bluuebunny/crossref_metadata_2025 huggingface dataset:
825-P: Depressive Symptoms Are Associated with Lower Diabetes Self-Management in Adults with Type 1 Diabetes
Authors: CRISTY R GENO RASMUSSEN , DRISCOLL KIMBERLY A. , SIPPL RACHEL M. , ALMAN AMY C. , KESHAWARZ AMENA , SNELL-BERGEON JANET K.
Published: June 2019

Depression is increased in people with type 1 diabetes (T1D), and may lead to poor disease self-management and suboptimal glycemic control. Depressive symptoms were assessed in adults with and without longstanding T1D (mean±SD T1D duration 38±8.6 years).

A total of 414 participants with T1D (mean±SD age 51±9 years) and 488 participants without T1D (mean±SD age 55±9 years) completed the Beck Depression Inventory II (BDI-II) and the Diabetes Self-Management Questionnaire (DSMQ).

BDI-II scores were significantly higher in people with T1D (mean±SD 5.4±5.6%) than in those without T1D (3.8±4.7, p<0.0001). In age-adjusted linear regression models, BDI-II scores were higher in participants with T1D vs. those without T1D in both men (LSmean±SE 5.3±0.4 vs. 3.1±0.3, p<0.001) and women (5.6±0.4 vs. 4.4±0.3, p=0.018). Depressive symptoms were higher in women compared to men among participants without T1D (p=0.01), but not among adults with T1D (p=0.56). Among participants with T1D, 9.7% of women and 10.4% of men (p=0.81) reported clinically elevated symptoms of depression (>13), whereas 7.1% of women and 1.7% of men without T1D reported clinically elevated symptoms of depression (p=0.004). Among participants with T1D, a higher BDI-II score was significantly correlated to HbA1c (r=0.21, p=0.0005). In age, sex, and T1D duration adjusted linear regression models, BDI-II scores >13 were associated with significantly lower total scores on the DSMQ (p<0.0001), and on the DSMQ subscales for Glucose Management (p=0.0005), Dietary Control (p=0.002), and Physical Activity (p=0.006) but not Health Care Use (p=0.73). There were no differences in these associations by sex.

Our data demonstrate elevated levels of depressive symptoms in adults with T1D, particularly men, which were associated with lower self-management behaviors. Interventions are needed to address the role of depression on glycemic control and behaviors around glucose management, diet and physical activity in adults.

Disclosure

C.R. Geno Rasmussen: None. K.A. Driscoll: None. R.M. Sippl: None. A.C. Alman: None. A. Keshawarz: None. J.K. Snell-Bergeon: None.

Funding

American Diabetes Association (7-13-CD-10 to J.K.S-B.); National Heart, Lung, and Blood Institute; JDRF International
83-LB: Missed Insulin Bolus Doses Are Associated with Hypoglycemic Fear
Authors: EDWARDS STEPHANIE S. , JOHNSON JENNAL , HOWARD WOLPERT , HE XUANYAO , KAO CHRISTI Y. , MEADOWS ERIC , POON JIAT LING , PRICE DAVID A. , POLONSKY WILLIAM
Published: June 2019

When people with diabetes (PwD) are introduced to real-time continuous glucose monitoring (rtCGM), they may still struggle to meet glycemic targets, as highlighted by the T1D Exchange. We assessed missed bolus doses (MBD) in relation to psychosocial factors and rtCGM use in PwD using insulin. This 12-week, single-arm, observational study enrolled PwD who reported A1C ≥8% and taking ≥3 insulin boluses/day. We administered the Adult Low Blood Sugar Survey short form (ALBSS), which evaluates hypoglycemic fear at baseline. Data from a connected insulin pen and CGM (1st 6 weeks blinded, 2nd 6 weeks rtCGM) were used to calculate MBD as defined by an 80 mg/dL glucose increase over ≤2 hours not preceded within 1 hour by an insulin dose. A mixed-effect model for repeated measures tested the association of MBD with ALBSS. Logistic regression assessed the relationship of MBD change (blinded to rtCGM) with ALBSS. Covariates in both models were baseline A1C (≤ or >9%), diabetes type and duration, sex, ethnicity, age, and BMI. Participants (N=68), mean age 48 (range 22-65 years), were 44% female, 18% Hispanic, 59% T1D. The mean ALBSS score was 13.7 (range 0-34). In the blinded period, a mean of 0.94±0.39 MBD/day were calculated, which reduced in rtCGM (0.85±0.37 MBD/day, p=0.05). For blinded and rtCGM, more frequent MBD were independently associated with greater hypoglycemic fear (ALBSS, p=0.04) and higher baseline A1C (p=0.001). Participants with greater hypoglycemic fear were more likely to miss more bolus doses even after switching to rtCGM (odds ratio 1.1, p=0.045). MBD were relatively common in PwD using multiple daily injections who had not achieved adequate glycemic control. Hypoglycemic fear was associated with more MBD, even following the introduction of rtCGM. Therefore, when managing PwD using bolus insulin, clinicians should address fear of hypoglycemia as a potential barrier to appropriate dosing. As shown in this exploratory study, without attention to psychosocial factors, technology may not contribute to improved self-care.

