bluuebunny/crossref_metadata_2025 huggingface dataset:
713-P: Educating Patients on Nutrition Using a Short Computer-Based Video: A Successful Clinic Model
Authors: COLE KALONJI , WENGER DANIELLE , GUHA ANIKA , YAROSH CARLYN , HOFFMAN CHERYL
Published: June 2020

Purpose: The purpose of this study is to determine if computer-based videos successfully educate patients on a whole food, plant-based diet (WFPBD) during clinic wait time. We recognize the importance of nutrition in disease prevention and treatment, particularly for diabetes, obesity, hypertension, and vascular disease. We investigated the effectiveness of this model in increasing patient knowledge and confidence about diet.

Methods: Subjects (n = 77) were recruited at a radiology clinic. A 19-question survey was administered using an iPad. Patients completed the survey before and after watching a 5-minute computer-based video about the beneficial health effects of WFPBD. To assess knowledge, patients’ responses to the survey’s 10 knowledge-based (KB) questions were scored on a dichotomous incorrect/correct scale. To assess confidence in their knowledge, patients’ responses to the survey’s 9 confidence-based (CB) questions were scored on a Likert scale from 1 (strongly disagree) to 5 (strongly agree). Two paired difference scores (knowledge and confidence) were calculated and independently analyzed using a Related-Samples Wilcoxon Signed Rank Test. A Stepwise Linear Regression was used to investigate which survey questions were most educational.

Results: The Related-Samples Wilcoxon Signed Rank Test showed a statistically significant improvement in both patients’ knowledge and confidence in their knowledge of nutrition. Patients scored significantly higher on KB survey questions (p < 0.001) and CB survey questions (p < 0.001) post-video. Stepwise Linear Regression showed that the most educational survey questions included information on fiber, plant-based foods, and saturated fats.

Conclusion: Our findings indicate that providing patients with a computer-based educational video during clinic wait time significantly increases patient knowledge on the benefits of a WFPBD. Future studies can test a larger sample of patients and gauge the longevity of knowledge gained.

Disclosure

K. Cole: None. D. Wenger: None. A. Guha: None. C. Yarosh: None. C. Hoffman: None.

Funding

University of California, Los Angeles
732-P: Effect of Serum 25-Hydroxyvitamin D on Blood Lipid Profile in Type 2 Diabetics
Authors: LI NAN , WANG YANRU , ZHU BING , SUN HANG , YANG PENG , ZHANG LIJUAN , LI HONG , QU SHEN
Published: June 2020

Objective: The relationship of serum 25-hydroxyvitamin D (25(OH)D) with type 2 diabetes(T2DM) is controversial and the correlation between 25 (OH) D and lipid metabolism is not clear. Therefore, our study intends to unveil the effect of 25(OH)D on blood lipid profile in T2DM.

Methods: A total of 587 patients with T2DM and 532 healthy people in our hospital from 2017 to 2018 were enrolled. The level of 25(OH)D between T2DM group and non-DM group was compared. Patients with T2DM were divided into a low 25(OH)D group(LVD group, <47.7nmol/L,n=425) and normal 25(OH)D group(NVD group, ≥47.7nmol/L,n=162). Furthermore, we analyzed the association between the level of 25(OH)D with patients’ BMI, age, TC, TG, HDL-C, and LDL-C. According to the diabetic duration, HbA1c, and vascular lesion, the relationship between 25 (OH) D and the severity of diabetes was compared.

Results: The level of 25(OH)D in the T2DM group was significantly lower than the non-DM group (39.99±15.25 vs.50.00±11.53, P<0.001). Level of TC (4.49(3.69∼5.34) vs. 4.09(3.45∼4.85), P<0.001), TG (1.46(1∼2.29) vs. 1.19(0.87∼1.73), P<0.001), LDL-C(2.75(2.07∼3.39) vs.2.44(1.96∼3.07), P=0.014) in the low 25(OH)D group were higher than normal group, and they all had significant difference. The level of HDL-C is lower (1.08(0.9∼1.33) vs. 1.13(0.97∼1.32), P=0.206), but there was no significant difference. In addition, gender, age, and BMI were found not related to 25(OH)D. Regression analysis showed that with the increase of diabetic duration and HbA1c, the level of 25(OH)D decreased, then the incidence of the vascular lesion was increased, but the difference was not statistically significant.

Conclusion: The 25(OH)D in patients with T2DM is lower than healthy people. Meanwhile, the atherosclerosis factors like TC, TG, and LDL-C are increased, but there is no definite correlation with HDL-C. Hence, we conclude that in patients with T2DM, supplementation of 25(OH) D may suppress the atherogenesis by regulating lipid metabolism, which needs further study.

Disclosure

N. Li: None. Y. Wang: None. B. Zhu: None. H. Sun: None. P. Yang: None. L. Zhang: None. H. Li: None. S. Qu: None.

Funding

National Natural Science Foundation of China (81900781, 81970677); National Key Research and Development Program of China (2018YFC1314100)
74-LB: Sustainable HbA1c Decrease at 12 Months for Adults with Type 1 and Type 2 Diabetes Using the FreeStyle Libre System: A Study within the National Diabetes Register in Sweden
Authors: EEG-OLOFSSON KATARINA , SVENSSON ANN-MARIE , FRANZÉN STEFAN , ISMAIL HODAN , LEVRAT-GUILLEN FLEUR
Published: June 2020

