bluuebunny/crossref_metadata_2025 huggingface dataset:
594-P: Telehealth Results in Increased Visit Frequency and Lower Diabetes Distress in Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: RAYMOND JENNIFER , FOGEL JENNIFER L. , REID MARK W. , SALCEDO-RODRIGUEZ ELIZABETH , FOX D STEVEN , PYATAK ELIZABETH
Published: May 2022

Background: Managing T1D as a YA is challenging due to changing physiology, psychosocial demands, and increasing independence. Fewer than one-third of YA with T1D meet the ADA guidelines of quarterly diabetes visits and only one in seven attain the recommended hemoglobin A1c level of <7%. YA from disadvantaged ethnic, racial, and socioeconomic backgrounds face even greater T1D management obstacles.

Methods: The CoYoT1 Care model was adapted for diverse, predominantly publicly insured, YA with T1D at a large urban hospital. A 15-month 4-arm randomized controlled trial collected data on 68 YA, ages 16-25. Participants received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) , prior to COVID-19; all in-person visits transitioned to TH in March 2020. CoYoT1 Care consists of patient-centered provider visits with bimonthly virtual T1D peer group sessions.

Results: YA who attended >50% of study visits by TH attended more visits during the study period (3.4) than those who primarily attended in-person (2.6, p<0.0001) . Those who were seen more by TH also had stable levels of diabetes distress versus increased distress in those attending in-person visits (p=0.02) . A conjoint analysis conducted with YA found that not having to travel to clinic for visits was TH’s greatest benefit; technical problems and not always having private space were its biggest challenges. Participants also rated access to a clinic coordinator and TH visits as extremely valuable.

Conclusions: TH was successfully adapted for diverse YA with T1D, resulting in increased attendance and stable diabetes distress compared to in-person care. Participants overwhelmingly indicated that the benefits associated with TH, such as saving time and money traveling and parking, outweighed any technical challenges. Larger studies with longer term follow-up, not occurring during a global pandemic, are needed to refine TH’s role in patient-centered care of YA with T1D.

Disclosure

J.Raymond: None. J.L.Fogel: None. M.W.Reid: None. E.Salcedo-rodriguez: None. D.Fox: None. E.Pyatak: Research Support; Abbott Diabetes.

Funding

Donaghue Foundation
599-P: Disparities in the Impact of COVID-on Adolescents Living with Type 1 Diabetes at a Pediatric Diabetes Center in NYC
Authors: GOLDBERG MADELEINE , ILKOWITZ JENIECE , GONZALEZ JUANA E. , STEIN CHERYL R. , GALLAGHER MARY PAT
Published: May 2022

Background: There are significant racial and socioeconomic disparities in health outcomes for patients with type 1 diabetes (T1D) . COVID-also disproportionately affected racial/ethnic minority groups.

Objective: We examined whether the pandemic differentially impacted patients with T1D who identified as minority (Hispanic, non-Hispanic Black, Asian) versus non-minority (non-Hispanic white) .

Methods: We administered the COVID-Exposure and Family Impact Survey to adolescents with T1D seen at the NYU Pediatric Diabetes Center from May 2020 - May 2021 (n=165) . Patient characteristics were compared using chi-square tests and linear regression models.

Results: Respondents (n=41) had a median age of 17 years (range 15-23, SD 2.2) . Most respondents identified as non-minority (58.5%) , female (53.7%) , and were privately insured (65.9%) . Those identifying as minority had higher distress scores (5.4 versus 3.9; p=.07) , less continuous glucose monitor use, and higher HbA1c levels compared to non-minority patients (p<0.05) . Higher distress scores were associated with lower family income and worse family dynamics (p<0.05) . Distress was also related to worse health behaviors, including reduced exercise, poor eating habits, and impaired sleep. Notably, impaired sleep was also associated with higher HbA1c levels (p<0.05) .

Conclusion: Adolescents with T1D who identified as minority race reported a greater impact of the COVID-pandemic on their physical and psychosocial functioning compared to their non-minority peers. Further study may identify how to mitigate these worse outcomes.

Disclosure

M.Goldberg: None. J.Ilkowitz: None. J.E.Gonzalez: None. C.R.Stein: None. M.Gallagher: None.
60-LB: Real-World Evidence of Improved Glycemic Control in People Using the OneTouch Verio Flex Blood Glucose Meter with the OneTouch Reveal Mobile Application
Authors: GRADY MIKE , CAMERON HILARY , HOLT ELIZABETH H.
Published: May 2022

Background: The OneTouch Verio Flex® (OTVF) meter with a 3-Color Range Indicator instantly sends readings by Bluetooth® to the OneTouch Reveal® (OTR) app. We sought to provide evidence that these products support improved glycemic control.

Methods: Anonymous glucose and app analytics were extracted from the LifeScan server for 100650 people with type 2 diabetes (T2D) and 20324 people with type 1 diabetes (T1D) . Data from their first 14 days was compared to 14 days prior to a 90 day timepoint using paired within-subject differences.

Results: Percentage glucose readings in-range (70-180mg/dl) improved by 8.7% (from 69.9 to 78.5%) in T2Ds and by 4.0% (from 56.1 to 60.1%) in T1Ds. Hyperglycemic readings (>180mg/dl) reduced by -8.8% (from 28.4 to 19.7%) in T2Ds and by -4.3% (from 38.4 to 34.0%) in T1Ds. Mean glucose reduced on average by -14.1mg/dl (from 160.6 to 146.5mg/dl) in T2Ds and by -6.7mg/dl (from 176.7 to 170.1mg/dl) in T1Ds. Just 4 to 10 sessions per week or 20 to 60 minutes per week on the OTR app improved readings in-range in T2Ds by 9% or 10%, respectively (see graphs below) . Similar trends were observed in people with T1D.

