bluuebunny/crossref_metadata_2025 huggingface dataset:
571-P: Analysis of Hearing Loss Characteristics in Prediabetic Patients
Authors: MENG YAN , ZHUANG XIAOMING , LU BIN , WU XIAOJUAN
Published: June 2019

Objective: The goal was to study auditory function in prediabetes. Pure Tone Audiometry (PTA), Distortion Product Otoacoustic Emission (DPOAE) and Auditory Brainstem Response (ABR) were used to detect whether there is early hearing deterioration in the prediabetes.

Methods: 168 participants underwent the Oral Glucose Tolerance Test (OGTT). 58 prediabetes patients younger than 60 years old, and 50 controls, age and sex matched, were enrolled. All subjects underwent PTA, DPOAE and ABR examinations. All relevant parameters including air and bone conduction pure tone audiometry, DPOAE amplitude and ABR latencies were collected.

Results: (1) There were 25 cases with hearing loss in prediabetes (43%), while 6 cases in the control group (12%) by PTA; the difference was statistically significant (P <0.001). The hearing thresholds at each frequency (0.25kHz, 0.5kHz, 1kHz, 2kHz, 4kHz and 8kHz) in the prediabetes were higher than those in controls but only statistically significant at 4kHz and 8kHz (P < 0. 001). Air- and bone-conduction pure-tone thresholds synchronization increased. The difference between air conduction and bone conduction checked by PTA was less than 10dB. (2) DPOAE amplitude at each frequency in the prediabetes group was lower than control group; there were statistically significant differences at 1, 1.5, 2, 3, 4, 6 kHz (P < 0. 001). (3) There were no significant differences of neuron response latencies in ABR measurements between prediabetes and the control group.

Conclusions: (1) Loss of auditory function began in the prediabetes stage. Sub-clinical presentations were more pronounced in the prediabetes stage. (2) Bilateral symmetry sensorineural hearing loss, especially at high frequencies, is very characteristic in prediabetic patients. (3)The preliminary findings are that DPOAE is needed to detect the usually slight hearing loss in prediabetes whereas PTA was less sensitive and did not detect such losses. (4) The damage is mainly cochlear, not in the central nervous system.

Disclosure

Y. Meng: None. X. Zhuang: None. B. Lu: None. X. Wu: None.

Funding

Capital Health Research and Development of Special Fund (2016-2-7022, 2019-1-1091); Science and Technology Plan of Beijing Municipal Education Commission (KM201610025020)
573-P: Diagnostic Performance of Heart Rate Variability for Detecting Diabetic Cardiac Autonomic Neuropathy
Authors: KOO BO KYUNG , MOON MIN KYONG
Published: June 2019

Heart rate variability (HRV) has been considered as a useful tool for detecting cardiac autonomic neuropathy (CAN) and predicting mortality in individuals with diabetes. We evaluated its diagnostic performance for CAN in a hospital-based cohort.

CAN was defined and classified according to Ewing’s criteria using standard 5 cardiovascular reflex test. HRV and power spectral density (PSD) were assessed by DiCAN (Medicore, Seoul, Korea); and diagnostic performance of Standard Deviation Normal to Normal (SDNN) and each PSD domain (total power, TP; very low frequency, VLF; low frequency, LF; high frequency, HF) were evaluated using receiver operating characteristic (ROC) analysis and Youden's index.

After excluding subjects with insufficient data, 2,209 diabetic patients were included the analyses (mean age, 60 ± 11 years; men, 49.6%). Early, definite, and severe CAN were detected in 38.7%, 10.4%, and 4.1% in them. Multivariable Poisson regression adjusted for age and sex showed that all SDNN, TP, VLF, LF, and HF were decreased as severity of CAN increased (P<0.001). Their area under curve of ROC for diagnosis of definite CAN was 0.67 (95% confidence interval, 0.64 - 0.70), 0.71 (0.68 - 0.74), 0.68 (0.65 - 0.71), 0.73 (0.70 - 0.75), and 0.68 (0.65 - 0.71), respectively; and their sensitivity was 0.74, 0.80, 0.70, 0.70, and 0.79, respectively in this analysis. For detection of early CAN, their sensitivity was more decreased to 0.71, 0.64, 0.52, 0.64, and 0.74, respectively.

In conclusion, even though there was significant decrease in HRV according to severity of CAN, HRV could not detect about 30% of diabetic subjects with CAN especially in the case with early impairment. Further studies evaluating diagnostic performance of HRV in various populations are needed.

Disclosure

B. Koo: None. M. Moon: None.
59-LB: Prevalence and Risk Factors of Lipohypertrophy and Lipoatrophy in Diabetes Patients Receiving Insulin Therapy
Authors: BUYRUK BETUL AYDIN , KEBAPCI NUR , YORULMAZ GOKNUR , ALAGUNEY ELIF SEVIL , AKALIN AYSEN , EFE BELGIN
Published: June 2019

Objectives: Insulin therapy is associated with skin-related complications, such as lipoatrophy, lipohypertrophy (LH), edema, and allergy. Lipohypertrophy (LH) is the most common cutaneous complication of injectable insulin therapy in the treatment of diabetes. Our aim in this study was to evaluate skin-related complications in diabetic patients receiving insulin therapy.

