bluuebunny/crossref_metadata_2025 huggingface dataset:
Cortisol Synthesis Enzyme CYP11B1 as Tissue Biomarker for Diabetic Foot Ulcers
Authors: VILEIKYTE LORETTA , SHEN BIING-JIUN , PASTAR IRENA , BOULTON ANDREW J. , KIRSNER ROBERT , TOMIC-CANIC MARJANA , HARDMAN MATTHEW
Published: June 2018

An urgent need exists to identify predictive biomarkers to guide management of diabetic foot ulcers (DFUs). The steroid hormone, cortisol, is elevated in chronic inflammatory states and its pathogenic role and/or prognostic role for poor outcomes across a range of diseases has been suggested. However, the role of cortisol in DFUs is not well understood and the significance of local, tissue-specific cortisol regulation in DFUs remains unclear. We performed a multi-center study of 63 well vascularized, superficial neuropathic, non-infected DFU subjects receiving standard care and used wound biopsy obtained at baseline study to quantify expression levels (via immunohistochemistry) of the major cortisol synthesis enzymes CYP11B1 and 11BHSD1, and other inflammatory cytokines. Subjects were predominantly men in their late-fifties (58±10 years) with poor glycemic control (HbA1C 8.9±2.3%); while hemoglobin (12.6±1.8g/dl), creatinine (1.27±0.5mg/dl) and albumin (4.1±0.42g/dl) were within the normal range. We found high cutaneous levels of CYP11B1 strongly linked to failure to heal DFUs at 6 weeks (p≤0.016), while 11BHSD1 did not correlate with healing (p=0.351). In the logistic regression analyses controlling for demographics and disease characteristics, higher levels of CYP11B1 (10-based log-transformed) were predictive of non-healing of DFU at 6 weeks (OR = 6.83, p =.010). High local tissue levels of the pro-inflammatory TNFalpha were also significantly associated with lack of ulcer healing (p≤0.019). This observation is consistent with reports that TNFalpha is essential for local induction of CYP11B1. In turn, local induction of CYP11B1 and subsequent induced tissue cortisol levels activate membranous glucocorticoid receptor triggering PLC/PKC/GSK-3beta/beta-catenin pathway that inhibits healing. Taken together, these data suggest CYP11B1 is a potential predictive biomarker for DFU outcomes, and may serve as a future target for therapeutic interventions.

Disclosure

L. Vileikyte: None. B. Shen: None. I. Pastar: None. A.J. Boulton: None. R. Kirsner: None. M. Tomic-Canic: None. M. Hardman: None.
Diabetes Foot Wound Healing—A Collaborative Approach
Authors: MCNULTY JACQUELINE N. , LEWIS BRANDON J. , LA FONTAINE JAVIER , ROSE APRIL , GOMEZ MIRIAM , MENEGHINI LUIGI , GUNASEKARAN UMA , RUIZ MARIA S.
Published: June 2018

There exists limited data demonstrating that glycemic control can improve healing of diabetic foot wounds. From March through December 2017, patients followed in the Foot Wound Clinic of a large urban safety net health system were concurrently seen by diabetes specialists to determine whether improving glycemic control via an integrated treatment approach impacted wound healing. This pilot study is the first to examine the effect of diabetes specialty co-management with podiatric care of diabetic foot wounds.

Sixty patients were included in the analysis of this pilot program and were followed for an average of 220 days. Patients were classified as having either improved glycemic control (IGC) or non-improved glycemic control (NIGC) defined as < 1% HbA1c change at study end. Cohort characteristics and outcomes are summarized in Table 1. All patients had aggressive diabetic foot care including wound debridement and appropriate antibiotic therapy as determined by their podiatrist.

Ulcers worsened in 47% of NIGC patients compared to 13% of IGC patients with IGC patients having an average HbA1c reduction of 2%. With both NIGC and IGC groups receiving similar wound management, 63% of NIGC patients had decreased ulcer volume compared to 87% of IGC patients, suggesting that improving glycemic control, in collaboration with diabetes specialist co-management, contributes to improved wound healing and a trend for decreased resource utilization.Table 1. Cohort characteristics and study outcomesIGCNIGCp-valueTotal No. of patients3030Total No. of ulcers3641Median ulcer size (mm3)BaselineStudy End170010040Patients with improved ulcer healing, n (%)26 (87)19 (63)0.04HbA1c, mg/dLBaselineStudy End10.68.210.211.10.47<0.005Hypertension, n (%)Pre-existingControlled at baselineControlled at study end25 (83)19 (63)19 (63)24 (80)16 (53)21 (70)ED visitsTotal visitsAverage No. of visits per patientFoot relatedDiabetes related351.9104502.32620.190.020.38Average number of podiatric appointments570.92No. of patients seen by Diabetes specialistAverage No. of specialist visits per patientNo. of patients seen in co-management visitNo. seen in sporadic visitNo visits252.32505242.81686Lost to follow-up with diabetes specialist, n (%)13 (43)15 (50)

Disclosure

J.N. McNulty: None. B.J. Lewis: None. J. La Fontaine: None. A. Rose: None. M. Gomez: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. U. Gunasekaran: None. M.S. Ruiz: None.
Osteomyelitis and Neuropathic Ulcers in Forefoot—Amputation Is the Only Surgical Intervention Resolving?
Authors: SKOUTAS DIMITRIOS , SAYEGH FARES , METALLIDIS SYMEON , SGOUTZAKOS SOKRATIS , KATSANOS IOANNIS , GEORGA STAMATA , NIKOLAIDIS ATHANASIOS , DOUKAS LOUKAS , MATOPOULOU ELENA , TESFAYE SOLOMON , MANES CHRISTOS , TZATZAGOU GLYKERIA
Published: June 2018

Background and Aim: The aim of this study is to show a simple therapeutic method in cases of neuropathic ulcer complicated by osteomyelitis in the forefoot to resolve this complication avoiding amputation.

