bluuebunny/crossref_metadata_2025 huggingface dataset:
789-P: Association of Zinc Intake with Obesity in Japanese Patients with Type 2 Diabetes Mellitus (T2DM)
Authors: NEDACHI RINA , FUJIHARA KAZUYA , HATTA MARIKO , MATSUBAYASHI YASUHIRO , TAKEDA YASUNAGA , ISHII DAI , HORIKAWA CHIKA , KATO NORIKO , MAEGAWA HIROSHI , SONE HIROHITO ,   JDDM GROUP
Published: June 2019

Obesity is associated with deterioration of T2DM and its complications. Although low serum zinc levels are reportedly associated with obesity in nondiabetic people, clinical evidence regarding the association between dietary intake of zinc and obesity in diabetic individuals is sparse. Thus, we aimed to clarify this issue utilizing our nationwide registry of Japanese patients with diabetes. Analyzed were 1891 patients with T2DM (mean age, 62 y; men, 62%) whose data from a food frequency questionnaire were available. Obesity was defined as BMI of ≥25. The associations between obesity and intake of zinc were determined by multivariate regression as well as quintile analyses. Odds ratio (OR) for obesity was 0.74 (0.65, 0.84) per 1 mg increase in zinc intake. Quintile analysis revealed a stepwise decrease in ORs for obesity at higher quintiles. ORs in Q3-Q5 were significant compared to Q1 as the reference (Table). Food groups strongly related to zinc intake among our patients were meats (correlation coefficients, 0.64), fish (0.49), and vegetables (0.47). These results suggest close associations between zinc intake and obesity in patients with T2DM. This information would be clinically applicable for nutrition education.

Disclosure

R. Nedachi: None. K. Fujihara: None. M. Hatta: None. Y. Matsubayashi: None. Y. Takeda: None. D. Ishii: None. C. Horikawa: None. N. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
79-LB: The Relationship between Diabetes Distress and Technology Experience in a Closed-Loop Control (CLC) Trial
Authors: GONDER-FREDERICK LINDA , BISIO ALESSANDRO , BROWN SUE A. , KOLLAR LAURA L. , EMORY EMMA , KOVATCHEV BORIS
Published: June 2019

At present, little is known about the relationship between emotional well-being and use of diabetes technology, such as closed loop control. This study examined the association between diabetes-related distress and technology opinions/experience in a cohort of people with type 1 diabetes participating in a CLC clinical trial. The trial involved use of sensor-augmented pump (SAP) therapy, overnight only CLC (ON CLC), and 24-hr CLC (24/7 CLC) over 8-week treatment periods. Participants (n=61, 60% F, age= 42.5 ± 11.6, T1D ys = 22.1 ± 12, BMI=29.6 ± 5.5, HbA1c at baseline = 7.4 ± 1.0 TDI/kg = 0.6 ± 0.2) completed the Diabetes Distress Scale (DDS) at baseline and the Closed Loop User Opinion Survey (CLUOS) following each treatment condition. The CLUOS was validated using factor analysis which yielded two subscales describing positive and negative experiences with the technologies (i.e., benefits and barriers), with all items loading .32 or higher on their respective subscales, and Cronbach’s α coefficients of .95 and .93, respectively. Participants were divided into two groups based on baseline DDS scores using the median score to create high and low distress groups for each DDS subscale. T-tests were used to compare CLUOS subscale scores in the high and low DDS groups. There were no differences on the Regimen, Physician or Interpersonal DDS subscales. However, individuals scoring higher on the Emotional DDS subscale at baseline had higher scores on the Negative CLUOS subscale after the SAP (p=0.024) and the ON CLC (p=0.039) conditions, and a trend toward higher Negative scores after the 24/7 CLC (p=0.061). Although preliminary, these findings suggest that higher levels of emotional diabetes distress should be considered and perhaps addressed prior to implementing new diabetes technologies and that higher emotional distress levels may increase the probability of negative experiences with technology, possibly limiting its uptake and use.

Disclosure

L. Gonder-Frederick: Employee; Self; HFS-Global. Research Support; Self; Dexcom, Inc., Jaeb Center for Health Research, Tandem Diabetes Care. Speaker’s Bureau; Self; Diabetes UK. Stock/Shareholder; Self; BeHealth Solutions. A. Bisio: None. S.A. Brown: Research Support; Self; Ascensia Diabetes Care, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. L.L. Kollar: None. E. Emory: None. B. Kovatchev: Advisory Panel; Self; Sanofi. Board Member; Self; TypeZero Technologies, Inc. Consultant; Self; Sanofi, Tandem Diabetes Care. Research Support; Self; Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. Speaker’s Bureau; Self; Dexcom, Inc. Stock/Shareholder; Self; TypeZero Technologies, Inc. Other Relationship; Self; Johnson & Johnson, Sanofi.

Funding

National Institutes of Health (R01DK085623); Roche Diagnostics; Tandem Diabetes Care, Inc.; Dexcom, Inc.
79-OR: Fully Closed-Loop Using Faster vs. Standard Aspart in Type 2 Diabetes (T2D): A Double-Blind Randomised Crossover Trial
Authors: BALLY LIA , HERZIG DAVID , WILINSKA MALGORZATA E. , RUAN YUE , VOGT ANDREAS , WERTLI MARIA M. , VOGT BRUNO , STETTLER CHRISTOPH , HOVORKA ROMAN
Published: June 2019

Aim: To evaluate the safety and efficacy of faster insulin aspart (FA) vs. insulin aspart (A) in T2D using fully closed-loop (CL) glucose control.

