bluuebunny/crossref_metadata_2025 huggingface dataset:
Problematika kesulitan belajar membaca menulis permulaan (MMP) di sekolah dasar kelas rendah
Authors: Solihah Dewi Siti , Hernawan Asep Herry
Published: June 2023

Problematika pendidikan kerap kita temui di lingkungan sekolah. Di sekolah dasar khususnya di kelas rendah terdapat problematika yang sangat penting untuk diselesaikan. Problematika tersebut adalah mengenai kesulitan belajar membaca menulis permulaan. Berdasarkan hal tersebut, maka penelitian ini mengambil permasalahan mengenai problematika peserta didik pada kesulitan membaca menulis permulaan (MMP) di sekolah dasar kelas rendah. Penelitian ini bertujuan untuk menjelaskan problematika kesulitan belajar peserta didik dalam membaca menulis permulaan (MMP) dengan menggunakan berbagai metode membaca menulis permulaan. Secara lebih khusus tujuan penelitian ini untuk mendeskripsikan problematika kesulitan belajar peserta didik pada kemampuan membaca menulis permulaan (MMP) di sekolah dasar dan mengetahui faktor-faktor yang menyebabkan peserta didik sulit membaca dan menulis permulaan. Penelitian ini bersifat deskriptif kualitatif dengan menggunakan metode penelitian studi kasus terhadap peserta didik kelas rendah di SDN Toblong 02 Desa Neglasari Kec. Majalaya Kab. Bandung tahun ajaran 2022-2023. Berdasarkan identifikasi masalah, masalah umum yang muncul dan perlu ditindaklanjuti adalah dengan mengimplementasikan metode pembelajaran membaca menulis permulaan sebagai upaya untuk meningkatkan kemampuan membaca menulis permulaan di sekolah dasar. Hasil dari penelitian menunjukan bahwa faktor yang menjadi penyebab kesulitan membaca menulis permulaan yang tejadi di SDN Toblong 02 yaitu disebabkan oleh faktor intelektual, faktor lingkungan, dan faktor motivasi serta minat peserta didik.
Pembelajaran online mata pelajaran bahasa indonesia pada materi cerita fiksi dongeng Siswa kelas IV Sd dalam masa pandemik covid-19
Authors: Indriani Brigita Nuki , Setiyadi Ruli
Published: June 2023

Penelitian ini digunakan untuk mengetahui bagaimana pelaksanaan pembelajaran cerita fiksi siswa kelas IV di SD Makedonia dan SDN Cibabat 4. Metode penelitian yang digunakan adalah deskriptif kualitatif. Subjek dalam penelitian ini yaitu 2 guru dan 24 siswa yang terbagi menjadi 4 siswa dengan kemampuan tinggi, 4 siswa dengan kemampuan sedang dan 4 siswa dengan kemampuan rendah. Siswa tersebut berasal dari dua sekolah yang berbeda yang pertama dari SD Makedonia dan yang kedua dari SDN Cibabat 4. instrument yang digunakan yaitu lembar wawancara dan lembar angket. hasil penelitian menunjukan bahwa pembelajaran online yang dilakukan ke dua sd tersebut adalah berhasil.Â
Kajian implementasi model problem based learning dalam meningkatkan hasil belajar ilmu pengetahuan sosial Siswa Sekolah Dasar
Authors: Sidik Ghany Taufik , Rohaeti Euis Eti , Murni Sukma , Puspita Ryan Dwi
Published: June 2023

Penelitian ini bertujuan untuk mengkaji bagaimana implementasi model Problem Based Learning dalam meningkatkan hasil belajar ilmu pengetahuan sosial kelas IV jenjang sekolah dasar. Metode dalam penelitian ini menggunakan metode kajian kepustakaan. Adapun Teknik pengumpulan data berupa dokumentasi. Kemudian Instrumen yang digunakan dalam penelitian ini yaitu berupa daftarÂ  klasifikasi bahan penelitian dan format catatan dari suatu penelitian. Hasil penelitian ini yakni model Problem Based Learning pada pembelajaran ilmu pengetahuan sosial jenjang kelas IV jenjang sekolah dasar mendapat respon positif dari guru dan siswa secara signifikan. Sehingga terbukti model Problem Based Learning berpengaruh terhadap peningkatan keaktifan guru dan keaktifan siswa yang menimbulkan peningkatan hasil belajar siswa secara signifikan.
SOUND/BODY
Authors: Petar Mrdjen
Published: June 2023

“My sound body is the ghostly embrace that physically envelops the listener, with acoustic energy. Feel my presence, as I hide in plain sight.”

This exposition explores the role of surround sound in filmmaking, its strength and pitfalls in space-making, as well as its viability as an image-making device.

The author challenges conservative usage of surround sound, advocating for a playful and resistant approach; with the aim to create active and immersive spatial soundscapes where each audience member can experience their own "sweet spot." They reflect on the limitations of traditional cinema sound and express their desire to empower listeners with a dense and rich auditory experience.

By focusing on capturing authentic acoustic spaces, challenging traditional recording practices, and exploring a resistant approach to surround sound; the author highlights the unique relationship between sound, image, and space; and how their interplay can evoke various impressions.

The text delves into the author's artistic approach to working with surround-scapes (surround-soundscapes), highlighting different strategies and providing examples from films and games. Three surround-aesthetics are defined and named, which the author refers to as "rooms." The transformative power of sound is underscored, with a focus on embracing vulnerability and fluidity as sources of strength.

