bluuebunny/crossref_metadata_2025 huggingface dataset:
711-P: Associations of Early-Year Exposure to Famine with Abdominal Fat Accumulation Are Independent of Family History of Diabetes and Physical Activity
Authors: HU XIANG , GU XUEJIANG
Published: June 2020

Background/Aims: Famines provide researchers with a quasi-experimental setting to investigate the long-term impact of nutritional deprivation during gestation and childhood on the adult health outcome. The present study was to investigate the association of early-year exposure to famine with abdominal fat accumulation and function, and further evaluate the influence of family history of diabetes and physical activity on this association.

Methods: The present work analyzed a part of the baseline data of REACTION study. A total of 3033 women were enrolled. Central obesity was defined as waist circumferences (W) ≥ 85 cm. Chinese visceral adiposity index (CVAI) was used to evaluate visceral adipose distribution and function in Chinese population.

Results: After adjusted for age and menopause status, partial correlation analysis showed body mass index (BMI), W, glycated hemoglobin A1c, and CVAI were associated with early-year exposure of famine (both P < 0.05). Logistic regression showed that the risks of overall overweight/obesity and central obesity in fetal, early-childhood, mid-childhood, and late-childhood exposed subgroups were increased significantly (all P < 0.05). Compared with non-exposed group, the BMI, W, and CVAI of fetal, early- to late-childhood exposed subgroups were significantly increased with the interference of family history of diabetes and physical activity degree, respectively (all P < 0.05). The associations of BMI, W, and CVAI with early-year exposure to famine were independent of their associations with family history of diabetes (P = 0.001 for BMI and < 0.001 for W and CVAI) or physical activity degree (all P < 0.001).

Conclusions: Early-year exposure to famine is associated with an increased risk of central obesity. Early-year exposure to famine contributed to abdominal fat accumulation and dysfunction, which was independent of the influence of genetic background and lifestyle intervention.

Disclosure

X. Hu: None. X. Gu: None.

Funding

Wenzhou Science and Technology Bureau (Y20190126, Y20170047); Zhejiang Provincial Natural Science Foundation of China (LY20H070003); National Key Research and Development Program of China (2016YFC1305202); National Natural Science Foundation of China (81900737)
719-P: A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Glucose-Lowering Effect of Green Jackfruit Flour in Type 2 Diabetes Mellitus Patients
Authors: JOSEPH JAMES , RAO A. GOPAL , NAYAK SUNIL
Published: June 2020

Objective: We tested the effects of 30g Jackfruit365™ Green Jackfruit flour in participants with type 2 diabetes (T2DM) as an integral part of daily meal by observing change of glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG) and postprandial glucose (PPG) in blood from baseline.

Research Design and Methods: A randomized double blind design was used in 40 participants with T2DM. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial glucose (PPG) were determined at day 0 (pre-dose) and 84 day (12 weeks). Paired t test was used for statistical analysis of changes within the group and independent t test was used for statistical analysis of changes between the groups.

Results: There were 40 participants with type 2 diabetes mellitus having mean age of 46.20±9.12 years (24 males and 16 females). One participant was lost to follow up in placebo group and total 39 participants with type 2 diabetes mellitus completed the study. In participants taking Green Jackfruit Flour meal, mean HbA1c at baseline was 7.23 ± 0.47 % and at end of study (12 weeks) mean HbA1c was 6.98 ± 0.48%. In participants taking placebo meal, mean HbA1c at baseline was 7.26 ± 0.45 % and at end of study (12 weeks) mean HbA1c was 7.28 ± 0.49%. A significant decrease in HbA1c was observed in participants taking Green Jackfruit flour meal (HbA1c mean difference of 0.25 in Green Jackfruit flour meal vs. -0.02 placebo meal; p =0.006) from baseline to end of the study. Fasting and Postprandial plasma glucose levels also showed similar improvements in participants taking Green Jackfruit flour meal.

Conclusions: Our results indicate decrease in Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial glucose (PPG) following consumption of Jackfruit365™ Green Jackfruit flour meal, suggesting a therapeutic potential of Green Jackfruit flour meal in improving glycemic control in T2DM.

Disclosure

J. Joseph: Board Member; Self; Diet Fibre 365 Food Products Pvt Ltd. Stock/Shareholder; Self; God’s Own Food Solutions Pvt Ltd. Other Relationship; Self; God’s Own Food Solutions Pvt Ltd. A. Rao: None. S. Nayak: None.

Funding

Diet Fibre 365 Food Products Private Limited
72-LB: Novel Epidermal Adhesive Sensors to Enhance Continuous Glucose Measurement in Patients with Diabetes: The EASE Study
Authors: CHAO EDWARD , PAZ ANDRES ERNESTO DE LA , BARFIDOKHT ABBAS , WANG JOSEPH
Published: June 2020

By providing a more comfortable and convenient glucose testing experience, non-invasive, wearable biosensors could bolster patients’ engagement with their diabetes mellitus (DM). We investigated the accuracy and acceptability of a novel, needle-free continuous glucose sensor.

At 2 g and 5 x 4 mm, this sensor is ultra-light, thin, flexible, and self-adherent to the skin. A mild electrical current applied to the epidermis causes sodium ions, then interstitial fluid (ISF) glucose molecules, to migrate toward an electrode. The sensor gauges glucose by detecting its electrical charge strength. Four individuals with DM participated (age 42-61 years, mean 51.5 years; 1 patient with type 1 DM). Over 4 hours, we obtained 3 sensor and 3 glucometer readings concurrently at each of the following time points: following an 8-hour fast, and every 60 minutes after a standard 500-kcal, 75-g high-carbohydrate meal.

