bluuebunny/crossref_metadata_2025 huggingface dataset:
611-P: Effect of Continuous Glucose Monitoring (CGM) vs. Blood Glucose Monitoring (BGM) during a Nutrition Intervention on Time in Range (TIR)
Authors: WILLIS HOLLY J. , ASCHE STEPHEN E. , MCKENZIE AMY L. , ADAMS REBECCA N. , KRIZKA SHANNON , ROBERTS CAROLINE G.P. , VOLK BRITTANIE M. , ATHINARAYANAN SHAMINIE J. , ZOLLER ALISON R. , BERGENSTAL RICHARD M.
Published: June 2024

Introduction: Reducing carbohydrate intake improves glycemia in people with T2D. Data on nutrition interventions using CGM are sparse. IGNITE (Impact of Glucose moNitoring and nutrItion on Time in rangE) compared differences in change in CGM-derived TIR (% time with glucose 70‑180 mg/dL) from baseline (Base) to three months (M3) in people using CGM or BGM during a medically supervised ketogenic diet program (MSKDP) delivered via continuous remote care.

Methods: IGNITE (NCT05516797) randomized adults with T2D to CGM (N=81) or BGM (N=82). CGM and BGM data were used by participants and the care team to support dietary adherence and medication management decisions. Blinded CGM data at Base were compared to CGM data at M3 (blinded for BGM and cloud-based for CGM).

Results: At baseline, participants were (mean + SD) 53 + 10 years; 106 + 25 kg; 10 + 8 years with T2D; taking 2.2 + 1.0 diabetes medications, and HbA1c 8.1% + 1.2%, with no differences between arms. TIR improved (Base to M3) for both arms, 28% for CGM and 23% for BGM (p<0.001) with no difference in change between arms (p=0.4); the % time <70 mg/dL and <54 mg/dL was negligible. Reaching TIR >70% and % time <70 mg/dL (TBR) <4% favored CGM arm. Full outcomes in Table 1.

Conclusion: TIR improved significantly for both CGM and BGM arms at M3. However, CGM users were more likely to see improvement in the combined CGM metrics of TIR >70% and TBR <4%.

Disclosure

H.J. Willis: Research Support; Abbott. Other Relationship; Abbott. Research Support; Academy of Nutrition and Dietetics, Dexcom, Inc. S.E. Asche: Stock/Shareholder; Gilead Sciences, Inc., AbbVie Inc., GlaxoSmithKline plc. A.L. McKenzie: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. Employee; Abbott. R.N. Adams: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S. Krizka: None. C.G.P. Roberts: Other Relationship; Virta Health Corp. B.M. Volk: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S.J. Athinarayanan: Employee; Virta Health Corp. A.R. Zoller: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. R.M. Bergenstal: Other Relationship; Abbott. Research Support; Arkray Marketing. Consultant; Ascensia Diabetes Care, Bigfoot Biomedical, Inc., CeQur. Other Relationship; Dexcom, Inc., Eli Lilly and Company. Consultant; embecta, Hygieia. Research Support; Insulet Corporation. Consultant; MannKind Corporation. Other Relationship; Medtronic, Novo Nordisk. Consultant; Onduo LLC, Roche Diabetes Care. Other Relationship; Sanofi. Research Support; Tandem Diabetes Care, Inc. Other Relationship; UnitedHealth Group. Consultant; Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S.

Funding

Abbott Diabetes Care
613-P: Patient Characteristics Associated with Annual Nutrition Visits in Children with Type 1 Diabetes
Authors: AZOVA SVETLANA , LENNERZ BELINDA S. , PETTY CARTER , MICHELSON HANNAH , SCHMIDT ANNA , GORDON ERIN N. , GARVEY KATHARINE , RHODES ERINN
Published: June 2024

Introduction & Objective: ADA and ISPAD recommend comprehensive nutrition education by a registered dietitian (RD) at least annually following T1D diagnosis. Study objectives were to describe longitudinal trends in annual RD follow-up in children with T1D and to identify patient characteristics associated with RD engagement.

Methods: Retrospective chart review was performed over a 5-year period (2018-2022) on patients aged <18 years with T1D for ≥1 year followed at a tertiary pediatric center. Mixed effects logistic and linear regression models were conducted to assess for trends in rates of RD visit completion in the year preceding the last MD/DNE encounter and to identify sociodemographic, disease-related, and clinical patient characteristics associated with RD follow-up.

Results: Data based on 6053 completed MD/DNE visits among 1995 patients was analyzed. Annual RD follow-up rate over a 5-year period was 21%, with no differences between the years (P=0.117). Younger age, historically marginalized background, and shorter T1D duration predicted higher likelihood of RD follow-up, and RD follow-up was associated with lower hemoglobin A1c within the subsequent year (Table).

Conclusion: Annual RD visit frequency among T1D patients is suboptimal, potentially limiting opportunities for better glycemic control. Study findings provide important insights for targeted intervention to improve RD follow-up rates.

Disclosure

S. Azova: None. B.S. Lennerz: None. C. Petty: None. H. Michelson: None. A. Schmidt: None. E.N. Gordon: None. K. Garvey: Advisory Panel; Sanofi. E. Rhodes: None.

Funding

National Institutes of Health (K12DK133995)
615-P: Associations between Food Addiction and Brain Tissue Integrity in Persons with Type 2 Diabetes Mellitus
Authors: SMELTZER JOLENE T. , KUMAR RAJESH , FONG TIM W. , WOO MARY A. , CHOI SARAH E.
Published: June 2024

Introduction & Objective: Maladaptive dietary behaviors contribute to poor glycemic outcomes for persons with type 2 diabetes (T2DM). Another factor that may contribute to poor T2DM dietary behaviors include food addiction (FA; overconsumption to the point there are similar symptoms to substance-related and addictive disorders). FA behaviors can be reflected by differences in brain tissue integrity, but the relationships between FA and brain tissue integrity in persons with T2DM are unclear. This study investigated the associations between FA and brain tissue integrity in persons with T2DM.

