bluuebunny/crossref_metadata_2025 huggingface dataset:
538-P: Effects of Exercise Timing on Glucometabolic Response in Patients with Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Controlled Trials
Authors: FU YIMAN , TANG XIXIANG , QIN BAODING , GUO XIAODI , HUANG YULI , CHEN YANMING , ZHU YANHUA
Published: May 2022

Background and purpose: Exercise is widely perceived to benefit glycemic control through remodeling metabolic pathways in patients with type 2 diabetes mellitus (T2DM) . Circadian clock-regulated metabolic pathways could be reprogrammed by dietary challenges, timing of exercise relevant to feeding may also create a divergent effect. Nowadays, the optimal time of day to amplify training-mediated benefits remains unknown. Here, we aimed to evaluate the effects of different exercise timing on glucometabolic response in patients with T2DM.

Data sources and study selection: PubMed/MEDLINE, EMBASE, and Cochrane Library were systematically reached on June 30, 2021 for randomized controlled trials investing the effects of exercise timing on glucometabolic response in patients with T2DM.

Data extraction and data synthesis: Reporting postprandial glucose (PPG) , or fasting blood glucose (FBG) , or incremental area under the blood glucose curve (iAUC) , or glycosylated hemoglobin (HbA1c) , or 24-hours average glucose concentrations, or insulin sensitivity index (HOMA-IS) , or insulin resistance index (HOMA-IR) were extracted. Random effects models were used to calculate the standardized mean differences (SMD) and 95% confidence intervals (CI) . A total of 29 studies were included, involving 516 individuals for analysis. Post-meal exercise improved PPG, iAUC, HbA1c, 24-h average glucose (SMD: -4.03, -1.15, -0.43, -0.83 respectively) , but not in HOMA-IS (SMD: 0.76) and HOMA-IR (SMD: 0.01) . Within 30-120 min after meal consumption lowered PPG, iAUC, HbA1c, and 24-h average glucose by a greater amount (SMD: -4.31, -1.25, -0.46, -0.75, respectively) .

Conclusion: Post-meal exercise exerted the most significant and consistent effects on glucometabolic respons. Within 30-120 min after meal is the optimal exercise timing for glycemic control. Promoting timely post-meal exercise would be of tremendous benefits to patients with T2DM.

Disclosure

Y.Fu: None. X.Tang: None. B.Qin: None. X.Guo: None. Y.Huang: None. Y.Chen: None. Y.Zhu: None.
543-P: Interruptions in Cardiac Rehabilitation Sessions Are Disproportionately Higher in Patients with Diabetes
Authors: KHONG ANTHONY A. , JUNKER MARGARET , GIANCATERINO SHAUN , LABIAK RACHEL , LIU NINA , CORTEZ-TOLEDO ELIZABETH , FAUSTO ALEJANDRA G. , CHEN CHRISTOPHER , SLACK DANIEL H. , LOPEZ JAVIER E.
Published: May 2022

Background: The clinical benefits of cardiac rehabilitation (CR) are attendance related; hence, interruptions or cancellations (I/C) of CR sessions limit clinical effectiveness. However, data on the frequency of I/C in CR is sparse. In this study, we aim to characterize the prevalence and clinical factors associated with I/C events among CR participants.

Methods: We retrospectively review 251 patients enrolled at our center from 8/2018-9/2021. I/C was defined as at least one event that led to pausing or stopping the exercise session due to a safety or medical concern such as blood pressure, arrhythmia, and/or glycemic control. P-values were determined by t-test, chi-squared, and multivariate logistic regression.

Results: Fifty percent (125) of patients had at least one I/C event during their participation in CR. A history of diabetes mellitus (DM) , coronary artery disease, or hyperlipidemia were significantly associated with I/C (Table 1) . Furthermore, logistical regression revealed that having DM had the strongest independent correlation with I/C events [hazard ratio, 2.66; 95% confidence interval, 1.57-4.52; p<0.0001].

Conclusion: Half of CR patients experienced I/C during their participation. DM was identified as the main risk factor of events. Further studies are needed to understand the root cause and to design preventive measures to maximize the potential of CR participation.

Disclosure

A.A.Khong: None. J.E.Lopez: None. M.Junker: None. S.Giancaterino: None. R.Labiak: None. N.Liu: None. E.Cortez-toledo: None. A.G.Fausto: None. C.Chen: None. D.H.Slack: None.
544-P: Poor Glycemic Control Leads to Major Disruptions of Cardiac Rehabilitation
Authors: KHONG ANTHONY A. , GIANCATERINO SHAUN , JUNKER MARGARET , LABIAK RACHEL , LIU NINA , CORTEZ-TOLEDO ELIZABETH , FAUSTO ALEJANDRA G. , CHEN CHRISTOPHER , SLACK DANIEL H. , LOPEZ JAVIER E.
Published: May 2022

Background: We have shown that 50% of cardiac rehabilitation (CR) patients have at least one exercise session interrupted or cancelled (I/C) . These disruptions were highly correlated with a diabetes mellitus (DM) diagnosis. The aim of this study was to characterize the frequency of I/C at the level of CR sessions and explore the event’s root cause (s) between patients with and without DM.

Methods: We retrospectively reviewed 5,038 CR sessions from 251 patients during 8/2018-9/2021 at our center. The frequency of I/C was normalized to the individual sessions to account for multiple events occurring to a single patient over time. Potential root causes were categorized as blood pressure control, glycemic control, symptomatic arrhythmias, and/or other cardiac symptoms. P-values were obtained by Fischer exact test and student t-test, as appropriate.

Results: Ten percent of all CR sessions (522) were disrupted during the observation period. No baseline differences between were noted [Table 1]. DM patients had 20.2% of sessions disrupted by I/C events compared to 4.0% in non-DM patients (p<0.00001) . The frequency of each root cause per group is noted in Table 2.

