bluuebunny/crossref_metadata_2025 huggingface dataset:
647-P: Role of Diabetes Educators in Providing Insulin Pump Training for School Nurses and School Physicians—Kuwait Experience
Authors: RAHME ZAHRA , MESBAH NAGLAA , ALJASER FAHED , SAAD EGLAL , TAHA NEHAD ABDULRAHEEM
Published: June 2019

Objective: to investigate the impact of basic insulin pump training for school nurses and physicians on knowledge and confidence in caring for type1 diabetes[T1D] students using insulin pump therapy [IPT].

Methods: In groups of 15 healthcare professionals, a pediatric diabetologist and 3 diabetes educators (who are certified pump trainers) provided basic pump training for 137 healthcare providers, who were novice to IPT. For a duration of 4 hours, the training included 2 interactive lectures about IPT, management protocols of hyperglycemia, hypoglycemia and ketosis, followed by hands-on insulin pump workshop. Pre and post knowledge assessment about IPT management was performed using a 10-item knowledge questionnaire. Pre and post confidence level were assessed with a 9-item questionnaire using Likert’s scale T.

Results: 62 school nurses (7males) mean age 41.5 ± 11.7, with school experience of 8.8 ± 9.1 y and 75 school physicians (13 males), mean age 36.25 ± 6.2, with school experience 3.4 ± 1.5 y; attended the mentioned training. Pre and post knowledge assessment and confidence level scores were compared using Pearson’s correlations. Significant improvement in knowledge were found for both schools' physicians (r=0.007) and nurses (r=0.01). Additionally, significant improvement in confidence in caring for T1D students on insulin pump were found for both school physicians (p-value=0.047) and school nurses (p-value=0.018).

Conclusion: Pre-assessment showed the lack of knowledge and low confidence of school healthcare professionals about IPT. Significant improvement in knowledge and confidence in caring for T1D students who are on IPT resulted from the delivery of these workshops, which proved the effective role of diabetes educators to pump the knowledge and skills and enhanced their confidence in providing essential management for students at schools.

Disclosure

Z. Rahme: None. N. Mesbah: None. F. Aljaser: None. E. Saad: None. N.A. Taha: None.
653-P: Changes in Knowledge and Self-Efficacy following a Reproductive Health (RH) Intervention (READY-Guys) in Transition Clinic for Adolescent and Young Adult (AYA) Males with T1D
Authors: FISCHL ANDREA F.R. , CHARRON-PROCHOWNIK DENISE , ABUJARADEH HIBA , SEREIKA SUSAN M. , FINNEY JESSICA , DIAZ ANA M. , CHARACHE NICOLE , LIBMAN INGRID
Published: June 2019

Background: 50% of males with T1D report RH complications (e.g., erectile dysfunction, decreased libido) starting at age 25 years; precursors to more life-threatening complications and affect family planning. Glycemic control may prevent/delay RH complications. AYA males are vulnerable to poor glycemic control. These issues are rarely discussed during routine clinic visits. Raising RH awareness regarding metabolic control and preventing RH complications starting in this age group is imperative.

Purpose: To examine the changes in knowledge and self-efficacy following a new educational/counseling intervention (READY-Guys) on diabetes and RH among AYA males enrolled in a large tertiary university-based children’s hospital transition clinic.

Methods: Diabetes and RH was a teaching module for AYA patients. Fourteen AYA males (17-22 years) completed quantitative measures on RH knowledge and self-efficacy before and after receiving READY-Guys (Reproductive-health Education & Awareness of Diabetes in Youth for Guys); and open-ended qualitative questions for feedback on the RH intervention. A paired t-test compared pre to post RH knowledge and self-efficacy; content analysis was used for open-ended responses.

Results: Both RH Knowledge (t=6.5, p<.001) and self-efficacy (t=2.7, p=.019) improved significantly after the session. Open-ended themes included “session provided new information,” “it was helpful,” “start RH education in early adolescence.”

Conclusion: Attending the RH session appeared to improve AYA male’s knowledge regarding diabetes and RH and their self-efficacy to initiate discussion with health professionals and to take actions to decrease their risks of RH complications. The new RH information was acceptable and informative. To start during adolescence was confirmed by participants. Group discussion sessions during a transition clinic provided a venue to raise awareness about RH.

Disclosure

A.F.R. Fischl: None. D. Charron-Prochownik: None. H. Abujaradeh: None. S.M. Sereika: None. J. Finney: None. A.M. Diaz: None. N. Charache: None. I. Libman: Consultant; Self; Novo Nordisk Inc.

Funding

David Paul Diabetes Transition Care Research Initiative Fund
656-P: Characteristics Associated with Dropout in the National Diabetes Prevention Program, Montana, 2008-2016
Authors: CARPENEDO DOROTA , BROKAW SARAH M. , TYSK SONJA , FERNANDES JESSIE , HARWELL TODD S. , HELGERSON STEVEN D. , GOHDES DOROTHY M.
Published: June 2019

Attendance and retention is a concern for the National Diabetes Prevention Programs (National DPP) because participants who complete more sessions benefit the most. This study identified characteristics of the National DPP participants associated with program dropout by comparing participant characteristics stratified by the number of program sessions completed (Table). From 2008 through 2016, 7,584 MT adults enrolled in the National DPP; 81% completed >=11 sessions. Enrollees with high participation rates were more likely to be older, have lower baseline BMI, self-pay to participate, and have a parental history of DM, but less likely to have a history of GDM or to deliver a baby >9lbs compared to enrollees with low participation rates. A logistic regression analysis found characteristics independently associated with early program dropout were aged 45-59 years [AOR 0.45, 95% 0.36-0.56], BMI 35+ [AOR 0.56, 95% 0.45-0.71], and having primary Medicaid/Medicare insurance [AOR 0.52, 95% 0.41-0.66]. Our findings identify participant subgroups that should be targeted to increase the National DPP participation rates in MT and provide benchmark comparison data for the National DPP programs elsewhere.

