bluuebunny/crossref_metadata_2025 huggingface dataset:
58-OR: Screening for Diabetic Retinopathy Increases by 32% with Education and Intervention Program in Primary Care
Authors: SIMON LESLEY , BEALS DEAN , POGROSZEWSKI STAN J. , DEERR RACHEL , HAIMOWITZ STEVEN , HERMANSEN CHRISTIAN
Published: June 2024

Introduction: Despite recommendations by the ADA and other medical societies, screening for diabetic retinopathy (DR) is suboptimal. We introduced an initiative at Penn Medicine Lancaster General Health (LGH) that included education of primary care providers (PCPs) and their patients with diabetes and installation of tele-retinal imaging service at the LGH PCP’s office.

Methods: PCPs at LGH and nationally were invited to participate in an online education program to reinforce knowledge of DR risk factors, screening recommendations, and treatments. Simultaneously, an order set for all patients with T2D presenting to the clinic was added to the EMR and retinal cameras fitted with technology for remote reading by retina specialists were installed in 34 LGH PCP clinics where staff was instructed on the use of these cameras and advised to recommend screening for patients with diabetes who did not have a diagnosis of retinopathy and were not screened in the past two years. Designated referral coordinators were assigned in each office to facilitate referrals to retina specialists when indicated by the reading retina specialist.

Results: Screening for DR increased by 32%, from 37.7% to 50.1%, with greater increases in people who were Hispanic (75.2% vs 25.6% for non-Hispanic), younger (55.6% for 18-54 yrs vs 21.4% for > 77 yrs), and with lowest and highest initial A1C (38.5% and 38.7% vs 25.3% for <6.3, >8.4, and 6.9-7.4, respectively). Overall, 760 people were screened with the camera; DR was identified in 40.1%, with other abnormalities (eg, glaucoma) identified in additional 12%. Inadequate images were captured in 19%. In addition, PCP knowledge increased significantly by 40%.

Conclusion: Installation of cameras equipped with technology to securely send images to retina specialists, along with patient and clinician education, enabled patients with diabetes to undergo guideline-recommended screening in the office of their PCP, overcoming barriers to care.

Disclosure

L. Simon: None. D. Beals: None. S.J. Pogroszewski: None. R. Deerr: None. S. haimowitz: None. C. Hermansen: None.

Funding

Regeneron Pharmaceuticals, Inc
583-P: Perspectives on Stringent Glycemic Control and Weight Loss among People with Type 2 Diabetes Mellitus (T2DM) in China
Authors: ZHANG JIAN , LI ANG , QUAN JINXING , WU JUN , CAI HANQING , DING YUCHEN , TANG JIANI , MA XIAO , ZHANG JUNQING
Published: June 2024

Introduction & Objective: While current guidelines for T2DM emphasize the importance of achieving glycemic control and weight management goals, it’s worth noting that the perspectives of people with T2DM (PWD) on achieving these goals remain unclear in China. This study aims to describe demographics and clinical experiences of PWD in China and to understand their perspectives on stringent glycemic control (HbA1c ≤ 6.5%) and weight loss (≥ 10%).

Methods: This cross-sectional mobile web survey was conducted in a representative sample of PWD across China from July to August 2023. Participants aged ≥ 18 years with diagnosed T2DM and aware of their latest HbA1c within past 6 months were enrolled as the study sample. Descriptive statistics were performed.

Results: The study sample comprised of 495 participants with the mean (SD) age 58.02 (12.44) years and the majority being male (60.20%), overweight/obese (56.37%) and having the latest HbA1c > 6.5% (71.31%). This sample indicated that achieving stringent glycemic control would be extremely (82.83%) or moderately (12.12%) important. Most of the study sample (90.10%) perceived achieving stringent glycemic control could bring positive impact to physical health. More than half of the sample (62.83%) perceived ≥ 10% weight loss as beneficial or neutral. Out of 231 participants who perceived beneficial, 117 (50.65%) and 84 (36.36%) indicated that ≥ 10% weight loss was extremely or moderately important, respectively. Moreover, around 70% of the study sample preferred treatments with higher rates of achieving both stringent glycemic control and weight loss, when safety profiles were similar.

Conclusion: This study underscored that the majority of PWD recognized paramount importance of stringent glycemic control and weight loss in China. Their treatment preferences, which reflected their perceptions, may have implications for decision-making of diabetes treatments in clinical practice.

Disclosure

J. Zhang: None. A. Li: None. J. Quan: None. J. Wu: None. H. Cai: None. Y. Ding: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. J. Tang: Employee; Lilly Diabetes. X. Ma: Employee; Eli Lilly and Company. J. Zhang: None.

Funding

Eli Lilly and Company, Shanghai, China
588-P: Knowledge and Attitudes about Diabetes in San Antonio Based on Educational Attainment
Authors: GEDALA AARAV , MADAN SHREYA , VENKATESH ARUNA
Published: June 2024

Introduction & Objective:A previous study aimed to assess the awareness levels of diabetes risk factors and complications within the San Antonio population. Now, using the same data, we aimed to stratify the data based on educational attainment to determine whether or not there is a correlation between educational attainment and awareness levels of diabetes risk factors and complications within the Bexar County population.

Methods: The previous study conducted a community-based study by administering surveys to individuals outside retail stores such as HEB and Walmart and at a health fair where participants received complimentary health check-ups. Direct emails to complete the survey were also sent.

