bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Effect That Diabetes Education Has on Acute-Care Nurses' Knowledge Level
Authors: KUCHTA JACKIE
Published: June 2018

Although there are published inpatient diabetes guidelines, successful implementation is often met with resistance and fear of complications in treated patients. This is often due to a lack of knowledge among healthcare providers and nurses (RNs), which increases the risk of complications, dysglycemia, length of stay and readmissions. Diabetes affects every hospitalization and healthcare organizations need to provide all RNs with the education to reduce the effects of uncontrolled or undiagnosed diabetes. This project developed a 25-question, multiple choice test to evaluate acute-care RNs knowledge on inpatient diabetes management and was evaluated to determine the validity and reliability of the test. Validity was verified by a certified nurse leader with advanced diabetes management to ensure the questions were within a registered nurses scope of practice and an endocrinologist verified comprehensive inclusion of published inpatient diabetes guidelines across the continuum. The questionnaire was completed by 13 RNs and included a focus on pathophysiology of type 1 and type 2 diabetes, non-insulin agents, insulin, acute complications, nutrition, and sick day management. A paired t-test statistical analysis was conducted to determine the reliability of the questionnaire post-administration of diabetes education to the same group of RNs. The comparison showed an improvement in the overall diabetes knowledge level with a mean score of 79.7%, SD= 3.796, compared to pre-test mean score of 67.38%, SD= 14.86 and t= -3.524, p=0.004. Additional variables evaluated through a two way ANOVA (F[2, 10], f=.931, p=.426) showed no significant effect were the years of experience or level of nursing degree on the overall scores. In order to further strengthen the reliability of the questionnaire, the project should be repeated throughout the organization including all inpatient nursing departments. Additional variables that should be evaluated for effect include nursing unit and type of experience.

Disclosure

J. Kuchta: Other Relationship; Self; Medtronic MiniMed, Inc..
Durability of Glycemic Control in a Diabetes Education Insurer-Based Intervention in Primary Care
Authors: ZUPA MARGARET , ARENA VINCENT C. , THEARLE MARGARET B. , JOHNSON PATRICIA A. , SIMINERIO LINDA M.
Published: June 2018

Background: Models that address the needs of patients with diabetes mellitus (DM) in primary care (PC) are needed, as health systems move to value-based care. To support DM patients at high risk, an insurer-based program that paired nurse practice care managers (PCM) with certified diabetes educators (CDE) was designed to improve outcomes for DM patients with complex needs.

Objective: To assess the durability of glycemic improvement after diabetes self-management education and support (DSMES) intervention within a model that relies on a PCM to identify, refer, and provide ongoing support to complex patients who received a CDE intervention in PC.

Methods: 2 CDEs, serving rural and urban areas, were introduced as team members into PC practices. CDEs provided DM training to PCMs who then proactively identified and referred patients under clear criteria (DM related ER visits, hospitalizations, HbA1c>9, reported barriers to care) for DSMES in collaboration with PC provider and PCM. Post CDE intervention, the PCM was available for follow-up and ongoing support. HbA1c was monitored every 3 months after intervention and compared to baseline value to assess durability of improvement in glycemic control.

Results: Of 222 patients referred, 1had 6 and 80 had 12-month data for analysis. Patients were 52% female; mean age 57 (SD 13.43). Mean HbA1c decreased from 9.6 to 8.4 over 6 months and 9.2 to 8.1 over 12 months (p<0.001). Improvement in glycemic control was maintained for at least 1 year after intervention. There was no significant change in BMI over this time.

Conclusions: A model where CDEs partner with PCMs, who identify, refer, and provide ongoing support to patients post-CDE delivered DSMES, is an effective and feasible intervention to improve and sustain DM outcomes in PC. This collaborative approach expands opportunities to meet complex needs of DM patients and can contribute to the ability of practices and health plans to provide an effective intervention with ongoing patient support.

Disclosure

M. Zupa: None. V.C. Arena: None. M.B. Thearle: None. P.A. Johnson: None. L.M. Siminerio: None.
The Relationship between A1C and Hypoglycemia in the Diamond Study
Authors: REDDY MONIKA , GIMENEZ MARGA , MOSCARDO VANESSA , OLIVER NICK
Published: June 2018

We revisited the well-known inverse relationship between A1C and hypoglycemia using data from phase 1 of the Diamond clinical trial that compared usual care to real-time continuous glucose monitoring (CGM) in subjects with type 1 diabetes using MDI and with A1C levels from 7.5% to 9.9%. Data from 157 subjects (104 and 53 in the CGM and control groups, respectively) were analyzed. The percentages of sensor glucose (SG) values ≤70 mg/dL (≤3.9 mmol/L) (“%≤70”) and of those indicating clinically significant hypoglycemia (≤54 mg/dL [≤3.0 mmol/L]) (“%≤54”) during the initial and final weeks of the 24-week study were calculated for each subject and compared to corresponding baseline and 24-week A1C values. At baseline, the percent ≤70 was similar for the two groups (p=0.24), as was the percent ≤54 (p=0.10). There was a trend toward more hypoglycemia for subjects near the minimum allowed A1C value of 7.5% (Figure A). At 24 weeks (Figure B), there were significant between-group differences in favor of CGM at both thresholds, and the association between decreasing A1C and increasing exposure to SG values ≤54 mg/dL was attenuated. Subjects in the CGM group averaged ∼16 minutes/day with SG ≤54 mg/dL. These data suggest patients with access to CGM alerts and alarms take appropriate and timely measures to nearly eliminate exposure to clinically meaningful hypoglycemia. CGM allows safe intensification of MDI therapy and achievement of near-normal A1C levels.

