bluuebunny/crossref_metadata_2025 huggingface dataset:
485-P: Alternate-Day Fasting and the 5:2 Diet Alleviate Distal Symmetric Polyneuropathy by Regulating Gut Microbiota and Metabolites
Authors: YUAN HUIJUAN
Published: June 2024

Objective: Intermittent fasting (IF) regimens such as alternate-day fasting (ADF) and the 5:2 diet have shown promise in mitigating diabetes mellitus (DM). We aimed to investigate whether IF by altering the gut microbiota and related metabolites promotes distal symmetric polyneuropathy (DSPN), which is the most common neuropathy in patients with DM.

Methods: Male db/db mice were subjected to ad libitum feeding, ADF, or the 5:2 diet to observe peripheral nerve function with or without an antibiotics cocktail treatment. Then we further verified the causality of the above symptoms by fecal microbiota transplantation.

Results: Both ADF and the 5:2 diet improved DSPN, fortified gut barrier function and reduced inflammatory factor levels while causing changes in microbiota. Lactobacillus, etc were enriched in ADF diet-treated mice, Mucispirillum, etc increased in 5:2 diet-treated mice. Furthermore, ADF increased levels of metabolites such as gamma-tocopherol while the 5:2 diet increased levels of n-acetylhistamine and asparagine, and both diets decreased levels of n-acetylputrescine and phenylacetic acid. However, depletion of gut microbiota via antibiotics negated the neuroprotective effects of ADF and the 5:2 diet. Pseudo germ-free mice that received fecal transplants from ADF or 5:2 diet-treated mice exhibited improved peripheral nerve function and reduced inflammatory factor levels. Similarly, the stools from ADF increased the abundances of gamma-tocopherol, while the 5:2 diet decreased N-acetylputrescine, both repaired gut barrier in colonic epithelium of pseudo germ-free mice.

Conclusion: Gut microbiota plays a significant role in the onset and progression of DSPN. Both ADF and the 5:2 diet appear to ameliorate DSPN by regulating gut microbiota, altering gut metabolites, reducing inflammatory factor levels and restoring gut barrier function.

Disclosure

H. Yuan: None.

Funding

National Natural Science Foundation of China under Grant (81970705, 82270865)
488-P: Phosphatidate Phosphatase Lipin1 Is Involved in the Development of Diabetic Encephalopathy by Regulating the Homeostasis of Mitochondria-Associated Endoplasmic Reticulum (MAMs)
Authors: CHEN SHIHONG , ZHUANG XIANGHUA , YU SHUYAN , HUANG SHAN , HAN XIAOLIN
Published: June 2024

Introduction & Objective: Diabetic encephalopathy (DE) is a common chronic central nervous system complication without clear elucidation of pathogenesis as well as effective therapy currently. Mitochondria-associated endoplasmic reticulum membrane is a dynamic contact site connecting mitochondrial membrane with endoplasmic reticulum (ER) membrane, where phospholipid components are exchanged to each other. Our previous work has revealed that Lipin1, a critical enzyme related to phospholipid synthesis, involves in the pathogenesis of DE. However, it needs further investigation whether Lipin1 affects cognitive function via regulating the homeostasis of MAMs in neurons of DE.

Methods: We used C57BL/6J mice in vivo and HT-22 neuronal cells in vitro to construct DE models and Lipin1-targeted regulation models to detect any changes in MAMs, ER stress, mitophagy, dendritic structure and cognitive function. Statistics were analyzed by using t-test and one-way ANOVA.

Results: Here, we demonstrate that Lipin1 is significantly reduced in hippocampus of DE mice. Knockdown of Lipin1 within hippocampus or neurons induces significant structural and functional impairment of MAMs with the enhancement of ER stress and mitophagy, and then leads to impaired dendritic structure and cognitive dysfunction, similar to that observed in DE. In contrast, up-regulation of Lipin1 within hippocampus or neurons in the DE model ameliorates this cascade of dysfunction.

Conclusion: Lipin1 deficiency in response to chronic hyperglycemia contributes to the imbalance of MAMs homeostasis in hippocampal neurons, accompanying the enhancement of ER stress and mitophagy, and finally leads to cognitive deficits observed in DE.

Disclosure

S. Chen: None. X. Zhuang: None. S. Yu: None. S. Huang: None. X. Han: None.

Funding

National Natural Science Foundation of China (82170828,82070847, 82270869) and the Natural Science Foundation of Shandong Province (ZR2021LSW016).
50-PUB: Maternal Apolipoprotein C3 and Diabetes in Pregnancy in a High-Risk Cohort
Authors: VAZQUEZ LAURA , VAZQUEZ ARREOLA ELSA , LOOKER HELEN C. , HANSON ROBERT L. , WASAK DOROTA , CABALLERO RACHEL , SINHA MADHUMITA
Published: June 2024

Introduction & Objective: Apolipoprotein C-III (ApoC3) regulates lipid metabolism by inhibiting lipoprotein lipase and reducing hepatic triglycerides uptake, higher levels associate with insulin resistance (IR). The role of ApoC3 in pregnancy is unclear. We study if apolipoprotein levels differ in women with diabetes in pregnancy.

Methods: Among 66 pregnant women (Hispanic and Indigenous American) in the Early Tracking of Childhood Health Determinants (ETCHED) study (April 2022-September 2023), 22 (33%) had diabetes. Baseline maternal prenatal lipids (triglycerides, total cholesterol, HDL-C, ApoA1, ApoB, and ApoC3 measured by immunoenzymatic assay) and glycemic markers (fasting glucose and insulin, HbA1c, C-peptide) were compared by diabetes status; IR was estimated by HOMA IR. Cord blood fructosamine, C-peptide, and apolipoproteins were analyzed in a subset (n=40).

