bluuebunny/crossref_metadata_2025 huggingface dataset:
943-P: Impact of Culturally Appropriate Diabetes Care amongst Asian Americans with Type 2 Diabetes during the COVID Pandemic
Authors: ADAM ATIF , LAU KA HEI KAREN , SHAH HETAL , YU MARC GREGORY , KING GEORGE L.
Published: May 2022

Even as patients with T2D have been shown to have increased COVID-related morbidity and mortality, little is known on the impact of COVID on appointment adherence. This report reviews the impact of culturally-relevant diabetes clinics on adherence to clinical appointments, (pre-and during COVID) . This is a retrospective observational study using EMR data of adult patients with T2D managed at Joslin Diabetes Center before the COVID pandemic (April 20to Dec. 2019) and during the COVID pandemic (April 2020 to Dec. 2020) . Demographic and clinical visit data were extracted from patients seen at least once in both time periods. Clinical appointment adherence and outcomes were compared to patients in the general adult diabetes clinic (GADC) versus the Asian American Diabetes Initiative clinic (AADI) . 297 adult patients with T2D were seen in the AADI clinic and 4,655 patients were seen in the GADC clinics. The AADI clinic catered to a significantly larger proportion of patients who were non-native English speaking (46.1% vs. 8.7%, p<0.001) and on Medicaid (8.4% vs. 4.6%, p<0.001) . Early in the pandemic, virtual appointments were the major source of kept visits, with in-person kept appointments adherence returning in late 2020 (Oct-Dec.) . While the AADI clinic saw no significant changes in kept appointment rates, the GADC clinic had significantly fewer kept appointments overall compared to a similar time frame pre-COVID (pre: 71.7% vs. during: 63.5%, p=0.03) . Both clinics had significantly higher no-show rates during the pandemic. Comparing clinical outcomes, while GADC clinic patients saw a decline in their eGFR during the pandemic (80 vs. 75; p-value=0.04) , the AADI clinic did not observe a significant change in their patient’s renal status (82 vs. 83; p-value=0.93) . Our study shows that culturally oriented clinics like the AADI can successfully allow lower-incomes and older adults to acclimatize to telehealth services while also ensuring ongoing clinical wellbeing

Disclosure

A.Adam: None. K.Lau: None. H.Shah: None. M.Yu: None. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc.
944-P: Medicaid Insured Persons with Diabetes Have Increased Proportion of Missed Appointments and Poor Diabetes Control
Authors: RADHAKRISHNAN RAMYA , CADE WILLIAM H. , BERNAL-MIZRACHI ERNESTO , GARG RAJESH
Published: May 2022

Poor socioeconomic status and inadequate insurance coverage may affect an individual’s ability to utilize healthcare services. This study was conducted to evaluate whether the type of insurance coverage is associated with missed appointments for diabetes care. Data analysis included all patients with diabetes mellitus (DM) managed at a major academic center between Jan 2015 and Dec 2020. Association between insurance coverage and proportion of missed appointments was evaluated using analysis of covariance with adjustments for demographic variables and social determinants of health. The relationship between proportion of missed appointments and glycemic control was also evaluated in multivariate analyses. The final dataset included 30,633 patients, out of which 14,064 (46%) reported commercial insurance, 13,376 (44%) reported Medicare and 3,193 (10%) reported Medicaid coverage. Medicaid group was identified to have the highest proportion of Spanish-speakers, African Americans, women, current smokers and single individuals. Proportion of missed appointments was 18.1 ± 18.1% in Medicaid covered patients as compared to 12.1 ± 15.3% among commercially insured and 10.2 ± 14.1% among Medicare covered patients (p <0.001) . Type of insurance was found to be a statistically significant predictor of the proportion of missed appointments after adjusting for age, race, preferred language, marital status, smoking, BMI, HbA1c and type of diabetes (p<0.001) . Proportion of missed appointments was associated with HbA1c with partial correlation coefficient +0.1 (p <0.001) after adjusting for age, race, gender, type of insurance, BMI and type of diabetes. We conclude that Medicaid covered patients with diabetes have higher proportion of missed clinic appointments and higher HbA1C. More research is needed to evaluate the root causes of inability to keep appointments in this population so that strategies for improved healthcare delivery can be designed.

Disclosure

R.Radhakrishnan: None. W.H.Cade: None. E.Bernal-mizrachi: None. R.Garg: None.
945-P: Predictors of Lack of Improvement in Glycemic Control in Persons with Type 2 Diabetes
Authors: GARG RAJESH , LOUIE JUDY Z. , SHIFFMAN DOV , ROWLAND CHARLES M. , MCPHAUL MICHAEL J. , BERNAL-MIZRACHI ERNESTO , KENYON NORMA SUE
Published: May 2022

The ADA recommends an A1C <7% for most people with diabetes and <8.5% for those with relaxed glycemic goals. However, a large proportion of people with T2D fail to achieve the goal A1C. This study was performed to evaluate the factors associated with lack of improvement in A1C over a period of 3 years. This was a retrospective analysis including all patients with T2D treated at an academic center from 2015 to 2020. Patients with at least one A1C value available in each of 3 years prior to current A1C and ≥1 of those values >8.5% (poor control) were included. Patients with improved glycemic control (current A1C ≤8.5%) were compared with those with lack of improvement (current A1C >8.5%) . On multivariate logistic regression analysis including all variables in the model, independent predictors of lack of improvement were: younger age (OR 0.89 per 1-SD [12 years]; 95 % CI 0.79 - 1.00) , female gender (1.30, 1.- 1.56) , presence of hypertension (1.29, 1.- 1.55) , Black race (1.32, 1.- 1.68, White as reference) , low income area code (1.86,1.28 - 2.68, high as reference) and insurance coverage other than Medicare (1.32, 1.- 1.66) . Presence of current smoking was associated with a paradoxical improvement in A1C (0.69, 0.47 - 0.99) . We conclude that socioeconomic factors like income, insurance coverage and neighborhood are associated with lack of improvement in A1C. Further studies need to identify specific modifiable socioeconomic factors.