Conclusion: Real world data from over 120000 people with diabetes demonstrates significantly improved data in-range and lower mean glucose in those using the OneTouch Verio Flex® meter and OneTouch Reveal® app.

Disclosure

M. Grady: Employee; LifeScan. H. Cameron: None. E. H. Holt: Employee; Intarcia Therapeutics, Inc., LifeScan.
602-P: Prenatal Exposure to Gestational Diabetes Mellitus and Autistic Traits among Typically Developing Children
Authors: ALVES JASMIN M. , ANGELO BRENDAN C. , NEGRIFF SONYA , LUO SHAN H. , CHOW TING , CABEEN RYAN , CARTER SARAH A. , XIANG ANNY , PAGE KATHLEEN A.
Published: May 2022

Children exposed to GDM in utero are at increased risk of developing autism spectrum disorder, a neurodevelopmental disorder characterized by social deficits. Limited studies have tested if GDM exposure is associated with higher autistic traits in typically developing children or what the neural substrates are. We used the social responsiveness scale (SRS) to measure differences in autistic traits between GDM-exposed and unexposed children and examined if white matter pathways involved in the social brain network (SBN) were related to autistic traits in children. Children were recruited from Kaiser Permanente Southern California to participate in BrainChild, a study assessing neural programming of disease risk (N=136; 9 ±1.5 years; 63% female; 52% GDM-exposed) . During visits, children completed a brain magnetic resonance imaging scan, demographics were collected, and parents completed the SRS. Maternal GDM diagnosis, glucose levels from a 1-hr 50g glucose challenge completed during pregnancy, and pre-pregnancy BMI were obtained from electronic medical records. Fractional anisotropy (FA) was used to assess white matter microstructure. Linear regression was used to test associations between SRS raw scores with GDM exposure, maternal glucose levels, and SBN white matter pathways, controlling for child age, sex, socioeconomic status, and maternal pre-pregnancy BMI. SRS scores were higher for GDM-exposed children than unexposed (GDM: 35.7±2.1; Unexposed: 29.5±2.3, p=0.03) . Maternal glucose levels were associated with higher child SRS scores (β=0.002, p=0.06) . Higher SRS scores were associated with reduced FA in multiple SBN white matter tracts (p<0.01) . GDM exposure and higher maternal glucose levels were associated with more autistic traits, suggesting that intrauterine exposure to a GDM hyperglycemic environment may affect autistic traits even among typically developing children. Further, SBN white matter tracts may be related to social deficits.

Disclosure

J.M.Alves: None. B.C.Angelo: None. S.Negriff: None. S.H.Luo: None. T.Chow: None. R.Cabeen: None. S.A.Carter: None. A.Xiang: None. K.A.Page: None.

Funding

pAmerican Diabetes Association (#1-14-ACE-36) ; R01DK116858
605-P: Self-Management Behaviors Mediate the Relationship between Diabetes Burden in Caregivers and A1C
Authors: O'DONNELL HOLLY K. , HIMELHOCH ALEXANDRA C. , VIGERS TIMOTHY B. , ALONSO GUY T. , MAJIDI SHIDEH , PYLE LAURA , SNELL-BERGEON JANET K. , WADWA R. PAUL , DRISCOLL KIMBERLY A.
Published: May 2022

Type 1 Diabetes (T1D) treatment involves engaging in multiple complex and burdensome self-management behaviors daily. The purpose of this study was to examine the relationship between diabetes burden, self-management behaviors, and A1C.

Caregivers of 77 adolescents with T1D (age=14.9±1.9 years, A1C=9.8±1.6%, T1D duration=6.8±3.5 years, 45.5% male) participating in a RCT that provided integrated behavioral intervention to improve A1C completed a short version of Problem Areas in Diabetes-Parent Revised (PAID-PR) at the baseline visit prior to beginning intervention. The Immediate Burden subscale of PAID-PR was used to assess diabetes burden. Objective self-management behaviors were calculated using data downloaded from adolescents’ T1D devices.

As caregiver burden increased, so did the frequency of self-management behaviors of carbohydrate entries per day (r=0.365, p<0.01) and insulin boluses per day (r=0.273, p<0.05) , but not blood glucose readings. Caregiver burden increased as A1C decreased (r=-0.224, p<0.05) . There was a significant indirect effect of diabetes burden on A1C through the self-management behaviors for carbohydrate entries per day (b=-0.023, 95% bias-corrected and accelerated bootstrap (BCa) CI [-0.056, -0.002] and insulin boluses per day (b=-0.016, 95% BCa CI [-0.041, 0.001]) .

Higher T1D self-management is associated with lower A1C, but this may come with a cost- greater feelings of burden due to T1D management. Family interventions to promote teamwork and assist caregivers and adolescents to appropriately distribute responsibility for T1D management may allow for continued high engagement while reducing burden.

Disclosure

H.K.O'donnell: None. A.C.Himelhoch: None. T.B.Vigers: None. G.T.Alonso: None. S.Majidi: None. L.Pyle: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)
608-P: Intersectional Identities, Social Risk Factors, and Quality of Life in Men and Women with Diabetes
Authors: WILLIAMS JONI S. , THORGERSON ABIGAIL , OZIEH MUKOSO N. , EGEDE LEONARD E.
Published: May 2022

Background: More than 34 million adults ≥18 years have diabetes in the U.S. Adverse social conditions associated with poor health, or social risk factors, contribute to poorer access to care, quality of care, and clinical outcomes for adults with diabetes. Intersectionality, defined as having multiple marginalized/disadvantaged social identities that reflect larger-scale inequalities and systems of oppression, may contribute to diabetes disparities. The study objective was to assess differences in the relationship between intersectionality and social risk factors between men and women with diabetes.

Methods: Data of 2,476 adults (weighted sample = 1,144,573) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The outcomes were physical and mental health quality of life, and the predictor was intersectionality summed as Non-Hispanic White, age ≥65 years, unemployment, less than high school education, and income <$25K. Covariates included comorbidities, insurance, region, and metropolitan statistical area. Logistic regression models were found for each of the outcomes to assess their independent association with intersectionality.

