterial plaque deposition due to coagulation blood products, lipid deposition, and inflammation. The latter has been known for more than a decade but only recently have inflammatory mediators proven to be a beneficial target once traditional treatment has been exhausted. T-cell mediators associated with the CD40-CD154 inflammatory dyad are found in autoimmune diseases such as T1D and rheumatoid arthritis and may be a cause of the added atherosclerotic risk which these disease states maintain. This study seeks to explore the role of T cells in atherogenesis through the use of pro-atherogenic ApoE-/- mice bred to create T cell deficiency (ApoE-/- TCRα-/-) for analysis of the overall effect of T cells in atherogenesis. Mice are sacrificed at 8 months of age and dissected to obtain the aortas and hearts. The aorta is used for en-face Sudan IV staining analysis while serial aortic valve cross sections are used to characterize the lesion in terms of area and content. Analyses of aortic valve cross sections (A-D) and whole aortas (E-F) of this novel model not only demonstrated a significant reduction in overall plaque, but also revealed a change in plaque composition due to T cell deficiency. Future aims are to define the specific subset of pathogenic T cells.

Disclosure

A.J.Shepherd: None. M.Yussman: None. D.H.Wagner: Other Relationship; Op-T, LLC. G.M.Vaitaitis: None.

Funding

National Institutes of Health (4R42DK115296-02)
454-P: Association between Insulin and C-Reactive Protein: Data from Athletes and Coronary Angiography Patients
Authors: LEIHERER ANDREAS , RINDERER MARTIN , MUENDLEIN AXEL , SAELY CHRISTOPH H. , MADER ARTHUR , SPRENGER LUKAS , MAECHLER MAXIMILIAN , VONBANK ALEXANDER , LARCHER BARBARA , FRAUNBERGER PETER , SOHM MARC , PHILIPPE MARC , DREXEL HEINZ
Published: May 2022

A better understanding of the relationship between insulin and inflammation may have important implications for the treatment and prevention of diabetes. Chronic inflammation and diabetes are associated with coronary artery disease (CAD) . That said, many studies found no correlation between insulin and C-reactive protein (CRP) , the most common marker of chronic inflammation. We hypothesize here that the association of insulin and CRP may differ in different patient groups and may be masked by factors such as age, fitness or diseases, in particular established CAD. We thus evaluated the correlates of insulin and CRP among healthy professional athletes (Group 1, mean age = 24 years (ranging from 18-35 years) , n=59) , and patients undergoing coronary angiography (27-88 years, n=1574) who were further divided into younger (<60 years) patients without sign. CAD (Group 2, mean age = 52 years, n=258) , younger patients with sign. CAD (Group 3, mean age = 52, n=287) and older (≥60 years) patients without sign. CAD (Group 4, mean age 69, n=407) as well as older patients with sign. CAD (Group 5, mean age 70, n=622) . CRP and insulin were positively correlated in athletes (r1=0.544, p<0.001) and in patients without sign. CAD (r2=0.194, p=0.002 and r4=0.134, p=0.007) but not in patients with sign. CAD (r3=-0.001, p=0.981 and r5=0.000, p=0.955) . In multivariate models including covariates BMI and age, CRP and insulin remained significantly associated in athletes (T1=4.7, p<0.001) and in patients without sign. CAD (T2+4=3.3, p=0.001) , but not in those with sign. CAD (T3+5=0.0, p=0.997) . We conclude that CRP and insulin correlate in young and fit subjects but also in older subjects who do not have sign. CAD. The presence of CAD may abrogate the association between inflammation and insulin, potentially due to the inflammatory state of atherosclerosis. This appears worthwhile to be considered in future screening and treatment approaches.

Disclosure

A.Leiherer: None. P.Fraunberger: None. M.Sohm: None. M.Philippe: None. H.Drexel: None. M.Rinderer: None. A.Muendlein: None. C.H.Saely: None. A.Mader: None. L.Sprenger: None. M.Maechler: None. A.Vonbank: None. B.Larcher: None.
457-P: Increase in Functional Connectivity of the Thalamus to the Primary Somatosensory Cortex and Insular Cortex after Withdrawal of Neuropathic Pain Medication: A Potential Biomarker of Painful-DPN
Authors: SLOAN GORDON P. , SELVARAJAH DINESH , TEH KEVIN , TESFAYE SOLOMON
Published: May 2022

Aims: Altered functional connectivity has been identified in key brain regions involved in somatosensory perception in patients with painful diabetic peripheral neuropathy (painful-DPN) , using resting state functional-magnetic resonance imaging (fMRI) . This study aimed to examine the impact of neuropathic pain treatments on these regions.

Methods: Fifteen participants with Painful-DPN enrolled in the OPTION-DM clinical trial underwent underwent fMRI imaging using 3T when the participants were on maximum tolerated medication (Treatment Scan) and one week after medication washout (Washout Scan) . The data was analysed using Conn Functional Connectivity Toolbox in SPM.

Results: There was a significant increase in Pain Numeric Rating Scale (NRS) from Treatment Scan (4.0 ± 2.1) to the Washout Scan (6.1 ± 2.4, p=0.044) with a corresponding rise in functional connectivity between the Primary Somatosensory Cortex (S1) and the Thalamus, and the Insular Cortex and Thalamus (p=0.041) . There was a significant difference in the change between scans in S1 - Thalamic functional connectivity in participants with Severe-Pain (NRS ≥8 at baseline: -0.372 ± 0.275) compared to participants with Moderate-Pain (NRS ≤7: -0.051 ± 0.180, p=0.035) . The change in S1-Thalamic connectivity also correlated with baseline pain (r -0.585, p=0.022) and the difference in NRS at the Treatment Scan and Baseline pain (r -0.513, p=0.050) .

