bluuebunny/crossref_metadata_2025 huggingface dataset:
424-P: Body-Weight Variability and Risk of Cardiovascular Outcomes in Type 1 Diabetes: Results from the DCCT/EDIC Studies
Authors: PETRIA IULIA , ALBUQUERQUE SAMUEL , VAROQUAUX GAEL , VIE JILL-JÊNN , VELHO GILBERTO , PERSEGHIN GIANLUCA , ROUSSEL RONAN , POTIER LOUIS
Published: May 2022

Cardiovascular (CV) complications are a major cause of morbimortality in long-standing type 1 diabetes (T1D) . Excessive weight gain has been associated with higher rates of CV events in the DCCT/EDIC studies. Moreover, fluctuation of body weight has emerged as an independent predictor of increased mortality and risk of CV outcomes, with evidence from the general population, from patients with coronary artery disease, and from patients with type 2 diabetes. We evaluated the association between weight fluctuation and CV events in patients with T1D from the DCCT/EDIC population.

Body-weight fluctuation was measured by the average successive variability (ASV: average absolute difference between successive values) over the 9-year period of the DCCT. The primary outcome was a composite of major adverse CV events (MACE: nonfatal myocardial infarctions or cerebrovascular events, CV deaths) occurring during the first 15 years of EDIC follow-up. The risk of outcomes during follow-up was analyzed using adjusted Cox models according to tertiles of ASV.

For the primary outcome, 1371 out of 1441 patients fulfilled the inclusion criteria for analysis [males: 52.41%, age: (37.53±6.82) years, mean HbA1c: (8.08±1.35) %, conventional/intensive treatment: 690/681 patients]. The cumulative incidence of MACE was 4.81%, 5.02%, and 6.58% for tertiles 1, 2, and 3, respectively (T1, T2, T3) (p=0.44) during (15.40±6.24) years of follow-up. Cox analysis adjusted for baseline EDIC characteristics (age, sex, treatment group) and time-dependent variables during DCCT (average BMI, CV risk factors, nephropathy) showed a hazard ratio (HR) for MACE of 1. (95% CI 0.58-1.92; p=0.85) for T2 and 1.34 (0.74-2.41; p=0.34) for T3, both compared to T1. For every increase of 1 standard deviation of ASV, the HR for MACE was 1. (0.86-1.42; p=0.44) .

Despite a trend for a positive association, body-weight fluctuation was not significantly associated with an increased risk of MACE in patients with T1D.

Disclosure

I.Petria: None. S.Albuquerque: None. G.Varoquaux: None. J.Vie: None. G.Velho: None. G.Perseghin: Advisory Panel; AstraZeneca, Lilly, Merck Sharp & Dohme Corp., Novo Nordisk, PIKDARE S.p.A., Sanofi. R.Roussel: None. L.Potier: Board Member; Boehringer Ingelheim International GmbH, Lilly, Novo Nordisk, Consultant; AstraZeneca, Sanofi.
432-P: Single and Joint Impact of Type 2 Diabetes and of Coronary Artery Disease on Albuminuria
Authors: MAECHLER MAXIMILIAN , SPRENGER LUKAS , MADER ARTHUR , LARCHER BARBARA , VONBANK ALEXANDER , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ , SAELY CHRISTOPH H.
Published: May 2022

Albuminuria is a characteristic feature of diabetic nephropathy, and increased urine albumin excretion is associated with an increased risk of coronary artery disease (CAD) . However, type 2 diabetes (T2DM) and CAD frequently coincide, and the single and joint effects of T2DM and angiographically determined CAD with albuminuria are unclear. This issue therefore was addressed in the present study. We investigated 831 patients with angiographically proven CAD, of whom 261 had T2DM (CAD+/T2DM+) and 570 did not have diabetes (CAD+/T2DM-) and 263 controls without CAD, of whom 63 had T2DM (CAD-/T2DM+) and 200 did not have diabetes (CAD-/T2DM-) . The albumin / creatinine ratio (ACR) was 37±1in CAD-/T2DM- patients. Compared to this group it was higher in CAD-/T2DM+ patients (193±642; p<0,001) , but not in CAD+/T2DM- patients (52±184; p=0,421) , in whom it was significantly lower than in CAD-/T2DM+ patients (p<0.001) . In CAD+/T2DM+ patients the ACR (162±466) was higher than in CAD-/T2DM- (p<0,001) and in CAD+/T2DM- patients (p<0,001) , but did not differ significantly to that in CAD-/T2DM+ patients (p=0,225) . In multivariate analysis of covariance, T2DM but not CAD proved to be an independent predictor of ACR after adjustment for age, sex, body mass index, LDL-C, smoking, hypertension and the use of ACE inhibitors /AT2-antagonists and statins (F=22.06; p<0.0 and F=0.520; p=0.471, respectively) . We conclude that T2DM but not CAD is an independent determinant of albuminuria.