Disclosure

S.S. Edwards: Employee; Self; Eli Lilly and Company. J. Johnson: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. H. Wolpert: Employee; Self; Eli Lilly and Company. X. He: Employee; Self; Eli Lilly and Company. C.Y. Kao: None. E. Meadows: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Poon: Employee; Self; Eli Lilly and Company. D.A. Price: Employee; Self; Dexcom, Inc. Stock/Shareholder; Self; Johnson & Johnson. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson & Johnson Diabetes Institute, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier.
830-P: Influence of Social Circumstances on Maintenance of Body Weight and Incident Type 2 Diabetes: Analyses from the Diabetes Prevention Program
Authors: NIELSEN JANNIE , ALI MOHAMMED K.
Published: June 2019

The impact of social and environmental circumstances on success in an intensive behavioral intervention to lose weight and reduce risk of type 2 diabetes is unknown. We examined the association of social and environmental circumstances such as provisions of social relations and support, home and work environment, and adverse life events on weight loss and diabetes incidence in the Diabetes Prevention Program (DPP) randomized controlled trial.

We included data on 650 female and 319 male adults from the DPP lifestyle intervention group with information on social circumstances and body weight at baseline and follow-up after 6 months (24 weeks of lifestyle intervention), 1, and 2 years. We applied Cox proportional hazards model to obtain hazard ratios (HRs), with social circumstances as the exposures and body weight gain (>7%) or development of diabetes as outcome, adjusting for baseline age, sex, marital status, and number of individuals in the home of the participant.

Life style intervention participants who experienced events or changes at work during the DPP trial had a 44% higher risk of developing diabetes [HRR=1.44, 95% CI:1.02;2.04] as compared to lifestyle intervention participants who did not have such experiences at work. Adjustment of body weight gain after the intervention period explained a small component of this risk: 1.38 [95% CI:0.94;2.03]. Negative changes in the home environment [HRR=1.09, 95% CI:0.76;1.56], low provision of social relations [HRR=1.15, 95% CI:0.81;1.65] or adverse life events [HRR=1.14, 95% CI:0.81;1.62] did not increase the HR of developing diabetes. Social circumstances were not associated with >7% body weight increase between the end of the intervention period and 1 or year 2.

Thus, our results suggest that work changes and stresses may worsen the possibility of lowering diabetes risk through intensive lifestyle interventions.

Disclosure

J. NIelsen: None. M.K. Ali: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases; General Clinical Research Center; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Aging; Office of Research on Women's Health; Office of Research on Minority Health; Centers for Disease Control and Prevention
832-P: Diabetes and Doom: Lay Perceptions of Diabetes Stratified by Biometrics in Latinos with Type 2 Diabetes
Authors: GLANTZ NAMINO M. , LAREZ ARIANNA J. , MORALES JESSIKAH , HOPPE CHARIS B. , BEVIER WENDY C. , CONNEELY MARY M. , ALATORRE CARLOS , PACZKOWSKI ROSIRENE , KERR DAVID
Published: June 2019

Latinos/Hispanics comprise 18% of the U.S. population and have the highest proportion of type 2 diabetes of any racial/ethnic group. Research tends to split quantitative clinical data from qualitative explanatory models of diabetes. In contrast, Mil Familias, a 10-year 1000-family research initiative, combined these two research methods. Trained community health workers asked, “In your own words, what is diabetes?” of 107 Latino adults (54 ± 12 years old, 65% female, 36% on insulin) with self-reported type 2 diabetes in Santa Barbara and measured their biometrics, including HbA1c, insulin use, mental health, and weight. Thematic analysis of participants’ definition of diabetes by 2 independent raters yielded 5 categories based on participant-reported terms: controllable (controlable), sugar (azúcar), body malfunction (cuerpo), illness (enfermedad), doom/death (muerte). To probe the theory that participants who related diabetes with doom (e.g., "silent assassin,” "worst that could happen”) had poorer health than those who did not cite doom, participants were stratified by doom mention and their biometrics (Table). While no pattern between doom and health emerged, the exercise enabled examination of culturally-relevant interactions between traditional biometric outcomes and qualitative perceptions of diabetes (e.g., fatalism) in U.S. Latino adults.

Disclosure

N.M. Glantz: Research Support; Self; Eli Lilly and Company. A.J. Larez: Research Support; Self; Eli Lilly and Company. J. Morales: Research Support; Self; Eli Lilly and Company. C.B. Hoppe: Research Support; Self; Eli Lilly and Company. W.C. Bevier: Research Support; Self; Eli Lilly and Company. M.M. Conneely: Research Support; Self; Eli Lilly and Company. C. Alatorre: Employee; Self; Eli Lilly and Company. R. Paczkowski: Employee; Self; Eli Lilly and Company. D. Kerr: Advisory Panel; Self; Ascensia Diabetes Care, Novo Nordisk A/S, Sanofi. Research Support; Self; Lilly Diabetes. Stock/Shareholder; Self; Glooko, Inc.

Funding

Eli Lilly and Company
836-P: Cannabis Use in Adults with Type 1 Diabetes (T1D) Is Associated with Poor Glycemic Control and Increased Risk for Diabetic Ketoacidosis (DKA)
Authors: SHAH VIRAL N. , TAYLOR DANIEL D. , FOSTER NICOLE C. , BECK ROY , AKTURK HALIS K. , KINNEY GREGORY L.
Published: June 2019

Cannabis has been legalized for medical or recreational use in 33 states and usage is increasing in adults. A prior study from Colorado showed a two-fold increased DKA risk among adults with T1D using cannabis. This study was aimed to evaluate glycemic control and DKA risk among adults with T1D who use cannabis from the T1D Exchange Clinic Registry (T1DX). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) questionnaire was emailed to 4311 adults at 69 T1DX clinic registry centers. Total Substance Score (TSC) for cannabis was used to classify adults with T1D requiring no intervention (TSC score 0-3), a brief intervention (TSC 4-26), and more intensive intervention (>26). A total of 932 adults with T1D completed the survey (61% female, 90% non-Hispanic white, mean age 38±16 years). The prevalence of cannabis use was 17.8%; prevalence was higher in states where cannabis is legal. Compared to participants categorized as ‘no intervention’ (n=871), cannabis users ‘brief intervention’ (n=61) were younger, had a younger age at T1D diagnosis, had higher A1c, and had similar use of insulin pumps and CGMs. Cannabis use (TSC >4) was associated with increased DKA risk (OR 2.5, 1.0-5.9) after adjusting for age, sex and A1c [Figure]. With the growing use of cannabis among adults with T1D, physicians should be aware of an association between cannabis use and a risk for DKA.