Methods: In this study, diabetic patients who were treated with insulin therapy in Endocrinology Department between 2015 and 2018 were evaluated. Observation and palpation technique was used in the evaluation of lipohypertrophy in diabetic subjects. The degree of lipohypertrophy was classified as follows: grade 0 = no change; grade 1 = visible hypertrophy of fat tissue but with normal consistency on palpation; grade 2 = intensive fat tissue thickening but with firm consistency; and grade 3 = lipoatrophy

Results: A total of 204 diabetic participants (52, 5 % female) were evaluated. The number of patients using insulin for more than 10 years was 81 (39,7%). The 4-mm needle was used more commonly in the study (54, 4 %). The recommended injection sites are the abdomen, thigh, arm and buttocks. Overall, 55, 9 % of patients were injecting insulin in the area of abdomen and 40, 2 % were injecting insulin four times per day. The ratio of the patients who do not change needle tip for each injection was 43,6%. In addition, lipohypertrophy was seen in 61, 8 % of the 204 diabetics in the study and most patients were revealed to have grade 1 (35,3%). Lipoatrophy was seen in 5.6% of the patients. Of the cases diagnosed as lipohypertrophy, 56, 3 % were women and 43,7% were men. Females were significantly more likely to have LH than males were (P = 0.042).

Conclusions: Increased prevelance of lipohypertrophy is an important complication of insulin therapy and clinicians must be aware of this complication.

Disclosure

B. Aydin Buyruk: None. N. Kebapci: None. G. Yorulmaz: None. E. Alaguney: None. A. Akalin: None. B. Efe: None.
590-P: Is Abdominal Obesity Associated with Diabetic Retinopathy in Chinese individuals: An Exploratory Study
Authors: ZHOU JIAN-BO , YUAN JING , CAI YAO-HUA , SHU LIN-PING , YANG JIN-KUI
Published: June 2019

Aim: To our knowledge, the independent associations of abdominal obesity (defined by waist circumference or waist hip ratio) with diabetic retinopathy (DR) remain unknown in Chinese individuals to date.

Methods: This study included two sets. Firstly, relationship between waist circumference (WC) or waist hip ratio (WHR) and DR was estimated in a case-control set (DR vs. non-DR) for the whole population before and after propensity-score matching (PSM). Subsequently, the accumulated evidence was explored to validate the relationship.

Results: Among 511 eligible patients, DR(N=156) and non-DR(N=156) patients who had similar propensity scores were included in the PSM analyses. Abdominal obesity (defined by waist circumference) was associated with risk of diabetic retinopathy (OR: 1.07(1.03-1.10)). Accumulated analysis of abdominal obesity on diabetic retinopathy showed that risk of DR might rise by 12% (OR 1.12, 95% CI: 1.02 to 1.22). Further accumulated evidences showed a significant association between continuous body mass index (BMI) and risk of proliferative diabetic retinopathy (PDR) (OR=0.96, 95% CI 0.93-0.98; P=.002; I2=50%).

Conclusions: Abdominal obesity, especially defined by waist circumference, is associated with the risk of diabetic retinopathy in Chinese population.

Disclosure

J. Zhou: None. J. Yuan: None. Y. Cai: None. L. Shu: None. J. Yang: None.

Funding

National Natural Science Foundation of China (81870556, 81670738); Beijing Municipal Administration of Hospital`s Youth Programme (QML20170204)
617-P: Current Practices and Gaps in Management of Type 2 Diabetes Mellitus (T2DM) with Dyslipidemia as per American Diabetes Association (ADA) Guidelines Subset Analysis from LEADD (Learning with Experts to Advance Diabetic Dyslipidemia Management) Study
Authors: UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , DAS ASHOK KUMAR , SABOO BANSHI D. , KALRA SANJAY , AYYAR VAGEESH , TIWASKAR MANGESH HARIHAR
Published: June 2019

Background: CAD (Coronary Artery Disease) and diabetes is strongly associated with high low-density lipoproteins (LDL) levels.

Objective: Understand evaluation practices and treatment for dyslipidemia with statin intensity in T2DM participants as per ADA guidelines.

Methods: A subset analysis of real world, prospective, cross sectional, observational LEADD study in T2DM participants conducted at 226 sites. “n”=number of participants analyzed for each parameter. Available lipid profile was recorded and stratified based on age and Atherosclerotic cardiovascular disease (ASCVD) risk factors and ASCVD as per ADA guidelines for percentages achieving LDL-C target and high intensity of statin.

Results: A total of 4002 participants enrolled with mean (±SD) Hb1Ac 8.15 ± 1.7%, LDL- C levels 117.7 ± 37.6 mg/dl. Rosuvastatin was given in 87% (n=2419/2757) participants. Participants <40 years, ASCVD risk factors and ASCVD were present in 95% (n=207/217) and 3.2% (n=7/217), in >40 years it was 86.7% (n=2908/3354) and 12.8% (n= 432/3354). Mean (±SD) LDL- C levels in ASCVD risk factors and ASCVD participants in <40 years was 129±37.9 mg/dl and 121±42mg/dl, in >40 years it was 120.9±36mg/dl and 118±41mg/dl. 64% (n= 155/162) and 80% (n= 4/5) participants <40 years with ASCVD risk factors and ASCVD, in >40 years 91.4% (n= 1925/2104) and 87.9% (278/316) were not on target LDL - C levels. In <40 years 15.6% (n = 22/141) and 83% (n = 5/6) statin receiving participants in the ASCVD risk factors and ASCVD group and in >40 years 87% (n = 1869/2143) and 77.8% (n = 271/348) were not receiving high intensity statins.

Conclusion: Adherence to ADA guidelines for diabetic participants despite having ASCVD risk factors/ASCVD was sub-optimal in study participants, when high intensity statins is required for dyslipidemia to achieve desired outcomes in them. The findings need further research.

Disclosure

A. Unnikrishnan: Other Relationship; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Dr. Reddys Laboratories, Eli Lilly and Company, Eris Pharmaceuticals, Ipca Laboratories Ltd., MSD, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi. A.K. Das: None. B.D. Saboo: None. S. Kalra: None. V. Ayyar: None. M.H. Tiwaskar: None.