Disclosure

M.Maechler: None. L.Sprenger: None. A.Mader: None. B.Larcher: None. A.Vonbank: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None. C.H.Saely: None.
448-P: Clinical Conversations Exchange: A Cardiologist-PCP Collaboration Discussing GLP-1 Receptor Agonists for Reducing Cardiovascular Risk in Patients with Diabetes
Authors: ALLEN RUSSIE , WELCH LAUREN K.
Published: May 2022

MLG is conducting a large-scale, Clinical Conversations Exchange series on type 2 diabetes (T2DM) inclusive of 25 case-based, collaborative workshops for cardiologists and primary care physicians (PCPs) . The education seeks to enhance HCPs ability to ability to determine the clinical implications of results from cardiovascular outcomes trials of GLP-1 receptor agonists; identify patients with T2DM who are most likely to benefit from the use of GLP-1 receptor agonists; personalize the selection of GLP-1 receptor agonists based on indications, guidelines recommendations and clinical data; and develop strategies for increasing collaboration between cardiologists and PCPs in managing cardiovascular risk in patients with T2DM. Despite being virtual, the meetings are conversational in nature, led by both a cardiologist and a PCP as faculty, and include discussions with active Q&A on specific patient scenarios. We have worked with our faculty to also develop a Clinical Conversations Exchange Treatment Simulator tool (available here) , an application that is accessible on desktop or mobile device through an internet browser, where users can quickly decide the best course of action for their T2DM patients. Learners can also download whiteboard animations on the MoA of treatments and patient-specific factors to reinforce learning gains and also share with patients. Finally, learners can also access an online Personalized Poster Portal where they can choose a variety of images and design a poster that was shipped to their practice setting. There have been with half of the programs complete reaching 712 learners so far, there have already been 315 Posters ordered, 221 Simulator Views, and 190 Animation Downloads. The outcomes that MLG has collected regarding this unique program and its point-of-care tools indicate how CME can lead to not only improved knowledge but can also translate to practice behavior and care coordination. MLG is looking forward to sharing the outcome of the program via a poster at the ADA Scientific Session.

Funding

Eli Lilly
455-P: Artificial Intelligence Approach to Treatment Classification in Painful Diabetic Neuropathy
Authors: TEH KEVIN , WILKINSON IAIN D. , SLOAN GORDON P. , TESFAYE SOLOMON , SELVARAJAH DINESH
Published: May 2022

Aim: Our study predicted treatment responses in patients with painful DPN (diabetic peripheral neuropathy) by developing a deep learning model using resting state functional magnetic resonance imaging (fMRI) neuroimaging datasets.

Methods: Forty-three consecutive patients who received intravenous lidocaine treatment for painful DPN were assessed. All subjects (responders n=29 and non-responders n=14) underwent detailed clinical and neurophysiological assessments to phenotype their pain sensory profile. Subjects also underwent brain resting-state fMRI. After pre-processing we performed a group concatenated independent component analysis (ICA) set to 30 components and automatically chose 7 highly correlated (p<0.05) ICA components. A 3D convolutional neural network (CNN) classification framework was trained using a VoxNet based architecture. This deep learning architecture compared models using (1) 7 correlated ICA networks 2) all 30 ICA networks generated 3) pre-processed resting state images.

Results: The deep learning treatment response classification in a ten-fold cross validation experiment using 7 ICA spatial maps has a mean AUC of 0.85 and an F1-Score of 0.90. However, with the extra information of all 30 ICA maps the mean AUROC increased to 0.97 with an F1-Score of 0.95. Using only pre-processed resting-state fMRI data achieved suboptimal F1-Score of 69% and AUC score of 44%.

Conclusion: Through the use of our deep learning model, we have demonstrated high classification performance. Our method improves painful DPN treatment efficiency by stratifying patients to receive the correct treatment from the outset. We believe to our knowledge this is the first study utilising deep learning methods to classify treatment response in painful DPN.

Disclosure

K.Teh: None. I.D.Wilkinson: None. G.P.Sloan: None. S.Tesfaye: Advisory Panel; Astellas Pharma Inc., Bayer AG, Grünenthal Group, Nevro Corp., Wörwag Pharma GmbH & Co. KG, Speaker's Bureau; Eva Pharma, Pfizer Inc., Viatris Inc. D.Selvarajah: None.

Funding

National Instituteof Health Research Efficacy and Mechanism Evaluation Programme (NIHR 129921) European Foundation for the Study of Diabetes (Microvascular Complications Project Grant) University of Sheffield, Health Education England, Knowledge Exchange
47-LB: Higher Weight Loss Is Associated with Improved Quality of Life in Patients with Type 2 Diabetes—SURPASS Program
Authors: BOYE KRISTINA , THIEU VIVIAN , YU MARIA , SAPIN HELENE
Published: May 2022

In addition to glycemic control, the ADA recommends weight management for patients with type 2 diabetes (T2D) with overweight or obesity. This analysis explored the association between weight loss and patients’ quality of life using pooled data from the SURPASS clinical trials, regardless of treatment and dosing. SURPASS 1 to 5 participants achieving ≥5%, ≥10%, or ≥15% weight loss were assessed for patient-reported outcomes (PRO) at baseline and endpoint. Weight related PROs investigated were Ability to Perform Physical Activities of Daily Living (APPADL) , Impact of Weight on Quality of Life-Lite Clinical Trials (IWQOL-Lite-CT) , Impact of Weight on Self-Perceptions (IW-SP) , and other measures were the EQ-5D-5L and Diabetes Treatment Satisfaction Questionnaire change (DTSQc) . Higher PRO scores indicate better outcomes. At endpoint, improvements were observed from baseline in all assessed PRO measures across weight loss categories (Table) . As we narrow the groups to those with higher weight loss percentages, we observed greater improvements in APPADL, IWQOL-Lite-CT, IW-SP, and EQ VAS scores. EQ-5D-5L index score changes and the DTSQc scores also increased but to a lesser extent. Weight loss was associated with improved quality of life with greater improvement seen in higher percentages of weight loss in patients with T2D, regardless of therapy.

Disclosure

K. Boye: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. V. Thieu: None. M. Yu: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. H. Sapin: Employee; Eli Lilly and Company.

