bluuebunny/crossref_metadata_2025 huggingface dataset:
749-P: Parents’ Psychosocial Outcomes from the Strategies to Encourage New CGM Use in Early Childhood (SENCE) Trial at 12 Months
Authors: HILLIARD MARISA E. , KANAPKA LAUREN , LAFFEL LORI M. , ANDERSON BARBARA , MILLER KELLEE , LEVY WENDY , VAN NAME MICHELLE A. , COMMISSARIAT PERSIS V. , DIMEGLIO LINDA
Published: June 2020

Objective: Parents of young children with type 1 diabetes report developmental and management challenges and diabetes-related distress. In the SENCE trial with children 2-<8 yrs, we described improved parental psychosocial outcomes from baseline to 26 wks when continuous glucose monitoring (CGM) was combined with a family behavioral intervention (FBI), compared to CGM alone and to standard blood glucose monitoring. We now explore psychosocial outcomes in the CGM+FBI and CGM alone groups over the extension phase (observation without intervention, 26 to 52 wks post-baseline).

Method: Parents (N=143, children: 50% female, 68% non-Hispanic White, age=5.7±1.8 yrs, A1c=8.2±0.8%) completed validated surveys of diabetes burden, diabetes family impact, hypoglycemia fear, and treatment regimen impact at baseline, 26, and 52 wks. We analyzed 52 week outcomes using within-group t tests and between-group longitudinal models.

Results: Survey scores were stable from 26 to 52 wks, although differences from baseline to 52 wks were not significant (p<.01) (Table).

Conclusion: Introducing CGM with FBI improves parental psychosocial outcomes for at least 6 mos; the similar results at 12 mos suggest durability to 1 yr. Importantly, adding CGM to diabetes regimens in young children, especially with behavioral support, does not appear to add to parents’ perceived burden or fear of low blood glucose.

Disclosure

M.E. Hilliard: None. L. Kanapka: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. B. Anderson: None. K. Miller: None. W. Levy: None. M.A. Van Name: None. P.V. Commissariat: None. L. DiMeglio: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
752-P: Effects of Diabetes and Menopause on Mood, Quality of Life, and A1C
Authors: SHARMA HIMANI , MYERS BARBARA A. , GROOT MARY DE
Published: June 2020

Women with type 1 (T1D) and type 2 diabetes (T2D) are living longer than any other time in history. Little is known about the effects of diabetes and the menopause transition on psychosocial outcomes at mid-life. We conducted a cross-sectional survey to evaluate the emotional and behavioral correlates of menopause in women ≥ age 40 with and without diabetes (ND). 655 women completed an online survey querying demographics, A1c, diabetes distress (DDS), depressive symptoms (PHQ-8), health-related quality of life (HRQOL; SF-12), Menopause Specific Quality of Life (MenQOL), and Pittsburgh Sleep Quality Index (PSQI). Mean age was 53 years, 83% self-identified as White, 52% married, >30% had a college degree and household income ≥$100,000/year. 55% (n=366) of had ND, 27% (n=181) T2D, 9% (n=60) TID and 7% (n=46) prediabetes. 6% (n=43) were premenopausal, 25% (n=167) perimenopausal and 67% (n=440) in menopause. Mean A1c in women with diabetes was higher in perimenopausal (7.8%) compared to menopausal women (7.1%, p=0.04). Depressive symptom levels were higher in T2D compared to ND (M=9.2 vs. 5.5, p<0.05). DDS was not different in T1D vs. T2D. T2D had lower HRQOL for both SF-12 mental (M=46.0 vs. 48.6, p=.004) and physical components (PCS; M=40.6 vs. 48.3, p<.05) compared to ND. T2D also had lower SF-12 PCS as compared to T1D (M=40.6 vs. 50.2) and prediabetes (M=40.6 vs. 42.7, all p<0.05). T2D reported worse subjective sleep quality (M=1.5 vs. 1.2) and more use of sleep medication (M=1.1 vs. 0.8) compared to ND. They also reported worse sleep disturbance (M=1.6) than T1D (M=1.3) and ND (M=1.3; all p<.05). MenQOL physical domain was worse in T2D (M=4.1) than T1D (M=3.6) and ND (M=3.1, p<0.05). Psychosocial (M=3.9 vs. 2.9), vasomotor (M=3.8 vs. 2.8) and sexual (M=3.6 vs. 2.6) functioning were worse in T2D compared to ND (p<0.05). T2D women had greater psychological and physical distress affecting HRQOL than T1D and ND across the menopause transition. Glycemic management appears to be more difficult in perimenopause than later in the menopause transition.

Disclosure

H. Sharma: None. B.A. Myers: None. M. de Groot: Consultant; Self; Kenner Family Foundation, Inc., LifeScan Diabetes Institute.
753-P: A Clinical Mixed-Methods Study of the Perceived Benefits of Using the Danish Diabetes Patient Reported Outcome Measure and Dialogue Support Tool in Routine Outpatient Diabetes Care
Authors: SKOVLUND SOREN E. , TROELSEN LISE , NØRGAARD LISE MELLERGAARD , KJAER PERNILLE H. , PIETRASZEK ANNA , LARSEN HANNE RAVN , HESSLER DANIELLE M. , JAKOBSEN POUL ERIK O. , EJSKJAER NIELS
Published: June 2020

Aim: To characterize validity, acceptability and perceived impact of the national Danish Diabetes PROM IT tool (DiaProfile) in routine diabetes care among people with both type 1 and 2 diabetes (PWD) and their health care professionals (HCP). To inform the evaluation design of a national study.