Methods: Fifteen adults (5 females, age 59±10 years, BMI 34.5±9.1kg/m2) with insulin-treated T2D (HbA1c 7.7±1.2% [60±13mM/mol], insulin dose 1.0±0.7U/kg) underwent two 22h-visits (1900-1700) receiving CL with either FA or A in a double-blind randomized crossover design. Basal-bolus regimen was replaced by model predictive control algorithm-directed s/c administration of FA or A based on sensor glucose levels. After an overnight stay, participants consumed matched breakfast and lunch and performed a 20 min-walk. Plasma glucose measurements every 15 min over 10h (0700-1700) evaluated CL performance.

Results: The proportion of time when plasma glucose was in target range from 5.6-10.0mM did not differ between FA and A (primary endpoint, p=0.17, Table). Mean glucose and glucose variability were comparable, as was time spent below and above target. The 2h-postprandial glucose increment was comparable after breakfast and significantly lower after lunch with FA vs. A (p=0.78 and p=0.047). One hypoglycaemic event (<3.5mM) occurred with FA and two with A. Insulin dose was significantly higher with FA vs. A (p=0.021).

Conclusion: Short-term use of fully CL with FA vs. A requires higher insulin doses to achieve comparable glucose control.

Disclosure

L. Bally: None. D. Herzig: None. M.E. Wilinska: None. Y. Ruan: None. A. Vogt: None. M.M. Wertli: None. B. Vogt: None. C. Stettler: None. R. Hovorka: Advisory Panel; Self; Novo Nordisk A/S. Research Support; Self; Abbott, Dexcom, Inc., Medtronic. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk A/S. Other Relationship; Self; B. Braun Medical Inc., Medtronic.

Funding

UDEM Scientific Fund; Swiss Diabetes Foundation; Diabetes Centre Bern
790-P: The Amount of Carbohydrate in the Diet Affects Glucose Dynamics Day and Night
Authors: SCHMIDT SIGNE , RANJAN AJENTHEN , CHRISTENSEN MERETE B. , NØRGAARD KIRSTEN
Published: June 2019

Aim: To investigate the effects of a low carbohydrate diet (<100 grams/day) and a high carbohydrate diet (>250 grams/day) on daytime (6:00-0:00) and nighttime (0:00-6:00) glucose dynamics in adults with type 1 diabetes.

Methods: Fourteen participants using sensor-augmented insulin pumps were included in a randomized crossover study with two 12-week intervention arms separated by a 12-week washout. Individual meal plans meeting the carbohydrate criteria were made for each study participant.

Results: Participant baseline characteristics were (mean ± SD): age 44 ± 12 years, BMI 24.8 ± 2.0 kg/m2, HbA1c 7.5 ± 0.4%, daily carbohydrate intake 152 ± 43 grams/day. Daily carbohydrate intake during the two intervention periods was (mean ± standard deviation) 98 ± 11 grams and 246 ± 34 grams, respectively. Distribution of glucose values are reported in the Table.

Discussion: Daytime hypoglycemia and nighttime hyperglycemia were lower during the low than the high carbohydrate diet. Further, more time was spent in normoglycemia at night during the low carbohydrate diet. These findings may be the results of smaller daytime meal boluses and fewer carbohydrates in the evening meal.

Disclosure

S. Schmidt: Speaker's Bureau; Self; Novo Nordisk A/S. A. Ranjan: None. M.B. Christensen: None. K. Nørgaard: Advisory Panel; Self; Abbott, Medtronic, Novo Nordisk A/S. Speaker's Bureau; Self; Bayer US, Medtronic, Roche Diabetes Care, Rubin Medical, Sanofi, Zealand Pharma A/S. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding

Danish Diabetes Academy
80-OR: 670G Clinical Experience
Authors: LAL RAYHAN , BASINA MARINA , MAAHS DAVID M. , BUCKINGHAM BRUCE A. , HOOD KOREY K. , CONRAD BARRY P. , LEVERENZ JEANNINE , CHMIELEWSKI ANNETTE , PETERSON KRISTINE , WILSON DARRELL
Published: June 2019

Objective: In September 2016, the FDA approved the Medtronic 670G “hybrid” closed-loop system. In “Auto Mode,” this system automatically controls basal insulin delivery based on CGM data, but requires users to enter carbohydrate intake and blood sugar for boluses. Studies show improved time in range associated with the use of Auto Mode. In an effort to track our real-world experience with this first commercial closed-loop device, we followed pediatric and adult patients placed on the 670G.

Methods: This was a 1-year prospective observational study, recruiting 5/2017-9/2018, of patients with type 1 diabetes, ≥7 years, starting the 670G system.

Results: 84 patients started on the 670G (range 9-61 years), 26 (31%) were <18 years. Figure 1 shows a violin plot of percentage time in Auto Mode at each visit. Upon starting Auto Mode, 96% of participants continued for the first week. For those with available data by 3 months 22% stopped using Auto Mode, at 6 months 30%, at 9 months 43% and by 12 months 50% (70% <18, 40% ≥18). Reasons for discontinuation included CGM issues, too many alarms and lack of control. At 6 months there was a significant correlation between improved A1c and time in Auto Mode (r = 0.4, p = 0.01).

Conclusions: While use of closed-loop technology correlates with improved glycemic control, a focus on usability and human factors is necessary to ensure patients stay on treatment. Alarms and sensor calibration are a major patient concern, which next generation technology should alleviate.

