bluuebunny/crossref_metadata_2025 huggingface dataset:
44-LB: Evaluating the Effectiveness of a Novel Form of Online Cognitive Behavioural Therapy for Patients with Type 2 Diabetes and Comorbid Anxiety or Depression
Authors: HAYES ANN G. , CATARINO ANA , MEHEW SHAUN , BLACKWELL ANDREW
Published: May 2022

Mental health disorders like depression and anxiety are highly prevalent in people with diabetes and are associated with poorer outcomes. The current study investigated the effect of a novel online cognitive behavioural therapy (CBT) based intervention derived from Acceptance and Commitment Therapy (ACT) for people with type 2 diabetes. A total of 102 patients with type 2 diabetes and a concomitant mental health disorder completed a course of the novel CBT-based intervention, delivered one-to-one over the internet, using text, by therapists who were specially trained in diabetes. Patients showed pre-treatment scores indicative of moderate to severe depression and anxiety and clinically significant diabetes distress. The treatment paradigm caused statistically significant and clinically meaningful decreases in depression, anxiety and diabetes distress scores. Changes in patient activation further illustrated the degree of improvement seen, with the proportion of patients at the lowest level of activation decreasing from 44.1% to 23.5%, pre- to post-treatment, and half of patients increasing by at least one level of activation. Comparisons between the study group and different synthetic control groups, derived from real-world data obtained using the same online platform as used for the trial, underlined the marked improvements achieved - recovery rates of 76% in the study group compared to 56% and 68% in the synthetic control arms. This study demonstrates that this novel CBT-based treatment, delivered by therapists who have specialism in the disease, provides an integrated therapy which can deliver substantial clinical benefit to patients with diabetes and comorbid mental health problems. Moreover, because it is delivered online, it can be given at a time and place that is convenient to both patients and therapists.

Disclosure

A. G. Hayes: Consultant; Ieso Digital Health Ltd. A. Catarino: Employee; ieso. S. Mehew: None. A. Blackwell: Employee; IESO.

Funding

Roche Diabetes Care Limited
442-P: Sorbs2 Deficiency–Mediated Vascular BK Channel Dysfunction in Type 2 Diabetes
Authors: LU TONG
Published: May 2022

Vascular BK channels, composed of the pore-forming α-subunits (BK-α) and the regulatory β1 subunits (BK-β1) , is a key determinant of vasoreactivity, and its function is impaired in diabetes. However, our understanding of the mechanisms causing BK channel dysfunction in diabetic vessels is incomplete. The Sorbin and SH3 domain-containing protein 2 (Sorbs2) is abundantly expressed in vascular smooth muscle cells (SMCs) . We hypothesize that Sorbs2 is critical for vascular BK channel physiology. In this study, we compared vascular BK channel function between Sorbs2 KO and WT mice at 4 months of age. There was no difference in body weight and blood glucose between WT and Sorbs2 KO mice (body weight: 25.9±1.3 g of WT vs. 23.3±1.5 g of KO, n=14, p=N.S.; blood glucose: 166.4±7.7 mg/dL of WT vs. 152.2±12.2 mg/dL of KO, n=14, p=N.S.) . However, Sorbs2 KO mice have markedly reduced cell surface and cytoplasmic expression of BK-α and BK-β1, as well as BK channel-mediated vasodilation in carotid arteries with a maximal dilatation of 64.70±1.92% for WT mice (n=4) and 20.74±4.66% for KO mice (n=5, p<0.05) . Patch clamp experiments revealed that BK channel sensitivity to Ca2+ activation was impaired in the coronary SMCs of Sorbs2 KO mice (EC50: 2.87±0.68 µM, n=13, p<0.05) with decreased Hill coefficient (nH: 1.26) , compared to those of WT mice (EC50: 0.48±0.µM, nH: 2.70, n=13) . In vivo studies showed that Sorbs2 interacted with BK-α and BK-β1 protein in vascular SMCs. Silencing of Sorbs2 by shRNA decreased BK-α and BK-β1 expression, while adenoviral expression of Sorbs2 increased BK-α and BK-β1 expression in vascular SMCs. Most importantly, Sorbs2 expression was significantly reduced in the arteries of db/db type 2 diabetic mice and high fat diet-induced diabetic mice. Our results indicate that Sorbs2 plays an important role in regulating BK channel function and expression in vascular SMCs. Sorbs2 deficiency is a risk factor of BK channelopathy and vasculopathy in diabetes, independent of obesity and glucotoxicity.

Disclosure

T.Lu: None.
447-P: C/EBPß-Lin28a Positive Feedback Loop Mediated by C/EBPß Hypomethylation Promotes the Proliferation and Migration of Vascular Smooth Muscle Cells in Restenosis
Authors: JIANG SHAN , ZHOU XIAOJUN , ZHANG QIAN , GUO SIYI , SHENG QIQI , LI XIANZHI , ZHANG RUI , XU CHUNMEI , GONG PIYUN , LIAO LIN , DONG JIANJUN
Published: May 2022

Background: The main reason for restenosis (RS) after percutaneous transluminal angioplasty is the excessive proliferation and migration of vascular smooth muscle cells (VSMCs) . C/EBPβ plays an important role in the process of vascular remodeling. However, the role of C/EBPβ in RS has not been clarified.

Methods: The type 2 diabetes rat models of RS and atherosclerosis (AS) were established to detect the difference in DNA methylation and expression levels of C/EBPβ. Simultaneously, the effect of C/EBPβ on the proliferation and migration of VSMCs was clarified by regulating C/EBPβ and Lin28a in vitro. The effect of decitabine, a demethylating agent, on the expression of C/EBPβ and Lin28a, and the further regulation of VSMCs proliferation and migration was confirmed.