Funding

Eli Lilly and Company
476-P: Role of TGR5 Signalling in Hepatic Lipid and Lipoprotein Metabolism in Normal and Insulin-Resistant States
Authors: ALVARES DANIELLE C.L. , HOFFMAN SIMON S. , ADELI KHOSROW
Published: May 2022

Fasting dyslipidemia is characterized by a lipid profile with elevated triglycerides, increased small dense LDL and low HDL-cholesterol, and is a commonly comorbid with insulin resistance. Bile acid (BA) signalling has been suggested to improve hepatic insulin sensitivity and lipid accumulation through activation of the Takeda G protein-coupled receptor 5 (TGR5) . As the role of TGR5 in regulating hepatic lipid and lipoprotein metabolism has not been explored, the present study was performed to characterize the role of bile acid signaling via TGR5 in hepatic lipid and lipoprotein metabolism. We have recently developed novel Tgr5-/- and GLP1R-/- hamster models. Tgr5+/+ and Tgr5-/ - hamsters were fed a high fat, high fructose, and low cholesterol (FFLC) diet for 6 weeks. Glucose tolerance, insulin tolerance, and fasting plasma lipids were examined at baseline, and following 6-weeks on diet. Loss of TGR5 signalling appeared to be initially protective against diet induced hypertriglyceridemia, however this effect was lost with prolonged feeding. Following 6 weeks of diet, Tgr5-/ - hamsters were less glucose tolerant, with similar insulin sensitivity. Fasting plasma deoxycholic acid (DCA) and taurocholic acid (TCA) compositions differed under chow fed conditions, with additional changes in postprandial DCA, TCA and cholic acid (CA) . Finally, chow fed Tgr5+/+ and Tgr5-/ - hamsters received intraduodenal injections (IDI) of DCA or TCA. Both DCA and TCA administration were associated with reduced VLDL-triglyceride secretion in Tgr5+/+ hamsters, an effect that was blunted in Tgr5-/ -hamsters. The lipid lowering effects of DCA were similarly blunted in GLP1R-/- hamsters, suggesting this effect is dependent on GLP-1R signalling. The present research will set a framework to expand our knowledge of the role of BA signaling through TGR5 in hepatic lipogenesis.

Disclosure

D.C.L.Alvares: None. S.S.Hoffman: None. K.Adeli: None.
48-LB: Retention in the National Diabetes Prevention Program Lifestyle Change Program by Participant-Level Factors
Authors: ZHANG XUANPING , CANNON MICHAEL , ELY ELIZABETH , SMITH BRYCE
Published: May 2022

Retention is closely linked to clinical outcomes in the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) . We examined retention, defined as the number of sessions attended, using data collected by the CDC Diabetes Prevention Recognition Program, the quality assurance component of the National DPP. We evaluated participants who enrolled in in-person lifestyle change programs from March 2018 to November 2020 and had the opportunity to complete at least 9 months of the 12-month program. To control for programmatic changes due to COVID-19, we divided enrollment into 3 cohorts: 1) 3/1/2018 - 5/31/2019 (before) , 2) 6/1/2019-2/29/2020 (mixed) , and 3) 3/1/2020-11/30/2020 (during COVID-19 pandemic) . Mean sessions attended was lower in cohort 3 (10.8, p<0.05) than in cohorts 1 (12.9) and 2 (12.6) . As shown in Table 1, across the 3 cohorts the following factors were associated with lower mean number of sessions attended: younger age, Hispanic ethnicity and non-White race, lower educational attainment, and Medicaid as a payer source. Our findings highlight that new strategies could be useful to improve retention among some demographic and socioeconomic groups (e.g., younger adults, Hispanic individuals, individuals with lower educational attainment, and Medicaid recipients) in the National DPP.

Disclosure

X. Zhang: None. M. Cannon: None. E. Ely: None. B. Smith: None.

Funding

CDC
487-P: Posttranslational Modifications of Apolipoproteins C-I, C-II, and C-III and Peripheral Artery Disease in Multiethnic Study of Atherosclerosis (MESA)
Authors: REAVEN PETER , HANSEN SPENCER , HU YUEMING , FURTADO JEREMY , SINARI SHRIPAD , BILLHEIMER DEAN , NEDELKOV DOBRIN , BUDOFF MATTHEW , MCCLELLAND ROBYN , KOSKA JURAJ
Published: May 2022

Apolipoproteins (apo) C-I, C-II and C-III in circulation are in several post-translational forms with distinct effects on lipoprotein metabolism. ApoC-I and apoC-II exist as dominant native and minor truncated (C-I’; C-II’) forms; apoC-III appears as unglycosylated (C-III0a) , or glycosylated with zero (C-III0b) , one (C-III1, most abundant) or two (C-III2) sialic acids. The association of these proteoforms with peripheral artery disease (PAD) in a general population is unstudied. Total apoC-I, C-II and C-III concentrations and relative amounts of their proteoforms were measured in baseline plasma of 5,681 MESA participants. The ankle-brachial index (ABI) was assessed at baseline, 3 and years. Prevalent PAD was defined as baseline ABI ≤ 0.9. Incident PAD was follow-up ABI ≤ 0.9 or a hospital-based diagnosis of PAD to include revascularization. After adjustment for baseline characteristics, lipid lowering therapy and plasma lipids, low baseline ABI was associated with low C-III0b to C-III1 ratio (C-III0b/III1, p=0.01) and high C-III2 to C-III1 ratio (C-III2/III1, p<0.01) . Prevalent PAD (n=226) was only associated with C-III2/III1 (OR 1.16, 95% CI: 1.01-1.33, p=0.03) . Lower ABI at follow-up was associated with lower C-III0b/III1 and higher C-III2/III1 at baseline (p<0.both) . Incident PAD (n=244) was associated with C-III2/III1 (HR 1.22, 1.06-1.41, p=0.01) . Total apoC-I, C-II and C-III concentrations, or apoC-I and C-II truncations were not associated with ABI at baseline and follow-up, or with cross-sectional and prospective PAD determinations. ApoC-I and apoC-II and their truncations do not appear linked with PAD. In contrast, we find different associations of apoC-III0b and apoC-III2 with prevalent and incident PAD that are independent of other risk factors, including plasma lipids. Our data provide further support that proteoforms may have unique properties not captured by “total” apolipoprotein measures.

