bluuebunny/crossref_metadata_2025 huggingface dataset:
658-P: Influence of Patient Health Literacy (HL) on Supporter Roles in Diabetes Self-Management
Authors: FIELDS BETH , LEE AARON A. , PIETTE JOHN , TRIVEDI RANAK B. , OBROSKY D. SCOTT , MOR MARIA K. , HEISLER MICHELE , ROSLAND ANN-MARIE
Published: June 2019

Background: It is unknown whether family members or friends (‘supporters’) tailor their assistance to the unique needs of patients with diabetes and low HL.

Methods: Surveys were conducted among 239 VA healthcare system patients with type 2 diabetes who were 30-70 years old, had A1c>8% or high blood pressure, did not have dementia or need help with basic activities of daily living, and had an unpaid supporter who was involved in their care. Patients reported the frequency of supporter involvement with diabetes management roles (e.g., help filling medications). HL was assessed using two items from the well-validated Chew scale: 1) How often do you have problems learning about medical conditions because of difficulty understanding written information (0=none of the time, 4=all of the time), and 2) How confident are you filling out medical forms by yourself (0=extremely, 4=not at all). Those responding ‘3’ (somewhat) or greater were designated as low health literacy. Logistic regression models were used to identify the independent association between patient HL and types of supporter assistance.

Findings: Patients with low HL were significantly more likely than patients with adequate HL to have a supporter with low HL (32% vs. 18% of supporters, p=0.02). Low patient HL was significantly associated with higher odds of supporters helping with: deciding when to call doctor (AOR=2.21, 95% CI: 1.10-4.42); remembering medical appointments (AOR=2.48, 95% CI: 1.24-4.98); navigating the health system (AOR=2.67, 95% CI: 1.34-5.32); and attending medical appointments with patient (AOR=2.11, 95% CI: 1.11-3.96). Patient HL was not associated with whether supporters helped with filling or taking medications, or managing diet and exercise.

Conclusion: Supporters of patients with low HL were more likely to have low HL themselves, and to help patients with care coordination and equally likely to help with carrying out diabetes medication and lifestyle behaviors compared to patients with adequate HL.

Disclosure

B. Fields: None. A.A. Lee: None. J. Piette: None. R.B. Trivedi: None. D. Obrosky: None. M.K. Mor: Stock/Shareholder; Spouse/Partner; AbbVie Inc. M. Heisler: None. A. Rosland: None.

Funding

U.S. Department of Veterans Affairs (IIR 14–074-1); Michigan Center for Diabetes Translational Research (NIDDK5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (NIA AG-024824)
67-OR: Plasma Copeptin and Risk for Lower Extremity Amputation in People with Type 1 and Type 2 Diabetes
Authors: POTIER LOUIS , ROUSSEL RONAN , MOHAMMEDI KAMEL , SAULNIER PIERRE , MARRE MICHEL , HADJADJ SAMY , VELHO GILBERTO
Published: June 2019

Recently, an increased risk of lower extremity amputation (LEA) was observed with canagliflozin, a SGLT2 inhibitor, in the CANVAS trial although observational studies showed conflicting results. This association could be related to the contraction of plasma volume induced by SGLT2 inhibition. In this case, copeptin, a surrogate marker of vasopressin, should be associated with LEA. Our aim was to analyze the association between LEA and plasma copeptin in 4 cohorts of patients with type 1 and type 2 diabetes (T1D, T2D). Analysis were done in 2 pooled cohorts of patients with type 2 diabetes (DIABHYCAR, SURDIAGENE, n=4532) and 2 pooled cohorts of patients with type 1 diabetes (GENESIS, GENEDIAB, n=712). Cox regression model was fitted to compute hazard ratio (HR) and 95% CI for incident LEA by tertiles of copeptin at baseline. C-statistic, integrated discrimination improvement (IDI) and continuous net reclassification improvement (cNRI) were used to assess the prognostic value of copeptin in LEA discrimination. Mean follow-up was 5.3 years for DT2 and 6.3 for DT1. Incidence of LEA was 1.6% (T1), 2.6% (T2) and 3.3% (T3) for DT2 (p<0.001) and 3.9% (T1), 3.3% (T2) and 10% (T3) for DT1 (p=0.003). In a Cox multivariable analysis model (adjusted for cohort, sex, diabetes duration, hypertension, previous cardiovascular and peripheral arterial disease and glomerular filtration rate), HR for LEA was 1.91 (1.13-3.24; p=0.016) in DT2 and 2.76 (1.05-7.66; p=0.04) in DT1, both for T3 vs. T1. Plasma copeptin yielded incremental information for the risk of LEA in DT2: C-statistic change 0.012 (p=0.005), IDI: 0.007 (0.005-0.025, p=0.05), cNRI: 0.13 (0.03-0.29, p=0.03). Plasma copeptin is significantly associated with an increased risk of LEA in patients with T1D and T2D. Mechanisms underlying this association are not known but could be related to hydration status. Our results suggest a potential role of contraction volume effect of SGLT2 inhibitor in the higher risk of LEA possibly associated with this class.

Disclosure

L. Potier: Advisory Panel; Self; Merck Sharp & Dohme Corp. Consultant; Self; Sanofi. R. Roussel: Advisory Panel; Self; Merck Sharp & Dohme Corp., Sanofi. Consultant; Self; Abbott, AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Physiogenex. Research Support; Self; Janssen Pharmaceuticals, Inc. K. Mohammedi: None. P. Saulnier: None. M. Marre: Advisory Panel; Self; Servier. Board Member; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S. S. Hadjadj: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Bayer AG, Janssen Research & Development. Speaker's Bureau; Self; Abbott, Valbiotis. G. Velho: None.
671-P: Patients Feel Responsible for Self-Care and Understand That Clinic Visits Are Vital, but Want More Interim Support
Authors: WOLF RACHEL , YEAGER KATE A. , CAUDLE JANE , WAN CLAIRE , BARNES CATHERINE S. , ZIEMER DAVID C.
Published: June 2019

Routine clinic visits provide intermittent opportunity for patients and providers to review patient status and adjust diabetes management. Yet little is known about patient views of the clinic role in managing diabetes.

