bluuebunny/crossref_metadata_2025 huggingface dataset:
608-P: Carbohydrate Intake, Glycemic Control, and Cardiometabolic Risk Factors in Type 1 Diabetes—A Systematic Review and Meta-regression
Authors: KOUTNIK ANDREW P. , WOOD THOMAS , STOROSCHUK KRISTI , LENNERZ BELINDA S.
Published: June 2024

The relationship between carbohydrate intake and cardiometabolic risk remains controversial in people with type 1 diabetes (T1D). In a systematic review of dietary carbohydrate (CHO) content [ranging from very-low (<10% of daily caloric intake) to high (≥45%kcal)], we performed a linear spline meta-regression on glycemic control, total daily insulin dose (TDD), and blood lipids. Inclusion was met by 101 studies with 45,972 participants (54% female, 45% pediatric). CHO intake was non-linearly associated with HbA1c (Figure 1) and TDD. Below the knot of 225 g CHO/day (mean intake), CHO intake was positively associated with HbA1c (+0.52% per 50 g, p<0.001) and TDD (+0.12 IU/kg/day per 50 g, p<0.001). Above the knot, CHO intake was positively associated with higher standard deviation on continuous glucose monitoring (+11.6 mg/dL per 50 g, p=0.031), but not associated with HbA1c or TDD. CHO intake was not associated with LDL-C, HDL-C or triglycerides. The ADA target of HbA1c <7% was achieved in 10% of high-, 24% of moderate- (26-44%kcal), 78% of low- (10-25%kcal), and 100% of very-low-CHO studies (p<0.001). In summary, lower CHO intake was associated with improved glycemic control, without - unlike previously described - altering blood lipids. While observational in nature, these findings suggest that dietary CHO reduction may help reduce cardiometabolic risk in T1D.

Disclosure

A.P. Koutnik: Advisory Panel; Simply Good Foods, Nutrishus Brands. T. Wood: None. K. Storoschuk: None. B.S. Lennerz: None.

Funding

NIH NIDDK (R01DK135884, K23DK119546, R03DK123541)
619-P: Oral Hygiene Practices Linked to Dietary Fiber and Essential Nutrients Intake and Glycemic Management in Type 2 Diabetes
Authors: SEKIGUCHI DAN , HARADA KAYO , MAEDA YASUTAKA , TAMURA AYUMI , MATSUMOTO MOTONOBU , ISHIKADO ATSUSHI , MINAMI MASAE
Published: June 2024

Introduction & Objective: In type 2 diabetes (T2D), dietary therapy focusing on high-fiber foods is recommended for better glycemic management. However, oral health issues like tooth loss disturb essential nutrient intake. This study investigates the relationship between oral hygiene, dietary intake, inflammation and glycemic markers in T2D.

Methods: The study involved 104 T2D outpatients with ≥15 natural teeth. We analyzed the association of questionnaire-based oral hygiene practices, tooth count (TC), nutrient intake (BDHQ) with clinical information (age, HbA1c, fasting glucose, TIR, BMI, insulin, HOMA-IR, UACR) and inflammation.

Results: Age 62.5 ± 9.7 years, 42% female, HbA1c 7.3 ± 0.7%, BMI 24.8 ± 4.6, number of teeth 25.0 ± 3.6, total dietary fiber 12.4 ± 6.0 g/day. TC positively correlated with green leafy vegetables, carrots/pumpkins, and carotenes intake. Participants with ≥24 teeth had higher fiber intake than those with fewer teeth. TC negatively correlated with age, and positively with dental visits, inversely with BMI, HbA1c, and fasting glucose. Tooth brushing frequency negatively correlated with male gender, BMI, UACR, hsCRP, and TNF-α. Frequent interdental cleaning correlated positively with TIR and negatively with male gender, BMI, insulin, HOMA-IR, hsCRP, IL-6, and TNF-α. Groups with frequent interdental cleaning or ≥20 teeth had lower CGM averages and higher TIR. Logistic regression showed interdental cleaning as significant for TIR <70%, independent of inflammation.

Conclusion: Reduced oral health in T2D is linked to insufficient dietary fiber intake. Interdental cleaning habits significantly impact glycemic variability and inflammation, suggesting the importance of oral hygiene in glycemic management.

Disclosure

D. Sekiguchi: None. K. Harada: Employee; Sunstar Inc. Y. Maeda: Speaker's Bureau; Sanofi, Abbott Japan Co., Ltd., Terumo Corporation, Novo Nordisk. A. Tamura: None. M. Matsumoto: Employee; SUNSTAR Inc. A. Ishikado: Employee; Sunstar Inc. M. Minami: None.
621-P: A First Glimpse into the Usual Dietary Intake of Older Adults with Type 1 Diabetes (T1D)
Authors: CRISTELLO SARTEAU ANGELICA , GOPISETTY NIKHITA R. , SPRINKLES JESSICA , ERCOLINO GABRIELLA , FRUIK ANGELA , QU XIAORUI , MAYER-DAVIS ELIZABETH J. , KAHKOSKA ANNA
Published: June 2024

Introduction & Objective: We characterized dietary intake of older adults with T1D as a first step towards developing interventions and informing guidelines in this growing and understudied population.

Methods: Older adults (≥65 years) with T1D recruited through a university-affiliated hospital system completed an online survey (Sept-Nov 2023) that included the 30 item dietary screener questionnaire (DSQ). We calculated sex-stratified (M/F) mean and median intakes of dietary factors relevant to United States dietary guidelines and predicted probabilities of sub-optimal intakes based on guideline targets.

Results: The DSQ was completed by 77 older adults (age 71.3 ± 4.1 yrs, 45.5% male, 93.5% non-Hispanic White) with T1D (duration 33.5± 18.1 yrs, Hba1c 6.8 ± 1.1%). Probabilities of sub-optimal intake across almost all dietary factors were greater among females, including over twice the probability of low calcium and fiber intake (Table 1).

