bluuebunny/crossref_metadata_2025 huggingface dataset:
566-P: Mild Increase of Proinflammatory Macrophages Correlates with Reduction of Nerve Fiber Density in Sural Nerve of Human Type 2 Diabetic Subjects
Authors: MIZUKAMI HIROKI , OSONOI SHO , TAKAHASHI KAZUHISA , KUDO KAZUHIRO , ITABASHI CHIEKO , YAGIHASHI SOROKU
Published: June 2019

The dominant infiltration of pro-inflammatory M1 macrophages (M1) compared to anti-inflammatory M2 macrophages (M2) exerts insulin resistance in peripheral tissues of type 2 diabetes (T2DM). This inflammatory reaction is also associated with the pathogenesis and development of diabetic complications including neuropathy (DPN). It is still unclarified, however, regarding macrophage infiltration in human DPN. The aim of this study is to clarify the significance of macrophage infiltration in sural nerve (SN) in subjects with T2DM. SN of autopsy cases was dissected from 2014 to 2016. Eleven cases (Male 6, Female 5) of non-T2DM (nDM) and 11 cases (Male 3, Female 8) of T2DM (T2D) were subjected to the evaluation. Double immunohistochemistry was performed in cross section of SN for CD68 (Pan-macrophage) and CD206 (M2). M1 was defined as CD68+ and CD206- and M2 was as CD206+, respectively. Epon-embedded semithin section was used for morphometrical assessment of SN fibers. In frozen SN, mRNA expression was evaluated by qPCR. Average age and BMI were comparable between 2 groups. HbA1c was significantly greater in T2D (mean±SE) (7.2±0.5%) than nDM (5.5±0.2%) (p<0.05). Pathological evaluation showed 2.4 times M1 in T2D more than that in nDM (p<0.05). On the other hand, M2 was comparable between 2 groups. Expression of iNOS for M1 in T2D was 1.8 times increased compared to that of nDM (p<0.05), whilst, that of CD163 for M2 was comparable between two groups. Correlation analysis between macrophage infiltration and clinical parameters disclosed that the M1 infiltration proportionally correlated with the value of HbA1c (p<0.05), whereas there was no correlation between M2 infiltration and HbA1c. SN fiber density inversely correlated with M1 population (p<0.05). Collectively, mild, but significant pro-inflammatory condition is associated with SN fiber loss, suggesting the pathogenic role of M1 in DPN.

Disclosure

H. Mizukami: None. S. Osonoi: None. K. Takahashi: None. K. Kudo: None. C. Itabashi: None. S. Yagihashi: None.
577-P: Increased Symptoms of Peripheral Neuropathy and Depression in Insulin-Treated Type 2 Diabetic Patients Are Associated with Reduced BDNF Serum Protein Levels and Val66Met-SNP
Authors: BASHKIN AMIR , SAFADI AKRAM , GROSS BELLA , HOROWITZ NETANEL A. , SHARON RIVKA , SHAOUL ESTHER , NODELMAN MARINA , AZOULAY DAVID
Published: June 2019

Background: BDNF is a neuronal growth factor essential for nervous system maintenance.

Objective: We have evaluated peripheral neuropathy (PN) and depression in patients with type 2 diabetic mellitus and looked for an association with serum protein levels of BDNF and the BDNF-Val66Met-SNP.

Methods: Symptoms of PN were clinically assessed and graded using Total Neuropathy Score (TNSr) scale. Small nerve fiber testing was performed using the Q-sense device. Depression was assessed using PHQ9 questionnaire. BDNF protein levels and Val66Met-SNP were determined with ELISA and Sanger sequencing respectively.

Results: 42 patients, 18 non-insulin treated (NIT) and 24 insulin treated (IT) were included. Albeit similar disease duration, the IT group show increased HbA1c and glucose levels as compared to NIT group, suggesting a more aggressive disease in the IT group. Higher TNSr-sensory and autonomic scores and low sensitivity thresholds to cold, warm and hot-pain signals were found in the IT group. Likewise, PHQ9 score was higher in the IT group. Serum BDNF protein levels were lower in the IT group. Met-BDNF proportion among female patients was lower relative to male patients (23.5% vs. 76.5% respectively, Prob>ChiSq=0.01). Of note, Met-BDNF female patients were all in the IT group and show a trend of increased TNSr and PHQ9 score as compared to Val-BDNF female patients. Correlations between patients' PHQ9 score and TNSr score or Q-sense cold and warm sensitivity thresholds were found only in Met-BDNF carriers, suggesting that PN and depression are coincided in Met-BDNF carriers.

Conclusion: A diminished peripheral BDNF resource in our IT patients is associated with uncontrol diabetes and underlined augmented symptoms of PN and depression. The negative effect of Met-BDNF in female patients and the correlation of depression and PN in Met-BDNF should be further studied.

Disclosure

A. Bashkin: None. A. Safadi: None. B. Gross: None. N.A. Horowitz: None. R. Sharon: None. E. Shaoul: None. M. Nodelman: None. D. Azoulay: None.

Funding

D-Cure
58-LB: Coordination of Care to Reduce Hypoglycemia: Everybody Counts...Including Patients
Authors: CHMELNIK SANDRA , ABDOLLAHI SHAGHAYEGH , NEAL CHANTÉ N. , CAMERON DEBORAH R.
Published: June 2019

The management of inpatient blood glucose control requires expertise among many healthcare providers. The purpose of this quality improvement project was to involve all processes of care, from patients calling to order a meal, to delivery at bedside. Learning about management of patients with diabetes in the hospital requires the participation of dietary personnel, dietitians, nurse assistants, nurses, physicians, diabetes educators, and patients. To reduce hypoglycemic events, physicians participated by chart reviews, evaluation of standardized order sets, improve insulin regimen to match intake. Nurses education was conducted via competencies on safe insulin management, annual updates, daily unit meetings. Regular feedback was provided by quality on glucometrics, timeliness of hypoglycemia management and monthly recurrent hypoglycemic events. Dietary participated by placing a 3x5 card “insulin tray tent card” at eye level, to encourage patient call the nurse when tray was delivered. Avoiding hypoglycemia requires coordination of insulin and meals and prompt response to concerns raised by the patients or their families. The inpatient setting is a rich learning environment, where also patients learn to improve clinical practice and facilitates a collaborative learning environment.

