bluuebunny/crossref_metadata_2025 huggingface dataset:
772-P: Both Sides of the Coin Matter: Resilience and Distress One Year Postdiagnosis Are Associated with Long-Term A1C Outcomes in Adolescents with Type 1 Diabetes Mellitus
Authors: SCOTT SAMANTHA R. , ELLISOR BRITNEY M. , O’DONNELL MAEVE B. , O’DAFFER ALISON , MANCZAK ERIKA M. , MALIK FAISAL , YI-FRAZIER JOYCE
Published: June 2020

Objectives: Adolescents with newly diagnosed T1D are at risk for poor physical and psychosocial outcomes. Our aim was to understand if diabetes distress and resilience assessed at 1-year post diagnosis was associated with A1C up to 5 years following diagnosis.

Method: Adolescents (age 10-17) with newly diagnosed T1D completed diabetes distress (Problem Area in Diabetes Scale – Teen version) and the Connor-Davidson Resilience Scale at one-year post diagnosis. A1C was extracted from patient charts from time of diagnosis up to 5 years later, and values were averaged for each year. Regression analyses were used to investigate the associations between: 1) resilience and A1C and 2) diabetes distress and A1C, both up to five years post diagnosis.

Results: At one year post-diagnosis, N=60 adolescents (M=13.22 years, SD=2.09 years) completed distress (M=27.97, SD=7.01) and resilience scales (M=40.35, SD=17.10). Average A1C was 7.73 (SD=1.57). Diabetes distress was associated with average A1C in the second year (F(1,29)=4.397, p=.045, R2=.132), third year, (F(1,27)=6.596, p=.016, R2=.196), fourth year, (F(1,24)=10.196, p=.004, R2=.298), and fifth year post-diagnosis (F(1,19)=10.665, p=.004, R2=.360).

Resilience was associated with average A1C in the second year (F(1,29)=6.848, p=.014, R2=.191) and fifth years (F(1,19)=4.790, p=.041, R2=.201) post-diagnosis. (Trends were observed for the third (p=.095) and fourth years (p=.065)).

Conclusions: Diabetes distress and resilience levels shortly following diagnosis (at 1-year) are both associated with glycemic control up to 5 years later. Thus, targeted psychosocial interventions to boost resilience and decrease diabetes distress in the first year following diagnosis should be explored to improve long term outcomes in this high-risk population.

Disclosure

S.R. Scott: None. B.M. Ellisor: None. M.B. O’Donnell: None. A. O’Daffer: None. E.M. Manczak: None. F. Malik: None. J. Yi-Frazier: None.

Funding

Seattle Children’s Research Institute’s Center for Clinical and Translational Research Clinical Research Scholars Program; National Institutes of Health Clinical and Translational Science Award (UL1TR000423) of the University of Washington Institute of Translational Health Science
775-P: Mobile Self-Management Apps to Manage Diabetes and Chronic Disease: A Systematic Review and Meta-analysis into Dropout and Attrition Rates
Authors: MEYEROWITZ-KATZ GIDEON , ASTELL-BURT THOMAS , RAVI SUMATHY , ARNOLDA LEONARD F. , FENG XIAOQI
Published: June 2020

Background: Management of diabetes and chronic disease is a challenge, making mHealth an increasingly attractive option. There is evidence that these apps may be effective, with systematic reviews demonstrating improvements in HbA1c and other measures of diabetes control. However, dropout can be a major issue in apps. Recent research has indicated that rates of attrition in mHealth interventions may be as high as 98%. Knowledge of mHealth dropout rates is critical to assessing their efficacy.

Methods: Medline, Pubmed, Cochrane CENTRAL, and Embase were searched from 2003 to the present, looking at mHealth and attrition or dropout. Studies looking at chronic disease with measures of dropout were included.

Results: Of 830 studies identified in the literature search, 16 were included in the review and meta-analysis (results presented below). Chronic disease management apps had an overall dropout rate of 47%. Apps targeting metabolic disease had a lower rate of 32%. The studies were varied, with high heterogeneity (I2>99%).

Conclusion: Dropout rates in mHealth interventions are high, but lower in apps targeting metabolic disease. Reducing dropout rates will make these apps more effective for disease management in the long term.

Disclosure

G. Meyerowitz-Katz: None. T. Astell-Burt: None. S. Ravi: None. L.F. Arnolda: None. X. Feng: None.
779-P: Fatigue in Adults with Type 2 Diabetes: An Integrative Review
Authors: KUO HSUAN-JU , HUANG YA CHING , GARCIA ALEXANDRA A.
Published: June 2020

Introduction: People with type 2 diabetes mellitus (T2DM) experience various symptoms that are likely to worsen mental and physical well-being. Fatigue is one of the most prevalent and disturbing symptoms for adults with T2DM. This literature review 1) examined demographic, physiologic, and psychosocial factors related to fatigue, and 2) explored the associations among fatigue, diabetes self-management and quality of life (QoL) in adults with T2DM.

Methods: We searched PubMed, PsycINFO, and CINAHL electronic databases for research articles that included a sample of adults with T2DM; were peer-reviewed, written in English; and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data.

Results: Twenty-two articles met the inclusion criteria (representing n = 15,610 people): 17 observational studies, 2 randomized controlled trials, 1 quasi-experimental study, and 2 qualitative studies. All were of high quality. Most studies were conducted in the U.S. (n = 13); others were conducted in 9 other countries. Non-Hispanic White and Black were the most studied. Fatigue was measured using the Multidimensional Fatigue Inventory (n = 6) and 8 other measures. Demographic (e.g., age, sex, education, social support), physiological (e.g., T2DM duration, complications, inflammatory biomarkers), and psychological factors (e.g., diabetes distress, depression, sleep quality) were related to fatigue in adults with T2DM. Most studies examined physiological factors related to fatigue using a cross-sectional design. Fatigue was negatively associated with both diabetes self-management and QoL.

