bluuebunny/crossref_metadata_2025 huggingface dataset:
527-P: Needs of mHealth Diabetes Services from Patients with Poorly Controlled Type 2 Diabetes Mellitus: A Qualitative Study
Authors: XIE QINQIN , CHENG LI
Published: May 2022

Aims: To explore the care needs to integrate mHealth technology to promote diabetes self-management engagement from the perspectives of patients with poorly controlled type 2 diabetes mellitus (T2DM) . Design: A phenomenological study using individual, semi-structured, face-to-face-based interviews.

Methods: Purposive sampling of 15 patients with poorly controlled T2DM were recruited from a tertiary hospital in Guangdong, China. Face-to-face semi-structured interviews were conducted to gain in-depth insight into the care needs regarding mHealth perceived by patients with poorly controlled type 2 diabetes. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using the thematic analysis approach.

Results: Four themes and fourteen subthemes emerged from the interview data: (1) informational needs (subthemes: symptoms management, self-care monitoring, complication prevention, and public awareness) , (2) emotional needs (subthemes: psychological flexibility and health coping) , (3) functional needs of mHealth services (subthemes: continuity of care, personalized coaching, family participation) , (4) technical needs related to online applications (subthemes: accessibility, convenience, efficiency, usability, and trustworthy)

Conclusion: This study shed light on the complex and changeable needs of patients with poorly controlled T2DM due to complications and comorbidities. Healthcare providers could incorporate the identified needs in the development of mHealth-based interventions to optimize the health outcomes of patients with poorly controlled type 2 diabetes. Keywords: poor glycemic control; type 2 diabetes mellitus; health needs; mHealth diabetes services.

Disclosure

Q.Xie: None. L.Cheng: None.

Funding

National Natural Science Foundation of China (Grant No.71904214)
536-P: Impact of Physical Activity (PA) and Macronutrient Intake on CGM Glucometrics in Youth with T1D
Authors: LA BANCA REBECCA O. , VOLKENING LISA K. , DASSAU EYAL , MEHTA SANJEEV N. , LAFFEL LORI M.
Published: May 2022

Aim: Maintaining in-range glucose on days with PA is challenging for youth with T1D, often requiring fine-tuning of diet and insulin. We examined how PA and macronutrient intake impact glycemic outcomes in youth with T1D.

Methods: Youth and parents completed 3-day PA and diet records and youth wore 3-day masked CGM (iPro) every 3 months for 18 months. Days were classified as active (≥60 min PA) or inactive. Diet data were analyzed using Nutrition Data System for Research (NDSR) . Daytime (6 AM-11:59 PM) CGM glucometrics were: % time (T) in range (TIR) 70-180 mg/dL, %T<70, %T>180, and glucose CV. Analyses included complete days for PA, diet, and CGM data. Separate longitudinal mixed models for daily carb, fat, and protein intake (adjusted for age, T1D duration, sex, pump vs. MDI) , assessed changes in glucometrics on active vs. inactive days.

Results: Youth (N=136, 49% male, 73% pump users) were ages 8-17 yrs (12.9±2.6) with T1D duration 6.0±3.1 yrs and daily insulin 0.9±0.3 U/kg. At baseline, A1c was 8.0±0.9%, daytime %TIR 50±22% (12.0 hrs) , %T<70 5±8% (1.2 hrs) , %T>180 44±25% (10.6 hrs) , CV 37±11%; macronutrient intake was 49±9% carb, 35±8% fat, 16±4% protein. In all models of macronutrient intakes, %TIR increased by ∼5.3% (76 min; p=.01) with pump use; by 2.8% (40 min; p=.02) on active days; by 1.4% (20 min; p=.03) with 10% increase in carb intake; and by 1.7% (24 min; p=.02) with 10% decrease in fat intake. PA and carb intake did not impact %T<70; %T<70 decreased by 0.6% (9 min; p=.03) with 10% increase in fat intake. PA did not impact %T>180; %T>180 decreased by ∼5.6% (81 min; p=.02) with pump use; by 1.7% (24 min; p=.02) with 10% increase in CHO intake; and by 2.2% (32 min; p=.01) with 10% decrease in fat intake. CV decreased by 1.3% on inactive days (p=.04) ; by 1.1% with 10% decrease in CHO intake (p<.01) ; and by 1.3% with 10% increase in fat intake (p<.01) .

Conclusion: PA and macronutrient intake have varying effects on glycemic outcomes. The findings reinforce the need to tailor insulin dosing algorithms for diet and PA.

Disclosure

R.O.La banca: None. L.K.Volkening: None. E.Dassau: Employee; Eli Lilly and Company, Research Support; Dexcom, Inc., JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; Eli Lilly and Company. S.N.Mehta: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Funding

National Institutes of Health (K12DK094721, P30DK036836) ; Iacocca Foundation
541-P: Patterns of Physical Activity and Cardiometabolic Risk in Hispanic/Latino Adults with or Vulnerable to Type 2 Diabetes
Authors: BEVIER WENDY C. , LAMUNION SAMUEL , ROACH MEGAN , GLANTZ NAMINO M. , LAREZ ARIANNA , CASTORINO KRISTIN N. , CHEN KONG Y. , KERR DAVID
Published: May 2022

While physical activity (PA) improves physical health, and wearable accelerometers clarify PA behavior, patterns of PA and cardiometabolic risk have not been well studied in ethnic minorities. In the Mil Familias observational cohort study of Hispanic/Latino adults with or at risk for type 2 diabetes (T2D) , PA was measured in 118 women and 59 men (age 56.9±10.6 years, mean±SD, HbA1c 7.1 [6.3, 9.2] %, median [IQR]) ; 150 had T2D (duration 12.2±8.2 years) . An ActiGraph wGT3X-BT was worn on the right hip 24 hours/day for 7 consecutive days (mean 4.5±1.8 days) with ≥hours waking wear time as a valid day. We found that study participants in the low HbA1c (<7.0%) had significantly less waking sedentary minutes (SED) per day than those with high (≥7.0%) HbA1c (see table) . For men, there were significant differences for time standing and sitting, levels of moderate to vigorous physical activity (MVPA) , and LDL cholesterol. In women with diabetes (n=103) , individual fasting HDL (50.7±11.7 mg/dL) was positively correlated with light physical activity minutes (266.0±66.8, r=0.3, p<0.05) . Also, sitting minutes (328±83.2) and standing minutes (352±97.4) correlated with waist circumference (100±12.9 cm) , r=0.2 & r=-0.2, p≤0.respectively. In these Hispanic/Latino adults, PA (from work and/or exercise) and SED time appear to have important cardiometabolic health implications.

