bluuebunny/crossref_metadata_2025 huggingface dataset:
1207-P: Positioning the Role of the Graduate of the Advanced Course in Diabetes in Primary Care Clinics by Diabetes Nurse Specialist
Authors: WAIZINGER ORIT
Published: June 2020

There are 70,942 people with diabetes in Haifa- Galil District of Clalit Health services, most are treated in primary care clinics. 10.7% have an HbA1c above 9% and 14.7% of the Arab patients. The HMO is in a process of reallocating and redistributing personnel to better meet the needs. The nursing staff and specifically the graduates of the advanced diabetes course (GADC) are an important asset that needs to be maximally utilized to meet this end. There are 24 nurses who are GADC, 19 work in primary care setting.

Aims: Improvement of metabolic control by enhancing intervention by the GADC. Positioning the role of the GADC in primary care clinics.

Methods: Initiating a quality forum for the graduates led by the diabetes nurse specialist (DNS) coordinator and the head of nursing services to launch a targeted plan of intervention in the 18 community clinics in which they work. The 19 nurses make the intervention in their clinics - 7,800 patient with diabetes in total: invite them for assessment of adherence to therapy, patient education, intensification of therapy and follow-up until getting to target. Support, empowerment, supervision and ongoing assessment of the process by the District DNS.

Results: Improvement in the implementation of performance measures in the clinic from 81.7 to 88.4 (6.6) % in the total population and from 74.9 to 83.5 (8.6) % in the Arab sector. Improvement in the overall metabolic control from 77.9 to 86 (8) % and from 68.9 to 79 (10.1) % respectively. Decrease in HbA1c in those above 9% by -2.3% and -3.3% respectively.

Conclusions: A DNS led structured intervention by GADC as part of the policy of the District nursing administration, maximizes their abilities and professional authority of the graduates. The knowledge and skills provided by the GADC significantly improves performance measures as well as metabolic control. Continue the integration of future graduates into the framework at the community clinic level.

Disclosure

O. Waizinger: None.
1215-P: Qualitative Assessment of a Novel Intervention to Reduce Hospital Readmission Risk among Patients with Diabetes
Authors: TANNER SAMUEL , BRZANA EMILY , DEAK ANDREW , RECCO DOMINIC , TIVON MADELINE , DILLARD FELICIA R. , WATTS SAMANTHA , KONDAMURI NEIL , ALBURY BONNIE S. , ALLEN SHANEISHA , IWAMAYE AMY , VAZ CHERIE LISA , RUBIN DANIEL J.
Published: June 2020

Patients with diabetes (DM) are at higher risk of hospital readmission within 30 days of discharge (30dRe) than patients without DM. We previously reported quantitative results of a pilot RCT testing a novel intervention, the Diabetes Transition of Hospital Care (DiaTOHC) Program, designed to reduce readmission risk. The current study qualitatively assessed the intervention.

We identified 115 hospitalized patients with DM at high risk for 30dRe using the Diabetes Early Readmission Risk Indicator (DERRITM). A total of 58 patients were randomized to the DiaTOHC Program, which consisted of program-specific inpatient DM education, coordination of care, telephonic post-discharge support by a nurse (Navigator), and an A1c-based algorithm to adjust DM therapy. At 5 to 12 weeks post-discharge, intervention patients were interviewed until saturation, resulting in 22 interviews. Study staff were also interviewed. We performed thematic analysis of the interviews.

We identified 5 themes: (1) the intervention increased agency over DM self-management, (2) Navigator phone calls reinforced patient education and provided subjects with accountability, (3) it was difficult for patients to engage in DM education in the hospital, (4) perceived lack of control was associated with readmission, and (5) most patients were unable to correctly interpret their A1c level. Patients with baseline A1c >8% were less likely to review the educational materials, had more difficulty adhering to discharge instructions, and reported more extreme blood glucose levels. However, this subgroup also reported making more improvements in diet and medication adherence due to the intervention.

The DiaTOHC intervention may instill a sense of personal responsibility for DM management after hospital discharge. Patients and staff valued the combination of education, care coordination, and follow up. All 3 components may interact synergistically with medical management to reduce readmission risk.

Disclosure

S. Tanner: None. E. Brzana: None. A. Deak: None. D. Recco: None. M. Tivon: None. F.R. Dillard: None. S. Watts: None. N. Kondamuri: None. B.S. Albury: None. S. Allen: None. A. Iwamaye: None. C. Vaz: None. D.J. Rubin: None.

Funding

National Institutes of Health (K23DK102963)
1236-P: Perceptions of People with Early-Onset Type 2 Diabetes Mellitus about Diabetes and Exercise
Authors: GU YU , HARMER ALISON , WONG JENCIA , GAULD AMANDA , CONSTANTINO MARIA I. , MUNOZ PHILLIP A. , DENNIS SARAH
Published: June 2020

Background: The prevalence of early-onset type 2 diabetes (EOT2D, diagnosed with T2DM under the age 40) is increasing. There is limited research on the perceptions and knowledge about diabetes and its management. The aim of the study was to explore the insights on diabetes and exercise among this cohort.

Method: Twelve participants who underwent an 8-week, supervised, high-intensity intermittent training (HIIT) program were invited to participate in a semi-structured interview. The interview explored exercise history, perception of EOT2D, knowledge of EOT2D management and complications, feedback on HIIT, and barriers and facilitators to regular exercise. Inductive thematic analysis was used.

Results: Eight males and four females aged between 20-44 years were interviewed. Four themes emerged from analysis: (i) The diagnosis of T2DM was often unexpected. Participants reported the sense of “loss control” at diagnosis. This motivated people to exercise, but regular and structured exercise was rarely maintained: “didn’t continue after a few months.” (ii) Participants had varying levels of knowledge about diabetes, its management and complications: “⋯didn’t really understand how T2DM works and how exercise could affect it.” Most participants did not monitor blood glucose levels regularly: “monitoring sugar regularly to me is obsessive behaviour.” (iii) Financial and time commitments were the two most common barriers to exercise, especially for people with young children. (iv) HIIT was well-tolerated. Participants valued the individual supervision - “having the supervision gives you structure and a commitment.” However, participants were unlikely to continue with the HIIT program independently or unsupervised.