Disclosure

V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. D.D. Taylor: None. N.C. Foster: None. R. Beck: Other Relationship; Self; Abbott Laboratories, Ascensia Diabetes Care, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Lilly Diabetes, Roche Diabetes Care, Tandem Diabetes Care. H.K. Akturk: Advisory Panel; Self; Sanofi. Research Support; Self; Eli Lilly and Company, MannKind Corporation, REMD Biotherapeutics. Speaker's Bureau; Self; MannKind Corporation. G.L. Kinney: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
837-P: Diabetes Support Needs in People with Severe Mental Illness and Diabetes
Authors: STENOV VIBEKE , WILLAING INGRID , KNUDSEN LENETTE , HANSEN DORTE L. , JOENSEN LENE E.
Published: June 2019

Background: People with severe mental illness (SMI) have a two to three-fold higher risk of developing diabetes. Mental healthcare providers have an important role in supporting people with SMI in diabetes management, but little is known about preferences for diabetes support among people with SMI and diabetes. The aim of the study was to explore the needs and preferences for diabetes support in this population.

Method: Semi-structured interviews were conducted with 15 adults with SMI and diabetes recruited from four psychiatric outpatient clinics in Denmark. Interviews were transcribed and analyzed using systematic text condensation.

Results: Participants’ mean age was 47 years, 40% were women, and 80% had T2DM. Mental health diagnoses included schizophrenia, bipolar disorder, severe depression, and personality disorder. Four main themes emerged in relation to support needs and preferences: 1) mental illness care significantly overshadowed diabetes care. It was difficult for people with SMI to prioritize diabetes management; 2) emotional state influenced diabetes management e.g., anxiety was linked to higher fat and sugar intake, and isolation lead to physical inactivity; 3) daily routines were experienced as difficult making diabetes routines even harder to perform, e.g., planning and preparing healthy meals and participating in routine diabetes health visits; 4) support from mental healthcare providers was perceived as crucial for managing diabetes for people with SMI. However, people with SMI experienced that the healthcare providers payed little attention to their physical health including their diabetes.

Conclusions: This study highlights difficulties of living with SMI and managing diabetes care. The results can facilitate the shaping of tailored interventions to support people with SMI in their diabetes management. Further studies are needed to develop and test relevant diabetes support for people with SMI and diabetes including training of mental healthcare providers.

Disclosure

V. Stenov: None. I. Willaing: None. L. Knudsen: None. D.L. Hansen: None. L.E. Joensen: None.
845-P: Relationship between Financial Hardship and Glycemic Control in Older Adults with Diabetes
Authors: WALKER REBEKAH J. , GARACCI EMMA , EGEDE LEONARD E.
Published: June 2019

Background: Evidence exists that socioeconomic status influences health, however, there is no consensus on the best measures to use when concerned with clinical outcomes. The aim of this analysis was to better understand the individual and cumulative influence of financial hardship on glycemic control in older adults with diabetes.

Methods: Using nationally representative data from 2012 and 2014 Health and Retirement Survey, we investigated 2,682 older adults with self-reported diabetes. Measures of financial hardship included 1) difficulty paying bills, 2) ongoing financial strain over 12 months or longer, 3) decreasing food intake due to lack of money, and 4) taking less medication than prescribed due to cost. Each measure was investigated individually, then a cumulative score of hardships for each person was created. Linear models for the relationship on continuous HbA1c were run unadjusted, then adjusted for age, gender, race/ethnicity, education, marital status, employment status, household income and asset quartiles, and comorbidity count.

Results: 58.5% of the sample reported at least 1 financial hardship, 37.5% reported 2+. After adjustment, a significant relationship existed with an increasing number of hardships associated with a 0.10 increase in HbA1c (95% CI 0.04, 0.15). While the adjusted relationship between ongoing financial strain and decreasing food intake due to money was no longer significant, difficulty paying bills (0.25, 95% CI 0.14, 0.36) and decreased medication usage due to cost (0.22, 95% CI 0.07, 0.36) remained significant. Once fully adjusted, the relationship with income lost its significance.

Conclusion: Financial hardship had a cumulative influence on glycemic control, with an increasing number of hardships associated with worse HbA1c. Difficulty paying bills and cost related non-adherence were independently associated with glycemic control, suggesting these may be better measures than income when considering the influence on clinical outcomes.

Disclosure

R.J. Walker: None. E. Garacci: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

National Institutes of Health
85-LB: A Phase 1b/2 Clinical Trial of Dantrolene Sodium in Patients with Wolfram Syndrome
Authors: ABREU DAMIEN , PEARSON TONI S. , BUCELLI ROBERT C. , SIMPSON ASHLEY , BROWN CRIS M. , KRIES KELLY , GU HONGJIE , STONE STEPHEN I. , TYCHSEN LAWRENCE , STAVERN GREGORY VAN , WHITE NEIL H. , MARSHALL BESS A. , HERSHEY TAMARA , URANO FUMIHIKO
Published: June 2019