Funding

Diabetes Care India; Dr. Reddy's Laboratories
622-P: Mechanism of Lin28a Promoting Vascular Smooth Muscle Cell Proliferation and Migration in Restenosis
Authors: ZHANG QIAN , ZHOU XIAOJUN , SHEN XUE , JIANG SHAN , XIE TIANYUE , ZOU ZHIWEI , XU CHUNMEI , ZHANG RUI , CUI YUJIAO , GONG PIYUN , DONG JIANJUN , LIAO LIN
Published: June 2019

Background: Restenosis (RS) after percutaneous transluminal angioplasty severely affects the curative effect of patients with lower extremity peripheral arterial disease. Our previous research indicated that abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) was the key factor in the RS plaque formation. The process of Lin28a regulating cell proliferation demonstrates similarities with the proliferation of VSMCs in RS. Here, we aim to explore the specific role of Lin28a in RS.

Methods: To distinguish from atherosclerotic lesions, RS and atherosclerosis (AS) models were simultaneously established in type 2 diabetic rats. Lin28a level in VSMCs was detected by immunofluorescence double staining. The changes of VSMCs were determined when modulating Lin28a in vivo and vitro and downstream mechanism was further explored.

Results: Thirty-two folds higher level of Lin28a was found in VSMCs in RS compared with AS (P<0.05). Overexpression of Lin28a significantly promoted proliferation and migration of VSMCs in vitro. Let7 was identified as the direct target of Lin28a; screening for Let7 subtypes by in vivo and vitro showed that Let7c, let7d, let7g, miR98 were negatively regulated by Lin28a in VSMCs. Among them, downregulation of Let7c markedly suppressed the VSMCs’ proliferation and migration accompanied by upregulation of Lin28a expression; while these effects were alleviated by overexpression of Let7c.

Conclusion: The present study demonstrated that Lin28a is critically involved in the progression of RS via facilitating the proliferation and migration of VSMCs. A double negative feedback loop is often present in Let7 and Lin28a, thus Let7 subtypes were detected and Let7c could be the direct downstream of Lin28a in regulating VSMCs in RS. Combined with the fact that Lin28a was also regulated by Let7c, we inferred a feedback loop could be formed between Let7c and Lin28a. Above all, the interaction in Lin28a and Let7c may contribute to rapid formation of RS.

Disclosure

Q. Zhang: None. X. Zhou: None. X. Shen: None. S. Jiang: None. T. Xie: None. Z. Zou: None. C. Xu: None. R. Zhang: None. Y. Cui: None. P. Gong: None. J. Dong: None. L. Liao: None.

Funding

National Natural Science Foundation of China (81670757, 81570742, 81770822, 81800732); Shandong Provincial Natural Science Foundation of China (ZR2017LH025); Shandong Provincial Medicine and Health Science and Technology Development Program (2017WS461)
63-LB: Transthyretin Contributes to Insulin Resistance and Its Role in Exercise-Induced Improvement of Insulin Sensitivity in Obese Mice
Authors: HE YINGZI , WANG ZHE , ZHENG FENPING
Published: June 2019

A major cause of type 2 diabetes is impaired insulin sensitivity. Our aim is to investigate the role of transthyretin (TTR), a molecule implicated in exercise-induced anorexia, in obesity-related insulin resistance and exercise-induced insulin sensitivity improvement. We found that serum TTR levels were elevated in obese C57BL/6 mice (DIO) induced by high-fat diet and 14 people with metabolic syndrome. Serum TTR levels in normal or DIO mice were decreased or normalized by treadmill training as a result of the decreased TTR-mRNA expression in the liver. Injection of recombinant TTR- adenovirus by tail-vein in normal mice caused TTR overexpression in the liver and increased TTR secretion to circulation, resulting in insulin resistance and glucose intolerance. Although the increased TTR levels in serum did not further impair glucose intolerance, it counteracted the exercise-induced improvement of insulin sensitivity in DIO mice. As expected, AMPK activity in muscle was induced by treadmill training in both normal and DIO mice, whereas it was inhibited by TTR overexpression. Although we did not find TTR-mRNA expression in the muscle, we detected TTR protein in muscle by western blotting and immunohistochemistry. Markedly, the change of TTR levels in muscle was in consistent with that in serum of both normal and DIO mice with exercise or not. Further in C2C12 skeletal muscle cells, we demonstrated that TTR protein could be internalized in a time-dependent manner, and exogenous TTR pure protein or adenovirus-mediated high expression of TTR protein inhibited the AMPK pathway activity in a dose-dependent manner. Our results suggest that TTR contributes to insulin resistance, and exercise may improve insulin resistance by reducing TTR expression in the liver, TTR secretion to circulation, and TTR uptake in skeletal muscle, thus increasing AMPK activity.

Disclosure

Y. He: None. Z. Wang: None. F. Zheng: None.

Funding

National Natural Science Foundation of China (491030-N11479)
636-P: Effect of Obesity and Weight Variations on the Decline of Ankle-Brachial Index in Type 2 Diabetes Subjects without Peripheral Artery Disease
Authors: YANG YEOREE , LIM JAYOUNG , LEE EUN YOUNG , YOON KUN-HO , CHA BONG-YUN , LEE SEUNG-HWAN , CHO YUNJUNG
Published: June 2019

Object: There are very few studies that evaluate the influence of obesity and weight variations on change in ankle-brachial index (ABI) in subjects with type 2 diabetes (T2D) but without peripheral artery disease (PAD).