Results: C/EBPβ was highly expressed and had a lower methylation level in RS compared with AS. In vitro C/EBPβ overexpression facilitated the proliferation and migration of VSMCs with increased expression of Lin28a. Conversely, C/EBPβ knockdown resulted in opposite effects. Chromatin immunoprecipitation assays further demonstrated that C/EBPβ could directly bind to the promoter of Lin28a. Furthermore, increased expression of C/EBPβ and enhanced proliferation and migration of VSMCs were observed after decitabine treatment. And mechanical stretch promoted the expression of C/EBPβ and Lin28a. Additionally, C/EBPβ expression increased following the overexpression of Lin28a. The reversed result was found in the Lin28a knockdown cells.

Conclusion: Our results have demonstrated that C/EBPβ expression is regulated partly by DNA methylation. Meanwhile, as a transcription factor, C/EBPβ promotes the transcription of Lin28a and enhances the proliferation and migration of VSMCs through a positive feedback loop between the two. Our study suggests C/EBPβ-Lin28a axis is a driver of the RS progression, providing a promising therapeutic strategy for RS.

Disclosure

S.Jiang: n/a. L.Liao: None. J.Dong: None. X.Zhou: n/a. Q.Zhang: None. S.Guo: None. Q.Sheng: None. X.Li: None. R.Zhang: None. C.Xu: None. P.Gong: None.

Funding

National Natural Science Foundation of China Grants (81800732,81670757,82170824) , Shandong Provincial Medicine and Health Science and Technology Development Program (No.202103060766) and Shandong Provincial Hospital Research incubation Fund (No.2021FY059)
45-LB: A Qualitative Study to Understand Why People Living with Obesity and General/Family Practitioners Experience Therapeutic Inertia in Obesity
Authors: LAU DAVID C. , PATTON IAN , LAVJI REENA , BELLOUM ADEL , NG GINNIE , MODI RENUCA
Published: May 2022

Medical nutrition therapy and physical activity are often used exclusively for obesity treatment despite the availability of effective adjunctive interventions, including psychological intervention, pharmacological therapy, and bariatric surgery. We conducted a qualitative study through interviews with people living with obesity (PwO) and general/family practitioners (GP/FPs) to better understand the factors contributing to healthcare decision-making and therapeutic inertia in obesity management. Phone interviews were conducted by the same investigator using discussion guides informed by the Theoretical Domains Framework (TDF) . Eligibility criteria for PwO included having a BMI over 30 kg/m2.

A total of 20 PwO and 20 GP/FPs across Canada were interviewed with representation across gender and ethnicity. PwO also varied in obesity classification and experience with management strategies. GP/FPs varied in practice type, local community, and awareness of the 2020 Canadian Adult Obesity Clinical Practice Guidelines.

Themes related to therapeutic inertia mapped to all 14 TDF domains. Both PwO and GP/FPs often perceived obesity to be a secondary health priority that is associated with negative emotions, which had pervasive influence on obesity management. PwO were hesitant to explore new strategies due to financial barriers, access to support, and concerns of adverse side-effects, effectiveness, and sustainability of interventions that support eating and physical activity behavioral changes. GP/FPs were limited in time and resources, and were hesitant to recommend specific treatments due to concerns of risks, effectiveness, and accessibility. GP/FPs were also hesitant to make referrals due to skepticism of whether other healthcare providers can provide better care. Future research will validate these themes in a larger, national sample of PwO and GP/FPs to understand how individuals can overcome the therapeutic inertia.

Disclosure

D. C. Lau: Advisory Panel; Amgen Canada, Novartis Canada, Novo Nordisk Canada Inc., Board Member; Canadian Association of Bariatric Physicians and Surgeons, Consultant; Pfizer Inc., Viatris Inc., Research Support; Novo Nordisk Canada Inc., Speaker’s Bureau; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Canadian Collaborative Research Network, CME at Sea, Eli Lilly and Company, HLS Therapeutics Inc., Novo Nordisk Canada Inc., Obesity Canada. I. Patton: None. R. Lavji: Employee; Novo Nordisk Canada Inc., Stock/Shareholder; Moderna, Inc., Novo Nordisk, Pfizer Inc. A. Belloum: None. G. Ng: Other Relationship; Novo Nordisk Canada Inc. R. Modi: Advisory Panel; Bausch Health, Canada, Eli Lilly and Company, Novo Nordisk Canada Inc., Other Relationship; Takeda Canada.
450-P: Soluble Guanylate Cyclase Stimulator Praliciguat Promotes Ischemic Leg Reperfusion in db/db Mice
Authors: FOUSSARD NINON , BUYS EMMANUEL S. , MOHAMMEDI KAMEL , RENAULT MARIE-ANGE
Published: May 2022

Background: Lower-limb peripheral artery disease (PAD) is a prevalent and challenging complication of diabetes, requiring innovating therapies. Praliciguat is an orally available stimulator of soluble guanylate cyclase reported to have favorable effects on metabolic and hemodynamic endpoints in preclinical and clinical studies, suggesting the potential for benefit in PAD. We evaluated the effect of praliciguat on hindlimb ischemia recovery in a mouse model of diabetes.

Methods: Hindlimb ischemia was induced in db/db mice by ligation and excision of the left femoral artery. Praliciguat 10mg/kg/day (N=mice) or vehicle (N=10) were administered in the diet for 31 days. Foot perfusion was assessed with a Laser Doppler Imager and reported as a ratio in the ischemic versus non-ischemic limb. Ischemic leg function was assessed with a 4-point scale: 0, plantar/toe flexion in response to tail traction; 1, plantar but not toe flexion; 2, no flexion; 3, foot dragging.

Results: Ischemic foot perfusion and function were better 28 days after surgery in praliciguat than in vehicle treated mice (mean ± SD: perfusion 1.± 0.23 vs. 0.38 ± 0.16; p<0.0001; function 1.14 ± 0.36 vs. 1.73 ± 0.80; p=0.03) . Praliciguat did not impact angiogenesis. Arteriolar diameter was higher (9.88 ± 0.96 vs. 8.57 ± 0.64 µm; p=0.004) and ICAM-1 expression lower (186 ± 41 vs. 403 ± 177 % of healthy muscle; p=0.005) in the ischemic limb of mice treated with praliciguat than with vehicle. Praliciguat attenuated accumulation of oxidative pro-angiogenic and pro-inflammatory muscle fibers. In cultured myoblasts praliciguat significantly downregulated Myh2 and Cxcl12 mRNA expression. Conditioned medium from praliciguat-treated myoblast decreased ICAM-1 mRNA expression in HUVECs.