Disclosure

D. Carpenedo: None. S.M. Brokaw: None. S. Tysk: None. J. Fernandes: None. T.S. Harwell: None. S.D. Helgerson: None. D.M. Gohdes: None.
657-P: Inclusion of the Patient Voice: Aligned HCP and Patient Education in Diabetes
Authors: BEASER RICHARD S. , TURELL WENDY , SEGAL ALISSA R.
Published: June 2019

Aligned educational programs for patient and health care provider (HCP) audiences were launched live and online in 2018 and were on-demand for 6 months. The patient program, “New Long-acting insulins for the Treatment of type 2 diabetes: Patient Perspectives,” consisted of four, 10-minute segments. The HCP program, “New Long-acting Insulins for the Treatment of type 2 diabetes: Data, Guidelines, and Perspectives on Patient and Provider Barriers,” was a 1-hour CME program. Both incorporated audience polling and question and answer segments. While each program was uniquely tailored to the different audiences, the overall goal was to provide knowledge and explore attitudes and barriers regarding ultra-long insulin therapy, including patient perspectives and exposing providers to the “patient voice” as part of their educational experience. The patient education was hosted on a patient-friendly diabetes education website and distributed through Facebook. Patient program faculty included physicians, a nurse educator, and a patient living with diabetes. The HCP program panel included a physician and a pharmacist CDE. Educational evaluation included pre/post/10-week follow-up online surveys targeting knowledge, competence and self-reported behavior changes. In total, 609 HCPs and 781 patients participated in the educational programs in-platform (on initiative web-sites) and 15,800 participants viewed the patient program via Facebook.

Results: Follow-up results indicated that 70% of patient learners improved HCP-related communication and 57% of improved health-related behaviors since participation. Of HCP learners, 75% reported the activity positively impact patient experience or outcome, and 87% reported the activity positively impacted clinical practice. 176 “themed” qualitative comments further detail the impact. Knowledge and competence questions that aligned with learning objectives consistently yielded improvements, 63% of which were statistically significant.

Disclosure

R.S. Beaser: None. W. Turell: None. A.R. Segal: None.

Funding

Sanofi U.S.
659-P: Family Caregivers' Roles in Supporting Adults' Self-Management of Diabetes
Authors: FIELDS BETH , RODRIGUEZ KERI L. , MAKAROUN LENA K. , ROBINSON CLAIRE H. , FORMAN JANE , ROSLAND ANN-MARIE
Published: June 2019

Background: Increased social support positively influences self-management of diabetes, but limited data exist documenting the specific roles that family caregivers assume in supporting adults with diabetes. Moreover, explanations for why caregivers take on certain roles has received little attention. Understanding what roles caregivers fill and why is critical to informing and targeting services aimed at improving caregiver competency in promoting diabetes self-management for their loved ones.

Methods: To characterize caregivers’ roles in supporting adults’ self-management of diabetes, as well as reasons for assuming those roles, 31 one-on-one, in-depth, semi-structured telephone interviews were conducted with adults with type 2 diabetes (n=19) and their family caregivers (n=12). Two coders independently reviewed transcripts from interview audio recordings in NVivo 12 Pro using interpretive phenomenological data analysis.

Findings: Adults and their caregivers described three central roles of caregivers in diabetes self-management: care organizer, health motivator, and medication tracker. Caregivers also recognized another prominent role, knowledge seeker. Two explanations for assuming specified roles emerged: changes in health and healthcare expertise. Caregivers reported taking on care roles because their loved one experienced a health problem that required medical or surgical attention. Some adults described turning to caregivers for diabetes management support because their family member had a healthcare background, such as a nurse or paramedic.

Conclusion: These adult and caregiver perspectives shed light on what roles families assume in supporting diabetes self-management and why. Information gleaned from this study may help healthcare providers target support for family roles to enhance caregivers’ ability to help adults with diabetes management.

Disclosure

B. Fields: None. K.L. Rodriguez: None. L.K. Makaroun: None. C.H. Robinson: None. J. Forman: None. A. Rosland: None.

Funding

Ann Arbor VA Center for Clinical Management Research; Michigan Center for Diabetes Translational Research (5P60-DK09292)
66-OR: Remission of Type 2 Diabetes for Two Years Is Associated with Full Recovery of Beta-Cell Functional Mass in the Diabetes Remission Clinical Trial (DiRECT)
Authors: ZHYZHNEUSKAYA SVIATLANA V. , AL-MRABEH AHMAD , BARNES ALISON C. , ARIBISALA BENJAMIN , HOLLINGSWORTH KIEREN G. , PILKINGTON HELEN , SATTAR NAVEED , LEAN MICHAEL E. , TAYLOR ROY
Published: June 2019

Aims: Observational studies have suggested that beta cell functional mass inevitably decreases over time. We assessed this after 2 years in a geographically defined subgroup of DiRECT who achieved initial remission after diet-induced weight loss.