The National Diabetes Register (NDR) launched in 1996 in Sweden includes primary and secondary care data and captures 94% of adult patients with diabetes. A cohort study using data from nationwide register from 2014/01/01 to 2019/06/25 was initiated with the objective to determine the effectiveness of the FreeStyle Libre system on HbA1c reduction. Eligible for inclusion were patients with diabetes (≥ 18 years old) using FreeStyle Libre recorded within the NDR. Index date was the 1st record of FreeStyle Libre use. Methodology was a before/after comparison; prior period was closest HbA1c measurement within 6 months before index date and after period was HbA1c closest to 6 and 12 months after index date within Day 91 - Day 272 and Day 272 - Day 455 respectively. During the study period, 39 554 T1 or T2 patients had at least one registration of FreeStyle Libre usage. HbA1c measurements were available within the defined prior and after period for a subset of the total patient study population who were incident FreeStyle Libre users. HbA1c was significantly reduced in T1 and T2 users with a sustainable effect at 12 months (-0.44 for type 1 and -0.66 for type 2). This large real-world study on a well-established diabetes register in Sweden concluded that people with T1DM and T2DM using FreeStyle Libre for between 9 to 15 months significantly reduced HbA1c.

Disclosure

K. Eeg-Olofsson: None. A. Svensson: None. S. Franzén: None. H. Ismail: None. F. Levrat-Guillen: Employee; Self; Abbott.

Funding

Abbott Diabetes Care
742-P: Socioeconomic Position (SEP) Attributes Intersect with Race to Influence Glycemic Control Patterns in Youth with Type 1 Diabetes (T1D) over Time
Authors: LIESE ANGELA D. , REBOUSSIN BETH A. , KAHKOSKA ANNA R. , FRONGILLO EDWARD A. , MALIK FAISAL , IMPERATORE GIUSEPPINA , SAYDAH SHARON , BELLATORRE ANNA , LAWRENCE JEAN M. , DABELEA DANA , MENDOZA JASON A.
Published: June 2020

SEARCH for Diabetes in Youth has identified racial/ethnic disparities in patterns of glycemic control among T1D youth. How SEP and race/ethnicity intersect to influence these disparities is poorly understood. SEARCH T1D participants (n=1,313) age ≤20 years at diagnosis (dx) in 2002-5 were followed 6-13 years with 3+ hemoglobin A1c measures. Group-based trajectory modeling of A1c identified Group 1 (G1, 77%): lower A1c with mild increases (from mean 7.4 to 8.4%) and Group 2 (G2, 23%): high and increasing A1c (from 8.5 to 11.2%). Classification and regression tree analysis modeled patterns in 8 demographic and SEP attributes that distinguished between G2 and G1 (prediction accuracy 0.68). Race/ethnicity was most influential in predicting G2, with 39.6% G2 in minorities vs. 18.2% in non-Hispanic whites (NHWs) (Figure). Among minorities, 52.5% of those with public insurance were in G2 vs. 32.4% of those with private insurance. Among NHWs without college-educated parents, older age at dx (≥10 years) was associated with G2 (34.0% vs. 20.5% in dx <10 years). Among NHWs with college-educated parents, living in a 1-parent household was associated with G2 (23.6% vs. 8.9% in a 2-parent household). Race/ethnicity intersects differentially with select SEP attributes for NHW vs. minorities suggesting more nuanced studies of health disparities are needed.

Disclosure

A.D. Liese: None. B.A. Reboussin: None. A.R. Kahkoska: Other Relationship; Self; Novo Nordisk A/S. E.A. Frongillo: None. F. Malik: None. G. Imperatore: None. S. Saydah: None. A. Bellatorre: None. J.M. Lawrence: None. D. Dabelea: None. J.A. Mendoza: None.

Funding

National Institutes of Health (1R01DK117461, 1UC4DK108173)
746-P: Identifying Health Care Disparities in Youth with T1D: Effectiveness of Novel Interventions in Children’s Healthcare (NICH) for Rural and Urban Youth
Authors: JENISCH CELESTE , WAGNER DAVID V. , MANABAT ANN JELINE F. , HEYWOOD MATTHEW , KARKULA ELIZABETH , SHEFFIELD ANNAN , OGDEN JIMMIE D. , NAGRA HARPREET , HARRIS MICHAEL A.
Published: June 2020

Objective: Novel Interventions in Children’s Healthcare (NICH), an intensive behavioral health program, has demonstrated promise in reducing avoidable complications in youth with T1D. However, it is unclear whether these outcomes are consistent across regions, and how those variables may impact intensity of service delivery. This study aims to identify whether region and distance from NICH team base, when considering treatment intensity, moderate NICH outcomes.

Methods: Youth with T1D served by NICH and covered by one of four major Medicaid providers were included (n=47). EHR review included frequency of DKA one year prior and two years following initiation of NICH services, distance from NICH team, type of region, and intensity of services delivered.

Results: NICH youth demonstrated similar DKA reduction regardless of living in a rural or urban community. NICH providers delivered a per-family mean of 3 hours and 58 minutes per week of indirect and direct services, with more time spent in face-to-face service delivery and less time on transportation with families living closer to NICH team. NICH providers were significantly (p<.05) more likely to meet weekly with caregivers if youth lived within an hour of the team. When examining DKA incidence following NICH initiation, youth living more than one hour from the NICH team averaged a 46% decrease, those within 1-2 hours showed a 71% decrease, and those living more than 2 hours away showed no change in DKA frequency.

Conclusion: This study represents the first examination of how system-level characteristics might moderate NICH services and related effectiveness. While outcomes were similar across urban and rural communities, NICH youth living closer to the NICH team experienced greater caregiver access to services and were more likely to demonstrate reductions in DKAs compared to those living more than 2 hours away. Such findings have implications for model adaptation and dissemination.