Patients-Methods: Our material consists of 28 patients (19 males, 9 females) with “diabetic foot” aged 57,31±10,25 years, mean HbA1c: 8,65±1,7%, of duration of diabetes 13,84±9,2 years and 32% of them are active smokers. NDS, VPT, ABI are measured. All of them had neuropathic ulcers located in the forefoot and 10 of them had previous amputations. The average duration of the ulcer was 1 year complicated with osteomyelitis in admission time. The diagnosis of osteomyelitis was made with MRI, RX, probe-to-bone test and verification of elevated ESR and CRP. We start with the collection of the cultures (bone sample in 6 of 28 patients) and antibiotic treatment according the cultures. After the diagnosis of osteomyelitis we proceeded to prepare a surgical field and through the ulcer we removed the infected bone-phalanx taking a bone sample for microbiological study. After we scraped and cleaned the cavity well, a 48-hour drain was placed and becomes transdermal wound suture if is a necessary. The duration of the antibiotic treatment depends from the lesion area, the results of microbiological culture and varies from 4-6 weeks to 4-6 months.

Results: After practicing this technique all cases were healed at an average 40 days with an effective offload and an appropriate topical care to keep the ulcer clean and with an optional moisture. The duration of hospitalization 2-8 days depending on the severity of the infection.

Conclusion: It is essential to raise other less invasive and conservative methods than amputation. Specially in those with good distal arterial perfusion that in many cases are young, the avoidance of a amputation has many benefits in their quality of life. Finally, the applied method is rapid inexpensive without disturbing the biomechanical balance of the foot to a large extent.

Disclosure

D. Skoutas: None. F. Sayegh: None. S. Metallidis: None. S. Sgoutzakos: None. I. Katsanos: None. S. Georga: None. A. Nikolaidis: None. L. Doukas: None. E. Matopoulou: None. S. Tesfaye: Speaker's Bureau; Self; Pfizer Inc.. Other Relationship; Self; Janssen Pharmaceuticals, Inc., Takeda Development Centre Europe Ltd.. Advisory Panel; Self; Wörwag Pharma GmbH & Co. KG. C. Manes: None. G. Tzatzagou: None.
Single Cell RNA-Seq Analyses of Healthy Lower Extremity Skin and Diabetic Foot Ulcers Uncover Distinct Immune Landscape of Diabetic Wound Healing
Authors: THEOCHARIDIS GEORGIOS , BHASIN SWATI S. , KOUNAS KONSTANTINOS , BHASIN MANOJ K. , VEVES ARISTIDIS
Published: June 2018

Fifteen percent of diabetes mellitus (DM) patients are expected to develop a diabetic foot ulcer (DFU) within their lifetime. DFUs represent an ever increasing burden for the healthcare system. Chronic wounds, lack the linear progression from one classical phase of healing to the next and are mainly characterized by the persistence of the inflammatory phase. To define the transcriptome landscape of healthy uninjured skin, DM and DFU skin, we performed transcriptome profiling on skin specimens from foot surgeries obtained from 4 controls, 4 DM patients without DFU and on samples from 2 DM patients after DFU debridement . We generated the single cell transcriptome profiles of 3,766 and 3,469 cells from non-DM and DM patients and of 660 cells from patients with active DFUs. Further, bioinformatics analysis identified clusters of cells with similar transcriptome states. The most abundant cell type was fibroblast. Other clusters included adipocytes and endothelial cells. T-cells, monocytes, and macrophages were the main immune cell types identified. As macrophages are critical for healing of DFUs, we estimated the abundance of total macrophages and their polarization. Approximately 10% of cells were macrophages in each group while DFU group had significantly more M1 polarized as compared to M2 (M1/M2=2.4 times). Supervised analysis identified a set of 66 and 1genes that are significantly differentially expressed in macrophages of DFU and DM patients respectively as compared to controls. A master regulator (MR) analysis in DFU patients identified activation of inflammatory and angiogenesis related MRs (e.g., STAT3, IL15). while in DM patients it identified activation of distinct inflammatory MRs (e.g., SMAD3, CD44).

In summary, we present for the first time sc-RNAseq data on lower extremity skin samples that could help delineate the molecular mechanisms of dysregulated wound healing and identify novel therapeutic targets.

Disclosure

G. Theocharidis: None. S.S. Bhasin: None. K. Kounas: None. M.K. Bhasin: None. A. Veves: Advisory Panel; Self; HyperMed Imaging, Inc., AOBiome.
Barriers and Facilitators to Perceived Diabetes Self-Management in Arab Americans with Diabetes
Authors: MASRI DANA EL , PIATT GRETCHEN , KOSCIELNIAK NIKOLAS J. , JABER LINDA
Published: June 2018

