bluuebunny/crossref_metadata_2025 huggingface dataset:
516-P: Objective and Subjective Physical and Mental Health Benefits in Older Adults with Cardiometabolic Risk after Diabetes Prevention Program (DPP)-Based Lifestyle Intervention
Authors: STERN HARRISON J. , MILLER RACHEL G. , CONLON RACHEL P.K. , LEVINE MICHELE D. , MARCUS MARSHA D. , VENDITTI ELIZABETH M.
Published: June 2021

Physical function, health-related quality of life (HRQoL), and depressive symptoms are key outcomes for older adults (≥65y) enrolled in behavioral weight management, but less is known about relationships among these variables. We evaluated associations between changes in these measures after a 1-year DPP-based lifestyle program. Participants (N=322) were M±SD age 71.2y±4.3, BMI 33.8±5.1, 77% women, 13% Black, averaged 4 chronic conditions, and 31% had prediabetes. Most took blood pressure (67%) and lipid (52%) medications. Participants attended 12 in-person weekly groups, then were randomized to continued monthly contact by phone or newsletter, losing 7.4% (CI) (-8.9, -5.9) and 6.1% (-8.6, -3.6) of weight at 1 year, respectively. Goals included reducing calorie/fat intake, increasing lean protein, ≥150 minutes aerobic activity/week, and strength training. Physical function was measured via Short Physical Performance Battery (SPPB) gait speed, chair rise, and balance tests, perceived HRQoL via SF-12 Physical and Mental Component Summary (PCS and MCS), and mood via Center for Epidemiologic Studies Depression Scale (CES-D) at pre- and post-intervention. Associations between baseline-12 month changes in SPPB, HRQoL and CES-D were estimated in mixed-effect models. SPPB improved by 0.3±1.4 (p=0.001) in phone and 0.3±1.7 (p=0.02) in newsletter. Increased SPPB was associated with improved PCS (β=1.18, SE=0.20, p<0.001) and CES-D (β=-0.50, SE=0.17, p=0.002) in all participants, and improved MCS in phone (β=0.19, SE=0.28, p=0.049) and decreased MCS in newsletter (β=-0.37, SE=0.22, p=0.049). After weight loss, regardless of follow-up mode, modestly improved physical function relates to greater perceived physical HRQoL and mood, but less change in perceived mental HRQoL. Future weight loss trials in high risk elders should evaluate how to optimize physical function and subjective well-being outcomes.

Disclosure

H. J. Stern: None. R. G. Miller: None. R. P. K. Conlon: None. M. D. Levine: None. M. D. Marcus: Advisory Panel; Self; Weight Watchers International, Inc. E. M. Venditti: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R18DK096405)
520-P: The Influences of Loneliness and Depression on A1C among Middle-Aged and Older Adults with Diabetes
Authors: HUANG YA CHING , GARCIA ALEXANDRA A. , CHO EMMA S. , KUO HSUANJU
Published: June 2021

Purpose: Loneliness and depression are significant challenges for middle-aged and older adults, and are associated with worse overall health. Even before the COVID-19 pandemic, about 43% of adults aged 60 and above reported experiencing loneliness. People with diabetes (DM) are 2 to 3 times more likely to have depression than those without DM. Loneliness and depression often co-exist and each is likely to worsen DM outcomes. The aim of this study was to examine how loneliness and depression affect A1C levels among middle-aged and older adults with DM.

Methods: This study is a secondary analysis of data from the Midlife in the United States Refresher (MIDUS-R) survey that included a national sample of U.S. adults aged 25 to 74 years. We conducted correlation analyses and estimated a hierarchical logistic regression to predict people with A1C levels ≤ 7 or > 7 using the following sets of predictors: 1) demographics and physical health (ethnicity, gender, education, age, and comorbidities), 2) family and friends support, and 3) psychological factors (loneliness and depression).

Results: The sample was composed of 92 participants with DM and A1C data in the MIDUS-R. Mean age was 57.37±11.83, 51% were male, and 68 % were non-Hispanic Whites; 39.1 % had A1C >7. The average level of depression was low (CES-D mean 9.42) and loneliness was moderate (mean 12.43, range 1-28). Loneliness was correlated with A1C (r= .26, p< .05); depressive symptoms (r= .71, p< .001), family and friends support (r=.36, r=.38, respectively, both p<.001). Only loneliness significantly predicted higher A1C levels in this analysis. People with higher levels of loneliness had increased odds of having an A1C >7 (OR = 1.18, p < .05) after controlling for depression and all other variables.

Conclusion: Loneliness is more prevalent and had a greater impact than depression on A1C level. Healthcare providers should assess patients for loneliness and reduce adverse health impacts by referring them for psychosocial interventions as needed.

Disclosure

Y. Huang: None. A. A. Garcia: None. E. S. Cho: None. H. Kuo: None.
530-P: Are Larger Support Networks More Helpful or Harmful for Adults with Type 2 Diabetes?
Authors: LEWIS BIANCA , KOLLIN SOPHIE R. , LEE AARON A.
Published: June 2021

Background: Adults with diabetes often receive self-management support from family and friends (care partners) living in and outside of their home. Helpful involvement from care partners (CPs) has positive impacts on diabetes self-management. Less is known regarding the relationship between the number of CPs and the level of helpful and harmful involvement. We examined the relationship between the number of in and out-of-home CPs and helpful and harmful involvement in patients’ diabetes self-management.