Purpose: To examine patient perceptions of the role of clinic visits.

Methods: A research nurse conducted semi-structured, audiotaped interviews with a convenience sample of 25 participants from a study of a coaching intervention in an urban diabetes clinic. Participants had A1c ;>7, at least two clinic visits and a prescription for insulin or high dose oral agents. Two qualitative researchers analyzed transcript content to identify themes on the clinic role in diabetes management.

Results: The population was 96% black, 52% female, with mean age of 56 years and A1c of 8.3%. Most participants (76%) reported household incomes < $15,000/year. Four main perception themes were identified: (1) “It’s on me.” (2) being held accountable (3) management prescription and (4) supportive relationships. Almost all felt responsible for following their diabetes management plans (88%). They perceived that clinic encounters provided assessment/feedback of their diabetes status and management and gave them incentive to improve self-care. They often expressed faith in providers and a sense that providers would give them the guidance to improve health. Some patients reported collaboration (36%) with providers, and they often valued nurse educators as integral to personalized, holistic care. Participants lamented visit time constraints and lack of support between visits. Yet some overcame these barriers by seeking out information on their own and preparing for visits ahead of time.

Conclusions: Diabetes requires a significant degree of self-management. Patients view clinic encounters as an important component of diabetes care that supports their self-management but desire more contact in and between visits.

Disclosure

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

Funding

American Diabetes Association (7-05-CR-03 to C.S.B.)
68-LB: Being Physically Active Does Not Rescue Skeletal Muscle Microvascular Dysfunction in Overweight Individuals
Authors: BETIK ANDREW C. , MORRISON DALE J. , PARKER LEWAN , ROBERTS-THOMSON KATHERINE , KESKE MICHELLE
Published: June 2019

Skeletal muscle microvascular blood volume increases after a meal to increase glucose and insulin delivery to the muscle. In obese individuals this microvascular action in muscle is lost (Keske et al. 2009 Diabetes Care). However, exercise training can improve muscle microvascular responses in the postprandial state (Russell et al. 2017 Diabetes Care). We hypothesized that people who are overweight but are habitual exercisers would have similar increases in microvascular perfusion following a mixed meal as people who are lean and exercise regularly.

Methods: Nine lean (LEAN+Ex, BMI < 23 kg/m2) and five overweight (OW+Ex, BMI > 27 kg/m2) physically active participants (> 75 min of vigorous intensity or > 150 min of moderate intensity exercise per week) were recruited. Body composition was assessed by DEXA. After an overnight fast, participants underwent a mixed meal challenge (1214 kJ). Thigh muscle microvascular responses were assessed by contrast-enhanced ultrasound at rest and 1 hour after the mixed meal.

Results: Data are presented in Table 1 (Mean ± SE, * p<0.05 vs. LEAN+Ex; + p<0.05 vs. resting).

Conclusion: The postprandial increase in microvascular blood volume in the Lean+Ex group was not observed in the OW+Ex group. These data suggest that habitual exercise is not sufficient to overcome the negative effects of being overweight on muscle microvascular responses to a mixed meal.

Disclosure

A.C. Betik: None. D.J. Morrison: None. L. Parker: None. K. Roberts-Thomson: None. M. Keske: None.

Funding

Institute for Physical Activity and Nutrition
68-OR: The Combined Impact of ABI and TcPO2 on Three-Year Mortality in Patients with Type 2 Diabetes and Foot Ulcers
Authors: FAGHER KATARINA , LONDAHL MAGNUS
Published: June 2019

A diabetic foot ulcer (DFU) is associated with increased cardiovascular risk and mortality independently of ulcer etiology (ischemic, neuro-ischemic or neuropathic). Traditional cardiovascular risk factors can partly, but not alone explain this risk increment. Ankle-brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is also considered a marker for increased cardiovascular risk. However, ABI do not reflect microvascular dysfunction, a condition often seen in DFU patients. Transcutaneous oxygen pressure (TcPO2) is considered to better evaluate microvascular function and has in previous studies shown correlations with both wound healing and survival. The aim of this study was to evaluate the combined impact of a low TcPO2 (< 30 mmHg) and a pathological ABI (< 0.8 or ≥1.4) on 3-year mortality rates in patients with DFU. We evaluated 202 type 2 diabetic patients with DFU, aged 18-85 years. As shown in the Figure, individuals with a combination of pathological ABI and low TcPO2 had the worst survival rates, with 3-year mortality of 54%, compared to 42% in those with pathological ABI alone and 21% in those with normal ABI/TcPO2. Age did not differ between groups (median 75, 75, 74 years respectively).

In conclusion, combining ABI and TCPO2 in routine assessment could provide additional predictive information when risk stratifying patients with type 2 diabetes and DFU.

Disclosure

K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.

Funding

Swedish Diabetes Foundation; Skåne County Councils Research and Development Foundation; Lund University
680-P: Impact of Continuous Glucose Monitoring Shared Medical Appointments on Planned Self-Management Changes
Authors: BLANCHETTE JULIA E. , NOE DAWN , GALLOWAY NICHOLAS , SULLIVAN HILLARY , HA ANNY , ISAACS DIANA
Published: June 2019

Introduction: Continuous glucose monitoring (CGM) measures glucose up to 288 times per day allowing people with diabetes (PWD) to see in real-time how medications, food, exercise, and stress, affect glucose levels. Clinicians interpret this information to make lifestyle and medication recommendations.

