bluuebunny/crossref_metadata_2025 huggingface dataset:
783-P: Correlations between Serum 25-Hydroxy Vitamin D and Vascular Disease in Type 2 Diabetics
Authors: LI NAN , XU LU , WANG YANRU , YANG SHAOLING , YANG PENG , DONG JIAQI , LI HONG , QU SHEN
Published: June 2019

Objective: Vascular lesions caused by type 2 diabetes (T2DM) is unquestionable, but the relationship with serum 25-hydroxyvitamin D (25(OH)D) is controversial. Our study intends to analyze the association between the vascular disease of T2DM and the level of 25(OH)D.

Methods: A total of 576 patients with T2DM and 532 healthy people in our hospital from 2016 to 2017 were enrolled. The level of 25(OH)D between T2DM group and non-DM group was compared. Patients with T2DM were divided into carotid intimal thickening group(472 cases, IMT>1.0mm) and normal carotid artery group(104 cases, IMT<1.0mm) by ultrasonography. According to whether hemorrhage or exudation in fundus photography, they were divided into microvascular disease group(226 cases) and non-microvascular disease group(350 cases). Furthermore, we analyzed the association between the level of 25(OH)D and clinical characters by SPSS22.0.

Results: The level of 25(OH)D in T2DM group was significantly lower than non-DM group(42.66±13.81 vs.66.00±11.53, P<0.001). Serum 25(OH)D concentration increased in carotid intimal thickening group(42.80±13.96 vs.42.07±13.16, P=0.626), but was lower in microvascular disease group(41.17±14.02 vs.43.63±13.60, P=0.036). Levels of HbA1c, FPG, FINS, FCP, Alanine aminotransferase, Aspartate aminotransferase, Creatinine, Uric acid, TC, TG, HOMA-IR in the low 25(OH)D group were higher than normal group, but HOMA-IS, HOMA-β were lower. Therein, levels of FPG(P=0.010), FCP(P=0.006), TC(P<0.001), TG(P<0.001), HOMA-IS(P=0.002)had significant difference. In addition, gender, age and duration of disease was not related to 25(OH)D.

Conclusion: The 25(OH)D in patients with T2DM is lower than healthy people and the incidence of microvascular disease is increased, but there is no definite correlation with macrovascular disease. In the T2DM population, supplementation of 25(OH)D may improve vascular lesions by regulating glycolipid metabolism, which needs further study.

Disclosure

N. Li: None. L. Xu: None. Y. Wang: None. S. Yang: None. P. Yang: None. J. Dong: None. H. Li: None. S. Qu: None.
795-P: Effect of Protein Intake (PI) on Postprandial Glycemia in Children and Adolescents with Type 1 Diabetes Mellitus
Authors: DALLE DALIA , SHAHMIRIAN SARINE G. , O'RIORDAN MARYANN , ZIMMERMAN TERESA N. , WOOD JAMIE R.
Published: June 2019

Dietary PI contributes to PPH in T1D patients. Current recommendations are to increase insulin dose for mixed meals containing ≥ 40 gm of protein, and consider insulin dosing for pure-protein meals containing ≥75 gm of protein. There are no studies to date that investigate this effect specifically in children and in relation to body weight. Our aim was to explore the role of weight and other demographic factors in the relationship between PI and PPH in children with T1D, hypothesizing that the protein amount that causes PPH in children with T1D is weight based. We conducted a self-controlled, prospective study, in children with T1D who were given Whey protein isolate drinks (carbohydrate and fat free) of varying protein amounts (0, 12.5, 25, 37.5, 50, and 62.5 gm) on 6 different nights based on a protocol approved by UHIRB. The glucose levels were monitored with the participants’ personal continuous glucose monitors for 5 hours post PI. PPH was defined as glucose elevations ≥ 50 mg/dL above baseline. Thirty-eight subjects were recruited and 11 subjects (6 females, 5 males) completed the intervention. Subjects had a mean (SD) age of 11.6 (3.5) years, diabetes duration of 6.1 (4.7) years, HbA1c of 7.2 (0.8) %. BMI %ile ranged from 8th to 87th. PPH was detected at 5 hours post PI in 1/11, 5/11, 6/10, 6/9, 5/9, and 8/9 subjects after receiving 0, 12.5, 25, 37.5, 50, and 62.5 gm, respectively. There were no significant correlations between the rise in glucose and body weight, however for those with BMI %ile > 50% (n=8), BMI %ile was strongly correlated with change in glucose for doses 37.5 (all rs > 0.85, all p <0.01) and 50 gm (all rs > 0.64, all p <0.08) for all times. The correlation was somewhat less for 62.5 gm (all rs > 0.52). This suggests that the protein amount associated with PPH in children with TID is less than the threshold (75 gm) found in previous studies mainly consisting of adults.

Disclosure

D. Dalle: None. S.G. Shahmirian: None. M. O'Riordan: None. T.N. Zimmerman: Research Support; Spouse/Partner; Merck & Co., Inc., Novo Nordisk Inc. Speaker's Bureau; Spouse/Partner; Merck Foundation. J.R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc.
797-P: Composition of Morning and Afternoon Meals Affects Metabolism and Inflammation in Human Adipose Tissue
Authors: KESSLER KATHARINA , JÜRCHOTT KARSTEN , RUDOVICH NATALIA N. , PFEIFFER ANDREAS F. , RAMICH OLGA
Published: June 2019