Methods: Twenty-one T2DM participants between the ages 40-65 years completed brain magnetic resonance imaging (MRI) scans and the Yale Food Addiction Scale 2.0 (YFAS). Using diffusion tensor imaging data, mean diffusivity (MD; a measure of brain integrity) values were calculated, and region-of-interest analyses were performed on various brain areas to examine correlations with YFAS 2.0 scores (partial correlations; covariates: age and sex).

Results: Significant correlations between tissue integrity and YFAS 2.0 scores were found in brain regions regulating executive decision-making (frontal cortices, precuneus, temporal); memory-visual or auditory (occipital, supramarginal); motor function (putamen); and emotion (cingulum) functions in T2DM patients.

Conclusions: Significant correlations appear between FA and brain tissue integrity in this population with T2DM and findings indicate that FA has a brain structural basis in persons with T2DM. Further studies are needed to understand the impact of FA on these altered brain tissue areas and to identify interventions to protect or promote neurogenesis and determine if such interventions improve T2DM outcomes.

Disclosure

J.T. Smeltzer: None. R. Kumar: None. T.W. Fong: None. M.A. Woo: None. S.E. Choi: None.

Funding

National Institutes of Health (1R01 NR017190-01)
618-P: Development of a New Index Based on 24-Hour Urinary Creatinine to Predict Improvement of Lumbar Spine BMD after One Year of Zoledronic Acid Treatment for Osteoporosis
Authors: ZENG JIANGPING , JING YUJIE , LI NANNAN , SHENG HUI
Published: June 2024

Introduction & Objective: Muscle and bone can interact with each other, but the effect of muscle on osteoporosis treatment is not clear. This study aims to study the correlation between 24 h Ucr (24-hour urinary creatinine excretion, an indicator of muscle mass) and the change of lumbar spine bone mineral density (BMD) after treatment with Zoledronic Acid (ZOL), and develop an effective model for BMD improvement prediction.

Patients and Methods: A total of 169 adults with primary osteoporosis receiving ZOL (5 mg once year) were included. BMD was measured at baseline and 1 year after treatment. BMD improvement was defined as a percentage increase greater than the minimum BMD change (2.78%).

Results: 24 h Ucr was negatively correlated with 1 year lumbar BMD changes (r = -0.208, p = 0.007) after treatment with ZOL. Binary logistic regression analysis showed that after adjusting for sex, age, height, weight, diabetes mellitus, baseline lumbar BMD and serum creatinine, 24 h Ucr was an independent predictor of improvement in lumbar BMD after 1 year of ZOL treatment (odds ratio 0.580, 95% confidence interval 0.456 - 0.738, p < 0.001). A new model logit (P) ( -1.321 + 1.864 × gender (female = 1, male = 2) + 9.8 × height (m) - 1.038 × T2DM (yes = 1, no = 0) - 0.582 × 24h Ucr (mmol/d) + 0.061 × creatinine (umol/L) - 16.958 × lumbar BMD (baseline) (g/cm2)) constructed by binary logistic regression analysis with backward selection predicted that the area under the curve (AUC) of lumbar BMD improvement was 0.871. With P = 0.739 as the cutoff value, the specificity was 89.3%, and the sensitivity was 73.5%. The final predictive model was internally validated using the bootstrap re-sampling procedure that calculated small AUC optimisms of -0.001 (95% CI -0.005-0.003).

Conclusion: 24 h Ucr was negatively correlated with 1 year change in lumbar BMD after treatment with ZOL and the index P showed good predictive value for 1 year lumbar BMD improvement after treatment with ZOL.

Disclosure

J. Zeng: None. Y. Jing: None. N. Li: None. H. Sheng: None.

Funding

Grants from National Natural Science Foundation of China (No. 82170894); Program of Shanghai Science and Technology Committee (21S11901100); The Research Physician Project of Shanghai Tenth People's Hospital (2023YJXYSA014).
630-P: Vitamin D Deficiency and Its Association with Clinical Parameters in Type 2 Diabetes—Findings from a Cross- Sectional Study in India
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , KATHRIKOLLY THEJAS , TIWARI DIPTIKA , SHARMA BABY , VYAWAHARE ANAGHA R. , GANLA MALHAR H. , HIREMATH MAMATA , SABOO BANSHI D.
Published: June 2024

Introduction & Objective: The interplay between vitamin D deficiency and type 2 diabetes (T2D) has gained significant attention, with studies indicating that vitamin D deficiency is a potential risk factor for T2D. This study aimed to explore the association between vitamin D deficiency and key clinical parameters in individuals diagnosed with T2D.

Methods: A cross-sectional study was conducted on 2787 T2D-diagnosed patients enrolled in a one-year online lifestyle intervention program at the Freedom from Diabetes Clinic, India, from January to September 2023. The intervention comprised a customized plant-based diet, exercise, stress management, and medical support. Demographic, clinical, and anthropometric data were collected. Serum vitamin D levels were assessed using standardized assays; levels <20 ng/ml indicated deficiency.

Results: The mean age of the study population was 49±10 years (62% male), and 43% had vitamin D deficiency. There was a statistically significant relationship between poor glycemic control (HbA1c>7%) and vitamin D deficiency (p<0.05). Vitamin D deficiency was associated with increased levels of LDL-C, triglycerides, and total cholesterol, and decreased HDL-C levels (p<0.05). Vitamin D deficiency was significantly higher in patients with elevated hsCRP levels (47%) than in those with normal hsCRP levels (42%) (p<0.05), highlighting the role of vitamin D in inflammatory processes. Additionally, vitamin D deficiency was associated with shorter disease duration (<6 years), younger age (<40 years), and male sex (p<0.05).