Disclosure

M. Reddy: Advisory Panel; Self; Roche Diabetes Care Health and Digital Solutions. Other Relationship; Self; Dexcom, Inc.. M. Gimenez: None. V. Moscardo: None. N. Oliver: Advisory Panel; Self; Dexcom, Inc., Roche Diabetes Care Health and Digital Solutions, Medtronic. Research Support; Self; Dexcom, Inc., Roche Diabetes Care Health and Digital Solutions. Other Relationship; Self; Novo Nordisk A/S, Takeda Development Centre Europe Ltd..
Real-World Patterns of Daytime and Nocturnal Hypoglycemia during Flash Continuous Glucose Monitoring
Authors: PRYOR HEATHER , BUDIMAN ERWIN S. , XU YONGJIN
Published: June 2018

This study evaluated patterns of daytime and nocturnal hypoglycemia during flash continuous glucose monitoring using the FreeStyle LibreTM system. Users scan the sensor to collect the current glucose, trend, and up to 8 hours of glucose readings which are automatically stored every 15 minutes. The internet-connected PC-based software uploads the de-identified 90-day reader data to a database. De-identified data from September 2014 to September 2017 of all sensors with at least 120 hours of operation were analyzed from 237,747 readers and 1,569,588 sensors worldwide (88% from Europe). Readers were ranked by scan frequency and allocated to 20 equally sized groups. The association of significant hypoglycemia (≤54 mg/dL) and scan rate were analyzed. Users performed a mean (SD) of 13.2 (9.0) glucose scans per 24 hours, with 11.5 (8.1) during the day (06:00-23:00) and 1.7 (1.5) during the night (23:00-06:00). Time in significant hypoglycemia (≤54 mg/dL) decreased from 24.2 to 15.2 minutes/day comparing low with high frequency scanners during the 17-hour day period (p<0.001), with a similar pattern overnight (19.0 and 12.7 minutes/night, p<0.001). When expressed as a proportion of time, hypoglycemia accounted for 2.4 to 1.5% of daytime glucose (for low to high frequency scanners), prevalence of night time hypoglycemia was 4.5 to 3.0%. The benefits of scanning frequently during the day are evident at night time.

Disclosure

H. Pryor: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. E.S. Budiman: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott, AbbVie Inc. Y. Xu: Employee; Self; Abbott.
Cost-Effectiveness of Diabetes Self-Management Education and Support in the Community—Projections from a Randomized Controlled Trial
Authors: PIATT GRETCHEN , YE WEN , KUO SHIHCHEN , SINCO BRANDY R. , HERMAN WILLIAM H. , SPENCER MICHAEL S. , PALMISANO GLORIA , HEISLER MICHELE , KIEFFER EDITH C.
Published: June 2018

To impact clinical and behavioral diabetes care, understanding the cost-effectiveness (CE) of diabetes self-management education and support (DSME/S) in community settings is critical. We aimed to determine the long-term CE of 2 DSME/S modalities (Community Health Worker (CHW) vs. CHW + Peer Leader (PL)), compared to enhanced usual care (EUC), in reducing risk of diabetes complications in Hispanic adults with type 2 diabetes (diabetes) in metro-Detroit. CE analyses were based on empirical outcome data from a randomized controlled effectiveness trial. Eligible subjects were recruited from one Federally Qualified Health Center and randomized to 1) 6 months of CHW-led DSME + 12 months of CHW-led telephone outreach, 2) 6 months of CHW-led DSME+ 12 months of PL-led weekly group sessions with telephone outreach, or 3) EUC. We used the validated Michigan Model for Diabetes to estimate the CE of the 2 DSME/S modalities compared to EUC over a 10-year simulation time horizon, discounting costs and benefits at 3% annually. Trial-based costs and outcomes were used; other data regarding costs, disease progression, mortality, and utilities were from published literature. From a healthcare sector perspective, CHW+PL was associated with lower costs ($76,599 vs. $77,203 in CHW and $76,779 in EUC) and increased health benefits (quality-adjusted life-years (QUALY): 5.137 vs. 5.1in CHW and EUC) compared to CHW and EUC, respectively, in the model time horizon. CHW was associated with higher costs but yielded similar QALYs compared to EUC. The greater intervention costs of CHW + PL were completely or substantially offset by savings arising from averted diabetes complications compared to CHW or EUC. Using CHW+PL for DSME/S appears to be a sound investment and may be cost-saving for Hispanic adults with diabetes in metro-Detroit.

Disclosure

G. Piatt: None. W. Ye: None. S. Kuo: None. B.R. Sinco: None. W.H. Herman: Other Relationship; Self; Merck Sharp & Dohme Corp., Lexicon Pharmaceuticals, Inc.. Consultant; Self; Janssen Scientific Affairs, LLC.. Research Support; Spouse/Partner; Nestlé. Other Relationship; Self; American Diabetes Association. Advisory Panel; Self; National Committee for Quality Assurance (NCQA). M.S. Spencer: None. G. Palmisano: None. M. Heisler: None. E.C. Kieffer: None.
Younger Patients with Type 2 Diabetes Have Poorer Self-Care Practices Compared with Older Patients—Results from the Australian National Diabetes Audit
Authors: NANAYAKKARA NATALIE , PEASE ANTHONY J. , RANASINHA SANJEEVA , WISCHER NATALIE , DE COURTEN BARBORA , ZOUNGAS SOPHIA
Published: June 2018

Introduction: Type 2 diabetes is increasingly diagnosed among younger people. Patient engagement with self-care practices is crucial for the optimal management of type 2 diabetes. This study examines the self-care practices of younger and older patients with type 2 diabetes.

Methods: Data were analysed from the Australian National Diabetes Audit (ANDA) that included 2552 adult patients with type 2 diabetes from 56 participating Diabetes Centres. Pre-specified demographic and clinical variables were obtained. Self-care variables (physical activity, following dietary recommendations, medication adherence and monitoring blood glucose levels) were compared in patients ≤64 years and >64 years of age.

