bluuebunny/crossref_metadata_2025 huggingface dataset:
625-P: CME Effectively Improves Physician Knowledge and Competence Related to Hypoglycemia Risk Reduction with Basal Insulin in the Modern Era
Authors: LARKIN AMY , LE ANNE
Published: June 2020

We sought to determine if an online continuing medical education (CME) curriculum could improve the clinical knowledge/competence of primary care physicians (PCPs) related to hypoglycemia risk reduction with basal insulin. We also measured education needed for endocrinologists (endos) in this area. The online CME curriculum consisted of 3 text- or video-based activities about reducing hypoglycemia risk with newer basal insulins. Educational effects were assessed using repeated pairs pre-assessment/post-assessment, where individual participants served as his/her own control. For all questions combined, a chi-squared test assessed whether the mean post-assessment score differed from the mean pre-assessment score. P values <.05 are statistically significant. The activities launched in November or December, 2018 and data were collected through November 2019. • 16% of PCPs (P<.01) demonstrated improvement in recognizing the impact of hypoglycemia in patients with diabetes (knowledge) • 11% of PCPs (P=.68) demonstrated improvement in recognizing the link between hypoglycemia and cardiovascular events (knowledge) • 20% of PCPs (P<.001) demonstrated improvement in using newer basal insulins to decrease hypoglycemia risk (competence) Persistent knowledge/competence gaps remain: • 19% of endos and 28% of PCPs need additional education to improve knowledge on the impact of hypoglycemia in patients with diabetes • 66% of endos and 72% of PCPs need additional education to improve knowledge on the link between hypoglycemia and cardiovascular events • 8% of endos and 18% of PCPs need additional education to improve competence related to using newer basal insulins to decrease hypoglycemia risk This study demonstrates the success of an online curriculum at improving knowledge and competence of PCPs related to reduction of hypoglycemia risk with basal insulins. Persistent gaps were identified among PCPs and endos for future educational targets.

Disclosure

A. Larkin: None. A. Le: None.

Funding

Novo Nordisk
631-P: Front-Line Clinician Perspectives on Immediate Self-Care Needs of Patients with Diabetes
Authors: COYNE KASEY , HAKIMIAN STEPHANIE , POLLACK TERESA , KARAM SUSAN , PRINCE GRACE , TOUMA EMILIE K. , GATCHELL DAVID W. , KHORZAD REBECA , ANKENMAN BRUCE , HOLL JANE L. , WALLIA AMISHA
Published: June 2020

Diabetes mellitus (DM) self-care teaching is often provided at point of care, but “clinician-centered” feedback about teaching is lacking. Semi-structured, facilitated interviews of front-line clinicians involved in DM care (e.g., meter, medications, injection technique) were conducted. Clinicians were asked their perspectives on the needs of newly diagnosed DM patients, specifically during transitions of care (e.g., discharge home). Clinicians were also asked to review current DM education materials (training supplies, print handouts) and subsequently developed potential solutions. Interview transcripts were independently coded by 3 coders, using a constant comparative method, to identify themes. MAXQDA software was used. Key themes were additionally audited by a diabetologist.

Eleven sessions were conducted with clinicians (N=14, 2 certified DM educators, 4 endocrinology MD fellows, 3 advanced practice providers, 1 DM nurse, 2 pharmacists, 2 internal medicine MDs). The most commonly identified theme across clinician type was simplified, understandable content (8/11 sessions). Participants identified lack of centralization of supplies and education materials as the most significant barrier (9/11 sessions) to optimal care. Other top themes were insurance coverage for diabetes supplies and medications, need for customization, and limited access to diabetes educators. The most preferred solution was use of patient simulation (repetitive practice) [7/11 sessions], followed by teaching videos (5/11 sessions).

Clinicians preferred comprehensive but simplified, understandable, customizable, diabetes teaching content. The lack of centralization of supplies and content and insurance coverage for supplies/medications are major barriers for clinicians to deliver optimal DM self-care teaching. These data also suggest that use of simulation could facilitate improvement in DM teaching by front-line clinicians.

Disclosure

K. Coyne: None. S. Hakimian: None. T. Pollack: None. S. Karam: None. G. Prince: None. E.K. Touma: None. D.W. Gatchell: None. R. Khorzad: None. B. Ankenman: None. J.L. Holl: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group.

Funding

American Diabetes Association (1-13-JF-54 to A.W.); Chicago Center for Diabetes Translation Research/National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949); Agency for Healthcare Research and Quality (5R18HS026143-02)
634-P: Improvement of Care for Type 2 Diabetes Outpatients through a Self-Care Multidisciplinary Workshop: A Randomized Controlled Trial
Authors: GARCIA SHEILA PICCOLI , TELO GABRIELA H. , SCHNEIDERS JOSIANE , BLUME CARINA , BERLANDA GABRIELA , SPARRENBERGER KAREN , GOSSENHEIMER AGNES N. , MADALOSSO MARIANA M. , BOTTINO LEONARDO G. , SCHEIN ANDRESSA S.O. , MACEDO ALINE C.P. , HELAL LUCAS , CHRISTOFOLI CHRISTOFER , SANTOS LUCAS P. , SCHAAN BEATRIZ D.
Published: June 2020

Type 2 diabetes (T2DM) is a chronic disease that requires multidisciplinary patient-centered treatment. Although important, promoting self-care strategies is still a challenge.

Methods: Patients with T2DM and poor glycemic control (HbA1c > 7.5%) were randomly assigned to participate in the Self-Care Multidisciplinary Workshop for Diabetes (MW) or usual care (UC). The MW consisted of 15-minute individual meetings with each T2DM providers (nurse, pharmacist, dietitian, physical educator and social worker) to approach diabetes self-care topics. It was offered in 3 different modules through 12 weeks aiming to bring knowledge and skills necessary for patients to improve their diabetes care. UC included 3 brief meetings in which printed educational folders were provided. Both groups maintained standard care at outpatient T2DM clinic with endocrinologists. Generalized estimating equation model was performed to assess HbA1c, Diabetes-related Quality of Life and Summary of Diabetes Self-Care Activities questionnaires variation from baseline to 12 months.