Disclosure

C. Jenisch: None. D.V. Wagner: None. A.F. Manabat: None. M. Heywood: None. E. Karkula: None. A. Sheffield: None. J.D. Ogden: None. H. Nagra: None. M.A. Harris: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
75-LB: Machine-Learned, Biophysical Prediction of Glucose Response for 1,000 Subjects
Authors: DALAL PARIN , YAZDANI MEHRDAD , SNYDER MICHAEL , RAHILI SALAR , TORBAGHAN SOLMAZ S.
Published: June 2020

Background: Reducing glycemic excursions following oral intake decreases the risk for microvascular disease in those with type 2 diabetes (T2D) and prevents conversion to T2D in those with prediabetes. Currently there are no accurate methods by which to predict a real world subject’s glycemic response to a particular meal. We developed a novel machine learning tool to infer personalized physiological parameters using consumer sensors for the accurate prediction of glycemic responses to food and activity.

Method: We prospectively recruited 1,000 healthy, prediabetic and type 2 diabetic subjects instructed to wear a Freestyle Libre Continuous Glucose Monitor (CGM) and Heart Rate Monitor (HRM) and logged foods for 10 days. A novel biophysical, machine-learned model was trained on CGM, HRM data and food logs to predict and tune glucose responses to food and activity. The training used a separate deep-learning network trained to predict the infusion of glucose into subject bloodstream using known glycemic index (GI) values.

Results: 715 nondiabetic, 35 prediabetic, and 246 T2D subjects were enrolled. Our novel biophysical, machine-learned model predicted glucose excursions over a database of many million foods and activity rates and exceeded 99.9% on the Clarke Error Grid regions A and B for a wide variety of individuals. Many correlations exist between caloric intake and composition, fiber intake, household income, sleep quality, and inferred physiological parameters.

Conclusion: Precise prediction of glycemic responses will allow accurate counterfactual analysis of lifestyle choices and allow all individuals to better plan and select foods and activities to match their lifestyle, physiology, and psychological predispositions. This novel technology has potential novel applications for both diabetes treatment and prevention.

Disclosure

P. Dalal: Advisory Panel; Spouse/Partner; Arc Bio, Caribou Biosciences, Inc., January, Inc. Employee; Self; January, Inc. Other Relationship; Spouse/Partner; Illumina. M. Yazdani: None. M. Snyder: Stock/Shareholder; Self; January, Inc. S. Rahili: Employee; Self; January, Inc. S.S. Torbaghan: None.
754-P: Design of a Protocol and Psychometric Evaluation Questionnaires for a National PRO Diabetes Multisector Pilot Study in Denmark
Authors: SKOVLUND SOREN E. , BOEL LISE , BALK-MØLLER NINA C. , HØJHOLT PERNILLE M. , BERTHELSEN DORTHE B. , GLÜMER CHARLOTTE , PERRILD HANS , HESSLER DANIELLE M. , KAPLAN SHERRIE H. , JAKOBSEN POUL ERIK O. , EJSKJAER NIELS
Published: June 2020

Aim: To develop a protocol and set of purpose-built psychometric PRO evaluation questionnaires for a national multi-sector study to evaluate feasibility, acceptability, validity, barriers, facilitators and perceived value of the National Danish PRO diabetes intervention (PRO diabetes questionnaire and dialogue tool) in Denmark.

Methods: The protocol was designed through a participatory process with People With Diabetes (PWD), multi-disciplinary representatives of diabetes centres and municipality diabetes rehabilitation centres from 3 regions of Denmark. Hypotheses and assessment tools were guided by formative qualitative research. The intervention involved that PWD fill out the PROM prior to their visit and the Health Care Professional (HCP) uses a PRO IT dialogue tool to collaboratively evaluate needs and plan care.

Results: The pragmatic mixed-methods study protocol involved hypothesis testing and exploratory research: 1) PRO-DIA-READY Scales for Clinic and HCP PRO-Diabetes Readiness (incl. structural/process indicators of person-centred care). 2) 6-item PRO-EVAL-P Scale completed by PWD after the PROM. 3) 8-item PROCON-EVAL-HCP and 13-item PROCON-EVAL-PWD scales completed by HCPs and PWD after the visit, 4) Clinician rating scales of PROM validity 5) Semi-structured interview/group workshop guides for PWD, Caregivers (CG), multi-disciplinary HCPs, and administrators based on RE-AIM: Reach, Effectiveness, Adoption, Implementation and Maintenance, 6) HCP/PWD Follow-Up Impact Questionnaires (incl. active participation, person-centred care, care utilisation and outcomes). Newly designed evaluation scales were analyzed psychometrically.

Conclusions: A protocol and new psychometric assessment tools for evaluation of validity, readiness, acceptability and impact of PRO in diabetes care were developed and successfully applied in large scale in Denmark. The new tools are available for comparative PRO research studies.

Disclosure

S.E. Skovlund: None. L. Boel: None. N.C. Balk-Møller: None. P.M. Højholt: None. D.B. Berthelsen: None. C. Glümer: None. H. Perrild: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. S.H. kaplan: None. P.O. Jakobsen: None. N. Ejskjaer: None.