Methods: In this case-control study, T2D subjects who were without baseline PAD (0.9 ≤ ABI < 1.4), and received minimum 2-year interval ABI exams were included. Subjects with prior diagnosed or treated PAD were excluded. Baseline body mass index (BMI) of all subjects was categorized as normal weight (< 23 kg/m2), overweight (23∼25 kg/m2), and obesity (≥ 25 kg/m2). Weight changes during follow-up were categorized by the percentage of weight change; weight loss (< -3%), stable (-3∼3%), gain (> 3%). Subjects with ABI decline were defined as one or both legs worsened to the abnormal (ABI < 0.9) at follow-up exam.

Results: A total of 575 subjects were analyzed (188 normal, 140 overweight, and 245 obesity). During the median 2.9 years of follow-up period, 122 (21.2%) subjects showed ABI decline. When split by category of BMI and weight change, the incidence rate of ABI decline showed stepwise increasing pattern according to the obesity and weight gain. Multivariable logistic regression analysis showed that baseline obesity (vs. normal) was significantly associated with the risk of developing ABI decline after adjusting for age, sex, smoking, diabetes duration, mean HbA1c, GFR, LDL cholesterol, blood pressure, hypertensive medication, insulin use, statin use, antiplatelet use, and weight change (OR = 2.06, 95% CI = 1.22 - 3.49). On the contrary, weight loss was significantly associated with reduction in risk of developing ABI decline (OR = 0.52, 95% CI = 0.31 - 0.86).

Conclusion: Obesity is an independent risk factor for developing ABI decline in T2D subjects without PAD, whereas weight loss is an independent protective factor. Weight loss should be emphasized especially in obese subjects with T2D.

Disclosure

Y. Yang: None. J. Lim: None. E. Lee: None. K. Yoon: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc. Speaker's Bureau; Self; Takeda Pharmaceutical Company Limited. B. Cha: None. S. Lee: None. Y. Cho: None.
645-P: QTc Prolongation as a Risk Factor for Five-Year Survival after Above-Ankle Amputation in Patients with Type 2 Diabetes
Authors: PUVANESWARALINGAM SHOBITHA , FAGHER KATARINA , LONDAHL MAGNUS
Published: June 2019

Patients with diabetic foot ulcers (DFU) are considered high-risk individuals for increased cardiovascular disease and mortality. After a major amputation the mortality risk is even higher, with five-year mortality rates exceeding 70%. QTc interval prolongation is a potential indicator of increased cardiovascular risk in the general population as well as in patients with diabetes. The aim of this study was to evaluate the impact of QTc prolongation on 5-years survival after above ankle amputation in patients with type 2 diabetes. We retrospectively enrolled all patients (n=97) with type 2 diabetes, not older than 85 years without a pacemaker, who underwent a major amputation at two hospitals with multidisciplinary DFU teams. Patients were grouped according to QTc time ≤ or >440 ms. Mortality data after 5 years was obtained from the Swedish National Death Registry. Non-parametric statistics were used when assessing differences and survival was analyzed with Kaplan-Meier estimates with log-rank test. As shown in the Figure, QTc prolongation was significantly associated with worse survival (82 vs. 57% 5-year mortality). Presence of ischemic heart disease, age and diabetes duration did not differ between groups.

In conclusion, we have demonstrated that routinely ECG screening with QT interval analysis in a DFU-population, provides important information regarding long-term survival.

Disclosure

S. Puvaneswaralingam: None. K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.

Funding

Craaford Foundation; Krapperyp Foundation; County of Skåne Foundation; Diabetes Foundation
646-P: The Efficacy and Safety of Cold Atmospheric Plasma as a Novel Therapy for Diabetic Wound In Vivo and In Vitro
Authors: HE RUI , LI QIN , YU MUYU , WANG TAO , LU HUIJUAN , LU JUNXI , ZHU WEI , LUO MING , ZHANG JIANKANG , GAO HAIWEI , XING WANLI , WANG DONG , LIU FANG
Published: June 2019

Aims: Cold atmospheric plasma (CAP) interacted with tissue and had potential effects on wound healing and tissue regeneration. The aim of this study is to investigate the efficacy and safety of CAP as a novel therapy for diabetic wounds in vitro and in vivo.

Methods: The plasma consists of ionized helium gas that is produced by a high-voltage (8.5kV) and high-frequency (17kHz) power supply. Eight-week-old male db/db mice were treated with conventional wound dressing only (control group), additional 90’s CAP (low-dose group) or 180’s CAP (high-dose group) for 2 weeks, respectively. Skin samples around wound in 3, 7, 14 days and blood samples were collected and analyzed in three groups. We carried out in vitro analysis included scratch wound healing assays in immortalized human epidermal HaCaT cells.

Results: After 14 days of treatment, CAP could obviously promote diabetic wound healing because of inflammation inhibition and angiogenesis increase. Wound- closure rates of two CAP groups were significantly faster than that of control group. The protein expression of IL-6, TNF-α, iNOS and SOD significantly decreased while the protein level of VEGF, TGF-β in two CAP groups significantly increased compared to those in control group (all p < 0.05). And such changes showed a good consistency with the change in mRNA level (all p < 0.05). In vitro, scratch wound healing assays showed that plasma treatment could effectively accelerate the wound healing within 3 minutes exposure (all p < 0.05). Additionally, there were no significant differences in histological observation and the level of serum ALT, AST, BUN, CREA and WBC among the three groups.

Conclusions: CAP treatment for 3 min daily improves diabetic wound healing by inhibiting inflammation, reducing oxidative stress and enhancing angiogenesis without toxicity to liver and kidney.

