bluuebunny/crossref_metadata_2025 huggingface dataset:
626-P: Integrated Approach of Yoga Therapy (IAYT) Improves Cerebrovascular Functions and Prefrontal Hemodynamic Activities Related to Cognition in Type 2 Diabetes
Authors: SINGH DEEPESHWAR , KALIGAL CHIDANANDA , M VIDYASHREE , KANTHI AMIT
Published: June 2023

The present study aimed to assess the integrated approach of yoga therapy (IAYT) effect on cerebrovascular reactivity in middle cerebral artery (MCA), prefrontal cortex (PFC) oxygenation and cognitive functions in patients with T2DM. Method: 75 patients were randomized to the IAYT group [n=38; 07 female; mean age 52.95 (8.20) years] and the waitlist control group [n=37; 06female; mean age (SD) 49.62 (10.94) years]. The cerebral blood flow and prefrontal hemodynamic activities were assessed using transcranial doppler and functional near-infrared spectroscopy, respectively, during resting and cognitive performance. IAYT group participants received 3 months of intervention and assessments were done at baseline (0-week), mid (after 6-week), and post (after 12-week). Results: After a 12-week intervention, participants of the yoga group showed improved accuracy and reaction time in a 2-back condition of the working memory task, and the scores of the Corsi Block Tapping task. Further, cerebrovascular changes were observed in the middle cerebral artery, which showed increased peak systolic velocity, mean blood flow velocity, end-diastolic velocity, and breath-holding index after 12-week yoga practice. The oxygenation was also higher at dorsolateral, dorsomedial, and ventromedial and orbitofrontal PFC in the 12th week of the yoga practitioners group compared to the control group. Moreover, during 2-back working memory task, yoga group participants demonstrated increased oxygenation at dorsolateral PFC compared to pre and higher oxygenation at dorsolateral, ventrolateral, ventromedial and orbitofrontal PFC compared to control group. Conclusion: The results suggest that IAYT practice may improve cognitive functions by improving cerebral blood flow through the middle cerebral artery and hemodynamic activities in the prefrontal regions in patients with T2DM.

Disclosure

D.Singh: None. C.Kaligal: None. V.M: None. A.Kanthi: None.

Funding

Ministry of Ayush, Government of India (Z.280152092015-HPC(EMR)-AYUSH)
629-P: Social Vulnerability Index and Recognition Status with the National Diabetes Prevention Program (National DPP)
Authors: FORMAGINI TAYNARA , REZWAN ARIBA , RODRIGUEZ DAPHNEE , PENG NG BOON
Published: June 2023

Individuals in low socioeconomic status (SES) areas are disproportionately affected by diabetes and have poor lifestyle change outcomes. Organizations delivering the CDC National DPP lifestyle change program receive pending, preliminary, or full recognition status based on specific program criteria and outcomes. Full recognition is critical for organizations to sustain the program and receive reimbursements to cover costs, but organizations in low SES areas may face barriers to receiving it. A multinomial logit model was used to examine the association between the CDC social vulnerability index (SVI) and in-person full recognition organizations at the county level, adjusting for confounders (n=843). Using the National DPP registry, Census data, SVI, and CDC Diabetes Surveillance System, a three-level categorical dependent variable was created: counties without full recognition organizations, counties with at least one non-full recognition organization, and counties with all organizations with full recognition (reference group). The CDC created a four-level categorical SVI (Low, Low-Medium, Medium-High, High) using 16 Census variables to rank counties by social vulnerability: SES, Household Composition and Disability (e.g., age), Minority Status and Language, and Housing Type and Transportation (e.g., vehicle). Of the studied counties, 38.4% had no organizations with full recognition, 22.6% had at least one organization without full recognition, and 39.0% had all organizations with full recognition. Counties with higher SVI were more likely to be in counties without full recognition organizations (High vs. Low; OR=2.71, P <0.001). Counties with high SVI lack fully recognized programs, indicating barriers for organizations in high SVI areas to attain full recognition. This study highlighted the need to develop strategies to ensure organizations in high SVI areas can reach full recognition status to better serve at-risk populations.

Disclosure

T.Formagini: None. A.Rezwan: None. D.Rodriguez: None. B.Ng: None.
63-OR: The Contribution of Social-Needs Factors to Racial Differences in Type 2 Diabetes
Authors: VUPPUTURI SUMA , KIM SEOHYUN , CLENNIN MORGAN , CROMWELL LEE , DAUGHERTY STACIE L.
Published: June 2023

Studies have attributed gaps in type 2 diabetes (T2D) between Black/African-American (BAA) and White adults to socioeconomic factors. We quantified the contribution of social risk factors to racial gaps in T2D in 6 Kaiser Permanente health systems across the U.S. We utilized data collected from the National KP Social Needs Survey conducted in 2020 among 10,226 health system members. We linked survey data to electronic health record data. Exposures included financial strain, food insecurity, and housing instability in the past year. The outcome, prevalent T2D, was defined as either a diagnosis of T2D or medication fills for antidiabetic medications. Self-reported BAA and White race were used to stratify data. Other covariates included demographics, insurance type, clinical measures, and comorbidities. Cross-sectional logistic regression models assessed the odds of T2D by race and the Oaxaca-Blinder decomposition method calculated the percent contribution of all variables to the racial difference in T2D. All statistical analysis were weighted to account for the complex survey design. Our final analysis included 1,223 BAA and 3,372 White survey participants. BAA participants were more likely to be younger, female, report more social risk factors, and have a greater burden of comorbidities. The prevalence of T2D was 22% in BAA patients and 11% in White patients. The covariates in the Oaxaca-Blinder analysis explained 43% of the 11% overall difference in T2D prevalence between BAA and White patients. Of this explained difference, the combined variable of financial strain, food insecurity, or housing instability significantly contributed to the racial gap in T2D by 11%. Our results demonstrated, that if social risk factors of BAA patients were equal to White patients, the racial difference in T2D would be reduced by 11% in our population with access to health care. However, the impact is relatively small and other social factors (e.g. discrimination) will be important to explore using this methodology.

