bluuebunny/crossref_metadata_2025 huggingface dataset:
68-OR: Digital Divide and Medicare Diabetes Prevention Program of Beneficiaries with Elevated BMI
Authors: PENG NG BOON , LAMANNA JACQUELINE B. , MASSEY MCKAYLA , HAWKINS GEORGIANNE T. , PARK CHANHYUN
Published: June 2023

The Medicare Diabetes Prevention Program (MDPP) encourages beneficiaries with prediabetes to build healthy lifestyle behaviors that reduce the risk of diabetes. Limited supply of in-person MDPP and telehealth growth, support virtual delivery of MDPP. Success of virtual MDPP is impacted by access to digital devices and the Internet. A survey-weighted multinomial logit model was performed to examine associations between socio-demographics, comorbidities, and computer access and internet usage among beneficiaries. Using the 2020 nationally representative Medicare Current Beneficiary Survey PUF, a three-level categorical dependent variable was created: (1) has a computer AND uses internet, (2) has a computer OR uses internet, and (3) has no access to either (reference group). Of beneficiaries reporting BMI ≥ 25 kg/m2 and no diabetes history (n=3,912), 70.6% had a computer AND used internet; 14.2% had a computer OR used internet; and 15.2% lacked a computer and did not use internet. Hispanics, Non-Hispanic Blacks (NHB), and Others were less likely to have a computer AND use internet than non-Hispanic Whites (NHB, OR=0.27; p<0.001). Beneficiaries with lower educational attainment (<high school (HS) and HS) were less likely to have a computer AND use internet (<HS, OR=0.04; p<0.001) or have a computer OR use internet (<HS, OR=0.21; p<0.001) than those with college education. Beneficiaries with lower incomes (<$25,000) were less likely to have a computer AND use internet (OR=0.24; p<0.001) or have a computer OR use internet (OR=0.58; p<0.001) than those with higher incomes. This study found that ~30% of beneficiaries likely eligible for MDPP (potentially representing 6 million beneficiaries) lack digital tools for virtual MDPP. Digital divides by race/ethnicity, income, and education were observed. Efforts to improve access and enrollment in MDPP using virtual delivery must consider digital access to avoid technological disparities among populations with heightened type 2 diabetes risk.

Disclosure

B.Ng: None. J.B.Lamanna: None. M.Massey: None. G.T.Hawkins: None. C.Park: None.
683-P: Lived Experiences of Using Omnipod DASH System among Australians with Type 1 Diabetes—A Qualitative Study
Authors: STOCCO AMBER P. , TRAWLEY STEVEN , KONG YEE W. , YI YUAN CHENG , KIBURG KATERINA V. , BROWN KATRIN , PARTOVI ANDISHEH , ROEM KERRYN L. , HARRISON NATALIE , FOURLANOS SPIROS , EKINCI ELIF I. , O'NEAL DAVID N.
Published: June 2023

Background: Tubeless insulin pump therapy (IPT) offers an alternative to tubed insulin pumps and multi-dose injections (MDI) for people with type 1 diabetes (T1D). No formal interview studies have explored individual's lived experiences of using tubeless IPT.

Aim: To gain insight into the lived experience of using a tubeless IPT system compared to usual tubed IPT or MDI care.

Methods: Interviews were conducted 12-weeks after using an Omnipod DASH® Insulin Management System (Insulet, Acton MA) in a randomised controlled trial. The interview transcripts were subject to a thematic analysis, a method for identifying patterned meaning across datasets.

Results: Thirty-six adults (24 female; age 43±14 years; 21 previous MDI) were interviewed. Overall experiences of the Omnipod DASH were encompassed by 3 major themes: 1. Taking back control of my diabetes: many previous MDI users perceived improvement in glycaemic control, explained by more accurate insulin dosing, with some reporting positive effects during exercise and sleep. 2. Taking back control of the narrative: many previous MDI and IPT users endorsed positive experiences in relation to concealing or disclosing their diabetes to others (“you can hide it if you want to, you can let it be seen if you want to”). However, some previous MDI users reported negative psychosocial experiences due to the visibility of their diabetes and continuous device attachment (“…it's always there, whereas with the needles, you just set and forget”). 3. Barriers affecting long-term use: many participants reported wearability issues, alarm issues and the financial burden of the device. However, the majority indicated they would use and recommend tubeless IPT to others with T1D.

Conclusion: Perceptions regarding tubeless IPT were related to individual needs and lifestyle, with previous treatment experience playing an important role. This work highlights the importance of understanding lived experience for future device development.

Disclosure

A.P.Stocco: None. S.Fourlanos: Advisory Panel; Viatris Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance. E.I.Ekinci: Advisory Panel; Eli Lilly Australia Pty Limited, Research Support; Eli Lilly Australia Pty Limited, Novo Nordisk, Boehringer Ingelheim and Eli Lilly Alliance, Insulet Corporation, Medtronic. D.N.O'neal: None. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). Y.W.Kong: None. C.Yuan: None. K.V.Kiburg: None. K.Brown: None. A.Partovi: None. K.L.Roem: None. N.Harrison: None.
685-P: Possibility of Oral Glucose Tolerance Test Clearance in Patients with Type 2 Diabetes Who Underwent Complete Diabetes Remission
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , VYAWAHARE ANAGHA R. , SHARMA BABY , GANLA MALHAR H. , DAS BISWAS MAYURIKA , SABOO BANSHI D.
Published: June 2023

Background and Aim­: Type 2 diabetes (T2D) remission through calorie and carbohydrate restriction has been reported. We conducted a pilot trial to observe whether oral Glucose tolerance test (OGTT) clearance is possible in T2D patients who underwent remission through a lifestyle modification program.