Results: Mean age (±SD) of participants was 63±13 years overall, 53±9 years for the younger group and 73±6 years for the older group. Mean diabetes duration was 9±8 years and 15±10 years for younger and older patients, respectively (p<0.01). A greater proportion of younger patients had HbA1c levels above 7.0% compared with older patients (76% vs. 68%, p<0.001). A greater proportion of younger compared to older patients reported difficulty following dietary recommendations (50% vs. 32%) and forgetting medications (37% vs. 22%) (all p values <0.001). A smaller proportion of younger compared with older patients reported monitoring their blood glucose levels as often as recommended (60%vs. 70%, p<0.001). Younger age was associated with a 2-fold increase in the odds of not following the recommended self-care practices after adjustment for gender, smoking, insulin therapy, depression and allied health attendance (all p values <0.001).

Conclusion: Despite shorter diabetes duration, younger age was associated with worse glycaemic control and poorer diabetes self-care practices among patients with type 2 diabetes. Targeted strategies are urgently required to optimise diabetes self-care practices and thereby improve glycaemic control.

Disclosure

N. Nanayakkara: None. A.J. Pease: None. S. Ranasinha: None. N. Wischer: None. B. de Courten: None. S. Zoungas: Advisory Panel; Self; AstraZeneca.
Glucose Variability and Flash Glucose Monitoring in the Real World
Authors: JANGAM SUJIT , XU YONGJIN , HAYTER GARY , DUNN TIMOTHY
Published: June 2018

High glucose variability is associated with increased hypoglycemia. Previous analyses of real-world data have shown that increased testing using flash glucose monitoring (FreeStyle LibreTM system) is associated with lower hypoglycemia and hyperglycemia. Here we studied: 1) The relationship between glucose variability and hypoglycemia/hyperglycemia during flash glucose monitoring 2) The relationship between increased glucose testing and glucose variability. De-identified glucose data is collected from individuals using the system when they upload data from their readers to the desktop software. Data from 237,747 individuals was analyzed. To understand the relationship between variability and hypoglycemia/hyperglycemia, individuals were divided into groups of high and low glucose variability using CV=36% as the threshold. Hypoglycemia (time below 70mg/dL) and hyperglycemia (time above 180mg/dL) metrics were then analyzed in the two groups. To understand the impact of testing frequency on glycemic variability, individuals were divided into 20 equal sized groups spanning the full range of daily testing frequency. Average CV was then calculated for each group. It was observed that individuals with high variability showed 35% more hyperglycemia (10.1±5.9 hours/day) compared to individuals with low variability (7.5±7.0 hours/day). Similarly, individuals with high variability showed 167% more hypoglycemia (144±281 minutes/day) compared to those with low variability (54±185 minutes/day). It was observed that increased testing with the system was associated with lower glucose variability. CV decreased from 40.6% to 34.5% from the lowest to highest testing frequency groups. High variability is associated with both increased hyperglycemia and hypoglycemia in a large sample population from the real world. Increased testing is associated with decreased glucose variability.

Disclosure

S. Jangam: Employee; Self; Abbott. Y. Xu: Employee; Self; Abbott. G. Hayter: Employee; Self; Abbott. T. Dunn: Employee; Self; Abbott.
The Role of Diabetes Educators in Reduction the Risk of Hypoglycemia in Type 1 Patients during Fasting Ramadan
Authors: MOURAD SAHAR
Published: June 2018

Background/Objectives: Fasting Ramadan for type 1 patients could be a challenging for both patients and physicians due to complications such as hypoglycemia, so in this study we choice to introduce glucose sensor and intensify the role of diabetes educator follow-up for type 1 patients who already on pump and willing to fast Ramadan for the first time.

Design and Methods: This is a pilot prospective cohort study. Total of 6 patients (4 females and 2 males) with type 1 diabetes were recruited. Their mean age is (21.8+/-2.2) years, diabetes duration(11.1+/-2.3) years, mean duration on insulin pump is (4+/-1.6)years. Insulin basal rates of infusion were reduced 5-10% during fasting hours and increased between 5-10% after breaking fast. Weekly follow-up visits during Ramadan took place as well a daily follow-up by phone with the educator. Patients were asked to wear glucose sensor for entire days of fasting to detect hypoglycemia.

Results: An (28.8+/- 8.6) units for 24 hours of basal insulin were set before fasting, and (26.8+/- 7.5) units for 24 hours of basal insulin were required for fasting Ramadan, and from that (15.1+/-4.3) units was basal insulin for total hours of fasting(14 hours), part of it explained by food habitus and lack of activity during Ramadan.

An average of blood glucose was (11.1+/-2.1) mmol/l an hour before futoor, (9.7+/-3.8) mmol/l two hours after futoor, and (12.5+/- 3.4) mmol/l at suhoor.

On the first week, four hypoglycemic episodes (BG less than 3.9 mmol/l), daily follow-up by diabetes educator, pop up visit in educator office and weekly visit to physician and educator office reduce the episode of hypoglycemia by the 2nd week till the 4th week of Ramadan.

Conclusions: The use of glucose sensor together with adjustment of basal insulin wasn’t enough to minimzing the fear of fasting Ramadan but with role of diabetes educator reduce the risk of further hypoglycemia episode.

Disclosure

S. Mourad: None.
Atypical Antipsychotics and Metabolic Complications
Authors: AKUNJEE MUNAZA , GANDHI SHRUTI M. , NYLEN ERIC
Published: June 2018

Introduction: Second generation antipsychotics (SGA) such as olanzapine are often used for psychotic disorders due to their efficacy and fewer neurological side effects. However, they have been associated with weight gain, prediabetes, diabetes ketoacidosis (DKA), myopathy and rarely rhabdomyolysis. These side effects were reported in individual cases. Our case had both DKA and rhabdomyolysis with chronic olanzapine use of 9 years.

