bluuebunny/crossref_metadata_2025 huggingface dataset:
45-OR: Less Favorable Response to Anti-VEGF Therapy in Patients with Diabetic Macular Edema and Decreased Baseline Outer Retinal Layer Thickness
Authors: MITZNER MARGALIT G. , FICKWEILER WARD , ROBINSON DEVON B. , BOUMENNA TAHANI , AIELLO LLOYD P. , SUN JENNIFER
Published: May 2022

Early identification of patients who are more likely to respond to anti-VEGF therapy for diabetic macular edema (DME) would improve patient management and allow for more rapid assessment of new therapeutic targets. This study evaluated retinal thickness variables and their association with anti-VEGF therapy response in patients with DME. We identified patients at the Joslin Diabetes Center who received their first anti-VEGF injection for DME between 1/2016-12/20 and assessed mean change in visual acuity (VA) and central retinal thickness (RT) at 6 mos. A good VA or RT response to anti-VEGF therapy was defined using thresholds of letter and retinal thickness change as follows: eyes with baseline VA of ≥20/32, ≥5 letters; 20/40-20/70, ≥letters; ≤20/80, ≥15 letters and eyes with baseline RT of <375µm, >10%; 375-449µm, >20%; >449µm, >25%. A total of 151 eyes from 126 patients fell into the following responder groups: both VA and RT response (32.5%) , only VA response (21.9%) or RT response (11.3%) , and neither VA nor RT response (34.4%) , with 57.0% of all eyes exhibiting VA response and 43.7% exhibiting RT response. While diabetes duration, A1c, and blood pressure were not associated with responder group, decreased baseline thickness of the outer retinal layer (ORL) was more likely to be present in eyes with neither VA nor RT response (β=-.018; 95% CI -0.03 to -0.01; P=.006) . Improvement in mean VA was associated with younger age (β=.004; 95% CI 0.001-0.007; P=.01) . Decreased baseline ORL thickness (β=-.003; 95% CI -0.0to -0.001; P=.01) and increased baseline inner retinal layer (IRL) thickness (β=.0004; 95% CI 0.0001-0.0007; P=.02) were associated with less VA gain at 6 mos. These findings suggest that decreased baseline ORL thickness is associated with less favorable outcome after anti-VEGF therapy and may be a potential biomarker for treatment response in patients with DME.

Disclosure

M.G.Mitzner: None. W.Fickweiler: None. D.B.Robinson: None. T.Boumenna: None. L.P.Aiello: Consultant; KalVista Pharmaceuticals, Inc., Novo Nordisk, Stock/Shareholder; KalVista Pharmaceuticals, Inc. J.Sun: Consultant; American Diabetes Association, American Medical Association, Research Support; Adaptive Sensory Technology, Boehringer Ingelheim International GmbH, Genentech, Inc., Jaeb Center for Health Research, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Optovue, Incorporated, Physical Sciences, Inc, Roche Pharmaceuticals.

Funding

American Diabetes Association (7-21-PDF-022) ; National Eye Institute (R01EYE26080-01) ; National Institute of Diabetes and Digestive and Kidney Diseases and National Institutes of Health (DP3-DK-094333-01) ; JDRF (17-2013-310) ; The Dianne Nunnally Hoppes Fund; The Beatson Pledge Fund
453-P: Role of JARID2 in Regulating Inflammatory Genes via Epigenetic Mechanisms in Monocyte/Macrophages in Type 2 Diabetes
Authors: REDDY MARPADGA A. , TANWAR VINAY S. , ZHANG LINGXIAO , LANTING LINDA L. , WANG MEI , PANDEY PRIYATAMA , CHEN ZHUO , WU XIWEI , NATARAJAN RAMA
Published: May 2022

The activation of monocytes and macrophages plays a central role in chronic inflammation associated with type 2 diabetes mellitus (T2D) and cardiovascular disease. However, the precise epigenetic mechanisms involved are unclear. From RNA-seq analysis we found dysregulated expression of several genes, including downregulation of JARID2 in human CD14+ monocytes obtained from T2D patients versus controls. JARID2 protein functions as a transcription repressor by facilitating the recruitment of polycomb repressor complex 2 and associated histone H3K27-trimethylation to target genes. RT-qPCR and RNA-seq analysis showed that high glucose +TNF-α (HT) , key pathological factors in diabetes, downregulated JARID2 in human monocytes along with genes involved in inflammation and cytokine related signaling networks. Western blotting also showed HT reduces JARID2 protein levels in human monocytes. Furthermore, JARID2 knockdown with siRNAs increased proliferation and enhanced LPS and HT induced inflammatory genes in human monocytes. ATAC-seq revealed that HT increased chromatin-accessibility at promoters of inflammatory genes like IL1B that were upregulated by JARID2 knockdown. Interestingly, microRNA-seq analysis revealed that CD14+ monocytes from T2D patients showed increased expression of several microRNAs with complementarity to the JARID2 3’-UTR, indicating cross-talk between epigenetic factors and microRNA-dependent mechanisms. Mouse orthologous Jarid2 was downregulated in macrophages from diabetic db/db mice and in macrophages from normal C57BL/6 mice treated with HT, similar to human JARID2. These results demonstrate that JARID2 plays a key role in chromatin remodeling and restraining inflammatory genes in monocytes, and its downregulation in T2D can augment inflammation. Further, understanding of epigenetic regulators like JARID2 can lead to novel therapies for chronic inflammatory diabetic complications.

Disclosure

M.A.Reddy: None. V.S.Tanwar: None. L.Zhang: None. L.L.Lanting: None. M.Wang: None. P.Pandey: None. Z.Chen: None. X.Wu: None. R.Natarajan: None.