Disclosure

R. Lal: Consultant; Self; Abbott. M. Basina: None. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. B.A. Buckingham: Advisory Panel; Self; ConvaTec Inc., Novo Nordisk Inc., Profusa, Inc. Consultant; Self; Medtronic MiniMed, Inc. Research Support; Self; Beta Bionics, ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. B.P. Conrad: None. J. Leverenz: None. A. Chmielewski: None. K. Peterson: None. D. Wilson: Advisory Panel; Self; Tolerion, Inc. Research Support; Self; Beta Bionics, Dexcom, Inc., Medtronic.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007217); Seiler Fund
810-P: Japanese Version of the Diabetes Distress Scale: Validation and Identification of Individuals at High Risk for Diabetes-Related Distress
Authors: TAKAMI NENE , OKAZAKI KENTARO , TAKAHASHI NORIYUKI , SUEMATSU MINA , OHASHI WATARU
Published: June 2019

Diabetes related distress (DRD) is usual for patients with type 2 diabetes (T2D), which worsens glycemic control through negative effects on well-being and self-care behaviors. Diabetes Distress Scale (DDS) is a globally-used instrument to measure DRD. The aim of this study was to validate the Japanese version of the DDS (DDS-J) and to identify the characteristics of individuals at high risk for DRD.

DDS-J was developed conceptually equivalent to the original version through an appropriate process. A cross-sectional study was conducted in 206 T2D patients (mean age 64.1 years, 62.1% male, mean duration 13.2 years, mean HbA1c 7.6%) at outpatient department of 2 hospitals in Aichi, Japan from February to May 2018. Cronbach's α and test-retest method were used to assess reliability, and factor analysis to analyze validity. The 5-item WHO Well-Being Index (WHO-5) and Patient Health Questionnaire-9 (PHQ-9) scale were adopted to evaluate the criteria-related validity.

Four factors of regimen-related distress (RD), emotional burden (EB), physician-related distress (PD), and interpersonal distress (ID) were extracted by factor analysis. This factor structure was the same as the original. The overall Cronbach's α was 0.92, while ones for RD, EB, PD, and ID were 0.86, 0.89, 0.75 and 0.82, respectively. Test-retest correlation score was 0.63. The DDS-J score showed a moderate and significant correlation with WHO-5 (r=-0.43, p<0.01) and PHQ-9 (r=0.49, p<0.01). To analyze the variables associated with the DDS-J score, a multiple regression analysis was performed with age, BMI, gender, HbA1c, and injection use as independent variables. HbA1c (slope 3.62, p<0.01) and age (slope -0.28, p<0.01) remained significantly associated with DDS-J score with an R2 of 0.22.

DDS-J showed good validity and reliability, and can be used as an effective tool to assess DRD of Japanese adult T2D patients. Those with higher HbA1c and younger age should be paid attention in terms of DRD.

Disclosure

N. Takami: None. K. Okazaki: Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Abbott, Mitsubishi Tanabe Pharma Corporation, Sanofi. N. Takahashi: None. M. Suematsu: None. W. Ohashi: None.
812-P: High Diabetes Distress Associated with Lower Diabetes Quality of Life in College Students
Authors: BEVERLY ELIZABETH A. , GUSEMAN EMILY H. , RENNIE ROCHELLE G. , HEALY AMBER M.
Published: June 2019

College is an exciting, challenging, and anxiety-provoking time that introduces new barriers to diabetes, such as inconsistent schedules, changes to diet and exercise routines, and social support issues. For students with diabetes, these barriers may contribute to new or existing psychosocial difficulties. The purpose of this study was to assess diabetes distress, depression, and diabetes quality of life (QoL) in a university population with type 1 diabetes (T1D). Using a descriptive, cross-sectional design, students completed the Type 1 Diabetes Distress Scale, Patient Health Questionnaire-9, Self-care Inventory-R, and Diabetes Quality of Life Scale. Linear regression analyses were conducted to assess the relationship between diabetes distress and 1) glycemic control, 2) self-care, 3) diabetes QoL. A total of 56 college students with T1D (age=21.5±5.2 years, 80.4% (n=45) female, 89.3% (n=50) white; A1C=8.2±1.6%; duration 10.3±5.4 years; BMI=25.3±4.2 kg/m2) participated in the study. Of the 56 students, 35.7% (n=20) reported high diabetes distress. The subscales with the highest distress scores included: Powerlessness (57.1%, n=32), Management Distress (50.0%, n=28), and Eating Distress (42.9%, n=24). Further, 23.2% (n=13) of T1D participants also screened positive for severe depression; Fisher’s exact tests showed severe depression was associated with high distress (p<0.001). Linear regression models found high scores of diabetes distress (standardized b= 0.718, p<0.001) were independently associated with lower diabetes QoL after controlling for depressive symptoms, age, and gender; this model accounted for 67% of the variation in diabetes QoL. Using the same model, diabetes distress was not associated with A1C levels or self-care. Participating students experienced high levels of diabetes distress at this university in the Midwest. Additional research is needed to establish potential causal effects of the college setting on diabetes distress levels and diabetes QoL.

Disclosure

E.A. Beverly: None. E.H. Guseman: None. R.G. Rennie: None. A.M. Healy: None.