Disclosure

R. He: None. Q. Li: None. M. Yu: None. T. Wang: None. H. Lu: None. J. Lu: None. W. Zhu: None. M. Luo: None. J. Zhang: None. H. Gao: None. W. Xing: None. D. Wang: None. F. Liu: None.

Funding

National Natural Science Fund of China; Shanghai Science & Technology; Shanghai Municipal Education Commission
650-P: An Audit of the Clinical Outcomes of DAFNE Singapore (2011-2018)
Authors: TAN SARAH , CHANDRAN SURESH RAMA , LIM HUEE BOON , ADAIKAN KALA , GOH SU-YEN , GARDNER DAPHNE
Published: June 2019

Background: The Dose Adjustment for Normal Eating (DAFNE) is a type 1 diabetes (T1D) group education program to enable self-management. Shown to improve outcomes in the UK, its application in Asian countries remains uncertain. We assessed the outcomes of Singapore (Sg)DAFNE, which remains the only Asian centre, from 2011-2018.

Methods: Prior to DAFNE entry, most had received one-on-one education from DAFNE educators. HbA1c, total daily dose (TDD) of insulin were retrieved at these timepoints: 1y before, at entry, 1y after, latest profile. Paired sample t-tests and Chi square tests were used; data is presented as means±SD.

Results: n=115 (33.9% male), age 28.3±8.5y, T1D duration 11.2± 8.4y, follow-up post-DAFNE 3.5 ±2.3y. n=104 completed 1y follow-up post-DAFNE. Mean HbA1c pre-DAFNE fell by entry into DAFNE: pre-vs.-entry: 8.5±1.68% (68 mmol/mol) vs. 7.9±1.4%, p<0.001. This fall was sustained 1y post-DAFNE and at latest follow-up (HbA1c 7.8±1.3%, 7.9±1.3%, all p<0.001). Proportion of those in HbA1c category ≤ 7.5% rose while the proportion in higher HbA1c categories fell post-DAFNE (Figure). TDD insulin fell alongside improvement in glycaemic control (pre-vs.-post-DAFNE: 45.5+14.9 vs. 42.5+12.0, p=0.02).

Conclusion: This demonstrates the effectiveness of SgDAFNE. Sustained improved glycaemic control was achieved with reduced insulin dosages, reinforcing that the quality of insulin use matters more than the quantity.

Disclosure

S. Tan: None. S. Rama Chandran: None. H. Lim: None. K. Adaikan: None. S. Goh: None. D. Gardner: None.
665-P: Diabetes Self-Management Education (DSME): What Will It Take to Improve Participation?
Authors: KRALL JODI , KANTER JUSTIN , RUPPERT KRISTINE , ARENA VINCENT C. , SOLANO FRANCIS X. , SIMINERIO LINDA M.
Published: June 2019

Despite evidence that DSME is a critical component of diabetes (DM) care, participation remains low. Innovative methods to improve attendance need to be explored. The purpose of this study was to evaluate the impact of a primary care (PC)-based DSME delivery model on DSME referrals and participation. Using a non-randomized design, diabetes educators (DEs) and PC practices were assigned to the intervention group (IG; 3 DEs, 6 practices) or control (CG; 2 DEs, 6 practices). IG practices applied patient-centered medical home elements to DSME delivery and had direct access to a DE. The CG employed traditional DSME delivery (PC patients referred to hospital-based DE). To examine DSME referrals and participation, medical record data were extracted for patients with DM, 18-75y, presenting to PC practices over 18 months (n=4,894; 59% IG, mean age 58.7y, 50.8% male) and compared between study groups. IG practices referred a higher percentage of patients to DSME compared to CG (18.4% v 13.4%; p<0.0001). Of those referred, IG patients were more likely to attend DSME than CG (34.9% v 26.1%; p=0.02). This equated to a total of 6.8% IG and 3.5% CG patients participating in DSME. Adjusted multiple logistic regression modeling found that IG practices were 1.8 times more likely to refer patients to DSME than CG (Confidence Level 1.4-2.2). Other factors that predicted referrals were female (Odds Ratio=1.3, CL 1.1-1.6), obesity (OR=1.6, CL 1.3-2), and higher A1c (OR=1.4, CL 1.3-1.4). Older patients were less likely to be referred (OR=0.98, CL 0.975-0.999). Similar adjusted regression modeling found that IG patients were 1.7 times more likely to participate in DSME than CG (CL 1.1-2.6); lower A1c also predicted DSME attendance (OR=0.9, CL 0.8-0.999). This study demonstrates the positive influence of a PC-based intervention on DSME referral and participation. However, modest improvements in DSME rates, even with targeted efforts to address barriers, raise questions as to what is truly needed to drive meaningful change.

Disclosure

J. Krall: None. J. Kanter: None. K. Ruppert: None. V.C. Arena: None. F.X. Solano: None. L.M. Siminerio: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
666-P: Development of a Self-Stigma Scale in Patients with Diabetes
Authors: SEO KAWOUN , CHO JEONGHWA , KU BON JEONG , LIM ANCHO , KO GEUMBO , SONG YOUNGSHIN
Published: June 2019

