bluuebunny/crossref_metadata_2025 huggingface dataset:
589-P: Impact of Sedentary Behavior on Glycemic Profiles by Real-Time Continuous Glycemic Monitoring in People with Type 1 Diabetes
Authors: HONDA HIROTO , HASHIMOTO NAOKO , ZENIBAYASHI MASAKO , TAKEUCHI TAKEHITO , YAMAMOTO AKANE , HIROTA YUSHI
Published: June 2023

The purpose of this study was to examine the association between sedentary behavior (SB) and glycemic profiles by real-time continuous glycemic monitoring (rt-CGM) in people with type 1 diabetes (T1D). Fifty-eight Japanese adults with T1D were assessed and analyzed in this study (8 men and 50 women, age: 43.5 [32.0-54.0], HbA1c: 7.1 [6.7-7.8], median [25%-75% quartiles]). The type of physical activity (PA) measured using a triaxial accelerometer was defined according to intensity: SB (≤1.5 metabolic equivalents [METs], light-intensity PA (1.6-2.9 METs), and moderate-to-vigorous-intensity PA (≥3.0 METs). Total SB per day was 506.4 (442.2-575.9) min. A longer prolonged (≥30 min) SB and fewer steps per day were associated with higher mean 24-h sensor glucose values, higher time above range, and lower time in range (prolonged SB: ρ = 0.662 [p < 0.01], 0.627 [p < 0.01], and −0.591 [p < 0.01]; steps: ρ = −0.405 [p < 0.01], −0.401 [p < 0.01], and 0.327 [p < 0.05], respectively) (Figure). Conversely, total SB and other PA had no association with glycemic profiles. These results implied that more time spent on prolonged SB and fewer steps might contribute to the deterioration of glycemic profiles by rt-CGM in people with T1D. It is important to consider these characteristics when managing T1D.

Disclosure

H.Honda: None. N.Hashimoto: None. M.Zenibayashi: None. T.Takeuchi: None. A.Yamamoto: None. Y.Hirota: Other Relationship; Lilly, Sanofi K.K., Terumo Corporation, Sumitomo Dainippon Pharma Co., Ltd., Research Support; Sumitomo Dainippon Pharma Co., Ltd.
591-P: Elite Cyclists with Type 1 Diabetes (T1D) Show Acceptable Glycemic Excursions during a Time-Trial Performance under High-Definition Transcranial Direct-Current Stimulation (HD-tDCS)
Authors: CODELLA ROBERTO , GALLO GABRIELE , MELONI ANDREA , LUZI LIVIO , FILIPAS LUCA
Published: June 2023

Patients with T1D are typically challenged by glycemic fluctuations during exercise. We recently applied HD-tDCS - a neuromodulation enhancer - both in healthy and T1D elite cyclists to improve endurance performance. Here, in a double-blind, counterbalanced, randomized order, nine elite cyclists (28 ± 3.5 years; BMI: 20.8 ± 1.3 kg/m2; VO2peak: 65.3 ± 1.7 mL/min/kg) with T1D (no complications) underwent either HD-tDCS (F3, F4) or control (SHAM) and completed a constant-load trial (CLT) at 75% of the 2nd ventilatory threshold plus a 15-km cycling time-trial (TT). Comparing the two conditions by real-time continuous glucose monitoring (CGM), subjects showed similar glycemic variability in any part of the session (Figure: bold line = mean; dotted lines = min & max), with a significant effect of time (F=26.32; P<0.0001), but no interaction stimulation x time (F=0.08; P>0.99) nor effect of stimulation (F=0.077; P=0.79). Further, CGM data were stable for the 3 days preceding and following the tests. Given that glycemic control becomes of critical interest not only for health but also for performance goals, these findings suggest that HD-tDCS can be safely used as a performance improvement device in athletes with T1D, and possibly in a wider population of active T1D-subjects.

Disclosure

R.Codella: None. G.Gallo: None. A.Meloni: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Medtronic, Research Support; Gelesis, Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Novo Nordisk, Novartis. L.Filipas: None.
596-P: Exercise Increases Plasma Neuronal Growth Regulator 1 (NEGR1) Concentrations in Human Subjects
Authors: NIGRO PASQUALE , CARBONE NICHOLAS P. , BUENO JUNIOR CARLOS , VAMVINI MARIA , SIMPSON LAURA , HANSBURY GEORGIA A. , HIRSHMAN MICHAEL F. , MIDDELBEEK ROELAND J.W. , GOODYEAR LAURIE
Published: June 2023

Recent studies suggest that exercise-induced circulating factors are critical for the health benefits of exercise. In rodent models, we have identified NEGR1 as a cell adhesion molecule that is essential for remodeling white adipose tissue (WAT) innervation via sympathetic neurite outgrowth, and that NEGR1 is a secreted factor that may be involved inter-tissue communication. In humans, exercise training increases NEGR1 mRNA in subcutaneous WAT, but whether exercise regulates circulating NEGR1 in humans is not known. Here, we investigated the effects of a single bout of maximal exercise and exercise training on plasma NEGR1 in two different cohorts of obese subjects. Acute exercise (single bout until VO2MAX achieved) increased NEGR1 in plasma in all subjects (p<0.05; n=M3/F4). For the training study, obese subjects were randomized to one of three protocols: two different high intensity interval training (HIIT) protocols and one moderate continuous training (MCT) (Table), and blood samples were taken four days after the last training session. 1-HIIT and 4-HIIT similarly increased plasma NEGR1 concentrations, while there was no significant effect of MCT on NEGR1. In conclusion, we identify NEGR1 as a novel exercise-induced circulating factor in human subjects. We hypothesize that NEGR1 plays a role in tissue cross-talk mediating neuronal refinement in several tissues.

Disclosure

P.Nigro: None. N.P.Carbone: None. C.Bueno junior: None. M.Vamvini: None. L.Simpson: None. G.A.Hansbury: None. M.F.Hirshman: Stock/Shareholder; Abbott, AbbVie Inc., Amgen Inc., Colgate-Palmolive, Eli Lilly and Company, Medtronic. R.J.W.Middelbeek: Research Support; Novo Nordisk. L.Goodyear: None.