The correlation coefficient of sensor and glucometer readings was 0.80 (p = 0.00023). Participants rated on a 1-5 scale, with 5 being the highest: 4.25 for comfort, and 4.0 for being receptive to long-term use of such a sensor. Two individuals denied discomfort; 1 felt tingling; and 1 noted a needle-like sensation.

The function and patient-friendly design of a wearable glucose sensor may help substantially advance glucose testing, and in turn, improve clinical outcomes and quality of life.

Disclosure

E. Chao: None. E. De La Paz Andres: None. A. Barfidokht: None. J. Wang: None.

Funding

University of California, San Diego; National Institutes of Health (UL1TR001442)
721-P: Fat Added to High-Glycemic–Index Foods Reduces Both Glycemic and Insulinemic Response to Moderate-Size Meals
Authors: JASS DANIEL K.
Published: June 2020

Fat has been shown to be a powerful modifier of dietary glycemic response (Flint et al 2004). But other research shows addition of fat to high GI meals worsens insulinemic response (Gannon et al 1993). The author hypothesized that researched insulin response was more related to excessive meal size (50+ gms of both carbohydrate and fat) than to fat content per se.

The current study compared starch or sugar based nonfat 50 gm carb meals (∼250 kcal) with meals containing 30 gm amounts of both fat and carb (∼450 kcal) in 12 healthy 21-75 year old volunteers (6-8 per subgroup) without glucose intolerance. Size of subgroups was similar to that used in establishing the glycemic index (Jenkins et al 1981). Each subject served as their own control. Despite the larger meal size, the balanced carb/fat meals had lower glycemic and insulin responses, with p values of 0.009 and 0.016 for glycemic response, and 0.014 and 0.0275 for insulin response to starch and sugar-based meals, respectively (Wilcoxson, one tailed). Post-study interviews also demonstrated that subjects preferred the balanced meals.

This pilot study has demonstrated that adding fat to moderate sized meals lowered, not raised, insulin levels, even when compared to much smaller nonfat meals. It also confirms previous research that fat lowers glycemic response and improves palatability.

Taken together, these findings support further research into the potential benefit of balanced carb/fat meal combinations. Such meals might improve diet sustainability as well as efficacy. Future research can explore other fat types/amounts, and evaluate the utility of this concept in real world dietary management.

Disclosure

D.K. Jass: None.
729-P: Decreased Serum Vitamin D Level Implies Increased Cardiovascular Risk in Diabetes
Authors: LJUBIC SPOMENKA , JAZBEC ANAMARIJA , CUDINA IVONA , TOMIC MARTINA , RAHELIC DARIO
Published: June 2020

Increase in homocysteine (HCY) level may increase cardiovascular risk (CVR), partly because of an impact on apolipoproteins and inflammation. Absorption of vitamin B12, involved in the regulation of HCY level, decreases with vitamin D deficiency. A possible association of vitamin D with visceral obesity and HCY was studied. HCY, 25-hydroxyvitamin D, vitamin B12, lipids, and other diabetes-related markers, including lipid accumulation product (LAP), were tested in 612 type 2 diabetic patients divided into four groups (1st group: LAP ≤ Q1; 2nd group: Q1 < LAP ≤ Med; 3rd group: Med < LAP ≤ Q3, 4th group: LAP ≥ Q3) according to LAP quartiles (Q1 = 28.5; Med = 50.59; Q3 = 80.64). LAP as an index, combining waist circumference and triglycerides, is related to risk of metabolic syndrome, diabetes and CVR. In all statistical tests: ANOVA, Tukey post-hoc test, and stepwise multivariate linear regression, α=0.05 was considered as statistically significant. Significant difference in vitamin D and B12, and high-density lipoprotein (HDL) according to LAP groups was determined. HDL differed significantly between the 1st (1.56±0.27) and the 3rd (1.24±0.17), and between the 1st and the 4th (1.19±0.25) group, vitamin D between the 1st (67.21±11.87) and the 3rd (60.34±10.78), and between the 1st and the 4th (51.29±13.41) group, and vitamin B12 differed significantly between the 1st (319.33±158.71) and the 3rd (212.14±71.92) group. After stepwise regression two best predictive variables for vitamin D were glomerular filtration rate (GFR) (parR2=0.12) and LAP (parR2=0.07), for vitamin B12 HCY (parR2=0.07) and age (parR2=0.07), and for HCY GFR (parR2=0.23) and vitamin B12 (parR2=0.09). Vitamins D and B12 differed according to quartiles of LAP, implying an influence of central obesity on their levels. LAP was one of the main predictors of vitamin D, and vitamin B12 was among the best predictive variables for HCY. The relationship between vitamin D, vitamin B12 and HCY implies involvement of decreased vitamin D in increased CVR.