Disclosure

S. Chmelnik: None. S. Abdollahi: None. C.N. Neal: None. D.R. Cameron: None.
585-P: Identifying Clinical Variables Critical for Effective Diabetic Retinopathy Prediction
Authors: WANG RU , MIAO ZHUQI
Published: June 2019

Objective: To identify essential predictors to build a cost-effective prediction model for early detection of diabetic retinopathy (DR).

Methods: We performed a retrospective case/control cohort study based on data extracted from a large electronic health records (EHR) database. Univariate association was used to evaluate patient demographics and 26 lab results in relation to incidence of DR within a 6-month window in future. Backward variable selection was implemented with logistic regression to develop a model based on significantly associated variables. The model was further simplified by narrowing down to shared predictors with previous models in literature. Highly correlated lab variables were further investigated to evaluate the impact of substituting or removing them from the model.

Results: A case cohort of 3,817 DR patients and a control cohort consisted of an equal number of non-DR diabetic patients were studied. Age, gender, race, and 22 lab values were found to be significantly associated with DR. The full model based on the 25 variables had AUC=0.817. Age, gender, race, and 4 lab variables - HbA1c, creatinine, red blood cell (RBC) count, and white blood cell count were efficient to predict DR. The AUC of the reduced model based on the 7 variables was 0.8, which was close to the accuracy of the full model. Furthermore, RBC could be replaced by its highly correlated equivalents, hematocrit (correlation coefficient r=0.9) and hemoglobin (r=0.86), without noticeably impacting the accuracy (AUC with variable substitution ranged from 0.798 to 0.801).

Conclusion: HbA1c, creatinine, RBC, and WBC were found to be key lab variables that can form an accurate DR prediction model. RBC could be replaced by one of their correlated equivalents. The choice of which variables are most cost-effective and efficient to include will depend on the expense and informativeness of the lab test performed in various clinical settings. Future work of this study will focus on external validation of proposed model.

Disclosure

R. Wang: None. Z. Miao: None.
587-P: miR34a-Induced Loss of Nicotinamide Phosphoribosyltransferase Mediates Diabetes-Induced Retinal Vascular Senescence
Authors: BARTOLLI MANUELA , JADEJA RAVIRAJSINH , THOUNAOJAM MENAKA , GUTSAEVA DIANA , MARTIN PAMELA
Published: June 2019

Stress-associated premature senescence (SAPS) has been implicated in diabetes-induced vascular dysfunction. We have shown that microRNA34a (miR-34a) is involved in promoting senescence of the retinal microvasculature. Loss of nicotinamide phosphoribosyltransferase (NAMPT), a rate-limiting enzyme of NAD+ biosynthesis from nicotinamide mononucleotide (NMN), has been implicated in aging and metabolic diseases. Interestingly NAMPT is a target of miR34a, therefore, herein, we investigated the role and reciprocal relationship of miR34a and NAMPT on diabetes-induced senescence of the retinal vasculature. NAMPT expression and NAD+ content were significantly reduced in retina of streptozotocin-induced diabetic rats (STZ-rats, 8-12 weeks of hyperglycemia) and in human postmortem diabetic retinas. On the contrary, miR34a expression was found increased and positively correlated with augmented levels of senescence markers. Exposure of human retinal endothelial cells (HuREC) to glucidic stress (25mM) also decreased NAMPT and NAD+ levels while augmented the expression of miR34a and of senescence markers. Transfection of HuREC with miR-34a mimic, but not a scramble construct, in normal glucose conditions inhibited the expression of NAMPT and reduced NAD+ levels while promoting the expression of senescence markers. These effects of miR34a mimic on HuREC were halted by supplementation with NMN (0.05-1mM), but without modifying NAMPT expression. Lastly, NMN supplementation also prevented high glucose-induced loss of NAD+ and elevation of senescence markers. Our data show that high glucose/diabetes-induced SAPS in the retinal microvasculature involves miR34a-mediated blockade of NAMPT and consequent loss of NAD+. Moreover, our data suggest that NMN supplementation could be a viable therapeutic strategy to improve endothelial dysfunction in diabetic retinopathy.

Disclosure

M. Bartolli: None. R. Jadeja: None. M. Thounaojam: None. D. Gutsaeva: None. P. Martin: None.

Funding

National Institutes of Health (EY022416, EY028714)
600-P: The 1000 Qatar Omics Study: Development of New Analytical Tools for Early Prediction and Treatment of Diabetic Retinopathy in Qatar
Authors: PADMAJEYA SUJITHA SUBASH , JERMAN LAILA , AL-KURBI ALYA , FAKHRO KHALID , JENKINS ALICIA J. , HARDIKAR ANAND , AKIL AMMIRA SARAH
Published: June 2019

Background: According to WHO, Qatar is one of the countries most affected by type 2 diabetes T2D worldwide. Despite current treatments, patients suffering from diabetes are still at risk of developing microvascular complications. Of which, Diabetic Retinopathy DR is a debilitating microvascular complication, which leads to blindness, if left untreated.