Methods: 12 PWD were recruited using a purposive analytical consecutive method in a single-arm mixed-methods qualitative clinical design. PWD completed the PROM prior to their visit and DiaProfile was used in visit to collaboratively identify individual care needs and options. PWD and HCP completed psychometric PROM evaluation scales on acceptability, validity, relevance, usability and perceived impact of the PROM intervention. Semi-structured interviews were done with all PWD (45-60 min). Visits/interviews were tape recorded and transcribed for coding. Phenomenological, thematic analyses with both inductive and deductive methods were used and all data sources were combined for triangulation.

Results: 12 PWD: 8 female/4 male, 4 type 2/8 type 1, mean age 51 (24-79), 9 on insulin pens, 2 on pumps, 2 on glp-1, 2 on metformin. Complications ranged from 0 to 6 per PWD. 2 physicians and 2 nurses each treated 3 PWD. PWD consistently found PROM easy and acceptable to complete, relevant, understandable and with no major topics missing. Triangulation identified consistent PWD and HCP experiences of improved visit preparedness, dialogue quality, care quality and focus, patient participation, and care confidence and experience with PRO use across users. All advocated for use in standard care.

Conclusions: This is the first real-world study to characterize perceptions of context validity, relevance, acceptability, usability and value (patient participation, dialogue, care quality) of the Danish diabetes PROM in a routine care setting. Outcomes were used to inform design of a national large-scale PRO diabetes study.

Disclosure

S.E. Skovlund: None. L. Troelsen: None. L. Nørgaard: None. P.H. Kjaer: None. A. Pietraszek: None. H. Ravn Larsen: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. P.O. Jakobsen: None. N. Ejskjaer: None.

Funding

Region of Northern Denmark; Danish National Health Data Board
756-P: Socioeconomic and Self-Management Factors Do Not Explain Racial/Ethnic Disparities in Advanced Diabetes Technology Use among Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: AGARWAL SHIVANI , SCHECHTER CLYDE , GONZALEZ JEFFREY S. , LONG JUDITH A.
Published: June 2020

Recent studies demonstrate wide racial/ethnic disparity in insulin pump and continuous glucose monitor (CGM) use in people with T1D. It remains unknown whether socioeconomic status (SES) or other factors drive disparities. We recruited 300 diverse YA with T1D from 6 diabetes centers across the U.S. (ages 18-28; 33% non-Hispanic White, 32% non-Hispanic Black, 34% Hispanic; 52% public/no insurance; median A1c 9.2%). We used logistic regression to examine how patient-reported and chart-extracted variables, including multiple socioeconomic and individual-level factors, accounted for racial/ethnic disparity in current pump or ever CGM use. Compared with White YA (71/72%), both Black (18/28%) and Hispanic (37/39%) YA had significantly lower pump and CGM use, respectively (p<0.001). Pump and CGM users were more likely to have lower A1c levels, higher attained education, greater household income, lower neighborhood poverty, private insurance, higher diabetes numeracy and literacy, and receive care in a pediatric or combined pediatric-adult center (p<0.001). They were also more likely to report frequent self-monitoring of blood glucose and diabetes medical visit attendance (p<0.001). Full adjustment for these multiple SES, self-management, and care factors did little to explain racial/ethnic disparity. Compared with White YA, Black and Hispanic YA had persistent 50-80% lower odds of insulin pump use and Black YA had 70% lower odds of CGM use (OR (95% CI) Pump: Black 0.125 (0.050, 0.313), Hispanic 0.427 (0.176, 1.035); CGM: Black 0.291 (0.121, 0.702)). In contrast, these variables accounted for more of the CGM disparity between White and Hispanic YA (OR (95% CI) 1.007 (0.409, 2.483)). Exploration of factors other than SES and self-management is needed to examine disparity in diabetes technology use, especially in Black YA. Black and Hispanic YA preferences for technology and provider factors should be considered.

Disclosure

S. Agarwal: None. C. Schechter: None. J.S. Gonzalez: None. J.A. Long: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)
759-P: Telephonic Coaching Is Associated with Improved Glycemic Control in Many Individuals with Type 1 and Type 2 Diabetes
Authors: BIGGS WILLIAM C. , BUSKIRK ANN , BORSA LENA , LYDEN MAUREEN R. , PARKIN CHRISTOPHER , PETERSEN BETTINA
Published: June 2020

Coordinated health coaching is associated with improved diabetes outcomes with lower cost vs. traditional diabetes management. Diabetes Health Partnership (DHP) is a telephonic coaching program designed to empower individuals with diabetes. This 12-month, observational, self-controlled multi-site study combined retrospective (6 mth pre-baseline) and prospective (6 mth post-baseline) data to assess the impact of the DHP program on A1C among 57 individuals with type 1 and type 2 diabetes. Mean change from baseline A1C (8.4±1.1%) was significant (-0.5 ± 0.9%, <0.0001) within the full cohort (n=54) but notable differences in A1C between Responders (n=27, ≥0.5% reduction) vs. Non-Responders (n=27, <0.5% reduction) were observed (Figure 1), with comparable medication changes with the exception of insulin. Differences in A1C between Responders and Non-Responders may be explained by a combination of differences in baseline A1C (8.5 ± 0.8% vs. 8.3 ± 1.2%), baseline body weight (191.2 ± 36.6 lbs vs. 201 ± 42.9 lbs) and change in body weight (-5.0 ± 10.1 lbs vs. 0.6 ± 6.7 lbs). Notably more Responders than Non-Responders had >3 coaching sessions focused on diet/nutrition (9 vs. 3, respectively). Participation in the DHP program was associated with clinically-significant improvements in glycemic control in many individuals with suboptimally controlled diabetes.