Clinical implication: Although diagnosis of EOT2D can be an impetus for behaviour change, diabetes management in this cohort was not prioritised over work and family commitments. Diabetes management and education in this young cohort needs to have tailored approaches.

Disclosure

Y. Gu: None. A. Harmer: None. J. Wong: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Merck & Co., Inc. A. Gauld: None. M.I. Constantino: None. P.A. Munoz: None. S. Dennis: None.

Funding

Diabetes Australia; Sydney Local Health District
1239-P: University of California Diabetes Initiative: A Multi-institution Collaboration to Improve Diabetes Care
Authors: KOMPALA TEJASWI , CLARK MACKENZIE , KIM SARAH , KROON LISA , PETERSON THOMAS A. , MOWERS ROBERT M. , SURAMPUDI PRASANTH , FREEBY MATTHEW , HAN MARIA , LAMBRECHTS SYLVIA , OFFER THERESE M. , CHRISTIAN MARY JEAN , DAHM LISA , GIBBS LISA , BOUW JUSTIN , MEDDERS KATHRYN , MORN CASSIE , PATEL AYAN , SAK RACHAEL , CABRERA MARICEL , NEINSTEIN AARON B.
Published: June 2020

Background: In Spring 2019, the University of California (UC) health system launched a UC Wide Diabetes Initiative. In response to the growing population of people with diabetes, as well as significant heterogeneity in diabetes care across five UC campuses, the UC Health Diabetes Initiative aims to increase alignment in methods of diabetes care delivery, and to improve clinical outcomes.

Methods: The UC Diabetes Initiative joins five financially and operationally independent academic medical campuses - UC Davis, UC San Francisco, UC Los Angeles, UC Irvine, and UC San Diego. Endocrinologists, primary care physicians, pharmacists, and program managers represent each campus, with data scientists and program leaders from the UC Office of the President. Powered by a central EHR data warehouse, we built a Diabetes Dashboard to show demographics, outcome (e.g., A1c) and process measures (e.g., eye exam) for more than 45,000 adults with diabetes cared for by more than 2,000 providers across the UC system.

Current Work: Our collaborative identified three focus domains for improvement: 1) Medical Neighborhood 2) Patient Education and 3) Pharmaceutical Use. Within each of these domains, we used a semi-structured approach based on local expertise and experience to narrow our focus. Specific interventions were selected based on potential impact, feasibility, and key stakeholder feedback. We focus on designing and delivering three UC-wide interventions to 1) increase use of A1c point-of-care testing 2) increase reach of diabetes education and 3) utilize a “UC-way” diabetes pharmaceutical algorithm. Implementation will begin in Summer 2020; our ongoing work will be the focus of subsequent evaluation.

Conclusions: The UC Health Diabetes Initiative provides a unique model of multi-institution collaboration joining independent health systems around a common mission, and using population-based real-world data to select, implement and measure best practices in diabetes care delivery.

Disclosure

T. Kompala: None. M. Clark: None. S. Kim: None. L. Kroon: None. T.A. Peterson: None. R.M. Mowers: None. P. Surampudi: None. M. Freeby: Research Support; Self; Abbott, Novo Nordisk Inc. M. Han: None. S. Lambrechts: None. T.M. Offer: None. M. Christian: None. L. Dahm: None. L. Gibbs: None. J. Bouw: None. K. Medders: Advisory Panel; Self; Lilly Diabetes. C. Morn: None. A. Patel: None. R. Sak: None. M. Cabrera: None. A.B. Neinstein: Consultant; Self; Steady Health.
1245-P: Maternal HbA1c Is Related to Childhood Fat Mass and Only Partially Mediated by Neonatal Fat Mass
Authors: FRANCIS ELLEN C. , RINGHAM BRANDY , GLUECK DEBORAH H. , PERNG WEI , DABELEA DANA
Published: June 2020

Maternal diabetes during pregnancy impacts offspring body composition and has been associated with greater offspring adiposity across the life course. However, the extent to which the relationship between maternal glycemia and offspring adiposity during later life is independent of neonatal adiposity is unclear. In a prospective study of 544 mother-child pairs in the Healthy Start Study, we estimated the total effect of maternal HbA1c on childhood fat mass (FM) %, and the direct effect independent of neonatal FM %. We measured maternal fasting HbA1c at a gestational age of 20-34 weeks, and offspring FM % using air displacement plethysmography at birth and during childhood (age 4-7 y). We used multivariable linear regression with HbA1c tertiles (T1 [reference], T2, T3) as the exposure, neonatal FM % as the mediator, and childhood FM % as the outcome. A counterfactual-based approach was used to estimate total and direct effects, while also accounting for exposure-mediator interaction. Covariates were maternal race, education, gestational weight gain and smoking, and offspring sex and age. The medians (interquartile ranges) of the HbA1c tertiles were T1: 4.80 (3.70, 4.90), T2: 5.05 (5.00, 5.10), and T3: 5.30 (5.20, 6.30). The estimated total effect on child FM % was 1.27 (95% CI: 0.00, 2.54) units higher for T2 vs. T1, and 1.53 (0.23, 2.82) units higher for T3 vs. T1 (P-trend=0.02). After adjusting for pre-pregnancy BMI, the total effect was 1.18 (-0.09, 2.44) and 1.31 (0.00, 2.62) units higher for T2 vs. T1 and T3 vs. T1, respectively (P-trend=0.04). The direct effect after accounting for neonatal FM % was slightly attenuated (T2 vs. T1: 1.14 [-0.11, 2.39], T3 vs. T1: 1.20 [-0.11, 2.51]; P-trend=0.07). Excluding women with gestational diabetes mellitus (n=27) did not substantially impact the results. Our data suggest that maternal glycemia during pregnancy, even within normal levels, may influence childhood adiposity through pathways that are in part mediated by programming of neonatal adiposity.

