bluuebunny/crossref_metadata_2025 huggingface dataset:
482-P: Comprehension of Medicare Program and Participation of Diabetes Self-Management Training among Medicare Beneficiaries with Diabetes
Authors: NG BOON PENG , TOWNE SAMUEL D. , LAMANNA JACQUELINE B. , KIM KIYOUNG
Published: June 2021

Poorly managed diabetes can lead to complications which account for a large portion of diabetes costs. Although diabetes self-management programs have been shown to be effective in reducing the risk of complications, low uptake of diabetes self-management training (DSMT) has been reported. Identifying factors associated with participation in DSMT among Medicare beneficiaries (MBs) with diabetes can provide information to improve uptake of these programs. DSMT is a Medicare-covered benefit. We analyzed the nationally representative 2018 Medicare Current Beneficiary Survey PUF of MBs aged ≥ 65 years with reported type 2 diabetes (n=1,056). A survey-weighted logistic model, adjusted for socio-demographics and co-morbidities, was performed to examine the relationship between participation of DSMT and two binary variables including: 1) whether providers gave instructions on how to take care of one’s health; and 2) whether the Medicare program was easy/difficult to understand. Of study MBs, 49.6% self-reported participation in DSMT (a rate higher than other studies analyzing claims data). DSMT participants had higher rates of reporting the Medicare program was easy to understand (73.3% vs. 66.1%), and that providers gave instructions on how to take care of one’s health (68.0% vs. 64.0%) than non-DSMT participants. Among the study MBs, those reporting the Medicare program was easy to understand were more likely to participate in DSMT (odds ratio (OR)=1.40, p<0.046). Surprisingly, those reporting that providers gave instructions on how to take care of one’s health were not significantly associated with the participation of DSMT (OR=1.12, p<0.506). Our finding highlights that a better comprehension of the Medicare Program has a positive impact on the participation of DSMT. Interventions to improve MBs’ understanding of the Medicare program and associated benefits may increase participation in DSMT.

Disclosure

B. Ng: None. S. D. Towne: None. J. B. Lamanna: None. K. Kim: None.
486-P: Does Racial Homogeneity within an Organization Affect Non-Hispanic Black Participant Performance Outcomes in the National Diabetes Prevention Program (National DPP)
Authors: LANDAU ERIN O. , ELY ELIZABETH
Published: June 2021

The National DPP is a partnership of public and private organizations working together to build a nationwide infrastructure to deliver a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. As of October 2020, there have been 444,087 eligible participants, in 1,342 organizations, ever enrolled in the National DPP lifestyle change program. This analysis only included participants who met the requirements of program completion prior to March 1, 2020 (82,021 in 1,013 organizations). Of these participants, 10,612 were classified as Non-Hispanic/Black Only (N-HB) based on their reported race identification. The N-HB participants were divided into 2 groups: Primarily N-HB organization enrollment (more than half of participants in the organization identify as N-HB: 3,344 in 122 organizations) and non-Primarily N-HB organization enrollment (≤ half of the participants in the organization identify as N-HB: 7,268 in 891 organizations). Primarily N-HB organizations achieved at least preliminary recognition at a slightly higher rate (93.4%) than non-Primarily N-HB organizations (90.6%). However, Primarily N-HB organizations were less likely to meet the requirements for full recognition (51.6%) than non-Primarily N-HB organizations (67.5%). For Primarily N-HB organizations that achieved preliminary recognition, 85% missed the requirement of 5% weight loss. For most, this was the only missed requirement. However, despite the failure to achieve 5% weight loss, N-HB participants in Primarily N-HB organizations lost more weight (4.7%) than N-HB participants in non-Primarily N-HB organizations (4.3 %), and more than N-HB participants overall (4.4 %). These results could indicate that N-HB participants perform better with regards to weight loss when they enroll in Primarily N-HB organizations as opposed to non-Primarily N-HB organizations.

Disclosure

E. O. Landau: None. E. Ely: None.
49-OR: Changes in Regional Cerebral Blood Flow during Hypoglycemia in T1DM
Authors: SIMONSON DONALD C. , BOLO NICOLAS R. , THEBERGE JEAN , MUSEN GAIL , JACOBSON ALAN M.
Published: June 2021

Regulation of cerebral blood flow (CBF) during hypoglycemia (HYPO) is critical for maintaining adequate glucose delivery to the brain; however, specific changes in regional CBF during HYPO are not well defined. We measured CBF in 14 T1DM (mean ± SD age 31 ± 7 yrs, DM duration 16 ± 5 yrs, A1c 7.2 ± 1.0 %) and 13 healthy controls (CON; age 35 ± 11 yrs, A1c 5.2 ± 0.5 %) using 3.0 T MRI continuous arterial spin labeling during fasting baseline (BAS), a hyperinsulinemic (2 mU/kg/min) euglycemic clamp (EUG; 90 mg/dl), followed by a hypoglycemic clamp (HYPO; 50 mg/dl). Global and regional changes in CBF were measured in 15 regions of interest (ROI). At BAS, gray matter CBF was similar in CON and T1DM (58 ± 16 vs. 61 ± 11 ml/100 gm brain/min). No significant changes in CBF were observed from BAS to EUG in any brain region in either CON or T1DM. However, during HYPO in T1DM, CBF increased by 10% in gray matter and 16% in brainstem, both p <0.05. CBF also increased by 10% - 18% in specific ROIs involved in awareness of internal states, reward and emotion (orbitofrontal cortex, insula, anterior cingulate cortex, thalamus, and substantia nigra; p<0.01 to p<0.05). Minimal increases in CBF (1% - 6%) were observed in regions primarily involved in sensory or motor function, (occipital cortex, motor cortex, cerebellum, caudate, putamen) or in the posterior cingulate (all p > 0.30). In CON, no significant global or regional changes in CBF occurred during HYPO. In all subjects, higher A1c correlated with greater increases in CBF during HYPO (p<0.05).