Results: In the fully adjusted model, women with 3+ intersecting social identities were 4x more likely to have poorer physical health (OR=4.13 (95% CI 0.54, 7.73)) compared to women reporting no intersectionality. Men with food insecurity were 5x more likely to have poorer mental health (OR=4.93, 95% CI 1.02, 8.84) than men without food insecurity, whereas women with food insecurity were 3x more likely to have poorer mental health (OR=2.56, 95% CI 0.61, 4.51) compared to women without food insecurity. There were no significant associations between intersectionality and housing instability in this sample.

Conclusions: These findings suggest the need for understanding the influence of intersectionality among women with diabetes and social risk factors, especially food insecurity, among men and women with diabetes.

Disclosure

J.S.Williams: None. A.Thorgerson: None. M.N.Ozieh: None. L.E.Egede: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 and R21DK123720)
61-LB: Real-World Evidence of Improved Glycemic Control in People Using the OneTouch Verio Reflect Glucose Meter with the OneTouch Reveal Mobile Application
Authors: GRADY MIKE , CAMERON HILARY , HOLT ELIZABETH H.
Published: May 2022

Background: The OneTouch Verio Reflect® (OTVR) meter provides advanced Color Range and Blood Sugar Mentor™ features that are complemented by the OneTouch Reveal® (OTR) app. We sought to provide evidence that these products support improved glycemic control.

Methods: Anonymous glucose and app analytics were extracted from our server for 1627 people with type 1 diabetes (T1D) and 5353 people with type 2 diabetes (T2D) . Data from their first 14 days was compared to 14 days prior to a 180 day timepoint using paired within-subject differences.

Results: Percentage glucose readings in-range (70-180mg/dl) improved by 6.0% (from 58.9 to 64.8%) in T1Ds and by 10.7% (from 73.2 to 83.9%) in T2Ds. Hyperglycemic readings (>180mg/dl) reduced by -6.5% (from 36.4 to 29.9%) in T1Ds and by -10.8% (from 25.7 to 14.9%) in T2Ds. Mean glucose reduced on average by -11.4mg/dl (from 173.9 to 162.5mg/dl) in T1Ds and by -17.3mg/dl (from 156.8 to 139.5) in T2Ds. 2 to 3 sessions per week or 11 to 20 minutes per week on the OTR app improved readings in-range in T1Ds by 5% or 6%, respectively (see graphs below) . Similar trends were observed in people with T2D.

Conclusion: Real world data from nearly 7000 people with diabetes demonstrates significantly improved readings in-range and lower mean glucose in those using the OneTouch Verio Reflect® meter and OneTouch Reveal® app.

Disclosure

M. Grady: Employee; LifeScan. H. Cameron: None. E. H. Holt: Employee; Intarcia Therapeutics, Inc., LifeScan.
610-P: Negative Affect and Symptom Experience in Type 2 Diabetes (T2D) : A Bidirectional Evaluation Using Ecological Momentary Assessment (EMA)
Authors: FISHMAN SARAH R. , HOOGENDOORN CLAIRE J. , WANG CUILING , MULVANEY SHELAGH A. , JONAS VICTORIA H. , MENDEZ-RODRIGUEZ HEIDY , FANG RAN , SOLON CARLY A. , CRANDALL JILL P. , GONZALEZ JEFFREY S.
Published: May 2022

Objectives: Physical symptoms (SXS) are commonly reported among adults with T2D and have a significant impact on functioning and self-management. Although there is evidence that symptom reporting is closely linked to the experience of negative affect (NA) , the directionality of this relationship remains unclear. This study used EMA to evaluate bidirectional temporal associations between SXS and NA in adults with sub-optimally controlled T2D.

Methods: Adults with T2D (N = 61; Age = 55 (10) yrs; Women = 64.5%; Black = 61%; Latino = 36%; A1C = 8.5 (2.3) completed smartphone EMA of SXS and NA 3 x daily over a 14-day period. Linear mixed effect models were used to assess associations of total number of SXS reported (0-13) and subsequent levels of NA (0-5) , and vice-versa.

Results: There were significant within- and between-person bidirectional associations between SXS and NA. Within-persons, a 1-point increase in SXS from one’s personal mean was associated with a 0.03-point increase in subsequent NA (95%CI: 0.01-0.04, p = .008) and a 1-point increase in NA from one’s personal mean was associated with a 0.39-point increase in subsequent SXS (95%CI: 0.27-0.50, p < .0001) . Between-persons, a 1-point increase in SXS personal mean was associated with a 0.18-point increase in subsequent NA (95%CI: 0.12-0.26, p < .0001) and a 1-point increase in one’s NA personal mean was associated with a 1.8-point increase in SXS (95%CI: 1.15-2.46, p < .0001) .

Conclusion: Results showed bidirectional relations between SXS and NA, observed both within- and between-persons over the course of a day, among predominantly ethnic minority adults with T2D. If these patterns reflect causal associations, they suggest that interventions that reduce negative affect would also reduce the experience of physical symptoms, and vice versa. Given prior evidence linking these factors to self-management, functioning, and health outcomes in T2D, such interventions could have substantial impact.

Disclosure

S.R.Fishman: None. J.S.Gonzalez: Consultant; Virta Health Corp. C.J.Hoogendoorn: None. C.Wang: None. S.A.Mulvaney: None. V.H.Jonas: None. H.Mendez-rodriguez: None. R.Fang: None. C.A.Solon: None. J.P.Crandall: Research Support; Abbott Diabetes.