Conclusion: These results suggest that praliciguat restored perfusion and function in the ischemic muscle of db/db mice by increasing arteriolar diameter and decreasing ICAM-1 expression in endothelial cells via downregulation of Cxcl12 in myocytes.

Disclosure

N.Foussard: None. E.S.Buys: Employee; Cyclerion Therapeutics, Inc. K.Mohammedi: Board Member; Lilly, Novo Nordisk, Sanofi, Research Support; Cyclerion Therapeutics, Inc., Speaker's Bureau; Abbott, AstraZeneca. M.Renault: None.
456-P: HMGB1 Inhibition Protects Schwann Cells from High Glucose–Induced Cytotoxicity
Authors: SHI MIN , SONG JING , CHEN YANNA , GU WENSHA , LIU YUTING , ZHANG HONG
Published: May 2022

Objective: Damage to Schwann cells play a crucial role in diabetic peripheral neuropathy (DPN) . To observe whether HMGB1 inhibitor (Glycyrrhizic acid, GA) can prevent diabetic Schwann cells damage and its potential mechanisms.

Methods: RSC96 cells were divided into 5 groups: NG group (5.6 mmol/L) and HG group (25.0 mmol/L) , HG+GA (1μM) group, HG+GA (10μM) , HG+GA (100μM) . Small interfering RNA was used to knock out HMGB1. CCK8 assay was used to detect the proliferation of RSC96 cells. The levels of inflammatory factors were determined by ELISA. The mRNA expression of NGF and neuritin-1 was detected by qRT-PCR. The expression levels of NSE, cleaved-caspase-3, RAGE, p38MAPK, ERK, JNK and NF-κBp65 in cells were measured by western blot.

Results: GA at the concentration of μM for 24h had significant inhibitory effect on HMGB1 synthesis and secretion (P<0.05) . Schwann cell viability in high glucose was restored due to GA and siHMGB1 (P<0.05) . GA intervention and siHMGB1 potently prevented inflammatory substance generation (TNF-α, IL-1β, IL-6, MCP-1 and ICAM-1) , alleviated the neurotrophic factor reduction (NGF and neuritin-1) , and suppressed cellular apoptosis related protein activation (cleaved caspase-3) in Schwann cells exposed to high glucose ambience (P<0.05) . Moreover, we found that RAGE expression, p38MAPK phosphorylation and nuclear NF-κBp65 expression in high glucose-stimulated Schwann cells was reversed by GA or siRNA interference with HMGB1 (P<0.05) .

Conclusions: GA and siHMGB1 can not only inhibit HMGB1 expression in Schwann cells exposed to high glucose, but also enhance cell viability. GA and siHMGB1 restored neurotrophic factors level and reduce cleaved caspase-3 expression in Schwann cell due to its anti-inflammatory ability, which may be related to the inhibition of RAGE/p38MAPK/nuclear NF-κBp65 pathway. HMGB1 may implicate in Schwann cells lesion in high glucose milieu and HMGB1 inhibition protects Schwann cells from high glucose induced cytotoxicity.

Funding

National Natural Science Foundation of China Grant Award (81700723)
460-P: Cellular Communication of Schwann Cell Subtypes in Metabolically-Acquired Neuropathy
Authors: EID STEPHANIE , NOURELDEIN MOHAMED H. , MENDELSON FAYE , FELDMAN EVA L.
Published: May 2022

The prevalence of the metabolic syndrome (MetS) is increasing worldwide due in part to the increased consumption of a Western diet. MetS is associated with peripheral neuropathy (PN) . PN develops in a cell non-autonomous manner with involvement of axons, Schwann cells (SC) and nerve tissue- infiltrating macrophages (TIM) . SC are divided into subtypes with different roles in nerve injury. Our aim in the current study was to determine how gene expression of different types of SC and macrophages are affected in MetS and how these cells communicate with one another. C57BL6/j male mice (6-weeks old) were fed either a standard diet (SD, 10% fat) or high fat diet (HFD, 60%) for 17 weeks. Metabolic and PN phenotyping were performed for all mice and SC were extracted from sciatic nerves for single cell RNA sequencing (scRNA-seq) . Cellular communication was determined using the CellChat tool. Mice on HFD had higher fasting blood glucose (FBG) , glycated hemoglobin (HbA1c) and decreased nerve conduction velocities and intraepidermal nerve fiber densities consistent with PN compared to mice on SD. Analysis of SC scRNA-seq data revealed unique RNA expression signatures for TIM and 4 subpopulations of SC denoted as myelinating SC (mySC) , non-myelinating SC (nmSC) , SC precursors (SCP) and regenerating SC. Inflammatory genes such as Ptprc and Il1b were significantly more expressed in both TIM and mySC in HFD mice compared to SD mice. CellChat analysis of cellular communication revealed more crosstalk between TIM and various types of SC in HFD animals and identified multiple metabolic and inflammatory pathways that were activated in HFD compared to SD mice.

In conclusion, our study shows that there are many subtypes of SC that behave differently in MetS. Their communication with each other and with TIM strongly implicates these two cell types in the pathogenesis of metabolically acquired PN.

Disclosure

S.Eid: None. M.H.Noureldein: None. F.Mendelson: None. E.L.Feldman: None.