Conclusion: Our study highlights significant links between vitamin D deficiency and metabolic markers, notably poor glycemic control, lipid abnormalities, and inflammation. Further investigations to determine the causal relationships between these factors and develop targeted interventions for managing vitamin D deficiency in individuals with type 2 diabetes are warranted.

Disclosure

P. Tripathi: None. N.S. Kadam: None. T. Kathrikolly: None. D. Tiwari: None. B. Sharma: None. A.R. Vyawahare: None. M.H. Ganla: None. M. Hiremath: None. B.D. Saboo: None.
643-P: Exploring Eating Styles of Older Adults with Type 1 Diabetes (T1D)
Authors: CRISTELLO SARTEAU ANGELICA , GOPISETTY NIKHITA R. , SPRINKLES JESSICA , ERCOLINO GABRIELLA , FRUIK ANGELA , MUTHUKKUMAR RASHMI , QU XIAORUI , MAYER-DAVIS ELIZABETH J. , KAHKOSKA ANNA
Published: June 2024

Introduction & Objective: Emotional, external, and restricted eating styles may shape diet, glycemic levels, and other cardiovascular risk factors in T1D. We characterized eating styles among older adults with T1D given scant knowledge to guide dietary counseling in this growing population.

Methods: Older adults with T1D seeking care at an academic endocrinology clinic completed an online survey (Sep-Nov 2023) with the Dutch Eating Behaviour Questionnaire (DEBQ). We calculated mean and median restrained, external, and emotional eating style scores and examined relationships between scores, BMI, and HbA1c.

Results: The DEBQ was completed by 77 older adults (age 71.3 ± 4.1, 93.5% non-Hispanic White) with T1D (duration 33.5± 18.1, Hba1c 6.8 ± 1.1, BMI 27.3 ± 4.7). Scores for restrained eating (M: 1.54, Range: 0.0 - 3.4), emotional eating (M: 0.94, Range: 0.0 - 3.8), and external eating (M: 1.51, Range: 0.0 - 3.2) were lower than estimates in extant studies. Results suggest a positive relationship between emotional and external eating, between emotional eating and BMI, as well as a negative relationship between restrained eating and HbA1c (Figure 1).

Conclusion: This is the first study to characterize eating styles among older adults with T1D. Results suggest distinct eating styles in this population that may correlate with key clinical outcomes. Research must further evaluate validity of the DEBQ and identify clinically relevant cut points.

Disclosure

A. Cristello Sarteau: None. N.R. Gopisetty: None. J. Sprinkles: None. G. Ercolino: None. A. Fruik: None. R. Muthukkumar: None. X. Qu: None. E.J. Mayer-Davis: None. A. Kahkoska: None.

Funding

K12TR004416
644-P: Racial Ethnic Disparities in Prescription of GLP-1 Receptor Agonists for People at High Risk for Diabetes on Atypical Antipsychotics
Authors: SAM VARGHESE JITHIN , GOLDSMITH DAVID , WAFORD RACHEL , CHAKKALAKAL ROSETTE , ALI MOHAMMED K. , PASQUEL FRANCISCO J. , COTES ROBERT O.
Published: June 2024

Introduction: Atypical antipsychotics (AAP) significantly increase the risk of obesity and type 2 diabetes (T2D). GLP-1 receptor agonists (GLP-1 RA) are weight-loss medications which may be beneficial in treating AAP-induced weight gain. We evaluated trends in prescriptions of GLP-1 RA among patients at high risk of T2D using AAP stratified by race-ethnicity.

Methods: We modeled covariate-adjusted trends in GLP-1 RA (liraglutide, semaglutide) prescriptions between January 2019-November 2023 from the Epic Cosmos dataset among a real-world cohort at high risk of T2D on AAP. We included 121,493 adults (18-99 years) with obesity or overweight (BMI ≥ 27kg/m2) and weight-related comorbidity (hypertension or hypercholesterolemia). We report trends in GLP-1 RA prescriptions by race-ethnicity (Hispanic, Non-Hispanic [NH] White, NH Black, NH Other).

Results: The analytic sample was 59.0% female, 72.2% NH White, 16.2% NH Black, and 5.8% Hispanic with mean age of 51.4 (SD: 19.2) years. There were no differences by race-ethnicity in 2019. However, in 2023 relative to NH White patients (2.2% [95% CI: 1.4, 3.1]), prescriptions were lower for NH Black (-1.1% [-2.8, 0.1]), Hispanic (-1.5% [-2.7, 0.0]) and NH Other (-1.2% [-2.7, 0.0]), Figure.

Conclusion: There are emerging racial-ethnic disparities and underuse of effective weight loss medications among patients treated with AAP.

Disclosure

J. Varghese: None. D. Goldsmith: None. R. Waford: None. R. Chakkalakal: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. F.J. Pasquel: Research Support; Tandem Diabetes Care, Inc., Insulet Corporation, Dexcom, Inc., Ideal Medical Technologies, Novo Nordisk. Consultant; Dexcom, Inc., Medscape. R.O. Cotes: Research Support; Roche Pharmaceuticals, Alkermes, Otsuka America Pharmaceutical, Inc., Karuna Therapeutics. Consultant; Saladax Biomedical. Speaker's Bureau; Saldax Biomedical, Clinical Care Options (CME company).
646-P: Improved Outcomes with Intensive Follow-up in Pediatric Diabetes Patients with Care Concerns
Authors: MCCAULEY MARY , FULTON CAROLINE , MORELOS CELIA
Published: June 2024

Introduction: Standards of pediatric diabetes care recommend routine clinic visits quarterly, but in some cases more frequent visits may aid in improving hyperglycemia. This study aimed to determine if intensive follow-up affected DM outcomes.