Disclosure

P.Reaven: Research Support; AstraZeneca, Dexcom, Inc. J.Koska: None. S.Hansen: None. Y.Hu: None. J.Furtado: Research Support; Eli Lilly and Company, Pfizer Inc. S.Sinari: None. D.Billheimer: None. D.Nedelkov: None. M.Budoff: Research Support; Amarin Corporation, Novo Nordisk, Speaker's Bureau; Boehringer Ingelheim International GmbH, Lilly. R.Mcclelland: None.

Funding

National Institutes of Health (R01-HL138969)
488-P: Diabetes-Related Major and Minor Amputation Risk Increased during the COVID-Pandemic
Authors: BANKS JAMINELLI
Published: May 2022

Background: Along with significant case transmission, hospitalizations, and mortality experienced during the global COVID-pandemic, there existed a disruption in the delivery of health care across multiple specialties.

Objective: The aim of our review was to analyse the possible relationship between COVID-infection and amputations. Methods We conducted a 2-year retrospective cohort study with prospective long-term follow-up of all diabetic patients admitted for a foot lesion at 353-bed, nonprofit, faith-based teaching hospital. Study variables included patient demographics and clinical parameters related to infection and diabetes. The average follow-up after hospital discharge was 2 years. Failure of conservative treatment was the main outcome measure. Independent predictor variables were selected by logistic regression analysis.

Results: A total of 849 consults were identified for use in the study, 356 consults for 20 and 493 consults for 2021. We excluded trauma/noninfectious consults. This represents a 38% increase in the number of podiatric consults over the time frame. On average, 42% of consults required podiatric surgical intervention for management/prevention of infection in 2021 compared to 44% in 2019. Amputation rates have fallen from 37.08% to 32.45% from 20to 2021. Rates of minor amputations decreased from 22.75% to 19.07%, rates of moderate amputations decreased from 5.06% to 4.87%, rates of major amputations decreased from 9.27% to 8.52% from 20to 2021, respectively.

Conclusion: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations.

Disclosure

J.Banks: None.
49-OR: Ten Years of the National Diabetes Prevention Program: Ten Years of Impactful Changes
Authors: ELY ELIZABETH
Published: May 2022

In 2010, Congress authorized the creation of the National Diabetes Prevention Program to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes. In 2012, the Diabetes Prevention Recognition Program (DPRP) approved its first CDC-recognized organization. Over the last years, CDC has recognized ∼4000 organizations to deliver the LCP to 500,000+ participants. This analysis looks at the impact of changes to the DPRP national quality standards on participant outcomes. The initial version of the DPRP Standards covered the period 1/1/12-12/31/14. Later versions were released on 1/1/15, 3/1/18, and 5/1/21. Data for participants who entered the LCP during each version were analyzed with respect to enrollment, starting body mass index (BMI) , and % weight change. Enrollment during version 1 climbed to 24,614 based on in-person delivery. Version 2 introduced virtual delivery and enrollment reached 227,329. Version 3 reflected changes to accommodate the Medicare Diabetes Prevention Program. In-person enrollment increased 36% from 2018 to 2019, while online enrollment decreased over that period. Version 3 saw the public health emergency that caused most in-person enrollment to halt while organizations shifted to virtual platforms. In-person enrollment during 2020 ranged from a low of 763 in April to almost normal numbers of 2000+/month by September. Mean BMI was highest for those who started the LCP in 2012 (version 1) and 2021 (version 4) at 36.2 and 36, respectively. Those enrolled in organizations using combination (in-person + virtual) delivery had the highest mean BMI, regardless of version. Mean % weight loss for those who completed 9+ months of the LCP was highest during version 1 (6.3) . Version 3 produced the lowest at 5.2, which was also the mean % in 2020. The DPRP has endured program changes, as well as external factors. The evidence-based LCP continues to enroll participants looking to reduce their risk of developing type 2 diabetes.

Disclosure

E.Ely: None.
499-P: Optimizing Diabetes Education before Total Pancreatectomy with Islet Cell Autotransplantation (TPIAT)
Authors: ELLISON RACHEL E. , TELLEZ SIOBHAN E.
Published: May 2022

Background: Caregivers of pediatric recipients of a TPIAT must receive extensive education prior to discharge home. Retrospective review found caregivers were often surprised by the amount of education required and were not prepared to learn while their child was recovering from surgery. Expectations of preparedness were not uniformly reinforced with caregivers, despite available resources. We aimed to provide caregivers with comprehensive education pre-surgery in line with programmatic goals to reduce the inpatient length of stay (LOS) post-TPIAT.

Method: We reviewed education time and days for 17 pre-intervention patients (September 2019-August 2020) , and 20 post-intervention patients (August 2020-October 2021) . Diabetes education time was consistently documented in the chart and represented the largest proportion of education needed prior to discharge. Pre-intervention patients received a printed binder of diabetes education and met with diabetes educators at least once in the 6 months prior to surgery. Post-intervention patients received an email with digital links to the timeline and expectations of pre-surgery education, modules for education on diabetes, medication administration, and feeding tube care, and received follow-up phone calls. The intervention was developed using the Plan-Do-Study-Act (PDSA) model of improvement.

Results: Prior to the intervention, patients averaged 7minutes of inpatient education spread over an average of 6.4 days. After implementation, patients averaged 575 minutes spread over 4.7 days. There was no cost associated with the development of the intervention.