Methods: Adults with type 2 diabetes (N=369) were recruited from a web-based panel. Participants completed the Family and Friend Involvement in Adults’ Diabetes (FIAD) scale and reported the number of in and out-of-home CPs who provide help with their diabetes self-management. A two-step hierarchical linear regression was used to examine the linear and quadratic trends between number of in and out-of-home CPs and helpful and harmful involvement in diabetes self-care, controlling for age, sex, ethnicity, and socioeconomic status.

Results: There was a positive linear relationship between the number of in and out-of-home CPs, and helpful and harmful involvement (p’s; range < .001 to .003). The addition of quadratic terms accounted for a significant increase in explained variance in helpful and harmful involvement (p’s < .001). There was a positive trend between the number of in and out-of-home CPs and helpful and harmful involvement among adults with up to approximately 5 CPs. In contrast, there was a negative trend between these variables among individuals with 5 or more CPs.

Conclusions: Patients with a relatively small or large number of CPs, receive less helpful and harmful support. Large CP networks are not necessarily indicative of high levels of helpful involvement in patients’ diabetes self-care. CP interventions should attempt to enhance helpful involvement while minimizing harmful involvement in these populations.

Disclosure

B. Lewis: None. S. R. Kollin: None. A. A. Lee: None.
533-P: Diabetes Related Stigma among Black and Hispanic Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: CRESPO-RAMOS GLADYS , FINNAN MOLLY , GONZALEZ JEFFREY S. , AGARWAL SHIVANI
Published: June 2021

Objective: Young adults with T1D of racial/ethnic minority status suffer adverse outcomes compared with White peers. Diabetes-related stigma (DRS) is common and may contribute to poor outcomes in minority YA, but further study is needed.

Methods: We recruited non-Hispanic Black and Hispanic YA with T1D from pediatric and adult diabetes centers at Montefiore Medical Center in the Bronx, NY for a qualitative study to explore YA lived experiences with T1D, challenges to diabetes self-management, and healthcare interactions. We conducted semi-structured individual interviews, which were audio-recorded, transcribed, and analyzed for common themes until thematic saturation was achieved. We coded for DRS in YA responses using the Diabetes Stigma Assessment Scale (DSAS), which includes three domains for stigma due to having diabetes: 1) treated differently, 2) blame and judgment, and 3) identity concerns.

Results: We included 41 YA participants for analysis (mean age 21 yrs, 68% female, 73% Hispanic, 27% Black, mean HbA1c 10.3%). Seventy-eight percent of participants (n=32) qualified as having at least one experience consistent with DRS. Of those, approximately half of participants had experiences consistent with one domain of DRS, nine participants with two DRS domains, and three participants with all three domains. Each stigma domain (treated differently, blame and judgment, and identity concerns) was represented equally among participants with DRS experiences. Notably, several Black participants mentioned that they experienced race discrimination from healthcare providers related to diabetes self-management and outcomes.

Conclusions: In this sample of minority YA with T1D, DRS prevalence was very high and had some race-specific associations. Greater recognition of DRS and its contribution to poor outcomes among YA with T1D belonging to racial/ethnic minority groups is needed.

Disclosure

G. Crespo-ramos: None. M. Finnan: None. J. S. Gonzalez: None. S. Agarwal: None.

Funding

National Institutes of Health (K23DK115896)
539-P: Parental Anxiety and Accuracy of Risk Perception upon Receipt of Positive Results of Screening for Presymptomatic Type 1 Diabetes: Autoimmunity Screening for Kids (ASK)
Authors: RASMUSSEN CRISTY GENO , BAXTER JUDITH , DONG FRAN , BAUTISTA KIMBERLY A. , SEPULVEDA FLOR , FELIPE-MORALES DANIEL , REWERS MARIAN
Published: June 2021

Screening for islet autoantibodies (IAb) followed by education and monitoring of children at high risk for type 1 diabetes (T1D) substantially reduces incidence of diabetic ketoacidosis at diagnosis. We assess parental anxiety and accuracy of risk perception as part of ASK screening, education and monitoring program.

The 10-y risk of clinical diabetes is 70% in children positive for multiple IAb, 50% with single high-affinity, and 2% with single low-affinity (confirmed twice). As of March 2020, ASK had screened for IAb 23,847 general population children and further monitored 280, including 136 with 50-70% high risk and 144 with 2% lower risk; 9% had a first degree relative (FDR) with T1D. At each visit, parental risk perception and anxiety were assessed using the State Anxiety Inventory (SAI), with a score >40 denoting elevated anxiety. Reported here are results from the 1st visit (N=280) and for those with a 2nd visit (N=119).

At the 1st visit, parental anxiety was elevated (mean SAI=46.1) with no difference by child’s risk status, family history, or by which parent responded. SAI was significantly higher in ethnic minorities than in non-Hispanic whites (p<0.0001). Anxiety decreased between the 1st and 2nd education and monitoring visit from a mean of 46.1 to 43.8 (p=0.024), most notably in parents of high risk children (44.9 to 42.7 p=0.009) and FDRs (44.6 to 38.6, p=0.059).

Accuracy of risk perception was low at 49% and did not improve at the 2nd visit. FDR compared to non-FDR (83% vs. 46%, p=0.004) and parents of high risk compared to low risk children had a more accurate risk perception (61% vs. 37% p <0.0001).