Conclusion: This is the first study to characterize dietary intake of older adults with T1D relative to national guidelines. We noted sub-optimal intakes of key nutrient groups in our overall sample. Females may be at higher risk than males. Further studies should characterize intakes alongside diabetes behaviors. Unpacking the reasons and clinical significance of these estimates is also essential to inform population-specific interventions and clinical guidance.

Disclosure

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

Funding

K12TR004416
623-P: Remission of Type 2 Diabetes by Low-Calorie Meal Replacement and Real Food–Based Diets—A Six-Month Pilot Intervention in China
Authors: ZHONG VICTOR W. , WANG SUJING , LIU YANG , FENG NANNAN , WANG JIE , DU XIHAO , XU YAQING , TAO FENG
Published: June 2024

Objective: To determine the feasibility of achieving type 2 diabetes (T2D) remission by low calorie meal replacement diet (LCMRD) and real food-based diet (LCRFD) in Chinese people with T2D.

Methods: This 6-month intervention consisted of a 3-month isocaloric intensive weight loss phase (815-835 kcal/d) and a 3-month weight maintenance phase (supervised transition to normal diet). Enrolled patients with T2D had BMI 24-45 kg/m2 and (HbA1c 6.5-12.0% or taking diabetes drugs). Everyone stopped diabetes drugs on day 1 and were non-randomly assigned to receive LCMRD (n=21) or LCRFD (n=20). Both diets had similar macronutrient compositions. LCMRD used Quaker’s Smart Calories. LCRFD was prepared by central kitchen daily. The primary outcomes were weight loss and T2D remission (HbA1c <6.5%, no drugs for ≥3 months). Intention to treat analysis was performed.

Results: The 41 participants had a mean age of 40.4 years, BMI of 29.8 kg/m2, HbA1c of 8.0% and diabetes duration of 2.7 years. Three people in LCMRD and 6 in LCRFD quit the intervention. At 6 months, the mean ± SD weight loss was 10.2 ± 8.0 kg in the LCMRD group and 8.9 ± 4.6 kg in the LCRFD group (P <0.001); ~80% of lost weight were fat mass in both groups. T2D remission rate was 62% in LCMRD and 50% in LCRFD. In those with ≥10% weight loss, T2D remission rate was 75% in both groups. Insulin sensitivity assessed by insulin tolerance test improved (P <0.001) whereas insulin secretory capacity assessed by arginine stimulation test did not change, in both groups. Significant improvement in cardiometabolic risk profiles were seen including blood pressure, serum lipids, inflammatory markers, among many other factors (all P <0.05). The most common adverse events were constipation and fatigue. No serious adverse event related to the intervention was reported.

Conclusion: Both LCMRD and LCRFD reduced weight effectively, led to T2D remission in the majority, were feasible, and appeared safe in Chinese people with T2D and overweight/obesity.

Disclosure

V.W. Zhong: None. S. Wang: None. Y. Liu: None. N. Feng: None. J. Wang: None. X. Du: None. Y. Xu: None. F. Tao: None.

Funding

National Natural Science Foundation of China (82373551)
627-P: Prediabetes Reduction from Food Allergen Elimination—A Controlled Pilot Study
Authors: BUCK WILLIS F , FLINT BRONSON
Published: June 2024

Currently Diabetes affects over 500 million people, worldwide, and the expense of treating this disease exceeded $870 Billion US dollars. Diabetes Mellitus Type 2 (DM2) is comorbid with numerous other pathologies including obesity and hypertension. The objective of this 6-month controlled pilot study was to determine if food allergy elimination is effective in reducing the HbA1c values in Pre-diabetic (PDM) patents.

Methods: Twenty-four PDM subjects were enrolled in this study (5.7 - 6.4 HbA1c), obesity and hypertension were also seen in these subjects (N=24). All subjects received nutritional counseling and recommendations for aerobic exercise, (the current standard of care for PDM). The EXP subjects had blood drawn for ALCAT leukocyte reaction testing to identify sub-acute food allergens (N=250 foods). Food Allergens were eliminated (or exchanged) for the 6-month study’s duration. The dependent variables in this study will be change in HbA1c and BMI (Enrolment, 3 and 6 months). Differences were calculated using a repeated measures ANOVA.

Results: The preliminary results at 90 of 180 days revealed that the EXP subjects had a significant HbA1c reduction (mean -0.8), while the CON subjects showed increases in A1c (mean +0.7), (p < 0.0001). The EXP subjects also showed significant reductions in BMI (-1.1), Blood pressure (-20%). Fat Mass (-8 pounds), and waist circumference (-2”).

Conclusion: The purpose of this controlled 6-month pilot study was to determine if food allergy elimination is effective in reducing the HbA1c values in Pre-diabetic (PDM) patents, and that change was significant in the first 90 days. The next investigation will examine efficacy of this protocol in a 4-year, global, randomized controlled trial.

Disclosure

F. Willis: None. B. Flint: None.

Funding

Travel will be paid for by Cell Science Systems.
63-PUB: Diabetes Control and Complications in South India—Three-Year Results of LANDMARC Trial
Authors: THACKER HEMANT , PRASANNA KUMAR K.M. , DAS ASHOK K. , RAMANATHAN BALAMURUGAN , ASIRVATHAM ARTHUR K. , SHUNMUGAVELU MINAKSHISUNDARAM , MRUTHYUNJAYA MAHESH D. , SELVAN CHITRA , SUNDARAM VIVEK , PHILIP ELIZABETH , MENON SHALINI K. , GADEKAR ARVIND , CHODANKAR DEEPA
Published: June 2024