Funding

National Institutes of Health (R01DK099511, R01DK101043, K23DK114550, 5T32DK00726042, F32DK12643201); Joslin Diabetes Center (P30DK36836)
603-P: Changes in Insulin Resistance by Protein Source and Level of Saturated Fat—An Analysis of the Animal and Plant Protein and Cardiovascular Health (APPROACH) Trial
Authors: GADGIL MEGHANA D. , KRAUSS RONALD M.
Published: June 2023

Background: Protein source and saturated fat (SFA) consumption may affect insulin resistance (IR). We aimed to assess IR using the ratio of triglycerides/HDL (TG/HDL) in the context of a randomized, controlled, crossover dietary intervention trial comparing red meat, white meat and non-meat protein sources at high and low SFA levels.

Methods: Healthy men and women aged 21-65 y with BMI 20-35 kg/m2 were randomly assigned to 1 of 2 parallel arms (14% or 7% energy from SFA), and within each consumed diets with protein source derived primarily from red meat, white meat, and nonmeat sources for 4 weeks each in random order. We assessed protein source and log transformed TG/HDL ratio using generalized mixed models adjusting for diet order by level of SFA. A significant interaction was found between SFA and red meat intake (p<0.05).

Results: Participants who completed all diets were included: 62 participants on high SFA diets (27 men, 30 women); 51 on low SFA (17 men, 34 women). Red and white meat consumption were each associated with lower log TG/HDL than non-meat protein consumption at high SFA but not low SFA (Table). There was no difference in log TG/HDL between white and red meat consumption at either level of SFA.

Conclusion: Diets high in both SFA and red or white meat protein have adverse effects on IR compared with either low SF or non-meat protein consumption.

Disclosure

M.D.Gadgil: None. R.M.Krauss: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R03DK132307); National Heart, Lung, and Blood Institute (R01HL106003); National Center for Advancing Translational Sciences; San Francisco Clinical and Translational Science Institute (UL1TR000004)
61-OR: Mobile Bolus Feature Improves Bolus Behavior in Control-IQ Users Who Bolus <3 Times/Day
Authors: MESSER LAUREL H. , MUELLER LARS , D'SOUZA EDWIN W. , HABIF STEPHANIE , PINSKER JORDAN E.
Published: June 2023

Background: In 2022, the smartphone application and pump software for the t:slim X2 with Control-IQ technology updated to allow bolus insulin programming from a user’s personal smartphone (mobile bolus, MB) in the United States. The aim of this study was to determine if MB increased bolus frequency in users who bolus <3 times/day.

Methods: De-identified data from users with low bolus frequency and >21 days with 70% CGM pre-and post MB were analyzed for changes in bolusing behavior and Time in Range (TIR) before and after MB.

Results: A total of 4,470 users bolused <3 times/day and upgraded to MB. After MB start, these users increased the number of boluses per day from 2.2 to 2.7 (+0.5 per day, p<0.001, table). After MB upgrade, approximately 1 bolus/day (36% of boluses) were delivered on the smartphone app instead of the insulin pump. TIR improved discreetly, with children <12 years old experiencing 34 more minutes in target range each day (p<0.01). Of all, 87% of users were very satisfied or satisfied with the MB feature.

Conclusions: For users with low bolus frequency, the MB feature meaningfully increased the number of boluses given each day, and can be leveraged as a way to increase daily bolusing behaviors.

Disclosure

L.H.Messer: Advisory Panel; Lilly, Consultant; Dexcom, Inc., Capillary Biomedical, Inc., Employee; Tandem Diabetes Care, Inc., Research Support; Beta Bionics, Inc., Medtronic, Insulet Corporation. L.Mueller: Employee; Tandem Diabetes Care, Inc., Stock/Shareholder; Tandem Diabetes Care, Inc. E.W.D'souza: None. S.Habif: Employee; Tandem Diabetes Care, Inc. J.E.Pinsker: Employee; Tandem Diabetes Care, Inc.

Funding

Tandem Diabetes Care, Inc.
612-P: The Effectiveness of Lifestyle, Metformin, or Dietary Supplements for the Prevention of Gestational Diabetes Mellitus (GDM) by Participant Characteristics—A Systematic Review and Meta-analysis
Authors: LIM SIEW , TAKELE WUBET W. , REDMAN LEANNE M. , VESCO KIMBERLY , GRIEGER JESSICA A. , HABIBI NAHAL , QUINTEROS ALEJANDRA , LEUNG GLORIA , ZHOU SHAO J. , TAYLOR RACHAEL , PATHIRANA MALEESA , LIU KAI , UKKE GEBRESILASEA G. , BONHAM MAXINE P. , CHEN MINGLING , FAWCETT ANDREA J. , CHIVERS SIAN C. , JOSEFSON JAMI L.
Published: June 2023

The GDM prevalence has been rising, affecting 7-28% of pregnancies worldwide. Prior systematic reviews examining the success of interventions for GDM prevention have presented results where some interventions have modest effect and others, no effect. The impact of individual characteristics on the efficacy of interventions has not been thoroughly investigated. To address this knowledge gap, we performed a systematic review of controlled trials of lifestyle (diet and exercise), metformin and dietary supplement interventions initiated in the preconception, prenatal or postpartum period to assess whether participant characteristics impact the interventions’ effectiveness in GDM prevention. Overall, 116 studies met inclusion criteria (lifestyle n=92, metformin n=13 and dietary supplements n=12). Lifestyle, metformin and dietary supplements reduced GDM risk by 24% (RR 0.76, 95% CI 0.69-0.83), 34% (RR 0.66, 95% CI 0.47-0.93), and 45% (RR 0.55, 95% CI 0.36-0.83). With lifestyle, lower risks of GDM was seen in individuals with overweight or obesity (n=33, RR 0.70, 95% CI 0.59-0.83), without PCOS (n=3, RR 0.62, 95% CI 0.47-0.82) and without a history of GDM (n=13, RR 0.63, 95% CI 0.53-0.70) (p<0.05). With metformin, lower GDM risks were achieved when commenced prior to conception (n=3, RR 0.22, 95% CI 0.11-0.45)(p<0.01). Dietary supplements resulted in lower GDM risks among individuals with normal weight (n=1, RR 0.42, 95% CI 0.24-0.72), with prediabetes (n=1, RR 0.08, 95% CI 0.02-0.31), and when initiated before 20 weeks’ gestation (n=10, RR 0.46, 95% CI 0.30-0.71) (p<0.05). Given the potentially greater effectiveness of these interventions in certain groups of individuals, future research on tailored recommendations in precision GDM prevention, replacing the current ‘one-size-fits-all’ approach, is needed.