Disclosure

S. Vupputuri: None. S. Kim: None. M. Clennin: None. L. Cromwell: None. S.L. Daugherty: None.

Funding

Kaiser Permanente Social Needs Network for Evaluation and Translation
630-P: Objective Self-Management Behaviors in Adolescents with Disordered Eating
Authors: O'DONNELL HOLLY K. , TROJANOWSKI PAIGE J. , ALONSO GUY T. , DRISCOLL KIMBERLY A.
Published: June 2023

Introduction: The positive association between disordered eating and A1C in individuals with type 1 diabetes is well-established, but little is known about the association between disordered eating and objectively measured self-management behaviors, which are essential behavioral precursors to A1C. The goal of this study was to describe these associations in adolescents with type 1 diabetes.

Methods: Participants included N=142 adolescent pump users (M age=13.8±2.1 years; M A1C=8.0±1.5%; 82.5% White, Non-Hispanic; 50.0% female) who completed the 16-item Diabetes Eating Problems Survey-Revised (DEPS-R), a type 1 diabetes-specific self-report questionnaire. A cut point of ≥20 was used to identify those with clinically elevated symptoms of disordered eating warranting further attention. Self-management behaviors were calculated using data exclusively obtained from devices (i.e., no self-reported data).

Results: Adolescents (n=26; 19%) who reported elevations on the DEPS-R engaged in significantly fewer self-management behaviors, including blood glucose readings per day [t(151)=3.0, p<0.01], carbohydrate entries per day [t(150)=3.3, p<0.001], and boluses administered per day [t(151)=2.3, p<0.05]. Adolescents with clinically elevated disordered eating scores also entered fewer carbohydrates per day into their insulin pump (137.6 vs. 90.8 grams of carbohydrates) [t(150)=3.3, p<0.001].

Conclusions: This is the first study to examine the association between disordered eating behaviors and objectively measured self-management behaviors in youth with T1D that use an insulin pump. Differences in self-management behaviors between those who reported elevations on the DEPS-R vs. those that did not were particularly pronounced for behaviors related to food. Objective data from device downloads may be a useful tool to cue providers to inquire about eating patterns during routine visits.

Disclosure

H.K.O'donnell: None. P.J.Trojanowski: None. G.T.Alonso: None. K.A.Driscoll: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (T32DK063687)
632-P: Glycemic Control in Diabetes Camp Attendees Remotely Monitored and Nonadjunctively Managed with CGM
Authors: GLEICH SARAH E. , TECCA HEATHER R. , GIBSON-NORTH NATHANIEL D. , ANDRADE SARAH B. , WELSH JOHN , SCHUSTER ERIKA , WALKER TOMAS C.
Published: June 2023

Remote monitoring of CGM data of children and youth attending diabetes camp has been shown to reduce overall and nocturnal hypoglycemia, compared to treatment decisions based on self-monitored blood glucose (SMBG) values. However, some diabetes camps still require regular SMBG testing. We compared at-home versus at-camp glucose control where CGM data were used as the basis for diabetes treatment decisions. Thirty-four campers with T1D (mean±SD age 12±3 years, A1C 7.5±1.2%) were eligible for inclusion if they were using Control-IQ technology (Tandem Diabetes Care) prior to and during their attendance at Camp Buck, a diabetes-focused facility near Lake Tahoe. At camp, their CGM data (Dexcom G6) were integrated with the CampViews EMR system (Nevada-California Diabetes Association). CGM data from at-home and at-camp intervals were compared. As shown in the Table, mean glucose and overall time in range (TIR, 70-180 mg/dL) improved at camp, with statistical significance in the overnight (10PM-6AM) interval. Although time in Level 1 hypoglycemia increased at camp, there were no significant changes between at-home and at-camp levels of Level 2 hypoglycemia. CGM data can be used nonadjunctively in the camp setting to maintain or improve glycemic control. Centralized remote monitoring of glucose data allows camp attendees and staff to safely reduce or eliminate SMBG testing.

Disclosure

S.E.Gleich: Research Support; Dexcom, Inc. H.R.Tecca: Employee; Dexcom, Inc. N.D.Gibson-north: None. S.B.Andrade: Employee; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. E.Schuster: Employee; Dexcom, Inc. T.C.Walker: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.
635-P: Health Disparities among People With and Without Diabetes during 24 Months of the COVID-19 Pandemic
Authors: MYERS BARBARA A. , KLINGENSMITH RACHEL , ANWAR FARRAH , GONZALEZ CASANOVA INES G. , DE GROOT MARY
Published: June 2023