Results: Table 1 contrasts measures in pregnancies by diabetes. In women with diabetes, pregestational BMI, glycemic markers, HOMA IR, and ApoC3 were higher. Cord-blood fructosamine levels were higher in offspring of mothers with diabetes. In similar analyses by hypertension in pregnancy the only difference between groups was higher pregestational BMI (p<0.001) in hypertensive women.

Conclusion: Women with diabetes in pregnancy had higher levels of ApoC3 and increased insulinemia, compared to those without it; ApoC3 may be a marker of IR in pregnancy.

Disclosure

L. Vazquez: None. E. Vazquez Arreola: None. H.C. Looker: None. R.L. Hanson: None. D. Wasak: None. R. Caballero: None. M. Sinha: None.
507-P: Human Liver-Specific Regulation of Lipogenesis by Long Noncoding RNA hLMR1
Authors: JASO VERA MARCOS E. , TAKAOKA SHOHEI , RUAN XIANGBO
Published: June 2024

Hepatic de novo lipogenesis (DNL) significantly contributes to circulating triglycerides in the presence of high carbohydrate diets, making liver-specific inhibition of DNL an attractive strategy for relieving hypertriglyceridemia to control coronary artery disease (CAD) risk. We recently identified a human lncRNA, hLMR1 (Gene symbol: LOC100507389), which promotes hepatic cholesterol synthesis. Our unpublished follow-up studies demonstrated that genetic variants associated with elevated blood triglyceride levels predispose carbohydrates-induced hLMR1 expression, and hLMR1 positively regulates the expression of glycolytic and lipogenic genes. The aim of this work is to define how hLMR1 regulates glycolysis and lipogenesis. ChiRP-Seq, a high-throughput sequencing method to discover regions of the genome that are bound by a specific RNA, was performed using hLMR1 targeting probes in human liver tissues. hLMR1 target genes were measured in cultured human hepatocytes and a humanized liver mouse model upon knocking down of hLMR1. One-way ANOVA is being used for the statistical analysis. We found that hLMR1 is robustly upregulated by carbohydrates and knocking down of hLMR1 in humanized livers resulted in decreased expression of genes in the glycolysis and lipogenesis pathway. Furthermore, hLMR1, and its interacting protein, PTBP1, positively regulate the expression and interact with an enhancer region of ChREBP-β, a known transcription factor strongly associated with hepatic lipogenesis and blood triglyceride levels in humans. As a human liver-specific lncRNA, hLMR1 positively regulates glycolysis and lipogenesis, likely by inducing the expression of ChREBP-β. Our future work will further explore the role of this hLMR1-ChREBP-β signaling pathway in high carbohydrate diet-induced fatty liver diseases and hypertriglyceridemia using the humanized liver mouse model.

Disclosure

M.E. Jaso Vera: None. S. Takaoka: None. X. Ruan: None.
51-OR: Vascular Sorbs2 Deficiency Is an Independent Risk of Vascular Complications in Diabetes
Authors: XIONG XIAOWEI , SUN XIAOJING , LEE HON-CHI , LU TONG
Published: June 2024

Introduction & Objective: We have recently reported that Sorbs2 (sorbin and SH3 domain-containing 2) proteins are abundantly expressed in vasculature and linked to BK channelopathies in Sorbs2 null mice. However, the role of Sorbs2 on vascular physiology is unknown.

Methods: We created the vascular smooth muscle cell (SMC)-specific Sorbs2 KO (SMC-Sorbs2 KO) mice. We examined BK channel activity and BK channel-mediated vasodilation in the coronary arteries of these animals as well as db/db and high-fat diet (HFD) diabetic mice.

Results: SMC-Sorbs2 KO mice at 6-7 months of age has normal body weights and blood glucose levels, but their coronary vasodilation to NS-1619 (a BK channel activator) was diminished by 41.52% * (n=7-12), which was associated with a 30% reduction of BK channel current density (defined as the iberiotoxin-sensitive K+ components) in freshly isolated coronary SMCs, compared to those of age-matched WT mice. Importantly, vascular Sorbs2 expression was downregulated by 58.82% * (n=6) and 51.12% * (n=4) in db/db mice and HFD mice, compared to nondiabetic controls. This was accompanied by decreased BK-α and BK-β1 protein levels by 76.0% and 69.74% in db/db mice and by 55.35% and 66.24% in HFD mice (n=6 for both), and by impaired BK channel activity and BK channel-mediated vasodilation in the coronary arteries of diabetic mice.

Conclusion: Sorbs2 is a key determinant of vascular BK channel physiology. Lack of vascular Sorbs2 manifests coronary BK channelopathy and vasculopathy observed in diabetes. Vascular Sorbs2 deficiency should be considered an independent risk of diabetic cardiovascular complications. *: p<0.05.

Disclosure

X. Xiong: None. X. Sun: None. H. Lee: None. T. Lu: None.
516-P: High-Fat Feeding Alters Circulating Triglyceride Profile by Decreasing SCD Activity and Depleting n-3 Fatty Acids
Authors: OH YOUNGTAEK , SHEN TONG , JEONG SHINWU , CHO SUENGMOK , FIEHN OLIVER , YOUN JANG
Published: June 2024

Introduction and Objective: Hypertriglyceridemia is a risk factor for type 2 diabetes and cardiovascular disease (CVD), and plasma triglyceride (TG) is considered as a major component in the assessment of diabetes or CVD risk. However, previous lipidomics studies demonstrated that not all TG molecules behave similarly, and that individual TGs with different fatty acid compositions are regulated differentially under various conditions. In addition, distinct groups of TGs were identified to be associated with increased (TGs with lower carbon number [C#] and double-bond number [DB#]) or decreased (TGs with higher C# and DB#) diabetes risk. In the present study, we examined the effects of high fat feeding in rats on plasma lipid profiles with special attention to TG profiles.