Conclusion: Patients with DM have a five-fold increase in CR disruptions (primarily due to glycemic control) when compared to those without DM. Further studies are needed to develop optimal glycemic control strategies that could minimize the disruption of cardiac rehabilitation.

Disclosure

A.A.Khong: None. J.E.Lopez: None. S.Giancaterino: None. M.Junker: None. R.Labiak: None. N.Liu: None. E.Cortez-toledo: None. A.G.Fausto: None. C.Chen: None. D.H.Slack: None.
545-P: The Impact of Gender on Physical Activity Preferences and Barriers in Adults with Type 1 Diabetes: A Qualitative Study
Authors: LOGAN JESSICA E. , PREVOST MELINDA , BRAZEAU ANNE-SOPHIE , HART SARAH , MALDANER MIRANDA , YARDLEY JANE E.
Published: May 2022

Exercise studies involving people with type 1 diabetes (T1D) have tested young, fit, men. As such, current insulin adjustment and carbohydrate intake advice may not work for women. A recent secondary analysis found different blood glucose (BG) responses to a weight lifting protocol between male and female T1D participants. It is unclear whether these differences were physiological (i.e., hormones, muscle mass, etc.) or behavioural (i.e., insulin adjustments, carbohydrate intake, etc.) . To explore gender-related differences in physical activity (PA) behaviours and preferences, we recruited men and women with T1D to take part in semi-structured interviews. Questions included demographics, perceived differences between genders (preferred type of PA, motivation, and barriers) , diabetes management strategies (i.e., insulin adjustments, carbohydrate intake, high intensity exercise, etc.) , and PA preferences (frequency, type, motivations, etc.) . Two analysts coded interview transcripts using a framework approach, through open coding of emergent themes. The most common themes were:1) Impact of support on PA success. Both men and women made statements about support, or lack of support, from family members, medical providers, and group exercise. Women reported receiving support from their healthcare team, while men did not.2) Strategies for BG management. This included reducing insulin pre-exercise and consuming extra carbohydrates. Few participants reported using intense exercise.3) Barriers to PA. Men and women reported similar barriers, including hypoglycemia, time limitations, and lack of motivation. Women reported more concerns about dysglycemia.4) Reasons to exercise. The main differences between genders were the importance of enjoyment for men and weight management for women. Overall, men and women with T1D possess similar barriers, sources of support, and BG management strategies around PA, despite differences in motivation.

Disclosure

J.E.Logan: None. M.Prevost: None. A.Brazeau: Research Support; Eli Lilly and Company, Novo Nordisk, Sanofi. S.Hart: None. M.Maldaner: None. J.E.Yardley: Research Support; Abbott, Dexcom, Inc., LifeScan, Speaker's Bureau; Abbott Diabetes.

Funding

Heart and Stroke Foundation of Canada, University of Alberta Undergraduate Research Initiative
546-P: Video Call-Based Assessment of Physical Fitness through Diabefly Digital Therapeutics Program for People with T2D in India
Authors: BHAGAT MADHURA , MANDLEKAR ANURADHA S. , VERMA RITIKA , KULKARNI SAMPADA S. , SELVAN CHITRA , MODI ALOK D. , SHENOY MOHAN T. , JAIN ALPESH L. , DAS RABINDRA , GUNTUR SAIMALA
Published: May 2022

Background: Exercise is an integral aspect for effective diabetes management. Supervised home-based exercise through exercise prescriptions customized based on a person's exercise status, pain complaints and fitness levels can help in better adherence and low risk of injury while reducing unnecessary hospital visits. The study was aimed at the assessment of physical fitness in people with diabetes (PWD) for the development of a personalized exercise plan.

Methods: Video-call based assessment of physical fitness was done in 470 participants (mean age 44.9 ± 10.4, 31.7% females) of Diabefly® digital therapeutics platform. Trained physiotherapist conducted the assessment with the corresponding tests: upper limb strength (1-min push up test) , lower limb strength (wall sit test) , core strength (1-min sit up test) , flexibility (V-sit and reach test) and cardiorespiratory fitness (6 minute walk test) . The scores of the tests were obtained through gender and age based normative data. Participants were categorized based on the physical activity (PA) status as non-exercisers (less than 150 mins/week of PA) , aerobic exercisers (performed only walking as PA) , exercisers (combined strength training and aerobic PA >150 mins/week) . Descriptive statistics and ANOVA were performed via SPPS v21.

Results: Out of all the participants, 69.4% were in the obese category with 42.1% of participants being non-exercisers, 42.1% were aerobic exercisers while only 15.7% were exercisers. Mild to moderate pain was reported by 36.1% participants. Cardiorespiratory fitness, upper limb strength, core strength and flexibility were significantly lower among non-exercisers as compared to exercisers (P<0.05) .

Conclusion: This study showed the feasibility of video call-based physical fitness assessment in PWD. The assessment along with consideration of pain and current exercise pattern will help in development of personalized exercise prescription for PWD.

Disclosure

M.Bhagat: Employee; Fitterfly Healthtech Pvt Ltd. S.Guntur: Employee; Fitterfly Health Tech Pvt. Ltd. A.S.Mandlekar: Employee; Fitterfly Healthtech Pvt Ltd. R.Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. S.S.Kulkarni: None. C.Selvan: None. A.D.Modi: None. M.T.Shenoy: None. A.L.Jain: None. R.Das: None.
547-P: Changes in Body Weight and Glucoregulatory Markers by Eight-Hour Time-Restricted Eating vs. Daily Calorie Restriction: A 6-Month Randomized Controlled Trial
Authors: CIENFUEGOS SOFIA , LIN SHUHAO , GABEL KELSEY , MCSTAY MARA , MULAS ANDREA , VARADY KRISTA
Published: May 2022

Background: Intermittent fasting has gained substantial popularity in the past decade. The most popular form of intermittent fasting is time restricted eating (TRE) , which involves eating within a 4-to-10-hour window and water fasting for the rest of the day. Short-term studies (2 months) indicate that TRE produces mild reductions in body weight and markers of glucose regulation. What remains unknown is whether longer durations of TRE (6-months) can lead to even greater improvements in these diabetes risk factors. In addition, whether TRE is more effective than daily calorie restriction (CR) for improving these endpoints, also remains unknown.