Objective: To identify common learning outcomes and planned self-management changes resulting from CGM shared medical appointments. Study Design: A two-part CGM Shared Medical Appointment was led by certified diabetes educators (pharmacists, nurses and dieticians). Professional CGM devices were inserted and participants returned the following week for removal, discussion and education in a group format. Inclusion criteria for this study were as follows: age > 18 years, >3 days of CGM data, and attendance of both classes. A post-course survey was given with structured interview questions asking (1) “What is one thing you learned from the CGM class experience?” and (2) “Which changes do you plan to make to your diabetes care?” Questions were answered in written format. After digital transcription entry, data were coded and analyzed using content analysis to devise themes by two reviewers.

Findings: A total of 170 PWD participated in the CGM class and 140 (82.35%) completed the post-course survey. Class sizes ranged from 3-6 participants. The most common learning outcomes were nutrition self-management knowledge (35.77%), pattern interpretation (18.25%) and blood glucose awareness (13.87%). The most common planned self-management changes were nutrition related (56.82%), self-management behavioral goals (24.42%) (log patterns, increase monitoring frequency) and medication adjustments (23.48%) (basal rates, carbohydrate ratios, timing and consistency of medications).

Conclusion: Continuous Glucose Monitoring Shared Medical Appointments are an innovative strategy to facilitate lifestyle changes and medication adjustments for people with diabetes.

Disclosure

J.E. Blanchette: Consultant; Self; Dexcom, Inc., Tandem Diabetes Care. D. Noe: None. N. Galloway: None. H. Sullivan: None. A. Ha: Consultant; Self; Tandem Diabetes Care. D. Isaacs: Advisory Panel; Self; BD, Sanofi-Aventis.
686-P: Temporal Association of Adherence to Diabetes Self-Management and Glycemic Control from Adolescence to Adulthood in a Longitudinal Cohort of Women with Type 1 Diabetes (T1D)
Authors: SEREIKA SUSAN M. , FISCHL ANDREA F. , CHARRON-PROCHOWNIK DENISE
Published: June 2019

Adherence to recommended diabetes self-management (DSM) is essential for glycemic control. Little is known regarding the association between DSM adherence and glycemic control as adolescents transition to adulthood. This secondary analysis examined the association of DSM adherence and glycemic control in adolescence and its temporal association with DSM adherence and glycemic control reported as adults in women with T1D. Data from female adolescents who participated in a preconception counseling intervention trial were linked with data collected in adulthood via a retrospective survey. DSM adherence was assessed regarding following a diet plan, checking blood sugar, taking insulin, exercising regularly, and keeping appointments and summed as a score ranging 5 to 25, where higher scores suggest greater DSM adherence. Glycemic control was measured via self-report (scaled as 1=poor to 4=excellent) and finger stick A1c. Of the 30 T1D women followed (100% Caucasian, Age [M±SD]: 25.8±2.4 years, Age at T1D diagnosis: 8.6±4.8 years), as teens most reported being adherent to the five DSM activities on average "most of the time" (20.4±2.4), being in good to excellent control (n=20, 66.7%; 2.8±0.7), and having a mean A1c of 7.5±0.7%, with moderate correlations between DSM adherence and self-reported glycemic control (r=.50, p<.001) and A1c (r=-.41, p=.005). As adults, mean DSM adherence improved (23.1±3.3, p=.001), while no significant changes were found for either self-reported glycemic control (2.7±0.8, p=.476) or A1c (7.2±1.0, p=.342). DSM adherence in adolescence was not associated with DSM adherence in adulthood (r=.21, p=.276), yet moderate associations were found for self-reported glycemic control (r=.51, p=.004) and A1c (r=.59, p=.044). These findings suggest DSM adherence may improve as adolescent females transition to adulthood and is related to glycemic control both in adolescence and adulthood.

Disclosure

S.M. Sereika: None. A.F. Fischl: None. D. Charron-Prochownik: None.

Funding

American Diabetes Association (1-11-CT-10, 7-02-CR-06 to D.C-P.)
689-P: The Effect of Multidisciplinary Intervention on Diabetes Control in Patients with Poor Glycemic Control
Authors: GABAY LINOY , MENASHE IDAN , YEHOSHUA ILAN
Published: June 2019

Many studies recommend that efficient diabetes care should be provided by a multidisciplinary team, but the optimal team composition and the independent contribution of each type of health professional on the studied outcomes are not well known. Additionally, real world evidence is needed to better understand the effectiveness of group approach strategies.

Objectives: to examine the effect of multidisciplinary intervention and group therapy on diabetes control.

Methods: A retrospective cohort study was performed among poorly controlled type 2 diabetes patients (HbA1c≥9%) insured by Maccabi Health Services, between 2012-2015. At the end of two-year follow-up (2013-2014), patients were divided into 2 groups, well controlled (HbA1c≤8%) and poorly controlled diabetes (HbA1c≥9%). Visits to each health professional (family physician/nurse/diabetic nurse/dietitian/etc.) and participation in diabetic group seminars were compared between these groups. Multivariable logistic regression was performed to assess the optimal multidisciplinary team composition associated with glycemic control.

Results: Of 8,811 eligible patients with HbA1c≥9% at baseline, 2,753 (31.2%) reached well-controlled diabetes and 3,929 (44.6%) remained poorly controlled. In multivariate analysis, primary care physician, dietitian and exercise specialist visits were significantly associated with glycemic control (p<0.05).

Visits to a dietitian and exercise specialist improved glycemic control by 18% and 16% respectively, and care by family physician improved it by 1%.