Results: Ninety-six patients (59 ±9 years-old, 60% women, diabetes duration of 16 ±10 years, 62% medium-low/low socio-economic status, HbA1c 9.6 ±1.4%) were included. Variation from baseline of HbA1c [UC -0.52% (CI 95% -1.08 to 0.26) vs. MW -0.30% (CI 95% -1.05 to 0.45) p=0.072], healthful eating plan in the last 7 days (d) [UC -0.22 d (CI 95% -1.27 to 0.82) vs. MW -0.03 d (CI 95% -0.85 to 0.79) p=0.15] and foot exam in the last 7 d [UC 0.51 d (CI 95% -0.75 to 1.77) vs. MW 1.1 d (CI 95% -0.16 to 2.39) p=0.329] to 12 months were not different between groups. There was a decrease in worry about future effects of diabetes in MW [-0.46 (CI -0.81 to -0.12)], not found in UC [0.11 (CI -0.20 to 0.42) p=0.004].

Conclusion: A short-term MW reduced worry about diabetes but failed to improve glycemic control and self-care activities in long-standing T2DM patients of a low-income country.

ClinicalTrials.gov Identifier: NCT03074383.

Disclosure

S. Piccoli Garcia: None. G.H. Telo: None. J. Schneiders: None. C. Blume: None. G. Berlanda: None. K. Sparrenberger: None. A.N. Gossenheimer: None. M.M. Madalosso: None. L.G. Bottino: None. A.S.O. Schein: None. A.C.P. Macedo: None. L. Helal: None. C. Christofoli: None. L.P. Santos: None. B.D. Schaan: None.

Funding

Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre
639-P: The HbA1c Test Frequency and Metabolic Control in Patients with Type 2 Diabetes after Share-Care Model Management: A Chinese Survey of 5,183 Adult Patients
Authors: AN LINGWANG , LEE TAO-CHUN , YEH KUEICHUN , HSU HUI-CHUN , JI LINONG
Published: June 2020

Background and Aims: To explore the effect of HbA1c test frequency on HbA1c control in patients with T2D who had been followed up in a diabetes share-care model in five Chinese diabetes hospitals.

Methods: From January 2016 to December 2019, 5183 patients with more than 2 times HbA1c tests and 6 months follow up were included in this study. Three groups were divided according to annual HbA1c tests frequency: <2.0 times [1495 (28.9%)], 2.0∼3.0 times [1898 (36.6%)] and <3.0 times [1790 (34.5%)].

Results: Significant difference was seen on the proportion of patients reaching HbA1c target of below 7.0% in the three groups from baseline to the last visit. Receiving >3.0 tests/year led to significant larger HbA1c change [-0.60 (-0.68∼-0.52)%] from baseline compared to receiving<2.0 tests/year [-0.16 (-0.27∼-0.04)%] and 2.0∼3.0 tests/year [-0.25 (-0.33∼-0.16)%]. Only >3.0 tests/year were positively associated with higher likelihoods of reaching HbA1c target at last visit (odds ratio 1.862, 95%CI 1.518 to 2.285). No significant association was found in group receiving 2.0∼3.0 times/year.

Conclusions: We showed that 71.1% of patients received more than 2.0 HbA1c tests/year within the diabetes share-care model management, however, only >3.0 tests/year is associated with higher likelihoods of achieving HbA1c target.

Disclosure

L. An: None. T. Lee: None. K. Yeh: None. H. Hsu: None. L. Ji: None.
645-P: Diabetes Pueblo: A Community Health Worker–Led Educational Intervention for Latinos with T2D
Authors: CREASON JAMIE , AXELROD CEARA , CONNEELY MARY M. , LANDEROS CHRISTOPHER , DIAZ-REA MARGARITA , XI ANN D. , PACZKOWSKI ROSIRENE , REED BEVERLY , GELSEY FELICIA , CASTORINO KRISTIN N.
Published: June 2020

In the U.S., Latinos have the highest proportion of type 2 diabetes (T2D) of any racial/ethnic group. Addressing cultural barriers and limited access to diabetes education may improve diabetes care and outcomes in this population. Diabetes Pueblo (DP) is an 11-week, culturally tailored, diabetes self-management education and support (DSMES) program led by Latinos in the community (Promotores). The program has two modules, diabetes fundamentals (DF) and insulin success. A pilot study was conducted to evaluate the feasibility of DP through class attendance and participant satisfaction. Additional endpoints included biometric data, HbA1c, the Diabetes Self-Management Questionnaire (DSMQ), and the Insulin Treatment Appraisal Scale (ITAS). Participants were 25 Latinos with T2D (20 completers) with a mean age of 55.8±10.5 years (64% female, 92% born in Latin America, 39% completed high school). Class attendance averaged 82%. Small nonsignificant improvements were observed in HbA1c, DSMQ, and ITAS positive appraisal at the completion of the program. ITAS negative appraisal scores improved significantly from 43 to 38 (p=0.02). Participant feedback reported improvement in distinguishing between diabetes and prediabetes (p=0.01). Post-class focus groups revealed very high satisfaction with the program, including improved understanding of how behaviors impact health and that insulin initiation does not indicate personal failure. There were no significant changes in biometrics possibly due to the short study duration. These results demonstrate the program’s feasibility through high attendance, program approval, improved diabetes self-management knowledge and acceptance of insulin therapy. This highlights the importance of using a culturally appropriate education program taught by community health workers for higher attendance and engagement. Future research may include larger-scale evaluations of the program with long-term follow-up to detect changes in biometric data.