Wolfram syndrome is a rare, progressive neurodegenerative disorder characterized by juvenile-onset diabetes, optic nerve atrophy and mutation of the WFS1 gene. Calcium dyshomeostasis is a key mechanism underlying neuronal and pancreatic β-cell death and dysfunction in this endoplasmic reticulum (ER) disorder. Dantrolene sodium is an FDA-approved muscle relaxant that preserves ER calcium through inhibition of ryanodine receptor (RyR) activity. We therefore hypothesized that dantrolene could have therapeutic potential for Wolfram syndrome. Our preclinical studies showed that dantrolene improves β-cell and neuronal cell survival in mouse and induced pluripotent stem (iPS) cell models of Wolfram syndrome. To translate these findings to humans, we conducted the first clinical trial in 19 Wolfram syndrome patients through a 6-month phase 1b/2 study of dantrolene sodium with an optional extension phase up to 24-months (NCT02829268). The endpoints of this study were to assess: (1) dantrolene safety and tolerability in pediatric and adult Wolfram syndrome patients and (2) its effects on remaining β-cell, visual and neurologic functions and quality of life measures. Among pediatric subjects, dantrolene was well-tolerated at a daily dose of 0.5mg/kg in those < 50kg and 2mg/kg in those > 50kg. Adults tolerated dantrolene well at 50mg - 100mg daily. Common adverse events included mild fatigue, diarrhea, headache and hypoglycemia. A mild increase in 30-minute mixed-meal-stimulated C-peptide was observed in subjects after 6- and 12-months of dantrolene treatment. No significant changes were observed in visual or neurological functions or quality of life measures, although mild improvement in disease severity was noted by the Wolfram Unified Rating Scale. These findings suggest that dantrolene is safe for use in Wolfram syndrome at the specified doses and support further study of dantrolene in a randomized, placebo-controlled trial.

Disclosure

D. Abreu: None. T.S. Pearson: None. R.C. Bucelli: None. A. Simpson: None. C.M. Brown: None. K. Kries: None. H. Gu: None. S.I. Stone: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Speaker’s Bureau; Self; AbbVie Inc. L. Tychsen: None. G. Van Stavern: None. N.H. White: None. B.A. Marshall: None. T. Hershey: Research Support; Spouse/Partner; Sage Pharmaceuticals. F. Urano: Board Member; Self; Healthbeat. Research Support; Self; Aetas, Amylyx, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Stock/Shareholder; Self; CytRx. Other Relationship; Self; Novus Biologicals.

Funding

National Institutes of Health (R21DK113487-02)
850-P: Modeling Pathways between Psychological Distress, Emergent Symptoms and Side Effects, and Endpoint A1C during Treatment
Authors: TESTA MARCIA A. , SU MAXWELL , SIMONSON DONALD C.
Published: June 2019

Achieving glycemic targets is often hampered by emerging symptoms and side effects (SSE). We previously showed that higher baseline psychological distress was associated with worsening treatment-related SSE; however, causal pathways among demographic, psychological and endpoint A1C (E-A1C) measures remain unclear. To explore these pathways, we used latent variable, structural equation models (SEM) and pooled data from 17 randomized clinical trials (N = 5209 patients, 712 centers) employing 32 different regimens of insulin and oral agents alone or in combination during 24 -52 weeks of treatment. Questionnaires of psychological distress (PD) and well-being (PWB) (24 items), and SSE distress (54 items) were completed longitudinally. At baseline, 707 patients (13.6%) were T1D (54.2% male, age 32.7 ± 14.4 years, A1C 8.0 ± 1.0%, BMI 25.1 ± 3.9 kg/m²) and 4,502 (86.4%) were T2D (58.5% male, age 57.3 ± 10.3 years, A1C 8.7 ± 1.3%, BMI 30.8 ± 5.2 kg/m²). The PD latent variable consisted of depression, anxiety, and loss of behavioral control scales. Controlling for baseline age, sex, A1C, BMI and SSE, the SEM model indicated that for T2D a 1 standard deviation (sd) better baseline PD in the PD -->SSE path resulted in an 11% sd improvement in SSE, while a 1 sd improvement in the SSE --> E-A1C path resulted in a 15% sd decrease in A1C (both p < 0.001). Neither coefficient was significant for T1D. Adding a PWB latent variable to the combined T1D and T2D SEM added no explanatory value, while adding an additional feedback path (E-A1C-->SSE) showed that influences could be bidirectional (p < 0.001). Results indicate that pre-existing mental health conditions, as well as worsening treatment-emergent symptoms and side effects, can interfere with A1C lowering. These findings support therapeutic regimens that include a plan for the proactive treatment of psychological and symptom distress to improve diabetes medication acceptance and adherence in order to better achieve diabetes treatment goals.

Disclosure

M.A. Testa: Stock/Shareholder; Spouse/Partner; GI Windows, Inc. Stock/Shareholder; Self; Phase V Technologies, Inc. M. Su: None. D.C. Simonson: Stock/Shareholder; Self; GI Windows, Inc. Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc.

Funding

Patient-Centered Outcomes Research Institute (CE1304-6756)
851-P: Sleep and Quality of Life in Adolescents with Type 1 or Type 2 Diabetes
Authors: FAULKNER MELISSA S.
Published: June 2019

Poor sleep due to the influence of mobile technology and hectic schedules is common in adolescents and may affect overall diabetes management. The purpose of this study was to examine associations between sleep quality and perceptions of physical health, emotional well-being, self, family support, friendships and life satisfaction in adolescents with diabetes. Seventy-six adolescents with either T1D (n = 49; 25 males) or T2D (n= 27) completed a self-report global measure of sleep quality using a 5-point scale with higher values representing more sleep difficulty and measures of quality of life based upon subscales from well-validated and reliable instruments. These included the Kiddo KINDL® and the Diabetes Quality of Life Instrument for Youth with higher values on a 5-point scale indicating more positive perceptions of quality of life and life satisfaction. Hemoglobin A1c% (HbA1c) was obtained using the Abbott IMx® assay method.