Funding

American Osteopathic Association (1291708718)
82-LB: In the Eye of the Beholder? Communication in Couples Coping with Type 1 Diabetes
Authors: BAUCOM KATIE J.W. , HELGESON VICKI , BERG CYNTHIA
Published: June 2019

A growing body of work highlights the need to better understand modifiable relationship processes in couples coping with chronic health conditions. The current study examines associations between couple communication during discussions about type 1 diabetes (T1D) and the relationship and psychological health outcomes of persons with T1D and their partners. Adults with T1D and their partners (N = 398 individuals [199 couples]) completed measures of relationship satisfaction and depressive symptoms. Couples then participated in an 8-min video-recorded discussion about an area of concern related to T1D. Following the discussion, persons with T1D and their partners each completed paper-and-pencil measures of communication. A team of 7 observers subsequently rated communication from the video-recordings. Paper-and-pencil and observer ratings were associated across aspects of communication. We hypothesized that (1) greater destructive communication (e.g., criticism) would be associated with poorer outcomes (i.e., lower levels of relationship satisfaction and higher levels of depressive symptoms), and (2) greater constructive communication (e.g., positivity/warmth) would be associated with superior outcomes (i.e., higher levels of relationship satisfaction and lower levels of depressive symptoms). Data were analyzed with a series of multilevel models in HLM, with both paper-and-pencil and observer measures included as predictors in each model. Consistent with hypotheses, paper-and-pencil measures of communication were generally uniquely associated with adjustment in expected directions. Contrary to hypotheses, observer ratings of communication were not uniquely associated with outcomes when modeled in concert with paper-and-pencil measures of communication. Understanding how persons with T1D and their partners perceive communication around diabetes provides a window into their individual and relationship well-being.

Disclosure

K.J.W. Baucom: None. V. Helgeson: None. C. Berg: None.

Funding

National Institutes of Health
822-P: Awareness, Knowledge, and Health Beliefs of American Indian/Alaska Native (AIAN) Girls and Their Mothers Regarding Risk Reduction of Gestational Diabetes Mellitus (GDM)
Authors: CHARRON-PROCHOWNIK DENISE , SEREIKA SUSAN M. , STOTZ SARAH A. , FISCHL ANDREA F. , O'BANION NANCY , POWELL JEFFREY , ASPAAS MELANIE L. , GOUDEAU SHARNELLA , THORKELSON SHELLEY J. , BEIRNE SANDRA , MOORE KELLY R.
Published: June 2019

AIAN women have a higher risk for GDM and subsequently type 2 diabetes (T2D) than non-AIAN white females. We adapted a validated diabetes preconception counseling (PC) program for AIAN girls at high risk for GDM and their mothers. This paper presents preliminary baseline data, prior to the intervention, of both the girls and their mothers enrolled in an RCT to evaluate changes in GDM risk-reduction awareness, knowledge, health beliefs and behaviors after the Stopping GDM intervention. Data were collected using a dyadic model; both AIAN girls and their AIAN mothers (adult female caregiver) participated. These findings are on 27 mother (M) - daughter (D) dyads (n=54) from 2 of 4 sites (Southwestern U.S.). D (ages 12-24 years) were at risk for GDM as defined by BMI ≥85thpercentile or family history of T2D, and did not have diabetes (HbA1c < 6.5%). M’s mean (±SD) age was 41.3±14.1 years and 56% (n=15) had at least some college education; D’s mean age was 16.3±2.9 years and 89% were students. M and D completed online questionnaires separately on awareness, knowledge and health beliefs regarding GDM and reproductive health and healthy lifestyle. One open-ended question on awareness of GDM revealed that participants were unaware of GDM or the daughters’ risks. Mean pre-intervention knowledge scores were low for both M and D on diabetes prevention (M: 76.4+14.3, range=54-100%; D: 58.2+12.4, range=27-82%) and reproductive health and GDM knowledge (M: 67.2+11.2, range=46-85%; D: 35.0+18.3, range=0-62%). D had moderate levels of self-efficacy for healthy living (53.2±14.6) and pregnancy planning (86.4±22.6). Most Ds reported no communication with healthcare professionals (HCP) or their Ms regarding GDM or PC [(with HCP=15%; 8%, respectively), (with M= 15%; 4%,)]. Both AIAN mothers and daughters lacked awareness and knowledge of the girl’s risk for developing GDM. Developing culturally relevant PC programs could help decrease these risks.

Disclosure

D. Charron-Prochownik: None. S.M. Sereika: None. S.A. Stotz: None. A.F. Fischl: None. N. O'Banion: None. J. Powell: None. M.L. Aspaas: None. S. Goudeau: None. S.J. Thorkelson: None. S. Beirne: None. K.R. Moore: None.

Funding

National Institute of Nursing Research (1R01NR014831-01A1)
828-P: The Impact of Diabetes and Depression Status on Weight Loss Outcomes in Mexican Patients with Severe Obesity
Authors: FLORES MARCELA RODRIGUEZ , STEPHANO Z. SYLVANA , RABASA MARÍA , MONTOYA JUANA , VELEZ CLAUDIA , GARCIA EDUARDO
Published: June 2019

Background: There is a well-known association between type 2 diabetes (T2DM) and depression, including inferior outcomes in weight loss treatments. However, obesity guidelines do not address psychiatric interventions during such programs.

Objective: We assessed the impact of T2DM in outcomes (weight loss, psychiatric diagnoses and quality of life) of a six-month public obesity program that incorporated a psychiatric intervention for patients with severe obesity.

Methods: Retrospective analysis of the registry of the behavioral obesity program at Instituto Nacional de Ciencias Médicas y Nutrición in Mexico City after implementation of a psychiatric intervention that includes diagnosis by a single psychiatrist with the DSMV criteria, psychoeducation, psychopharmacological prescription and/or psychotherapy accordingly. We determined weight loss, frequency of psychiatric diagnoses (depression, anxiety, binge eating disorder [BED]), and quality of life according with T2DM diagnosis.