Disclosure

J. Creason: None. C. Axelrod: None. M.M. Conneely: None. C. Landeros: None. M. Diaz-Rea: None. A.D. Xi: Employee; Self; Eli Lilly and Company. R. Paczkowski: Employee; Spouse/Partner; Amgen. Employee; Self; Eli Lilly and Company. B. Reed: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. F. Gelsey: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc.

Funding

Eli Lilly and Company
65-OR: Remote Monitoring of CGM Data at Diabetes Camp Mitigates Hypoglycemia Day and Night
Authors: GLEICH SARAH E. , GIBSON-NORTH NATHANIEL D. , PUHR SARAH , WELSH JOHN , WALKER TOMAS C. , CARUSO DANIEL
Published: June 2020

Some diabetes camps require campers to relinquish diabetes technology upon arrival. We evaluated the acceptability of continuous glucose monitoring (CGM) use and remote monitoring of CGM data at camp. Insulin-treated campers ages 7-18 years were enrolled at a week-long diabetes camp in the U.S. All campers performed regular fingerstick testing, which informed treatment decisions. Campers that monitored their glucose with fingerstick testing at home were fitted with blinded Dexcom CGM at camp. Campers that used Dexcom CGM Systems with the capacity to share data at home continued to use their self-supplied systems; shared data were displayed on the Follow app on counselor-carried smart devices and on a centralized display in the medical cabin. Remote monitoring informed staff of glucose values 250 mg/dL, prompting fingerstick testing outside of regular intervals. Data were compared between blinded and remotely monitored, non-blinded CGM systems. Remote monitoring of CGM data was associated with significant reductions in hypoglycemia and improvements in overnight time in range (Table). Remote monitoring facilitated 73 interventions overnight that may have otherwise been missed by fingerstick testing. Remote monitoring of CGM data at diabetes camp allows implementation of tighter target glucose ranges, facilitates timely hypoglycemia treatment, and should be encouraged at all diabetes camps.

Disclosure

S.E. Gleich: Research Support; Self; Dexcom, Inc. N.D. Gibson-North: None. S. Puhr: Employee; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. T.C. Walker: Employee; Self; Dexcom, Inc. D. Caruso: None.
650-P: Safety and Effectiveness of Recombinant Human Insulin Insugen in Real-World Clinical Setting
Authors: RAJ PRAVEEN , J PRIYA , MATHEW DANO C. , BISWAS CAMELIA , NETHRA SABARRI
Published: June 2020

Background: As the burden of diabetes is increasing dramatically, the demand of insulin is also on rise, affordable access to insulin remains a challenge, particularly in Low and Mid income countries. For that reason, recombinant human insulin (rHI) formulations are considered to be effective alternatives to insulin analogues in countries with limited healthcare systems and resources. Continuing patient education and support programmes with rHI are critical role players in improving the access and overall disease management.

Objective: This is a non-interventional study to observe the safety and effectiveness of Recombinant Human insulin in a real world population with type 2 (T2DM) diabetes mellitus from Indian perspective.

Methodology: Out of 10426 diabetes patients who were enrolled in patient support program i.e “Insulin Therapy Assistance Program (iTAP)”, 5691 patients were initiated with various formulations of rHI (Insugen R, N, 30/70 and 50/50). Insulin therapy was initiated in T2DM patients with A1C > 7%. HbA1c, FPG and PPG values were recorded at baseline and follow up of 3, 6 and 9 months.

Results:

The Figure 1, 2, 3 depict the baseline and follow up of FBG, PPG and HbA1c respectively.

Figure 1. Change in FPG (*p<0.05).

Figure 2. Change in PPG (*p<0.05).

Figure 3. Change in HbA1c (*p<0.05).

Conclusion: In the current study, various formulations of rHI were well tolerated and resulted in significant reduction of HbA1c, FPG and PPG when aided with patient support program. Considering the economic impact of diabetes patients in taking insulins, human insulin become an alternative option in comparison to analogues which are expensive. Early initiation of insulin therapy can prevent or delay diabetes complications. Access to affordable insulin therapy is the key success factor while considering Insulin Therapy.

Disclosure

P. Raj: Employee; Self; Biocon. P. J: None. D.C. Mathew: None. C. Biswas: None. S. Nethra: None.
662-P: Oral Health: Neglected Diabetes Intervention
Authors: ZIEMER DAVID C. , BARNES CATHERINE S. , RUPASINGHE RUPPAGE S.M. , KHARE SMRITI
Published: June 2020

Oral health and diabetes can be mutually detrimental, Diabetes Education guidelines encourage good oral health practices: brushing, flossing and visiting dentist. We assessed the quality of patient outcomes and behaviors and provider support for oral health in a public hospital specialty diabetes (DM) clinic.

Patients (n=99) completed waiting room surveys on oral health history, practices, barriers and knowledge. For quality assessment, providers completed self-administered surveys on their visit discussions for oral health. Population was 54% male, had mean age 59 yr and mean DM duration 13 yr, 24% had completed < 12th grade, 23% were current smokers, and 36% had some dental coverage.

While most patients knew good oral health practices, only a minority followed them. This was reflected in tooth loss and oral problems. Most patients knew DM causes dental problems (75%) and dental problems could worsen DM (60%). Most (93%) reported they should brush 2 or more times per day, only 51% did that; (74%) believed in at least once daily flossing but only 31% did so; 82% said they should visit a dentist 2 or more times a year, only 17% did so. Access to dental care was a major issue: 66% reported cost and 11% time as barriers to dental visits. Brushing barriers included: time – 23%, forget – 11%, “don’t know”/”lazy” – 11% and tired – 7%. Good oral health practices decreased with age and tooth loss but increased with higher education. Only 17% utilized charity or sliding scale clinics. They had lost median of 7 teeth and 13% were completely edentulous. In past year 40%, had tooth ache, 30% bleeding gums, 20% loose teeth, and 28% decayed teeth.