Disclosure

S.Lim: None. R.Taylor: None. M.Pathirana: None. K.Liu: None. G.G.Ukke: None. M.P.Bonham: None. M.Chen: None. A.J.Fawcett: None. S.C.Chivers: None. J.L.Josefson: None. W.W.Takele: None. L.M.Redman: Research Support; Dexcom, Inc., Abbott Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; ABGIL, Teladoc Health. K.Vesco: Research Support; Pfizer Inc. J.A.Grieger: None. N.Habibi: None. A.Quinteros: None. G.Leung: None. S.J.Zhou: None.
614-P: Effect of Non-nutritive Sweetener Sucralose on Cardiometabolic Risk Factors among Overweight and Obese Adults in India—A Randomized Clinical Trial
Authors: MOHAN VISWANATHAN , KUZHANTHAIVELU ABIRAMI , RAJAGOPAL GAYATHRI , VASUDEVAN KAVITHA , NAGAMUTHU GAYATHRI , SHEKINAH DAVID , UNNIKRISHNAN RANJIT , MOHAN ANJANA RANJIT , VASUDEVAN SUDHA , KAMALA KRISHNASWAMY
Published: June 2023

Background: The aim of this free living, randomized parallel arm study was to evaluate the effect of replacing added sugar in beverages with non-nutritive sweetener (NNS)- Sucralose on body weight and metabolic factors in overweight and obese adults.

Method: Adults aged 25-50 years with BMI ≥23 kg/m2, were randomized into Intervention arm (replacement of sugar with NNS) and Control arm (no replacement) for a period of 12 weeks. Change in anthropometric and biochemical measurements were analysed using standard methods.

Results: Data of 154 subjects, was analyzed; significant reduction in waist circumference (p=0.01), fasting blood glucose (p<0.001), HbA1C (p =0.02), total Cholesterol/HDL cholesterol ratio (p=0.03), visceral adiposity index (p=0.04), HOMA IR (p=0.03), Triglyceride/glucose Index (p=0.04) & increase in HDL cholesterol (p=0.004) were seen at the end of trial in the Intervention arm. There was non-significant reduction in body fat, BMI, lipid accumulation product and high sensitivity CRP. Plasma sucralose analyzed in a subset of participants was undetectable indicating sucralose is not systematically absorbed.

Conclusion: In overweight and obese participants, replacement with NNS, helps in reducing adiposity indices, along with improvement in cardio metabolic parameters.

Disclosure

V.Mohan: None. K.Kamala: None. A.Kuzhanthaivelu: None. G.Rajagopal: None. K.Vasudevan: None. G.Nagamuthu: None. D.Shekinah: None. R.Unnikrishnan: None. R.Anjana: None. S.Vasudevan: None.
615-P: Effect of Nonnutritive Sweetener Sucralose on Cardiometabolic Risk Factors among Adults with Type 2 Diabetes in India—A Randomized Clinical Trial
Authors: MOHAN VISWANATHAN , KUZHANTHAIVELU ABIRAMI , RAJAGOPAL GAYATHRI , GUNASEKERAN GEETHA , SOUNDARARAJAN PADMAVATHI , MARIMUTHU RAJALAKSHMI , UNNIKRISHNAN RANJIT , MOHAN ANJANA RANJIT , VASUDEVAN SUDHA , KAMALA KRISHNASWAMY
Published: June 2023

Background: Non-Nutritive sweeteners (NNS) can help in reducing calorie intake if substituted for sugar. Studies on the effect of replacing sugar with NNS in adults with type 2 diabetes (T2D) from India are sparse. The present study was carried out to evaluate, the effect of replacing added sugar with sucralose-based NNS in daily beverages like coffee, tea and fruit juices on cardiometabolic risk factors.

Method: This randomized parallel arm trial was done among adults (30-50 yrs) with T2D. Participants were randomized into Intervention arm (replacement of added sugar with NNS) and Control arm (no sugar replacement) group for a period of 12 weeks. Change in anthropometric and biochemical markers from baseline were analyzed using standard protocols.

Results: Data of 115 participants who completed the study (Control group, n=42 and intervention group, n=73) was analyzed. Significant reduction in waist circumference (p=0.02), lipid accumulation product (p=0.02), and visceral adiposity index (p= 0.02) was seen in the intervention group, when compared to control group. Plasma sucralose was analyzed in a subset of participants and was undetectable, indicating that sucralose is not absorbed, systematically.

Conclusion: The study shows that replacement of added sugar with NNS, leads to favourable changes in adiposity indices among adults with T2D.

Disclosure

V.Mohan: None. K.Kamala: None. A.Kuzhanthaivelu: None. G.Rajagopal: None. G.Gunasekeran: None. P.Soundararajan: None. R.Marimuthu: None. R.Unnikrishnan: None. R.Anjana: None. S.Vasudevan: None.
628-P: Symptoms of Autonomic Nervous System Dysregulation and Diabetes Distress in T2D Adults
Authors: DE GROOT MARY , MYERS BARBARA A. , STUMP TIMOTHY , DANA DEBORAH , KOLACZ JACEK , PORGES STEPHEN W.
Published: June 2023

Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 2 diabetes (T2D). US adults (n=299) with self-identified type 2 diabetes completed a web-based survey in October 2022, including demographics, ANS reactivity symptoms (Body Perception Questionnaire; BPQ), diabetes-related distress (Diabetes Distress Scale-17; DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). Mean age was 60.2 years (S.D. = 13.6), 58.7% female, 82.9% White, with a median annual household income of $40,000-$60,000. Mean self-reported A1c was 7.0% (S.D. 1.2%). Self-reported medications: oral hypoglycemic agents (51.8%), oral medications and injectable insulin or other medications (26.7%), and diet and exercise alone (8.4%). Mean glucose checks was 1.5 times/day (S.D. = 4.9). The sample reported high levels of comorbid hypertension (65.4%), dyslipidemia (55.8%), sleep apnea (33.9%) and depression (36.2%). Mean DDS-17 score was 2.3 (S.D. 1.0; moderate severity). The highest scores were observed in the emotional burden (mean = 2.6; S.D. 1.3) and regimen-related distress (mean = 2.7; S.D. 1.2) subscales. Mean PHQ-8 score was 6.7 (S.D. = 6.0; mild) and the mean GAD-7 score was 4.74 (S.D. 5.6, mild). BPQ mean T scores were 49.9 (S.D. 9.4) for Supradiaphragmatic and 52.0 (S.D. 8.8) for Subdiaphragmatic Reactivity subscales. Positive correlations between the DDS-17 and BPQ subscales (range: r=0.53-0.58, all p’s<.05) were observed. Controlling for covariates, significant differences in BPQ subscale T scores were observed across clinical severity levels of the DDS on all subscales, with the highest BPQ scores observed in the ‘high’ distress DDS category compared to ‘no/mild distress’ (p’s < 0.05). Findings confirm a relationship between ANS reactivity symptoms and diabetes-related distress, consistent with the Polyvagal Theory. Development of interventions that target ANS regulation to treat DD for T2D adults are needed.

Disclosure

M.De groot: Consultant; Barbara Kenner Family Foundation, Medscape, Mediflix, Inc. B.A.Myers: None. T.Stump: None. D.Dana: None. J.Kolacz: None. S.W.Porges: None.
638-P: Social Media as a Source of Personalized Weight-Loss Information
Authors: CLARK CALLAHAN , STREMMEL JOEL , MCCOY ROZALINA G. , JARVIS MEGAN , ARD JAMY D. , LAMBERT NATALIE
Published: June 2023

People with obesity may seek clinical, nutritional, activity, and psychosocial guidance, but recommendations they receive in clinical settings may be inadequate or lack sufficient personalization to be implemented into their lives. Understanding unmet information needs may enable more tailored weight guidance. We used health narratives posted in a weight loss forum to research topics of information being sought. Public posts (N=52,576) from 1/2020-1/2022 were extracted from r/LoseIt, a Reddit weight loss forum of 3.8M members. From these, 63,006 questions were extracted using a research-purpose BERT language model tested and fine-tuned on 500 hand-annotated questions. Extracted questions were clustered into distinct topics by Top2Vec and hierarchical clustering. Excluding 2 uninterpretable topics, 27 of 28 (96%) topics represented requests for personalized recommendations. Topics focused on diet (7%), exercise (7%), sensemaking (11%), how to implement a behavior change or solve a weight-loss problem (11%), tips for specific stages of weight loss (beginning, plateau) (7%), and comparing weight loss experiences (11%). Weight-loss forum users requested personalized recommendations to support sensemaking of frustrating weight loss problems and ask for help choosing and deploying behavior change. Results call for interventions customized to individuals’ weight loss stage, process, experiences, and motivations.

Disclosure

C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. J.Stremmel: None. R.G.Mccoy: Consultant; Emmi. M.Jarvis: Employee; Optum Labs, UnitedHealth Group, Stock/Shareholder; Oramed Pharmaceuticals, UnitedHealth Group, Dexcom, Inc., Apple, Hologic Inc., Intuitive Surgical. J.D.Ard: Advisory Panel; Novo Nordisk, Consultant; Eli Lilly and Company, Intuitive Surgical, Regeneron, Other Relationship; Optum Labs, Weight Watchers International, Research Support; Nestlé Health Science, Boehringer Ingelheim Inc., Epitomee, KVK Tech. N.Lambert: Employee; Optum Labs.
651-P: Sensitivity and Specificity of the PHQ-8 to Identify Depressive Disorder (DD) in Teens with Type 1 Diabetes (T1D)
Authors: PATTON SUSANA R. , MARKER ARWEN , MCDONOUGH RYAN , CLEMENTS MARK A.
Published: June 2023

Objective: A recent study identified that a cut-off score >5 on the Patient Health Questionnaire (PHQ-9) had greater sensitivity and specificity to detect DD in teens with T1D than the normative cut-off score. Still, limited provider training or capacity to intervene on a suicide screening item (item 9) leads some clinics to omit item 9. We examined the ideal cut-off score to detect DD in teens with T1D using the modified PHQ-8 screener, and if removing item 9 impacts sensitivity.

Methods: Teens (N=100; Mean age = 15.0 ± 1.7; 60% Male; 87% White; Mean HbA1c = 8.88 ± 1.8%) completed the PHQ-8 electronically. We used the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS DSM-5) depression module to determine if the teen met criteria for DD. We compared teens’ PHQ-8 cut-off scores (PHQ-8 ≥ 10) to KSADS results.

Results: Per KSADS, 15% of teens met criteria for current DD. The PHQ-8 demonstrated low sensitivity (.20) to detect DD using a normative cut-off score, but an adjusted cut-off score >5 increased sensitivity (.87) while maintaining good specificity (.80) (Table 1).

Conclusions: Using a lower cut-off score of >5 on the PHQ-8 can more reliably identify DD in teens with T1D and matches previous PHQ-9 sensitivity and specificity metrics. This suggests removing item 9 does not negatively impact DD screening accuracy, although clinics should consider alternative methods to screen for suicide risk.