Glycemic control, therapy trends, and diabetes complications were evaluated in LANDMARC — a prospective observational 3-year (y) study (CTRI/2017/05/008452) of participants with T2D on ≥2 antihyperglycemic medications. This sub-analysis of 135 sites in South India (Bangalore, Chennai, Coimbatore, Hyderabad, Kerala, and Vijayawada) included 2354 participants (mean [SD] baseline [BL] age: 51.4 [9.2] y, T2D duration: 8.4 [5.5] y and A1C: 8.1% [1.6]). At BL, most were insulin-naïve (n=1665; 70.8%), mainly on OADs (n=1638; 69.6%). At 3 y, 1149 (57.8%) participants were on OADs only, while 806 (40.5%) were on insulin + OADs. Biguanides was the most prescribed drug class (BL: 2184/2353 [92.8%] and 3 y: 1853/1988 [93.2%]). Basal insulin usage increased from BL (n=335; 14.2%) to 3 y (n=465; 23.4%). A decrease in mean (SD) A1C (-0.6 [1.7] %), FPG (-18.0 [60.3] mg/dL), and PPG (-30.3 [81.5] mg/dL); and an increase in those with A1C<7% (BL: 414 [24.5%]; 3 y: 440 [30.1%]), was noted. MI and neuropathy were the most common macro and microvascular complications, respectively (Table). The rate of microvascular complications (n, %) was highest in South India (519, 22.1%) vs. West (252, 18.8%), North (243, 14.4%) and East (107, 12.7%) at 3 y. Hypertension and dyslipidemia were the most common CV risk factors. There is need to further evaluate diabetes management strategies employed in South India to achieve optimal glycemic control.

Disclosure

H. Thacker: Other Relationship; Merck Sharp & Dohme Corp., Novartis India, Sanofi. K. Kumar: None. A.K. Das: Other Relationship; Sanofi. B. Ramanathan: None. A.K. Asirvatham: None. M. Shunmugavelu: None. M.D. Mruthyunjaya: None. C. Selvan: None. V. Sundaram: None. E. Philip: Other Relationship; Sanofi, Novo Nordisk, Eris Lifesciences Ltd. Research Support; Sun Pharmaceutical Industries Ltd. S.K. Menon: Employee; Sanofi. A. Gadekar: None. D. Chodankar: Employee; Sanofi.

Funding

Sanofi
636-P: Disordered Eating and Glycemic Control among Youth with Type 2 Diabetes
Authors: KREYNIN ANNA , MANN ELIZABETH A. , FENSKE RACHEL
Published: June 2024

Introduction and Objective: Disordered eating (DE) has been associated with poorer glycemic control among youth with Type 2 diabetes (T2D). Screening may help identify patients at risk for DE. We sought to determine whether screening positive for DE was associated with a significant difference in average HbA1c compared to screening negative for DE among youth with T2D.

Methods: A retrospective chart review of youth with T2D receiving care at a pediatric diabetes clinic was completed. Demographic information, DE screening results, and HbA1c were collected for all visits occurring between October 2020 and September 2023. Registered Dietitians (RDs) used a 4-item modified version of the Screen for Disordered Eating (SDE), with the goal of screening all youth aged 12 and older with T2D once per year. Mean HbA1c between groups were compared using t-tests.

Results: Of the 59 screened, 39.0% (n=23) reported a positive screen (2 or more positive responses) and 61.0% (n = 36) reported a negative screen. Those who screened positive had an average HbA1c of 7.9 (+/- 2.5) and those who screened negative had an average HbA1c of 8.4 (+/- 2.5; p = 0.50). Demographic information is presented in Table 1.

Conclusion: Among a diverse sample of youth with T2D, more than one-third of screened patients were positive on a DE questionnaire. Screening positive for DE was not associated with a significant difference in average HbA1c compared to screening negative for DE.

Disclosure

A. Kreynin: None. E.A. Mann: None. R. Fenske: None.
64-PUB: Risk of Complications in Type 2 Diabetes Mellitus with Increase in Disease Duration—A Report of Real-World Data of Indian Population
Authors: SESHADRI KRISHNA , POLISETTI SUBHADRA , TIPPISETTY SUREKHA , KRISHNA KOLUKULA VAMSI
Published: June 2024

Introduction: T2DM is a progressive disease characterized by worsening of not only β cell function but also an increased risk of complications with time.

Methods: In this real world single center study we did a cross sectional analysis of patients to evaluate common markers of diabetes complications based on the duration of diabetes (DoD). Total 3330 patients were identified who had sufficient information to qualify for the study. Patients were categorized as duration of <1; 1 - <5; 5 - 10 and >10 years of diabetes (self-reported). BMI, waist circumference (WC), HbA1C, eGFR, UACR, FIB4 score and NT proBNP were collected.

Results: In 3330 T2DM patients, male and female were 1762 (53%) and 1568 (47%). Mean DoD was 7.6 years, age 45 years, HbA1c 8.3%, BMI 27.6 Kg/m2, WC 97.6 cms, NT proBNP 153 pg/mL and FIB4 1.34, eGFR 91 mL/min/1.73m2. A progressive increase in mean HbA1c 7.8% to 8.7%, NT proBNP 117 to 220 pg/mL, FIB4 score 1.15 to 1.48 and WC 97.9 to 97.2 cms for duration < 1 to >10 years was noted. eGFR declined from 94 to 86 mL/min/1.73m2 over same duration. Oral medication differed significantly from 70% to 41%, while injectable increased from 30% to 59%. Similarly, NT ProBNP (n=275), risk of heart failure increased from 37% to 45%; FIB4 score (n=802), at indeterminant and high risk of NAFLD significantly increased (p<0.01) from 29% to 38% and 2% to 9%, respectively. eGFR level (n=1134) at mild to moderate and severe risk significantly increased from 44% to 53% and 2% to 20%, respectively.

Conclusion: Our study documents the duration associated decline in various markers of diabetes complications from a single center in India. Of note, this is one of the first studies to document the effect of duration on FIB4, NT proBNP and eGFR from this part of the world. An arbitrary 10-year mark seems to segregate significant deterioration of functional markers when compared to those with early disease. The effects of medication on delaying the progression of complications need to be considered in further analysis.