Methods: A total of 3689 patients who had previously undergone remission through our lifestyle modification program at Freedom from Diabetes Clinic, India, were asked to enroll for the OGTT; 1121 accepted the invitation and enrolled (June 2022). Remission was defined as HbA1c<48mmol/mol for a minimum of three months without glucose-lowering medication. Of 1121, 400 participants completed a 3-month training (where foods with increasing glycemic load were introduced every week while monitoring the blood sugar levels (BSL)). Subsequently, they appeared for OGTT (75g) from October-November 2022.

Results: Of the 400 participants, 207 (51.7%) cleared OGTT [Fasting BSL(FBSL)≤100, 2-hrs postprandial (PP2) <140], 175 (43.7%) cleared IGT-Impaired Glucose Tolerance (FBSL<126, PP2<200), while 18 (4.5%) did not clear. The median BMI at the time of appearing for OGTT was 22.8 kg/m2. Those clearing OGTT had significantly higher weight loss during the program than those clearing IGT (10 kg vs 6.4 kg) and had a shorter duration of diabetes (5 years vs 6.9 years) (p<0.05). Medication status at the start of the intervention (OHA, Insulin, both, and no medication) did not affect the possibility of clearing OGTT (p>0.1).

Conclusion: Complete remission of type 2 diabetes to the point of achieving a nondiabetes glycemic profile irrespective of initial medication status is possible through lifestyle intervention if weight loss is achieved and maintained. The long-term sustainability of lifestyle interventions in achieving remission needs to be explored through a larger cohort study with a control group.

Disclosure

P. Tripathi: Board Member; Freedom from Diabetes Clinic. N.S. Kadam: Research Support; Freedom from Diabetes Clinic. A.R. Vyawahare: Research Support; Freedom From Diabetes. B. Sharma: Research Support; Freedom From Diabetes clinic. M.H. Ganla: Employee; Freedom from Diabetes Clinic. M. Das Biswas: Employee; Freedom from Diabetes Clinic. B.D. Saboo: None.
688-P: Severity of Type 2 Diabetes and the Risk of Depression—A Nationwide Population-Based Study
Authors: CHO YUNJUNG , HAN KYUNGDO , JO KWANHOON , MOON SUNGDAE , HAN JEHO , SOOK KIM EUN
Published: June 2023

Background: Because of a bidirectional relationship between type 2 diabetes mellitus (T2DM) and depression, we aimed to investigate the association of the severity of diabetes with the risk of depression.

Methods: Total 2,067,017 adults who diagnosis with T2DM excluding those diagnosed with depression before were identified from a nationwide population-based cohort in Korea. Diabetes mellitus (DM) severity scores consisted of insulin user, DM duration more than 5 years, using 3 or more oral hypoglycemic agents, and diagnosed with DM complications including chronic kidney disease, myocardial infarction, stroke, and diabetes retinopathy. DM severity scores were calculated as 0 to 6.

Results: As the DM severity score was increased, the frequency of depression was significantly increased, and the follow up period until the diagnosed with depression was significantly decreased. This tendency of increasing depression incidence was also significant in each components constituting the DM severity score.

Conclusion: An increase in the severity of diabetes, represented by duration of diabetes, insulin or multi-drug use, and presence of major complications of diabetes, was associated with higher risk of depression. Physicians should carefully monitor whether depression develops in patients with uncontrolled diabetes in order to improve quality of life and achieve glycemic control goals.

Disclosure

Y.Cho: None. K.Han: None. K.Jo: None. S.Moon: None. J.Han: None. E.Kim: None.
691-P: Characteristics of People with Type 1 Diabetes Who Consider Fear of Hypoglycemia a Barrier to Their Diabetes Management
Authors: TALBO MERYEM K. , LEROUX CATHERINE , HILL LEE , BRAZEAU ANNE-SOPHIE
Published: June 2023

Hypoglycemia is a common side effect of insulin therapy, the constant threat of hypoglycemia symptoms and consequences may lead people with type 1 diabetes (T1D) to develop fear of hypoglycemia (FOH). This analysis aims to explore the characteristics of people who consider FOH as a barrier to managing diabetes.

Methods: Self-reported data from an online T1D registry were analyzed to compare participants who consider FOH a barrier to those who do not (a registry-specific yes/no question) using χ2 test for categorical variables (gender, diabetes technology use, and hypoglycemia history) and the Mann-Whitney Test for age, T1D duration, Hypoglycemia Fear Survey (HFS-II), Hypoglycemia Confidence Survey (HCS), and Diabetes Distress Scale (DDS) scores.

Results: Among 780 adults, 65% women, aged 44±15 years, had T1D for 25±15 years, 35% reported HbA1c≤ 7%, and 45% perceived FOH as a barrier. The prevalence of FOH as a barrier was higher in women, participants with history of symptomatic nocturnal or level 3 hypoglycemia, higher HbA1c, higher HFS and DDS scores, and lower HCS scores (Table 1).

Conclusion: A significant proportion of adults, in particular women and those with a challenging T1D management (high HbA1c, history of hypoglycemia, diabetes distress, and low hypoglycemia confidence), consider FOH to be a barrier in T1D management, thus it needs to be considered as part of clinical follow-up.