Meal timing is an important factor for metabolic regulation. We recently showed that a diet where fat is mainly eaten in the morning and carbohydrates mainly in the evening worsens glycaemic control in subjects with prediabetes. Here, we investigated the effects of the day time of carbohydrate and fat intake on the subcutaneous adipose tissue (SAT) transcriptome in humans. In a cross-over study 34 non-obese men without diabetes (age 47.4 ± 2.4 years, BMI 27.4 ± 0.7 kg/m2) consumed two 4-week isocaloric diets - (1) HC/HF diet consisted of a high-carb breakfast and lunch (65 EN% carbohydrates, 20 EN% fat, 15 EN% protein) and a high-fat snack and dinner (35 EN% carbohydrates, 50 EN% fat, 15 EN% protein) or (2) inverse sequence of meals (HF/HC). After both dietary interventions, SAT samples were collected at 8.40, 12.20 and 19.00 hr. Gene expression was analyzed by microarrays and validated by PCR. Sinus model was fitted to expression levels of each transcript to predict the 24h rhythm. Out of 1345 SAT transcripts with a significant cosine rhythm, 37.8% transcripts were rhythmic on both diets, whereas 27.3% and 34.9% transcripts were rhythmic only on the HC/HF and HF/HC diet, respectively. Diets neither affected the oscillations of clock genes in SAT nor the salivary cortisol rhythm used as a central clock marker. However, dietary effects on a large set of oscillating and non-oscillating genes involved in glucose (e.g., IRS1, IRS2, PCK1, PDK4) and lipid metabolism (e.g., ACACA, ACAT1, ACOX2, PPARA) were found. Consumption of a HC/HF diet increased the expression of numerous inflammatory genes (e.g., CCL5, IL1B, ITGAX, CD3E) in SAT. Mechanisms underlying this remodeling included the change of activity of the insulin signaling, I-kappa B kinase/NF-kappa B and MAPK pathways. Collectively, our study revealed that the composition of the morning and afternoon meals strongly affect adipose tissue transcriptome in humans including the alteration of glucose and lipid metabolism and inflammatory pathways.

Disclosure

K. Kessler: None. K. Jürchott: None. N.N. Rudovich: None. A.F. Pfeiffer: Advisory Panel; Self; Abbott, Berlin-Chemie AG, Novo Nordisk A/S. Speaker's Bureau; Self; Lilly Diabetes, Novartis AG, Sanofi-Aventis Deutschland GmbH. O. Ramich: None.

Funding

German Science Foundation (KFO218 PF164/16-1 to O.R., A.F.P.); German Diabetic Association (to O.R.); German Center for Diabetes Research (82DZD0019G to O.R.)
801-P: Group Appointments (GA) via Home Telehealth (HT) for Young Adults (YA) with Type 1 Diabetes (T1D) May Improve Psychosocial Functioning
Authors: BISNO DANIEL I. , REID MARK W. , BERGET CARI , CAIN CINDY L. , KLINGENSMITH GEORGEANNA J. , RAYMOND JENNIFER
Published: June 2019

Background: Participation in GA via HT is associated with improved attendance, satisfaction, and psychosocial functioning in YA with T1D. The effects of long-term participation are unknown.

Objective: Evaluate whether exposure to GA via HT improves psychosocial functioning in YA with T1D receiving care via HT.

Methods: Patients in the Colorado Young Adults with T1D (CoYoT1) prospective study of GA via HT self-selected into an initial year-long study phase comparing GA to usual care. Next, 58 new and returning patients were randomized to receive HT with or without GA for one year. Overall, 19 patients were exposed to HT alone for one year (GA0), 29 were exposed to HT with GA for one year (GA1), and 10 were exposed to HT with GA for two years (GA2). They completed the EQ-5D, Diabetes Distress Scale (DDS), Center for Epidemiologic Studies Depression (CES-D), Self-Efficacy in Diabetes (SED), and Self-Management of Type 1 Diabetes in Adolescence (SMOD-A) measures.

Results: YA patients were 67% female, 86% white, and 11% Latinx. Regardless of attendance, greater exposure to GA was associated with greater communication and self-efficacy; and reduced pain, depressive symptoms, and distress at study end (See Figure 1). Overall, GA1 and GA2 reported better psychosocial functioning than GA0.

Conclusions: Greater exposure to GA via HT may improve psychosocial functioning in YA with T1D.

Disclosure

D.I. Bisno: None. M.W. Reid: None. C. Berget: Consultant; Self; Insulet Corporation, Medtronic. C.L. Cain: None. G.J. Klingensmith: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. Research Support; Self; Novo Nordisk Foundation. Stock/Shareholder; Spouse/Partner; Dexcom, Inc. J. Raymond: Other Relationship; Self; Insulet Corporation.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
803-P: Modifiable Diabetes-Specific Factors and Glycemic Control in Economically Vulnerable and Racial/Ethnic Minority Young Adults with Type 1 Diabetes
Authors: AGARWAL SHIVANI , KANAPKA LAUREN , RAYMOND JENNIFER , WALKER ASHBY F. , GONZALEZ ANDREA GERARD , KRUGER DAVIDA F. , REDONDO MARIA JOSE , RICKELS MICHAEL R. , SHAH VIRAL N. , BUTLER ASHLEY , MILLER VICTORIA , VERDEJO ALANDRA , GAL ROBIN L. , WILLI STEVEN M. , LONG JUDITH A.
Published: June 2019

Minority and socioeconomic disparity in glycemic control exists in young adults (YA) with type 1 diabetes (T1D). The contribution of social determinants of health versus diabetes-specific clinical care factors to these disparities remains unclear. We administered a survey on demographics, clinical factors, self-management, and social determinants to non-Hispanic black (NHB), Hispanic, and non-Hispanic white (NHW) YA from 6 centers in the T1D Exchange. We examined bivariate associations of variables with A1c and added significant factors to a linear regression model in sequential groups. A1c disparity was the outcome. We adjusted models for race-ethnicity, age, gender, and T1D duration. We recruited 300 YA (97 NHB, 103 Hispanic, 100 NHW) with mean age of 21±2 years and T1D duration of 11±5 years. NHB but not Hispanic YA had higher A1c vs. NHW (p<0.001) (NHB 10.5%, Hispanic 8.6%, NHW 8.1%). Only lower education attainment, lower pump use, receiving care in an adult system, and worse self-management were associated with A1c in the final model (Table 1), explaining 31% of the variance in A1c. Few social determinants were associated with A1c once examined with diabetes care factors. While social factors should be considered in the care of vulnerable YA, clinicians should continue to emphasize diabetes self-management and technology treatment options.