Disclosure

R. Garg: None. J.Z. Louie: None. D. Shiffman: Employee; Quest Diagnostics. Stock/Shareholder; Quest Diagnostics. C.M. Rowland: Employee; Quest Diagnostics. Stock/Shareholder; Quest Diagnostics. M.J. McPhaul: Employee; Quest Diagnostics. E. Bernal-Mizrachi: None. N. Kenyon: Research Support; Elodon Phamaceutical, Takeda Pharmaceutical Company Limited.
948-P: Patient Satisfaction with Virtual Diabetes Care during the COVID-Pandemic
Authors: CHANG CALVIN , DISSANAYAKE ASHINI , PAWLOWSKA MONIKA , SCHROEDER BENJAMIN , MACKENZIE-FEDER JESSICA , WHITE ADAM
Published: May 2022

The COVID-pandemic has required changes to healthcare delivery and has been a stressful time for people with diabetes mellitus (DM) . Previous literature suggests that virtual health appointments for diabetes care can be effective and result in high patient satisfaction. However, it is unclear if patients with DM are satisfied with the widespread adoption of virtual care during the pandemic. The aim of this study was to evaluate the impact of virtual care during the pandemic on patient satisfaction in patients with type 1 and type 2 DM. The validated Patient Satisfaction Questionnaire (PSQ-III) was completed by 197 patients who had an in-person appointment in the six months before March 18, 2020 (pre-COVID) and a subsequent virtual appointment within six months after that date. For each form of healthcare delivery (i.e. in-person and virtual) , the satisfaction in six aspects of care was measured: general satisfaction, technical quality, interpersonal manner, communication, time spent with doctor, and accessibility of care. Both type 2 DM and age >55 years were associated with decreased general satisfaction with virtual care compared to in-person care. Both type 2 DM and female sex were associated with decreased technical quality of care. Accessibility of care decreased significantly in the overall study group. No significant differences in patient satisfaction were observed in the type 1 DM group. Despite our findings, 74% of respondents answered they would consider virtual health appointments in the future. Our data suggests that many patients welcome virtual health as an addition to their medical care. However, virtual health does not seem to deliver the same level of patient satisfaction as in-person appointments over the longer term. Future research on how fatigue with pandemic restrictions has affected patient satisfaction is needed to evaluate whether virtual health appointments are a viable option for long term diabetes care.

Disclosure

C.Chang: None. A.Dissanayake: None. M.Pawlowska: Advisory Panel; Novo Nordisk, Other Relationship; Medtronic. B.Schroeder: Advisory Panel; Novartis Canada, Novartis Canada, Novartis Canada, Novo Nordisk Canada Inc., Novo Nordisk Canada Inc., Novo Nordisk Canada Inc. J.Mackenzie-feder: Advisory Panel; Recordati S.p.A. A.White: Advisory Panel; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc.
95-LB: Interim Data from a Prospective Study Measuring User Satisfaction and Metabolic Outcome while Using a Novel Modular Patch Pump System
Authors: DAIN ALEJANDRO , MOCERI SANDRA , DAGENBACH NICOLE , REES CHRISTEN , VULCANO CRISTINA , VOGT GERHARD , ETTER TOBIAS J.
Published: May 2022

Background and aims: Intensified insulin therapy for type 1 diabetes (T1D) can be administered by multiple daily injection therapy (MDI) or continuous subcutaneous insulin infusion therapy (CSII) . Despite the clinical benefits of CSII, its therapeutic implementation rate remains low. Thus, this study aims to evaluate the change in treatment satisfaction and metabolic changes of people with T1D switching from MDI to CSII therapy using a novel modular patch pump system.

Materials and Methods: A total of 50 adults from Argentina with T1D, naïve to CSII, were enrolled in a multi - center, prospective, single - armed study for the Accu-Chek® Solo micropump system (ACS) . Change in diabetes treatment satisfaction after 13 weeks (mean 106, min 83, max 176 days) was assessed by the “Impact and Satisfaction” section of the Diabetes Technology Questionnaire (DTQ) as the primary outcome. In addition, changes in the HbA1c were reported by the investigator as a secondary outcome.

Results: The mean DTQ “now” score improved from 92.96 ± 14.98 to 103.15 ± 19.47 (p = 0.0166) and the “change” score, as the primary outcome, was 113.24 ± 17.50 (p < 0.0001) . Based on pre - defined sub - categories, the following mean DTQ scores were measured: 3.83 ± 0.62 for “diabetes distress and burden,” 3.98 ± 0.70 for “hypoglycemia fear, worry and behavior,” 3.59 ± 0.70 for “device acceptance and satisfaction,” 3.92 ± 0.61 for “other.” In addition, the mean HbA1c, as a secondary outcome, decreased from 8.19 % ± 1.36 to 7.83 % ± 1.23 (- 0.37 %pt, p = 0.0148) . Thereby, the HbA1c reduction was not associated with any reported incidents of hypoglycemia.

Conclusion: The switch from MDI to the Accu-Chek® Solo micropump system led to a significant improvement of subjects’ treatment satisfaction after 13 weeks, which was linked to a significant reduction of the outcome HbA1c without any reported incidents of hypoglycemia.

Disclosure

A. Dain: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Roche Diabetes Care, Speaker’s Bureau; Abbott Diabetes, AstraZeneca, Lilly Diabetes, Novo Nordisk. S. Moceri: Employee; Roche Diabetes Care. N. Dagenbach: Employee; Roche Diabetes Care. C. Rees: Employee; Roche Diabetes Care. C. Vulcano: Employee; Roche Diabetes Care. G. Vogt: Employee; Roche Diabetes Care. T. J. Etter: Employee; Roche Diabetes Care.