Through the context of foley-practice and surround-scaping; this exposition questions the role and reach of the author's body - a sound body.
Quantitative Study of Butterfly Diversity in Wando Quercus acuta Forest Over 5 Years (2017-2021)
Authors: Lee Sanghun , Ahn Na-Hyun
Published: June 2023

This study presents the long-term quantitative data on butterflies in Wando Arboretum, which represents the only warm-temperate forest located in the southernmost part of South Korea. This arboretum has significant academic value as approximately 770 species of rare woody plants or herbs, such as the Japanese evergreen oak (Quercus acuta), found in warm temperate zones grow under natural conditions here. In this project, the butterflies in this region were studied due to their sensitivity to temperature changes. The study was conducted from March-April to October-November over 5 years (2017-2021) in the region dominated by Japanese evergreen oak. We found 1,743 individuals of 47 butterfly species belonging to five families. The acquired butterfly data could serve as a reference for the further development of a network-oriented database for assessing temporal climate changes.
1-LB: Evaluating the Effectiveness of the Novel Somatostatin Receptor Antagonist (SSTR2a) ZT-01 for Hypoglycemia Prevention in a Rodent Model of Type 2 Diabetes
Authors: D'SOUZA NINOSCHKA C. , AIKEN JULIAN , HOFFMAN EMILY G. , ATHERLEY SARA C. , CHAMPSI SABRINA , ALEALI NADIA , SHAKERI DORSA , EL-ZAHED MAYA , AKBARIAN NICKY , NEJAD-MANSOURI MEHRAN , LIGGINS RICHARD , CHAN OWEN , RIDDELL MICHAEL C. , ZAREE BAVANI PARINAZ
Published: June 2023

Background: Few pharmacological strategies exist to prevent hypoglycemia in diabetes, other than reducing the intensity of glucose-lowering therapy. SSTR2a treatment increases glucagon counterregulation and reduces the time spent in hypoglycemia in rodent models of type 1 diabetes (T1D), but the utility of this approach in type 2 diabetes (T2D) is unclear. The purpose of this study was to test the effect of acute SSTR2a treatment in a rodent model of hypoglycemia in T2D.

Methods: High fat fed (HFF), low dose streptozotocin (35 mg/kg) T2D rats received SSTR2a treatment (subcutaneous ZT-01 3 mg/kg) or vehicle (N=9-11/group) 60 min before the induction of hypoglycemia using rapid-acting insulin (12 U/kg). Glycemia, glucagon and c-peptide levels were measured intermittently pre- and post-dosing.

Results: T2D in the rats was characterized by significantly higher baseline glucose (21.8 ± 4.7 vs 6.5 ± 0.7 mmol/L, p<0.05) and HbA1c (8.6 ± 0.6% vs 5.5 ± 0.5%; p<0.0001) levels relative to HFF controls (n=3). T2D rats also displayed reduced c-peptide levels relative to controls (3.1 ± 1.3 vs 6.1 ± 1.2 ng/ml, p<0.05). During hypoglycemic challenge (T2D rats only), SSTR2a elevated glucagon levels relative to vehicle treatment (glucagon Cmax: 156 ± 50 vs 77 ± 46 pg/ml, p<0.01) and reduced the incidence of hypoglycemia by ~40% (5/8 SSTR2a treated vs 9/9 vehicle treated rats). In those that developed hypoglycemia, the average time to hypoglycemia onset was delayed (103.1± 24.6 vs 66.1 ± 23.6 min, p<0.05) with SSTR2a compared to vehicle.

Conclusion: SSTR2a treatment increases glucagon levels in this rodent model of T2D, which appears to reduce the risk for hypoglycemia following bolus insulin dosing.

Disclosure

N. C. D'souza: None. M. Nejad-mansouri: None. R. Liggins: Employee; Zucara Therapeutics, Stock/Shareholder; Zucara Therapeutics. O. Chan: None. M. C. Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Indigo Diabetes, Consultant; Lilly Diabetes, Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi, Stock/Shareholder; Supersapiens, Zucara Therapeutics. P. Zaree bavani: None. J. Aiken: None. E. G. Hoffman: None. S. C. Atherley: None. S. Champsi: None. N. Aleali: None. D. Shakeri: None. M. El-zahed: None. N. Akbarian: None.

Funding

GlycoNet (CD-85)
10-OR: The Triple Roles of Tubular Mitochondria AKT in the Regulation of Renal Function, Insulin Resistance, and Body Composition during Development of Diabetic Nephropathy
Authors: SALEM ESAM , TA ALBERT , LIN HUGO Y.H. , LI JUNFENG , WANG PING H.
Published: June 2023

Diabetic nephropathy is a major cause of end-stage renal disease. We have recently shown translocation of AKT to mitochondria in proximal tubules played a renoprotective role in murine ischemia/reperfusion injury. In this study, we tested the hypothesis that activation of mitochondrial AKT (mito-AKT) signaling in renal proximal tubules improves kidney function in diabetic nephropathy and modulates overall glucose homeostasis. We used renal tubule-specific bigenic mice that harbor tamoxifen-inducible mitochondria-targeting constitutively active AKT1 (KMCAKT), which were fed with either normal chow diet or high fat and fructose diet (HFFD). Wild type mice fed with HFFD developed nephropathy after 24 wks. Activation of renal tubular mito-AKT significantly attenuated urinary albumin, creatinine, and glucose excretion in the KMCAKT mice on HFFD. Interestingly, activation of tubular mito-AKT also decreased fasting hyperglycemia, and improved glucose tolerance of HFFD-fed mice. Insulin resistance (HOMA-IR) was significantly reduced when tubular mito-AKT was activated. In addition, mito-AKT activation reduced plasma cholesterol. Furthermore, mito-AKT activation increased total body weight and fat mass of HFFD-fed mice, but had no effect on their water and food intake. To dissect the underlying mechanism, we used 18F-fluoro-4-thia-oleate PET scan to define organ specific fatty acid uptake, and revealed a significant increase of uptake in white and brown adipose tissues in KMCAKT mice on HFFD. In conclusion, this is the first report to demonstrate critical roles of mitochondrial AKT in renal tubules in the regulation of whole-body metabolism, insulin sensitivity, and body composition beyond its local effect on kidney function in diabetic nephropathy, which suggests kidney function and nephropathy associated metabolic dysfunction could be mediated through a common pathway in tubular mitochondria.