Disclosure

W.C. Biggs: Consultant; Self; Roche Diabetes Care. Research Support; Self; Dexcom, Inc., Gan & Lee Pharmaceuticals, Mylan, Novo Nordisk A/S, Sanofi US. A. Buskirk: Employee; Self; Roche Diabetes Care. L. Borsa: None. M.R. Lyden: None. C. Parkin: Consultant; Self; Abbott, CeQur Corporation, Dexcom, Inc., DreaMed Diabetes, Novo Nordisk Inc., Onduo, Roche Diabetes Care, Valeritas, Inc. B. Petersen: Employee; Self; Roche Diabetes Care.
762-P: High Hypoglycemia Self-Confidence Is Related to Better Glycemic Control and Low Diabetes Distress Levels in a Brazilian Sample of T1D Adults from Public and Private Diabetes Clinics
Authors: KOELLE MARIA B. , PASTORE ANDREIA , PAVIN ELIZABETH J. , SILVEIRA MÔNICA S.V.
Published: June 2020

Keeping blood glucose levels within 70% in range 70-180 mg/dl and HbA1c < 7% are the main treatment goals for T1D patients. Recent studies have shown that hypoglycemia self-confidence (HC) has a major impact on self-care and diabetes outcomes and several studies demonstrated that diabetes-distress (DD) negatively affects glycemic control. This study aimed: 1- to measure HC and DD scores in T1D patients, and 2- to determine the association among HC, DD and glycemic control in a sample of T1D adults followed at the State University of Campinas and in a private diabetes clinic in Campinas, Brazil. In a cross-sectional study, 66 T1D adults were evaluated. Inclusion criteria were age >18 and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, and severe diabetes-related complications. The Hypoglycemia Self-Confidence Scale (HCS), assessed HC, and Type One Diabetes Distress Scale (T1DDS), assessed DD. Metabolic control was evaluated by HbA1c. Severe hypoglycemia and ketoacidosis episodes were obtained through interview and from medical records. Sixty-two percent were female, aged 35.33 ± 11.07 years, time of T1D: 21.21 ± 11.02 years, schooling: 15.24 ± 3.83 years. The mean HbA1c was 8.29% ± 1.32%. Thirty-three percent reported severe hypoglycemia and 19.70% had ketoacidosis in the last 12 months. T1DDS score was 2.39 ± 0.90, indicating clinically relevant distress and the HCS score was 2.97 ± 0.66, demonstrating moderate hypoglycemia self-confidence. HCS was significantly associated with HbA1c, DD, and masculine gender (p<0.05). High HC is related to less DD and low HbA1c. Strategies to improve HC may contribute to improve glycemic control and to decrease psychological suffering in T1D patients.

Disclosure

M.B. Koelle: None. A. Pastore: None. E.J. Pavin: None. M.S.V. Silveira: None.
768-P: Perceived Burdens and Benefits Associated with Continuous Glucose Monitor Use in Type 1 Diabetes
Authors: DIVAN VIDITA , GREENFIELD MARGARET , MORLEY CHRISTOPHER P. , WEINSTOCK RUTH S.
Published: June 2020

Objective: To describe perceived burdens and benefits of continuous glucose monitor (CGM) use in CGM non-users vs. users with type 1 diabetes across the lifespan.

Research Design and Methods: The Burdens of CGM (BurCGM) and Benefit of CGM (BenCGM) questionnaires were completed at clinic visits from Feb 2019 to Nov 2019. Mean scores were calculated (scale 1-5; higher score reflects greater perceived burdens and benefits). Data collected from medical records included demographic information, CGM and insulin pump use, and HbA1c within 3 months of the visit.

Results: Participant characteristics (n=1143) and the 3 most common perceived CGM burdens (in non-CGM users) and benefits (in non-CGM users and CGM users) are shown in the Table. Individuals using real time (RT) and non-RT CGM described more benefits (mean scores 34.9 and 34.0) when compared to those who never used CGM (mean score 30.2) (p<.001). There were no differences in burdens or benefits by sex or race. Mean HbA1C was lower in CGM users (8.2%) vs. non-CGM users (mean A1c 9.3%; p<.001); 47.4% of non-CGM users vs. 29.3% of RT-CGM users and 30.6% of non-RT-CGM users had A1c>9.0%.

Conclusions: Cost is a barrier to CGM use, particularly in adults. In non-CGM users (vs. users), CGM was perceived as having less benefit and to be associated with pain and concern that readings cannot be trusted. Advocacy (for lower cost) and education are needed to address these barriers.

Disclosure

V. Divan: None. M. Greenfield: None. C.P. Morley: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.

Funding

Type 1 Diabetes Exchange QI Learning Collaborative
769-P: Diabetes Distress Screening in an Academic Young Adult Diabetes Transition Program
Authors: RODEMAN KATHRYN , RAO AMITH , KONIGSBERG ANNA , ANG LYNN , THOMAS INAS H. , SOLEIMANPOUR SCOTT , IYENGAR JENNIFER J.
Published: June 2020

Background: The transition from pediatric to adult care is a high risk time for young adults with diabetes associated with poor glycemic control and psychosocial challenges. However, little is known about how to prospectively identify patients most at risk during transition. Thus, we screened young adults for diabetes distress as part of a multidisciplinary diabetes transition program and identified correlations between distress and patient outcomes.

Methods: Diabetes distress was measured during enrollment in the Michigan Medicine Diabetes Transition Program (MMDTP) using the Problem Areas in Diabetes (PAID) questionnaire, a validated diabetes distress screening tool. Patients with high distress were referred to the program social worker. We performed a retrospective chart review on MMDTP participants who were screened from 7/2017 to 12/2018.

