bluuebunny/crossref_metadata_2025 huggingface dataset:
549-P: Assessing Feasibility of a Diabetes Mellitus Program Using Behavioral Economics to Optimize Outreach and Self-Management Support with Technology—The DM-BOOST Project
Authors: AMANTE DANIEL J. , SHENETTE LISA L. , PUERTO GERALDINE , LEMON STEPHENIE , HARLAN DAVID M. , GERBER BEN S.
Published: June 2023

Introduction: The DM-BOOST intervention was developed to enhance engagement with diabetes self-management training (DSMT). Participants received peer-written text message tips with nudges to reply with personal preferences. They then completed a video call with the DM-BOOST team to confirm patient portal access, review key functions, and set a diabetes behavior goal. This was later followed by receipt of a patient portal message with their goal, which they commit to sending to the DSMT provider they are scheduled to meet with.

Methods: Adults with poorly controlled type 2 diabetes (HbA1c ≥ 8) received mailed invitations and a recruitment phone call. Participants (n=60) were randomized (1:1) to usual care or DM-BOOST. All participants received assistance obtaining a DSMT referral and scheduling a DSMT appointment. The primary outcome of interest was the DSMT appointment no-show/cancellation rate.

Results: Enrolled participants (n=60) were 60.0% female with a mean age of 45.5 years (SD = 8.3). The average HbA1c at enrollment was 10.1% (SD = 1.8). All intervention participants (30/30) had a DSMT appointment scheduled compared to 86.7% of comparison participants (26/30). Intervention group participants had fewer DSMT no-shows/cancellations (3/30, 10%) compared to comparison group participants (10/26, 35%) (p = 0.01).

Conclusions/Discussion: Technology-based interventions guided by behavioral economics can increase initial engagement with DSMT. Several system-level barriers, including challenges in obtaining referrals and scheduling appointments, were identified. Secondary outcomes, including patient-reported changes in diabetes self-efficacy, self-management skills, and treatment satisfaction are being evaluated. Future research efforts include cultural adaption of DM-BOOST for Spanish-speaking patients and rigorous implementation evaluation.

Disclosure

D.J.Amante: None. L.L.Shenette: None. G.Puerto: None. S.Lemon: None. D.M.Harlan: Advisory Panel; Novartis, Vertex Pharmaceuticals Incorporated, Diabeloop SA, Other Relationship; Stability Health, Wolters Kluwer Health. B.S.Gerber: Other Relationship; Abbott.

Funding

National Center for Advancing Translational Sciences (KL2TR001455); National Institute for Diabetes and Digestive and Kidney Diseases (1K01DK131318)
557-P: Effect of MyPlate Nutrition and Diabetes Education Delivered by Promotoras de Salud in Low-Income Latinx Adults Living in Rural Communities
Authors: MARIN STEPHANIE C. , MARQUEZ IRIS , FLORES RICARDO R. , LEE DAVID , WRAICH DIMPY , DURAN HENRY , CHENEY ANN M.
Published: June 2023

Background: Latinx individuals have over a 50% chance of developing type II diabetes within their lifetime compared to 40% of the general population1,2. Further, a lack of diabetes education significantly contributes to poor health literacy surrounding diabetes treatment and management among ethnic minorities3.

Methods: The study utilized a pre and posttest design using the General Nutrition Knowledge Questionnaire-Revised to assess changes in the nutrition knowledge of individuals 18 years or older, after receiving a tailored nutrition education presentation based on U.S. Department of Agriculture MyPlate's dietary guidelines. The difference between pre and posttest nutrition knowledge scores was measured using paired samples t-test for the overall survey and separately for three questions that assessed the diet-diabetes relationship.

Results: Most participants were Spanish-speaking Latinx/Hispanic females between the ages of 40-49, where 66% reported middle school education or lower, 26.4% reported being diagnosed with diabetes, and 56% had a family history of diabetes. The paired t-test of the pre and posttests (n=82) resulted in one and two-sided p-values < 0.001. The comparative pre versus posttest analysis for the diabetes knowledge-related questions showed that the diabetes-related questions one, two, and three resulted in p-values <0.227, <0.02, and <0.03, respectively.

Conclusion: Latinx individuals in rural communities face systemic barriers, including poor medical coverage, low health literacy rates, language and immigration barriers4. Our study brought together promotoras to create and deliver culturally-conscious, evidence-based nutrition education material through platicas. Increased access to nutrition and diabetes education contributes to improved patient health knowledge and addresses negatively impactful social determinants of health among rural Latinx American populations.

Disclosure

S.C.Marin: None. I.Marquez: None. R.R.Flores: None. D.Lee: None. D.Wraich: None. H.Duran: None. A.M.Cheney: None.

Funding

University of California, Riverside School of Medicine
567-P: Impact of Diabetes Prevention Education Program on Diabetes Knowledge among Adults with Prediabetes—A Cluster Randomized Controlled Trial in Nepal
Authors: SHAKYA PUSHPANJALI , SHRESTHA ARCHANA , KARMACHARYA BIRAJ M. , SHRESTHA ABHA , BAJRACHARYA MONISH , KULSENG BÅRD E. , SKOVLUND EVA , SEN ABHIJIT
Published: June 2023

Background: Diabetes knowledge is important for diabetes prevention but has been less studied among people with prediabetes. This study aimed to assess the impact of a community-based lifestyle intervention program called Diabetes Prevention Education Program (DiPEP) on diabetes knowledge among adults with prediabetes in Nepal.