Provider support was low. Per the provider survey a minority (<30%) discussed the 3 oral health practices with half or more of patients.

Patient oral health outcomes and practices are poor. Knowledge is not a major barrier. Oral health is associated with better DM control and quality of life, but intervention and support may be neglected by providers. DM Clinics must assess and improve oral health practices and education.

Disclosure

D.C. Ziemer: None. C.S. Barnes: None. R.S.M. Rupasinghe: None. S. Khare: None.
665-P: An Online Insulin Pump and CGM Curriculum for Parents of Children with T1D: TeKnO T1D
Authors: MARKS BRYNN E. , WOLFSDORF JOSEPH I. , RICHARDSON ALEXIS M. , SLAATS JULIE , MONAGHAN MAUREEN , STREISAND RANDI , GARVEY KATHARINE
Published: June 2020

Background: With increasing use of insulin pumps and CGM, parents of children with T1D may benefit from educational opportunities to optimize device use.

Objectives: We assessed parents’ satisfaction with an online educational curriculum- Technology Knowledge Optimization in T1D (TeKnO T1D)- originally developed to improve clinicians’ knowledge of T1D technology.

Methods: Parents (n=29) of children (M age 10.4 ± 2.2 yrs) with well-controlled T1D (M A1c 6.8 ± 0.5%) managed with a pump and CGM piloted the TeKnO T1D curricula. Parents were randomized to begin with the pump or CGM content and completed surveys containing Likert-scale and free-text items before accessing the second curriculum. Iterative, qualitative thematic analysis was conducted by 3 team members.

Results: Table 1 shows percentages of parents who agreed or strongly agreed with statements in the evaluations. Qualitative analyses showed positive reactions to the curricula. Parents desired device and age-specific curricula with additional focus on interpretation of glycemic data and management of specific scenarios (exercise, sick days) including the use of temporary basal rates and extended boluses.

Conclusion: TeKnO T1D is a feasible, enjoyable educational approach for parents. Results will guide future development of device and age-specific curricula so that its impact on knowledge and glycemic control can be evaluated in a more diverse sample.

Disclosure

B.E. Marks: None. J.I. Wolfsdorf: Other Relationship; Self; Ultragenyx Pharmaceutical, UpToDate, Xeris Pharmaceuticals, Inc. A.M. Richardson: None. J. Slaats: Other Relationship; Self; Tandem Diabetes Care. M. Monaghan: Research Support; Self; American Diabetes Association. R. Streisand: None. K. Garvey: None.

Funding

National Institutes of Health (T32DK007699); Pediatric Endocrine Society; Boston Children’s Hospital
669-P: Serial Online Education Helps Break Down Primary Care Practitioner Barriers to Insulin Therapy for T2DM Management
Authors: TURELL WENDY , DREXEL CAROLE , BEASER RICHARD S.
Published: June 2020

Introduction: Clinicians in primary care settings play key roles in T2DM care, yet data and past educational outcomes suggest they’re ill-prepared in insulin replacement therapy delivery, including recognition of need, and its optimization.

Methods: An online interactive CME series for health care providers (HCPs) launched live-online in June 2019 and remained online for 6 months. “Insulin Replacement Therapy: Evolving Treatments and their Clinical Implications” included three 1-hour sessions focusing on: 1) insulin treatment options; 2) indications for initiation/advancement of insulin; and, 3) individualization/optimization. Sessions included polling and live Q and A segments. Faculty included physicians and a clinical pharmacist who specialize in diabetes and endocrinology. Evaluation included pre/post/2-mos. post surveys measuring knowledge, competence and self-reported clinical impact. In total, 2,230 learners participated in the series, including 819 physicians, 397 NPs/PAs, and 169 pharmacists. Primary care, internal medicine and diabetes specialists totaled 1,318.

Results: Follow-up results indicated that 76% of learners reported positive educational impact on clinical practice and 128 examples were shared of specific clinical improvements, many relative to insulin use for T2DM. Additionally, 76% of respondents reported positive impact on patient outcomes and/or satisfaction, with 106 specific impact examples shared. Knowledge and competence questions that aligned with learning objectives consistently yielded improvements, all of which (12 questions) demonstrated statistically significant pre to post change.

Conclusion: CME on diabetes management and insulin use leads to increased clinical confidence among HCPs, ultimately improving the quality of care of T2DM people who are in need of insulin replacement therapy. Data continue to confirm previous results about the positive impact of continuing education for clinicians.

Disclosure

W. Turell: None. C. Drexel: None. R.S. Beaser: None.

Funding

Eli Lilly and Company; Novo Nordisk; Medtronic; MannKind Corporation
691-P: Exercise Effect on Endogenous Glucose Production in Type 1 Diabetes: A Modeling Analysis
Authors: ROMERES DAVIDE , SCHIAVON MICHELE , VISENTIN ROBERTO , BASU ANANDA , COBELLI CLAUDIO , BASU RITA , CHIARA DALLA MAN
Published: June 2020

Quantifying the exercise effect (EE) on glucose turnover is fundamental for type 1 diabetes (T1D) management. We recently proposed a model describing EE on insulin-dependent and -independent glucose utilization in subjects with and without T1D (ND). However, to date, a model of EE on endogenous glucose production (EGP) is still lacking. To do so, we analysed existing data on 6 T1D (age 29±3 yrs, BMI 28.3±2.0 kg/m2, VO2 max 28.7±2.9 ml/kg/min, mean±SE) and 6 ND (age=28.2±4.2 yr, BMI=23.6 ±1.0 kg/m2, VO2 max 36.6±2.9 ml/kg/min) subjects studied with a glucose clamp, during, before and after a 60 min aerobic exercise session at 65% VO2max on three visits: euglycemia-low insulin (V1); euglycemia-high insulin (V2) and hyperglycemia-low insulin (V3) in random order. EGP was measured with the isotope dilution technique using [6,6-2H2]glucose. A battery of models was tested against data to assess if EE on EGP is mediated by insulin, glucose or both. The best model (Fig 1) provided a good description of the data in both groups. Results show that EE on EGP is delayed and insulin mediated. Further studies are needed to validate the model in real life conditions thus making it usable for optimization of insulin therapy.