Conclusion: Research demonstrates significant relationships between fatigue and self-management and QoL in adults with T2DM. Gaps in the literature include the trajectory of fatigue over time, effects of interventions (e.g., sleep interventions) to alleviate fatigue, and unique experiences of fatigue in under-represented populations.

Disclosure

H. Kuo: None. Y. Huang: None. A.A. Garcia: None.
784-P: Personality Traits as Predictors of Self-Management Behaviors and Glycemic Control in Taiwanese Adults with Type 2 Diabetes
Authors: YANG SHIAN-CHIN , LEE TAO-CHUN , HSU HUI-CHUN
Published: June 2020

Purpose: Because the individual differences influenced the execution of diabetes self-management, the present study explored the contribution of personality traits associated with the depressive mood, the self-management and the glycemic control among adults with diabetes.

Method: We measured the Big Five personality traits and self-care behaviors of 440 outpatients (mean age = 61.6 years) with type 2 diabetes in Taiwan. After 2-4 months (mean interval= 88.6 days) personality traits scale was administered, the depressive mood, self-care behaviors and glycosylated hemoglobin (HbA1c) were measured.

Results: The path analysis (Figure 1) revealed that conscientiousness predicted HbA1c via the mediation of taking medication and emotional stability predicted HbA1c via healthy eating. The extroverted patients were prone to do exercise regularly, but patients with lower emotional stability did exercise less through the contribution of depressive mood. And then, doing exercise indirectly (via BMI) predicted lower HbA1c. However, only emotional stability had the significant total effect (Bootstrapping Percentile 95% CI=-.029 ∼ -.006) on HbA1c.

Conclusion: The present findings revealed that Big Five personality maybe predicted the glycemic control after 2-4 months via mediators. Evaluation of personality might be helpful in providing tailored patient education.

Disclosure

S. Yang: None. T. Lee: None. H. Hsu: None.
79-LB: Automatically Generated Continuous Glucose Monitoring (CGM) Notifications and Their Association with Glycemic Control
Authors: SHANKAR KAUSHIK , HASTEDT PRISCILLA , DERDZINSKI MARK , WELSH JOHN , BARGER CALEB , COHEN GARY
Published: June 2020

CGM data can be summarized and reviewed retrospectively. CLARITY provides options for reviewing data from Dexcom CGM systems, including on-demand reports and five types of notifications (disabled by default) that are auto-generated and pushed to users’ smart devices. We examined user engagement with CLARITY reports and notifications, and their associations with estimated glucose value (EGV)-based parameters. EGVs uploaded in October 2019 from a convenience sample of 2,637 U.S.-based users of Dexcom CGM systems were analyzed. Group 1 did not access CLARITY, Group 2 accessed on-demand reports but not auto-generated notifications, and Group 3 enabled all types of auto-generated notifications throughout that month. For each group, EGV-based parameters including time in range (TIR) and the % of users meeting consensus-based goals were calculated. Unpaired t-tests were used to compare time in ranges; two-proportion z-tests were used to compare % of users meeting goals. Auto-generated CLARITY notifications were associated with more TIR and less time spent in hyperglycemia, with clinically and statistically significant differences in favor of Group 3 vs. Group 1. A significantly higher proportion of users in Group 3 than in Group 1 met consensus goals for TIR (Table). Push notifications related to CGM data may contribute to patient engagement and/or to beneficial therapeutic choices.

Disclosure

K. Shankar: Employee; Self; Dexcom, Inc. P. Hastedt: None. M. Derdzinski: Employee; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. C. Barger: Employee; Self; Dexcom, Inc. G. Cohen: Employee; Self; Dexcom, Inc.
79-OR: Signal-Dependent Chromatin Accessibility Dynamics in Pancreatic Islet Dysfunction
Authors: WEI ZONG
Published: June 2020

In type 2 diabetes (T2D), inflammation induces massive changes in beta cell transcriptome and epigenome, resulting in eventual dysfunction and death of beta cells. Accordingly, strategies designed to protect beta cells from inflammatory stress at transcriptional and epigenetic level could be attractive for combating diabetes. Through genome-wide CRISPR screening in human stem cell differentiated islet like organoids, we identified a novel mechanism connecting signal- dependent transcription by vitamin D receptor (VDR) and fine-tuning of chromatin accessibility by a balance between two SWI/SNF complexes, BAF and PBAF. Our studies revealed that VDR recruits BAF and PBAF complexes through two bromodomain proteins, BRD9 and BRD7, respectively. The balance between BAF-BRD9 and PBAF-BRD7 determines the VDR-driven anti-inflammatory and pro-survival response in pancreatic beta cells. In a dual regulatory mechanism, inhibition of the VDR-BRD9 interaction in combination with ligand activation of VDR cooperate to dismiss the BAF-BRD9 complex and shift the balance to the activating PBAF-BRD7 complex to induce a coordinated transcriptional response. Notably, pharmacologically potentiated VDR signaling by a synthetic ligand in combination with a BRD9 inhibitor can partially restore beta cell function and glucose homeostasis in various T2D mouse models. Tissue specific models further confirmed the functional role of VDR and BRD9 in beta cell stress response in vivo. Together, our results revealed that an unexpected epigenetic balance between the bromodomain readers has a major impact on beta cell survival and glucose homeostasis, and demonstrated the therapeutic potential of targeting inflammatory/metabolic stress through synergistic modulation of hormone receptors and chromatin accessibility.

Disclosure

Z. Wei: None.

Funding

National Institutes of Health (1K01DK120808)
791-P: Identifying the Diabetes Distress among People with Diabetes in Taiwan
Authors: CHEN KWANG-WEN , CHEN HSIAO-HSUAN , HUNG CHIA-WEI , HWANG JING-FEN , CHUANG YUH JUE , CHEN ZHI-XIAN
Published: June 2020

Objective: People with higher level of diabetes distress (DD) may have difficulty in managing their diabetes and possible higher A1c. In order to provide proper psychosocial care, we designed this study to understand the DD of participants in a diabetes clinic.