Conclusion: We created our intervention in response to the goal of reducing LOS and adapted it to the low-resource and staffing constraints of a pandemic. We generated a free, sustainable tool that used existing resources. Though our project is ongoing, we are encouraged that inpatient education has been reduced from 7to 575 minutes and from 6.4 to 4.7 days.

Disclosure

R.E.Ellison: Other Relationship; AbbVie Inc. S.E.Tellez: None.
50-OR: Peer Support Improves Health Behaviors in People with Prediabetes
Authors: SCHMITTDIEL JULIE , FINERTIE HOLLY , RODRIGUEZ LUIS A. , THOMAS TAINAYAH , SANCHEZ PERLA , HEISLER MICHELE
Published: May 2022

Up to one third of Americans have prediabetes, a condition of elevated glucose levels linked with greater diabetes incidence. Strong evidence shows that peer support is an effective strategy to improve outcomes for people with diabetes; however, no studies have examined whether peer support can be leveraged to improve outcomes in people with prediabetes. The “Using Peer Support To Aid in Prevention and treatment of Prediabetes (UPSTART) ” study is a pragmatic randomized controlled trial at Kaiser Permanente Northern California and the University of Michigan that randomized 351 people with prediabetes (A1c 5.7-6.4; BMI >25 or BMI >23 for Asian patients) from 10/19/2018-3/31/2021 to one of two study arms: a peer support intervention with 1:1 matching of prediabetes patients with coaches trained in motivational interviewing (intervention group) ; or enhanced usual care (control group) . All participants received information on healthy eating, active living, wellness, and diabetes prevention programs. Lifestyle and psychosocial factors were measured via baseline and six-month surveys. In our sample, 2of study patients were female; 1were Black; 147 were White; 31 were Hispanic/Latino; 30 were Asian; 24 were Multiracial or ‘Other’ race. At six months, intervention participants had higher participation in diabetes education and prevention programs (25.2% vs. 11.1%, p=.002) ; higher Patient Activation Measure (PAM) scores (68.9 vs. 65.7 on a 0-100 scale, p=.043) ; greater perceived social support (55.3 vs. 49.6 on a 12-72 scale; p<.001) ; and greater whole grain consumption (19.2 vs. 14.5 days out of 30; p=.024) compared to controls. There were no differences in physical activity, vegetable, fruit, or soda consumption at six months. A peer-support program for people with prediabetes has a positive impact on factors linked to diabetes prevention and better health outcomes. Future research from this study will examine whether the intervention and these improvements are also associated with decreased A1c and weight.

Disclosure

J.Schmittdiel: None. H.Finertie: None. L.A.Rodriguez: None. T.Thomas: None. P.Sanchez: None. M.Heisler: n/a.

Funding

National Institutes of Health (R18DK113403)
500-P: Gaps in Patient Education upon Initial Diabetes Diagnosis among Adults Living with Type 1 and 2 Diabetes in the United States
Authors: XU EMILY , GOWEN REBECCA , STEVENSON JULIA , MONROY-SPANGENBERG ERIK , WOOD RICHARD
Published: May 2022

Patient education is an essential component of diabetes care that can influence diabetes management self-efficacy and help prevent long-term health complications for people with diabetes (PWD) . The present study aims to understand unmet needs in patient education upon initial diabetes bolddiagnosis.

In December 2021, 1,056 adult PWD in the United States completed an online survey in which they indicated their satisfaction with the education they received from their healthcare provider (HCP) upon first being diagnosed with diabetes on a 10-point scale. Respondents who were diagnosed within the last years and gave a satisfaction score of 1-6 were asked to explain what information they wish they had received upon diagnosis. The subsequent 472 qualitative write-in responses (29% type 1, 74% female) were coded and analyzed.

Among all respondents, 47% were not satisfied with the information they received at diagnosis (satisfaction score of 1-6) . Over a fifth of type 1 (22%) and over a quarter of type 2 (27%) adults reported receiving little to no information about diabetes from their HCP upon diagnosis. Over a quarter (28%) of type 1 PWD reported being initially misdiagnosed or not properly diagnosed at all, and 7% reported a lack of empathy from their HCP upon diagnosis. Type 1 PWD also reported gaps in education on monitoring and managing blood glucose levels (22%) , diet and exercise management (12%) , and diabetes technology options (10%) . Type 2 PWD most commonly reported a need for more information on diet and exercise management (37%) ; 17% also reported a lack of education on monitoring and managing managingblood glucose levels.

These results highlight widely reported gaps in adequate diabetes education and support from healthcare providers at the time of PWDs’ initial diagnosis. Steps must be taken to provide PWD with improved education and empower PWD in their diabetes management with the help of free, accurate, and accessible resources.

Disclosure

E.Xu: Employee; dQ&A. R.Gowen: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Virta Health Corp. J.Stevenson: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc. E.Monroy-spangenberg: Employee; dQ&A, Stock/Shareholder; Senseonics. R.Wood: Other Relationship; Multiple companies and patient organizations (>10) .
503-P: Online, Interactive Case Study Is Successful at Improving Pharmacists’ Knowledge, Competence, and Confidence Related to Use of CGM and Patient Education in Practice
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE
Published: May 2022

Objective: We sought to determine if online, case-based medical education with patient vignettes could improve the knowledge, competence and confidence of pharmacists related to CGM use and education.

Methods: The CME activity was a 15-minute interactive case study with pharmacist-patient vignettes featuring a patient initiating CGM. A repeated pairs pre-/post-assessment study design and chi-square test (P <.is considered significant) assessed educational effect, with Cohen’s d being used to assess educational impact (0.06-0.15 is a noticeable effect, 0.16-0.26 considerable, and >0.26 extensive) . The activity launched February 23, 2021 and data were collected through April 12, 2021.