Methods: A Stepped Insulin Secretion Test with Arginine (SISTA) was used to quantify functional beta cell mass (maximum insulin secretory response during hyperglycemia). Insulin secretion rates were estimated by de-convolution; 40 subjects initially achieved remission (HbA1c<6.5% and FPG <126mg/dl on no antidiabetic drug therapy). At 2 years 20 subjects (13M/7F) remained in remission, 13 gained weight and relapsed, and 7 lost to follow-up. A nondiabetic Comparator (NDC) group, matched for age/gender of DiRECT intervention group participants after weight loss, was studied.

Results: In the responder group, median (IQ range) maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p=0.017 from baseline) at 12 months, and 0.94(0.64 to 1.44) (p=0.030 from baseline) nmol/min/m2 at 24 months. This was comparable to NDC (1.02(0.86 to 1.51) nmol/min/m2) by 12 (p=0.064) and 24 months (p=0.244).

Median first phase insulin response increased in responders from 0.042 (0.004 to 0.0637) at baseline to 0.108 (0.058 to 0.163) nmol/min/m2 (p<0.0001) at 5 months, to (0.110(0.059 to 0.201) then 0.125(0.066 to 0.166) nmol/min/m2; p<0.0001)] at 12 and 24 months.

Those who failed to maintain remission were characterized by more weight regain 5-24 months (11. 3±1.9 vs. 6.6±1.0 kg, p=0.036). In responders mean HBA1C was 6.0±0.0% at 24 months.

Conclusion: Provided weight regain is minimized, remission of type 2 diabetes is durable over 2 years, with a gradual increase to normal beta cell functional mass.

Disclosure

S.V. Zhyzhneuskaya: None. A. Al-Mrabeh: None. A.C. Barnes: None. B. Aribisala: None. K.G. Hollingsworth: None. H. Pilkington: None. N. Sattar: Advisory Panel; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. Consultant; Self; NAPP Pharmaceuticals Limited. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Amgen Inc., Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. M.E. Lean: Consultant; Self; Counterweight Ltd., Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. R. Taylor: Advisory Panel; Self; Wilmington Healthcare. Speaker's Bureau; Self; Lilly Diabetes, Novartis AG.

Funding

Diabetes UK
661-P: Medical Officers (MOs) Training in Diabetes Management by Public Health Foundation of India (PHFI)—A Role Model to Improve Primary Health Care in Chronic Conditions
Authors: KUMAR PUSHKAR , BHALLA SANDEEP , CHANDWANI HARESH , MONGA ANURADHA
Published: June 2019

Objective: To describe the unique training model of PHFI for training MOs in diabetes and associated comorbidities through state Government collaborations.

Intervention: In PHFI, the training division has been building capacities of physicians to upgrade their knowledge and skills in chronic conditions since 2010. These training initiatives are currently running at 533 centers in 27 States and UTs covering more than 101 cities and have trained 16878 PCPs across the country in diabetes, gestational diabetes, cardio diabetes and diabetic retinopathy programs. An analysis revealed that 30% of the trainees were from Government sector. An innovative collaborative model between PHFI, academic partners and various State Governments was established. MoU was signed with state governments, training of trainers was conducted and MOs were nominated from sub district health facilities. MOs were trained using evidence-based curriculum which included national guidelines. Curriculum was developed by the academic partners and reviewed by national experts. PHFI assured training quality by a robust monitoring and evaluation mechanism.

Result: Initially 2 State governments (Kerala, Kolkata Municipal Corporation) have partnered with PHFI for training their MOs, and every year 2-3 new State Governments have been adopting these diabetes initiatives for increasing knowledge and skills of their physicians. As a result, partnership with 10 States have trained 1156 MOs. State Governments have designated these trained MOs as NCD nodal officers and posted them at Primary health centers. End line evaluation has found increased confidence among MOs in managing diabetes in the primary health setup and decrease in referrals.

Conclusion: Collaboration with governments built capacities of MOs and strengthened primary care in the country. The success of this model in Indian setting implies its use in other LMICs.

Disclosure

P. Kumar: None. S. Bhalla: None. H. Chandwani: None. A. Monga: None.
663-P: Online Diabetes Nutrition Education for American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives
Authors: STOTZ SARAH A. , BREGA ANGELA G. , MOORE KELLY R.
Published: June 2019

Nutrition education is known to promote healthful dietary behaviors and reduce diet-related complications among people with diabetes. American Indians and Alaska Natives (AIAN) have more than double the risk for type 2 diabetes (T2D) and diabetes-related complications than non-Hispanic whites. Despite the high prevalence of T2D in AIAN communities, AIANs often lack access to diabetes-related nutrition education, particularly resources targeted to AIAN audiences. Literature suggests that online nutrition education may effectively serve low-income audiences, but research specific to AIANs is scarce. We employed qualitative focus group and individual interview methods to understand stakeholder perspectives on the feasibility of an online eLearning diabetes nutrition education program for AIAN adults with T2D. We interviewed four types of stakeholders, including: experts in AIAN diabetes nutrition education (n=9); AIAN educators, Native elders, and tribal leaders (n=11); and AIAN adults with T2D (n=29) and their family members (n=22) at 4 geographically distinct urban and reservation sites. Focus groups and interviews were recorded and transcribed verbatim. The constant comparison method guided data coding and thematic analysis and Atlas.ti (Mac Version 8.0) was used to digitalize the analysis. Participants shared that smartphone-based Internet access is common among AIAN adults, except for the very old. Sixty percent of focus group participants indicated that they use the Internet at least daily. Participants reported interest in online education opportunities that are reputable, culturally adapted for AIAN people, and smartphone friendly. Educators and leaders indicated that access to a registered dietitian and food resource management education via online learning would provide Native people with the additional support needed to eat healthfully in communities with high rates of food insecurity and limited access to healthy food.