In a multivariable model accounting for the number of visits to each provider and glycemic control, each additional group session improved the likelihood of achieving glycemic balance by 13%.

Conclusion: These results suggest that the optimal treatment of poorly controlled diabetes is a multidisciplinary team consists of physician, dietitian and exercise specialist, combined with diabetes group education.

Disclosure

L. Gabay: None. I. Menashe: None. I. Yehoshua: None.

Funding

Maccabi Healthcare Services
690-P: Building a Healthy Temple: A Faith-Based Diabetes Self-Management Support Program
Authors: WILMOTH SUMMER R. , CARRILLO LEAH , PAN MEIXIA , CHAVARRIA DIANA , WILHITE BRADLEY , PARRA-MEDINA DEBORAH , HE MEIZI
Published: June 2019

Background and Objective: Type 2 diabetes disproportionally affects Hispanics. Diabetes self-management is key to preventing its life threating complications. Most Hispanics affiliate with churches, presenting a promising venue for delivering diabetes self-management support (DSMS) program. “Faith-placed” (FP) programing refers to health intervention implemented in church setting; while "faith-based" (FB) signifies integrating spirituality with health interventions. Building a Healthy Temple DSMS Program integrates spirituality with DSMS to improve diabetic outcomes.

Setting and Subjects: Predominantly Hispanic churches in Texas; Diabetic churchgoers.

Methods: This 13-week cluster-RCT assigned 18 churches to: 1) FB Group receiving a Health Sermon, 6-session DSMS, and 6-session Healthy Bible Study delivered by trained church lay leaders; or 2) FP Group receiving 6-session DSMS accompanied by a 7-session partial attention control curriculum delivered by outside professionals. Key outcome measures included HbA1c, BMI, waist circumference (WC), DSM Self-efficacy and diabetes quality of life (DQL) using the Problem Areas in Diabetes Scale (PAID). Data are collected at baseline, 6, 9, and 12 months. Intervention effects were determined using Linear mixed-effect models, controlled for age, gender and baseline corresponding outcome measures.

Preliminary Results: To date, 3 FP (n=48) and 3 FB churches (n=49) have delivered interventions and collected 9 month data. Post intervention, the FB Group appears to have a lower HbA1c than the FP Group (6.56 vs. 6.79; p=0.095). Single-group sub-analyses showed that only the FB Group sustained a 4% HbA1c reduction at 9 months (p<0.05), and a 16% increase in DSM Self-efficacy scores at 6 and 9 months (p<0.05). Compared to baseline, both groups significantly reduced WC and PAID scores (i.e., improved DQL) at 6 and 9 months.

Conclusions: Integrating spirituality with DSMS could lead to improved diabetes outcomes among Hispanic diabetic churchgoers.

Disclosure

S.R. Wilmoth: None. L. Carrillo: None. M. Pan: None. D. Chavarria: None. B. Wilhite: None. D. Parra-Medina: None. M. He: None.

Funding

American Diabetes Association (1-17-ICTS-029 to M.H.)
7-LB: Dichloroacetate Improves Cognitive Function during Hypoglycemia in T1DM Patients
Authors: GROSKREUTZ DEREK , TRICO DOMENICO , TAI NINGWEN , BELFORT-DEAGUIAR RENATA , LEVENTHAL JESSICA , LAM WAI , KNIGHT MARI-LYNET , GANNON JENNA , HERZOG RAIMUND I.
Published: June 2019

Magnetic Resonance Spectroscopy (MRS) studies have suggested that exposure to recurrent hypoglycemia (RH) reduces brain cortical Pyruvate Dehydrogenase (PDH) flux in animal models. Examination of rat cortical RNA for inhibitory PDH kinase (PDK) isoform expression patterns identified a two-fold upregulation of PDK4 (p>0.01) after three episodes of hypoglycemia. To date no study has examined the functional role of PDH complex inhibition in the cognitive deficits associated with hypo in patients with T1DM. In a randomized controlled cross-over trial of 11 intensively treated T1DM subjects we examined whether PDK inhibition by dichloroacetate (DCA; 12.5mg/kg), which maintains PDH in its active state might restore cognitive function, counterregulatory hormonal responses and symptoms during clamped hypoglycemia (target 50mg/dL). Cognitive testing included measures of visual matching ability and short term visual and auditory memory as well as the ability to manage conflicting information while ignoring task-irrelevant information. Symptom ratings during hypoglycemia were measured using a modified Edinburgh scale. We found that DCA ingestion is associated with increased performance related to visual memory (DCA: 89% correct vs. Placebo: 69% correct, p=0.049), as well as a faster response time during the multitasking test (549ms DCA vs. 603ms placebo; p=0.028). On the Edinburgh scale, patients reported lower ratings of warmness during hypoglycemia with DCA vs. Placebo (2.5 vs. 3.6; p=0.075). Furthermore, we did not observe an effect of DCA on CRR hormonal responses. These results suggest that inhibition of PDH flux by enhanced PDK activity significantly contributes to cognitive impairment under hypoglycemia and may contribute to subjective symptoms and possibly hypoglycemia awareness. We therefore conclude that strategies focusing on reactivation of oxidative glucose metabolism in the brain may play an important role in mitigating the negative impact of hypoglycemia on cognitive function.

Disclosure

D. Groskreutz: None. D. Trico: None. N. Tai: None. R. Belfort-DeAguiar: Research Support; Self; Silver Palate Kitchens, Inc. J. Leventhal: None. W. Lam: None. M. Knight: None. J. Gannon: None. R.I. Herzog: Consultant; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc.