Method: This study is a part of a two-arm open cluster randomized controlled trial conducted from October 2019-September 2021 in two urban areas of Nepal. Participants of the intervention arm received four 1-hour weekly education sessions, follow-up for the next 5 months, diabetes prevention education brochure, exercise calendar and daily food logbook. The control arm received an education brochure at baseline and 1-hour education session after endline data collection. The change in diabetes knowledge was assessed using Nepali validated 24-items Diabetes Knowledge Questionnaire (DKQ), with higher score representing better disease knowledge. Linear mixed model was used to analyze the impact of the DiPEP on diabetes knowledge score with intent-to-treat approach.

Results: A total of 291 participants were recruited in the trial with mean age of 50.3±7.6 years and 67% were female. Only 290 participants had baseline DKQ (158 intervention, 132 control), out of these 258 completed the endline DKQ (139 intervention, 119 control). At baseline, mean DKQ score was 9.2 (SD 5.2) in intervention and 10.6 (SD 4.8) in control arm. After the intervention, mean change in the score between intervention and control group was 0.4 (95% CI -1.0-1.7) among those with good compliance to DiPEP. The results did not change from main analysis for those who attended ≥3 of all 4 sessions.

Conclusion: Diabetes knowledge did not improve significantly after the intervention among the participants. Regular and frequent engagement of participants might help to improve diabetes knowledge among the individuals.

Disclosure

P.Shakya: None. A.Shrestha: None. B.M.Karmacharya: None. A.Shrestha: None. M.Bajracharya: None. B.E.Kulseng: None. E.Skovlund: None. A.Sen: None.

Funding

Norwegian University of Science and Technology, Department of Public Health and Nursing (81850087)
577-P: A Novel Program to Help Teens Manage Type 1 Diabetes during Physical Activity—Diabetes Training Camp Teen Boot Camp
Authors: SIMMONS KIMBER M. , HALL JACOB D. , O'DONNELL HOLLY K. , DEBLOIS JACOB P. , TANNER BAILEY , FERRI CHRISTINE , ZAHARIEVA DESSI P. , POWELL ROBERT , CORCORAN MATTHEW H.
Published: June 2023

Introduction: Physical activity (PA) has many health benefits in people with type 1 diabetes (T1D), yet adolescents with T1D engage in less PA than their peers and may struggle to employ strategies that allow them to participate fully and maintain glucose levels in target range. Diabetes Training Camp Teen Boot Camp (DTC-TBC) is an intensive 3-day program that includes education and workouts geared for teens with T1D and their parents/guardians. We aimed to determine if indicators of psychosocial (confidence in glucose management during PA, positive experience, barriers to PA) and health (HbA1c) changed after attending DTC-TBC in summer 2022.

Methods: DTC-TBC participants included 16 adolescents aged 13-18 years (HbA1c=7.3±1.4%; 25% female). Most used a continuous glucose monitor (93%) and insulin pump (69%) to manage T1D. Participants completed questionnaires on the first day of camp (baseline), last day of camp and 1 month after camp. Paired t-tests were used to compare 1) mean 7-point Likert scale scores for confidence in managing T1D (1 = not confident, 7= very confident) before and immediately post camp and 2) mean scores on the Barriers to PA in T1D and reported HbA1c before and 1-month post camp (n=11).

Results: Both parents and teens reported high satisfaction with the DTC-TBC experience; 100% of participants said they would recommend DTC-TBC. Confidence in managing T1D significantly increased (baseline 4.9±1.2 vs post-camp 6.0±0.6; p<0.0001). Teens reported lower barriers to PA 1-month post-camp (baseline 25.0±14.3, 1 month 21.5±8.0; p=0.170). HbA1c decreased by 0.26% 1 month after camp (95% CI −0.18, 0.70; p=0.106).

Conclusions: Barriers to PA and HbA1c both trended towards significant reductions even with a small sample size, whereas confidence significantly increased. Follow-up at regular intervals and inclusion of future camp participants will help determine if DTC-TBC has a statistically significant positive impact on psychosocial and health outcomes.

Disclosure

K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc., Provention Bio, Inc., Research Support; Novartis. J.D.Hall: None. H.K.O'donnell: None. J.P.Deblois: None. B.Tanner: None. C.Ferri: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. R.Powell: None. M.H.Corcoran: Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk.
58-OR: Glycemic Impact of Meal-Dosing Behavior in Users of the InPen Smart Insulin Pen (SIP) Paired with Continuous Glucose Monitoring (CGM)
Authors: MACLEOD JANICE , SMITH MADISON , HEUNGYONG IM GLEN , CORDERO TONI L. , VIGERSKY ROBERT A.
Published: June 2023

Background: Data from connected insulin pen therapies are revealing both gaps and opportunities to significantly improve care for people on multiple daily insulin injections therapy. This real-world (RW) data analysis reports on the impact of meal-dosing behavior (missed and late) on glycemia in adult and pediatric InPen users with type 1 (T1D) or type 2 diabetes (T2D).

Method: The RW data from 5,153 deidentified individuals who used the InPen SIP and CGM for at least 30 days between January 2020 and December 2021, and who had dosing and CGM data between 30 and 59 days since first bolus date, were analyzed using a meal detection algorithm. Users with <14 days of bolus data or inadequate CGM data (<14 days of 70% or more SG data/day) were excluded.

Results: The impact of dosing behavior (≤2 versus >3 doses/day) and missed dose frequency (<20% versus ≥20%) on glycemia was analyzed (Table). A dosing frequency of >3 (including correction-only doses) and a missed dose frequency of <20% were associated with improved glycemic metrics. Overall, the frequency of on-time dosing was significantly correlated with user TIR (r=0.59, p<0.001).

Conclusion: Real-world InPen with CGM use data provide insights into the impact of meal-dosing behavior on glycemic outcomes, which may inform counseling strategies for care teams and open the door to precision insulin injection management.