Results: We included 329 subjects (66% women aged 43.7±12.2 years, initial BMI of 44.2±9.6 kg/m2). The frequency of psychiatric diagnoses in patients with and without T2DM was: Depression 43% and 32% (p=0.05), anxiety 25% and 24% (p=0.42), and BED 32% and 32% (p=0.50). Baseline quality of life (QoL) was lower in patients with T2DM than in those without it (p<0.001), and both were prescribed a pharmacological treatment similarly. Subjects with T2DM were prescribed an obesity drug more often (p=0.004) but lost similar weight (p=0.07). Patients with T2DM had higher depression remission, to similar frequency at the end (p=0.42), and QoL improved significantly (p=0.02), but remained lower than in subjects without T2DM (p<0.001).

Conclusion: In subjects with severe obesity and T2DM, pharmacological obesity treatment and a psychiatric intervention and were beneficial for weight loss and depression control. Improvement in QoL might require additional T2DM interventions.

Disclosure

M. Rodriguez Flores: None. S. Stephano Z.: None. M. Rabasa: None. J. Montoya: None. C. Velez: None. E. Garcia: None.
833-P: Relationship between Prediabetes and Depression in Korean Adults
Authors: JEON EONJU , KIM SUNG-WOO , LEE JI-HYUN , SHON HO-SANG
Published: June 2019

Objective: Currently, emotional well-being is becoming an increasingly important aspect of diabetes care and self-management. Routine screening for depressive symptoms is indicated in high-risk populations, including people with prediabetes and diabetes. However, a limited number of studies about the relationship between prediabetes and depression have been conducted in Asians. The aim of this study was to investigate the potential synergistic relationship between prediabetes and depression.

Methods: This was a cross-sectional survey derived from the 2014 Korea National Health and Nutrition Examination Survey. 9-item Patient Health Questionnaire (PHQ-9) depression-screening test was used. Depression was defined as a score ≥10 on PHQ-9. Prediabetes was defined by the presence of impaired fasting glucose or A1c between 5.7 and 6.4%.

Results: In total, 3848 subjects (1570 Men and 2278 women) aged 16 to 80 years without diabetes were studies. Among them, 1809 (47%) were prediabetes. The prevalence of depression was higher in the participants with prediabetes (4.7%) than without prediabetes (3.4%) (P<0.003). On multivariate logistic analyse, depression was significantly related with prediabetic participant with obesity (odds ratio (OR)= 3.103; 95% confidence interval (CI), 1.295-7.439). However, depression was not related with prediabeteic participant wit underweight (OR =1.001; CI, 0.662-1.514).

Conclusion: This study shows the risk of depression in prediabetes with obesity. Future research is required to examine the mechanisms underlying the associations between prediabetes, mental health, and the risk of diabetes.

Disclosure

E. Jeon: None. S. Kim: None. J. Lee: None. H. Shon: None.
835-P: Examining and Validating Social Support (SS) Related to Reproductive Health (RH) Behaviors and Seeking Preconception Counseling (PC) in Female Adolescents with Diabetes
Authors: ABUJARADEH HIBA , SEREIKA SUSAN M. , BECKER DOROTHY J. , FISCHL ANDREA F. , CHARRON-PROCHOWNIK DENISE
Published: June 2019

Adolescent girls with diabetes are at risk for RH complications and unplanned pregnancies. Tight glycemic control with PC can reduce these risks. Social support from significant others has improved health outcomes in people with diabetes, and may help adolescent girls regarding RH. This secondary analysis: 1)described the amount (1=no help, to 7=a lot of help) and type of available SS (3 subscales: emotional, informational, and instrumental) perceived by adolescent females with diabetes toward RH behaviors and seeking PC; 2)examined the construct validity among total and subscale scores of a SS measure adapted for RH and diabetes; 3)examined the associations of SS with RH behaviors (e.g., birth control), seeking PC, and RH communication with healthcare providers (HCPs). Baseline data were used from 113 adolescent girls with diabetes (90% T1D; duration of diabetes of 9.3±3.9 years; average HbA1c 8.4±1.7%; mean±SD age of 16.2±1.6 years; 81% white, 20% sexually active), who participated in READY-Girls Trial testing the efficacy of a PC intervention to reduce RH complications among adolescents with diabetes. Teens completed measures on SS, RH behaviors, seeking PC, and communication with HCPs. Descriptive, correlational, and regression analyses were performed. Adolescents perceived on average moderately high levels of SS: total (5.5±1.5), emotional (5.5±1.6), instrumental (5.4±1.5), and informational (5.6±1.5); 31% had some communication with HCPs. There were significant associations between total SS and all its subscales (p<.05) and among all SS subscales (p<.05). Significant associations were found between emotional and instrumental SS with effective use of birth control (p=.047, .055). Our measure of SS appears to have strong construct validity with trends for concurrent validity. Following further psychometric analyses, this SS measure could help advance research in the area.

Disclosure

H. Abujaradeh: None. S.M. Sereika: None. D.J. Becker: Other Relationship; Self; Jaeb Center for Health Research, MannKind Corporation, Sanofi Research & Development. A.F. Fischl: None. D. Charron-Prochownik: None.

Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD-044097); Children’s Hospital of Pittsburgh (M01-RR-0084); Pediatric Clinical and Translational Research Center; National Center for Research Resources (UL1-RR-024153); National Institute of Nursing Research (P30-NR-03924)
838-P: Financial Incentives to Improve Glycemic Control in Adults with Diabetes: A Pilot Randomized Controlled Trial
Authors: EGEDE LEONARD E. , WALKER REBEKAH J. , PRIGMORE HEATHER L. , WILLIAMS JONI S. , CAMPBELL JENNIFER A. , DAWSON APRILL
Published: June 2019

Background: Behavioral economics research has identified several decision-making patterns that contribute to poor adherence to medical regimens, however, few studies have investigated the possible influence of financial incentives on diabetes outcomes.