Arab Americans (AAs) are at increased risk of type 2 diabetes, with a reported prevalence of 18%. Despite the increasing prevalence, there remains a lack of data on diabetes self-management (DSM) practices and barriers to care in this population. The purpose of this study was to assess patient perceptions of DSM behaviors in order to facilitate individualized care plans by providers. A 39-item survey was created based on focus group discussions designed to understand the impact of AA culture on DSM. The survey assessed diet, adherence to medications, exercise, healthy lifestyle, and family support. Two hundred AAs with diabetes completed the survey via face-to-face interviews. Most participants were above fifty years of age (79%), females (59%), and originated from Lebanon (73%). Individuals receiving Arabic instructions perceived that good portion control (p=0.07), food selection (p=0.01), and maintaining a healthy lifestyle (p=0.003) were important DSM behaviors, compared to those who did not receive Arabic instructions. Unemployed individuals were less likely to perceive regular exercise (p=0.05), portion control (p=0.06), and maintaining a healthy lifestyle (p=0.08) as important DSM behaviors compared to employed individuals. Individuals who had family support and encouragement were more likely to perceive that discussions with their clinicians were important (p=0.003) compared to those without family support. Individuals with family who understood their food choices were more likely to perceive regular exercise (p=0.03) as important compared to those with families who did not understand food choices.

In conclusion, this survey may serve as a valuable tool for providers to assess perceptions surrounding DSM behaviors in order to provide patient-centered care that will help to improve patient outcomes. This study supports the importance of integrating cultural influences into DSM education and support when providing care to a population with a strong cultural identity.

Disclosure

D. El Masri: None. G. Piatt: None. N.J. Koscielniak: None. L. Jaber: None.
Insomnia Is Associated with an Increased Risk of Type 2 Diabetes in the Clinical Setting
Authors: LEBLANC ERIN , SMITH NING , ALLISON MICHAEL , NICHOLS GREGORY , CLARKE GREG
Published: June 2018

Aims: Determine association between insomnia and risk of type 2 diabetes (T2DM).

Methods: We conducted a retrospective panel cohort study to examine risk of developing T2DM among prediabetes patients with and without insomnia (physician identified or insomnia medication dispense). Participants with prediabetes (physician identified or by 2 laboratory tests) between 1/1/2007 and 12/31/2015 were followed until 12/31/2016. Patients were determined to have T2DM when two of the following occurred within 2 years: physician-entered outpatient T2DM diagnosis, dispensing of an anti-hyperglycemia agent, A1C ≥6.5%, or fasting plasma glucose >125 mg/dl. One hospital inpatient stay with an associated T2DM diagnosis was also sufficient for T2DM classification.

Results: Our cohort comprised 79,608 persons with prediabetes. Almost 30% (23,370) were classified as having insomnia during the observation period. After adjustment for traditional risk factors, those with insomnia were 28% more likely to develop T2DM than those without. This estimate was essentially unchanged after adjusting for baseline A1C level (Table).

Conclusions: The association of insomnia with increased T2DM risk is similar to that of traditional risk factors such as overweight and nonwhite race. This finding has the potential to be of great value as a modifiable factor in diabetes prevention efforts.

Disclosure

E. LeBlanc: None. N. Smith: None. M. Allison: None. G. Nichols: Research Support; Self; Boehringer Ingelheim GmbH, Amarin Corporation, Janssen Pharmaceuticals, Inc., Sanofi. G. Clarke: None.
Exercise Regulates the Concentration of Novel Circulating Factors in Humans
Authors: MIDDELBEEK ROELAND , RICHARD JEFFREY J. , PRINCE NOAH B. , ROWLAND LESLIE , DREYFUSS JONATHAN , PAN HUI , GOODYEAR LAURIE J.
Published: June 2018

Exercise can improve metabolic health for all people and patients with diabetes; however, the molecular mechanisms that mediate the exercise response are not well understood. We and others have hypothesized that exercise causes factors to be released from skeletal muscles, adipose tissue, and possibly other tissues into the circulation, and that these factors may contribute to the beneficial effects of exercise on health. To identify novel exercise-stimulated factors, healthy subjects (n=6 males and 6 females; age=29.2±0.6 years; BMI=22.5±0.7; VO2peak=40.6±1.3ml/kg/min) performed 45min of treadmill exercise at 75% VO2peak. Blood was collected at baseline, 15min, 45min during acute exercise, and 1 hour post-exercise and 1,310 circulating factors were measured using an aptamer-based proteomic method. Remarkably, this single bout of moderate intensity exercise significantly altered 247 or 19% of the measured circulating factors. In total, 171 unique proteins were increased and 76 proteins were decreased. Importantly, based on our literature review, ∼85% of these proteins have not been previously identified as exercise-stimulated circulating factors. Cardiorespiratory fitness (VO2peak) significantly correlated with the concentration of 112 factors at rest, suggesting that some of these proteins may be biomarkers of cardiorespiratory fitness. Of these factors, baseline concentrations of 40S ribosomal protein S3, a multi-functional protein that has been reported to be present in exosomes, correlated most strongly with VO2peak (p<0.0007). This data set will provide the basis for ongoing studies to unravel the mechanisms by which exercise mediates its beneficial effects on diabetes and overall health.

In summary, we have identified >200 novel exercise-stimulated proteins and >100 circulating proteins that correlate with cardiorespiratory fitness level in healthy human subjects.