Results: A total of 273 individuals were included in the survey, of whom 33.3% had a college degree as their highest level of education, 24.2% had a professional degree, 26.4% had a high school degree, and 16.1% had a high school diploma. When asked about the prevalence of diabetes in the San Antonio community, there was a definite correlation between educational attainment and knowledge about the prevalence of diabetes in San Antonio-44.4% of those with a professional degree were able to correctly identify that less than 25% of the San Antonio population had diabetes, while this statistic was 38.5% for those with associates, 30.5% for those with a college degree, and 25.5% for those with a high school diploma. However, this is not a perfect correlation as those with an associate degree were more accurate than those with college degrees. There was also a direct correlation between educational attainment and preventability perception in San Antonio, as 75% of those with a professional degree knew that diabetes could be prevented, as opposed to those with a high school diploma (64.8%).

Conclusion:Higher education correlates with increased diabetes knowledge in San Antonio. Further research should consider geographic location to identify awareness patterns.

Disclosure

A. Gedala: None. S. Madan: None. A. Venkatesh: None.
589-P: Diabetes Training for Deaf and Hard-of-Hearing Community Health Workers
Authors: LITCHMAN MICHELLE L. , MIRUS KARISSA A. , LEE SHINDUK , ALLEN NANCY A.
Published: June 2024

Introduction & Objective: Deaf Diabetes Can Together (DDCT) is a diabetes self-management education and support intervention for individuals who communicate using American Sign Language (ASL). The Deaf and hard of hearing (DHH) community indicated the need for DHH Community Health Workers (CHW) to co-deliver DDCT. The purpose of this pilot was to describe an adapted CHW training for DHH and its feasibility.

Methods: Participants were those who had previously completed DDCT and self-identified interest in becoming a CHW (N=3). The CHW training included eleven 2-hour sessions, during which CHWs trainees watched the videos together on zoom with 2 rotating ASL interpreters. Existing CHW training videos were adapted by adding closed captioning as appropriate. Concurrently, participants had their training videos running on a personal computer. Quizzes were signed in ASL and completed individually. CHW trainees were asked to evaluate the training via interview.

Results: Participants completed the CHW training in 22 hours, longer than the standard CHW training lasting 11-14 hours, due to deaf culture adaptations. According to participants, helpful components included diabetes-specialty nurse practitioners in attendance to clarify content and downloadable resources. One complaint was that despite the videos having closed captioning added, the font size was too small to be accessible. Automated captions on Zoom were needed for size, but not 100% accurate.

Conclusions: Despite the pilot nature of the study, completion of the 22 hours of planned training by three DHH trainees showed the feasibility of the CHW training in this population. Adaptations were needed to make the CHW training more accessible for trainees who communicate in ASL. Solely adding closed captioning would not meet the needs of people who primarily communicate using ASL. Diabetes CHW trainings should be delivered in ASL for more effective communication and additional time to ensure DHH culture-appropriate communication and learning experiences.

Disclosure

M.L. Litchman: Research Support; American Diabetes Association, Association of Diabetes Care & Education Specialists, Dexcom, Inc. Other Relationship; Association of Diabetes Care & Education Specialists. Research Support; National Institutes of Health. K.A. Mirus: None. S. Lee: Research Support; Olera, Clairvoyant Network, Inc. N.A. Allen: Research Support; Dexcom, Inc. Consultant; Diathrive Health.

Funding

American Diabetes Association (11-22-ICTSHD-06 )
598-P: Sex-Specific Differences of Human Skeletal Muscle—A Multiomics Exercise Study
Authors: DREHER SIMON I. , GOJ THOMAS , VON TOERNE CHRISTINE , HOENE MIRIAM , IRMLER MARTIN , OUNI MERIEM , JÄHNERT MARKUS , BECKERS JOHANNES , PETER ANDREAS , BIRKENFELD ANDREAS L. , SCHÜRMANN ANNETTE , HAUCK STEFANIE M. , WEIGERT CORA
Published: June 2024

Exercise is a potent skeletal muscle stimulus and one of the most effective strategies to prevent muscle loss and type 2 diabetes. Biological sex-based differences are reported for aerobic capacity, muscle mass, and exercise performance. We aimed to provide a yet missing comprehensive picture of molecular differences between female and male skeletal muscle at baseline, after acute exercise and training. Further we investigated which differences were conserved in vitro. We characterized muscle biopsies from 25 (16f/9m) subjects in a multi-omics approach employing epigenomics, transcriptomics and proteomics at baseline, after acute exercise and 8 weeks of supervised endurance training. Donor matched myoblasts and myotubes were analyzed in vitro. We found differential CpG-site methylation in 16.012 genes, 1.366 differentially expressed genes and 120 proteins at baseline. Differential transcripts were associated with translational regulation, histone methylation, glucose homeostasis and insulin signaling. Type-2 fast-twitch fiber-type proteins were elevated in males, along with proteins regulating glycolysis. Y-linked transcript expression was conserved in vitro, but only a few differences in expression of autosomal genes, e.g. elevated LDHB in females. Acute exercise upregulated oxidative stress-responsive transcripts predominantly in males. After 8-week-training, both sexes had upregulated mitochondrial proteins involved in substrate oxidation and ATP production, while glycolytic fiber marker MYH1 and MYH3 were only reduced in males. Thus, sex specific differences exist in resting skeletal muscle and in exercise adaptation on epigenomic, transcriptomic and proteomic level. The few conserved differences in vitro hint towards hormonal or yet undefined mechanisms. Training might mitigate initially differential responses to exercise. The question remains whether there are sex specific differences within individual fiber-types or whether it is just a matter of composition.