Parental anxiety after learning of a child’s positive screening result decreased rapidly in families enrolled in monitoring. However, accurate perception of T1D risk appears less malleable during the initial 3-6 months of the monitoring. Tailored intervention for parents with inaccurate risk perception may be warranted.

Disclosure

C. Geno rasmussen: None. J. Baxter: None. F. Dong: None. K. A. Bautista: None. F. Sepulveda: None. D. Felipe-morales: None. M. Rewers: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; RTI, Research Support; Self; Janssen Research & Development, LLC, JDRF.

Funding

JDRF (3-SRA-2018-564-M-N)
544-P: Communication between Adolescents/Young Adults and Health Care Providers during Routine T1D Care
Authors: ZINN MARY E. , WANG CHRISTINE H. , BRYANT BREANA , MONAGHAN MAUREEN
Published: June 2021

Background: Adolescents and young adults (AYAs) are at higher risk for diabetes self-care challenges and elevated A1c. Understanding AYA/health care provider (HCP) communication may provide insight to better support T1D management. The current study examined content and quality of AYA/HCP communication during routine T1D care.

Methods: Thirty-two AYAs (M age=20.5 ± 9.1 yrs; 53.1% male; 43.8% non-Hispanic Black; M A1c=8.± 1.4%) and 9 HCPs (100% female) participating in an RCT promoting AYA health communication had a routine T1D visit audio-recorded and transcribed. A coding framework was developed to assess communication content and quality, including: AYA initiation, self-disclosure, preparation, and future planning; HCP goal setting, supportive language, problem-solving, education/information sharing, and warnings/threats. Coders double and triple-coded transcripts until 90% agreement was reached. Chi square analyses evaluated associations among codes.

Results: Routine T1D visits were primarily attended by AYAs alone (78.1%), ranging from 8-45 min (M=30.3 ±9.3). AYAs and HCPs spoke 27.0% and 69.1% of the visit, respectively. T1D adherence, lifestyle adherence, and developmental issues were discussed in all visits (100%); insurance, mental health, and T1D support systems were each discussed in 53.1% of visits. AYA preparation (e.g., bringing glucose values, regimen knowledge) was positively associated with HCP supportive language (X2(1,N=32)=5.7, p=.02) and HCP education (X2(1,N=32)=8.3, p<.01). HCP warnings/threats were identified in 25% of visits; 75% of AYAs in these visits had A1c levels ≥7.0%.

Conclusion: Results highlight reciprocal AYA-HCP communication. Improving AYA preparation for T1D care visits may facilitate more efficient and informative AYA-HCP interactions, potentially leading to improved T1D outcomes. Future studies will evaluate associations among communication and T1D outcomes over time, including A1c and transition to adult care.

Disclosure

M. E. Zinn: None. C. H. Wang: None. B. Bryant: None. M. Monaghan: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
553-P: The Type 1 Diabetes High-Fidelity Wraparound (T1D HFW) Program: An Option for the Management of High-Risk Youth?
Authors: SCHREIBER JUSTIN , NEVIN AMY G. , JONES LAUREN , PAYNE MONICA W. , NASH KENNETH C. , MUZUMDAR RADHIKA , LIBMAN INGRID
Published: June 2021

Despite advances in management, many young adolescents with T1D continue to struggle. Psychosocial factors play a major role. The T1D HFW Program is an innovative strategy to improve the adherence to medical regimens, including self-management and self-efficacy in high-risk youth. It is based on HFW, an evidence-based behavioral health concept described as a structured, team-based and individualized process that includes members who have experience either living with or raising a child with T1D. The aim of this pilot study is to test the feasibility and impact of this intervention in youth 11 to 16 years with T1D followed in a large academic diabetes center who are struggling with their management as defined by poor glycemic control and/or repeated emergency room visits and/or hospitalizations. Outcomes include assessment for behavioral, psychosocial and diabetes related measures with validated instruments. Seventeen youth enrolled and participated so far (58% females, 58% Caucasian, 23% African American, mean age 14±1.4 years, T1D duration 7.5±3.5 years, HbA1c at entry 10.3±2.3%, 65% with a deterioration in HbA1c, 45% prior diabetes related hospitalizations). A significant percent (57%) reported at least one traumatic experience including bullying (66%), witnessing violence (50%), physical/emotional abuse (33%). To date, eight families have transitioned out of the program after a mean of 6.5 months with 62.5% showing improvement and 25% no deterioration in HbA1c. Youth scoring positive for moderate depression on the PHQ-9 went from 27% to 9%. 1/3 of youth indicated positive results for generalized anxiety by the Screen for Child Anxiety Disorders (SCARED) with no change upon finishing the program. 60% of caregivers indicated a positive score on the Diabetes Distress Scale at start, which decreased to 20%. The T1D HFW program through personalized plans with identified support systems may be a promising strategy for youth struggling with T1D.

Disclosure

J. Schreiber: None. A. G. Nevin: None. L. Jones: None. M. W. Payne: None. K. C. Nash: None. R. Muzumdar: None. I. Libman: Advisory Panel; Self; Novo Nordisk.