Conclusions: On neuropathic pain medication withdrawal there is an increase S1 - Thalamus and Insular Cortex - Thalamus functional connectivity. Moreover, the change in S1 - Thalamus functional connectivity from the Treatment Scan to Withdrawal Scan differentiated participants with high and low baseline neuropathic pain. This study demonstrates that thalamic functional connectivity to the S1 and Insular Cortex has the potential to act as a biomarker of painful-DPN.

Disclosure

G.P.Sloan: None. D.Selvarajah: None. K.Teh: None. S.Tesfaye: Advisory Panel; Astellas Pharma Inc., Bayer AG, Grünenthal Group, Nevro Corp., Wörwag Pharma GmbH & Co. KG, Speaker's Bureau; Eva Pharma, Pfizer Inc., Viatris Inc.
459-P: Effects of Liraglutide on Somatic Nerve Function in Subjects with Type 2 Diabetes
Authors: CASELLINI CAROLINA M. , PARSON HENRI , BAILEY MICHAEL D. , SIRAJ ELIAS S.
Published: May 2022

Background: Preclinical data has shown that GLP-1 receptor agonists play a role in nerve regeneration and repair. However, few studies have investigated the effects of these compounds on nerve function in humans. The aim of this study was to examine the effect of Liraglutide (Lira) on somatic nerve function in patients with type 2 diabetes.

Methods: Randomized, double-blind, placebo-controlled study of Lira 1.8 mg daily for 52 weeks. All participants were evaluated with the following somatic nerve function tests: Utah Early Neuropathy Scale (UENS) , quantitative sensory testing (QST) for cold and warm perception thresholds (Q-Sense v6.0.13.1; Medoc - Minneapolis, MN) , nerve conduction studies (NCS) (Sierra Summit System; Cadwell Industries - Kennewick, WA) and in vivo corneal confocal microscopy (CCM) to measure corneal nerve fiber density, branching and length (Tomograph III; Heidelberg Engineering - Smithfield, Rhode Island)

Results: We randomized 44 subjects (21 to Lira and 23 to pb) . Baseline characteristics were similar. Main results are shown in Table 1. In both groups, there was no significant change on UENS, QSTs, NCS and CCM measures after 1 year of treatment. The results also were not significantly different between the groups.

Conclusions: This study did not show improvements in somatic nerve function after 52 weeks of treatment with Lira. The small sample size may have contributed to the negative result.

Disclosure

C.M.Casellini: Advisory Panel; Nevro Corp. H.Parson: None. M.D.Bailey: None. E.S.Siraj: Consultant; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Research Support; Novo Nordisk.

Funding

Novo Nordisk (Grant#15-12-FB-0218)
464-P: Detecting Diabetic Peripheral Neuropathy Utilizing Thermoregulation of the Plantar Foot
Authors: SOLIZ PETER , DURAN-VALDEZ ELIZABETH , BANCROFT ANNA P. , TANG GUANLIN , SCHADE DAVID S. , VIJAYAMOHANAN JAYAKRISHNAN
Published: May 2022

Purpose: To demonstrate thermal features of the foot in diabetic subjects without known peripheral neuropathy.

Background: Assessment of thermoregulation of the foot in patients diagnosed with diabetes identifies those predisposed to foot ulcer and amputation.

Methods: The clinical study of the thermoregulation of the microvascular processes of the plantar foot included 100 subjects with diabetes ages 35 to 76. Subjects underwent a complete clinical exam and nerve conduction study. Thermal imaging with a portable device followed a standard procedure for cooling of the plantar foot, followed by video imaging of the plantar surface during re-warming. The reference standard for neuropathy was a nerve conduction study. Features included: Initial temperature; temperature after cold provocation; and recovery temperatures.

Results: The figure shows the 6 standard regions studied. The temperature after cooling for the normal subject was 16 deg C with a recovery temperature of 6 to 8 deg C after 400 s. For the subject with neuropathy the temperature after cooling dropped only to 18 deg C and recovered 2 to 4 deg C. Using these features, the sensitivity was 85% sensitivity and 70% specificity.

Conclusion: Quantification of thermoregulation of the foot provides a new and non-invasive assessment of diabetic peripheral neuropathy in patients with diabetes. Identification of these at-risk patients may prevent amputation.

Disclosure

P.Soliz: None. E.Duran-valdez: None. A.P.Bancroft: None. G.Tang: None. D.S.Schade: Consultant; AbbVie Inc. J.Vijayamohanan: None.

Funding

NIH 2R44DK104578-04A1
465-P: AGE Precursor Methylglyoxal May Result in Behavioral Pattern of Neurological Disorders in Animal Mouse Model
Authors: YUE KEVIN
Published: May 2022

Purpose of the study: Diabetes mellitus (DM) is characterized by chronic hyperglycemia and diabeticcomplications. Impairment in neuropsychological functioning in DM patients is shownin clinical studies. Patients with DM have a higher risk of developing neurologicaldisorders, including Parkinson’s disease (PD) , depression, and anxiety. Symptoms ofthese diseases are observed in diabetic animal models and in population-based studies.DM-induced activation of stress responses in the central nervous system (CNS) such asoxidative stress and neuroinflammation may lead to various neurological disorders.Abnormal accumulation of methylglyoxal (MG) , one of the most reactive advancedglycation end-product (AGE) precursors, is found in the serum of DM patients. As MGis reported to induce brain cells impairment in the CNS, the effect of MG leading tosubsequent symptoms of the three neurological disorders was investigated.