Disclosure

S.I. Dreher: None. T. Goj: None. C. von Toerne: None. M. Hoene: None. M. Irmler: None. M. Ouni: None. M. Jähnert: None. J. Beckers: None. A. Peter: None. A.L. Birkenfeld: None. A. Schürmann: None. S.M. Hauck: None. C. Weigert: None.
599-P: Automated Insulin Delivery Systems and Physical Activity—Management and Outcomes
Authors: MOLVEAU JOSÉPHINE , RUSSON CATHERINE L. , BOUDREAU VALERIE , NGUYEN ELISABETH , HEYMAN ELSA , YARDLEY JANE E. , RABASA-LHORET RÉMI P.R.
Published: June 2024

Introduction: Physical activity (PA), along with insulin adjustments and food intake for its purpose, can cause dysglycemia for people with type 1 diabetes (PWT1D), acting as a major barrier to activity. It is unclear if automated insulin delivery (AID) systems improve this situation.

Methods: Observational study in real-life conditions to assess time in, below or above range (TIR, TBR [< 70mg/dl], TAR [> 180 mg/dl]) and glucose variability (CV%) during PA, 1-h post-, 4-h post-PA compared to non-PA periods with continuous glucose monitors. Participants also completed a PA log for 6 weeks including PA type (continuous, intermittent or resistance) and duration. Data were analyzed using a mixed model with Bonferroni correction for post-hoc comparisons.

Results: We enrolled 22 PWT1D using AID (8 males, age: 48.7 ± 13.2 years, A1c: 6.7 ± 0.5%). Participants recorded a total of 339 PA sessions (mean 15 ± 13 [5 - 64]; 251 continuous, 59 intermittent, 29 resistance) lasting 60.9 ± 55.6 min (10 - 430 min). We found no significant effect of PA type on TIR, TBR, TAR or CV during, 1-h post or 4-h post PA. TBR as well as TAR during, 1-h and 4-h PA were comparable to non-PA periods. CV was higher in non-PA periods. All values for TBR, TAR and CV remained within optimal recommended ranges (Table).

Conclusion: PWT1D using AID successfully manage PA. Respective roles of AID algorithm and adaptive behaviors need to be investigated on a larger sample size.

Disclosure

J. Molveau: None. C.L. Russon: None. V. Boudreau: None. E. Nguyen: None. E. Heyman: None. J.E. Yardley: Speaker's Bureau; Dexcom, Inc. Research Support; LifeScan Diabetes Institute. R.P.R. Rabasa-Lhoret: Other Relationship; Abbott, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Dexcom, Inc. Research Support; Diabetes Canada. Other Relationship; Eli Lilly and Company. Research Support; Cystic Fibrosis Canada, Canadian Institutes of Health Research, FFRD - Fondation Francophone pour la Recherche du Diabète. Other Relationship; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Other Relationship; Novo Nordisk, GlaxoSmithKline plc. Consultant; HLS Therapeutics Inc., Insulet Corporation. Speaker's Bureau; CPD Networks. Other Relationship; Medtronic. Consultant; Pfizer Inc. Speaker's Bureau; Tandem Diabetes Care, Inc. Other Relationship; Sanofi. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; SFD - Société Francophone du Diabète.

Funding

Diabetes Canada (OG-3-21-5586-RR)
622-P: Carbohydrate Counting and Bolus Calculator Mobile-Based Application in Adults with Type 1 Diabetes Mellitus—A Randomised Controlled Study
Authors: ALBABTAIN SARA , ALAFIF NORA , ALMEHTHEL MOHAMMED , ALZAHRANI SAAD H.
Published: June 2024

Introduction & Objective: Carbohydrates counting is crucial for proper glycaemic control of Type 1 diabetes mellitus (T1DM). We aimed to study the usefulness and safety of a mobile application (app) for Carbohydrates counting and bolus calculation (CHOC/BC) developed at King Fahad medical city, Riyadh.

Methods: The study included 127 subjects (63 controls) with T1DM using multiple daily insulin injections. Subjects were randomised to either use CHOC/BC app or continue using conventional nutritional management. Patients were taught about Carb counting and using the app in the first visit by a trained nutritionist and remotely followed every two weeks. Insulin sensitivity factor, Carbohydrates ratio and glucose target were calculated for each subject separately. Three months glucose data were recorded using Ambulatory glucose profile.

Results: The mean age of subjects was (mean±SD) 26.7±4.8 (39.1% males) and controls 26.6±6.5 years (54% males). Subjects on CHOC/BC app had better time in range compared to controls 51.2±11.6 vs 46.2±13.0% p=0.02 respectively, that is mainly driven by an improvement of Time above 250 mg/dl 17.3±11.6 vs 24.1±15.7% respectively p=0.002. Average glucose was better in app users 179.2±27.9 vs 191.7±35.8 mg/dl p=0.03. Glucose variability assessed by coefficient of variation was better in app users 39.8±5.5 vs 41.9±5.8 p=0.045. Time below range was not statistically different between the two groups 3.6±3.0 vs 3.8±2.4 % p=0.3. Furthermore, the CHOC/BC users didn’t gain significant weight compared to controls 67.3±15.1 vs 68.6±14.3 kg respectively p=0.6. HbA1c was not different between both groups 7.93±0.8 vs 8.15±1.0% respectively p=0.1.

Conclusions: CHOC/BC application was associated with better control of glucose and lower glucose variability without increased risk of hypoglycaemia or weight gain.

Disclosure

S. Albabtain: None. N. Alafif: None. M. Almehthel: None. S.H. Alzahrani: None.

Funding

King Fahad medical city, research centre
626-P: Insulin Dosing Strategies Surrounding Food Intake among Older Adults with Type 1 Diabetes (T1D)
Authors: KAHKOSKA ANNA , SPRINKLES JESSICA , GOPISETTY NIKHITA R. , ERCOLINO GABRIELLA , MUTHUKKUMAR RASHMI , QU XIAORUI , FRUIK ANGELA , MAYER-DAVIS ELIZABETH J. , CRISTELLO SARTEAU ANGELICA
Published: June 2024

Introduction & Objective: T1D management evolves over the lifespan, as the risk for hypoglycemia increases. Data are limited to guide diabetes education and nutrition in older adults. Our objective was to assess strategies employed by older adults with T1D employ to accurately dose insulin surrounding food intake.