Disclosure

M.K.Talbo: None. C.Leroux: None. L.Hill: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.
7-OR: Evaluation of Saroglitazar’s Effects on Small Dense LDL and Non-HDL Cholesterol Particles in Diabetic Dyslipidemia Patients
Authors: DINKAR JYOTI , RANJAN RAJEEV , CHANDRA ABHISHEK
Published: June 2023

The dual PPAR α/γ agonist Saroglitazar is used to treat diabetic dyslipidemia (DD) that cannot be managed with statins. Due to its association with high triglycerides (TG), high small dense LDL (sdLDL), and low HDL-C, DD is extremely atherogenic. The efficacy and safety of saroglitazar have been assessed in this prospective multi-centric research in patients with type 2 diabetes and triglycerides (TG) 200 mg/dL following stable statin medication for at least 3 months and a steady lifestyle. A total of 104 patients (78% of whom were men) were enrolled, with a mean age of 59.1 ± 11.4 years. Saroglitazar 4 mg was administered to each subject once daily for 24 weeks. Using a paired t-test, the effects of saroglitazar were assessed after 24 weeks. 73 patients' six-month follow-up data are available. Non-HDL-C and sdLDL levels both significantly decreased at 24 weeks, with non-HDL-C dropping from 138 ± 51 mg/dL to 113 ± 44 mg/dL and from 31.7 ± 11.8 mg/dL to 26.0 ± 11.9 mg/dL, respectively. The values of HDL-C, TG, HbA1c and total cholesterol among the secondary end goals also considerably improved after 24 weeks (Table). No significant adverse event was reported during the investigation. This is the initial investigation on how saroglitazar affects sdLDL in DD patients. According to the findings, saroglitazar effectively lowers non-HDL-C and sdLDL particles while being safe and well tolerated.

Disclosure

J.Dinkar: None. R.Ranjan: None. A.Chandra: None.
700-P: Outcomes of a Diabetes Support Coach Intervention Implemented during the COVID-19 Pandemic
Authors: MAIZEL JENNIFER , HALLER MICHAEL J. , MAAHS DAVID M. , ADDALA ANANTA , LAL RAYHAN , FIGG LAUREN , HECHAVARRIA MELANIE , MALDEN KEILECIA G. , SHEEHAN ELENI , WESTEN SARAH C. , HOOD KOREY K. , WONG JESSIE J. , DIXON BRITTNEY , FILIPP STEPHANIE L. , GURKA MATTHEW J. , WALKER ASHBY F.
Published: June 2023

During the COVID-19 pandemic, people with diabetes reported increased diabetes distress and difficulty maintaining glycemic control. These challenges were exacerbated for racial minorities and those with low socioeconomic status. As part of a Project Extension for Community Healthcare Outcomes (ECHO) program, an intervention using 28 diabetes support coaches (DSCs), adults with diabetes who served as peer mentors and healthcare navigators, was implemented with underserved patients with type 1, type 2, and other forms of diabetes at 41 federally qualified health centers in FL and CA (intervention n=74, control n=363). Patients self-enrolled and engaged with DSCs via 1-1 weekly text messages, phone calls, or virtual meetings. Patients’ HbA1c was measured at baseline and 6-month follow-up. The Diabetes Distress Scale (DDS-17), Coronavirus Anxiety Scale (CAS-19), and a survey of diabetes technology use and COVID-19 outcomes were also administered. Descriptive statistics were computed for all metrics (n, %; median IQR for skewed data). Between-group comparisons were evaluated via Chi-Square tests for categorical data and t-tests for continuous data. Diabetes distress was significantly lower among the intervention group [DDS-17 score median=1.6] than controls [DDS-17 score median=2.1] (p=.0077). More patients in the intervention regularly used a continuous glucose monitor (CGM) (69.9% vs. controls: 38.8%, p<.001). There were no significant differences between groups in insulin pump use, HbA1c, COVID-19 anxiety, or other COVID-19 outcomes. The latter results were likely due to the COVID-19 survey evaluating structural outcomes like financial stability that were beyond the scope of the DSC intervention. Overall findings demonstrate that DSCs reduced diabetes distress and improved CGM use among underserved patients with diabetes. Support coaching is valuable for this population; further research is needed to improve their HbA1c levels and COVID-19 outcomes.

Disclosure

J.Maizel: None. S.C.Westen: None. K.K.Hood: Consultant; Cecelia Health. J.J.Wong: None. B.Dixon: None. S.L.Filipp: None. M.J.Gurka: None. A.F.Walker: None. M.J.Haller: Board Member; SAB Biotherapeutics, Inc., Consultant; Sanofi, MannKind Corporation. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. A.Addala: None. R.Lal: Advisory Panel; Provention Bio, Inc., Consultant; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Deep Valley Labs, Gluroo, Tidepool, PhysioLogic Devices, Morgan Stanley. L.Figg: None. M.Hechavarria: None. K.G.Malden: None. E.Sheehan: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (G-2005-03934)
703-P: Community-Based Peer Support for Diabetes Management—Impacts Relative to Comparison Communities
Authors: LIU YUEXING , CAI CHUN , WU XIAOYU , TANG PATRICK Y. , COUFAL MUCHIEH M. , SHEN LI , FISHER EDWIN B. , JIA WEIPING
Published: June 2023

Community-based Peer Leader (PL) program in 12 PL communities (PLCs) was compared to 4 Comparison Communities (CCs) in Shanghai, China from 2019 to 2021. Key collaborators included district and sub-district health promotion offices, community health centers (CHCs), community self-management groups, and neighborhood committees. Implementation assessment indicated community adaptation of standardized intervention components: public education about diabetes, neighborhood activities, diabetes education classes, diabetes management meetings, follow-up with individuals and families, and online communication via WeChat due to COVID disruptions.