Methods: The study was a cross-sectional design conducted in a diabetes clinic in Taiwan. Diabetes distress (DD) was assessed by Diabetes Distress Scale and accompanied by a semi-structured interview to collect qualitative information. DD includes 4 dimensions which are emotional burden (EB), interpersonal (IP), physician related (PR) and regimen-related (RR) distress. The correlation analysis was conducted to portray the relationships between DD and sociodemographic variables. Emotional state using Hospital Anxiety and Depression Scale, quality of life using WHO Quality of Life-BREF, and HbA1C levels were also gathered as the dependent variables in regression models to understand how DD related to the adaptive index in people with diabetes.

Results: There were 71 (37 M and 34 F, 64 T2D and 7 T1D, 27 insulin treated) participants and mean age 51.6 ± 14.5 yrs. According to correlation analysis, age (r = -.30, p = .011) and taking insulin (r = .33, p = .005) were associated with the level of DD. Female participants had a higher level of EB (r = .26, p = .031) and IP distress (r = .29, p = .014). In the regression model with single independent variable, mean DD (β = .29, p = .016) and RR (β = .24, p = .040) was related to the level of HbA1C respectively, but they were not significant after entering control variables of taking insulin and new patients. Mean DD and EB distress were significant association with quality of life, the symptoms of depression and anxiety in the regression models.

Conclusions: Younger people and using insulin were associated with higher level of DD. The mean score of DD and RR dimension were also associated with the levels of A1c, however, using insulin and new patients might have a stronger association with the levels of A1c.

Disclosure

K. Chen: None. H. Chen: None. C. Hung: None. J. Hwang: None. Y. Chuang: None. Z. Chen: None.
80-OR: ß-Cell Hif1a-miR-21 Signaling Exacerbates ß-Cell Dysfunction Occurring during Diabetogenic Stress
Authors: IBRAHIM SARA , STEPHENS CLARISSA , MOORE RACHEL E. , MIRMIRA RAGHAVENDRA , SIMS EMILY K.
Published: June 2020

We previously showed that β cell microRNA 21 (miR-21) is increased by islet inflammatory stress and diabetes, that miR-21 induces β cell dysfunction by targeting mRNAs maintaining β cell identity, and that β cell miR-21 induction in vivo leads to hyperglycemia. However, upstream regulators of β cell miR-21 are poorly defined. We hypothesized that increases in the transcriptional regulator Hypoxia Inducible Factor 1 Subunit Alpha (Hif1a) during diabetogenic islet stress activate β cell miR-21 transcription, thereby contributing to loss of β cell identity occurring under these conditions. To test this, we examined Hif1a and miR-21 levels in β cell lines and mouse islets. Hif1a was increased in islets from mice after multiple low dose streptozotocin (STZ) or 4 wks of 60% high fat diet (HFD). INS1 cells and flow-sorted β cells showed increases in both miR-21 and Hif1a mRNA after 24-hr IL1β treatment. Hif1a overexpression in INS1 cells increased miR-21 levels, insulin and glucagon co-expression, and aldehyde dehydrogenase 1a3 staining, all suggesting loss of β cell identity. By contrast, siRNA depletion of Hif1a abrogated cytokine-induced reductions in mRNAs regulating β cell identity. Chromatin immunoprecipitation studies verified increased HIF1a occupancy at the miR-21 promoter after IL1β treatment. To test if these HIF1a-mediated increases in β cell miR-21 exacerbate β cell dysfunction under diabetogenic conditions in vivo, transgenic mice harboring a β cell tamoxifen inducible miR-21 transgene (Tg(β-miR-21, Ins1(CreERT2)Thor) were treated with STZ or HFD. Compared to controls, STZ and HFD-induced hyperglycemia was exacerbated in Tg(β-miR-21) mice following tamoxifen administration. By contrast, after STZ, conditional β cell miR-21 knock out (Ins1(Cre)Thor) mice showed improved glycemia.

In conclusion, these findings implicate Hif1a-miR-21 signaling as a contributor to β cell dysfunction under conditions of inflammation and diabetes.

Disclosure

S. Ibrahim: None. C. Stephens: None. R.E. Moore: None. R. Mirmira: Advisory Panel; Self; Hibercell, Sigilon Therapeutics, Veralox Therapeutics. Employee; Spouse/Partner; Eli Lilly and Company. E.K. Sims: None.
801-P: Health Beliefs and Knowledge about Gestational Diabetes (GDM) in American Indian/Alaska Native (AI/AN) Female Adolescents and Young Adults (AYA) and Their Mothers: Preliminary Findings from the Stopping GDM Trial
Authors: SEREIKA SUSAN M. , MOORE KELLY R. , STOTZ SARAH A. , FISCHL ANDREA F. , CHALMERS LAURA , GARROW HEATHER , GONZALES KELLY L. , O’BANION NANCY , CHARRON-PROCHOWNIK DENISE
Published: June 2020

Introduction: Little research has focused on enhancing knowledge and health beliefs in female AYA at risk for GDM and their mothers, particularly in the AI/AN population. We examined the change in knowledge and health beliefs about GDM at the baseline visit between the intervention (n=60) and control (n=53) arms of the Stopping GDM Trial among AI/AN female AYA at risk for GDM (i.e., daughters) and their mothers.

Methods: Grounded in the Expanded Health Belief Model and using a randomized controlled trial design, this investigation focused on the efficacy of a video viewed at the baseline visit of a culturally tailored online program to enhance knowledge and health beliefs to decrease GDM risk in 113 AI/AN female AYA (74% AI; on average 16.9±3.0 years old; 45% in grades 9-12) and their mother or an adult female (e.g., grandmother) (80% mother; 82% AI; on average 44.7±9.4 years old; 44% college educated). All completed established measures of knowledge and health beliefs (benefits, barriers, severity, susceptibility) before and after viewing the video. Data were analyzed using descriptive statistics and linear mixed modeling.