Funding

JDRF
70-LB: Fat Mass and Obesity-Associated rs9939609 Gene Variant Is Related to Fasting Glucose in Children with Mental Health Conditions
Authors: WIEDEMAN ALEJANDRA M. , NGAI YING FAI , HENDERSON AMANDA M. , PANAGIOTOPOULOS CONSTADINA , DEVLIN ANGELA M.
Published: June 2019

Over one million Canadian children are estimated to have a mental health condition, such as depression, anxiety, and attention deficit hyperactivity disorder. Many are treated with second-generation antipsychotics (SGA). In some children, SGA treatment is associated with excessive weight gain and metabolic complications including a 3-fold greater risk for type 2 diabetes. We currently have no way to identify SGA-treated children at risk for metabolic complications. The goal of our study is to determine if the fat mass and obesity-associated gene (FTO) rs9939609 variant is associated with metabolic complications in SGA-treated children. A cross-sectional population of SGA-treated (n=232) and SGA-naïve (n=378) children (≤18y) were recruited through Child and Adolescent Psychiatry at BC Children’s Hospital. Participants were genotyped, metabolic markers assessed; dietary intakes were estimated in a subset of children (n=79). The FTO rs9939609 variant genotype frequencies were not different between SGA-treated (TT 44%, TA 38%, AA 18%) and SGA-naïve (TT 42%, TA 39%, AA 19%) children. An interaction was found between SGA status and FTO genotype for fasting glucose (p=0.014). In SGA-naïve children, the A allele carriers compared to non-carriers had higher fasting glucose (4.95 vs. 4.78 mmol/L; p=0.001) in a model adjusted for age, sex, ethnicity, and zBMI. This difference was not observed in SGA-treated children. Daily energy intakes of A allele carriers were not significantly higher compared to non-carries in SGA-treated (1855 vs. 2087 kcal) and SGA-naïve (1606 vs. 1871 kcal) children. Our findings suggest that the A allele of the FTO rs9939609 variant is associated with higher fasting glucose in SGA-naïve children with mental health conditions.

Disclosure

A.M. Wiedeman: None. Y. Ngai: None. A.M. Henderson: None. C. Panagiotopoulos: Advisory Panel; Self; Dexcom, Inc. A.M. Devlin: None.

Funding

BC Mental Health & Substance Use Services
702-P: Perceptions of Caribbean Type 2 Diabetes Patients towards Insulin Prescription and Therapy
Authors: EZENWAKA CHIDUM E. , ONUOHA PHILIP C. , EXTAVOUR RIAN MARIE , YEARWOOD SAFIYA S.
Published: June 2019

Background and Aim: Previous research studies have shown that poorly controlled type 2 diabetes patients do not receive insulin therapy because of the resistance of the patients to insulin prescription. This study aimed to assess the belief of Caribbean insulin-naive type 2 diabetes patients on insulin therapy.

Methods: We recruited 510 insulin-naive type 2 diabetes patients who have had diabetes for at least five years for a questionnaire interview. The questionnaire was a modified version of a validated research questionnaire previously used by other researchers. Data collected was analysed with SPSS software using chi-square to test for significances.

Results: The majority of the patients were females, of East Indian descent, have had diabetes for more than 10 years and take more than two different diabetes medications daily. About 67% and 81% of the patients do not believe that insulin therapy will cause them hypoglycaemia and weight gain respectively. Similarly, a significant percent do not believe that taking insulin will interfere with their normal lifestyle activities (72.2%, p=0.048). Although, a majority (64%) of the patients believe that taking insulin translates to personal failure in optimal blood glucose control, an overwhelming percent (90%) do not believe that taking insulin will cause people to treat them differently. Whereas a majority of the patients do not believe that taking insulin will be helpful in preventing long-term diabetes complications (63.9%, p=0.001), 51% thought that switching to insulin therapy would make them feel better within six months.

Conclusion: Contrary to several reports, this study shows that insulin-naïve Caribbean type 2 diabetes patients do not have a significant negative perception towards insulin therapy. This finding might be related to the socio-cultural background of the patients studied.

Disclosure

C.E. Ezenwaka: None. P.C. Onuoha: None. R. Extavour: None. S.S. Yearwood: None.

Funding

University of the West Indies at St. Augustine
704-P: Tailoring of a Pragmatic MA Health Coaching Intervention for Diverse T2D Populations
Authors: CLARK TAYLOR , GALLO LINDA , EUYOQUE JOHANNA A. , SAVIN KIMBERLY L. , BRAVIN JULIA I. , SANDOVAL HALEY , LEDESMA DUVIA LARA , PHILIS-TSIMIKAS ATHENA , FORTMANN ADDIE L.
Published: June 2019

To address the burgeoning primary care demand-capacity imbalance, team-based models using medical assistants (MAs) to provide evidence-based, disease self-management support have been proposed. Randomized controlled trials (RCT) have shown MA health coaching improves clinical outcomes in chronic disease populations; however, pragmatic research is needed to evaluate effectiveness and feasibility in real-world health settings. Thus, we adopted a unique, cluster RCT to compare MA health coaching with usual care in N=600 adults with T2D, plus HbA1c ≥8.0% and/or SBP ≥140 mmHg, and/or LDL-C ≥100 mg/dL. Importantly, this in-progress trial examines implementation and outcomes across two very distinct settings: a federally qualified health center (Site A; majority Hispanic/Spanish-speaking, low SES patients; M age = 58.2) and a large, private insurance-based health system (Site B; majority non-Hispanic white/English-speaking, middle/upper SES; M age = 73.4). To facilitate integration with routine clinic processes, existing MAs are trained to perform at top of license, and EMR-based risk stratification identifies qualifying patients presenting to clinic each day. MA health coaches join primary care visits to understand the care plan and provide self-management support in conjunction with medical visits and by phone for 1 year. Dosage and intervention components (medication reconciliation, assessment, goal setting, lab review) are tailored to patient needs. A process evaluation revealed differences between Sites A and B in session frequency (M = 7 ± 3 vs. 4 ± 2), duration (M = 20 ± 15 vs. 14 ± 10 minutes), and focus (healthful eating vs. blood pressure monitoring) (all ps<.05). Marked differences in the need for, and focus of self-management support parallel the relative differences in clinical control in these two distinct T2D populations (M A1c = 10.4 ± 1.8 vs. 9.4 ± 1.7%; M LDL-C = 142.1 ± 34.6 vs. 129.5 ± 21.7 mg/dL, ps<.05). Valuable, site-based implementation successes and challenges will be presented.