Disclosure

R. Middelbeek: None. J.J. Richard: None. N.B. Prince: None. L. Rowland: None. J. Dreyfuss: None. H. Pan: None. L.J. Goodyear: None.
Feasibility of Mother–Daughter Dyadic Gestational Diabetes (GDM) Risk Reduction Intervention for American Indian and Alaska Native (AIAN) Teens
Authors: MOORE KELLY R. , STOTZ SARAH A. , NADEAU KRISTEN J. , SEREIKA SUSAN M. , REYES YESENIA GARCIA , STEIN HOWARD R. , CHARRON-PROCHOWNIK DENISE
Published: June 2018

AIAN women have twice the risk compared to the general U.S. population of adolescent obesity, pregnancy, and GDM. Stopping GDM (SGDM), a GDM risk reduction intervention tailored for at-risk AIAN teens, is based on a validated preconception-counseling program, READY-Girls. Prior to starting a multi-tribal randomized controlled trial (RCT) to test SGDM’s effectiveness, a feasibility study was conducted in Denver, CO with AIAN participants (4 mothers, 5 daughters). Mother-daughter (M-D) dyads were recruited through an Urban Indian Health program. Daughters were at risk for GDM as assessed by BMI >85th percentile and did not have diabetes based on finger-stick HbA1c < 6.5%. Mother’s (M) mean age was 44.4±8.8 years and 100% had some college education; daughter’s (D) mean age was 15.9±2.7 years and 80% were <12th grade. A pre-post online questionnaire evaluated the 2-hour online intervention which included viewing the electronic SGDM book and video. Outcomes included knowledge about GDM, reproductive health and healthy lifestyle, self-efficacy, and satisfaction with the eBook and video. Post open-ended questions revealed that participants had concerns about the font size and length of the materials and enjoyed the video; could relate to the stories, images, and actors; and appreciated learning about GDM specific to AIAN women. Mean pre- to post-knowledge increased for both mothers and daughters on diabetes prevention (M 70% to 80%; D 42% to 60%) and reproductive health and GDM knowledge (M 65% to 92%; D 34% to 71%). Daughters also demonstrated increased self-efficacy for healthy living and pregnancy planning. The eBook, video, and website were scored moderately high to very high on satisfaction.

In conclusion, we determined that the SGDM intervention is feasible and acceptable in AIAN M-D dyads. These findings will be used to finalize the SGDM education materials and data collection protocol for the upcoming full-scale RCT.

Disclosure

K.R. Moore: Advisory Panel; Self; Merck Foundation. S.A. Stotz: None. K.J. Nadeau: None. S.M. Sereika: None. Y. Garcia Reyes: None. H.R. Stein: None. D. Charron-Prochownik: None.
GDF15 Is a Contraction-Induced Myokine That Regulates Pancreatic ß-Cell Function
Authors: ZHANG HUI , MULYA ANNY , NIEUWOUDT STEPHAN , MCDOWELL RUTH , KIRWAN JOHN P.
Published: June 2018

β-cell dysfunction plays a major role in the onset of type 2 diabetes (T2D). Exercise improves or restores β-cell function in both humans and rodents with T2D. The specific mechanism is unclear. We hypothesized that exercise-induced myokines engage in cross-talk with the pancreas to help regulate β-cell function and mass. To test our hypothesis, differentiated C2C12 myotubes were subjected to electrical pulse stimulation (EPS) to simulate in vivo exercise. EPS-conditioned media from the contracting myotubes significantly elevated glucose-stimulated insulin secretion (GSIS) in β-cells vs. non-EPS control conditions (P<0.05). RNA-sequencing and bioinformatic analysis enabled us to identify Growth Differentiation Factor 15 (GDF15) as a novel contraction-induced myokine that potentially communicates with β-cells. At the cellular level, recombinant GDF15 protein treatment upregulated the GSIS response in β-cells by 55% (P<0.05), with no effect on cellular apoptosis, cytotoxicity or proliferation. Furthermore, qRT-PCR analysis, ELISA, immunoblots, and intracellular assays demonstrated that GDF15 may regulate first-phase insulin secretion by increasing the intracellular ATP/ADP ratio, inhibiting K+ channels and increasing the intracellular Ca2+ without affecting insulin synthesis. Using translational approaches, we found a positive correlation between fasting plasma GDF15 and insulin secretion in prediabetic subjects (R=0.64, P<0.01, n=22). A 6 week supervised functional high-intensity exercise intervention increased fasting plasma GDF15 by 35% in adults with T2D (P<0.01, n=12) and, interestingly, the increase in GDF15 was positively correlated with an increase in the β-cell disposition index (R=0.72, P<0.01, n=12), providing further support that GDF15 may be involved in improving β-cell function.

In summary, these findings expand our understanding of skeletal muscle as an endocrine organ and identify GDF15 as a potential myokine for T2D therapy.

Disclosure

H. Zhang: None. A. Mulya: None. S. Nieuwoudt: None. R. McDowell: None. J.P. Kirwan: None.
The Impact of Lifestyle Intervention on Stage of Change toward Healthy Eating and Development of Diabetes in Prediabetic Individuals in Precontemplation Stage
Authors: SAKANE NAOKI , NIRENGI SHINSUKE , TAKAHASHI KAORU , SUGANUMA AKIKO , OKAZAKI KENTARO , IZUMI KAZUO , NODA MITSUHIKO , KUZUYA HIDESHI
Published: June 2018

Objective: The aim of this study was to evaluate the stages of change toward healthier behavior by telephone-delivery intervention in prediabetic individuals.

Research Design and Methods: A total of 2607 participants aged 20-65 years with impaired fasting glucose were randomized to a one-year telephone-intervention intervention arm (n=1240) or a self-directed control arm with weighing scale and pedometer (n=1367). Stages of change were assessed using a self-administered questionnaire.