Adolescents with T2D were significantly older (15.2±2.0 vs. 14.0±1.4 years), had higher body mass index z-scores (2.0±0.6 vs. 0.6±0.9) and less duration of diabetes (2.0±1.8 vs. 5.5±3.2 years) (P < 0.01). There were no group differences in median scores for sleep quality or mean HbA1c (8.1±2.4 vs. 8.8±1.8) and no association between HbA1c and sleep quality. Using Spearman rho correlational analyses, there were significant associations between sleep quality and perceptions of physical health (rho = -.44), self (rho = -.19), family (rho = -.20), friends (rho = -.23) and life satisfaction (rho = -.25), P <0.05). Significant associations were stronger in those with T1D, ranging from rho = -.36 to -.64, including emotional well-being, likely due to the larger sample size for those with T1D.

Results indicate those with greater sleep difficulty had lower quality of life. Greater emphasis on overall sleep quality and personal health and relationships are needed in future research and the clinical management of diabetes in adolescents.

Disclosure

M.S. Faulkner: None.

Funding

National Institutes of Health (R01NR07719)
859-P: Social Support and Diabetes Distress among Adults with Alabama Medicaid
Authors: PRESLEY CAROLINE A. , MONDESIR FAVEL L. , AGNE APRIL A. , RIGGS KEVIN R. , PISU MARIA , LEVITAN EMILY B. , BRONSTEIN JANET M. , CHERRINGTON ANDREA
Published: June 2019

Background: Diabetes distress affects up to 45% of adults with diabetes and is associated with reduced treatment adherence and poor glycemic control. We evaluated diabetes distress and the relationship between social support and diabetes distress in adults with Medicaid.

Methods: We surveyed a population-based sample of adults, aged 19 to 64 years old, covered by Alabama Medicaid, and diagnosed with type 2 diabetes. Diabetes distress was measured with the 17-item Diabetes Distress Scale (DDS) assessing emotional burden, physician-related distress, regimen-related distress, and interpersonal distress. A score of <2 indicates little/no distress, 2-2.9 moderate distress, and ≥3 high distress. Social support was assessed by the question “How much support do you get for dealing with your diabetes?” and responses were categorized as low, moderate, or high social support. We performed multivariate logistic regression of diabetes distress by social support, adjusting for demographics, disease severity, self-efficacy, and depressive symptoms.

Results: In total, 541 individuals participated; 72% were female, 40% white, 58% black, and 3% Hispanic. Mean diabetes distress score was 1.7 (SD 0.88); 72.8% of participants had little/no diabetes distress, 16.8% moderate distress, and 10.4% high distress. Most participants (56.9%) reported high social support, but 13.5% reported low and 29.6% moderate social support. Participants who reported low and moderate social support were significantly more likely to have high diabetes distress (≥3) than those who reported high social support, adjusted odds ratio 14.3 (95% CI 5.2, 39.1) and 4.2 (95% CI 1.6, 10.7), respectively. This relationship was present for each diabetes distress domain, with particularly strong relationships between low social support and high interpersonal and regimen-related distress.

Conclusions: Interventions seeking to reduce diabetes distress in adults with type 2 diabetes may benefit from a focus on improving social support.

Disclosure

C.A. Presley: None. F.L. Mondesir: None. A.A. Agne: None. K.R. Riggs: None. M. Pisu: None. E.B. Levitan: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen Inc. J.M. Bronstein: None. A. Cherrington: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
860-P: Benefits of Real-Time Sharing and Following of Continuous Glucose Monitoring Data from Youth
Authors: PARKER ANDREW , DERDZINSKI MARK , PUHR SARAH , WELSH JOHN , WALKER TOMAS C. , JIMENEZ ANNIKA
Published: June 2019

Background: Children and adolescents with diabetes may use data from continuous glucose monitoring (CGM) in management decisions and may share it in real time with others involved in their care. CGM systems from Dexcom (San Diego, CA) allow real-time sharing with up to 5 remote “Followers.” We explored associations between the presence of Follower(s), device utilization, and glycemic parameters.

Methods: We used estimated glucose values (EGVs) from a convenience sample of 25,000 CGM users of Dexcom's G5 or G6 system ages 2-24 that were uploaded between 5/1/2018 and 9/30/2018 by an app that allows for sharing. The number of Follower(s) was established on 8/10/2018. Each day with ≥1 valid EGV was counted as a day of device usage. Comparisons were made with two-sided Welch’s t-tests.

Results: Overall, 90.0% of the population used the sharing feature and had ≥1 Follower; the mean numbers of Followers for patients ages <8, 8-14, and 15-24 years were 2.73, 2.69, and 1.83, respectively. In all 3 age groups, having a Follower was associated with lower mean EGVs, more EGVs in the 70-180 mg/dL range, fewer EGVs in hypo- or hyperglycemia, and more device utilization (Table).

Conclusions: Real-time sharing and following of CGM data may encourage consistent device usage and facilitate timely interventions by parents of young children with diabetes or improve self-care behaviors among adolescents and young adults with diabetes.

Disclosure

A. Parker: Employee; Self; Dexcom, Inc. M. Derdzinski: Employee; Self; Dexcom, Inc. S. Puhr: None. J. Welsh: Employee; Self; Dexcom, Inc. T.C. Walker: Employee; Self; Dexcom, Inc. A. Jimenez: Employee; Self; Dexcom, Inc.
861-P: Barriers to Technology Use in Pediatric Patients with Type 1 Diabetes
Authors: TSAI DAVID , REID MARK W. , FLORES GARCIA JAQUELIN J. , RAYMOND JENNIFER
Published: June 2019

Type 1 diabetes (T1D) affects many youth in the United States and the incidence is rising. Diabetes technology such as insulin pumps and continuous glucose monitors (CGM) have been associated with improved glycemic control and improved quality of life. However, as of 2015 only 60% of children used a pump and only 6% used CGM. The use of diabetes devices is even lower in minorities. Potential barriers to device uptake in the T1D population have been described, but studies were mostly conducted in adults who were predominantly white, of higher socioeconomic status, and privately insured.