Disclosure

S. Agarwal: None. L. Kanapka: None. J. Raymond: Other Relationship; Self; Insulet Corporation. A.F. Walker: None. A. Gerard Gonzalez: None. D.F. Kruger: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation. Consultant; Self; CeQur Corporation, Hygieia. Speaker's Bureau; Self; AstraZeneca, Dexcom, Inc., Eli Lilly and Company. Stock/Shareholder; Self; Dexcom, Inc. Other Relationship; Self; Novo Nordisk Inc. M.J. Redondo: None. M.R. Rickels: None. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. A. Butler: None. V. Miller: None. A. Verdejo: None. R.L. Gal: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Roche Diagnostic USA. Research Support; Self; Jaeb Center for Health Research, National Institute of Allergy and Infectious Diseases, Sanofi-Aventis. Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. J.A. Long: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust; National Institute of Diabetes and Digestive and Kidney Diseases
807-P: The Diabetes-Related Emotional and Attitude Distress (DREAD) Scale
Authors: GROOT MARY DE , CRAVEN MICHAEL , VRANY ELIZABETH A. , SIMONS ZACHARY
Published: June 2019

Diabetes-related distress (DD) is defined as the emotional and regimen-specific burdens of managing diabetes and affects 38%-45% of patients. It is associated with poorer medical outcomes. Health care providers (HCPs) are on the frontline of diabetes care, but no known research has assessed DD in HCPs. This study developed a measure of DD from the perspective of HCPs.

Items (N=69) were based on interviews and focus groups with HCPs who treat people with diabetes and rated on a 5-point Likert scale. The DREAD scale was completed by 135 HCPs. Mean age was 48.9 years, 90.8% female, 79.6% white, and 67.6% married. 49.3% were nurses/nurse practitioners, 16.9% endocrinologists and 16.2% dieticians. 56.3% identified as Certified Diabetes Educators.

Evaluation of item distribution characteristics, Cronbach’s α, factor analysis and scree plot analysis indicated a 1-factor solution with 43 items. Cronbach’s α item to total was 0.92. A principal axis factor analysis was conducted; the Kaiser-Meyer-Olkin test supported sampling adequacy (KMO = .80, p < .001). The eigenvalue for the single factor was 9.11. Factor loadings ranged from 0.63 to 0.31.

To test convergent validity, the DREAD total score was correlated with the Maslach Burnout Inventory Human Services Survey for Medical Personnel (r = 0.56, p< .001 for emotional exhaustion; r = 0.39, p < .001 for depersonalization; and r = 0.40, p < .001 for personal accomplishment) and the Marlow-Crowne Social Desirability Scale (r = 0.32, p < .001). Test-retest reliability (n = 93) was conducted >2-4 weeks after the first survey: coefficient r = 0.78 (p < .001).

Diabetes-related distress is part of the caregiving experience among HCPs who treat diabetes. The DREAD scale demonstrated acceptable levels of validity and reliability in a diverse sample of HCPs. These results suggest that the DREAD scale measures a related, yet distinct, construct from general physician burnout. This measure may be used to evaluate the psychological impact of treating diabetes among HCPs in future samples.

Disclosure

M. de Groot: Consultant; Self; Eli Lilly and Company, Johnson & Johnson Diabetes Institute. M. Craven: None. E.A. Vrany: None. Z. Simons: None.
815-P: Eating Behaviors, Personality Traits, and Diabetes Fatalism: Predictors of HbA1c in Type 2 Diabetes
Authors: FARRAN NATALI , SUKKARIEH-HARATY OLA ALI , BAKHOUR DALAL AL , BASSIL MAYA
Published: June 2019

The effect of eating behavior and personality on glycemic outcomes in type 2 diabetes (T2DM) has received little attention. Diabetes fatalism has furthermore been associated with uncontrolled glycemia. The aim of the present study is to explore the interrelationship of these constructs, which might uncover new insights for diabetes management. A total of 333 Lebanese patients (Age: 59 ± 13 years, 50.2% M) with T2DM were recruited. Eating behaviours (Dutch Eating Behaviour Questionnaire), personality traits (NEO Five-Factor Inventory-3), and diabetes related fatalistic attitudes (Diabetes Fatalism Scale) were assessed. Regression analyses showed that neuroticism, restrained eating, and external eating predicted A1C. Total diabetes fatalism and its ‘despair’ subscale also predicted HbA1C. Multiple regression analysis showed that neuroticism, restrained eating, and fatalism subscale ‘despair’ predicted HbA1C levels and explained 5.4% of the variance (F(3,302) = 5.77, p = .001). A moderated moderation was run and revealed that the effect of conscientiousness on restrained eating was moderated by powerlessness (fatalism subscale) and neuroticism. At low neuroticism levels and with any powerlessness levels, conscientiousness did not exert a significant effect on restrained eating. However, at high levels of neuroticism with low or moderate levels of powerlessness, conscientiousness exerted significant effect on restrained eating (low powerlessness: B = .07, t = 4.39, p < .001; medium powerlessness: B = .04, t = 3.24, p < .01). On the other hand, when powerlessness was high, conscientiousness did not exert a significant effect on restrained eating.

In summary, the impact of conscientiousness on restrained eating, which in turn predicts HbA1C levels, is moderated by the belief of powerlessness and neuroticism in T2DM. These factors should be taken into account in the clinical practice. Further exploring similar constructs in T2DM to improve the quality of health care is warranted.