Funding

Danish Health Data Board
757-P: Financial Strain and Relationship Quality in Young Married Couples Managing Type 1 Diabetes
Authors: YORGASON JEREMY B. , SAYLOR JENNIFER , RELLAFORD SUSANNAH , PORTER MATTHEW S.
Published: June 2020

Over the last 5 years, individual diabetes management costs have increased 26%, with the average diabetes patient spending $16,752 per year and those with type 1 diabetes mellitus (T1DM) paying a disproportionately higher amount than their type 2 counterparts. With T1DM diagnoses increasing by around 40,000 each year and the majority of diagnoses among adolescents and emerging adults approaching financial independence with limited funds, young T1DM patients and their partners may experience relational strain that often accompanies financial stress. Using data from a nationally representative sample of over 2,000 young married couples involved in the CREATE study, we identified 16 couples wherein one partner had T1DM. Among these, 8 wives had T1DM and 8 husbands had T1DM. For comparisons, we matched these couples with others in the CREATE study based on household income, husband and wife education, and husband and wife approximate number of weekly hours worked. A total of 116 matches were found, for a total of 132 couples in the analytic sample. Among the 16 couples with T1DM, half earned less than $50,000 annually (mean = $50,000-60,000/year). Mean comparisons indicated that both partners in couples with T1DM reported higher levels of financial distress and worry compared to matched couples, albeit not at a statistically significant level. Financial distress and worry were both significant predictors of relationship quality a year later for all couples in the study. However, associations between financial distress and relationship quality did not differ for couples with T1DM. Additional research is needed to explore specific diabetes supplies costs and how these may relate to relationship quality.

Disclosure

J.B. Yorgason: None. J. Saylor: None. S. Rellaford: None. M.S. Porter: None.

Funding

Brigham Young University
793-P: Exploring the Lived Experience of Inner-City, Food Insecure, African Americans with Type 2 Diabetes
Authors: WALKER REBEKAH J. , MOSLEY-JOHNSON ELISE , EGEDE LEONARD E.
Published: June 2020

Food insecurity influences the health of adults with diabetes, however, limited information exists on the contribution of the lived experience of inner-city African Americans on clinical outcomes. The goal of this study was to understand the lived experience and its role in managing type 2 diabetes in inner-city, food insecure, African Americans. Two focus groups and two semi-structured interviews were conducted. Participants had a diagnosis of diabetes and indicated it was difficult to obtain enough food, or worried food would run out. Questions explored a) challenges and barriers in managing diabetes, b) the role of food insecurity in managing diabetes, and c) facilitators and resources that improve diabetes management. A grounded theory approach was used by reviewing field notes and identifying overarching concepts. In addition, following each session, facilitators and notetakers discussed key findings and incorporated into themes identified. Four themes emerged. 1) Barriers to eating healthy foods, included availability and cost of food, lack of discipline to follow a healthy diet, and uncertainty in taste of new foods. 2) Life stressors, included difficult decisions regarding money, the inner-city environment, such as violence and poverty, and needs of family and friends that distract from their needs. 3) Support resources, included obtaining food at pantries, community resources, such as social workers to identify programs and determine eligibility, and faith as an important supportive function. 4) Facilitators to obtaining healthcare, included access to care through insurance and transportation, providers who understood the financial situation and treated them with respect, options for medication, and knowledge of diabetes. Greater attention needs to be paid to the lived experience of inner-city, food insecure, African Americans with diabetes when designing interventions to improve health in this highly vulnerable population.

Disclosure

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

Funding

American Diabetes Association (1-19-JDF-075 to R.J.W.); National Institutes of Health (R01MD013826, K24DK093699, R01DK118038, R01DK120861)
8-LB: Emotional Impact of Hypoglycemia and Use of Glucagon: Perspectives of People with T1D and Caregivers of Minors with T1D
Authors: HUGHES ALLYSON , BISPHAM JEOFFREY , FULLER LILY , WOLF WENDY , FITCH SUSANNE A. , WEINZIMER STUART A.
Published: June 2020

Severe hypoglycemia is a complication of insulin therapy and a continuing barrier to achieving glycemic targets at every age. Glucagon, a drug that has been on the market for several decades, is an effective treatment for severe hypoglycemia, but is underutilized. The emotional impact of severe hypoglycemia and the emergency use of glucagon is not clear. This study aimed to understand current perceptions of glucagon from both the perspective of people with T1D and people likely to aid in an emergency situation. All participants were recruited from T1D Exchange Glu (www.myglu.org), an online community for individuals living with T1D. The current study conducted interviews with people with T1D (n=9, average age 44.7 years) and caregivers (n=8, average age 37.8 years) of minors with T1D. Interviews were recorded, transcribed, and thematically analyzed. Participants described experiences and emotions surrounding severe hypoglycemia, importance of specific glucagon characteristics, and priorities during severe hypoglycemia. Participants expressed on a 1-10 scale the importance of glucagon’s time to recovery (average: 8.56), mode of administration (average: 8.56), cost (average: 5.67), and not requiring refrigeration (average: 9.56). Themes among participants with T1D included feelings of distress, fear, and helplessness; common caregiver themes included feeling intimidated by the administration of glucagon. People with T1D discussed how they make decisions during a hypoglycemic emergency and rely on others for decision-making. Participants described their ideal glucagon and emphasized how fast glucagon needs to be, the desire for minimal side effects, and different administration types. These results provide insight into the real-world impact of diabetes on both persons with T1D and their caregivers and highlight the attitudes about severe hypoglycemia and emergency treatment with glucagon.