Results: Fifty-eight young adults (age 17-23 years) completed distress screening, with PAID scores ranging from 0 to 82.5 (median 11.9). 13.8% of patients had high distress (PAID>40). Mean HbA1c prior to transition was 9.7 ± 2.3% and did not correlate with PAID scores nor did distress correlate with insulin pump or continuous glucose monitor use. Among 48 patients >1 year from first adult endocrine visit, those attending at least 3 visits in the first year (n=35) had lower median PAID scores than those attending 2 or fewer visits (10.0 vs. 26.2, p=0.02). Those attending at least 3 visits also had significantly lower mean HbA1c prior to transition (9.0% vs. 12.2%, p<0.01).

Discussion: Here we report the successful implementation of diabetes distress screening for young adults during the transition to adult care. While distress scores were lower than anticipated based on prior studies, we still found 13.8% of our patients had high distress levels. High distress and HbA1c levels at program entry both correlated with reduced visit frequency in the first year post-transition. Future interventions will aim to improve clinic attendance in patients with high distress.

Disclosure

K. Rodeman: None. A. Rao: None. A. Konigsberg: None. L. Ang: None. I.H. Thomas: None. S. Soleimanpour: None. J.J. Iyengar: None.
773-P: A Sleep Intervention to Improve Sleep Duration and Variability, Glucose, and Distress in Adults with Type 1 Diabetes
Authors: MARTYN-NEMETH PAMELA , REUTRAKUL SIRIMON , DUFFECY JENNIFER , QUINN LAURIE T. , STEFFEN ALANA D.
Published: June 2020

Despite improvements in treatment regimens and technology, less than 20% of adults with type 1 diabetes (T1D) achieve glycemic targets. Sleep variability (variability in sleep duration) and insufficient sleep duration may adversely affect glycemic control, diabetes distress, and mood. This 8-week pilot RCT aimed to determine if a sleep intervention (Sleep Opt) would improve sleep variability and duration, glucose (A1C, time-in-range (TIR), glycemic variability), and patient-reported outcomes compared to an attention control intervention in adults with T1D.

Methods: Eight T1D subjects with inadequate (sleep duration < 6.5 hr) or irregular sleep (standard deviation, SD, of sleep duration ≥1 hour) were randomized to Sleep Opt (n=5) or attention control (n=3) groups. Sleep Opt included use of a Fitbit, weekly digital content, interactive tools, and weekly coach delivered feedback, targeting insufficient and irregular sleep behavior. Sleep recording (7-day actigraphy) and continuous glucose monitoring (Abbott FreeStyle Libre®), questionnaires and A1C were performed at baseline and week 8.

Results: Sleep duration and A1C improved in both groups (Sleep duration: Sleep Opt +7 minutes vs. control +25 minutes, A1C: Sleep Opt -0.085% vs. control -0.9%). Glycemic variability (CV%) and TIR improved in the Sleep-Opt vs. control group (%CV -3.2 vs. +0.32, TIR +7.0% vs. -5.7%) respectively. Sleep regularity (SD of midsleep time) improved in Sleep Opt vs. control group (-26 vs. +1 minute). Fatigue, depressed mood and diabetes distress had a greater improvement in Sleep Opt vs. control group.

Conclusion: This pilot study provides preliminary evidence that the Sleep-Opt intervention improved sleep, glucose parameters and important patient-reported variables. Larger studies and more scalable intervention should be explored as means to improve sleep and glycemic control in T1D with inadequate or irregular sleep.

Disclosure

P. Martyn-Nemeth: None. S. Reutrakul: None. J. Duffecy: Consultant; Self; Kitchry Health. L.T. Quinn: None. A.D. Steffen: None.

Funding

Chicago Center for Diabetes Translation Research; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949)
774-P: Fully Integrated Medical and Psychological Intervention for T1D Self-Management in Adolescents: Trial Design and Baseline Characteristics
Authors: ODONNELL HOLLY , ALONSO GUY T. , GOMER TARA , MAJIDI SHIDEH , SNELL-BERGEON JANET K. , REZNICK-LIPINA TYLER , WADWA R. PAUL , DRISCOLL KIMBERLY A.
Published: June 2020

There is an urgent need to address medical and psychosocial needs of adolescents with T1D. Baseline sample characteristics and study progress data are presented from a combined in-person/telehealth RCT using multiphasic optimization strategy (2x2 factorial design) to improve A1C in 10-17 yr olds (≥1 A1C 9-12% in prior yr). During Phase 1, 88 adolescents (target N=100) with T1D (Mage=14.5 yrs; 50% female; 79.5% White, 10.2% Hispanic; 76.1% insulin pump) were randomized to Enhanced Standard Care (Medical visit only every 6 weeks) or Integrated Medical/Psychology (Enhanced Standard Care+Personalized Adherence Feedback Report). During Phase 2 (6-mo visit; N completed=75) all adolescents are re-randomized to another 6 months of intervention every 6 weeks: Enhanced Standard Care or Integrated Medical/Psychology (Enhanced Standard Care+Problem-Solving). During Phase 3 (12-mo visit; N complete=50), psychology support is withdrawn; participants are randomized to Enhanced Standard Care (Medical visit only every 6 weeks) or Standard Care (Medical visit only every 3 months) for 6 months). Adolescents and caregivers download devices and complete psychosocial questionnaires at visits (Table; no statistically significant group differences). N=25 completed the study (18-month visit) and 5 withdrew (94% retention to date); data collection is ongoing.

Disclosure

H. ODonnell: None. G.T. Alonso: None. T. Gomer: None. S. Majidi: Advisory Panel; Self; Companion Medical. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. T. Reznick-Lipina: None. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company, Medtronic. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk Inc., Tandem Diabetes Care. K.A. Driscoll: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)
778-P: The Impact of Self-Management Blood Glucose (SMBG) Real-Time Decision Support on Glycemic Control in Adult with T1D in China
Authors: LIU ZIYU , WANG CHAOFAN , ZHENG XUEYING , LUO SIHUI , YANG DAIZHI , YAN JINHUA , WENG JIANPING
Published: June 2020

Objective: To assess the effect of use frequency of SMBG real-time decision support in a diabetes app on glycemic control in adult with T1D.