Disclosure

J.Macleod: Employee; Medtronic. M.Smith: Employee; Medtronic. G.Im: Employee; Medtronic. T.L.Cordero: Employee; Medtronic. R.A.Vigersky: Employee; Medtronic.
581-P: The Effects of Resistance Training on Insulin Resistance Development in Female Rodents with Type 1 Diabetes
Authors: SAMMUT MITCHELL , MCBEY DAVID , JAMES MELLING C.W.
Published: June 2023

The etiology of insulin resistance (IR) development in type 1 diabetes (T1D) remains unclear; however, impaired glucose metabolism in skeletal muscle may play a role. While IR development has been established in male rodents with T1D, female rodents have yet to be examined in this context. Resistance exercise training (RT) has been shown to improve IR and is associated with a lower risk of hypoglycemia onset in T1D compared to aerobic exercise. The purpose of this study was to investigate the effects of RT on IR development in female rodents with T1D. Forty Sprague-Dawley 8-week-old female rats were divided into four groups: control sedentary (CS; n=10), control trained (CT; n=10), T1D sedentary (DS; n=10), T1D trained (DT; n=10). Multiple low-dose Streptozotocin injections (20 mg/kg each day for 7 consecutive days) were used to induce T1D. Blood glucose levels were maintained in normal range (4-9mmol/L) with one implanted insulin pellet (2IU/day). CT and DT underwent weighted ladder climbing 5 days/week for 6 weeks. Intravenous glucose tolerance tests (IVGTT) were conducted on all animals during weeks 4 and 7. Results demonstrate that DS animals exhibited significantly increased weekly blood glucose measures compared to all groups including DT (p<0.05), despite similar insulin dosage levels. This was concomitant with a significant increase in area under the curve following IVGTT from week 4 to week 7 in DS (p<0.05), indicative of a reduction in insulin sensitivity. DS animals also exhibited significantly greater glycogen content in white gastrocnemius muscle compared to all groups (p<0.05). These results indicate that female rodents with T1D develop poor glycemic control and IR which can be attenuated with RT, possibly related to differences in glycogen content within muscle. This data supports the negative role of elevated muscle glycogen on insulin sensitivity in T1D and the potential role of RT in ameliorating these metabolic changes.

Disclosure

M.Sammut: None. D.Mcbey: None. C.Melling: None.
593-P: Effect of Nurse-Led Exercise Intervention in Type 2 Diabetes Mellitus
Authors: LIU XIAOQIAN , JIA ZHUMIN , NIU WENCHANG , FANG WENJING
Published: June 2023

Objective: To investigate the effect of diabetes nurse specialist-led exercise on ankle-brachial index (ABI) and glucose and lipid metabolism in patients with type 2 diabetes mellitus (T2DM).

Methods: 60 patients with T2DM without exercise contraindication who were discharged from the Department of Endocrinology in a hospital were selected and randomly divided into the experimental group (36 cases) and the control group (24 cases). The two groups were given routine diabetes diet and medication guidance, while the experimental group wore a scanning flash glucose monitoring (FGM), heart rate arm watch, and exercised in the endocrinology clinic once every other day for 45 minutes for a total of two weeks. Nurse specialists give the home exercise guidance based on the exercise program obtained from the outpatient exercise intervention, and the patient sent the exercise status to the WeChat group for a total of 22 weeks. The control group were guided by nurse specialists in accordance with the exercise guidelines for 24 weeks. The changes of ABI, fasting blood glucose, glycosylated hemoglobin, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and triglyceride contents were compared between the two groups.

Results: After 24 weeks, the ABI in the experimental group was higher than that in the control group (1.07±0.73 vs 1.04±0.09, P<0.05), the glycosylated hemoglobin in the experimental group was lower than that in the control group (6.81±1.09 vs 7.57±1.66 mmmol/L,P<0.05), and the low density lipoprotein cholesterol in the experimental group was lower than that in the control group (1.88±0.73 vs 2.80±0.78 mmmol/L,P<0.01).

Conclusion: Diabetes nurse specialist-led exercise intervention can significantly improve ABI and glucose and lipid metabolism in T2DM.

Disclosure

X.Liu: None. Z.Jia: None. W.Niu: None. W.Fang: None.

Funding

Henan Province Science and Technology Project Joint Construction (LHGJ20190557)
594-P: Untrained Men and Women with Diabetes Mellitus Have Impaired Interoceptive Accuracy
Authors: SUMMERS JACK , MIKLJA ZACHARY , LOCKETTE WARREN
Published: June 2023

Background: The ADA recommends 150 minutes/week of physical activity for patients with diabetes mellitus (DM). Training-induced reductions in autonomic reactivity could impair awareness of hypoglycemia (IAH) in some patients with DM unless there are compensatory signals of low blood glucose not dependent upon the autonomic nervous system. The receptors for exteroceptive senses (e.g. temperature, pain, vision, hearing) are known, interoceptive signal transduction is unexplored. This mechanism allows us to detect the cardiac, respiratory, and gastric sensations from stress (“My heart is pounding,” and “I can’t breathe,” and I feel queasy”).

Hypothesis: We posit cardiac interoceptive accuracy (IA) is impaired in patients with DM, but exercise training could enhance IA and reduce IAH. We assessed IA in healthy, fit subjects, and also, untrained men and women with DM.

Methods: IA was determined by comparing the number of heartbeats a subject could count without taking their pulse while their EKG was surreptitiously recorded. Heart rate variability (HRV) was assessed by measuring the root mean square of successive differences of the interval between sequential heartbeats.