Funding

National Institutes of Health (DK065073) to RN AR-DMRI Endowment Pilot grant to MAR
46-LB: A New Approach to Understand Diabetes Burnout—Examining Potential Burnout Profiles?
Authors: ABDOLI SAMEREH , MILLER KATHERINE L. , HESSLER DANIELLE M.
Published: May 2022

Aim: The study aimed to identify latent profiles of diabetes burnout and examine if there are significant differences in psychosocial well-being, diabetes outcomes, and demographic characteristics between individuals with varying burnout profiles.

Methods: A national sample of adults with T1D (n=1099) completed an online cross-sectional survey across the U.S. We used Diabetes Burnout Scale (DBS) to collect data on diabetes burnout (i.e., exhaustion, detachment, lack of control) . We also measured diabetes distress, depressive symptoms, glycemic control, and demographic characteristics. Data were analyzed using latent class analysis (LCA) , and the resulting profiles were validated using Chi-square and Kruskal Wallis test.

Results: Results showed a seven latent burnout profiles: (a) fully burned out (n=275, 25.02%) ; (b) exhausted (n=148, 13.47%) ; (c) Dissociated (n= 132, 12.56%) ; (d) overextended (n= 135, 12.28%) ; (e) disengaged (n=90, 8.18%) ; (f) loss of control (n=48, 4.37%) . Among participants, 275 (25.02%) were categorized as not having any symptoms of burnout. Examination of the profiles suggested a non-linear relationship between exhaustion, detachment, and lack of control. The results revealed that there were significant differences in diabetes distress, depressive symptoms, and demographic characteristics between individuals with different burnout profiles. Among profiles, fully burned-out profile was a stronger predictor for glycemic control.

Conclusion: This is the first study examining statistically different profiles of diabetes burnout in adults with T1D. The identification of burnout profiles and the developmental model can inform targeted interventions to address burnout in each specific profile and prevent burnout to result devastating consequences.

Disclosure

S. Abdoli: None. K. L. Miller: None. D. M. Hessler: None.
482-P: Do Varied Off-Loading Modalities Have Differing Impacts Upon Users' Fall Risk?
Authors: CREWS RYAN T. , ROSENBLATT NOAH J.
Published: May 2022

Aim: Adherence to offloading devices for diabetic foot ulcers (DFU) is poor and postural instability influences adherence. Prior research suggests an ankle-high removable cast walker (RCW) in tandem with a contralateral shoe lift might increase users’ balance relative to a traditional knee-high RCW without a lift. This study compared compensatory responses to perturbations under both conditions.

Methods: Twenty-five individuals (48% male; age: 68±8 years) with diabetic peripheral neuropathy participated. Participants completed trials under three conditions: bilateral standardized shoes, knee-high RCW, and ankle-high RCW with contralateral shoe lift. Stepping thresholds (ST) were assessed for two types of perturbations:1) From a stopped position, a treadmill rapidly accelerated at 3.5m/s² to reach a set peak-velocity and then decelerated and stopped. The smallest peak-velocity to elicit a step was identified as the ST. Participants were separately oriented on the treadmill to elicit anterior and lateral ST; 2) A waist mounted spring scale was pulled until a target load was reached, then the spring was rapidly released. ST was the lowest load necessary to force a step upon release. Anterior and posterior waist-pull perturbations were done.Participants also rated their stability in each footwear condition via a 10cm visual analog scale. Data analyses focused upon the primary comparison of the two offloading conditions.

Results: The knee-high RCW resulted in significantly decreased ST for two of the four tests (treadmill anterior: mean difference .037m/s2, p=.048 and anterior waist-pull: mean difference 2.2lbs, p<.001) relative to the ankle-high RCW with a contralateral lift. Participants reported a large and statistically significant reduction in perceived stability with the knee-high RCW (mean difference= 0.93cm, p=0.030) .

Conclusions: Future prospective studies should assesses whether the differences noted in this study translate into differences in RCW adherence by patients with DFU.

Disclosure

R.T.Crews: None. N.J.Rosenblatt: None.

Funding

National Institute of Diabetes and Digestive and Kidney Disease
485-P: DFUCare Deep-Learning–Based Mobile App for Diabetic Foot Ulcer Monitoring
Authors: SENDILRAJ VARUN , PILCHER WILLIAM C. , BHASIN MANOJ K.
Published: May 2022

In 2021, 1 out of adults suffered from diabetes mellitus globally. A major complication resulting from this is diabetic foot ulcers (DFU) , which can lead to amputation if improperly managed. Current clinical approaches to DFU have significant limitations, such as the high cost involved in the diagnosis and time-consuming care. In light of this, we have developed DFUCare, a mobile app that uses the built-in camera and deep learning to diagnose and quantify patients' diabetic foot ulcers. DFUCare is trained on an extensive foot dataset containing over 5000 images of normal and infected DFU patients. For binary classification of infected and non-infected patients, we use a combination of transfer and ensemble learning. Using transfer learning, DFUCare uses the pretrained InceptionResNetV2 model for deep learning derived feature extraction. With an ensemble approach, we compare the deep learning derived feature extraction results to handcrafted color and textural feature extraction results to come up with a final prediction of infected vs. non-infected patients. In the end, we achieved top-level results with a binary accuracy of .9014, AUC of .9437, specificity of .9023, and precision of .8901. In addition, using standardized metrics and computer vision algorithms, DFUCare can determine the dimensions of the DFU to quantify the severity over time. With all of the information stored in the cloud, doctors and patients can use the share feature in the mobile app to send medical reports to anyone in the world. In the future, we are planning to add clinical, biological, and epidemiological features along with macroscopic image features to improve the performance of the tool in predicting infection and healing. This novel approach has the potential to deliver a paradigm shift in diabetic foot care among patients by being a cost-effective, remote, and convenient healthcare solution.