Objective: The purpose of this study was to compare the effects of 8-h TRE versus daily CR on body weight, body composition, and markers of glucoregulation, in adults with obesity.

Design: Participants were randomized to 1 of 3 groups for 6-months: 8-h TRE (n = 24, 12-8pm eating window, 8pm-12pm fasting window) , CR (n = 22, 25% energy restriction daily) , or a control (n = 19, no food or meal timing restrictions) .

Results: Weight loss was not significantly different between the TRE (-3.4 ± 0.7%) and CR group (-4.9 ± 1.4%) by month 6. Only the CR group experienced significant weight loss (P = 0.02) versus controls (-0.7 ± 1.1%) . Changes in fat mass, lean mass, and visceral fat mass were not significantly different between groups post-treatment. Likewise, no significant changes in fasting glucose, fasting insulin, or HbA1c were observed. Changes in insulin resistance (assessed via HOMA-IR) did not differ between TRE (-0.50± 0.35 %) , CR (-0.56 ± 0.39 %) , or controls (0.37 ± 0.43%) .

Conclusions: These findings suggest that TRE does not produce greater weight loss than traditional dieting (CR) over 6-months. Our findings also show that neither diet had any beneficial effect on body composition of markers of glucoregulation, versus controls, in adults with obesity.

Disclosure

S.Cienfuegos: None. S.Lin: None. K.Gabel: None. M.Mcstay: None. A.Mulas: None. K.Varady: None.

Funding

R01DK128180 , NIH (NIDDK)
553-P: Changes in Circulating Bile Acids and the Improvements in Glucose and Insulin Metabolism in Response to Weight-Loss Diets: The POUNDS Lost Trial
Authors: HEIANZA YORIKO , WANG XUAN , MA HAO , ROOD JENNIFER , CLISH CLARY B. , BRAY GEORGE , SACKS FRANK , QI LU
Published: May 2022

Bile acids (BAs) are synthesized from cholesterol in the liver and are essential for nutrient absorption. The host-derived primary BAs are transformed into secondary BAs in the intestine. Various BA subtypes may play pivotal roles as endocrine molecules to affect glucose and insulin metabolism. We tested whether changes in distinct BA subtypes were associated with improved glucose and insulin metabolism among adults with overweight and obesity who participated in a weight-loss diet intervention trial. Circulating primary and secondary unconjugated BAs and their taurine-/glycine-conjugates were measured at baseline and 6 months after the intervention; 6-month changes in BAs were calculated (n=515) . When we analyzed associations of BA changes with changes in fasting glucose, insulin, and insulin resistance at 6 months, more decreases in several primary BAs (CDCA, taurocholate [TCA], and taurochenodeoxycholate [TCDCA]) and secondary TDCA were associated with larger reductions of glucose (PFDR <0.for all) , although the associations were dependent on concurrent weight changes. The decreases in primary BAs (including CA, CDCA, TCA, TCDCA) and secondary BAs (including DCA, GDCA, TDCA, GUDCA) were significantly related to improved hyperinsulinemia and insulin resistance, independent of weight changes. Also, we found significant interactions between dietary fat intake and changes in lithocholate and glycolithocholate for changes in insulin metabolism. Further, the initial changes in several primary and secondary BAs showed significant associations for 2-year improvements in glucose/insulin metabolism.

In conclusion, decreases in distinct primary and secondary BAs during weight-loss dietary interventions were associated with improved glucose and insulin metabolism. Changes in various BA subtypes were related to the improved insulin metabolism independent of weight loss status during the interventions.

Disclosure

Y.Heianza: None. X.Wang: None. H.Ma: None. J.Rood: None. C.B.Clish: None. G.Bray: None. F.Sacks: None. L.Qi: None.

Funding

National Institutes of Health (DK091718, DK100383, DK115679)
555-P: Premenopausal vs. Postmenopausal Women: Effect of Time-Restricted Eating on Body Weight and Metabolic Health Markers
Authors: GABEL KELSEY , VARADY KRISTA , CIENFUEGOS SOFIA , EZPELETA MARK
Published: May 2022

Background: Time restricted eating (TRE) involves restricting the ad libitum eating window to a specific number of hours daily, while water fasting for the remaining hours.

Objective: This study examined if changes in body weight and metabolic risk factors during TRE, differ in women based on menopausal status. Methods: This is a secondary analysis of an 8-week TRE study (4-6 h eating window, 18-20 h fasting window daily) conducted in adults with obesity. Male participants were excluded, and female subjects were classified in two groups based on menstrual status: premenopausal (n = 13) , or postmenopausal (n = 19) . Perimenopausal women were excluded from the original study.

Results: Body weight decreased in both premenopausal women (-3.3 ± 0.4%) and postmenopausal women (-3.3 ± 0.5%) (main effect of time, P < 0.001) , with no difference between groups (no group × time interaction) by week 8. Adherence in both groups was very high, with premenopausal women adhering to their prescribed eating window on 6.2 ± 0.1 d/week, and postmenopausal women adhering to their window on 6.2 ± 0.2 d/week. Fat mass, lean mass, fasting insulin, insulin resistance, and 8-isoprostane (marker of oxidative stress) were reduced similarly in both groups (main effect of time, P < 0.for all comparisons) . Visceral fat mass, relative skeletal muscle index (RSMI) , blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, HbA1c, TNF-alpha and IL-6 remained unchanged by 8 weeks in both groups.