Methods: Wistar rats were maintained on a low-fat (control) or high-fat (HFD) diet for 2 weeks, and plasma samples were obtained before and 2.5 h after a meal (n = 10 each) and subjected to a lipidomics analysis.

Results: High fat feeding had significant impacts on circulating lipid profiles with most significant effects observed on TG profile. The effects of HFD on individual TG species depended on DB# in their fatty acid chains; HFD increased TGs with low DB#, known to be associated with increased diabetes risk, but decreased TGs with high DB#, known to be associated with decreased diabetes risk. These changes in TGs with HFD were associated with decreased hepatic stearoyl-CoA desaturase (SCD) activity, assessed from hepatic fatty acid profile. Decreased SCD activity would reduce the conversion of saturated to monounsaturated fatty acids, contributing to the increases in saturated TGs or TGs with low DB#. In addition, HFD selectively depleted n-3 polyunsaturated fatty acids (PUFAs), contributing to the decreases in TGs with high DB#.

Conclusion: HFD had profound impacts on circulating TG profile, and some of these changes are explained, at least in part, by decreased SCD activity and depleted n-3 PUFA.

Disclosure

Y. Oh: None. T. Shen: None. S. Jeong: None. S. Cho: None. O. Fiehn: None. J. Youn: None.

Funding

National Institutes of Health (HL146570)
527-P: How Stressed Are Feet? Novel Methods for Quantifying the Daily Cumulative Stress Imparted on Diabetic Foot Ulcers
Authors: CREWS RYAN T. , JHAVERI SANAM , YALLA SAI V. , FLEISCHER ADAM E. , MILLER STEVEN A. , BOULTON ANDREW J. , ROSENBLATT NOAH J.
Published: June 2024

Introduction: Physical stress is a key factor in diabetic foot ulcer (DFU) formation and healing. However, knowledge on the association of stress with DFU is still limited due to the complexities in quantifying the magnitude of stress imparted on feet over 24hr periods. This project utilized novel methods to quantify the daily cumulative stress (CS) applied to active DFU.

Methods: Plantar pressures were measured in participants with DFU while walking offloaded with a removable cast walker and while walking unshod (Figure 1). Similar measurements were made while participants stood still. Pressure values (pressure time integral) were paired with steps/day & standing time/day over a one-month period during which adherence with the cast walker was objectively monitored via accelerometry.

Results: For a sample of 5 DFU patients the following median and ranges were found for the 4 components to CS: offloading adherent walking 80.9 MPa*s/day (9.9 - 126.7); non-adherent walking 69.0 MPa*s/day (28.5 - 156.5; offloading adherent standing 313.8 MPa*s/day (25.5 - 649.6); non-adherent standing 341.8 MPa*s/day (165.6 - 500.2).

Conclusion: The methodology developed is the most comprehensive assessment of foot loading in patients’ daily lives to date. In accordance with past work showing DFU patients spend more time standing than walking each day, standing contributed more to the daily CS than walking.

Disclosure

R.T. Crews: Other Relationship; OPED Medical. S. Jhaveri: None. S.V. Yalla: None. A.E. Fleischer: None. S.A. Miller: None. A.J. Boulton: None. N.J. Rosenblatt: None.

Funding

National Institutes of Health Award Number (R01DK131303)
53-OR: Individual Sources of Diabetes Distress—A Precision Mental Health Approach Combining Ecological Momentary Assessment and Continuous Glucose Monitoring
Authors: EHRMANN DOMINIC , KULZER BERNHARD , SCHMITT ANDREAS J. , HERMANNS NORBERT
Published: June 2024

Using n-of-1 analyses, we aimed at identifying individual sources of diabetes distress. Using ecological momentary assessment (EMA) and CGM, subjective EMA-based experiences of glucose management (hypoglycemia, hyperglycemia and glucose variability distress) and objective CGM-based markers of glucose management (time in hypo- and hyperglycemia, glucose variability) were assessed on a daily level for 17 days. Mixed-effect regression analysis with daily diabetes distress as dependent variable and daily subjective and objective markers of glucose management as random factors was performed, controlled for gender, diabetes type and study day. Individual estimates of the associations between subjective and objective markers and diabetes distress were extracted per person to identify individual sources of diabetes distress. Associations of these individual sources and psychosocial well-being 2 months later were examined. Data from 379 participants were analyzed (50.9% type 1 diabetes, 92.9% insulin therapy). Subjective experiences of glucose variability (t=14.4, p<.0001) and hyperglycemia (t=13.6, p<.0001) were the strongest predictors of daily diabetes distress while CGM-based glucose variability was not significantly associated with daily distress (t=1.13, p=0.26). Individuals for whom subjective markers were a more significant source of diabetes distress had more depressive symptoms (DS: r=0.32), more diabetes distress (DD: r=0.39), and more hypoglycemia fear (FoH: r=0.34) at follow-up (all p<.001). Individuals for whom objective markers were a more significant source of diabetes distress had more favorable psychosocial well-being at follow-up (DS: r=-0.31; DD: r=-0.33; FoH: r=-0.27; all p<.001). N-of-1 analyses demonstrated the differential effects of objective and subjective sources of diabetes distress on psychosocial well-being highlighting the need for individualized approaches.