Disclosure

S. Ljubic: None. A. Jazbec: None. I. Cudina: None. M. Tomic: None. D. Rahelic: None.
737-P: Positive Impact of Social Support and Diabetes Community Participation on Patient-Reported Outcomes
Authors: SUHL SARA , ROST JONATHAN B. , STONER KEATON C. , GOWEN REBECCA , FLORISSI CATERINA , WOOD RICHARD
Published: June 2020

Social support plays an important role in both mental and physical well-being. This study used patient-reported outcomes to better understand the effect of social support and diabetes communities on the behaviors and health outcomes of those living with diabetes. People with diabetes (n=4,717) from an opted-in U.S. research panel were surveyed about their level of social support using the Interpersonal Support Evaluation List-12 (ISEL-12). Physical activity level was determined using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and health and demographic information were collected. Findings show that higher levels of support are associated with better glycemic control, healthier lifestyle choices, and lower rates of diabetes complications and comorbidities.

Notably, when controlling for overall level of social support and evaluating participants within one SD of the ISEL-12 mean, diabetes community members are more likely than those not in a community to have high diet adherence (≥80%) and high levels of physical activity. These diabetes community members are also less likely to have A1c >7, heart/circulation problems, high blood pressure, and cholesterol/triglyceride problems. These findings emphasize the importance of social support on the overall health of those with diabetes and suggest that diabetes communities are an important tool for managing diabetes.

Disclosure

S. Suhl: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. J.B. Rost: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. K.C. Stoner: Other Relationship; Self; Various companies and organizations. R. Gowen: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. C. Florissi: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Wood: Consultant; Self; Abbott, ADOCIA, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim Pharmaceuticals, Inc., CeQur Corporation, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation. Employee; Self; dQ&A Market Research Inc.
75-OR: Dietary Nitrate and Fecal Transplantation Prevent Cardiac Dysfunction and Attenuate Left Ventricular Mitochondrial Reactive Oxygen Species Emission in High-Fat Diet-Fed Mice
Authors: PETRICK HEATHER L. , BRUNETTA HENVER , KIRSH ALEAH , BARBEAU PIERRE-ANDRE , OGILVIE LESLIE M. , SIMPSON JEREMY , SCHERTZER JONATHAN D. , HOLLOWAY GRAHAM
Published: June 2020

Cardiometabolic diseases are multifactorial conditions involving dysfunction within the left ventricle (LV), adipose tissue (AT), and gut microbiome. Nitrate supplementation has been shown to influence cardiac contractility, mitochondrial function, and microbial populations, effects which require commensal gut bacteria to metabolize nitrate. Therefore, we examined if dietary nitrate and fecal microbial transplant (FMT) from nitrate-fed mice were capable of preventing high fat diet (HFD) induced cardiac abnormalities.

Male C57Bl/6N mice were fed a control diet, or HFD (60% fat) in the absence or presence of 4mM sodium nitrate in drinking water for 8 weeks. A further subset of HFD-fed mice were gavaged with feces from HFD+nitrate donors or HFD donors for 3 days at the beginning of week 7, and followed until week 8.

Compared to controls, HFD mice presented with ∼25% reduction in end diastolic volume, stroke volume, and cardiac output, in association with an increase in cardiac fibrosis, AT inflammation, and serum lipids. In contrast, dietary nitrate prevented these detrimental effects. The improvement in cardiac function following dietary nitrate was not attributed to changes in LV mitochondrial respiration, however, nitrate prevented the increase in LV mitochondrial reactive oxygen species (ROS) emission associated with HFD. While FMT from HFD+nitrate donors did not influence AT inflammation or cardiac fibrosis, HFD+nitrate FMT decreased serum lipids, LV ROS, and improved cardiac function compared to FMT from HFD-fed donors, without increasing serum nitrate concentrations.

Altogether, dietary nitrate prevents the detriments of HFD on cardiac function and LV mitochondrial ROS emission, effects which may not be directly dependent on increasing serum nitrate. Rather, the beneficial effects of nitrate may be linked to changes in the gut microbiome, as FMT from nitrate-fed donors improved LV function.

Disclosure

H.L. Petrick: None. H. Brunetta: None. A. Kirsh: None. P. Barbeau: None. L.M. Ogilvie: None. J. Simpson: None. J.D. Schertzer: None. G. Holloway: None.

Funding

Natural Sciences and Engineering Research Council of Canada (400362)
751-P: Cost Effectiveness of Program Active II: A Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes
Authors: KUO SHIHCHEN , YE WEN , GROOT MARY DE , SHUBROOK JAY H. , HORNSBY W. GUYTON , PILLAY YEGAN , MATHER KIEREN J. , HERMAN WILLIAM H.
Published: June 2020

Objective: Program ACTIVE II was a randomized controlled trial to assess the comparative effectiveness of cognitive behavioral therapy (CBT) and/or community-based exercise (EXER) individually and in combination (EXER+CBT) compared to usual care (UC) in adults with type 2 diabetes and major depression. We sought to estimate the cost-effectiveness of the three interventions relative to each other and to UC.

Research Design and Methods: Empirical trial data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year time horizon from the healthcare sector and societal perspectives, discounting both costs and benefits at 3% annually. The primary outcome was costs per quality-adjusted life-year (QALY) gained.

Results: From the healthcare sector perspective, compared to UC, the EXER intervention saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention cost $596 more and gained 0.29 more QALY ($2,054/QALY), and the EXER+CBT intervention cost $403 more and gained 0.69 more QALY ($585/QALY). Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention still saved $126, the CBT intervention cost $2,833/QALY, and the EXER+CBT intervention cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention cost $3,021/QALY. Results were robust in sensitivity analyses.

Conclusions: All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the EXER or CBT intervention.