Youth with T1D (n=143) followed at Children’s Hospital Los Angeles were surveyed to investigate barriers to diabetes technology and explore potential differences between Latinx and non-Latinx populations. Latinx patients reported higher percentage of never having used CGM (64.6% vs. 41.3%, p=0.005) or pump (50.8% vs. 28.6%, p=0.002), and were found to have higher HbA1c levels (9.3% vs. 8.1%, p=0.0002). Latinx patients had less positive attitudes toward general and diabetes technology as seen in Table 1.

Less positive attitudes toward technology in general may contribute to the lack of exposure to diabetes devices in the Latinx community. However, physician-perceived barriers might also contribute to the differences. Further investigation into patient and physician-perceived barriers will assist in improving patient adoption of diabetes technology.

Disclosure

D. Tsai: None. M.W. Reid: None. J.J. Flores Garcia: None. J. Raymond: Other Relationship; Self; Insulet Corporation.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
864-P: Utilizing Certified Diabetes Educators to Manage Smoking Cessation
Authors: SCHWARTZ ABBY , DEPALO LOUIS R. , SIMONSON JULIE K. , WEINBERGER ELISHEVA , RODRIGUEZ MARIA ELENA , ROSENBERG DEBORAH L. , KARTASHEVSKY JENNIFER
Published: June 2019

Introduction: Many health systems lack internal smoking cessation programs despite the need to personalize smoking cessation support for patients. Though smoking cessation services are important, systems often lack needed resources to create programs from scratch. Mount Sinai Hospital System implemented a smoking cessation program by cross training CDEs as smoking cessation health coaches since they were embedded across the network and experts in health behavior change.

Methods: The entire CDE team was trained via WebEx lectures and through shadowing a tobacco treatment specialist pulmonologist in her practice. Patient and HCP engagement materials were developed as well as EHR enablement and policies/procedures to support the new program. The initial, target population was smokers with upcoming surgery since they were a discrete population and likely motivated to quit smoking to improve surgical outcomes. CDEs created personalized smoking cessation plans with patients and obtained medications through collaborative discussions with the patients’ primary care physician.

Results: Eight CDEs participated. The CDEs report increased job satisfaction by operating at the top of their licenses and learning a new therapeutic area. Patient and provider feedback has been strongly positive, and the program is expanding.

Conclusion: CDEs may serve as an internal resource to expand smoking cessation services within a health system.

Disclosure

A. Schwartz: None. L.R. DePalo: None. J.K. Simonson: Employee; Self; Pfizer Inc. E. Weinberger: None. M.E. Rodriguez: None. D.L. Rosenberg: None. J. Kartashevsky: None.

Funding

Pfizer Inc.
873-P: "I Had Nobody to Represent Me"—How Patient Perceptions of Diabetes Health Care Providers' Age, Gender, and Ethnicity Impact Shared Decision-Making
Authors: AHMAD TEHMINA , HARI SHRIYA , CLEARY DEVIN E. , YU C.
Published: June 2019

Background: When patients and clinicians establish diabetes care plans together, patients are more likely to successfully manage their diabetes. Although studies reveal diabetes healthcare provider (HCP) bias and healthcare inequities, the potential impact of patient perceptions of their diabetes HCP is unknown. We explored how patient perceptions of their diabetes HCP influences treatment plans and shared decision-making (SDM).

Methods: Adult participants with diabetes receiving diabetes care at community sites, primary care, or specialty clinics were invited to participate in semi-structured 30- to 45-minute interviews. Interviews were conducted from Nov 2018 to Jan 2019. Responses were qualitatively analyzed with NVivo for emergent themes.

Results: We conducted 28 interviews with participants aged 34-81. Participants were female (16), male (11), FtM (1), and white (9), black/Caribbean (11), Asian/South Asian (4), Middle Eastern (2) and Hispanic (2). We identified the following themes: 1) Hidden bias for stated preference of HCP ethnicity: While most participants stated no preference, we identified hidden preferences via cultural relatability as well as evidence of color blindness. 2) Impact of HCP characteristics on SDM: Participants felt junior HCPs had up-to-date knowledge, while others preferred senior HCPs’ clinical experience. HCP gender and ethnicity impacted SDM via relatability; participants who related to their HCP were more likely to engage in a care plan. 3) Other factors affecting HCP preference: Participants preferred HCPs who provided patient-centered care, characterized by individualized referrals, trusting relationships, and HCPs’ investment in patient success.

Conclusion: Diabetes affects persons of all ages, genders, and ethnicities. Exploring how patient perceptions of HCPs inform shared decision-making offers insight into systemic barriers to equitable person-centered care.