Methods: T1D users from TangTangQuan® App meeting the following criteria will be selected: physician diagnosed T1D with aged≥18 years old, T1D duration ≥1 year. Frequency of uploading SMBG was be calculated in 2018. Patients were divided into two groups according to frequency of uploading SMBG (high engagement group (HE, ≥15 days/month; and control group<15 days/month). The changes in HbA1c, incidence of hyper- and hypo-glycemia from baseline to 12 months after using app were compared.

Results: Of 3474 users over 1 year, 562 eligible patients had complete set of HbA1c records. At baseline, the mean age was 26.6±7.3 years, 33.5% were male, the mean HbA1c was 6.5±0.9%. Change in HbA1c from baseline improved in the HE group than that in control [-0.3 (-0.6, 0.2) vs. -0.1 (-0.8, 0.5) %, p=0.023]. Furthermore, Incidence of hyperglycemia at 12 months was significantly decrease in HE group than control, while no difference in Hypoglycemia between two groups (Table 1). Engagement intensity was significantly and independently associated with changes in HbA1c after adjustment by multiple regression analysis [-0.4 (-0.7, -0.0), p=0.036].

Conclusions: High engagement in SMBG real-time decision support may benefit for glycemic control in Chinese T1D adult.

Disclosure

Z. Liu: None. C. Wang: None. X. Zheng: None. S. Luo: None. D. Yang: None. J. Yan: None. J. Weng: None.

Funding

National Key Research and Development Program of China (2018YFC1314100)
78-LB: HbA1c Reduction Associated with a FreeStyle Libre System in People with Type 2 Diabetes Not on Bolus Insulin Therapy
Authors: WRIGHT EUGENE , KERR MATTHEW S.D. , REYES IGNACIO J. , NABUTOVSKY YELENA , MILLER EDEN
Published: June 2020

Continuous glucose monitoring (CGM) in patients with diabetes using intensive insulin therapy has been well established, but there are limited data for CGM in other diabetes populations. We assessed HbA1c changes following a FreeStyle Libre prescription in people with type 2 diabetes (T2D) with poor glycemic control not using bolus insulin. IBM Explorys, a U.S. electronic health record database, was used in this retrospective, observational study. Cohort requirements included: FreeStyle Libre prescription in 2017 Q4-2020 Q1, de novo to CGM, T2D diagnosis, lack of rapid-/short-acting insulin, age <65 years, baseline HbA1c ≥ 8%, and presence of HbA1c data before and after FreeStyle Libre prescription. Baseline HbA1c was defined as the value within 180 days pre-index closest to CGM prescription date and post-CGM HbA1c as the value closest to 180 days post-index and within 60-300 days after CGM prescription. The outcome of the study was change in HbA1c from baseline to post-FreeStyle Libre prescription. The cohort (n=1,183, age 52 (SD 9.2) years, 52% male) had a reduction in HbA1c from 10.16 (SD 1.75) to 8.78 (SD 1.92) (p<0.001). Those starting with higher HbA1c and those on non-insulin therapy saw the greatest reduction. After receiving a prescription for a FreeStyle Libre system, people with T2D, poor glycemic control, and not using bolus insulin had a significant reduction in HbA1c.

Disclosure

E. Wright: Advisory Panel; Self; Abbott, Sanofi. Consultant; Self; Abbott, AstraZeneca, Bayer U.S., Boehringer Ingelheim Pharmaceuticals, Inc., MannKind Corporation, Merck & Co., Inc., Voluntis France. Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes. M.S.D. Kerr: Employee; Self; Abbott. I.J. Reyes: None. Y. Nabutovsky: Employee; Self; Abbott. E. Miller: None.
781-P: Exploring Concerns and Preventative Behaviors Regarding Reproductive Health (RH) Complications in Female Adolescents and Young Adults (AYA) with T1D
Authors: CHARRON-PROCHOWNIK DENISE , FISCHL ANDREA F. , KRALL JODI T. , FINNEY JESSICA , ABUJARADEH HIBA , BECKER DOROTHY J. , DIAZ ANA M. , LIBMAN INGRID
Published: June 2020

Background: AYA women with T1D are vulnerable to poor glycemic control which could increase their risks of RH complications. ADA recommends starting preconception counseling (PC) at puberty. Purpose to explore concerns for and preventative behaviors regarding RH complications in AYA females with T1D.

Methods: New AYA patients attending a diabetes transition clinic at a pediatric teaching hospital completed a short survey on concerns for diabetes-related complications and preventative actions taken: ranking their concerns on a scale 1=most important to 5=least important from a list of five complications. They identified any actions ever taken to prevent complications by a list of items and an open-ended response. This reports on female participant (n=49; ages 17-22) responses regarding RH complications at baseline prior to any peer-group information sessions. Descriptive analyses were used for quantitative and qualitative data. Open-ended data were clustered and analyzed to identify themes with 2 researchers reaching agreement.

Results: Only 29% of AYA female participants (n=14) ranked RH complications as most important concern (rank of 1) and 12% (n=6) ranked it as important (rank of 2); while 20% (n=10) ranked RH complications as least important (rank of 5). Several participants (n=33) checked off one or more behaviors they have taken to prevent RH complications (e.g., control glucose, discussed family planning with health provider). Themes for ’other preventative actions’ remained broad, “healthy lifestyle” and “self-management.” Almost all (88%; n=29/33) believe RH complications can be prevented.

