bluuebunny/crossref_metadata_2025 huggingface dataset:
635-P: Therapeutic Footwear Is the Main Way to Prevent Foot Ulcer Relapse, but Is Insufficiently Respected
Authors: LALOI-MICHELIN MARIE , VIDAL-TRÉCAN TIPHAINE , FÉRON FLORINE , KEVORKIAN JEAN-PHILIPPE , ACKER DIDIER , BOUCHE CLARA , GAUTIER JEAN-FRANCOIS , RIVELINE JEAN-PIERRE
Published: June 2019

Therapeutic footwear (TFW) is essential to prevent diabetic foot ulcer (DFU) relapse after healing. Our retrospective study aimed at investigating patient’s compliance with TFW 1 year after complete healing, and whether the respect of this TFW in real life conditions was associated with a decrease of DFU recurrence during a 1-year follow-up. This is a retrospective study in which all consecutive patients attending our ambulatory foot unit between 01.2015 and 01.2016, were included if they had a TFW prescription after complete healing. The primary study endpoint was the percentage of compliant patients, who wear the TFW at 1 year. The proportion of patient with DFU relapse was compared in compliant versus non-compliant patients (secondary endpoint). The use of TFW was assessed by analyzing the points of wear and cleanliness of the shoes by the same podiatrist. We included 117 consecutive patients: age 63 ± 13 years, women 29/117 (24,7%), type 2 diabetes: 108/117 (92%), diabetes duration: 17.5 ± 12.5 years. After 12 months, 28/117 patients (24%) were lost of follow-up. TFW was respected in 60/117 cases (51.2%). None of these factors influenced the TFW compliance: sex, age, type of diabetes, diabetic treatment, diabetic duration or complications, HbA1c level, peripheral artery disease, neuropathy, amputations, ulcer localization, healing time, TFW type nor the lack of social insurance. DFU recurrence was observed in 24/89 cases (27%) and was significantly higher in non-compliant patients: 16/29 (55%) vs. 8/60 (13.3%) (P=0.05). The only factor predictive of DFU relapse was non-compliance for TFW. After complete DFU healing, TFW prescription is respected only by half of the patients at 1 year. Non-compliant patients are at higher risk of DFU. Further surveys need to be designed to determine the reasons of non-compliance and to conceive more adapted educational programs.

Disclosure

M. Laloi-Michelin: None. T. Vidal-Trécan: Board Member; Self; Novo Nordisk Inc. F. Féron: None. J. Kevorkian: None. D. Acker: None. C. Bouche: None. J. Gautier: None. J. Riveline: Board Member; Self; Abbott, Lilly Diabetes, Novo Nordisk Inc. Consultant; Self; Novo Nordisk Inc. Research Support; Self; Air Liquide, Amgen Inc. Speaker's Bureau; Self; Abbott, Lilly Diabetes, Sanofi.
637-P: Angiopoietin-Like 2 Is a Potential Biomarker for Diabetic Foot Patients
Authors: WANG YAN , YANG LONGYAN , ZHENG ZHAOHUI , WANG XIN , ZHAO DONG
Published: June 2019

Angiopoietin-like 2 (ANGPTL2) is a proinflammatory protein belonging to the angiopoietin-like family. ANGPTL2 is secreted and detected in the systemic circulation. Serum levels of ANGPTL2 increase significantly in various chronic inflammatory diseases and show associations between ANGPTL2 levels and diagnosis and/or prognosis of cardiovascular diseases, diabetes, chronic kidney disease, and various types of cancers. However, no data regarding the relationship between ANGPTL2 and diabetic foot are available. Here, we explored the potential link between ANGPTL2 and diabetic foot. We recruited 66 participants, including 16 patients with diabetic foot and 50 patients with type 2 diabetes mellitus without diabetic foot. Serum ANGPTL2, CRP, VEGF, ICAM-1 and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA) kits. We demonstrated that serum levels of ANGPTL2 in diabetic foot patients were higher than those in diabetes controls (6.696±0.6759 vs. 4.444±0.2135, p<0.0001). In the spearman correlation analysis, serum ANGPTL2 level had strong positive correlation with CRP (r=0.4924, p<0.0001), VEGF(r=0.4116, p=0.0006), ESR (r=0.5282, p<0.0001) among all subjects. After adjusted for age, sex, smoking and duration of diabetes, ANGPTL2 was demonstrated to be an independent risk factor for diabetic foot (OR, 3.835, 95% CI 1.608-14.81, p=0.0002). In addition, serum ANGPTL2 was still positively correlated diabetic foot stage after adjusting age, sex, smoking, HbA1c, duration of diabetes and use of drugs (β=0.3838, p=0.002).

In conclusion, serum ANGPTL2 acted as a contributor for diabetic foot and had strong association with diabetic foot progression in all stages. Blockade of ANGPTL2 may postpone the onset and development of diabetic foot.