Disclosure

S.A. Stotz: None. A.G. Brega: None. K.R. Moore: None.

Funding

American Diabetes Association (4-18-SMSC-01 to K.R.M.)
667-P: Effect of the Diabetes BeHaS Program on Diabetes Self-Care, Diabetes Empowerment, and Physical Function in Older Adults with Type 2 Diabetes
Authors: PARK KEUMOK , KU BON JEONG , KIM BOHYUN , JIN SOHYUN , SONG YOUNGSHIN
Published: June 2019

The Be Happy and Strong (BeHaS) program was developed to improve self-esteem and physical function in 2006. In this study, the contents of BeHaS program was revised to include empowerment strategies (named of Diabetes BeHaS program) to improve diabetes self-care. The purpose of this study was to re-develop the Diabetes BeHaS Program in older adults with type 2 diabetes and its effect on diabetes self-care, diabetes empowerment, and physical function. Participants were recruited from a public healthcare center in S-city of South Korea. A matched subject design was used to allocate the intervention (n=31) and control (n=31) groups based on age, gender and HbA1c. Demographics, and clinical factors were checked via medical record. Researchers measured physical functions (handgrip strength and shoulder flexibility), and main variables were measured using validated instruments. Χ2-test and independent t-test were performed to confirm the homogeneity and the change scores of physical functions, diabetes self-care, and diabetes empowerment. Based on the empowerment theory, the Diabetes BeHaS Program were re-developed consisting of an education [10min/session] + diabetes empowerment strategies [10min/session] + physical activities [40min/session]), which was applied once a week by a trained nurse for two months. The change scores of physical functions (both hands grip strength [p <.001], shoulder flexibilities [p <.001]), diabetes self-care (p <.001) and diabetes empowerment (p <.001) were significantly increased in intervention group when comparing to counter group. The Diabetes BeHaS Program in older adults with type 2 diabetes that focused on empowering self-care might be an effective strategy to improve the diabetes self-care and diabetes empowerment as well as physical functions.

Disclosure

K. Park: None. B. Ku: Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes, Sanofi-Aventis. B. Kim: None. S. Jin: None. Y. Song: None.
675-P: Final Outcomes of a Four-Year Effort to Support, Scale, and Sustain the National Diabetes Prevention Program
Authors: MENSA-WILMOT YVONNE , MENSA-KWAO AUGUSTINA , FARRIS KIMBERLY D. , BOWEN SHELLY-ANN , THUMMALAPALLY SHARANYA , MURPHY MONICA D. , RUTLEDGE GIA E.
Published: June 2019

CDC’s State and Local Public Health Actions 1422 Cooperative Agreement funded 17 states and 4 large cities for four years to develop and sustain the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) by implementing comprehensive environmental, health system, and community-clinical linkage strategies for populations at high-risk for type 2 diabetes.

Objectives: (1) Describe health system and community-clinical linkage strategies implemented; (2) share findings from baseline to year 4, and (3) highlight key facilitators and barriers to scale and sustain the National DPP. Qualitative and quantitative data were analyzed from awardees’ annual performance reports and health impact statements. Performance measure data from baseline to year 4 were analyzed to determine year-to-year percent change. Qualitative data from awardees were analyzed to identify barriers and facilitators to implementing activities, and understand how barriers were overcome. Recipients and sub-awardees worked with partners across key sectors to implement evidence-based strategies and increase coverage and referral policies to promote engagement in CDC-recognized LCPs. Outcomes from baseline to year 4 will be shared on reach of diabetes prevention media campaigns, the number of people in health systems identified as having prediabetes, the number of health systems engaging community health workers, and the total number of people enrolled in CDC-recognized diabetes prevention programs. Barriers and facilitators to implementation of the National DPP will also be shared. Key lessons learned from SLPHA-1422 include the importance of leveraging existing programs and infrastructure (i.e., SPHA-1305 resources) to scale and sustain the National DPP, establishing strong partnerships across sectors, providing on-going training and technical assistance to recipients and prioritizing enrollment of participants in CDC-recognized LCPs.

Disclosure

Y. Mensa-Wilmot: None. A. Mensa-Kwao: None. K.D. Farris: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.
677-P: Bioimpedance Phase Angle in Diabetes and Change after an Interdisciplinary Care and Diabetes Self-Management Education Program
Authors: SILVA-TINOCO RUBÉN , CUATECONTZI-XOCHITIOTZI TERESA , CASTILLO-MARTÍNEZ LILIA , LEÓN-GARCÍA PLACIDO , CABRERA-GERARDO DOLORES , HERNÁNDEZ JORGE , FERREIRA-HERMOSILLO ALDO , ZÁRATE CLAUDIA , DELATORRE-SALDAÑA VIRIDIANA A.
Published: June 2019