Methods: We administered a one-time electronic survey (Sept - Nov 2023) to capture dietary beliefs and practices among older adults (≥65 years) with T1D receiving care in a university-affiliated hospital system. We analyzed responses using descriptive statistics. We extracted clinical data from the EHR.

Results: Data from 77 older adults were analyzed [45.5% male, 93.5% non-Hispanic White; mean age 71.3±4.1 yrs; mean diabetes duration 33.5±18.1yrs; mean HbA1c 6.8±1.1; mean BMI 27.3±4.70]. Most older adults endorsed counting carbohydrates (CHO), checking glucose before eating, and eating in approximately the same way every day, while few endorsed using CHO exchanges, phone apps, or following a pre-specified meal plan. Education, sex, and age were associated with several strategies; mean HbA1c and BMI were significantly higher among those who did not count CHO (Figure).

Conclusion: Older adults with T1D utilize varying strategies to dose insulin. Understanding factors underlying preferences may enable better matching of adults with acceptable and effective methods for managing T1D and diet.

Disclosure

A. Kahkoska: None. J. Sprinkles: None. N.R. Gopisetty: None. G. Ercolino: None. R. Muthukkumar: None. X. Qu: None. A. Fruik: None. E.J. Mayer-Davis: None. A. Cristello Sarteau: None.

Funding

National Center for Advancing Translational Sciences, National Institutes of Health (K12TR004416)
628-P: Receipt and Perceived Importance of Nutrition Counseling among Older Adults with Type 1 Diabetes (T1D)
Authors: KAHKOSKA ANNA , SPRINKLES JESSICA , GOPISETTY NIKHITA R. , ERCOLINO GABRIELLA , MUTHUKKUMAR RASHMI , QU XIAORUI , YOUNG LAURA A. , MAYER-DAVIS ELIZABETH J. , FRUIK ANGELA , CRISTELLO SARTEAU ANGELICA
Published: June 2024

Introduction & Objective: Dietetics guidelines recommend adults with T1D are referred to nutrition counseling for individualization of an eating plan. We characterized the extent to which older adults receive nutrition counseling and how important they perceive it to be.

Methods: Adults (≥65 yrs) with T1D receiving care in a university-affiliated hospital system completed a one-time electronic survey (Sept- Nov 2023). Respondents reported history of nutrition education/counseling and perceived importance on a scale of 1-10 (low -> high) and provided suggestions to support nutrition among older adults with T1D.

Results: Data from 77 older adults were analyzed (45.5% male, 93.5% non-Hispanic White; mean age 71.3±4.1 yrs; diabetes duration 33.5 ± 18.1 yrs; HbA1c 6.8 ± 1.1%). The range of most recent nutrition counseling varied (Figure). The perceived importance was rated ≤5/10 by 67.9% of respondents and was highest among those with higher BMI and more disordered eating behaviors (DEPS-R score), with no differences by age, gender, disease duration, or HbA1c. Free responses underscored the need for easy and specific meal suggestions, to account for age-related difficulties, and increased peer support.

Conclusion: There are opportunities to increase awareness for and utilization of evidence-based nutrition counseling for older adults with T1D, incorporating age-relevant guidance and peer support.

Disclosure

A. Kahkoska: None. J. Sprinkles: None. N.R. Gopisetty: None. G. Ercolino: None. R. Muthukkumar: None. X. Qu: None. L.A. Young: Research Support; Novo Nordisk, Eli Lilly and Company, vTv Therapeutics, Beta Bionics, Inc., Corcept Therapeutics, Rhythm Pharmaceuticals, Inc., Bayer Inc., Jaeb Center for Health Research. E.J. Mayer-Davis: None. A. Fruik: None. A. Cristello Sarteau: None.

Funding

National Institutes of Health (DK056350); National Center for Advancing Translational Sciences, National Institutes of Health (K12TR004416)
633-P: Insight to the Association between Serum Fibroblast Growth Factor 23 Levels and Presarcopenia in Nondiabetic Individuals—A Longitudinal Cohort Study
Authors: XU YITING , HU TINGTING , SHEN YUN , WANG YUFEI , MA XIAOJING , BAO YUQIAN
Published: June 2024

Introduction & Objective: Pre-sarcopenia, characterized by early signs of muscle wasting and weakness, represents a critical stage for intervention and prevention strategies. While pre-sarcopenia is commonly observed in adults with diabetes, there is growing interests in understanding its occurrence in nondiabetic individuals. This study was aimed to identify a predictive biomarker of pre-sarcopenia in nondiabetic individuals.

Methods: This study included 1243 adults (Men 51.5%, median age: 58 [53-62] years) without baseline diabetes from 2013-2014. The follow-up assessment was conducted in 2015-2016. Participants underwent serum FGF23 measurement at baseline and follow-up visit. Serum FGF23 levels were determined using a sandwich enzyme-linked immunosorbent assay. Skeletal muscle mass was estimated by bioelectrical impedance analysis and converted to skeletal muscle index (SMI) adjusted for body weight. Pre-sarcopenia was defined as SMI less than 1 SD of the sex-specific mean for a young reference group. The glycemic status was defined according to the American Diabetes Association 2023 guideline.

Results: Serum FGF23 levels were significantly higher in participants with baseline pre-sarcopenia than those without (P = 0.001). During an average follow-up of 2.1 years, pre-sarcopenia occurred in 57 (5.3%) participants without baseline pre-sarcopenia. Multivariate Logistic regression model showed that, compared with lowest tertile of baseline FGF23, the highest tertile was associated with an elevated risk of incident pre-sarcopenia (HR 2.69, 95%CI 1.33-5.73). Further stratified by glycemic status, the predictive ability of serum FGF23 on pre-sarcopenia was more predominant in those with prediabetes.