Conclusions: 1) Hyperinsulinemia per se does not alter CBF in T1DM or CON, 2) During HYPO, brain blood flow increases more in T1DM vs. CON, especially in regions involved in integration of internal awareness, reward and emotion, compared to sensory or motor function, and 3) Greater increases in CBF in subjects with higher A1c suggest that compensatory physiologic mechanisms enable subjects with chronic exposure to hyperglycemia to maintain adequate cerebral glucose supply when plasma glucose levels are suddenly reduced.

Disclosure

D. C. Simonson: Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. N. R. Bolo: None. J. Theberge: None. G. Musen: None. A. M. Jacobson: None.

Funding

National Institutes of Health (DK073843)
491-P: Severe Muscle Insulin Resistance in Inuit Homozygous Carriers of the Common Greenlandic P.Arg684Ter TBC1D4 Variant Is Improved by a Single Bout of Exercise
Authors: KRISTENSEN JONAS M. , LARSEN TRINE L.J. , CARL CHRISTIAN S. , THORUP ANETTE , HINGST JANNE , ONSLEV JOHAN , OLESEN JESPER S. , PEDERSEN MICHAEL L. , RICHTER ERIK A. , HANSEN TORBEN , JØRGENSEN MARIT E. , WOJTASZEWSKI JØRGEN F.P.
Published: June 2021

In the Greenlandic Inuit population a common nonsense TBC1D4 p.Arg684Ter variant in muscle is found with an allele frequency of 17%. Homozygous carriers of this variant have impaired glucose tolerance, and a 10-fold increased risk of type 2 diabetes. Here we investigate whether the TBC1D4 p.Arg684Ter affects regulation of skeletal muscle glucose uptake during exercise and during insulin stimulation in the post exercise period. Inuits carrying zero (n=8) or two (n=8) alleles of TBC1D4 p.Arg684Ter were recruited from population surveys in Greenland. Glucose tolerance was measured during a 6 hour oral glucose tolerance test (OGTT). Skeletal muscle glucose uptake was measured by applying arterial-venous balance technique across the legs during one-legged exercise and during subsequent euglycemic hyperinsulinemic clamp. Glucose uptake was measured in both the rested and the exercised leg. During the OGTT blood glucose was similar at fasting but markedly elevated (by 4.4 mM) in TBC1D4 p.Arg684Ter carriers compared to matched controls at 2 hours, and variants became hypoglycemic at 4 hours (3.3 vs. 4.7 mM) and similar to controls at 6 hours. During exercise, TBC1D4 variant carriers and controls displayed similar glucose uptake in skeletal muscle. During insulin clamp, glucose uptake in the previously rested leg was lower (~50%) in TBC1D4 variant carriers compared to controls. In the prior exercised leg, glucose uptake during the insulin clamp was higher in both groups compared to the rested leg. However, glucose uptake in the previously exercised leg from TBC1D4 variant carriers was comparable to the previously rested leg in controls and thus still markedly lower than controls.

In conclusion: TBC1D4 p.Arg684Ter carriers have impaired insulin stimulated but normal exercise stimulated glucose uptake in skeletal muscle. A single bout of exercise improves muscle glucose uptake in carriers to levels seen in non-exercise muscle of controls.

Disclosure

J. M. Kristensen: None. T. Hansen: None. M. E. Jørgensen: Research Support; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis, Stock/Shareholder; Self; Novo Nordisk A/S. J. F. P. Wojtaszewski: None. T. L. J. Larsen: None. C. S. Carl: None. A. Thorup: None. J. Hingst: None. J. Onslev: None. J. S. Olesen: None. M. L. Pedersen: None. E. A. Richter: None.

Funding

Novo Nordisk Foundation (NNF14OC0013057, NNF17OC0028136); Independent Research Fund Denmark (FSS802000288B5855628)
492-P: Glucose Level Recommendations for Vo2 Max Exercise Testing in Adolescents with Type 1 Diabetes
Authors: KING KRISTI , THRASHER BRAD J. , MCKAY TIM E. , WINTERGERST KUPPER A.
Published: June 2021

Glucose level recommendations have yet to be established for adolescents diagnosed with type 1 diabetes (T1D) who participate in VO2 max exercise testing for clinical or strength and conditioning purposes. Although a decrease in glucose may be expected throughout, and immediately after exercise testing, a minimal pre-test glucose setpoint has not been established to reduce the risk of hypoglycemia. Retrospective medical and sports medicine chart reviews were conducted of clinical pediatric sports medicine and physical activity program patients with a diagnosis of T1D (N = 24; mean age = 15.5 ± 1.7 years; male = 14, 58.3%) who participated in a modified Bruce protocol for maximal oxygen uptake (VO2 max). The majority of the participants identified as non-Hispanic (n = 22, 91.7%) and white (n = 19, 79.2%). Their average body mass index (BMI) based on age and sex was in the 66th percentile ± 19.5 and their average hemoglobin A1c (HbA1c) was 8.8% ± 1.8. Almost 2/3 of the participants (n = 15, 62.5%) wore a continuous glucose monitor. Their average VO2 max peak was 43.7 ml/kg/min ± 7.1. A paired-samples t-test was employed to detect a statistically significant reduction in glucose levels between pretest (< 30 minutes, mean = 191.1 mg/dl ± 61.2) and post-test VO2 max (< 5 minutes, mean = 166.7 mg/dl ± 57.9); t(21) = 2.3, p <. 05). The American Diabetes Association recommends that glucose levels do not fall below 70 mg/dl in order to prevent symptoms of hypoglycemia. These results demonstrated a mean decrease in glucose of 24.4 mg/dl and provide further data which can be used to set safety parameters and expectations for adolescents with T1D participating in VO2 max testing.