Conclusion: Less than half of AYA females ranked RH complications as an important concern, which could reflect unawareness. Although most have taken some general preventive actions, enhancing other more specific behaviors to decrease their risks that were not identified could be targeted for future interventions through PC.

Disclosure

D. Charron-Prochownik: None. A.F. Fischl: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Finney: None. H. Abujaradeh: None. D.J. Becker: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S.

Funding

David Paul Diabetes Transition Care Research Initiative Fund
786-P: Describing and Comparing Mindfulness Practices on Diabetes Self-Management (DSM) and Glycemic Control in Adolescents with T1D
Authors: ABUJARADEH HIBA , CHARRON-PROCHOWNIK DENISE , GALLA BRIAN , SEREIKA SUSAN M. , DINARDO MONICA , FEELEY CHRISTINE A. , VISWANATHAN PUSHPA
Published: June 2020

Adolescents with T1D often experience stress leading to poor DSM and suboptimal glycemic control. Mindfulness, as a trait or learned skill, is a protective factor against stress and is associated with positive wellbeing. Yet, little is known about mindfulness in adolescents with T1D. This study describes self-reported mindfulness practices and compares mindfulness on DSM and A1c in adolescents with T1D. Adolescents (12-18 yrs) completed questions on mindfulness practices [having mindfulness experience (yes vs. no), types, and duration] and a valid measure of DSM (Self-care Inventory) during routine diabetes clinic. A1c was obtained from medical record. Data were analyzed using descriptive analyses and group comparative analyses were used to examine the association between mindfulness experiences, type and duration on DSM and A1c.

Adolescents (n=128) were 59% male, 88% white, on average 15±2 yrs of age, mean diabetes duration of 7±4 yrs, mean moderate level of DSM of 57±8 (range:15-75), and A1c of 8.3±1.6%. About one third (30%; n=38) reported having mindfulness experience with 23 (61%) being formal (e.g., breathing, body scan, mindful meditation, mindful yoga); 19 (50%) being non formal (e.g., mindful walking); and 4 (11%) being religious. Almost half (45%, n=17) reported practicing mindfulness for < 3 mos, 5 (13%) for (3 - 12 mos), and 16 (42%) for > 1 yr. Several participants (n=8, 21%) reported using mindfulness mobile apps (e.g., Headspace, Calm, Pokémon Go) or YouTube. Adolescents with more than one type of mindfulness practice (e.g., formal with non formal or religious) and those with religious experience reported better DSM than those with one type of mindfulness practice [F(3, 34)= 5.2, p=0.005].

About a third adolescents have been exposed to some mindfulness practices. DSM was better among participants who reported practicing more than one type of mindfulness. Introducing mindfulness training tailored to adolescents with T1D could be beneficial.

Disclosure

H. Abujaradeh: None. D. Charron-Prochownik: None. B. Galla: None. S.M. Sereika: None. M. DiNardo: None. C.A. Feeley: None. P. Viswanathan: None.

Funding

National Association of Pediatric Nurse Practitioners; Sigma Eta Chapter; University of Pittsburgh School of Nursing
787-P: Mental Health Discussions during Routine Diabetes Care Visits with Adolescents and Young Adults
Authors: MONAGHAN MAUREEN , WONG CONNIE , POLYAKOV DIANE L. , ROSE MEREDITH
Published: June 2020

Background: Adolescents and young adults (AYAs) with T1D are at risk for elevated depressive symptoms. Health care providers (HCPs) are in a unique position to discuss mental health (MH) and T1D self-care during routine diabetes medical visits.

Objective: Evaluate the frequency and content of MH discussions during medical visits.

Methods: Data were drawn from a longitudinal study of AYA-HCP communication and T1D care. Secondary analyses include evaluation of 108 medical visits (M duration=22.5 min; n=8 HCPs) with 33 AYAs with T1D (48.5% male; 45.5% non-Hispanic White; M age=17.5±1.1 yrs; M clinic visits=3.27). 22 AYAs self-reported elevated depressive symptoms using the Center for Epidemiologic Studies-Depression scale (M CES-D score=22.6±8.3); a matched sample of 11 AYAs without elevated depressive symptoms was selected for comparison (M CES-D score=5.7±3.9). Medical visits were audio-recorded, transcribed, and coded by trained coders to identify and characterize MH discussions.

Results: Coding of transcripts identified 43/108 medical visits (39.8%) with ≥ 1 MH discussion. AYAs with elevated depressive symptoms were as likely to have a MH discussion (42.6%) as AYAs without elevated depressive symptoms (35.0%; p=.43); the elevated group had 2.48 distinct MH conversations/visit compared to 1.64 distinct MH conversations/visit for the non-elevated group (p=.10). MH discussions were initiated most often by HCPs (67.4%), followed by AYAs (23.3%) and parents (9.3%). MH resources were provided in 60.5% of all visits with MH discussion, including: referral for MH services (76.9%), general MH education (30.8%), and recommendation to continue current MH services (26.9%).

Discussion: MH content is commonly discussed in routine T1D care. Results suggest a need to increase HCP-delivered resources for AYAs with MH concerns. Evaluation of MH discussions can improve the quality of AYA-HCP communication around MH symptoms and, ultimately, improve diabetes care.

Disclosure

M. Monaghan: Research Support; Self; American Diabetes Association. C. Wong: None. D.L. Polyakov: None. M. Rose: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.); National Institutes of Health (R03DK110259)
788-P: “That’s How You Connect with Someone”: Preferences of Minority Young Adults (YA) with Type 1 Diabetes (T1D) for In-Person Visits over Telemedicine
Authors: COMMISSARIAT PERSIS V. , CRESPO-RAMOS GLADYS , JANG ALYSSA , AGARWAL SHIVANI
Published: June 2020

Objective: Telemedicine has gained popularity as an approach to improve health outcomes by enhancing care delivery to vulnerable populations. However, research is lacking on minority patient preferences for telemedicine, to whom these interventions would likely be offered. In this study, we explored opinions of ethnically diverse, underserved YA with T1D on the use of telemedicine videoconferencing for medical visits.