Results: At the baseline, 5.9% were in the precontemplation stage, 50.6% were in the contemplation stage, and 25.5% were in the preparation stage in the change to healthy eating. At the baseline, 9.4% were in the precontemplation stage, 50.2% were in the contemplation stage, and 12.0% were in the preparation stage in the change toward adopting exercise habits. For participants who were in the precontemplation stage, the proportions of those progressing to the action/maintenance stage for a healthy eating after 1-year intervention and at the end of the trial were increased (17.5 and 16.1-percentage-point increase, respectively), but there was small increase for exercise habits (5.4 and 2.7-percentage-point increase, respectively). For participants who were in the precontenplation stage, the odds of progressing to the action/maintenance stage for the intervention vs. control arm for healthy eating after 1-year intervention and at the end of the trial were 3.07 (95% CI=1.23, 8.13) and 2.21 (95% CI=1.04, 4.67), respectively. The corresponding odds for excise habits were 1.59 (95% CI=0.70, 3.61) and 1.27 (95% CI=0.55, 2.91). The hazard ratio for the development of diabetes on receiving the intervention in the precontenplation stage of healthy eating at the baseline was 0.51.

Conclusions: The intervention advanced the stages of changes toward healthy eating and might be effective for preventing diabetes even in the precontemplation stage.

Disclosure

N. Sakane: Research Support; Spouse/Partner; Pwc. S. Nirengi: None. K. Takahashi: None. A. Suganuma: None. K. Okazaki: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Taisho Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Astellas Pharma US, Inc., Takeda Development Center Asia, Pte. Ltd., Terumo Medical Corporation, MSD K.K., Sanwa Kagaku Kenkyusho Co., Ltd.. Other Relationship; Self; Aichi prefecture government and Nagoya city government. K. Izumi: None. M. Noda: None. H. Kuzuya: None.
Development and Content Validation of the Health Care Transition Outcomes Inventory
Authors: PIERCE JESSICA , WYSOCKI TIM , GANNON ANTHONY
Published: June 2018

Background: Much of the literature on the healthcare transition from pediatric to adult centered-care focuses on how to prepare adolescents and young adults with chronic illness for a successful healthcare transition, with much less emphasis on how to measure whether the healthcare transition was successful. Research on healthcare transition outcomes is fraught with methodological difficulties, making it difficult to generalize and compare findings across studies. To address these gaps, we began an integrative research agenda to develop a multidimensional, multi-informant (i.e., young adult, parent, and healthcare provider versions) measure of healthcare transition outcomes, the Healthcare Transition Outcomes Inventory (HCTOI). Our preliminary qualitative study defined six content domains for the measure. The current study describes the development and refinement of the HCTOI item pool.

Results: Using rigorous measurement development methods including mixed qualitative and quantitative methods, the researchers developed a pool of 88 items evaluating the extent to which a young adult with T1D is successful on each of the six domains of healthcare transition outcomes. Ten physician and psychologist experts provided content validity ratings and feedback and the item pool was reduced and refined to 69 items. Cognitive interviews were then conducted on every item with end users (young adults, parents, and healthcare providers) and the item pool was further reduced to 54-item young adult- and parent-versions and a 47-item healthcare provider version.

Conclusions: Each stage informed development and refinement of the item pool. The HCTOI represents the first multi-informant, rigorously developed item pool that comprehensively measures the multiple components of the transition from pediatric to adult specialty healthcare. Discussion includes clinical implications and next steps for validation, item reduction and refinement.

Disclosure

J. Pierce: None. T. Wysocki: None. A. Gannon: None.
The Influence of Outpatients’ Wait Times and Health Care Professionals’ Communication Behaviors on Treatment Satisfaction and the Intention to Drop Out
Authors: SATO SHIORI , TOSAKI TAKAHIRO , OSHIRO CHIE , KUDARA AYAE , INAGAKI AKEMI , KONDO MASAKI , TSUNEKAWA SHIN , KATO YOSHIRO , KAMIYA HIDEKI , NAKAMURA JIRO
Published: June 2018

We studied influences of perceptions of patients’ wait times and communication behaviors of healthcare professionals on treatment satisfaction and the intention to drop out in diabetes outpatients. A questionnaire was sent to 888 outpatients with diabetes or impaired glucose tolerance who visited our clinic in April 2016. We also measured time spent in clinics. Totally, 759 patients responded to the questionnaire; 717 valid responses were obtained for statistical analyses. In the group with the intention to drop out,” many replied that they felt that “the wait time from physical examination to accounting” was long; this association was significant (P = 0.009, χ2 test). Time spent in clinics was also significantly associated with the “perception of wait time (total).” Communication behaviors of healthcare professionals were also significantly associated with the presence of the intention to drop out. Median scores of the first factor of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) were lower in those who intended to drop out than in those who did not (52 vs. 632 patients); the DTSQ first factor score was significantly associated with the presence of intention to drop out (P < 0.001, Mann-Whitney U test). Receiver operating characteristic curve analysis revealed the DTSQ score as a significant predictor of the presence of intention to drop out (area under the curve = 0.746, P < 0.001), with an optimal cut-off of 22.5 (sensitivity 70.6%, specificity 67.3%). The findings of this study suggest that improved treatment satisfaction may reduce incidences of drop out. Thus, improved wait times and better communication behavior from healthcare professions may improve patient satisfaction and reduce the intention to drop out and possibly the dropout rate.