Case: A 36 year-old AAM with schizophrenia on olanzapine and risperidone, diet-controlled hyperlipidemia, obesity and prediabetes (HbA1c 6%,) admitted with fatigue, polyuria, polydipsia and confusion. He was diagnosed with DKA with HbA1c 13.7%, rhabdomyolysis (CK 13000 units/L) and acute kidney injury (peak creatinine 12, eGFR<10), requiring insulin infusion, dialysis and mechanical ventilation. Olanzapine was discontinued; his creatinine and glucose improved. His C-peptide was 4.28 ng/ml. Anti-GAD and islet cell antibodies were negative. He was discharged on glargine and risperidone. Two months after discharge, HbA1c was 5.8%, creatinine 1 (eGFR>60) and insulin was stopped.

Discussion: This case highlights the importance of monitoring patients on SGA for metabolic complications. Olanzapine’s association with DKA is rare and with rhabdomyolysis is very rare. Several mechanisms for SGA-induced glucose intolerance exist, the most common being the antagonistic effect of olanzapine on serotonin 5HT2C and histamine (H1) receptors in the hypothalamus which leads to increased appetite and weight gain (our patient gained 40 lbs). Additionally, few reports on the association between olanzapine and rhabdomyolysis have been published. The mechanism remains unclear but may be due to drug-related myopathy secondary to high affinity for H1, 5-HT2A and D2 receptors. It is possible that the development of DKA predisposed our patient to developing rhabdomyolysis.

Disclosure

M. Akunjee: None. S.M. Gandhi: None. E. Nylen: None.
Use of Continuous Glucose Monitoring during Dose Adjustment for Normal Eating Course Favors the Emergence of Positive Patient–Provider Language Code
Authors: MAMED MARCELO DOS SANTOS , GASTALDI GIACOMO
Published: June 2018

Personalized approach to diabetes care and educations are worldwide recognized to favor health outcomes and health-related quality of life. Continuous glucose monitoring (CGM) can be a powerful tool to help diabetes education. Language and the way clinicians use it has an interactive impact on education. The aim of the study is to explore the language in narrative form emerging from the patient-provider interactions mediated by the use of CGM readings. Researchers transcribed and coded the data collected during the seven sessions of Dose Adjustment For Normal eating course taking place at University Hospital of Geneva in Switzerland. The course involved 3 health care providers (dietician, nurse and medical doctor) and 12 participants. All the sessions were filmed and semi-structured interviews of 10 participants and the 3 providers completed the data. Conversation Analysis of the interactive and discursive space created by the narrative’s experiences from participants mediated by CGM readings was investigated as well as Content analysis of the semi-structured interviews in order to put in perspective learning traces through participant's discourses. The results have shown that health care providers adjust and coordinate their languages through CGM readings in order to organize the narrative’s experiences from the participants. The use of technology reduced judgmental and negative words and promoted the development of a patient-provider narrative useful for learning. The narrative organization clearly impacted the participants. Diabetes technology and particularly CGM readings are powerful tools to develop a specific patient-provider language code promoting effective diabetes education.

Disclosure

M. Dos Santos Mamed: None. G. Gastaldi: Speaker's Bureau; Self; Abbott, Eli Lilly and Company, Novo Nordisk A/S, Medtronic, Dexcom, Inc., Sanofi, Roche Diabetes Care Health and Digital Solutions, Boehringer Ingelheim GmbH.
Rapid Improvement of Metabolic Control in Type 1 Diabetes after Transition from Paediatric Clinics to an Adult Diabetes Center
Authors: MAURIZI ANNA RITA , PIERALICE SILVIA , TUCCINARDI DARIO , GUGLIELMI CHIARA , LAURIA ANGELO , MADDALONI ERNESTO , FIORITI ELVIRA , MANFRINI SILVIA , POZZILLI PAOLO
Published: June 2018

Transition from paediatric to adult diabetes clinics for type 1 diabetes (T1D) patients represents a critical phase often characterized by worsening effects on diabetes outcomes as care visit attendance, metabolic control and diabetes related complications. Aim of this study was to evaluate metabolic control of 122 T1D patients [82/40 M / F, mean (SD), age 25.1 ± 5.7 years, disease duration 17.2 ± 8.1 years, HbA1c 7.9% ± 1.4] at time of transition from paediatric clinics to our adult diabetes center. At baseline, 102 patients were on multiple daily insulin injections (MDI) and 20 subjects were on continuous subcutaneous insulin infusion (CSII). The transition process was performed in a specific "transition clinic" according to the protocol of the Consensus Statement of the American Academy of Paediatrics, American Diabetes Association, Academy of Family Physicians and the American College of Physicians. Results after 3 and 6 months follow-up showed a significant improvement in metabolic control with reduction of HbA1c in the whole population [Δ HbA1c 0-3 months: -0.3% (p <0.05), Δ HbA1c 0-6 months: -0.5% (p <0.02)] as well as in the different age groups [15-20, 21-30 (p <0.05, p <0.001, respectively)]. At baseline females showed a worst metabolic control compared to male patients (HbA1c: 8.3% ± 1.5 vs. 7.6% ± 1.1, p = 0.005) and this result was confirmed at the end of the study period (HbA1c: 7.9% ± 1.0 vs. 7.1% ± 0.8, p <0.001). After 6 months since transition 27% of patients were on CSII compared to 16% of patients in the pre-transfer period, however improvement of metabolic control was independent of CSII use.

In conclusion, our data showed that transition from paediatric to our adult diabetes center promotes a very fast reduction of HbA1c already detectable after 3 months of follow-up. This unexpected improvement is likely due not only to increased use of technology but to a more proper clinical setting for emerging adults as recommended by different scientific societies.