Disclosure

E.Salem: None. A.Ta: None. H.Y.H.Lin: None. J.Li: None. P.H.Wang: Research Support; ViaCyte, Inc.

Funding

Shannon & Amy Ko Foundation
1043-P: Uncovering Root Causes Contributing to Persistent Gaps in Glycemic Control and Effective Weight Management in Patients with Type 2 Diabetes and Obesity
Authors: ZYBOROWICZ EMILY , HEGGEN CHERILYN , RODRIGUEZ MELISSA A. , CARTER JEFFREY D. , FRIAS JUAN P.
Published: June 2023

This QI initiative in 2 large US-based community health systems assessed root causes hindering A1C control and weight management in people with T2D and obesity through health care provider (HCP) surveys (n = 29), baseline EMR audits (n = 100), team-based audit-feedback (AF) sessions, and patient-provider collaborative education sessions. Lack of treatment access and delayed treatment intensification were identified as factors contributing to inadequate A1C control. In the survey, 48% of HCPs reported providing treatment access support as a top barrier. Missed opportunities to escalate care were revealed through gaps in key care measures for patients not on target to achieve their A1C goal, including reevaluating current diabetes medication (77% HCPs reported routinely performing) and referring patients to a diabetes care and education specialist (49%). Following the AF intervention, the percentage of HCPs who plan to consider therapy escalation within 3 months increased from 38% to 80%. Following collaborative education, the percentage of patients who reported understanding the importance of achieving their A1C goal increased from 47% to 71% and 81% committed to taking a more active role in their diabetes management and self-care. Gaps were uncovered in weight management counseling, support, and shared decision-making (SDM). Asking patients about treatment goals was documented in 57% of charts. Reporting weight loss goal discussion every 3 months were 60% of HCPs and 33% of patients. Following AF sessions, the percentage of HCPs who plan to prioritize SDM as a top 2 goal increased from 21% to 53% and HCPs committed to updating patient materials to support more productive conversations about individual health goals. Key factors hindering attainment of A1C and weight management goals revealed through this study include gaps in treatment access, treatment intensification, SDM, and weight management counseling, support.

Disclosure

E.Zyborowicz: None. C.Heggen: None. M.A.Rodriguez: None. J.D.Carter: None. J.P.Frias: Advisory Panel; Becton, Dickinson and Company, Pfizer Inc., Sanofi, Consultant; Akero Therapeutics, Inc., 89bio, Inc., Aimmune, Boehringer Ingelheim Inc., Eli Lilly and Company, Carmot Therapeutics, Inc., Echosens, Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Employee; Ionis Pharmaceuticals, Research Support; Akero Therapeutics, Inc., 89bio, Inc., Altimmune, Axcella Health Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Intercept Pharmaceuticals, Inc., Carmot Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Oramed Pharmaceuticals, Novartis, Pfizer Inc., Sanofi, Speaker's Bureau; Eli Lilly and Company, Sanofi.

Funding

Eli Lilly and Company (A-31209)
1147-P: Disparities in Insulin Pump and CGM Use in Youth with Type 1 Diabetes
Authors: CRAIN EMILY R. , RAMPHUL RYAN , BUTLER ASHLEY , HUANG XIAOFAN C. , MINARD CHARLES G. , REDONDO MARIA J. , DESALVO DANIEL
Published: June 2023

Youth with T1D of underrepresented race/ethnicity (URE) have lower pump/CGM use, higher A1c, and greater DKA risk; however, the correlation of social determinants of health (SDoH) and neighborhood-level factors to pump/CGM use and clinical outcomes are unknown. In this study, multivariable models were used to evaluate the association of race/ethnicity, SDoH factors, and area deprivation index (ADI, range 1-10 with 10 being most deprived neighborhood) with pump/CGM use, A1c, and DKA in 1,461 T1D youth (50% F, age 12.8 ± 3.6 yrs, A1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen over a 1-yr period. Youth were less likely to use a pump if they were Black or Hispanic, had Medicaid or were uninsured, received government assistance (i.e., SSI, Temporary Assistance for Needy Families (TANF), WIC, SNAP), or lived in a higher ADI neighborhood. Youth were less likely to use CGM if they were Black or Hispanic, had Medicaid or were uninsured, or lived in a higher ADI neighborhood. Youth had higher DKA risk in the past year if they lived in a higher ADI neighborhood or had government assistance; however, pump and CGM use were associated with lower DKA risk (Figure 1). For every 1 unit increase in ADI, A1c increased by 0.09 (95% CI: 0.05, 0.13). A1c was 0.62 lower (95% CI: -0.82, -0.42) in pump users vs. not and 0.78 lower (95% CI: -0.99, -0.56) in CGM users vs. not. Advocacy efforts and QI projects promoting technology use in T1D youth of URE and lower SES may improve A1c and decrease risk of DKA.

Disclosure

E.R.Crain: None. R.Ramphul: None. A.Butler: None. X.C.Huang: None. C.G.Minard: None. M.J.Redondo: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation.
1151-P: Predicting Adverse Events in Patients with DKA or HHS
Authors: YOUSIF MAHA , ADHIKARI SOUMYA , WHITE PERRIN C.
Published: June 2023

Background: Management of diabetic ketoacidosis (DKA) in pediatric patients is well established, but optimal management for hyperglycemic hyperosmolar state (HHS) and mixed DKA/HHS is uncertain.