Conclusion: Serum FGF23 levels may be a promising clinical marker for pre-sarcopenia in nondiabetic individuals, especially those with prediabetes.

Disclosure

Y. Xu: None. T. Hu: None. Y. Shen: None. Y. Wang: None. X. Ma: None. Y. Bao: None.
634-P: Effects of 72-Hour Induction Fast on Participants with Type 2 Diabetes Mellitus Participating in Early Time-Restricted Eating Plan
Authors: NIJJAR AVNEET , SHAIKH KANNAN , CALINAWAN TESS L. , MALDONADO ITZEL , MARIE JONES GRACE , SHUBROOK JAY H.
Published: June 2024

There continues to be debate about optimal eating times and patterns for weight management and glycemic control in people with T2D. Intermittent fasting or early time-restricted eating (eTRE) has succeeded in clinical trials and gained popularity. The impact of a 72 - hour induction fast is a novel approach to amplify the benefits of eTRE in type 2 diabetes.The aim of this study is to determine the effects of 72 - hour induction fast on T2D patients undergoing 3 months of eTRE.In this single cohort experimental study, participants were randomized into either an initial 72 - hour induction fast group or a non-induction fast group. Both groups underwent an 8 - hour feeding window (8 AM to 4 PM) and a 16 - hour fasting window daily for 3 months.Participants were recruited from a network of healthcare centers of FQHC and were required to have a T2D diagnosis and diabetes medication therapy. A total of 17 participants enrolled with 11 completing the study. Key exclusion criteria included recent AKI or DKA. At baseline and 12 - weeks blood draws were performed to analyze glycemic and lipid profiles, and anthropometrics, number of medications, and blood pressure were measured.Paired t-tests showed there were no significant differences in results between the two groups. Induction Fast + eTRE group (n = 4), the pre - and post - data mean, respectively were A1c (7.9% vs 7.7%, p = 0.7), weight (265 vs 259 lbs., p = 0.09), BMI (37.8 vs 37.1, p = 0.12), & systolic bp (123 vs 112 mmHg, p = 0.05). For the non-Induction Fast + eTRE group (n = 7), the pre- and post-data mean, respectively were A1c (7.6% vs 7.7%, p = 0.69), weight (231 vs 227 lbs., p = 0.01), BMI (36 vs 33, p = 0.03), & systolic bp (122 vs 118, p = 0.46).This pilot study demonstrates that a 72 - hour Induction Fast resulted in a significant reduction in blood pressure whereas eTRE alone showed significant reductions in weight and BMI. Further planned analysis of blood chemistries may illustrate the additional benefits of a 72 - hour Induction Fast on eTRE.

Disclosure

A. Nijjar: None. K. Shaikh: None. T.L. Calinawan: None. I. Maldonado: None. G. Jones: None. J.H. Shubrook: Consultant; Abbott Diagnostics. Advisory Panel; Bayer Inc., Eli Lilly and Company, Madrigal Pharmaceuticals, Inc., Nevro Corp. Consultant; Novo Nordisk, Sanofi.
638-P: Feasibility of Using eButton for Dietary Management in Chinese Americans with Type 2 Diabetes
Authors: GREENLEE MICHAELA D. , WYLIE-ROSETT JUDITH , CHEN KEER , SUN MINGUI , WU BEI , ZWEIG SUSAN , JIA WENYAN , MELKUS GAIL D. , PAREKH NIYATI , ZHENG YAGUANG
Published: June 2024

Background & Objective: Chinese Americans are at a higher risk for type 2 diabetes (T2D) than other racial/ethnic groups despite having a lower body mass index. This population has challenges in dietary management that is key for glycemic control. Leveraging wearable sensors (e.g., eButton) is promising to overcome such challenges. We aimed to assess the feasibility of the eButton for dietary management among Chinese Americans, as its effectiveness in this group remains unknown.

Methods: Chinese Americans with T2D (N=11) participated in a one-group prospective study. They wore an eButton on their chest to record their 10-day meals over two weeks. This wearable device contains a digital camera that collects dietary intake data by automatically taking pictures every three seconds. The eButton pictures were used to determine food names, volumes, and nutrient value. Individual interviews were conducted after 2 weeks to discuss their experience. We used ATLAS.ti software to thematically analyze the interviews.

Results: Facilitators included the device’s ease of use, ability to make participants more mindful, and influence on increased sense of control. Being more conscious of food intake enabled participants to eat smaller portions. Barriers include subjects’ privacy concerns, having difficulty staging the camera for pictures, and needing a record of pictures to understand the trends in glucose spikes. Suggestions for future eButton designs were adding language translations, sending reminders to turn the camera off, and automatically detecting and saving pictures of meals.

Conclusions: Our findings suggest that it is feasible for Chinese Americans with T2D to use the eButton for dietary management. The practice of taking meal pictures improved their awareness of food portion sizes. Future studies are needed with adding certain features (e.g., saving pictures), larger sample sizes, and a longer duration of wearing to inform effective dietary management for Chinese Americans with T2D.

Disclosure

M.D. Greenlee: None. J. Wylie-Rosett: None. K. Chen: None. M. Sun: None. B. Wu: None. S. Zweig: None. W. Jia: None. G.D. Melkus: None. N. Parekh: None. Y. Zheng: None.