Funding

Children’s Hospital of Pittsburgh Foundation
556-P: Codesigning a Diabetes Online Community Intervention for Adults with Type 1 and Type 2 Diabetes
Authors: LITCHMAN MICHELLE L. , SHOCKLEY CHERISE , GRIGORIAN ERNEST , WALKER HEATHER R. , WILSON ELLERY , THOMPSON ASHLEY , BLANCHETTE JULIA E. , RICE CHELCIE , HILLIARD MARISA E. , OSER TAMARA
Published: June 2021

Engagement in Diabetes Online Communities (DOCs) and diabetes online resources have proven benefits, including improved psychosocial, behavioral and clinical outcomes. However, patients report that finding credible and relevant information can be daunting. The aim of this study was to co-design an intervention with people with diabetes (PWD) to train “Peer Connectors” to help adults with type 1 and type 2 diabetes navigate DOCs and diabetes online resources to improve social support.

A community advisory board (CAB) of 11 diverse (race, ethnicity, age, diabetes type, diabetes duration) PWD who were active in a variety of DOCs convened over four 2-hour meetings to discuss and prioritize intervention components and outcome measures. Field notes and audio recordings were analyzed to guide development of the D-COPES (Diabetes - Connecting Online Peers to Enhance Support) intervention.

The CAB recommended three intervention components: 1) pairing participants to trained Peer Connectors based on matching characteristics/interests, (2) Peer Connectors delivering a small group intervention to orient participants to DOCs and online resources, and (3) Intervention content that includes tailoring to participants’ individual needs and how to identify misinformation. Recommended outcome measures focused on psychosocial (diabetes distress, empowerment), behavioral (self-efficacy, self-care), and clinical outcomes (A1C as secondary outcome), as well as usage of DOCs and online resources.

The co-design process centered the D-COPES intervention on avoidance of misinformation and provided strategies to expand the benefits of DOCs to PWD who might not otherwise have the knowledge and skills to engage most effectively. Co-design also served as a form of social validation, ensuring the intervention itself would be of interest and socially relevant to PWD. The D-COPES intervention will be iteratively piloted with 12 participants over 12 weeks.

Disclosure

M. L. Litchman: Research Support; Self; Abbott Diabetes. T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. C. Shockley: None. E. Grigorian: None. H. R. Walker: None. E. Wilson: None. A. Thompson: None. J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. C. Rice: None. M. E. Hilliard: None.

Funding

Dick and Timmy Burton Foundation
567-P: The Role of Family History In Self-Management of T2D: A Qualitative Examination
Authors: BLATCHINS MARUTA A. , XU KAREN , ALTSCHULER ANDREA , GRANT RICHARD W. , GOPALAN ANJALI
Published: June 2021

Adults diagnosed with type 2 diabetes (T2D) at a younger age are at increased risk for poor outcomes. We examined how family history of diabetes shaped the experiences and self-management perspectives of younger-onset individuals newly diagnosed with T2D.

We conducted six focus groups between Nov 2017 and May 2018. Participants (n=41) were members of an integrated healthcare delivery system, had been diagnosed with T2D during the prior two years, and were 21-44 years old at the time of diagnosis. Each group met twice for 60-90 minutes, two weeks apart. Groups were led by an experienced facilitator, audio-recorded, transcribed verbatim, and coded by two reviewers using thematic analysis.

The average age of participants was 38.4 years (±5.8 years); 20 were women, 10 self-identified as Latinx, 12 as Black, 12 as White and 7 as multiple or other races. Over 65% had a family history of T2D. Having a family member with T2D facilitated self-management in several ways. First, personal familiarity with T2D and related lifestyle changes, as well as advice from older relatives, led individuals to feel that they were capable of modifying behaviors and made adjusting to the diagnosis easier. In addition, family members with T2D served as both positive and negative role models that motivated individuals to adapt relatives’ health-promoting behaviors and take steps to avoid adverse outcomes. Conversely, for some, the perception that T2D diagnosis was inevitable was a barrier to initial self-care. Perceived lack of control over developing T2D due to family history of the disease led to feelings of self-blame and futility regarding self-management efforts.

Our results highlight the importance of recognizing how familial experiences impact patients’ ability to navigate a new T2D diagnosis. Proactively addressing perceived barriers to and facilitators of self-management in the context of family T2D history may aid in efforts to educate and support high-risk, younger patients establish a trajectory towards improved health.

Disclosure

M. A. Blatchins: None. K. Xu: None. A. Altschuler: None. R. W. Grant: None. A. Gopalan: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK116968); Kaiser Permanente Northern California
57-LB: Daily Communal Coping and Blood Glucose in Young Adult Couples with Type 1 Diabetes
Authors: YORGASON JEREMY B. , SAYLOR JENNIFER , BERG CYNTHIA , RELLAFORD SUSANNAH , STEEGER DANIELLE (ELLIE) L. , DAVEY ADAM
Published: June 2021

Young adulthood is a time when persons with type 1 diabetes (PWD) become more fully responsible for diabetes management. Establishing healthy diabetes routines during this period is foundational for successful management across adulthood, yet this age group experiences higher HbA1c levels and more frequent diabetes-related hospital visits than any other age group. New partnered relationships during young adulthood may play a crucial role in mitigating these risks. Long-term married couples with type 1 diabetes report poorer outcomes (lower self-care, lower physical health and higher HbA1c) when they report greater critical and overprotective behaviors from their spouse (Helgeson et al., 2019). Daily collaboration and support may be associated with poorer self-care (Berg et al., 2020). The objective of this study was to examine associations between daily communal coping and PWD blood glucose. Twenty-four young married couples (ages 20-37, M=25.7 years) wherein one spouse had T1D completed daily measures of communal coping (i.e., emotional support, instrumental support, over-protective behavior, illness avoidance, and controlling behavior) for 9 consecutive days. Daily average blood glucose and time-in-range were computed from PWD glucose meter or continuous blood glucose monitor. Results from multilevel models suggested that higher within-person (person mean centered) instrumental support (b = -1.38, p=.002) and overprotective (b = -1.36, p=.025) or controlling (b = -1.86, p=.027) spousal behaviors predicted lower PWD time-in-range. Higher between-person (grand-mean centered) overprotective spousal behaviors predicted higher PWD daily average blood glucose (b = 32.20, p=.002). Findings suggest that some young romantic partners may engage in behaviors that are associated with higher average PWD blood glucose and lower time-in-range.