Funding

NIH P30 DK111022
612-P: Predicting Behavioral Intervention Choices in Women with Previous GDM
Authors: HUME MATTHEW , HANNON TAMARA S. , SANDY ROBERT , CONNOR ULLA M.
Published: May 2022

Women with previous gestational diabetes mellitus (WPGDM) have high risk for T2D but low rates of engagement in diabetes prevention interventions. We used an informed decision-making strategy with WPGDM to promote participation in behavioral interventions. These included group (National Diabetes Prevention Program (DPP) , web-based DPP, modified DPP for families, WW) ; individual (health coaching, digital WW) ; and dietician consult (passive) . We evaluated 1) intervention preferences, and 2) determinants of intervention choices. We used the CoMac Descriptor™ (CoMac) to assess person-centered determinants of intervention choice. CoMac’s 12-question survey categorizes patients into three engagement categories based on locus of control, emotional state, and agency.

Of 116 WPGDM (age 34±7) who participated, 95 chose an intervention. CoMac predicted high (H) , moderate (M) or low (L) engagement with behavioral intervention (63% H; 29% M; 8% L) . Group interventions were chosen by a majority (58%) of participants (53% H, 79% M, 74% L) . Individual interventions were chosen by 34% (33% H, 21% M, 26% L) . Passive interventions were chosen by 8% (13.7% H, 0% M/L) . Participants categorized as H (mean A1C 5.2±.1) chose group interventions just more than half of the time. Participants categorized as M (mean A1C 5.3±.1) and L (mean A1C 5.4±.1) chose group interventions over individual at a higher rate than Hs, nearly three-quarters of the time. Our results show that the majority of WPGDM prefer active over passive behavior interventions. This runs counter to the passive behavioral interventions typically offered in healthcare settings. Results further show that person-centered trait clusters are associated with intervention preference, and CoMac’s patient categorization may help providers to better align interventions with patient preference.

Disclosure

M.Hume: None. T.S.Hannon: Advisory Panel; Eli Lilly and Company. R.Sandy: None. U.M.Connor: Other Relationship; CoMac Analytics, Inc.

Funding

Indiana University Grand Challenge Precision Health Initiative
616-P: Self-Care Scores Predicting Cognition Status in Patients with Type 2 Diabetes
Authors: CHOI SARAH E. , FREEBY MATTHEW , ROY BHASWATI , WOO MARY A. , KUMAR RAJESH , BRECHT MARY-LYNN
Published: May 2022

Cognitive impairment is common in patients with type 2 diabetes mellitus (T2DM) and negatively impacts effective diabetes self-care. However, it is unclear whether self-care level can predict cognition status in T2DM patients. We aimed to identify self-care scores that would provide information on the patients’ cognition status.

Methods: We collected diabetes self-care and cognition data from 50 T2DM patients (age 55.9±7.6 years, diabetes duration 10.1±8.2 years, A1C 7.1±1.4%, 54% female) using the Scale for Summary of Diabetes Self-Care Activities Assessment (SDSCA) and the Montreal Cognitive Assessment (MoCA) . A mixed effects logistic regression model for repeated measures used both baseline and 6 months follow-up observations with adjustment for within-subject correlation (SAS GLMMIX) . First, from nine potential covariates, an iterative backward elimination process selected a parsimonious subset of covariates for predicting MoCA level (normal vs. impairment) , optimizing area under the curve (AUC) . Four covariates were identified (education, income, ethnicity, sleep quality; AUC=.75) . Then an iterative process calculated AUC for MoCA level predicted from self-care level, using each possible self-care score cut point from .to 6.95 in .increments, controlling for the four identified covariates. An optimal cut point was selected that produced the highest AUC value.

Results: The optimal self-care cut point was 2.95 (AUC=.76) , producing good discrimination of MoCA level. As a sensitivity analysis, the second best cut point of 3.95 produced AUC=.75.

Conclusion: Self-care cut points, accounting for education, income, ethnicity, and sleep quality, could be used to gain information on T2DM patients’ cognition status, which may prompt clinicians and researchers to further evaluation with formal cognitive tests.

Disclosure

S.E.Choi: None. M.Freeby: Research Support; Abbott Diabetes, Novo Nordisk. B.Roy: None. M.A.Woo: None. R.Kumar: None. M.Brecht: None.

Funding

National Institutes of Health (RNR017190)
619-P: Understanding Parental Influences on T1D Incorporation in Adolescents and Young Adults
Authors: COMMISSARIAT PERSIS V. , VOLKENING LISA K. , WEINZIMER STUART A. , DASSAU EYAL , LAFFEL LORI M.
Published: May 2022

Aim: Positive incorporation of diabetes into one’s identity involves accepting and adjusting to the physical and emotional demands of T1D. Parents likely influence adolescent and young adult (AYA) illness identity. We evaluated alignment of AYA and parent experiences of diabetes distress (DD) and fear of hypoglycemia (FOH) , two potential barriers to T1D incorporation, and assessed associations of alignment with AYA incorporation.

Methods: AYA with T1D, ages 13-25 years with T1D duration ≥1 year, and their parents were recruited from 2 pediatric diabetes centers. AYA and parents completed validated measures of DD and FOH. AYA also completed a measure of T1D incorporation. Surveys were scored 0-100; higher score=more DD, FOH, incorporation. DD and FOH scores were categorized as Low (<median) or High (≥median) for each AYA and parent. For DD and FOH, dyads were grouped based on AYA/parent survey score alignment: Low/Low (L/L) , Low/High (L/H) , High/Low (H/L) , High/High (H/H) . AYA incorporation scores were compared among DD and FOH groups.