Disclosure

T. Clark: None. L. Gallo: None. J.A. Euyoque: None. K.L. Savin: None. J.I. Bravin: None. H. Sandoval: None. D. Lara Ledesma: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. A.L. Fortmann: None.

Funding

National Institutes of Health
71-OR: Dynamic Nrf2 Expression in Cutaneous Wounds Regulates Skin Reepithelialization
Authors: VILLARREAL PONCE ALVARO P. , DAVID JOSHUA A. , TIRUNEH MELAT WORKU , ABDOU SALMA , SULTAN DARREN , KWONG JENNIFER , KUHN JOSEPH , RABBANI PIUL S. , CERADINI DANIEL
Published: June 2019

Diabetic ulcers are chronic cutaneous complications that amount to more than $50M in healthcare costs and are the leading cause of lower extremity amputations. In part, diabetic wound repair pathology results from over-production of reactive oxygen species (ROS) that stem from mis-regulation of Nrf2, a master transcriptional regulator of antioxidant genes. While regulation of Nrf2 and redox balance is critical for proper wound repair, the precise role of Nrf2 in coordinating wound regeneration is unclear. Here, utilizing an in-depth analysis of Nrf2 in the wound environment, we uncover an indispensable role of epithelial Nrf2 in promoting adult cutaneous re-epithelialization. Through spatio-temporal expression analysis and chromatin immunoprecipitation, we show mis-regulation of Nrf2 in diabetic wounds results from defective nuclear translocation of Nrf2 in epithelial cells of the wound environment (WT 96.97±3.58% vs. Diabetic 22.5±16.40%). Integrating K14-CreER;Nrf2flox/flox double transgenic mice, we demonstrate epithelial-specific deletion of Nrf2 results in a significant wound healing delay that is reminiscent to the diabetic wound burden (Control 16±0 days vs. Diabetic 32±0 days vs. KO 33±2 days). In addition to compromised proliferation indicated by reduced expression of Ki67+ in the epidermis (Control 66.36±7.63% vs. KO 25.78±4.01% p=0.0004), Nrf2-null keratinocytes exhibit reduced capacity to migrate in explant cultures. Using high-throughput transcriptome analysis and ex vivo functional assays, we show a prominent role of Nrf2 in regulating epidermal migration by governing directly governing onset of epithelial-to-mesenchymal transition (EMT) by regulating expression of Snai1 and Twist1 (5.6 and 8.9-fold reduction, respectably), two important regulators of EMT. Together, we provide evidence demonstrating the importance of Nrf2 in regulating critical events underlying wound repair and highlight its value as a promising agent in therapeutic intervention.

Disclosure

A.P. Villarreal Ponce: None. J.A. David: None. M. Worku Tiruneh: None. S. Abdou: None. D. Sultan: None. J. Kwong: None. J. Kuhn: None. P.S. Rabbani: None. D. Ceradini: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-16-ACE-08 to D.C.)
710-P: The Relationship between Health Literacy, Cardiovascular Disease Knowledge, and Diabetes Prevention Knowledge in Middle Eastern Patients at a Free Clinic
Authors: KAWATA CHRISTOPHER , JIANG LUOHUA
Published: June 2019

This study's purpose was to investigate the level of health literacy, cardiovascular disease (CVD) knowledge and diabetes prevention knowledge, as well as the relationship among them, in the Middle Eastern population. A survey was conducted among the Middle Eastern patients of a free health clinic to obtain information on the health literacy and knowledge of these patients. A total of 73 surveys were collected and analyzed in this study. Print literacy and numeracy were strongly correlated with each other (r=0.4949, P<0.0001). Both print literacy and numeracy were significantly correlated with the Diabetes Prevention knowledge score (print literacy: r=0.2764, P=0.0179; numeracy: r=0.4110, P=0.0003), but not with the CVD knowledge score. The Diabetes Prevention knowledge score had a high correlation with the CVD knowledge score (r=0.6980, P<0.0001). Furthermore, print literacy was significantly associated with self-reported health status (r=0.2637, P=0.0242). Our results support that health literacy was associated with some disease-specific knowledge and self-reported health status in the Middle Eastern population. Future research that includes measures of health behaviors and objective measure of health status could help provide more insight into the interactions between these variables in this understudied population.

Disclosure

C. Kawata: None. L. Jiang: None.
711-P: Factors Associated with Insulin Adherence in Patients Initiating Insulin Therapy: A Three-Month Prospective Study
Authors: MA SHIHMING , WANG RUEY HSIA , LEE CHUN MING , HSU HUI-CHUN , LEE TAO-CHUN , CHEN SIH-YU
Published: June 2019

Background: Insulin therapy is the most effective treatment to achieve optimal glycemic control in patients with type 2 diabetes (T2DM), while insulin adherence is crucial to achieve optimal glycemic control in insulin-treated patients. Understanding factors associated with insulin adherence in patients initiating insulin therapy will help to improve long-term insulin adherence.