Disclosure

W.C.Bevier: Research Support; Abbott Diabetes. S.Lamunion: None. M.Roach: None. N.M.Glantz: Research Support; Abbott. A.Larez: Research Support; Abbott. K.N.Castorino: Consultant; Lilly Diabetes, Research Support; Abbott Diabetes, Dexcom, Inc., Drawbridge Health, Inc., Eyenuk, Inc., Laxmi Therapeutic Devices, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Speaker's Bureau; Dexcom, Inc. K.Y.Chen: None. D.Kerr: Advisory Panel; Abbott Diabetes, Novo Nordisk A/S, Sanofi, Consultant; Evidation Health, Research Support; Novo Nordisk A/S, Stock/Shareholder; Glooko, Inc., Hi.Health.
557-P: Effect of Monocarbonyl Curcumin Analogues C66 and B2BrBC on Pancreatic Expression of Genes Related to Insulin Signaling Pathway and Oxidative Stress in Streptozotocin-Induced Diabetes
Authors: STOJCHEVSKI RADOSLAV , ANGELOVSKI MARIJA , VELICHKOVIKJ SARA , HADZI-PETRUSHEV NIKOLA , MLADENOV MITKO , BOGDANOV JANE B. , PORETSKY LEONID , AVTANSKI DIMITER
Published: May 2022

Curcumin has well documented beneficial effects against diabetes but its poor bioavailability limits its use. Here, we investigated the effects of two monocarbonyl curcumin analogues - (2E,6E) -2,6-bis[ (2-trifluoromethyl) benzylidene]cyclohexanone (C66) and (2E,6E) -2,6-bis (2-bromobenzylidene) cyclohexanone) (B2BrBC) - on the expression of genes involved in insulin signaling and oxidative stress in pancreas samples from streptozotocin (STZ) -induced diabetic rats. Animals were divided into two experiments: (Experiment 1) STZ injection (60 mg/kg) followed by 30 days treatment with C66 or B2BrBC (both 50 µmol/kg, daily) or (Experiment 2) single-dose treated with C66 or B2BrBC (125 µmol/kg) , 6 hours before STZ injection, and sacrifice after 72 hours. Quantitative RT-PCR analysis was used to assess the expression of: insulin (Ins1) , insulin receptor substrate 2 (Irs2) , Slc2a2 solute carrier family 2 member 2 (Slc2a2) (s. Glut2) , mitogen-activated protein kinase 14 (Mapk14) , protein kinase AMP-activated catalytic subunit alpha 1 (Prkaa1) , peroxisome proliferator-activator receptor gamma (Pparg) , BCL2 apoptosis regulator (Bcl2) , BCL2-associated X apoptosis regulator (Bax) , and NF-κB inhibitor alpha (Nfkbia) . Results demonstrated that when C66 and B2BrBC were administered at lower, chronic doses after STZ application (Experiment 1) , they both reversed the effect of STZ on Irs2 mRNA levels in the pancreas, with the effect of C66 being significantly higher. At higher, acute doses (Experiment 2) , C66 ameliorated Ins1 mRNA levels after STZ treatment. Also, although not statistically significant, at higher doses, both C66 and B2BrBC showed a trend to normalize the suppressing effect of STZ on Glut2 mRNA levels. Overall, our data demonstrate that these two monocarbonyl curcumin analogues have direct effects on the expression of insulin signaling pathway-related genes in the pancreas.

Disclosure

N. Hadzi-Petrushev: None. M. Mladenov: None. J.B. Bogdanov: None. L. Poretsky: None. D. Avtanski: None.

Funding

Gerald J. and Dorothy R. Friedman New York Foundation for Medical Research
560-P: Medical Nutrition Therapy Treatment for Gestational Diabetes
Authors: SHANKAR ANAND
Published: May 2022

Objective: Gestational Diabetes Mellitus (GDM) is a controversial disorder that can be defined as glucose intolerance or obesity in offspring or unfortunate perinatal complications and outcomes. Inadequate treatment of GDM might lead to foetal complications. This study will aim at assessing the effects of Medical Nutritional Therapy (MNT) as a treatment therapy for pregnant women with gestational diabetes.

Methods: This study was conducted in two center between March to July 2021. A total of 76 patients had been evaluated among whom 20 women had been diagnosed with GDM while the other 56 women had normal tolerance for glucose. Women diagnosed with GDM had received medical nutrition therapy with recommended nuts and olive oil intake.

Results: The HbA1C level of the GDW women (5.1% ± 0.3% (32 ± 0.9 mmol/mol) was higher as opposed to those with Normal tolerance for glucose (NGT) (4.9% ± 0.3% (30 ± 0.9 mmol/mol) , p = 0.001) . In a similar manner, the insulin resistance among the GDM women (24-28 GWs, p = 0.001) was higher. The total weight gain during the pregnancy period was lesser in comparison with the NGT women. Along with these, occurrences of adverse events during pregnancy were lesser among GDW women.

Conclusion: With the help of Medical Nutrition therapy during gestational diabetes management, the outcomes of pregnancies among GDW women can be made similar to those

with NGT. MNT is an effective treatment since it reduces pregnancy complications and enhances outcomes.