Disclosure

D. Romeres: None. M. Schiavon: None. R. Visentin: None. A. Basu: Consultant; Spouse/Partner; GENFIT. Research Support; Spouse/Partner; AstraZeneca. C. Cobelli: None. R. Basu: Consultant; Self; GENFIT. Research Support; Self; AstraZeneca. C. Dalla Man: Research Support; Self; Sanofi-Aventis Deutschland GmbH.

Funding

Italian Ministry of Education (232/2016); National Institute of Diabetes and Digestive and Kidney Diseases (DK029953 to R.B.), (DK085516 to A.B.)
70-LB: Noninvasive Blood Glucose Measurement Techniques Based on Nonequilibrium Metabolic Heat Conformation Method
Authors: TAN HOCK S. , HE ZONGYAN
Published: June 2020

Traditional metabolic heat conformation (MHC) method can be used for non-invasive blood glucose measurements when the body is in thermal equilibrium state. But in non-thermal equilibrium state, such as after meals, the traditional method may result in a poor accuracy. We propose a new method by extending the MHC principle to cover non-equilibrium state and develop a new measurement standard and calculation algorithm. The blood glucose measurement for the new algorithm is the sum of the blood glucose in equilibrium state and the blood glucose increase in non-equilibrium state. Results from clinical trials using this new method show significant improvement in accuracy of blood glucose measurements. Compared with the traditional MHC method, measurements using the new method results in improvement in correlation coefficients with intravenous blood-draw glucose concentration from 0.71 to 0.93 (for fasting measurements), from 0.61 to 0.93 (for measurements of 2 hours after a meal) and from 0.63 to 0.89 (for measurements of 3.5 hours after a meal). Applying Parkes Error Standard analysis, in the traditional MHC method, Range A (relative error does not exceed ±20%) accounts only for 54.3%, Range B (relative error does not exceed ±50%) accounts for 39.6%. In the new method, Range A accounts for 81.1%, and Range B accounts for 16.2%.

Disclosure

H.S. Tan: None. Z. He: None.
708-P: Medical Prescriptions of Fresh Vegetables Improve Clinical and Psychosocial Outcomes for Adults with or at Risk of Type 2 Diabetes (T2D)
Authors: KUJAN MARY A. , GLANTZ NAMINO M. , CONNEELY CASEY , CHEN VINCENT , KERR DAVID
Published: June 2020

For adults with T2D, food insecurity and low socio-economic status are major barriers to accessing nutritious food, leading to compensatory consumption of foods harmful to health. In particular, consumption of fresh vegetables is well below recommended levels in the United States. The aim of this project was to examine the health impact of improving access to fresh vegetables through the use of medical prescriptions for organic vegetables for adults with or at risk of T2D (ADA Risk Calculator).

Over 12 weeks (and after obtaining informed consent), participants provided baseline clinical information and then received weekly medical prescriptions of 21 servings of locally sourced organic vegetables at three community based distribution centers in Santa Barbara, CA, after which baseline measurements were repeated. No additional structured nutrition education was provided.

Overall, 145 adults (74% Hispanic/Latino, aged 53 [42-62] years (median [IQ range]), 78% female, with (31%) or at risk of T2D have been enrolled. At entry, 62% were food insecure which reduced to 37% after 12 weeks (p<0.0001) associated with lowering of systolic blood pressure (SBP) (-2.5 [95%CI: -4.8 to -0.2] mmHg, p=0.035) which was greater for those with an initial SBP >130 mmHg (-6.8 [95%CI: -11.7, -1.9] mmHg, p=0.005), and a reduction in waist circumference (0.9 [95%CI -1.6 to -0.2] cm, p=0.002). The change in waist circumference was also significant with baseline high-risk values of >88 cm (p=0.02) for women and >102 cm (p=0.02) for men. Median weight also fell slightly (-0.45 kg, p=0.04). For participants with a baseline HbA1c >7.0%, this reduced significantly (-0.6 [95% CI -1.2 to -0.05] %, p=0.01). Overall self-reported sleep quality, mood and pain (100 mm visual analogue scales) also improved (all p<0.001).

Medical prescriptions of organic vegetables are associated with measurable clinical and psychosocial benefits for adults with or at risk of T2D.

Disclosure

M.A. Kujan: None. N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. C. Conneely: None. V. Chen: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc.

Funding

U.S. Department of Agriculture (2018-01793)
709-P: Long-Term Adherence to Carbohydrate Restriction Confers Added Benefits for Adults with T2D
Authors: ADAMS REBECCA N. , ATHINARAYANAN SHAMINIE J. , PHINNEY STEPHEN , MCKENZIE AMY
Published: June 2020

Background: We previously observed that adherence to carbohydrate restriction (CR) nutrition therapy during the first 3 months of a continuous remote care intervention predicted 1-yr improvements in weight and HbA1c in adults with T2D. However, the extent to which ongoing CR is needed to sustain health improvements is unknown.

Methods: 262 adults with T2D counseled on CR reported adherence measured by blood beta-hydroxybutyrate (BHB) regularly via a mobile app. Patients enrolled 1-yr with mean BHB ≥0.3 mM in the first 3 months (n=174) were split into quartiles based on the percent of BHB logs ≥ 0.3 and 0.5 mM during months 4 through 12. We conducted ANOVAs to compare the groups’ percent change in weight and HbA1c from baseline to 1-yr.