Results: There were 88 AYA/parent dyads (AYA age 16.8±2.4 years, T1D duration 8.6±4.2 years, 48% male, 91% White, 75% pump users, 69% CGM users, HbA1c 8.4±1.3%) ; 82% of parents were mothers. Incorporation scores differed significantly between the 4 DD groups (L/L: 77.3, n=23; L/H: 69.0, n=19; H/L: 59.7, n=22; H/H: 44.3, n=22; p<.001) . Incorporation scores of dyads with L/L FOH (72.0, n=24) were significantly higher than other FOH groups (L/H: 59.0, n=19; H/L: 59.9, n=25; H/H: 59.4, n=20; p=0.04) . AYA in dyads with H/H DD had significantly higher A1cs (9.2%) than other DD groups (8.2-8.7%) (p=0.004) ; there was no A1c difference among FOH groups.

Conclusion: Low DD in AYA is associated with the highest incorporation scores, suggesting identity is closely tied to personal experience of T1D. Low parent DD may protect AYA’s incorporation, while high FOH in either AYA or parents may hinder incorporation. Reducing AYAs’ DD and FOH may be valuable in integrating T1D into identity.

Disclosure

P.V.Commissariat: None. L.K.Volkening: None. S.A.Weinzimer: Consultant; Dompé, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. E.Dassau: Employee; Eli Lilly and Company, Research Support; Dexcom, Inc., JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; Eli Lilly and Company. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Funding

National Institutes of Health (P30DK036836, DP3DK113511)
62-LB: Rapid CGM Uptake among Adults with Type 2 Diabetes
Authors: MAYBERRY LINDSAY S. , HENDRICKSON CHASE , MCCOY ALLISON B. , ELASY TOM A.
Published: May 2022

Recently, continuous glucose monitors (CGM) have become increasingly available and affordable to support T2D management. Evidence to date supports CGM use in T2D to improve glycemic control and quality of life, across medication regimens and care settings. However, the rate and correlates of CGM uptake in T2D are unknown. We used electronic health record data to examine incidence of CGM use among adults (≥18 years old) receiving care for T2D at Vanderbilt University Medical Center. Eligible patients had T2D per a validated algorithm, and an A1c test and a primary care or endocrinology clinic visit from 10/1/2020 to 09/30/2021. We extracted historical data on CGM prescriptions and A1c values for these patients and compared CGM users and non-users on age, gender, race, ethnicity, insulin prescriptions, and A1c. Of the 26,841 adults seen for T2D, 12.3% (n=3,310) had been prescribed CGM. The earliest CGM prescriptions for the cohort appeared in Spring 2018. In 2021, each month an average of 110.2 patients (0.4% of cohort) were newly prescribed CGM (range 85-126 per month) . CGM use was associated with younger age, insulin use, and higher A1c, but not gender, race, or ethnicity (Table) . Since 2018, CGM use among adults with T2D has increased rapidly. Adults who are younger with higher A1c and using insulin are more likely to be prescribed CGM. There is potential to leverage the increase in CGM use among adults with T2D to improve outcomes and quality of life.

Disclosure

L. S. Mayberry: Consultant; Abbott Diabetes, Cecelia Health. C. Hendrickson: None. A. B. Mccoy: None. T. A. Elasy: None.
622-P: Comorbid ESRD and Diabetes Is Associated with Greater Odds for Depression
Authors: WOOLLEY RYAN , PARIS MELANIE , PIERCE ROBERT , DEWBERRY GWENDOLYN , SPIGLER MICHAEL
Published: May 2022

People with comorbid end-stage renal disease (ESRD) and diabetes are more prone to poor clinical outcomes including increased mortality and hospitalization, poor treatment compliance and quality of life. Self-management of these coexisting conditions is challenging as the treatment regime is complex, burdensome, and nutrition guidelines may conflict. While it is known that each morbidity is known to be associated with an increased risk for depression, limited research has explored the potential compounding effect of comorbidity. To explore this, determinants of depression were compared between a cohort of ESRD patients with and without diabetes.

Data from the American Kidney Fund Health Insurance Premium Program of 63,254 low-income adults with ESRD were analyzed. All demographic and health condition data were collected through self-report. A logistic regression was performed to ascertain the effect of diabetes on the likelihood of depression in individuals with ESRD. Unadjusted and adjusted odds of having depression were calculated in those with and those without diabetes. Age, sex, race/ethnicity, income, marital status, employment status, and health conditions known to be associated with depression including anxiety, cardiovascular disease, insomnia, and sexual problems were included as covariates.

After adjusting for demographic and clinical variables, diabetes remained independently associated with higher odds of depression (1.9; 95% confidence interval: 1.8-2.1) .

Odds of depression significantly increased among adults with ESRD in the presence of diabetes. Screening for depression among people with ESRD is of particular importance to mitigate adverse outcomes and disease progression. Future studies should further examine the mechanisms of depression in both ESRD and diabetes, and test modifiable targets for interventions to prevent and treat depression in these populations.

Disclosure

R. Woolley: None. R. Pierce: None. M. Spigler: None.
625-P: Exploring Social Media as Potential Support for Young Adults (YA) with T1D
Authors: KAUSHAL TARA , BRANKA LILLIAN A. , WENTZELL KATHERINE , COMMISSARIAT PERSIS V. , LAFFEL LORI M.
Published: May 2022

Objective: YA use social media (SM) frequently. Diabetes-focused SM posts may offer support for those with T1D. This qualitative study sought to explore perspectives of YA with T1D on diabetes-focused SM posts.

Methods: Semi-structured interviews were conducted through videoconferencing with YA with T1D (age 18-25 years, T1D duration 1 year) . Ten diabetes-focused Instagram posts were selected, encompassing major topic areas identified in previous SM literature (e.g., humor, venting) . Participants viewed posts with captions and provided their perspectives. Interview transcripts were coded and evaluated using thematic analysis.