Disclosure

A. Hughes: None. J. Bispham: None. L. Fuller: None. W. Wolf: None. S.A. Fitch: Employee; Self; Zealand Pharma A/S. S.A. Weinzimer: Consultant; Spouse/Partner; Tandem Diabetes Care. Consultant; Self; Zealand Pharma A/S. Speaker’s Bureau; Self; Insulet Corporation.
80-LB: Hypoglycemia in People with Type 2 Diabetes Using Premixed (Biphasic) Insulin
Authors: IDRIS ISKANDAR R. , ANNAMALAI NARAYAN , AUNG THEINGI , BINNIAN IAN , GIBB FRASER W. , MALIK MOHAMMED I.
Published: June 2020

Hypoglycemia is under-reported by many patients; but the time in hypoglycemia among patients with type 2 diabetes (T2D) using pre-mixed (biphasic) insulin is not clear. This pilot study aimed to determine the amount of time in hypoglycemia in this patient cohort. The study included people with T2D, aged 18 or over, treated with pre-mixed (biphasic) insulin for at least 6 months with their most recent HbA1c <7.5% (58 mmol/mol) recorded in medical notes in the last 12 months. Pregnant patients were excluded, as were patients on dialysis. A total of 43 participants (65.1% male) from 12 primary and secondary care sites in the UK enrolled in the 2-week single arm study using the FreeStyle Libre Pro Flash Glucose Monitoring SystemTM. Mean HbA1c was 6.9±0.8% (52.1±8.3 mmol/mol), age was 68.8±8.3 years, BMI was 35.0±9.2 kg/m2, average duration of pre-mixed insulin was 6.8±4.8 years with a mean daily dose of 53.4±40.7 units (mean±SD). The number of blood glucose tests performed per day (self-reported) was 1.9±1.1. Time in hypoglycemia <70 mg/dL (3.9 mmol/L) was 1.35±1.56 hours per day, biological hypoglycemia was experienced by 34 patients. Approximately half of the time in hypoglycemia (<70 mg/dL [3.9 mmol/L]; 0.82±1.06 hours) was during night time hours (23:00 to 06:00). Time in hyperglycemia >180 mg/dL (10.0 mmol/L) was 3.55±3.07 hours per day, which mostly occurred was during daytime hours (06:00 to 23:00) (3.15±2.83 hours per day) (mean±SD). Five anticipated sensor insertion site symptoms were experienced by four participants: erythema (n=2 [1 slight pink, 1 well-defined redness]), pain (n=1), bruising (n=1) and bleeding (n=1), all were mild in severity. This population, with HbA1c in target range, have a greater amount of hypoglycemia than the International Consensus and ADA targets of <1 hour per day, excursions occurred both during the day and at night. Further improvements on this level of glycemic control is challenging for this type of insulin therapy due to further escalation of the risk of nocturnal hypoglycemia.

Disclosure

I.R. Idris: None. N. Annamalai: None. T. Aung: None. I. Binnian: None. F.W. Gibb: None. M.I. Malik: None.
82-LB: Including Continuous Glucose Monitoring (CGM) to Provide Personalized Glycemic Profiles as Part of a Pilot Worksite Health Screening
Authors: KLEIN ILENE J. , CRAWFORD MARGARET , NORMAN GREGORY J. , HAMES KAZANNA C. , JUSTUS JORDAN I. , TREADWELL SABRINA , COMBEE TIFFANY M. , KINZLER SUSAN , WELSH JOHN , JOHNSON MATTHEW
Published: June 2020

Incorporating CGM into worksite health screenings may help employees gain insight into their glycemic patterns. This observational study piloted a voluntary health screening at a large employer that included 10 days of blinded Dexcom G6 CGM wear. At enrollment, HbA1c values and participants’ reports were used to assign diabetes status. Participants and their primary care providers received summaries of their CGM-based glucose profiles. A total of 207 participants (mean (sd) age = 50.7 (10), 84% female, 15% African American, 15% Hispanic, 56% obese) enrolled in the screening from April through August 2019, and 85% (175) wore the CGM for ≥4 days. HbA1c identified 7 and 24 participants with previously undiagnosed T2D and prediabetes, respectively. The final diabetes prevalence was 61 (35%) with T2D, 5 (3%) with T1D, 35 (20%) with prediabetes, and 74 (42%) with no diabetes. Among those with T2D, 27 (44%) met consensus-based goals for TIR. The Table shows CGM-based metrics from health screening participants compared to Shah’s (2019) normative sensor glucose data of people without diabetes. Those with prediabetes had higher mean glucose and lower TIR than the normative sample. Health screenings that include blinded CGM provide personalized feedback regarding glycemic patterns, even among people without known diabetes.

Disclosure

I.J. Klein: Consultant; Self; Dexcom, Inc. M. Crawford: Employee; Self; Dexcom, Inc. G.J. Norman: Employee; Self; Dexcom, Inc. K.C. Hames: Employee; Self; Dexcom, Inc. J.I. Justus: None. S. Treadwell: Employee; Self; Dexcom, Inc. T.M. Combee: None. S. Kinzler: Research Support; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. M. Johnson: Employee; Self; Dexcom, Inc.
823-P: Diabetes Camp Experience Associated with Improved Glycemia and Treatment Satisfaction
Authors: DARUKHANAVALA AMY , DINUNNO KYLE V. , PUHR SARAH , WELSH JOHN B. , BUTLER LYNN , ALFEGO DAVID , MAGYAR KENDRA L.
Published: June 2020

We compared glycemic metrics using continuous glucose monitoring (CGM) and quality of life between diabetes camp and the preceding home week. Insulin-treated youth (6-17 years) with T1D were enrolled at Barton Diabetes Camp and participated in 3 clinic visits: at the start of home week, where a Dexcom G6 CGM system was initialized; at the start of camp week, where the home week G6 was removed and a camp week G6 was inserted; and after camp, where the camp week G6 was removed. Problem areas in diabetes (PAID) surveys were administered at visits 2 and 3. Data from campers who did not complete all surveys were excluded. At camp, treatment decisions were informed by G6 as per FDA guidelines; interventions were prompted by daytime glucose levels ≤55 mg/dL or ≥350 mg/dL and for nighttime glucose levels ≤80 mg/dL or ≥300 mg/dL. Glycemic control and PAID scores were compared between home and camp weeks. Of 76 enrolled campers, 69 completed the study and 52 had results that qualified for analysis. Mean (SD) age was 12.5 (2.2) years. Most campers used insulin pumps (87.2%) and had experience with CGM (86.6%). Camp was associated with significant improvements in treatment satisfaction, time in range and in hyperglycemia, decreased basal insulin requirements, and improved insulin sensitivity (Table). Diabetes camp is associated with significant improvements in diabetes treatment satisfaction and glycemia compared to home care.