Methods: EHR data was reviewed (2020-23) to identify subjects with a prior diagnosis of T1D or T2D on insulin therapy at start of intervention. Increased follow-up was initiated for hyperglycemia (84%), education needs (64%), DM burnout (42%), behavioral health (BH) concern (42%), family dynamics (34%), recent onset (32%), pump start (32%), or young age (10%). BH interventions targeted coping, problem-solving, and communication. Data analyzed with SPSS. Primary outcomes were A1c, time-in-range (TIR); secondary outcomes included medications, technology use, and ED/hospital visits.

Results: Cohort (n=50) included subjects with T1D (66%) and T2D (32%). Intervention occurred 2.4 years post-diagnosis with a mean duration of 6 months or 5 clinic visits. Initial A1c (n=50) was 10.85% (95% CI 10.23-11.48, SD 2.18); post-A1c (n=50) was 8.35% (95% CI 7.87-8.92, SD 1.93); mean decrease in A1c was 2.5% (95% CI 1.89-3.10, SD 2.13, p<0.001). Initial TIR (n=17) was 31.47% (95% CI 17.21-45.72, SD 27.72); post-TIR was 47.35% (95% CI 37.39-57.31, SD 19.37); mean increase was15.88% (95% CI 8.71-21.8, SD 3.467, p=0.007). Subjects with identified DM burnout, BH concerns, DSM-5 TR diagnosis, or IEP were just as successful in achieving A1c improvement. There was a reduction in MDI therapy (p<0.001) and an increase in hybrid closed-loop pump use (p<0.001). There was an increase in CGM use (p<0.001) and a reduction in ED visits/hospitalizations (p<0.001).

Conclusion: In a pediatric diabetes cohort with identified care concerns, significant improvement in mean A1c/TIR and increased diabetes technology utilization were seen following brief intensive intervention. These findings strongly support short-term increased follow-up to improve diabetes outcomes.

Disclosure

M. McCauley: None. C. Fulton: None. C. Morelos: None.
653-P: Do Specific Fears or General Anxiety Mediate the Relationship between Child Nighttime Glucose Levels and Parent Sleep Quality?
Authors: MONZON ALEXANDRA , PIERCE JESSICA S. , WASSERMAN RACHEL M. , MCDONOUGH RYAN , PATTON SUSANA R.
Published: June 2024

Introduction: Many caregivers of youth with type 1 diabetes (T1D) report reduced sleep at night and sleep disruptions due to overnight diabetes care and fear of nighttime hypoglycemia (FoNH). Data suggests that child nighttime glycemic variability is associated with increased FoNH, and increased nighttime caregiving due to out-of-range glucose levels may also impact parent sleep, but no studies have examined relations among these variables in a single model. The current study examines if parent FoNH or general anxiety mediates the relationship between child nighttime glycemic variability and parent sleep quality.

Methods: We recruited 165 parents/caregivers of youth with T1D. We administered the Pittsburg Sleep Quality Scale, State-Trait Anxiety Inventory, and the Hypoglycemia Fear Survey for Parents, along with new items that assessed additional nighttime fears more comprehensively. Youth provided 14 days of glucose data from their personal continuous glucose monitor. We conducted mediation analysis in R using the Lavaan package.

Results: Most caregivers (89%) self-identified as mothers with a Mage= 41.76+6.52 years. For youth, 49% were female, Mage= 13.41+2.59 years, MT1D duration= 3.97+3.14 years, and MHbA1C= 7.81 + 1.43. Mediation analyses revealed a direct effect of glycemic variability on parent sleep quality (b=0.04, p>0.05), and parent FoNH mediated this effect (b=2.9, p>0.05). Neither state (p=0.29) nor trait anxiety (p=0.28) mediated this effect.

Conclusions: It is important to consider how child glucose levels at night relate to parents' sleep quality to reduce the risk that parental fatigue may impact their functioning the following day. The results of this study suggest that parental FoNH is an important factor that relates to parent sleep quality. Clinicians may consider providing strategies that may help parents manage their specific worries related to hypoglycemia to potentially help parents improve sleep.

Disclosure

A. Monzon: None. J.S. Pierce: None. R.M. Wasserman: None. R. McDonough: Speaker's Bureau; Provention Bio, Inc. S.R. Patton: None.
663-P: Acceptability and Preferences for Features of a Family Module in an Artificial Intelligence–Enabled Empower Mobile App to Support Type 2 Diabetes Self-Management—A Formative Study
Authors: LING RENA LAU RUI , LIU HUIYI , KIE PHANG JIE , HENG KWAN YU , LENG LOW LIAN , YOON SUNGWON
Published: June 2024

Despite the pivotal role of family support for type 2 diabetes (T2DM) management, research on family-based intervention that leverages AI-enabled mobile apps is limited. This study aims to explore perceptions of T2DM patients and family members on the acceptability of a FAMILY module in the EMPOWER mobile app and their feedback on specific FAMILY module features to inform future EMPOWER-FAMILY intervention.

We conducted semi-structured interviews with 25 T2DM patients and 25 family members. All interviews were audio-recorded and transcribed verbatim. The transcripts were analyzed using NVivo.

The FAMILY module was seen as an opportunity to cultivate shared decision making by both patients and family members. However, concerns evolved around increased family burden and diminished sense of patient autonomy, leading to potential patient-family conflicts. Leveraging on AI technology, the FAMILY module sends tailored nudges to a family member based on patient’s lifestyle behaviors. While participants acknowledged its benefits, some expressed a desire for greater customization in both frequency and content. Participants appreciated user-friendly meal logging using AI-powered food detection. Nevertheless, app feedback on dietary choices and healthier alternatives is desired, which is particularly relevant for family members involved in preparing patients’ meals. The inclusion of patient-family collaborative goal setting and achievement tracking features via wearable devices was viewed as beneficial, fostering motivation and dedicated family time. Other proposed enhancements include a platform for sharing experiences and incorporate telemedicine functionality.