Funding

Roche Diabetes Care Gmbh, Mannheim, Germany
956-P: Integrating an Evidence-Based Diabetes Digital Texting Program (Dulce Digital) via an EMR Patient Portal in a Large Health System
Authors: RUIZ MONICA , PHILIS-TSIMIKAS ATHENA , SANDOVAL HALEY , FORTMANN ADDIE L. , STECHSCHULTE MARIAH A. , BAGSIC SAMANTHA R. , PATEL KAREN , MENDEZ KRISTINE
Published: May 2022

Dulce Digital (DD) , a simple low-cost text message program designed to enhance clinical diabetes care with educational, motivational and glucose reminder messages when delivered 2-3 times/day over 6 months has been shown to be highly acceptable in diverse racial/ethnic minorities and low SES communities and results in a mean 1% reduction in HbA1c compared to usual care. During the COVID pandemic, barriers to in-person care, including quarantines, stay-at-home work schedules, childcare, and transportation, make digital messaging a practical means of improving patient health. To maximize reach in the T2DM population, a large Southern California health care provider integrated DD into their DSME/S offering. This study aims to learn the reach, acceptability, and effectiveness of Dulce Digital in a real-world patient care setting to motivate patients with daily self-care behaviors. An existing diabetes registry identified N=1423 patients with T2DM and HbA1c>7.5% in the last 6 months. There was enthusiastic adoption of the DD texting program byprimary care clinic sites with 78 providers across the County. Patient recruitment was conducted via a patient portal message (EPIC My Chart) sent from healthcare providers encouraging participation in the program. Within one week of portal outreach, 116 patients (8.2%) enrolled (mean age = 57.3 y/o +/- 14.4, range 24-92; 50% female; mean HbA1c= 9.9 % +/- 1.5, range 8.1-16.2) . Program workflows include using support staff to monitor blood glucose responses in the texting platform, assess possible reasons for hyper/hypoglycemia, and encourage follow up with a provider as needed. Adoption by patients and providers to date demonstrate a digital texting program is acceptable and desired equally by men and women across a wide range of ages in patients with T2D and elevated HbA1c. Outreach to enroll patients using a patient EMR portal can be successful and can serve as an enhanced approach to support DSME/S.

Disclosure

M.Ruiz: n/a. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. H.Sandoval: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. M.A.Stechschulte: None. S.R.Bagsic: None. K.Patel: None. K.Mendez: None.
962-P: Interim Real-World Ten-Site Data from the National Danish PRO Diabetes Multisector Study (M-PRODIA) Engaging 460 Persons with Diabetes and 30 Health Care Professionals Shows High Acceptability and Benefits
Authors: EJSKJAER NIELS , KJAER PERNILLE H. , BERTHELSEN DORTHE B. , KAPLAN SHERRIE H. , JAKOBSEN POUL ERIK O. , GLÜMER CHARLOTTE , SKOVLUND SOREN E.
Published: May 2022

Introduction: A national value-based health care project, VBHC-PRO-DIA, was initiated in 2017 to develop and evaluate a scalable solution for value based diabetes care in Denmark. Our project was undertaken in partnership and alignment with a national PRO diabetes program. We present the study design for this national project.

Materials and Methods: A participatory multi-stakeholder research design process 2017-2020 with systematic involvement of > 70 PWD using interviews, workshops, clinical & qualitative research: 1) A minimal patient-important diabetes outcome domain set (VBHC structure) . 2) A unified PRO diabetes “logic model” for how to use PRO to drive health value. 3) A national psychometric PRO Diabetes Questionnaire & Decision-Algorithm. 4) A VBHC-PRO IT Tool for seamless use of outcome data in routine diabetes care. 5) A multi-center real-world PRO pilot study of public health potential (RE-AIM) . 6) Implementation planning, data-driven VBHC model design and effectiveness study.

Results: National PRO Model: PWD fills out PRO before visit. PRO is used in-visit for collaborative, focused, whole-person care. A multi-dimensional PRO questionnaire (36-70 items) covering: General health/wellbeing, daily life with diabetes, diabetes distress, self-care, BG regulation, symptoms, access to care, personal goals and priorities. Real-world 10-site PRO study : Interim data: > 460 PWD/ 30 HCPs showed high acceptability and experience of benefits related to active engagement of PWD and person-centred diabetes care quality.

Disclosure

N.Ejskjaer: None. P.H.Kjaer: None. D.B.Berthelsen: None. S.H.Kaplan: n/a. P.O.Jakobsen: None. C.Glümer: n/a. S.E.Skovlund: Consultant; Roche Diabetes Care.
963-P: Preservation of Renal Function in Patients with Diabetes and Comorbid CKD 3 as Measured by eGFR in 1,877 Elderly Patients at CanoHealth. A Two-Year Retrospective EHR-Based Analysis.
Authors: AGUILAR RICHARD , KENNEY ROBERT E. , ANTUNEZ EFRAIN , OSORIO MERLIN , HERMAN MARY , CONGER MORGAN , AGUILAR MICHELLE
Published: May 2022

This study sought to explore the effect of the CANO Model of Care (CMC) on renal function in elderly Medicare Advantage patients. A 2-Y retrospective review of laboratory data for patients new to CANO (≤3 mos) between Jan 1 and Dec 31, 2018 with diabetes and CKD 3 was conducted. We identified 1,877 patients and collected eGFR, A1C, BMI, SBP/DBP at baseline and at various time points for 24 months (Table 1) . Mean age was 76.5 +/- 9.2Y. Preservation of renal function as represented by eGFR was evident at all time points. Statistically significant improvements in eGFR values were observed during the first 15 months, with no significant changes from baseline for months 18 to 24. Renal function in patients with diabetes and CKD 3 decreases over time. In this cohort renal function, as measured by eGFR, was preserved for 24 months. Subgroup analysis of patients with CKD 3b (n=606) shows similar results. The preservation in renal function may be attributable in part to the Cano Model of Care. The CMC includes a propriety population health platform (CanoPanorama™) which informs care management decisions, imbedded structured data within the EHR, attainment of high PCP NCQA recognition for diabetes care (1) , monthly coordinated physician CMEs, pursuit of 5-star HEDIS® (2) quality metric ratings, and addressing clinical inertia (3) .