Disclosure

S.R.Patton: None. A.Marker: None. R.Mcdonough: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes.
657-P: Diabetes Stigma and Use of Diabetes Technologies among U.S. Adults Living with Type 2 Diabetes
Authors: GARZA MATTHEW , SHOGER ERIK , HOLMES-TRUSCOTT ELIZABETH , JOINER KEVIN , ADDALA ANANTA , NARANJO DIANA , BEVERLY ELIZABETH A. , SPEIGHT JANE
Published: June 2023

Nearly 80% of adults with diabetes report experiences of diabetes stigma, varying by the use of insulin therapy. We aimed to examine associations between diabetes stigma and the use of diabetes technologies among adults with insulin and non-insulin-treated type 2 diabetes (T2D). In August 2022, 947 adults with T2D (mean age: 64±11 years; duration T2D: 19±9 years; 62% women; 61% insulin-treated) from the dQ&A US Patient Panel completed an online survey. Questions included the Type 2 Diabetes Stigma Assessment Scale (DSAS-2) and diabetes and demographic characteristics. DSAS-2 total and subscale (Treated Differently, Blame and Judgment, Self Stigma) scores were compared by device use (independent samples t-test), and separately by treatment (insulin vs. non-insulin). Individuals with non-insulin-treated T2D using (vs. not using) CGM reported more stigma (Total; Treated Differently; Blame & Judgment) but did not differ on Self Stigma (Table). Stigma did not differ by device use among participants on insulin treatment, but was higher overall than those on non-insulin treatment. Further research is needed to understand how the experience of diabetes stigma may be affected by the visibility of T2D, specifically via diabetes technologies.

Disclosure

M.Garza: Other Relationship; Sanofi. E.Shoger: Other Relationship; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Beta Bionics, Inc., Xeris Pharmaceuticals, Inc., MannKind Corporation. E.Holmes-truscott: Research Support; Sanofi, AstraZeneca. K.Joiner: None. A.Addala: None. D.Naranjo: None. E.A.Beverly: None. J.Speight: Research Support; Sanofi, Medtronic, Abbott Diabetes, Lilly, Novo Nordisk A/S, Speaker's Bureau; Sanofi.
663-P: Dynamic Real-Time Relationships among Glucose and Cognitive Performance in Diverse Adults with T1D
Authors: HOOGENDOORN CLAIRE J. , HERNANDEZ RAYMOND , SCHNEIDER STEFAN , PETERS ANNE L. , CRANDALL JILL P. , CRESPO-RAMOS GLADYS , JIN HAOMIAO , PHAM LOREE T. , AGARWAL SHIVANI , SPRUIJT-METZ DONNA , PYATAK ELIZABETH , GONZALEZ JEFFREY S.
Published: June 2023

Introduction: Blood glucose (BG) regulation is linked to cognitive performance among people with diabetes. Most studies are cross-sectional and limited to adults with T2D. Pairing continuous glucose monitoring (CGM) with ambulatory cognitive tests, we examined real-time bidirectional associations between BG and cognition in everyday life among adults with T1D.

Methods: Participants wore a blinded CGM for 10-14 days and completed ambulatory cognitive tests 5-6 times daily. Using dynamic structural equation modeling, we evaluated within-person bidirectional relationships between BG and cognition over sequential 3-hr periods. BG metrics included mean BG, time in range (TIR; 70-180 mg/dL), % time in low (50-69 mg/dL), high (181-250 mg/dL) and very high BG (>250 mg/dL), and coefficient of variation (CV). Cognitive variables included processing speed and sustained attention.

Results: Among 182 adults with T1D (40±14 yrs, 46% male, 41% Latino, 29% White, 15% Black), greater mean BG (beta=0.03), lower TIR (beta=-0.03), and more time in high (beta=0.03) and very high BG (beta=0.03) predicted slower processing speed 3 hrs later (ps<.05); no BG metric predicted sustained attention ability. Surprisingly, slower processing speed predicted lower mean BG (beta=-0.05), more TIR (beta=0.04) and less time in high (beta=-0.01) and very high BG (beta=-0.04) over the next 3 hrs. Reduced sustained attention predicted more time in very high BG (beta=-0.01) and lower CV (beta=0.03) (ps<0.05).

Conclusion: Our findings suggest that poorer BG regulation negatively influences processing speed over short time frames. Slower processing speed predicted subsequent improvements in CGM metrics, suggesting that individuals may take steps to correct BG when experiencing cognitive effects of poor BG regulation. These short-term relationships illuminate opportunities for in-the-moment interventions.

Disclosure

C.J.Hoogendoorn: None. D.Spruijt-metz: None. E.Pyatak: Research Support; Abbott Diabetes. J.S.Gonzalez: Consultant; Virta Health Corp. R.Hernandez: None. S.Schneider: None. A.L.Peters: Advisory Panel; Abbott Diabetes, Medscape, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Stock/Shareholder; Omada Health, Inc., Livongo. J.P.Crandall: Research Support; Abbott. G.Crespo-ramos: None. H.Jin: None. L.T.Pham: None. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.

Funding

National Institutes of Health (R01DK121298, P30DK020541, P30DK111022)
67-LB: Factor Structure and Effects of Illness Perception on Depression and Anxiety in Patients with Diabetes
Authors: TAJIMA EMI , HATA KOTONE , SUZUKI SHIN-ICHI
Published: June 2023

Objective: Illness perception represents how a patient perceives his or her health and illness. The Brief Illness Perception Scale (BIPQ; Broadbent et al. 2006) is often used to assess illness perception. However, the factor structure of the BIPQ is inconsistent across studies. The present study aimed to confirm the factor structure of the BIPQ in diabetic patients and to examine its impact on depression and anxiety.

Methods: Patients with diabetes (N = 340, type 1: 39. type 2; 296, others: 5) provided demographic and clinical information and completed the Japanese version of the BIPQ, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder -7. This research was conducted with the approval of Waseda University's Ethics Review Committee on Human Studies (Accreditation Number: 2021-351).

Results: We eliminated one item on the timeline because of the ceiling effect. Then, we conducted an exploratory factor analysis and adopted a two-factor structure. Moreover, a confirmatory factor analysis with the same two-factor structure indicated the sufficient model fit (GFI = .93, AGFI = .86, CFI = .87) Furthermore, from multiple regression analyses, assessed the effects of "Impact on daily life" and "Sense of control", the two factors we named, on depression and anxiety indicated a significant coefficient of determination (R 2 = .31, p < .001, R 2 = .30, p < .001). Additionally, the Impact on daily life (β = .36, p < .01, β = .29, p < .01) and the Sense of control (β = - .29, p < .001, β = -.23, p < .001) had significant effects on depression and anxiety.