Stigma is known as social isolation of an individual because of his/her situation such as chronic disease conditions. Stigma in chronic disease have been associated with patients’ psychosocial behaviors. Stigma is classified as social stigma and self-stigma, but studies of self-stigma in diabetes was insufficient due to lack of measuring tools. The aim of this study was to develop and evaluate the self-stigma scale in patients with diabetes. The preliminary items of self-stigma scale developed through hybrid concept analysis. To confirm the psychometric properties, contents validity by experts, construct validity such as item analysis, exploratory and confirmatory factor analysis, and reliability were performed. Total 399 patients with diabetes (type 1 and type 2) were recruited from two University hospital in Korea. Initial 40 items were extracted through literature review and in-depth interview during hybrid concept analysis. In content validity, 27 items remained. At item analysis for construct validity, two items below score 0.2 for total correlation of correlated items were deleted. In exploratory factor analysis, 21 items with 4 factors (incompetence, social withdrawal, self-devaluation, and negative feeling) were extracted and it accounted for 51.17% of the variance. In confirmatory factor analysis, 5 items below 0.4 for standard regression weight were dropped. Final 16 items with four factors was acceptable level of goodness-of-fit parameters (CMIN/DF=2.742, SRMR=0.149, RMSEA=0.090, GFI=0.867, AGFI=0.816, CFI=0.910). The reliability of the scale was Cronbach’s alpha=.89.

In conclusion, the self-stigma scale in diabetes have shown good validity and reliability. This scale can be used as an effective tool to measure diabetes related self-stigma, and be investigated what factors can be associated with self-stigma in diabetes in future study.

Disclosure

K. Seo: None. J. Cho: None. B. Ku: Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes, Sanofi-Aventis. A. Lim: None. G. Ko: None. Y. Song: None.
668-P: A Coaching Intervention with Low Literacy Progress Report Improves Glycemic Control
Authors: WOLF RACHEL , BARNES CATHERINE S. , WAN CLAIRE , CAUDLE JANE , ZIEMER DAVID C.
Published: June 2019

Diabetes imposes a greater burden on minority and disadvantaged populations. Tailored interventions are needed to improve self-management outcomes among these populations.

Purpose: To determine a) the effect of tailored coaching on patient knowledge, attitudes, and A1c and b) whether patient age, diabetes duration, or education level moderated intervention effect.

Methods: A pre-post efficacy analysis of a randomized patient coaching intervention in an urban diabetes clinic was conducted. Eligibility included diagnosed diabetes, A1c ≥ 7.0%, on insulin or high dose oral agents, at least two clinic visits in the prior year and at least four coaching sessions at ∼6-month intervals. Participants received either standard diabetes handouts (N=192) or one-on-one, low literacy tailored coaching (N=161). Coaching included review of home and clinic blood sugars/A1c using a color coded graphical printed progress report, goal setting and formulation of questions for the provider. Outcomes included A1c/blood sugar target knowledge, measured A1c, Diabetes Empowerment Scale scores, and Patient Activation Measure scores.

Results: Most participants were female (64%), black (96%), had household incomes < $15,000/year (83%), and had type 2 diabetes (96%). Mean age was 56.5 years and mean baseline A1c was 8.7%. Coaching increased knowledge of target A1c compared to control (OR 3.2, CI 1.6-6.2) but not knowledge of target blood sugar. Coaching improved measured A1c (-1.0% vs. -0.4% p < 0.05). The magnitude of improvement tended to be somewhat greater at higher educational levels (high school -0.97, p<.01; more than high school -1.19, p<.05). Coaching did not significantly increase diabetes self-efficacy or patient activation.

Summary: Personalized, multi-component low literacy coaching significantly improves A1c and knowledge of A1c control targets. Repeated coaching sessions can enhance the effectiveness of medical management visits.

Disclosure

R. Wolf: None. C.S. Barnes: None. C. Wan: None. J. Caudle: None. D.C. Ziemer: None.

Funding

American Diabetes Association (7-05-CR-03 to C.S.B.)
672-P: Diabetes Education Model for Primary Care Physicians (PCPs)
Authors: BHALLA SANDEEP , KUMAR PUSHKAR , MEHRA RAKESH
Published: June 2019

India is home to over 72.9 million individuals with diabetes which is expected to rise to 134.3 million by 2045. Given the low doctor population ratio, maldistribution of specialists with an urban preference and initial diagnosis being made by non-specialists, strengthening primary health care is the key in effectively addressing this challenge. Considering the burden, Public Health Foundation of India in 2010 launched pan-India capacity building programs for PCPs. The aim of these programs is to enhance knowledge, skills and core competencies of PCPs in managing diabetes and comorbidities. The program is conceptualized and built on a PPP model with the involvement of various stakeholders including implementing, academic, funding partners, national experts (33), faculty (428), observers (150) and PCPs. Every stakeholder has unique role and responsibilities (Figure). A total 16878 PCPs have been trained under these programs in 101 cities across 27 states/UTs. Passing percentages ranged from 88 to 92 with an average score of 39 out of 50. PCPs reported a significant increase in knowledge (p<0.05) and confidence in managing diabetes in end line evaluation and establishing a referral linkage in an organic manner. The learning from the model is now adopted by other LMICs including Bangladesh, Nepal, Myanmar, Afghanistan and East African countries that are in throes of an alarming burden of diabetes and shortage of trained physicians.

Disclosure

S. Bhalla: None. P. Kumar: None. R. Mehra: None.
673-P: Certificate Course in Evidence-Based Management of Diabetic Retinopathy: A Unique Partnership Model for Capacity Building of Primary Care Physicians in India
Authors: BHALLA SANDEEP , KUMAR PUSHKAR , CHANDWANI HARESH , JOSHI MANOJ
Published: June 2019

Background: In India, 72 million people are suffering from diabetes. Studies showed that every fifth person in India with diabetes could have Diabetic Retinopathy (DR) causing a significant impact on health system. To address this burden, a capacity-building model was initiated with an objective to build the skills and core competencies of physicians for evidence based management of DR.