Results: All groups had clinically significant improvements on average in weight and HbA1c, but the percent change statistically differed by group (Ps<0.01). Participants who reported CR more often had greater benefit at 1-yr (Table 1). Using a 0.3 mM BHB cut-off, very consistent restriction (≥95% of the time) yielded significantly greater benefit. A 0.5 mM cut-off demonstrated greater benefit with lower frequencies of reporting (≥38% for weight and ≥66% for HbA1c).

Discussion: More frequent CR over the remainder of the year conferred greater benefit on health outcomes. Future analyses should carefully examine whether the pattern of BHB values over time influences outcomes.

Disclosure

R.N. Adams: Employee; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Stock/Shareholder; Self; Beyond Obesity LLC (publishing), Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp.
710-P: Serum DPP-4 Protein Is Decreased upon Consuming an Isocaloric High Saturated Fat Diet and Genetically Determined in Healthy Human Twins
Authors: KRUSE MICHAEL , OST ANNE-CATHRIN , HORNEMANN SILKE , HOFFMANN DANIELA , FRAHNOW TURID , BUSJAHN ANDREAS , PFEIFFER ANDREAS F.
Published: June 2020

Obesity is associated with increased levels of soluble Dipeptidyl Peptidase-4 (DPP-4) in serum leading to adipose tissue inflammation and insulin resistance. Animal studies, however, have shown that a high fat diet acutely decreases serum DDP-4 levels. This study investigated the response of serum DDP-4 to a sudden switch from a healthy isocaloric low fat diet to an isocaloric high fat diet (HFD) in healthy human twins. 35 monzyogotic and 11 dizygotic healthy pairs of twins (women and men, age 18 - 70) were investigated for 12 weeks. An isocaloric diet rich in carbohydrates (55% carbohydrates, 30% fat, 15% protein, LF) was applied for 6 weeks, followed by an isocaloric diet rich in saturated fat (40% carbohydrates, 45% fat, 15% protein, HF) for another 6 weeks. Body weight (BW) and serum concentrations of DPP-4, tumor necrosis factor α (TNFα) and insulin were analyzed after the LF period, after one week (HF1w) and at the end (HF6w) of the HF period. Total body fat and lean mass were determined by DEXA-Scan at LF and HF6w. BW was constant over the time of intervention. Serum DPP-4 protein was decreased by 15% at HF1w and by 18% at HF6w, respectively, compared to LF (both P<0.001). At HF1w DPP-4 and TNFα serum levels were positively correlated (r=0.299, P=0.004) however, this correlation was lost at HF6w. Serum DPP-4 was positively correlated with lean mass at LF (r=0.357, P<0.001) and HF6w (r=0.218, P<0.05), however not with body fat content. DPP-4 serum protein was strongly positively correlated within monzogotic twins at LF, HF1w and HF6w (for all P<0.01), but not within dizygotic twins. Insulin was increased 1.20-fold and 1.12-fold at HF1w and HF6w, respectively, compared to LF (both P<0.001). These data indicate that serum DPP-4 protein responds to nutritional stimuli and is decreased upon consuming a HFD under isocaloric conditions in healthy human subjects which is in contrast to overt adiposity. Moreover, expression of serum DPP-4 protein is genetically determined.

Disclosure

M. Kruse: None. A. Ost: None. S. Hornemann: None. D. Hoffmann: None. T. Frahnow: None. A. Busjahn: None. A.F. Pfeiffer: None.

Funding

German Federal Ministry of Education and Research (0315424)
73-OR: Gut–Brain Signals That Regulate Hunger
Authors: KNIGHT ZACHARY
Published: June 2020

Body weight is regulated by interoceptive neural circuits that track energy need, but how the activity of these circuits is altered in obesity remains poorly understood. Here we describe the in vivo dynamics of hunger-promoting AgRP neurons during the development of diet-induced obesity in mice. We show that high-fat diet attenuates the response of AgRP neurons to an array of stimuli including food cues, intragastric nutrients, and the hormones cholecystokinin and ghrelin. These alterations are nutrient-specific, with AgRP neurons becoming desensitized to dietary fat but not carbohydrate or protein. Subsequent weight loss restores the responsiveness of AgRP neurons to exterosensory cues but fails to rescue their sensitivity to gastrointestinal hormones or nutrients. These findings reveal that obesity triggers broad dysregulation of hypothalamic hunger neurons that is incompletely reversed by weight loss and may contribute to the difficulty of maintaining a reduced weight.

Disclosure

Z. Knight: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-16-ACE-29)
733-P: Postprandial Glucose Variability in People with Type 1 Diabetes Is Individual and Impacted by Physiological and Clinical Parameters
Authors: DINGENA CASSY F.B. , MARSH AILSA , AJJAN RAMZI , CAMPBELL MATTHEW
Published: June 2020

Aim: To assess whether postprandial glucose responses (PPGRs) are individual in people with type 1 diabetes (T1DM) and influenced by personal physiological and clinical parameters.

Methods: We assessed physiological and clinical parameters of one-hundred and twenty individuals with type 1 diabetes (mean±SD: Age 31±7years, BMI 26.9±2.3kg.m2, HbA1c 7.6±0.8% [55.8±8.2mmol/moL]) and captured postprandial interstitial glucose responses via continuous glucose monitoring (CGM) in response to two carbohydrate-based standardised meals (shredded wheat [SW] or millet oat-porridge [OP]), twice, on four separate occasions. Each meal was matched for energy, fibre, and macronutrient composition, glycaemic index (GI), and insulin administration.

Results: Despite identical energy, fibre, and macronutrient content, GI, and prandial insulin administration, the average PPGR differed significantly between OP and SW, respectively (IG AUC: 1807±588 vs. 1678±533 mmol.L.min-1; p=0.05). PPGRs to each meal type showed a high degree of reproducibility within individuals (OP r=0.994, p<0.001 vs. SW r=0.987 p<0.001), but large interpersonal variation within each meal type (CV%: OP 32.5% vs. SW 31.7%). Higher PPGR was positively associated with PPGR variability (r=0.698, p<0.001), HbA1c (r=0.223, p=0.014), BMI (r=0.316, p<0.001), and age (r=0.277, p<0.001).