Conclusion: The results supported the two-factor structure of the BIPQ, similar to that for cancer survivors (Hata et al., 2020), even though we eliminated one item. Illness perception in patients with diabetes consists of the impact of the disease on their daily lives and their sense of control over diabetes and its symptoms. Improving these perceptions would reduce depression and anxiety.

Disclosure

E. Tajima: None. K. Hata: None. S. Suzuki: None.

Funding

Japan Society for the Promotion of Science (19J22933)
672-P: Supporting Gestational Diabetes (GDM) Risk Reduction among Young Indigenous Females Who Experience Food Insecurity—A Qualitative Exploration
Authors: STOTZ SARAH A. , HEBERT LUCIANA E. , SCARTON LISA , BEGAY KELLI R. , GONZALES KELLY L. , GARROW HEATHER , ASPAAS MELANIE L. , CHARLEY MELANIE , CHARRON-PROCHOWNIK DENISE
Published: June 2023

The purpose of this study was to re-engage participants of a GDM risk reduction study along with additional key informants to explore GDM risk reduction opportunities among young Indigenous females who experience food insecurity. Participants were adult American Indian (AI) women who had GDM or who have female relatives (e.g., daughters) between 12-24 yo (n= 41), AI females between 12-24 yo (n=18), and key informants with expertise in food/nutrition and health within Indigenous communities (n=32) across the US. Data were collected using a semi-structured, conversation-based moderator guide. Zoom interviews were recorded, transcribed, and coded using thematic content analysis methods. Three themes emerged, which emphasize supporting wellness among young Indigenous females through culturally centered approaches and describe how colonization has interrupted healthful dietary practices. Themes include: 1) Guidance on how to support young female's holistic wellness (e.g., strong cultural identity, physical activity, and support from multigenerational family and community); 2) Generations of colonial violence including forced removal, forced poverty, and the imposition of a western based food system of high fat and sugary foods causes deeper, systemic fracturing of traditional cultural food knowledge and practice; 3) Opportunities for support may include investment in place-based, community-driven Indigenous food sovereignty efforts with economy and relationship building including traditional food teachings (e.g., gardening, gathering, farming, seed and land stewardship, hunting, fishing, and food/meal planning and preparation). These themes suggest alternative understanding about the relationships between food insecurity and GDM risk drawing from Indigenous values, strengths, and knowledge, within the context of colonialism, and can guide next steps of decreasing GDM disparities in Indigenous communities.

Disclosure

S.A.Stotz: None. L.E.Hebert: None. L.Scarton: None. K.R.Begay: None. K.L.Gonzales: None. H.Garrow: None. M.L.Aspaas: None. M.Charley: None. D.Charron-prochownik: None.

Funding

National Institute on Minority Health and Health Disparities (R21MD016126 to S.A.S.)
680-P: Improvement in Anxiety and Depression in Patients with Type 2 Diabetes through Customized Lifestyle Intervention
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , SHARMA BABY , VYAWAHARE ANAGHA R. , DAS BISWAS MAYURIKA , GANLA MALHAR H. , SABOO BANSHI D.
Published: June 2023

Background: Type 2 diabetes (T2D) is a chronic metabolic disorder that has a significant impact on the mental health of an individual, which in turn results in increased morbidity and mortality.

Objective: To evaluate the effect of holistic lifestyle intervention in improving mental health outcomes in patients with T2D. Materials and

Methods: In this quasi-experimental study, baseline data (anthropometry and medical history) on 428 T2D patients enrolled in a one-year online holistic lifestyle intervention program at the Freedom from Diabetes Clinic (Pune, India) between May 2021 and Feb 2022 were collected. The validated Patient Health Questionnaire (PHQ-9) (scoring 0-27) and Generalized Anxiety Disorder Assessment (GAD-7) scale (scoring 0-21) were used to assess depression and anxiety, respectively. The intervention included a customized vegan diet and exercise protocol along with stress-relieving group sessions for diabetes management and one-on-one psychological counselling sessions (aimed specifically at people with anxiety and/or depression). After 6 months of intervention, the questionnaires were re-administered to assess the reduction in anxiety and depression.

Results: The prevalence of depression, anxiety, and both was 7.9%, 7.2%, and 8.9% at baseline, respectively. Post-intervention, it reduced to 3.5%, 3.7%, and 4.9%, respectively. The absolute change (calculated as final score-initial score/initial score*100) was significantly higher for both depression and anxiety scores in those who received the intervention (group therapy or individual counselling) vs those who chose not to receive the intervention (p<0.05). Of the 72 and 69 patients who showed depression and anxiety at baseline, 43 and 40 shifted to the minimal to mild categories, respectively, indicating improvement.

Conclusion: Our findings suggest that incorporating a psychological component into lifestyle interventions may help improve mental health in patients with T2D.

Disclosure

P.Tripathi: Board Member; Freedom from Diabetes Clinic. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. B.Sharma: Research Support; Freedom From Diabetes clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. M.Das biswas: Employee; Freedom from Diabetes Clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.
690-P: Variation in Physical Activity and Weight Loss by Demographic Characteristics among Participants in the National Diabetes Prevention Program
Authors: CANNON MICHAEL , PENG NG BOON , ELY ELIZABETH
Published: June 2023

The National Diabetes Prevention Program lifestyle change program aims to prevent type 2 diabetes by promoting behavioral changes such as increased physical activity and improved nutrition, with a goal of losing ≥5% of body weight. We analyzed data from 2012-2019 from participants who reported weekly physical activity (PA) minutes and weight and who participated either in-person (N=127,092) or online (self-paced, asynchronous interactions with coach) (N=196,670). Among those retained through the core phase (16 sessions), average weekly PA minutes were higher among men than women (228 vs. 182 in-person and 277 vs. 204 online), higher for older than younger participants (210 vs. 187 vs. 164 in-person and 248 vs. 233 vs. 191 online for ≥65, 45-64, and 18-44 years), higher for those with lower BMI (213 vs. 184 in-person and 244 vs. 215 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (187 in-person and 183 online for non-Hispanic Black participants, 183 in-person and 207 online for Hispanic participants, and 198 in-person and 227 online for non-Hispanic White participants). Percent weight loss by session 16 was greater for men than women (6.0 vs. 5.2 in-person and 5.5 vs. 4.2 online), greater for older than younger participants (5.8 vs. 5.3 vs. 4.6 in-person and 5.5 vs. 4.7 vs. 4.0 online for ≥65, 45-64, and 18-44 years), greater for those with higher BMI (5.2 vs. 5.4 in-person and 4.4 vs. 4.6 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (3.8 in-person and 3.7 online for non-Hispanic Black participants, 4.4 in-person and 4.0 online for Hispanic participants, and 5.9 in-person and 4.8 online for non-Hispanic White participants). We found that participants with different demographic characteristics experience program successes differently despite similar time in the program, suggesting a need to understand the reasons for these differences and customize program delivery strategies to address them.