Disclosure

R.Aguilar: Speaker's Bureau; Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S. R.E.Kenney: None. E.Antunez: None. M.Osorio: None. M.Herman: None. M.Conger: None. M.Aguilar: None.
969-P: Changes in Patterns of Care in Diabetes via Virtual Care Delivery Prior to and During COVID-Pandemic
Authors: PALCU PATRICIA , MUKERJI GEETHA , CHU CHERRY , PENDRITH CIARA
Published: May 2022

Background: The COVID-pandemic and virtual care has impacted the care delivery of many health care conditions including diabetes. This study aimed to compare how patterns of care for diabetes have changed as a result of virtual care and the COVID-pandemic at a large academic ambulatory care facility in Toronto, Canada.

Methods: Patients were included who had an initial diabetes visit between September 15, 20 and September 20, 2020. Fisher's exact test was used to determine differences in care patterns between visits pre and during COVID- (after March 14, 2020) .

Results: Pre-COVID-19, there were 240 (72.7%) completed initial visits and 90 (27.3%) follow-up visits, including 27.5% and 36.7% for type 1 diabetes, respectively. During COVID-19, there were 235 (44.1%) initial visits and 298 (56%) follow-up visits including 29.4% and 27.2% for type 1 diabetes, respectively. Including all visits, there were more no-shows during COVID-19, 4.5% vs. 1.5%; p<0.05. Out of 330 pre-COVID-visits, all (100%) were done in-person. During COVID-19, out of 533 visits, 89.3% were done by phone, 7.5% by video, and only 3.2% in-person.

Conclusion: During COVID-19, there were more follow-up diabetes visits seen compared to initial visits and more no-shows. Most diabetes visits were done by phone during COVID-19. More data is needed to understand how diabetes care delivery has changed as a result of virtual care during COVID-19.

Disclosure

P.Palcu: None. G.Mukerji: n/a. C.Chu: None. C.Pendrith: None.
971-P: Use of Telemedicine for Type 1 Diabetes Care in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) in 2021
Authors: LEE JOYCE M. , OSPELT EMMA L. , MUNGMODE ANN , EBEKOZIEN OSAGIE , GUPTA MEENAL , MALIK FAISAL , FOGEL NAOMI R. , ACCACHA SIHAM , HSIEH SUSAN , WILKES MEREDITH , NEYMAN ANNA , VENDRAME FRANCESCO
Published: May 2022

Background: The COVID-pandemic accelerated adoption of telemedicine for diabetes care in 2020. We sought to describe the utilization of telemedicine across the T1DX-QI in 2021.

Methods: Twenty four pediatric and nine adult clinics completed a survey about the proportion of televisits performed, center goals and processes in fall of 2021.

Results: The majority of clinics reported performing between 11-25% (n=16, 48%) and 0-10% televisits (n=9, 27%) . The majority reported a pre-visit preparation workflow (n=24, 73%) , but most sites reported not having a staff member dedicated to supporting televisits (n=21, 64%) . No major differences in televisit use, goals, and processes were observed between pediatric and adult sites. For diabetes technology data downloads, the majority of clinics integrated data automatically into the EHR (n=25, 73%) . The major barriers to sustaining telemedicine practice across clinics were patient internet access, patient health disparities and access to device data (Figure 1) .

Conclusion: More than one year into the pandemic the proportion of televisits performed by the T1DX-QI collaborative is modest. Clinic workflows have been implemented to support telemedicine but insufficient institutional support and technology barriers still represent an obstacle.

Disclosure

J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. M.Wilkes: None. A.Neyman: None. F.Vendrame: None. E.L.Ospelt: None. A.Mungmode: None. O.Ebekozien: None. M.Gupta: None. F.Malik: n/a. N.R.Fogel: None. S.Accacha: None. S.Hsieh: None.
973-P: By How Much Does Red Blood Cell Status Affect the Accuracy of HbA1c?
Authors: KARWATH ANDREAS , WILLIAMS JOHN A. , ROUND RACHEL A. , STRATTON IRENE M. , GKOUTOS GEORGIOS , MOSTAFA SAMIUL , ROBERTS GRAHAM , WEBBER JONATHAN , MANLEY SUSAN E.
Published: May 2022

Medical conditions can affect haematological factors altering relationship between HbA1c and glucose. Patients were recruited at hospital over 3 visits (*1/**2&3 only) comprising 20 with diabetes and in Fig 1 with liver disease (LD) & hepatitis C (HC) on ribavirin*, on dapsone*, with macrocytosis, and in Fig 2 LD & HC off ribavirin**, LD with nonalcoholic steatohepatitis and cirrhosis, rheumatoid arthritis, renal disease on erythropoietin (EPO) , renal disease off EPO and with microcytosis. Glucose and full blood count were measured with HbA1c on Tosoh G8 analysers, ref range 20-42mmol/mol.

In Fig 1 HbA1c was more depressed relative to glucose than Fig 2, both p<0.001, with a combination of lower red blood cell (rbc) count & higher mean cell volume. The macrocytic nature of rbc implies faster turnover and less contact of haemoglobin with circulating glucose.

Disclosure

A. Karwath: None. J.A. Williams: None. R.A. Round: None. G. Gkoutos: None. G. Roberts: None. J. Webber: None.

Funding

Medical Research Council (MR/S003991/1) , MRC HDR UK (HDRUK/CFC/01) , NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032) , MAESTRIA (Grant agreement ID 965286)
980-P: Continuous Glucose Monitor Improves Glycemic Control in Youth-Onset Type 2 Diabetes
Authors: CHANG NANCY T. , SMITH JOSEPHINE ANDREA , CHAO LILY
Published: May 2022

Background: Youth with type 2 diabetes (T2D) develop early treatment failure. Most patients do not self-monitor blood glucose (SMBG) levels at recommended frequency. Continuous glucose monitor (CGM) has been shown to improve glycemic control in pediatric T1D and adult T2D. Its feasibility and efficacy in youth-onset T2D is unknown.