Funding

National Institutes of Health (Grant No: R56 DK113819 and R01 DK127310); NIH/NCATS (UL1TR001445); CTSI Collaborative Translational Pilot Project Award
650-P: Attitudes and Barriers to Implantable AID Solutions—Development of a New Assessment Tool
Authors: HERMANNS NORBERT , FINKE-GROENE KATHARINA , KULZER BERNHARD , EHRMANN DOMINIC
Published: June 2024

Major limitations of current automated insulin delivery (AID) systems are the subcutaneous insulin route and the need to wear devices on the body. The EU project “FORGETDIABETES” (supported by H2020-FETPROACT, n.951933) will develop a fully implantable AID systems to overcome these barriers. To assess attitudes and barriers to such an implantable solution, a new assessment tool was developed. A list of 19 items assessing different aspects of an implantable AID system were developed. In an online survey, 366 people with type 1 diabetes (27.0% insulin pen, 45.9% insulin pump, 27.0% AID) completed the item pool and answered questions about the expected reductions in diabetes distress and improvement in quality of life from such an implantable AID system. Factor analysis revealed 4 factors explaining 63.7% of the variance. Overall reliability was very high with Cronbach’s alpha (CR-a)=0.88. The factors were named “glycemic benefits” (e.g. protection from complications; 6 items, CR-a =0.85), “mental benefits” (e.g. less thinking about diabetes; 3 items, CR-a =0.81), “technical barriers” (e.g. complications during implantation; 3 items, CR-a =0.80), and “emotional barriers” (e.g. loss of control; 7 items, CR-a =0.86). Higher glycemic benefits and higher mental benefits were associated with higher expected reductions in diabetes distress (r=0.47, r=0.42) and quality of life (r=0.42, r=0.38) (all p<.01). Higher technical and emotional barriers were associated with lower expected reductions in diabetes distress (r=-0.35, r=-0.41) and quality of life (r=-0.34, r=-0.42) (all p<.01). There were no differences between therapy regimens, except for lower emotional barriers in AID users (p<.001). The new questionnaire is a reliable and valid tool to assess attitudes and barriers to implantable AID systems. It can be used to assess and consequently address human factors associated with use of implantable AID solutions.

Disclosure

N. Hermanns: Speaker's Bureau; Berlin-Chemie AG, Sanofi-Aventis Deutschland GmbH. Research Support; Sanofi-Aventis Deutschland GmbH. Speaker's Bureau; Roche Diabetes Care. Research Support; Roche Diabetes Care. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Abbott Diagnostics, Ypsomed AG. K. Finke-Groene: None. B. Kulzer: Advisory Panel; Abbott Diagnostics, Berlin-Chemie AG, Dexcom, Inc., Sanofi, embecta, Novo Nordisk, Roche Diabetes Care. Speaker's Bureau; Bayer Inc., Insulet Corporation, Lilly Diabetes. D. Ehrmann: Advisory Panel; Dexcom, Inc. Speaker's Bureau; Dexcom, Inc., Sanofi-Aventis Deutschland GmbH. Advisory Panel; Roche Diabetes Care. Speaker's Bureau; Roche Diabetes Care, Berlin-Chemie AG.

Funding

This project has received funding from the European Union's Horizon 2020 research and innovation programme (No 951933)
661-P: Exploring the Real-World Impact of Late-Day Glucose Spikes on Weight Loss in People without Diabetes
Authors: DIXON WILLIAM , LEVONIAN DMITRI , KIM STEPHANIE , FOULADGAR-MERCER SHARAM , TANCER BILL , GUSZ DAN
Published: June 2024

Background and Aims: Population-level distribution of various glucose spikes throughout the day for people without diabetes is a relatively under-researched domain. Enhanced insights at population-level as well as individual patterns in the timing of glucose spikes and their correlation with weight loss may shed light on behavior modifications that individuals may adopt to stimulate weight loss or pause / reverse weight gain.

Methods: As part of a larger study (in partnership with Dexcom), we analyzed the correlation patterns between participants' weight trajectories and the timing of their glucose spikes using data from more than 19,000 participants (median age: 46, 66% women, 76% overweight or obese) wearing a Dexcom G6 or G7 real-time CGM. Participants were also utilizing the Signos personalized program for weight management. We identify glucose spikes based on individual variability in CGM signals for each participant and will further review glucose spike definitions.

Results: Overall, the earlier the glucose spikes occurred during the day, the more weight loss that individual experienced. The pattern is observed at both population level and demographic cohort level, e.g. for gender, age, BMI cohorts. The earliest-spiking cohort (~20% of participants) started their latest glucose excursion before 4 pm, whereas the latest-spiking cohort (~20% of participants) started their spikes after 6:15 pm. The observed 180-day Total Body Weight Loss for the earliest-spiking cohort was twice more compared to the latest-spiking cohort (p-value < 0.01).

Conclusions: The observed data suggests that having glucose spikes earlier in the day (e.g. shifting heavier carb intake earlier in the day) is a positive behavior modification for weight management. Further research into time-based postprandial glucose excursion monitoring and the associated behavior modifications is needed.

Disclosure

W. Dixon: Employee; Signos. D. Levonian: Employee; Signos. S. Kim: None. S. Fouladgar-Mercer: Employee; Signos. B. Tancer: Employee; Signos. D. Gusz: Employee; Signos.
667-P: Disordered Eating Attitudes and Behaviors among Older Adults with Type 1 Diabetes (T1D)—An Exploratory Study
Authors: KAHKOSKA ANNA , ERCOLINO GABRIELLA , SPRINKLES JESSICA , GOPISETTY NIKHITA R. , FRUIK ANGELA , MUTHUKKUMAR RASHMI , QU XIAORUI , YOUNG LAURA A. , MAYER-DAVIS ELIZABETH J. , CRISTELLO SARTEAU ANGELICA
Published: June 2024

Introduction & Objective: Despite evidence associating T1D in young people with disordered eating attitudes and behaviors (DEBS), there is scarce evidence in the growing number of older adults with T1D. We explored the association of DEBS with demographic and clinical outcomes among older adults with T1D.