Among those with baseline and follow-up data (n = 1066), PLCs (n = 799) and CCs (n = 267 in 4 CCs) differed significantly on age (66.4 vs 63.7 years), gender (56.8% vs 46.4% female), diabetes duration (8.0 vs 6.5 years), and BMI (25.3 vs 26.0 kg/m2) (all ps ≤ 0.009). Controlling for these and baseline levels of HbA1c, reductions of HbA1c favored the PLCs (-0.06±1.27 vs 0.22±1.56, p < 0.001). Parallel analyses showed significant reductions favoring PLCs for FPG (-0.04±2.50 vs 0.76±2.84, p < 0.001), a 4-item measure of diabetes distress (-0.07±0.41 vs 0.06±0.37, p = 0.004), and depressive symptoms (PHQ-8) (-0.49±3.21 vs 0.54±2.73, p = 0.002). Among those with elevated baseline levels, greater reductions for PLC vs CC were observed for those with HbA1c ≥ 8% at baseline (-0.76±1.56 vs -0.41±2.09, p = 0.038) and those with FPG > 7 mmol/L (-0.54±2.93 vs -0.06±2.95, p = 0.007). Significant PLC vs CC differences were not observed for SBP, DPB, or general quality of life (EQ5D). A slight difference in change of LDLc favored CCs (-0.28±0.90 vs -0.38±0.86, p = 0.042) but only for those with elevated LDLc ≥ 2.6 mmol/L.

Community organization of PL for diabetes management implemented through community groups and CHCs showed greater changes in glucose control, diabetes distress, and depressive symptoms compared with comparison groups.

Disclosure

Y.Liu: None. C.Cai: None. X.Wu: None. P.Y.Tang: None. M.M.Coufal: None. L.Shen: None. E.B.Fisher: Advisory Panel; Eli Lilly and Company, Research Support; Merck Sharp & Dohme Corp. W.Jia: None.

Funding

Chinese Academy of Engineering (2022-XY-08); Shanghai Municipal Science and Technology Commission (22692114600); Shanghai Municipal Grant (GWIV-3.1); Shanghai Municipal Health Commission (20194Y0141, JKKPYC-2022-12); Merck Foundation; Sanofi China; National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092926)
706-P: Lived Experiences of Diverse Muslim Women with Type 2 Diabetes Who Live in the U.S.
Authors: ALI ASMA , CHEWNING BETTY A.
Published: June 2023

Objective: To explore lived experiences of a diverse group of Muslim American women in managing type 2 diabetes in the US.

Methods: We conducted a one hour one-on-one qualitative interview with first generation immigrant or refugee Muslim American women. Interviews were conducted in-person or via phone, and were audio recorded. Interpretation services were provided for participants who speak Dari, Rohingya, and Urdu. The interviewer speaks Arabic and English, so no interpretation was needed for these interviews. Two trained researchers conducted inductive thematic analysis using NVivo.

Results: A total of 13 women who come from 6 different countries in the Middle East (Palestine, Egypt) and Asia (Afghanistan, India, Pakistan, Burma) were interviewed. Mean age was 58 years, only three women had a college education or higher, and 11 women had an income < $25,000. Results are presented in Figure 1. Themes include: 1) Patient-provider communication; 2) Factors influencing exercising; 3) Access to care. The third theme was common within the two refugee groups (Rohingya and Afghan).

Conclusion: This research presents experiences and preferences for Muslim women who come from diverse cultures. Clinicians and researchers need to understand and respond to these preferences while not judging patients for their preferences. A patient-centered approach is important to help women achieve better health outcomes and overall quality of life.

Disclosure

A. Ali: None. B.A. Chewning: None.

Funding

Health Resources and Services Administration (T32HP10010); Department of Family Medicine and Community Health
707-P: Motivation for Maternal Healthy Lifestyle Behaviors—Implications for the Perinatal Period
Authors: BROWN SUSAN D. , HEDDERSON MONIQUE M. , MILLMAN ANDREA , DAREDIA SAHER , SERRATO BANDERA HILLARY , QUESENBERRY CHARLES , FERRARA ASSIAMIRA
Published: June 2023

Background: Healthy lifestyle behaviors are critical to maternal cardiometabolic health. Yet little research examines whether motivations for these behaviors shift from pregnancy—considered a time of strong motivation for self-care—to postpartum, often a vulnerable period marked by weight retention and barriers to self-care.

Methods: We prospectively examined intrinsic motivation from early pregnancy to 1-year postpartum for 3 key behaviors: self-monitoring of weight (i.e., self-weighing, a standard weight management technique); healthy eating; and physical activity (PA) in the Pregnancy, Lifestyle and Environment Study-2 (PETALS-2). Diverse participants (N=167; 20% Asian, 7% Black, 27% Hispanic, 17% multiracial, 30% White) completed validated surveys at 10-13 weeks’ gestation and 1-year postpartum; higher scores on 5-point scales indicated greater motivation.

Results: Overall, motivation for self-weighing was similarly low in pregnancy as postpartum (mean [SD] = 2.53 [0.84] vs. 2.42 [0.84]; p=.16). Motivation for healthy eating was descriptively higher, but with a non-significant trend toward decline over time (3.93 [0.66] vs. 3.83 [0.83]; p=.06). Motivation for PA was moderate and stable (3.32 [1.08] vs. 3.35 [1.03]; p=0.66). In regression analyses adjusted for education, race/ethnicity, pre-pregnancy BMI, and parity, motivation for PA declined significantly more over time among older vs. younger participants (40-44 vs. 18-24 years of age; score difference [95% CI]: -1.16 [-1.99, -0.32], p=.007).

Conclusions: Intrinsic motivation for key lifestyle behaviors was generally stable from early pregnancy to 1-year postpartum, although older age was linked to decline in motivation for PA over time. Interventions to improve cardiometabolic health could capitalize on comparatively high motivation for healthy eating, while mitigating consistently low motivation for self-weighing and declining motivation for PA among older individuals in the perinatal period.