Disclosure

K. Seshadri: None. S. Polisetti: None. S. Tippisetty: None. V. Kolukula: None.
645-P: Feasibility of Kanasina Gulabi, a Peer Support Intervention for Young Adults with Type 2 Diabetes in Mysore, India
Authors: GOPISETTY NIKHITA R. , MURALIDHAR KIRANMAYEE , NINGAIAH NAGALAMBIKA , KARNAM RAGHAVI , CHINNAPPA RANI , JAYAKRISHNA POORNIMA , ARIELY SUMEDHA , PUFFER EVE S. , MADHIVANAN PURNIMA
Published: June 2024

Introduction & Objective: To address the knowledge gap and emotional burden in young adults with type 2 diabetes (T2D), we designed a four-week education and goal-based peer support intervention, Kanasina Gulabi (Kannada: My Dream Rose), implemented in Mysore, India between June and July 2023.

Methods: The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to assess feasibility. Peer navigators (n=3, mean age: 33 years) were recruited from the community and trained to deliver the intervention. Twenty-eight adults ≤ 40 years of age with T2D were recruited and quasi-randomly allocated to the intervention group (n=14, mean age: 33 years) or the control group (n=14, mean age: 33 years). Hemoglobin A1c, T2D knowledge, diabetes distress, diabetes-related stigma, depression severity, and optimism were assessed at baseline, immediately after the intervention, and at the 2-month follow-up. Attendance, fidelity, and acceptability were also assessed.

Results: Intervention participants expressed high satisfaction with Kanasina Gulabi and expressed gratitude for the guided knowledge and mentorship from their peer navigators. Participants displayed excellent attendance and adherence, with an average of 5 hours of Kanasina Gulabi exposure over 4 weeks. Peer navigators delivered the intervention with 100% fidelity. Results showed reductions in diabetes distress (Intervention: 30.9%, Control: 6.5%), diabetes-related stigma (Intervention: 25.3%, Control: 14.5%), and depression severity (Intervention: 58.3%, Control: 38.5%). Both groups presented an increase in T2D knowledge (Intervention: 19.7%, Control: 25.2%).

Conclusion: Implementing Kanasina Gulabi in Mysore is feasible and acceptable, with intervention participants showing more positive changes on multiple psychosocial outcomes compared to the control group. Results support a full trial to evaluate its effectiveness and sustainability in young adults with T2D.

Disclosure

N.R. Gopisetty: None. K. Muralidhar: None. N. Ningaiah: None. R. Karnam: None. R. Chinnappa: None. P. Jayakrishna: None. S. Ariely: None. E.S. Puffer: None. P. Madhivanan: None.
65-PUB: Relationship between Dietary and Metabolic Control in Patients with DM in Guangdong Province
Authors: CHEN XUANRONG , JIANG WEI , XIONG FEI , YANG LI , XU WEN , ZENG LONGYI , CHINA NATIONAL DIABETIC CHRONIC COMPLICATIONSSTUDY GROUP THE
Published: June 2024

Objective: This subanalysis of a cross-sectional, nationwide study was conducted to assess the dietary status and the relationship between dietary and metabolic control in patients with DM in Guangdong Province.

Methods: Data of 1623 residents with DM (48.2% male, average HbA1c: 7.6%, average calorie intake: 1869 kcal/day) in Guangdong aged 18-74 years were included. Participants were asked to finish the questionnaires including the information of consumption of different food components. Blood glucose, HbA1c, lipids, and uric acid were also measured.

Results: Among all subjects, 55.5% had hypertension, 92.7% had dyslipidemia. And 46.6% of the subjects were with HbA1c<7%, 35.7% with blood pressure<130/80mmHg, and 7.1% met blood lipid control target. Only 1.7% of the subjects met all three above metabolic targets. The consumption of vegetables and livestock meat in urban areas was lower significantly, while the other food components were higher significantly in urban areas than those in rural areas. As shown in Table 1, the consumptions of food components were significantly different between subjects with optimal glycemic control, achieving LDL-C target, or with normal uric acid levels and those with poor metabolic control.

Conclusion: The metabolic control in patients with DM in Guangdong Province was still unsatisfactory. The consumption of different food components may affect the metabolic status.

Disclosure

X. Chen: None. W. Jiang: None. F. Xiong: None. L. Yang: None. W. Xu: None. L. Zeng: None.
655-P: Realizing the Hidden Emotional Burden—Systematic Detection of Diabetes Distress in Adults with Type 1 Diabetes in Routine Consultations
Authors: STENOV VIBEKE , CHRISTENSEN JETTE N. , DUE-CHRISTENSEN METTE , CLEAL BRYAN
Published: June 2024

It is estimated that up to 40 % of people with type 1 diabetes (PWT1D) experience diabetes distress (DD) resulting in decreased quality of life and increased HbA1c. Aligned with international guidelines recommending annual DD screening in PWT1D, this study aimed to pilot test methods for nurses to systematically detect and address DD in routine consultations.

The pilot test involved 30 consultations incorporating: 1) DD screening using a validated short-form measure, the Type 1 Diabetes Distress Scale-7, capturing the most common sources of DD, 2) test of a dialogue tool supporting nurses in addressing DD, 3) semi-structured interviews with 30 PWT1D after DD screening, 4) post-consultation evaluation questionnaires for nurses. Interviews were analyzed using thematic text condensation and descriptive statistics were used for questionnaires.

The mean age and diabetes duration of PWT1D were 47 and 26 years, respectively. Fifteen participants were women. Of the 30 participants included, 53% of participants reported moderate to high DD. All PWT1D expressed very high satisfaction with discussing psychological aspects of diabetes in consultations. Analysis of interviews revealed three themes: 1) detecting sources of DD framed and structured content of crucial conversations, 2) addressing DD revealed a hidden mental burden, and 3) engaging in discussions about DD enhanced emotional well-being. Approximately 80% of the nurses reported successful dialogue about DD and 71% found the screening and dialogue tool to be a good conversation starter.