Hypothesis: Participants who wear the CGM >85% of the time will lower their HbA1c by at least 0.5%.

Methods: T2D patients prescribed insulin were eligible to participate if their HbA1c was at least 8%. Participants were randomized to 3-months of SMBG or Dexcom G6 CGM, followed by 3 months of washout (SMBG) and 3-month crossover to the other treatment arm. Participants and their clinical providers agreed to not start new diabetes medications but could adjust insulin dosing or add on rapid-acting insulin if HbA1c >9% at follow-up. A nurse care manager provided coaching for the first 30 days of CGM use. The CGM-SAT satisfaction survey was administered at the end of CGM wear. Student t-test and Fisher’s exact test were used to compare differences in continuous and categorical variables between groups, respectively. A 5% level of significance was used.

Results: out of 14 participants completed the study. Our cohort was 55% female. At enrollment, mean age was 17.4±2.0 years, diagnosis duration was 4.0±2.8 years, and HbA1c was 11.5±2.5%. The percentage of days with CGM data trended from 89% down to 73% between the 1st and 3rd month of CGM use (not statistically significant) . CGM use lowered HbA1c by 2.8% for the cohort (SMBG: -0.1%, CGM: -3.1%, P=0.005) and by 3.8% for those who wore the CGM >85% of the time (P=0.01) . The mean CGM item score was 3.7 ± 0.5, comparable to prior results reported in T1D youth.

Conclusion: Consistent CGM use improves glycemic control in youth-onset type 2 diabetes in this pilot study. Not all patients experienced an improvement in HbA1c. A larger study is warranted to validate the findings of this study and to identify patients who are most likely to benefit from CGM use.

Disclosure

N.T.Chang: None. J.Smith: None. L.Chao: None.

Funding

Dexcom
99-OR: HbA1c Variability Predicts Both Coronary Atherosclerosis and CVD Events in Type 1 Diabetes
Authors: HORTON WILLIAM B. , SNELL-BERGEON JANET K.
Published: May 2022

Introduction: Interventions that decrease mean glucose have reduced rates of type 1 diabetes (T1D) vascular complications, but the difference in cardiovascular disease (CVD) risk between people with T1D and the general population endures. This suggests that factors beyond hemoglobin A1c (HbA1c) normalization may drive T1D CVD outcomes. HbA1c variability is an established predictor of T1D microvascular disease, but thus far only the FinnDiane Study has implicated it as a risk factor for T1D CVD events. No studies have examined the relationship of HbA1c variability to both CVD risk factors and events in a prospective T1D cohort.

Methods: We used multivariable logistic regression to analyze the Coronary Artery Calcification in Type 1 Diabetes (CACTI) T1D cohort (N=597) . Primary outcomes were square root-transformed coronary artery calcium (CAC) volume and CVD events. CVD events were defined as myocardial infarction, coronary artery bypass grafting, angioplasty, or cardiovascular death. HbA1c variability was defined as a 1-standard deviation increment in HbA1c and calculated as standard deviation of all HbA1c values for each subject.

Results: After adjustment for age, sex, and T1D duration, HbA1c variability predicted both CVD events (HR: 1.562, 95% CI: 1.052-2.318, P=0.0269) and CAC volume (rpartial= 0.3346, P<0.001) , while mean HbA1c predicted CVD events (HR: 1.399, 95% CI: 1.079-1.816, P=0.0114) but not CAC volume (rpartial= 0.0934, P=0.2886) . Further investigation revealed that the relationship between HbA1c variability and CVD events was strongest in those with good glycemic control (HR: 6.330 at mean HbA1c of 6.0%, HR: 3.920 at mean HbA1c of 7.0%, HR: 2.428 at mean HbA1c of 8.0%, HR: 1.5at mean HbA1c of 9.0%, and HR: 0.931 at mean HbA1c of 10.0%) .

Conclusion: HbA1c variability may be a risk factor for both coronary atherosclerosis and CVD events in T1D, and the appropriate care strategy for this population may include maintaining an HbA1c value over time that is both at-target and stable.

Disclosure

W.B.Horton: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.

Funding

National Institutes of Health (R01DK116731) National Institutes of Health (R01HL113029)
990-P: Prebiotics and Metformin: A Pilot Randomized Controlled Trial in Youth-Onset Type 2 Diabetes
Authors: DIXON SYDNEY A. , MEYERS ABBY , TUTTLE KUNANI , MABUNDO LILIAN , STAGLIANO MICHAEL S. , VILLALOBOS-PEREZ ALFREDO , DIETSCHE KATRINA B. , COURVILLE AMBER B. , ESTRADA DORIS E. , CHUNG STEPHANIE T.
Published: May 2022

Metformin is the only first-line oral agent for youth with type 2 diabetes mellitus (Y-T2D) , but efficacy and adherence is complicated by gastrointestinal (GI) side effects. Prebiotic microbiome modulators (MM) may reduce side effects by shifting the microbial flora and promoting metabolism of short-chain fatty acid producing bacteria. The feasibility and tolerability of prebiotic use in Y-T2D is unknown. We hypothesized that a prebiotic MM would be safe, tolerable, and decrease GI symptoms in youth. We compared lower GI symptoms and glycemia in Y-T2D at initiation of daily metformin therapy in a 1-week, randomized, double-blind, crossover trial of a daily prebiotic MM versus placebo shake (Phase 1) followed by a 1 month open-labeled extension (Phase 2) . We assessed stool frequency, stool consistency (King’s Stool Chart) , and used principal component analysis to create a composite GI symptom score (urgency, bloating, flatulence, consistency) . Mixed effects models were used to compare continuous glucose monitor profiles and quality of life metrics (Pediatric Quality of Life Inventory™) . In six Y-T2D (17.2±1.7y (mean±SD) , 66% female, BMI 42±9 kg/m2, HbA1c 6.4±0.6%) stool frequency was assessed every 1-2 days. Stool frequency, stool composition, GI symptom score, and quality of life scores were not different by group or study phase. There were no severe adverse effects during the trial. One youth had increased bloating and discontinued the prebiotic in Phase 2. During phase 1, prebiotic MM tended to have lower average glucose (122±26 vs. 135±23 mg/dL, P=0.07) but this was not sustained in phase 2 (136±31 vs.135±23, P=0.8) . Time in range, standard deviation, and coefficient of variation of glucose were similar during the study.