This study describes the mental health of US adults with (PWD) and without (ND) diabetes during the COVID-19 pandemic. A 24-month web-based survey was administered from May 2020 (baseline, n=2,176) to June 2022 (24MO; n=1,172; 5 time points). Demographics, pandemic experiences, diabetes distress (DDS-17), depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS-10), and resilience (BRS) were collected. On average, 24MO completers (53.1%) were 53 years (SD=16.4), primarily female (80.9%) and White (91.3%), highly educated (45.0% post-master’s degree), homeowners (72.7%), with an annual household income of ≥ $60,000 (62.2%). They were less likely to have a diagnosis of depression compared to non-completers (all p<0.05). Mental health score means (SD) were DDS= 2.2 (1.0; moderate), PHQ=4.9 (5.0; mild), GAD=4.0 (4.7), PSS=13.3 (8.0). At 24MO, type 2 diabetes (TD2) prevalence was 14% (167), prediabetes 7% (82), and type 1 4% (52; T1D). PWD showed higher levels of financial worry/distress compared to ND (all p<0.05). Similarly, PWD reported COVID as a greater personal health threat (range of means= 4.3-4.8) compared to ND (M=3.7, SD=1.8; p< 0.001). Greatest pandemic burnout was reported by T1D (M=2.9, SD=2.0) and lowest among T2D (M=2.0, SD=2.1; p<0.05). Across the 5 time points, measures of depression, anxiety, perceived stress and diabetes distress improved (all p<0.001). At 24MO, rates of personal COVID infection (33.0%), knowing someone with (93.7%) or who died from COVID (41.4%) increased compared to 12MO (first time point queried; 10.2%, 81.3%, and 34.1%, respectively; all p<0.001). However, financial concerns worsened. Difficulty paying bills increased (11.8% at 24MO v. 6.1% at baseline; p<0.001) and worsening financial appraisal increased (25.4% at 24MO vs. 17.1% at baseline; p<0.05). These data show that, despite improvements in mental health from the height of the pandemic to summer 2022, financial concerns persisted, particularly in those with diabetes.

Disclosure

B.A.Myers: None. R.Klingensmith: None. F.Anwar: None. I.G.Gonzalez casanova: None. M.De groot: Consultant; Barbara Kenner Family Foundation, Medscape, Mediflix, Inc.
646-P: Improved Metabolic Outcomes in Individuals with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease after a Digital Intervention
Authors: BJORNSDOTTIR SIGRIDUR , ÚLFSDÓTTIR HILDIGUNNUR , DOBIES BARTOSZ , GUDMUNDSSON ELIAS F. , SVEINSDOTTIR KOLBRUN , ISBERG ARI P. , BJORNSDOTTIR GUDLAUG , SIGURDSSON SIGURDUR , GUDNASON VILMUNDUR
Published: June 2023

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity among individuals with type 2 diabetes mellitus (T2DM). The aim of this study was to test the feasibility and efficacy of a digital intervention to improve metabolic outcomes for patients with T2DM and NAFLD.

A single-arm study was conducted in Iceland. Participants were provided with a 12-week digital behavioral intervention via the Sidekick app, focused on health education and lifestyle coaching, reducing carbohydrate intake, increasing physical activity, and improving mental health. Individuals with NAFLD and either BMI>30, metabolic syndrome, or T2DM were recruited; here we present a sub-analysis of participants with T2DM. The primary outcome was feasibility, as measured by user retention and engagement; secondary outcomes were changes in anthropometric and clinical measures from baseline to post-program.

Out of 38 recruited participants, 19 (50%) had T2DM (mean age 61.1 (SD 10.8) years, 10 (53%) female) and 18/19 (95%) completed the program. The 19 participants were active for a median of 7 days/week (IQR 4.76-7.0). Mean weight reduction was 3.9 kg (SD 4.1, p<0.001) and the average fat mass reduced by 2.4 kg (SD 2.9, p=0.002); a 4.9% relative change (SD 6.3). The median decrease in HbA1c levels was 4.0 mmol/mol (IQR -0.5, 5.0, p=0.05), fasting insulin decreased by 4.8 µU/ml (SD 9.2, p=0.03), and HOMA-IR by 2 mmol/L (SD 3.7, p=0.03). Mean systolic blood pressure reduced by 9.1 mmHg (SD 16.6, p=0.03), and relative liver fat by 18.6% (SD 25.3, p<0.01). These changes were not explained by changes in prescriptions or dosages, nor by self-reported medication adherence, and were not different between patients with or without T2DM.

At the end of the 12-week digital intervention, participants with T2DM had improved glucose metabolism, liver fat values and body composition, suggesting that this digital intervention can help individuals with T2DM and NAFLD achieve better metabolic outcomes.

Disclosure

S. Bjornsdottir: Research Support; Sidekick Health, Reykjavik, Iceland. H. Úlfsdóttir: Employee; Sidekick Health. B. Dobies: Employee; Sidekick Health. E.F. Gudmundsson: Employee; Sidekick Health. K. Sveinsdottir: Employee; Sidekick Health. A.P. Isberg: Employee; Sidekick Health. G. Bjornsdottir: None. S. Sigurdsson: None. V. Gudnason: None.
65-LB: Social Determinants of Health Predict Self-Care in Type 1 Diabetes
Authors: MATUS AUSTIN M. , RIEGEL BARBARA , RICKELS MICHAEL R.
Published: June 2023