This study showed that methods for systematically detecting and addressing DD in clinical settings were useful and acceptable. Future research should explore methods for upscaling and implementing DD screening tools, ensuring a widespread and systematic approach to detect PWT1D with DD in consultations and referring to relevant treatments reducing DD in PWT1D.

Disclosure

V. Stenov: None. J.N. Christensen: None. M. Due-Christensen: Stock/Shareholder; Novo Nordisk A/S. Research Support; Novo Nordisk Foundation. B. Cleal: None.

Funding

The Juvenile Diabetes Research Foundation (201309274): Novo Nordisk Foundation (0079851)
656-P: Adapting a Personalized Text Messaging Intervention to Improve Diabetes Medication Adherence in a Spanish-Speaking Population
Authors: SEIGLIE JACQUELINE A. , TOBOLSKY SETH , CRESPO TREVINO RICAURTE , JANE CROMER SARA , MEDINA BAEZ ARANTXA , CALVERLEY MELISSA M. , LARKIN MARY E. , WEXLER DEBORAH J. , MAYBERRY LINDSAY S.
Published: June 2024

Introduction & Objective: Medication non-adherence is a key modifiable contributor to suboptimal glycemic management among Latino adults with type 2 diabetes, but tools that address commonly reported barriers to diabetes medication adherence in this population are lacking. REACH is a text messaging platform based on the Information-Motivation-Behavioral skills (IMB) model that addresses barriers to adherence and can improve both adherence and HbA1c but is only available in English. We aimed to identify barriers to diabetes medication adherence among Latino adults with type 2 diabetes to adapt REACH to REACH-Español.

Methods: Latino adults with type 2 diabetes were invited to participate in focus groups. First, we did a free listing discussion of barriers to diabetes medication adherence, then asked participants to rank 40 barriers to diabetes medication adherence according to personal relevance (“never,” ”sometimes,” or “always”). We identified the most prevalent barriers and categorized them according to the IMB model.

Results: A total of 18 participants attended one of three focus groups. Mean age was 63.3 years and 55.0% were female. Mean HbA1c was 8.3% and mean diabetes duration was 21 years. Among the top five barriers, 80% corresponded to the Information domain: brand medication better than generic, don’t understand purpose of diabetes medication, don’t understand dose changes, and doubt that medications will improve diabetes control or prevent complications.

Conclusions: Diabetes medication adherence barriers that relate to information gaps are common in this population and can inform tailored text messaging for this intervention to reduce barriers to adherence.

Disclosure

J.A. Seiglie: Consultant; BDMT Global, Techspert.io. S. Tobolsky: None. R. Crespo Trevino: None. S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. A. Medina Baez: None. M.M. Calverley: None. M.E. Larkin: None. D.J. Wexler: Other Relationship; Novo Nordisk. L.S. Mayberry: Consultant; Cecelia Health. Research Support; Hemsley Charitable Trust.

Funding

NIH/NIDDK (K23DK135798) MGH Physician Scientist Development Award
657-P: Association between Sleep and Glycemic Variability in People with Type 2 Diabetes in Real-Life Setting
Authors: YUAN JINJIN , WANG JINLE , WANG YUEYING , LIU FAN , ZHANG JIAHUI , ZHU BINGQIAN
Published: June 2024

Objective: Glucose variability (GV) is an important indicator for glycemic control. This study aimed to investigate the association between sleep and GV among people with T2D.

Methods: A correlational design was used. Data were collected during 7 days in real-life setting. Sleep and GV were assessed simultaneously using Actigraphy and CGM. Sleep parameters were derived from Actigraphy using default algorithm. GV was quantified as standard deviation (SD) and coefficient of variation (CV) of glucose, percentage of time in range (TIR), time above range (TAR), time below range (TBR), mean amplitude of glycemic excursion (MAGE) during rest interval at night. Associations were examined using linear mixed-effect models.

Results: Fifty participants (60.1 years, 27 females) were recruited and 295-night data were analyzed. Controlling for covariates, longer wake after sleep onset was associated with higher SD, CV, and MAGE (coefficient=0.003, p=0.023; coefficient=0.001, p=0.002; coefficient=0.009, p=0.006), and lower TIR (coefficient=-0.001, p=0.049). Higher sleep efficiency was associated with lower SD, CV, MAGE, and TAR (coefficient=-1.003, p=0.049; coefficient=-0.174, p=0.005; coefficient=-3.758, p=0.012; coefficient=-0.396, p=0.031), and higher TIR (coefficient=0.437, p=0.020). Higher sleep fragmentation index was associated with higher TAR (coefficient=0.002, p=0.045). Earlier sleep timing (sleep midpoint<4:00 am) compared to late sleep timing, was associated with lower nighttime TAR (coefficient=-0.092, p=0.017). Shorter sleep duration (<8h) compared to longer, was associated with lower SD and MAGE (coefficient=-0.609, p<0.001; coefficient=-1.624, p<0.001).

Conclusions: At the individual level, better sleep is associated with lower GV, supporting the importance of sleep in optimizing glycemic control. Interventional studies are needed to reveal the causal relationship.

Disclosure

J. Yuan: None. J. Wang: None. Y. Wang: None. F. Liu: None. J. Zhang: None. B. Zhu: None.

Funding

National Natural Science Foundation of China (71904119)
659-P: Racial and Ethnic Differences in Risky Behavior and Sedentation among Young Adults with Diabetes
Authors: JACOBS MOLLY M. , BURCH ASHLEY
Published: June 2024

Background: A healthy lifestyle plays a key role in managing diabetes and limiting long-run complications. Using a nationally representative panel data set of youth and young adults, this study examined racial and ethnic differences in risky behaviors (smoking, alcohol consumption, marijuana use, sexual activity, fast food consumption) and sedentation (hours of television, exercise frequency) among respondents aged 18 to 43 with diabetes.