Both patients and family members indicated their willingness to engage in the FAMILY module. The feedback collected from the study will be used to inform the development of the EMPOWER-FAMILY module and future intervention.

Disclosure

R. Lau: None. H. Liu: None. J. Phang: None. Y. Kwan: None. L. Low: None. S. Yoon: None.

Funding

Ministry of Education Tier 1 grant (2022-MOET1-0005)
671-P: Development of Novel Infrastructure for Diabetes Distress Screening in the Electronic Health Record
Authors: FRUIK ANGELA , YOUNG LAURA A. , GOEKE-AUSTIN KAREN K. , BEEZLEY LISA R. , THOMAS AARON , KAHKOSKA ANNA
Published: June 2024

Introduction & Objective: Though clinical guidelines recommend diabetes distress (DD) screening, real-world screening is hindered by the burden of implementing screening regimens into clinical workflow. Our objective was to automate DD screening for people with type 1 diabetes (T1D) at a university-affiliated outpatient endocrinology clinic by building it into the EHR system.

Methods: We undertook an EPIC build to screen patients with T1D using the T1-DDAS Core Distress Scale (“screener”) and equip providers with the language to address DD. We developed and iterated the (1) eligibility criteria for distribution; (2) the patient-view of the screener; (3) scoring and storing of results; and (4) infrastructure for providers to be notified and research personnel to receive lists of patients with elevated DD.

Results: Our EHR now supports delivery of a DD screener with built-in scoring in MyChart (Figure 1); a Flowsheet showing current and past results; a front desk view to identify patients who had not yet completed the screener; a BPA (Best Practice Advisory) for the provider to address DD; and a research view.

Conclusion: This project provides proof of concept that DD screening can be integrated into the EHR to promote guidelines-aligned screening and increased clinical attention to DD. Future work involves clinic-level implementation and evaluation with patients, providers, and staff feedback.

Disclosure

A. Fruik: None. L.A. Young: Research Support; Novo Nordisk, Eli Lilly and Company, vTv Therapeutics, Beta Bionics, Inc., Corcept Therapeutics, Rhythm Pharmaceuticals, Inc., Bayer Inc., Jaeb Center for Health Research. K.K. Goeke-Austin: None. L.R. Beezley: None. A. Thomas: None. A. Kahkoska: None.

Funding

American Diabetes Association (12-22-ACE-18)
673-P: Impact of Language in Clinical Discussions of Diabetes-Related Complications in a Predominantly Non-White Sample
Authors: GARZA MATTHEW , COX EVELYN , WILSON KAREN , MORGAN ALICE J.
Published: June 2024

The language used to talk about diabetes impacts the mental, physical, and emotional health of people with diabetes (PWD) and others’ perception of PWD. While general language recommendations for healthcare professionals (HCPs) exist, less is known about the language surrounding diabetes-related complications. This qualitative study aimed to examine how diabetes-related complications are discussed in clinics, the language used, and the emotional impact of these conversations on PWD. In October 2023, 42 PWD were recruited through the dQ&A US Patient Panel to participate in a 5-day asynchronous online discussion board via QualBoard®. Participants submitted written and video responses to a structured discussion guide and data were transcribed and analyzed using thematic analysis. The resulting participants were 57% women, 81% non-white, and included those with type 1 (21%), type 2 on insulin therapy (38%), and type 2 diabetes not on insulin therapy (41%). Discussions of diabetes-related complications varied by race and ethnicity, diabetes type, and duration of diabetes. Thematic analysis revealed three types of diabetes-related complications that struck the most fear among PWD: eye and kidney complications, and amputation. When addressing these, some HCPs used fear-based approaches, emphasizing outcomes such as blindness, dialysis, and amputation. Language depicting 'loss,' such as 'loss of limbs' or 'loss of eyesight,' used by some HCPs contributed to heightened emotional distress among PWD, and invoked a fear of lost independence or normalcy. Furthermore, framing these complications as 'end stage' prompted reflections on mortality, while the phrase 'kidney failure' led to feelings of personal failure in diabetes management. These findings highlight the use of loss-framing communication and stigmatizing, fear-based language in these conversations, as well as the negative impact this can have on the emotional state of PWD.

Disclosure

M. Garza: Other Relationship; Sanofi. E. Cox: Employee; dQ&A. K. Wilson: Employee; dQ&A. A.J. Morgan: Employee; dQ&A.

Funding

This research was funded, in part, by support from Genentech and Abbott.
687-P: Effectiveness of a Hybrid Care Model on Mental Health in a Type 2 Diabetic Population
Authors: ZAKARIA HALA , CACCELLI MILENA , OZKAN CIGDEM , DEBS JOELLE , DAHLSTROM NICOLE C. , DE LOS RIOS CELESTE , BANGAYAN JESTONI , JANE DIVINO DIANNE , SAID YOUSEF , HASHEMI ALI , ALMARZOOQI IHSAN
Published: June 2024