Results: In total, 359 pharmacists were included in the analysis. Matched learner data indicate that overall, 64% improved their knowledge and competence from pre-to-post (P<.with extensive overall impact 0.96) . On a question-level: 49% of pharmacists (P<.01) improved knowledge of differences among available CGM systems in the US. 29% of pharmacists (P<.01) improved competence related to educating patients about time in range goals. 4% of pharmacists (P=NS; 87% were reinforced) improved competence related to patients education related to hypoglycemia as it relates to CGM use. Overall, 71% of pharmacists reported increased confidence in education patients on CGM use, for a total confidence shift of +89% for those with increased confidence.

Conclusion: This study demonstrates the success of an interactive case study directed at pharmacists on improving knowledge, competence and confidence related to CGM use. Case-based education with interactive polling questions and detailed explanations related to best choices should be employed more often to help pharmacists apply knowledge/skills into practice to expand their role on the healthcare team and improve patient management.

Disclosure

A.Larkin: None. J.Schrand: None. A.Le: None.

Funding

Developed through an Independent Educational Grant from Dexcom.
509-P: Trends in Diabetes Self-Management Education and Support Referrals in Kentucky: 2016–2019
Authors: BRYANT GEORGE C. , KECK JAMES , LACY MARY E.
Published: May 2022

Background: Diabetes self-management education and support (DSMES) services are an integral part of quality diabetes care. However, despite strong evidence regarding its effectiveness and clear guidelines from the ADA recommending its use, <10% of eligible patients have received DSMES. In this study, we examine rates of referral to DSMES across specific subgroups at an academic medical center in Kentucky.

Methods: We analyzed patterns of DSMES referrals at University of Kentucky HealthCare from 1/1/2016-12/31/20among adult patients (aged ≥ 18) with diabetes (ICD-9: 249, 250; ICD-10: E08-E13) . We restricted our sample to patients receiving primary care at UKHC with at least 365 days of follow-up and examined referral rates across the following subgroups: sex, race/ethnicity, age group, insurance type.

Results: In our sample of 3,854 patients with diabetes (mean (SD) age=56.8 (13.9) ; 50% female) , 9.3% of eligible patients were referred for DSMES. Referral rates were higher in non-Hispanic Black patients (14.5%) compared to non-Hispanic Whites (9.4%) and Hispanics (9.4%; p<0.001) . Females were more likely to be referred for DSMES than males (12.3% vs. 8.7%; p<0.001) and younger patients were more likely to be referred than older patients (27.5% of patients age 18-24 vs. 5.0% of patients aged 65+; p<0.0001) . Referral rates were lower in patients with Medicare coverage (7.6%) compared to those with Medicaid (13.0%) or commercial insurance (11.6%; p<0.0001) .

Conclusions: Results from our study highlight low referral rates for DSMES services in the primary care setting for patients with diabetes. Our findings also underscore disparities in key subgroups that can be targeted to improve DSMES referrals. Of particular significance are differences in DSMES referral rates across age categories. Older patients face diabetes-related challenges they may change as they age. The importance of continuing DSMES services across the lifespan should be highlighted.

Disclosure

G.C.Bryant: None. J.Keck: None. M.E.Lacy: None.

Funding

National Institutes of Health (UL1TR000117, UL1TR001998, KL2TR001996)
51-LB: Depression Scores and Suicide Attempt History Are Independently Associated with Hemoglobin A1c (HbA1c) in Adolescents and Young Adults with Type 1 Diabetes
Authors: GETTINGS JULIE M. , PANTESCO ELIZABETH J. , FLOYD ALFONSO , WILLI STEVEN M.
Published: May 2022

Adolescents and young adults (AYA) with type 1 diabetes (T1D) are at an elevated risk for depression and suicide, and regular screening is an integral part of medical care. The Patient Health Questionnaire-9 Adolescent Version (PHQ-9; Johnson et al., 2002) is commonly used to screen for depression and suicide risk, and more information is needed about how ratings relate to diabetes management. The goal of this study was to quantify PHQ-9 scores, suicidal ideation (SI) in the past 2 weeks, and suicide attempt history (SAH) in AYA with T1D and to examine their relationships with HbA1c. The PHQ-9 was electronically administered to AYA with T1D (n = 759) at outpatient medical visits, and results from the PHQ-9, relevant background variables (age, sex, race, diabetes duration, BMI and systolic blood pressure) , and HbA1c values were obtained from the medical record. On average, AYA were 17.2 years old, had diabetes for 7.6 years, and had an HbA1c of 8.5%. On the PHQ-9, 72.6% scored in the normal range (0-4) , 19.9% in the subthreshold range (5-10) , and 7.5% at or above threshold (≥ 11) . SI was reported by 4.2% of the sample and 5.3% noted SAH. In linear regression models adjusted for relevant background variables, greater levels of PHQ-9 symptoms were associated with higher HbA1c (B = .06, p < .001) . When examining categories of PHQ-9 scores, those with subthreshold depressive symptoms had marginally higher, (B = .331, p =.07) , and those at or above threshold had significantly higher, HbA1c (B = .799, p =.003) . SI was not associated with HbA1c, but SAH was associated with higher HbA1c (B = 1.13, p < .001) . Notably, PHQ-9 scores (B = .05, p =.005) and SAH (B = .884, p =.007) were each independently associated with higher HbA1c after adjusting for the other. These findings highlight the importance of identifying and providing additional support for AYA with elevated PHQ-9 scores, as well as those with SAH even if current depression scores are not concerning.