Disclosure

A. Maurizi: None. S. Pieralice: None. D. Tuccinardi: None. C. Guglielmi: None. A. Lauria: None. E. Maddaloni: Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; European Foundation for the Study of Diabetes. E. Fioriti: None. S. Manfrini: None. P. Pozzilli: Research Support; Self; Sanofi. Speaker's Bureau; Self; Eli Lilly and Company. Research Support; Self; Merck Sharp & Dohme Corp..
"It Was All Trial and Error"—The Perspective of Parents of Emerging Adults with Type 1 Diabetes during the Transition to Independence
Authors: ALBANESE-O'NEILL ANASTASIA , WESTEN SARAH C. , THOMAS NICOLE T. , HALLER MICHAEL J. , SCHATZ DESMOND
Published: June 2018

Introduction: Emerging adults ages 18-25 years with type 1 diabetes (T1D) navigate the transition to independence in partnership with their parents. Few programs exist to meet the educational needs of parents during this transition, and little is known about their perceived knowledge deficits or readiness to provide guidance for their children. The purpose of this study was to describe the lived experience and diabetes-specific educational needs of parents of emerging adults with T1D.

Methods: Parents of adults with T1D aged 18-25 years were recruited to participate. Written informed consent was obtained and participants then took part in a semi-structured interview. Interviews were digitally recorded and professionally transcribed. A descriptive content analysis of the transcripts began after the first interview and proceeded until saturation was reached. Following the interview, participants were sent links to the study’s diabetes education website that included information on transition topics.

Results: Twenty-two parents (5 fathers, 17 mothers) of emerging adults participated in the study. Six themes emerged from the transcribed interviews: No Roadmap, Few Resources; Peers as Primary Source of Support; New Roles Require a New Communication Style; Parents Sometimes Excluded from Care; Begin Early, Go at the Child’s Pace; and Fears, Challenges, and Opportunities. All participants expressed openness to diverse education modalities, including in person, online, group videoconference, and social media. Participants received 110 push notifications, resulting in 964 page views on the study website.

Conclusions: Parents of emerging adults with T1D have a central role in their child’s transition to independence, but may not receive adequate guidance to be successful in this endeavor. The results of this study underscore the need for a tailored diabetes education program for parents of emerging adults that includes a component of peer support.

Disclosure

A. Albanese-O'Neill: None. S.C. Westen: None. N.T. Thomas: None. M.J. Haller: None. D. Schatz: None.
Exploring the Type 2 Diabetes Mellitus Experience from the Patient Perspective
Authors: YU-ISENBERG KRISTINA , GRAY GEOF D. , FOLEY CATHERINE , STOKES JONATHAN T. , SHIELDS ALAN , DICKIE GAVIN , LAMOUREUX ROGER , JACKSON CLARK V. , PADILLA BRAD , POLONSKY WILLIAM
Published: June 2018

Introduction: Type 2 diabetes mellitus (T2DM) exacts tremendous burdens on the patient and patient-focused qualitative research can yield data to deepen our understanding of the individual disease experience.

Methods: Research was conducted to illustrate the T2DM patient experience ranging from its proximal signs/symptoms to its distal impacts (e.g., the disease’s impact on physical, social, or emotional functioning). A targeted literature review, meetings with therapeutic experts, and qualitative concept elicitation interviews with T2DM patients were conducted, and results were thematically analyzed and then harmonized into a conceptual model to organize the sign, symptom, and disease-related impact experiences most relevant to T2DM.

Results: A total of 38 unique sign/symptom and 62 impact concepts of T2DM were identified across the reviewed literature (N=26 publications), expert advice meetings (N=13), and patient interviews (N=20, mean age=60.5±9.5 years, 45% female). The signs/symptoms most frequently reported by patients were tiredness (n=16), dizziness (n=10), and neuropathy-related (n=10), while experts reported excessive thirst (n=12), frequent urination (n=11), and vision problems (n=11) most frequently. For disease impacts, the concepts most frequently reported by both experts and patients were the need to modify diet (n=11 and n=20, respectively), implement an exercise regimen (n=13 and n=17, respectively), and monitor glucose more frequently (n=10 and n=16, respectively). The most bothersome signs/symptoms reported by patients were neuropathy-related (n=8), tiredness (n=5), and vision disorders (n=4).

Conclusions: Patients with T2DM experience many signs, symptoms, and impacts that if improved could give meaningful treatment benefit. Data generated from this research could be used by researchers and healthcare providers to identify treatment outcomes and inform the target concepts of T2DM questionnaires to reliably assess those outcomes.

Disclosure

K. Yu-Isenberg: Employee; Self; Intarcia Therapeutics, Inc. G.D. Gray: Employee; Self; Servier Global Medical Affairs. C. Foley: Consultant; Self; Intarcia Therapeutics, Inc., Servier. J.T. Stokes: None. A. Shields: Consultant; Self; Intarcia Therapeutics, Inc. G. Dickie: Consultant; Self; Intarcia Therapeutics, Inc. R. Lamoureux: Research Support; Self; Intarcia Therapeutics, Inc.. C.V. Jackson: None. B. Padilla: None. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions.
Visiting Rate of Dental Clinic by the Recommendation Based on the Periodontal Screening Tests for DM Patients
Authors: KATO NORIKO
Published: June 2018

Aim: To investigate the dental visit status of DM patients who needed to treatment of periodontitis screened by Perioscreen test in the medical and dental clinic cooperation at community base.

Material and Method: The study population was DM patient undergone perio dontal screening tests by diabetologist . In total, 100 subjects (65 male and 35 female) were selected. The dental visit status of DM patients with positive results was investigated according to correspondence between the medical and dental information including intraoral clinical examination: number of remaining teeth, maximum value of the periodontal pocket and percent of bleeding on probing, and type of periodontal treatment.