Disclosure

J. B. Yorgason: None. J. Saylor: None. C. Berg: None. S. Rellaford: None. D. L. Steeger: None. A. Davey: None.
572-P: Impact of Isolation during the COVID-19 Pandemic on the Care of Older Adults with Type 1 Diabetes: A Qualitative Study
Authors: MUNSHI MEDHA , SLYNE CHRISTINE , SIFRE KAYLA , DAVIS DAI’QUANN J. , DEWAR RACHEL , SY SARAH M. , ATAKOV-CASTILLO ASTRID , MICHALS AMY , HAQUE SAIRA N. , NEUWAHL SIMON , CUMMINGS STIRLING , BROWN STEPHEN L. , WEINGER KATIE , TOSCHI ELENA
Published: June 2021

Background: Older adults with type 1 diabetes (T1D) face unique challenges, especially when their support structure is disrupted, as happened during the Covid-19 lockdown. We evaluated the clinical and psychological impact of this imposed isolation on the older population with T1D.

Methods: We conducted semi-structured interviews with older adults with T1D who were part of an ongoing study, which was paused from March - August 2020. The interviews were performed between May - August 2020, and were transcribed, coded, and analyzed using content analysis to derive theme. A multidisciplinary team of 12 individuals coded the interviews to identify the themes and included geriatricians, endocrinologists, a nurse educator, infomaticists, an economist, a methodologist, and research assistants.

Results: We have analyzed 12/35 interviews at this time; mean age 74±4 years, 50% female, 92% non-Hispanic white, mean duration of diabetes 37±18 years, and A1C 7.3±0.7%. Three main themes have emerged. The challenges related to diabetes care included fear of hypoglycemia, interruption in supply chain related to diabetes technology (insulin pump and continuous glucose monitoring (CGM) supplies), use of telehealth, diabetes-related distress, and adapting to new routines in self-care (diet and exercise). Challenges related to the Covid-19 pandemic included fear of getting Covid-19 infection, and a lack of reliable information on pandemic. The challenges related to psychological well-being included a feeling of isolation, loneliness, inability to spend time with family and friends, lack of in-person communication, and lack of recreational activity.

Conclusion: The results of this qualitative study help to understand critical areas of need when social support structures are unavailable to older adults with T1D. Our results will help develop intervention strategies to overcome barriers in maintaining support for this vulnerable population.

Disclosure

M. Munshi: Consultant; Self; Sanofi. S. Neuwahl: None. S. Cummings: None. S. L. Brown: Stock/Shareholder; Self; Pfizer Inc., Siemens Corporation. K. Weinger: None. E. Toschi: Consultant; Self; Medtronic. C. Slyne: None. K. Sifre: None. D. J. Davis: None. R. Dewar: None. S. M. Sy: None. A. Atakov-castillo: None. A. Michals: None. S. N. Haque: None.

Funding

National Institutes of Health (1DP3DK112214-01)
574-P: GoFundMe Isn’t a Medical Plan
Authors: BLANCHETTE JULIA E. , TRAN M.J. , IACOB ELI , OSER TAMARA , GRIGORIAN ERNEST , EDELMAN LINDA S. , LITCHMAN MICHELLE L.
Published: June 2021

The rising cost of insulin, costly insurance premiums and the popularity of high deductible insurance plans have resulted in decreased access to insulin. People with diabetes who need financial support for insulin turn to crowdfunding websites, such as GoFundMe, to raise funds. It is unknown if crowdfunding is successful in funding insulin campaigns. This study aims to explore the success and contributing factors for crowdfunding insulin requests in the United States (US). In this retrospective, descriptive study, data were extracted from GoFundMe insulin campaigns for human use in the US from February to April 2019. Data were coded for the following characteristics: campaign requestor, the reason for the request, facial recognition age, gender and race, education level of the post (Flesch-Kincaid), diabetes type, insurance status, disability status, and previous request for pharma support. Descriptive statistics and chi-square tests were utilized to describe and analyze the campaign requestor, purpose and success rate, and contributing factors to campaign success. Of 205 GoFundMe campaigns, 114 (55.0%) were started by the person with diabetes (as opposed to family/friends). Campaigns were created due to insurance issues (i.e., loss of insurance, inadequate insurance coverage; N=125, 61.0%) and requested a median of $1,100 ($50-$200,000), and raised a median of $65 ($0-$6,920). A mean of 29.5% (± 0.6%) of the requested campaign amounts were met. There were no differences in funded status by the characteristics tested. Those who requested lower amounts of money <$500 were more likely to achieve funding X2(1, N=205) = 9.6, p<.01. Despite crowdfunding websites being used to augment insulin purchases, campaigns raise only a fraction of the money requested. Generally, crowdsourcing for insulin is not successful. Diabetes providers should routinely assess their patients’ ability to access insulin and provide resources as needed. People with diabetes must understand the limited success of crowdfunding insulin online.