Disclosure

S.D.Brown: None. M.M.Hedderson: None. A.Millman: None. S.Daredia: None. H.Serrato bandera: None. C.Quesenberry: None. A.Ferrara: None.

Funding

National Institutes of Health (R01HL142996)
709-P: A Multistakeholder, Longitudinal Perspective on the Perceived Impact of a Diabetes Intervention for South Asians in New York
Authors: ALI SHAHMIR H. , ONAKOMAIYA DEBORAH , MOHSIN FARHAN M. , MOHAIMIN SADIA , SAIF NABEEL I. , RAHMAN FARDIN , ZANOWIAK JENNIFER , MAMMEN SHINU , LIM SAHNAH , ISLAM NADIA
Published: June 2023

Multi-stakeholder community-clinical linkage models hold the potential to address the significant diabetes burden faced by South Asians in the US. This study longitudinally evaluates stakeholders’ perspectives on the implementation of a diabetes management and prevention intervention among South Asians in NYC. Participating intervention stakeholders were interviewed annually (2019-2022) on their experience of the intervention's implementation (79 interviews). Stakeholders included 5 research personnel, 8 CHWs, 8 CBO partners, and 18 primary care providers/staff. Qualitative coding was informed by the Consolidated Framework for Implementation Research (CFIR); our analysis focuses on the types of perceived benefits for participants/stakeholders. Along with observing changes related to interventional targets (weight/A1C reduction), CHWs expressed that the intervention structure helped facilitate referrals to social services (e.g., health insurance, financial assistance) and address secondary health concerns (e.g., mental health). Participant occupation, family structure, and technological capacity were reported as mediators in the intervention's perceived impact. Providers/staff (particularly from smaller, less-resourced clinics) emphasized improvements in patients’ health literacy and self-efficacy as important gaps addressed by the intervention. CBO partners highlighted that intervention participation helped develop strong collaborations with academic partners (which helped them secure additional resources) and other CBOs. Research personnel reported that stakeholder perceptions of the intervention's importance increased as greater participant health impact was observed. Findings suggest that community-clinical linkage models can provide multi-faceted benefits to both participants and stakeholders by holistically supporting participant health needs and facilitating strong partnerships.

Disclosure

S.H.Ali: None. N.Islam: None. D.Onakomaiya: None. F.M.Mohsin: None. S.Mohaimin: None. N.I.Saif: None. F.Rahman: None. J.Zanowiak: None. S.Mammen: None. S.Lim: None.

Funding

National Institute on Minority Health and Health Disparities (U54MD000538, R01DK11004801A1)
71-LB: Tirzepatide Reduces the Predicted Risk of Developing Type 2 Diabetes—SURMOUNT-1 Post Hoc Analysis by Prediabetes Status
Authors: HANKOSKY EMILY R. , WANG HUI , NEFF LISA M. , KAN HONGJUN , WANG FANGYU , AHMAD NADIA , STEFANSKI ADAM , TIMOTHY GARVEY W.
Published: June 2023

Background: This study assessed the effect of tirzepatide (TZP) on the 10-year risk of developing type 2 diabetes (T2D) in people with overweight or obesity with and without prediabetes.

Methods: The Cardiometabolic Disease Staging model was applied to the SURMOUNT-1 trial to derive T2D risk scores at baseline, 24, and 72 weeks. Mean change from baseline to week 72 was derived for participants with and without prediabetes at baseline.

Results: Age, sex, BMI, and other cardiometabolic factors were significantly different between participants with (n=987) and without prediabetes (n=1552). Mean baseline 10-year diabetes risk scores of participants with and without prediabetes were 29-32% and 19-20%, respectively, and did not differ by treatment group. Mean absolute reductions from baseline in the risk score at week 72 for TZP 5/10/15 mg were greater in participants with prediabetes (16-20%) vs those without prediabetes (10-11%), and both were greater than PBO. Mean change in 10-year risk vs PBO in the TZP 5/10/15 mg groups was -13%, -17%, and -18% respectively in those with prediabetes and -11%, -12%, and -12% in those without; the reduction was greater in participants with prediabetes (interaction p<0.001). Conclusion: TZP significantly reduced the predicted risk of developing T2D compared to PBO regardless of prediabetes status. Risk reduction was greater in participants with prediabetes.

Disclosure

E. R. Hankosky: Employee; Eli Lilly and Company, Other Relationship; Eli Lilly and Company. H. Wang: None. L. M. Neff: Employee; Eli Lilly and Company, Research Support; Aegerion Pharmaceuticals, Stock/Shareholder; Eli Lilly and Company. H. Kan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. F. Wang: None. N. Ahmad: Employee; Eli Lilly and Company. A. Stefanski: Employee; Eli Lilly and Company. W. Garvey: Advisory Panel; Boehringer-Ingelheim, Novo Nordisk, Eli Lilly and Company, Merck & Co., Inc., Alnylam Pharmaceuticals, Inc., Fractyl Health, Inc., Inogen, Research Support; Novo Nordisk, Eli Lilly and Company, Epitomee, Pfizer Inc., Neurovalens.

Funding

Eli Lilly and Company
711-P: Measuring Social Determinants of Health (SDOH) Using Ecological Momentary Assessment (EMA) in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: FINNAN MOLLY , SCHECHTER CLYDE , CRESPO-RAMOS GLADYS , HOOGENDOORN CLAIRE J. , GONZALEZ JEFFREY S. , AGARWAL SHIVANI
Published: June 2023

Background: While it is recognized that underserved YA with T1D experience SDOH that contribute to adverse outcomes, it is unknown how often and what SDOH are most frequently experienced, or whether they interfere with self-management, which limits potential for intervention. Using EMA methods, we explored relationships between daily experience of SDOH and diabetes self-management.