Methods: C57BL/6 mice were treated with MG solution (60mg/kg) or sham control byintraperitoneal injection for weeks. Rotarod test, open-field test (OFT) , and forcedswim test (FST) were used to examine the motor coordination, anxiety-like behavior,and depressive-like behavior of mice respectively. Corresponding parameters of thetests were measured and recorded.

Summary of the results: In the rotarod test, significantly reduced latency to fall off was observed in the MG-treated group (74.1 ± 5.33) than that in the control group (92.9 ± 5.80) . In the OFT,significantly reduced total traveled distance (285 ± 1.01) was observed in the MG-treated group than that in the control group (13.4 ± 1.48) . In the FST, significantlyincreased percentage of immobile time was observed in the MG-treated group (77.6 ±2.19) than that in the control group (68.7 ± 2.42) .

Conclusions: MG could induce symptoms of PD, depression, and anxiety in mice. MG may play arole in the dysfunction of brain cells and dysregulation of CNS resulting in neurologicaldisorders

Disclosure

K.Yue: None.
466-P: Changes in Oral and Intestinal Bacterial Flora Associated with Pain Thresholds
Authors: KUDOH KAZUHIRO , TAKEUCHI YUKI , OSONOI SHO , SASAKI TAKANORI , OGASAWARA SAORI , YAGIHASHI SOROKU , MIZUKAMI HIROKI
Published: May 2022

Small fiber neuropathy (SFN) manifests from the early stages of diabetic polyneuropathy. Changes in the oral and intestinal bacterial flora are known to be associated with the onset and progression of diabetes and its complications. However, correlation between SFN and each bacterial flora has not yet been investigated. In the 2018 Iwaki health promotion project, which is a local health promotion study in Aomori prefecture, 1037 participants (431 males and 6females including 814 non-glucose metabolism disorders, 143 fasting hyperglycemia (IFG) , and 80 type 2 diabetic cases (DM) , were evaluated. SFN was evaluated by the pain threshold evoked by intraepidermal electrical stimulation (PINT) . A PINT value of 0.or less was designated as Pint-L, and otherwise was designated as Pint-H. DNA was isolated from saliva and feces and relative bacterial abundance was determined with a next-generation sequencer. Bacteria that account for 1% or more of all bacteria were examined. PINT was significantly increased in IFG (0.12 ± 0.11mA) and DM (0.15 ± 0.13mA) compared to healthy subjects (0.± 0.08mA) (p<0.vs. IFG, p <0.vs. DM) . No significant difference was found depending on the PINT value in the bacteria flora of oral cavity. There were significant differences of gut bacterial flor in α and β-diversity (p<0.05) and principal component analysis (p <0.01) depending on the PINT value. The genus Bacteroides was significantly higher in PINT-H than in PINT-L (p<0.01) . After IFG and DM cases were excluded, a significant difference was maintained. The amount of bacteroides was significantly correlated with age, abdominal circumference, fasting blood glucose, HbA1c (p<0.001) , BMI and PINT value (p <0.05) . In the multiple regression analysis adjusted for these factors, PINT was significantly correlated with the amount of Bacteroides (β = -0.089, p = 0.026) . Our results suggest that the gut Bacteroides may correlate with SFN. The involvement of deterioration of glucose metabolism may not be high in this correlation.

Disclosure

K.Kudoh: None. Y.Takeuchi: None. S.Osonoi: None. T.Sasaki: None. S.Ogasawara: None. S.Yagihashi: None. H.Mizukami: None.
48-OR: Barriers to Follow-Up Specialized Eye Care following Retinopathy Identification with Traditional vs. Autonomous Artificial Intelligence (AI) Camera
Authors: WAHL MATTHEW , KIANI RABIA , NEUBERGER JULIE , WILSON BONNIE , HARTNETT MARY ELIZABETH , FISHER SIMON
Published: May 2022

Point-of-care retinal imaging is effective at identifying diabetic retinopathy. However, appropriate follow-up, referral, and access to specialized eye care remains a barrier for the treatment of identified eye disease. We tested the hypothesis that rapid results and immediate referrals afforded by use of an automated diabetic retinopathy screening platform with AI technology (EyeArt) would result in greater patient follow up with ophthalmology specialists as compared to “traditional” tele-retinal screening (images acquired in clinic and transmitted electronically for interpretation by a vitreoretinal specialist) . All images were acquired during a patient’s regularly scheduled diabetes clinic visit. With traditional tele-retinal screening, the average turnaround time to patient notification of findings was days. Among the 357 patients that underwent traditional screening, 42 (12%) were found to have referable (more-than-mild) retinopathy, and of these, 32 (76%) followed up in ophthalmology clinic. In contrast, the fully autonomous diabetic retinopathy screening platform using AI technology provided an immediate assessment on the presence of retinopathy (within 60 seconds of photo acquisition) . Patients were given this point-of-care summary of their eye-exam findings. When indicated, an ophthalmology referral was ordered and patients were provided with contact information for the ophthalmology office. Of the 81 patients screened with AI technology, 22 (27%) had referable retinopathy detected, 15 (68%) of whom followed up in ophthalmology clinic. The higher detection rate with AI screening raises the question of “overcalling” the presence of disease. We conclude that although AI screening offers immediate results allowing for immediate ophthalmology referral, there remains a substantial barrier to ophthalmology follow up after a positive retinopathy screen identified by either screening method.