Disclosure

V.Sendilraj: None. W.C.Pilcher: None. M.K.Bhasin: None.
490-P: Macrophage-Regulating Drug Promotes Tissue Proliferation in a DFU Real-World Case
Authors: CHEN SHYI-GEN , LIN YUN-NAN , CHEN JUI-CHING , KUO YUR-REN
Published: May 2022

A 53-year-old female with type 2 DM (HbA1c 11.7%) , peripheral artery disease (PAD) , hypertension, and hyperlipidemia was sent to the emergency room of Kaohsiung Medical University Hospital due to presence of an infected DFU with exposed tendon and ischemic necrosis (Figure 1a) . Ankle brachial index of her right leg was 0.8 and angiography revealed severe stenosis over posterior/anterior tibial artery. The ulcer was downgraded from Wagner grade IV to II after a 10-day treatment by broad-spectrum antibiotics and angioplasty for infection and ulcer severity control. However, the tissue proliferation was halted by persistent inflammation and ischemia (Figure 1b) . The growth of granulation tissue was limited despite using fat grafting to boost mesenchymal tissues. Pseudomonas contamination occurred after a 3-month care. We tried artificial dermis after further debridement and intravenous antibiotics but noted poor ingrowth of cells. The patient declined the recommended surgical reconstruction with flap coverage so ON101, a topical macrophage-regulating drug, was applied twice a day. The ulcer area measured digitally by imitoMeasure, was 7.23cm2 before treated by ON1 (Figure 1c) and reached closure (Figure 1d) after 16 weeks. Wound healing is often hindered by DM or PAD despite of multiple interventions. Macrophage-regulation can be deemed as a novel approach to promote tissue repair and salvage difficult wounds.

Disclosure

S.Chen: Employee; Oneness Biotech Co., Ltd. Y.Lin: None. J.Chen: Employee; Oneness Biotech Co., Ltd. Y.Kuo: None.
494-P: Introducing a Patient with Diabetes Experiencing the Social Determinants of Health to Students through Cinematic Virtual Reality
Authors: WARDIAN JANA L.
Published: May 2022

Background: Cinematic virtual reality (cine-VR) is an innovative educational technique allowing users to immerse themselves in three-dimensional sensory environments. Cine-VR gives access to life-like medical encounters without risk or harm to the patient and offers insight into the lived experience of patients. Storytelling is a powerful tool to help health professions students to immerse themselves in another’s experience. We utilized a diabetes cine-VR training to highlight social determinants of health and impact on patient engagement. The purpose of this study was to compare the effectiveness of web-based diabetes cine-VR training to improve diabetes attitudes and empathy among health professional students.

Methods: Our institution utilized the cine-VR web-based training for several healthcare profession student programs. We conducted paired t-tests to assess changes in diabetes attitudes and empathy at baseline and after the training. All analyses used SPSS version 26.0 (SPSS Inc.) . Statistical significance was defined as P<0.05.

Results: We had a total of 127 students participate including Doctor of Physical Therapy students (60) , Pharmacy students (10) , and Physician Assistant students (57) . Following viewing the 12 modules, we observed improvements in four of the diabetes attitude subscales: “Seriousness of type 2 diabetes” (P<0.001) ; “Value of tight glucose control” (P=0.01) ; “Psychosocial impact of diabetes” (P<0.001) ; and “Attitude toward patient autonomy” (P<0.001) . In addition, we observed significant improvements in empathy (P<0.001) .

Conclusions: Diabetes is a complex disease that involves an individual’s physical, social, and emotional well-being. To holistically meet the needs of people with diabetes, we must train our health professions students to recognize and appreciate the social needs of their patients. Our findings support the use of cine-VR trainings to improve diabetes attitudes and empathy.

Disclosure

J.L.Wardian: None.

Funding

Medicaid Equity Simulation Project funded by the Ohio Department of Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center.
507-P: Eighteen-Month Follow-Up of Peer Support for Diabetes Management in Shanghai Integration Model
Authors: LIU YUEXING , CAI CHUN , WU XIAOYU , TANG PATRICK Y. , COUFAL MUCHIEH M. , SHEN LI , QIAN YIQING , LUU SAMANTHA , FISHER EDWIN B. , JIA WEIPING
Published: May 2022

In 9 Community Health Centers (CHCs) , peer leaders led neighborhood activities, co-led meetings on diabetes management, and followed up with individuals and families, all under the Shanghai Integration Model coordinating primary (CHCs) , hospital, and specialty diabetes care. Previously reported were significant changes in HbA1c, other clinical markers, and diabetes distress from baseline to the end of the active program at 12 months. Changes were pronounced among those exceeding criteria for heightened concern at baseline. Here we report extended impacts for all participants (1009) with baseline and 18-month data, controlling for all individual characteristics. Evaluation indicators and criteria for heightened concern were: HbA1c ≥ 8%, SBP ≥ 130 and DBP ≥ 80 mmHg, LDLc ≥ 2.6 mmol/L, BMI ≥ 26 kg/m2, PHQ8 ≥ - moderate depression, EQ5D quality of life and 4-item measure of diabetes distress - top tertiles. Reductions from baseline to 18 months were significant for HbA1c, SBP and DBP, and PHQ8 depression (ps: 0.00to 0.0088) . Among those exceeding criteria for heightened concern, reductions from baseline to 18-months were significant for all variables (ps ≤ 0.0001) including, e.g., HbA1c from 9.06% to 8.50% (SDs = 0.96, 1.55) . Research staff blinded to outcomes rated implementation of the peer leader program, yielding high- and low-implementation CHCs. For all participants, changes from baseline to 18 months were significantly greater in high- than low-implementation CHCs for HbA1c (p = 0.0246) and SBP (p < 0.0001) . Among those at heightened concern, reductions were greater in high- vs. low-implementation CHCs for HbA1c, SBP and DBP (ps: < 0.0to 0.0073) . Conclusion: Improvements in clinical and quality of life measures following peer leaders promoting diabetes self management as part of the Shanghai Integration Model were sustained over 18 months, especially for those with baseline measures indicating heightened concern and in high implementation CHCs.