Disclosure

N. Farran: None. O.A. Sukkarieh-Haraty: None. D. Al Bakhour: None. M. Bassil: None.
819-P: Personalized Texts Improve Adherence and A1c over 6 Months among High-Risk Adults with Type 2 Diabetes
Authors: MAYBERRY LINDSAY S. , NELSON LYNDSAY A. , GREEVY ROBERT A. , WALLSTON KENNETH , KRIPALANI SUNIL , OSBORN CHANDRA Y. , BERGNER ERIN M. , LESTOURGEON LAUREN , WILLIAMSON SARAH E. , SPIEKER ANDREW J. , GENTRY CHAD , BROWN ANNE W. , GREGORY BECKY P. , ACUFF S. WILL , ELASY TOM
Published: June 2019

Medication nonadherence and suboptimal glycemia are common among adults with T2D, particularly minorities and people with low SES. Text messaging is used ubiquitously without disparities. REACH (Rapid Education/Encouragement And Communications for Health) is a theory-based text messaging intervention that iteratively personalizes content to participants’ diabetes medicines and barriers to adherence.

All participants have completed 6-month follow-up of a 15-month pragmatic RCT evaluating REACH. Adults (N=512) with T2D were recruited from community health centers and medical center primary care clinics. All participants received educational newsletters, completed A1c tests (venipuncture or mail-in kit) and surveys every 3 months; those assigned to REACH received daily texts. Surveys included a barriers assessment and the Summary of Diabetes Self-Care Activities medications subscale. Regression models examined change in barriers, adherence, and A1c (adjusted for test type) relative to controls.

Participants were predominantly non-white (53%) and low SES (56% annual incomes <$35K; 49% underinsured; 42% <high school degree; 11% homeless/unstably housed), with an average age 56.0±9.5 years; 54% female; 49% on insulin; and baseline A1c 8.6±1.8%. At 6 months, retention was 90% and average response rate to daily interactive texts was mean 84% [IQR 79-90]. The 6-month overall REACH effect on A1c was -0.3% (p<.05), but reductions were greater among participants with higher baseline A1c (interaction term p<.05) - demonstrating A1c reductions ≥1.0% among participants with baseline A1c≥12.5% and ≥0.5% among participants with baseline A1c≥8.0% (both p<.05). Relative to controls, REACH also reduced adherence barriers (p<.05) and improved adherence (.53 days per week, p<.001).

REACH engaged a diverse and high-risk group with daily texts, reduced barriers to adherence, improved adherence, and substantively improved A1c among patients with elevated glycemia at baseline.

Disclosure

L.S. Mayberry: None. L.A. Nelson: None. R.A. Greevy: None. K. Wallston: None. S. Kripalani: None. C.Y. Osborn: Employee; Self; One Drop. E.M. Bergner: None. L. LeStourgeon: None. S.E. Williamson: None. A.J. Spieker: None. C. Gentry: None. A.W. Brown: None. B.P. Gregory: None. S. Acuff: None. T. Elasy: None.

Funding

National Institutes of Health (R01DK100694)
829-P: The Choice Should Be Yours: Diabetes-Related Distress by Insulin Delivery Method for Patients with Type 1 Diabetes
Authors: WARDIAN JANA L. , TRUE MARK W. , COLBURN JEFFREY A. , FOLARON IRENE , TATE JOSHUA M. , BECKMAN DARRICK
Published: June 2019

The ADA recommends psychosocial assessment as an integrated part of care for people with diabetes, which includes diabetes-related distress. Elevated diabetes-related distress is associated with poor self-management, lower medication adherence, and poorer quality of life. Intensive insulin delivery is achieved with a combination of basal and bolus dosing, which attempts to mimic normal pancreatic function. Delivery methods can be either multiple daily injections (MDI) via a syringe or pen or through continuous subcutaneous insulin injection (CSII). CSII is recommended for patients with type 1 diabetes (T1DM) who prefer pump therapy over MDI. Thus, we explored the relationship of insulin delivery method (MDI versus CSII) to diabetes-related distress in patients with T1DM.

The Diabetes Center of Excellence (DCOE), a specialty clinic for military health system beneficiaries, administered the 17-item Diabetes-related Distress Scale (DDS-17) from June 2015 through August 2016 as standard care. Adults with T1DM receiving diabetes care at the DCOE were included in this study.

There were 203 patients with T1DM who completed the DDS-17 during the time period. Patients were categorized as CSII (57.6%) or MDI (42.4%). There were no significant differences in diabetes-related distress by insulin delivery method. Furthermore, no significant differences were found in HbA1c between CSII (7.85%) and MDI (8.10%) users. In addition, no significant differences in BMI between patients using CSII (M=28.33 kg/m2) and MDI (28.49 kg/m2) users.

Our study demonstrated that there were no differences in diabetes distress scores, HbA1c, or BMI between CSII and MDI. As we move toward more patient-centered care, patients with T1DM may benefit from choosing the method of delivery that will enable them to achieve individual goals without increased diabetes-related distress.

Disclosure

J.L. Wardian: None. M.W. True: None. J.A. Colburn: None. I. Folaron: None. J.M. Tate: None. D. Beckman: None.
842-P: Damage Control (Group) for Youth with T1D: Capturing the True Value of NICH
Authors: WAGNER DAVID V. , JENISCH CELESTE , KOSKELA-STAPLES NATALIE C. , GUTTMANN-BAUMAN INES , LARSEN CHRISTOPHER E. , TEPLITSKY LENA , HARRIS MICHAEL A.
Published: June 2019

Objective: Novel Interventions in Children’s Healthcare (NICH) is an ecologically valid intervention for youth with T1D who experience avoidable acute complications. While NICH has been associated with reductions in DKA events, the true impact of NICH is unclear without a control group. This study compares NICH youth utilization over time to youth referred to but denied NICH by insurance (i.e., unserved).