Social determinants of health (SDH), or the conditions in which people live, learn, work, play, and age strongly influence health inequities among adults with type 1 diabetes (T1D). Diabetes self-care, or daily behaviors performed to maintain health (maintenance), monitor for changes (monitoring), and manage illness (management), is essential for T1D management, but may also be impacted by SDH. We aimed to determine if SDH predicted self-care maintenance, monitoring and management, and if so, identify which SDH items were the most salient predictors. A diverse sample of adults with T1D (n=200, 27% Black, 61% female, median age: 35 years, disease duration: 19 years) completed an SDH risk assessment (PRAPARE tool; Risk Tally Scoring Method applied to 14 items to yield a composite risk score) and self-care assessment (Self-Care of Diabetes Inventory [SCODI]; 3 self-care [maintenance, monitoring, and management] and 1 confidence scale). A multivariable linear regression model of each self-care scale was built with SDH risk and confidence as predictors of self-care. For each self-care scale exhibiting a significant association with SDH risk, an exploratory multivariable model was built to determine which of the 14 SDH items were the most salient predictors. SDH risk was a significant predictor of self-care maintenance. For every 1 unit increase in SDH risk, maintenance was estimated to decrease by 1.14 units (p< .01). Exploratory multivariable analysis revealed employment insecurity and material insecurity to be the most salient SDH risk predictors of maintenance. Participants who were not employed full-time were estimated to have maintenance scores 5.15 ± 2.27 units (p<.05) less. For every 1 unit increase in material insecurity (score range:0 - 7), estimated maintenance decreased by 2.6 ± .89 units (p < .01). Those with higher SDH risks are less likely to perform behaviors to maintain health. Providers may facilitate self-care of patients by assessing SDH risks and offering self-care guidance considerate of SDH risks.

Disclosure

A. M. Matus: None. B. Riegel: None. M. R. Rickels: Consultant; Sernova, Corp., Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Dompé.

Funding

National Institutes of Health (31NR020137, R01DK091331)
65-OR: Differences in the Use of Diabetes Medications with Cardiorenal Benefits between Rural and Urban America
Authors: STEIGER KYLE , SWARNA KAVYA , HERRIN JEPH , MCCOY ROZALINA G.
Published: June 2023

Rural Americans are more likely than urban Americans to have poorly controlled diabetes and to die from diabetes-related complications. This is due to multiple biopsychosocial factors, including poor access to primary and specialty care. Previous studies found disparities in the use of newer glucose-lowering medications with cardiovascular and renal benefits (GLP-1RA and SGLT2i) by women, Black patients, and low-income patients. Whether there are disparities in the use of GLP-1RA and SGLT2i based on rurality is unknown. Using a de-identified dataset of commercially insured and Medicare Advantage beneficiaries with type 2 diabetes, we examined diabetes medication use across the spectrum of rurality: urban (population >50,000), small town (population 2500-50,000), and rural (population <2500). Patients with type 2 diabetes and vascular disease (rural n=25,684, small town n=147,045, urban n=810,647) were prescribed the preferred GLP-1-RA (rural 6.6%, small town 7.2%, urban 6.5%) and SLGT2i (rural 4.6%, small town 5.3%, urban 4.5%) less often than non-preferred sulfonylureas (rural 28.7%, small town 29%, urban 27.4%). Patients with heart failure (rural n=8,818, small town n=50,489, urban n=247,621) were prescribed preferred SGLT2i (rural 3.7%, small town 4.3%, urban 3.5%) less often than non-preferred DPP4i (rural 10.3%, small town 11.8%, urban 12%) and sulfonylurea (rural 27.4%, small town 27.7%, urban 26.0%). Patients with stages 3-4 chronic kidney disease (rural n=7444, small town n=43,483, urban n=236,982) were prescribed preferred GLP-1-RA (rural 7.6%, small town 8%, urban 7.2%) and SGLT2i (rural 3.4%, small town 3.7%, urban 3.3%) less often than non-preferred sulfonylureas (rural 29.9%, small town 30.8%, urban 30%). Given these data, interventions to improve prescribing of diabetes medications with cardiorenal benefits are needed in all areas of the US. Rural disparities in diabetes outcomes do not appear to be driven by differences in medication use alone.

Disclosure

K.Steiger: None. K.Swarna: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. R.G.Mccoy: Consultant; Emmi.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)
650-P: Qualitative Findings from D-COPES Emerging Adult Peer Connectors Pilot Study
Authors: ALLEN NANCY A. , BLANCHETTE JULIA E. , SHAH NAZEEN , GONZALES BRUNO , MARIE MORAITIS ANN , HILLIARD MARISA E. , LITCHMAN MICHELLE L.
Published: June 2023

Background: Emerging adults with Type 1 Diabetes (T1D) undergo transitions that necessitate a strong social support system. The Diabetes Connecting Online Peers To Enhance Support (D-COPES) pilot intervention was designed by a multidisciplinary group of researchers and people with T1D to engage emerging adults in small-group discourse with “peer connectors” through virtual biweekly sessions and in-between text communication. The purpose of this study was to determine the peer connector's acceptability of the D-COPES intervention.

Methods: Five peer connectors with T1D (age 18-30) were trained to deliver D-COPES via 6 biweekly 1-hour group sessions, with text messaging between. Peer connector guides (n=24) included topic-specific discussion questions and resources. Topics addressed included disclosing T1D to others, diabetes burnout, and relationships with food. Semi-structured interviews with peer connectors were conducted at the end of the 12-week pilot study to learn about the acceptability of training, group dynamics, resources, and any areas for improvement. Data were transcribed and analyzed using a qualitative descriptive approach.

Results: Key themes included 1) benefits of training, suggestion to include 1 additional training meeting; 2) variety of peer connector guides, suggestion for additional topics (e.g., menstruation, intimate relationships); 3) positive group dynamics resulting from group matching and desire to stay connected after the intervention, though group size could be increased; and 4) peer connector benefits of increased knowledge, social support and opportunity to pay it forward.