Funding

Funding was provided by the National Institutes of Health (NIH) (1R24082841 to ELF) , Novo Nordisk Foundation (NNF14OC0011633 to ELF) , the Nathan and Rose Milstein Research Fund (to SAE) , NeuroNetwork for Emerging Therapies at the University of Michigan (to SAE, MHN, and ELF) , and the A. Alfred Taubman Medical Research Institute (to SAE, MHN, and ELF) .
462-P: Improvement of Cardiovascular Autonomic Neuropathy after Metabolic Bariatric Surgery in Korean Subjects with Obesity
Authors: JANG HAN NA , MOON SEOIL , MOON JOON HO , PARK YOUNG SUK , CHOI SUNGHEE , JANG HAK CHUL , OH TAE JUNG
Published: May 2022

Object: Cardiovascular autonomic neuropathy (CAN) is one of chronic vascular complications of diabetes, and obesity is a major risk factor for CAN. Metabolic bariatric surgery (MBS) dramatically improved both diabetes and obesity. In this study we investigated the influence of MBS on CAN in Korean subjects with obesity.

Method: We recruited patients who underwent bariatric surgery from October 20to February 2021 prospectively. CAN was evaluated before and 6 months after surgery by Ewing method including change in heart rate (HR) and blood pressure (BP) according to deep breathing, Valsalva maneuver, and postural change by AFT-800 (MEDICORE, Gyeonggi-do, Republic of Korea) . Standard deviation of NN interval (SDNN) , root mean square of successive RR interval difference (RMSSD) , total power, and very low, low, and high frequency were compared before and after surgery.

Result: A total of 22 patients were evaluated. Patients' mean age was 42.1 ± 9.1 years, and 8 patients (36.4%) were male, and the mean follow-up duration was 189.0 days. Among them, 15 (68.2%) subjects had diabetes, and none had cardiovascular disease. The resting HR before surgery was 79.2 ± 13.7 bpm, and it decreased significantly to 67.4 ± 8.2 bpm after surgery (P<0.001) . Changes in HR and BP according to Valsalva maneuver, posture change, and handgrip were not significantly different before and after surgery. However, SDNN significantly increased from 25.3 [13.7-41.8] ms to 35.2 [22.6-40.4] ms (P=0.046) , and RMSSD also tended to increase. In addition, the high frequency significantly increased from 36.1 [16.8-180.3] ms2 to 117.8 [34.6-357.7] ms2 (P=0.042) after surgery.

Conclusion: MBS significantly improved indicators of parasympathetic denervation, an early manifestation of CAN.

Disclosure

H.Jang: None. S.Moon: None. J.Moon: None. Y.Park: None. S.Choi: None. H.Jang: None. T.Oh: None.
473-P: Correlation between Serum Elabela and Type 2 Diabetic Retinopathy
Authors: GU WENSHA , SHI MIN , CHEN YANNA , LIU YUTING , SONG JING , ZHANG HONG
Published: May 2022

Aim: To analyze the relationship between serum Elabela (ELA) levels and type 2 diabetic retinopathy (DR) .

Methods: A total of 81 patients with type 2 diabetes were collected. According to the stages of diabetic retinopathy, the patients were divided into three groups: group 1: no diabetic retinopathy stage, group 2: non-proliferative diabetic retinopathy (NPDR) and group 3: proliferative diabetic retinopathy (PDR) , with 27 patients in each group. Serum ELA levels were detected by ELISA. Relevant clinical datas were recorded and analyzed.

Results: There were no statistical significance in age, BMI, FPG, HbA1c, t-chol, TG, LDL-C, HDL-C among 3 groups (all P> 0.05) . The duration of diabetes in group 1 was significantly shorter than that in groups 2 and 3 (all P<0.05) , and there were significant differences in SBP, DBP, eGFR and Cre in groups 3 compared with those in groups 1 and 2 (P<0.05) . From group 1 to group 3, the levels of ELA decreased gradually, with statistical significance among the three groups (P<0.05) . Correlation analysis showed that serum ELA levels were negatively correlated with the course of diabetes, DR, SBP, Cre (P<0.05) , and positively correlated with eGFR (P<0.05) . Stepwise multiple linear regression analysis showed that the most relevant variables for ELA were age, BMI and DR (P=0.005; P = 0.000; P = 0.001) . According to ROC curve analysis, the sensitivity and specificity of ELA in the diagnosis of diabetic retinopathy were 59.3%, 83.3%, and the area under the curve was 0.753 (95%CI: 0.638, 0.869, P=0.000) .

Conclusions: With the progressive of diabetic retinopathy, the level of serum ELA decreases gradually. ELA may be a potential clinical predictor and therapeutic target of diabetic retinopathy.

Disclosure

W.Gu: None. M.Shi: None. Y.Chen: None. Y.Liu: None. J.Song: None. H.Zhang: None.

Funding

National Natural Science Foundation of China Grant Award (81200595/81400807/81700723) , Six High-peak Talents Project of Jiangsu Province (WSN-101) , Research Project of Jiangsu 333 engineering (BRA2016232) and Research Project of Jiangsu Provincial Commission of Health and Family Planning (F201549/H201667) , and International Science and Technology Cooperation Project of Huaian (HAC201707) .
478-P: GALNT2 Variant Associates with Increased ANGPTL3 Circulation Level and Obesity
Authors: THANGAVEL ALPHONSE T. , ABU-FARHA MOHAMED , HEBBAR PRASHANTHA , QADDOUMI MOHAMMAD G. , ALMULLA FAHD , ABUBAKER JEHAD
Published: May 2022

Background: Polypeptide N-Acetylgalactosaminyltransferase 2 (GALNT2) gene has been associated with serum lipid levels, insulin resistance, and adipogenesis. One of its variants, rs4846914 has been shown to associate with Triglycerides and HDL levels in global genome-wide association studies. ANGPTL proteins have emerged as important regulators of lipid metabolism through its regulation of lipoprotein lipase activity. In this study we aimed to evaluate the association between GALNT2 variant with plasma level of ANGPTL3, 8 and apolipoproteins in individuals of Arab ethnicity.

Methods: GALNT2 rs4846914 variant was genotyped in a cohort of 278 Arab individuals from Kuwait. Plasma levels of ANGPTL3 and 8 were measured by ELISA. Apolipoproteins were measured by Luminex multiplexing assay. Significance of association signals was assessed using Bonferroni-corrected P-values.