Method: This study was a 3-month prospective study. One hundred and twenty-six (63 males and 63 females) patients with T2DM who were initiating insulin therapy were recruited. At baseline, when patients accepted receiving insulin therapy, demographic data (age, sex, duration of diabetes), psychosocial factors (health literacy, diabetes distress, quality of life, perceived benefits of insulin therapy, and perceived barriers of insulin therapy) were measured by self-reported questionnaires. Clinical data (HbA1c levels, body mass index) were collected from medical records. Adherence to insulin injection was measured by the 8-item Moriskey Medication Adherence Scale (MMAS) after 3 months of initiating insulin therapy. Higher score MMAS indicated poorer insulin adherence.

Results: The mean age of participants was 59.11 years (SD: 13.30). Baseline diabetes distress (r=0.202, p=0.024), quality of life(r=-0.227, p=0.010), and perceived benefit of insulin therapy (r=-0.189, p=0.035) significantly correlated with 3-month insulin adherence. Age, sex, baseline HbA1c levels, duration of diabetes, body mass index, health literacy, and perceived barriers of insulin injection did not significantly associate with insulin adherence.

Conclusion: Baseline psychosocial factors rather than demographic data and clinical data are associated with insulin adherence 3 months later. To improve insulin adherence, healthcare providers should address the diabetes distress, QoL, and perceived benefit of insulin therapy when educating patients initiating insulin therapy.

Disclosure

S. Ma: None. R.H. Wang: None. C. Lee: None. H. Hsu: None. T. Lee: None. S. Chen: None.
719-P: Inducible Estrogen-Related Receptor Alpha Overexpression Stimulates Skeletal Muscle Oxidative Metabolism and Improves Exercise Endurance in Mice
Authors: LI JING , HAMILTON ANGELICA , HUSS JANICE M.
Published: June 2019

Aerobic exercise promotes skeletal muscle insulin sensitivity by enhancing glucose uptake and storage and by increasing mitochondrial oxidative capacity. Exercise-responsive transcriptional pathways that regulate metabolism represent potential therapeutic targets to combat insulin resistance. The ERRα nuclear receptor regulates mitochondrial oxidative metabolism and is required for the skeletal muscle metabolic response to exercise. In the current study investigated whether ERRα expression is sufficient to drive exercise-induced adaptations in muscle. We generated conditional ERRα transgenic mice that overexpress human ERRα in a tetracycline-inducible and skeletal muscle-specific manner (ERRαMOEiHSA). Dox-induced ERRαMOEiHSA (versus non-induced) mice exhibited reddening in glycolytic muscles, a characteristic of oxidative muscle. Mitochondrial content was increased in these muscles, based on mtDNA quantitation and citrate synthase activity. Consistently, ERRα-overexpressing muscles had higher O2 consumption rates and increased glycogen content. To determine if these metabolic changes altered exercise capacity, run performance was assessed in untrained mice. Dox-induced ERRαMOEiHSA mice tested at constant speed (endurance test) or at increasing speeds (aerobic test) ran longer compared to controls. Post-run blood glucose levels were higher in both testing paradigms, which may be due to greater reliance on β-oxidation and higher basal glycogen stores in ERRα-expressing muscles. Using ChIP and reporters assays we showed that ERRα directly activates gene encoding the catalytic (Ppp1ca) and regulatory subunits (Ppp1r3c) of protein phosphatase 1, involved in hormonal and contractile-activity control of glycogen metabolism. Collectively, these results demonstrate that short-term ERRα activation promotes muscle metabolic adaptations and exercise performance similar to exercise training.

Disclosure

J. Li: None. A. Hamilton: None. J.M. Huss: None.

Funding

American Diabetes Association (1-18-IBS-103 to J.M.H.)
72-LB: The T1DLoCHO Study: Effects of a Low-Carbohydrate, Nonketogenic Diet vs. Standard Diabetes Diet on Glycemic Control in Young Adults with Type 1 Diabetes
Authors: CROWDER CHRISTINA M. , JELLEY DAVID , CONDREN MICHELLE , CHALMERS LAURA , GRAEF JENNIFER L.
Published: June 2019

While standard of care medical nutrition therapy for type 1 diabetes (T1D) centers on matching carbohydrate to insulin at meals, recent literature has shown superior glycemic control and cardiovascular measures with lower carbohydrate dietary patterns (<130g/day) compared to the standard MyPlate (50% total calories as carbohydrate) approach.

Aims: To determine if a 60-80 g CHO (LC) per day diet leads to improved glycemic control, cardiovascular, and inflammatory markers compared to the standard of care (SOC) (> 150 g CHO per day).

Methods: Participants (age 18-30) with T1D on insulin pump therapy were recruited from an endocrinology practice from May through December, 2018. Glycemic variability (continuous glucose monitor derived time in range (TIR), 70-180 mg/dL and hemoglobin A1c), total cholesterol, HDL, LDL, triglycerides (TRIG), and LDL particle number, and nutrient intake were assessed using a randomized cross over design with 12 week interventions of LC and SOC. An 8-week washout period was employed between interventions.

Preliminary Results: Expressed Mean(SD). 11 subjects started the study and 5 withdrew due to noncompliance. Of the first 4 patients to finish the LC arm, mean TIR increased from 62.2 (16 .2) to 65.7 (16.2) %, + 3.5 (13.4)%; A1c decreased from 7.1 (0.6) to 6.7 (0.6), -0.5% (0.2); Total Cholesterol decreased from 186.3 (7.2) to 172.0 (25.7) mg/dL; LDL decreased from 104.8 (25.7) to 85.0 (9.2) mg/dL; HDL increased from 63.5 (21.9) to 69.8 (25.5) mg/dL; TRIG decreased from 89.5 (14.9) to 75.8 (21.4) mg/dL; LDL Particle number decreased from 1233.7 (286.6) to 1008.3 (61.5) nmol/L. Of the first 3 patients to finish SOC, no significant differences were seen.