Conclusion: D-COPES pilot was acceptable and will be revised (e.g., increased training and materials, larger groups) to be evaluated in a fully powered trial.

Disclosure

N.A.Allen: Consultant; Diathrive Health, Dexcom, Inc. J.E.Blanchette: Advisory Panel; LifeScan Diabetes Institute, Cardinal Health/Edgepark, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists, Speaker's Bureau; Insulet Corporation. N.Shah: None. B.Gonzales: None. A.Moraitis: None. M.E.Hilliard: None. M.L.Litchman: None.

Funding

Franklin S. Ivory and Rachael C. Ivory Foundation
654-P: Characterizing Mental Health Status and Service Utilization in Chinese Americans with Type 2 Diabetes
Authors: SHI YUN , WU BEI , ISLAM NADIA , ANN SEVICK MARY , SHALLCROSS AMANDA , BAO HAN , XU XINYI , JIANG YULIN , HU LU
Published: June 2023

Objectives: Mental health issues are common in people with type 2 diabetes (T2D). Yet, the mental health burden of Chinese immigrants with T2D remains unknown. This study examined mental health status, mental health-seeking behaviors, and service utilization among Chinese immigrants with T2D.

Methods: We conducted a telephone-based cross-sectional survey among 66 Chinese immigrants with T2D recruited from the diabetes registry in NYC. Participants’ mental health status including anxiety, depressive symptoms, general stress, and diabetes-specific distress were measured using the Hospital Anxiety and Depression Scale-Anxiety subscale, Patient Health Questionnaire-9, Perceived Stress Scale, and Diabetes Distress Scale, respectively. Information related to mental health-seeking behaviors and service utilization was also collected. Descriptive statistics were used.

Results: Most participants (mean age 56.1±10.5 years) were female (57.6%), currently married (80.3%), foreign born (100%), high school graduate or less (77.3%), with annual household income < $25,000 (50.8%), and limited English proficiency (95.5%). About 9%, 25.7%, and 23.7% reported moderate or higher depressive symptoms, general stress, and diabetes-specific distress, respectively. Only 11.5% with elevated symptoms have ever seen a mental health professional and 3.8% were currently seeking mental health services. Not seeking mental health services was attributed to no need (92.4%), not knowing where to find Chinese-speaking providers (4.5%), cost (1.5%), and time (1.5%).

Conclusions: Mental health issues, especially general stress and diabetes-specific stress were high among Chinese immigrants with T2D. However, very few of them have ever sought or are currently seeking mental health services. Future research needs to gain a better understanding of the barriers and design culturally tailored programs to serve the needs of this minority group.

Disclosure

Y.Shi: None. B.Wu: None. N.Islam: None. M.Sevick: None. A.Shallcross: None. H.Bao: None. X.Xu: None. Y.Jiang: None. L.Hu: None.

Funding

National Institutes of Health (P50MD017356)
656-P: COVID-19 Exposure and Perceived Impact Associated with Poor Psychosocial, Behavioral, and Physical Health
Authors: YI-FRAZIER JOYCE , O'DONNELL MAEVE B. , ELLISOR BRITNEY M. , GARCIA PEREZ SAMANTHA , MALIK FAISAL , ROJAS YULIANA , DESALVO DANIEL , PIHOKER CATHERINE , SCOTT SAMANTHA R. , BRADFORD MIRANDA , ZHOU CHUAN , ROSENBERG ABBY , HILLIARD MARISA E.
Published: June 2023

Aim: To describe the exposure and impact of COVID-19 in teens with T1D and associations with health outcomes.

Methods: In the first month of an intervention trial to reduce distress in teens with T1D, COVID-19 emerged. Thus, in addition to planned surveys (Table), participants reported on COVID-19 exposure and perceived impact of the pandemic. Subscales assessed: 1) COVID-19 exposure - a tally of whether teen/important contact was diagnosed, hospitalized, or died, 2) Pandemic-impact - overall worry/feelings about the pandemic (range: 2-10), and 3) T1D-impact - pandemic effect on diabetes care (range: 13-65). Higher scores indicated more exposure or perceived impact. Pearson correlations described all associations.

Results: Of the 172 teens (A1C M=8.7%±2.0%, 56% female, 73% White, 19% Hispanic), 50% reported no exposures, 23% reported 1, 24% 2-3, and 2% 4-7 exposures. Mean pandemic-impact score was 5.6±1.6 (range=2-10), while mean T1D-impact was 36.8±6.9 (range=18-54). Table summarizes associations of subscales with A1C and behavioral markers.

Conclusions: COVID-19 exposure and perceived impact were consistently linked with worse psychosocial and behavioral metrics and A1C for teens with T1D. In particular, associations with T1D-impact were strong. These findings suggest the impact of stressful life events should be monitored within the context of T1D management.

Disclosure

J.Yi-frazier: None. M.Bradford: None. C.Zhou: None. A.Rosenberg: None. M.E.Hilliard: None. M.B.O'donnell: None. B.M.Ellisor: None. S.Garcia perez: None. F.Malik: None. Y.Rojas: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. C.Pihoker: None. S.R.Scott: None.