Results: The GALNT2 rs4846914_G allele was associated with increased ANGPTL3 but not ANGPTL8 plasma levels. It was associated with obesity status with an odds ratio of 1.45 (CI:1.024-2.055) (P-value =0.036) . It also associated with increased levels of ApoC1 (P-values ≤0.006) and lower levels of HDL (P-values ≤0.05) . Levels of HDL were found to be mediated by interactions between genotypes (AG+GG) at rs4846914 and measures of percentage body fat (PBF) , apolipoproteins A1a, C1 and B48.

Conclusions: Association between GALNT2 variant and lipid metabolism could be mediated through the increased ANGPTL3 protein level.

Disclosure

A.T.Thangavel: None. M.Abu-farha: None. P.Hebbar: None. M.G.Qaddoumi: None. F.Almulla: None. J.Abubaker: None.
479-P: Lipid Pattern in Men with Hypogonadism and Type 2 Diabetes Receiving Long-Term Testosterone Treatment Compared with an Untreated Control Group: Update of a Real-World Registry
Authors: SAAD FARID , HAIDER KARIM S. , HAIDER AHMAD
Published: May 2022

Background: Previous studies reported inconsistent effects of testosterone therapy on the lipid profile in men with hypogonadism.

Methods: Of 370 men with hypogonadism and T2DM, 190 received testosterone undecanoate 1000 mg/12 weeks (T-group) , 180 opted against treatment (CTRL) . Means and standard deviations of absolute measures over 13 years of treatment are reported.

Results: Mean baseline age: 62.0±5.2, mean (median) follow-up: 9.3±3.1 (10) years. Total cholesterol (TC) (mmol/L for all lipids) decreased from 8.3±1.1 to 5.1±0.3 in T-group and increased from 7.1±1.2 to 8.4±1.4 in CTRL (p<0.00for both) . HDL increased from 1.0±0.4 to 1.6±0.3 in T-group and decreased from 1.1±0.5 to 0.8±0.4 in CTRL (p<0.00for both) . The TC:HDL ratio decreased from 9.8±4.2 to 3.2±0.6 in T-group and increased from 8.0±3.9 to 13.8±6.8 in CTRL (p<0.00for both) .LDL decreased from 4.7±0.8 to 2.6±0.2 in T-group and increased from 4.1±1.4 to 5.2±1.6 in CTRL (p<0.00for both) . Triglycerides decreased from 3.5±0.6 to 2.2±0.1 in T-group and increased from 3.1±0.6 to 3.8±0.8 in CTRL (p<0.00for both) . Non-HDL decreased from 7.3±1.1 to 3.5±0.3 in T-group and increased from 6.0±1.4 to 7.7±1.5 in CTRL (p<0.00for both) . Remnant cholesterol decreased from 2.7±0.9 to 0.9±0.3 in T-group and increased from 2.0±1.0 to 2.5±0.7 in CTRL (p<0.00for both) . The triglyceride:HDL ratio decreased from 9.4±4.4 to 3.1±0.7 in T-group and increased from 8.0±4.0 to 14.1±6.9 in CTRL (p<0.00for both) .

Conclusions: Long-term treatment with TU in men with hypogonadism and T2DM improved the lipid profile, which worsened in controls.

Disclosure

F.Saad: Consultant; Bayer AG, Stock/Shareholder; AbbVie Inc., Bayer AG, GlaxoSmithKline plc. K.S.Haider: Other Relationship; Bayer AG. A.Haider: Other Relationship; Bayer AG.

Funding

Bayer AG
491-P: Ten Years of the National Diabetes Prevention Program: Scaling the Lifestyle Change Program across the United States
Authors: CHAPPELL ASHLEY , ELY ELIZABETH
Published: May 2022

The National Diabetes Prevention Program (National DPP) is a public-private partnership to build a nationwide delivery system for an evidence-based lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes. Using data collected through the Diabetes Prevention Recognition Program (DPRP) , which certifies programs as official National DPP sites since 2012, this study shows how programmatic milestones have impacted enrollment trends over the past years. At the end of 2012, only 13 states had enrolled participants, with the highest number reported by MT (269) . By 2013, the number of states with programs increased to 41, with the highest number of enrollees reported by OH (931) and FL (840) . In 2015, online delivery modes were introduced, this allowed participants to enroll in programs located outside of their current states of residence and led, to an increase in enrollment across 50 states and DC. Notable increases were then seen in IL (13 to 670) , KS (9 to 786) , and LA (59 to 1362) . In January 2018, the Medicare Diabetes Prevention Program (MDPP) was launched, which allowed eligible Medicare beneficiaries to enroll in the LCP as a covered service. By the end of 2018, in-person (IP) enrollment sharply increased in organizations approved as MDPP suppliers, and large increases in IP enrollment from 2017 to 2018 were seen in AL, MO, NJ, and NV. The ongoing COVID-pandemic significantly impacted National DPP enrollment trends. Most states’ online enrollment increased by at least 20% from March 2020 to March 2021, with NC, CO, and NY showing large increases of 176%, 243%, and 590%, respectively. In contrast, CA, DE, and MS had decreases in online enrollment of 7%, 8%, and 26%, respectively. Enrollment trends have proven to be important reflections of milestones in the evolution of the National DPP. Expanding the number of organizations offering the MDPP, as well as those offering virtual delivery, allows the Program to continue to scale.

Disclosure

A.Chappell: None. E.Ely: None.
495-P: Fully Immersive Virtual Reality Improves Empathy towards People with Diabetes
Authors: BEVERLY ELIZABETH A. , LOVE MATTHEW , LOVE CARRIE
Published: May 2022

Background: Virtual reality (VR) is a major driving factor in the growth of the medical education market. VR simulates objects, places, and interactions in a 3D multimedia sensory environment. Research shows its effectiveness in surgical training, anatomy, and role-playing in clinical encounters. However, minimal research has compared the effectiveness of different delivery modes. The purpose of this study was to compare fully-immersive and semi-immersive VR in diabetes training.