Results: Fifteen YA participated (age 22±1.9 years, 86% white, 33% male, T1D duration 12±5.7 years, A1c 8.1±1.6%, 80% pump use, 100% CGM use) . All participants reported using SM at least once daily, but very few reported viewing or posting diabetes content. YA reactions to posts encompassed four major themes: 1. Perception of personal relevance: many participants noted whether posts applied to them. While many posts were described as “relatable,” others were suggested to be more useful soon after diagnosis or in contrast to participants’ own self-care behaviors. 2. Reduced isolation with T1D: many participants reported the posts made them feel “not alone;” some noted their lack of friends with T1D and mentioned benefits of community. 3. Frustration about living with T1D: some participants expressed anger or annoyance with diabetes, especially about hyperglycemia and cost of insulin. 4. Appreciation of public displays of T1D self-care: many participants valued openness with self-management in posts, although some expressed hesitancy in self-displays. After viewing and discussing all posts, some participants reported they may seek out diabetes-focused SM in the future when they had not previously.

Conclusions: SM may be a source of community, support, and reduced isolation for YA with T1D. Further research is needed to assess SM as a means to improve self-care in this group.

Disclosure

T.Kaushal: None. L.A.Branka: None. K.Wentzell: None. P.V.Commissariat: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Funding

NIH/NIDDK (K12DK094721,P30DK036836)
628-P: Factor Structure and Validity of a Dietary Screener among Diverse Adults with Suboptimally Controlled Type 2 Diabetes (T2D)
Authors: PAPPALARDO LINDSEY D. , SCHECHTER CLYDE , FANG RAN , HOOGENDOORN CLAIRE J. , GONZALEZ JEFFREY S. , WALKER ELIZABETH A.
Published: May 2022

Objective: Although following a healthy diet is a key aspect of diabetes self-care, few brief, validated dietary measures exist. The 8-item Starting the Conversation (STC) questionnaire shows promise but has limited validation, particularly among Latinos, who are disproportionately impacted by T2D.

Methods: We assessed the STC’s factor structure in English and Spanish, convergent and divergent validity, and internal reliability at baseline using data from 812 predominantly Latino adults with T2D who participated in a trial of telephonic self-management support (Female = 56.9%; Latino = 85.8%; Mean (SD) Age and A1C = 59.2 (10.8) , 9.3 (1.8) , respectively) . We also examined the STC’s sensitivity to this intervention over 12 months.

Results: Exploratory factor analysis yielded 2 factors: Junk Food and Healthy Food. When 3 items were excluded due to low loadings, a single Junk Food factor was retained, explaining 40% of variance in STC scores. Cronbach’s alphas for the 5-item Junk Food scale were similar in Spanish (α = .61) and English (α = .57) at baseline. The Junk Food scale demonstrated convergent validity with BMI (r = .13, p < .001) and self-reported diabetes self-care (r = -.33, p < .001) , but not with A1C (r = .04, p = .328) , systolic BP (r = -.09, p = .011) , or diastolic BP (r = -.04, p = .312) . Demonstrating divergent validity, the Junk Food scale did not correlate with 4 scales assessing beliefs about medication (rs ≤ .06; ps ≥ .103) . There was no significant difference in change in Junk Food scores over time between the intervention and control arms (DID = -.02, SE = .03, , 95% CI [-.08, .04]) .

Conclusions: Although the Junk Food scale demonstrates mixed evidence for convergent validity, this 5-item measure may provide a useful assessment of unhealthy food consumption among English- and Spanish-speakers with T2D. To our knowledge, this is the first study to investigate the factor structure of the STC, which may inform its utility for research and practice.

Disclosure

L.D.Pappalardo: None. C.Schechter: None. R.Fang: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. E.A.Walker: None.

Funding

National Institutes of Health (R18 DK098742) Einstein–Mount Sinai Diabetes Research Center (P30 DK020541) New York Regional Center for Diabetes Translation Research (P30 DK111022)
63-OR: A Model-Based Clinical Trial Simulation Tool to Optimize Clinical Trial Designs for Type 1 Diabetes Prevention Studies
Authors: MORALES JUAN F. , MUSE RHODA , PODICHETTY JAGDEEP , BURTON JACKSON , DAVID SARAH , MARTIN FRANCIS , ATKINSON MARK A. , HALLER MICHAEL J. , CAMPBELL-THOMPSON MARTHA , ROMERO KLAUS , O'DOHERTY INISH , SCHMIDT STEPHAN , KIM SARAH
Published: May 2022

Trials seeking to delay or prevent type 1 diabetes (T1D) continue to face multiple challenges, including both clinical endpoint (s) and cohort selection. While it is clear that individuals who possess islet cell autoantibodies (AAbs) are at elevated risk for developing T1D, it remains unclear as to what additional factors, including metabolic activities and anthropometric data, may contribute to this increased risk. The aim of this project was to inform T1D prevention trial designs by developing a quantitative joint model based-clinical trial simulation (CTS) tool. Individual-level data obtained from the NIH TEDDY and TrialNet TNnatural history studies were used in this tool’s development. To describe T1D disease progression quantitatively, both longitudinal and time-to-event variables were simultaneously quantified as a joint model, with results from a 2-hour oral glucose tolerance test (OGTT) assessed at each visit included as a time-varying longitudinal covariate affecting the T1D diagnosis event. Our study focused on individuals at risk of developing T1D with two or more AAbs. Among the investigated individuals, those with a high BMI and the presence of GADA AAb at baseline had less risk, while those with an elevated HbA1c value, high fasting OGTT value, increased fasting OGTT to 2-hour OGTT ratio, and the presence of the IA2A AAb at baseline had higher risk. The developed model based-CTS tool, where users can specify the trial design, participants’ characteristics and hypothetical drug effect, provides a framework to perform T1D prevention clinical trial simulations with the intention to assist in future trial design decision-making processes.

Disclosure

J.F. Morales: None. R. Muse: None. J. Podichetty: None. S. David: None. M.A. Atkinson: None. M.J. Haller: Advisory Panel; SAB Biotherapeutics. Consultant; MannKind Corporation, Sanofi. M. Campbell-Thompson: Consultant; TRex Bio. K. Romero: None. I. O'Doherty: None. S. Schmidt: None. S. Kim: None.