Methods: Adults 65+ years with T1D from a university-affiliated hospital system were recruited via clinical messaging, e-mail, and in-person to complete a one-time electronic survey (Sept-Nov 2023) that included the Diabetes Eating Problem Survey-Revised (DEPS-R)). Clinical data were collected from the EHR. Total DEPS-R scores were plotted against HbA1c and BMI.

Results: The DEPS-R was completed by 77 older adults (age 71.3 ± 4.1, 93.5% non-Hispanic White) with T1D (duration 33.5 ± 18.1). Mean (sd) HbA1c was 6.83 (1.12) and mean (sd) BMI was 27.3 (4.70). Mean DEPS-R Score was 11.5 (6.05), with 5.2% (n=4) classified as having clinically significant DEBs (DEPS-R score >20). We found a non-linear association between the DEPS-R score and BMI and HbA1c, with increasing DEPS-R score correlating with increasing HbA1c and BMI until DEPS-R score of 20 (Figure).

Conclusion: To our knowledge, this is the first study to explore DEBS in older adults with T1D using the DEPS-R. The relationships between scores and clinical outcomes suggest the instrument may confer construct validity in this age group.

Disclosure

A. Kahkoska: None. G. Ercolino: None. J. Sprinkles: None. N.R. Gopisetty: None. A. Fruik: None. R. Muthukkumar: None. X. Qu: None. L.A. Young: Research Support; Novo Nordisk, Eli Lilly and Company, vTv Therapeutics, Beta Bionics, Inc., Corcept Therapeutics, Rhythm Pharmaceuticals, Inc., Bayer Inc., Jaeb Center for Health Research. E.J. Mayer-Davis: None. A. Cristello Sarteau: None.

Funding

National Center for Advancing Translational Sciences, National Institutes of Health (K12TR004416)
668-P: Examining the Diabetes Management Questionnaire among Racially Minoritized Youth with Type 1 Diabetes
Authors: STRATON EMMA , WANG CHRISTINE H. , NAVEED MARIA S. , KANG LEYI , BARBER JOHN , PERKINS AMANDA G. , GALLANT LETITIA , MAJIDI SHIDEH , STREISAND RANDI
Published: June 2024

Introduction: Type 1 diabetes (T1D) racialized health inequities have resulted from centuries of racial oppression and discriminatory policies. Racially minoritized families report higher T1D adherence but worse HbA1c outcomes than non-Hispanic white families. The Diabetes Management Questionnaire (DMQ) is a measure of T1D adherence, normed in a primarily white, higher-class sample, where there were several demographic/medical correlates of the DMQ (see Table 1 Column C). We examined correlates of the DMQ in a racially minoritized sample.

Methods: Fifty-seven youth aged 10-15 years who reported <75% continuous glucose monitor (CGM) use and their caregivers completed the DMQ. Associations between variables were analyzed using correlations or t-tests (child and caregiver report; Column B).

Results: HbA1c was a measure of DMQ predictive validity in the original sample, but not in our sample (Column D).

Conclusion: Racialized health inequities contribute to differences between the two samples. The DMQ may have weaker psychometric properties in racially minoritized youth; factors due to structural racism e.g., racial residential segregation may be more germane to HbA1c than individual T1D management behaviors. The two samples also had different characteristics e.g., T1D technology use, HbA1c outcomes, caregiver education, insurance type, age, sampling methods/size, geographic locations.

Disclosure

E. Straton: None. C.H. Wang: None. M.S. Naveed: None. L. Kang: None. J. Barber: Stock/Shareholder; AbbVie Inc., Boston Scientific Corporation, UnitedHealth Group. A.G. Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. L. Gallant: None. S. Majidi: Other Relationship; Sanofi. R. Streisand: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK131026)
674-P: Information Overload following a Type 1 Diabetes Diagnosis—The Need for Ongoing Diabetes Education
Authors: FELDMAN MARISSA , GARZA KIMBERLY P. , HOWARD KELSEY R. , SMITH NICHOLAS DAVID W. , MILLMANN MEGAN M. , WEISSBERG-BENCHELL JILL
Published: June 2024

Introduction & Objective: A T1D diagnosis is unexpected and life-changing. We assessed families’ experiences following diagnosis, including initial responses and needs.

Methods: Focus groups with children (ages 8-12; n=10), teens (13+; n=11), and parents (under 8 years n=12; 8-12 years old n=15; 13+ n=12) explored feelings, challenges, and experiences of that first year. Using thematic analysis and deductive coding, data informed the development of a psychosocial intervention (Triple T) to support families during that first year via brief videos and scheduled telehealth visits with behavioral health specialists. Exit interviews (n= 17) were subsequently examined.

Results: Youth and parents reported the initial diagnosis and the education they received were overwhelming. Parents shared difficulties remembering everything and keeping track of the data. Anxiety around diabetes management and concerns about glycemic excursions, carbohydrate and insulin calculations, and injection frequency were raised. Most parents reported an expectation of perfection in glycemic outcomes. Frustrations were expressed that the education received was “textbook” versus “real life.” Results also suggest that families forgot initial educational topics, as many expressed a desire to learn about managing highs/lows and insulin dosing. These findings were supported by data from Triple T. While all families reported benefits in regular meetings with behavioral health specialists, they continued to express diabetes education needs regarding nutrition, glycemic variability, and technology.

Conclusions: An approach to education at diagnosis that promotes the integration of knowledge and provides families with increased psychosocial support and reassurance is needed. Providing a review of basic education soon after discharge and scheduling check-ins with educators independent of clinic visits may help ensure that families are able to digest pertinent education and use it in everyday practice.