Aims: Develop a model to identify patients at increased risk of adverse events and identify management differences associated with adverse outcomes.

Methods: Retrospective chart review of 5,346 admissions from 3,104 unique patients with type 1 diabetes (T1D) or T2D at a large children’s hospital from 1/1/2010-7/1/2022 requiring IV insulin to manage DKA (pH <7.3, glucose > 200 mg/dl) and/or HHS (glucose >600 mg/dl). An ICU stay >48 hours (h) was a surrogate for severe adverse events. Risk of death or ICU stay >48 h (high risk [HR] group) was modeled using generalized estimating equations on a training dataset of 3,979 admissions from 2010-2019. Admissions 2020-2022 were the test dataset. Discrimination was assessed with receiver-operator-characteristic (ROC) curves. Using this predictive model, we selected a control (C) group at similar risk of adverse events to identify outcome-related management differences.

Results: There were 810 ICU admissions; 90 were >48 h. There were 8 diabetes-related deaths, 5 in 2020-2022. In the multivariate model, risk factors for severe adverse events included initial pH, glucose, absolute value of the deviation of glucose-corrected serum Na from 140, and a diagnosis of T2D. Discrimination was excellent; area under the ROC curve was 0.938 and 0.964 in the training and test datasets respectively. HR and C groups were similar for pH, glucose and sodium on admission, but altered mental status was more frequent in the HR group. Glucose and sodium corrected more slowly in the HR patients.

Conclusions: The prediction model accurately identified patients at increased risk of prolonged ICU stay or death. Rates of death and prolonged ICU stay increased during the Covid pandemic, correlated with more severe clinical presentation. Slower correction of metabolic abnormalities was associated with prolonged ICU stay.

Disclosure

M.Yousif: None. S.Adhikari: None. P.C.White: Consultant; Provention Bio, Inc.
1153-P: Postprandial Increase in Inflammation Is Not Affected by Glycemic Index in Children and Adolescent with Type 1 Diabetes
Authors: DAMILANO CECILIA P. , HOFFMAN ROBERT P.
Published: June 2023

Patients with type 1 diabetes (T1D) have lower life expectancy than individuals without diabetes. Most of this reduction is due to cardiovascular disease, the major cause of death in patients with T1D. Post-prandial inflammation after high glycemic index (GI) meals may cause cardiovascular disease in adults. Differences in postprandial inflammatory responses between high and low GI foods have not been studied in children and adolescents with T1D. Twelve non-obese children and adolescents, 10-18 years old, with type 1 diabetes were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. Baseline blood sample were taken (plasma glucose, triglyceride, IL-6, CRP, and TNF-α), rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) after an overnight fast. Visits 1 and 2 were identical except for the GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Glucose response were significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, repeated measures ANOVA, p<0.001), as expected. TNF-α (High 0 min: 0.86±0.08, 30 min: 1.83±0.08; Low 0 min: 0.82±0.06, 30 min 1.81±0.06 ng/ml) and IL-6 (High 0 min: 0.38±0.06, 120 min: 0.68±0.25; Low 0 min: 0.49±0.11, 120 min 0.71±0.14 ng/ml) increased following both high and low GI meals (p <0.001 and p=0.008, respectively), but there were no statistically significant differences between the two groups. CRP did not increase with either type of meal. Children and adolescent with T1D have post prandial inflammation, as indicated by increased TNFα and IL-6 levels. The post-prandial inflammation is not different between high and low GI meals in spite of higher glucose levels with the former.

Disclosure

C.P.Damilano: None. R.P.Hoffman: None.

Funding

Abigail Wexner Research Institute; University of Ohio
1170-P: Barriers to Transition and Proposed Transition Methods from Pediatric to Adult Care—A Qualitative Study of Patients with Type 1 Diabetes in Gaborone, Botswana
Authors: REYNOLDS DANA , CRAVEN MEGHAN E. , AHMED DERARTU , BROOKS MERRIAN , JOEL DIPESALEMA , LOWENTHAL ELIZABETH D.
Published: June 2023

Objective: The time of transition from pediatric to adult diabetes care is a high-risk period when many youth with Type 1 diabetes (T1D) have worsening glycemic control. The aim of this study was to conduct research to inform transition support for youth with T1D in low resource settings.

Methods: In-depth interviews with patients between 16-25 years old diagnosed with T1D were conducted in Botswana. The interviews discussed diabetes care and support systems, perceived or experienced barriers and facilitators to transition, readiness, and four proposed transition support systems (orientation, peer support, text messaging, and designated clinic days). Interviews were coded independently by three investigators in NVivo and analyzed using the Consolidated Framework for Implementation Research.

Results: Twenty-three patient interviews were conducted. The mean age of interviewed patients was 20.8 years (±2.88). Eight had transitioned to adult care. Among the 21 patients with a recent hemoglobin A1c, the mean was 10.4% (IQR 3.35). Patient reported inner setting factors impacting readiness included awareness and education surrounding transition, mental health resources, and relationships with providers. Outer setting themes impacting transition included acceptance and awareness of T1D in Botswana and cost of diabetes care. Of the four transition support strategies proposed, clinic orientation was universally supported. A designated clinic day was least supported due to a need for more flexibility.

Conclusions: As the number of patients with T1D increases in Botswana, a systematic approach to support the transition from pediatric to adult care that is culturally relevant and addresses the needs of transitioning adolescents to optimize health is needed. Our study highlighted youth identified barriers and facilitators to successful transition and suggested the most acceptable low-cost support strategies.

Disclosure

D.Reynolds: None. M.E.Craven: None. D.Ahmed: None. M.Brooks: None. D.Joel: None. E.D.Lowenthal: None.