Conclusion: These findings suggest that the weight loss and metabolic benefits of TRE do not differ between premenopausal and postmenopausal women with obesity.

Disclosure

K.Gabel: None. K.Varady: None. S.Cienfuegos: None. M.Ezpeleta: None.

Funding

R01DK119783
559-P: The Advancing Care for T1D Obesity Network (ACT1ON) Sequential Multiple Assignment Randomized Trial Pilot Results for Effect on Weight and Glycemia
Authors: IGUDESMAN DARIA , CRANDELL JAMIE , POKAPRAKARN TEERANAN , CORBIN KAREN , ZAHARIEVA DESSI P. , ADDALA ANANTA , THOMAS JOAN , CASU ANNA , RIDDELL MICHAEL , PRATLEY RICHARD E. , KOSOROK MICHAEL R. , MAAHS DAVID M. , MAYER-DAVIS ELIZABETH J.
Published: May 2022

Background: People with T1D commonly struggle with co-managing weight and glycemia, which increases cardiovascular disease risk. We evaluated the effect of an adaptive Sequential, Multiple Assignment, Randomized Trial (SMART) pilot on weight and glycemia in people with T1D.

Methods: The SMART pilot tested the hypocaloric Look AHEAD (Low Fat) or Low Carbohydrate (Low Carb) ; or Mediterranean (Med, not calorie restricted) diets among young adults with T1D ages 19-30 (BMI 27-39.9 kg/m²) . We report data from the first 3-month diet period pre-pandemic before a shift to a virtual protocol for primary (weight, HbA1c, and % time below range [TBR, 54-69 mg/dl]) and secondary outcomes (body fat % and % time in range [70-180 mg/dl]) . We computed descriptive within-group changes in outcomes. Adjusted models tested diet differences.

Results: Overall weight change was -2.0 kg (95% CI -3.0, -1.1, p<0.0001, n=38) and did not vary by diet. Body fat % decreased overall. Per adjusted models, HbA1c decreased on Low Fat vs. Low Carb (-0.60% [95% CI -1.5, -0.3], p=0.049) and TBR trended towards a decrease on Med vs. Low Carb (-3.1% [95% CI -6.4, 0.083], p=0.056) .

Conclusions: Our intervention decreased adiposity and maintained glycemia in young adults with T1D. We will use these results to power an efficacy trial to co-optimize weight and glycemia among individuals with T1D.

Disclosure

D.Igudesman: None. R.E.Pratley: Other Relationship; Bayer AG, Corcept Therapeutics, Dexcom, Inc., Hanmi Pharm. Co., Ltd., Merck & Co., Inc., Metavention, Novo Nordisk, Pfizer Inc., Poxel SA, Sanofi, Scohia Pharma Inc., Sun Pharmaceutical Industries Ltd. M.R.Kosorok: n/a. D.M.Maahs: Advisory Panel; Abbott Diabetes, Eli Lilly and Company, Medtronic, Novo Nordisk, Sanofi, Consultant; Aditx Therapeutics, Inc., Biospex. E.J.Mayer-davis: None. J.Crandell: n/a. T.Pokaprakarn: None. K.Corbin: None. D.P.Zaharieva: Research Support; Insulet Corporation, International Society for Pediatric and Adolescent Diabetes, Leona M. and Harry B. Helmsley Charitable Trust. A.Addala: None. J.Thomas: None. A.Casu: None. M.Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Consultant; Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk.

Funding

National Institutes of Health 1DP3DK113358
561-P: The Effect of Time-Restricted Eating on Glycemic Control and Insulin Sensitivity in Women with Prediabetes: A Pilot Study
Authors: CHONDRONIKOLA MARIA , ZHU SHENGJIE , SURAMPUDI PRASANTH , ROSHANRAVAN BABACK , SANCHEZ CEDRICK JOSH
Published: May 2022

Time-restricted eating (TRE) is a dietary pattern in which daily food intake is restricted to a 6-h period without any caloric intake for the rest of the day. TRE improves glucose homeostasis in animal models even independent of weight loss and calorie intake. However, the weight-loss independent effect of TRE on glucose homeostasis in people remains debatable. We conducted a pilot study to investigate whether TRE without weight loss improves glycemic control and insulin sensitivity in women with prediabetes. Participants were randomized to the TRE (9-h daily eating period) or Control group (15-h daily eating period) for 12 weeks. We studied five participants (TRE n = 3 and Control n = 2) with overweight/obesity, prediabetes, and habitual daily eating period greater than 14 hours ([means and SD] age 50 ± 16 years, BMI 31 ± 5 kg/m2) . The daily eating period decreased in the TRE group (13.8 ± 0.5 vs. 8.5 ± 0.5 h) , but not in the Control group (13.9 ± 0.9 vs. 14.1 ± 1.1 h) . Participants’ weight, diet composition, and number of eating occasions remained unchanged during the study period for both groups. Glycemic control in free-living conditions assessed by using continuous glucose monitoring tended to improve in the TRE group (24-h area under the curve for interstitial glucose concentration: 2572 ± 286 vs. 2161 ± 216 mg/dl/24 h) , but not in the Control group (23± 59 vs. 2374 ± 2mg/dl/24 h) . Skeletal muscle insulin sensitivity assessed by using a hyperinsulinemic-euglycemic clamp procedure tended to increase in the TRE group (median and IQR: 27 (21, 37) vs. 34 (27, 41) μmol/kg/min) , but not in the Control group (41 ± 9 vs. 36 ± μmol/kg/min) . These preliminary results suggest that TRE may lead to weight-loss-independent improvements in glycemic control and insulin sensitivity in women with prediabetes. Further ongoing research will establish the effect of TRE without weight loss on glucose homeostasis and insulin sensitivity in people at high risk for type 2 diabetes mellitus.