Bioimpedance phase angle (PA) is an index of cellular health and function, and a high PA suggest better cellular membrane integrity and a higher cell mass. PA has been identified as a valuable measurement for the diagnosis, monitoring and prognosis of various disorders. We evaluated baseline differences and change in PA in patients who attended a five months Interdisciplinary Care and Diabetes Self-management Education Program in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa in 2018. In 327 persons with type 2 diabetes, PA was evaluated by bioelectrical impedance multifrequency analysis (Seca® 515/514, 50 Hz). Diabetes-related microvascular complications (MiVC) were defined by fundoscopy with mydriatic camera assessed by an ophthalmologist (retinopathy) and increased urine albumin/creatinine ratio and/or decreased estimated glomerular filtration rate (diabetic kidney disease). Women represented 67% and 56% had elementary or less education. Mean age was 55±10 years old, mean duration of diabetes was 12±8 years, 32.7% presented nephropathy and 24.8% retinopathy. Baseline PA was different among participants with or without MiVC (4.66±0.65 vs. 5.02±0.58, p<0.0001). Change in PA was different among participants with non-MiVC (5.02±0.58 to 5.11±0.62, p=<0.0001) but not among participants with MiVC (4.66±0.65 to 4.62±0.65, p=0.136) after the program. Diet self-care behavior improvement (2.6± 1.6 to 5.4±0.9 days/week, p=<0.001) and HbA1c reduction (9.45±2.0 to 6.7±1.2%, p=<0.001) were also observed with no differences among groups. Baseline PA was different according to the MiVC profile implying its prognosis and diagnosis role. PA improvement in persons with diabetes and absence of MiVC suggest a monitoring role of PA, but also suggest an added effect and the efficacy of this program since it favors the achievement of multiple diabetes care goals, that could be being reflected in PA as a marker of cellular integrity.

Disclosure

R. Silva-Tinoco: Speaker's Bureau; Self; Novo Nordisk Inc. T. Cuatecontzi-Xochitiotzi: None. L. Castillo-Martínez: None. P. León-García: None. D. Cabrera-Gerardo: None. J. Hernández: None. A. Ferreira-Hermosillo: Speaker's Bureau; Self; Sanofi, Takeda Mexico. C. Zárate: None. V.A. DeLaTorre-Saldaña: None.
682-P: Early Detection and Prevention of Dulaglutide-Induced Asymptomatic Nocturnal and Persistent Hypoglycemia in Patients with Advanced Diabetic Kidney Disease
Authors: NISHIHARA HARUMI , INOUE MAYA , UMEZU JUNKO , ARAI KAORI , SUDO TOMIKO , SASAKI JUNKO , KOIZUMI CHIAKI , SAITO MASUMI , SUNAGAWA HIROSHI , HIRAI AIZAN
Published: June 2019

Purpose: Dulaglutide, a long acting GLP-1 receptor agonist (GLP-1 RA) is reported to reduce decline in eGFR in patients with diabetic kidney disease (DKD). Dulaglutide has been applied to the treatment and prevention of advanced DKD. GLP-1RA is well known to suppress glucagon secretion from the pancreas. In advanced DKD, renal gluconeogenesis is reduced due to the progression of DKD, and thereby the incidence of hypoglycemia is increased in advanced DKD. However, hypoglycemia due to GLP-1RA is rarely reported in advanced DKD. The present study was performed in order to get further insight into the risk management of hypoglycemia in advanced DKD patients treated with GLP-RA using continuous glucose monitoring (CGM).

Methods: Eleven patients with advanced DKD (eGFR<45) were included in the present study. Whole patients were treated with dulaglutide over 1 year and no other hypoglycemic agents were administered. Two weeks CGM was performed using Free Style Libre Pro. In the case of nocturnal hypoglycemia, the effect of oral administration of medium-chain triglyceride (MCT), which directly stimulates hepatic glucose production, was studied.

Results: Two weeks CGM revealed that asymptomatic nocturnal and persistent hypoglycemia lasting 4 to 6 hours occurred in patients with advanced DKD during dulaglutide monotherapy. Late evening oral administration of a small amount (10-15g) of MCT is effective to avoid dulaglutide-induced nocturnal and persistent hypoglycemia.

Discussion: Dulaglutide-induced nocturnal hypoglycemia in advanced DKD may be attributed to reduced hepatic glycogenolysis and renal gluconeogenesis.

Conclusion: The present study firstly demonstrated that dulaglutide produced asymptomatic nocturnal and persistent hypoglycemia in patients with advanced DKD, which can be prevented by the administration of MCT. CGM is essential for early detection and prevention of dulaglutide-induced hypoglycemia.

Disclosure

H. Nishihara: None. M. Inoue: None. J. Umezu: None. K. Arai: None. T. Sudo: None. J. Sasaki: None. C. Koizumi: None. M. Saito: None. H. Sunagawa: None. A. Hirai: None.
692-P: Development and Adoption of CDISC Clinical Data Standards for Type 1 Diabetes (T1D)
Authors: OWEN JOHN M.
Published: June 2019

Development and adoption of global, non-proprietary and platform-independent CDISC standards a) enables traceability from data collection through data analysis, b) improves data quality, c) reduces costs, d) streamlines processes facilitating data sharing, and e) enables reliable and accurate data reuse.

CDISC collaborates with type 1 diabetes subject matter experts to lead a unique effort that brings academia and industry together to create T1D clinical data standards in the areas of pediatrics, devices, exercise, and prevention. The T1D team is tasked with developing standards for collection, tabulation, and analysis of the data by building on existing foundational diabetes standards. They will use a multiphase, consensus-driven process, that includes scoping key data concepts commonly used in T1D clinical studies.

The Pediatrics and Devices team has identified several data concepts that would benefit from development of data standards: diabetic ketoacidosis, diabetes history, CGM data, insulin management, laboratory tests related to diabetes, and vital signs percentiles for pediatrics. The public review of the standards developed will be launched in Summer 2019.