Diabetes necessitates continuous self-regulation and behavioral management. Individuals with diabetes usually navigate disjointed care systems, manage stress, and need to maintain emotional balance. This often-invisible workload, overlooked by professionals fixated on numerical data, contributes to emotional distress in one-third of diabetes patients. Mental health scores are not reported by the majority of providers.This study aims to evaluate mental health and glycemic control in Type 2 Diabetes (T2D) patients through a hybrid care model (physical and digital engagement) to address challenges and guide multidisciplinary interventions.In a retrospective study of 89 patients with T2D who were managed by GluCare.Health for a year, coaches and a wider healthcare team (physicians, educators, dietitians) provided continuous engagement and support) both in-clinic and remotely (via an app). Three mental health measures were used: the World Health Organization-5 score (WHO-5), a self-reporting measure of mental well-being and quality of life, the Problem Areas in Diabetes Questionnaire (PAID) and the Patient Health Questionnaire-9 (PHQ9), which detects mental illnesses. Paired sample t-test was performed for annual improvements. Significant improvements were observed across various parameters. Patients showed weight loss (-4.0 ± 5.3, p<0.001), reduced waist circumference (-4.74 ± 7.8, p<0.001), and lowered HbA1c levels (-1.00 ± 1.3, p<0.001). Importantly, WHO-5 scores improved from 23.56 ± 1.1 at baseline to 24.60 ± 0.7 annually (+4%) (p < 0.0001). Similarly, PAID score decreased from 17.46 ± 13.6 to 12.65 ± 9.2 (-28%) (p < 0.0001), and PHQ9 decreased from 1.67 ± 1.4 to 1.18 ± 1.2 (-29%) (0.005). Hybrid care models for T2D patients can potentially improve biomarkers and overall quality of life. The potential of such continuous models can address the long standing mental health issues suffered by T2D patients that are usually not addressed under traditional, episodic care.

Disclosure

H. Zakaria: None. M. Caccelli: None. C. Ozkan: None. J. Debs: None. N.C. Dahlstrom: None. C. Rios: None. J. Bangayan: None. D. Divino: None. Y. Said: None. A. Hashemi: None. I. Almarzooqi: None.
689-P: Type 2 Diabetes Risk Perception and Health Behaviors among Women with History of Gestational Diabetes Mellitus
Authors: MALONE ALLYSON , TURK NORMAN , KENRIK DURU O. , WISK LAUREN E. , MANGIONE CAROL , PAGE JESSICA , THOMAS SAMUEL C. , HAN CHRISTINA S. , VU AMANDA V. , MADIEVSKY RUTH , NORRIS KEITH C. , MOIN TANNAZ
Published: June 2024

Introduction & Objective: Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes (T2D). Our goal was to examine the association between perceived risk of developing T2D and health behaviors in this population.

Methods: We analyzed surveys and electronic health records of participants in the GRAND Study, a multisite RCT testing the effectiveness of shared decision-making for women with elevated body mass index (BMI), prediabetes and history of GDM. Data on demographics, health behaviors, and perceived T2D risk were self-reported. We ran four regressions to examine the association between women’s perceived risk of developing T2D and four key health behaviors: 1) physical activity levels, 2) sugar-sweetened beverage consumption, 3) ultra-processed food consumption, and 4) consumption of meals prepared outside the home. All models were adjusted for age, race, ethnicity, income, A1c, BMI, family history of T2D, and study arm.

Results: Our sample included 165 women with a history of GDM, prediabetes, with mean age 41.3 (± 5.6 years) and mean BMI 32.1 (± 6.9 kg/m2). Perceived risk of developing T2D was not significantly associated with physical activity, consumption of sugar-sweetened beverages, or meals prepared outside of the home (p>0.05). However, women reporting lower perceived T2D risk had 2.9 times the odds of less frequent ultra-processed food consumption than those with higher perceived risk (p=.029). Higher BMI was significantly associated with increased consumption of sugar-sweetened beverages (p=0.005), but not other health behaviors.

Conclusion: We found perceived risk of developing T2D was significantly associated with ultra-processed food consumption but not physical activity, consumption of sugar-sweetened beverages, or meals prepared outside the home. Women with GDM are at high risk of developing T2D and may benefit from tailored interventions promoting health behavior changes shown to lower T2D risk.

Disclosure

A. Malone: None. N. Turk: None. O. Duru: Consultant; ExactCare Pharmacy. L.E. Wisk: None. C. Mangione: None. J. Page: None. S.C. Thomas: Stock/Shareholder; PocketRN. C.S. Han: None. A.V. Vu: None. R. Madievsky: None. K.C. Norris: None. T. Moin: None.

Funding

National Institutes of Health (R01DK127733)
691-P: The Use of Peer Connector Guides to Support an Emerging Adult Type 1 Diabetes Intervention
Authors: SHAH NAZEEN , RODRIGUEZ GONZALES BRUNO , IACOB ELI , LITCHMAN MICHELLE L. , BLANCHETTE JULIA E. , MARIE MORAITIS ANN , ALLEN NANCY A.
Published: June 2024

Introduction & Objective: The Diabetes - Connecting Online Peers to Enhance Support (D-COPES) pilot intervention engages emerging adults (EA) with type 1 diabetes (T1D) through group discussion using topic guides with a peer connector (PC). Topic guides are comprised of questions and credible online resources to facilitate group discussion around a specific diabetes topic. This study assessed topic guide use throughout D-COPES.

Methods: An EA focus group (N=6) determined the initial set of topic guides and additional guides were developed throughout the pilot as requested by PC. The PC worked with their group to select topics the EA wanted to discuss throughout 6 virtual sessions. There were 6 PC who led 14 group sessions. Each session focused on 1-2 topics. A subset of participants were interviewed to understand the value of the 21 topic guides.

Results: Considering the topic guide options, the most frequently discussed were diabetes burnout (N=13), diabetes technology (N=10), navigating insurance and the healthcare system (N=10), relationship with food (N=9), physical activity (N=8) and traveling with diabetes (N=8). Interviewed participants (N=14) appreciated the comprehensive list of topics to choose from and found them to be useful. Topic discussions provided social support not found in other clinical settings. Occasionally a topic such as menstruation with diabetes was uncomfortable to discuss in mixed-gender groups, for some.

Conclusion: Topic guides help spark discourse of daily struggles EA with T1D face, providing avenues for social support. The most frequently discussed topic guides highlight the unaddressed education needs within EA with T1D.