Disclosure

M.Chondronikola: None. S.Zhu: None. P.Surampudi: n/a. B.Roshanravan: None. C.Sanchez: None.

Funding

NIH-UL1-TR001860, Clinical and Translational Science Center-Highly Innovative Pilot Award and USDA NationalInstitute of Food and Agriculture, Hatch project numberCA-D-NTR-2618-H
562-P: Analysis of Dietary Characteristics and Blood Glucose Control in Participants with Fragile Diabetes
Authors: LI PAN , ZHANG LIHUA , ZHANG JINGRONG , LIU FEN , YUAN XIANGLIN
Published: May 2022

Objective: To investigate the dietary characteristics and blood glucose control in participants with fragile diabetes mellitus (FDM) .

Methods: A total of 61 diabetes participants in our hospital from January 20 to August 2021 were selected as the subjects. Demographic information, laboratory examination data, dietary status, nutritional indicators and blood glucose control of participants 1-3 days ahead of investigation were collected. By using nutrition calculator for dietary analysis, and dynamic blood glucose indicators, glucose metabolism indicators and incidence of hypoglycemia were compared between the two groups. SPSS23.0 software for data statistical analysis.

Results: A total of 61 participants were collected, including 28 FDM participants (45.9%) and 33 T2DM participants (54.1%) , which included 29 women (47.5%) and 32 men (52.5%) . A total of 42 (15 FDM and 27 T2DM) participants were monitored by dynamic glucose monitoring (CGM) . Compared with T2DM group, FDM group had higher level in breakfast energy supply, nutrient (vitamin B1, vitamin B2, calcium and iron) sources of animal origin, the intake of dairy products, the incidence of ketosis and hypoglycemia,β hydroxybutyric acid, half hour postprandial insulin, the incidence of dynamic glucose ≤3.9mmol/L and the amplitude of glucose fluctuation, but had lower level in nutrient sources of plant origin, half hour and 2 hour postprandial C peptide, the target glucose time (TIR) (P < 0.05) . There were no significant differences in the intake of main nutrients in whole day, the time ratios of glucose>13.9mmol/L,>10mmol/L and>7.8mmol/L between FDM and T2DM participants (P>0.05) .

Conclusions: FDM participants are more challenging in blood glucose control and have a higher incidence of hypoglycemia. There are some differences in dietary structure between the two groups, and adjusting the structure of some nutrients may have a positive effect on blood glucose control in FDM.

Disclosure

P.Li: None. L.Zhang: None. J.Zhang: None. F.Liu: None. X.Yuan: None.
569-P: Effects of Racial Residential Segregation on Black Youth with Type 1 Diabetes
Authors: ELLIS DEBORAH A. , CUTCHIN MALCOLM , CARCONE APRIL I. , WEISSBERG-BENCHELL JILL , EVANS MEREDYTH A. , BOUCHER-BERRY CLAUDIA C. , MILLER JENNIFER , DROSSOS TINA , DEKELBAB M BASSEM , RHIND JILLIAN T. , WORLEY JESSICA , BUGGS-SAXTON COLLEEN
Published: May 2022

Studies testing the effects of neighborhoods on the health of Black youth with T1D are limited. Racial residential segregation (RRS) is a form of structural racism that may affect health through various pathways, including limiting access to resources and increasing exposure to stress. The present study tested associations between RRS, diabetes management and glycemic control in a sample of 144 Black youth with T1D. Participants were recruited from seven pediatric clinics in two large US cities. Diabetes management was assessed by youth self-report using the Diabetes Management Scale (DMS) . RRS was calculated at the census block group level based on US census data using Location Quotient (LQ) s. LQs represented the ratio of Black to total population in the block group compared to the same ratio in the metro area. Mean youth age = 13.3 years (SD=1.7) , mean HbA1c = 11.5% (SD=2.7%) , mean family income = $34,163 (SD=$25,549) and mean LQ = 3. (SD=1.49) , indicating residence in highly segregated neighborhoods. In bivariate analyses, RRS was associated with HbA1c (r= .28, p= .001) but not DMS (r= -.08, p= .311) . Stepwise multiple regression was used to further test the effects of RRS on HbA1c. Covariates including youth age, insulin delivery method, and family income were entered on Step 1. RRS and a composite measure of neighborhood adversity were entered on Step 2. The R2 change on Step 2 was significant (p= .007) , indicating improved model fit. The final model accounted for 26% of the variance in HbA1c [F (5, 146) = 9.9, p= .001]. Only age (β= .23 p= .003) , insulin delivery method (β= -20 p= .01) and RRS (β= .18 p= .04) had significant effects on HbA1c. Results suggest that RRS had independent effects on glycemic control of Black youth with T1D even after controlling for effects of family income and neighborhood adversity. Findings are consistent with other studies demonstrating negative health consequences of structural racism; advocacy and policy-making to address such inequities could improve diabetes population health.