Disclosure

E.C. Francis: None. B. Ringham: None. D.H. Glueck: None. W. Perng: None. D. Dabelea: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (5R01DK076648-10)
125-LB: Beta-Cell Antigen-Specific Chimeric Antigen Receptor Tregs for Type 1 Diabetes Prevention and Treatment
Authors: IMAM SHAHNAWAZ , DAR PERVAIZ , ALFONSO-JAUME MARIA A. , JAUME JUAN C.
Published: June 2020

Background: Autoimmunity is a consequence of low/unfit antigen-specific Tregs. If antigen-specific Tregs could be produced on demand against a desire autoimmune target, suppression of autoimmune diseases would be achievable. Here, we developed pancreatic beta cell-specific GAD65 CAR Tregs and explored their therapeutic potential against T1D.

Methods: Two GAD65 B cell epitopes known to interact with two immunodominant regions in the N-terminal (CAR-N) and Middle (CAR-M) regions were selected for assembly onto T cell receptors (CD28 hinge-transmembrane-intracellular regions and CD3ζ intracellular domain) (1). These GAD65 CAR Tregs were used to prevent/treat diabetes in our humanized mouse model of T1D.

Results: Adoptive transfer of CAR-N Tregs to the diabetic T1D mice (2) revealed that administration of beta-cell specific Tregs leads to enrichment of Treg cells at the pancreas level. Confocal images demonstrated the homing of CAR Tregs to peri-insular areas 48 hours after intravenous immunization. 30-day follow up, fasting blood glucoses and GTT/insulin secretion tests significantly deteriorated in control Groups as compared with CAR-N/M Tregs treated Groups. The pancreatic islet localization of GAD65 CAR Tregs was still demonstrable at 30 days.

Conclusions: This is the first time a therapeutic approach is successful in abrogating the diabetes phenotype in T1D mice model. Conceivably, antigen-specific Treg redirection using antigen-specific CAR Tregs and consequent Teff downregulation will allow for recovery and reconstitution of beta cells in humans as well.

References: 1)S Imam, Jaume JC. “CAR T Preventive/Therapeutic approach for type 1 Diabetes” U.S. Provisional Patent #60439-US-PSP. http://utoledo.technologypublisher.com/technology/31853 (2019).

2)S Imam, M Alfonso-Jaume, JC Jaume Spontaneous Autoimmune Diabetes in Humanized Mice Carrying Human Type 1 Diabetes Susceptibility and Uses Therefor - US Patent App.16/530,452, 2020.

Disclosure

S. Imam: None. P. Dar: None. M.A. Alfonso-Jaume: None. J.C. Jaume: None.

Funding

University of Toledo (to J.C.J.)
1250-P: Lifestyle + Mindfulness Pilot Trial in Latinx Teens at Risk for Type 2 Diabetes (T2D)
Authors: SANCHEZ NATALIA L. , JIMENEZ VIRGINIA , HAEMER MATTHEW , SHOMAKER LAUREN B. , CASAMASSIMA MILENA , VERROS MEGAN M. , ANNAMEIER SHELLY
Published: June 2020

Objective: Latinx teens have elevated risk for youth and adult-onset T2D, yet few preventive interventions have succeeded, in part due to inadequate cultural-tailoring and psychosocial stress. We conducted a pilot trial to determine feasibility/acceptability of a culturally-tailored, family lifestyle+mindfulness (life+mind) program, and explored effects on depression and glucose, vs. lifestyle only.

Methods: N=18 Latinx patients (14±1y) recruited from a FQHC, with BMI ≥85th%ile (97.7± 1.9%ile) and ≥1 T2D relative, participated. Families were randomized to a 6-wk, 12-session (24 total hrs) life+mind (n=11) or lifestyle only (n=7) program, delivered in the community by bilingual staff. Assessments were at baseline, 6-wks, and 6-mos. Feasibility was determined as recruitment rate/retention, and acceptability as program attendance and acceptability ratings. Depression was assessed with the CES-D, BMI from measured height/weight, and blood was sampled for fasting glucose (FG).

Results: Recruitment rate was 10 families/month; 61% of those eligible enrolled. Retention was adequate at 6-wks (life+mind vs. lifestyle: 72 vs. 75%), but suboptimal at 6-mos (62 vs. 71%). Median attendance for life+mind was 10/12 and for lifestyle, 11/12 sessions. Parent ratings were uniformly positive, but teens had mixed ratings and some discomfort with mindfulness. There was a non-significant trend for more reduction in depression rates in life+mind vs. lifestyle from baseline (36 vs. 43%; p=.78) to 6-wks (0 vs. 40%; p=.05) and 6-mos (14 vs. 40%; p=.31). There was a pattern for greater decreases in FG at 6-wks (Δ-5±2 vs. 0±3mg/dL; p=.17), with both conditions showing 6-mos decrease (Δ-2±1 vs. -2±2mg/dL; p=.93). BMI was stable (Δ6mos: 0.4±0.5 vs. -0.5±0.7kg/m2, p=.36).

Conclusions: A culturally-tailored family program with mindfulness for Latinx teens at-risk for T2D is feasible, acceptable to parents, and could reduce depression and FG. Yet, more work is needed to tailor mindfulness acceptability for Latinx teens.

Disclosure

N.L. Sanchez: None. V. Jimenez: None. M. Haemer: None. L.B. Shomaker: None. M. Casamassima: None. M.M. Verros: None. S. Annameier: None.