Disclosure

Y. Wang: None. L. Yang: None. Z. Zheng: None. X. Wang: None. D. Zhao: None.

Funding

National Natural Science Foundation of China; National Science Funding in China
640-P: Willingness to Adopt Devices for Prevention of Foot Ulcers in High-Risk Diabetic Patients
Authors: NOVICE TAYLOR , VEMURI CHANDU , GILBERT CATHERINE , FICI ANTHONY J. , VANWIEREN ELIZABETH F. , SCHMIDT BRIAN M.
Published: June 2019

The objective was to evaluate whether high risk diabetic patients are willing to implement wearable technology to prevent diabetic foot ulcer (DFU) formation. There is increasing evidence that self-monitoring devices for DFU prevention may be effective. However, there is a paucity of literature assessing the willingness of patients to employ these technologies for DFU prevention. We analyzed patient interest around advancing wearable technology through an anonymous, voluntary survey. Adult diabetic patients 18 years or older with a history of peripheral neuropathy, foot deformity, and those with and without DFU who presented to a tertiary care center were included. Surveys were performed consecutively. Descriptive statistics were calculated to describe survey responses. We used a combination of t-tests and chi-square tests to compare the responses of diabetic patients with and without DFUs. One hundred and forty-nine patients met the inclusion criteria for this study. One hundred patients completed the questionnaire, a response rate of 67%. Fifty-four patients had a history of a previous DFU, while 46 patients had no history of previous ulceration. Patients with no history of a prior DFU were significantly more interested in preventing foot ulcers (p=0.003) when compared to those with a prior history of a DFU. Patients without a history of ulcer formation were significantly more likely to obtain a self-monitoring device compared to patients with a prior history of a DFU (86.97% v 68.52%, p=0.02) Our results suggest that diabetic patients with no history of a prior DFU are more motivated to prevent foot ulcers and more likely to adopt technologies. However, since home-monitoring devices are most efficacious in those with a history of a previous foot ulcer, providers should develop strategies to better educate these high-risk patients. Our findings strongly support that inclusion of advancing self-monitoring technology in the management of diabetic foot ulcer prevention is warranted.

Disclosure

T. Novice: None. C. Vemuri: Consultant; Self; Cook Medical. C. Gilbert: None. A.J. Fici: None. E.F. Vanwieren: None. B.M. Schmidt: None.
648-P: Developing a National Competency-Based Diabetes Curriculum in Undergraduate Medical Education: A Delphi Study
Authors: SHAH SAPNA , MCCANN MAGGIE , YU C.
Published: June 2019

Introduction: In recent years there has been an increased emphasis on competency-based medical education (CBME) internationally, as can be seen with the implementation of competency-based curriculums for postgraduate medical education (PGME) through the Royal College of Physicians and Surgeons of Canada. Currently, no Canada-wide consensus exists on educational competencies relating to diabetes in undergraduate medical education (UGME).

Objective: To develop a list of competencies and objectives for diabetes teaching in medical school using a modified Delphi method.

Methods: Representatives involved in the development of the diabetes curriculum at all 17 medical schools across Canada were contacted. A draft list of competencies and objectives was developed by the research team using the existing curriculums at nine Canadian medical schools and was organized using the CanMEDS framework. A Delphi method was used, with two iterations in order to reach consensus. The first survey was conducted in May 2018. The data was analyzed and the survey was revised to include the opinions and remarks of respondents. The revised version of the survey was then sent to the respondents in July 2018.

Results: Out of 17 medical schools contacted, 12 (70.6%) agreed to participate. One school declined participation and four did not respond. Out of 12 surveys sent in the first round, eight responses were received (response rate 66.7%). The revised version was then resent to the eight respondents in July 2018 and seven responses were received (response rate 87.5%). A list of nine competencies and 65 objectives was finalized.

Conclusion: A competency-based consensus curriculum for diabetes education for medical students was developed using a modified Delphi method. The final consensus syllabus will be disseminated throughout the country. This curriculum serves as a step in the transition to CBME and in ensuring that future medical school graduates are proficient in diabetes care.

Disclosure

S. Shah: None. M. McCann: None. C. Yu: None.
654-P: Effect of a Streamlined Diabetes Device Clinic Model on Education Utilization and Glycemic Control among Insulin Pump Patients
Authors: PARK CANDICE K. , ZAPPE JANET G. , SNYDER ELIZABETH , DUNGAN KATHLEEN M.
Published: June 2019

Objective: As diabetes technologies increase in prevalence and complexity, flexible models of care are needed to provide ongoing support. The objective of this study is to determine whether a streamlined Diabetes Device Clinic (DDC) model is associated with improvement in glycemic control and education utilization among insulin pump users.

Research Design and Methods: The DDC was available for patients in need of focused device-related education; all patients had previously received comprehensive education and insulin pump training. The DDC consists of an abbreviated visit with a certified diabetes educator (CDE, 40 minutes) followed by a hand-off and visit with the endocrinologist (20 minutes). Participants were compared to insulin pump users who received traditional care. Pre- and post-HbA1c values were obtained within 6 months prior to and 6 months after the DDC visit. The two most recent HbA1c values at least 3 months apart were obtained for non-device clinic patients.

Results: A total of 437 patients were identified, 79 of whom attended the DDC. Of the non-attendees (n=358), 48.7% were referred to the CDE and 39% completed an education visit. Among patients with a baseline HbA1c >8.0%, those who attended the DDC witnessed a significant reduction in HbA1c (-0.52% +/- 0.71, p=0.002) whereas non-attendees saw no such improvement (-0.14% +/- 1.29, p=0.29). For patients with a baseline HbA1c <8.0%, there was a slight increase in HbA1c in DDC attendees and no change in non-attendees (0.20% +/- 0.66, p=0.028, vs. 0.04% +/- 0.54, p=0.24 respectively). Multivariable analysis confirmed a significant interaction between baseline HbA1c and DDC. Results were similar in patients receiving traditional education.

Conclusions: These data illustrate that the streamlined DDC model of care may improve glycemic control and education utilization among established insulin pump patients. Additional study is needed to address ongoing education needs.