Results: Although MAP was not significantly different between these two cohorts, when compared to DM (N=8), the fit subjects (N=9) had (all values in mean ± SEM) lower resting HR (63±3 vs. 85±4 bpm, p<0.001) and greater HRV (85±4 vs. 69±11 ms, p=0.01) and IA (82±7 vs. 50±12 in percent, p=0.02). Furthermore, HR was highly correlated with both HRV (r=−0.63, p=0.007) and IA (r=−0.72, p=0.001). Conclusion: Untrained DM have diminished IA which may be improved by fitness training without fear of worsening IAH; resting HR should be used to track changes in HRV and IA as DM subjects undergo fitness training.

Disclosure

J.Summers: None. Z.Miklja: None. W.Lockette: None.
595-P: Exercise Training Improves Cardiorespiratory Parameters but Not VO2peak in People with Type 2 Diabetes
Authors: MIDDELBEEK ROELAND , SIMPSON LAURA , HANSBURY GEORGIA A. , CARBONE NICHOLAS P. , NIGRO PASQUALE , LESSARD SARAH J. , VAMVINI MARIA , GOODYEAR LAURIE
Published: June 2023

Maximal oxygen consumption (VO2peak), a measure of cardiorespiratory fitness (CRF), is a strong predictor of mortality. People with type 2 diabetes (T2D) have lower VO2peak compared to healthy controls, and unfortunately, studies suggest that training has limited effects to improve VO2peak in T2D. Although VO2peak is a key component, additional respiratory functions may also be important markers of cardio-metabolic fitness. Here, we determined the effects of a 10-week moderate-intensity exercise training program on VO2peak, power (indicator of muscle strength), VO2/work (index of the body’s efficiency at producing work), OUES (protective in heart failure), and ventilatory threshold (marker of aerobic endurance) in lean, obese, and T2D subjects. Training improved VO2peak in lean and obese, but not in T2D (Table 1). Likewise, training increased power, and tended to increase OUES in lean and obese, but not T2D. However, training was effective in increasing ventilatory threshold (VT) and VO2/Work in T2D, and also improved glycemic control (HbA1c). We hypothesize that the increased VT functions to improve training-induced muscular efficiency and capillary delivery, contributing to improved glycemic control. In conclusion, despite no change in VO2peak, exercise training increases multiple CRF and metabolic parameters in people with T2D, and should continue to be a mainstay in treatment of T2D.

Disclosure

R.Middelbeek: Research Support; Novo Nordisk. L.Simpson: None. G.A.Hansbury: None. N.P.Carbone: None. P.Nigro: None. S.J.Lessard: None. M.Vamvini: None. L.Goodyear: None.

Funding

National Institutes of Health (K23DK114550 to R.M.), (R01DK112283 to L.G.); Joslin Diabetes Center (T32DK07260-038, 5P30DK36836)
6-OR: PAR2 Downregulates Adipose LPL through MIF—A Novel Adipose Mechanism Contributing to the Development of Hypertriglyceridemia
Authors: HUANG YIHENG , LI LISHA , CHEN LIUJUN , CHEN XI , GAO PINGYI , QI YADAN , QI DAKE
Published: June 2023

Lipoprotein lipase (LPL) is a key enzyme that hydrolyzes circulating triglycerides to release fatty acid (FA). In adipose tissue, LPL is required for lipid storage. However, it is currently unknown whether alteration of LPL in white adipose tissue (WAT) contributes to the development of hypertriglyceridemia. Our present study indicated that WAT isolated from human obese patients have increased expression of PAR2 which is negatively associated with LPL gene. The reduced LPL expression is also negatively correlated with increased plasma TG levels, suggesting that adipose PAR2 may modulate hyperlipidemia through downregulating LPL. In mice, aging and high palmitic oil diet significantly increased PAR2 expression in adipose tissue which was associated with high plasma MIF levels. PAR2 deficiency attenuates the rise of MIF, suggesting a key role of PAR2 in regulating adipose MIF release. MIF reduced LPL expression and activity in adipocytes. In a MIF overexpressed animal model (Mif lung Tg), high circulating MIF levels inhibited adipose LPL which was associated with increased plasma triglyceride but not fatty acid. Following high palmitic oil diet feeding, adipose LPL expression and activity were also reduced, and this reduction was reversed in PAR2 knockout mice. Interestingly, PAR2 mediated LPL in adipose tissue regulates hypertriglyceridemia through controlling adipocyte lipid storage. In Par2-/- mice, recombinant MIF perfusion recovered high plasma MIF levels, which decreased LPL and attenuated adipocyte lipid storage leading to hypertriglyceridemia. These data together suggest that the downregulation of adipose LPL by PAR2/MIF is an important mechanism for the development of hypertriglyceridemia.

Disclosure

Y.Huang: None. L.Li: None. L.Chen: None. X.Chen: None. P.Gao: None. Y.Qi: None. D.Qi: None.

Funding

Canadian Institutes of Health Research (PJT156116)
606-P: The Effect of a Dietary Intervention on Insulin Requirements in Type 1 Diabetes—A 12-Week Randomized Clinical Trial
Authors: KAHLEOVA HANA
Published: June 2023

Background and Objective: A plant-based has been shown to improve glycemic control and insulin resistance in people with type 2 diabetes. The aim of this study was to test the effect of this diet in people with type 1 diabetes.

Methods: Fifty-eight people with type 1 diabetes were randomly assigned to follow a low-fat vegan diet (vegan group, n=29), or a standard portion-controlled diet (control group, n=29) for 12 weeks. All meals were tracked, using the Cronometer mobile application. Insulin sensitivity was assessed, using the carbohydrate to insulin ratio, which was calculated as the number of grams of total dietary carbohydrate to total units of insulin administered. Total insulin dose was calculated as a sum of basal and bolus insulin units injected per day.