Disclosure

K. King: None. B. J. Thrasher: None. T. E. Mckay: None. K. A. Wintergerst: None.
496-P: Large-Scale Association of Basal Metabolic Rate and Blood Glucose Outcomes in People with Type 2 Diabetes
Authors: WEXLER YDO , GOLDNER DAN
Published: June 2021

Background: Basal metabolic rate (BMR) measures the energy utilized by the body at rest. A growing body of literature reports increased BMR in people with type 2 diabetes (T2D), after controlling for sex, age and weight. We used blood glucose (BG) measurements and BMR values from the Apple Watch collected in the One Drop app, to measure the correlation of BMR and BG for the population as a whole, and for individuals over time.

Method: Data included over 48,000 person-months of blood-glucose and BMR measurements from 5,585 people with T2D. BG was self-monitored except for 186 people who provided continuous glucose monitoring (CGM) data through Dexcom’s API. BMR values were summed daily and correlated with 30-day average BG for the study population by linear regression. For each person using CGM, we computed the Pearson correlation coefficient of BMR with Time-in-Range (TIR), and used a random effects model to compute the overall correlation and associated p-value.

Results: The correlation coefficient of 30-day average BMR with 30-day average BG was 0.07 (p < 10-6), and of BMR with 30-day TIR was -0.26 (p < 10-6). The average correlation coefficient for individuals of BMR with TIR was -0.23±0.38. After applying the random effects model, the overall adjusted coefficient for individuals was -0.18 (p < 10-6).

Conclusion: BMR and BG measurements collected in the One Drop app for 5,585 people with T2D show significant correlation of BMR with monthly BG levels at the population level and for individuals over time. This is among the largest scale analyses of such correlation, and the first one to use highly available BMR measurements from the Apple Watch.

Disclosure

Y. Wexler: None. D. Goldner: Employee; Self; One Drop.
498-P: Resistance Exercise Rapidly Alters Citric Acid Cycle and Amino Acid Metabolism in Skeletal Muscle
Authors: PATAKY MARK W. , KUMAR ARATHI PRABHA , KLAUS KATHERINE , NAIR K. SREEKUMARAN
Published: June 2021

Muscle glucose metabolism is improved by either aerobic or resistance exercise (RE) training, but the mechanisms leading to improved metabolism for each of these exercise modes are not identical. Much work has been done onimproved oxidative metabolism by aerobic exercise, but far less is known about how RE impacts fuel metabolism. Here, TCA and amino acid metabolites are measured in skeletal muscle after a single bout of RE. Twenty one healthy subjects performed a session of one-legged knee extension RE that consisted of 3 sets of 10 reps at 70% of their 1 rep max. Two muscle biopsies were obtained from the vastus lateralis of each leg. From the RE leg, biopsies were obtained ≤10min post-RE (0hr PEX) and approximately 1hr post-RE (1hr PEX), respectively. From the non-RE leg, biopsies were obtained before and 1hr PEX, respectively. Muscle samples were frozen and stored until mass spectrometry analysis of metabolites was performed. A 2-fold increase in plasma lactate (P<0.05) and a 30-40% increase in muscle glycolytic enzyme activity (P<0.05) at 0hr PEX suggest increased activation of the glycolytic pathway. Also at 0hr PEX, TCA metabolites citrate and isocitrate were increased (P<0.05) compared to the pre-RE biopsy (0.35 and 0.01 mmol/μg, respectively). Further, multiple amino acid metabolites Arg, Asn, Lys, Thr, and Val were increased (P<0.05) in the REmuscle at 0hr PEX. These amino acids can enter the TCA cycle at various steps, indicating increased flux through the TCA cycle immediately after RE. By 1hr PEX, TCA intermediates malate and fumarate were reduced (P<0.05)compared to the non-RE leg (-0.65 and -0.35 mmol/μg, respectively), and multiple amino acid metabolites were also reduced (P<0.05). The decrease in these metabolites at 1hr PEX suggests increased use of metabolites for mitochondrial respiration. These results suggest activation of glycolytic and amino metabolism pathways, contributing to citric acid flux immediately following RE in order to meet energy needs in skeletal muscle.

Disclosure

M. W. Pataky: None. A. Prabha kumar: None. K. Klaus: None. K. Nair: None.

Funding

National Institutes of Health (R01AG062859)
506-P: Weight Loss Is Associated with Changes in Gut Microbiome: A Randomized, Crossover Trial Comparing a Mediterranean and a Low-Fat Vegan Diet in Overweight Adults
Authors: KAHLEOVA HANA , HOLUBKOV RICHARD , BARNARD NEAL
Published: June 2021

Background: Mediterranean and vegan diets improve body weight and gut microbiome composition. The aim of this study was to compare both diets head-to-head.

Methods: Randomized cross-over trial, conducted February-October 2019. Sixty-two overweight adults were assigned to each diet for 16-week periods in random order, separated by a 4-week washout. Body weight was the primary outcome. Secondary measures included changes in gut microbiome which was measured using 16S rRNA sequencing.

Results: Body weight decreased on the vegan compared with the Mediterranean diet (treatment effect -6.0 kg [95% CI -7.5 to -4.5]; p<0.001). The relative abundance of Bacteriodetes decreased (p<0.001 for both diets) and Eubacteria increased on both diets (p<0.001 for the Mediterranean and p=0.009 for the vegan diet). The relative abundance of Lachnospiraceae increased (p=0.03), the Firmicutes to Bacteroidetes ratio increased (p=0.04) and the butyrate-producing bacteria decreased (p=0.02) on the Mediterranean diet. The relative abundance of Proteobacteria decreased (p<0.001), and Enterobacteria and Ruminococcus increased on the vegan diet (p=0.04 and p<0.001, respectively). Changes in body weight correlated positively with changes in relative abundance of Firmicutes both on the Mediterranean (r=+0.36; p=0.01) and the vegan diet (r=+0.41; p<0.001) and with changes in relative abundance of Lachnospiraceae both on the Mediterranean (r=+0.40; p<0.001) and the vegan diet (r=+0.44; p<0.001). In addition, the changes in body weight correlated negatively with changes in relative abundance of Enterobacteria on the Mediterranean diet (r=-0.32; p=0.02) and Eubacteria on the vegan diet (r=-0.49; p<0.001).