Disclosure

C.K. Park: None. J.G. Zappe: None. E. Snyder: None. K.M. Dungan: Advisory Panel; Self; Eli Lilly and Company, Elsevier, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company, GlaxoSmithKline plc., Novo Nordisk Inc., Sanofi-Aventis, Viacyte. Other Relationship; Self; DKBmed, UpToDate.
655-P: Effect of an Interdisciplinary Care and Diabetes Self-Management Education Program on Weight among Persons with Social and Clinical Complex Profile
Authors: DELATORRE-SALDAÑA VIRIDIANA A. , SILVA-TINOCO RUBÉN , HERNÁNDEZ JORGE , GUZMAN EILEEN B. , CASTILLO-MARTÍNEZ LILIA , OREA-TEJEDA ARTURO , GALLARDO-RINCÓN HECTOR , MARTÍNEZ-ANZURES CARMEN , SEGOVIA ALMA , CUATECONTZI-XOCHITIOTZI TERESA
Published: June 2019

People with diabetes/obesity, especially those on insulin treatment and with the intention of achieving glycemic control goal, may have more difficulty losing weight. Evidence suggests a relationship between social determinants of health (socio-economic status, education, etc.) and worst diabetes-related outcomes. We evaluated the change on weight in patients who attended an Interdisciplinary Care and Diabetes Self-management Education Program in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa in 2018. In 327 persons with type 2 diabetes, body weight and composition were evaluated by bioelectrical impedance multifrequency analysis (Seca® 515/514, 50 Hz). Women represented 67%, 56% had elementary or less education and 63.9% had medium-low or lower socio-economic status. Mean age was 55±10 years old, mean duration of diabetes was 12±8 years, baseline weight was 72.9±16.1 kg and 68% were on insulin treatment. Drugs with recognized weight loss effect were not added. Weight loss was observed after the program: BMI 25-29.9 category (n=118) 1.4 kg (-0.4-2.9 95% CI, p=<0.0001), in BMI 30-34.9category (n=77) 1.9 kg (0.3-4.2 95% CI, p=<0.0001), and in BMI ≥35 category (n=61) 2.5 kg (0.3-5.2 95% CI, p=<0.0001) of weight loss was observed. Proportion of patients with BMI≥30 and weight loss >5% was 26.1%. Fat mass loss was 2.1 kg (0.3-3.1 95% CI, p=<0.0001) in BMI≥30 category. Diet self-care behavior improved (2.6±1.6 to 5.4±0.9 days/week, p=<0.0001), HbA1c decreased (9.45±2.0 to 6.7±1.2%, p=<0.0001) as well as total daily insulin units (36.2±16.9 to 27.2±12.2 units, p=<0.0001) among on-insulin treatment subjects. We show that this strategy non-primarily designed to lose weight but rather to propitiate diabetes empowerment had a valuable positive effect on weight in a real world-setting, even when the studied population has complex and adverse clinical and social features.

Disclosure

V.A. DeLaTorre-Saldaña: None. R. Silva-Tinoco: Speaker's Bureau; Self; Novo Nordisk Inc. J. Hernández: None. E.B. Guzman: None. L. Castillo-Martínez: None. A. Orea-Tejeda: None. H. Gallardo-Rincón: None. C. Martínez-Anzures: None. A. Segovia: None. T. Cuatecontzi-Xochitiotzi: None.
660-P: Nationwide Capacity Building Model in Gestational Diabetes Management for Primary Care Physicians in India
Authors: KUMAR PUSHKAR , BHALLA SANDEEP , CHANDWANI HARESH
Published: June 2019

Background: Pregnancies complicated by GDM have fourfold increased risk of perinatal mortality and has a long-term health impact, with more than 50% of women with GDM going on to develop type 2 diabetes within 5-10 years of delivery. In India an estimated 4 million women have GDM.

Aim: To highlight the components of a PAN India training model specifically designed to enhance the knowledge, skills, and core competencies of Primary Care Physicians (PCPs) in the management of GDM.

Methodology: Addressing the issue of dearth of trained professionals in specialized area like gestational diabetes by building the capacity of PCPs is an important strategy towards improving GDM management. A four modular course was developed jointly by Public Health Foundation of India and Dr. Mohan’s Diabetes Education Academy to train primary care physicians with strong course curriculum, vetted and approved by the eminent panel of national experts constituting of eminent endocrinologists and gynecologists.

Result: Certificate Course in Gestational Diabetes Mellitus (CCGDM) has trained 3200 participants and covered 26 states, 3 Union Territories, 257 districts and 437 cities in the last 4 cycles. This model has been adopted by five state governments- Gujarat, Madhya Pradesh, Meghalaya, Tripura and Uttarakhand for training their medical officers. Out of the trained participants, 52% were post- graduates and 39% belonged to Government sector. The robust monitoring mechanism and precise certification method led to 90% pass percentage and 92% of trained physicians claimed that it helped them in better diagnosis, timely referral and management of GDM patients with significant knowledge improvement.

Conclusion: Focusing on GDM by training PCPs is a low-cost intervention both to improve maternal and child health as well as to prevent future diabetes. This is a well- defined progressive training model to build capacity among doctors in GDM Management and has the potential to be adopted by low income countries.