Disclosure

N. Shah: None. B. Rodriguez Gonzales: None. E. Iacob: None. M.L. Litchman: Research Support; American Diabetes Association, Association of Diabetes Care & Education Specialists, Dexcom, Inc. Other Relationship; Association of Diabetes Care & Education Specialists. Research Support; National Institutes of Health. J.E. Blanchette: Speaker's Bureau; Insulet Corporation. Board Member; Juvenile Diabetes Research Foundation (JDRF). Research Support; American Heart Association, Association of Diabetes Care & Education Specialists, National Institute of Diabetes and Digestive and Kidney Diseases, Leona M. and Harry B. Helmsley Charitable Trust. Advisory Panel; LifeScan Diabetes Institute. Consultant; WellDoc. Advisory Panel; Cardinal Health/Edgepark. A. Moraitis: None. N.A. Allen: Research Support; Dexcom, Inc. Consultant; Diathrive Health.

Funding

Franklin S. Ivory and Rachael C. Ivory Foundation
697-P: Evaluation of Acceptance and Commitment Therapy on Glycemic Control in Type 2 Diabetes Patients
Authors: MAKINO HISASHI , OYA AIKO , SHIMA TAIKI , TSUDA NATSUMI , KOEZUKA RYO , TOCHIYA MAYU , OHATA YOKO , TAMANAHA TAMIKO , NOGUCHI MICHIO , HOSODA KIMINORI
Published: June 2024

Background and Aim: Acceptance and commitment therapy (ACT) is a psychological intervention using uses mindfulness strategies and acceptance along with commitment and behavior. In this study, we aimed to assess the effects of group-based ACT on self-management of patients with diabetes.

Methods: One hundred and six patients with type2 diabetes were randomly assigned either to the education alone (conventional group, n = 53) to a combination of education and 4-hour ACT workshop (ACT group, n = 53). Observation period was 12 months, and both groups were allowed to change hypoglycemic drugs after 6 months. The primary outcome was HbA1c change after 6 months. Major secondary outcome was HbA1c change after 12 months, change of body weight, carolie intake, and physical activity.

Results: After 6 and 12 months, there was no significant difference of HbA1c change between conventional group and ACT group. In patients with a low degree of psychological diabetes avoidance as assessed by acceptance and action diabetes questionary (AADQ) score, HbA1c reduction of ACT group tended to be greater than conventional group. There was no significant difference of body weight change between the two groups. Carolie intake after 12 months in ACT group was significantly lower than conventional group, whereas there was no significant difference of physical activity.

Conclusions: In this study, a single 4-hour workshop intervention did not significantly reduce HbA1c, although it did reduce caloric intake. However, in patients with high AADQ scores, a single workshop intervention may be effective in lowering HbA1c.

Disclosure

H. Makino: None. A. Oya: None. T. Shima: None. N. Tsuda: None. R. Koezuka: None. M. Tochiya: None. Y. Ohata: None. T. Tamanaha: None. M. Noguchi: None. K. Hosoda: None.
698-P: "Come to a Conclusion Together"—Feedback on the Collaboration around Technology Using Community Health Workers in Type 1 Diabetes (T1D-CATCH) Study
Authors: FINNAN MOLLY , ADAMU ASUMAWU , MATHIAS PRIYANKA M. , SANCHEZ STEVEN , TALLA ASTOU , LONG JUDITH A. , AGARWAL SHIVANI
Published: June 2024

Background: Diabetes technology is now considered a standard of care for T1D; however, its adoption remains limited in minoritized populations. Community health workers (CHWs) engender trust by providing: unique assistance, social needs support, and extra healthcare system navigation. The T1D-CATCH intervention aims to enhance core CHW roles, adding specialty T1D support to increase diabetes technology use.

Methods: In this ongoing randomized controlled trial testing the efficacy of T1D-CATCH, we report preliminary qualitative findings from post-intervention interviews with participants who have completed the intervention. We conducted semi-structured individual interviews, which were audio-recorded, transcribed, and analyzed by two independent coders utilizing a deductive coding approach.

Results: We included 11 participants who completed the intervention (mean age 25 yrs, 73% female, n=4 Hispanic, n=7 non-Hispanic Black). Common themes identified included high satisfaction and increased engagement with diabetes self-management, attributed to the increased flexibility in communication methods and scheduling offered by CHWs compared to healthcare providers. Participants saw CHWs as a valuable source of information and a tangible resource for unmet social needs. Participants also noted enhanced trust in the healthcare system due to shared decision-making, increasing their likelihood to adopt diabetes technology. Overall, participants noted that improvement in communication methods with the CHW and extra outreach for social needs management and diabetes technology navigation changed their self-perception of diabetes and improved self-management.

Conclusions: In this initial sample of study completers, the T1D-CATCH intervention appears to be feasible and acceptable, and may provide a new resource to improve diabetes technology uptake and self-management in minoritized young adults with T1D.

Disclosure

M. Finnan: None. A. Adamu: None. P.M. Mathias: None. S. Sanchez: None. A. Talla: None. J.A. Long: None. S. Agarwal: Research Support; Dexcom, Inc. Advisory Panel; Medtronic. Consultant; Beta Bionics, Inc.

Funding

National Institutes of Health (R01DK132302)
704-P: Unearthing Implicit Beliefs—Beyond Symptoms in Social Determinants of Health in Immigrants and Refugees with Type 2 Diabetes
Authors: ALI ASMA , VIVIAN EVA M. , CHEWNING BETTY A.
Published: June 2024

Background: Social determinants of health (SDOH) account for 50% of health outcomes compared to 20% by clinical care. This work highlights SDOH in Muslims with type 2 diabetes (T2D) who receive healthcare services in the US.

Methods: Semi-structured qualitative one-hour interviews were conducted with adult Muslim participants diagnosed with T2D for at least 6 months and using diabetes oral medications and/or injections. Maximum variation sampling captured the Muslim population’s heterogeneity with five groups who spoke different languages with different countries of origin.