Conclusions: A low-fat vegan diet lead to a greater weight loss compared with a Mediterranean diet. This may be partly explained by the difference in gut microbiome composition.

Disclosure

H. Kahleova: None. R. Holubkov: Advisory Panel; Self; National Institutes of Health, U. S. Food and Drug Administration, Board Member; Self; Pfizer Inc., Revance Therapeutics. N. Barnard: None.

Funding

Physicians Committee for Responsible Medicine
507-P: Effectiveness of a Ketogenic Diet and Virtual Coaching Intervention for Patients with Diabetes: A Difference-in-Differences Analysis
Authors: STROMBOTNE KIERSTEN , LUM JESSICA , NDUGGA NAMBI , UTECH ANNE , PIZER STEVEN , FRAKT AUSTIN , CONLIN PAUL
Published: June 2021

Objective: Nutrition interventions are key components of diabetes care. In light of increased disease prevalence among Veterans, the Veterans Health Administration (VA) partnered with Virta Health to test the effectiveness of a ketogenic-diet and virtual coaching intervention in controlling markers of diabetes care and healthcare utilization.

Research Design and Methods: Using a difference-in-differences analysis with a waitlist-control group—a quasi-experimental methodology—we estimated the five-month change in hemoglobin A1c (HbA1c), body mass index, blood pressure, prescription medication use, and healthcare utilization. The analysis included 590 patients with diabetes who were also overweight or obese, and who regularly utilize VA for healthcare. We used data from VA electronic health records from 2018-2020.

Results: The ketogenic diet and virtual coaching intervention was associated with significant reductions in HbA1c levels (-0.68, [95% CI -1.01, -0.35]), diabetes medication fills (-0.38, [-0.49, -0.26]), body mass index (-1.08, [-1.96, -0.20]), diastolic blood pressure levels (-1.4, [-2.73, -0.14]) and outpatient visits (-0.36, [-0.70, -0.02]). We found no significant change in emergency department visits.

Conclusions: This real-world assessment of a virtual coaching and diet program shows that such an intervention offers short-term benefits on markers of diabetes care and healthcare utilization in patients with diabetes. It remains unclear whether the effect of the program operates primarily through the personalized coaching component, the ketogenic diet recommendations, or some combination of the two.

Disclosure

K. Strombotne: None. J. Lum: None. N. Ndugga: None. A. Utech: None. S. Pizer: None. A. Frakt: None. P. Conlin: None.

Funding

U.S. Department of Veterans Affairs (HSR&D SDR 20-386); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114098)
527-P: Pediatric Parenting Stress, Child Behavior, and COVID-19-Specific Parent Functioning among Parents of Youth with Type 1 Diabetes (T1D)
Authors: ROONEY KELLYANN , WANG CHRISTINE H. , HILLIARD MARISA E. , STREISAND RANDI , DANKO CHRISTINA
Published: June 2021

Introduction: Parents of children with T1D experience substantial caregiving distress, and child behavior problems are common among children with T1D. Stressors associated with the COVID-19 pandemic may disrupt T1D management and/or parent psychological functioning. This study examined the associations among pediatric parenting stress, child behavior, and diabetes- and COVID-19-specific psychosocial experiences among parents of children with T1D during the initial months of the COVID-19 pandemic.

Methods: Participants were 100 parents of young children with T1D (M age=6.7±1.6; M T1D duration=2.9±.5 years), who had completed participation in a multi-site behavioral intervention trial. In June/July 2020 (≥6 months after trial completion), parents self-reported on demographics, pediatric parenting stress (Pediatric Inventory for Parents; PIP), child behavior (Eyberg Child Behavior Inventory; ECBI), and a newly developed questionnaire measuring negative/positive impact of COVID-19 on T1D management and parent mood related to COVID-19.

Results: During the COVID-19 pandemic, there were significantly lower ECBI scores for married versus non-married participants (t=2.53, p<.05). PIP was positively correlated with ECBI (r=.35, p<.01) and negative COVID-related T1D management (r=.42, p<.01), but negative COVID-related T1D management was not associated with ECBI. Worse COVID-19-specific parent mood was associated with PIP (r=.63, p<.01) and ECBI (r=.28, p<.01). Positive COVID-related T1D management was unrelated to PIP or ECBI.

Conclusion: Given the increased demands of managing home, school, work and adhering to social distancing measures while managing a chronic illness, parents of children with T1D are particularly vulnerable during the COVID-19 pandemic. Clinically, findings highlight the importance of assessing parent psychosocial functioning, child behavior, and challenges to children’s T1D management.

Disclosure

K. Rooney: None. C. H. Wang: None. M. E. Hilliard: None. R. Streisand: None. C. Danko: None.
53-LB: Prevalence and Correlates of Diabetes Distress in Low-Income Immigrants with Type 2 Diabetes
Authors: HU LU , XU XINYI , YANG SHUWEN , LEI LEI , BAO HAN , FAN BAOLUN , SEVICK MARY ANN
Published: June 2021

Objective: The American Diabetes Association has called for more research on distress in adults with type 2 diabetes (T2D). There is a dearth of data on diabetes distress in underserved immigrants. This study aimed to examine prevalence and correlates of diabetes distress among Chinese immigrants with T2D.