Methods: Medical providers referred youth with T1D who experienced avoidable utilization to NICH (n=110). Unserved youth (n=50) were more likely than NICH youth (n=60) to have commercial insurance and less accessible medical records. There were no demographic differences between the groups (M age=14.0 years; 58% were female; 79% were non-Hispanic white). Medical record review included 1 year prior to and 2 years following NICH.

Results: NICH youth had more documented hospital admissions and ED visits in the year prior to services (p<.05) than unserved youth. Compared to unserved youth, NICH youth experienced a greater reduction in days admitted during the 1st year and in DKA events in the 2nd year post-initiation (p<.05).

Conclusions: This study was the first to compare NICH to a control group. NICH youth demonstrated greater reductions in acute complications following treatment; however, findings indicate that these groups were different in important ways, likely under capturing control group utilization following referral.

Disclosure

D.V. Wagner: None. C. Jenisch: None. N.C. Koskela-Staples: None. I. Guttmann-Bauman: None. C.E. Larsen: None. L. Teplitsky: None. M.A. Harris: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
843-P: Hypoglycemia Unawareness Is Associated with Attachment and Reflective Functioning in People with Type 1 Diabetes
Authors: THOMAKOS PETROS , GRIVA FAY , KEPAPTSOGLOU OLGA , MITRAKOU ASIMINA , VASLAMATZIS GRIGORIS , ZOUPAS CHRISTOS
Published: June 2019

The importance of attachment has been studied extensively as a frame for understanding the self-care behaviours of people with diabetes and their relations with practitioners. A component of attachment is the ability to reflect upon one’s mental state and understand what one is feeling and why.

Aim of the study was to investigate attachment patterns and their relation with the reflective function of people with type 1 diabetes. 102 people (age 38.6±10 years, 63% females, diabetes duration 21.3±13 years, HbA1c 7.5±1.2%, Gold Score 2.2±1.5) completed measures of attachment (ECR-R) and reflective functioning (RFQ). Results suggested that there were differences in the attachment styles (χ2= 9.04, p= 0.02) between individuals who were able to detect hypoglycemia symptoms quickly enough to avoid progression to a severe hypoglycemic episode and those with hypoglycemia unawareness. 63.6% (p< 0.001) of participants with hypoglycemia unawareness were characterized as fearfully attached, a pattern associated with emotional dysregulation and problems in interpersonal relationships. People with impaired reflective functioning were more likely to report hypoglycemia unawareness (t= 2.74, p= 0.007) suggesting that impairments in identifying and expressing emotional states are associated with the ability to recognize hypoglycemic symptoms. Mediation analysis revealed significant indirect effects with a point estimate of b= 0.128 (SE= 0.055), excluding zero (95% CI= 0.033, 0.248) for anxiety and b= 0.109 (SE= 0.052), excluding zero (95% CI = 0.019, 0.226) for avoidance, indicating that attachment insecurities indirectly influence hypoglycemia awareness via the capacity to recognize and understand one’s own and other’s psychological state. Overall, the results indicate that impaired reflective processes may be involved in the recognition of hypoglycemia. Therapeutic interventions designed to enhance reflective functioning could improve hypoglycemia awareness.

Disclosure

P. Thomakos: None. F. Griva: None. O. Kepaptsoglou: None. A. Mitrakou: None. G. Vaslamatzis: None. C. Zoupas: None.
855-P: The Relationship between Primary Care Providers’ Perceptions of Patient Motivation and Their Referral Practices for the National Diabetes Prevention Program Lifestyle Change Program
Authors: ZHANG XUANPING , CANNON MICHAEL , LANZA ANDREW , KHAN TAMKEEN , JACKSON MATTHEW C. , NHIM KUNTHEA
Published: June 2019

Previous studies indicate that primary care providers’ (PCP) clinical decision making is affected by their perceptions of patient motivation. However, it is unclear how these perceptions affect PCP’s decisions to refer patients to community-based programs, such as the National Diabetes Prevention Program lifestyle change program (National DPP LCP), a structured, evidence-based, year-long lifestyle change program to prevent or delay onset of type 2 diabetes in adults with prediabetes or at risk of developing type 2 diabetes. Using data from the DocStyles 2018 web-based cross-sectional survey, we examined the relationship between PCP perceptions and referral practices. The following questions were asked to ascertain PCP perceptions and referral practices respectively: 1) “I need to make sure that my patients are motivated and ready to succeed in the National DPP LCP”; and 2) “Have you referred your patients with prediabetes to the in-person or online National DPP LCP to prevent or delay type 2 diabetes?” We analyzed the data using logistic regression analysis, with the final adjusted model controlling for PCP’s age, gender, practice years, PCP practitioner type, practice setting, and region. Our study sample included 1253 PCPs (46.3% female), with a mean age of 48.4 years and a mean practice duration of 17.4 years. We found that PCPs who realized the importance of patient motivation and readiness for their referral decision were more likely to refer their patients to the National DPP LCP, in both unadjusted (odds ratio [OR]=2.59, 95% confidence interval [CI]=1.85, 3.65) and adjusted (OR=2.58, 95% CI= 1.83, 3.64) models. Our findings highlight the importance of PCPs’ perceptions of patient motivation in their referral practices, suggesting that patient motivation and their PCP’s awareness of this motivation may need to be addressed to increase referrals to and enrollment in the National DPP LCP.

Disclosure

X. Zhang: None. M. Cannon: None. A. Lanza: None. T. Khan: None. M.C. Jackson: None. K. Nhim: None.
86-LB: Elevated First-Trimester Neutrophil Count Is Associated with the Development of Gestational Diabetes Mellitus in Pregnant Women
Authors: SUN TIANGE , MENG FANHUA , ZHANG RUI , YU ZHIYAN , ZANG SHUFEI , LIU JUN , YANG MIN
Published: June 2019

Aims: Chronic low-grade inflammation is an important cause of systemic insulin resistance and play a central role in the pathophysiology of gestational diabetes mellitus (GDM). This study aimed to investigate the correlation between neutrophil(N) in first-trimester pregnancy and the development of GDM.