Disclosure

Y.Liu: None. W.Jia: None. C.Cai: None. X.Wu: None. P.Y.Tang: None. M.M.Coufal: None. L.Shen: None. Y.Qian: None. S.Luu: None. E.B.Fisher: Advisory Panel; Lilly, Consultant; WellDoc, Research Support; Merck & Co., Inc.

Funding

Shanghai Municipal Grants Award (GWIV-3.1) Shanghai Public Health Youth Award (GWV-10.2-YQ24) Shanghai Municipal Health Commission (201940141) Shanghai 6th People's Hospital (ynlc201812) The Merck FoundationSanofi China National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092926)
524-P: CME Activity Series Highlights Changes in Clinicians’ Knowledge and Competence about Novel Approaches to Reduce DKD Progression
Authors: KARANDREA SHPETIM , AGARWAL NEHA , JAMROGIEWICZ AMANDA
Published: May 2022

Diabetic kidney disease (DKD) is one of the most common complications of diabetes, significantly impacting morbidity and mortality. Novel approaches to target DKD progression are needed, and non-steroidal mineralocorticoid receptor antagonists (MRAs) have recently emerged as a viable option, however, clinicians may not be aware of them. Based on this gap, CMHC organized 4 accredited virtual symposia from 2020 to 2021 to educate multi-disciplinary clinicians and assess knowledge/competence changes using pre-/post assessment questions. The activities took place between Oct. 2020 - Oct 2021 with the participation of 829 healthcare professionals (MD/DO, PAs, RNs, NPs, PharmDs) representing specialties that treat high-risk diabetes patients. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p <0.05) . A significant increase in knowledge regarding the pathophysiology of DKD and emerging non-steroidal MRAs in DKD was observed (43% and 34% relative increase in knowledge compared to baseline, p <0.0001) . Additionally, a significant increase in competency regarding identifying patients at-risk for DKD progression and management of DKD patients was demonstrated (37% relative increased to baseline, p<0.0001) . At post-activity evaluation, 99.7% indicated that information via these activities is useful for their practice. Furthermore, the majority of participants indicated that they intended to change their practice based on information received, including monitoring clinical trial advances with non-steroidal MRAs, evaluating the risk of potential hyperkalemia with DKD treatments, and screen for risk of DKD progression. It is evident from the outcomes of these educational activities that they led to significant improvement in knowledge and competence related to novel DKD treatment options and commitment to change among learners.

Disclosure

S.Karandrea: None. N.Agarwal: None. A.Jamrogiewicz: None.

Funding

Bayer HealthCare Pharmaceuticals (24656) Bayer HealthCare Pharmaceuticals (66351473) Bayer HealthCare Pharmaceuticals (25319) Bayer HealthCare Pharmaceuticals (67463661)
526-P: e-Health Literacy Rates and Applicability of a Patient-Facing Mobile App Intervention in a Predominantly African-American and Latinx Cohort with Type 2 Diabetes
Authors: KAUR SAVNEET , MAHALI LAKSHMI PRIYANKA , COSAR EMINE , JARIWALA SUNIT
Published: May 2022

Introduction: Racial and ethnic minorities have a higher burden of type 2 diabetes in part due to limited access to health-promoting resources and self-management tools. We developed and implemented a patient-centric mobile application, DiabetesXcel, to provide guideline-based education (via animated videos) and adherence support via goal setting and tailored push notifications.

Methods: Patients provided verbal or e-consent via REDCap generated e-mail links virtually (in-light of COVID-19) and completed baseline sociodemographic and e-health literacy (EHL) surveys (eHEALs) ; and DQoL (Diabetes quality of life) , DSMQ (Diabetes Self-Management Questionnaire) and DKQ-24 (Diabetes Knowledge Questionnaire) . Participants were guided on downloading the app and its functionality was explained in detail. Laboratory data were obtained by chart review from the Epic EHR.

Results: Of the 50 patients, mean age was 46.9 (± 9.2) years, 70% were female, and 82% identified as Blacks and Hispanics. Overall, the cohort, with an average 13.1 ± 8.3 years since diagnosis, had high prevalence of complications (60%) , and poor glycemic control (HbA1C > 7.5, 58%) . At baseline, scores of satisfaction (22.6 ± 6.9) , worry (10.9 ± 8.4) , impact (15.5 ± 5.2) and total DQoL scores (48.9 ± 15.6) indicated low quality of life (QoL) . DSMQ (21.8 ± 6.9) and DKQ (18.4 ± 3) were low across patients with and without complications (p= 0.5 and 0.8, respectively) . Interestingly, 88% had moderate-good EHL scores.

Conclusion: Most patients in our cohort demonstrated good e-health literacy scores. We expect that our mobile health application will promote diabetes education and self-management skills in our underserved minority community and favorably impact clinical outcomes. We eventually plan to disseminate the app and promote its uptake across marginalized populations on the national level.

Disclosure

S.Kaur: None. L.Mahali: None. E.Cosar: None. S.Jariwala: None.