Results: At the baseline visit daughters in the intervention group had greater mean increase in overall reproductive health and GDM knowledge (p=.010), and more specifically family planning knowledge (p=.003), compared to the control group. Daughters on average increased both diabetes prevention comprehensive (p=.048) and GDM (p<.001) knowledge. Mothers showed mean increases in all knowledge scores (p<.05). Regarding health beliefs, both daughters and mothers on average increased perceived susceptibility scores and decreased perceived barriers scores (p<.05).

Conclusions: These initial results support the use of culturally tailored behavioral interventions to improve knowledge and health beliefs to reduce GDM risk in AI/AN female AYA.

Disclosure

S.M. Sereika: None. K.R. Moore: None. S.A. Stotz: None. A.F. Fischl: None. L. Chalmers: None. H. Garrow: None. K.L. Gonzales: None. N. O’Banion: None. D. Charron-Prochownik: None.

Funding

National Institutes of Health (R01NR114831)
804-P: How Barriers Affect Primary Care Providers’ Referral to the National Diabetes Prevention Program Lifestyle Change Program
Authors: ZHANG XUANPING , CANNON MICHAEL , NHIM KUNTHEA , KHAN TAMKEEN
Published: June 2020

Primary care providers’ (PCP) referral of participants to the National Diabetes Prevention Program lifestyle change program (National DPP LCP) needs to be amplified or increased. Using data from 2016, 2017, and 2018 DocStyles surveys, we examined how barriers affect PCPs’ referral and how their practice patterns change over time. Barriers were measured by survey questions regarding PCPs’ perspectives on the importance of 1) claim adjudication processes/payment for the service; 2) interconnectivity of electronic health records (EHRs) with other systems; 3) incentives for referrals; and 4) awareness of prediabetes and National DPP LCP. A logistic model was used to analyze the trend, and the full model controlled for age, gender, practice type, and practice regions. Our analytic cohorts consist of PCPs who were selected repeatedly in two years. The 2016-2018 cohort had 502 PCPs, and the 2017-2018 cohort had 462 PCPs. In the first cohort, the referral rate decreased by 38.5%, from 23.3% in 2016 to 14.3% in 2018 (P<0.05). In the second cohort, the rate decreased by 37.8%, from 24.0% in 2017 to 14.9% in 2018 (P<0.05). Not realizing the importance of the above 4 barriers contributed significantly to the decreased referral rate. Referral rates for those who did not realize barriers 1 and 2 in 2016 did not differ significantly from those who did; however, by 2018 those who did not realize the barriers had lower referral rates (odds ratio (OR) 2.26 (95% confidence interval: 1.31-3.91) for barrier 1 and 1.78 (1.05-3.00) for barrier 2). Similarly, for barriers 3 and 4 differences were not significant in 2017, but ORs increased to 1.89 (1.02-3.51) and 2.91 (1.62-5.20) in 2018. Our findings suggest that lack of realizing the importance of claim/payment, EHR usage, incentives for referrals, and awareness of National DPP LCP discouraged PCP referral practice and the negative effect amplified over time. Future interventions need to focus on how to overcome these barriers.

Disclosure

X. Zhang: None. M. Cannon: None. K. Nhim: None. T. Khan: None.
807-P: Pathways between Neighborhood Factors, Stress, and Glycemic Control in Adults with Type 2 Diabetes
Authors: MOSLEY-JOHNSON ELISE , CAMPBELL JENNIFER A. , WALKER REBEKAH J. , EGEDE LEONARD E.
Published: June 2020

Background: Neighborhood factors are known barriers to optimal diabetes outcomes; however, the pathways for these findings are not adequately understood. This study examined the direct and indirect pathways between neighborhood factors and glycemic control.

Methods: Data on 615 adults with type 2 diabetes was analyzed. Latent variables were created for neighborhood violence, neighborhood aesthetics, social cohesion, and access to healthy foods. Stress and HbA1c were entered as measured variables. Structured equation modeling (SEM) was used to investigate direct and indirect relationships between neighborhood factors, stress, and glycemic control.

Results: In the final model (Figure 1) (chi2 (158)= 406.97, p<0.001, RMSEA=0.05, p-close 0.38, CFI=0.97, TLI 0.96, CD=1.0), neighborhood violence (r=0.79, p=0.006), neighborhood aesthetics (r=0.74, p=0.02), and social cohesion (r=0.57, p=0.04) were significantly directly associated with stress. Stress was significantly directly associated with glycemic control (r=0.06, p=0.004). Neighborhood violence (r=0.05, p=0.05) and aesthetics (r=0.05, p=0.07) were marginally indirectly associated with glycemic control through stress.

Conclusions: The pathway between neighborhood factors and glycemic control is via chronic stress, therefore, interventions are needed to target chronic stress in adults with type 2 diabetes.

Disclosure

E. Mosley-Johnson: None. J.A. Campbell: None. R.J. Walker: None. L.E. Egede: None.

Funding

American Diabetes Association (1-19-JDF-075 to R.J.W.); National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861); National Institute on Minority Health and Health Disparities (R01MD013826)
810-P: A Behaviorally-Enriched Diabetes Prevention Program for a State Employee Driver Population
Authors: WELCH GARRY , DOWNS SARAH M. , VIDETTO MARYANN , GRISWOLD ALYSSA M.
Published: June 2020

Objective: Transportation workers, including drivers, are at high risk of developing diabetes but are a challenging workforce to reach for public health initiatives. We evaluated an innovative, culturally-tailored Diabetes Prevention Program (DPP) designed to strengthen driver behavioral engagement and program outcomes as part of a collaboration with the CT State Employer and the drivers’ Labor Union. The DPP included behavior and psychosocial assessments and health coaching to meet ADA Psychosocial Care Guideline recommendations.