Disclosure

A.Shankar: None.
563-P: A Community Health Worker–Led Hypertension and Diabetes Management Program for South Asians in Atlanta: The DREAM Atlanta Study
Authors: SHAH MEGHA K. , WYATT LAURA , GIBBS CHRISTINA C. , MAMMEN SHINU , MOHSIN FARHAN M. , ISLAM NADIA
Published: May 2022

Background: South Asians are disproportionately affected by type 2 diabetes (DMII) and comorbid hypertension (HTN) , which increases the risk of stroke and myocardial infarction. In Atlanta, South Asians represent one of the fastest growing immigrant populations. Community health worker (CHW) interventions have been shown to improve chronic disease outcomes, yet few tailored interventions have addressed the high burden of cardiovascular disease among South Asians.

Objective: To test the effectiveness of an evidence-based, CHW-led, and culturally-tailored HTN and DMII management program for South Asian adults with DMII and comorbid HTN.

Methods and Study Design: Randomized-Waitlist Controlled Trial Setting/intervention: The treatment group received 5 group virtual DMII and HTN education sessions as well as 2 one-on-one goal setting sessions. The waitlist control group received 3 group virtual sessions at the end of study.

Measures: Primary outcomes included feasibility, acceptability, and change in BP control (systolic blood pressure (SBP) <130 and diastolic blood pressure (DBP) <80) . Secondary outcomes included changes in glycated hemoglobin (HbA1c) , weight, diabetes self-efficacy, healthy eating, and physical activity.

Results: A total of 199 South Asian adults were randomized to treatment or control groups. At 6-month follow-up, 40.2% of the treatment group had controlled BP, compared to 24.2% of the control group (p=0.020) . Absolute change in mean SBP and DBP was significantly greater for the treatment group vs. control group. Weight change was -4.8lbs in the treatment group, compared to +0.6lbs in the control group (p=0.007) . The intervention had an overall retention of 95% (treatment = 92, control=91) .

Conclusions: A culturally-tailored CHW-led intervention is feasible, acceptable, and can significantly improve diabetes and HTN among South Asians. Further study will evaluate the implementation and scalability of the intervention.

Disclosure

M.K.Shah: None. L.Wyatt: None. C.C.Gibbs: None. S.Mammen: None. F.M.Mohsin: None. N.Islam: None.

Funding

NIMHD: K23 MD015088-and 3U54MD000538-17S1
57-LB: Evaluating the Receptiveness to Wear Flash Glucose Monitoring System (FGMS) Sensors in People with Prediabetes—A Feasibility and Acceptability Study
Authors: LEE JOYCE Y. , NGUYEN JENNY T. , ARROYO JEFFREY , TRAN TRACEY , HANAMI DYLAN , MAYORGA JOSE
Published: May 2022

Flash glucose monitoring system (FGMS) may empower people with prediabetes to become more aware of their glucose impairment, allowing timely lifestyle modification and diabetes prevention. This study aimed to evaluate the feasibility and acceptability of wearing FGMS sensors in people with prediabetes.

We conducted a single-arm, prospective study in two federally qualified health center sites where people with prediabetes were invited to wear FGMS sensors for 28 days through provider referral. Participants with contraindications to wearing sensors were excluded. Feasibility was measured through recruitment rate and total days of sensor wear. Acceptability was measured through a semi-structured interview conducted at the end of the study.

Between July and Dec 2021, a total of 135 eligible participants were identified and referred, of which 46 were uncontactable, 13 were undecided and 45 declined due to disinterest or lack of time, leaving a total of 31 subjects (17 males, 14 females) entering the study. The mean age and duration of prediabetes were 52 and 1.5 years, respectively. The average duration of sensor wear was 25 days. All subjects completed the semi-structured interview with 29 (95%) subjects recommending sensor wear for people with prediabetes.

In conclusion, our study showed that wearing FGMS sensors appeared receptive, with 1 in every 3 contactable persons with prediabetes willing to wear FGMS sensors and reporting positive behavior change.

Disclosure

J. Y. Lee: None. J. T. Nguyen: None. J. Arroyo: None. T. Tran: None. D. Hanami: None. J. Mayorga: None.

Funding

National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (UL1 TR0001414) . The content is solely the responsibility of the authors and does not necessarilyrepresent the official views of the NIH.
570-P: Household Food Insecurity, Stress, and Anxiety among Youth and Young Adults with Diabetes
Authors: BROWN ANDREA D. , MENDOZA JASON A. , FRONGILLO EDWARD A. , FLORY KATE , REBOUSSIN BETH A. , JENSEN ELIZABETH T. , DOLAN LAWRENCE M. , BELLATORRE ANNA , MALIK FAISAL , MARCOVINA SANTICA M. , PIHOKER CATHERINE , LIESE ANGELA D.
Published: May 2022

Although household food insecurity (HFI) has been associated with depressive symptoms in youth and young adults (YYA) with youth-onset diabetes, little is known about the association of HFI with other mental health comorbidities. We examined the association of HFI with stress and anxiety symptoms among YYA with diabetes using cross-sectional data from the SEARCH Food Security Cohort study (assessments conducted 2018-2020; n = 1030, age =23.8± 0.3, female =58.8%, type 1 diabetes (T1D) = 881, type 2 diabetes (T2D) =149) . HFI was defined as 3+ affirmations on the USDA Household Food Security Survey Module. The Generalized Anxiety Disorder (GAD-7) and Cohen’s Perceived Stress Scale (PSS-14) were used to assess outcomes of anxiety (score range 0-21) and stress (score range 0-56) , higher scores indicating greater anxiety or stress. Linear regression models were adjusted for age, sex, race/ethnicity, site, diabetes duration, parental education, income, and whether assessment was completed pre/post the coronavirus pandemic. Analyses were stratified by diabetes type. HFI was present in 17.3% of T1D and 35.6 % of T2D. Moderate/severe anxiety symptom scores (range 10-21) were found in 27.5 % (mean=6.9, s.d. =5.5) of T1D and 40.9% (mean=8.4, s.d. =6.5) of T2D. Mean stress scores were 26.7 (s.d.=6.3) for T1D and 27.9 (s.d.=6.3) for T2D. In T1D, HFI was associated with higher anxiety (β=4.8, p=<0.0001) and stress (β=4.9, p=<0.0001) symptom scores compared to those with food security adjusted for covariates. Among T2D, HFI was associated with greater anxiety symptoms (β=2.8, p=0.0247) but no association was observed with stress. These findings suggest that assessing and alleviating HFI may help improve stress and anxiety among YYA with diabetes, and further study is warranted to determine associations over time.