Disclosure

P. Kumar: None. S. Bhalla: None. H. Chandwani: None.
670-P: Provider Medication Use Changes for Better and Worse with Education
Authors: SARKAR SUNANDA , BARNES CATHERINE S. , CAUDLE JANE , JOHN SMITHA M. , CLARK KYRA P. , HEIMAN ERICA , VOLCY JUDITH C. , SCHMIDT STACIE , ZIEMER DAVID C.
Published: June 2019

ADA guidelines for type 2 diabetes recommend metformin (MET) at all A1c levels, combination (COMBO) therapy at higher A1c levels and insulin (INS) for symptoms or A1c > 10. Current provider adherence to guidelines and the ability of educational session to alter that are unclear.

Methods: We assessed provider medication use before and after didactic diabetes medication and case management sessions designed to encourage multi-combination therapy and guideline adherence. Surveys asked 163 participants to report preferred drug regimens to be used for 6 patient cases: newly diagnosed (NEW) or established (EST) diabetes patients with A1c of 7.5 (LO), 9.5 (MID) or 10.5 (HI).

Results: MET use was remarkably low at higher A1c’s (69% HI, 85% MID, 98% LO) at baseline. After sessions, MET use improved significantly to 84%, 94%, 99%. COMBO (no-INS) was most frequently chosen for MID A1c levels: NEW 67%/EST 43%; compared to 13%/23% for LO 7%/5% HI. In the higher A1c cases, COMBO use increased dramatically with sessions to: 83%/72% MID, 30%/16% HI (all p< 0.005). Use of sulfonylureas decreased for 5 of the 6 cases. Changes in INS use were nuanced. Few providers (2%/4%) chose insulin for LO A1c; this decreased to near 0 after the sessions. INS was used in the majority of patients with HI A1c. INS use decreased significantly in favor of COMBO, not only for MID A1c (38%/51% to 13%/26%), but also for HI (93%/94% to 70%/84%).

Summary: Initially, guideline adherence was sub-optimal (underutilization of MET, COMBO and at HI A1c of INS). Short Provider Education sessions improved practices. Use of COMBO’s less likely to cause hypoglycemia increased substantially. However, appropriate INS at HI A1c also decreased.

Conclusion: There is a need for more training for better use of the antidiabetic armamentarium by primary care providers. Provider education emphasizing COMBO advantages improves planned prescribing patterns, but careful message tailoring is needed to avoid unintended consequences.

Disclosure

S. Sarkar: None. C.S. Barnes: None. J. Caudle: None. S.M. John: None. K.P. Clark: None. E. Heiman: None. J.C. Volcy: None. S. Schmidt: None. D.C. Ziemer: None.

Funding

Sanofi U.S.
676-P: The Efficacy and Safety of Careful Management of Self-Dose-Adjustment Intervention of Basal Insulin by the Nurse in Outpatients with T2DM
Authors: HU XILING , YANG XUBIN , DENG HONGRONG , GUO XIAODI , YAO BIN
Published: June 2019

Background: Basal insulin therapy is widely used in patients with type 2 diabetes mellitus (T2DM). After giving the initial dose, the follow-up of the patients from the doctors, including the dose adjustment and the hypoglycemia, is not sufficient in China, which influences the glucose control obviously. Thus, we intended to invest if the patients with T2DM would benefit from careful follow-up and management of the basal insulin therapy by the nurse.

Methods: The patients with T2DM who were ≥ 18 years old and glycosylated hemoglobin A1c (HbA1c) > 7% were eligible for the 12-week study. After they were randomized to the control group and the careful care group, glargine was added to them. All of the patients accepted the routine guidance by the doctor. In addition to that, patients in the careful care group were guided to adjust their insulin dose 2-6U to reach the glucose target and followed-up at the 1, 2, 4, 8, 12 weeks by the Diabetes Specialist Nurses. The laboratory indices and questionnaire were assessed at baseline and at the end of the study.

Results: Four hundred and twenty-three patients (53.6 ± 14.3 years) in the control group and four hundred and twenty-six patients (54.7 ±13.4 years) in the careful care group finished the 12-week study. The patients in the careful care group had greater reduction of fasting plasma glucose (-2.64±0.44mmol/L vs. -1.63±0.53mmol/L, P<0.05) and HbA1c (-2.8±0.5% vs. -1.8±0.5%, P<0.05), higher improvements of the score of diabetes knowledge (6.10 ± 0.76 vs. 2.87± 1.72, P<0.001), the score of Diabetes Empowerment Scale-Short Form (39.07 ± 17.82 vs. 26.93 ± 19.17, P<0.05), and the score of self-management ability (including diet, exercise, etc., P<0.05), compared with the control group. The hypoglycemic percentages were similar between them (17.73% vs. 20.65%, P=0.279).

Conclusions: The careful follow-up and management of self-insulin dose adjustment by Diabetes Specialty Nurses is effective and safe in patients with T2DM.

Disclosure

X. Hu: None. X. Yang: None. H. Deng: None. X. Guo: None. B. Yao: None.
685-P: Insights into Online Delivery of the National Diabetes Prevention Program
Authors: ELY ELIZABETH , JABRAH RAJAI
Published: June 2019

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working together to build a nationwide delivery system for a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. In 2015, the Diabetes Prevention Recognition Program (DPRP), the quality assurance arm of the National DPP, began recognizing lifestyle change programs delivered through an online platform, meaning participants log into course sessions via a computer, tablet, or smart phone. In November 2018, the total number of participants ever enrolled in the program reached 250,000. Those in online programs have now exceeded the number in in-person programs (144,122 vs. 109,951), despite the fact that online participation is not currently covered as part of the Medicare Diabetes Prevention Program. Among men eligible for participation in the program, more were found to enroll in online programs (65.6%) than in-person programs (34.4%), while among women, the difference was not as great (54.4% online and 45.6% in-person). With respect to age, eligible participants aged 18-44 enrolled in online programs at a rate of 75.5%, while eligible participants 65+ enrolled in in-person programs at a rate of 81.8%, seeming to show that younger participants prefer online, while older participants prefer in-person. Hispanic and white participants enrolled in online at a higher rate than in-person (54.9% and 62.4%), while 51.6% of black participants enrolled in in-person over online. Mean weight loss is used to determine the effectiveness of programs. Participants strive to lose at least 5% of their starting body weight over 12 months. When only eligible participants who were fully engaged for at least 9 of the 12 program months were considered, mean weight loss was found to be 6.3% for in-person programs and 5.4% for online programs. The addition of online programs has allowed the National DPP to reach underserved populations with prediabetes with favorable results.