Methods: Outcomes were: program attendance, weight loss, and physical activity level. Drivers (N=117) attended informational sessions, completed DPP screening, and signed up for a 1-year DPP at 11 work sites. Standard DPP group education was enriched with group and individual health coaching sessions that targeted behavioral and psychosocial barriers. Health coaches (N=3) developed customized educational resources and used validated behavior and psychosocial barriers assessments.

Results: Participants (N=98, 84% of enrolled) were: 97.8% male, mean age=49.0±8.9 yrs., baseline weight=245±48.6 lbs., gender 95% male, race 76% White, Ethnicity 13.6% Latino. One year results showed: mean attendance=70.8% ≥ 22 sessions and N=418 coaching sessions using individual driver behavior and psychosocial diagnostic results to compliment DPP group work. Behavior and psychosocial assessments completed were: Health literacy N=86, Self-management (Meal plan, Physical activity) N=77, Behavioral health N=80, Bodily pain N=83, Poor sleep N=92. Mean weight loss=14.0±11.5 lbs. with 63.3% achieving ≥5% body weight, and 89.8% ≥150 min/week of physical activity. Mean HbA1c improved from 5.7%±0.8 to 5.3%±0.6.

Conclusions: Drivers with challenging work schedules at high risk of developing diabetes were strongly engaged in a tailored, behaviorally-focused, enriched DPP that showed strong weight loss and physical activity improvements at the end of the one year DPP.

Disclosure

G. Welch: Stock/Shareholder; Self; Silver Fern Healthcare LLC. S.M. Downs: Employee; Self; WellSpark Health. M. Videtto: None. A.M. Griswold: None.
811-P: Depression and Suicidal Risk in Adolescents and Young Adults with Diabetes: Are Screeners Sufficient?
Authors: MOSS ASHLEY , ROBERTS ALISSA J. , YI-FRAZIER JOYCE , READ KENDRA L. , PIHOKER CATHERINE , HIRSCH IRL B. , WEAVER KATHRYN W. , TAPLIN CRAIG , MALIK FAISAL
Published: June 2020

Aims: Depression screeners in adolescents and young adults (AYAs) with diabetes may under-identify patients at risk for suicide. We examined prevalence of suicidal ideation (SI) using the Patient Health Questionnaire 9 (PHQ-9) depression screener and an in-person safety assessment conducted by a pediatric psychologist.

Methods: Participants included 104 AYAs with diabetes seen for their first Diabetes Transition Clinic appointment. Participants were administered the PHQ-9 and completed a safety assessment with a pediatric psychologist. The safety assessment included questions about AYA’s recent history of passive/active SI, plan, or intent (suicidal risk). Safety assessment responses were dichotomized to represent presence or absence of suicidal risk. Analyses included rates of positive depression screens and comparison of SI risk based on response to PHQ-9 SI question (i.e., “thoughts that you’d be better off dead or thoughts of hurting yourself in some way” over the past 2 weeks) and the safety assessment.

Results: On PHQ-9 screening, 19% of AYAs (n=21; age 20.3 + 1.0 years, 66.7% female) reported moderate to severe symptoms of depression and 5 reported SI in the past 2 weeks. The safety assessment identified 5 AYAs as at suicidal risk. The SI sensitivity rate for the PHQ-9 was 60% and specificity rate was 98%. The PHQ-9 misclassified 40% of AYAs as not at risk that were identified by the safety assessment and over-identified 2% of patients as at risk not corroborated by the safety assessment.

Conclusion: Moderate to severe symptoms of depression are common in AYAs with diabetes. Results suggest the PHQ-9 as a proxy for identifying SI may result in under-identification of some patients who may otherwise be at risk for suicide. The need for consistent identification of suicidality is critical. Besides better assessment tools for SI, this study reinforces the value of an embedded pediatric psychologist as a part of a multidisciplinary care team to address the needs of this unique population.

Disclosure

A. Moss: None. A.J. Roberts: None. J. Yi-Frazier: None. K.L. Read: None. C. Pihoker: None. I.B. Hirsch: Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care. Research Support; Self; Medtronic, Omnipod. K.W. Weaver: None. C. Taplin: None. F. Malik: None.
817-P: Financial Stress Factors, Psychological Factors, and Self-Management Outcomes in Emerging Adults with Type 1 Diabetes
Authors: BLANCHETTE JULIA E. , TOLY VALERIE B. , WOOD JAMIE R. , MUSIL CAROL M. , MORRIS DIANA L. , VOTRUBA MARK E.
Published: June 2020

Emerging adults, ages 18-25, with type 1 diabetes (T1D) may be vulnerable to financial and psychological barriers to self-management as they grapple with the developmental milestones of financial and self-management independence. This correlational, cross-sectional study described the relationships among financial stress factors (perceived stress, financial stress, and financial independence) and psychological factors (depressive symptoms, trait anxiety, and diabetes distress) on self-management outcomes (HbA1c and diabetes-related quality of life [DQoL]) in emerging adults with T1D. Data from 413 emerging adults recruited from the T1D Exchange (mean age 22.1±1.83 years; 62% female; 80.4% white; 37.3% private high-deductible insurance; T1D duration 13.2±4.41 years; 8.0±1.6 HbA1c) were analyzed. The Perceived Stress Scale, Personal Financial Well-Being Scale, Willingness to Pay Scale, Financial Independence Visual Analog Scale, Center for Epidemiological Studies-Depression Inventory, State-Trait Anxiety Inventory, Diabetes Distress Scale and DQoL Measure were completed via REDCap surveys. Hierarchical Multiple Regression analyses revealed that 20.6% of variance in HbA1c (F=15.555, p<.001) was explained by greater financial stress (β=-.197, p<.001) and diabetes distress (β=.181, p<.001); 64.5% of the variance in DQoL (F=148.469, p<.001) was explained by greater financial stress (β=-.112, p = .002), diabetes distress (β=.512, p<.001), trait anxiety (β=.183, p=.001) and depressive symptoms (β=.162, p=.001). Greater financial stress and psychological factors have detrimental impacts on self-management outcomes during emerging adulthood. Future interventions should assess and address these self-management barriers in practice.