Disclosure

A.D.Brown: n/a. S.M.Marcovina: None. C.Pihoker: None. A.D.Liese: None. J.A.Mendoza: None. E.A.Frongillo: None. K.Flory: None. B.A.Reboussin: None. E.T.Jensen: Consultant; Regeneron Pharmaceuticals Inc. L.M.Dolan: None. A.Bellatorre: None. F.Malik: n/a.

Funding

NIH/NIDDK (1R01DK117461-01) ; NIH/NIDDK/CDC (1UC4DK108173) ; NIH/NIGMS (T32-GM081740)
574-P: Meta-analysis Shows Mind- and Body-Based Interventions Improve Glycemic Control in Patients with Type 2 Diabetes
Authors: SANOGO FATIMATA , XU KEREN , CORTESSIS VICTORIA K. , WEIGENSBERG MARC , WATANABE RICHARD M.
Published: May 2022

Only 57% of type 2 diabetes (T2D) patients achieve HbA1c <7%. Mind and body practices (MBP) are increasingly used to improve glycemic control inT2D, but individual studies show inconsistent efficacy. We performed a meta-analysis of MBP to assess their overall effect to improve glycemia in patients with T2D. We identified 489 articles with 25 having required HbA1c or fasting glucose measures and meeting other inclusion criteria. Interventions included yoga (n=16) , meditation (n=2) , Qigong (n=2) , guided imagery (n=1) , and mindfulness-based stress reduction (n=4) . We used restricted maximum likelihood random effects modeling to combine individual study results and estimate weighted means and 95% confidence intervals. Heterogeneity was assessed Cochran's Q and I2, bias assessed by funnel plots, and potential sources of heterogeneity assessed using meta regression. Overall, there was a statistically significant and clinically relevant mean reduction in HbA1C (‑0.94%; 95% CI: (-1.23%, -0.65%) ; p=5.4x10-10) . We observed a similar significant mean reduction in fasting glucose (-22.4 mg/dl; 95% CI: (-33.4, -11.6 mg/dl) ; p=5.4x10-5) . Funnel plots revealed no evidence for bias. Significant heterogeneity was observed (Q=71.2; p=2.3x10-9) , which could not be accounted for by variation in duration of the individual interventions (p=0.32) . We conclude MBP results in clinically significant improvement in glycemic control and may be an effective tool to treat patients with T2D.

Disclosure

F.Sanogo: None. K.Xu: None. V.K.Cortessis: None. M.Weigensberg: None. R.M.Watanabe: None.
58-LB: Antidiabetic Effects of Pediococcus acidilactici pA1c on HFD-Induced Mice
Authors: CABELLO MIRIAM , ONECA MARÍA , PAJARES MARIA J. , AYO JOSUNE , ENCÍO IGNACIO J. , ARAÑA MIRIAM , BARAJAS MIGUEL
Published: May 2022

Prediabetes (PreD) , which is associated with impaired glucose tolerance and fasting blood glucose, is a potential risk factor for type 2 diabetes mellitus (T2D) . Growing evidence suggests the role of the gastrointestinal microbiota in both PreD and T2D, which opens the possibility for a novel nutritional approach, based on probiotics, for improving glucose regulation and delaying disease progression of PreD to T2D. In this light, the present study aimed to assess the antidiabetic properties of Pediococcus acidilactici pA1c (pA1c) in a murine model of high-fat diet (HFD) -induced T2D. For that purpose, C57BL/6 mice were given HFD enriched with either probiotic (1×10E10 CFU/day) or placebo for 12 weeks. We determined body weight, fasting blood glucose, glucose tolerance, HOMA-IR and HOMA-β index, C-peptide, GLP-1, leptin, and lipid profile. We also measured hepatic gene expression (G6P, PEPCK, GCK, IL-1β, and IL-6) and ex-amined pancreatic and intestinal histology (% of GLP-1+ cells, % of goblet cells and villus length) . We found that pA1c supplementation significantly attenuated body weight gain, mitigated glucose dysregulation by reducing fasting blood glucose levels, glucose tolerance test, leptin levels, and insulin resistance, increased C-peptide and GLP-1 levels, enhanced pancreatic function, and improved intestinal histology. These findings indicate that pA1c improved HFD-induced T2D derived insulin resistance and intestinal histology, as well as protected from body weight increase. Together, our study proposes that pA1c may be a promising new dietary management strategy to improve metabolic disorders in PreD and T2D.

Disclosure

M. Cabello: None. M. Oneca: Employee; GENBIOMA APLICACIONES SL. M. J. Pajares: None. J. Ayo: Board Member; Genbioma Aplicaciones S. L., Employee; Genbioma Aplicaciones S. L. I. J. Encío: Other Relationship; Genbioma Aplicaciones SL. M. Araña: None. M. Barajas: None.