Disclosure

E. Ely: None. R. Jabrah: None.
687-P: Early Detection of Insulin-Derived Amyloid Deposits in Abdominal Wall and the Management of Insulin Injection Site Using CGM and Abdominal Wall CT Examination
Authors: HIRAI AIZAN , HIRAI KEIJI , NISHIHARA HARUMI , SASAKI JUNKO , SUDO TOMIKO , FUJIMURA KOJI , KAGEYAMA TAKAHIRO
Published: June 2019

Purpose: Long-term injection of insulin preparations causes subcutaneous amyloid deposits called "insulin balls", leading to impaired blood glucose control due to delayed absorption of the drugs. In order to get therapeutic effects of insulin, proper selection of the injection site is quite essential. Subcutaneous amyloid deposition in abdominal wall can be detected by CT examination. The present study was conducted to establish a method for detection of insulin-derived amyloid deposits and the management of insulin injection site by the combination of continuous blood glucose monitoring (CGM) and abdominal wall CT examination.

Methods: The present study included 120 T2DM patients who were treated with insulin preparations over 5 years. Two weeks CGM was performed using Free Style Libre Pro. In case of significant day-to-day variation in blood glucose control, abdominal wall CT was performed to detect amyloid deposition.

Results: As shown in Figure, abdominal wall CT revealed that subcutaneous amyloid deposition is caused not by ultra-short acting insulin but by long-acting insulin. Blood glucose control was stabilized by insulin injection avoiding amyloid deposits detected by CGM and CT.

Conclusion: CGM and abdominal wall CT examination are useful tools for early detection of amyloid deposition by insulin and optimization of injection site.

Disclosure

A. Hirai: None. K. Hirai: None. H. Nishihara: None. J. Sasaki: None. T. Sudo: None. K. Fujimura: None. T. Kageyama: None.
69-LB: Postprandial 2-hr Rise in Insulin Is a Strong Predictor of Glycemic Responses to Different Meals in Healthy and Prediabetic Individuals: The PREDICT I Study
Authors: FRANKS PAUL W. , BERRY SARAH , CHAN ANDREW T. , DAVIES RICHARD J. , DREW DAVID A. , SPECTOR TIM D. , VALDES ANA M.
Published: June 2019

Objective: Postprandial glucose is a predictor of later diabetes and vascular complications. The study aims to identify determinants of inter-individual variability in postprandial responses in healthy and prediabetic individuals.

Methods: A multi-centre study in the UK and the U.S. assessed the postprandial insulin, glucose and triglyceride responses to a dietary challenge (50g fat and 85g carbohydrate) in the clinic. The inter-individual variability in postprandial glycemic responses was then measured over 2 weeks for isocaloric meals of different macronutrient content using a continuous glucose monitor (CGM). Interim analyses of the 30- and 120-min insulin rises and meal content contributions to the incremental glucose area under the curve (iAUC) were performed in 573 individuals (age 47.5 (19-66) years, BMI 25.7 (17-53) kg/m2; F=76%; n=108 with HbA1c > 5.7% [prediabetic]).

Results: A machine learning algorithm showed that 29% of variation in glucose iAUC of at home meals was explained by the meal’s macronutrient content. In clinic, the 30min insulin postprandial rise (strongly associated with same meal’s glucose iAUC r=0.39 p=1.25x10[-20]) was not correlated with at-home postprandial glucose iAUCs in healthy (r=-0.012 p=0.62) or prediabetic (r=-0.074 p=0.17) individuals after adjustment for age, sex and BMI. However, 2hr insulin rise was significantly associated in healthy (r=0.13 p=1.6 x 10[-7]) and prediabetic (r=0.22 p=3.2x10[-5]) individuals, explaining 15% of the variance in glucose iAUCs. This was the same for all meals regardless of macronutrient content.

Conclusions: The 2hr postprandial insulin rise is a predictor of glycemic responses to different meal types. Ongoing exploration in PREDICT I using additional environmental, genetic and microbiome variables should advance our ability to predict an individual’s response to food.

Disclosure

P.W. Franks: Board Member; Self; Zoe Ltd. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Novo Nordisk Foundation, Sanofi, Servier. S. Berry: Consultant; Self; Zoe Ltd. A.T. Chan: Consultant; Self; Bayer AG, Janssen Pharmaceuticals, Inc., Pfizer Inc. R.J. Davies: Employee; Self; Zoe Global Limited. D.A. Drew: Consultant; Spouse/Partner; PathAI. T.D. Spector: Stock/Shareholder; Self; Zoe Global Ltd. A.M. Valdes: Consultant; Self; Zoe Ltd Global. Research Support; Self; Pfizer Inc.