Disclosure

D.A. Ellis: None. A.I. Carcone: None. M.A. Evans: None. C.C. Boucher-Berry: None. J. Miller: Other Relationship; Element Bars, Inc. T. Drossos: None. M. Dekelbab: None. J.T. Rhind: None. J. Worley: None. C. Buggs-Saxton: Research Support; Boehringer Ingelheim International GmbH, National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110075)
571-P: Body Mass Index Moderates the Association between Diabetes Distress and Objective Self-Management Behaviors in Adolescents with Type 1 Diabetes
Authors: TROJANOWSKI PAIGE , O'DONNELL HOLLY K. , VIGERS TIMOTHY B. , ALONSO GUY T. , MAJIDI SHIDEH , PYLE LAURA , SNELL-BERGEON JANET K. , WADWA R. PAUL , DRISCOLL KIMBERLY A.
Published: May 2022

High diabetes distress is associated with elevated A1C in adolescents with T1D; however, no studies have examined the relationship between diabetes distress and objective measures of self-management behaviors. Whether adolescent diabetes distress and BMI are associated is also unclear. This cross-sectional study examined the relationship between diabetes distress and average daily blood glucose (BG) readings, carbohydrate entries, and insulin boluses administered as well as the interaction of diabetes distress and BMI Z-score (zBMI) on these behaviors in 1adolescents (M age 14.7±1.9 years, 47.7% male, M zBMI 0.51±0.88 kg/m2) . Objective self-management behaviors were assessed via diabetes device downloads prior to beginning intervention for a RCT. BG data was available for the full sample, while carbohydrate and bolus analyses reflect pump users only (n=78) . In separate multiple hierarchical regressions, diabetes distress, zBMI, and their interaction accounted for significant variance in average daily carbohydrate entries (R2=0.21, p<0.001) and boluses administered (R2=0.20, p<0.001) but not BG readings. Main effects of distress were not significant. zBMI moderated the relationship between diabetes distress and average daily carbohydrate entries (p<0.01) and boluses administered (p<0.05) ; those with higher zBMI and higher distress engaged in fewer daily self-management behaviors while those with higher zBMI and lower distress entered carbohydrates and bolused more frequently. This is the first study to demonstrate a relationship between diabetes distress and BMI in the context of objectively measured self-management behaviors in youth with T1D. Although separate interventions exist to improve self-management or diabetes distress, none address them together while also intervening on weight. Decreasing diabetes distress could be an especially important intervention target for youth with high BMI.

Disclosure

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

Funding

National Institutes of Health (7DP3DK113363-02)
573-P: Continuous Glucose Monitoring Measures Impact Cognitive Function in Long-Duration Type 1 Diabetes
Authors: SHAH HETAL , YU MARC GREGORY , BOUMENNA TAHANI , GAUTHIER JOHN , THAM REGINA , ADAM ATIF , KING GEORGE L.
Published: May 2022

As people with type 1 diabetes (T1D) live longer, they are increasingly presented with greater health risks tied to aging-related cognitive decline. We previously reported that participants of the Joslin 50-year Medalist Study (“Medalists”) , with T1D ≥50 years, have impaired cognitive function compared to controls without diabetes, and similar to those with type 2 diabetes. While glycemic control has been shown to impact cognitive function, the impact of day-to-day continuous glucose monitoring (CGM) measures is unclear. CGM provides measures of glycemic variability uncaptured by HbA1c alone. A 2-week block of CGM data was procured from a subset of Medalists (n=64) who also had undergone a cognitive battery testing psychomotor function (Grooved Pegboard) , verbal learning and memory (RAVLT- immediate and delayed recall) , working memory (Wechsler) and executive function (WASI) . In a cross-sectional study, log-transformed CGM metrics were tested for associations with cognitive domains in linear regression models adjusted for duration of diabetes, education status and sex. Better psychomotor function was associated with a higher time in range 70 - 180 mg/dL (p=0.04) , and with lower: glucose coefficient of variation (p=0.02) , time above range (TAR) >180 -250 mg/dL (p=0.01) , TAR > 250 mg/dL (p=0.07) , mean glucose (p=0.07) and glucose management indicator (p=0.07) . Better delayed recall associated with lower time below range < 70 mg/dL (p=0.02) and better immediate recall with lower TAR > 180 -250 mg/dl (p=0.08) . Lower HbA1c previously associated with better executive function in the Medalists, but not with other cognitive domains. This CGM study shows that glucose variability and hyperglycemia impact psychomotor function, while hypoglycemia impacts verbal learning and memory. Thus, better day-to-day glucose management in conjunction with long-term HbA1c control, are potentially important to prevent cognitive decline in aging populations with long-duration T1D.

Disclosure

H.Shah: None. M.Yu: None. T.Boumenna: None. J.Gauthier: None. R.Tham: None. A.Adam: None. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc.

Funding

Beatson Foundation
576-P: Cocreating a Virtual Care Platform That Delivers Mental Health Support to Adults with Type 1 Diabetes (T1D) Living in Rural and Remote Communities
Authors: TANG TRICIA S. , JOHAL PARTEEK , AZHAR AYMAN , FISHER LAWRENCE , POLONSKY WILLIAM H. , GÖRGES MATTHIAS
Published: May 2022

Introduction: While mental health (MH) is the cornerstone of diabetes care, access to MH support in rural and remote communities in British Columbia (BC) is limited. The purpose of this study was to design REACHOUT, a virtual care platform, to deliver peer-led MH support to adults with T1D in geographically marginalized communities in BC.

Methods: The REACHOUT platform was co-created by our T1D Patient Partner Team (n=16) and experts in digital health, biomedical engineering, behavioural science, and rural health. REACHOUT is built as a customizable extension to the Rocket.chat open-source platform, deployed privately on Amazon Web Services servers in Canada; it offers various forms of encryption to maintain data security. We applied an Agile iterative development approach with multi-staged feedback from T1D Patient Partners and key stakeholders in a participatory action framework.

Results: The REACHOUT app has three support delivery features: 1) 1-ON-1 SUPPORT delivered by an individual Peer Supporter (PS) self-selected by the participant from a library of PS profiles. Profiles include descriptors such as stage of life, hobbies, and interests, sociodemographic information, diabetes history and treatment etc. Mode, content, and structure of communication are driven entirely by participants’ support preferences and needs; 2) 24/7 COMMUNITY CHAT ROOMoffers “just-in-time” group support and accommodates needs for emotional validation, normalization, and non-judgmental acceptance; 3) VIDEO HUDDLES are monthly PS-led virtual group sessions highlighting a distress or resilience related theme (e.g. workplace bias and discrimination, cooking low-carb, insurance coverage challenges) .