Disclosure

S. Sato: None. T. Tosaki: Other Relationship; Self; Eli Lilly and Company, Takeda Development Center Asia, Pte. Ltd., MSD K.K., Mitsubishi Tanabe Pharma Corporation. C. Oshiro: None. A. Kudara: None. A. Inagaki: None. M. Kondo: None. S. Tsunekawa: None. Y. Kato: Speaker's Bureau; Self; Merck Sharp & Dohme Corp., Sanofi, Takeda Pharmaceutical Company, Eli Lilly Japan. H. Kamiya: Other Relationship; Self; MSD K.K., Ono Pharmaceutical Co., Ltd., Sanofi K.K., AstraZeneca, Astellas Pharma KK, Eli Lilly and Company, Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Ltd, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd. J. Nakamura: Other Relationship; Self; Astellas Pharma US, Inc., AstraZeneca, Ono Pharmaceutical Co., Ltd., MSD K.K., Kyowa Hakko Kirin Co., Ltd., Kowa Pharmaceuticals America, Inc., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Mitsubishi Tanabe Pharma Corporation, Eli Lilly and Company, Novartis Pharma K.K., Pfizer Inc..
Diabetes Self-Management Education (DSME) and Diabetes Preventive Care Practices among People With and Without Vision Impairment
Authors: SEKAR SWATHI , GERZOFF ROBERT B. , SAADDINE JINAN B. , SAUNDERS MAGON M.
Published: June 2018

Objective: To examine whether participating in Diabetes Self-Management Education (DSME) was associated with increased diabetes preventive care practices among those with and without self-reported vision impairment (VI).

Background: Over 30 million people in the United States have diagnosed diabetes. DSME is a vital component of care, facilitating the knowledge and skills needed to improve self-care for diabetes. Those with VI are more likely to have diabetes than those without, highlighting a need to examine DSME participation and preventive care practices among those with and without VI.

Methods: We used data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large ongoing landline and cellular telephone based survey. The question “Have you ever taken a course or class in how to manage your diabetes yourself?” was asked in 37 states plus the District of Columbia and Guam. In a logistic regression, we examined if the association between DSME and 9 preventive care practices was significantly modified by VI status.

Results: Regardless of VI status, respondents with diabetes who participated in DSME had a greater predicted probability of engaging in each preventive care practice than those who did not. Compared to respondents with VI who did not participate in DSME, those with VI who participated in DSME had a significantly greater predicted probability of having administered a daily glucose check (83.7% vs. 59.3%) and having had an annual visit to a health care professional for their diabetes (95.3% vs. 82.1%).

Conclusions: Participants with VI who received DSME have increased predicted probability of engaging in certain self-care practices compared to those with VI who did not receive DSME. This highlights the importance of people with diabetes and VI acquiring the appropriate tools to positively affect their own health.

Disclosure

S. Sekar: None. R.B. Gerzoff: None. J.B. Saaddine: None. M.M. Saunders: None.
Effects on Insulin Sensitivity, but Not on Mitochondrial Function Are Dependent on Insulin Resistance Status after High Intensity Interval Training
Authors: APOSTOLOPOULOU MARIA , PESTA DOMINIK , KARUSHEVA YANISLAVA , GANCHEVA SOFIYA , JELENIK TOMAS , BIERWAGEN ALESSANDRA , MÜSSIG KARSTEN , SZENDROEDI JULIA , RODEN MICHAEL
Published: June 2018

High intensity interval training (HIIT) is a time-efficient training approach to stimulate biogenesis in healthy populations. We hypothesized that HIIT would increase skeletal muscle insulin sensitivity due to improved muscle mitochondrial function in type 2 diabetes (T2D) patients and age- and BMI-matched controls (CON). We examined 18 sedentary male patients with T2D and 23 healthy male CON (age: 58±5 vs. 57±4 years, BMI: 31.4±2.4 vs. 30.4±2.3 kg.m-2) that were enrolled in a 12-week HIIT cycling protocol. CON were further grouped in insulin-sensitive (IS) and -resistant (IR) (baseline M in mg.kg-1.min-1; 7.4 ± 1.3 vs. 4.2 ± 1.1, p<0.001). Two-step hyperinsulinemic-euglycemic clamps, skeletal muscle biopsies for high resolution respirometry and magnetic resonance spectroscopy for liver fat quantification were performed. After 12 weeks of HIIT, T2D and IR CON increased their insulin sensitivity (3.9±1.9 vs. baseline: 2.7±1.6, p=0.02 and 5.5±2.1 vs. 4.2 ± 1.1, p=0.03, respectively), which returned to baseline after detraining. T2D and IR CON increased suppression of endogenous glucose production (EGP) during the high-insulin clamp (T2D: 91 ± 14% vs. baseline: 76 ± 11%, p=0.003 and IR CON: 107 ± 13% vs. 94 ± 14%, p=0.04). IR CON also increased suppression of lipolysis during the low-insulin clamp (82 ± 9 vs. 84 ± 8%, p=0.04). In T2D liver fat was decreased by 17% and remained decreased after detraining. Liver fat content remained unchanged by HIIT training in both CON groups. Muscle maximal uncoupled respiration increased in T2D and CON by 44% and 48%, respectively, at 12 weeks and remained increased after detraining in all groups (p<0.01). We conclude that at the same level of insulin resistance HIIT training improved hepatic and peripheral insulin sensitivity in patients with T2D and insulin resistant controls whereas changes in mitochondrial function occurred irrespective of insulin resistance status.