The Prevention and Exercise team has initiated the scoping process to identify the most urgent areas for standards development, which will be followed by modeling. The public review of these standards will commence beginning of 2020.

As the project progresses, the T1D community is encouraged to participate in the informational webinars and public review stages, which will enable all-inclusive development and adoption of the resultant data standards. Factors involved in the adoption of clinical data standards within organizations will be discussed.

Disclosure

J.M. Owen: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
7-OR: Effect of Dapagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, on Vascular Function in Patients with Type 2 Diabetes Compared with Gliclazide
Authors: LIM SOO , CHERNEY DAVID
Published: June 2019

Objective: Recent studies showed that sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce the risk of cardiovascular events and mortality in patients with type 2 diabetes (T2D). However, the mechanisms underlying this effect remain unclear. We compared the effects of dapagliflozin, a SGLT2 inhibitor, with those of gliclazide on vascular function in patients with T2D.

Research Design and Methods: This was a prospective, randomized, blinded-endpoint, comparative clinical trial. In 2016−2017, T2D patients treated with ≥750 mg of metformin (HbA1c, 7.5%−10.0%; n = 32) were enrolled and randomized to receive either gliclazide (30 mg/day) with uptitration, or dapagliflozin (10 mg/day) for 24 weeks. The primary endpoint was a change in flow-mediated dilation (FMD) from baseline to the end of the study. The secondary outcomes included changes in pulse wave velocity (PWV), microvascular reactivity, ankle-brachial index (ABI), and carotid intima-medial thickness (IMT). Biochemical parameters related to glucose homeostasis, atherogenic dyslipidemia, oxidative stress, and adverse events, were evaluated.

Results: Glycated hemoglobin and fasting glucose levels decreased significantly in both groups. The FMD, PWV, microvascular reactivity, and ABI improved significantly in the dapagliflozin group, but not in the gliclazide group. Lipoprotein(a), oxidized LDL, and thiobarbituric acid reactive substance levels decreased, whereas LDL particle sizes increased, in the dapagliflozin group exclusively. Hypoglycemia was more common in the gliclazide group.

Conclusions: Dapagliflozin therapy for 24 weeks improved vascular function, alleviated atherogenic dyslipidemia, and decreased oxidative stress in patients with T2D. Glucose independent changes in cardiometabolic risk factors may contribute to the cardiovascular benefits observed in clinical trials with SGLT2 inhibitors.

Disclosure

S. Lim: None. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Prometic Life Sciences Inc., Sanofi.
700-P: Treatment of New-Onset Type 2 Diabetes after Age 65: A Longitudinal Cohort Study
Authors: MISHRA PRANITA , GOPALAN ANJALI , GRANT RICHARD W.
Published: June 2019

As the U.S. population ages, more older adults will be newly diagnosed with type 2 diabetes (T2D). These individuals have a greater prevalence of comorbidities placing them at increased risk for T2D-related adverse drug events. We identified adults ≥ 65 within an integrated care system with newly diagnosed T2D, defined by a first elevated A1c (≥6.5%) with no evidence of T2D prior 18 months. We examined treatment initiation (metformin, sulfonylurea [SFU], insulin) during the 5 years following diagnosis among patients with 3 treatment-sensitive comorbid conditions (chronic kidney disease [CKD], dementia, frailty) at time of diagnosis. We compared A1c levels between treatment initiators vs. non-initiators and identified independent predictors of treatment initiation using multivariate logistic models. The 4,011 older adults with new T2D had mean age 72.2 ± 6.4 years, 53% were women, 50% were non-Hispanic white. Among those with advanced CKD (≥ stage 3b, 4% of cohort), nearly one-quarter (23%) were initiated on metformin (mean A1C 8.3 ± 2.7 vs. untreated 7.3 ± 1.4 p<0.01). Among people with dementia (1.8%), 27.8% were initiated on SFU (8.7 ± 1.2 vs. not treated 7.2± 1.2, p <0.01) and 8.3% on insulin (8.7 ± 2.8 vs. 7.5±1.5, p <0.34). Among frail elders (self-reported physically inactive [43%] or requiring a walker [5%]), 29.6% were started on SFU (8.6 ± 2.2 vs. not treated 7.2 ±1.4, p <0.01) and 7.5% on insulin (9.5 ± 2.8 vs. untreated 7.5 ± 1.6, p<0.01). Overall, 63% of the cohort was initiated on treatment, including 6.7% on insulin. Independent predictors of insulin initiation included age 65-74 (vs. 75+, aOR 1.42 [95% CI:1.03-1.95], p=0.03), higher A1c (aOR 4.86[3.60-6.56] per 1% increase), and presence of cardiovascular disease (1.52 [1.15-2.02], p<0.01). Among older adults with newly diagnosed T2D, treatment is frequently initiated among individuals with potentially risky co-morbid conditions. Our results suggest the need for more robust evidence-based guidelines tailored for older adults with newly diagnosed T2D.

Disclosure

P. Mishra: None. A. Gopalan: None. R.W. Grant: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
71-LB: Personal Metabolic Responses to Food Predicted Using Multi-omics Machine Learning: The PREDICT I Study
Authors: SPECTOR TIM D. , BERRY SARAH , CHAN ANDREW T. , DAVIES RICHARD J. , DREW DAVID A. , VALDES ANA M. , FRANKS PAUL W.
Published: June 2019

Background: Postprandial glycemic variations impact diabetes risk and are influenced by food consumed, a focus of major nutritional guidelines. However, a person’s biological characteristics and environment likely influence postprandial response.