Methodology: Certificate Course in Evidence Based Management of Diabetic Retinopathy (CCDR) is a joint partnership program implemented via a robust curriculum developed by leading academic partners, vetted by 8 renowned Diabetologists/Retina specialists, delivered by 40 Regional Faculty in 20 centers across India, comprised of didactic lectures, case studies and instructional videos. The four modular course conducted as once a month contact session and one session as hands-on-training at premier retina institute with an integral monitoring and supervision mechanism.

Results: Over 3 cycles; 445 participants have been trained from 100 districts (159 cities, 22 states and 2 UTs); 42% affiliated to public sector and 51% are postgraduates. Pre/Post-test knowledge score revealed a significant change (p< 0.05). Participants rated overall course as an ‘excellent’ (9.1/10). The course is endorsed by UKRI Council GCRF through Ornate-India and has been adopted by various state government and international organizations. The fourth cycle of the course will train another 100 physicians. To ensure sustainability and expand the reach of the course, it has also been developed into an e-learning platform.

Conclusion: This unique educational model has met an excellent response from physicians, which probably reflects the felt need of physician community in India for skill improvement in DR management.

Disclosure

S. Bhalla: None. P. Kumar: None. H. Chandwani: None. M. Joshi: None.
679-P: Learner Preferences Related to Diabetes Medical Education
Authors: LARKIN AMY , LACOUTURE MICHAEL
Published: June 2019

Introduction: Understanding how clinicians prefer to learn and participate in continuing medical education (CME) and continuing education (CE) for certified diabetes educators (CDEs) can help providers of such education design more engaging and effective activities that can potentially further improve diabetes management in practice.

Methods: Medscape conducted a 10 question, online, incentivized survey in May 2018. Respondents’ confidentiality was maintained and responses were de-identified and aggregated prior to analyses.

Results: Most preferred duration for a CME activity: 30 minutes (33% PCP, 42% D/Es, and 41% CDEs). Most preferred format for a CME activity: online (52% PCP, 58% D/Es, and 63% CDEs), followed by live events at a medical conference (38% PCP, 30% D/Es, and 18% CDEs). Most preferred format for an online CME activity: video (60% PCP, 48% D/Es, and 51% CDEs), followed by text (37% PCP, 43% D/Es, and 41% CDEs). For online CME/CE, most preferred instructional design format: case-based (54% PCP, 56% D/Es, and 57% CDEs). Most important factors in selecting online CME/CE activities: content description (58% PCP, 52% D/Es, and 61% CDEs), credit hours for D/Es (40%) and CDEs (49%), and credit hours and title for PCPs (both 36%). The most important factors in selecting which symposia to attend at a scientific congress were content agenda for all groups (62% PCP, 64% D/Es, and 63% CDEs), learning objectives for D/E (29%) and CDEs (41%), and faculty for PCPs (44%). Most common ways of becoming aware of available professional education activities: invitation from online providers (PCPs 60%, D/Es 60%, CDEs 67%) and societies (PCPs 50%, D/Es 70%, CDEs 63%). The majority of participants reported that in the past 12 months they have learned something from CME/CE that changed their practice (88% PCP, 92% D/Es, and 82% CDEs).

Conclusion: Learner preferences for diabetes-related to live and online CME/CE were identified. These data should inform development of future CME/CE activities that are engaging and impactful.

Disclosure

A. Larkin: None. M. LaCouture: None.
681-P: Survey of Medical Staff on Use of Glucagon Injection in the Event of Serious Hypoglycemia in Japanese Diabetic Patients—Reason for Poor Spread of Glucagon Use in Japan
Authors: SAITO NOBUMICHI , TOYODA MASAO , KIMURA MORITSUGU , FUKAGAWA MASAFUMI
Published: June 2019

Glucagon injection is effective in the event of serious hypoglycemia, especially in unconscious patients who cannot swallow their medications. However, recent surveys in Japan found that only 15.9% of patients have glucagon injections in their possession, and both the adoption rate and the level of awareness in Japan lag behind those of Western countries. This suggests that the medical care and education system for diabetes patients in Japan should deal with this issue not only with patients and their families, but also with healthcare professionals engaged in patient guidance. We carried out a questionnaire survey of the staff at our hospital to determine the state of awareness and provision of glucagon injections by the medical staff in the event of serious hypoglycemia. A questionnaire was distributed to 100 medical staff at our hospital who were engaged in treatment of diabetes, requesting information about the state of knowledge and awareness on glucagon injections. All physicians and about 30% of nurses provided guidance on glucagon injection. In contrast, only a few nutritionists, pharmacists, clinical technologists, and other professionals, who were Certified Diabetes Educators of Japan, had ever done so. We concluded that the lack of knowledge among the medical staff about the technique of glucagon injection and related specific instructions may be one reason for the low rate of glucagon possession and use among the Japanese diabetics. The results suggested that the medical staff have poor knowledge about the technique of injection of glucagon and related instructions, and that a procedure has yet to be established for collection of expired unused dispensed glucagon vials and for re-prescription. Our results highlighted the need for educational programs for a sizeable proportion of healthcare professionals who are involved in the management of diabetes but lack specific information on glucagon injection.