Disclosure

S. Kuo: None. W. Ye: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc. M. de Groot: Consultant; Self; Kenner Family Foundation, Inc., LifeScan Diabetes Institute. J.H. Shubrook: Advisory Panel; Self; Bayer U.S., Eli Lilly and Company, Novo Nordisk Inc., Sanofi US. W. Hornsby: None. Y. Pillay: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R18DK092765, R34DK071545)
758-P: Daily Blood Glucose Predicted by Sleep, Exercise, and Relationship Quality in Young Married Couples with Type 1 Diabetes
Authors: YORGASON JEREMY B. , SAYLOR JENNIFER
Published: June 2020

T1DM care is critical during emerging adulthood (18-30 years of age), as this age group is known for inconsistent T1DM management, beginning complications, and frequent hospital visits, along with higher hemoglobin A1c levels than any other age group. Complications related to maintaining blood glucose may be due to emerging adults transitioning to new environments, where T1DM management patterns change and less time is spent with blood glucose “in range” (the time in which glucose levels are in an ideal range). An important new environment for emerging adulthood with T1DM is the transition to living with a partner resulting in new patterns of diabetes management, sleep and exercise patterns, and relationship processes. Using data from a pilot study of 15 young married couples, we examined daily glucose levels as predicted by daily sleep, daily physical activity, and baseline relationship quality. We controlled for relationship length, income, education, time since diagnosis, and baseline hemoglobin A1c levels. Sleep and physical activity were measured using actigraphy watches, and daily glucose levels were measured using continual glucose monitors (where available). Findings suggest that sleep efficiency is linked with higher average daily blood glucose readings. Further, this link was moderated by relationship quality such that those with higher relationship quality and higher sleep efficiency also reported higher average glucose levels. Results from this preliminary study suggest that better sleep and relationship processes are associated with higher average blood glucose levels.

Disclosure

J.B. Yorgason: None. J. Saylor: None.

Funding

Brigham Young University
761-P: Historical Trauma, Contemporary Trauma, and Type 2 Diabetes Self-Management among American-Indian/Alaska-Native Women
Authors: JOLLEY DOROTHY R. , PERRY ANTHONY
Published: June 2020

Endemic type 2 diabetes mellitus (T2DM) is one of the leading causes of mortality among American Indian/Alaska Natives (AI/ANs). Trauma and stress have been shown to impact the progression of diabetes and can negatively impact health-related behaviors. Previous studies have not examined the relationship between historical and contemporary trauma and T2DM self-management among AI/AN women. The purpose of this research was to examine the relationship between historical loss, historical loss associated loss symptoms, stressful life events, microaggressions (microinsults and microinvalidations), and T2DM self-management (glucose management, dietary control, physical activity, healthcare-use) among AI/AN women with diabetes. Historical trauma theory was the basis of this study and explains the consequences of colonization resulting in contemporary trauma that affects physical and mental health. A cross-sectional survey design included data from a convenience sample of AI/AN adult women. Multiple regression analyses showed that the more experiences with microinvalidations predicted poorer glucose management (B = -0.283, p < .05), less physical activity (B = -0.272, p < .05), less health care use (B = -0.248, p < .05), and poorer overall T2DM self-management

(B = -0.848, p < .05). Also, more experiences of historical loss predicted poorer glucose management (B = -0.054, p < .05), and the more stressful life events predicted poorer dietary control (B = -0.040, p < .05). The study demonstrated that microaggressions and historical loss had a significant and negative impact on T2DM self-management among AI/AN women. The results may be used to improve T2DM self-management and the high levels of mortality, morbidity, costs, and quality of life among AI/AN women.

Disclosure

D.R. Jolley: None. A. Perry: None.
763-P: Parent–Child Mealtime Behavior and Glycemic Control in T1D Preschoolers
Authors: MEIGHAN SEEMA , SINISTERRA MANUELA , TULLY CARRIE , MACKEY ELEANOR , STREISAND RANDI
Published: June 2020

Parents of T1D preschoolers must balance nutrition, insulin needs, and eating behaviors of this age group. The present study examined the relationship between parent feeding practices, child mealtime behavior, and glycemic control in T1D preschoolers. 36 parent-child dyads (2-5 y, T1D≥1 y) were part of a baseline assessment for a RCT (M child age=4.7 y; M A1c=8.3; M parent age=36.3 y). Parent feeding practices and child mealtime behaviors were measured using the Structure and Control in Parent Feeding Questionnaire (SCPF Table 1) and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS Table 1). Glycemic control measured with CGM. Descriptive statistics for glycemic control, parent and child behaviors are in Table 1. Greater frequency of problematic child behavior at mealtime was associated with greater reports of control-based feeding practices (restriction and pressure to eat; r=.44, p<.01) and greater problematic feeding practices as a whole (r=.37, p<.05). There was a trend towards an association (p<.1) between limiting food exposure, food restriction, and % TBR at breakfast. Problematic child behavior at mealtimes may be related to parents’ engagement in control-based feeding practices, which may lead to increased hypoglycemia at breakfast. Understanding behaviors that trigger more problematic feeding practices may help parents engage in more positive feeding practices, with the goal of better glycemic control.