Methods: Among the 12,300 respondents in Waves III (2001-02), IV (2008-09), and V (2016-18) of the National Longitudinal Study of Adolescent to Adult Health (ADD Health), 780 (6.34%) had been diagnosed with diabetes. Stratified, mixed effects regression models assessed racial and ethnic differences in risky behavior and sedentation accounting for heterogeneity in age, sex, income, region of residence, education, and health insurance. Odds ratios and marginal effects quantified the comparative differentials between groups.

Results: The sample of young adults with diabetes was 39.51% male and 60.49% female and composed of 61.28% White, 22.24% Black, 3.36% other racial groups, and 12.85% Hispanic. Respondents ranged in age from 18-27 (Wave III), 25-34 (Wave IV), and 33-43 (Wave IV). Relative to Whites, Blacks reported smoking cigarettes 4.32 (SE=1.01) less days per month and were less likely to use marijuana (OR=0.41, CI=0.35, 0.48), but were significantly more likely to use alcohol (OR=1.53, CI=1.21, 1.86) and consume fast food (OR=1.76, CI=1.45, 2.05). Other racial groups, compared to Whites, were more likely to exercise (1.25, CI=1.01, 1.50), while Hispanics watched an average of 5.37 (SE=5.46) more hours of television each week.

Conclusions: Results suggest racial and ethnic differences in risky behavior patterns among young adults with diabetes which may explain differences in later-life complications and mortality.

Disclosure

M.M. Jacobs: None. A. Burch: None.
666-P: CGMs, Pumps, and Insulin Pen Access Assessment of Pediatric Type 1 Diabetes Population at a Southeastern Academic Medical Center
Authors: HALL MEGAN , RODRIGUEZ CARLA , MALONEY MADISON G. , GONDER-FREDERICK LINDA
Published: June 2024

Introduction & Objective: Academic medical centers have identified disparities in access to diabetes technology among adults but pediatric population access is understudied. This analysis performed a self-assessment of potential inequities in access to diabetes technology at this medical center, including CGMs, insulin pumps, and insulin pens for pediatric patients.

Methods: This study analyzed deidentified EMR data using multivariable logistic regressions to determine the association of social determinants (age, sex, race-ethnicity, insurance, and neighborhood socioeconomic disadvantage) with technology use among pediatric patients (ages ≤18) with T1D.

Results: Of 332 patients with T1D seen at UVA Health in 2022, 229 accessed CGMs, 57 used pumps, and 115 used insulin pens. For CGMs, public insurance and uninsured status related to lesser use/access. Pens appear to be accessed more equitably. (See Figure 1.)

Conclusion: CGMs are by far the most utilized technology in this pediatric population, followed by pens. Barriers to pump usage in this population need to be better understood but this center's small sample size makes the extent of inequities in access unclear.

Disclosure

M. Hall: None. C. Rodriguez: None. M.G. Maloney: None. L. Gonder-Frederick: None.

Funding

Lomar Foundation
675-P: Relationship between Perceived Technology Burden and Diabetes Distress in Closed-Loop Control (CLC) System Use
Authors: GANJIARJENAKI MOHAMMADREZA , FERNANDES MOURA B BATISTA ANNANDA , GONDER-FREDERICK LINDA
Published: June 2024

The influence of CLC systems on quality-of-life factors is complex. This study investigates the dynamic relationship between diabetes distress and perceived technology burden in CLC users over a 26-wk period. The study utilized data from clinical trial NCT03563313, in which individuals with T1D used CLC systems. Diabetes distress and technology burden were assessed at three-time points: baseline (wk 0), mid-study (wk 13), and study end (wk 26). Cross-lagged panel models were tested in structural equations to explore the temporal dynamics between diabetes distress and technology burden throughout the research. The structural equation model shown in Figure 1 demonstrated a good fit to the data, with a non-significant chi-square (p = 0.18), Comparative Fit Index of 0.99, Tucker-Lewis Index of 0.98, and Root Mean Square Error of Approximation of 0.07. The model and significant autoregressive and cross-lagged paths indicate that increases in perceived technology burden are associated with subsequent increased diabetes distress. These results show that rising technology burden from CLC predicts higher diabetes distress, impacting life quality and CLC continuation.

Disclosure

M. Ganjiarjenaki: None. A. Fernandes Moura B Batista: None. L. Gonder-Frederick: None.
696-P: Women Benefit from Community-Based Peer Support for Diabetes Management in Shanghai, China
Authors: LIU YUEXING , CAI CHUN , WU XIAOYU , TANG PATRICK Y. , COUFAL MUCHIEH M. , SHEN LI , FISHER EDWIN B. , JIA WEIPING
Published: June 2024

Women face varied challenges in diabetes management. These call for examination of women’s responses to diabetes management and support programs. A community-based peer support program was implemented in 12 Intervention Communities (ICs) with 4 Comparison Communities (CCs) in Shanghai, China from 2019-2021.

Women constituted 56.8% of the sample in ICs but 46.4% in CCs (p = 0.003), indicating advantages of the program in recruiting women. Accordingly, all analyses controlled for variables associated with gender differences: age, diabetes duration, baseline BMI.

Analyses of clinical/quality of life changes controlled for corresponding baseline measures.At baseline, women had lower HbA1c (7.44% vs 7.63%) and FPG (7.74 vs 8.12 mmol/L), but slightly higher SBP (138.25 vs 136.12 mmHg). Women scored slightly higher on a four item measure of diabetes distress, (1.17 vs 1.15, range = 1-3) and on the PHQ8 measure of depressed mood (1.96 vs 1.33).