Results: The consumption of carbohydrates increased in the vegan group by an average of 118 g/day (p=0.002), compared with no significant change in the control group (−18 g/day; p=0.11; treatment effect +137 [95% CI, +65 to +208]; p<0.001). Insulin sensitivity, assessed by the carbohydrate to insulin ratio, increased in the vegan group by 6.2 on average (p=0.002), compared with no significant change in the control group (−0.8; p=0.32; treatment effect +7.0 [95% CI, +3.1 to +10.9]; p=0.001). Total daily dose of insulin decreased by 12.1 units/day in the vegan group (p=0.007), compared with no significant change in the control group (−18 units/day; p=0.66; treatment effect −10.7 [95% CI, −21.3 to −0.2]; p=0.046).

Conclusions: This study suggests that a low-fat vegan diet may have beneficial effects on insulin sensitivity and insulin requirements in people with type 1 diabetes. Larger trials are needed to confirm these findings.

Trial Registration: ClinicalTrials.gov, NCT04944316

Disclosure

H.Kahleova: None.

Funding

Physicians Committee for Responsible Medicine (330072)
607-P: The Impact of Telenutrition vs. In-Person Nutrition Consultations on Glycemic Control in People with Type 1 Diabetes—Data from Saudi Arabia
Authors: AL-SOFIANI MOHAMMED , ALMUAMMAR SARA
Published: June 2023

Background: Telehealth has the potential to improve accessibility to nutrition clinics, particularly in parts of the world where the number of certified nutritionists is limited. Here, we evaluate the impact of utilizing telehealth for nutrition consultations on glycemic control and patients satisfaction when managing people with type 1 diabetes (PwT1D).

Methods: A retrospective analysis of data from 137 PwT1D referred to the nutrition clinic at King Saud University to learn carb counting (2021-2022). Participants were divided into 2 groups: 1) Telenutrition group (those who had 4 virtual & 2-3 in-person visits) (n=107) and 2) In-person group (those who had 6-7 in-person & no virtual visits) (n=30). Changes in hemoglobin A1C and CGM metrics from baseline to month 3 (i.e. end of the study (EOS)) were compared between the groups. At the EOS, participants were asked to fill out a satisfaction survey.

Results: The reduction in A1c from baseline to EOS was comparable in both groups (1.2% and 1.1%, in the Telenutrition and In-person groups, respectively, both p<0.01). Likewise, the glucose time in range (TIR) increased from 53.9% at baseline to 58.5% at the EOS (p<0.01) in the telenutrition group and from 49.1% at baseline to 54.7% at the EOS (p=0.13) in the in-person group. This was accompanied by a significant reduction in the prandial insulin doses from baseline to EOS by 32% in the telenutrition group and 28% in the in-person group (both p<0.01). Majority (98%) of those who attended the telenutrition clinic reported satisfaction with the quality of healthcare provided and 97% reported that their experience with the telenutrition clinic was as satisfying or more satisfying than that in the in-person clinic.

Conclusion: Telenutrition clinic is as effective in improving glycemic control in people with T1D as the traditional “in-person” nutrition clinics, and its utilization may improve patients' satisfaction and accessibility to certified nutritionists

Disclosure

M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Almuammar: None.
610-P: Comparison of Dietary Habits among Rural Americans With and Without Diabetes
Authors: RONY MELISSA , QUINTERO ARIAS CAROLINA , WISE NATHAN N. , PRABU ANIRUDH , DORAN KELLY , ANTHOPOLOS REBECCCA , ELBEL BRIAN , THORPE LORNA , LEE DAVID C.
Published: June 2023

Introduction: Residents of rural communities face unique geographic challenges in accessing food and healthcare, which may contribute to poor diet quality and increase the risk of diabetes. We compared Alternative Healthy Eating Index (aHEI) scores among residents with and without a history of diabetes from a rural county in New York known to have poor health outcomes.

Methods: In 2021, we performed a cross-sectional survey and validated food frequency questionnaire (FFQ) among residents in Sullivan County, NY, a rural county that has the second-worst health outcomes among all counties in New York. We compared overall total aHEI scores and the 11 component scores of the aHEI between 155 rural participants with diabetes and 961 without a history of diagnosed diabetes.

Results: We found statistically lower healthy eating scores among rural study participants with diabetes compared to those without diabetes (p=0.01). While the overall magnitude of this difference in total aHEI was not large (54.1 versus 56.7), our analysis of aHEI component scores found that study participants with diabetes had statistically worse eating habits for nuts/legumes, red meat, trans-fats, and alcoholic drinks (p-values of 0.036, 0.001, 0.002 and 0.002 respectively). Notably, one category where rural residents with diabetes had better eating habits than those without diabetes was for sugary beverages/juice.

Discussion: Our study found worse eating habits among rural residents with diabetes compared to those without diabetes in a rural county with particularly poor health outcomes. Additionally, this study highlights the potential need for accessible nutritional education in high-risk rural communities. While study participants with diabetes on average, consumed fewer sugary beverages and juice, more attention may need to be focused on reducing other food categories that might increase the risk of poor glycemic control.

Disclosure

M.Rony: None. C.Quintero arias: None. N.N.Wise: None. A.Prabu: None. K.Doran: None. R.Anthopolos: None. B.Elbel: None. L.Thorpe: None. D.C.Lee: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)
618-P: Association of Intuitive Eating Patterns and Metabolic Control in Outpatients with Type 2 Diabetes
Authors: ALMEIDA JUSSARA , KOLLER OLIVIA G. , MENEZES VANESSA M. , BUSANELLO ALINE
Published: June 2023

Aim: Evaluate the possible association between intuitive eating (IE) patterns and metabolic control in patients with type 2 diabetes (T2DM).