Funding

Government of Navarre (Ref 0011-1365-2020-000290) and the European Regional Development Fund (ERDF) . Maria Oneca is supported by Torres-Quevedo grants from the Spanish Ministry of Science and innovation (Ayudas para contratos Torres Quevedo PTQ2019-010384/AEI/10.13039/501100011033)
582-P: Process Evaluation of Dulce Digital–Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes
Authors: SPIERLING BAGSIC SAMANTHA R. , SAVIN KIMBERLY L. , SORIANO EMILY , SAN DIEGO EMILY ROSE N. , ORENDAIN NATALIA , CLARK TAYLOR , SANDOVAL HALEY , CHICHMARENKO MARIYA , PEREZ-RAMIREZ PERLA , FARCAS EMILIA , GODINO JOB G. , PHILIS-TSIMIKAS ATHENA , GALLO LINDA , FORTMANN ADDIE L.
Published: May 2022

Diabetes self-management education and support improves clinical outcomes in populations disproportionately impacted by type 2 diabetes, including ethnic/racial minorities and individuals of low socioeconomic status. Mobile health (mHealth) interventions have been shown to reduce barriers to accessing these services. The Dulce Digital-Me study sought to integrate adaptive mHealth technologies into diabetes management to enhance self-management support and reduce inequities. This process evaluation uses the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. The study was effective in reaching a sample that was representative of the intended population, with no differences in baseline clinical characteristics (HbA1c, systolic blood pressure, or LDL cholesterol) between eligible participants who did not (N=261) versus did (N=310) enroll in the study (ps>0.15) . A key informant interview revealed that the medical assistant health coach (MA) found the adoption of the study to be successful in positively impacting patients’ diabetes self-management. Participants across study arms had no significant differences in delivery of mHealth content (ps>0.07) , demonstrating that the intervention was implemented with fidelity. Participants who received Dulce Digital-Me with additional support from an MA were most engaged in responses to ecological momentary assessment prompts (p<0.02) , suggesting utility and acceptability of integrating medical assistants with mHealth interventions. Perceptions of implementation among study participants were positive—with 93% of all participants reporting that the intervention was helpful in managing their diabetes—and were consistent across study arms (p=0.7) . Further studies are warranted to evaluate the efficacy and maintenance of the study following the RE-AIM model to determine whether this intervention warrants expansion to additional settings and patient populations.

Disclosure

S.R.Spierling bagsic: None. E.Farcas: None. J.G.Godino: None. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. L.Gallo: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. K.L.Savin: None. E.Soriano: None. E.N.San diego: None. N.Orendain: None. T.Clark: None. H.Sandoval: None. M.Chichmarenko: None. P.Perez-ramirez: None.

Funding

National Institutes of Health, NIDDK: (R01DK112322) National Institutes of Health, NCATS: (UL1TR002550 & KL2TR002552)
588-P: Examining Psychosocial and Comorbidity Factors Associated with Diabetes Distress among Medicaid Beneficiaries
Authors: VERDECIAS NIKO , MCQUEEN AMY , SMITH RACHEL E. , KREUTER MATTHEW
Published: May 2022

Evidence supports diabetes distress’ (distress hereafter) effect on diabetes self-management. Few studies have examined factors that influence distress. We used self-reported cross-sectional data from Medicaid beneficiaries in Louisiana to examine psychosocial and clinical factors and their associations with distress. The sample (n=345) was mostly female (75%) , age >45 (77%) , Black (65%) , >years since diabetes diagnosis (51%) , had A1c values ≥7.0% (46%) or unknown (30%) , high distress (71%) , ≥1 social needs (94%) , poor self-rated health (68%) , lower stress (54%) and depression (51%) , more social support (56%) , high # of comorbidities (7.3 ± 2.9) and burden (21.2 ± 11.3) , medication adherence challenges (21%) , and moderately strong self-efficacy (56.0 ± 15.1) . Correlations revealed time since diabetes diagnosis (r= -.11, p<.05) , social support (r= -.28, p<.001) , and self-efficacy (r= -.34, p<.001) were inversely associated with distress. While unemployment (r=.13, p<.05) , A1c (r=.19, p<.05) , more social needs (r=.12, p<.05) , worse self-rated health (r=.32, p<.001) , more stress (r=.16, p<.05) and depression (r=.52, p<.001) , more comorbidities (r=.28, p<.001) and burden (r=.41, p<.001) , and poor medication adherence (r=.19, p<.001) were positively correlated with distress. A multiple linear regression model explained 36% of the variance in distress. Significant factors of distress were less time since diabetes diagnosis (β=-.04, p<.05) , higher A1c (β=.94, p<.05) , higher depression (β=.57, p<.001) , more comorbidity burden (β=.06, p<.001) , and lower self-efficacy (β=-.04, p<.001) . Findings suggest key modifiable factors that may increase distress, warranting research examining strategies to screen and address such factors to improve diabetes self-management.

Disclosure

N.Verdecias: None. A.Mcqueen: None. R.E.Smith: n/a. M.Kreuter: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK115916)
589-P: Health Disparities among People with and without Diabetes during COVID-19: An 18-Month Evaluation
Authors: MYERS BARBARA A. , KLINGENSMITH RACHEL , CASANOVA INES GONZALEZ , DE GROOT MARY
Published: May 2022