Disclosure

J.E. Blanchette: Other Relationship; Self; Tandem Diabetes Care. V.B. Toly: None. J.R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. C.M. Musil: None. D.L. Morris: None. M.E. Votruba: None.

Funding

Frances Payne Bolton School of Nursing; Sigma Theta Tau International
818-P: Mental Health History and DECIDE Self-Management Support Program Outcomes in an African American Sample with T2DM
Authors: VRANY ELIZABETH A. , JENNINGS ARIANNE , HILL-BRIGGS FELICIA
Published: June 2020

Objective: To evaluate changes in behavioral and clinical outcomes from the DECIDE (Decision-making Education for Choices in Diabetes Everyday) self-management support program trial among participants with and without a mental health (MH) history.

Methods: Participants were urban African American adults with type 2 diabetes (T2DM) (N=182). DECIDE is a problem solving diabetes self-management support program. Participants were randomized to 1 of 4 intervention arms: Self Study (n=46), Individual (n=45), Group (n=46), or Enhanced Print Education (EPE; n=45). Those who screened positive on the Patient Health Questionnaire 2 or reported a mental health diagnosis were coded as having MH history. Outcomes were self-management, knowledge, problem solving, and A1C assessed at baseline and 6 months post intervention, stratified by MH history status.

Results: 72 participants (40%) reported a MH history, including depression, bipolar, and schizophrenia. Among those with no MH history, knowledge and problem solving improved at 6 months post intervention in all intervention arms (knowledge: Self Study p<.001, Individual p=.011, Group p=.004, EPE p=.026; problem solving: Self Study p=.023, Individual p=.015, Group p=.010, EPE p=.015). For those with MH history, knowledge and problem solving improved in the Self Study and Individual arms (diabetes knowledge: Self Study p=.018, Individual p=.037; health problem solving: Self Study p=.006, Individual p=.011) but not in the Group or EPE arms (ps≥.10). Although changes in A1C were not significant in any group (ps≥.20), A1C decreased by 1% among those with MH history in the Self Study arm (baseline A1C=9.1%; 6 month A1C=8.1%; p=.20).

Conclusion: In an urban minority sample with T2DM, those with a MH history benefited from a diabetes self-management intervention, but delivery modality mattered. Robust improvements in skills and A1C were observed when those with a MH history had self-paced or one-on-one formats rather than group.

Disclosure

E.A. Vrany: None. A. Jennings: None. F. Hill-Briggs: None.

Funding

National Heart, Lung, and Blood Institute (R01HL089751, 5T32HL007180)
820-P: Depression and Glycemic Control after Identification of Depression in Adults with Type 1 Diabetes
Authors: ZAFFUTO BRANDON J. , GREENFIELD MARGARET , TRIEF PAULA M. , MORLEY CHRISTOPHER P. , WEINSTOCK RUTH S.
Published: June 2020

Objectives: Assess whether adults with type 1 diabetes (T1D) with probable depression subsequently received pharmacological intervention for depression, and the impact of this intervention on glycemic control.

Research Design and Methods: Retrospective chart reviews were performed on adults ages 18-85 years, routinely screened for depression, with T1D of >1-year duration and no hemoglobinopathy, renal dysfunction (GFR <30), or dementia. Probable depression was defined by a score of ≥10 on the Patient Health Questionnaire (PHQ-9). Adults with probable depression at Time-1 were included if they had a follow-up PHQ-9 10-16 months later (Time-2) and a HbA1c within 1 month of completing each PHQ-9.

Results: The study included 93 participants (mean age=44 years, 55% female, 81% white, mean HbA1c 8.9%). At Time-1, 50 persons (53.8%) were prescribed anti-depressants. At Time-2, 5 additional persons (5.3%) received prescriptions. There were decreases in mean PHQ-9 scores (Time-1 15.99; Time-2= 4.55, p<.001) and HbA1c levels (Time-1= 9.3%; Time-2= 8.9%, p=.03). PHQ-9 scores related to HbA1c at each time point but did not relate to HbA1c change (p=0.48). There were marginally significant differences in PHQ-9 scores at Time-2 for those given anti-depressants (mean PHQ-9 = 5.75) versus those who were not (mean PHQ-9 = 2.82; p=.058), and a smaller decrease in HbA1c for those prescribed antidepressants (-.09) vs. those who were not (-.82; p= .042). Other interventions for depression (e.g., counseling) are not reliably captured in the EMR.

Conclusions: About 60% of adults with T1D and probable depression received anti-depressant medications. Despite an association between measures of depression and glycemic control, changes in each did not relate over 10-16 months. EMRs should improve documentation of therapeutic strategies to facilitate communication between providers working with depressed individuals and better inform future approaches to improve care.

Disclosure

B.J. Zaffuto: None. M. Greenfield: None. P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. C.P. Morley: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.

Funding

Type 1 Diabetes Exchange QI Learning Collaborative
826-P: Diabetes and Sleep: Qualitative Perspectives from People with Type 1 Diabetes and Their Parents and Partners
Authors: CARREON SAMANTHA A. , CAO VIENA T. , ANDERSON BARBARA , ESHTEHARDI SAHAR S. , THOMPSON DEBORAH , MARRERO DAVID G. , MCKINNEY BRETT M. , HILLIARD MARISA E.
Published: June 2020

Introduction: There is growing interest in how type 1 diabetes (T1D) impacts sleep, yet little is known about patient and family experiences. This study characterized perspectives of people with diabetes (PWD) and their parents and partners about T1D-related sleep issues.

Methods: As part of a qualitative study on T1D-related quality of life, 44 PWD ages 9-69 (M=31.9±19.29 years; 50% female; MA1c=8.25±1.51%), 25 parents (96% female), and 14 partners (43% female) participated in semi-structured interviews. We coded transcripts using content analysis to derive sleep-related themes.