Hypothesis and Aims: the genetic variants SNPs, circulating non-coding RNAs, mRNAs, and proteins, detected in diabetic individuals progressing to DR are accurate biomarkers for DR detection, progression and can be utilized effectively in future screening programs for at-risk individuals as well as for monitoring the outcome of interventions/treatments for DR. The aim is to investigate the SNPs using WGS data, and assess microRNA, mRNA and protein signature of DR progression in T2D patients with and without DR comparing to the healthy controls.

Methodology: plasma samples, WGS data of 500 T2D with and without DR and 500 healthy controls subjects were included in this study. Retinal scans are available for all the study participants to assess and classify the DR stages. Total RNA was extracted from plasma samples, microRNA customes assays profiling, proteins and mRNAs are currently at the final stages of analysis and will be ready at the time of the presentation.

Preliminary Results: our preliminary analyses through genome-and proteome-wide discovery studies using cellular systems and clinical samples, identified an omics signature of DR comprising of: four mRNAs of endothelial stress, 45 microRNAs of progressing to DR, eight proteins of proliferative DR vs. no DR and candidate SNPs identified in a Qatari cohort that are associated with DR progression.

Conclusion: This information will significantly impact the development of newer analytical tools and better therapies that will allow early prediction and treatment of DR, thereby reducing the burden of sight threatening diabetes complications in Qatar.

Disclosure

S. Subash Padmajeya: None. L. Jerman: None. A. Al-Kurbi: None. K. Fakhro: None. A.J. Jenkins: Advisory Panel; Self; Abbott, Australian Diabetes Society, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. A. Hardikar: None. A.S. Akil: None.

Funding

Qatar National Research Fund
602-P: Explaining an Artificial Intelligence (AI) System for Diabetic Retinopathy (DR) Screening in Primary Care
Authors: PAREKH NISHIT UMESH , BHASKARANAND MALAVIKA , RAMACHANDRA CHAITHANYA , BHAT SANDEEP , SOLANKI KAUSHAL
Published: June 2019

We have developed a novel technique to explain results of an AI system and demonstrate its ability in explaining the EyeArt AI eye screening system for DR. Besides providing clinically consistent and accurate results, AI systems in healthcare must be explainable (be able to provide reasons for their decisions). This is paramount in making them trustworthy. The EyeArt system is intended for use by healthcare providers to screen for referable DR using color fundus photographs from 18 years or older diabetic patients who do not have persistent visual impairment. It is designed to provide screening results in under a minute and enable DR screening at point of care in endocrinology and primary care clinics. Figure shows that the explainability technique highlights image regions that most significantly contribute to the EyeArt system’s results. These highlighted regions correspond to lesions marked by an expert human grader. In a previous study on 107,001 consecutive patient visits, the EyeArt system has been shown to achieve sensitivity of 91.3% (95% CI: 90.9%-91.7%), specificity of 91.1% (95% CI: 90.9%-91.3%), NPV of 97.6% (95% CI: 97.5%-97.7%), and PPV of 72.5% (95% CI: 71.9%-73.0%). The work presented here provides evidence that the EyeArt system is explainable and has been designed to report DR screening results based on lesions considered important by the ophthalmology community for DR severity grading.

Disclosure

N. Parekh: Employee; Self; Eyenuk Inc. M. Bhaskaranand: Employee; Self; Eyenuk Inc. C. Ramachandra: Employee; Self; Eyenuk Inc. S. Bhat: Employee; Self; Eyenuk Inc. K. Solanki: Employee; Self; Eyenuk Inc. Stock/Shareholder; Self; Eyenuk Inc.

Funding

National Institutes of Health
610-P: Sphingosine Kinase 1 Dissociates Glucocorticoid-Induced Insulin Resistance and Hepatic Dyslipidemia
Authors: LEE REBECCA A. , TSAY ARIEL , CHANG MAGGIE , YIV NICHOLAS , TAN JENNA H. , WANG JEN-CHYWAN
Published: June 2019

It is well established that chronic and/or excess glucocorticoid (GC) exposure causes glucose and lipid homeostasis disorders. Previous studies have shown that chronic glucocorticoid exposure elevates hepatic ceramide production to inhibit insulin action and increase triglyceride accumulation in the liver. Glucocorticoid treatment not only increases the levels of hepatic ceramides, but also the levels of sphingosine-1-phosphate (S1P). This is because glucocorticoids not only promote the ceramide synthetic pathway, but also increase the expression of sphingosine kinase 1 (Sphk1). Ceramides can be converted to sphingosine, which is further converted to S1P through Sphk1. Here, we reduced the expression of Sphk1 in liver to evaluate its role in chronic glucocorticoid exposure-induced glucose and lipid disorders. We found that mice with reduced hepatic Sphk1 expression had improved glucose and pyruvate tolerance, while no significant difference in insulin tolerance was found upon glucocorticoid treatment. In contrast, glucocorticoid treatment-induced hepatic steatosis and hypertriglyceridemia were exacerbated in these mice with reduced hepatic Sphk1 expression. These results are surprising, as insulin resistance is frequently associated with the development of hepatic dyslipidemia. In this case, while Sphk1 is involved in the insulin resistance induced by glucocorticoids, it plays a negative role in chronic glucocorticoid treatment-induced hepatic dyslipidemia. Here, we will report our recent analysis on the mechanism underlying the role of Sphk1, ceramides, and S1P, in chronic glucocorticoid exposure-induced metabolic disorders.

Disclosure

R.A. Lee: None. A. Tsay: None. M. Chang: None. N. Yiv: None. J.H. Tan: None. J. Wang: None.