Methods: We conducted semi-structured interviews in 41 YA, ages 18-25, at a major diabetes center in the Bronx, NY. We audio-recorded, transcribed, and coded interviews using content analysis. We achieved thematic saturation.

Results: YA participants (53% female, 96% Black or Hispanic, 88% Medicaid) were 21±2.4 yrs, with T1D duration 11±2.3 yrs and mean HbA1c 9.6±1.2%. We found that the overwhelming majority of participants preferred to meet with their healthcare provider in person. Participants cited 3 major reasons for preference of in-person over telemedicine visits: 1) in-person visits felt more personal; 2) meeting in clinic helped YA feel more focused and accountable for past and future diabetes management (particularly if they liked their provider); and 3) it was easier to communicate diabetes issues person-to-person. Few stated a preference for telemedicine visits, however noted convenience and not having to navigate transportation as benefits. Notably, some participants would consider virtual communication with providers between visits, but preferred standard visits to remain in clinic.

Conclusions: In this sample of ethnically diverse, underserved YA with T1D, telemedicine visits were not well-accepted. Participants suggested that virtual visits would not provide the same comfort and investment in care as in-person visits. Future interventions using telemedicine as a new mode of care delivery in YA with T1D should consider minority patient preferences.

Disclosure

P.V. Commissariat: None. G. Crespo-Ramos: None. A. Jang: None. S. Agarwal: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896 to S.A.), (P30DK036836 to P.V.C.)
798-P: New Insights into Diabetes Burnout
Authors: ABDOLI SAMEREH , HESSLER DANIELLE M. , MILLER-BAINS KATE , VORA AMIT C. , SMITHER BETSEY , BURR ERIN M. , STUCKEY HEATHER L.
Published: June 2020

Significance: Individuals with type 1 diabetes (T1D) frequently report experiencing diabetes burnout, a feeling of exhaustion, and frustration that may lead to ignoring self-care behaviors. Though the construct was identified in the early 1980s as a primary barrier to optimal diabetes care, scientific understanding of the concept is lacking. Prior literature has conflated diabetes burnout with the other psychosocial concepts of diabetes distress and depression. In an attempt to address the gap, our qualitative findings highlighted that diabetes burnout includes: (1) feelings of mental, emotional, and physical exhaustion, (2) detachment from illness identity, support systems, and self-care, and (3) a sense of powerlessness to re-take the ownership of self-care.

Aim: To examine the relationship between the three hypothesized dimensions of diabetes burnout and to determine if the data would be able to identify a relationship between diabetes burnout, distress, depression, and short-term outcomes.

Methods: We conducted a cross-sectional study on a sample of 111 adults with T1D who completed an online survey developed by existing valid and reliable measures.

Results: All dimensions of diabetes burnout were significantly correlated between .60 and .85 (p<.001). We found that diabetes burnout was significantly associated with both depression (es=0.67; p<.001) and diabetes distress (es=0.83; p<.001). Although overall burnout score explained more of the variation in key diabetes outcomes such as last reported HbA1C or missed appointments than diabetes distress or depression, and those relationships persist and strengthen even after controlling for these other related constructs.

Conclusion: A single cross-sectional study is insufficient for any strong claims; however, this study challenges current knowledge on diabetes care by suggesting diabetes burnout as a distinct but interrelated concept with distress or depressions. These findings need to be replicated, ideally with larger and more diverse samples and with longitudinal studies.

Disclosure

S. Abdoli: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. K. Miller-Bains: None. A.C. Vora: Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Novo Nordisk Inc. B. Smither: None. E.M. Burr: None. H.L. Stuckey: None.

Funding

Oak Ridge Associated Universities
799-P: Gender Differences in Diabetes Distress Comparing Dapagliflozin plus Saxagliptin to Glimepiride When Added to Metformin in Poorly Controlled Type 2 Diabetes
Authors: TESTA MARCIA A. , SIMONSON DONALD C.
Published: June 2020

Distress due to diabetes symptoms and medication side effects is distinct from psychological disorders and can interfere with A1C control and quality of life (QOL). We analyzed patient-reported outcomes (PRO) during a double-blind, 156-wk randomized clinical trial to evaluate effects of gender and treatment on diabetes distress in T2D patients (A1C, 7.5-10.5%) receiving stable metformin (M) ≥1500 mg/d and assigned to either dual add-on therapy with dapagliflozin (D) 10 mg/d + saxagliptin (S) 5 mg/d (n = 227) or single add-on glimepiride (G) titrated 1-6 mg/d (n = 216). A1C, weight and PRO (353 items) were assessed at baseline and wks 12, 28, 52, 104 and 156, and analyzed using linear mixed-effects models. At wk 52, D+S+M resulted in greater reductions in A1C (-1.4±0.1 vs. -1.0±0.1%) and weight (-3.1±0.3 vs. 1.0±0.3 kg) vs. G+M (p<0.001) that remained lower through wk 156. Men had lower A1C at each visit vs. women (all p<0.05). Distress scores (0-100) due to weight gain for D+S+M vs. G+M (83.0±0.8 vs. 75.4±0.9), weight concern (59.9±1.3 vs. 52.5±1.4) and being overweight (40.6±1.2 vs. 44.8±1.2) all favored D+S+M (p<0.01). Model interactions showed that women vs. men experienced greater distress (p = 0.01) that interfered with work, role and daily activities (p<0.001) on G+M compared to D+S+M. Mental health (p = 0.11) and health perceptions (p = 0.59) did not show treatment differences. QOL ratings for women favored D+S+M (p<0.01). Overall satisfaction (78.4±0.3 vs. 76.7±0.3, p<0.001) favored D+S+M, as did subscales of work/role, effectiveness, side effects, burden, preference, net benefit, and regimen acceptance (all p<0.05). Women showed greater improvements in treatment satisfaction compared to men. While addressing diabetes distress to improve a patient’s well-being is important, ameliorating diabetes distress related to medication side effects such as weight gain may also lead to improved adherence, self-care and glycemic control.