Methods: A cross sectional study was conducted among Chinese immigrants with T2D in New York City in 2018. Sociodemographic survey and diabetes distress scale (DDS) were administered face-to-face by bilingual study staff. DDS is a validated 17-item survey to assess diabetes distress and includes 4 subscales: physician, regimen, interpersonal, and emotional-related distress. Responses for each item ranged from 1 (not a problem) to 6 (a very significant problem) with a score greater than 2 indicating a clinically significant and at least a moderate level of distress. Descriptive statistics and multivariable logistic regression modeling were used.

Results: The sample (N=94) was mostly female (60.6%), married (75.5%), retired (57.4%), limited English proficient (86.2%) with a mean age of 70.6 (SD=11.6). The majority of participants had a high school education or less (61.7%) and a household income of ≤$25,000/yr (69.1%). Overall, 23.4% of the participants reported at least a moderate level of distress. The most common sources of distress were emotional burden (33.0%), followed by regimen (30.9%), interpersonal (29.8%), and physician (18.1%). Compared to those who were currently employed, those who were retired had a lower odds of diabetes distress (OR=0.12, 95% CI 0.02-0.83). Age, gender, years living in the US, education, and income were not significant correlates.

Conclusions: We found high rates of diabetes distress and emotional burden among Chinese immigrants with T2D. Given the known link between diabetes distress and poor health outcomes, it may be important to consider screening for diabetes distress and incorporating psychological counseling in diabetes care.

Disclosure

L. Hu: None. X. Xu: None. S. Yang: None. L. Lei: None. H. Bao: None. B. Fan: None. M. Sevick: None.

Funding

National Institutes of Health (U54MD000538-15, K99MD012811, R00MD012811, P30DK111022)
53-OR: Structural Grey Matter Alterations and Cognitive Function in Diabetes: A UK Biobank Study
Authors: BURGESS JAMIE , KELLER SIMON S. , PETROPOULOS IOANNIS N. , SELVARAJAH DINESH , TESFAYE SOLOMON , ALAM UAZMAN
Published: June 2021

Structural alterations of the central nervous system are demonstrated in people with diabetes. We aimed to characterise areas of global and anatomical grey matter volumes using T1-weighted magnetic resonance (MR) brain imaging (3-T MR imaging machine) in participants from the UK Biobank dataset. Participants with diabetes (DM) (n=569) and people without diabetes (CON) (n=20,801) were analysed. The mean age of DM diagnosis was 49.5±15 years. Baseline demographic and anthropometric data are as follows: DM group included more men (DM: 65% vs. CON: 47%) but were of a similar age (DM: 57.6±7.1 vs. CON: 55±7.5 years). BMI (DM: 29.6±5.2 vs. CON: 26.5±4.2 kgm2; p<0.0001) and systolic blood pressure (DM: 141±17 vs. CON: 137±19mmHg; p<0.0001) were higher in DM compared to CON with no difference in diastolic blood pressure (DM: 82±10 vs. CON: 81±10mmHg; p=NS). The majority of participants in both groups were right-handed (DM: 88.9%, CON: 89.1%) with a minority reporting ambidexterity (DM: 2.1%, CON: 1.5%). When comparing grey matter volume of DM vs. CON: peripheral cortical grey matter (corrected for head size) (599002±41503mm3 vs. 621942±40421mm3; p<0.0001), superior frontal gyrus (left: 10715±1695mm3 vs. 11056±1766mm3; p=0.001; right: 9279±1513mm3 vs. 9608±1612mm3; p<0.0001), left middle frontal gyrus (9894±1721mm3 vs. 10082±1786mm3; p=0.035), right anterior division of the supramarginal gyrus (3061±598mm3 vs. 3143±614mm3; p=0.001), right posterior supramarginal gyrus (5337±1052mm3 vs. 5476±1035mm3; p=0.002), paracingulate gyrus (left: 5558±866mm3 vs. 5749±856mm3; p=0.0006; right: 5456±845mm3 vs. 5700±852mm3; p<0.0001), precentral gyrus (left: 13712±1717mm3 vs. 14065±1748mm3; p=0.04; right: 13294±1652 vs. 13711±1731 p<0.0001) and left postcentral gyrus (10905±1481mm3 vs. 11313±1492mm3; p=0.0008) were all lower in DM compared to CON. People with diabetes have a significant reduction in global grey matter volume in distinct brain regions as previously described in the literature.

Disclosure

J. Burgess: None. S. S. Keller: None. I. N. Petropoulos: None. D. Selvarajah: None. S. Tesfaye: Advisory Panel; Self; Angellini, Bayer AG, Eva Pharma, Wörwag Pharma, Speaker's Bureau; Self; Abbott, AstraZeneca, Grunenthal Group, MSD Corporation, Novo Nordisk, Pfizer Inc. U. Alam: None.
545-P: Experiences of Emerging Adults with T1D during the COVID-19 Pandemic
Authors: MONAGHAN MAUREEN , BRYANT BREANA , WANG CHRISTINE H.
Published: June 2021

Introduction: Emerging adults (EAs) with T1D may be disproportionately affected by COVID-19 related disruptions given the many transitions that occur during this developmental period. The current study examined self-reported challenges in daily routines and T1D care in a sample of EAs during the COVID-19 pandemic.

Method: Participants included 22 EAs with T1D (M age=21.6±1.1 yrs; 45.4% male; 40.9% non-Hispanic white; 86.4% enrolled in higher education; 77.3% employed; M A1c=7.8%±1.2%). EAs completed surveys about exposure/personal impact of COVID-19 (n=13), a structured interview (n=2), or both (n=7) during the first 9 months of the COVID-19 pandemic (3/2020 - 11/2020).