Funding

National Institutes of Health (R01DK113019)
613-P: Preventive Effect of Sulforaphane on Type 2 Diabetes-Induced Diabetic Cardiomyopathy via AMPK-Mediated Activation of Glucose/Lipid Metabolism and Nrf2 Function
Authors: SUN YIKE , CAI LU , LI ZHUO
Published: June 2019

Dyslipidemia has been shown to play a crucial role in the development of diabetic cardiomyopathy (DCM) in type 2 diabetes (T2D). AMP-activated protein kinase (AMPK), particularly α2 isoform can improve energy metabolism in cardiomyopathy. Sulforaphane (SFN), a natural isothiocyanate in vegetables, is important in cardiac protection from diabetes. We investigated whether SFN can protect heart from T2D damage, which is mediated by AMPKα2 via improving energy metabolism and activating Nrf2-mediated anti-oxidative pathways. AMPKα2 knockout (AMPKα2-KO) mice and their wild type (WT, C57BL/6J) mice were fed high-fat diet (HFD) for 3 months to induce insulin resistance, and then intraperitoneal injection of streptozotocin to induce hyperglycemia as T2D model. Age-matched mice were fed with normal diet (ND) without streptozotocin as control. T2D and control mice were treated with or without SFN for 3 months (3m) and then stop SFN treatment, remained feeding either ND or HFD for additional three months (6m). Echocardiography were performed before sacrifice both in 3m and 6m group. SFN treatment improved cardiac remodeling and dysfunction induced by T2D both in 3m and 6m group. The cardiac pathogenic changes induced by T2D, including fibrosis, lipotoxicity, inflammation, oxidative stress/damage along with suppression of AMPK signaling pathways was prevented by SFN in WT diabetic mice, as evidenced by down-regulating FN, TGF-β PAI-1, TNF-α, SCD-1and up-regulating CPT1-B, PPARα, Nrf2. The cardiac protection by SFN for 3 months from T2D could last till 6 months. AMPKα2-KO mice are also susceptible to T2D-induced cardiomyopathy; however, the protective effect of SFN on the heart from diabetes was lost in diabetic AMPKα2-KO mice. These results suggest that SFN treatment can attenuate cardiac damage induced by T2D both in the 3m and 6m group, and AMPKα2 plays the pivotal role in the SNF-mediated cardiac protection.

Disclosure

Y. Sun: None. L. Cai: None. Z. Li: None.

Funding

American Diabetes Association (1-18-IBS-082 to L.C.)
628-P: Insulin's Regulation of CXCL1 Expression Is Critical for Neutrophil Recruitments and the Development of Periodontitis and Poor Wound Healing in Diabetes
Authors: SHINJO TAKANORI , LI QIAN , ISHIKADO ATSUSHI , PARK KYOUNGMIN , ST-LOUIS RONALD , YOKOMIZO HISASHI , FU JIALIN , YU MARC GREGORY , WANG HAIYAN , HASTURK HATICE , VAN DYKE THOMAS E. , KING GEORGE L.
Published: June 2019

A major cause of poor wound healing and periodontitis in diabetes is defective immune response to infections. Insulin signaling via the PI3K/Akt pathway is selectively inhibited in the gingival and wound fibroblasts of diabetic rodents and patients. To determine how loss of insulin actions in gingival fibroblasts can affect periodontitis development, myofibroblast insulin receptors (IR) were deleted by crossbreeding IRβ-flox/flox mice with SM22-Cre C57BL/6 (SMIRKO) mice, which were fed with regular diet (RD), while wild type (WT) littermates were fed with high-fat diet (HFD) for 10 weeks. To induce periodontitis, 7-0 silk ligatures were tied around maxillary molars for 4, 7 or 14 days. When mice were sacrificed to assess alveolar bone loss, immune cell populations and inflammatory cytokine expression in the gingiva was assessed. Gingival IRβ expression in SMIRKO and HFD-fed mice was decreased by 70% and 50%, respectively, with comparable reductions in insulin-induced (100nM) phosphorylation of Akt (pAkt). Ligature-induced alveolar bone loss in SMIRKO and HFD-fed mice was greater by 70% and 40%, respectively, as compared to RD-fed WT mice. Post-ligature time course analysis showed that while neutrophil recruitment was delayed significantly, macrophages and lymphocyte numbers were elevated in both SMIRKO and HFD-fed mice. Similarly, neutrophil-recruiting factors CXCL1 and 2 expression were decreased in the gingiva, whereas TNFα and IL-1β expression were elevated. Gingival myofibroblasts from SMIRKO and HFD-fed mice showed dramatic reductions of IRβ expression and insulin-induced pAkt with parallel lowering of E.coli LPS-induced CXCL1 expression via downregulation of TLR2, compared to RD-fed mice. These data provided the first evidence that insulin action is critical for neutrophil recruitment during infection by enabling CXCL1 expression in gingival myofibroblasts, which is inhibited in diabetes.

Disclosure

T. Shinjo: None. Q. Li: None. A. Ishikado: Employee; Self; SunStar Inc. Employee; Spouse/Partner; SunStar Inc. K. Park: None. R. St-Louis: None. H. Yokomizo: None. J. Fu: None. M. Yu: None. H. Wang: None. H. Hasturk: None. T.E. Van Dyke: None. G.L. King: Research Support; Self; Sanofi.

Funding

Sunstar Foundation; Iacocca Family Foundation
632-P: Anterior vs. Posterior Circulation for Below-Knee Amputations in Patients with Severe Peripheral Arterial Disease
Authors: WALTERS ELLIOT , COERDT KATHLEEN , WANG JING , BEKENY JENNA C. , NIGAM MANAS , ATTINGER CHRISTOPHER
Published: June 2019

Background: The posterior flap, utilizing the gastrocnemius muscle, is a common technique for closure of a below knee amputation. This flap is based on perfusion from the deep posterior compartment arteries of the lower leg (posterior tibialis and peroneal). The gastrocnemius gets additional blood supply from the sural arteries originating from the proximal popliteal artery. As peripheral arterial disease is a major indication for below-knee amputation the deep posterior compartment blood supply may be compromised and this flap must rely on reconstitution from the sural arteries. The purpose of this study is to compare the post-operative outcomes of below-knee amputations with and without perfusion of the deep posterior compartment.