Disclosure

M.Wahl: None. R.Kiani: None. J.Neuberger: None. B.Wilson: None. M.Hartnett: None. S.Fisher: None.
483-P: Predictors of Major Adverse Lower Limb Events for Chronic Arterial Trophic Disorders
Authors: VOSGIN-DINCLAUX VALÉRIAN , MOHAMMEDI KAMEL , CARADU CAROLINE
Published: May 2022

Background: Peripheral arterial disease (PAD) affects more than 200 million people with an ever-increasing prevalence. Faced with this public health issue, it seems crucial to take an interest in PAD management. In this study, we evaluated the predictors of major adverse lower limb events (MALEs) and wound healing following revascularization for chronic arterial trophic disorders in people with and without diabetes.

Methods: This retrospective study included all patients with Rutherford-Becker stage 5 or 6 who required a minor amputation in combination with a revascularization procedure in our vascular surgery department at Bordeaux University Hospital, from January 2016 to December 2018. The primary endpoint was MALEs. The secondary endpoints were wound healing at 6 months and 2 years, in-hospital and all-cause mortality.

Results: We included 241 patients, 180 with diabetes (74,7%) , with an average age of 74 years, 79,7% men. According to the Wound, Ischemia and foot Infection classification, 95,9% were ranked clinical stage 4, and to the TransAtlantic Inter-Society Consensus for the management of PAD (TASC) below-the-knee classification, 50,7% were stage C/D. Among patients with diabetes, 63,3% had post-operative uncontrolled diabetes. One-hundred seven MALEs occurred during 2-year follow-up (estimated rate of patients free of MALEs 48,7%, 95% CI: 41,7-55,4) , 78 MALEs in patients with diabetes. Revascularization failure predicted the occurrence of MALEs in multivariate analysis, while the lack of revascularization option predicted major amputation. Wound healing was adversely affected by haemodialysis, TASC C/D below-the-knee lesions, the number of bacteria, and reocclusion of the target artery. The in-hospital mortality rate was 5,4% and the overall 2-year mortality rate was 22,8%.

Conclusion: This study highlights the necessity to provide optimal revascularization associated with comprehensive medical care using multidisciplinary approaches to those patients affected by PAD.

Disclosure

V.Vosgin-dinclaux: None. K.Mohammedi: Board Member; Lilly, Novo Nordisk, Sanofi, Research Support; Cyclerion Therapeutics, Inc., Speaker's Bureau; Abbott, AstraZeneca. C.Caradu: None.
484-P: Uncoupling of IL-1beta and VEGF-A Signaling Axis Contributes to Impaired Arteriogenesis in the Context of Aging and Diabetes Mellitus
Authors: MANTSOUNGA CHRIS S. , SHARMA SHEILA , LEE CADENCE , CARLEY RACHEL , CHOUDHARY GAURAV , MORRISON ALAN R.
Published: May 2022

Peripheral artery disease (PAD) caused by atherosclerosis leads to considerable morbidity and mortality throughout the world, in large part, due to tissue damage from both acute and chronic occlusive ischemia. Preclinical studies have identified mechanisms involving bone marrow derived macrophage (BMDM) -dependent angiogenesis in an inflammation suppressed state and we recently defined a novel IL-1beta-dependent transcriptional regulation of the pro-angiogenic isoform of VEGF-A. We sought to understand the impact of diabetes on inflammatory angiogenesis in the context of aging. We hypothesized that the uncoupling of IL-1beta and VEGF-A expression with consequent impairments in angio/arteriogenesis. Control mice at 26-week-old of age or mice with experimental diabetes have reductions of angio/arteriogenesis, using a PAD model of femoral artery ligation that involves macrophage-directed blood flow recovery. Combined aging with chronic diabetes led to further reductions in blood flow recovery consequent to impaired angiogenesis. We also found elevated VEGF-R2 (relative to VEGF-R1) expression in the inflammatory “M1” state which was associated with elevations of IL-1beta and VEGF-A. Interestingly selective inhibition of VEGF-R2 led to reduced VEGF-A expression despite stable IL-1beta levels, suggesting an uncoupling of the relationship between IL-1beta and VEGF-A. Lastly, BMDMs from aged, diabetic mice demonstrated an uncoupling of IL-1beta and VEGF-A expression and VEGF-R2 was decreased in aged, diabetic BMDMs. Defining inflammatory macrophages as key, early drivers of angio/arteriogenesis via IL-1beta and VEGF-A/VEGF-R2 signaling supports a paradigm shift away from inflammation-suppression for adequate healing, allowing for macrophage reprograming strategies that promote appropriate inflammation-dependent healing responses.

Disclosure

C.S.Mantsounga: None. S.Sharma: None. C.Lee: None. R.Carley: None. G.Choudhary: None. A.R.Morrison: None.

Funding

National Institute of Health NIGMS (P20GM103652)
492-P: National Diabetes Prevention Program (DPP) Outcomes during the COVID-Pandemic, Montana, 2020 Compared with 2017–2019
Authors: DUTHIE MARY K. , FERNANDES JESSIE , HOUSE MELISSA , BUTCHER MARCI , HARWELL TODD S. , HELGERSON STEVEN D. , GOHDES DOROTHY M.
Published: May 2022