Funding

UK National Institute for Health Research; UK Wellcome Trust; Zoe Global Limited
693-P: Baseline Characteristics and Self-Care Behavior Goals of Adolescents with Type 1 Diabetes Enrolled in MyDiaText™
Authors: KAUSHAL TARA , KATZ L. E. , MAROWITZ MICHELLE E. , JOSEPH JANET , RITTER DEAN P. , LIPMAN TERRI H.
Published: June 2019

Background: Adolescence is associated with suboptimal diabetes control, with average HbA1C levels of 9.0%. Adolescents are highly engaged in mobile technology; over half report sending text messages at least daily. Text messaging (TM) is most commonly used technology in adolescents with type 1 diabetes (T1D). Pilot studies have demonstrated TM to be a useful tool in diabetes education. MyDiaText™ is a website and TM platform created to support behavior change in adolescents with T1DM. Enrollment in a randomized controlled trial (RCT) using MyDiaText™ began in August 2018.

Objective: To report the baseline characteristics, self-care behaviors, and engagement in a TM intervention for T1D education and support in a diverse population.

Methods: Subjects were recruited from the CHOP Diabetes Center. Enrollment criteria for the trial included: 12-18 years, >1 year from diagnosis and point-of-care HbA1C > 8%. Adolescents selected an AADE7™ Self-Care Behavior (SCB) goal on which to focus. Those in the intervention group received daily educational and motivational text messages. Self-Care Inventory (SCI), 14 questions scored 1-5, and HbA1C were obtained at baseline. Engagement index, defined as number of responses/total messages received, was calculated by the application.

Results: There were 107 subjects (average age = 15.8 years {45.8% M, 52.3% F, 1.9% other; 60 (56.1%) W, 33 (30.8%) B, 10 (9.3%) mixed race and 4 (3.7%) other; 11 (10.2%) identified as Hispanic}) enrolled. “Monitoring” was most common SCB selected, 45 subjects (42.4%). Mean (range) baseline HbA1C was 10.0% (8.0-14.1). Mean baseline SCI score was 3.36 (1.07-5.0). Engagement was 60% or greater for 74% of subjects in treatment arm.

Conclusions: A diverse population of adolescents with T1D and suboptimal control preferred text messaging support for blood glucose monitoring and demonstrated high engagement in MyDiaText™. Further analyses will determine the efficacy of MyDiaText™ on diabetes outcomes.

Disclosure

T. Kaushal: None. L.E. Katz: None. M.E. Marowitz: None. J. Joseph: None. D.P. Ritter: None. T.H. Lipman: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (2T32DK063688-11-12 to L.E.K.)
696-P: The CDC Web-Based Diabetes Self-Management Education and Support Toolkit
Authors: HOUSTON JACQUELYN , EDWARDS LAURA E.
Published: June 2019

Diabetes self-management education and support (DSMES) provides an evidence-based approach to empower people with diabetes to navigate self-management decisions and activities, and has been shown to improve health outcomes. Despite the evidence that DSMES services are cost-effective and have a positive impact on diabetes-related outcomes, they are underutilized. To address this problem, the Centers for Disease Control and Prevention (CDC) developed a DSMES toolkit to increase access to and participation in DSMES services among people with diabetes and to promote health care provider referrals. The toolkit explains the process for securing recognition or accreditation of DSMES services. It offers resources to assist in maximizing reimbursement, eliminating barriers to participation, and linking DSMES to quality measures. The toolkit suggests improving access to DSMES through shared medical appointments, pharmacies, and telehealth. It describes the four critical times to refer persons to DSMES and provides tools to assist with making referrals. National experts from the American Diabetes Association and the American Association of Diabetes Educators, certified diabetes educators (CDE), and public health professionals informed the content of the toolkit. Participants from six state health departments; three DSMES services (pharmacy, federally qualified health center, local health department); and experts from the CDC (pharmacist CDE, nurse diabetes educator, project officer, endocrinologist) tested the toolkit and found it easy to use with relevant information that will be helpful in addressing barriers and challenges to improving access to and participation in DSMES. Expanded use of and referrals to DSMES can help ensure that people with diabetes receive the support they need to successfully manage their diabetes and prevent or delay serious and costly complications. The DSMES toolkit can assist diabetes and public health professionals in working together to address underuse of DSMES.

Disclosure

J. Houston: None. L.E. Edwards: None.
697-P: Final Outcomes of a 5-Year National Effort to Increase Awareness, Availability, Referrals, and Coverage for the CDC-Recognized Diabetes Prevention Programs and DSMES Programs
Authors: MENSA-KWAO AUGUSTINA , MENSA-WILMOT YVONNE , FARRIS KIMBERLY D. , BOWEN SHELLY-ANN , THUMMALAPALLY SHARANYA , MURPHY MONICA D. , RUTLEDGE GIA E.
Published: June 2019

CDC’s State Public Health Actions 1305 Cooperative Agreement funded all 50 state health departments and DC for 5 years to increase the use of diabetes self-management education and support (DSMES) programs and the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) through strategies such as implementing referral policies in health care systems.