Results: Most EAs (86.4%) denied COVID-19 symptoms, diagnoses, or hospitalizations in themselves or close contacts; 3 EAs (13.6%) reported COVID-19 diagnoses in family members, with one reported death of a family member. Fifty-five percent of EAs reported strictly social distancing. On the survey, 85% of EAs reported significant disruptions due to COVID-19, including job loss/reduction in hours (45%), education changes (45%), and moving (40%). T1D impact varied, with 50% reporting easier management of T1D; 30% reporting less exercise/worse diet; 30% reporting sleep problems; and 40% reporting more health anxiety. For EAs with more than one instance of survey completion (n=9), diabetes-specific impact worsened over time (t(8)=-2.20, p=.06; Cohen’s d = -.72). Interview data (n=9) supported quantitative results, with themes related to the impact of COVID-19 on daily routines for T1D management and delayed transition to adult T1D care.

Discussion: EAs with T1D experienced many COVID-related changes and increasing negative impact on T1D self-care over time. EAs may be particularly vulnerable to the widespread impacts of COVID-19 on employment, education, and receipt of medical care. Future research should examine longitudinal responses to the COVID-19 pandemic to identify EAs who may need additional support or resources for T1D care.

Disclosure

M. Monaghan: None. B. Bryant: None. C. H. Wang: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
547-P: Worry and Mental Health in Young Adults with Type 1 Diabetes during the COVID-19 Pandemic
Authors: COMMISSARIAT PERSIS V. , PIERRE DANIELLE ST. , SABINO ANNA , LEE SARA , SAYLOR JENNIFER
Published: June 2021

Aim: There are many challenges to navigating young adulthood with type 1 diabetes (T1D). The COVID-19 pandemic has negatively impacted mental health, particularly in young adults (YA) who may already struggle to find structure and support.

Methods: Surveys were distributed electronically to YA with T1D (ages 17-30) associated with the College Diabetes Network, a nonprofit organization serving YA with diabetes, in Spring and Fall 2020. Participants in each cohort were asked to rate their worry about contracting COVID-19 (scale of 1-5, 5=”very worried”), and report current diagnoses of depression or anxiety by a healthcare professional (yes/no). T-tests and chi-square tests examined the differences in reported COVID-19 worry, anxiety, and depression from Spring to Fall, as well as the association between worry and diagnosed depression/anxiety at both time points.

Results: Participants were demographically similar at both time points ((M±SD) Spring: n=468, age 22.1±2.7 years, 82% female, 84% white; Fall: n=375, 22.4±3.2 years, 79% female, 82% white; p>.10). Overall, participants endorsed significantly more COVID-19 worry in Fall than in Spring (3.57±1.1 vs. 3.29±1.4; p<.001). Self-reported anxiety diagnoses showed an increasing trend from Spring to Fall (p=.065), while self-reported depression diagnoses showed no change between time points (p>.10). Participants with a pre-existing diagnosis of anxiety or depression endorsed significantly more COVID-19 worry than those without a mental health diagnosis at both time points during the pandemic (Spring: anxiety p=.012, depression p=.031; Fall: anxiety: p=.001, depression: p=.004).

Conclusions: YA with T1D endorse more worry about contracting COVID-19 as the pandemic progresses, with an upward trend in anxiety diagnoses. Worry was exacerbated in those with a pre-existing mental health condition. These results underscore the need for greater support for YA with T1D, to reduce COVID-19 related worry and protect mental health outcomes.

Disclosure

P. V. Commissariat: None. D. St. pierre: None. A. Sabino: None. S. Lee: None. J. Saylor: None.
555-P: Leveling the Playing Field of Technology Access for Youth with T1D: NICH Helps, but Challenges Persist
Authors: LELY JUSTINE , HARRIS MICHAEL A. , NARANJO DIANA , JENISCH CELESTE , CADIZ WINNIEBHELLE C. , BENSEN RACHEL , VIANA JULIA , WAGNER DAVID V.
Published: June 2021

Objective: Advancements in technology (insulin pumps, CGMs) for youth with type 1 diabetes (T1D) hold promise for better outcomes, but multiple barriers to access exist, especially for underserved and underrepresented populations. Novel Interventions in Children’s Healthcare (NICH), was designed to improve health for youth with T1D and social vulnerabilities. NICH is associated with improvements in glycemic control and reductions in complications (DKA), but less is known regarding technology access for participating youth. This study aims to 1) identify prevalence of technology use prior to and after NICH initiation and 2) examine the relationship between technology access and NICH outcomes.

Methods: Youth with T1D served by NICH (n=65) across three distinct geographical sites were included. EHR review included T1D complications (DKA), HbA1c values, and presence of T1D technology one year prior and two years following initiation of NICH services. Mean age was 15.0 years (SD=3.5); 52% female; 73% non-Hispanic White.

Results: Ten percent of youth had access to technology prior to NICH (pump=8%; CGM=2%), and 22% had access to technology 2 years post NICH initiation (pump=17%; CGM=14%). Youth were significantly more likely to gain access to CGMs (p<.01) and any T1D technology (p=.02) while in NICH. Youth with technology prior to NICH had fewer days admitted (p=.001) and ED visits (p<.01) pre-referral than those without technology. Youth who gained access to a CGM within the first year of NICH services were significantly more likely to show improvements in glycemic control (p=.01) compared to those without.

Conclusion: With rates of access hovering around 40% for CGMs and 50% for pumps, this study demonstrates that 1) youth referred to NICH experience substantial barriers to accessing T1D technology, 2) NICH participation is associated with increased access to T1D technology for socially vulnerable youth, and 3) despite program involvement, technology access inequities persist.