Funding

National Center for Advancing Translational Sciences; Colorado Clinical and Translational Science Awards (UL1TR002535)
126-LB: Glycemic Outcomes for People with Type 1 and Type 2 Diabetes Using Control-IQ Technology: Real-World Data from Early Adopters
Authors: HABIF STEPHANIE , CONSTANTIN ALEXANDRA , MUELLER LARS , SINGH HARSIMRAN
Published: June 2020

The Food and Drug Administration recently cleared the t:slim X2 with Control-IQ technology in the United States. This advanced hybrid closed-loop system automatically adjusts insulin based on predicted sensor glucose (SG) levels to help increase sensor time in range (TIR) (70-180 mg/dL). The pivotal DCLP3 trial demonstrated noteworthy glycemic improvements in people with type 1 diabetes (PwT1D) using Control-IQ technology. However, DCLP3 did not include people with type 2 diabetes (PwT2D). We performed retrospective analysis of users who uploaded at least 14 days of pre and 14 days of post Control-IQ software usage data to Tandem’s t:connect® web application as of March 11, 2020 and had ≥75% CGM use during this time. Glycemic outcomes, total daily insulin (TDI), and time in closed loop were analyzed by diabetes type. Of the 3,278 PwDs included in the sample, 144 had T2D, 52% were female, mean age=43 years (SD=17.47), diabetes duration=23 years (SD=15). Wilcoxon signed-rank tests were used to examine pre-post differences in outcomes by diabetes type. Post 14-day Control-IQ technology use, PwT1Ds recorded 96% time in closed loop and showed significant improvements in their TIR (+9% from pre, p<0.001), reduced time in SG<70 (-0.04% from pre, p<0.001), and SG>180 (-8.45% from pre, p<0.001). Median TDI at post was 48 units (pre=46 units, p<0.001). Similar trends were observed for the type 2 sample, in that PwT2Ds recorded 96% time in closed loop and showed significant improvements in TIR (+6% from pre, p<0.001) and reduced SG time >180 (-5.8% from pre, p<0.001). Median SG time <70 remained unchanged (0.2%). Median total daily insulin for PwT2Ds increased to 82 units from pre-CIQ use of 73 units (p=0.003). These results from early adopters of Control-IQ technology confirm its efficacy in assisting both PwT1Ds and PwT2Ds achieve their recommended glycemic targets and improve their glycemic control.

Disclosure

S. Habif: Employee; Self; Tandem Diabetes Care. A. Constantin: Employee; Self; Tandem Diabetes Care. Other Relationship; Self; Bigfoot Biomedical. L. Mueller: Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. H. Singh: Employee; Self; Tandem Diabetes Care.
1262-P: Metabolic Flexibility across the Spectrum of Glycemic Regulation in Youth
Authors: BACHA FIDA , BARTZ SARA K. , JINDAL ISHITA , PUYAU MAURICE R. , ADOLPH ANNE , SHARMA SUSAN
Published: June 2020

Metabolic flexibility (MF) refers to the ability to suppress lipid and increase glucose oxidation (as reflected by increase in the respiratory quotient [ΔRQ]) under insulin-stimulated conditions. It is not clear if youth with type 2 diabetes (T2D) and prediabetes have a defect in MF compared with controls. We investigated the determinants of MF in youth with normal weight (NW) and obesity (OB) across the spectrum of glucose tolerance. Youth (n=104; 15.6±1.8 yrs, Tanner stage (TS) II-V) had evaluation of body composition (DXA), visceral fat (VAT) in a subset (MRI), RQ (indirect calorimetry) fasting and during a hyperinsulinemic-euglycemic clamp for measurement of glucose disposal rate (GDR) and insulin sensitivity (IS). Youth with prediabetes and T2D had lower ∆RQ, and lower oxidative and non-oxidative GDR compared to NW with no significant difference in ΔRQ between NW and OB-NGT (Table). ∆RQ correlated with GDR, IS (r=0.3, p=0.02), VAT (r=-.23, p=0.04), and HbA1c (r=-.26, p=0.03) after adjusting for sex, race and TS, but not with % body fat. In multiple regression, Rd (or IS) (β=0.26, p=0.04) and race-ethnicity (β= -0.3, p=0.01) contributed to the variance in ∆RQ (R2=0.25, p=0.005) independent of % body fat, VAT, sex, TS and HbA1c. MF is impaired in youth with prediabetes/T2D compared with NGT-OB and NW in relation to a defect in glucose disposal and appears to be modulated by race-ethnicity (lower in Hispanics).

Disclosure

F. Bacha: Research Support; Self; AstraZeneca, Takeda Development Center Americas, Inc. S.K. Bartz: None. I. Jindal: None. M.R. Puyau: None. A. Adolph: None. S. Sharma: None.

Funding

U.S. Department of Agriculture
127-OR: Pharmacologic Management of Diabetic Peripheral Neuropathy
Authors: FAN JUNGWEI , JEFFERY MOLLY M. , HOOTEN W. MICHAEL , SHAH NILAY , MCCOY ROZALINA G.
Published: June 2020

Approximately half of all people with diabetes develop diabetic peripheral neuropathy (DPN) and half experience pain. Guidelines recommend pregabalin, gabapentin, and duloxetine (a selective norepinephrine and serotonin reuptake inhibitor [SNRI]) due to their demonstrated efficacy and safety. Topical analgesics, tricyclic anti-depressants (TCA), and anti-convulsants may also be used. Opioids are discouraged due to lack of effectiveness, risk of addiction, and safety concerns. To promote safe evidence-based pain management, we examined pain medication use by adults diagnosed with DPN between 2002-2019 in an integrated healthcare system across 5 states. We identified 13,815 adults with newly diagnosed DPN; mean age 66 (SD, 13) years, 42% female, 93% white, 29% insulin-treated. Overall, 56% received a pain medication from DPN diagnosis (1 month prior or continued from baseline) to 2 years later. Limiting to treatment pathways observed in ≥1% of cases, opioids were the most used 1st line medication, followed by gabapentin and others (Figure). Opioids and gabapentin were also the most prevalent 2nd line drugs. High rates of opioid use by patients with DPN, a life-long pain syndrome, are concerning particularly as safer effective treatment options are available. Further research is needed to identify drivers of opioid use and barriers to evidence-based alternatives, and develop interventions to improve DPN management in clinical practice.