Conclusion: These preliminary results are encouraging, demonstrating that LC is associated with trends towards improvements in glycemic control (TIR and A1c) without deleterious effects on lipids. Larger more robust studies are needed for further exploration.

Disclosure

C.M. Crowder: None. D. Jelley: Research Support; Self; AbbVie Inc., AstraZeneca, Novo Nordisk Inc. M. Condren: None. L. Chalmers: None. J.L. Graef: None.

Funding

University of Oklahoma Health Sciences Center; Harold Hamm Diabetes Center; OU-TU School of Community Medicine; Dexcom, Inc.
725-P: Reducing Hypoglycemic Risk during Postprandial Exercise with Closed-Loop Insulin Delivery in Adults with Type 1 Diabetes: Announced and Unannounced Exercise
Authors: TAGOUGUI SEMAH , TALEB NADINE , SUPPERE CORINNE , BOUKABOUS INÈS , MESSIER VIRGINIE , RABASA-LHORET RÉMI
Published: June 2019

Background: Exercise-induced hypoglycemia is a major barrier for physical activity practice. Compared to conventional insulin therapy, closed-loop (CL) insulin delivery reduces hypoglycemic risk during post-absorptive exercise but has not been studied during postprandial exercise.

Methods: Randomized crossover trial comparing 3 strategies for a postprandial (PP) exercise (90 min after breakfast) at 60% of VO2peak for 60min: 1) Unannounced exercise (Unann); 2) Announced exercise with reduced insulin bolus (Ann+RB): increased glucose target combined with a 33% meal bolus reduction); 3) Announced exercise with full bolus (Ann+FB): increased glucose target combined with usual meal bolus in 37 adults with type 1 diabetes.

Results: Median percentage time spent in hypoglycemia (<70 mg/dl) was reduced with Ann+RB compared to Unann (Primary outcome; 0[0-0]% vs. 0[0-26]%; p<0.05). The drop in plasma glucose during exercise was smaller with Ann+RB (-5.5 ± 50.5 than with Ann+FB (-46.8 ± 52.2) and Unann (-43.2 ± 48.6) strategies (p <0.05). Accordingly, hypoglycemic events were reduced with Ann+RB (n=2) compared to Ann+FB (n=3) and Unann (n=9). However, Ann+BR strategy was associated with increased time in hyperglycemia (> 250mg/dl).

Conclusion: Announcement of postprandial exercise to the closed-loop algorithm combined with meal bolus reduction reduced hypoglycemic risk, yet at the expense of mild increase in hyperglycemia.

Disclosure

S. Tagougui: None. N. Taleb: None. C. Suppere: None. I. Boukabous: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S.
734-P: Perceived Barriers to Physical Activity in People with Type 1 Diabetes Using CGM
Authors: ANDRE CAMILLE C. , KUDVA YOGISH C. , DADLANI VIKASH , CESCON MARZIA , MCCRADY-SPITZER SHELLY K. , CHURCH MEI MEI , REID COREY , KUMARI KANCHAN , CHOUDHARY DIVYA , DOYLE FRANCIS J. , DASSAU EYAL , PINSKER JORDAN E.
Published: June 2019

Objective: Prior reports using the validated Barriers to Physical Activity in Diabetes (type 1) [BAPAD1] scale showed fear of hypoglycemia was the strongest barrier to regular physical activity (PA) in people with type 1 diabetes (T1D). This was before the higher prevalence of continuous glucose monitoring (CGM) use today.

Methods: Twenty adults with T1D enrolling in an exercise tracking study completed the BAPAD1, reporting perceived barriers to regular PA on a scale of 1 (extremely unlikely) to 7 (extremely likely). All used insulin pumps. Fifteen of the 20 were current CGM users.

Results: Baseline characteristics were age 44.9±15.0 years, F/M 12/8, HbA1c 6.8±0.7%, and diabetes duration 22.9±15.9 years. Mean BAPAD1 score was 2.55±1.05. The highest scores were for risk of hypoglycemia (4.00±1.78) and work schedule (3.70±2.00), with current CGM users reporting higher overall scores than non-CGM users (2.71±1.04 vs. 2.10±1.07, p=0.28). Significantly higher scores were reported by CGM users for “The fear of being tired” (p=0.01), “The fact that you have diabetes” (p=0.03), and “The location of a gym” (p=0.04) (Table 1). Greater barrier scores for work schedule were associated with lower age (r=-0.5, p=0.02).

Conclusions: CGM use was not associated with lower perceived barriers to regular PA, suggesting additional interventions beyond providing ways to measure glucose are needed to reduce these barriers in people with T1D.

Disclosure

C.C. Andre: None. Y.C. Kudva: Advisory Panel; Self; Novo Nordisk Inc. Other Relationship; Self; Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. V. Dadlani: None. M. Cescon: None. S.K. McCrady-Spitzer: None. M. Church: None. C. Reid: None. K. Kumari: None. D. Choudhary: None. F.J. Doyle: Consultant; Self; ModeAGC. Other Relationship; Self; Insulet Corporation. E. Dassau: Consultant; Self; Eli Lilly and Company, Insulet Corporation. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Ltd., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; Roche Diabetes Care. Other Relationship; Self; ModAGC. J.E. Pinsker: Research Support; Self; Ascensia Diabetes Care, Dexcom, Inc., Insulet Corporation, LifeScan, Inc., Roche Diabetes Care, Tandem Diabetes Care. Speaker's Bureau; Self; Tandem Diabetes Care.

Funding

JDRF; The Leona M. and Harry B. Helmsley Charitable Trust (2-SRA-2017-503-M-B); Dexcom, Inc. (IIS-2017-043)