Methods: 258 women with GDM and 1412 women without GDM were included in this retrospective study. Demographic, pregnancy variables, white blood cell(WBC), neutrophil(N) counts, Neutrophil-to-Lymphocyte Ratio(NLR), clinical biochemical characteristics, delivery information were got from all subjects. Logistic regression analysis with forward stepwise selection were used to determine the independent risk factors for the development of GDM.

Result: GDM patients had much higher level of blood glucose(BG), triglyceride(TG), fetal birth weight, WBC, N counts and NLR than women without GDM. There were significant positive association between N counts and 1-hour BG, 2 hour BG, glycosylated hemoglobin(HbA1c), pregnancy body mass index(BMI), and homeostasis model assessment for insulin resistance(HOMA-IR). Additionally, there were significant negative association between N and quantitative insulin sensitivity check index (QUICKI) and low-density lipoprotein(LDL) cholesterol. After adjusting confounding variables, we found N counts was an independent factor for the development of GDM (OR = 1.35; 95% confidence interval, 1.08 to 1.69), regardless the history of GDM (OR = 1.32 for without GDM history).

Conclusion: N counts in first-trimester pregnancy is closely associated with the development of GDM in pregnant women.

Disclosure

T. Sun: None. F. Meng: None. R. Zhang: None. Z. Yu: None. S. Zang: None. J. Liu: None. M. Yang: None.

Funding

Shanghai Fifth People’s Hospital Research Project Plan; Minhang District Natural Science Research
865-P: Some Diabetes Words Really Do Hurt—Measuring the Emotional Burden of Diabetes Language
Authors: BEENEY LINDA J. , HINTON RENE' , OVERLAND JANE
Published: June 2019

Opinion-based consensus guidelines promote the use of certain diabetes-related words and avoidance of others, based on the assumption they cause distress. Our study tested this hypothesis using a validated tool to systematically assess the emotional responses of people with type 1 and type 2 diabetes to diabetes-specific language.

Methods: The Diabetes Language Task (DLT), a tablet-based Application, includes words and phrases derived from consensus guidelines and other published research. Each word/phrase is rated on 2 scales assessing levels of Anxiety and Distress. T-tests were used to determine differences between the recommended Avoid and Use Language and among sub-groups, applying the Bonferroni correction for multiple comparisons.

Results: The DLT was completed by 90 study participants (Median age= 50 years (range 19-75 years); 66% female; 59% with type 1 diabetes; median A1c=8% (range 6-13%); median diabetes duration=15 years (range 3 months-45 years)) attending public and private diabetes services. Hypotheses were confirmed in 8/14 (57%) comparisons of Avoid vs. Use words, e.g., ‘suffering from diabetes’ was rated more distressing than ‘person living with diabetes’ (p<0.00001) and ‘non-compliant’ rated more distressing than ‘making choices’ (p<0.00001). Other terms assumed to be negative were rated as positive by study participants including ‘nondiabetic’, ‘normal’, ‘in control' and ‘adherent.’ Complications-related terminology including ‘Amputations’, ‘Blindness’, 'Kidney damage’ and ‘Disease progression’ generated the highest levels of distress and anxiety within the DLT. Few differences in emotional reactions were found according to type of diabetes, complications status or A1c.

Conclusions: Study findings provide support for some published diabetes language recommendations but also highlight discrepancies and identify the need to address the use of Complications Language.

Disclosure

L.J. Beeney: None. R. Hinton: Other Relationship; Self; Medtronic, Novo Nordisk Inc., Roche Diabetes Care. J. Overland: None.

Funding

Australian Diabetes Educators Association; Australian Diabetes Research Foundation
870-P: Utilities to Measure Valuation of Diabetes in Haiti
Authors: BELANGER-BISHINGA CLEMENT , PARTRIDGE COLIN , BAPTISTE EDDY JEAN , CHARLES LARCO MARIE-NANCY , LARCO PHILIPPE , VON OETTINGEN JULIA E. , ALTENOR KETLY
Published: June 2019

Background: Assessing the valuation of diabetes in a low-income country such as Haiti is novel and may improve culturally sensitive values-based counseling. Objectives: To assess how Haitians with diabetes value quality of life with disability and diabetes.

Methods: Cross-sectional study in Haiti of adult participants with diabetes type 1 (T1D) and type 2 (T2D), recruited from diabetes clinics. We asked “If born tomorrow, how many years of disabled life (y) would you trade to avoid lifelong disability” for 4 hypothetical scenarios of mild, moderate, severe and profound disability and 4 hypothetical scenarios of T1D and T2D with and without complications (T1D, T2D, T1D+C and T2D+C). Utility scores were calculated as: (life span - y)/life span, where death = 0 and full life without disability = 1 with >0 indicating better than death (BTD) and <0 indicating worse than death (WTD). We also evaluated religiosity, support and perceived rejection.

Results: One hundred adults with diabetes (65% female, 57% T1D, mean age 26±14y for T1D and 46±18y for T2D) participated. On 5-point Likert scales, scores for religiosity were 4.2±0.8; instrumental support 3.5±0.9; emotional support 3.1±0.9; and perceived rejection 2.2±0.9. Utilities were >0 (BTD) for mild and moderate, and <0 (WTD) for severe and profound disabilities. Patients with T1D valued all diabetes scenarios as >0 (BTD). Patients with T2D valued T2D and T2D+C scenarios as <0 (WTD) and assigned lower utilities to scenarios T1D (p=0.01), T2D (p=0.03) and T2D+C (p=0.01) but not T1D+C (p=0.16). Having T2D and lower religiosity predicted lower utilities for scenarios T2D (p=0.002 and p<.0001) and T2D+C (p=0.0009 and p=0.0006) after adjusting for age, sex, support and rejection.