Results: Two major themes emerged (Figure). Emotional Distress: all groups expressed worries about hypoglycemia while asleep, and parents described distress about the constant demands of T1D and nighttime management burdens. Sleep Disruption: blood glucose excursions and overnight management interrupted sleep. Technology both disrupted sleep (e.g., alarms) and improved sleep (e.g., trust device to inform about urgent problems).

Conclusions: PWDs and family members described emotional and behavioral aspects of T1D impacting sleep. Emotional distress, overnight management, and glucose variability disrupted sleep. Taking steps to minimize overnight glucose excursions may reduce distress and improve sleep. More research on sleep disruption and the impact of technology on sleep may inform diabetes care.

Disclosure

S.A. Carreon: None. V.T. Cao: None. B. Anderson: None. S.S. Eshtehardi: None. D. Thompson: None. D.G. Marrero: None. B.M. McKinney: None. M.E. Hilliard: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D084)
827-P: Association between Household Food Security and Depression Symptoms among Youth and Young Adults with Diabetes
Authors: BROWN ANDREA D. , MENDOZA JASON A. , FLORY KATE , REBOUSSIN BETH A. , MERCADO CARLA , JENSEN ELIZABETH T. , DOLAN LAWRENCE M. , DABELEA DANA , LAWRENCE JEAN M. , LIESE ANGELA D.
Published: June 2020

Household food insecurity (HFI) (or unavailability of nutritionally adequate and safe foods) is associated with unhealthy diet and increased risk of obesity and chronic diseases. Additionally, people with diabetes are at increased risk for depression. Although access to a regular and healthy diet is important to proper nutrition and to diabetes management, no studies have assessed how HFI is related to depression among youth and young adults (YYA) with type 1 diabetes (T1D) or type 2 diabetes (T2D).

This study used cross-sectional data from the SEARCH for Diabetes in Youth study collected in 2015-2019 to evaluate associations between HFI and depression among YYA with T1D and T2D. HFI was categorized as a binary variable (food secure vs. food insecure) using the 18-item U.S. Department of Agriculture food security survey, where ≥3 affirmations indicated being food insecure. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to quantify depression symptoms as a continuous outcome (scores 0-60). Linear regression models were adjusted for age, sex, race/ethnicity, site, and diabetes duration. Models were analyzed separately for youth with T1D, young adults with T1D, and young adults with T2D.

HFI and CES-D data were available for 335 T1D youth (10-17 years), 731 T1D young adults (18-35 years), and 272 T2D young adults (18-34 years). Of these, 18.8%, 17.5%, and 30.1%, respectively, reported being food insecure. Adjusted models showed that food insecure young adults with T1D had 7.4 higher scores on symptoms of depression (p<.0001) and those with T2D had 4.8 higher scores on symptoms of depression (p=0.0002), when compared to those that were food secure. Food insecure youth with T1D had 3.2 higher scores on symptoms of depression compared to food secure youth with T1D after adjustment for covariates (p=0.0031).

Findings from this study suggest that living in a food insecure household is associated with increased depression symptomology among YYA with T1D or T2D.

Disclosure

A.D. Brown: None. J.A. Mendoza: None. K. Flory: None. B.A. Reboussin: None. C. Mercado: None. E.T. Jensen: None. L.M. Dolan: None. D. Dabelea: None. J.M. Lawrence: None. A.D. Liese: None.

Funding

SEARCH for Diabetes in Youth Cohort Study (1UC4DK108173); SEARCH Food Security Cohort Study (1R01DK117461-01); National Institute of General Medical Sciences (T32GM081740)
831-P: Children at Increased Risk for Type 1 Diabetes Using a Study Educational Tool Have Better Understanding of Genetic Risk: The TEDDY Study
Authors: SMITH LAURA B. , TAMURA ROY , KARBAN RACHEL , MELIN JESSICA , WIMAR ÅSA E. , GARDINER MELISSA , DRISCOLL KIMBERLY A. , JOHNSON SUZANNE B.
Published: June 2020

The Environmental Determinants of Diabetes in the Young (TEDDY) is an international study of 8,676 children from birth to age 15 at increased genetic risk for type 1 diabetes. Before the 10-year study visit, children received a book explaining their increased genetic risk for type 1 diabetes and TEDDY study aims. We compared children who read the book to those who did not read the book on their (1) type 1 diabetes risk perception accuracy, (2) anxiety about their increased risk for type 1 diabetes (using a modified version of Spielberg State Anxiety Inventory for children), (3) actions intended to prevent diabetes, and (4) study satisfaction. Overall, 2064/3306 (62%) children read the book; girls, children from two parent families, and Swedish and Finnish children (all p<0.001) were more likely to read the book. Using generalized linear modeling we examined differences in those who read versus did not read the book on child outcome measures while controlling for demographic (e.g., parent education, first-degree relative with diabetes, child sex) and parent measures (e.g., parent risk perception, anxiety, study satisfaction). Children who read the book had more accurate risk perception (read book = 30% accurate versus 24% accurate; OR=1.41, 95% CI=1.19-1.68, p<0.001) and greater TEDDY study satisfaction measured on a 0-2 scale (average treatment difference = 0.10, 95% CI=0.07-0.13, p<0.001) compared to those who did not read the book. No significant group differences in anxiety or behaviors to prevent diabetes occurred.

In conclusion, the use of an educational tool is well accepted, is not related to increased child anxiety about diabetes, and is related to greater child diabetes risk perception accuracy and study satisfaction. However, even after reading the book, 70% of children had inaccurate diabetes risk perception, suggesting additional strategies are needed. Findings have implications for retention and education in long-term research cohorts.