Funding

Children’s Hospital of Philadelphia
122-OR: What Are the Barriers and Facilitators of Resistance Training in Mildly Frail Older Adults with Insulin-Treated Diabetes? A Qualitative Analysis Using the Capability, Opportunity, Motivation, and Behaviour (COM-B) Behavioural Science Model
Authors: STOCKER RACHEL , SHAW JAMES A. , WITHAM MILES D. , TAYLOR GUY , WEST DANIEL J.
Published: June 2023

Background: Resistance exercise offers many benefits for those with frailty and sarcopenia and may carry less risk of exercise induced hypoglycaemia. However most older adults do not meet recommended levels of exercise. Little is known about why, especially for mildly frail older adults with insulin treated diabetes. Our aim was to investigate behavioural related influences to undertaking resistance exercise in this vulnerable group.

Methods: A phenomenological qualitative study using semi structured interviews with mildly frail adults aged ≥60 with insulin-treated diabetes (Type 1 (n=12); Type 2 (n=3)) recruited via online advert, in the UK. Frailty was assessed using the Rockwood Clinical Frailty Scale. Those with a history of myocardial infarction, stroke, renal failure, severe hypertension or liver disease in the last 12 months were excluded. Data were analysed inductively using thematic analysis, then aligned to the COM-B.

Results: Barriers to exercise centred on the physical capability, opportunity, and reflective motivation COM-B domains. Primary barriers included exacerbating existing fatigue or diabetes-related complications, exercise induced hypoglycaemia and injury, and inability to use resistance equipment. Most were unaware of the benefits of exercise on diabetes and muscle health. Many with a decades-long diagnosis were initially told that exercise was unsafe. Facilitators included an informative and flexible training environment, clarity on potential diabetes specific benefits, and having a supportive partner ideally also capable of exercise.

Conclusion: Older, mildly frail adults with insulin-treated diabetes are a vulnerable group whose beliefs may prevent them from undertaking regular exercise. They may benefit from a specific programme of awareness raising and a tailored, flexible exercise environment.

Disclosure

R.Stocker: None. J.A.Shaw: Advisory Panel; Betalin Therapeutics, Provention Bio, Inc., Consultant; Mogrify. M.D.Witham: None. G.Taylor: None. D.J.West: None.

Funding

UK Wellcome Trust
124-LB: Randomized Trial of Continuous Glucose Monitors for the Care of Pregnant People to Limit Staff Exposure
Authors: GRASCH JENNIFER , NANDAM NEEHARIKA , BUSCHUR ELIZABETH
Published: June 2023

Introduction: During a pandemic, use of remote monitors may reduce close patient contact and decrease risk of occupational exposure. This study evaluated the impact of continuous glucose monitor (CGM) use on the number of close encounters required for diabetes management in pregnant individuals.

Methods: This study included 24 pregnant people with pregestational diabetes or medication-controlled gestational diabetes admitted for antepartum care. Participants received a Dexcom G6 CGM and were randomized to clinical use of CGM (intervention) or to standard care with fingerstick point-of-care (POC) glucose checks and a CGM device in blinded mode (control). The primary outcome was the number of POC glucose measurements per nursing shift. Secondary outcomes included glycemic control, neonatal outcomes, and patient and nursing satisfaction measured with surveys.

Results: Patients in the intervention group required fewer POC measurements per shift than the control group, but this difference did not reach statistical significance (1.56 ± 0.88 vs 2.28 ± 1.17, p=0.08). Time in the pregnancy-recommended glycemic range (63-140 mg/dL) was similar in both the intervention and the control groups (77.65% ± 22.95 vs. 73.30% ± 27.23, p = 0.89). Time above range (21.64% ± 23.49 vs. 24.84% ± 27.82, p = 0.95) and below range (0.70% ± 1.58 vs. 1.86% ± 4.93, p = 0.64) were also comparable in the intervention and control patients. Neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, hyperbilirubinemia and supplemental oxygen were less likely in the intervention group, however this difference was not significant when adjusted for gestational age at delivery. Patient and nursing satisfaction was high in both groups and not significantly different.

Conclusion: Although use of CGM's for antepartum admissions did not significantly decrease close patient contact, equivalent glycemic control was achieved as with standard care. Neonatal outcomes were also similar in both groups.

Disclosure

J. Grasch: Research Support; Dexcom, Inc., TrueRelief, LLC. N. Nandam: None. E. Buschur: Consultant; Beta Bionics, Inc., Research Support; Dexcom, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust.

Funding

Dexcom, Inc. (IIS-2020-052)
1240-P: Triglyceride Variability and Risk of Adverse Cardiovascular Outcomes—Results from the ACCORD Trial
Authors: NUYUJUKIAN DANIEL S. , ZHOU JIN , KOSKA JURAJ , REAVEN PETER
Published: June 2023

The potential role of visit-to-visit variability of lipid parameters in risk of adverse cardiovascular events is not well established. We used data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial to examine the relationship between visit-to-visit variability in triglycerides and risk of both heart failure (HF) events and the primary CVD outcome. Variability of triglycerides was computed as coefficient of variation (CV-Trig). In both age-adjusted models and models adjusting for covariates that differed between those who did and did not develop HF, CV-Trig was associated with risk of HF (Model 2, HR = 1.13, p = 0.03) (Table). This association was somewhat attenuated when accounting for mean triglyceride level (Table). Conversely, we did not observe any relationship between CV-Trig and the primary CVD outcome in ACCORD (Model 1: HR = 1.04, p = 0.21) (Table). LDL variability was not linked to risk of HF in ACCORD. Our results suggest that variability in triglycerides may play a more important role in HF than in other cardiovascular outcomes. Studies to elucidate mechanisms which may underlie these risk patterns are warranted.

Disclosure

D.S.Nuyujukian: None. J.Zhou: None. J.Koska: None. P.Reaven: Research Support; Dexcom, Inc.