Disclosure

J. Lely: None. M. A. Harris: None. D. Naranjo: None. C. Jenisch: None. W. C. Cadiz: None. R. Bensen: None. J. Viana: None. D. V. Wagner: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust; BUILD EXITO Foundation; Central Oregon Health Council
56-LB: The Mediating Role of Shared Responsibility in the Relationship of Trait Mindfulness and Diabetes-Related Outcomes
Authors: ABUJARADEH HIBA , VISWANATHAN PUSHPA , SEREIKA SUSAN M. , DINARDO MONICA M. , FEELEY CHRISTINE A. , CHARRON-PROCHOWNIK DENISE
Published: June 2021

In youth with T1D, mindfulness and parental involvement (i.e., shared responsibility) of diabetes self-management (DSM) behaviors are associated with positive diabetes-related outcomes. This study explored the mediating role of shared responsibility in the relationship of mindfulness with DSM and A1c. A cross-sectional study was conducted among 129 adolescents aged 12-18 years with T1D at a tertiary medical center. Adolescents completed a survey on mindfulness (Child Acceptance & Mindfulness Measure), shared responsibility (Diabetes Family Responsibility Questionnaire-Short) and DSM (Self-care Inventory). A1c was obtained from medical records. The PROCESS SPSS macro by Hayes (v3.5) was used to assess mediation. Unstandardized and standardized path coefficients (β), SE, p-value, and 10,000 bias-corrected bootstraps 95% CI reported.

Results: Mindfulness had positive significant association with shared responsibility (a-path=0.974, SE=.045, β=.189, R2=.036, p=.032). Shared responsibility had significant association with DSM (b-path=0.055, SE=.017, β=.275, p=.0015). The direct (c’) and total (c) relationships between mindfulness and DSM were significant (c’=0.198, SE=.087, β=.193, p=.024; c=.251, SE=.088, β=.245, R2=.06, p=.005). The relationship between mindfulness and DSM was partially mediated by shared responsibility (ab=0.053, SE=0.031 bias-corrected bootstrapped 95% CI = [0.0059, 0.0119]). For the second mediational model, neither mindfulness nor shared responsibility was associated with A1c (p>.05). Mindfulness and shared responsibility had positive association with DSM but not A1c. Shared responsibility partially mediated the relationship between mindfulness and DSM, whereby youth with higher levels of trait mindfulness had greater shared responsibility and better DSM. Temporal inferences should be interpreted with caution. Interventions targeting both mindfulness and shared responsibility should be explored.

Disclosure

H. Abujaradeh: None. P. Viswanathan: None. S. M. Sereika: None. M. M. DiNardo: None. C. A. Feeley: None. D. Charron-Prochownik: None.

Funding

National Association of Pediatric Nurse Practitioners; Eta Chapter-Sigma Research Award; Swigart/Gold Doctoral Student Award; J. Wiggins Scholarship
560-P: Reimagining the Assessment of Diabetes Distress in Type 2 Diabetes
Authors: POLONSKY WILLIAM H. , FISHER LAWRENCE , HESSLER DANIELLE M. , KING SARAH B. , DESAI URVI , KIRSON NOAM , PEREZ-NIEVES MAGALY
Published: June 2021

Recent advances in type 2 diabetes (T2D) care have led to changes in the lived experience of diabetes. Thus, an updated understanding of concomitant changes in diabetes distress (DD) and its measurement is now warranted. Toward this end, we developed a new measurement strategy and instrument to assess DD among adults with T2D: the T2-Diabetes Distress Assessment Tool.

Cognitive interviews with a diverse group of 11 T2D adults and 6 diabetes clinicians resulted in the development of 51 items that were administered through an online survey to a validation sample of 599 T2D adults from the TCOYD Research Registry. Included for construct validity were measures of affect (WHO-5, PHQ-8, PSS), hypoglycemic concerns (HABS), self-management (SDSCA), and clinical outcomes (A1C).

Item content suggested two broad categories: (1) the core affective experience of DD (T2-DD Core), e.g., feeling overwhelmed with diabetes, and (2) 7 contributors to DD (T2-DD Sources): concerns about hypoglycemia, complications, healthcare provider, management demands, interpersonal issues, shame and stigma, and diabetes care access.

The T2-DD Core items and each of the 7 T2-DD Sources items were submitted separately to an EFA with PROMAX rotation. Each analysis yielded a single, dominant factor. Poorly loaded and conceptually overlapping items were removed for parsimony. The final T2-DD Core measure (8 items) and each of the 7 T2-DD Sources measures (22 items in total) yielded acceptable alpha coefficients. T2-DD Core was significantly associated with all construct validity measures; while each of the 7 T2-DD Sources was associated with validity measures in expected areas (e.g., hypoglycemia with HABS). Results were similar for insulin users and non-insulin users.

In total, these scales comprise the T2-Diabetes Distress Assessment Tool, which provides a unique method of assessing two complementary and clinically relevant aspects of DD, based on T2D adults’ lived experience: the core level of DD and the specific sources of DD.

Disclosure

W. H. Polonsky: Advisory Panel; Self; Intarcia Therapeutics, Inc., Consultant; Self; Abbott Diabetes, ADOCIA, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Insulet Corporation, Lilly Diabetes, Novo Nordisk, Onduo LLC., Sanofi US. L. Fisher: Consultant; Self; Ascensia Diabetes Care, Lilly Diabetes, Speaker’s Bureau; Self; Dexcom, Inc. D. M. Hessler: Consultant; Self; Eli Lilly and Company. S. B. King: Consultant; Self; Eli Lilly and Company. U. Desai: Consultant; Self; Eli Lilly and Company. N. Kirson: Consultant; Self; Eli Lilly and Company. M. Perez-nieves: Employee; Self; Eli Lilly and Company.

Funding

Eli Lilly and Company
562-P: Transition of Care in Type 1 Diabetes and Association with Student and Employment Status
Authors: MAJIDI SHIDEH , ROBERTS ALISSA J. , SUERKEN CYNTHIA , REBOUSSIN BETH A. , MALIK FAISAL , MARCOVINA SANTICA M. , CORATHERS SARAH , REYNOLDS KRISTI , IMPERATORE GIUSEPPINA , WADWA R. PAUL , PIHOKER CATHERINE
Published: June 2021

Transition between pediatric and adult diabetes care is often associated with new responsibilities in diabetes care and increased risk of acute complications. This study examines post-transition rates of acute complications and independence in diabetes self-care as a function of student and employment status based on time since transfer.