Funding

New York Regional Center for Diabetes Translation Research
530-P: Complex Diabetes Management in Primary Care: Confidence and Opportunities for Specialty Support
Authors: MENDEZ CARLOS E. , MATTOX ELIZABETH A. , KADIYALA SUSHMA , XHIKOLA MAJLINDA , YANTSIDES KONSTANTINA , OIEN ANGELA D. , O'SHAUGHNESSY IRENE , HANSEN ANN E. , LUCAS JESSICA , HAZEN KYLE , SEMEAH LUZ M. , LEEY JULIO A.
Published: May 2022

Access to specialized diabetes care is limited due to shortage of endocrinologists and distance to specialty clinics. In addition, referrals to out-of-network providers frequently results in suboptimal care coordination. Tele-mentoring models such as ECHO (Extension for Community Healthcare Outcomes) extends specialty knowledge to primary care providers. Prior to the implementation of a series of ECHO sessions, we assessed provider confidence in managing type 2 diabetes (T2D) .

Methods: Prescribing providers (PP) from three VA Health Care Systems in Florida (North Florida/South Georgia) , Texas (Valley Coastal Bend) and Wisconsin (Milwaukee) were invited to participate. We asked questions about practice patterns, prescription habits, and confidence level treating T2D.

Results: A total of 49 PP completed the assessment. Mean age was 42.5 years and 74% were females. They were clinical pharmacists (63%) , physicians (22%) , ARNP (8%) , and the rest were trainees. Clinical experience < 5 year was present in 14.2%, whereas 67% had > years. Half of the providers felt very or extremely confident managing a complicated case (A1c>8% on two oral agents) , whereas only 14% of providers felt either “not at all” or somewhat confident. Most of the providers felt very or extremely confident obtaining a diabetes-focused history (63%) , educating patients about complications (69%) , or changing insulin regimens (61%) . Although most of the providers prescribed a glucose meter very often or always (81%) , only 6% of them prescribed a continuous glucose monitor frequently. When sending a referral, 32% mentioned either lack of local endocrinologists or long waiting time as main barriers. Providers felt that patients prefer to stay with their local VA PCP for diabetes care instead of seeing a specialist (65%)

Conclusions: A third of providers perceive significant barriers to access specialized diabetes care. There are opportunities to improve provider confidence and skills managing diabetes.

Disclosure

C.E.Mendez: Advisory Panel; Monarch Medical Technologies . K.Hazen: None. L.M.Semeah: None. J.A.Leey: None. E.A.Mattox: None. S.Kadiyala: None. M.Xhikola: None. K.Yantsides: None. A.D.Oien: None. I.O'shaughnessy: None. A.E.Hansen: None. J.Lucas: None.

Funding

Veterans Rural Health Resource Center - 00RH
539-P: Evaluation of a Comprehensive Physical Fitness Index to Predict Future Prediabetes and Metabolic Syndrome (MetS)
Authors: SATO TAKAAKI , FUJIHARA KAZUYA , YAMADA MAYUKO H. , CHO KAORI , YAGUCHI YUTA , YAMAMOTO MASAHIKO , KITAZAWA MASARU , ISHIGURO HAJIME , OSAWA TAEKO , YAMADA TAKAHO , KATO KIMINORI , SONE HIROHITO
Published: May 2022

Muscle strength, balance, and flexibility has been associated with the development of type 2 diabetes and atherosclerosis, but little is known whether the physical score (PS) , which integrates these physical fitness indices, can predict future metabolic diseases. We investigated the longitudinal relationship between baseline and changes in PS and future prediabetes and MetS. Analyzed were 5620 men aged 30 to 69 y without MetS who underwent physical fitness tests. Principal component analysis was performed on the correlation matrix of the physical fitness test results according to age. PS was defined as the first principal component score. Associations between PS values at the start of observation (year 0) , change in the PS one year later (year 1) and the onset of prediabetes and MetS at the end of observation (years 4 or 5) were examined by Cox hazard regression analysis. The same analysis was performed for the 3812 men without prediabetes at baseline. No significant difference was found for the development of prediabetes, but a significant difference was found for development of MetS. The hazard ratio for the development of MetS was 1.30 (1.18,1.44) for every 1 decrease in the PS in year 0 and 1.35 (1.13,1.60) for every 1 decrease in the change in PS from year 0 to year 1. PS was a simple and non-invasive indicator to predict MetS.

Disclosure

T. Sato: None. K. Fujihara: None. M. Yamamoto: None. M. Kitazawa: None. H. Ishiguro: None. T. Osawa: None. H. Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited.
542-P: Determinants of Objectively Measured Physical Activity in Chinese Immigrants in the U.S. with Prior Gestational Diabetes
Authors: HUANG SHUYUAN , ASH GARRETT I. , NAM SOOHYUN , JEON SANGCHOON , MCMAHON ERIN , WHITTEMORE ROBIN
Published: May 2022

Background: Women with prior gestational diabetes (GD) have times the risk of developing type 2 diabetes (T2D) as women without prior GD. Chinese immigrants in the US are disproportionately affected by GD and T2D. Physical activity (PA) is a modifiable lifestyle strategy to reduce the risk of T2D. The aim of this study was to identify health beliefs, cultural, and psychosocial determinants of objectively-measured PA among Chinese immigrants in the US with prior GD.

Methods: We conducted a cross-sectional study among 1Chinese immigrants with prior GD (6 months to 5 years postpartum) across the US, recruited primarily via WeChat. PA was measured by GT9X+ hip accelerometers for 7 consecutive days. Validated questionnaires in English and Chinese were used to assess health beliefs, cultural, and psychosocial characteristics. Descriptive, bivariate, and multiple regression analyses were performed to identify factors associated with PA levels.