Methods: We randomized 60 African Americans with type 2 diabetes to one of three financial incentive structures: 1) single incentive at 3 months for A1c reduction, 2) two-part incentive for home testing of glucose and A1c reduction at 3 months, and 3) multiple component incentive for home testing, attendance of weekly telephone education classes and A1c reduction at 3 months. The primary outcome was A1c reduction within each arm at 3 months. As a pilot, this study was not powered to test between group differences.

Results: The mean age for individuals was 57.9, with 71.9% women. Each incentive structure led to significant reductions in A1c at 3 months with the greatest magnitude of change from baseline in the group with incentives for multiple components: group 1 mean reduction = 1.25, group 2 mean reduction = 1.73, group 3 mean reduction = 1.74.

Conclusion: Financial incentives across three separate structures led to significant decrease in A1c over 3 months. The magnitude of this effect was large and, in the range, found with diabetes medication trials, rather than smaller effects often seen in behavioral interventions. Therefore, this pilot randomized controlled trial suggests that structured incentives has significant impact on A1c reduction beyond what is typically seen with behavioral interventions and may be an important focus of future interventional studies to improve metabolic control and hence reduce diabetes complication and mortality rates in African Americans with type 2 diabetes.

Disclosure

L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. R.J. Walker: None. H.L. Prigmore: None. J.S. Williams: None. J.A. Campbell: None. A. Dawson: None.

Funding

National Institutes of Health
840-P: Lower Health-Care Utilization among Diverse Adolescents and Young Adults (AYA) Who Receive Culturally Discordant Care
Authors: FLORES GARCIA JAQUELIN J. , RAYMOND JENNIFER , AGARWAL SHIVANI , SANCHEZ ALEJANDRA TORRES , REID MARK W.
Published: June 2019

Background: AYA with T1D encounter many challenges in managing their diabetes, such as uncontrolled glycemic levels, higher probability of complications, and poor clinic attendance. AYA minorities often encounter health care disparities that could be addressed with culturally competent care, which considers the patient’s diverse background and sociocultural factors like communication, language, and beliefs that may influence health behaviors.

Objective: To assess patient-reported provider cultural competence and health care utilization among diverse AYA population with T1D.

Methods: Patients were recruited during routine diabetes outpatient care visits and asked to complete questionnaires on sociodemographic variables, health care utilization, and clinical experiences and cultural competence as assessed by the Consumer Assessment of Healthcare Providers and Systems (CAHPS).

Results: One-hundred forty three AYA (58.7% Male; 45.5% Latinx, 22.4% non-Latinx white) participated, with an average HbA1c of 9.8% in Latinx and 8.6% in non-Latinx whites. Participants who reported some negative experience with provider cultural competence were marginally lower health care utilizers. Specifically, these AYA went to the ER for diabetes-related problems less frequently (p=0.07), had fewer urgent care visits (p=0.08), went to urgent care for hypoglycemia issues less frequently (p=0.08), and attended fewer diabetes care visits (p=0.07). They also went to urgent care for reasons unrelated to diabetes less frequently (p=0.11) and spent fewer days in the hospital when admitted (p=0.13), but these results were not significant.

Conclusions: AYA who experience culturally discordant care may utilize health care less frequently. It is unclear if AYA receiving discordant care need less healthcare support, or if their experiences lead to avoidance of needed care. Our results are hypothesis-generating and further investigation is needed.

Disclosure

J.J. Flores Garcia: None. J. Raymond: Other Relationship; Self; Insulet Corporation. S. Agarwal: None. A. Torres Sanchez: None. M.W. Reid: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
853-P: Caring for Someone with Type 1 Diabetes: Health-Related Quality of Life of Parents and Partners
Authors: HILLIARD MARISA E. , MINARD CHARLES G. , MARRERO DAVID G. , WIT MAARTJE DE , THOMPSON DEBORAH , VERDEJO ALANDRA , ANDERSON BARBARA
Published: June 2019

Objective: Health-related quality of life (HRQoL) is a key patient-reported outcome in care and research. The few instruments that assess the HRQoL of parents and partners of people with type 1 diabetes (T1D) emphasize caregiving burden or are usually proxy measures (reporting on behalf of person with T1D). We created measures assessing parents’ and partners’ own HRQoL as part of a larger study to develop and validate a suite of instruments to measure HRQoL in children through older adults with T1D.

Methods: Qualitative interviews (n=81 people with T1D and parents/partners, 8 providers) identified HRQoL themes to include. Drafts were piloted with n=41. Resulting measures were validated with n=644 parents and n=186 partners from 6 T1D Exchange sites across the U.S., including the HRQoL measure (2 times, approx. 3 months apart), measures of relevant constructs (SF-12, Satisfaction with Life Scale, Diabetes Family Impact Scale, Partner Diabetes Distress Scale), and medical chart-confirmed HbA1c. We report exploratory factor analyses (Promax rotation) and psychometric data for the 4 parent measures (child age <8, 8-11, 12-17, 18-25) and 1 partner measure (person with T1D age ≥18).

Results: Each measure had a unique set of 21-30 positive and negative items loading on 3-4 scales. Reliability was good: total score α range=0.80-0.88, test-retest r range=0.75-0.86. Significant correlations between the total HRQoL scores and measures of general quality of life (r=0.30-0.53), mental well-being (r=0.37-0.53), T1D family impact (parents of youth, r=-0.64--0.72), and diabetes distress (parents/partners of adults, r=-0.76--0.75) indicated construct validity. Scores were not correlated with HbA1c.