Methods: Medical records were reviewed for patients receiving below-knee amputations with a posterior muscle flap from 2010-2017 who also received angiography of the affected limb.

Results: There were 135 patients identified. Patients excluded from analysis included 15 with no patent vessels below the popliteal artery, 41 with 3-vessel runoff, and 22 with runoff to a combination of AT and either PT or peroneal arteries. There were 16 patients with popliteal runoff only to the anterior tibialis (and patent sural arteries), 14 patients had run-off only to the PT, 17 had run-off only to the peroneal artery, and 10 patients had run-off to both the PT and peroneal arteries. There was no significant difference in time to healing, ambulation, complications, or conversion to AKA when anterior tibialis only perfusion is compared to any combination of posterior tibialis and peroneal circulation (p>0.05).

Conclusions: Successful post-operative outcomes can be accomplished with a posterior based flap despite the absence of the deep posterior compartment arteries because of compensatory perfusion through the sural arteries.

Disclosure

E. Walters: None. K. Coerdt: None. J. Wang: None. J.C. Bekeny: None. M. Nigam: None. C. Attinger: Consultant; Self; Acelity, Integra LifeSciences.
633-P: Assessment of Calf Skeletal Muscle in Individuals with Diabetes and a Foot Ulcer Using Diffusion MRI
Authors: EDALATI MASOUD , HASTINGS MARY , SORENSEN CHRISTOPHER J. , MUELLER MICHAEL J. , ZHENG JIE
Published: June 2019

Aim: This study is to investigate changes in microstructure in the calf muscles of patients with type 2 diabetes mellitus (DM) and foot ulcers.

Methods: 42 subjects were recruited: 14 without DM (WDM), 19 DM, and 9 DM and ulcer (DMU). They all underwent non-contrast diffusion imaging scans in a 3T MRI scanner, at rest and during a plantarflexion exercise with a fixed resistance.

Results: Reserve data (exercise/rest) of major diffusion indexes for medial gastrocnemius (MG) and soleus (SOL) were calculated for analysis. The indexes were: Fractional Anisotropy (FA), Mean Diffusivity (MD), primary eigenvalue λ1, fiber length, and fiber angle. Diffusional and fiber changes (P<.05) were evident for the MG muscle in the DM and DMU groups (larger diffusional reserve values and larger fiber loss were observed in the DMU group) compared to the WDM group (Figure 1). The DMU was the only group that showed statistically significant diffusional variations (reserve FA, MD, and λ1) for the SOL muscle (P<.05).

Conclusion: Diffusion imaging was able to identify DM associated muscle microstructure dysfunction in the calf.

Disclosure

M. Edalati: None. M. Hastings: None. C.J. Sorensen: None. M.J. Mueller: None. J. Zheng: Consultant; Self; KBI international.

Funding

National Institutes of Health
664-P: What Do Youth with Type 1 Diabetes (T1DM) and Caregivers Know about Cardiovascular Disease (CVD) Risk and Reduction?
Authors: KRALL JODI , RUPPERT KRISTINE , DIAZ ANA M. , FINNEY JESSICA , SIMINERIO LINDA M. , LIBMAN INGRID
Published: June 2019

Risk factors for CVD, the leading cause of premature death in adults with T1DM, are under-recognized and/or undertreated in youth with T1DM, suggesting a need for enhancing prevention and early self-management education efforts. As a first step, this cross-sectional study was conducted to learn about youth with T1DM and their caregivers’ understanding of CVD in relation to DM. Teenagers and young adults with T1DM (n=80; 18.1±1.5y, 41% female, 86% white) attending a DM clinic at a large pediatric academic center and their caregivers (n=64) were surveyed about CVD-DM awareness and self-management practices. Clinical indicators of CVD risk (hemoglobin A1c (HbA1c), blood pressure (BP), and lipid profile) were extracted from medical records. Only 24% youth and 41% caregivers reported that anyone had ever talked to them about the connection between DM and CVD, with the most frequent source being doctors. Merely 14% of youth and 27% caregivers reported having a good/very good understanding of the connection between DM and CVD. Interestingly, 71% of youth and 81% caregivers correctly listed CVD prevention behaviors (e.g., healthy eating, being active), with 35% youth and 44% caregivers listing actions specific to DM care (e.g., good blood glucose control). Most youth and caregivers correctly identified the recommended testing frequency for HbA1c (81% and 78%) and BP (81% and 86%), with fewer youth familiar with the annual testing of lipid profile (41%). A majority of youth and caregivers also correctly listed recommended target values for HbA1c (70% and 77%), but fewer knew target values for BP (25% and 49%) and LDL cholesterol (6% for both groups). In comparison, percentage of youth meeting recommended targeted values for clinical indicators of CVD risk were 29% for HbA1c, 45% for BP, and 70% for LDL cholesterol. These results strongly support a need to raise awareness and address CVD risk and reduction practices as part of ongoing diabetes self-management education.

Disclosure

J. Krall: None. K. Ruppert: None. A.M. Diaz: None. J. Finney: None. L.M. Siminerio: None. I. Libman: Consultant; Self; Novo Nordisk Inc.
669-P: Factors to Improve Attendance at Diabetes Self-Management Education Classes
Authors: WOLF RACHEL , BARNES CATHERINE S. , CAUDLE JANE , KRISHNAPURA SHREYAS G. , DUPONT JACQUELINE L. , CRAWFORD ROCHANDA J. , DICKERSON PATRICE L. , ZIEMER DAVID C.
Published: June 2019

Formal diabetes self-management education (DSME) improves glycemic control. Yet, many patients referred to DSME do not attend. This study examined differences between patients referred to DSME who attended class (PA) and those who did not (PN) to assess factors that might be associated with attendance.