Disclosure

J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. M. Tran: None. E. Iacob: None. T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. E. Grigorian: None. L. S. Edelman: None. M. L. Litchman: Research Support; Self; Abbott Diabetes.
576-P: Maintenance of Time-Restricted Eating in Daily Life to Lose Weight and Lower Risk of Type 2
Authors: BJERRE NATASJA , HOLM LOTTE , QUIST JONAS S. , FÆRCH KRISTINE , HEMPLER NANA F.
Published: June 2021

Background: Effective weight loss maintenance interventions are a key factor to lower the risk of type 2 diabetes (T2D), and time-restricted eating (TRE) is a novel strategy which has proven successful in obtaining a weight loss in a few studies. This study examined if people with overweight or obesity at high risk of T2D were able to maintain TRE in real-life settings.

Methods: Participants were recruited from the randomized controlled RESET study, an RCT investigating effects of TRE on body weight and other cardiometabolic risk factors. Semi-structured interviews were conducted with a subgroup of 20 participants allocated to 12 weeks of TRE (i.e., consuming all foods and beverages within a 10-h window). The intervention was followed by a 12-week follow-up period with no intervention. All participants were interviewed at the end of intervention and again at 12-week follow-up. Data were analyzed using a thematic analysis approach.

Result: Participants had a positive attitude towards TRE, and seven wished to maintain it stringently during the follow-up period. Half of the participants wished to maintain an individually adjusted TRE concept by e.g., drinking coffee outside the interval or exceeding it at social events. Some participants found it easy to maintain TRE stringently, while two struggled to do so. A few participants were able to maintain their individually adjusted TRE concept, while seven found it too intrusive. Particularly the degree of daily life structure, meal pattern organization and social support determined maintenance success. The three remaining participants chose not to maintain TRE in the follow-up period and experienced a relief when going back to usual rhythms.

Conclusion: Elements from the TRE concept were highly valued by most participants, but it often required individual adjustments in order to undertake TRE on a longer-term basis. A tailored fit to daily life activities is therefore crucial to maintain TRE which underlines the complexity of long-term maintenance.

Disclosure

N. Bjerre: None. L. Holm: None. J. S. Quist: None. K. Færch: Board Member; Self; ChemoMetec, Research Support; Self; Novo Nordisk Foundation, Stock/Shareholder; Self; Novo Nordisk A/S. N. F. Hempler: None.

Funding

Novo Nordisk Foundation; Helsefonden (20-B-0109)
579-P: Behavioral Outcomes of a Digital Health Coaching Program Stratified by Baseline A1C: A Real-World Retrospective Analysis
Authors: MARTIN MEGAN , PATTERSON JONATHAN , TRAN VANESSIA T. , OCONNOR BLAKELY B. , ALLISON MATTHEW , PATEL DHIREN
Published: June 2021

Background: The 2021 ADA Standards of Medical Care suggest digital health coaching (DHC) programs can be beneficial in treating diabetes. As programs expand, it is increasingly important to understand expected benefits for diverse populations. Studies have shown greater clinical impact for patients with suboptimal baseline health, yet little is known about the influence of health on behavioral outcomes. In this real-world study, we analyzed trends in lifestyle change by baseline A1c following exposure to a T2DM DHC program.

Methods: The 12-week DHC program, including patient-centered phone, email and/or text interactions, was delivered to T2DM patients. Retrospective analysis of patient reported data at baseline and program completion was conducted to evaluate impact on engagement in CDC recommended physical activity and healthy meal consumption (defined by USDA MyPlate guidelines). Outcomes were analyzed for 3 cohorts stratified by baseline A1c (<7% 7-9%, >9%) using Wilcoxon matched-pairs signed rank tests and paired proportion tests.

Results: Individuals who completed all measures (n=130) were included in the study. A majority (82.30%) reported a baseline A1c ≥ 7%, and 27.69% were high-risk (A1c > 9%). Across all cohorts, there were significant improvements in the percent of participants adherent to CDC guidelines, median weekly activity minutes and number of healthy meals (p<0.01). For subgroup analyses, weekly activity minutes improved the most for the A1c < 7% cohort (50 minutes; p<0.01). Change to weekly healthy meals was greatest for those with an A1c ≥ 7%.

Conclusions: Outcomes suggest that DHC can improve lifestyle behaviors among all individuals with T2DM, irrespective of baseline A1c, with those at an elevated glycemic risk reporting the greatest dietary benefit and those with the lowest risk reporting the greatest shift in physical activity. If confirmed, findings may inform DHC referral strategies and individualized behavioral goals.

Disclosure

M. Martin: Consultant; Self; PACK HEALTH. J. Patterson: None. V. T. Tran: None. B. B. Oconnor: Employee; Self; Pack Health. M. Allison: None. D. Patel: None.
581-P: It Is What It Is...You Don’t Have to be Perfect: Life after T1D Diagnosis
Authors: GARZA KIMBERLY P. , HOWARD KELSEY R. , SMITH NICHOLAS DAVID W. , WEISSBERG-BENCHELL JILL , FELDMAN MARISSA
Published: June 2021

Purpose: A T1D diagnosis can have a profound psychosocial impact on families, and adaptation post diagnosis is critical for long term well-being. This study sought to assess the psychosocial experiences of families during the first year following T1D diagnosis.