Disclosure

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

Funding

German Centre for Diabetes Research (DZD; FKZ 82DZD01102)
532-P: Comprehensive Analysis of Cardiovascular and Metabolic Health in Type 2 Diabetes Mellitus—Insights from the UDF Study on ABI, BMI, and Neuropathy Across Diverse Population
Authors: ROHATGI RAGINI M. , SHAH PRANJALI K. , PADHYE DAKSHATA , KOVIL RAJIV R. , SOWANI ALPANA , METHIL VINOD , PATANGE SONALI A. , TANNA SNEHAL R. , KARKHANIS SHEFALI A. , GONSALVES BENSLEY L. , ASHTEKAR CHANDRASHEKHAR , DESHMANE RAJESH
Published: June 2024

Studies link T2DM with obesity, poor glucose control, CV risk, peripheral arterial disease, and prevalent neuropathy in diverse populations. We analyzed 537 T2DM patients, across 18 centres (UDF Study), aged 12-89 for BMI, HbA1C, LDL, ABI, and neuropathy to assess obesity, cardiovascular, and circulatory health. Ankle-brachial index (ABI) was categorised as normal (0.9 to 1.4), <0.9 strong indicator of CV risk, >1.4 stiff peripheral arteries associated with CV disease. Ages ranged from 12 to 89 years with a mean age of 56 ± 12 years. The median age was 58, with most (50%) between 49 and 65 years. The 95% confidence interval for the mean age was 55 to 57 years. The BMI ranged from 12 to 49 with a mean of 27 ± 4.7. Half had BMIs between 24 and 30. 95% CI for the mean BMI was 27 to 28. HbA1C levels varied from 4 to 15, with a mean of 8.4 ± 1.8. The median was 7.9, and the 95% CI for the mean was 8.2 to 8.5. The LDL levels ranged from 15 to 221 mg/dl, with a mean of 92 ± 35 mg/dl. The median LDL level was 89 mg/dl, with a 95% CI for the mean between 89 and 95 mg/dl. Neuropathy assessments in right and left feet show no significant difference (P=0.9764) with similar distribution across normal, mild, moderate, and severe categories. ABI values. Right foot: (0.9 to 1.4): (n=418), <0.9 (n=81), >1.4 (n=38). Left foot: (0.9 to 1.4) (n=428), <0.9: (n=71), >1.4 (n= 38). Moderate correlations observed between right and left metatarsals (0.343-0.429) and heels (0.349), indicating symmetrical pressure change patterns in diabetic feet. The UDF Study's comprehensive analysis of 537 T2DM patients highlighted a significant spectrum of metabolic health challenges linked to varied BMI, HbA1C, and LDL levels. ABI categorization underscored the prevalent cardiovascular risks and arterial stiffness. Despite the diverse age range, foot neuropathy showed uniformity, with moderate correlations in foot pressures suggesting consistent patterns of diabetic foot complications.

Disclosure

R.M. Rohatgi: None. P.K. Shah: None. D. Padhye: None. R.R. Kovil: None. A. Sowani: None. V. Methil: None. S.A. Patange: None. S.R. Tanna: None. S.A. Karkhanis: None. B.L. Gonsalves: None. C. Ashtekar: None. R. Deshmane: None.
533-P: Geospatial Analysis of a Diabetes Management Program—Program Participation and Social Determinants of Health
Authors: KANNY SAMANTHA , CUMMINGS WILLIAM H. , QUAYE ISAAC , CARBAJALES-DALE PATRICIA , SHERRILL WINDSOR W. , STANCIL MICHELLE D. , EVATT JANET H.
Published: June 2024

Introduction & Objective: The American Diabetes Association has recognized Health Extension for Diabetes (HED) as a practice-tested diabetes support program. HED is a community-based program that offers a standardized education and individualized support to those with diabetes. HED improves the health status of individuals living with diabetes, specifically targeting vulnerable populations.

Purpose: The purpose of this study is to utilize Geospatial Analysis to evaluate the social determinants of health (SDoH) of HED program participants.

Methods: Using demographic data collected from individuals enrolled in HED, the research team analyzed the geographic distribution of participants and SDoH variables. Using geospatial analysis, other variables were calculated, such as distance to grocery stores, pharmacies, and hospitals. Key SDoH variables include income, educational attainment, distance to grocery stores, pharmacies and hospitals. These were used to create a Diabetes Burden Index, which in turn characterized the cumulative burden program participants face in managing their diabetes.

Results: The analysis comprised 980 individuals, with an average Diabetes Index Burden score of 0.51. This indicated the typical individual enrolled in HED has a moderate to high SDOH burden when managing their diabetes. Additional geospatial analysis will be presented on drive time to pharmacy and food sources.

Conclusion: Geospatial analysis provides a clear visual representation of geographic distribution of individuals enrolled in HED as well insights into specific SDoH characteristics of those who enrolled in the program. The utilization of GIS in diabetes management programs enhances the ability of both researchers and program facilitators to understand populations served and more accurately target services, particularly for at risk and underserve groups.

Disclosure

S. Kanny: None. W.H. Cummings: None. I. Quaye: None. P. Carbajales-Dale: None. W.W. Sherrill: None. M.D. Stancil: None. J.H. Evatt: None.
539-P: How Do Aging Adults with Diabetes Engage with Technology for Behavior Change?
Authors: BLANCHETTE JULIA E. , HART ALLISON A. , LEE KIPUM , HATIPOGLU BETUL
Published: June 2024

Introduction: Ensuring diabetes technology and education remain patient-centered, equitable, and relevant is critical. Therefore, we explored how aging adults with diabetes desire to engage with self-management technology for behavior change.

Methods: The transtheoretical model of health behavior change was applied to guide this analysis. A semi-structured interview guide was utilized for 3, 60-minute focus groups. De-identified transcripts were cross-referenced for deductive thematic analysis with a priori codes. Codes were cross-checked independently, and discrepancies were resolved.