Methods: The study was conducted at an urban safety net hospital over two months. Phone interviews (128) were conducted with a convenience sample of patients after the scheduled DSME class (43 PA and 85 PN) to assess reason for attendance or not. Medical records supplied data on demographics, insurance status, and co-morbidities.

Results: DSME overall attendance was 32% of 197. While obesity was associated with increased likelihood of attendance (OR 2.67, P < .05), overall disease burden was not. Attendance did not differ by age, sex, diabetes duration, insurance status, or A1c. PA and PN reported similar reasons for planning to attend (general knowledge, 36%; “told to”, 32%; dietary information, 24%). Primary reasons for not attending were time conflicts (31%), poor health (24%), lack of perceived need (24%), and transportation (22%). Excluding those PN who denied perceived need for DSME, 64% of PN wanted to reschedule. Thus, lack of attendance may be related more to barriers than lack of interest. PN wanting knowledge were more likely (OR 6.7 p< 0.001) to want to reschedule and those just “told to” go (OR 0.24 p< 0.05) or felt no need (OR 0.15 p< 0.05) were less likely to reschedule.

Conclusions: Addressing both external and internal factors should improve DSME attendance. Flexible/negotiated scheduling, greater variety of class times/locations, ease of rescheduling, and access to alternative transportation options may address external barriers. To address perception of a lack of need for DSME, additional strategies such as clear communication of DSME benefits by clinical providers are needed to enhance attendance.

Disclosure

R. Wolf: None. C.S. Barnes: None. J. Caudle: None. S.G. Krishnapura: None. J.L. Dupont: None. R.J. Crawford: None. P.L. Dickerson: None. D.C. Ziemer: None.
674-P: Glycemic Management Practice Guideline Combined with a Multidisciplinary Champion Team Approach Increased the Use of Basal Bolus Insulin Regimen and Reduced the Use of Sliding Scale Insulin
Authors: BOGUN MAGDALENA M. , ZAGOREN ELEANOR , ACKERMAN KEVIN , CIOLEK ALANA M.
Published: June 2019

Basal-bolus insulin (BBI) therapy is recommended for treatment of hyperglycemia in the inpatient setting, but many patients still receive sliding scale insulin (SSI) that has been shown to be less effective. To evaluate the transition from insulin drip to subcutaneous insulin therapy we performed a retrospective chart review spanning four months in the cardiothoracic intensive care unit (CTICU) at our institution. Of the patients in the unit who were transitioned from insulin drip, 84% (n=63) were transitioned to sliding scale insulin, while only 16% (n=12) were transitioned to basal bolus insulin therapy. Of those patients treated with basal bolus insulin, 33% (n=4) had a delay in basal insulin administration, while 17% (n=2) of patients experienced interrupted basal insulin therapy. In order to increase the use of basal bolus insulin and reduce the use of sliding scale, we developed a glycemic practice guideline which focused on when and how to transition from insulin drip to basal bolus insulin therapy. We launched a multidisciplinary champion team who assisted with the implementation of the guideline in the CTICU. After implementing the guideline for one year, we found the use of basal bolus therapy increased from 16% (n=12) to 68% (n=50), and use of sliding scale decreased from 84% (n=63) to 22% (n=16), (p=0.008). Furthermore, patients who were treated with basal bolus insulin therapy had less delay and interruption of basal insulin by 21% and 7%, respectively, although the difference was not statistically significant (p=0.10). Additional studies are necessary to determine whether our guideline, combined with a multidisciplinary team approach, would affect clinical outcomes.

Disclosure

M.M. Bogun: None. E. Zagoren: None. K. Ackerman: None. A.M. Ciolek: None.
678-P: Drivers of Weight Loss in a CDC-Recognized Virtual Diabetes Prevention Program
Authors: PAINTER STEFANIE L. , LU WEI , BOLLYKY JENNIFER
Published: June 2019

Background: Over 84 million adults in the U.S. have prediabetes. The CDC National Diabetes Prevention Program (DPP) provides a 12-month structured program to achieve weight loss and increase physical activity to reduce the risk of developing type 2 diabetes.

Methods: A retrospective analysis was performed using data from 658 participants enrolled in the Livongo DPP with a recorded start weight during 2016-2017 and who completed at least 12 lessons, thereby meeting the CDC DPP standards for recognition. Self-monitoring behaviors including weigh-ins, food logging, activity and coach-participant interactions were analyzed at 6 and 12-months. Multiple regression analysis was performed using demographics, self-monitoring and interactions to determine predictors of weight loss at 12-months.

Results: Participants were a mean age of 54 years (SD 10.8), with start weight of 199 pounds (SD 43.7), college educated (82%), and female (72%). On average, participants lost 6.1% of their starting body weight at 6-months and 6.4% at 12-months with 25.2% of participants losing ≥10% at 12 months. Logistic regression analysis showed that each food log was associated with an increase of 0.25% weight loss, a week of 150 active minutes was associated with 0.07% of weight loss, and each lesson completed was associated with 0.21% of increased weight loss.

Conclusions: Overall, participants engaged in the Livongo DPP lost >6% of their start weight with continual weight loss throughout program. More than 25% of highly engaged participants lost ≥10% of their start weight. Food logging was relatively more impactful on weight loss than achieving weeks with 150 minutes of activity completed or lesson attendance.