Disclosure

S. Meighan: None. M. Sinisterra: None. C. Tully: None. E. Mackey: None. R. Streisand: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
764-P: Art Therapy as a Novel Mental Health Therapy Aimed at Reducing the Psychological Burden of Living with Type 1 Diabetes
Authors: LAMPRON CARA , GOLAND ROBIN , LEIBEL NATASHA
Published: June 2020

Objectives: Type 1 diabetes (T1D) is strongly linked with an increase in stress, depression, and anxiety. Mental health care is widely acknowledged to be an essential component of T1D clinical care. However, it has proven challenging to identify a successful model of mental health care for T1D. We investigated whether art therapy could be used in the psychological care of patients with T1D. Art therapy allows for the expression and exploration of complex emotions related to illness in an age-appropriate manner, and has been shown to be an effective mental health therapy in other chronic illnesses, but has not been studied in T1D.

Methods: We evaluated the effectiveness of an art therapy intervention for stress management in T1D patients. We administered a 17-question questionnaire to 22 sequential patients referred to the on-site art therapist. Mean age of the subjects was 13.1 +/- 7.5 years (range: 8-40 years) and mean duration of diabetes was 5.3 +/- 5 years. The subjects saw the art therapist a mean of 7 +/- 6.4 visits prior to completing the questionnaire.

Results: All participants found the sessions stress reducing and planned to continue with ongoing therapy and to incorporate strategies learned into diabetes self-care. The most common responses associated with art therapy were “calm,” “safe,” “feeling understood,” “less overwhelmed.” The average A1c prior to receiving art therapy was 8.7+/-1.8%, and fell to 7.7% +/- 1.5% after a mean of 7 art therapy sessions.

Conclusions: Art therapy was a well-received effective mental health treatment in reducing stress in T1D. In this sample, glucose control improved as well. Art therapy is a novel modality in the psychological care of patients living with T1D that can alleviate some of the psychological burden of the disease, a treatment that will be studied in a larger trial.

Disclosure

C. Lampron: None. R. Goland: None. N. Leibel: None.
776-P: Characteristics of Overnight Blood Glucose Levels Are Related to Sleep Quality in People with Type 1 Diabetes
Authors: BRANDT RACHEL , PARK MINSUN , QUINN LAURIE T. , CHU MINSEUNG , SONG YOUNGKWAN , BURTON-FREEMAN BRITT M. , CINAR ALI
Published: June 2020

Nineteen people with T1D (10 male, 9 female. Age: 31 +/- 9 yrs, A1c: 6.6 +/- 0.8 and duration of diabetes: 19 +/- 11 years) had their sleep monitored with an EEG-based device (Zmachine Insight+) for a total of 154 nights. Their blood glucose levels (BGL) were measured with a CGM. From the CGM data, the participant’s average BGL, standard deviation of BGL, coefficient of variation of BGL, Percent Time in Range (70-180 mg/dL), Percent Time Above Range (>180 mg/dL), and Percent Time Below Range (<70 mg/dL) was calculated for each overnight period. A t-Test was used to determine if there was a difference between characteristics in the participants’ overnight BGL based on different sleep quality metrics. Participants who had sleep efficiency scores > 85% had less variable overnight BGL determined by the standard deviation and coefficient of variation of CGM (p = 0.0013 and 0.017). Participants who had higher average overnight BGL and more fluctuations, as determined by standard deviation and coefficient of variation, in their BGL (p = 0.017, 0.000004, and 0.0004) spent more time awake overnight. Those who have lower average overnight BGL spent more time in Deep and REM sleep stages (p = 0.044 and 0.0043). From these findings, we can conclude that overnight BGL has a significant impact on sleep quality in people with T1D. Based on previous research, this reduction in sleep quality may negatively impact daytime control.

Disclosure

R. Brandt: None. M. Park: None. L.T. Quinn: None. M. Chu: None. Y. Song: None. B.M. Burton-Freeman: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care.

Funding

JDRF (A18-0036-001)
790-P: Multicomponent Integrated Care Program Benefits on Diabetes-Related Grief and Stage of Change and Glycemic Control Association
Authors: SILVA-TINOCO RUBÉN , SALAS-MARTÍNEZ OSCAR , DELATORRE-SALDAÑA VIRIDIANA , GUZMAN EILEEN B. , CUATECONTZI ENEDINA TERESA C. , CABRERA-GERARDO DOLORES , CASTILLO-MARTINEZ LILIA , GALLARDO-RINCÓN HECTOR , SERNA JAVIER , GONZALEZ-CANTU ARNULFO , ROMERO-IBARGUENGOITIA MARIA ELENA
Published: June 2020

Self-care behavior is the cornerstone in diabetes care. Strategies to promote behavior change and overcome grief process to improve diabetes outcomes have been poorly studied. We examined a quality initiative Multicomponent Integrated Care (MIC) program on Grief Stage (GS) and Stage of Change (SOC) allocation and its association with A1c in persons with type 2 diabetes (PwT2D) in a public primary care T2D clinic. DIABEMPIC is a 5-months empowerment-based program including: interdisciplinary case management team, diabetes self-management education, individual/group sessions, shared medical appointments, audit and feedback, and guaranteed supply of medications. We evaluated the effect of the intervention using a ’before and after’ design. Advanced stages were defined by higher than “anger” and higher than “contemplation” for GS and SOC, respectively. Total PwT2D were 451, the mean (SD) age was 54.6 (11) years, 66% were female, diabetes duration was 12 (8) years and baseline A1c was 9.5% (2.1). Baseline GS: denial 43.6%, anger 25.1%, bargaining 22.8%, depression 8.2% and acceptance 0.3%. Baseline SOC: precontemplation 55.4%, contemplation 40.6%, determination 2.5%, action 2.5% and maintenance 0%. GS and SOC improved after the intervention (83% and 68.7% presented advanced stages, respectively), p<0.001. A1c decreased 2.7% (2.2), p-value <0.001. Advanced GS and SOC were associated with an A1c ≦ 8% (OR 0.29, 95% CI, 0.16-0.52 and OR 0.21, 95% CI, 0.12-0.38, respectively). Also, these advanced stages had higher decrease of A1c (-0.8, -0.7%, respectively) than those who persist in earlier stages (p<0.001). We report a high prevalence of initial GS and SOC in PwT2D and poor glycemic control. MIC program participation was associated with improving GS and SOC. Advanced stages of GS and SOC at the end of the program were associated with better glycemic control. MIC strategies must be considered to promote behavior change and overcome grief process in PwT2D.