Disclosure

M. Feldman: None. K.P. Garza: None. K.R. Howard: Stock/Shareholder; Abbott, AbbVie Inc. N.W. Smith: None. M.M. Millmann: None. J. Weissberg-Benchell: Consultant; Beta Bionics, Inc. Advisory Panel; American Diabetes Association. Research Support; Juvenile Diabetes Research Foundation (JDRF), National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

Juvenile Diabetes Research Foundation (2-SRA-2020-985-S-B)
681-P: Demographic and Medical Correlates of Caregiver Reported Benefits and Burdens of Continuous Glucose Monitor (CGM) Use among Racially Minoritized Youth with Type 1 Diabetes (T1D)
Authors: VEMULAKONDA MADHU , STRATON EMMA , WANG CHRISTINE H. , BARBER JOHN , GALLANT LETITIA , KANG LEYI , MAJIDI SHIDEH , PERKINS AMANDA G. , STREISAND RANDI
Published: June 2024

Introduction: Due to racialized health inequities in T1D research and technology distribution, little is known about T1D technology experiences in racially minoritized youth and their caregivers. This study examines demographic and medical correlates of CGM benefits/burdens among racially minoritized families.

Methods: Fifty-seven youth aged 10-15 (Mage=12.9 ± 1.7 years, 58% male, 42% female, MT1D Duration=5.2 ± 3.4 years, MHbA1c=10.6 ± 2.0%, MCGM Wear-time=69%, MCGM Time in range= 29%, 39% pump use, 56% two-caregiver household, 32% public insurance, 56% Black/African American non-Hispanic, 26% Hispanic/Latinx/a/o, 5% white, non-Hispanic, 5% Mixed Race, 4% MENA/SWANA, 4% Another race/ethnicity) who reported <75% CGM use and their caregivers. Demographic and medical variables were caregiver reported or obtained from the electronic health record. Caregivers completed the Benefits and Burdens of CGM (Ben/Bur) form. Mann-Whitney U tests or Spearman’s Rank Correlation tests were used.

Results: The highest rated benefit was “⋯CGM makes taking care of diabetes easier” (M Ben=4.4 ± 1.1) and burdens were “⋯CGM sensor readings cannot be trusted” and “⋯ CGM is painful to wear” (M Bur1=2.2 ± 0.95; M Bur2=2.2 ± 1.0). Increased CGM wear time and shorter T1D duration was associated with increased CGM burden (rho=0.37, p=0.02; rho=-0.30, p=0.03). Race/ethnicity, insurance, age, gender, CGM use duration, CGM time in range, and A1c were not associated with Ben/Bur.

Conclusion: In a sample of racially minoritized families, those with shorter T1D durations may still be working through the emotional adjustment process, which may exacerbate caregiver perceptions of CGM burdens. This study is limited by a lack of prior research on the psychometrics of Ben/Bur in a racially minoritized sample. Future studies should examine whether the increased burden from higher CGM use is a risk factor for negative psychosocial outcomes.

Disclosure

M. Vemulakonda: None. E. Straton: None. C.H. Wang: None. J. Barber: Stock/Shareholder; AbbVie Inc., Boston Scientific Corporation, UnitedHealth Group. L. Gallant: None. L. Kang: None. S. Majidi: Other Relationship; Sanofi. A.G. Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. R. Streisand: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK131026)
683-P: Association between Glycaemic Variability and Sleep in Adults with Type 1 and Type 2 Diabetes—A Systematic Review
Authors: PHAM CECILIA T. , ALI ALEENA , CHURILOV LEONID , BAQAR SARA , HENDRIECKX CHRISTEL , O'NEAL DAVID N. , HOWARD MARK E. , EKINCI ELIF I.
Published: June 2024

Context: Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycemic management. We review the relationship between sleep and glycemic variability in adults with diabetes.

Methods: We systematically searched Medline, EMBASE, and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycemic variability metrics in adults with type 1 and type 2 diabetes.

Results: Among 3,049 records, 26 met inclusion criteria (type 1 diabetes studies=21). Due to methodological heterogeneity, a qualitative analysis was conducted. Most studies measuring sleep quality (5 out 7; 71%) reported a significant association with glycemic variability in type 1 and type 2 diabetes. In type 1 diabetes, sleep duration showed no significant association with glycemic variability, while other sleep metrics yielded inconclusive results. Hybrid closed-loop pump interventions (n=12) demonstrated varying sleep outcomes but consistently improved glycemic variability. Conversely, sleep interventions (n=3) enhanced sleep but not glycemic variability. Limitations included moderate to high-risk of study bias, confounders, methodological heterogeneity, and limited type 2 diabetes data.

Conclusion: A potential association between sleep quality and glycemic variability exists. However, associations with other sleep metrics remain elusive, with no discernible association between sleep duration and glycemic variability in type 1 diabetes. Despite advancements in continuous glucose monitoring and ambulatory sleep monitoring, standardized sleep assessment methodologies are lacking in real-world research. Establishing standard protocols for sleep assessment and defining optimal sleep targets is crucial for meaningful comparisons between studies. Understanding the complex interplay between sleep and glycemic variability holds promise for improving diabetes management and sleep health.

Disclosure

C.T. Pham: Research Support; Eli Lilly and Company, Boehringer-Ingelheim, Sanofi, Novo Nordisk, Versanis, Endogenex. A. Ali: None. L. Churilov: None. S. Baqar: None. C. Hendrieckx: None. D.N. O'Neal: None. M.E. Howard: None. E.I. Ekinci: Advisory Panel; Lilly Diabetes. Research Support; Novo Nordisk, Boehringer-Ingelheim, Eli Lilly and Company. Board Member; Eli Lilly and Company. Advisory Panel; Abbott. Research Support; Endogenex, Versanis, AstraZeneca.