The study included young adults with type 1 diabetes (T1D) between 18-26 years of age who completed a SEARCH for Diabetes in Youth Study visit between 2016-2019. Subgroup analysis compared those that transitioned care to an adult provider in the past 2 years to those who had transitioned ≥2 years prior. Chi-squared tests and linear and logistic regression models were applied. The models for diabetes complications and care included an interaction term between student and employment status and adjusted for gender, race/ethnicity, age, education level, insurance type, diabetes duration, and site.

1,043 participants were included in the analysis (56.6% female, mean age 22.2±2.5 years, mean T1D duration 11.7±3.0 years). Overall, 65.9% of participants had transferred to an adult diabetes care provider prior to their study visit. Among those who transitioned within the past two years (N=254), unemployed non-students were significantly more likely to experience diabetic ketoacidosis or severe hypoglycemia than unemployed students (p=0.01). Non-students who transferred within the past two years were less likely to be performing all diabetes self-care independently (p=0.03).

In conclusion, recent transition from pediatric to adult diabetes care represents a high-risk period for acute complications, specifically for non-students who are unemployed. For those who had transitioned in the past 2 years, students were more likely to be independent in their diabetes self-care. Additional support may be needed in this group to improve independent diabetes care and reduce the risk for acute complications.

Disclosure

S. Majidi: Advisory Panel; Self; Companion Medical. R. Wadwa: Consultant; Self; Tandem Diabetes Care, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care. C. Pihoker: None. A. J. Roberts: None. C. Suerken: None. B. A. Reboussin: None. F. Malik: None. S. M. Marcovina: None. S. Corathers: None. K. Reynolds: Research Support; Self; Merck & Co., Inc. G. Imperatore: None.

Funding

National Institutes of Health (1UC4DK108173, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); Centers for Disease Control and Prevention
563-P: The Relationship between Educational Attainment and Attrition Rates among Participants in the National Diabetes Prevention Program
Authors: ZHANG XUANPING , CANNON MICHAEL , NG BOON PENG , ELY ELIZABETH
Published: June 2021

Research shows that education plays a critical role in participants’ commitment to public health programs. While participants’ age and race/ethnicity have been shown to be associated with attrition in the National Diabetes Prevention Program (National DPP), the effect of education remains uncertain. Using data from the CDC Diabetes Prevention Recognition Program, we examined the relationship between educational attainment and attrition rates. We included the study population who enrolled from March 2018 through February 2019 and had the opportunity to attend for at least one year. Cumulative attrition rates were calculated by delivery mode: in-person, online, distance-learning, and combination. Education was categorized as follows: <high school (HS), HS graduate, 1-3 years college, and college graduate. We used cross-tabulation method with chi-square tests in our analyses. The study population (N=313,150) was 74.8% female and 65.5% white, with a mean age of 49.1 years (SD: 12.5) and mean BMI of 35.0 kg/m2 (SD: 7.1). Participants with lower educational attainment had significantly higher cumulative attrition rates compared to those with higher educational attainment among programs delivered in-person (through Session 5: 20.4% in <high school (HS) group vs. 12.5% in HS graduate group vs. 9.3% in 1-3 years college group vs. 8.4% in college graduate group, p<0.05) and distance-learning programs; by contrast, differences were not significant in online and combination programs. This pattern continued through Session 16, when similar attrition rates emerged from all education groups. These findings highlight the need for new strategies to better engage participants in the National DPP, especially those with lower educational attainment.

Disclosure

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

Funding

Centers for Disease Control and Prevention
573-P: Insulin and Supply Rationing in Emerging Adults with Type 1 Diabetes
Authors: BLANCHETTE JULIA E. , TOLY VALERIE B. , WOOD JAMIE R. , LITCHMAN MICHELLE L.
Published: June 2021

Over 25% of adults with diabetes have reported rationing insulin in the United States. Emerging adults, ages 18-25, may be even more vulnerable to rationing as they grapple with financial instability during this developmental period of increasing independence coupled with the rising cost of healthcare. The purpose of this study was to explore factors related to insulin and diabetes supply rationing in a sample of emerging adults with type 1 diabetes (T1D). Content analysis was used to examine a single open-ended response to the question, “Please tell me about your experiences rationing insulin or diabetes supplies,” in a parent cross-sectional study. The parent study explored financial stress factors, psychological factors, and self-management outcomes in 413 emerging adults from the T1D Exchange Clinic Registry. Chi-square tests were utilized to understand if rationing (yes or no) differed based on gender, race/ethnicity, employment status, type of health insurance, insulin pump usage, CGM usage, and A1c level (<8.9% or >9.0%). Alpha was set at .05. A total of 268 participants responded to the open-ended question about rationing. Over one-third of respondents (N=99, 36.9%) reported rationing insulin or diabetes supplies. Lack of private health insurance X2(3, N=224)=8.38, p<.05, racial/ethnic diversity (non-white, Hispanic) race/ethnicity X2(6, N=224)=13.54, p<.05 and no CGM usage X2(1, N=224)=9.75, p<.01 had significant relationships with rationing. Gender, employment status, A1C level, and insulin pump usage were not associated with rationing. A considerable number of emerging adults with T1D have experience rationing. Diabetes providers should routinely assess for insulin and diabetes supply rationing in this population. Attention should be paid to emerging adults who are racially/ethnically diverse, lack private insurance, and do not use CGM. Policy changes are necessary in order to improve access to affordable diabetes management tools in this vulnerable population.

Disclosure

J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. V. B. Toly: None. J. R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation, Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes.

Funding

Sigma Theta Tau Alpha Mu; Frances Payne Bolton School of Nursing