Funding

National Heart, Lung, and Blood Institute (F32HL156626, R21HL150374, R21HL150268, R01HL138969)
1251-P: Glycaemic Trajectory before Diabetes Diagnosis in People with Young-Onset and Usual-Onset Type 2 Diabetes—A Population-Based Retrospective Study in Hong Kong
Authors: FAN YINGNAN , WU HONGJIANG , LAU ERIC S.H. , YANG AIMIN , CHOW ELAINE , KONG ALICE P. , MA RONALD C. , CHAN JULIANA C. , LUK ANDREA
Published: June 2023

Objectives: To identify distinct glycaemic trajectories before diabetes diagnosis in people with young-onset (<40 years) and usual-onset type 2 diabetes (≥40 years).

Methods: Adult patients with incident type 2 diabetes diagnosed between 2002 and 2019 who had at least three HbA1c measurements before diabetes diagnosis in Hong Kong Hospital Authority electronic medical record system were included in this study. Latent class trajectory modelling was applied to identify distinct HbA1c trajectories before diabetes diagnosis, adjusted for sex and age. The shape and number of trajectory classes (one to five) were selected based on a combination of Bayesian Inclusion Criteria, model adequacy and proportion of people in each trajectory class (no less than 2% required).

Results: A total of 2,252 people with young-onset type 2 diabetes (age [mean ± SD]: 34.1 ± 4.9 years; 40.0% male) and 77,892 people with usual-onset type 2 diabetes (age [mean ± SD]: 64.9 ± 11.0 years; 51.4% male) were included in this analysis. The 2-class solution and 1-class solution were chosen as the most appropriate models for young-onset and usual-onset type 2 diabetes respectively. A stable-increase trajectory with HbA1c rising gradually before diabetes diagnosis was identified in 96% of people with young-onset type 2 diabetes, while the other 4% had an accelerated-increase trajectory with HbA1c increasing rapidly within one year before diagnosis. People with usual-onset type 2 diabetes had HbA1c value increasing gradually before diabetes diagnosis.

Conclusion: Blood glucose climbed gradually at a steady rate before diabetes diagnosis in most people with type 2 diabetes, while a small proportion of people with young-onset type 2 diabetes showed a rapid deterioration within a short period before disease onset.

Disclosure

Y.Fan: None. H.Wu: None. E.S.H.Lau: None. A.Yang: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company.
1290-P: Diabetes Provider Perceptions of Barriers and Benefits to Type 1 Diabetes Autoantibody Screening among Patients and Relatives
Authors: OSPELT EMMA L. , HARDISON HOLLY , RIOLES NICOLE , NOOR NUDRAT , CROSSEN STEPHANIE , SMEGO ALLISON , ALEPPO GRAZIA , FRIEDMAN JARED , ENG DONNA , SULLIVAN CATHERINE , MAJIDI SHIDEH , LORINCZ ILONA , EBEKOZIEN OSAGIE
Published: June 2023

Background: This study highlights perceived benefits and barriers to type 1 diabetes (T1D) autoantibody screening rates in U.S. endocrinology practices.

Methods: Fifty eligible endocrinology providers participated in a 15-question survey distributed via Qualtrics. Participants were recruited from the T1D Exchange Quality Improvement Collaborative. Data was cleaned, sorted, and analyzed. Summary statistics, including frequencies and proportions for categorical variables were evaluated and plotted using bar charts. z

Results: Overall, 82% of providers stated interest towards autoantibody screening in their clinics. The following were ranked as benefits of autoantibody screening: opportunity for early diabetes management (90%), enrollment in research projects (84%), clinical guidance and diagnosing abilities (80%), and DKA prevention at diagnosis (76%). Providers identified multiple barriers to autoantibody screening in clinical practice including the associated cost and anxiety for patients, as well as limited staff time and resources (Figures 1, 2).

Conclusion: The majority of surveyed providers feel confident recommending autoantibody screening for patients and those at risk for diabetes. However, clinic limitations exist that may affect the feasibility of this in practice. These barriers should be targeted with specific interventions moving forward.

Disclosure

E.L.Ospelt: None. C.Sullivan: None. S.Majidi: None. I.Lorincz: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. H.Hardison: None. N.Rioles: None. N.Noor: None. S.Crossen: None. A.Smego: None. G.Aleppo: Advisory Panel; Medscape, Consultant; Bayer Inc., Insulet Corporation, Research Support; Dexcom, Inc., Eli Lilly and Company, Emmes, Insulet Corporation, Fractyl Health, Inc., WellDoc, Speaker's Bureau; Dexcom, Inc. J.Friedman: None. D.Eng: None.
1327-P: The Association between Adherence to Mediterranean Dietary Pattern and Nephropathy in Long-Duration Type 1 Diabetes
Authors: HAYES AMANDA , VISHVA TEJA JANGOLLA SURYA , GAUTHIER JOHN , ZIEMNIAK NOLAN A. , WU I-HSIEN , HEI KAREN LAU KA , ADAM ATIF , HU FRANK , TABUNG FRED K. , KING GEORGE L. , SHAH HETAL
Published: June 2023