Disclosure

A. Darukhanavala: None. K.V. Dinunno: None. S. Puhr: Employee; Self; Dexcom, Inc. J.B. Welsh: Employee; Self; CSL Behring. L. Butler: None. D. Alfego: None. K.L. Magyar: None.

Funding

Dexcom, Inc.
83-LB: Are Activation, Behaviors, and Attitudes to Managing Care Associated with Utilization of a Remote Diabetes Monitoring Platform (RDMP) and Improvement of A1C?
Authors: PEREZ-NIEVES MAGALY , LU WEI , POON JIAT LING , FAN LUDI , JAMES ROBERTA , SHAH BIMAL
Published: June 2020

Background: Many validated patient-reported outcome measures (PROMs) evaluate activation, behaviors, and attitudes towards managing one’s own health and care. However, their association with utilization of diabetes management technology and glycemic control has not been well studied.

Methods: People participating in Livongo’s RDMP for 12-18 months were surveyed using 3 validated PROMs that assessed activation (PAM), empowerment (DES), and distress (DDS). Pearson correlation was used to assess the relationship between PROMs and multivariable logistic regression was used to evaluate associations of PROM scores on RDMP usage and A1c improvement overall and by insulin use.

Results: PAM and DES scores were most correlated with each other (r=0.48); neither were associated with A1c improvement. People with higher DES scores were 20% more likely to have high RDMP usage (p<0.05) and people with high RDMP usage were 4.4 times more likely to have A1c improvement. High distress (DDS17>=3) was negatively associated with A1c improvement.

Conclusions: In this study, PAM was not associated with activation, behaviors, and attitudes influencing RDMP usage and outcomes, while the DES and DDS17 were associated with RDMP. Because of the impact of distress on outcomes, it should be monitored and RDMP interventions should focus on distress reduction.

Disclosure

M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. W. Lu: Employee; Self; Livongo Health. J. Poon: Employee; Self; Eli Lilly and Company. L. Fan: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. R. James: Advisory Panel; Self; AstraZeneca. Employee; Self; Livongo Health. B. Shah: Employee; Self; Livongo Health.
838-P: Air Quality and HbA1c Levels in U.S. Hispanic/Latino Immigrants with Type 2 Diabetes: An Exploratory Observation
Authors: GLANTZ NAMINO M. , DESCHENES OLIVIER , KERR DAVID
Published: June 2020

In the U.S., Hispanic/Latino populations bear a disproportionate burden of type 2 diabetes (T2D) and its complications. Research suggests that poor air quality may have an influence on progression of T2D.

We compared HbA1c levels in Hispanic/Latino (95% Mexican-origin) adults with T2D by exposure to particulate matter <2.5 micrometers in diameter (PM2.5).

HbA1c levels were measured on 101 participants (54±12 years, 65% female, 25% insulin users, 60% uninsured, 40% food insecure). A third (36%) had an HbA1c <7.0% and 30% >9.0%. We matched HbA1c with California Air Resource Board (CARB) air pollution records to create a regression model relating HbA1c to average ambient PM2.5 concentration with participant zip codes 14 days prior to HbA1c measurement. PM2.5 exposure was stratified as “high” or “low,” (> or < 12 µg/m³ annual CARB standard PM2.5 concentration), controlling for other PM2.5-correlated factors (location, year and month fixed effects).

Figure 1 shows regression-adjusted mean [95% CI] HbA1c for low (N=85) and high exposure individuals (N=16) and estimated difference between groups (2.2%, p<0.05). Individuals with high PM2.5 exposure had higher HbA1c levels than those with lower exposure.

Air pollution exposure should be considered as an independent factor impacting glycemic control in Hispanic/Latino adults with T2D.

Disclosure

N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. O. Deschenes: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc.

Funding

Eli Lilly and Company (2017-5864)
842-P: Analysis of Primary Care Provider (PCP) EHR Notes for Discussions of Prediabetes Using Natural Language Processing (NLP) Methods
Authors: TSENG EVA , SCHWARTZ JESSICA L. , ROUHIZADEH MASOUD , MARUTHUR NISA M.
Published: June 2020

Background: Prior studies using structured EHR data suggest that patients with prediabetes are not receiving evidence-based care, but prediabetes may be discussed in unstructured data. We developed and validated an NLP tool to identify discussions about prediabetes in EHR notes.

Methods: We included adult patients without diabetes with an in-person office visit at any general medicine clinic at a single academic center and at least one HbA1c 5.7-6.4% between 7/1/2016 and 12/31/2018. In phase 1, we devised an initial keyword search strategy based on clinical experience. We extracted notes with at least one of the keywords and manually annotated them to determine whether they represented clinical discussions of prediabetes. We used the annotated notes to train and evaluate multiple machine learning and deep learning classifiers to replicate human annotation. In phase 2, we applied a similar annotation process and machine learning method on notes from a different group of clinic practices. We analyzed notes from phase 2 to describe the content of prediabetes discussions: labs ordered or reviewed (HbA1c or fasting glucose); lifestyle counseling; diabetes prevention program (DPP) discussion/referral; nutrition referral/discussion; and metformin discussion or ordering/continuation.