Methods: Cross-sectionally, outpatients with T2DM attended in University Hospital (Brazil) were submitted to clinical, laboratory, and lifestyle evaluation. IE was assessed by Intuitive Eating Scale-2 (IES-2). Metabolic control evaluated were BMI, HbA1c, LDL and triglycerides targets according to ADA recommendations. Eating patterns were identified by cluster analysis and patients characteristics were compared by appropriate tests. P<0.05 (two-tailed) was considered statistically significant. Study approved Hospital's Ethics Committee (2020-0654).

Results: A total of 267 patients were evaluated: 62.2% female, 60 (53-65) years old, BMI=31.9±5.4kg/m², diabetes duration=16±9 years, HbA1c=8.5±1.5%, and median IES-2 total score was 58 (50-67)%. Three IE patterns were identified: Pattern 1=patients with higher intuitive eating; Pattern 2=non emotional-oriented coping; Pattern 3=patients with lower intuitive eating. Pattern 3 patients were younger, included a higher proportion of women, with obesity, psychotropic drugs use, and higher HbA1c values than those in Pattern 1, but not than Pattern 2. Pattern 1 patients presented a lower BMI, fasting plasma glucose and serum triglycerides values as compared to the other groups (P<0.05 for all analyses). Logistic regression models confirmed the association of Pattern 3 with higher obesity prevalence (OR=2.21; 95%CI=1.04-4.70) and triglycerides values out of target (OR=3.32; 95%CI=1.53-7.71) as compared to Pattern 1, after adjusting for confounders. No associations were observed between HbA1c out of target and lower intuitive eating.

Conclusion: In this sample of outpatients with T2DM, eating less intuitively was associated with higher obesity prevalence and triglycerides values out of target as compared to eating more intuitively.

Disclosure

J.Almeida: None. O.G.Koller: None. V.M.Menezes: None. A.Busanello: None.

Funding

CAPES (001); FIPE/HCPA (2020-0654)
624-P: Portrayal of Perceived Stigma across Ages in Type 1 Diabetes—A BETTER Registry Analysis
Authors: HOUSNI ASMAA , KATZ ALEXANDRA , KICHLER JESSICA C. , NAKHLA MERANDA , BRAZEAU ANNE-SOPHIE
Published: June 2023

Background: People with type 1 diabetes (PWT1D) perceiving high diabetes-related stigma are less likely to report in-target A1c levels. We hypothesized that people with higher levels of stigma have suboptimal psychosocial outcomes and that stigma would be perceived differently across age groups.

Methods: Cross-sectional analysis of 709 PWT1D aged ≥14 years in the BETTER T1D registry (Quebec, Canada) who completed the T1D Stigma Assessment Scale (DSAS-1). The DSAS-1 (/95) includes 3 subscales; Blame & Judgment (6 items), Identity Concern (7 items), and Treated Differently (6 items). Individuals who perceived more stigma compared to the total cohort (DSAS-1 mean score +1 standard deviation), were stratified into groups by age to determine associations with diabetes self-management behaviours and outcomes.

Results: Across groups, youth (n=105; 14-24 years) had the highest stigma perception (20%), followed by 18% in middle-aged adults (n=401; 35-64 years), then 15% for both young adults (n=130; 25-34 years) and seniors (n=73; 65+ years). The majority of youth, young and middle-aged adults, and seniors perceived stigma as Blame & Judgment (51%, 44%, 33%, and 19%, respectively). Stigma related to Identity Concern was highest among seniors (15%). In an age- and diabetes duration-adjusted models, 40% of adjusted variance in stigma score was explained by increased diabetes distress (p<0.001), depression (p=0.005), hyperglycemia avoidance behaviours (p<0.001), fear of hypoglycemia (p<0.001) and decreased social support (p<0.001).

Conclusion: Interventions targeting diabetes-related stigma need to be tailored for different age groups to target suboptimal diabetes self-management behaviours and improve psychosocial outcomes.

Disclosure

A.Housni: None. A.Katz: None. J.C.Kichler: None. M.Nakhla: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.

Funding

JDRF (4-SRA-2018-651-Q-R); Canadian Institutes of Health Research (JT1-157204)
63-LB: Real-Time Continuous Glucose Monitoring (rtCGM) Is Associated with Improved Clinical and Psychosocial Health in People with Type 2 Diabetes on Basal Insulin (T2D-BI)
Authors: CRAWFORD MARGARET A. , HICKS CHRISTIAN , ZHOU TERESA , KLEINHANZL AFSHAN , SINGH HARSIMRAN
Published: June 2023

Background and Aims: Introduction of basal insulin (BI) can be an intimidating treatment escalation due to increased risk of hypoglycemia and weight gain for people with type 2 diabetes (T2D). There is growing evidence supporting the glycemic and quality of life benefits of rtCGM in T2D. We analyzed survey and rtCGM data for T2D-BI users of the Dexcom G6 rtCGM system to investigate the impact on sensor metrics, self-reported body weight, and psychosocial health.

Methods: Three hundred T2D-BI Dexcom G6 users completed online surveys regarding their demographics and diabetes health. Participants’ sensor metrics were analyzed for duration of wear and glycemic changes from CGM initiation onwards (14-day time periods with ≥70% data available). Changes in variables were evaluated for clinical significance (weight loss ≥5%, transition to A1C <7%, ΔTIR ≥5%) and statistical significance (p<0.05 from paired t-tests).