Disclosure

M.A. Testa: Stock/Shareholder; Spouse/Partner; GI Windows. Stock/Shareholder; Self; Phase V Technologies, Inc. D.C. Simonson: Stock/Shareholder; Self; GI Windows. Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc.
805-P: The Joint Association of Diabetes Distress and Depressive Symptoms with All-Cause Mortality in Japanese Patients with Type 2 Diabetes: A Prospective Cohort Study
Authors: HAYASHINO YASUAKI , OKAMURA SHINTARO
Published: June 2020

Aims/Hypothesis: The independent association of depressive symptoms and diabetes distress (DD) with the mortality risk in patients with diabetes has not been evaluated. We examined the temporal joint association of DD and depression at baseline and the subsequent risk of all-cause mortality.

Methods: The longitudinal data of 3118 patients with type 2 diabetes were obtained from a large Japanese diabetes registry. To assess the joint association of DD and depression at baseline with the subsequent risk of all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders.

Results: The mean age, body mass index, and HbA1c level were 64.7 years, 24.6 kg/m2, and 58.6 mmol/mol (7.5%), respectively, and 38.1% of the participants were women. We observed 238 of any death cases during the median follow-up of 7.1 years (incidence ratio = 12.3 per 1000 person-years). In the multivariable-adjusted models evaluating the DD and depression separately, the hazard ratios (HRs) of all-cause mortality were 1.67 (95% confidence interval [CI], 1.14-2.43; p = 0.008) and 1.40 (95%CI, 1.05-1.85; p = 0.020), respectively. In such models evaluating the joint association of DD and depression, compared with DD (−)/depression (−), the HRs of all-cause mortality for DD (−)/depression (+), DD (+)/depression (−), and DD (+)/depression (+) were 1.34 (95%CI, 0.99-1.86; p = 0.056), 1.96 (95%CI, 1.10-3.50; p = 0.023), and 1.71 (95%CI, 1.06-2.77; p = 0.029), respectively. In the stratified analysis by gender, the aforementioned significant association was observed only in men.

Conclusions: We observed a significant independent association of DD and depression with all-cause mortality in male patients with type 2 diabetes, and this finding was only observed in men, not in women. Further research is needed to determine the mechanism of the association between DD or depression and mortality.

Disclosure

Y. Hayashino: None. S. Okamura: None.

Funding

Manpei Suzuki Diabetes Foundation; Japan Society for the Promotion of Science (25460641)
806-P: Weight Loss vs. Postprandial Glucose Reduction in Adults with Type 2 Diabetes: A Randomized Clinical Trial
Authors: COX DANIEL , BANTON TOM , MONCRIEF MATTHEW A. , DIAMOND ANNE , HOLMES VIOLA , WOLF ANNE , FANG KUN , MCCALL ANTHONY L.
Published: June 2020

Background: Weight loss (WL) is the initial treatment of choice for adults with t2d, but it is inappropriate for lean patients, unwanted/unsuccessful for some obese individuals, and unsustainable for others. An alternative is needed.

Aim: Because post-prandial glucose (PPG) contributes strongly to A1c, we tested if a treatment focused on reducing PPG by reducing carbohydrate intake and increasing physical activity (Glycemic Excursion Minimization - GEM) would be equal or superior to WL for improving A1c and secondary benefits. We also hypothesized GEM would be enhanced by the quality and quantity of blood glucose (BG) feedback.

Methods: Generally healthy adults (t2d ≤ 10 years, not on insulin, A1c ≥ 6.8) were randomized to WL (n = 36) or one of 3 GEM subgroups: 1) Didactic (GEMD, n = 35) taught participants how to choose low glycemic load foods, reduce sedentary time and increase moderate routine physical activity, 2) Didactic + systematic BG monitoring (GEMS, n =48) before and after meals and physical activity to educate, activate and motivate food and activity choices, or 3) Didactic + continuous glucose monitoring (GEMC, n = 43). WL treatment was led by diabetes nutritionists and followed the CDC Prevent T2 weight loss manual. GEM treatment was led by a diabetes nurse educator. All subjects received 6 hours of training, BG meters and wore activity monitors. A1c, weight, UKPDS, DDS, DES and PHQ-9 were assessed pre and 3 months post treatment.

Results: The GEM subgroups did not differ, so they were combined. Both WL and GEM significantly reduced weight and diabetes distress (regimen). Only GEM significantly improved A1c (8.3 to 7.3, p <.001), cardiovascular risk (p <.001), empowerment (p <.001), and diabetes distress (emotional, p <.02).

Discussion: Lifestyle interventions focused on minimizing PPG by reducing carbohydrates and increasing routine physical activity are effective alternatives to WL. Adding BG monitoring did not significantly enhance GEM’s effectiveness.

Disclosure

D. Cox: Research Support; Self; Dexcom, Inc. T. Banton: Research Support; Self; Dexcom, Inc. M.A. Moncrief: Research Support; Self; Dexcom, Inc. A. Diamond: Research Support; Self; Dexcom, Inc. V. Holmes: None. A. Wolf: None. K. Fang: None. A.L. McCall: None.

Funding

Dexcom, Inc. (IIS-2017-047); National Institutes of Health (R01DK108957)