Disclosure

M. Apostolopoulou: None. D. Pesta: None. Y. Karusheva: None. S. Gancheva: None. T. Jelenik: None. A. Bierwagen: None. K. M ssig: None. J. Szendroedi: None. M. Roden: Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH. Consultant; Self; Poxel SA. Research Support; Self; Danone Nutricia Early Life Nutrition, GlaxoSmithKline plc., Nutricia Advanced Medical Nutrition, Sanofi.
Free Weight-Loss Apps and Diabetes Management for the Patient
Authors: WU GLORIA , BILLARD LAURA , NGO VY-VY , DOAN AMY , MURO ELENA , LE BRYAN
Published: June 2018

Weight loss and obesity are concerns shared by diabetic patients and the lay public. These search terms, "weight loss," "obesity," generate 72M and 30M webpages, respectively. "Diabetes" as a search term generates 104M webpages. According to Google Trends, "weight loss," " diabetes" terms are searched 7x more than "obesity." In 2016, there were 59,000 medical health apps. It is expected that at the end of 2017, apps will reach $26 billion in revenue. Are these apps useful to our diabetic patients?

Purpose: To evaluate free weight loss droid apps in terms of the Diabetes Self-management Education and Support Guidelines.

Methods: Using Google Play to find the most droid downloads in free weight loss apps in 2017. Droid apps downloads are documented by Google Play whereas iPhone apps' downloads are not available to the public. We included only those apps that emphasized weight loss. We excluded those apps with malfunctioning web on a daily basis.

Results: The majority of the apps have calorie counting. However, 4/10 are lacking in basic information about BMI; only half of the apps have a med log/diary. None include psychological moods.

Conclusions: Weight loss mobile phone app are commonly used by the general public not only diabetic patients. Most do not track fasting blood glucose, lipids and blood pressure. There is room for improvement for this growing field of health apps and diabetes.

Disclosure

G. Wu: None. L. Billard: None. V. Ngo: None. A. Doan: None. E. Muro: None. B. Le: None.
Introduction of a Web-Based Computerized Personal Diabetes Educational System
Authors: CHEN KWANG-WEN , CHUANG YUH-JUE , LIU CHAO KUN , CHIU YU-YEN , LIN HAN-YI
Published: June 2018

We establish a computerized diabetes educational system which may provide a personal educational advice come after a prior questionnaire. The questionnaire and educational advice were formed by a team of a physician, a dietitian, 3 nurses, and 3 information technology (IT) personnel. The questionnaire comprises the basic data of age, weight, height, and the level of blood pressure, lipid profile, and also the status of retinaopthy, nephropathy, and neuropathy. Our IT personnel design the programmatic link bewteen the result of questionnaire and educational advice on website, which using open source software, including Apache software, with Hypertext Preprocesssor (PHP) and MySQL database server. The precision and fluency of the advice was modified after repeated discussion on multiple clinical conditions. The final version was first applied on 14 patients (10 men, 4 women), the mean age is 51.6± 11.0 years (from 30 to 71 years). Furthermore, a satisfaction survey was performed and showed this system is helpful, feasible, and satisfied to them, also learning motivation was raised.

Conclusion: We developed a web-base computerized diabetic educational system which may provide individualized education, and the system is helpful and feasible to people with diabetes.

Disclosure

K. Chen: None. Y. Chuang: None. C. Liu: None. Y. Chiu: None. H. Lin: None.
The Efficacy of Registered Dietitian Interventions in Type 2 Diabetes Management in a Family Practice Clinic in North Alabama
Authors: CHESTER BRITTANNIE H. , STANLEY WAYNE G. , THANGIAH GEETHA
Published: June 2018

Background: Diabetes self-management education and support (DSMES) and medical nutrition therapy (MNT) have been proven to improve patient outcomes. However, many patients rely on their physician solely for diabetes education despite referrals for diabetes education outside of the physician’s office.

Objective: Our aim was to optimize type 2 diabetes management in a family practice clinic by providing patients with individualized DSMES and MNT by a Registered Dietitian inside of the family practice clinic.

Methods: A random sample of 40 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSMES and individualized MNT with a Registered Dietitian. Data was extracted from a retrospective chart review on hemoglobin A1C levels before and after appointments with the Registered Dietitian in the family practice clinic from September 2015-November 2015. Analyses were used to assess frequency of patients decreasing their hemoglobin A1C levels, which reveals good glycemic control.

Results: A paired sample t test was performed (n=40). The results revealed that post DSMES and MNT Hemoglobin A1C values (M = 6.84%, SD ± 1.0) were significantly lower than the pre DSMES and MNT Hemoglobin A1C values (M = 7.17%, SD ± 1.3), t (40) = 2.89, p < 006.

Conclusions: Many healthcare professionals can give dietary advice to patients, but Registered Dietitians are trained to provide individualized nutrition therapy to patients. Combining the knowledge of the physician and registered dietitian can help patients to reach optimal diabetes control in order to prevent or minimize complications. Research has demonstrated a 1% decrease in Hemoglobin A1C levels result in a 21% reduction in diabetes associated mortality, a 14% reduction in myocardial infarction, and a 37% reduction in microvascular complications.

Disclosure

B.H. Chester: Employee; Self; Huntsville Hospital Diabetes Control Center, Wayne G. Stanley, MD, PC, Boston Heart Diagnostics. W.G. Stanley: Other Relationship; Self; Wayne G. Stanley, MD, PC. G. Thangiah: None.
Implementation and Evaluation of Gestational Diabetes Management Using Mobile Health Care Service—A Pilot Study
Authors: LEE MINKYUNG , PARK CHEOL-YOUNG , PARK SUNG-WOO , LEE DA YOUNG , SUNG JI-HEE
Published: June 2018

Background: Gestational diabetes mellitus (GDM) affects approximately 7% of all pregnancies and is associated with increased risk for the development of diabetes. It is important to recognize and treat GDM to minimize the risk of complications to mother and baby. Multifaceted professional interventions are more effective and mobile healthcare can be one of the good approaches. In this study, we aimed to develop and evaluate the model for prevention and management of GDM using mobile healthcare.