Disclosure

M.Cannon: None. B.Ng: None. E.Ely: None.
692-P: Characteristics of Young Adults with Type 1 Diabetes (T1D) Attending a Virtual Young Adult Diabetes Clinic (YADC) as a Component of Transition from Pediatric to Adult Diabetes Care
Authors: JOARDER FARAHNAZ , PANDHARPURKAR TEJAL H. , TWEET RYAN D. , HEYERMAN TESS , O'NEIL KELLY , PARK JULIE J. , GUTTMANN-BAUMAN INES
Published: June 2023

Objectives: Young adults (18-25) living with T1D are at high risk of acute and chronic complications and poor glycemic control in part because of difficulties seen in transitioning from pediatric to adult care. In 2017 an in-person YADC was created to help engage and support new patients transitioning from pediatric to adult care. In 2021, in response to the COVID-19 pandemic, the YADC was adapted to a virtual model. This study characterizes the participants of the virtual YADC.

Methods: The YADC is a comprehensive virtual clinic that includes a group welcome, orientation to adult diabetes care, peer-to-peer interaction, group discussion about pediatric-to-adult transition of care (facilitated by a behavioral health clinician), a diabetes education visit and a medical provider visit. Young adult attendees were self-select; those who were referred to an adult endocrinologist were given the option to join the YADC. Descriptive statistics were utilized to summarize the characteristics of patients attending the virtual YADC.

Results: Of 89 patients scheduled, 61 patients attended the virtual YADC between January 2021 and December 2022. Attendees ranged in age from 18 to 25, with a mean age of 21. Forty-one attendees (67%) had private insurance and 20 had state insurance. The mean HbA1c of virtual YADC participants was 8.61%. In comparison, the mean HbA1c of those who did not attend was 9.84%. Among young adult patients who did not attend, 19 (67%) attendees had state insurance, whereas 9 attendees had private insurance.

Conclusions: Characterization of virtual YADC attendees reveals a higher proportion with private insurance vs state insurance. This finding implies potential differences in access to care. Future studies will focus on understanding the differences between those who do and do not attend virtual YADC and how to increase patient engagement.

Disclosure

F.Joarder: None. T.H.Pandharpurkar: None. R.D.Tweet: None. T.Heyerman: None. K.O'neil: None. J.J.Park: None. I.Guttmann-bauman: None.
717-P: Unmet Needs and Communication Preferences for mHealth Self-Management Solutions in People with Type 1 Diabetes and Insulin Resistance
Authors: WILSON ANDREW R. , FARRAR MATTHEW , CAMPBELL MATTHEW D.
Published: June 2023

Insulin resistance (IR) is prevalent within type 1 diabetes (T1D) and associated with increased morbidity and mortality. Mobile health (mHealth) applications are useful platforms for delivering health behaviour interventions, but technologies focusing on addressing IR in T1D are absent. The aim of this formative study was to identity salient unmet patient needs, communication preferences, and barriers for mHealth self-management solutions in people with T1D and IR. 70 adults with type 1 diabetes (male=57%; HbA1c 8.1±3.4%; 28±5years) completed an online survey evaluating skills gaps in self-management and priorities for diabetes mHealth apps. Survey responses were ranked using a 9-point scale and analysed using descriptive and inferential statistics. Qualitative write-in responses were subsequently coded and analysed using inductive thematic analysis. IR was assessed using estimated glucose disposal rate (eGDR). Among all respondents, 49% (n=34) identified glycemic control/variability as the principle unmet self-management need. Fewer than 5% (n=3) reported having no self-perceived skills gaps. 89% (n=62) identified paternalistic communication and weight stigmatization as barriers to mHealth use. Real-life/situational feedback for glucose control/variability was reported as the single largest facilitator of mHealth use (65%, n=46). Preferred communication strategies were empathy, concern, and compassion (81%, n=57), and informal, open, and direct (77%, n=54). Our results highlight that glucose control/variability is the principle unmet self-management need in T1D adults with IR. Several communication barriers negatively impact mHealth acceptability and efficacy in this group, particularly paternalistic and weight-stigmatizing language. mHealth solutions that target glycemic control/variability and are non-weight stigmatizing are urgently needed for people with T1D and IR.

Disclosure

A.R.Wilson: None. M.Farrar: None. M.D.Campbell: None.
718-P: Digital Health for Self-Management and Psychoeducational Support of Caregivers of Children with Type 1 Diabetes—A Feasibility Study
Authors: FERNANDEZ-LUQUE LUIS , DE ARRIBA ANTONIO , CIVITANI ELISA , PILAR FERRER MARIA , GARCÍA CASTELLANOS TERESA , LÓPEZ-GUIMET JÚLIA , QUER PALOMAS SILVIA
Published: June 2023

Becoming a caregiver of child with Type 1 Diabetes (T1D) involves understanding, accepting, and managing the new medical condition that may cause sleep deprivation, depression, anxiety, self-neglection, and poorer quality of life. Related to family caregiver fatigue, parental mental well-being has been associated with less effective parenting and poorer disease management of those kids. Digital Health programs can offer psychoeducational support to caregivers during family daily life, complementing medical care. The present study aims to better understand the barriers/facilitators to the adoption of a digital health solution for adaptive self-management. The digital solution provides a personalized digital program that includes motivational messages, educational units, mental well-being activities, and coaching services. A cohort of 20 caregivers of children with type 1 diabetes was recruited at a large pediatric hospital in Spain. Demographic and health data were recorded at baseline. After joining the program for 1 month, a SUS (System Usability Scale) questionnaire and a semi-structured interview were administrated. Preliminary results showed that the digital solution is widely useful in obtaining a SUS score of 95’38 out of 100 (SD 7’95) and achieved positive engagement outcomes. In the interviews, caregivers expressed that the educational units reinforced disease self-management. Mental health data at baseline exposed a high percentage of caregivers with symptoms of depression (25%), anxiety (35%), and stress (30%). These results highlight the importance of caregivers’ emotional wellness and the digital health solution's potential to empower them to self-manage during the disease. A subsequent study clinical study will evaluate the clinical impact of the digital intervention on a larger cohort during 2023.