Disclosure

R. Silva-Tinoco: Speaker’s Bureau; Self; Novo Nordisk Inc. O. Salas-Martínez: None. V. delaTorre-Saldaña: None. E.B. Guzman: None. E.C. Cuatecontzi: None. D. Cabrera-Gerardo: None. L. Castillo-Martinez: None. H. Gallardo-Rincón: None. J. Serna: None. A. Gonzalez-Cantu: None. M. Romero-Ibarguengoitia: None.
794-P: “The Tool Created a Chance to Discuss Topics You Don’t Normally Address in Diabetes Consultations”: A Study of Using Patient-Reported Outcomes to Promote Person-Centered Care and Psychosocial Support
Authors: JOENSEN LENE E. , SCHULTZ ASTRID A. , MADSEN KRISTOFFER P. , PERSSON FREDERIK , NØRGAARD KIRSTEN , WILLAING INGRID
Published: June 2020

The aim of this study was to test the usefulness of a dialogue tool from the perspective of people with type 1 diabetes. The tool was expected to prime adults with type 1 diabetes and diabetologists to discuss relevant psychosocial aspects of diabetes during diabetes consultations. The tool (PAID-5, WHO-5 and three open-ended questions) was filled out by 40 people with type 1 diabetes three days before routine diabetes consultations and tested in consultations. Participants’ age ranged from 22 to 72 years; 39% were men; diabetes duration was four to 59 years; HbA1c: 41-59 mmol/mol (5.9-7.9%). Perceptions of using the tool and overall experience of the consultation were explored with interviews and questionnaires (CARE, PEQ). A control group of 42 people with type 1 diabetes (attending regular consultations) also filled out questionnaires about overall consultation experiences. No differences were found in age, diabetes duration, HbA1c or gender between control and intervention group. Questionnaires showed that the dialogue tool did not influence perceptions of patient-centered care (no significant between-group differences in CARE or PEQ). However, participants who experienced high diabetes distress (n=6) found the tool more relevant and useful in bringing up important and difficult topics compared to people experiencing no distress (p=0.004). Interviews showed that participants found the tool useful and relevant in preparing them for consultations and in creating an opportunity for dialogue about psychosocial aspects of diabetes. However, some participants found the tool irrelevant and the dialogues to be “mechanical.” Consultation dialogue tools seem to be a relevant way to meet the needs of people experiencing diabetes-related emotional difficulties, but these tools require diabetologists to be flexible in adapting them to the needs and wishes of the person with diabetes.

Disclosure

L.E. Joensen: None. A.A. Schultz: None. K.P. Madsen: None. F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; Amgen, AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S. K. Nørgaard: Advisory Panel; Self; Abbott, Medtronic. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk Inc. I. Willaing: None.
795-P: Novel Brief Questionnaire and User Guide to Improve Injection Technique
Authors: BARNARD KATHARINE D. , MAHONEY EDWARD T. , MOREL DIDIER , GLEZER STANISLAV
Published: June 2020

Background and Aim: The efficacy of insulin and other injectable therapies depends on injection technique. To develop and validate a brief self-administered injection technique assessment questionnaire.

Methods: The questionnaire was developed using an iterative process with people with diabetes (PWD) and healthcare professionals (HCP). Focus groups and 1:1 interviews were held with adults with T1D, T2D and HCPs separately to elicit views and refine the tool ready for broader distribution to target audience. Questions addressed ease of understanding, relevance, included questions and potential missing questions, feelings about diabetes and any discomfort or judgement felt. A user guide was developed with cognitive interviewing performed to ensure relevance, acceptability and understanding by potential users. Multiple Component Analysis assessed relationships between questions after extensive descriptive statistical analysis. Propensity score matching compared the questionnaire to the ITQ WW.

Results: Five HCPs and 16 PWD participated in the initial focus groups and interviews. Questions were reported to be clinically relevant by HCPs and simple to complete. PWD reported the 9-item questionnaire to be ’about the right length’, with questions relevant and the user guide easy to read and interpret. 268 participants completed the survey reviewing the questionnaire and provided feedback. A further 16 participants (10 HCPs and 6 PWD) took part in the cognitive interviews. The complete resource was finally reviewed by a further 23 PWD as a check of completeness and usability. Statistical analyses showed the questionnaire to depict similar trends to those assessed in the detailed questionnaire (ITQ WW), confirming the validity of this new questionnaire as a shorter, more straightforward tool.

Conclusions: The novel, brief questionnaire and user guide are clinically relevant, acceptable and easy to use both as a clinical resource and a self-assessment tool for people using injectable therapies.