Disclosure

J. Fan: None. M.M. Jeffery: None. W. Hooten: None. N. Shah: None. R.G. McCoy: None.

Funding

National Institutes of Health (K23DK114497)
1270-P: Glycemic Control in Youth with Type 2 Diabetes Correlates with Weight Loss and Markers of Beta-Cell Function, but Not Intense Insulin Regimen
Authors: CHAO LILY , YEH MEIYU , RAYMOND JENNIFER , RYOO JI HOON , CHANG NANCY T.
Published: June 2020

Background: Youth with type 2 diabetes develop early treatment failure to metformin and diabetes-related comorbidities.

Objective: To identify risk factors for glycemic failure in youth with type 2 diabetes.

Methods: Anthropomorphic measures, medication records, and laboratory studies were collected from patients attending a dedicated type 2 diabetes clinic. Repeat measures of HbA1c were averaged to prevent errors from unbalanced data points. Latent profile analysis (LPA) was performed to model longitudinal trajectory of HbA1c over 5 years.

Results: The registry includes 226 patients, of which 80% are Latinx. Analysis of the glycemic outcomes showed that the odds ratio (OR) for uncontrolled diabetes 5 years after diagnosis (HbA1c>8%) is proportional to baseline HbA1c, with OR of 2.41 when diagnostic HbA1c >8.5% (sensitivity 68%, specificity 54%, P=0.015). LPA modeling identified three HbA1c profiles, all demonstrating some improvement in HbA1c at 4-6 months: (A) HbA1c <8% throughout the 5 years, (B) persistent elevation of HbA1c >9%, and (C) mean HbA1c of 12% at diagnosis, rapid decline to 6.4% by 4-6 months, but rose to 11% by 18 months. At diagnosis, group A had lower HbA1c and higher fasting c-peptide levels than B and C, suggesting that baseline beta-cell function is a dominant variable in long-term glycemic control. Our analysis of medication regimen showed that amongst patients treated with metformin, the addition of multiple daily injections (MDI) did not improve HbA1c compared to those on basal insulin. Finally, weight loss correlated with improved HbA1c outcome in patients on metformin monotherapy, but not in patients prescribed insulin.

Conclusion: Patients with baseline HbA1c >8.5% are at high risk for glycemic failure, irrespective of short-term improvement in HbA1c. Additional studies are needed to decipher if medication omission accounts for the comparable HbA1c outcome between patients on MDI and basal insulin.

Disclosure

L. Chao: None. M. Yeh: None. J. Raymond: None. J. Ryoo: None. N.T. Chang: None.

Funding

Good Hope Foundation; Saban Research Institute
1274-P: Prevalence of Addictive-Like Eating in Hispanic Adolescents with Obesity Seeking Weight Management Treatment
Authors: GONZALEZ JANELLE , FINK CASSANDRA , WEE CHOO PHEI , HEGEDUS ELIZABETH , LOPEZ KELLEEN , VIDMAR ALAINA
Published: June 2020

Background: There is a growing body of literature exploring food addiction (FA) in adolescents with obesity and how it impacts treatment outcomes. Several studies have evaluated the prevalence of FA in youth with obesity as measured by the Yale Food Addiction Scale for children (YFAS-c) and rates vary from 4-22%. The rates of obesity in Hispanic youth is reported to be higher than in other ethnic groups however there is a paucity of literature exploring the prevalence of FA in this population. Due to our geographic location and our majority Hispanic patient population, we examined 1) the prevalence of FA in Hispanic adolescents with obesity and 2) the association between FA and demographic characteristics.

Methods: Baseline data from a RCT on behavioral weight management interventions was used. Participants who self-identified as Hispanic, were 14-18 years of age, and with a BMI >95th% met criteria. Fisher’s exact test was used to assess the differences between adolescents with positive and negative YFAS-c scores and demographic characteristics.

Results: In a sample of 59 Hispanic youth, 29% met criteria for FA. There was no significant difference in age, gender, or household income between adolescents with positive YFAS-c at baseline compared to those with negative scores.

Conclusions: Hispanic youth with obesity have higher rates of FA than previous prevalence reports. This information is essential to consider prior to implementation of a weight management program as it may impact adherence, retention, and ultimately weight outcomes. Baseline behavioral phenotyping may be a strategy to ensure adolescents are receiving the services they require in conjunction with participation in a weight management program. These findings can help inform providers of the importance of screening for FA prior to intervention administration and possibly modifying the intervention content to address addictive like eating behaviors.

Disclosure

J. Gonzalez: None. C. Fink: None. C. Wee: None. E. Hegedus: None. K. Lopez: None. A. Vidmar: None.

Funding

eHealth International (CHLA 000193)
1278-P: Up All Night? Sleep in Parents of Young Children Newly Diagnosed with Type 1 Diabetes
Authors: AL-GADI IMAN , STREISAND RANDI , MONAGHAN MAUREEN , TULLY CARRIE , SINISTERRA MANUELA , HILLIARD MARISA E.
Published: June 2020

Background: Parents of young children with type 1 diabetes (PYC-T1D) may be susceptible to poor sleep due to the 24/7 demands of diabetes care and concerns about overnight hypoglycemia, yet sleep patterns of PYC-T1D shortly after T1D diagnosis have not been reported. We aimed to describe the sleep of PYC-T1D in the first 2 months post-diagnosis and explore any differences with continuous glucose monitor (CGM) use.

Methods: Participants were 157 PYC-T1D (M child age=4.5±1.6 years, 90% mothers, 61% White/non-Hispanic) assessed at baseline (M duration=27±15 days) of a behavioral RCT. Parents self-reported about sleep (Pittsburgh Sleep Quality Index, PSQI), T1D-specific sleep disruptions, and children’s use of CGM (20%). We report descriptive statistics for the full sample and compared by CGM use (independent t-test, X2).

Results: Most (80%) PYC-T1D had PSQI≥5 indicating clinically significant sleep disturbance (M=8.3±4.1). Mean sleep duration was 5.9±1.4 hours/night. Table 1 shows over 2/3 reported T1D-related sleep disruptions and presents comparisons between CGM groups.

Conclusion: Sleep disruption is a pervasive problem among PYC-T1D soon after diagnosis, with the majority not meeting recommendations for sleep duration and having clinically elevated sleep disturbances. Though some aspects of sleep disruption were higher in CGM users, we cannot infer causality and poor sleep was prevalent regardless of CGM use.