Disclosure

S.L. Painter: Employee; Self; Livongo Health. W. Lu: None. J. Bollyky: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health.
684-P: Assessment of Individual Self-Management Using the Novel LMC Skills, Confidence, and Preparedness Index (SCPI)
Authors: ARONSON RONNIE , LI AIHUA , BROWN RUTH E. , ORZECH NAOMI , LYONS ASHLEY , WALKER ASHLEIGH
Published: June 2019

Objective: The SCPI was developed to assess knowledge, confidence and preparedness, for the AADE7 Self-Care Behaviours™, in a clinically meaningful, easy to use measure; with immediate feedback to the healthcare providers (HCP). This final version, an electronic 23-item, 7-point Likert questionnaire, was evaluated for validity, reliability (Part 1) and responsiveness to an intervention (Part 2).

Methods and Results: Part 1: 405 participants (200 T1D and 205 T2D; duration 15 ± 12 years (mean ± SD); A1C 7.7 ± 1.3%) completed the SCPI (completion time 4.9 ± 4.3 minutes). Internal consistency was high: intraclass correlation (ICC) was 0.93 overall (p<0.01) with a range of 0.84 to 0.88 for each subscale of Skill, Confidence and Preparedness. There was good external validity in correlation with A1C for the total score (T1D r=-0.26; T2D r=-0.20) (p<0.001) and for each of the subscales. Demographic variables (age, sex, education, ethnicity and income) were not associated. Test-retest reliability after a 1-week interval was high (r=0.79, P<0.001).

Part 2: 51 subjects with A1C > 8.0% (17 T1D and 34 T2D; duration 15 ± 11 years; A1C 9.3 ± 1.0%) were enrolled in a comprehensive education program (6 visits over 4 months) targeting areas identified by the SCPI as needing improvement. At completion, mean A1C had improved by 1.2 ± 0.2% (mean ± SE, p<0.001). Total SCPI score and each of the three subscores similarly increased significantly compared to baseline (p<0.01). Among ‘education responders’ (A1C improvement >0.5% with no therapy change), A1C improvement was correlated with the change in total SCPI scores (r=-0.3, p=0.17).

Conclusions: The SCPI is a highly valid and reliable, easy to use, electronic tool with immediate guidance to the HCP. In general populations with both T1D and T2D, SCPI scoring correlates with glycemic control and is unaffected by unrelated demographic factors. It is effective as a guide to educational intervention and patient gains correlate with SCPI score improvement.

Disclosure

R. Aronson: Research Support; Self; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Senseonics. A. Li: None. R.E. Brown: None. N. Orzech: None. A. Lyons: Consultant; Self; Novo Nordisk Inc. A. Walker: Other Relationship; Self; Medtronic.
688-P: Factors Associated with Diabetes Prevention Program (DPP) Compliance and Weight Loss among Low Income Participants
Authors: DESAI JAY R. , O'CONNOR PATRICK J , TAYLOR GRETCHEN L. , JOHNSON SARA , GARRETT JOYCE E. , RINN SARAH , VUE-HER HOUA
Published: June 2019

Achieving 5% weight loss in the DPP is challenging. We examine factors associated with compliance and weight change in low income participants.

The We Can Prevent Diabetes study enrolled 854 Medicaid beneficiaries (93 DPP groups) for 16 weekly core sessions with. Financial incentives for attendance and weight loss were offered to 568 participants (63 DPP groups). Participants were aged 18-74 years, BMI ≥ 25 kg/m2, had prediabetes, and enrolled in Medicaid. Compliance measures were attendance, self-reported physical activity, and food logs. Patient factors were sex, age, race/ethnicity, primary language, BMI, education, marital status, chronic and mental health conditions. Program factors were incentives, lifestyle coach (YMCA or clinic staff), and DPP group size. Analyses examined bivariate associations with three weight trajectories (gain, stable, loss). Factors significant at p<0.25 were included in regression models examining compliance and weight trajectories.

Participants (N=647) who attended 4+ sessions were analyzed, with 450 eligible for incentives. Patient factors significantly associated (p<0.05) with attendance were aged 45-64 years (OR=1.5), aged 65-84 years (OR=3.6) and presence of a chronic condition (OR=2.0). Those associated with weight change were aged 45-64 years (OR=1.4), English speaking (OR=0.4), and being Hispanic (OR=0.5). At the program level, incentives were associated with attendance (OR=2.9) but not weight change. Clinic lifestyle coach was associated with weight change (OR=1.6). Participants with 8+ sessions (OR 1.8), having an average of more than 150 minutes/week (OR 2.1), and food log documentation (OR 1.6) were more likely (p<0.05) to lose weight.

In culturally diverse low income DPP participants, incentives improve attendance but not weight loss. Use of clinic-based coaches and attention to cultural factors, such language, may enhance program effectiveness.

Disclosure

J.R. Desai: None. P.J. O'Connor: None. G.L. Taylor: None. S. Johnson: None. J.E. Garrett: None. S. Rinn: None. H. Vue-Her: None.

Funding

National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases
694-P: Assessing Social Support in Diabetes Camp
Authors: BEEBE CHRISTINE A. , JOYCE MONICA T. , ALESIA TERESA
Published: June 2019

Social and family support in diabetes predicts self-efficacy, adherence, and positive health outcomes. Peer and family support are explicit strengths of youth possessing resilience to flourish despite challenges of diabetes. Interest in strength-based assessment and interventions in pediatric diabetes practices is increasing in recognition that youth spend significant time away from home and management responsibilities shift away from parents. Nearly 150 diabetes camps reach 25,000 children annually. Camps demonstrate improved self-efficacy and self-confidence. We examined whether youth attending a sports-based day camp exhibit resilience factors that can impact diabetes-related distress levels related to participating in exercise. With parent consent, 44 youth (8-17 year) completed the Diabetes Strengths and Resilience Measure (DSTAR) the first day of camp. Factors related to diabetes confidence and management skewed high with scores of often or almost always for most of the 12- item survey. Mean parental help/support with diabetes was high at 3.6 (of 4) as 90% of youth identified they often/almost always get parental help. Friend support was the lowest scoring factor with mean of 2.6 for youth telling friends about diabetes. Often or almost always was chosen by 50% of youth, 32% sometimes, and 18% never. Counting on friends if I need help scored lowest (mean 2.1) as 35% chose never/rarely, 21% sometime, and 44% often/almost always. Parent surveys indicated 100% of children are physically active 1 hour/day nearly every day (70% 5-7 days/week, 30% 2-4 days/week). Hypoglycemia frequency was 5.5/month (44% >9).