Results: We identified 269 patients with prediabetes discussions in phase 2. Most commonly, PCPs provided lifestyle counseling (80%), reviewed current labs (63%) and ordered follow-up labs (60%). PCPs rarely discussed/referred to a nutritionist (4%). We did not find any discussions/referrals to a DPP. Metformin was discussed, ordered or continued in <2% of patients.

Conclusions: We developed and validated a NLP tool that identifies clinical discussions about prediabetes in the EHR. PCPs most commonly provided lifestyle counseling in the office and infrequently placed referrals to nutrition or DPPs, which have strong evidence for preventing progression to diabetes.

Disclosure

E. Tseng: None. J.L. Schwartz: None. M. Rouhizadeh: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK118205-01A1)
853-P: Continuous Glucose Monitor Predicts Glycemic Variability in High-Risk Individuals with HbA1c <5.7%
Authors: DORCELY BRENDA , SIFONTE ELIUD , DIVAKARAN ANJANA , KATZ KARIN , JAGANNATHAN RAM , GOLDBERG IRA J. , BERGMAN MICHAEL
Published: June 2020

Objective: Glycemic variability (GV) and 1 hour plasma glucose (1-h PG) ≥ 8.6 mmol/L during a 75-gram oral glucose tolerance test (OGTT) are associated with increased risk for type 2 diabetes (T2D). GV may be overlooked in high-risk individuals. The objectives of this study are: (1) to determine if continuous glucose monitoring (CGM) using the Abbott Freestyle Libre Pro can replace the OGTT in high-risk subjects with HbA1c < 5.7%; and (2) to determine if GV indices correlate with the OGTT-derived 1-h PG ≥ 8.6 mmol/L.

Methods: Subjects were recruited with a HbA1c < 5.7% and at least one other risk factor including: overweight or obesity, PCOS, fatty liver, hypertension, family history of T2D, or history of gestational diabetes. The CGM, placed days prior to the OGTT, was worn up to 14 days. Anthropometric and vital signs were measured. HbA1c, fasting, 1-h and 2-h PG levels during an OGTT were obtained.

Results: The 1-h PG correlated significantly with CGM glucose levels (r=0.883, p<0.001) and GV indices: mean amplitude of glucose excursions (MAGE) (r=0.665,p=0.006), lability index (LI) (r=0.601, p=0.014), and high blood glucose index (HBGI) (r=0.743, p=0.001) (Table 1).

Conclusions: The 1-h CGM glucose and elevated GV indices significantly correlate with 1-h PG (> 8.6 mmol/L) in high-risk subjects with HbA1c < 5.7%. CGM could potentially replace the OGTT for detecting early dysglycemia in those with HbA1c < 5.7%.

Disclosure

B. Dorcely: None. E. Sifonte: None. A. Divakaran: None. K. Katz: None. R. Jagannathan: None. I.J. Goldberg: None. M. Bergman: None.

Funding

Abbott Diabetes Care; New York University Clinical and Translational Science Award (UL1 TR001445)
865-P: Influence of Glucose Measurement Interval on Glycemic Variability Values
Authors: TAKEISHI SOICHI , TSUBOI HIROKI
Published: June 2020

We examined how glucose measurement intervals influence glycemic variability (GV) values. In this cross-sectional study, we analyzed 24-h sensor glucose levels (SG) measured during hospitalization using a continuous glucose monitor (iPro2) in 96 patients with type 2 diabetes. GV was calculated from SG values extracted every 5 min × the divisors of 288 (excluding 10, 360, 480, 720, 1440 minutes). Because mean glucose level (Mean) values are influenced more from extraction start time as extraction intervals increase, to maximumly reduce that influence, at first, the 96 patients were ranked from “1” (highest Mean) to “96” (lowest Mean) according their individual Mean values. Then, we delayed the extraction start time every 15 min in the following order: “96,” “2,” “95”⋯ “48,” “49,” from 00:00 of “1.” In the percentage of time in range (70-180 mg/dL) [TIR 70-180], Mean, standard deviation (SD), and coefficient of variation (CV), the values were numerically almost equal in every extraction. The mean absolute glucose (MAG) and glycemic variability percentage (GVP) became lower as extraction intervals increased. Extraction every 240 min showed a correlation coefficient to measurement every 5 min (r to 5 min) of about 0.9 for TIR 70-180, Mean, SD, and CV. Extraction every 60 min had an r to 5 min of about 0.9 for MAG and GVP (Table). Theoretically, for TIR 70-180, SD, and CV, measurements performed every 4 hours may maintain an r to 5 min of about 0.9.

Disclosure

S. Takeishi: None. H. Tsuboi: None.
869-P: Using CGM as Feedback Tool in Diabetes Mellitus Patients Management: A Retrospective Real-World Evidence Study Conducted in India
Authors: SABHARWAL MUDIT , PALUKURI SRIVANI , DEKA SAURAV , CHANANA GARIMA , KUMAR ROHIT
Published: June 2020

Introduction: Since many new diabetic medications are costly and often have side effects, quick feedback would allow for timely decisions. The current study present the role of CGM in titrate medication to achieve glycemic target of diabetes mellitus patients using 14 days CGM report (AGP).

Methodology: Retrospective AGP of 214 patients was collected from 2017 to 2019. Target glucose range was considered as 70-180 mg/dL, hypoglycemia was categorized as low (54-69 mg/dL) and very low (<54 mg/dL) and hyperglycemia as high (180-250 mg/dL) and very high (>250 mg/dL). The % of time a patient spent in above ranges was illustrated as time in target range (TIR), time below range (TBR), and time above range (TAR), respectively. The glycemic variability (GV) parameters included standard deviation (SD) and coefficient of variation (CV). Changes in diabetic medications were done, if required, after first week of CGM. Variation in TIR, TAR, TBR and CV were analyzed before (first week) and after medication (last week).