Disclosure

T. Ahmad: None. S. Hari: None. D.E. Cleary: None. C. Yu: None.
889-P: Early Engagement in a Continuous Care Intervention Predicts One-Year Improvements in Weight and HbA1c among Adults with T2D
Authors: ADAMS REBECCA N. , MCKENZIE AMY , ATHINARAYANAN SHAMINIE J. , HALLBERG SARAH , MCCARTER JAMES P. , PHINNEY STEPHEN
Published: June 2019

We previously showed that a digitally-monitored continuous care intervention (CCI) including nutritional ketosis (NK) substantially improved weight and HbA1c in adults with T2D. In this intervention, health coaches provided personalized nutrition guidance informed by biomarker data participants entered into a mobile app. Here, we examined whether indicators of early treatment engagement (i.e., messaging coaches, logging biomarkers, achieving NK) predicted the decreases in weight and HbA1c at 1 and 2 years. 262 adults with T2D (mean age=54 years, 67% female, mean HbA1c %=7.6, 92% obese) in the CCI were counseled to eat a whole foods very low carbohydrate diet. The percentage of days participants messaged their coach and logged ≥1 biomarker or symptom, and percentage of blood beta-hydroxybutyrate (BHB) readings ≥0.5 mM (indicating NK) during the first 10 weeks were obtained from the app. Weight and HbA1c were measured in clinic. We conducted correlation and GLM intent-to-treat analyses to assess relations between measures of treatment engagement and percent change in weight and HbA1c from baseline to 1 and 2 years. Coach messaging and logging were not correlated with percent change in weight or HbA1c; however, a greater percentage of BHB readings ≥0.5 was correlated with a greater percent decrease in weight (r=-0.25, p=0.001) and HbA1c (r=-0.19, p=0.004) from baseline to 1 year (but not 2 years). In GLM analyses, a greater percentage of BHB readings ≥0.5 predicted greater percent decrease in weight (b=-0.06, p=0.01) and HbA1c (b=-0.06, p=0.03) at 1 year after accounting for coach messaging, logging, and baseline demographic and medical characteristics. Results indicate that greater adherence to NK during the first 10 weeks explained a significant proportion of the variance in weight loss and A1c reduction, whereas simple app-based engagement did not. Future analyses should explore the role of maintaining NK over the remainder of the year on 1 year outcomes.

Disclosure

R.N. Adams: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity.
891-P: Hypoglycemia Prevention Behaviors Prevent Moderate Hypoglycemic Events: The REPLACE-BG Trial
Authors: CRAWFORD MARGARET A. , WHITE MARTHA M. , STRONG DAVID R. , PIERCE JOHN P.
Published: June 2019

Background: Continuous glucose monitoring (CGM) provides real-time glucose levels and alarms for hypoglycemia. We analyze CGM data from the REPLACE-BG trial, which had 6 months of CGM data on people with well controlled type 1 diabetes (T1D), to characterize hypoglycemic events and evaluate their association with hypoglycemia-related behaviors.

Methods: We conducted a psychometric analysis of the Hypoglycemia Fear Survey- Behavior scale to identify unique hypoglycemia behavior constructs. We identified and categorized hypoglycemic events in CGM data as mild (min glucose <70 mg/dL) and moderate (min glucose <50 mg/dL) and used ANOVA to evaluate differences in the frequency and duration of events by high and low score categories of hypoglycemia behavior constructs. We used multivariate linear regression to evaluate the association between hypoglycemia behavior constructs and 1) duration of moderate hypoglycemic events and 2) proportion of moderate hypoglycemic events.

Results: We separated the HFS-B into three scales: hypoglycemia avoidance, reaction, and prevention. In low vs. high hypoglycemia prevention score categories, the duration of moderate hypoglycemic events was significantly longer (73 vs. 66 minutes, p<0.05) and proportion of moderate hypoglycemic events was higher (22.4 vs. 20.1, p<0.1). In multivariate models that included all three hypoglycemia behavior scales, hypoglycemia prevention behavior was significantly, inversely associated with 1) duration of moderate hypoglycemic events (β= -6.9, SE= 2.2, p< 0.01) and 2) proportion of moderate hypoglycemic events (β= -2.2, SE= 0.7, p-value < 0.01).

Conclusion: Hypoglycemia is common in T1Ds. The increased likelihood of engaging in hypoglycemia prevention behaviors reduces the frequency and duration of dangerous moderate hypoglycemic events. Analyzing CGM data in its continuous form reveals the frequency and characteristics of individual hypoglycemic events.

Disclosure

M.A. Crawford: Employee; Self; Dexcom, Inc. M.M. White: None. D.R. Strong: None. J.P. Pierce: None.
894-P: The Risk for Type 2 Diabetes beyond Age: Contributors to the FINDRISC-Score in Each Age Category
Authors: EHRMANN DOMINIC , ETTER TOBIAS J. , WEISSMANN JOERG , KULZER BERNHARD , HERMANNS NORBERT
Published: June 2019

With increasing age, the risk for type 2 diabetes increases. Little is known about the relative importance of other risk factors for different age groups. Pharmacy customers in Germany completed the FINDRISC questionnaire. An ANOVA with age category as between factor and the age-adjusted FINDRISC-score as the dependent variable was conducted. Separate linear regression analyses for each age group were conducted to predict the total risk score from the risk factors. A total of 292 people participated. The ANOVA revealed that while the age-adjusted risk score for the first age category (< 35 years) was significantly different from all other age categories (p < .01 for all comparisons), there were no differences between the different age categories ≥ 35 years (p > .35 for all) indicating a similar risk exposition across these age groups. Results of the linear regression analyses (Table) revealed that the relative importance of genetic factors in younger people (< 35 years) is more pronounced and relatively more important than other factors. Additionally, fat distribution played an important role only in the youngest age groups. In older people, the importance of genetic factors for the overall risk score dropped while previously elevated blood sugar levels were more important. Understanding possible risk factors beyond age are helpful to develop targeted educational material or raise awareness for specific age groups.