Disclosure

K.D. Barnard: Advisory Panel; Self; Roche Diabetes Care, Sanofi-Aventis. Research Support; Self; BD, Novo Nordisk A/S, Roche Diabetes Care. E.T. Mahoney: Employee; Self; Becton, Dickinson and Company. D. Morel: Employee; Self; Becton, Dickinson and Company. S. Glezer: Employee; Self; Becton, Dickinson and Company. Employee; Spouse/Partner; Pfizer Inc. Stock/Shareholder; Self; Sanofi. Stock/Shareholder; Spouse/Partner; Sanofi.

Funding

BD
796-P: Undiagnosed Diabetes Is Associated with Stress-Related Behaviors in African Immigrants
Authors: OSEI-TUTU NANA H. , HORMENU THOMAS , SHOUP ELYSSA M. , HOBABAGABO ARSENE F. , DUBOSE CHRISTOPHER , CHUNG STEPHANIE T. , MABUNDO LILIAN , SUMNER ANNE E.
Published: June 2020

Whether stress-related behaviors or social factors are associated with diabetes (DM) in African-born blacks living in the United States is unknown. Thus, African immigrants who identified as healthy underwent OGTT and had extensive questioning about lifestyle and socioeconomic status. Neither participants nor investigators knew the outcome of the OGTT at the time surveys were administered. The participants were 470 African-born blacks living in Washington, DC (male: 66%, age 38±10y, range 20-65y, BMI 27.6±4.5, range 19.5-39.9). DM was diagnosed by glucose criteria for the OGTT or A1C≥6.5%. DM was identified in 9% (40/470) of participants. Age, BMI and years in the United States were higher in the group with DM (age: 44±10 vs. 38±10y; BMI: 29.8±4.9 vs. 27.4±4.4; Years in U.S.:16±10 vs. 12±10y, all P<0.01). Participants with DM had significantly higher alcohol intake and tended to have higher rates of smoking and a lower intake of fruits and vegetables (Figure). There was no difference by DM status in exercise, sleep duration, education, income or health insurance (all P>0.5). Overall, undiagnosed DM was associated with stress-related behaviors such as alcohol intake, smoking and diet. Whereas, difficult to address social characteristics such as education, income and health insurance did not differ by DM status. Combining DM screening with counseling on stress may lead to improved health for African immigrants.

Disclosure

N.H. Osei-Tutu: None. T. Hormenu: None. E.M. Shoup: None. A.F. Hobabagabo: None. C. DuBose: None. S.T. Chung: None. L. Mabundo: None. A.E. Sumner: None.
797-P: Impact of Carbohydrate Counting on Glycaemic Control in People with Type 1 and Type 2 Diabetes on Intensified Insulin Therapy
Authors: HERMANNS NORBERT , EHRMANN DOMINIC , KULZER BERNHARD
Published: June 2020

This study involved 154 subjects with type 1 and type 2 diabetes (84.6% with type 1 diabetes, age 46.6 ±13.6 years; 52% female, A1c 8.3 ± 0.9 %) who were undergoing intensified insulin therapy. Participants completed a questionnaire (SMART) that measures the accuracy of estimating carbohydrates in 27 foods or in meals, using the multiple-choice method. At the same time, glucose data collected by a flash glucose monitoring system were analysed in the two weeks prior to completion of the SMART questionnaire. The level of estimation error regarding carbohydrates correlated significantly with glucose variability (CV; r=-0.29; p<0.001), range of glucose values (r=0.33, p<.001) and maximum glucose values (r=0.32, p<.001). These significant effects remained even after adjustment for HbA1c. Interestingly, there was no significant correlation between estimation error and mean glucose values (r=0.012, p=0.882), time in range (r=-0.018; p=0.815) or percentage of hyperglycemic (>180 mg/dl; r=0.015, p=0.843) or hypoglycemic phases (<70 mg/dl; r=0.005; p=0.953). The negative correlation coefficient indicates that underestimation of the amount of carbohydrates in a meal is more significant in terms of glucose variability than overestimation of the amount of carbohydrates. The results suggest that a good estimation ability regarding carbohydrate content is associated with lower glucose variability but does not necessarily affect glucose levels.

Disclosure

N. Hermanns: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, AstraZeneca, Berlin-Chemie AG. D. Ehrmann: Speaker’s Bureau; Self; Abbott, Berlin-Chemie AG, Glooko, Inc. Other Relationship; Self; Dexcom, Inc., Roche Diabetes Care. B. Kulzer: Research Support; Self; Abbott, AstraZeneca, Berlin-Chemie AG, Roche Diabetes Care. Speaker’s Bureau; Self; Abbott, Ascensia Diabetes Care, Berlin-Chemie AG, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Roche Diabetes Care.