Results: The mean age of participants was 34.3±3.7 years, and mean body mass index was 21.7±2.6 kg/m2. Mean daily steps were 5912±2139. Only 28% met the PA guidelines of ≥150 minutes of moderate- to vigorous- physical activity (MVPA) per week. The duration of MVPA per week was 86 [IQR 39- 152] minutes. Participants had an average of 9.2±1.4 hours of sedentary time per day, which was about 64.7±7.8% of the total wear time. In the final adjusted model, participants who had higher acculturative stress [-0.25 (SE=0.14) , p=.006], were not living with parents [-0.21 (SE=0.22) , p=.020], had no knowledge of PA guidelines [-0.18 (SE=0.17) , p=.039], and had an annual household income of < $60K [-0.21 (SE=0.23) , p=.025] were had fewer MVPA minutes per week.

Conclusion and implication: Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing knowledge of PA guidelines. The findings from this study will inform the development of culturally-sensitive interventions.

Disclosure

S.Huang: None. G.I.Ash: None. S.Nam: None. S.Jeon: None. E.Mcmahon: None. R.Whittemore: None.

Funding

Connecticut Nurses’ Foundation Scholarship Award
550-P: A Randomized Trial of Low-Carbohydrate Diet on Hemoglobin A1c among Individuals with Elevated Hemoglobin A1c
Authors: DORANS KIRSTEN S. , BAZZANO LYDIA A. , QI LU , HE HUA , CHEN JING , APPEL LAWRENCE J. , HU FRANK , SAMET JONATHAN , MILLS KATHERINE T. , O'BRIEN MATTHEW J. , UWAIFO GABRIEL I. , HE JIANG
Published: May 2022

Background: Low-carbohydrate diets decrease hemoglobin A1c among patients with type 2 diabetes mellitus. However, evidence on effects of low-carbohydrate diets on hemoglobin A1c among individuals with prediabetes is limited.

Methods: We conducted a randomized parallel-group trial of 150 adults aged 40-70 years with untreated hemoglobin A1c from 6.0-6.9%. Participants were assigned to a healthy low-carbohydrate diet (target <40 grams net carbohydrates months 1-3; <60 grams months 3-6) or usual diet. The low-carbohydrate arm received regular dietary counseling. Data on hemoglobin A1c and other metabolic risk factors were collected at 0, 3, and 6 months.

Results: Mean age was 59 years; 72% were female and 59% were Black. 95% completed the study. Participants in the low-carbohydrate arm had significantly greater 6-month decrease in hemoglobin A1c (net difference, -0.23% [95% CI, -0.32 to -0.14%]) , fasting plasma glucose (net difference, -10.3 mg/dL [95% CI, -15.7 to -4.9 mg/dL]) , and body weight (net difference, -5.9 kg [95% CI, -7.2 to -4.7 kg]) compared with usual diet arm. At 6 months, 53% in the low-carbohydrate arm and 32% in the usual diet arm had hemoglobin A1c <6.0% (p=0.01) .

Conclusion: A healthy low-carbohydrate diet led to improvements in glycemic and other cardiometabolic outcomes in adults with elevated hemoglobin A1c and could be recommended for prevention of type 2 diabetes mellitus.

Disclosure

K.S.Dorans: None. M.J.O'brien: None. G.I.Uwaifo: None. J.He: None. L.A.Bazzano: None. L.Qi: None. H.He: None. J.Chen: None. L.J.Appel: n/a. F.Hu: None. J.Samet: None. K.T.Mills: None.

Funding

National Institute of General Medical Sciences (1P20GM109036-01A1) . The California Walnut Commission (Folsom, CA) supported the study by providing walnuts. Shakes and bars were donated by The Simply Good Foods Company (Denver, CO) . Sugar replacement samples were provided by Swerve LLC (New Orleans, LA) .
551-P: Effects of a Plant-Based Intensive Lifestyle Intervention in Adults with Type 2 Diabetes: A Randomized Controlled Trial
Authors: HANICK CODY , PETERSON COURTNEY M. , SABATÉ JOAN , DAVIS BRENDA C. , SPENCE JAMIE W. , KELLY JOHN
Published: May 2022

Background: The Republic of the Marshall Islands (RMI) has the highest rate of type 2 diabetes (T2D) in the world. Lifestyle interventions, including plant-based diets and exercise, have been shown to effectively manage T2D.

Objective: We therefore conducted the largest plant-based lifestyle intervention in adults with T2D. The goal of this study was to determine whether a plant-based lifestyle intervention is more effective than the standard of care for treating type 2 diabetes.

Methods: We conducted a parallel-arm randomized clinical trial in Majuro, RMI. Adults with T2D were randomized to either standard of diabetes care (SOC) or a plant-based lifestyle intervention (PB+Ex) for 24 weeks. The first 12 weeks of the intervention involved the provision of plant-rich meals, counselling, cooking classes, and group exercise sessions, which gradually decreased in frequency over the 12-week period. Thereafter, from Weeks 13-24, participants in the PB+Ex group were instructed to continue the lifestyle intervention on their own. The primary outcome was change in HbA1c. Secondary outcomes included fasting glucose, insulin, blood pressure, lipids, and medication use. Outcome data was collected at five time points and analyzed using linear mixed models.

Results: One hundred thirty-eight adults with T2D started the intervention (mean ± SD; age: 54.3 ± 8.6 years, HbA1c: 10.3 ± 2.1%; 50.7% female) . PB+Ex reduced HbA1c by 1.3 ± 0.3% (lsmean ± SEM; p<0.001) and 0.7 ± 0.3% (p=0.01) at weeks 12 and 24, respectively, compared to SOC. PB+Ex also decreased BMI at weeks 12 and 24 (both -1.1 kg/m2; p<0.001) . Additionally, PB+Ex reduced C-reactive protein and waist circumference compared to SOC. Additional analyses on other fasting cardiometabolic endpoints and medication changes are underway.