Disclosure

I. Al-Gadi: None. R. Streisand: None. M. Monaghan: Research Support; Self; American Diabetes Association. C. Tully: None. M. Sinisterra: None. M.E. Hilliard: None.

Funding

National Institutes of Health (1R01DK102561)
1289-P: The Association between Time-in-Range, Mean Glucose, and Incidence of Hypoglycemia in Youth with Newly Diagnosed T1D
Authors: GU ANGELA , PRAHALAD PRIYA , MAAHS DAVID M. , ADDALA ANANTA , SCHEINKER DAVID
Published: June 2020

New hypoglycemia guidelines define <70 mg/dl as a clinical alert for hypoglycemia and <54 mg/dl as clinically significant hypoglycemia. Fear of hypoglycemia is a significant barrier to increased time in range (TIR, 70-180 mg/dl). We examined the association between incidence of hypoglycemia and TIR and mean glucose (MG).

CGM data were collected from youth starting CGM within 1 month of a T1D diagnosis. For each patient, for each two-week period, TIR, MG, and percent time in hypoglycemia (Hyp) (<70) and clinically significant hypoglycemia (csHyp) (<54) were calculated. The associations between each of TIR, MG and each of Hyp and csHyp in each two-week period were modelled with multivariate linear regression, controlling for age, race, sex, insurance type, CGM wear time, and partial clinical remission status (Table 1).

In total, 1049 two-week periods from 51 patients were reviewed; 41% of these patients were female, the mean age was 9.4 years, and patients wore their CGMs an average of 89% within each two-week period. For csHyp, there was a non-significant negative association with TIR and a significant negative association with MG (p<0.001). For Hyp, there was a significant association with TIR and MG (Table 1).

We found no association between csHyp and TIR. These findings suggest that high TIR may be maintained without increasing csHyp. Further study should examine the use of CGM to improve TIR.

Disclosure

A. Gu: None. P. Prahalad: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. A. Addala: None. D. Scheinker: None.
1295-P: Newly Diagnosed Pediatric Patients with Type 1 Diabetes Show Steady Decline in Glucose Time-in-Range (TIR) over 1 Year: Pilot Study
Authors: ZAHARIEVA DESSI , PRAHALAD PRIYA , ADDALA ANANTA , SCHEINKER DAVID , DESAI MANISHA , HOOD KOREY K. , LEVERENZ BRIANNA , MAAHS DAVID M.
Published: June 2020

Optimal glycemic control is associated with improved T1D outcomes. However, in the U.S. over the last decade, glycemic control has worsened. We aimed to monitor glucose time-in-range (TIR) in the first year after diagnosis in pediatric T1D to identify the time when glucose control worsens. Newly diagnosed patients (N=67) with T1D were commenced on continuous glucose monitoring (CGM). Data was uploaded to Dexcom Clarity and analyzed retrospectively. Sample size differences at each time period vary due to patient enrollment start dates. All data was analyzed by mixed model and Tukey’s multiple comparison test. In 67 children (mean age 10±5 yrs, A1c at onset 12.1±1.9%) glucose TIR decreased from 64±21% to 55±18% at 10±9 days to 361±23 days post-diagnosis (P=0.03, Table). Mean glucose increased from 146±28 mg/dL at nadir to 172±29 mg/dL at 361±23 days post-diagnosis (P=0.001). CGM wear time also increased from 83±20% to 95±9% at 10±9 days to 361±23 days post-diagnosis (P=0.04). Time spent <70 mg/dL was 2±3% throughout. Newly diagnosed pediatric T1D patients continue to wear CGM throughout the first year of diagnosis. The apparent increase in mean CGM glucose and decrease in TIR as early as 205±9 days post-diagnosis presents an opportunity for more frequent monitoring and unified education by healthcare providers to target tighter glucose control for this population.

Disclosure

D. Zaharieva: Speaker’s Bureau; Self; Ascensia Diabetes Care, Insulet Corporation, Medtronic. P. Prahalad: None. A. Addala: None. D. Scheinker: None. M. Desai: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. B. Leverenz: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care.
130-LB: Retrospective Evaluation of Treatment Patterns in a Real-Life Setting Environment with Dapagliflozin or DPP-4 Inhibitors as Add-On Therapy in Uncontrolled DM2 Patients Who Previously Failed on Other Regimens
Authors: ESPINOZA-PERALTA DIEGO , GONZÁLEZ-CANTÚ ARNULFO , SILVA ALEJANDRA I. , COLLADO JUAN G. , ROGEL-MANZANARES JORGE DAVID , HERNÁNDEZ-ALARCÓN JIMENA H. , NORIEGA-MUÑOZ ANA G.
Published: June 2020

Mexico is one of LatinAmerica countries with the highest prevalence (14.4%) of DM. Medical institutions face the challenge to provide medical care to T2DM patients that failed to several antidiabetic regimens. We conducted a retrospective study to assess the response to dapagliflozin (Dapa) or DPP-4-inhibitors (DPP-4i) as added-on therapy in T2DM patients with failure to previous medications.

Objectives: Compare subjects with ≥5% improvement of the weighted sum of the three variables of the composite variable (HbA1c plus body weight (BW) plus blood pressure (BP) by the end of the 74-week observation period from index date) and proportion of patient achieving HBA1c of 7%.

Inclusion Criteria: T2DM subjects ≥18 years old with failure to any previous antidiabetic medication and HbA1c% ≥7 that started Dapa or DPP-4i as add-on to other antidiabetic drugs from August 2014 to Jun 2018.

Statistical Methods and Analysis: A propensity score matching model (nearest neighbor algorithm) was used, covariates included were treatment regimen, TC, LDL-c, HbA1c, BW, systolic BP and age.