Method: Focus groups and interviews with children diagnosed with T1D between 8-12 years of age within the past two years (n=10) and parents (n=16) were conducted to explore the feelings, challenges, and experiences of that first year. Transcripts were analyzed using thematic analysis and deductive coding.

Results: Children reported fear of needles and concerns about their relationships with peers, family and teachers changing once people knew of their diagnosis. They expressed annoyance with the number of questions asked of them and the intrusion of diabetes tasks in activities. Children and parents experienced feelings of distress, isolation, and sadness during the first year and were overwhelmed by the amount of information they were required to master. Parents expressed distress over keeping their child safe while also managing the emotional burden of diagnosis. Parents reported frustration with their inability to recall the content of their diabetes education and the calculations necessary to maintain “ideal” blood sugars. After receiving formal education, families reported fear and anxiety around managing food and insulin, concern about hyper- and hypoglycemia, feeling overwhelmed by the practical demands, like supply management, and a general lack of support. Most parents felt the need for their child maintain perfect blood sugars and a sense of hopelessness in trying to do so.

Conclusions: Prior research has shown that individuals who are overwhelmed, worried, or sleep-deprived find it more difficult to learn new content. Our results suggest the need for an alternate approach to education at diagnosis that provides families with increased psychosocial support in a way that assists families during this first year, a time of learning and change.

Disclosure

K. P. Garza: None. K. R. Howard: None. N. W. Smith: None. J. Weissberg-benchell: None. M. Feldman: None.

Funding

JDRF (2-SRA-2020-985-S-B)
584-P: Diabetes Distress, Depressive Symptoms, and Gender Disparities in Glycemic Control among African Americans with Type 2 Diabetes
Authors: HAWKINS JACLYNN M. , KOSCIELNIAK NIKOLAS J. , NWANKWO ROBIN , FUNNELL MARTHA M. , KLOSS KATHERINE A. , HALL DIANA , PIATT GRETCHEN
Published: June 2021

Despite advances in diabetes self-management education and support (DSMES), disparities persist in clinical, behavioral, and psychosocial outcomes. Evidence suggests that, in addition to racial/ethnic disparities in diabetes self-management, gender disparities in glycemic control (A1c) exist in patients with type 2 diabetes (T2D). However, there is a knowledge gap in determining if gender differences in A1c are mediated by Diabetes Distress (DD) and/or Depressive Symptoms (DS), or if gender moderates this relationship. Therefore, we aimed to investigate the relationship between gender, DD, DS, and A1c in 94 African American adults with T2D from 9 churches in metro-Detroit, MI. All churches participated in a 15-month, cluster randomized controlled trial focused on DSMS efforts to maintain T2D outcomes following DSME. DD was defined as DD Scale score >=3. DS was measured with the PHQ-9. PHQ-9 was categorized into no DS (PHQ-9 score < 5), minimal DS (PHQ-9 score >=5<10), and depression (PHQ-9 scores >=10). Participants were 44% male, had a mean age of 65.0±10.46 years, and 32% were prescribed insulin. Mean baseline A1c was 7.1±1.7 (males: 7.4±2.0; females: 6.9±1.5, p=0.78). 34.4% of participants reported having DD. More females (35%) reported DD compared to males (31.2%) p=0.72. Approximately 63% of participants reported no DS, 21% reported minimal DS, and 16% reported having DS. There were no differences in PHQ-9 scores when stratified by gender (p=0.17). Mixed effects logistic regression revealed that gender did not moderate the relationship between DD or DS and A1c. However, DD mediated gender differences in A1c (β=-1.7, p=0.02) but DS did not (β=-0.25, p=0.76). Gender differences in a1c for patients with T2D may be attributable to DD, but not DS. As females traditionally report higher DD levels than males and a1c is often worse in males than females, increased attention to these gender differences is warranted, particularly among African Americans.

Disclosure

J. M. Hawkins: None. N. J. Koscielniak: None. R. Nwankwo: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. K. A. Kloss: None. D. Hall: None. G. Piatt: None.

Funding

National Institutes of Health (5R01DK10473305)
592-P: Patient Perception of RT-CGM for Lifestyle Change Six Months after Two Sessions of RT-CGM
Authors: PORTER MICHAEL W. , NEEDLEMAN LEOR , RAMHMDANI SEBA , EHRHARDT NICOLE M.
Published: June 2021

Background: Real-time continuous glucose monitoring (RT-CGM) provides glucose readings to patients with diabetes, potentially supporting self-care. Preliminary data suggests efficacy of these devices influencing behavior change but data are limited on the sustainability of this change following short term use.

Methods: Following completion of a 14 week intervention involving use of RT-CGM as a behavior modification tool, a 6 month follow up survey was conducted. The survey included ten questions evaluating the impact of the subject's participation in the study on their continued lifestyle and health. The final question of the survey inquired if the subject had a significant other available to answer questions regarding their awareness of the subject's participation and impact on their own lifestyle choices.

Results: Twenty-two participants with diabetes participated in the initial intervention, of which sixteen responded to the survey. In the six months since their participation, 100% of respondents reported that CGM continues to contribute to a healthier lifestyle. 75% reported that they have excluded or limited certain foods as a result of participating and participation has motivated them to increase activity level. If available, 88% reported that they would you like to wear a CGM device on a regular basis. 68.8 % reported subjective weight loss since participating in the study with 7 (63.7%) of those participants reporting a weight loss of 10lbs or greater. Of the 16 participants, 3 subjects had a significant other that lived with the subject throughout the study and was able to be contacted. Of these three, 1 reported feeling healthier and changing their food choices as a result of their partner wearing a CGM.