Methods: In ∼1000 healthy UK (unrelated + DZ/MZ twins) and 100 unrelated U.S. adults, glycemic responses to a variety of meals were tested in clinic and at home (using CGM). Baseline factors included metabolomics, genomics, gut metagenomics and body composition. Genetic contributions to postprandial responses were determined by classical twin methods.

Results: Within-individual concordance in metabolic responses (2hr glucose iAUC) for pairs of isocaloric meals at home was moderate to high: high fat (fat = 40g/71% energy) (ICC=0.46, 95% CI:0.37,0.55), high protein (protein = 41g/32% energy) (ICC=0.54, 95% CI:0.44,0.62), high carb (carbohydrate = 95g/76% energy) (ICC=0.65, 95% CI:0.59,0.70), average lunch (carbohydrate = 68g/54% energy) (ICC=0.61, 95% CI:0.53,0.67), and OGTT (carbohydrate = 75g) (ICC=0.66, 95% CI:0.61,0.71). Inter-individual variability for the same meals was (IQRs: 20, 29, 45, 68, 76 mmol/L*min, respectively). Using the twin data, the unadjusted genetic contribution of postprandial glycemic responses in the clinic was 53%. An interim machine learning algorithm predicted 46% of the variation in glycemic responses based on meal content, meal context and the participant’s baseline characteristics, excluding genetic and microbiome features.

Conclusions: Variation in metabolic responses to the same meals between healthy people is high, helping explain why ‘one-size-fits-all’ nutritional guidelines often fail. The genetic component to these responses is moderate, which leaves much of the variation potentially modifiable. By collecting information on glucose responses to over 100,000 meals, we now have excellent power to use machine learning to predict which foods optimize responses.

Disclosure

T.D. Spector: None. S. Berry: Consultant; Self; Zoe Ltd. A.T. Chan: Consultant; Self; Bayer AG, Janssen Pharmaceuticals, Inc., Pfizer Inc. R.J. Davies: Employee; Self; Zoe Global Limited. D.A. Drew: Consultant; Spouse/Partner; PathAI. A.M. Valdes: Consultant; Self; Zoe Ltd Global. Research Support; Self; Pfizer Inc. P.W. Franks: Board Member; Self; Zoe Ltd. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Novo Nordisk Foundation, Sanofi, Servier.

Funding

UK National Institute for Health Research; UK Wellcome Trust; Zoe Global Limited
712-P: Lessons from a Pragmatic Trial to Implement a Patient Self-Management Support Program in Primary Care
Authors: FERNALD DOUGLAS , HESSLER DANIELLE M. , BOWYER VICKY , JORTBERG BONNIE , WEARNER ROBYN , FISHER LAWRENCE , DICKINSON PERRY
Published: June 2019

Advanced primary care models emphasize patient-centered care, including self-management support (SMS). Connection to Health (CTH) is a comprehensive, evidence-based SMS program that enhances interactions between primary care clinicians and patients. Uptake and maintenance of programs such as CTH in primary care have been limited by the inability of practices to adapt and implement program components into their culture, patient flow, and work processes. Thirty-six primary care practices participated in a three-arm, cluster-randomized trial to determine the incremental benefit of brief, targeted practice facilitation on the implementation of CTH. Practices receiving the CTH program, compared to those receiving only standard SMS education, showed significantly greater improvement in SMS activities (e.g., goal setting, action planning, patient follow-up, behavioral health discussions), as assessed by chart audit (p<0.022). Yet, there was variable practice-level use of the CTH tools during the 9-month intervention. Practices receiving practice facilitation used CTH more with patients with higher hemoglobin A1c levels and more comorbidity. Qualitative analysis of interviews and field notes point to barriers impeding uptake and maintenance of SMS: lack of visible champions, lack of shared vision, low interest in CTH/SMS, emergent higher priorities, clinician/staff turnover, and perceived redundancy of CTH. Facilitating factors included alignment with system priorities, role and time dedicated to SMS delivery, functional practice teams, and adapting CTH to fit with existing workflows. The overall effect of introducing the SMS program and facilitation support suggests primary care practices can improve their delivery of SMS to patients with T2DM with a brief targeted intervention. However, broadly implementing and sustaining SMS programs in primary care will require attention to overcoming barriers and building on individual practice’s facilitating factors.

Disclosure

D. Fernald: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. V. Bowyer: None. B. Jortberg: None. R. Wearner: None. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. P. Dickinson: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1R18DK096387-01)
714-P: How Often Do Patients on Insulin Therapy Measure Postprandial Glycemia and Modify Insulin Doses Accordingly? From an Online Survey in Spain
Authors: TEJERA CRISTINA , LECUMBERRI EDURNE , MUÑOZ-GARACH ARACELI , AMPUDIA BLASCO FRANCISCO JAVIER , AMPUDIA BLASCO FRANCISCO JAVIER
Published: June 2019

Introduction: Controlling postprandial glycemia (PPG) is critical to achieve glycemic targets and has been associated with poor cardiovascular outcomes. However, few patients measure PPG and even less make changes on treatment based on these data.

Objectives: To evaluate how often patients on insulin therapy analyze PPG and modify insulin doses based on these data. As secondary objectives, we evaluate how patients discussed PPG during the visits and the predictive factors for PPG measurement.