Objectives: (1) Describe activities implemented by states to increase awareness, access, utilization, and coverage of DSMES and CDC-recognized LCPs; (2) share findings from baseline to year 5 for CDC-recognized LCPs and DSMES-related activities, and (3) describe facilitators and barriers to implementing prevention and management programs. Qualitative and quantitative data were abstracted from state health departments’ annual evaluation and progress reports and health impact statements. Qualitative data were analyzed using thematic analysis. Quantitative data were analyzed to determine year-to-year percent change from baseline to Year 5. Common activities implemented by recipients included establishing new programs, securing insurance coverage for programs, and using marketing strategies to educate patients about the National DPP LCP and DSMES programs. Outcomes from baseline to year 5 will be shared on the total number of American Diabetes Association recognized/American Association of Diabetes Educators accredited DSMES programs and the number of people who had at least one encounter with a program. Key facilitators for and challenges to increasing program utilization for DMSES and the National DPP will be shared. Findings provide relevant data on best practices to support and scale the National DPP and DSMES programs for improved health outcomes in diabetes. Findings will inform the implementation of sustainable strategies for National DPP and DSMES programs and shape future technical assistance to recipients.

Disclosure

A. Mensa-Kwao: None. Y. Mensa-Wilmot: None. K.D. Farris: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.
698-P: Factors Significantly Associated with Adherence to Diabetes Medications: Findings from a Large Japanese Claims Database
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , OSAWA TAEKO , YAMAMOTO MASAHIKO , KANEKO MASANORI , KITAZAWA MASARU , HARADA MAYUKO , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , YAMANAKA NAUTA , SEIDA HIROYASU , SONE HIROHITO
Published: June 2019

Poor medication adherence is a well-known barrier to meeting therapeutic goals in diabetes mellitus (DM). We aimed to clarify the status of medication adherence and determine clinical variables significantly associated with medication adherence in Japanese patients with DM using a large claims database. Analyzed were data from 7459 patients with DM whose medical records on oral hypoglycemic agents (OHA) were available for at least 1 y (mean age 53 y, HbA1c 7.2%). Medication adherence was evaluated by the proportion of days covered (PDC); PDC <80% was defined as non-adherent. Multivariate logistic regression model was used to identify clinical variables significantly associated with non-adherence. The mean PDC was 80.4%, and 33.1% of patients were non-adherent. The PDC for sulfonylureas, biguanides, thiazolidines, α-glucosidase inhibitors, glinides, and DPP-4 inhibitors were 82% 82%, 79%, 79%, 73%, and 84%, respectively. The PDC for OHA was negatively correlated with HbA1c, LDL cholesterol, and triglycerides. HbA1c decreased by 0.2% with 25% increases in PDC. Logistic analysis indicated that older age and ≥3 concomitant medications were significantly associated with adherence while male sex and smoking were significantly associated with non-adherence (Figure), implying the necessity for effective strategies to improve medication adherence in patients in these categories.

Disclosure

Y. Yaguchi: None. K. Fujihara: None. T. Osawa: None. M. Yamamoto: None. M. Kaneko: None. M. Kitazawa: None. M. Harada: None. Y. Matsubayashi: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
705-P: Health Extension: A Better Way to Manage Diabetes?
Authors: DIETZ CHRISTINA J. , TILKEMEIER PETER , SHERRILL WINDSOR W. , MCFALL DANIELLE E. , STANCIL MICHELLE D. , PARISI MICHELLE A. , BEAUCHAMP CELIA , WHITE HANNAH N.
Published: June 2019

Background: Given the increasing number of individuals with diabetes who live in settings with limited access to care, new models of care delivery for management of diabetes are critical. Health Extension for Diabetes (HED), a community-based non-clinical diabetes education program delivered by a Health Extension Agent, is based on the AADE7 Self-Care Behaviors for Managing Diabetes.

Methods: This intervention is a mixed-methods research study with a primary outcome to reduce/prevent complications associated with diabetes. Goal assessment metrics were selected by clinical, non-clinical and evaluation staff, and resulted in 3 categories: health behaviors, health outcomes, and healthcare utilization. Pre/post analysis of graduates in HED cohorts 1-3 focuses on health behaviors and health outcomes with emphasis on 2 crucial measures, diet and exercise. Pre/post data were compared using Stata 15.

Results: Table 1 shows client demographics and the pre/post analysis of several variables collected during evaluation process.

Conclusion: Overall, this novel educational diabetes self-management support intervention was found to be effective shown through the short-term outcome measures. This new method increased client physical activity and confidence (self-efficacy) in regard to diabetes management while lowering consumption of sugary beverages.

Disclosure

C.J. Dietz: None. P. Tilkemeier: None. W.W. Sherrill: None. D.E. McFall: None. M.D. Stancil: None. M.A. Parisi: None. C. Beauchamp: None. H.N. White: None.

Funding

Greenville Health Authority
706-P: Enrollment in a Diabetes Prevention Program in the San Francisco Safety Net
Authors: KIM STEPHANIE , TANG AUDREY H. , KUO CHARLOTTE , GARCIA REBECA S. , KIM SARAH , MURPHY ELIZABETH
Published: June 2019

There is a crucial need for successful strategies for DPP enrollment and implementation in safety net populations which are disproportionally affected by diabetes. We examine enrollment outcomes in a DPP referral program in the San Francisco Health Network, a safety net serving over 140,000 patients. Overweight patients with prediabetes are referred via an electronic consultation system from 20 community primary care and weight management clinics. Eligible Spanish- or English-speaking patients are contacted by a patient navigator, screened for eligibility, given a readiness assessment and if appropriate, invited to participate in either a digital or in-person DPP. Patients interested in an in-person program but not ready for the full DPP are offered the 6-week Diabetes Empowerment Education Program (DEEP). From August 2017 to November 2018, 305 patient referrals were evaluated: 44 (14.4%) did not qualify after chart review (e.g., they already had diabetes, were not prediabetic, or were out of network), 124 (40.7%) were unable to be reached (13 did not have a working phone, 23 had no voicemail, 88 did not return calls) and 137 (44.9%) patients were reached. Of those 137, 26 (19.0%) were unaware that their provider had referred them or were not interested while 111 (81.0%) were interested. Ten of those patients were not ready for the full DPP and chose DEEP. The remaining 101 patients completed the intake process, passed a readiness assessment and chose to enroll in a DPP: 25 (24.8%) chose a digital DPP and 76 (75.2%) an in-person DPP with a nonsignificant trend towards a preference for a digital DPP by younger patients. Thus, of 305 initial referrals less than half (36.4%) were successfully enrolled. The primary challenge was difficulty reaching and engaging patients. Potential strategies to improve patient yield include better education of referring providers on initial readiness assessments, DPP eligibility, and the importance of a good contact number. Measuring weight loss outcomes in these patients will be crucial.