Vascular complications contribute to the high morbidity and mortality in type 1 diabetes (T1D), necessitating a search for new therapeutic measures. The Alternative Mediterranean diet score (aMED), high in vegetable, fruits, legumes, whole grains, nuts, and low in red and processed meat and uses olive oil as the main fat source, has been shown to improve glycemic control and reduce cardiovascular disease (CVD) risk in type 2 diabetes, but has not been examined for relationships to vascular complications in T1D. We examined the cross-sectional relationships between aMed adherence and vascular complications among 645 individuals of the Joslin 50-year Medalist study having T1D > 50 years and food frequency histories captured. In multivariable logistic regression models adjusting for age and sex, a higher adherence to a Mediterranean diet was associated with a 17% reduced odds of diabetic nephropathy (DN, eGFR <60 ml/min/1.73m2) [OR 0.83, 95% Cl 0.72-0.95, p=0.008], and this remained significant (p<0.05) after further adjustments for HbA1c, diabetes duration, lipids and blood pressure. There were no significant associations between aMed and CVD, diabetic retinopathy or neuropathy. Among the specific aMED components, higher intake of nuts, higher ratio of monounsaturated fat to saturated fat and lower intake of red and processed meats were all associated with significantly (p<0.05) reduced odds of DN. Triglycerides, HDL and albumin-creatinine ratio (ACR) were significant effect modifiers (p for interaction <0.05) such that, more DN-protective effects of aMed were observed among those with higher triglycerides, lower HDL, and higher ACR. To conclude, our findings suggest that greater adherence to a Mediterranean diet in individuals with long duration T1D is associated with lower risk of DN, independent of traditional risk factors. Further studies are warranted to validate its potential as an effective therapeutic approach against DN in people with T1D.

Disclosure

A.Hayes: None. G.L.King: Research Support; Janssen Research & Development, LLC. H.Shah: None. S.Jangolla: None. J.Gauthier: None. N.A.Ziemniak: None. I.Wu: None. K.Lau: None. A.Adam: None. F.Hu: None. F.K.Tabung: None.

Funding

Nunnally Foundation Inc.; Thomas J. Beatson, Jr. Foundation
1340-P: Complications 30 Years from Diagnosis amongst Participants in the Cognition and Longitudinal Assessment of Risk Factors over 30 Years (CLARiFY) Study
Authors: BROWN AMY , REYNOLDS EVAN L. , GBADEYAN OYETUNDE , MORAN CHRIS , SAKOWSKI STACEY A. , SRIKANTH VELANDAI , NORTHAM ELISABETH A. , CAMERON FERGUS , BEARE RICHARD , FELDMAN EVA L.
Published: June 2023

There are few longitudinal cohort studies in type 1 diabetes that originate in the immediate post-DCCT era. We recruited participants who had initially presented with childhood onset type 1 diabetes (<15 yr age) to a tertiary hospital in Australia between 1990-1992 into the Cognition and Longitudinal Assessment of Risk Factors over 30 Years (CLARiFY) Study. Microvascular co-morbidity outcomes were measured using a clinical neuropathy screening tool and spot urinary albumin to creatinine ratios (ACR). In this interim study, 56 participants had complete neuropathy screening. 7/56 (12.5%) met the criteria for neuropathy with the mean (SD) HbA1c of 8.57 (1.49) compared to 8.04 (1.46) in the non-neuropathy participants (p-value=0.41). Pearson's correlation coefficients were calculated to assess pairwise associations between HbA1c and continuous neuropathy outcomes and observed non-significant negative correlations between HbA1c and vibration (r=-0.12, P=0.38). Of the 56 participants with neuropathy measurements, 40 also had urine albumin-creatinine ratios (ACR). 27/40 (67.5%) had normal ACR (ACR<3 mg/mmol) with HbA1c of 7.8 (1.3); 10/40 (25.0%) had microalbuminuria (3 mg/mmol<ACR<30 mg/mmol) with HbA1c of 10.3 (2.3); and 3/40 (7.5%) had macroalbuminuria (ACR>30 mg/mmol) with HbA1c of 10.3 (2.3). Using a one-way ANOVA test, HbA1c was significantly different between the three groups (p-value = 0.01.). Using the ACR as a continuous variable, the Pearson's correlation coefficient with A1c was 0.49 (p-value= 0.001). Collectively, these data show that in a cohort of type 1 adults diagnosed in childhood, elevations of ACR are more common and associate with glycemic control when compared to measures of neuropathy.

Disclosure

A.Brown: None. E.L.Feldman: None. E.L.Reynolds: None. O.Gbadeyan: None. C.Moran: None. S.A.Sakowski: None. V.Srikanth: None. E.A.Northam: None. F.Cameron: None. R.Beare: None.

Funding

National Institutes of Health (R01DK129320)
139-LB: Use of Digital Diabetes Solution Is Associated with Improved Glycemic Control without Increased Risk of Severe Hypoglycemia in Adults with Type 2 Diabetes Mellitus in the United States—Retrospective Cohort Study
Authors: THINGALAYA NITA , KERR DAVID , KUMAR POTUKUCHI PRAVEEN , WILSON LAURA , LEE KENI C. , HAN-BURGESS EDWARD JONATHAN K. , EDWARDS ALISON , YU XINYAN , KENNEDY ADEE , LEE FELIX
Published: June 2023

Background: Dario Diabetes Solution (DDS) is a digital health application (app) that combines blood glucose (BG) monitoring system with a smartphone app, allowing tracking of BG levels in real time. This study assessed effects of DDS on HbA1c levels in adults with type 2 diabetes mellitus (T2DM) with baseline (BL) HbA1c ≥8% and on severe hypoglycemia (SH).

Methods: This retrospective cohort analysis included adults with T2DM who used DDS (users) and nonusers from 1JAN2017 to 31OCT2021. BL period was 1 year before index date (users, first DDS registration; nonusers, first claim date in the quarter); follow up was 6 months. DDS users and nonusers were sequentially matched 1:3 using exact and propensity score matching. Secondary endpoints included SH (event requiring medical intervention) rates for all patients (pts) and for pts with BL HbA1c ≥8% who achieved predefined target HbA1c <8%. SH incidence in users vs nonusers was examined.