Disclosure

D. Ehrmann: Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Abbott, Berlin-Chemie AG, Dexcom, Inc. T.J. Etter: Employee; Self; Roche Diabetes Care. J. Weissmann: Employee; Self; Roche Diabetes Care. B. Kulzer: Advisory Panel; Self; Ascensia Diabetes Care, Berlin-Chemie AG, Medtronic, Novo Nordisk Inc., Roche Diabetes Care. Research Support; Self; Abbott, Berlin-Chemie AG, Roche Diabetes Care. Speaker's Bureau; Self; Abbott, Ascensia Diabetes Care, Berlin-Chemie AG, Eli Lilly and Company, Novo Nordisk Inc., Roche Diabetes Care. N. Hermanns: Advisory Panel; Self; Abbott. Board Member; Self; Eli Lilly and Company. Research Support; Self; Abbott, Berlin-Chemie AG, Dexcom, Inc., Roche Diabetes Care. Speaker's Bureau; Self; Berlin-Chemie AG, Dexcom, Inc., Novo Nordisk A/S.

Funding

Roche Diabetes Care GmbH
895-P: Effects of Dapagliflozin, Metformin, or Exercise on Markers of Cardiometabolic Risk: The PRE-D Trial
Authors: FÆRCH KRISTINE , BLOND MARTIN B. , AMADID HANAN , NIELSEN LEA BRUHN , TVERMOSEGAARD MARIA , RIED-LARSEN MATHIAS , KARSTOFT KRISTIAN , PERSSON FREDERIK , JØRGENSEN MARIT E.
Published: June 2019

We assessed effects of dapagliflozin, metformin or exercise on markers of cardiometabolic health in individuals with prediabetes.

Methods: 120 participants were randomized to 13 weeks to either 1) dapagliflozin (DAP, 10 mg once daily); 2) metformin (MET, 850 mg twice daily); 3) exercise (EXE, interval training 5x30 min/week); or 4) control (CON, no treatment). Intention-to-treat analyses were conducted (baseline-adj.).

Results: 44% were men. At baseline, the median (Q1; Q3) age was 62 (54; 68) years, HbA1c 41 (39; 43) mmol/mol (5.9 (5.7; 6.1)%), BMI 30.8 (28.6; 34.3) kg/m2, fat mass 34.5 (28.7; 40.7) kg, waist circumference (WC) 104 (97; 113) cm, blood pressure 131/86 (123/79; 144/91) mmHg, cardiorespiratory fitness (CRF) 23.0 (20.4; 27.7) mLO2/kg/min, total cholesterol 5.1 (4.2, 5.9) mmol/L, HDL 1.3 (1.1; 1.5) mmol/L, VLDL 0.6 (0.4; 0.8) mmol/L and triglycerides 1.3 (0.9; 1.8) mmol/L. EXE led to a small reduction (1.1 kg) in fat mass which was also reflected in the change in BMI and weight (Table 1). Small reductions of 2.4 cm in WC were observed in DAP and EXE. In addition, EXE increased CRF by 2.8 mLO2/kg×min and decreased triglycerides and VLDL by 12-13%. DAP increased HDL by 0.1 mmol/l.

Conclusion: DAP and EXE led to minor improvements in body composition and lipids. EXE improved cardiorespiratory fitness; otherwise the risk profile of the participants was largely unaffected by the interventions.

Disclosure

K. Færch: Research Support; Self; Ascensia Diabetes Care, AstraZeneca, Unilever. Stock/Shareholder; Self; Novo Nordisk A/S. M.B. Blond: None. H. Amadid: None. L.B. Nielsen: None. M. Tvermosegaard: None. M. Ried-Larsen: Other Relationship; Self; Novo Nordisk A/S. K. Karstoft: Employee; Self; Novo Nordisk A/S. F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M.E. Jørgensen: Research Support; Self; Amgen Inc., AstraZeneca, Danish Diabetes Association, Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding

Novo Nordisk Foundation; AstraZeneca
903-P: Unique Cardiovascular Risk Stratification Using Prediabetes Metrics in High-Risk South Asian Cohort
Authors: SHEARER JENNIFER L. , JOSAN KIRANBIR , KHANDELWAL ABHA , NALLAMSHETTY SHRIRAM , ABBASI FAHIM , DASH RAJESH
Published: June 2019

Background: Elevated 1 hour plasma glucose (>155mg/dl) and glucose curve shape are predictive markers of diabetes risk. We evaluated varying patterns of impaired glucose tolerance and associated CVD risk.

Methods: At Stanford’s South Asian Translational Heart Initiative, 260 patients were evaluated for diabetic and CVD risk: OGTT with insulin, lipid panel, HbA1c, blood pressure, BMI, QRisk2 (10-year CVD risk), inflammatory markers, and FHx. Glucose curve “shape” was categorized by phase changes and time of curve peak.

Results: Classification showed 78.3% of patients were prediabetic and 5.2% had normal glucose tolerance (NGT) but elevated 1 hour glucose. These subgroups also exhibited more unclassified and monophasic 60 min glucose peak (Mono60) shapes compared to the total population (83.8% vs. 51.9%, p <0.01). Mono 60 patients had significantly higher fasting and 2 hour glucose, insulin levels, and QRisk2 (16% vs. 12%, p<0.01) than Mono30. The median CRP of Mono60 was higher than Mono 30 (1 vs. 1.5, p=0.02). A “dose-dependent” relationship between prediabetic criteria and average glucose area under curve (AUC) was observed; elevated 1 hour glucose further stratified prediabetic severity (Figure 1).

Conclusion: Mono60 glucose patterns exceed the CVD risk stratification of prediabetes alone and may indicate a need for more aggressive medical therapy to prevent diabetes and CVD progression.

Disclosure

J.L. Shearer: None. K. Josan: None. A. Khandelwal: None. S. Nallamshetty: None. F. Abbasi: None. R. Dash: None.