Conclusions: In Haiti, major disabilities are valued as worse than death. Patients with T1D and T2D value T1D as better than death, whereas patients with T2D, but not T1D, perceive T2D as worse than death. Stronger religious beliefs but not other measures of support influence the valuation of quality of life with diabetes.

Disclosure

C. Belanger-Bishinga: None. C. Partridge: None. E. Jean Baptiste: None. M. Charles Larco: None. P. Larco: None. J.E. von Oettingen: None. K. Altenor: None.
871-P: The Impact of Integrated Behavioral Health in a Diabetes Center
Authors: MACGREGOR KRISTIN L. , DEMARTINI KELLY S. , BARRY SAMANTHA A. , DERR ALAN G. , THOMPSON MICHAEL J.
Published: June 2019

Integrated behavioral healthcare (IBH) is recommended as the gold standard to address psychosocial factors in diabetes management. While it is well documented that psychosocial interventions improve outcomes, there is a dearth of literature on the benefits of integrating behavioral health providers (BHP) into standard diabetes care. IBH involves collaborating with physicians, nurses, educators, and dieticians to formulate comprehensive treatment plans, and has the potential to have a substantial impact on diabetes management beyond any standalone intervention. The purpose of this study was to examine the impact of IBH on HbA1c levels in patients seen by BHPs. Data were drawn from electronic medical records and included demographic characteristics, dates of each IBH encounter, and A1c’s beginning one year before first BHP visit through one year post initial visit. Patients with a baseline A1c over 8% who had at least one visit with a BHP in a diabetes clinic at a large academic medical center were included (n = 374). Piecewise mixed effects growth mixture models were run to assess whether A1c slope was different between two time periods: pre-initial BHP visit and post-initial BHP visit. Random intercepts and random slopes were used to best model the variability in encounter frequencies among patients. The overall model was significant (Wald χ2 = 48.19, p<0.001). The slope for the period before initial BHP visit was not significant (p=0.28), indicating no evidence of linear decrease or increase in A1c values. The slope for the period after initial BHP visit was significant (p<0.001) and negative (z=-6.45), indicating that A1c values showed a significant, linear decrease over the first year after an initial BHP visit. These results provide early evidence that BHP encounters are associated with statistically significant reductions in A1c values in the year after first encounter, illustrating the benefit of IBH in diabetes care.

Disclosure

K.L. MacGregor: None. K.S. DeMartini: None. S.A. Barry: None. A.G. Derr: None. M.J. Thompson: None.
874-P: Experiences of Young Professionals with Type 1 Diabetes Mellitus Launching into the Workplace
Authors: SAYLOR JENNIFER , YORGASON JEREMY B. , MILLETT MALLORY A. , JACKSON AMY L. , NESS MICHELLE , FLOREEN SABINO ANNA
Published: June 2019

Every year 1.5 million individuals are diagnosed with type 1 diabetes mellitus (T1DM), with an expected increase of 1.8% each year. Independent diabetes management may present unique challenges for young adults with T1DM transitioning to the workplace. In this qualitative study, we explore the experiences of young professionals living with T1DM (20-30 years old) as they launch their professional careers and transition to adulthood while living with a chronic condition. We conducted two in-person focus groups with subjects at the College Diabetes Network in Boston, MA during a weekend retreat. After obtaining informed consent, the 12 participants (5 males, 7 females) attending were randomly selected into each focus group that lasted approximately 60 minutes. Subjects were 24±2.24 years old on average with a mean hemoglobin A1c of 7.9±2.65. Time since T1DM diagnosis ranged from 3 to 20 years with a mean of 9±5.68 years. All but one subject used a pump and continuous glucose monitor for T1DM management. Four subjects were current students (2 undergraduate, 2 graduate) and 8 were employed after completing their bachelor's degrees. Four researchers conducted a thematic analysis of the verbatim transcripts. We followed Merriam’s (2009) qualitative analysis process of open coding, axial coding, and establishing consensus among coders. Five main themes emerged from the focus groups including (1) challenges around disclosure of T1DM in professional settings, (2) support from family, friends, and workplace, (3) accommodations for T1DM in college and the workplace, (4) benefits and challenges associated with diabetes management technology, and (5) having a sense of ownership of T1DM. The theme of T1DM management ownership in the current study goes beyond illness management behaviors to being part of the person’s identity and body image. Results have important implications for young professionals with T1DM launching professional careers.

Disclosure

J. Saylor: None. J.B. Yorgason: None. M.A. Millett: None. A.L. Jackson: None. M. Ness: None. A. Floreen Sabino: None.
877-P: Correlates of Retention among Participants in the National Diabetes Prevention Program (National DPP) Lifestyle Change Program, 2012-2017
Authors: MASALOVICH SVETLANA , SOLER ROBIN , SMITH BRYCE , JABRAH RAJAI , ELY ELIZABETH , CANNON MICHAEL
Published: June 2019

Background: The National DPP lifestyle change program (LCP) is proven to prevent or delay type 2 diabetes among adults with prediabetes. The yearlong LCP consists of a minimum of 22 coach-led group-sessions offered at weekly and then monthly intervals. Program retention is highly correlated with desired outcomes but can be challenging to achieve.

Methods: We analyzed data from organizations that participate in CDC’s Diabetes Prevention Recognition Program. Specifically, we computed weekly retention proportions and used random effects models to account for confounding and organization-specific correlation. We limited our analyses to the 38,441 individuals who enrolled in CDC-recognized in-person LCPs from 2012-2017.