Funding

National Institutes of Health (R01DK121224)
659-P: The Effectiveness of Lifestyle, Metformin, or Dietary Supplements for the Prevention of Gestational Diabetes Mellitus (GDM) by Intervention Characteristics—A Systematic Review and Meta-analysis
Authors: TAKELE WUBET W. , UKKE GEBRESILASEA G. , JOSEFSON JAMI L. , VESCO KIMBERLY K. , REDMAN LEANNE M. , GRIEGER JESSICA A. , HABIBI NAHAL , QUINTEROS ALEJANDRA , LEUNG GLORIA , ZHOU SHAO J. , TAYLOR RACHAEL , PATHIRANA MALEESA , LIU KAI , BONHAM MAXINE P. , CHEN MINGLING , FAWCETT ANDREA J. , CHIVERS SIAN C. , LIM SIEW
Published: June 2023

Systematic reviews examining the effectiveness of interventions for GDM prevention have reported inconsistent results. Intervention characteristics such as intervention type, provider, delivery mode (individual, group or both), the use of theory, intervention location (home- or centre-based), duration, frequency, monitoring (supervised or unsupervised) and other characteristics have not been thoroughly investigated and likely impact intervention efficacy. This study was a systematic review and meta-analysis of controlled trials on lifestyle (diet and/or exercise), metformin and dietary supplementation. The impact of intervention characteristics on GDM prevention was conducted using the ‘Template for Intervention Description and Replication framework’. Overall, 116 studies were included. For lifestyle interventions (n=92), lower risks of GDM were observed in studies with supervised sessions (n=13, RR 0.63, 95% CI 0.50-0.79, p=0.04) compared with those with unsupervised sessions, with group-only delivery (n= 17, RR 0.61, 95% CI 0.51-0.74, p=0.04) compared with those with a combination of individual and group delivery, and in low-middle income countries (n=7, RR 0.58 95% CI 0.42-0.8, p=0.03) compared with studies conducted in middle or high-income countries. Lifestyle intervention effect sizes did not differ by any other intervention characteristics. No significant effect of intervention characteristics was seen in metformin studies (n=13). For dietary supplementation studies (n=12), lower risks of GDM were observed with myoinositol (n=7, RR 0.38, 95% CI 0.23-0.65) but not with probiotics (n=5, RR 0.88, 95% CI 0.52-1.47). Country setting, delivery mode, session supervision may be important characteristics determining the effectiveness of GDM prevention. Further research is needed to tailor these intervention approaches for specific populations.

Disclosure

W.W.Takele: None. S.J.Zhou: None. R.Taylor: None. M.Pathirana: None. K.Liu: None. M.P.Bonham: None. M.Chen: None. A.J.Fawcett: None. S.C.Chivers: None. S.Lim: None. G.G.Ukke: None. J.L.Josefson: None. K.K.Vesco: Research Support; Pfizer Inc. L.M.Redman: Research Support; Dexcom, Inc., Abbott Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; ABGIL, Teladoc Health. J.A.Grieger: None. N.Habibi: None. A.Quinteros: None. G.Leung: None.
66-OR: The Lasting Effects of Redlining on Diabetes Rates—A Tri-city Statistical Analysis
Authors: SHAH SHILP R. , MARTHESWARAN TARUN , SHAH SAHIL R. , KUMAR ASHVIN
Published: June 2023

Introduction: The relationship between redlining and diabetes prevalence has been understudied. Residents of redlined tracts experience risk factors (inadequate diet, lack of exercise, etc.) at higher rates, which can precipitate increases in diabetes cases, especially in low-income neighborhoods. We observe the statistical association between redlining regions and diabetes prevalence and establish causality through access quantification.

Methods: Historic Redlining Scores (HRS) were collected from the Inter-university Consortium for Political and Social Research. HRS were weighted averages of HOLC A, B, C, and D grades from the 1930s. Through connection with the U.S Census Tract, we obtained diabetes rates from Houston, Miami, and Cleveland, cities with prevalent adult diabetes cases and discriminatory housing policies. Generalized Linear Regression (LR) computed the correlation between HRS and diabetes rates from 2018-2020. USDA Food Access Research Dataset was used to deduce access disparity for low-income residents in the three cities.

Results: LR models for 2018-2020 demonstrated a significant positive association between HOLC grade and diabetes rate of 3.35, 3.22, and 3.17 (all p < 2e-16), respectively. Furthermore, there is a 35% decrease in food accessibility for low-income residents within a half-mile for grade C/D tracts compared to grade A/B tracts, with over half (54%) of residents in C/D tracts without access to supermarkets within a half-mile.

Conclusion: The significant positive relationship between historic redlining rates and diabetes rates strongly suggests the effects of discriminatory policies continue to adversely affect minority communities. We believe the lack of adequate healthy food access results in minority demographics more heavily relying on processed and fast food, predisposing them to a higher risk of diabetes. Increasing infrastructure for healthy food access presently may alleviate diabetes rates in the next few decades.

Disclosure

S.R.Shah: None. T.Martheswaran: None. S.R.Shah: None. A.Kumar: None.
662-P: Diabetes Self-Management in Breast Cancer Survivors—Racial and Ethnic Disparities
Authors: LEITER AMANDA , DORON EILAM , GOEL MITA S. , LIN JENNY J.
Published: June 2023