Funding

Abbott Diabetes Care Germany
8-OR: Coronary Calcium Scoring to Select Asymptomatic Diabetic Patients with Coronary Artery Stenoses Suitable for Revascularization
Authors: BERKANE NARIMANE , COSSON EMMANUEL , PINTO SARA , CIUNGANU TIT-LIVIU , VALENSI PAUL
Published: June 2020

The aim of the study was to test various criteria to select asymptomatic patients with diabetes to be screened for silent myocardial ischemia (SMI). This screening might improve cardiovascular prognosis through identification of coronary stenoses (CS) suitable for revascularization. Clinical/biological/imaging criteria including coronary artery calcium (CAC) score were considered. We selected 416 asymptomatic patients with diabetes and very high cardiovascular risk according to ESC-EASD-2019 criteria (either 3 risk factors (RFs) or diabetes duration>20 years and one RF or peripheral vascular disease or target organ damage). These patients had had a stress myocardial scintigraphy to detect SMI, with a coronary angiography in case of SMI. A CAC score >100UA was present in 182 patients (43.7%). SMI was present in 40 patients (9.6%); 28 of them had a coronary angiography. CS were found in 15 out of these 28 patients (54%) and 11/15 of them had a revascularization procedure (73.5%). We tested the performances of various criteria to identify patients with SMI and CS. Performing a scintigraphy (i) only in patients with peripheral artery disease and/or a severe nephropathy (n=141) would have led to miss 6 patients with CS suitable for revascularization; (ii) in all patients but those who had only 3 RFs (n=283) would have led to miss 2 of them and (iii) only in patients with peripheral vascular disease and/or a severe nephropathy and if not in those with a CAC score >100 (n=239) would have led to miss none of them. The algorithm which requires CAC score measurement (iii) was the most cost-effective. Among the asymptomatic diabetic patients fulfilling the very high cardiovascular risk criteria according to ESC-EASD-2019 guidelines, screening for SMI and CS only those with peripheral artery disease or severe nephropathy or a high CAC score (> 100AU) appears to be a good compromise, which allows not to miss patients with CS suitable for revascularization, at a controlled cost.

Disclosure

N. Berkane: None. E. Cosson: None. S. Pinto: None. T. Ciunganu: None. P. Valensi: None.
800-P: Sleep Quality for Adults with Type 1 Diabetes Using Multiple Daily Injections (MDI) of Insulin Flying across Multiple Time Zones: A Pilot Study
Authors: BEVIER WENDY C. , CASTORINO KRISTIN N. , FARFAN CHRISTIAN C. , HAROUSH GAL , MEFFORD MIKAYLA R. , AXELROD CEARA , NELSON KRISTEN , SPINK LISA A. , KERR DAVID
Published: June 2020

Long-haul travel (flights >6 hours) can be disruptive for people living with type 1 diabetes (T1D). As part of a study comparing insulin Degludec U100 (DEG) with insulin Glargine U100 (GLA) during long-haul travel (ClinicalTrials.gov Identifier: NCT03668808), we evaluated the impact of direction of travel on sleep quality and glucose control. The study began, after randomization to GLA or DEG, in Honolulu (HI) with a non-stop flight to New York (NY). After 72 hours, subjects returned non-stop to HI. Six weeks later subjects repeated travel using the other basal insulin. Sleep was monitored with ActiGraph wGT3x worn on the non-dominant wrist for 24 hours at the destination and blinded continuous glucose monitoring (CGM) using the Abbott Freestyle Libre Pro. Usual care was used for glucose monitoring. Jet lag was assessed by a validated questionnaire. Twenty-one subjects (13 women) mean (SD) age 34.2 (15.2) years and HbA1c 7.5 (1.2) % completed travel (Table). TST, SE, and median glucose were significantly different between NY and HI. Sleep also differed subjectively with “ease of going to sleep” and “sleep quality” better in NY vs. HI; “alertness on waking” and “jet lag” were not different. We found that traveling across multiple time zones from East to West was more disruptive to sleep and associated with higher average glucose levels for adults with T1D using MDI.

Disclosure

W.C. Bevier: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. C.C. Farfan: None. G. Haroush: None. M.R. Mefford: None. C. Axelrod: None. K. Nelson: None. L.A. Spink: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc.

Funding

Novo Nordisk
803-P: Odds of Depressive Symptoms Vary Based on Childhood A1C Trajectory
Authors: MAJIDI SHIDEH , GENO RASMUSSEN CRISTY R. , DRISCOLL KIMBERLY A. , ODONNELL HOLLY , YOUNGKIN ERIN M. , SNELL-BERGEON JANET K.
Published: June 2020

Higher A1c in adolescents with T1D may result from consistently elevated A1c since diagnosis or increasing A1c across time. Identifying modifiable risk factors may allow for individualized care to reduce A1c. Prevalence of elevated (≥5) scores on the Patient Health Questionnaire-9 was examined in 888 youth ≥10 years. Five A1c trajectory groups (Figure) were identified using Proc Traj (i.e., mid increasing group had moderately elevated A1c with rising levels over time). The association between elevated depressive symptoms and A1c trajectory groups was examined. Prevalence of elevated depressive symptoms was 31%, and increased significantly across A1c trajectory groups: low stable =21%, mid stable =31%, high stable =41%, mid increasing =34%, and high increasing =52% (p<0.0001). Odds of elevated depressive symptoms in the high increasing vs. low stable group was 3.6 (95% CI 1.9-6.8). Similarly, being in the high stable (OR 2.4, 95% CI 1.5-3.9), mid stable (OR 1.7, 1.2-2.5) and mid increasing (OR 1.9, 1.01-3.4) groups were associated with higher odds compared to being in the low stable group. Even mildly elevated depressive symptoms may contribute to persistently elevated or rising A1c throughout childhood. Screening, monitoring, and discussing depressive symptoms in youth may help prevent a rise in A1c over time. Future studies should assess whether A1c trajectory can be changed through early intervention of depressive symptoms.

Disclosure

S. Majidi: Advisory Panel; Self; Companion Medical. C.R. Geno Rasmussen: None. K.A. Driscoll: None. H. ODonnell: None. E.M. Youngkin: None. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc.