bluuebunny/crossref_metadata_2025 huggingface dataset:
602-P: A Higher Complex-Carbohydrate Diet Lowers Metabolically Unfavorable Markers Associated with Gestational Diabetes Mellitus
Authors: SUGINO KAMERON , HERNANDEZ TERI L. , BARBOUR LINDA A. , FRIEDMAN JACOB E. , FRANK DANIEL
Published: June 2023

First-line, conventional dietary treatment for gestational diabetes (GDM) recommends a carbohydrate-restricted, higher fat diet to reduce postprandial glucose and mitigate glucose-mediated fetal macrosomia. However, a higher fat maternal diet may worsen insulin resistance (IR), impairing glucose uptake. Emerging studies have identified potentially impactful diet-sensitive metabolites associated with GDM, such as elevated aspartate and decreased deoxycholic acid have been associated with GDM risk and may confer worse IR. We performed a targeted metabolomic analysis in a subset from the “Choosing Healthy Options in Carbohydrate Energy” (CHOICE) study which randomized GDM women to a CHOICE (60% complex carb/25% fat/15% protein) or a conventional diet (CONV, 40% carb/45% fat/15%) from diagnosis to delivery. All meals were provided, diets were eucaloric, and fiber content was similar. Plasma was collected at baseline (31 wks) and 36 wks (n=20 CHOICE; n=17 CONV) and subjected to targeted metabolomic analysis (n=527 metabolites; n=12 short chain fatty acids). Thirty-one metabolites were significantly different between diets (p< 0.05): species of ceramides (n=4), cholesterol esters (n=2), lysophosphatidyl choline (n=5), phosphatidyl choline (n=10), and triglycerides (n=6) as well as sphingomyelin C26:1, hexosylceramide d18:1/16:0, deoxycholic acid, and aspartate. Aspartate and one triglyceride species significantly decreased on CHOICE, but increased on CONV (p<0.05). The remaining 29 metabolites were increased in women on CHOICE. In contrast, CONV resulted in a slight decrease in concentration of these metabolites, and a smaller increase of the ceramide species than CHOICE. These results suggest the CHOICE diet improves metabolic markers associated with GDM and IR compared to conventional GDM diet treatments.

Disclosure

K.Sugino: None. T.L.Hernandez: None. L.A.Barbour: None. J.E.Friedman: None. D.Frank: None.
608-P: Association of Neck Circumference and Sarcopenic Obesity in a Cohort of Chinese Community-Based Individuals
Authors: XU YITING , HU TINGTING , SHEN YUN , WANG YUFEI , MA XIAOJING , BAO YUQIAN
Published: June 2023

Aims: Neck circumference (NC) is a simple and reliable anthropometric measurement for estimating obesity. Sarcopenic obesity is a distinct condition of sarcopenia in the context of obesity, with the cumulative health risks of both phenotypes. This study was aimed to explore the association between NC and sarcopenic obesity in a Shanghai community population.

Methods: The study included 1542 participants (622 men and 920 women) with mean age of 58.1 ± 7.06 years who underwent complete examinations at baseline in 2013-2014 and received a re-examination in 2015-2016. An automatic bioelectric impedance analyser (BIA) was used to measure body compositions. Relative skeletal muscle index was calculated using the BIA equation from Janssen et al. The abdominal fat distribution, including visceral fat area (VFA), was assessed by magnetic resonance imaging. Elevated NC was defined as NC ≥ 38.5 cm in men and NC ≥ 34.5 cm in women. The definition of sarcopenic obesity combined low muscle mass (skeletal muscle mass index of 1 SD below the sex-specific mean value) with obesity which defined according to overall adiposity or fat distribution as body mass index (BMI) ≥ 25 kg/m2, fat% ≥ 25% in men and 30% in women, or VFA ≥ 80cm2, respectively.

Results: Subjects with elevated NC had a higher incidence of sarcopenic obesity in both men and women regardless of adiposity status assessed by BMI, fat%, or VFA (all P < 0.001). During the follow up, higher cumulative incidence of sarcopenic obesity was found in those with elevated NC (all P < 0.001). For each 1 cm increase in NC, multivariable-adjusted hazard ratios of sarcopenic obesity in which adiposity status assessed by high BMI were 1.40 (1.11-1.76) in men and 1.32 (1.13-1.56) in women; besides, the association assessed by high fat% or high VFA remained in both men and women.

Conclusion: NC was closely associated with the incidence of sarcopenic obesity, which suggested that it could be helpful to screening sarcopenic obesity in a community-based population.

Disclosure

Y.Xu: None. T.Hu: None. Y.Shen: None. Y.Wang: None. X.Ma: None. Y.Bao: None.
613-P: Low Muscle Mass and/or Function Is Common in Type 2 Diabetes
Authors: CONTE CATERINA , BOUSSETTA SARA , LEVA FRANCESCO , MORO PAOLO , BERRA CESARE C. , LUZI LIVIO
Published: June 2023

Sarcopenia (low muscle mass/muscle function [MM/MF]) and sarcopenic obesity (sarcopenia+obesity, SO) have relevant clinical implications, but few data are available on pts with type 2 diabetes (T2D), especially in Western populations. We assessed the proportion of Caucasian pts with T2D and sarcopenia/SO and clinical correlates of sarcopenia. During routine follow-up outpatient visits (Jun-Dec 2022), we measured skeletal MM by bioelectrical impedance analysis (BIA) and MF by hand-grip strength in all pts except those with contraindications to BIA. Low MM and low MF were diagnosed using validated sex- and sex-/age-specific cut-offs, respectively, as recommended by ESPEN & EASO. Anthropometrics, glycemic control (HbA1c) and type/number of complications were recorded for all pts. A total of 116 pts with T2D were included (64.7% F, median [25°; 75° percentile] age 70.0 [62.3; 78.0] years, 35.3% with obesity). Sarcopenia was diagnosed in 12.9% of pts. Of these, 40% (5.2% of the total) had SO. Low MM with normal MF (LMM) and low MF with normal MM (LMF) were found in 16.4% and 21.6% of pts. There were no significant differences in sex, age, HbA1c, or number of complications between patients with or without sarcopenia nor among subgroups, but the proportion of elderly pts (age ≥65y) was lower among those with vs those without sarcopenia (26.7% vs 57.4%, p=0.026). Median BMI was greater (p<0.05) in pts with LMM or sarcopenia vs those with normal MM/MF or LMF (31.6 [30.5; 34.6], 29.2 [26.1; 34.8], 26.7 [23.4; 30.4] and 24.5 [21.3; 29.8] kg/m2, respectively). At logistic regression adjusted by sex and age, the likelihood of sarcopenia increased by 11.4% for each unit increase in BMI (odds ratio 1.114, [95%CI 1.01; 1.23] p=0.037). In conclusion, the majority of Caucasian pts with T2D has low MM, MF or both (sarcopenia), the risk of sarcopenia increasing with greater BMI. The lower proportion of elderly suggests reduced life expectancy in T2D pts with sarcopenia. The assessment of sarcopenia in T2D should be implemented in routine clinical practice.

Disclosure

C.Conte: None. S.Boussetta: None. F.Leva: None. P.Moro: None. C.C.Berra: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Medtronic, Research Support; Gelesis, Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Novo Nordisk, Novartis.
62-LB: Sleep Improves over Five Years of Very Low Carbohydrate Nutrition Therapy for Prediabetes Delivered by Continuous Remote Care
Authors: ADAMS REBECCA N. , ATHINARAYANAN SHAMINIE J. , VOLK BRITTANIE M. , PHINNEY STEPHEN D. , VOLEK JEFF , MCKENZIE AMY L.
Published: June 2023

Background: People with prediabetes are more likely to suffer from poor sleep, and sleep characteristics are correlated with metabolic markers such as glycemia and weight. We previously reported 1-yr improvements in sleep and metabolic health among people with prediabetes participating in a very low carb intervention including nutritional ketosis delivered via continuous remote care. Improvements in metabolic health were also observed out to 5 yrs. Given the relationships between sleep and metabolic health, in this analysis we explored whether sleep characteristics that improved at 1 yr were also improved at 5 yrs.

Methods: Adults with prediabetes initially enrolled in a 2-yr single-arm trial were offered to continue for 3 more yrs of prospective follow-up. Of the 72 participants completing 2 yrs, 58 (81%) of participants consented to the extension and 45 (78%) were retained at 5 yrs. Baseline characteristics of those who extended include: 83% female, mean age= 53 yrs, mean HbA1c = 5.9%, and mean BMI= 39. Sleep was assessed with the Pittsburgh Sleep Quality Index at baseline, 3 mos, 1 yr, 2 yrs, 3.5 yrs, and 5 yrs. Among all extending participants, we explored changes over time in Global Sleep, Sleep Quality, Sleep Disturbances, and Daytime Dysfunction using 4 linear mixed effects models (intent-to-treat analyses) controlling for age, gender, and race.

Results: The overall effect of time was significant for all sleep measures, such that sleep improved over time (ps <0.02). From baseline to 5 yrs, sleep score improvements ranged from 21-28% (ps <0.02).

Conclusions: Participants in a virtual nutrition therapy intervention focused on nutritional ketosis reported long-term improvements in sleep out to 5 yrs concurrent with sustained metabolic health improvements. This provides additional evidence that this intervention benefits overall health. Additional research is needed to better understand what drove perceptions of sleep improvement.

Disclosure

R. N. Adams: Employee; Virta Health Corp. S. J. Athinarayanan: Employee; Virta Health Corp. B. M. Volk: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S. D. Phinney: Stock/Shareholder; Virta Health Corp. Board Member; Virta Health Corp. Employee; Virta Health Corp. J. Volek: Stock/Shareholder; Virta Health Corp. A. L. McKenzie: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp.
620-P: Key Sociodemographic Factors and Food Packaging Attributes Associated with Poor Diet Quality among Rural Americans
Authors: QUINTERO ARIAS CAROLINA , RONY MELISSA , JENSEN ERICA , PRABU ANIRUDH , WISE NATHAN N. , DORAN KELLY , ANTHOPOLOS REBECCCA , ELBEL BRIAN , THORPE LORNA , LEE DAVID C.
Published: June 2023

Introduction: In addition to socioeconomic factors, residents in rural areas face unique challenges that contribute to poor diet quality. We assessed Alternative Healthy Eating Index (aHEI) scores among residents of a rural county in New York with documented poor health outcomes.

Methods: In 2021, we performed a cross-sectional survey of residents in Sullivan County, NY. This survey included questions on sociodemographics and a validated food frequency questionnaire (FFQ). We used multivariable linear regression to identify factors associated with lower aHEI scores, including: age, sex, race/ethnicity, household type, income, education, unemployment, disability, distance to grocery store, frequency of eating from canned foods and plastic-wrapped foods consumption (two attributes not captured in the FFQ), use of food support programs, food insecurity, housing insecurity, and difficulty meeting essential household and medical expenses.

Results. Of 1,356 respondents analyzed, aHEI scores followed a normal distribution (mean: 56.5, standard deviation: 12.0). Adjusting for other factors, respondents that did not enter high school had an average aHEI that was 9.7 points lower compared to those that had completed college. Respondents reporting disability or food insecurity had lower aHEI compared to those that did not (respectively 3.6 and 3.2 points lower). Respondents consuming canned foods most of the time had a 6.0 lower aHEI than those that never ate canned foods.

Discussion. We identified potentially modifiable risk factors for poor diet quality among rural residents. Efforts to reduce food insecurity along with better access to healthy foods in order to reduce canned food intake may be needed to address these rural health disparities.

Disclosure

C.Quintero arias: None. D.C.Lee: None. M.Rony: None. E.Jensen: None. A.Prabu: None. N.N.Wise: None. K.Doran: None. R.Anthopolos: None. B.Elbel: None. L.Thorpe: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)
622-P: Characteristics of Diabetes Remission in Patients with Type 2 Diabetes
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , VYAWAHARE ANAGHA R. , SHARMA BABY , GANLA MALHAR H. , DAS BISWAS MAYURIKA , SABOO BANSHI D.
Published: June 2023

Background: Lifestyle intervention in achieving Type 2 diabetes (T2D) remission is gaining increasing significance. We aimed to identify predictors of diabetes remission after a one-year lifestyle intervention program in the Indian population.

Materials and methods: The current study enrolled 4948 patients with diagnosed T2D (>18 years) who underwent a lifestyle modification program at Freedom from Diabetes clinic between April & December 2021. The intervention included a customized vegan diet, exercise, stress management support, along with conventional medical management. Anthropometric and biochemical parameters were monitored with scheduled consultations every 3 months. Post-intervention remission was defined as HbA1c<48mmol/mol for a minimum of 3 months in the absence of pharmacotherapy. The primary outcome measure was predictors of diabetes remission based on regression analysis.

Results: Post-intervention, data on 2764 patients were available for analysis where 837 (30.2%) achieved remission. Remission was significantly associated with intermittent fasting (during intervention), initial medication status (OHA, external insulin, both or never started medicines), age at onset, absolute change in HbA1c & body weight, HOMA-IR (post-intervention), and duration of diabetes.

Conclusion: T2D remission can be achieved in nearly one-third of the patients through lifestyle intervention. Few baseline (age at onset, duration of diabetes, medication status) and few post-intervention parameters (decrease in weight and HbA1c, HOMA-IR) are independently associated with predicting T2D remission in this Indian population.

Disclosure

P.Tripathi: Board Member; Freedom from Diabetes Clinic. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. B.Sharma: Research Support; Freedom From Diabetes clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. M.Das biswas: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.
623-P: Impact of a Low-Carbohydrate vs. Low-Fat Breakfast on Blood Glucose Control in Type 2 Diabetes
Authors: OLIVEIRA BARBARA , CHANG COURTNEY , FALKENHAIN KAJA , OETSCH KATIE , FRANCOIS MONIQUE E. , LITTLE JONATHAN P.
Published: June 2023

Postprandial hyperglycemia and glycemic variability are independent risk factors for cardiovascular disease and mortality in people living with type 2 diabetes (T2D). The highest glucose spike often occurs after the first morning meal, highlighting the major influence that breakfast has on overall glycemic control. We examined how advice and guidance to consume a low-carbohydrate (LC) versus standard dietary guidelines low-fat control (CTL) breakfast influenced glycemic control assessed by continuous glucose monitoring (CGM). Participants with T2D (N=121, 53% female, mean age 64 years) completed a remote 3-month parallel-group RCT comparing LC to CTL with 14-day CGM at the start and end of the intervention. Daily mean glucose, maximum glucose, area under the curve (AUC), mean amplitude of glycemic excursions, standard deviation (SD), and time above range (>10mmol/L) were all significantly lower, and time in range (3.9-10mmol/L) significantly higher, in the LC group versus CTL (all P<0.05). Post-breakfast mean and maximum glucose, SD and iAUC were also significantly lower in the LC group (all P<0.001). A low-carbohydrate breakfast appears to be a simple dietary strategy to improve several CGM metrics when compared to a typical dietary guidelines breakfast in persons living with T2D.

Disclosure

B.Oliveira: None. C.Chang: None. K.Falkenhain: None. K.Oetsch: None. M.E.Francois: None. J.P.Little: None.

Funding

Egg Nutrition Center; Egg Farmers of Canada
625-P: Psychosocial Factors Predict Health Care Usage in Young Adults with Youth-Onset Type 2 Diabetes—TODAY2 iCount Study
Authors: TRIEF PAULA M. , USCHNER DIANE , ANDERSON BARBARA , WEN HUI , BULGER JANE D. , WEINSTOCK RUTH S.
Published: June 2023

Background: Established diabetes care (“diabetes home”) and regular healthcare visits are important to achieve good outcomes. Nothing is known about psychosocial factors that predict healthcare usage (HCU) in young adults with youth-onset type 2 diabetes.

Objective: To identify psychosocial predictors of HCU in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.

Design: Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for covariates, were used to identify predictors of sub-optimal HCU (defined as no diabetes home, 0 routine care visits, ≥1 urgent care visit in prior 6 months).

Participants: N= 366 TODAY2 participants. Mean age=26.0 years, 67.8% female, 37.7% non-Hispanic Black, 35.8% Hispanic, 20.2% non-Hispanic white, mean HbA1c=9.4%.

Main measures: HCU survey; reliable, valid measures of diabetes self-efficacy, depressive symptoms, anxiety symptoms, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities and self-management support.

Key Results: 25.4% had no diabetes home, 23.7% had 0 routine care visits, 46% had ≥1 urgent care visit in prior 6 months. Beliefs in the necessity of (p<0.001), and concerns about (p=0.004), diabetes medicines, and diabetes having negative psychosocial impacts (p=0.034), predicted higher odds of having a diabetes home at T2. Beliefs that medicines are harmful predicted lower odds of having a diabetes home (p=0.006). Necessity beliefs (p=0.002), concerns (p=0.025), and self-management support (p=0.014) predicted higher odds of having ≥ 1 diabetes care visit in prior 6 months, harm beliefs predicted lower odds (p=0.005).

Conclusions: Sub-optimal healthcare usage is common in young adults with youth-onset type 2 diabetes and is predicted by beliefs about medicines and self-management support. We must address these factors to help this vulnerable group establish a stable foundation for diabetes care.

Disclosure

P.M.Trief: None. D.Uschner: None. B.Anderson: None. H.Wen: None. J.D.Bulger: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)
627-P: Cortisol-Based Measures of Stress Are Associated with Fasting Blood Glucose but Not Perceived Stress in Adolescents
Authors: SANOGO FATIMATA , WATANABE RICHARD M. , WEIGENSBERG MARC , RUTH AVAION
Published: June 2023

Objective: We previously showed that mind/body practices improve glycemic control in people with type 2 diabetes presumably by reducing stress and lowering stress biomarkers thereby reducing glycemia. The relationship between subjectively experienced stress and stress biomarkers and subsequent glycemic effects is not understood. Our objective was to determine if subjective stress predicts cortisol levels.

Methods: We examined 232 healthy, primarily Latino, adolescents (mean age=15.8 years, 70 males, all BMI categories). Stress was assessed using the 14-item questionnaire of perceived stress scale (PSS). Serum cortisol (sCOR) was measured at fasting. Salivary cortisol was measured 3 times daily (awakening, 30-min post-awakening, and evening) to assess Cortisol Awakening Response (CAR= 30-minute post-awakening - awakening) and Diurnal Cortisol Slope (DCS= evening-awakening). We performed multivariate regression to test association between PSS and sCOR and mixed effects regression to test association between PSS and CAR and DCS. Analyses were adjusted for age, sex, and BMI. Additional covariates (e.g. SES, ethnicity, etc.) gave similar results. Multivariate regression was used to assess association between PSS and fasting blood glucose (FBG), biomarkers of stress and FBG, a biologic outcome affected by stress.

Results: There was no association between PSS and sCOR (p= 0.40), CAR (p =0.26), DCS (p =0.38), or FBG (p = 0.47). There was a significant association between sCOR and FBG (β=0.02, p <0.001).

Conclusion: We found no evidence of association between PSS and biomarkers of stress. We further show an association between sCOR and FBG, but no association between PSS and FBG, suggesting PSS may measure a different aspect of stress than reflected in sCOR and diurnal cortisol patterns.

Disclosure

F.Sanogo: None. R.M.Watanabe: None. M.Weigensberg: None. A.Ruth: None.
64-OR: Trends in Racial, Ethnic, and Socioeconomic Inequalities in Diagnosed Diabetes Prevalence and Incidence among U.S. Adults, 2008–2021
Authors: SAELEE RYAN , HORA ISRAEL A. , PAVKOV MEDA E. , IMPERATORE GIUSEPPINA , BENOIT STEPHEN R. , HOLLIDAY CHRISTOPHER S. , BULLARD KAI M.
Published: June 2023

We examined national trends in racial, ethnic, and socioeconomic status (SES) inequalities for diagnosed diabetes prevalence and incidence. Self-reported data were from adults aged ≥18 years in the National Health Interview Survey 2008-2021. Annual prevalence and incidence estimates were age-standardized to the 2010 U.S. Census population. Absolute measures of inequality in diagnosed diabetes prevalence and incidence included between-group variance (BGV) for race and ethnicity (nominal categories) and the slope index of inequality (SII) for SES (educational attainment and family poverty-to-income ratio (PIR) ordinal categories). We calculated BGV and SII for each year along with the average annual percent change (AAPC) to assess trends in inequalities over time. PIR inequalities in diabetes prevalence increased (AAPC for SII: -1.7%, p=.010) while racial and ethnic (AAPC for BGV: -10.9%, p=.010) and education (AAPC for SII: 5.8%, p=.001) inequalities in diabetes incidence decreased over time (Figure). From 2008-2021, racial, ethnic, and education inequalities in diagnosed diabetes incidence improved but persisted. Income-related inequalities in diagnosed diabetes prevalence worsened over time. To close these gaps, future research could focus on identifying factors driving these trends including the contribution of morbidity and mortality.

Disclosure

R.Saelee: None. I.A.Hora: None. M.E.Pavkov: None. G.Imperatore: None. S.R.Benoit: None. C.S.Holliday: None. K.M.Bullard: None.
640-P: Coping Strategies, Quality of Life, and Glycemic Control among Adolescents with Diabetes Distress
Authors: STRATON EMMA , INVERSO HAILEY , STREISAND RANDI , JASER SARAH S.
Published: June 2023

Objective: Up to half of adolescents with type 1 diabetes (T1D) experience diabetes distress (DD) which has been associated with lower health-related quality of life (HRQOL) and suboptimal glycemic control. The ways in which adolescents respond to DD may serve as a risk or protective factor for these outcomes, but few studies have examined the coping strategies adolescents use to manage DD.

Methods: Participants included 198 adolescents with elevated DD who completed baseline data for a randomized controlled trial (Mage 15.3±1.4, 58% female, 58% Non-Hispanic White, MT1D duration 6.4±3.7 years, MA1c = 9.2±2.2%). Adolescents completed the Responses to Stress Questionnaire, assessing coping strategies related to diabetes stressors. Subscales include primary control engagement coping (e.g., problem solving), secondary control engagement coping (e.g., positive thinking), and disengagement coping (e.g., avoidance). Adolescents also completed the Type 1 Diabetes and Life (T1DAL) measure of HRQOL. HbA1c data were gathered from medical records or at-home kits. The association of coping strategies with HRQOL and HbA1c was examined among adolescents experiencing DD.

Results: Bivariate correlations revealed that higher use of primary and secondary engagement coping strategies was associated with higher HRQOL (r=0.58; r=0.58, respectively), while higher use of disengagement coping strategies was associated with lower HRQOL (r=−0.51). Higher use of primary engagement coping strategies was associated with lower HbA1c (r=−0.21) while higher use of disengagement strategies was associated with higher HbA1c (r=0.17); all p<0.05.

Discussion: Among a diverse group of adolescents experiencing DD, the use of engagement coping strategies was significantly correlated with higher HRQOL and lower HbA1c. These results highlight the value in promoting engagement coping strategies and discouraging the use of disengagement coping strategies among adolescents experiencing DD.

Disclosure

E.Straton: None. H.Inverso: None. R.Streisand: None. S.S.Jaser: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)
643-P: Engagement of Young Adults with Type 1 Diabetes (T1D) in a Virtual Young Adult Diabetes Clinic as a Component of Transition from Pediatric to Adult Diabetes Care
Authors: PANDHARPURKAR TEJAL H. , TWEET RYAN D. , PARK JULIE J. , HEYERMAN TESS , O'NEIL KELLY , GUTTMANN-BAUMAN INES , JOARDER FARAHNAZ
Published: June 2023

Objectives: Young adults with Type 1 Diabetes (T1D) face unique challenges with engaging in care as they transition from the pediatric to the adult setting. The Young Adult Diabetes Clinic (YADC) is a multidisciplinary clinic that includes a group clinic, combining endocrinology, diabetes education, and behavioral health. Due to the COVID-19 pandemic, the need for a virtual YADC group clinic arose. We sought to understand how this virtual setting could impact engagement as compared with the in-person model.

Methods: We conducted a retrospective cohort study comparing in-person to virtual engagement, characterized by three central measures: rates of scheduled group visits after referral, rates of attended group visits after scheduling, and rates of follow-up after attending a group visit. A z-test was used to compare proportions of no-shows and lost-to-follow-ups between the in-person and virtual attendees.

Results: Two hundred and seventy-one patients were referred to the YADC between December 2017 and December 2022. Out of those, 149 (54%) scheduled a group visit. Subsequently, 112 scheduled patients attended a group visit. Sixty-one (54%) attended a virtual group visit, compared to 51 (46%) in-person. Out of these attendees, 45 (62%) in-person attendees followed-up subsequently with a member of the care team, and 28 (38%) virtual attendees. No-show rates were significantly higher in the virtual population at 35% vs. 4% in-person (P=.002). Lost-to-follow-up rate was 27% in the virtual population and 12% in-person, (P=.07).

Conclusions: Young adults with T1D face significant barriers to engagement that virtual medicine may help overcome. This data illustrates the continued challenges with engaging young adults in the virtual setting, and need for further understanding of what other factors may influence follow-up in this patient population.

Disclosure

T.H.Pandharpurkar: None. R.D.Tweet: None. J.J.Park: None. T.Heyerman: None. K.O'neil: None. I.Guttmann-bauman: None. F.Joarder: None.
644-P: Experiences of Community and Health Care Organizations Delivering the National DPP Lifestyle Change Program
Authors: FORMAGINI TAYNARA , REZWAN ARIBA , RODRIGUEZ DAPHNEE , PENG NG BOON
Published: June 2023

The CDC National DPP lifestyle change program (LCP) is delivered by community and healthcare organizations nationwide to prevent or delay the onset of type 2 diabetes in adults with prediabetes. CDC recognition status assures fidelity and quality in delivering the program but receiving and maintaining it can be challenging. Using a pilot online semi-structured questionnaire, we explored the experiences of community and healthcare organizations delivering the National DPP LCP in receiving and maintaining CDC recognition. Participants were recruited from organizations delivering the National DPP LCP, prioritizing organizations in counties with low socioeconomic status. Participants were asked to discuss the challenges and facilitators their organizations faced in delivering the LCP and in achieving and maintaining CDC recognition. Thematic analysis was used to analyze and report emerging themes. A total of 25 participants completed the questionnaire (all from low SES counties). Our results indicate funding availability was the main facilitator in delivering the program, along with strong partnerships with community organizations and a dedicated team. Barriers to achieving and maintaining CDC recognition to deliver the program included difficulties recruiting and retaining participants, and issues securing funding to cover program costs. Participants reported that easing requirements to achieve/maintain recognition, increasing training opportunities, advocating for better reimbursement, and supporting network development between community organizations can increase the program's sustainability. Our findings highlighted barriers/facilitators related to the success of delivering the National DPP LCP and achieving/maintaining CDC recognition. Strategies to reduce those barriers and promote those facilitators should be considered.

Disclosure

T.Formagini: None. A.Rezwan: None. D.Rodriguez: None. B.Ng: None.

Funding

University of Central Florida
647-P: Patient Preferences Informing Choice of Second-Line Type 2 Diabetes Medications
Authors: GOLEMBIEWSKI ELIZABETH , GARCIA ANDREA E. , POLLEY ERIC , UMPIERREZ GUILLERMO , GALINDO RODOLFO J. , BRITO JUAN , MONTORI VICTOR M. , MICKELSON MINDY , MCCOY ROZALINA G.
Published: June 2023

Available second-line glucose-lowering medications for type 2 diabetes (T2D) have variable efficacy and side effect profiles, administration requirements, and impacts on short-term and long-term health outcomes. Therefore, medication choice is informed by each patient's clinical needs and personal preferences. However, patient rationale for selecting a second-line medication for T2D is not well understood. In this mixed methods study, 40 adults with T2D across 2 health systems in the U.S. completed an individual ranking activity, sorting 16 health outcomes and 8 medication attributes by relative importance and providing context on ranking decisions. Participants were between 45-64 years old (38%), non-Hispanic White (50%) or Black (38%), 15% Hispanic, and 55% women. For health outcomes, the highest proportion of patients ranked blindness (63%), death (60%), heart attack (48%), or heart failure (48%) as very important. For medication attributes, most participants indicated that greater efficacy with respect to lowering hemoglobin A1c was very important (68%), followed by oral administration (45%) and absence of gastrointestinal side effects (38%). Combinations of outcomes and attributes ranked as very important were highly heterogeneous across individual participants, with only 2/40 patients ranking the same combination. Qualitative findings indicated that outcome importance is a function of perceived severity, susceptibility, personal relevance, preventability, and potential life impacts. For medication attributes, most participants emphasized the primary importance of lowering blood glucose and hemoglobin A1c, while treatment processes and side effects were secondary and largely idiosyncratic to the patient's lifestyle, prior experiences, and preferences. Findings underscore the importance of engaging patients in conversations about goals and preferences for care and contextualizing therapeutic decisions in patient-described priorities for T2D management.

Disclosure

E.Golembiewski: None. A.E.Garcia: None. E.Polley: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. V.M.Montori: None. M.Mickelson: None. R.G.Mccoy: Consultant; Emmi.

Funding

Patient-Centered Outcomes Research Institute (DB-2020C2-20306)
649-P: Preliminary Outcomes of a Transition Intervention with Adolescents and Young Adults (AYAs) with Type 1 Diabetes (T1D)
Authors: MONAGHAN MAUREEN , BRYANT BREANA L. , WANG CHRISTINE H. , BOST JAMES E. , STREISAND RANDI
Published: June 2023

Introduction: The transition from pediatric to adult diabetes care is particularly risky for AYAs with T1D. We evaluate preliminary outcomes of a behavioral intervention targeting AYA health communication, T1D self-care, and transition readiness.

Methods: 52 AYAs (48.1% male; 48.1% non-Hispanic White; M age=20.63±1.10 yrs) enrolled in Planning, Reflecting, and Engaging with Providers for Diabetes Care (PREP-DC) and were randomized to intervention (Int; n=26) or standard care (SC; n=26) groups. AYAs reported on communication, T1D self-care, and transition readiness at baseline and 4 mos (1 mo post-intervention); A1c was taken from medical records. AYAs rated satisfaction with PREP-DC participation (1-5; 5=extremely satisfied). T-tests examined change from baseline to follow-up and by group.

Results: At follow-up, 51 AYAs (98%) completed questionnaires and 37 (71%) had A1c data. AYAs reported improvements in communication, T1D self-care, and transition readiness (Table 1), with few group differences. Both groups reported high satisfaction with participation (Int M=4.41±.59; SC M=4.45±.60).

Discussion: AYAs were engaged in a behavioral trial promoting health communication; the Int group did not demonstrate significant improvements as compared to SC. Future analyses will evaluate final follow-up outcomes (8 mos post-intervention), including transfer to adult care.

Disclosure

M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.L.Bryant: None. C.H.Wang: None. J.E.Bost: None. R.Streisand: None.

Funding

American Diabetes Association (1-18-ACE-27 to M.M.)
652-P: Understanding the Impact of Insulin Affordability Challenges across Demographic Groups and on Mental Well-Being in the U.S.
Authors: XU EMILY , ZENG ALISON , BELL TREVOR , BRISTOW TRACY L.
Published: June 2023

Over 30% of people with diabetes (PWD) in the United States require insulin to manage their diabetes, and the rising cost of insulin over the past two decades has put a large financial burden on many of these PWD. This study aimed to understand differences in insulin affordability challenges across demographic groups and their association with mental well-being.

In 2022, 2,794 insulin-using adult PWD in the U.S. responded to three online questionnaires in which they reported challenges affording their insulin in the past 6 months and the mental health burden of their diabetes. Respondents also answered the 5-item WHO-5 Well-being Index. Results were analyzed across demographic groups (58% type 1, 66% female, 85% white).

The prevalence of insulin affordability challenges was highest among Black/African American PWD (20%) compared to Hispanic/Latinx (12%) and white PWD (11%). Among those who had challenges affording insulin, non-white respondents were more likely to experience these challenges “all of the time” compared to white respondents (39% vs. 23%, p=.015).

PWD who struggled to afford their insulin were more likely to have a poor well-being score as measured by the WHO-5 compared to those who did not (p<.001). They were also more likely to agree that diabetes management takes too much effort (p<.01) and that they felt overwhelmed by their diabetes (p<.001), unmotivated to manage their diabetes (p<.001), and burned out by their diabetes (p<.001).

PWD who struggle to afford their insulin have a higher prevalence of poor well-being and mental burden from their diabetes. These issues may disproportionately affect certain racial minority groups, among whom insulin affordability challenges are higher in prevalence and frequency. As new legislation capping insulin out-of-pocket costs come into effect this year, it will be important to understand how they impact inequalities in access to medical needs and quality of life for PWD.

Disclosure

E.Xu: Employee; dQ&A. A.Zeng: Employee; dQ&A. T.Bell: Employee; dQ&A. T.L.Bristow: Employee; dQ&A.
653-P: Associations between Anxiety and Depression Levels and Hypoglycemia Awareness and Beliefs in Long-Term Advanced Diabetes Technology Users with Type 1 Diabetes (T1D)
Authors: KUEI LIN YU , AIKENS JAMES E. , YE WEN , PIATT GRETCHEN , FISHER SIMON , BUSUI RODICA
Published: June 2023

The information characterizing anxiety and depression levels and associated factors in long-term T1D advanced diabetes technology users is sparse. A cross-sectional observational study in T1D adults using continuous glucose monitors (CGMs) ≥1 year was conducted in a tertiary academic medical center. The Hospital Anxiety and Depression Scale was used to evaluate anxiety levels (HADS-A) and depression levels (HADS-D). CGM % of time with glucose <70 mg/dL, hypoglycemia awareness (measured with Gold questionnaire), hypoglycemia beliefs (with Attitude to Awareness of Hypoglycemia questionnaire) and demographic information were collected. Multivariable linear regression was used to identify factors associated with higher HADS-A and HADS-D. Among 196 participants (63% female; mean±SD age 47±16; 91% non-Hispanic Caucasian; 80% using insulin pumps with 55% closed-loop pump users), mean±SD HADS-A was 6.5±4.0 (40% scores≥8), HADS-D was 4.1±3.1 (15% score≥8), and % of CGM time <70 mg/dL was 2.0±3.0%; 34% had impaired hypoglycemia awareness. Higher HADS-A was independently associated with less time with glucose <70 mg/dL, female sex, younger age, lower hypoglycemia awareness, weaker hypoglycemia concern minimization, and stronger hyperglycemia avoidance prioritization (P<0.05). Higher HADS-D was independently associated with less time with glucose <70 mg/dL, lower hypoglycemia awareness, and stronger hyperglycemia avoidance prioritization (P<0.05).

In summary, clinically significant anxiety and depression presented in 40% and 15% of T1D patients using advanced diabetes technologies, respectively. Hypoglycemia awareness and hypoglycemia beliefs, rather than time spent in hypoglycemia, were associated with greater anxiety and depression levels. Attention to hypoglycemia awareness, hypoglycemia beliefs and mental health are needed to improve overall outcomes in T1D advanced technology users.

Disclosure

Y. Lin: None. J.E. Aikens: None. W. Ye: None. G. Piatt: None. S. Fisher: None. R. Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp. Research Support; Novo Nordisk. Consultant; Novo Nordisk, Roche Diagnostics. Research Support; Medtronic, National Institutes of Health. Consultant; Procter & Gamble.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724); Michigan Center for Clinical and Translational Research (P30DK092926)
66-LB: Poor Sleep Is Correlated with Higher Parenting Stress in Women Who Have Had Gestational Diabetes
Authors: PARK MINSUN , SONG YOUNGKWAN , CHU MINSEUNG , QUINN LAURIE T.
Published: June 2023

Background: Theoretically, women who have had GDM are likely to have increased stress levels following pregnancy related to parental stress exacerbated by concerns about personal health (e.g., development of T2DM). Such stress may negatively impact sleep, however, the relationship between parenting stress and sleep in women who have had GDM has not been well investigated. Therefore, the purpose of the study was to explore the correlations between sleep and parenting stress in people who have had GDM.

Methods: Twenty-six woman (ages: 34.22 ± 3.51 years; ethnicity: African American [38.46%], Hispanic [30.77%], Caucasian [19.23%], and Asian [11.54%]; A1C: 5.78 ± .98 %; BMI: 36.28 ± 10.70; age of child from GDM pregnancy: 6.07 ± 3.95 months; number of children: range1-6; months of postpartum: 6.06 ± 3.96) who had GDM on the previous pregnancy completed self-reported questionnaires. These included Parenting Stress Index (PSI-4, SF), PROMIS Global Health-Physical (v.1.2;2a), PROMIS Fatigue (v.1.0;8a), PROMIS Sleep Disturbance (v.1.0;8b), and PROMIS Sleep-Related Impairment (v.1.0;8a). The Spearman’s correlation was used to analyze data using STATA 17.0.

Results: The mean total score on the Parenting Stress Index was positively correlated with PROMIS Fatigue (Spearman’s r = 0.61, p < .01); PROMIS Sleep Disturbance (r = 0.61, p < .001); and PROMIS Sleep-Related Impairment (r= 0.57, p < .001). On the other hand, the mean total score on the Parenting Stress Index was negatively correlated with PROMIS Global Health-Physical (r = -0.58, p < .01), and was not correlated with A1C and BMI.

Conclusion: In this glucose intolerant group of women with previous GDM, parenting stress was correlated with fatigue alone with sleep disturbances and impairments. In addition, parenting stress was negatively correlated with individuals’ assessment of their health. Finding suggested that it is necessary to explore the associations between parenting stress, sleep, and glucose metabolism in women who have had GDM.

Disclosure

M. Park: None. Y. Song: None. M. Chu: None. L. T. Quinn: None.
661-P: Associations of Food Security Status with Diet Quality and Glycemic Control over Two Years in Adults with Type 2 Diabetes on Medicaid
Authors: GU KRISTINE D. , CHENG JESSICA , MCGOVERN SYDNEY H. , MCCURLEY JESSICA L. , LEVY DOUGLAS E. , FUNG VICKI , CLARK CHERYL , THORNDIKE ANNE N.
Published: June 2023

Background: Little is known about the association of food insecurity (FI) with changes in diet quality and hemoglobin A1c (HbA1c) over time in people with type 2 diabetes (T2D).

Methods: In an analysis of adults with Medicaid and T2D enrolled in a longitudinal cohort study in 2020, demographics, depression (Patient Health Questionnaire-8 [PHQ-8]), food security status (USDA Food Security Module), Healthy Eating Index-2015 (HEI-15) diet quality scores, and other social determinants of health were assessed with annual surveys. Primary outcomes were HEI-15 and HbA1c, obtained from electronic health records. Separate propensity-score adjusted linear mixed models with a random intercept were used to test associations of baseline FI with changes in HEI-15 and A1c over 2 years.

Results: Of 846 participants, 133 (16%) had T2D at baseline; 79 (59.4%) of those with T2D had FI. Those with baseline FI vs. food security had higher PHQ-8 scores and prevalence of housing instability, financial stress, and cost-related barriers to care (p<0.05). Over 2 years, changes in HEI-15 (p=0.45) and HbA1c (p=0.86) did not differ by baseline food security status (Table 1).

Conclusion: In adults with T2D on Medicaid, diet quality remained low and HbA1c high over 2 years regardless of food security status, highlighting the importance of addressing nutrition when managing T2D in Medicaid patients.

Disclosure

K.D.Gu: None. J.Cheng: None. S.H.Mcgovern: None. J.L.Mccurley: None. D.E.Levy: None. V.Fung: Other Relationship; Vertex Pharmaceuticals Incorporated, Stock/Shareholder; Vertex Pharmaceuticals Incorporated. C.Clark: None. A.N.Thorndike: None.

Funding

National Institutes of Health (T32DK007028, 5T32HL098048, R01DK124145)
664-P: Efficacy of a Digital Diabetes Logbook for Reducing Treatment Burden—Results of a Randomized Controlled Trial
Authors: EHRMANN DOMINIC , HERMANNS NORBERT , SILBERMANN STEPHAN , KOBER JOHANNA , FINKE-GROENE KATHARINA , ROOS TIMM , VESPER IRIS , SCHAEFER VANESSA L. , KULZER BERNHARD
Published: June 2023

The digital diabetes logbook mySugr is designed to help people with diabetes manage their diabetes and to reduce burden of diabetes management. To test the efficacy of the app, a randomized controlled trial (RCT) was conducted.

The RCT was designed as a multi-center, open-label, parallel study with a 3-month follow-up in Germany. Participants were randomized to either using the mySugr app or to the treatment-as-usual control group in a 2:1 ratio. Primary outcome was change in diabetes distress using the Problem Areas in Diabetes (PAID) questionnaire. Based on the power analysis, the recruitment goal was 396 participants, anticipating 15% drop-out it was planned to recruit 466 participants. Robust regression was used to analyze the data with follow-up scores as dependent variable, group as independent variable and controlled for respective baseline scores. Primary analysis was based on the intention-to-treat population with jump-to-reference approach for multiple imputation of missing data.

A total of 424 people with diabetes were randomized, 282 to the intervention and 142 to the control group (12.5% type 1 diabetes, 68.2% type 2 diabetes, 18.9% gestational diabetes, age: 51.7±15.2 years, 50% female, diabetes duration: 9.5±10.8 years, A1c: 7.1±1.5%, PAID: 21.6±17.4); 397 completed the 3-month follow-up. Intention-to-treat analysis revealed a significant between-group difference in the primary outcome (p = 0.0182). PAID scores at follow-up in the mySugr group were significantly lower than in the control group (Δ -2.20, 95% CI: -4.02 to -0.38). This was corroborated by the per-protocol analysis (Δ -2.43, 95% CI: -4.49 to -0.37, p = 0.0211).

Recruitment was successful and could be stopped earlier due to the very low drop-out rate (6.4%). Use of mySugr led to a significant improvement in diabetes distress after 3 months compared to the treatment-as-usual control group. Thus, the efficacy of mySugr regarding the reduction of diabetes distress could be demonstrated in the RCT.

Disclosure

D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. S.Silbermann: Employee; Roche Diabetes Care. J.Kober: Employee; mySugr. K.Finke-groene: None. T.Roos: None. I.Vesper: None. V.L.Schaefer: Employee; Roche Diabetes Care. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care.

Funding

Roche Diabetes Care GmbH (DC000097)
667-P: Enrollment Characteristics of Adults Aged 18–44 in the National Diabetes Prevention Program (National DPP)
Authors: BELL MIRIAM , PAPALII MICHELLE , VAN AACKEN SUSAN , ELY ELIZABETH
Published: June 2023

The Centers for Disease Control and Prevention (CDC) estimates that 96 million adults aged 18 years or older had prediabetes in 2019. Of these, 32.2 million, or 33.5%, were aged 18-44, emphasizing the need for efforts to prevent or delay onset of type 2 diabetes within this population. CDC's National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations collaborating to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes or at high risk. While the mean age of participants in the LCP is 51 years, 31.6% of the participants enrolled as of October 2022 were in the 18-44 age group. When examining the characteristics of this age group, 52.1% of participants identified as non-Hispanic or Latino White, 18.4% identified as Hispanic or Latino, and 12.9% identified as non-Hispanic or Latino Black or African American. Overall, 71.4% of participants in this group enrolled in an online program and 81% participated through a worksite wellness program. For those who had the opportunity to complete the year-long LCP, the mean number of days spent in the program was 110. By comparison, among 45-64-year-olds, the mean number of days spent in the program was 161, and for those 65 and older, the mean number of days was 210. This is of note because participants who stay in the LCP longer are more likely to meet the risk reduction outcomes. Participants 18-44 met the programmatic risk reduction 5% weight loss goal at a lower rate (18.4%) than participants aged 45-64 (27%) and 65 and over (40.2%). These findings highlight the opportunity to develop strategies focused on supporting this younger adult population to enroll in and complete the LCP.

Disclosure

M.Bell: None. M.Papalii: None. S.Van aacken: None. E.Ely: None.