In 2020, the COVID-pandemic challenged the delivery of the National DPP and presented unique stressors for participants. Since 2008, Montana’s DPP has maintained a registry to track participant retention, goal achievement, and changes in cardiometabolic (CM) risk. To measure effects of the COVID pandemic on DPP outcomes in Montana, we compared data from participants in 2020 to those in 2017 - 2019. Baseline, 6 and 12-month data were available for 522 participants from 2020 and 2,313 from 2017-2019. Changes in participation and measures of CM were compared using chi-square analysis, t-test and ANOVA analysis. The average number of sessions attended was lower in 2020, 13.6, than in 2017-2019, 14.4 (p=0.02) . The average percent of body weight lost was lower in 2020 at both six-months, 3.9%, and twelve-months, 3.7%, compared to the same measurements in 2017 to 2019, 4.4% (p=0.03) and 4.4% (p=0.01) . Among CM risk measurements, significant differences occurred only for increases in the HDL cholesterol levels measured in 2020, 52.9 mg/dL baseline, 54.7 at 6 months and 56.4 at 12 months, compared to those in 2017 to 2019, 53.6, 52.9 and 55.8 (p=0.00for 6 and p=0.0087 for 12-month) (Table) . During the COVID-pandemic DPP participants continued to lose weight and achieve significant improvements in overall CM risk despite slightly less weight loss compared to participants in previous years.

Disclosure

M.K.Duthie: None. J.Fernandes: None. M.House: None. M.Butcher: None. T.S.Harwell: None. S.D.Helgerson: None. D.M.Gohdes: None.

Funding

Centers for Disease Control and Prevention (NU58DP006517 and NU58DP006610)
497-P: Ten Years of the National Diabetes Prevention Program: The Effect of Interventions on Priority Population Enrollment
Authors: LANDAU ERIN O. , ELY ELIZABETH
Published: May 2022

In 2010, Congress authorized the creation of the National Diabetes Prevention Program to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay onset of type 2 diabetes. In 2012, the Diabetes Prevention Recognition Program (DPRP) approved its first CDC-recognized organization and in 2012 and 2017, CDC awarded funding to organizations (grantees) to increase enrollment of priority populations. In 2015 and 2018, DPRP Standards expanded approved delivery modes to include online delivery (2015) and distance learning and combined delivery (2018) . As of October 2021, the DPRP has received data from 2,200 organizations on 550,000+ participants ever enrolled in the LCP; this analysis is limited to participants who enrolled prior to 2020. From the end of 2017 to the end of 2019, total enrollment in the LCP more than doubled from 217,115 to 470,7participants. The proportion of participants who identified as Hispanic grew among grantee organizations (6.5% in 2017 to 15.7% in 2019) but remained constant in non-grantee organizations (2.3% in 2017 to 2.2% in 2019) . The proportion identifying as non-Hispanic Black varied across years but overall was higher among grantee organizations (19.9% in 2017, 20.5% in 2018, and 16.2% in 2019) compared to non-grantee organizations (12.0% in 2017, 12.4% in 2018, and 12.8% in 2019) . Between 2017 and 2019, 80-85% of participants identifying as Hispanic enrolled in in-person programs, compared to 11-16.5% in online, 1.1-1.7% in distance learning, and 1.8-2.5% in combination programs. Among participants identifying as non-Hispanic Black, 50.1-58.2% enrolled in online programs each year, compared to 35.8-41.8% in in-person, 3.0-8.3% in combination, and 0.7-2.0% in distance learning programs. These results suggest that enabling organizations to reach priority populations and tailoring delivery modes to each population are effective strategies to increase enrollment.

Disclosure

E.O.Landau: None. E.Ely: None.
505-P: Fasting in Ramadan during the Peak of COVID-Pandemic: DAFNE Graduates Experience
Authors: IRSHAD MOHAMMAD , ELSAMAD ABEER K. , ABDULLAH AMAL , AZIZIEH MAJDOLEEN , ALKANDARI JUMANA , VARGHESE ANISHA , MURAD SAHAR , TAGHADOM ETAB , MEGAHED AMIRA , ALOZAIRI EBAA S.
Published: May 2022

Background: The lockdown due to the COVID-pandemic in April 2020 led to the suspension of face-to-face diabetes care and education. In this period, management of diabetes emergency was a challenge because it needed rapid recognition, diagnosis and treatment. Despite adverse situations, many DAFNE graduates had chosen to fast during Ramadan. This was supported virtually to DAFNE graduates through intermittently scanned continuous glucose monitoring (isCGM) . Aims: This study aimed to compare the isCGM glucose metrics of people with T1D who fasted during Ramadan.

Methods: Baseline and fasting period isCGM data were collected. The primary outcome measures HbA1c, time in range [ (TIR) 3.9- mmol/L], time below range [ (TBR) <3.9 mmol/L], coefficient of variation (CV) , and self-reported adverse events.

Results: A total of 35 people with T1D fasted with a median of 20 days. Mean HbA1c was 7.5 (0.93) % and 7.4 (0.91) % before and after fasting periods, respectively. No significant change in TIR (pre 61.1 ± 17.9% vs. during 61.9 ± 14.9%) and TAR (pre 32.1 ± 19.0% vs. during 33.1 ± 15.6%) were found. However, TBR (pre 6.8 ± 5.4% vs. during 5.0 ± 4.6%) was significantly decreased (p= 0.045) . The CV (-2.3%) and low glucose events (-5.0) also decreased during the fasting period (p≤ 0.010) . No episodes of severe hypoglycemia, DKA, or hospitalization occurred during the fasting period.

Conclusions: DAFNE graduates can fast safely without the fear of hypoglycemia, and safe metrics of glycemia using diabetes self-management skills, including disaster situations like the COVID-pandemic.