Result: 57 patients were positive for Perioscreen test. Among the patients with positive results, 34 patients (59.6%) visited one of three partnership dental offices and all received periodontal treatment. 26 patients (45.6%) were finished their periodontal treatment within 6 months. For the patients who finished dental treatment, parameters of periodontal diseases were improved.

Conclusion: About 60% DM patients who regularly attend the medical clinic were positive for periodontitis by Perioscreen test. Among them, about 60% patients attended for dental clinic by the recommendation by family doctor. These results may provide the basic information to medical and dental clinic cooperation and community medical care networks.

Disclosure

N. Kato: None.
Exercise Performance Is Not Impaired by Hyperglycemia in Type 1 Diabetes
Authors: ROTHACKER KAREN , ARMSTRONG SAM , SMITH GRANT J. , BENJANUVATRA NAT , LAY BRENDAN S. , FOURNIER PAUL A. , ADOLFSSON PETER , JONES TIM , DAVIS ELIZABETH A.
Published: June 2018

It is unclear whether acute hyperglycemia impairs exercise performance in T1D. To address this question we compared different exercise performance measures under 3 different conditions: euglycemia with basal insulin, hyperglycemia with basal insulin and hyperglycemia with low insulin.

In a randomized, counter-balanced, blinded study design, we studied 12 recreationally active individuals with T1D (8 males, 4 females, 17.9 ± 3.9 years, HbA1c 7.7 ± 1.0%, mean ± SD). Each completed exercise testing under 3 conditions: euglycemia (5 mM) with basal insulin (20 mU/m2 BSA/min) and hyperglycemia (17 mM) with basal insulin and hyperglycemia with low insulin (5 mU/m2 BSA/min). The clamp technique was used to achieve study conditions which were maintained for at least 60 min prior to exercise. Standardised exercise performance assessment consisted of 6 tests: a single cycle ergometer V˙2 peak test and the following tests performed in triplicate: 6-sec maximal sprint cycling, vertical jump, grip strength, single leg static balance, and modified Star Excursion Balance Test. Ten simple and choice reaction times were also performed.

Target glucose levels were achieved in all subjects: 4.9 ± 0.03 mM for euglycemia and 17.3 ± 0.04 mM for hyperglycemia (mean ± SE). Mean exercise testing duration was 110 min (range 90-130 min) with no observed ketosis. Analysis of the 6 exercise performance tests using mixed method models did not show any consistent difference in performance between the 3 study conditions. Choice reaction time was slower in hyperglycemia with low insulin compared to the other conditions (p<0.01).

This is the first study to comprehensively assess the effect of acute hyperglycemia on exercise performance. Our findings show that hyperglycemia in either basal or low insulin condition does not impair exercise performance as measured by a combination of maximal muscle power and strength, postural balance, and maximal aerobic capacity in recreationally active individuals with T1D.

Disclosure

K. Rothacker: None. S. Armstrong: None. G.J. Smith: None. N. Benjanuvatra: None. B.S. Lay: None. P.A. Fournier: None. P. Adolfsson: Advisory Panel; Self; Abbott, Eli Lilly and Company, Roche Diagnostics Corporation. Speaker's Bureau; Self; JDRF, Nordic Infucare, Rubin Medical. T. Jones: None. E.A. Davis: None.
Optimal Insulin Correction Factor (ICF) for Post-exercise Hyperglycemia following High-Intensity Training in Adults with Type 1 Diabetes (T1D)—The FIT Study
Authors: ARONSON RONNIE , BROWN RUTH E. , RIDDELL MICHAEL
Published: June 2018

The phenomenon of post-exercise hyperglycemia following high-intensity training (HIT) in T1D patients has led to debate of corrective therapy options but has not been definitively investigated to date. The FIT study was a randomized, cross-over investigation of 4 post-HIT bolus insulin correction strategies in patients with T1D. Patients with T1D (n=18) using multi-daily injections (MDI) were enrolled and underwent an 8-week insulin optimization period using insulin glargine 300 U/mL as their basal insulin. On 4 separate days, each subject performed 25 minutes of HIT. If hyperglycemia (>8.0 mmol/L) resulted, subjects received a bolus insulin correction 15 minutes post-HIT, based on their own ICF, adjusted by one of 4 commonly used multipliers: 0%, 50%, 100%, or 150%. At 180 minutes following bolus correction, change in plasma glucose (PG) was greatest in both the 100% (-4.7 mmol/L) and 150% (-5.3 mmol/L) ICF arms, vs. 50% (-2.3 mmol/L, p<.05) and 0% (+1.0 mmol/L, p<.05) (Figure). Percent time in euglycemia (4.0-8.0 mmol/L) progressively increased with each increasing correction factor. Hypoglycemia was rare and only seen in the 150% arm. In correction of post-exercise hyperglycemia following HIT, correction based on a patient’s usual ICF is safe and effective. Optimal BG reduction, with no hypoglycemia, occurred in the 100% ICF correction arm.

Disclosure

R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck & Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc.. R.E. Brown: None. M. Riddell: Speaker's Bureau; Self; Medtronic. Consultant; Self; Eli Lilly and Company, JAEB Center For Health Research, Xeris Pharmaceuticals, Inc.. Research Support; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; Zucara Theraputics. Other Relationship; Self; JDRF.
Provider Perspectives on Exercise in Children with Type 1 Diabetes
Authors: ILKOWITZ JENIECE , GALLAGHER MARY PAT
Published: June 2018

Background: The benefits of exercise for adults with type 1 diabetes (T1D) are well known but literature in children is limited creating knowledge deficits for pediatric providers and patients. The objective of this study was to determine provider awareness of guidelines, current practices and barriers to counseling during visits.