In summary, the prebiotic MM was well tolerated during short-term metformin therapy in Y-T2D, but was not associated with GI symptom, quality of life, or metabolic changes. Future studies should explore localized gut and systemic metabolic effects of prebiotics in youth.

Disclosure

K. Tuttle: None. L. Mabundo: None. M.S. Stagliano: None. K.B. Dietsche: None. A.B. Courville: None. D.E. Estrada: None. S.T. Chung: None.

Funding

NIDDK/NIH Intramural Research Program
999-P: Associations between Perceived Stress and Morning Serum Cortisol with Glycemic Measures in Minority Youth with Overweight or Obesity
Authors: FELIX KIMBERLY , WEIGENSBERG MARC , TOLEDO-CORRAL CLAUDIA M.
Published: May 2022

Background: In youth, higher morning serum cortisol has been associated with fasting glucose, however the direct role of psychosocial stress as risk factor type 2 diabetes has not been well established; therefore, in this study, we examined the associations between perceived stress and fasting serum cortisol with fasting and 2-hour post glucose challenge and hemoglobin A1c.

Methods: In this cross-sectional study among Latino and African American youth with overweight or obesity (n=195, age=14.6±2.8yrs) we measured psychosocial stress with the 14-item Perceived Stress Scale for children and glucose concentrations at fasting and 2-hour post glucose challenge (1.75g oral glucose solution/kg body weight to a maximum 75g) . Hemoglobin A1c (HbA1c) and morning serum cortisol were measured from the fasting blood draw. Linear regression models assessed the relationships between perceived stress and morning cortisol with fasting glucose, 2-hour glucose, and HbA1c. With logistic regression models, we tested if perceived stress and morning serum cortisol associated with impaired fasting glucose, impaired glucose tolerance, or impaired HbA1c status. A priori covariates included age, sex, and ethnicity.

Results: Perceived stress scores were not associated with any glycemic measures (all p>0.05) . Morning serum cortisol was positively associated with HbA1c (β=0.016; 95%CI=0.002,0.030) and impaired HbA1c status (OR=1.090; 95%CI=1.006,1.181) in unadjusted models and results were largely unchanged in adjusted models.

Conclusion: Perceived stress, a common way to measure psychosocial stress, was not associated with any glycemic measures. Morning fasting cortisol was not associated with glucose levels, but was associated with HbA1c, a novel finding in this population of minority children. This finding adds to previous literature which showed that fasting serum cortisol associates with fasting glucose in children with overweight and obesity.

Disclosure

K.Felix: None. M.Weigensberg: None. C.M.Toledo-corral: None.

Funding

National Institutes of Health (P60 MD00254) National Institutes of Health (UL1GM118976) National Institutes of Health (RLGM118975) National Institutes of Health (TL4GM118977)
To elevers udvikling gennem vejledning i de store opgaver i gymnasiet
Authors: Bang-Larsen Anne , Dreyer Søren Nygaard
Published: May 2022

I danske læreplaner for gymnasiet fremhæves det, at vejledning og skriftlighed er tæt forbundne. Vejledningsforskning har i nogen grad fokuseret på vejlederpositioner og modeller for vejledning, mens man i forskning i skrivning i gymnasiet i dansk kontekst har undersøgt skriverudviklinger i fag og i de store, flerfaglige opgaver. Imidlertid har koblingen mellem vejledning og skriverudvikling været underbelyst. I denne artikel undersøger vi med et sociokulturelt afsæt, hvordan vejledninge  i de store skriftlige opgaver i gymnasiet i dansk kontekst påvirker elevernes udvikling som skrivere. Vi fokuserer på to elevskriveres erfaringer med vejledning gennem tre store opgaver. Analyserne, som er baseret på kvalitative data fra et casestudie, viser, at de to elevers udvikling er besværlig og kompleks. Eleverne efterspørger vejledning, der er tæt på deres tekst og skrivning, men dette imødekommes kun i begrænset omfang i vejledningen: Vejledningen er enten meget lokal eller meget generisk og overvejende færdighedsorienteret. Desuden peger analyserne på, at vejledningen kun i begrænset omfang inddrager det diakrone perspektiv i elevernes udvikling. Derved vises det, at det i høj grad overlades til eleverne selv at etablere sammenhæng i deres udvikling gennem vejledning og skrivning.
English abstract
Two pupils’ development through participation in supervision in connection with written projects as part of upper secondary school
The Danish upper secondary school curricula emphasise an interconnectivity of supervision and writing. Research has to some extent focused on supervisor positions and models for supervision, while the Danish research into upper secondary school literacy has focused on writer development in the individual disciplines as well as in the students’ three individual interdisciplinary written projects. The connection between supervision and writer development, however, has been overlooked. With a sociocultural basis, this article examines how supervision leading up to the individual interdisciplinary written projects influences the students’ development as writers. The article focuses on two student writers’ supervision experiences throughout all three obligatory written projects in Danish upper secondary school. Analyses, based on qualitative data, show that the developments of the two students are strenuous and complex. The students seek a type of supervision specifically aimed at their text and concrete writing process, but this is only seldom met during the supervisions. Rather, the supervision tends to be either very local or quite generic and predominately proficiency-oriented. In addition, the analysis shows that the observed supervision only to a limited extent includes the diachronic perspective in the students’ development. Thus, it is shown that it is the students themselves who are predominately responsible for establishing coherence in their own developments through supervision and writing.
Pengaruh Model Pembelajaran Kooperatif Tipe Teknik Think-Pair-Share Terhadap Peningkatan Kemampuan Pemahaman dan Komunikasi Matematis
Authors: Tambunan Lois
Published: May 2022