Among all participants (all ps ≤ 0.04), ICs exceeded CCs on beneficial changes in HbA1c (-0.06% vs. 0.22%) including among those with HbA1c ≥ 8% at baseline (-0.76% vs. -0.41%), FPG (-0.04 vs. 0.76 mmol/L), among those with FPG > 7 mmol/L at baseline (-0.54 vs. -0.06 mmol/L), and both diabetes distress (-0.07 vs. 0.06) and PHQ8 (-0.49 vs. 0.54).

Among women, ICs exceeded CCs for change in HbA1c (-0.12% vs. 0.15%), FPG (-0.15 vs. 1.12 mmol/L) and among those ≥ FPG 7 mmol/L at baseline (-0.74 vs. 0.39 mmol/L), and both diabetes distress (-0.06 vs. 0.11) and PHQ8 (-0.55 vs. 0.93) (all ps≤0.008). For men, ICs differed significantly from CCs for only two variables, less worsening for both HbA1c (0.02 vs. 0.28) and FPG (0.10 vs. 0.46) (ps ≤ 0.028).

Summarizing, women showed beneficial changes, including HbA1c, FPG, diabetes distress, and PHQ8. Community based peer support for diabetes management may offer both clinical and quality-of-life benefits for women, in spite of other biological and social challenges to diabetes and its management that women face.

Disclosure

Y. Liu: None. C. Cai: None. X. Wu: None. P.Y. Tang: None. M.M. Coufal: None. L. Shen: None. E.B. Fisher: None. W. Jia: None.

Funding

Shanghai Key Discipline of Public Health Grants Award No. GWVI-11.1-20, and Shanghai Municipal Grants Award No. GWIV-3.1 to Professor Weiping Jia as principal investigator, Shanghai Municipal Health Commission “Health Promotion Talent” grant No. JKKPYC-2022-12 to Dr. Yuexing Liu as principal investigator, and by grants from The Merck Foundation and from Sanofi China, both to Professor Edwin Fisher as principal investigator, and by the UNC-Michigan Community, Family, and Peer Support Core of the Michigan Center for Diabetes Translational Research, P30 DK092926.
7-PUB: Student-Led Initiative Addressing Health Care Gaps in South Carolina Free Medical Clinics
Authors: LUNT ANNABELLE , BECKER MADELINE E. , PARKER MARTINEZ O. , REESE MOLLIE
Published: June 2024

Introduction & Objective: Diabetes is a leading cause of death in South Carolina and disproportionally affects those of lower socioeconomic status. Medical Students Making Change (MSMC) is an initiative at the University of South Carolina that aims to improve lifestyle management and glycemic control in uninsured patients with diabetes. Via an innovative telehealth approach, this project provides patients guidance to address and identify health disparities affecting their chronic condition. We hypothesize that this intervention will significantly reduce hemoglobin A1c and improve patient confidence in managing their diabetes over a six-month period.

Methods: Patients with newly diagnosed or uncontrolled diabetes in two free medical clinics are paired with a medical student volunteer who follows them over the course of six months with biweekly telephone visits. Visits primarily focus on diabetic education, lifestyle goals, and barriers to care. Hemoglobin A1cs are obtained at enrollment, three months, and six months.

Results: Patient screening began in August 2023 and was performed regardless medical history of diabetes. Currently, 46 patients have been screened: 14 patients are enrolled with a baseline A1c of 10.3; 15 patients are not enrolled despite A1c values >6.5%; and 16 patients did not meet A1c requirements for enrollment. Patient barriers most identified included food insecurity, exercise ability, and lack of transportation.

Conclusion: Our initiative promotes longitudinal relationships allowing patients the education and resources needed to manage their diabetes. From our pilot study, we gained resources to increase monitoring for appropriate follow up A1cs and increase screening among all clinic patients regardless of medical history of diabetes. As the current results highlight the need for increased diabetic screening, the goal of this project is to make a significant impact on diabetes outcomes and reduce healthcare barriers for this vulnerable population.

Disclosure

A. Lunt: None. M.E. Becker: None. O. Martinez: None. M. Reese: None.
702-P: Prescription Medication Use for Treatment of Mental Health Conditions among Adults With and Without Diabetes, 1999–2020
Authors: RUTKOWSKI RACHEL E. , BULLARD KAI M. , ROLKA DEBORAH B.
Published: June 2024

Introduction & Objective: Mental health conditions, such as depression and anxiety, can adversely affect one’s quality of life. Prescription medication and other therapeutic measures are often needed for treatment. The purpose of this study is to estimate the prevalence and trends of psychotherapeutic medication use, and associated clinical and sociodemographic factors, among US adults with and without diabetes.

Methods: Data from 57,083 non-pregnant adults (≥20 years) in the 1999-March 2020 National Health and Nutrition Examination Survey were analyzed. Diabetes status was based on self-reported diagnosis or HbA1c level ≥6.5%. Prescriptions for anti-depressants, stimulants, anti-psychotics, anti-stimulants, anti-anxiety (anxiolytics, sedatives, and hypnotics), and psychotherapeutic combinations taken in the past 30 days were assessed with a medication container inventory and classified using the Lexicon Plus classification system. Predictive margin percentages and ratios with 95% confidence intervals were calculated from multivariable logistic regression models adjusted for age, race and ethnicity, sex, BMI, and time to assess the association of diabetes status and medication use.

Results: During 1999-March 2020, the covariate adjusted percentages of US adults reporting use of psychotherapeutic medications was 20.1% (95% CI: 18.8-21.5) for those with diabetes and 15.5% (95% CI: 14.9-16.2) for those without diabetes. The highest ratio of psychotherapeutic medication use among those with diabetes compared to those without was observed for stimulants (2.3, 95% CI: 1.8-2.9), followed by anti-depressants (1.6, 95% CI: 1.5-1.7), anti-psychotics (1.6, 95% CI: 1.3-1.9), and lastly anti-anxiety (1.3, 95% CI: 1.2-1.5).

Conclusion: Our study findings support an association of diabetes and mental health prescription drug usage. Adults with diabetes have higher observed prevalence of taking psychotherapeutic medications.