Type 2 diabetes (T2DM) is associated with 40% increased breast cancer (BC) mortality. Black and Latina BC survivors have worse BC mortality outcomes and are more likely to have T2DM. We aimed to assess the association of race/ethnicity with adherence to T2DM self-management behaviors (SMBs), medication beliefs, and control in BC survivors. We recruited Stage 0-III BC survivors ≥ 55 years who had preexisting T2DM taking ≥ 1 oral DM medications. Adherence to T2DM SMBs and medication beliefs were assessed with validated questionnaires. Hemoglobin A1c (A1c) was measured at recruitment to assess T2DM control. We compared variables by race/ethnicity using the Fisher's exact (categorical) and Kruskal Wallis (continuous) tests. Multivariable linear regression evaluated the relationship between race/ethnicity and T2DM variables and adjusted for age, education and BC stage. Of 194 participants, median age was 67 years (interquartile range [IQR] 60-72), A1c was 7.4% (IQR 6.4-7.9); 27% self-identified as Black, 41% as non-Hispanic white (NHW), 18% as Latina, and 14% as other/unknown race. NHWs (70 years, IQR 56-83) were older than Black (63 years, IQR 55-87), Latina (64 years, IQR 56-83), and other/unknown race (64 years, IQR 55-77) participants (p=0.01). Black (76%), Latina (49%), and other/unknown race (83%) participants were less likely to have some college education than NHWs (88%, p<0.01). BC stage did not significantly differ by race/ethnicity. In multivariate analyses, Latina participants were more likely to believe T2DM medications disrupted their lives and were not important for their health. However, race/ethnicity was not associated with adherence to T2DM SMBs nor A1c in multivariate analyses.

In summary, race/ethnicity was not correlated with T2DM SMBs or control in BC survivors, but Latinas differed regarding some medication beliefs. Future studies should explore other T2DM-related factors, potentially related to medication beliefs, to improve outcomes for Black and Latina BC survivors.

Disclosure

A. Leiter: None. E. Doron: Other Relationship; Teva Pharmaceutical Industries Ltd. M.S. Goel: None. J.J. Lin: None.
665-P: Longitudinal Impact of Daily Experienced Diabetes Distress and Affective Symptoms on the Incidence and Remission of Depressive Symptoms—Results of the DIA-LINK 1 and 2 Studies
Authors: EHRMANN DOMINIC , SCHMITT ANDREAS J. , OLESEN BIRGIT , KULZER BERNHARD , HERMANNS NORBERT
Published: June 2023

We analyzed whether daily experience of diabetes distress and affective symptoms, assessed with ecological momentary assessment (EMA) can predict incidence or remission of elevated depressive symptoms in people with type 1 and type 2 diabetes. In the DIA-LINK studies, 203 people with type 1 and 193 people with type 2 diabetes participated. In the 17-day EMA phase, participants completed daily prompts assessing different affective symptoms and diabetes distress. 358 participants completed the CES-Depression questionnaire at baseline and 3 months later. Incidence and remission of elevated depressive symptoms were defined by a cut-off score of 22. Area under receiver operating characteristics curves were used to analyse the predictive performance of EMA variables on incidence and remission of depressive symptoms. Incidence of elevated depressive symptoms was 18.3% while 32.3% showed a remission. Predictive performances of 15 different EMA variables are shown in Table 1. Daily experience of diabetes distress and affective symptoms can predict incidence and remission of elevated depressive symptoms. These variables could be used for designing just-in-time adaptive interventions for preventing elevated depressive symptoms in people with diabetes experiencing daily emotional burden of living with diabetes.

Disclosure

D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. A.J.Schmitt: None. B.Olesen: Advisory Panel; AstraZeneca, Evivamed, Berlin-Chemie AG, Speaker's Bureau; Medtronic, Medtrixx. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG.

Funding

German Center for Diabetes Research (FKZ82DZD1102A)
666-P: How Satisfied Are People with Type 2 Diabetes with a Basal Insulin Titration App? Findings from the Intervention Group of a Randomized Controlled Trial
Authors: EHRMANN DOMINIC , HERMANNS NORBERT , ROOS TIMM , FINKE-GROENE KATHARINA , KULZER BERNHARD
Published: June 2023

A randomized controlled trial (RCT) was conducted to evaluate the efficacy of the myDoseCoach app, an insulin titration app for basal insulin for people with type 2 diabetes. We asked app users in this study to evaluate the quality of the app via a modified version of the Mobile App Rating Scale (MARS). A total of 120 participants (median age: 60.0 yrs; A1C 8.1%; BMI 31.8 kg/m², diabetes duration 10.0 yrs., 39.0% female) of the intervention arm completed the MARS. Reliability of the 11 item version was high with Cronbach’s α = 0.915. Mean MARS rating was 4.4 (range 1-5), indicating a rather high quality rating. Less than 10% indicated a low quality of the app (rating <3); 10% were indifferent and more that 70% rated the quality of the app as “4” or higher. Figure 1 shows the ratings of the 11 single items. Bivariate correlations showed that neither older age (r=-0.064; p=0.322) nor gender (r=0.102; p=0.180) were significantly associated with the quality rating. The results indicate that the vast majority of the app users evaluated the quality of the App positively with regard to its engagement, functionality, aesthetics, and information quality.

Disclosure

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

Funding

Sanofi
67-OR: Examining the Association between Health Care Utilization and Race/Ethnicity in U.S. Adults with Diabetic Kidney Disease—2000–2020
Authors: OZIEH MUKOSO N. , DAWSON APRILL Z. , WILLIAMS JONI S. , EGEDE LEONARD E.
Published: June 2023

Background: No recent national estimates have examined overall trends in health care utilization in adults with diabetic kidney disease (DKD) or the association between DKD health care utilization and race/ethnicity. This study sought to fill this current gap in knowledge.

Methods: Medical Expenditure Panel Survey data (2000-2020) for adults with DKD was used for this analysis. The dependent variable was total health care utilization for the calendar year for each individual including office-based medical provider, hospital outpatient, emergency room, inpatient hospital, pharmacy, dental, and home health care visits. The primary independent variable was race/ethnicity. Mean health care utilization by DKD status was estimated and negative binominal regression was used to estimate Incident Rate Ratios (IRR) for health care utilization while adjusting for demographics, comorbidities, and time. Stata version 17 was used with a significant p-value set at <0.05.