Disclosure

J. M. Gettings: None. E. J. Pantesco: None. A. Floyd: None. S. M. Willi: Advisory Panel; Boehringer Ingelheim International GmbH, Medtronic, Other Relationship; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; Jaeb Center for Health Research, Provention Bio, Inc.
51-OR: Anxiety and Changes in Health Care Access and Health Behaviors during COVID-in Southwest Tribal Community Patients with Prediabetes and Diabetes
Authors: RENO JESSICA , ZHU YILIANG , SHAH VALLABH
Published: May 2022

Objective: The impact of COVID-has been devastating to many, but particularly to rural populations of American Indians from Zuni Pueblo who suffer multiple vulnerabilities which places them at greater risk for infection and death. Very little is known about the change in health behaviors owing to the COVID pandemic among a chronically ill (diabetes) rural Zuni population. We evaluated the anxiety and stress about COVID-contributing to poorer mental health outcomes in Zuni Indians with PreDM and T2DM.

Methods: We conducted a survey among individuals with hyperglycemia in Zuni Indians. There were 300 participants who responded to the survey, of which 193 participants also had baseline clinical health data.

Results: Those with T2DM experienced higher pandemic-related anxiety than those with pre-DM (+3.9 vs. -0.6, p=0.0616, on a scale -30 to +30) . Those with T2DM were more likely to report decreased physical activity (54% vs. 44%) , decreased frequency in lab testing (21% vs. 10%) , and increased virtual contact with providers (61% vs. 48%) during the pandemic. We conducted regression analyses to describe correlations of anxiety and weight change with the changes in health behaviors. We found that participants with improved diet and exercise during the pandemic were less likely to experience weight gain (OR= 0.78, p=0.0017 and OR=0.75, p=0.0094, respectively) . We also found that those who reported worsening health care during the pandemic experienced increased anxiety (+4.9, p=0.0049) .

Conclusion: Our study provides important insights into (unintended) consequential effect of COVID crisis in rural Zuni which will contribute to a better understanding of how to preserve mental health and maintain health behaviors in patients with diabetes during the pandemics.

Disclosure

J.Reno: None. Y.Zhu: None. V.Shah: n/a.

Funding

National Institute of General Medical Sciences of the National Institutes of Health (P20GM103451)
516-P: A One-Year Curriculum for Diabetes Self-Management Education to Promote Lasting Lifestyle Changes
Authors: SALLAM HANAA , PAN WENTONG , FERGUSON MONIQUE L. , LEE WEI-CHEN , MCKINNEY KEVIN H. , SERAG HANI
Published: May 2022

The use of telehealth for Diabetes Self-Management Education and Support (DSMES) is expanding. There is a need among people with diabetes (PWD) to manage their diabetes, as they represent 20% of ICU admissions, 30% of hospitalized cases and have an increased risk of COVID-related mortality. While people at risk for diabetes or prediabetes may join a 1-year CDC accredited diabetes prevention program to make lifestyle changes to reduce their diabetes risk, PWD are often offered short-term DSMES programs that do not necessarily incorporate long-term goals. We developed a year-long intensive Diabetes Self-Management Education and Support (iDSMES) program combining Virtual Diabetes Conversation Map® and selected modified modules from the PreventT2® curriculum to suit PWD. The curriculum included 18 maps/modules. Our team of certified lifestyle coaches/diabetes educators/Conversation Map® Trainers used shared decision-making and problem-solving approaches to improve glycemic control and diabetes self-management. We hypothesized that iDSMES would improve diabetes outcomes in PWD. Fourteen PWD (12F/2M) with a BMI of 25 or above underwent the iDSMES in a group with their lifestyle coaches using the Zoom® platform. We collected their fasting blood glucose, weight, blood pressure, and physical activity minutes at each session (every three weeks) and assessed their Hemoglobin A1c quarterly. Nine PWD completed the iDSMES and lost an average of 8.8% of their initial body weight (a total of 203lbs) . We observed a 1% decrease in their A1c, 10mg/dL decrease in fasting blood glucose, and mm Hg decrease in systolic and diastolic blood pressure, respectively. There was also a 110-minute increase in their physical activity. A year-long iDSMES distance learning program effectively enhances lasting lifestyle changes to improve diabetes self-management in PWD. A 5-year follow-up is warranted to assess factors affecting the maintenance of accomplished lifestyle changes.

Disclosure

H.Sallam: None. W.Pan: None. M.L.Ferguson: None. W.Lee: None. K.H.Mckinney: None. H.Serag: None.

Funding

Texas Department of State Health Services (#HHS000740800001)
517-P: The Prevalence and Predictors of Improper Sharps Disposal among People with Diabetes in Saudi Arabia
Authors: ALSUWAILEM GHADAH , BARAKEH MAEE , ALMARSHOUD GHAIDA A. , ZAWAWI ALIA , BAKADER RAWAN A. , AL-SOFIANI MOHAMMED
Published: May 2022

Background: Diabetes often requires the use of sharp objects (e.g. needles, lancets, etc) to maintain optimal glycemic control. Improper disposal of sharps poses substantial threats to the environment and public health.

Objectives: To estimate the prevalence, and identify predictors, of improper sharps disposal among people with diabetes (PWD) in Saudi Arabia.

Method: We surveyed PWD, visiting a diabetes center in Riyadh, Saudi Arabia in Sep- Oct, 2021. We asked questions about sociodemographics, type and duration of diabetes, methods of sharps disposal, and whether the study participants had received instructions on proper sharps disposal. We defined “proper sharps disposal” as: dispensing sharps into a designated sharps disposal container or home-made sealed container.