Results: Of 1800 subjects, 221 met statistical matching criteria. No differences in basal characteristics of age, SBP, CrCl, but DAPA group had higher basal HbA1c (8.68±1.59 vs. 8.19±1.4, p<0.01). Dapa group had a significant improvement (>5%) in the composite variable compared to DPP-4i at 24 (76.9% vs. 46%, p<0.01), 52 (82.4% vs. 49.5%, p<0.01) and 76 weeks(84.6% vs. 39.2%, p<0.01). Patients with HbA1c goal of <7% in Dapa group compared to iDPP-4 at 24 (44.3% vs. 29.9%, p<0.01), 52 (48.9% vs. 29.1%, p<0.01) and 76 weeks (51.9% vs. 21.8%, p<0.01).

Conclusion: In patients with uncontrolled T2DM who have failed to previous antidiabetic therapies, the add-on of dapagliflozin significantly provides reductions of HbA1c, glucose, weight and blood with more patients achieving glucose control goals compared to iDPP-4.

Disclosure

D. Espinoza-Peralta: None. A. González-Cantú: None. A.I. Silva: Employee; Self; AstraZeneca. J.G. Collado: None. J. Rogel-Manzanares: None. J.H. Hernández-Alarcón: None. A.G. Noriega-Muñoz: None.
1305-P: Cyber School: A Help or Hindrance for Youth with Diabetes?
Authors: MARCH CHRISTINE , LEIKAM LINDSAY M. , SIMINERIO LINDA M. , MILLER ELIZABETH , LIBMAN INGRID
Published: June 2020

Cyber school (CS) is an online alternative to K-12 education with variable academic performance. Little is known about the health status and school achievement of youth with diabetes (DM) in CS compared to their peers. All youth with type 1 or type 2 diabetes enrolled in CS for the academic year 2017-18 were identified from a large pediatric diabetes center and matched to control subjects by diagnosis, race, sex, age and duration of DM. A retrospective chart review was conducted to identify variables such as hemoglobin a1c (HbA1c), body mass index (BMI) percentile, use of devices, adherence to recommended screenings, comorbidities, and health care utilization. Eighty youth attending CS were identified (5% of school age clinic population): 73 (91%) with type 1 DM, mean duration 6.0±4.0 years, 76 (95%) white, 48 (60%) female, mean age 14.5±3.0 years. Matching was adequate (p>0.99 all parameters). Mean HbA1c was higher in those attending CS compared to controls (9.0±1.9 vs. 8.3±1.5%, p=0.001), with no difference in BMI percentiles (72.6±27.4 vs. 76.2±22.8, p=0.4). Fewer youth in CS used insulin pumps (37% vs. 60%, p=0.01) or continuous glucose monitors, though this did not reach statistical significance (29% vs. 42%, p=0.08). Youth in CS were less likely to have recommended annual vision (58% vs. 76%, p=0.02) and dental exams (63% vs. 84%, p=0.002). Mental health diagnoses were more common among CS youth (46% vs. 20%, p<0.001) and they more often met PHQ-9 criteria for depression (42% vs. 24%, p=0.04). Youth in CS more commonly missed two or more routine diabetes appointments (31% vs. 18%, p=0.04) and had at least two emergency department visits (16% vs. 5%, p=0.02). Regarding academics, more youth in CS were documented as failing a grade or needing to make up credits (11% vs. 1%, p=0.009). In summary, CS was associated with concerning health metrics and perhaps academic outcomes. CS enrollment may reflect a high-risk population of youth with DM. Special attention from DM providers may help focus additional resources and tailor counseling to this population.

Disclosure

C. March: None. L.M. Leikam: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. E. Miller: None. I. Libman: Consultant; Self; Novo Nordisk A/S.

Funding

National Institutes of Health (DK007729)
1313-P: Associations of Executive Function (EF) Problems with Demographic and Diabetes Factors in Teens with T1D from the EU and U.S.
Authors: GOETHALS EVELINE R. , WIT MAARTJE DE , VOLKENING LISA K. , LUYCKX KOEN , CASTEELS KRISTINA , LAFFEL LORI M.
Published: June 2020

Aim: EF (ability to initiate, plan, monitor behavior) impacts self-care and glycemic control in teens with T1D. We examined demographics, insulin therapy, A1c, and EF in 3 international cohorts of teens with T1D.

Methods: Parents of 337 teens (13-18) with T1D from Belgium (BE), Netherlands (NL), and U.S. completed the BRIEF to assess teen EF. Parents/medical records provided demographic and diabetes data. BRIEF score ≥60 (composite score or either of 2 main indices) defined EF problems. Logistic regression determined associations of EF problems with A1c (<7.5 vs. ≥7.5%), controlling for country, sex, T1D duration, and pump use.

Results: Teens (54% male; 27% BE, 24% NL, 49% U.S.) were 15.0±1.5 yrs old with T1D duration 7.4±4.0 years, A1c 8.1±1.2%, 61% pump. Teens from BE, NL, U.S. differed with respect to A1c (7.4±1.0, 8.1±1.3, 8.5±1.2%) and pump use (27%, 72%, 74%) (all p<.01). Overall, 30% had EF problems (26% BE, 32% NL, 32% U.S.). Generally, teens with EF problems had higher A1c vs. those without (Table). Pump use was less common in teens with EF problems in NL and U.S. and more common in BE. Odds of A1c ≥7.5% was 2.0 (95% CI 1.1, 3.6; p=.03) in teens with EF problems.

Conclusion: In an international sample, teens with T1D and EF problems were twice as likely to have suboptimal A1c. Given country differences in pump use in teens with EF problems, future studies can assess potential benefit of technology in at-risk teens.

Disclosure

E.R. Goethals: None. M. de Wit: None. L.K. Volkening: None. K. Luyckx: None. K. Casteels: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding

Iacocca Family Foundation; National Institutes of Health (P30DK036836, R01DK095273, K12DK094721); JDRF (2-SRA-2014-253-M-B)
1314-P: A Low HbA1c during the First 2 Years Correlates with a Higher Percentage of HbA1c ≤6.5% (48 mmol/mol) and Lower Percentage >8.0% (64 mmol/mol) on a Clinic Level
Authors: HANAS RAGNAR , HANBERGER LENA , LYCKÅ AUSTE PUNDZIUTE , SAMUELSSON ULF , SVENSSON ANN-MARIE , AKESSON KARIN
Published: June 2020

Background: The mean HbA1c in children and adolescents varies between countries, but there is a considerable variation also between clinics within a country. The Swedish HbA1c target in children and adolescents is ≤6.5% (48 mmol/mol). Our aim was to compare early metabolic control with percentage of patients with HbA1c ≤6.5% (A1c6.5) and >8.0% (64 mmol/mol) (A1c8) for all clinics in Sweden.