Material and Methods: This was an anonymous on-line cross-sectional observational study of an unselected sample of diabetes patients on insulin. Data were extracted from a questionnaire available in two internet sources: Canal Diabetes and the Spanish Diabetes Foundation. The study was approved by the Ethics Committee of the Fundación Jiménez Díaz Hospital in Madrid.

Results: Data presented as means ± (SD) or frequencies (%).

Among the predictive factors for PPG measurement and based treatment changes were diabetes type, follow-up setting (Specialized vs. Primary Care), insulin injection number and CGM use.

Conclusions: In this unselected on-line sample of insulin-treated adults, 50.7% measured their PPG, despite this was recommended by HCP and most (95%) considered PPG measurement as relevant. Therefore, improvement in diabetes education on PPG and its treatment is key to improve overall glycemic control.

Disclosure

C. Tejera: None. E. Lecumberri: None. A. Muñoz-Garach: Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis. F. Ampudia Blasco: None. F. Ampudia Blasco: None.
730-P: Inverse Association between Physical Activity and Blood Glucose Is Independent of Sex, Menopause, and Family History of Diabetes
Authors: HU XIANG , GU XUEJIANG
Published: June 2019

Objectives: Exercise training is critical to the prevention, treatment and management of diabetes and prediabetes. The present study was to investigate the association between physical activity and blood glucose, as well as the influence of sex, menopause status, and family history of diabetes.

Methods: Subjects with normal weight (body mass index ≥ 18.5 and < 25) were selected from REACTION study, and divided into inactive (moderate-to-vigorous-intensity physical activity [MVPA] < 30 min/week), low-degree (MVPA ≥ 30 and ≤ 420 min/week), and high-degree (MVPA > 420 min/week) active groups.

Results: A total of 2601 individuals with an average age of 57.85 ± 8.39 years were enrolled. Multivariate ANOVA uncovered that after adjustment for sex and menopause status and first-degree family history of diabetes respectively, fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), and glycated hemoglobin A1c (HbA1c) decreased through inactive, low-degree and high-degree active groups (all P for trend < 0.05). The association of blood glucose indexes with physical activity was independent of this association with sex and menopause status and family history of diabetes, respectively. Multivariate linear regression analyses showed that MVPA was an independent factor associated negatively with FPG (standardized β = -0.057, P = 0.003), 2hPG (standardized β = -0.094, P < 0.001), and HbA1c (standardized β = -0.071, P < 0.001), respectively.

Conclusions: Higher degree of physical activity was associated with lower blood glucose regardless of sex, menopause status, and family history of diabetes. MVPA is a negative factor associated with blood glucose independently. Physical activity with adequate time and intensity is strongly recommended to individuals with susceptibility to diabetes but without overweight/obesity.

Disclosure

X. Hu: None. X. Gu: None.

Funding

National Key Research and Development Program of China (2016YFC1305202); Wenzhou Science & Technology Bureau (Y20170047)
744-P: Associated Factors with Limb Muscle Volume Distribution in Type 2 Diabetes
Authors: MOTOYAMA KOKA , TAZOE SATOSHI , TAMAI ANNA , SAKURA TAKESHI , OHARA MASAYA , YAKUSHIJI YOSUKE , FUKUMOTO MARIKO , HOSOI MASAYUKI
Published: June 2019

Background: Type 2 diabetes (T2DM) and sarcopenia have a reciprocal association and could cause a vicious cycle. Resistance training has been proposed to prevent the cycle. It has been postulated that the associated factors with upper limb muscle volume (MV) and lower limb MV were different in T2DM. For efficient resistance training programs, it is needed to understand the factors affect to the imbalance between upper and lower limb MV in T2DM. Aim: We aimed to clarify the clinical associated factors for lower-to-upper limb MV ratio in T2DM.

Method: We assessed in 505 patients with T2DM visited at Osaka City Hospital (male: n=303, mean ages 63.5±13.1, female: n=202, mean ages 64.3±13.4). MV in upper and lower limb were measured by a bioelectrical impedance analysis. The association between lower-to-upper limb MV ratio and clinical parameters were investigated.

Results: Mean body mass index (BMI) were 26.2±5.0kg/m2 in male and 26.8±5.5kg/m2 in female. Mean lower-to-upper limb MV ratio were significantly lower in male than female (male: 2.9±0.3 vs. female: 3.2±0.5, p<0.001). Mean lower-to-upper limb MV ratio in male was correlated with age, BMI, visceral fat area (VFA), estimated GFR (eGFR), hemoglobin (Hb), C reactive protein (CRP). In female, that was correlated with age, BMI, VFA, Hb, CRP and HbA1c. Multiple regression analysis showed that BMI and Hb were the negative independent factors, and VFA and systolic blood pressure were the positive independent factors for lower-to-upper limb MV ratio in male T2DM (R2=0.262, p<0.001). In female T2DM, BMI was the negative independent factor for lower-to-upper limb MV ratio. Notably, VFA exhibit positive correlation to lower-to-upper limb MV ratio in male obese T2DM (r=-0.252, p=0.001), but VFA negatively correlated in male non-obese T2DM (r=0.244, p=0.006).

Conclusions: Gender, blood pressure, Hb and especially visceral obesity, were the important relevant factors for imbalance between upper and lower limb muscle volume in type 2 diabetes.

Disclosure

K. Motoyama: None. S. Tazoe: None. A. Tamai: None. T. Sakura: None. M. Ohara: None. Y. Yakushiji: None. M. Fukumoto: None. M. Hosoi: Speaker's Bureau; Self; Eli Lilly and Company.