Methods: A total of 21 subjects with no previous history of diabetes, who were diagnosed with GDM during 24-28 weeks of gestation were randomly divided into conventional management group (CM group, n=10) and mobile management group (MM group, n=11). CM group received conventional GDM management and could use mobile application about healthcare freely. MM group received mobile healthcare service including tailored mobile coaching.

Results: Baseline characteristics including HbA1C were not significantly different between the two groups. There were no statistically significant differences in maternal laboratory findings, fetal status and cesarean section rate between the two groups at the time of delivery. Both groups were satisfied with the gestational diabetes management service. Four patients (CM group, n=2 and MM group, n=2) were diagnosed with diabetes by oral glucose tolerance test that followed 4 to 12 weeks after delivery and there was no significant difference in glycated hemoglobin between the two groups. However, postpartum weight and body fat were significantly lower in the MM group.

Conclusions: Mobile healthcare service in patients with GDM showed no significant difference in GDM self-management compared to the conventional management. In addition, it resulted in a significant reduction in maternal weight gain after delivery. Our study showed that mobile healthcare service could be an efficient GDM management tool.

Disclosure

M. Lee: None. C. Park: None. S. Park: None. D. Lee: None. J. Sung: None.
Medical Student Knowledge of Current Recommendations for Glucose Screening and Obesity-Related Risk Assessment in Children
Authors: GUSEMAN EMILY H. , WHIPPS JONATHON , JENSEN LAURA L. , BEVERLY ELIZABETH A.
Published: June 2018

Surveillance data regarding diabetes rates among Appalachian youth are limited. Risk factors for type 2 diabetes among children include obesity, food insecurity, physical inactivity, and familial history. Child obesity runs especially high in Appalachian Ohio, where at least 22% of third graders are obese, compared to 14.3% in suburban counties. In addition to this, one in four children in Appalachian Ohio live below the federal poverty level and many can be expected to have parents with type 2 diabetes, given the high prevalence among adults in the region. Therefore, medical students must be knowledgeable about screening recommendations. We distributed a modified version of the National Cancer Institute’s Physician Survey of Practice on Diet, Physical Activity, and Weight Control: Questionnaires on Child/Adolescent Care to osteopathic medical students at one university. Descriptive and frequency analyses were used to analyze students’ knowledge and attitudes related to childhood obesity and diabetes. Participants in this study were 238 first- through fourth-year medical students (62% pre-clinical, 38% in clinical rotations) Time spent working directly with pediatric patients in a clinical setting differed between pre-clinical and clinical students (21.4 ± 62.0 h vs. 129.7 ± 195.8 h, p<0.001 respectively). Most students (74%) indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). Students indicated they would initiate glucose screening approximately 4.5 years earlier in overweight/obese patients with risk factors than those with perceived lower risk (p<0.001). Although students recognize the need for earlier diabetes screening in children with additional risk factors and/or family history, there is a need to emphasize systematic approaches to diabetes risk reduction in medical school.

Disclosure

E.H. Guseman: None. J. Whipps: None. L.L. Jensen: None. E.A. Beverly: None.
Narrative Medicine in Diabetes—A Randomized Trial
Authors: ROSÁRIO FRANCISCO , CORREIA ISABEL , OLIVEIRA JORGE , RAPOSO JOAO
Published: June 2018

Background and Aims: Group dynamics in diabetes have positive outcomes. This study attempts to determine if a group dynamic using narrative and reading is non-inferior to a conventional group approach.

Material and Methods: We studied 49 patients (32 - intervention, 17 - control) with type 2 diabetes, were randomized to two different Group Care dynamics. “Control group” - Classical structured educational approach of six monthly sessions. “Intervention group” - Close reading and creative writing using literary narratives. They were evaluated before the first session and after the third and the sixth, including weight, A1c and satisfaction questionnaire (GSS). A1c in the six previous years were collected from clinical records. The statistical procedures were based on ANOVA and Pearson bivariate correlations.

Results: The entire sample had an initial BMI of 29,1 (SD- 4,67) and A1c of 7,51% (SD- 1,13). There were 7 drop-outs, (5 intervention; 2 control). 5 other patients didn’t finished the evaluations by medical reasons. Both groups showed a reduction of A1c between the first and the last session (intervention group initial A1c 7,55% (SD-1,13); last A1c 6,83% (SD - 0,94) p<0,001; control group initial A1c 7,44% (SD- 1,11); last A1 7,21% (SD - 1,48) p<0,001. Regarding patients previous records, a decrease of A1c levels was observed in the trial (p<0,05). A significant increase (p<0,05) in satisfaction with therapist and with group process was observed.

Conclusions: This is the first randomized trial evaluating a Group Care intervention to manage type 2 diabetes using narrative skills. A significant reduction of A1c in the intervention group showed non-inferiority in relation to the classical approach. A significant decrease in A1c was observed in relation with the A1c levels of the previous six years. A significant increase in satisfaction with therapist and with group process was observed. This may be a useful model for patients with several years of formal education, and may constitute an alternative for the long term educational process.

Disclosure

F. Rosário: None. I. Correia: None. J. Oliveira: None. J. Raposo: Advisory Panel; Self; Boehringer Ingelheim GmbH, Sanofi, Novo Nordisk A/S, Eli Lilly and Company, AstraZeneca.