Methods: In this quasi-experimental study, healthcare trainees participated in either a fully-immersive 360-degree VR training with head-mounted displays (prior to SARS-CoV-2 pandemic) or a semi-immersive online VR training (during pandemic) . Participants completed the Diabetes Attitude Scale-3, Jefferson Scale of Empathy, and Transcultural Self-Efficacy Tool pre- and post-training. We conducted paired t-tests and independent t-tests with mean change scores for each measure to examine differences between study arms.

Results: A total of 115 trainees participated (22.0±3.7 years, 82.6% women, 79.1% White, 24.3% medical students) . Participants in the fully-immersive VR arm (n=69) showed improvements in all diabetes attitude subscales, empathy, and all cultural self-efficacy subscales. Participants in the semi-immersive arm (n=46) showed improvements in all diabetes attitude subscales and two of the three cultural self-efficacy subscales, but not empathy (t=1.360, p=.182) or affective cultural self-efficacy (t= -1.798, p=.081) . Comparisons between fully-immersive and semi-immersive VR revealed no differences in diabetes attitudes or cultural self-efficacy; however, the fully-immersive VR showed greater improvements in empathy (t= -4.325, p<.001) .

Conclusion: Our findings suggest fully-immersive VR is more effective in improving empathy than semi-immersive VR training. Future research should use a randomized-control design to compare the two delivery modes and examine the measures over time.

Disclosure

E.A.Beverly: None. M.Love: None. C.Love: None.
496-P: Biomedical Expertise in the Face of Social Media: How Is Diabetes-Related Information That Stems from Social Media Discussed in Clinical Encounters?
Authors: KJÆRULFF EMILIE M. , NEXO METTE A. , BJERRE-CHRISTENSEN ULLA , LANGSTRUP HENRIETTE
Published: May 2022

Background and Aim: In today’s digital world, people with type 1 and 2 diabetes turn to peers on social media to exchange information and support. However, little is known about what the online sharing of diabetes-related information implies for the clinical encounter. This study examines how information that stems from social media is discussed in clinical encounters between healthcare professionals (HCPs) and people with diabetes (PWD) .

Methods: We conducted semi-structured interviews with 25 PWD aged 22-76 (type 1: n= 17, type 2: n=8) and HCPs (nurses n=9, medical doctors n=7, dieticians n=3) . The participants were recruited from the diabetes outpatient care setting in Denmark. Two researchers independently developed a thematic coding framework that was compared, revised, and then applied to analyze each interview. Subsequently, overarching themes were identified across the whole data set.

Results: The first theme suggests that HCPs tend to have a ‘blind spot’ towards information that stems from social media: Most HCPs have not asked whether PWD retrieve information from social media and most PWD present information that is accessed on social media without naming their source. The second theme reflects that clinical dialogues about online information rest upon trustful relationships: PWD find online peer exchanges valuable and request for HCPs to acknowledge this. Still, PWD navigate large amounts of information and treatment advice online, and while PWD may seek to discuss their information in clinical encounters, initiating these dialogues is sensitive to the reactions of HCPs.

Discussion: The results suggest that HCPs should encourage curious dialogues about how PWD retrieve diabetes-related information. This serves for HCPs to learn what PWD gain from peers online and for HCPs to be able to offer their expertise to support PWD who are navigating large flows of information and advice online.

Disclosure

E.M.Kjærulff: None. M.A.Nexo: None. U.Bjerre-christensen: None. H.Langstrup: None.

Funding

Innovation Fund Denmark (Ref.no. 9163-00016B)
50-LB: Perceived Control over Eating Improves following Initiation of Carbohydrate-Restricted Nutrition Therapy in a Continuous Remote Care Model
Authors: ADAMS REBECCA N. , VANTIEGHEM MICHELLE , VOLK BRITTANIE M. , ATHINARAYANAN SHAMINIE J. , MCKENZIE AMY L.
Published: May 2022

Background: Nutrition is an important component of metabolic disease prevention and treatment, yet eating and perceived control over eating (PCOE) are complex behaviors. Most people who attempt lifestyle changes have setbacks that can interfere with confidence and motivation for sustained change. The Virta Health virtual clinic provides medically-supervised nutrition therapy for metabolic disease focused on carbohydrate restriction and provides education and tools to: (1) understand how foods impact metabolic health; (2) facilitate autonomy for food choices; and (3) disentangle physiological and emotional food cues, to foster patients’ eating confidence even if they struggle with adherence. This analysis explored whether Virta patients’ PCOE improved during early treatment as these concepts were taught.

Methods: As part of standard clinical care, Virta patients (N=5940, Mean (M) age = 54 years, 72% white, 61% female, 73% T2D, M BMI = 36) responded to 4 items (total score range 4-20) assessing PCOE before the dietary intervention and at follow-up (M days = 60, SD = 15) . Paired t-tests were conducted to assess changes in PCOE over time among all patients and separately within subgroups based on dietary adherence (M ketones during treatment ≥ or < 0.5 mM) .

Results: PCOE improved from pre-treatment (M=13.3, “slightly” in control) to the first follow-up (M=15.7, “somewhat” in control) in all patients (p<0.0001) and within both subgroups of dietary adherence (more-adherent group: +3.0 from 13.3, p<0.0001; less-adherent group: +1.7 from 13.3, p<0.0001) .

Conclusions: Consistent with treatment aims, patients’ PCOE improved. Importantly, patients who did not meet dietary adherence targets still gained confidence for controlling eating, though to a lesser extent. We predict that a healthier relationship with food, which includes greater PCOE, will help patients maintain motivation and get back on track following a setback; future research should investigate whether greater PCOE is associated with long-term adherence and metabolic health outcomes.