Conclusions: Using a total of 19,200 glucose measurements, we show that PPGR in individuals with type 1 diabetes is interpersonal and influenced by BMI, age, and HbA1c. We show that identification of personal characteristics is a promising means for designing effective nutritional interventions to predict and control glycaemic responses to food in this population.

Disclosure

C.F.B. Dingena: None. A. Marsh: None. R. Ajjan: Advisory Panel; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Takeda Pharmaceutical Company Limited. Other Relationship; Self; Abbott. M. Campbell: None.
736-P: Diabetes Distress and Depression Are Reduced through Neighborhood Support in Peer Support Program in Shanghai
Authors: FISHER EDWIN B. , QIAN YIQING , TANG PATRICK Y. , LIU YUEXING , COUFAL MUCHIEH M. , JIA WEIPING
Published: June 2020

Depression and diabetes distress (DD) are both important features of diabetes in China, as in other countries. A study of Chinese adults with type-2 diabetes, e.g., found 42% prevalence of moderate/high levels of DD. Here we examine whether peer support may increase neighborhood support and whether changes in neighborhood support may be associated with changes in depression and DD in Shanghai. In extension of the Shanghai Integration Model that links specialty/hospital care with primary care, trained volunteer peer leaders (PL) implemented varied supportive activities in 9 Community Health Centers (CHCs). In addition to diabetes education, PLs led activities to increase sense of solidarity among participants, such as walking or dance clubs. Neighborhood support for diabetes management was measured by 8 items (e.g., “other people understand the importance of diabetes management”) in an evaluation sample of 1284 before and after 12 months’ PL activity. Research staff unaware of outcomes rated the number of PLs working from each CHC and the extent to which they led activities and contacted individuals. Combining these ratings, PL activity predicted increased neighborhood support (ß = 0.187, p < 0.001, controlling for baseline neighborhood support, gender, age, education, years with diabetes, and clustering within sites). Increases in neighborhood support in turn were associated with decreased DD and depression (partial correlations = -0.170 and -0.161, ps < 0.001, controlling for gender, etc., baseline neighborhood support and baseline DD and depression, respectively). Neighborhood support may be an important path through which peer support programs reduce DD and depression. Research suggests Chinese individuals with diabetes experience DD in culturally unique ways. Further research might examine how benefits of peer and neighborhood support for DD and depression may also reflect Chinese culture and suggest approaches to tailoring peer support for other cultures.

Disclosure

E.B. Fisher: Research Support; Self; Merck Foundation, Sanofi China. Y. Qian: None. P.Y. Tang: Research Support; Self; Merck Foundation. Y. Liu: None. M.M. Coufal: None. W. Jia: None.

Funding

Shanghai Municipal Grants (GWIV-3.1 to W.J.); Shanghai 6th People’s Hospital (YNLC201812 to Y.L.); Shanghai Municipal Health Commission (20194Y0141 to Y.L.); Merck Foundation; Sanofi China; Michigan Center for Diabetes Translational Research; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
743-P: Examining the Intersection between Unmet Social Needs, Chronic Disease Comorbidities, and Emergency Room Utilization among Medicaid Beneficiaries with Diabetes
Authors: VERDECIAS NIKO , MCQUEEN AMY , LI LINDA , BADDAM CHANDRA DEEPAK R. , SMITH RACHEL E. , KREUTER MATTHEW
Published: June 2020

Diabetes self-management (i.e., glucose control, medication adherence, healthy behaviors) is important but challenging, especially among low-income populations. Competing priorities such as social needs (i.e., food, housing, safety, financial) and managing comorbidities adds further burden and may affect healthcare utilization. A large Medicaid managed care plan in Louisiana assessed self-reported social needs among clients with type 2 diabetes from July 2018 - June 2019. We examined the number and pattern of social needs and their association with number of chronic disease comorbidities and emergency room (ER) visits from medical claims data in the 12-months prior to completing the social needs assessment. The sample (n=2902) was mostly female (69.2%), >45 years old (71.2%), Black (61.0%), with ≥1 social need (59.9%; mean= 1.12 ± 1.33; range= 0-8), ≥1 comorbidity in addition to diabetes (97.3%; mean= 3.91 ± 2.14; range= 0-13), and a mean of 4.11 ± 5.83 ER visits. Findings revealed a positive association between social needs and comorbidities (χ2= 32.49; p <0.05); the majority (36.8%) of those with 1 social need (n=929) had 3-4 comorbidities, while the majority (41.2%) of those with ≥2 social needs (n=809) had ≥5 comorbidities. GLM results showed positive associations between social needs (0, 1, ≥2) and ER visits (F=3.74, p=.02) and between comorbidities (0-1, 2-3, ≥4) and ER visits (F=61.17, p<.001) but not the interaction of social needs and comorbidities. Post-hoc Tukey tests showed more ER visits for those with ≥2 social needs vs. 1 need and for those with ≥4 comorbidities vs. fewer. Findings suggest that having ≥2 unmet social needs creates an independent and added burden to the effect of comorbidities on ER utilization. Future research will examine whether addressing unmet social needs among Medicaid beneficiaries with type 2 diabetes and comorbidities can reduce ER utilization and improve health-related outcomes.