Methods: In this register-based nationwide cohort with type 1 diabetes, 98% of children and adolescents <18 years in Sweden were covered. We captured HbA1c for all patients (last value recorded in 2019) and calculated the mean. We then compared the mean HbA1c of all patients with up to 2 years duration with the percentage of patients with A1c6.5 and A1c8.

Results: Mean overall HbA1c was 7.0% (95% CI 7.0-7.1) (53.3 mmol/mol, 95% CI 52.6-54.0) (n=7433) and for those with 0-2 years' duration 6.6% (95% CI 6.5-6.7) (49.1 mmol/mol, (95% CI 48.2-50.0) (n=1911). The mean overall percentage of patients with A1c6.5 was 35.3% (95% CI 32.4-38.2) (n=2575) and A1c8 was 13.2 (95% CI 11.5-14.8) (n=958). The correlation between mean HbA1c 0-2 y. and A1c6.5 was -0.80 (p<0.001) and A1c8 0.48 (p=0.004).

Conclusions: An intensive treatment program at the onset of diabetes resulting in a low HbA1c early on is a good investment to increase HbA1c values within target and to minimize high HbA1c values.

Disclosure

R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. L. Hanberger: None. U. Samuelsson: None. A. Svensson: None. K. Akesson: None.
1322-P: Communication Frequency between Visits Is Associated with Improved Glycemic Control in Pediatric Diabetes
Authors: ABEL KIMBER-LEE , VERMA ROHINI , THOMAS CHRYSTAL G. , WEST MARGARET , GLANCEY CHRISTINE , TRACEY JULIA , ARCARA KRISTIN , MAGGE SHEELA N. , WOLF RISA
Published: June 2020

Background: Children with diabetes are advised to see their diabetes team every 3 months. While we encourage patients and caregivers to communicate between visits, there is limited evidence to support this recommendation. Therefore, we assessed patterns of communication between visits and whether communication frequency via phone and electronic messaging (EMs) is associated with glycemic control. We hypothesized that patients who communicate more frequently will have better glycemic control as measured by hemoglobin A1c (HbA1c).

Methods: We assessed communication patterns via EMs and phone calls in children with type 1 and type 2 diabetes over a 1-year period at an urban academic pediatric diabetes center. Demographic and clinical data were extracted from the electronic medical record. The association between frequency of communication and HbA1c was analyzed using regression analysis.

Results: 122 patients were included in this analysis, of which 99 (80%) had T1D, 23 (20%) had T2D. Mean age 11.8y (SD 3.9), mean duration of diabetes 3.5y (SD 3.4), and mean HbA1c 9% (range 4.7-15%). Most patients/caregivers (101/122, 89%) communicated with the diabetes team between office visits. Communications were via phone (27%), EM (29%), or both (42%). Patients with more frequent communication had lower HbA1c values (p=0.008, β =-0.04). Method of communication was not associated with HbA1c.

Conclusions: More frequent communication with the diabetes team between visits is associated with improved glycemic control, irrespective of the method of communication. Thus, communication with patients should be tailored to their preference.

Disclosure

K. Abel: None. R. Verma: None. C.G. Thomas: None. M. West: None. C. Glancey: None. J. Tracey: None. K. Arcara: None. S.N. Magge: None. R. Wolf: None.
1330-P: Molecular Biomarkers during Gestational Diabetes Mellitus
Authors: DIAS STEPHANIE , ADAM SUMAIYA , RHEEDER PAUL , LOUW JOHAN , PHEIFFER CARMEN
Published: June 2020

Background/Aim: Gestational diabetes mellitus (GDM) is associated with short- and long-term complication in both mothers and offspring. Molecular mechanisms are attracting increased interest for their potential as biomarkers for GDM that could lead to improved detection of GDM with positive effects on health outcomes. The aim of this study was to explore the potential of DNA methylation and single nucleotide polymorphisms (SNPs) to serve as molecular biomarkers for GDM in South African women.

Methods: Genome-wide DNA methylation using a MethylationEPIC BeadChip Array (n=24) and gene-specific methylation of the adiponectin (ADIPOQ) gene using bisulfite pyrosequencing (n=286) were profiled in the peripheral blood of women with or without GDM. In addition, variants ADIPOQ rs266729 and rs17300539, and methylenetetrahydrofolate reductase (MTHFR) rs1801133 were quantified using quantitative real-time PCR (n=449).

Results: Genome-wide methylation analysis identified 1046 differentially methylated CpG sites (associated with 939 genes), of which 148 CpG sites were hypermethylated and 898 CpG sites were hypomethylated (p<0.01). Among the top five CpG sites, one CpG mapped to the calmodulin-binding transcription activator 1 (CAMTA1) gene, which has been shown to regulate insulin production and secretion. Two CpG sites (-3410: p=0.048 and -3400: p=0.004) in the ADIPOQ promoter were hypomethylated during GDM in Human Immunodeficiency Virus (HIV) negative, but not in HIV positive women. Lastly, no association between ADIPOQ and MTHFR polymorphisms and GDM was observed in our population.

Discussion: DNA methylation may offer potential as molecular biomarkers for GDM in a South African population. Future longitudinal studies in larger samples that include both HIV negative and positive pregnant women are warranted to explore the candidacy of DNA methylation as molecular biomarkers for GDM.

Disclosure

S. Dias: None. S. Adam: None. P. Rheeder: None. J. Louw: None. C. Pheiffer: None.

Funding

National Research Foundation (99391); South African Medical Research Council