Disclosure

R. N. Adams: Employee; Virta Health Corp. M. Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B. M. Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S. J. Athinarayanan: Employee; Virta Health Corp. A. L. Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp.
502-P: Increasing Provider Referrals to Diabetes Self-Management Education and Support Services: Recommendations from Virtual Focus Groups with Providers in New York State
Authors: ARENA LAURA , ESQUIVEL NIKIE S. , AUSTIN RACHAEL , MILLSTEIN SUSAN , KAELIN-KEE JAN
Published: May 2022

Background: In New York, Medicaid began covering diabetes self-management education and support (DSMES) services in 2009, but participation in these services remains low. This study sought to understand barriers and facilitators to referring and enrolling eligible Medicaid members to DSMES, and to yield recommendations for increasing referrals and enrollment.

Methods: We conducted 14 virtual focus groups with primary care providers, endocrinologists, and certified diabetes care and education specialists (CDCESs) in New York City and the rest of the state. We used an inductive-deductive coding process to identify common themes and recommendations across participant types.

Results: Participants recommended resources for addressing knowledge gaps about the benefits of DSMES and how to refer eligible Medicaid members: an online resource guide and directory of accredited services by location and insurance type; automated provider prompts; materials for exam rooms; and reimbursement guidance. Recommended strategies for disseminating resources to increase provider and patient awareness of DSMES included an advertising campaign targeting physicians and people with diabetes; academic detailing; e-mail blasts from credible sources (e.g., health department, Medicaid) ; and direct outreach (e.g., personal phone calls) to eligible Medicaid members.

Conclusions: Increasing participation in DSMES hinges upon increasing provider referrals and addressing barriers to participation. CDCESs in NY reported limited capacity to provide DSMES to referred patients in a timely manner, highlighting a need to expand the workforce to meet current and future demands should referrals increase with improved awareness and buy-in. Although the strategies and recommendations identified in this study reflect the perspectives of NY providers, they may have broad applicability to other states in which Medicaid covers DSMES.

Disclosure

L.Arena: None. N.S.Esquivel: None. R.Austin: None. S.Millstein: None. J.Kaelin-kee: None.

Funding

Centers for Disease Control and Prevention (CDC NU58DP006523)
504-P: Success of Aligned Clinician–Patient Education Improves Clinicians’ Ability to Use GLP-1 RAs in Practice and Patients’ Understanding of GLP-1 RAs
Authors: LARKIN AMY , LE ANNE
Published: May 2022

We sought to determine if online aligned education for clinicians and patients could improve understanding and use of GLP-1 RAs for T2D. For clinicians, a live-streamed virtual symposium was held as part of the 2021 Metabolic and Endocrine Disease Summit (MEDS) summer (July) and fall (October) meetings, followed by an enduring available in August, 2021. Pre/post questions were used to assess changes in knowledge, confidence and practice. For patients, the online text, integrated visuals and patient video activity, which launched in June 2021, used a pre/post knowledge question and post-activity intent to change and confidence questions to assess impact. Absolute improvements were calculated for all questions, data collected through November 1, 2021. Clinician Activity Learners: 581 (Summer) and 364 (Fall) . Demographics: 47%-56% were nurse practitioners, 22% physician assistants, and 9%-12% physicians. Knowledge changes: 13%-16% increase in recognizing GLP-1 RAs with CV benefits/indications, 6%-7% increase in identifying weight loss as a benefit of GLP-1 RAs, 12%-23% increase in selecting patient education to help mitigate side effects. After the education, 80%-86% reported confidence in starting a patient with CVD/obesity on a GLP-1 RA. Enduring Learners: 1,662 clinicians (as of November 1, 2021) . Patient Activity: 11,029 learners have participated in the patient/caregiver activity, “Understanding the Use of GLP-1 Receptor Agonists for Type 2 Diabetes.” Knowledge changes: 22% increase in recognizing how GLP-1 RAs work (39% pre to 61% post) . Intent-to-act: 70% plan to talk to their HCP about if taking a GLP-1 RA can help manage their T2D better. Confidence changes: 78% reported increased confidence in talking to my HCP about GLP-1 RAs for T2D. These outcomes are a strong indicator that aligned clinician and patient activities are successful at improving both clinicians’ and patients’ understanding and use of GLP-1 RAs for T2D.

Disclosure

A.Larkin: None. A.Le: None.

Funding

Independent Educational Grant from Novo Nordisk.
510-P: DKA Prevention on Insulin Pumps: Lessons Learned from a Large Pediatric Pump Practice
Authors: DOYLE ELIZABETH , WEINZIMER STUART A. , TAMBORLANE WILLIAM V.
Published: May 2022

While the Type 1 Diabetes Exchange data noted that diabetic ketoacidosis (DKA) is more common in those utilizing injection regimens than insulin pumps, DKA remains a risk for pump users, as it can precipitously develop if insulin infusion is interrupted. We sought to obtain more recent DKA admission data in T1D youth using insulin pumps and the impact of CGM on DKA rates.

Methods: We characterized DKA data in insulin pump users from episodes between 12/20 and 6/2021 in an academic pediatric endocrine practice in which 68% were pump users.

Results: Among 591 pump patients aged <25 years (y) , 28 events occurred (3.16 events per 100 patient-y. Mean age was 13.6±3.4y; 85.7% were 12-19y old. More events were in males (60.7%) , 53.6% were white, 71.4% non-Hispanic. Mean HbA1c was 10.22.3%, diabetes duration 6.1±4.0y, and 57.1% used CGM; 28.6% of patients were new to pump therapy (<1y) .Admission pH levels ranged between 7.0-7.31, with 28.6% of events classified as “moderate” and 46.4% as “severe.” Average length of stay was 2.0±0.7 days. While there was no significant difference in pH levels, CGM wearers had higher admission bicarbonate values (11.8 vs. 9.3, p=0.04) . Clinicians assessed the cause of DKA to be related to concurrent illness (10.7%) , insulin omission (14.3%) , pump infusion site failure (57.1%) or other pump malfunctions (14.3%) . For most (60.7%) , this was the first documented DKA event. Alcohol consumption was a contributing factor in only one event.