Methods: We recruited 61 underserved YA (18-30 yo) with T1D from the Bronx, New York. We prompted EMA surveys via smartphone 3 times daily over a 14-day period. We asked YA how SDOH interfered with self-management twice daily: “Since the last survey, which of the following life factors got in the way of your diabetes care today?”. Answer choices included money, food, housing, transportation, personal safety, mental health, and racial/ethnic or socioeconomic discrimination. Descriptive statistics were used to quantify and report frequency and variation of SDOH related care burden over the 14-day period.

Results: Overall, 51 YA completed 778 EMA surveys over the 14-day period (23±4 yo, 65% F, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean HbA1c 8.6%). Thirty-seven YA (73%) endorsed at least one daily SDOH related diabetes care burden, on an average of 22% of days. Mental health problems were reported most frequently (n=23 [62%], 11% of days), followed by transportation problems (n=17 [46%], 6% of days), and financial problems (n=15 (41%), 5% of days). The other SDOH choices accounted for less than 5% of responses.

Conclusion: Using EMA to study SDOH in a short timeframe identified significant daily SDOH related diabetes care burdens in underserved YA with T1D. Mental health, transportation, and financial barriers prominently and frequently interfered, while others were described more sporadically albeit still present. SDOH need to be measured in new ways to better understand how and when to intervene to improve outcomes in underserved populations.

Disclosure

M.Finnan: None. C.Schechter: None. G.Crespo-ramos: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.

Funding

NY-Regional Center for Diabetes Translational Research (5P30DK111022-08); National Institute for Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
713-P: The Concomitant Health Needs and Health Care Utilization Patterns of U.S. Women with Lifetime Criminal Legal Involvement and Diabetes, 2015–2019
Authors: HAWKS LAURA , WALKER REBEKAH J. , EGEDE LEONARD E.
Published: June 2023

Background: Over 100 million Americans have a history of criminal legal involvement (CLI), which is increasingly recognized as a risk for poor disease outcomes. Women with diabetes and CLI may have unique needs and utilization patterns, but this population has not been studied.

Methods: Using nationally representative data, we examined a sample of respondents with lifetime CLI and self-reported diabetes. We compared rates by gender of physical conditions, mental health conditions, and substance use disorders using multivariate logistic regression considering relevant sociodemographic confounders. We then estimated the adjusted odds of outpatient, emergency department and inpatient hospitalization using similar models. Stata 16.1 was used.

Results: In our sample of US adults with diabetes and CLI (N=2,742), 28% were women. Women were generally of lower socioeconomic status but more likely to have insurance. Compared to men, women reported higher rates of comorbid physical conditions, including having ≥2 conditions (aOR 1.5, 95% CI 1.2-1.9); higher rates of serious mental illness (aOR 2.5, 95% CI 1.8-3.6), any mental illness (aOR 2.1, 95% CI 1.6-2.6), and past year major depression (aOR 2.1, 95% CI 1.6-2.8). They were less likely to have a substance use disorder (aOR 0.7, 95% CI 0.5-0.9). Compared to men, women were more likely to use the emergency department (aOR 1.2, 95% CI 1.1-1.3) with a trend towards increased hospitalizations (aOR 1.2, 95% CI 0.9-1.5). They were also more likely to use outpatient care (aOR 2.1, 95% CI 1.3-3.5).

Conclusions: Women with diabetes and CLI have higher rates of chronic disease and mental illness, but lower rates of substance use disorders, a pattern which is distinct. Additional research should consider if addressing the unique needs of this marginalized population could improve diabetes outcomes and decrease unnecessary acute care utilization.

Disclosure

L.Hawks: None. R.J.Walker: None. L.E.Egede: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK132505-01A1)
715-P: How Frequently Do People with Diabetes Use a Digital Diabetes Logbook and How Satisfied Are They with It?
Authors: HERMANNS NORBERT , EHRMANN DOMINIC , SILBERMANN STEPHAN , KOBER JOHANNA , VESPER IRIS , FINKE-GRÖNE KATHARINA , ROOS TIMM , BINGOL EZGI , KULZER BERNHARD
Published: June 2023

A randomized controlled trial (RCT) was conducted to evaluate the efficacy of a digital diabetes logbook (mySugr) to help with diabetes self-management. Frequency of use as well as satisfaction with the app were assessed. A total of 424 people were included in the RCT with 282 being randomized to the intervention group using the app for 3 months (2:1 randomization) (age: 51.2±14.6 years; 13.1% type 1, 66.7% type 2, 20.2% gestational diabetes). Frequency of use was assessed with user data from the pseudonymized study server. Satisfaction with mySugr was assessed with an adapted version of the Mobile App Rating Scale (MARS). Mean MARS scores were calculated (range: 1-5) with higher scores indicating higher satisfaction.

User data from 249 participants of the intervention group (88.3%) were analyzable. The app was used on a median of 92.6% (IQR: 57.7 - 100%) of the study days (median study duration: 91 [IQR: 84-96] days). Over the study duration, participants logged 3.1±2.5 blood glucose values. Satisfaction was very high with a mean MARS score of 4.3±0.7. 64.7% of participants agreed that the app is appealing for people with diabetes and 82.5% agreed that the app is easy to use. Satisfaction was highest in women with gestational diabetes, followed by people with type 1 and people with type 2 diabetes (4.5±0.5 vs. 4.3±0.6 vs. 4.2±0.7; p=0.037). Higher satisfaction was associated with higher percentage of days with app use (r=0.23, p<0.001), higher logging frequency (r=0.20, p=0.002) and less problems with the app (r=-0.20, p=0.001). Those who contacted mySugr support when they had problems were significantly more satisfied than those who did not contact support when they had problems (4.6±0.4 vs. 3.8±0.7, p=0.023).