Conclusions: A plant-based intensive lifestyle intervention with exercise is more effective at improving glycemic control, BMI, and inflammatory markers than the standard of diabetes care.

Disclosure

C.Hanick: None. C.M.Peterson: None. J.Sabaté: None. B.C.Davis: None. J.W.Spence: None. J.Kelly: None.

Funding

Department of the Army (W81XWH-05-1-0547)
554-P: Complex Meal Handling with Advanced Hybrid Closed-Loop (AHCL) System
Authors: HIRSH MAYA LARON , SHALIT ROY , SHALEM SHIRAN , COHEN OHAD , KURTZ NATALIE , ROY ANIRBAN , GROSMAN BENYAMIN , CUKIERMAN-YAFFE TALI , TIROSH AMIR
Published: May 2022

Background and Aims: Meal management is a major challenge for people with type 1 diabetes (PWD) . We aimed to explore 3 approaches to complex meal planning, from a most comprehensive scheme in open loop (OL) to a simplified, carbohydrate (CHO) counting-free scheme when using the MiniMed™ 780G system AHCL.

Methods: Participants (N=13, mean age 46.8±12.8 years and baseline A1C of 6.1±1.2%) consumed a high fat, high protein, meal using 3 types of insulin boluses;1) OL utilizing the dual-wave bolus and elaborate CHO counting;2) AHCL with accurate CHO amount;3) AHCL with a predefined bolus and no CHO counting,

Results: No significant differences in TIR and 5-hour iAUC were observed between the 3 bolus groups (P=0.401, P=0.526, respectively) There were no significant differences in other glucose metrics. (Table 1)

Conclusion: Our results indicate that glycemic control following a complex meal challenge is similar when using AHCL with or without accurate CHO counting and with less tendency for hypoglycemia when compared with the most elaborate meal management in OL. Thus, the current burden of meal management for PWD during OL system use is alleviated with AHCL.

Disclosure

M.Laron hirsh: None. R.Shalit: Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk. S.Shalem: None. O.Cohen: Employee; Medtronic. N.Kurtz: Employee; Medtronic. A.Roy: Employee; Medtronic. B.Grosman: Employee; Medtronic. T.Cukierman-yaffe: Research Support; European Association for the Study of Diabetes, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi. A.Tirosh: Advisory Panel; Abbott Diagnostics, AstraZeneca, Boehringer Ingelheim International GmbH, Merck & Co., Inc., Novo Nordisk, Sanofi, Consultant; Bayer AG, DreaMed Diabetes, Ltd., Research Support; Medtronic, Speaker's Bureau; Eli Lilly and Company.
56-LB: Racial/Ethnic Differences in the Use of Blood Pressure–Lowering Drugs Associated with Different Risk levels of Type 2 Diabetes among U.S. Adults without Diabetes
Authors: SHAO HUI , ALKHUZAM KHALID , GUO JINGCHUAN , JIAO TIANZE , SMITH STEVEN M. , ZHANG PING , GREGG EDWARD W.
Published: May 2022

Understanding differences in risk factors can assist in identifying means to reduce racial/ethnic disparities in type 2 diabetes (T2D) prevalence. Different types of blood pressure (BP) lowering drugs are associated with different levels of T2D risk. This study examined the utilization of BP-lowering drugs among US adults aged 18 and over without diabetes with diagnosed hypertension by racial/ethnic group. We used self-report or ICD-10 diagnostic codes to identify our study population using the 2016-2019 Medical Expenditure Panel Survey. The high T2D risk drugs included beta-blockers and diuretics and the low-risk drugs were ACEI and ARBs. We calculated the percentage of high-risk and low-risk drug use in non-Hispanic Black (NHB) , non-Hispanic White (NHW) , Hispanic, and Asian persons. Logistic regression was used to compare the uses of two drug types across different racial/ethnic groups, controlling for demographics, history of cardiovascular and renal diseases, insurance, duration of hypertension, and general health measurements. We have identified 18,283 individuals, with a mean age of 60.7 and 52.4% were females. Compared with NHB, NHW persons (adjusted odds ratio (aOR) :0.90, 95% CI: 0.58-0.98) , Hispanic (aOR:0.62, 95% CI: 0.56-0.70) , and Asian (aOR:0.54, 95% CI: 0.46-0.64) persons were less likely to receive high-risk drugs. Meanwhile, NHW (aOR: 1.19, 95% CI: 1.09-1.29) , Hispanic (aOR:1.14, 95% CI: 1.03-1.27) , and Asian (aOR:1.19, 95% CI: 1.02-1.40) persons were more likely to use low-risk drugs than NHB persons (all p<0.05) . The highest use of high-risk BP-lowering drugs and the lowest use of low-risk BP-lowering drugs by NHB persons could increase their risks of T2D and contribute to disparities in T2D prevalence between NHB and other racial/ethnic groups. Future studies can quantify the effect of the BP-lowering drug choices on T2D disparities.

Disclosure

H. Shao: Board Member; BRAVO4HEALTH, LLC. K. Alkhuzam: None. J. Guo: None. T. Jiao: None. S. M. Smith: None. P. Zhang: None. E. W. Gregg: None.
575-P: Screening, Selecting, and Training Peers to Deliver Mental Health Support via a Virtual Care Platform to Adults with Type 1 Diabetes Living in Rural and Remote Communities
Authors: TANG TRICIA S. , YIP KAI WAI , MOORE LAUREN , KLEIN GERRI
Published: May 2022

Introduction: While the diabetes distress (DD) experience is unique for adults with type 1 diabetes (T1D) compared to those with type 2 diabetes (T2D) , DD interventions involving peer support have focused largely on the T2D population. This study describes the process of screening, selecting, and training peers to provide mental health support to adults with T1D living in geographically marginalized settings.