Disclosure

N. Verdecias: None. A. McQueen: None. L. Li: None. C.R. Baddam: None. R.E. Smith: None. M. Kreuter: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK115916-01A1)
748-P: Emergency Department Use and Social Vulnerability in Youth with T1D
Authors: HARTMAN ALEXANDRA , WAGNER DAVID V. , JENISCH CELESTE , BARRY-MENKHAUS SAMANTHA A. , LUZOD HANNAH , VAZ LOUISE E. , GOTTFRIED-LEE HANNAH , PHAN DAVID , HARRIS MICHAEL A.
Published: June 2020

Objective: A subset of youth with T1D are at high risk of preventable acute events, such as DKA, and associated emergency department (ED) visits. Although studies have identified social factors associated with acute utilization risk between all youth with T1D, less is known about how to distinguish such risk amongst those already demonstrating poor health outcomes. This study examines the association between social risk and preventable complications in youth already struggling with self-management.

Methods: Youth (n=50) identified by medical providers as exhibiting chronic self-management difficulties were included in this study. Retrospective chart reviews of the year prior to medical provider referral included number of ED visits and identified social risk factors. Mean youth age was 14.6 years (SD=2.9); 38% were female; 90% were Caucasian.

Results: The relationship between frequency of ED visits and total number of social risks was nonsignificant; however, the presence of specific individual social risks was associated with presence of an ED visit (Table 1).

Conclusions: This is one of the first studies that identified the relationship between social risk and ED utilization in a high-risk pediatric population with T1D. While it is widely understood that social risk is associated with increased utilization, this study identifies key variables that may differentiate youth already at-risk for poor health outcomes.

Disclosure

A. Hartman: None. D.V. Wagner: None. C. Jenisch: None. S.A. Barry-Menkhaus: None. H. Luzod: None. L.E. Vaz: None. H. Gottfried-Lee: None. D. Phan: None. M.A. Harris: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
76-LB: Differences in Time-In-Range, Glycemic Variability, and the Glucose Management Indicator in Pregnant Women with Type 1 (T1D), Type 2 (T2D), and Gestational Diabetes (GDM)
Authors: POLSKY SARIT , LEVY CAROL J. , ZHANG XIAOHE , SHAH SALONI , HAROUSH GAL , NELSON KRISTEN , O’MALLEY GRENYE , OGYAADU SELASSIE J. , BRACKETT SCOTT J. , LEVISTER CAMILLA , CASTORINO KRISTIN N.
Published: June 2020

Glycemic control varies among different cohorts of pregnant women with diabetes. Most studies examining differences between groups using continuous glucose monitoring (CGM) data were performed with older CGM systems worn for 2-7 days. We examined differences in glycemic control and glycemic variability (GV) between pregnant women (n=32) with T1D (n=20), T2D (n=3), or GDM (n=9) in the 2nd and 3rd trimesters using the Dexcom G6 CGM system, worn for 10 days as part of a pregnancy CGM accuracy trial. Pair-wise comparisons were made between groups and group heterogeneity testing was performed. No adjustments were made for multiple comparisons analyses. Most women required insulin therapy (26/32, 81%). The baseline HbA1C levels were similar between groups (Table). The glucose management indicator (GMI) was numerically similar to HbA1C for the T1D and GDM cohorts. Time spent >140 mg/dL (p=0.009) was highest and time in range (63-140 mg/dL) was lowest (p=0.001) in women with T1D compared to the other groups. The coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE) were highest in the T1D group, lowest in the GDM group, and intermediate in the T2D group (p<0.0001 for each). Glycemic control was better and GV was lower for pregnant women with T2D and GDM compared to women with T1D. CGM use in pregnancy helps elucidate GV.

Disclosure

S. Polsky: None. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. X. Zhang: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. S.J. Brackett: None. C. Levister: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc.

Funding

Dexcom, Inc.
76-OR: UK 1st National Health Service (NHS) EndoBarrier (EB) Service for Uncontrolled Diabesity: 2-Year Outcomes for All 62 Treated Patients
Authors: RYDER ROBERT E.J. , YADAGIRI MAHENDER , IRWIN SUSAN P. , BURBRIDGE WYN , WYRES MELANIE C. , BASHIR TAHIRA , GANDHI HARDEEP , ALLDEN RACHAEL , BLEASDALE JOHN , FOGDEN EDWARD , ANDERSON MARK , GUPTA PIYA SEN
Published: June 2020

EB, a 60cm endoscopically inserted proximal intestinal liner, reduces weight and HbA1c over 1 year. In the 1st NHS EB service, we provided EB to patients with sub optimally controlled diabesity and monitored outcomes in a registry. 46/62 (72%) completing 1 year post EB removal (age 51.5±7.7 years, 52% male, diabetes duration 14.5 (8-20) years, BMI 41.6±7.1 kg/m2) attended follow-up. During EB treatment, mean ± SD HbA1c fell by 1.9±1.8 %, from 9.2±1.8 to 7.2±1.0 % (p<0.001), weight by 17.2±8.8 kg from 121.9 ± 29.4 to 104.7±30.1 kg (<0.001), systolic BP from 139.0±14.0 to 126.0±14.6 mmHg (<0.001), serum alanine aminotransferase (marker of liver fat) from 30.0±16.9 to 18.8±11.0 U/L (p<0.001). Median (IQR) total daily insulin dose reduced from 104 (54-162) to 30 (0-62) units (n=31, p<0.001); 10/31 (32%) insulin treated patients discontinued insulin. One year after EB removal 18/46 (39%) demonstrated sustained improvement, 18/46 (39%) partially sustained improvement and 10/46 (22%) reverted to baseline (Figure). Of those deteriorating, 9/10 (90%) had depression and/or bereavement. 10/62 (16%) had early EB removal for adverse events or symptoms; all 10 fully recovered after removal and most derived significant benefit. Our data demonstrates EB as highly effective in patients with refractory diabesity, with maintenance of significant improvement 1 year after removal in 78%.

Disclosure

R.E.J. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S. M. Yadagiri: None. S.P. Irwin: None. W. Burbridge: None. M.C. Wyres: None. T. Bashir: None. H. Gandhi: None. R. Allden: None. J. Bleasdale: None. E. Fogden: None. M. Anderson: None. P. Sen Gupta: None.