Disclosure

L.B. Smith: None. R. Tamura: None. R. Karban: None. J. Melin: None. Å.E. Wimar: None. M. Gardiner: None. K.A. Driscoll: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Environmental Health Sciences; Centers for Disease Control and Prevention; JDRF; National Institutes of Health/National Center for Advancing Translational Sciences (UL1TR000064, UL1TR001082)
839-P: Peripheral and Central Blood Pressure Regulation in Recently Diagnosed Prediabetes
Authors: BOGACZEWICZ-SLOWIKOWSKA ANNA , ABRAMCZYK PIOTR , CIENSZKOWSKA KATARZYNA , JANECZKO-SOSNOWSKA EWA , GACIONG ZBIGNIEW , CZUPRYNIAK LESZEK
Published: June 2020

Hypertension is found in up to 90% people with type 2 diabetes. The relationship between blood pressure (BP) (dys)regulation and prediabetes is much less clear. Fifty individuals (mean age [±SD] 42.7±13.1 years, BMI 29.2±7.3 kg/m2) with prediabetes (31 IFG; 19 IGT) and normal BP and 20 age- and BMI-matched healthy persons (40.8±9.6 years, BMI 27.9±6.6 kg/m2) were enrolled into the study. In all participants fasting plasma insulin, adiponectin and interleukin-8 (IL-8) were assessed; and 24-hour ambulatory BP monitoring (ABPM Monitor Schiller BR-102 Plus) and central BP assessment with the applanation tonometry method (SphygmoCor XCEL) were perfomed. ABPM results were similar in both groups: 24-hour systolic, diastolic, mean arterial pressure (MAP) and pulse pressure were 124.1±10.8 and 123.5±7.6; 74.3±7.9 and 74.3±7.0; 89.8±7.2 and 90.4±6.6; 50.5±7.9 i 48.6±5.3 mmHg, respectively (p>0.05). In daytime the respective values were 127.0±11.2 and 126.6±7.4; 75.7±6.5 and 77.2±7.0; 92.4±7.5 and 93.2±6.5; 50.9±8.0 and 48.9±5.5 mmHg, and at nighttime 109.1±21.8 and 109.8±10.5; 61.5±12.7 and 62.7±8.8; 77.1±15.4 and 78.1±9.0; 47.1±11.3 and 46.7±5.4 mmHg (p>0.05). Central systolic, diastolic, end systolic BP, central mean pressure, central pulse height, augmentation index and central stroke volume index were also similar in both groups: 109.3±13.7 and 112.1±14.4, 77.1±9.5 and 80.4±10.7, 99.0±11.7 and 102.1±13.0, 91.3±10.6 and 95.2±11.4, 32.1±9.7 and 31.9±9.4 mmHg, 16.7±13.2 and 15.5±14.3%, 149.5±25.3 and 144.2±29.2 (p>0.05). No significant diffferences in plasma insulin, adiponectin or IL-8 were found between the groups (30.4±25.3 and 26.5±28.8 µIU/ml; 4.86±2.56 and 6.28±3.48 µg/ml; and 25.6±2.58 and 27.9±9.76 pg/ml, respectively, p>0.05).

In conclusion, recently diagnosed prediabetes is not associated with any blood pressure abnormalities. Vigorous prevention of diabetes in people with prediabetes should be encouraged as it may lead to maintaining cardiovascular health.

Disclosure

A. Bogaczewicz-Slowikowska: None. P. Abramczyk: None. K. Cienszkowska: None. E. Janeczko-Sosnowska: None. Z. Gaciong: None. L. Czupryniak: None.
84-OR: Laminin-Islet Interactions Protect against Cytokine-Mediated Beta-Cell Death via Down-Regulation of Protein Kinase C Delta
Authors: FARNSWORTH NIKKI L. , PISCOPIO ROBERT A. , BENNINGER RICHARD K.
Published: June 2020

Islets are surrounded by a specialized extracellular matrix (ECM). Interactions with the peri-islet ECM, specifically laminin, promote islet viability and function. In T1D during immune infiltration the peri-islet ECM is broken down and β-cell death occurs in part through production of high levels of Th1 cytokines. Recent work has shown that cytokines alter islet function via protein kinase C Δ (PKCΔ) dependent mechanisms and that islet interactions with laminin reduce PKCΔ activity. We hypothesize that laminin-islet interactions protect against cytokine-mediated β-cell death via downregulation of PKCΔ. To test our hypothesis, we used a 3D reverse thermal gel (RTG) scaffold with either laminin-10 (RTG-Lam) or lysine (RTG-Lys) as a control. Islets were isolated from WT or mice with an inducible β-cell specific PKCΔ knockout (PKCΔ-βKO) and encapsulated in RTG-Lam and RTG-Lys for 24hrs with or without cytokines (10ng/mL TNF-α, 5ng/mL IL-1β, 100ng/mL IFN-γ). Viability, PKCΔ translocation, and PKCΔ activity were measured in encapsulated islets in situ using fluorescent biosensors or by western blot. PKCΔ-βKO islets were protected against cytokine-induced death compared to controls (p=0.003). Cytokines increased β-cell death in RTG-Lys (p<0.001), while islets encapsulated in RTG-Lam were protected against cytokine-mediated death (p<0.04). Islets encapsulated in RTG-Lam had reduced PKCΔ activity at the cell membrane compared to RTG-Lys and were also protected against cytokine-mediated increases in PKCΔ activity at the cell membrane.

In summary, islet interactions with laminin protect against cytokine-induced β-cell death via downregulation of PKCΔ activity at the cell membrane. Our results suggest that loss of islet interactions with laminin, as occurs in T1D, may make islets more susceptible to cytokine-mediated death. This mechanism of β-cell death provides a novel therapeutic target to prevent β-cell death and halt the progression of T1D.

Disclosure

N.L. Farnsworth: None. R.A. Piscopio: None. R.K. Benninger: None.

Funding

JDRF (3-APF-2019-749-A-N, 1-FAC-2020-891-A-N); Colorado Clinical and Translational Sciences Institute (CO-M-19-133)