This study describes the mental health of US adults with and without diabetes (ND) over an 18-month period of the COVID-pandemic. A 12-month web-based survey was administered in May 2020 (N = 2,176) to June 2021 and November 2021 (18MO; N = 1,192) including demographics, pandemic experiences, depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS) , and resilience (BRS) . Mean age of 18MO Completers (55%) was 53 years (SD = 16.4) , primarily female (80%) , White (91%) , with an annual household income of ≥ $60,000 (58%) . 165 had type 2 diabetes (T2D; 14%) , 83 had prediabetes (7%) , and 56 had type 1 (T1D; 5%) . Completers were more likely to be White, educated (45% post-master’s degree) , and homeowners with fewer medical and emotional comorbidities at baseline than non-completers (all p<.05) . At 18MO, mean PHQ-8 score was 5.2 (SD = 5.3; mild) , GAD-7 was 4.1 (SD = 4.8) , PSS was 13.2 (SD = 5.5) . All improved from baseline (p<.001) . Ages 18-30 had the highest scores on anxiety (M = 6.1; SD = 5.4) and perceived stress (M = 16.5; SD = 8.3) compared to other age groups (p<.001) . At 18MO, rates of COVID-infection (9.1%; p<.001) , knowing someone with COVID- (86.7%) , loss from COVID- (40.7%) and pandemic burnout (M = 2.6, SD = 2.1) were increased. Greatest burnout was reported by women (M = 2.9, SD = 2.1) , 18-30 y.o.s (M = 3.5, SD = 2.0) and T1Ds (M = 3.5, SD = 1.7) , all p<.05. Financial disparities persisted at all time points. At 18MO, women (15.98%) and Latinos (28.57%) reported difficulty paying monthly bills (p<.001) . Asian/American Indian/Multiracial (23.73%) subgroup reported worsening financial situations compared to Whites (p<.001) . 51-64 y.o.s reported difficulty paying bills (20.4%) , less financial optimism (13.4%) and worsening financial situation (21.45%) compared to other age groups (p<.001) . Over 18 months, mental health outcomes improved slightly while gender, age, ethnic and racial disparities persisted as personal exposure to COVID-and pandemic burnout increased.

Disclosure

B.A.Myers: None. R.Klingensmith: None. I.Gonzalez casanova: None. M.De groot: None.

Funding

Indiana University Diabetes Translational Research Center
59-OR: Long-Term Sustainability and Durability of Diabetes Prevention via Nutritional Intervention
Authors: MCKENZIE AMY L. , ATHINARAYANAN SHAMINIE J. , VANTIEGHEM MICHELLE , VOLK BRITTANIE M. , ADAMS REBECCA N. , ROBERTS CAROLINE G.P. , FELL BRANDON , RATNER ROBERT E. , VOLEK JEFF , PHINNEY STEPHEN , HALLBERG SARAH
Published: May 2022

The national Diabetes Prevention Program (nDPP) failed to translate the efficacy of the Diabetes Prevention Program (DPP) into real world effectiveness. We initiated a prevention program, previously publishing outcomes on 96 patients with prediabetes over two years with 75% retention. This single center observational trial examines the effectiveness of a very low carbohydrate intervention (VLCI) including nutritional ketosis delivered via a continuous remote care (CRC) model; here, we report sustainability and durability at 5 years. At completion of the 2-year trial, 58 of the original cohort (80%) renewed consent and 78% completed the 5 year follow-up. At baseline, all had prediabetes, with mean weight 109 kg and mean BMI 38.9 kg/m2. Using intention to treat analysis at 5 years, 22% regressed to normoglycemia, 13% progressed to diabetes, and 65% remained prediabetes. A1c remained unchanged (mean 5.9%) , and mean fasting glucose fell from 112 to 108 mg/dl (p=NS). Weight fell from 1 to 103 kg (p<0.001) , with insulin resistance falling from a HOMA-IR of 6.1 to 4.7 (p<0.05) . The nDPP utilizes 5% weight loss as a surrogate outcome for prevention. Forty-eight percent of the sample met that criteria at 5 years, with 19% achieving a 5-9.9% weight loss, 19% a 10-19.9% weight loss, and 10% with at least 20% weight loss. There was a 30% reduction in class 3 obesity (BMI ≥40) , contributing to a 2.7 fold increase in those now overweight (BMI 25-29.9). These results show that a VLCI delivered via CRC is sustainable in prediabetes, resulting in normalization of A1c without medication in over 20% with limited glycemic deterioration to the diabetes threshold. No other real world intervention has presented glycemic data on diabetes prevention, but only reported surrogate weight change as an outcome. Over 5 years, almost half of the cohort achieved that surrogate with significant population shifts to lower obesity classes. The promise of the DPP is met via telehealth-supported VLCI and is sustainable over the long term.

Disclosure

A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.Phinney: Employee; Virta Health Corp. S.Hallberg: Advisory Panel; Atkins Nutritionals Inc., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.J.Athinarayanan: Employee; Virta Health Corp. M.Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.Fell: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.E.Ratner: Employee; Virta Health Corp. J.Volek: Advisory Panel; Abbott Diagnostics, Simply Good Foods, Stock/Shareholder; Virta Health Corp.
591-P: Green Diabetes: What Do People with Diabetes Think about Packaging Waste and Sustainability?
Authors: HEINEMANN LUTZ , EHRMANN DOMINIC , ROOS TIMM , HERMANNS NORBERT , KULZER BERNHARD
Published: May 2022

Aims: More and more people with diabetes (PwD) are paying attention to the waste associated with new technologies and want more sustainable concepts for waste prevention and a positive ecological footprint. So far, there are little results on the importance people with diabetes attach to the issue of sustainability and environmental compatibility. In an online survey, we wanted to determine the extent of these wishes and ecological needs of PwD.

Methods: PwD in Germany were asked via online surveys (2.417 PwD; 47.5% female, 57.8% type 1 diabetes (T1D) , 20.7% type 2 diabetes (T2D) , 19.0% parents of children with diabetes; Ø 47.7 years) .

Results: For more than half of all respondents, the topic of packaging waste is important (54.5%) , two out of three respondents say they would like to see more reusable utensils in diabetes therapy (67.1%) . However, the amount of packaging waste in diabetes technologies does not seem to be a decision criterion for most PwD when selecting modern technologies - this is only significant for 15% (TSD 21,9%) . Overall, there were only slight differences between the groups of PwD.

Conclusions: Ecological aspects are becoming increasingly important in diabetes therapy: most PwD are concerned about the issue of packaging waste in diabetes technologies and would like to see more recyclable utensils for their diabetes therapy. Although the number of respondents who consider the amount of packaging waste to be a decisive criterion for the choice of a diabetes technology is low - among people with type 2 diabetes, however, this is already around one in five persons.