Disclosure

M.Irshad: None. E.S.Alozairi: None. A.K.Elsamad: None. A.Abdullah: None. M.Azizieh: None. J.Alkandari: None. A.Varghese: None. S.Murad: None. E.Taghadom: None. A.Megahed: None.
515-P: Harnessing Simulation-Based Corrective Mentoring in Continuing Medical Education to Improve Clinical Decision Making and Identify Persisting Educational Needs
Authors: ROBINSON KATIE , SEIFERT DOUGLAS , FREDERICK JENNIFER , ESGRO ROBERT A.
Published: May 2022

Rationale: Due to the vast number of treatment options and clinical presentations of patients with T2DM, providers are challenged to individualize treatment. Incorporating corrective mentoring into decision-based continuing medical education (CME) is a proven method to improve clinical decision-making while simultaneously elucidating persisting educational needs.

Methods: Vindico Medical Education and Syandus partnered to develop four virtual clinical scenarios designed to encourage optimal decision making for patients with T2DM by providing immediate feedback via simulated corrective mentoring.

Results: A total of 765 primary care providers (PCPs) and 103 endocrinology providers participated in the simulation. Across all four simulations, only 15% of decisions were optimal on the first selection. At baseline, the most challenging topics were evaluating comorbidities and optimizing the use of SGLT-2 inhibitors (13% and 3% optimal decisions made, respectively) . However, after corrective mentoring, there was a 400% relative increase in optimal decisions made. Relative to PCPs, endocrinology providers were 11% more likely to eliminate non-ideal treatment options for a patient with T2DM, obesity, and ASCVD. Similarly, endocrinologists were 14% more competent than PCPs regarding the use of an SGLT-2 inhibitor for a patient with T2DM and worsening kidney disease. The reason for these findings may be that, relative to endocrinologists, PCPs are nearly twice as concerned with optimizing A1C control versus managing comorbidities such as kidney disease or obesity.

Conclusion: The use of corrective mentoring in simulation-based CME is an impactful way to encourage clinical decision-making in alignment with the latest evidence-based care. Moreover, these data highlight the need to educate PCPs on the importance of considering comorbidities when individualizing treatment for patients with T2DM.

Disclosure

K.Robinson: None. D.Seifert: Other Relationship; Amgen Inc., Merck & Co., Inc. J.Frederick: None. R.A.Esgro: None.

Funding

Independent Educational Grants from Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC; and Merck & Co., Inc.
52-OR: The Burden of Food Insecurity on Quality of Life in Adults with Diabetes
Authors: WALKER REBEKAH J. , THORGERSON ABIGAIL , MOSLEY-JOHNSON ELISE , EGEDE LEONARD E.
Published: May 2022

Food insecurity, or the lack of consistent access to enough food for an active, healthy life, is associated with worse glycemic control and higher mortality in adults with diabetes. However, little is known regarding the burden of food insecurity on health-related quality of life, a global measure that captures physical and mental health over time. Using two years of national data collected through the Medical Expenditure Panel Survey (2016-2017) , we investigated the relationship between food insecurity and physical health related (PCS) and mental health related (MCS) quality of life in adults with diabetes. Ten questions asked about running out of food, affording balanced meals, skipping meals, and losing weight due to not eating. Adults scoring 3 or more were considered food insecure. Unadjusted and adjusted linear regression weighted to represent the US adult population was run with PCS and MCS treated as separate continuous outcomes. Food insecure adults with diabetes reported significantly lower physical and mental health related quality of life (PCS 42.2 vs. 35.9; MCS 51.5 vs. 42.7) . After adjusting for demographics, insurance coverage, and comorbidities, food insecure adults with diabetes maintained significantly lower scores compared to food secure adults with diabetes (PCS: -3.43, 95%CI -4.63,-2.25; MCS: -5.37, 95%CI -6.68,-4.06) . This drop in PCS scores of 3.4 and MCS of 5.4 was similar to or larger than differences between those with comorbidities known to significantly impact quality of life, such as stroke (decrease of 2.6 in PCS and 0.5 in MCS) , joint pain (decrease of 4.5 in PCS and 2.4 in MCS) , and heart disease (decrease of 2.0 in PCS and 3.8 in MCS) . Results highlight the significant burden of food insecurity on both physical and mental health related quality of life in adults with diabetes. Interventions are needed that integrate clinical and social factors impacting health-related quality of life to ensure overall well-being in adults with diabetes.

Disclosure

R.J.Walker: None. A.Thorgerson: None. E.Mosley-johnson: None. L.E.Egede: None.

Funding

American Diabetes Association (1-19-JDF-075) ; National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker) , National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede)
522-P: Qualitative Findings of a Culturally Tailored Rural Diabetes One-Day DSMES Program in Eastern Colorado
Authors: CURCIJA KRISTEN , OSER TAMARA , LITCHMAN MICHELLE L. , KWAN BETHANY , ZITTLEMAN LINDA K. , NEUBERGER JULIE , SUTTER CHRISTIN , IACOB ELI , GONZALEZ SINDY J. , LATENDRESSE GWEN
Published: May 2022

DSMES is an essential component to equip people with diabetes to improve health behaviors and outcomes, and accessing culturally tailored and accessible DSMES services in rural communities is challenging. The Rural Diabetes One-Day (R-D1D) intervention used CBPR to adapt complex clinical information about diabetes into locally-relevant, actionable messages and materials. The products accompanied the implementation of a one-day 5-hour long DSMES program tailored to a rural community delivered to English and Spanish-speaking adults with diabetes in eastern Colorado. A second cohort will take place in Spring 2022. As part of an iterative design, key informant interviews were conducted with healthcare professionals and staff from participating clinics. A trained member of the study team used a semi-structured interview guide to collect qualitative data from clinical staff. A total of 6 individuals were interviewed from two clinics. Key themes included close-knit relationships between clinical staff and their patients with diabetes, lack of resources for patients in rural communities, and ongoing need for DSMES programs available through primary care clinics - particularly for patients with newly-diagnosed diabetes. Practice staff reflections on the R-D1D program were positive. Interviewees appreciated having a program offered to both English and Spanish-speaking patients to address disparities among their patient population. Staff reported patients appreciated meeting as a group - in a supportive setting - and enjoyed having access to a professional class made for them and offered to them. Changes recommended included setting the intervention date in advance, offering a program overview at a staff meeting to ensure all team members were aware of the program and felt comfortable discussing it with patients, and offering the class in the requested language. R-D1D will undergo iterations, as guided by these interviews, in the next phase of this research.