Results: Improvement was observed in mean glucose values and SD from 152.1 to 135.5 and 41.0 to 35.1 mg/dL, respectively, % of time in TIR from 57.9 to 64.5% and TAR from 25.9 to 16.9% (high: 16.9 to 12.6% and very high: 9.0 to 4.3%) from first to last week. However, % of time in hypoglycemia (TBR) was increased from 7.9 to 11.2% (low: 6.6 to 8.8% and very low: 1.3 to 2.4%). The patients count with high glycemic variability (CV >36) was reduced from 27 to 21. The average eA1C was improved by 0.6 units (6.9 to 6.3).

Conclusion: The patients who were hyperglycemic were well controlled with medication, albeit with episodes of hypoglycemia during night-time. The treating clinicians can focus on these soft spots after first week instead of waiting long to intervene if they use CGM to titrate the medication. Thus, CGM can be instrumental in giving quick feedback in maintaining desired glycemic targets.

Disclosure

M. Sabharwal: None. S. Palukuri: None. S. Deka: None. G. Chanana: None. R. Kumar: None.
885-P: Evaluation of a Novel Continuous Glucose Monitoring System in Insulin-Treated Patients with Diabetes: A Pilot Study
Authors: TOMAH SHAHEEN , ELDIB AHMED H. , TASABEHJI MHD WAEL , BHATIA VIKAS , GARDNER HANNAH , HAMDY OSAMA
Published: June 2020

Continuous glucose monitoring has been shown to be an effective tool in management of type 1 and type 2 diabetes. Non-invasive techniques may provide a convenient alternative to current invasive methods but their precision is lacking.

We evaluated the accuracy of “LabPatch”, a non-invasive continuous glucose monitoring system that uses micropipette technology to sip interstitial fluid in comparison to YSI® (laboratory reference glucose analyzer) and 2 glucose meters (Onetouch Verio® and Freestyle Lite®) in 30 insulin-treated patients with diabetes at multiple points over 6 hours. LabPatch glucose readings significantly correlated with those of YSI (R-square=0.23, p<0.0001). Moreover, 85.69% of LabPatch glucose readings were within zones A and B of the Clarke Error Grid albeit B>A. LabPatch had an absolute relative difference (ARD) of 35.5% compared with YSI indicating wide variation in glucose readings. For glucose values between 70-180 mg/dL, LabPatch readings were within +/-15% of YSI values with a lower one-sided 95 % confidence bound of 75.25%. Estimated average glucose value (eAGV) were the closest between LabPatch and YSI than between either of the 2 glucose meters and YSI. We conclude that first-generation LabPatch Precision technology has potential to identify glucose trends in situations that require close monitoring of diabetes over shorter intervals such as gestational diabetes, pre-pregnancy planning and patients preparing for elective surgery. Additionally, LabPatch has the potential to be used for diabetes screening due to its non-invasive nature. Larger sample size and more precision of manufacturing technology may make it a valid non-invasive and wireless glucose monitor.

Disclosure

S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A.H. Eldib: None. M. Tasabehji: None. V. Bhatia: None. H. Gardner: None. O. Hamdy: Consultant; Self; Abbott, AstraZeneca, Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Healthimation, LLC.

Funding

Cambridge Medical Technologies, LLC
887-P: Development of the Noninvasive Diabetes Monitoring Method
Authors: AIHARA MASAKAZU , KUBOTA NAOTO , KADOWAKI TAKASHI
Published: June 2020

Aims/Background: To prevent diabetic complications, strict glucose control and frequent monitoring of blood glucose levels with invasive methods are necessary. We considered monitoring of diabetes-related biomarkers in tears may be the possible methods for diabetes monitoring methods. Many studies about tear glucose levels have been reported and tear glucose levels correlate with blood glucose levels. This time, we focused on glycoalbumin (GA) levels, which reflect an average of blood glucose levels over the preceding 2 weeks, and studied the correlation between GA levels in blood and tears.

Methods: We recruited 100 diabetic subjects and collected blood and tear samples. GA levels in blood were measured by an enzymatic method, and GA levels in tears were measured by Liquid Chromatography/Mass Spectrometry (LC-MS/MS).

Results: The GA levels in tears of 99 out of 100 samples were appropriately measured by LC-MS/MS. GA levels in blood and tears were significantly correlated (P < 0.001). Multiple regression analysis revealed that this correlation was maintained even after adjustment for age, gender, nephropathy stage, and obesity (P < 0.001).

Conclusions: GA in tears was the first measured diabetes-related biomarker. GA levels in tears were strongly correlated with those in blood, considering various factors. As GA value is a ratio, GA levels in tears were not thought to be influenced by dilution or concentration of tears and showed strong correlation with those in blood. From the above, GA in tears could be a diabetes-related biomarker that can be measured noninvasively. In the future, we plan to optimize measurement conditions, develop measurement equipment and verify the effectiveness and usefulness of this diabetes monitoring method.

Disclosure

M. Aihara: None. N. Kubota: None. T. Kadowaki: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Abbott, Astellas Pharma Inc., AstraZeneca K.K., Boehringer Ingelheim Pharmaceuticals, Inc., Cosmic Corporation, Daiichi Sankyo, Eli Lilly Japan K.K., FUJIFILM, Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Medscape Education, Medtronic, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, NIPRO Medical Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Asahi Mutual Life Insurance.