Disclosure

L.Heinemann: Board Member; Lifecare, Inc., Consultant; Becton, Dickinson and Company, Roche Diabetes Care, Stock/Shareholder; Profil Institut für Stoffwechselforschung GmbH, Science Consulting in Diabetes GmbH. D.Ehrmann: Advisory Panel; Dexcom, Inc., Consultant; mySugr, Roche Diabetes Care, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. N.Hermanns: Advisory Panel; Abbott Diabetes, Research Support; Becton, Dickinson and Company, Roche Diagnostics, Speaker's Bureau; Berlin-Chemie AG, Novo Nordisk, Sanofi. B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care.
592-P: Living with Type 1 Diabetes (T1DM) as an Older Adult: A Qualitative Study Examining Experiences and Attitudes about Continuous Glucose Monitoring (CGM)
Authors: KAHKOSKA ANNA , CRISTELLO ANGELICA , SMITH CAMBRAY , THOMAS SHARITA R. , BATSIS JOHN , MAYER-DAVIS ELIZABETH J. , KOSOROK MICHAEL R. , PRATLEY RICHARD E. , WEINSTOCK RUTH S. , YOUNG LAURA A. , LICH KRISTEN HASSMILLER
Published: May 2022

There is a growing population of adults over the age of 65 years with T1DM, but their lived experiences have not been well-characterized, especially in the context of evolving advances in self-management technology. We conducted focus groups with adults 65+ yrs with T1DM to characterize their perspectives surrounding T1DM and its management, focusing on CGM experiences. Participants were recruited from a US academic medical center and encouraged to bring a caregiver. Focus groups were stratified by CGM use, facilitated by standardized questions, audiotaped and transcribed. A team-based, inductive coding approach using ATLAS.ti identified themes. There were 33 adults (mean age 73.3±4.3 years [range 66-85]; 55% women, 82% non-Hispanic white, 12% non-CGM users, 83% pump users, 12% caregivers) . Five CGM-related themes were identified from all participants, including adoption challenges and complex clinical and psychosocial effects (Table) . Caregiver participants emphasized increased security with CGM use. Patient participants expressed a prevalent “survivor” mentality and a desire for increased peer support and strategies to minimize intrusiveness of T1DM management. Findings reinforce that older adults’ experiences with T1DM and CGM necessitate individualized psychosocial and tactical support for management and adoption of new technology.

Disclosure

A.Kahkoska: None. L.A.Young: Research Support; Bayer AG, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, vTv Therapeutics. K.Hassmiller lich: None. A.Cristello: None. C.Smith: None. S.R.Thomas: None. J.Batsis: None. E.J.Mayer-davis: None. M.R.Kosorok: n/a. R.E.Pratley: Other Relationship; Bayer AG, Corcept Therapeutics, Dexcom, Inc., Hanmi Pharm. Co., Ltd., Merck & Co., Inc., Metavention, Novo Nordisk, Pfizer Inc., Poxel SA, Sanofi, Scohia Pharma Inc., Sun Pharmaceutical Industries Ltd. R.S.Weinstock: Research Support; Boehringer Ingelheim International GmbH, Dexcom, Inc., Diasome, Eli Lilly and Company, Insulet Corporation, Kowa Pharmaceuticals America, Inc., Medtronic, Novo Nordisk, Tandem Diabetes Care, Inc., Tolerion, Inc.

Funding

ARK is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR002490. The project was supported by UL1TR002489 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
598-P: Discussion Recall in Diabetes Care Visits with Young Adults with T1 Diabetes
Authors: MONAGHAN MAUREEN , BRYANT BREANA , WANG CHRISTINE H. , STREISAND RANDI
Published: May 2022

Introduction: Engagement in and recall of clinical discussions is a key component of patient-centered care. We evaluated frequency and agreement on discussion topics between young adults (YAs) with type 1 diabetes (T1D) and their health care provider (HCP) .

Methods: 52 YAs (51.9% female; 48.1% non-Hispanic White (NHW) ; M age = 20.6±1.1 yrs; M T1D duration = 10.9±4.7 yrs; M A1c = 8.2±1.8%) and 9 HCPs (5 MDs; 4 NPs; 100% female) enrolled in a randomized trial to improve health communication skills in YAs preparing for adult T1D care. At baseline, YAs reported demographic information; after the baseline clinic visit, YAs and HCPs separately completed a checklist of topics discussed and rated satisfaction with the visit. Topic frequency and agreement between YAs and HCPs were calculated. Independent samples t-tests and correlations evaluated associations among demographic and clinical characteristics, discussion topics, and agreement.

Results: YAs and HCPs had adequate agreement (M = 76.4%; Table 1) . Agreement was not associated with YA gender, age, T1D duration, A1c, or overall visit satisfaction. YAs of color had significantly higher agreement with HCPs than NHW YAs (81.4% vs. 70.8%; t (50) =2.3, p<.05) .

Conclusions: Results highlight YA engagement and frequency of developmentally important topics in routine T1D visits. Communication plans may improve frequency of topics raised and recall, and will be evaluated in future research.

Disclosure

M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.Bryant: None. C.H.Wang: None. R.Streisand: None.

Funding

American Diabetes Association (1-18-ACE-27) ;
600-P: Examining Beliefs about Type 2 Diabetes Medications: A Multidimensional Approach
Authors: ASMAN ARIELLE G. , PHILLIPS LEIGH A. , WALKER ELIZABETH A. , PAPPALARDO LINDSEY D. , GONZALEZ JEFFREY S.
Published: May 2022

Background: Beliefs about type 2 diabetes (T2D) medications predict treatment adherence; yet, factors that influence these beliefs are poorly understood. Further, prior studies reduce the complex interplay between beliefs about treatment necessity and medication-related concerns to a single dimension by using a difference score. This study examined correlates of T2D medication beliefs and modeled the multidimensional associations of beliefs and adherence.