Conclusion: In patients with diabetes, RT-CGM creates a sustainable lifestyle impact 6 months following use and is a desired tool for self care. However, longer prospective studies need to be completed. Further evaluation of RT-CGM contribution to the “health” of the household is also needed.

Disclosure

M. W. Porter: None. L. Needleman: None. S. Ramhmdani: None. N. M. Ehrhardt: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk.
593-P: Effectiveness of Digital Therapeutics to Improve Clinical Outcomes in Patients with Type 2 Diabetes Mellitus on Insulin Therapy
Authors: ADHIKARY RISHI R. , KOLWANKAR SIDDDHESH , VERMA RITIKA , BHATT JITESH , PAKHALE KETAN L. , SAHAY RAKESH
Published: June 2021

Background: Diabetes self-management education and support (DSMES) is integral towards maintaining continuity of care between physician visits especially for patients on insulin therapy to facilitate healthy coping. The present study explores the usage patterns and real-world effectiveness of the Wellthy CARE™ digital therapeutic (WDTx) platform in achieving glycemic control among patients with type 2 diabetes mellitus (T2DM) on insulin therapy.

Methods: The WDTx platform consists of a smartphone application with a 52-week program to provide DSMES through self-monitoring of blood glucose, access to evidence-based content regarding insulin usage and remote guidance by a health coach to enable lifestyle modifications and healthy coping. All app interactions were analyzed at baseline and during the program to determine factors driving patient engagement and clinical outcomes.

Results: Study participants (n=106) had a mean age of 51.4 years (SD 14.0 years) and consisted of 39 females (36.8%). Overall, a significant mean decrease in average blood sugar (ABS) by 29.9 mg/dl (95%CI 16.6-43.3 mg/dl, P<0.001) was observed with a 31.9% reduction in proportion of hypoglycemia logs and an average of 6.1 app interactions per patient per week on the platform thus proving continuity of care provided through WDTx. Users in the highest tertile for early app interactions (within week 1) demonstrated a significant mean decrease in ABS by 30.8 mg/dl (95%CI 7.5-54.0 mg/dl, P<0.01) while no significant change was seen in the corresponding lowest tertile. Over the entire program, users in the tertile with highest app engagement showed a significant mean decrease in ABS of 27.4 mg/dl (95%CI 8.8-46.1 mg/dl, P<0.01) as compared to no significant change in the lowest tertile.

Conclusion: This study thus demonstrates the effectiveness of the WDTx platform to impart critical DSMES, maintain continuity of care and improve clinical outcomes in patients with T2DM on insulin therapy.

Disclosure

R. R. Adhikary: Employee; Self; Wellthy Therapeutics Pvt Ltd. S. Kolwankar: Employee; Self; Wellthy Therapeutics Pvt Ltd. R. Verma: Consultant; Self; Wellthy Therapeutics Pvt Ltd. J. Bhatt: Employee; Self; Wellthy Therapeutics Pvt Ltd. K. L. Pakhale: None. R. Sahay: Advisory Panel; Self; Cipla Inc., USV Private Limited, Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Pharma Ltd.
596-P: Machine Learning Prediction of Blood Glucose in Hospitalized Patients
Authors: ZALE ANDREW D. , ABUSAMAAN MOHAMMED S. , MATHIOUDAKIS NESTORAS
Published: June 2021

Background: Inpatient glucose management can be challenging due to various evolving factors that influence a patient's blood glucose (BG). Providers could benefit from a clinical decision support tool that predicts the trajectory of a patient's BG reading. The purpose of our study was to predict the category of a patient's next BG reading based on electronic medical record (EMR) data.

Methods: EMR data from 184,361 admissions, containing 4,538,418 BG readings from five hospitals in the Johns Hopkins Health System were collected over a 4.5 year period. The outcome was category of next BG reading: hypoglycemic (BG <=70 mg/dl), controlled (BG 71-180 mg/dl), or hyperglycemic (BG >180 mg/dl). A LogitBoost machine learning algorithm that included a broad range of clinical predictors was used to predict the outcome and validated internally (within one hospital) and externally (between different hospitals).

Results: Our machine learning model achieved 86.2% (95% CI: 86.1%-86.2%) accuracy on internal validation and 80.4%-83.2% on external validation. On internal validation, the positive likelihood ratio (+LR) for a prediction of controlled, hyperglycemic, and hypoglycemic were 2.4, 12.3, and 47.4 respectively; the negative likelihood ratio (-LR) for a prediction of controlled, hyperglycemic, and hypoglycemic were 0.09, 0.38, and 0.99 on internal validation. From a safety standpoint, only 0.23% of hyperglycemic observations were predicted to be hypoglycemic on internal validation. On external validation, the +LR for prediction of controlled, hyperglycemic, and hypoglycemic were 2.2-2.8, 6.3-8.5, and 23.1-62.7; the -LR for a prediction of controlled, hyperglycemic, and hypoglycemic were 0.13-0.16, 0.32-0.42, and 0.98-0.99.

Conclusions: A machine learning algorithm accurately predicts the category of a patient's next BG reading. Further studies should determine the success of implementing this model into the EMR to decrease the rates of hypoglycemia and hyperglycemia in hospitalized patients.

Disclosure

A. D. Zale: None. M. S. Abusamaan: None. N. Mathioudakis: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK111986)