Results: Retention typically dropped 1%-2% each week, but dropped ∼5% between weeks 1-2 and between weeks 16-17, where session frequency typically transitions from weekly to monthly. Retention at 18 weeks varied by years of age (46% for 18-29, 53% for 30-44, 60% for 45-54, 67% for 55-64, 68% for 65-75), race/ethnicity (70% for non-Hispanic whites, 60% for non-Hispanic blacks, 52% for Hispanics, 51% for Other), mean physical activity minutes (13% for 0, 49% for 1-30, 72% for 30-149, 85% for ≥150), and mean weekly percentage of body weight lost (32% for ≤0, 66% for 0-0.25, 73% for 0.25-0.5, 74% for ≥0.5). Retention did not vary by sex (63% for men, 63% for women). The random effects model results were consistent with these findings.

Conclusions: Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations, and among those who report less physical activity or weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions, offer the biggest opportunity for impact.

Disclosure

S. Masalovich: None. R. Soler: None. B. Smith: None. R. Jabrah: None. E. Ely: None. M. Cannon: None.
88-LB: Effects of Grape Skin Extract (GSE) on Glycemic Response to a Starch Challenge in Prediabetic Subjects
Authors: ALKASEM MEIS , ABDALHAKAM IBRAHEM , SULEIMAN NOOR N. , ISKANDARANI AHMAD NABIL , SAMRA TAREQ A. , MIR FAYAZ AHMAD , MOHAMMAD RAMZI M. , ABOU-SAMRA ABDUL-BADI , ZHOU KEQUAN , SKARULIS MONICA C.
Published: June 2019

Prediabetes is a condition leading to increased risk of diabetes and its complications and cardiovascular disease. Annually, ∼10% prediabetic subjects progress to T2D. We, and other investigators, reported that grape skin extract (GSE) impacts postprandial glycemia through alpha glucosidase inhibition. This study aims to examine the effect of GSE on glycemic response to a starch challenge in healthy prediabetic subjects. The study was approved by the IRB of Hamad Medical Corporation. Subjects were screened from a high-risk population based on family history and/or fasting glucose (5.7-7.3 mmol) and IGT confirmed with 75 gram OGTT. Subjects were randomized to GSE capsule 600 (N=4), 1200 (N=8), 1800 (N=15) or 2400 mg (N=14). Each received a meal of 35 gram (uncooked weight) rice with or without the assigned dose of GSE and blood glucose was measured at time 0, 15, 30, 60 and 120 minutes. Area under the curve (AUC) was calculated using the trapezoidal method and the subjects were classified into “responders” or “non-responders” if AUC after GSE was reduced by at least 1 SD.

A total of 41 eligible subjects (83% male; age 29±8 years; BMI 23.2%±5.9, 34% Arab, 24% African, 17% Asian, 24% Indian) with prediabetes were enrolled. A total of 4 (9.7%)subjects decreased AUC by 2SD; 24% decreased by 1 SD and the remainder had no positive response to a single dose of GSE. There were no responders to 600 mg; 2 in 1200 mg; 4 in 1800 mg; and 3 in 2400 mg dose. There were no differences between the responders and non-responders in clinical or biochemical characteristics.

In conclusion, 24% of prediabetic subjects had a positive response to GSE in a starch challenge test. The value of the test in characterizing prediabetic subjects who may benefit from GSE to reverse their prediabetic condition is currently under further investigation. In Qatar, the prevalence of diabetes is 17% and expected to increase. Studies to develop natural products to prevent diabetes are of great public health interest.

Disclosure

M. Alkasem: None. I. Abdalhakam: None. N.N. Suleiman: None. A.N. Iskandarani: None. T.A. Samra: None. F.A. Mir: None. R.M. Mohammad: None. A. Abou-Samra: None. K. Zhou: None. M.C. Skarulis: None.

Funding

Qatar National Research Fund
88-OR: hsTroponin and NT-proBNP in Type 1 Diabetes (T1D): Association with Incident Cardiovascular Disease (CVD) and Major Atherosclerotic Cardiovascular Events (MACE)
Authors: COSTACOU TINA , SAENGER AMY K. , ORCHARD TREVOR J.
Published: June 2019

High-sensitivity troponin T (hsTnT), a marker of CVD, and N-Terminal pro B-Type Natriuretic Peptide (NT-proBNP), a marker of heart failure, have not been widely studied in type 1 diabetes. We thus assessed the ability of these markers to independently predict CVD and MACE in a cohort with childhood-onset T1D (n=583, mean age 29 and duration 21 years) during a median follow-up of 21 years. CVD was defined as CVD death, myocardial infarction, revascularization, angina, or ischemia, and MACE as CVD death, myocardial infarction, or stroke. hsTnT and NT-proBNP were assessed with electrochemiluminescence immunoassays. Median hsTnT was 5.0 ng/L (IQR: 2.0, 10.0) and median NT-proBNP was 22.0 pg/mL (7.0, 61.0). In Cox proportional hazards models allowing for diabetes duration, gender, BMI, smoking status, HbA1c, hypertension status, HDL and non-HDL cholesterol, white blood cell count, estimated glomerular filtration rate and albumin excretion rate, both log hsTnT (HR=1.30, 95% CI: 1.06-1.59) and log NT-proBNP (HR=1.29, 95% CI: 1.13-1.48) independently predicted CVD. However, the prediction of CVD between models with and without these two markers improved only marginally (Uno’s concordance statistic p=0.06). Furthermore, log hsTnT was a slightly weaker predictor of MACE (HR=1.22, 95% CI: 0.97-1.55) compared with log NT-proBNP (HR=1.28, 95% CI: 1.11-1.47). The addition of these two markers to models already including traditional risk factors did not enhance MACE prediction (p=0.39).

In conclusion, although hsTnT and NT-proBNP independently predicted both CVD and MACE, they marginally increased the area under the curve only for CAD in this type 1 diabetes cohort.

Disclosure

T. Costacou: None. A.K. Saenger: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.

Funding

National Institutes of Health (DK34818); Rossi Memorial Fund