Methods: Participants were 812 primarily disadvantaged and ethnic minority adults with T2D (Female = 56.9%; Latino = 86.5%; Mean [SD] Age and A1C = 59.2 [10.8], 9.3 [1.8], respectively) recruited for a self-management trial. Informed by the Common Sense Model and prior research, relations of patient- and illness-related factors with medication beliefs (Horne, Weinman, Hankins, 1999) were examined using linear regression. Confirmatory and exploratory polynomial regression examined associations of medication beliefs and self-reported adherence.

Results: Hispanic ethnicity (p < .01) , insulin use (p < .05) , greater number of medications (p < .05) , and lower levels of education (p < .05) were associated with stronger necessity beliefs. Lower income (p < .05) and Hispanic ethnicity (p < .01) were associated with greater concerns. Adherence was lowest among those with strong concerns and weak necessity beliefs. Non-reciprocal effects were also observed, which could not have been assessed using a difference score. Patients with ambivalent beliefs had lower adherence than those with indifferent beliefs.

Discussion: Indicators of lower SES were associated with concerns about T2D medications. Increased disease severity and Hispanic ethnicity were associated with stronger necessity beliefs. However, Hispanics also reported more concerns about their medications. Results further support use of polynomial regression to assess medication beliefs and adherence. Addressing concerns, in particular, may enhance T2D medication adherence.

Disclosure

A.G.Asman: None. L.A.Phillips: None. E.A.Walker: None. L.D.Pappalardo: None. J.S.Gonzalez: Consultant; Virta Health Corp.

Funding

National Institutes of Health (R18 DK098742) Einstein–Mount Sinai Diabetes Research Center (P30 DK020541) New York Regional Center for Diabetes Translation Research (P30 DK111022) J.S.G. is supported by National Institutes of Health (RDK104845, RDK121298, RDK121896)
607-P: Gender Differences in the Relationship between Financial Barriers and Emergency Department Visits due to Diabetes
Authors: AKINBOBOYE OLAITAN J. , EGEDE LEONARD E. , THORGERSON ABIGAIL , WILLIAMS JONI S.
Published: May 2022

Background: This study assessed gender differences in the relationship between financial barriers and Emergency Department (ED) visits due to diabetes in a sample of adults with diabetes.

Methods: Data from 1,278 patients (weighted=3,500,000) in the 2014 Health Center Patient Survey (HCPS) were analyzed. Financial barrier was measured by summing ‘yes’ responses from the following questions: “In the last 12 months, were you unable to get medical care, tests, or treatments you or a doctor believed necessary?.” and “In the last 12 months, were you unable to get prescription medicines you or a doctor believed necessary?.” ED visits due to diabetes were measured using the question: “In the past 12 months, have you been in the hospital or visited an emergency room because of diabetes?”. Logistic regression was used to assess the association between financial barriers and ED visits due to diabetes by gender.

Results: There was a statistically significant relationship between financial barriers and ED visits due to diabetes among men. In the adjusted model, the odds of ED visits due to diabetes was 5.66 times higher in men with one or more financial barrier than in men with no financial barrier (OR= 5.66, p=0.002) . Among women, financial barriers were not significantly associated with ED visits due to diabetes in the adjusted model.

Conclusions: Our study shows that financial barriers drive ED visits due to diabetes among men but not women. Policy interventions should be developed to target vulnerable groups with diabetes, and future studies should elucidate the mechanisms responsible for the differences observed in this study.

Disclosure

O.J.Akinboboye: None. L.E.Egede: None. A.Thorgerson: None. J.S.Williams: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases K24Dk093699 (PI: Leonard E. Egede, MD, MS) , R01DK118038 (PI: Leonard E. Egede, MD, MS) , and R01DK120861 (PI: Leonard E. Egede, MD, MS) and R21DK123720 (PI: Joni S. Williams, MD, MPH) .
609-P: Virtual Peer Groups (VPG) for Adolescents and Young Adults (AYA) with Type 1 Diabetes (T1D) : Patient-Reported Importance of Specific Features
Authors: BISNO DANIEL I. , PYATAK ELIZABETH , REID MARK W. , FOX D. STEVEN , FOGEL JENNIFER L. , SALCEDO-RODRIGUEZ ELIZABETH , FLORES GARCIA JAQUELIN J. , SANCHEZ ALEJANDRA TORRES , RAYMOND JENNIFER
Published: May 2022

Background: VPG have been shown to improve psychosocial well-being in AYA with T1D, but it is unknown what aspects of VPG are most or least valued.

Methods: CoYoT1 to California is a 15 month randomized controlled trial for patients ages 16-25 with T1D. AYA received Usual Care (n=28) or CoYoT1 Care (n=40) , which consisted of patient-centered provider visits and bimonthly VPG led by a YA with T1D. VPG were AYA-driven discussions focused on topics pertinent to AYA with T1D, emphasizing problem-solving and emotional support. At study end, VPG participants responded to a survey about their preferences for intervention features.

Results: CoYoT1 Care patients were 40% female, 53% Latinx, and 72% publicly insured; and they attended 1.9 VPG each on average. AYA who attended at least one VPG participated in 4.1 VPG on average. The average session had 4.5 AYA present; each topic was covered by 9.6 AYA on average. Most survey respondents (75%) reported VPG were extremely or very valuable in supporting their T1D care. Seeing peers use diabetes technology and being supported by same-aged peers with T1D increased VPG value the most. Larger group size and not feeling comfortable sharing decreased value the most.

Conclusion: Peer interactions may support unmet needs of AYA with T1D from diverse backgrounds. Further work will help optimize the design of VPG based on patient preferences.

Disclosure

D.I.Bisno: None. E.Pyatak: Research Support; Abbott Diabetes. M.W.Reid: None. D.Fox: None. J.L.Fogel: None. E.Salcedo-rodriguez: None. J.J.Flores garcia: None. A.Torres sanchez: None. J.Raymond: None.

Funding

The Donaghue Foundation