Rendahnya kompetensi belajar matematika dipengaruhi oleh kurangnya partisipasi aktif siswa dalam pembelajaran di kelas. Hal ini sangat menghambat siswa untuk dapat menyelesaikan permasalahan yang ada. Partisipasi ini berhubungan erat dengan kemampuan pemahaman dan komunikasi matematis siswa. Rendahnya kemampuan pemahaman dan komunikasi matematis ini mengakibatkan siswa sulit untuk mencerna soal-soal yang diberikan sehingga mereka tidak bisa memecahkan masalah tersebut. Seorang siswa yang memiliki kemampuan pemahaman dan komunikasi yang baik akan dapat dengan mudah mengambil suatu langkah untuk menyelesaikan sebuah persoalan. Secara khusus penelitian ini bertujuan untuk mengetahui apakah peningkatan kemampuan pemahaman dan komunikasi matematis siswa yang model pembelajaran kooperatif tipe Think-Pair-Share lebih tinggi daripada siswa yang mendapat pembelajaran konvensional serta mendeskripsikan sikap siswa terhadap pembelajaran kooperatif dengan model Think-Pair-Share. Penelitian ini menggunakan metode penelitian ekperimen. Penggunaan metode penelitian ini karena penelitian ini benar-benar untuk melihat hubungan sebab akibat antara model pembelajaran kooperatif tipe Think-Pair-Share dan kemampuan pemahaman dan komunikasi matematis siswa, dan tes statistik yang akan digunakan untuk pengujian perbedaan dua rata-rata adalah uji-t.Kata Kunci: Pemahaman Matematis, Komunikasi Matematis, Think-Pair-Share.
Analisis kemampuan Komunikasi Matematis Siswa Pada Pembelajaran Daring
Authors: Fauzi Ahmad
Published: May 2022

Kemampuan Komunikasi, Pembelajaran Daring
Poikittaisisotrooppinen lineaarikimmoinen materiaalimalli
Authors: Kolari Kari , Kouhia Reijo
Published: May 2022

Artikkelissa johdetaan lineaarisesti kimmoisan poikittaisisotrooppisen materiaalimallin konstitutiivinen yhtälö invarianttiteorian avulla koordinaatistoriippumattomassa muodossa. Poikittaisisotrooppisen kimmoisan aineen jännitysenergia tai vastaavasti venymäenergiariippuu viidestä invariantista, kolmesta jännitystensorin invariantista ja kahdesta jännityksen ja rakennetensorin tulon invariantista, tai venymäenergian tapauksessa kolmesta venymätensorin invariantista ja kahdesta venymän ja rakennetensorin tulon invariantista.
On the Problem of Quantitative Assessment of Fatigue of the Technological Vehicle Drivers
Authors:   ООО «SPbGASU-Dorservis», Dobroborskiy B.S. , Medres E.E. ,   Saint-Petersburg State University of Architecture and Civil Engineering
Published: May 2022

Cargo transportation by the technological vehicles is one of the main links in functioning of the industrial enterprises. At the same time, the operation of vehicles directly depends on the human factor, which contributes to an increase in the road accidents, one of the causes of which is driver fatigue. Numerous works were devoted to the attempts on solving this problem, containing an analysis of the signs of fatigue, which include changes in the time of reactions to light and sound, vehicle control dynamics, eyes functioning, blinking frequency, and others. It is required to find the ways for their quantitative assessment. However, the studies based on the principles of observation and experiment accepted in biology do not allow obtaining the specific result, since these studies are of descriptive character. In connection with it, the analysis of this problem from the standpoint of the laws of physics was carried out. From this point of view, a living organism is a biological system functioning in accordance with the laws of non-equilibrium thermodynamics in the form of a continuous alternation of cycles of the biochemical reactions that ensure the maintenance of its non-equilibrium state and vital activity by consuming and releasing energy. Analysis of the published studies results showed that it is enough to analyze the process of fatigue by changes in the time of reactions to light and sound, for which the required technical means are available. It is necessary to abandon the analysis of other features, the measurement of which is very problematic. The conducted studies of the patterns of changes in the reaction time to light and sound of the driver both in the process of driving a vehicle and during short and long breaks showed that these patterns are identical and obey the law of mass action, which allows to carry out the required calculations of the safe time of driving a vehicle.
Special Features of the Release of Indicator Fire Gases at the Nitrogen Supply to the Foci of Coal Spontaneous Combustion
Authors:   T.F. Gorbachev Kuzbass State Technical University, Portola V.A. , Bobrovnikova A.A. ,   T.F. Gorbachev Kuzbass State Technical University, Sin S.A. ,   T.F. Gorbachev Kuzbass State Technical University, Igishev V.G. ,   AO «NTs VostNII»
Published: May 2022

The most common method for monitoring the processes of spontaneous combustion of coal in the mines is the analysis of the composition of the mine atmosphere to detect gases released from coal when the temperature rises. Carbon monoxide and hydrogen are usually used as the main indicators. In recent years, nitrogen is widely used to prevent and extinguish the underground fires. It reduces the oxygen concentration in the fire area and can affect the indicator gases release. To study this effect, the samples of coal with a fraction of 1–3 mm, and the samples of coal dust with a particle size of 0.2–0.4 mm were used. Nitrogen with an admixture of oxygen was supplied to the heated samples. Studies showed that the carbon monoxide and hydrogen are released from the coal dust much more intensively than from the coal. Therefore, high concentrations of these indicator gases may point to the spontaneous combustion of the coal dust. As the proportion of oxygen in the mixture with nitrogen decreases, the release of carbon monoxide and hydrogen from the heated samples of coal and coal dust decreases. This can make it difficult to assess the state of spontaneous combustion foci in an inert environment. To determine the coal temperature when nitrogen with different oxygen content is supplied, the ratio of carbon monoxide and hydrogen concentrations can be used. In the coal dust it turns out to be the same as in the coal only at 3 % oxygen content. With an increase in the oxygen concentration, this ratio for the coal dust changes significantly. This fact can be used for the identification of fire foci.
CARACTERIZAÇÃO E ANÁLISE SENSORIAL DE FRUTOS DE MORANGUEIRO CULTIVADO EM DIFERENTES CONDIÇÕES DE SOMBREAMENTO
Authors: Inês Kemper Back Patrícia , Guerra Divanilde , Hart Weber Fernanda , Frank Thies Vanderlei , Lorensi de Souza Eduardo , De Castro Vasconcelos Marlon
Published: May 2022