Conclusions: DKA events were relatively uncommon; most episodes occurred in adolescents in poor diabetes control. Notably, most events could have been avoided if users followed standard trouble shooting guidelines. Thus, education on DKA prevention should be reinforced at each visit, particularly for teens on pumps with higher A1c levels. Moreover, while CGM wearers had higher admission bicarbonate values, over 50% of those hospitalized for DKA wore a CGM, suggesting even pump users using CGM require frequent reinforcement of DKA prevention education.

Disclosure

E.Doyle: None. S.A.Weinzimer: Consultant; Dompé, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. W.V.Tamborlane: Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Medtronic, Novo Nordisk, Sanofi, Takeda Pharmaceutical Company Limited.
518-P: “What Can I Eat?” Healthy Choices for American Indians and Alaska Natives with T2D: Facilitators’ and Participants’ Voices from a Virtual Diabetes Nutrition Education Program
Authors: STOTZ SARAH A. , BREGA ANGELA G. , MCNULTY MONICA C. , ADEDOYIN IBUKUNOLUWA , AUSTIN GEMALLI , BEGAY KELLI R. , COUTURE NILOFER , GARROW HEATHER , JIANG LUOHUA , O'BANION NANCY , PAVLI DAWN , PONTIUS HEATHER , SCARTON LISA , YANSON JESSIE , MOORE KELLY R. ,   AI/AN WCIE STUDY GROUP
Published: May 2022

“What Can I Eat? (WCIE) Healthy Choices for American Indians and Alaska Natives (AI/AN) with T2D is a 5-lesson diabetes nutrition education program culturally adapted for AI/ANs with T2D. Registered dietitian nutritionists (RDNs) taught classes synchronously via Zoom at 5 reservation-based or urban inter-tribal sites nationwide throughout 2021. Each class included a didactic session, interactive learning activities, physical activity, a mindful eating activity, and goal setting. Participants were recruited through diabetes registries at each collaborating site. Participants were randomized to either the immediate or wait list control group. Virtual classes were taught weekly for 4 weeks (classes 1-4) with a 5th class 3 months after class 1. Participants and facilitating RDNs completed short answer feedback surveys after each class. A sample of participants (n=24) and all RDN/site coordinators (n=10) engaged in virtual focus groups after completing WCIE to understand their experiences of the program. Focus groups were audio recorded, transcribed, and analyzed using qualitative thematic analysis, as were the short answer post-class feedback surveys from participants (n=186) and RDNs (n=58) . Key themes emerged: 1) class satisfaction largely focused on peer-to-peer interaction, camaraderie, and broader support (e.g., tribe) ; 2) pros, cons, and tips to improve virtual classes; 3) preference for AI/AN RDN educator; 4) recommendations to improve recruitment and retention. These findings will guide program modifications prior to piloting in-person and peer-educator-led WCIE classes.

Disclosure

S.A.Stotz: n/a. N.O'banion: None. D.Pavli: None. H.Pontius: None. L.Scarton: None. J.Yanson: None. K.R.Moore: Consultant; Novo Nordisk. Ai/an wcie study group: n/a. A.G.Brega: None. M.C.Mcnulty: None. I.Adedoyin: None. G.Austin: None. K.R.Begay: None. N.Couture: None. H.Garrow: None. L.Jiang: None.

Funding

American Diabetes Association (4-18-SMSC-01)
519-P: “What Can I Eat?” Healthy Choices for American Indians and Alaska Natives with T2D: Randomized Wait-List Controlled Trial Outcomes from a Nutrition Diabetes Education Program
Authors: MOORE KELLY R. , STOTZ SARAH A. , BREGA ANGELA G. , MCNULTY MONICA C. , ADEDOYIN IBUKUNOLUWA , AUSTIN GEMALLI , COUTURE NILOFER , GARROW HEATHER , O'BANION NANCY , PAVLI DAWN , PONTIUS HEATHER , YANSON JESSIE , JIANG LUOHUA ,   AI/AN WCIE STUDY GROUP
Published: May 2022

“What Can I Eat? (WCIE) Healthy Choices for American Indians and Alaska Natives (AI/ANs) with T2D” is a 5-lesson diabetes nutrition education program culturally adapted for AI/ANs with T2D. Classes were taught synchronously via Zoom at 5 reservation-based or urban inter-tribal clinical sites nationwide in 2021. Classes were taught by registered dietitian nutritionists (RDN) and topics included the diabetes plate, sugar sweetened beverages, heart healthy choices, food label reading. Class activities included didactic sessions, hands-on interactive learning, physical activity, mindful eating, and goal setting. Participants were recruited through diabetes registries at each collaborating site and randomized to either the immediate or the wait list group. The former group started classes immediately upon randomization; the latter started classes 3 months after randomization. Participants (N=58) were AI/AN adults with T2D (baseline data: mean age 58.6 +/-11.1 years, 26% male; BMI 33.8 (+/- 7.1)) . Before participation, each enrollee received a “class kit” including class activity resources and tools to collect evaluation data (i.e., scale, A1C kit, blood pressure monitor, and paper impact surveys) . Classes 1-4 were taught weekly for 4 weeks; the 5th class was taught 3 months after class #1. Data were collected at 3 timepoints: baseline, 1 month (after class 4) and 3 month (after class 5) . Outcomes included diabetes self-efficacy, behavior (physical activity and diet) , and clinical measures (BMI, blood pressure, A1c) . Linear mixed models were used to assess intervention effects on changes in outcome measures from baseline. No significant changes from pre to post were observed in behavior or clinical outcomes. Compared to the wait list group, the immediate group had greater increase in self-efficacy for using the diabetes plate at 1 and 3 months (ps<0.01) and for making healthy food choices at 1 month (p=0.047) .

Disclosure

K.R.Moore: Consultant; Novo Nordisk. D.Pavli: None. H.Pontius: None. J.Yanson: None. L.Jiang: None. Ai/an wcie study group: n/a. S.A.Stotz: n/a. A.G.Brega: None. M.C.Mcnulty: None. I.Adedoyin: None. G.Austin: None. N.Couture: None. H.Garrow: None. N.O'banion: None.

Funding

American Diabetes Association (4-18-SMSC-01)