Results: Data from 150 CGM-naïve (prior to Dexcom G6 initiation) T2D-BI users were analyzed. Mean (IQR) age=60 years (53, 70), 45% female, 81% White, 50% reported annual household income <$75K. CGM duration was 11 months (4, 13). Body weight at baseline=235 pounds (190, 270), A1C=8.4% (7, 9.3), TIR= 69% (58, 86). Reported weight loss averaged 13 (-20, 0) pounds, A1C decrease averaged 1.6 (-2.5, 0) percentage points (both p<0.001) with no increase in hypoglycemia. Overall, 53 users experienced clinically significant weight loss (5% of total body weight), 48 improved their A1C to <7%, and 46 improved TIR by ≥ 5%. Participants reported healthier eating patterns, simplified diabetes management routines, and increased peace of mind using Dexcom G6. Conclusions: These real-world outcomes demonstrate clinically valuable improvements in T2D-BI on Dexcom G6 with respect to glycemic control, body weight, diabetes behaviors, and psychosocial health.

Disclosure

M. A. Crawford: Employee; Dexcom, Inc. C. Hicks: Employee; Dexcom, Inc. T. Zhou: Employee; Pfizer Inc. A. Kleinhanzl: Employee; Dexcom, Inc. H. Singh: Employee; Tandem Diabetes Care, Inc., Dexcom, Inc.
631-P: Development of Noninvasive Diabetes Management Method Using Glycated Albumin in Tears
Authors: AIHARA MASAKAZU , KUBOTA NAOTO , YAMAUCHI TOSHIMASA
Published: June 2023

Aims/Background: Several clinical trials have demonstrated that strict glycemic control is important to minimize the risk of diabetic complications. Although frequent measurement of blood glucose levels by the invasive finger prick method is useful to achieve strict glycemic control, this method is invasive and burdensome to the patients. Glycated albumin (GA) is a biomarker which reflects the glycemic control status over the previous 2 weeks. We demonstrated GA levels in tears correlated those in blood. We hypothesized that regular GA tests in tears caused behavior change and improved glycemic control.

Methods: Participants with type 2 diabetes were recruited and randomly divided to two groups. One group (intervention group) was performed tear GA tests every 2 weeks and reported the results, while the other group (control group) was not. After 8 weeks of intervention, the two groups were compared. GA levels in tears were measured by Liquid Chromatography / Mass Spectrometry.

Results: We enrolled 56 participants to the study. Compared with the control group, the intervention group showed improvement in fasting blood glucose, HbA1c, GA, non-HDL cholesterol.

Conclusions: Levels of GA, as a diabetes-related biomarker, in tears can be measured noninvasively. Regular measurement of the GA levels in tears could allow smoother management of diabetes mellitus and reduce the risk of complications noninvasively.

Disclosure

M.Aihara: None. N.Kubota: None. T.Yamauchi: Other Relationship; Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited, Novo Nordisk, Astellas Pharma Inc., AstraZeneca, Ono Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim, Kyowa Kirin Co., Ltd., Kowa Company, Ltd., Merck & Co., Inc., Sanofi, Sanwa Kagaku Kenkyusho, Shionogi & Co., Ltd., Daiichi Sankyo, Taiho Pharmaceutical Co. Ltd., Tosoh Corporation, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., NTT Docomo Inc., Aero Switch, Asahi Mutual Life Insurance Company, NIPRO Medical Corporation, Abbott Japan Co., Ltd., Bayer Inc., Kyorin Pharmaceutical Company, Limited.
641-P: Diabetes Distress and Blood Glucose in the Function and Emotion in Everyday Life with Type 1 Diabetes (FEEL-T1D) Study—Which Comes First, the Chicken or the Egg?
Authors: GONZALEZ JEFFREY S. , HERNANDEZ RAYMOND , SPRUIJT-METZ DONNA , HOOGENDOORN CLAIRE J. , CRESPO-RAMOS GLADYS , AGARWAL SHIVANI , CRANDALL JILL P. , PETERS ANNE L. , PHAM LOREE T. , LEE PEY-JIUAN , SCHNEIDER STEFAN , PYATAK ELIZABETH
Published: June 2023

Introduction: Diabetes Distress (DD) has been consistently linked with suboptimal blood glucose in T1D. However, prior studies have rarely used methods that can adequately evaluate the directionality of this relationship. This study paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine the relative strength of lagged effects of blood glucose (BG) on DD and vice versa.

Methods: FEEL-T1D participants (N=182, 40±14 yrs, 54% women, 41% Latino, 29% White, 15% Black) wore blinded CGM for 10-14 days and completed 5-6 smartphone EMA surveys per day. Using multilevel cross-lagged panel modeling, we evaluated within-person lagged effects from momentary ratings of DD (scale: 0-100) to various BG metrics (BG average, Time in Range [TIR, 70-180 mg/dL], % time 181-250 mg/dL, % time > 250 mg/dL, % time 54-69 mg/dL, % time <54 mg/dL, and coefficient of variation [CV]) over the subsequent 3 hours and between 3 hours of BG metrics and subsequent DD ratings.

Results: Unstandardized within-person parameter estimates and 95% confidence intervals for lagged effects of BG on subsequent DD ratings were significant for average BG (0.01; 0.01, 0.02), TIR (−0.01; −0.02, −0.004), % time 181-250 mg/dL (0.01; 0.001, 0.02), and % time > 250 mg/dL (0.02; 0.01, 0.04), but not for CV or % time in low BG; as expected, higher BG predicted subsequently higher DD. Lagged effects of DD ratings on subsequent 3-hour BG metrics were only significant for % time 54-69 mg/dL (−0.02; −0.04, −0.002); unexpectedly, DD was predictive of less % time with low BG.