Disclosure

L.Fernandez-luque: Other Relationship; Adhera Health Inc. A.De arriba: Board Member; Merck KGaA, Speaker's Bureau; Novo Nordisk. E.Civitani: None. M.Pilar ferrer: None. T.García castellanos: None. J.López-guimet: None. S.Quer palomas: Employee; AdheraHealth Inc.

Funding

Novo Nordisk Pharma S.A. (Spain)
741-P: Avoiding Type 2 Diabetes after Pancreas Transplantation—A Look into Pancreas Plasticity
Authors: MCCUNE KASI R.
Published: June 2023

Purpose: Weight gain often coincides with aging. Post pancreas transplant, can allografts compensate to the added body mass?

Methods: We conducted a retrospective review of pancreas transplant at CUIMC from 1/1/08-11/1/22. All were >18 yo and underwent simultaneous kidney pancreas transplant, pancreas after kidney, or pancreas alone. Patients with <1yr graft survival were excluded. We compared recipient and donor factors of recipients with functional grafts (FF) vs those with post-transplant graft dysfunction (PTGD).

Results: 121 patients were included. BMI at evaluation 24.2±3.2kg/m2. 11.6% had T2DM. Pre-operative A1C was 8.2±1.7%. Donor age was 24.7±11yo with BMI 23.7±6kg/m2. 20 (17%) of recipients developed PTGD defined as an A1C>6.5% or need for diabetes medication. 50% of PTGD had BMI gain >5kg/m2 vs 25% FF (p=0.01). Most recent A1C 6.8±4% PTGD vs 5.3±3.5% FF (p<0.01). Donor age was higher in PTGD vs FF (29.6±10.5 vs 23.7±10.9 yo, p=0.03) On subanalysis of those who increased BMI >5kg/m2, donor age >30yo was associated with PTGD (p=0.03) (Fig 1). Comparing donor age >or<30yo, odds of PTGD with BMI gain was 12X with donors >30yo vs 1.2X with donors <30yo. Factors associated with BMI increase were age <40yo at transplant and BMI >25kg/m2 at evaluation.

Conclusions: When transplanting a patient <40yo with a BMI>25kg/m2, consider that they have an increased risk of weight gain after transplant and use a graft <30yo.

Disclosure

K.R.Mccune: None.
749-P: Selection of BI 456906 as a Dual GCGR/GLP-1R Agonist Based on In Vitro Potency and In Vivo Target Engagement Biomarkers
Authors: AUGUSTIN ROBERT , THOMAS LEO , ZIMMERMANN TINA , SIMON ERIC , RIST WOLFGANG , UPHUES INGO , REINDL WOLFGANG , KLEIN THOMAS , NEUBAUER HEIKE
Published: June 2023

Glucagon (GCG) and glucagon-like peptide 1 (GLP-1) are peptide hormones that pharmacologically regulate bodyweight by increasing energy expenditure and reducing energy intake, respectively. Several dual (GCG receptor [GCGR]/GLP-1 receptor [GLP-1R]) agonistic peptides are in clinical development for obesity. We describe preclinical data leading to selection of BI 456906 as a dual agonist. Functional potencies of the compounds were determined in CHO-K1 cells stably expressing human GCGR and GLP-1R. EC50 for GCGR mediated cAMP increase were 0.52 nM for BI 456906, 0.92 nM for BI 456908 and 0.44 nM for BI 456987. EC50 for GLP-1R engagement were 0.33 nM, 0.61 nM and 1.43 nM, respectively. Upon acute, single dosing to lean mice, engagement of the GCGR and GLP-1R was determined by testing for improvement in oral glucose tolerance (30 nmol/kg) and increase in plasma FGF-21 and liver nicotinamide N-methyltransferase mRNA expression (100 nmol/kg), respectively. Specificity of the biomarkers was confirmed using the selective GLP-1R agonist semaglutide and GLP-1R knockout mice. Bodyweight and glucose lowering (HbA1c) efficacies were investigated in subchronic dosing studies in diet-induced obese (DIO) and diabetic (db/db) mice, respectively. In DIO mice, BI 456906 (30 nmol/kg qd), BI 456908 (30 nmol/kg qd) and BI 456897 (10 nmol/kg qd) achieved bodyweight lowering from baseline of 25%, 27%, and 26%, respectively. In db/db mice, BI 456906 and BI 456908 (10 and 20 nmol/kg qd) substantially lowered HbA1c (0.4-0.6%); no clear effect was observed for BI 456897 (3 and 7 nmol/kg qd). As a balanced GCGR/GLP-1R agonist with robust in vivo efficacy BI 456906 (30 nmol/kg qd) was further characterized, and superior bodyweight lowering (32% vs 27%; p<0.05) was seen versus a maximally effective semaglutide dose (100 nmol/kg qd). This was attributed to an increase in energy expenditure. The selected candidate, BI 456906, is currently in clinical development in people with obesity and NASH.

Disclosure

R.Augustin: None. L.Thomas: Employee; Boehringer Ingelheim Pharma GmbH&Co.KG. T.Zimmermann: Employee; Boehringer Ingelheim Pharma GmbH&Co.KG. E.Simon: Employee; Boehringer Ingelheim Pharma GmbH&Co.KG. W.Rist: None. I.Uphues: Employee; Boehringer Ingelheim Pharma GmbH&Co.KG. W.Reindl: None. T.Klein: Employee; Boehringer Ingelheim Pharma GmbH&Co.KG. H.Neubauer: None.

Funding

Zealand Pharma A/S; Boehringer Ingelheim