Participants randomized to using mySugr for 3 months (no prior app use) were highly satisfied with the app. Frequency of use of the app across the study period was very high. Satisfaction was high in all diabetes types with women with gestational diabetes having the highest satisfaction.

Disclosure

N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. S.Silbermann: Employee; Roche Diabetes Care. J.Kober: Employee; mySugr. I.Vesper: None. K.Finke-gröne: None. T.Roos: None. E.Bingol: Employee; Roche Diabetes Care. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care.

Funding

Roche Diabetes Care GmbH (DC000097)
719-P: Feasibility and Acceptability of the Quality of Life, Burden of Treatment, Safety, and Avoidance of Future Events Agenda Setting Kit (QBSAFE ASK)
Authors: HAIDER SHANZAY , GONZALEZ LOPEZ CAROLINA , CLARK JENNIFER , GRAVHOLT DEREK L. , BRESLIN MAGGIE , BOEHMER KASEY , HARTASANCHEZ SANDRA A. , SANCHEZ BRIANNA B.M. , MONTORI VICTOR M. , LIPSKA KASIA J.
Published: June 2023

Objectives: Diabetes care has traditionally focused on target A1c, leaving other patient goals and needs under-addressed. We assessed the feasibility and acceptability of conversation cards (QBSAFE agenda setting kit) during routine clinic visits.

Methods: We recruited clinicians and their patients with diabetes into a single-arm intervention study. The intervention consisted of a set of 14 conversation cards (QBSAFE ASK) describing diabetes-related topics. The cards were presented to patients and asked to select 0-3 cards for discussion. Clinicians and patients completed post-encounter acceptability surveys. Feasibility was assessed based on participant enrollment, time to enrollment, and percent who completed study procedures. Encounters were recorded and analyzed to describe the cards selected and clinician responses to the cards.

Results: A total of 85 patients (63yo ± 14.7, 43.5% female, and 84.5% white) and 7 clinicians were recruited over 5 months. Among 85 patients, 68.2% completed all study procedures. Most patients (63.8%) agreed the cards helped discuss their situation, 77.6% agreed other patients could benefit from them, but only 37.9% would use the cards again. Clinicians felt confident responding to issues raised by the cards during 89.9% of encounters and would recommend the cards to their colleagues (82.4%). Based on video analysis, 83.3% of patients selected at least 1 card, with the common being “I have difficulties with diet and exercise” (34.5%). Clinicians most often responded by asking elaborating questions (81.8% of encounters) followed by change in treatment (34.5%). The tool often elicited collaborative conversations between clinicians and patients (58% of encounters).

Conclusions: QBSAFE ASK can be feasibly implemented into clinical care, is generally acceptable, and holds promise in helping patients discuss their situation with clinicians and in eliciting collaborative problem-solving.

Disclosure

S.Haider: None. K.J.Lipska: Other Relationship; UpToDate. C.Gonzalez lopez: None. J.Clark: None. D.L.Gravholt: None. M.Breslin: None. K.Boehmer: None. S.A.Hartasanchez: None. B.B.M.Sanchez: None. V.M.Montori: None.

Funding

National Institute on Aging (5R21AG061427)
721-P: Mood and Sleep in Young Adults with Type 1 Diabetes
Authors: CARREON SAMANTHA A. , MINARD CHARLES G. , LYONS SARAH , STREISAND RANDI , TANG TRICIA S. , MCKAY SIRIPOOM , ANDERSON-THOMAS BARBARA J. , NOWAKOWSKI SARA , BUTLER ASHLEY , HILLIARD MARISA E.
Published: June 2023

Introduction: Depression is linked with sleep problems and for people with T1D, mood concerns and sleep are associated with A1c. There are psychosocial and sleep challenges in young adulthood, yet their associations are unknown in racially/ethnically diverse young adults with T1D. We aimed to evaluate general mood and T1D-specific mood in relation to sleep in young adults with T1D, controlling for relevant medical and demographic factors. We hypothesized that depressive symptoms and T1D distress would explain the greatest variance in sleep outcomes.

Methods: Young adults with T1D (n=83, M age=19.9±1.3 yrs, M A1c=8.9±2.0%) self-reported on sleep, T1D distress, depressive symptoms, race/ethnicity, insurance status and device use at baseline of a behavioral trial. Hierarchical regression models evaluated factors related to sleep quality and duration.

Results: Participants reported M=7.1±1.4 (range: 4-12) hrs sleep/night and 28% described their sleep as fairly-very bad. As detailed in the Table, only greater diabetes distress was significantly associated with worse sleep quality. No factors significantly related to duration.

Conclusions: Despite sleeping near the target 7-9 hrs/night, the centrality of diabetes distress for young adults’ perceived sleep quality highlights its importance beyond commonly related medical and demographic factors. Clinical attention to T1D-specific mood concerns may benefit sleep health during young adulthood.