In conclusion, youth with type 1 diabetes who are physically active and at risk for frequent hypoglycemia do not share their diabetes needs with friends and rarely feel they can count on friends to help them (such as recognizing/treating exercise related hypoglycemia). Camps are non-clinical venues to assess social support and intervene with non-traditional age-appropriate education.

Disclosure

C.A. Beebe: Consultant; Self; Xeris Pharmaceuticals, Inc. M.T. Joyce: None. T. Alesia: None.
713-P: Predictors of Reach and Patient Engagement in a Program Involving Family Supporters of Adults in Phone-Based Diabetes Management
Authors: STOLL SHELLEY C. , PIETTE JOHN , TRIVEDI RANAK B. , LEE AARON A. , OBROSKY D. SCOTT , MOR MARIA K. , HEISLER MICHELE , ROSLAND ANN-MARIE
Published: June 2019

Many adults with diabetes have family or friend ‘supporters’ involved in their care. Adult-supporter dyads were recruited to a trial comparing usual care to a 12-month program to engage and train supporters. Potentially eligible patients with T2DM and either HbA1c>8% or high systolic BP were identified via medical records. Patients randomized to the program received biweekly automated calls prompting reports on diabetes status, with tailored feedback to patients and supporters. Before primary care appointments, health coaches conducted a ‘visit prep call’ to improve dyad engagement in the visit. We examined patient characteristics predicting enrollment, and patient, supporter, and call characteristics predicting visit prep and automated call completion via separate multi-level regression models. Of 1119 contacted, 239 dyads (21%) enrolled. Patient predictors of enrollment included younger age (M=60y enrolled vs. 62 not, p <.01), and reason qualifying (BP+HbA1c criteria 30% enrolled, HbA1c only 22%, BP only 16%, p<.01). Of 123 dyads randomized to the program, 87 completed 12 months, and 32 are still enrolled. For 328 eligible visits, patients with high school-only education (AOR=5.7 vs. college degree, p<.01) and higher baseline SBP (AOR=1.2 per 10mmHg, p=.04) were more likely to complete prep calls. Among 2465 eligible automated calls, patients were more likely to complete calls if they had high satisfaction with their primary care team (AOR 1.4, p=.03). Those with higher baseline HbA1c (AOR 0.75, p=.06) trended towards less call completion. Patient insulin use, health literacy, patient activation, and diabetes distress did not predict completion of either type of call.

In conclusion, high BP predicted enrollment and engagement in a dyadic-based diabetes program more than high HbA1c. Programs emphasizing the importance of BP in preventing diabetes complications may increase participant engagement.

Disclosure

S.C. Stoll: None. J. Piette: None. R.B. Trivedi: None. A.A. Lee: None. D. Obrosky: None. M.K. Mor: Stock/Shareholder; Spouse/Partner; AbbVie Inc. M. Heisler: None. A. Rosland: None.

Funding

U.S. Department of Veterans Affairs (IIR 14–074-1); Michigan Center for Diabetes Translational Research (NIDDK5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (NIA AG-024824)
715-P: Reimbursement of Transition-Related Services in an Adult Diabetes Clinic
Authors: JOARDER FARAHNAZ , NAGRA HARPREET , ANDREAS LAURA , ROCHA LOLIS , KRAUS KIMBERLY
Published: June 2019

Objectives: A reimbursement model for a multidisciplinary young adult diabetes clinic supporting pediatric to adult transition of care was examined.

Method: In approximately one year (Dec 2017-Oct 2018), 31 patients with type 1 diabetes (T1D; ages 17-25; 56% males, Hemoglobin A1C ranged from 6.0 to >14.0 (M=9.44, SD=2.07) were billed for attending a Young Adult Diabetes Clinic. Data were extracted via electronic medical record. Reimbursement rates, as noted by Got Transition and American Academy of Pediatrics for Medicare 2018, were used to assess financial sustainability.

Results: Services billed included a 45-minute behavioral health group intervention (96153), emotional/behavioral (96127) and substance use questionnaires (96160). This was followed by a 25 minute diabetes education visit (G0108), a 10 minute warm hand off and a 25 minute medical provider visit (99203). Medical CPT Codes (99213, 99205, and 99204) were reimbursed 76% of the time, producing wRVUs of approximately 50. Behavioral health CPT codes (96150, 96152, and 96127) were reimbursed 46% of the time and produced wRVUs of approximately 14. Approximately $8300 was billed for the half-day clinic over the course of 11 months. Approximately $5700 was returned (68% return rate) and wRVUs were around 70. More than 50% of the patients who agreed to attend the clinic also established ongoing clinical services. The clinic model also supported only 10% of patients being lost to follow-up compared to higher rates previously predicted in the literature.

Conclusions: The half-day, once a month, multidisciplinary transition clinic designed to support transition-age youth with T1D yielded additional funds and increased youth engagement. While not highly lucrative, this may be due to antiquated billing infrastructure and a small sample size. Future studies are needed to assess the link between outpatient engagement, billing, and reduced health crises, hospitalizations and related costs.

Disclosure

F. Joarder: None. H. Nagra: None. L. Andreas: None. L. Rocha: None. K. Kraus: None.