Results: Of the 293 PWD surveyed, 60% were women, 54% were ≥35 years old, and 53% had type 1 diabetes. Majority (80% and 72%) reported improper disposal of needles and lancets, respectively. Approximately, 56% of needle users and 61% of lancet users reported that they had never received instructions on safe sharps disposal. Receiving education on safe sharps disposal was associated with a 66% reduction in the risk of improper sharps disposal practice[OR (95% CI) : 0.34 (0.16-0.68) ] after adjusting for age, gender, type and duration of diabetes, income, education, and nationality of the study participants. Among those who improperly dispose their needles, 67% thought their way of sharps disposal was appropriate and 47% did not know what type of infections can be transmitted via needlestick injuries.

Conclusion: Our findings highlight the high prevalence of unsafe sharps disposal practices among PWD, and how providing education on safe sharps disposal can help address this environmental and public health threat. Policies to reduce diabetes-related waste, unify the approach to proper sharps disposal, and educate PWD on how to safely dispose sharps are needed to achieve a sustainable and safe waste management system.

Disclosure

G.Alsuwailem: None. M.Barakeh: None. G.A.Almarshoud: None. A.Zawawi: None. R.A.Bakader: None. M.Al-sofiani: None.
52-LB: Adult’s Lived Experience Using the Insulin-Only Bionic Pancreas
Authors: GARZA KIMBERLY P. , HOWARD KELSEY R. , WEISSBERG-BENCHELL JILL , FELDMAN MARISSA ,   BIONIC PANCREAS GROUP
Published: May 2022

The Insulin-only Bionic Pancreas (BP) Pivotal Trial compared the BP initialized only with body weight vs. standard-of-care (SC) . The BP autonomously determines all insulin doses. Meals are announced without carbohydrate counting. For adults aged 19-75 the mean adjusted difference of HbA1c at 13 weeks between BP and SC was -0.5% (95% CI: -0.6, -0.3, P<0.001) ; percent of time <54 mg/dl was not different between groups. Focus groups were conducted among BP users at the trial’s end.

Adults reported improved time in range and A1c. Many reported it corrected highs well; others felt it took too long. Some experienced fewer lows; others reported more, stating the algorithm was too aggressive in correcting highs. Concerns were raised about the inability to prevent lows even when predicted. Many experienced improved glycemia at night, improved sleep and waking up in target range; some found night-time lows negatively impacted sleep. Many reported difficulties suspending insulin to prevent lows, leading to less exercise during the trial. Meal announcements were appreciated, with increased freedom to eat without guilt, but most wished for snack announcements. Some found challenges managing high-fat foods and not having an extended bolus.

Many reported decreased emotional, cognitive and management burden with less worry, guilt, and burnout due to increased TIR and no need to carbohydrate count. Some found increased burden due to increased lows, and increased time filling cartridges and changing infusion sites. Some trusted the BP immediately, felt it learned their body quickly, and appreciated the automation. Others found waiting for corrections intolerable, engaging in either over-treating lows or administering external insulin for highs. Not knowing insulin-on-board was difficult for some.

System-specific concerns included: cartridge capacity, short tubing, no clip, poor back-lighting, the screen timing out quickly, and not being waterproof. Gathering patient perspectives offers insights into learning and using the BP as well as the psychosocial impact of the BP which can be used to guide future innovations.

Disclosure

K. P. Garza: None. K. R. Howard: None. J. Weissberg-benchell: None. M. Feldman: None. Bionic pancreas group: n/a.

Funding

National Institute of Diabetes Digestive and Kidney Disease (#1UC4DK108612-01)
521-P: Care Partner in Virtual Diabetes Self-Management Education and Support
Authors: ZUPA MARGARET , JOHNSON PATRICIA A. , KRALL JODI S. , NG JASON , REYNOLDS SHARI L. , ROSLAND ANN-MARIE , SIMINERIO LINDA M.
Published: May 2022

Background: Support from care partners (CPs) , family or friends who are involved in diabetes management, is associated with improved self-management and clinical outcomes for adults with type 2 diabetes (T2D) . Therefore, guidelines recommend active CP involvement in diabetes self-management education and support (DSMES) . Telemedicine is increasingly being used to deliver DSMES and may facilitate CP involvement.

Objective: To examine the frequency and type of CP involvement in virtual DSMES sessions delivered to patients in their homes over 12 months as part of the Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support study, designed to evaluate the impact of longitudinal DSMES conducted via videoconferencing.

Methods: 43 patients with T2D and an HbA1c>9% were enrolled from rural federally qualified health centers. A diabetes care and education specialist (DCES) performed an initial in-person needs assessment, followed by individualized virtual DSMES sessions via videoconferencing over 12 months. Participants were surveyed on the presence and roles of CPs at baseline, and DCES recorded CP involvement at each DSMES session. Twenty participants identified a diabetes CP at baseline; 75% lived with their CP and 60% of CPs were the patient’s significant other. Patients reported that CPs regularly helped with self-management by encouraging healthy eating (80%) , medication adherence (70%) , and discussing home blood glucose results (70%) . Nine participants had a CP involved in at least one virtual DSMES session; CPs performed diverse functions, including assisting with technology, setting up continuous glucose monitors, reviewing nutrition recommendations, and facilitating information sharing between participants and DCES.

Conclusions and Future Direction: For adults with T2D, virtual visits offer opportunities for CPs to support and enhance DSMES. Efforts to more actively engage existing CPs could better leverage this resource to support ongoing diabetes self-management.

Disclosure

M.Zupa: None. P.A.Johnson: None. J.S.Krall: Research Support; Becton, Dickinson and Company, Sanofi. J.Ng: Research Support; Sanofi. S.L.Reynolds: None. A.Rosland: None. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi.

Funding

NIDDK (R34DK123370) NCATS (TR001856)