O trabalho objetivou avaliar a produtividade, as características físico-químicas e sensoriais de morangos da cultivar Camino Real cultivado em diferentes condições de sombreamento. Utilizou-se um delineamento experimental de blocos ao acaso, com quatro repetições. Foi avaliado o efeito de dois ambientes de cultivo (sombreado e não sombreado) sobre a massa de frutos, número de frutos, largura e comprimento, teor de sólidos solúveis, dureza e pH. A análise sensorial foi realizada por um painel de 50 avaliadores através do teste de aceitação. A maior produtividade de frutos foi obtida no ambiente não sombreado com 1018 frutos, com massa total de 14,48 kg e com valor médio de 10 °Brix, embora sem diferir significativamente em comprimento e largura, dureza e pH de frutos obtidos em ambiente sombreado. Com relação a aceitação dos frutos, os avaliadores demonstraram maior preferência pelos morangos cultivados sem sombreamento, e esta escolha ocorreu devido a maior acidez, ao sabor mais doce e textura mais macia, paramentos estes que diferiram significativamente quando comparados aos frutos obtidos em ambiente sombreado. Portanto, o ambiente não sombreado permitiu a obtenção de maior produtividade, maior massa de frutos, maior °Brix e frutos com melhor aceitação pelos avaliadores.
KEMAMPUAN ALJABAR DITINJAU DARI SIKAP SISWA
Authors: Rohman Muhamad Gani , Mulyono Mulyono , Dwidayati Nurkaromah
Published: May 2022

AbstractAlgebraic ability is an important part in mathematics. Someone with good algebraic ability will have good performancein mathematics. Math performance has related with attitudes toward mathematics. Someone with good math performance will have good math ability too. Algebraic ability can represent the quantitative situation so someone with good algebraic ability can see the relationship between variables clearly. Attitudes toward mathematics is positive or negative feelings toward math.  The methods in this study uses a mixed methods with sequential explanatory design where research is conducted in two stages, followed by a quantitative research to know algebraic ability after learning with TAI’s Learning Model and followed with a qualitative research to analyze the algebraic in terms of  attitudes toward mathematics. The quantitative research start with choosing sample students in XI IPA 5 of MAN 2 Kudus, when the qualitative research took seven students in that class. After all students in that class learned and participated in algebraic ablility test, there are correlation between attitute towards mathematics and algebraic ability.AbstrakKemampuan aljabar merupakan salah satu hal penting dalam matematika. Dengan kemampuan aljabar yang baik, performa matematika seseorang akan meningkat. Performa matematika memiliki kaitan dengan  sikap terhadap matematika. Ketika performa matematika seseorang baik, maka kemampuan-kemampuan matematika dalam diri orang tersebut juga relatif baik. Kemampuan aljabar mampu merepresentasikan situasi kuantitatif sehingga seseorang yang memiliki kemampuan aljabar mampu melihat hubungan antar variabel menjadi jelas. Sikap terhadap matematika merupakan perasaan positif atau negatif seseorang terhadap matematika. Metode penelitian yang digunakan adalah mixed methods dengan menggunakan desain sequential explanatory dimana penelitian dilakukan dengan dua tahap yaitu penelitian kuantitatif dengan menguji kemampuan aljabar setelah diajar dengan model TAI dan selanjutnya akan dilanjutkan dengan analisis kemampuan aljabar bila ditinjau dari sikap siswa. Penelitian kuantitatif mengambil sampel siswa kelas XI IPA 5 di MAN 2 Kudus, sementara penelitian kualitatifnya mengambil subjek penelitian tujuh siswa dari kelas tersebut. Setelah siswa kelas tersebut menerima pembelajaran dan mengikuti tes kemampuan aljabar, ditemukan pengaruh sikap siswa terhadap matematika pada tingkat kemampuan aljabar yang dimiliki.
Struktur, Makna, Fungsi, Dan Nilai Budaya, Dalam Mantra Aji Pemikat di Desa Margotani II Kecamatan Madang Suku II Kabupaten Oku Timur
Authors: Evriana Anggun , Missriani Missriani , Fitriani Yessi
Published: May 2022

Tujuan penelitian  ini untuk mendeskripsikan Struktur, Makna, Fungsi, Dan Nilai Budaya Dalam  Mantra Aji Pemikat. Dalam  mencapai validitasi, penelitian ini menggunakan jenis penelitian deskriptif dengan pendekatan kualitatif. Melalui metode pengumpulan data observasi, wawancara, rekam, pencatatatan, dan dokumentasi. Data dan sumber data dalam penelitian  ini adalah mantra Aji Pemikat yang dimiliki oleh dukun atau paranormal yang terdapat di Desa Margotani II Kecamatan Madang Suku II Kabupaten Oku Timur. Sumber data dalam  penelitian  ini adalah  penutur mantra yang terdapat yang terdapat di Desa Margotani II Kecamatan Madang Suku II Kabupaten Oku Timur. Makna yang muncul dari mantra Aji Pemikat yaitu penggunaan  mantra sebagai ilmu keluhuran. Fungsi mantra Aji Pemikat yaitu sesuai kegunaan mantra.