Results: After full adjustments, African American (IRR 1.20 95% CI 1.09 - 1.31) and Hispanic (IRR 1.15 95% CI 1.04 - 1.28) adults with DKD had significantly higher rates of total health care utilization compared with Whites. In addition, African American adults with DKD had significantly higher rates of office visits (IRR 1.10 95% CI 1.01 - 1.20) and outpatient visits (IRR 1.41 95% CI 1.14 - 1.75) compared with Whites and lower rates of dental care visits (IRR 0.74 95% CI 0.61 - 0.89) and prescription utilization (IRR 0.83 95% CI 0.78 - 0.88) compared with Whites with DKD. Further, over time adults with DKD had higher mean total health care visits (17.0 - 23.6) compared with 8.8-10.4 visits in adults without DKD.

Conclusions: Our findings show that compared with individuals without DKD, individuals with DKD had significantly higher health care utilization from 2000 to 2020 and racial differences in health care utilization exists and persists over this period.

Disclosure

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

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R21DK131356 to M.N.O.), (R01DK118038, R01DK120861 to L.E.E.); National Institute on Minority Health and Health Disparities (K23MD016448 to M.N.O), (R01MD013826 to L.E.E.)
671-P: Obesity in African Immigrants Is Associated with Body Size Dissatisfaction and Poor Cardiometabolic Health
Authors: HURSTON JAMAIICA , SHOUP ELYSSA , DE DIEU GATETE JEAN , SCHENK BLAYNE R. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , JAGANNATHAN RAM , HORLYCK-ROMANOVSKY MARGRETHE F. , SUMNER ANNE E. , WORTHY CHARLITA C.
Published: June 2023

In African immigrants, the relationship between obesity and body size dissatisfaction and cardiometabolic health is unknown. Hence, we assessed body size dissatisfaction and cardiometabolic health in 352 African-born Blacks living in the Washington DC area (female: 39% (137/352) age 40±11y (mean±SD)). Using the Stunkard Figure Rating Scale, participants ranked their perceived body size and wish body size. Body size dissatisfaction was defined as the difference between perceived and wish body size. Adverse cardiometabolic health was determined by the presence of type 2 diabetes (T2D) or elevated BP (BP≥120/80) or elevated non-HDL cholesterol levels. Obesity prevalence was 27% (94/352) and higher in women than men (38% (52/137) vs 20% (42/215) P<0.01). Body size dissatisfaction was also higher in women than men (83% vs 69% P<0.01). However, among participants with obesity there was no sex difference in body size dissatisfaction (94% vs 91% P=0.49). Persons with obesity judged themselves to be: Too Large (92%) Just Right (7%) or Too Small (1%) (Figure). Obesity was associated with a higher prevalence of T2D (14% vs 5% P<0.01) elevated BP (51% vs 41% P=0.02) and higher non-HDL cholesterol (121±34 vs 113±33 mg/dL P=0.06). Obesity is viewed negatively by African immigrants and is associated with poor cardiometabolic health.

Disclosure

J.Hurston: None. C.C.Worthy: None. E.Shoup: None. J.Gatete: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. R.Jagannathan: None. M.F.Horlyck-romanovsky: None. A.E.Sumner: None.
674-P: Barriers to Healthy Lifestyle Behaviors among Adolescents with Comorbid Type 1 Diabetes and Overweight/Obesity
Authors: WARNICK JENNIFER , DARLING KATHERINE , SWARTZ TOPOR LISA , JELALIAN ELISSA
Published: June 2023

Introduction: Comorbid obesity and type 1 diabetes (T1D) were previously rare, but the prevalence of overweight/obesity among youth with T1D now exceeds that of youth in the general population, significantly increasing cardiovascular risk. While the ADA recommends lifestyle modifications for youth with T1D and elevated cardiovascular risk, uptake is limited. The study purpose was to identify barriers to healthy lifestyle behavior engagement and T1D management concurrently.

Methods: Adolescents with comorbid T1D and BMI≥85th percentile (n=12; M(SD) age=15(1.2) years, 58% female) and their caregivers (n=12; 67% female) participated in individual interviews concerning adolescents’ engagement in healthy lifestyle behaviors and T1D management. Caregivers completed a demographics questionnaire, and adolescents completed the Barriers to Diabetes Adherence (BDA) measure. Interviews were transcribed verbatim, and two coders independently analyzed the data using thematic analysis. Coders came to 100% agreement on all codes.

Results: During interviews, 83% of adolescents reported wanting to change their weight/body shape. Three themes emerged from the interviews: (1) Discomfort with aspects of T1D management that draw attention to themselves and their illness; (2) Barriers to setting up environments that encourage healthy behaviors; and (3) Physiological dysregulation (i.e., aspects of T1D management that disrupt internal signals like hunger and sleep). Adolescents rated time (25%) and social support (16.7%) as the primary barriers to T1D adherence on the BDA.

Conclusions: Adolescents with T1D and overweight/obesity experience common barriers to healthy living that are exacerbated by environmental challenges and T1D management requirements. Specific recommendations on how to manage healthy living, weight/shape, and T1D concurrently are needed. Results will inform the design of a healthy lifestyles program specific to adolescents with T1D.

Disclosure

J.Warnick: None. K.Darling: None. L.Swartz topor: None. E.Jelalian: None.

Funding

National Institutes of Health (T32HL076134)