Conclusion: These novel findings reveal that the experience of DD is significantly influenced by preceding suboptimal BG levels, particularly high BG, even when individuals are blinded to their BG values. Results suggest that interventions that improve BG levels may reduce DD but do not support the hypothesis that reductions in DD will conversely lead to improvements in BG.

Disclosure

J.S.Gonzalez: Consultant; Virta Health Corp. P.Lee: None. S.Schneider: None. E.Pyatak: Research Support; Abbott Diabetes. R.Hernandez: None. D.Spruijt-metz: None. C.J.Hoogendoorn: None. G.Crespo-ramos: None. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. J.P.Crandall: Research Support; Abbott Diabetes. A.L.Peters: Advisory Panel; Abbott Diabetes, Medscape, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Stock/Shareholder; Omada Health, Inc., Livongo. L.T.Pham: None.

Funding

National Institutes of Health (R01DK121298, P30DK111022)
642-P: Discovering Nonadherence to Diabetes Medications—Which Questions Are Most Effective?
Authors: PILLA SCOTT J. , BUGAYONG MARIELLE T. , LONG JUDITH A. , GORDON HOWARD S. , BATES JEFFREY T. , WASHINGTON DONNA , BOKHOUR BARBARA G. , TUEPKER ANAIS , CATHERINE BEACH MARY , MARUTHUR NISA M. , SAHA SOMNATH
Published: June 2023

Half of patients with diabetes have difficulty taking medications as directed, creating a major barrier to glycemic control. In studies outside of diabetes, specific, negatively-framed questions (e.g. “Are you missing doses?”) were most effective in eliciting patient nonadherence disclosure. Therefore, we performed the first study examining how primary care providers (PCPs) evaluate nonadherence to diabetes medications. We analyzed audio-recorded PCP visits for 341 adults with diabetes from 4 geographically diverse Veterans Affairs medical centers from 2017-2020. This analysis focused on patients who reported substantial nonadherence on a post-visit questionnaire, defined as taking their diabetes medications “some of the time,” “hardly ever,” or “never.” Using an established framework, two coders independently classified PCP’s medication-related questions as broad (e.g. “How are you doing with your medications?”), clarifying of dose/regimen (e.g. “Is insulin still 30 units?”), positively-framed (e.g. “Are you taking your medications every day?”) or negatively-framed. We analyzed associations between question type and nonadherence disclosure using Fisher’s Exact tests. Results: there were 41 patients with substantial nonadherence who were seen by 25 PCPs. Fewer than half of these patients (19/41; 46%) disclosed nonadherence to their PCP. PCPs asked 42 medication-related questions: most were clarifying (37/42; 88%), 2 were broad, 2 positively-framed and 1 negatively-framed. Patients disclosed nonadherence more often after specific positively- or negatively-framed questions (100% disclosed) vs. other question types (18% disclosed), p=0.008. In conclusion, over half of patients with substantial nonadherence to diabetes medications did not disclose this to their PCP. While PCPs often reviewed patients’ medications and dosing, this rarely uncovered nonadherence. Asking specific questions about nonadherence was infrequent, yet is likely a more effective strategy.

Disclosure

S.J.Pilla: None. N.M.Maruthur: Other Relationship; Johns Hopkins HealthCare Solutions. S.Saha: None. M.T.Bugayong: None. J.A.Long: None. H.S.Gordon: None. J.T.Bates: None. D.Washington: None. B.G.Bokhour: None. A.Tuepker: None. M.Beach: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK128572); U.S. Department of Veterans Affairs (IIR 14-007)
655-P: Diabetes Distress and Associated Factors among Low-Income Chinese Immigrants with Type 2 Diabetes
Authors: HU LU , SHI YUN , WANG CHAN , LI HUILIN , BAO HAN , XU XINYI , JIANG YULIN , ANN SEVICK MARY , ISLAM NADIA
Published: June 2023

Purpose: To describe diabetes distress and its associated factors among Chinese immigrants with type 2 diabetes (T2D) in NYC.

Methods: Cross-sectional data were derived from three research studies conducted among Chinese immigrants with T2D in NYC. Diabetes Distress Scale (DDS) was used to measure diabetes distress, which includes 4 subscales: emotional, regimen, interpersonal and physician-related distress. A total or subscale score ≥ 2 indicates a moderate or higher distress level and is considered clinically important. Patient Health Questionnaire-2 was used to measure depressive symptoms. Participants’ sociodemographic data were collected. Descriptive statistics and stepwise logistic regression were used.

Results: Most participants (n=178) were currently married (76%), limited English proficient (93%), high school graduates or less (66%), and had an annual household income of less than $25K (62%). The mean age was 63.6 (SD=13.6) years old. About 26% of them reported moderate or higher overall distress levels. The most common sources of distress were emotional burden (30%), followed by regimen (29%), interpersonal (19%), and physician-related distress (14%). Participants who were younger, female, and had elevated depressive symptoms were more likely to have higher diabetes distress.

Conclusions: Diabetes distress is prevalent in Chinese immigrants with T2D, especially emotional distress and regimen-related distress. Given the known negative impact of diabetes distress, it is critical to consider screening for diabetes distress and incorporating psychological counseling in diabetes care in this underserved population.

Disclosure

L.Hu: None. Y.Shi: None. C.Wang: None. H.Li: None. H.Bao: None. X.Xu: None. Y.Jiang: None. M.Sevick: None. N.Islam: None.

Funding

National Institutes of Health (R00MD012811, P30DK111022, U54MD000538-15)