Conclusions: Launched in November 2021, the REACHOUT pilot supports 40 participants with 40 PS. Adoption and utilization patterns for each of the support delivery mechanisms are being monitored and will be compared in mid-2022.

Disclosure

T.S.Tang: None. P.Johal: None. A.Azhar: None. L.Fisher: Consultant; Ascensia Diabetes Care, Research Support; Eli Lilly and Company. W.H.Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., Provention Bio, Inc., Sanofi. M.Görges: Research Support; Careteam Technologies Inc, Excelar Technologies, IDENTOS Inc, MedStack Inc, SecureKey Technologies Inc, Smile CDR Inc, Thrive Health, Xerus Medical.

Funding

Juvenile Diabetes Research Foundation (2-SRA-2020-986-S-B)
577-P: The Association of Prediabetes, Awareness and Risk Perception, and Lifestyle Behaviors among U.S. Young Adults: NHANES 2005–2018
Authors: YAN ALICE , WANG JASON J. , SHI ZUMIN
Published: May 2022

Introduction: Individuals with prediabetes (preDM) are at increased risk of developing type 2 diabetes (T2DM) and cardiovascular disease. We know little about the risk perception and lifestyle behaviors of young adults with preDM.

Methods: This nationally representative cross-sectional analysis of 2005-2018 National Health and Nutrition Examination Survey data was conducted on nonpregnant young adults (aged - 34) . PreDM and Diabetes (DM) were based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) definitions recommended by the American Diabetes Association. We used fasting sample weight to generate nationally representative estimates. Measures also include sociodemographic, lifestyle behaviors (diet, physical activity, and sleep) , awareness, and perceived risk for diabetes or preDM. Analyses were accounted for the complex sample design and performed using Stata 17.

Results: Overall, among 4272 young adults, the weighted prevalence of PreDM and DM were 26% and 2.6%, respectively. There was a significant difference (p<0.001) in the awareness of their disease condition between individuals with preDM (3.7%) and those with DM (13.2%) . The multivariable logistic regression model found that women were less likely to have preDM than men. Obese subjects were more likely (OR=3.19, 95%CI 2.39 - 4.27) to have preDM. College education, higher income, and physical activity (600 -1200 MET minutes/week) were protective factors against preDM. Long sleep duration (>=9 hours per day) is associated with a 56% increased risk for prediabetes (95%CI 1.02 - 2.39) .

Conclusions: The high prevalence of preDM in young adults reinforces the critical need for effective public health strategies that promote lifestyle behaviors, including physical activity, and improve sleep quality.

Disclosure

A.Yan: None. J.J.Wang: None. Z.Shi: None.
578-P: Telemedicine Intervention Is Effective in Changing Psychological and Behavioral Correlates of Weight Loss in the REAL HEALTH-Diabetes Trial
Authors: VAKHARIA JANAKI , DELAHANTY LINDA M. , THAWEETHAI TANAYOTT , YU CHU , WEXLER DEBORAH J.
Published: May 2022

Prior studies have shown that telemedicine (telemed) weight loss interventions are non-inferior to in-person in achieving weight loss. The REAL-HEALTH Diabetes RCT studied the effectiveness of a group lifestyle intervention (LI) for weight loss in adults with T2D and overweight/obesity. Intervention was delivered either in-person (LI-IP) or via telephone (LI-Tele) . We found clinically significant weight loss with no difference between arms. We sought to determine whether there was a difference between the LI-IP and LI-Tele arms in change of psychological and behavioral correlates of weight loss from baseline to 6 months. We compared the change scores for psychological (diabetes-related distress, depression, diet self-efficacy and autonomous motivation for regulation of diet) and behavioral (dietary restraint, fat related diet behavior) measures between the LI-IP (n=69) and LI-Tele (n=72) groups. There was no significant difference between the groups in mean age (62 years) , percent male (44.7%) , race (79.4% white) , baseline HbA1c (7.7%) and baseline BMI (34.7 kg/m2) . At 6 months, scores for all the measures improved from baseline in both arms with no significant difference between LI-IP and LI-Tele (Table 1) , demonstrating that telemed LI was as effective as the in-person intervention at improving psychological and behavioral correlates of weight loss.

Disclosure

J. Vakharia: None. L.M. Delahanty: Advisory Panel; Lilly Diabetes, Omada Health, Inc., WW International, Inc., ZOE Limited. Stock/Shareholder; Jana Care Inc., Omada Health, Inc., ZOE Limited. T. Thaweethai: None. D.J. Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate.

Funding

T32 DK007028
581-P: Implementing the 3Ms eHealth Intervention in Clinical Settings: Exploring Caregivers’ and Health Care Providers’ Impressions
Authors: REARDON MADELEINE , MCKENZIE LAUREN , CARCONE APRIL I. , WEISSBERG-BENCHELL JILL , EVANS MEREDYTH A. , ELLIS DEBORAH A.
Published: May 2022