Disclosure

S.A.Carreon: None. M.E.Hilliard: None. C.G.Minard: None. S.Lyons: None. R.Streisand: None. T.S.Tang: Research Support; Juvenile Diabetes Research Foundation (JDRF), Speaker's Bureau; Abbott Diabetes, Insulet Corporation. S.Mckay: None. B.J.Anderson-thomas: None. S.Nowakowski: None. A.Butler: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK119246 to M.E.H.), (3R01DK119246-04S1 to M.E.H., S.A.C.)
722-P: The Value of Collaborative Parental Involvement in Diabetes Management for Youth with Type 1 Diabetes
Authors: ANIFOWOSHE KASHOPE I. , JASER SARAH S.
Published: June 2023

Type 1 diabetes (T1D) is typically diagnosed during late childhood or early adolescence. Parents are often initially responsible for their child's diabetes management, which transfers to the child over time. The Collaborative Parent Involvement (CPI) Scale measures the child's perceived quality of parental involvement in their diabetes care. We examined the relationship between CPI and other key factors of child and adolescent T1D management: self-care, Diabetes Family Conflict (DFC), and Pediatric Quality of Life (PedsQL). Data were collected from participants in a randomized controlled trial which included adolescents with T1D (age 11-17) and their female caregivers. Participants completed baseline surveys, including the CPI, DFC, and PedsQL, as well as a parent- and self-report measure of how well the child manages their diabetes. HbA1c was extracted from adolescents’ medical charts. Bivariate correlations were used to assess relationships between CPI and other diabetes outcomes. Higher levels of collaborative parenting were associated with greater self- and parent-reports of perceived self-care (r= .23, .22, both p<.01). In contrast, greater collaboration was associated with lower levels of child- and parent-reported diabetes-specific conflict (r= -.23, -.20, p<.01, p<.05). Higher levels of collaboration were also associated with higher quality of life (r= .45, p<.01) and lower HbA1c (r= -.28, p<.01). No significant differences in CPI scores were found related to child gender, race/ethnicity, diabetes device use, or between different income groups. Findings indicate that adolescents’ perceived quality of parental involvement is associated with several key factors of T1D management. While the quantity of parental involvement is often a targeted area in pediatric T1D care, clinicians and parents should also focus on the quality of involvement. Enhanced parent-child collaboration may help families handle the many stressors associated with T1D management.

Disclosure

K.I.Anifowoshe: None. S.S.Jaser: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK11545)
723-P: Patient-Reported Barriers to Continuous Glucose Monitor Usage
Authors: PARK JULIE J. , GUTTMANN-BAUMAN INES , CHUN ARUM , PANDHARPURKAR TEJAL H. , MULLIN RACHAEL
Published: June 2023

Aims: What are patient reported barriers to continuous glucose monitor (CGM) use in the pediatric type 1 diabetes population?

Methods: Recruited patients with type 1 diabetes of ≥6 months at Harold Schnitzer Diabetes Health Center filled out a survey regarding their current glucose monitoring system. The survey incorporated the GMSS-T1D1 and qualitative sections to assess patient's satisfaction, experience, quality of life, and barriers of using CGM and standard glucometers (SGM). Caregivers of patients younger than 15 years were surveyed with verbal assent from patients who were ≥7 years. Duration of diabetes, A1c, and type of insurance were also studied.

Results: 114 patients were recruited with 69 patients completing the study. Ages ranged from 3 - 19 years, with a mean age of 12.6 years. 70% were CGM users and 30% SGM users. 64% of current SGM users had CGM use in the past. 28% of current CGM users reported difficulties using the CGM. Reported difficulties were grouped into categories; healthcare system related, physical, difficult to use, trust, and device malfunction. The most common difficulty among current CGM users was in regards to obtaining the device related to cost, delivery, and replacements. Past CGM users reported the same difficulty obtaining the device and difficulty using the device as top reasons for not using CGM. Overall current CGM users had higher satisfaction scores on the GMSS and better A1c than SGM users.

Conclusion: CGM users reported higher satisfaction with their device and better control of their diabetes. Current CGM users reported difficulties with cost, unreliable delivery of refills and replacements, and physical barriers including limited sites, pain and bleeding. Past CGM users reported additional barriers with device malfunction and not liking it.

Disclosure

J.J.Park: None. I.Guttmann-bauman: None. A.Chun: None. T.H.Pandharpurkar: None. R.Mullin: None.
725-P: Depressive Symptoms and Insomnia and Their Relationship with Lack of Adherence to Treatment and Metabolic Control in Patients with Type 2 Diabetes Mellitus
Authors: ESCOBAR MELISSA N. , RAMIREZ ANA I. , BUENO COLMAN ELVIO D. , BENITEZ ALDO , PALACIOS MAFALDA , JIMENEZ JORGE T.
Published: June 2023

Aim: To determine the relationship between depressive symptoms and insomnia with therapeutic non-adherence and metabolic control in patients with T2DM.

Methods: Observational, descriptive, cross-sectional study with analytical component. Adult patients with DM2 treated in an Endocrinology Service of a University Hospital of Asunción-Paraguay from May to October 2022. The Morinsky-Green adherence questionnaires, the Insomnia Severity Index (ISI), the Patient Health Questionnaire 9 (PHQ-9) and predetermined questionnaire for clinical characteristics where used.

Results: 171 patients were studied. Women: 69%. Mean age 54.9 ± 11.8 years. Symptoms of depression occurred in 61.9%. 59% suffered insomnia. The 64.3% of patients had moderate non-adherence. The mean HbA1c was 8.08 ± 0.16 %. Inadequate metabolic control (HbA1c >7%) was seen in 68% of patients. A relationship was found between depression and insomnia (p<0,001), in addition to the fact that the worse adherence the more depressive symptoms (p<0,001) and the more insomnia (p <0.001).Patients with poor metabolic control have more depressive symptoms (p=0,005) and insomnia (p=0,009).

Conclusion: Depressive symptoms were significantly related to non-adherence to treatment and to worse metabolic control, but not the presence of insomnia without depressive symptoms.

Disclosure

M.N.Escobar: None. A.I.Ramirez: None. E.D.Bueno colman: None. A.Benitez: None. M.Palacios: Speaker's Bureau; Sanofi. J.T.Jimenez: None.