Results: Focus Group A comprised 6 individuals with pre-diabetes/recent T2D (66.6% White, non-Hispanic, 66.6% female, mean age 52.83 SD 8.64, preparation/action phase of behavior change). Group B comprised 4 individuals with T2D (75% White, non-Hispanic, 75% female, mean age 64.5 SD 9.11, maintenance phase). Group C comprised 3 individuals with T1D (66.6% White, non-Hispanic, 100% female, mean age 58.33 SD 6.66, termination phase). Key themes across groups were desire for accurate, individualized real-time data, yet data type and interaction level differed by behavior change phase (Table 1).

Conclusion: Aging adults have unique self-management technology and engagement preferences in the stages of the behavior change cycle. Clinicians should empower individuals to choose appropriate technology for behavior change.

Disclosure

J.E. Blanchette: Speaker's Bureau; Insulet Corporation. Board Member; Juvenile Diabetes Research Foundation (JDRF). Research Support; American Heart Association, Association of Diabetes Care & Education Specialists, National Institute of Diabetes and Digestive and Kidney Diseases, Leona M. and Harry B. Helmsley Charitable Trust. Advisory Panel; LifeScan Diabetes Institute. Consultant; WellDoc. Advisory Panel; Cardinal Health/Edgepark. A.A. Hart: None. K. Lee: None. B. Hatipoglu: Research Support; Tandem Diabetes Care, Inc.

Funding

University Hospitals JobsOhio grant for the Cleveland Innovation District
540-P: Qualitative Findings from the Deaf Diabetes Can Together Pilot
Authors: MIRUS KARISSA A. , ALLEN NANCY A. , LEE SHINDUK , LITCHMAN MICHELLE L.
Published: June 2024

Introduction & Objective: Deaf Diabetes Can Together (DDCT) is a 10-week intervention committed to providing accessible diabetes education for the deaf and hard of hearing community, using multiple modes of culturally-appropriate communication, such as American Sign Language (ASL), closed captioning, and graphics. The purpose of this study was to pilot test DDCT.

Methods: Eight participants, including those with diabetes (Type 1 or 2) and a care partner, were interviewed to gather feedback on their experience with DCCT. They received DDCT virtually through Zoom and a learning platform (i.e., Canvas). After receiving the 10-week intervention, a semi-structured interview guide was used to explore participant experiences with DCCT. Data were qualitatively coded, line-by-line, using principles of qualitative thematic analysis.

Results: Feedback was overwhelmingly positive and all participants would recommend DDCT to others. Four key themes emerged regarding DDCT were: 1) helpful in managing diabetes by increasing motivation and providing education, practical tips to apply in their daily lives, and community support; 2) highly accessible for deaf individuals due to direct communication, data collection, and resources in ASL; 3) supportive of deaf culture by being deaf-led with an expert clinician fluent in ASL and the ability to learn from deaf peers living with diabetes; and 4) desire for additional content (e.g., lengthening DCCT beyond 10 weeks to cover additional topics like cultural food, stress management, and kidney health) and opportunities for more individualized education.

Conclusion: This is the first deaf-led and group-based diabetes education intervention and pilot results indicate high acceptability and satisfaction in persons with DHH and diabetes and their care partner. This pilot study shows the proof of concept, supporting future clinical trial to test effectiveness and feasibility of the intervention in a diverse community and clinical settings.

Disclosure

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

Funding

This work was funded by the Gordon and Betty Moore Foundation through grant GBMF9048.
554-P: Long-Term Glycemic Improvement after the Korean Government's Home and Self-Care Program (HELP) for Patients with Type 1 Diabetes Mellitus—A Prospective Cohort Study
Authors: KOO DAE-JEONG , DAYEON LEE , KO JIHEE , JOON MOON SUN , PARK CHEOL-YOUNG
Published: June 2024

Aim: After periodic implementation of the Home and sELf care Program (HELP, a pilot project supported by the ministry of health and welfare of the Korean government) in patients with T1DM, we evaluated the long-term effects on glycemic control.

Methods: We included 120 T1DM patients aged 15 years or older. Structured educations, including physician consultation as well as nursing and nutrition education, were provided to the subjects up to four times a year, and remote support using digital apps and phones was provided between educations. Patients were followed up at average intervals of 2 to 4 months, up to a maximum of 24 months. The primary endpoint was mean HbA1c of subjects at f/u visit.

Results: Patients who received at least one structured education had a mean HbA1c reduction of more than 1.0% from baseline, even after adjusting for confounders [%, from 8.52 ± 2.11(SD) to 7.31 ± 1.20 at 1st f/u visit (p < 0.001); 7.42 (after adjustment, 7.29-7.54, 95% CI), from 8.50 ± 2.12 to 7.37 ± 1.32 at 7th f/u visit (p < 0.001); 7.42 (after adjustment,7.31-7.53, 95% CI)]. TIR was maintained at least 55% or more on average for 24 months, and TBR (70 & 54) also gradually improved to the recommended range (<5% & <1%, 18 - 24 moths).

Conclusion: The effect of HELP on glycemic control in patients with T1DM was found to be a significant improvement, as well as an improvement in CGM-based indices.

Disclosure

D. Koo: None. L. Dayeon: None. J. Ko: None. S. Moon: None. C. Park: None.
564-P: Insights into How Health Technologies Can Support Patient-Centered Diabetes Self-Management—A Mixed-Methods Approach
Authors: BOBER TIMOTHY M. , KRALL JODI S. , GARVIN SOPHIA , ZUPA MARGARET , WHITE CHRISTINA , SOTAA BHAVINI , LOW CARISSA , ROSLAND ANN-MARIE
Published: June 2024

Background & Objective: New technologies like mobile applications (apps), activity trackers, and continuous glucose monitors (CGM) are available to support people with diabetes (PWD), but it is not clear how these tools are currently used together for diabetes self-management (DSM). This mixed methods study assessed how PWD use technology to relate diabetes self-care behaviors to DSM goals.