Adolescence is a high-risk period during which youth with T1D often experience declines in illness management and increases in HbA1c. Black youth with T1D have higher HbA1cs and are more likely to engage in suboptimal management compared to White youth, elevating their risk. Parental monitoring, i.e., direct supervision of adolescents' daily diabetes care, is associated with youth diabetes management. eHealth interventions may be an effective strategy to increase parental monitoring with high dissemination potential. The present study explored caregivers’ and health care providers’ (HCP) impressions of The 3Ms, an eHealth intervention to improve parental monitoring of Black adolescents’ daily diabetes management. Semi-structured interviews were completed with caregivers (N=21) who completed The 3Ms and pediatric diabetes HCPs (N=7) . Data were analyzed using content analysis by two coders who resolved all coding discrepancies to consensus. Caregivers rated the helpfulness of The 3Ms 8.6 out of (SD = 1.4) and indicated a high likelihood of recommending The 3Ms to others (M = 9.2/10, SD = 1.4) . Primary themes were that The 3Ms was a helpful reminder to caregivers of the importance of parental supervision of adolescents’ diabetes care, The 3Ms mnemonic provided clear, simple supervision strategies, and the intervention increased collaboration between adolescents and caregivers. HCPs feedback centered on facilitators (e.g. HCP and institutional buy-in) and barriers (e.g. disruption to clinic flow, and resource limitations including space, staff, and technological resources) to using The 3Ms in diabetes clinics. HCPs reported that ancillary psychosocial support in conjunction with routine clinical care could benefit patients and families in improving diabetes health. Next steps include testing the efficacy of The 3Ms for improving caregivers’ supervision behaviors and improving youth diabetes outcomes.

Disclosure

M.Reardon: None. L.Mckenzie: None. A.I.Carcone: None. J.Weissberg-benchell: None. M.A.Evans: None. D.A.Ellis: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (DK11075- A1)
586-P: COVID-Vaccine Attitudes and Uptake in Young Adults with Type 1 Diabetes (T1D)
Authors: DESAI KISHAN R. , CARREON SAMANTHA A. , DURAN BRENDA , LEVY WENDY , LYONS SARAH , STREISAND RANDI , TANG TRICIA S. , MCKAY SIRIPOOM , ANDERSON BARBARA , DEVARAJ SRIDEVI , MINARD CHARLES G. , HILLIARD MARISA E.
Published: May 2022

Objective: Vaccination can help prevent COVID-infection and serious health complications. This is particularly important for people with diabetes, who may be at higher risk for COVID-complications. While unvaccinated adults tend to be younger in general, there are no data on vaccine attitudes or uptake in young adults with T1D. We explored vaccine uptake in young adults with T1D across demographic and clinical factors and identified common reasons for not getting the vaccine.

Methods: At baseline of an ongoing behavioral intervention trial (Feb-Dec 2021) , 35 young adults with T1D (M age= 20.2±1.6, 57% female, 54% non-Hispanic White, 23% Hispanic, 9% Black, 14% other/multiple, M A1c=8.9±2.4%) reported on vaccination status. Unvaccinated participants provided open-text comments on their reasons.

Results: Overall, 69% of participants were vaccinated (2 doses) . Unvaccinated participants had higher median A1c than vaccinated participants (9.7% vs. 7.6%, p=0.03) ; every 1.0% increase in A1c was associated with 22.2% decreased odds of being vaccinated. There were no differences in vaccine uptake by age, gender, race/ethnicity, education, employment, pump or CGM use, or health insurance. The unvaccinated participants reported reasons including: distrust of the vaccine research/effectiveness (4) , uncertainty about health impacts (including T1D) /waiting to see impact on others’ health (2) , no time to get vaccinated (1) , indifference (1) , no desire for vaccination (2) , and still thinking about it (1) .

Conclusion: In a small, diverse sample of young adults with T1D, COVID-vaccinations mirrored national rates. Some participants may have been vaccinated after completing surveys at baseline. Patterns of high A1c and unvaccinated status may place young adults at increased risk as the pandemic continues. Healthcare providers are well positioned to counsel young adults about vaccine information and considerations related to T1D, which may reduce misinformation and increase uptake.

Disclosure

K.R.Desai: None. S.Devaraj: None. C.G.Minard: None. M.E.Hilliard: None. S.A.Carreon: None. B.Duran: None. W.Levy: None. S.Lyons: None. R.Streisand: None. T.S.Tang: None. S.Mckay: None. B.Anderson: None.
590-P: Improving Access to Fresh Vegetables Is Associated with Lower Stress, Anxiety, and Depression in Predominantly Mexican-American Adults with or At-Risk of Noninsulin Treated Diabetes
Authors: ARAM MCKENNA L. , GLANTZ NAMINO M. , LAREZ ARIANNA , KERR DAVID
Published: May 2022

Poor diet is the leading cause of ill health in the U.S., including type 2 diabetes (T2D) , obesity as well as anxiety and stress. A medical prescription program providing access to fresh vegetables was associated with improved cardiometabolic health for predominantly Mexican-American adults at risk for or with non-insulin treated T2D. In a sub-study, we used the Depression Anxiety Stress Scales (DASS-21) short form to assess depression, anxiety, and stress.From August 20to November 2021, 1participants (73 female, 92% Mexican, 34% with non-insulin treated T2D, age 55.1 [12.6] years) were recruited using English/Spanish community outreach materials and received prescriptions for 21 servings/week of fresh vegetable for weeks.Compared to baseline, post-prescription DASS-21 results indicated significantly lower stress (-2.9 [-4.38, -0.82, mean [95% CI], p-0.0056) ; anxiety (-2.4 [-0.68, -4.04]) ; and depression (-3.7 [-5.74, -1.7]) (Table) associated with improved self-reported mood (p=0.0using 100mm Likert scales) , sleep (p=0.02) , and less pain (p=0.008) .

In summary, improving access to fresh vegetables is associated with better psychological health for predominantly Mexican-American adults with or at-risk of non-insulin treated T2D.

Disclosure

M.L.Aram: None. N.M.Glantz: Research Support; Abbott. A.Larez: Research Support; Abbott. D.Kerr: Advisory Panel; Abbott Diabetes, Novo Nordisk A/S, Sanofi, Consultant; Evidation Health, Research Support; Novo Nordisk A/S, Stock/Shareholder; Glooko, Inc., Hi.Health.

Funding

US Department of Agriculture (#2018-33800-28404)