Methods: Members of the Pediatric Endocrine Society were asked to take an online survey including questions about provider demographics and perspectives on exercise counseling for children with T1D. Descriptive analyses were performed.

Results: A total of 80 providers completed the survey. The majority practice in an urban setting (69%) at academic medical centers (82%). Of respondents, 54% reported they were unaware of exercise guidelines from the American Diabetes Association (ADA) that suggest 60 minutes of exercise daily. Of those who reported awareness, 16 of 37 identified them correctly but only 7 of the 16 reported recommending them clinically. Most providers (40%) reported recommending at least 30 minutes of exercise 5 days per week. The majority reported exercise counseling should be a priority at all visits (55% strongly agree, 30% agree) and cited barriers to counseling were: presence of more pressing issues (76%) and lack of time (61%). Respondents reported cardiovascular health (85%), improved insulin sensitivity (68%) and weight control (56%) as the most important exercise benefits.

Conclusions: Pediatric endocrinologists report exercise counseling is important for patients with T1D but time barriers to counseling exist for the majority. Counseling tools that require less time during clinical visits may be beneficial to providers and patients. Also, even respondents who were aware of current guidelines reported recommending shorter periods of exercise. The reason for this discrepancy is unknown but it may reflect the desire to recommend more realistic goals. Further research about the benefits of shorter periods of exercise in this population is needed.

Disclosure

J. Ilkowitz: None. M. Gallagher: None.
Variability and Reproducibility in the Rise in Blood Glucose Levels in Response to High Intensity Interval Training (HIIT) in Type 1 Diabetes (T1D)—The FIT Reproducibility Study
Authors: RIDDELL MICHAEL , POONI RUBIN , BROWN RUTH E. , YAVELBERG LOREN , LI ZOEY , KOLLMAN CRAIG , ARONSON RONNIE
Published: June 2018

Hyperglycemia can occur when individuals with type 1 diabetes (T1D) perform high intensity interval training (HIIT). However, the reproducibility of the glycemic response to a HIIT session has not been definitively tested. Seventeen patients with T1D, all using insulin glargine 300 U/mL (Toujeo®) as basal insulin, were asked to perform four separate in clinic HIIT sessions in an overnight fasted state. HIIT consisted of two bouts of cycling at 90% peak power, separated by a series of ‘CrossFit’-type activities, spanned over a 25 min period (∼75-95% of maximal heart rate). Plasma glucose (YSI) was measured pre-exercise (-10 min) and at 5- and 15-min into the HIIT session, as well as at 5- and 15-min in recovery. A total of 64 HIIT sessions were compiled. Pre-exercise blood glucose levels were similar among the four HIIT visits (8.8 ± 1.0 mmol/L, mean SD), as were the rise in glucose levels in response to HIIT (+3.9 ± 1.6; +3.8 ± 1.8; +3.9 ± 2.3; +3.9 ± 1.5 mmol/L, in visits 1-4, respectively). In almost all occasions (63 of 64 sessions), HIIT produced a rise in glycemia, but the inter-individual responses did vary, ranging from -0.3 to +9.0 mmol/L. The change in glucose during HIIT was not influenced by the baseline glucose concentration and was predictable within an individual based on the measured response in visit 1 (composite correlation with post-exercise glucose rise among the four visits was 0.56 [0.33-0.79, 95% CI]). Following HIIT, there appears to be a consistent increase from the pre-exercise glucose concentration in patients living with T1D and the degree of response is moderately reproducible within a given patient. Individualized insulin correction strategies, which take into account the rise in glucose observed and the patient’s sensitivity to insulin, may be helpful in restoring glucose control after HIIT in patients living with T1D.

Disclosure

M. Riddell: Speaker's Bureau; Self; Medtronic. Consultant; Self; Eli Lilly and Company, JAEB Center For Health Research, Xeris Pharmaceuticals, Inc.. Research Support; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; Zucara Theraputics. Other Relationship; Self; JDRF. R. Pooni: None. R.E. Brown: None. L. Yavelberg: None. Z. Li: None. C. Kollman: Research Support; Self; JDRF, Bigfoot Biomedical, Dexcom, Inc., Tandem Diabetes Care, Inc., Medtronic MiniMed, Inc., Helmsley Charitable Trust. R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck & Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc..
Short Sprints during Exercise Reduce Exercise-Mediated Hypoglycaemia in Type 1 Diabetes in a Real-Life Setting
Authors: CHETTY TARINI , ROBY HEATHER , PARAMALINGAM NIRUBASINI , DART JULIE , SOON WAYNE , SMITH GRANT J. , SHETTY VINUTHA B. , FOURNIER PAUL A. , JONES TIM , DAVIS ELIZABETH A.
Published: June 2018

Background: Short sprints have been shown to prevent exercise induced hypoglycaemia in controlled laboratory settings. Using a randomised controlled study design, we tested the hypothesis that incorporating sprinting into moderate intensity exercise can reduce the incidence of exercise mediated hypoglycaemia in individuals with T1D in a real-life setting.

Methods: Individuals with T1D, diagnosed for >1 year, aged 14-35 years, with an HbA1c of ≤9% were recruited into a prospective randomised controlled cross over study. Participants completed three 14-day periods in random order. In one period participants adhered to their usual exercise management (control period), in the other 2 periods, participants additionally incorporated 10s (every 20 mins) or 4s sprints (every 2 mins) into moderate intensity exercise. Outcome measures included the incidence of hypoglycaemia (defined as sensor glucose readings <3.1mmol/L for ≥ to 20 minutes) over the 14-day period; and percent time spent <3.1mmol/L and <3.5mmol/L. CGM data were analysed using a mixed model approach.