Methods: Peer Supporter (PS) candidates (n=65) underwent a two-component screening process involving an online personality assessment and a semi-structured interview. Individuals who passed participated in a 6-hour Zoom-based Peer Supporter Training (PST) consisting of three parts: (1) identifying internal motivation, boosting resilience, and expressing empathy; (2) exercising mindfulness, sitting with difficult emotions, and exploring DD; and (3) practicing active listening, avoiding advice giving (including clinical) . Candidates were assigned a standardized patient (SP) with T1D and invited to complete a 5-day peer support trial. To graduate successfully, trainees needed to score ≥ 4 of a 5-point Likert scale for each of 8 competencies criteria.

Results: Of the 65 participants screened, 52 participated in PST. For the 5-day trial, candidates facilitated a values exercise and explored the SP’s DD profile. Mean scores for the 8 competency domains were: listening actively (4.55) ; no passing judgment (4.67) ; asking open-ended questions (4.12) ; making reflections (4.5) ; expressing empathy (4.42) ; sitting with strong emotions (4.44) ; avoiding advice giving (4.38) ; and deferring medical questions (4.58) . Forty-six of 52 participants graduated successfully.

Conclusions: A rigorous process is feasible for screening, selecting and training peers to deliver mental health support to adults with T1D. The next step is to examine the impact of this peer support intervention on DD outcomes.

Disclosure

T.S.Tang: None. K.Yip: None. L.Moore: None. G.Klein: None.

Funding

Juvenile Diabetes Research Foundation (2-SRA-2020-986-S-B)
579-P: Diabetes-Related Distress Is Inversely Associated with Weight Loss with Lifestyle Intervention in T2D
Authors: VAKHARIA JANAKI , WEXLER DEBORAH J. , THAWEETHAI TANAYOTT , YU CHU , DELAHANTY LINDA M.
Published: May 2022

Measures of depression (e.g., PHQ-8) and diabetes-related distress (e.g., Problem Areas In Diabetes, or PAID) are associated with diabetes self-care and adherence to lifestyle regimens in patients with T2D. The REAL HEALTH-Diabetes trial evaluated a Look-AHEAD adapted group lifestyle intervention (LI) . We sought to determine baseline characteristics that were associated with achieving ≥5% weight loss during the first year of the intervention. Participants were randomly assigned to receive LI either in-person (IP, n = 69) or by telephone (Tele, n =72) . At baseline, 12.9% had a PHQ-8 score of ≥ 10, indicating current depression, and 50.4% had a baseline PAID score of ≥ 40, indicating severe emotional distress. At 6 months and 12 months, 46.8% and 45.7% achieved ≥ 5% weight loss (Table 1) . Participants who achieved ≥ 5% weight loss at 6 and 12 months had lower mean baseline PAID scores than non-achievers (35 vs. 44, P=0.021 at 6 months; 35 vs. 43, P=0.036 at 12 months) . Achievers also had lower mean baseline PHQ-8 scores compared to non-achievers, but this difference was not statistically significant (4.0 vs. 5.1, P=0.596 at 6 months; 3.8 vs. 5.1, P=0.842 at 12 months) . We found that diabetes distress was more common than depression, and that baseline levels of diabetes-related distress were inversely associated with achievement of ≥ 5% weight loss at 6 and 12 months of LI.

Disclosure

J.Vakharia: None. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate. T.Thaweethai: None. C.Yu: None. L.M.Delahanty: Advisory Panel; Lilly Diabetes, Omada Health, Inc., WW International, Inc., ZOE Limited, Stock/Shareholder; Jana Care Inc., Omada Health, Inc., ZOE Limited.

Funding

T32 DK007028
580-P: Clinical and Psychological Differences in Depression in Distressed Teens with Type 1 Diabetes (T1D)
Authors: SCOTT SAMANTHA R. , O'DONNELL MAEVE B. , ZHOU CHUAN , MALIK FAISAL , PIHOKER CATHERINE , DESALVO DANIEL , BRADFORD MIRANDA , ROSENBERG ABBY , HILLIARD MARISA E. , YI-FRAZIER JOYCE
Published: May 2022

Introduction: Teens with T1D are at risk for depression and diabetes distress. While diabetes distress is typically more predictive of A1C, less is known about teens experiencing both concerns. In teens with T1D with elevated diabetes distress, we explored clinical and psychological differences between those with or without depression.

Methods: At baseline of a psychosocial intervention trial, teens (N=173) with PAID-T scores ≥30 (elevated diabetes distress) reported demographics and Patient Reported Outcomes (PROs) of depression, general/T1D resilience, diabetes quality of life (QoL) , and family conflict. A1C and pump use were extracted from medical records. Using Fisher’s exact, X-square, and Wilcoxon rank sum tests, we compared demographics, pump use, A1C, and PROs by depression status (clinical cutoff of PHQ-8 ≥10) .

Results: Distressed teens with depression (34%) were more likely to be female and have unemployed caregivers. Compared to participants without depression, distressed teens with depression reported lower resilience and QoL and higher distress and family conflict. There were no differences in mean HbA1c or insulin pump use.

Conclusions: Screening for depression is an important clinical initiative-teens with general and T1D-specific mood concerns are at risk for multiple psychosocial challenges that may warrant intervention and may be impacted by social determinants of health.

Disclosure

S.R.Scott: None. J.Yi-frazier: None. M.B.O'donnell: None. C.Zhou: None. F.Malik: n/a. C.Pihoker: None. D.Desalvo: Consultant; Dexcom, Inc., Insulet Corporation, Research Support; Insulet Corporation. M.Bradford: None. A.Rosenberg: None. M.E.Hilliard: None.

Funding

NIH 1R01DK121224-01