Results: Twenty-two participants, mostly immigrants or refugees, were included. Themes were distributed across the 5 main SDOH domains. Economic stability included low income and/or working in demanding stressful jobs or multiple employments that hindered access to healthy food. Low education and limited English proficiency hindered patient-provider communication or ability to read instructions on medication bottles. Factors related to healthcare access and quality included health knowledge and advocating for oneself with providers. Neighbourhood and built environment themes included harsh winter weather, lack of access to convenient transportation, and lack of understanding about public transportation systems. Varying social support by family and friends were important to facilitate healthy behaviours and access to care.

Conclusions: Building compassionate trust-based relationships with patients is key. Healthcare providers can use cues to investigate SDOH. For instance, in addition to the regular SDOH screening, a missed appointment can be a cue to ask about transportation access or the convenience of the appointment time.

Disclosure

A. Ali: None. E.M. Vivian: None. B.A. Chewning: None.

Funding

This work is supported by the Small Grant Funding by the Department of Family Medicine and Community Health at the University of Wisconsin-Madison. Dr. Ali was supported by the University of Wisconsin Primary Care Research Fellowship, funded by grant T32HP10010 from the Health Resources and Services Administration.
729-P: Interactive, Online, Case-Based Education Effective at Improving Clinical Competence Related to Staging and Comprehensively Treating Type 1 Diabetes
Authors: LARKIN AMY , LE ANNE
Published: June 2024

Introduction: We sought to determine if interactive, case-based, online continuing medical education (CME) could improve the competence and confidence of diabetologists/endocrinologists (D/Es) and pediatricians related to T1D.

Methods: Educational design included a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design and a McNemar’s test (P <.05 is considered significant) assessed educational effect, with Cohen’s d being used to assess educational impact (<0.2 modest effect, 0.2-0.49 small effect, 0.5-0.79 moderate effect and >0.8 extensive effect). Data collected April 24, 2023 through June 15, 2023.

Results: 102 D/Es and 168 pediatricians were included. Matched learner data indicate that overall 79% D/Es and 77% of pediatricians improved their competence from pre-to-post (both P<.001 with extensive overall impacts in both groups 1.12-1.29). 53% of D/Es (P<.001) and 49% of pediatricians (P<.001) improved at correctly staging a patient with T1D. 18% of D/Es (P<.001) and 35% of pediatricians (P<.001) improved at accurately treating a patient with stage 2 T1D. 44% of D/Es (P<.001) and 36% of pediatricians (P<.001) improved at identifying best practices for educating a patient with T1D. Overall, 50% of D/Es and 45% of pediatricians reported increased confidence in implementing new preventive treatment approaches for the management of early-stage T1D.

Conclusion: This study demonstrates the success of interactive, case-based, online CME on improving competence and confidence of D/Es and pediatricians related to staging and comprehensively treating/delaying/preventing T1D. Case-based education with interactive polling questions and detailed explanations related to best choices should be employed more often to help clinicians apply guidelines into practice to improve patient care.

Disclosure

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

Funding

Developed through an independent educational grant from Provention Bio, a Sanofi Company.
73-PUB: Endogenous GIP Lowers Plasma Glucose during Fasting in Obese Individuals
Authors: KOEFOED-HANSEN FREDERIKKE , SHEYMA KIZILKAYA HÜSÜN , HELSTED MADS M. , SØRUM NIKOLAJ E. , HARTMANN BOLETTE , KNOP FILIP KRAG K. , GASBJERG LÆRKE S.
Published: June 2024

The incretin hormone glucose-dependent insulinotropic polypeptide (GIP) is secreted from enteroendocrine K cells in the small intestine following food intake. Exogenous GIP stimulates glucagon secretion during fasting at low blood sugar and exerts anabolic effects in fat and bone in healthy individuals. Using the GIP receptor antagonist GIP(3-30)NH2, we investigated the effects of endogenous GIP in humans during fasting.

In a randomized, placebo-controlled, double-blind, crossover study comprising two experimental days, 12 healthy participants (7 men, 5 women; mean (±SEM) age 35±4 years; mean BMI 38 ±1.6 kg/m2; mean body fat percentage 37 ± 2.2%) received 180-minute infusions of GIP(3-30)NH2 (1,000 pmol/kg/min) and placebo (saline), respectively, after 10 hours of fasting. An ad libitum meal was provided at time 180 min, during continuous infusion.

Comparing paired values for each participant, baseline-subtracted plasma glucose was higher during GIP(3-30)NH2infusion compared to placebo (mean bsAUC0-180 (±SEM) -53.6 ± 12.2 vs. -31.7 ± 6.6 min×mmol/L, P = 0.031) whereas systolic blood pressure (P = 0.44), diastolic blood pressure (P = 0.59), pulse rate (P = 0.92) and ad libitum food intake (P = 0.31) were unaffected.

In conclusion, endogenous GIP seem to have glucose-lowering effects in obese individuals in the fasting state.

Disclosure

F. Koefoed-Hansen: None. H. Kizilkaya: None. M.M. Helsted: None. N.E. Sørum: None. B. Hartmann: Board Member; Bainan Biotech. F.K. Knop: Advisory Panel; AstraZeneca. Consultant; AstraZeneca. Speaker's Bureau; AstraZeneca. Advisory Panel; Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. Advisory Panel; Novo Nordisk A/S. Consultant; Novo Nordisk A/S. Employee; Novo Nordisk A/S. Research Support; Novo Nordisk A/S. Speaker's Bureau; Novo Nordisk A/S. Stock/Shareholder; Novo Nordisk A/S. Advisory Panel; Sanofi. Speaker's Bureau; Lundbeck. Advisory Panel; Zealand Pharma A/S. Consultant; Zealand Pharma A/S. Research Support; Zealand Pharma A/S. Speaker's Bureau; Zealand Pharma A/S. Stock/Shareholder; Zealand Pharma A/S. L.S. Gasbjerg: Stock/Shareholder; Antag Therapeutics.