Conclusions: The new measures of T1D-specific HRQoL in parents and partners have relevant items and factors, and demonstrate strong psychometric properties. These innovative tools will permit assessment of the experiences of parents and partners of people with T1D for use in research and practice.

Disclosure

M.E. Hilliard: None. C.G. Minard: None. D.G. Marrero: None. M. de Wit: Research Support; Self; Sanofi. D. Thompson: None. A. Verdejo: None. B. Anderson: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D084)
856-P: Can Monetary-Based Reinforcement for Self-Monitoring Blood Glucose (SMBG) Impact Psychosocial Outcomes? A Randomized Controlled Trial
Authors: WONG JESSIE J. , ADDALA ANANTA , HOOD KOREY K. , WAGNER JULIE , CENGIZ EDA , TICHY EILEEN M. , WEYMAN KATE , NARANJO DIANA
Published: June 2019

Background: Members of our group previously reported that monetary reinforcement of SMBG related behaviors shows robust increases in frequency of SMBG and modest decreases in A1c among youth with type 1 diabetes (T1D). In these secondary data analyses, we explored effects on psychosocial functioning.

Methods: Sixty youth ages 12-21 (Mage=15.58, SD=2.31) with T1D, A1c 7.5-13%, and <4 BG checks per day were randomized to either a 24-week reinforce intervention or enhanced usual care (EUC). The intervention consisted of monetary incentives for completing blood glucose checks, texts with provider, glucose data uploads, and glucose pattern recognition forms. Validated psychosocial questionnaires were administered at baseline, 6, 12, 24, and 36 weeks. Measures included youth reported diabetes distress, family conflict, and negative affective responses to out-of-range glucose results.

Results: Generalized linear models showed no significant time x condition effects. In t-tests at discrete follow-ups, compared to the control group, the reinforce group had significantly lower youth-reported diabetes related family conflict at 12 weeks (22.39 vs. 25.11, p=.043) and significantly higher negative affective responses to out-of-range glucose results at 24 weeks (13.62 vs. 11.71, p=.047).

Conclusion: Monetary reinforcers targeting SMBG behaviors may produce transitory decreases in youth perceptions of family conflict and transitory iatrogenic increases in youth’s negative affective responses to out-of-range glucose results. The timing of changes in family conflict, negative affect, and previously reported changes in A1c suggest that psychosocial changes may reflect youth responses to A1c as well as to reinforcers per se. For broader effects, the intervention could include psychosocial components that seek to directly maintain decreased family conflict and mitigate negative affect related to increased awareness of glucose control.

Disclosure

J.J. Wong: None. A. Addala: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. J. Wagner: None. E. Cengiz: Advisory Panel; Self; Abvance, ADOCIA, MannKind Corporation, Novo Nordisk Inc. Speaker's Bureau; Self; Novo Nordisk Inc. E.M. Tichy: None. K. Weyman: None. D. Naranjo: Advisory Panel; Spouse/Partner; Eli Lilly and Company. Speaker's Bureau; Spouse/Partner; Johnson & Johnson Diabetes Institute. Other Relationship; Self; Abbott.

Funding

National Institutes of Health
863-P: Insomnia Severity and Insulin Adherence
Authors: ZHENG YAGUANG , KORYTKOWSKI MARY T. , SEREIKA SUSAN M. , BURKE LORA E. , ATWOOD CHARLES W. , STROLLO PATRICK J. , JEON BOMIN , CHASENS EILEEN R.
Published: June 2019

Background: Adherence to medications is vital for glycemic control in type 2 diabetes. It is unclear if insomnia is a barrier to medication adherence. The aim of this secondary analysis was to examine the association between insomnia and adherence to insulin therapy.

Method: Using a cross-sectional design, baseline data from subjects (N=139) prescribed insulin from the Diabetes Sleep Treatment Trial were analyzed. Measures included demographics, A1C, BMI, the Insomnia Severity Index, and the Pittsburgh Sleep Quality Index. Self-reported adherence to insulin therapy was determined by response to the question: How many of the past 7 days did you take your recommended insulin injections and scored as 7 days for adherent (77.7%; n=107) and 0 to 6 days for non-adherent (23.0%; n=32). Data were analyzed using univariate and backward multivariate logistic regression.

Results: The sample was diverse (55.4% white; 46.0% female; 41.7% married/partnered; 55.4% >2 years post high school with a mean age of 56.3±10.9 years, BMI of 35.2±6.6 kg/m2; and A1C of 8.3±1.7%). Individuals with insulin adherence had a lower A1C than those with non-adherence (8.0±1.6% vs. 9.5±1.7%, p<.001). Insomnia was negatively associated with insulin adherence in univariate and multivariate logistic regression.

Conclusion: These results suggest insomnia severity and race are associated with deceased insulin adherence. The mechanisms for these potential associations need to be further explored.

Disclosure

Y. Zheng: None. M.T. Korytkowski: None. S.M. Sereika: None. L.E. Burke: None. C.W. Atwood: None. P.J. Strollo: Consultant; Self; Emmi, Inspire Medical Systems, Philips Respironics. Research Support; Self; Jazz Pharmaceuticals, ResMed. B. Jeon: None. E.R. Chasens: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, Philips Respironics, ResMed Inc.

Funding

National Institutes of Health (R01DK096028)
87-OR: Disappearing Antibodies: Frequency and Effect on T1D Progression
Authors: O'ROURKE COLIN , SO MICHELLE , GREENBAUM CARLA , BAHNSON HENRY T. , SPEAKE CATE
Published: June 2019

While the majority of individuals with ≥2 autoantibodies (AAB) will progress to clinical T1D, there are reports that AAB disappear in some individuals. Clinical trials to delay or prevent disease progression often enroll those at stage 1 or 2, defined as individuals with ≥2 AAB confirmed on two separate occasions. Using data from TrialNet’s Pathway to Prevention study, we aimed to determine (a) how many individuals at stage 1 or 2 subsequently lost AAB, and (b) how this impacted the risk of T1D progression.