Methods: Sixty-one adults aged 18-75 with type I or II diabetes (DM) who used ≥1 diabetes medication were surveyed about health app and monitor use (glucose, food, exercise/activity, weight, sleep, and stress trackers) as well as digital and general health literacy. 18 survey respondents completed semi-structured interviews examining how technologies were and could be used in daily DSM.

Results: Survey respondents were 34% African American and 38% female, 48% were >45 years old. Regarding DM type and treatment, 72% had Type II diabetes, 59% used insulin, and 56% had used CGMs. Participants had high levels of digital and general health literacy. For tech use, 87% of respondents used ≥1 health app; 59% had used an activity tracker; and 47% had used apps to track ≥3 separate health behaviors. While glucose-tracking apps were more common among CGM (92%) and insulin users (100%), survey respondents used other health apps at similar rates regardless of CGM (57% vs. 60%) or insulin status (61% vs. 60%). Interviewees described using glucose-tracking apps to personalize dietary choices, but less often reported using data from other health apps or monitors for DSM goals. For data to be helpful for DSM, interviewees desired data that was passively collected, easily integrated across monitors, easily visualized, and tailorable to personal health goals.

Conclusion: PWD reported using apps to monitor multiple behaviors that impact DSM. Findings suggest that there are untapped opportunities to integrate diabetes apps with trackable lifestyle data to support patient-centered DSM.

Disclosure

T.M. Bober: None. J.S. Krall: Research Support; Becton, Dickinson and Company, Sanofi. S. Garvin: None. M. Zupa: None. C. White: None. B. Sotaa: None. C. Low: None. A. Rosland: None.

Funding

The Pittsburgh Foundation (MR2022-128717)
566-P: Satisfaction with Information Regarding Pharmaceutic Therapy in Men and Women with Type 2 Diabetes Undergoing Coronary Angiography
Authors: VOGEL JOHANNES , RATZ MAGDALENA , ELSNER PASCAL , PLATTNER THOMAS , VONBANK ALEXANDER , MADER ARTHUR , LARCHER BARBARA , LEIHERER ANDREAS , MUENDLEIN AXEL , FRICK MATTHIAS , DREXEL HEINZ , SAELY CHRISTOPH H.
Published: June 2024

Satisfaction with information regarding pharmaceutic therapy is important because it may strongly affect the appropriate use of drug therapy including medication adherence. Data on this parameter in the clinically important population of patients with type 2 diabetes (T2DM) undergoing coronary angiography is scarce and is therefore addressed in the present study. We consecutively enrolled a cohort of 515 patients (383 men and 132 women) who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease. Satisfaction with information regarding pharmaceutic therapy was measured using the validated Satisfaction with Information about Medicines Scale (SIMS-D) which consists of two sub-scales covering action and usage (questions 1-9) or potential problems (questions 10-17), respectively. Further, health literacy, which includes the ability to understand and follow instructions for treatment was determined using the EU-HLS-Q16 questionnaire. For SIMS-D a response rate of 68.4% (n=353, 280 men and 73 women) was achieved. From our patients, 124 (36.4% of males and 30.1% of females) had T2DM according to ADA criteria. SIMS-D scores did not differ significantly between T2DM patients and those who did not have diabetes among men 11.5 [IQR=6-16] vs. 9 [IQR=6-15] p=0.121, nor among women 10 [IQR=5.5-12.25] vs. 10 [IQR=5-17] p=0.537. Independent of gender and diabetes status patients scored significantly lower on items targeting satisfaction with information about potential problems of medication than the in sub-scale for action and usage (p<0.001). In analysis of covariance, health literacy independently of T2DM, gender and age predicted SIMS-D (F=41.3; p<0.001). From our findings we conclude that satisfaction with information about medicines in angiographied coronary patients does not depend on the presence of T2DM or gender but is significantly impacted by health literacy.

Disclosure

J. Vogel: None. M. Ratz: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.
567-P: Health Literacy in Men and in Women with Type 2 Diabetes Undergoing Coronary Angiography
Authors: RATZ MAGDALENA , VOGEL JOHANNES , ELSNER PASCAL , PLATTNER THOMAS , VONBANK ALEXANDER , MADER ARTHUR , LARCHER BARBARA , LEIHERER ANDREAS , MUENDLEIN AXEL , FRICK MATTHIAS , DREXEL HEINZ , SAELY CHRISTOPH H.
Published: June 2024

Health literacy reflects the ability to make appropriate health decisions and affects health outcomes. It therefore is an important parameter in patient care and for health care providers. Health literacy in patients undergoing coronary angiography, the standard procedure for the definite evaluation of coronary artery disease (CAD) is unclear and is addressed in the present study. We recruited 515 consecutive patients (383 men and 132 women) undergoing coronary angiography for the evaluation of established or suspected stable CAD in a tertiary care setting in central Europe. Health literacy was measured using the validated HLS-EU-Q16 questionnaire. A response rate of 80.4% was achieved. Overall, 177 patients (i.e. 34.3% of the cohort) had type 2 diabetes (T2DM); the prevalence of T2DM was 36.8% in men and in 27.3% in women (p=0.047). Comparing T2DM patients to those who did not have diabetes, overall median health literacy scores (HLS) were 13 [IQR=11-15] vs. 13 [IQR=10-15] among men (p=0.424) and 12 [IQR=10-15] vs. 13 [IQR=10.25-15] among women (p=0.517). Prevalence rates of adequate (HLS 13-16), problematic (HLS 9-12) and inadequate (HLS 0-8) health literacy did not differ significantly between patients with T2DM vs. subjects without T2DM (53.0% vs. 55.4%, 34.8% vs. 29.9% and 12.2% vs. 14.7% among men and 37.5% vs. 55.6%, 45.8% vs. 31.9% and 16.7% vs. 12.5% among women, respectively. We conclude that among patients undergoing coronary angiography for the evaluation of established or suspected stable CAD, health literacy regardless of sex is suboptimal both in patients with T2DM and in nondiabetic subjects.