Disclosure

N. Saito: None. M. Toyoda: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kyowa Hakko Kirin Co., Ltd., Medtronic Japan Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. M. Kimura: None. M. Fukagawa: Research Support; Self; Kyowa Hakko Kirin Co., Ltd. Speaker's Bureau; Self; Bayer Yakuhin, Ltd., Kissei Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Torii Pharmaceutical Co., Ltd.
683-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy May Prolong Survival and Decrease the Mortality after the Induction of Dialysis
Authors: HITOMI MAMIKO , SATO TERUKO , MORIYA TATSUMI
Published: June 2019

Although a multidisciplinary individual team approach (MTA) has been thought to help prevent the progression of diabetic nephropathy (DN), its efficacy on patient survival has not been fully examined. We compared the effect of an MTA on the hemodialysis (HD) course of 60 DN patients with that of 40 DN patients managed via a dietitian approach (DA) alone (total patients, n=100; 68 male, age, 61±12 years; 95 T2DM). In all cases, HD was initiated between January 2010 and June 2017. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. The team provided broad education such as advice on nutrition, medication, medical exam, and foot care. In the MTA group, the hematocrit value was significantly better, and the difference between real body weight at the initiation HD and dry weight was significantly smaller (vs. DA group: 28.3±4.8% vs. 26.6±4.1% p=0.033, 6.4±5.6kg vs. 8.9±7.1kg p=0.036, respectively). The MTA group tended to have a lower CTR, lower cost per admission for HD induction and lower urinary sodium excretion in 24h urine collection (vs. DA group: 53.4±6.6% vs. 55.5±8.2% p=0.095, $14,861±8,222 vs. $18,693±14,149 p=0.064, 8.2±2.2g/day vs. 13.0±6.9g/day p=0.095, respectively). The number of rehospitalizations due to macroangiopathy after HD induction was smaller in the MTA group (Pearson 3.444, p=0.064). The frequency of death after HD was significantly lower in the MTA group (Pearson 4.575, p=0.032). A Kaplan-Meier survival analysis showed that the MTA group had superior patient survival (log rank 5.727, p=0.017).

In conclusion, the MTA provided prolonged survival and might prevent rehospitalization. Both might be resulted from predominant and non-inferior effects of an MTA on DN patients with HD; thus, further study is warranted to examine the combined effects of the predominant or non-inferior advantages of MTA in providing longer life expectancy in comparison to DA.

Disclosure

M. Hitomi: None. T. Sato: None. T. Moriya: None.
69-OR: Mobility, Satisfaction, and Quality of Life among Long-Term Dysvascular/Diabetic Prosthesis Users: Results of a National Cross-Sectional Survey
Authors: STEVENS PHILLIP , WURDEMAN SHANE R.
Published: June 2019

Objective: To establish the mobility, satisfaction and quality of life among prosthesis users with major lower limb dysvascular/diabetic amputation (transtibial or proximal) at various long-term phases of prosthetic rehabilitation.

Methods: A multi-site, cross-sectional outcomes analysis. A total of 341 individuals met inclusion/exclusion criteria. Individuals were grouped in acute phases (0-3 mos (n=24); 4-6 mos (n=72)) and chronic phases (24-36 mos (n=91), 37-48 mos (n=53), 49-60 mos (n=47) and 60-84 mos (n=54)) post-amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M) while quality of life (Qol) and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire-Well Being (PEQ-WB).

Results: The average mobility, Qol and Sat among prosthesis users was, respectively, 44.8±10.6, 7.6±2.2 and 7.6±2.2. There were no observed differences in mobility (F5,330=1.52, p=0.18) or Qol (F5,333=0.78, p=0.57) between any groups. For Sat, there was a group difference (F5,334=2.44, p=0.03) as individuals who receive a prosthesis 0-3 mos experience initial higher Sat values compared to those 25-36 mos (p=0.005), 49-60 mos (p=0.008), and 61-84 mos (p=0.009).

Conclusion: Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to maintain reasonable levels of mobility, satisfaction and quality of life as much as 7 years post amputation. There may be a modest initial increase in satisfaction with the early receipt of a prosthesis. However, transfemoral amputations were under represented in this cohort of individuals fitted shortly after amputation. Notably, the mobility levels observed in the dysvascular population through a range of extended post-amputation durations remain within a single standard deviation of the amputee population mean for mobility.

Disclosure

P. Stevens: Employee; Self; Hanger Clinic. S.R. Wurdeman: None.

Funding

American Orthotics & Prosthetics Association (EB-043016)
70-OR: Are Surrogate Markers for Osteomyelitis Remission Reliable?
Authors: CRISOLOGO PETER A. , FONTAINE JAVIER LA , DAVIS KATHRYN , WUKICH DANE , LAVERY LAWRENCE A.
Published: June 2019

Aim: To evaluate surrogate markers commonly used in the literature for osteomyelitis remission after initial treatment for diabetic foot infections (DFIs).

Methods: 35 patients with DFIs were prospectively enrolled and followed for 12 months. Osteomyelitis (OM) was determined from bone culture and histology initially and for recurrence. We used X2 test for dichotomous variables and ANOVA for continuous variables.

Results: 24 patients were diagnosed with OM and 11 with soft-tissue infections (STI). There was no difference between the two groups for OM re-infection, healed ulcers, re-ulceration, re-admission for DFI at the same site, amputation at the same site after discharge. There were more surgeries after discharge in the STI group (p=0.02, Table 1).

Conclusions: OM at the same site based on bone biopsy indicated that 16.7% failed therapy; this was the only direct measure of OM. Indirect markers demonstrated a higher rate of failure. Failure ranged from 8.3-20.8% with surrogate markers. Most OM markers were similar to markers in STI subjects. Surrogate markers should not be the sole criteria used in place of more accurate measures such as advanced imaging or the gold standard of a bone culture and histopathology.

Disclosure

P.A. Crisologo: None. J. La Fontaine: None. K. Davis: None. D. Wukich: Consultant; Self; Orthofix. Other Relationship; Self; Arthrex. L.A. Lavery: Consultant; Self; Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Medline Industries, Inc. Research Support; Self; Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Osiris Therapeutics, Inc.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (3U24DK076169-08S4)