Individuals confirmed to be at stage 1 or stage 2 diabetes with a mean follow-up of 2.2 years (0.1 to 13) were included (n=3267). 3141 (96%) maintained their status over time while 126 (4%) did not (non-maintainers). This affected their risk of progression (Figure).

Conclusion: Reverting from stage 1 or stage 2 diabetes is rare; yet, if it occurs, the risk of progressing to stage 3 during the follow-up period is reduced. This suggests that there are unknown mechanisms that can lead to immune remission in some individuals.

Disclosure

C. O'Rourke: None. M. So: None. C. Greenbaum: Research Support; Self; Janssen Research & Development. H.T. Bahnson: None. C. Speake: None.

Funding

JDRF; National Institutes of Health
875-P: To Treat High Diabetes Distress or Not: Determining the Clinical Impact of Targeted Interventions with Type 1 Adults
Authors: PARRA JOSÉ , HESSLER DANIELLE M. , FISHER LAWRENCE , POLONSKY WILLIAM , STRYCKER LISA A. , BOWYER VICKY , DEDHIA MANSI , MASHARANI UMESH
Published: June 2019

A recent study (T1-REDEEM) reported the relative effectiveness of two interventions to reduce high diabetes distress (DD) among adults with type 1 diabetes (T1). While these results show promise regarding the efficacy of DD-targeted interventions, there is little evidence to support their use when compared to non-treatment controls. We leveraged two recent studies to examine differences between the effect of targeted interventions on high DD T1 adults and a comparable sample of untreated participants, as well as to document the stability of untreated DD over time. T1 adults with elevated baseline DD (mean ≥ 2.0) and HbA1c (≥ 7.5), identified from a longitudinal, non-intervention, observational study (non-INT) (N = 51, age = 40.4 [SD = 16.8], 72.5% female, baseline DD = 2.5 [SD = 0.4], baseline HbA1c = 8.4 [SD = 1.3]), were compared to a matched sample of T1 adults who participated in T1-REDEEM (INT) (N=51, age = 48.8 [SD = 15.3], 74.5% female, baseline DD = 2.6 [SD = 0.4], baseline HbA1c = 8.7 [SD = 1.0]). Both groups completed the T1-DDS questionnaire at baseline and 9 months. Large reductions in DD (mean ∆ ± SD) were reported in the INT group (-0.6 ± 0.6), while minimal change was reported in the non-INT group (-0.2 ± 0.6), yielding a statistically and clinically meaningful difference (-0.4±0.6, p = 0.002; effect size d=.67) between groups. Additional analyses using the established MCID (0.19) for the T1-DDS showed that DD increased significantly (≥ 1 MCID) or persisted at high levels for 51% of non-INT participants, compared to 23.5% in the INT group. Targeted interventions lead to dramatic reductions in DD when compared to untreated individuals. Furthermore, high DD does not resolve over time when left unaddressed; in fact, DD remains high or worsens in more than half of non-INT participants. These data suggest that interventions targeting DD are clinically effective in T1 adults with high DD relative to non-treatment controls, and that high DD can become chronic if left untreated.

Disclosure

J. Parra: Employee; Self; Behavioral Diabetes Institute. D.M. Hessler: Consultant; Self; Eli Lilly and Company. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson & Johnson Diabetes Institute, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier. L.A. Strycker: None. V. Bowyer: None. M. Dedhia: None. U. Masharani: Research Support; Self; Clementia Pharmaceuticals.

Funding

National Institutes of Health
887-P: Biological and Psychological Risk Factors for Eating Disorders in Type 1 Diabetes
Authors: LEE-AKERS DAWN , SIMON JUDY , AKERS ERIN
Published: June 2019

Background: Women with type 1 diabetes (T1D) are 2.4 times more likely to develop an eating disorder than their nondiabetic peers. In addition, T1D has been reported as a risk factor associated with the development of an eating disorder.

Objective: To identify the biological disruptions and psychological pressures unique to a person with T1D that create a higher risk for developing an eating disorder.

Design and Methods: Conducted a three-year review of literature, articles and research studies on biological systems impacted by T1D, and on the psychological factors involved in eating disorders. Merged the research with case-study evidence obtained from Diabulimia Helpline clients and online support group members through discussions, posts and responses to questions.

Results: A number of physiological consequences of the destruction or removal of beta cells are known precursors to the onset of an eating disorder. Insulin is required for proper regulation of leptin, neuropeptide Y and dopamine, all of which are involved in the consumption and use of energy. While insulin analogs have made great strides, they do not perfectly mimic natural insulin or it’s interactions with other hormones and neurochemicals in the body. In addition, the more “out of range” a person’s blood glucose is, the more disrupted are these physiological mechanisms. The absence of amylin disrupts satiety mechanisms both directly in the brain and indirectly in the intestine through uncontrolled gastric emptying. In addition, certain character traits that are associated with eating disorders, such as avoiding thoughts and emotions or black and white thinking, can be exacerbated with a T1D diagnosis.

Conclusion: The development of T1D increases the number of risk factors a person has for developing an eating disorder, some of which are biological in nature and thus cannot be avoided. We can also see how biology becomes psychology when, for example, a reduction of leptin creates a risk of binging which in turn creates a risk for insulin omission.

Disclosure

D. Lee-Akers: None. J. Simon: None. E. Akers: None.