Disclosure

S. Kim: None. A.H. Tang: None. C. Kuo: None. R.S. Garcia: None. S. Kim: None. E. Murphy: None.
708-P: Effectiveness of CHO-Counting on Glycometabolic Control and Comparison between the Methods of I/CHO Ratio Calculation in Subjects with Cystic Fibrosis-Related Diabetes (CFRD)
Authors: GRANCINI VALERIA , GAGLIO ALESSIA , RESI VERONICA , PALMIERI EVA , ORSI EMANUELA
Published: June 2019

DM is a complication of cystic fibrosis and it’s caused mainly by insulin deficiency. A glycometabolic decompensation, due to incorrect therapeutic management, leads to a worsening of the catabolic state (already caused by malabsorption and high metabolic requests, and a known risk factor for worsening of respiratory function). The therapy for CFRD is insulin. Cho-counting, an effective technique to manage insulin therapy in T1DM subjects, allows patients to achieve a better glycemic control.

Aim: to evaluate the efficacy of cho-counting in patients with CFRD on glycemic control.

Materials and Methods: 21 patients with CFRD, randomized in 2 groups. gr.1: 9 patients performing cho-counting; gr.2: 12 patients followed according to ambulatory standard care. Glycometabolic control was evaluated with: a. variation of HbA1c, b. variation of pre and postprandial average SMBG in a period of 12 months. In group 1, the I/CHO ratio obtained with the 500-formula was compared with those obtained from food and glucose diaries.

Results: gr.1 showed a reduction of HbA1c, compared to gr. 2 (7.4 ± 0.9% to 6.6 ± 0.3%, Δ -0.8% vs. 7.4 ± 1.5% to 7.5 ± 1.4%, Δ + 0.1%, P <0.05). There was also an improvement, even if not significant, in gr.1 and a worsening (p <0.05 for post) in gr.2, of pre and post-prandial average SMBG. In gr.1, the I/CHO ratio obtained through the 500-formula was 1/20. Based on diaries, it was 1/18 for breakfast, 1/25 for lunch and 1/25 for dinner.

Conclusions: Cho-counting is effective in improving glycometabolic control in individuals with CFRD, avoiding the risk to worsen the already delicate metabolic balance of these patients. The use of dietary and glycemic diaries allows to estimate the I/CHO ratio differentiating the insulin needs during the day. This allows a more accurate personalization of the therapy compared to the use of 500-formula, which, in these patients, often overestimate the need for insulin at meals.

Disclosure

V. Grancini: Board Member; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Merck Sharp & Dohme Corp. A. Gaglio: Consultant; Self; Roche Diabetes Care. V. Resi: Speaker's Bureau; Self; Sanofi. E. Palmieri: Speaker's Bureau; Self; Eli Lilly and Company. E. Orsi: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis.
709-P: The Use of Advanced Learning Formats and Partnerships to Enhance CME and Diabetes Care
Authors: HOSMER-GALLO CHRISTINA , WELCH LAUREN K. , HEFELE BROOKE
Published: June 2019

In 2018, Med Learning Group (MLG) launched the THRIVE initiative, a large-scale, multi-faceted continuing medical education series in glycemic control that incorporates a variety of live and online educational activities/tools for enriched comprehension and engagement. This programming included partners such as ADA chapters, AAFP, Pack Health, Health Resources and Services Administration, Public Health Foundation, and the Hypoglycemia Support Foundation to further enhance content and offer an opportunity for long lasting impact on diabetes care. The series launched 3 national summit meetings with expert and local faculty and 25 grand rounds with chart audits in community-based practices/hospitals throughout the country showing improvements in both knowledge and competence. An online enduring program was created to further extend the impact. THRIVE includes unique and innovative tools to enhance the learning experience, facilitate continuous learning and translation into practice, and encourage patient education and dialogue. These included:

App/Mobile website: Features quickly downloadable materials and links to published articles and patient and provider tool kits.

iPads: Facilitate Q and A during live sessions and allow participants to engage in the lecture.

ADA materials: Provided local patient support information to participants.

Chart Audit: Occurred in institutions to identify gaps in care and highlighted change.

Personalized Posters: Choose a variety of images to design unique office posters.

Health advisors: Pack Health provided patients personalized health coaching.

The combination of advanced technology, diverse partnerships, and variety of educational channels ensures a robust delivery and distribution network. CME can advance the conversion of knowledge into practice while also having a visible impact on HCP-patient dialogue. THRIVE outcomes demonstrate how CME creates space for collaboration and partnership among HCPs, patients, and support groups.

Disclosure

C. Hosmer-Gallo: None. L.K. Welch: None. B. Hefele: None.

Funding

Novo Nordisk