Funding

JDRF (grant #: 2-SRA-2020-903-A-N) ; NIDDK Central Repositories
630-P: Diabetes Management for People with Comorbid Substance Use Disorder
Authors: BALAPAL NEHA , SLAMA NATALIE , ASYYED ASMA , ITURRALDE ESTI
Published: May 2022

Importance: Comorbid substance use disorder (SUD) is associated with poor clinical outcomes among people with diabetes, but limited research has examined targeted intervention strategies for patients with both conditions.

Methods: We conducted a rapid literature review using PubMed to examine past diabetes screening and intervention studies for patients with SUD (study 1) . To investigate potential intervention targets, we compared clinical factors and health care utilization among patients with SUD and diabetes comorbidity (comorbid group) to patients with one but not both of these conditions (SUD-only or diabetes-only groups; study 2) . Study 2 included electronic health record (EHR) data from 2,734 adults with SUD (of whom 8% had comorbid diabetes) who were treated for SUD in an integrated health care system in 20 (comorbid group N = 217; SUD-only group N = 2,517) . We also evaluated previously published data from the same health system for patients with diabetes and low rates of SUD (diabetes-only group, N = 264,844) .

Results: In study 1, there was limited literature found on comorbid SUD and diabetes. No studies were found on interventions in the behavioral health or SUD treatment setting. In study 2, comorbid diabetes relative to SUD-only was associated with higher rates of emergency department (ED) and hospital use (aOR = 1.85, 1.56; p values < 0.05) , after adjusting for demographic and SUD factors. The comorbid group had higher rates of diagnosed cardiovascular disease, hypertension, and dyslipidemia (29%, 69.6%, 56.7%, versus 6.6%, 22.6%, 17% in SUD-only) . Relative to the diabetes-only group, the comorbid group had similar rates of HbA1c > 9.0.

Conclusions and Relevance: Patients with diabetes who are receiving SUD treatment are vulnerable to poor cardiovascular health and frequent visits to the ED and hospital. Though understudied, models that integrate diabetes care into SUD treatment could be helpful.

Disclosure

E. Iturralde: None.
631-P: Youth with Type 1 Diabetes (T1D) and High Social Risk: Predictors of Glycemic Control
Authors: WAGNER DAVID V. , CLEMENTS MARK A. , RAYMOND JENNIFER , WONG JENISE C. , REED ALISON , NARANJO DIANA , JENISCH CELESTE , CRUZ CRISTIAN , MITCHELL SUSANNE , YGLECIAS LOREN , GARCIA JAQUELIN J. FLORES , SALCEDO-RODRIGUEZ ELIZABETH , SANCHEZ ALEJANDRA TORRES , DASIKA POOJITA , VIANA JULIA , WILLIAMS DAVID D. , FERRO DIANA , HARRIS MICHAEL A.
Published: May 2022

Objective: A subset of youth with T1D experience ongoing challenges with diabetes self-management, often due to social risk. This 5-site study examined which social factors were associated with hemoglobin A1c (A1c) , specifically in youth with preexisting high A1c.

Methods: Youth with T1D for more than 1 year were included if between 12-17 years old and with at least one A1c value ≥10% in the past year. Chart review captured A1c values, and caregivers reported on social risk- with 16 risk variables (e.g., housing security, employment status) in initial analyses. Multivariable linear regression model included A1c from 1 year prior to enrollment as an outcome and backwards stepwise procedure retained covariates with p<0.10.

Results: Participants (n=130) had a mean age of 14.4 (±1.6) years and mean A1c of 11.1 (±1.7) ; 49% reported male gender; 51% self-identified as Non-Hispanic White. A1c prior to study enrollment was predicted to be 0.68 lower in individuals whose caregiver had at least a college education and 0.65 higher when caregivers were divorced or separated.

Conclusion: Findings suggest that, in youth with preexisting difficulty with glycemic variability, caregiver education level and marital status are associated with A1c - and, while not causal, may reflect unique value when screening for risk. This cohort will be followed to determine which factors predict future health concerns and associated need for intervention.

Disclosure

D.V.Wagner: None. L.Yglecias: None. J.J.Flores garcia: None. E.Salcedo-rodriguez: None. A.Torres sanchez: None. P.Dasika: None. J.Viana: None. D.D.Williams: None. D.Ferro: None. M.A.Harris: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. J.Raymond: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. D.Naranjo: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None.

Funding

JDRF
633-P: Families' Lived Experience Guides Intervention Development: Addressing the Psychosocial Needs of Families in the First Year after Diagnosis
Authors: GARZA KIMBERLY P. , HOWARD KELSEY R. , WEISSBERG-BENCHELL JILL , FELDMAN MARISSA
Published: May 2022

A diagnosis of T1D can be overwhelming. Offering psychosocial support throughout the first year may facilitate family adjustment. To our knowledge, no interventions exist that promote psychosocial adjustment in families immediately following diagnosis. Family-based interventions are rarely developed with a focus on the experiences of the families who have lived through the diagnosis. This study offers a novel approach to developing a family-based intervention for youth with T1D, with content developed from the lived experiences of youth and their parents. The goal of Teaming up for T1D with Telehealth (Triple T) is to support families post-diagnosis, combining brief, targeted telehealth sessions and access to a video library depicting common family experiences during the first year. We conducted age specific focus groups to explore challenges, fears, successes, and advice of youth and their families, diagnosed within the past 2 years. Children (8-12 years; n= 10) ; teens (13-17 years; n= 11) ; their caregivers (n= 27) and parents of children 7 or younger (n= 12) participated. Main themes were sorted into topics to be addressed by telehealth visits or videos. These themes informed the development of 20 videos with age-specific themes. There were five main topics: Reassurance that they will be “Okay”; Strategies for getting to “Okay”; Managing activities; Handling disclosure and questions; and Family teamwork. Test videos were reviewed by the original focus group participants for additional stakeholder feedback. Final videos were filmed with professional actors to be used in conjunction with telehealth sessions during the intervention. Using stakeholder experience in addition to clinical experience and empirical research to inform interventions represents a novel approach to developing interventions that may directly address the needs of families and inform future interventions and education following a T1D diagnosis.