Disclosure

K.Curcija: None. G.Latendresse: None. T.Oser: Advisory Panel; Cecelia Health, Dexcom, Inc. M.L.Litchman: None. B.Kwan: None. L.K.Zittleman: None. J.Neuberger: None. C.Sutter: None. E.Iacob: None. S.J.Gonzalez: None.

Funding

National Institute of Nursing Research 1R56NR019466-01
53-OR: Diabetes Stigma and Clinical Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study
Authors: EITEL KELSEY B. , ROBERTS ALISSA J. , DAGOSTINO RALPH , BELL RONNY A. , BELLATORRE ANNA , BARRETT CATHERINE E. , CRISTELLO ANGELICA , DABELEA DANA , DOLAN LAWRENCE M. , JENSEN ELIZABETH T. , LIESE ANGELA D. , MARCOVINA SANTICA M. , MAYER-DAVIS ELIZABETH J. , REYNOLDS KRISTI , PIHOKER CATHERINE
Published: May 2022

We examined the association between diabetes stigma and glycemic control, treatment regimen, and acute and chronic complications in adolescents and young adults (AYAs) with type 1 (T1D) and type 2 diabetes (T2D) in the SEARCH for Diabetes in Youth Study, 2016-2019. A 5-question survey assessed frequency of perceived stigma experience, from which we created a total stigma score. We used multivariable linear modeling, stratified by T1D and T2D, to examine the association of diabetes stigma with clinical factors, adjusting for sociodemographic, clinic site, duration of diabetes, health insurance type, treatment regimen, and HbA1c. Of 16respondents, 78% had T1D, 56% were female, and 48% were non-Hispanic White. Mean (SD) age at study visit was 21.7 (5.1) years (range - 24.9 years) . Mean (SD) HbA1c was 9.2% (2.3) . Higher stigma scores were associated with female sex and higher HbA1c (both p <0.01, table) . No statistically significant association between stigma score and insulin pump or continuous glucose monitor use was observed. In participants with T2D, higher stigma scores were associated with insulin use (p = 0.04) . Independent of HbA1c, higher stigma scores were associated with acute complications for AYAs with T1D and chronic complications for AYAs with T1D and T2D (table) . Diabetes stigma in AYAs is associated with worse diabetes outcomes and therefore is important to address in diabetes care.

Disclosure

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

Funding

The SEARCH for Diabetes in Youth Cohort Study (1R01DK127208-01, 1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention.
566-P: Development and Evaluation of Pharmacotherapy Decision Support Technology for Type 2 Diabetes Mellitus
Authors: TARUMI SHINJI , TAKEUCHI WATARU , CHALKIDIS GEORGE , BAN HIDEYUKI , KAWAMOTO KENSAKU
Published: May 2022

Background and Objectives: The established treatment target for most patients with type 2 diabetes mellitus (T2DM) is controlling HbA1c levels to less than 7%; however, about half of patients fail to achieve this target. In order to support optimal prescription selection, we have been developing a prescription selection support system that predicts expected outcomes by treatment options. In this presentation, we report a novel analytical method named Treatment Pathway Based Estimation (TPGE) , which predicts the probability of achieving a treatment goal, such as HbA1c less than 7% in 3 months, using a treatment pathway graph built from the data.

Methods: The TPGE model was built and evaluated using EHR data from 27,9 patients with T2DM. TPGE was compared with a conventional machine learning approach, gradient boosting decision tree (GBT) , across two dimensions. First, the prediction error of the probability of achieving treatment was evaluated by the Brier Score. Second, the characteristics of the prescriptions recommended with the highest probability were investigated, referring to the prescriptions actually prescribed by clinicians.

Results: TPGE achieved a prediction error of 0.158, which is lower than the prediction error of 0.162 of GBT. In addition, the calibration error was 0.002 (84.6% reduction) , much lower than that of GBT (0.013) . A prescription to add two or more drugs was selected by clinicians for 0.7% of cases. GBT recommended that prescription for 42.2 % of cases, while TPGE recommended for 1.4%, which was closer to the clinicians’ decision.

In summary, the superiority of TPGE over GBT was confirmed.

Conclusion: We have developed a pharmacotherapy decision support technology for T2DM to help clinicians and patients select the optimal prescription.