Disclosure

M. Ratz: None. J. Vogel: None. P. Elsner: None. T. Plattner: None. A. Vonbank: None. A. Mader: None. B. Larcher: None. A. Leiherer: None. A. Muendlein: None. M. Frick: None. H. Drexel: None. C.H. Saely: None.
582-P: Enhanced Patient Education—Use of Body Composition and Muscle Strength Data to Improve HbA1c Control in Early Diabetes
Authors: KIMURA AKIRA
Published: June 2024

The study addresses the gap in motivation for lifestyle modifications in early diabetes patients without obesity, a common scenario in Asian populations. Japanese healthcare systems offer frequent diet and exercise guidance with minimal economic burden, yet there is a lack of short-term, high-confidence physical activity information promoting continued exercise. This study focuses on body composition and exercise-specific muscle strength in early-stage diabetic patients.

Subjects and Methods:1200 patients attending a suburban Japanese diabetic clinic were observed from April 1, 2022, to March 31, 2023. Inclusion criteria were recent onset of diabetes and consent to participate alongside standard treatment. Bi-monthly body composition assessments were performed using Inbody (USA), including measurements of muscle mass, fat mass, and grip strength. Statistical analyses involved ROC analysis with HbA1c levels as dependent variables.

Results:65 of 221 first-time patients participated. The average participant age was 65 years, with 66% male and an average BMI of 24.4. No dropouts occurred. ROC analysis identified significant influences of right upper arm and trunk muscle mass on achieving an HbA1c of less than 6% after 6 months. A significant change in body fat mass between the second and third assessments was correlated with a prediction of HbA1c >8%.

Considerations:This study suggests that changes in muscle strength and fat mass in non-obese early-stage diabetic patients can influence HbA1c levels. Detailed body composition information could offer new insights into data analysis and improve self-management practices for both patients and healthcare providers, particularly through the use of cloud-based technologies.

Disclosure

A. Kimura: None.
59-PUB: Leveraging Machine Learning for Precise Prediction of Type 2 Diabetes
Authors: BARAKEH RAGHAD
Published: June 2024

Introduction: Diabetes, a global chronic ailment, necessitates advanced predictive models.

Methods: This study leverages the Pima Indian dataset, implementing Logistic Regression (LR), Naïve Bayes, Random Forest, and Decision Tree algorithms. Algorithmic performance is assessed using accuracy, precision, recall, and F1-score.

Results: Table 1 data reveal commendable performance. LR led with 83% accuracy, Decision Tree at 82%, Random Forest at 81%, and Naïve Bayes at 80%. Glucose, BMI, age, insulin, skin fold thickness were identified by the Correlation Heatmap (Fig. 1).

Conclusion: This study affirms the effectiveness of four machine learning algorithms, achieving approximately 80% accuracy in predicting type II diabetes. Findings underscore the relevance and applicability in healthcare scenarios, aligning with real-world considerations.

Disclosure

R. Barakeh: None.
596-P: Real-World Evaluation of Exercise Consensus Guidelines in Adults with Type 1 Diabetes—New Findings from the T1DEXI study
Authors: JACOBS PETER G. , MARAK CHASE , CALHOUN PETER , GAL ROBIN L. , RIDDELL MICHAEL C. , CASTLE JESSICA
Published: June 2024

Objective: Consensus guidelines may help people with type 1 diabetes (T1D) improve exercise glucose outcomes. Glucose outcomes were evaluated in real-world exercise when participants did or did not follow guidelines.

Methods: In a 4-week observational study, continuous glucose, insulin and nutrient data were collected from 561 adults with T1D. Participants completed study and personal exercise. Glucose outcomes were compared when participants followed versus did not follow exercise guidelines for open-loop (OL) and automated insulin delivery (AID).

Results: Guidelines requiring behavior modification (e.g. reduce meal insulin before exercise) were rarely followed while guidelines not requiring modification were often followed (Fig). The guideline recommending reduced meal insulin before exercise was associated with lower % time <70 mg/dL (T<70) during exercise (-2.2%, P=0.02) for OL but was not significant for AID (-1.5%, P=0.22). Compared to exercise with low glucose (<70 mg/dL) in prior 24 hours, sessions without recent low glucose had lower T<70 during exercise (-1.2%, P<0.001). The AID guideline for no carbs before exercise if CGM is flat and increasing was not associated with improved outcomes.

Conclusions: Real-world evidence suggests OL participants who reduced meal insulin prior to exercise and did not have low glucose in the prior 24 hours had less time below range.

Disclosure

P.G. Jacobs: Advisory Panel; Eli Lilly and Company. Research Support; Dexcom, Inc. Stock/Shareholder; Pacific Diabetes Technologies. C. Marak: None. P. Calhoun: None. R.L. Gal: None. M.C. Riddell: Consultant; Eli Lilly and Company. Speaker's Bureau; Novo Nordisk. Advisory Panel; Supersapiens. Consultant; Dexcom, Inc. Speaker's Bureau; Sanofi. Advisory Panel; Zealand Pharma A/S. Speaker's Bureau; Dexcom, Inc. Stock/Shareholder; Zucara Therapeutics. J. Castle: Employee; Dexcom, Inc.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
60-OR: Implementing a Machine-Learning Model to Predict Risk of Chronic Kidney Disease (CKD) Progression
Authors: TANGRI NAVDEEP , SINGH RAKESH , BETTS KEITH A. , DU YUXIAN , GAO SOPHIE , KATTA ARVIND , FARAG YOUSSEF , FATOBA SAMUEL T. , LIU HONGJIAO , CHEN JINGYI , FERGUSON THOMAS , WHITLOCK REID , LEON SILVIA J. , SINGH AJAY K.
Published: June 2024

Introduction & Objective: Early identification of at-risk CKD can facilitate timely interventions and improve patient (pt) outcomes. This study applied a previously published and validated machine learning model, Klinrisk, to predict CKD progression risk in a US population.