Disclosure

K.P.Garza: None. K.R.Howard: None. J.Weissberg-benchell: None. M.Feldman: None.

Funding

Juvenile Diabetes Research Foundation
635-P: Maternal Social Support (SS) related to Reproductive Health (RH) and Healthy Lifestyle Behaviors among American Indian and Alaska Native (AIAN) Female Adolescents and Young Adults (AYA) to Minimize Risk for Gestational Diabetes (GDM)
Authors: CHARRON-PROCHOWNIK DENISE , SEREIKA SUSAN M. , ABUJARADEH HIBA , STOTZ SARAH A. , FISCHL ANDREA F. , GARROW HEATHER , O'BANION NANCY , GONZALES KELLY L. , CHALMERS LAURA , MOORE KELLY R.
Published: May 2022

AIAN women have higher risk for GDM. Early preconception counseling (PC) about healthy lifestyle/weight and mothers’ support could reduce these risks. We describe and compare parallel measures of SS with RH/GDM risk: daughters’ perceived SS from mothers, and mothers’ perceived SS for daughters. Methods: Secondary analysis used baseline data from 113 mother-daughter (M-D) dyads from four sites participating in Stopping GDM, an online randomized trial to reduce risks of GDM. Perceived maternal SS was amounts (0=no support, to 5=a lot of support) and types of SS re: RH, healthy lifestyle behaviors, and seeking PC to prevent GDM (instrumental SS, e.g., help get birth control; informational SS, e.g., on pregnancy/GDM) . M-D independently completed online measures of perceived available maternal SS. We performed descriptive, within-dyad comparative/correlational analyses. Results: AIAN AYA (n=113; mean age 17±3yrs; BMI 29±8.3 kg/m2) and their mothers (n=113; age 44.7±9yrs; 45% had > 2-4 college; 44% married) . AYA reported moderately high levels of maternal SS: total (16±5; range:0-20) ; instrumental (12±4; 0-15) ; informational (4±2; 0-5) . Mothers reported high levels of SS to give their daughters: total (20±1; range:15-20) ; instrumental (15±1; 10-15) ; informational (5±0; 0-5) . Mothers reported significantly higher levels of SS to give their daughters compared to their daughters’ perception of available maternal SS (p<.001) . Daughters and mothers’ perceived available maternal SS were positively correlated: total: rS=.218, p=.024; instrumental: rS=.229, p=.016. Conclusion: Maternal SS perceived by AIAN AYA females for RH and GDM prevention was lower than their mothers’ perception of available SS for their daughters. Mothers could potentially provide SS for their daughters. M-D dyadic approach could be beneficial to minimize the risk of GDM.

Disclosure

D. Charron-Prochownik: None. S.M. Sereika: None. A.F. Fischl: None. N. O'Banion: None. K.L. Gonzales: None. L. Chalmers: None. K.R. Moore: Consultant; Novo Nordisk.

Funding

RNR014831 grant
640-P: The Association of Happiness and Resilience with Glycemic Control in Pediatric Type 1 Diabetes Mellitus
Authors: RAMESH RESHMIKA , BYEON GA YOUNG , SANFILIPPO ANDREW , MARLEN NATALIE , HANKINS ANDREA , GUILLEN MICHELE , ALFORD JENNIFER , NADGIR ULHAS , PRAKASAM GNANAGURUDASAN , PARISE CAROL , VYAS ARPITA
Published: May 2022

Background: Depression and anxiety are examples of states of emotion that are associated with poor adherence to treatment in pediatric type 1 diabetes mellitus (T1DM) . The relationship between perceived happiness and glycemic control is unknown. Resilience also influences perceived happiness and is positively correlated with improved compliance in T1DM. The purpose of this study is to determine if perceived happiness and resilience are positively correlated with better diabetes control.

Methods: Participants were patients between 12-18 years of age with T1DM for 2 or more years without a mental health condition, learning disability, history of substance abuse, or recent significant adverse life events. The Oxford Happiness Score and the Diabetes Strengths and Resilience (DSTAR) Questionnaires were completed by patients. Demographics, hemoglobin A1c (HbA1c) , mode of treatment, and duration of TIDM were documented. Pearson Correlations were used to assess the relationship of Happiness with HBA1c, DSTAR, and duration of diabetes. Analysis of Variance was used to determine if mean happiness and DSTAR varied by mode of treatment.

Results: Data were obtained from 34 patients with a mean age of 14.7±2.16 years, had a mean HbA1c of 8.5±2.03, and had T1DM for 6.8±3.79 yrs. Happiness did not correlate with HbA1c (r =-0.229, p=0.201) . Higher resilience was correlated with lower HbA1c (r=-0.562, p=0.002) and a higher resilience correlated with increased happiness (r= 0.597, p=0.001) . Patients using pump therapy had both higher DSTAR (F1,25 =15.39, p = 0.001) and happiness scores (F1,31=12.44, p=0.001) when compared with patients on insulin injections.

Conclusion: Our preliminary data suggests that increased happiness is associated with higher resilience in patients with T1DM. Furthermore, patients with higher resilience have lower HBA1c. Our ongoing study aims to recruit more patients and identify targeted interventions to improve states of emotion in T1DM.

Disclosure

R.Ramesh: None. C.Parise: None. A.Vyas: None. G.Byeon: None. A.Sanfilippo: None. N.Marlen: None. A.Hankins: None. M.Guillen: None. J.Alford: None. U.Nadgir: None. G.Prakasam: None.