Disclosure

S.Tarumi: None. W.Takeuchi: None. G.Chalkidis: Employee; Hitachi, Ltd. H.Ban: None. K.Kawamoto: Consultant; Korean Society of Medical Informatics, NORC at the University of Chicago, Pfizer Inc., RTI International, Security Risk Solutions, Other Relationship; MD Aware, Research Support; Hitachi, Ltd., Pfizer Inc.
567-P: A Weight Management Program Tailored for Adults with Type 2 Diabetes: Effects on Glycemic Control
Authors: APOLZAN JOHN W. , LAROSE JESSICA G. , ANTON STEPHEN D. , BEYL ROBBIE A. , GREENWAY FRANK L. , WICKHAM EDMOND P. , LANOYE AUTUMN , HARRIS MELISSA N. , KAUFMAN ADAM , BULLARD TIFFANY , FOSTER GARY D. , CARDEL MICHELLE
Published: May 2022

Background: Clinical weight loss interventions improve glycemic control in adults with type 2 diabetes (T2D) , but are costly and have limited accessibility. The objective of this trial was to test the efficacy of a diabetes-tailored widely available weight management program (WW, formerly Weight Watchers) on glycemic control in adults with T2D.

Methods: This was a prospective 24-week single arm, three-site clinical trial. Participants (n= 136) had T2D, a baseline HbA1c between 7-11%, and a BMI between 27-50 kg/m2. All participants received the 24-wk intervention, which consisted of the WW digital + workshop program tailored for people with T2D, and included weekly virtual workshops and use of the WW App. Assessments occurred at baseline, wk 12 (83.8% retention) , and wk 24 (83.1%) . Primary outcome was change in HbA1c at 24 weeks. Secondary endpoints were changes in body weight and the Diabetes Distress Scale (DDS) . Generalized linear effects models were used for statistical analysis (MAR) and used an intent-to-treat analysis.

Results: Participants were 56.8 ± 0.8 y (Mean ± SEM) , 80.2% Female, 62.2% non-Hispanic white. Baseline BMI was 36.2±0.6 kg/m2. Baseline HbA1c, weight, and total DDS score were 7.9±0.1%, 104.3±1.8 kg, and 2.2±0.1, respectively. HbA1c decreased 0.6±0.1% at wk 12 and 0.8±0.1% at wk 24 (both p <.0001) . Body weight decreased 4.6±0.5% at wk 12 and 5.7±0.5% at wk 24 (both p <.0001) . Total DDS score decreased 0.2±0.1 at wk 12 and 0.3±0.1 at wk 24 (both p <.0001) .

Conclusions: The widely available WW program, modified for those with T2D, had favorable and clinically meaningful effects on glycemic control, body weight, and diabetes distress at 12 and 24 weeks.

Disclosure

J.W.Apolzan: Research Support; Mizkan Holdings, LLC , WW International, Inc. T.Bullard: Employee; WW International, Inc. G.D.Foster: Employee; WW International, Inc. M.Cardel: Employee; WW International, Inc. J.G.Larose: Research Support; WW International, Inc. S.D.Anton: None. R.A.Beyl: None. F.L.Greenway: Advisory Panel; General Nutrition Corporation, Jenny Craig, NovMeta Pharma, Nutraceutical Corporation, Pfizer Inc., Plensat, UR Labs, Consultant; Basic Research, Dr. Reddy’s Laboratories Ltd., Energesis, Gedeon Richter, Jazz Pharmaceuticals, Rejuvenate Bio, Other Relationship; Academic Technology Ventures, Inc., Melior Discoveries, Stock/Shareholder; Energesis, Ketogenic Health Systems, NovMeta Pharma, Plensat, Rejuvenate Bio, Slim Health Nutrition, UR Labs. E.P.Wickham: Board Member; American Board on Obesity Medicine, Research Support; National Institutes of Health, WW International, Inc. A.Lanoye: Research Support; WW International, Inc. M.N.Harris: None. A.Kaufman: Employee; WW International.

Funding

WW International, Inc.
568-P: Predictors of Engagement and Adherence in a Text Messaging Diabetes Intervention for Hispanics
Authors: CLARK TAYLOR , FORTMANN ADDIE L. , PHILIS-TSIMIKAS ATHENA , SAVIN KIMBERLY L. , SANDOVAL HALEY , SPIERLING BAGSIC SAMANTHA R. , GALLO LINDA
Published: May 2022

Mobile health delivery of diabetes self-management education and support (DSME/S) can reduce barriers among racial/ethnic minority populations (e.g., Hispanics) , but little is known about how participant characteristics shape adherence and engagement with mHealth interventions. The current study examined this using data from Dulce Digital-Me, a randomized trial that tested an adaptive mHealth DSME/S intervention among 3Hispanic adults with poorly managed type 2 diabetes from a Federally Qualified Health Center in San Diego, CA. In addition to core educational content, participants in three intervention arms received text messages with ecological momentary assessment (EMA) of health behaviors and prompts to check their blood glucose (BG) over 24 weeks. Linear regression models examined associations of age, sex, diabetes duration, health literacy (Single Item Literacy Scale) , and diabetes distress (Diabetes Distress Scale-17) at baseline with the percentage of EMA and BG checks completed, controlling for study arm. Average participant age was 52.6 years ± 11.5; 70% were female. Younger age (B=-.88) , longer diabetes duration (B=.51) , lower health literacy (B=-4.7) , and lower diabetes distress (B=-6.7) predicted significantly higher EMA completion, while only lower distress (B=-4.5) predicted higher BG check completion (all ps<.05) . Follow-up analyses revealed that those with moderate distress tended to have higher completion rates than those with low or high diabetes distress. Overall, these results were in line with prior research in predominantly non-Hispanic samples, with the exception of health literacy, where we typically see a positive association with mHealth engagement. This finding may reflect that our intervention content was written for populations of lower literacy levels. Future qualitative research should expand on these findings to explore who adheres to and engages most with mHealth DSME/S.

Disclosure

T.Clark: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. K.L.Savin: None. H.Sandoval: None. S.R.Spierling bagsic: None. L.Gallo: None.

Funding

National Institutes of Health (NCT03130699)