Disclosure

R.E. Rutkowski: None. K.M. Bullard: None. D.B. Rolka: None.
710-P: Social Determinants of Health (SDOH)—The Importance of Screening, Resource Delivery, and Follow-up
Authors: HOLLY SARAH L. , SEGAWA MAI , DEANNA LAUREN , VELASQUEZ ROXANNA E. , ROBERTS JASMINE , MAJIDI SHIDEH
Published: June 2024

Introduction: The significant transition that a family must undergo after a diabetes diagnosis can be particularly difficult for families facing other barriers and disparities. Patients with adverse SDOH may endure negative impacts to their diabetes care and management. Assessing and addressing these underlying determinants, particularly during new diagnosis, is critical to identifying barriers to care as early as possible and working towards equitable care. SDOH screening, resource delivery, and follow-up were established in a large academic center.

Methods: A literature review of SDOH screens was conducted with subsequent edits by the diabetes social workers (SW). The screen targets 10 domains of SDOH and is administered by the SW to caregivers at time of diabetes diagnosis. Caregivers who identify a barrier(s) are provided with a list of tailored resources by the SW. One week after resources are provided, the diabetes health coach (HC) checks in via phone to assess resource utilization and/or if additional help is needed.

Results: Thirty SDOH screens have been completed to date with 11 caregivers identifying a barrier(s). Twenty-six total barriers were identified across all domains with 22 subsequent resources provided. Food insecurity and mental health were among the most identified SDOH barriers. The HC assessed resource utilization and/or provided additional assistance to 9 of the 11 caregivers. All 9 caregivers reported successful utilization of the SDOH resource(s).

Conclusions: Health disparities in care must be and can be addressed as early as diagnosis so proper care, resources, and follow-up can be put in place to meet the needs of families and improve diabetes outcomes. The combination of a comprehensive set of SDOH resources and supportive follow-up is necessary to offsetting disparities. Further expansion of this initiative will include periodic screening beyond the time of diagnosis, continued resource follow-up, and impact evaluation on diabetes outcomes.

Disclosure

S.L. Holly: None. M. Segawa: None. L. DeAnna: None. R.E. Velasquez: None. J. Roberts: None. S. Majidi: Other Relationship; Sanofi.

Funding

CareFirst
722-P: One Year Real-World Evidence of Effectiveness of Carbohydrate-Restricted Nutrition Therapy in Adults with Prediabetes across Age Groups and Gender
Authors: ROBERTS CAROLINE G.P. , ADAMS REBECCA N. , ATHINARAYANAN SHAMINIE J. , VOLK BRITTANIE M. , ZOLLER ALISON R. , MCKENZIE AMY L.
Published: June 2024

Prediabetes (preD) affects 38% of US adults with a higher prevalence in men than women and a growing presence among younger adults. Virta Health provides carbohydrate restricted nutrition therapy (CRNT) through continuous remote care (CRC) to US adults with preD, but the impact of the program across age and gender groups is unknown. This retrospective real-world study assessed differences in health marker change over one year between age groups, and secondarily between genders, with linear mixed effects models. One year retention was high across age groups (65%, 76%, 75%; ages 18-44, 45-64, 65+) and gender (74% male, 72% female), and a random sample (N=750) of patients enrolled one year was selected for this analysis. Broadly, all age groups and both genders improve multiple health markers over time (weight, A1c, triglycerides, HDLc, liver enzymes) with no or minimal change in Total Cholesterol, LDLc, and aspartate aminotransferase, and with few differences between groups. These results provide real-world evidence that CRNT favorably impacts glycemia, cardiometabolic health, and hepatic function in adults with prediabetes across age groups and in both men and women.

Disclosure

C.G.P. Roberts: Other Relationship; Virta Health Corp. R.N. Adams: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S.J. Athinarayanan: Employee; Virta Health Corp. B.M. Volk: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. A.R. Zoller: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. A.L. McKenzie: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. Employee; Abbott.
723-P: "One Size Does Not Fit All” among Church-Based Black Adult Diabetes Prevention Program Participants
Authors: WILLIAMS LOVORIA B. , KAY RAYENS MARY , GUSTAFSON ALISON A. , KARLE ERIKA , MOSER DEBRA K.
Published: June 2024

Black adults bear disproportionate obesity and Type 2 Diabetes.Group-based translation of the Diabetes Prevention Program is the gold standard with Black participants in these interventions having the lowest weight loss. Weight loss in the early intervention weeks predicts post-treatment outcomes. One limitation of these group-based interventions is that all receive the same treatment without personalized attention to those needing more support. We examined the weight loss effects of adding telephone motivational-interviewing (MI) sessions for Nonresponders (4-wk loss ≤ 1%) to their DPP intervention. Through a cluster randomized community based participatory design among Black churches, 216 participants received 18 group-based classes over 24 weeks delivered by trained Community Health Workers. Nonresponders in both intervention and control groups were identified with those in the intervention group receiving an additional weekly telephone MI session by CHWs to develop personalized strategies to overcome barriers to weight loss. Participants were 55 years (SD=11) with mean weight 234lbs (SD=53). Repeated measures mixed modeling evaluated the percent weight change from baseline to weeks 12 and 24, including class attendance as covariate, with separate models for Responders and Nonresponders. Significant effects in the Responder model (n=154) were time and classes attended (p<.001 for both). Among Nonresponders (n=62), significant effects were treatment group and classes attended (p .020 and.035, respectively). Nonresponders in the personalized telephone MI group achieved 2.7% weight loss compared to controls (0.3%). These results suggest that identifying potential Nonresponders early and adding personalized attention may enhance the effectiveness of group-based DPP programs.

Disclosure

L.B. Williams: None. M. Rayens: None. A.A. Gustafson: None. E. Karle: None. D.K. Moser: None.

Funding

National Institutes of Health (DK125801)