Results: 24 participants completed the study, performing a total of 420 exercise episodes. The 10s period was associated with fewer hypoglycaemia events (<3.1mmol/L) than the control period (adjusted incidence rate ratio of 0.67, 95% CI 0.46-0.98: p=0.04), with a hypoglycaemia incidence rate of 0.40 (95% CI 0.26-0.55), 0.33 (95% CI 0.21-0.45) and 0.28 (95% CI 0.17-0.38) events per day in the control, 4s and 10s periods respectively. The 10s period was associated with a reduction in time spent <3.5mmol/L (control vs. 10s period, 3.1% vs. 2.1%, p=0.03) and time spent <3.1mmol/L (control vs.10s period, 1.9% vs. 1.2%, p= 0.03) compared to the control period. There was no increase in nocturnal hypoglycaemia during the sprinting periods.

Conclusion: In a real-life setting the inclusion of 10s sprints into moderate intensity exercise reduces the incidence of hypoglycaemia, without increasing the risk of nocturnal hypoglycaemia.

Disclosure

T. Chetty: None. H. Roby: None. N. Paramalingam: None. J. Dart: None. W. Soon: None. G.J. Smith: None. V.B. Shetty: None. P.A. Fournier: None. T. Jones: None. E.A. Davis: None.
Real-World Flash Glucose Monitoring in a Developing Country
Authors: CALLIARI LUIS EDUARDO P. , XU YONGJIN , JANGAM SUJIT , HAYTER GARY , DUNN TIMOTHY
Published: June 2018

Previous studies showed results of flash glucose monitoring (FreeStyle LibreTM) in European countries. This study evaluated real-world impact of device use and glucose metrics using a cross-sectional observational design in a developing country - Brazil. A server collected de-identified data from readers, and completed sensors (>120 hours of operation) were analysed. Comparison of 1,569,588 sensors (237,747 readers) worldwide were made with 57,713 sensors (8,979 readers) from Brazil. Readers were divided into 10 rank-ordered groups by daily scan rate. Users worldwide performed a mean (±SD) of 13.2±8.9 daily glucose scans and a rate of 13.5±9.1/day in Brazil (p=0.002). Time in range (70-180 mg/dL) increased from 13.5 to 16.2 h/day (20% increase, p<0.001) comparing the lowest and highest scan groups in Brazil, with a similar association worldwide (12.0 to 16.3 h/day; 35% increase; p<0.001). Time in hyperglycemia decreased from 10.6 to 6.4 h/day (40% decrease, p<0.001) comparing low with high frequency users worldwide. Brazil users had a similar decrease, though the lowest scan group was 90-minutes lower (9.2 and 6.4 h/day; 30% decrease; p<0.001). Similar daily scan rates were observed in Brazil and worldwide, and those users having the highest daily scans also had the most time in range and least time in hyperglycemia. This is the first study showing that a developing country in Latin America can also benefit from flash glucose monitoring.

Disclosure

L.P. Calliari: Board Member; Self; Abbott. Speaker's Bureau; Self; Novo Nordisk Inc.. Board Member; Self; Sanofi. Speaker's Bureau; Self; Medtronic, Roche Diagnostics Corporation. Board Member; Self; Eli Lilly and Company. Y. Xu: Employee; Self; Abbott. S. Jangam: Employee; Self; Abbott. G. Hayter: Employee; Self; Abbott. T. Dunn: Employee; Self; Abbott.
Predicting Exercise-Related Changes in Glucose in People with Type 1 Diabetes Using Linear Models and Incorporating Knowledge of Prior Exercise
Authors: TYLER NICHOLE S. , REDDY RAVI , EL YOUSSEF JOSEPH , CASTLE JESSICA R. , JACOBS PETER G.
Published: June 2018

Exercise-related hypoglycemia in T1D is frequent and can be life-threatening. The ability to predict glucose changes at the start of exercise could significantly improve exercise outcomes for people with T1D. We developed multivariate adaptive regression splines (MARS) to predict changes to blood glucose dynamics and to assess whether including past glucose changes during exercise improves prediction accuracy. Data was collected from 20 adults during a 4-arm, 4-day, outpatient artificial pancreas (AP) study (14 F, weight: 76.3 ±14.6 kg, age: 35.2 ± 4.6 years, height: 172.0 ± 10.6 cm). Days 1 and 4 of the study consisted of identical controlled meals and aerobic exercise events at an academic medical center. Insulin delivery data, heart rate, continuous glucose measurement (CGM) data, and carbohydrate intake were recorded. Subjects exercised at 60% of their maximal VO2 for 45 minutes. Using the 160 aerobic exercise sessions, 2 linear predictive models were developed to estimate glucose drop during exercise: (1) a model excluding past exercise history (naïve), and (2) a model including past exercise (historical). A greedy approach was used to eliminate non-predictive features and build sparse models consisting of CGM at the start of exercise, the rate of change of CGM within 5 minutes of exercise, the metabolic expenditure 5 minutes into exercise, and participant height. Leave-one-out cross validation was done to fit the model and estimate root-mean squared error (RMSE). R2 was calculated between empirical and predicted glucose drops. The naïve model was able to predict glucose drop to within 18.7 mg/dL. Including historical exercise data improved accuracy and increased R2 only nominally (naïve R2=0.78, RMSE=18.7, historical R2= 0.81, RMSE=17.54). Results demonstrate prediction accuracy of linear models in estimating exercise-related glucose changes with moderate improvement by including prior exercise data.

Disclosure

N.S. Tyler: None. R. Reddy: None. J. El Youssef: None. J.R. Castle: Consultant; Self; Zealand Pharma A/S. Advisory Panel; Self; Novo Nordisk Inc. P.G. Jacobs: Stock/Shareholder; Self; Pacific Diabetes Technologies.