Results: Overall cohort included 568 DDS users and 1699 nonusers: mean age, 57.5±11.3 years; mean BL HbA1c, 9.14±1.83%; oral antidiabetic drugs, 51%; insulin, 6%. BL SH was rare (users, 7/568; nonusers, 12/1699). There were 387 users and 1089 nonusers with BL HbA1c ≥8% (mean BL HbA1c, 10.0±1.7%). In this subgroup, HbA1c <8% was achieved by 9% more DDS users (174/387 [45%]) vs nonusers (393/1089 [36%]) at 6 months; P=0.002. At 6 months, overall SH rate was 38.8 (users) vs 10.6 (nonusers) events/1000 pts per year (incidence rate ratio, 0.9; P=0.9). No observed increase in SH risk was associated with DDS in this population. SH was rare in pts who achieved HbA1c <8% (users, 1/174; nonusers, 3/393).

Conclusions: In this retrospective study, a larger proportion of adults with uncontrolled T2DM (BL HbA1c ≥8%) achieved HbA1c <8% after using DDS vs nonusers, with no increased risk of SH.

Disclosure

N. Thingalaya: None. F. Lee: Employee; Sanofi, Stock/Shareholder; Sanofi. D. Kerr: Consultant; Sanofi-Aventis U. S. P. Potukuchi: None. L. Wilson: Employee; Sanofi. K. C. Lee: Employee; Sanofi. E. K. Han-burgess: Employee; Sanofi. A. Edwards: Employee; Symphony Health, an ICON plc company, Other Relationship; Sanofi. X. Yu: None. A. Kennedy: None.

Funding

Sanofi
1398-P: Contribution of New-Onset Diabetes after Organ Transplantation on the Incident Cardiovascular Disease and Malignancy in Korea—A Nationwide Population-Based Study
Authors: KYUNG KOO BO , KYONG MOON MIN , SHIN PARK SEUNG , HAN KYUNGDO
Published: June 2023

Background: In Korea, the number of solid organ transplantation (TPL) has been markedly increased; however, there has been limited data on the adverse effect on the cardiovascular disease and malignancy of new onset diabetes after transplantation (NODAT) in solid organ TPL other than kidney.

Methods: Using the National Health Insurance Service (NHIS) database which covers the claims of 97.0% of the population in Korea, the recipients of kidney, liver, and heart TPL in 2009-2015 were identified and categorized into 3 groups: without NODAT (reference), with NODAT, and pre-existing diabetes mellitus (DM). The incidence of myocardial infarction (MI), stroke, and malignancy till December 2018 in each group were compared using Cox-regression analysis.

Results: Among the entire 18,763 cases of TPL identified, NODAT was detected in 29.8% (27.2% [2,903 out of 10,687], 43.4% [3,247 out of 7,747], and 41.5% [250 out of 602] in kidney, liver, and heart TPL, respectively); and 77.3% of NODAT cases were detected within 3 months after TPL. NODAT increased the risk of MI, but not of stoke, by 2.3 times compared to the reference group after adjustment for age, sex, hypertension, dyslipidemia, and immunosuppressants (hazard ratio [HR], 2.34; 95% CI, 1.61-3.51), which was observed only in kidney TPL (HR, 2.44; 95% CI, 1.52-3.91) but not in liver TPL. A significant increment of the risk of malignancy by NODAT was found only in kidney TPL (HR, 1.30; 95% CI, 1.04-1.64), whose statistical significance was lost after adjusting confounders. During the same period, no association between pre-existing DM and malignancy was found, neither.

Conclusion: NODAT independently increased the risk of MI after organ transplantation, which was more evident in the recipient of kidney TPL. There was no additional increased risk of stroke or malignancy by NODAT in solid-organ TPL.

Disclosure

B.Koo: None. M.Moon: None. S.Park: None. K.Han: None.
140-OR: Adoption of State-Level Complete Streets Legislations and U.S. Prevalence of Obesity
Authors: LINDE SEBASTIAN , EGEDE LEONARD E.
Published: June 2023

Background: The US obesity prevalence has increased from 30.5% in 1999 to 41.9% in 2020, and the medical cost of obesity is estimated at $173 billion annually. Given the health and cost implications of obesity and its direct relationship with the growing prevalence of diabetes, there is a need to identify policy levers that can ameliorate these public health burdens. Complete Streets policies aim to strengthen transportation systems, promote physical activity and improve health outcomes related to obesity and in turn diabetes. It addresses issues like sidewalks, bicycle lanes, bus lanes, public transportation stops, crossing opportunities, median islands, accessible pedestrian signals, curb extensions, modified vehicle travel lanes, streetscape, and landscape treatments. This study examines the effect of state adoption of Complete Streets policies on prevalence of obesity.

Methods: We combined data on state obesity rates from America's Health Ranking database with legal information on state's adoption of Complete Streets policies from the PHACCS Initiative. Using the data we estimated overall average, as well as state specific, policy effects due to Complete Streets policy adoption. Our approach utilized a generalized difference-in-difference design and additional testing of model assumptions.

Results: Our analysis sample consisted of a panel of 1,479 state-year observations (across 50 US States and the District of Columbia, for the period of 1990-2018). This corresponds to 22 exposed states (with Complete Streets policies), and 29 control states (without Complete Streets policies). Preliminary analyses indicate significant reduction of obesity prevalence (-0.5%; 95%CI: -0.9 to -0.1; p=0.006) in exposed vs. control states, with heterogenous policy effects across states.

Conclusions: Complete Streets policy adoption is associated with reduced obesity rates. Given these associations, Complete Street policy adoption is also likely to result in reductions in prevalence of diabetes.

Disclosure

S.Linde: None. L.E.Egede: None.

Funding

National Institute of Diabetes and Digestive and Kidney Disease (K24DK093699, R01DK118038, R01DK120861 to L.E.E.); National Institute for Minority Health and Health Disparities (R01MD013826 to L.E.E.)