Methods: A retrospective observational study was conducted in 1,050,552 adult pts with CKD from Optum’s electronic health records database (1/1/2007 - 9/30/2022). Klinrisk was applied to predict risk of CKD progression. The predicted risk was used to classify pts into 3 risk groups: low, medium, and high, which were compared to the Kidney Disease Improving Global Outcomes (KDIGO) classification criteria. Kaplan-Meier (KM) analysis of actual disease progression was performed in each risk group defined by 2-year predicted risk.

Results: Pts classified as high-risk were older, with a larger proportion of males, lower eGFR levels, and higher urine albumin-to-creatinine ratio (UACR) levels. Compared to the KDIGO criteria, Klinrisk identified more pts who progressed into medium and high-risk groups. Observed progression rate matched the predicted progression risk with clear separations observed for different risk groups (Figure).

Conclusion: The Klinrisk model accurately identifies pts at high-risk, enabling early detection and intervention.

Disclosure

N. Tangri: Consultant; AstraZeneca. Research Support; Bayer Inc. Consultant; Bayer Inc., Eli Lilly and Company, Boehringer-Ingelheim, Roche Diagnostics, Otsuka America Pharmaceutical, Inc. Other Relationship; Klinrisk. R. Singh: None. K.A. Betts: Consultant; Bayer Inc. Y. Du: Employee; Bayer Inc. Stock/Shareholder; Bayer Inc. S. Gao: Other Relationship; Bayer Inc. A. Katta: None. Y. Farag: Employee; Bayer Inc. S.T. Fatoba: Employee; Bayer Inc. H. Liu: Other Relationship; Bayer Inc. J. Chen: Other Relationship; Bayer Inc. T. Ferguson: Stock/Shareholder; Klinrisk Inc. Consultant; Klinrisk Inc., Strategic Health Resources Ltd., ClinPredict Ltd, AlphaLabs. R. Whitlock: None. S. Leon: Other Relationship; Quanta Dialysis Technologies. A.K. Singh: Consultant; Bayer Inc., GlaxoSmithKline plc, Novartis AG, Novo Nordisk.
603-P: In Type 1 Diabetes, Meta-analysis Identifies Variable Glucose Response to Exercise Based on Intensity
Authors: PHAN CAITLINE , FISHER SIMON J. , ZHANG XIAOHUA D.
Published: June 2024

Introduction & Objective: For people with Type 1 diabetes, changes in sugar levels in response to exercise can be highly variable. A meta-analysis of recent continuous glucose monitoring (CGM) studies was conducted to identify glucose changes in response to exercise.

Methods: A literature search was conducted on the PubMed database using keywords "CGM," "Type 1 Diabetes," and "Exercise". Forest plots were created using the R language to visualize mean glucose change and its confidence intervals utilizing the random effect model.

Results: The literature search identified 5 CGM studies matching the criteria. Overall, glucose levels did not change significantly in response to exercise although the changes in glucose levels was highly variable. When subdivided based on exercise intensity, moderate intensity exercise demonstrated significant decrease in glucose levels (p<0.001), whereas high intensity exercise tended to demonstrate an increase in glucose levels but the change is not statistically significant.

Conclusion: This meta-analysis of CGM exercise studies in people with Type 1 diabetes demonstrate that the glucose response to exercise is highly variable in part because moderate intensity aerobic exercise lowers glucose levels while high intensity aerobic exercise tends to increase glucose levels.

Disclosure

C. Phan: None. S.J. Fisher: None. X.D. Zhang: None.

Funding

the National Institutes of Health (UL1TR001998, 1U01DK135111 and OT2HL161847) and by the DRC at Washington University (P30 DK020579)
605-P: Barriers of Exercise in Children and Adolescents with Diabetes Mellitus in Hong Kong
Authors: POON IRIS Y.M.
Published: June 2024

Objective: According to World Health Organization (WHO), children and adolescents are recommended to exercise at least 150 mins per week to maintain good physical and psychosocial health. This study aimed to determine the barriers of exercise among children and adolescents with diabetes.

Methods: School-aged children who attended Diabetes Clinic at the Hong Kong Children’s Hospital between January 2021 and December 2023 were invited to complete questionnaire in December 2023 on their exercise habits and their barriers in achieving the recommended exercise duration.

Results: 52 children (male: 50%, median age: 12.6 years) completed the questionnaire. 45 had type 1 and 7 had type 2 diabetes, median duration of diabetes was 4.2 years. Median total duration of school PE class per week was 90 minutes, while median total duration of sports outside PE class was 90 minutes. 19 (36.5%) had total duration of exercise less than 150 minutes per week. The top 3 barriers of achieving optimal exercise duration were 1) busy school schedule, 2) weather conditions and 3) location of sports facilities / inconvenience transportation. Interestingly, the group with the lowest socioeconomic status had the lowest rate of achieving the recommended exercise duration (55% vs 100% in the highest socioeconomic class).

Conclusion: More than one-third of our included subjects could not achieved WHO exercise recommendation. To tackle the identified exercise barriers, school-based exercise program especially targeting the less resourceful families is recommended. Also, healthcare providers could promote home exercise to overcome the limitation on time, weather and transportation issues.

Disclosure

I.Y.M. Poon: None.